Hyperhomocysteinemia as an Independent Risk Factor for Coronary Heart Disease. Comparison with Conventional Risk Factors / Hiper-homocisteinemia como fator de risco independente para doença coronariana: comparação com fatores de risco convencionais

Abstract The present study was designed to evaluate the strength of association of raised plasma homocysteine concentration as a risk factor for coronary heart disease independent of conventional risk factor. It was a case control study conducted at Punjab Institute of Cardiology Lahore. A total of 210 subjects aged 25 to 60 years comprising of 105 newly admitted patients of CHD as cases and 105 age and sex matched healthy individuals with no history of CHD as control were recruited for the study. Fasting blood samples were obtained from cases and controls. Plasma homocysteine was analyzed by fluorescence polarization immunoassay (FPIA) method on automated immunoassay analyzer (Abbott IMX). Total cholesterol, triglyceride and HDL cholesterol were analyzed using calorimetric kit methods. The concentration of LDL cholesterol was calculated using Friedewald formula. The patients were also assessed for traditional risk factors such as age, sex, family history of CVD, hypertension, smoking and physical activity, and were compared with control subjects. The collected data was entered in SPSS version 24 for analysis and interpretation.The mean age in controls and experimental groups were 43.00± 8.42 years and 44.72± 8.59 years with statistically same distribution (p- value= 0.144). The mean plasma homocysteine for cases was 22.33± 9.22 µmol/L where as it was 12.59±3.73 µmol/L in control group. Highly significant difference was seen between the mean plasma level of homocysteine in cases and controls (p˂0.001).Simple logistic regression indicates a strong association of coronary heart disease with hyperhomocysteinemia (OR 7.45), which remained significantly associated with coronary heart disease by multivariate logistic regression (OR 7.10, 95%C1 3.12-12.83, p=0.000). The present study concludes that elevated levels of Plasma homocysteine is an independent risk factor for coronary heart disease independent of conventional risk factors and can be used as an indicator for predicting the future possibility for the onset of CVD.

Resumo O presente estudo foi desenhado para avaliar a força da associação da concentração elevada de homocisteína no plasma como um fator de risco para doença cardíaca coronária independente do fator de risco convencional. Foi um estudo de caso-controle realizado no Punjab Institute of Cardiology Lahore. Um total de 210 indivíduos com idade entre 25 e 60 anos, compreendendo 105 pacientes recém-admitidos de CHD como casos e 105 indivíduos saudáveis ​​pareados por idade e sexo sem histórico de CHD como controle, foi recrutado para o estudo. Amostras de sangue em jejum foram obtidas de casos e controles. A homocisteína plasmática foi analisada pelo método de imunoensaio de polarização de fluorescência (FPIA) em analisador de imunoensaio automatizado (Abbott IMX). Colesterol total, triglicerídeos e colesterol HDL foram analisados ​​usando métodos de kit calorimétrico. A concentração de colesterol LDL foi calculada pela fórmula de Friedewald. Os pacientes também foram avaliados para fatores de risco tradicionais, como idade, sexo, história familiar de DCV, hipertensão, tabagismo e atividade física, e foram comparados com indivíduos de controle. Os dados coletados foram inseridos no SPSS versão 24 para análise e interpretação. A média de idade nos grupos controles e experimentais foi de 43,00 ± 8,42 anos e 44,72 ± 8,59 anos com distribuição estatisticamente igual (p-valor = 0,144). A homocisteína plasmática média para os casos foi de 22,33 ± 9,22 µmol / L, enquanto no grupo controle foi de 12,59 ± 3,73 µmol / L. Diferença altamente significativa foi observada entre o nível plasmático médio de homocisteína em casos e controles (p ˂ 0,001). A regressão logística simples indica uma forte associação de doença cardíaca coronária com hiper-homocisteinemia (OR 7,45), que permaneceu significativamente associada com doença cardíaca coronária por multivariada regressão logística (OR 7,10, 95% C1 3,12-12,83, p = 0,000). O presente estudo conclui que níveis elevados de homocisteína plasmática são fator de risco independente para doença cardíaca coronária, independentemente dos fatores de risco convencionais, e pode ser usado como um indicador para prever a possibilidade futura de aparecimento de DCV.

Tumor fibroso solitario de mediastino anterior adherido a pericardio. Reporte de un caso / Solitary fibrous tumor of anterior mediastinum adhered to pericardium. A case report

Se presenta el caso de un paciente de 82 años, con tumor intratorácico de crecimiento rápido, con aumento progresivo de la disnea, antecedentes de enfermedad coronaria y baja función cardíaca, obesidad y síndrome de apnea de sueño, quien fue sometido a toracotomía y a quien se le diagnosticó un tumor solitario fibroso de la pleura, tumor de muy baja frecuencia, adherido en forma sésil al pericardio, lo cual lo hace aún menos frecuente. Se hace una revisión general de las posibilidades terapéuticas, el diagnóstico histológico y por inmunohistoquímica, así como los criterios de benignidad y malignidad para este tipo de tumor, que son en su mayoría de buen pronóstico.

We present the case of an 82-year-old patient with a rapidly growing intrathoracic tumor, progressive increase in dyspnea, and a history of coronary heart disease and low cardiac function, obesity, and sleep apnea syndrome, who underwent thoracotomy and who was diagnosed with a Solitary Fibrous Tumor of the Pleura, a very low frequency tumor, adhered in sessile form to the pericardium, which makes it even less frequent. A general review is made of the therapeutic possibilities, the histological and immunohistochemical diagnosis, as well as the criteria of benignity and malignancy for this type of tumor, most of which have a good prognosis.

Acute Myocardial Infarction and Percutaneous Coronary Intervention: What does the Epidemiological Data of the Last Years Indicate?

Abstract Background: ST-segment elevation acute myocardial infarction (STEMI) is a pathological process that involves cardiac muscle tissue death. Intravenous thrombolysis with fibrinolytics or primary percutaneous coronary intervention (PCI), an invasive technique, can be performed for tissue revascularization. PCI has been preferred as compared to non-invasive methods, although few studies have described its use in Brazil. Objectives: The aim of the present study was to analyze data on the use of primary PCI and investigate the relevance of hospitalizations for the treatment of STEMI in the country. Methods: A descriptive, cross-sectional analysis of data from the Brazilian Unified Health system (SUS) Department of Informatics (DATASUS) from 2010 to 2019 was conducted. Results: Hospitalizations for STEMI represented 0.6% of all hospital admissions in Brazil in the analyzed period, 0.9% of hospital costs, and 2.1% of deaths. The number of hospitalizations due to STEMI was 659,811, and 82,793 for PCIs. Length of hospital stay was 36.0% shorter and mortality rate was 53.3% lower in PCI. The mean cost of PCI was 3.5-fold higher than for treatment of STEMI. Conclusions: Data on hospitalizations for STEMI treatment in Brazil revealed high hospitalization and mortality rates, elevated costs, and long hospital stay. Although primary PCI is a more expensive and less used technique than other methods, it can reduce the length of hospital stay and mortality in the treatment of STEMI.

Gene-lifestyle interaction on coronary heart disease in adult twins of China / 中华流行病学杂志

Objective: To explore the gene-lifestyle interaction on coronary heart disease (CHD) in adult twins of China. Methods: Participants were selected from twin pairs registered in the Chinese National Twin Registry (CNTR). Univariate interaction model was used to estimate the interaction, via exploring the moderation effect of lifestyle on the genetic variance of CHD. Results: A total of 20 477 same-sex twin pairs aged ≥25 years were recruited, including 395 CHD cases, and 66 twin pairs both had CHD. After adjustment for age and sex, no moderation effects of lifestyles, including current smoking, current drinking, physical activity, intake of vegetable and fruit, on the genetic variance of CHD were found (P>0.05), suggesting no significant interactions. Conclusion: There was no evidence suggesting statistically significant gene-lifestyle interaction on CHD in adult twins of China.

A descriptive analysis on coronary heart disease in adult twins in China / 中华流行病学杂志

Objective: To describe the distribution characteristics of coronary heart disease in adult twins recruited from Chinese Twin Registry (CNTR), and provide clues and evidence for the effect of genetic and environmental influences on coronary heart disease. Methods: By using the data of CNTR during 2010-2018, a total of 34 583 twin pairs aged ≥18 years who completed questionnaire survey and had related information were included in the current study to analyze the population and area distribution characteristics of coronary heart disease. Random effect models were used to compare the differences between groups. The concordane rate of coronary heart disease were calculated respectively in monozygotic (MZ) twin pairs and dizygotic (DZ) twin pairs to estimate the heritability. Results: The twin pairs included in this analysis were aged (34.2±12.4) years. The overall prevalence rate of coronary heart disease in twin pairs was 0.7%. Twin pairs who were women, older, obese and lived in northern China had higher prevalence of coronary heart disease (P<0.05). Intra-pair analysis in the same-sex twin pairs found that the concordane rate of coronary heart disease was higher in MZ twin pairs (25.3%) than in DZ twins (7.4%), and the difference was statistically significant (P<0.001). The overall heritability of coronary heart disease was 19.3% (95%CI: 11.8%-26.8%). Stratified by gender, age and area, the concordane rate was still higher in MZ twin pairs than in DZ pairs. Participants who were women, aged 18-30 years or ≥60 years and lived in northern China had a higher heritability of coronary heart disease. Conclusion: The distribution of coronary heart disease in twin pairs differed in populations and areas. The prevalence of coronary heart disease was affected by genetic factors, but the effect varied with age, gender and area.

Correlation between Serum Homocysteine Level, MTHFR Gene Polymorphism and Patients with Hematological Diseases Complicated with Coronary Heart Disease / 中国实验血液学杂志

OBJECTIVE@#To observe the expression level of serum homocysteine (Hcy) and methylenetetrahydrofolate reductase (MTHFR) gene polymorphism in patients with hematological diseases complicated with coronary heart disease, and analyze the relationship between serum Hcy level, MTHFR gene polymorphism and coronary heart disease.@*METHODS@#The medical records of 80 patients with coronary heart disease who completed treatment of hematological diseases during the period from March 2018 to March 2020 were selected as observation group. In addition, the medical records of 92 patients with hematological diseases who completed treatment in our hospital during the same period were selected as control group. Venous blood samples of the two groups were collected to detect serum Hcy level and MTHFR gene polymorphism. The serum Hcy levels of the two groups with different MTHFR genotypes were compared, and the effects of the above indicators on hematological diseases complicated with coronary heart disease were analyzed.@*RESULTS@#The detection rates of MTHFR gene TT and TC in the observation group were higher than those in the control group, while the distribution frequency of MTHFR genotype CC was lower (P<0.05). The serum Hcy levels of the patients with MTHFR genotype TT and TC in the observation group was higher than the control group (P<0.05). Binary logistic regression analysis showed that MTHFR gene TC/CC genotype serum Hcy overexpression may be influencing factor which induced coronary heart disease in patients with hematological diseases (OR=2.107/OR=1.634, P<0.05). ROC curves showed that the AUC of serum Hcy level of MTHFR gene TC/CC genotype and hematological disease complicated with coronary heart disease were both > 0.8. When MTHFR gene TC reaching the optimal threshold of 22.165 μmol/L, the sensitivity was 0.950 and the specificity was 0.837, While MTHFR gene CC reached the optimal threshold of 19.630 μmol/L, the sensitivity was 0.938 and the specificity was 0.826, the best predictive value could be obtained.@*CONCLUSION@#The changes of serum Hcy and MTHFR gene polymorphisms may be involved in the pathological process in patients with hematological diseases complicated with coronary heart disease. In the future, early detection of serum Hcy levels and MTHFR gene polymorphisms in patients with hematological diseases can be used to predict the risk of coronary heart disease.

Evaluation of diagnostic efficacy of artery elasticity and endothelial function indexes for coronary heart disease with blood stasis syndrome in postmenopausal women by Logistic regression combined with ROC curve model / 中国中药杂志

The present study explored the correlation of coronary heart disease(CHD) with blood stasis syndrome in postmenopausal women with artery elasticity and endothelial function indexes and evaluated the diagnostic efficacy of the prediction model via logistic regression and receiver operating characteristic(ROC) curve model. A retrospective comparison was made between 366 postmenopausal CHD patients from August 1, 2020, to September 30, 2021, in the Department of Cardiology of Integrated Traditional Chinese and Western Medicine of China-Japan Friendship Hospital, who were divided into the blood stasis syndrome group(n=196) and the non-blood stasis syndrome group(n=170). General clinical characteristics of the two groups were compared. Multivariate logistic regression analysis was used to probe the correlation of CHD with blood stasis syndrome in postmenopausal women with brachial-ankle pulse wave velocity(baPWV), ankle-brachial index(ABI), and flow-mediated dilatation(FMD), and the ROC curve was drawn to evaluate the diagnostic efficiency of the prediction model. Multivariate logistic regression analysis showed that the correlation coefficients of CHD with blood stasis syndrome in postmenopausal women with baPWV, ABI, and FMD were 1.123, 0.109, and 0.719, respectively(P=0.004, P=0.005, P<0.001),and the regression equation for predicting probability P was P=1/[1+e~(-(3.131+0.116×baPWV-2.217×ABI-0.330×FMD))]. ROC curve analysis suggested that in the context of baPWV≥19.19 m·s~(-1) or ABI≤1.22 or FMD≤9.7%, it was of great significance to predict the diagnosis of CHD with blood stasis syndrome in postmenopausal women. The AUC of baPWV, ABI, FMD, and prediction probability P was 0.763, 0.607, 0.705, and 0.836, respectively. The AUC of prediction probability P was higher than that of each index alone(P<0.001), and the sensitivity and specificity were 0.888 and 0.647, respectively. The results demonstrate that baPWV, ABI, and FMD are independently correlated with CHD with blood stasis syndrome in postmenopausal women, and show certain independent predictive abilities(P<0.05). The combined evaluation of the three possesses the best diagnostic efficiency.

Clinical comprehensive evaluation of Guanxin Shutong Capsules in treatment of coronary heart disease angina pectoris with heart blood stasis syndrome / 中国中药杂志

This study aims to comprehensively summarize articles on the treatment of coronary heart disease angina pectoris with heart blood stasis syndrome(CHD-AP-HBSS) by Guanxin Shutong Capsules(GSC), and comprehensively evaluate the evidence and value of the formula in "6+1" dimensions based on multi-criteria decision analysis(MCDA) model and Guidelines for Management of Comprehensive Clinical Evaluation of Drugs(trial version 2021) with quantitative and qualitative methods, which is expected to highlight the clinical characteristics and advantages of the prescription and serve as a reference for medical and health departments. The dimensions are grade A, B, C, or D. In terms of safety, according to the reports from the spontaneous reporting system of National Center for ADR Monitoring, and literature analysis, GSC mainly results in the adverse reactions of mild or moderate nausea, diarrhea, rash, palpitation, and headache, with favorable prognosis in patients. Nevertheless, severe adverse reactions have been reported after marketing. Thus, additional evidence for its safety should be accumulated, and the current safety is grade B. Meta-analysis proves that GSC in combination with conventional treatment is superior to conventional treatment alone in alleviating AP and symptoms indicated by electrocardiogram(ECG). Therefore, the effectiveness of the medicine is grade A. As for the pharmacoeconomic value, based on the assumption that the per capita disposable income in 2020 is the willingness-to-pay threshold, it is more economical for CHD-AP patients to use GSC combined with conventional treatment than conventional treatment alone. However, as the currently available clinical parameters fail to support the difference in indirect cost between the two groups, the accuracy in the cost of intervention plan needs to be further improved. Therefore, the economy of the prescription is grade B. GSC has been awarded 13 national invention patents and 1 utility model patent, and won a lot of national and provincial patent awards, marking the enterprise service awareness and innovativeness. As a result, it is grade A in aspect of innovation. A questionnaire on the suitability of GSC suggests that publicity and promotion influence patients' choice and thus additional efforts should be made in this aspect. The suitability of this formula is grade B. Both rural and urban residents can afford the medicine for the whole course and the price is close to that of similar Chinese patent medicines. In addition, it is accessible regardless of season and place, so accessibility is grade A. As a Mongolian empirical formula destined to treat heart stabbing pain, it has the effects of activating blood and resolving stasis, dredging channels and activating collaterals, and moving Qi to relieve pain, and boasts the empirical evidence of more than 2 000 human cases. With prominent characteristics of traditional Chinese medicine, it is grade B. Based on the MCDA model and CSC v2.0, GSC is comprehensively class A in the treatment of CHD-AP-HBSS. The result can serve as a reference for basic clinical medication management.

Screening methods of traditional Chinese medicine for coronary heart disease and angina pectoris: an exploration based on core outcome set and fuzzy comprehensive evaluation / 中国中药杂志

It was pointed out in Opinions on Promoting the Inheritance, Innovation and Development of Traditional Chinese Medicine issued by the State Council in 2019 that 100 varieties of traditional Chinese medicine(TCM) with unique curative effects should be screened out within about three years. Due to the multi-component and multi-target mechanisms of TCM varieties, it is difficult to directly and simply evaluate their multi-dimensional clinical value using methods applicable to chemical or biological agents. The heterogeneity of outcomes for similar TCM makes it difficult to determine the advantages of similar products. The fuzzy comprehensive evaluation method that is developed on the basis of core outcome set and fuzzy mathematics for clinical efficacy evaluation of TCM may solve these problems. This study developed a fuzzy comprehensive evaluation model for the clinical efficacy evaluation of Chinese patent me-dicines for coronary heart disease and angina pectoris, and selected the previous normative studies with complete or incomplete data for verifying the model application. The results showed that original studies with complete data failed to evaluate and compare the comprehensive efficacy of different interventions. The original research only mentioned the advantages and disadvantages of different interventions in different aspects. The comprehensive clinical efficacy of three different interventions obtained through fuzzy comprehensive evaluation was all graded as level Ⅱ. The original research with incomplete data drew the same conclusions as the fuzzy comprehensive evaluation, and the results of fuzzy comprehensive evaluation can provide more comprehensive information. Therefore, the fuzzy comprehensive evaluation shows the products with overall advantages of clinical efficacy, which may become a feasible method for the screening of TCM.

Signo de Spodick: ¿aliado o enemigo? / Spodick's sign: ally or enemy?

La pericarditis se refiere a la inflamación de las capas del pericardio y es la forma más común de enfermedad pericárdica. Puede estar asociada a derrame pericárdico y resultar en un taponamiento. La enfermedad puede ser una condición aislada o una manifestación cardíaca de un trastorno sistémico (por ejemplo, enfermedades autoinmunes o autoinflamatorias). La pericarditis se categoriza como aguda, incesante, recurrente o crónica, pero se debe tener en cuenta que también se clasifica como de etiología infecciosa y no infecciosa, siendo la presentación idiopática la más común

Pericarditis refers to inflammation of the layers of the pericardium and is the most common form of pericardial disease. It may be associated with pericardial effusion and result in tamponade. The disease may be an isolated condition or a cardiac manifestation of a systemic disorder (e.g., autoimmune or autoinflammatory diseases). Pericarditis is categorized as acute, incessant, recurrent, or chronic, but it should be noted that it is also classified as being of infectious and noninfectious etiology, with the idiopathic presentation being the most common

¿Es seguro el ácido tranexámico en la cirugía de reemplazo total de rodilla de pacientes con enfermedad coronaria? / Is tranexamic acid safe in total knee replacement surgery in patients with coronary artery disease?

Introducción: El ácido tranexámico reduce la pérdida sanguínea y los requerimientos de transfusiones luego de un reemplazo total de rodilla. Una de sus contraindicaciones relativas son los antecedentes de colocación de prótesis intravasculares coronarias, por un supuesto aumento de eventos tromboembólicos. materiales y métodos:Análisis retrospectivo de pacientes sometidos a un reemplazo total de rodilla primario y de revisión que recibieron ácido tranexámico y tenían antecedente de colocación de prótesis intravascular coronaria. Se los comparó con un grupo sin estas prótesis. Se analizó la presencia de cualquier cambio clínico o electrocardiográfico de oclusión coronaria aguda, eventos tromboembólicos, el requerimiento de transfusión sanguínea y el nivel de hemoglobina pre y posoperatorio. Resultados: 57 pacientes (59 cirugías, 56 reemplazos primarios y 3 revisiones) con colocación de prótesis intravascular coronaria, al menos, un año antes de la artroplastia. Un paciente tuvo síntomas de síndrome coronario agudo y cambios en el electrocardiograma. No hubo diferencias en la cantidad de eventos tromboembólicos. Solo un paciente del grupo de control recibió una transfusión de glóbulos rojos. El sangrado relativo fue menor en el grupo coronario independientemente del uso crónico de aspirina y clopidogrel antes de la cirugía (2,09 vs. 3,06 grupo de control; p = 0,01). En pacientes del alto riesgo, el ácido tranexámico no se asoció con más eventos tromboembólicos. Conclusiones: El ácido tranexámico impresionó ser seguro y efectivo en nuestro grupo de pacientes con prótesis intravasculares coronarias; sin embargo, se necesita un estudio prospectivo con más casos para confirmar estos resultados. Nivel de Evidencia: IV

Introduction: Tranexamic acid (TXA) reduces blood loss and need for a transfusion after total knee arthroplasty (TKA). However, patients with a history of coronary artery (CA) stent placement might be at increased risk for thromboembolic complications. Materials and methods: We performed a retrospective analysis of patients with a history of coronary stenting who had undergone primary and revision TKA and received preoperative TXA. A comparison was made with a group of patients without coronary stenting. The presence of any clinical or electrocardiographic changes of acute coronary occlusion, thromboembolic events (TEE), blood transfusion, and pre- and postoperative hemoglobin levels were analyzed. Results: 57 patients underwent 59 TKA surgeries (56 primary and 3 revisions) with a history of coronary stenting at least 1 year before arthroplasty. One patient presented symptoms of acute coronary syndrome and electrocardiogram (ECG) changes. There were no differences in the number of thromboembolic events. Only 1 patient received red blood cell transfusion in the control group. Relative bleeding was lower in the coronary group regardless of chronic use of aspirin and clopidogrel before surgery (2.09 vs 3.06 in the control group; p=0.01). In high-risk patients, TXA was not associated with higher TEEs. Conclusions: Although TXA seemed safe and effective in this database review of patients with previous placement of CAS; a larger prospective trial is warranted to confirm these results. Level of Evidence: IV

Cholesteryl ester transfer protein inhibitory oxoacetamido-benzamide derivatives: Glide docking, pharmacophore mapping, and synthesis

Abstract Dyslipidemia is an abnormal lipid profile associated with many common diseases, including coronary heart disease and atherosclerosis. Cholesteryl ester transfer protein (CETP) is a hydrophobic plasma glycoprotein that is responsible for the transfer of cholesteryl ester from high-density lipoprotein athero-protective particles to pro-atherogenic very low-density lipoprotein and low-density lipoprotein particles. The requirement for new CETP inhibitors, which block this process has driven our current work. Here, the synthesis as well as the ligand-based and structure-based design of seven oxoacetamido-benzamides 9a-g with CETP inhibitory activity is described. An in vitro study demonstrated that most of these compounds have appreciable CETP inhibitory activity. Compound 9g showed the highest inhibitory activity against CETP with an IC50 of 0.96 µM. Glide docking data for compounds 9a-g and torcetrapib provide evidence that they are accommodated in the CETP active site where hydrophobic interactions drive ligand/CETP complex formation. Furthermore, compounds 9a-g match the features of known CETP active inhibitors, providing a rationale for their high docking scores against the CETP binding domain. Therefore, these oxoacetamido-benzamides show potential for use as novel CETP inhibitors

Utilidad del índice UDT-65 en adultos con dolor torácico y electrocardiograma normal o no diagnóstico / Usefulness of the CPU-65 index in adults with chest pain and normal or non-diagnostic electrocardiogram

Resumen Objetivo: Evaluar la utilidad del índice UDT-65 para la estratificación del dolor torácico en urgencias en una población colombiana en la que se sospecha enfermedad coronaria. Método: Se condujo la validación externa del índice UDT-65 en una cohorte concurrente que incluyó pacientes que ingresaron a urgencias de una clínica cardiovascular en Bogotá con dolor torácico no traumático, y electrocardiograma normal o no diagnóstico. Se evaluaron 1320 pacientes de 18 o más años y se determinó la utilidad del índice en términos de calibración (uso de gráfico, ji al cuadrado para datos agrupados y prueba de bondad de ajuste de Hosmer-Lemeshow) y de capacidad de discriminación del modelo (curva de características operativas del receptor [ROC] y área bajo ella [AUC]). Resultados: El índice UDT-65 en esta población suministró evidencia de su utilidad en términos de calibración y capacidad de discriminación, para efectuar una buena aplicación de él en aquellos pacientes que consulten al servicio de urgencias de una clínica cardiovascular por dolor torácico no traumático de posible origen coronario. La capacidad de discriminación del índice UDT-65 fue adecuada, pues con un área bajo la curva ROC de 0.867 (IC 95% 0-847-0.885), que se acerca al valor obtenido (AUC 0.87) en la población española en que se desarrolló el índice. Conclusiones: Se necesitan más estudios similares en otras instituciones, dado el buen resultado, en beneficio de más pacientes.

Abstract Objective: To evaluate the clinical usefulness, in the emergency service, of the UDT-65 index for chest pain stratification in colombian population with suspected coronary disease. Method: The external validation of the UDT-65 index was conducted in a concurrent cohort that included patients admitted to the emergency service of the cardiovascular clinic in Bogotá with non-traumatic chest pain and normal or non-diagnostic electrocardiogram. 1320 patients were evaluated and the usefulness of this instrument was determined in terms of calibration (use of graph, Chi-square test for group data and the Hosmer-Lemeshow goodness-of-fit test) and discrimination capacity of the model (curve of receiver operating characteristics [ROC] and by finding the area under the curve [AUC]). Results: The UDT-65 index in the population under study, provided evidence of its usefulness in terms of calibration and discrimination capacity; this, in pursuance of a good application of the instrument in those patients who consult the Emergency Department of the cardiovascular clinic for non-traumatic chest pain of possible coronary origin. The discrimination capacity of the UDT65 index was adequate, with an area under the ROC curve of 0.867 (95 % CI 0.847-0.885), which is close in value to the one obtained (AUC 0.87) in the Spanish population where the original index was developed. Conclusions: More similar studies are needed in other institutions, due to the excellent and beneficial outcomes.

Anesthetic considerations and postoperative pain management in radical penectomy: Case report / Penectomía radical, consideraciones anestésicas y manejo del dolor postoperatorio: Reporte de un caso

Abstract Radical penectomy (RP) is infrequently performed as it is reserved for specific cases of penile cancer, hence the paucity of reports regarding surgical and anesthetic considerations. Acute postoperative pain, chronic post-surgical pain, concomitant mood disorders as well as a profound impact on the patient's quality of life have been documented. This case is of a patient with diabetes and coronary heart disease, who presented with advanced, over infected penile cancer, depressive disorder and a history of pain of neuropathic characteristics. The patient underwent radical penectomy using a combined spinal-epidural technique for anesthesia. Preoperatively, the patient was treated with pregabalin and magnesium sulphate, and later received a blood transfusion due to intraoperative blood loss. Adequate intra and postoperative analgesia was achieved with L-bupivacaine given through a peridural catheter during one week. Recovery was good, pain was stabilized to preoperative levels and the patient received pharmacological support and follow-up by psychiatry and the pain team.

Resumen La penectomía radical (PR) es una cirugía infrecuente, reservada para casos específicos de cáncer de pene, por lo que hay escasos informes sobre sus consideraciones quirúrgicas y anestésicas. Se ha documentado dolor agudo postoperatorio, dolor crónico posquirúrgico y alteraciones del estado de ánimo concomitantes, así como un profundo impacto en la calidad de vida posterior del paciente. Se presenta el caso de un paciente diabético y cardiópata coronario con cáncer de pene avanzado y sobreinfectado, trastorno depresivo y dolor previo de características neuropáticas, que recibe técnica combinada espinal-peridural para cirugía de penectomía radical. Se le trata también con pregabalina preoperatoria, sulfato de magnesio y transfusión por sangrado quirúrgico. Se otorgó una adecuada analgesia intra y postoperatoria, mediante catéter peridural con L-bupivacaína hasta por una semana. El paciente tuvo una buena recuperación, estabilización del dolor a niveles preoperatorios, controles y apoyo farmacológico por psiquiatría de enlace y equipo del dolor.

Factores de riesgo cardiovascular y condiciones socioeconómicas y sociodemográficas en México, 2000 - 2018 / Cardiovascular risk factors and socioeconomic and sociodemographic conditions in Mexico, 2000 ­ 2018

Resumen Introducción: En países de ingresos altos, el nivel socioeconómico se relaciona con diferencias en la prevalencia e incidencia de los factores de riesgo cardiovascular. En países de ingresos medios como México, la evidencia es menor por lo que el objetivo del estudio fue estimar las tendencias en las prevalencias de seis de los principales factores modificables de riesgo cardiovascular; a saber, diabetes, hipertensión arterial, colesterol elevado, consumo de tabaco, consumo de alcohol y obesidad, según el nivel de condiciones socioeconómicas en el hogar y su asociación con determinados factores sociodemográficos entre personas adultas de 20 y más años en el periodo 2000-2018. Método: Los datos se obtuvieron de cuatro encuestas de salud de tipo transversal, representativas a nivel nacional. Con muestras individuales de cada encuesta, se estimaron las prevalencias de los factores de riesgo cardiovascular. Con un análisis por conglomerados se determinaron tres niveles de condiciones socioeconómicas. En cada muestra, con regresiones logísticas, se estimaron las prevalencias de cada factor de riesgo, según el nivel socioeconómico determinado por cada conglomerado ajustando por sexo, edad y escolaridad. Resultados: A diferencia de la diabetes, la hipertensión, el colesterol o la obesidad, el consumo de tabaco y de alcohol ha disminuido. La obesidad, la hipertensión arterial, el consumo de tabaco o de alcohol y el colesterol elevado mostraron diferencias entre los niveles alto y bajo de condiciones socioeconómicas en los cuatro puntos analizados, pero no la diabetes. Conclusión: Deben consolidarse programas y políticas enfocadas a la modificación, atención y tratamiento médico de los factores de riesgo cardiovascular.

Abstract Introduction: In high-income countries, socioeconomic status is related to differences in the prevalence and incidence of cardiovascular risk factors. In middle-income countries like Mexico, the evidence is less so the objective of the study was to estimate the trends in the prevalences of six of the main modifiable cardiovascular risk factors: diabetes, hypertension, high cholesterol, tobacco use, alcohol use, and obesity, according to the level of socioeconomic conditions at home among adults 20 years of age and over in the period 2000 - 2018. Method: The data were obtained from four nationally representative cross-sectional health surveys. With individual samples from each survey, the prevalences of cardiovascular risk factors were estimated. With a cluster analysis, three levels of socioeconomic conditions were determined. In each sample, with logistic regressions, the prevalences of each risk factor were estimated according to the socioeconomic level determined by each cluster, adjusting for sex, age, and education. Results: Unlike diabetes, hypertension, cholesterol or obesity, tobacco and alcohol consumption have decreased. Obesity, arterial hypertension, tobacco or alcohol consumption and high cholesterol showed differences between the high and low levels of socioeconomic conditions in the four points analyzed, but not diabetes. Conclusion: Programs and policies focused on the modification, care and medical treatment of cardiovascular risk factors should be consolidated.

Efecto del programa de rehabilitación cardiaca en la calidad de vida de pacientes con enfermedad coronaria / Effect of cardiac rehabilitation program on the quality of life of patients with coronary heart disease

Resumen Objetivo: Evaluar el efecto del programa de rehabilitación cardiaca en la calidad de vida, la clase funcional y la tolerancia al ejercicio de pacientes con enfermedad coronaria en un centro médico de la ciudad de Medellín. Método: Estudio descriptivo, longitudinal, comparativo antes y después, del cambio en la calidad de vida, la clase funcional y la tolerancia al ejercicio de pacientes con enfermedad coronaria sometidos a rehabilitación cardiaca. Resultados: Completaron 12 sesiones de rehabilitación 41 pacientes, de los que 28 eran hombres (68.3%), con una edad promedio de 61.59 ± 9.5 años. La frecuencia cardiaca máxima lograda tuvo una reducción estadísticamente significativa (p < 0.0001). Tanto la clase funcional como la capacidad funcional no presentaron cambios significativos con el programa de rehabilitación; el peso y el índice de masa corporal tampoco se modificaron. Posterior al programa de rehabilitación se observó una mejoría significativa en los dominios de función física, dolor, salud general, vitalidad y salud mental. Conclusiones: Luego del programa de rehabilitación se observaron mejorías en la calidad de vida de los participantes, en los dominios físicos, de dolor, salud general, vitalidad y salud mental.

Abstract Objective: To assess the effect of a cardiac rehabilitation program on the quality of life, functional status and exercise tolerance of patients with coronary heart disease in a medical center in the city of Medellín. Method: A descriptive, longitudinal study comparing the change in quality of life, functional status and exercise tolerance of patients with coronary heart disease undergoing cardiac rehabilitation. Results: Twelve rehabilitation sessions were completed by 41 patients, 28 were men (68.3%). The mean age was 61.59 ± 9.5 years. The maximum heart rate had a statistically significant reduction (p < 0.0001). Both functional status and functional capacity did not show a significant change with the rehabilitation program, weight and body mass index were neither modified. Significant improvement was observed in the domains of physical function, pain, general health, vitality and mental health after the rehabilitation program. Conclusions: The rehabilitation program improved quality of life, physical and pain domains, vitality and mental health of participants.

Brugada syndrome: current concepts and genetic background / Síndrome de Brugada: conceitos atuais e antecedentes genéticos

BACKGROUNG: Brugada syndrome (BrS) is a hereditary clinical-electrocardiographic arrhythmic entity with low worldwide prevalence. The syndrome is caused by changes in the structure and function of certain cardiac ion channels and reduced expression of Connexin 43 (Cx43) in the Right Ventricle (RV), predominantly in the Right Ventricular Outflow Tract (VSVD), causing electromechanical abnormalities. The diagnosis is based on the presence of spontaneous or medicated ST elevation, characterized by boost of the J point and the ST segment ≥2 mm, of superior convexity "hollow type" (subtype 1A) or descending rectilinear model (subtype 1B). BrS is associated with an increased risk of syncope, palpitations, chest pain, convulsions, difficulty in breathing (nocturnal agonal breathing) and/or Sudden Cardiac Death (SCD) secondary to PVT/VF, unexplained cardiac arrest or documented PVT/VF or Paroxysmal atrial fibrillation (AF) in the absence of apparent macroscopic or structural heart disease, electrolyte disturbance, use of certain medications or coronary heart disease and fever. In less than three decades since the discovery of Brugada syndrome, the concept of Mendelian heredity has come undone. The enormous variants and mutations found mean that we are still far from being able to concretely clarify a genotype-phenotype relationship. There is no doubt that the entity is oligogenetic, associated with environmental factors, and that there are variants of uncertain significance, especially the rare variants of the SCN5A mutation, with European or Japanese ancestors, as well as a spontaneous type 1 or induced pattern, thanks to gnomAD (coalition) researchers who seek to aggregate and harmonize exome and genome sequencing data from a variety of large-scale sequencing projects and make summary data available to the scientific community at large). Thus, we believe that this in-depth analytical study of the countless mutations attributed to BrS may constitute a real cornerstone that will help to better understand this intriguing syndrome.

INTRODUÇÃO: A Síndrome de Brugada (SBr) é uma entidade arrítmica clínico-eletrocardiográfica hereditária com baixa prevalência mundial. A síndrome é causada por alterações na estrutura e função de certos canais iônicos cardíacos e redução da expressão da Connexina 43 (Cx43) no Ventrículo Direito (VD), predominantemente no Trato de Saída do Ventricular Direito (VSVD), causando anormalidades eletromecânicas. O diagnóstico é baseado na presença de supradesnivelamento de ST espontâneo ou medicamentoso caracterizado por supradesnivelamento do ponto J e do segmento ST ≥2 mm, de convexidade superior "tipo covado" (subtipo 1A) ou modelo retilíneo descendente (subtipo 1B). A SBr está associado a um risco aumentado de síncope, palpitações, dor precordial, convulsões, dificuldade em respirar (respiração agonal noturna) e/ou Morte Cardíaca Súbita (MSC) secundária a PVT/VF, parada cardíaca inexplicada ou PVT/VF documentado ou Fibrilação atrial paroxística (FA) na ausência de doença cardíaca macroscópica ou estrutural aparente, distúrbio eletrolítico, uso de certos medicamentos ou coração coronário e febre. Em menos de três décadas desde a descoberta da síndrome de Brugada, o conceito de hereditariedade mendeliana se desfez. As enormes variantes e mutações encontradas significam que ainda estamos longe de sermos capazes de esclarecer concretamente uma relação genótipo-fenótipo. Não há dúvida de que a entidade é oligogenética associada a fatores ambientais, e que há variantes de significado incerto, principalmente as raras variantes da mutação SCN5A, com ancestrais europeus ou japoneses, bem como padrão espontâneo tipo 1 ou induzido, graças ao gnomAD (coalizão de pesquisadores que buscam agregar e harmonizar dados de sequenciamento de exoma e genoma de uma variedade de projetos de sequenciamento em grande escala e disponibilizar dados resumidos para a comunidade científica em geral). As enormes variantes e mutações encontradas significam que ainda estamos longe de sermos capazes de esclarecer concretamente uma relação genótipo-fenótipo. Assim, acreditamos que este estudo analítico em profundidade das inúmeras mutações atribuídas à BrS pode constituir uma verdadeira pedra angular que ajudará a compreender melhor esta síndrome intrigante.

Infarto de miocardio con arterias coronarias no obstruidas en pediatría: una afección poco conocida / Myocardial infarction with unobstructed coronary arteries in pediatrics: a little-known entity

Resumen El infarto de miocardio con arterias coronarias no obstruidas (MINOCA, por sus siglas en inglés) ha ganado importancia en los últimos 20 años gracias a la dilucidación de etiologías fisiopatológicas diferentes de las causas obstructivas del flujo coronario. Diversos estudios han evidenciado una prevalencia variable, la cual es más alta en las mujeres. Se han descrito dos grupos de alteraciones en la reactividad coronaria que afectan el flujo: las causas epicárdicas y las causas microvasculares. El diagnóstico de MINOCA es de exclusión; por lo tanto, inicialmente se deben descartar otras posibles causas de isquemia, como miocarditis, miocardiopatía séptica, choque hipovolémico por trauma o quemaduras, y enfermedades renales o pulmonares. Los reportes y estudios de esta enfermedad suelen incluir pacientes adultos o mayores de 18 años. Se presenta el caso de una paciente de 16 años con antecedente de tetralogía de Fallot corregida en etapa de lactante menor y reemplazo valvular pulmonar con bioprótesis y ampliación del tronco pulmonar a los 11 años, quien ingresó con dolor torácico de características coronarias. Cursó con un diagnóstico de MINOCA por exclusión en una institución de cuarto nivel en Cali, Colombia. El diagnóstico de MINOCA en edad pediátrica es raro; sin embargo, es importante saber acerca de su existencia para brindar a los pacientes el mejor manejo disponible, de manera que se aseguren los mejores desenlaces a largo plazo.

Abstract Myocardial infarction with non-obstructed coronary arteries (MINOCA) has gained importance in the last 20 years, due to the elucidation of physiopathological etiologies different from the obstructive causes of coronary flow. Different studies have shown variable prevalence, being higher in women. Different causes have been evidenced in the studies found in two groups of alterations in coronary reactivity: epicardial causes and microvascular causes. The diagnosis of MINOCA must be a diagnosis of exclusion. Therefore, other possible causes of ischemia, such as myocarditis, septic cardiomyopathy, hypovolemic shock due to trauma or burns, renal or pulmonary diseases, should be ruled out initially. The reports and studies done around this pathology usually include adult patients and people older than 18 years. We present the case of a 16-year-old patient with a history of Tetralogy of Fallot corrected as an infant and pulmonary valve replacement with bioprothesis and enlargement of the pulmonary trunk at 11 years of age who was admitted with chest pain of coronary characteristics. The diagnosis after multiples studies and exclusion of other causes was MINOCA in a fourth level institution in Cali, Colombia.

Factores asociados a complicaciones en pacientes diabéticos con enfermedad coronaria multivaso intervenidos quirúrgicamente en un centro cardiovascular de alta complejidad / Factors associated with complications in diabetic patients with multivessel coronary disease surgically operated in a highly complex cardiovascular center

Resumen Objetivo: Determinar las características sociodemográficas, clínicas y de procedimiento asociadas a complicaciones en pacientes diabéticos con enfermedad coronaria severa, sometidos a revascularización quirúrgica. Métodos: Estudio de cohortes retrospectivo en pacientes mayores de 18 años con diagnóstico de diabetes mellitus y enfermedad coronaria multivaso, sometidos a revascularización quirúrgica, en el que se evaluaron las características individuales, clínicas y de procedimiento asociadas a complicaciones posquirúrgicas. Se realizó un análisis bivariado y multivariado mediante regresión logística binaria. Resultados: Los factores asociados a complicaciones fueron edad, índice de masa corporal, fracción de eyección del ventrículo izquierdo, clase funcional de la Asociación del Corazón de Nueva York (NYHA, su sigla en inglés por New York Heart Association) preintervención y antecedente de consumo de alcohol y tabaco; de estos, la edad es la variable que persiste con significancia estadística tras el modelo de regresión logística binaria. Conclusión: La incidencia de complicaciones posoperatorias en pacientes diabéticos sometidos a revascularización quirúrgica es comparable con la observada en estudios previos, y el factor asociado encontrado para este grupo de pacientes es la edad. El modelo podría explicar el 23 % del desarrollo de complicaciones en la cohorte estudiada.

Abstract Objective: To determine the sociodemographic, clinical and procedural characteristics associated with complications in diabetic patients with severe coronary disease treated by coronary artery bypass surgery. Methods: A retrospective cohort study in patients over 18 years old with a diagnosis of diabetes mellitus and multivessel coronary disease, undergoing surgical revascularization, where individual, clinical and procedural characteristics associated with surgical complications were evaluated. A bivariate and multivariate analysis was performed using binary logistic regression. Results: The factors associated with complications that were found were: age, body mass index, left ventricular ejection fraction, pre intervention New York Heart Association (NYHA) functional class, alcohol and tobacco history. Of these, age was the only variable that persists with statistical significance after the logistic regression model. Conclusion: The incidence of postoperative complications in diabetic patients undergoing surgical revascularization is comparable to that observed in previous studies. The associated factor found for this group of patients is the age.