Health need assessment in an indigenous high-altitude population living on an island in Lake Titicaca, Perú.

BACKGROUND: Health needs and access to health care is a huge challenge in developing countries, especially in some isolated indigenous communities. Amantani is an island located at 3854 m above sea level in Lake Titicaca, Peru. There is no official date on key local health needs and determinants, which precludes the prioritization and efficient implementation of health interventions. The objective of this study is to validate a health need assessment tool and ascertain the main health needs of the indigenous high-altitude population living on Amantani. METHODS: We conducted a cross-sectional study to describe the health needs of the indigenous population of Amantani using a questionnaire based on the "Peruvian Demographic and Health Survey". The questionnaire underwent expert and field-work validation. We selected a random sample of the island residents using two-stage cluster sampling. We estimated the prevalence of key health needs and determinants, and evaluated their distribution by age, sex and education through prevalence ratio. All analyses accounted for the complex sampling design. RESULTS: We surveyed 337 individuals (223 adults and 144 children) in 151 houses. The most frequent health needs were: (i) lack of access to medical screening for a)non-communicable diseases (> 63.0%) and b)eye problems (76.5%); and (ii) poor knowledge about communicable diseases (> 54.3%), cancer (71.4%) and contraception (> 32.9%). Smoking and alcohol use was more frequent in males (PR = 4.70 IC95%:1.41-15.63 and PR = 1.69 95% CI:1.27-2.25, respectively). People with higher education had more knowledge about TB/HIV and cancer prevention (p < 0.05). Regarding children's health, > 38% have never undergone eye or dental examination. Corporal punishment and physical bullying at school in the last month were relatively common (23 and 33%, respectively). CONCLUSION: The main health needs in Amantani are related to poor healthcare access and lack of awareness of disease prevention. Our findings can be used to develop and implement efficient health interventions to improve the health and quality of life of indigenous populations living in the islands in Southern Peru/Northern Bolivia.

Plagiarism, Cheating and Research Integrity: Case Studies from a Masters Program in Peru.

Plagiarism is a serious, yet widespread type of research misconduct, and is often neglected in developing countries. Despite its far-reaching implications, plagiarism is poorly acknowledged and discussed in the academic setting, and insufficient evidence exists in Latin America and developing countries to inform the development of preventive strategies. In this context, we present a longitudinal case study of seven instances of plagiarism and cheating arising in four consecutive classes (2011-2014) of an Epidemiology Masters program in Lima, Peru, and describes the implementation and outcomes of a multifaceted, "zero-tolerance" policy aimed at introducing research integrity. Two cases involved cheating in graded assignments, and five cases correspond to plagiarism in the thesis protocol. Cases revealed poor awareness of high tolerance to plagiarism, poor academic performance, and widespread writing deficiencies, compensated with patchwriting and copy-pasting. Depending on the events' severity, penalties included course failure (6/7) and separation from the program (3/7). Students at fault did not engage in further plagiarism. Between 2011 and 2013, the Masters program sequentially introduced a preventive policy consisting of: (i) intensified research integrity and scientific writing education, (ii) a stepwise, cumulative writing process; (iii) honor codes; (iv) active search for plagiarism in all academic products; and (v) a "zero-tolerance" policy in response to documented cases. No cases were detected in 2014. In conclusion, plagiarism seems to be widespread in resource-limited settings and a greater response with educational and zero-tolerance components is needed to prevent it.

Unstable Malaria Transmission in the Southern Peruvian Amazon and Its Association with Gold Mining, Madre de Dios, 2001-2012.

The reemergence of malaria in the last decade in Madre de Dios, southern Peruvian Amazon basin, was accompanied by ecological, political, and socioeconomic changes related to the proliferation of illegal gold mining. We conducted a secondary analysis of passive malaria surveillance data reported by the health networks in Madre de Dios between 2001 and 2012. We calculated the number of cases of malaria by year, geographic location, intensity of illegal mining activities, and proximity of health facilities to the Peru-Brazil Interoceanic Highway. During 2001-2012, 203,773 febrile cases were identified in Madre de Dios, of which 30,811 (15.1%) were confirmed cases of malaria; all but 10 cases were due to Plasmodium vivax Cases of malaria rose rapidly between 2004 and 2007, reached 4,469 cases in 2005, and then declined after 2010 to pre-2004 levels. Health facilities located in areas of intense illegal gold mining reported 30-fold more cases than those in non-mining areas (ratio = 31.54, 95% confidence interval [CI] = 19.28, 51.60). Finally, health facilities located > 1 km from the Interoceanic Highway reported significantly more cases than health facilities within this distance (ratio = 16.20, 95% CI = 8.25, 31.80). Transmission of malaria in Madre de Dios is unstable, geographically heterogeneous, and strongly associated with illegal gold mining. These findings highlight the importance of spatially oriented interventions to control malaria in Madre de Dios, as well as the need for research on malaria transmission in illegal gold mining camps.

Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients.

Autonomic dysfunction is common in Chagas disease and diabetes. Patients with either condition complicated by cardiac autonomic dysfunction face increased mortality, but no clinical predictors of autonomic dysfunction exist. Pupillary light reflexes (PLRs) may identify such patients early, allowing for intensified treatment. To evaluate the significance of PLRs, adults were recruited from the outpatient endocrine, cardiology, and surgical clinics at a Bolivian teaching hospital. After testing for Chagas disease and diabetes, participants completed conventional autonomic testing (CAT) evaluating their cardiovascular responses to Valsalva, deep breathing, and orthostatic changes. PLRs were measured using specially designed goggles, then CAT and PLRs were compared as measures of autonomic dysfunction. This study analyzed 163 adults, including 96 with Chagas disease, 35 patients with diabetes, and 32 controls. PLRs were not significantly different between Chagas disease patients and controls. Patients with diabetes had longer latency to onset of pupil constriction, slower maximum constriction velocities, and smaller orthostatic ratios than nonpatients with diabetes. PLRs correlated poorly with CAT results. A PLR-based clinical risk score demonstrated a 2.27-fold increased likelihood of diabetes complicated by autonomic dysfunction compared with the combination of blood tests, CAT, and PLRs (sensitivity 87.9%, specificity 61.3%). PLRs represent a promising tool for evaluating subclinical neuropathy in patients with diabetes without symptomatic autonomic dysfunction. Pupillometry does not have a role in the evaluation of Chagas disease patients.

Beta-cell function and insulin resistance among Peruvian adolescents with type 2 diabetes.

OBJECTIVE: To characterize and compare the beta-cell function and insulin resistance among Peruvian adolescents with type 2 diabetes (T2D) and their non-diabetic, overweight and lean peers. METHODS: Cross-sectional study of 54 adolescents aged 10-19 years, distributed in three sex- and age-matched groups (n = 18): (i) adolescents with T2D; (ii) overweight adolescents without T2D; and (iii) lean adolescents without T2D, at the Diabetes, Obesity and Nutrition Research Center in Lima, Peru. Fasting glucose, insulin, C-peptide, and glycated hemoglobin were measured for all participants. In addition, a two-hour oral glucose tolerance test (OGTT, 1.75 mg of glucose/kg body weight) was performed, during which glucose and C-peptide were quantified. The homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-B) were derived for all participants, and beta-cell function was further examined by the area under the curve (AUC) of C-peptide. RESULTS: The median HOMA-IR score was higher in adolescents with T2D compared to lean adolescents (6.1 vs. 2.1; p = 0.002), but was not different from that of overweight adolescents (6.1 vs. 4.0; p = 0.322). The median HOMA-B was higher in overweight adolescents than in lean adolescents (256.9 vs. 134.2; p = 0.015), and adolescents with T2D (256.9 vs. 119.8; p = 0.011). The mean AUC of glucose in adolescents with T2D was 1.8-fold higher than that of overweight adolescents, and 1.9-fold higher than that of lean adolescents (p < 0.001). Although the median AUC of C-peptide in adolescents with T2D was lower than that of overweight and lean adolescents, this difference was not statistically significant (230.7 vs. 336.6 vs. 267.3 nmol/l120 min, respectively; p = 0.215). CONCLUSION: Among Peruvian adolescents with T2D, insulin resistance is the most prominent characteristic, rather than beta-cell dysfunction.

Outbreak of Cutaneous Leishmaniasis in Peruvian Military Personnel Undertaking Training Activities in the Amazon Basin, 2010.

Military personnel deployed to the Amazon Basin are at high risk for cutaneous leishmaniasis (CL). We responded to an outbreak among Peruvian Army personnel returning from short-term training in the Amazon, conducting active case detection, lesion sample collection, and risk factor assessment. The attack rate was 25% (76/303); the incubation period was 2-36 weeks (median = 8). Most cases had one lesion (66%), primarily ulcerative (49%), and in the legs (57%). Real-time polymerase chain reaction (PCR) identified Leishmania (Viannia) braziliensis (59/61 = 97%) and L. (V.) guyanensis (2/61 = 3%). Being male (risk ratio [RR] = 4.01; P = 0.034), not wearing long-sleeve clothes (RR = 1.71; P = 0.005), and sleeping in open rooms (RR = 1.80; P = 0.009) were associated with CL. Sodium stibogluconate therapy had a 41% cure rate, less than previously reported in Peru (~70%; P < 0.001). After emphasizing pre-deployment education and other basic prevention measures, trainees in the following year had lower incidence (1/278 = 0.4%; P < 0.001). Basic prevention can reduce CL risk in deployed militaries.

Social capital and chronic post-traumatic stress disorder among survivors of the 2007 earthquake in Pisco, Peru.

This study aimed to evaluate the association between chronic Post-Traumatic Stress Disorder (PTSD) and both structural and cognitive social capital in adult survivors of the 2007 earthquake in Pisco, Peru. Cognitive social capital measures trust, sense of belonging and interpersonal relationships in the community and structural social capital measures group membership, support from community groups and individuals, and involvement in citizenship activities. We conducted a population-based cross-sectional study in five counties in Pisco, selecting 1012 adults through complex, multi-stage random sampling. All participants completed socio-demographic questions and validated Spanish-language versions of the Adapted Social Capital Assessment Tool (SASCAT) and the civilian PTSD checklist (PCL-C). After performing descriptive and bivariate analyses, we carried out prevalence ratio (PR) regression. The overall prevalence of chronic PTSD was 15.9% (95% CI: 12.3, 19.8), much higher than anticipated based on existing evidence. Cognitive social capital was found to be negatively associated with chronic PTSD, while no significant association was found for structural social capital. Specifically, those with high cognitive social capital had an almost two times lower prevalence of chronic PTSD (PR = 1.83, 95% CI: 1.50, 2.22) compared with those with low cognitive social capital. No independent association between structural social capital and chronic PTSD was found (PR = 1.44, 95% CI: 0.70, 2.97). In conclusion, cognitive social capital, but not structural social capital, has a protective influence on the occurrence of chronic PTSD in survivors of natural disasters. These results may have public health implications. For example, pre- and post-disaster community-based interventions that catalyze and foster dimensions of cognitive social capital may aid in ameliorating the effect of earthquakes and other natural disasters on populations with high vulnerability to such events and poor access to mental health and other support services.

Changes in tuberculin skin test positivity over 20 years in periurban shantytowns in Lima, Peru.

A cross-sectional, community-based study was performed in 2012 with 428 residents of periurban shantytowns in Lima, Peru to study risk factors for and changes in latent tuberculosis infection in age-stratified groups compared with our data from the same region in 1990 (N = 219) and 2005 (N = 103). Tuberculin skin test positivity in these communities was highly prevalent at 52% overall, increased with age (P < 0.01) and was similar to 2005 (53%) and 1990 (48%). From 1990 to 2012, the prevalence of tuberculin positivity decreased in 5-14 and 15-24 year old groups (to 17% and 34%, respectively, both P < 0.05). However, this may be explained by cessation of Bacille Calmette-Guérin revaccination during this period, because Bacille Calmette-Guérin revaccination doubled tuberculin positivity. Over the same 22-year period, tuberculin positivity in the ≥ 25 year old group remained high (71%, P = 0.3), suggesting that prevalent latent tuberculosis infection persists in the adult population despite improving medical care and socioeconomic development in this region.

Autoevaluación de habilidades investigativas e intención de dedicarse a la investigación en estudiantes de primer año de medicina de una universidad privada en Lima, Perú / Self-assessment of research skills and intention to pursue a career in research among, first year medical students from a private university in Lima, Peru

Objetivo: Determinar el número de habilidades auto-percibidas relacionadas a la investigación biomédica y la proporción de alumnos interesados en dedicar su carrera a la investigación, e identificar los factores asociados a este interés en estudiantes de medicina del primer año de una universidad privada de Lima, Perú. Material y métodos: Se realizó un estudio transversal analítico en estudiantes de medicina del primer año de la Universidad Peruana Cayetano Heredia, matriculados en el 2011. Se usó un cuestionario auto-aplicado, anónimo, validado por expertos y previamente probado, se preguntó sobre las habilidades para la investigación que los alumnos consideraban tener y la intención de dedicar su carrera a la investigación. Resultados: La proporción de respuesta fue del 100% (143 estudiantes). La mediana del número de habilidades auto-percibidas fue de 2,0 (de 7,0 posibles), siendo las habilidades menos frecuentes el análisis estadístico y el cálculo del tamaño de muestra. El 71,2% de los alumnos reportó tener la intención de dedicarse a la investigación como carrera. Luego de ajustar por el sexo, la edad, la modalidad de ingreso y el desarrollo de investigación escolar, las características asociadas a dicha intención fueron la edad y el planear involucrarse en investigación tardíamente en la carrera. Conclusiones: Aunque el nivel de habilidades auto-percibidas para la investigación en estudiantes de medicina del primer año es limitado; ellos poseen un interés significativo por dedicarse a la investigación, constituyendo una potencial fuente de recursos humanos.

Objective: To determine de number of self-perceived skills related to biomedical research and the proportion of students interested in devoting his career to research and identify the factors associated to such interest in first year medical students of a private university in Lima, Peru. Methods: We conducted a cross-sectional analytic study in first-year medical students of Universidad Peruana Cayetano Heredia, enrolled in 2011. We used a self applied, anonymous, questionnaire, which was previously tested and validated by experts, to assess the number of self-reported research-related skills, and the intention to pursue a research-oriented career. Results: The response proportion was 100% (143 students). The median number of self perceived skills was 2.0 (7.0 possible). Statistical analysis and sample size calculation were the less frequent skills reported. The 71.2% of students reported intending to pursue research as a career. After adjusting for gender, age, admission modality and development of research at school, student characteristics associated to such intention included a greater age and the plan to involve in research late in their career. Conclusions: Although self-perceived level of skills for research in first year medical students is limited, they have a significant interest in engaging in research, constituting a potential source of human resources.

Determinants of burnout in acute and critical care military nursing personnel: a cross-sectional study from Peru.

BACKGROUND: Evidence on the prevalence and determinants of burnout among military acute and critical care nursing personnel from developing countries is minimal, precluding the development of effective preventive measures for this high-risk occupational group. In this context, we aimed to examine the association between the dimensions of burnout and selected socio-demographic and occupational factors in military acute/critical care nursing personnel from Lima, Peru. METHODS AND FINDINGS: We conducted a cross-sectional study in 93 nurses/nurse assistants from the acute and critical care departments of a large, national reference, military hospital in Lima, Peru, using a socio-demographic/occupational questionnaire and a validated Spanish translation of the Maslach Burnout Inventory. Total scores for each of the burnout dimensions were calculated for each participant. Higher emotional exhaustion and depersonalisation scores, and lower personal achievement scores, implied a higher degree of burnout. We used linear regression to evaluate the association between each of the burnout dimensions and selected socio-demographic and occupational characteristics, after adjusting for potential confounders. The associations of the burnout dimensions were heterogeneous for the different socio-demographic and occupational factors. Higher emotional exhaustion scores were independently associated with having children (p<0.05) and inversely associated with the time working in the current department (p<0.05). Higher depersonalization scores were independently associated with being single compared with being divorced, separated or widowed (p<0.01), working in the emergency room/intensive care unit compared with the recovery room (p<0.01), and inversely associated with age (p<0.05). Finally, higher personal achievement scores were independently associated with having children (p<0.05). CONCLUSION: Among Peruvian military acute and critical care nursing personnel, potential screening and preventive interventions should focus on younger/less experienced nurses/nurse assistants, who are single, have children, or work in the most acute critical care areas (e.g. the emergency room/intensive care unit).

Safety and predictors of complications with a new accelerated dobutamine stress echocardiography protocol.

BACKGROUND: This study sought to document the safety of a new accelerated dobutamine-atropine stress echocardiography protocol and to analyze its complications. METHODS: Dobutamine-atropine stress echocardiography studies were performed using an incremental dobutamine infusion protocol from 20 to 40 microg/kg/min in 3-minute stages and followed by atropine. RESULTS: A total of 962 patients were included. Mean age was 64 +/- 11 years and 584 were male (61%). Mean ejection fraction was 62 +/- 10%. Complications included hypertensive responses in 66 patients (7%), arrhythmias in 26 (2.7%), and symptomatic hypotension in 16 (1.7%). No patient developed heart failure, acute myocardial infarction, ventricular fibrillation, or died. The independent predictors of hypertensive responses were age, baseline systolic blood pressure, and treatment with nitrates. The independent predictors of arrhythmias were history of hypertension, previous coronary artery disease, and baseline heart rate. CONCLUSIONS: This accelerated dobutamine-atropine stress echocardiography protocol is safe in a low-risk population and has a rate of complications similar to that reported for the standard protocol.

[Prognostic value of tumor necrosis factor-alpha in patients with ST-segment elevation acute myocardial infarction]. / Valor pronóstico del factor de necrosis tumoral alfa en pacientes con infarto agudo de miocardio con elevación del segmento ST.

INTRODUCTION AND OBJECTIVES: Tumor necrosis factor-alpha (TNFalpha in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the prognostic value of TNFalpha in this clinical setting at six-month follow-up. METHODS: The levels of TNFalpha, C-reactive protein (CRP), interleukin 6 and type 1 soluble intercellular adhesion molecules measured within the first 10 h of symptom onset and at 48 h in 74 consecutive patients admitted with STEMI. The relationships between these levels and the incidence of ischemic events (i.e., angina, reinfarction, and death), heart failure (HF), or both (i.e., all cardiovascular events) were studied. RESULTS: Overall, TNFalpha levels were significantly higher in patients who had an ischemic event or HF than in those who did not (P<.02 for both). At 48 h, the adjusted odds ratios of those in the highest TNFalpha quartile (2.92 pg/mL) for the development of ischemic events, HF, and all cardiovascular events combined were 13.1, 9.59 and 9.75, respectively. A TNFalpha level of 2.04 pg/mL at 48 h had a sensitivity of 78% and a specificity of 72.5% in predicting a cardiovascular event of any form. The CRP level, but not the TNFalpha level, at admission was found to be an independent predictor of the development of a cardiovascular events. CONCLUSIONS: In patients with STEMI, the plasma TNFalpha level 48 h after symptom onset and the CRP level at admission were independent predictors of cardiovascular events.

Valor pronóstico del factor de necrosis tumoral alfa en pacientes con infarto agudo de miocardio con elevación del segmento ST / Prognostic value of tumor necrosis factor-alpha in patients with ST-segment elevation acute myocardial infarction

Introducción y objetivos. Entre la variedad de procesos inflamatorios que implican al factor de necrosis tumoral alfa (TNFα), se encuentra la enfermedad cardiovascular. Su valor pronóstico en el infarto agudo de miocardio con elevación del segmento ST (IAMEST) es poco conocido. Este estudio trata de determinar el valor pronóstico del TNFα en este marco clínico tras 6 meses de seguimiento. Métodos. Se midieron las concentraciones de TNFα, proteína C-reactiva (PCR), interleucina 6 y moléculas solubles de adhesión celular tipo 1 en las primeras 10 h tras el inicio de los síntomas y tras 48 h en 74 pacientes con IAMEST. Se correlacionaron sus valores con la incidencia de eventos isquémicos (angina, reinfarto y muerte), insuficiencia cardiaca o ambos (eventos cardiovasculares). Resultados. Los valores de TNFα fueron significativamente mayores en pacientes con eventos isquémicos o insuficiencia cardiaca que en aquellos sin eventos (p < 0,02 para todos). A las 48 h, las odds ratio (OR) ajustadas para el último cuartil de TNFα (2,92 pg/ml) eran OR = 13,1; OR = 9,59 y OR = 9,75 para el desarrollo de eventos isquémicos, insuficiencia cardiaca y eventos cardiovasculares combinados, respectivamente. La concentración de TNFα a las 48 h de 2,04 pg/ml tuvo una sensibilidad del 78% y una especificidad del 72,5% en la predicción conjunta de dichos eventos. Al ingreso, la PCR, pero no el TNFα, mostró valor predictivo independiente en el desarrollo de eventos cardiovasculares. Conclusiones. En pacientes con IAMEST, la concentración plasmática de TNFα a las 48 h y la PCR al ingreso son predictores independientes de eventos cardiovasculares (AU)

Introduction and objectives. Tumor necrosis factor-alpha (TNF-alpha) is implicated in a variety of inflammatory processes, including cardiovascular disease. Little is known about the prognostic value of TNF-alpha in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the prognostic value of TNF-alpha in this clinical setting at six-month follow-up. Methods. The levels of TNF-alpha, C-reactive protein (CRP), interleukin 6 and type 1 soluble intercellular adhesion molecules measured within the first 10 h of symptom onset and at 48 h in 74 consecutive patients admitted with STEMI. The relationships between these levels and the incidence of ischemic events (i.e., angina, reinfarction, and death), heart failure (HF), or both (i.e., all cardiovascular events) were studied. Results. Overall, TNF-alpha levels were significantly higher in patients who had an ischemic event or HF than in those who did not (P<.02 for both). At 48 h, the adjusted odds ratios of those in the highest TNF-alpha quartile (2.92 pg/mL) for the development of ischemic events, HF, and all cardiovascular events combined were 13.1, 9.59 and 9.75, respectively. A TNF-alpha level of 2.04 pg/mL at 48 h had a sensitivity of 78% and a specificity of 72.5% in predicting a cardiovascular event of any form. The CRP level, but not the TNF-alpha level, at admission was found to be an independent predictor of the development of a cardiovascular events. Conclusions. In patients with STEMI, the plasma TNF-alpha level 48 h after symptom onset and the CRP level at admission were independent predictors of cardiovascular events (AU)

[Assessment of left atrial wall velocities by pulsed wave tissue Doppler imaging. A new approach to the study of atrial function]. / Evaluación de las velocidades de pared de la aurícula izquierda mediante Doppler pulsado tisular. Una nueva aproximación al estudio de la función auricular.

INTRODUCTION AND OBJECTIVES: To analyze the profile of left atrial wall velocities by pulsed wave tissue Doppler imaging, and to compare the relationship between these observations and the transmitral and pulmonary vein flow velocities obtained by conventional pulsed Doppler echocardiography. PATIENTS AND METHOD: We studied 90 patients (50 women and 40 men, mean age 48 [22] years). Pulsed tissue Doppler images of the left atrial wall were obtained and analyzed in all subjects. The study population was then divided in two groups: group I (age < 45 years) and group II (age > 45 years). Transmitral and pulmonary vein flow velocity tracings were obtained simultaneously by pulsed Doppler echocardiography. RESULTS: With pulsed tissue Doppler interrogation of the left atrial wall, a triphasic signal was recorded in all patients, consisting of a positive wave (A1) followed by two negative waves (A2 and A3). Younger subjects (group I) showed a pattern with a prominent A2 wave and an A2/A3 ratio > 1. In older patients (group II) peak velocity of the A2 wave diminished and peak velocity of the A3 wave increased, so that the A2/A3 ratio was < 1. We found no differences in peak velocity of the A1 wave between the two age groups (13.5 (3.9) cm/s in group I vs 13.1 (5.4) cm/s in group II; P = .59). Significant concordance was observed between the transmitral flow pattern and the left atrial pulsed tissue Doppler tracing (kappa = 0.584; P < .0001). CONCLUSIONS: Evaluation of the left atrial wall using pulsed tissue Doppler imaging is feasible and reproducible. Tissue Doppler imaging provides new quantitative insights of potential use in the assessment of left atrial function.

[Effect of the early administration of pravastatin on C-reactive protein and interleukin-6 levels in the acute phase of myocardial infarction with ST segment elevation]. / Efecto de la administración precoz de pravastatina en los valores de proteína C reactiva y de interleucina 6 en la fase aguda del infarto de miocardio con elevación del segmento ST.

INTRODUCTION AND OBJECTIVES: C-reactive protein (CRP), whose synthesis in the liver is regulated by interleukin 6 (IL-6), is related with the prognosis for ischemic heart disease. The aim of this study was to evaluate the effect of early administration of pravastatin on plasma levels of CRP and IL-6 in patients with acute myocardial infarction and ST segment elevation. PATIENTS AND METHOD: 71 patients were randomized during the first 10 hours from the onset of symptoms to receive 40 mg of pravastatin once a day or not. CRP and IL-6 were measured on admission, 48 hours and 7 days later. CRP was also measured 2 months later. RESULTS: On admission, levels of CRP and IL-6 were similar in both groups. After 7 days of treatment the administration of pravastatin was associated with a lower level of CRP (P=.002). Mean and median CRP levels decreased from 48 hours to day 7 by 48.4% and 51.9% respectively in the pravastatin group, and by 32.5% and 15.9% respectively in the control group. In contrast, no significant differences in IL-6 levels were observed between the two groups. After 2 months of follow-up, 50% of the treated patients and 25% of the control patients had CRP levels lower than 6.6 mg/L (P=.039). CONCLUSIONS: Early administration of pravastatin in the acute phase of myocardial infarction with ST segment elevation was associated with a lower level of CRP after 7 days of treatment, with no concomitant changes in IL-6 levels.

[Predictors of myocardial contractile reserve in patients with nonischemic dilated cardiomyopathy. An echo-stress dobutamine study]. / Predictores de reserva contráctil miocárdica en pacientes con miocardiopatía dilatada no isquémica. Estudio mediante ecocardiografía de estrés con dobutamina.

INTRODUCTION AND OBJECTIVES: Myocardial contractile reserve studies with low-dose dobutamine echocardiography have been shown to be useful to assess functional myocardial status. However, the variables associated with contractile reserve after inotropic stimulation are not well known. PATIENTS AND METHOD: We studied 50 patients (35 men, mean age 56.4 +/- 9.5 years) with nonischemic dilated cardiomyopathy (NIDC), LVEF 28.7% +/- 8.5% and wall motion score index (WMSI) 2.42 +/- 0.34 with low-dose dobutamine echocardiography. Left ventricular contractile reserve was assessed by a differential parameter defined as the difference between rest and stress WMSI (DeltaWMSI). RESULTS: After dobutamine infusion the WMSI was 1.95 +/- 0.58; from this value we calculated a DeltaWMSI of 0.45 +/- 0.39. None of the clinical variables showed a relationship with the presence of contractile reserve. In contrast, the following echocardiographic parameters correlated with DeltaWMSI: end-diastolic (p=0.05) and end-systolic (p=0.02) diameters, end-systolic volume index (p=0.01) and LVEF (p=0.002). In the multivariate analysis, only end-diastolic diameter was an independent predictor of contractile reserve (hazard ratio=0.852; 95% CI, 0.735-0.987; p=0.03). CONCLUSIONS: Ventricular diameters, end-systolic volume index and LVEF are related with improvements in myocardial contractility after dobutamine infusion, although only end-diastolic diameter was an independent predictor of contractile reserve. Thus, this parameter should receive particular attention in evaluations of the functional status of the myocardium in patients with NIDC.

Predictores de reserva contráctil miocárdica en pacientes con miocardiopatía dilatada no isquémica. Estudio mediante ecocardiografía de estrés con dobutamina / Predictors of myocardial contractile reserve in patients with nonischemic dilated cardiomyopathy. An echo-stress dobutamine study

Introducción y objetivos. Los estudios de reserva contráctil con dobutamina han demostrado su utilidad en la valoración del estado funcional del miocardio. Sin embargo, no se conocen bien las variables asociadas a la presencia de reserva contráctil tras la estimulación inotrópica. Pacientes y método. Con este fin, estudiamos a 50 pacientes (35 varones con una edad de 56,4 ñ 9,5 años) con miocardiopatía dilatada no isquémica (MDNI), fracción de eyección (FE) de 28,7 ñ 8,5 por ciento e índice de motilidad parietal (IMP) de 2,42 ñ 0,34, a los que se realizó una ecocardiografía de estrés con dobutamina a dosis bajas. Se evaluó la respuesta contráctil mediante un parámetro diferencial obtenido de restar del índice de motilidad parietal basal el obtenido al pico del estrés ( IMP).Resultados. Tras la dobutamina se obtuvo un IMP pico de 1,95 ñ 0,58, pudiéndose calcular un IMP medio de 0,45 ñ 0,39. Ninguna variable clínica ni electrocardiográfica mostró relación con la presencia de reserva contráctil. Por el contrario, los diámetros telediastólico (p = 0,05) y telesistólico (p = 0,02), el índice de volumen telesistólico (p = 0,01) y la FE (p = 0,002) se asociaron con la presencia de reserva contráctil. En el análisis multivariable, únicamente el diámetro telediastólico se asoció de forma independiente con el grado de reserva contráctil (OR = 0,852; IC del 95 por ciento, 0,735-0,987; p = 0,03).Conclusiones. Los diámetros ventriculares, el volumen telesistólico y la FE se relacionan con la mejoría de la contractilidad miocárdica tras la infusión de dobutamina, aunque únicamente el diámetro telediastólico es predictor independiente de la presencia de reserva contráctil. Por ello, este parámetro debe ser especialmente considerado a la hora de evaluar el estado funcional del miocardio en pacientes con MDNI (AU)