Cardio-Metabolic Health Venezuelan Study (EVESCAM): Design and Implementation / Estudio Venezolano de Salud Cardio-Metabólica (EVESCAM): Diseño e Implementación

The EVESCAM (EstudioVenezolano de Salud Cardio-Metabólica) is the first national, population survey in Venezuela, designed to examine the prevalence of diabetes and cardio-metabolic risk factors and its relationship with lifestyle. It is a cross-sectional, cluster sampling study, which recruited 4454 participants aged ≥ 20 years. The data were collected in community health-care centers by trained health professionals and medical students. The data collected from each subject included, after informed consent, structured questionnaires (clinical, demographic, physical activity, nutritional and psychological), anthropometric measurements (weight, height and waist circumference), body fat by bioelectrical impedance, hand grip, blood pressure, electrocardiogram, and biochemical measurements (standard 75 g oral glucose tolerance test, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). The data will be used to estimate the prevalence of overweight, obesity, prediabetes, diabetes, hypertension, dyslipidemias, sarcopenia and metabolic syndrome; and to examine their relationships with lifestyle factors. The risk of coronary heart disease and impaired glucose regulation will be estimated using the Framingham Coronary Heart Disease Risk Score and the Latin America adaptation of the Finnish Diabetes Risk Score (LA-FINDRISC), respectively. These results will guide national cardiovascular and diabetes prevention strategies, and will be available for government agencies to help in the implementation of public health policies.

El EVESCAM (Estudio Venezolano de Salud Cardio-Metabólica) es el primer estudio poblacional de muestreo nacional en Venezuela diseñado para examinar la prevalencia de diabetes y factores de riesgo cardio-metabólico, y su relación con el estilo de vida. Se trata de un estudio transversal de muestreo por conglomerados, reclutando 4454 participantes de 20 años o más. Los datos fueron recogidos en centros de salud de la comunidad por profesionales de salud y estudiantes de medicina entrenados. Después del consentimiento infor mado, los datos recolectados en cada sujeto incluyeron: cuestionarios estructurados (clínico, demográfico, actividad física, nutricional y psicológico), medidas antropométricas (peso, talla y circunferencia de cintura), grasa corporal por impedancia bioeléctrica, fuerza de aprehensión de la mano, presión arterial, electrocardiograma y medidas bioquímicas (prueba de tolerancia a la glucosa oral estándar con 75 g de glucosa, colesterol total, colesterol HDL, colesterol LDL y triglicéridos). Los datos se utilizarán para estimar la prevalencia de sobrepeso, obesidad, prediabetes, diabetes, hipertensión arterial, dislipidemias, sarcopenia y síndrome metabólico; y para examinar sus relaciones con factores de estilo de vida. El riesgo de cardiopatía coronaria y de alteración de la regulación de la glucosa se calculará utilizando la puntuación de riesgo de la enfermedad coronaria de Framingham y la adaptación para Latinoamérica de la puntuación finlandesa del riesgo de diabetes (LA-FINDRISC), respectivamente. Estos resultados guiarán las estrategias nacionales de prevención cardiovascular y diabetes, y estarán disponibles para que las agencias gubernamentales ayuden en la implementación de las políticas de salud pública.

Cardio-Metabolic Health Venezuelan Study (EVESCAM): Design and Implementation.

The EVESCAM (EstudioVenezolano de Salud Cardio-Metabólica) is the first national, population survey in Venezuela, designed to examine the prevalence of diabetes and cardio-metabolic risk factors and its relationship with lifestyle. It is a cross-sectional, cluster sampling study, which recruited 4454 participants aged ≥ 20 years. The data were collected in community health-care centers by trained health professionals and medical students. The data collected from each subject included, after informed consent, structured questionnaires (clinical, demographic, physical activity, nutritional and psychological), anthropometric measurements (weight, height and waist circumference), body fat by bioelectrical impedance, hand grip, blood pressure, electrocardiogram, and biochemical measurements (standard 75 g oral glucose tolerance test, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). The data will be used to estimate the prevalence of overweight, obesity, prediabetes, diabetes, hypertension, dyslipidemias, sarcopenia and metabolic syndrome; and to examine their relationships with lifestyle factors. The risk of coronary heart disease and impaired glucose regulation will be estimated using the Framingham Coronary Heart Disease Risk Score and the Latin America adaptation of the Finnish Diabetes Risk Score (LA-FINDRISC), respectively. These results will guide national cardiovascular and diabetes prevention strategies, and will be available for government agencies to help in the implementation of public health policies.

Estudio venezolano de salud cardiometabólica (EVESCAM): descripción general y muestreo / Venezuelan cardiometabolic health study (EVESCAM): overview and sampling

El Estudio Venezolano de Salud Cardio-Metabólica (EVESCAM) es el primer estudio multicéntrico sobre la Salud cardiometabólica del venezolano. Evaluar la prevalencia de diabetes y Factores de Riesgo Cardio-Metabólico (FRCM), y su relación con el estilo de vida en Venezuela. Es un estudio poblacional, transversal, con muestreo por conglomerados, cuyo objetivo es evaluar a 4200 participantes ≥ 20 años de las 8 regiones de Venezuela. Los datos serán recolectados en centros asistenciales por profesionales de la salud y estudiantes de medicina previamente capacitados y certificados. Después de obtener el consentimiento informado, en cada participante se realizarán: a. Cuestionarios estructurados para obtener datos clínicos, demográficos, de actividad física, nutricionales, psicológicos y estratos sociales; b. examen físico (peso, talla, grasa corporal por bioimpedancia, circunferencia de la cintura, fuerza de aprehensión de la mano, presión arterial y electrocardiograma) y c. Pruebas bioquímicas (Prueba de Tolerancia a la Glucosa -PTGO- estándar 75 g, colesterol total, HDL-colesterol, LDL-colesterol y triglicéridos). Además se calculará el riesgo de enfermedad cardíaca coronaria (por puntaje de Framingham) y la regulación de la glucosa alterada (por puntaje FINDRISC modificado). Se estimará la prevalencia de sobrepeso, obesidad, prediabetes, diabetes, hipertensión, dislipidemias, sarcopenia, síndrome metabólico y su relación con los factores de estilo de vida (nutrición, actividad física, estrés psicosocial, uso de tabaco y alcohol). En esta primera parte se explica la metodología y la aplicación del muestreo a la Ciudad de Barquisimeto.

This is the first cardiometabolic multicentric study of the Venezuelan people cardiometabolic health. To evaluate the relationship of the prevalence of diabetes and risk factors with Venezuelan lifestyle. This is a population, transverse, with conglomerates of 4200 of 20 or more years-old in 8 areas of Venezuela. Data were colected in different health centers by physicians and medical students, who had been enabled for this. After obtaining consented inform, to each participant the following was applied: 1) structured questionaires for clinical data, demography, physical activity, nutrition, psicological traits and social status. 2. complete physical examination, including EKG). 3. Glucose tolerance test, lipid profile, Framingham score and FINDRISK modified score. Prevalence of overweight, obesity, prediabetes, hypertension, dyslipidemia, sarcopenia, metabolic syndrome and their relationship with lifestyle factors. This is the first parte in the city of Barquisimeto.

Denervação simpática renal para o controle da hipertensão arterial resistente / Renal sympathetic denervation for treatment of resistant hypertension

INTRODUÇÃO: A hipertensão arterial sistêmica afeta mais de 1,2 milhão de pessoas no mundo. Apenas 35% dos pacientes hipertensos têm valores de pressão arterial controlados. Recentemente a denervação simpática renal (DSR) tem demonstrado diminuir significativamente os valores de pressão arterial nos pacientes com hipertensão arterial sistêmica resistente. MÉTODOS: Estudo prospectivo, de braço único, observacional, multicêntrico, incluindo pacientes consecutivos submetidos a DSR. O objetivo primário foi avaliar os níveis da pressão arterial sistólica aos 30 dias de seguimento. O objetivo secundário foi determinar a ocorrência de qualquer evento adverso relacionado com o procedimento. RESULTADOS: Foram incluídos os primeiros 20 pacientes submetidos a DSR. A média de pressão arterial antes do procedimento foi de 171,6/93,2 ± 15,5/11,3 mmHg, com média de uso de 4,1 ± 1,5 fármacos anti-hipertensivos por paciente. A taxa de sucesso foi de 95%, tendo sido aplicadas 11,1 ± 1,9 ablações por paciente. Foi observada diminuição média de 29 ± 21 mmHg (P = 0,009) na pressão arterial sistólica 30 dias após o procedimento. Não houve complicação associada ao procedimento. CONCLUSÕES: A DSR por cateter em pacientes da prática clínica diária diminuiu significativamente os valores de pressão arterial. Em nossa experiência, a DSR demonstrou ser factível e segura.

BACKGROUND: Systemic arterial hypertension affects over 1.2 million people worldwide. Only 35% of hypertensive patients have controlled blood pressure levels. Renal sympathetic denervation (RSD) has shown to significantly decrease blood pressure levels in patients with resistant systemic hypertension. METHODS: Prospective, single arm, observational, multicenter study including consecutive patients undergoing RSD. The primary endpoint was to assess systolic blood pressure levels at the 30-day follow-up. The secondary endpoint was to determine the presence of procedure-related adverse events. RESULTS: The first 20 patients undergoing RSD were included. The average blood pressure prior the procedure was 171.6/93.2 ± 15.5/ 11.3 mmHg, with the use of 4.1 ± 1.5 antihypertensive drugs per patient. Success rate was 95%, and 11.1 ± 1.9 ablations were performed per patient. A systolic blood pressure decrease of 29 ± 21 mmHg (P = 0.009) was observed 30 days after the procedure. There were no procedure-related complications. CONCLUSIONS: Catheter-based RSD in daily clinical practice patients significantly decreased blood pressure levels. In our experience, RSD proved to be feasible and safe.

Amiloidosis cutánea / Cutaneous amyloidosis

Paciente masculino de 54 años de edad, quien refiere inicio de enfermedad actual en junio de 2010 cuando evidencia aumento de volumen y dolor en ambos tobillos, astenia y pérdida de peso de 20 kilogramos y fiebre. Ingresó con epistaxis profusa, lesiones descamativas, dolorosas en miembros superiores, a predominio de regiones antebraquiales y manos. Inmunoelectroforesis de Ig en suero: hipergammaglobulinemia 2494mg/100ml. Biopsia de grasa periumbilical: positiva para depósitos amiloides a tinción con rojo Cong...

The "crush and aspiration" technique for debridement of the aortic annulus revisited.

An effective technique for the debridement of the aortic annulus using a needle holder to crush the calcify nodules, follow by the immediate aspiration of the pulverized material using a Yankauer suction device is reported.

[Effect of using several levels of positive end-expiratory pressure over barotrauma's induced lung injury in a model of isolated and perfused rabbit lungs]. / Estudio del efecto de las variaciones de la Presión Positiva Espiratoria Final en el daño pulmonar inducido por barotrauma en un modelo de pulmones de conejo aislados y perfundidos.

The use of Positive end-expiratory pressure (PEEP) as a strategy of mechanical ventilation offers its advantages, such as improved oxygenation, without causing alveolar overstretching and barotrauma. We aim to investigate the effect of several levels of PEEP on barotrauma and, whether an optimal level of PEEP exists. Forty-eight New Zealand rabbits (2.5-3.5 kg) were divided into four groups with PEEP settings of 0, 4, 8 and 12 cmH2O, at increasing levels of inspiratory volume (IV). This was done in blood perfused rabbit lungs and in lungs perfused with a Buffer-Albumin Solution. We observed that lungs ventilated with PEEP 0 cmH2O suffered pulmonary rupture at high IV (300cc), with significant increases of Pap (Pulmonary artery pressure) and FFR (Fluid filtration rate). Lungs ventilated with PEEP 8 and 12 suffered pulmonary rupture at lower IV (200cc and 150cc vs. 300cc respectively) On the other hand, lungs ventilated with PEEP 4 cmH2O reached the highest IV (400cc), in addition, they showed the lowest elevations of Pap and FFR. The acellular lungs ventilated with PEEP 4, 8 and 12 showed pulmonary rupture at lower IV when compared with cellular ones (300cc vs. 400cc: 100cc vs. 200cc and 100cc vs. 150cc respectively). We concluded that an optimal PEEP exists, which protects against barotrauma, however, excess of PEEP could enhance its development. The blood could contain some mediators which attenuate the damage induced by barotrauma.

Estudio del efecto de las variaciones de la presión positiva espiratoria Final en el daño pulmonar inducido por barotrauma en un modelo de pulmones de conejo aislados y perfundidos / Effect of using several levels of positive end-expiratory pressure over barotrauma's induced lung injury in a model of isolated and perfused rabbit lungs

El uso de Presión Positiva Espiratoria Final (PPEF) como estrategia de ventilación mecánica es beneficioso, permite una mejor oxigenación, sin ocasionar estiramiento alveolar y barotrauma El objetivo de este trabajo es estudiar el efecto del uso de varios niveles de PPEF sobre el barotrauma y determinar si existe un nivel de PPEF óptimo protector. Cuarenta y ocho conejos New Zeland se dividieron en cuatro grupos con PPEF establecidos en 0, 4, 8 y 12 cmH2O, a niveles crecientes de volumen inspiratorio (VI). Se utilizó un modelo de pulmones de conejo aislados y perfundidos con sangre (PC) o Solución Buffer-Albúmina (PA). Las preparaciones celulares con PPEF 0 cmH2O sufrieron ruptura a VI elevados (300cc), observándose incrementos significativos de la Pap (Presión de arteria pulmonar) y de la TFL (Tasa de filtración de líquidos). Las preparaciones con PPEF 8 y 12 cmH2O sufrieron ruptura a más bajos VI (200cc y 150cc vs. 300cc respectivamente). Las preparaciones celulares con PPEF 4 cmH2O alcanzaron el VI más elevado (400cc) con el menor incremento de Pap y TFL. Las preparaciones acelulares con PPEF 4, 8 y 12 sufrieron ruptura pulmonar a menores VI en comparación con las celulares (300cc vs. 400cc; 100cc vs. 200cc y 100cc vs. 150cc respectivamente), desarrollaron mayor edema con Pap más baja. Se pudo concluir que existe una PPEF óptima que protege contra el barotrauma, excesos de PPEF, pueden, por el contrario, acelerar el desarrollo del mismo. En la sangre podría existir algún mediador que atenúa el daño producto del barotrauma

Elicitation of salient beliefs related to drug preparation practices among injection drug users in Puerto Rico.

Even when IDUs use their own syringes, the common use of drug preparation materials can expose them to blood-borne pathogens. Notwithstanding the accumulated evidence about the riskiness of drug preparation practices (DPPs), the factors that lead IDUs to engage in DPPs have remained understudied. We conducted 80 semi-structured interviews to elicit salient beliefs about engaging in low-risk DPPs. Data were content analyzed for consequences, normative influences, and barriers. For the most part respondents described positive consequences of engaging in low-risk DPPs. The majority of respondents mentioned IDU peers as a major source of pressure to engage in high-risk DPPs. Lack of access to clean materials and the need to carry materials on oneself were the most salient barriers elicited. The results suggest that preventive interventions need to address the preference for re-using filters, help develop skills to fend off pressures from peers, and increase the accessibility of materials in ways that do not require IDUs to carry additional items.

The indirect effect of Tityus discrepans on rabbit pulmonary vasculature.

Serum (IS) was obtained 0.5, 2, 4 or 6 h after inoculating s.c. six rabbits (approximately 2 kg) in each time period with 1 mg/kg of Tityus discrepans (Td) venom; the control was serum obtained from four rabbits 4 h after injecting them 1 ml s.c. of 0.9% NaCl. IS produced a transient (<25 min) rise in pulmonary artery pressure of isolated and perfused rabbit lungs, other lung parameters were not altered. We found that both scorpion venom and IS produced a approximately 50% transient increase of transendothelial electric resistance in cultured tissue human umbilical cord vein. Neither venom nor IS changed the transepithelial electrical resistance of tissue cultured human airway epithelia. The experiments suggest that humoral factors contained in the inoculated serum modify vascular endothelium in a much more effective manner than the venom by itself. These experiments also make it unlikely that vascular endothelium is the source of the humoral factors contained in inflammatory serum.

Piomiositis tropical: presentación de cuatro casos con especial análisis de las dificultades en su reconocimiento / Tropical pyomyositis: presentation of 4 cases with special analysis of difficulties in its recognition

El presente reporte de casos trata de ilustrar las dificultades que se tienen a la hora de diagnósticar una enfermedad propia de nuestro medio, pero que con frecuencia nos simula otras patologías tales como espondiloartropatías, sepsis, artritis séptica, tromboflebitis y otras. El S. aureus es el responsable de la mayoría de los casos y en los cuales es necesario un fuerte índice de sospecha para identificar la presencia de la infección muscular. El diagnóstico precoz y tratamiento oportuno reduce la morbilidad y mortalidad en la población afectada

Hepatitis crónica autoinmune: espectro clínico patológico en 7 casos / Autoimmune chronic active hepatitis: clinical and pathological findings in 7 patients

Se presentan los hallazgos clínicos y anatomopatológicos de 7 pacientes del sexo femenino con hepatitis crónica activa autoinmune. Los motivos de consulta fueron: ictericia y coluria (3 casos), artralgias (2), malestar general (2), fiebre (1), dolor abdominal, púrpura y astenia en (1). Se detectó hepatoesplenomegalia en todas las pacientes, ictericia en (4), ascitis en (2) y várices esofágicas en (1). Las pruebas de bioquímica evidenciaron grados variables de alteración y las proteínas plasmáticas estuvieron elevadas en 6, a expensas de las gammaglobulinas. Los marcadores para hepatitis B fueron negativos. Las pruebas inmunológicas revelaron AAN en 6 casos, antimúsculo liso en 3 y antimitocondriales en 1. Las biopsias hepáticas mostraron evidencia de hepatitis crónica activa, con regeneración nodular incipiente del parénquima en 3 y evidencia de cirrosis en 1. Los infiltrados inflamatorios se consideraron conspicuos en todas las muestras, constantándose una proporción importante de plasmocitosis. Todos recibieron tratamiento con prednisona y en 3 pacientes aparecieron efectos secundarios. En la mayoría de los casos se logró una mejoría del funcionalismo hepático y disponemos de biopsia control en uno