Juan Villar - Academia.edu (original) (raw)
Papers by Juan Villar
International Journal of Epidemiology, 2001
Chagas' disease is a chronic disease caused by the parasite Trypanosoma cruzi, which is transmitt... more Chagas' disease is a chronic disease caused by the parasite Trypanosoma cruzi, which is transmitted by a triatomine bug and also by blood transfusion and transplacentally. The infection may cause an acute self-limited disease, which evolves to a symptomless period. Several years after infection about 30% of individuals present clinical evidence of heart disease, and around 8% develop megavisceras. 1 It is estimated that 16-18 million people are currently infected in South and Central America. 2 Infection is thought to be lifelong though detection of parasitaemia during the chronic phase is very difficult. 3 Thus, its diagnosis is based mainly on the detection of serum antibodies to T. cruzi using serological tests. 4 The effect of treatment during the chronic phase is controversial. Early clinical trials did not show any effect of treatment in preventing the development of chronic Chagas' disease in adults. More recent findings suggest that treatment may be effective in producing negative seroconversion of specific antibodies in schoolchildren treated during the first year of infection. 1 The Chagas' Disease Control Programme in Brazil is based on control of the triatomine bug. This programme began on a national scale in the mid-1970s and mortality and hospitalizations due to Chagas' disease have been declining since then. 5 In addition,
The New England journal of medicine, Sep 26, 2018
Background We reported previously that, in patients undergoing cardiac surgery who were at modera... more Background We reported previously that, in patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive transfusion strategy was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis by hospital discharge or 28 days after surgery, whichever came first. We now report the clinical outcomes at 6 months after surgery. Methods We randomly assigned 5243 adults undergoing cardiac surgery to a restrictive red-cell transfusion strategy (transfusion if the hemoglobin concentration was <7.5 g per deciliter intraoperatively or postoperatively) or a liberal red-cell transfusion strategy (transfusion if the hemoglobin concentration was <9.5 g per deciliter intraoperatively or postoperatively when the patient was in the intensive care unit [ICU] or was <8.5 g per deciliter when the patient was in the non-ICU ward). The primary composite outco...
Canadian journal of surgery. Journal canadien de chirurgie, Jun 1, 2018
Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is stro... more Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is strongly associated with 30-day mortality; however, it remains mostly undetected without systematic troponin T monitoring. We evaluated the cost and consequences of postoperative troponin T monitoring to detect MINS. We conducted a model-based cost-consequence analysis to compare the impact of routine troponin T monitoring versus standard care (troponin T measurement triggered by ischemic symptoms) on the incidence of MINS detection. Model inputs were based on Canadian patients enrolled in the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study, which enrolled patients aged 45 years or older undergoing inpatient noncardiac surgery. We conducted probability analyses with 10 000 iterations and extensive sensitivity analyses. The data were based on 6021 patients (48% men, mean age 65 [standard deviation 12] yr). The 30-day mortality rate for MINS was 9.6%. We determi...
Lancet (London, England), Jun 9, 2018
Myocardial injury after non-cardiac surgery (MINS) increases the risk of cardiovascular events an... more Myocardial injury after non-cardiac surgery (MINS) increases the risk of cardiovascular events and deaths, which anticoagulation therapy could prevent. Dabigatran prevents perioperative venous thromboembolism, but whether this drug can prevent a broader range of vascular complications in patients with MINS is unknown. The MANAGE trial assessed the potential of dabigatran to prevent major vascular complications among such patients. In this international, randomised, placebo-controlled trial, we recruited patients from 84 hospitals in 19 countries. Eligible patients were aged at least 45 years, had undergone non-cardiac surgery, and were within 35 days of MINS. Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally twice daily or matched placebo for a maximum of 2 years or until termination of the trial and, using a partial 2-by-2 factorial design, patients not taking a proton-pump inhibitor were also randomly assigned (1:1) to omeprazole 20 mg once daily, for which...
The Canadian journal of cardiology, Mar 1, 2018
Worldwide approximately 200 million adults undergo major surgery annually, of whom 8 million are ... more Worldwide approximately 200 million adults undergo major surgery annually, of whom 8 million are estimated to suffer a myocardial injury after noncardiac surgery (MINS). There is currently no trial data informing the management of MINS. Antithrombotic agents such as direct oral anticoagulants might prevent major vascular complications in patients with MINS. The Management of Myocardial Injury After Noncardiac Surgery (MANAGE) trial is a large international blinded randomized controlled trial of dabigatran vs placebo in patients who suffered MINS. We used a partial factorial design to also determine the effect of omeprazole vs placebo in reducing upper gastrointestinal bleeding and complications. Both study drugs were initiated in eligible patients within 35 days of suffering MINS and continued for a maximum of 2 years. The primary outcome is a composite of major vascular complications for the dabigatran trial and a composite of upper gastrointestinal complications for the omeprazole...
The New England journal of medicine, Nov 30, 2017
Background The effect of a restrictive versus liberal red-cell transfusion strategy on clinical o... more Background The effect of a restrictive versus liberal red-cell transfusion strategy on clinical outcomes in patients undergoing cardiac surgery remains unclear. Methods In this multicenter, open-label, noninferiority trial, we randomly assigned 5243 adults undergoing cardiac surgery who had a European System for Cardiac Operative Risk Evaluation (EuroSCORE) I of 6 or more (on a scale from 0 to 47, with higher scores indicating a higher risk of death after cardiac surgery) to a restrictive red-cell transfusion threshold (transfuse if hemoglobin level was <7.5 g per deciliter, starting from induction of anesthesia) or a liberal red-cell transfusion threshold (transfuse if hemoglobin level was <9.5 g per deciliter in the operating room or intensive care unit [ICU] or was <8.5 g per deciliter in the non-ICU ward). The primary composite outcome was death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis by hospital discharge or by day 28, wh...
Annals of internal medicine, Feb 14, 2017
Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary int... more Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery. To evaluate benefits and harms of perioperative aspirin in patients with prior PCI. Nonprespecified subgroup analysis of a multicenter factorial trial. Computerized Internet randomization was done between 2010 and 2013. Patients, clinicians, data collectors, and outcome adjudicators were blinded to treatment assignment. (ClinicalTrials.gov: NCT01082874). 135 centers in 23 countries. Adults aged 45 years or older who had or were at risk for atherosclerotic disease and were having noncardiac surgery. Exclusions were placement of a bare-metal stent within 6 weeks, placement of a drug-eluting stent within 1 year, or receipt of nonstudy aspirin within 72 hours before surgery. Aspirin therapy (overall trial, n = 4998; subgroup, n = 234) or placebo (overall trial, n = 5012; subgroup, n = 236) initiated within 4 hours before surgery and continued throug...
JAMA, Jan 25, 2017
Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) ... more Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS). To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries; follow-up finished in December 2013. Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement. A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-da...
UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collectio... more UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collection of dissertations and theses. Learn more... ProQuest, Challenges in identifying subclinical chronic chagasic cardiomyopathy in a Colombian urban population. ...
ABSTRACT Chagas (CH) disease, found throughout Latin America, is caused by the parasite Trypanoso... more ABSTRACT Chagas (CH) disease, found throughout Latin America, is caused by the parasite Trypanosoma cruzi. Heart failure is a common (i.e. 10-30%) late outcome for people who develop symptomatic Chagas disease. Studies show that patients with Chagasic heart failure have a worse prognosis than patients with heart failure from other aetiologies. As most people living with CH are from lower socioeconomic backgrounds where access to quality medical care can be limited, the study investigated the equality of patient care between Chagas and non-Chagas heart failure patients in La Fundación Cardioinfantil (FCI), Bogotá, Colombia. Methods The study was a retrospective cohort study, compiling data from medical files of patients hospitalized for heart failure between 2001-2011. Each CH patient (n=41) was matched with 1-2 comparable non-Chagas (no-CH) patients (n=77). Results/Projected Outcomes At the FCI, no differences were observed between care given to CH and no-CH patients, concluding that patients with CH receive a similar standard of care to patients with no-CH. Because this report is not inclusive of other health institutions in Colombia, the FCI is recommended as a model institution for equal patient treatment.
Medunab, Sep 6, 2010
Base de dados : LILACS. Pesquisa : 344830 [Identificador único]. Referências encontradas : 1 [ref... more Base de dados : LILACS. Pesquisa : 344830 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. Texto completo. experimental, Documentos relacionados. Id: 344830 ...
Rev Colomb Cardiol, Apr 1, 1999
Circulation, Mar 10, 2015
Revista Colombiana De Cardiologia, Jun 1, 2009
Acta Med Colomb, Apr 1, 1997
Resumo: La enfermedad de Chagas crónica se caracteriza por daño cardiaco microvascular, contrácti... more Resumo: La enfermedad de Chagas crónica se caracteriza por daño cardiaco microvascular, contráctil y autonómico, sin que se comprenda completamente cuál de ellos determina el inicio de la enfermedad. Con el fin de edentificar alteraciones autonómicas ...
International Journal of Epidemiology, 2001
Chagas' disease is a chronic disease caused by the parasite Trypanosoma cruzi, which is transmitt... more Chagas' disease is a chronic disease caused by the parasite Trypanosoma cruzi, which is transmitted by a triatomine bug and also by blood transfusion and transplacentally. The infection may cause an acute self-limited disease, which evolves to a symptomless period. Several years after infection about 30% of individuals present clinical evidence of heart disease, and around 8% develop megavisceras. 1 It is estimated that 16-18 million people are currently infected in South and Central America. 2 Infection is thought to be lifelong though detection of parasitaemia during the chronic phase is very difficult. 3 Thus, its diagnosis is based mainly on the detection of serum antibodies to T. cruzi using serological tests. 4 The effect of treatment during the chronic phase is controversial. Early clinical trials did not show any effect of treatment in preventing the development of chronic Chagas' disease in adults. More recent findings suggest that treatment may be effective in producing negative seroconversion of specific antibodies in schoolchildren treated during the first year of infection. 1 The Chagas' Disease Control Programme in Brazil is based on control of the triatomine bug. This programme began on a national scale in the mid-1970s and mortality and hospitalizations due to Chagas' disease have been declining since then. 5 In addition,
The New England journal of medicine, Sep 26, 2018
Background We reported previously that, in patients undergoing cardiac surgery who were at modera... more Background We reported previously that, in patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive transfusion strategy was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis by hospital discharge or 28 days after surgery, whichever came first. We now report the clinical outcomes at 6 months after surgery. Methods We randomly assigned 5243 adults undergoing cardiac surgery to a restrictive red-cell transfusion strategy (transfusion if the hemoglobin concentration was <7.5 g per deciliter intraoperatively or postoperatively) or a liberal red-cell transfusion strategy (transfusion if the hemoglobin concentration was <9.5 g per deciliter intraoperatively or postoperatively when the patient was in the intensive care unit [ICU] or was <8.5 g per deciliter when the patient was in the non-ICU ward). The primary composite outco...
Canadian journal of surgery. Journal canadien de chirurgie, Jun 1, 2018
Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is stro... more Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is strongly associated with 30-day mortality; however, it remains mostly undetected without systematic troponin T monitoring. We evaluated the cost and consequences of postoperative troponin T monitoring to detect MINS. We conducted a model-based cost-consequence analysis to compare the impact of routine troponin T monitoring versus standard care (troponin T measurement triggered by ischemic symptoms) on the incidence of MINS detection. Model inputs were based on Canadian patients enrolled in the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study, which enrolled patients aged 45 years or older undergoing inpatient noncardiac surgery. We conducted probability analyses with 10 000 iterations and extensive sensitivity analyses. The data were based on 6021 patients (48% men, mean age 65 [standard deviation 12] yr). The 30-day mortality rate for MINS was 9.6%. We determi...
Lancet (London, England), Jun 9, 2018
Myocardial injury after non-cardiac surgery (MINS) increases the risk of cardiovascular events an... more Myocardial injury after non-cardiac surgery (MINS) increases the risk of cardiovascular events and deaths, which anticoagulation therapy could prevent. Dabigatran prevents perioperative venous thromboembolism, but whether this drug can prevent a broader range of vascular complications in patients with MINS is unknown. The MANAGE trial assessed the potential of dabigatran to prevent major vascular complications among such patients. In this international, randomised, placebo-controlled trial, we recruited patients from 84 hospitals in 19 countries. Eligible patients were aged at least 45 years, had undergone non-cardiac surgery, and were within 35 days of MINS. Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally twice daily or matched placebo for a maximum of 2 years or until termination of the trial and, using a partial 2-by-2 factorial design, patients not taking a proton-pump inhibitor were also randomly assigned (1:1) to omeprazole 20 mg once daily, for which...
The Canadian journal of cardiology, Mar 1, 2018
Worldwide approximately 200 million adults undergo major surgery annually, of whom 8 million are ... more Worldwide approximately 200 million adults undergo major surgery annually, of whom 8 million are estimated to suffer a myocardial injury after noncardiac surgery (MINS). There is currently no trial data informing the management of MINS. Antithrombotic agents such as direct oral anticoagulants might prevent major vascular complications in patients with MINS. The Management of Myocardial Injury After Noncardiac Surgery (MANAGE) trial is a large international blinded randomized controlled trial of dabigatran vs placebo in patients who suffered MINS. We used a partial factorial design to also determine the effect of omeprazole vs placebo in reducing upper gastrointestinal bleeding and complications. Both study drugs were initiated in eligible patients within 35 days of suffering MINS and continued for a maximum of 2 years. The primary outcome is a composite of major vascular complications for the dabigatran trial and a composite of upper gastrointestinal complications for the omeprazole...
The New England journal of medicine, Nov 30, 2017
Background The effect of a restrictive versus liberal red-cell transfusion strategy on clinical o... more Background The effect of a restrictive versus liberal red-cell transfusion strategy on clinical outcomes in patients undergoing cardiac surgery remains unclear. Methods In this multicenter, open-label, noninferiority trial, we randomly assigned 5243 adults undergoing cardiac surgery who had a European System for Cardiac Operative Risk Evaluation (EuroSCORE) I of 6 or more (on a scale from 0 to 47, with higher scores indicating a higher risk of death after cardiac surgery) to a restrictive red-cell transfusion threshold (transfuse if hemoglobin level was <7.5 g per deciliter, starting from induction of anesthesia) or a liberal red-cell transfusion threshold (transfuse if hemoglobin level was <9.5 g per deciliter in the operating room or intensive care unit [ICU] or was <8.5 g per deciliter in the non-ICU ward). The primary composite outcome was death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis by hospital discharge or by day 28, wh...
Annals of internal medicine, Feb 14, 2017
Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary int... more Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery. To evaluate benefits and harms of perioperative aspirin in patients with prior PCI. Nonprespecified subgroup analysis of a multicenter factorial trial. Computerized Internet randomization was done between 2010 and 2013. Patients, clinicians, data collectors, and outcome adjudicators were blinded to treatment assignment. (ClinicalTrials.gov: NCT01082874). 135 centers in 23 countries. Adults aged 45 years or older who had or were at risk for atherosclerotic disease and were having noncardiac surgery. Exclusions were placement of a bare-metal stent within 6 weeks, placement of a drug-eluting stent within 1 year, or receipt of nonstudy aspirin within 72 hours before surgery. Aspirin therapy (overall trial, n = 4998; subgroup, n = 234) or placebo (overall trial, n = 5012; subgroup, n = 236) initiated within 4 hours before surgery and continued throug...
JAMA, Jan 25, 2017
Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) ... more Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS). To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries; follow-up finished in December 2013. Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement. A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-da...
UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collectio... more UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collection of dissertations and theses. Learn more... ProQuest, Challenges in identifying subclinical chronic chagasic cardiomyopathy in a Colombian urban population. ...
ABSTRACT Chagas (CH) disease, found throughout Latin America, is caused by the parasite Trypanoso... more ABSTRACT Chagas (CH) disease, found throughout Latin America, is caused by the parasite Trypanosoma cruzi. Heart failure is a common (i.e. 10-30%) late outcome for people who develop symptomatic Chagas disease. Studies show that patients with Chagasic heart failure have a worse prognosis than patients with heart failure from other aetiologies. As most people living with CH are from lower socioeconomic backgrounds where access to quality medical care can be limited, the study investigated the equality of patient care between Chagas and non-Chagas heart failure patients in La Fundación Cardioinfantil (FCI), Bogotá, Colombia. Methods The study was a retrospective cohort study, compiling data from medical files of patients hospitalized for heart failure between 2001-2011. Each CH patient (n=41) was matched with 1-2 comparable non-Chagas (no-CH) patients (n=77). Results/Projected Outcomes At the FCI, no differences were observed between care given to CH and no-CH patients, concluding that patients with CH receive a similar standard of care to patients with no-CH. Because this report is not inclusive of other health institutions in Colombia, the FCI is recommended as a model institution for equal patient treatment.
Medunab, Sep 6, 2010
Base de dados : LILACS. Pesquisa : 344830 [Identificador único]. Referências encontradas : 1 [ref... more Base de dados : LILACS. Pesquisa : 344830 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. Texto completo. experimental, Documentos relacionados. Id: 344830 ...
Rev Colomb Cardiol, Apr 1, 1999
Circulation, Mar 10, 2015
Revista Colombiana De Cardiologia, Jun 1, 2009
Acta Med Colomb, Apr 1, 1997
Resumo: La enfermedad de Chagas crónica se caracteriza por daño cardiaco microvascular, contrácti... more Resumo: La enfermedad de Chagas crónica se caracteriza por daño cardiaco microvascular, contráctil y autonómico, sin que se comprenda completamente cuál de ellos determina el inicio de la enfermedad. Con el fin de edentificar alteraciones autonómicas ...