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Córdoba, Argentina

Albert M.A.,Harvard University | Glynn R.J.,Harvard University | Fonseca F.A.H.,University of Sao Paulo | Lorenzatti A.J.,Hospital Cordoba | And 3 more authors.
American Heart Journal | Year: 2011

Objectives: The aim of this study was to evaluate the effect of statin treatment in primary prevention of cardiovascular events in different race/ethnic groups. Background: Clinical trial evidence about the efficacy of statins in the primary prevention of cardiovascular events among nonwhites is uncertain. Methods: JUPITER trial, a randomized, double-blind, placebo-controlled evaluation of rosuvastatin 20 mg in the primary prevention of myocardial infarction (MI), stroke, arterial revascularization, hospitalization for unstable angina, and cardiovascular death included 12,683 whites and 5,117 nonwhites with low-density lipoprotein levels <130 mg/dL and high-sensitivity C-reactive protein levels ≥2.0 mg/L. Results: Random allocation to rosuvastatin resulted in a 45% reduction in the primary end point among whites (hazard ratio [HR] 0.55, 95% CI 0.43-0.69) and a 37% reduction among nonwhites (HR 0.63, 95% CI 0.41-0.99). Blacks (HR 0.65, 95% CI 0.35-1.22) and Hispanics (HR 0.58, 95% CI 0.25-1.39) had similar risk reductions. Among nonwhites in the placebo group, the stroke rate exceeded the MI rate (0.44 vs 0.20 per 100 person-years); an opposite pattern was observed among whites (0.31 vs 0.42 per 100 person-years). Nonwhites had higher death rates than whites (2.25 vs 0.93 per 100 person-years); however, all-cause mortality was similar at 20% with rosuvastatin treatment in both participant groups. Conclusions: When used in primary prevention among individuals with low-density lipoprotein <130 mg/dL and high-sensitivity C-reactive protein ≥2 mg/L, rosuvastatin significantly reduced first MI, stroke, arterial revascularization, hospitalization for unstable angina, and cardiovascular death among whites and nonwhites. © 2011 Mosby, Inc.

Sanchez E.,Oklahoma Medical Research Foundation | Rasmussen A.,Oklahoma Medical Research Foundation | Riba L.,National Autonomous University of Mexico | Acevedo-Vasquez E.,Hospital Nacional Guillermo Almenara Irigoyen | And 50 more authors.
Arthritis and Rheumatism | Year: 2012

Objective American Indian-Europeans, Asians, and African Americans have an excess morbidity from systemic lupus erythematosus (SLE) and a higher prevalence of lupus nephritis than do Caucasians. The aim of this study was to analyze the relationship between genetic ancestry and sociodemographic characteristics and clinical features in a large cohort of American Indian-European SLE patients. Methods A total of 2,116 SLE patients of American Indian-European origin and 4,001 SLE patients of European descent for whom we had clinical data were included in the study. Genotyping of 253 continental ancestry-informative markers was performed on the Illumina platform. Structure and Admixture software were used to determine genetic ancestry proportions of each individual. Logistic regression was used to test the association between genetic ancestry and sociodemographic and clinical characteristics. Odds ratios (ORs) were calculated with 95% confidence intervals (95% CIs). Results The average American Indian genetic ancestry of 2,116 SLE patients was 40.7%. American Indian genetic ancestry conferred increased risks of renal involvement (P < 0.0001, OR 3.50 [95% CI 2.63- 4.63]) and early age at onset (P < 0.0001). American Indian ancestry protected against photosensitivity (P < 0.0001, OR 0.58 [95% CI 0.44-0.76]), oral ulcers (P < 0.0001, OR 0.55 [95% CI 0.42-0.72]), and serositis (P < 0.0001, OR 0.56 [95% CI 0.41-0.75]) after adjustment for age, sex, and age at onset. However, age and sex had stronger effects than genetic ancestry on malar rash, discoid rash, arthritis, and neurologic involvement. Conclusion In general, American Indian genetic ancestry correlates with lower sociodemographic status and increases the risk of developing renal involvement and SLE at an earlier age. Copyright © 2012 by the American College of Rheumatology.

Basquiera A.L.,Hospital Privado Centro Medico Of Cordoba | Tabares A.H.,Hospital Privado Centro Medico Of Cordoba | Soria N.,University of Cordoba, Spain | Ryser R.,Hospital Cordoba | Garcia J.J.,Hospital Privado Centro Medico Of Cordoba
Medicina | Year: 2011

We aimed to study patients with splanchnic vein thrombosis (SVT) and cerebral vein thrombosis (CVT) searching for JAK2 mutations. We evaluated 14 patients (median age: 41.5 years) with portal vein thrombosis (PVT) = 7; mesenteric vein thrombosis (MVT) = 3; and CVT = 4. JAK2 V617F was assessed by allele specific PCR of peripheral blood DNA. In addition, DNA was sequenced for other JAK2 mutations. Other inherited and acquired thrombophilia risk factors were evaluated. JAK2 V617F was positive in four out of seven patients with PVT and in one CVT patient. These five patients had a diagnosis of myeloproliferative disorder (MPD) at the moment of the occurrence of thrombosis (n = 2) or later (n = 2). Patients with MVT and CVT were negative for JAK2 V617F, except one patient with CVT and a diagnosis of essential thrombocythemia. No other JAK2 mutations were found in this cohort. Besides MPD, other thrombophilia risk factors were identified in five patients. One patient had MPD as well as thrombophilia risk factor. In this group, 4 out of 7 of the patients with PVT carried the JAK2 V617F mutation with or without overt MPD. However, the investigation of other JAK2 mutations may not be necessary in patients with thrombosis at unusual sites.

Fonseca I.B.,National University of Cordoba | Guerini J.C.,National University of Cordoba | Strelzik I.,National University of Cordoba | Ghirardi G.,Hospital Nuestra Senora de la Misericordia | And 3 more authors.
International Journal of Morphology | Year: 2010

Gastrointestinal stromal tumors or GISTs are neoplasms belonging to the soft tissue sarcomas and can be located anywhere in the body. They most frequently occur in the gastrointestinal tract (esophagus to rectum), in fact, over 50% occur at the gastric level. However, they have also been described elsewhere (mesentery and omentum, retroperitoneum, gall bladder, bladder wall and uterus). Extragastrointestinal latter location havebeen published by the acronym EGIST (representing 5% of all GISTs. We report four cases of EGIST (2 of mesenteric and retroperitoneal location) describe the histopathological, clinical aspects and immunohistochemical profile. We studied 32 cases of GISTs in a prospective and retrospective analysis of files for the Service and IInd Chair of Pathology (Emergency Municipal Hospital), Hospital Córdoba, and Our Lady of Mercy, Cordoba (Argentina), between 1987 and 2008. In that series were extracted and analyzed four cases (two retroperitoneal and two mesenteric). All cases were female patients whose ages ranged from 42 to 72 years who consulted for abdominal pain, pelvic pain and weight loss. Tumor size ranged from 4 to 28 cm. All were partially cystic mass, showing hemorrhage and necrosis, in varying degrees. Microscopic patterns were observed 2 spindle and epithelioid-looking lax, arranged in bundles intertwined with low mitotic index. Immunohistochemistry panel: Vimentin, CD34 and CD117: Positive. Actin, chromogranin and S-100: Negative. Ki 67: + 2 to 10%. Diagnosis: extragastrointestinal stromal tumor, borderline. Complete histopathological and immunohistochemical panels should be considered for a definite diagnosis. The main peculiarity of the present cases is their location. The EGIST are rare (5% of GIST).

Mordini O.D.,Hospital Aurelio Crespo | Bavio E.,Neuquen Capital | Beloscar J.,Hospital Provincial del Centenario | Tognoni G.,Fundacion Mario Negri Sud | And 49 more authors.
Revista de la Federacion Argentina de Cardiologia | Year: 2016

Introduction: Chagas disease remains endemic in our country. A total of 2.500.000 infected individuals are estimated. Movements from rural areas to urban areas and migration to non-endemic countries are changing the epidemiology. The more prevalent complication is Chagas cardiomyopathy, manifesting in various forms, from divisional and atrioventricular blocks, to tachyarrhythmias and bradyarrhythmias, heart failure or embolic ischemic stroke. Knowledge on exposure and risk until the development of the disease is the main tool to propose strategies for disease control Material and Methods: A descriptive cross-sectional study was conducted, the sample was not random. Researchers from regions of high, medium, and low risk of vector transmission have participated. We included, between 2008 and 2013, 3344 patients aged from newborns to 95 years old, diagnosed with Chagas disease, determined by two of the following methods: Hemagglutination, IFI or ELISA. A semistructured questionnaire was used. Data collected were: socio-cultural situation, type of housing, area of birth, current residence, educational level, kind of work, possession or not of health insurance, heart failure, cardiac blocks and arrhythmias, electrocardiographic abnormalities and comorbidities. Results: The mean age was 49.21 +/- 18.18 years. We found that 1471 patients (p) (44%) were male and 79 p (3.73%) had qualified jobs and 1875 p (88.57%) unqualified. Vector infection was more frequently recognized as the route of infection 1661 p (50%). Epidemiological determinants or symptoms most useful for clinical diagnostic were: heart failure 425 p (12.8%), arrhythmias 732 p (22%), abnormal ECG 716 p (21.6%). The most widely used diagnostic methods were indirect Hemagglutination technique 77.3%, followed by ELISA in 73.1% of cases. The most frequent comorbidity was hypertension 1098 p (35.29%). We found that 1542 p (46.4%) had heart disease (cardiomegaly, arrhythmias, abnormal ECG, symptoms of heart failure). Cardiomegaly was found in 659 p (25.7%). The average age of patients with cardiomegaly was 60. 42 +/- 13.46 years. From those, 264 p (40%) had been born and lived in rural areas, and 395 p (60%) in urban areas. 168 p suffered syncope (5.1%), which was more prevalent in those with cardiomegaly, redistribution of flow at chest x-ray and presence of divisional block. Conclusions: Since 1924 to nowadays, the age in infected patients has increased. Residence in rural areas is an independent factor with the greatest impact of the disease (ECG disorders, arrhythmias, HF, syncope). Coming from rural areas and abnormal ECG findings were the most common indicators to suspect the disease. Being older than 60 years was a predictor of worse prognosis. © 2016, Federacion Argentina de Cardiologia. All rights reserved.

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