Electrocardiogram sensitivity in left ventricular hypertrophy according to gender and cardiac mass

BACKGROUND: Several factors are known to interfere with electrocardiogram (ECG) sensitivity when diagnosing Left Ventricular Hypertrophy (LVH), with gender and cardiac mass being two of the most important ones OBJECTIVE: To evaluate the influence of gender on the sensitivity of some of the criteria used to detect LVH, according to the progression of ventricular hypertrophy degree. METHODS: According to gender and the degree of LVH at the echocardiogram, the patients were divided in three groups: mild, moderate and severe LVH. ECG sensitivity to detect LVH was assessed between men and women, according to the LVH degree. RESULTS: Of the 874 patients, 265 were males (30.3%) and 609, females (69.7%). The [(S + R) X QRS], Sokolow-Lyon, Romhilt-Estes, Perugia and strain criteria showed high discriminatory power in the diagnosis of LVH between men and women in the three groups with LVH, with a superior performance in the male population and highlighting the importance of the [(S + R) X QRS] and Perugia scores. Conclusion: The diagnostic sensitivity of the ECG increases with the cardiac mass. The examination is more sensitive in men, highlighting the importance of the [(S + R) X QRS] and Perugia scores. CONCLUSION: The diagnostic sensitivity of the ECG increases with the cardiac mass. The examination is more sensitive in men, highlighting the importance of the [(S + R) X QRS] and Perugia scores.FUNDAMENTO: Sabe-se que vários fatores interferem na sensibilidade do Eletrocardiograma (ECG) no diagnóstico da Hipertrofia Ventricular Esquerda (HVE), sendo o gênero e a massa cardíaca alguns dos principais. OBJETIVO: Avaliar a influência do sexo na sensibilidade de alguns dos critérios utilizados para a detecção de HVE, de acordo com a progressão do grau de hipertrofia ventricular. MÉTODOS: De acordo com o gênero e com o grau de HVE ao ecocardiograma, os pacientes foram divididos em três grupos: HVE leve, moderada e severa. Avaliou-se a sensibilidade do ECG para detectar HVE entre homens e mulheres, conforme o grau de HVE. RESULTADOS: Dos 874 pacientes, 265 eram homens (30,3%) e 609, mulheres (69,7%). Os critérios [(S + R) X QRS], Sokolow-Lyon, Romhilt-Estes, Perúgia e padrão strain mostraram alto poder discriminatório no diagnóstico de HVE entre homens e mulheres nos três grupos de HVE, com desempenho superior na população masculina e destaque para os escores [(S + R) X QRS] e Perúgia. CONCLUSÃO: A sensibilidade diagnóstica do ECG é maior com o aumento da massa cardíaca. O exame é mais sensível entre homens, destacando-se os escores [(S + R) X QRS] e Perúgia.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Fatores associados à incidência e mortalidade por acidentes de estrada envolvendo motociclistas e pedestres: uma revisão sistemática rápida

Introduction: traffic accidents are the third leading cause of death in the world. Vulnerable road users do not benefit from a high level of protection. As such, they face devastating consequences when involved in accidents. Objective: to analyze the incidence and mortality, and associated factors in traffic accidents among motorcyclists and pedestrians. Methods: rapid Systematic review of articles from the National Library of Medicine (PubMed), Virtual Health Library (VHL), and Web of Science databases using the descriptors Mortality, Accidents, traffic, Motorcyclists and Pedestrians. Inclusion criteria were: (1) studies involving pedestrians and motorcyclists; (2) the object of study is traffic accidents; (3) articles that studied mortality; and (4) articles published in the last ten years (2010-2019). Results: of the 206 articles found, 19 met the inclusion criteria. Factors such as increased sales of motorcycles, darkness on the roads, older pedestrians, lack of safety equipment for motorcyclists, and drug and alcohol intake contribute to the increase of the mortality rate of these individuals. Conclusion: mortality due to traffic accidents involving pedestrians and motorcyclists has increased during the analyzed period, especially among men.Introdução: os acidentes de trânsito são a terceira causa de morte no mundo. Os usuários vulneráveis ​​da estrada não têm um alto nível de proteção como outros tipos de vítimas. Portanto, esses indivíduos enfrentam consequências devastadoras quando envolvidos em acidentes. Objetivo: identificar a tendência da mortalidade, incidência e fatores associados aos acidentes de trânsito entre motociclistas e pedestres por meio de revisão sistemática da literatura. Método: trata-se de uma revisão sistemática das bases de indexação da National Library of Medicine (PubMed), Virtual Health Library (VHL) e Web of Science utilizando os descritores Mortality AND Accidents, Traffic AND Motorcycles AND Pedestrians. Para a seleção dos artigos, foram incluídos aqueles que obedeciam aos seguintes critérios: população que (1) inclui motociclistas e pedestres e (2) se envolveu em acidentes de trânsito; e artigos que (3) estudaram mortalidade, incidência e / ou fatores associados a acidentes de trânsito e (4) foram publicados nos últimos 10 anos. Resultados: dos 206 artigos encontrados, 19 preencheram os critérios de inclusão. Fatores como aumento da venda de motocicletas, escuridão das vias, pedestres mais velhos, falta de equipamentos de segurança para os motociclistas e ingestão de drogas e / ou álcool contribuem para o aumento da taxa de mortalidade e incidência desses indivíduos. Conclusão: a mortalidade por acidentes de trânsito com pedestres e motociclistas tem aumentado nos últimos anos, com alta prevalência de mortalidade entre os homens. A maioria dos acidentes foi devido a falhas humanas e / ou deficiências nas vias públicas

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Significance of vectorcardiogram in the cardiological diagnosis of the 21st century

Until the mid-1980s. it was believed that the vectorcardiogram presented a greater specificity, sensitivity and accuracy III comparison to the conventional electrocardiogram. in the diagnosis of the different heart diseases. Recent studies revealed that the vectorcardiogram still is superior to the electrocardiogram in very specific situations, such as in the evoluation of electrically inactive areas. in intraventricular conduction disorders combined and/or in association to inactive areas, in the identification and location of ventricular preexcitation, in the differential diagnosis of patterns varying from normal of electrical axis deviation, in the evaluation of particular aspects of Brugada synchome, and in the estimation of the severity of some enlargements, among others.With the advent of computerized vectorcardiography, a technology that improves the processing and recording method; a future still promising is expected for this methodology.In the fields of education and research, vectorcardiography provided a better and more rational insight into the electrical phenomena that occurs spatially, and represented an important impact on the progress of electrocardiography. Although a few medical centers still use the method as a routine, we hope that the use of this resource will not get lost over time, since vectorcardiography still represents a source to enrich science by enabling a better morphological interpretation of the electrical phenomena of the heart.Clin & Maternidad Suizo Argentina, Arrhythmias & Electrophysiol Serv, RA-1124 Buenos Aires, DF, ArgentinaABC Fdn, Sector Electrovectorcardiog, Discipline Cardiol, Sch Med, Santo Andre, BrazilUniv São Paulo, Sch Med, Div Electrocardiol, Inst Heart, São Paulo, BrazilUNISA, Sch Med Santo Amaro, Discipline Cardiol, Sch Med, Santo Andre, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use