Exercise Testing Score for Myocardial Ischemia Gradation

Scores aimed at contributing to the optimization of exercise testing (ET) have been developed and the experience with their application in coronary artery disease (CAD) has proven to be favorable1. Although there is debate on the use of scores in clinical practice, those that stand for it argue that they may decrease the rate of undiagnosed CAD, besides reducing the number of patients without disease that undergo highly expensive tests2. Additionally, scores may be helpful, in a more consistent and organized fashion, in prognosis evaluation and in the adoption of an appropriate plan of action for the triage of this disease in the general population

Accelerated Idioventricular Rhythm: History and Chronology of the Main Discoveries

Accelerated Idioventricular Rhythm (AIVR) is a ventricular rhythm consisting of three or more consecutive monomorphic beats, with gradual onset and gradual termination. It can rarely manifest in patients with completely normal hearts or with structural heart disease. It is usually seen during acute myocardial infarction reperfusion. This manuscript aims to review the history of the main discoveries that lead to the identification and comprehension of this fascinating arrhythmia

Bidirectional Ventricular Tachycardia: A Hallmark of Catecholaminergic Polymorphic Ventricular Tachycardia

Catecholaminergic polymorphic ventricular tachycardia is a familial cardiac arrhythmia that is related to RYR2 or CASQ2 gene mutation. It occurs in patients with structurally normal heart and causes exercise-emotion triggered syncope and sudden cardiac death. We present a 13 year-old girl with recurrent episodes of exercise-related syncope and prior history of sudden death in a first degree relative

Prevalence and long-term prognostic implications of prolonged QRS duration in left ventricular hypertrophy : a population-based observational cohort study

Objectives ECG left ventricular hypertrophy (ECG-LVH) has been associated with left ventricular dysfunction and adverse prognosis, but little is known about the prevalence and prognostic significance of different levels of QRS duration in the presence of ECG-LVH in a general population. Design Population-based observational prospective cohort study. Participants Nationally representative random cluster of Finnish adult population. Methods We assessed the prevalence and long-term (median 15.9 years) prognostic significance of QRS duration in ECG-LVH, and compared the risk to individuals without ECG-LVH in a predominantly middle-aged random sample of 6033 Finnish subjects aged over 30 years (mean age 52.2, SD 14.6 years), who participated in a health examination including a 12-lead ECG. Main outcome measures Cardiovascular and all-cause mortality, incidence of heart failure (HF). Results ECG-LVH was present in 1337 (22.2%) subjects; 403 of these (30.1%) had QRS duration >= 100 ms and 100 (7.5%) had >= 110 ms. The increased risk of mortality in ECG-LVH became evident after a QRS threshold of >= 100 ms. After controlling for known clinical risk factors, QRS 100-109 ms was associated with increased cardiovascular (HR 1.38, 95% CI 1.01 to 1.88, p=0.045) and QRS >= 110 ms with cardiovascular (1.74, 95% CI 1.07 to 2.82, p=0.025) and all-cause mortality (1.52, 95% CI 1.02 to 2.25, p=0.039) in ECG-LVH. The risk of new-onset HF was two-fold in subjects with QRS 100-109 ms and threefold in subjects with QRS >= 110 ms, even after adjustment for incident myocardial infarction within the follow-up. When the prognosis was compared with subjects without ECG-LVH, subjects with ECG-LVH but QRS duration Conclusions In ECG-LVH, the risk of excess mortality and new-onset HF markedly increases with longer QRS duration, but even QRS duration within normal limits in ECG-LVH carried a risk of HF compared with the risk in individuals without ECG-LVH.Peer reviewe

Uso de digeridos derivados de la producción de biogás como biofertilizante y enmienda del suelo

Este documento tiene el objetivo de evaluar la factibilidad de la aplicación de digeridos derivados de la producción de biogás como biofertilizantes para los cultivos y mejoradores de la calidad del suelo. Para esto, se trabaja para sistematizar la caracterización de los digeridos para su uso como enmienda para el suelo y como biofertilizante para los cultivos. Se estudia y determina el valor agronómico de los digeridos para su utilización en agricultura, evaluando sus efectos en el rendimiento y en la calidad del suelo, el agua y el aire. Además, se analiza el impacto de la aplicación de digeridos sobre el cambio climático. Se evalúa económicamente la aplicación de digeridos como alternativa al uso de fertilizantes inorgánicos, y se estudia la factibilidad técnica de la aplicación de digeridos como sustitutos de los fertilizantes inorgánicos.Instituto de Ingeniería RuralFil: Mórtola, Natalia Andrea. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Romaniuk, Romina Ingrid. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Suelos; ArgentinaFil: Cosentino, Vanina Rosa Noemi. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Suelos; ArgentinaFil: Carfagno, Patricia. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Suelos; ArgentinaFil: Eiza, Maximiliano Joaquín. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Balcarce; ArgentinaFil: Otero Estrada, Edit. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Suelos; ArgentinaFil: Rorig, Marcela Laura. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Suelos; ArgentinaFil: Rodriguez, Analia. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Suelos; ArgentinaFil: Brutti, Lucrecia Noemi. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Investigación Suelos; Argentina. Universidad de Buenos Aires. Facultad de Agronomía. Cátedra de Edafología; ArgentinaFil: Sainz, Daiana Soledad. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Suelos; ArgentinaFil: Becerra, Juan Francisco. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Suelos; ArgentinaFil: Pattini, Miriam Graciela. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Suelos; ArgentinaFil: Roba, Marcos Andrés. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Ingeniería Rural. Laboratorio de Terramecánica e Implantación de Cultivos; ArgentinaFil: Manosalva, Jonatan. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Ingeniería Rural; ArgentinaFil: Beily, María Eugenia. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Microbiología y Zoología Agrícola; ArgentinaFil: Bres, Patricia Alina. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Microbiología y Zoología Agrícola; ArgentinaFil: Riera, Nicolas Iván. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Microbiología y Zoología Agrícola; ArgentinaFil: Rizzo, Pedro Federico. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Mendoza; ArgentinaFil: Butti, Mariano. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Pergamino; ArgentinaFil: Rubio, Esteban Julian. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto De Investigación Floricultura; Argentin

Rate and duration of hospitalisation for acute pulmonary embolism in the real-world clinical practice of different countries : Analysis from the RIETE registry

publishersversionPeer reviewe

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

Background Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH,non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2–F3, or F1 with at least oneaccompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpointsfor the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2–F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1–F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2–F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1–F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes