Prevalencia de alteraciones electrocardiográficas en una amplia muestra de la población laboral española

Introducción y objetivos: nuestro objetivo fue describir los hallazgos electrocardiográficos de una muestra extensa de trabajadores españoles procedentes de muy diversos campos laborales. Métodos: entre mayo de 2008 y noviembre de 2010, 13.495 trabajadores de 5 ciudades españolas de diferentes regiones, con edades entre 16 y 74 años, fueron sometidos a un reconocimiento médico que incluyó un electrocardiograma de 12 derivaciones en reposo. Los hallazgos electrocardiográficos de los 13.179 registros con calidad suficiente para su adecuada interpretación fueron clasificados por el mismo cardiólogo según el Código de Minnesota. Resultados: la edad media fue 40 años, y el 73,4% fueron hombres. Las prevalencias del bloqueo completo de rama derecha e izquierda y de la hipertrofia ventricular izquierda fueron del 1,1%, 0,2% y 3,6% respectivamente. El 1,7% de los trabajadores presentó onda Q patológica, el 0,7% onda T negativa, el 2,4% repolarización precoz y el 0,2% otras alteraciones del segmento ST. La prevalencia de la fibrilación auricular fue del 0,08% y la del flutter auricular del 0,02%. Se observó patrón de Wolff-Parkinson-White en el 0,2% de los trabajadores, patrón de Brugada en el 0,068%, intervalo QT largo en el 0,038% y QT corto en el 0,015%. Conclusiones: este trabajo muestra los hallazgos electrocardiográficos de una muestra de la población laboral española. Se observó una baja prevalencia en numerosos patrones relacionados con mal pronóstico: hipertrofia ventricular izquierda, bloqueo completo de rama izquierda, fibrilación auricular, alteración del segmento ST e inversión de onda T

Evaluación de la adquisición de competencias en sistema cardiovascular en Medicina: autopercepción, asistencia a clase y rendimiento académico.

The acquisition of competencies is essential in clinically relevant areas such as cardiovascular pathology. This study aims to assess the acquisition of the main competencies regarding the cardiovascular system by medical students, as well as their self-perception, and the relation with regular lecture attendance and academic performance. In order to achieve this aim, data were remotely obtained from 142 students in the fourth, fifth and sixth year of Medicine Degree at University of Málaga using an author-made questionnaire (0-15 points) with multiple-choice questions based on clinical situations and a self-evaluation survey about competencies. Analyzing the results, the competencies that were considered as acquired by the largest and the lowest number of students were, respectively, the handling of cardiovascular risk factors (100%) and cardiopulmonary auscultation (38.3%), respectively. Better results were obtained by students who regularly attended lectures (11.28±1.84 vs 9.54±2.45; p<0.01). In addition, it was demonstrated that self-perception (odds ratio [OR]=1.26; 95% confidence interval [95%CI]=1.07-1.50), lecture attendance (OR=3.55; 95%CI=1.64-7.70) and better academic performance (OR=2.6; 95%CI=1.46-4.63) were predictors of high scores in the questionnaire (≥11 points). In conclusion, lecture attendance seems to be fundamental in learning. In addition, self-perception could be used as a tool to guide teaching. On the other hand, it is detected an insufficient development of eminently practical competencies as well as the importance of interrelating knowledge, since a better general academic performance during degree is also reflected in the speciality studied in this research.  La adquisición de competencias resulta fundamental en ámbitos tan relevantes clínicamente como la patología cardiovascular. Este estudio pretende valorar la adquisición por parte de estudiantes de Medicina de las principales competencias respecto al sistema cardiovascular, así como su autopercepción y la relación con la asistencia presencial y el rendimiento académico. Para lograr este objetivo, se analizaron los datos obtenidos mediante la cumplimentación telemática por parte de 142 estudiantes de cuarto, quinto y sexto curso del Grado en Medicina de la Universidad de Málaga de un cuestionario de elaboración propia (0-15 puntos) con preguntas de elección múltiple basadas en situaciones clínicas y una autoevaluación sobre competencias. Analizando los resultados, las competencias consideradas como adquiridas por un mayor y menor número de estudiantes fueron, respectivamente, el manejo de los factores de riesgo cardiovascular (100%) y la auscultación cardiopulmonar (38,3%). Se obtuvieron mejores resultados en estudiantes que asistieron a clase (11,28±1,84 vs 9,54±2,45; p<0,01). Además, se demostró que la autopercepción de un correcto aprendizaje (odds ratio [OR]=1,26, intervalo de confianza al 95% [IC95%]=1,07-1,50), la asistencia a clase (OR=3,55; IC95%=1,64-7,7) y la nota media del expediente (OR=2,6; IC95%=1,46-4,63) son variables predictoras de calificaciones altas en el cuestionario (≥11 puntos). Esto nos permite inferir que la asistencia a clase se antoja fundamental en el aprendizaje. Además, la autopercepción podría utilizarse como herramienta para guiar la docencia. Por otro lado, se sugiere un insuficiente desarrollo de las competencias eminentemente prácticas, así como la importancia de interrelacionar conocimientos, pues un mejor rendimiento académico general durante el grado se refleja también en la especialidad estudiada en este trabaj

Experimental evidence of the genetic hypothesis on the etiology of bicuspid aortic valve aortopathy in the hamster model.

Bicuspid aortopathy occurs in approximately 50% of patients with bicuspid aortic valve (BAV), the most prevalent congenital cardiac malformation. Although different molecular players and etiological factors (genetic and hemodynamic) have been suggested to be involved in aortopathy predisposition and progression, clear etiophysiopathological mechanisms of disease are still missing. The isogenic (genetically uniform) hamster (T) strain shows 40% incidence of BAV, but aortic dilatations have not been detected in this model. We have performed comparative anatomical, histological and molecular analyses of the ascending aorta of animals with tricuspid aortic valve (TAV) and BAV from the T strain (TTAV and TBAV, respectively) and with TAV from a control strain (HTAV). Aortic diameter, smooth muscle apoptosis, elastic waviness, and Tgf-β and Fbn-2 expression were significantly increased in T strain animals, regardless of the valve morphology. Strain and aortic valve morphology did not affect Mmp-9 expression, whereas Mmp-2 transcripts were reduced in BAV animals. eNOS protein amount decreased in both TBAV and TTAV compared to HTAV animals. Thus, histomorphological and molecular alterations of the ascending aorta appear in a genetically uniform spontaneous hamster model irrespective of the aortic valve morphology. This is a direct experimental evidence supporting the genetic association between BAV and aortic dilatation. This model may represent a population of patients with predisposition to BAV aortopathy, in which increased expression of Tgf-β and Fbn-2 alters elastic lamellae structure and induces cell apoptosis mediated by eNOS. Patients either with TAV or BAV with the same genetic defect may show the same risk to develop bicuspid aortopathy.This work was supported by Consejería de Salud y Familias, Junta de Andalucía (PI-0530-2019), Consejería de Economía y Conocimiento, Junta de Andalucía (UMA20-FEDERJA-041), Ministerio de Ciencia e Innovación (grants CGL2017-85090- P and PT20/00101, fellowship PRE2018-083176 to MS-N), and FEDER funds.S

Spanish citizens’ opinions on future trends in cardiology as expressed in digital ecosystems

[Abstract] Patient-centred medicine is a healthcare approach that focuses on patients’ wants, needs and preferences. An obstacle to implement patient-centred medicine is the difficulty of obtaining data that is relevant and representative of the whole society. In 2019, the Spanish Society of Cardiology highlighted eight trends that would exert a determining influence on the future of cardiology: “demographics”, “economic environment”, “political environment”, “citizens’ expectations”, “incorporation of women”, “technological innovation”, “health levels and cardiovascular risk factors” and “healthcare organisation and management”. In order to assess these trends from a pacient-centred approach, the aim of this study is to evaluate the opinions of the individuals who are part of Spanish society, regarding the eight trends identified by the Spanish Society of Cardiology, using natural language processing tools to analyse the communications expressed by citizens in digital ecosystems and official channels of communication. We analysed communications published between 2007 and 2019. Natural language processing identified 17 areas of opinion that support the eight trends. We evaluated the impact of each area of opinion based on the standard metrics of online reputation: presence, emotion and reach. Thus, 257,456 communications were analysed. The most relevant trend was “healthcare organisation and management” (54% of the total impact), followed by “health levels and cardiovascular risk factors” and “demographics” (14% and 10%, respectively). The least relevant trend was “citizens’ expectations” (1%). Within the areas of opinion identified, the one with greatest impact was “the cardiologist” (16% of the total impact). In conclusion, the results of this research show that natural language processing tools are a useful tool for patient-centred medicine. The high impact associated with the cardiologist’s role, together with the low impact observed for “citizen’s expectations” show that Spanish citizens identify the cardiologist as the leading figure regarding their cardiovascular health

Evaluation of Adipose Tissue Zinc-Alpha 2-Glycoprotein Gene Expression and Its Relationship with Metabolic Status and Bariatric Surgery Outcomes in Patients with Class III Obesity

Zinc-α2 glycoprotein (ZAG) is an adipokine involved in adipocyte metabolism with potential implications in the pathogenesis of metabolic disorders. Our aim was to evaluate the relationship between visceral (VAT) and subcutaneous adipose tissue (SAT) ZAG expression and metabolic parameters in patients with class III obesity, along with the impact of basal ZAG expression on short- and medium-term outcomes related to bariatric surgery. 41 patients with class III obesity who underwent bariatric surgery were included in this study. ZAG gene expression was quantified in SAT and VAT. Patients were classified into two groups according to SAT and VAT ZAG percentile. Anthropometric and biochemical variables were obtained before and 15 days, 45 days, and 1 year after surgery. The lower basal SAT ZAG expression percentile was associated with higher weight and waist circumference, while the lower basal VAT ZAG expression percentile was associated with higher weight, waist circumference, insulin, insulin resistance, and the presence of metabolic syndrome. Basal SAT ZAG expression was inversely related to weight loss at 45 days after surgery, whereas no associations were found between basal VAT ZAG expression and weight loss after surgery. Additionally, a negative association was observed between basal SAT and VAT ZAG expression and the decrease of gamma-glutamyl transferase after bariatric surgery. Therefore, lower SAT and VAT ZAG expression levels were associated with an adverse metabolic profile. However, this fact did not seem to confer worse bariatric surgery-related outcomes. Further research is needed to assess the clinical significance of the role of ZAG expression levels in the dynamics of hepatic enzymes after bariatric surgeryThis study has been co-funded by FEDER funds (“A way to make Europe”). M.M. and L.G.S. are also supported by UMA18-FEDERJA-285 and UMA20-FEDERJA-144, co-funded by Malaga University, Junta de Andalucía and FEDER funds, CB06/03/0018, PI-0297-2018 and PI-0194-2017, co-funded by FEDER funds and Consejería de Salud y Familias, Junta de Andalucía, and CP17/00133, Instituto de Salud Carlos III (ISCIII), Ministry of Science, Innovation and Universities, Spain Partial funding for open access charge: Universidad de Málag

Beneficial effects of essential oils from the mediterranean diet on gut microbiota and their metabolites in ischemic heart disease and type-2 diabetes mellitus

[Abstract] Ischemic heart disease (IHD) and type-2 diabetes mellitus (T2DM) remain major health problems worldwide and commonly coexist in individuals. Gut microbial metabolites, such as trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFAs), have been linked to cardiovascular and metabolic diseases. Previous studies have reported dysbiosis in the gut microbiota of these patients and the prebiotic effects of some components of the Mediterranean diet. Essential oil emulsions of savory (Satureja hortensis), parsley (Petroselinum crispum) and rosemary (Rosmarinus officinalis) were assessed as nutraceuticals and prebiotics in IHD and T2DM. Humanized mice harboring gut microbiota derived from that of patients with IHD and T2DM were supplemented with L-carnitine and orally treated with essential oil emulsions for 40 days. We assessed the effects on gut microbiota composition and abundance, microbial metabolites and plasma markers of cardiovascular disease, inflammation and oxidative stress. Our results showed that essential oil emulsions in mice supplemented with L-carnitine have prebiotic effects on beneficial commensal bacteria, mainly Lactobacillus genus. There was a decrease in plasma TMAO and an increase in fecal SCFAs levels in mice treated with parsley and rosemary essential oils. Thrombomodulin levels were increased in mice treated with savory and parsley essential oils. While mice treated with parsley and rosemary essential oils showed a decrease in plasma cytokines (INFɣ, TNFα, IL-12p70 and IL-22); savory essential oil was associated with increased levels of chemokines (CXCL1, CCL2 and CCL11). Finally, there was a decrease in protein carbonyls and pentosidine according to the essential oil emulsion. These results suggest that changes in the gut microbiota induced by essential oils of parsley, savory and rosemary as prebiotics could differentially regulate cardiovascular and metabolic factors, which highlights the potential of these nutraceuticals for reducing IHD risk in patients affected by T2DM.Junta de Andalucía; PI-0170-2018Instituto de Salud Carlos III; PT20/00101Junta de Andalucía; RH-0078-2021Instituto de Salud Carlos III; CPII19/00022Instituto de Salud Carlos III; FI20/0022

Improving Uncertainty Estimation With Semi-supervised Deep Learning for COVID-19 Detection Using Chest X-ray Images

In this work we implement a COVID-19 infection detection system based on chest Xray images with uncertainty estimation. Uncertainty estimation is vital for safe usage of computer aided diagnosis tools in medical applications. Model estimations with high uncertainty should be carefully analyzed by a trained radiologist. We aim to improve uncertainty estimations using unlabelled data through the MixMatch semi-supervised framework. We test popular uncertainty estimation approaches, comprising Softmax scores, Monte-Carlo dropout and deterministic uncertainty quantification. To compare the reliability of the uncertainty estimates, we propose the usage of the Jensen-Shannon distance between the uncertainty distributions of correct and incorrect estimations. This metric is statistically relevant, unlike most previously used metrics, which often ignore the distribution of the uncertainty estimations. Our test results show a significant improvement in uncertainty estimates when using unlabelled data. The best results are obtained with the use of the Monte Carlo dropout method

Postural orthostatic tachycardia syndrome and other related dysautonomic disorders after SARS-CoV-2 infection and after COVID-19 messenger RNA vaccination

The COVID-19 pandemic has caused a challenge for our society due to the post-acute sequelae of the disease. Persistent symptoms and long-term multiorgan complications, known as post-acute COVID-19 syndrome, can occur beyond 4 weeks from the onset of the COVID-19 infection. Postural orthostatic tachycardia syndrome (POTS) is considered a variety of dysautonomia, which is characterized by chronic symptoms that occur with standing and a sustained increase in heart rate, without orthostatic hypotension. POTS can lead to debilitating symptoms, significant disability, and impaired quality of life. In this narrative review, the etiopathogenic basis, epidemiology, clinical manifestations, diagnosis, treatment, prognosis, and socioeconomic impact of POTS, as well as other related dysautonomic disorders, after COVID-19 infection and SARS-CoV-2 postvaccination, were discussed. After a search conducted in March 2023, a total of 89 relevant articles were selected from the PubMed, Google Scholar, and Web of Science databases. The review highlights the importance of recognizing and managing POTS after COVID-19 infection and vaccination, and the approach to autonomic disorders should be known by all specialists in different medical areas. The diagnosis of POTS requires a comprehensive clinical assessment, including a detailed medical history, physical examination, orthostatic vital signs, and autonomic function tests. The treatment of POTS after COVID-19 infection or vaccination is mainly focused on lifestyle modifications, such as increased fluid and salt intake, exercise, and graduated compression stockings. Pharmacotherapy, such as beta-blockers, fludrocortisone, midodrine, and ivabradine, may also be used in selected cases. Further research is needed to understand the underlying mechanisms, risk factors, and optimal treatment strategies for this complication

Búsqueda de nuevos biomarcadores de aortopatía en un modelo animal espontaneo de válvula aortica bicúspide

La válvula aortica bicúspide (VAB) es la malformación cardiaca congénita más frecuente en el hombre. Aproximadamente el 50% de los pacientes desarrollan dilatación en la aorta ascendente (DA), una condición denominada aortopatía bicúspide. Actualmente, no existen biomarcadores efectivos de la patología más allá de la medida del diámetro de la aorta ascendente. El foco clínico se pone ahora en la estratificación de la enfermedad y la búsqueda de biomarcadores que permitan establecer criterios clínico-quirúrgicos adecuados. El único modelo animal espontáneo de VAB es una cepa isogénica (cepa T) de hámster sirio con una incidencia del 40%. En un estudio reciente hemos demostrado que la cepa T, pese a no manifestar DA, presenta el sustrato histopatológico de la enfermedad. Las alteraciones de la aorta de la cepa T son independientes del fenotipo valvular, por lo que constituye un modelo adecuado para el estudio de la base genética de la aortopatía bicúspide. El objetivo de este trabajo es analizar la expresión proteica en la aorta ascendente de la cepa T frente a una cepa control, identificando nuevos marcadores de enfermedad. Se ha identificado, cuantificado y comparado el proteoma completo de la aorta ascendente de individuos de la cepa T y una cepa control no isogénica mediante proteómica cuantitativa. Del total de proteínas detectadas, solo se han seleccionado aquellas con una expresión diferencial que excedía el doble de la abundancia con una significación de p<0,05. Del total de proteínas, solo 18 proteínas mostraron una expresión diferencial acorde a los criterios de inclusión. Trece de estas proteínas se encuentran en mayor abundancia en la aorta ascendente de la cepa T. Las restantes muestran una expresión menor con respecto a la cepa control. De estas 18 proteínas, cinco han sido previamente asociadas con la DA. Proponemos que la cepa T es un modelo apropiado para la búsqueda e identificación de marcadores de predisposición a la aortopatía bicúspide.CGL2017-85090-P, PI-0530-2019, PRE2018-083176, IBIMA y FEDER. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio