Hospital Británico

La oclusi6n aguda del tronco de la arteria coronaria izquierda se ve solamente en el 0,37% de los infartos de miocardio estudiados mediante coronariografías. La sobrevida de estos pacientes parece que depende de las características anatómicas de su árbol coronario y de la precocidad con que se logre repermeabilizar la arteria. Los dos pacientes que presentamos fueron reperfundidos mediante angioplastía primaria; uno a los 5 minutos y el otro a las 2 horas del evento oclusivo. A pesar del éxito primario, la recuperación de la función ventricular fue diferente y ambos tuvieron una evolución t6rpida por el desarrollo de un síndrome de respuesta inflamatoria sistémica.

Abstract Dementia prevalence is increasing with aging worldwide, a leading cause of disability in Latin American Countries (LAC). Interestingly, physical performance has been reported as a predictor of cognitive decline, and gait speed has emerged as a potential clinical marker of executive dysfunction. However, evidence of the association between physical and cognitive measures remains scarce, especially in LAC older adults. This study examined the association between gait speed and executive function in older adults from 12 LAC countries. A cross-sectional study including 1,243 participants aged 60 to 77 years from the LatAm-FINGERS randomized multicenter cohort at baseline. Sociodemographic, lifestyle, and health data were collected. Physical performance was assessed using the Short Physical Performance Battery (SPPB), with gait speed measured by a standardized 4-meter walk test. Executive and processing speed were evaluated with the Trail Making Test A and B, Stroop interference index (SII), semantic and phonological fluency, and Concept Shifting Test motor speed (CST-MS). Linear regressions and composite scores were computed. The preliminary results indicate that participants’ mean age was 67.5 ± 4.7 years (67.5% female). Faster gait speed was significantly associated with better Stroop C (p < 0.00001), Stroop P (p = 0.001), semantic fluency (p = 0.02), and higher Mini-Mental State Examination (MMSE) scores. Associations with CST-MS and TMT tests were not statistically significant. This study is the first effort in LAC to associate gait speed with executive tests, contributing to the understanding of a useful functional measure as gait speed, and its potential future preventive applications in LAC.

BackgroundThe cytokine A proliferation-inducing ligand (APRIL) is considered a key driver of the pathogenesis of IgA nephropathy. Sibeprenlimab, a humanized IgG2 monoclonal antibody, selectively binds to and inhibits APRIL.MethodsIn this phase 3, multicenter, double-blind, randomized, placebo-controlled trial, we assigned adults with biopsy-confirmed IgA nephropathy in a 1:1 ratio to receive either subcutaneous sibeprenlimab at a dose of 400 mg or placebo administered every 4 weeks for 100 weeks. The primary end point for this interim analysis was the 24-hour urinary protein-to-creatinine ratio at 9 months as compared with baseline. The key secondary end point, to be reported at trial completion, is the annualized slope of estimated glomerular filtration rate over 24 months. Other secondary end points included the change in the level of serum immunoglobulin and safety. Exploratory end points included the change in galactose-deficient IgA1 and APRIL concentrations, the spot 24-hour urinary protein-to-creatinine ratio, hematuria, and remission of proteinuria.ResultsA total of 510 patients underwent randomization — 259 to the sibeprenlimab group and 251 to the placebo group. The prespecified interim analysis included the first 320 patients (152 who received sibeprenlimab and 168 who received placebo) who had the opportunity to complete the 9-month evaluation of the 24-hour urinary protein-to-creatinine ratio. At 9 months, a significant reduction in 24-hour urinary protein-to-creatinine ratio was observed with sibeprenlimab (–50.2%) as compared with an increase with placebo (2.1%), corresponding to an adjusted geometric least-squares mean 24-hour urinary protein-to-creatinine ratio that was 51.2% (96.5% confidence interval [CI], 42.9 to 58.2) lower with sibeprenlimab than with placebo (P<0.001). The levels of APRIL and pathogenic galactose-deficient IgA1 at week 48 were reduced from baseline by 95.8% and 67.1%, respectively, with sibeprenlimab. The safety profile appeared to be similar with sibeprenlimab and placebo. No deaths were reported, and the incidence of serious adverse events that occurred during the treatment period was 3.5% with sibeprenlimab and 4.4% with placebo.ConclusionsSibeprenlimab resulted in a significant reduction in proteinuria as compared with placebo in patients with IgA nephropathy. (Funded by Otsuka Pharmaceutical Development and Commercialization. VISIONARY ClinicalTrials.gov number, NCT05248646.)