BackgroundThe metabolic syndrome (MetS) is associated with increased cardiovascular morbidity and mortality. Characterization of cardiac structural and functional abnormalities due to the MetS can help recognize individuals who would benefit the most from preventive interventions. Transthoracic echocardiography (TTE) provides an opportunity to identify those abnormalities in a reproducible and cost-efficient manner. In research settings, implementation of protocols for the acquisition and analysis of TTE images are key to ensure validity and reproducibility, thus facilitating answering relevant questions about the association of the MetS with cardiac alterations.Methods and ResultsThe Palma Echo Platform (PEP) is a coordinated network that is built up to evaluate the underlying structural and functional cardiac substrate of participants with MetS. Repeated TTE will be used to evaluate 5-year changes in the cardiac structure and function in a group of 565 individuals participating in a randomized trial of a lifestyle intervention for the primary prevention of cardiovascular disease. The echocardiographic studies will be performed at three study sites, and will be centrally evaluated at the PEP core laboratory. Planned analyses will involve evaluating the effect of the lifestyle intervention on cardiac structure and function, and the association of the MetS and its components with changes in cardiac structure and function. Particular emphasis will be placed on evaluating parameters of left atrial structure and function, which have received more limited attention in past investigations. This PEP will be available for future studies addressing comparable questions.ConclusionIn this article we describe the protocol of a central echocardiography laboratory for the study of functional and structural alterations of the MetS.

BackgroundThe prevalence of dementia in Sub‐Saharan Africa, particularly in French‐speaking countries, has received limited attention. This study investigates the prevalence and risk factors of suspected dementia in elderly adults in Kinshasa, Democratic Republic of the Congo (DRC).MethodsA community‐based sample of 355 individuals over 65 years old was selected using multistage probability sampling in Kinshasa. Participants were screened using the Community Screening Instrument for Dementia, Alzheimer's Questionnaire, Geriatric Depression Scale, Beck Anxiety Inventory, and Individual Fragility Questionnaire, followed by clinical interview and neurological examination. Suspected dementia diagnoses were made based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) criteria including significant cognitive and functional impairments. Prevalence and odds ratios (ORs) with 95% confidence interval (CI) were calculated using, respectively, regression and logistic regression.ResultsAmong 355 participants (mean age 74, SD = 7; 51% male), the crude prevalence of suspected dementia was 6.2% (9.0% in women and 3.8% in men). Female sex was a significant factor associated with suspected dementia [OR = 2.81, 95% CI (1.08–7.41)]. The prevalence of dementia increased with age (14.0% after 75 years and 23.1% after 85 years), with age being significantly associated with suspected dementia [OR = 5.42, 95% CI (2.86–10.28)]. Greater education was associated with a lower prevalence of suspected dementia [OR = 2.36, 95% CI (2.14–2.94), comparing those with ≥7.3 years of education to those with <7.3 years of education]. Other factors associated with the prevalence of suspected dementia included being widowed (OR = 1.66, 95% CI (1.05–2.61), being retired or semi‐retired (OR = 3.25, 95% CI (1.50–7.03)], a diagnosis of anxiety [OR = 2.56, 95% CI (1.05–6.13)], and death of a spouse or a relative after age 65 [OR = 1.73, 95% CI (1.58–1.92)]. In contrast, depression [OR = 1.92, 95% CI (0.81–4.57)], hypertension [OR = 1.16, 95% CI (0.79–1.71)], body mass index (BMI) [OR = 1.06, 95% CI (0.40–2.79)], and alcohol consumption [OR = 0.83, 95% CI (0.19–3.58)] were not significantly associated with suspected dementia.ConclusionsThis study found a prevalence of suspected dementia in Kinshasa/DRC similar to other developing countries and Central African countries. Reported risk factors provide information to identify high‐risk individuals and develop preventive strategies in this setting.

The potential role of the lipidome in atrial fibrillation (AF) development is still widely unknown. We aimed to assess the association between lipidome profiles of the Prevención con Dieta Mediterránea (PREDIMED) trial participants and incidence of AF. We conducted a nested case–control study (512 incident centrally adjudicated AF cases and 735 controls matched by age, sex, and center). Baseline plasma lipids were profiled using a Nexera X2 U-HPLC system coupled to an Exactive Plus orbitrap mass spectrometer. We estimated the association between 216 individual lipids and AF using multivariable conditional logistic regression and adjusted the p values for multiple testing. We also examined the joint association of lipid clusters with AF incidence. Hitherto, we estimated the lipidomics network, used machine learning to select important network-clusters and AF-predictive lipid patterns, and summarized the joint association of these lipid patterns weighted scores. Finally, we addressed the possible interaction by the randomized dietary intervention.Forty-one individual lipids were associated with AF at the nominal level (p < 0.05), but no longer after adjustment for multiple-testing. However, the network-based score identified with a robust data-driven lipid network showed a multivariable-adjusted ORper+1SD of 1.32 (95% confidence interval: 1.16–1.51; p < 0.001). The score included PC plasmalogens and PE plasmalogens, palmitoyl-EA, cholesterol, CE 16:0, PC 36:4;O, and TG 53:3. No interaction with the dietary intervention was found. A multilipid score, primarily made up of plasmalogens, was associated with an increased risk of AF. Future studies are needed to get further insights into the lipidome role on AF.Current Controlled Trials number, ISRCTN35739639.

Introduction: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a class of antihyperglycemic drugs recommended to patients with type 2 diabetes (T2D) as a 2 nd line therapy after metformin. Recent evidence suggests they may reduce the risk for cardiovascular disease (CVD); however, prior studies have been clinical trials, which do not reflect real-world data, and did not conduct head-to-head comparisons of SGLT2 inhibitors. Therefore, utilizing data from the US MarketScan administrative databases in 2013-19, we tested the hypothesis that patients with T2D taking SGLT2 inhibitors have a lower risk of CVD compared to those taking other 2 nd line therapies. Methods: We included 313,626 patients with T2D who were taking metformin and a 2 nd line therapy (SGLT2 vs. other). SGLT2 inhibitor users were matched with up to 5 users of other 2 nd line therapies by age, sex, date of enrollment, and date of 2 nd line therapy initiation. The primary CVD outcome was a composite of stroke, atrial fibrillation, myocardial infarction, and heart failure. Patients with prevalent CVD were excluded. We also conducted head-to-head comparisons of SGLT2 inhibitors. Cox proportional hazards models were used to estimate hazard ratios (HR). Results: Participants were on average age 53±10 years at baseline and 47% were female. Median follow-up time was 1.4 years. After multivariable adjustments, SGLT2 inhibitor users had a lower risk of CVD than those taking other 2 nd line therapies [Table; HR (95% CI): 0.66 (0.62, 0.71)]. Significant associations were also observed when each CVD outcome was assessed separately, with the strongest associations for stroke and heart failure. No differences were observed when comparing individual SGLT2 inhibitors. Conclusion: Using MarketScan data in patients with T2D, we found that users of SGLT2 inhibitors had a lower risk of CVD compared to users of other 2 nd line therapies. By using real-world data, these findings complement clinical trial results supporting the effectiveness of SGLT2 inhibitors in reducing risk of CVD.

Background: Lifestyles influence atrial fibrillation (AF) risk. Blood biomarkers can characterize the atrial substrate that facilitates the development of AF. Therefore, determining the effect of lifestyle interventions on blood concentrations of biomarkers of AF-related pathways could help understand AF pathophysiology and contribute to AF prevention. Methods: The PREDIMED-PLUS study is a Spanish multicenter randomized trial in adults (55-75 years) with metabolic syndrome and body mass index between 27-40 kg/m 2 . Participants were randomized 1:1 to an intensive lifestyle intervention (ILI) program, emphasizing physical activity, weight loss, and adherence to the Mediterranean diet, or a control intervention. In a sub-sample, serum biomarkers including carboxy-terminal propeptide of procollagen type I (PICP), high-sensitivity troponin T (hsTnT), high-sensitivity C reactive protein (hsCRP), N-terminal propeptide of B-type natriuretic peptide (NT-proBNP), and 3-nitrotyrosine (3-NT) were measured at baseline and years 3 and 5 after randomization. Mixed models were used to evaluate the effect of ILI on changes in biomarkers through years 3 and 5. Follow-up time was modeled as a categorical and continuous variable. Results: Of 481 participants (65 mean age, 40% female, 49% assigned to ILI), 453 (94%) and 442 (92%) had available samples at years 3 and 5. After 5 years, mean changes in log-transformed biomarkers were -0.01 (PICP), 0.20 (hsTnT), -0.17 (hsCRP), 0.12 (3-NT), and 0.25 (NT-proBNP). Participants in the ILI group experienced greater decreases in hsCRP or smaller increases in 3-NT, NT-proBNP, and in hsTnT to a lesser extent, as compared to the control group (Table). The ILI did not affect PICP concentrations. Results were consistent when modeling follow-up time as a continuous variable. Conclusion: Over five years, an ILI favorably affected concentrations of hsCRP, 3-NT, and NT-proBNP, and of hs-TnT to a lesser degree, pointing to specific mechanisms in the pathways linking lifestyles and AF.

Purpose: Concomitant use of diuretics, renin-angiotensin-aldosterone system (RAAS) inhibitors, and non-steroidal anti-inflammatory drugs (NSAIDs) or metamizole, known as 'triple whammy' (TW), has been associated with an increased risk of acute kidney injury (AKI). Nevertheless, there is still uncertainty on its impact in hospitalisation and mortality. The aim of the study was to analyse the association between exposure to TW and the risk of hospitalisation for AKI, all-cause mortality and the need for renal replacement therapy (RRT).

La evolución con o sin tratamiento de las lesiones exudativas que rodean una cavidad pueden llevar a una imagen residual de pared fina, que asemeja una lesión bullosa, en la que a veces se puede apreciar un bronquio de drenaje (1,2). La cavidad sobre la que asienta el Aspergillus de forma saprofita suele estar producida por diversas causas entre las que destacan la tuberculosis, las bronquiectasias, la sarcoidosis, la espondilitis anquilosante, los abscesos bacterianos crónicos o las neoplasias (3). El Aspergillus es de los hongos más abundantes de la naturaleza, se trata de un hongo filamentoso saprofito, cuyo hábitat natural es el suelo donde sobrevive y se desarrolla sobre la materia orgánica. Debido a su tamaño, alrededor de 3 micras, puede estar suspendido en el aire y ser inhalado, y de esta forma llegar a los alvéolos pulmonares.Varón de 46 años que consultó por esputo hemoptoico que se autolimitó en 4 días. Entre sus antecedentes destacaban, enolismo hasta los 26 años y una tuberculosis pulmonar a los 26 años que se trató correctamente, quedando lesión cavitaria residual de pared fina.La exploración física era normal. Las pruebas de laboratorio como el hemograma, la función hepática, la función renal y la hemostasia fueron normales. El estudio microbiológico de esputo fue negativo para hongos y micobacterias. La radiografía de tórax mostraba en el pulmón izquierdo una retracción hiliar superior con lesiones fibroproductivas en el vértice; también aparecía una lesión cavitada en el lóbulo superior de borde interno regular y borde externo peor definido, con una imagen en su interior densa y bilobulada que se apoyaba en el borde inferior de la caverna. En la TAC torácica (Fig. 1) se observaba en el lóbulo superior izquierdo una masa en el interior de una cavidad que presentaba el signo del menisco. Posteriormente presentó hemoptisis masiva, por lo que se realizó tratamiento quirúrgico, en el cultivo y en el estudio anatomopatológico del material obtenido identificó Aspergillus fumigatus.La tuberculosis pulmonar es la causa más frecuente de cavidades pulmonares, aunque pueden producirse por otras entidades como la sarcoidosis, las neoplasias, y las bronquiectasias.El Aspergillus fumigatus representa el 90% de todas las infecciones producidas por especies de aspergillus, la infección la puede causar de cuatro formas diferentes que son aspergiloma (saprofita), semiinvasiva, invasiva y alérgica. El aspergiloma se produce por la colonización saprofita de una cavidad, en la que se forma una masa de formada por hifas, moco, detritus celulares y células inflamatorias, en un huésped que generalmente es inmunocompetente (4). El aspergiloma generalmente cursa de forma asintomática, siendo la hemoptisis la forma de presentación más frecuente, apareciendo hasta en un 55-85% de los casos, puede variar desde el esputo hemoptoico hasta la hemoptisis masiva4.El cultivo de esputo tiene una rentabilidad del 50-75%, pero la interpretación es difícil debido a que el Aspergillus es un contaminante habitual del laboratorio o bien...

Introduction: Cerebral venous sinus thrombosis (CVST) is a rare but potentially debilitating thrombosis affecting 3-4 cases per million adults in the United States. Risk factors are thought similar to venous thrombosis, but there is little epidemiologic data corroborating this assertion. Concern about a possible association between the Janssen (Johnson and Johnson) and Oxford-AztraZenaca COVID-19 vaccines and cases of CVST resulted in increased global attention to this condition. Thus, large epidemiological assessment of the risk factors, treatment and outcomes of CVST are needed. Objective: Estimate the distributions of risk factors antecedent to CVST diagnosis, report CVST treatments in clinical practice, and potential sequelae of CVST in a large retrospective cohort of adults with CVST in the United States. Methods: MarketScan Commercial and Medicare Supplemental administrative databases were employed to assess CVST diagnosed between 2011 and 2019 in the U.S. Validated International Classification of Disease (ICD) codes and receipt of an outpatient anticoagulant (either oral or subcutaneous anticoagulant) prescription within 30 days of the ICD code identified incident CVST. Antecedent clinical characteristics, treatments, and sequelae of CVST were identified using inpatient, outpatient, and prescription data. For outcomes, proportions and incidence with 95% confidence intervals (CIs) were calculated, stratified by sex. Results: We identified 1,869 CVST patients. Of these 1,314 (70%) were female, with 200 (10%) events identified as a pregnancy-related CVST. The average age was 41 years for females and 48 years for men. Among women, 24.7% were on hormonal therapy (oral contraceptive, estrogen, and progestin) prior to diagnosis. Men had a higher prevalence of comorbidities, such as diabetes (15% men vs. 9% women) and cancer (19% men vs. 10% women). Oral anticoagulant (OAC) use was the most common treatment for CVST in both men (88%) and women (85%) and did not vary by sex. Use of procedures to treat CVST, optic nerve fenestration and catheter directed thrombolysis, were 0.5% and 4.1%, respectively. The most common sequela after CVST was incidence of intracranial hypertension (Incidence: 4.2 per 100 person-years; 95% CI: 3.3, 5.1) and palliedema was rare. Conclusions: Overall, a majority of CVST patients were women of reproductive age. Our findings suggest a potential association with both endogenous (pregnancy) and exogenous (oral contraceptives, HRT) hormones which needs further study. In our sample, CVST was managed with oral anticoagulants, regardless of sex, and intracranial hypertension was elevated following CVST. This large claims-based analysis is a descriptive insight into the risk factors and management of CVST, a rare and debilitating condition.