Present and Future Applications of Digital PCR in Infectious Diseases Diagnosis.

Infectious diseases account for about 3 million deaths per year. The advent of molecular techniques has led to an enormous improvement in their diagnosis, both in terms of sensitivity and specificity and in terms of the speed with which a clinically useful result can be obtained. Digital PCR, or 3rd generation PCR, is based on a series of technical modifications that result in more sensitive techniques, more resistant to the action of inhibitors and capable of direct quantification without the need for standard curves. This review presents the main applications that have been developed for the diagnosis of viral, bacterial, and parasitic infections and the potential prospects for the clinical use of this technology.

Real-life experience of hepatitis C treatment in a Spanish prison / Tratamiento de la hepatitis C en un centro penitenciario Español

Background. Hepatitis C virus (HCV) infection is a majorpublic health problem that causes multiple comorbidities. People in prisons who inject intravenous drugs are at increasedrisk of HCV infection, and HCV infection is 15-fold more prevalent among prisoners compared with the community. Theobjective of this study was to analyse the clinical and epidemiological characteristics of residents of a Spanish prison withHCV infection who received antiviral treatment.Material and methods. An observational, descriptiveand retrospective study was performed. All patients with HCVinfection diagnosed or followed up in an Infectious Diseasesattached to a penitentiary were included in this study.Results. Of 81 patients analysed, sixty-nine (83.1%) patients were male. The mean age was 50.1 (SD8.8) years, and 70%of the inmates had a history of injection drug use. Coinfectionwith HIV was detected in 30%. In up to 25% of the sample, therewere data on chronic liver disease in the degree of liver cirrhosis. The diagnosis of HCV infection had been made more than15 years earlier in 28% of those studied. Decompensations fromliver disease, hepatocellular carcinoma, or hospital admissionswere exceptional. Most of the inmates with HCV accepted treatment, and approximately 94% of the patients who completedtreatment achieved a sustained virological response without interactions or complications of interest.Conclusions. The availability of direct-acting antiviralsand their exceptional side effects constitute an opportunity toreduce the burden of HCV infection in Spain, particularly inthese high-risk populations. (AU)

Introducción. La infección por el virus de la hepatitis C(VHC) es un importante problema de salud pública con unagran morbimortalidad. El consumo de drogas inyectables es laprincipal vía de transmisión, siendo la infección por VHC 15veces más prevalente en las cárceles españolas respecto a lacomunidad. El objetivo de este estudio fue analizar las características clínico-epidemiológicas de los residentes de un centro penitenciario con VHC que recibieron tratamiento.Material y métodos. Estudio observacional, descriptivoy retrospectivo. Se incluyeron en este estudio todos los pacientes con infección por VHC diagnosticados o seguidos enuna Unidad de Enfermedades Infecciosas adscrito a un centropenitenciario.Resultados. De 81 pacientes analizados, sesenta y nueve(83,1%) pacientes eran varones. La edad media fue de 50,1 (DE8,8) años y el 70% de los internos tenía antecedentes de consumo de drogas inyectables. Se detectó coinfección por VIH en30%. En un 25% presentaban enfermedad hepática en gradode cirrosis. En el 28% de los internos el diagnóstico de VHC sehabía realizado hacia más de 15 años. Las descompensacionespor enfermedad hepática, carcinoma hepatocelular o ingresohospitalario fueron excepcionales. El 94% de los pacientes quecompletaron el tratamiento lograron una respuesta virológicasostenida sin interacciones ni complicaciones de interés.Conclusiones. La disponibilidad de antivirales de accióndirecta y sus excepcionales efectos secundarios constituyenuna oportunidad para reducir la carga de infección por VHCen España, especialmente en estas poblaciones de alto riesgo (AU)

Prevention of Severe Vestibular Hypofunction after Systemic Gentamicin.

The importance of early evaluation by a neurotologist in patients with infective endocarditis treated with systemic gentamicin and its impact on the patients' quality of life was evaluated. This is a longitudinal retrospective cohort study of 29 patients who received intravenous gentamicin for the treatment of infective endocarditis. Patients were classified into two groups: group A, before a neurotologist was included in the treatment protocol, and group B, after the inclusion of a neurotologist. The frequency of the different symptoms in each group was measured, and the gain of the vestibulo-ocular reflex (VOR) and its relationship with the presence of oscillopsia. In total, 13 and 16 patients were assigned to groups A and B, respectively. The mean gain of the VOR measured using the video head impulse test in group A was 0.44 in the best side and 0.39 in the worst side. In group B, the mean gain was 0.71 (best side) and 0.64 (worst side) (p < 0.0001). The patients who complained about oscillopsia had a main gain of 0.41 in the best side and 0.35 in the worst side. Evaluation of vestibular function should be included in the infective endocarditis treatment protocol, including the adverse effects of systemic gentamicin.

Retrospective Identification of Early Autochthonous Case of Crimean-Congo Hemorrhagic Fever, Spain, 2013.

Before this report, 7 autochthonous human cases of Crimean-Congo hemorrhagic fever had been reported in Spain, all occurring since 2016. We describe the retrospective identification of an eighth case dating back to 2013. This study highlights that the earliest cases of an emerging disease are often difficult to recognize.

Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone.

BACKGROUND: The evidence for the efficacy of glucocorticoids combined with tocilizumab (TCZ) in COVID-19 comes from observational studies or subgroup analysis. Our aim was to compare outcomes between hospitalized COVID-19 patients who received high-dose corticosteroid pulse therapy and TCZ and those who received TCZ. METHODS: A retrospective single-center study was performed on consecutive hospitalized patients with severe COVID-19 between 1 March and 23 April 2020. Patients treated with either TCZ (400-600 mg, one to two doses) and methylprednisolone pulses (MPD-TCZ group) or TCZ alone were analyzed for the occurrence of a combined endpoint of death and need for invasive mechanical ventilation during admission. The independence of both treatment groups was tested using machine learning classifiers, and relevant variables that were potentially different between the groups were measured through a mean decrease accuracy algorithm. RESULTS: An earlier date of admission was significantly associated with worse outcomes regardless of treatment type. Twenty patients died (27.0%) in the TCZ group, and 33 (44.6%) died or required intubation (n = 74), whereas in the MPD-TCZ group, 15 (11.0%) patients died and 29 (21.3%) patients reached the combined endpoint (n = 136; p = 0.006 and p < 0.001, respectively). Machine learning methodology using a random forest classifier confirmed significant differences between the treatment groups. CONCLUSIONS: MPD and TCZ improved outcomes (death and invasive mechanical ventilation) among hospitalized COVID-19 patients, but confounding variables such as the date of admission during the COVID-19 pandemic should be considered in observational studies.

Endocarditis infecciosa sobre TAVI: la necesidad de trabajar en equipo para mejorar los resultados / Infective Endocarditis after Transvalvular Aortic Replacement: A call for a joined effort to improve its results

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Los médicos que realizan su labor asistencial e investigadora en unidades de dolor en el uso de internet: identificación, caracterización y determinantes / The medical doctors who perform their care and research work in pain units in the use of the internet: identification, characterization and determinants

Objetivos: La información proporcionada por las Encuestas de Condiciones de Trabajo y Salud (ECTS) permite la formulación de programas de acción públicos que generen cambios, fijen prioridades y evalúen tendencias. Desde 1987 que se realizó la primera ECTS en España, este instrumento se ha ido consolidando como fuente de datos del sistema de las tecnologías de la información y la comunicación. Los resultados muestran la necesidad de establecer el avance de las innovaciones tecnológicas sanitarias y la investigación biomédica. Estos avances serán determinantes en la mejora de la salud, ya que supondrán nuevas formas de cuidados médicos que contribuyen al aumento de la esperanza de vida, la reducción del dolor y la gestión de las enfermedades. El objetivo de este estudio es valorar el nivel de aceptación de las nuevas tecnologías en médicos que traten el dolor a través de unidades específicas. Material y métodos: Se realizó un estudio para comprobar el uso de las TIC en médicos que realizan su labor asistencial y de investigación en Unidades de Dolor. Este estudio consta de una encuesta online, enviada a través de correo electrónico a los alumnos del máster en Tratamiento del Dolor de la Universidad de Salamanca. Tras la recogida sistemática de la información, se realizó el análisis estadístico abordando la frecuencia de las variables y las relaciones estadísticamente significativas relevantes para nuestro estudio. Posteriormente se realizó un análisis utilizando una metodología de regresión logística a través del modelo Logit binomial. Resultados: De los profesionales médicos que contestaron a nuestra encuesta, se obtuvo que aquellos que son varones y trabajan en Unidades del Dolor eran un 39,46 % y en Cuidados Paliativos eran un 21,35 %. Agregando estos datos obtenemos que el 75,94 % de los profesionales trabajan en entidades públicas, el 9,72 % en entidades privadas y el 11,05 % en ambas. Más del 55 % de los profesionales encuestados "Nunca utilizan ordenadores o Tecnologías de la Información y la Comunicación para la realización remota de evaluación diagnóstica o prescripción de medidas terapéuticas". Conclusiones: Los resultados obtenidos nos muestran que los médicos de unidades de dolor consideran un elemento relevante las aplicaciones de las Tecnologías de la Información y la Comunicación para la práctica clínica. Además, se constata, dada la experiencia clínica de los profesionales, la necesidad de cambios organizativos asociados a los nuevos sistemas informáticos

Objectives: The information provided by the Labor Conditions and Health Surveys (ECTS) allows for the formulation of public action programs that generate changes, set priorities and evaluate trends. Since 1987, when the first ECTS was carried out in Spain, this instrument has been consolidated as a data source for the information and communication technology system. The results show the need to establish the advance of the technological innovations in health and biomedical research. These advances will be decisive in the improvement of health, since they will involve new forms of medical care that contribute to the increase of life expectancy, the reduction of pain and the management of diseases. The objective of this study is to assess the level of acceptance of new technologies in physicians who treat pain through specific units. Matherial and method: A study was carried out to verify the use of ICTs in doctors who perform their care and research work in Pain Units. This study consists of an online survey, sent via email to the students of the Master's Degree in Pain Treatment at the University of Salamanca. After the systematic collection of the information, the statistical analysis was carried out, addressing the frequency of the variables and the statistically significant relationships relevant to our study. Subsequently, a factor analysis, a cluster analysis and new composite variables are constructed to synthesize the data, to which, finally, an analysis was made using a logistic regression methodology through the Binomial Logit model. Results: Of the medical professionals who answered our survey, it was obtained that those who are men and work in Pain Units were 39.46 % and in Palliative Care they were 21.35 %. Adding this data, we obtain that 75.94 % of professionals work in public entities, 9.72 % in private entities and 11.05 % in both. More than 55 % of the professionals surveyed "never use computers or Information and Communication Technologies for the remote realization of diagnostic evaluation or prescription of therapeutic measures". Conclutions: The results obtained show that Pain Units physicians consider the applications of Information and Communication Technologies to be a relevant element for clinical practice. In addition, given the clinical experience of professionals, the need for organizational changes associated with new computer systems is confirmed

Las tecnologías de la información y la comunicación aplicadas entre los profesionales de la medicina que realizan tratamiento del dolor / Information and communication technologies applied among medical professionals who perform pain treatment

Objetivos: La revolución de las tecnologías de la información y la comunicación es la base sobre la que se ha desarrollado el avance de las innovaciones tecnológicas sanitarias y la investigación biomédica. Estos avances han sido determinantes en la mejora de la salud, ya que han supuesto nuevas formas de cuidados médicos que contribuyen al aumento de la esperanza de vida, la reducción del dolor y la gestión de las enfermedades. Se pretende valorar el nivel de aceptación de las nuevas tecnologías en médicos que traten el dolor a través de unidades específicas. Material y métodos: Se llevó a cabo un estudio sobre el uso de las nuevas tecnologías de la información en médicos que realizan tratamiento del dolor en centros específicos. Los datos se obtuvieron a partir de la elaboración de un cuestionario online que ha sido enviado a través del correo electrónico a los alumnos del Máster en Tratamiento del Dolor de la USAL. Tras la recogida sistemática de la información, hemos realizado los análisis estadísticos abordando la frecuencia de las variables y las relaciones estadísticamente signifi cativas relevantes para nuestro estudio. Posteriormente realizamos un análisis de factores, análisis de clúster y la construcción de nuevas variables compuestas para sintetizar los datos. Tras esta identificación, el análisis de las relaciones estadísticamente significativas nos ha permitido caracterizar a estos individuos. Finalmente, hemos realizado un análisis utilizado una metodología de regresión logística a través del modelo Logit binomial. La herramienta utilizada para la realización de la encuesta online fue Google Sheets, herramienta englobada dentro de Google Docs, que está diseñada para trabajar a través de internet y de la web. Resultados: El 57 % de los profesionales médicos que contestaron a nuestra encuesta son hombres, mientras que el 43 % de las respuestas pertenecen a mujeres, de Unidad del Dolor (39,46 %), Cuidados Paliativos (21,35 %) y en los Centros de Atención Primaria (CAP). Agregando estos datos obtenemos que el 75,94 % de los profesionales trabajan en entidades públicas, el 9,72 % en entidades privadas y el 11,05 % en ambas. El 79,5 % de los profesionales encuestados no ofrecen su teléfono móvil a los pacientes. Más del 83 % de los profesionales encuestados utilizan muy frecuentemente (29,5 %) o frecuentemente (54,2 %) directrices/protocolos médicos en su práctica clínica; más del 55 % de los profesionales encuestados "Nunca utilizan ordenadores o tecnologías de la información y la comunicación para la realización remota de evaluación diagnóstica o prescripción de medidas terapéuticas". No obstante, un 40 % de los encuestados declaran que han realizado telemedicina. Conclusiones: En general, los datos nos muestran una concepción benefi ciosa de las aplicaciones de las tecnologías de la información y la comunicación para la práctica clínica en lo relativo a la digitalización y distribución de la información clínica. Además, se constata, dada la experiencia clínica de los profesionales, la necesidad de cambios organizativos asociados a los nuevos sistemas informáticos

Target: The revolution in information and communication technologies is the basis on which the advance of health technological innovations and biomedical research has been developed. These advances have been decisive in the improvement of health, since they have involved new forms of medical care that contribute to the increase in life expectancy, pain reduction and disease management. The aim is to assess the level of acceptance of new technologies in physicians who treat pain through specific units. Material and method: A study was carried out on the use of new information technologies in physicians who perform pain treatment in specifi c centers. The data was obtained from the elaboration of an online questionnaire that has been sent via email to the students of the Master in Pain Treatment of the USAL. After the systematic collection of information, we performed the statistical analyzes addressing the frequency of the variables and the statistically signifi cant relationships relevant to our study. Later, we carried out a factor analysis, cluster analysis and the construction of new compound variables to synthesize the data. After this identifi cation, the analysis of statistically significant relationships has allowed us to characterize these individuals. Finally, we performed an analysis using a logistic regression methodology through the Binomial Logit model. The tool used to carry out the online survey was Google Sheets, a tool included within Google Docs, which is designed to work through the Internet and the Web. Results: The 57 % of the medical professionals who answered our survey are men, while 43 % of the answers belong to women, of Pain Unit (39.46 %), Palliative Care (21.35 %) and in the Centers of Primary Care (CAP), Adding this data we obtain that 75.94 % of professionals work in public entities, 9.72 % in private entities and 11.05 % in both. 79.5 % of the surveying professionals do not offer their mobile phone to patients. More than 83 % of the professionals surveyed use very frequently (29.5 %) or Frequently (54.2 %) guidelines / medical protocols in their clinical practice; More than 55% of the professionals surveyed "never use computers or Information and Communication Technologies for the remote realization of diagnostic evaluation or prescription of therapeutic measures". However, 40 % of the respondents declare that they have done telemedicine. Conclusions: In general, the data show us a beneficial conception of the applications of Information and Communication Technologies for clinical practice in relation to the digitalization and distribution of clinical information. In addition, given the clinical experience of professionals, the need for organizational changes associated with new computer systems is confirmed

Results of the Use of a Simulator for Training in Anesthesia and Regional Analgesia Guided by Ultrasound.

Show the learning results obtained by a simulation tool used by students of an online course on anesthesia techniques and regional analgesia guided by ultrasound. A satisfaction survey generated with a form of Google Forms was carried out in September 2018 with 14 questions related to the quality, ease and capacity of the learning obtained after the use of the nerve blocks Simulator, which was firstly published on the first edition of the course for 34 students. An average of 7.3 attempts of resolution have been made per practice and per student in the simulator. The students are, in their immense majority, habitual users of the ICTs and 73% of them consider that their experience with the simulator has been satisfactory and that their learning has been favored by this fact. The authors have verified that the ultrasound simulator contributes to the learning of skills for the practice of nerve blocks and, furthermore, it helps to ensure that theoretical knowledge is carried out in a more productive and efficient way.

Combined Transcranial Direct Current Stimulation and Virtual Reality-Based Paradigm for Upper Limb Rehabilitation in Individuals with Restricted Movements. A Feasibility Study with a Chronic Stroke Survivor with Severe Hemiparesis.

Impairments of the upper limb function are a major cause of disability and rehabilitation. Most of the available therapeutic options are based on active exercises and on motor and attentional inclusion of the affected arm in task oriented movements. However, active movements may not be possible after severe impairment of the upper limbs. Different techniques, such as mirror therapy, motor imagery, and non-invasive brain stimulation have been shown to elicit cortical activity in absence of movements, which could be used to preserve the available neural circuits and promote motor learning. We present a virtual reality-based paradigm for upper limb rehabilitation that allows for interaction of individuals with restricted movements from active responses triggered when they attempt to perform a movement. The experimental system also provides multisensory stimulation in the visual, auditory, and tactile channels, and transcranial direct current stimulation coherent to the observed movements. A feasibility study with a chronic stroke survivor with severe hemiparesis who seemed to reach a rehabilitation plateau after two years of its inclusion in a physical therapy program showed clinically meaningful improvement of the upper limb function after the experimental intervention and maintenance of gains in both the body function and activity. The experimental intervention also was reported to be usable and motivating. Although very preliminary, these results could highlight the potential of this intervention to promote functional recovery in severe impairments of the upper limb.

Study of the uses of Information and Communication Technologies by Pain Treatment Unit Physicians.

Adequate use of Information and Communication Technologies (ICTs) in health has been shown to save the patient and caregiver time, improve access to the health system, improve diagnosis and control of disease or treatment. All this results in cost savings, and more importantly, they help improve the quality of service and the lives of patients. The purpose of this study is to analyse the differences in the uses of this ICTs between those physicians that belong to Pain Treatment Units (PU) and other physicians that work in pain not linked to these PUs. An online survey, generated by Netquest online survey tool, was sent to both groups of professionals and the data collected was statistical analysed through a logistic regression methodology which is the Logit binomial model. Our results show that those physicians that belong to PUs use ICTs more frequently and consider it more relevant to their clinical practice.

Effect of elevated pulmonary vascular resistance on outcomes after percutaneous mitral valvuloplasty.

Patients with mitral stenosis with severe pulmonary hypertension constitute a high-risk subset for surgical commissurotomy or valve replacement. The aim of the present study was to examine the effect of elevated pulmonary vascular resistance (PVR) on percutaneous mitral valvuloplasty (PMV) procedural success, short- and long-term clinical outcomes (i.e., mortality, mitral valve surgery, and redo PMV) in 926 patients. Of the 926 patients, 263 (28.4%) had PVR ≥4 Woods units (WU) and 663 (71.6%) had PVR <4 WU. Patients with PVR ≥4 WU were older and more symptomatic and had worse valve morphology for PMV. The patients with PVR ≥4 WU also had lower PMV procedural success than those with PVR <4 WU (78.2% vs 85.6%, p = 0.006). However, after multivariate adjustment, PVR was no longer an independent predictor of PMV success nor an independent predictor of the combined end point at a median follow-up of 3.2 years. In conclusion, elevated PVR at PMV is not an independent predictor of procedural success or long-term outcomes. Therefore, appropriately selected patients with rheumatic mitral stenosis might benefit from PMV, even in the presence of elevated preprocedural PVR.

Difference in outcome among women and men after percutaneous mitral valvuloplasty.

OBJECTIVE: To analyze the differences in anatomical, clinical and echocardiographic characteristics of women and men undergoing PMV and to evaluate the relationship between sex, PMV success, and immediate and long-term clinical outcome. BACKGROUND: Rheumatic mitral stenosis (MS) is predominantly a disease of middle-aged women. Percutaneous mitral valvuloplasty (PMV) has become the standard of care for suitable patients. However little is known about the relationship between sex, PMV success, and procedural outcome. METHODS AND RESULTS: We evaluated measures of procedural success and clinical outcome in consecutive patients (839 women and 176 men) who underwent PMV. Despite a lower baseline echocardiographic score (7.47 ± 2.15 vs. 8.02 ± 2.18, P = 0.002), women were less likely to achieve PMV success (69% vs. 83%, adjusted OR 0.44, 95% CI 0.27-0.74, P = 0.002), and had a smaller post-procedural MV area (1.86 ± 0.7 vs. 2.07 ± 0.7 cm(2), P < 0.001). Overall procedural and in-hospital complication rates did not differ significantly between women and men. However, women were significantly more likely to develop severe MR immediately post PMV (adjusted OR 2.41, 95% CI 1.0-5.83, P = 0.05) and to undergo MV surgery (adjusted HR 1.54, 95% CI 1.03-2.3, P = 0.037) after a median follow-up of 3.1 years. CONCLUSIONS: Compared to men, women with rheumatic MS who undergo PMV are less likely to have a successful outcome and more likely to require MV surgery on long-term follow-up despite more favorable baseline MV anatomy.

Hyperglycemia on admission predicts larger infarct size in patients undergoing percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.

AIMS: To determine if hyperglycemia on admission correlates to infarct size measured by single-photon emission computed tomography (SPECT) in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). METHODS: We evaluated 347 STEMI patients who underwent primary PCI. Infarct size was determined by SPECT on Day 5. The population was divided into: hyperglycemia (glycemia on admission >11mmol/L) or non-hyperglycemia (

Impact of pre- and postprocedural mitral regurgitation on outcomes after percutaneous mitral valvuloplasty for mitral stenosis.

Percutaneous mitral valvuloplasty (PMV) is an effective therapy in patients with significant mitral stenosis. Few studies have examined the effect of mitral regurgitation (MR), a frequent periprocedural finding, on PMV outcomes. We examined the effects of pre- and postprocedural MR after PMV. Contrast left ventriculography was performed before and after PMV, and the MR severity was assessed using Sellers' classification. Clinical, hemodynamic, and morphologic variables were collected for all patients. Consecutive patients (n = 876) undergoing a first PMV procedure at a single tertiary center were evaluated. An increasing preprocedural MR severity was associated with reduced PMV success (no MR, 75%; 1+ MR, 65%; 2+ MR, 44%; p <0.0001), increased in-hospital mortality (0.6% vs 2.8% vs 4.9%, respectively; p = 0.007), and other complications. Increasing grades of pre- and postprocedural MR predicted, independently and in a grade-dependent manner, the composite outcome of mortality, mitral valve surgery, or redo PMV (preprocedural MR >or=1+, relative risk [RR] 1.4, 95% confidence interval [CI] 1.2 to 1.8; preprocedural MR >or=2+, RR 1.6, 95% CI 1.1 to 2.4; postprocedural MR >or=1+, RR 1.6, 95% CI 1.2 to 2.0; postprocedural MR >or=2+, RR 2.2, 95% CI 1.7 to 2.7; and postprocedural MR >or=3+, RR 4.6, 95% CI 3.4 to 6.2, respectively). In conclusion, increasing pre- and postprocedural MR grades independently predicted the long-term clinical outcomes after PMV. Patients with moderate preprocedural MR, in particular, appeared to have suboptimal short- and long-term outcomes, necessitating careful monitoring and early referral for mitral valve surgery, when appropriate.

Association between -T786C NOS3 polymorphism and resistant hypertension: a prospective cohort study.

BACKGROUND: It is estimated that 5% of the hypertensive patients are resistant to conventional antihypertensive therapy. Polymorphisms in the endothelial nitric oxide synthase (NOS3) gene have been associated with high blood pressure levels, but not with resistant hypertension. The aim of the present study was to investigate if the -786T>C and G894T (Glu298Asp) polymorphisms of the NOS3 gene were associated with resistant hypertension. METHODS: A prospective case-control observational study was performed. From a series of 950 consecutive patients followed up during 42 months, 48 patients with resistant hypertension were detected. 232 patients with controlled high blood pressure were also included. RESULTS: No differences were observed in the distribution of G894T (Glu298Asp) NOS3 genotypes between the resistant hypertension group and the controlled hypertension patients. However, genotype -786CC was more frequent in the group of patients with resistant hypertension (33.3%) than in the group of patients with controlled high blood pressure (17.7%) (p 0.03). Furthermore carriers of allele T (-786TC and -786TT) were more frequent in patients with controlled hypertension (82.3%) than those with resistant hypertension (66.7%) (Multivariate analysis; RR 2.09; 95% CI 1.03-4.24; p 0.004). CONCLUSION: Our results indicate that genotype -786CC of the NOS3 gene increase the susceptibility to suffer resistant hypertension, which suggest that resistance to conventional therapy could be determined at the endothelial level.

Predicting success and long-term outcomes of percutaneous mitral valvuloplasty: a multifactorial score.

BACKGROUND: Percutaneous mitral valvuloplasty (PMV) success depends on appropriate patient selection. A multifactorial score derived from clinical, anatomic/echocardiographic, and hemodynamic variables would predict procedural success and clinical outcome. METHODS: Demographic data, echocardiographic parameters (including echocardiographic score), and procedure-related variables were recorded in 1085 consecutive PMVs. Long-term clinical follow-up (death, mitral valve replacement, redo PMV) was performed. Multivariate regression analysis of the first 800 procedures was performed to identify independent predictors of procedural success. Significant variables were formulated into a risk score and validated prospectively. RESULTS: Six independent predictors of PMV success were identified: age less than 55 years, New York Heart Association classes I and II, pre-PMV mitral area of 1 cm(2) or greater, pre-PMV mitral regurgitation grade less than 2, echocardiographic score of 8 or greater, and male sex. A score was constructed from the arithmetic sum of variables present per patient. Procedural success rates increased incrementally with increasing score (0% for 0/6, 39.7% for 1/6, 54.4% for 2/6, 77.3% for 3/6, 85.7% for 4/6, 95% for 5/6, and 100% for 6/6; P < .001). In a validation cohort (n = 285 procedures), the multifactorial score remained a significant predictor of PMV success (P < .001). Comparison between the new score and the echocardiographic score confirmed that the new index was more sensitive and specific (P < .001). This new score also predicts long-term outcomes (P < .001). CONCLUSION: Clinical, anatomic, and hemodynamic variables predict PMV success and clinical outcome and may be formulated in a scoring system that would help to identify the best candidates for PMV.