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ObjectivesTo determine the risk of mortality and need for aortic valve replacement (AVR) in patients with low-flow low-gradient (LFLG) aortic stenosis (AS).MethodsA longitudinal multicentre study including consecutive patients with severe AS (aortic valve area [AVA] < 1.0 cm2) and normal left ventricular ejection fraction (LVEF). Patients were classified as: high-gradient (HG, mean gradient ≥ 40 mmHg), normal-flow low-gradient (NFLG, mean gradient < 40 mmHg, indexed systolic volume (SVi) > 35 ml/m2) and LFLG (mean gradient < 40 mmHg, SVi ≤ 35 ml/m2).ResultsOf 1,391 patients, 147 (10.5%) had LFLG, 752 (54.1%) HG, and 492 (35.4%) NFLG. Echocardiographic parameters of the LFLG group showed similar AVA to the HG group but with less severity in the dimensionless index, calcification, and hypertrophy. The HG group required AVR earlier than NFLG (p < 0.001) and LFLG (p < 0.001), with no differences between LFLG and NFLG groups (p = 0.358). Overall mortality was 27.7% (CI 95% 25.3–30.1) with no differences among groups (p = 0.319). The impact of AVR in terms of overall mortality reduction was observed the most in patients with HG (hazard ratio [HR]: 0.17; 95% CI: 0.12–0.23; p < 0.001), followed by patients with LFLG (HR: 0.25; 95% CI: 0.13–0.49; p < 0.001), and finally patients with NFLG (HR: 0.29; 95% CI: 0.20–0.44; p < 0.001), with a risk reduction of 84, 75, and 71%, respectively.ConclusionsParadoxical LFLG AS affects 10.5% of severe AS, and has a lower need for AVR than the HG group and similar to the NFLG group, with no differences in mortality. AVR had a lower impact on LFLG AS compared with HG AS. Therefore, the findings of the present study showed LFLG AS to have an intermediate clinical risk profile between the HG and NFHG groups.

Background Diseases of the descending aorta have emerged as a clinical issue in Marfan syndrome following improvements in proximal aorta surgical treatment and the consequent increase in life expectancy. Although a role for hemodynamic alterations in the etiology of descending aorta disease in Marfan patients has been suggested, whether flow characteristics may be useful as early markers remains to be determined. Methods Seventy-five Marfan patients and 48 healthy subjects were prospectively enrolled. In- and through-plane vortexes were computed by 4D flow cardiovascular magnetic resonance (CMR) in the thoracic aorta through the quantification of in-plane rotational flow and systolic flow reversal ratio, respectively. Regional pulse wave velocity and axial and circumferential wall shear stress maps were also computed. Results In-plane rotational flow and circumferential wall shear stress were reduced in Marfan patients in the distal ascending aorta and in proximal descending aorta, even in the 20 patients free of aortic dilation. Multivariate analysis showed reduced in-plane rotational flow to be independently related to descending aorta pulse wave velocity. Conversely, systolic flow reversal ratio and axial wall shear stress were altered in unselected Marfan patients but not in the subgroup without dilation. In multivariate regression analysis proximal descending aorta axial (p = 0.014) and circumferential (p = 0.034) wall shear stress were independently related to local diameter. Conclusions Reduced rotational flow is present in the aorta of Marfan patients even in the absence of dilation, is related to aortic stiffness and drives abnormal circumferential wall shear stress. Axial and circumferential wall shear stress are independently related to proximal descending aorta dilation beyond clinical factors. In-plane rotational flow and circumferential wall shear stress may be considered as an early marker of descending aorta dilation in Marfan patients.

]Spanish abstract] Se realiza una aproximación al análisis, síntesis e integración sistémica de la información, que ocurre durante el transcurso de la investigación metanalítica desde la perspectiva de los procesos de producción de información. Se establecen los antecedentes y las formas de clasificación de los metanálisis. Se estudia cada una de las 6 etapas por las que transcurre la investigación metanalítica, a saber: formulación del problema, búsqueda de la literatura, codificación de los estudios, medida de los resultados, análisis e interpretación y publicación del informe final. Se exponen los diferentes tipos de sesgos que pueden perjudicar la calidad de la revisión metanalítica y se repasan los conceptos estadísticos necesarios para la correcta comprensión de esta clase de estudios.

Aimed at the development of the Medical Virtual Library of Holguin Province a preliminary diagnosis of existing conditions was carried out. The main concepts related to the virtual library are exposed, institutions with a higher scientific potential in health care areas are identified as well as the products and information services that can be moved to the web. The strategy to the introduction of the virtual library is provided as well as its extension to the different institutions of the Health Care System of the province. Finally, some critical aspects for the success of this project are exposed.

A set of knowledge is expounded aimed at introducing the key concepts related to telecommunication networks among the information specialists, as a way to improve the librarian culture in the field of new information technologies. This knowledge will contribute decisively to a more efficient use of the National Health Care System networks, based on the progressive development of an electronic information infrastructure that will allow the contact among the communication sector professionals and the exchange with the international scientific community, as well as a convenient and timely access to information.

Endemic mycoses are systemic fungal infections. Histoplasmosis is endemic in all temperate areas of the world; coccidioidomycosis and paracoccidioidomycosis are only present in the American continent. These pathogens are not present in Spain, but in the last years there has been an increase of reported cases due to migration and temporary movements. We obtained from the Spanish hospitals records clinical and demographic data of all hospitalized cases between 1997 and 2014. There were 286 cases of histoplasmosis, 94 of Coccidioidomycosis and 25 of paracoccidioidomycosis. Overall, histoplasmosis was strongly related to HIV infection, as well as with greater morbidity and mortality. For the other mycoses, we did not find any immunosuppressive condition in most of the cases. Although we were not able to obtain data about clinical presentation of all the cases, the most frequently found was pulmonary involvement. We also found a temporal correlation between the Spanish population born in endemic countries and the number of hospitalized cases along this period. This study reflects the importance of imported diseases in non-endemic countries due to migratory movements., Author summary Histoplasmosis, coccidioidomycosis and paracoccidioidomycosis are infections produced by environmental fungi. Despite the fact that these pathogens are not found in Spain, these diseases are an important health problem in many countries of the world, especially in Latin America. Due to the increased migration from these countries in Spain in the last years, we have observed a rise in the number of new reported cases of these diseases. Nevertheless, they probably remain underestimated since it is likely that physicians do not initially suspect them, and their notification is not mandatory. People who travel to endemic countries are at risk to become infected as well. In this article we used data from the Spanish hospitals records with the aim to describe the main clinical and epidemiological characteristics of these endemic mycoses in Spain, and try to find a correlation between the growing Spanish population at risk and the number of cases hospitalized. This study contributes to have a more accurate knowledge about the burden of these diseases in Spain.

At the moment, with the exponential increase of the investigations and publications related to medical sciences and their compatible disciplines, it is practically impossible to use traditional methods of integration of the results obtained in the studies on a specific subject. In these methods, calls qualitative revisions, in which the integration method does not incorporate the use of formal statistical procedures, generally the revisory one takes each study by its value pretends and tries to find a theory that reconciles the contradictory results. On the other hand, Gene Glass, in 1976, proposed an integration method that uses the statistical tools in its analyses and to that it called metanálisis. The metanálisis (it puts, in Greek, after, and analisis, description, interpretation), consists of the statistical analysis of a great collection of extracted results of individual works in order to integrate the obtained results.

ObjectiveBicuspid aortic valve (BAV) is the most common congenital heart disease. This study aimed to determine the prevalence rate of BAV in first-degree relatives (FDR) and the inheritance pattern according to different morphotypes and aortic dilation.MethodsBAV probands were consecutively studied at eight tertiary referral centres. After sequential screening, FDR were included in the study. The BAV morphotype, aortic dilation and aortic phenotype were assessed by transthoracic echocardiography.ResultsSeven hundred and twenty-four FDR of 256 BAV probands agreed to undergo family screening. The prevalence of BAV was 6.4% in FDR (9.2% in men, 3.5% in women, p=0.002). Aortic dilation was diagnosed in 9.6% of FRD with tricuspid aortic valves (TAV), with a root phenotype in 2.7% and tubular in 6.9% and more frequently in the presence of arterial hypertension (OR 4.48; CI 95% 2.51 to 7.99; p=0.0001) and valvular regurgitation (OR 5.87, CI 95% 1.37 to 25.16; p=0.025). The heritability (h2) of BAV was highly significant (0.47; p=0.002); however, no concordance was observed among valve morphotypes. Aortic dilation heritability was not significant.ConclusionsThe BAV prevalence rate in FDR was low (6.4%) but aortic dilation was observed in 9.6% of FDR with TAV. The heritability of BAV was high without concordance in valve morphotypes, and aortic dilation heritability was not observed. Patients with BAV should be made aware of its familial pattern.