Hypotensive episodes at 24-h ambulatory blood pressure monitoring predict adverse outcomes in Parkinson's disease.

PURPOSE: Neurogenic orthostatic hypotension (nOH) is a frequent nonmotor feature of Parkinson's disease (PD), associated with adverse outcomes. Recently, 24-h ambulatory blood pressure monitoring (ABPM) showed good accuracy in diagnosing nOH. This study aims at evaluating the prognostic role of ABPM-hypotensive episodes in predicting PD disability milestones and mortality and comparing it to the well-defined prognostic role of bedside nOH. METHODS: Patients with PD who underwent ABPM from January 2012 to December 2014 were retrospectively enrolled and assessed for the development of falls, fractures, dementia, bed/wheelchair confinement, hospitalization, and mortality, during an up-to-10-year follow-up. Significant ABPM-hypotensive episodes were identified when greater than or equal to two episodes of systolic BP drop ≥ 15 mmHg (compared with the average 24 h) were recorded during the awakening-to-lunch period. RESULTS: A total of 99 patients (74% male, age 64.0 ± 10.1 years, and PD duration 6.4 ± 4.0 years) were enrolled. At baseline, 38.4% of patients had ABPM-hypotensive episodes and 46.5% had bedside nOH. On Kaplan-Meier analysis, patients with ABPM-hypotensive episodes showed earlier onset of falls (p = 0.001), fractures (p = 0.004), hospitalizations (p = 0.009), bed/wheelchair confinement (p = 0.032), dementia (p = 0.001), and shorter survival (8.0 versus 9.5 years; p = 0.009). At Cox regression analysis (adjusted for age, disease duration, Charlson Comorbidity Index, and Hoehn and Yahr stage) a significant association was confirmed between ABPM-hypotensive episodes and falls [odds ratio (OR) 3.626; p = 0.001), hospitalizations (OR 2.016; p = 0.038), and dementia (OR 2.926; p = 0.008), while bedside nOH was only associated with falls (OR 2.022; p = 0.039) and dementia (OR 1.908; p = 0.048). CONCLUSIONS: The presence of at least two ABPM-hypotensive episodes independently predicted the development of falls, dementia, and hospitalization, showing a stronger prognostic value than the simple bedside assessment.

Hypotensive episodes at 24-h Ambulatory Blood Pressure Monitoring predict adverse outcomes in Parkinson's Disease.

Purpose: Neurogenic orthostatic hypotension (nOH) is a frequent non-motor feature of Parkinson's disease (PD), associated with adverse outcomes. Recently, 24-hour ambulatory BP monitoring (ABPM) has been shown to diagnose nOH with good accuracy (in the presence of at least 2 episodes of systolic BP drop ≥ 15 mmHg compared to the average 24-h). This study aims at evaluating the prognostic role of ABPM-hypotensive episodes in predicting PD disability milestones and mortality and comparing it to well-defined prognostic role of nOH. Methods: PD patients who underwent ABPM from January 2012 to December 2014 were retrospectively enrolled and assessed for the development of falls, fractures, dementia, bed/wheelchair confinement, hospitalization, mortality, during an up-to-10-year follow-up. Results: Ninety-nine patients (male 74%; age: 64.0 ± 10.1 years; PD duration: 6.4 ± 4.0 years) were enrolled. At baseline, 38.4% of patients had ABPM-hypotensive episodes and 46.5% had bedside nOH.At Kaplan-Meier analysis patients with ABPM-hypotensive episodes had an earlier onset of falls (p = 0.001), fractures (p = 0.004), hospitalizations (p = 0.009), bed/wheelchair confinement (p = 0.032), dementia (p = 0.001), and showed a shorter survival (8.0vs9.5 years; p = 0.009). At Cox regression analysis (adjusted for age, disease duration, Charlson Comorbidity Index, and H&Y stage at baseline) a significant association was confirmed between ABPM-hypotensive episodes and falls (OR:3.626; p = 0.001), hospitalizations (OR:2.016; p = 0.038), and dementia (OR:2.926; p = 0.008), while bedside nOH was only associated with falls (OR 2.022; p = 0.039) and dementia (OR:1.908; p = 0.048). Conclusion: The presence of at least two ABPM-hypotensive episodes independently predicted the development of falls, dementia, and hospitalization, showing a stronger prognostic value than the simple bedside assessment.

Diagnosis and Management of Cardiovascular Risk in Patients with Polycythemia Vera.

Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by aberrant myeloid lineage hematopoiesis with excessive red blood cell and pro-inflammatory cytokine production. Patients with PV present with a range of thrombotic and hemorrhagic symptoms that affect quality of life and reduce overall survival expectancy. Thrombotic events, transformation into acute myeloid leukemia, and myelofibrosis are largely responsible for the observed mortality. Treatment of PV is thus primarily focused on symptom control and survival extension through the prevention of thrombosis and leukemic transformation. Patients with PV frequently experience thrombotic events and have elevated cardiovascular risk, including hypertension, dyslipidemias, obesity, and smoking, all of which negatively affect survival. To reduce the risk of thrombotic complications, PV therapy should aim to normalize hemoglobin, hematocrit, and leukocytosis and, in addition, identify and modify cardiovascular risk factors. Herein, we review what is currently known about the associated cardiovascular risk and propose strategies for diagnosing and managing patients with PV.

Ascending aorta dilatation is associated to hard cardiovascular events, follow-up from multicentric ARGO-Perspective project.

Aortic root dilatation has been proposed as hypertension-mediated organ damage (HMOD). Nevertheless, the role of the aortic root dilatation as a possible additional HMOD is still unclear since studies conducted so far are quite heterogeneous regarding the type of population analyzed, the aortic tract considered, and the type of outcomes accounted for. The aim of the present study is to assess whether the presence of aortic dilatation is associated with strong cardiovascular (CV) events (MACE: heart failure, CV death, stroke, acute coronary syndrome, myocardial revascularization) in a population of patients affected by essential hypertension. Four hundred forty-five hypertensive patients from six Italian hospitals were recruited as part of ARGO-SIIA study1. For all centers, follow-up was obtained by re-contacting all patients by telephone and through the hospital's computer system. Aortic dilatation (AAD) was defined through absolute sex-specific thresholds as in previous studies (41 mm for males, 36 mm for females). Median follow-up was 60 months. AAD was found to be associated with the occurrence of MACE (HR = 4.07 [1.81-9.17], p < 0.001). This result was confirmed after correction for main demographic characteristics such as age, sex and BSA (HR = 2.91 [1.18-7.17], p = 0.020). At penalized Cox regression, age, left atrial dilatation, left ventricular hypertrophy and AAD were identified as best predictor of MACEs and AAD resulted a significant predictor of MACEs even after correction for these confounders (HR = 2.43 [1.02-5.78], p = 0.045). The presence of AAD was found to be associated with an increased risk of MACE independently of for major confounders, including established HMODs. AAD ascending aorta dilatation, LAe left atrial enlargement, LVH left ventricular hypertrophy, MACEs major adverse cardiovascular events, SIIA Società Italiana dell'Ipertensione Arteriosa (Italian Society for Arterial Hypertension).

Alexithymia and Hypertension: Does Personality Matter? A Systematic Review and Meta-analysis.

PURPOSE OF REVIEW: Personality characteristics, such as alexithymia, may lead to alterations in the autonomic nervous system functionality, predisposing individuals to an increased risk of hypertension (HTN). The present meta-analysis aimed to quantify the presence of alexithymia in people with HTN and to assess for potential sources of heterogeneity between studies. PubMed, PsycINFO and Scopus databases were systematically searched, using the following strings: ("alexithymia" OR "alexithymic") AND ("hypertension" OR "hypertensive"). Data were meta-analyzed with random-effects models. RECENT FINDINGS: A total of 13 studies met the inclusion criteria. The prevalence of alexithymia in people with and without HTN were obtained from 5 studies (26.3% vs 15.0%; pooling of odd ratios, 3.15 [95% CI, 1.14;8.74]), whereas the mean level of alexithymia between people with and without HTN was obtained from 7 studies Hedges g, 1.39 [95% CI, -0.39;3.16]). There was a significant association between alexithymia prevalence and year of article publication (g = -0.04; 95% CI, -0.07;-0.01), whereas no significant relationship was detected between the former and both sex and age. Findings revealed a greater prevalence of alexithymia in people with HTN than in participants without HTN. These findings suggest that alexithymia may contribute to both the onset and persistence of HTN symptomatology. However, future research is needed to clarify this association.

Patients with Very High Risk of Cardiovascular Adverse Events during Carfilzomib Therapy: Prevention and Management of Events in a Single Center Experience.

Carfilzomib (CFZ) improves the prognosis of multiple myeloma (MM) patients but has shown cardiovascular toxicity. The risk stratification of cardiovascular adverse events (CVAEs) now seems well established, while little is known about the course and management of patients with a high-cardiovascular-risk profile or experiencing CVAEs during therapy. Therefore, we aimed to describe our experience in decision making to support health professionals in selecting the best management strategies to prevent and treat CVAEs. A total of 194 patients with indication to CFZ underwent baseline evaluation of CVAEs risk and were prospectively followed. We propose a novel approach, which includes advanced cardiac imaging testing for patients at high baseline CV risk to rule out clinical conditions that could contraindicate starting CFZ. After baseline evaluation, 19 (9.8%) patients were found at high risk of CVAEs: 13 (6.7%) patients underwent advanced cardiac testing and 3 (1.5%) could not receive CFZ due to CV contraindications. A total of 178 (91.7%) patients started CFZ: 82 (46%) experienced arterial-hypertension-related events and 37 (20.8%) major CVAEs; 19 (10.7%) patients had to discontinue or modify the CFZ dosing regimen. Along with baseline risk stratification, subsequent cardiovascular clinical events and diagnostic follow-up both provided critical data to help identify conditions that could contraindicate the anticancer therapy.

Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO.

Hypertensive urgencies (HU) and hypertensive emergencies (HE) are challenges for the Emergency Department (ED). A prospective multicentre study is ongoing to characterize patients with acute hypertensive disorders, prevalence of subclinical hypertension-mediated organ damage (HMOD), short- and long-term prognosis; this is a preliminary report. Patients admitted to the ED with symptomatic blood pressure (BP) ≥180/110 mmHg were enrolled. They were managed by ED personnel according to their clinical presentations. Subsequently they underwent clinical evaluation and subclinical HMOD assessment at a Hypertension Centre within 72 h from enrolment. 122 patients were included in this report. Mean age was 60.7±13.9 years, 52.5% were females. 18 (14.8%) patients were diagnosed with HE, 108 (88.5%) with HU. There were no differences in gender, BMI, and cardiovascular comorbidities between groups. At ED discharge, 66.7% and 93.6% (p = 0.003) of HE and HU patients, respectively, had BP < 180/110 mmHg. After 72 h, 34.4% of patients resulted normotensive; 35.2%, 22.1%, and 8.2% had hypertension grade 1, 2, and 3, respectively. Patients with uncontrolled BP at office evaluation had higher vascular HMOD (49.1 vs. 25.9%, p = 0.045). Cardiac (60 vs. 34%, p = 0.049), renal (27.8 vs. 9.6%, p = 0.010) and cerebral (100 vs. 21%, p < 0.001) HMOD was more frequent in HE compared to HU group. HE showed greater cardiac, renal, and cerebral subclinical HMOD, compared to HU. 72-hours BP control is not associated with different HMOD, except for vascular HMOD; therefore, proper comprehensive examination after discharge from the ED could provide added value in cardiovascular risk stratification of such patients. One third of patients with acute blood pressure rise evaluated to the ED resulted normotensive at office evaluation (<72 hours after discharge). Patients with hypertensive emergency showed greater cardiac, renal, and cerebral subclinical HMOD, compared to the patients with hypertensive urgency. BP: blood pressure; HMOD: hypertension-mediated organ damage; y.o.: years old; mo.: months.

Carfilzomib-Based Regimen and Cardiotoxicity in Multiple Myeloma: Incidence of Cardiovascular Events and Organ Damage in Carfilzomib-Dexamethasone versus Carfilzomib-Lenalidomide-Dexamethasone. A Real-Life Prospective Study.

Carfilzomib-mediated cardiotoxicity in multiple myeloma (MM) is a well-established adverse effect, however limited data are available on the comparison of cardiovascular complications in patients treated with Carfilzomib-dexamethasone (target dose of K 56 mg/m2) versus Carfilzomib-lenalidomide-dexamethasone (target dose of K 27 mg/m2) beyond controlled trials. A total of 109 patients were enrolled, 47 (43%) received Kd and 62 (57%) KRd. They then underwent a baseline and follow-up evaluation including trans-thoracic echocardiography and arterial stiffness estimation. All types of cardiovascular and hypertensive events occurred more frequently in the Kd group compared with the KRd (59% vs. 40% and 55% vs. 35.5% patients, respectively, p ≤ 0.05), with higher incidence of hypertensive. The time of onset of any type of CVAE, and of major and hypertensive events was shorter in the Kd regimen (p ≤ 0.05). At follow-up, Kd patients more frequently developed signs of cardiac (decline of global longitudinal strain) and vascular organ damage (rise of pulse wave velocity), as compared with KRd. Despite the older age, longer history of MM and longer period of pre-treatment of Kd patients, these factors did not increase the probability of incidence for all types of cardiovascular events at multivariate analysis (p > 0.05). In conclusion, the Kd regimen showed greater cardiovascular toxicity and earlier onset of events with respect to KRd. Thus, a closer and thorough follow-up should be considered.

Cardiovascular Hypertension-Mediated Organ Damage in Hypertensive Urgencies and Hypertensive Outpatients.

Background: The prevalence of hypertension mediated organ damage (HMOD) in patients attending the Emergency Department (ED) with symptomatic blood pressure (BP) rise is unknown, and whether HMOD varies between asymptomatic and symptomatic patients with grade 3 hypertension is unclear. Aim: This study aimed to investigate cardiac and vascular HMOD in hypertensive urgencies (HU) and asymptomatic outpatients with grade 1-3 hypertension. Methods: Patients attending the ED with a symptomatic BP rise ≥180/110 mmHg were prospectively enrolled (HU group), after the exclusion of acute organ damage. HMOD and BP were assessed after 72 h from ED discharge in an office setting. These patients were matched by age and sex to outpatients with grade 3 hypertension (Grade 3 group), and by age, sex, and 72 h office BP values to outpatients with any grade hypertension (Control group). Results: A total of 304 patients were enrolled (76 patients in the HU group, 76 in the Grade 3 group, and 152 in the Control group). Grade 3 patients had increased left ventricular mass (LVMi) compared to patients with HU (106.9 ± 31.5 vs. 96.1 ± 30.7 g/m2, p = 0.035). Severe left ventricular hypertrophy (LVH) was more frequent in grade 3 (21.1 vs. 5.3%, p = 0.004), and pulse wave velocity (PWV) was similar in the two groups. There was no difference in LVMi between ED and Control patients (96.1 ± 30.7 vs. 95.2 ± 26.6 g/m2, p = 0.807). LVH prevalence was similar (43.4 vs. 35.5%, p = 0.209, respectively), but patients with HU had thicker interventricular septum (11.9 ± 2.2 vs. 11.1 ± 2.2 mm, p = 0.007). PWV was similar between these two groups. Patients with HU needed more antihypertensive drugs than Control patients (2 vs. 1, p < 0.001). Conclusions: Patients with HU had a better cardiac HMOD profile than outpatients with grade 3 hypertension. Their cardiac and vascular HMOD is more comparable to an outpatient with similar in-office BP, although they need more antihypertensive medications.

Estado psicológico del personal estomatológico de la consulta de urgencias durante la COVID-19 / Psychological state of the stomatological staff of the emergency department during COVID-19 / Situação psicológica da equipe estomática da consulta de emergência durante o COVID-19

RESUMEN En los servicios de urgencia estomatológica diariamente acuden pacientes aquejados de diferentes problemas de salud, para lo cual, ante el enfrentamiento a la nueva pandemia se impone la necesidad de estar bien informados sobre la COVID19, de servir como promotores de salud en las comunidades y cumplir con las medidas de protección para evitar el contagio por este virus. El objetivo fue evaluar el estado psicológico del personal estomatológico de la consulta de urgencias de la Clínica Universitaria de Especialidades Estomatológicas "Manuel Cedeño" durante la COVID-19. Se realizó un estudio descriptivo transversal en 12 profesionales de la estomatología que labraron en la consulta de urgencias estomatológicas entre los meses de abril y mayo de 2020. Se estudiaron el nivel de estrés, ansiedad y nivel de funcionamiento. Resultó que el 91,66 % de los estudiados presentó un estrés normal; predominó la ansiedad como estado, sobre todo con niveles medio y bajo para el 33,33 % y 25,00 % respectivamente; el 100,0 % presentó un funcionamiento neurótico; no se presentó asociación entre el nivel de funcionamiento y el estrés (p= 0,91) y la ansiedad (p= 0,98). Se concluye que el estado psicológico del personal estomatológico de la consulta de urgencias durante la COVID-19 se caracterizó por un nivel de estrés normal, niveles medio y bajo de estados de ansiedad con un funcionamiento neurótico.

ABSTRACT Patients suffering from different health problems come to the stomatological emergency services daily, for which, in the face of the new pandemic, the need to be well informed about COVID19, to serve as health promoters in the communities and comply with with the protection measures to avoid contagion by this virus. The objective was to evaluate the psychological state of the stomatological staff of the emergency consultation of the "Manuel Cedeño" University Clinic of Stomatological Specialties during COVID-19. A descriptive cross-sectional study was carried out in 12 dental professionals who worked in the dental emergency consultation between April and May 2020. The level of stress, anxiety and level of functioning were studied. It turned out that 91.66% of those studied presented normal stress; Anxiety as a state predominated, especially with medium and low levels for 33.33% and 25.00% respectively; 100.0% presented neurotic functioning; there was no association between the level of functioning and stress (p = 0.91) and anxiety (p = 0.98). It is concluded that the psychological state of the stomatological staff of the emergency department during COVID-19 was characterized by a normal stress level, medium and low levels of anxiety states with neurotic functioning.

RESUMO Nos serviços de emergência estomatológica, os pacientes que sofrem de diferentes problemas de saúde vêm diariamente, para os quais, diante da nova pandemia, é imposta a necessidade de estar bem informado sobre o COVID19, para servir como promotores de saúde nas comunidades e cumprir as medidas de proteção para evitar o contágio por esse vírus. O objetivo foi avaliar o estado psicológico da equipe estomática da consulta emergencial da Clínica Universitária de Especialidades Etomatológicas "Manuel Cedeño" durante o COVID-19. Um estudo transversal descritivo foi realizado em 12 profissionais de estomatologia que trabalharam na consulta de emergência estomática entre os meses de abril e maio de 2020.Foram estudados o nível de estresse, ansiedade e nível de funcionamento. Verá-lo que 91,66% dos entrevistados apresentavam estresse normal; a ansiedade predominou como estado, especialmente com níveis médios e baixos para 33,33% e 25,00%, respectivamente; 100,0 % apresentaram funcionamento neurótico; não houve associação entre o nível de funcionamento e o estresse (p = 0,91) e a ansiedade (p = 0,98). Conclui-se que o estado psicológico da equipe estomática da consulta de emergência durante o COVID-19 foi caracterizado por um nível normal de estresse, médio e baixo dos estados de ansiedade com funcionamento neurótico.

Caries, maloclusión y caries-maloclusión en adolescentes de 7mo grado

RESUMEN Introducción: las caries dentales y las maloclusiones son preocupaciones para pacientes y profesionales de la estomatología por su incidencia a nivel mundial, por las manifestaciones bucales que desencadenan y por la alteración estética del paciente. Objetivo: identificar la incidencia de caries, maloclusión y caries-maloclusión en adolescentes de 7mo grado de la Escuela Secundaria Básica "XXX Aniversario de la Batalla de Guisa" del municipio Bayamo. Métodos: se realizó una investigación descriptiva transversal en los adolescentes de 7mo grado en el período de enero de 2017 a diciembre de 2018 con un universo de 142 estudiantes. Resultados: se reveló que el sexo masculino tuvo una incidencia de 85,71% de afectación por caries dental, la maloclusión incidió en el 43,10 % en el sexo femenino; la incidencia de caries-maloclusión en la población objeto de estudio, fue de 29,31 % y 27,38 % según el sexo femenino y masculino respectivamente. Conclusiones: se determinó la incidencia de la caries dental, maloclusiones y caries-maloclusión las cuales tuvieron una alta incidencia en la población adolescente.

ABSTRACT Introduction: dental caries and malocclusions are concerns for patients and dental professionals due to their worldwide incidence, due to the oral manifestations that they trigger and due to the aesthetic alteration of the patient. Objective: to identify the incidence of caries, malocclusion and caries-malocclusion in 7th grade adolescents from the Basic Secondary School "XXX Anniversary of the Battle of Guisa" of the Bayamo municipality. Methods: a cross-sectional descriptive research was carried out in the 7th grade adolescents in the period from January 2017 to December 2018 with a universe of 142 students. Results: it was revealed that the male sex had an incidence of 85.71% of affectation by dental caries, the malocclusion affected 43.10% in the female sex; the incidence of caries-malocclusion in the population under study was 29.31% and 27.38% according to the female and male sex, respectively. Conclusions: the incidence of dental caries, malocclusions and caries-malocclusion was determined, which had a high incidence in the adolescent population.

RESUMO Introdução: a cárie e as maloclusões são uma preocupação dos pacientes e profissionais da odontologia devido à sua incidência mundial, pelas manifestações bucais que desencadeiam e pela alteração estética do paciente. Objetivo: identificar a incidência de cárie, má oclusão e má oclusão cárie em adolescentes da 7ª série do Ensino Médio Básico "XXX Aniversário da Batalha de Guisa" do município de Bayamo. Métodos: foi realizada uma pesquisa descritiva transversal realizada com adolescentes da 7ª série no período de janeiro de 2017 a dezembro de 2018 com um universo de 142 alunos. Resultados: revelou-se que o sexo masculino teve uma incidência de 85,71% de acometimento por cárie dentária, a má oclusão afetou 43,10% no sexo feminino; a incidência de maloclusão cárie na população em estudo foi de 29,31% e 27,38% de acordo com o sexo feminino e masculino, respectivamente. Conclusões: foi determinada a incidência de cárie dentária, maloclusões e má oclusão cárie, as quais tiveram alta incidência na população de adolescentes.

Estado psicológico del personal estomatológico de la consulta de urgencias durante la COVID-19 / Psychological state of the stomatological staff of the emergency department during COVID-19

En los servicios de urgencia estomatológica diariamente acuden pacientes aquejados de diferentes problemas de salud, para lo cual, ante el enfrentamiento a la nueva pandemia se impone la necesidad de estar bien informados sobre la COVID-19, de servir como promotores de salud en las comunidades y cumplir con las medidas de protección para evitar el contagio por este virus. El objetivo fue evaluar el estado psicológico del personal estomatológico de la consulta de urgencias de la Clínica Universitaria de Especialidades Estomatológicas Manuel Cedeño durante la COVID-19. Se realizó un estudio descriptivo transversal en 12 profesionales de la estomatología que laboraron en la consulta de urgencias estomatológicas entre los meses de abril y mayo de 2020. Se estudiaron el nivel de estrés, ansiedad y nivel de funcionamiento. Resultó que el 91,66 por ciento de los estudiados presentó un estrés normal; predominó la ansiedad como estado, sobre todo con niveles medio y bajo para el 33,33 por ciento y 25,00 por ciento respectivamente; el 100,0 por ciento presentó un funcionamiento neurótico; no se presentó asociación entre el nivel de funcionamiento y el estrés (p= 0,91) y la ansiedad (p= 0,98). Se concluye que el estado psicológico del personal estomatológico de la consulta de urgencias durante la COVID-19 se caracterizó por un nivel de estrés normal, niveles medio y bajo de estados de ansiedad con un funcionamiento neurótico(AU)

Patients suffering from different health problems come to the stomatological emergency services daily, for which, in the face of the new pandemic, the need to be well informed about COVID19, to serve as health promoters in the communities and comply with the protection measures to avoid contagion by this virus. The objective was to evaluate the psychological state of the stomatological staff of the emergency consultation of the Manuel Cedeño University Clinic of Stomatological Specialties during COVID-19. A descriptive cross-sectional study was carried out in 12 dental professionals who worked in the dental emergency consultation between April and May 2020. The level of stress, anxiety and level of functioning were studied. It turned out that 91.66 percent of those studied presented normal stress; Anxiety as a state predominated, especially with medium and low levels for 33.33 percent and 25.00 percent respectively; 100.0 percent presented neurotic functioning; there was no association between the level of functioning and stress (p = 0.91) and anxiety (p = 0.98). It is concluded that the psychological state of the stomatological staff of the emergency department during COVID-19 was characterized by a normal stress level, medium and low levels of anxiety states with neurotic functioning(EU)

Caries, maloclusión y caries-maloclusión en adolescentes de 7mo grado / Caries, malocclusion and caries-malocclusion in 7th grade adolescents

Introducción: las caries dentales y las maloclusiones son preocupaciones para pacientes y profesionales de la estomatología por su incidencia a nivel mundial, por las manifestaciones bucales que desencadenan y por la alteración estética del paciente. Objetivo: identificar la incidencia de caries, maloclusión y caries-maloclusión en adolescentes de 7mo grado de la Escuela Secundaria Básica XXX Aniversario de la Batalla de Guisa del municipio Bayamo. Métodos: se realizó una investigación descriptiva transversal en los adolescentes de 7mo grado en el período de enero de 2017 a diciembre de 2018 con un universo de 142 estudiantes. Resultados: se reveló que el sexo masculino tuvo una incidencia de 85,71 por ciento de afectación por caries dental, la maloclusión incidió en el 43,10 por ciento en el sexo femenino; la incidencia de caries-maloclusión en la población objeto de estudio, fue de 29,31 por ciento y 27,38 por ciento según el sexo femenino y masculino respectivamente. Conclusiones: se determinó la incidencia de la caries dental, maloclusiones y caries-maloclusión las cuales tuvieron una alta incidencia en la población adolescente(AU)

Introduction: dental caries and malocclusions are concerns for patients and dental professionals due to their worldwide incidence, due to the oral manifestations that they trigger and due to the aesthetic alteration of the patient. Objective: to identify the incidence of caries, malocclusion and caries-malocclusion in 7th grade adolescents from the Basic Secondary School XXX Anniversary of the Battle of Guisa of the Bayamo municipality. Methods: a cross-sectional descriptive research was carried out in the 7th grade adolescents in the period from January 2017 to December 2018 with a universe of 142 students. Results: it was revealed that the male sex had an incidence of 85.71 percent of affectation by dental caries, the malocclusion affected 43.10 percent in the female sex; the incidence of caries-malocclusion in the population under study was 29.31 percent and 27.38 percent according to the female and male sex, respectively. Conclusions: the incidence of dental caries, malocclusions and caries-malocclusion was determined, which had a high incidence in the adolescent population(EU)

Introduction to Hemodynamic Forces Analysis: Moving Into the New Frontier of Cardiac Deformation Analysis.

The potential relevance of blood flow for describing cardiac function has been known for the past 2 decades, but the association of clinical parameters with the complexity of fluid motion is still not well understood. Hemodynamic force (HDF) analysis represents a promising approach for the study of blood flow within the ventricular chambers through the exploration of intraventricular pressure gradients. Previous experimental studies reported the significance of invasively measured cardiac pressure gradients in patients with heart failure. Subsequently, advances in cardiovascular imaging allowed noninvasive assessment of pressure gradients during progression and resolution of ventricular dysfunction and in the setting of resynchronization therapy. The HDF analysis can amplify mechanical abnormalities, detect them earlier compared with conventional ejection fraction and strain analysis, and possibly predict the development of cardiac remodeling. Alterations in HDFs provide the earliest signs of impaired cardiac physiology and can therefore transform the existing paradigm of cardiac function analysis once implemented in routine clinical care. Until recently, the HDF investigation was possible only with contrast-enhanced echocardiography and magnetic resonance imaging, precluding its widespread clinical use. A mathematical model, based on the first principle of fluid dynamics and validated using 4-dimensional-flow-magnetic resonance imaging, has allowed HDF analysis through routine transthoracic echocardiography, making it more readily accessible for routine clinical use. This article describes the concept of HDF analysis and reviews the existing evidence supporting its application in several clinical settings. Future studies should address the prognostic importance of HDF assessment in asymptomatic patients and its incorporation into clinical decision pathways.

A Novel Approach to Left Ventricular Filling Pressure Assessment: The Role of Hemodynamic Forces Analysis.

Background: Diastolic function in patients with heart failure is usually impaired, resulting in increased left ventricular (LV) filling pressures, whose gold standard assessment is right heart catheterization (RHC). Hemodynamic force (HDF) analysis is a novel echocardiographic tool, providing an original approach to cardiac function assessment through the speckle-tracking technology. The aim of our study was to evaluate the use of HDFs, both alone and included in a new predictive model, as a potential novel diagnostic tool of the diastolic function. Methods: HDF analysis was retrospectively performed in 67 patients enrolled in the "Right1 study." All patients underwent RHC and echocardiography up to 2 h apart. Increased LV filling pressure (ILFP) was defined as pulmonary capillary wedge pressure (PCWP) ≥ 15 mmHg. Results: Out of 67 patients, 33 (49.2%) showed ILFP at RHC. Diastolic longitudinal force (DLF), the mean amplitude of longitudinal forces during diastole, was associated with the presence of ILFP (OR = 0.84 [0.70; 0.99], p = 0.046). The PCWP prediction score we built including DLF, ejection fraction, left atrial enlargement, and e' septal showed an AUC of 0.83 [0.76-0.89], with an optimal internal validation. When applied to our population, the score showed a sensitivity of 72.7% and a specificity of 85.3%, which became 66.7 and 94.4%, respectively, when applied to patients classified with "indeterminate diastolic function" according to the current recommendations. Conclusion: HDF analysis could be an additional useful tool in diastolic function assessment. A scoring system including HDFs might improve echocardiographic accuracy in estimating LV filling pressures. Further carefully designed studies could be useful to clarify the additional value of this new technology.

Accuracy of a new instrument for noninvasive evaluation of pulse wave velocity: the Arterial sTiffness faitHful tOol aSsessment project.

BACKGROUND: Large artery stiffness, assessed by carotid--femoral pulse wave velocity (cfPWV), is a major risk factor for cardiovascular events, commonly used for risk stratification. Currently, the reference device for noninvasive cfPWV is SphygmoCor but its cost and technically challenging use limit its diffusion in clinical practice. AIM: To validate a new device for noninvasive assessment of cfPWV, ATHOS (Arterial sTiffness faitHful tOol aSsessment), designed in collaboration with the Politecnico di Torino, against the reference noninvasive method represented by SphygmoCor. METHODS: Ninety healthy volunteers were recruited. In each volunteer, we assessed cfPWV, using SphygmoCor (PWVSphygmoCor) and ATHOS (PWVATHOS) devices in an alternate fashion, following the ARTERY Society guidelines. The accuracy was assessed by Bland--Altman plot, and reproducibility was assessed by interoperator correlation coefficient (ICC). RESULTS: Mean PWVATHOS and mean PWVSphygmoCor were 7.88 ±â€Š1.96 and 7.72 ±â€Š1.95 m/s, respectively. Mean difference between devices was 0.15 ±â€Š0.56 m/s, with a high correlation between measurements (r = 0.959, P < 0.001). Considering only PWV values at least 8 m/s (n = 30), mean difference was 0.1 ±â€Š0.63 m/s. The ICC was 97.7% with ATHOS. CONCLUSION: ATHOS showed an excellent level of agreement with SphygmoCor, even at high PWV values, with a good reproducibility. Its simplicity of use could help increase clinical application of PWV assessment, improving patients' cardiovascular risk stratification.

Effects of Carfilzomib Therapy on Left Ventricular Function in Multiple Myeloma Patients.

Background: Carfilzomib improves the prognosis of multiple myeloma (MM) patients but significantly increases cardiovascular toxicity. The timing and effect of Carfilzomib therapy on the left ventricular function is still under investigation. We sought to assess the echocardiographic systo-diastolic changes, including global longitudinal strain (GLS), in patients treated with Carfilzomib and to identify predictors of increased risk of cardiovascular adverse events (CVAEs) during therapy. Methods: Eighty-eight patients with MM performed a baseline cardiovascular evaluation comprehensive of transthoracic echocardiogram (TTE) before the start of Carfilzomib therapy and after 6 months. All patients were clinically followed up to early identify the occurrence of CVAEs during the whole therapy duration. Results: After Carfilzomib treatment, mean GLS slightly decreased (-22.2% ± 2.6 vs. -21.3% ± 2.5; p < 0.001). Fifty-eight percent of patients experienced CVAEs during therapy: 71% of them had uncontrolled hypertension, and 29% had major CVAEs or CV events not related to arterial hypertension. GLS variation during therapy was not related to an increased risk of CVAEs; however, patients with baseline GLS ≥ -21% and/or left ventricular ejection fraction (LVEF) ≤ 60% had a greater risk of major CVAEs (OR = 6.2, p = 0.004; OR = 3.7, p = 0.04, respectively). Carfilzomib led to a higher risk of diastolic dysfunction (5.6 vs. 13.4%, p = 0.04) and to a rise in E/e' ratio (8.9 ± 2.7 vs. 9.7 ± 3.7; p = 0.006). Conclusion: Carfilzomib leads to early LV function impairment early demonstrated by GLS changes and diastolic dysfunction. Baseline echocardiographic parameters, especially GLS and LVEF, might improve cardiovascular risk stratification before treatment.

Cardiovascular Organ Damage in Clinical Subtypes of Systemic Sclerosis: Arterial Stiffness and Echocardiography Might Not Be the Ideal Tools for Patient Risk Stratification.

BACKGROUND: Vascular damage is recognized as a diagnostic landmark in systemic sclerosis (SSc), both in its limited and diffuse subtypes. Early detection at a subclinical stage with transthoracic echocardiography (TTE) and carotid femoral pulse wave velocity (cfPWV) may be helpful in therapeutic planning and management. Aim of the Study. The aim of the study was to evaluate presence of subclinical cardiovascular damage in patients with limited and diffuse SSc in comparison with a cohort of healthy individuals. METHODS: Consecutive patients with limited and diffuse SSc underwent complete TTE and cfPWV and a complete review of clinical data. As controls, 23 healthy subjects with similar hemodynamic profiles were selected. RESULTS: 41 patients (35 female, aged 56.9 years), 21 with diffuse and 20 with limited SSc, were recruited. Past medical history, cardiovascular risk factors, gender distribution, and disease duration were similar in the two groups as well as TTE parameters and hemodynamic indexes-cfPWV (6.5 [6-6.8] vs. 7.0 [6.2-8.5], p=0.24) and augmentation index (145.6 ± 14.2 vs. 149 ± 20.6, p=0.52). Patients with limited SSc were 10 years older than patients with diffuse SSc. In the multiple regression analysis, only age (p=0.0154) and disease duration (p=0.0467) resulted as the significant determinant of cfPWV. When compared to healthy controls, no significant difference emerged in TTE or hemodynamic indexes. CONCLUSION: In SSc, cfPWV increases with age, with no additional impact of pathology or subtype. Vascular damage in the SSc population is not accurately reflected in increased arterial stiffness, as evaluated with cfPWV, or classically defined echocardiographic findings of organ damage (i.e., left ventricular concentric remodelling and increased filling pressures).