In memoriam : Dr. Juan Karlo Urrea Zapata, Goodbye to a “friend” more than colleague

Son pocas las personas que han despertado en la Sociedad Colombiana de Cardiología y Cirugía Cardiovascular, tan grandes sentimientos de amor, apoyo, admiración y respeto.Revista Nacional - Indexad

Use of cardiovascular events prediction models for the prognosis of a severe coronary artery lesion

Objetivos: Determinar el mejor punto de corte y el grado de conformidad de las escalas de riesgo, Framingham, PROCAM y Reynolds, para el diagnóstico de lesión vascular coronaria arte- rioesclerótica severa a través de la comparación de las áreas bajo la curva de acuerdo con las curvas operativas del receptor (COR). Métodos: Estudio de corte transversal en adultos que fueron sometidos a arteriografía corona- ria. Se aplicaron las escalas Framingham, PROCAM y Reynolds, las dos primeras ajustadas según estudio de calibración colombiano. Luego se realizó la recolección de los datos de manera concurrente en instituciones de referencia en cardiología y hemodinámica en Bogotá. Resultados: De 200 pacientes estudiados, 66% eran mujeres, 37,5% mayores de 70 a ̃nos, 53,2% con hipertensión, 52,7% en sobrepeso u obesidad, 61,5% presentaron valores altos de Proteína C Reactiva ultrasensible (PCRus) y 50% tenían al menos una lesión coronaria mayor de 70%. Se encontraron los mejores puntos de corte, de acuerdo con cada curva de características operativas del receptor (COR): Framingham ajustado 5,8% (sensibilidad 80%, especificidad 41%). PROCAM ajustado 1,7% (sensibilidad 78%, especificidad 45%) y Reynolds 3,8% (sensibilidad 68%, especificidad 45%). Adicionalmente, se encontró que las tres escalas presentaron áreas bajo la curva (ABC) de 0,59, 0,59 y 0,57, respectivamente.Q4Objectives: To determine the best cut-off point and the level of agreement of the Framingham, PROCAM, and Reynolds risk scales, for the diagnosis of a severe atherosclerotic coronary artery lesion by comparing the areas under the receiver operator characteristics (ROC) curves. Methods: A cross-sectional study was carried out on adults that were subjected to coronary angiography. The Framingham, PROCAM, and Reynolds were applied, with the first two adjus- ted to a Colombian calibration study. Data were collected concurrently in the institutions of reference in Cardiology and haemodynamics in Bogota. Results: Of the 200 patients study, 66% were female, and 37.5% greater than 70 years-old. Hypertension was recorded in 53.2%, and overweight and obesity in 52.7%. Elevated levels of high sensitivity C-Reactive Protein (hsCRP) were observed in 61.5% of cases and 50% had at least one major coronary lesion greater than 70%. The best cut-off points according to each of the ROC curves: Adjusted Framingham, 5.8% (sensitivity, 80%, specificity, 41%), Adjusted PROCAM, 1.7% (sensitivity, 78%, specificity, 45%) and Reynolds, 3.8% (sensitivity, 68%, specificity, 45%). Additionally, the three areas under the curve (AUC) were 0.59, 0.59, and 0.57, respectively.Revista Nacional - Indexad

Are many patent foramen ovale closure procedures being performed in Colombia? Patent foramen ovale, atrial septal aneurysm and the risk of recurring cryptogenic stroke. Systematic review of literature

Introducción el foramen ovale permeable y el aneurisma del septum interauricular, son hallazgos frecuentes en la población general. En los últimos años múltiples estudios han sugerido la asociación entre estas entidades y el accidente cerebrovascular, de origen criptogénico como consecuencia de embolia paradójica, en especial en la población menor de 55 años, que ha estimulado el desarrollo de dispositivos de cierre percutáneo para este tipo de defectos, con el objetivo de reducir la recurrencia de eventos isquémicos cerebrales, sin que se hayan podido demostrar claramente estos beneficios. Objetivo realizar una revisión sistemática de la literatura para evaluar el riesgo de recurrencia y beneficio de esta intervención. Resultados Se obtuvieron 1.208 artículos para evaluación, con un total de 11 artículos incluidos para el análisis posterior a la selección, evaluación y aplicación de criterios de inclusión y exclusión, encontrando 3 ensayos clínicos y 8 revisiones sistemáticas y/o metaanálisis. Conclusiones En pacientes adultos con ataque cerebrovascular isquémico o accidente isquémico transitorio de origen criptogénico a quienes se les ha documentado mediante ecocardiografía transesofágica la presencia de foramen oval permeable, no existe beneficio en la reducción del riesgo de recurrencia de ataque cerebrovascular, accidente isquémico transitorio o eventos neurológicos, en comparación con la terapia médica convencional.Q4Artículo de revisión389-402Introduction Patent foramen ovale and atrial septal aneurysm are frequent findings in the average population. Over the last years multiple studies have suggested there is an association between both entities and cerebrovascular accidents of cryptogenic origin as a consequence of paradoxical embolism, specially among population under age 55, which has stimulated the development of devices for percutaneous closure of these defects with the goal of reducing recurring cerebral ischemic events, without a clear demonstration of their efficacy. Motivation To perform a systematic review of literature to assess the risk of recurrence and benefits of this surgery. Results 1,208 articles were collected for this evaluation, with a total of 11 papers included in the analysis following selection, assessment and application of selection criteria. 3 of them were clinical trial and 8 were systematic reviews or meta-analysis. Conclusions In adult patients with cryptogenic cerebrovascular ischemic or transient ischemic attacks with patent foramen ovale documented via transthoracic echocardiogram no decrease has been found in the risk of recurrence of cerebrovascular attacks, transient ischemic accidents or neurological events in comparison with traditional medical therapy

Semiological signs of aortic insufficiency : history Notes

La insuficiencia aórtica, referida como la incompetencia de la válvula para generar un adecuado cierre, constituye una de las valvulopatías con mayor riqueza semiológica. A lo largo de la historia, se ha descrito una gran variedad de signos periféricos, la mayoría de ellos epónimos de sus autores. El objetivo del presente artículo es hacer una revisión de la historia de los signos semiológicos más comunes y las contribuciones más relevantes de quienes los describieron.The aortic insufficiency is the inability of the valve to close properly, with a great amount of physical findings. The objective of this article is to make a review of the history and medical contributions of the authors who describe the principles signs.Revista Nacional - Indexad

Is levosimendan infusion useful in patients with advanced heart failure? Meta-analysis and systematic review

Background: Heart failure is a growing problem with a progressive increase in the number of patients as a result of better treatment outcomes and medical interventions. Patients with advanced heart failure who are not candidates for heart transplantation or left ventricular assist device become a major challenge for the health system, as they have a high mortality and hospitalization rate. Intermittent levosimendan infusion has been used in this group of patients even though the evidence is still controversial. Objective: The purpose of this study is to determine the efficacy of intermittent levosimendan infusion in patients with advanced heart failure. Methods: We conducted a systematic review of the literature on EMBASE, EPISTEMONIKOS, MEDLINE/Pubmed and Trip database until January 2018. We included published randomized clinical trials and meta-analysis without language restriction. Results: Eleven studies including 586 patients evaluating intermittent levosimendan infusions in patients with advanced heart failure were included for evaluation. After a follow up period between 3 and 12 months there was a 55% reduction in mortality Odds Ratio (OR) 0.45 CI 95% (0.26; 0.78. p<0.003), a reduction in natriuretic peptide levels and an improvement in left ventricular ejection fraction without a reduction in hospitalization rates. Conclusions: Intermittent levosimendan infusions in patients with advanced heart failure showed significant benefit in patients with advanced heart failure with mortality reduction becoming a promising alternative in the treatment of this group of patients.N/

Use and Impact of Social Networks on Physical Medicine and Rehabilitation Scientific Journals

Q4Objectives: Our research seeks to examine the correlation between the presence of physical medicine and rehabilitation journals in social networks and the SJR impact factor. Methods: We carried out a correlation study. For the research, we took into account all physical medicine and rehabilitation journals included in the SCImago Journal Rank. The number of followers on Twitter, Facebook, YouTube, and the number of tweets were extracted from verified accounts. Journal differences according to the presence in social networks were evaluated using non-parametric tests, and the Spearman correlation coefficient was calculated between the metrics of dissemination in social networks and the SCImago Journal Rank. Results: Out of 122 physical medicine and rehabilitation journals, 25.4% had the presence in one social network. The H Index medians (32 vs 17, P=0.014) and of the SJR (0.67 vs 0.32, P= 0.001) were better in journals with the presence in social networks. A moderate correlation was found between the SJR and the number of followers on Twitter (r=0.5, P=0.066). The global correlation between the SJR and followers on Facebook was acceptable (r=0.4, P=0.1205). Discussion: Our data show that scientific journals of physical medicine and rehabilitation with presence in social networks have superior quality metrics. Additionally, SJR and the indicators of dissemination in social networks are moderately correlated. Both metrics offer complementary information. Presence in social networks could improve the visibility of journals and their interaction with readers.Revista Internacional - Indexad

THU0626 Social networks as a source of information for patients with rheumatic diseases

Background: Internet is an informative source for patients with different diseases. False information in social networks about health issues is a growing problem. Rheumatology is no stranger to this problem and there is a lot of false information regarding rheumatic diseases. Objectives: To show objective data on misinformation published in social networks available to spanish-speaking rheumatic patients Methods: We create accounts on Facebook (FB) and Google unique for this work. Multimedia was included in Spanish, with a convenience sampling according to the deployment of the platform (FB) or in descending order for reproductions on YouTube (YT). Two independent reviewers extracted information on online time, number of reproductions and characteristics of the most popular videos. Videos consulted on 10-11-18. Results: With the search term ”rheumatoid arthritis” (RA), the most reproduced video is titled ”celery green juice for arthritis” (6.4 million reproductions). Of the first 50 videos with more reproductions, 39 are of natural or home remedies such as vinegar, “moringa”, etc., and 35 videos indicate in their content, that they can cure RA. With the term ”lupus”, the most reproduced video is titled ”God’s tea, cure chronic tiredness, thyroid, arthritis, lupus and vertigo” (1.4 million reproductions). Of the first 50 videos with more reproductions, 31 correspond to natural or home remedies such as celery, thyme, diets among others and 29 videos indicate that they can cure lupus. With the term ”fibromyalgia”, the most reproduced video is entitled ”I am 61 years old and this cured my arthritis, vertigo, fibromyalgia, lupus, chronic fatigue and the thyroid” (1.1 million reproductions). Of the 50 first videos with more reproductions, 40 are of natural or home remedies such as thyme, tea, among others and 33 videos indicate that they can cure the disease. With the data of the videos uploaded online in October 2018, 50 videos were chosen in YT and FB. There was no correlation between online time and the number of views on any platform. In FB, 56% of the videos contained false information, with no difference in online time in both groups (16 [12-22] vs 18 [13-25], p = 0.3).). In YT, only 38% was considered false information, without differences between groups in online time (19 [11-26] vs 22 [12-24])

Pediatric Index of Mortality 2 e 3 são preditores de mortalidade iguais? Estudo de concordância com base em unidade de terapia intensiva

Q2Objective: To determine the concordance of mortality risk classification through the use of the Pediatric Index of Mortality (PIM) 2 and 3. Methods: Through a retrospective cohort, we evaluated patients admitted to the pediatric intensive care unit between April 2016 and December 2018. We calculated the mortality risk with the PIM 2 and 3. Analyses were carried out to determine the concordance between the risk classification obtained with both scales using unweighted and linearly weighted kappa. Results: A total of 722 subjects were included, and 66.6% had a chronic condition. The overall mortality was 3.7%. The global kappa concordance coefficient for classifying patients according to risk with the PIM 2 and 3 was moderate at 0.48 (95%CI 0.43 - 0.53). After linear weighting, concordance was substantial at 0.64 (95%CI 0.59 - 0.69). For cardiac surgery patients, concordance for risk classification was fair at 0.30 (95%CI 0.21 - 0.39), and after linear weighting, concordance was only moderate at 0.49 (95%CI 0.39 - 0.59). The PIM 3 assigned a lower risk than the PIM 2 in 44.8% of patients in this subgroup. Conclusion: Our study proves that the PIM 2 and 3 are not clinically equivalent and should not be used interchangeably for quality evaluation across pediatric intensive care units. Validation studies must be performed before using the PIM 2 or PIM 3 in specific settings.Revista Internacional - Indexad