Cardiometabolic risk factors and antithrombotic treatment in a Mexican population with atrial fibrillation and heart failure with reduced ejection fraction.

INTRODUCTION: Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF. OBJECTIVE: To identify cardiometabolic risk factors (CMRF) and antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender. METHODS: CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender. RESULTS: Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women. CONCLUSIONS: Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.

INTRODUCCIÓN: La insuficiencia cardiaca en pacientes con fibrilación auricular no valvular (FANV) es de dos a tres veces más frecuente que en individuos sin FANV. OBJETIVO: Identificar los factores de riesgo cardiometabólico (FRCM) y el tratamiento antitrombótico de pacientes con FANV e insuficiencia cardiaca con fracción de expulsión reducida (IC-FEr), y determinar si existen diferencias conforme al sexo. MÉTODOS: En forma global y de acuerdo con el sexo se analizaron FRCM, riesgo protrombótico, riesgo de sangrado y terapia antitrombótica. RESULTADOS: De 1423 pacientes con FANV, 336 tuvieron IC-FEr. Las mujeres promediaron mayor edad que los hombres. No hubo diferencia entre los sexos respecto al tipo de FANV o uso de anticoagulantes orales directos. La hipertensión arterial sistémica fue más frecuente en mujeres. Un 3.6 % de los pacientes reportó antecedente de ataque isquémico transitorio y 10 % de evento vascular cerebral, sin diferencias en cuanto al sexo. El porcentaje de hombres con riesgo embólico elevado fue mayor, pero sin tratamiento antitrombótico, en comparación con las mujeres. CONCLUSIONES: Se encontraron diferencias significativas de acuerdo con el sexo en pacientes con FANV e IC-FEr, tanto en FRCM y algunas comorbilidades, como en el tratamiento antitrombótico de acuerdo con el riesgo embólico y de sangrado.

Factores de riesgo cardiometabólico y tratamiento antitrombótico en población mexicana con fibrilación auricular e insuficiencia cardiaca con fracción de expulsión reducida / Cardiometabolic risk factors and antithrombotic treatment in a Mexican population with atrial fibrillation and heart failure with reduced ejection fraction

Resumen Introducción: La insuficiencia cardiaca en pacientes con fibrilación auricular no valvular (FANV) es de dos a tres veces más frecuente que en individuos sin FANV. Objetivo: Identificar los factores de riesgo cardiometabólico (FRCM) y el tratamiento antitrombótico de pacientes con FANV e insuficiencia cardiaca con fracción de expulsión reducida (IC-FEr), y determinar si existen diferencias conforme al sexo. Métodos: En forma global y de acuerdo con el sexo se analizaron FRCM, riesgo protrombótico, riesgo de sangrado y terapia antitrombótica. Resultados: De 1423 pacientes con FANV, 336 tuvieron IC-FEr. Las mujeres promediaron mayor edad que los hombres. No hubo diferencia entre los sexos respecto al tipo de FANV o uso de anticoagulantes orales directos. La hipertensión arterial sistémica fue más frecuente en mujeres. Un 3.6 % de los pacientes reportó antecedente de ataque isquémico transitorio y 10 % de evento vascular cerebral, sin diferencias en cuanto al sexo. El porcentaje de hombres con riesgo embólico elevado fue mayor, pero sin tratamiento antitrombótico, en comparación con las mujeres. Conclusiones: Se encontraron diferencias significativas de acuerdo con el sexo en pacientes con FANV e IC-FEr, tanto en FRCM y algunas comorbilidades, como en el tratamiento antitrombótico de acuerdo con el riesgo embólico y de sangrado.

Abstract Introduction: Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF. Objective: To identify cardiometabolic risk factors (CMRF) and antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender. Methods: CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender. Results: Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women. Conclusions: Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.

The influence of cognitive factors in relation to the patients' treatment adherence for non-specific chronic low-back pain. A case series.

INTRODUCTION: The positive effects of exercise programs in relation to chronic low-back pain have been long established and patient adherence has a fundamental role in the impact of the resulting benefits. On the other hand, cognitive factors have shown to be the predictors of poor outcomes in patient suffering from this condition to the point of possibly affecting adherence. OBJECTIVE: To determine the influence of cognitive factors on the adherence to a home exercise program, the patient's pain intensity and their level of disability at a two-month follow-up, specifically regarding patients with non-specific chronic low-back pain (NSCLBP). METHOD: ology: Ten patients with NSLBP underwent a home exercise program. This study was undertaken to assess their adherence rate after two months. The assessment tools included the Visual Analogue Scale (VAS), the Oswestry Disability Index pre-follow-up and post-follow-up (ODI1 and ODI2), the Tampa Kinesiophobia Scale (TSK-11), the Pain Catastrophism Scale (PCS), the Fear-Avoidance Beliefs Questionnaire (FABQ) and the General Self-efficacy Scale (GSS) respectively. RESULTS: There were no significant associations found between adherence and the selected cognitive factors. There was an association between GSS and VAS (R = 0.68, p = 0.031). A clinically relevant improvement of 6.8 points in the mean of ODI2 in relation to ODI1 was observed. CONCLUSION: The influence of cognitive factors on adherence has not been ruled out because the study had a low sample size. Future studies should replicate the evaluation protocol in a larger population.

Psychological distress and unsatisfied information needs in heart failure patients and ventricular dysfunction without previously diagnosed psychiatric disorder. Cross-sectional study in a national reference center / Distrés psicológico y necesidades de información insatisfechas en pacientes con insuficiencia cardiaca y disfunción ventricular sin trastorno psiquiátrico previamente diagnosticado. Estudio transversal en un centro de referencia nacional.

Introduction: Heart failure (HF) is a chronic disease that acutely and progressively reduces physical functionality. The patient commonly suffers from intermittent relapses that increase the likelihood of comorbidities such as chronic insomnia, cognitive impairment, alterations in sexual response, psychological distress, symptoms of anxiety and depression disorder, and decreased self-care behaviors. The objective of this study was to identify the main needs for psychological support in patients with HF. Methodology: A descriptive, cross-sectional and analytical study was carried out. Participants were selected through consecutive non-probability samples. 150 patients with a diagnosis of HF who attended the Specialized Center for Heart Failure at the National Institute of Cardiology "Ignacio Chávez" were evaluated from November 2018 to April 2019, applying the inventories: Quality of life in patients with HF (Minnesota), Hospital Anxiety and Depression Scale (HADS), psychological distress thermometer (visual analog scale) and the HF Patient Information Needs Inventory. Results: 33% of the patients perceive a high level of psychological distress that requires immediate assistance and 26.6% report a medium level that requires monitoring. The main information needs reported by the patients were information on taking medications (53.7%) and managing psychological distress (43.9%). Conclusion: Active assessment of psychological distress and unmet information needs is relevant in patients with heart failure, thus highlighting the importance of their identification and the correct design and application of evidence-based interventions aimed at their resolution.

Introducción: La insuficiencia cardiaca crónica (ICC) es una enfermedad que reduce de manera aguda y progresiva la funcionalidad física. El paciente comúnmente sufre de recaídas intermitentes que aumentan la probabilidad de comorbilidades como insomnio crónico, deterioro cognitivo, alteraciones en la respuesta sexual, estrés psicológico, síntomas de trastorno de ansiedad y depresión y disminución de las conductas de autocuidado. Objetivo: Identificar las principales necesidades de apoyo psicológico en pacientes con IC. Metodología: Se realizó un estudio descriptivo, transversal y analítico. Se evaluaron 150 pacientes con ICC del Centro Especializado en Insuficiencia Cardiaca del Instituto Nacional de Cardiología Ignacio Chávez de noviembre de 2018 a abril de 2019. Se aplicaron los inventarios: Calidad de vida en pacientes con IC (Minnesota), Escala de Ansiedad y Depresión Hospitalaria (HADS), termómetro del distrés psicológico (escala analógica visual) y el Inventario de Necesidades de Información del Paciente con IC. Resultados: Treinta y tres por ciento de los pacientes perciben un nivel alto de distrés psicológico que requiere asistencia inmediata y el 26.6% reporta un nivel medio que requiere monitoreo. Las principales necesidades de información reportadas por los pacientes fueron información sobre la toma de medicamentos (53.7%) y manejo del estrés psicológico (43.9%). Conclusión: En pacientes con IC es relevante la valoración activa de distrés psicológico y necesidades de información no cubiertas, resaltando de este modo la importancia de su identificación y el correcto diseño y aplicación de intervenciones basadas en la evidencia enfocadas a su resolución.

Employment Loss in Informal Settlements during the Covid-19 Pandemic: Evidence from Chile.

The Covid-19 pandemic has reached almost every corner of the world. Despite the historical development, approval, and distribution of vaccines in some countries, non-pharmaceutical interventions will remain an essential strategy to control the pandemic until a substantial proportion of the population has immunity. There is increasing evidence of the devastating social and economic effects of the pandemic, particularly on vulnerable communities. Individuals living in urban informal settlements are in a structurally disadvantaged position to cope with a health crisis such as the Covid-19 pandemic. Estimates of this impact are needed to inform and prioritize policy decisions and actions. We study employment loss in informal settlements before and during the Covid-19 pandemic in Chile, using a longitudinal panel study of households living in Chile's informal settlements before and during the health crisis. We show that before the pandemic, 75% of respondents reported being employed. There is a decrease of 30 and 40 percentage points in May and September 2020, respectively. We show that the employment loss is substantially higher for individuals in informal settlements than for the general population and has particularly affected the immigrant population. We also show that the pandemic has triggered neighborhood cooperation within the settlements and that targeted government assistance programs have reached these communities in a limited way. Our results suggest that individuals living in informal settlements are facing severe hardship as a consequence of the pandemic. In addition to providing much-needed support, this crisis presents a unique opportunity for long-term improvements in these marginalized communities.

Empagliflozin in Heart Failure with a Preserved Ejection Fraction.

BACKGROUND: Sodium-glucose cotransporter 2 inhibitors reduce the risk of hospitalization for heart failure in patients with heart failure and a reduced ejection fraction, but their effects in patients with heart failure and a preserved ejection fraction are uncertain. METHODS: In this double-blind trial, we randomly assigned 5988 patients with class II-IV heart failure and an ejection fraction of more than 40% to receive empagliflozin (10 mg once daily) or placebo, in addition to usual therapy. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure. RESULTS: Over a median of 26.2 months, a primary outcome event occurred in 415 of 2997 patients (13.8%) in the empagliflozin group and in 511 of 2991 patients (17.1%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.69 to 0.90; P<0.001). This effect was mainly related to a lower risk of hospitalization for heart failure in the empagliflozin group. The effects of empagliflozin appeared consistent in patients with or without diabetes. The total number of hospitalizations for heart failure was lower in the empagliflozin group than in the placebo group (407 with empagliflozin and 541 with placebo; hazard ratio, 0.73; 95% CI, 0.61 to 0.88; P<0.001). Uncomplicated genital and urinary tract infections and hypotension were reported more frequently with empagliflozin. CONCLUSIONS: Empagliflozin reduced the combined risk of cardiovascular death or hospitalization for heart failure in patients with heart failure and a preserved ejection fraction, regardless of the presence or absence of diabetes. (Funded by Boehringer Ingelheim and Eli Lilly; EMPEROR-Preserved ClinicalTrials.gov number, NCT03057951).

Adverse effects, pharmacological interactions, and cardiovascular drugs in COVID-19 treatment.

In severe coronavirus disease (COVID)-19 patients, an extraordinary systemic inflammatory response is seen. It could impact in multiple organ disorders, specially a severe myocardial injury, an acute myocarditis results in focal or global myocardial inflammation and necrosis. Those events can be present in healthy subjects or cardiovascular (CV) patients. It is clinically associated with ventricular dysfunction exacerbation or worsening and tachyarrhythmias. It is also related to a poor outcome for CV patients with ischemic heart disease, hypertensión, and heart failure. COVID-19 patients require multiple and complex treatment that alleviates symptoms, the vast variety of agents interacts with diseases and CV drugs. Our purpose is to correlate in guidance synopsis: Adverse effects, pharmacological interactions, and CV drugs in COVID-19 treatment.

En pacientes con COVID-19 grave se ha observado una extraordinaria respuesta inflamatoria sistémica. Este impacto se traduce en múltiples trastornos de órganos, especialmente cardíacos, por lesión miocárdica grave, miocarditis aguda que resulta en inflamación focal o miocárdica global, necrosis cardiaca. Estos tremendos eventos son observados en sujetos sanos como pacientes cardiovasculares. Clínicamente asociados con nueva presentación o empeoramiento de la disfunción ventricular y taquiarritmias. Relacionado a un predictor principal de malos resultado en pacientes cardiovasculares (CV), especialmente en aquellos con cardiopatía isquémica, hipertensión e insuficiencia cardíaca. Los enfermos con COVID-19 requieren múltiples y complejos tratamientos que alivien los síntomas, esta gran variedad de agentes interactúa con enfermedades y medicamentos CV. Nuestro propósito es correlacionar, en una guía sinóptica: efectos adversos, interacciones farmacológicas y fármacos cardiovasculares en el tratamiento del COVID-19.

Explaining the increment in coronary heart disease mortality in Mexico between 2000 and 2012.

BACKGROUND: Mexico is still in the growing phase of the epidemic of coronary heart disease (CHD), with mortality increasing by 48% since 1980. However, no studies have analyzed the drivers of these trends. We aimed to model CHD deaths between 2000 and 2012 in Mexico and to quantify the proportion of the mortality change attributable to advances in medical treatments and to changes in population-wide cardiovascular risk factors. METHODS: We performed a retrospective analysis using the previously validated IMPACT model to explain observed changes in CHD mortality in Mexican adults. The model integrates nationwide data at two-time points (2000 and 2012) to quantify the effects on CHD mortality attributable to changes in risk factors and therapeutic trends. RESULTS: From 2000 to 2012, CHD mortality rates increased by 33.8% in men and by 22.8% in women. The IMPACT model explained 71% of the CHD mortality increase. Most of the mortality increases could be attributed to increases in population risk factors, such as diabetes (43%), physical inactivity (28%) and total cholesterol (24%). Improvements in medical and surgical treatments together prevented or postponed 40.3% of deaths; 10% was attributable to improvements in secondary prevention treatments following MI, while 5.3% to community heart failure treatments. CONCLUSIONS: CHD mortality in Mexico is increasing due to adverse trends in major risk factors and suboptimal use of CHD treatments. Population-level interventions to reduce CHD risk factors are urgently needed, along with increased access and equitable distribution of therapies.

Management of Cardiovascular Disease Patients With Confirmed or Suspected COVID-19 in Limited Resource Settings.

In this paper, we provide recommendations on the management of cardiovascular disease (CVD) among patients with confirmed or suspected coronavirus disease (COVID-19) to facilitate the decision making of healthcare professionals in low resource settings. The emergence of novel coronavirus disease, also known as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented global challenge for the healthcare community. The ability of SARS-CoV-2 to get transmitted during the asymptomatic phase and its high infectivity have led to the rapid transmission of COVID-19 beyond geographic regions, leading to a pandemic. There is concern that COVID-19 is cardiotropic, and it interacts with the cardiovascular system on multiple levels. Individuals with established CVD are more susceptible to severe COVID-19. Through a consensus approach involving an international group this WHF statement summarizes the links between cardiovascular disease and COVID-19 and present some practical recommendations for the management of hypertension and diabetes, acute coronary syndrome, heart failure, rheumatic heart disease, Chagas disease, and myocardial injury for patients with COVID-19 in low-resource settings. This document is not a clinical guideline and it is not intended to replace national clinical guidelines or recommendations. Given the rapidly growing burden posed by COVID-19 illness and the associated severe prognostic implication of CVD involvement, further research is required to understand the potential mechanisms linking COVID-19 and CVD, clinical presentation, and outcomes of various cardiovascular manifestations in COVID-19 patients.

Correction: Management of Cardiovascular Disease Patients With Confirmed or Suspected COVID-19 in Limited Resource Settings.

[This corrects the article DOI: 10.5334/gh.823.].

Characteristics and 2-year outcomes of dabigatran treatment in patients with heart failure and atrial fibrillation: GLORIA-AF.

AIMS: This study aimed to describe baseline characteristics of patients with atrial fibrillation (AF) at risk of stroke with and without history of heart failure (HF) and report 2-year outcomes in the dabigatran-treated subset of a prospective, global, observational study (GLORIA-AF). METHODS AND RESULTS: Newly diagnosed patients with AF and CHA2 DS2 -VASc score ≥ 1 were consecutively enrolled. Baseline characteristics were assessed by the presence or absence of HF diagnosis at enrolment. Incidence rates for outcomes in dabigatran-treated patients were estimated with and without standardization by stroke (excluding HF component) and bleeding risk scores. A total of 15 308 eligible patients were enrolled, including 15 154 with known HF status; of these, 3679 (24.0%) had been diagnosed with HF, 11 475 (75.0%) had not. Among 4873 dabigatran-treated patients, 1169 (24.0%) had HF, and 3658 (75.1%) did not; the risk of stroke was high (CHA2 DS2 -VASc score ≥ 2) for 94.3% of patients with HF and 85.8% without, while 6.0% and 7.0%, respectively, had a high bleeding risk (HAS-BLED ≥ 3). Incidence rates of all-cause death in dabigatran-treated patients with and without HF, standardized for CHA2 DS2 -VASc and HAS-BLED scores, were 4.76 vs. 1.80 per 100 patient years (py), with roughly comparable rates of stroke (0.82 vs. 0.60 per 100 py) and major bleeding (1.20 vs. 0.92 per 100 py). CONCLUSIONS: Patients with AF and history of HF may have greater disease burden at AF diagnosis and increased mortality rates vs. patients without HF. Stroke and major bleeding rates were roughly comparable between groups confirming the long-term safety and effectiveness of dabigatran in patients with HF.

Clinimetric analysis of heart failure in Mexican patients.

Heart failure (HF) is a syndrome characterized basically by a circulatory deficit to cover the metabolic and energetic demands of the body. This condition has a broad spectrum in its clinical presentation, affects the quality of life significantly, impacts the family/social environment, and generates a great demand for health services. The purpose of this research is to report the situational diagnose of patients with HF in Mexico. We evaluated 292 patients, 70.2% were men. Average age was 56.7 ± 14.3 years. Ischemic heart disease is the main etiology (98 patients, 33.9%) followed by hypertensive (22.6%) and idiopathic (23.3%) heart disease. The associated clinical background was obesity (31.1%), systemic hypertension (36.7%), myocardial infarction (26.4%), and dyslipidemia (15.1%). The most common symptom was stress dyspnea (41.4%) and jugular vein engorgement at physical examination (32.5%). Anemia was observed in 1% of patients. The average left ventricular ejection fraction was 29.2 ± 10.6%. Sinus rhythm was the most frequently detected in 84.9%. 19.9% of patients had an implantable cardioverter-defibrillator or cardiac resynchronization therapy. 13.7% of patients with QRS > 130 ms. In our population, the meta-analysis global group in chronic heart failure risk score calculated was 16.8 ± 5.7 and for EMPHASIS 3.3 ± 1.5. We observed that age at presentation in HF in this analysis is at least 10 years younger than in other reports. The grade of obesity takes relevance in our group. The association of anemia and HF in Mexico is rare.

La insuficiencia cardiaca es un síndrome caracterizado fundamentalmente por un déficit circulatorio para cubrir las demandas metabólicas y energéticas del organismo. Esta entidad tiene un amplio espectro en su presentación clínica, afecta de manera significativa la calidad de vida, impacta en el entorno familiar/social y genera una gran demanda de los servicios de salud. El propósito de esta investigación es reportar el diagnóstico situacional de pacientes con insuficiencia cardiaca (IC) en México. Evaluamos 292 enfermos, 70.2% eran hombres. Con edad promedio 56.7 ± 14.3 años. La principal etiología es la cardiopatía isquémica (33.9%), seguida de la hipertensiva (22.6%) e idiopática (23.3%). Los antecedentes clínicos asociados fueron: obesidad (31.1%), hipertensión arterial sistémica (36.7%), infarto al miocardio (26.4%) y dislipidemia (15.1%). El síntoma con mayor presentación fue la disnea de esfuerzos (41.4%) y a la exploración física la ingurgitación yugular (32.5%). Se observó anemia en 1% de los enfermos. La fracción de expulsión del ventrículo izquierdo (FEVI) promedio fue de 29.2 + 10.6%. El ritmo sinusal fue el más frecuentemente detectado en 84.9%. El 19.9% de los pacientes tenían instalado un desfibrilador automático implantable (DAI) o tratamiento de resincronización cardiaca (TRC). El 13.7% de los enfermos con QRS mayor de 130 ms. El riesgo (MAGGIC) calculado en nuestro grupo poblacional fue de 16.8 ± 5.7 y para EMPHASIS 3.3 ± 1.5. Observamos que la edad de presentación de la IC en el presente análisis es menor por 10 años en comparación con otros reportes. El grado de obesidad toma relevancia en nuestro grupo. La asociación de anemia e IC en México es poco frecuente.

Clinimetric analysis of heart failure in Mexican patients / Análisis clinimétrico de la insuficiencia cardiaca en pacientes mexicanos

Abstract Heart failure (HF) is a syndrome characterized basically by a circulatory deficit to cover the metabolic and energetic demands of the body. This condition has a broad spectrum in its clinical presentation, affects the quality of life significantly, impacts the family/social environment, and generates a great demand for health services. The purpose of this research is to report the situational diagnose of patients with HF in Mexico. We evaluated 292 patients, 70.2% were men. Average age was 56.7 +- 14.3 years. Ischemic heart disease is the main etiology (98 patients, 33.9%) followed by hypertensive (22.6%) and idiopathic (23.3%) heart disease. The associated clinical background was obesity (31.1%), systemic hypertension (36.7%), myocardial infarction (26.4%), and dyslipidemia (15.1%). The most common symptom was stress dyspnea (41.4%) and jugular vein engorgement at physical examination (32.5%). Anemia was observed in 1% of patients. The average left ventricular ejection fraction was 29.2 +- 10.6%. Sinus rhythm was the most frequently detected in 84.9%. 19.9% of patients had an implantable cardioverter-defibrillator or cardiac resynchronization therapy. 13.7% of patients with QRS > 130 ms. In our population, the meta-analysis global group in chronic heart failure risk score calculated was 16.8 +- 5.7 and for EMPHASIS 3.3 +- 1.5. We observed that age at presentation in HF in this analysis is at least 10 years younger than in other reports. The grade of obesity takes relevance in our group. The association of anemia and HF in Mexico is rare.

Resumen La insuficiencia cardiaca es un síndrome caracterizado fundamentalmente por un déficit circulatorio para cubrir las demandas metabólicas y energéticas del organismo. Esta entidad tiene un amplio espectro en su presentación clínica, afecta de manera significativa la calidad de vida, impacta en el entorno familiar/social y genera una gran demanda de los servicios de salud. El propósito de esta investigación es reportar el diagnóstico situacional de pacientes con insuficiencia cardiaca (IC) en México. Evaluamos 292 enfermos, 70.2% eran hombres. Con edad promedio 56.7 +- 14.3 años. La principal etiología es la cardiopatía isquémica (33.9%), seguida de la hipertensiva (22.6%) e idiopática (23.3%). Los antecedentes clínicos asociados fueron: obesidad (31.1%), hipertensión arterial sistémica (36.7%), infarto al miocardio (26.4%) y dislipidemia (15.1%). El síntoma con mayor presentación fue la disnea de esfuerzos (41.4%) y a la exploración física la ingurgitación yugular (32.5%). Se observó anemia en 1% de los enfermos. La fracción de expulsión del ventrículo izquierdo (FEVI) promedio fue de 29.2 + 10.6%. El ritmo sinusal fue el más frecuentemente detectado en 84.9%. El 19.9% de los pacientes tenían instalado un desfibrilador automático implantable (DAI) o tratamiento de resincronización cardiaca (TRC). El 13.7% de los enfermos con QRS mayor de 130 ms. El riesgo (MAGGIC) calculado en nuestro grupo poblacional fue de 16.8 +- 5.7 y para EMPHASIS 3.3 +- 1.5. Observamos que la edad de presentación de la IC en el presente análisis es menor por 10 años en comparación con otros reportes. El grado de obesidad toma relevancia en nuestro grupo. La asociación de anemia e IC en México es poco frecuente.

Diversity and growth-effects of ectomycorrhizal fungi of a Nothofagus pumilio forest in the Andes of Southern Chile / (Diversidad y efectos de crecimiento de hongos ectomicorrízicos en un bosque de Nothofagus pumilio en los andes del sur de Chile

Chilean temperate rainforests have unique climatic, edaphic and biotic conditions, constituting pre-industrial blueprint ecosystems. Mycorrhizal associations play a central role in the biogeochemical processes of these ecosystems´ functioning. Baseline forest ecology studies are necessary in order to better understand diversity patterns, specifically regarding mycorrhizal symbiosis. Therefore, here we describe the vegetation characteristics and the mycorrhizal relationships of vascular plants in a Nothofagus pumilio forest. We also describe, via morphological methods, the ectomycorrhizal diversity present in this forest. Additionally, we determined whether ectomycorrhizal inoculation confers positive growth effects on N. pumilio seedlings. We found that from 46 vascular plant species identified in this study, 42 (91%) were mycorrhizal and of these 33 (72%) were associated with arbuscular mycorrhizae (AM), two (the dominant trees N. pumilio and N. dombeyi) were forming ectomycorrhizae (EM), five were associated with ericoid mycorrhizae, two with orchid mycorrhizae, and four were nonmycorrhizal. Additionally, 26 EM species were detected of which 15 belong to Cortinarius. Finally, there were clear differences in the growth of N. pumilio seedlings inoculated with the ectomycorrhizal fungus Laccaria laccata compared to noninoculated plants. We suggest that mycorrhizal fungi play a key role in seedling colonization of harsh environments such as the Andean treeline.

Los bosques templados lluviosos de Chile tienen condiciones climáticas, edáficas y bióticas únicas, constituyendo ecosistemas preindustriales modelo. Las asociaciones micorrízicas juegan un rol central en los procesos biogeoquímicos del funcionamiento de estos ecosistemas. Por lo tanto, en este estudio describimos las características de la vegetación y las relaciones micorrízicas de las plantas vasculares de un bosque de Nothofagus pumilio. También describimos, vía métodos morfológicos, la diversidad ectomicorrízica presente en este bosque. Adicionalmente, determinamos si inoculaciones ectomicorrízicas confieren efectos de crecimiento positivos a semilleros de N. pumilio. Encontramos que, de 46 especies de plantas vasculares identificadas en este estudio, 42 (91%) son micorrízicas, y de estas, 33 (72%) están formando micorrizas arbusculares (AM), dos (los árboles dominantes N. pumilio y N. dombeyi) están asociados con ectomicorrizas (EM), cinco están asociadas con micorrizas ericoides, dos con micorrizas orquioides, y cuatro fueron nomicorrizadas. Adicionalmente, 26 especies de EM fueron detectadas, de las cuales 15 pertenecen a Cortinarius. Finalmente, hubo claras diferencias en el crecimiento de los semilleros de N. pumilio inoculados con el hongo ectomicorrízico Laccaria laccata, comparados a plantas no inoculadas. Sugerimos que los hongos micorrízicos juegan un rol clave en la colonización de ambientes severos por juveniles, como en el límite altitudinal andino.

Embolización selectiva de la arteria rectal superior, ¿alternativa a la cirugía hemorroidal? / Selective embolization of the superior rectal artery: An alternative to hemorrhoid surgery?

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Mental health and associated factors among young offenders in Chile: a cross-sectional study.

BACKGROUND: Few studies in Latin America have explored mental disorder among young offenders, or variables associated with it. AIMS: Our aim was to test for associations between childhood adversity or substance misuse and psychiatric disorders among young offenders. METHODS: Sentenced adolescent offenders were recruited from young offenders' institutions or community centres provided by the Chilean National Service for Minors. Psychiatric disorders were assessed using the Mini International Neuropsychiatric Interview, conducted by trained psychologists. A trained sociologist used an ad hoc interview to collect information about childhood experiences, including parenting, trauma, education and substance misuse. Multivariable logistic regressions were used to analyse data. RESULTS: The most prevalent psychiatric disorders among the 935 participants were marijuana dependence disorder, major depressive disorder, and anxiety disorders. Substance use disorders were less frequent among young offenders who were serving their sentence in young offenders' institutions than among those serving in community centres and more frequent among those who started to use marijuana at an earlier age. Among other variables, childhood maltreatment was related to major depressive disorder, and maternal death to anxiety disorders. Higher educational status was related to a lower frequency of depressive and anxiety disorders. CONCLUSIONS: Our findings suggest that greater efforts must be made to identify vulnerable young people much earlier. Few of these young offenders with mental health problems had been well adjusted in health, education or socially before this period of detention. © 2017 The Authors. Criminal Behaviour and Mental Health Published by John Wiley & Sons Ltd.

Preocupación a caer: validación de un instrumento de medición en personas mayores chilenas que viven en la comunidad / Fear of falling: validation of a measurement tool in Chilean elderly living in the community

Introducción. La preocupación a caer, con o sin antecedentes de caídas previas, es un factor de riesgo de disminución de la movilidad, de incapacidad, de disminución de la calidad de vida y puede desencadenar la autorrestricción de las actividades, con pérdida de independencia y funcionalidad. Medir la preocupación a caer, con instrumentos validados en población chilena, es una necesidad para detectar a personas mayores en riesgo. En Chile no existen instrumentos validados que midan este fenómeno. El objetivo de este estudio es validar en español la versión acortada del instrumento Falls Efficacy Scale-International (FES-I) en personas mayores chilenas que viven en la comunidad. Material y método. Se realizó un estudio prospectivo con 2aplicaciones: una al ingreso y otra a las 4 semanas. El FES-I fue traducido según el método back-translation, evaluado por un panel de expertos y aplicado en 10 personas mayores. Después de la aplicación piloto, se elaboró la versión final, la cual fue aplicada a una muestra de 113 personas mayores. Se utilizaron medidas de tendencia central y dispersión, análisis de confiabilidad y análisis factorial confirmatorio. Resultados. La versión acortada y en español del FES-I mostró buena confiablidad y validez en población chilena de personas mayores. Conclusiones. A futuro se espera que este instrumento sea usado, por clínicos e investigadores, para conocer la magnitud del problema y el impacto que tiene el miedo a caer en las caídas, funcionalidad y calidad de vida de las personas mayores que viven en la comunidad (AU)

Introducción. Fear of falling, with or without previous falls history, is a risk factor for decreased mobility, disability, as well as a decreased quality of life, and can trigger the self-restriction of activities with loss of independence and functionality. Validated tools for measuring the fear of falling in the Chilean population is a needed to detect those at risk. There are currently no validated instruments to measure this phenomenon in Chile. The aim of this study is to validate the Spanish version of the short «Falls Efficacy Scale-International» (FES-I) in an elderly population living in the community in Chile. Material and method. A cross-sectional study was performed using applications at baseline and 4 weeks. The short FES-I was translated using the back-translation method, evaluated by a panel of experts, and piloted in 10 older adults. After the pilot study, the final version was applied to a sample of 113 elderly persons. Data analysis used measures of central tendency, and reliability and confirmatory factor analysis was used. Results. The Spanish version of the short FES-I showed good reliability and validity in an elderly Chilean population. Conclusions. This falls risks measurement tool can be used by clinicians and researchers in order to determine the magnitude of the problem and the impact of fear of falling on falls, functionality, and quality of life of the elderly who live in the community (AU)

Substance Use among Adolescents Involved in Bullying: A Cross-Sectional Multilevel Study.

Being involved in bullying as a victim or perpetrator could have deleterious health consequences. Even though there is some evidence that bullies and victims of bullying have a higher risk for drug use, less is known about bystanders. The aim of this research was to study the association between bullying experience (as victims, bullies, or bystanders) and substance use. We gathered complete information from a nationally representative sample of 36,687 students (51.4% female) attending 756 schools in Chile. We used a self-reported questionnaire which was developed based on similar instruments used elsewhere. This questionnaire was piloted and presented to an expert panel for approval. We used multilevel multivariate logistic regression analyses, controlling for several variables at the individual (e.g., school membership, parental monitoring) and school levels (e.g., school type, school denomination). This study shows that bullies and bully-victims have a high risk for cigarette, alcohol, and cannabis use than bystanders. This is one of the few studies exploring the association between witnessing bullying and substance use. These findings add new insights to the study of the co-occurrence of bullying and substance use. Other factors, such as higher academic performance, stronger school membership, and better parental monitoring reduced the risk of any substance use, while the experience of domestic violence and the perception of social disorganization in the neighborhood, increased the risk. These findings may help the design of preventive interventions.

[Fear of falling: Validation of a measurement tool in Chilean elderly living in the community]. / Preocupación a caer: validación de un instrumento de medición en personas mayores chilenas que viven en la comunidad.

INTRODUCCIóN: Fear of falling, with or without previous falls history, is a risk factor for decreased mobility, disability, as well as a decreased quality of life, and can trigger the self-restriction of activities with loss of independence and functionality. Validated tools for measuring the fear of falling in the Chilean population is a needed to detect those at risk. There are currently no validated instruments to measure this phenomenon in Chile. The aim of this study is to validate the Spanish version of the short «Falls Efficacy Scale-International¼ (FES-I) in an elderly population living in the community in Chile. MATERIAL AND METHOD: A cross-sectional study was performed using applications at baseline and 4 weeks. The short FES-I was translated using the back-translation method, evaluated by a panel of experts, and piloted in 10 older adults. After the pilot study, the final version was applied to a sample of 113 elderly persons. Data analysis used measures of central tendency, and reliability and confirmatory factor analysis was used. RESULTS: The Spanish version of the short FES-I showed good reliability and validity in an elderly Chilean population. CONCLUSIONS: This falls risks measurement tool can be used by clinicians and researchers in order to determine the magnitude of the problem and the impact of fear of falling on falls, functionality, and quality of life of the elderly who live in the community.