Evaluation of cell toxicity and DNA and protein binding of green synthesized silver nanoparticles.

Silver nanoparticles (AgNPs) were prepared by GREEN chemistry relying on the reduction of AgNO3 by phytochemicals present in black tea extract. AgNPs were fully characterized by transmission electron microscopy (TEM), ultraviolet-visible spectroscopy ((UV-vis)), X-ray diffraction (XRD) and energy dispersive absorption spectroscopy (EDS). The synthesized AgNPs induced a decrease of the cell viability in a dose-dependent manner with a low IC50 (0.5 ±â€¯0.1 µM) for an ovarian carcinoma cell line (A2780) compared to primary human fibroblasts (IC50 5.0 ±â€¯0.1 µM). The DNA binding capability of CT (calf thymus) DNA was investigated using electronic absorption and fluorescence spectroscopies, circular dichroism and viscosity titration methods. Additionally, the AgNPs strongly quench the intrinsic fluorescence of BSA, as determined by synchronous fluorescence spectra.

[Cryptogenic stroke in a young patient with heart disease and kidney failure]. / Ictus criptogenico en un paciente joven con cardiopatia y fallo renal.

INTRODUCTION: Fabry's disease is an infrequent metabolic pathology linked to the X chromosome which causes a wide variety of signs and symptoms. CASE REPORT: A 39-year-old male who was admitted to our stroke unit with right-side hemiparesis (1 + 0) and dysarthria (1). The score on the National Institute of Health Stroke Scale was 2. The patient presented angiokeratomas in both thighs. A computerised axial tomography scan of the head showed left thalamic acute infarction. The duplex scan of the supra-aortic trunks was normal, and the transcranial Doppler reflected a generalised increase in the pulsatility indices. Transthoracic echocardiography showed left ventricular hypertrophy and left atrial dilatation. He was discharged five days later, with antiaggregating medication but asymptomatic. The prolonged Holter-electrocardiogram recording showed paroxysmal atrial fibrillation. One notable value in the urine analysis was microalbuminuria of 281 mg/L. In view of the multi-organic involvement and the family history, a study for Fabry's disease was performed. Activity of the enzyme alpha-galactosidase A was diminished, and the presence of a mutation in the GLA gene was found. The patient's brother, who suffered from kidney failure and atrial fibrillation, was positive for this mutation. The patient is on treatment with agalsidase beta. CONCLUSIONS: Fabry's disease must be suspected in young males with heart disease, stroke or peripheral neuropathy, skin lesions, kidney failure and a history of cases in the family. Hormone replacement therapy must be established at an early stage, as it can improve the prognosis.

TITLE: Ictus criptogenico en un paciente joven con cardiopatia y fallo renal.Introduccion. La enfermedad de Fabry es una patologia metabolica infrecuente ligada al cromosoma X, que provoca una amplia variedad de signos y sintomas. Caso clinico. Varon de 39 antilde;os que ingreso en nuestra unidad de ictus con hemiparesia derecha (1 + 0) y disartria (1). La puntuacion en la National Institute of Health Stroke Scale era de 2. Presentaba angioqueratomas en ambos muslos. La tomografia axial computarizada craneal mostraba un infarto agudo talamico izquierdo. El duplex de los troncos supraaorticos era normal, y el Doppler transcraneal reflejaba un aumento generalizado de los indices de pulsatilidad. El ecocardiograma transtoracico mostraba hipertrofia ventricular izquierda y dilatacion de la auricula izquierda. Recibio el alta cinco dias despues, asintomatico, con antiagregacion. El registro Holter-electrocardiografico prolongado mostraba fibrilacion auricular paroxistica. En la analitica de orina destacaba microalbuminuria de 281 mg/L. En vista de la afectacion multiorganica y la historia familiar, se curso estudio de enfermedad de Fabry. La actividad de la enzima alfa-galactosidasa-A se encontro disminuida, y se demostro la presencia de una mutacion en el gen GLA. Su hermano, que padecia insuficiencia renal y fibrilacion auricular, fue positivo para dicha mutacion. El paciente se encuentra en tratamiento con agalsidasa beta. Conclusiones. La enfermedad de Fabry debe sospecharse en varones jovenes con cardiopatia, ictus o neuropatia periferica, lesiones cutaneas, fallo renal e historia de familiares afectos. El tratamiento hormonal sustitutivo debe comenzarse precozmente, ya que puede mejorar el pronostico.

Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica / Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice

Las VI Guías Europeas de Prevención Cardiovascular recomiendan combinar las estrategias poblacional y de alto riesgo, con los cambios de estilo de vida como piedra angular de la prevención, y proponen la función SCORE para cuantificar el riesgo cardiovascular. Esta guía hace más hincapié en las intervenciones específicas de las enfermedades y las condiciones propias de las mujeres, las personas jóvenes y las minorías étnicas. No se recomienda el cribado de aterosclerosis subclínica con técnicas de imagen no invasivas. La guía establece cuatro niveles de riesgo (muy alto, alto, moderado y bajo), con objetivos terapéuticos de control lipídico según el riesgo. La diabetes mellitus confiere un riesgo alto, excepto en sujetos con diabetes tipo 2 con menos de 10 años de evolución, sin otros factores de riesgo ni complicaciones, o con diabetes tipo 1 de corta evolución sin complicaciones. La decisión de iniciar el tratamiento farmacológico de la hipertensión arterial dependerá del nivel de presión arterial y del riesgo cardiovascular, teniendo en cuenta la lesión de órganos diana. Siguen sin recomendarse los fármacos antiplaquetarios en prevención primaria por el riesgo de sangrado. La baja adherencia al tratamiento exige simplificar el régimen terapéutico e identificar y combatir sus causas. La guía destaca que los profesionales de la salud pueden ejercer un papel importante en la promoción de intervenciones poblacionales y propone medidas eficaces, tanto a nivel individual como poblacional, para promover una dieta saludable, la práctica de actividad física, el abandono del tabaquismo y la protección contra el abuso de alcohol

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don’t recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse

Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica / Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice

Las VI Guías Europeas de Prevención Cardiovascular recomiendan combinar las estrategias poblacional y de alto riesgo, con los cambios de estilo de vida como piedra angular de la prevención, y proponen la función SCORE para cuantificar el riesgo cardiovascular. Esta guía hace más hincapié en las intervenciones específicas de las enfermedades y las condiciones propias de las mujeres, las personas jóvenes y las minorías étnicas. No se recomienda el cribado de aterosclerosis subclínica con técnicas de imagen no invasivas. La guía establece cuatro niveles de riesgo (muy alto, alto, moderado y bajo), con objetivos terapéuticos de control lipídico según el riesgo. La diabetes mellitus confiere un riesgo alto, excepto en sujetos con diabetes tipo 2 con menos de 10 años de evolución, sin otros factores de riesgo ni complicaciones, o con diabetes tipo 1 de corta evolución sin complicaciones. La decisión de iniciar el tratamiento farmacológico de la hipertensión arterial dependerá del nivel de presión arterial y del riesgo cardiovascular, teniendo en cuenta la lesión de órganos diana. Siguen sin recomendarse los fármacos antiplaquetarios en prevención primaria por el riesgo de sangrado. La baja adherencia al tratamiento exige simplificar el régimen terapéutico e identificar y combatir sus causas. La guía destaca que los profesionales de la salud pueden ejercer un papel importante en la promoción de intervenciones poblacionales y propone medidas eficaces, tanto a nivel individual como poblacional, para promover una dieta saludable, la práctica de actividad física, el abandono del tabaquismo y la protección contra el abuso de alcohol

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don’t recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse

Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

[Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

Location of side branch access critically affects results in bifurcation stenting: Insights from bench modeling and computational flow simulation.

BACKGROUND: The aim of this study was to evaluate the impact of stent design and side branch access on final strut apposition during bifurcation stenting. METHODS AND RESULTS: A series of 6 different commercially available Drug Eluting Stents (DES) (n=42) were deployed in an identical model of a coronary bifurcation. Kissing Balloon (KB) optimization was performed after either proximal or distal recrossing of the guidewire and results were analyzed by micro-Computed-Tomography. Stent design only had a minor impact on side branch lumen area free of stent struts. Similar rate of strut malapposition was observed within the bifurcation when a consistent KB optimization protocol and an optimal distal recrossing of the wire to reaccess the side branch (SB) are followed. Conversely, proximal instead of distal cell recrossing toward the side branch produced a significant lower area of the side branch lumen free of struts than an optimal distal recrossing (60.3±7.1% versus 81.1±8.0%, p<0.0001), as well as a higher rate of strut malapposed toward the SB ostium (40.6±6.0% versus 26.0±5.7%, p=0.0005). CONCLUSIONS: Optimal cell recrossing of the guidewire may be critical to ensure successful stent optimization in bifurcation PCI.

MYC antagonizes the differentiation induced by imatinib in chronic myeloid leukemia cells through downregulation of p27(KIP1.).

Chronic myeloid leukemia (CML) progresses from a chronic to a blastic phase where the leukemic cells are proliferative and undifferentiated. The CML is nowadays successfully treated with BCR-ABL kinase inhibitors as imatinib and dasatinib. In the CML-derived K562 cell line, low concentrations of imatinib induce proliferative arrest and erythroid differentiation. We found that imatinib upregulated the cell cycle inhibitor p27(KIP1) (p27) in a time- and -concentration dependent manner, and that the extent of imatinib-mediated differentiation was severely decreased in cells with depleted p27. MYC (c-Myc) is a transcription factor frequently deregulated in human cancer. MYC is overexpressed in untreated CML and is associated to poor response to imatinib. Using K562 sublines with conditional MYC expression (induced by Zn(2+) or activated by 4-hydroxy-tamoxifen) we show that MYC prevented the erythroid differentiation induced by imatinib and dasatinib. The differentiation inhibition is not due to increased proliferation of MYC-expressing clones or enhanced apoptosis of differentiated cells. As p27 overexpression is reported to induce erythroid differentiation in K562, we explored the effect of MYC on imatinib-dependent induction of p27. We show that MYC abrogated the imatinib-induced upregulation of p27 concomitantly with the differentiation inhibition, suggesting that MYC inhibits differentiation by antagonizing the imatinib-mediated upregulation of p27. This effect occurs mainly by p27 protein destabilization. This was in part due to MYC-dependent induction of SKP2, a component of the ubiquitin ligase complex that targets p27 for degradation. The results suggest that, although MYC deregulation does not directly confer resistance to imatinib, it might be a factor that contributes to progression of CML through the inhibition of differentiation.

Metabolic syndrome and coronary heart disease among Spanish male workers: a case-control study of MESYAS.

BACKGROUND AND AIMS: In Spain, the incidence of coronary heart disease is below that expected based on the burden of classic cardiovascular risk factors present in the population. Whether the risk associated with metabolic syndrome is lower in Spain deserves to be investigated. This study evaluates the association of incident clinical coronary heart disease with metabolic syndrome and each of its individual defining components in a sample of Spanish working males. METHODS AND RESULTS: Among the workers of a factory (MESYAS registry), 208 incident cases of coronary heart disease (between 1981 and 2005) were age-matched with 2080 healthy workers visited in 2004-2005. Metabolic syndrome was characterized using modified criteria of the joint consensus definition (2009). Metabolic syndrome was strongly associated with coronary heart disease (OR = 4.03; 95% CI: 2.98, 5.45) and the risk seemed to be fully explained by metabolic syndrome components (OR = 0.84, p = 0.54 after adjustment). Odds ratios for the independent effects of the diagnostic criteria were: hypertriglyceridemia (OR = 3.39, p < 0.001), hyperglycemia (OR = 2.70, p < 0.001), low HDL cholesterol (OR = 2.35, p < 0.001), hypertension (OR = 1.49, p = 0.016) and overweight (OR = 1.07, p = 0.678). Young workers showed a higher risk associated with metabolic syndrome. CONCLUSION: The risk associated with metabolic syndrome is fully explained by its components considered independently. The risk of coronary heart disease in a Spanish male working population is considerably increased among those with metabolic syndrome, by a factor similar to that described for other countries. Public health measures to prevent a rise in the prevalence of metabolic syndrome are advisable to minimize cardiovascular disease rate in Spain.

Carga epidemiológica y económica de la hipertensión arterial en pacientes con síndrome metabólico en España: un modelo basado en la prevalencia / Epidemiological and economic burden of arterial hypertension in patients with metabolic syndrome in spain: a prevalence-based model

Introducción: La presencia del síndrome metabólico en pacientes hipertensos aumenta significativamente el riesgo de enfermedades cardiovasculares, diabetes tipo 2 y mortalidad. El objetivo fue calcular la carga epidemiológica y económica del síndrome metabólico en pacientes hipertensos para el Sistema Nacional de Salud español en 2008 y 2020. Material y métodos: Modelo de coste de la enfermedad basado en la prevalencia según grupo de edad, sexo y riesgo. Se utilizaron datos publicados sobre prevalencia, patrones de tratamiento, incidencia de mortalidad y episodios cardiovasculares, prevalencia de diabetes tipo 2 y costes del manejo, estimaciones de población y grupos de riesgo y del crecimientofuturo. Resultados: La prevalencia de la hipertensión arterial con síndrome metabólico en la población general fue del 11% en 2008 y del 22% según la estimación para 2020. La proporción de hipertensos con síndrome metabólico fue del 23% en 2008 y del 45% en 2020. La incidencia de episodios cardiovasculares y mortalidad fue dos veces superior en pacientes hipertensos con síndrome metabólico frente a hipertensos sin SM y la prevalencia de diabetes tipo 2 fue casi seis veces superior. La carga económica en 2008 ascendió a 1.909 millones de euros en 2008para los pacientes con síndrome metabólico. Conclusión: Los pacientes con síndrome metabólico representan casi la cuarta parte de la población hipertensa, pero generan casi la mitad de los costes. La carga económica probablemente se incrementará en el futuro por el envejecimiento de la población y el aumento de la prevalencia de los componentes del síndrome metabólico (AU)

Introduction: The presence of metabolic syndrome in patients with hypertension significantly increases the risk of cardiovascular disease, type 2 diabetes and mortality. This study has aimed to estimate the epidemiological and economic burden of the metabolic syndrome in patients with hypertension in Spain in 2008 and 2020 for the Spanish National Health System. Material and methods: A model on the cost of the diseased based on prevalence according to age, sex and risk group was used. The data published on prevalence, treatment patterns, mortality incidence and cardiovascular events, prevalence of type 2 diabetes and cost of management as well as population and risk groups and future growth estimates were used. Results: The prevalence of arterial hypertension with metabolic syndrome in the general population was 11% in 2008 and a value of 22% has been estimated for 2020. The proportion of hypertensive population with metabolic syndrome was 23% in 2008 and 45% has been estimated for 2020. Incidence of cardiovascular events and mortality was two fold higher among hypertensive patients with metabolic syndrome compared to those without it and prevalence of type2 diabetes was nearly six times higher. The economic burden in 2008 was estimated at D1, 909 million in 2008 for patiens with metabolic syndrome. Conclusion: Patients with metabolic syndrome currently make up about one-fourth of the population with hypertension but account for nearly half the costs. The economic burden is likely to increase in the future due to an aging population and an increase in the prevalence of components of metabolic syndrome (AU)

[Blood pressure and lipid control and coronary risk in the hypertensive population attended in Primary Care setting in Spain. The PRESCOT study]. / Control de presión arterial y lípidos y riesgo coronario en la población hipertensa asistida en Atención Primaria en España. Estudio PRESCOT.

OBJECTIVES AND METHODS: The aim of this cross-sectional and multicenter study was to determine the coronary risk of hypertensive patients attended in Spanish Primary Care and to evaluate whether blood pressure and LDL-cholesterol (LDL-c) control rates could change according to the ATP-III risk groups. Good blood pressure control was considered <140/90 mmHg (<130/80 mmHg for diabetics) and LDL-c according to the established by ATP-III for every risk group. RESULTS: A total of 12,954 patients were included in the study (49.9 % women, mean age 62.1+/-10.7 years). Of these, 12.6% belonged to the group of low risk, 45% to the medium risk group and 42.4% to the high risk group. The control rates were different according to the risk group (p <0.0001). Blood pressure control: 37.5 % in low risk, 30.2 % in medium and 15.4 % in high risk group. LDL-c control: 65.6 % in low risk group, 28 % in medium risk group and 12.3 % in high risk group. Only 25.8 % of the patients of low risk were controlled for both blood pressure and LDL-c, 9.6 % of medium risk group and 2.7 % of high risk group. CONCLUSIONS: The majority of hypertensive patients daily attended in Primary Care setting in Spain belongs to the medium or high coronary risk groups. Blood pressure and LDL-c controls rates in hypertensive population are low, and very few patients have both risk factors controlled. The control rates decline when the risk increases. In fact, less than 3% of high-risk patients have both parameters well controlled, what may result in significant clinical implications.

Contribution of malolactic fermentation by Oenococcus oeni and Lactobacillus plantarum to the changes in the nonanthocyanin polyphenolic composition of red wine.

The changes in the nonanthocyanin phenolic composition during red wine malolactic fermentation carried out spontaneously and by four different starter cultures of the species Oenococcus oeni and Lactobacillus plantarum were examined to determine whether differences in nonanthocyanin polyphenolic compounds could be attributed to the lactic acid bacteria (LAB) strain that performs this important step of the wine-making process. The polyphenolic compounds were analyzed by high-performance liquid chromatography with photodiode array detection and HPLC with electrospray ionization-mass spectrometry detection. The malolactic cultures selected for this study were indigenous wine LAB strains from the A.O.C. Rioja (Spain). Results showed different malolactic behaviors in relation to wine phenolic compositions for O. oeni and L. plantarum, and also, a diversity was found within each group. The hydroxycinnamic acids and their derivatives, the flavonols and their glycosides, the flavanol monomers and oligomers, and trans-resveratrol and its glucoside were the main compounds modified by the different LAB. The wild LAB population exerted a greater impact in the wine content of some of these phenolic compounds than the inoculated selected monocultures of this study.

Control de presión arterial y lípidos y riesgo coronario en la población hipertensa asistida en Atención Primaria en España. Estudio PRESCOT / Blood pressure and lipid control and coronary risk in the hypertensive population attended in Primary Care setting in Spain. The PRESCOT study

Objetivo y métodos. El objetivo de este trabajo, de diseño transversal y multicéntrico, fue conocer el perfil de riesgo coronario de los pacientes hipertensos que acuden a la consulta de Atención Primaria, y evaluar si el control de presión arterial y de colesterol LDL podía variar según el grupo de riesgo coronario ATP-III. Se consideró buen control de presión arterial cifras menores a 140/90 mmHg (< 130/80 mmHg en diabéticos) y de colesterol LDL los establecidos para ATP-III para cada grupo de riesgo. Resultados. Se incluyeron 12.954 pacientes (49,9% mujeres, 62,1 ± 10,7 años). El 12,6% pertenecía al grupo de bajo riesgo, el 45% al de riesgo medio y el 42,4% al de riesgo alto. El grado de control fue diferente según el grupo de riesgo (p < 0,0001). Así, para la presión arterial se alcanzó en un 37,5% de los sujetos de riesgo bajo, en un 30,2% de los del grupo de riesgo medio y en un 15,4% de los de riesgo alto, y para el colesterol LDL se consiguió en el 65,6% del grupo de riesgo bajo, el 28% del de riesgo medio y el 12,3% del de riesgo alto. Globalmente, si consideramos el control adecuado de presión arterial y de colesterol LDL, sólo el 25,8% de los de bajo riesgo estaba controlado, el 9,6% de los de riesgo medio y el 2,7% de los de riesgo alto. Conclusiones. La mayoría de los hipertensos asistidos diariamente en Atención Primaria en España son de riesgo medio o alto. Las cifras de control de presión arterial y colesterol LDL en los hipertensos en general son bajas y son muy pocos los pacientes que tienen cifras adecuadas de ambos factores de riesgo. Pero las tasas de control son aún peores según aumenta el riesgo coronario; de hecho, menos del 3% de los pacientes de alto riesgo tienen bien controlados ambos parámetros, con las implicaciones clínicas que ello conlleva (AU)

Objectives and methods. The aim of this cross-sectional and multicenter study was to determine the coronary risk of hypertensive patients attended in Spanish Primary Care and to evaluate whether blood pressure and LDL-cholesterol (LDL-c) control rates could change according to the ATP-III risk groups. Good blood pressure control was considered <140/90 mmHg (<130/80 mmHg for diabetics) and LDL-c according to the established by ATP-III for every risk group. Results. A total of 12,954 patients were included in the study (49.9 % women, mean age 62.1±10.7 years). Of these, 12.6% belonged to the group of low risk, 45% to the medium risk group and 42.4% to the high risk group. The control rates were different according to the risk group (p <0.0001). Blood pressure control: 37.5 % in low risk, 30.2 % in medium and 15.4 % in high risk group. LDL-c control: 65.6 % in low risk group, 28 % in medium risk group and 12.3 % in high risk group. Only 25.8 % of the patients of low risk were controlled for both blood pressure and LDL-c, 9.6 % of medium risk group and 2.7 % of high risk group. Conclusions. The majority of hypertensive patients daily attended in Primary Care setting in Spain belongs to the medium or high coronary risk groups. Blood pressure and LDL-c controls rates in hypertensive population are low, and very few patients have both risk factors controlled. The control rates decline when the risk increases. In fact, less than 3% of high-risk patients have both parameters well controlled, what may result in significant clinical implications (AU)

[Albuminuria and cardiovascular risk: basal results of the KORAL-CARDIO study]. / Albuminuria y riesgo cardiovascular. Estudio KORAL-CARDIO.

BACKGROUND AND OBJECTIVES: Albuminuria is a marker of higher cardiovascular and renal risk in hypertension; it also indicates the need of a tighter control of blood pressure with drugs blocking the renin-angiotensin system. The objective of the KORAL-CARDIO study was to assess the clinical picture and management of patients with hypertension and cardiac disease and albuminuria not previously treated with angiotensin inhibitors. METHODS: A total of 2711 hypertensive patients (44% female) with ischemic or hypertensive cardiopathy or atrial fibrillation and with a positive screening test for albuminuria was included. Type 2 diabetes was also present in 42%. RESULTS: Macroalbuminuria was present in 7.2% of non diabetic and 12.7% of diabetic patients, respectively. Associated complications were: 25% and 35% body mass index over 30 kg/m2; 22% and 39% ischemic heart disease; 4% and 8% stroke; 19% and 22% atrial fibrillation; 42% and 53% high cholesterol levels; 8% and 8% grade 3 hypertension, for non-diabetics and diabetics respectively. Antihypertensive monotherapy was used in 66% of non-diabetics and in 63% of diabetics; only 7% of patients in both groups were treated with triple antihypertensive therapy. CONCLUSIONS: Cardiovascular complications are very frequently associated to albuminuria in patients with hypertension and heart disease not previously treated with angiotensin inhibitors. Blood pressure control was clearly inadequate in this group.

[Heart transplant]. / Trasplante cardíaco.

A heart transplant is at present considered the treatment of choice in cases of terminal cardiac insufficiency refractory to medical or surgical treatment. Due to factors such as the greater life expectancy of the population and the more efficient management of acute coronary syndromes, there is an increasing number of people who suffer from heart failure. It is estimated that the prevalence of the disease in developed countries is around 1%; of this figure, some 10% are in an advanced stage and are thus potential receptors of a heart transplant. The problem is that it is still not possible to offer this therapeutic form to all of the patients that require it. Consequently, it is necessary to optimise the results of the heart transplant through the selection of patients, selection and management of donors, perioperative management and control of the disease due to graft rejection. Since the first transplant carried out in 1967, numerous advances and changes have taken place, which has made it possible to increase survival and quality of life of those who have received a new heart. In this article we review the most relevant aspects of the heart transplant and the challenges that are currently faced.

Screening for MECP2 mutations in Spanish patients with an unexplained mental retardation.

Rett syndrome (RTT) is an X-linked progressive encephalopathy. Mutations in the MECP2 (methyl-CpG-binding protein) gene have been found to cause RTT. In the past few years, the role of MECP2 mutations in patients with mental disorders other than RTT has been studied, finding that mutations in MECP2 also contribute to non-syndromic entities. More recently, it has been demonstrated that RTT shares clinical features with those of Angelman syndrome, another neurodevelopmental disorder. These observations must be confirmed in a large series, to better understand the criteria needed for justifying a molecular test. Consequently, we have searched for MECP2 mutations in 294 patients (43 Angelman and Prader-Willi like included) with mental retardation (MR) of unknown aetiology. We found six polymorphisms (three novel, three previously reported) in 10 patients, one novel unclassified silent change (p.V222V) in a man, and one causative mutation in a girl with MR. Once this case was clinically reviewed, the girl presented symptoms of atypical RTT. The mutation (p.Y141C) lies within the methyl-binding domain, and has only been reported once in another atypical RTT. Our results show that the MECP2 mutations account for a low frequency (1/416 chromosomes = 0.24%) among mentally retarded individuals, which imply that it is necessary to perform an exhaustive clinical examination of patients before determining whether analysis of MECP2 is required or not.

Trasplante cardíaco / Heart transplant

El trasplante cardíaco es considerado actualmente como el tratamiento de elección en la insuficiencia cardíaca terminal refractaria a tratamiento médico o quirúrgico. Debido a factores como la mayor esperanza de vida de la población y el manejo más eficaz de los síndromes coronarios agudos, cada vez hay un número mayor de personas que padecen fallo cardíaco. Se estima que la prevalencia de la enfermedad en países desarrollados está en torno al 1%; de éstos, un 10% está en una etapa avanzada y por tanto son potenciales receptores de un trasplante cardíaco. El problema está en que aún no es posible ofrecer esta modalidad terapéutica a todos los pacientes que la requieren. Por consiguiente, se hace necesario optimizar los resultados del trasplante cardíaco mediante la selección de pacientes, selección y manejo de los donantes, manejo perioperatorio y control de la enfermedad por rechazo del injerto. Desde el primer trasplante efectuado en diciembre de 1967, numerosos avances y cambios se han producido, lo que ha permitido aumentar la supervivencia y calidad de vida de quienes han recibido un nuevo corazón. A continuación se revisarán los aspectos más relevantes del trasplante cardíaco y los desafíos que enfrenta en la actualidad

A heart transplant is at present considered the treatment of choice in cases of terminal cardiac insufficiency refractory to medical or surgical treatment. Due to factors such as the greater life expectancy of the population and the more efficient management of acute coronary syndromes, there is an increasing number of people who suffer from heart failure. It is estimated that the prevalence of the disease in developed countries is around 1%; of this figure, some 10% are in an advanced stage and are thus potential receptors of a heart transplant. The problem is that it is still not possible to offer this therapeutic form to all of the patients that require it. Consequently, it is necessary to optimise the results of the heart transplant through the selection of patients, selection and management of donors, perioperative management and control of the disease due to graft rejection. Since the first transplant carried out in 1967, numerous advances and changes have taken place, which has made it possible to increase survival and quality of life of those who have received a new heart. In this article we review the most relevant aspects of the heart transplant and the challenges that are currently faced

Albuminuria y riesgo cardiovascular. Estudio KORAL-CARDIO / Albuminuria and cardiovascular risk: basal results of the Koral-Cardio study

Introducción y objetivos: La presencia de albuminuria identifica a un grupo dehipertensos con mayor riesgo cardiovascular y renal y obliga a controlar mejor lapresión arterial con fármacos que bloqueen el sistema renina-angiotensina. El objetivodel estudio KORAL-CARDIO fue determinar las características clínicas y demanejo de pacientes con hipertensión, albuminuria y cardiopatía no tratados previamentecon inhibidores angiotensínicos.Pacientes y métodos: Se incluyen prospectivamente 2.711 pacientes (44% mujeres)de 64 años de media con hipertensión arterial, cardiopatía isquémica o hipertensivao fibrilación auricular con positividad en la detección cualitativa de albuminuria.El 42% tenían además diabetes mellitus de tipo 2.Resultados: El 7,2% de los no diabéticos y el 12,7% de los diabéticos teníanmacroalbuminuria; el 25% y el 35% respectivamente tenían índice de masa corporalde más de 30 kg/m2. Las complicaciones asociadas fueron: cardiopatía isquémica(22 y 39%), ictus (4 y 8%), fibrilación auricular (19 y 22%), hipercolesterolemia(42 y 53%), hipertensión de grado 3 (8% en ambos casos). Recibíantratamiento antihipertensivo monofármaco el 66% de los no diabéticos y el 63%de los diabéticos, y sólo el 7% triple terapia; otros tratamientos fueron: hipolipemiantes(41 y 57%) y antiagregantes (37 y 58% respectivamente).Conclusiones: Las complicaciones asociadas a la albuminuria en hipertensos concardiopatías, diabéticos y no diabéticos, no tratados con inhibidores angiotensínicosson muy frecuentes. El grado de control tensional fue escaso en este grupo

Background and objectives: Albuminuria is a marker of higher cardiovascularand renal risk in hypertension; it also indicates the need of a tighter control of blood pressure with drugs blocking the renin-angiotensin system. The objective ofthe KORAL-CARDIO study was to assess the clinical picture and management ofpatients with hypertension and cardiac disease and albuminuria not previously treatedwith angiotensin inhibitors.Methods: A total of 2,711 hypertensive patients (44% female) with ischemic orhypertensive cardiopathy or atrial fibrillation and with a positive screening test foralbuminuria was included. Type 2 diabetes was also present in 42%.Results: Macroalbuminuria was present in 7.2% of non diabetic and 12.7% ofdiabetic patients, respectively. Associated complications were: 25% and 35% bodymass index over 30 kg/m2; 22% and 39% ischemic heart disease; 4% and 8%stroke; 19% and 22% atrial fibrillation; 42% and 53% high cholesterol levels; 8%and 8% grade 3 hypertension, for non-diabetics and diabetics respectively. Antihypertensivemonotherapy was used in 66% of non-diabetics and in 63% of diabetics;only 7% of patients in both groups were treated with triple antihypertensivetherapy.Conclusions: Cardiovascular complications are very frequently associated to albuminuriain patients with hypertension and heart disease not previously treatedwith angiotensin inhibitors. Blood pressure control was clearly inadequate in thisgroup

Sex differences and cardiovascular risk.

Cardiovascular risk factors such as diabetes confer differing degrees of risk in men and women.