Abstract Background Acute coronary syndrome (ACS) is one of the leading causes of mortality worldwide. Knowing the predisposing factors is essential for preventing it. Objectives To describe the etiological and epidemiological characteristics of the population with ACS admitted to an emergency room in the State of São Paulo. Methods The prospective cohort study, based on electronic medical records from a public cardiology institute located in the state of São Paulo, Brazil, describes 5,580 patients hospitalized with ACS between August 2018 and October 2022. The main epidemiological characteristics, the association between confirmed ACS and risk scores, and adverse events during hospitalization and in the 30-day follow-up after hospital discharge were evaluated. The significance level was set at 5%. Results The main factors associated with ACS were hypertension (80.38%), obesity or overweight (72.47%), and previous coronary artery disease (CAD) (59.11%). In the GRACE score, 65.10% were considered low risk, while 81.34% in the TIMI and 71.16% in the HEART were identified as moderate risk. Catheterization represented 84.93% of the diagnostic methods. Clinical treatment was the strategy adopted in 46.47% of the cases. In the 30-day evolution, 3.10% presented major bleeding, 7.86% infarction/reinfarction, 5.55% stroke, and 2.53% evolved to death. Conclusion The results of the largest Brazilian ACS registry to date highlight the impact of potentially modifiable risk factors on the occurrence of ischemic events in the local population. The findings may contribute to the development of public policies aimed at preventing and controlling the burden of ischemic disease in the country.

Resumo Fundamentos A síndrome coronariana aguda (SCA) é uma das principais causas de mortalidade no mundo. Conhecer os fatores predisponentes é essencial para a prevenção desta. Objetivos Descrever as características etiológicas e epidemiológicas da população com SCA admitida em um pronto-socorro do Estado de São Paulo. Métodos A coorte prospectiva realizada com base nos registros de prontuário eletrônico de um instituto cardiológico público localizado no Estado de São Paulo descreve 5.580 pacientes internados com SCA entre agosto de 2018 e outubro de 2022. Avaliou-se as principais características epidemiológicas, a associação entre confirmação de SCA e escores de risco, eventos adversos durante o internamento e no seguimento de 30 dias após a alta hospitalar. O nível de significância foi de 5%. Resultados Os principais fatores associados a SCA foram hipertensão (80,38%), obesidade ou sobrepeso (72,47%) e doença arterial coronariana prévia (59,11%). No escore Grace, 65,10% foram considerados de baixo risco, enquanto 81,34% no TIMI e 71,16% no HEART foram identificados como risco moderado. O cateterismo representou 84,93% dos métodos diagnósticos. O tratamento clínico foi a estratégia adotada em 46,47% dos casos. Na evolução em 30 dias, 3,10% apresentaram sangramento maior, 7,86% infarto/reinfarto, 5,55% acidente vascular encefálico e 2,53% evoluíram para óbito. Conclusão Os resultados do maior registro de SCA brasileiro até o momento evidenciam o impacto dos fatores de risco potencialmente modificáveis na ocorrência de eventos isquêmicos na população local. Os achados podem contribuir para o desenvolvimento de políticas públicas visando a prevenção e controle da carga da doença isquêmica no país.

RESUMO Objetivo: Avaliar a associação entre a combinação da adiposidade corporal (AC) e da aptidão física cardiorrespiratória (ApFCR) com fatores de risco cardiometabólico em crianças (7–10 anos). Métodos: Estudo transversal com amostra de 251 crianças cadastradas em Unidades Saúde da Família. Dados sociodemográficos, de hábitos de vida, antropométricos, bioquímicos, de pressão arterial (PA) e ApFCR foram coletados. Fatores de risco cardiometabólico avaliados: colesterol total, HDL-c, LDL-c, triglicerídeos (TG), glicemia de jejum e pressão arterial (PA). A ApFCR foi avaliada pelo teste de corrida/caminhada de 6 minutos e classificada nos grupos “fisicamente inapto” e “fisicamente apto”. O estado nutricional foi avaliado pelo índice de massa corporal (IMC)/idade e categorizado em grupos de AC: “sem excesso de peso [≤z-score+1]” e “com excesso de peso [>z-score+1]”. AC e ApFCR foram combinados e as crianças foram categorizadas em: “sem excesso de peso+aptidão física”, “sem excesso de peso+inaptidão física”, “excesso de peso+aptidão física” e “excesso de peso+inaptidão física”. Análises bivariadas foram realizadas e modelos de regressão de Poisson testados, utilizado o software Statistical Package for the Social Sciences (SPSS) versão 21.0, adotando-se p<0,05. Resultados: Cerca de 65% da amostra apresentou baixa ApFCR e 59% excesso de peso. Foram observadas maiores ocorrências de HDL-colesterol alterado, TG alterado e da presença de ≥3 fatores cardiometabólicos agrupados em crianças com excesso de peso + inaptidão física. Conclusões: A prevalência de HDL e TG alterado e de ≥3 fatores cardiometabólicos agrupados foi significativamente maior entre as crianças com excesso de peso e que também apresentavam inaptidão física.

ABSTRACT Objective: To assess the association between the combination of corporal adiposity (CA) and cardiorespiratory physical fitness (CRF) with cardiometabolic risk factors in children aged 7–10 years. Methods: Cross-sectional observational study with a sample of 251 children registered in Family Health Units. Sociodemographic, lifestyle, anthropometric, biochemical, blood pressure, and CRF data were collected. Cardiometabolic risk factors assessed: total cholesterol, HDL-c, LDL-c, triglycerides (TG), fasting glucose and blood pressure. CRF was assessed by the 6-minute run/walk test and classified into: “physically unfit” and “physically fit”. Nutritional status was assessed by body mass index (BMI)/age and categorized into CA groups: “no excess weight [≤ z-score+1]” and “excess weight [> z-score+1]”. CRF and CA were combined, and the children were classified as “no excess weight + physically fit”, “no excess weight + physically unfit”, “excess weight + physically fit” and “excess weight + physically unfit”. Bivariate analyses were performed, and Poisson regression models were tested. The Statistical Package for the Social Sciences (SPSS) version 21.0 software was used, adopting p<0.05. Results: Around 65% of the children had low CRF and 59% had excess weight (overweight+obesity). After adjustment, there was a greater occurrence of having altered HDL-c, TG and presence of ≥ 3 grouped cardiometabolic factors among those who had excess weight + physically unfit. Conclusions: The prevalence of altered HDL and TG and of ≥3 grouped cardiometabolic risk factors was significantly higher among children who had excess weight and were physically unfit.

Abstract The objective of this study is to investigate the influence of physical activity on heart rate (HR) recovery, after treadmill exercise testing, in asymptomatic adults, with and without familial risk factors (FR) for cardiovascular disease. Two hundred and fifty (250) adults of both sexes aged 18 to 59 years were included in the study. None of the participants had a history of cardiovascular disease or used medications for chronic diseases. All individuals underwent exercise testing using the Ellestad protocol. Delta values were calculated by subtracting peak HR from HR in the first, second, fourth, and sixth minutes of recovery. The family history of cardiovascular disease and physical activity were documented. For statistical analysis, ANOVA was performed, followed by Bonferroni or Kruskall-Wallis multiple comparisons, followed by Dunn’s multiple comparisons. The delta values at the first, second, fourth, and sixth minutes of recovery were lower in individuals who did not engage in physical activity and had no family cardiovascular risk factor, compared to those who were physically active and had no family risk factor. No differences in delta values were observed between physically active individuals with cardiovascular risk factors and physically inactive individuals with a family history at the time points studied. In individuals without a family risk factor, physical activity appears to enhance autonomic control, increasing the capacity to reduce HR after exercise. However, this effect was not evident in those with a family risk factor, as physical activity did not impact recovery HR.

Resumo O objetivo do presente estudo é investigar a influência da prática de atividade física, na frequência cardíaca (FC) de recuperação após o teste ergométrico, em esteira, em adultos assintomáticos, com e sem fator de risco familiar para doença cardiovascular. Duzentos e cinquenta adultos de ambos os sexos com idades entre 18 e 59 anos foram estudados. Nenhum dos participantes tinham histórico de doença cardiovascular e não utilizavam remédios para doenças crônicas. Todos foram submetidos ao teste de esforço com o protocolo Ellestad. Os valores de delta foram calculados pela subtração da FC de pico pela FC do primeiro, segundo, quarto e sexto minuto de recuperação. O histórico familiar cardiovascular e de atividade física foram documentados. Para a análise estatística foi feito o teste de ANOVA seguido pelas comparações múltiplas de Bonferroni ou Kruskall-Wallis seguido das comparações múltiplas de Dunn. O delta do primeiro, segundo, quarto e sexto minuto da recuperação, foi menor nos indivíduos que não praticavam atividade física e que não tinham fator de risco cardiovascular familiar, em comparação aos fisicamente ativos e sem fator de risco familiar. Os valores de delta não foram diferentes entre os fisicamente ativos com fatores de risco cardiovascular em comparação aos fisicamente inativos com histórico familiar nos momentos estudados. A prática de atividade física, em indivíduos sem fator de risco familiar, pode promover melhor controle autonômico, proporcionando maior capacidade de reduzir a FC após o esforço. Isso não foi observado naqueles com fator de risco familiar, pois a prática de atividade física não influenciou a FC de recuperação.

Resumo O objetivo é estimar sobrevida global em um ano e taxa de reinternação após primeiro infarto do miocárdio. Estudo de coorte com 689 pacientes acompanhados entre agosto de 2016 e março de 2022. Foram utilizados o estimador de Kaplan-Meier e o teste de log-rank. O modelo semiparamétrico de Cox foi empregado para estimar o risco de óbito e readmissão. A média de idade foi de 60,0 (DP 11,0) anos, 67,9% homens e 50,7% de infarto agudo do miocárdio com supradesnivelamento de ST. A taxa de sobrevida global foi de 96,3%, com a mediana de tempo de óbito de 41,5 dias. A taxa de sobrevida livre de reinternação foi de 83,3%, com a mediana de tempo de readmissão de 54 dias. Idade igual ou superior a 60 anos aumentou o risco de morte em 10,01 e a presença de hipertensão arterial sistêmica aumentou o risco de readmissão em 1,52. A taxa de sobrevida global foi de 96,2%, com diferença entre grupos de idade. A taxa de sobrevida livre de reinternação foi de 83,3%, com diferença pela presença de hipertensão arterial sistêmica. Como os eventos são bastante prevalentes, faz-se necessária melhor avaliação da efetividade dos cuidados de saúde prestados e das ações que devem ser tomadas para reduzir a incidência e consequente morbidade e mortalidade.

Resumen El objetivo es estimar la supervivencia global a un año y la tasa de reingreso después del primer infarto de miocardio. Estudio de cohorte con 689 pacientes seguidos entre agosto de 2016 y marzo de 2022. Se utilizó el estimador de Kaplan-Meier y la prueba de log-rank. Se utilizó el modelo semiparamétrico de Cox para estimar el riesgo de muerte y reingreso. La edad media fue 60,0 (DE 11,0) años, el 67,9% eran hombres y el 50,7% presentaron infarto agudo de miocardio con elevación del ST. La tasa de supervivencia general fue del 96,3%, con una mediana de tiempo hasta la muerte de 41,5 días. La tasa de supervivencia libre de reingreso fue del 83,3% con una mediana de tiempo de reingreso de 54 días. La edad de 60 años o más aumentó el riesgo de muerte en 10,01 y la presencia de hipertensión arterial sistémica aumentó el riesgo de reingreso en 1,52. La tasa de supervivencia global fue del 96,2%, con diferencias entre grupos de edad. La tasa de supervivencia libre de reingreso fue del 83,3%, con diferencias por la presencia de hipertensión arterial sistémica. Como los eventos son bastante frecuentes, es necesario evaluar mejor la efectividad de la atención médica brindada y las acciones que deben tomarse para reducir la incidencia y la consiguiente morbilidad y mortalidad.

Abstract The aim is to estimate the overall one-year survival rate and readmission rate after the first myocardial infarction. A cohort study involving 689 patients followed up between August 2016 and March 2022. The Kaplan-Meier estimator and the log-rank test were used. Cox semiparametric model was used to estimate death and readmission risk. The mean age was 60.0 (SD 11.0) years old, 67.9% men and 50.7% with ST-elevation myocardial infarction. The overall survival rate was 96.3%, with median time of death of 41.5 days. The readmission-free survival rate was 83.4%, with median time of readmission of 54 days. Age of 60 years and over increased death risk by 10.01 and the presence of systemic arterial hypertension increased readmission risk by 1.52. The overall survival rate was 96.2% with difference in age groups. The readmission-free survival rate was 83.4%, with difference by the presence of systemic arterial hypertension. As these events are quite prevalent, a better assessment of the effectiveness of the health care provided and the actions that must be taken to reduce the incidence and consequent morbidity and mortality is necessary.

SUMMARY OBJECTIVE: Coronary artery bypass graft surgery is one of the most frequently performed surgeries worldwide. Coronary artery bypass graft surgery induces an inflammatory response. Interleukin-8 is a pro-inflammatory cytokine that plays a role in the pathogenesis of cardiovascular diseases. C1q/TNF-related protein-12 is implicated in mitigating inflammation and cardiomyocyte damage. This study aimed to compare interleukin-8 and C1q/TNF-related protein-12 levels before and 45 days after coronary artery bypass graft surgery. METHODS: A total of 43 patients who underwent coronary artery bypass graft surgery were studied. Serum concentrations of interleukin-8 and C1q/TNF-related protein-12 were evaluated using the enzyme-linked immunosorbent assay method before and 45 days after the surgery. RESULTS: No significant differences were observed in interleukin-8 levels between pre- and post-coronary artery bypass graft surgery (p=0.077). However, serum levels of C1q/TNF-related protein-12 were found to be lower 45 days after coronary artery bypass graft surgery compared to pre-surgery levels (p<0.001). Moreover, changes in C1q/TNF-related protein-12 were not associated with diabetes, hypertension, and body mass index (p>0.05), but C1q/TNF-related protein-12 alterations were found to be associated with opium addiction. CONCLUSION: These findings suggest that the evaluation of C1q/TNF-related protein-12 can be beneficial for the late assessment of post-coronary artery bypass graft surgery inflammation. The reduction of C1q/TNF-related protein-12 levels might indicate increased levels of inflammation after surgery at this time point, which requires the assessment of further inflammatory factors to confirm this finding. OBJECTIVE worldwide response Interleukin8 Interleukin 8 Interleukin- proinflammatory pro diseases C1q/TNFrelated C1qTNFrelated CqTNFrelated C1q/TNF related C1q TNF C q protein12 protein 12 protein-1 damage interleukin8 interleukin interleukin- 4 METHODS studied enzymelinked enzyme linked RESULTS pre postcoronary post p=0.077. p0077 p p=0.077 . 0 077 (p=0.077) However presurgery p<0.001. p0001 p<0.001 001 (p<0.001) Moreover diabetes hypertension p>0.05, p005 p>0.05 , 05 (p>0.05) addiction CONCLUSION point finding TNFrelated qTNFrelated C1qTNF CqTNF Cq protein1 1 protein- p007 p=0.07 07 (p=0.077 p000 p<0.00 00 (p<0.001 p00 p>0.0 (p>0.05 qTNF p=0.0 (p=0.07 p<0.0 (p<0.00 p0 p>0. (p>0.0 p=0. (p=0.0 p<0. (p<0.0 p>0 (p>0. p=0 (p=0. p<0 (p<0. p> (p>0 p= (p=0 p< (p<0 (p> (p= (p< (p

ABSTRACT BACKGROUND: Detraining can partially or completely reduce training-induced metabolic adaptations. However, the duration for which the rehabilitation effects persist after detraining, especially in patients with heart disease, remains unclear. OBJECTIVES: To evaluate the principle of reversibility/detraining in patients with heart disease via the 6-minute walk test (6MWT) after a period of rest. DESIGN AND SETTING: A retrospective cohort study developed at the Rehabilitation Center of the Universidade Federal do Triângulo Mineiro in Uberaba/MG, Brazil. METHODS: This clinical, retrospective longitudinal study involved 20 patients with heart disease who underwent 5 months of supervised cardiac rehabilitation (CR). The mean age of participants was 64.05 ± 9.25 years. The initial rehabilitation was followed by an interruption period and rehabilitation for another 5 months. Functional capacity was assessed using the 6MWT. RESULTS: In the specific analysis of the distance covered, values of P = 0.03 and P = 0.01 were obtained on comparing post-training (669.64 ± 58.80 meters) with post-detraining (640.82 ± 101.23 meters) and post-detraining with post-retraining (650.82 ± 96.28 meters), respectively. No significant difference was observed for the comparison between training and retraining (P = 0.83). CONCLUSION: Cardiovascular rehabilitation positively stimulates functional capacity, whereas detraining significantly reduces it. The 6MWT is effective in measuring changes in physical capacity. BACKGROUND traininginduced induced adaptations However unclear OBJECTIVES reversibilitydetraining reversibility 6minute minute 6 MWT (6MWT rest SETTING UberabaMG Uberaba MG Uberaba/MG Brazil METHODS clinical 2 CR. CR . (CR) 6405 64 05 64.0 925 9 25 9.2 years RESULTS covered 003 0 03 0.0 001 01 posttraining post 669.64 66964 669 (669.6 5880 58 80 58.8 meters postdetraining 640.82 64082 640 82 (640.8 10123 101 23 101.2 postretraining 650.82 65082 650 (650.8 9628 96 28 96.2 meters, , respectively 0.83. 083 0.83 83 0.83) CONCLUSION it (CR 64. 92 9. 00 0. 669.6 6696 66 (669. 588 8 58. 640.8 6408 (640. 1012 10 101. 650.8 6508 65 (650. 962 96. 08 0.8 669. (669 640. (640 1 650. (650 (66 (64 (65 (6 (

Resumen Marco contextual: El dolor torácico agudo (DTA) es un síntoma frecuente en las personas con síndrome coronario agudo (SCA) que a menudo requiere atención de urgencias. Objetivo: Conocer el tiempo de respuesta prehospitalaria y el papel del enfermero de la ambulancia de soporte vital inmediato en casos de DTA en personas con posible SCA en dos distritos del norte de Portugal. Metodología: Estudio observacional, analítico, transversal, retrospectivo, cuantitativo, con una muestra de 75 casos. Resultados: Se registraron tiempos totales de respuesta prehospitalaria largos, superiores a 95 minutos en ambos distritos, y en infarto agudo de miocardio con elevación del segmento ST (EAMCSST), con tiempos medios de 131 ± 22,23 minutos, seguido del 10,66% de la muestra total. Los enfermeros utilizaron el protocolo de dolor torácico en la mayoría de los casos (98,7%), realizaron electrocardiogramas (97,3%) y contribuyeron a la mejoría de los síntomas (72%). Conclusión: El enfermero es fundamental para diagnosticar y controlar los síntomas, pero los tiempos de respuesta, sobre todo en el IAMCEST, superan los recomendados para el procedimiento de elección, la angioplastia.

Abstract Background: Acute chest pain (ACP) is a common symptom in patients with acute coronary syndrome (ACS) that often requires emergency care. Objective: Examine the out-of-hospital response time and the role of immediate life support nurses in the presence of ACP in patients with suspected ACS, in two districts in the interior north of Portugal. Methodology: Observational, analytical, cross-sectional, retrospective, quantitative study with a sample of 75 occurrences. Results: Total out-of-hospital response times were high, exceeding 95 minutes in both districts. In ST-elevation myocardial infarction (STEMI), total mean times were 131 ± 22.23 minutes, which occurred in 10.66% of the total sample. The nurses used the chest pain protocol in the majority of occurrences (98.7%), performed electrocardiogram (97.3%), and contributed to symptom improvement (72%). Conclusion: Although the nurse’s role is crucial for establishing the diagnosis and managing symptoms, the response times, especially in STEMI cases, exceed the recommended time for the procedure of choice (angioplasty).

Resumo Enquadramento: A dor torácica aguda (DTA) é um sintoma comum na pessoa com síndrome coronária aguda (SCA) que requer frequentemente cuidados de emergência. Objetivo: Conhecer o tempo de resposta pré-hospitalar e a atuação do enfermeiro da ambulância suporte imediato de vida nas ocorrências de DTA, na pessoa com suspeita de SCA, relativamente a dois distritos do interior norte de Portugal. Metodologia: Estudo observacional, analítico transversal, retrospetivo, de cariz quantitativo, numa amostra de 75 ocorrências. Resultados: Verificaram-se tempos totais longos na resposta pré-hospitalar, ultrapassando os 95 minutos em ambos os distritos e, no enfarte agudo miocárdio com elevação do segmento ST (EAMCSST), apresentando tempos médios de 131 ± 22,23 minutos, sucedido em 10,66% da amostra total. Os enfermeiros utilizaram o protocolo da dor torácica na generalidade das ocorrências (98,7%), realizaram eletrocardiograma (97,3%) e contribuíram para a melhoria dos sintomas (72%). Conclusão: O enfermeiro é essencial no diagnóstico e controlo da sintomatologia, mas os tempos de resposta, particularmente no EAMCSST, ultrapassam o recomendado para a realização do procedimento de eleição, a angioplastia.

Resumo: A doença de von Willebrand adquirida (EVW acq, AVWS) é um distúrbio hemorrágico adquirido raro com características clínicas e laboratoriais semelhantes à doença de von Willebrand congênita. Associado a doenças hemato-oncológicas, autoimunes, cardiovasculares e tumores sólidos. As gamopatias monoclonais constituem um grupo heterogêneo de distúrbios caracterizados pela proliferação de linfócitos B nos últimos estágios de maturação ou plasmócitos que preservam a capacidade de produzir uma imunoglobulina monoclonal (Ig) ou um de seus componentes. Como consequência, ocorre o aparecimento de uma paraproteína ou componente M (CM) no soro e/ou na urina, que serão formados pela mesma cadeia pesada ou leve, e por regiões variáveis idênticas. Apresentamos o caso de uma mulher de 57 anos, que apresentava um síndroma hemorrágico, alteração da crase na sua via intrínseca, onde é diagnosticada Doença de Von Willebrand Adquirida secundária a Mieloma Múltiplo. O tratamento visava estancar o sangramento, prevenir complicações e abordar prontamente a patologia hemato-oncológica subjacente. Para sua abordagem, exigiu a realização de plasmaférese terapêutica que teve papel de ação terapêutica precoce e efetiva com excelente tolerância. Diante do diagnóstico, rapidamente foi iniciada poliquimioterapia, sendo este paciente candidato a transplante de células-tronco hematopoiéticas. O objetivo da apresentação deste caso clínico é realçar a importância de um diagnóstico correto e atempado face à suspeita clínica de uma coagulopatia secundária a uma doença hemato-oncológica subjacente. Portanto, enfatizamos a abordagem multidisciplinar.

Abstract: Acquired von Willebrand disease (AVWS) is a rare acquired bleeding disorder with clinical and laboratory features similar to congenital von Willebrand disease. Associated with hemato-oncological, autoimmune, cardiovascular diseases and solid tumors. Monoclonal gammopathies constitute a heterogeneous group of disorders characterized by the proliferation of B lymphocytes in the last stages of maturation or plasma cells that preserve the capacity to produce a monoclonal immunoglobulin (Ig) or one of its components. As a consequence, the appearance of a paraprotein or M component (CM) occurs in serum and/or urine, which will be formed by the same heavy or light chain, and by identical variable regions. We present the case of a 57-year-old woman, who presented with a hemorrhagic parous syndrome, alteration of the crasis in its intrinsic way, where Acquired Von Willebrand Disease secondary to Multiple Myeloma is diagnosed. Treatment was aimed at stopping the bleeding, preventing complications, and promptly addressing the underlying hemato-oncological pathology. For its approach, it required the performance of therapeutic plasma exchanges that had a role of early and effective therapeutic action with excellent tolerance. Given the diagnosis, polychemotherapy was quickly started, this patient being a candidate for hematopoietic stem cell transplantation. The objective of presenting this clinical case is to highlight the importance of a correct and timely diagnosis in the face of clinical suspicion of a coagulopathy secondary to an underlying hemato-oncological disease. Therefore, we emphasize the multidisciplinary approach.

Resumen: La Enfermedad de Von Willebrand adquirida (EVW adquirida) es un trastorno hemorrágico adquirido poco frecuente, con características clínicas y de laboratorio similares a la Enfermedad de Von Willebrand congénita. Asociándose con enfermedades hemato-oncológicas, autoinmunes, cardiovasculares y tumores sólidos. Las gammapatías monoclonales constituyen un grupo heterogéneo de trastornos caracterizados por la proliferación de linfocitos B en los últimos estadios madurativos o células plasmáticas que preservan la capacidad de producir una inmunoglobulina (Ig) monoclonal o alguno de sus componentes. Como consecuencia, se produce la aparición de una paraproteína o componente M (CM) en suero y/o orina que estará formado por la misma cadena pesada o ligera, y por regiones variables idénticas. Se presenta el caso de una mujer de 57 años, que se presenta con un síndrome hemorragíparo, alteración de la crasis en su vía intrínseca, donde se diagnostica EVW adq secundaria a Mieloma Múltiple (MM) con CM IgM 5,9 g/dl. El tratamiento tuvo como objetivos detener el sangrado, prevenir complicaciones y abordar precozmente la patología hemato-oncológica causante. Para su abordaje requirió la realización de recambios plasmáticos terapéuticos (RPT) que tuvieron un rol de acción terapéutica temprana y eficaz con excelente tolerancia. Ante el diagnóstico se inició rápidamente poliquimioterapia siendo ésta una paciente candidata a trasplante de progenitores hematopoyéticos. El objetivo de la presentación de este caso clínico es destacar la importancia de un correcto y oportuno diagnóstico ante la sospecha clínica de una coagulopatía secundaria a una enfermedad hemato-oncológica subyacente. Por lo que hacemos énfasis en el abordaje multidisciplinario.

Resumen Los trabajadores agrícolas se exponen frecuentemente a los pesticidas, los cuales pueden afectar el sistema cardiovascular. El objetivo de la investigación fue revisar la asociación entre la exposición ocupacional a pesticidas, el desarrollo de enfermedades cardiovasculares y los biomarcadores utilizados en la vigilancia de la salud de los trabajadores. Para ello se realizó una revisión no sistemática de la literatura en tres bases de datos: Pubmed, Embase y Scopus, con ecuaciones de búsqueda elaboradas con los términos “agrochemicals”, “myocardial infarction”, “occupational exposure” y “farmers", y se incluyeron artículos publicados entre 2007 y 2022. Se encontró que los pesticidas causan elevación de las cifras de presión arterial en trabajadores expuestos y en mujeres embarazadas se relaciona con hipertensión gestacional y preeclampsia. Respecto al infarto agudo de miocardio (IAM), el contacto con los pesticidas clorpirifós, coumafós, carbofurano, pendimetalina, trifluralina y acilalanina aumentan el riesgo de IAM en mujeres, y entre los trabajadores masculinos la exposición a dibromuro de etileno, maneb/mancozeb y dimetil-ditiocarbamato de zinc se asoció con mayor mortalidad. La vigilancia epidemiológica se realiza principalmente con la medición de la actividad de la acetilcolinesterasa eritrocitaria (AChE). Se puede concluir que la exposición a pesticidas puede desencadenar enfermedades cardiovasculares agudas y crónicas, como elevación de las cifras de presión arterial, IAM fatal y no fatal. Los pesticidas dimetil ditiocarbamato de zinc, clorpirifós, coumafós, carbofurano, paratión y malatión son las sustancias que tienen mayor relación con el desarrollo de enfermedad cardiovascular.

Abstract Farmworkers are frequently exposed to pesticides, which can affect the cardiovascular system. The objective of the research was to review the association between occupational exposure to pesticides and the development of cardiovascular diseases, and the biomarkers used in monitoring the health of workers. For this, a non-systematic review of the literature was carried out in three databases: Pubmed, Embase and Scopus, with search equations prepared with the terms "agrochemicals", "myocardial infarction", "occupational exposure" and "farmers". Articles published between 2007 and 2022 were included. Pesticides were found to cause elevated blood pressure levels in exposed workers, and in pregnant women it is related to gestational hypertension and preeclampsia. Regarding acute myocardial infarction (AMI), contact the pesticides chlorpyrifos, coumaphos, carbofuran, pendimethalin, trifluralin, and acylalanine increased the risk of AMI in women, and among male workers exposure to ethylene dibromide, maneb/mancozeb, and zinc dimethyldithiocarbamate was associated with increased mortality. Epidemiological surveillance is mainly carried out by measuring erythrocyte acetylcholinesterase (AChE) activity. It can be concluded that exposure to pesticides can trigger acute and chronic cardiovascular diseases, such as elevated blood pressure, fatal and non-fatal AMI. Zinc dimethyl dithiocarbamate, chlorpyrifos, coumafos, carbofuran, parathion and malathion pesticides are the substances most closely related to the development of cardiovascular disease.

Resumo Enquadramento: A principal causa de morte no mundo são as doenças cardiovasculares, constituindo uma preocupação central em saúde. Objetivo: Descrever o número de ativações da via verde coronária (VVC) num serviço de urgência médico-cirúrgica (SUMC) de uma unidade hospitalar do norte de Portugal. Metodologia: Estudo quantitativo, descritivo e transversal, respeitante aos doentes admitidos num SUMC, a quem foi ativada VVC, entre dezembro de 2017 e dezembro de 2021. Resultados: Amostra de 831 indivíduos, maioritariamente do sexo masculino (60,5%), com 45,3% a integrar o grupo dos 61-80 anos e 48% a apresentar a hipertensão arterial como antecedente patológico. Constatou-se que 98,9% das ativações foram efetuadas pelos enfermeiros. Em 2020 (ano da pandemia), verificou-se um considerável decréscimo no número de ativações. Realizou-se eletrocardiograma nos primeiros 10 minutos em 99,2% das ativações. A hora do início de sintomas com maior predomínio ocorreu entre as 6-12 horas. Diagnosticado Enfarte Agudo do Miocárdio a 11,7% da amostra. Conclusão: O número elevado de ativações da VVC, efetuadas essencialmente pelos enfermeiros, enfatiza a importância do seu papel.

Resumen Marco contextual: La principal causa de muerte en el mundo son las enfermedades cardiovasculares, que constituyen un importante problema de salud. Objetivo: Describir el número de activaciones de la vía verde coronaria (VVC) en un servicio de urgencias médico-quirúrgicas (SUMC) de una unidad hospitalaria del norte de Portugal. Metodología: Estudio cuantitativo, descriptivo y transversal de los pacientes ingresados en un SUMC a los que se les activó la VVC entre diciembre de 2017 y diciembre de 2021. Resultados: Muestra de 831 individuos, en su mayoría varones (60,5%), con un 45,3% en el grupo de edad de 61-80 años y un 48% con antecedentes de hipertensión. El 98,9% de las activaciones fueron realizadas por enfermeros. En 2020 (año de la pandemia) se produjo un descenso considerable del número de activaciones. Se realizó un electrocardiograma dentro de los 10 primeros minutos en el 99,2% de las activaciones. El momento más frecuente de aparición de los síntomas fue entre las 6 y las 12 horas. Se diagnosticó infarto agudo de miocardio en el 11,7% de la muestra. Conclusión: El elevado número de activaciones de la VVC, llevadas a cabo principalmente por enfermeros, subraya la importancia de su papel.

Abstract Background: Cardiovascular diseases are the primary cause of death worldwide and a significant health concern. Objective: To describe the number of activations of via verde coronária (VVC) in an emergency room (ER) at a hospital in northern Portugal. Methodology: Quantitative, descriptive, and cross-sectional study of patients admitted to an ER and who had VVC activated between December 2017 and December 2021. Results: The study sample consisted of 831 individuals, with a majority being men (60.5%). Among them, 45.3% were aged between 61-80 years and 48% had a history of hypertension. The activations were carried out mostly by nurses (98.9%). A significant decrease in the number of activations was observed in 2020, the year of the pandemic. An electrocardiogram was performed within the first 10 minutes in 99.2% of the activations. The most common time of symptom onset was between 6-12 hours. Acute Myocardial Infarction was diagnosed in 11.7% of the sample. Conclusion: The significant number of VVC activations performed by nurses highlights the importance of their role.

Abstract: Background: Cardiovascular diseases (CVD) are a public health problem at global and national levels. Among them, stroke and acute myocardial infarction (AMI) stand out for their increasing incidence. A territorial view allows us to detect places with high prevalence and focus local resources and public policies on those most in need. Objective: To analyze hospital discharges due to CVD in the Ñuble region, Chile, between 2011 and 2021, with a particular focus on stroke and AMI. Methods: Ecological study. The records of cardiovascular hospital discharges were used using the International Classification of Diseases (ICD10) between 2011 and 2021. Absolute figures and proportions were used. The results are presented in rankings and maps, according to provinces and communes. Results: Between 2011 and 2021, stroke, AMI, and heart failure accounted for nearly 45% of hospital discharges in Ñuble. In women, AMI increased in Itata (3.3% to 7.1%), Diguillín (6.0% to 8.8%), and Punilla (4.6% to 11%), while hypertension decreased significantly in all places. In men, AMI increased by up to 7 % in all provinces. Conclusion: The high prevalence of stroke, AMI, and heart failure in Ñuble, together with their differences by sex and territory, underscores the need for targeted strategies that address inequalities in cardiovascular health. This study provides key evidence for policy design in Chile and other Latin American countries with similar territorial characteristics.

Resumen: Antecedentes: Las enfermedades cardiovasculares (ECV) son un problema de salud pública tanto a nivel mundial como nacional. Entre ellas, el accidente cerebrovascular (ACV) y el infarto agudo al miocardio (IAM) destacan por su creciente incidencia. Una mirada territorial, permite detectar lugares de altas prevalencias y enfocar los recursos y políticas públicas locales en los más necesitados. Objetivo: Analizar los egresos hospitalarios por ECV en la región de Ñuble, Chile, durante los años 2011 y 2021, con un enfoque particular en ACV e IAM. Métodos: Estudio ecológico. Se utilizaron los registros de egresos hospitalarios cardiovasculares utilizando la Clasificación Internacional de Enfermedades (CIE-10) entre los años 2011 y 2021. Se trabajó con las cifras absolutas y proporciones. Los resultados se presentan en ranking y mapas, según provincias y comunas. Resultados: Entre 2011 y 2021, ACV, IAM e insuficiencia cardíaca representaron cerca del 45% de los egresos hospitalarios en Ñuble. En mujeres, el IAM aumentó en Itata (3,3% a 7,1%), Diguillín (6,0% a 8,8%) y Punilla (4,6% a 11%), mientras que la HTA disminuyó significativamente. En hombres, el IAM incrementó hasta 7 puntos porcentuales en todas las provincias. Conclusiones: La alta prevalencia de ACV, IAM e insuficiencia cardíaca en Ñuble, junto con sus diferencias por sexo y territorio, subraya la necesidad de estrategias focalizadas que aborden las desigualdades en salud cardiovascular. Este estudio proporciona evidencia clave para el diseño de políticas en Chile y otros países de América Latina con características territoriales similares.

Resumen El Cannabis sativa reporta más de 500 compuestos cannabinoides, lo cual ha alcanzado más de 192 millones de consumidores en el mundo. Su actividad en los receptores cannabinoides tipo 1 (CB1) y tipo 2 (CB2) está involucrada en diferentes actividades biológicas, incluyendo su implicación cardiovascular. Reconocer el impacto del uso de cannabis en el desarrollo de alteraciones cardiovasculares en adultos. Se realizó una revisión sistemática mediante la guía PRISMA durante 2017-2023, empleando los repositorios: ScienceDirect, PubMed/MEDLINE y EBSCO. Se emplearon las palabras clave “Cannabis” y “cardiovascular diseases”. Finalmente, se realizó una evaluación del riesgo de sesgo mediante Critical Appraisal Skills Programme. Se obtuvieron 831 artículos, a los cuales se les aplicaron criterios de inclusión y exclusión, obteniendo siete estudios definitivos publicados en los últimos cinco años. Adicionalmente, esta revisión señala una dualidad en los efectos cardiovasculares del cannabis, que pueden depender de la forma de consumo y potenciales metabolitos. Algunos estudios sugieren efectos protectores en la progresión vascular, mientras otros relacionan su consumo con riesgos cardiovasculares, como arritmias y arteriosclerosis. La evidencia es limitada y contradictoria, y se destaca la necesidad de estudios longitudinales para entender la relación causal con los eventos cardiovasculares.

Abstract Cannabis sativa contains over 500 cannabinoid compounds, which have reached over 192 million consumers globally. Its activity on cannabinoid receptor type 1 (CB1) and type 2 (CB2) is involved in various biological activities, including its implication in cardiovascular processes. To recognize the impact of cannabis use on the development of cardiovascular disorders in adults. A systematic review was conducted following the PRISMA guidelines from 2017 to 2023, using the repositories: ScienceDirect, PubMed/Medline, and EBSCO. The following keywords were employed: “Cannabis” and “cardiovascular diseases”. Finally, a bias risk assessment was performed using the Critical Appraisal Skills Programme. 831 articles were obtained, which were subjected to inclusion and exclusion criteria, resulting in seven definitive studies published in the last five years. Additionally, this review highlights a duality in the cardiovascular effects of cannabis, which may depend on the method of consumption and potential metabolites. Some studies suggest protective effects on vascular progression, while others associate its consumption with cardiovascular risks such as arrhythmias and arteriosclerosis. The evidence is limited and contradictory, emphasizing the need for longitudinal studies to understand the causal relationship with cardiovascular events.

Abstract Reactive oxygen species are produced by aerobic organisms, including humans, because of metabolism. They can oxidise biomolecules and cause degenerative and cardiovascular diseases (diabetes, atherosclerosis, and neurological damage, among others). However, the consumption of different plant products is related to the prevention of reactive oxygen species-mediated damage because they contain various antioxidants that inhibit the oxidation of biomolecules. Some important natural antioxidants are carotenoids, flavonoids, polyphenols, and vitamins. These molecules are found in various crops produced in Mexico, some of which have been cultivated for a long time, while others have emerged in recent years. The study of the antioxidant capacity of these crops has increased over time. Different methods are used to determine this capacity, depending on the type of antioxidants. In this review, we analyse the antioxidant quantification methods of various crops of interest in Mexico (traditional and emergent), as well as their relationship to prevent the oxidation of biomolecules.

RESUMEN Objetivo. Determinar la tasa de eventos de infarto agudo de miocardio (IAM) estandarizada por edad y su tendencia en los últimos años. Materiales y métodos. Se realizó un estudio ecológico de datos secundarios sobre la morbilidad en áreas de emergencia de hospitales peruanos entre 2018 y 2023. Se identificaron casos de IAM en adultos de 20 años o más mediante los códigos CIE-10. Se calcularon las tasas de eventos de IAM por 100 000 personas, estandarizadas por edad. Además, se calculó el cambio de la tasa de eventos entre los años extremos, y se utilizó una regresión de Poisson para estimar el cambio porcentual anual de las tasas de eventos junto a su intervalo de confianza (IC) al 95%, ajustando por edad y año calendario. Estas tasas se estratificaron por sexo y región político-administrativa. Resultados. Se registraron 28 088 eventos de IAM entre 2018 y 2023. La tasa nacional estandarizada por edad aumentó de 22,77 en 2018 a 25,60 por 100 000 personas en 2023, con un cambio porcentual anual de 6,72% (IC 95%: 4,25-9,25). Los hombres presentaron tasas de eventos de IAM más altas comparado con las mujeres en todo el periodo de estudio. Además, las tasas de eventos más altas se observaron en la Provincia Constitucional del Callao, San Martín y Loreto. Conclusiones. Nuestros hallazgos proporcionan un mejor conocimiento de la epidemiología del IAM en el Perú y su evolución en los últimos años, datos importantes para mejorar las estrategias de prevención, tratamiento y distribución de recursos para el manejo del IAM.

ABSTRACT Objective. To determine the age-standardized rate of acute myocardial infarction (AMI) events and its trend in recent years. Materials and methods. An ecological study of secondary data on morbidity in emergency areas of Peruvian hospitals between 2018 and 2023 was conducted. Cases of AMI in adults aged 20 years or older were identified using ICD-10 codes. Age-standardized AMI event rates per 100,000 person-years were calculated. In addition, the change in event rate between extreme years was calculated, and a Poisson regression was used to estimate the annual percentage change in event rates along with their 95% confidence interval (CI), adjusting for age and calendar year. These rates were stratified by sex and political-administrative regions. Results. 28,088 AMI events were recorded between 2018 and 2023. The national age-standardized rate increased from 22.77 in 2018 to 25.60 per 100,000 person-years in 2023, with an annual percentage change of 6.72% (95% CI 4.25-9.25). Men had higher AMI event rates compared to women throughout the study period. In addition, the highest event rates were observed in the Constitutional Province of Callao, San Martin and Loreto. Conclusions. Our findings provide a better understanding of the epidemiology of AMI in Peru and its evolution in recent years, important data to improve prevention, treatment and resource distribution strategies for the management of AMI.