Functional evaluation of coronary disease by CT angiography

Publisher Copyright: © 2015 American College of Cardiology Foundation.In recent years, several technical developments in the field of cardiac computed tomography (CT) have made possible the extraction of functional information from an anatomy-based examination. Several different lines have been explored and will be reviewed in the present paper, namely: 1) myocardial perfusion imaging; 2) transluminal attenuation gradients and corrected coronary opacification indexes; 3) fractional flow reserve computed from CT; and 4) extrapolation from atherosclerotic plaque characteristics. In view of these developments, cardiac CT has the potential to become in the near future a truly 2-in-1 noninvasive evaluation for coronary artery disease.publishersversionpublishe

Socioeconomic Inequalities and Toothbrushing Frequency among Schoolchildren Aged 6 to 12 Years in a Multi-Site Study of Mexican Cities: A Cross-Sectional Study

Periodic toothbrushing is the most common, effective, and reliable way to mechanically remove biofilm from oral tissues. The objective of the present study was to determine the association between toothbrushing frequency and socioeconomic position for schoolchildren between 6 and 12 years of age in four cities in Mexico. A cross-sectional study was conducted on 500 Mexican schoolchildren between 6 and 12 years of age from public schools in four Mexican cities. Questionnaires were administered to the parents/guardians of the schoolchildren to obtain the variables included in the study. The dependent variable was toothbrushing frequency, dichotomized as: 0 = less than twice a day and 1 = at least twice a day. The analysis was performed in Stata. The average age of the schoolchildren was 8.9 1.9 years; 50.4% were female. The prevalence of toothbrushing was 52.8% (at least twice a day) (95% CI = 48.457.1). In the multivariate model, the variables associated (p < 0.05) with toothbrushing frequency were older age of the schoolchild (OR = 1.14); younger age of the mother (OR = 0.93); being a girl (OR = 1.70); being enrolled in Seguro Popular (OR = 0.69); being in a household that was owned (OR = 2.43); and being a schoolchild who lived in a home that owned a car (OR = 1.31). The prevalence of toothbrushing at least twice a day was just over 50% in these Mexican children. We found demographic and socioeconomic variables to be associated with toothbrushing. Based on socioeconomic variables that were associated with toothbrushing frequency—such as health insurance, home ownership and the household owning a car—the results of the present study confirm the existence of health inequalities in toothbrushing frequency

Pérdida de dientes en adolescentes y adultos jóvenes universitarios mexicanos

una población universitaria de adolescentes y adultos jóvenes, así como conocer su distribución por edad y sexo. Se realizó un estudio transversal en una muestra de 1027 adolescentes y adultos jóvenes de 16 a 25 años de edad seleccionados aleatoriamente del total de aspirantes a las licenciaturas de la Universidad Autónoma de San Luis Potosí, México. La variable dependiente fue la prevalencia de PD, codificándose como 0=sujetos sin PD y 1=sujetos que tuvieron almenos un diente perdido. Otras variables incluidas fueron edad y sexo del sujeto. El análisis se llevó a cabo en STATA v9,0 con regresión logística. El promedio de edad de los sujetos incluidos fue de 18,20±1,65 y 52,0% fueron hombres. La prevalencia de sujetos con PD fue de 18,0% (n=185) y el promedio de 0,46±1,13, mientras que en quienes tuvieron al menos uno perdido fue de 2,54±1,32. El número máximo de PD fue de 5. En el modelo ajustado obtuvimos significancia estadística en la edad (RM=1,11; p&lt;0,05). Las mujeres tuvieron 41% mayor riesgo de presentar al menos un diente perdido que los hombres. Los sujetos que presentaron más de 6 obturacionestuvieron mayor posibilidad de tener dientes perdidos (RM=1,60; p&lt;0,05). Los hallazgos indican que la experiencia de tener PD alcanza casi el 20%, además se mostró una asociación entre la PD con la edad, el sexo y el número de obturaciones. Este estudio demuestra la existencia de desigualdades de género

Non-contrast cardiac computed tomography can accurately detect chronic myocardial infarction: Validation study

BackgroundThis study evaluates whether non-contrast cardiac computed tomography (CCT) can detect chronic myocardial infarction (MI) in patients with irreversible perfusion defects on nuclear myocardial perfusion imaging (MPI).MethodsOne hundred twenty-two symptomatic patients with irreversible perfusion defect (N = 62) or normal MPI (N = 60) underwent coronary artery calcium (CAC) scanning. MI on these non-contrast CCTs was visually detected based on the hypo-attenuation areas (dark) in the myocardium and corresponding Hounsfield units (HU) were measured.ResultsNon-contrast CCT accurately detected MI in 57 patients with irreversible perfusion defect on MPI, yielding a sensitivity of 92%, specificity of 72%, negative predictive value (NPV) of 90%, and a positive predictive value (PPV) of 77%. On a per myocardial region analysis, non-contrast CT showed a sensitivity of 70%, specificity of 85%, NPV of 91%, and a PPV of 57%. The ROC curve showed that the optimal cutoff value of LV myocardium HU to predict MI on non-contrast CCT was 21.7 with a sensitivity of 97.4% and specificity of 99.7%.ConclusionNon-contrast CCT has an excellent agreement with MPI in detecting chronic MI. This study highlights a novel clinical utility of non-contrast CCT in addition to assessment of overall burden of atherosclerosis measured by CAC

Factor structure and measurement invariance across various demographic groups and over time for the phq-9 in primary care patients in spain

The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression in primary care settings. The purpose of the present study is to identify the factor structure of the PHQ-9 and to examine the measurement invariance of this instrument across different sociodemographic groups and over time in a sample of primary care patients in Spain. Data came from 836 primary care patients enrolled in a randomized controlled trial (PsicAP study) and a subsample of 218 patients who participated in a follow-up assessment at 3 months. Confirmatory factor analysis (CFA) was used to test one- and two-factor structures identified in previous studies. Analyses of multiple-group invariance were conducted to determine the extent to which the factor structure is comparable across various demo- graphic groups (i.e., gender, age, marital status, level of education, and employment situa- tion) and over time. Both one-factor and two-factor re-specified models met all the pre- established fit criteria. However, because the factors identified in the two-factor model were highly correlated (r = .86), the one-factor model was preferred for its parsimony. Multi-group CFA indicated measurement invariance across different demographic groups and across time. The present findings suggest that physicians in Spain can use the PHQ-9 to obtain a global score for depression severity in different demographic groups and to reliably monitor changes over time in the primary care setting

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Mis casos clínicos de especialidades odontológicas

Libro que muestra la atención de casos clínicos particulares referente a las diferentes especialidades odontológicasLibro que muestra la atención de casos clínicos particulares referente a las diferentes especialidades odontológicasUniversidad Autónoma de Campeche Universidad Autónoma del Estado de Hidalgo Universidad Autónoma del Estado de Méxic

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Epicardial Fat and Hepatic Steatosis as Cardiovascular Risk Markers

Epicardial adipose tissue (EAT) is a metabolically active tissue which has raised great interest in the last decade as a cardiovascularrisk marker. It is related with the production of proinflammatory cytokines and free fatty acids, the promotion of a state of hypercoagulabilityand with numerous cardiometabolic risk factors. Between EAT and coronary arteries, there is not only an intimateanatomical association, but also bidirectional physiological aspects of paracrine regulation. In addition, several studies have founda relationship between EAT and endothelial dysfunction, non-obstructive atheromatosis, oxidative stress, atrial fibrillation anddiastolic dysfunction.Parallel to these findings, there is a tight association between hepatic steatosis (the most prevalent chronic hepatic disease), coronaryatheromatosis and cardiovascular risk. One of the interesting and differential characteristics of hepatic steatosis with respectto coronary artery disease is its dynamic, and to a certain point reversible, character.Despite their association with atheromatosis and cardiovascular risk, and simple assessment from non-invasive imaging methods,epicardial fat and non-alcoholic fatty liver are seldom considered as risk markers in clinical practice.El tejido adiposo epicárdico (TAE) es el depósito graso visceral intratorácico localizado entre el miocardio y el pericardio, en íntimo contacto con las arterias coronarias en todo su trayecto. Considerado históricamente como un simple depósito de energía, el TAE es un tejido metabólicamente activo que ha cobrado gran interés en la última década como marcador de riesgo cardiovascular. Tanto el TAE como el tejido adiposo visceral abdominal, de mismo origen embriológico, se relacionan con la producción de citoquinas proinflamatorias y de ácidos grasos libres (AGL), con la promoción de un estado de hipercoagulabilidad, y con numerosos factores de riesgo cardiometabólico. En particular, los pacientes diabéticos evidencian un mayor volumen de TAE, con un perfil metabólicamente más activo y proinflamatorio independientemente de los otros factores de riesgo cardiovasculare