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1.
Am J Med ; 2020 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-33228950

RESUMO

BACKGROUND: Older adult patients with frailty are rarely involved in rehabilitation programs after myocardial infarction. Our aim was to investigate the benefits of exercise intervention in these patients. METHODS: A total of 150 survivors after acute myocardial infarction, ≥70 years and with pre-frailty or frailty (Fried scale ≥1 points), were randomized to control (n = 77) or intervention (n = 73) groups. The intervention consisted of a 3-month exercise program, under physiotherapist supervision, followed by an independent home-based program. The main outcome was frailty (Fried scale) at 3 months and 1 year. Secondary endpoints were clinical events (mortality or any readmission) at 1 year. RESULTS: Mean age was 80 years (range = 70-96). In the intervention group, 44 (60%) out of 73 patients participated in the program and 23 (32%) completed it. Overall, there was a decrease in the Fried score in the intervention group at 3 months, with no effect at 1 year. However, in the intention-to-treat analysis, such change did not achieve statistical significance (P = 0.110). Only treatment comparisons made among the subgroups that participated in (P = 0.033) and completed (P = 0.018) the program achieved statistical significance. There were no differences in clinical events. Worse Fried score trajectory along follow-up increased mortality risk (hazard ratio [HR] = 2.38, 95% confidence interval [CI] 1.24-4.55, P = 0.009) CONCLUSIONS: Recruitment and retention for a physical program in older adult patients with frailty after myocardial infarction was challenging. Frailty status improved in the subgroup that participated in the program, although this benefit was attenuated after shifting to a home-based program. A better frailty trajectory might influence midterm prognosis. (ClinicalTrials.govNCT02715453).

2.
Reumatol. clín. (Barc.) ; 16(5,pt.2): 373-377, sept.-oct. 2020. ilus, tab
Artigo em Espanhol | IBECS-Express | IBECS | ID: ibc-ET1-6649

RESUMO

El diagnóstico y tratamiento de las enfermedades autoinmunes sistémicas (EAS) constituye un reto. Aunque infrecuentes, afectan a cientos de miles de pacientes en España. El médico de familia (MF) se enfrenta a síntomas o signos inespecíficos que hacen sospechar EAS al inicio del proceso, y tiene que decidir a quiénes debería derivar. Para facilitar su reconocimiento y mejorar su derivación, expertos de la Sociedad Española de Medicina de Familia y Comunitaria y de la Sociedad Española de Reumatología seleccionaron 26 síntomas/signos-guía y alteraciones analíticas. Se escogieron parejas de MF y reumatólogo para elaborar algoritmos diagnósticos y de derivación. Posteriormente se revisaron y adaptaron al formato de aplicación para móviles (app) descargable. El resultado es el presente documento de derivación de EAS para MF en formato de papel y app. Contiene algoritmos de fácil manejo utilizando datos de la anamnesis, exploración física y pruebas analíticas accesibles en atención primaria para orientar el diagnóstico y facilitar la derivación a reumatología o a otras especialidades


Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed

3.
Cir Esp ; 2020 Aug 15.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32928499

RESUMO

INTRODUCTION: COVID-19 pandemic has lead to lockdown of population in many countries. In Spain, the state of alarm was established from March 15 to June 20, 2020. Usually this fact decreased people's mobility and physical activity, in addition to producing or exacerbating psychological disorders. Our aim was to determine the influence that this condition had over the short-term ponderal results of patients undergoing laparoscopic vertical gastrectomy from May 2019 to May 2020. METHODS: Case-control study for comparing the percentage of excess weight lost (%EWL) and the percentage of total weight lost (%TWL) of patients that underwent a VG during the last year, so they were affected by lockdown in April and part of March 2020 (group 1), to the %EWL and %TWL of a control group (group 2), obtained from our previous series. RESULTS: The mean %EWL in group 1 is 47,37±18,59 and in group 2 is 51,13±17,59, being p=0,438. Meanwhile, the mean %TWL in group 1 is 21,14±8,17 and in group 2 is 24,67±8,01, with p=0,115. CONCLUSIONS: Population lockdown by COVID-19 did not get worse short-term results of vertical gastrectomy. More studies with a larger number of patients are necessary to draw firm conclusions.

5.
Arch Cardiol Mex ; 90(Supl): 26-32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32523139

RESUMO

The COVID-19 pandemic decreed by the World Health Organization (WHO) since March 12, 2020 is wreaking havoc globally and it is a true economic, social and health challenge. Although the clinical manifestations of COVID-19 are respiratory symptoms, some patients also have cardiological symptoms. Among patients with cardiological conditions2 they represent a group of higher risk and, in fact, they are a particularly vulnerable group, due to their higher risk of contagion and greater severity in case of acquiring the disease1 those with heart failure (HF), including heart transplant (CT) and ventricular assists, as well as patients with pulmonary arterial hypertension (PAH). HF is the main chronic cardiovascular disease and patients in this group are the most vulnerable for the development of more serious clinical symptoms after suffering the infection, and to a greater extent cases with advanced HF3. In fact, HF is one of the most frequent complications in patients with COVID-194. Likewise, transplant patients who require immunosuppressants to avoid graft rejection, constitute a population especially susceptible to infection and to develop more serious processes. This situation has made the National Association of Cardiologists of Mexico (ANCAM) and the Mexican Society of Cardiology (SMC) together with their respective chapters, have prepared the following recommendations for medical personnel, who participate in the care of this special group of patients in the different clinical settings, who suffer or not, of COVID-19.


Assuntos
Doenças Cardiovasculares/virologia , Infecções por Coronavirus/complicações , Insuficiência Cardíaca/virologia , Pneumonia Viral/complicações , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , México , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Fatores de Risco , Índice de Gravidade de Doença
6.
Arch Cardiol Mex ; 90(Supl): 100-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32523138

RESUMO

The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.


Assuntos
Cardiologia , Doenças Cardiovasculares/terapia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Reabilitação Cardíaca/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/virologia , Humanos , México , Pandemias , Sociedades Médicas
7.
J. negat. no posit. results ; 5(5): 535-553, mayo 2020. tab, mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-194127

RESUMO

OBJETIVO: Presentar una revisión sistemática de estudios donde se evalúa el impacto provocado por los residuos sólidos urbanos generados en la Mixteca Oaxaqueña. RESULTADOS: El análisis de los resultados de investigación consultados en las bases de datos: Red de Revistas Científicas de América Latina y el Caribe (Redalyc), Scientific Electronic Library Online (Scielo), Dialnet, EBSCO y Consorcio Nacional de Recursos de Información Científica y Tecnológica (CONRICYT), ponen de manifiesto que la contaminación es un problema que se ha venido incrementando a nivel global gradualmente lo que ha derivado que exista presencia de organismos y sustancias extraños que interfieren y dañan la salud de las personas, los recursos naturales y el equilibrio ecológico; cabe mencionar que el impacto en las comunidades provocado por la generación y manejo de los residuos sólidos en forma inadecuada altera de forma importante el ecosistema de los lugares aledaños a los sitios de disposición final de dichos residuos. Es importante hacer notar que existe legislación en la materia y clasifica de forma puntual los diferentes sitios de disposición final y encomienda a los municipios llevar a cabo el manejo integral de los residuos sólidos urbanos pero dicha legislación no es aplicada en forma correcta a pesar de que esta problemática ha tomado mucha relevancia en las últimas dos décadas en los ámbitos gubernamentales. CONCLUSIONES: México tiene el reto de lograr resolver los problemas ambientales para lograr alcanzar un nivel de sustentabilidad y sostenibilidad a mediano plazo, las tasas de generación de residuos sólidos urbanos siguen aumentando por que se vive en una sociedad que ha modificado drásticamente sus hábitos de consumo. La degradación del medio ambiente y los recursos naturales para la región de la Mixteca Oaxaqueña está clasificada en rangos de inestable-crítico a crítico provocando que se ejerza presión sobre los recursos naturales, es por ello que se debe tener una adecuada gestión y disposición de los residuos sólidos urbanos, para lograrlo es preciso contar con el apoyo de la sociedad, gobiernos y sociedad en general, esta sinergia es necesaria para reducir la extracción de recursos empleados al producirlos obteniendo beneficios económicos, sociales y ambientales a largo plazo para la región


OBJECTIVE: To present a systematic review of studies assessing the impact caused by municipal solid waste generated in the mixtec region of oaxaca. RESULTS: The analysis of the research results consulted in the databases: Red de Revistas Científicas de América Latina y el Caribe (Redalyc), Scientific Electronic Library Online (Scielo), Dialnet, EBSCO and Consorcio Nacional de Recursos de Información Científica y Tecnológica (CONRICYT), show that pollution is a problem that has been increasing at a global level gradually what has resulted in the presence of foreign organisms and substances that interfere with and damage people's health, natural resources and ecological balance; It is worth mentioning that the impact on the communities caused by the generation and management of solid waste in an inadequate manner significantly alters the ecosystem of the places adjacent to the final disposal sites of these wastes. It is important to note that there is legislation on the subject and classifies in a specific way the different final disposal sites and entrusts municipalities to carry out the integral management of urban solid waste but this legislation is not applied correctly despite the fact that this problem has become very relevant in the last two decades in government spheres. CONCLUSIONS: Mexico has the challenge of solving environmental problems to achieve a level of sustainability and sustainability in the medium term, the rates of generation of solid urban waste continue to increase because we live in a society that has drastically changed their consumption habits. The degradation of the environment and natural resources for the Mixteca Oaxaqueña region is classified in ranges from unstable-critical to critical, causing pressure to be exerted on the natural resources. This is why it is necessary to have adequate management and disposal of solid urban waste, to achieve this it is necessary to have the support of society, governments and society in general; this synergy is necessary to reduce the extraction of resources used to produce them, obtaining long-term economic, social and environmental benefits for the region


Assuntos
Humanos , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Poluição Ambiental/análise , Volume de Resíduos Sólidos/análise , México/epidemiologia , Gerenciamento de Resíduos/métodos , Poluentes do Solo/análise
9.
Am J Cardiol ; 125(7): 1033-1038, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31959430

RESUMO

Low lymphocyte count, as a marker of inflammation and immunosuppression, may be useful for identifying frail patients. In this work, we aimed to evaluate the association between low-relative lymphocyte count (Lymph%) and frailty status in patients >65 years old with acute coronary syndromes (ACS), and whether Lymph% is associated with morbimortality beyond standard prognosticators and frailty. In this prospective observational study, we included 488 hospital survivors of an episode of an ACS >65 years old. Total and differential white blood cells and frailty status were assessed at discharge. Frailty was evaluated using the Fried score at discharge and defined as Fried≥3. The independent association between Lymph% and Fried≥3 was evaluated by multivariate logistic regression analysis. The associations between Lymph% with long-term all-cause mortality and recurrent admission were evaluated with Cox regression and shared frailty regression, respectively. The mean age of the sample was 78 ± 7 years and 41% were females. The median (interquartile range) of the Lymph% was 21% (15 to 27) and 41% showed Fried≥3. In multivariate analysis, Lymph% was inversely related to the odds of frailty with an exponential increase risk from values below 15% (p = 0.001). Likewise, Lymph% was inverse and independently associated with a higher risk of long-term mortality (p = 0.011), recurrent all-cause (p = 0.020), and cardiovascular readmissions (p = 0.024). In conclusion, in patients >65 years with a recent ACS, low Lymph% evaluated at discharge is associated with a higher risk of frailty. Low Lymph% was also associated with a higher risk of long-term mortality and recurrent admissions beyond standard prognosticators and Fried score.


Assuntos
Síndrome Coronariana Aguda/sangue , Fragilidade/sangue , Avaliação Geriátrica/métodos , Síndrome Coronariana Aguda/mortalidade , Idoso , Biomarcadores/sangue , Feminino , Fragilidade/mortalidade , Humanos , Contagem de Linfócitos , Masculino , Prognóstico , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Taxa de Sobrevida/tendências
10.
Rev Esp Enferm Dig ; 112(2): 161-162, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31985256

RESUMO

We wish to respond to the comments provided by José Miguel Esteban López-Jamar and Ravishankar Asokkumar (1) about our report in this Journal (2). Some of the comments were perhaps prompted by inadequately explained or understood concepts, since they mention aspects that we never even considered or stated.


Assuntos
Esôfago de Barrett , Neoplasias Esofágicas , Humanos
11.
PLoS One ; 15(1): e0227548, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31990958

RESUMO

A common single nucleotide polymorphism in the ACTN3 gene might result in the complete deficiency of α-actinin-3 (i.e., XX genotype). It has been found that ACTN3 XX individuals have several traits related to lessened muscle performance. This study aimed to determine the influence, if any, of ACTN3 genotypes on injury incidence of marathoners during the year preceding to participating in a competitive marathon race. Using a cross-sectional experimental design, the type and conditions of sports injuries were documented for one year in a group of 139 marathoners. Injuries were recorded following a consensus statement on injuries in Athletics. Afterward, ACTN3 genotyping was performed, and injury epidemiology was compared among RR, RX, and XX genotypes. The distribution of the RR/RX/XX genotypes was 28.8/42.8/23.5%, respectively. A total of 67 injuries were recorded. The frequency of marathoners that reported any injury during the previous year was not different across the genotypes (55.0/38.8/40.6%, P = 0.241). Although the overall injury incidence was not different among genotypes (2.78/1.65/1.94 injuries/1000 h of running, P = 0.084), the likelihood of suffering an injury was higher in RR than in RX (OR = 1.93: 95%CI = 0.87-4.30), and higher than in XX (OR = 1.79: 0.70-4.58). There was no difference in the conditions, severity, body location, time of year, or leading cause of injury among genotypes. However, XX presented a higher frequency of sudden-onset injuries (P = 0.024), and the OR for muscle-type injuries was 2.0 (0.51-7.79) times higher compared to RR runners. Although XX marathoners did not have a higher overall incidence of injury, the OR in these runners for muscle-type injuries was superior to RR and RX runners. The likelihood of suffering a muscle injury, especially with a sudden-onset, was twice in XX than in RR endurance runners.


Assuntos
Actinina/genética , Traumatismos em Atletas/epidemiologia , Genótipo , Resistência Física/genética , Corrida/lesões , Adulto , Feminino , Humanos , Masculino
12.
Int J Cardiol ; 302: 30-33, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31924393

RESUMO

BACKGROUND: The potential sex-differential effect of frailty in patients with acute coronary syndromes (ACS) has not been well-evaluated. We sought to examine the sex-differential association between frailty status on long-term mortality in elderly patients with an ACS. METHODS AND RESULTS: This is a prospective observational single-center study that included 488 elderly patients (>65 years) hospitalized for ACS who survived the index hospitalization. Multivariate Cox regression was used to determine the association among the exposures (interaction of sex with Fried score and sex with Fried ≥ 3) and all-cause mortality. The mean age of the sample was 78 ±â€¯7 years; 41% were female and the median Fried score was higher in women [3 (2-3) vs. 2 (1-2) points, p < 0.001]. At a median follow-up of 3.12 years (IQR:1.38-5.13), 182 deaths (37.3%) were registered. The association of Fried ≥ 3 with mortality varied across sex (p-value for interaction = 0.022). In males, Fried ≥ 3 was independently associated with all-cause death (HR = 1.89; CI 95%:1.25-2.85, p = 0.003). However, it showed a neutral effect on women (HR = 0.92; CI 95%:0.57-1.49, p = 0.726). CONCLUSIONS: In this work, we found that the frailty status assessed by Fried score was independently associated with mortality in elderly males but not in females with ACS.

13.
Reumatol Clin ; 16(5 Pt 2): 373-377, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31722849

RESUMO

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed.

14.
Cir. Esp. (Ed. impr.) ; 98: 0-0, 2020. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-192834

RESUMO

INTRODUCCIÓN: La pandemia por COVID-19ha obligado al confinamiento de la población en muchos países. En España, el estado de alarma se estableció desde el 15 de marzo al 20 de junio del 2020. Este hecho, por lo general, disminuyó la movilidad y la actividad física de las personas, además de producir o exacerbar alteraciones psicológicas. Nuestro objetivo es analizar la influencia que esta situación ha ejercido sobre los resultados ponderales a corto plazo de los pacientes tratados mediante una gastrectomía vertical laparoscópica entre mayo del 2019 y mayo del 2020. MÉTODOS: Estudio de casos y controles donde se compararon el porcentaje de exceso de peso perdido (%EWL) y el porcentaje de peso total perdido (%TWL) de los pacientes intervenidos en el último año y a los que ha afectado el confinamiento durante el mes de abril y parte de marzo del 2020 (grupo 1; n = 20), con el de un grupo control (grupo 2; n = 40) de nuestra casuística previa. RESULTADOS: El %EWL medio en el grupo 1 es de 47,37 ± 18,59 y en el grupo 2 es de 51,13 ± 17,59, siendo la p = 0,438. Por su parte, el %TWL medio en el grupo 1 es de 21,14 ± 8,17 mientras que en el grupo 2 es de 24,67 ± 8,01, resultando la p = 0,115. CONCLUSIONES: El confinamiento de la población por COVID-19 no empeoró los resultados ponderales a corto plazo de la gastrectomía vertical. Son necesarios más estudios con un mayor número de pacientes para obtener conclusiones más sólidas


INTRODUCTION: COVID-19 pandemic has lead to lockdown of population in many countries. In Spain, the state of alarm was established from March 15 to June 20, 2020. Usually this fact decreased people's mobility and physical activity, in addition to producing or exacerbating psychological disorders. Our aim was to determine the influence that this condition had over the short-term ponderal results of patients undergoing laparoscopic vertical gastrectomy from May 2019 to May 2020. METHODS: Case-control study for comparing the percentage of excess weight lost (%EWL) and the percentage of total weight lost (%TWL) of patients that underwent a VG during the last year, so they were affected by lockdown in April and part of March 2020 (group 1), to the %EWL and %TWL of a control group (group 2), obtained from our previous series


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Pacientes Domiciliares , Isolamento Social , Quarentena , Perda de Peso , Obesidade Mórbida/cirurgia , Gastrectomia , Cirurgia Bariátrica
15.
Arch. cardiol. Méx ; 90(supl.1): 26-32, may. 2020. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1152839

RESUMO

Resumen La pandemia por COVID-19 decretada por la Organización Mundial de la Salud (OMS) desde el 12 de marzo de 2020 está produciendo estragos a nivel mundial y es un verdadero reto económico, social y sanitario. Aunque las manifestaciones clínicas del COVID-19 son síntomas respiratorios, algunos pacientes también tienen síntomas cardiológicos. Dentro de los pacientes con afecciones cardiológicas2 suponen un grupo de mayor riesgo y que de hecho son un grupo especialmente vulnerable, por su mayor riesgo de contagio y mayor gravedad en caso de adquirir la enfermedad1 aquellos con insuficiencia cardiaca (IC), incluyendo al trasplante cardiaco (TC) y las asistencias ventriculares, así como los pacientes con hipertensión arterial pulmonar (HAP). La IC es la principal patología cardiovascular crónica y los pacientes en este grupo son los más vulnerables para el desarrollo de cuadros clínicos más graves tras sufrir la infección, y en mayor medida los casos con IC avanzada3. De hecho, la IC es unas de las complicaciones más frecuentes en los pacientes con COVID-194. De igual forma, los pacientes trasplantados que requieren de los inmunosupresores para evitar el rechazo del injerto, constituyen una población especialmente susceptible a la infección y a desarrollar procesos más graves. Esta situación ha hecho que la Asociación Nacional de Cardiólogos de México (ANCAM) y la Sociedad Mexicana de Cardiología (SMC) junto con sus respectivos capítulos, hayan elaborado las siguientes recomendaciones para el personal médico, que participa en la atención de este grupo especial de pacientes en los diferentes escenarios clínicos, que padezcan o no, COVID-19.


Abstract The COVID-19 pandemic decreed by the World Health Organization (WHO) since March 12, 2020 is wreaking havoc globally and it is a true economic, social and health challenge. Although the clinical manifestations of COVID-19 are respiratory symptoms, some patients also have cardiological symptoms. Among patients with cardiological conditions2 they represent a group of higher risk and, in fact, they are a particularly vulnerable group, due to their higher risk of contagion and greater severity in case of acquiring the disease1 those with heart failure (HF), including heart transplant (CT) and ventricular assists, as well as patients with pulmonary arterial hypertension (PAH). HF is the main chronic cardiovascular disease and patients in this group are the most vulnerable for the development of more serious clinical symptoms after suffering the infection, and to a greater extent cases with advanced HF3. In fact, HF is one of the most frequent complications in patients with COVID-194. Likewise, transplant patients who require immunosuppressants to avoid graft rejection, constitute a population especially susceptible to infection and to develop more serious processes. This situation has made the National Association of Cardiologists of Mexico (ANCAM) and the Mexican Society of Cardiology (SMC) together with their respective chapters, have prepared the following recommendations for medical personnel, who participate in the care of this special group of patients in the different clinical settings, who suffer or not, of COVID-19.

16.
Alcocer-Gamba, Marco A.; Gutiérrez-Fajardo, Pedro; Cabrera-Rayo, Alfredo; Sosa-Caballero, Alejandro; Piña-Reyna, Yigal; Merino-Rajme, José A.; Heredia-Delgado, José A.; Cruz-Alvarado, Jaime E.; Galindo-Uribe, Jaime; Rogel-Martínez, Ulises; González-Hermosillo, Jesús A.; Ávila-Vanzzini, Nydia; Sánchez-Carranza, Jesús A.; Jímenez-Orozco, Jorge H.; Sahagún-Sánchez, Guillermo; Fanghänel-Salmón, Guillermo; Albores-Figueroa, Rosenberg; Carrillo-Esper, Raúl; Reyes-Terán, Gustavo; Cossio-Aranda, Jorge E.; Borrayo-Sánchez, Gabriela; Ríos, Manuel Odín de los; Berni-Betancourt, Ana C.; Cortés-Lawrenz, Jorge; Leiva-Pons, José L.; Ortiz-Fernández, Patricio H.; López-Cuellar, Julio; Araiza-Garaygordobil, Diego; Madrid-Miller, Alejandra; Saturno-Chiu, Guillermo; Beltrán-Nevárez, Octavio; Enciso-Muñoz, José M.; García-Rincón, Andrés; Pérez-Soriano, Patricia; Herrera-Gomar, Magali; Lozoya del Rosal, José J.; Fajardo-Juárez, Armando I.; Olmos-Temois, Sergio G.; Rodríguez-Reyes, Humberto; Ortiz-Galván, Fernando; Márquez-Murillo, Manlio F.; Celaya-Cota, Manuel de J.; Cigarroa-López, José A.; Magaña-Serrano, José A.; Álvarez-Sangabriel, Amada; Ruíz-Ruíz, Vicente; Chávez-Mendoza, Adolfo; Méndez-Ortíz, Arturo; León-González, Salvador; Guízar-Sánchez, Carlos; Izaguirre-Ávila, Raúl; Grimaldo-Gómez, Flavio A.; Preciado-Anaya, Andrés; Ruiz-Gastélum, Edith; Fernández-Barros, Carlos L.; Gordillo, Antonio; Alonso-Sánchez, Jesús; Cerón-Enríquez, Norma; Núñez-Urquiza, Juan P.; Silva-Torres, Jesús; Pacheco-Beltrán, Nancy; García-Saldivia, Marianna A.; Pérez-Gámez, Juan C.; Lezama-Urtecho, Carlos; López-Uribe, Carlos; López-Mora, Gerardo E.; Rivera-Reyes, Romina.
Arch. cardiol. Méx ; 90(supl.1): 100-110, may. 2020.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1152852

RESUMO

Resumen Se presentan las recomendaciones en las cuales la Sociedad Mexicana de Cardiología (SMC) en conjunto con la Asociación Nacional de Cardiólogos de México (ANCAM), así como diferentes asociaciones médicas mexicanas vinculadas con la cardiología, después de una revisión y análisis exhaustivo y consensuado sobre los tópicos relacionados con las enfermedades cardiovasculares en la pandemia de COVID-19, se analizan posturas científicas y se dan recomendaciones responsables sobre medidas generales a los pacientes, con cuidados personales, alimentación saludable, actividad física regular, acciones en caso de paro cardiorrespiratorio, la protección del paciente y del personal de salud así como las indicaciones precisas en el uso de la imagen cardiovascular no invasiva, la prescripción de medicamentos, cuidados en tópicos específicos como en la hipertensión arterial sistémica, insuficiencia cardiaca, arritmias y síndromes coronarios agudos, además de hacer énfasis en los procedimientos de electrofisiología, intervencionismo, cirugía cardiaca y en la rehabilitación cardiaca. El interés principal es brindar a la comunidad médica una orientación general sobre el quehacer en la práctica cotidiana y pacientes con enfermedades cardiovasculares en el escenario esta crisis epidemiológica sin precedentes de COVID-19.


Abstract The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.

17.
Rev Esp Enferm Dig ; 111(10): 789-794, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31566411

RESUMO

Barrett's esophagus (BE) is a controversial condition. The significance of this condition lies in its premalignant potential, so it is important that clinically applicable biomarkers be identified for early detection and targeted prevention. Dysplasia is currently used as main biomarker, but others most recently surveyed in cancer also include microRNAs. Classically, BE was considered to be an acquired disease related to pathological gastroesophageal acid and bile reflux. However, some cases are associated with genetic predisposition, representing an inherited, familial form of BE. The actual gene, or genes, involved in this condition have not yet been identified. Main therapeutic options include medical treatment and antireflux surgery. Both types of treatment are equally efficient in controlling symptoms and neither is able to cause the metaplastic segment to disappear, which is why the risk of malignancy remains. However, we may use endoscopic radiofrequency to eradicate BE and replace it by the typical squamous epithelium of the esophagus. The currently accepted indications of radiofrequency in BE include low- and high-grade dysplasia, but not Barrett's esophagus without dysplasia. In conclusion, BE may have two different presentations: environmental ("human", reflux) or sporadic BE, which is the most common form, and genetic ("divine", inherited) or familiar BE, less common but with a greater risk for malignancy. As they might be two different diseases, surveillance programs and treatments should also be different.


Assuntos
Esôfago de Barrett/etiologia , Esôfago de Barrett/terapia , Esôfago de Barrett/genética , Neoplasias Esofágicas/etiologia , Fundoplicatura/métodos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/cirurgia , Interação Gene-Ambiente , Marcadores Genéticos , Humanos , MicroRNAs/metabolismo , Linhagem , Inibidores da Bomba de Prótons/uso terapêutico , Ablação por Radiofrequência
18.
Rev. esp. enferm. dig ; 111(10): 789-794, oct. 2019. graf
Artigo em Inglês | IBECS | ID: ibc-190452

RESUMO

Barrett's esophagus (BE) is a controversial condition. The significance of this condition lies in its premalignant potential, so it is important that clinically applicable biomarkers be identified for early detection and targeted prevention. Dysplasia is currently used as main biomarker, but others most recently surveyed in cancer also include microRNAs. Classically, BE was considered to be an acquired disease related to pathological gastroesophageal acid and bile reflux. However, some cases are associated with genetic predisposition, representing an inherited, familial form of BE. The actual gene, or genes, involved in this condition have not yet been identified. Main therapeutic options include medical treatment and antireflux surgery. Both types of treatment are equally efficient in controlling symptoms and neither is able to cause the metaplastic segment to disappear, which is why the risk of malignancy remains. However, we may use endoscopic radiofrequency to eradicate BE and replace it by the typical squamous epithelium of the esophagus. The currently accepted indications of radiofrequency in BE include low- and high-grade dysplasia, but not Barrett's esophagus without dysplasia. In conclusion, BE may have two different presentations: environmental ("human", reflux) or sporadic BE, which is the most common form, and genetic ("divine", inherited) or familiar BE, less common but with a greater risk for malignancy. As they might be two different diseases, surveillance programs and treatments should also be different


No disponible


Assuntos
Humanos , Esôfago de Barrett/genética , Neoplasias Esofágicas/genética , Adenocarcinoma/genética , Esôfago de Barrett/terapia , Fundoplicatura/métodos , Refluxo Gastroesofágico/epidemiologia , Predisposição Genética para Doença , Interação Gene-Ambiente , Marcadores Genéticos
19.
Rev. esp. enferm. dig ; 111(9): 662-666, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-190348

RESUMO

Introducción: la relación entre la gastrectomía vertical laparoscópica (GVL) y el reflujo gastroesofágico (RGE) es aún controvertida, por lo que su investigación tiene gran interés para llegar a conclusiones definitivas. Nuestro objetivo es determinar si la GVL modifica el RGE pH-métrico de los pacientes obesos y, en caso de que así sea, analizar algunos factores que pudieran explicarlo. Pacientes y métodos: incluimos los primeros 26 pacientes que recibieron una GVL en nuestro centro. Se realizaron un tránsito baritado, una pH-metría ambulatoria de 24 horas y una manometría intraluminal esofágica (MIE) con cuatro canales previamente y al año de la operación. Resultados: de los datos pH-métricos, el índice de DeMeester mostró un aumento significativo (p = 0.028) tras la intervención, mientras que los demás parámetros fueron similares. Por otra parte, se observó que el 50% de los pacientes con RGE pH-métrico preoperatorio mostraron tasas normales al año de la operación. En la MIE objetivamos que la presión del esfínter esofágico inferior (EEI) disminuyó, así como la amplitud media de las ondas en el tercio distal esofágico (p = 0,007 y p = 0,025, respectivamente). En el estudio radiológico la tasa de hernias de hiato "de novo" fue del 36,4%. Conclusión: la GVL determina un aumento leve del RGE, probablemente relacionado con la aparición de hernias de hiato así como con una disminución de la presión del EEI y de la capacidad de barrido esofágico. Sin embargo, no debe contraindicarse la GVL a pacientes con RGE preoperatorio pH-métrico pues puede negativizarse tras la operación


Introduction: the relationship between laparoscopic vertical gastrectomy (LVG) and gastroesophageal reflux (GER) is still controversial. Therefore, its study is of great interest in order to obtain definitive conclusions. The goal of the study was to establish whether LVG modifies pH-metric GER in obese patients and to analyze the associated factors. Patients and methods: the first 26 patients who underwent LVG in our institution were enrolled in the study. A barium swallow, 24-hour ambulatory pH-metry and four-channel intraluminal esophageal manometry (IEM) were all performed before and one year after surgery. Results: among the pH-metric data, there was a significant increase in the DeMeester index after the procedure (p = 0.028), while other parameters remained unchanged. Furthermore, 50% of patients with preoperative pH-metric GER had normal values at one year after surgery. IEM showed a decrease in lower esophageal sphincter (LES) pressure and in the mean wave amplitude at the distal third of the esophagus (p = 0.007 and p = 0.025, respectively). The rate of newly-developed hiatal hernias in the radiographic study was 36.4%. Conclusion: LVG mildly increases GER, which is likely related to the development of hiatal hernias and a decrease in LES pressure and esophageal sweep. However, LVG should not be contraindicated for patients with preoperative pH-metric GER, as this may clear after the procedure


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Refluxo Gastroesofágico/cirurgia , Gastrectomia/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Obesidade Mórbida/cirurgia , Refluxo Gastroesofágico/fisiopatologia , Alcalinização/análise , Concentração de Íons de Hidrogênio , Manometria/métodos , Estudos Prospectivos
20.
J Assist Reprod Genet ; 36(10): 2111-2119, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446545

RESUMO

PURPOSE: To investigate if the vaginal microbiome influences the IVF outcome. METHODS: Thirty-one patients undergoing assisted reproductive treatment (ART) with own or donated gametes and with cryotransfer of a single euploid blastocyst were recruited for this cohort study. Two vaginal samples were taken during the embryo transfer procedure, just before transferring the embryo. The V3 V4 region of 16S rRNA was used to analyze the vaginal microbiome, and the bioinformatic analysis was performed using QIIME2, Bioconductor Phyloseq, and MicrobiomeAnalyst packages. Alpha diversity was compared between groups according to the result of the pregnancy test. RESULTS: Fourteen (45.2%) patients did not and seventeen (54.8 %) did achieve pregnancy under ART. A greater index of alpha diversity was found in patients who did not achieve pregnancy comparing to those who did, although this difference was not significant (p = 0.088). In the analysis of beta diversity, no statistically significant differences were observed between groups established as per the pregnancy status. Samples from women who achieved pregnancy showed a greater presence of Lactobacillus spp. The cluster analysis identified two main clusters: the first encompassed the genera Lactobacillus, Gardnerella, Clostridium, Staphylococcus, and Dialister, and the second included all other genera. Women who achieved pregnancy were mainly detected microorganisms from the first cluster. CONCLUSIONS: The vaginal microbiome can influence the results of ART. The profiles dominated by Lactobacillus were associated with the achievement of pregnancy, and there was a relationship between the stability of the vaginal microbiome and the achievement of pregnancy.


Assuntos
Taxa de Gravidez , Reprodução/fisiologia , Técnicas de Reprodução Assistida , Vagina/microbiologia , Adulto , Transferência Embrionária/métodos , Feminino , Fertilização In Vitro/métodos , Humanos , Microbiota/genética , Gravidez , RNA Ribossômico 16S/genética
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