ABSTRACT
BACKGROUND: Peripheral arterial disease (PAD) was reported to increase the risk of new cardiovascular events in patients with acute coronary syndromes (ACS). However, most of the evidence comes from randomized clinical trials. We aimed to assess the impact of PAD on cardiovascular outcome and treatment decisions in ACS patients in a current real-life setting. METHODS: START-ANTIPLATELET is a multicenter registry enrolling ACS patient. Baseline clinical characteristics and treatment at discharge were recorded and follow-up was repeated at 6-months and 1-year. PAD was defined as intermittent claudication and/or previous revascularization. RESULTS: Among 1442 patients enrolled, 103 (7.1%) had PAD. PAD patients were older (71.8 ± 10.6vs66.2 ± 12.6 yrs., p < 0.0001), more frequently hypertensive (90.3vs68.6%, p< 0.0001), hypercholesterolemic (66vs52%, p= 0.037), diabetic (51.5vs24%, p= 0.0001), obese (28.2vs19.3%, p= 0.029) and with previous TIA (7.8vs2.8%, p= 0.005) or stroke (11.7vs3.1%, p< 0.0001). Clinical presentation and acute treatment were similar in non-PAD and PAD patients, but the latter were discharged significantly less frequently on dual antiplatelet therapy (DAPT) (68.9vs85%, p= 0.005). After a median follow-up time of 11.1 months, major cardio/cerebrovascular event-free survival [MACCE, including cardiovascular death, MI, TIA and stroke, target-vessel revascularization (TVR) and major arterial ischemic events] was significantly shorter (9.0vs11.2 months, p= 0.02; HR 3.2, 2.4-8.4) in PAD patients and net adverse cardiovascular events (NACE = MACCE plus major hemorrhages) were significantly more frequent (19.1%vs10.5%, p = 0.049). CONCLUSIONS: PAD identifies a subgroup of ACS patients at significantly increased cardiovascular risk, but these patients tend to be undertreated. Patients admitted for ACS should be screened for PAD and optimal medical therapy at discharge should be implemented.
Subject(s)
Acute Coronary Syndrome , Percutaneous Coronary Intervention , Peripheral Arterial Disease , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/drug therapy , Acute Coronary Syndrome/epidemiology , Humans , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/drug therapy , Peripheral Arterial Disease/epidemiology , Platelet Aggregation Inhibitors , Registries , Risk Factors , Treatment OutcomeABSTRACT
Introducción: La espirometría es el examen más utilizado para evaluar la función pulmonar. El año 2007 se publicaron guías que definieron criterios de aceptabilidad y repetibilidad para su realización e interpretación en preescolares. Nuestro objetivo fue describir las espirometrías de pacientes de este grupo etario según el cumplimiento de estos criterios. Pacientes y Método: Se revisaron las espirometrías basales de pacientes de 2 a 5 años realizadas en el Laboratorio de Función Pulmonar Pediátrico de la P. Universidad Católica de Chile derivados por tos o sibilancias recurrentes o persistentes. Se consideraron solo las obtenidas en pacientes que la realizaban por primera vez. Se analizaron según criterios internacionales. Resultados: Se obtuvieron 93 espirometrías (edad promedio 57,4 ± 8,6 meses, 48 varones): 44 (47%) tuvieron todos los criterios aceptables, 87 (93%) obtuvieron un tiempo espiratorio ≥ 0,5 segundos, 67 (72%) de los pacientes tuvieron un flujo espiratorio de final de espiración en valor ≤ 10% del flujo espiratorio máximo. La variabilidad de las mediciones de capacidad vital forzada (CVF) y volumen espirado al primer segundo (VEF1) fue muy baja (coeficiente de correlación intraclase > 0,9). Conclusión: En nuestro centro fue factible cumplir criterios de aceptabilidad y repetibilidad en espirometrías en preescolares, semejante a descripciones previas. Al igual que en niños mayores, se recomienda realizar este examen en preescolares que requieren estudio de la función pulmonar.
Introduction: Spirometry is the most used test to evaluate pulmonary function. Guidelines that defined acceptability and repeatability criteria for its implementation and interpretation among preschoolers were published in 2007. Our objective was to quantify the actual compliance with these criteria among pre-school patients. Methods: A review was performed on the baseline spirometry measured in patients aged 2 to 5 years in the Pediatric Respiratory Laboratory of the Pontificia Universidad Catolica de Chile, who were admitted due to recurrent or persistent coughing or wheezing. Only those results obtained in patients who took the test for the first time were considered. They were analyzed by international standards. Results: A total of 93 spirometry results (mean age 57.4 ± 8.6 months, 48 males) were obtained, of which 44 (47%) met all acceptable criteria, 87 (93%) obtained expiratory time of ≥ 0.5 seconds, and 67 (72 %) of the patients had an end-expiratory flow of ≤ 10% from peak flow. The variation in the measurement of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) was very low (intraclass correlation coefficient > 0.9). Conclusion: It was possible to meet the acceptability and repeatability criteria for spirometry among pre-school children in our Center, which was similar to previous reports. As in older children, this test is fully recommended for pre-school children who require lung function studies.
Subject(s)
Humans , Male , Female , Child , Spirometry/methods , Practice Guidelines as Topic , Lung Diseases/diagnosis , Chile , Respiratory Sounds , Vital Capacity , Forced Expiratory Volume , Feasibility Studies , Cough/etiologySubject(s)
Molecular Motor Proteins/genetics , Myosin Heavy Chains/genetics , Base Sequence , Child , Genotype , Humans , Male , Molecular Sequence Data , Mutation , Pedigree , Phenotype , Phylogeny , Sequence Analysis, DNA , ThrombocytopeniaABSTRACT
The combination of oral anticoagulants with dual antiplatelet therapy (DAT) in patients undergoing percutaneous coronary intervention with stent implantation (PCI-stenting) is subject to controversy due to the high risk of bleeding. In this multicenter retrospective parallel-group study, we compared the rate of adverse events in chronically anticoagulated patients who underwent PCI-stenting and were discharged on aspirin, clopidogrel and warfarin (triple antithrombotic therapy [TT] group) and were followed in Italian anticoagulation centers, with a parallel cohort of patients who underwent PCI-stenting and were discharged on DAT group. The primary endpoint was the incidence of major bleeding while the patients were in TT and DAT. A secondary endpoint was the occurrence of major ischemic adverse events (MACEs). The final cohort consisted of 229 TT patients and 231 DAT patients followed up for 6 and 7 months, respectively. There were 11 (4.8%; 9.1% patient/years) major bleeding events in the TT group (1 was fatal) as compared to 1 (0.4%; 0.7% patient/years) event in the DAT group (p = 0.003). Of the 28 (6.1%) MACE recorded during the follow-up, 12 (5.2%) occurred in the TT group and 16 (6.9%) in the DAT group. In conclusion, despite close monitoring of anticoagulated patients in dedicated centers, the major bleeding incidence remains high among unselected patients undergoing PCI-stenting and treated with TT. Any efforts to minimize these events should be pursued.
Subject(s)
Fibrinolytic Agents/administration & dosage , Fibrinolytic Agents/adverse effects , Hemorrhage/chemically induced , Hemorrhage/epidemiology , Percutaneous Coronary Intervention/adverse effects , Adult , Aged , Cohort Studies , Drug Therapy, Combination , Female , Follow-Up Studies , Hemorrhage/diagnosis , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Introducción: Un factor de riesgo para las neoplasias escamosas de faringe son las nitrosaminas, las que derivan de los nitratos salivales que provienen de la dieta y en especial del agua si los niveles están por sobre la norma. Objetivos: Conocer y comparar los niveles de nitratos y nitritos en agua y saliva de habitantes de la región precordillerana y en población urbana de Concepción. Material y método: Estudio prospectivo, tipo caso y control. Determinan niveles de nitratos y nitritos en agua de la zona precordillerana y en agua de Concepción y en saliva de habitantes de la zona rural y de grupo control de Concepción. Resultados: Se obtienen 10 muestras de agua del sector rural y 1 muestra de agua potable de Concepción. Nivel de nitratos en agua rural 23,29 mg/L, en agua urbana 3,6 mg/L (p <0,05). En saliva, grupo estudio (n =15) con nivel de nitritos de 9,58 mg/ml, grupo control (n =24) nivel de 3,8 mg/ml (p <0,05). Conclusión: En la zona rural hay niveles significativamente mayores de nitratos en el agua y nitritos en saliva. Los niveles en agua son superiores a normas nacionales e internacionales. Nuestros resultados resaltan la posible importancia de las nitrosaminas y sus precursores como elementos carcinogónicos en los carcinomas escamosos orofaríngeos.
Introduction: A risk factor for squamous carcinomas of the oropharynx are the nitrosamines, which are derived from salivary nitrate coming from diet and water, especially if the levels are above the allowed levels. Aim: To determine and compare the levels of nitrates and nitrites in drinking water and saliva of people at the foothills of our region and urban population of Concepcion. Material and method: A descriptive cross sectional study. Determination of levels of nitrates and nitrites in drinking water in the Andean foothills and Concepcion and in saliva of people from same locations. Results: We obtained 10 rural water samples and 1 from Concepcion drinking water. Nitrate levels in rural water were 23.29 mg/L and 3.6 mg/L (p <0.05) in urban water. In saliva, the study group (n =15) had 9.58 mg/ml nitrite in saliva, the control group (n =24) 3.8 mg/ml (p <0.05). Conclusion: In rural areas there are significantly higher levels of nitrates in drinking water and saliva. The water levels are higher than national and international standards. Our results confirm high amounts of nitrogen cycle products (nitrites and nitrates) in drinking water and in saliva so it could be considered as carcinogenic elements in oropharyngeal squamous cell carcinomas.
