Prevalence of Disordered Eating Among International Sport Lead Rock Climbers.

Disordered eating (DE) is characterized as a range of irregular eating patterns or behaviors, which may lead to pathological eating or a clinical eating disorder diagnosis. DE patterns are associated with a variety of negative health outcomes. The prevalence of DE is highest in female athletes who participate in aesthetic or weight dependent sports. Elite rock climbers tend to be strong, small and lean, but the prevalence of DE in rock climbers is unknown. The purpose of the present study was to assess DE prevalence in a large group of international rock climbers and to explore the relationship between sport rock climbing ability and DE. A web-based survey assessed both DE (Eating Attitudes Test-26) and climbing ability based on the International Rock Climbing Research Association's position statement on comparative grading scales. The survey was distributed to international climbing communities; 810 individuals attempted the survey; 604 completed all questions; 498 identified as sport lead climbers. The majority of sport lead climbers were lower grade/intermediate (57.8%), compared to advanced (30.7%) and elite/higher elite (11.4%), and male (76.9%). Forty-three sport lead climbers reported a score of 20 or above on the EAT-26 indicating an 8.6% prevalence of DE in this sample. Male climbers had a DE prevalence of 6.3% (24 of 383) and female climbers more than doubled that with 16.5% (19 of 115). Chi-square analysis revealed that DE was associated with climbing ability level [χ2 (2, n = 498, 8.076, p = 0.02)], and when analyzed by sex, only the female climbers had a significant relationship of DE with climbing ability [χ2 (2, n = 115, 15.640, p = 0.00)]. These findings suggest sport lead rock climbers are not immune to DE and that the risk is elevated in female climbers, particularly at the elite/high elite climbing ability level. Our research indicates further investigations are warranted to determine if and how disordered eating behaviors affect health and performance of adult rock climbers.

Experiencia inicial en la adaptación del instrumental del tratamiento video asistido modificado de las fistulas perianales complejas (VAMAFT) / Initial experience in the adaptation of the instruments of the modified assisted video treatment of complex perianal fistulas (VAMAFT)

Introducción: Las fístulas perianales tienen dos problemas fundamentales, la tasa de recurrencia y de incontinencia fecal postoperatoria, complicaciones que varían en frecuencia dependiendo de varios factores como el tipo de fistula, la técnica quirúrgica usada y la experiencia del cirujano. Debido a esto existen técnicas quirúrgicas no conservadoras y conservadoras de esfínteres donde se incluye el tratamiento video asistido que aparece desde el año 2006 y en la cual se utiliza un sistema de video endoscopio sofisticado y de alto valor económico el cual hemos adaptado a nuestro medio. Pacientes y método: De septiembre del 2015 al 2017 en la Unidad de Coloproctología del Hospital Domingo Luciani IVSS se realizó un estudio prospectivo experimental, donde se incluyeron 18 pacientes con fístulas perianales complejas diagnosticadas previamente con Ecofistulografía 3D y los cuales se operaron con un sistema adaptado usando citoscopio pediátrico de 4 mm y energía láser. Se evaluaron parámetros referentes a la técnica así como la tasa de éxito y riesgo de incontinencia. Resultados: Tiempo quirúrgico de 40 a 80 minutos, con tasa de éxito de 89%, recidiva en 2 pacientes, con tiempo de seguimiento entre 12 a 36 meses y sin cambios en la escala de incontinencia pre y post quirúrgica. Conclusión: El tratamiento video asistido modificado para fistulas anales (VAMAFT) es una técnica innovadora y factible de realizar al adaptar algunos instrumentos, con una tasa de éxito adecuada y sin riesgo de incontinencia, pero más trabajos aleatorizados con mayor números de pacientes deben ser realizados.

Introduction: Anal fistulas have two basic problems, rate of recurrence and postoperative anal incontinence. These complications vary according to several factors such as type of anal fistula, surgical technique and the surgeon´s experience. For each cases there are different surgical techniques with and without conservation of anal sphincters like conservative video assisted anal fistula treatment, described in 2006, this technique uses a sophisticated and expensive endoscope system but that we modified to use in our hospitals. Patients and method: Between September 2015 to 2017 in the Unit of Coloproctology of Domingo Luciani Hospital, was perfomed a prospective and experimental trial in 18 patients with anal complex fistulas previously diagnosed using tridimensional anal ultrasound and operated with a modified system consisting of pediatric cystoscope of 4 mm and laser energy. Some parameters were evaluated including surgical technique, recurrence and anal incontinence rate. Results: Surgical times were between 40 to 80 minutes, success rate of 89%, recurrence in two patients with follow up of 12 to 36 months and no changes in pre and post surgical anal incontinence scale. Conclusion: Video assited modified anal fistula treatment (VAMAFT) is an innovative and feasible surgical technique to do adapting some instruments, with suitable success rate and without anal incontinence risk but many randomized research with more patients have to be perfomed.

Sesgo en la estratificación del síndrome coronario agudo al calcular el grace- score con 1ª, 2ª o troponina Δ / Grace score bias in acute coronary syndrome due to use 1th, 2th or troponin Δ

Introducción: el síndrome coronario agudo (SCA) es la primera causa de mortalidad en Colombia. Una estratificación de riesgo errónea, en la sala de emergencias (ER), afecta las intervenciones realizadas y la tasa de eventos adversos cardiovasculares puede ser mayor. El objetivo de esta investigación fue medir la diferencia en el puntaje GRACE y la estratificación del riesgo coronario, utilizando los resultados de las troponinas medidas secuencialmente durante la atención inicial. Metodología: con un diseño descriptivo retrospectivo, se evaluaron los registros clínicos de pacientes tratados por dolor precordial de probabilidad intermedia para SCA, sin indicación de manejo invasivo inmediato, atendidos en la sala de emergencias de una clínica del tercer nivel de Bogotá, durante el año 2017. Se determinó la diferencia entre la puntuación GRACE calculada con la primera troponina (GRACE-1), la segunda troponina (GRACE-2) o la troponina delta (GRACE-delta) [prueba T pareada], y la proporción de pacientes poco estratificados se midió al usar la primera troponina [X2, puntaje Z]. Resultados: se identificaron 44 pacientes en un período de 6 meses. La mayoría hombres con edad mediana de 73 años. El promedio (DE) de los puntajes GRACE-1, GRACE-2 y GRACE-delta, fue de 114.14 (30.73), 115.55 (30.14) y 111.11 (28.79), respectivamente; al comparar GRACE-delta con GRACE-1 y GRACE-2 se identificaron diferencias significativas (p:<0.05). Se identificó un error en la estratificación del riesgo coronario en 10/44 pacientes (22.7%) y 9/44 (20.4%) presentaron sobreestratificación. Conclusión: la estratificación del riesgo coronario con la primera troponina, a diferencia de la troponina delta (ítem no aclarado en las guías), evidenció una sobreestratificación en al menos 20% de los pacientes, estableciendo la necesidad de procedimientos más invasivos y posiblemente hospitalización más prolongada permanecer.

Background: Acute coronary syndrome (ACS) is the first cause of mortality in Colombia. An erroneous risk stratification, in the emergency room (ER), affects the interventions performed and the rate of major cardiovascular adverse events. We measured the difference in GRACE score and stratification of coronary risk, by using the results of troponins measured sequentially during initial care. Methods: With a retrospective descriptive design, clinical records of patients treated for precordial pain of ≥ intermediate probability for ACS were evaluated, without indication of immediate invasive management, attended in the ER of a clinic of the third level of Bogotá, during 2017. De-termined the difference between the GRACE score calculated with the first (GRACE-1), second (GRACE-2) or troponin delta (GRACE-delta [paired T-test], and the proportion of poorly stratified patients was measured when using the first troponin [X2, Z-score]. Results: 44 patients in a period of 6 months were identified. The majority men, older adults, middle age 73 years. The average (SD) of scores GRACE-1, GRACE-2 and GRACE-delta, was 114.14 (30.73), 115.55 (30.14) and 111.11 (28.79), respectively; when comparing GRACE-delta with GRACE-1 and GRACE-2 significant differences were identified (p:<0.05). Error in the stratification of coronary risk was identified in 10/44 patients (22.7%), and 9/44 (20.4%) presented over-stratification. Conclusion: The stratification of coronary risk using the first troponin, unlike the troponin delta (item not clarified in the guidelines), evidenced an over-stratification in at least 20% of the patients, establishing the need for more invasive procedures and possibly longer hospital stay.

Predictive equations for maximum heart rate. Myth or reality / Ecuaciones predictivas para la frecuencia cardiaca máxima. Mito o realidad

Abstract: Introduction and objective: Maximum heart rate (MHR) is essential to establish the effort, intensity and strategies for physical activity. For this, there are more than 40 formulas; among the best known are 220-Age and Tanaka. The objective of this research is to determine the validity and effectiveness of the equations for MHR. Material and methods: Observational, descriptive and transversal study with a sample of 300 participants (181 women and 119 men) with a mean age of 26 ± 10 years. For the development of this research, we used anthropometry, vital signs, Borg scale and questionnaire for cardiovascular risk factors and a stress test and compare the data with 25 equations of MHR. Results: Maximum heart rate by stress test of the 300 participants was 179.6 ± 15 beats per minute; regarding 25 equations, was observed an overestimation up to 19 beats per minute. Only the formulas of Morris and Graettinger scored less than 4 beats per minute apart to stress test. Conclusions: No one is recommended equations evaluated for their significant difference in the stress test; especially 220-edad, Hossack y Bruce, Cooper and Lester whose difference mean were above 14 beats per minute (p = 0.000). The equation of Morris (p = 0.380) no were found significant differences and were the most successful to estimate the MHR for a minimum difference compared to a stress test.

Resumen: Introducción y objetivo: La frecuencia cardiaca máxima (FCM) es un parámetro esencial para esTablecer el esfuerzo, intensidad y estrategias de la actividad física. Para ello, existen más de 40 fórmulas; entre las más conocidas son 220-edad y Tanaka. El objetivo de la presente investigación es determinar la validez y efectividad de las ecuaciones para la FCM. Material y métodos: Estudio observacional, descriptivo y transversal con 300 participantes (181 mujeres y 119 hombres), de edad promedio de 26 ± 10 años. Para el desarrollo de esta investigación, se obtuvo antropometría, signos vitales, escala de Borg, cuestionario para factores de riesgo cardiovascular y realización de prueba de esfuerzo para comparar datos con 25 ecuaciones de FCM. Resultados: La FCM por prueba de esfuerzo en los 300 participantes fue de 179.6 ± 15 latidos por minuto; en cuanto a las 25 ecuaciones, se observó una sobreestimación hasta en 19 latidos por minuto y sólo las fórmulas de Morris y Graettinger obtuvieron menos de cuatro latidos por minuto de diferencia a la prueba de esfuerzo. Conclusiones: No se recomienda alguna de las ecuaciones evaluadas por su diferencia significativa respecto a la prueba de esfuerzo; especialmente 220-edad, Hossack y Bruce, Cooper y Lester cuya diferencia de media estuvo por encima de 14 latidos por minutos (p = 0.000). Para la ecuación de Morris (p = 0.380) no se encontraron diferencias significativas y fue la más acertada para estimar la FCM comparada con una prueba de esfuerzo.

Estado del hierro en la insuficiencia cardiaca crónica: impacto en síntomas, clase funcional y capacidad de ejercicio submáxima / Iron status in chronic heart failure: impact on symptoms, functional class and submaximal exercise capacity

Introducción y objetivos: Evaluar el efecto del déficit de hierro y la anemia en la capacidad de esfuerzo submáxima de pacientes con insuficiencia cardiaca crónica. Métodos: Se llevó a cabo un estudio transversal unicéntrico en un grupo de pacientes estables con insuficiencia cardiaca crónica. En el momento de incluirlos en el estudio, los pacientes aportaron información basal y realizaron una prueba de marcha de 6 minutos para evaluar la capacidad de ejercicio submáxima y los síntomas desencadenados por el esfuerzo. Al mismo tiempo, se obtuvieron muestras de sangre para la evaluación serológica. El déficit de hierro se definió como un valor de ferritina < 100 ng/ml o una saturación de transferrina < 20% cuando la ferritina era < 800 ng/ml. Se efectuaron también determinaciones de otros marcadores del estado del hierro. Resultados: Se consideró aptos para la inclusión en el estudio a 538 pacientes con insuficiencia cardiaca. La media de edad era 71 años y el 33% se encontraba en las clases III/IV de la New York Heart Association. La distancia media recorrida en la prueba de marcha de 6 minutos por los pacientes con alteración del estado del hierro fue 285 ± 101 m, en comparación con los 322 ± 113 m del otro grupo (p = 0,002). Los síntomas durante la prueba fueron más frecuentes en los pacientes con déficit de hierro (el 35 frente al 27%; p = 0,028) y el síntoma registrado con más frecuencia fue la fatiga. Los análisis de regresión logística multivariables mostraron que el aumento de la concentración de receptor de transferrina soluble, que indica un estado anormal del hierro, se asociaba de manera independiente con una clase avanzada de la New York Heart Association (p < 0,05). En el análisis multivariable realizado empleando modelos aditivos generalizados, el receptor de transferrina soluble y el índice de ferritina, biomarcadores que miden el estado del hierro, mostraron una asociación lineal, significativa e independiente con la capacidad de ejercicio submáxima (p = 0,03 en ambos casos). En cambio, en el análisis multivariable los valores de hemoglobina no mostraron una asociación significativa con la distancia recorrida en la prueba de marcha de 6 minutos. Conclusiones: En los pacientes con insuficiencia cardiaca crónica, el déficit de hierro, pero no así la anemia, se asoció con deterioro de la capacidad de ejercicio submáxima y limitación funcional sintomática (AU)

Introduction and objectives: To evaluate the effect of iron deficiency and anemia on submaximal exercise capacity in patients with chronic heart failure. Methods: We undertook a single-center cross-sectional study in a group of stable patients with chronic heart failure. At recruitment, patients provided baseline information and completed a 6-minute walk test to evaluate submaximal exercise capacity and exercise-induced symptoms. At the same time, blood samples were taken for serological evaluation. Iron deficiency was defined as ferritin < 100 ng/mL or transferrin saturation < 20% when ferritin is < 800 ng/mL. Additional markers of iron status were also measured. Results: A total of 538 heart failure patients were eligible for inclusion, with an average age of 71 years and 33% were in New York Heart Association class III/IV. The mean distance walked in the test was 285 ± 101 meters among those with impaired iron status, vs 322 ± 113 meters (P = .002). Symptoms during the test were more frequent in iron deficiency patients (35% vs 27%; P = .028) and the most common symptom reported was fatigue. Multivariate logistic regression analyses showed that increased levels of soluble transferrin receptor indicating abnormal iron status were independently associated with advanced New York Heart Association class (P < .05). Multivariable analysis using generalized additive models, soluble transferrin receptor and ferritin index, both biomarkers measuring iron status, showed a significant, independent and linear association with submaximal exercise capacity (P = .03 for both). In contrast, hemoglobin levels were not significantly associated with 6-minute walk test distance in the multivariable analysis. Conclusions: In patients with chronic heart failure, iron deficiency but not anemia was associated with impaired submaximal exercise capacity and symptomatic functional limitation (AU)

Insuficiencia cardíaca: Aspectos básicos de una epidemia en aumento / Heart Failure: basic issues of a growing epidemic

La insuficiencia cardíaca representa un gran problema de salud pública en el mundo, ya sea por su creciente prevalencia, como por el costo que implica el tratamiento adecuado de los pacientes que la padecen. Esta afectación es un complejo problema que se origina de un desorden estructural o funcional y deteriora lacapacidad de llenado o expulsión ventricular de la sangre. Se caracteriza a su vez, por la presencia de síntomas cardinales, como la disnea, fatiga y retención de líquido. Las principales causas de la insuficiencia cardíaca son la enfermedad isquémica, la cardiopatía hipertensiva, las cardiomiopatías dilatadas y las valvulopatias. En las etapas iniciales, la función cardíaca puede ser normal en reposo, pero noaumenta adecuadamente con el ejercicio; en estadios avanzados se vuelve anormal también en reposo. En esta revisión se resumen los aspectos básicos principales de este síndrome(AU)

Iron Status in Chronic Heart Failure: Impact on Symptoms, Functional Class and Submaximal Exercise Capacity.

INTRODUCTION AND OBJECTIVES: To evaluate the effect of iron deficiency and anemia on submaximal exercise capacity in patients with chronic heart failure. METHODS: We undertook a single-center cross-sectional study in a group of stable patients with chronic heart failure. At recruitment, patients provided baseline information and completed a 6-minute walk test to evaluate submaximal exercise capacity and exercise-induced symptoms. At the same time, blood samples were taken for serological evaluation. Iron deficiency was defined as ferritin < 100 ng/mL or transferrin saturation < 20% when ferritin is < 800 ng/mL. Additional markers of iron status were also measured. RESULTS: A total of 538 heart failure patients were eligible for inclusion, with an average age of 71 years and 33% were in New York Heart Association class III/IV. The mean distance walked in the test was 285 ± 101 meters among those with impaired iron status, vs 322 ± 113 meters (P=.002). Symptoms during the test were more frequent in iron deficiency patients (35% vs 27%; P=.028) and the most common symptom reported was fatigue. Multivariate logistic regression analyses showed that increased levels of soluble transferrin receptor indicating abnormal iron status were independently associated with advanced New York Heart Association class (P < .05). Multivariable analysis using generalized additive models, soluble transferrin receptor and ferritin index, both biomarkers measuring iron status, showed a significant, independent and linear association with submaximal exercise capacity (P=.03 for both). In contrast, hemoglobin levels were not significantly associated with 6-minute walk test distance in the multivariable analysis. CONCLUSIONS: In patients with chronic heart failure, iron deficiency but not anemia was associated with impaired submaximal exercise capacity and symptomatic functional limitation.

Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status.

AIMS: To evaluate the effect of iron deficiency (ID) and/or anaemia on health-related quality of life (HRQoL) in patients with chronic heart failure (CHF). METHODS AND RESULTS: We undertook a post-hoc analysis of a cohort of CHF patients in a single-centre study evaluating cognitive function. At recruitment, patients provided baseline information and completed the Minnesota Living with Heart Failure questionnaire (MLHFQ) for HRQoL (higher scores reflect worse HRQoL). At the same time, blood samples were taken for serological evaluation. ID was defined as serum ferritin levels <100 ng/mL or serum ferritin <800 ng/mL with transferrin saturation <20%. Anaemia was defined as haemoglobin ≤12 g/dL. A total of 552 CHF patients were eligible for inclusion, with an average age of 72 years and 40% in NYHA class III or IV. The MLHFQ overall summary scores were 41.0 ± 24.7 among those with ID, vs. 34.4 ± 26.4 for non-ID patients (P = 0.003), indicating worse HRQoL. When adjusted for other factors associated with HRQoL, ID was significantly associated with worse MLHFQ overall summary (P = 0.008) and physical dimension scores (P = 0.002), whereas anaemia was not (both P > 0.05). Increased levels of soluble transferrin receptor were also associated with impaired HRQoL (P ≤ 0.001). Adjusting for haemoglobin and C-reactive protein, ID was more pronounced in patients with anaemia compared with those without (P < 0.001). CONCLUSION: In patients with CHF, ID but not anaemia was associated with reduced HRQoL, mostly due to physical factors.