Androgen deprivation therapy mimicking acute coronary syndrome: A case report.

An 80-year-old man diagnosed with prostate cancer and under treatment with androgen deprivation therapy presented at the emergency room with chest pain, repolarization abnormalities and QT interval prolongation on electrocardiogram. An initial diagnosis of acute coronary syndrome was proposed, but biomarkers and coronary angiography were negative. Hydroelectrolyte balance and echocardiogram were also normal. Some weeks after drug withdrawal, repolarization changes reverted. A rare side effect of these drugs mimicking an acute coronary syndrome was the most probable diagnosis.

Procedimiento para el análisis y la prevención de errores de medicación usando el enfoque de la ergonomía

Los errores de medicación representan un problema de salud pública que afecta la seguridad del paciente y la calidad de los servicios de salud a escala global. En este artículo se presenta un procedimiento para el análisis y la prevención de los errores de medicación desde la perspectiva de la ergonomía, ejemplificándose su aplicación mediante un caso de estudio ilustrativo de administración de un medicamento inyectable. Como parte del procedimiento expuesto, se incluyeron los reconocidos métodos Hierarchical Task Analysis (HTA) para el análisis de la tarea y Systematic Human Error Reduction and Prediction Approach (SHERPA) para la identificación de los modos de error. Para la valoración de riegos se empleó la matriz de riesgos propuesta en la norma ISO 45001. El procedimiento propuesto quedó conformado por cuatro etapas: 1) selección de la tarea objeto de estudio, 2) análisis detallado de la tarea, 3) predicción de la posibilidad de error y 4) desarrollo de estrategias para la reducción del error. Se espera que la utilización sistemática de este procedimiento contribuya en la mejora de la calidad de los servicios de salud, disminuyendo los errores humanos y los posibles eventos adversos.

Medication errors represent a public health problem that affects patient safety and the quality of healthcare services globally. This article presents a procedure for the analysis and prevention of medication errors from the perspective of ergonomics, exemplifying its application through a case study. The well-known Hierarchical Task Analysis (HTA) and the Systematic Human Error Reduction and Prediction Approach (SHERPA) methods are included. The risk assessment was based on the risk matrix proposed in the ISO 45001 standard. The proposed procedure is structured in four stages: 1) selection of the task to be analysed, 2) detailed analysis of the task, 3) prediction of the possibility of error, 4) error reduction strategies. The use of the procedure is exemplified through a case study of the administration of an injectable drug. The systematic use of this procedure is expected to contribute to the improvement of the quality of health services by reducing human errors and possible adverse events.

Os erros de medicação representam um problema de saúde pública que afeta a segurança do paciente e a qualidade dos serviços de saúde em escala global. Este artigo apresenta um procedimento para a análise e prevenção de erros de medicação do ponto de vista ergonômico, exemplificado por um estudo de caso. Foram incluídos os métodos reconhecidos de Análise Hierárquica de Tarefas (HTA) para análise de tarefas e a Abordagem Sistemática de Redução e Previsão de Erros Humanos (SHERPA) para identificação de modos de erro. A avaliação do risco baseou-se na matriz de risco proposta na norma ISO 45001. O procedimento proposto é composto de quatro etapas: 1) seleção da tarefa em estudo, 2) análise detalhada da tarefa, 3) previsão da possibilidade de erro, 4) estratégias de redução de erros. A aplicação do procedimento é ilustrada por um estudo de caso de administração de um medicamento injetável. Espera-se que o uso sistemático deste procedimento contribua para a melhoria da qualidade dos serviços de saúde, reduzindo erros humanos e possíveis eventos adversos.

Evaluation of Fatigue and Workload among Workers Conducting Complex Manual Assembly in Manufacturing.

OCCUPATIONAL APPLICATIONSWe conducted a study to evaluate fatigue and workload among workers performing complex assembly tasks. We investigate several predictors of fatigue, including subjective workload estimates, sleep duration, the shift being worked, and production levels. High levels of fatigue were reported in one-third of the shifts evaluated. The main predictors of high fatigue were workload estimates, working evening shifts, and baseline fatigue. Among the six dimensions of workload, only mental demand and frustration were predictors of high fatigue. Mental demand was also rated highest. Participants reported less than seven hours of sleep in 60% of the nights evaluated. These results suggest that managers and supervisors should consider cognitive workload as a key contributing factor to fatigue in complex manual assembly. Similarly, work schedule planning should consider shift duration, start times, and end times, because of the negative influence on fatigue and the potential disruptions on sleep among workers.

TECHNICAL ABSTRACTBackground: General fatigue and mental workload have been studied extensively in safety-critical contexts; wherein human performance degradation can lead to catastrophic outcomes. In the manufacturing sector, the physical demands of a job have received most of the attention because of the presence of biomechanical loads and the incidence of musculoskeletal disorders. However, in complex manual assembly, cognitive and chronobiology aspects of work can contribute to fatigue and degrade worker performance.Purpose: We aimed to evaluate self-reported levels of fatigue and workload among a group of workers performing complex assembly tasks. We also sought to investigate several predictors of fatigue, including workload estimates, sleep duration, the shift being worked, and production levels.Methods: Fourteen assembly line workers participated in a two-week study. They evaluated their levels of fatigue at the beginning and end of each shift using the Samn-Perelli Fatigue Scale. They also evaluated their workload according to the NASA-TLX scale at the end of each shift.Results: High levels of fatigue (fatigue score ≥ 5) were reported in approximately one-third of 114 work shifts evaluated. Binary logistic regression indicated that fatigue scores at the beginning of the shift, NASA-TLX scores, and working evening shifts were significant predictors of high levels of fatigue. Among the six dimensions measured by NASA-TLX, only mental demand and frustration were predictors of high fatigue. Mental demand was also rated highest by the workers. Participants reported less than seven hours of sleep in 60% of the nights evaluated.Conclusions: These results suggest that cognitive load can contribute to fatigue in complex manual assembly work. Circadian and homeostatic processes related to shift duration, start times, and end times are also potential contributing factors. Similarly, existing work schedules may be contributing to sleep disruptions among workers.

New Parameter of the Second Half of the P-Wave, P-Wave Duration, and Atrial Conduction Times Predict Atrial Fibrillation during Electrophysiological Studies.

OBJECTIVE: Several P-wave parameters reflect atrial conduction characteristics and have been used to predict atrial fibrillation (AF). The aim of this study was to determine the relationship between maximum P-wave duration (PMax) and new P-wave parameters, with atrial conduction times (CT), and to assess their predictive value of AF during electrophysiological studies (AF-EPS). SUBJECTS AND METHODS: This was a cross-sectional study in 153 randomly selected patients aged 18-70 years, undergoing EPS. The patients were divided into 2 groups designated as no AF-EPS and AF-EPS, depending on whether AF occurred during EPS or not. Different P-wave parameters and atrial CT were compared for both study groups. Subsequently, the predictive value of the P-wave parameters and the atrial CT for AF-EPS was evaluated. RESULTS: The values of CT, PMax, and maximum Ppeak-Pend interval (Pp-eMax) were significantly higher in patients with AF-EPS. Almost all P-wave parameters were correlated with the left CT. PMax, Pp-eMax, and CT were univariate and multivariate predictors of AF-EPS. The largest ROC area was presented by interatrial CT (0.852; p < 0.001; cutoff value: ≥82.5 ms; sensitivity: 91.1%; specificity: 81.1%). Pp-eMax showed greater sensitivity (79.5%) to discriminate AF-EPS than PMax (72.7%), but the latter had better specificity (60.4% vs. 41.5%). CONCLUSIONS: Left atrial CT were directly and significantly correlated with PMax and almost all the parameters of the second half of the P-wave. CT, PMax, and Pp-eMax (new parameter) were good predictors of AF-EPS, although CT did more robustly.

Surgimiento y evolución de la ergonomía como disciplina: reflexiones sobre la escuela de los factores humanos y la escuela de la ergonomía de la actividad / Emergence and evolution of ergonomics as a discipline: reflections on the school of human factors and the school of ergonomics of the activity / Surgimento e evolução da ergonomia como disciplina: reflexões sobre a escola dos fatores humanos e a escola de ergonomia da atividade

Resumen La ergonomía es considerada, en la actualidad, una disciplina científica consolidada, que se expande continuamente a nivel global. Este escenario actual es el resultado de diferentes visiones que han permeado la evolución de la ergonomía. En este artículo se hace un recorrido histórico de la ergonomía como disciplina, tomando en cuenta la escuela de los factores humanos y la escuela de la ergonomía de la actividad. Se presentan los orígenes de estas escuelas, sus paradigmas subyacentes y se realiza una comparación entre ellas. Las reflexiones presentadas en el artículo en torno a la ergonomía parten de la idea que, desde las diferencias y la diversidad, se erige el desarrollo. Los autores de este artículo son partidarios de abordar la ergonomía como una única disciplina, reconociendo la convergencia y la complementariedad entre las dos escuelas. Más allá de las diferencias existentes, la práctica de la ergonomía debe enfocarse en el diseño de los sistemas de trabajo, tomando como eje central al ser humano. Se espera que estas reflexiones permitan a los profesionales de la ergonomía y de otras diciplinas afines ganar mayor comprensión de cómo abordar la actividad humana para transformarla positivamente.

Abstract Ergonomics is now considered a consolidated scientific discipline that is continually expanding globally. This current scenario is the result of different visions that have permeated the evolution of ergonomics. This article presents a historical overview of ergonomics as a discipline considering human factors and the activity-oriented ergonomics schools. The origins of these two schools of thought on ergonomics and their underlying paradigms are presented, and a comparison between them is made. The reflections presented in the article on ergonomics are based on the idea that progress is built on differences and diversity. The authors of this article support the idea of approaching ergonomics as a single discipline, recognizing the convergence and complementarity between the two schools. Beyond the existing differences, ergonomics' practice should be focused on the design of human-centered work systems. It is hoped that the reflections made in this article will enable professionals in ergonomics and other related disciplines to understand how to approach human at work to transform working conditions positively.

Resumo A ergonomia é considerada, na atualidade, uma disciplina científica consolidada, que se expande continuamente a nível global. Este cenário atual es el resultado de diferentes visões que han permeado la evolución de la ergonomía. Neste artigo se tem uma recorrido histórico da ergonomia como disciplina, tomando na cuenta a escola dos fatores humanos e a escola da ergonomia da atividade. Se presentan los orígenes de estas escuelas, sus paradigmas subyacentes y se una realiza comparación entre ellas. Las reflexiones presentadas en el artículo en torno a la ergonomía parten de la idea that, from las diferencias y la diversidad, se erige el desarrollo. Los autores de este artículo son partidarios de abordar la ergonomía como una única disciplina, reconociendo la convergencia y la complementariedad entre las dos escuelas. Más allá de las diferencias existentes, la práctica de la ergonomía debe enfocarse en el diseño de los sistemas de trabajo, tomando como eje central al ser humano. Se espera que estas reflexiones permitan a los profesionales de la ergonomía y de otras diciplinas afines ganar mayor comprensión de cómo abordar la actividad humana para transformarla positivamente.

Recently Approved and Under Investigation Drugs for Treating Patients with Heart Failure.

Heart Failure (HF) represents a leading cause of morbidity and mortality worldwide. Despite the recent advances in the treatment of this condition, patients´ prognosis remains unfavorable in most cases. Sacubitril/valsartan and ivabradine have been recently approved to improve clinical outcomes in patients with HF with reduced ejection fraction. Drugs under investigation for treating patients with HF encompass many novel mechanisms including vasoactive peptides, blocking inflammatory- mediators, natriuretic peptides, selective non-steroidal mineralocorticoid-receptor antagonists, myocardial ß3 adrenoreceptor agonists, inhibiting the cytochrome C/cardiolipin peroxidase complex, neuregulin-1/ErbB signaling and inhibiting late inward sodium current. The aim of this manuscript is to review the main drugs under investigation for the treatment of patients with HF and give perspectives for their implementation into clinical practice.

Rehabilitación cardiovascular en pacientes con infarto agudo de miocardio con elevación del segmento ST e intervencionismo coronario percutáneo / Cardiac rehabilitation in patients with ST-segment elevation acute myocardial infarction and percutaneous coronary intervention

RESUMEN Introducción: La rehabilitación cardiovascular es beneficiosa en múltiples situaciones clínicas. En pacientes que son tratados mediante intervencionismo coronario es necesario seguir profundizando su estudio. Objetivos: Determinar los efectos de la rehabilitación cardiovascular en pacientes con infarto agudo de miocardio con elevación del segmento ST a quienes se les realizó intervencionismo coronario percutáneo. Método: Estudio cuasi-experimental en 30 pacientes con infarto agudo de miocardio con elevación del ST después de ser tratados con angioplastia coronaria y que se atendieron en el Servicio de Rehabilitación Cardiovascular del Hospital Universitario Celestino Hernández Robau, en el período de septiembre de 2016 a marzo de 2018. Se recolectaron datos clínicos y epidemiológicos, y se analizaron variables ergométricas y ecocardiográficas al inicio y luego de 12 semanas de realizar un programa de rehabilitación cardiovascular. Resultados: Existió un efecto positivo en la frecuencia cardíaca en reposo (66±11 vs. 61±11 latidos/minuto; p=0,008), el tiempo de ejercicio (8,3±2,5 vs. 10,2±2,0 minutos; p<0,0001) y del máximo consumo de oxígeno (24,2±5,0 vs. 27,6±4,9 ml/kg/min; p<0,0001). Existió mejoría de la fracción de eyección y reducción del diámetro del ventrículo izquierdo en diástole, pero sin diferencia estadística significativa. Conclusiones: Existió mejoría en los parámetros ergométricos y ecocardiográficos luego del programa de rehabilitación cardiovascular, que fue más beneficioso en pacientes con hipertensión arterial, hábito de fumar e intervencionismo coronario percutáneo de dos arterias.

ABSTRACT Introduction: Cardiovascular rehabilitation is beneficial in multiple clinical situations. In patients who are treated through percutaneous coronary intervention it is necessary to continue deepening its study. Objectives: To determine the effects of cardiovascular rehabilitation in patients with ST-segment elevation acute myocardial infarction who underwent percutaneous coronary intervention. Method: Quasi-experimental study in 30 patients with ST-segment elevation acute myocardial infarction after being treated with coronary angioplasty, and who were attended at the Department of Cardiovascular Rehabilitation of the Hospital Universitario Celestino Hernández Robau, in the period from September 2016 to March 2018. Clinical and epidemiological data were collected, and ergometric and echocardiographic variables were analyzed before and after 12 weeks of developing a cardiovascular rehabilitation program. Results: There was a positive effect on heart rate at rest (66±11 vs. 61±11 beats/minute; p=0.008), exercise time (8.3±2.5 vs. 10.2±2.0 minutes; p <0.0001) and maximum oxygen consumption (24.2±5.0 vs. 27.6±4.9 ml/kg/min; p<0.0001). There was improvement of the ejection fraction and reduction of the diameter of the left ventricle in diastole left ventricular end diastolic diameter, but without significant statistical difference. Conclusions: There was improvement in the ergometric and echocardiographic parameters after the cardiovascular rehabilitation program, which was more beneficial in patients with high blood pressure, smoking habit and percutaneous coronary intervention of two arteries.

Tpeak-Tend, Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables

Abstract Aim: To characterize the Tpeak-Tend, the Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables. Methods: Cross-sectional study in 126 children between 9 and 12 years of the Camilo Cienfuegos School in Santa Clara, Cuba. Clinical and anthropometric variables were obtained to determine their relationship with electrocardiographic parameters: Tpeak-Tend V5, Tpeak-Tend dispersion and Tpeak-Tend/QT ratio V5. In addition, laboratory tests were conducted. Results: Age and systolic blood pressure are associated with an increased probability of having values of Tpeak-Tend/QT V5 ≥75 percentile for both sexes (OR: 1.72, CI 95%: 1.02-2.91; p= 0.043), (OR: 1.08, CI 95%: 1.01-1.16; p= 0.017) respectively. The body mass index and systolic blood pressure are linearly and significantly correlated with the Tpeak-Tend/QT V5 (r= 0.224; p= 0.012) and (r= 0.220; p= 0.014) respectively. Conclusions: The age of the patients and the systolic blood pressure figures are factors that increase the probability of having values of the Tpeak-Tend/QT V5 ≥75 percentile. There was a significant linear correlation between the Tpeak-Tend/QT V5 with the body mass index and the systolic blood pressure.

Resumen Objetivo: Caracterizar el Tpico-Tfinal, la dispersión del Tpico-Tfinal y el Tpico-Tfinal/QT en niños y su relación con variables clínicas. Métodos: Estudio transversal en 126 niños entre 9 y 12 años de la escuela Camilo Cienfuegos en Santa Clara, Cuba. Se obtuvieron variables clínicas y antropométricas para determinar su relación con los parámetros electrocardiográficos: el Tpico-Tfinal V5, la dispersión del Tpico-Tfinal y el Tpico-Tfinal/QT V5. Además, se realizaron pruebas de laboratorio. Resultados: La edad y la presión arterial sistólica se asocian con una mayor probabilidad de tener valores del Tpico-Tfinal/QT V5 ≥75 percentil para ambos sexos (OR: 1.72, IC 95%: 1.02-2.91; p= 0.043), (OR: 1.08, IC 95%: 1.01-1.16; p= 0.017) respectivamente. El índice de masa corporal y la presión arterial sistólica están correlacionados de manera lineal y significativa con el Tpico-Tfinal/QT V5 (r= 0.224; p= 0.012) y (r= 0.220; p= 0.014) respectivamente. Conclusiones: La edad de los pacientes y las cifras de presión arterial sistólica son factores que aumentan la probabilidad de tener valores del percentil Tpico-Tfinal/QT V5 ≥75. Existe correlación lineal significativa entre el Tpico-Tfinal/QT V5 con el índice de masa corporal y la presión arterial sistólica.

Tpeak-Tend, Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables.

AIM: To characterize the Tpeak-Tend, the Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables. METHODS: Cross-sectional study in 126 children between 9 and 12 years of the Camilo Cienfuegos School in Santa Clara, Cuba. Clinical and anthropometric variables were obtained to determine their relationship with electrocardiographic parameters: Tpeak-Tend V5, Tpeak-Tend dispersion and Tpeak-Tend/QT ratio V5. In addition, laboratory tests were conducted. RESULTS: Age and systolic blood pressure are associated with an increased probability of having values of Tpeak-Tend/QT V5 ≥75 percentile for both sexes (OR: 1.72, CI 95%: 1.02-2.91; p= 0.043), (OR: 1.08, CI 95%: 1.01-1.16; p= 0.017) respectively. The body mass index and systolic blood pressure are linearly and significantly correlated with the Tpeak-Tend/QT V5 (r= 0.224; p= 0.012) and (r= 0.220; p= 0.014) respectively. CONCLUSIONS: The age of the patients and the systolic blood pressure figures are factors that increase the probability of having values of the Tpeak-Tend/QT V5 ≥75 percentile. There was a significant linear correlation between the Tpeak-Tend/QT V5 with the body mass index and the systolic blood pressure.

OBJETIVO: Caracterizar el Tpico-Tfinal, la dispersión del Tpico-Tfinal y el Tpico-Tfinal/QT en niños y su relación con variables clínicas. MÉTODOS: Estudio transversal en 126 niños entre 9 y 12 años de la escuela Camilo Cienfuegos en Santa Clara, Cuba. Se obtuvieron variables clínicas y antropométricas para determinar su relación con los parámetros electrocardiográficos: el Tpico-Tfinal V5, la dispersión del Tpico-Tfinal y el Tpico-Tfinal/QT V5. Además, se realizaron pruebas de laboratorio. RESULTADOS: La edad y la presión arterial sistólica se asocian con una mayor probabilidad de tener valores del Tpico-Tfinal/QT V5 ≥75 percentil para ambos sexos (OR: 1.72, IC 95%: 1.02-2.91; p= 0.043), (OR: 1.08, IC 95%: 1.01-1.16; p= 0.017) respectivamente. El índice de masa corporal y la presión arterial sistólica están correlacionados de manera lineal y significativa con el Tpico-Tfinal/QT V5 (r= 0.224; p= 0.012) y (r= 0.220; p= 0.014) respectivamente. CONCLUSIONES: La edad de los pacientes y las cifras de presión arterial sistólica son factores que aumentan la probabilidad de tener valores del percentil Tpico-Tfinal/QT V5 ≥75. Existe correlación lineal significativa entre el Tpico-Tfinal/QT V5 con el índice de masa corporal y la presión arterial sistólica.

Atrial fibrillation and cryptogenic stroke. What is the current evidence? Role of electrocardiographic monitoring.

The diagnosis of cryptogenic stroke is made by exclusion. However, current evidence supports the role of atrial fibrillation episodes as a cause of this condition. Prospective data have demonstrated the benefits of long-term electrocardiographic monitoring to identify atrial fibrillation in association with cryptogenic stroke. This aim of this article was to analyze the contemporary evidence for the possible relationship between atrial fibrillation and cryptogenic stroke and the role of continuous electrocardiographic monitoring to clarify this hypothesis.

Levels of uric acid and increased diastolic blood pressure: Risk factors for atrial fibrillation in patients older than 60 years.

OBJECTIVE: To characterize the maximum P-wave duration (Pmax) and P-wave dispersion (PWD) according to blood pressure (BP) and uric acid (UA) levels in geriatric patients. METHOD: An analytical study was performed in 83 patients aged over 60 years treated at the Family Medical Office 5 of the Aracelio Rodríguez Castellón Polyclinic, in Cienfuegos, Cuba between January and December 2015. The sample was divided into two groups (patients with hyperuricemia and patients with normal UA levels). RESULTS: We found a linear and significant correlation between diastolic BP and Pmax in patients with hyperuricemia (r=0.695; p=0.026), but not in patients with normal UA (r=0.048; p=0.757). A linear and significant correlation was demonstrated between diastolic BP and PWD in patients with hyperuricemia (r=0.657; p=0.039), but not in patients with normal UA (r=0.054; p=0.730). CONCLUSION: There is correlation between diastolic BP and Pmax plus PWD in elderly patients with hyperuricemia.

Levels of uric acid and increased diastolic blood pressure: Risk factors for atrial fibrillation in patients older than 60 years / Niveles de ácido úrico y presión arterial diastólica elevada: factores de riesgo de fibrilación atrial en pacientes mayores de 60 años

Summary Objective: To characterize the maximum P-wave duration (Pmax) and P-wave dispersion (PWD) according to blood pressure (BP) and uric acid (UA) levels in geriatric patients. Method: An analytical study was performed in 83 patients aged over 60 years treated at the Family Medical Office 5 of the Aracelio Rodríguez Castellón Polyclinic, in Cienfuegos, Cuba between January and December 2015. The sample was divided into two groups (patients with hyperuricemia and patients with normal UA levels). Results: We found a linear and significant correlation between diastolic BP and Pmax in patients with hyperuricemia (r=0.695; p=0.026), but not in patients with normal UA (r=0.048; p=0.757). A linear and significant correlation was demonstrated between diastolic BP and PWD in patients with hyperuricemia (r=0.657; p=0.039), but not in patients with normal UA (r=0.054; p=0.730). Conclusion: There is correlation between diastolic BP and Pmax plus PWD in elderly patients with hyperuricemia.

Resumen Objetivo: Caracterizar la máxima duración de la onda P (Pmáx) y la dispersión de la onda P (DP) según las cifras de tensión arterial (TA) y los niveles de ácido úrico en pacientes geriátricos. Método: Se realizó un estudio analítico en 83 pacientes mayores de 60 años pertenecientes al Consultorio Médico de la Familia 5 del Policlínico Aracelio Rodríguez Castellón, Cienfuegos, Cuba entre enero y diciembre de 2015. La muestra se dividió en dos grupos (pacientes con hiperuricemia y pacientes con AU normal). Resultados: Existe correlación lineal y significativa entre la tensión arterial diastólica y la Pmáx en los pacientes con hiperuricemia (r=0,695; p=0,026), mas no en los pacientes con AU normal (r=0,048; p=0,757). Se demuestra correlación lineal y significativa entre la tensión diastólica y la DP en los pacientes con hiperuricemia (r=0,657; p=0,039), aunque no en los pacientes con AU normal (r=0,054; p=0,730), respectivamente. Conclusión: Existe correlación entre la Pmáx y la DP y las cifras de tensión arterial diastólica en pacientes geriátricos con hiperuricemia.

Razão entre Duração Máxima e Mínima da Onda P (Pmax/Pmin): um Novo Preditor Eletrocardiográfico para Fibrilação Atrial em Pacientes com Infarto Agudo do Miocárdio com Supradesnível do Segmento ST / Ratio between Maximum and Minimum P Wave Duration (MaxPWD/MinPWD Ratio): a New Electrocardiographic Predictor for Atrial Fibrillation in Patients with ST-Elevation Acute Myocardial Infarction

Fundamento: Existem marcadores eletrocardiográficos para predição de fibrilação atrial (FA) na prática clínica, mas não há consenso sobre sua real utilidade. O desenvolvimento de novos marcadores pode ser uma alternativa para melhorar a predição de FA. Este estudo tem o objetivo de demonstrar a utilidade da razão entre a duração máxima e a mínima da onda P (Pmax/Pmin) na predição de FA em pacientes com infarto agudo do miocárdio com supradesnível do segmento ST (IAMCS). Objetivo: Este estudo tem o objetivo de demonstrar a utilidade da razão entre a duração máxima e a mínima da onda P (Pmax/Pmin) na predição de FA em pacientes com infarto agudo do miocárdio com supradesnível do segmento ST (IAMCS). Métodos: Nós estudamos retrospectivamente 108 pacientes com IAMCS admitidos no Hospital Celestino Hernández Robau entre janeiro de 2012 a julho de 2014. Foram calculadas a dispersão da onda P e a razão Pmax/Pmin em pacientes com FA. A sensibilidade e a especificidade da razão Pmax/Pmin para predição de AF foi determinada. A associação entre os valores de glicemia e a razão Pmax/Pmin foi avaliada por correlação linear de Pearson. Resultados: A dispersão da onda P e razão Pmax / Pmin foram maiores nos pacientes com FA que em pacientes sem FA (46,2 ms ± 8,9 ms vs. 38,7 ms ± 9,8 ms; p = 0,019) e (1,89 ± 0,37 vs. 1,65 ± 0,24, p = 0,003). A área sob a curva ROC para o razão Pmax/Pmin foi 0,755; IC 95%: 0,633-0,876; p = 0,006. Existe uma correlação direta entre os valores de glicemia e a razão Pmax/Pmin em pacientes com FA (r = 0,765; p = 0,016), mas não em pacientes sem FA (R = 0,076; p = 0,474). Conclusão: A razão Pmax/Pmin é útil para identificar pacientes em risco de FA durante IAMCS. Há uma associação entre os valores de glicemia e a razão Pmax/Pmin

Background: There are electrocardiographic markers for prediction of atrial fibrillation (AF) in the clinical practice, but there is no consensus on their real utility. The development of new markers may be an alternative to improve AF prediction. This investigation has the aim to demonstrate the utility of MaxPWD/MinPWD ratio for AF prediction in patients with ST-elevation acute myocardial infarction (STEAMI). Objective: The development of new markers may be an alternative to improve AF prediction. This investigation has the aim to demonstrate the utility of MaxPWD/MinPWD ratio for AF prediction in patients with ST-elevation acute myocardial infarction (STEAMI). Methods: We retrospectively studied 108 patients with STEAMI admitted at Celestino Hernández Robau Hospital between January 2012 to July 2014. P wave dispersion and MaxPWD/MinPWD ratio in patients with AF were calculated. Sensibility and specificity of MaxPWD/MinPWD ratio for AF prediction was determined. Pearson linear correlation to determine the association between glycaemia values and MaxPWD/MinPWD ratio was explored. Results: P wave dispersion and MaxPWD/MinPWD ratio were higher in patients with AF compared without AF (46.2 ms ± 8.9 ms vs. 38.7 ms ± 9.8 ms; p = 0.019) and (1.89 ± 0.37 vs. 1.65 ± 0.24, p = 0.003). The area under the ROC curve for the MaxPWD/MinPWD ratio was 0.755; 95% CI: 0.633 to 0.876; p = 0.006. There is a direct correlation between glycaemia values and MaxPWD/MinPWD ratio in patients with AF (r = 0.765; p = 0.016), but not in patients without AF (r = 0.076; p = 0.474). Conclusion: MaxPWD/MinPWD ratio is useful to identify patients at risk for AF during STEAMI. There is association between the glycemic values and MaxPWD/MinPWD ratio

Déficit de la vitamina D e hipertensión arterial. Evidencias a favor / Vitamin D deficiency and hypertension. Supporting evidence

El déficit de la vitamina D se ha relacionado con el aumento en las cifras de la presión arterial. Un incremento en la actividad del sistema renina-angiotensina-aldosterona, la disfunción endotelial, las alteraciones en la homeostasis del calcio, el aumento del estrés oxidativo y la disminución en la síntesis de las prostaglandinas parecen ser los principales mecanismos fisiopatológicos involucrados en los pacientes con déficit de la vitamina D y aumento de la presión arterial. El uso de suplementos de la vitamina D para reducir el riesgo o la progresión de la hipertensión arterial puede ser una alternativa en los pacientes con bajos niveles de esta vitamina. El déficit de la vitamina D se ha relacionado con el fallo de la terapéutica antihipertensiva y debe continuar evaluándose la efectividad del tratamiento hipotensor en pacientes con bajos niveles de este compuesto.

Vitamin D deficiency has been related with a rise in blood pressure values. An increase in renin-angiotensin-aldosterone system activity, endothelial dysfunction, calcium homeostasis modifications, a rise in oxidative stress and reduction in prostaglandins production appear to be the main pathophysiological mechanisms associated in patients with low vitamin D levels and high blood pressure values. The use of supplements of vitamin D for reducing the risk or progression of hypertension could be a choice for patients with low levels of this vitamin. Low levels of vitamin D have been related with a failure in antihypertensive treatment, and further evaluation of efficacy of antihypertensive treatment in patients with low levels of this substance should be continued.

Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice.

Malignant cardiac arrhythmias which result in sudden cardiac death may be present in individuals apparently healthy or be associated with other medical conditions. The way to predict their appearance represents a challenge for the medical community due to the tragic outcomes in most cases. In the last two decades some ventricular repolarization (VR) markers have been found to be useful to predict malignant cardiac arrhythmias in several clinical conditions. The corrected QT, QT dispersion, Tpeak-Tend, Tpeak-Tend dispersion and Tp-e/QT have been studied and implemented in clinical practice for this purpose. These markers are obtained from 12 lead surface electrocardiogram. In this review we discuss how these markers have demonstrated to be effective to predict malignant arrhythmias in medical conditions such as long and short QT syndromes, Brugada syndrome, early repolarization syndrome, acute myocardial ischemia, heart failure, hypertension, diabetes mellitus, obesity and highly trained athletes. Also the main pathophysiological mechanisms that explain the arrhythmogenic predisposition in these diseases and the basis for the VR markers are discussed. However, the same results have not been found in all conditions. Further studies are needed to reach a global consensus in order to incorporate these VR parameters in risk stratification of these patients.

Natriuretic peptides, obesity and cardiovascular diseases.

Obesity, hypertension and heart failure are conditions commonly associated with each other. Recent investigations have demonstrated that low plasmatic levels of natriuretic peptides are linked with obesity. Thus, knowing the actions of these hormones in water and salt homeostasis, it is possible to establish that low levels of natriuretic peptides may be the common denominator among obesity, hypertension and heart failure. Knowledge on this topic is crucial to develop further investigation for definitive conclusions.

Natriuretic peptides, obesity and cardiovascular diseases / Peptídeos natriuréticos, obesidade e doenças cardiovasculares

Obesity, hypertension and heart failure are conditions commonly associated with each other. Recent investigations have demonstrated that low plasmatic levels of natriuretic peptides are linked with obesity. Thus, knowing the actions of these hormones in water and salt homeostasis, it is possible to establish that low levels of natriuretic peptides may be the common denominator among obesity, hypertension and heart failure. Knowledge on this topic is crucial to develop further investigation for definitive conclusions.