[Validation of a high sensitive troponin 99th percentile obtained in a general hospital]. / Validación de percentil 99 de troponina ultrasensible obtenido en la población de un hospital general.

Introduction: High sensitivity cardiac Troponin T (hs-cTnT) dosage is recommended for myocardial infarction diagnosis, by applying the 99th percentile obtained from a healthy population by the manufacturer. The objective is to validate the 99th percentile in a population from our hospital (99L), compared with the manufacturer´s 99th percentile (99F) by using coronary angiography as gold standard. Materials and Methods: Retrospective analysis of every hs-cTnT (Roche) obtained from patients admitted with acute coronary syndromes (ACS) who underwent coronary angiography between 2015 and 2018. Results: 415 patients were included for analysis (118 females, 64.2 yo). 99F sensitivity (Sn) for significant coronary artery disease (stenosis >70%) was 83.6%, with a specificity (Sp) of 44.5%. Positive predictive value (PPV) and negative predictive value (NPV) were 77% and 55% respectively. 99L Sn was 69.7% and Sp 58.6%. PPV was 79% and NPV 46%. ROC curve was 0.641 for 99F and 0.641 for 99L. Conclusion: Given the importance of hs-cTnT in ACS diagnosis, the 99F should be the preferred upper reference limit since the sensitivity is better, although lower compared to prior studies.

Introducción: El dosaje de troponina ultrasensible (TnT US) se recomienda para el diagnóstico de infarto de miocardio, para lo cual se utiliza como punto de corte el percentil 99 (p99) obtenido por el fabricante (99F) en población sana. El objetivo de este estudio es validar el p99 obtenido en la población de este hospital (99L) frente al 99F, utilizando la cinecoronariografía (CCG) como gold standard. Materiales y Métodos: análisis retrospectivo de TnT US Roche realizada a todos los pacientes que ingresaron por SCA (síndrome coronario agudo) a los que se les realizó CCG entre 2015 y 2018. Se utilizó para el procesamiento estadístico el programa IBM SPSS Statistics 24 y tablas de sensibilidad y especificidad para métodos diagnósticos (EviCardio). Resultados: se incluyeron 415 pacientes, 118 de sexo femenino, con edad de 64,2 ± 12,5 años. La sensibilidad del 99F para diagnóstico de enfermedad coronaria severa (obstrucción ≥ 70%) fue de 83,6% y la especificidad, 44,5%. El valor predictivo positivo (VPP) fue de 77% y el negativo (VPN) 55%. La sensibilidad del 99L se calculó en 69,7% y la especificidad, 58,6%. El VPP fue 79% y el VPN 46%. El ABC (área bajo la curva) resultó ser 0,641 para el 99Fy 0,641 para el 99L Conclusiones: Debido a la importancia de la sensibilidad en el uso de la TnT US como herramienta diagnóstica ante la sospecha de SCA, debemos seguir utilizando el 99F ya que mostró mayor sensibilidad que 99L (aunque menor a la reportada en estudios previos).

[Effectiveness of transthoracic echocardiogram in patent foramen ovale diagnosis. Systematic review of last ten years.] / Eficacia del ecocardiograma transtorácico para el diagnóstico de foramen oval permeable. Revisión sistemática de los últimos diez años.

Background: Transesophageal echo (TEE) bubble study is the current gold standard for patent foramen ovale (PFO) diagnosis, but it has the disadvantage of being semi-invasive and not exempted from risks. The aim of this study was to determine the accuracy of TTE compared to TEE for PFO diagnosis. Methods and results: a systematic review was done on Medline with the terms "transthoracic echocardiography, transesophageal echocardiography, patent foramen ovale, diagnosis" yielding published literature of the last ten years. The search was completed in february 2018. Of 715 articles, 10 were analyzed. The total of patients were 1268 (mean age of 47 years +/-14) with a global prevalence of PFO of 48%. The sensibility of ETT was 90 % (IC 95: 88 % - 92 %) and the specificity 92% (IC 95: 89 % - 94 %). The positive predictive value was 93% (IC 95: 90 % - 94 %) and the negative predictive value 89 % (IC 95: 87 % - 91 %). The area under the curve and Q index value were 0,97 and 0,93 respectively. The positive and negative likelihood ratio were 18,989 and 0,072 respectively. Conclusion: The ETT shows a good specificity and sensibility for PFO diagnosis with last generation equipments, contrast use and valsalva maneuver; according to the analyzed studies.

Introducción: El ecocardiograma transesofágico (ETE) con burbujas es el estudio de referencia para el diagnóstico de foramen oval permeable (FOP), es semi-invasivo y no exento de riesgos. Nuestro objetivo fue determinar la eficacia del ecocardiograma transtorácico (ETT) para el diagnóstico de FOP, en comparación con el ETE. Métodos y resultados: Se realizó una búsqueda en MEDLINE de los últimos 10 años con las palabras claves: "ecocardiograma transtorácico, ecocardiograma transesofágico, foramen oval permeable, diagnóstico". La búsqueda se completó el 28 de Febrero de 2018. De 715 artículos, se seleccionaron 10 para analizar. El total de pacientes fue 1268, edad promedio de 47 años +/-14. La prevalencia global de FOP fue de 48%. La sensibilidad del ETT fue de 90% (IC 95: 88% - 92%) y la especificidad de 92% (IC 95: 89% - 94%). El valor predictivo positivo fue de 93% (IC 95: 90% - 94%) y el valor predictivo negativo de 89% (IC 95: 87% - 91%). El área bajo la curva y el índice Q fueron 0,97 y 0,93 respectivamente. El cociente de probabilidad positivo fue de 18,989 y el negativo de 0,072. Conclusión: El ETT muestra una buena especificidad y sensibilidad para el diagnóstico de FOP con equipos de última generación, uso de contraste y maniobra de Valsalva; según los estudios analizados.

Unchanged Levels of Soluble CD14 and IL-6 Over Time Predict Serious Non-AIDS Events in HIV-1-Infected People.

HIV-1-infected persons have increased risk of serious non-AIDS events (SNAEs) despite suppressive antiretroviral therapy. Increased circulating levels of soluble CD14 (sCD14), soluble CD163 (sCD163), and interleukin-6 (IL-6) at a single time point have been associated with SNAEs. However, whether changes in these biomarker levels predict SNAEs in HIV-1-infected persons is unknown. We hypothesized that greater decreases in inflammatory biomarkers would be associated with fewer SNAEs. We identified 39 patients with SNAEs, including major cardiovascular events, end stage renal disease, decompensated cirrhosis, non-AIDS-defining malignancies, and death of unknown cause, and age- and sex-matched HIV-1-infected controls. sCD14, sCD163, and IL-6 were measured at study enrollment (T1) and proximal to the event (T2) or equivalent duration in matched controls. Over ∼34 months, unchanged rather than decreasing levels of sCD14 and IL-6 predicted SNAEs. Older age and current illicit substance abuse, but not HCV coinfection, were associated with SNAEs. In a multivariate analysis, older age, illicit substance use, and unchanged IL-6 levels remained significantly associated with SNAEs. Thus, the trajectories of sCD14 and IL-6 levels predict SNAEs. Interventions to decrease illicit substance use may decrease the risk of SNAEs in HIV-1-infected persons.

Situación de Salud de la adolescencia en la Argentina / Situation of Adolescent Health in Argentina

El informe se estructura en capítulos que describen diferentes dimensiones de la salud de los y las adolescentes del país. En el primer capitulo se describen las fuentes que utilizaron para el diagnostico. Los capítulos siguientes abordan en forma sucesiva la dimensión sociodemográfica, la situación de salud enfermedad, incluyendo la salud sexual y reproductiva, la alimentación, la actividad física, la salud mental, las violencias, el consumo de sustancias y la mortalidad de los y las adolescentes y el acceso a los servicios de salud

[Infant Mortality in Argentina: reducibility criteria, 3rd review]. / Mortalidad infantil en Argentina: 3a revisión de los criterios de reducibilidad.

The infant mortality rate is an indicator of quality of life, development, and quality and accessibility of health care. Improvements in science, technology and better access to health care have contributed to a major decrease in the infant mortality rate in Argentina. Since the 1980s, infant deaths have been classified based on the opportunities for reducibility yielded by scientific knowledge and available technologies, in order to obtain a basis for the monitoring and implementation of health policies. The last review of this classification was in 2011. In 2012, a total of 5,541 neonatal deaths (less than 28 days of life) were registered and, under this new classification, over 61% were reducible mainly by the improvement of perinatal health care and adequate and timely treatment of the at-risk newborn. In 2012, a total of 2,686 post-neonatal deaths (from 28 days of life to a year) were registered and, under this new classification, over 66.8% were reducible by improving prevention strategies and providing adequate and timely treatment. This new analysis demonstrates the need to improve the opportunity, accessibility and quality of perinatal care starting at pregnancy, guaranteeing quality care at delivery and reinforcing prevention and timely treatment of common diseases in childhood over the first year of life.

Safety, efficacy and acceptability of outpatient mifepristone-misoprostol medical abortion through 70 days since last menstrual period in public sector facilities in Mexico City.

Extensive evidence exists regarding the efficacy and acceptability of medical abortion through 63 days since last menstrual period (LMP). In Mexico City's Secretariat of Health (SSDF) outpatient facilities, mifepristone-misoprostol medical abortion is the first-line approach for abortion care in this pregnancy range. Recent research demonstrates continued high rates of complete abortion through 70 days LMP. To expand access to legal abortion services in Mexico City (where abortion is legal through 12 weeks LMP), this study sought to assess the efficacy and acceptability of the standard outpatient approach through 70 days in two SSDF points of service. One thousand and one women seeking pregnancy termination were enrolled and given 200 mg mifepristone followed by 800 µg misoprostol 24-48 hours later. Women were asked to return to the clinic one week later for evaluation. The great majority of women (93.3%; 95% CI: 91.6-94.8) had complete abortions. Women with pregnancies ≤ 8 weeks LMP had significantly higher success rates than women in the 9th or 10th weeks (94.9% vs. 90.5%; p = 0.01). The difference in success rates between the 9th and 10th weeks was not significant (90.0% vs. 91.2%; p = 0.71). The majority of women found the side effects (82.9%) and the use of misoprostol (84.4%) to be very acceptable or acceptable. This study provides additional evidence supporting an extended outpatient medical abortion regimen through 10 weeks LMP.

Efficacy and acceptability of a mifepristone-misoprostol combined regimen for early induced abortion among women in Mexico City.

OBJECTIVE: To evaluate the experience of women receiving mifepristone-misoprostol for early induced abortion in public sector facilities in the Federal District of Mexico City. METHODS: An open-label prospective study was conducted with 1000 pregnant women who sought induced abortion with a pregnancy of up to 63days of gestation, as measured from the date of their last menstrual period. The study was conducted in three public sector healthcare facilities: two secondary level hospitals and one primary care clinic. Women ingested 200mg mifepristone on day 1, followed by 800µg buccal misoprostol 24hours later, and they returned for follow-up on day 8. The primary outcome was complete abortion without recourse to surgical intervention. RESULTS: A total of 971 women received mifepristone-misoprostol and were included in the analysis for efficacy of treatment. The overall efficacy of the combined medical abortion regimen studied was 97.3% (n=945); the success rate did not vary significantly by gestational age (95.9%-100%; P=0.449). Most women (n=922, 95.0%) had a successful induced abortion with only one dose of misoprostol. CONCLUSION: The combined mifepristone and buccal misoprostol regimen was found to be highly effective and acceptable among Mexican women. www.ClinicalTrials.gov: NCT00386282.

[Social inequalities in cervical cancer mortality in the Autonomous City of Buenos Aires, 1999-2003 and 2004-2006]. / Desigualdades sociales en la mortalidad por cáncer de cuello de útero en la Ciudad Autónoma de Buenos Aires, 1999-2003 y 2004-2006.

The aim of this study was to describe the spatial distribution of cervical cancer mortality in the Autonomous City of Buenos Aires during the period 1999-2003 and its relationship to the socioeconomic conditions of the population, as well as to compare the distribution during this period with that of the triennium 2004-2006. This ecological study used electoral districts as the unit of analysis. The selected socioeconomic indicators were educational deficit, lack of health insurance and the Material Deprivation of Households Index (Índice de Privación Material de Hogares), taken from the National Population and Housing Census (Censo Nacional de Población, Hogares y Viviendas) of 2001. The stratification of the city into areas according to these conditions and the analysis of standardized mortality ratios showed an increased risk of dying from cervical cancer associated with worse socioeconomic conditions. The stratification and death risks demonstrated a clear spatial pattern, with the south of the city presenting the highest death risks, and the northern and central areas presenting the lowest risks.

Desigualdades sociales en la mortalidad por cáncer de cuello de útero en la Ciudad Autónoma de Buenos Aires, 1999-2003 y 2004-2006 / Social inequalities in cervical cancer mortality in the Autonomous City of Buenos Aires, 1999-2003 and 2004-2006

El objetivo del trabajo fue describir la distribución espacial de la mortalidad por cáncer de cuello de útero en la Ciudad Autónoma de Buenos Aires en el período 1999-2003 y su relación con condiciones socioeconómicas de la población y cotejar esa distribución con la observada en el trienio 2004-2006. Se utilizó un diseño de estudio ecológico cuya unidad de análisis fueron las circunscripciones electorales. Los indicadores socioeconómicos seleccionados fueron déficit de instrucción, ausencia de cobertura de salud e Índice de Privación Material de Hogares, provenientes del Censo Nacional de Población, Hogares y Viviendas 2001. La estratificación de la ciudad en áreas según dichas condiciones y el análisis de las razones de mortalidad estandarizadas mostraron que el riesgo de morir por esta causa aumentó a medida que empeoraron las condiciones socioeconómicas de la ciudad. Se evidenció una clara espacialidad en la estratificación y los riesgos de mortalidad. La zona sur presentó los mayores riesgos, mientras que en la zona norte-centro se registraron los menores.

The aim of this study was to describe the spatial distribution of cervical cancer mortality in the Autonomous City of Buenos Aires during the period 1999-2003 and its relationship to the socioeconomic conditions of the population, as well as to compare the distribution during this period with that of the triennium 2004-2006. This ecological study used electoral districts as the unit of analysis. The selected socioeconomic indicators were educational deficit, lack of health insurance and the Material Deprivation of Households Index (Índice de Privación Material de Hogares), taken from the National Population and Housing Census (Censo Nacional de Población, Hogares y Viviendas) of 2001. The stratification of the city into areas according to these conditions and the analysis of standardized mortality ratios showed an increased risk of dying from cervical cancer associated with worse socioeconomic conditions. The stratification and death risks demonstrated a clear spatial pattern, with the south of the city presenting the highest death risks, and the northern and central areas presenting the lowest risks.

Desigualdades sociales en la mortalidad por cáncer de cuello de útero en la Ciudad Autónoma de Buenos Aires, 1999-2003 y 2004-2006 / Social inequalities in cervical cancer mortality in the Autonomous City of Buenos Aires, 1999-2003 and 2004-2006

El objetivo del trabajo fue describir la distribución espacial de la mortalidad por cáncer de cuello de útero en la Ciudad Autónoma de Buenos Aires en el período 1999-2003 y su relación con condiciones socioeconómicas de la población y cotejar esa distribución con la observada en el trienio 2004-2006. Se utilizó un diseño de estudio ecológico cuya unidad de análisis fueron las circunscripciones electorales. Los indicadores socioeconómicos seleccionados fueron déficit de instrucción, ausencia de cobertura de salud e Indice de Privación Material de Hogares, provenientes del Censo Nacional de Población, Hogares y Viviendas 2001. La estratificación de la ciudad en áreas según dichas condiciones y el análisis de las razones de mortalidad estandarizadas mostraron que el riesgo de morir por esta causa aumentó a medida que empeoraron las condiciones socioeconómicas de la ciudad. Se evidenció una clara espacialidad en la estratificación y los riesgos de mortalidad. La zona sur presentó los mayores riesgos, mientras que en la zona norte-centro se registraron los menores.(AU)

The aim of this study was to describe the spatial distribution of cervical cancer mortality in the Autonomous City of Buenos Aires during the period 1999-2003 and its relationship to the socioeconomic conditions of the population, as well as to compare the distribution during this period with that of the triennium 2004-2006. This ecological study used electoral districts as the unit of analysis. The selected socioeconomic indicators were educational deficit, lack of health insurance and the Material Deprivation of Households Index (Indice de Privación Material de Hogares), taken from the National Population and Housing Census (Censo Nacional de Población, Hogares y Viviendas) of 2001. The stratification of the city into areas according to these conditions and the analysis of standardized mortality ratios showed an increased risk of dying from cervical cancer associated with worse socioeconomic conditions. The stratification and death risks demonstrated a clear spatial pattern, with the south of the city presenting the highest death risks, and the northern and central areas presenting the lowest risks.(AU)

Desigualdades sociales en la mortalidad por cáncer de cuello de útero en la Ciudad Autónoma de Buenos Aires, 1999-2003 y 2004-2006. / [Social inequalities in cervical cancer mortality in the Autonomous City of Buenos Aires, 1999-2003 and 2004-2006].

The aim of this study was to describe the spatial distribution of cervical cancer mortality in the Autonomous City of Buenos Aires during the period 1999-2003 and its relationship to the socioeconomic conditions of the population, as well as to compare the distribution during this period with that of the triennium 2004-2006. This ecological study used electoral districts as the unit of analysis. The selected socioeconomic indicators were educational deficit, lack of health insurance and the Material Deprivation of Households Index (Indice de Privación Material de Hogares), taken from the National Population and Housing Census (Censo Nacional de Población, Hogares y Viviendas) of 2001. The stratification of the city into areas according to these conditions and the analysis of standardized mortality ratios showed an increased risk of dying from cervical cancer associated with worse socioeconomic conditions. The stratification and death risks demonstrated a clear spatial pattern, with the south of the city presenting the highest death risks, and the northern and central areas presenting the lowest risks.

Evaluación del programa de detección prenatal de defectos congénitos por ultrasonido en la provincia Granma, 2008-2011 / Evaluation of the congenital defects ultrasonographic prenatal diagnosis program in the Granma province: 2008-2011

Se realizó un estudio descriptivo de corte transversal, sobre el programa de detección prenatal de defectos congénitos por ultrasonido, en la provincia de Granma, en el periodo de 2008 a 2011. Se incluyeron las gestantes evaluadas en los 13 municipios, los datos del Registro Cubano de Malformaciones Congénitas, y se valoraron los informes de las interrupciones de embarazos por defectos congénitos. Se estudiaron las variables: cobertura de ultrasonido, casos positivos del primer y segundo trimestre, patologías diagnosticadas, entre otras. Se calculó la especificidad, sensibilidad, valores predictivos, proporciones y porcentajes. La cobertura del programa en el primer trimestre fue 92,8(percent), mientras que la del segundo trimestre ascendió a 99,1 (percent). La sensibilidad de la prueba diagnóstica osciló entre 64,4 y 77 (percent), con una especificidad de 100 (percent). Los defectos congénitos más frecuentes fueron las cardiopatías. El programa mostró resultados positivos en el periodo…(AU)

Metabolic and mitogenic effects of IGF-I and insulin on muscle cells of rainbow trout.

The relative function of IGF-I and insulin on fish muscle metabolism and growth has been investigated by the isolation and culture at different stages (myoblasts at day 1, myocytes at day 4, and myotubes at day 10) of rainbow trout muscle cells. This in vitro model avoids interactions with endogenous peptides, which could interfere with the muscle response. In these cells, the effects of IGF-I and insulin on cell proliferation, 2-deoxyglucose (2-DG), and l-alanine uptake at different development stages, and the use of inhibitors were studied and quantified. Insulin (10-1,000 nM) and IGF-I (10-100 nM) stimulated 2-DG uptake in trout myocytes at day 4 in a similar manner (maximum of 124% for insulin and of 142% for IGF-I), and this stimulation increased when cells differentiated to myotubes (maximum for IGF-I of 193%). When incubating the cells with PD-98059 and especially cytochalasin B, a reduction in 2-DG uptake was observed, suggesting that glucose transport takes place through specific facilitative transporters. IGF-I (1-100 nM) stimulated the l-alanine uptake in myocytes at day 4 (maximum of 239%), reaching higher values of stimulation than insulin (100-1,000 nM) (maximum of 160%). This stimulation decreased when cells developed to myotubes at day 10 (118% for IGF-I and 114% for insulin). IGF-I (0.125-25 nM) had a significant effect on myoblast proliferation, measured by thymidine incorporation (maximum of 170%), and required the presence of 2-5% fetal serum (FBS) to promote thymidine uptake. On the other hand, insulin was totally ineffective in stimulating thymidine uptake. We conclude that IGF-I is more effective than insulin in stimulating glucose and alanine uptake in rainbow trout myosatellite cells and that the degree of stimulation changes when cells differentiate to myotubes. IGF-I stimulates cell proliferation in this model of muscle in vitro and insulin does not. These results indicate the important role of IGF-I on growth and metabolism of fish muscle.