Headache and Other Factors Modifying Cerebrospinal Fluid Opening Pressure in Pediatric Patients.

Cerebrospinal fluid opening pressure values are associated with various neurologic diseases; however, numerous factors can modify this measurement. This study aims to describe factors related to modifications in opening pressure measurements in pediatric patients. Methods: A retrospective analysis of lumbar punctures in pediatric patients conducted by the neuropediatrics group with institutional standardization. Bivariate and linear regression analyses were performed to determine the association between opening pressure and variables included in the study. Results: 544 events, median age 107 months, median opening pressure 19.7 cm H2O. Bivariate analysis found no association with medication use; anesthetics that increased opening pressure were remifentanil (P = .02) and propofol (P = .05), along with a positive linear correlation between opening pressure and age (P < .0001). Multiple linear regression analysis revealed that age, BMI, male gender, and remifentanil use were associated with an increase in opening pressure, whereas corticosteroid withdrawal was associated with a reduction in opening pressure. There is an interaction between age and headache, with an association with increased opening pressure up to around 140 months. Conclusion: This study identifies factors associated with changes in opening pressure, crucial for estimating normal opening pressure values in children. Headaches, anesthetic use, and corticosteroid withdrawal are confirmed as significant factors.

Detection of inflammasome activation in liver tissue during the donation process as potential biomarker for liver transplantation.

Deceased donor liver transplantation (LT) is a crucial lifesaving option for patients with end-stage liver diseases. Although donation after brain death (DBD) remains the main source of donated organs, exploration of donation after circulatory death (DCD) addresses donor scarcity but introduces challenges due to warm ischemia. While technical advances have improved outcomes, challenges persist, with a 13% mortality rate within the first year. Delving into liver transplantation complexities reveals the profound impact of molecular signaling on organ fate. NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome activation play a pivotal role, influencing inflammatory responses. The NLRP3 inflammasome, found in hepatocytes, contributes to inflammation, fibrosis, and liver cell death. This study explores these dynamics, shedding light on potential biomarkers and therapeutic targets. Samples from 36 liver transplant patients were analyzed for ASC specks detection and inflammasome-related gene expression. Liver biopsies, obtained before and after cold ischemia storage, were processed for immunofluorescence, qRT-PCR, and Western blot. One year post-LT clinical follow-up included diagnostic procedures for complications, and global survival was assessed. Immunofluorescence detected activated inflammasome complexes in fixed liver tissues. ASC specks were identified in hepatocytes, showing a trend toward more specks in DCD livers. Likewise, inflammasome-related gene expression analysis indicated higher expression in DCD livers, decreasing after cold ischemia. Similar results were found at protein level. Patients with increased ASC specks staining exhibited lower overall survival rates, correlating with IL1B expression after cold ischemia. Although preliminary, these findings offer novel insights into utilizing direct detection of inflammasome activation in liver tissue as a biomarker. They suggest its potential impact on post-transplant outcomes, potentially paving the way for improved diagnostic approaches and personalized treatment strategies in LT.

Cell-specific Extracellular Vesicles and Their miRNA Cargo Released Into the Organ Preservation Solution During Cold Ischemia Storage as Biomarkers for Liver Transplant Outcomes.

BACKGROUND: Liver transplantation (LT) is crucial for end-stage liver disease patients, but organ shortages persist. Donation after circulatory death (DCD) aims to broaden the donor pool but presents challenges. Complications like acute rejection, hepatic artery thrombosis, and biliary issues still impact posttransplant prognosis. Biomarkers, including extracellular vesicles (EVs) and microRNAs (miRNAs), show promise in understanding and monitoring posttransplant events. This study explores the role of EVs and their miRNA cargo in LT, including their potential as diagnostic tools. METHODS: EVs from intrahepatic end-ischemic organ preservation solution (eiOPS) in 79 donated livers were detected using different techniques (nanosight tracking analysis, transmission electron microscopy, and flow cytometry). EV-derived miRNAs were identified by quantitative real time-polymerase chain reaction. Bioinformatics analysis was performed using the R platform. RESULTS: Different-sized and origin-specific EVs were found in eiOPS, with significantly higher concentrations in DCD compared with donation after brain death organs. Additionally, several EV-associated miRNAs, including let-7d-5p, miR-28-5p, miR-200a-3p, miR-200b-3p, miR-200c-3p, and miR-429, were overexpressed in DCD-derived eiOPS. These miRNAs also exhibited differential expression patterns in liver tissue biopsies. Pathway analysis revealed enrichment in signaling pathways involved in extracellular matrix organization and various cellular processes. Moreover, specific EVs and miRNAs correlated with clinical outcomes, including survival and early allograft dysfunction. A predictive model combining biomarkers and clinical variables showed promise in acute rejection detection after LT. CONCLUSIONS: These findings provide new insights into the use of EVs and miRNAs as biomarkers and their possible influence on posttransplantation outcomes, potentially contributing to improved diagnostic approaches and personalized treatment strategies in LT.

Operational tolerance research in liver transplantation: a bibliometric analysis using a new web resource.

Background: Operational tolerance in liver transplantation (OT-LT), defined as the graft survival with normal function in absence of immunosuppression, has been a field of intense research since the 1980s. Thereafter, tens of clinical trials and hundreds of articles have been published, making it challenging for researchers to assimilate all the information, more so outside of their disciplines. The aim of the present study was to analyze the research in OT-LT through a new web tool (https://tolerance.imib.es). Methods: We have developed a web resource that allowed the identification of the present trends and potential research avenues in OL-LT, an overview biomedical terms that were most often cited, including which journals published the most articles, and an advanced search engine that exploited all the information in these publications. Results: A total of 734 studies were analyzed until November 2023, with a mean of 15 articles published per year, a total sum of 3,751 impact factor points and a total of 26,542 citations. The analysis of citations allowed us to establish a ranking of the most prolific countries, authors, journals and institutions, in addition to the most influential publications in OT-LT. Likewise, keyword and co-occurrence analyses answered which themes involving OT-LT are the most popular, whereas cooperation analysis showed that principal authors in OT-LT form a network, although the lack of international cooperation, especially with regard to clinical trials, appears to be one of the main challenges. Conclusion: Despite its limitations, our web tool will allow both OT-LT expert and novel researchers to be able to draw a comprehensive picture of the past, present and future of OT-LT research.

Dietary antioxidant intake reduces carotid intima-media thickness in coronary heart disease patients: From the CORDIOPREV study.

BACKGROUND: Atherosclerosis is the leading underlying cause of coronary heart disease (CHD). In patients with CHD, intima-media thickness of common carotid arteries (IMT-CC) is a reliable, validated, and non-invasive marker of the progression of atherosclerosis. Dietary intervention may affect IMT-CC evolution through different pathways. There is a lack of clinical trials evaluating the effect of total dietary antioxidant content of diets on IMT-CC, especially in patients with CHD. OBJECTIVE: We evaluated the correlation between the diet's total antioxidant content and the changes in IMT-CC produced after 5 years of dietary intervention following two healthy diet models (Mediterranean diet and low-fat diet). We also evaluated whether the diet's total antioxidant content was related to the total redox capacity of the participants. METHODS: From the total participants of the CORDIOPREV study (clinical trial register NCT00924937), 805 participants completed the IMT-CC measurement and the dietary antioxidant evaluation at baseline and after 5 years of dietary intervention. IMT-CC was carried out by ultrasound and the dietary antioxidant evaluation was performed by the Dietary Antioxidant Index (DAI). Additionally, direct redox balance was evaluated in a subset of population by the ratio of reduced glutathione (GSH) to oxidized glutathione (GSSH) by colorimetric assay. RESULTS: We observed an inverse correlation between evolution of DAI and IMT-CC after 5-years of dietary intervention. The mean of the DAI index augmented in the Mediterranean Diet group, whereas it decreased in the Low-fat group. DAI was correlated to the GSH/GSSG ratio, supporting DAI as an adequate estimator of diet's antioxidant content. When looking for individual components of the DAI that were associated to the changes in IMT-CC, an inverse correlation was found for carotenoids, vitamin E, vitamin C, and zinc and the IMT-CC. CONCLUSIONS: Our study indicates that, after five years of dietary intervention, changes in DAI inversely correlate with changes in IMT-CC in patients with CHD. Overall effect of Mediterranean diet resulted in an increase of DAI, conversely to low-fat. Specific elements included in the DAI index were inversely correlated with IMT-CC.

Two-Year Changes in Physical Activity and Concurrent Changes in Cognitive Function in a Cohort of Adults with Metabolic Syndrome.

BACKGROUND: It has been proposed that physical activity (PA) could prevent cognitive decline. OBJECTIVE: To evaluate the association between changes in PA and changes in cognitive function in a cohort of adults with metabolic syndrome. METHODS: Longitudinal observational study including 5,500 adults (mean age 65 years, SD = 5; women = 49.3% ) with metabolic syndrome. Participants underwent physical activity measurements and cognitive evaluation at baseline and at two-years of follow-up. PA was quantified using the Minnesota questionnaire-shortened version. Cognitive function was evaluated using a battery of tests: Mini-Mental Test Examination, Clock Drawing Test, Trail Making Test A and B, Verbal Fluency Test, and Digit Span. The primary outcome was two-year change in cognition, measured through the Global Composite Score (GCS) of all neuropsychological tests. Multivariable-adjusted linear regression models were fitted with baseline PA and their changes as the main exposures and changes in cognitive function as the outcome. RESULTS: No significant association was found between PA levels (or their changes) in the GCS of cognitive function. A greater increase in PA levels was associated with a more favorable two-year change in the Trail Making Test A (Q4 versus Q1: b = - 2.24s, 95% CI -4.36 to -0.12s; p-trend = 0.020). No significant association was found for other neuropsychological test. CONCLUSION: Our results do not support an association between increases in PA and the evolution of the global cognitive function at two-year in an intervention trial which included PA promotion in one of its two randomized arms, but they suggested a possible beneficial effect of PA on attentional function in older adults.

Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial.

BACKGROUND: Mediterranean and low-fat diets are effective in the primary prevention of cardiovascular disease. We did a long-term randomised trial to compare the effects of these two diets in secondary prevention of cardiovascular disease. METHODS: The CORDIOPREV study was a single-centre, randomised clinical trial done at the Reina Sofia University Hospital in Córdoba, Spain. Patients with established coronary heart disease (aged 20-75 years) were randomly assigned in a 1:1 ratio by the Andalusian School of Public Health to receive a Mediterranean diet or a low-fat diet intervention, with a follow-up of 7 years. Clinical investigators (physicians, investigators, and clinical endpoint committee members) were masked to treatment assignment; participants were not. A team of dietitians did the dietary interventions. The primary outcome (assessed by intention to treat) was a composite of major cardiovascular events, including myocardial infarction, revascularisation, ischaemic stroke, peripheral artery disease, and cardiovascular death. This study is registered with ClinicalTrials.gov, NCT00924937. FINDINGS: From Oct 1, 2009, to Feb 28, 2012, a total of 1002 patients were enrolled, 500 (49·9%) in the low-fat diet group and 502 (50·1%) in the Mediterranean diet group. The mean age was 59·5 years (SD 8·7) and 827 (82·5%) of 1002 patients were men. The primary endpoint occurred in 198 participants: 87 in the Mediterranean diet group and 111 in the low-fat group (crude rate per 1000 person-years: 28·1 [95% CI 27·9-28·3] in the Mediterranean diet group vs 37·7 [37·5-37·9] in the low-fat group, log-rank p=0·039). Multivariable-adjusted hazard ratios (HRs) of the different models ranged from 0·719 (95% CI 0·541-0·957) to 0·753 (0·568-0·998) in favour of the Mediterranean diet. These effects were more evident in men, with primary endpoints occurring in 67 (16·2%) of 414 men in the Mediterranean diet group versus 94 (22·8%) of 413 men in the low-fat diet group (multiadjusted HR 0·669 [95% CI 0·489-0·915], log-rank p=0·013), than in 175 women for whom no difference was found between groups. INTERPRETATION: In secondary prevention, the Mediterranean diet was superior to the low-fat diet in preventing major cardiovascular events. Our results are relevant to clinical practice, supporting the use of the Mediterranean diet in secondary prevention. FUNDING: Fundacion Patrimonio Comunal Olivarero; Fundacion Centro para la Excelencia en Investigacion sobre Aceite de Oliva y Salud; local, regional, and national Spanish Governments; European Union.

Vulnerabilidad cardiometabólica por adiposidad corporal e índices aterogénicos en el posparto a corto plazo

RESUMEN Introducción: Acumulaciones excesivas de tejido adiposo constituyen una amenaza para la salud cardiometabólica, el estudio en la mujer orientaría mejor sobre su estado metabólico. Objetivo: Identificar asociaciones entre estados de vulnerabilidad cardiometabólica e índices aterogénicos en el posparto a corto plazo. Método: Se realizó un estudio observacional descriptivo, entre enero 2017 y agosto 2018, en 119 mujeres en el posparto a corto plazo, a partir de una población de 773 gestantes de peso adecuado y aparentemente sanas al momento de la captación, clasificadas por su vulnerabilidad cardiometabólica por adiposidad corporal en el Policlínico Chiqui Gómez Lubián, entre enero 2012 y diciembre 2016. Se estudió la asociación de la vulnerabilidad cardiometabólica con los índices aterogénicos: Castelli, Kannel y la relación TG/HDLc. Se aplicó la prueba de Kruskal-Wallis para la comparación de muestras independientes. Resultados: Los índices Castelli (3,37), Kannel (2,02) y TG/HDLc (0,71) tuvieron valores medios más bajos en las mujeres sin vulnerabilidad. Los índices Castelli (4,20) y Kannel (2,69) mostraron valores más elevados en mujeres con vulnerabilidad global extrema por adiposidad general alta y central alta. El índice TG/HDLc (1,18) tuvo los valores más elevados en mujeres con vulnerabilidad global por adiposidad general intermedia y central alta. Conclusiones: Los valores de los índices aterogénicos estudiados en el posparto a corto plazo estuvieron asociados con la vulnerabilidad cardiometabólica, con cifras más elevadas en mujeres con adiposidad general intermedia y alta, y adiposidad central alta. La vulnerabilidad cardiometabólica por adiposidad corporal en el posparto a corto plazo, puede alertar sobre alteraciones metabólicas aterogénicas, como riesgo cardiovascular.

ABSTRACT Introduction: Excessive accumulations of adipose tissue are a threat to cardiometabolic health; their assessment in women would better inform about their metabolic state. Objective: To identify associations between cardiometabolic vulnerability states and atherogenic indices in the short-term postpartum period. Method: A descriptive observational study was conducted from January 2017 to August 2018 on 119 women in short-term postpartum. The study population consisted of 773 pregnant women with adequate weight and apparently healthy at the time of recruitment, who were classified based on their cardiometabolic vulnerability due to body adiposity at the Policlínico Chiqui Gómez Lubián, between January 2012 and December 2016. The association of cardiometabolic vulnerability with the atherogenic indices was studied: Castelli, Kannel and the TG/HDLc ratio. The Kruskal-Wallis test was applied to compare independent samples. Results: The Castelli (3.37), Kannel (2.02) and TG/HDL (0.71) indices showed lower mean values in women without vulnerability. The Castelli (4.20) and Kannel (2.69) indices showed higher values in women with extreme global vulnerability due to high overall adiposity and high central adiposity. The TG/HDLc index (1.18) reached the highest values in women with global vulnerability due to intermediate and high central overall adiposity. Conclusions: The values of the atherogenic indices studied in the short-term postpartum period were associated with cardiometabolic vulnerability, with higher figures in women with intermediate and high general adiposity, and high central adiposity. Cardiometabolic vulnerability due to body adiposity in the short-term postpartum period may alert about atherogenic metabolic disorders, such as cardiovascular risk.

Biological senescence risk score. A practical tool to predict biological senescence status.

BACKGROUND: Ageing and biological senescence, both related to cardiovascular disease, are mediated by oxidative stress and inflammation. We aim to develop a predictive tool to evaluate the degree of biological senescence in coronary patients. METHODS: Relative telomere length (RTL) of 1002 coronary patients from the CORDIOPREV study (NCT00924937) was determined at baseline in addition to markers of inflammatory response (hs-C-Reactive Protein, monocyte chemoattractant protein-1, IL-6, IL-1ß, TNF-α, adiponectin, resistin and leptin) and oxidative stress (nitric oxide, lipid peroxidation products, carbonylated proteins, catalase, total glutathione, reduced glutathione, oxidized glutathione, superoxide dismutase and peroxidated glutathione). Biological senescence was defined using the cut-off value defined by the lower quintile of relative telomere length in our population (RTL = 0.7629). We generated and tested different predictive models based on logistic regression analysis to identify biological senescence. Three models were designed to be used with different sets of information. RESULTS: We selected those patients with all the variables proposed to develop the predictive models (n = 353). Statistically significant differences between both groups (Biological senescence vs. Nonbiological senescence) were found for total cholesterol, catalase, superoxide dismutase, IL-1ß, resistin and leptin. The area under the curve of receiver-operating characteristic to predict biological senescence for our models was 0.65, 0.75 and 0.72. CONCLUSIONS: These predictive models allow us to calculate the degree of biological senescence in coronary patients, identifying a subgroup of patients at higher risk and who may require more intensive treatment.

Resultados de la terapia con ondas de choque extracorpórea de baja intensidad en pacientes con angina refractaria / Results of low intensity extracorporeal shock wave therapy in patients with refractory angina

RESUMEN Introducción: La terapia con ondas de choque extracorpórea de baja intensidad ha demostrado ser útil en el tratamiento de los pacientes con angina de pecho refractaria. Objetivo: Valorar los resultados de este tipo de terapia en pacientes con angina refractaria al tratamiento farmacológico. Método: Se realizó un estudio cuasiexperimental en 30 pacientes con angina de pecho refractaria a tratamiento, seleccionados de forma no probabilística a partir de los criterios de inclusión. A todos los pacientes se les aplicó terapia con ondas de choque extracorpórea de baja intensidad en el Cardiocentro Ernesto Guevara de Santa Clara, en el período comprendido de enero a diciembre de 2017. Se analizaron variables epidemiológicas, clínicas y ecocardiográficas al inicio del tratamiento y 6 meses después de concluido este. Resultados: Los resultados obtenidos demostraron una mejoría de la clase funcional (CF) de la Canadian Cardiovascular Society (CCS). Previo al tratamiento el 76,7% de los pacientes tenían una CF III y un 23,3% una CF IV, y a los 6 meses de concluida la terapia el 73,3% mejoró a la CF II y solo un 26,7% quedó en CF III. También se evidenció mejoría con respecto a parámetros ecocardiográficos como la motilidad regional y la fracción de eyección del ventrículo izquierdo, la cual, en los hombres, de una media al inicio de la terapia de un 37,81% alcanzó 44,14% a los 6 meses de concluida; y en las mujeres, de una media de 37,11% inicial llegó a 47,22% a los 6 meses después. Conclusiones: El tratamiento con ondas de choque constituye una alterativa terapéutica para los pacientes con angina refractaria.

ABSTRACT Introduction: Low intensity extracorporeal shock wave therapy has proven useful in the treatment of patients with refractory angina pectoris. Objective: To assess the results of this type of therapy in patients with refractory angina to drug treatment. Method: A quasi-experimental study was carried out in 30 patients with refractory angina pectoris to treatment, selected in a non-probabilistic way, taking into account the following inclusion criteria. All patients were applied low intensity extracorporeal shock wave therapy in the Cardiocentro Ernesto Guevara of Santa Clara, in the period from January to December 2017. Epidemiological, clinical and echocardiographic variables were analyzed at the beginning of the treatment and six months after it was completed. Results: The results obtained demonstrated an improvement of the functional class (FC) of the Canadian Cardiovascular Society (CCS). Previous to treatment, 76.7% of patients had a FC III and 23.3% a FC IV, and after six months of completed therapy, 73.3% improved to FC II and only 26.7 % remained in FC III. There was also an improvement with respect to echocardiographic parameters such as regional motility and left ventricular ejection fraction, which, in men, of an average at the start of therapy of 37.81% it reached 44.14% at six months of completed; and in women, of an average of 37.11% initially, it reached 47.22 % six months later. Conclusions: The treatment with shock waves represents a therapeutic alternative for patients with refractory angina.

Long-term consumption of a Mediterranean diet improves postprandial lipemia in patients with type 2 diabetes: the Cordioprev randomized trial.

Background: Patients with type 2 diabetes (T2D) have an elevated postprandial lipemia (PPL) that has been associated with increased cardiovascular risk. Objective: We aimed to analyze whether the long-term consumption of 2 healthy dietary patterns is associated with an improvement in PPL and remnant cholesterol (RC) concentrations in patients with T2D. Design: We selected patients from the Cordioprev study who underwent oral fat load tests (FLTs) at baseline and the 3-y follow-up (241 patients with and 316 patients without T2D). Subjects were randomly assigned to receive either a Mediterranean diet rich in olive oil (MedDiet; 35% of calories from fat [22% monounsaturated fatty acids (MUFAs)] and 50% from carbohydrates) or a low-fat (LF) diet [<30% fat (12-14% MUFAs) and 55% of calories from carbohydrates]. Lipids were measured in serial bloods drawn at 0, 1, 2, 3, and 4 h after the FLT. Results: After 3 y of dietary intervention, patients with T2D showed an improvement in their PPL measured as postprandial triglycerides (TGs) (P < 0.0001), TG area under the curve (AUC) (P = 0.001), and TG-rich lipoproteins (TRLs-TG; P = 0.001) compared with baseline. Subgroup analysis, based on the type of dietary intervention, showed that those T2D patients randomly assigned to the MedDiet presented a reduction in the TG AUC of 17.3% compared with baseline (P = 0.003). However, there were no differences for T2D patients randomly assigned to the LF diet (P > 0.05) or in patients without T2D (P > 0.05) regardless of the dietary intervention. In addition, the MedDiet induced a significant improvement in the RC AUC in patients with T2D (P = 0.04). However, there was no significant improvement in those following the LF diet. Conclusions: Our findings show that the long-term consumption of a MedDiet rich in olive oil improves PPL and RC concentrations mainly in patients with T2D. This trial was registered at clinicaltrials.gov as NCT00924937.

Hemoglobina glucosilada e índice leucoglucémico como determinacionespronósticas en el síndrome coronario agudo / Glycosylated hemoglobin and leukoglycemic index as prognostic determinations in acute coronary syndrome

Introducción: El síndrome coronario agudo es una de las causas más frecuentes de morbilidad y mortalidad a nivel mundial; es importante encontrar determinaciones de laboratorio de fácil alcance que ayuden a valorar el pronóstico de estos pacientes. Objetivo: Determinar el valor pronóstico de la hemoglobina glucosilada (HbA1c) y el índice leucoglucémico (ILG) en pacientes con síndrome coronario agudo. Método: Se realizó un estudio descriptivo transversal en 142 pacientes, diabéticosy no diabéticos, con síndrome coronario agudo, ingresados en el Hospital Universitario Dr. Celestino Hernández Robau de Santa Clara, Cuba, desde octubre de 2012 a octubre de 2013. Se evaluaron la HbA1c, el ILG y las complicaciones después del ingreso.Resultados: Se encontraron 40 pacientes diabéticos y 102 no, con edad promedio de 68,2 años y predominio de hipertensión arterial y dislipidemia. A medida que aumentaron las cifras del ILG aumentó también la frecuencia de complicaciones en los diabéticos (p=0,422) y en los no diabéticos (p=0,007). La HbA1c media de los diabéticos complicados (8,8 por ciento) fue superior a la de los no diabéticos (7,5 por ciento) (p<0,01). Los valores 1443 del ILG y 6,9 por ciento de la HbA1c se establecieron como puntos de corte predictores de complicaciones. Conclusiones: La valoración conjunta del ILG y la HbA1c resultó un predictor de alta especificidad y buena sensibilidad en ambos grupos de estudio(AU)

CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (the CORDIOPREV study): Rationale, methods, and baseline characteristics: A clinical trial comparing the efficacy of a Mediterranean diet rich in olive oil versus a low-fat diet on cardiovascular disease in coronary patients.

Coronary heart disease (CHD) represents a major global health burden. However, despite the well-known influence that dietary habits exert over the progression of this disease, there are no well-established and scientifically sound dietary approaches to prevent the onset of clinical outcomes in secondary prevention. The objective of the CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (CORDIOPREV study, clinical trials number NCT00924937) is to compare the ability of a Mediterranean diet rich in virgin olive oil versus a low-fat diet to influence the composite incidence of cardiovascular events after 7 years in subjects with documented CHD at baseline. For this purpose, we enrolled 1,002 coronary patients from Spain. Baseline assessment (2009-2012) included detailed interviews and measurements to assess dietary, social, and biological variables. Results of baseline characteristics: The CORDIOPREV study in Spain describes a population with a high body mass index (37.2% overweight and 56.3% obesity) and with a median of low-density lipoprotein cholesterol of 88.5 mg/dL (70.6% of the patients having <100 mg/dL and 20.3% patients <70 mg/dL). A total of 9.6% of the participants were active smokers, and 64.4% were former smokers. Metabolic syndrome was present in 58% of this population. To sum up, we describe here the rationale, methods, and baseline characteristics of the CORDIOPREV study, which will test for the first time the efficacy of a Mediterranean diet rich in extra virgin olive oil as compared with a low-fat diet on the incidence of CHD recurrence in a long-term follow-up study.

Lipoproteína(a) y fibrinógeno como predictores de complicacionesen pacientes con síndrome coronario agudo / Lipoprotein(a) and fibrinogen as predictors of complications in patients with acute coronary syndrome

Introducción: Las enfermedades cardiovasculares aportan el mayor número de defunciones anuales en el mundo desarrollado, por lo que se les considera un azote para la humanidad; entre ellas, la cardiopatía isquémica.Objetivos: Determinar el valor de la lipoproteína(a), el fibrinógeno y el índice fibrinógeno-lipoproteína(a) en la predicción de complicaciones a corto plazo en los pacientes con síndrome coronario agudo. Método: Se realizó un estudio descriptivo transversal en 115 pacientes ingresados con síndrome coronario agudo en el Hospital Dr. Celestino Hernández Robau de SantaClara, desde noviembre de 2012 a octubre de 2013. Resultados: Los pacientes fueron 43 del sexo femenino y 72 del masculino. Los factores de riesgo más frecuentes fueron la hipertensión arterial (70,43 por ciento), la dislipidemia (50,43 por ciento) y los antecedentes familiares de coronariopatía (47,83 por ciento). Se presentaron complicaciones en 39 pacientes (33,9 por ciento). Se establecieron puntos de corte en 4,50 g/L para el fibrinógeno, 341 mg/L para la lipoproteína(a) y 1,50 para el índice fibrinógeno-lipoproteína(a). Este último mostró una sensibilidad de 89 por ciento, especificidad de 94 por ciento y una capacidad predictiva dada por una razón de posibilidades de 122, por lo que clasifica como de muy buen valor predictivo. Conclusiones: El índice fibrinógeno-lipoproteína(a) mostró un excelente poder predictivo para las complicaciones a corto plazo en pacientes con síndrome coronario agudo(AU)

Beneficios del ejercicio físico en el adulto mayor con enfermedades asociadas / Benefits of physical exercises in elderly people with associated illnesses

El envejecimiento poblacional constituye un serio problema de salud. Un programa de ejercicios físicos sería beneficioso en ancianos con enfermedades asociadas. El objetivo de este estudio fue desarrollar un programa de ejercicios físicos para lograr beneficios en la función cardiovascular. Método: Se realizó un estudio descriptivo, prospectivo, en 20 pacientes (hombres y mujeres por igual) mayores de 60 años de edad del municipio de Cifuentes. Resultados: La edad promedio fue de 68,9 años. Predominó la hipertensión arterial, cardiopatía isquémica crónica, insuficiencia cardíaca, hipercolesterolemia, diabetes mellitus y enfermedades del sistema osteomioarticular. El 20 por ciento de los pacientes fueron considerados como ancianos frágiles. No existieron diferencias significativas en cuanto al consumo de medicamentos según el sexo, sin embargo sí se redujo al final del estudio de forma significativa el consumo de estos en el sexo femenino, de 8,3 a 6,6 diarios (x² = 14,1 p < 0,05). El programa de ejercicios empleado produjo un resultado estadísticamente muy significativo sobre el bienestar físico-psíquico (x² = 24,1, p < 0,01), y un total de 16 ancianos (80 por ciento), x² =15,4, p < 0,05, lograron el control sobre la tensión arterial y la frecuencia cardíaca, lo que disminuyó el doble producto y el consumo miocárdico de oxígeno. Conclusiones: La ejecución de un programa de ejercicios físicos, bajo supervisión de personal entrenado, contribuye al control de la tensión arterial y la frecuencia cardíaca, y favorece un gasto cardíaco óptimo; además tiene un efecto muy positivo en el bienestar físico-psíquico de este grupo de pacientes, al mejorar su autoestima y deseos de vivir

Tumoración sangrante perianal / Bleeding perianal tumor

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Dos casos de lepra en Valladolid / Two cases of leprosy in Valladolid

La lepra continúa siendo un importante problema de salud en todo el mundo y aunque en nuestro continente no alcanza cifras de endemia, parece existir una tendencia al alza debido al número de casos importados diagnosticados cada año. Se describen 2 casos de lepra lepromatosa diagnosticados en Valladolid en un periodo de 5 meses. El último caso declarado de esta enfermedad en nuestra comunidad data de hace más de 20 años

Leprosy is still a major health problem on a worldwide level, and although it does not reach endemic levels on our continent, it seems that there is an upward trend due to the number of imported cases diagnosed each year. We present two cases of lepromatous leprosy diagnosed in Valladolid within a five-month period. The last reported case of this disease in our community was over 20 years ago

[Two cases of leprosy in Valladolid]. / Dos casos de lepra en Valladolid.

Leprosy is still a major health problem on a worldwide level, and although it does not reach endemic levels on our continent, it seems that there is an upward trend due to the number of imported cases diagnosed each year. We present two cases of lepromatous leprosy diagnosed in Valladolid within a five-month period. The last reported case of this disease in our community was over 20 years ago.

Interrelación de factores de riesgo en el síndrome coronario agudo / Interrelation of risk factors in acute coronary syndrome

Introducción: Se han acumulado evidencias de la importancia de los procesos trombogénico-antitrombogénico y fibrinolítico-antifibrinolítico en la patogenia de la enfermedad coronaria, determinando la inclusión de pruebas para hipercoagulabilidad y fibrinólisis deficiente con fines predictivos. Objetivos: Relacionar y valorar los niveles de fibrinógeno y antitrombina III plasmáticos de pacientes que han sufrido un síndrome coronario agudo con la presencia en ellos de otros factores de riesgo cardiovascular. Métodos: Se estudiaron 102 pacientes que sufrieron un síndrome coronario agudo, a los que se aplicó una encuesta y una batería de análisis, entre ellos la determinación de fibrinógeno y de antitombina III en el plasma. Resultados: Las disciplinas que más se acompañaron de hiperfibrinogenemia, baja actividad de antitrombina III o ambas, fueron los valores elevados de triglicéridos y no deseables de colesterol de las lipoproteínas de alta densidad; entre los factores no lipídicos, el hábito de fumar y la diabetes mellitus. La hiperfibrinogenemia y la disminución de antitrombina III también estuvieron presentes en pacientes sin dislipidemias u otros factores de riesgo. En el infarto, la hiperfibrinogenemia fue mayor que la disminución de antitrombina III, especialmente en los que presentaban valores no deseables de colesterol de las lipoproteínas de alta densidad y triglicéridos, relación contraria a la observada en los anginosos, excepto los diabéticos. Conclusiones: Nuestros hallazgos confirman la relación entre los niveles plasmáticos de fibrinógeno y antitrombina III y la presencia de otros factores de riesgo cardiovascular en pacientes que han sufrido un síndrome coronario agudo, así como la necesidad de tal estudio en ellos (AU)