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AIM: To determine the effectiveness of functional stress testing and computed tomography angiography (CTA) for diagnosis of obstructive coronary artery disease (CAD). METHODS AND RESULTS: Two-thousand nine-hundred twenty symptomatic stable chest pain patients were included in the international Collaborative Meta-Analysis of Cardiac CT consortium to compare CTA with exercise electrocardiography (exercise-ECG) and single-photon emission computed tomography (SPECT) for diagnosis of CAD defined as ≥ 50% diameter stenosis by invasive coronary angiography (ICA) as reference standard. Generalised linear mixed models were used for calculating the diagnostic accuracy of each diagnostic test including non-diagnostic results as dependent variables in a logistic regression model with random intercepts and slopes. Covariates were the reference standard ICA, the type of diagnostic method, and their interactions. CTA showed significantly better diagnostic performance (p < 0.0001) with a sensitivity of 94.6% (95% CI 92.7-96) and a specificity of 76.3% (72.2-80) compared to exercise-ECG with 54.9% (47.9-61.7) and 60.9% (53.4-66.3), SPECT with 72.9% (65-79.6) and 44.9% (36.8-53.4), respectively. The positive predictive value of CTA was ≥ 50% in patients with a clinical pretest probability of 10% or more while this was the case for ECG and SPECT at pretest probabilities of ≥ 40 and 28%. CTA reliably excluded obstructive CAD with a post-test probability of below 15% in patients with a pretest probability of up to 74%. CONCLUSION: In patients with stable chest pain, CTA is more effective than functional testing for the diagnosis as well as for reliable exclusion of obstructive CAD. CTA should become widely adopted in patients with intermediate pretest probability. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Database for Systematic Reviews-CRD42012002780. CRITICAL RELEVANCE STATEMENT: In symptomatic stable chest pain patients, coronary CTA is more effective than functional testing for diagnosis and reliable exclusion of obstructive CAD in intermediate pretest probability of CAD. KEY POINTS: Coronary computed tomography angiography showed significantly better diagnostic performance (p < 0.0001) for diagnosis of coronary artery disease compared to exercise-ECG and SPECT. The positive predictive value of coronary computed tomography angiography was ≥ 50% in patients with a clinical pretest probability of at least 10%, for ECG ≥ 40%, and for SPECT 28%. Coronary computed tomography angiography reliably excluded obstructive coronary artery disease with a post-test probability of below 15% in patients with a pretest probability of up to 74%.

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CONTEXT: The electron localization is a concept that allows scientists to better understand the physical and chemical properties of electronic systems. It is associated with the propensity of electron pairs with opposite spins to accumulate as well as with their response to external perturbations. This paper contains a detailed description of the design and implementation of the program KLD, which was primarily developed in our research group to elucidate electron localization in molecular systems by evaluating the information content of electron-pair density functions. KLD employs two information-based functions as a real space measure of the Fermi and Coulomb holes for same-spin electrons and shows a better resolution as compared to other methods (i.e., ELF). Information about the acceleration of the code is also included in the present work, being noticeable the reduction of wall-time calculation and the error calculation between versions. METHODS: KLD was designed to be easy to use, extend, and maintain; thus, many principles of modern software development, extensive testing, and package management were adopted. The latest version of the KLD program was created utilizing the Compute Unified Device Architecture (CUDA) version, which allows it to use the computational capacity of NVIDIA Graphics Processing Units (GPUs) for processing purposes. The electron-pair conditional density was calculated from the canonical molecular orbitals obtained at the HF/6-31G(2df,p) level, or alternatively the natural orbitals in the case of explicit correlated wavefunctions computed at the MP2/6-31G(2df,p)//HF/6-31G(2df,p) level.

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This work delves into the bonding nature of the pentagonal-pyramidal benzene and hexamethylbenzene dications, C6R62+ (R = H and CH3), which contain a hexacoordinate carbon. The study employs a range of methodologies to analyze a series of scalar fields, including electron density, electron localization function, local momentum representation, and the evaluation of the Coulomb hole through information theory-derived functions. The findings unveil that electron density undergoes transfer from the pentagonal ring to the apical group. As a result, the base of the complex accumulates the positive charge. Moreover, an extended electron density domain emerges between the carbon pentagon and the apical carbon atom. This phenomenon is related to the molecular orbitals with a dipolar character aligned with the principal axis of the molecule. The results also indicate an electron density polarization towards the apical carbon, coupled with an exclusion of electron density surrounding both the apical carbon and the lower portion of the pentagonal ring. These provide valuable insights into the complex bonding nature of hexacoordinate carbon and its implications for organic chemistry.

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The C-X bond cleavage in different methyl halides (CH3X; X = Cl, Br, I) mediated by 5,6-dimethylbenzimidazole-bis(dimethylglyoximate)cobalt(II) (CoIICbx) was theoretically investigated in the present work. An SN2-like mechanism was considered to simulate the chemical process where the cobalt atom acts as the nucleophile and the halogen as the leaving group. The reaction path was computed by means of the intrinsic reaction coordinate method and analyzed in detail through the reaction force formalism, the quantum theory of atoms in molecules (QTAIM), and the calculation of one-electron density derived quantities, such as the source function (SF) and the spin density. A thorough comparison of the results with those obtained in the same reaction occurring in presence of 5,6-dimethylbenzimidazole-bis(dimethylglyoximate)cobalt(I) (CoICbx) was conducted to reveal the main differences between the two cases. The reactions mediated by CoIICbx were observed to be endothermic and possess higher activation energies in contrast to the reactions where the CoICbx complex is present. The latter was supported by the reaction force results, which suggest a relationship between the activation energy and the ionization potentials of the different nucleophiles present in the cleavage reaction. Moreover, the SF results indicates that the lower axial ligand (i.e., 5,6-dimethylbenzimidazole) exclusively participates on the first stage of the reaction mediated by the CoIICbx complex, while for the CoICbx case, it appears to have an important role along the whole process. Finally, the QTAIM charge analysis indicates that oxidation of the cobalt atom occurs in both cases; at the same time, it suggests the formation of an uncommon two-center one-electron bond in the CoIICbx case. The latter was confirmed by means of electron localization calculations, which resulted in a larger electron count at the Co-C interatomic region for the CoICbx case upon comparison with its CoIICbx counterpart.

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The nature of the Na⋯B bond, in the recently synthesized NaBH 3 - adduct, is analyzed on the light of the Na- propensity to polarize along the bond axis as a consequence of the electric field produced by the BH3 fragment. The observed induced polarization has two consequences: (i) the energetic stabilization of the Na- , and (ii) the split of its valence electrons into two opposite lobes along the bond axis. Additionally, an analysis of the electron localization is presented using the information content of the correlated conditional pair density that reveals a significant delocalization between one lobe of the polarized Na- anion and the BH3 fragment at the equilibrium distance. Our findings reported here complement previous works on this system.

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Coronavirus disease 2019 (COVID-19) is currently the major public health problem worldwide. Neutral electrolyzed saline solution that contains reactive chlorine and oxygen species may be an effective therapeutic. In the present study, the treatment efficacy of intravenous and/or nebulized neutral electrolyzed saline combined with usual medical care vs. usual medical care alone was evaluated in ambulatory patients with COVID-19. A prospective, 2-arm, parallel-group, randomized, open-label, multi-center, phase I-II clinical trial including 214 patients was performed. The following two outcomes were evaluated during the 20-day follow-up: i) The number of patients with disease progression; and ii) the patient acceptable symptom state. Serial severe acute respiratory syndrome coronavirus 2 naso/oro-pharyngeal detection by reverse transcription-quantitative (RT-q) PCR was performed in certain patients of the experimental group. Biochemical and hematologic parameters, as well as adverse effects, were also evaluated in the experimental group. The experimental treatment decreased the risk of hospitalization by 89% [adjusted relative risk (RR)=0.11, 95% confidence interval (CI): 0.03-0.37, P<0.001] and the risk of death by 96% (adjusted RR=0.04, 95% CI: 0.01-0.42, P=0.007) and also resulted in an 18-fold higher probability of achieving an acceptable symptom state on day 5 (adjusted RR=18.14, 95% CI: 7.29-45.09, P<0.001), compared with usual medical care alone. Overall, neutral electrolyzed saline solution was better than usual medical care alone. Of the patients analyzed, >50% were negative for the virus as detected by RT-qPCR in naso/oro-pharyngeal samples on day 4, with only a small number of positive patients on day 6. Clinical improvement correlated with a decrease in C-reactive protein, aberrant monocytes and increased lymphocytes and platelets. Cortisol and testosterone levels were also evaluated and a decrease in cortisol levels and an increase in the testosterone-cortisol ratio were observed on days 2 and 4. The experimental treatment produced no serious adverse effects. In conclusion, neutral electrolyzed saline solution markedly reduced the symptomatology and risk of progression in ambulatory patients with COVID-19. The present clinical trial was registered in the Cuban public registry of clinical trials (RPCEC) database (May 5, 2020; no. TX-COVID19: RPCEC00000309).

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In the present work, the fast amide bond cleavage of [3-((1R,5S,7s)-3-azabicyclo[3.3.1]nonane-7-carbonyl)-3-azabicyclo[3.3.1]nonane-7-carboxylic acid (bi-ATDO)], through an intramolecular nucleophilic attack of an amine group is evaluated. First, six possible peptide bond cleavage mechanisms, two of them including a water molecule, are described at the ωB97XD/6-311 + G(d,p)//MP2/6-311 + G(d,p) level of theory. The reaction consisting of an intramolecular nitrogen nucleophilic attack followed by a proton transfer and the amide bond cleavage is determined as the most favorable mechanism. The activation free energy computed for the latter is 20.5 kcal mol-1 , which agrees with the reported experimental result of 24.8 kcal mol-1 . Inclusion of a water molecule to assist the first step of the reaction results in an activation free energy increase of about 17 kcal mol-1 . All the steps in the most favorable mechanism are studied more in detail employing intrinsic reaction coordinate as well as the reaction force and reaction electronic flux analysis.

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Background: Coronavirus disease (COVID-19) is currently the main public health problem worldwide. The administration of neutral electrolyzed saline, a solution that contains reactive species of chlorine and oxygen (ROS), may be an effective therapeutic alternative due to its immunomodulating characteristics, in systemic inflammation control, as well as in immune response improvement, promoting control of the viral infection. The present study evaluated the efficacy of treatment with intravenous and/or nebulized neutral electrolyzed saline combined with usual medical care versus usual medical care alone, in ambulatory patients with COVID-19. Methods: A prospective, 2-arm, parallel group, randomized, open-label, phase I-II clinical trial included 39 patients in the control group (usual medical care alone) and 45 patients in the experimental group (usual medical care + intravenous and/or nebulized electrolyzed saline, with dose escalation). Two aspects were evaluated during the twenty-day follow-up: i) the number of patients with disease progression (hospitalization or death); and ii) the Patient Acceptable Symptom State (PASS), a single-question outcome that determines patient well-being thresholds for pain and function. Biochemical and hematologic parameters, as well as adverse effects, were evaluated in the experimental group. Results: The experimental treatment decreased the risk for hospitalization by 92% (adjusted RR=0.08, 95% CI: 0.01-0.50, P=0.007), with a 43-fold increase in the probability of achieving an acceptable symptom state on day 5 (adjusted RR= 42.96, 95% CI: 9.22-200.0, P<0.001). Intravenous + nebulized administration was better than nebulized administration alone, but nebulized administration was better than usual medical care alone. Clinical improvement correlated with a decrease in C-reactive protein, and aberrant monocytes and an increase of lymphocytes, and platelets. Cortisol and testosterone levels were also evaluated, observing a decrease in cortisol levels and an increment of testosterone-cortisol ratio, on days 2 and 4. Conclusions: The experimental treatment produced no serious adverse effects. In conclusion, intravenous and/or nebulized neutral electrolyzed saline importantly reduced the symptomatology and risk of progression (hospitalization and death), in ambulatory patients with COVID-19. Trial registration: Cuban Public Registry of Clinical Trials (RPCEC) Database RPCEC00000309. Registered: 05. May 2020. https://rpcec.sld.cu/en/trials/RPCEC00000309-En.

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In the present work, a number of R-X⋯NH3 (X = Cl, Br, and I) halogen bonded systems were theoretical studied by means of DFT calculations performed at the ωB97XD/6-31+G(d,p) level of theory in order to get insights on the effect of the electron-donating or electron-withdrawing character of the different R substituent groups (R = halogen, methyl, partially fluorinated methyl, perfluoro-methyl, ethyl, vinyl, and acetyl) on the stability of the halogen bond. The results indicate that the relative stability of the halogen bond follows the Cl < Br < I trend considering the same R substituent whereas the more electron-withdrawing character of the R substituent the more stable the halogen bond. Refinement of the latter results, performed at the MP2/6-31+G(d,p) level showed that the DFT and the MP2 binding energies correlate remarkably well, suggesting that the Grimme's type dispersion-corrected functional produces reasonable structural and energetic features of halogen bond systems. DFT results were also observed to agree with more refined calculations performed at the CCSD(T) level. In a further stage, a more thorough analysis of the R-Br⋯NH3 complexes was performed by means of a novel electron localization/delocalization tool, defined in terms of an Information Theory, IT, based quantity obtained from the conditional pair density. For the latter, our in-house developed C++/CUDA program, called KLD (acronym of Kullback-Leibler divergence), was employed. KLD results mapped onto the one-electron density plotted at a 0.04 a.u. isovalue, showed that (i) as expected, the localized electron depletion of the Br sigma-hole is largely affected by the electron-withdrawing character of the R substituent group and (ii) the R-X bond is significantly polarized due to the presence of the NH3 molecule in the complexes. The afore-mentioned constitutes a clear indication of the dominant character of electrostatics on the stabilization of halogen bonds in agreement with a number of studies reported in the main literature. Finally, the cooperative effects on the [Br-CN]n system (n = 1-8) was evaluated at the MP2/6-31+G(d,p) level, where it was observed that an increase of about ~14.2% on the complex stability is obtained when going from n = 2 to n = 8. The latter results were corroborated by the analysis of the changes on the Fermi-hole localization pattern on the halogen bond zones, which suggests an also important contribution of the electron correlation in the stabilization of these systems.

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OBJECTIVE: To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. DESIGN: Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. DATA SOURCES: Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. RESULTS: Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v 0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 v all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)). CONCLUSIONS: In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42012002780.

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RESUMEN Las manifestaciones clínicas de las malformaciones vasculares intracraneanas en niños incluyen las derivadas de sangrados, así como las hemodinámicas que dependen del tamaño de la malformación. Algunas pueden consumir un alto porcentaje del gasto cardiaco, y llevar a falla cardiaca o a hipertensión pulmonar derivada del hiperflujo. Se presenta el caso de un lactante con hipertensión pulmonar y falla cardiaca que fue diagnosticada tardíamente, aunque con corrección endovascular dentro de la edad recomendada y buen desenlace neurológico. Se enfatiza en la necesidad de considerar las malformaciones vasculares intracraneales dentro del diagnóstico diferencial de niños con hipertensión pulmonar que no responden al tratamiento.

SUMMARY Clinical manifestations of intracranial vascular malformations in children include those derived from bleeding, as well as hemodynamic problems due to the size of some large malformations These may consume a high percentage of cardiac output, leading to heart failure, or pulmonary hypertension. We present the case of an infant with pulmonary hypertension and heart failure who was diagnosed late, but with endovascular correction within the recommended age, and had good neurological outcome. Emphasis is placed on the need to consider intracranial vascular malformations within the differential diagnosis of children with pulmonary hypertension who do not respond to treatment.

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Se han desarrollado estudios relacionados con la influencia de la diabetes mellitus en el sistema estomatognático de manera general y en particular en la salud periodontal, sin embargo es un campo insuficientemente abordado, principal motivación para la realización de esta investigación epidemiológica del tipo analítica de caso y control, la que tuvo como objetivo determinar el efecto de la diabetes mellitus tipo I y II en la salud periodontal, de pacientes con 30 a 60 años, del Consultorio Médico de la Familia No. 39, en el Reparto Rosa La Bayamesa, de Bayamo. El universo fue de 631 personas y la muestra de 168, distribuidas en grupos casos y controles. Las principales variables estudiadas fueron: tipo de diabetes mellitus, grupos de edades, sexo, enfermedad periodontal inflamatoria crónica y su severidad. Predominaron como resultados que, la morbilidad de la diabetes mellitus (DM) aumentó con la edad 75,00 por ciento, predominando esta en el sexo femenino 62,50 por ciento. Se observó que la enfermedad periodontal inflamatoria crónica presentó una frecuencia total 88,10 por ciento; para un (OR) de 5,17 y p=0,0164; los más afectados fueron aquellos que padecían (DM), 96,43 por ciento. En los pacientes con diabetes mellitus, presentó mayor severidad la periodontitis 78,57 por ciento, mientras que en los controles predominó la gingivitis 64,29 por ciento, se cuantificó un (OR) de 2,00(AU)

Studies have been developed related to the influence of diabetes mellitus in the stomatognathic system in a general way and in particular in periodontal health, however it is an insufficiently addressed field, the main motivation for carrying out this epidemiological investigation of the analytical type of case and control, which aimed to determine the effect of type I and II diabetes mellitus on the periodontal health of patients aged 30 to 60 years, from the Family Medical Office No. 39, in the Rosa La Bayamesa Division, of Bayamo. The universe was of 631 people and the sample of 168, distributed in case and control groups. The main variables studied were: type of diabetes mellitus, age groups, sex, chronic inflammatory periodontal disease and its severity. Predominated as results that the morbidity of diabetes mellitus (DM) increased with age 75.00 percent, predominantly in the female sex 62.50 percent. It was observed that chronic inflammatory periodontal disease presented a total frequency 88.10 percent; for an (OR) of 5.17 and p = 0.0164; The most affected were those who suffered (DM), 96.43 percent. In patients with diabetes mellitus, periodontitis was more severe, 78.57 percent, while in controls, 64.29 percent had gingivitis, and a (OR) of 2.00 was quantified(EU)

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RESUMEN Se han desarrollado estudios relacionados con la influencia de la diabetes mellitus en el sistema estomatognático de manera general y en particular en la salud periodontal, sin embargo es un campo insuficientemente abordado, principal motivación para la realización de esta investigación epidemiológica del tipo analítica de caso y control, la que tuvo como objetivo determinar el efecto de la diabetes mellitus tipo I y II en la salud periodontal, de pacientes con 30 a 60 años, del Consultorio Médico de la Familia No. 39, en el Reparto Rosa La Bayamesa, de Bayamo. El universo fue de 631 personas y la muestra de 168, distribuidas en grupos casos y controles. Las principales variables estudiadas fueron: tipo de diabetes mellitus, grupos de edades, sexo, enfermedad periodontal inflamatoria crónica y su severidad. Predominaron como resultados que, la morbilidad de la diabetes mellitus (DM) aumentó con la edad 75,00%, predominando está en el sexo femenino 62,50%.Se observó que la enfermedad periodontal inflamatoria crónica presentó una frecuencia total 88,10%; para un (OR) de 5,17 y p=0,0164; los más afectados fueron aquellos que padecían (DM), 96,43%. En los pacientes con diabetes mellitus, presentó mayor severidad la periodontitis78,57%, mientras que en los controles predominó la gingivitis 64,29%, se cuantificó un (OR) de 2,00.

ABSTRACT Studies have been developed related to the influence of diabetes mellitus in the stomatognathic system in a general way and in particular in periodontal health, however it is an insufficiently addressed field, the main motivation for carrying out this epidemiological investigation of the analytical type of case and control, which aimed to determine the effect of type I and II diabetes mellitus on the periodontal health of patients aged 30 to 60 years, from the Family Medical Office No. 39, in the Rosa La Bayamesa Division, of Bayamo . The universe was of 631 people and the sample of 168, distributed in case and control groups. The main variables studied were: type of diabetes mellitus, age groups, sex, chronic inflammatory periodontal disease and its severity. Predominated as results that the morbidity of diabetes mellitus (DM) increased with age 75.00%, predominantly in the female sex 62.50%. It was observed that chronic inflammatory periodontal disease presented a total frequency 88.10% ; for an (OR) of 5.17 and p = 0.0164; The most affected were those who suffered (DM), 96.43%. In patients with diabetes mellitus, periodontitis was more severe, 78.57%, while in controls, 64.29% had gingivitis, and a (OR) of 2.00 was quantified.

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The original version of this article, published on 19 March 2018, unfortunately contained a mistake. The following correction has therefore been made in the original: The names of the authors Philipp A. Kaufmann, Ronny Ralf Buechel and Bernhard A. Herzog were presented incorrectly.

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OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). RESULTS: 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. CONCLUSIONS: Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. KEY POINTS: • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.

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Introducción: la cardiopatía isquémica es un problema de salud que cobra un grannúmero de vidas y es causa de invalidez en la población mundial. Constituyó en el2013, la primera causa de muerte en el mundo, en Cuba y en la provincia deMatanzas.Objetivo: cuantificar la presencia de factores de riesgo de cardiopatía isquémica en elAIM del Policlínico Docente Cesáreo Sánchez, en Pedro Betancourt entre los meses dediciembre 2013 a Mayo del 2014.Materiales y Métodos: se realizó un estudio observacional, descriptivo, transversalde 59 pacientes que ingresaron con este diagnóstico entre los meses de diciembre2013 a Mayo 2014. Se recogieron variables como la edad, sexo, factores de riesgo,formas clínicas de presentación, complicaciones presentadas durante el ingreso ypresencia del síndrome metabólico.Resultado: hubo un predominio del sexo masculino y del grupo de edad de 65 y más.La hipertensión arterial y el sedentarismo fueron los factores de riesgo mássobresalientes, así como la angina estable y las arritmias cardíacas como la formaclínica y complicación más frecuente respectivamente. La presencia del síndromemetabólico caracterizó a los pacientes estudiados.Conclusiones: la detección y control oportuno de los factores de riesgo de lacardiopatía isquémica continuara siendo la piedra angular de cualquier estrategiapreventiva esencial (AU).

Introduction: the ischemic cardiopathy or ischemic cardiovascular disease is a healthproblem claiming a great number of lives, being a cause of disability in the worldpopulation. In 2013 it was the first cause of death worldwide, in Cuba and in theprovince of Matanzas.Objective: to quantify the presence of the ischemic cardiopathy risk factors in themunicipal intensive area (AIM as abbreviation in Spanish) of the Teaching PoliclinicCesareo Sanchez, in Pedro Betancourt, from December 2013 to May 2014.Materials and methods: a cross-sectional, descriptive, observational study wascarried out in 59 patients who entered the area with this diagnosis from December2013 to May 2014. The collected variables were age, sex, risk factors, clinical forms ofpresentation, complications during staying, and presence of the metabolic syndrome.Results: the results showed the predominance of the male sex and the age group of65 years and more. Arterial hypertension and sedentary lifestyle were the mostoutstanding risk factors, and the stable angina and heart arrhythmias were the mostfrequent clinical form and complication, respectively. The presence of metabolicsyndrome characterized the studied patients.Conclusions: the timely detection and control of the ischemic cardiopathy risk factorsis still going to be the cornerstone of any essential preventive strategy (AU).

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Introducción: la cardiopatía isquémica es un problema de salud que cobra un gran número de vidas y es causa de invalidez en la población mundial. Constituyó en el 2013, la primera causa de muerte en el mundo, en Cuba y en la provincia de Matanzas. Objetivo: cuantificar la presencia de factores de riesgo de cardiopatía isquémica en el AIM del Policlínico Docente Cesáreo Sánchez, en Pedro Betancourt entre los meses de diciembre 2013 a Mayo del 2014. Materiales y Métodos: se realizó un estudio observacional, descriptivo, transversal de 59 pacientes que ingresaron con este diagnóstico entre los meses de diciembre 2013 a Mayo 2014. Se recogieron variables como la edad, sexo, factores de riesgo, formas clínicas de presentación, complicaciones presentadas durante el ingreso y presencia del síndrome metabólico. Resultado: hubo un predominio del sexo masculino y del grupo de edad de 65 y más. La hipertensión arterial y el sedentarismo fueron los factores de riesgo más sobresalientes, así como la angina estable y las arritmias cardíacas como la forma clínica y complicación más frecuente respectivamente. La presencia del síndrome metabólico caracterizó a los pacientes estudiados. Conclusiones: la detección y control oportuno de los factores de riesgo de la cardiopatía isquémica continuara siendo la piedra angular de cualquier estrategia preventiva esencial (AU).

Introduction: the ischemic cardiopathy or ischemic cardiovascular disease is a health problem claiming a great number of lives, being a cause of disability in the world population. In 2013 it was the first cause of death worldwide, in Cuba and in the province of Matanzas. Objective: to quantify the presence of the ischemic cardiopathy risk factors in the municipal intensive area (AIM as abbreviation in Spanish) of the Teaching Policlinic Cesareo Sanchez, in Pedro Betancourt, from December 2013 to May 2014. Materials and methods: a cross-sectional, descriptive, observational study was carried out in 59 patients who entered the area with this diagnosis from December 2013 to May 2014. The collected variables were age, sex, risk factors, clinical forms of presentation, complications during staying, and presence of the metabolic syndrome. Results: the results showed the predominance of the male sex and the age group of 65 years and more. Arterial hypertension and sedentary lifestyle were the most outstanding risk factors, and the stable angina and heart arrhythmias were the most frequent clinical form and complication, respectively. The presence of metabolic syndrome characterized the studied patients. Conclusions: the timely detection and control of the ischemic cardiopathy risk factors is still going to be the cornerstone of any essential preventive strategy (AU).

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Se realiza un estudio del comportamiento de los brotes de enfermedades trasmitidas por los alimentos en Guantánamo en el período comprendido 2002 2012. El universo está conformado por todos los brotes de estas enfermedades notificados en la provincia en el período. Las fuentes de información fueron las encuestas archivadas en el Departamento Provincial de Higiene de los Alimentos y Nutrición y de Estadísticas del Centro Provincial de Higiene Epidemiología y Microbiología. Las variables estudiadas son: número de afectados, agentes contaminantes, alimentos implicados, municipios, organismos afectados y meses del año. El municipio con mayor número de reportes fue Guantánamo. El organismo más afectado fue vivienda familiar y el año 2012. La salmonella fue el agente contaminante de alimentos más frecuente. Los alimentos frecuentemente implicados en los brotes fueron los cárnicos y sus derivados. Los meses de mayor incidencia fueron abril, mayo y junio (AU)

The universe consists of all these outbreaks reported in the province in the period 2002-2012. The sources of information were surveys in the Provincial Department of Food Hygiene and Nutrition, Statistics Provincial Center of Hygiene Epidemiology and Microbiology. The variables studied were: number of affected pollutants, foods involved towns, affected agencies and months. The municipality with the largest number of reports was Guantanamo. The houses were the most affected in 2012. Salmonella was the most common contaminant of food. The foods were implicated in outbreaks meat and its derivatives. The highest incidence months were April, May and June

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La neurocisticercosis es una enfermedad con alta prevalencia en países tropicales y de bajos recursos, sin embargo su incidencia ha aumentado en países desarrollados. Este es el caso de una mujer de 49 años con neurocisticercosis subaracnoidea generalizada asociada a compromiso encefálico y medular, una presentación rara de este parásito neurotrópico,con convulsiones y limitación motora severa. Las imágenes muestran respuesta inflamatoria generalizada del cerebro y el espacio subaracnoideo, hidrocefalia y múltiples lesiones calcificadas, reafirmando la importancia de las neuroimágenes para la correlación clínica y el diagnóstico de las enfermedades infecciosas cerebrales como la neurocisticercosis, con variabilidad en la presentación y múltiples compromisos del sistema nervioso central.

Neurocysticercosis is a disease of high prevalence in tropical and low-income countries and its incidence has been increased in developed countries. This is the case of 49-year-old woman with generalized subarachnoid neurocysticercosis associated to encephalic and medullar compromise, a rare presentation of this neurotropic parasite, with seizures and severe motor limitation. Images showed generalized inflammatory response of the brain and spinal subarachnoid space, hydrocephalus and multiple calcified lesions, demonstrating and reaffirming the importance of neuroimaging tools for the clinical correlation and diagnosis of brain infectious diseases as neurocysticercosis with variability on the presentation and multiple central nervous system involvement.

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BACKGROUND: Coronary computed tomography angiography has become the foremost noninvasive imaging modality of the coronary arteries and is used as an alternative to the reference standard, conventional coronary angiography, for direct visualization and detection of coronary artery stenoses in patients with suspected coronary artery disease. Nevertheless, there is considerable debate regarding the optimal target population to maximize clinical performance and patient benefit. The most obvious indication for noninvasive coronary computed tomography angiography in patients with suspected coronary artery disease would be to reliably exclude significant stenosis and, thus, avoid unnecessary invasive conventional coronary angiography. To do this, a test should have, at clinically appropriate pretest likelihoods, minimal false-negative outcomes resulting in a high negative predictive value. However, little is known about the influence of patient characteristics on the clinical predictive values of coronary computed tomography angiography. Previous regular systematic reviews and meta-analyses had to rely on limited summary patient cohort data offered by primary studies. Performing an individual patient data meta-analysis will enable a much more detailed and powerful analysis and thus increase representativeness and generalizability of the results. The individual patient data meta-analysis is registered with the PROSPERO database (CoMe-CCT, CRD42012002780). METHODS/DESIGN: The analysis will include individual patient data from published and unpublished prospective diagnostic accuracy studies comparing coronary computed tomography angiography with conventional coronary angiography. These studies will be identified performing a systematic search in several electronic databases. Corresponding authors will be contacted and asked to provide obligatory and additional data. Risk factors, previous test results and symptoms of individual patients will be used to estimate the pretest likelihood of coronary artery disease. A bivariate random-effects model will be used to calculate pooled mean negative and positive predictive values as well as sensitivity and specificity. The primary outcome of interest will be positive and negative predictive values of coronary computed tomography angiography for the presence of coronary artery disease as a function of pretest likelihood of coronary artery disease, analyzed by meta-regression. As a secondary endpoint, factors that may influence the diagnostic performance and clinical value of computed tomography, such as heart rate and body mass index of patients, number of detector rows, and administration of beta blockade and nitroglycerin, will be investigated by integrating them as further covariates into the bivariate random-effects model. DISCUSSION: This collaborative individual patient data meta-analysis should provide answers to the pivotal question of which patients benefit most from noninvasive coronary computed tomography angiography and thus help to adequately select the right patients for this test.

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