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Funding Acknowledgements Type of funding sources: None. Background Adherence to medical therapy after myocardial infarction (MI) is a crucial part of patient care and indispensable for reaching clinical goals, however, data from low to middle income countries (LMIC) regarding adherence and persistence of optimal medical treatment (OMT) is scarce. Purpose To evaluate adherence and persistence to OMT after acute coronary syndrome (ACS) in a cohort of patients with ST elevation myocardial infarction (STEMI) in a low to middle income country. Methods We conducted a survey study evaluating adherence and persistence of OMT after 6 months of the index event in patients with STEMI. Patients were surveyed via phone call using the simplified medication adherence questionnaire (SMAQ) tool, which has been previously validated (both in English and Spanish) as a clinical tool to evaluate adherence to medication. We evaluated persistence of OMT as well. A secure electronic database was constructed to capture information, regarding adherence and persistence, and other clinically relevant variables. Study population The study included consecutive patients aged 18-99 years old with the diagnosis of STEMI form Mexico City’s STEMI Network, who received either pharmacoinvasive strategy (PIS) or Primary Percutaneous Coronary Intervention (pPCI) during the first 12 hours from symptom onset. This population is derived from the PHASE-Mx study (ClinicalTrials.gov Identifier: NCT03974581), which results have been previously published. Results A total of 602 patients were initially screened; among these, 158 patients (26.2%) were lost to contact, 5 patients (n = 0.008%) refused to answer and 65 patients (10.7%) died during follow up. The final analytic sample consisted of 375 patients; among them, 192 (51.2%) received primary PCI and 183 (48.8%) received pharmacoinvasive strategy. Mean age was 58 + 10 years old and most of the patients were male (90.1%). Hypertension (44.8%) and diabetes (32.0%) were common. Mean follow-up time after index STEMI was 650 (IQR: 416-832) days. After SMAQ evaluation, only 26.1% of the patients were considered to be adherent to their medications (>95% compliance), as shown in the Table 1. Persistence of OMT after STEMI included: ASA (84.6%), P2Y12i (71.5%), statin (83.6%), ACEI/ARB (77.1%) and beta blocker (63.7%) (Table 2). Conclusions In patients with STEMI in a low to middle income country, persistence and adherence to OMT were low. Actions to improve adherence to therapy after mayor cardiovascular events are needed. Risk factors associated to poor adherence included diabetes (OR 0.46), age (OR 0.76) and atrial fibrillation (OR 0.42). Abstract Figure.

Intro: Von Willebrand disease (VWD) is a coagulopathy caused by deficiency or dysfunction of von Willebrand factor (VWF), resulting in prolonged and excessive bleeding. Patients are advised to avoid aspirin (ASA), P2Y12 inhibitors, or anticoagulation (AC) so as not to exacerbate this condition. However, typical treatment for atrial fibrillation (AF) includes anticoagulation, particularly if the risk of stroke by CHA 2DS 2-VASC score is 2+. Current recommendations suggest giving necessary antiplatelet (AP) or AC therapy over no treatment with assessment of bleeding risk throughout the course. However, this is a conditional recommendation based on low certainty in evidence, and there are no specific guidelines on treating AF in patients with VWD. This study aims to assess anticoagulation use, bleeding risk, and stroke risk in patients with VWF and AF. Methods: We conducted an IRB-approved analysis of coded data from institutional electronic medical records to select patients with diagnosis of VWD, low ristocetin cofactor level, or any abnormal VWF panel as well as patients with diagnosis of AF or atrial flutter. Three hundred and forty patients met criteria. Patients were manually screened for inclusion criteria and excluded for inaccurate diagnosis or insufficient data. Eighty-nine patients were included in the analysis. Primary endpoint was rate of major bleeding defined by ISTH criteria while on AC or AP. Categorical data were tested using the Fisher exact test at the nominal 0.05 two-sided significance level, and all person-time comparisons are made against the rate of bleeding on AC alone. Results: Most patients were female (64.0%; 57/89), and 28.1% (25/89) were deceased at the time of data collection. Date of diagnosis of AF ranged from 1980-2020. 42.7% (38/89) of patients were ever prescribed ASA, 43.8% (39/89) a P2Y12 inhibitor, 56.2% (50/89) AC, and 23.6% (21/89) had never been prescribed AP or AC. Of patients with a CHA 2DS 2-VASC of 2+, 57.5% (46/80) were ever prescribed AC. 32.0% (16/50) of patients ever prescribed AC and 25.6% (10/39) patients never prescribed AC had at least one major bleeding event (p=0.428). The rate of major bleeding on AC alone was 8.9 events per 100 person-years (32 events/359.2 years), 10.2 events per 100 person-years on AP alone (41 events/402.3 years) (p=0.572), and 1.06 events per 100 person-years (8 events/757.47 years) in patients never prescribed AC or AP (p= Discussion: This retrospective observational study over 40 years characterizes AC and AP use in patients with VWD and AF. Only 57.5% of patients with CHA 2DS 2-VASC of 2+ received standard of care AC despite conditional recommendations to give necessary anticoagulation to patients with VWD. In parallel with the general population, AC use significantly increases the rate of major bleeding in patients with VWD, but there was no difference in bleeding rate between standard AC and AP monotherapy. However, major bleeding rates were notably elevated in patients prescribed concomitant AC and AP which most commonly occurred in the setting of ACS. This analysis is limited by its retrospective nature, the lack of granular details in the coded database, and incomplete data in older charts. Overall, these data do not support the use of AP monotherapy over standard AC to reduce bleeding rates for patients with VWD and AF. Additionally, AC and AP co-administration should be avoided due to high rates of major bleeding, but more studies are required to understand AP and AC strategies in patients with VWD, AF, and ACS. Although the rate of major bleeding is elevated with AC use in patients with VWD, there is no difference in lifetime prevalence of major bleeding events by AC vs no AC use. Finally, over half of thromboembolic strokes occurred when not prescribed AC. Shared decision-making around stroke and bleeding risk is advised in considering AC use for AF in patients with VWD. Prospective studies should further evaluate the risk of major bleeding and stroke in patients with VWD and AF on standard AC vs no AC. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Mediterranean diet (MD) is acknowledged to exert a number of beneficial health effects. We assessed the efficacy and the durability of a 3-month intensive dietary intervention aimed at implementing the MD on body weight and cardiometabolic risk factors in subjects at high risk. One hundred and sixteen subjects participated in the study (71 assigned to the intensive intervention and 45 to the conventional intervention). The intensive intervention consisted of 12 weekly group educational meetings and a free-of-charge supply of meals prepared according to the MD model. The conventional intervention consisted of an individual education session along with monthly reinforcements of nutritional messages by the general practitioner. All participants were followed up for 9 months. The two groups had similar pre-intervention characteristics. After the intervention, mean body weight decreased significantly in both groups (p

NA is a rare abnormality, not a neoplasm but an immature urothelial metaplasia, first described by Davis in 1949 in a 40 -yrs- old man with a history of urinary tract infections. It is an adenomatous form of metaplasia associated with chronic urinary tract infections, trauma, urinary tract surgery, calculi. tubercolosis, schistosomiasis. The lesion is generally isolated but may be multiple in almost 20% of cases; its size ranges from microscope to the entire bladder involvement Some cases have been reported in association with renal transplantation. where predisposing factors can be defined: bladder implantation of the ureter, recurrent urinary tract infections, vescicoureteral reflux, immunosuppressive therapy. The AA. describe the occurrence of 3 cases in a population of 796 patients transplanted at their institution from 11/81 to 4/95.

Despite careful pretransplant investigations and rigorous selection of donors, it is not possible always to avoid any transfer of infraclinical malignancy. It must be stressed that most transmitted cancers were in the pioneering era of transplantation, while today the situation occurs very rarely.

The purpose of the present study was to characterize the time course of adaptation (i.e., circulating metabolites and hormones, fat pad mass, lipoprotein lipase) to a high-fat diet in obesity-prone (OP) and obesity-resistant (OR) male Wistar rats. Delineation of OP and OR was based on body weight gain (upper tertile for OP; lower tertile for OR) after 1 wk on a high-fat diet (60% of kcal from corn oil). Rats were killed after 1, 2, or 5 wk of the dietary period. Increased body weight and percent body fat in OP rats at 1 wk could not be accounted for by increased retroperitoneal or epididymal fat pad weight. Plasma nonesterified fatty acids and triglycerides, as well as blood concentrations of glucose, lactate, and glycerol, were similar throughout the study. Plasma insulin was significantly greater in OP vs. OR rats and low-fat diet (LFD; 20% of kcal from corn oil) controls at 5 wk only, and blood beta-hydroxybutyrate (mM) was significantly higher in OR compared with OP and LFD rats at 1, 2, and 5 wk. Lipoprotein lipase mRNA and activity were significantly greater in epididymal fat pad and significantly lower in gastrocnemius muscle of OP vs. OR rats at 1 wk. Results suggest that early (i.e., 1 wk) differences in body weight and fat weight between OP and OR rats are not due to fat deposition in retroperitoneal or epididymal fat depots, and tissue-specific changes in LPL (increase in epididymal fat pad and decrease in gastrocnemius muscle) that occur in OP compared with OR rats after 1 wk on a high-fat diet provide a metabolic environment favoring fat storage.

Daily plasma progesterone (P(4)) was determined during one estrous cycle of 19 cows and 18 heifers of four different breeds: Holstein (H), Brahman (B), Carora-type (C) and crossbred (CB) females. Estrus detection was made by visual observation and using a teaser bull with a chin-ball marker. The P(4) profiles showed no differences among groups. In Group 1 (H), P(4) levels ranged from 0.5 ng/ml plasma on the day of estrus (Day 0) to 5.1 ng/ml at the luteal phase peak (Day 13). In Group 2 (B), P(4) levels ranged from 0.5 ng/ml on Day 0 to 9.2 ng/ml on Day 13. In Groups 3 (C) and 4 (CB), P(4) levels ranged from 0.5 ng/ml, on Day 0, to 13.7 ng/ml on Day 12 and 8.8 ng/ml on Day 13. These last two groups were moved to the same location and then compared. It was found that P(4) concentrations were significantly higher (P0.025) in Group 3 between Days 7 and 14 of the estrous cycle. In all groups, P(4) levels were lower than 1 ng/ml one day before the next estrus, and levels of 0.4, 0.5, 0.4 and 0.4 ng/ml were obtained the day of estrus in Groups 1 to 4, respectively. Results indicated that the pattern of P(4) for each one of the groups was similar to those reported by other investigators.

Background: The number of indications for strictureplasty for Crohn’s disease has been greatly reduced since the widespread use of biologics, although the risk of intestinal failure remains. The aim of the study was to analyze the outcomes of strictureplasty and to identify risk factors for site-specific recurrence in the era of biologics. Methods: Consecutive patients treated with strictureplasty for Crohn’s disease between 2002 and 2018 were retrospectively included. Univariate analysis was carried out. Risk factors for recurrence were identified through a multilevel logistic regression analysis. Results: Two hundred sixty-six patients were included in the study (171 males, median age 39.5years, range 18–76years). The majority of the 718 strictures requiring surgery in these patients were located in the ileum (61%), treated with conventional strictureplasty (89.6%) and required an additional resection (73.7%). Median follow-up time and time to recurrence were 96months and 62.5months respectively. The site-specific recurrence rate was 12.2% at 5years and 25.7% at 10years. Smoking was associated with a higher risk of recurrence in patients with milder disease. The 10-year recurrence rate was significantly higher for strictureplasties performed in the terminal ileum (30.9%, p = 0.0019) as compared to the ileum (21.8%) and the jejunum (8.4%). Multilevel logistic regression analysis showed that postoperative exposure to biologics (OR 4.74, p 0.001), nonconventional strictureplasty (OR 3.57, p 0.008) and a strictureplasty performed on a previous anastomosis (OR 13.58, p 0.002) were associated with site-specific recurrence. Conclusions: Strictureplasty is associated with optimal long-term outcomes in the biologic era and should be performed when feasible, to reduce the risk of intestinal failure in Crohn’s disease patients.