Sleep duration and its association with cardiometabolic outcomes among adolescents enrolled in the SI Program in Spain

Background

Sleep duration has been inversely associated with increased prevalence of overweight/obesity in childhood and adolescence [1, 2]. However, large studies linking over time objectively measured sleep duration and other cardiometabolic outcomes in adolescence are lacking.

Purpose

To evaluate sleep duration and its association with cardiometabolic outcomes in a large cohort of adolescents aged 12 to 16 years from the SI! Program for Secondary Schools trial in Spain [3], together with its relationship with sociodemographic variables.

Methods

Seven-day actigraphic recording was performed in 1229 adolescents at baseline (49.7% girls; 12.5 (0.4) years), 1058 at first follow-up (51.1% girls; 13.9 (0.4) years), and 895 at second follow-up (52.3% girls; 15.8 (0.4) years). Three groups were defined: very short sleep duration (<7 h), short sleep duration (7 to 8 h), and reference sleep duration (≥8 h) [4]. Overweight/obesity were determined according to BMI age- and sex-adjusted percentiles. Continuous Metabolic Syndrome (MetS) score was calculated as the sum of the age-and-gender specific z-scores of mean arterial pressure (MAP) (MAP = ((systolic BP − diastolic BP)/3) + diastolic BP), waist circumference, and fasting blood measures of high-density lipoprotein cholesterol (HDL-c) levels multiplied by −1, triglycerides, and glucose levels [5]. Associations between sleep duration and cardiometabolic outcomes were analyzed using generalized linear and Poisson distribution adjusted models.

Results

At 12 years of age, only 34.2% of the adolescents met sleep recommendations (sleep hours ≥8), and this percentage decreased with advancing age (23.4% and 19.4% at approximately 14 and 16 years of age, respectively) (Figure 1). Boys and individuals from migrant families tended to sleep shorter. Moreover, sleep duration was directly associated with sleep quality and efficiency. After adjusting for potential cofounders, very short sleepers (<7h) had a higher prevalence ratio (PR) of overweight/obesity at baseline (PR: 1.21 [95% CI: 1.16 to 1.27]) and at first follow-up (PR: 1.72 [95% CI: 1.08 to 2.74]) than the reference group (≥8 h) (Figure 2). Similarly, very short sleepers showed higher mean MetS scores at baseline (0.98 [95% CI: 0.43 to 1.54] and at first follow-up (0.76 [95% CI: 0.24 to 1.27]) as compared with the reference group. Short sleepers showed similar trends with associations of weaker magnitude, as they were the overall associations between sleep duration and cardiometabolic outcomes at second follow-up.

Conclusions

Most adolescents, and particularly those with a migrant background, did not meet sleep recommendations. Moreover, a shorter sleep duration was associated with cardiometabolic outcomes, particularly at 12 and 14 years of age and when sleeping less than 7 hours. Health promotion programs should emphasize the importance of good sleep habits.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): 1. Fundaciό la Maratό de TV3.2. SHE Foundation and “la Caixa” Foundation.

Cardiovascular health trajectories among adolescents enrolled in the SI Program in Spain: a longitudinal study

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): 1. Fondo de Investigación Sanitaria- Instituto de Salud Carlos III2. SHE Foundation and “la Caixa” Foundation.

Background

There is a paucity of data on adolescents’ cardiovascular health (CVH) profiles and longitudinal trajectories.

Purpose

To identify CVH trajectories in a large cohort of Spanish adolescents aged 12 to 16 years and their relationship with sociodemographic variables.

Methods

This study collected data at approximately 12, 14 and 16 years of age from 1078 adolescents attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain [1]. The status (non-ideal = 0 points; ideal = 1 point) of each CVH individual metric (smoking status, body mass index, physical activity, dietary habits, blood pressure, total cholesterol, and blood glucose) was determined following the criteria established by the American Heart Association [2]. An overall CVH score was constructed summing the number of ideal CVH metrics (ranged thus from 0 to 7 points), and poor, intermediate, or ideal overall CVH score was defined as ≤3, 4-5, or 6-7 ideal metrics, respectively [3]. CVH trajectories were identified using latent class trajectory modeling with the Stata command traj [4]. Next, individuals were assigned to the trajectory group they were most likely to belong based on the posterior predictive probabilities of group membership.

Results

Among 1078 adolescents with a baseline mean (SD) age of 12.5 (0.4) years, 48.5% girls, four distinct CVH trajectory groups were identified: low-stable (56 adolescents [5.0%]), low-rise (232 [21.3%]), intermediate-decline (136 [18.2%]) and intermediate-stable (654 [55.5%]) (Figure 1). Adolescents belonging to the intermediate-stable and the low-stable trajectories showed the highest and lowest overall CVH mean (SD) scores at baseline [4.8 (0.8) and 2.6 (0.9), respectively] (Figure 2). Similar differences were observed for the analysis of overall CVH score as a categorical variable (poor, intermediate, ideal). Sociodemographic differences between CVH trajectories were identified, with the highest proportion of girls, high-income and non-migrant families within the intermediate-stable trajectory.

Conclusions

In a large cohort of adolescents, ~55% of adolescents showed an intermediate CVH score at baseline and did not decline over time. The characterization of distinct CVH trajectories and sociodemographic differences between them may help tailoring health promotion programs for adolescents.

Transthyretin cardiac amyloidosis scintigraphy, experience in a reference cardiology center

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Instituto Nacional de Cardiologia Ignacio Chavez

Introduction

Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive disease that significantly reduces patients" quality of life and survival.1 In our country there are no statistics of this disease, only isolated cases. The ability to diagnose it has dramatically improved since the 2019 Multisociety Consensus for Multimodality Imaging.2,3 The study aimed to know patients" demographic and imaging characteristics in suspected ATTR-CA and the prevalence of positive cases in a reference Cardiology Center using 99mTc-pyrophosphate scintigraphy (99mTc-PYP).

Methods

Prospective, observational study approved by Institutional committees. We studied with 99mTc-PYP patients from November 2019 to December 2020 sent to the Nuclear Cardiology Department with clinical suspicion of ATTR-CA and negative light chain quantification. We included parameters as red flags, ECHO suggestive findings (septal thickness >12 mm, diastolic dysfunction), and MRI suggestive findings.  ATTR-CA was diagnosed by clinical suspicious, positive scintigraphy, and negative serum studies. 99mTc-PYP were acquired according to current recommendations. Frequency distribution of categorical variables were reported as frequencies and percentages; continuous variables are presented in mean.  Mann-Whitney U tests were conducted for continuous variables, while Fisher"s exact test was performed for categorical variables.

Results

Due to the Covid-19 pandemic, our Cardiology Hospital reconverted to covid attention; we studied a reduced number, and they were mainly inpatients: total 35 (28-inpatients, 7-outpatients). 21 (60%) were male, 14 (40%) were female, average age was 56.5 yo. 31%-heart failure diagnosis, 6%-history of carpal tunnel syndrome and 3%-spinal stenosis. ECHO: 26% had suggestive imaging, 43% with diastolic dysfunction, and 37% had a septal thickness >12mm. MRI: 42.9% had suggestive CA findings. No significant differences were found in the characteristics of suspicion between positive and negative patients. Regarding of the 35 patients scintigraphy, 7 (20%) were positives, establishing ATTR-CA diagnosis, 28 (80%) were negatives. The positivity probability was significant by H/Cl ratio, Perugini score, and SPECT findings (p 0.001). Until this protocol started and we share it among hospital physicians, we had never been asked to acquired this type of scintigraphy. Our study shows that if we purposely search for the disease, it can be found. The sample is small due to the limitations we had in the face of the pandemic; however, the study findings are significant for ATTR-CA diagnosis. It is striking that the ECHO and MRI suggestive findings were not statistically significant for the diagnosis. 

Conclusions

We present the initial experience of the first study of cardiac amyloidosis in our country, to show the disease"s presence and that the diagnosis can be made effectively, quickly, economically, and non-invasively by nuclear medicine scintigraphy.

High prevalence of bla OXA-23 in Acinetobacter spp. and detection of bla NDM-1 in A. soli in Cuba: report from National Surveillance Program (2010-2012)

As a first national surveillance of Acinetobacter in Cuba, a total of 500 Acinetobacter spp. isolates recovered from 30 hospitals between 2010 and 2012 were studied. Acinetobacter baumannii–calcoaceticus complex accounted for 96.4% of all the Acinetobacter isolates, while other species were detected at low frequency (A. junii 1.6%, A. lwoffii 1%, A. haemolyticus 0.8%, A. soli 0.2%). Resistance rates of isolates were 34–61% to third-generation cephalosporins, 49–50% to β-lactams/inhibitor combinations, 42–47% to aminoglycosides, 42–44% to carbapenems and 55% to ciprofloxacin. However, resistance rates to colistin, doxycycline, tetracycline and rifampin were less than 5%. Among carbapenem-resistant isolates, 75% harboured different bla_OXA genes (OXA-23, 73%; OXA-24, 18%; OXA-58, 3%). The bla_NDM-1 gene was identified in an A. soli strain, of which the species was confirmed by sequence analysis of 16S rRNA gene, rpoB, rpoB–rpoC and rpoL–rpoB intergenic spacer regions and gyrB. The sequences of bla_NDM-1 and its surrounding genes were identical to those reported for plasmids of A. baumannii and A. lwoffi strains. This is the first report of bla_NDM-1 in A. soli, together with a high prevalence of OXA-23 carbapenemase for carbapenem resistance in Acinetobacter spp. in Cuba.

Primary solitary Echinococcosis in cervical spine. Postsurgical successful outcome after long-term albendazole treatment

STUDY DESIGN

A case report of a young man with isolated cervical hydatidosis treated postoperatively with sustained cyclical albendazole therapy for 9 years of follow-up.

OBJECTIVES

To communicate the efficacy and safety of prolonged albendazole treatment in the postoperative management of spinal hydatid disease, and recommend therapeutic regimes for preventing its recurrence.

SUMMARY AND BACKGROUND DATA

Bone involvement in hydatid disease is uncommon and the cervical region of the spine is rarely affected. Surgical excision remains the treatment of choice but high rates of postoperative recurrence have highlighted the importance of adjuvant anthelmintic therapy. The selection of the drug(s) and the duration of the medical treatment is still controversial.

METHODS

The patient described herein presented with isolated bone lesions, in an unusual cervical location, and without coincidental visceral involvement. Therefore, diagnosis was delayed and surgical debridement was carried out without any preoperative anthelmintic therapy. To prevent late recurrences, therapy with intermittent courses of albendazole has been maintained for nine years and is still ongoing. Response and toxicity related to therapy has been closely monitored by clinical, biochemical and radiological follow up.

RESULTS

After surgery the patient has remained asymptomatic without sequelae or evidence of relapses. No clinically relevant side effects has been observed.

CONCLUSION

Prolonged albendazole treatment appears to be safe and effective in the prevention of late recurrences after spine hydatidosis surgery. Long-term chemotherapeutic schedules should be considered after surgical excision of spine or bone lesions.

[Heart transplantation in a patient with rheumatoid arthritis]

A 56 year-old woman with rheumatoid arthritis was diagnosed with idiopathic dilated cardiomyopathy. She developed progressive heart failure that was refractory to conventional medical management. Heart transplantation was performed bearing in mind the controversy that surrounds its use in patients with a systemic disease. Transplant and rheumatoid arthritis were favorable at 33 month evolution. The immunosuppressive therapy required for the transplant helped the control of her articular disease.

Reduction of bone mass in women after bone marrow transplantation

Osteoporosis is a common disease among patients undergoing transplantation. Its prevalence and complications have been well described in solid organ recipients, especially kidney, liver, and heart. However, studies in bone marrow transplantation (BMT) are scarce. Among the mechanisms invoked in the pathogenesis of BMT osteoporosis are the baseline disease, the use of immunosuppressive drugs and, more remarkably, secondary hypogonadism. We present a study of 27 women who underwent BMT, all of them suffering ovarian failure. We studied different biochemical markers of bone formation/resorption and also evaluated the presence of osteopenia/osteoporosis by dual energy X-ray absorptiometry (DXA) of the lumbar spine. Osteopenia was observed in nine patients (33%) and osteoporosis in another five (18%), according to the World Health Organization criteria. We also detected a subgroup showing elevation of several bone turnover biochemical markers, indicating high osseous remodeling. A remarkable increase in urine hydroxyproline/creatinine was detected in 95% of cases, although an explanation is lacking. We outline a reasonable therapeutic approach for osteoporosis in BMT emphasizing the need to monitor these patients after transplantation.

Antibodies to dietary antigen in serum from patients with sickle cell anemia

The levels of antibodies of the IgG, IgA and IgM isotypes reacting against ovoalbumin (OVA), gliadin (GL) and cow's milk proteins (CMP), were determined by ELISA in sera from a group of adult patients with sickle cell anemia (SCA) bearing homozygous Ss hemoglobinopathy and from matched health donors. Only patients with steady-state disease were included in the study. Increased amounts of IgG and IgA reacting with OVA, GL and CMP were observed in the group of patients as compared with the controls. In contrast, the levels of IgM antibodies against each of the three dietary antigens were similar in patients and controls. Increased levels of IgG and IgA antibodies against dietary antigens in SCA may result from enhanced permeability of the gut mucosa to macromolecules of dietary origin as a consequence of microinfarctions, chronic polyclonal B cell activation and/or diminished inhibitory control of antibody synthesis.

[Changes in the serum lipid fractions of malnourished children with and without clinical infection. Paradoxical hypertriglyceridemia in malnutrition]

We have studied the levels of total triglycerides, total cholesterol and high, low and very low density lipoproteins, in serum from undernourished children and from eutrophic controls matched by age, race and socioeconomical condition with the undernourished group. Malnourished children were classified according to the severity of the nutritional deficiency and according to the presence or absence of associated overt infections. Serum lipids fractions were evaluated by colorimetric procedures and by electrophoretic isolation and elution of the desired lipoprotein followed by colorimetric evaluation of the cholesterol content. Increased levels of total triglycerides and very low density lipoproteins were observed in the undernourished group. The rise in the levels of total triglycerides and very low density lipoproteins was more marked in children with moderate and severe undernutrition as well as in undernourished with associated overt infection. In contrast, as expected, serum levels of total cholesterol, high density and low density lipoproteins were significantly diminished in undernourished children. The depression in the amount of total cholesterol, high density and low density lipoproteins was more marked in the severe forms of undernutrition. Increased levels of total triglycerides and very low density lipoprotein could be determined by a defect in the clearance of these lipid fractions due to depressed activity of lipoprotein lipase.