Javier Mariani - Academia.edu (original) (raw)
Papers by Javier Mariani
Revista Panamericana de Salud Pública, 2021
Objective. Evaluate primary health care functions from the perspective of patients with tuberculo... more Objective. Evaluate primary health care functions from the perspective of patients with tuberculosis from slums in the city of Buenos Aires, Argentina. Methods. Cross-sectional observational study with adult patients with tuberculosis (TB) and without TB (NoTB), living in slums (S) and outside them (NoS). Participants’ perceptions were evaluated using the Primary Care Assessment Tool for users (abbreviated version), which measures four main domains (first contact, ongoing care, coordination with specialists, and comprehensiveness) and selected secondary domains. A Likert scale was used, ranging from “No, not at all” (1 point) to “Yes, definitely” (4 points). Scores ≥ 3 were considered to indicate adequate performance of functions. Averages were calculated for each domain, as well as two overall scores: with and without secondary domains. Results. 83 participants were included (20 TB-S, 21 TB-NoS, 19 NoTB-S, and 23 NoTB-NoS). The evaluated functions were perceived as inadequate. The ...
American Journal of Physiology-Lung Cellular and Molecular Physiology, 2020
The COVID-19 pandemic has reached most of the countries worldwide causing death, which often resu... more The COVID-19 pandemic has reached most of the countries worldwide causing death, which often results from an inflammatory storm associated with severe acute respiratory syndrome (SARS). This has prompted researchers to seek specific novel and definitive treatments urgently. In this context, it is interesting to evaluate the preventive and therapeutic effects of existing pharmacological agents that could be useful. In this regard, vitamin D supplementation, particularly in individuals likely to be deficient, may be a promising option. Vitamin D is a hormone that modulates many of the same inflammatory and oxidative signaling pathways triggered during COVID-19. For example, vitamin D suppresses the actions of the renin-angiotensin system, which has a determining role in the pathophysiology of the inflammatory response related to COVID-19. This paper analyzes the evidence that vitamin D supplementation might be a valuable preventive/therapeutic measure in groups at risk for or infected...
Argentine Journal of Cardiology, 2017
Background: Interhospital transfer of critically ill patients is frequent in our country. However... more Background: Interhospital transfer of critically ill patients is frequent in our country. However, despite the existence of emergency medical transfer services both in public and private settings, no scientific publications have been generated regarding the transfer of critically ill patients to understand their operation, planning and results. Objective: The aim of this study was to describe the conditions of interhospital transfer of cardiovascular disease patients. Methods: This was an observational, prospective, multicenter design study, analyzing interhospital land transfer of patients admitted to a third level coronary care unit between April 2014 and April 2015. The transfer physician was surveyed. Complications related to hospital transfer and mortality were also recorded. Results: A total of 214 transfers were analyzed. Median transfer time was 30 minutes (IQR 18.5-50). Among all transfers, 16.1% of cases were considered to be at high risk, 71.2% at moderate risk and 12.7% ...
Journal of Clinical Oncology, 2020
4054 Background: NMASCC is a rising incidence disease with up to 30% of treatment failure to achi... more 4054 Background: NMASCC is a rising incidence disease with up to 30% of treatment failure to achieve complete response (CR) after standard chemoradiotherapy (CRT) leading to severe morbidity and death. Stage III-TNM, p53 mutations, HPV negativity, HIV infection are linked to treatment failure. We investigated the predictive/prognostic role of TNM, CR, HPV, PDL1 positivity and CD3/CD8 densities in NM-ASCC from a single institution. Methods: All 79 eligible consecutive NMASCC pts (available FFPE pre-treatment samples) seen from October-2009 to April-2019 having completed definitive CRT (50.4 Gy Pelvic Radiotherapy with Mitomycin-C 12mg/m2/IV/d1-5 / FU 1000mg/m2/d1-4 d29-32 (28%), Mitomycin-C/Capecitabine 825 mg/m2/bid (38%), Cisplatin 60 mg/m2/IV d1-29 and 5FU (34%) were analyzed. Mean age: 59 (range 26-87), 72% female, Stage III: 59%, HPV positive: 86% (HPV-16: 80%);14% HIV positive. IHC assessed by two pathologist for PD-L1 expression (ClonSP263) and CD3-CD8+ TILS densities (Clone 2...
Revista Argentina de Cardiologia, 2017
Journal of Clinical Oncology, 2018
e15533Background: In pts. with advanced CRC, KRAS mutations predicts response to treatment with E... more e15533Background: In pts. with advanced CRC, KRAS mutations predicts response to treatment with EGFR inhibitor. The Liver metastases selection criteria include anatomic and biological variables. Re...
Revista Argentina de Cardiología, 2016
Background: Although the relationship between premature death and socioeconomic status has been r... more Background: Although the relationship between premature death and socioeconomic status has been recently reported in Argentina, there are no analyses on the impact of this condition in different regions of the country. Objective: The aim of this study was to describe the influence of socioeconomic status on the incidence of premature death rate in different provinces of Argentina, from 2000 to 2010. Methods: An ecological model was used to evaluate standardized premature death rates (≤74 years) during the period between 2000 and 2010. In addition, the relationship between socioeconomic status, measured in deciles of unmet basic needs at geographic departmental level, and premature death was examined. The units of analysis were the 512 Argentine departments and the 15 communes of the city of Buenos Aires. Results: Socioeconomic status was significantly associated with premature death rate in Argentina during the study period. A linear gradient was observed between premature death and socioeconomic status in all provinces and regions. However, the slope index of inequality varied significantly between departments. While the absolute difference in standardized premature death rate between the extreme components of socioeconomic status was 10 deaths (range: 7.81-12.36) per 10,000 persons per year in all Argentina, in the city of Buenos Aires this difference was 61 deaths (range: 53-69). The Southern communes of Buenos Aires were the areas with the highest social and health inequalities of Argentina. Conclusions: Although social inequity had a significant impact on premature death rate throughout Argentina during the study period, the city of Buenos Aires was the most unequal region.
Revista Argentina de Cardiología, 2016
Introducción: Aunque recientemente se reportó la relación entre la muerte prematura y la condició... more Introducción: Aunque recientemente se reportó la relación entre la muerte prematura y la condición socioeconómica en la Argentina, no existen análisis sobre el impacto que dicha condición tiene en distintas regiones del país. Objetivo: Describir el impacto que la condición socioeconómica presentó sobre la incidencia de muerte prematura en las distintas provincias de la Argentina durante el período 2000-2010. Material y métodos: Se utilizó un modelo ecológico, que evaluó las tasas estandarizadas de muerte prematura (≤ 74 años) durante el período 2000-2010. Asimismo, se examinó la relación entre la condición socioeconómica medida en deciles de necesidades básicas insatisfechas por departamento geográfico y la muerte prematura. La unidad de análisis fueron los 512 departamentos de la Argentina y las 15 comunas de la ciudad de Buenos Aires. Resultados: La condición socioeconómica estuvo significativamente asociada con la muerte prematura en la Argentina durante el período analizado. En todas las provincias y regiones se observó un gradiente lineal entre la muerte precoz y la condición socioeconómica. Sin embargo, la pendiente de desigualdad entre los componentes de la condición socioeconómica varió significativamente entre los distintos departamentos. Mientras que en toda la Argentina la diferencia absoluta en la tasa estandarizada de muerte prematura entre los componentes extremos de condición socioeconómica fue de 10 muertes (rango: 7,81-12,36) por cada 10.000 personas por año, en la ciudad de Buenos Aires esa diferencia fue de 61 muertes (rango: 53-69). Las comunas del sur de la ciudad de Buenos Aires fueron las zonas con mayor desigualdad social y sanitaria de la Argentina. Conclusiones: Aunque la inequidad social tuvo un impacto significativo en la muerte prematura en todo el período en toda la Argentina, la ciudad de Buenos Aires se mostró como la región más desigual.
Revista Argentina de Cardiología, 2016
Introducción: Desde 2003, el programa Remediar (+Redes) distribuye gratuitamente medicación antih... more Introducción: Desde 2003, el programa Remediar (+Redes) distribuye gratuitamente medicación antihipertensiva. Durante este período, la mortalidad por accidente cerebrovascular disminuyó, aunque con inequidades entre grupos socioeconómicos. Objetivos: Evaluar la asociación entre la mortalidad por accidente cerebrovascular y la provisión de fármacos antihipertensivos. Estudiar la posible interacción entre los efectos de los antihipertensivos sobre la mortalidad y el nivel socioeconómico. Material y métodos: Se realizó un estudio ecológico para datos de panel. La mortalidad se expresa como tasas estandarizadas. Los fármacos antihipertensivos están ajustados a la población entre la que se distribuyeron y se expresan en cuartiles de dispensación. El nivel socioeconómico se midió por las necesidades básicas insatisfechas. Resultados: Desde el inicio del programa en 2003, la distribución de antihipertensivos aumentó significativamente, sobre todo en los grupos menos afluentes (p < 0,001). No hubo una asociación estadísticamente significativa entre la tasa de dispensación de antihipertensivos y la mortalidad por accidente cerebrovascular globalmente. Sin embargo, en los análisis de interacción se observó que en los quintiles 3 a 5 de necesidades básicas insatisfechas (menos afluentes), los cuartiles en los que se distribuyeron más antihipertensivos tuvieron significativamente menor mortalidad por accidente cerebrovascular (p = 0,004, p = 0,015 y p = 0,017, para los quintiles 3 a 5 de nivel socioeconómico). Conclusiones: Los resultados del presente análisis sugieren la ausencia de efectos globales de la provisión de antihipertensivos sobre la mortalidad por accidente cerebrovascular. Sin embargo, los datos muestran que, entre los grupos más desfavorecidos, la distribución de antihipertensivos estuvo asociada con una reducción de la mortalidad por esta causa.
Revista argentina de cardiología
Introduction Between 20% and 30% of persons present syncope throughout their lives and reflex syn... more Introduction Between 20% and 30% of persons present syncope throughout their lives and reflex syncope represents the most common cause. The differential diagnosis of syncope is based on the characteristics of the episode and on the reproducibility of symptoms with the head-up tilt test. Yet, as tilt test has important limitations, we began exploring a new parameter in successive stages of investigation, which we called "delay of the carotid pulse wave". Objectives To present the results of the investigation about the discovery, development and clinical applicability of the parameter: "delay of the carotid pulse wave", capable of identifying patients with reflex syncope. Methods The development of the idea and the results of the analysis of the correlation between the parameter and the tilt test evaluated in a pilot study of 43 patients with syncope are described. The correlation is confirmed in 100 patients with syncope and in controls; the pathophysiological mec...
Journal of the American Heart Association, Jan 19, 2013
Previous studies have suggested that n-3 polyunsaturated fatty acids (n-3 PUFAs) have antiarrhyth... more Previous studies have suggested that n-3 polyunsaturated fatty acids (n-3 PUFAs) have antiarrhythmic effects on atrial fibrillation (AF). We aimed to assess the effects of therapy with n-3 PUFAs on the incidence of recurrent AF and on postoperative AF. Electronic searches were conducted in Web of Science, Medline, Biological Abstracts, Journal Citation Reports, and the Cochrane Central Register of Controlled Trials databases. In addition, data from the recently completed FORωARD and OPERA trials were included. We included randomized controlled trials comparing treatment with n-3 PUFAs versus control to (1) prevent recurrent AF in patients who underwent reversion of AF or (2) prevent incident postoperative AF after cardiac surgery. Of identified studies, 12.9% (16 of 124) were included, providing data on 4677 patients. Eight studies (1990 patients) evaluated n-3 PUFA effects on AF recurrence among patients with reverted AF and 8 trials (2687 patients) on postoperative AF. Pooled risk...
Reviews on Recent Clinical Trials, 2011
Background: The impact of treatment with vasodilators on the survival of patients with pulmonary ... more Background: The impact of treatment with vasodilators on the survival of patients with pulmonary arterial hypertension (PAH) remains uncertain. Despite several clinical trials have been carried out in the last 15 years, their primary objective was not to assess mortality but the changes on surrogate end points. Methods and results: We reviewed the results of all clinical trials with vasodilators in PAH and the main results of different metaanalysis. Clinical trials and systematic reviews confirm that vasodilator therapies in patients with PAH who are non-vasoreactive produce a consistent, statistically significant but a marginal effect on exercise capacity assessed by the six-minute walk test. The weighted mean difference (95% CI) achieved with epoprostenol (EPO) or other prostacyclin analogues (PCA), endothelin receptor antagonists (ETRA) and phosphodiesterase-type-5 inhibitors (PDE5-I) was 35.4 m (17.3-53.5), 46.1 m (38.1-54.2) and 33.8 m (24.8-42.7), respectively. When considering the cumulative effects within each drug family, no class of drug produced a statistically significant reduction in all cause mortality. The relative risk rates (95% CI) conferred by EPO or PCA, ETRA and PDE5-I were 0.66 (0.36-1.21), 0.48 (0.19-1.23) and 0.65 (0.16-2.67), respectively. Interpretation: Further trials utilizing similar classes of drugs, and following similar trial designs are unlikely to yield different results or offer any more clinical benefits. Given that PAH is a fatal disease this raises concerns about whether they are ethical to conduct or not. Future trials will need to utilize clinical endpoints rather than the ones that are easy to administer and will need to include longer durations of study and other strategies to test the durability of effect.
European Journal of Clinical Pharmacology, 2015
Recent guidelines expand indications for statins. However, research on practical economic feasibi... more Recent guidelines expand indications for statins. However, research on practical economic feasibility and cost-effectiveness in low-risk people is lacking. We aimed to describe the incidence of cardiovascular events (CVE), their total direct costs and the hypothetical effects of wide provision of statins on those rates and expenditures. We conducted a population-based cohort study using administrative data among low risk individuals. Estimators of effects of statins were taken from Cholesterol Treatment trialist metaanalysis and from Heart Protection Study trial. Two statin prices were used for analyses: National Italian Health System (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.36) and the International Drug Price Indicator (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.021). Overall, 920,067 persons at low risk were identified and 14,849 CVE were registered (incidence rate 27.3 per 10,000 person-years). Direct costs for hospitalizations for CVE were 143 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;. Universal provision of statins would result in a significant decrease in CVE rates, from 27.3 to 17.5 per 10,000 person-years (PY) (95 % confidence interval (CI): 15.8-19.4). Universal prescription of simvastatin 20 mg would cost 802 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;. Otherwise, provision of simvastatin at International Drug Price Indicator&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s prices would be both clinically effective and cost saving in men older than age 44 (observed expenditures 120 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;, expected 97.4 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;) but not in women (observed expenditures 22.7 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;, expected 36.5 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;). Among a low-risk population, hypothetical universal provision of low-cost simvastatin to men over 44 years could be both clinically effective and a cost-saving strategy.
Revista Argentina de Cardiología, 2013
Infarto del miocardio-Angioplastia coronaria-Fibrinolíticos-Registro ATCP Angioplastia primaria I... more Infarto del miocardio-Angioplastia coronaria-Fibrinolíticos-Registro ATCP Angioplastia primaria IAM Infarto agudo de miocardio ECG Electrocardiograma RIQ Rango intercuartil FL Fibrinolíticos SCA Síndrome coronario agudo
European Journal of Clinical Investigation, 2015
Background Postoperative atrial fibrillation (POAF) is a common complication after cardiac surger... more Background Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and predicts increased morbidity and mortality. Identification of patients at high risk of POAF with the help of circulating biomarkers may enable early preventive treatment but data are limited, especially in contemporary surgical patients. Methods Plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured at enrolment, on the morning of cardiac surgery, at end surgery, and 2 days postsurgery in 562 patients undergoing cardiac surgery, randomized to perioperative supplementation with oral fish oil or placebo in the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation trial (OPERA). The primary endpoint was incident POAF lasting ≥ 30 s, centrally adjudicated and confirmed electrocardiographically. Results Higher levels of NT-proBNP and hs-cTnT before surgery were associated with older age, renal or cardiac dysfunction and EuroSCORE. NT-proBNP peaked on postoperative day 2 (2172 [1238-3758] ng/L, median [Q1-Q3]), while hs-cTnT peaked at the end of surgery (373 [188-660] ng/L). Fish oil supplementation did not alter the time course of the cardiac biomarkers (P > 0Á05). Concentrations of NT-proBNP or hs-cTnT, on the morning of surgery, or changes in their level between morning of surgery and postsurgery, were not significantly associated with POAF after adjustment for clinical and surgical characteristics. Conclusion Among patients undergoing cardiac surgery, NT-proBNP and hs-cTnT are related to clinical and surgical characteristics, have different perioperative time courses but are not independently associated with risk of POAF.
Revista Argentina de Cardiología, 2013
Síndromes coronarios agudos-Género-Cardiopatía isquémica-Mujeres IAM Infarto agudo de miocardio S... more Síndromes coronarios agudos-Género-Cardiopatía isquémica-Mujeres IAM Infarto agudo de miocardio SCA-SSTE Síndrome coronario agudo sin SCA Síndrome coronario agudo segmento ST elevado
Revista Argentina de Cardiología, 2013
Introducción: Una particularidad de los síndromes coronarios agudos (SCA) es que su distribución ... more Introducción: Una particularidad de los síndromes coronarios agudos (SCA) es que su distribución impresiona tener aspectos cronobiológicos, ya que no se mantiene estable a lo largo del año y varía incluso según el día de la semana y la hora del día. No tenemos conocimiento de evidencia publicada acerca de la distribución de los casos de SCA acorde al día de la semana en nuestro país, por lo que se ignora si sigue un patrón determinado y cuáles podrían ser las variables asociadas. Objetivo: Analizar la distribución diaria de los casos de SCA y las eventuales diferencias en el tratamiento y la evolución clínica de los pacientes. Material y métodos: Se estudió el número y la evolución de SCA sin ST elevado (SCA no-STE, n = 6.277) y con ST elevado al ingreso (SCA-STE, n = 4.237) acorde al día de la semana mediante el análisis del registro Epi-Cardio 2006-2012. Resultados: La frecuencia fue mayor en los primeros días de la semana, descendiendo durante el fin de semana (global y SCA no-STE: p < 0,001; SCA-STE: p < 0,01), sin relación con la edad y el sexo. En los SCA-STE, la indicación y el tipo de reperfusión no tuvieron diferencias según el día de la semana. Conclusiones: La frecuencia de internaciones por SCA es mayor en los primeros días laborables y menor los fines de semana, sin diferencias en el uso de recursos complejos ni en la evolución inicial.
Molecular and Clinical Oncology, 2014
Neuroendocrine tumors (NET) include a spectrum of malignancies arising from neuroendocrine cells ... more Neuroendocrine tumors (NET) include a spectrum of malignancies arising from neuroendocrine cells throughout the body. The objective of this clinical investigation of retrospectively and prospectively collected data was to describe the prevalence, demographic data, clinical symptoms and methods of diagnosis of NET and the treatment and long-term follow-up of patients with NET. Data were provided by the participating centers and assessed for consistency by internal reviewers. All the cases were centrally evaluated (when necessary) by the pathologists in our group. The tissue samples were reviewed by hematoxylin and eosin and immunohistochemical staining techniques to confirm the diagnosis of NET. In total, 532 cases were documented: 461 gastroenteropancreatic-NET (GEP-NET) and 71 bronchial NET (BNET). All the tumors were immunohistochemically defined according to the World Health Organization (WHO) and European Neuroendocrine Tumor Society criteria. The most common initial symptoms in GEP-NET were abdominal pain, diarrhea, bowel obstruction, flushing, gastrointestinal bleeding and weight loss. The most common tumor types were carcinoid (58.0%), non-functional pancreatic tumor (23.0%), metastatic NET of unknown primary (16.0%) and functional pancreatic tumor (3.0%). Of the BNET, 89.0% were typical and 11.0% atypical carcinoids. Of the patients with GEP-NET, 59.2% had distant metastasis at diagnosis. The locations of the primary tumors in GEP-NET were the small bowel (26.9%), pancreas (25.2%), colon-rectum (12.4%), appendix (7.6%), stomach (6.9%), esophagus (2.8%), duodenum (2.0%) and unknown primary (16.3%). The histological subtypes based on the WHO classification were well-differentiated NET (20.1%), well-differentiated neuroendocrine carcinomas (66.5%) and poorly differentiated neuroendocrine carcinomas (10.3%). Overall, 67.3% of the patients underwent surgery, 41.2% with curative intent and 26.1% for palliative purposes. The 5-year survival rates were 65.1% (95% confidence interval, 58.0-71.4%) in GEP-NET and 100.0% in typical carcinoid of the lung. This observational, non-interventional, longitudinal study aimed to accumulate relevant information regarding the epidemiology, clinical presentation and current practices in the treatment of NET patients in Argentina, providing insight into regional differences and patterns of care in this heterogeneous disease.
Journal of the American College of Cardiology, 2011
Expert Review of Cardiovascular Therapy, 2009
In patients with heart failure, anemia is highly prevalent and associated with impaired outcomes.... more In patients with heart failure, anemia is highly prevalent and associated with impaired outcomes. These clinical observations necessitate the realization of pharmacologic interventions to mitigate the effects of anemia and a number of available agents are being tested in large, randomized clinical trials. However, from the pathophysiologic point of view, anemia is multifactorial and difficult to attribute to a single mechanism. Moreover, classic indicators for the identification of etiology and pathways have been found to be less accurate than expected. For these reasons future clinical trials must be designed to be able to elucidate the complexity of mechanisms and the implications for treatment strategies.
Revista Panamericana de Salud Pública, 2021
Objective. Evaluate primary health care functions from the perspective of patients with tuberculo... more Objective. Evaluate primary health care functions from the perspective of patients with tuberculosis from slums in the city of Buenos Aires, Argentina. Methods. Cross-sectional observational study with adult patients with tuberculosis (TB) and without TB (NoTB), living in slums (S) and outside them (NoS). Participants’ perceptions were evaluated using the Primary Care Assessment Tool for users (abbreviated version), which measures four main domains (first contact, ongoing care, coordination with specialists, and comprehensiveness) and selected secondary domains. A Likert scale was used, ranging from “No, not at all” (1 point) to “Yes, definitely” (4 points). Scores ≥ 3 were considered to indicate adequate performance of functions. Averages were calculated for each domain, as well as two overall scores: with and without secondary domains. Results. 83 participants were included (20 TB-S, 21 TB-NoS, 19 NoTB-S, and 23 NoTB-NoS). The evaluated functions were perceived as inadequate. The ...
American Journal of Physiology-Lung Cellular and Molecular Physiology, 2020
The COVID-19 pandemic has reached most of the countries worldwide causing death, which often resu... more The COVID-19 pandemic has reached most of the countries worldwide causing death, which often results from an inflammatory storm associated with severe acute respiratory syndrome (SARS). This has prompted researchers to seek specific novel and definitive treatments urgently. In this context, it is interesting to evaluate the preventive and therapeutic effects of existing pharmacological agents that could be useful. In this regard, vitamin D supplementation, particularly in individuals likely to be deficient, may be a promising option. Vitamin D is a hormone that modulates many of the same inflammatory and oxidative signaling pathways triggered during COVID-19. For example, vitamin D suppresses the actions of the renin-angiotensin system, which has a determining role in the pathophysiology of the inflammatory response related to COVID-19. This paper analyzes the evidence that vitamin D supplementation might be a valuable preventive/therapeutic measure in groups at risk for or infected...
Argentine Journal of Cardiology, 2017
Background: Interhospital transfer of critically ill patients is frequent in our country. However... more Background: Interhospital transfer of critically ill patients is frequent in our country. However, despite the existence of emergency medical transfer services both in public and private settings, no scientific publications have been generated regarding the transfer of critically ill patients to understand their operation, planning and results. Objective: The aim of this study was to describe the conditions of interhospital transfer of cardiovascular disease patients. Methods: This was an observational, prospective, multicenter design study, analyzing interhospital land transfer of patients admitted to a third level coronary care unit between April 2014 and April 2015. The transfer physician was surveyed. Complications related to hospital transfer and mortality were also recorded. Results: A total of 214 transfers were analyzed. Median transfer time was 30 minutes (IQR 18.5-50). Among all transfers, 16.1% of cases were considered to be at high risk, 71.2% at moderate risk and 12.7% ...
Journal of Clinical Oncology, 2020
4054 Background: NMASCC is a rising incidence disease with up to 30% of treatment failure to achi... more 4054 Background: NMASCC is a rising incidence disease with up to 30% of treatment failure to achieve complete response (CR) after standard chemoradiotherapy (CRT) leading to severe morbidity and death. Stage III-TNM, p53 mutations, HPV negativity, HIV infection are linked to treatment failure. We investigated the predictive/prognostic role of TNM, CR, HPV, PDL1 positivity and CD3/CD8 densities in NM-ASCC from a single institution. Methods: All 79 eligible consecutive NMASCC pts (available FFPE pre-treatment samples) seen from October-2009 to April-2019 having completed definitive CRT (50.4 Gy Pelvic Radiotherapy with Mitomycin-C 12mg/m2/IV/d1-5 / FU 1000mg/m2/d1-4 d29-32 (28%), Mitomycin-C/Capecitabine 825 mg/m2/bid (38%), Cisplatin 60 mg/m2/IV d1-29 and 5FU (34%) were analyzed. Mean age: 59 (range 26-87), 72% female, Stage III: 59%, HPV positive: 86% (HPV-16: 80%);14% HIV positive. IHC assessed by two pathologist for PD-L1 expression (ClonSP263) and CD3-CD8+ TILS densities (Clone 2...
Revista Argentina de Cardiologia, 2017
Journal of Clinical Oncology, 2018
e15533Background: In pts. with advanced CRC, KRAS mutations predicts response to treatment with E... more e15533Background: In pts. with advanced CRC, KRAS mutations predicts response to treatment with EGFR inhibitor. The Liver metastases selection criteria include anatomic and biological variables. Re...
Revista Argentina de Cardiología, 2016
Background: Although the relationship between premature death and socioeconomic status has been r... more Background: Although the relationship between premature death and socioeconomic status has been recently reported in Argentina, there are no analyses on the impact of this condition in different regions of the country. Objective: The aim of this study was to describe the influence of socioeconomic status on the incidence of premature death rate in different provinces of Argentina, from 2000 to 2010. Methods: An ecological model was used to evaluate standardized premature death rates (≤74 years) during the period between 2000 and 2010. In addition, the relationship between socioeconomic status, measured in deciles of unmet basic needs at geographic departmental level, and premature death was examined. The units of analysis were the 512 Argentine departments and the 15 communes of the city of Buenos Aires. Results: Socioeconomic status was significantly associated with premature death rate in Argentina during the study period. A linear gradient was observed between premature death and socioeconomic status in all provinces and regions. However, the slope index of inequality varied significantly between departments. While the absolute difference in standardized premature death rate between the extreme components of socioeconomic status was 10 deaths (range: 7.81-12.36) per 10,000 persons per year in all Argentina, in the city of Buenos Aires this difference was 61 deaths (range: 53-69). The Southern communes of Buenos Aires were the areas with the highest social and health inequalities of Argentina. Conclusions: Although social inequity had a significant impact on premature death rate throughout Argentina during the study period, the city of Buenos Aires was the most unequal region.
Revista Argentina de Cardiología, 2016
Introducción: Aunque recientemente se reportó la relación entre la muerte prematura y la condició... more Introducción: Aunque recientemente se reportó la relación entre la muerte prematura y la condición socioeconómica en la Argentina, no existen análisis sobre el impacto que dicha condición tiene en distintas regiones del país. Objetivo: Describir el impacto que la condición socioeconómica presentó sobre la incidencia de muerte prematura en las distintas provincias de la Argentina durante el período 2000-2010. Material y métodos: Se utilizó un modelo ecológico, que evaluó las tasas estandarizadas de muerte prematura (≤ 74 años) durante el período 2000-2010. Asimismo, se examinó la relación entre la condición socioeconómica medida en deciles de necesidades básicas insatisfechas por departamento geográfico y la muerte prematura. La unidad de análisis fueron los 512 departamentos de la Argentina y las 15 comunas de la ciudad de Buenos Aires. Resultados: La condición socioeconómica estuvo significativamente asociada con la muerte prematura en la Argentina durante el período analizado. En todas las provincias y regiones se observó un gradiente lineal entre la muerte precoz y la condición socioeconómica. Sin embargo, la pendiente de desigualdad entre los componentes de la condición socioeconómica varió significativamente entre los distintos departamentos. Mientras que en toda la Argentina la diferencia absoluta en la tasa estandarizada de muerte prematura entre los componentes extremos de condición socioeconómica fue de 10 muertes (rango: 7,81-12,36) por cada 10.000 personas por año, en la ciudad de Buenos Aires esa diferencia fue de 61 muertes (rango: 53-69). Las comunas del sur de la ciudad de Buenos Aires fueron las zonas con mayor desigualdad social y sanitaria de la Argentina. Conclusiones: Aunque la inequidad social tuvo un impacto significativo en la muerte prematura en todo el período en toda la Argentina, la ciudad de Buenos Aires se mostró como la región más desigual.
Revista Argentina de Cardiología, 2016
Introducción: Desde 2003, el programa Remediar (+Redes) distribuye gratuitamente medicación antih... more Introducción: Desde 2003, el programa Remediar (+Redes) distribuye gratuitamente medicación antihipertensiva. Durante este período, la mortalidad por accidente cerebrovascular disminuyó, aunque con inequidades entre grupos socioeconómicos. Objetivos: Evaluar la asociación entre la mortalidad por accidente cerebrovascular y la provisión de fármacos antihipertensivos. Estudiar la posible interacción entre los efectos de los antihipertensivos sobre la mortalidad y el nivel socioeconómico. Material y métodos: Se realizó un estudio ecológico para datos de panel. La mortalidad se expresa como tasas estandarizadas. Los fármacos antihipertensivos están ajustados a la población entre la que se distribuyeron y se expresan en cuartiles de dispensación. El nivel socioeconómico se midió por las necesidades básicas insatisfechas. Resultados: Desde el inicio del programa en 2003, la distribución de antihipertensivos aumentó significativamente, sobre todo en los grupos menos afluentes (p < 0,001). No hubo una asociación estadísticamente significativa entre la tasa de dispensación de antihipertensivos y la mortalidad por accidente cerebrovascular globalmente. Sin embargo, en los análisis de interacción se observó que en los quintiles 3 a 5 de necesidades básicas insatisfechas (menos afluentes), los cuartiles en los que se distribuyeron más antihipertensivos tuvieron significativamente menor mortalidad por accidente cerebrovascular (p = 0,004, p = 0,015 y p = 0,017, para los quintiles 3 a 5 de nivel socioeconómico). Conclusiones: Los resultados del presente análisis sugieren la ausencia de efectos globales de la provisión de antihipertensivos sobre la mortalidad por accidente cerebrovascular. Sin embargo, los datos muestran que, entre los grupos más desfavorecidos, la distribución de antihipertensivos estuvo asociada con una reducción de la mortalidad por esta causa.
Revista argentina de cardiología
Introduction Between 20% and 30% of persons present syncope throughout their lives and reflex syn... more Introduction Between 20% and 30% of persons present syncope throughout their lives and reflex syncope represents the most common cause. The differential diagnosis of syncope is based on the characteristics of the episode and on the reproducibility of symptoms with the head-up tilt test. Yet, as tilt test has important limitations, we began exploring a new parameter in successive stages of investigation, which we called "delay of the carotid pulse wave". Objectives To present the results of the investigation about the discovery, development and clinical applicability of the parameter: "delay of the carotid pulse wave", capable of identifying patients with reflex syncope. Methods The development of the idea and the results of the analysis of the correlation between the parameter and the tilt test evaluated in a pilot study of 43 patients with syncope are described. The correlation is confirmed in 100 patients with syncope and in controls; the pathophysiological mec...
Journal of the American Heart Association, Jan 19, 2013
Previous studies have suggested that n-3 polyunsaturated fatty acids (n-3 PUFAs) have antiarrhyth... more Previous studies have suggested that n-3 polyunsaturated fatty acids (n-3 PUFAs) have antiarrhythmic effects on atrial fibrillation (AF). We aimed to assess the effects of therapy with n-3 PUFAs on the incidence of recurrent AF and on postoperative AF. Electronic searches were conducted in Web of Science, Medline, Biological Abstracts, Journal Citation Reports, and the Cochrane Central Register of Controlled Trials databases. In addition, data from the recently completed FORωARD and OPERA trials were included. We included randomized controlled trials comparing treatment with n-3 PUFAs versus control to (1) prevent recurrent AF in patients who underwent reversion of AF or (2) prevent incident postoperative AF after cardiac surgery. Of identified studies, 12.9% (16 of 124) were included, providing data on 4677 patients. Eight studies (1990 patients) evaluated n-3 PUFA effects on AF recurrence among patients with reverted AF and 8 trials (2687 patients) on postoperative AF. Pooled risk...
Reviews on Recent Clinical Trials, 2011
Background: The impact of treatment with vasodilators on the survival of patients with pulmonary ... more Background: The impact of treatment with vasodilators on the survival of patients with pulmonary arterial hypertension (PAH) remains uncertain. Despite several clinical trials have been carried out in the last 15 years, their primary objective was not to assess mortality but the changes on surrogate end points. Methods and results: We reviewed the results of all clinical trials with vasodilators in PAH and the main results of different metaanalysis. Clinical trials and systematic reviews confirm that vasodilator therapies in patients with PAH who are non-vasoreactive produce a consistent, statistically significant but a marginal effect on exercise capacity assessed by the six-minute walk test. The weighted mean difference (95% CI) achieved with epoprostenol (EPO) or other prostacyclin analogues (PCA), endothelin receptor antagonists (ETRA) and phosphodiesterase-type-5 inhibitors (PDE5-I) was 35.4 m (17.3-53.5), 46.1 m (38.1-54.2) and 33.8 m (24.8-42.7), respectively. When considering the cumulative effects within each drug family, no class of drug produced a statistically significant reduction in all cause mortality. The relative risk rates (95% CI) conferred by EPO or PCA, ETRA and PDE5-I were 0.66 (0.36-1.21), 0.48 (0.19-1.23) and 0.65 (0.16-2.67), respectively. Interpretation: Further trials utilizing similar classes of drugs, and following similar trial designs are unlikely to yield different results or offer any more clinical benefits. Given that PAH is a fatal disease this raises concerns about whether they are ethical to conduct or not. Future trials will need to utilize clinical endpoints rather than the ones that are easy to administer and will need to include longer durations of study and other strategies to test the durability of effect.
European Journal of Clinical Pharmacology, 2015
Recent guidelines expand indications for statins. However, research on practical economic feasibi... more Recent guidelines expand indications for statins. However, research on practical economic feasibility and cost-effectiveness in low-risk people is lacking. We aimed to describe the incidence of cardiovascular events (CVE), their total direct costs and the hypothetical effects of wide provision of statins on those rates and expenditures. We conducted a population-based cohort study using administrative data among low risk individuals. Estimators of effects of statins were taken from Cholesterol Treatment trialist metaanalysis and from Heart Protection Study trial. Two statin prices were used for analyses: National Italian Health System (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.36) and the International Drug Price Indicator (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.021). Overall, 920,067 persons at low risk were identified and 14,849 CVE were registered (incidence rate 27.3 per 10,000 person-years). Direct costs for hospitalizations for CVE were 143 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;. Universal provision of statins would result in a significant decrease in CVE rates, from 27.3 to 17.5 per 10,000 person-years (PY) (95 % confidence interval (CI): 15.8-19.4). Universal prescription of simvastatin 20 mg would cost 802 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;. Otherwise, provision of simvastatin at International Drug Price Indicator&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s prices would be both clinically effective and cost saving in men older than age 44 (observed expenditures 120 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;, expected 97.4 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;) but not in women (observed expenditures 22.7 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;, expected 36.5 M &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;). Among a low-risk population, hypothetical universal provision of low-cost simvastatin to men over 44 years could be both clinically effective and a cost-saving strategy.
Revista Argentina de Cardiología, 2013
Infarto del miocardio-Angioplastia coronaria-Fibrinolíticos-Registro ATCP Angioplastia primaria I... more Infarto del miocardio-Angioplastia coronaria-Fibrinolíticos-Registro ATCP Angioplastia primaria IAM Infarto agudo de miocardio ECG Electrocardiograma RIQ Rango intercuartil FL Fibrinolíticos SCA Síndrome coronario agudo
European Journal of Clinical Investigation, 2015
Background Postoperative atrial fibrillation (POAF) is a common complication after cardiac surger... more Background Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and predicts increased morbidity and mortality. Identification of patients at high risk of POAF with the help of circulating biomarkers may enable early preventive treatment but data are limited, especially in contemporary surgical patients. Methods Plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured at enrolment, on the morning of cardiac surgery, at end surgery, and 2 days postsurgery in 562 patients undergoing cardiac surgery, randomized to perioperative supplementation with oral fish oil or placebo in the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation trial (OPERA). The primary endpoint was incident POAF lasting ≥ 30 s, centrally adjudicated and confirmed electrocardiographically. Results Higher levels of NT-proBNP and hs-cTnT before surgery were associated with older age, renal or cardiac dysfunction and EuroSCORE. NT-proBNP peaked on postoperative day 2 (2172 [1238-3758] ng/L, median [Q1-Q3]), while hs-cTnT peaked at the end of surgery (373 [188-660] ng/L). Fish oil supplementation did not alter the time course of the cardiac biomarkers (P > 0Á05). Concentrations of NT-proBNP or hs-cTnT, on the morning of surgery, or changes in their level between morning of surgery and postsurgery, were not significantly associated with POAF after adjustment for clinical and surgical characteristics. Conclusion Among patients undergoing cardiac surgery, NT-proBNP and hs-cTnT are related to clinical and surgical characteristics, have different perioperative time courses but are not independently associated with risk of POAF.
Revista Argentina de Cardiología, 2013
Síndromes coronarios agudos-Género-Cardiopatía isquémica-Mujeres IAM Infarto agudo de miocardio S... more Síndromes coronarios agudos-Género-Cardiopatía isquémica-Mujeres IAM Infarto agudo de miocardio SCA-SSTE Síndrome coronario agudo sin SCA Síndrome coronario agudo segmento ST elevado
Revista Argentina de Cardiología, 2013
Introducción: Una particularidad de los síndromes coronarios agudos (SCA) es que su distribución ... more Introducción: Una particularidad de los síndromes coronarios agudos (SCA) es que su distribución impresiona tener aspectos cronobiológicos, ya que no se mantiene estable a lo largo del año y varía incluso según el día de la semana y la hora del día. No tenemos conocimiento de evidencia publicada acerca de la distribución de los casos de SCA acorde al día de la semana en nuestro país, por lo que se ignora si sigue un patrón determinado y cuáles podrían ser las variables asociadas. Objetivo: Analizar la distribución diaria de los casos de SCA y las eventuales diferencias en el tratamiento y la evolución clínica de los pacientes. Material y métodos: Se estudió el número y la evolución de SCA sin ST elevado (SCA no-STE, n = 6.277) y con ST elevado al ingreso (SCA-STE, n = 4.237) acorde al día de la semana mediante el análisis del registro Epi-Cardio 2006-2012. Resultados: La frecuencia fue mayor en los primeros días de la semana, descendiendo durante el fin de semana (global y SCA no-STE: p < 0,001; SCA-STE: p < 0,01), sin relación con la edad y el sexo. En los SCA-STE, la indicación y el tipo de reperfusión no tuvieron diferencias según el día de la semana. Conclusiones: La frecuencia de internaciones por SCA es mayor en los primeros días laborables y menor los fines de semana, sin diferencias en el uso de recursos complejos ni en la evolución inicial.
Molecular and Clinical Oncology, 2014
Neuroendocrine tumors (NET) include a spectrum of malignancies arising from neuroendocrine cells ... more Neuroendocrine tumors (NET) include a spectrum of malignancies arising from neuroendocrine cells throughout the body. The objective of this clinical investigation of retrospectively and prospectively collected data was to describe the prevalence, demographic data, clinical symptoms and methods of diagnosis of NET and the treatment and long-term follow-up of patients with NET. Data were provided by the participating centers and assessed for consistency by internal reviewers. All the cases were centrally evaluated (when necessary) by the pathologists in our group. The tissue samples were reviewed by hematoxylin and eosin and immunohistochemical staining techniques to confirm the diagnosis of NET. In total, 532 cases were documented: 461 gastroenteropancreatic-NET (GEP-NET) and 71 bronchial NET (BNET). All the tumors were immunohistochemically defined according to the World Health Organization (WHO) and European Neuroendocrine Tumor Society criteria. The most common initial symptoms in GEP-NET were abdominal pain, diarrhea, bowel obstruction, flushing, gastrointestinal bleeding and weight loss. The most common tumor types were carcinoid (58.0%), non-functional pancreatic tumor (23.0%), metastatic NET of unknown primary (16.0%) and functional pancreatic tumor (3.0%). Of the BNET, 89.0% were typical and 11.0% atypical carcinoids. Of the patients with GEP-NET, 59.2% had distant metastasis at diagnosis. The locations of the primary tumors in GEP-NET were the small bowel (26.9%), pancreas (25.2%), colon-rectum (12.4%), appendix (7.6%), stomach (6.9%), esophagus (2.8%), duodenum (2.0%) and unknown primary (16.3%). The histological subtypes based on the WHO classification were well-differentiated NET (20.1%), well-differentiated neuroendocrine carcinomas (66.5%) and poorly differentiated neuroendocrine carcinomas (10.3%). Overall, 67.3% of the patients underwent surgery, 41.2% with curative intent and 26.1% for palliative purposes. The 5-year survival rates were 65.1% (95% confidence interval, 58.0-71.4%) in GEP-NET and 100.0% in typical carcinoid of the lung. This observational, non-interventional, longitudinal study aimed to accumulate relevant information regarding the epidemiology, clinical presentation and current practices in the treatment of NET patients in Argentina, providing insight into regional differences and patterns of care in this heterogeneous disease.
Journal of the American College of Cardiology, 2011
Expert Review of Cardiovascular Therapy, 2009
In patients with heart failure, anemia is highly prevalent and associated with impaired outcomes.... more In patients with heart failure, anemia is highly prevalent and associated with impaired outcomes. These clinical observations necessitate the realization of pharmacologic interventions to mitigate the effects of anemia and a number of available agents are being tested in large, randomized clinical trials. However, from the pathophysiologic point of view, anemia is multifactorial and difficult to attribute to a single mechanism. Moreover, classic indicators for the identification of etiology and pathways have been found to be less accurate than expected. For these reasons future clinical trials must be designed to be able to elucidate the complexity of mechanisms and the implications for treatment strategies.