Enhancing the Maturation of Human Pluripotent Stem Cell-Derived Cardiomyocytes with an n-Type Organic Semiconductor Coating.

Human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) are a promising cell source for cardiac regenerative medicine and in vitro modeling. However, hPSC-CMs exhibit immature structural and functional properties compared with adult cardiomyocytes. Various electrical, mechanical, and biochemical cues have been applied to enhance hPSC-CM maturation but with limited success. In this work, we investigated the potential application of the semiconducting polymer poly{[N,N'-bis(2-octyldodecyl)-naphthalene-1,4,5,8-bis(dicarboximide)-2,6-diyl]-alt-5,5'-(2,2'-bithiophene)} (P(NDI2OD-T2)) as a light-sensitive material to stimulate hPSC-CMs optically. Our results indicated that P(NDI2OD-T2)-mediated photostimulation caused cell damage at irradiances applied long-term above 36 µW/mm2 and did not regulate cardiac monolayer beating (after maturation) at higher intensities applied in a transient fashion. However, we discovered that the cells grown on P(NDI2OD-T2)-coated substrates showed significantly enhanced expression of cardiomyocyte maturation markers in the absence of a light exposure stimulus. A combination of techniques, such as atomic force microscopy, scanning electron microscopy, and quartz crystal microbalance with dissipation monitoring, which we applied to investigate the interface of the cell with the n-type coating, revealed that P(NDI2OD-T2) impacted the nanostructure, adsorption, and viscoelasticity of the Matrigel coating used as a cell adhesion promoter matrix. This modified cellular microenvironment promoted the expression of cardiomyocyte maturation markers related to contraction, calcium handling, metabolism, and conduction. Overall, our findings demonstrate that conjugated polymers such as P(NDI2OD-T2) can be used as passive coatings to direct stem cell fate through interfacial engineering of cell growth substrates.

Protocol to measure calcium spikes in cardiomyocytes obtained from human pluripotent stem cells using a ready-to-use media.

The derivation of cardiomyocytes from human pluripotent stem cells (hPSCs) is a powerful tool to investigate early cardiogenesis and model diseases in vitro. Here, we present an optimized protocol to obtain contracting hPSCs-derived cardiomyocytes using a ready-to-use kit. We describe steps for hPSC culture and differentiation to cardiomyocytes including the identification of key parameters such as starting cell confluency and temperature. We then detail immunofluorescence, flow cytometry, and the quantification of cardiomyocytes' calcium spikes using live imaging. For complete details on the use and execution of this protocol, please refer to Astro et al.1.

Evaluación del Orbit Bleeding Risk Score como predictor de sangrado mayor en pacientes con síndrome coronario agudo / Evaluation of the Orbit Bleeding Risk Score as Predictor of Major Bleeding in Patients with Acute Coronary Syndrome

RESUMEN Introducción: El sangrado mayor es la complicación más importante del tratamiento antitrombótico en el síndrome coronario agudo (SCA), y se asocia a mayor mortalidad. Evaluar el riesgo de sangrado es un desafío. La utilidad del Orbit Bleeding score (ORBIT) para evaluar el riesgo de sangrado en SCA ha sido poco estudiada. Objetivo: Evaluar al ORBIT como predictor de sangrado mayor en pacientes internados por SCA en los que se decide la anticoagulación como parte de la estrategia antitrombótica. Materiales y métodos: Se incluyeron en forma retrospectiva pacientes internados en dos unidades coronarias con diagnóstico de SCA que recibieron anticoagulación como parte de la terapia antitrombótica. A todos se les calcularon los scores CRUSADE, ACTION-GWTG y ORBIT con los datos clínicos del ingreso. Se analizo el punto primario de sangrado mayor, definido como una clasificación de BARC 3 o 5. Resultados: Se incluyeron 762 pacientes. El sangrado mayor se presentó en el 3.4%. En el análisis univariado los tres scores fueron predictores de sangrado mayor, mientras que en el multivariado sólo el ORBIT fue predictor independiente de sangrado mayor, con OR 2,46, IC95% 1,61-3,97, p <0,001. El área bajo la curva ROC fue de 0,70, 0,68 y 0,80 para los scores ACTIONGWTG, CRUSADE y ORBIT, respectivamente. El ORBIT presento una mayor área bajo la curva que el CRUSADE (p = 0,03) sin diferencias significativas con el ACTION-GWTG (p = 0,06) Conclusiones: El ORBIT fue el único predictor independiente de sangrado mayor, con una mejor capacidad de discriminación que el CRUSADE, y tendencia a mejor capacidad que el ACTION-GWTG.

ABSTRACT Background: Major bleeding is the most important complication of antithrombotic treatment in acute coronary syndrome (ACS) and is associated with higher mortality. Assessing the risk of bleeding is a challenge. The usefulness of the Orbit Bleeding Score (ORBIT) to assess the risk of bleeding in ACS has been scarcely studied. Objective: The aim of this study was to evaluate the ORBIT score as a predictor of major bleeding in patients hospitalized for ACS in whom anticoagulation is decided as part of the antithrombotic strategy. Methods: Patients admitted to two coronary care units with diagnosis of ACS who received anticoagulation as part of the antithrombotic therapy were retrospectively included in the study. The CRUSADE, ACTION-GWTG and ORBIT scores were calculated using the admission clinical data. The primary endpoint was major bleeding, defined as BARC 3 or 5 classification. Results: The study included 762 patients. Major bleeding occurred in 3.4% of cases. In the univariate analysis, the three scores were predictors of major bleeding, while in the multivariate analysis only the ORBIT score was an independent predictor of major bleeding (OR: 2.46, 95% CI 1.61-3.97, p <0.001). The area under the ROC curve was 0.70, 0.68 and 0.80 for the ACTION-GWTG, CRUSADE and ORBIT scores, respectively. The ORBIT score presented a higher area under the curve than the CRUSADE score (p=0.03) but without significant difference with the ACTION-GWTG score (p=0.06) Conclusions: The ORBIT score was the only independent predictor of major bleeding, presenting a better discrimination capacity than the CRUSADE score and a tendency to better capacity than the ACTION-GWTG score.

Fine-tuned KDM1A alternative splicing regulates human cardiomyogenesis through an enzymatic-independent mechanism.

The histone demethylase KDM1A is a multi-faceted regulator of vital developmental processes, including mesodermal and cardiac tube formation during gastrulation. However, it is unknown whether the fine-tuning of KDM1A splicing isoforms, already shown to regulate neuronal maturation, is crucial for the specification and maintenance of cell identity during cardiogenesis. Here, we discovered a temporal modulation of ubKDM1A and KDM1A+2a during human and mice fetal cardiac development and evaluated their impact on the regulation of cardiac differentiation. We revealed a severely impaired cardiac differentiation in KDM1A-/- hESCs that can be rescued by re-expressing ubKDM1A or catalytically impaired ubKDM1A-K661A, but not by KDM1A+2a or KDM1A+2a-K661A. Conversely, KDM1A+2a-/- hESCs give rise to functional cardiac cells, displaying increased beating amplitude and frequency and enhanced expression of critical cardiogenic markers. Our findings prove the existence of a divergent scaffolding role of KDM1A splice variants, independent of their enzymatic activity, during hESC differentiation into cardiac cells.

Heart in a Dish: From Traditional 2D Differentiation Protocols to Cardiac Organoids.

Human pluripotent stem cells (hPSCs) constitute a valuable model to study the complexity of early human cardiac development and investigate the molecular mechanisms involved in heart diseases. The differentiation of hPSCs into cardiac lineages in vitro can be achieved by traditional two-dimensional (2D) monolayer approaches or by adopting innovative three-dimensional (3D) cardiac organoid protocols. Human cardiac organoids (hCOs) are complex multicellular aggregates that faithfully recapitulate the cardiac tissue's transcriptional, functional, and morphological features. In recent years, significant advances in the field have dramatically improved the robustness and efficiency of hCOs derivation and have promoted the application of hCOs for drug screening and heart disease modeling. This review surveys the current differentiation protocols, focusing on the most advanced 3D methods for deriving hCOs from hPSCs. Furthermore, we describe the potential applications of hCOs in the pharmaceutical and tissue bioengineering fields, including their usage to investigate the consequences of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV2) infection in the heart.

Delivery of Endothelial Cell-Laden Microgel Elicits Angiogenesis in Self-Assembling Ultrashort Peptide Hydrogels In Vitro.

Blood vessel generation is an essential process for tissue formation, regeneration, and repair. Notwithstanding, vascularized tissue fabrication in vitro remains a challenge, as current fabrication techniques and biomaterials lack translational potential in medicine. Naturally derived biomaterials harbor the risk of immunogenicity and pathogen transmission, while synthetic materials need functionalization or blending to improve their biocompatibility. In addition, the traditional top-down fabrication techniques do not recreate the native tissue microarchitecture. Self-assembling ultrashort peptides (SUPs) are promising chemically synthesized natural materials that self-assemble into three-dimensional nanofibrous hydrogels resembling the extracellular matrix (ECM). Here, we use a modular tissue-engineering approach, embedding SUP microgels loaded with human umbilical vein endothelial cells (HUVECs) into a 3D SUP hydrogel containing human dermal fibroblast neonatal (HDFn) cells to trigger angiogenesis. The SUPs IVFK and IVZK were used to fabricate microgels that gel in a water-in-oil emulsion using a microfluidic droplet generator chip. The fabricated SUP microgels are round structures that are 300-350 µm diameter in size and have ECM-like topography. In addition, they are stable enough to keep their original size and shape under cell culture conditions and long-term storage. When the SUP microgels were used as microcarriers for growing HUVECs and HDFn cells on the microgel surface, cell attachment, stretching, and proliferation could be demonstrated. Finally, we performed an angiogenesis assay in both SUP hydrogels using all SUP combinations between micro- and bulky hydrogels. Endothelial cells were able to migrate from the microgel to the surrounding area, showing angiogenesis features such as sprouting, branching, coalescence, and lumen formation. Although both SUP hydrogels support vascular network formation, IVFK outperformed IVZK in terms of vessel network extension and branching. Overall, these results demonstrated that cell-laden SUP microgels have great potential to be used as a microcarrier cell delivery system, encouraging us to study the angiogenesis process and to develop vascularized tissue-engineering therapies.

Optimization of a 3D bioprinting process using ultrashort peptide bioinks.

The field of three-dimensional (3D) bioprinting is rapidly emerging as an additive manufacturing method for tissue and organ fabrication. The demand for tissues and organ transplants is ever increasing, although donors are not as readily available. Consequently, tissue engineering is gaining much attention to alleviate this problem. The process of achieving well-structured 3D bioprinted constructs using hydrogel bioinks depends on symmetrical precision, regulated flow rates, and viability of cells. Even with the mentioned parameters optimized, the printed structures need additional refining by removing excessive liquids, as peptide hydrogel bioprints encapsulate water. However, it is challenging to eliminate the confined fluids without compromising the printing process. In this paper, we introduced a vacuum system to our 3D bioprinting robotic arm and thus optimized the printing quality for complex and refined 3D scaffolds. Moreover, the proposed vacuum system supports printing with cells. Our results show improved printing resolution which facilitates the printing of higher and more stable structures.

Utilidad de diferentes puntajes de riesgo de mortalidad en pacientes con insuficiencia cardíaca. Estudio observacional retrospectivo / Usefulness of Different Mortality Risk Scores in Patients with Heart Failure. A Retrospective and Observational Study

RESUMEN Introducción: El Cardiac and Comorbid Conditions - Heart Failure (3C-HF) y el Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) son dos sistemas de puntaje desarrollados para predecir la mortalidad en pacientes con insuficiencia cardíaca (IC). El desempeño de estos puntajes ha sido poco estudiado en nuestro medio. Objetivo: Evaluar el desempeño del 3C-HF y del MAGGIC para predecir la mortalidad al año en una población de pacientes con IC. Material y métodos: Se incluyeron pacientes con diagnóstico de IC ambulatorios y dados de alta luego de una internación por IC aguda atendidos en dos centros. Se calcularon los puntajes 3C-HF y MAGGIC. Se evaluó como punto final la mortalidad global al año. La capacidad de discriminación de estos puntajes se analizó a partir del cálculo del área bajo la curva (ABC) ROC, y la calidad de su calibración, aplicando el test de Hosmer-Lemeshow. Se compararon ambas ABC mediante el test de Hanley-Mc Neil. Resultados: Se incluyeron 704 pacientes con una edad promedio de 73 ± 11 años, el 39,6% eran mujeres. La mortalidad al año fue del 12,4% (n = 87). Ambos puntajes fueron predictores independientes de mortalidad, con HR de 1,03 (IC95% 1,008-1,06; p = 0,02) y 1,08 (IC95% 1,02-1,13; p = 0,004) para el puntaje 3C-HF y el MAGGIC, respectivamente. El 3C-HF presentó un ABC de 0,70 (IC95% 0,64-0,75) y el MAGGIC de 0,67 (IC95% 0,61-0,73), sin diferencias entre las ABC (p = 0,41). Ambos presentaron adecuada calibración (p = 0,06 y p = 0,32, respectivamente). Conclusión: Los puntajes 3C-HF y MAGGIC fueron predictores de mortalidad a un año, con una moderada capacidad de discriminar eventos y una adecuada calibración. No hubo diferencias en la capacidad de discriminación entre ambos puntajes.

ABSTRACT Background: The Cardiac and Comorbid Conditions - Heart Failure (3C-HF) and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) are two score models developed to predict mortality in patients with heart failure (HF). The performance of these scores has been little studied in our setting. Objective: The aim of this study was to assess the performance of the 3C-HF and the MAGGIC scores to predict one-year mortality in a population of patients with H F. Methods: Ambulatory HF patients discharged after hospitalization due to acute HF in two centers were included in the study. The 3C-HF and MAGGIC scores were calculated and one-year mortality was the study endpoint. The discrimination ability of the scores was analyzed from the calculated area under the ROC curve and their calibration quality was assessed applying the Hosmer-Lemeshow test. Both areas under the ROC curve were compared using the Hanley-Mc Neil test. Results: A total of 704 patients with mean age of 73±11 years and 39.6% women were included in the study. One-year mortal-ity was 12.4% (n=87). Both scores were independent predictors of mortality, with HR of 1.03 (95% CI 1.008-1.06; p=0.02) and 1.08 (95% CI 1.02-1.13; p=0.004) for the 3C-HF and MAGGIC scores, respectively. The area under the ROC curve for the 3C-HF score was 0.70 (95% CI 0.64-0.75) and for the MAGGIC score 0.67 (95% CI 0.61-0.73), without significant differences between them (p=0.41). Both scores presented adequate calibration (p=0.06 and p=0.32, respectively). Conclusion: The 3C-HF and MAGGIC scores were predictors of one-year mortality, with a moderate ability to discriminate events and adequate calibration. The discrimination ability between both scores was not significant.

Novel antimalarial chloroquine- and primaquine-quinoxaline 1,4-di-N-oxide hybrids: Design, synthesis, Plasmodium life cycle stage profile, and preliminary toxicity studies.

Emergence of drug resistance and targeting all stages of the parasite life cycle are currently the major challenges in antimalarial chemotherapy. Molecular hybridization combining two scaffolds in a single molecule is an innovative strategy for achieving these goals. In this work, a series of novel quinoxaline 1,4-di-N-oxide hybrids containing either chloroquine or primaquine pharmacophores was designed, synthesized and tested against both chloroquine sensitive and multidrug resistant strains of Plasmodium falciparum. Only chloroquine-based compounds exhibited potent blood stage activity with compounds 4b and 4e being the most active and selective hybrids at this parasite stage. Based on their intraerythrocytic activity and selectivity or their chemical nature, seven hybrids were then evaluated against the liver stage of Plasmodium yoelii, Plasmodium berghei and Plasmodium falciparum infections. Compound 4b was the only chloroquine-quinoxaline 1,4-di-N-oxide hybrid with a moderate liver activity, whereas compound 6a and 6b were identified as the most active primaquine-based hybrids against exoerythrocytic stages, displaying enhanced liver activity against P. yoelii and P. berghei, respectively, and better SI values than primaquine. Although both primaquine-quinoxaline 1,4-di-N-oxide hybrids slightly reduced the infection of mosquitoes, they inhibited sporogony of P. berghei and compound 6a showed 92% blocking of transmission. In vivo liver efficacy assays revealed that compound 6a showed causal prophylactic activity affording parasitaemia reduction of up to 95% on day 4. Absence of genotoxicity and in vivo acute toxicity were also determined. These results suggest the approach of primaquine-quinoxaline 1,4-di-N-oxide hybrids as new potential dual-acting antimalarials for further investigation.

Prevención cardiovascular en pacientes octononagenarios / Cardiovascular Prevention in Octo/Nonagenarian Patients

RESUMEN: Objetivos: Analizar en octononagenarios los factores de riesgo cardiovasculares, la medicación y el cumplimiento de las metas en prevención cardiovascular. Material y métodos: Estudio descriptivo, multicéntrico, de muestras consecutivas que incluyó sujetos ≥ 80 años. Se evaluaron las metas de C-LDL (< 130 y < 100 mg/dL en prevención primaria y secundaria), presión arterial (< 150/90 mmHg) y HbA1c (< 7%). Resultados: Se incluyeron 265 pacientes (mujeres 54,0%, edad 85,0 ± 4 años). El 74,3%, 47,5%, 4,5% y 16,2% mostró hipertensión arterial, dislipidemia, tabaquismo o diabetes, respectivamente. El 26,2% recibía ≥ 3 antihipertensivos, el 18,5% (prevención primaria) y 58,3% (prevención secundaria) aspirina y el 50,6% estatinas. El 80,8% alcanzó la meta de presión arterial, el 67,4% y 63,9% alcanzó los objetivos de C-LDL (prevención primaria y secundaria) y el 76,9% mostró control glucémico. Conclusión: La prevalencia de factores de riesgo fue considerable, y alcanzó una gran proporción de pacientes las metas recomendadas.

SUMMARY: Objectives: The aim of this study was to analyze cardiovascular risk factors, medication and cardiovascular prevention goals achieved in an octo/nonagenarian population. Methods: This was a descriptive, multicenter study of consecutive samples that included subjects ≥80 years. LDL-C (<130 and <100 mg / dL in primary and secondary prevention), blood pressure (<150/90 mmHg), and HbA1c (<7%) goals were evaluated. Results: A total of 265 patients were included in the study (women 54.0%, age 85.0±4 years). History of hypertension, dyslipidemia, smoking, or diabetes was present in 74.3%, 47.5%, 4.5% and 16.2% of patients, respectively. In 26.2% received ≥3 antihypertensive drugs, 18.5% (primary prevention) and 58.3% (secondary prevention) received aspirin, and 50.6% received statins. The blood pressure goal was fulfilled in 80.8% of cases. The LDL-C goals were attained in 67.4% (primary prevention) and 63.9% (secondary prevention) patients and 76.9% showed glycemic control. Conclusion: The prevalence of risk factors was significant, with a high proportion of patients achieving the recommended goals.

New hydrazine and hydrazide quinoxaline 1,4-di-N-oxide derivatives: In silico ADMET, antiplasmodial and antileishmanial activity.

We report the design (in silico ADMET criteria), synthesis, cytotoxicity studies (HepG-2 cells), and biological evaluation of 15 hydrazine/hydrazide quinoxaline 1,4-di-N-oxide derivatives against the 3D7 chloroquine sensitive strain and FCR-3 multidrug resistant strain of Plasmodium falciparum and Leishmania infantum (axenic amastigotes). Fourteen of derivatives are novel quinoxaline 1,4-di-N-oxide derivatives. Compounds 18 (3D7 IC50=1.40µM, FCR-3 IC50=2.56µM) and 19 (3D7 IC50=0.24µM, FCR-3 IC50=2.8µM) were identified as the most active against P. falciparum, and they were the least cytotoxic (CC50-values>241µM) and most selective (SI>86). None of the compounds tested against L. infantum were considered to be active. Additionally, the functional role of the hydrazine and hydrazide structures were studied in the quinoxaline 1,4-di-N-oxide system.

Cómo usan los pacientes Internet para la prevención cardiovascular / How Patients Use the Internet for Cardiovascular Prevention

Introducción: El uso de Internet y las redes sociales por parte de los pacientes en busca de información relacionada con la salud ha crecido en los últimos años. Desconocemos la utilización de estas herramientas en el contexto de la prevención cardiovascular en la Argentina. Objetivos: Analizar la utilización de Internet y las redes sociales en pacientes evaluados en el contexto de prevención cardiovascular, determinar las características de los sujetos que las utilizan, analizar la fiabilidad y utilidad percibida por los pacientes y describir el potencial impacto conductual. Material y métodos: Se encuestaron pacientes mayores de 18 años atendidos, en forma consecutiva, en 10 consultorios de cardiología con orientación en la prevención cardiovascular de la Ciudad de Buenos Aires y el Conurbano Bonaerense. De las encuestas entregadas, el 97% fueron completadas. Se recolectaron las características demográficas y clínicas de los participantes, excluyendo los sujetos con incapacidad para leer e interpretar un cuestionario. Resultados: Se incluyeron 1.135 pacientes (edad 49 ± 17 años). El 68%, 65% y 52% utilizaban Internet, correo electrónico o las redes sociales, respectivamente. El 58,2% buscó información relacionada con la salud. Los temas sobre prevención cardiovascular buscados con más frecuencia fueron alimentación (48%), actividad física (35%), medicación (32%), hipertensión (26%) y obesidad (25%). El 54,6% consideró que la información era confiable o muy confiable. Se observó interés en utilizar dichas herramientas para contactarse con el médico u otros pacientes. El 57,8% consideró que la red podría influir en su conducta. Tener menos de 50 años, atenderse en centros privados o tener más educación se asoció independientemente con una probabilidad mayor de buscar información sobre la salud. Conclusiones: En esta población, el uso de Internet en busca de información relacionada con la salud fue considerable. Los sujetos más jóvenes, más educados o atendidos en centros privados mostraron mayor probabilidad de buscar contenidos sobre la salud. El interés generado por estas herramientas permitiría utilizarlas en la atención de nuestros pacientes.

Background: The use of the Internet and social networks by patients seeking health-related information has grown in recent years. The application of these tools in the context of cardiovascular prevention in Argentina is unknown. Objectives: The aim of this study was to analyze the use of the Internet and social networks in patients evaluated in the context of cardiovascular prevention, determine the characteristics of subjects using them, analyze the reliability and usefulness perceived by patients and describe the potential behavioral impact. Methods: Patients over 18 years of age, consecutively attending 10 cardiology centers focusing on cardiovascular prevention of the City of Buenos Aires and suburban areas, were surveyed. In 97% of cases the surveys were completed by the patients. Participants’ demographic and clinical data were collected, excluding subjects with inability to read and interpret a questionnaire. Results: A total of 1,135 patients (age 49±17 years) were included in the study. Among them 68%, 65% and 52% used Internet, email or social networks, respectively, and 58.2% sought health-related information. The most searched-for topics were food (48%), physical activity (35%), medication (32%), hypertension (26%) and obesity (25%). Information was considered reliable or very reliable in 54.6% of cases, and interest was perceived in using these tools to contact the physician or other patients. In 57.8% of cases, patients felt that the network could influence their behavior. Characteristics such as less than 50 years of age, attending private healthcare centers or higher education were independently associated with a greater possibility of seeking health information. Conclusions: In this population, the Internet was significantly used to explore about health information. Younger subjects, with higher education and those attending private healthcare centers were more likely to seek health-related information. The interest generated by these tools could be used for patient care.

Adaptación para la Argentina y evaluación de las propiedades psicométricas del Cuestionario sobre la Dieta Restrictiva de Sodio en pacientes con insuficiencia cardíaca / Evaluation of Psychometric Properties in the Argentine-Adapted Dietary Sodium Restriction Questionnaire in Heart Failure Patients

Introducción: El Cuestionario sobre la Dieta Restrictiva de Sodio [Dietary Sodium Restriction Questionnaire (DSRQ)] está basado en la teoría del comportamiento planificado. Originalmente desarrollado en inglés, este instrumento, compuesto por tres subescalas (en 16 ítems que evalúan los parámetros vinculados con la actitud en relación con el comportamiento, la norma subjetiva y el control comportamental percibido), identifica los factores que afectan la adhesión a la dieta hiposódica en pacientes con insuficiencia cardíaca congestiva (ICC). Objetivos: Realizar la adaptación transcultural del DSRQ en idioma español para su utilización en la Argentina y evaluar las propiedades psicométricas (validez y confiabilidad). Material y métodos: La adaptación transcultural se realizó con la metodología recomendada (traducción, síntesis, revisión y retrotraducción). La validez se determinó mediante análisis de forma y factorial de componentes principales con la extracción de factores y rotación Varimax. El análisis de la confiabilidad se efectuó mediante el cálculo de la consistencia interna (alfa de Cronbach) y la correlación ítem-total de la escala. Resultados: En la adaptación transcultural se adaptaron los encabezados y solamente una pregunta tuvo alteraciones semánticas relevantes. Para el análisis de las propiedades psicométricas se incluyeron 230 pacientes con ICC. La proporción de datos faltantes fue muy baja (0,20%). En el análisis de componentes principales se extrajeron tres factores. Luego de la rotación Varimax, los ítems se agruparon con los factores seleccionados, coincidiendo con las tres subescalas originales. En el análisis ítem-total, ninguna correlación mostró un valor < 0,30. El alfa de Cronbach global fue de 0,86 (0,89, 0,71 y 0,89 para las tres subescalas, de actitud en relación con el comportamiento, norma subjetiva y control comportamental percibido, respectivamente). Conclusiones: En nuestro trabajo se realizó por primera vez la adaptación transcultural del DSRQ al español para su utilización en la Argentina; la confiabilidad y la validez de esta versión del instrumento fueron adecuadas.

Background: The Dietary Sodium Restriction Questionnaire (DSRQ) is based on the theory of planned behavior. Originally developed in English, this instrument, consisting of three subscales (divided in 16 items evaluating the parameters associated with attitude relative to behavior, the subjective norm and the perceived behavioral control), identifies the factors affecting adherence to low-sodium diet in patients with congestive heart failure (CHF). Objectives: The purpose of this study was to perform the DSRQ transcultural adaptation into Spanish to be used in Argentina and assess its psychometric properties (validity and reliability). Methods: The transcultural adaptation was done with the recommended methodology (translation, synthesis, revision and back translation). Its validity was explored by principal component structure and factor analysis with factor extraction and Varimax rotation. Reliability was analyzed by internal consistency calculation (Cronbach's alpha) and the item-total scale correlation. Results: Headlines were adjusted and one question only had relevant semantic changes in the transcultural adaptation. A total of 230 CHF patients were included for the psychometric analysis. The proportion of missing data was very low (0.20%). Three factors were extracted from the main component analysis. After Varimax rotation, the items were grouped with the selected factors, matching the three original subscales. In the item-total analysis, no correlation showed a value < 0.30. Global Cronbach's alpha was 0.86 (0.89, 0.71 and 0.89 for the three subscales, of attitude relative to behavior, subjective norm and perceived behavioral control, respectively). Conclusions: We performed for the first time the DSRQ transcultural adaptation into Spanish for its use in Argentina. This version of the instrument showed adequate validity and reliability.

Adaptación para la Argentina y evaluación de las propiedades psicométricas del Cuestionario sobre la Dieta Restrictiva de Sodio en pacientes con insuficiencia cardíaca / Evaluation of Psychometric Properties in the Argentine-Adapted Dietary Sodium Restriction Questionnaire in Heart Failure Patients

Introducción: El Cuestionario sobre la Dieta Restrictiva de Sodio [Dietary Sodium Restriction Questionnaire (DSRQ)] está basado en la teoría del comportamiento planificado. Originalmente desarrollado en inglés, este instrumento, compuesto por tres subescalas (en 16 ítems que evalúan los parámetros vinculados con la actitud en relación con el comportamiento, la norma subjetiva y el control comportamental percibido), identifica los factores que afectan la adhesión a la dieta hiposódica en pacientes con insuficiencia cardíaca congestiva (ICC). Objetivos: Realizar la adaptación transcultural del DSRQ en idioma español para su utilización en la Argentina y evaluar las propiedades psicométricas (validez y confiabilidad). Material y métodos: La adaptación transcultural se realizó con la metodología recomendada (traducción, síntesis, revisión y retrotraducción). La validez se determinó mediante análisis de forma y factorial de componentes principales con la extracción de factores y rotación Varimax. El análisis de la confiabilidad se efectuó mediante el cálculo de la consistencia interna (alfa de Cronbach) y la correlación ítem-total de la escala. Resultados: En la adaptación transcultural se adaptaron los encabezados y solamente una pregunta tuvo alteraciones semánticas relevantes. Para el análisis de las propiedades psicométricas se incluyeron 230 pacientes con ICC. La proporción de datos faltantes fue muy baja (0,20%). En el análisis de componentes principales se extrajeron tres factores. Luego de la rotación Varimax, los ítems se agruparon con los factores seleccionados, coincidiendo con las tres subescalas originales. En el análisis ítem-total, ninguna correlación mostró un valor < 0,30. El alfa de Cronbach global fue de 0,86 (0,89, 0,71 y 0,89 para las tres subescalas, de actitud en relación con el comportamiento, norma subjetiva y control comportamental percibido, respectivamente). Conclusiones: En nuestro trabajo se realizó por primera vez la adaptación transcultural del DSRQ al español para su utilización en la Argentina; la confiabilidad y la validez de esta versión del instrumento fueron adecuadas.(AU)

Background: The Dietary Sodium Restriction Questionnaire (DSRQ) is based on the theory of planned behavior. Originally developed in English, this instrument, consisting of three subscales (divided in 16 items evaluating the parameters associated with attitude relative to behavior, the subjective norm and the perceived behavioral control), identifies the factors affecting adherence to low-sodium diet in patients with congestive heart failure (CHF). Objectives: The purpose of this study was to perform the DSRQ transcultural adaptation into Spanish to be used in Argentina and assess its psychometric properties (validity and reliability). Methods: The transcultural adaptation was done with the recommended methodology (translation, synthesis, revision and back translation). Its validity was explored by principal component structure and factor analysis with factor extraction and Varimax rotation. Reliability was analyzed by internal consistency calculation (Cronbachs alpha) and the item-total scale correlation. Results: Headlines were adjusted and one question only had relevant semantic changes in the transcultural adaptation. A total of 230 CHF patients were included for the psychometric analysis. The proportion of missing data was very low (0.20%). Three factors were extracted from the main component analysis. After Varimax rotation, the items were grouped with the selected factors, matching the three original subscales. In the item-total analysis, no correlation showed a value < 0.30. Global Cronbachs alpha was 0.86 (0.89, 0.71 and 0.89 for the three subscales, of attitude relative to behavior, subjective norm and perceived behavioral control, respectively). Conclusions: We performed for the first time the DSRQ transcultural adaptation into Spanish for its use in Argentina. This version of the instrument showed adequate validity and reliability.(AU)

Ejercicio en médicos argentinos: encuesta sobre hábitos y actitudes frente a la actividad física / Physical Exercise in Argentine Physicians: a Survey on Their Habits and Attitudes Towards Physical Activity

Introducción La inactividad física se asocia con mayor morbimortalidad cardiovascular y está en aumento en la población general. Los médicos serían los mejor preparados para brindar asesoramiento sobre actividad física a los pacientes; no obstante ello, no existen datos locales validados relativos a los hábitos y las actitudes de los médicos frente al ejercicio. Objetivos Analizar las características de la actividad física en una población de médicos, determinar la actitud del médico frente al paciente con respecto al ejercicio, estudiar la relación entre la actividad física y la edad, el sexo y la especialidad y evaluar los factores de riesgo de esta población. Material y métodos Se realizó una encuesta a médicos de la Ciudad Autónoma de Buenos Aires y del Conurbano bonaerense. Se utilizó el International Physical Activity Questionnaire (Cuestionario Internacional de Actividad Física). Para evaluar el nivel de actividad física se empleó una escala basada en los MET semanales ( 3.000 MET = actividad física vigorosa). Resultados Se incluyeron 550 médicos (53% hombres, edad media 38 años). El 37,5%, el 57,5% y el 5% realizan actividad física baja, moderada o vigorosa, respectivamente. Al 80% de la población le gusta hacer ejercicio, el 92% recomienda hacer ejercicio a sus pacientes y el 97% lo considera beneficioso para la salud. El principal motivo para no realizar ejercicio es la falta de tiempo. Los hombres realizan más actividad física vigorosa 3 o más veces por semana (20% vs. 15%; p < 0,01) que las mujeres. La especialidad cardiología es en la que se indica más frecuentemente realizar ejercicio (75%). Conclusiones En esta población médica, independientemente del sexo, el grupo etario o la especialidad analizada, se observó una prevalencia menor de actividad física baja en comparación con la población general. La recomendación de ejercicio a los pacientes fue globalmente elevada, aunque mayor en las especialidades clínicas.

Background Sedentarism is associated with higher cardiovascular morbidity and mortality and is increasing in the general population. Physicians should have the best preparation to instruct patients on physical activity. There are, however, no validated local data regarding physician’s habits and attitudes towards physical exercise. Objectives The aim of the study was to analyze the characteristics of physical activity in a medical population, determine the attitude towards patients regarding exercise, study the relationship between physical activity and age, gender and specialty and evaluate the risk factors of this population. Methods We surveyed physicians from the Autonomous City of Buenos Aires and the Greater Buenos Aires using the International Physical Activity Questionnaire (IPAQ). To assess the physical activity level a scale based on weekly METS ( 3000 METS = vigorous physical activity) was applied. Results Five hundred and fifty physicians were included (53% male, mean age 38 years). Physical activity levels were low, moderate or vigorous in 37.5%, 57.5%, and 5% of cases, respectively. Eighty percent of the medical population liked to exercise, 92% recommended exercise to their patients and 97% saw it as beneficial for health. The main reason for not performing exercise was lack of time. Men performed more vigorous physical activity than women (20 vs. 15%, p <0.01). Cardiology was the specialty which recommended exercise more frequently to patients (75%). Conclusions In this medical population there was a lower prevalence of low physical activity than in the general population, independently of gender, age group or specialty analyzed. Exercise recommendation to patients was generally high, though more elevated in clinical specialties.

Ejercicio en médicos argentinos: encuesta sobre hábitos y actitudes frente a la actividad física / Physical Exercise in Argentine Physicians: a Survey on Their Habits and Attitudes Towards Physical Activity

Introducción La inactividad física se asocia con mayor morbimortalidad cardiovascular y está en aumento en la población general. Los médicos serían los mejor preparados para brindar asesoramiento sobre actividad física a los pacientes; no obstante ello, no existen datos locales validados relativos a los hábitos y las actitudes de los médicos frente al ejercicio. Objetivos Analizar las características de la actividad física en una población de médicos, determinar la actitud del médico frente al paciente con respecto al ejercicio, estudiar la relación entre la actividad física y la edad, el sexo y la especialidad y evaluar los factores de riesgo de esta población. Material y métodos Se realizó una encuesta a médicos de la Ciudad Autónoma de Buenos Aires y del Conurbano bonaerense. Se utilizó el International Physical Activity Questionnaire (Cuestionario Internacional de Actividad Física). Para evaluar el nivel de actividad física se empleó una escala basada en los MET semanales ( 3.000 MET = actividad física vigorosa). Resultados Se incluyeron 550 médicos (53% hombres, edad media 38 años). El 37,5%, el 57,5% y el 5% realizan actividad física baja, moderada o vigorosa, respectivamente. Al 80% de la población le gusta hacer ejercicio, el 92% recomienda hacer ejercicio a sus pacientes y el 97% lo considera beneficioso para la salud. El principal motivo para no realizar ejercicio es la falta de tiempo. Los hombres realizan más actividad física vigorosa 3 o más veces por semana (20% vs. 15%; p < 0,01) que las mujeres. La especialidad cardiología es en la que se indica más frecuentemente realizar ejercicio (75%). Conclusiones En esta población médica, independientemente del sexo, el grupo etario o la especialidad analizada, se observó una prevalencia menor de actividad física baja en comparación con la población general. La recomendación de ejercicio a los pacientes fue globalmente elevada, aunque mayor en las especialidades clínicas.(AU)

Background Sedentarism is associated with higher cardiovascular morbidity and mortality and is increasing in the general population. Physicians should have the best preparation to instruct patients on physical activity. There are, however, no validated local data regarding physicianÆs habits and attitudes towards physical exercise. Objectives The aim of the study was to analyze the characteristics of physical activity in a medical population, determine the attitude towards patients regarding exercise, study the relationship between physical activity and age, gender and specialty and evaluate the risk factors of this population. Methods We surveyed physicians from the Autonomous City of Buenos Aires and the Greater Buenos Aires using the International Physical Activity Questionnaire (IPAQ). To assess the physical activity level a scale based on weekly METS ( 3000 METS = vigorous physical activity) was applied. Results Five hundred and fifty physicians were included (53% male, mean age 38 years). Physical activity levels were low, moderate or vigorous in 37.5%, 57.5%, and 5% of cases, respectively. Eighty percent of the medical population liked to exercise, 92% recommended exercise to their patients and 97% saw it as beneficial for health. The main reason for not performing exercise was lack of time. Men performed more vigorous physical activity than women (20 vs. 15%, p <0.01). Cardiology was the specialty which recommended exercise more frequently to patients (75%). Conclusions In this medical population there was a lower prevalence of low physical activity than in the general population, independently of gender, age group or specialty analyzed. Exercise recommendation to patients was generally high, though more elevated in clinical specialties.(AU)

[Patients' preferences for information in health care decision-making]. / Preferencias de los pacientes sobre la información de su enfermedad.

A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely. A trend to trust only in the doctor's knowledge to obtain information (81.7%), in wanting to know the options of treatment and express one's point of view (85.9%), and to involve the family in the decisions (63.2%) was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (or: 0.64), giving less freedom to family involvement (or: 1.31). people with a lower social and economical level claim fewer options (or: 0.48) and gave less family participation (or = 1.79). Natives from other South American countries had a minor tendency to demand for options and express their thoughts (or: 0.60); and the ones with lower education level trusted less in the doctor's knowledge (or: 1.81), demanded fewer options (or: 0.45) and chose not to know the severity of the disease (or: 0.56). the analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patient's autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.

Preferencias de los pacientes sobre la información de su enfermedad / Patients' preferences for information in health care decision-making

Se realizó una encuesta a pacientes que concurrían a servicios de cardiología para conocer cómo preferían ser informados sobre su estado de salud, y las características sociodemográficas asociadas con estas preferencias, considerando los siguientes ítems: conocimiento sobre la enfermedad, información sobre opciones terapéuticas y toma de decisiones. De 770 encuestados, 738 (95.8%) respondieron completamente el formulario. Se observó una tendencia a confiar sólo en el médico para obtener información (81.7%), a querer conocer las opciones de tratamiento y poder opinar (85.9%) y en menor medida, a la participación de la familia en las decisiones (63.2%). El 9.6% deseaba recibir la información mínima necesaria o "no saber nada" sobre una presunta enfermedad grave. Los varones fueron menos proclives a solicitar opciones y dar opinión (OR: 0.64), dando menos libertad a la participación familiar (OR: 1.31). Los de menor nivel socioeconómico reclamaron menos opciones (OR: 0.48) y dieron menor participación familiar (OR: 1.79). Los provenientes de otros países de Sudamérica tuvieron una menor tendencia a reclamar opciones y manifestar opinión (OR: 0.60); y los de menor nivel educativo confiaron menos en el conocimiento del médico (OR: 1.81), exigieron menos opciones (OR: 0.45) y prefirieron no conocer la gravedad de la enfermedad (OR: 0.56). El análisis de las variables demográficas permitió definir distintas preferencias de información asociadas a la edad, sexo, procedencia, educación, religión y estado de salud. Se concluye que, aunque es imperativo promover la autonomía del paciente, se deben conocer las preferencias individuales antes de informar y comprometer al paciente en el proceso de toma de decisiones sobre su enfermedad.

A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely. A trend to trust only in the doctor's knowledge to obtain information (81.7%), in wanting to know the options of treatment and express one's point of view (85.9%), and to involve the family in the decisions (63.2%) was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (OR: 0.64), giving less freedom to family involvement (OR: 1.31). People with a lower social and economical level claim fewer options (OR: 0.48) and gave less family participation (OR = 1.79). Natives from other South American countries had a minor tendency to demand for options and express their thoughts (OR: 0.60); and the ones with lower education level trusted less in the doctor's knowledge (OR: 1.81), demanded fewer options (OR: 0.45) and chose not to know the severity of the disease (OR: 0.56). The analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patient's autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.

Preferencias de los pacientes sobre la información de su enfermedad / Patients preferences for information in health care decision-making

Se realizó una encuesta a pacientes que concurrían a servicios de cardiología para conocer cómo preferían ser informados sobre su estado de salud, y las características sociodemográficas asociadas con estas preferencias, considerando los siguientes ítems: conocimiento sobre la enfermedad, información sobre opciones terapéuticas y toma de decisiones. De 770 encuestados, 738 (95.8%) respondieron completamente el formulario. Se observó una tendencia a confiar sólo en el médico para obtener información (81.7%), a querer conocer las opciones de tratamiento y poder opinar (85.9%) y en menor medida, a la participación de la familia en las decisiones (63.2%). El 9.6% deseaba recibir la información mínima necesaria o "no saber nada" sobre una presunta enfermedad grave. Los varones fueron menos proclives a solicitar opciones y dar opinión (OR: 0.64), dando menos libertad a la participación familiar (OR: 1.31). Los de menor nivel socioeconómico reclamaron menos opciones (OR: 0.48) y dieron menor participación familiar (OR: 1.79). Los provenientes de otros países de Sudamérica tuvieron una menor tendencia a reclamar opciones y manifestar opinión (OR: 0.60); y los de menor nivel educativo confiaron menos en el conocimiento del médico (OR: 1.81), exigieron menos opciones (OR: 0.45) y prefirieron no conocer la gravedad de la enfermedad (OR: 0.56). El análisis de las variables demográficas permitió definir distintas preferencias de información asociadas a la edad, sexo, procedencia, educación, religión y estado de salud. Se concluye que, aunque es imperativo promover la autonomía del paciente, se deben conocer las preferencias individuales antes de informar y comprometer al paciente en el proceso de toma de decisiones sobre su enfermedad.(AU)

A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely. A trend to trust only in the doctors knowledge to obtain information (81.7%), in wanting to know the options of treatment and express ones point of view (85.9%), and to involve the family in the decisions (63.2%) was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (OR: 0.64), giving less freedom to family involvement (OR: 1.31). People with a lower social and economical level claim fewer options (OR: 0.48) and gave less family participation (OR = 1.79). Natives from other South American countries had a minor tendency to demand for options and express their thoughts (OR: 0.60); and the ones with lower education level trusted less in the doctors knowledge (OR: 1.81), demanded fewer options (OR: 0.45) and chose not to know the severity of the disease (OR: 0.56). The analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patients autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.(AU)