Estudio de prevalencia, conocimiento y control de la hipertensión arterial en barrios vulnerables de Argentina / Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study

Introducción: La hipertensión arterial (HTA) representa el principal factor de riesgo individual, con mayor carga a nivel mundial de enfermedades cardiovasculares (ECV). En nuestro país, algunos trabajos epidemiológicos han mostrado marcadas diferencias en las prevalencias de estos factores de riesgo de acuerdo con la población evaluada. Sin embargo, no hay estudios epidemiológicos de evaluación de factores de riesgo cardiovascular exclusivos referentes a barrios vulnerables con muy bajos recursos económicos, socioculturales y poca accesibilidad a los sistemas de salud. Materiales y métodos: Estudio observacional de corte transversal multicéntrico en habitantes de comunas vulnerables de muy bajos recursos, como asentamientos populares y barrios carenciados con muestreo aleatorizado simple de casas. Se realizaron tomas de presión arterial (PA), medidas antropométricas, así como cuestionarios epidemiológicos, económicos y socioculturales. Se describen los hallazgos: prevalencia, conocimiento y control de la PA en las distintas regiones. Se efectuó una regresión logística para determinar las variables independientes a los resultados principales. Resultados: Se analizaron 989 participantes. La prevalencia de HTA global fue de 48,2%. Un total de 82% tenía un índice de masa corporal (IMC) >25 kg/m2. De estos pacientes, 45,3% tenían menos de seis años de educación. Este último aspecto se asoció a mayor prevalencia de HTA de forma independiente. De los hipertensos, 44% desconocían su padecimiento y solo en 17,2% estaba controlado, asociándose esto a tener obra social (OS) y mayor nivel educativo. Únicamente 24% estaban bajo tratamiento combinado. Conclusión: La prevalencia de HTA en barrios vulnerables es elevada, superando a la de otros estratos sociales con niveles de conocimiento, tratamiento y control de la HTA bajos, similar a otras poblaciones. Se detectó un uso insuficiente de la terapia combinada.

Introduction: Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. Methods: A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. Results: A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. Conclusion: The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations... (AU)

Anaesthesia praCtice for Caesarean dElivery Snapshot Study (ACCESS): Protocol and baseline characteristics of registered centres.

BACKGROUND: Specific guidelines to manage caesarean delivery anaesthesia are lacking. A European multicentre study, ACCESS investigates caesarean delivery anaesthesia management in European centres. In order to identify ACCESS participating centres, a registration survey was created. OBJECTIVE: The aim of the current report is to describe the characteristics of ACCESS study participating centres, the rationale for the ACCESS study and the study methodology. DESIGN AND SETTING: The ACCESS study is a European multicentre cross-sectional study to describe anaesthesia management for caesarean delivery (CD) using a snapshot (2-week) design. The ACCESS registration survey gathered: contact details for National Coordinators (NC); Lead Investigators (LI) per centre; centre annual CD volume; expected no. of CD during 2-week snapshot window; centre practice information; data collection language. The ACCESS registration survey was launched July 2022 (Google Forms, Google Inc., Mountain View, CA, USA) and distributed through personal connections, national and international societies, social media networks, during Euroanaesthesia 2023, through the European Society of Anaesthesiology and Intensive Care newsletter. RESULTS: The ACCESS registration survey identified Lead Investigators for 418 centres, in 32 countries, representing an anticipated number of 15,073 CD cases over the planned 12-month study period. A median (range) of 20 (2 to 400) CD cases are anticipated per centre during the 2-week snapshot window. Most 366/418 (87.6%) centres are small, ≤2000 annual CD cases, 42 are medium 2000-5000 cases and 10 are large, ≥5000 annual CD cases. Registered centres reported in 134 (32.0%) centres that anaesthesia for caesarean delivery is performed mostly by a specialist obstetric anaesthesiologist. CONCLUSION: The ACCESS registration survey revealed variability in volume and CD practice as well as training-levels and staffing among European countries. The ACCESS study (https://www.access-study.org/) aims to generate practice data to guide CD anaesthetic management strategies.

[Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study]. / Estudio de prevalencia, conocimiento y control de la hipertensión arterial en barrios vulnerables de Argentina.

INTRODUCTION: Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. METHODS: A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. RESULTS: A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence. Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. CONCLUSION: The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations. Inadequate use of combination therapy was observed. This study underscores the urgent need for targeted interventions addressing cardiovascular risk factors in poor areas to mitigate the burden of CVD.

SUNCT/SUNA: ¿frecuentemente mal diagnosticada como neuralgia del trigémino? / SUNCT/SUNA: frequently misdiagnosed as trigeminal neuralgia?

Objetivo: Identificar el número de casos con posible diagnóstico de cefalea neuralgiforme unilateral de corta duración con inyección conjuntival y lagrimeo (SUNCT) o cefalea neuralgiforme unilateral de corta duración con síntomas autonómicos craneales (SUNA) en pacientes con un previo diagnóstico de neuralgia del trigémino (NT) en el servicio de neurología del Centro Médico Nacional 20 de Noviembre, comprobando así que estas cefaleas trigeminoautonómicas deben ser descartadas y consideradas como diagnósticos diferenciales de la NT. Pacientes y métodos: Estudio transversal y retrospectivo. Se evaluaron los expedientes clínicos electrónicos completos de 100 pacientes con diagnóstico de NT durante el período de abril de 2010 a mayo de 2020. Intencionalmente se buscaron síntomas autonómicos en éstos y se compararon con los criterios diagnósticos de SUNCT y SUNA de la Clasificación Internacional de las Cefaleas, tercera edición. Se realizaron pruebas de chi cuadrado y posteriormente de regresión bivariada para determinar la asociación entre las variables. Resultados: Se incluyó a 100 pacientes con diagnóstico de NT. Tras la revisión de las manifestaciones clínicas, se encontró a 12 pacientes con síntomas autonómicos y se compararon con los criterios diagnósticos de SUNCT y SUNA. Estos no cumplieron los criterios absolutos para ser diagnosticados con las enfermedades previamente mencionadas; sin embargo, cumplieron las características del espectro de cefaleas trigeminoautonómicas. Conclusión: La NT es una entidad dolorosa y frecuente que puede presentar síntomas autonómicos, y es importante pensar en diagnósticos diferenciales, como la SUNCT y la SUNA, para la identificación y el tratamiento correctos.(AU)

Objective: Identify the number of cases with a possible diagnosis of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) in patients with a previous diagnosis of Trigeminal Neuralgia (TN) at the Neurology Service of the National Medical Center 20 de Noviembre. This will confirm that these trigeminal-autonomic cephalalgias should be ruled out and considered as differential diagnoses of trigeminal neuralgia. Patients and methods: Cross-sectional and retrospective study. The complete electronic medical records of 100 patients with a diagnosis of TN were evaluated during the period from April 2010 to May 2020. Autonomic symptoms were intentionally searched for in these patients and compared with the diagnostic criteria of SUNCT and SUNA of the 3rd edition of the International Classification of Headache Disorders. Chi-square tests and subsequent bivariate regression were performed to determine the association between variables. Results: One hundred patients with a diagnosis of TN were included. After reviewing the clinical manifestations, 12 patients with autonomic symptoms were found and compared with the diagnostic criteria of SUNCT and SUNA. However, they did not meet the absolute criteria to be diagnosed with the previously mentioned diseases, nor to be ruled out. Conclusions: TN is a painful and frequent entity that can present with autonomic symptoms, therefore making it important to identify SUNCT and SUNA as differential diagnoses, to recognize them and treat them appropriately.(AU)

[Impact of the ''Enhanced Recovery After Surgery'' program in knee arthroplasty at the institutional level]. / Impacto del programa ''Enhanced Recovery After Surgery'' en artroplastía de rodilla a nivel institucional.

INTRODUCTION: total knee arthroplasty has gained popularity over decreasing pain, restoring mobility and improving patients' quality of life. At the institutional level, there is no multidisciplinary model in the treatment of our patients, and in our environment, physical rehabilitation starts late, making it difficult for patients to reincorporate and attain adequate pain control. MATERIAL AND METHODS: a controlled, randomized, prospective and longitudinal study was conducted, 55 patients underwent total knee arthroplasty, assigned to two study groups: the ERAS (enhanced recovery after surgery) group (n = 27) and the usual group (n = 28). Inclusion criteria were patients with Kellgren-Lawrence classification grade 4 gonarthrosis, age between 30-70 years and follow-up for six months. Descriptive statistics were performed using medians and interquartile range, while inferential statistics were performed using the Kruskal-Wallis test. RESULTS: the results obtained at six months showed no statistically significant differences in age (p = 0.327) and gender (p = 0.588). The results obtained in the scales of VAS, WOMAC and IKDC showed statistically significant difference (p = 0.000). The rapid recovery group with a 120° flexion median and the usual group with 90° flexion, both groups with 0° extension. CONCLUSIONS: the enhanced recovery after surgery pathway in joint replacement procedures showed good results on pain, function, mobility and complications compared to patients undergoing usual management.

INTRODUCCIÓN: la artroplastía total de rodilla ha ganado popularidad sobre la disminución del dolor, restablecer la movilidad y mejorar la calidad de vida de los pacientes. A nivel institucional, no existe un modelo multidisciplinario en el tratamiento de nuestros pacientes y en nuestro medio la rehabilitación física se inicia de manera tardía, dificultando la reincorporación de los pacientes y el control analgésico. MATERIAL Y MÉTODOS: se realizó un estudio clínico controlado, aleatorizado, prospectivo y longitudinal que incluyó 55 pacientes sometidos a artroplastía de rodilla, asignados a dos grupos de estudio: el grupo ERAS (Enhanced Recovery After Surgery) (n = 27) y el grupo habitual (n = 28). Los criterios de inclusión fueron pacientes con gonartrosis grado IV de Kellgren y Lawrence, edad comprendida entre 30-70 años y seguimiento de seis meses. La estadística descriptiva se realizó mediante medianas y rango intercuartílico, mientras la estadística inferencial mediante la prueba de Kruskal-Wallis. RESULTADOS: los resultados obtenidos a los seis meses no mostraron diferencias estadísticas significativas de edad (p = 0.327) y género (p = 0.588). Los resultados obtenidos en las escalas de EVA, WOMAC e IKDC mostraron diferencia estadística significativa (p = 0.000). El grupo de recuperación rápida con una mediana de flexión de 120° y el grupo habitual con flexión de 90°, ambos grupos con extensión de 0°. CONCLUSIONES: el programa de recuperación rápida en procedimientos de remplazo articular, mostró buenos resultados sobre el dolor, función, movilidad y complicaciones en comparación con los pacientes sometidos al manejo habitual.

Postoperative management and nursing care after implantation of a total artificial heart: Scoping review.

INTRODUCTION: End-stage heart failure (HF) is a condition whose only successful long-term treatment, with a survival of more than 10 years, is heart transplantation. However, limited organ availability and the progressive increase in the number of patients with advanced HF have served as an impetus for the development of implantable mechanical assistive devices. AIM: To provide an overview of postoperative management and nursing care after the implementation of a Total Artificial Heart (TAH). METHODS: A scoping review was carried out by consulting the PUBMED, CINAHL, and COCHRANE databases. From all the documents located, information was extracted on the date of publication, country of publication, type of study, and results of interest to answer the research question. In addition, the degree of recommendation was identified. RESULTS: Twenty-three documents were included in the scoping review. Results were classified in relation to: 1) description of the CAT SynCardia®; 2) nursing care in the immediate postoperative period (management of the device and management of hematological, infectious, nephrological, nutritional complications, related to immobilization, sleep-rest disturbances, psychological disorders, and patient and family education); and 3) follow-up at home. CONCLUSIONS: The complexity of implantation of the TAH, the multiple related complications that can arise during this process, both in the immediate post-operative and late, require a standardised and multidisciplinary management. The absence of standardised protocols raises the need for future studies to measure the effectiveness of care in patients with TAH. A multidisciplinary approach is crucial. Nurses must acquire autonomy and involvement in decision-making and develop competencies to address the patient's and family's physiological and psychosocial needs.

[SUNCT/SUNA: frequently misdiagnosed as trigeminal neuralgia?] / SUNCT/SUNA: ¿frecuentemente mal diagnosticada como neuralgia del trigémino?

OBJECTIVE: Identify the number of cases with a possible diagnosis of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) in patients with a previous diagnosis of Trigeminal Neuralgia (TN) at the Neurology Service of the National Medical Center 20 de Noviembre. This will confirm that these trigeminal-autonomic cephalalgias should be ruled out and considered as differential diagnoses of trigeminal neuralgia. PATIENTS AND METHODS: Cross-sectional and retrospective study. The complete electronic medical records of 100 patients with a diagnosis of TN were evaluated during the period from April 2010 to May 2020. Autonomic symptoms were intentionally searched for in these patients and compared with the diagnostic criteria of SUNCT and SUNA of the 3rd edition of the International Classification of Headache Disorders. Chi-square tests and subsequent bivariate regression were performed to determine the association between variables. RESULTS: One hundred patients with a diagnosis of TN were included. After reviewing the clinical manifestations, 12 patients with autonomic symptoms were found and compared with the diagnostic criteria of SUNCT and SUNA. However, they did not meet the absolute criteria to be diagnosed with the previously mentioned diseases, nor to be ruled out. CONCLUSIONS: TN is a painful and frequent entity that can present with autonomic symptoms, therefore making it important to identify SUNCT and SUNA as differential diagnoses, to recognize them and treat them appropriately.

TITLE: SUNCT/SUNA: ¿frecuentemente mal diagnosticada como neuralgia del trigémino?Objetivo. Identificar el número de casos con posible diagnóstico de cefalea neuralgiforme unilateral de corta duración con inyección conjuntival y lagrimeo (SUNCT) o cefalea neuralgiforme unilateral de corta duración con síntomas autonómicos craneales (SUNA) en pacientes con un previo diagnóstico de neuralgia del trigémino (NT) en el servicio de neurología del Centro Médico Nacional 20 de Noviembre, comprobando así que estas cefaleas trigeminoautonómicas deben ser descartadas y consideradas como diagnósticos diferenciales de la NT. Pacientes y métodos. Estudio transversal y retrospectivo. Se evaluaron los expedientes clínicos electrónicos completos de 100 pacientes con diagnóstico de NT durante el período de abril de 2010 a mayo de 2020. Intencionalmente se buscaron síntomas autonómicos en éstos y se compararon con los criterios diagnósticos de SUNCT y SUNA de la Clasificación Internacional de las Cefaleas, tercera edición. Se realizaron pruebas de chi cuadrado y posteriormente de regresión bivariada para determinar la asociación entre las variables. Resultados. Se incluyó a 100 pacientes con diagnóstico de NT. Tras la revisión de las manifestaciones clínicas, se encontró a 12 pacientes con síntomas autonómicos y se compararon con los criterios diagnósticos de SUNCT y SUNA. Estos no cumplieron los criterios absolutos para ser diagnosticados con las enfermedades previamente mencionadas; sin embargo, cumplieron las características del espectro de cefaleas trigeminoautonómicas. Conclusión. La NT es una entidad dolorosa y frecuente que puede presentar síntomas autonómicos, y es importante pensar en diagnósticos diferenciales, como la SUNCT y la SUNA, para la identificación y el tratamiento correctos.

Preeclampsia and risk of maternal pulmonary hypertension at high altitude in Bolivia.

Women with a history of preeclampsia (PE) have a greater risk of pulmonary arterial hypertension (PAH). In turn, pregnancy at high altitude is a risk factor for PE. However, whether women who develop PE during highland pregnancy are at risk of PAH before and after birth has not been investigated. We tested the hypothesis that during highland pregnancy, women who develop PE are at greater risk of PAH compared to women undergoing healthy highland pregnancies. The study was on 140 women in La Paz, Bolivia (3640m). Women undergoing healthy highland pregnancy were controls (C, n = 70; 29 ± 3.3 years old, mean±SD). Women diagnosed with PE were the experimental group (PE, n = 70, 31 ± 2 years old). Conventional (B- and M-mode, PW Doppler) and modern (pulsed wave tissue Doppler imaging) ultrasound were applied for cardiovascular íííassessment. Spirometry determined maternal lung function. Assessments occurred at 35 ± 4 weeks of pregnancy and 6 ± 0.3 weeks after birth. Relative to highland controls, highland PE women had enlarged right ventricular (RV) and right atrial chamber sizes, greater pulmonary artery dimensions and increased estimated RV contractility, pulmonary artery pressure and pulmonary vascular resistance. Highland PE women had lower values for peripheral oxygen saturation, forced expiratory flow and the bronchial permeability index. Differences remained 6 weeks after birth. Therefore, women who develop PE at high altitude are at greater risk of PAH before and long after birth. Hence, women with a history of PE at high altitude have an increased cardiovascular risk that transcends the systemic circulation to include the pulmonary vascular bed.

Modified Chevrel technique for abdominal closure in critically ill patients with abdominal hypertension and limited options for closure.

Abdominal compartment syndrome is a potentially life-threatening condition seen in critically ill patients, and most often caused by acute pancreatitis, postoperative abdominal vascular thrombosis or mesenteric ischemia. A decompressive laparotomy is sometimes required, often resulting in hernias, and subsequent definitive wall closure is challenging. AIM: This study aims to describe short term results after a modified Chevrel technique for midline laparotomies in patients witch abdominal hypertension. MATERIALS AND METHODS: We performed a modified Chevrel as an abdominal closure technique in 9 patients between January 2016 and January 2022. All patients presented varying degrees of abdominal hypertension. RESULTS: Nine patients were treated with new technique (6 male and 3 female), all of whom had conditions that precluded unfolding the contralateral side as a means for closure. The reasons for this were diverse, including presence of ileostomies, intraabdominal drainages, Kher tubes or an inverted T scar from previous transplant. The use of mesh was initially dismissed in 8 of the patients (88,9%) because they required subsequent abdominal surgeries or active infection. None of the patients developed a hernia, although two died 6 months after the procedure. Only one patient developed bulging. A decrease in intrabdominal pressure was achieved in all patients. CONCLUSION: The modified Chevrel technique can be used as a closure option for midline laparotomies in cases where the entire abdominal wall cannot be used.

Histomorphological evaluation, cell proliferation and endothelial immunostaining in oral and maxillofacial myofibroblastic lesions.

BACKGROUND: Myofibroblasts (MF) are mesenchymal cells with features of both fibroblasts and smooth muscle cells. Although these are usually reactive cells, they can lead to myofibroblastic tumors that may share clinical and histomorphological characteristics but with different prognosis. The aim of this study is to perform a histomorphological evaluation as well as to compare and evaluate two different cell proliferation immunomarkers and two endothelial markers in a group of oral and maxillofacial myofibroblastic lesions (MFL). MATERIAL AND METHODS: Cross-sectional and retrospective study. Demographic, clinical, histomorphological and immunohistochemical characteristics of 39 cases of MFL were analyzed. Immunohistochemical reactions were performed with the Ki67, MCM2, CD34 and CD105 antibodies. Kruskal-Wallis test and Spearman correlation analysis were used. RESULTS: Four cases of nodular fasciitis (NF), 18 myofibromas (My), 6 desmoplastic fibromas (DF), 7 inflammatory myofibroblastic tumors (IMT) and 4 myofibroblastic sarcomas (MFS) were studied. There were twenty women (51.2%); the median age was 13 [Q1-Q3: 8-24] years and most cases occurred in the mandible (48.7%). A statistically significant difference with MCM2 immunostaining (p=0.0221) was observed between the MFL; furthermore, a correlation between CD34 and CD105 immunostaining in NF (p <0.0001) and IMT (p=0.0408), between MCM2 and CD34 in IMT (p=0.0362) and between MCM2 and CD105 in MFS (p <0001) were found. CONCLUSIONS: MCM2 immunostaining could assess more clearly the cell growth fraction in MFL. The correlation between MCM2 and CD34 in IMT and between MCM2 and CD105 in MFS are indicative of the high activity of these lesions. These results emphasize the importance of the studied immunohistochemistry markers as possible tools for a better characterization of some of the MFL.

Metas de logro 3x2 y mediadores psicológicos en estudiantes de educación física / 3x2 Achievement Goals and Psychological Mediators in Physical Education Students

Esta investigación examina la relación entre las metas de logro 3x2, las necesidades psicológicas básicas, la motivación autodeterminada, la intención de ser físicamente activo y la satisfacción con la vida. Participaron en el estudio 1706 estudiantes de Educación Física de 10 a 17 años (M = 13.75; DT = 2.98). Se realizaron análisis descriptivos y regresiones lineales. La validez y la consistencia interna fueron apropiadas. Los resultados señalaron la importancia de la satisfacción de la competencia y la relación, la motivación autodeterminada, y las metas de aproximación-tarea y aproximación-otro en la predicción de la intención de ser físicamente activo, así como de las metas basadas en la tarea y la satisfacción de las tres necesidades psicológicas básicas en la predicción de la satisfacción con la vida. El marco de metas de logro 3x2 supone una contribución relevante en la explicación de las consecuencias motivacionales y del bienestar del alumnado. (AU)

This research examines the relationship between 3x2 achievement goals, basic psychological needs, self-determined motivation, intention to be physically active, and satisfaction with life. The sample was comprised of 1706 Physical Education students with aged between 10 and 17 years old (M = 13.75; DT = 2.98). Descriptive analysis and linear regressions were performed. Validity and internal consistency were appropriate. The results pointed out the importance of competence and relationship satisfaction, self-determined motivation, and task-approach and other-approach goals in predicting the intention to be physically active, as well as task-based goals and satisfaction of the three basic psychological needs in predicting satisfaction with life. The 3x2 achievement goal framework is a relevant contribution in explaining the motivational and welfare consequences of the students. (AU)

Effect of metabolic control on recurrent major adverse cardiovascular events and cardiovascular mortality in patients with premature coronary artery disease: Results of the Genetics of Atherosclerotic Disease study.

BACKGROUND AND AIMS: Coronary artery disease (CAD) is the leading cause of death around the world, and its rate of presentation is increasing at young ages. Despite the evidence that secondary prevention in CAD reduces the risk of recurrent major adverse cardiovascular events (MACE), no studies have analyzed the composite control of blood pressure, lipids, and glucose control in premature CAD. METHODS AND RESULTS: This was a real-world prospective cohort study of patients with premature CAD. The composite control in blood pressure <140/80 mmHg, LDL-C <70 mg/dL, non-HDL-C <100 mg/dL, and Hemoglobin A1c <8% was considered as metabolic control. The primary endpoint was the occurrence of non-fatal and fatal MACE. The data included 1042 patients with premature CAD. The mean age of the patients was 54.1 ± 8.1 years, 18.5% were women, and had a median follow-up of 59.1 ± 11.8 months. Of them, 7% had non-fatal MACE, and 4% had a fatal MACE. Overall, 21.3% achieved metabolic control, and 3.0% did not achieve any target. Cox regression analysis showed that percutaneous coronary intervention (Hazzard ratio = 1.883 [95% CI, 1.131-3.136]), C-reactive protein (1.046 [1.020-1.073]), blood pressure >140/90 mmHg (2.686 [1.506-4.791]), fibrates (2.032 [1.160-3.562]), calcium channel blockers (2.082 [1.158-3.744]) had greater risk to present a recurrent non-fatal MACE; whereas familial history of premature CAD (2.419 [1.240-4.721]), heart failure (2.139 [1.032-4.433]), LDL-C >70 mg/dL (4.594 [1.401-15.069]), and diuretics (3.328 [1.677-6.605]) were associated with cardiovascular mortality. CONCLUSIONS: The composite goal achievement in lipids, blood pressure and glucose, reduced the risk for recurrent MACE in 80%.

Recurrencia y mortalidad a largo plazo de los pacientes con síncope no cardiogénico / Long-term recurrences and mortality in patients with noncardiac syncope

Introducción y objetivos: La evolución a largo plazo de los pacientes que padecen síncope, una vez descartada su etiología cardiaca, no se ha descrito en profundidad. Se describe la evolución a largo plazo de esta población. Métodos: Durante 147 meses, se estudió a todos los pacientes remitidos a nuestra unidad de síncope tras haberse descartado una causa cardiaca. Resultados: Se incluyó a 589 pacientes consecutivos, 313 de ellos mujeres (53,1%), con una mediana de 52 [34-66] años. A 405 (68,8%) se les diagnosticó síncope vasovagal (SVV); a 65 (11%), síncope por hipotensión ortostática (SHO), y a 119 (20,2%), síncope de etiología desconocida (SED). Durante una mediana de 52 [28-89] meses de seguimiento, 220 (37,4%) tuvieron recurrencias (el 21,7%, 2 o más recurrencias) y se produjeron 39 muertes (6,6%). La recurrencia del síncope se produjo en el 41% de los pacientes con SVV, el 35,4% del grupo con SHO y el 25,2% del de SED (p=0,006). La recurrencia se correlacionó en el análisis multivariado con la edad (p=0,002), el sexo femenino (p<0,0001) y el número de episodios previos (< 5 frente a ≥ 5; p <0,0001). Fallecieron 15 pacientes (3,5%) con SVV, 11 (16,9%) con SHO y 13 (10,9%) con SED (p=0,001), El análisis multivariado asoció edad (p=0,0001), diabetes (p=0,007) y diagnóstico de SHO (p=0,026) y SED (p=0,020) con la muerte. Conclusiones: En los pacientes con síncope de origen no cardiaco, a los 52 meses de seguimiento, la tasa de recurrencias es del 37,4% y la de mortalidad, del 6,6%. Hay más recurrencias en los pacientes con perfil neuromediado y más mortalidad en los pacientes con perfil no neuromediado (AU)

Introduction and objectives: There are no in-depth studies of the long-term outcome of patients with syncope after exclusion of cardiac etiology. We therefore analyzed the long-term outcome of this population. Methods: For 147 months, we included all patients with syncope referred to our syncope unit after exclusion of a cardiac cause. Results: We included 589 consecutive patients. There were 313 (53.1%) women, and the median age was 52 [34-66] years. Of these, 405 (68.8%) were diagnosed with vasovagal syncope (VVS), 65 (11%) with orthostatic hypotension syncope (OHS), and 119 (20.2%) with syncope of unknown etiology (SUE). During a median follow-up of 52 [28-89] months, 220 (37.4%) had recurrences (21.7% ≥ 2 recurrences), and 39 died (6.6%). Syncope recurred in 41% of patients with VVS, 35.4% with OHS, and 25.2% with SUE (P=.006). In the Cox multivariate analysis, recurrence was correlated with age (P=.002), female sex (P <.0001), and the number of previous episodes (< 5 vs ≥ 5; P <.0001). Death occurred in 15 (3.5%) patients with VVS, 11 (16.9%) with OHS, and 13 (10.9%) with SUE (P=.001). In the multivariate analysis, death was associated with age (P=.0001), diabetes (P=.007), and diagnosis of OHS (P=.026) and SUE (P=.020). Conclusions: In patients with noncardiac syncope, the recurrence rate after 52 months of follow-up was 37.4% and mortality was 6.6% per year. Recurrence was higher in patients with a neuromedial profile and mortality was higher in patients with a nonneuromedial profile (AU)

Rehabilitación basada en el razonamiento clínico. A propósito de un caso de encefalopatía hipóxico-isquémica en el adulto / Rehabilitation based on clinical reasoning: A case of hypoxi-ischemic encephalopathy in adult

Introducción: El tratamiento de los déficits motores y sensitivos tras encefalopatía hipóxico-isquémica requiere de fisioterapia centrada en el reaprendizaje del movimiento.Objetivo: Razonar la clínica y el efecto inmediato del tratamiento de fisioterapia para conseguir mejorar el equilibrio y la locomoción en una paciente con encefalopatía hipóxico-isquémica.Presentación del caso: Mujer de 55 años, que sufre una parada cardiorrespiratoria, con encefalopatía hipóxico-isquémica y, secundariamente, polineuropatía del paciente crítico. La paciente cursa con apraxia de la locomoción, alteración cognitiva, ataxia apendicular y alteración de la locomoción.Intervenciones: Se plantearon 12 sesiones de tratamiento de fisioterapia para conseguir el reaprendizaje del movimiento, mejorar la estabilidad y optimizar la función motora. Se evaluó pre- y postintervenciones, y a los 3 meses del final de las intervenciones.Resultados: La paciente reportó satisfacción al finalizar las 12 sesiones, con mejor equilibrio y menor sensación de inestabilidad durante la locomoción. Tras 3 meses del tratamiento, la paciente continuó mejorando.Conclusiones: Se ha observado el beneficio del razonamiento clínico diario, como instrumento de planificación del tratamiento de fisioterapia, sobre la mejora de la estabilidad proximal y la locomoción de una paciente con encefalopatía hipóxico-isquémica. (AU)

Introduction: Treatment of motor and sensory deficits after hypoxic̶ischemic encephalopathy requires physical therapy focused on motor relearning.Purpose: To reason the symptoms and the immediate effect of the physiotherapy treatment to improve balance and locomotion in a patient with hypoxic̶ischemic encephalopathy.Case presentation: Fifty-five-Year-old woman suffering cardiorespiratory arrest, with hypoxic̶ischemic encephalopathy and polyneuropathy of the critical patient. Clinic presentation of apraxia of locomotion, cognitive alteration, appendicular ataxia, and alteration of locomotion.Interventions: 12 physiotherapy treatment sessions were proposed to re-learn movement, improve stability, and optimize motor function. It was evaluated pre- and post-interventions, and 3 months after the end of the interventions.Results: The patient reported satisfaction at the end of the 12 sessions, with better balance and less feeling of instability during locomotion. After 3 months of treatment, the patient continued to improve.Conclusions: The benefit of daily clinical reasoning, as a physiotherapy treatment planning instrument, has been observed on improving proximal stability and locomotion in a patient with hypoxic-ischemic encephalopathy. (AU)

Lesion-associated microglia and macrophages mediate corralling and react with massive phagocytosis for debris clearance and wound healing after LPS-induced dopaminergic depletion.

Neuroinflammation contributes to neuronal degeneration in Parkinson's disease (PD). However, how brain inflammatory factors mediate the progression of neurodegeneration is still poorly understood. Experimental models of PD have shed light on the understanding of this phenomenon, but the exploration of inflammation-driven models is necessary to better characterize this aspect of the disorder. The use of lipopolysaccharide (LPS) to induce a neuroinflammation-mediated neuronal loss is useful to induce reliable elimination of dopaminergic neurons. Nevertheless, how this model parallels the PD-like neuroinflammation is uncertain. In the present work, we used the direct LPS injection as a model inductor to eliminate dopaminergic neurons of the substantia nigra pars compacta (SNpc) in rats and reevaluated the inflammatory reaction. High-resolution 3D histological examination revealed that, although LPS induced a reliable elimination of SNpc dopaminergic neurons, it also generated a massive inflammatory response. This inflammation-mediated injury was characterized by corralling, a damaged parenchyma occupied by a vast population of lesion-associated microglia and macrophages (LAMMs) undertaking wound compaction and scar formation, surrounded by highly reactive astrocytes. LAMMs tiled the entire lesion and engaged in long-standing phagocytic activity to resolve the injury. Additionally, modeling LPS inflammation in a cell culture system helped to understand the role of phagocytosis and cytotoxicity in the initial phases of dopaminergic degeneration and indicated that LAMM-mediated toxicity and phagocytosis coexist during LPS-mediated dopaminergic elimination. However, this type of severe inflammatory-mediated injury, and subsequent resolution appear to be different from the ageing-related PD scenario where the architectural structure of the parenchyma is mostly preserved. Thus, the necessity to explore new experimental models to properly mimic the inflammatory compound observed in PD degeneration.