Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

[Diet quality and diversity in the urban population of Argentina]

Following a varied diet is associated with a healthier diet and a greater likelihood of incorporating the necessary micronutrients. The dietary diversity index (DDI) is the indicator that measures this variety, while the diet quality index (DQI) determines how much of this diversity consists of the inclusion of healthy foods. The aim of the study was to evaluate the quality and diversity of the diet of the Argentine population by identifying differences by sex, age, socioeconomic level, nutritional status and region. The sample consisted of 1266 subjects of urban population, of both sexes, between 15 and 65 years of age and of all socioeconomic levels. Anthropometric and intake assessment was performed, through 2 24-hour recalls. The DDI was assessed following the guidelines proposed in 2016 by Food and Agriculture Organization and the development of the DQI was performed following the methodology of Imamura y col. The DQI was relatively low, with a score of 63.9%. The DDI was 4.48 out of a maximum of 10, reflecting a poorly varied diet; additionally, only 50% of the population reported a varied diet. These indicators are significantly lower in people with low SEL. The DDI and the percentage of people with a diverse diet was higher in people from the metropolitan area of Buenos Aires. This study showed that the quality of the diet in the Argentine population is low and with a limited consumption of the food groups that provide the most micronutrients.

Modelo preclínico de obesidad basado en alimentos altamente procesados y de alta palatabilidad

Introducción: el alarmante incremento de la obesidad en todo el mundo y en Costa Rica responde principalmente a modificaciones en la composición de la dieta habitual de las personas. La presente investigación tuvo como objetivo implementar un protocolo de alimentación formulado a partir de alimentos altamente procesados y de alta palatabilidad (APAP) consumidos por la población costarricense para, luego, evaluar sus efectos en la conducta alimentaria y en parámetros biométricos y bioquímicos. Metodología: ratas adultas macho Wistar se asignaron a dos grupos. Al primero se le administró alimento estándar para roedores (grupo DC) y al segundo, alimentos APAP (grupo APAP), durante ocho semanas. Resultados: a lo largo de ese periodo, los animales expuestos a los APAP exhibieron mayor ingesta y energía, caracterizadas por un alto consumo de grasas y uno menor de proteínas y fibra; además, mostraron un incremento significativo en los diversos parámetros de obesidad (e. g., peso corporal y ganancia de peso, índice de Lee y adiposidad central) y niveles descriptivamente superiores de glucosa y triglicéridos en sangre, pero notablemente menores de colesterol total. Conclusiones: los resultados indican que una dieta basada en los alimentos APAP más frecuentes en la población costarricense es capaz de inducir hiperfagia y obesidad. Así, este modelo constituye una herramienta prometedora para ahondar en el estudio de las factores neurobiológicos y metabólicos relacionados con la obesidad por el sobreconsumo de alimentos APAP.

A Comparison of Associations Between Self-Reported and Device-Based Sedentary Behavior and Obesity Markers in Adults: A Multi-National Cross-Sectional Study

The purpose of this study was to examine the associations between self-reported and device-based measures of sedentary behavior (SB) with obesity markers in adults from Latin American countries. Sitting time and total time spent in different SBs were self-reported using two different questionnaires. Accelerometers were used to assess total sedentary time. Body mass index, waist, and neck circumferences were assessed. The highest self-reported sitting time was in Argentina, the highest total time spent in different SBs was in Brazil and Costa Rica, and the highest device-based sedentary time was observed in Peru. Neither self-reported sitting time, total time spent in different SBs or device-based sedentary time were associated with body mass index. Device-based sedentary time was positively associated with waist circumference and self-reported sitting time was positively associated with neck circumference. Caution is warranted when comparing the associations of self-reported and device-based assessments of SB with anthropometric variables.

Dietary Diversity and Micronutrients Adequacy in Women of Childbearing Age: Results from ELANS Study

Dietary diversity, an important component of diet quality, is associated with an increased probability of adequate micronutrient intake. Women of childbearing age (WCA) are particularly vulnerable to micronutrient inadequacy. The Minimum Dietary Diversity for Women (MDD-W) has been used widely as a proxy measurement of micronutrient adequacy. This study aimed to assess the association between MDD-W and nutrients adequacy among WCA of eight Latin American countries. Nutrient intakes from 3704 WCA were analyzed with two 24-hour dietary recalls. Dietary diversity was calculated based on ten food groups with a cut-off point of intake ≥5 groups. The mean dietary diversity score was 4.72 points, and 57.7% of WCA achieved MDD-W. Vitamin D and E showed a mean Nutrient Adequacy Ratio (NAR) of 0.03 and 0.38, respectively. WCA with a diverse diet (MDD-W > 5) reported a significantly higher intake of most micronutrients and healthy food groups with less consumption of red and processed meats and sugar-sweetened beverages. MDD-W was significantly associated with the mean adequacy ratio (MAR) of 18 micronutrients evaluated. Nevertheless, even those women with a diverse diet fell short of meeting the Estimated Average Requirements (EAR) for vitamins D and E. MDD-W is an appropriate tool to evaluate micronutrients adequacy in WCA from Latin America, showing that women who achieved the MDD-W reported higher adequacy ratios for most micronutrients and an overall healthier diet.

Consumo de frutas y vegetales en la población urbana costarricense: Resultados del Estudio Latino Americano de Nutrición y Salud (ELANS)-Costa Rica

Introducción: El consumo suficiente de frutas y vegetales ha sido ampliamente asociado con diversos beneficios para la salud, entre ellos, el actuar como factor protector contra el desarrollo de enfermedades crónicas no transmisibles, cáncer y enfermedades mentales. La Organización Mundial de la Salud (OMS) recomienda un consumo diario de 400 gramos entre frutas y vegetales. Este estudio tuvo como objetivo la caracterización del consumo de frutas y vegetales, según variables sociodemográficas en la población costarricense y el cumplimiento de la recomendación de la OMS. Metodología: Los datos se obtuvieron del Estudio Latino Americano de Nutrición y Salud (ELANS)-Costa Rica. Se reclutaron 798 sujetos de 15 a 65 años, residentes en zonas urbanas del país, y se evaluó el consumo de alimentos mediante dos recordatorios de 24 horas. El consumo de frutas y vegetales se analizó según el sexo, el grupo de edad y el nivel socioeconómico. Resultados: Se encontró un consumo promedio de frutas y vegetales de 220g/d/p; el cual incrementó con la edad (p=0.035 entre el grupo de 15 a 19 años y el grupo de 50 a 65 años) y con el nivel socioeconómico (p=0.004 entre el NSE bajo y medio). Sin asociación con el sexo y al nivel educativo (p>0.05). Solamente el 12.0 % de la población urbana costarricense cumple con la recomendación de la OMS. Conclusiones: Los datos obtenidos ponen en evidencia la necesidad de la implementación de programas e intervenciones adaptados a las características y preferencias de la población costarricense para la promoción del aumento en el consumo de frutas y vegetales. Es necesario extender estos estudios a la población rural de Costa Rica, pues el consumo y los factores asociados a este, podría ser diferente entre regiones.

P1188Oral antibiotic treatment for local cardiac implantable electronic device infections: our 6-year experience

INTRODUCTION

Cardiac implantable electronic device (CIED) infection is a severe disease with an increasing incidence due to the rise in the number of CIEDs implanted world-wide. Complete hardware removal is the treatment of choice, but there is little clinical data about the best antimicrobial strategy, such as the best choice of antibiotics, treatment duration and when to switch to oral administration in cases of local CIED infections.

PURPOSE

  In 2013, we designed a new protocol for CIED infection management, by which local infections were treated with complete hardware removal followed by empiric parenteral antibiotic during the first 72h, which was replaced to an oral agent (in case of negative blood cultures) and continued for 10 days. The oral antibiotic was selected according to the local cultures when positive, or to Clindamicin, Levofloxacin or Cotrimoxazole when no germ was identified. Our purpose is to describe our experience and results after the implementation of this strategy.

METHODS

We retrospectively reviewed all consecutive local CIED infection cases from the implementation of the protocol until September 2019, and evaluated the population characteristics, type of infection, rate of positive cultures and outcomes.

RESULTS

We identified 74 cases of CIED infection, of which 46 (62%) were local. The average age of this population was 75.3 ± 13.2 yo and 65% (30) were male. The predominant comorbidities were diabetes (41%), congestive heart failure (30%), and malignancies (22%). Eighteen patients (39%) had previous local infection treated medically without hardware removal. Mean number of previous procedures was 2.65 ± 1.8, and 34 (74%) of the devices were pacemakers (single and dual chamber), 5 (11%) ICDs, 6 (13%)CRT-P and 1 (2%) CRT-D. Blood cultures were negative in all cases, whereas local cultures (exudate or intraoperative tissue) were positive in 32 (70%). The most frequent microorganisms were Staphylococcus epidermidis in 18 (56%) and Staphylococcus aureus in 8 (25%), including 1 case of meticillin-resistance.  Intravenous Vancomycin was administered in all cases during 72 h, followed by oral antibiotics for a mean duration of 8.8 ± 3.3 days. Hardware removal was intended in all cases, with complete or clinical success in 42 and 3 cases respectively (global success rate 97.8%), and in one case (2.2%) an epicardial lead was not removed. During a mean follow-up of 30 months, 1 infection-related death occurred (2%) due to a side effect of intravenous antibiotic therapy, and there was 1 infection relapse (2%) in the only patient without complete hardware removal, related to the remnant epicardial lead.

CONCLUSIONS

Oral antimicrobial treatment with good bioavailability agents, associated with complete hardware removal is an effective strategy for the management of local CIED infections, with a low recurrence rate, and avoiding long hospitalizations and potential side effects of intravenous antibiotic therapy.

Interactions of mycobacterial glycopeptidolipids with membranes: influence of carbohydrate on induced alterations

Glycopeptidolipids (GPLs) are specific constituents of mycobacteria known as opportunistic pathogens. The influence of the carbohydrate moiety on GPL-induced membrane alterations was examined with GPLs bearing 1-5 sugar residues (GPL-1 to GPL-5) and a sulfated GPL (S-GPL-2). GPLs decreased the ADP/O ratio and increased controlled respiration of isolated mitochondria. The more polar GPLs were the less active, with the following order of efficiency: GPL-1 > GPL-2 > S-GPL-2 = GPL-3 = GPL-5. GPL-1 and GPL-2 increased passive permeability of liposomes to carboxyfluorescein (GPL-1 > GPL-2), while GPL-3 and GPL-5 were inactive. GPL-2 and GPL-3 decreased the transmembrane electrical potential (delta psi) in isolated mitochondria (GPL-2 > GPL-3). These results suggest that GPLs uncouple oxidative phosphorylation by increasing the passive permeability of the mitochondrial membrane to protons. Compression isotherms of GPL-2 monolayers showed that, at low surface pressure, the area per GPL-2 molecule was about 5 times that of an acyl chain: it is likely that the peptide moiety was at the air/water interface. With an increase in the surface pressure, its area decreased, down to that of a tightly packed acyl chain. It is postulated that the glycopeptidic moiety can be either at in the interface or dipping into the water.(ABSTRACT TRUNCATED AT 250 WORDS)