Clinical impact of acute kidney injury on short- and long-term outcomes after transcatheter aortic valve implantation with the CoreValve prosthesis

AbstractBackgroundAcute kidney injury (AKI) after cardiac surgery is associated with increased mortality, but few data exist on the occurrence and clinical impact of AKI associated with transcatheter aortic valve implantation (TAVI). The objective of this study was to determine the incidence and prognosis of AKI after percutaneous implantation of the CoreValve® (Medtronic, Minneapolis, MN, USA) prosthesis.MethodsA total of 357 patients with severe aortic stenosis and 9 patients with pure native aortic regurgitation were treated with the CoreValve prosthesis. AKI was defined according to Valve Academic Research Consortium criteria as the absolute increase in serum creatinine ≥0.3mg/dl at 72h post percutaneous procedure.ResultsAKI was identified in 58 patients (15.8%), none of whom required renal replacement therapy. In patients with AKI, the mortality at 30 days was 13.5% compared with 1.6% of patients without AKI, [odds ratio (OR)=12.2 (95% CI 3.53–41.9); p<0.001] and total mortality after a mean of 26.2±17 months was 29.3% vs. 14.9% [OR=2.36 (95% CI 1.23–4.51), p=0.008]. In the multivariate analysis, AKI was an independent predictor of cumulative total mortality [hazard ratio=2.151, (95% CI from 1.169 to 3.957), p=0.014].ConclusionsThe deterioration of renal function in patients undergoing TAVI with the CoreValve prosthesis is a serious and frequent complication. The occurrence of AKI was associated with increased early mortality and was also a predictor of worse outcomes in follow-up

GCAT|Genomes for life: a prospective cohort study of the genomes of Catalonia

PURPOSE: The prevalence of chronic non-communicable diseases (NCDs) is increasing worldwide. NCDs are the leading cause of both morbidity and mortality, and it is estimated that by 2030, they will be responsible for 80% of deaths across the world. The Genomes for Life (GCAT) project is a long-term prospective cohort study that was designed to integrate and assess the role of epidemiological, genomic and epigenomic factors in the development of major chronic diseases in Catalonia, a north-east region of Spain. PARTICIPANTS: At the end of 2017, the GCAT Study will have recruited 20 000 participants aged 40-65 years. Participants who agreed to take part in the study completed a self-administered computer-driven questionnaire, and underwent blood pressure, cardiac frequency and anthropometry measurements. For each participant, blood plasma, blood serum and white blood cells are collected at baseline. The GCAT Study has access to the electronic health records of the Catalan Public Healthcare System. Participants will be followed biannually at least 20 years after recruitment. FINDINGS TO DATE: Among all GCAT participants, 59.2% are women and 83.3% of the cohort identified themselves as Caucasian/white. More than half of the participants have higher education levels, 72.2% are current workers and 42.1% are classified as overweight (body mass index ≥25 and <30 kg/m2). We have genotyped 5459 participants, of which 5000 have metabolome data. Further, the whole genome of 808 participants will be sequenced by the end of 2017. FUTURE PLANS: The first follow-up study started in December 2017 and will end by March 2018. Residences of all subjects will be geocoded during the following year. Several genomic analyses are ongoing, and metabolomic and genomic integrations will be performed to identify underlying genetic variants, as well as environmental factors that influence metabolites

Newly impaired glucose metabolism and prognosis after percutaneous revascularization

Background: Clinical practice guidelines recommend ad hoc screening of diabetes in patients admitted for macrovascular disease; however, these recommendations are rarely followed in real practice. This study was undertaken to assess whether impaired glucose metabolism, newly diagnosed after percutaneous coronary intervention (PCI) or known diabetes, provides prognostic information. Methods: We studied 374 patients who underwent PCI. An oral glucose tolerance test was carried out in the known non-diabetic patients with fasting glucose &lt; 7 mmol/L. Results: Eighty-one percent of the patients presented impaired glucose metabolism, from which 35.3% were previously diagnosed with diabetics, 21.4% were newly detected diabetics, and 24.3% were pre-diabetics. After a mean follow-up of 35.8 ± 13.4 months, only a known history of diabetes was an independent predictor of revascularization (OR = 2.03, p = 0.025), non-fatal acute myocardial infarction (OR = 2.70, p = 0.029) and readmission due to heart failure during the follow-up (OR = 3.82, p = 0.022). Conclusions: Screening for impaired glucose metabolism after PCI permits the detection of a high proportion of patients with abnormal glucose regulations. However, previously known diabetes remains the only independent predictor of cardiovascular events in the follow-up.

GCAT|Genomes for life : A prospective cohort study of the genomes of Catalonia

The prevalence of chronic non-communicable diseases (NCDs) is increasing worldwide. NCDs are the leading cause of both morbidity and mortality, and it is estimated that by 2030, they will be responsible for 80% of deaths across the world. The Genomes for Life (GCAT) project is a long-term prospective cohort study that was designed to integrate and assess the role of epidemiological, genomic and epigenomic factors in the development of major chronic diseases in Catalonia, a north-east region of Spain. Participants At the end of 2017, the GCAT Study will have recruited 20 000 participants aged 40-65 years. Participants who agreed to take part in the study completed a self-administered computer-driven questionnaire, and underwent blood pressure, cardiac frequency and anthropometry measurements. For each participant, blood plasma, blood serum and white blood cells are collected at baseline. The GCAT Study has access to the electronic health records of the Catalan Public Healthcare System. Participants will be followed biannually at least 20 years after recruitment. Findings to date Among all GCAT participants, 59.2% are women and 83.3% of the cohort identified themselves as Caucasian/white. More than half of the participants have higher education levels, 72.2% are current workers and 42.1% are classified as overweight (body mass index ≥25 and <30 kg/m 2). We have genotyped 5459 participants, of which 5000 have metabolome data. Further, the whole genome of 808 participants will be sequenced by the end of 2017. Future plans The first follow-up study started in December 2017 and will end by March 2018. Residences of all subjects will be geocoded during the following year. Several genomic analyses are ongoing, and metabolomic and genomic integrations will be performed to identify underlying genetic variants, as well as environmental factors that influence metabolites

Uso de composta, minerales primarios amorfos y microorganismos para la producción y calidad de tomate

This research was carried out with the aim to determine the influence of the bocashi compost, amorphous primary minerals and microorganisms in post-harvest yield and quality of saladette tomato (Lycopersicum esculentum Mill.) hibrid “Moctezuma”. The crop was carried in soil under greenhouse conditions during the agricultural cycle 2011-2012 autumn-winter. A population density of 2.5 plants m2 managed to a single stem and a separation of 1.6 m between rows was used. The bocashi compost and amorphous primary minerals were incorporated into the soil 30 days before the start of cultivation. Total and extra-large, large, medium and small tomatoes yields of eight clusters per plant and their postharvest quality were evaluated. An experimental design of randomized complete blocks with nine treatments was applied for yield variables, while a completely randomized design was used for postharvest quality variables. The highest yield (113.97 Mg ha-1) was obtained with the treatment consisting of 25 and 6 Mg ha-1 of compost and amorphous primary minerals, respectively, which exceeded 9.3% those achieved with the Steiner solution based treatments, although no significant statistically difference were found between the two averages. pH, titratable acidity and total soluble solids of fruits were not significantly affected by treatments.La presente investigación se realizó con el objetivo de determinar el efecto de la composta bocashi, minerales primarios amorfos y microorganismos en el rendimiento y calidad postcosecha de tomate tipo saladette (Lycopersicum esculentum Mill.), híbrido “Moctezuma”. El cultivo se realizó en suelo bajo condiciones de invernadero, durante el ciclo agrícola otoño-invierno 2011-2012. Se utilizó una densidad de población de 2,5 plantas m2, manejadas a un tallo y con una separación de 1,6 m entre hileras. La composta bocashi, los minerales primarios amorfos y los microorganismos fueron incorporados al suelo 30 días antes del inicio del cultivo, y estos últimos también se aplicaron después del trasplante. Se evaluó el rendimiento total y de tomates extra grandes, grandes, medianos y chicos de ocho racimos por planta, así como su calidad postcosecha. Para las variables de rendimiento se consideró un diseño experimental de bloques completos al azar conformado por nueve tratamientos, mientras que para el estudio de calidad postcosecha se utilizó un diseño completamente al azar con los mismos tratamientos. El mayor rendimiento (113,97 Mg ha-1) se obtuvo con el tratamiento compuesto por 25 y 6 Mg ha-1 de composta y minerales primarios amorfos, respectivamente, el cual superó en 9,3 % a los rendimientos logrados solo con la solución Steiner, aunque sin diferencia estadísticamente significativa entre ambos promedios. Los tratamientos no tuvieron ningún efecto en el pH, la acidez titulable y los sólidos solubles totales

The effect of post-discharge educational intervention on patients in achieving objectives in modifiable risk factors six months after discharge following an episode of acute coronary syndrome, (CAM-2 Project): a randomized controlled trial

<p>Abstract</p> <p>Objectives</p> <p>We investigated whether an intervention mainly consisting of a signed agreement between patient and physician on the objectives to be reached, improves reaching these secondary prevention objectives in modifiable cardiovascular risk factors six-months after discharge following an acute coronary syndrome.</p> <p>Background</p> <p>There is room to improve mid-term adherence to clinical guidelines' recommendations in coronary heart disease secondary prevention, specially non-pharmacological ones, often neglected.</p> <p>Methods</p> <p>In CAM-2, patients discharged after an acute coronary syndrome were randomly assigned to the intervention or the usual care group. The primary outcome was reaching therapeutic objectives in various secondary prevention variables: smoking, obesity, blood lipids, blood pressure control, exercise and taking of medication.</p> <p>Results</p> <p>1757 patients were recruited in 64 hospitals and 1510 (762 in the intervention and 748 in the control group) attended the six-months follow-up visit. After adjustment for potentially important variables, there were, between the intervention and control group, differences in the mean reduction of body mass index (0.5 vs. 0.2; p < 0.001) and waist circumference (1.6 cm vs. 0.6 cm; p = 0.05), proportion of patients who exercise regularly and those with total cholesterol below 175 mg/dl (64.7% vs. 56.5%; p = 0.001). The reported intake of medications was high in both groups for all the drugs considered with no differences except for statins (98.1% vs. 95.9%; p = 0.029).</p> <p>Conclusions</p> <p>At least in the short term, lifestyle changes among coronary heart disease patients are achievable by intensifying the responsibility of the patient himself by means of a simple and feasible intervention.</p

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Evolución en la epidemiología de la hemorragia digestiva alta no varicosa desde el año 1985 hasta 2006 Evolution in the epidemiology of non-variceal upper digestive hemorrhage from 1985 to 2006

Objetivos: describir los cambios que se han producido en las características de los pacientes aquejados de hemorragia digestiva alta no varicosa y en la epidemiología de la misma. Material y métodos: mediante un estudio prospectivo observacional de la incidencia y causas de la hemorragia digestiva no varicosa en el área de salud correspondiente al Hospital Virgen de las Nieves de Granada, España, comparando tres periodos: durante 1985 (grupo 1): 284 pacientes; otro en 1996 (grupo 2): 259 pacientes; y en 2006 (grupo 3) : 291 casos. Resultados: la incidencia estudiada es de 71/100.000 habitantes al año en el grupo 1, 64 en el 2 y 66 en el 3. La edad media en 1985 fue de 57,4 años; en 1996: de 59,6 años; y en 2006 de 62,38. En todos los grupos evidenciamos una mayoría de hombres (75,4, 69,5 y 72,2% respectivamente). Entre las causas destaca: ulcus duodenal (1: 40,5%; 2: 43,2%; 3: 40,5%), úlcera gástrica (1: 24,3%; 2: 30%; 3: 18,9%), LAMG (1: 15,3%; 2: 8,9%; 3: 9,6%), neoplasia (1: 1,7%; 2: 1,9%; 3: 5,2%), lesiones vasculares ( 1: 0,5%; 2: 1,5%; 3: 9,3%). La mortalidad en 1985: 2,5%; 1996: 1,5%; y 2006: 1%. Conclusiones: aumento significativo de la edad media con el paso de los años. La causa más frecuente es el ulcus duodenal; seguida del gástrico. Señalamos el aumento de la proporción de las neoplasias y sobre todo de las lesiones vasculares de la última serie respecto a las primeras. No encontramos diferencias significativas en la mortalidad entre los diferentes grupos.Objectives: to describe changes occurred in the characteristics of patients suffering from non-variceal upper gastrointestinal bleeding, and in this condition&rsquo;s epidemiology. Methods: a prospective study was carried out to examine the occurrence and causes of non-variceal upper digestive bleeding in the corresponding health department at Virgen de las Nieves Hospital in Granada, Spain. In this study three periods of time were compared. Group 1 (1985): 284 patients; group 2 (1996): 259 patients; and group 3 (2006) 291 patients. Results: in group 1 the incidence was 71/100,000 inhabitants; in group 2, 64/100,000; and in group 3, 66/100,000. Mean age in 1985 was 57.4; in 1996, 59.6; and in 2006, 62.38. In all groups a majority of cases were men (75.4, 69.5, and 72.2%, respectively). Major causes included duodenal ulcer (1: 40.5%; 2: 43.2%; 3: 40.5%), gastric ulcer (1: 24.3%; 2: 30%; 3: 18.9%); LAMG (1: 53.3%; 2: 43.2%; 3: 9.6%); neoplasia (1: 1.7%; 2: 1.9%; 3: 5.2%), and vascular injuries (1: 0.5%; 2: 1.5%; 3: 9.3%). The death rate was 2.5% in 1985; 1.5% in 1996; and 1% in 2006. Conclusions: a significant increase in mean age over the years was detected. The most frequent cause of hemorrhage was duodenal ulcer followed by gastric ulcer. Of significance is an increase in the proportion of neoplasms above of vascular injuries in the later group as apposed to the earlier one. We found no significant difference in mortality between groups

Efecto del ejercicio sobre las velocidades de flujo sistólico ventricular izquierdo en adultos sanos

Ecocardiografía esfuerzo. Gradiente intraventricular izquierdo. Ventrículo izquierdo