May Measurement Month 2017-2019: an analysis of blood pressure screening results from Dominican Republic.

Arterial hypertension is the main risk factor that contributes to cardiovascular disease and represents a leading cause of morbidity and mortality globally. May Measurement Month (MMM) is a global screening campaign with the aim of improving awareness of hypertension at the individual and population level, an initiative that has been supported in the Dominican Republic (DR) since 2017. Adults (≥18 years) were recruited by sampling in different places in the DR, three blood pressure (BP) readings were performed per participant, and data on risk factors and comorbidities were collected. Hypertension was defined as systolic BP ≥140 mm Hg, diastolic BP ≥ 90 mm Hg (mean of second and third readings), and/or taking antihypertensive medication. Multiple imputation was used to estimate participants' mean BP when three readings were not available. Of 3693 participants, 2134 (57.8%) had hypertension, of whom 1646 (77.1%) were taking medication, but only 38.6% of those on treatment had their BP under control(<140/90 mmHg). The remaining 61.4% of the participants received inadequate treatment. A total of 66% of treated patients were taking a single antihypertensive drug. MMM provides an important platform for the standardized compilation of BP data and the creation of awareness of hypertension in the DR and other nations of the world. The data generated from the 2017-2019 MMM campaigns highlight the importance of adequate detection, knowledge, and control of BP.

Gender Influences on Physical Activity Awareness of Adolescents and Their Parents.

The imbalances between the actual physical activity (PA) of adolescents and the subjective perception both they and their parents have in this regard can play an important role in perpetuating inactive lifestyles. The aim of this study is to analyse these discrepancies by considering gender as a conditioning factor. The participants in the study were 1697 adolescents, 1244 mothers and 1052 fathers in the educational communities of 26 secondary schools located in urban environments of the Autonomous Community of Galicia (Spain). With regard to actual physical activity, a high prevalence of sedentarism (82.1%) was revealed, this being even more acute in girls (87.8%). However, the perceived levels of activity differed significantly from the actual ones with a clear general overestimation both by the adolescents and their parents. When further exploring the data, gender influences were also detected both in adolescent and parental perceptions, since the high rates of overestimation in sedentary individuals were lower in girls and, on the contrary, the low rates of underestimation in active individuals were higher in girls. Moreover, although the level of agreement between actual and perceived physical activity was low overall, with Cohen's kappa values ranging from 0.006 to 0.047, the lowest values were observed in the case of girls. In conclusion, both the adolescents and their parents were incapable of correctly assessing the actual physical activity of the former, so it seems that the general population lacks knowledge about the amount of physical activity that adolescents need to do to achieve a healthy lifestyle. Consequently, it would be advisable to implement health education campaigns and awareness-raising interventions directed to young people as well as to their parents and, in doing so, gender must be considered by establishing distinct program designs in terms of this variable.

Optical Coherence Tomography for the Diagnosis of Exercise-Related Acute Cardiovascular Events and Inconclusive Coronary Angiography.

OBJECTIVES: The aim of this study is to assess the utility of optical coherence tomography (OCT) in patients with exercise-related acute coronary syndrome (ACS) presenting with inconclusive angiographic findings. BACKGROUND: Regular physical activity reduces the incidence of cardiovascular events. Nevertheless, the risk of ACS or sudden cardiac death (SCD) increases during sport. In adults older than 35 years, exercise-related ACS or SCD is associated with plaque rupture, but not infrequently patients present ambiguous angiographic findings. METHODS: Between September 2015 and January 2020, patients admitted for ACS or SCD triggered by physical exertion and with coronary stenosis ≤50% were included in this prospective observational study. OCT was performed on the artery deemed to be responsible of the event. RESULTS: Ten patients were enrolled, predominantly men (80%) of middle age (51 years old, IQR 41-63) with low cardiovascular risk burden. Cycling was the most frequent (50%) exercise-related trigger, 8 patients were regular sport practitioners, and 7 had the clinical event during strenuous exertion. Five patients presented with non-ST-elevation ACS, two with ST-elevation ACS, and three with SCD. Angiographic analysis showed nonsignificant stenosis in all patients (42% stenosis, IQR 36-46). OCT identified the etiology of the event in 9 patients (4 plaque erosion, 3 plaque rupture, 1 eruptive calcific nodule, and 1 coronary dissection). Treatment was adjusted according to OCT findings. CONCLUSIONS: OCT is a valuable technique to identify the etiology of exercise-related ACS or SCD in patients with nonobstructive coronary arteries and, as a result, may lead to a more specific treatment.

Diagnostics, taxonomy, nomenclature and distribution of perennial Sesuvium (Aizoaceae) in Africa.

The taxonomy of perennial Sesuvium species in Africa has been poorly investigated until now. Previously five perennial species of Sesuvium were recognised in Africa (S. congense, S. crithmoides, S. mesembryanthemoides, S. portulacastrum, and S. sesuvioides). Based on the differing number of stamens, S. ayresii is accepted here as being distinct from S. portulacastrum. Field observations in Angola also led the authors to conclude that S. crystallinum and S. mesembryanthemoides are conspecific with S. crithmoides. A new subspecies, Sesuvium portulacastrum subsp. persoonii, is described from West Africa (Cape Verde, Gambia, Guinea-Bissau, Mauritania, Senegal). The molecular phylogeny indicates the position of S. portulacastrum subsp. persoonii within the "American lineage" as a part of the Sesuvium portulacastrum complex which needs further studies. A diagnostic key and taxonomic notes are provided for the six perennial species of Sesuvium found in Africa and recognised by the authors (S. ayresii, S. congense, S. crithmoides, S. portulacastrum subsp. portulacastrum, S. portulacastrum subsp. persoonii, S. verrucosum and the facultatively short-lived S. sesuvioides). The distribution of S. crithmoides, previously considered to be endemic to Angola, is now confirmed for the seashores of Republic of Congo and DR Congo. The American species S. verrucosum is reported for the first time for Africa (the Macaronesian islands: Cape Verde and the Canaries). It is locally naturalised in Gran Canaria, being a potentially invasive species. These findings as well as new records of S. verrucosum from Asia and the Pacific Islands confirm its proneness to transcontinental introduction. Lectotypes of S. brevifolium, S. crithmoides, S. crystallinum and S. mesembryanthemoides are selected. The seed micromorphology and anatomy of the perennial African species is studied. Compared to the seeds of some annual African Sesuvium investigated earlier, those of perennial species are smooth or slightly alveolate. The aril is one-layered and parenchymatous in all species and usually tightly covers the seed. The aril detachments from the seed coat that form a white stripe near the cotyledon area easily distinguish S. verrucosum from other species under study.

Hydrothermal fractionation of woody biomass: Lignin effect on sugars recovery.

Subcritical water was employed to fractionate woody biomass into carbohydrates and lignin. Nine urban trees species (hardwood and softwood) from Spain were studied. The experiments were carried out in a semi-continuous reactor at 250 °C for 64 min. The hemicellulose and cellulose recovery yields were between 30%wt. and 80%wt. while the lignin content in the solid product ranged between 32%wt. and 92%wt. It was observed that an increment of solubilized lignin disfavored the hydrolysis of hemicelluloses. It was determined that the maximum extraction of hemicellulose was achieved at 20 min of solid reaction time while the extraction of celluloses not exhibited a maximum value. The hydrolysis of hemicellulose and cellulose would be governed by the hydrolysis kinetic and the polymers accessibility. In addition, the extraction of hemicellulose was negatively affected by the lignin content in the raw material while cellulose hydrolysis was not affected by this parameter.

Uso de prebióticos y probióticos en las fórmulas lácteas infantiles / No disponible

No disponible

Electrocardiographic changes of ST-elevation myocardial infarction in patients with complete occlusion of the left main trunk without collateral circulation: differential diagnosis and clinical considerations.

Acute coronary syndromes due to involvement of the left main trunk usually present with subtotal occlusion and electrocardiographic pattern with predominant ST depression (non-ST-elevation myocardial infarction). The cases with complete occlusion frequently present an ST-elevation myocardial infarction pattern, but these patients usually die before reaching the hospital. We present a series of 7 patients with total left main trunk occlusion without collateral circulation showing ST-elevation myocardial infarction pattern. The electrocardiographic pattern is similar to left anterior descending coronary artery proximal occlusion to first septal and first diagonal but without ST elevation in V(1) and aVR because of left circumflex coronary artery compromise. In 4 (60%) of 7 of cases, there is also advanced right bundle-branch block plus superoanterior hemiblock. Despite severe clinical state at entrance (5/7 presented cardiac arrest/cardiogenic shock), 3 patients (43%) survived after percutaneous coronary intervention.

Modelo de intervención coronaria percutánea primaria en las Islas Baleares / The primary percutaneous coronary intervention program in the Balearic Islands

Uno de los objetivos críticos de la estrategia de salud en la cardiopatía isquémica es la atención urgente del infarto agudo de miocardio con elevación del ST (IAMCEST) y más concretamente del síndrome coronario agudo con elevación del ST, en los que el tiempo asistencial es crítico. Esta inmediatez del tratamiento (ya sea mecánica o farmacológica) se debería reflejar en los resultados de morbimortalidad. En 2003, tras la evidencia científica de la necesidad de una revascularización mecánica (intervención coronaria percutánea primaria) en el infarto agudo de miocardio con elevación del segmento ST, se estableció esta opción terapéutica en el hospital de referencia de nuestra comunidad (programa de intervención coronaria percutánea primaria). En marzo de 2008, tras múltiples reuniones con diferentes estamentos y centros, se puso en marcha el Registro Comunitario de la Asistencia al Síndrome Coronario Agudo con Elevación del ST (Registro Código Infarto de las Illes Balears). Se realiza: a) detección y documentación de todos los casos diagnosticados de IAMCEST en la comunidad autónoma; b) evaluación sistemática de los resultados asistenciales del IAMCEST y su ajuste a los objetivos asistenciales (tiempos, morbimortalidad, complicaciones, tratamientos, etc.); c) identificación y abordaje de las desviaciones respecto a los objetivos; d) conocimiento exhaustivo e implicación en el proyecto de todos los dispositivos asistenciales, y e) seguimiento al mes, a los 6 meses y al año del alta hospitalaria tras el proceso agudo del IAMCEST (AU)

One of the main objectives of any health-care strategy for ischemic heart disease is to provide emergency treatment for acute myocardial infarction and especially for ST-elevation acute coronary syndrome (STEACS), where any delay in treatment is crucial. The speed with which treatment (whether mechanical or pharmacologic) can be implemented will be reflected in morbidity and mortality rates. In 2003, in response to scientific evidence that mechanical revascularization (i.e. primary percutaneous coronary intervention) is essential for ST-elevation acute myocardial infarction, this therapeutic technique was introduced at the referral hospital in our region (in a primary percutaneous coronary intervention program). In March 2008, after several meetings between various stakeholders and institutions, a regional trial of treatment for STEACS (i.e. the Balearic Islands myocardial infarction code trial) started. It involved: a) the identification and reporting of all patients diagnosed with STEACS in the region; b) a systematic analysis of the results of treatment for STEACS in comparison with treatment goals (e.g. treatment times, morbidity, mortality, complications and treatment provided); c) identifying and responding to any deviations from targets; d) thorough understanding of and involvement in the project by all parts of the health-care system, and e) follow-up 1 month, 6 months and 1 year after hospital discharge following the STEACS episode (AU)

Minor myocardial damage during percutaneous coronary intervention does not affect long-term prognosis.

INTRODUCTION AND OBJECTIVES: To determine whether long-term prognosis is affected by myocardial damage taking place during percutaneous coronary intervention (PCI). METHODS: The study included consecutive patients undergoing PCI. Those with elevated baseline cardiac marker levels were excluded. Cardiac markers were evaluated and an ECG was recorded before and 12 and 24 hours after PCI. Patients were divided into three groups after PCI according to their cardiac marker levels: no myocardial damage (i.e. normal troponin and creatine kinase MB fraction [CK-MB]), minor damage (elevated troponin with normal CK-MB), and myonecrosis (elevated troponin and CK-MB). The occurrence of death, myocardial infarction or repeat revascularization during follow-up was recorded. RESULTS: Minor myocardial damage associated with PCI was observed in 127 (16.8%) of the 757 patients included in the study and myonecrosis, in 46 (6.1%). During a follow-up of 45+/-14 months, cardiac events occurred in 151 (19.1%) patients. Mortality during follow-up was significantly higher in patients with myonecrosis (13%) than in the other two groups (4.8% and 3.9%; log rank, 6.83; P=.032). No difference was observed in the rate of myocardial infarction or repeat revascularization during follow-up. CONCLUSIONS: Minor myocardial damage during PCI had no effect on long-term prognosis. In contrast, myonecrosis was associated with increased mortality. Consequently, the CK-MB level should be measured after all PCIs because of its prognostic implications, and strategies for reducing the risk of myonecrosis developing should be implemented.

El daño miocárdico mínimo durante el intervencionismo coronario percutáneo no influye en el pronóstico a largo plazo / Minor Myocardial Damage During Percutaneous coronary intervention Does not affect long- term Prognosis

Introducción y objetivos. Evaluar el pronóstico a largo plazo del daño miocárdico producido durante el intervencionismo coronario percutáneo (ICP). Métodos. Incluimos una serie de pacientes consecutivos a quienes se practicó ICP, excluyendo a los que ya presentaban basalmente elevación de marcadores cardiacos. El ECG y los marcadores de daño miocárdico se evaluaron antes y a las 12 y 24 h tras el procedimiento. Según el valor de dichos marcadores, se clasificó a los pacientes en tres grupos: ausencia de daño miocárdico (troponina y CK-MB normal), daño miocárdico mínimo (elevación del valor de troponina, con CK-MB normal) y mionecrosis (elevación de troponina I y CK-MB). Muerte, infarto de miocardio y nueva revascularización fueron evaluados durante el seguimiento. Resultados. De 757 pacientes incluidos, en 127 (16,8%) se detectó daño miocárdico mínimo asociado al procedimiento y en 46 (6,1%) mionecrosis. Durante un seguimiento de 45 ± 14 meses, 151 (19,1%) pacientes sufrieron eventos cardiacos. Los pacientes que presentaron mionecrosis tuvieron un significativo incremento de la mortalidad durante el seguimiento (13%) respecto a los otros dos grupos (el 4,8 y el 3,9%; log rank test, 6,83; p = 0,032). No se detectaron diferencias en la tasa de IAM o nueva revascularización en el seguimiento. Conclusiones. El daño miocárdico mínimo durante el intervencionismo no influye en el pronóstico a largo plazo. Por contra, la mionecrosis se asocia a un incremento de mortalidad. Este hecho implica la necesidad de determinar la CK-MB tras todo ICP debido a su implicación pronóstica y la aplicación de estrategias que disminuyan la aparición de mionecrosis (AU)

Introduction and objectives. To determine whether long-term prognosis is affected by myocardial damage taking place during percutaneous coronary intervention (PCI).Methods. The study included consecutive patients undergoing PCI. Those with elevated baseline cardiac marker levels were excluded. Cardiac markers were evaluated and an ECG was recorded before and 12 and 24 hours after PCI. Patients were divided into three groups after PCI according to their cardiac marker levels: no myocardial damage (i.e. normal troponin and creatine kinase MB fraction [CK-MB]), minor damage (elevated troponin with normal CK-MB), and myonecrosis (elevated troponin and CK-MB). The occurrence of death, myocardial infarction or repeat revascularization during follow-up was recorded.results. Minor myocardial damage associated with PCI was observed in 127 (16.8%) of the 757 patients included in the study and myonecrosis, in 46 (6.1%). During a follow-up of 45±14 months, cardiac events occurred in 151 (19.1%) patients. Mortality during follow-up was significantly higher in patients with myonecrosis (13%) than in the other two groups (4.8% and 3.9%; log rank, 6.83; P=.032). No difference was observed in the rate of myocardial infarction or repeat revascularization during follow-up.conclusions. Minor myocardial damage during PCI had no effect on long-term prognosis. In contrast, myonecrosis was associated with increased mortality. Consequently, the CK-MB level should be measured after all PCIs because of its prognostic implications, and strategies for reducing the risk of myonecrosis developing should be implemented (AU)

[Incidence of allergy to cow's milk protein in the first year of life and its effect on consumption of hydrolyzed formulae]. / Incidencia de alergia a proteínas de leche de vaca en el primer año de vida y su repercusión en el consumo de hidrolizados.

OBJECTIVES: The aims of this study were to determine the incidence of allergy to cow's milk protein in infants and the cost of treatment with hydrolyzed formulae in the Autonomous Community of Madrid. PATIENTS AND METHODS: Infants with suspected adverse reaction to cow's milk protein born between March 1, 2000 and February 28, 2001 within the catchment area covered by the pediatric services of Hospital La Paz were studied. The diagnostic algorithm of allergy to cow's milk protein of our department was used. The theoretical consumption of hydrolyzed formulae in the treatment of allergic infants was calculated and extrapolated to the Community of Madrid. RESULTS: There were 5367 live births in the above-mentioned catchment area. Adverse reaction to cow's milk protein was suspected in 185 infants. Allergy to cow's milk protein was confirmed in 101 (54 %). The incidence of allergy to cow's milk protein was 101/5356 (1.9 %). In the same period there were 57 078 live births in the Autonomous Community of Madrid. The number of infants that might be allergic in one year would be 1084. The cost of hydrolyzed formulae per infant and year would be 1,585.72 Euros. Thus, the cost of hydrolyzed formulae in the 1084 allergic infants would be 1,718,922.9 Euros; in the 923 in whom allergy was ruled out, the cost would be 1,463,621.8 Euros. CONCLUSIONS: The incidence of allergy to cow's milk protein in the first year of life is at least 1.9 %. The correct diagnosis allows us to rule out allergy to cow's milk protein in almost half of the cases, thus avoiding the use of unnecessary substitutive diets involving a high cost.

Incidencia de alergia a proteínas de leche de vaca en el primer año de vida y su repercusión en el consumo de hidrolizados / Iincidence of allergy to cow's milk protein in the first year of life and its effect on consumption of hydrolyzed formulae

Objetivos: Cálculo de la incidencia de alergia a proteínas de leche de vaca (APLV) en el lactante y coste del tratamiento con hidrolizados de leche de vaca en la comunidad de Madrid. Pacientes y métodos Lactantes con sospecha de APLV nacidos entre el 1 de marzo de 2000 y el 28 de febrero de 2001 en el Hospital La Paz pertenecientes a las áreas que atiende el Hospital Infantil. Se les aplicó el algoritmo diagnóstico de APLV del servicio. Se realizó el cálculo teórico del consumo de hidrolizados utilizados en el tratamiento de los APLV y se extrapoló a la comunidad de Madrid. Resultados Nacidos vivos en el Hospital La Paz pertenecientes a las áreas citadas: 5.356 niños. Consultaron por sospecha fundada de APLV: 185 niños. Se diagnosticaron como alérgicos a PLV a 101 (54 per cent). La incidencia calculada de APLV fue de: 101/5.356: 1,9 per cent. Nacidos en la comunidad de Madrid en el mismo período: 57.078 niños. El número de posibles APLV en un año sería de 1.084. El cálculo aproximado de consumo de hidrolizados en el primer año de vida por niño, supone un coste de 1.585,72 3. El gasto de hidrolizados en los 1.084 alérgicos en la comunidad de Madrid sería de 1.718.922,9 3. El gasto de los 923 niños en los que se descartó alergia supondría 1.463.621,8 3.Conclusiones La incidencia de APLV en el primer año de vida en nuestro medio es de, al menos, 1,9 per cent. El diagnóstico correcto permite descartar APLV en casi la mitad de los casos, evitando someter al lactante a dietas innecesarias y que suponen un elevado coste (AU)

Possible consequences of elimination diets in asymptomatic immediate hypersensitivity to fish.

The natural history of IgE antibodies to food without related symptoms is unknown. We have followed the progress of 7 children with various atopic diseases and asymptomatic immediate hypersensitivity to fish, treated with elimination diet in spite of full alimentary tolerance. During the diet period, between 24 and 113 months, all 7 patients presented immediate symptoms upon accidental exposure to or challenge tests with fish (skin symptoms in all 7 cases, digestive in 5, respiratory in 4, and anaphylaxis in 2), which differed from those related to atopic diseases previously present. The levels of fish-specific IgE (prick test, RAST) remained unchanged or were increased. These findings suggest that during elimination diet, and perhaps due to minimal and hidden contact with the allergen, the patients' degree of sensitization may increase, turning an asymptomatic into a symptomatic immediate hypersensitivity.

Egg protein sensitization in patients with bird feather allergy.

We have studied the hypersensitivity to hen's egg protein and chicken meat in 25 adults with a previous diagnosis of bronchial asthma and rhinoconjunctivitis due to bird feather sensitization. Seventeen of the 25 reported good tolerance to the ingestion of egg and chicken meat. The skin tests were negative to both antigens in 15 of them, and positive for egg in two. All 17 patients had negative RAST to chicken meat and egg protein. The remaining eight patients had intolerance to egg, and three of them also to chicken meat ingestion; in seven of the eight cases allergic to egg, the alimentary intolerance began after the clinical symptoms of bird feather sensitization. In all eight cases the skin tests were positive to egg yolk, and in five of them also to egg white and chicken meat. These patients evidenced specific serum IgE antibodies to egg yolk, four of them to egg white, and seven to chicken meat. These results demonstrate the high frequency (32%) of the association of sensitization to egg proteins, particularly egg yolk, in a selected population of patients with known allergy to bird feathers, thus suggesting that in some patients feather sensitization could trigger or somehow facilitate the later sensitization to egg yolk proteins.

[Food hypersensitivity in infants]. / Hipersensibilidad a alimentos en el lactante.

In a group of 41 infants with immediate, IgE mediated, food hypersensitivity, food anamnesis was specific in 60 per 100 and food challenge positive in 29 out of 34 times. Total serum IgE levels were raised in 80 per 100. In 26 instances symptoms appeared with the first food intake (15 cases) or there was sensitization before ingestion (11 cases); all but three were breast fed. Moreover, breast feeding in patients of the whole group had higher prevalence (p less than 0,001) than in a non-sensitized control group. These results suggest that food hypersensitivity in infants occurs very often without previous antigen intake and it is not always followed by clinical intolerance. Breast milk and/or transplacental antigen passage are probably important ways of sensitization. If so, it seems that minute quantities of antigen may be more fit for sensitization, provided the possible genetic high responsiveness for IgE synthesis in those infants.