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2.
BMJ ; 368: l6794, 2020 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-31941657

RESUMEN

OBJECTIVE: To investigate the impact of modifications to contemporary cancer protocols, which minimize exposures to cardiotoxic treatments and preserve long term health, on serious cardiac outcomes among adult survivors of childhood cancer. DESIGN: Retrospective cohort study. SETTING: 27 institutions participating in the Childhood Cancer Survivor Study. PARTICIPANTS: 23 462 five year survivors (6193 (26.4%) treated in the 1970s, 9363 (39.9%) treated in the 1980s, and 7906 (33.6%) treated in the 1990s) of leukemia, brain cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, renal tumors, neuroblastoma, soft tissue sarcomas, and bone sarcomas diagnosed prior to age 21 years between 1 January 1970 and 31 December 1999. Median age at diagnosis was 6.1 years (range 0-20.9) and 27.7 years (8.2-58.3) at last follow-up. A comparison group of 5057 siblings of cancer survivors were also included. MAIN OUTCOME MEASURES: Cumulative incidence and 95% confidence intervals of reported heart failure, coronary artery disease, valvular heart disease, pericardial disease, and arrhythmias by treatment decade. Events were graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events. Multivariable subdistribution hazard models were used to estimate hazard ratios by decade, and mediation analysis examined risks with and without exposure to cardiotoxic treatments. RESULTS: The 20 year cumulative incidence of heart failure (0.69% for those treated in the 1970s, 0.74% for those treated in the 1980s, 0.54% for those treated in the 1990s) and coronary artery disease (0.38%, 0.24%, 0.19%, respectively), decreased in more recent eras (P<0.01), though not for valvular disease (0.06%, 0.06%, 0.05%), pericardial disease (0.04%, 0.02%, 0.03%), or arrhythmias (0.08%, 0.09%, 0.13%). Compared with survivors with a diagnosis in the 1970s, the risk of heart failure, coronary artery disease, and valvular heart disease decreased in the 1980s and 1990s but only significantly for coronary artery disease (hazard ratio 0.65, 95% confidence interval 0.45 to 0.92 and 0.53, 0.36 to 0.77, respectively). The overall risk of coronary artery disease was attenuated by adjustment for cardiac radiation (0.90, 0.78 to 1.05), particularly among survivors of Hodgkin lymphoma (unadjusted for radiation: 0.77, 0.66 to 0.89; adjusted for radiation: 0.87, 0.69 to 1.10). CONCLUSIONS: Historical reductions in exposure to cardiac radiation have been associated with a reduced risk of coronary artery disease among adult survivors of childhood cancer. Additional follow-up is needed to investigate risk reductions for other cardiac outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT01120353.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Supervivientes de Cáncer/estadística & datos numéricos , Cardiopatías , Neoplasias , Radioterapia , Ajuste de Riesgo , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Cardiotoxicidad , Niño , Estudios de Cohortes , Femenino , Cardiopatías/inducido químicamente , Cardiopatías/clasificación , Cardiopatías/epidemiología , Humanos , Incidencia , Masculino , Neoplasias/clasificación , Neoplasias/tratamiento farmacológico , Neoplasias/epidemiología , Neoplasias/radioterapia , Modelos de Riesgos Proporcionales , Radioterapia/efectos adversos , Radioterapia/métodos , Estudios Retrospectivos , Ajuste de Riesgo/métodos , Ajuste de Riesgo/tendencias , Estados Unidos/epidemiología
3.
Mymensingh Med J ; 29(1): 43-47, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915334

RESUMEN

Hypertension is a major public health challenge to population in socio-economic and epidemiological transition. It is a risk factor for cardiovascular mortality which accounts for 20-50 per cent of all deaths. Hypertension has been recognized among young adults more frequently in recent years. Data regarding hypertension in Bangladesh is often insufficient. The purpose of the study was to find out the risk factors of hypertension in young adults of Bangladesh. The study was conducted among 322 purposively selected young adults aged 20 to 49 years attending in the outpatient department of one public and five private hospitals of Mymensingh and Dhaka division of Bangladesh during the period of January 2018 to December 2018. More than half (54.4%) of the patients were at or below the age of 40 years. Mean age of the patients was 38.7±7.8 years and 58.7% were male. Maximum patients (87.6%) were married and with variable educational and occupational status. More than three fourth of the patients (76.7%) were from urban area whereas 14.3% from rural and 9.0% were from sub-urban area. Family history of hypertension was positive in 86.6% of patients. Blood pressure was categorized according to JNC 7. About half (49.4%) of the patients were stage I hypertensive; 22.4% were stage II hypertensive and 28.3% were pre-hypertensive. The major risk factor was tobacco smoking (46.0%), obesity (29.2%), dyslipidaemia (25.2%), high salt intake 21.8% and use of chewable tobacco (13.7%). Serum creatinine was found raised in 11.5%, cardiomegaly in 2.2% and concentric left ventricular hypertrophy in 18.6% of patients. In 38.5% patients hypertension was complicated affecting heart (27.0%) and kidney (11.5%). Common comorbidities were ischaemic heart diseases (20.5%) and diabetes mellitus (13.4%). Tobacco use, obesity, dyslipidaemia and high salt intake are the major modifiable risk factors found in hypertensive young adults. In addition to medication these factors should be addressed for prevention and effective control of hypertension.


Asunto(s)
Presión Sanguínea/fisiología , Diabetes Mellitus/epidemiología , Cardiopatías/epidemiología , Hipertensión/epidemiología , Adulto , Bangladesh/epidemiología , Comorbilidad , Femenino , Humanos , Hipertensión/diagnóstico , Isquemia/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Población Rural/estadística & datos numéricos , Clase Social , Población Urbana/estadística & datos numéricos , Adulto Joven
4.
Int Heart J ; 60(6): 1253-1258, 2019 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666454

RESUMEN

On March 11, 2011, a great earthquake, known as the Great East Japan Earthquake, hit northeastern Japan, resulting in a tsunami that caused a nuclear disaster, the Fukushima Daiichi Nuclear Power Plant accident, forcing about 160,000 people to evacuate. We, therefore, sought to examine the effects of this evacuation on the onset of cardiovascular diseases and sudden death (SD) in Fukushima Prefecture, three years after the earthquake. We divided the evacuation zone into two areas, whole evacuation zone (Area 1) and partial evacuation zone (Area 2), and we defined the north district of the prefecture as the control area (Area 3). We cross-referenced the death certificate data with data from the Fukushima Prefecture acute myocardial infarction registration survey. For each area, we tallied the number of people who fell into the SD, myocardial infarction (MI), and MI suspected groups. We calculated the age-adjusted incidence rates and analyzed the differences in the adjusted incidence rates across three years using a Poisson regression model. The age-adjusted death rate of the SD group was significantly higher in 2011 in all areas than in 2012 or 2013 (P < 0.05). The total death rate was higher in Area 1 in March 2011, just after the disaster, than in the other two areas. The rate of SD was also higher in Area 1 than in the other areas in March 2011. The incidence of sudden cardiac death might have increased just after the Great East Japan Earthquake in the evacuation area, but not in other areas in Fukushima Prefecture.


Asunto(s)
Muerte Súbita/epidemiología , Terremotos , Accidente Nuclear de Fukushima , Cardiopatías/epidemiología , Tsunamis , Adulto , Anciano , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Distribución de Poisson
5.
Pan Afr Med J ; 33: 156, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31565118

RESUMEN

Cardiac manifestations develop in the majority of patients with systemic lupus erythematosus (SLE) at some time during the course of their disease. This study was designed to assess cardiac abnormalities in patients with SLE by echocardiography and to compare the 2 groups of patients with and without cardiac manifestations. It was a transversal, descriptive study, conducted in the Internal Medicine Department at the Military Hospital of Tunis from January 2016 to June 2018. Eighty lupus patients, diagnosed on the basis of ACR (American college of rheumatology) criteria, were enrolled in the study and were evaluated by standard echocardiography with color Doppler. Out of 80 patients 42 (52%) had abnormal echocardiographic findings. Pericardial effusion was found in 55%, valvular abnormalities in 52% and 38% had pulmonary hypertension. Patients with pleural effusion (45 vs 15%) were more vulnerable to cardiac involvement as well as renal impairment (57 vs 44%). The difference, however, were not statistically significant (p>0.05) in the renal involvement. Active disease with low complement (80%) was associated with higher frequency of cardiac involvement than disease in remission (64%) but the result was not statistically significant (p=0.11). Cardiac abnormalities are very common in lupus patients even when clinically asymptomatic form. Echocardiography is an excellent non-invasive tool for cardiac evaluation. Their research must be systematic with echocardiography in order to reduce subsequent cardiac morbidity and mortality among the lupus patients.


Asunto(s)
Ecocardiografía/métodos , Cardiopatías/diagnóstico por imagen , Lupus Eritematoso Sistémico/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Cardiopatías/epidemiología , Cardiopatías/etiología , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/etiología , Hospitales Militares , Humanos , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/epidemiología , Hipertensión Pulmonar/etiología , Masculino , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/epidemiología , Derrame Pericárdico/etiología , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/epidemiología , Derrame Pleural/etiología , Túnez
6.
Cardiol Clin ; 37(4): 385-397, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31587780

RESUMEN

The advent of immunotherapy, particularly immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy, has ushered in a promising new era of treatment of patients with a variety of malignancies who historically had a poor prognosis. However, these therapies are associated with potentially life-threatening cardiovascular adverse effects. As immunotherapy evolves to include a wider variety of malignancies, risk stratification, prompt recognition, and treatment of cardiotoxicity will become increasingly important and hence cardiologists will need to play a fundamental role in the comprehensive care of these patients. This article reviews cardiotoxicity associated with contemporary immunotherapy and discusses potential management strategies.


Asunto(s)
Cardiopatías/etiología , Inmunidad Celular , Inmunoterapia/efectos adversos , Neoplasias/terapia , Cardiotoxicidad , Salud Global , Cardiopatías/epidemiología , Cardiopatías/inmunología , Humanos , Incidencia
7.
Cardiol Clin ; 37(4): 399-405, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31587781

RESUMEN

Fluoropyrimidines are chemotherapeutic agents that confer great benefit to many patients with solid tumors, but their use is often limited by cardiotoxicity. The incidence and precise mechanisms of cardiotoxicity remain uncertain. Clinical presentations of fluoropyrimidine toxicity are varied and include chest pain, myocardial infarction, acute cardiomyopathy, arrhythmia, cardiogenic shock, and sudden cardiac death. Proposed mechanisms include coronary vasospasm, coronary endothelial dysfunction, direct myocardial toxicity, myocarditis, and Takotsubo cardiomyopathy. Therapeutic and prophylactic interventions primarily target coronary vasospasm as the underlying cause. Prospective studies are needed to develop evidence-based approaches to cardioprotection in patients receiving fluoropyrimidines.


Asunto(s)
Fluorouracilo/efectos adversos , Cardiopatías/inducido químicamente , Neoplasias/tratamiento farmacológico , Antimetabolitos Antineoplásicos/efectos adversos , Cardiotoxicidad , Salud Global , Cardiopatías/epidemiología , Humanos , Incidencia
8.
High Blood Press Cardiovasc Prev ; 26(5): 361-373, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31650516

RESUMEN

High blood pressure (BP) is becoming a growing health issue even in children and adolescents. Moreover, BP elevation in youth frequently translates into children and adult hypertension contributing to the development of cardiovascular disease. The detection of early markers of vascular damage, potentially leading to overt cardiovascular disease, is important for clinical decisions about if and how to treat hypertension and can be useful in monitoring the effectiveness of the treatment. The purpose of this review is to summarize the actual knowledge about subclinical organ damage (SOD) in hypertensive children and adolescents and its association with cardiovascular disease in children and young adults. Our focus is especially put on left ventricular mass, pulse wave velocity, carotid intima-media thickness and microalbuminuria. We also want to address the scientific evidence about possible regression of SOD and cardiovascular risk with the use of behavioural and specific anti-hypertensive therapy. Indications from current guidelines are critically discussed.


Asunto(s)
Albuminuria/epidemiología , Presión Sanguínea , Cardiopatías/epidemiología , Hipertensión/epidemiología , Enfermedades Renales/epidemiología , Enfermedades Vasculares/epidemiología , Adolescente , Factores de Edad , Albuminuria/diagnóstico , Albuminuria/fisiopatología , Enfermedades Asintomáticas , Niño , Femenino , Cardiopatías/diagnóstico , Cardiopatías/fisiopatología , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Enfermedades Renales/diagnóstico , Enfermedades Renales/fisiopatología , Masculino , Factores de Riesgo , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/fisiopatología , Remodelación Vascular , Rigidez Vascular
9.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190016.SUPL.2, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31596387

RESUMEN

OBJECTIVE: To analyze the risk factors associated with the self-reported medical diagnosis of heart disease in Brazil. METHODS: This is a cross-sectional study, analyzing information from 60,202 adult participants of the Brazilian National Health Survey in 2013. Heart disease was defined by self-reported medical diagnosis of heart disease. We analyzed associations between the occurrence of disease and sociodemographic characteristics, health conditions and lifestyle. A hierarchical binary logistic regression model was used. RESULTS: The prevalence of self-reported diagnosis of heart disease in Brazil was 4.2% (confidence interval of 95% [95%CI] 4.0 ‒ 4.3) and was associated with females (odds ratio [OR] = 1.1; 95%CI 1.1 ‒ 1.1), people 65 years old or older (OR = 4.7; 95%CI 3.3 ‒ 5.6), poor or very poor health conditions (OR = 4.1; 95%CI 3.5 ‒ 4.6) and fair health conditions (OR = 2.4; 95%CI 2.2 ‒ 2.7), hypertensive individuals (OR = 2.4; 95%CI 2.2 ‒ 2.7), those with increased cholesterol (OR = 1.6; 95%CI 1.5 ‒ 1.8), overweight individuals (OR = 1.5; 95%CI 1.4 ‒ 1.8) and obese individuals (OR = 2.0; 95%CI 1.7 ‒ 2.2), sedentary behavior (OR = 1.5; 95%CI 1.02 ‒ 2.1), former smokers (OR = 1.4; 95%CI 1.3 ‒ 1.6) or current smokers (OR = 1.2; 95%CI 1.03 ‒ 1.3) and the consumption of fruits and vegetables 5 or more days each week (OR = 1.5; 95%CI 1.1 ‒ 1.5). CONCLUSION: The importance of knowledge on the prevalence of heart disease and associated risk factors in the present Brazilian epidemiological context must be emphasized because it guides actions to control and prevent cardiovascular diseases, the leading cause of death in Brazil and worldwide.


Asunto(s)
Autoevaluación Diagnóstica , Encuestas Epidemiológicas/métodos , Cardiopatías/diagnóstico , Cardiopatías/epidemiología , Autoinforme/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Brasil/epidemiología , Estudios Transversales , Femenino , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Valores de Referencia , Medición de Riesgo , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Adulto Joven
10.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(9): 1130-1133, 2019 Sep 10.
Artículo en Chino | MEDLINE | ID: mdl-31594159

RESUMEN

Objective: To investigate the relationship between maternal disease in early pregnancy of women of childbearing age and congenital heart disease of neonates. Methods: A cross-sectional design was used in this study and stratified multistage random sampling method was used. A questionnaire survey was conducted in the childbearing-aged women during 2010-2013 in Shaanxi province. Propensity score (PS) matched (1∶1) analysis was used to match participants with diseases to those without disease in early pregnancy. Through the control of the confounders step by step, a logistic regression model was established to evaluate the ORs of congenital heart disease according to the independent variable of maternal disease. Results: A total of 28 680 pairs of mothers and infants were included in this study, the proportion of the women with disease in early pregnancy was 20.25% (5 807). After PS matching, 5 436 pairs were matched. After adjusting all confounding factors, the multivariable logistic regression analysis results showed that maternal disease (OR=1.86, 95%CI: 1.23-2.81), especially cold (OR=2.19, 95%CI: 1.46-3.28), gynecological disease (OR=4.74, 95%CI: 2.03-11.09) and diabetes (OR=14.00, 95%CI: 1.64-119.21), in early pregnancy were the risk factors for congenital heart disease of neonate. Conclusion: In women of childbearing age, disease in early pregnancy, especially cold, gynecological disease and diabetes, can increase the risk of congenital heart disease in neonates.


Asunto(s)
Cardiopatías/epidemiología , Madres , Estudios Transversales , Femenino , Cardiopatías/congénito , Humanos , Lactante , Recién Nacido , Embarazo , Factores de Riesgo , Encuestas y Cuestionarios
11.
Medicine (Baltimore) ; 98(39): e16774, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31574793

RESUMEN

BACKGROUND: Total hip arthroplasty (THA) relieves pain and restores function in patients with severe rheumatoid arthritis and osteoarthritis. Over the past few decades, several authors have attempted to assess the efficacy and safety of simultaneous bilateral THA compared with staged bilateral THA. The purpose of this meta-analysis is to compare the mortalities and complications between simultaneous bilateral THA and staged bilateral THA. METHODS: A literature search to identify eligible studies was undertaken to identify all relevant articles published until August 2018. We included studies that compared simultaneous bilateral THA and staged bilateral THA and their effects on mortality and complications. The outcomes included mortality, the occurrence of deep venous thrombosis (DVT), the occurrence of pulmonary embolism (PE), respiratory complications, cardiovascular complications, digestive system complications and the occurrence of dislocation. Stata 12.0 was used for the meta-analysis. RESULTS: Nineteen studies involving 59,257 patients were identified; among them, 16,758 patients were selected for treatment with simultaneous bilateral THA, and 42,499 patients were chosen for the purpose of staged bilateral THA. The meta-analysis results demonstrated that there was no significant difference between simultaneous bilateral THA and staged bilateral THA in terms of mortality (risk ratio [RR] = 1.15, 95% CI = 0.76, 1.74; P = .520). Compared with staged bilateral THA, simultaneous bilateral THA was associated with a reduction in the occurrence of DVT, PE and respiratory complications (P < .05). There were no significant differences in the cardiovascular complications, digestive system complications or the occurrence of dislocation and infection (P = .057). CONCLUSIONS: We observed that the prevalence of DVT, PE and respiratory complications was considerably lower with the use of simultaneous bilateral THA than with the use of staged bilateral THA. Thus, simultaneous bilateral THA is a considerably safer procedure than staged bilateral THA in selected THA patients.


Asunto(s)
Artritis Reumatoide/cirugía , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/epidemiología , Artroplastia de Reemplazo de Cadera/mortalidad , Enfermedades del Sistema Digestivo/epidemiología , Cardiopatías/epidemiología , Humanos , Luxaciones Articulares/epidemiología , Prevalencia , Embolia Pulmonar/epidemiología , Trastornos Respiratorios/epidemiología , Trombosis de la Vena/epidemiología
12.
Artículo en Alemán | MEDLINE | ID: mdl-31529181

RESUMEN

Trends of frequent chronic diseases and health problems, e.g. allergic diseases, have already been published based on the KiGGS Wave 2 study as part of the health monitoring of children and adolescents in Germany. The present work complements these findings with results on less frequent noncommunicable diseases and the trend of communicable, vaccine-preventable diseases.Information from parents about diagnoses and diseases of their 0­ to 17-year-old children from the representative cross-sectional survey KiGGS Wave 2 (2014-2017) are compared with those from the KiGGS baseline survey (2003-2006) and KiGGS Wave 1 (2009-2012).The current KiGGS results show almost unchanged prevalences for the noncommunicable diseases epilepsy, migraine, and heart disease. However, the data from KiGGS Wave 2 are supportive of an increased prevalence of diabetes mellitus, which nevertheless continues to be relatively rare and predominantly type 1 diabetes in children and adolescents.The decline in measles, chicken pox, and whooping cough diseases related to changes in vaccination recommendations shows that preventive measures can effectively benefit children and adolescents.However, the data on vaccine-preventable diseases indicate regionally varying immunity gaps in certain age groups, so the prevention potential of the vaccination recommendations of the Standing Vaccination Commission (STIKO) at the Robert Koch Institute does not seem to have been sufficiently exploited.


Asunto(s)
Salud del Adolescente/estadística & datos numéricos , Enfermedad Crónica/epidemiología , Virosis/epidemiología , Adolescente , Varicela/epidemiología , Niño , Preescolar , Estudios Transversales , Epilepsia/epidemiología , Alemania/epidemiología , Encuestas Epidemiológicas , Cardiopatías/epidemiología , Humanos , Lactante , Recién Nacido , Sarampión/epidemiología , Trastornos Migrañosos/epidemiología , Convulsiones Febriles/epidemiología , Tos Ferina/epidemiología
13.
West J Emerg Med ; 20(5): 810-817, 2019 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-31539339

RESUMEN

INTRODUCTION: Sudden cardiac death is a rare cause of death in young athletes. Current screening techniques include history and physical exam (H and P), with or without an electrocardiogram (ECG). Adding point of care cardiac ultrasound has demonstrated benefits, but there is limited data about implementing this technology. We evaluated the feasibility of adding ultrasound to preparticipation screening for collegiate athletes. METHODS: We prospectively enrolled 42 collegiate athletes randomly selected from several sports. All athletes were screened using a 14-point H and P based on 2014 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, ECG, and cardiac ultrasound. RESULTS: We screened 11 female and 31 male athletes. On ultrasound, male athletes demonstrated significantly larger interventricular septal wall thickness (p = 0.002), posterior wall thickness (p <0.001) and aortic root breadth (p = 0.002) compared to females. Based on H and P and ECGs alone and a combination of H and P with ECG, no athletes demonstrated a positive screening for cardiac abnormalities. However, with combined H and P, ECG, and cardiac ultrasound, one athlete demonstrated positive findings. CONCLUSIONS: We believe that adding point of care ultrasound to the preparticipation exam of college athletes is feasible. This workflow may provide a model for athletic departments' screening.


Asunto(s)
Atletas , Muerte Súbita Cardíaca/prevención & control , Cardiopatías/diagnóstico , Tamizaje Masivo/métodos , Sociedades , Estudiantes , Universidades , Adolescente , Muerte Súbita Cardíaca/epidemiología , Ecocardiografía , Electrocardiografía , Femenino , Cardiopatías/epidemiología , Humanos , Incidencia , Masculino , Deportes , Estados Unidos/epidemiología , Adulto Joven
14.
Nutrients ; 11(9)2019 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-31527417

RESUMEN

There is a wealth of research lauding the benefits of exercise to oppose cardiometabolic disease such as diabetes, CVD and hypertension. However, in the great majority of these studies, the nutritional context (energy balance, deficit, or surplus) has been ignored, despite its profound effect on responses to both exercise and inactivity. Even a minor energy deficit or surplus can strongly modulate the magnitude and duration of the metabolic responses to an intervention; therefore, failure to account for this important confounding variable obscures clear interpretation of the results from studies of exercise or inactivity. The aim of this review is to highlight key lessons from studies examining the interaction between exercise and sedentary behavior, energy status, and glucose and insulin regulation. In addition to identifying notable problems, we suggest a few potential solutions.


Asunto(s)
Ingestión de Energía , Metabolismo Energético , Ejercicio , Estilo de Vida Saludable , Cardiopatías/prevención & control , Enfermedades Metabólicas/prevención & control , Estado Nutricional , Conducta de Reducción del Riesgo , Conducta Sedentaria , Animales , Biomarcadores/sangre , Glucemia/metabolismo , Cardiopatías/epidemiología , Cardiopatías/metabolismo , Cardiopatías/fisiopatología , Humanos , Insulina/sangre , Resistencia a la Insulina , Enfermedades Metabólicas/epidemiología , Enfermedades Metabólicas/metabolismo , Enfermedades Metabólicas/fisiopatología , Factores Protectores , Factores de Riesgo
15.
BMC Pregnancy Childbirth ; 19(1): 325, 2019 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-31484509

RESUMEN

BACKGROUND: Women with cardiac disease are thought to be at increased risk of post-partum haemorrhage. We sought to assess the estimated blood loss (EBL) in our cohort of women with and without cardiac disease (CD) in a quaternary hospital in the UK. Our population consisted of both congenital and acquired CD; and low risk women who delivered in our unit between 01/01/2012-30/09/2016. METHODS: Data were collected using computerised hospital records. CD was classified according to the modified WHO classification (mWHO). The primary outcome measure was estimated blood loss (mL). RESULTS: A total of 5413 women with a singleton fetus in the cephalic presentation delivered during the study period (159 women with CD and 5254 controls). In the CD group, active management of the third stage of labour was consistent with that used in low risk women in 98% (152/155) of cases. Multivariable analyses demonstrated no significant difference in EBL between women with CD vs controls. The adjusted average blood losses were 247.2 ml, 241.8 ml and 295.9 ml in the control group, mWHO 1-2 and 3-4, respectively (p = 0.165). CONCLUSIONS: Women with CD have comparable EBL to low risk women when management of the active third stage of labour is the same.


Asunto(s)
Cardiopatías/epidemiología , Oxitócicos/uso terapéutico , Oxitocina/uso terapéutico , Hemorragia Posparto/prevención & control , Complicaciones Cardiovasculares del Embarazo/epidemiología , Adulto , Estudios de Casos y Controles , Cesárea , Estudios de Cohortes , Parto Obstétrico , Femenino , Humanos , Tercer Periodo del Trabajo de Parto , Análisis Multivariante , Embarazo , Estudios Retrospectivos , Reino Unido/epidemiología , Adulto Joven
16.
Int Heart J ; 60(5): 1106-1112, 2019 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-31484874

RESUMEN

A useful biomarker for detecting cardiac amyloidosis (CA) has not been fully established. We aimed to investigate the utility of several biomarkers to detect CA in patients with amyloid light-chain (AL) amyloidosis.We examined the plasma levels of B-type natriuretic peptide (BNP), N-terminal fragment of the pro-brain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), serum amyloid A, and the difference between kappa and lambda free light chain (dFLC) between CA patients (n = 30, 47.6%) and non-CA patients (n = 33, 52.4%). Levels of BNP were significantly higher in the CA group compared to the non-CA group (1200.0 versus 224.0 pg/mL, P = 0.001). From the ROC analysis, the sensitivity and specificity of BNP for detecting CA (with a cut-off value of 412 pg/mL) were 83% and 70%, respectively, and the area under the receiver operating curve was 0.75 (95% CI 0.61-0.90, P < 0.001) in all AL amyloidosis patients (n = 63). In contrast, other markers such as NT-proBNP, hs-cTnT, serum amyloid A, and dFLC were not useful for detecting CA in AL amyloidosis patients. Additionally, in the Cox proportional hazard analysis, BNP was a predictor of all-cause mortality (hazard ratio 3.266, 95% confidence interval 1.498-7.119, P = 0.003).BNP is a useful biomarker for detecting cardiac involvement and predicting prognosis in AL amyloidosis patients.


Asunto(s)
Cardiopatías/sangre , Cardiopatías/epidemiología , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/sangre , Péptido Natriurético Encefálico/sangre , Troponina T/sangre , Anciano , Biomarcadores/sangre , Causas de Muerte , Estudios de Cohortes , Progresión de la Enfermedad , Ecocardiografía Doppler/métodos , Electrocardiografía/métodos , Femenino , Cardiopatías/diagnóstico por imagen , Hospitales Universitarios , Humanos , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/fisiopatología , Japón , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia
17.
Pan Afr Med J ; 33: 114, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31489092

RESUMEN

Introduction: Sudden death that occurs during sporting activity affects patients with ignored heart disease. Black athlete's ECG has been little studied and the features of this ethnic group have been discussed. This study aims to study the epidemiological profile and the peculiarities of repolarization of black athletes. Methods: We conducted a descriptive study of black athletes selected among all the athletes followed in the sectoral Center of Sports Science and Medicine in Sousse over a period of 8 months from March to October 2014. Data were collected using a medical questionnaire. Results: Data on 35 athletes were collected, with a male predominance (94,28%), with an average age of 24,34 years. Four athletes had left ventricular hypertrophy on cardiac ultrasound. There were 8 athletes with atrioventricular block degree I and 8 athletes with electrical type of left ventricular hypertrophy (LVH). ST segment changes were more marked at the level of precordial leads. Five athletes (14.2%) had inverted T waves in V2 and V3. These were the same athletes who ST-segment depression in these same leads. Early repolarization was found in 3 athletes. All these cases had notch signaling. Conclusion: Black athletes have quite specific electrical modifications which are important to know. However, our sample is not sufficiently large to certify these results. A comparative study of white athletes would be very interesting.


Asunto(s)
Arritmias Cardíacas/diagnóstico , Atletas , Cardiopatías/diagnóstico , Hipertrofia Ventricular Izquierda/diagnóstico , Adolescente , Adulto , Grupo de Ascendencia Continental Africana , Arritmias Cardíacas/epidemiología , Bloqueo Atrioventricular/diagnóstico , Bloqueo Atrioventricular/epidemiología , Muerte Súbita/prevención & control , Ecocardiografía , Electrocardiografía/métodos , Femenino , Cardiopatías/epidemiología , Humanos , Hipertrofia Ventricular Izquierda/epidemiología , Masculino , Estudios Retrospectivos , Deportes , Encuestas y Cuestionarios , Adulto Joven
18.
Urology ; 133: 121-128, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31377255

RESUMEN

OBJECTIVE: To determine whether the association between male infertility and incident cardiometabolic disease is modified by socioeconomics, race, or geographic region. MATERIALS AND METHOD: Retrospective review of data from insurance claims from Optum's de-identified Clinformatics Data Mart Database. Subjects were men, 18-50 years old, with an associated diagnosis of infertility in the United States between 2003 and 2016. Analytical sample were men captured by the Optum's de-identified Clinformatics Data Mart Database with an associated diagnosis of infertility. Men were classified as either infertile, or not, based on diagnosis or procedural codes. Cardiometabolic health outcomes were then assessed using current procedural terminology codes for diabetes, hypertension, hyperlipidemia, and heart disease. Confounding factors were controlled for such as race, education, socioecomonic status, and region. The main outcomes were development of diabetes, hypertension, hyperlipidemia, and heart disease. RESULTS: A total of 76,343 males were diagnosed with male factor infertility, 60,072 males who underwent fertility testing, and 183,742 males that underwent vasectomy (control population). For all men, infertile men had a higher risk of incident hypertension, diabetes, hyperlipidemia, and heart disease when compared to those undergoing vasectomy. Identical associations were found across all education, income, racial, and geographic strata. CONCLUSION: Our study suggests that men with infertility have a higher risk of cardiometabolic disease in the years following a fertility evaluation regardless of race, region, or socioeconomic status.


Asunto(s)
Cardiopatías/epidemiología , Infertilidad Masculina/complicaciones , Enfermedades Metabólicas/epidemiología , Adolescente , Adulto , Demografía , Cardiopatías/etiología , Humanos , Incidencia , Masculino , Enfermedades Metabólicas/etiología , Persona de Mediana Edad , Estudios Retrospectivos , Factores Socioeconómicos , Estados Unidos , Adulto Joven
19.
Res Vet Sci ; 126: 51-58, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31437776

RESUMEN

Cardiopulmonary nematodes are among the most pathogenic parasites of domestic and wild canids. The aim of this study was to describe the species diversity, prevalence and infection intensity of these parasites in the Iberian wolf (Canis lupus signatus) and the red fox (Vulpes vulpes) in the northwest of the Iberian Peninsula. 257 foxes and 74 wolves were necropsied between 2008 and 2014. Four nematode species were identified: Angiostrongylus vasorum, Eucoleus aerophilus, Crenosoma vulpis and Filaroides hirthi. This last species was only found in wolves, being the first time that is cited worldwide in this wild canid. The overall parasite prevalence was significantly higher in foxes (70%) than in wolves (28%). Specifically, prevalences in foxes and wolves were, respectively, 43% and 22% for A. vasorum, 33% and 5% for E. aerophilus, and 30% and 9% for C. vulpis. The prevalence of F. hirthi was 16%. The A. vasorum intensity was significantly higher in foxes than in wolves. Differences between host species in the risk of infection would be associated to diverging feeding behavior, and possibly reflects a parasite-host adaptation related to host's hunting strategies and cardiorespiratory requirements. This study revealed an association between infection and environmental factors, and highlighted a wide variation in the spatial distribution of A. vasorum. Our results indicate that cardiopulmonary parasites are widespread in wild canids in northwest Spain, and further agrees with other studies indicating the expansion of A. vasorum in Europe and, therefore, the urgent need to investigate infection in dogs in sympatric areas.


Asunto(s)
Zorros/parasitología , Cardiopatías/veterinaria , Enfermedades Pulmonares Parasitarias/veterinaria , Infecciones por Nematodos/veterinaria , Lobos/parasitología , Angiostrongylus , Animales , Animales Salvajes , Corazón/parasitología , Cardiopatías/epidemiología , Cardiopatías/parasitología , Enfermedades Pulmonares Parasitarias/epidemiología , Enfermedades Pulmonares Parasitarias/parasitología , Metastrongyloidea , Infecciones por Nematodos/epidemiología , Infecciones por Nematodos/parasitología , Prevalencia , España/epidemiología
20.
Pediatrics ; 144(2)2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31366685

RESUMEN

Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients' management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model's feasibility, acceptability, and efficacy.


Asunto(s)
Cardiopatías/terapia , Unidades de Cuidados Intensivos/organización & administración , Cuidados Paliativos/métodos , Cuidados Paliativos/organización & administración , Niño , Cuidados Críticos/métodos , Cuidados Críticos/organización & administración , Cardiopatías/diagnóstico , Cardiopatías/epidemiología , Humanos , Lactante
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