European society of cardiology: Cardiovascular disease statistics 2019

peer reviewedAims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are and results drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index >_30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.523.1%] vs. 15.7% (IQR 14.521.1%)}, diabetes [7.7% (IQR 7.110.1%) vs. 5.6% (IQR 4.87.0%)], and among males smoking [43.8% (IQR 37.448.0%) vs. 26.0% (IQR 20.931.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.010.8) vs. 16.7% (IQR 13.919.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 56558115)] compared with high-income [2235 (IQR 18963602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest. © The Author(s) 2019

Effect of heat treatment of fishmeal on ruminal degradation, protein solubility and methionine sulphoxide content

One of the factors that determines the nutritive value of fishmeal as a protein concentrate for ruminants is its ruminal degradability, which varies with processing methods. It is possible that this variation could be related to the chemical modification of the amino acids/protein or to the change in protein solubility during the industrial processing. The objective of this work was to examine the effect of heat treatment of fishmeal on its ruminal degradability, protein solubility and the oxidation state of methionine.</jats:p

Effect of heat treatment of fishmeal on ruminal degradation, protein solubility and methionine sulphoxide content

One of the factors that determines the nutritive value of fishmeal as a protein concentrate for ruminants is its ruminal degradability, which varies with processing methods. It is possible that this variation could be related to the chemical modification of the amino acids/protein or to the change in protein solubility during the industrial processing. The objective of this work was to examine the effect of heat treatment of fishmeal on its ruminal degradability, protein solubility and the oxidation state of methionine.</jats:p

P1460 Atrial myxoma with atypical location in an asymptomatic patient

Abstract Introduction Primary cardiac tumours are rare. Most of them are benign, among which myxomas are the most common. Usually they occur in the left atrium (75%) but there are cases of right atrial myxomas. The majority of patients with atrial myxoma present with one or more symptoms of clinical triad of embolic events, intracardiac obstruction, or nonspecific manifestations. We report a rare case of cardiac myxoma arising from the right atrium as an accidental finding during routine medical checkup. Case report A 52 years-old woman was admitted to ambulatory care for a general checkup. At presentation, her heart rate was 82 bpm, regular and blood pressure was 150/90 mmHg. Other investigative results were normal. Her ECG showed normal sinus rhythm. She was sent for a routine echocardiography to judge for further treatment of the arterial hypertension. Transthoracic echocardiogram showed normal left ventricular ejection fraction. There was a mobile echogenic mass of nearly 6 cm2 in the right atrium, prolapsing through the tricuspid valve with mild tricuspid regurgitation without causing obstruction and protruding into the inferior vena cava (IVC). The transesophageal echocardiographic examination confirmed the presence of a mobile multilobular mass in the right atrial free wall close to the IVC origin. A total body angio-CT scan showed an intraatrial mass measuring approximately 5 × 4 cm, without infiltration of the adjacent structures, suggesting the diagnosis of myxoma. Coronary angiography revealed normal coronary arteries. The patient underwent median sternotomy under general anesthesia. The tumor was completely excised through a right atriotomy. The resected mass was sent for histological assessment which confirmed the diagnosis of myxoma. Discussion RA myxomas usually originate in the fossa ovalis or base of the interatrial septum, but in this case, the myxoma was implanted in the atrial inferior vena cava junction. Myxomas are usually polypoid and pedunculated tumors (approximately 83% of cases). In this report, our patient had a solitary, pedunculated mass with polypoid areas and a lobulated surface. Echocardiography remains the best diagnostic method for locating and assessing the extent of myxomas and for detecting their recurrence, with a sensitivity of up to 100%. However, transthoracic echocardiogram may not identify tumors smaller than 5 mm in diameter, and a transesophageal echocardiogram is required when there is suspicion of a very small tumor. In this case, an echocardiogram suggested the hypothesis of RA myxoma, which was confirmed by a histopathological exam. Myxomas are friable with high chance of systemic or pulmonary embolization depending on tumour location. Early diagnosis and timely surgical resection is the treatment of choice to prevent possible fatal consequences such as sudden death. Abstract P1460 Figure. Right Atrial Myxoma </jats:sec

A framework for assessing the impact of health research from a broad population perspective

Background: research in the health sector is an activity associated with an uncertain return on investment. This study aims to outline a multidimensional framework for assessing the impact of research funded by public (or mixed public and private) sponsors. Methods: a focus group representing different stakeholders was created to develop a sense of purpose that would be shared by the intended beneficiaries of the research assessment process, and others with a direct or indirect interest in a program\u2019s implementation. Results: a framework was designed that takes a holistic approach to the impact of research in which not only technical, but also economic, social and political dimensions are interrelated with the results achieved for the population and health services. Conclusions: the framework reflected the views of different stakeholders, favoring the development of the positive, proactive relationships essential to orienting the process of transforming the evidence emerging from research into action for health

La vicenda arbereshe tra storia e mito

I primi anni dell'insediamento albanese in Sicilia attraverso ricostruzioni mitiche relative sia alla dimensione religiosa che a quella legata all'intelligentsia locale: vera e propria costruzione d'identità