Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

The article addresses the navigation difficulties encountered on the web pages of Ecuadorian universities about accessibility. The aim is to determine the extent to which the WCAG 2.1 guidelines applied in these universities. Of the 61 web pages analyzed, only 11 featured a button for visual adjustments. Utilizing TAW (Web Accessibility Test) and  dispersion analysis, it was found that most universities exhibit up to 26.8 errors in the 'Perceivable' principle, 46.8 errors in the 'Operable' principle, 9.4 errors in the 'Understandable' principle, and 9.4 errors in the 'Robust' principle. When using the Markup Validation Service, as many as 80 markup errors were discovered. Similarly, with the CSS Validation Service, up to 143 errors were identified on the web pages. These findings enable web developers to better target their improvements, considering accessibility guidelines.

Introduction: Given the increasing number of cancer survivors, often with cardiovascular disease, pre-existing or new risk factors, cardio-oncologists have a critical role in creating a comprehensive plan to address comorbidities and provide guidance based on optimal treatment choice.Purpose: To determine the variation in ventricular depolarization and repolarization in patients undergoing docetaxel chemotherapy.Methods: An analytical and prospective investigation was carried out in patients undergoing chemotherapy with taxols in the Cardiology Department of the Medical-Surgical Research Center of Cuba from December 2019 to June 2021. The sample consisted of all selected patients undergoing antineoplastic drugs. A 12-lead electrocardiogram was performed and medical records were reviewed.Results: The average age of the patients was 60.4 years. The predominant cardiovascular risk factor was arterial hypertension (39.2 % of the total number of patients studied). Lung cancer prevailed in the general population, while breast cancer was the most frequent neoplasm in the female sex. The electrocardiographic variables analyzed had a demonstrated variation, which according to chemotherapy cycles were: the QTc, QTc dispersion, RTp-Tf/QT and QRS duration.Conclusions: These results highlight the importance of an adequate clinical evaluation for the correct identification of patients at risk of cardiotoxicity. Electrocardiographic surveillance and follow-up show predictors of malignant arrhythmias and sudden death that help to improve the quality of life of these patients. 

Introduction: Myotonic dystrophy type 1 is a multisystem genetic disorder. Cardiac involvement is frequent and includes different electrocardiographic alterations.Objective: To identify factors associated with electrocardiographic abnormalities in myotonic dystrophy type 1.Methods: A retrospective case-control study was conducted in Pinar del Río from January 2019 to August 2022 in 81 people with the disease and 162 healthy controls. Multiple variables were analysed: age, sex, personal history of chronic diseases, dyslipidemias, body mass index and electrocardiographic alterations. Data processing was performed with the SPSS statistical package.Results: Underweight and electrocardiographic abnormalities were associated with disease (OR = 7.551 and OR = 2.306) respectively. Factors associated with atrioventricular and intraventricular conduction disturbances included: age greater than or equal to 40 years (OR = 4.870), normal weight with OR = 6.400, and male and female sex with OR = 2.106 and OR = 2.558. For electrocardiographic signs of cardiac ischaemia, age greater than or equal to 40 years increased the risk up to 12.288 times; female sex was another factor associated with a risk of 18.839 times.Conclusions: There are factors that, when associated, increase the risk of electrocardiographic alterations. These factors include age greater than or equal to 40 years, female sex and a history of other chronic diseases.

The risk factors involved in the development or suffering of cardiovascular diseases can be modifiable and non-modifiable; Its recognition and evaluation is often considered a first step in clinical treatment. Otherwise, without therapeutic follow-up, the burden of morbidity and mortality would increase. There are countless entities, both physiological and pathological, that must be taken into account as possible associations of risk factors in cardiovascular diseases.

Introduction: Atrial fibrillation is the most common sustained supraventricular tachycardia. Elective electrical cardioversion is a procedure to restore sinus rhythm. However, its predictors of failure are not well established.Objective: To evaluate clinical and echocardiographic variables and pharmacological treatment in patients with atrial fibrillation that could predict failure of electrical cardioversion.Methods: A prospective cohort study was conducted at the Hermanos Ameijeiras Hospital, from March 2019 to December 2020. The sample consisted of 104 patients. Failure of electrical cardioversion was defined as the impossibility to restore sinus rhythm or recurrence of arrhythmia, after four weeks of the procedure.Results: The electrical cardioversion failure group was dominated by patients with higher body mass index (p = 0.011), chronic obstructive pulmonary disease (p = 0.024), obstructive sleep apnea (p < 0.001), chronic coronary syndrome (p = 0.041), valvular heart disease (p < 0.001), cardiomyopathies (p = 0.002), heart failure (p < 0.001), longer time to diagnosis (p < 0.001), number of episodes of atrial fibrillation (p < 0, 001), greater diameter (p < 0.001), area (p < 0.001), volume (p < 0.001), left atrial pressure, lower left ventricular ejection fraction (p = 0.014), higher incidence of left ventricular systolic dysfunction (p = 0, 012), lower use of antiarrhythmic drugs (p = 0.047), history (p < 0.001), higher number of previous cardioversions (p < 0.001), number of shocks (p < 0.001), and higher applied energy (p < 0.001). Volume (p < 0.001) [OR 1.64(1.22-2.19)] and left atrial pressure (p = 0.038) [OR 1.10(1.00-1.21)] constituted predictors of failure.Conclusions: Increased left atrial volume and elevated left atrial pressure constitute predictors of failure of electrical cardioversion in patients with persistent atrial fibrillation.

Introduction: Acute coronary syndrome with persistent ST-segment elevation is a condition with high morbidity and mortality and numerous factors are related to complications.Objective: To characterize patients with persistent ST-segment elevation acute coronary syndrome in the Cardiology Department of the Carlos J. Finlay Hospital from 2020 to 2022.Methods: A cross-sectional analytical study of 186 patients with this diagnosis was performed. Adverse events were defined as death, heart failure, post-infarction angina, malignant ventricular arrhythmias, shock and all combined.Results: Male sex (59.1%), average age 63.9 years, hypertension (69.4%) and lower topography (47.3%) were the prevalent baseline characteristics. Thrombolysis was the main method of reperfusion (66.7%). Combined adverse events occurred in 27.4% of the sample; heart failure (10.2%) was the most documented. Extensive anterior topography (p = 0.01; CI: 1.840-5.284), no reperfusion (p = 0.00; CI: 1.792-4.821) and hospital arrival time (≥ 12 hours) (p = 0.02; CI: 1.685-4.409) were associated with increased risk of major adverse cardiac events.Conclusions: Acute coronary syndrome with persistent ST-segment elevation predominated in men and hypertensives and thrombolysis was the most commonly employed method of reperfusion. Extensive anterior topography, non-reperfusion and delay of more than 12 hours were associated with the occurrence of in-hospital complications.

Introduction: Cardiotoxicity is a serious complication in oncologic therapies, so exposure to doxorubicin should be adequately monitored.Objective: To determine the echocardiographic evolution of doxorubicin cardiotoxicity in oncologic patients.Methods: Observational, analytical and prospective study was performed at the Medical-Surgical Research Center of Havana, Cuba between 2020 and 2023. Thirty-six oncologic patients treated with doxorubicin were included. Echocardiographic follow-up was performed at the beginning of the study and periodically for three years. Patients were divided into two groups, according to the presence of cardiotoxicity. For statistical analysis, absolute and relative frequencies were used for qualitative variables and the mean with standard deviation for quantitative variables. Relative risk with 95% confidence interval was used; p values < 0.05 were considered significant.Results: Women and breast cancer were more frequent (80 and 58 %, respectively). The average age was 57 ± 9.6 years. Twenty-two percent of patients developed cardiotoxicity; this was related to the presence of dyslipidemia (p = 0.04 [RR 6.1 CI: 1.1 RR 33.2]) and mean dose of doxorubicin (p < 0.01). The most affected echocardiographic variables at 3 years were ejection fraction (p < 0.02) and global longitudinal deformity (p < 0.04).Conclusions: Doxorubicin cardiotoxicity is frequent and the main affectations are evidenced in ejection fraction and global longitudinal deformity of the left ventricle.

Introduction: Aortic stenosis is a complex disease, valve replacement is the only effective treatment and the most frequent valve surgery in the world.Objectives: To describe the results of the use of continuous suturing in aortic valve replacement by mini-sternotomy.Methods: A cohort of patients operated on at the Hermanos Ameijeiras Hospital was followed up. The population included 48 patients with aortic valve replacement by ministernotomy between August 2016 and December 2021. Demographic, clinical, intraoperative and postoperative variables were defined.Results: Dyslipidaemia (83.3%) and hypertension (58.3%) were the most frequent risk factors. The average aortic clamping time was 63.64 minutes and the mean extracorporeal circulation time was 82.20 minutes. The most commonly used prosthesis, according to size, was the St. Jude number 21 (58.3%). There was only one patient with periprosthetic leak.Conclusions: The use of continuous suture is safe, decreases aortic clamping times and extracorporeal circulation, allows placement of larger prostheses without risk of leakage and avoids the use of Teflon.

Introduction: Cardiovascular complications are the main causes of mortality in cancer survivors.Objective: To design an index with the capacity to predict the development of early cardiotoxicity due to chemotherapy using a model based on risk factors.Methods: Analytical cohort study with 327 patients with breast cancer under chemotherapy treatment, followed in the Cardio-oncology office of the General Carlos Manuel de Céspedes Provincial Hospital of Bayamo municipality, Granma from January 15th, 2019 to May 25th, 2022. The construction of the index included the selection of risk factors and the calculation of their weights.Results: The model identified 10 factors with independent influence, including atrial fibrillation (adjusted OR 22.2), hemoglobin (adjusted OR 14.9), dyslipidemia (adjusted OR 5.74), corrected QT interval (adjusted OR 5.55), smoking (adjusted OR 4.83) and glomerular filtration rate (adjusted OR 4.49). A quantitative index was obtained that was subdivided into four risk categories and reached an average value in patients with cardiotoxicity of 9.35 points. The highest morbidity was represented in subjects classified as high (32.8 %) and very high (93.1 %) risk, indicating that the proposed index accurately classifies the risk of developing cardiotoxicity. The model achieved a good fit with all data (Hosmer and Lemeshow test p = 0, 640) and showed good discriminative ability (area under the curve 0.927).Conclusions: The proposed risk factor-based index predicts cardiotoxicity development and is considered ready for application.

Introduction: Cardiovascular risk factors, including menopause, are fundamental in atherogenesis and explain more than 90 % of myocardial infarctions in women and their increased morbidity and mortality.Objective: To describe some risk factors for atherosclerosis in women aged 40 to 64 years.Methods: A cross-sectional study was conducted in 332 women who attended the climacteric and menopause consultation of the University Polyclinic "19 de Abril" of the Plaza de la Revolución Municipality, during the period 2018-2020. The variables studied were: overweight and obesity, abdominal obesity, arterial hypertension, smoking, type 2 diabetes mellitus, hypercholesterolemia and sedentary lifestyle.Results: The predominant risk factors were sedentary lifestyle in 257 patients (77.4%), excess weight (overweight plus obesity) in 213 (64.2%), arterial hypertension in 176 (53.01%), smoking in 180 (52.4%) and abdominal obesity in 165 (49.7%). Fifty-one-point eight percent had more than three risk factors. Arterial hypertension possessed the highest risk associated with overweight/obesity and sedentary lifestyle, type 2 diabetes mellitus with overweight/obesity and arterial hypertension.Conclusions: Risk factors such as sedentary lifestyle, overweight and arterial hypertension are prevalent in middle-aged women, as well as the combination of some of them.