Estudio de cohortes para evaluar la prevalencia de QT prolongado y arritmias en pacientes críticos durante la primera fase de la pandemia por COVID-19 / Cohort study to assess the prevalence of prolonged QT and arrhythmias in critically ill patients during the early phase of the COVID-19 pandemic

Antecedentes y objetivo: Los pacientes con infección por SARS-CoV-2 pueden presentar afectación cardiovascular, incluyendo miocarditis, arritmias y prolongación del intervalo QT. Nuestro objetivo fue evaluar el impacto de la COVID-19 y su tratamiento en la repolarización ventricular y el desarrollo de arritmias en pacientes críticos. Material y métodos: Estudio de cohortes retrospectivo de pacientes críticos con infección confirmada por SARS-CoV-2 durante un periodo de 3meses. Se registraron los datos clínicos relevantes y el tratamiento específico administrado para la COVID-19. Se consideró QTc prolongado cuando medía ≥460ms en mujeres y ≥450ms en hombres. Se registró la incidencia y el tipo de arritmias durante el mismo periodo. Resultados: Se evaluaron 77 pacientes con una edad media de 62±13años: 20 mujeres y 57 hombres. El 60% de los pacientes eran hipertensos, el 52% presentaban un IMC>30 y el 70% desarrollaron fracaso renal agudo durante el ingreso. El 56% de los pacientes presentaron prolongación del QTc. El 44% presentaron algún tipo de arritmia durante su estancia en la UCI, siendo en el 21% arritmias auriculares. La mortalidad global fue del 53%, sin diferencias entre los pacientes con o sin QTc prolongado. Conclusiones: En nuestra serie, una elevada proporción de pacientes críticos con COVID-19 han presentado QTc prolongado y arritmias. Los factores implicados se han relacionado con la elevación de biomarcadores cardiacos, la propia afectación miocárdica del virus y la medicación concomitante recibida en la UCI.(AU)

Introduction and objective: Patients with SARS-CoV-2 infection may present cardiovascular involvement including myocarditis, arrhythmias and QT interval prolongation. Our objective was to evaluate the impact of COVID-19 and its treatment on ventricular repolarization and development of arrhythmias in critically ill patients. Material and methods: Retrospective cohort study of critically ill COVID-19 patients during a 3-month period in whom at least one ECG was available. Relevant clinical data and specific treatment administered for COVID-19 were recorded. Prolonged QTc was considered prolonged when it measured ≥460ms in women and ≥450ms in men. The incidence and type of arrhythmias during the same period were recorded. Results: A total of 77 patients with a mean age of 62±13years, 20 women and 57 men, were evaluated. Sixty percent of the patients were hypertensive, 52% had a BMI>30, and 70% developed acute renal failure during admission. Some 56% of the patients presented QTc prolongation. Forty-four percent presented some type of arrhythmia during their stay in the ICU, 21% of which were atrial arrhythmias. Overall mortality was 53%, with no differences between patients with or without prolonged QTc. Conclusions: In our series, a high proportion of critical patients with COVID-19 presented prolonged QTc and arrhythmias. The factors involved have been related to the elevation of cardiac biomarkers, the myocardial involvement of the virus and concomitant medication received in the ICU.(AU)

Cohort study to assess the prevalence of prolonged QT and arrhythmias in critically ill patients during the early phase of the COVID-19 pandemic.

INTRODUCTION: Patients with SARS-CoV-2 infection may present cardiovascular involvement including myocarditis, arrhythmias and QT interval prolongation. Our objective was to evaluate the impact of COVID-19 and its treatment on ventricular repolarization and development of arrhythmias in critically ill patients. METHODS: Retrospective cohort study of critically ill COVID-19 patients during a 3-month period in whom at least one ECG was available. Relevant clinical data and specific treatment administered for COVID-19 were recorded. Prolonged QTc was considered prolonged when it measured ≥ 460 ms in women and ≥450 ms in men. The incidence and type of arrhythmias during the same period were recorded. RESULTS: A total of 77 patients with a mean age of 62 ±â€¯13 years, 20 women and 57 men, were evaluated. Sixty percent of the patients were hypertensive, 52% had a BMI > 30, and 70% developed acute renal failure during admission. Some 56% of the patients presented QTc prolongation. Forty-four percent presented some type of arrhythmia during their stay in the ICU, 21% of which were atrial arrhythmias. Overall mortality was 53%, with no differences between patients with or without prolonged QTc. CONCLUSIONS: In our series, a high proportion of critical patients with COVID-19 presented prolonged QTc and arrhythmias. The factors involved have been related to the elevation of cardiac biomarkers, the myocardial involvement of the virus and concomitant medication received in the ICU.

Laboratorio de función tiroidea en pediatría. Ventajas y limitaciones de los métodos indirectos para la obtención de intervalos de referencia / Thyroid function laboratory in pediatrics. Advantages and limitations of indirect methods to obtain reference intervals

Obtener intervalos de referencia (IRs) confiables para pruebas de laboratorio en pediatría es particularmente complejo y costoso. Una alternativa a este problema es el uso de métodos indirectos, donde se usan grandes bases de datos preexistentes de pacientes. Nuestros objetivos fueron: calcular IR para TSH y hormonas tiroideas (Perfil tiroideo, PT) en población pediátrica que asiste al Hospital de Pediatría Juan P. Garrahan, por método indirecto y verificar la confiabilidad de los mismos para su aplicación. Se recolectaron datos de 19.842 pacientes entre enero de 2020 y diciembre de 2021. Se aplicaron filtros para eliminar los pacientes que pudieran tener afectado el PT. Los 4.861 pacientes incorporados al análisis fueron divididos en 3 grupos: G1: 0-12 meses (n: 551), G2:13 meses- 7 años (n: 1347) y G3: 8 -18 años (n: 2963). Los IR fueron calculados por 2 métodos: el de Hoffman adaptado y el de CLSI EP28A3, para cada grupo de edad. TSH, TT3 y T4L se analizaron con Architect i4000-Abbott y TT4 con Immulite 2000XPi-Siemens. Para la primera etapa de verificación se utilizaron 20 sueros de pacientes provenientes de análisis prequirúrgicos. Los outliers se detectaron aplicando el método de Tukey. Los datos fueron procesados según CLSI EP28A3c. Los IR obtenidos fueron similares a los previamente publicados obtenidos por método directo. Los resultados de la verificación fueron en su mayoría aceptados. Por lo tanto, los métodos indirectos son una buena alternativa de cálculo de IR en pediatría (AU)

Obtaining reliable reference ranges (RRs) for laboratory tests in pediatrics is particularly complex and costly. An alternative to this problem is to use of indirect methods, where large pre-existing patient databases are used. Our aims were to calculate RRs for TSH and thyroid hormones (thyroid profile, PT) in children seen at Hospital de Pediatría Juan P. Garrahan by indirect methods and to verify their reliability for their application. Data were collected from 19,842 patients seen between January 2020 and December 2021. Filters were applied to eliminate patients in whom the PT was potentially affected. The remaining 4,861 patients included in the analysis were divided into 3 groups: G1: 0-12 months (n: 551), G2: 13 months-7 years (n: 1347) and G3: 8-18 years (n: 2963). RRs were calculated by 2 methods: the adapted Hoffman method and the CLSI EP28A3 method, for each age group. TSH, TT3, and FT4 were analyzed with Architect i4000-Abbott and TT4 with Immulite 2000XPi-Siemens. For the first stage of verification, 20 patient sera from pre-surgical analysis were used. Outliers were detected by applying the Tukey method. The data were processed according to CLSI EP28A3c. The RRs obtained were similar to those previously published using the direct method. The verification results were mostly acceptable. Therefore, indirect methods are a good option for calculating RRs in children (AU)

Revisión del intervalo de referencia del recuento plaquetario: ¿son adecuados los valores que estamos utilizando? / Review of the platelet count reference range: are the values we are using appropriate?

Los intervalos de referencia (IR) dependen de la población y de las características metrológicas del procedimiento de medida utilizado. A pesar de las recomendaciones internacionales, son pocos los laboratorios que establecen sus propios IR para cada magnitud por la dificultad para conseguir voluntarios de referencia y el elevado costo económico asociado. La International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) acepta la adopción de IR bibliográficos o su cálculo por métodos indirectos dado su bajo costo y fácil obtención. Existen varias fuentes confiables de IR bibliográficos para el hemograma. No obstante, para el recuento plaquetario, es una práctica común de los laboratorios emplear el rango de valores de 150-450.109 /L independiente de la metodología utilizada y grupo etario. El objetivo de este trabajo fue revisar los IR bibliográficos disponibles para el recuento plaquetario y estimarlo empleando el método indirecto de Hoffmann a partir de nuestra población. Los métodos indirectos se basan en aplicar criterios de exclusión y cálculos matemáticos sobre los resultados de una base de datos de laboratorio. Nuestros IR para el recuento plaquetario se comparan con los bibliográficos, que han sido establecidos por técnicas de muestreo directo. Por este motivo y dado que no existen estudios poblacionales que lo avalen, sería apropiado reemplazar el rango de 150-450.109 / L. Estos límites podrían seguir empleándose como puntos de corte o niveles de decisión médica para definir, según la clínica y otros resultados de laboratorio, los pacientes que ameritan un seguimiento posterior (AU)

Reference ranges (RR) depend on the population and the metrological characteristics of the measurement procedure used. Despite international recommendations, few laboratories establish their own RRs for each magnitude because of the difficulty in obtaining reference volunteers and the associated high economic cost. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) accepts the use of literaturebased RRs or RRs calculated by indirect methods because of their low cost and easy collection. There are several reliable sources of literature-based RRs for the Cell Blood Count. However, for platelet count, it is common laboratory practice to use the range of 150-450,109 /L regardless of the methodology used and age group. The aim of this study was to review the available literature regarding RRs for platelet count and to establish it using the indirect Hoffmann method in our population. Indirect methods are based on applying exclusion criteria and mathematical calculations on the results of a laboratory database. Our RRs for platelet counts are compared with those in the literature, which have been established by direct sampling techniques. Therefore, and given that there are no population studies to support these findings, it would be appropriate to replace the 150-450,109 /L range. These limits may continue to be used as cut-off points or medical decision levels to define, according to clinical manifestations and other laboratory results, patients who warrant further follow-up (AU)

Atrial fibrillation and QT prolongation after a single dose of hydroxychloroquine / Fibrilación auricular y prolongación del QT después de una dosis única de hidroxicloroquina

Non-antiarrhythmic drugs may induce QT-prolongation and increase the risk of arrhythmias. Recent studies have determined that there is a risk of atrial fibrillation (AF) due to QT prolongation. We report a case of FA associated to QT prolongation secondary to a single dose of hydroxychloroquine (HCQ) in an 83-years-old polymedicated patient admitted to our hospital due to SARS-CoV-2 infection. Quetiapine was prescribed as regular medicine after admission and a 5-days oral HCQ regimen was started for COVID-19. Thirty minutes after HCQ loading dose, FA was reported on electrocardiogram (EKG). COVID-19 treatment is leading to use off-label drugs that may generate adverse effects. It should be considered that drugs that induce QT prolongation may be triggers for atrial arrhythmias. There is not any report of sudden onset of increased QT interval with associated arrythmia after a single dose of HCQ, even in a short course treatment. (AU)

Los fármacos no antiarrítmicos pueden inducir la prolongación del intervalo QT y aumentar el riesgo de arritmias. Estudios recientes han determinado que existe riesgo de desarrollar fibrilación auricular (FA) asociada a la prolongación del intervalo QT. Presentamos un caso de FA asociado a prolongación del QT secundario a una dosis única de hidroxicloroquina (HCQ) en una paciente polimedicada de 83 años ingresada en nuestro hospital por infección por SARS-CoV-2. A la paciente se le prescribió quetiapina como parte de su medicamento habitual al ingreso y se inició tratamiento frente a COVID-19 basado en HCQ oral. Treinta minutos tras la dosis de carga de HCQ, se informó FA en el electrocardiograma (ECG). El tratamiento de COVID-19 está llevando al uso de medicamentos no aprobados que pueden generar efectos adversos. Además, debe considerarse que los fármacos que inducen la prolongación del QT pueden desencadenar arritmias auriculares. No se han reportado casos de aparición repentina de aumento del intervalo QT con arritmia asociada después de una dosis única de HCQ. (AU)

Relationship of the T-wave Tpeak-Tend interval with conduction system disorders in arterial hypertension / Relación del intervalo Tpico-Tfinal de la onda T con trastornos del sistema de conducción en hipertensión arterial

Abstract Purpose: The Tpeak-Tend interval of the T wave has emerged as a new electrocardiographic marker of increased transmural dispersion of ventricular repolarization. We aimed to determine the presence of cardiac conduction system disorders in patients with systemic arterial hypertension (SAH) who have altered Tpeak-Tend interval of the T wave. Methods: The 67 patients with SAH were divided into two groups. Those with prolonged (≥ 77 ms) Tpeak-Tend intervals, 21 (31%) patients were in the study group. Those with normal (< 77 ms) Tpeak-Tend intervals, 46 (69%) patients were in the control group. Alteration of ventricular repolarization manifested as a prolongation of the Tpeak-Tend interval was detected by computerized electrocardiographic analysis tools. Results: The median value of QRS complex duration was significantly wider in the study group as compared to the control group (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). There was a significantly greater incidence of left anterior hemiblock in the study group (14% vs. 0% p < 0.04). The median value of the QTc interval was significantly greater in the study group (440 ± 26 vs. 422 ± 15 p < 0.01). There was a significantly greater incidence of patients with prolonged QTc interval in the study group (33% vs. 11% p < 0.02). The median value of the Tpeak-Tend interval was significantly greater in the study group (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), as well as, the Tpeak-Tend/QTc ratio in the study group (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusion: There is a significantly greater ventricular repolarization disorders and abnormalities of the cardiac conduction system in SAH patients who possess altered Tpeak-Tend interval of the T wave.

Resumen Objetivo: El intervalo Tpico-Tfinal de la onda T es un marcador electrocardiográfico de la dispersión transmural aumentada de la repolarización ventricular. Investigamos la presencia de trastornos del sistema de conducción cardíaca en pacientes con hipertensión arterial sistémica (HA) que poseen alterado el intervalo Tpico-Tfinal de la onda T. Métodos: Los 67 pacientes con HA fueron divididos en dos grupos. Aquellos con intervalos de Tpico-Tfinal prolongados (≥ 77 ms), 21 (31%) pacientes (grupo de estudio). Aquellos con intervalos normales (< 77 ms) Tpico-Tfinal, 46 (69%) pacientes (grupo control). Los intervalos Tpico-Tfinal fueron medidos por herramientas de análisis electrocardiográfico computarizado. Resultados: El valor mediano de la duración del complejo QRS fue significativamente más amplio en el grupo de estudio (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). Hubo una incidencia significativamente mayor de hemibloqueo anterior izquierdo en el grupo de estudio (14% vs. 0% p < 0.04). El valor mediano del intervalo QTc fue significativamente mayor en el grupo de estudio (440 ± 26 vs. 422 ± 15 p < 0.01). Hubo una incidencia significativamente mayor de pacientes con intervalo QTc prolongado en el grupo de estudio (33% vs. 11% p < 0.02). El valor mediano del intervalo Tpico-Tfinal fue significativamente mayor en el grupo de estudio (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), así como el cociente Tpico-Tfinal/QTc (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusión: Existe una alteración de la repolarización ventricular significativamente mayor y anomalías del sistema de conducción cardíaca en pacientes con HA que poseen alteración del intervalo Tpico-Tfinal de la onda T.

Relationship of the T-wave Tpeak-Tend interval with conduction system disorders in arterial hypertension.

PURPOSE: The Tpeak-Tend interval of the T wave has emerged as a new electrocardiographic marker of increased transmural dispersion of ventricular repolarization. We aimed to determine the presence of cardiac conduction system disorders in patients with systemic arterial hypertension (SAH) who have altered Tpeak-Tend interval of the T wave. METHODS: The 67 patients with SAH were divided into two groups. Those with prolonged (≥ 77 ms) Tpeak-Tend intervals, 21 (31%) patients were in the study group. Those with normal (< 77 ms) Tpeak-Tend intervals, 46 (69%) patients were in the control group. Alteration of ventricular repolarization manifested as a prolongation of the Tpeak-Tend interval was detected by computerized electrocardiographic analysis tools. RESULTS: The median value of QRS complex duration was significantly wider in the study group as compared to the control group (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). There was a significantly greater incidence of left anterior hemiblock in the study group (14% vs. 0% p < 0.04). The median value of the QTc interval was significantly greater in the study group (440 ± 26 vs. 422 ± 15 p < 0.01). There was a significantly greater incidence of patients with prolonged QTc interval in the study group (33% vs. 11% p < 0.02). The median value of the Tpeak-Tend interval was significantly greater in the study group (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), as well as, the Tpeak-Tend/QTc ratio in the study group (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). CONCLUSION: There is a significantly greater ventricular repolarization disorders and abnormalities of the cardiac conduction system in SAH patients who possess altered Tpeak-Tend interval of the T wave.

OBJETIVO: El intervalo Tpico-Tfinal de la onda T es un marcador electrocardiográfico de la dispersión transmural aumentada de la repolarización ventricular. Investigamos la presencia de trastornos del sistema de conducción cardíaca en pacientes con hipertensión arterial sistémica (HA) que poseen alterado el intervalo Tpico-Tfinal de la onda T. MÉTODOS: Los 67 pacientes con HA fueron divididos en dos grupos. Aquellos con intervalos de Tpico-Tfinal prolongados (≥ 77 ms), 21 (31%) pacientes (grupo de estudio). Aquellos con intervalos normales (< 77 ms) Tpico-Tfinal, 46 (69%) pacientes (grupo control). Los intervalos Tpico-Tfinal fueron medidos por herramientas de análisis electrocardiográfico computarizado. RESULTADOS: El valor mediano de la duración del complejo QRS fue significativamente más amplio en el grupo de estudio (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). Hubo una incidencia significativamente mayor de hemibloqueo anterior izquierdo en el grupo de estudio (14% vs. 0% p < 0.04). El valor mediano del intervalo QTc fue significativamente mayor en el grupo de estudio (440 ± 26 vs. 422 ± 15 p < 0.01). Hubo una incidencia significativamente mayor de pacientes con intervalo QTc prolongado en el grupo de estudio (33% vs. 11% p < 0.02). El valor mediano del intervalo Tpico-Tfinal fue significativamente mayor en el grupo de estudio (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), así como el cociente Tpico-Tfinal/QTc (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). CONCLUSIÓN: Existe una alteración de la repolarización ventricular significativamente mayor y anomalías del sistema de conducción cardíaca en pacientes con HA que poseen alteración del intervalo Tpico-Tfinal de la onda T.

Interval gastric cancer: A call to attentiveness and action.

INTRODUCTION AND AIMS: Endoscopy is the most effective method for identifying gastric adenocarcinoma (GAC). Interval gastric cancer (IGC) is GAC that is diagnosed 2-3 years after a normal endoscopy. Its characteristics are unknown in the Colombian environment. The clinical, histopathologic, and endoscopic characteristics were evaluated, along with the presentation rate, proton pump inhibitor (PPI) use, and IGC survival rate, and compared with other types of GAC. METHODS: A retrospective, analytic study was conducted on a prospective cohort. It evaluated 513 patients with GAC treated at our institution, within the time frame of January 2012 and June 2018. The patients had endoscopic diagnosis of GAC and endoscopy within the past three years that was negative for tumor. RESULTS: A total of 513 patients diagnosed with GAC were evaluated. Forty-two of the patients had IGC (8.2%): 9 early lesions and 33 advanced lesions (79%). The IGCs were smaller (31 vs. 41 mm; P < .01), as well as flatter and more depressed (P < .01). There was no association with PPI use, but there was an association with a history of gastrectomy and anastomosis (P = .02), as well as the absence of red flags (P < .003). The most frequent locations were the gastric body (52%) and the antrum (26%). Overall two-year survival was similar between IGC and GAC (37.1 vs. 39.3%, P = .72). CONCLUSION: A total of 8.2% of recently diagnosed GAC were cases of IGC. The presence of anastomosis and the absence of red flags were related to IGC. Overall survival was poor and there were no differences from the other types of GAC detected.

Influence of high-intensity interval training on table tennis players / Influência do treinamento intervalado de alta intensidade nos jogadores de tênis de mesa / Influencia del entrenamiento de intervalos de alta intensidad en los jugadores de tenis de mesa

ABSTRACT Introduction The development of the technical level of table tennis and the reform of the rules require players to have a proportionally comprehensive technical base, aiming to climb to the top of world table tennis. Objective Study the effect of high-intensity competition on the physical fitness of table tennis players. Methods By analyzing the questionnaires of coaches and athletes in colleges and universities in Zhejiang province, as well as the development status and situation of soldiers and soldier teams in colleges and universities in Zhejiang province, find out the factors that restrict the competitive level of table tennis in ordinary colleges and universities in our province. Results Most athletes felt that the specific qualities of agility and strength were important, accounting for 63% of the total, while endurance and speed were less important, accounting for 19% and 18%, respectively. Conclusion The time devoted to physical training is short, and the disposition of training time is insufficient. Compared to high-level sports teams, the quality of physical preparation and the particular technical training time cannot be combined rationally and satisfactorily. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução O desenvolvimento do nível técnico do tênis de mesa e a reforma das regras, requerem que os jogadores de tênis de mesa tenham uma base técnica proporcionalmente abrangente, visando escalar o topo do tênis de mesa mundial. Objetivo Estudar o efeito da competição de alta intensidade sobre a aptidão física dos jogadores de tênis de mesa. Métodos Ao analisar os questionários de treinadores e atletas nas faculdades e universidades da província de Zhejiang, bem como o estado de desenvolvimento e a situação dos soldados e equipes de soldados nas faculdades e universidades da província de Zhejiang, descobrir os fatores que restringem o nível competitivo do tênis de mesa nas faculdades e universidades comuns de nossa província. Resultados A maioria dos atletas sentiu que as qualidades específicas de agilidade e força eram importantes, representando 63% do total, enquanto a resistência e a velocidade eram menos importantes, representando 19% e 18% respectivamente. Conclusão O tempo dedicado ao treinamento físico é breve, e a disposição do tempo de treinamento é insuficiente. Em comparação com as equipes esportivas de alto nível, a qualidade da preparação física e o tempo de treinamento técnico particular não podem ser combinados de forma racional e satisfatória. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción El desarrollo del nivel técnico del tenis de mesa y la reforma de las reglas, requieren que los jugadores de tenis de mesa tengan una base técnica proporcionalmente amplia, con el objetivo de subir a la cima del tenis de mesa mundial. Objetivo Estudiar el efecto de la competición de alta intensidad sobre la aptitud física de los jugadores de tenis de mesa. Métodos Mediante el análisis de los cuestionarios de los entrenadores y atletas de los colegios y universidades de la provincia de Zhejiang, así como del estado de desarrollo y la situación de los equipos de soldados y soldados de los colegios y universidades de la provincia de Zhejiang, averiguar los factores que restringen el nivel competitivo del tenis de mesa en los colegios y universidades ordinarios de nuestra provincia. Resultados La mayoría de los atletas consideraron que las cualidades específicas de agilidad y fuerza eran importantes, con un 63% del total, mientras que la resistencia y la velocidad eran menos importantes, con un 19% y un 18% respectivamente. Conclusión El tiempo dedicado al entrenamiento físico es breve, y la disposición del tiempo de entrenamiento es insuficiente. En comparación con los equipos deportivos de alto nivel, la calidad de la preparación física y el tiempo de entrenamiento técnico particular no pueden combinarse de forma racional y satisfactoria. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Implant-supported canine retraction using different reactivation intervals of elastomeric chains: A CBCT-based split-mouth randomized controlled trial

ABSTRACT Introduction: Orthodontists attempt to maximize treatment efficiency regarding time, tooth position and adverse effects. A new approach, not yet explored, is the activation frequency. Objective: The aim of this split-mouth randomized controlled trial was to evaluate the effect of reactivation intervals on the efficiency of tooth movement. Methods: Thirty eight patients having a Class I malocclusion with bimaxillary dentoalveolar protrusion or severe crowding, Class II with mandibular deficiency or Class III, requiring first premolar extraction and canine retraction were recruited. Elastomeric chains producing 150g were replaced every two, four, six or eight weeks. There were 36, 37, 36, and 36 quadrants randomly allocated to these groups, respectively. The canine retraction rate was the primary outcome. Canine tipping, rotation, and root resorption and pain were the secondary outcomes. Only the outcome assessors were blinded to group assignment. Results: The average total movement for the 6 months was 5.14, 5.31, 2.79 and 3.85 mm for the two-week, four-week, six-week and eight-week reactivation intervals, respectively. Root resorption was significantly higher in the two-week and four-week groups. No adverse events were observed. Conclusion: The canine retraction rate, tipping, rotation and pain were similar in 2, 4, 6 and 8-week activation intervals groups. Longer reactivation intervals show less root resorption. The trial protocol was not pre-registered. The study was self-funded.

RESUMO Introdução: Os ortodontistas buscam otimizar a eficiência do tratamento quanto ao tempo de duração, à posição dos dentes e aos efeitos adversos. Um aspecto ainda não avaliado são os diferentes intervalos entre as ativações. Objetivo: O objetivo desse estudo controlado e randomizado de boca dividida foi avaliar a influência de diferentes intervalos de reativação na eficiência da movimentação dentária. Métodos: Foram recrutados 38 pacientes com má oclusão de Classe I com biprotrusão dentoalveolar ou apinhamento severo, Classe II com deficiência mandibular ou Classe III, que necessitavam de extração do primeiro pré-molar e retração do canino. As cadeias elastoméricas gerando 150 g foram substituídas a cada duas, quatro, seis ou oito semanas, constando 36, 37, 36 e 36 quadrantes alocados aleatoriamente nesses grupos, respectivamente. O desfecho primário foi a taxa de retração do canino. Os desfechos secundários foram a inclinação, a rotação e a reabsorção radicular do canino, e a dor. Somente os avaliadores dos resultados não tinham conhecimento da alocação nos grupos. Resultados: O movimento total médio para os seis meses foi de 5,14; 5,31; 2,79 e 3,85 mm para os intervalos de reativação de duas semanas, quatro semanas, seis semanas e oito semanas, respectivamente. A reabsorção radicular foi significativamente maior nos grupos de duas e quatro semanas. Não foram observados eventos adversos. Conclusão: A taxa de retração, a inclinação e a rotação do canino e a dor foram semelhantes nos grupos com intervalos de ativação de duas, quatro, seis e oito semanas. Intervalos de reativação mais longos mostram menos reabsorção radicular. O protocolo do estudo não foi pré-registrado. O estudo foi autofinanciado.

Re-warm-up practices in elite and sub-elite Spanish men's and women's basketball team: practitioners' perspectives / Prácticas de re-calentamiento en equipos de baloncesto masculino y femenino de élite y sub-élite españoles: perspectivas de los profesionales / Práticas de reaquecimento nas equipas de elite e subelite espanholas de basquetebol masculino e feminino: perspectivas dos praticantes

Objective: Research suggests that an active re-warm-up (RW-U) during half-time improves performance capacity in team sports, despite limited evidence in basketball. This study aimed to identify the practice of RW-U activities during the half-time period in elite and sub-elite Spanish men's and women's basketball teams. Methods: We asked strength and conditioning coaches from all teams competing at ACB, LF, LF2, LEB Oro, LEB Plata and EBA leagues during the 2020/21 season to fill in a web survey. Results: All respondents reported familiarization with the RW-U concept, although 45% only reproduced traditional strategies. Half of the coaches indicated that they always performed some activity, while the other half pointed out lack of time (45.7%) and player demands (62.9%) as the main constraints impeding its regular use. Conclusion: Spanish basketball teams continue to reproduce traditional practices of active re-warm-up during half-time, regardless of their competitive level.(AU)

Objetivo: La investigación sugiere que un recalentamiento activo (RW-U) durante el descanso mejora la capacidad de rendimiento en los deportes de equipo, a pesar de que la evidencia en el baloncesto es limitada. Este estudio tiene como objetivo identificar la práctica de actividades de RW-U durante el periodo de descanso en equipos de baloncesto españoles de élite y sub-élite. Métodos: Se pidió a los preparadores físicos de todos los equipos que compiten en las ligas ACB, LF, LF2, LEB Oro, LEB Plata y EBA durante la temporada2020/21 que rellenaran una encuesta web. Resultados: Todos los encuestados declararon estar familiarizados con el concepto RW-U, aunque el 45% sólo reprodujo las estrategias tradicionales. La mitad de los entrenadores indicó que siempre realizaba alguna actividad, mientras que la otra mitad señaló la falta de tiempo (45,7%) y la exigencia de los jugadores (62,9%) como las principales razones que limitan su uso regular. Conclusión: Los equipos de baloncesto español siguen reproduciendo prácticas tradicionales de re-calentamiento activo durante el medio tiempo, independientemente de su nivel competitivo.(AU)

Objectivos: A investigação sugere que um reaquecimento activo (RW-U) durante o intervalo melhora a capacidade de desempenho nos desportos de equipa, apesar das provas limitadas no basquetebol. Este estudo visava identificar a prática de actividades de RW-U durante o intervalo nas equipas de elite e subelite espanholas de basquetebol masculino e feminino. Métodos: Pedimos força e condicionamento aos treinadores de toda as equipas que competiram nas ligas ACB, LF, LF2, LEB Oro, LEB Plata e EBA durante a época de 2020/21 para preencher um inquérito na web. Resultados: Todos os inquiridos relataram familiarização com o conceito de RW-U, embora 45% reproduzissem apenas estratégias tradicionais. Metade dos treinadores indicaram que sempre realizaram alguma actividade, enquanto a outra metade apontou a falta de tempo (45,7%) e as exigências dos jogadores (62,9%) como os principais constrangimentos que impedem a sua utilização regular.Conclusão: As equipas espanholas de basquetebol continuam a reproduzir práticas tradicionais de reaquecimento activo durante o intervalo, independentemente do seu nível competitivo.(AU)

Severe primary hypothyroidism presenting as polymorphic ventricular tachycardia / Hipotiroidismo primario grave que se presenta como taquicardia ventricular polimórfica

Abstract Introduction: Hypothyroidism may have various cardiovascular manifestations due to morphological, functional and electrical alterations in the heart. The usual electrocardiographic findings being sinus bradycardia, low voltage complexes, and slowed intraventricular conduction. Hypothyroidism manifesting as polymorphic ventricular tachycardia has only been reported in a few case reports. Clinical case. A 60-year-old lady presented to us in the emergency department in an unresponsive and unconscious state and electrocardiogram showed a polymorphic ventricular tachycardia. After initial resuscitation with direct current cardioversion and supportive care, she found to have severe hypothyroidism and responded well to thyroid replacement therapy. Conclusion. Polymorphic ventricular tachycardia is a life threatening emergency that can have various etiologies. Polymorphic ventricular tachycardia secondary to primary hypothyroidism is a rare presentation but it is treatable and reversible with thyroid replacement therapy. In patients presenting with QT interval prolongation and ventricular tachycardia, hypothyroidism should be one of the differential diagnosis.

Resumen Introducción: El hipotiroidismo puede presentar diferentes manifestaciones cardiovasculares dadas por alteraciones morfológicas, funcionales y eléctricas en el corazón, siendo los hallazgos electrocardiográficos usuales son la bradicardia sinusal, los complejos de bajo voltaje y la conducción intraventricular lenta. El hipotiroidismo manifestado como taquicardia ventricular polimórfica solo se ha descrito en unos pocos reportes de caso. Caso clínico: Se trata de una mujer de 60 años que acudió que acurdió al servicio de urgencias en un estado inconsciente y sin respuesta a estímulos, y el electrocardiograma reveló taquicardia ventricular polimórfica. Luego de la reanimación inicial con cardioversión con corriente directa y tratamiento sintomático se le encontró un hipotiroidismo grave, el cual se trató con terapia de reemplazo con hormona tiroidea. y se obtuvo una buena respuesta Conclusión. La taquicardia ventricular polimórfica es una emergencia vital que puede tener varias etiologías. La taquicardia ventricular polimórfica secundaria a un hipotiroidismo primario es una presentación poco común, pero es tratable y reversible con la terapia de reemplazo con hormona tiroidea. En los pacientes que presentan una prolongación del intervalo QT y taquicardia ventricular, es pertinente incluir el hipotiroidismo en el diagnóstico diferencial.

¿Es el intervalo libre de docetaxel un factor predictivo para el cáncer de próstata resistente a la castración? / Is docetaxel-free interval a predictive factor for castration-resistant prostate cancer?

Objetivo: El cáncer de próstata (CaP) es el segundo tumor sólido más frecuente en los varones y la quinta causa de muerte relacionada con el cáncer. En los estadios avanzados de la enfermedad se administran tratamientos paliativos en lugar de terapias curativas, por lo que, conocer los posibles indicadores predictivos, parece importante. Se revisaron retrospectivamente los pacientes con cáncer de próstata resistente a la castración (CPRC) que recibieron quimioterapia con docetaxel (Dx). El objetivo de este estudio fue investigar si el intervalo libre de Dx podría tener un valor predictivo para el CaP e influir en las terapias secuenciales.Material y métodos: Este ensayo clínico se realizó en 104 pacientes en la Clínica de Oncología de la Universidad de Medeniyet en 2018-2020. Todos los pacientes con CPRC metastásico recibieron Dx como primer tratamiento y fueron sometidos a terapia dirigida al receptor de andrógenos (ARAT, por sus siglas en inglés) tras la progresión de la enfermedad. Se analizó el tiempo hasta la progresión de los pacientes después de la terapia con Dx y los efectos sobre el tratamiento secuencial.Resultados: Posterior al tratamiento con Dx, los pacientes recibieron ARAT (abiraterona [ABI] n: 49 [47,1%] y enzalutamida [ENZ] n: 54 [51,9%]) como tratamiento de segunda línea, excepto un paciente que recibió cabazitaxel. Hubo una relación estadísticamente significativa entre el intervalo libre de Dx y la duración de la respuesta al ARAT (p<0,001). El tiempo de respuesta al tratamiento con ARAT fue <10,5 meses en todos los pacientes con un período de intervalo libre de Dx<9 meses.Conclusiones: Nuestros resultados avalan la hipótesis de que el intervalo libre de Dx puede ser un factor predictivo para el CPRC. El CPRC podría clasificarse como enfermedad sensible al Dx o resistente al Dx en función del intervalo libre de Dx; y la decisión sobre los tratamientos posteriores podría tomarse con base en esta información. (AU)

Objective: Prostate cancer (PCa) is the second most common solid tumor in men and the fifth leading cause of cancer-related death. In advanced stage, palliative treatments are used instead of curative therapies. Therefore, finding predictive indicators seems crucial. Patients with castration-resistant prostate cancer (CRPC) that received Dx chemotherapy have been retrospectively reviewed. The aim of this study was to investigate whether docetaxel (Dx)-free interval could have a predictive value for PCa and influence other sequential therapies.Material and methods: This clinical trial study was performed on 104 patients at Medeniyet University Oncology Clinic in 2018-2020. All CRPC patients had metastases, received Dx as first-line treatment and underwent androgen receptor axis targeted (ARAT) therapy after disease progression. We analyzed patients’ progression time after Dx therapy and the effects on sequential treatment.Results: After Dx therapy, all patients received ARAT (abiraterone (ABI) n: 49 (47.1%) and enzalutamide (ENZ) n: 54 (51.9%)) as a second-line treatment, except for one patient who received cabazitaxel. There was a statistically significant relationship between the Dx-free interval and duration of response to ARAT (P<.001). The response time of ARAT treatment was <10.5 months in all patients whose Dx-free interval period was <9 months.Conclusions: Our findings support the theory that Dx-free interval can be a predictive factor for CRPC. CRPC disease can be classified as Dx-sensitive disease or Dx-resistance disease, based on the Dx-free interval. Decision on subsequent treatments could be made considering this information. (AU)

Androgen deprivation therapy mimicking acute coronary syndrome: A case report.

An 80-year-old man diagnosed with prostate cancer and under treatment with androgen deprivation therapy presented at the emergency room with chest pain, repolarization abnormalities and QT interval prolongation on electrocardiogram. An initial diagnosis of acute coronary syndrome was proposed, but biomarkers and coronary angiography were negative. Hydroelectrolyte balance and echocardiogram were also normal. Some weeks after drug withdrawal, repolarization changes reverted. A rare side effect of these drugs mimicking an acute coronary syndrome was the most probable diagnosis.

Ventricular arrhythmias are associated with increased QT interval and QRS dispersion in patients with ST-elevation myocardial infarction.

INTRODUCTION AND OBJECTIVES: The electrocardiogram continues to be essential in the diagnosis of acute myocardial infarction, and a useful tool in arrhythmic risk stratification. We aimed to determine which electrocardiographic variables can successfully predict the occurrence of ventricular arrhythmias (VA) in patients following ST-segment elevation myocardial infarction (STEMI). METHODS: We performed an observational study including 667 patients with STEMI admitted to the University Hospital in Sancti Spíritus, Cuba. Demographic variables, cardiovascular risk factors, and clinical variables were recorded. Electrocardiographic variables included QT interval duration (measured and corrected) and QT dispersion, QRS duration and dispersion, JT interval duration and ST-segment elevation magnitude. We also determined left ventricular ejection fraction and glomerular filtration rate. A binary statistical regression model and a regression tree were used to determine the variables that successfully predicted VA. RESULTS: VA occurred in 92 (13.8%) patients, within the first 48 hours in 68 (73.9%) and after this period in 24 (26.1%) patients. The variables associated with VA were QT interval duration >529 ms and QT dispersion >66 ms, QRS dispersion >50 ms, and the presence of ST-segment elevation in six or more leads. CONCLUSIONS: The main predictor of VA occurring during the initial 48 hours was QT interval duration, while, after this period, it was QRS dispersion.

Effects of high intensity intermittent training on lipid profile and blood glucose overweight/obese university students / Efectos del entrenamiento intermitente de alta intensidad sobre el perfil lipídico y la glucosa en sangre en estudiantes universitarios con sobrepeso/obesidad / Efeitos do treinamento intermitente de alta intensidade no perfil lipídico e glicemia de universitários com sobrepeso/obesidade

Introduction: High-Intensity Interval Training (HIIT) involves developing exercises in short periods of time with high intensity, followed by periods of rest between the series of exercises performed, and is considered an important tool to combat obesity. Therefore, the present work aimed to identify the effects of high-intensity intermittent training on the lipid profile in overweight and obese university students. Materials and methods: quasi-experimental study, consisting of a sample of 30 students, who were randomly assigned into two groups of 15 students, thus leaving a control group (continuous training): 15 and an experimental group (intermittent exercise of high intensity: 15. Moreover, there were carried out Laboratory tests before and after training to find the lipid profile. Also, the realization of 20 training sessions, which were distributed three times a week, with an average duration of 50 minutes. Additionally, the performed of statistical tests with a level of statistical significance of p <0.05. Results: there is a statistically significant relationship in the HDL value of the control and experimental group. The Glucose values show statistically significant relationships in the experimental group (p = 0.001). Conclusions: Intermittent high-intensity training and continuous moderate-intensity work generate a decrease in LDL and Triglycerides variables and an increase in HDL. However, they are not statistically significant after 20 training sessions. However, high-intensity intermittent training results in glucose-lowering in overweight and obese people.

Introducción: El Entrenamiento Interválico de Alta Intensidad (HIIT) implica desarrollar ejercicios en períodos cortos de tiempo con alta intensidad, seguidos de períodos de descanso entre las series de ejercicios realizados, y se considera una herramienta importante para combatir la obesidad. Por lo tanto, el presente trabajo tuvo como objetivo identificar los efectos del entrenamiento intermitente de alta intensidad sobre el perfil lipídico en estudiantes universitarios con sobrepeso y obesidad. Materiales y métodos: estudio cuasi-experimental, conformado por una muestra de 30 estudiantes, quienes fueron asignados aleatoriamente en dos grupos de 15 estudiantes, quedando así un grupo control (entrenamiento continuo): 15 y un grupo experimental (ejercicio intermitente de alta intensidad: 15. Además, se realizaron pruebas de laboratorio antes y después del entrenamiento para determinar el perfil lipídico, así como la realización de 20 sesiones de entrenamiento, las cuales se distribuyeron tres veces por semana, con una duración promedio de 50 minutos, adicionalmente se realizó la pruebas estadísticas con un nivel de significación estadística de p < 0,05. Resultados: existe una relación estadísticamente significativa en el valor de HDL del grupo control y experimental, los valores de Glucosa muestran relaciones estadísticamente significativas en el grupo experimental (p = 0,001) Conclusiones: El entrenamiento intermitente de alta intensidad y el trabajo continuo de intensidad moderada generan una disminución de las variables LDL y Triglicéridos y un aumento de HDL. Estos datos, no son estadísticamente significativos después de 20 sesiones de entrenamiento. Sin embargo, el entrenamiento intermitente de alta intensidad da como resultado una disminución de la glucosa en personas con sobrepeso y obesidad.

Introdução: O Treinamento Intervalado de Alta Intensidade (HIIT) envolve desenvolver exercícios em curtos períodos com alta intensidade, seguidos de períodos de descanso entre as séries de exercícios realizados, sendo considerado uma importante ferramenta no combate à obesidade. Objetivo: identificar os efeitos do treinamento intermitente de alta intensidade no perfil lipídico de universitários com sobrepeso e obesidade. Materiais e métodos: estudo quase-experimental, composto por uma amostra de 30 alunos, que foram distribuídos aleatoriamente em dois grupos de 15 alunos, ficando assim um grupo controle (treinamento contínuo): 15 e um grupo experimental (exercício intermitente de alta intensidade: 15. Além disso, foram realizados exames laboratoriais antes e após o treinamento para determinação do perfil lipídico, além da realização de 20 sessões de treinamento, que foram distribuídas três vezes por semana, com duração média de 50 minutos. Além disso, testes estatísticos com nível de significância estatística de p < 0,05. Resultados: há relação estatisticamente significativa no valor de HDL do grupo controle e experimental. Os valores de Glicose mostram relações estatisticamente significativas no grupo experimental (p = 0,001). Conclusões: Treinamento intermitente de alta intensidade e trabalho contínuo de intensidade moderada geram diminuição das variáveis ​​de LDL e triglicerídeos e aumento de HDL. Embora, eles não são estatisticamente significativos após 20 sessões de treinamento. No entanto, o treinamento intermitente de alta intensidade resulta na redução da glicose em pessoas com sobrepeso e obesas.

Is docetaxel-free interval a predictive factor for castration-resistant prostate cancer?

OBJECTIVE: Prostate cancer (PCa) is the second most common solid tumor in men and the fifth leading cause of cancer-related death. In advanced stage, palliative treatments are used instead of curative therapies. Therefore, finding predictive indicators seems crucial. Patients with castration-resistant prostate cancer (CRPC) that received Dx chemotherapy have been retrospectively reviewed. The aim of this study was to investigate whether docetaxel (Dx)-free interval could have a predictive value for PCa and influence other sequential therapies. MATERIAL AND METHODS: This clinical trial study was performed on 104 patients at Medeniyet University Oncology Clinic in 2018-2020. All CRPC patients had metastases, received Dx as first-line treatment and underwent androgen receptor axis targeted (ARAT) therapy after disease progression. We analyzed patients' progression time after Dx therapy and the effects on sequential treatment. RESULTS: After Dx therapy, all patients received ARAT (abiraterone (ABI) n: 49 (47.1%) and enzalutamide (ENZ) n: 54 (51.9%)) as a second-line treatment, except for one patient who received cabazitaxel. There was a statistically significant relationship between the Dx-free interval and duration of response to ARAT (p<0.001). The response time of ARAT treatment was <10.5 months in all patients whose Dx-free interval period was <9 months. CONCLUSIONS: Our findings support the theory that Dx-free interval can be a predictive factor for CRPC. CRPC disease can be classified as Dx-sensitive disease or Dx-resistance disease, based on the Dx-free interval. Decision on subsequent treatments could be made considering this information.

Estudio mediante técnicas moleculares del tanatomicrobioma intestinal en la estimación del intervalo post mortem temprano empleando un modelo de ratón / Early post mortem interval estimation in a mouse model using molecular analyses of the gut thanatomicrobiome

Introducción: en la actualidad, la falta de métodos cuantitativos fiables ha llevado a distintas líneas de investigación a buscar un modelo que prediga el intervalo post mortem (IPM). El tanatomicrobioma, presente desde el momento de la muerte, parece sufrir cambios predecibles y que siguen una correlación con el IPM.Materiales y métodosse ha analizado experimentalmente el comportamiento del tanatomicrobioma en la región del intestino delgado posterior y del colon ascendente durante las primeras 24 h de descomposición en Mus musculus. Para ello, se ha llevado a cabo una aproximación molecular basada en el análisis del gen ribosomal 16S (ARNr 16S) mediante electroforesis en gel con gradiente desnaturalizante (DGGE) y, seguidamente un análisis de la alfa y beta diversidad.Resultadoslos resultados basados en el análisis de los índices de diversidad ecológica reflejaron cambios estadísticamente significativos antes de las 12 h, y un descenso de la diversidad a partir de esas 12 h postmortem, siendo este estadísticamente significativo en las 2 regiones intestinales analizadas. Por otro lado, el estudio comparativo de las comunidades microbianas mostró que cambian estructurada y diferenciablemente desde el momento de la muerte, alejándose en similitud de las mostradas en vida (IPM 0 h).Discusiónestos resultados coinciden con el descenso de la diversidad sugerido a largo plazo por distintos autores. Sin embargo, en las condiciones del estudio, se ha visto que este descenso no se inicia hasta las 12 h. Conclusión como conclusión, se han podido establecer, según los cambios en la diversidad bacteriana, fases de la dinámica bacteriana durante la descomposición que podrían ayudar a mejorar los modelos de correlación microbiana para la estimación del IPM. (AU)

Introduction: Currently, the lack of reliable quantitative methods has led different research lines to find a model that predicts the postmortem interval (PMI). The thanatomicrobiome, present from the moment of death, has been shown to change in predictable ways, allowing a correlation with PMI.Materials and methodsIn this study, the shifts of the thanatomicrobiome in the region of the posterior small intestine and the ascending colon in Mus musculus during the first 24 hrs of decomposition have been analyzed experimentally. For this purpose, a molecular approach based on the analysis of the 16S ribosomal gene (16S rRNA) and a denaturing gradient gel electrophoresis (DGGE) was adopted, followed by analyses of the ecological diversity indices Alpha and beta diversity.ResultsThe results based on the analysis of the ecological diversity indices reflected statistically significant changes before 12 hrs, and a decrease in diversity after 12 hrs postmortem, this being statistically significant in the two intestinal regions analyzed. Moreover, the comparative study of microbial communities indicated distinct and structured changes from the moment of death, with shifts in the degree of similarity from the composition detected in life (PMI 0 hrs).DiscussionThese results agree with other studies demonstrating a decrease in microbial diversity. However, under the conditions of the study, this decrease does not begin until 12 hrs after death. Conclusions: In conclusion, by examining the dynamics of bacterial diversity our study has identified phases during decomposition that could help to improve microbial correlation models for PMI estimation. (AU)