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OBJECTIVE: To analyze the prevalence of no-reflow and the 30-day mortality in a university center in a middle-income country. METHOD: We analyzed 2463 patients who underwent primary PCI from January 2006 to December 2021. The outcome measure was 30-day mortality. RESULTS: Of a total of 2463 patients, no-reflow phenomenon was found in 413 (16.8%) patients, 30-day mortality was 16.7 vs. 4.29% (p < 0.001). Patients with no-reflow were older 60 (53-69.5) vs. 59 (51-66) (p = 0.001), with a higher delay in onset of symptom to emergency department arrival 270 vs. 247 min (p = 0.001). No-reflow patients also had had fewer previous myocardial infarction, 11.6 vs. 18.4 (p = 0.001) and a Killip class > 1, 37 vs. 26% (p < 0.001). No-reflow patients were more likely to have an anterior myocardial infarction (55.4 vs. 47.8%; p = 0.005) and initial TIMI flow 0 (76 vs. 68%; p < 0.001). CONCLUSION: No-reflow occurred in 16.8% of STEMI patients undergoing primary PCI and was more likely with older age, delayed presentation, anterior myocardial infarction and Killip class > 1. No-reflow was associated with a higher mortality at 30-day follow-up.
OBJETIVOS: Analizar la prevalencia de no reflujo y la mortalidad a 30 días en un centro universitario de un país de ingresos medios. MÉTODO: Analizamos 2,463 pacientes que se sometieron a ICP primaria desde enero de 2006 hasta diciembre de 2021. La medida de resultado fue la mortalidad a los 30 días. RESULTADOS: Del total de 2,463 pacientes, se encontró fenómeno de no reflujo en 413 (16.8%), la mortalidad a los 30 días fue del 16.7 vs. 4.29% (p < 0.001). Los pacientes sin reflujo tenían mayor edad 60 (53-69.5) vs. 59 (51-66) (p = 0.001), con mayor retraso del inicio de los síntomas a la llegada a urgencias, 270 vs. 247 min (p = 0.001). Los pacientes sin reflujo también tenían menos infarto de miocardio previo, 11.6 vs. 18.4 (p = 0.001), y una clase Killip > 1, 37 vs. 26% (p < 0.001). Los pacientes sin reflujo tenían más probabilidades de tener un infarto de miocardio anterior (55.4 vs. 47.8%; p = 0.005) y flujo TIMI inicial 0 (76 vs. 68%; p < 0.001). CONCLUSIÓN: Ocurrió ausencia de reflujo en el 16.8% de los pacientes con IAMCEST sometidos a ICP primaria y fue más probable con la edad avanzada, presentación tardía, infarto de miocardio anterior y clase Killip > 1. El no reflujo se asoció con una mayor mortalidad a los 30 días de seguimiento.
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Fenómeno de no Reflujo , Intervención Coronaria Percutánea , Humanos , Masculino , Femenino , Persona de Mediana Edad , Intervención Coronaria Percutánea/métodos , Prevalencia , Anciano , Pronóstico , Fenómeno de no Reflujo/epidemiología , Infarto del Miocardio/epidemiología , Estudios Retrospectivos , Factores de Tiempo , Factores de Edad , Hospitales Universitarios , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/cirugía , Infarto del Miocardio con Elevación del ST/epidemiología , Infarto del Miocardio con Elevación del ST/terapiaRESUMEN
One of the main factors that influences the fertility of cattle in grazing systems in hot tropical climates is heat stress. The objective of this study was to evaluate the effect of season, breed, hormonal and physiological condition on the quantity and quality of cumulus-oocyte complexes (COCs) and embryos produced in vitro, from Romosinuano (RM) and Tropical Milking (TM) donors. Three ovum pick-up and in vitro fertilization (OPU-IVF) were performed, one per season: hot dry (HD; 10, 10), hot humid (HH; 9, 9) and fresh dry (FD; 7, 10) in RM and LT donors. Serum levels of cortisol, insulin and glucose were measured, in addition to heart rate (HR), respiratory rate (RR) and rectal temperature (RT). Effect of season x genotype interaction (p ≤ 0.05) was observed in all COC variables and only in cleavage embryos (CLI) (p ≤ 0.05). Body weight (BW) affected all COC variables (p ≤ 0.01), except unviable (UNV) although affected degenerated embryos (DEG) (p ≤ 0.01) and total blastocysts (BLAST) (p ≤ 0.01). Cow age only affected viable COCs (VIAB) (p ≤ 0.05), code one blastocysts (BC1) and BLAST (p ≤ 0.01). Cortisol affected total COCs (COCsT), VIAB and total matured in vitro (TMIV) (p ≤ 0.01), as well as CLI, BC1 (p ≤ 0.01) and BLAST (p ≤ 0.05). Insulin affected COCsT (p ≤ 0.01), UNV (p ≤ 0.05), denuded oocytes (DE) (p ≤ 0.01), BC1 and code two blastocysts (BC2) (p ≤ 0.01). Glucose affected all COC variables (p ≤ 0.01), except UNV and all embryo variables except BC2. HR affected COCsT, DE, TMIV (p ≤ 0.01), CLI, BLAST and DEG (p ≤ 0.05). RR affected COCsT, UNV, VIAB, CLI (p ≤ 0.05), BC1, BLAST and DEG (p ≤ 0.01). RT only affected DE, VIAB (p ≤ 0.01) and BLAST (p ≤ 0.05). The seasonal climatic year variation of Veracruz and changes in physiological and hormonal variables have diverse effects on the cumulus-oocyte complexes and embryos produced by RM and TM donors.
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Introduction: The end of the coronavirus disease 2019 (COVID-19) pandemic has been declared by the World Health Organization on May 5, 2023. Several vaccines were developed, and new data is being published about their effectiveness. However, the clinical trials for the vaccines were performed before the Omicron variant appeared and there are population groups where vaccine effectiveness still needs to be tested. The overarching goal of the present study was to analyze the effects of COVID-19 vaccination before and after the Omicron variant in patients considering comorbidities in a population from Nuevo Leon, Mexico. Methods: Epidemiological COVID-19 data from the Mexican Social Security Institute were collected from 67 hospitals located in northeastern Mexico, from July 2020 to May 2023, and a total of 669,393 cases were compiled, 255,819 reported a SARS-CoV-2 positive reverse transcription quantitative polymerase chain reaction (RT-qPCR) test or a positive COVID-19 antigen rapid test. Results: Before Omicron (BO, 2020-2021), after 14 days of two doses of COVID-19 vaccine, BNT162b2 and ChAdOx1 vaccines were effective against infection in non-comorbid and all comorbid subgroups, whereas after Omicron (AO, 2022- 2023) there was no significant effectiveness against infection with none of the vaccines. Regarding hospitalization BO, BNT162b2, ChAdOx1, CoronaVac and mRNA-1273 significantly protected non-comorbid patients whereas BNT162b2, ChAdOx1, and mRNA-1273, protected all comorbid subgroups against hospitalization. AO, BNT162b2, ChAdOx1, CoronaVac and mRNA-1273 were effective against hospitalization in non-comorbid patients whereas for most comorbid subgroups BNT162b2, ChAdOx1 and CoronaVac were effective against hospitalization. Non-comorbid patients were protected against death as an outcome of COVID-19 during the BO period with most vaccines whereas a reduction in effectiveness was observed AO with mRNA-1273 vaccines in patients with hypertension, and diabetes mellitus. Discussion: BO, COVID-19 vaccines were effective against infection, hospitalization, and death whereas AO, COVID-19 vaccines failed to protect the population from COVID-19 infection. A varying effectiveness against hospitalization and death is observed AO.
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Vacunas contra la COVID-19 , COVID-19 , Comorbilidad , SARS-CoV-2 , Eficacia de las Vacunas , Humanos , COVID-19/prevención & control , COVID-19/epidemiología , México/epidemiología , Vacunas contra la COVID-19/administración & dosificación , Persona de Mediana Edad , Femenino , Masculino , Eficacia de las Vacunas/estadística & datos numéricos , Estudios Retrospectivos , SARS-CoV-2/inmunología , Adulto , Anciano , Adolescente , Adulto JovenRESUMEN
Colonoscopy has attached great importance to early screening and clinical diagnosis of colon cancer. It remains a challenging task to achieve fine segmentation of polyps. However, existing State-of-the-art models still have limited segmentation ability due to the lack of clear and highly similar boundaries between normal tissue and polyps. To deal with this problem, we propose a region self-attention enhancement network (RSAFormer) with a transformer encoder to capture more robust features. Different from other excellent methods, RSAFormer uniquely employs a dual decoder structure to generate various feature maps. Contrasting with traditional methods that typically employ a single decoder, it offers more flexibility and detail in feature extraction. RSAFormer also introduces a region self-attention enhancement module (RSA) to acquire more accurate feature information and foster a stronger interplay between low-level and high-level features. This module enhances uncertain areas to extract more precise boundary information, these areas being signified by regional context. Extensive experiments were conducted on five prevalent polyp datasets to demonstrate RSAFormer's proficiency. It achieves 92.2% and 83.5% mean Dice on Kvasir and ETIS, respectively, which outperformed most of the state-of-the-art models.
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Colonoscopía , Procesamiento de Imagen Asistido por Computador , IncertidumbreRESUMEN
Although primary percutaneous coronary intervention (pPCI) is the treatment of choice in ST-elevation myocardial infarction (STEMI), challenges may arise in accessing this intervention for certain geodemographic groups. Pharmacoinvasive strategy (PIs) has demonstrated comparable outcomes when delays in pPCI are anticipated, but real-world data on long-term outcomes are limited. The aim of the present study was to compare long-term outcomes among real-world patients with STEMI who underwent either PIs or pPCI. This was a prospective registry including patients with STEMI who received reperfusion during the first 12 hours from symptom onset. The primary objective was cardiovascular mortality at 12 months according to the reperfusion strategy (pPCI vs PIs) and major cardiovascular events (cardiogenic shock, recurrent myocardial infarction, and congestive heart failure), and Bleeding Academic Research Consortium type 3 to 5 bleeding events were also evaluated. A total of 799 patients with STEMI were included; 49.1% underwent pPCI and 50.9% received PIs. Patients in the PIs group presented with more heart failure on admission (Killip-Kimbal >I 48.1 vs 39.7, p = 0.02) and had a lower proportion of pre-existing heart failure (0.2% vs 1.8%, p = 0.02) and atrial fibrillation (0.25% vs 1.2%, p = 0.02). No statistically significant difference was observed in cardiovascular mortality at the 12-month follow-up (hazard ratio for PIs 0.74, 95% confidence interval 0.42 to 1.30, log-rank p = 0.30) according to the reperfusion strategy used. The composite of major cardiovascular events (hazard ratio for PIs 0.98, 95% confidence interval 0.75 to 1.29, p = 0.92) and Bleeding Academic Research Consortium type 3 to 5 bleeding rates were also comparable. A low socioeconomic status, Killip-Kimball >2, age >60 years, and admission creatinine >2.0 mg/100 ml were predictors of the composite end point after multivariate analysis. In conclusion, this prospective real-world registry provides additional support that long-term major cardiovascular outcomes and bleeding are not different between patients who underwent PIs versus primary PCI.
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Insuficiencia Cardíaca , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Humanos , Persona de Mediana Edad , Infarto del Miocardio con Elevación del ST/terapia , Fibrinolíticos/uso terapéutico , Terapia Trombolítica/efectos adversos , Intervención Coronaria Percutánea/efectos adversos , México , Resultado del Tratamiento , Hemorragia/inducido químicamente , Insuficiencia Cardíaca/tratamiento farmacológicoRESUMEN
Capsule networks (CapsNets) aim to parse images into a hierarchy of objects, parts, and their relationships using a two-step process involving part-whole transformation and hierarchical component routing. However, this hierarchical relationship modeling is computationally expensive, which has limited the wider use of CapsNet despite its potential advantages. The current state of CapsNet models primarily focuses on comparing their performance with capsule baselines, falling short of achieving the same level of proficiency as deep convolutional neural network (CNN) variants in intricate tasks. To address this limitation, we present an efficient approach for learning capsules that surpasses canonical baseline models and even demonstrates superior performance compared with high-performing convolution models. Our contribution can be outlined in two aspects: first, we introduce a group of subcapsules onto which an input vector is projected. Subsequently, we present the hybrid Gromov-Wasserstein (HGW) framework, which initially quantifies the dissimilarity between the input and the components modeled by the subcapsules, followed by determining their alignment degree through optimal transport (OT). This innovative mechanism capitalizes on new insights into defining alignment between the input and subcapsules, based on the similarity of their respective component distributions. This approach enhances CapsNets' capacity to learn from intricate, high-dimensional data while retaining their interpretability and hierarchical structure. Our proposed model offers two distinct advantages: 1) its lightweight nature facilitates the application of capsules to more intricate vision tasks, including object detection; and 2) it outperforms baseline approaches in these demanding tasks. Our empirical findings illustrate that HGW capsules (HGWCapsules) exhibit enhanced robustness against affine transformations, scale effectively to larger datasets, and surpass CNN and CapsNet models across various vision tasks.
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Introduction: Time-fixed analyses have traditionally been utilized to examine outcomes in post-infarction ventricular septal defect (VSD). The aims of this study were to: (1) analyze the relationship between VSD closure/non-closure and mortality; (2) assess the presence of immortal-time bias. Material and methods: In this retrospective cohort study, patients with ST-elevation myocardial infarction (STEMI) complicated by VSD. Time-fixed and time-dependent Cox regression methodologies were employed. Results: The study included 80 patients: surgical closure (n = 26), transcatheter closure (n = 20), or conservative management alone (n = 34). At presentation, patients without VSD closure exhibited high-risk clinical characteristics, had the shortest median time intervals from STEMI onset to VSD development (4.0, 4.0, and 2.0 days, respectively; P = 0.03) and from STEMI symptom onset to hospital arrival (6.0, 5.0, and 0.8 days, respectively; P < 0.0001). The median time from STEMI onset to closure was 22.0 days (P = 0.14). In-hospital mortality rate was higher among patients who did not undergo defect closure (50%, 35%, and 88.2%, respectively; P < 0.0001). Closure of the defect using a fixed-time method was associated with lower in-hospital mortality (HR = 0.13, 95% CI 0.05-0.31, P < 0.0001, and HR 0.13, 95% CI 0.04-0.36, P < 0.0001, for surgery and transcatheter closure, respectively). However, when employing a time-varying method, this association was not observed (HR = 0.95, 95% CI 0.45-1.98, P = 0.90, and HR 0.88, 95% CI 0.41-1.87, P = 0.74, for surgery and transcatheter closure, respectively). These findings suggest the presence of an immortal-time bias. Conclusions: This study highlights that using a fixed-time analytic approach in post-infarction VSD can result in immortal-time bias. Researchers should consider employing time-dependent methodologies.
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Purpose: While pharmacoinvasive strategy (PI) is a safe and effective approach whenever access to primary percutaneous intervention (pPCI) is limited, data on each strategy's economic cost and impact on in-hospital stay are scarce. The objective is to compare the cost-effectiveness of a PI with that of pPCI for the treatment of ST-elevation myocardial infarction (STEMI) in a Latin-American country. Patients and Methods: A total of 1747 patients were included, of whom 470 (26.9%) received PI, 433 (24.7%) pPCI, and 844 (48.3%) NR. The study's primary outcome was the incremental cost-effectiveness ratio (ICER) for PI compared with those for pPCI and non-reperfused (NR), calculated for 30-day major cardiovascular events (MACE), 30-day mortality, and length of stay. Results: For PI, the ICER estimates for MACE showed a decrease of $-35.81/per 1% (95 confidence interval, -114.73 to 64.81) compared with pPCI and a decrease of $-271.60/per 1% (95% CI, -1086.10 to -144.93) compared with NR. Also, in mortality, PI had an ICER decrease of $-129.50 (95% CI, -810.57, 455.06) compared to pPCI and $-165.27 (-224.06, -123.52) with NR. Finally, length of stay had an ICER reduction of -765.99 (-4020.68, 3141.65) and -283.40 (-304.95, -252.76) compared to pPCI and NR, respectively. Conclusion: The findings of this study suggest that PI may be a more efficient treatment approach for STEMI in regions where access to pPCI is limited or where patient and system delays are expected.
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Objective: The objective of the study is to identify clinical and angiographic characteristics of patients with ST-segment elevation myocardial infarction (STEMI) but without clinical manifestations of COVID-19 infection during the pandemic, compared with patients 1 year before the pandemic. Methods: Observational study that included 138 consecutive patients hospitalized with STEMI who underwent primary percutaneous coronary intervention (PCI) without COVID-19 infection during the 2020 pandemic. A group of 175 STEMI patients treated with PCI in the year before the pandemic served as the control group. Results: During the periods analyzed, compared with the control group, patients admitted during the pandemic without clinical manifestations of COVID-19 did not have significant differences in demographic characteristics, comorbidities, or delayed time and location of the acute myocardial infarction. Furthermore, there were no differences between the two groups concerning levels of CK-MB and NT-proBNP, or in inflammation markers and left ventricular ejection fraction. In patients without COVID-19 during the pandemic compared with control, we found a higher intracoronary thrombus burden (thrombus grade 5; 78.3% vs. 62.9%, respectively. p = 0.002). Accordingly, the use of glycoprotein IIB/IIIa inhibitors (37.7% vs. 26.3%, p = 0.03) was higher in these patients. Conclusions: This study demonstrates an increased thrombus burden in STEMI patients without clinical manifestation of COVID-19 during the pandemic compared with the same time period in the previous year.
Objetivo: Identificar las características clínicas y angiográficas de los pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) sin manifestaciones clínicas de COVID-19 durante la pandemia y compararlos con los pacientes en el año previo. Métodos: Estudio observacional que incluyó 138 pacientes consecutivos que fueron hospitalizados por IAMCEST y que fueron tratados con angioplastía primaria (ACTP) sin manifestaciones clínicas de COVID-19 durante la pandemia de 2020. Se seleccionó a un grupo control de 175 pacientes con IAMCEST tratados con ACTP en el año previo a la pandemia. Resultados: Los pacientes atendidos durante la pandemia no tuvieron diferencias significativas en cuanto a las características clínicas, demográficas, comorbilidades, tiempo de retraso y localización del infarto. Además, no hubo diferencias entre ambos grupos en los niveles de CK-MB, NT-proBNP, marcadores de inflamación ni en la fracción de eyección del ventrículo izquierdo. En los pacientes sin COVID-19 tratados durante la pandemia encontramos mayor carga trombótica intracoronaria (trombo grado 5; 78.3% vs. 62.9%, respectivamente. p = 0.002). De igual manera, el uso de inhibidores de la glucoproteina IIB/IIIa (37.7% vs. 26.3%, p = 0.03) fue mayor. Conclusiones: Este studio demostró un aumento en la carga trombótica en los pacientes con IAMCEST sin manifestaciones clínicas de COVID-19 durante la pandemia al compararlos con los pacientes tratados por la misma patología en el año previo.
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COVID-19 , Infarto del Miocardio , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Trombosis , Humanos , Infarto del Miocardio con Elevación del ST/terapia , Volumen Sistólico , Pandemias , COVID-19/complicaciones , Función Ventricular Izquierda , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Trombosis/epidemiología , Trombosis/etiología , Resultado del TratamientoRESUMEN
BACKGROUND: Epilepsy is one of the most common neurological conditions globally, and the fourth most common in the United States. Recurrent non-provoked seizures characterize it and have huge impacts on the quality of life and financial impacts for affected individuals. A rapid and accurate diagnosis is essential in order to instigate and monitor optimal treatments. There is also a compelling need for the accurate interpretation of epilepsy due to the current scarcity in neurologist diagnosticians and a global inequity in access and outcomes. Furthermore, the existing clinical and traditional machine learning diagnostic methods exhibit limitations, warranting the need to create an automated system using deep learning model for epilepsy detection and monitoring using a huge database. METHOD: The EEG signals from 35 channels were used to train the deep learning-based transformer model named (EpilepsyNet). For each training iteration, 1-min-long data were randomly sampled from each participant. Thereafter, each 5-s epoch was mapped to a matrix using the Pearson Correlation Coefficient (PCC), such that the bottom part of the triangle was discarded and only the upper triangle of the matrix was vectorized as input data. PCC is a reliable method used to measure the statistical relationship between two variables. Based on the 5 s of data, single embedding was performed thereafter to generate a 1-dimensional array of signals. In the final stage, a positional encoding with learnable parameters was added to each correlation coefficient's embedding before being fed to the developed EpilepsyNet as input data to epilepsy EEG signals. The ten-fold cross-validation technique was used to generate the model. RESULTS: Our transformer-based model (EpilepsyNet) yielded high classification accuracy, sensitivity, specificity and positive predictive values of 85%, 82%, 87%, and 82%, respectively. CONCLUSION: The proposed method is both accurate and robust since ten-fold cross-validation was employed to evaluate the performance of the model. Compared to the deep models used in existing studies for epilepsy diagnosis, our proposed method is simple and less computationally intensive. This is the earliest study to have uniquely employed the positional encoding with learnable parameters to each correlation coefficient's embedding together with the deep transformer model, using a huge database of 121 participants for epilepsy detection. With the training and validation of the model using a larger dataset, the same study approach can be extended for the detection of other neurological conditions, with a transformative impact on neurological diagnostics worldwide.
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Epilepsia , Calidad de Vida , Humanos , Epilepsia/diagnóstico , Bases de Datos Factuales , Aprendizaje Automático , ElectroencefalografíaRESUMEN
BACKGROUND: Primary Health Care nurses express deficits in their training in Palliative Care. The purpose of this study is to design a Palliative Care training plan and a bereavement care protocol for Primary Health Care nurses of the Dr. Peset Health Department according to their needs. METHODS: Assessment of theoretical and practical training needs and literature review for the design of the training plan. RESULTS: A training plan was elaborated that included a protocol of care for the bereaved. The plan was adjusted to the needs detected in Primary Health Care nurses of the Dr. Peset Health Department. Important training deficits were detected in clinical practice; Conclusions: Improving the care of people with palliative needs in Primary Health Care requires adequate training of the nurses who care for them so their knowledge is the basis of their interventions. This study was not registered.
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People with comorbidities and the male sex are at a higher risk of developing severe COVID-19. In the present study, we aim to investigate the associated factors for infection, severity, and death due to COVID-19 in a population from Nuevo León, México. Epidemiological COVID-19 data were collected from 65 hospitals from December 2020 to May 2022. A total of 75,232 cases were compiled from which 25,722 cases were positive for SARS-CoV-2. Male sex, older age, diabetes, obesity, and hypertension were associated with infection. In addition to the above-mentioned factors, renal disease, cardiovascular disease, and immunosuppression were found to be associated with increased COVID-19 severity. These factors, as well as neurological diseases, are also associated with death due to COVID-19. When comparing the different variants of SARs-CoV-2, the variant B1.1.519 increased the probability of death by 2.23 times compared to the AY.20 variant. Male sex, older age, diabetes, obesity, and hypertension are associated with SARS-CoV-2 infection, severity, and death. Along with the aforementioned comorbidities, renal disease, cardiovascular disease, and immunosuppression are also associated with severity and death. Another factor associated with death is the presence of neurological disease. The SARS-CoV-2 B1.1.519 variant increases the odds of death compared to the SARS-CoV-2 AY.20 variant.
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Background: Women are underrepresented in acute myocardial infarction (AMI) studies. Furthermore, there is scarce information regarding women with AMI in Latin America. Aims: To describe the presentation, clinical characteristics, risk factor burden, evidence-based care, and in-hospital outcome in a population of women with AMI admitted to a coronary care unit (CCU) in Mexico. Methods: Retrospective cohort study including patients with AMI admitted from January 2006 to December 2021 in a CCU. We identified patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). We described demographic characteristics, clinical variables, treatment, and in-hospital outcomes according to gender. Cox regression analysis was used to identify predictors of mortality. Results: Our study included 12,069 patients with AMI, of whom 7,599 had STEMI and 4,470 had NSTEMI. Women represented 19.6% of the population. Women had higher rates of hypertension, diabetes, stroke, and atrial fibrillation than men. For STEMI, women were less likely to receive reperfusion therapy (fibrinolysis; 23.7 vs. 28.5%, p < 0.001 and primary percutaneous coronary intervention (PCI); 31.2 vs. 35.1%, p = 0.001) and had more major adverse events than men: heart failure (4.2 vs. 2.5%, p = 0.002), pulmonary edema (3.4% vs. 1.7%, p < 0.001), major bleeding (2.1% vs. 1%, p = 0.002), stroke (1.3% vs. 0.6%, p = 0.008), and mortality (15.1% vs. 8.1%, p < 0.001). For NSTEMI, women were less likely to undergo coronary angiography or PCI and had more major bleeding and mortality. Multivariate Cox regression analysis revealed that females had an increase in mortality in STEMI and NSTEMI (HR 1.21, CI 1.01-1.47, p = 0.05 and HR 1.39, CI 1.06-1.81, p = 0.01). Conclusion: Real-world evidence from a hospital in a Latin American low- to middle-income country (LMIC) showed that women with AMI had more comorbidities, received less reperfusion treatment or invasive strategies, and had worse outcomes. In STEMI and NSTEMI, female gender represented an independent predictor of in-hospital mortality.
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Infarto del Miocardio , Infarto del Miocardio sin Elevación del ST , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Accidente Cerebrovascular , Masculino , Humanos , Femenino , Infarto del Miocardio con Elevación del ST/epidemiología , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio sin Elevación del ST/diagnóstico , Infarto del Miocardio sin Elevación del ST/epidemiología , Infarto del Miocardio sin Elevación del ST/terapia , América Latina/epidemiología , Estudios Retrospectivos , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Factores de Riesgo , Hemorragia , Hospitales , Resultado del Tratamiento , Sistema de RegistrosRESUMEN
Celiac disease is strongly associated with HLA DQ, specifically with haplotypes. DRB1*03-DQA1*05:01/DQB1*02:01 (DQ2.5),DRB1*07-DQA1*02:01/DQB1*02:02 (DQ2.2), DRB1*11-DQA1*05:05/DQB1*03:01 (DQ7.5), and DRB1*04-DQA1*03:01/DQB1*03:02 (DQ8). The distribution of these risk haplotypes in patients with celiac disease is different in the geographical areas investigated. A high frequency of DRB1*07- DQA1*02:01/DQB1*02:02 (DQ2.2) and DRB1*11-DQA1*05:05/DQB1*03:01 (DQ7.5), has been described in Southern Europe. We analyzed 2102 confirmed CD cases with information on both DQB1* alelles and their distribution by geographical area in Spain. According to the presence of this haplotype in one or two chromosomes, the genotype is classified in: DQ2 homozygous, DQ2 heterozygous (cis or trans), DQ8 homozygous, DQ8/DQ2.5, DQ 2.2 homozygous and genotype known as "half DQ2". Two different patterns of risks related to CD were identified. In the Basque Country and Navarre, the Mediterranean Area (Aragon, Catalonia, Valencia, Balearic Islands, and Murcia), the South of Spain (Andalucía and Extremadura), and the Canary Islands, higher frequency of DQ2.5 trans, and more than 80% of DQ2.5/DQ2.2 homozygosis were described. The Cantabrian Coast (Cantabria, Asturias, and Galicia) and Central Areas (Castilla-León and Castilla-La Mancha) showed a higher percentage of DQ2.5/DQ2.5 homozygosis and a lower DQ2.5 in trans frequency, as in Northern Europe. Madrid has an intermediate model between the two described above. 17 cases (0.8%) did not carry any CD risk haplotypes.
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Enfermedad Celíaca , Antígenos HLA-DQ , Humanos , Niño , España/epidemiología , Antígenos HLA-DQ/genética , Enfermedad Celíaca/genética , Predisposición Genética a la Enfermedad , Alelos , Genotipo , Haplotipos , Cadenas beta de HLA-DQ/genética , Cadenas alfa de HLA-DQ/genéticaRESUMEN
Abstract Objective: The objective of the study was to analyze the differences between survivors and non-survivors with non-reperfused ST-segment elevation myocardial infarction (STEMI) and to identify the predictors of in-hospital mortality. Methods: A retrospective cohort study included non-reperfused STEMI patients from October 2005 to August 2020. Patients were classified into survivors and non-survivors. We compared patient characteristics, treatments, and outcomes among the groups and identified factors associated with in-hospital mortality. Results: We included 2442 patients with non-reperfused STEMI and we found a mortality of 12.7% versus 7.2% in reperfused STEMI. The main reason for non-reperfusion was delayed presentation (96.1%). Non-survivors were older, more often women, and had diabetes, hypertension, or atrial fibrillation. The left main coronary disease was more frequent in non-survivors as well as three-vessel disease. Non-survivors developed more in-hospital heart failure, reinfarction, atrioventricular block, bleeding, stroke, and death. The main predictors for in-hospital mortality were renal dysfunction (HR 3.41), systolic blood pressure < 100 mmHg (HR 2.26), and left ventricle ejection fraction < 40% (HR 1.97). Conclusion: Mortality and adverse outcomes occur more frequently in non-reperfused STEMI. Non-survivors tend to be older, with more comorbidities, and have more adverse in-hospital outcomes.
Resumen Objetivo: Analizar las diferencias entre los sobrevivientes y no sobrevivientes con infarto agudo de miocardio no reperfundido y conocer los predictores de mortalidad intrahospitalaria. Métodos: Estudio de cohorte retrospectiva que incluyó pacientes con infarto agudo de miocardio no reperfundido de octubre de 2005 a agosto de 2020. Se clasificaron los pacientes de acuerdo a su estado de sobrevida y se compararon las características clínicas, tratamientos y desenlaces para poder identificar los predictores de mortalidad intrahospitalaria. Resultados: Se incluyeron 2442 pacientes con infarto agudo de miocardio no reperfundido, en los que se encontró una mortalidad de 12.7% vs 7.2% los que si recibieron tratamiento de reperfusión. La principal razón para no recibir tratamiento de reperfusión fue el retraso en la atención médica (96.1%). Los no sobrevivientes tuvieron mayor edad, fueron mujeres y tuvieron mayor frecuencia de diabetes, hipertensión y fibrilación atrial. El tronco de la coronaria izquierda y la enfermedad trivascular fueron más frecuentes en los que no sobrevivieron. Los pacientes que no sobrevivieron desarrollaron más insuficiencia cardiaca, reinfarto, bloqueo atrioventricular, sangrados, evento vascular cerebral y muerte. Los principales predictores de mortalidad intrahospitalaria fueron: insuficiencia renal (HR 3.41), tensión arterial sistólica al ingreso < 100 mmHg (HR 2.26) y fracción de eyección del ventrículo izquierdo < 40% (HR 1.97). Conclusiones: Los pacientes con infarto de miocardio no reperfundido tienen mayor mortalidad y desenlaces adversos. Los no sobrevivientes fueron mayores, con más comorbilidades y desarrollaron más desenlaces adversos intrahospitalarios.
RESUMEN
OBJECTIVE: The objective of the study was to analyze the differences between survivors and non-survivors with non-reperfused ST-segment elevation myocardial infarction (STEMI) and to identify the predictors of in-hospital mortality. METHODS: A retrospective cohort study included non-reperfused STEMI patients from October 2005 to August 2020. Patients were classified into survivors and non-survivors. We compared patient characteristics, treatments, and outcomes among the groups and identified factors associated with in-hospital mortality. RESULTS: We included 2442 patients with non-reperfused STEMI and we found a mortality of 12.7% versus 7.2% in reperfused STEMI. The main reason for non-reperfusion was delayed presentation (96.1%). Non-survivors were older, more often women, and had diabetes, hypertension, or atrial fibrillation. The left main coronary disease was more frequent in non-survivors as well as three-vessel disease. Non-survivors developed more in-hospital heart failure, reinfarction, atrioventricular block, bleeding, stroke, and death. The main predictors for in-hospital mortality were renal dysfunction (HR 3.41), systolic blood pressure < 100 mmHg (HR 2.26), and left ventricle ejection fraction < 40% (HR 1.97). CONCLUSION: Mortality and adverse outcomes occur more frequently in non-reperfused STEMI. Non-survivors tend to be older, with more comorbidities, and have more adverse in-hospital outcomes.
OBJETIVO: Analizar las diferencias entre los sobrevivientes y no sobrevivientes con infarto agudo de miocardio no reperfundido y conocer los predictores de mortalidad intrahospitalaria. MÉTODOS: Estudio de cohorte retrospectiva que incluyó pacientes con infarto agudo de miocardio no reperfundido de octubre de 2005 a agosto de 2020. Se clasificaron los pacientes de acuerdo a su estado de sobrevida y se compararon las características clínicas, tratamientos y desenlaces para poder identificar los predictores de mortalidad intrahospitalaria. RESULTADOS: Se incluyeron 2442 pacientes con infarto agudo de miocardio no reperfundido, en los que se encontró una mortalidad de 12.7% vs 7.2% los que si recibieron tratamiento de reperfusión. La principal razón para no recibir tratamiento de reperfusión fue el retraso en la atención médica (96.1%). Los no sobrevivientes tuvieron mayor edad, fueron mujeres y tuvieron mayor frecuencia de diabetes, hipertensión y fibrilación atrial. El tronco de la coronaria izquierda y la enfermedad trivascular fueron más frecuentes en los que no sobrevivieron. Los pacientes que no sobrevivieron desarrollaron más insuficiencia cardiaca, reinfarto, bloqueo atrioventricular, sangrados, evento vascular cerebral y muerte. Los principales predictores de mortalidad intrahospitalaria fueron: insuficiencia renal (HR 3.41), tensión arterial sistólica al ingreso < 100 mmHg (HR 2.26) y fracción de eyección del ventrículo izquierdo < 40% (HR 1.97). CONCLUSIONES: Los pacientes con infarto de miocardio no reperfundido tienen mayor mortalidad y desenlaces adversos. Los no sobrevivientes fueron mayores, con más comorbilidades y desarrollaron más desenlaces adversos intrahospitalarios.
Asunto(s)
Infarto del Miocardio sin Elevación del ST , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Humanos , Femenino , Resultado del Tratamiento , Estudios Retrospectivos , Función Ventricular Izquierda , Volumen Sistólico , Intervención Coronaria Percutánea/efectos adversosRESUMEN
ABSTRACT: Background : Mortality in cardiogenic shock (CS) is up to 40%, and although risk scores have been proposed to stratify and assess mortality in CS, they have been shown to have inconsistent performance. The purpose was to compare CS prognostic scores and describe their performance in a real-world Latin American country. Methods : We included 872 patients with CS. The Society for Cardiovascular Angiography and Interventions (SCAI), CARDSHOCK, IABP-Shock II, Cardiogenic Shock Score, age-lactate-creatinine score, Get-With-The-Guidelines Heart Failure score, and Acute Decompensated Heart Failure National Registry scores were calculated. Decision curve analyses were performed to evaluate the net benefit of the different scoring systems. Logistic and Cox regression analyses were applied to construct area under the curve (AUC) statistics, this last one against time using the Inverse Probability of Censoring Weighting method, for in-hospital mortality prediction. Results: When logistic regression was applied, the scores had a moderate-good performance in the overall cohort that was higher AUC in the CARDSHOCK ( c = 0.666). In acute myocardial infarction-related CS (AMI-CS), CARDSHOCK still is the highest AUC (0.68). In non-AMI-CS only SCAI (0.668), CARDSHOCK (0.533), and IABP-SHOCK II (0.636) had statistically significant values. When analyzed over time, significant differences arose in the AUC, suggesting that a time-sensitive component influenced the prediction of mortality. The highest AUC was for the CARDSHOCK score (0.658), followed by SCAI (0.622). In AMI-CS-related, the highest AUC was for the CARDSHOCK score (0.671). In non-AMI-CS, SCAI was the best (0.642). Conclusions : Clinical scores show a time-sensitive AUC, suggesting that performance could be influenced by time and the type of CS. Understanding the temporal influence on the scores could provide a better prediction and be a valuable tool in CS.
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Insuficiencia Cardíaca , Infarto del Miocardio , Humanos , Choque Cardiogénico , América Latina , Contrapulsador Intraaórtico , Mortalidad HospitalariaRESUMEN
There is the notion that dysregulation of executive function (EF), which disrupts behavior and cognitive processes, may explain the emotional impairment which leads to increasing sugar sweetened beverages (SSBs) intake. We aimed to test whether anxiety and depression mediate the association between self-reported problems in EF and sugar sweetened beverage intake in Mexican adults between 18-40 years. An open survey advertised as a 'mental health and sugar sweetened beverages study' was conducted, participants were recruited through Facebook ads. Males and females, between 18-40 years, able to read and write, and currently residing in Mexico were included. We analyzed data using causal mediation analysis with latent variables using a structural equation modelling framework. Significant indirect effects were found for somatic symptoms of depression (ß = 6.601, SE = 2.657, p < .05) and anxiety (ß = .679, SE =.334, p < .05). In depression model no significant direct effects of EF were found in the depression model, however they were found in the anxiety model (ß = 1.335 SE =.566, p < .05). Somatic symptoms of depression were a total mediator, and anxiety a partial mediator. The results suggest that EF increased the probability of emotional symptoms, which led to a higher consumption of SBBs.
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Síntomas sin Explicación Médica , Bebidas Azucaradas , Masculino , Femenino , Humanos , Adulto Joven , Bebidas Azucaradas/efectos adversos , México/epidemiología , Función Ejecutiva , Análisis de Mediación , Depresión/epidemiología , Ansiedad/epidemiologíaRESUMEN
INTRODUCTION AND OBJECTIVE: There is little literature on the use of face masks in a treadmill test (TMT) during the COVID-19 pandemic. The objective of this study is to analyze the impact of face masks during a TMT performed during the prepandemic (without face mask) and postpandemic (with face mask) era. METHODS: Retrospective observational unicentric study of patients undergoing TMT. The inclusion criterion were being over 16years old and having performed at least one TMT in the prepandemic and postpandemic period. RESULTS: One thousand six hundred fifty-five patients were included in the study. Nine hundred thirty-five (56.5%) were men and 720 (43.5%) women. The mean age was 57.3±14.9 and the mean follow-up time was 15.4 months. Fifty-three percent patients had arterial hypertension, 20% dyslipidemia, 12% diabetes mellitus, 8% smoking habit, 19% personal history of ischemic heart disease, 5% COPD, 8% bronchial asthma, and 8% atrial fibrillation. In almost all the variables studied in PE, including the appearance of ventricular arrhythmias, no significant differences were found, neither by age nor sex, except for the existence of a very slight decrease in exercise capacity with mask use in older patients (>65years). CONCLUSIONS: The use of surgical or FFP2 face masks during the TMT did not affect functional capacity, blood pressure, heart rate, or increased ventricular arrhythmias.
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COVID-19 , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , COVID-19/epidemiología , COVID-19/prevención & control , Prueba de Esfuerzo , Máscaras , Pandemias/prevención & control , Estudios Retrospectivos , SARS-CoV-2RESUMEN
Support vector machines (SVMs) are popular learning algorithms to deal with binary classification problems. They traditionally assume equal misclassification costs for each class; however, real-world problems may have an uneven class distribution. This article introduces EBCS-SVM: evolutionary bilevel cost-sensitive SVMs. EBCS-SVM handles imbalanced classification problems by simultaneously learning the support vectors and optimizing the SVM hyperparameters, which comprise the kernel parameter and misclassification costs. The resulting optimization problem is a bilevel problem, where the lower level determines the support vectors and the upper level the hyperparameters. This optimization problem is solved using an evolutionary algorithm (EA) at the upper level and sequential minimal optimization (SMO) at the lower level. These two methods work in a nested fashion, that is, the optimal support vectors help guide the search of the hyperparameters, and the lower level is initialized based on previous successful solutions. The proposed method is assessed using 70 datasets of imbalanced classification and compared with several state-of-the-art methods. The experimental results, supported by a Bayesian test, provided evidence of the effectiveness of EBCS-SVM when working with highly imbalanced datasets.