Relationship between electrocardiographic characteristics of left bundle branch block and echocardiographic findings

Background: Complete left bundle branch block (CLBBB) is an electrocardiographic (ECG) dromotropic disorder seen in patients with various structural heart diseases and sometimes is associated with poor prognosis. Its presence confounds the application of standard ECG criteria for the diagnosis of left ventricular hypertrophy (LVH), myocardial infarction (MI) in the chronic phase, and pathologies that produce changes on ST-T segment. The aim of this investigation was to establish the relationship between CLBBB and cardiac structural abnormalities assessed by echocardiography. Methods: This observational, cross-sectional study included ECG with CLBBB from 101 patients who also had transthoracic echocardiogram (TTE) performed within 6 months. Results: The prevalence of structural heart disease on TTE was 90%. No ECG criterion was useful to diagnose LVH since no relationship was observed between 9 different ECG signs and increased left ventricular mass index. QRS duration (p = 0.16) and left axis deviation (p = 0.09) were unrelated to reduced left ventricular ejection fraction (LVEF). Eight ECG signs proposed for the diagnosis of the chronic phase of MI demonstrated similar effectiveness, with high specificity and reduced sensitivity. Conclusions: CLBBB is associated with elevated prevalence of cardiac structural disease and hinders the application of common ECG criteria for the diagnosis of LVH, reduced LVEF, or chronic phase of MI. No ECG finding distinguished patients with structural heart disease from those with normal hearts. Electrocardiographic criteria for the diagnosis of MI in the chronic phase are useful when present, but when absent cannot rule it out.

First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR)

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.Fil: Pons Estel, Bernardo A.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Bonfa, Eloisa. Universidade de Sao Paulo; BrasilFil: Soriano, Enrique R.. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cardiel, Mario H.. Centro de Investigación Clínica de Morelia; MéxicoFil: Izcovich, Ariel. Hospital Alemán; ArgentinaFil: Popoff, Federico. Hospital Aleman; ArgentinaFil: Criniti, Juan M.. Hospital Alemán; ArgentinaFil: Vásquez, Gloria. Universidad de Antioquia; ColombiaFil: Massardo, Loreto. Universidad San Sebastián; ChileFil: Duarte, Margarita. Hospital de Clínicas; ParaguayFil: Barile Fabris, Leonor A.. Hospital Angeles del Pedregal; MéxicoFil: García, Mercedes A.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Amigo, Mary Carmen. Centro Médico Abc; MéxicoFil: Espada, Graciela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Catoggio, Luis J.. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Sato, Emilia Inoue. Universidade Federal de Sao Paulo; BrasilFil: Levy, Roger A.. Universidade do Estado de Rio do Janeiro; BrasilFil: Acevedo Vásquez, Eduardo M.. Universidad Nacional Mayor de San Marcos; PerúFil: Chacón Díaz, Rosa. Policlínica Méndez Gimón; VenezuelaFil: Galarza Maldonado, Claudio M.. Corporación Médica Monte Sinaí; EcuadorFil: Iglesias Gamarra, Antonio J.. Universidad Nacional de Colombia; ColombiaFil: Molina, José Fernando. Centro Integral de Reumatología; ColombiaFil: Neira, Oscar. Universidad de Chile; ChileFil: Silva, Clóvis A.. Universidade de Sao Paulo; BrasilFil: Vargas Peña, Andrea. Hospital Pasteur Montevideo; UruguayFil: Gómez Puerta, José A.. Hospital Clinic Barcelona; EspañaFil: Scolnik, Marina. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Pons Estel, Guillermo J.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; Argentina. Hospital Provincial de Rosario; ArgentinaFil: Ugolini Lopes, Michelle R.. Universidade de Sao Paulo; BrasilFil: Savio, Verónica. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Drenkard, Cristina. University of Emory; Estados UnidosFil: Alvarellos, Alejandro J.. Hospital Privado Universitario de Córdoba; ArgentinaFil: Ugarte Gil, Manuel F.. Universidad Cientifica del Sur; Perú. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Babini, Alejandra. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cavalcanti, André. Universidade Federal de Pernambuco; BrasilFil: Cardoso Linhares, Fernanda Athayde. Hospital Pasteur Montevideo; UruguayFil: Haye Salinas, Maria Jezabel. Hospital Privado Universitario de Córdoba; ArgentinaFil: Fuentes Silva, Yurilis J.. Universidad de Oriente - Núcleo Bolívar; VenezuelaFil: Montandon De Oliveira E Silva, Ana Carolina. Universidade Federal de Goiás; BrasilFil: Eraso Garnica, Ruth M.. Universidad de Antioquia; ColombiaFil: Herrera Uribe, Sebastián. Hospital General de Medellin Luz Castro de Gutiérrez; ColombiaFil: Gómez Martín, DIana. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Robaina Sevrini, Ricardo. Universidad de la República; UruguayFil: Quintana, Rosana M.. Hospital Provincial de Rosario; Argentina. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Gordon, Sergio. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Fragoso Loyo, Hilda. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Rosario, Violeta. Hospital Docente Padre Billini; República DominicanaFil: Saurit, Verónica. Hospital Privado Universitario de Córdoba; ArgentinaFil: Appenzeller, Simone. Universidade Estadual de Campinas; BrasilFil: Dos Reis Neto, Edgard Torres. Universidade Federal de Sao Paulo; BrasilFil: Cieza, Jorge. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: González Naranjo, Luis A.. Universidad de Antioquia; ColombiaFil: González Bello, Yelitza C.. Ceibac; MéxicoFil: Collado, María Victoria. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Sarano, Judith. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Retamozo, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Sattler, María E.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gamboa Cárdenas, Rocio V.. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Cairoli, Ernesto. Universidad de la República; UruguayFil: Conti, Silvana M.. Hospital Provincial de Rosario; ArgentinaFil: Amezcua Guerra, Luis M.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Silveira, Luis H.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Borba, Eduardo F.. Universidade de Sao Paulo; BrasilFil: Pera, Mariana A.. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Alba Moreyra, Paula B.. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: Arturi, Valeria. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Berbotto, Guillermo A.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gerling, Cristian. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Gobbi, Carla Andrea. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gervasoni, Viviana L.. Hospital Provincial de Rosario; ArgentinaFil: Scherbarth, Hugo R.. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Brenol, João C. Tavares. Hospital de Clinicas de Porto Alegre; BrasilFil: Cavalcanti, Fernando. Universidade Federal de Pernambuco; BrasilFil: Costallat, Lilian T. Lavras. Universidade Estadual de Campinas; BrasilFil: Da Silva, Nilzio A.. Universidade Federal de Goiás; BrasilFil: Monticielo, Odirlei A.. Hospital de Clinicas de Porto Alegre; BrasilFil: Seguro, Luciana Parente Costa. Universidade de Sao Paulo; BrasilFil: Xavier, Ricardo M.. Hospital de Clinicas de Porto Alegre; BrasilFil: Llanos, Carolina. Universidad Católica de Chile; ChileFil: Montúfar Guardado, Rubén A.. Instituto Salvadoreño de la Seguridad Social; El SalvadorFil: Garcia De La Torre, Ignacio. Hospital General de Occidente; MéxicoFil: Pineda, Carlos. Instituto Nacional de Rehabilitación; MéxicoFil: Portela Hernández, Margarita. Umae Hospital de Especialidades Centro Medico Nacional Siglo Xxi; MéxicoFil: Danza, Alvaro. Hospital Pasteur Montevideo; UruguayFil: Guibert Toledano, Marlene. Medical-surgical Research Center; CubaFil: Reyes, Gil Llerena. Medical-surgical Research Center; CubaFil: Acosta Colman, Maria Isabel. Hospital de Clínicas; ParaguayFil: Aquino, Alicia M.. Hospital de Clínicas; ParaguayFil: Mora Trujillo, Claudia S.. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Muñoz Louis, Roberto. Hospital Docente Padre Billini; República DominicanaFil: García Valladares, Ignacio. Centro de Estudios de Investigación Básica y Clínica; MéxicoFil: Orozco, María Celeste. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Burgos, Paula I.. Pontificia Universidad Católica de Chile; ChileFil: Betancur, Graciela V.. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Alarcón, Graciela S.. Universidad Peruana Cayetano Heredia; Perú. University of Alabama at Birmingahm; Estados Unido

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Concordance between Carotid and Femoral Ultrasound for the Diagnosis of Subclinical Atherosclerosis in Patients with Low or Intermediate Cardiovascular Risk

Background: Approximately 50% of coronary events and sudden death occur in patients with low or intermediate cardiovascular risk, as determined by the Framingham risk score. Subclinical atherosclerosis in the carotid and femoral territories is a powerful predictor of cardiovascular events. Identifying patients with subclinical atherosclerosis allows reclassification of the cardiovascular risk in an individualized manner. Objective: The aim of this study was to investigate the prevalence of subclinical atherosclerosis in both territories in patients with low or intermediate cardiovascular risk, to evaluate the diagnostic agreement between carotid and femoral Doppler ultrasound, and to determine the independent predictors of subclinical atherosclerosis in both locations. Methods: Patients with low or intermediate risk of the Framingham risk score underwent carotid and femoral Doppler ultrasound for the diagnosis of subclinical atherosclerosis; patients with diabetes and those treated with statins were excluded. Results: A total of 207 patients were included: 50.2% were classified as low-risk patients, 50.2% were women, and mean age was 52±9 years. The prevalence of subclinical atherosclerosis was 42.5%. The concordance between carotid and femoral Doppler ultrasound was weak (kappa 0.28; 95% CI, 0.13-0.44). Age and sex were independent predictors of subclinical atherosclerosis in both territories, while smoking was an independent and powerful predictor only in the femoral arteries. Conclusions: Approximately 40% of patients with low or intermediate cardiovascular risk of the Framingham risk score have evidence of subclinical atherosclerosis. Concordance between the carotid and femoral Doppler ultrasound is weak, implying that the two methods identify subclinical atherosclerosis in different populations of patients.Introducción: Aproximadamente el 50% de los eventos coronarios y la muerte súbita tienen lugar en pacientes con riesgo cardiovascular bajo o intermedio del puntaje de Framingham. La aterosclerosis subclínica en los territorios carotídeo y femoral es un potente indicador de eventos cardiovasculares. La identificación de los pacientes con aterosclerosis subclínica permite reclasificar el riesgo cardiovascular de manera individual. Objetivos: Investigar la prevalencia de aterosclerosis subclínica en pacientes con riesgo cardiovascular bajo o intermedio, evaluar la concordancia entre el eco-Doppler carotídeo y el femoral para su diagnóstico y determinar los indicadores independientes en ambas localizaciones. Material y métodos: Se realizó eco-Doppler carotídeo y femoral a pacientes con riesgo bajo o intermedio del puntaje de Framingham para detectar aterosclerosis subclínica; se excluyeron los pacientes diabéticos y los tratados con estatinas. Resultados: Se incluyeron 207 pacientes; el 50,2% eran de riesgo bajo, el 50,2% eran mujeres y la edad media fue de 52 ± 9 años. La prevalencia de aterosclerosis subclínica fue del 42,5%. La concordancia entre el eco-Doppler carotídeo y el femoral fue débil (coeficiente kappa 0,28, IC 95% 0,13-0,44). La edad y el sexo fueron indicadores independientes de aterosclerosis subclínica en ambos territorios, mientras que el tabaquismo fue un poderoso indicador solo en las arterias femorales. Conclusiones: Aproximadamente el 40% de los pacientes con riesgo cardiovascular bajo o intermedio del puntaje de Framingham tienen evidencia de aterosclerosis subclínica. La concordancia entre el eco-Doppler carotídeo y el femoral es débil, lo que implica que ambos métodos identifican aterosclerosis subclínica en diferentes poblaciones de pacientes

Efecto hipoglicemiante del extracto acuoso de las hojas de Smallanthus sonchifolius (Yacón) en pacientes con diabetes mellitus tipo 2

The present study was conducted to evaluate the hypoglycemic effect of Smallanthus sonchifolius (yacon) leaves, in the form of infusion (aqueous extract) administered to patients with type 2 diabetes mellitus. After signing informed consent, were included 206 people aged 30 to 70 years old, male and female: 105 diagnosed with type 2 diabetes mellitus and 101 apparently healthy control group. Type 2 diabetic patients were people who go to Scholar Healthcare of Clinical Analysis (SAAAC), Office of Pharmaceutical Care (GAF) of the Faculty of Pharmacy and Biochemistry, Club of type 2 diabetic patients of Cayetano Heredia Hospital and Patrucco Raul Puig Health Center (CERIT). From type 2 diabetic patients receiving drug treatment, there were 46 metabolically controlled patients and 59 not metabolically controlled ones. The latter group was given filter bags of yacon leaves of 1 g each, to be taken as an infusion three times a day for 90 days, plus glibenclamide. The apparently healthy subjects were divided into two groups, one ingested the yacon leaf tea and the other not. All were determined in fasting: glucose concentration, glycosylated hemoglobin (HbA1c) and fructosamine before and after treatment. After treatment, it was found that administration of the leaf tea yacon values decreased by 42.7 % glucose, glycosylated hemoglobin 21.7 % and fructosamine 33,78 %, with a statistically significant difference with baseline values. The effectiveness of the studied combination is able to reduce HbA1c by 4.5 % at 30 days and 21.7 % at 90 days. In conclusion, infusion of leaves Smallanthus sonchifolius (yacon) administered to patients with type 2 diabetes mellitus, has a beneficial protective effect on glycemic control.El presente estudio se realizó con el objetivo de evaluar el efecto hipoglicemiante de las hojas de Smallanthus sonchifolius (yacón), en la forma de infusión (extracto acuoso), administrada a pacientes con diabetes mellitus tipo 2. Previa firma de su consentimiento informado, participaron 206 personas de 30 a 70 años de edad, hombres y mujeres: 105 con diagnostico de diabetes mellitus tipo 2 y 101 aparentemente sanas, como grupo control. Los pacientes diabéticos tipo 2 fueron personas que acuden al Servicio Académico Asistencial de Análisis Clínicos (SAAAC), al Gabinete de Atención Farmacéutica (GAF) de la Facultad de Farmacia y Bioquímica, al Club de diabéticos tipo 2 del Hospital Cayetano Heredia, y al Centro de Salud (CERIT) Raúl Patrucco Puig. De los 105 diabéticos tipo 2 que recibían tratamiento farmacológico 46 estaban metabólicamente controlados (Grupo A1) y 59 no (Grupo A2). Los sujetos aparentemente sanos fueron divididos en dos grupos: 60 sujetos normales (Grupo B1) y 41 sujetos sin diabetes mellitus tipo 2 con mal control metabólico (Grupo B2). A los Grupos A2 y B2 se les proporcionó bolsas filtrantes de hojas de yacón de 1 g cada una, para ser tomadas en infusión tres veces al día por 90 días. El Grupo A2 continuó recibiendo glibenclamida. A todos se les determinó en ayunas la concentración de glucosa, hemoglobina glicosilada (HbA1c) y fructosamina, antes y después del tratamiento. Al final del tratamiento, se encontró que, la administración de la infusión de hojas de yacón disminuyó los valores de: glucosa en 42,7 %, hemoglobina glicosilada en 21,7 % y fructosamina en 33,78 %, observándose una diferencia estadísticamente significativa con los valores basales. La eficacia de la combinación estudiada logra reducir las cifras de HbA1c en 4,5 % a los 30 días y 21,7 % a los 90 días. En conclusión, la infusión de hojas de Smallanthus sonchifolius (yacón), administrada a pacientes con diabetes mellitus tipo 2, tiene un efecto protector beneficioso sobre el control glucémico