Introduction: Tuberous sclerosis complex is a rare genetic disorder leading to the growth of hamartomas in multiple organs, including cardiac rhabdomyomas. Children with symptomatic cardiac rhabdomyoma require frequent admissions to intensive care units, have major complications, namely, arrhythmias, cardiac outflow tract obstruction and heart failure, affecting the quality of life and taking on high healthcare cost. Currently, there is no standard pharmacological treatment for this condition, and the management includes a conservative approach and supportive care. Everolimus has shown positive effects on subependymal giant cell astrocytomas, renal angiomyolipoma and refractory seizures associated with tuberous sclerosis complex. However, evidence supporting efficacy in symptomatic cardiac rhabdomyoma is limited to case reports. The ORACLE trial is the first randomised clinical trial assessing the efficacy of everolimus as a specific therapy for symptomatic cardiac rhabdomyoma.Methods: ORACLE is a phase II, prospective, randomised, placebo-controlled, double-blind, multicentre protocol trial. A total of 40 children with symptomatic cardiac rhabdomyoma secondary to tuberous sclerosis complex will be randomised to receive oral everolimus or placebo for 3 months. The primary outcome is 50% or more reduction in the tumour size related to baseline. As secondary outcomes we include the presence of arrhythmias, pericardial effusion, intracardiac obstruction, adverse events, progression of tumour reduction and effect on heart failure.Conclusions: ORACLE protocol addresses a relevant unmet need in children with tuberous sclerosis complex and cardiac rhabdomyoma. The results of the trial will potentially support the first evidence-based therapy for this condition.

Introduction: During the current confinement situation arising from COVID-19, the population has been exposed to states where their quality of sleep has been affected. For this reason, this research determined the impact of social confinement by COVID- 19 on sleep quality in adults aged 18 to 60 years in the Dominican Republic. Materials and methods: This cross-sectional observational study was conducted in the Dominican Republic in 2020, specifically in adults aged 18 to 60 years. The survey was spread virtually via Google Forms. The variables used were categorical (sex, marital status, area of residence, academic level, employment, substance use) and continuous (age, sleep quality, stress level). Similarly, internationally approved surveys such as the Pittsburgh Sleep Quality Index were used. Results: The study population consisted of 821 participants (mean age 30.94 years, 74.3% women). The overall prevalence of poor sleep quality was 80.7%. The average score of PSQI was 8.56 ± 4.20. Moreover, the relationship between stress and poor quality of sleep stands out, obtaining a p = 0.00. Independent related factors of poor sleep quality included age and female gender. Conclusions: This study shows an overview of the different causes related to alterations in sleep quality. It is worth highlighting the exposure to high levels of stress during social isolation as a result of the pandemic caused by COVID-19, associated with poor quality of sleep. In addition, the female gender showed a greater tendency to present sleep disorders, as did alcohol consumers. Introducción: durante la actual situación de confinamiento surgida por el COVID-19, la población ha estado expuesta a estados emocionales donde su calidad de sueño se ha visto afectada. Por esta razón, esta investigación se ha propuesto determinar el impacto del aislamiento social por el COVID-19 en la calidad del sueño en adultos de 18 a 60 años en la República Dominicana. Materiales y métodos: este estudio observacional de corte transversal fue realizado en la República Dominicana en el 2020, específicamente en adultos de 18 a 60 años. La encuesta fue esparcida virtualmente vía Google Forms. Las variables utilizadas fueron categóricas (sexo, estado civil, zona de residencia, nivel académico, consumo de sustancias) y continuas (edad, calidad de sueño, nivel de estrés). De igual forma, se utilizaron encuestas aprobadas internacionalmente, como el Índice de Calidad de Sueño de Pittsburgh. Resultados: la población del estudio consistió en 821 participantes (edad media 30.94 años, 74.3 % mujeres). La prevalencia de una mala calidad del sueño fue de 80.7 %. La puntuación media del PSQI fue de 8.56 ± 4.20. Por otro lado, se destacó la relación del estrés con una mala calidad de sueño, obteniendo una p=0.00. Los factores independientes relacionados con la mala calidad del sueño incluyeron la edad y el sexo femenino. Conclusiones: el presente estudio muestra una visión general de las diferentes causas relacionadas a alteraciones en la calidad de sueño. Cabe destacar, la exposición a altos niveles de estrés durante el aislamiento social fruto de la pandemia causada por el COVID-19, asociado con una pobre calidad de sueño. Además, el sexo femenino mostró mayor tendencia a presentar trastornos de sueño, por igual los consumidores de alcohol.

Introducción: la malnutrición infantil representa uno de los problemas de salud pública más importantes de la República Dominicana (RD) y el mundo. A pesar de esto, actualmente, no existen estudios en la RD que describa el estado nutricional en los niños de la escuela primaria. Material y métodos: este estudio transversal describió las principales variables antropométricas en niños de 1ero a 6to de primaria en Santiago, RD, además de determinar la relación existente entre la antropometría y variables sociodemográficas. Resultados: de los 2,271 estudiantes estudiados, la media del peso fue 33,2 ± 11,4 kg, la talla fue 1,36 ± 0,13 m. La media del percentil fue 65,33 %. El 3.92 % (n=89) estuvo en bajo peso, el 17.57 % (n=399) estuvo en sobrepeso y el 22.94 % (n=521) estuvo en obesidad. Conclusión: el sobrepeso y la obesidad infantil fueron los trastornos más comunes en zonas rurales y urbanas, y tanto en centros privados como públicos.

Introduction: Asthma is a respiratory pathology characterized by chronic and reversible airway inflammation. It is associated with modifiable and non-modifiable risk factors that influence its control and exacerbations. In countries such as Puerto Rico (22.8 %) and Cuba (23 %), the prevalence of asthma is significantly higher than the global prevalence (6.6 %). Objective: To estimate the asthma status of adult asthmatic patients who attended the emergency or consultation of a center in the Dominican Republic based on absenteeism and the frequency of exacerbations of the pathology. Methods: An observational cross-sectional study was conducted on patients diagnosed with asthma in a private clinic in the Dominican Republic. Data on asthma presentation and sociodemographic characteristics were collected. A sample size of 95 participants was used. Data was collected safely and analyzed using statistical methods: chi-square tests and logistic regression. Primary and secondary analyses were performed to evaluate asthma control and associated comorbidities. Results: We obtained a sample of 92 participants of whom, in all control groups, reported having interrupted the purchase of medication due to its cost. Regarding work absenteeism, patients with total control lost 2 working days and patients with very poor control were absent for 9.96 days (p = 0.011). It was also found that patients with longer diagnosis time presented low asthma control (p=0.075). Conclusion: This project highlights the importance of implementing a comprehensive approach to patients with asthma, in order to reduce the influence of factors that negatively affect the control of the pathology. Introducción: El asma es una patología respiratoria caracterizada por inflamación crónica y reversible de las vías aéreas. Esta se asocia con factores de riesgo modificables y no modificables que influyen sobre su control y exacerbaciones. En países como Puerto Rico y Cuba, la prevalencia del asma es significativamente mayor a la global (22.8 %, 23 % y 6.6 %, respectivamente). Objetivo: Estimar el estado de asma de los pacientes adultos asmáticos que asistieron a la emergencia o a la consulta de un centro de República Dominicana a partir del absentismo y la frecuencia de exacerbaciones de la patología. Métodos: Se realizó un estudio observacional transversal de asmáticos en una clínica en República Dominicana. Tamaño de muestra de 95 participantes. Se realizaron análisis primarios y secundarios para evaluar el control del asma y las comorbilidades asociadas. Resultados: Muestra total de 92 participantes. Todos los grupos refieren haber interrumpido la compra de medicación debido a su costo. En cuanto al absentismo laboral, los pacientes con control total perdieron 2 días laborables y los pacientes con control muy pobre se ausentaron durante 9.96 días en el transcurso del último año (p = 0.011). Conclusión: Es importante abordar de manera integral a los pacientes con asma, con el fin de disminuir la influencia de factores que afectan de manera negativa el control de la patología.

Objective. The prognostic value of N-terminal procerebral natriuretic peptide (NT-proBNP) in patients with heart failure (HF) is well established. In contrast, its role as an early predictor of mortality in patients hospitalized for heart failure with preserved ejection fraction (HF-EF) and heart failure with reduced ejection fraction (HF-EF) is less well documented. Therefore, the objective of this study is to evaluate the usefulness and prognostic value of plasma NT-proBNP in these patients. Method. This retrospective observational study included 620 patients admitted for acute heart failure, classified into 3 groups according to their left ventricular ejection fraction (LVEF): HF-EF (LVEF ≥ 50%), HF-mEF (heart failure with ejection fraction mean) (LVEF 35-49%) and HF-rEF (LVEF 15001pg / ml (30.6%). The mortality rate increased significantly in patients with NT-proBNP concentrations > 15001 pg / ml (40%) and decreased with NT-proBNP levels <250 pg / ml (4%), compared to the other NT-proBNP groups. The mortality rate increased proportionally to elevated baseline NT-proBNP, regardless of LVEF. Conclusion. In patients hospitalized for an acute decompensated event with HF-cEF (LVEF ≥50%) and HF-mEF (LVEF 35-49%), plasma levels of NT-proBNP are a useful tool to predict early mortality, as for HF -FEr (LVEF <40%).