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Background: After its outbreak in China, the novel COronaVIrus Disease 19 is spreading across the globe. It is an emergency the world has never seen before., Main Text: The attention of health systems is mainly focused on COronaVIrus Disease 19 patients and on the risk that intensive care units might be overwhelmed by the serious pulmonary complications. Different countries are also attempting to establish infection prevention and control strategies which proved effective in China where the outbreak was initially reported. We reflect on important lessons to be learnt from different countries. The effects that infection prevention and control strategies, such as social distancing or isolation, can have on the care of millions of patients with non-communicable diseases, who may be indirectly affected, have not been taken into consideration so much., Conclusions: When dealing with COronaVIrus Disease 19, policy makers and healthcare personnel should consider the indirect effects on the treatment of non-communicable diseases.

Migration flows from China are largely directed towards the South of Europe, Chinese being now the third largest overseas-born population in Italy. The aim of the study was to investigate hypertension burden and self-reported sleep disorders among 1608 first-generation Chinese migrants aged 16 to 59 years settled in Prato and recruited in a cross-sectional survey. Hypertension was defined as systolic BP ≥ 140  mm Hg and/or diastolic BP ≥ 90  mm Hg or self-reported antihypertensive treatment; potential impact of sleep disorders was analyzed by logistic regression adjusted for age, sex, marital status, education, health insurance, current smoking, parental hypertension, alcohol drinking, overweight or obesity, central obesity, diabetes, high total cholesterol, and high triglycerides. Among the 1608 participants, 21.7% were hypertensive (age-standardized prevalence 19.2%; 95% Cl: 18.5-20.0); 54% of hypertensive subjects were aware of their condition; 70% of aware hypertensive subjects received drugs, and 39% of treated subjects had blood pressure controlled. Self-reported snoring increased the risk of hypertension; when compared with no snoring, the age- and sex-adjusted OR for hypertension of snoring 3 to 6  d/week was 2.11 (95% Cl: 1.48-3.01) and 2.48 (95% Cl: 1.79-3.46) of snoring every day. When compared with a sleep duration ≤ 5  hours, subjects with sleep duration of 7  hours had reduced risk of high triglycerides (adjusted OR: 0.66; 95% Cl: 0.43-0.95).Despite a high level of awareness, low treatment rates for hypertension were observed among Chinese participants, independently of health insurance. Sleep history is to be considered in screening and prevention programs., Competing Interests: The authors have no conflicts of interest to disclose.

Little information is available on the meanings of proteinuria in low-resource settings. A population-based, cross-sectional survey was performed in Yemen on 10 242 subjects aged 15-69 years, stratified by age, gender and urban/rural residency. Hypertension is defined as systolic blood pressure (BP) of 140 mm Hg and/or diastolic BP of 90 mm Hg, and/or self-reported use of antihypertensive drugs; diabetes is diagnosed as fasting glucose of 126 mg dl(-1) or self-reported use of hypoglycaemic medications; proteinuria is defined as +1 at dipstick urinalysis. Odds ratios (ORs) for associations were determined by multivariable logistic regression models. Prevalence (weighted to the Yemen population aged 15-69 years) of hypertension, diabetes and proteinuria were 7.5, 3.7 and 5.1% in urban, and 7.8, 2.6 and 7.3% in rural locations, respectively. Proteinuria and hypertension were more prevalent among rural dwellers (adjusted ORs 1.56; 95% confidence limit (Cl) 1.31-1.86, and 1.23; 1.08-1.41, respectively), diabetes being less prevalent in rural areas (0.70; 0.58-0.85). Differently from hypertension and diabetes, proteinuria was inversely related with age. Most importantly, 4.6 and 6.1% of urban and rural dwellers, respectively, had proteinuria in the absence of hypertension and diabetes. The approach of considering kidney damage as a consequence of hypertension and diabetes might limit the effectiveness of prevention strategies in low-income countries.

Aim: To establish percentile curves and to explore prevalence and correlates of central obesity among Yemeni children in a population based cross-sectional study., Methods: A representative sample of 3114 Yemeni children (1564 boys, 1550 girls) aged 6-19 years participating in the HYpertension and Diabetes in Yemen study was studied. Data collection was conducted at home by survey teams composed of two investigators of both genders. Study questionnaire included questions about demographics, lifestyle, and medical history. Anthropometric measurements included body weight, height, waist circumference (WC) and hip circumferences. Waist to hip ratio (WHR) and waist-to-height ratio (WHtR) were then calculated. Age and gender specific smoothed percentiles of WC, WHR, and WHtR were obtained using lambda-mu-sigma parameters (LMS method). The independent predictors of central obesity defined as (1) WC percentile ≥ 90(th); (2) WHtR ≥ 0.5; or (3) WC percentile ≥ 90(th) and WHtR ≥ 0.5, were identified at multivariate logistic regression analysis adjusted for age, gender, urban/rural location, years of school education, sedentary/active life-style., Results: Percentile curves for WC, WHR and WHtR are presented. Average WC increased with age for both genders. Boys had a higher WC than girls until early adolescence and thereafter girls had higher values than boys. WHR decreased both in boys and girls until early adolescence. Thereafter while in boys it plateaued in girls it continued to decrease. Mean WHtR decreased until early adolescence with no gender related differences and thereafter increased more in girls than in boys towards adult age. Prevalence of central obesity largely varied according to the definition used which was 10.9% for WC ≥ 90(th) percentile, 18.3% for WHtR ≥ 0.5, and 8.6% when fulfilling both criteria. At adjusted logistic regression WC ≥ 90(th) percentiles and WHtR ≥ 0.5 were less prevalent in rural than in urban areas (OR = 0.52, 95%CI: 0.41-0.67 and 0.66, 0.54-0.79 respectively), being more prevalent in children with sedentary lifestyle rather than an active one (1.52, 95%CI: 1.17-1.98 and 1.42, 95%CI: 1.14-1.75, respectively)., Conclusion: Yemeni children central obesity indices percentile curves are presented. Central obesity prevalence varied according to the definition used and was more prevalent in urban sedentary subjects.

Although globalization can contribute to increased blood pressure by spreading unhealthy behaviors, it also provides powerful means to tackle hypertension. The dissemination of information about and advice on cardiovascular prevention and facilitated contact with health services are valuable resources. To investigate the effects of urbanization, geographical area, and air temperature on hypertension burden and kidney damage, a survey was performed in 2008 with a door-to-door approach among urban and rural adult dwellers of three geographic areas (capital, inland, coast) of Yemen. Subjects (n=10 242) received two visits several days apart to confirm the diagnosis of hypertension. Proteinuria (dipstick test +1) was used as a marker of kidney damage. Prevalence rates were weighted to represent the Yemen population aged 15-69 years in 2008. Rates of hypertension and proteinuria progressively increased from the capital (6.4%; 95% confidence level (CI) 5.8-7.0 and 5.1%; 4.4-5.9, respectively), to inland areas (7.9%; 7.0-8.7 and 6.1%; 5.1-7.1), to the coastal area (10.1%; 8.9-11.4 and 8.9%; 7.3-10.4). When compared with urban dwellers, rural dwellers had similar hypertension prevalence (adjusted odds ratios (ORs) 1.03; 95% CI 0.91-1.17) but higher proteinuria rates (adjusted ORs 1.55; 1.31-1.85). Overall, home temperature was associated with a lower hypertension rate (adjusted OR 0.98; 0.96-0.99). This large population study reveals that the highest burden of hypertension and kidney damage is detectable in remote areas of the country.

Context: The prevalence of hypertension in developing countries is coming closer to values found in developed countries. However, surveys usually rely on readings taken at a single visit, the option to implement the diagnosis on readings taken at multiple visits, being limited by costs., Objective: To estimate more accurately the magnitude and extent of the resource that should be allocated to the prevention of hypertension., Design: Population-based cross-sectional survey with triplicate blood pressure (BP) readings taken on two separate home-visits., Setting: Rural and urban locations in three areas of Yemen (capital, inland and coast)., Participants: A nationally representative sample of the Yemen population aged 15-69 years (5063 men and 5179 women), with an overall response rate of 92% in urban and 94% in rural locations., Main Outcome Measure: Hypertension diagnosed as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or self-reported use of antihypertensive drugs., Results: Hypertension prevalence (age-standardised to the WHO world population 2001) based on fulfilling the same criteria on both visits (11.3%; 95% Cl 10.7% to 11.9%), was 35% lower than estimation based on the first visit (17.3%; 16.5% to 18.0%). Advanced age, blood glucose ≥7 mmol/l or proteinuria ≥1+ at dipstick test at visit one were significant predictors of confirmation at visit 2. The 959 participants found to be hypertensive at visit 1 or at visit 2 only and thus excluded from the final diagnosis had a rate of proteinuria (5.0%; 3.8% to 6.5%) comparable to rates of the general population (6.1%; 5.6% to 6.6%), and of subjects normotensive at both visits (5.6%; 5.1% to 6.2%). Only 1.9% of Yemen population classified at high or very high cardiovascular (CV) risk at visit 1 moved to average, low or moderate CV risk categories after two visits., Conclusions: Hypertension prevalence based on readings obtained after two visits is 35% lower than estimation based on the first visit, subjects were excluded from final diagnosis belonging to low CV risk classes.

The aim of this study was to evaluate the accuracy of a new-generation spiral multidetector computed tomographic scanner (the Brilliance 64) in the diagnosis of coronary in-stent restenosis (ISR). Forty-one patients with 87 coronary stents (70 drug-eluting stents) implanted were examined. Patients underwent multidetector computed tomography (MDCT) 6.7 +/- 6.9 days before scheduled invasive coronary angiography, using intravenous contrast enhancement. Images were reconstructed in multiple formats using retrospective electrocardiographic gating. Stents were viewed in their long and short axes and were visually classified for the presence or absence of binary ISR (diameter reduction >50%), including the 5-mm borders proximal and distal to the stent. ISR was found by invasive coronary angiography in 13 of the stented segments (15%) and in 8 patients (19%). Of these, 11 cases of ISR were correctly detected by MDCT; additionally, 1 severely calcified stented segment was considered as occluded by MDCT (sensitivity 84%, 95% confidence interval [CI] 54% to 98%). Seventy-three of 74 stented segments without ISR were correctly classified by MDCT (specificity 97%, 95% CI 93% to 100%), whereas 2 stented segments were classified as false-negative ISR. The positive predictive value was 92% (95% CI 84% to 97%), the negative predictive value was 97% (95% CI 90% to 99%), and predictive accuracy was 96% (95% CI 90% to 99%). After the exclusion of the calcified stented segment, the sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy were 84% (95% CI 74% to 91%), 100% (95% CI 96% to 100%), 100% (95% CI 96% to 100%), 97% (CI 90% to 99%), and 98% (95% CI 92% to 99%), respectively. In conclusion, even with improved scanner technology, the sensitivity for the detection of ISR was moderate (84%). Thus, further studies are needed to determine whether MDCT will be a clinically useful and cost-effective tool for the evaluation of ISR in the clinical arena.

To evaluate the efficacy of propafenone in converting recent-onset atrial fibrillation (AF) lasting < 7 days, 182 patients were treated intravenously with propafenone (Group 1, n = 98) and with placebo 0.9% saline solution (Group 2, n = 84) in a double blind study. The treatment was continued until sinus rhythm (SR) was restored, but for no more than 24 h. Eighty-nine patients treated with propafenone (90.8%) and 27 patients treated with placebo (32.1%) responded to the treatment and SR was restored (p < 0.0005). The mean time for SR restoration was 2.51 +/- 2.77 h in Group 1, and 17.15 +/- 7.8 h in Group 2 (p < 0.0005). In both groups the patients in whom SR was not restored (nonresponders) had larger left atrial size and longer duration of AF than responders at the onset of the arrhythmia. Nonresponders in Group 1 showed a decrease in mean ventricular rate (MVR) from 143 +/- 16 to 101 +/- 18 (p < 0.0005), while in the nonresponders in Group 2 no reduction of MVR was observed. Two patients whose SR was restored with propafenone had sinus standstill lasting 3.4 and 3.8 s, respectively. Propafenone used intravenously is an effective, quick, and safe drug for treating AF. Moreover, it significantly reduces MVR in nonresponders.

The purpose of this study was to evaluate the wavelength index (WLI) at three atrial sites in a group of 23 patients with recurrent episodes of lone paroxysmal atrial fibrillation (LPAF) and a control group (n = 20). All patients underwent programmed atrial stimulation (paced cycle length = 600 ms) at high, medium, and low lateral right atrial wall. P wave duration, sinus cycle length, and corrected sinus node recovery time were not significantly different between the two study groups. WLI was calculated according to the following formulas: atrial effective refractory period (AERP)/duration of atrial extrastimulus electrogram (A2) or AERP/A2 + atrial latency; and atrial functional refractory period (AFRP)/A2. WLI was significantly shorter in LPAF than in the control group at each of the paced atrial sites independently of the formula used. Duration of premature atrial electrogram appeared to play the major role in determining the difference in WLI between patients with paroxysmal atrial fibrillation and the control group.

It is well known that one of the most evident effects of prolonged and intense physical training is an increase of left ventricular mass. This increase could have a great influence on the diastolic properties of the heart, which can now be accurately evaluated by use of pulsed- and continuous-wave of Doppler echocardiography. The aim of this study was to evaluate the diastolic function of a group of superendurance athletes (professional bicyclists, exercising more than forty hours a week). Sixteen athletes (A), aged between twenty and thirty-one years, during the period of maximal training, and 16 age-matched controls (C) were studied. All subjects were evaluated at rest with mono-dimensional, two-dimensional, and Doppler echocardiography. Diastolic (DD) and systolic (SD) diameter, posterior wall (PW), and interventricular septum (IVS) thickness were also measured. The left ventricular mass (LVM) was calculated. Diastolic function was evaluated by calculating isovolumetric relaxation time (IVR) with continuous-wave Doppler, and deceleration time (DT), rapid filling flow peak (Ep), and atrial filling peak (Ap) were evaluated with pulsed Doppler echocardiography. The LVM (A: 354 +/- 47 g vs C: 170.6 +/- 33.4, p < 0.05), DD (A: 57.7 +/- 3.9 mm vs C: 50.5 +/- 2.7, p < 0.01), PW thickness (A: 11.9 +/- 0.7 mm vs C: 8.4 +/- 0.6, p < 0.05), and IVS thickness (A: 12.3 +/- 1 mm vs C: 8.2 +/- 0.9, p < 0.05) were significantly greater in the athletes than in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)