Let's talk about sex: consensus guidelines of the GINECOR working group of the Spanish Society of Radiation Oncology: clinical recommendations after pelvic radiotherapy.

PURPOSE: The present consensus statement was developed by the GINECOR working group on behalf of the Spanish Society of Radiation Oncology (SEOR). This document addresses sexual health management in patients with gynaecological cancer after pelvic radiotherapy. METHODS: A modified two-round online Delphi study was conducted, where GINECOR members were surveyed on the diagnosis, treatment, and follow-up of sexual health problems. An expert panel of radiation oncologists, nurses and a gynaecologist participated in the Delphi study to reach a consensus, applying GRADE criteria to establish the level of agreement. RESULTS: The consensus recommendations cover both diagnosis and treatment, with an emphasis on patient-reported outcome measures (PROMs). They highlight recommendations such as the systematic assessment of genitourinary, gastrointestinal, and sexual symptoms, and the use of several treatments after radiotherapy. Recommendations include pharmacological options like vaginal lubricants and hormone therapy, and mechanical interventions such as vaginal dilators and vibrators. These suggestions stem from both scientific evidence and clinical expertise. CONCLUSION: This consensus statement describes a comprehensive, multidisciplinary approach developed to address the sexual needs and enhance the quality of life of patients with gynaecological tumours after pelvic radiotherapy. It offers specific recommendations for managing sexual issues, emphasizing the importance of specialized care and regular assessment. The document underscores the significance of proactive, patient-centered sexual health management in gynaecological cancer patients.

May Measurement Month 2021: an analysis of blood pressure screening results from Paraguay.

The aim of this study was to highlight the importance of measuring blood pressure (BP) to identify new, known, and treated individuals with hypertension and to raise awareness in the general population about the importance of good BP control. In Paraguay, 3663 individuals aged ≥18 years of both sexes were recruited from May to November 2021 as part of the May Measurement Month (MMM) campaign, which was initiated by the International Society of Hypertension in 2017. Volunteers of 18 regional health teams applied the questionnaire provided by the MMM 2021 organization throughout the country. Due to COVID-19 constraints, the majority of the questionnaires (52.2%) were administered in health centres of the Ministry of Health and concluded with three BP and pulse readings using OMRON-automated BP measurement devices. Hypertension was defined as a systolic BP ≥ 140 mmHg or as a diastolic BP ≥ 90 mmHg or taking antihypertensive medication. We found that 57.4% of screenees were hypertensive and 72.9% of these (82.3% of women and 59.4% of men) had known hypertension. Of patients with hypertension, 70.1% were on antihypertensive medication, and 40.9% had controlled BP (<140/90 mmHg). Among hypertensives detected, 79.7% of women were on antihypertensive medication and 44.1% had controlled BP, while 56.4% of men were on treatment and 34.3% had controlled BP. In summary, we found high levels of hypertension with high rates of awareness and treatment particularly among women, although control rates were low particularly among men. This may be because most screening was conducted predominately in hospital settings.

How diverse are the mountain karst forests of Mexico?

Tropical forests on karstic relief (tropical karst forest) are among the most species-rich biomes. These forests play pivotal roles as global climate regulators and for human wellbeing. Their long-term conservation could be central to global climate mitigation and biodiversity conservation. In Mexico, karst landscapes occupy 20% of the total land surface and are distributed mainly in the southeast of the country, along the eastern slope, and in the Yucatan Peninsula. Within each of these areas, the following types of karst occur: coastal karst, plain karst, hill karst, and mountain karst (low, medium, high). Mountain karst cover 2.07% of Mexico's land surface and are covered by tropical rainforests, montane cloud forests, and tropical deciduous forests. These are probably one of the most diverse biomes in Mexico. However, the mountain karst forests of Mexico have received little attention, and very little is known about their diversity. Here, we evaluated the vascular plant species richness within the mountain karst forests of Mexico. We assembled the first, largest, and most comprehensive datasets of Mexican mountain karst forest species, from different public databases (CONABIO, GBIF, IBdata-UNAM), which included a critical review of all data. We compiled a list of the families, genera, and species present within the mountain karst forests of Mexico. Taxa that best characterize these forests were identified based on their spatial correlation with this biome. We explored biodiversity patterns, identifying areas with the highest species richness, endemism centers, and areas of relatively low sampling intensity. We found that within the mountain karst forests of Mexico there are representatives of 11,771 vascular plant species (253 families and 2,254 genera), ca. 50% of the Mexican flora. We identified 372 species endemic to these forests. According to preliminary IUCN red list criteria, 2,477 species are under some category of conservation risk, of which 456 (3.8%) are endangered. Most of the Mexican mountain karst forests have been extensively explored and six allopatric, species-rich areas were identified. Compared to other regions in the world, the mountain karst forests of Mexico are one of the most diverse biomes. They contain more species than some entire montane systems in Mexico such as Sierra Madre Oriental, and Sierra Madre del Sur. Also, the mountain karst forests of Mexico are most diverse than similar forests of South America and Asia, even if considering the effect of different sampling areas. The fact that mountain karst forests are embedded in areas of high biotic diversity, probably contributes to their great floristic diversity. Thus, the mountain karst forests of Mexico are an important source of diversity and shelters a large percentage of the Mexican flora.

May Measurement Month 2017-19: an analysis of blood pressure screening results from Paraguay.

The aim of this study was to highlight the importance of measuring blood pressure (BP) and to identify and reduce the BPs of those people who require intervention to lower their BP according to current guidelines. A total of 7782 individuals aged ≥18 years were recruited during the 3 years of the May Measurement Month (MMM) campaign (2017: 1196, 2018: 2285, 2019: 4301). Recruitment was through opportunistic sampling at a variety of screening sites distributed throughout the country. Each participant underwent a pre-specified questionnaire with questions on risk factors concluding with three BP measurements at 1 min intervals and measurement of weight and height. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg or those receiving antihypertensive therapy. Of all 7782 participants, 3323 had hypertension (42.7%) of whom 61.8% were aware and 50.4% were not receiving antihypertensive medication. Of those treated (49.6%), 43.8% had controlled BP (<140/90 mmHg). Among all hypertensive patients (with and without medication), 21.7% had controlled BP. In relation to previous surveys carried out in the country, awareness of hypertension increased two-fold, with no change in the proportion of hypertensive patients on treatment and the proportion of hypertensive patients with controlled BP which remained low.

In Vitro and In Vivo Characterization of a Broadly Neutralizing Anti-SARS-CoV-2 Antibody Isolated from a Semi-Immune Phage Display Library.

Neutralizing antibodies targeting the receptor-binding domain (RBD) of SARS-CoV-2 are among the most promising strategies to prevent and/or treat COVID-19. However, as SARS-CoV-2 has evolved into new variants, most of the neutralizing antibodies authorized by the US FDA and/or EMA to treat COVID-19 have shown reduced efficacy or have failed to neutralize the variants of concern (VOCs), particularly B.1.1.529 (Omicron). Previously, we reported the discovery and characterization of antibodies with high affinity for SARS-CoV-2 RBD Wuhan (WT), B.1.617.2 (Delta), and B.1.1.529 (Omicron) strains. One of the antibodies, called IgG-A7, also blocked the interaction of human angiotensin-converting enzyme 2 (hACE2) with the RBDs of the three strains, suggesting it may be a broadly SARS-CoV-2 neutralizing antibody. Herein, we show that IgG-A7 efficiently neutralizes all the three SARS-CoV-2 strains in plaque reduction neutralization tests (PRNTs). In addition, we demonstrate that IgG-A7 fully protects K18-hACE2 transgenic mice infected with SARS-CoV-2 WT. Taken together, our findings indicate that IgG-A7 could be a suitable candidate for development of antibody-based drugs to treat and/or prevent SARS-CoV-2 VOCs infection.

Anti-SARS-CoV-2 Omicron Antibodies Isolated from a SARS-CoV-2 Delta Semi-Immune Phage Display Library.

This report describes the discovery and characterization of antibodies with potential broad SARS-CoV-2 neutralization profiles. The antibodies were obtained from a phage display library built with the VH repertoire of a convalescent COVID-19 patient who was infected with SARS-CoV-2 B.1.617.2 (Delta). The patient received a single dose of Ad5-nCoV vaccine (Convidecia™, CanSino Biologics Inc.) one month before developing COVID-19 symptoms. Four synthetic VL libraries were used as counterparts of the immune VH repertoire. After three rounds of panning with SARS-CoV-2 receptor-binding domain wildtype (RBD-WT) 34 unique scFvs, were identified, with 27 cross-reactive for the RBD-WT and RBD Delta (RBD-DT), and seven specifics for the RBD-WT. The cross-reactive scFvs were more diverse than the RBD-WT specific ones, being encoded by several IGHV genes from the IGHV1 and IGHV3 families combined with short HCDR3s. Six cross-reactive scFvs and one RBD-WT specific scFv were converted to human IgG1 (hIgG1). Out of the seven antibodies, six blocked the RBD-WT binding to angiotensin converting enzyme 2 (ACE2), suggesting these antibodies may neutralize the SARS-CoV-2 infection. Importantly, one of the antibodies also recognized the RBD from the B.1.1.529 (Omicron) isolate, implying that the VH repertoire of the convalescent patient would protect against SARS-CoV-2 Wildtype, Delta, and Omicron. From a practical viewpoint, the triple cross-reactive antibody provides the substrate for developing therapeutic antibodies with a broad SARS-CoV-2 neutralization profile.

Asociación de la dilatación auricular izquierda con los trastornos del sistema de conducción en pacientes con hipertensión arterial sistémica / Association of left atrial dilatation with conduction system disorders in patients with systemic arterial hypertension

La dilatación de la aurícula izquierda (AI) se considera un predictor ecocardiográfico para la remodelación auricular y la fibrilación auricular. Por ende, hemos investigado la correlación existente entre la dilatación de la AI con las arritmias cardíacas y los trastornos del sistema de conducción en pacientes con hipertensión arterial (HTA). En este estudio observacional y prospectivo hemos investigado las variaciones electrocardiográficas, mediciones ecocardiográficas y Holter ECG de 24 hs en pacientes hipertensos y no hipertensos ambulatoria y hospitalizados que acuden a un hospital terciario entre marzo a septiembre del 2018. Se estudiaron 104 pacientes, 65 hipertensos conocidos y 39 no hipertensos como grupo control. El diámetro promedio de la AI fue significativamente mayor (p=0,03) en pacientes hipertensos que los no hipertensos (37±8 mm vs. 34±5 mm). Se encontró una asociación significativa entre hipertensión y la aurícula izquierda dilatada (>40 mm) (p= 0,026 OR: 3,25 IC95%: 1,01-11,02). La dilatación de la AI tuvo una especificidad de 73% y un valor predictivo negativo de 98% relacionado con la presencia de trastornos del sistema de conducción y arritmias cardiacas en pacientes con HTA. Se encontró asociación entre la hipertensión arterial y la dilatación de la aurícula izquierda. La dilatación de la aurícula izquierda tiene una elevada especificidad y un alto valor predictivo negativo en la detección de la presencia de prolongación del intervalo QT, ensanchamiento del complejo QRS, dispersión de la onda P, y trastornos del sistema de conducción y arritmias cardiacas en pacientes con hipertensión arterial(AU)

Dilation of the left atrium (LA) is considered an echocardiographic predictor for atrial remodeling and atrial fibrillation. Therefore, we have investigated the correlation between dilatation of the LA with cardiac arrhythmias and conduction system disorders in patients with systemic arterial hypertension. In this observational and prospective study we have investigated electrocardiographic variations, echocardiographic measurements and Holter ECG of 24 hours in hypertensive patients who attend a tertiary hospital from March 2018 to September 2018 as outpatients and inpatients. One hundred four patients were studied, 65 known to be hypertensive and 39 non-hypertensive subjects as control group. The diameter of the LA ​​had a mean value of 37±8 in hypertensive patients, while in non-hypertensive patients was 34±5 ​​(p = 0.03). A significant association was found between hypertension and increased diameter of the LA (p = 0.04 OR: 2.6 CI 0.88-7.7). Dilatation of the LA had a specificity of 73% and a negative predictive value of 98% related to the presence of conduction system disorders and cardiac arrhythmias in patients with hypertension. A significant relationship between arterial hypertension and dilatation of the left atrium was observed. The dilatation of the left atrium has a high specificity and a high negative predictive value in the detection of the presence of prolongation of the QT interval, widening of the QRS complex, dispersion of the P wave, and disorders of the conduction system and cardiac arrhythmias in patients with hypertension(AU)

Correlación entre la dispersión de la onda P con las arritmias cardíacas y los trastornos del sistema de conducción en pacientes con hipertensión arterial del Hospital de Clínicas, Asunción-Paraguay / Correlation among P wave dispersion and cardiac arrhythmias and alterations of the conduction system in patients with arterial hypertension from the Hospital de Clinicas, Asunción, Paraguay

RESUMEN Introducción: La hipertensión arterial puede producir cambios auriculares que generan arritmias auriculares. La dispersión de la onda P (PWD) se considera un marcador electrocardiográfico no invasivo para la remodelación auricular y un predictor para el desarrollo de fibrilación auricular. Nuestro objetico es estudiar la correlación entre la dispersión de la onda P con las arritmias cardíacas y los trastornos del sistema de conducción en pacientes con hipertensión arterial (HTA). Metodología: Estudio observacional y prospectivo en el que estudiamos las variaciones electrocardiográficas, mediciones ecocardiográficas y Holter ECG de 24 hs en pacientes hipertensos que acuden a un hospital terciario desde marzo del 2018 a septiembre del 2018 en forma ambulatoria y a internados. Resultados: Se estudiaron 104 pacientes, 65 hipertensos conocidos y 39 no hipertensos como grupo control. El valor promedio de la dispersión de la onda P en hipertensos fue de 37±8 ms, y en el grupo control fue de 27±13 ms, P <0,001. Además se encontró una diferencia significativa entre estos dos grupos en la duración máxima de la onda P (p<0,05), y el diámetro de la aurícula izquierda (p<0,05). La PWD posee una especificidad de 72% y un valor predictivo negativo de 78% relacionado con la presencia de trastornos del sistema de conducción y arritmias cardiacas en pacientes con HTA. Además, la PWD posee una especificidad de 73% y un valor predictivo negativo de 83% relacionado con la presencia de ensanchamiento del complejo QRS. Conclusiones: Existe una mayor alteración significativa en la dispersión de la Onda P, la Onda P máxima, y la dilatación de la aurícula izquierda en HTA. También se observó una correlación significativa entre la dispersión de la onda P y el riesgo de desarrollar arritmias auriculares. La dispersión de la onda P tiene una elevada especificidad y un alto valor predictivo negativo en la detección de la presencia de prolongación del intervalo QT, ensanchamiento del complejo QRS, dilatación de la aurícula izquierda y trastornos del sistema de conducción y arritmias cardiacas en pacientes con hipertensión arterial. Palabras clave: Dispersión de la Onda P; Hipertensión arterial; Arritmias cardiacas.

Introduction:High blood pressure can produce atrial changes that generate atrial arrhythmias. P wave dispersion (PWD) is considered a noninvasive electrocardiographic marker for atrial remodeling and a predictor for the development of atrial fibrillation. Our objective is to study the correlation between the dispersion of the P wave with cardiac arrhythmias and conduction system disorders in patients with arterial hypertension (AHT). Methodology:Observational and prospective study in which we studied the electrocardiographic variations, echocardiographic measurements and Holter ECG of 24 hours in hypertensive patients who attend a tertiary hospital from March 2018 to September 2018 on an outpatient basis. Results:104 patients were studied, 65 known hypertensive patients and, 39 non-hypertensive as control group. The average value of the P wave dispersion in hypertensive patients was 37±8 ms, and in the control group it was 27±13 ms, P <0.001. In addition, a significant difference between these two groups was found in the maximum duration of the P wave (p <0.05), and the diameter of the left atrium (p <0.05). The PWD has a specificity of 72% and a negative predictive value of 78% related to the presence of disorders of the conduction system and cardiac arrhythmias in patients with hypertension. In addition, the PWD has a specificity of 73% and a negative predictive value of 83% related to the presence of the widening of the QRS complex. Conclusion:There is a greater significant alteration in the P Wave dispersion, the maximum P Wave, and the dilatation of the left atrium in AHT. A significant correlation was also observed between the dispersion of the P wave and the risk of developing atrial arrhythmias. The P wave dispersion has a high specificity and a high negative predictive value in the detection of the presence of QT interval prolongation, widening of the QRS complex, dilatation of the left atrium and disorders of the conduction system and cardiac arrhythmias in patients with arterial hypertension. Key words: P wave dispersion Arterial Hypertensión Cardiac arrhythmias

Asociación de la dilatación auricular izquierda con alteraciones hemodinámicas del ventrículo izquierdo en pacientes con Hipertensión Arterial del Hospital de Clínicas. Asunción, Paraguay / Association of left atrial dilatation with hemodynamic alterations of the left ventricle in patients with arterial hypertension of the Hospital de Clinicas. Asuncion, Paraguay

Introducción: La dilatación de la aurícula izquierda (AI) se considera un marcador ecocardiográfico para la remodelación auricular y la fibrilación auricular. Por ende, hemos investigado la correlación entre la dilatación de la AI con las alteraciones hemodinámicas del ventrículo izquierdo en pacientes con hipertensión arterial. Objetivo: Determinar la relación existente entre la hipertensión arterial y la dilatación auricular izquierda. Así mismo determinar las características epidemiológicas de la población en estudio y las diferencias ecocardiográficas entre pacientes hipertensos y pacientes sin HTA. Metodología: En este estudio observacional y prospectivo hemos investigado las variaciones electrocardiográficas, mediciones ecocardiográficas y Holter ECG de 24 hs en pacientes hipertensos que acuden a un hospital terciario desde marzo a septiembre del 2018 en forma ambulatoria y a internados en el Hospital de Clínicas. Resultados: Se estudiaron 104 pacientes, 65 hipertensos conocidos y 39 no hipertensos como grupo control. El diámetro de la AI tuvo una media de 37±8 en pacientes hipertensos, mientras que en pacientes no hipertensos la media fue de 34±5 (p=0,03). Se encontró una asociación significativa entre hipertensión y aumento del diámetro de la AI (p=0,04 OR: 2,6 IC 0,88­7,7). En los pacientes hipertensos se observó una asociación significativa entre la aurícula izquierda dilatada y la fracción de eyección disminuida (p= 0,01 OR: 4,66 IC: 1,28­16,98). Además, una asociación significativa entre la AI dilatada y el diámetro diastólico aumentado del ventrículo izquierdo (VI) (p= 0,0004 OR: 8,75 IC 2,18­35,01). Se observó una asociación significativa entre la presencia de una AI dilatada y el diámetro sistólico del VI aumentado en hipertensos (p= 0,006 OR: 5,74 IC 1,5­21,91). Conclusiones: Hubo una relación significativa entre la hipertensión arterial y la dilatación de la aurícula izquierda. Los pacientes hipertensos con una dilatación de la AI tuvieron un aumento significativo de los diámetros sistólicos y diastólicos del ventrículo izquierdo, así como una disminución significativa de la funcionalidad sistólica del ventrículo izquierdo. Por ende, los pacientes hipertensos que tienen una dilatación de la aurícula izquierda presentaron además alteraciones hemodinámicas asociadas del ventrículo izquierdo. Palabras clave: Dilatación de la aurícula izquierda; Hipertensión arterial; Fracción de eyección del VI. Diámetro sistólico y diastólico del VI.

Introduction: Dilation of the left atrium (LA) is considered an echocardiographic marker for atrial remodeling and atrial fibrillation. Therefore, we have investigated the correlation between dilatation of the IA with hemodynamic alterations of the left ventricle in patients with arterial hypertension. Objetive: Determine the relationship between arterial hypertension and left atrial dilatation. The same epidemiological characteristics of the study population and the echocardiographic differences between hypertensive patients and patients without HTN. Methodology: In this observational and prospective study we have investigated electrocardiographic variations, echocardiographic measurements and Holter ECG of 24 hours in hypertensive patients who attend a tertiary hospital from March 2018 to September 2018 as outpatients and inpatients. Results: 104 patients were studied, 65 known hypertensive patients and, 39 non-hypertensive as control group. The diameter of the AI had a mean of 37 ± 8 in hypertensive patients, while in non-hypertensive patients the mean was 34 ± 5 (p = 0.03). A significant association was found between hypertension and increased diameter of the LA (p = 0.04 OR: 2.6 CI 0.88-7.7). In hypertensive patients, a significant association was observed between the dilated left atrium and the decreased ejection fraction (p = 0.01 OR: 4.66 CI: 1.28- 16.98). In addition, a significant association between dilated LA and the increased diastolic diameter of the LV (p = 0.0004 OR: 8.75 IC 2.18-35.01). A significant association was observed between the presence of dilated IA and the left ventricular systolic diameter increased in hypertensive patients (p = 0.006 OR: 5.74 CI 1.5-21.91). Conclusion: There was a significant relationship between arterial hypertension and dilatation of the left atrium. Hypertensive patients with dilatation of the IA had a significant increase in systolic and diastolic diameters of the left ventricle, as well as a significant decrease in systolic functionality of the left ventricle. Therefore, hypertensive patients who have dilation of the left atrium also had associated hemodynamic alterations of the left ventricle. Key words: Dilation of the left atrium; Arterial hypertension; LV ejection fraction. Systolic and diastolicdiameter of the LV.

Niveles sanguíneos de digoxina en pacientes con fibrilación auricular y su relación con alteraciones de la repolarización y arritmias ventriculares. Hospital de Clínicas. FCM-UNA, Paraguay / Plasma levels of digoxin in patients with atrial fibrillation and its relation to alterations of repolarization and ventricular arrhythmias. Hospital de Clínicas, FCM-UNA, Paraguay

Introducción: La fibrilación auricular es la arritmia sostenida más común en el campo de la medicina interna, con prevalencia de 1% y riesgo de vida 25% aproximadamente, después de los 40 años. Estudios previos para examinar la seguridad de la digoxina en pacientes con fibrilación auricular, presentan como limitación, la falta de determinaciones de la concentración sérica de este fármaco, necesarias para definir una posible relación entre dosis y respuesta. Metodología: Estudio prospectivo, descriptivo, de corte transversal con componente analítico,se analizó el valor de la digoxina en sangre, los tipos de arritmias cardiacas concomitantes con la fibrilación auricular, factores de riesgo, dosis diaria de digoxina recibida, en pacientesambulatorios de la División de Medicina Cardiovascular-Hospital de Clínicas, de julio a octubre de 2018. Resultados: De 48 pacientes, 5 (10%) tenían una digoxinemia mayor a 1,2ng/ml, y 43 (90%) pacientes tenían una digoxinemia menor a 1,2ng/ml.Del total de pacientes, 18 (38%) pacientes recibían una dosis diaria de 0,25 mg y 30 (62%) pacientes una dosis diaria menor a 0,25 mg.El trastorno del sistema de conducción más frecuente encontrado fue la alteración de la repolarización (20%), la presencia de ondas Q (9%), las alteraciones de la repolarización con extrasístoles ventriculares y la presencia de ondas T negativas (7%), la presencia de bloqueo completo de rama derecha y hemibloqueo anterior izquierdo (5%).Se encontró una asociación significativa entre la dosis de digoxina y la digoxinemia en rango normal (p=0,03); también se halló una asociación significativa entre la digoxinemia alta y alteraciones de la repolarización(p=0,0005). Se halló asociación entre la digoxinemia alta y la presencia de aurícula izquierda dilatada (p=0,001 OR: 0,8 IC 0,6 - 1,03). Conclusión: La mayoría de los pacientes presentaron digoxinemia en rango de seguridad es decir menor a 1,2 ng. La mayoría de los pacientes recibían una dosis menor a 0,25 mg. Existe asociación significativa entre la dosis de digoxina y la digoxinemia sérica. También encontramos asociación significativa entre la digoxinemia alta y las alteraciones de la repolarización y la presencia de aurícula izquierda dilatada. Palabras clave: Fibrilación auricular; Arritmias ventriculares; Dilatación auricular izquierda

Introduction: Atrial fibrillation is the most common sustained arrhythmia in the field of internal medicine, with prevalence of 1% and risk of life 25% approximately, after 40 years. Previous studies to examine the safety of digoxin in patients with atrial fibrillation have as limitation, the lack of determinations of the serum concentration of this drug, necessary to define a possible relationship between dose and response. Methodology: Prospective, descriptive, cross-sectional study with analytical component, the value of digoxin in blood was analyzed the types of cardiac arrhythmias concomitant with atrial fibrillation, risk factors, daily dose of digoxin received, in ambulatory patients from the Division of Cardiovascular Medicine-Hospital de Clínicas, from July to October 2018. Results: Of 48 patients, 5 (10%) had a digoxinemia greater than 1.2 ng / ml, and 43 (90%) patients had digoxinemia less than 1.2 ng / ml. Of the total patients, 18 (38%) patients received a daily dose of 0.25 mg and 30 (62%) patients a daily dose of less than 0.25 mg. The most frequent conduction system disorder found was the alteration of repolarization (20%), the presence of Q waves (9%), the alterations of repolarization with ventricular premature beats and the presence of negative T waves (7%), the presence of complete blockage of the right bundle branch and left anterior hemiblock (5%). A significant association was found between the dose of digoxin and digoxinaemia in the normal range (p = 0.03); A significant association was also found between high digoxinemia and alterations in repolarization (p = 0.0005). An association was found between high digoxinemia and the presence of a dilated left atrium (p = 0.001 OR: 0.8 CI 0.6 - 1.03). Conclusion: The majority of patients presented digoxinemia in a safety range, that is, less than 1.2 ng. The majority of patients received a dose of less than 0.25 mg. There is a significant association between digoxin dose and serum digoxinemia. We also found a significant association between high digoxinemia and alterations in repolarization and the presence of a dilated left atrium. Keywords: Atrial fibrillation; Ventricular arrhythmias; Left atrial dilatation.

Factores de riesgo y cardiopatías prevalentes en mujeres internadas en la división de medicina cardiovascular del hospital de clínicas / Risk factors and prevalent cardiopathies in hospitalized women in the cardiovascular medicine division of the clinical hospital

La representación de las mujeres ha sido marginal en la mayoría de los ensayos clínicos o registros dedicados a las enfermedades cardiovasculares (ECV). Por eso, recientemente, se ha adoptado una política de estimular la inclusión de mujeres en los ensayos clínicos. En este estudio descriptivo retrospectivo y de corte transversal, nos hemos propuesto determinar la forma de presentación de las cardiopatías, describir los factores de riesgo cardiovasculares presentes en estas pacientes, determinar el número de mujeres que presentaron cardiopatía isquémica, y establecer el tratamiento recibido por las mujeres que presentaron cardiopatía isquémica en mujeres internadas en la División de Medicina Cardiovascular del Hospital de Clínicas. El estudio incluyó un total de 250 pacientes, de los cuales 187 (75%) correspondían al sexo masculino y 63 (25%) al sexo femenino. Las edades de las mujeres se encontraban entre 25 y 94 años (60±7,3 años). Las mujeres estudiadas presentaron: insuficiencia cardiaca 26 (41%), síndromes coronarios agudos 20 (32%), valvulopatías 8 (13%), bloqueo AV completo 7 (11%) y otros 2 (3%). De las mujeres con síndrome coronario agudo, 3 pacientes tuvieron enfermedad de 3 vasos, 1 sola tuvo coronarias normales, y 8 (40%) tenían lesiones de la arteria descendente anterior. Los factores de riesgo más frecuentes fueron el sedentarismo en la totalidad de las mujeres, la hipertensión arterial en 55 (87%), dislipidemias en 39 (62%), obesidad en 34 (54%), diabetes mellitus tipo 2 en 12 (19%) y tabaquismo en 12 pacientes (19%). La magnitud del riesgo cardiovascular de la mujer depende no solamente de la alteración de un parámetro sino también de la presencia de otros factores de riesgo, razón por la cual se requiere de un manejo multifactorial integral dentro del concepto de riesgo cardiovascular global en la mujer.

Most of the clinical trials on cardiovascular diseases had scant women representation inthe population studied. Hence, there has been a movement to stimulate the inclusion ofmore women in the clinical studies. In this present descriptive retrospective cross-sectionalstudy we aimed to determine the form of presentation of cardiopathies, to describe thecardiovascular risk factors, to determine the incidence of ischemic cardiopathy and the treatment received in hospitalized women in the Division of Cardiovascular Medicine of theClinical Hospital. The study included 250 patients with 187 male patients (75%) and 63(25%) female patients. The age of the women was between 25 and 94 years old, with anaverage of 60±7,3 years. The women had heart failure 26 (41%), acute coronary syndrome20 (32%), valvulopathy 8 (13%), and complete AV block 7 (11%). Out of the women withacute coronary syndrome, 3 patients had three vessel disease, only 1 had normal coronaryarteries, and 8 patients had stenosis of the anterior descendent coronary artery. All womenhad sedentary lifestyle as cardiovascular risk factor, 55 (87%) arterial hypertension, 39(62%) dyslipidemia, 34 (54%) obesity, 12 (19%) type II diabetes mellitus, and 12 (19%)smoking. The magnitude of the cardiovascular risk factors in women depends not only onthe alteration of one parameter but also on the presence of other risk factors. Therefore, anadequate integral multifactorial management in the global concept of cardiovascular riskfactor in women is required.

Dislipidemia aterogénica en Latino América: prevalencia, causas y tratamiento / Atherogenic dislipidemia in Latin America: prevalence, causes and treatment

En las guías clínicas actuales, la dislipidemia aterogénica (DA) es una entidad escasamente atendida. Debido a las frecuentes alteraciones en los lípidos asociados a la DA en Latino América (LA), se organizó un grupo de expertos que se ha denominado Academia Latino Americana para el estudio de los Lípidos (ALALIP) para generar un documento con análisis de su prevalencia y ofrecer recomendaciones prácticas. Se utilizó la metodología Delphi modificada, con revisión comprensiva de la literatura con énfasis en aquellas publicaciones con implicaciones para LA. Subsecuentemente, se desarrollaron preguntas claves para ser discutidas. En LA no existe un estudio global sobre los factores de riesgo que representan a la totalidad de la población. El análisis sistemático de las encuestas nacionales de salud y de los estudios sistemáticos de cohorte muestran consistentemente una alta prevalencia de las anormalidades lipídicas que definen la DA. La concentración baja del colesterol unido a las lipoproteínas de alta densidad (C-HDL) varía entre 34,1% a 53,3% y la de triglicéridos (TG) elevados del 25,5% al 31,2%, con mayor prevalencia entre los hombres. Múltiples causas se han reconocidos, como alta ingesta de alimentos de mayor densidad calórica, contenido de colesterol, grasas trans, sedentarismo y cambios epigenéticos. La DA bien puede ser tratada con los cambios terapéuticos del estilo de vida (CTEV) con incremento en la actividad física, ejercicio regular y dieta baja en carbohidratos y alta en ácidos grasos poliinsaturados, tales como los ácidos grasos omega-3 como intervención primaria. De ser necesario, esta estrategia sera suplementada con terapia farmacológica como la monoterapia con estatinas o la combinación de fibratos/ácidos grasos omega-3. Las anormalidades lipídicas que definen la DA tienen una elevada prevalencia en LA; su interacción con un estilo de vida no saludable, herencia y cambios epigenéticos están ligados a sus posibles causas. La DA es una causa importante de riesgo cardiovascular residual (RCVR) que debe ser diagnosticada y tratada. Es importante y necesario diseñar un estudio global de factores de riesgo en LA para conocer la real prevalencia de la DA.

In the current clinical guidelines, atherogenic dyslipidemia (AD) is a poorly recognized entity. Due to the frequent lipid alterations associated with AD in Latin America (LA), we organized a group of experts named Latin American Academy for the study of Lipids (ALALIP), to generate a document for analyzing its prevalence and to offer practical recommendations. Using the Delphi methodology, we conducted a comprehensive literature review, with emphasis on those publications with implications for LA. Subsequently we developed key questions to be discussed. In LA there is no a global study on risk factors that represent the entire population. The systematic analysis of national health surveys and regional cohort studies showed a consistent high prevalence of the lipid abnormalities that define AD. Low high density lipoprotein cholesterol (HDL-C) ranges from 34.1% to 53.3% and elevated triglycerides (TG) from 25.5% to 31.2%, more prevalent in men. There are multiple causes: high consumption of foods with a high caloric density, cholesterol and trans fats, sedentary lifestyle and epigenetic changes. AD must be well treated with therapeutic changes in lifestyle with increased in physical activities, regular exercise and a diet with a low proportion of carbohydrates y rich in poliunsatured fatty acid, such as omega-3 fatty acid as primary intervention. If needed, this strategie must be supplemented with pharmacological therapies such as monotherapy with statins or a combination of fibrates plus omega-3.fatty acid. Lipid abnormalities that define AD have a high prevalence in LA; the interaction between non-healthy lifestyle, inheritance and epigenetic changes, possibly are its cause. AD is an important cause of cardiovascular residual risk (CVRR), that must be diagnosed and treated. It is important and neccesary to design a global study of risk factors in LA to know the true prevalence of AD.

Atherogenic Dyslipidemia in Latin America: Prevalence, causes and treatment: Expert's position paper made by The Latin American Academy for the Study of Lipids (ALALIP) Endorsed by the Inter-American Society of Cardiology (IASC), the South American Society of Cardiology (SSC), the Pan-American College of Endothelium (PACE), and the International Atherosclerosis Society (IAS).

This is an executive summary made by a group of experts named Latin American Academy for the study of Lipids (ALALIP). In the current clinical guidelines, atherogenic dyslipidemia (AD) is a poorly recognized entity. Due to the frequent lipid alterations associated with AD in Latin America (LA), we organized a group of experts named (ALALIP) to generate a document in order to analyze their prevalence and to offer practical recommendations. METHODOLOGY: using the Delphi methodology, we conducted a comprehensive literature review with emphasis on those publications related to LA. Subsequently, we developed key questions for discussion. As a convention, those recommendations that had a 100% of acceptance were considered unanimous, those with >80% were consensual, and those with <80% were in disagreement. RESULTS: a systematic analysis of national health surveys and regional cohort studies showed a consistently high prevalence of the lipid abnormalities that define AD: low levels of high-density lipoprotein cholesterol (HDL-C) range from 34.1% to 53.3% and elevated triglycerides (TG) range from 25.5% to 31.2%. These abnormalities could be related to high consumption of food with a high caloric density, cholesterol and trans fats, a sedentary lifestyle and perhaps epigenetic changes CONCLUSIONS: lipid abnormalities that define AD have a high prevalence in LA. The interaction between an unfavorable lifestyle, inheritance and epigenetic changes is probably their cause. It is important to design a global study of risk factors in LA to know its true prevalence in the region, its consequences and to derive from its treatment strategies.

Dislipidemia aterogénica en latino américa: prevalencia, causas y tratamiento / Atherogenic dyslipidemia in Latin America: prevalence, causes and treatment

En las guías clínicas actuales, la dislipidemia aterogénica (DA) es una entidad no muy atendida. Debido a las frecuentes alteraciones en los lípidos asociados a la DA en Latino América (LA). Métodos: organizamos un grupo de expertos denominado Academia Latino Americana para el estudio de los Lípidos (ALALIP) para así generar un documento con análisis de su prevalencia y recomendaciones terapéuticas prácticas. Se utilizó la metodología Delphi modificada, con una revisión integral de la literatura y énfasis en las publicaciones con implicaciones para LA. Subsecuentemente, desarrollamos preguntas claves para ser discutidas. Resultados: En Latinoamérica (LA) no existe un estudio global sobre los factores de riesgo que representan a la totalidad de la población. El análisis sistemático de las encuestas nacionales de salud y de los estudios sistemáticos de cohorte muestran consistentemente una alta prevalencia de las anormalidades lipídicas que definen la DA. La concentración baja del colesterol unido a las lipoproteínas de alta densidad (C-HDL) varía entre 34,1% a 53,3% y la de triglicéridos (TG) elevados del 25,5% al 31,2%, con mayor prevalencia entre los hombres. La DA bien puede ser tratada con los cambios del estilo de vida (CTEV) como ncremento en laactividad física, dieta baja en carbohidratos y alta en ácidos grasos poliinsaturados, tales como los ácidos grasos omega-3 como intervención primaria. De ser necesario, esta estrategia sera suplementada con terapia farmacológica como la monoterapia con estatinas o la combinación de fibratos/ácidos grasos omega-3. Conclusiones: Las anormalidades lipídicas que definen la DA tienen una elevada prevalencia en LA; su interacción con un estilo de vida no saludable, herencia y cambios epigenéticos están ligados a sus posibles causas. La DA es una causa importante de riesgo cardiovascular residual (RCVR) que debe ser diagnosticada y tratada. Es importante y necesario diseñar un estudio global de factores de riesgo en LA para conocer la real prevalencia de la DA(AU)

In the current clinical guidelines, atherogenic Med Interna (Caracas) 2017; 33 (3): 121 - 139 Dislipidemia Aterogénica en Latino América: Prevalencia, causas y tratamiento Carlos I. Ponte-N, Jesús E. Isea-Pérez, Alberto J. Lorenzatti, Patricio López-Jaramillo, Fernando Stuardo Wyss-Q, Xavier Pintó, Fernando Lanas, Josefina Medina, Livia T. Machado-H, Mónica Acevedo, Paola Varleta Alfonso Bryce, Carlos Carrera, Carlos Ernesto Peñaherrera, José Ramón Gómez-M, Alfredo Lozada, Alonso Merchan-V, Daniel Piskorz, Enrique Morales, María Paniagua, Félix Medina-Palomino, Raúl Alejandro Villar-M, Leonardo Cobos, Enrique Gómez-Álvares, Rodrigo Alonso, Juan Colan, Julio Chirinos, Jofre Lara, Vladimir Ullauri, Ildefonso Arocha Documento de la posición de expertos de la Academia Latino Americana para el estudio de los Lípidos (ALALIP) y avalado por la Sociedad Interamericana de Cardiología (SIAC), Sociedad Sur Americana de Cardiología (SSC), el Colegio Panamericano de Endotelio (CPAE) y la Sociedad Internacional de Aterosclerosis (IAS). Publicado en conjunto con las Revistas de la Sociedad Venezolana de Medicina Interna y de la Sociedad Venezolana de ndocrinología y Metabolismo. dyslipidemia (AD) is a poorly recognized entity. Due to the frequent lipid alterations associated with AD in Latin America (LA), we organized a group of experts named Latin American Academy for the study of Lipids (ALALIP), to generate a document to analize it´s prevalence and to offer practical recommendations. Methodology: Using the Delphi methodology, we conducted a comprehensive literature review, with emphasis on those publications with implications for LA. Subsequently we developed key questions to be discussed. Results: In LA There is no a global study on risk factors that represent the entire population. The systematic analysis of national health surveys and regional cohort studies showed a consistent high prevalence of the lipid abnormalities that define AD. Low high density lipoprotein cholesterol (HDL-C) ranges from 34.1% to 53.3% and elevated triglycerides (TG) from 25.5% to 31.2% more prevalent in men. There are multiple causes: high consumption of foods with a high caloric density, cholesterol and trans fats, sedentary lifestyle and epigenetic changes. AD must be well treated with therapeutic changes in lifestyle with increase in physical activities, regular exercise and a diet with a low proportion of carbohydrates and rich in poliunsatured fatty acid, such as omega-3 fatty acids as primary intervention. If needed, this strategy must be supplemented with pharmacological therapies such as monotherapy with statins or a combination of fibrates plus omega-3. fatty acid. conclusions: Lipid abnormalities that define AD have a high prevalence in LA; the interaction between non-healthy lifestyle, inheritance and epigenetic changes, possibly are the cause. AD is an important cause of cardiovascular residual risk (CVRR), that must be diagnosed and treated It is important and necesary to design a global study of risk factors in LA to know the true prevalence of AD(AU)

Efficacy of an orlistat-resveratrol combination for weight loss in subjects with obesity: A randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of an orlistat-resveratrol (O-R) combination in subjects with obesity over a 6-month period. METHODS: This study was a double-blind, parallel, randomized controlled clinical trial. Patients fulfilling the selection criteria (age from 20 to 60 years and body mass index (BMI) ≥30 and ≤39.9 kg/m(2) ) consumed an energy-reduced diet with 500 fewer calories than their usual diet for 2 weeks. Then the participants were randomly assigned to four groups, placebo, resveratrol, orlistat, or O-R, and they consumed the energy-reduced diet for 6 months. The study consisted of seven visits. During each visit, a 24-h recall was performed, along with measurements of anthropometric and serum biochemical parameters. RESULTS: A total of 161 participants were selected. Of these, 84 participants completed the study. A significant weight loss of -6.82 kg (95% CI -8.37 to -5.26) was observed in the O-R group compared with -3.50 kg (-5.05 to -1.95, P = 0.021) in the placebo group. In contrast, the -6.02 kg (-7.68 to -4.36) orlistat and -4.68 kg (-6.64 to -2.71) resveratrol monotherapy losses did not significantly differ from the placebo. Significant decreases in BMI, waist circumference, fat mass, triglycerides, leptin, and leptin/adiponectin ratio were observed with the O-R combination. CONCLUSIONS: The O-R combination was the most effective weight loss treatment.

Availability and characteristics of cardiovascular rehabilitation programs in South America.

PURPOSE: Cardiac rehabilitation (CR) programs decrease morbidity and mortality rates in patients with coronary artery disease, the leading cause of death in Latin America. This study was carried out to assess the characteristics and current level of CR program implementation in South America. METHODS: We carried out a survey of CR programs that were identified using the directory of the South American Society of Cardiology and through an exhaustive search by the investigators. RESULTS: We identified 160 CR programs in 9 of the 10 countries represented in the South American Society of Cardiology and 116 of those responded to our survey. On the basis of survey results from the responding programs, we estimate that the availability of CR programs in South America is extremely low, approximately 1 CR program for every 2 319 312 inhabitants. These CR programs provided services to a median of 180 patients per year (interquartile range, 60-400) and were most commonly led by cardiologists (84%) and physical therapists (72%). Phases I, II, III, and IV CR were offered in 49%, 91%, 89%, and 56% of the centers, respectively. The most commonly perceived barrier to participation in a CR program was lack of referral from the cardiologist or primary care physician, as reported by 70% of the CR program directors. CONCLUSIONS: The number of CR programs in South America appears to be insufficient for a population with a high and growing burden of cardiovascular disease. In addition, there appears to be a significant need for standardization of CR program components and services in the region.