Contributions to the metallogenesis of the upper proterozoic-cambrian basement at the eastern sierras pampeanas: Mineralogy, thermometry and sulfur isotopes in the malagueño skarn (cu-fe±zn), sierra chica, córdoba, Argentina

El avance de las tareas de explotación de mármoles en Malagueño, Sierra Chica de Córdoba, Argentina,ha puesto al descubierto en la Cantera Centro, vetas, vetillas y lentes de pirrotina >pirita≅calcopirita >>esfalerita. Estoscuerpos mineralizados no superan los 0,3 m de espesor y los 2-3 m de largo continuo y, en conjunto, constituyen corridasintermitentes de hasta un centenar de metros. Los depósitos de sulfuros están asociados espacial y genéticamente acuerpos de skarn. La secuencia metasedimentaria, que hospeda a los depósitos de skarn, constituida mayoritariamente porgneises, anfibolitas y mármoles, está intruida por diques metagábricos anfibólicos con diferenciaciones dioríticas, diquesy plutones metatonalíticos y un metagranito álcali-feldespático; todo el complejo se halla metamorfizado en facies deanfibolita media a alta y fuertemente deformado como resultado del evento regional M2-D2/D3 que afectó al basamentoneoproterozoico-cámbrico durante la orogenia Pampeana. A excepción de los gneises, todas las litologías registran evidenciasde skarnificación diferencial, preferentemente desarrollada en mármoles, anfibolitas y metagranito, y en menor grado enlos diques metagabro-dioríticos y metatonalíticos. Las rocas metasomáticas están representadas por un skarn granatífero(Grs27-48Adr22-34Alm15-27Sps9-21) y piroxénico (Hd40-61Di35-54Jo4,7-6,4), formado a partir del reemplazo de un metagranito;un skarn esencialmente piroxénico (Hd42-63Di32-50Jo3-5) desarrollado a partir de anfibolitas y un skarn formado a partirde un mármol cálcico y constituido principalmente por granate (Adr54-71Grs22-40Alm4-7Sps1-2)±wollastonita. Los diquesevidencian pobre reemplazo metasomático y carecen de sulfuros de origen metasomático-hidrotermal. La asociaciónretrogradante se compone de hastingsita, ferroactinolita, epidoto, clinozoisita, sericita, plagioclasa (An18), chamosita ycalcita. Los sulfuros están asociados a la paragénesis de relleno tardía del skarn, depositada según la sucesión temporal:calcita→clinocloro→cuarzo→pirita→pirrotina→calcopirita+esfalerita, como vetas y vetillas en el skarn de granate-piroxenoy como lentes de pirrotina maciza en el skarn de piroxeno. Los datos microtermométricos obtenidos a partir de inclusionesfluidas en calcita asociada a los sulfuros, la variación de la relación Fe/Mg en clinocloro y las relaciones de equilibrio defases en pirrotina, sugieren que la paragénesis de relleno con sulfuros se formó entre ∼360 y 250 °C; cada rango termométricoguarda correspondencia con la secuencia temporal de precipitación de cada fase mineral, iniciada por descenso térmicoa partir de un fluido en ebullición de moderada a alta salinidad (∼14,5 a 33,5% en peso NaCl eq.). La elevada relaciónFe+2/(Fe+2+Fe+3) en granates y clinopiroxenos, los altos contenidos de granates subcálcicos (Alm+Sps), la presencia desulfuros como cristales hijos y las altas relaciones H2S/SO42- del fluido vinculado a la precipitación de sulfuros, sugierenque el sistema evolucionó dominantemente bajo condiciones reductoras, lo que es también consistente con la presencia depirrotina en la asociación de minerales sulfurados. La presencia de calcopirita y pirita diseminadas en metagabro-dioritas(Cu ~300 ppm), así como los elevados contenidos de Cu en anfibolitas (∼900 ppm) permiten interpretar a estas litologíascomo potenciales fuentes de metales (Cu-Fe-Zn±Ag). Los valores de δ34SΣfluido≈-4 a+1,4? calculados a partir del δ34S depirita, pirrotina y calcopirita entre 350 y 150 ºC, indican un origen magmático para el azufre, probablemente derivado dela lixiviación o desulfurización de los sulfuros primarios presentes en los intrusivos metagabro-dioríticos. Los metales yel azufre derivados de estos intrusivos y anfibolitas se habrían redistribuido en el skarn, movilizados por la acción de losfluidos metasomático-hidrotermales. Los skarns se habrían formado por infiltración de fluidos metasomáticos profundos einteracción fluido-roca que afectó las distintas litologías del basamento metamórfico-plutónico del Proterozoico superiorCámbrico. Los fluidos podrían provenir de intrusivos cámbricos no aflorantes o bien de la migmatización del basamentopampeano, canalizados a lo largo de contactos litológicos y fallas/fracturas. Las evidencias de yacencia, texturales ymineralógicas de la mineralización de sulfuros en Cantera Centro sugieren una edad cámbrica pos-deformacional asociadaal orógeno Pampeano.On-going mining operations in a marble quarry (Cantera Centro) from Malagueño, Sierra Chica de Córdoba, Argentina, have unearthed veins, veinlets and lenses of sulfides (pyrrhotite>pyrite≅chalcopyrite> >sphalerite). These veins and lenses are up to 0.3 m thick and 2-3 m long, although intermittently can extend about a hundred meters. They are associated with skarns. The metasedimentary host sequence, largely composed of gneisses, amphibolites and marbles, was intruded by amphibolic metagabbro and metadiorite dykes, metatonalite plutons and alkali-feldspar metagranites; the whole complex was metamorphosed into medium to high amphibolite facies and strongly deformed as a result of the a regional event M2-D2/D3 that affected the Neoproterozoic-Cambrian basement during the Pampean orogeny. Except for gneisses, all the other metamorphic lithologies register evidence of differential alteration into skarn, although the process was preferentially developed on marbles, amphibolites and metagranite, and to a lesser extent on mafic and mesosilicic dykes. The metasomatic rocks are characterized by a garnet>>pyroxene skarn (Grs27-48Adr22-34Alm15-27Sps9-21), formed after the replacement of the metagranite; a pyroxene-rich skarn (Hd42-63Di32-50Jo3-5) developed after para-amphibolite, and a garnet (Adr54-71Grs22-40Alm4-7Sps1-2) (±wollastonite) skarn that replaced a calcic marble. The dykes show poor metasomatic replacement and lack sulfides of metasomatic-hydrothermal origin. Retrograde mineral associations include hastingsite, ferroactinolite, epidote, clinozoisite, sericite, plagioclase (An18), chamosite and calcite. The sulfide mineralization is paragenetically associated with late-stage, infilling skarn-hydrothermal minerals that were sequentially deposited as: calcite→clinochlore→quartz→pyrite→pyrrhotite→chalcopyrite+sphalerite; these phases occur as veins and veinlets within the garnet-pyroxene skarn, and as massive pyrrhotite lenses in the piroxenerich skarn. Microthermometric data from fluid inclusions in sulfide related calcite, together with the geothermometric data from the Fe/Mg ratios in clinochlore and the phase equilibria data from intergrown high and low T ºC pyrrhotite phases, all constrain the infilling gangue phases and sulfide crystallization temperature within the ∼360 °C to 250 °C range; the gradual thermal decrease is in agreement with the temporal depositional sequence of the infilling phases. Fluid inclusion petrographic data and salinity estimations suggest that sulfide precipitation was triggered by boiling, from a fluid of moderate to high salinity (∼14.5 to 33.5 wt% eq. NaCl). Evidence that the fluid evolved under dominantly reducing conditions are the high Fe+2/(Fe+2+Fe+3) ratios and molar proportions of subcalcic garnet (Alm+Sps) in garnet-pyroxene skarn, the presence of fluid inclusion sulfide daughter crystals in calcite, the high H2 S/SO4 2- ratios in the sulfide-bearing fluid and the presence of pyrrhotite among the sulfide phases. Disseminated primary chalcopyrite and pyrite in metagabbro-diorite dykes (Cu ~300 ppm) and the high contents of Cu in amphibolite (∼900 ppm) suggest that these protolithic lithologies were the probable sources of metals (Cu>>Zn±Ag). Values of δ34SΣfluid between ≈-4 to +1.4‰ obtained from the fractionations factors of pyrite, pyrrhotite and chalcopyrite within the thermal range 350- 150 ºC, indicate a magmatic source for sulfur, likely provided by leaching or desulfidation of primary sulfides of the metagabbro-diorite dykes. Metals and sulfur supplied by these dykes and amphibolite would have been redistributed in the skarn after the circulation of the metasomatic-hydrothermal fluids. Skarn bodies would have formed by infiltration of deep metasomatic fluids and fluid-rock interaction which affected lithologies of the Upper Proterozoic-Cambrian metamorphic basement. Fluids could have derived from hidden Cambrian intrusives, or from the surrounding regional migmatization, channeled along lithological contacts and faults/fractures. Field setting, textural and mineralogical evidence of sulfide mineralization in the skarn assemblage of Cantera Centro, suggest a Cambrian age associated to the post-deformational stage of the Pampean Orogeny.Fil: Espeche, María José. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Museo de Mineralogía y Geología "Dr. A. Stelzner"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Lira, Raul. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Museo de Mineralogía y Geología "Dr. A. Stelzner"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Viñas, Nicolás A.. Michelotti E Hijos S.r.l.; Argentin

Contributions to the metallogenesis of the upper proterozoic-cambrian basement at the eastern sierras pampeanas: Mineralogy, thermometry and sulfur isotopes in the malagueño skarn (cu-fe±zn), sierra chica, córdoba, Argentina

El avance de las tareas de explotación de mármoles en Malagueño, Sierra Chica de Córdoba, Argentina,ha puesto al descubierto en la Cantera Centro, vetas, vetillas y lentes de pirrotina >pirita≅calcopirita >>esfalerita. Estoscuerpos mineralizados no superan los 0,3 m de espesor y los 2-3 m de largo continuo y, en conjunto, constituyen corridasintermitentes de hasta un centenar de metros. Los depósitos de sulfuros están asociados espacial y genéticamente acuerpos de skarn. La secuencia metasedimentaria, que hospeda a los depósitos de skarn, constituida mayoritariamente porgneises, anfibolitas y mármoles, está intruida por diques metagábricos anfibólicos con diferenciaciones dioríticas, diquesy plutones metatonalíticos y un metagranito álcali-feldespático; todo el complejo se halla metamorfizado en facies deanfibolita media a alta y fuertemente deformado como resultado del evento regional M2-D2/D3 que afectó al basamentoneoproterozoico-cámbrico durante la orogenia Pampeana. A excepción de los gneises, todas las litologías registran evidenciasde skarnificación diferencial, preferentemente desarrollada en mármoles, anfibolitas y metagranito, y en menor grado enlos diques metagabro-dioríticos y metatonalíticos. Las rocas metasomáticas están representadas por un skarn granatífero(Grs27-48Adr22-34Alm15-27Sps9-21) y piroxénico (Hd40-61Di35-54Jo4,7-6,4), formado a partir del reemplazo de un metagranito;un skarn esencialmente piroxénico (Hd42-63Di32-50Jo3-5) desarrollado a partir de anfibolitas y un skarn formado a partirde un mármol cálcico y constituido principalmente por granate (Adr54-71Grs22-40Alm4-7Sps1-2)±wollastonita. Los diquesevidencian pobre reemplazo metasomático y carecen de sulfuros de origen metasomático-hidrotermal. La asociaciónretrogradante se compone de hastingsita, ferroactinolita, epidoto, clinozoisita, sericita, plagioclasa (An18), chamosita ycalcita. Los sulfuros están asociados a la paragénesis de relleno tardía del skarn, depositada según la sucesión temporal:calcita→clinocloro→cuarzo→pirita→pirrotina→calcopirita+esfalerita, como vetas y vetillas en el skarn de granate-piroxenoy como lentes de pirrotina maciza en el skarn de piroxeno. Los datos microtermométricos obtenidos a partir de inclusionesfluidas en calcita asociada a los sulfuros, la variación de la relación Fe/Mg en clinocloro y las relaciones de equilibrio defases en pirrotina, sugieren que la paragénesis de relleno con sulfuros se formó entre ∼360 y 250 °C; cada rango termométricoguarda correspondencia con la secuencia temporal de precipitación de cada fase mineral, iniciada por descenso térmicoa partir de un fluido en ebullición de moderada a alta salinidad (∼14,5 a 33,5% en peso NaCl eq.). La elevada relaciónFe+2/(Fe+2+Fe+3) en granates y clinopiroxenos, los altos contenidos de granates subcálcicos (Alm+Sps), la presencia desulfuros como cristales hijos y las altas relaciones H2S/SO42- del fluido vinculado a la precipitación de sulfuros, sugierenque el sistema evolucionó dominantemente bajo condiciones reductoras, lo que es también consistente con la presencia depirrotina en la asociación de minerales sulfurados. La presencia de calcopirita y pirita diseminadas en metagabro-dioritas(Cu ~300 ppm), así como los elevados contenidos de Cu en anfibolitas (∼900 ppm) permiten interpretar a estas litologíascomo potenciales fuentes de metales (Cu-Fe-Zn±Ag). Los valores de δ34SΣfluido≈-4 a+1,4? calculados a partir del δ34S depirita, pirrotina y calcopirita entre 350 y 150 ºC, indican un origen magmático para el azufre, probablemente derivado dela lixiviación o desulfurización de los sulfuros primarios presentes en los intrusivos metagabro-dioríticos. Los metales yel azufre derivados de estos intrusivos y anfibolitas se habrían redistribuido en el skarn, movilizados por la acción de losfluidos metasomático-hidrotermales. Los skarns se habrían formado por infiltración de fluidos metasomáticos profundos einteracción fluido-roca que afectó las distintas litologías del basamento metamórfico-plutónico del Proterozoico superiorCámbrico. Los fluidos podrían provenir de intrusivos cámbricos no aflorantes o bien de la migmatización del basamentopampeano, canalizados a lo largo de contactos litológicos y fallas/fracturas. Las evidencias de yacencia, texturales ymineralógicas de la mineralización de sulfuros en Cantera Centro sugieren una edad cámbrica pos-deformacional asociadaal orógeno Pampeano.On-going mining operations in a marble quarry (Cantera Centro) from Malagueño, Sierra Chica de Córdoba, Argentina, have unearthed veins, veinlets and lenses of sulfides (pyrrhotite>pyrite≅chalcopyrite> >sphalerite). These veins and lenses are up to 0.3 m thick and 2-3 m long, although intermittently can extend about a hundred meters. They are associated with skarns. The metasedimentary host sequence, largely composed of gneisses, amphibolites and marbles, was intruded by amphibolic metagabbro and metadiorite dykes, metatonalite plutons and alkali-feldspar metagranites; the whole complex was metamorphosed into medium to high amphibolite facies and strongly deformed as a result of the a regional event M2-D2/D3 that affected the Neoproterozoic-Cambrian basement during the Pampean orogeny. Except for gneisses, all the other metamorphic lithologies register evidence of differential alteration into skarn, although the process was preferentially developed on marbles, amphibolites and metagranite, and to a lesser extent on mafic and mesosilicic dykes. The metasomatic rocks are characterized by a garnet>>pyroxene skarn (Grs27-48Adr22-34Alm15-27Sps9-21), formed after the replacement of the metagranite; a pyroxene-rich skarn (Hd42-63Di32-50Jo3-5) developed after para-amphibolite, and a garnet (Adr54-71Grs22-40Alm4-7Sps1-2) (±wollastonite) skarn that replaced a calcic marble. The dykes show poor metasomatic replacement and lack sulfides of metasomatic-hydrothermal origin. Retrograde mineral associations include hastingsite, ferroactinolite, epidote, clinozoisite, sericite, plagioclase (An18), chamosite and calcite. The sulfide mineralization is paragenetically associated with late-stage, infilling skarn-hydrothermal minerals that were sequentially deposited as: calcite→clinochlore→quartz→pyrite→pyrrhotite→chalcopyrite+sphalerite; these phases occur as veins and veinlets within the garnet-pyroxene skarn, and as massive pyrrhotite lenses in the piroxenerich skarn. Microthermometric data from fluid inclusions in sulfide related calcite, together with the geothermometric data from the Fe/Mg ratios in clinochlore and the phase equilibria data from intergrown high and low T ºC pyrrhotite phases, all constrain the infilling gangue phases and sulfide crystallization temperature within the ∼360 °C to 250 °C range; the gradual thermal decrease is in agreement with the temporal depositional sequence of the infilling phases. Fluid inclusion petrographic data and salinity estimations suggest that sulfide precipitation was triggered by boiling, from a fluid of moderate to high salinity (∼14.5 to 33.5 wt% eq. NaCl). Evidence that the fluid evolved under dominantly reducing conditions are the high Fe+2/(Fe+2+Fe+3) ratios and molar proportions of subcalcic garnet (Alm+Sps) in garnet-pyroxene skarn, the presence of fluid inclusion sulfide daughter crystals in calcite, the high H2 S/SO4 2- ratios in the sulfide-bearing fluid and the presence of pyrrhotite among the sulfide phases. Disseminated primary chalcopyrite and pyrite in metagabbro-diorite dykes (Cu ~300 ppm) and the high contents of Cu in amphibolite (∼900 ppm) suggest that these protolithic lithologies were the probable sources of metals (Cu>>Zn±Ag). Values of δ34SΣfluid between ≈-4 to +1.4‰ obtained from the fractionations factors of pyrite, pyrrhotite and chalcopyrite within the thermal range 350- 150 ºC, indicate a magmatic source for sulfur, likely provided by leaching or desulfidation of primary sulfides of the metagabbro-diorite dykes. Metals and sulfur supplied by these dykes and amphibolite would have been redistributed in the skarn after the circulation of the metasomatic-hydrothermal fluids. Skarn bodies would have formed by infiltration of deep metasomatic fluids and fluid-rock interaction which affected lithologies of the Upper Proterozoic-Cambrian metamorphic basement. Fluids could have derived from hidden Cambrian intrusives, or from the surrounding regional migmatization, channeled along lithological contacts and faults/fractures. Field setting, textural and mineralogical evidence of sulfide mineralization in the skarn assemblage of Cantera Centro, suggest a Cambrian age associated to the post-deformational stage of the Pampean Orogeny.Fil: Espeche, María José. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Museo de Mineralogía y Geología "Dr. A. Stelzner"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Lira, Raul. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Museo de Mineralogía y Geología "Dr. A. Stelzner"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Viñas, Nicolás A.. Michelotti E Hijos S.r.l.; Argentin

Isolated nocturnal hypertension in individuals with human immunodeficiency virus

Introducción: La hipertensión nocturna aislada se asocia a mayor cantidad de eventos cardiovasculares y daño de órgano blanco por hipertensión arterial. La prevalencia en poblaciones especiales no se encuentra del todo descrita. El objetivo del siguiente estudio es describir la prevalencia de hipertensión nocturna aislada en población conviviendo con el virus de la inmunodeficiencia humana, y observar su relación con las categorías de presión arterial en el consultorio y los fenotipos de la medición ambulatoria de presión arterial de 24 h. Metodología: Se realizó una cohorte retrospectiva en una población con el virus de la inmunodeficiencia humana en un hospital público de España, se registraron características clínico epidemiológicas, mediciones de presión arterial en consultorio y medición ambulatoria de presión arterial de 24 h (MAPA). Se realizó un análisis en función de los diferentes fenotipos de presión arterial por MAPA, así como también en función de las diferentes categorías de presión arterial de consultorio se calcularon los riesgos para la hipertensión nocturna aislada. Resultados: Se incluyeron en el análisis 116 individuos, sin medicación antihipertensiva ni antecedentes de enfermedad cardiovascular establecida. Se describió una prevalencia de hipertensión nocturna del 23,3%. No se pudo demostrar diferencias significativas entre fenotipos por MAPA de ninguna variable propia del VIH. No hubo diferencias de riesgo ajustadas entre las diferentes categorías de normotensos en consultorio. Conclusiones: La hipertensión nocturna aislada es más frecuente en pacientes con VIH, y los valores de presión arterial de consultorio en normotensos no son suficientes para predecir HTA nocturna aislada.Introduction: Isolated nocturnal hypertension is associated with a greater number of cardiovascular events and target organ damage due to arterial hypertension. It has been observed that patients in the general population with this entity do not have high blood pressure figures in the office; and it is necessary to perform an outpatient measurement to unmask it. The prevalence in special populations is not fully described. The objective of the following study is to describe the prevalence of isolated nocturnal hypertension in a population living with the human immunodeficiency virus and to observe its relationship with the categories of office blood pressure and the phenotypes of the 24-hour ambulatory blood pressure measurement. Methodology: A retrospective cohort was carried out in a population with human immunodeficiency virus in a public hospital in Spain, clinical epidemiological characteristics, office blood pressure measurements and 24-hour ambulatory blood pressure measurement (ABPM) were recorded. An analysis was performed based on the different ABPM blood pressure phenotypes, as well as based on the different office blood pressure categories, the risks for isolated nocturnal hypertension were calculated. Results: One hundred and sixteen individuals, without antihypertensive medication or history of established cardiovascular disease, were included in the analysis. A prevalence of nocturnal hypertension of 23.3% was described. It was not possible to demonstrate significant differences between phenotypes by ABPM of any variable specific to HIV. There were no adjusted risk differences between the different categories of office normotensives. Conclusions: Isolated nocturnal hypertension is more frequent in patients with HIV and office blood pressure values in normotensive patients are not sufficient to predict isolated nocturnal hypertension.Facultad de Ciencias Médica

Efecto del antígeno excretor-secretor de leishmania braziliensis sobre la fagocitosis en macrófagos.

Leishmania braziliensis es un flagelado digénico que causa patología en mamíferos.El insecto vector inocula formas promastigotes del parásito en el torrente circulatorio delhospedador. Los parásitos deben ser endocitados rápidamente por los macrófagos u otrosfagocitos, en los que se reproduce como amastigote dentro de una vacuola parasitófora; lospromastigotes que no son internalizados mueren. Se sabe que la activación de los macrófagos, pormoléculas como los lipopolisacáridos (LPS) por ejemplo, producen mediadores químicos queregulan la respuesta inmune humoral y determinan la producción de interleuquinas Th1 o Th2, perose desconoce el efecto de la activación de los macrófagos sobre el proceso de fagocitosis. Por otraparte, se ha visto que el antígeno excretor-secretor producido por promastigotes (AESPL) de L.donovani activa a macrófagos murinos para la producción de interleuquinas pero no se conoce suefecto sobre el proceso de fagocitosis

Treatment of seizures in the neonate: Guidelines and consensus-based recommendations—Special report from the ILAE Task Force on Neonatal Seizures

Seizures are common in neonates, but there is substantial management variability. The Neonatal Task Force of the International League Against Epilepsy (ILAE) developed evidence-based recommendations about antiseizure medication (ASM) management in neonates in accordance with ILAE standards. Six priority questions were formulated, a systematic literature review and meta-analysis were performed, and results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards. Bias was evaluated using the Cochrane tool and risk of Bias in non-randomised studies - of interventions (ROBINS-I), and quality of evidence was evaluated using grading of recommendations, assessment, development and evaluation (GRADE). If insufficient evidence was available, then expert opinion was sought using Delphi consensus methodology. The strength of recommendations was defined according to the ILAE Clinical Practice Guidelines development tool. There were six main recommendations. First, phenobarbital should be the first-line ASM (evidence-based recommendation) regardless of etiology (expert agreement), unless channelopathy is likely the cause for seizures (e.g., due to family history), in which case phenytoin or carbamazepine should be used. Second, among neonates with seizures not responding to first-line ASM, phenytoin, levetiracetam, midazolam, or lidocaine may be used as a second-line ASM (expert agreement). In neonates with cardiac disorders, levetiracetam may be the preferred second-line ASM (expert agreement). Third, following cessation of acute provoked seizures without evidence for neonatal-onset epilepsy, ASMs should be discontinued before discharge home, regardless of magnetic resonance imaging or electroencephalographic findings (expert agreement). Fourth, therapeutic hypothermia may reduce seizure burden in neonates with hypoxic–ischemic encephalopathy (evidence-based recommendation). Fifth, treating neonatal seizures (including electrographic-only seizures) to achieve a lower seizure burden may be associated with improved outcome (expert agreement). Sixth, a trial of pyridoxine may be attempted in neonates presenting with clinical features of vitamin B6-dependent epilepsy and seizures unresponsive to second-line ASM (expert agreement). Additional considerations include a standardized pathway for the management of neonatal seizures in each neonatal unit and informing parents/guardians about the diagnosis of seizures and initial treatment options

Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: an individual-level pooled analysis of 31 cohort studies

Background: Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains un- known. Methods: We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n = 168,287) and non-fatal (13 cohorts, n = 27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results: Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 10 0,0 0 0 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation: RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those esti- mated from cohorts in high-income countries

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Treatment of seizures in the neonate: Guidelines and consensus-based recommendations-Special report from the ILAE Task Force on Neonatal Seizures

Seizures are common in neonates, but there is substantial management variability. The Neonatal Task Force of the International League Against Epilepsy (ILAE) developed evidence-based recommendations about antiseizure medication (ASM) management in neonates in accordance with ILAE standards. Six priority questions were formulated, a systematic literature review and meta-analysis were performed, and results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards. Bias was evaluated using the Cochrane tool and risk of Bias in non-randomised studies - of interventions (ROBINS-I), and quality of evidence was evaluated using grading of recommendations, assessment, development and evaluation (GRADE). If insufficient evidence was available, then expert opinion was sought using Delphi consensus methodology. The strength of recommendations was defined according to the ILAE Clinical Practice Guidelines development tool. There were six main recommendations. First, phenobarbital should be the first-line ASM (evidence-based recommendation) regardless of etiology (expert agreement), unless channelopathy is likely the cause for seizures (e.g., due to family history), in which case phenytoin or carbamazepine should be used. Second, among neonates with seizures not responding to first-line ASM, phenytoin, levetiracetam, midazolam, or lidocaine may be used as a second-line ASM (expert agreement). In neonates with cardiac disorders, levetiracetam may be the preferred second-line ASM (expert agreement). Third, following cessation of acute provoked seizures without evidence for neonatal-onset epilepsy, ASMs should be discontinued before discharge home, regardless of magnetic resonance imaging or electroencephalographic findings (expert agreement). Fourth, therapeutic hypothermia may reduce seizure burden in neonates with hypoxic-ischemic encephalopathy (evidence-based recommendation). Fifth, treating neonatal seizures (including electrographic-only seizures) to achieve a lower seizure burden may be associated with improved outcome (expert agreement). Sixth, a trial of pyridoxine may be attempted in neonates presenting with clinical features of vitamin B6-dependent epilepsy and seizures unresponsive to second-line ASM (expert agreement). Additional considerations include a standardized pathway for the management of neonatal seizures in each neonatal unit and informing parents/guardians about the diagnosis of seizures and initial treatment options

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection