Handedness and gender influence blood pressure in young healthy men and women: A pilot study.

OBJECTIVE: The type and level of sex steroids influence blood pressure (BP). It has been suggested that functional brain asymmetries may be influenced by sex hormones. In addition, there are inter-arm differences in BP not yet related with handedness. In this study, we hypothesize a possible association between sex hormones, handedness, and inter-arm differences in blood pressure. METHODS: To analyze this hypothesis, we measured BP in the left and right arm of the left and right handed adult young men and women in menstrual and ovulatory phase and calculated their mean arterial pressure (MAP). RESULTS: Significant differences depending on sex, arm, handedness or phase of the cycle were observed. MAP was mostly higher in men than in women. Remarkably, in women, the highest levels were observed in the left handed in menstrual phase. Interestingly, the level of handedness correlated negatively with MAP measured in the left arm of right-handed women in the ovulatory phase but positively with the MAP measured in the right arm of right-handed women in the menstrual phase. CONCLUSIONS: These results may reflect an asymmetrical modulatory influence of sex hormones in BP control.

Tratamiento precoz con estatinas en el infarto agudo de miocardio / Early statin therapy in acute myocardial infarction

OBJETIVOS: Evaluar el efecto de la administración precoz de estatinas durante la fase aguda del infarto de miocardio (IM). DISEÑO: Estudio de cohortes retrospectivo. Ámbito: Nacional. PACIENTES O PARTICIPANTES: Pacientes incluidos en el registro ARIAM desde enero de 1999 hasta diciembre de 2008 con diagnóstico de IM. INTERVENCIONES: Ninguna. Variables de interés principales: Se utilizaron análisis de regresión logística y de propensión para determinar si la administración de estatinas, durante las primeras 24h del IM, se comportaba como un factor protector frente a: 1) la mortalidad, 2) la incidencia de arritmias letales o 3) el shock cardiogénico. RESULTADOS: Se incluyeron 36.842 pacientes en el estudio. En un 50,2% de los pacientes las estatinas se administraron de forma precoz. Su administración se asoció a pacientes más jóvenes, con dislipidemia previa conocida, obesidad, antecedentes personales de cardiopatía isquémica, insuficiencia cardiaca, presencia de taquicardia inusal, uso de betabloqueantes, inhibidores de la enzima convertidora de angiotensina, trombolisis e intervencionismo coronario percutáneo. La mortalidad fue del 8,2% (13,2% sin estatinas vs. 3% con estatinas; p < 0,001). El análisis multivariante demostró que la administración de estatinas actuó como factor protector frente a la mortalidad (OR ajustada 0,518; IC 95% 0,447-0,601). La continuación de la administración de estatinas se asoció con una reducción en la mortalidad (OR ajustada 0,597; IC 95% 0,449-0,798), y el inicio del tratamiento fue un factor protector frente a la mortalidad (OR ajustada 0,642; IC 95% 0,544-0,757). El tratamiento con estatinas también fue factor protector contra la incidencia de arritmias letales y shock cardiogénico. CONCLUSIONES: Estos resultados sugieren que el tratamiento precoz con estatinas en los pacientes con IM se asocia con una reducción de la mortalidad

OBJECTIVES: To evaluate the effects of the early administration of statins during acute myocardial infarction (MI). DESIGN: A retrospective cohort study was carried out. Setting National (Spain). PATIENTS OR PARTICIPANTS: Patients included in the ARIAM registry from January 1999 to December 2008 with a diagnosis of MI. INTERVENTIONS: None MAIN VARIABLES: We used logistic regression analysis and propensity scoring to determine whether the administration of statins during the first 24h of MI acts as a protective factor against: 1) mortality, 2) the incidence of lethal arrhythmias, or 3) cardiogenic shock. RESULTS: A total of 36 842 patients were included in the study. Statins were administered early in 50.2% of the patients. Statin administration was associated with younger patients with known previous dyslipidemia, obesity, a history of ischemic heart disease, heart failure, presence of sinus tachycardia, use of beta-blockers, angiotensin-converting enzyme inhibitors, thrombolysis and percutaneous coronary intervention. Mortality was 8.2% (13.2% without statin versus without statin versus 3% with statin, P < .001). Multivariate analysis demonstrated that statin administration acted as a protective factor against mortality (adjusted OR 0.518, 95%CI 0.447 to 0.601). Continued use of statins was associated with a reduction in mortality (adjusted OR 0.597, 95%CI 0.449 to 0.798), and the start of treatment was a protective factor against mortality (adjusted OR 0.642, 95%CI 0.544 -0.757). Statin therapy also exerted a protective effect against the incidence of lethal arrhythmias and cardiogenic shock. CONCLUSIONS: These results suggest that early treatment with statins in patients with MI is associated with reduced mortality

[Consensus document on ultrasound training in Intensive Care Medicine. Care process, use of the technique and acquisition of professional skills]. / Documento de consenso para la formación en ecografía en Medicina Intensiva. Proceso asistencial, uso de la técnica y adquisición de competencias profesionales.

Ultrasound has become an essential tool in assisting critically ill patients. His knowledge, use and instruction requires a statement by scientific societies involved in its development and implementation. Our aim are to determine the use of the technique in intensive care medicine, clinical situations where its application is recommended, levels of knowledge, associated responsibility and learning process also implement the ultrasound technique as a common tool in all intensive care units, similar to the rest of european countries. The SEMICYUC's Working Group Cardiac Intensive Care and CPR establishes after literature review and scientific evidence, a consensus document which sets out the requirements for accreditation in ultrasound applied to the critically ill patient and how to acquire the necessary skills. Training and learning requires a structured process within the specialty. The SEMICYUC must agree to disclose this document, build relationships with other scientific societies and give legal cover through accreditation of the training units, training courses and different levels of training.

[Early statin therapy in acute myocardial infarction]. / Tratamiento precoz con estatinas en el infarto agudo de miocardio.

OBJECTIVES: To evaluate the effects of the early administration of statins during acute myocardial infarction (MI). DESIGN: A retrospective cohort study was carried out. SETTING: National (Spain). PATIENTS OR PARTICIPANTS: Patients included in the ARIAM registry from January 1999 to December 2008 with a diagnosis of MI. INTERVENTIONS: None. MAIN VARIABLES: We used logistic regression analysis and propensity scoring to determine whether the administration of statins during the first 24h of MI acts as a protective factor against: 1) mortality, 2) the incidence of lethal arrhythmias, or 3) cardiogenic shock. RESULTS: A total of 36 842 patients were included in the study. Statins were administered early in 50.2% of the patients. Statin administration was associated with younger patients with known previous dyslipidemia, obesity, a history of ischemic heart disease, heart failure, presence of sinus tachycardia, use of beta-blockers, angiotensin-converting enzyme inhibitors, thrombolysis and percutaneous coronary intervention. Mortality was 8.2% (13.2% without statin versus 3% with statin, P<.001). Multivariate analysis demonstrated that statin administration acted as a protective factor against mortality (adjusted OR 0.518, 95%CI 0.447 to 0.601). Continued use of statins was associated with a reduction in mortality (adjusted OR 0.597, 95%CI 0.449 to 0.798), and the start of treatment was a protective factor against mortality (adjusted OR 0.642, 95%CI 0.544 -0.757). Statin therapy also exerted a protective effect against the incidence of lethal arrhythmias and cardiogenic shock. CONCLUSIONS: These results suggest that early treatment with statins in patients with MI is associated with reduced mortality.

Cardiogenic shock: management of right ventricular infarction shock.

Right ventricular infarction is a not uncommon cause of cardiogenic shock, whose frecuency is variable and could be underestimated. Although left ventricular myocardial management is well defined in the right ventricular infarction are few studies with low level of evidence, to establish definitive guidelines. It is assumed that the treatment is similar to that of the left ventricle, although there are some differences. The axis of the therapeutic management, as well as the left ventricle infarction, is based on early myocardial reperfusion, particularly through percutaneous coronary interventionism. Throm-bolysis is an option, especially after an increase in systemic blood pressure using vasoactive drugs such as norepinephrine. The preload optimization by volume administration during resuscitation of shock is useful, but it must be with caution. The use of levosimendan could be potentially beneficial option. On the neurohormonal modulation of systemic inflammatory response produced after the cardiogenic shock (CS), the use of ACE inhibitors and beta-blockers is controversial.

Blood pressure increased dramatically in hypertensive rats after left hemisphere lesions with 6-hydroxydopamine.

Plasma angiotensinase activity, nitric oxide and systolic blood pressure (SBP) were differently affected after unilateral intrastriatal injection of 6-hydroxydopamine (6-OHDA), depending on the brain hemisphere injured. Moreover, normotensive and hypertensive rats responded differently suggesting an asymmetry in the organization of the autonomic nervous system of the vessels. The aim of this study was to investigate the evolution of SBP and heart rate (HR) over time after nigrostriatal lesions in normotensive and hypertensive rat strains. Unilateral depletions of brain dopamine were performed by injecting 6-OHDA into the left or right striatum of normotensive and hypertensive rats. Vehicle without 6-OHDA was unilaterally injected in control (sham) groups. SBP and heart rate (HR) were measured in un-anesthetised animals 10 and 3 days before administration of 6-OHDA or vehicle and 3 and 25 days after treatment. In normotensive rats, at the end of study, SBP increased significantly from pre-lesioned values in left-lesioned animals but no differences were observed in right-lesioned or sham groups. Before sacrifice, there was a significant reduction from pre-lesion values in HR. In hypertensive animals, there was a highly significant increase of SBP in left-lesioned and sham left rats and a slight increase in right-lesioned but no differences were observed in sham right group. No differences in HR were observed throughout the study in the groups studied. The present results represent direct experimental evidence of an asymmetrical cardiovascular response to unilateral brain lesions, suggesting that left injury may have a worst prognosis.

Efecto de la administración de las estatinas en la patología crítica no cardiológica / Resumen La administración de estatinas se ha mostrado eficaz en reducir la mortalidad cardiovascular. Su beneficio podría expandirse hacia otras áreas de la medicina intensiva, pudiendo disminuir la mortalidad del paciente críticamente enfermo. Existen diversos estudios, aunque sin un alto nivel de evidencia, en el que parece detectarse un posible beneficio en su administración, y un empeoramiento clínico con la discontinuación de estos fármacos, sobre los pacientes que previamente las tomaban. A pesar de que la mayoría de los pacientes que tomaban previamente estatinas, lo hacían como prevención primaria o secundaria, teniendo por tanto una mayor comorbilidad, en global se detecta una disminución de la mortalidad en dichos subgrupos. Este beneficio podría ser generalizado ante toda la patología crítica, aunque se requieren estudios con un mayor nivel de evidencia, para su adecuada contrastación

La administración de estatinas se ha mostrado eficaz en reducir la mortalidad cardiovascular. Su beneficio podría expandirse hacia otras áreas de la medicina intensiva, pudiendo disminuir la mortalidad del paciente críticamente enfermo. Existen diversos estudios, aunque sin un alto nivel de evidencia, en el que parece detectarse un posible beneficio en su administración, y un empeoramiento clínico con la discontinuación de estos fármacos, sobre los pacientes que previamente las tomaban.A pesar de que la mayoría de los pacientes que tomaban previamente estatinas, lo hacían como prevención primaria o secundaria, teniendo por tanto una mayor comorbilidad, en global se detecta una disminución de la mortalidad en dichos subgrupos. Este beneficio podría ser generalizado ante toda la patología crítica, aunque se requieren estudios con un mayor nivel de evidencia, para su adecuada contrastación (AU)

Administration of statins has been shown to be effective in reducing cardiovascularmortality. Their benefit could expand towards other areas of intensive medicine, it beingpossible to decrease mortality of the critically ill patient. There are several studies, althoughwithout a high level of evidence, that have detected a possible benefit when they are administeredas well as clinical deterioration when they are discontinued, compared to those patientswho had previously taken them.Even though most of the patients who had previously taken statins did so as primary orsecondary prevention, thus having greater comorbidity, overall, a decrease is detected in themortality of these subgroups. This benefit could be generalized to all the critical conditions,although studies with a higher level of evidence are needed for their adequate comparison.© 2009 Elsevier Espa˜na, S.L. y SEMICYUC. All rights reserved (AU)

Infarto agudo de miocardio en el paciente trasplantado cardiaco: un reto diagnóstico y terapéutico / Acute myocardial infarction in the heart transplant patient: A diagnostic and therapeutic challenge

No disponible

[Effect of the administration of statins in non-cardiac critical disease]. / Efecto de la administración de las estatinas en la patología crítica no cardiológica.

Administration of statins has been shown to be effective in reducing cardiovascular mortality. Their benefit could expand towards other areas of intensive medicine, it being possible to decrease mortality of the critically ill patient. There are several studies, although without a high level of evidence, that have detected a possible benefit when they are administered as well as clinical deterioration when they are discontinued, compared to those patients who had previously taken them. Even though most of the patients who had previously taken statins did so as primary or secondary prevention, thus having greater comorbidity, overall, a decrease is detected in the mortality of these subgroups. This benefit could be generalized to all the critical conditions, although studies with a higher level of evidence are needed for their adequate comparison.

Administración precoz de estatinas sobre el síndrome coronario agudo / Early administration of statins in a cute coronary syndrome

No disponible

Efecto de la retirada de las estatinas durante el ingreso en unidades de Medicina Intensiva / Effect of delay in statins during admission in medical units

Las estatinas se están convirtiendo en uno de los fármacos más utilizados ante la prevención cardiovascular. Dada la edad de los pacientes admitidos en las unidades de medicina intensiva, muchos de ellos reciben tratamiento previo con estatinas. Sin embargo, tras el ingreso en estas unidades suele discontinuarse el tratamiento de estatinas. No existen grandes estudios que evalúen el efecto de la retirada de estatinas sobre la mortalidad. No obstante, los estudios existentes apoyan la hipótesis de que la retirada de estatinas se sigue de un claro efecto perjudicial. Por esto, nos deberíamos replantear de forma muy juiciosa la retirada de las estatinas tras el ingreso en medicina intensiva (AU)

Statins are becoming one of the drugs used most for cardiovascular prevention. Given the age of the patients admitted to the intensive medicine units, many of them receive previous treatment with statins. However, after admission to these units, statin treatment is generally discontinued. There are no important studies that evaluate the effect of discontinuing statins on mortality. However, the existing studies support the hypothesis that withdrawing statins has a clear harmful effect. Thus, the withdrawal of statins after admission to an intensive medicine unit should be carefully evaluated (AU)

Administración de estatinas durante la fase aguda del síndrome coronario agudo / Administration of statins during the acute phase of acute coronary syndrome

Es indiscutible el beneficio de las estatinas en los pacientes con síndrome coronario estable, pero en el síndrome coronario agudo (SCA) su administración precoz es controvertida. Existen pocos ensayos clínicos y metaanálisis sobre este tema, con resultados poco aclaratorios. Sin embargo, la mayoría de los registros la encuentra eficiente. No existe ningún estudio que encuentre inseguro este tratamiento, por lo que podría estudiarse su inclusión en las guías terapéuticas durante la fase aguda del SCA (AU)

The benefits of statins in patients with stable coronary syndrome is indisputable, however their early use in acute coronary syndrome (ACS) is under debate. There are few existing clinical trials and meta-analysis results on this and their results provide little clarification. However, most of the registries have found them to be efficient. There are no studies that show this therapy to be unsafe, so its inclusion in treatment guidelines during the acute phase of ACS could be studied (AU)

[Effect of delay statins withdrawal during admission in medical units]. / Efecto de la retirada de las estatinas durante el ingreso en unidades de Medicina Intensiva.

Statins are becoming one of the drugs used most for cardiovascular prevention. Given the age of the patients admitted to the intensive medicine units, many of them receive previous treatment with statins. However, after admission to these units, statin treatment is generally discontinued. There are no important studies that evaluate the effect of discontinuing statins on mortality. However, the existing studies support the hypothesis that withdrawing statins has a clear harmful effect. Thus, the withdrawal of statins after admission to an intensive medicine unit should be carefully evaluated.

[Administration of statins during the acute phase of acute coronary syndrome]. / Administración de estatinas durante la fase aguda del síndrome coronario agudo.

The benefits of statins in patients with stable coronary syndrome is indisputable, however their early use in acute coronary syndrome (ACS) is under debate. There are few existing clinical trials and meta-analysis results on this and their results provide little clarification. However, most of the registries have found them to be efficient. There are no studies that show this therapy to be unsafe, so its inclusion in treatment guidelines during the acute phase of ACS could be studied.

[Use of the propensity score methodology in health care research]. / Uso de la metodología propensity score en la investigación sanitaria.

Observational studies are frequently used in biomedical research to determine associations between a treatment or exposure and the effects they can produce. Randomized control trials have been developed with the same purpose. Although they provide more precise results, they are more complex and costly. The use of propensity score methodology in observational studies helps to decrease the appearance of bias that they normally present, making them more accurate and with better reliability than randomized control trials. Given the increase in the use of the propensity score methodology in clinical research in recent years, we consider that it is of particular interest to make a description of it, highlighting its application scope and different use techniques.

Uso de la metodología propensity score en la investigación sanitaria / Use of the propensity score methodology in health care research

En la investigación biomédica es frecuente el diseño de estudios observacionales para determinar la asociación entre un tratamiento o exposición y el efecto que pueden producir. Con el mismo fin se desarrollan los estudios aleatorizados, que aunque obtienen resultados más precisos, son más complejos y costosos. La aplicación de la metodología propensity score (PS) en los estudios observacionales hace que disminuya la aparición de los sesgos que normalmente presentan, acercándolos en precisión y fiabilidad a los estudios aleatorizados. Dado el incremento que se ha producido en los últimos años respecto a la utilización de metodología PS en investigación clínica, consideramos que es de especial interés realizar una descripción de la misma, resaltando su ámbito de aplicación y las diferentes técnicas de uso (AU)

Observational studies are frequently used in biomedical research to determine associations between a treatment or exposure and the effects they can produce. Randomized control trials have been developed with the same purpose. Although they provide more precise results, they are more complex and costly. The use of propensity score methodology in observational studies helps to decrease the appearance of bias that they normally present, making them more accurate and with better reliability than randomized control trials. Given the increase in the use of the propensity score methodology in clinical research in recent years, we consider that it is of particular interest to make a description of it, highlighting its application scope and different use techniques (AU)

Síndrome coronario agudo con elevación del segmento ST (SCACEST). Estrategia de consenso para una reperfusión precoz. Empresa pública de emergencias sanitarias (EPES) y grupo ARIAM-Andalucía / Acute coronary syndrome (ACS) with elevated ST segment: consensus strategy for early reperfusion. The Public Enterprise for Health Emergencies and the ARIAM Project Andalusia

El manejo adecuado de los pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMEST) requiere, como elementos centrales, la accesibilidad inmediata a la desfibrilación y la instauración precoz de tratamiento de reperfusión. La empresa pública de emergencias sanitarias de Andalucía (EPES) y el proyecto análisis de los retrasos en el tratamiento del infarto agudo de miocardio (ARIAM), pretenden construir una estrategia básica común, sobre la cual adaptar aspectos locales, que facilite la toma de decisiones sobre el tratamiento de estos pacientes. Ámbito. Comunidad Autónoma de Andalucía. Período: marzo-mayo 2006. Participantes. Profesionales que atienden a pacientes con IAMEST: médicos del grupo de trabajo en procesos cardiológicos de la EPES, médicos de Servicios de Urgencias hospitalarios y médicos de las Unidades de Cuidados Intensivos de los hospitales del sistema sanitario público de Andalucía. Sistema de trabajo. Niveles de evidencia. Se emplearon los niveles de evidencia recogidos en la guía de práctica clínica ACC/AHA de 2004. Elaboración del consenso. Se mantuvo una reunión de discusión sobre los aspectos que debía abordar el documento. Se realizó un documento base que se distribuyó por correo electrónico entre los participantes. En una reunión final se elaboró el documento de consenso. Conclusiones. El consenso establece como prioritarios los siguientes aspectos: 1. Mantener una aplicación estricta y adecuada del conjunto de medidas generales aconsejadas en el proceso de asistencia al IAMEST. 2. Favorecer la realización de reperfusión precoz a la mayor cantidad de pacientes, promoviendo la extensión de la fibrinólisis extrahospitalaria y la derivación a centro útil para intervencionismo coronario percutáneo primario. 3. Monitorizar y evaluar el manejo realizado, con especial atención sobre los resultados y la seguridad de los pacientes

The two pillars of the appropriate management of patients with ST-elevation myocardial infarction (STEMI) are immediate access to defibrillation and early reperfusion. The Public Enterprise for Health Emergencies (EPES) and the Andalusian ARIAM (Analysis of the Delay in the Treatment of Acute Myocardial Infarction) Project aim to implement a common basic strategy that can be adapted to local situations in order to facilitate decision making about the treatment of these patients. Context. The Autonomous Community of Andalusia. Period: March-May 2006. Participants. Professionals that attend patients with STEMI: physicians in the EPES’ work group on cardiological processes, emergency department physicians, and physicians working in the intensive care units in the hospitals of the public healthcare system of Andalusia. Approach. Levels of evidence. The levels of evidence laid out in the 2004 ACC/AHA Clinical Practice Guidelines. Reaching a consensus. A meeting was held to discuss the aspects to be included in the document. A working document was drafted and distributed to the participants via email. The final consensus document was drafted at another meeting. Conclusions. The consensus document establishes the following priorities: 1. To apply the set of general measures recommended for the care of STEMI patients strictly and appropriately 2. To foster the use of early reperfusion in as many patients as possible, promoting the extension of fibrinolysis outside of hospitals and referral to a center with facilities for primary percutaneous coronary intervention. 3. To monitor and evaluate the management of these patients, with special attention placed on outcome and safety