Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Estrategia educativa para incrementar la captación de sintomáticos respiratorios y adhesión al tratamiento de pacientes con tuberculosis en las comunidades UNE-Totoracocha y El Cebollar del cantón Cuenca 2008

Se aplicó un modelo educativo a una muestra representativa de la población mayor de 15 años. Se formó dos grupos con características similares, grupo intervención: Une Totoracocha y grupo control: El Cebollar. Los centros de salud fueron seleccionados por criterios de inclusión y los/as participantes al azar, establecidos en el proyecto general que se realiza en las áreas urbanas de uenca. Aplicamos a los dos grupos una encuesta sobre conocimientos, actitudes y prácticas (CAP); después, en el grupo I implementamos el programa para el control de la tuberculosis, mientras al grupo C impartimos charlas de primeros auxilios. Dieciocho semanas después aplicamos una segunda encuesta CAP a ambos grupos, medimos los sintomáticos respiratorios y Participaron 50 personas resultando ser similares (p mayor que 0,05), excepto en sexo, ocupación y educación (pmenor que 0,05), sin embargo estas diferencias no influyeron en los resultados finales, demostrado por una regresión lineal (menor que 0.05) Después de la intervención se incrementó el nivel de conocimientos sobre la tuberculosis de manera significativa (RR: 46.67 IC 95%: 11.87; 188.09). En cuanto al número de sintomáticos respiratorios no reveló cambios significativos (p mayor que 0,05) y la adhesión al tratamiento no se pudo analizar puesto que en el Subcentro de Salud UNE Totoracocha, solo existía un paciente BK+ que fue tratado antes de la intervención. Conclusiones: la aplicación del programa educativo de prevención, captación de sintomáticos respiratorios y adhesión al tratamiento de pacientes con tuberculosis mejoró el nivel deMédicoCuenc

Levantamiento catastral y evaluación hidráulico-sanitario de los sistemas de alcantarillado de la ciudad de Cuenca. Zona este

Para facilitar la realización del levantamiento catastral de la red de alcantarillado, se debe de sectorizar de acuerdo a la necesidad y conveniencia. Una vez determinadas las características de todo el sistema de alcantarillado existentes en la zona de trabajo se procedió a calcular los datos hidráulicos necesarios para la comprobación de la capacidad de los colectores. Luego se diseñan colectores de alivio que sirven para evacuar directamente el caudal pico de agua lluvia hasta el río o el afluente que más convengaIngeniero CivilCuenc

The QT Interval Dynamic in a Human Experimental Model of Controlled Heart Rate and QRS Widening

Background: there is increasing interest for computing corrected QT intervals in patients with prolonged depolarization. We aimed to analyze the effect of prolonged QRS in the QT and in the diagnostic accuracy of frequency-correction. Methods and Results: in 28 patients admitted for self-expanding aortic valve implantation, sequential pacing was performed in the AAI mode in two different phases: before and immediately after the release of the prosthesis. We evaluated the accuracy of the Bazett, Fridericia, Framingham and Hodges formulas with the reference of the QT at 60 bpm (QTc/deviation). The widening of the QRS was the main contributor to the QT prolongation (Pearson 0.79; CI95%: 0.75–0.84). Prolongation in other intervals (ST segment and T-wave) significantly contribute in the higher frequency range (p < 0.05). The Bazett’s formula displayed the highest QTc/deviation, while Framingham and Hodges retrieved the lowest QTc/deviation and the best fit (p < 0.001). In addition, the Bazett’s formula displayed the highest correlation between variations in the QTc/deviation and the widening of the QRS (Pearson coefficient −0.54; p < 0.001) in comparison with the Fridericia, Framingham and Hodges formulas (−0.51, −0.37 and −0.38 respectively; p < 0.001). There was also a linear effect of the heart rate in the QTc/deviation obtained with the Bazett’s formula (p = 0.015), not observed for other formulas. Conclusions: The prolonged depolarization of the ventricles introduces direct and linear prolongation in the QT interval, but also a non-linear distortion in cardiac repolarization that contributes for QT prolongation at the higher frequency range. The Bazett’s formula displays significantly higher sensitivity to prolongation of ECG intervals

Valvuloplastia aórtica de urgencia por fallo cardiaco biventricular refractario, secundario a estenosis aórtica crítica.

ResumenLa estenosis valvular aórtica se ha convertido en la causa más importante de enfermedad valvular cardiaca en Europa y Norteamérica.  La valvuloplastia aórtica con balón constituye una opción de tratamiento con indicaciones limitadas en adultos. Se reporta el primer caso realizado en nuestro centro de valvuloplastia aórtica de urgencia, por fallo bi-ventricular refractario, secundario a estenosis valvular crítica. Se hace revisión actualizada acerca de las indicaciones del tratamiento percutáneo  de esta patología. Palabras clave: Estenosis valvular aórtica, valvuloplastia aórtica, fallo bi-ventricular Summary Valvular aortic stenosis is considered the most important cause of cardiac valvular disease in North America and Europe. The aortic valvuloplasty with balloon has limited indications in adult´s patients. We report the first case (made in our center) of urgent aortic valvuloplasty due to bi-ventricular acute heart failure secondary to critical valvular aortic stenosis. A recent review of the percutaneus  treatment is presented. Key words: Valvular aortic stenosis, aortic valvuloplasty, bi-ventricular failur

Late Cerebrovascular Events Following Transcatheter Aortic Valve Replacement.

This study sought to determine the incidence, clinical characteristics, associated factors, and outcomes of late cerebrovascular events (LCVEs) (>30 days post-procedure) following transcatheter aortic valve replacement (TAVR). Scarce data exist on LCVEs following TAVR. This was a multicenter study including 3,750 consecutive patients (mean age, 80 ± 8 years; 50.5% of women) who underwent TAVR and survived beyond 30 days. LCVEs were defined according to the Valve Academic Research Consortium 2 (VARC 2) criteria. LCVEs occurred in 192 (5.1%) patients (stroke, 80.2%; transient ischemic attack, 19.8%) after a median follow-up of 2 (1 to 4) years. Late stroke was of ischemic, hemorrhagic, and undetermined origin in 80.5%, 18.8%, and 0.7% of patients, respectively. Older age, previous cerebrovascular disease, higher mean aortic gradient at baseline, the occurrence of stroke during the periprocedural TAVR period, and the lack of anticoagulation (novel oral anticoagulants or vitamin K antagonists) post-TAVR were independent factors associated with late ischemic stroke/transient ischemic attack (p  LCVEs occurred in 5.1% of TAVR recipients after a median follow-up of 2 years. LCVEs were ischemic in most cases, with older age, previous cerebrovascular events, higher mean aortic gradient at baseline, the occurrence during the periprocedural TAVR period, and lack of anticoagulation (but not valve thrombosis/degeneration) determining an increased risk. Late stroke was disabling in most cases and associated with dreadful early and midterm outcomes