Alcohol-attributable burden of cancer in Argentina

Introduction

Alcohol consumption is a risk factor for several types of cancer. Alcohol consumption levels in Argentina are among the highest in the world, and malignant neoplasms are the second cause of death in the country. Public health strategies aimed at reducing alcohol consumption could possibly lead to a decrease in cancer burden. Alcohol-attributable burden has been estimated before in neighboring countries Chile and Brazil. We now aimed to quantify the burden for Argentina.

Methods

We obtained data on alcohol consumption levels from a national representative health survey and etiologic effect sizes for the association between alcohol and cancer from the most recent comprehensive meta-analysis. We estimated the number of alcohol-attributable cancer-related deaths and disability-adjusted life years (DALYs), stratified by consumption level (light (0.1–12.5 g/day), moderate (12.6–50 g/day), or heavy (> 50 g/day) drinking). We additionally explored which hypothetical scenario would achieve the highest reduction in alcohol-attributable cancer burden: 1) heavy drinkers shifting to moderate drinking or 2) moderate drinkers shifting to light drinking.

Results

In 2018, 53% of the Argentinean population consumed alcohol. In men 3.7% of all cancer deaths and DALYs were attributable to alcohol consumption, in women this was 0.8% of all cancer deaths and DALYs. When moderate drinkers would shift to light drinking, 46% of alcohol-attributable cancer deaths and DALYs would be prevented, opposed to only 24% when heavy drinkers would shift to moderate drinking.

Conclusion

Most cancer deaths and DALYs were attributable to moderate alcohol consumption (50%). This calls for implementation of population-wide strategies—instead of targeting heavy drinking only—to effectively reduce harmful use of alcohol and its impact on disease burden.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12549-7.

Takayasu arteritis: clinical features in 110 Mexican Mestizo patients and cardiovascular impact on survival and prognosis

OBJECTIVE

Takayasu Arteritis (TA) is a rare disease that mainly affects large elastic arteries. It is more frequently seen in Asia, the Mediterranean basin, South Africa and Latin America. We have characterized its clinical manifestations and identified the cardiovascular mortality predictors in a cohort of 110 Mexican Mestizo patients.

MATERIAL AND METHOD

Retrospective review of 110 charts of TA patients complying with the American College of Rheumatology (ACR) criteria, seen in a single hospital between 1976 and 2003. Demographic, clinical, and radiological characteristics were described. With the use of actuarial table analysis at 2, 5, and 10 years, and Kaplan Meier methods applying t function for probability, plus Cox regression analysis, the following factors were identified as mortality predictors: systemic arterial hypertension, coronary heart disease and aortic valve regurgitation. Informed consent and approval from the institutional Internal Review Board (IRB) were obtained.

RESULTS

We observed a slowly progressive widespread obstructive arterial disease with cardiovascular (48%), neuro-ophthalmic (36%), and skin morbidity (13%). Systemic hypertension and heart disease were significant mortality predictors. Twenty-six percent of cases died due to myocardial infarction, chronic renal failure, stroke, or surgical complications.

CONCLUSION

TA in Mexican Mestizos shows a clinical pattern similar to the one recognized in the Far East. Management strategies must be directed at reducing the identified mortality risk factors.

Heart surgery with cardiopulmonary bypass in pregnant women

OBJECTIVE

Definite data in heart surgery with extracorporeal circulation during pregnancy is limited. This report analyzes our experience in this area.

METHODS

Fifteen women underwent open heart surgery under cardiopulmonary bypass during pregnancy at our institution between 1972 and 1998. Surgical procedures included valve replacement in 13 patients (12 mitral, 1 aortic), declotting of a tilting disk mitral prosthesis in one and closure, of an atrial septal defect in the remaining patient.

RESULTS

Thirteen patients were in New York Heart Association functional class III to IV and were operated on urgently. Eight of these women had severe acute dysfunction of either a mechanical or a biological mitral prosthesis. There were 2 maternal operative deaths for a rate of 13.3%. Fetal losses resulted at the time of these maternal deaths. Fetal deaths occurred in 5 of the 13 pregnancies (38.5%) in women who survived the surgical procedure.

CONCLUSIONS

Because of the fetal risks, open heart surgery during pregnancy should be advised only in extreme emergencies. Although pregnancy per se does not increase the maternal risk, a high maternal mortality results from the emergency nature of the surgical intervention. Fetal mortality remains high.

Effect of pregnancy on the duration of bovine pericardial bioprostheses

BACKGROUND

This study sought to evaluate the effect of pregnancy on the rate of deterioration of bovine pericardial bioprostheses. To avoid the fetal and maternal risks associated with anticoagulant therapy during pregnancy, the use of bioprostheses has been advocated for young women with cardiac valve disease who may later wish to bear children. Several reports have suggested the probability of pregnancy-related accelerated deterioration of these valves.

METHODS AND RESULTS

The incidence of prosthetic dysfunction and the freedom from deterioration were investigated in 48 women who had 58 pregnancies and in a control group of 167 patients in the same age range. There were 39 cases of prosthetic dysfunction (deaths plus reoperations resulting from valve failure): 12 in the pregnant group for a linearized rate of 3.5% +/- 0.99% (SE) per patient-year and 27 in the control group or 3.4% +/- 0.65% per patient-year (P = not significant). The actuarial freedom from dysfunction was 90.4% (95% confidence interval 77.9 to 96.2) at 5 years and 77.0% (59.7 to 88.3) at 8 years for the pregnancy group and 86.3% (77.3 to 92.0) and 73.4% (56.6 to 84.8), respectively, for the control group ( P = not significant). In the Cox proportional hazard regression analysis, pregnancy did not influence dysfunction. A direct correlation was found between freedom from dysfunction and the patient's age at surgery.

CONCLUSIONS

Pregnancy does not accelerate the rate of deterioration of bovine pericardial bioprostheses. It is more likely that biological valves deteriorate more rapidly in these patients because of their young age.

Utility of transesophageal echocardiography in the examination of adult patients with patent ductus arteriosus

Thirteen patients with clinical suspicion of patent ductus arteriosus were evaluated by transthoracic and transesophageal echocardiographic studies. Findings were corroborated during corrective surgery in 8 patients and by cardiac catheterization in 5. Transthoracic echocardiography confirmed the diagnosis in 7 patients; in 2 of the patients endarteritis of the pulmonary artery was demonstrated, and in one infective vegetations in aortic and mitral valves. With transesophageal echocardiography, patent ductus arteriosus was established in all 8 patients and endarteritis of the pulmonary artery was shown in 3, including 1 not discovered by transthoracic technique. In 1 of these patients, vegetations were also found on the pulmonic valve. Both techniques demonstrated significant pulmonary hypertension in 5 cases; contrast studies showed the venoarterial shunt between the pulmonary artery and the aorta with particular clarity in transesophageal images. On the basis of these findings it may be concluded that transesophageal echocardiography complements the information provided by transthoracic recordings in adult patients with patent ductus arteriosus, especially when it is associated with pulmonary hypertension or pulmonary endarteritis.

[Structural and functional changes in the heart of the hypertensive patient. An echocardiographic study]

We studied 15 patients with essential hypertension (EH) in whom the diagnosis was corroborated with ambulatory blood pressure monitoring (ABPM). The blood pressure levels (BP) were compared with values obtained from healthy people (HP). We studied 31 HP with 2-D echocardiogram and the parameters of ventricular performance were compared with the values obtained from EH people. ABPM shown that the EH people has higher BP values than HP around 24 hs (EH loss the circadian rhythm of BP). On the other hand the EH had left ventricular hypertrophy (LVH) with normal systolic ventricular function (VF). The systolic wall stress was low because the LVH was inappropriate. The LVH as adaptative mechanism maintains normal the VF in spite of pressure overload without increasing MVO2. When the pressure overload is not eradicated in a variable amount of time the adaptative mechanisms slowly change to a pathologic process caused by collagen deposition in the interstitium of the heart. In advanced stages the remodeling process causes diastolic disfunction, myocardial ischemia, arrhythmias and death by heart failure or suddenly. This last stage is the real hypertensive heart disease.