Heavy weekly alcohol consumption versus binge drinking after an acute coronary syndrome and risk of major adverse cardiovascular events at one year follow up

Background

The association between heavy weekly alcohol consumption or binge drinking and the risk of major adverse cardiovascular events (MACE) after acute coronary syndromes (ACS) is still unclear.

Purpose

To determine the risks of MACE at one year follow up according to baseline alcohol consumption, especially in patients with heavy weekly alcohol consumption or binge drinking.

Methods

We analyzed data of 6053 patients hospitalized in 4 Swiss centres for an ACS and followed over 12 months. Data on alcohol consumption were collected at baseline and at one year follow up after ACS. Binge drinking was defined as the consumption of ≥6 units of alcohol on one occasion, for the 12-months period preceding the one-year follow up. We defined MACE as a composite of cardiac death, myocardial infarction, stroke or clinically indicated target vessel coronary revascularization. We applied Cox regression to assess the risk of MACE associated with heavy alcohol weekly consumption (>14 standard units/week) compared to light consumption (<1 standard unit/week) or abstinence, as well as the risk with binge drinking, compared to no binge drinking, adjusting for baseline differences (age, sex, body-mass index, smoking, diabetes, peripheral artery disease, stroke, hypertension, use of aspirin, anticoagulation, statin, beta-blocker, ACE-inhibitor or ATII receptor blocker).

Results

At baseline, 817 (13.4%) patients reported heavy weekly alcohol consumption and 717 (11.8%) reported to have at least one episode of binge drinking per month. The risk for MACE at one year follow up was not increased in those with heavy weekly consumption compared to light consumption (8.7% vs. 8.5%, HR 0.96, 95% CI 0.69–1.33, P=0.80) or no consumption (8.7% vs. 10.3%, HR 1.26, 95% CI 0.88–1.80, P=0.21). However, the risk of MACE was higher in those reporting binge drinking with less than one episode a month (9.4% vs. 7.7%, HR 1.67, 95% CI 1.32–2.12, P<0.001), as well as in those with at least one episode of binge drinking per month (13.4% vs. 7.7%, HR 2.07, 95% CI 1.62–2.65, P<0.001), when compared to no binge drinking.

Conclusion

In contrast to regular heavy alcohol consumption, binge drinking behavior is associated with significant increased risk of MACE 12 months after ACS.

Funding Acknowledgement

Type of funding sources: None.

Statin therapy intensity and physical activity after acute coronary syndrome

Introduction/Purpose

High-intensity statin after acute coronary syndrome (ACS) may cause reduced physical activity because of statin-associated muscle symptoms. We aimed to assess the association between statin intensity and physical activity one year after ACS.

Methods

We studied patients from the Special Program University Medicine-Acute Coronary Syndromes (SPUM-ACS) study, a large multicenter prospective Swiss cohort. In a cross-sectional assessment one year after the index ACS, we identified high-intensity, low/moderate intensity, and no statin users. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ). Using a multivariable adjusted negative binomial hurdle model, metabolic equivalent-minutes per week (MET-min/week) were first stratified into sedentary and physically active categories, and then analyzed continuously among physically active patients. Models were adjusted for age, sex, education, body mass index, depression, type of ACS, pre-existing chronic disease, premature coronary heart disease, LDL-cholesterol, anti-hypertensive treatment, cardiac rehabilitation, and follow-up medical visits after hospital discharge.

Results

Among the 2274 patients included in the SPUM-ACS cohort, 1222 (53.7%) were on high intensity statin, 890 (39.1%) on low/moderate intensity statin, and 162 (7.1%) were not on statin. Compared to no statin users, low/moderate intensity statin users were more likely to be physically active than sedentary, with a fully adjusted odds ratio (OR) of 2.78, 95% confidence interval (CI) 1.11–6.93. A similar association was found when comparing non-users with high-intensity statin users, with a fully adjusted OR of 4.18, 95% CI 1.65–10.60. Among physically active patients, physical activity level median scores were 2792.5 MET-min/week in no statin category, 2712.0 and 2839.5 in moderate/low statin category and high statin category respectively (p=0.307), showing no statistically significant difference with median ratios of 1.02, 95% CI 0.84–1.22 and 1.06, 95% CI of 0.88–1.27 for low/moderate intensity and high-intensity statin use, respectively.

Conclusion

One year after an ACS, neither low/moderate nor high-intensity statin was associated with reduced physical activity compared to no statin use. These findings go against the belief that statin therapy may lead to reduced physical activity among ACS patients because of associated muscular symptoms.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Center for primary care and public health (Unisanté)

Effectiveness, adherence and safety of evolocumab in a Swiss multicenter prospective observational study

Background/Introduction

Achievement of low LDL-C-levels and adherence to lipid lowering therapy (LLT) is essential to prevent recurrent cardiovascular (CV) events. However, most patients (pts) with acute coronary syndromes don't maintain LDL-C levels within guideline recommendations beyond 1 year. Practical solutions to increase long-term adherence to LLT are needed.

Purpose

To describe pts receiving evolocumab (evo) and drug adherence in a real-world clinical setting.

Methods

We enrolled adults ≥18 years with confirmed atherosclerotic cardiovascular disease (ASCVD) or at high CV risk, and elevated LDL-C levels despite maximally tolerated statin therapy. Physicians in clinical practice prescribed evo according to Swiss reimbursement limitations. At baseline (BL), all pts used evo; some were already on PCSK9i treatment (PCSK9i pre-treated), others were newly initiated on evo (PCSK9i naïve); planned follow-up was 12 months. The web-based mHealthAlert system was offered to support pts' therapy management. The primary outcome was cholesterol levels at BL and after 3, 6 and 12 months of evo therapy.

Results

All 100 enrolled pts completed 12 months follow-up. For BL characteristics see Table. 81% had a history of at least one CV event and 55% had ≥2 previous CV events; 3% had familial hypercholesterolemia. At BL, 71% had a history of statin-related muscle symptoms, 44% had documented statin use, 65% were PCSK9i pre-treated and 35% were PCSK9i naïve; overall median LDL-C was 1.9 mmol/L. In PCSK9i naive pts, median LDL-C at enrolment was 3.5 mmol/L and fell by a mean of 2.1 mmol/L (60% reduction) within 3 months of evo initiation; this reduction was maintained over 12 months. The 2016 ESC/EAS LDL-C goals (<1.8 mmol/L) were attained at least once over 12 months by 74% of pts while 69% attained the 2019 goals (<1.4 mmol/L). In PCSK9i pre-treated pts, LDL-C remained stable during evo treatment; 79% and 74% attained the 2016 and 2019 goals, respectively, at least once over 12 months. Goal attainment was higher in pts receiving combination therapy of evo ± statin ± ezetimibe (Figure). Overall, 89% of pts self-reported full adherence to evo. Adverse events were reported in 30% of pts, two events in one pt were considered serious (increased blood creatine phosphokinase and myopathy) and three pts discontinued evo due to adverse events.

Conclusion

In Swiss clinical practice, evo was mainly used in high CV risk pts with statin-related muscle symptoms and severe CV disease. In this population, adherence to evo and low LDL-C levels were maintained over one-year. Among pts using evo either in mono- or combination therapy, the majority attained guideline recommended LDL-C levels. However, goal attainment was higher in pts using evo in combination with other LLT, especially with regards to LDL-C <1.4 mmol/L. Effectiveness and safety of evo in real-world clinical practice was comparable to that found in randomized, controlled clinical trials.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Study 20150245 was funded by Amgen Switzerland AG

Impact of smoking cessation on depression after acute coronary syndrome

Background

Smoking and depression are two risk factors for acute coronary syndrome (ACS) that often go hand-in-hand, as smokers are more likely to be depressed and people that are depressed are more likely to be smokers. Smoking cessation in depressed patients with ACS may worsen depressive symptoms, which could increase the risk of recurrence of cardiac events and decrease adherence to other cardiac risk-reducing lifestyle changes.

Purpose

We aimed to investigate the evolution of depression according to smoking cessation one-year after ACS. Furthermore, we investigated if there was a higher incidence of one-year depression among ACS smokers who quit in comparison to continuous smokers.

Method

Data from 1,822 patients with ACS of the Swiss multicenter SPUM-ACS cohort study were analysed over a one-year follow-up period. Participants were classified in three groups based on smoking status one-year post-ACS – continuous smokers, smokers who quit within the year post-ACS, and non-smokers. Depression status at baseline and at one-year after the index ACS event was assessed with the Center for Epidemiologic Studies Depression scale (CES-D) and antidepressant drug use. A multivariate adjusted logistic regression model was used to calculate the risk ratio (RR) between groups.

Results

In comparison to depressed smokers who continued to smoke one year post-ACS, depressed smokers who quit smoking had an adjusted RR of 2.02 (95% CI 1.04–3.92) of improving their depression. Among 543 non-depressed ACS smokers, new depression at one-year was found in 57/266 (21.4%) smokers who quit, and 68/277 (24.6%) continuous smokers, with an adjusted RR of 0.89 (95% CI 0.58–1.36) of incidence of new depression.

Conclusion

Smokers with depression at the time of ACS who quit smoking improved more frequently their depression compared to those who continued smoking. Although not statistically significant, there was a smaller incidence of new depression among smokers who quit after ACS in comparison to continuous smokers.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation

Residual inflammatory risk at 12 months after acute coronary syndromes is associated with cardiovascular outcome

Background

C-reactive protein measured by high sensitivity assays (hsCRP) is an established biomarker of systemic inflammation and a cut-off at 2 mg/L has been widely studied and proposed to identify patients at residual inflammatory risk (RIR).

Purpose

It remains unclear how many patients remain at residual inflammatory risk (RIR) at 12 months after acute coronary syndromes (ACS) in a contemporary real-world cohort and if RIR is associated with cardiovascular outcome.

Methods

Patients included in the SPUM-ACS cohort (NCT01000701) with a primary diagnosis of ACS referred for coronary angiography between 2009 and 2012 and available hsCRP measurements at baseline and at 1 year follow-up. High RIR was defined as hsCRP ≥2mg/L. Patients were divided into four groups: persistently high RIR, increased RIR (first low-, then high hsCRP), attenuated RIR (first high-, then low hsCRP), or persistently low RIR. Adjudicated major adverse cardiac and cerebrovascular events (MACCE) at 365 days were defined as the composite of MI, clinically indicated coronary revascularization or stroke. Logistic regression models were used to evaluate associations between MACCE and RIR groups and continuous long-term GRACE risk score. Adjustment was made for long-term GRACE risk score.

Results

1209 patients had available serial biomarker measurements (baseline and 12 months) with clinical and demographic data. Among those, 295 (24.4%) patients (UA 3.4%, NSTEMI 47.5%, STEMI 49.2%) fell in the category persistently high RIR (delta hsCRP median (IQR): −2.3 (−9.9; 0.3) (mg/L) and 72 (5.96%) patients (UA 8.3%, NSTEMI 47.2%, STEMI 44.4%) were in category increased RIR (delta hsCRP median (IQR): +2.45 (1.2; 8.35) (mg/L). Conversely, 390 (32.26%) patients (UA 3.3%, NSTEMI 46.9%, STEMI 49.7%) fell in the category attenuated RIR (delta hsCRP median (IQR): −3.55 (−10; −2) (mg/L) and 452 (37.38%) patients (UA 5.5%, NSTEMI 33.2%, STEMI 61.3%) were in category persistently low RIR (delta hsCRP median (IQR): −0.2 (−0.6; 0.1) (mg/L). Of 90 MACCE, 31 (10.5%) were found in the persistently high RIR group yielding a significantly higher event rate (adjusted HR: 1.71, (95% CI 1.08; 2.7), p-value: 0.02) compared with the three other groups combined (increased RIR: 3 (4.2%), attenuated RIR 30 (7.7%), persistent low RIR 26 (5.8%)). Of note, in that group the long-term GRACE risk score was significantly higher compared with the three other groups (adjusted HR: 1.1, (95% CI 1.0; 1.17), p-value: 0.04).

Conclusion

Residual inflammatory risk at 12 months after an ACS is found in nearly a third of patients. Patients with persistently elevated hsCRP throughout the first year post-ACS suffered most adverse events warranting studies of anti-inflammatory drugs in these patients.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Swiss Heart Foundation, Swiss National Science Foundation

P1222Intensification of lipid lowering therapy before and after publication of the IMPROVE-IT trial: A temporal analysis from the SPUM-ACS cohort

Background

The gradual implementation of evidence-based treatment strategies has improved outcomes in patients with acute coronary syndromes (ACS). The Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) was published on June 3rd, 2015, but its relevance on real life practice has not been explored.

Methods

We analyzed a prospective Swiss cohort of 6266 patients hospitalized for ACS between 2009 and 2017. The primary endpoints were the ezetimibe use overall or in combination with high-intensity statin at discharge and at one year after ACS. Secondary endpoint was LDL-C target achievement at one year in a subsample of 2984 patients. Relative Ratios (RR) were used to assess changes in primary endpoints before and after the publication of IMPROVE-IT, adjusting for age, sex, pre-existing diabetes, history of myocardial infarction, baseline low-density lipoprotein cholesterol (LDL-C) and attendance to cardiac rehabilitation.

Results

The period following the publication of the IMPROVE-IT trial was associated with an overall increase in the use of ezetimibe at discharge (from 1.8% to 3.8%, P<0.001, adjusted RR 2.85, 95% CI 1.90–4.25) and at one year (from 5.0% to 13.8%, P<0.001, adjusted RR 3.00, 95% CI 2.40–3.75). Before IMPROVE-IT trial, ezetimibe use at one year was stable around 5%, then steadily increased after its publication until 20% for patients included in 2017. The combination of high-intensity statin and ezetimibe increased from 0.9% to 2.1% at discharge (P<0.001, adjusted RR 3.35, 95% CI 1.90–5.89) and from 2.1% to 7.8% at one year (P<0.001, adjusted RR 3.98, 95% CI 2.90–5.47). The period following the publication of the IMPROVE-IT trial was associated with an improvement of LDL-C target <1.8 mmol/L (adjusted RR 1.37, 95% CI 1.12–1.68).

Conclusion

After the publication of the IMPROVE-IT trial, the use of ezetimibe was increased by three-fold in a large contemporary cohort of ACS patients, concomitant with an improved LDL-C target achievement.

464Optimal timing of invasive coronary angiography following NSTEMI

Introduction

Current guidelines recommend angiography within 24 hours of hospitalisation for patients with non-ST elevation myocardial infarction (NSTEMI). The recent VERDICT study found that angiography within 12 hours of hospitalisation was associated with improved cardiovascular outcomes among high-risk patients. We aimed to obtain a real-world perspective of the impact of angiography timing on one-year outcomes of patients admitted with NSTEMI.

Methods

Data was obtained from the SPUM-ACS registry, a cohort of consecutive patients hospitalised with acute coronary syndromes in four university hospitals in Switzerland between 2009 and 2017. Patients without a door-to-catheter (DTC) time and those with life-threatening features were excluded. Cox proportional hazards models evaluated the impact of DTC time on the primary endpoint, defined as one-year major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, stroke), and on one-year all-cause mortality.

Results

Of 2,672 NSTEMI patients, 1,832 met the inclusion criteria. Among them, 1,464 patients underwent angiography within 12 hours of admission (12h group) while 368 patients underwent angiography between 12 and 24 hours (12–24h group). After 2:1 propensity score matching, 736 patients from the 12h group and 368 patients from the 12–24h group were deemed equivalent in terms of main baseline clinical characteristics. Multiple logistic regression identified admission out-of-hours (night or weekend) as the most significant factor associated with delayed angiography. Cox models found no significant association between early angiography and one-year MACE (12h group: n=57 (7.7%) vs. 12–24h group: n=27 (7.3%), HR: 1.050, 95% CI 0.637- 1.733, p=0.847), or one-year all-cause mortality (12h group: n=25 (3.4%) vs. 12–24h group: n=17 (4.6%), HR: 1.514, 95% CI 0.774- 2.962, p=0.225) (Figure 1A). After stratification based on GRACE score (>140 vs. ≤140), there was no significant difference in one-year MACE or one-year all-cause mortality in the 12h group compared with the 12–24h group (p for interaction=0.601 and 0.463, respectively) (Figure 1A + 1B).

Figure 1

Conclusion

In an unselected real-world cohort of NSTEMI patients, angiography within 12 hours of hospitalisation was not associated with improved one-year outcomes when compared with angiography between 12 and 24 hours, even among patients with an elevated GRACE score.

Dose-response effects of TPI ASM8 in asthmatics after allergen

BACKGROUND

TPI ASM8 contains two modified antisense oligonucleotides (AON) targeting the beta subunit (β(c) ) of the IL-3, IL-5, GM-CSF receptors and the chemokine receptor CCR3. A previous study suggested that TPI ASM8 had broader effects than just inhibition of eosinophils in asthmatics.

OBJECTIVE

We assessed whether TPI ASM8 caused a dose-dependent attenuation in the inflammatory and physiological changes after inhaled allergen challenge (AIC).

METHODS

This single-center, open-label, stepwise-ascending dose study was conducted in fourteen stable, mild allergic asthmatics. Following placebo AIC, subjects underwent AIC after 4 days treatment with 1, 2, and 4 mg BID and finally 8 mg once daily (OD) of TPI ASM8, inhaled via the I-Neb™ nebuliser. Treatments were separated by 2-3-week washout periods.

RESULTS

TPI ASM8 was safe and well tolerated at all doses. TPI ASM8 8 mg OD reduced eosinophils in sputum after AIC (by 60.9% at 7 h and 68.4% at 24 h post-AIC, P=0.016 and P=0.007, respectively). Additionally, TPI ASM8 8 mg OD significantly attenuated the early and late airway responses as shown by the reduction in the area under the curve by 45% (P=0.016) and 59%, (P=0.0015), respectively, the increase in eosinophil cationic protein (ECP) by up to 57% (P=0.021), and airway responsiveness to methacholine by more than 1 doubling dose (P=0.012). A dose-response relationship was noted, and efficacy was maintained with once per day administration.

CONCLUSIONS

TPI ASM8 attenuated a broad range of inflammatory and physiological changes after AIC, suggesting that CCR3, IL-3, and GM-CSF also are important targets for the management of asthma.

[Specificities of diabetes in acute coronary syndromes]

Contrary to the decline in the prevalence of several risk factors such as hypertension, hypercholesterolemia and smoking, diabetes is an expanding health burden in the western world. Because of the proatherosclerotic, proinflammatory, and prothrombotic states associated with diabetes, diabetic patients with acute coronary syndromes (ACS) are at high risk of subsequent cardiovascular events. However, they derive greater benefit from aggressive platelet inhibition and an early invasive strategy than non-diabetic individuals. Despite the documented efficacy, diabetic patients with ACS receive evidence-based treatments less frequently than non-diabetic individuals.

Diabetes and acute coronary syndrome

Contrary to the decline in the prevalence of several risk factors such as hypertension, hypercholesterolemia and smoking, diabetes is an expanding health burden in the Western world. Because of the proatherosclerotic, proinflammatory, and prothrombotic states associated with diabetes, diabetic patients with acute coronary syndromes (ACS) are at high risk of subsequent cardiovascular events. However, they derive at the same time greater benefit from evidence-based therapy than the non-diabetic individuals. The two mainstays of acute ACS therapy for diabetic patients are an aggressive platelet inhibition and an early invasive strategy. Aspirin should be administered in all patients and prasugrel is to be considered superior to clopidogrel in this setting. While the use of glycoprotein IIb/IIIa receptor inhibitors in the diabetic ACS population has been associated with a mortality reduction, the role of these agents in the prasugrel era remains to be elucidated. Importantly, the aggressiveness of anti-thrombotic therapy should be balanced in each individual patient with the risk of bleeding. The benefit of early coronary angiography and, if needed, revascularization, in the setting of non-ST-segment elevation ACS is more pronounced in diabetic than in non-diabetic individuals. All patients, diabetics and non-diabetics, qualify for primary percutaneous coronary intervention (PCI) as the therapy of choice for ST-segment elevation myocardial infarction. In order to reduce hemorrhagic complications related to vascular access for PCI, the radial approach should be favored. Additional important secondary preventive measures include high-dose statin therapy, ACE-Inhibition/angiotensin II receptor blockade, and adequate glucose metabolism control. Despite the documented efficacy, diabetic patients with ACS receive evidence-based treatments less frequently than non-diabetic individuals.

Role of echocardiography in the evaluation of syncope: a prospective study

OBJECTIVE

To study the role of echocardiography in the stepwise evaluation of syncope.

DESIGN

A prospective observational study with an 18 month follow up.

SETTING

University teaching hospital providing primary and tertiary care.

SUBJECTS

650 consecutive patients with syncope and clinical suspicion of an obstructive valvar lesion, or with syncope not explained by history, physical examination, or a 12 lead ECG, who underwent bidimensional Doppler transthoracic echocardiography.

MAIN OUTCOME MEASURES

The causes of syncope were assigned using published diagnostic criteria. Echocardiography was considered diagnostic when confirming a suspected diagnosis, or when revealing occult cardiac disease explaining the syncope.

RESULTS

A systolic murmur was identified in 61 of the 650 patients (9%). Severe aortic stenosis was suspected in 20 of these and was confirmed by echocardiography in eight. Follow up excluded further cases of aortic stenosis. In patients with unexplained syncope (n = 155), routine echocardiography showed no abnormalities that established the cause of the syncope. Echocardiography was normal or non-relevant in all patients with a negative cardiac history and a normal ECG (n = 67). In patients with a positive cardiac history or an abnormal ECG (n = 88), echocardiography showed systolic dysfunction (left ventricular ejection fraction < or = 40%) in 24 (27%) and minor non-relevant findings in the remaining 64. Arrhythmias were diagnosed in 12 of the 24 patients with systolic dysfunction (50%), and in 12 of the 64 remaining patients (19%) (p < 0.01).

CONCLUSIONS

Echocardiography was most useful for assessing the severity of the underlying cardiac disease and for risk stratification in patients with unexplained syncope but with a positive cardiac history or an abnormal ECG.

Prospective evaluation of patients with syncope: a population-based study

PURPOSE

To determine the diagnostic yield of a standardized sequential evaluation of patients with syncope in a primary care teaching hospital.

PATIENTS AND METHODS

All consecutive patients who presented to the emergency department with syncope as a chief complaint were enrolled. Their evaluation included initial and routine clinical examination, including carotid sinus massage, as well as electrocardiography and basic laboratory testing. Targeted tests, such as echocardiography, were used when a specific entity was suspected clinically. Other cardiovascular tests (24-hour Holter monitoring, ambulatory loop recorder ECG, upright tilt test, and signal-averaged electrocardiography) were performed in patients with unexplained syncope after the initial steps. Electrophysiologic studies were performed in selected patients only as clinically appropriate. Follow-up information on recurrence and mortality were obtained every 6 months for as long as 18 months for 94% (n = 611) of the patients.

RESULTS

After the initial clinical evaluation, a suspected cause of syncope was found in 69% (n = 446) of the 650 patients, including neurocardiogenic syncope (n = 234, 36%), orthostatic hypotension (n = 156, 24%), arrhythmia (n = 24, 4%), and other diseases (n = 32, 5%). Of the 67 patients who underwent targeted tests, suspected diagnoses were confirmed in 49 (73%) patients: aortic stenosis (n = 8, 1%), pulmonary embolism (n = 8, 1%), seizures/stroke (n = 30, 5%), and other diseases (n = 3). Extensive cardiovascular workups, which were performed in 122 of the 155 patients in whom syncope remained unexplained after clinical assessment, provided a suspected cause of syncope in only 30 (25%) patients, including arrhythmias in 18 (60%), all of whom had abnormal baseline ECGs. The 18-month mortality was 9% (n = 55, including 8 patients with sudden death); syncope recurred in 15% (n = 95) of the patients.

CONCLUSION

The diagnostic yield of a standardized clinical evaluation of syncope was 76%, greater than reported previously in unselected patients. Electrocardiogram-based risk stratification was useful in guiding the use of specialized cardiovascular tests.

Assessment of a recombinant antigen versus natural hypodermin C for the serodiagnosis of hypodermosis in cattle

An indirect ELISA test using as antigen a recombinant parasite protein, hypodermin C, was developed to measure Hypoderma-specific antibodies in cattle sera and compared with natural hypodermin C. To evaluate the field efficacy of the ELISA test, 334 serum samples were collected from cows raised at farms in Galicia for a serological survey. Compared with an ELISA based on natural parasite antigen, the recombinant hypodermin C gave excellent results, with a sensitivity of 95.8% and a specificity of 95.7%. Considering the cut-off point, with the recombinant hypodermin C, 70.9% of the animals had positive levels of antibodies to Hypoderma and with natural hypodermin C, 73.6%. Recombinant hypodermin C appears to be a useful alternative to the natural parasite antigen for the serodiagnosis of Hypoderma sp in cattle.

[Trichuriasis in Cuba]

A representative sample of the Cuban population (11,364) is studied by using Willis and direct coproparasitological techniques. It was found that Trichuris trichiura is the most prevailing intestinal parasite (17.8%). A higher frequency of this kind of geohelminthiasis in people living in Cuban rural zones is seen. A prevalence peak is found in ages from 6 to 9 years, and a higher association of parasitism was found in those with worst hygienic and sanitary conditions.

[Isoenzymatic characterization of strains of Entamoeba histolytica isolated from Cuban patients and foreigners from Africa]

An analysis was made of the isoenzyme patterns of 61 Entamoeba histolytica strains: 42 from Cuba and 19 from Angola Mozambique and Ghana. By means of these patterns the non-pathogenic nature of the Cuban strains (Group 1) was shown. It coincided with the clinical characteristics of the infection in the carriers. Among the imported strains were 2 samples with pathogenic patterns II corresponding to 1 dysentery case and to 1 asymptomatic patient, and also non-pathogenic ones (I, II, III and XVIII).