Análisis morfométrico de fracturas vertebrales (La Plata, Argentina)

Las fracturas vertebrales por compresión se encuentran entre las más frecuentes en mujeres postmenopáusicas. Sin embargo, son escasos los estudios sobre las mismas realizados de manera directa sobre el material esquelético. A partir de esto es que nos propusimos como objetivo determinar la prevalencia de estas fracturas en una población contemporánea a través del análisis osteológico. Fueron observados 39 esqueletos de la Colección Lambre (Argentina), con una media de edad de 56,1 años. Se relevaron macroscópicamente las vértebras en búsqueda de modificaciones de la altura del cuerpo, para luego realizar una aproximación morfométrica semicuantitativa. Estos resultados se relacionaron con la calidad ósea de los individuos estimada a partir de radiografías de calcáneo y fémur. Los resultados obtenidos evidenciaron cuatro individuos con fracturas vertebrales (10,25% de la muestra), correspondiendo dos al sexo masculino (11,1%) y dos al sexo femenino (9,52%), con una media de edad de muerte de 68,5 años. Las ocho vértebras fracturadas corresponden al segmento torácico inferior y lumbar superior, al tiempo que no se observó una relación directa entre las fracturas y la calidad ósea de los individuos. La prevalencia estimada podría estar afectada por sesgos muestrales y por el efecto de medicamentos resortivos. La baja expresión dimórfica del rasgo se relacionaría con la actividad laboral de los individuos masculinos de la población, a la vez que se corrobora que la calidad ósea no es el único determinante de una fractura vertebral osteoporótica

Análisis morfométrico de fracturas vertebrales (La Plata, Argentina)

Vertebral compression fractures are one of the most frequent types of fractures in postmenopausal women. However, there are few studies on these fractures carried out directly on osteological material. Therefore, the objective of this article is to determine the prevalence of these fractures in a contemporary population through an osteological analysis. For this purpose, 39 skeletons belonging to the Lambre Collection (Faculty of Medical Sciences, National University of La Plata) were analyzed. The mean age was 56.1 years. For the diagnosis of fractures, the vertebrae were macroscopically inspected in search of changes in body height, and then a semiquantitative morphometric approximation was carried out. These results were related to the bone quality of the individuals estimated from X-rays of the calcaneus and femur. The results obtained from the morphometric analysis revealed four individuals with vertebral fractures, which comprised 10.25% of the sample. Two of the observed cases corresponded to males (11.1%), and the remaining two to females (9.52%), with a mean age at death of 68.5 years. The eight fractured vertebrae found correspond to the lower thoracic and upper lumbar segment, while no direct relationship was observed between the fractures and the bone quality of the affected individuals. The estimated prevalence could be affected by sample bias and the effect of resorptive drugs. The low dimorphic expression of the trait might be related to the physical activity performed by the male individuals in the population, while corroborating that bone quality is not the only determinant of an osteoporotic vertebral fracture.Las fracturas vertebrales por compresión se encuentran entre las más frecuentes en mujeres postmenopáusicas. Sin embargo, son escasos los estudios sobre las mismas realizados de manera directa sobre el material esquelético. A partir de esto es que nos propusimos como objetivo determinar la prevalencia de estas fracturas en una población contemporánea a través del análisis osteológico. Fueron observados 39 esqueletos de la Colección Lambre (Argentina), con una media de edad de 56,1 años. Se relevaron macroscópicamente las vértebras en búsqueda de modificaciones de la altura del cuerpo, para luego realizar una aproximación morfométrica semicuantitativa. Estos resultados se relacionaron con la calidad ósea de los individuos estimada a partir de radiografías de calcáneo y fémur. Los resultados obtenidos evidenciaron cuatro individuos con fracturas vertebrales (10,25% de la muestra), correspondiendo dos al sexo masculino (11,1%) y dos al sexo femenino (9,52%), con una media de edad de muerte de 68,5 años. Las ocho vértebras fracturadas corresponden al segmento torácico inferior y lumbar superior, al tiempo que no se observó una relación directa entre las fracturas y la calidad ósea de los individuos. La prevalencia estimada podría estar afectada por sesgos muestrales y por el efecto de medicamentos resortivos. La baja expresión dimórfica del rasgo se relacionaría con la actividad laboral de los individuos masculinos de la población, a la vez que se corrobora que la calidad ósea no es el único determinante de una fractura vertebral osteoporótica

Morphometric analysis of vertebral fractures (La Plata, Argentina)

Las fracturas vertebrales por compresión se encuentran entre las más frecuentes en mujeres postmenopáusicas. Sin embargo, son escasos los estudios sobre las mismas realizados de manera directa sobre el material esquelético. A partir de esto es que nos propusimos como objetivo determinar la prevalencia de estas fracturas en una población contemporánea a través del análisis osteológico. Fueron observados 39 esqueletos de la Colección Lambre (Argentina), con una media de edad de 56,1 años. Se relevaron macroscópicamente las vértebras en búsqueda de modificaciones de la altura del cuerpo, para luego realizar una aproximación morfométrica semicuantitativa. Estos resultados se relacionaron con la calidad ósea de los individuos estimada a partir de radiografías de calcáneo y fémur. Los resultados obtenidos evidenciaron cuatro individuos con fracturas vertebrales (10,25% de la muestra), correspondiendo dos al sexo masculino (11,1%) y dos al sexo femenino (9,52%), con una media de edad de muerte de 68,5 años. Las ocho vértebras fracturadas corresponden al segmento torácico inferior y lumbar superior, al tiempo que no se observó una relación directa entre las fracturas y la calidad ósea de los individuos. La prevalencia estimada podría estar afectada por sesgos muestrales y por el efecto de medicamentos resortivos. La baja expresión dimórfica del rasgo se relacionaría con la actividad laboral de los individuos masculinos de la población, a la vez que se corrobora que la calidad ósea no es el único determinante de una fractura vertebral osteoporótica.Vertebral compression fractures are one of the most frequent types of fractures in postmenopausal women. However, there are few studies on these fractures carried out directly on osteological material. Therefore, the objective of this article is to determine the prevalence of these fractures in a contemporary population through an osteological analysis. For this purpose, 39 skeletons belonging to the Lambre Collection (Faculty of Medical Sciences, National University of La Plata) were analyzed. The mean age was 56.1 years. For the diagnosis of fractures, the vertebrae were macroscopically inspected in search of changes in body height, and then a semiquantitative morphometric approximation was carried out. These results were related to the bone quality of the individuals estimated from X-rays of the calcaneus and femur. The results obtained from the morphometric analysis revealed four individuals with vertebral fractures, which comprised 10.25% of the sample. Two of the observed cases corresponded to males (11.1%), and the remaining two to females (9.52%), with a mean age at death of 68.5 years. The eight fractured vertebrae found correspond to the lower thoracic and upper lumbar segment, while no direct relationship was observed between the fractures and the bone quality of the affected individuals. The estimated prevalence could be affected by sample bias and the effect of resorptive drugs. The low dimorphic expression of the trait might be related to the physical activity performed by the male individuals in the population, while corroborating that bone quality is not the only determinant of an osteoporotic vertebral fracture.Asociación de Antropología Biológica Argentin

Morphometric analysis of vertebral fractures (La Plata, Argentina)

Las fracturas vertebrales por compresión se encuentran entre las más frecuentes en mujeres postmenopáusicas. Sin embargo, son escasos los estudios sobre las mismas realizados de manera directa sobre el material esqueletal. A partir de esto es que nos propusimos como objetivo determinar la prevalencia de fracturas vertebrales osteoporóticas en una población contemporánea a través de un análisis osteológico. Fueron observados 39 esqueletos, con una media de edad de 56,1 años. Se relevaron macroscópicamente las vértebras en búsqueda de modificaciones de la altura del cuerpo, luego se realizó una aproximación morfométrica siguiendo la propuesta de Genant et al. (1993). Estosresultados se relacionaron con la calidad ósea de los individuos estimada a partir de radiografías de calcáneo y fémur. Los resultados obtenidos evidenciaron cuatro individuos con fracturas vertebrales (10,25% de lamuestra), siendo dos de sexo masculino (11,1%) y dos de sexo femenino (9,52%), con una media de edad de muerte de 68,5 años. Las ocho vértebras fracturadas corresponden al segmento torácico inferior y lumbar superior, al tiempo que no se observó una relación directa entre las fracturas y la calidad ósea de los individuos. La prevalencia estimada podría estar afectada por sesgos muestrales y por el efecto de medicamentos resortivos. La baja expresión dimórfica del rasgo se relacionaría con la actividad laboral de los individuos masculinos de la población, a la vez que se corrobora que la calidad ósea no es el único determinante de una fractura vertebral osteoporótica.Vertebral compression fractures are one of the most frequent types of fractures in postmenopausal women. However, there are few studies on these fractures carried out directly on osteological material. Therefore, the objective of this article is to determine the prevalence of these fractures in a contemporary population through an osteological analysis. For this purpose, 39 skeletons belonging to the Lambre Collection (Faculty of Medical Sciences, National University of La Plata) were analyzed. The mean age was 56.1 years. For the diagnosis of fractures, the vertebrae were macroscopically inspected in search of changes in body height, and then a semiquantitative morphometric approximation was carried out. These results were related to the bone quality of the individuals estimated from X-rays of the calcaneus and femur. The results obtained from the morphometric analysis revealed four individuals with vertebral fractures, which comprised 10.25% of the sample. Two of the observed cases corresponded to males (11.1%), and the remaining two to females (9.52%), with a mean age at death of 68.5 years. The eight fractured vertebrae found correspond to the lower thoracic and upper lumbar segment, while no direct relationship was observed between the fractures and the bone quality of the affected individuals. The estimated prevalence could be affected by sample bias and the effect of resorptive drugs. The low dimorphic expression of the trait might be related to the physical activity performed by the male individuals in the population, while corroborating that bone quality is not the only determinant of an osteoporotic vertebral fracture.Fil: Plischuk, Marcos. Laboratorio de Investigaciones En Ciencias Forenses (licif) ; Facultad de Cs.medicas ; Universidad Nacional de la Plata; . Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Datino, Agustina Aldana. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo; Argentin

Do Elderly Patients with Heart Failure and Reduced Ejection Fraction Benefit from Pharmacological Strategies for Prevention of Arrhythmic Events?

Background Heart failure constitutes one of the leading causes of morbidity and mortality in Western countries, in which it is also the leading cause of hospitalization in elderly patients. The pharmacological therapy of patients with heart failure with reduced ejection fraction (HFrEF) has greatly improved during the last years. Summary The quadruple therapy (sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors) is nowadays the cornerstone of medical treatment since it associates lower risk of heart failure hospitalizations and mortality (also of arrhythmic origin). Cardiac arrhythmias, including sudden cardiac death, are common in patients with HFrEF, entailing worse prognosis. Previous studies addressing the role of blocking the renin-angiotensin-aldosterone system and beta-adrenergic receptors in HFrEF have suggested different beneficial effects on arrhythmia mechanisms. Therefore, the lower mortality associated with the use of the four pillars of HFrEF therapy depends, in part, on lower sudden (mostly arrhythmic) cardiac death. Key Messages In this review, we highlight and assess the role of the four pharmacological groups that constitute the central axis of the medical treatment of patients with HFrEF in clinical prognosis and prevention of arrhythmic events, with special focus on the elderly patient, since evidence supports most benefits provided are irrespective of age, but elderly HF patients receive less frequently guideline recommended medical treatment.12 página

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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Structural remodeling and rotational activity in persistent/long-lasting atrial fibrillation: gender-effect differences and impact on post-ablation outcome

Background: Structural and post-ablation gender differences are reported in atrial fibrillation (AF). We analyzed the gender differences in structural remodeling and AF mechanisms in patients with persistent/long-lasting AF who underwent wide area circumferential pulmonary vein isolation (WACPVI). Materials and Methods: Ultra-high-density mapping was used to study atrial remodeling and AF drivers in 85 consecutive patients. Focal and rotational activity (RAc) were identified with the CartoFinder system and activation sequence analysis. The impact of RAc location on post-ablation outcomes was analyzed. Results: This study included 64 men and 21 women. RAc was detected in 73.4% of men and 38.1% of women (p = 0.003). RAc patients had higher left atrium (LA) voltage (0.64 ± 0.3 vs. 0.50 ± 0.2 mV; p = 0.01), RAc sites had higher voltage than non-RAc sites 0.77 ± 0.46 vs. 0.53 ± 0.37 mV (p < 0.001). Women had lower LA voltage than men (0.42 vs. 0.64 mV; p < 0.001), including pulmonary vein (PV) antra (0.16 vs. 0.30 mV; p < 0.001) and posterior wall (0.34 vs. 0.51 mV; p < 0.001). RAc in the posterior atrium was recorded in few women (23.8 vs. 54.7% in men; p = 0.014). AF recurrence rate was higher in patients with RAc outside WACPVI than those with all RAc inside WACPVI or no RAc (63.4 vs. 11.1 and 31.0%; p = 0.008 and p = 0.01). Comparison of selected patients using propensity score matching confirmed lower atrial voltage (0.4 ± 0.2 vs. 0.7 ± 0.3 mV; p = 0.007) and less RAc (38 vs. 75%; p = 0.02) in women. Conclusion: Women have shown more advanced structural remodeling at ablation, which is associated with a lower incidence of RAc (usually located outside the WACPVI). These findings could explain post-ablation gender differences.This study was supported by the Instituto de Salud Carlos III, Madrid, Spain (PI18/01895 and DTS21/00064), Red de Terapia Celular from the Instituto de Salud Carlos III, Madrid, Spain (RD16/0011/0029), Ricors "Red de Investigación Cooperativa Orientada a Resultados en Salud" RICORS TERAV (RD21/0017/0002), and the Sección del Ritmo de la Sociedad Española de Cardiología (Grant: Beca de la Asociacion del Ritmo para formación en investigacion post-residencia en centros españoles de la Sección del Ritmo de la Sociedad Española de Cardiología), Madrid, Spain

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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Predicting sudden cardiac death in adults with congenital heart disease

[Objectives] To develop, calibrate, test and validate a logistic regression model for accurate risk prediction of sudden cardiac death (SCD) and non-fatal sudden cardiac arrest (SCA) in adults with congenital heart disease (ACHD), based on baseline lesion-specific risk stratification and individual’s characteristics, to guide primary prevention strategies.[Methods] We combined data from a single-centre cohort of 3311 consecutive ACHD patients (50% male) at 25-year follow-up with 71 events (53 SCD and 18 non-fatal SCA) and a multicentre case–control group with 207 cases (110 SCD and 97 non-fatal SCA) and 2287 consecutive controls (50% males). Cumulative incidences of events up to 20 years for specific lesions were determined in the prospective cohort. Risk model and its 5-year risk predictions were derived by logistic regression modelling, using separate development (18 centres: 144 cases and 1501 controls) and validation (two centres: 63 cases and 786 controls) datasets.[Results] According to the combined SCD/SCA cumulative 20 years incidence, a lesion-specific stratification into four clusters—very-low (12%)—was built. Multivariable predictors were lesion-specific cluster, young age, male sex, unexplained syncope, ischaemic heart disease, non-life threatening ventricular arrhythmias, QRS duration and ventricular systolic dysfunction or hypertrophy. The model very accurately discriminated (C-index 0.91; 95% CI 0.88 to 0.94) and calibrated (p=0.3 for observed vs expected proportions) in the validation dataset. Compared with current guidelines approach, sensitivity increases 29% with less than 1% change in specificity.[Conclusions] Predicting the risk of SCD/SCA in ACHD can be significantly improved using a baseline lesion-specific stratification and simple clinical variables.Peer reviewe