Background. Accurate aortic valve area (AVA) estimation is central to aortic stenosis (AS) severity grading. The continuity equation (CE) is the reference echocardiographic method but is vulnerable to squared-error propagation from left ventricular outflow tract (LVOT) diameter measurement. The Tango formula (TF) estimates AVA from three continuous-wave Doppler parameters obtained from a single window, eliminating LVOT measurement. As a simplified Doppler-only index, TF has not been adequately validated outside its original description. We designed this pilot and proof-of-concept study to generate preliminary agreement and reproducibility data that can inform the design of future adequately-powered multicentre validation work. Methods. Single-centre retrospective pilot study. Echocardiographic reports from January 2022 to December 2023 were reviewed. Adults (≥ 18 years) with moderate (AVA > 1.0 cm²) or severe (AVA ≤ 1.0 cm²) AS confirmed by CE were included. Method-agreement was assessed with Lin’s concordance correlation coefficient (CCC) and Bland–Altman analysis, with pre-specified subgroup analyses by AS severity. A reproducibility sub-study was performed in 15 randomly selected cases, in which TF measurements were repeated by the same observer (intra-observer) and by a second independent level-3 echocardiographer (inter-observer) blinded to prior values. Results. Of 3,433 studies reviewed, 54 patients (median age 74 years, IQR 67–79; 50% women; 22 moderate, 32 severe AS) met inclusion criteria. Overall CE–TF agreement was excellent for absolute AVA (CCC = 0.94; 95% CI 0.89–0.98) and indexed AVA (CCC = 0.95; 95% CI 0.91–0.98); Bland–Altman bias was negligible (mean difference 0.001 cm²; 95% limits of agreement [LoA] − 0.22 to 0.21 cm²). In severe AS, agreement was excellent (CCC = 0.87; 95% CI 0.75–0.93); in moderate AS, agreement was more limited (CCC = 0.46; 95% CI − 0.04 to 0.88). Reproducibility of TF was good: intra-observer CCC = 0.87 (95% CI 0.66–0.95) and inter-observer CCC = 0.82 (95% CI 0.56–0.93). Four of 54 patients (7.4%) were reclassified between methods, all within the moderate AS group; no reclassification occurred in severe AS. Conclusions. This pilot and proof-of-concept study provides the first single-centre agreement and reproducibility data for the Tango formula. TF shows excellent agreement with CE in severe AS and good intra- and inter-observer reproducibility (CCC 0.87 and 0.82, respectively), supporting further evaluation as a complementary Doppler-only tool when LVOT measurement is technically unreliable. The wider confidence intervals in moderate AS and the modest sample size underline that these findings should be interpreted as hypothesis-generating. A prospective, adequately-powered multicentre study with anatomical validation is warranted.
Muir–Torre syndrome is a rare autosomal dominant genetic disorder associated with Lynch syndrome, characterized by the coexistence of cutaneous sebaceous neoplasms and visceral malignancies, primarily colorectal and gynecological cancers. Early recognition of this syndrome enables the identification of individuals with a hereditary predisposition to cancer and facilitates the implementation of appropriate surveillance strategies. The aim of this review was to analyze the available evidence regarding the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of Muir–Torre syndrome. A narrative literature review was conducted through the evaluation of studies published in high-impact biomedical databases. The available evidence indicates that diagnosis relies on the integration of clinical, histopathological, and genetic findings, whereas management requires a multidisciplinary approach with regular surveillance for the early detection of malignancies. A comprehensive understanding of this syndrome promotes timely diagnosis and improves outcomes for affected patients and their families.
Cardiovascular disease remains the leading cause of morbidity and mortality worldwide, with dyslipidemia playing a key role in its progression. Despite advances in lipid-lowering therapy (LLT), LDL-C (Low-Density Lipoprotein Cholesterol) goal achievement remains suboptimal. This study evaluated LDL-C goal attainment in Colombian patients with very high cardiovascular risk (CVR) due to coronary artery disease (CAD) following ESC/EAS guidelines updates. EDHIPO MARCA (Evaluación De adherencia a la terapia HIPOlipemiante en pacientes de Muy Alto Riesgo CArdiovascular) is a retrospective, multicenter study assessing LDL-C goal achievement in patients with CAD. Data were collected from previous coronary angiogram reports and medical records across 11 Colombian healthcare institutions with certified interventional cardiology services. Patients with CAD who had at least one follow-up LDL-C measurement and an LLT prescription within 12 months post-angiogram were included. LDL-C goal attainment was assessed across three periods—2011–2012, 2016–2017, and 2021–2022—corresponding to the updates of ESC/EAS guidelines (2011, 2016, and 2019, respectively). The LDL-C goals were <70 mg/dL for the first two periods and <55 mg/dL for the most recent one. LDL-C was measured or estimated using the Friedewald equation. Descriptive analyses were performed. A total of 1,788 patients were included, with a median age of 66 years (IQR: 59–74), and 70.7
BackgroundVisual impairment (VI) significantly impacts quality of life, particularly in autonomous pedestrian navigation. Limitations in independent navigation lead to frustration, diminished confidence, and risks to bodily integrity for individuals with VI. In Colombia, the pilot country of this study, approximately 2 million people live with some form of visual disability. Globally, only 1 in 10 people requiring assistive devices have access to them, with factors such as deficient product design stemming from limited knowledge of user expectations, local needs, and environmental constraints, posing significant challenges, particularly in low- and middle-income countries. ObjectiveWe aimed to evaluate the feasibility and limitations of applying the human-centered design (HCD) principles outlined by the International Organization for Standardization (ISO) 9241-210:2019 standard in assistive technology (AT) development for individuals with VI in Colombia. MethodsWe developed a prototype navigation device using the HCD principles, emphasizing a thorough analysis of user needs and environmental contexts. The project leveraged multidisciplinary collaboration to address challenges associated with user engagement and design adaptability while managing legal and bureaucratic constraints. The navigation system integrates artificial intelligence algorithms, specifically developed by the research team as part of this work, to enhance its adaptability and responsiveness to diverse environments. The development process featured iterative prototyping cycles, incorporating user feedback at each stage, all within the boundaries of applicable regulatory frameworks. ResultsThe development and evaluation of the initial prototype highlighted both the feasibility and key limitations of applying the ISO 9241-210:2019 HCD principles in AT for individuals with VI in the Colombian context. The prototype met several user-defined expectations by prioritizing affordability; extended battery life; autonomy in internet-constrained environments; and improved ergonomics, concealability, aesthetics, and obstacle detection. These achievements demonstrated the potential of HCD to guide context-sensitive innovation. However, the process also revealed significant barriers: limited legal and procedural clarity for engaging users in design phases, difficulties navigating ethics committees, and a lack of practical guidance within the ISO standard itself. These constraints, compounded by challenges in interdisciplinary collaboration, limited the depth and adaptability of user involvement across development stages. ConclusionsImplementing HCD principles in AT development shows promise for creating effective and affordable solutions tailored to user needs and contexts. However, legislative and methodological barriers must be addressed to fully realize HCD’s potential. Future efforts should focus on aligning research methodologies with hardware and software development practices while integrating legislative frameworks to enhance the accessibility and effectiveness of AT innovations.
Type 2 diabetes mellitus (T2DM) impacts the development of cardiovascular disease. Prediabetes, called intermediate hyperglycemia, is diagnosed with glucose levels that do not meet the criteria for T2DM, but are elevated. Lifestyle changes achieve a reversal of up to 58
