Trends and inequalities in (healthy) life expectancy by neighbourhood during the COVID-19 epidemic in Barcelona

OBJECTIVE

To analyse the trend in life expectancy (LE), healthy life expectancy (HLE) and socio-economic inequalities by neighbourhood in Barcelona from the pre-pandemic period (2018-2019) to the pandemic period (2020-2021).

METHOD

LE and HLE at birth were computed using the municipal register of inhabitants and quality of life (EuroQol) from the Barcelona Health Survey of 2016. Inequalities were assessed with the gap between quantiles of neighbourhood income.

RESULTS

In 2020, there was a reduction in LE among men (-1.98 years) and women (-2.44) and in HLE among men (-1.44). Socio-economic inequalities in LE and HLE between neighbourhoods widened since 2019 to 2021 (LE: from 3.92 to 4.86 years for men, and from 1.30 to 3.60 for women; HLE: from 6.88 to 7.70 years for men, and from 7.85 to 9.31 for women).

CONCLUSIONS

The pandemic has substantially reduced LE and HLE, with larger effects among low-income neighbourhoods, especially among women.

[Epidemiology of pseudotumor cerebri]

OBJECTIVE

To determine the epidemiology of pseudotumor cerebri (PTC) as seen in patients attending our ophthalmology department.

METHODS

The medical records of patients diagnosed with PTC in our hospital during a ten-year period (1994 to 2004) were obtained, with only those patients with PTC diagnosed in our ophthalmology department being considered. The following data were reviewed: sex, age at diagnosis, body mass index (BMI), opening cerebrospinal fluid (CSF) pressure, and the results of CT and MRI.

RESULTS

Twenty-nine patients were diagnosed with PTC during this time period. Twenty-six were females (89.6%) and 3 were males (10.4%). The calculated incidence of PTC in our population was 3.2 per 100.000 persons and 5.1 per 100.000 persons in the general population that attend our hospital.

CONCLUSION

The incidence of PTC was higher than that previously reported.

[Deposits of perfluoroctane after prolonged use as a post-operative vitreous substitute]

CASE REPORT

We describe a 72-year-old woman with a retinal detachment who underwent pars plana vitrectomy (PPV) and intraocular tamponade with a combination of silicone oil and perfluoro-n-octane as a postoperative vitreous tamponade. Three months later, plaque-like deposits of emulsified perfluoro-n-octane were visible on the inferior retina.

DISCUSSION

Deposits of emulsified perfluoro-n-octane, as epiretinal plaques, have not been previously been described as adverse reactions following the use of perfluorocarbons in the eye.

[Severe ocular side effects with Topamax]

CASE REPORTS

We describe 2 patients who developed ocular side effects during treatment with topiramate. One was a 16-year-old woman with generalized seizures who developed a homonymous hemianopia after using topiramate 125 mg per day for 12 weeks, and the other was a 24-year-old epileptic female who developed a bilateral maculopathy after using topiramate 150 mg per day for 8 weeks.

DISCUSSION

We identified two severe ocular adverse reactions from topiramate. Both reactions necessitated discontinuing the treatment, but the topiramate-associated maculopathy was irreversible.

Prevalencia y consumo de medicación antidiabética en la Comunidad de Madrid (1996-2002)

OBJECTIVES/AIMS

To determine the prevalence of diabetes mellitus treated with drugs and the prescription of drugs in diabetes (oral anti-diabetics and insulin) in the Community of Madrid between 1996-2002.

METHODS

We used the indirect method for estimating the rate of prevalence of diabetes based on antidiabetic drug in the Madrid Community. We studied the consumption or oral antidiabetics (OH) and insulin (IN) in all the Madrid Community Area from 1996 to 2002. To make consumption uniform we used the daily doses/1,000 inhabitants/day (DHD). The total consumption was obtained using the official billing data and the annual population data provided by the "Institute Madrileño de Salud".

RESULTS

The prevalence of diabetes mellitus increased 62.5% in the period studied, ranging from 1.6% in 1996 up to 2.6% in 2002. The DHD of oral drugs increased 87.8% from 12.2 in 1996 to 23.07 in 2002. The DHD of insulin decreased 28.2% from 3.99 in 1996 down to 3.11 in 2002. The OH/IN ratio increased 138%, from 3.11 to 7.42 in 2002. There is a tendency to increase biguanide and sulfonilureas with low risk of hypoglycemia. The total cost of insulin and oral medication increase every year, the increase of diabetic patients and the cost/DDD of the new drugs are factors that increase the total cost of diabetes.

CONCLUSIONS

The prevalence of diabetes mellitus treated with drugs increased in the Community of Madrid. There is a progressive use of oral drugs versus insulin, and a tendency to prescribe biguanide, sulfonylureas, especially gliclazide and glimepiride. A tendency to substitute insulin with insulin analogues is also seen in the use of insulin. The cost of diabetes increases yearly.

[Visual symptoms as the first manifestation of Alzheimer's disease]

CASE REPORT

We report a 59-year-old patient with difficulty in visual perception, difficulty reading and episodes of dyschromatopsia. The ocular examination was unremarkable. Structural neuro-imaging and neuro-ophthalmology tests were normal. Positron emission tomography scanning showed decreased metabolism in the parieto-occipital cortex bilaterally. Several months later the patient developed Alzheimer's disease.

DISCUSSION

Visual symptoms may be the first manifestation of Alzheimer's disease.

[Tuberculous papillitis]

CASE REPORT

We describe a 65-year-old asymptomatic woman with unilateral optic disc edema. Laboratory testing revealed a very marked positive PPD (25 mm) with dermatolysis. Anti-tuberculosis therapy resulted in complete resolution.

DISCUSSION

Tuberculosis should be considered in the diagnosis of papillitis, even in asymptomatic patients.

[Acute zonal outer occult retinopathy]

CASE REPORT

In May 2001 a 10-year-old boy, examined 3 months after the development of a large temporal scotoma in the right eye, was diagnosed with photopsia. The fundus appeared normal, visual field examination revealed a large temporal defect and, in July 2001, electroretinography (ERG) was nonrecordable. The left eye was normal. The field defects and ERG abnormality remained 4 years later, and the fundus developed a sharply demarcated zone of atrophy of the RPE.

DISCUSSION

We report a typical case of acute zonal occult outer retinopathy (AZOOR). Although rare, its symptoms are variable, and its shape is not characteristic, making it difficult to make the correct diagnosis.

Limb deficiencies in infants with trisomy 13

In 1994, we published a case with trisomy 13 who presented with ectrodactyly [Urioste et al., 1994: Am J Med Genet 53:390-392]. Recently, Kuschel and Gillessen-Kaesbach [2000: Am J Med Genet 90:87-88] presented an infant with trisomy 13 who also had oligodactyly, and they considered their case as the second published with oligodactyly. Here, we present three cases with any type of limb deficiencies who, together with the one that was published previously [Urioste et al., 1994], correspond to the total of 75 cases with trisomy 13 identified in the Spanish Collaborative Study of Congenital Malformations (ECEMC). This gives us a minimum frequency of 5.33% (CI:1.45-13.65) for trisomy 13 cases having limb deficiencies whereas these defects have a frequency of 5.51 per 10,000 births in our population. Consequently, we think that limb deficiencies could be considered as one of the defects that constitute the spectrum of anomalies observed in infants with trisomy 13.

[Role of retrograde endoscopic dilatation with balloon and derivation using double pig-tail catheter as an initial treatment for vesico-ureteral junction stenosis in children]

The purpose of this project is to determine the role of the retrogade endoscopic dilatation with balloon and derivation using double pig-tail catheter, as inicial treatment for the vesicoureteral junction stenosis in children. As there are no previous paediatric publications, we present the technical details and early results. From August 1994 to December 1995, we have treated 11 children (8 boys and three girls), whose ages were between 4 months and eleven years, with objectivated vesicoureteral stenosis. Six of which were primary obstructive megaureters, and the other five were secondary obstructive megaureters (two were secondary to posterior urethral valves, one to neurogenic bladder, another one to ectopic ureter, and the last one was secondary to previous antirreflux surgery). We have used rigid dilatators and 7 Fr balloons over guide. All the patients have improved from their obstruction (proved by renogram). In six of the cases only one dilatation was needed, and in the other five only two dilatations. Only two patients presented reflux (grade I and IV).

CONCLUSIONS

The endoscopic dilatation of the obstructive megaureter in children is possible, and reflux is rare.

Efficacy of senna versus lactulose in terminal cancer patients treated with opioids

The best laxative for terminal cancer patients treated with opioids still remains to be determined. This comparative study was conducted with the objective of determining treatment and cost efficiency for senna and lactulose in terminal cancer patients treated with opioids. The methodology used a randomized, open, parallel group design. The study was conducted in the Palliative Care Unit in one Madrid Health Care District. Ninety-one terminal cancer patients were randomized into two groups: A = treated with senna (starting with 0.4 mL daily), and B = treated with lactulose (starting with 15 mL daily) for a 27-day period. The main outcome measures were defecation-free intervals of 72 hr, days with defecation, general health status, and treatment cost. Laxative efficacy was analyzed through t test and analysis of variance. No difference was found between the laxatives in defecation-free intervals or in days with defecation. The final scores for general health status were similar in both groups. Given that the two treatments have similar efficacy and adverse effects, a recommendation is made for the use of senna because its cost is lower than lactulose.

[Tracheocele in childhood]

Three cases of male children presenting a tracheocele with the common feature of repeating catarrhal affections and frequent cough are described. Results of analytic and roentgenographic studies performed are commented. Authors consider that treatment should be expectant unless any complication is present, then surgery and/or antibiotic treatment should be undertaken.

[Use of skull radiography in craniocerebral injuries in childhood]

Authors review the usefulness of radiographic skull examination in childhood head injury. Two hundred and forty-two patients assisted at the emergency area were prospectively recorded during one year. Data of filiation and epidemiology and symptoms and signs posed by Leonidas as "high risk criteria" to have a skull fracture, were registered. AP and L X-Ray skull were performed in all patients. Thirteen (5.37%) of them had a fracture. Blood discharge from the ear and skull depressed fracture were more frequently found in the fracture group with statistically significant difference (p less than 0.05 and p less than 0.01, respectively). The probability of positive finding was 8.8 for blood discharge from the ear, 17.6 for skull depressed fracture and 4.4 for bilateral black eyes. Because of no correlation between clinical and radiological findings, the radiographic skull examination must be systematically performed in every head injury if the purpose is to diagnose a fracture.