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González-López MA. [Hidradenitis suppurativa]. Med Clin (Barc) 2024; 162:182-189. [PMID: 37968174 DOI: 10.1016/j.medcli.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic and debilitating inflammatory disease derived from the pilosebaceous unit, that affects approximately 1% of the general population. Clinically, it is characterized by inflammatory nodules, abscesses, and tunnels in the intertriginous areas of the body, especially in the axillary, inguinal, and anogenital regions. The etiopathogenesis of HS is not completely understood, although it is considered to be multifactorial, and the result of a complex interaction between genetic, hormonal, environmental, and immunological factors. In this sense, several proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-L-1β, and IL-17, among others, appear to play a crucial role in the pathogenesis of the disease. Currently, HS is recognized as a systemic disease associated with numerous comorbidities, including cardiovascular, immune-mediated, and endocrine-metabolic diseases. The treatment of HS must be carried out with an individualized and patient-oriented approach, considering medical and surgical treatment modalities.
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Affiliation(s)
- Marcos A González-López
- Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, España; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria, España; Real Academia de Medicina de Cantabria, Santander, Cantabria, España.
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Pérez Cavazos S, Aguayo Samaniego R, Díaz González JF, Vaquera Aparicio DN, Castillo Bejarano JI, de Los Santos AM. Chryseobacterium indologenes bacteremia in children with comorbidities. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:494-500. [PMID: 36707279 DOI: 10.1016/j.eimce.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/08/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION We describe a series of pediatric cases of bacteremia, all of them with a history of heart disease, use of central venous catheter and coinfections. A review of the published literature was carried out in order to enrich the available information. MATERIAL AND METHODS Pediatric observational retrospective study in which three cases of catheter-related bloodstream infection due to Chryseobacterium indologenes were reported in a period of two years in a tertiary care hospital. The analysis was performed with the cases previously reported in the literature. RESULTS Three cases were reported in our center in a period of two years. We found 26 cases reported in the literature. Overall mortality was 26.92% (7/26). CONCLUSIONS This microorganism with characteristics of multidrug resistance is associated with the use of medical devices in hospitalized patients. Early identification of this pathogen is crucial to starting treatment.
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Affiliation(s)
- Samantha Pérez Cavazos
- Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Rebeca Aguayo Samaniego
- Department of Pediatrics/Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - José Francisco Díaz González
- Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | | | - José Iván Castillo Bejarano
- Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Abiel Mascareñas de Los Santos
- Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico.
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Alén de Hoyos MJ, Romero-Collazos JF, Martín-Almena FJ, López-Ejeda N. Impact of obesity on the use of healthcare resources by young adults aged 18-45 years: Results of the 2017 National Health Survey. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 2:45-54. [PMID: 37268357 DOI: 10.1016/j.endien.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/14/2022] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Excess weight is a public health problem associated with a greater burden of chronic diseases and increased use of health resources. MATERIAL AND METHODS A subsample of Spanish adults aged 18-45 from the 2017 Spanish National Health Survey (N=7081) was used. The odds ratios of service utilisation of the group with BMI≥30kg/m2 were compared to the normal-weight group, using a model adjusted for sex, age, education, socioeconomic level, perceived health status and the presence of comorbidities. RESULTS In all, 12.4% of the sample had obesity. Of these, 24.8% visited their general physician, 37.1% attended emergency services and 6.1% were hospitalised during the last 12 months, which were significantly higher rates than in the normal-weight population (20.3%, 29.2%, 3.8%, respectively). However, 16.1% visited a physiotherapist and 3.1% used alternative therapies, compared to 20.8% and 6.4% in the healthy weight group. After adjusting for confounding factors, people with obesity were more likely to visit emergency services (OR: 1.225 [1.037-1.446]) and less likely to visit a physiotherapist (OR: 0.720 [0.583-0.889]) or use alternative therapies (OR: 0.481 [0.316-0.732]). CONCLUSIONS Spanish young adults suffering from obesity are more likely to use some health resources than those of normal weight, even after adjusting for socioeconomic variables and comorbidities, but they are less likely to attend physical therapy. The literature shows that these differences are less marked than in older ages, so this stage of life could be a window of opportunity for prevention to achieve better resource management.
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Affiliation(s)
- María José Alén de Hoyos
- Department of Human Nutrition and Dietetics, Faculty of Health Sciences, International University Isabel I de Castilla, 09003 Burgos, Spain
| | - Juan Francisco Romero-Collazos
- Department of Human Nutrition and Dietetics, Faculty of Health Sciences, International University Isabel I de Castilla, 09003 Burgos, Spain; Research Group EPINUT, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, 28040 Madrid, Spain; DeporClinic, Sports Medicine and Physiotherapy Clinic, 28823, Coslada, Madrid, Spain
| | - Francisco Javier Martín-Almena
- Department of Human Nutrition and Dietetics, Faculty of Health Sciences, International University Isabel I de Castilla, 09003 Burgos, Spain
| | - Noemí López-Ejeda
- Department of Human Nutrition and Dietetics, Faculty of Health Sciences, International University Isabel I de Castilla, 09003 Burgos, Spain; Research Group EPINUT, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, 28040 Madrid, Spain.
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Robustillo-Villarino M, Alegre-Sancho JJ, Martínez-Ferrer MDLÁ. Evaluation of the sexual sphere in patients with psoriatic arthritis. Reumatol Clin (Engl Ed) 2023; 19:249-254. [PMID: 37087380 DOI: 10.1016/j.reumae.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/03/2022] [Indexed: 04/24/2023]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic inflammatory disorder that primarily affects the joints and entheses. In addition, it is associated with depressive syndrome (DS), cardiovascular disease, hypertension (HT), diabetes mellitus (DM), obesity and psoriasis (Pso). There are few studies aimed to analyze the association of the involvement of the musculoskeletal system with sexual function (SF). METHODS A cross-sectional observational study was proposed in patients diagnosed with PsA, to whom self-administered validated questionnaires were applied to determine alterations in SF: MGH-SFQ and CSFQ-14, which assess the 4 domains of sexual function; Qualisex and DLQI designed for joint and dermatological pathology respectively, which explore sexual aspects. The objective was to describe the existence of altered sexual function in patients with PsA; analyze the association between sociodemographic characteristics, comorbidities (Pso, DS, cardiovascular risk factors) and the treatments of patients on SF; and describe differences of SF according to gender. RESULTS 72 patients were evaluated. It was observed that the variables of patients with PsA that were associated with lower scores in SF were gender and age in the CSFQ-14 and MGH-SFQ; annual incomes, treatment with NSAIDs, DL and depression were associated with worse results in some domains of the sexual sphere. CONCLUSIONS Patients with PsA had impaired SF, especially women, elder patiens, those with low annual incomes, DL and emotional disorders. Anti-inflammatory treatments were associated with better SF. Globally, the chronic disease and the psychological burden behaved as factors associated with sexual dysfunction.
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Ferreira AF, Azevedo MJ, Saraiva FA, Trindade F, Barros A, Leite S, Proença T, Sousa C, Machado AP, Leite-Moreira A, Sampaio-Maia B, Ramalho C, Falcão-Pires I. The PERInatal MYocardial Remodeling (PERIMYR) cohort study protocol: A prospective study of cardiac remodeling and "recovery" in pregnancy as a model to understand the impact of comorbidities in cardiac remodeling and reverse remodeling. Rev Port Cardiol 2023:S0870-2551(23)00173-7. [PMID: 36958578 DOI: 10.1016/j.repc.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Heart failure (HF) is among the leading causes of morbidity and mortality worldwide. Several conditions trigger left ventricular chronic pressure or volume overload, hypertrophy, systolic and diastolic dysfunction, leading to cardiac remodeling and a rapid progression toward HF. Therapeutic interventions elicit reverse remodeling (RR), a highly variable myocardial response that ranges from none to total ventricular structural/functional recovery. However, HF patients present several comorbidities and medications that mask a comprehensive molecular knowledge of RR and hinder the identification of potential biomarkers of its progression or prognosis. Therefore, instead of using this heterogeneous population or even animal models to understand myocardial remodeling, we propose studying pregnancy-induced cardiovascular remodeling and postpartum-induced RR. OBJECTIVES To assess cardiovascular functional and structural adaptations during pregnancy and in postpartum, characterizing the associated molecular changes; as well as to explore the impact of hypertension, obesity and diabetes on these processes. METHODS We will perform echocardiography and assess endothelial function and arterial stiffness (EndoPAT® and pulse wave velocity, respectively) and assess potential markers of remodeling and RR using plasma and urine samples from pregnant women. To translate to a HF context, we will determine the impact of risk factors (hypertension, obesity and diabetes) by studying subgroups of pregnant women with these comorbidities. RESULTS Not applicable Conclusion: We are convinced that understanding the impact of these comorbidities in such a homogeneous population, such as pregnant women, provides a valuable model to unveil the most relevant pathologic and often masked signaling pathways underlying cardiac remodeling and incomplete RR in a heterogeneous population, such as HF patients. Moreover, we expect to identify potential novel biomarkers of RR progression/prognosis more easily.
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Affiliation(s)
- A F Ferreira
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - M J Azevedo
- Faculdade de Medicina Dentária, Universidade do Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, The Netherlands
| | - F A Saraiva
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - F Trindade
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - A Barros
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - S Leite
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Anta Family Health Unit, Espinho/Gaia Healthcare Center, Espinho, Portugal
| | - T Proença
- Cardiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - C Sousa
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - A P Machado
- Center of Prenatal Diagnosis, Obstetrics Department, São João Hospital, Porto, Portugal
| | - A Leite-Moreira
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiothoracic Surgery Department, Centro Hospitalar de São João, Porto, Portugal
| | - B Sampaio-Maia
- Faculdade de Medicina Dentária, Universidade do Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
| | - C Ramalho
- Center of Prenatal Diagnosis, Obstetrics Department, São João Hospital, Porto, Portugal; Obstetrics, Gynecology and Pediatrics Department, Faculty of Medicine of the University of Porto, Portugal
| | - I Falcão-Pires
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
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López-Galisteo JP, Gavela-Pérez T, Mejorado-Molano FJ, Pérez-Segura P, Aragón-Gómez I, Garcés C, Soriano-Guillén L. Prevalence and risk factors associated with different comorbidities in obese children and adolescents. ENDOCRINOL DIAB NUTR 2022; 69:566-575. [PMID: 36347797 DOI: 10.1016/j.endien.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/18/2021] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Different obesity-related comorbidities already present in childhood, such as: vitamin D deficiency, impaired carbohydrate metabolism, dyslipidaemia, arterial hypertension and non-alcoholic steatohepatitis. In this study, we aim to analyse the prevalence of comorbidities and to determine the predictive factors that affect these comorbidities. MATERIAL AND METHODS Anthropometric, demographic and biochemical variables were collected from obese patients between six and 18 years of age. Subsequently, a statistical analysis was performed to describe the characteristics of the patients and the prevalence of comorbidities, as well as their predictive factors. RESULTS A total of 158 obese children (76 boys and 82 girls) with a mean age at diagnosis of 12.48 years and a BMI Z-score of +3.24 SDS were included. The most prevalent comorbidities were vitamin D deficiency (64.2%), insulin resistance (45.1%), dyslipidaemia (32.2%), hyperuricaemia (18.5%) and arterial hypertension (15%). Age, BMI Z-score, percentage of fat mass and male sex have been found to be predictors of these comorbidities. CONCLUSION Obese children and adolescents have a high prevalence of comorbidities. Once the diagnosis of obesity has been established, it would be very useful to identify early those patients with a higher risk of comorbidities, knowing their relationship with sex, age, BMI Z-score, percentage of fat mass and pubertal stage.
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Affiliation(s)
| | - Teresa Gavela-Pérez
- Unidad de Endocrinología Infantil, Servicio de Pediatría, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Francisco Javier Mejorado-Molano
- Unidad de Endocrinología Infantil, Servicio de Pediatría, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Pilar Pérez-Segura
- Unidad de Endocrinología Infantil, Servicio de Pediatría, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Isabel Aragón-Gómez
- Unidad de Endocrinología Infantil, Servicio de Pediatría, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Carmen Garcés
- Laboratorio de Lípidos, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Leandro Soriano-Guillén
- Unidad de Endocrinología Infantil, Servicio de Pediatría, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.
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Perpiñá M, Gómez-Bastero A, Trisán A, Martínez-Moragón E, Álvarez-Gutiérrez FJ, Urrutia I, Blanco-Aparicio M. Expert consensus recommendations for the management of asthma in older adults. Med Clin (Barc) 2022; 159:53.e1-53.e14. [PMID: 34226059 DOI: 10.1016/j.medcli.2021.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 10/20/2022]
Abstract
Asthma is a public health problem in patients of any age, although there is still a tendency to erroneously assume that it is almost always confined to children and young people. Epidemiological studies indicate that, from the sixth decade of life, the prevalence of this disease in countries such as Spain reaches 6-10%, with a higher prevalence among women aged 64 to 75 years. In addition, two-thirds of asthma deaths occur at this stage of life, resulting in a substantial number of hospital admissions, longer hospital stays and, from a finance point of view, significant direct economic costs. Asthma in older adults (65 years or older) is now a matter of great concern, the reality of which is underestimated and undertreated. It is therefore essential to establish appropriate recommendations for the diagnosis and treatment of asthma in the aging population. This consensus, which brings together the latest evidence available, was conceived with this objective. The proposed recommendations/conclusions are the result of a nominal consensus developed throughout 2019 and validated by panellists in successive rounds of voting.
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Affiliation(s)
- Miguel Perpiñá
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Andrea Trisán
- Servicio de Neumología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | | | - Isabel Urrutia
- Unidad de Asma y Enfermedades Ocupacionales-Medioambientales, Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia, España
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Lopez-Campos JL, Almagro P, Gómez JT, Chiner E, Palacios L, Hernández C, Navarro MD, Molina J, Rigau D, Soler-Cataluña JJ, Calle M, Cosío BG, Casanova C, Miravitlles M. Spanish COPD Guideline (GesEPOC) Update: Comorbidities, Self-Management and Palliative Care. Arch Bronconeumol 2022; 58:334-344. [PMID: 35315327 DOI: 10.1016/j.arbres.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022]
Abstract
The current health care models described in GesEPOC indicate the best way to make a correct diagnosis, the categorization of patients, the appropriate selection of the therapeutic strategy and the management and prevention of exacerbations. In addition, COPD involves several aspects that are crucial in an integrated approach to the health care of these patients. The evaluation of comorbidities in COPD patients represents a healthcare challenge. As part of a comprehensive assessment, the presence of comorbidities related to the clinical presentation, to some diagnostic technique or to some COPD-related treatments should be studied. Likewise, interventions on healthy lifestyle habits, adherence to complex treatments, developing skills to recognize the signs and symptoms of exacerbation, knowing what to do to prevent them and treat them within the framework of a self-management plan are also necessary. Finally, palliative care is one of the pillars in the comprehensive treatment of the COPD patient, seeking to prevent or treat the symptoms of a disease, the side effects of treatment, and the physical, psychological and social problems of patients and their caregivers. Therefore, the main objective of this palliative care is not to prolong life expectancy, but to improve its quality. This chapter of GesEPOC 2021 presents an update on the most important comorbidities, self-management strategies, and palliative care in COPD, and includes a recommendation on the use of opioids for the treatment of refractory dyspnea in COPD.
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Affiliation(s)
- José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - Pere Almagro
- Servicio de Medicina Interna, Hospital Universitario Mutua de Tarrasa, Tarrasa, Barcelona, España
| | | | - Eusebi Chiner
- Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, España
| | - Leopoldo Palacios
- Unidad de Gestión Clínica El Torrejón, Distrito Sanitario Huelva-Costa y Condado-Campiña, Huelva, España
| | - Carme Hernández
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Dispositivo transversal hospitalización a domicilio, Dirección Médica y Enfermera, Hospital Clínic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | | | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, Fuenlabrada, Madrid, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | | | - Myriam Calle
- Servicio de Neumología, Hospital Clínico San Carlos, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Borja G Cosío
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Baleares, España
| | - Ciro Casanova
- Unidad de Investigación, Servicio de Neumología, Hospital Universitario de La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Tenerife, España
| | - Marc Miravitlles
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
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Gómez-Huelgas R, Gómez-Peralta F, Cos FX. Evaluation of knowledge, barriers, and attitudes in the management of type 2 diabetes in elderly patients: A Delphi study on primary and hospital care. Rev Clin Esp 2022:S2254-8874(22)00016-9. [PMID: 35300934 DOI: 10.1016/j.rceng.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/23/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This work aims to explore attitudes regarding the management of elderly or frail patients with type 2 diabetes mellitus in the routine clinical practice of a multidisciplinary group of physicians in Spain. METHODS A mixed survey was used that included both Delphi and opinion, attitude, and behaviour (OAB) questions. Perceptions in primary care (n = 211) and hospital care (n = 80) were compared. RESULTS Consensus was obtained on all statements. Eighty-seven percent of participants considered that severe psychiatric disorders conditioned antidiabetic treatment and 72% that a psychocognitive assessment is as relevant as the assessment of other comorbidities. Hospital care physicians more frequently considered that comorbidity affects self-care (95.0% vs. 82.9%), that a lack of de-intensification is a form of therapeutic inertia (88.8% vs. 76.3%), that classifying older adults as frail is fundamental to choosing targets (96.3% vs. 87.7%), that de-intensification of antidiabetic treatment and control of cardiovascular risk factors should be considered in those over 80 years of age (90.0% vs. 78.7%), and that type 2 diabetes mellitus predisposes patients to sarcopenia (86.3% vs. 71.6%). The usefulness of clinical guidelines was more highly valued among primary care participants (79.1% vs. 72.5%). CONCLUSIONS There is room for improvement on several aspects of managing elderly or frail patients with type 2 diabetes mellitus, including inertia in treatment de-intensification, conducting a psychocognitive assessment, or the identification of frailty and sarcopenia.
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Melo Cruz MC, Santeularia Verges MT, Rius Llorens C, Gich Saladich IJ, Català Puigbó E. Influence of comorbidities on pain intensity in patients with chronic low back pain. Med Clin (Barc) 2021; 159:73-77. [PMID: 34879972 DOI: 10.1016/j.medcli.2021.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Chronic pain is a complex process that can vary depending on factors such as time evolution, mood, or even previous experiences. Our objective is to describe patient's characteristics from those who were referred with a diagnosis of low back pain in their first Pain Unit (PU) visit, and identify those factors that may interfere with their pain perception. METHODS Inferential analysis was carried out from data recorded in the PU database of the Hospital de la Santa Creu y Sant Pau in Barcelona, from November 2012 to November 2018. The average pain intensity during the last 24 hours (EVN24) was quantified using data from the BPI (Brief Pain Inventory) questionnaire. Using multiple linear regression, the independent predictive factors related to pain intensity (EVN24) were assessed. RESULTS Mood disorders (Degree of depresión acording HAD_D level) was the variable with the highest impact in pain perception. Using binary logistic regression for multivariate analysis, a model of variables related to pain intensity (EVN24) was obtained (R = 0.354, P < 0.001). CONCLUSIONS The specialized treatment of low back pain in PUs must take into account the patient's profile and especially the affective disorders and associated comorbidities since they predict a greater intensity of pain. Consequently, the associated comorbidity not only affects the greater intensity of pain, but the physical characteristics that accompany the patient throughout the process can influence or even compromise treatment.
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Affiliation(s)
- Martha Cristina Melo Cruz
- Servicio de Anestesiología y Reanimación. Unidad del Dolor Hospital de la Santa Creu i Sant Pau. Servicio de Epidemiología Clínica y Salud Pública del Hospital de la Santa Creu i Sant Pau , Barcelona, España.
| | - Maria Teresa Santeularia Verges
- Servicio de Anestesiología y Reanimación. Unidad del Dolor Hospital de la Santa Creu i Sant Pau. Servicio de Epidemiología Clínica y Salud Pública del Hospital de la Santa Creu i Sant Pau , Barcelona, España
| | - Carme Rius Llorens
- Servicio de Anestesiología y Reanimación. Unidad del Dolor Hospital de la Santa Creu i Sant Pau. Servicio de Epidemiología Clínica y Salud Pública del Hospital de la Santa Creu i Sant Pau , Barcelona, España
| | - Ignasi J Gich Saladich
- Servicio de Anestesiología y Reanimación. Unidad del Dolor Hospital de la Santa Creu i Sant Pau. Servicio de Epidemiología Clínica y Salud Pública del Hospital de la Santa Creu i Sant Pau , Barcelona, España
| | - Elena Català Puigbó
- Servicio de Anestesiología y Reanimación. Unidad del Dolor Hospital de la Santa Creu i Sant Pau. Servicio de Epidemiología Clínica y Salud Pública del Hospital de la Santa Creu i Sant Pau , Barcelona, España
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11
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Granel Villach L, Laguna Sastre JM, Ibáñez Belenguer JM, Beltrán Herrera HA, Queralt Martín R, Fortea Sanchis C, Martínez Ramos D, Escrig Sos VJ. Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure. Cir Esp 2021; 99:737-744. [PMID: 34776409 DOI: 10.1016/j.cireng.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 11/06/2020] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. MATERIAL AND METHODS Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2 years after surgery. RESULTS 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type 2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507 euros per month (P < 0.001). CONCLUSIONS In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term.
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Affiliation(s)
- Laura Granel Villach
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain.
| | - José Manuel Laguna Sastre
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain; Universitat Jaume I, Castellón, Spain
| | | | | | - Raquel Queralt Martín
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain
| | - Carlos Fortea Sanchis
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain
| | - David Martínez Ramos
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain
| | - Vicente Javier Escrig Sos
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain; Universitat Jaume I, Castellón, Spain
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12
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Carretero Gómez J, Ena J, Arévalo Lorido JC, Seguí Ripoll JM, Carrasco-Sánchez FJ, Gómez-Huelgas R, Pérez Soto MI, Delgado Lista J, Pérez Martínez P; Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine. Obesity is a chronic disease. Positioning statement of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine (SEMI) for an approach centred on individuals with obesity. Rev Clin Esp 2021; 221:509-16. [PMID: 34752262 DOI: 10.1016/j.rceng.2020.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Obesity is a chronic, complex and multifactorial metabolic disease involved in the development of chronic noncommunicable diseases such as type 2 diabetes mellitus, cardiovascular disease and cancer. The care of individuals with obesity is an essential part of the holistic approach provided by internal medicine to patients. MATERIAL AND METHODS Between September 2019 and January 2020, we distributed an online survey to the members of the Spanish Society of Internal Medicine. We prepared a Strengths, Weaknesses, Opportunities, and Threats analysis using the responses and, using the nominal group technique, developed the recommendations. RESULTS We obtained 599 responses. The respondents mean age was 44.4 ± 11 years, and 52.1% were women. Some 91.8% of the internists evaluate their patients to rule out the comorbidities associated with obesity, mainly type 2 diabetes mellitus (96.2%), cardiovascular disease (88.9%) and obesity-associated hypoventilation syndrome (73%), among others. Some 79.9% provided indications on lifestyle changes. Some 64.1% and 74.9% of the respondents knew the indications for the drugs and bariatric surgery, respectively. Some 93.8% and 83% of the respondents considered obesity and excess weight a chronic disease, and 88.7% considered it a disease of specific interest to internists, who should take an active and leading role in its treatment (85.3%). CONCLUSIONS The objective of the present document is to determine the degree of understanding and sensitivity of internists regarding the management of obesity and to develop a consensus of recommendations for the Spanish Society of Internal Medicine based on the scientific evidence and the opinion of its members.
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13
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Salinas-Aguirre JE, Sánchez-García C, Rodríguez-Sanchez R, Rodríguez-Muñoz L, Díaz-Castaño A, Bernal-Gómez R. Clinical characteristics and comorbidities associated with mortality in patients with COVID-19 in Coahuila (Mexico). Rev Clin Esp 2021; 222:288-292. [PMID: 34620580 PMCID: PMC8491924 DOI: 10.1016/j.rceng.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/21/2020] [Indexed: 11/24/2022]
Abstract
Background and objective This study aims to describe the characteristics of patients with COVID-19 in a state in northern Mexico and establish the comorbidities associated with mortality. Methods Patients with COVID-19, divided into survivors and non-survivors, were analyzed. The data were analyzed using the chi-square test, Student’s t-test, and Cox’s regression model. Results A total of 17,479 patients were included and mortality rate of 6.3% was reported. Age over 60 years (HR = 8.04; 95%CI 7.03–9.19), diabetes (HR = 1.63; 95%CI 1.40–1.89), high blood pressure (HR = 1.48; 95%CI 1.28–1.72), obesity (HR = 1.37; 95%CI 1.18–1.60) and chronic kidney disease (HR = 2.06; 95%CI 1.64–2.59) were significantly associated with mortality. Conclusions Diabetes, high blood pressure, obesity, and chronic kidney disease increased mortality among patients with COVID-19 in the population of Coahuila, Mexico. The factor that most contributed to risk of death was age over 60 years.
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Affiliation(s)
- J E Salinas-Aguirre
- Secretaría de Salud del Estado de Coahuila de Zaragoza, Coahuila de Zaragoza, Mexico
| | - C Sánchez-García
- Secretaría de Salud del Estado de Coahuila de Zaragoza, Coahuila de Zaragoza, Mexico.
| | - R Rodríguez-Sanchez
- Secretaría de Salud del Estado de Coahuila de Zaragoza, Coahuila de Zaragoza, Mexico
| | - L Rodríguez-Muñoz
- Secretaría de Salud del Estado de Coahuila de Zaragoza, Coahuila de Zaragoza, Mexico
| | - A Díaz-Castaño
- Secretaría de Salud del Estado de Coahuila de Zaragoza, Coahuila de Zaragoza, Mexico
| | - R Bernal-Gómez
- Secretaría de Salud del Estado de Coahuila de Zaragoza, Coahuila de Zaragoza, Mexico
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14
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Vila-Corcoles A, Satue-Gracia E, Vila-Rovira A, de Diego-Cabanes C, Forcadell-Peris MJ, Ochoa-Gondar O. Development of a predictive prognostic rule for early assessment of COVID-19 patients in primary care settings. Aten Primaria 2021; 53:102118. [PMID: 34139400 PMCID: PMC8162822 DOI: 10.1016/j.aprim.2021.102118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 01/16/2023] Open
Abstract
Objective To investigate possible early prognostic factors among middle-aged and older adult and explore prognostic rules stratifying risk of patients. Design Community-based retrospective cohort. Setting Primary Health Care Tarragona region. Participants 282 community-dwelling symptomatic patients ≥50 years with laboratory-confirmed COVID-19 (hospitalised and/or outpatient) during March-June 2020 in Tarragona (Southern Catalonia, Spain). Main outcome measurements Relationship between demographics, pre-existing comorbidities and early symptomatology (first 5-days) and risk of suffering critical outcome (ICU-admission/death) across clinical course was evaluated by logistic regression analyses, and simple predictive models were developed. Results Of the 282 cases (mean age: 65.9 years; 140 men), 154 (54.6%) were hospitalised (30 ICU-admitted) and 45 (16%) deceased. Median time follow-up in clinical course was 31 days (range: 30–150) for survivors and 14 days (range: 1–81) for deceased patients. In crude analyses, increasing age, male sex, some comorbidities (renal, respiratory or cardiac disease, diabetes and hypertension) and symptoms (confusion, dyspnoea) were associated with an increased risk to suffer critical outcome, whereas other symptoms (rinorrhea, myalgias, headache, anosmia/disgeusia) were related with reduced risk. After multivariable-adjustment only age/years (OR: 1.04; 95% CI: 1.01–1.07; p = 0.004), confusion (OR: 5.33; 95% CI: 1.54–18.48; p = 0.008), dyspnoea (OR: 5.41; 95% CI: 2.74–10.69; p < 0.001) and myalgias (OR: 0.30; 95% CI: 0.10–0.93; p = 0.038) remained significantly associated with increased or reduced risk. A proposed CD65-M prognostic rule (acronym of above mentioned 4 variables) showed a good correlation with the risk of suffering critical outcome (area under ROC curve: 0.828; 95% CI: 0.774–0.882). Conclusion Clinical course of COVID-19 is early unpredictable, but simple clinical tools as the proposed CD65-M rule (pending external validation) may be helpful assessing these patients in primary care settings.
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Affiliation(s)
- Angel Vila-Corcoles
- Primary Care Department Camp de Tarragona, Institut Catala de la Salut, Tarragona, Spain; Universitary Institute of Primary Care Research IDIAP Jordi Gol, Barcelona, Spain
| | - Eva Satue-Gracia
- Primary Care Department Camp de Tarragona, Institut Catala de la Salut, Tarragona, Spain; Universitary Institute of Primary Care Research IDIAP Jordi Gol, Barcelona, Spain
| | - Angel Vila-Rovira
- Universitary Institute of Primary Care Research IDIAP Jordi Gol, Barcelona, Spain
| | - Cinta de Diego-Cabanes
- Primary Care Department Camp de Tarragona, Institut Catala de la Salut, Tarragona, Spain
| | | | - Olga Ochoa-Gondar
- Primary Care Department Camp de Tarragona, Institut Catala de la Salut, Tarragona, Spain; Universitary Institute of Primary Care Research IDIAP Jordi Gol, Barcelona, Spain.
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15
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Gracia Baena JM, Calaf Vall I, Zielonka M, Marsal Mora JR, Godoy P, Worner Diz F. Risk factors and comorbidities associated with severe aortic stenosis: a case-control study. Rev Clin Esp 2021; 221:249-257. [PMID: 32591111 DOI: 10.1016/j.rce.2020.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Aortic stricture (AS) is one of the most prevalent cardiovascular diseases in individuals 65 years of age or older. A number of epidemiological studies have suggested that certain cardiovascular risk factors (CRFs) and comorbidities could be associated with AS. The aim of this study was to evaluate the association between CRFs and comorbidities and severe symptomatic AS in individuals 65 years of age or older in a Spanish healthcare region. PATIENTS AND METHODS We conducted an epidemiological case-control study from a single primary care centre. We collected information on exposure to CRFs and comorbidities and determined their association with AS, employing adjusted odds ratios (OR) and multiple logistic regression models. RESULTS The study included 102 cases (mean age, 77.6 years) and 221 controls (mean age, 75.5 years). The CRFs significantly associated with severe symptomatic AS were hypercholesterolaemia (OR, 2.67; p<.001), tobacco use (OR, 2.60; p<.001), hypertension (OR, 2.41; p=.010) and low HDL cholesterol readings (OR, 2.20; p=.007). The comorbidities significantly associated with severe symptomatic AS were carotid stenosis (OR, 14.5; p=.017), stroke (OR, 4.14; p=.024), chronic renal failure (OR, 3.78; p<.001) and low haemoglobin levels (OR, 0.76; p<.001). CONCLUSIONS Hypercholesterolaemia, tobacco use, arterial hypertension and low HDL cholesterol levels are the CRFs with a greater risk of severe AS. Furthermore, this disease is associated with a number of comorbidities (chronic renal failure, stroke, carotid stenosis and low haemoglobin levels), which could be markers of AS.
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Affiliation(s)
- J M Gracia Baena
- Servei de Cirurgia Cardíaca d'Adults, Hospital Universitari Vall d'Hebron, Barcelona, España; Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lérida, España.
| | - I Calaf Vall
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lérida, España
| | - M Zielonka
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lérida, España
| | - J R Marsal Mora
- Unitat de Suport a la Recerca Lleida, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España
| | - P Godoy
- Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lérida, España; CIBER de Epidemiología y Salud Pública CIBERESP, Barcelona, España; Agència de Salut Pública de Catalunya, Barcelona, España
| | - F Worner Diz
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lérida, España
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16
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Mena-Vázquez N, Pérez Albaladejo L, Manrique-Arija S, Romero Barco CM, Gómez Cano C, Ureña Garnica I, Fernández-Nebro A. Analysis of Clinical-Analytical Characteristics in Patients with Rheumatoid Arthritis and Interstitial Lung Disease: Case-Control Study. Reumatol Clin (Engl Ed) 2021; 17:197-202. [PMID: 31474500 DOI: 10.1016/j.reuma.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To study the differences between rheumatoid arthritis (RA)-interstitial lung disease (ILD) patients and RA patients without ILD in severity markers and disease activity and to identify factors associated with the presence of ILD in RA patients. PATIENTS AND METHODS Patients: RA-ILD patients selected from a multicentre cohort in Andalusia, Spain. CONTROLS RA-patients without ILD paired by sex, age and disease duration. PROTOCOL RA patients are reviewed every 3-6months in rheumatology consultation. All patients are reviewed according to a predetermined protocol with systematic data collection. OUTCOMES description of ILD type, differences in severity markers and disease activity in both groups. Other variables: ILD type by imaging technique (HRCT): nonspecific interstitial pneumonia (NSIP)/usual interstitial pneumonia (UIP). Lung function by PTF. Activity and severity markers of arthritis by DAS28-ESR, HAQ, RF, ACPA and erosions. Treatment with DMARD. STATISTICAL ANALYSIS descriptive and paired T-test or Chi-square test followed by binary logistic regression (DV: ILD in patients with RA). RESULTS Eighty-two patients were included, 41 RA-ILD and 41 RA controls. RF and ACPA positivity, serositis and osteoporosis were more frequent in RA-ILD patients. No significant differences in DAS28 were observed (P=.145) between RA-ILD and RA control patients. RA-ILD patients presented worse HAQ scores (P=.006). All patients were treated with disease modifying antirheumatic drugs (DMARDs). The risk of developing ILD in RA patients is tripled by a history of smoking or the presence of erosive arthritis (R2=.36). CONCLUSIONS The results of our study support the higher frequency of UIP and NSIP in RA patients. DLCO is the most sensitive parameter to detect ILD in RA patients. Our study showed that ILD in RA patients was associated with RA severity (presence of erosions and ACPA) and with a history of smoking.
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Affiliation(s)
- Natalia Mena-Vázquez
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | | | - Sara Manrique-Arija
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España.
| | | | | | - Inmaculada Ureña Garnica
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | - Antonio Fernández-Nebro
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
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17
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Gracia Baena JM, Calaf Vall I, Zielonka M, Marsal Mora JR, Godoy P, Worner Diz F. Risk factors and comorbidities associated with severe aortic stenosis: A case-control study. Rev Clin Esp 2021; 221:249-257. [PMID: 33998510 DOI: 10.1016/j.rceng.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/13/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Aortic stricture (AS) is one of the most prevalent cardiovascular diseases in individuals 65 years of age or older. A number of epidemiological studies have suggested that certain cardiovascular risk factors (CRFs) and comorbidities could be associated with AS. The aim of this study was to evaluate the association between CRFs and comorbidities and severe symptomatic AS in individuals 65 years of age or older in a Spanish healthcare region. PATIENTS AND METHODS We conducted an epidemiological case-control study from a single primary care centre. We collected information on exposure to CRFs and comorbidities and determined their association with AS, employing adjusted odds ratios (OR) and multiple logistic regression models. RESULTS The study included 102 cases (mean age, 77.6 years) and 221 controls (mean age, 75.5 years). The CRFs significantly associated with severe symptomatic AS were hypercholesterolaemia (OR, 2.67; p < .001), tobacco use (OR, 2.60; p < .001), hypertension (OR, 2.41; p = .010) and low HDL cholesterol readings (OR, 2.20; p = .007). The comorbidities significantly associated with severe symptomatic AS were carotid stenosis (OR, 14.5; p = .017), stroke (OR, 4.14; p = .024), chronic renal failure (OR, 3.78; p < .001) and low haemoglobin levels (OR, 0.76; p < .001). CONCLUSIONS Hypercholesterolaemia, tobacco use, arterial hypertension and low HDL cholesterol levels are the CRFs with a greater risk of severe AS. Furthermore, this disease is associated with a number of comorbidities (chronic renal failure, stroke, carotid stenosis and low haemoglobin levels), which could be markers of AS.
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Affiliation(s)
- J M Gracia Baena
- Servei de Cirurgia Cardíaca d'Adults, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lleida, Spain.
| | - I Calaf Vall
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Zielonka
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J R Marsal Mora
- Unitat de Suport a la Recerca Lleida, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol iGurina (IDIAPJGol), Barcelona, Spain
| | - P Godoy
- Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lleida, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - F Worner Diz
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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18
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Blázquez Cabrera JA, Sosa Henriquez M, Diaz-Curiel M, Sánchez Molini P, Arranz Garcia F, Montoya MJ, Filgueira J, Olmos JM, Coco-Martín MB, Castrillón JLP. Profile of patients who consult with internists for an osteoporosis assessment: The OSTEOMED registry. Rev Clin Esp 2021; 221:9-17. [PMID: 33998484 DOI: 10.1016/j.rceng.2020.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 06/05/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; p<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; p<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; p<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.
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Affiliation(s)
| | - M Sosa Henriquez
- Servicio de Medicina Interna, Hospital Universitario Insular, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - M Diaz-Curiel
- Servicio de Medicina Interna, Fundación Jiménez Díaz, Madrid, Spain
| | - P Sánchez Molini
- Servicio de Medicina Interna, Hospital de la Princesa, Madrid, Spain
| | - F Arranz Garcia
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain
| | - M J Montoya
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J Filgueira
- Servicio de Medicina Interna, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - J M Olmos
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - M B Coco-Martín
- Grupo de Investigación en Neurociencias Clínicas Aplicadas, Universidad de Valladolid, Valladolid, Spain
| | - J L Pérez Castrillón
- Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, Spain.
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Blázquez Cabrera JA, Sosa Henriquez M, Diaz-Curiel M, Sánchez Molini P, Arranz Garcia F, Montoya MJ, Filgueira J, Olmos JM, Coco-Martín MB, Castrillón JLP. Profile of patients who visit medical internists for an osteoporosis assessment: The OSTEOMED registry. Rev Clin Esp 2021; 221:9-17. [PMID: 32682689 DOI: 10.1016/j.rce.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; P<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; P<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; P<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.
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Affiliation(s)
| | - M Sosa Henriquez
- Servicio de Medicina Interna, Hospital Universitario Insular, Las Palmas de Gran Canaria, Las Palmas, España
| | - M Diaz-Curiel
- Servicio de Medicina Interna, Fundación Jiménez Díaz, Madrid, España
| | - P Sánchez Molini
- Servicio de Medicina Interna, Hospital de la Princesa, Madrid, España
| | - F Arranz Garcia
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, España
| | - M J Montoya
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J Filgueira
- Servicio de Medicina Interna, Hospital Universitario Gregorio Marañón, Madrid, España
| | - J M Olmos
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - M B Coco-Martín
- Grupo de Investigación en Neurociencias Clínicas Aplicadas, Universidad de Valladolid, Valladolid, España
| | - J L Pérez Castrillón
- Servicio de Medicina Interna. Hospital Universitario Río Hortega, Valladolid, España.
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20
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Granel Villach L, Laguna Sastre JM, Ibáñez Belenguer JM, Beltrán Herrera HA, Queralt Martín R, Fortea Sanchis C, Martínez Ramos D, Escrig Sos VJ. Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure. Cir Esp 2020; 99:S0009-739X(20)30379-1. [PMID: 33358406 DOI: 10.1016/j.ciresp.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 09/26/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. MATERIAL AND METHODS Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2years after surgery. RESULTS 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507euros per month (P<.001). CONCLUSIONS In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term.
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Affiliation(s)
- Laura Granel Villach
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España.
| | - José Manuel Laguna Sastre
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España; Universitat Jaume I, Castellón, España
| | | | | | - Raquel Queralt Martín
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España
| | - Carlos Fortea Sanchis
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España
| | - David Martínez Ramos
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España
| | - Vicente Javier Escrig Sos
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España; Universitat Jaume I, Castellón, España
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21
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Puig L, Ferrándiz C, Pujol RM, Vela E, Albertí-Casas C, Comellas M, Blanch C. Burden of Psoriasis in Catalonia: Epidemiology, Associated Comorbidities, Health Care Utilization, and Sick Leave. Actas Dermosifiliogr (Engl Ed) 2020; 112:425-433. [PMID: 33290733 DOI: 10.1016/j.ad.2020.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Epidemiologic and disease burden data are essential for disease control and optimal health care resource planning. The aims of this study were to estimate the epidemiologic burden of psoriasis and evaluate associated comorbidities, health care utilization, and sick leave. MATERIAL AND METHODS We collected data from the 2016 Catalan Health Survey (ESCA), the Catalan Registry of Morbidity and Utilization of Health Care Services (MUSSCAT) (2016), and the database of the Catalan Medical Evaluations Institute (ICAM) (2012-2016). RESULTS The prevalence of psoriasis in Catalonia according to 2016 ESCA data is approximately 1.8%. The MUSSCAT registry data indicate that the incidence has remained stable in recent years. The most common comorbidities associated with psoriasis are hypertension (35%) and diabetes (15%). Forty percent of patients with psoriasis have a moderate to high risk for death or high health resource utilization. Annual use of resources by psoriasis patients is high: they make a mean of 8.7 primary care visits, 2.8 outpatient visits, 0.5 emergency and day hospital visits, 0.2 mental health visits, and use 6.1 medications. Sick leave due to psoriasis or psoriatic arthritis accounted for 0.04% of all cases. CONCLUSIONS The prevalence of psoriasis in Catalonia is high at 1.8%. The disease burden is also high, both in terms of comorbidities and health care utilization.
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Affiliation(s)
- L Puig
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - C Ferrándiz
- Servicio de Dermatología, Hospital Universitari Germans Trías i Pujol (HUGiT), Badalona, España
| | - R M Pujol
- Servicio de Dermatología, Hospital del Mar, Barcelona, España
| | - E Vela
- Àrea de Sistemes d'Informació, Servei Català de la Salut, Barcelona, España
| | - C Albertí-Casas
- Subdirecció General d'Avaluacions Mėdiques, Departament de Salut, Barcelona, España
| | - M Comellas
- Outcomes'10, Espaitec 2, Universitat Jaume 1, Castelló de la Plana, España
| | - C Blanch
- Health Economics & Market Access Novartis Farmacéutica, Barcelona, España.
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22
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García Rey E, Cruz Pardos A, Ortega Chamarro J. Mortality as a competition risk factor in the survival analysis of the results of the type of fixation of the total hip prosthesis in octogenarian patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:99-107. [PMID: 33172799 DOI: 10.1016/j.recot.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/01/2020] [Accepted: 07/12/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Total hip replacement (THR) is challenging in octogenarians due to associated comorbidities and controversy regarding fixation type. We ask whether cemented THR is superior to uncemented THR in patients above the age of 80 years. MATERIAL AND METHODS A total of 382 patients (441 hips) aged 80 years or older who underwent THR between 2004 and 2015 were analysed. A cemented THR was implanted in 196 hips (group 1), an uncemented THR with a grit-blasted stem in 121 (group 2), or with a porous-coated stem in 124 (group 3). Patients in group 1 had a higher mean age, more comorbidities and osteoporotic bone. Survival analysis was calculated using cumulative incidence function to account for the competing risk of death. RESULTS Medical complications rate was similar. There were 3post-operative fractures: one in group 2 and 2in group 3. Competing risk analysis showed that the cumulative incidence of revision for any cause was 2.3 in group 1, 6.0 in group 2 and 4.1 in group 3 at 10years, and the cumulative incidence of revision for aseptic loosening was 1.2 in group 1, 3.7 in group 2 and 0 in group 3 at the same period. CONCLUSIONS THR presents an acceptable number of adverse events for octogenarian patients. Despite uncemented fixation was satisfactory, the higher peri-prosthetic fracture rate worsens results in this group.
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Affiliation(s)
- E García Rey
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-Idi Paz, Madrid, España.
| | - A Cruz Pardos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-Idi Paz, Madrid, España
| | - J Ortega Chamarro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-Idi Paz, Madrid, España
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23
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Miró Ò, Alquézar-Arbé A, Llorens P, Martín-Sánchez FJ, Jiménez S, Martín A, Burillo-Putze G, Jacob J, García-Lamberechts EJ, Piñera P, Del Castillo JG. [Comparison of the demographic characteristics and comorbidities of patients with COVID-19 who died in Spanish hospitals based on whether they were or were not admitted to an intensive care unit]. Med Intensiva 2020; 45:14-26. [PMID: 33158594 PMCID: PMC7522623 DOI: 10.1016/j.medin.2020.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/02/2020] [Accepted: 09/17/2020] [Indexed: 12/22/2022]
Abstract
Objetivo Describir las características demográficas y de comorbilidad de los pacientes con COVID-19 fallecidos en hospitales españoles durante el brote pandémico de 2020 y compararlas según si ingresaron o no en una Unidad de Cuidados Intensivos (UCI) antes del fallecimiento. Métodos Análisis secundario de los pacientes de la cohorte SIESTA (formada por pacientes COVID de 62 hospitales españoles) fallecidos durante la hospitalización. Se recogieron sus características demográficas y comorbilidades, individuales y globalmente, estimadas mediante el índice de comorbilidad de Charlson (ICC). Se identificaron los factores independientes relacionados con ingreso en UCI, y se realizaron diversos análisis de sensibilidad para contrastar la consistencia de los hallazgos del análisis principal. Resultados Se incluyeron los 338 pacientes de la cohorte SIESTA fallecidos; de ellos, 77 (22,8%) accedieron a una UCI previamente al fallecimiento. En el análisis multivariable, tres de las 20 características basales analizadas se asociaron independientemente con ingreso en UCI de los pacientes fallecidos: demencia (no hubo pacientes fallecidos con demencia que ingresasen en UCI; OR = 0, IC 95% = no calculable), cáncer activo (OR = 0,07, IC 95% = 0,02-0,21) y edad (< 70 años: OR = 1, referencia; 70-74 años: OR = 0,21, IC 95% = 0,08-0,54; 75-79 años: OR = 0,21, IC 95% = 0,08-0,54; ≥ 80 años: OR = 0,02, IC 95% = 0,01-0,05). La probabilidad de ingreso en UCI de los pacientes que fallecieron disminuyó significativamente al aumentar el ICC, incluso tras ajustarla por edad (ICC 0 puntos: OR = 1, referencia; ICC 1 punto: OR = 0,36, IC 95% = 0,16-0,83; ICC 2 puntos: OR = 0,36, IC 95% = 0,16-0,83; ICC > 2 puntos: OR = 0,09, IC 95% = 0,04-0,23). Los análisis de sensibilidad no mostraron diferencias destacables respecto al análisis principal. Conclusiones El perfil de los pacientes COVID fallecidos sin ingresar en UCI se ajustó a lo observado en la práctica médica habitual antes de la pandemia, y las características basales que limitaron su ingreso fueron la edad y la carga de comorbilidad global, especialmente la demencia y el cáncer activo.
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Affiliation(s)
- Ò Miró
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España.
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - P Llorens
- Servicio de Urgencias, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | - S Jiménez
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - A Martín
- Servicio de Urgencias, Hospital Universitario de Móstoles, Madrid, España
| | - G Burillo-Putze
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - E J García-Lamberechts
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | - P Piñera
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, España
| | - J González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
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Sanchis J, García Acuña JM, Raposeiras S, Barrabés JA, Cordero A, Martínez-Sellés M, Bardají A, Díez-Villanueva P, Marín F, Ruiz-Nodar JM, Vicente-Ibarra N, Alonso Salinas GL, Rigueiro P, Abu-Assi E, Formiga F, Núñez J, Núñez E, Ariza-Solé A. Comorbidity burden and revascularization benefit in elderly patients with acute coronary syndrome. ACTA ACUST UNITED AC 2020; 74:765-772. [PMID: 32778402 DOI: 10.1016/j.rec.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the interaction between comorbidity burden and the benefits of in-hospital revascularization in elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). METHODS This retrospective study included 7211 patients aged ≥ 70 years from 11 Spanish NSTEACS registries. Six comorbidities were evaluated: diabetes, peripheral artery disease, cerebrovascular disease, chronic pulmonary disease, renal failure, and anemia. A propensity score was estimated to enable an adjusted comparison of in-hospital revascularization and conservative management. The end point was 1-year all-cause mortality. RESULTS In total, 1090 patients (15%) died. The in-hospital revascularization rate was 60%. Revascularization was associated with lower 1-year mortality; the strength of the association was unchanged by the addition of comorbidities to the model (HR, 0.61; 95%CI, 0.53-0.69; P=.0001). However, the effects of revascularization were attenuated in patients with renal failure, peripheral artery disease, and chronic pulmonary disease (P for interaction=.004, .007, and .03, respectively) but were not modified by diabetes, anemia, and previous stroke (P=.74, .51, and .28, respectively). Revascularization benefits gradually decreased as the number of comorbidities increased (from a HR of 0.48 [95%CI, 0.39-0.61] with 0 comorbidities to 0.83 [95%CI, 0.62-1.12] with ≥ 5 comorbidities; omnibus P=.016). The results were similar for the propensity score model. The same findings were obtained when invasive management was considered the exposure variable. CONCLUSIONS In-hospital revascularization improves 1-year mortality regardless of comorbidities in elderly patients with NSTEACS. However, the revascularization benefit is progressively reduced with an increased comorbidity burden. Renal failure, peripheral artery disease, and chronic lung disease were the comorbidities with the most detrimental effects on revascularization benefits.
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Affiliation(s)
- Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Jose María García Acuña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Sergio Raposeiras
- Servicio de Cardiología. Hospital Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, Spain
| | - Jose A Barrabés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Alberto Cordero
- Servicio de Cardiología, Hospital Clínico Universitario de San Juan, Alicante, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - Francisco Marín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Juan M Ruiz-Nodar
- Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Gonzalo L Alonso Salinas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Ramón y Cajal de Madrid, Madrid, Spain
| | - Pedro Rigueiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología. Hospital Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, Spain
| | - Frances Formiga
- Servicio de Medicina Interna, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Gil-Rodrigo A, Miró Ò, Piñera P, Burillo-Putze G, Jiménez S, Martín A, Martín-Sánchez FJ, Jacob J, Guardiola JM, García-Lamberechts EJ, Espinosa B, Martín Mojarro E, González Tejera M, Serrano L, Agüera C, Soy E, Llauger L, Juan MÁ, Palau A, Del Arco C, Rodríguez Miranda B, Maza Vera MT, Martín Quirós A, Tejada de Los Santos L, Ruiz de Lobera N, Iglesias Vela M, Torres Garate R, Alquézar-Arbé A, González Del Castillo J, Llorens P. Analysis of clinical characteristics and outcomes in patients with COVID-19 based on a series of 1000 patients treated in Spanish emergency departments. Emergencias 2020; 32:233-241. [PMID: 32692000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To describe the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) treated in hospital emergency departments (EDs) in Spain, and to assess associations between characteristics and outcomes. MATERIAL AND METHODS Prospective, multicenter, nested-cohort study. Sixty-one EDs included a random sample of all patients diagnosed with COVID-19 between March 1 and April 30, 2020. Demographic and baseline health information, including concomitant conditions; clinical characteristics related to the ED visit and complementary test results; and treatments were recorded throughout the episode in the ED. We calculated crude and adjusted odds ratios for risk of in-hospital death and a composite outcome consisting of the following events: intensive care unit admission, orotracheal intubation or mechanical ventilation, or in-hospital death. The logistic regression models were constructed with 3 groups of independent variables: the demographic and baseline health characteristics, clinical characteristics and complementary test results related to the ED episode, and treatments. RESULTS The mean (SD) age of patients was 62 (18) years. Most had high- or low-grade fever, dry cough, dyspnea, and diarrhea. The most common concomitant conditions were cardiovascular diseases, followed by respiratory diseases and cancer. Baseline patient characteristics that showed a direct and independent association with worse outcome (death and the composite outcome) were age and obesity. Clinical variables directly associated with worse outcomes were impaired consciousness and pulmonary crackles; headache was inversely associated with worse outcomes. Complementary test findings that were directly associated with outcomes were bilateral lung infiltrates, lymphopenia, a high platelet count, a D-dimer concentration over 500 mg/dL, and a lactate-dehydrogenase concentration over 250 IU/L in blood. CONCLUSION This profile of the clinical characteristics and comorbidity of patients with COVID-19 treated in EDs helps us predict outcomes and identify cases at risk of exacerbation. The information can facilitate preventive measures and improve outcomes.
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MESH Headings
- Adolescent
- Adult
- Age Distribution
- Age Factors
- Aged
- Aged, 80 and over
- Betacoronavirus
- COVID-19
- Cardiovascular Diseases/epidemiology
- Child
- Child, Preschool
- Comorbidity
- Coronavirus Infections/diagnosis
- Coronavirus Infections/epidemiology
- Coronavirus Infections/mortality
- Coronavirus Infections/therapy
- Emergency Service, Hospital/statistics & numerical data
- Female
- Hospital Mortality
- Humans
- Infant
- Infant, Newborn
- Intubation, Intratracheal/statistics & numerical data
- Logistic Models
- Male
- Middle Aged
- Neoplasms/epidemiology
- Obesity/complications
- Odds Ratio
- Pandemics
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/mortality
- Pneumonia, Viral/therapy
- Prognosis
- Prospective Studies
- Respiration Disorders/epidemiology
- Respiration, Artificial/statistics & numerical data
- SARS-CoV-2
- Sex Distribution
- Spain/epidemiology
- Symptom Assessment
- Young Adult
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Affiliation(s)
- Adriana Gil-Rodrigo
- Servicio de Urgencias, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), España
| | - Òscar Miró
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Pascual Piñera
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, España
| | | | - Sònia Jiménez
- Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Alfonso Martín
- Servicio de Urgencias, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | | | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Begoña Espinosa
- Servicio de Urgencias, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), España
| | | | | | - Leticia Serrano
- Servicio de Urgencias, Hospital Politécnico La Fe, Valencia, España
| | - Carmen Agüera
- Servicio de Urgencias, Hospital Costa del Sol, Marbella, Málaga, España
| | - Ester Soy
- Servicio de Urgencias, Hospital Universitari Doctor Josep Trueta, Girona, España
| | - Lluís Llauger
- Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, España
| | | | - Anna Palau
- Servicio de Urgencias, Hospital Universitari Joan XXIII, Tarragona, España
| | | | | | - María Teresa Maza Vera
- Servicio de Urgencias, Complejo Hospitalario Universitario de Vigo. Hospital Álvaro Cunqueiro de Vigo, Pontevedra, España
| | | | | | | | | | - Raquel Torres Garate
- Servicio de Urgencias, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - Pere Llorens
- Servicio de Urgencias, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), España
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Carretero Gómez J, Ena J, Arévalo Lorido JC, Seguí Ripoll JM, Carrasco-Sánchez FJ, Gómez-Huelgas R, Pérez Soto MI, Delgado Lista J, Pérez Martínez P. Obesity is a chronic disease. Positioning statement of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine (SEMI) for an approach centred on individuals with obesity. Rev Clin Esp 2020; 221:S0014-2565(20)30180-6. [PMID: 32723530 DOI: 10.1016/j.rce.2020.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Obesity is a chronic, complex and multifactorial metabolic disease involved in the development of chronic noncommunicable diseases such as type 2 diabetes mellitus, cardiovascular disease and cancer. The care of individuals with obesity is an essential part of the holistic approach provided by internal medicine to patients. MATERIAL AND METHODS Between September 2019 and January 2020, we distributed an online survey to the members of the Spanish Society of Internal Medicine. We prepared a Strengths, Weaknesses, Opportunities, and Threats analysis using the responses and, using the nominal group technique, developed the recommendations. RESULTS We obtained 599 responses. The respondents mean age was 44.4±11 years, and 52.1% were women. Some 91.8% of the internists evaluate their patients to rule out the comorbidities associated with obesity, mainly type 2 diabetes mellitus (96.2%), cardiovascular disease (88.9%) and obesity-associated hypoventilation syndrome (73%), among others. Some 79.9% provided indications on lifestyle changes. Some 64.1% and 74.9% of the respondents knew the indications for the drugs and bariatric surgery, respectively. Some 93.8% and 83% of the respondents considered obesity and excess weight a chronic disease, and 88.7% considered it a disease of specific interest to internists, who should take an active and leading role in its treatment (85.3%). CONCLUSIONS The objective of the present document is to determine the degree of understanding and sensitivity of internists regarding the management of obesity and to develop a consensus of recommendations for the Spanish Society of Internal Medicine based on the scientific evidence and the opinion of its members.
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Affiliation(s)
| | - J Ena
- Servicio de Medicina Interna, Hospital de la Marina Baixa, Alicante, España
| | | | - J M Seguí Ripoll
- Servicio de Medicina Interna, Hospital Universitario San Juan de Alicante, Alicante, España
| | - F J Carrasco-Sánchez
- Servicio de Medicina Interna, Hospital Universitario Juan Ramón Jiménez, Huelva, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna. Hospital Regional Universitario de Málaga, Málaga. Instituto de Investigación Biomédica de Málaga Institute of Biomedical (IBIMA). CIBER Physiopathology of Obesity and Nutrition - CIBERobn
| | - M I Pérez Soto
- Servicio de Medicina Interna, Hospital Universitario de Vinalopó, Elche, Alicante, España
| | - J Delgado Lista
- Servicio de Medicina Interna, Hospital Universitario Reina Sofía/Universidad de Córdoba/ Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba. CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
| | - P Pérez Martínez
- Unidad de Lípidos y Arterioesclerosis, Hospital Universitario Reina Sofía/Universidad de Córdoba/ Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba. CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
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Carrascosa JM, Morillas-Lahuerta V. Comorbidities in Atopic Dermatitis: An Update and Review of Controversies. Actas Dermosifiliogr (Engl Ed) 2020; 111:481-486. [PMID: 32401719 DOI: 10.1016/j.ad.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/28/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022] Open
Abstract
Early onset of atopic dermatitis is considered a risk factor for any atopic disease, especially when the skin manifestations are persistent, and there is sensitization to multiple allergens and a family history. Atopic dermatitis is also thought to exert a synergistic effect with inflammation present in other organs and systems, as is the case in other immune-mediated inflammatory diseases. Most studies show a statistical relationship between obesity, various cardiometabolic comorbid conditions, and atopic dermatitis; this relationship is more marked when the disease is more severe or active over a longer period of time. However, other than epidemiological assessments, few studies provide in-depth evidence of functional mechanisms. Furthermore, various confounders, such as deterioration of quality of life and the psychological aspects of atopic dermatitis, could favor unhealthy habits, including a sedentary lifestyle and smoking, which could in turn increase the risk of morbidity and mortality. Chronic inflammation with differentiation toward a type 2 helper T cell pattern and the long-term use of immunosuppressants could be risk factors for some hematologic diseases, although they could exert a protective effect in others. The presence of proinflammatory cytokines capable of crossing the blood-brain barrier could favor an increase in the frequency of psychological diseases (eg, depression, anxiety, and suicidal ideation) and attention disorders (eg, attention deficit or hyperactivity). However, other factors, such as chronic pruritus and sleep disorders, could also play roles.
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Affiliation(s)
- J M Carrascosa
- Servicio de Dermatología. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona, España.
| | - V Morillas-Lahuerta
- Servicio de Dermatología. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona, España
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Romero-González M, Marín E, Guzmán-Parra J, Navas P, Aguilar JM, Lara JP, Barbancho MÁ. [Relationship between parental stress and psychological distress and emotional and behavioural problems in pre-school children with autistic spectrum disorder]. An Pediatr (Barc) 2020; 94:99-106. [PMID: 32402776 DOI: 10.1016/j.anpedi.2020.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/08/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The Autistic Spectrum Disorders (ASD) are characterised by general deficits in social communication, stereotypes, and restricted interests. The ASD have a high prevalence of additional psychiatric disorders that make their daily functioning worse, and reduces the quality of life of them and their families. MATERIAL AND METHODS In an effort to identify family environmental characteristics that may influence in the course of additional psychiatric disorders, this study has focused on the symptoms of parental stress and psychological distress as possible risk factors. A cross-section study was carried out on the relationship between the stress and psychological distress of the parents and its relationship with co-existing psychopathology in a population of pre-school children with ASD (2-6 years). RESULTS AND CONCLUSIONS High levels of stress and psychological distress of the parents arealready associated, since early childhood, with co-existing psychiatric symptoms, specifically with emotional and behavioural problems (p < 0.05). However, further longitudinal studies are needed for a better understanding of the causal relationship between these variables and their possible bidirectional relationship.
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Affiliation(s)
- Marina Romero-González
- U.G.C Salud Mental, Hospital Regional Universitario de Málaga, IBIMA, Málaga, España; Unidad de Salud Cerebral, CIMES, Facultad de Medicina, Universidad de Málaga, IBIMA, Málaga, España.
| | - Ester Marín
- U.G.C Salud Mental, Hospital Regional Universitario de Málaga, IBIMA, Málaga, España
| | - Jose Guzmán-Parra
- U.G.C Salud Mental, Hospital Regional Universitario de Málaga, IBIMA, Málaga, España
| | - Patricia Navas
- Unidad de Salud Cerebral, CIMES, Facultad de Medicina, Universidad de Málaga, IBIMA, Málaga, España; U.G.C Neurociencias, Servicio de Neurofisiología, Clínica HRU Málaga, Málaga, España
| | - Juan Manuel Aguilar
- U.G.C Salud Mental, Hospital Regional Universitario de Málaga, IBIMA, Málaga, España
| | - J Pablo Lara
- Unidad de Salud Cerebral, CIMES, Facultad de Medicina, Universidad de Málaga, IBIMA, Málaga, España
| | - Miguel Ángel Barbancho
- Unidad de Salud Cerebral, CIMES, Facultad de Medicina, Universidad de Málaga, IBIMA, Málaga, España
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Marques da Silva P, Lima MJ, Neves PM, Espiga de Macedo M. Prevalence of cardiovascular risk factors and other comorbidities in patients with hypertension in Portuguese primary health care populations: The PRECISE study. Rev Port Cardiol 2019; 38:427-437. [PMID: 31307727 DOI: 10.1016/j.repc.2018.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/15/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cardiovascular (CV) disease is the leading cause of death in Portugal. The prevalence of hypertension, the second most important risk factor accounting for overall disability-adjusted life years (DALYs), is significant. Hypertension rarely occurs in isolation, but is usually associated with other determining risk factors that contribute to greater overall CV risk. The main objective of the PRECISE study, a cross-sectional epidemiological study, was to determine the prevalence of other concomitant modulating CV risk factors in hypertensive patients. METHODS The prevalence of other CV risk factors and target organ damage was assessed in 2848 hypertensive patients of both sexes followed in primary health care centers. Demographic, anthropometric and clinical data and antihypertensive and lipid-lowering therapies prescribed were collected. RESULTS Of the study population (mean age 65.8±11.0 years, 60.8% women), 98.0% were treated for hypertension, but only 56.7% had controlled blood pressure. Hypercholesterolemia was the most frequent concomitant CV risk factor (82.1%), followed by sedentary behavior (71.4%). Prevalences of concomitant modulating risk factors were significantly different between the sexes and age groups. Overall, 81.7% of hypertensive patients had three or more concomitant CV risk factors. CONCLUSIONS The study showed that, in Portugal, hypertensive patients have a high prevalence of other CV risk factors, confirming the need to identify these factors, calculate overall CV risk and continuously monitor the care provided and the results obtained.
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Affiliation(s)
- Pedro Marques da Silva
- Núcleo de Investigação Arterial, Medicina 4, Hospital de Santa Marta - CHLC, EPE, Lisboa, Portugal.
| | - Maria João Lima
- Consulta de Hipertensão Arterial, Medicina Interna, Hospital São João - CHSJ, EPE, Lisboa, Portugal
| | - Pedro Macedo Neves
- Consulta de Hipertensão e Doença Vascular, Centro Hospitalar do Médio Ave, EPE, Lisboa, Portugal
| | - Mário Espiga de Macedo
- Programa Nacional para as Doenças Cérebro-Cardiovasculares, Direção-Geral de Saúde, Lisboa, Portugal
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Zimman S, Comparatore MV, Vulcano AF, Absi ML, Mazzuoccolo LD. Hidradenitis Suppurativa: Estimated Prevalence, Clinical Features, Concomitant Conditions, and Diagnostic Delay in a University Teaching Hospital in Buenos Aires, Argentina. Actas Dermosifiliogr (Engl Ed) 2019; 110:297-302. [PMID: 30885385 DOI: 10.1016/j.ad.2019.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa is a chronic recurrent systemic inflammatory disease that mainly involves large skin folds. It develops when pilosebaceous units become blocked, leading to the formation of painful nodules, abscesses, fistulas, and scarring. The impact of this disease on quality of life is great. OBJECTIVES To describe the prevalence and clinical features of hidradenitis suppurativa in patients treated at Hospital Italiano de Buenos Aires and determine the frequency of comorbidities and time to diagnosis in this population. MATERIAL AND METHODS Retrospective descriptive cross-sectional study. Information was extracted from the computerized clinical records of all patients with a diagnosis of hidradenitis suppurativa managed in Hospital Italiano de Buenos Aires between July 2012 and October 2017. RESULTS Our initial search of the records yielded 180 cases; the diagnosis was confirmed in 66 cases. Sixty-five percent of the patients were women, and the mean age was 37 years. The prevalence of this diagnosis was 0.02%. The armpits, vulva, and groin were the locations most frequently affected. Smoking, overweight, and obesity were the most commonly recorded concomitant conditions. Male sex and perianal and gluteal locations were associated with severity. Time until diagnosis varied widely, ranging from diagnosis at the first visit in some cases to as long as 142 months and 21 visits. CONCLUSIONS Our findings are consistent with the literature on hidradenitis suppurativa. This is the first Argentinian study to describe the prevalence of this disease as well as the concomitant conditions found and the rate of diagnostic error.
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Affiliation(s)
- S Zimman
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M V Comparatore
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A F Vulcano
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M L Absi
- Servicio de Ginecología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L D Mazzuoccolo
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Juárez-Vela R, Sarabia-Cobo CM, Antón-Solanas I, Vellone E, Durante A, Gea-Caballero V, Pérez-Calvo JI. Investigating self-care in a sample of patients with decompensated heart failure: A cross-sectional study. Rev Clin Esp 2019; 219:351-359. [PMID: 30850119 DOI: 10.1016/j.rce.2018.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is scarce evidence relating to self-care of heart failure (HF) in Spain. In particular, there is a need to establish patients' level of understanding of HF, as well as their ability to recognise signs and symptoms of decompensation. PATIENTS AND METHODS Cross-sectional study to determine the level of self-care in a population of Spanish patients admitted to hospital with a primary diagnosis of decompensated HF. A convenience sample of 108 patients (50 women and 58 men) aged 83±8 were recruited to participate in this study. RESULTS The Self-Care of Heart Failure Index version 6.2 was used to quantify self-care in our sample. Mean and standard deviation from the Self-Care of Heart Failure Index self-care maintenance subscale were: a) "exercise for 30 minutes", 1±1; b) "forget to take one of your medicines", 2±2; c) "ask for low-salt items when eating out or visiting others", 2±1. A percentage of 67.6 had experienced shortness of breath or ankle swelling in the past month. However, the vast majority of our patients were unlikely to independently implement a remedy: a) reduce salt, 2±1; b) reduce fluid intake, 1±1; c) take an extra diuretic, 1±1. Over 50% of our sample felt confident or very confident at following professional advice (3±1), keeping themselves free of symptoms (3±1), recognizing changes in their condition (3±1) and evaluating the significance of such changes (3±1). CONCLUSIONS HF patients have a significantly low level of self-care when compared with HF patients from other countries, especially when it comes to managing their condition. Self-care promotion should be a priority for all healthcare professionals involved in the care and management of HF patients.
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Affiliation(s)
- R Juárez-Vela
- Grupo de Investigación en Insuficiencia Cardiaca e Insuficiencia Fisiopatológica de la Interacción Cardiorrenal (IFICaR), Escuela de Enfermería, Instituto de Investigación Sanitaria de Aragón-ISS, Universidad de La Rioja, Logroño, La Rioja, España
| | - C M Sarabia-Cobo
- Facultad de Enfermería, Universidad de Cantabria, Santander, España
| | - I Antón-Solanas
- Facultad de Ciencias de la Salud, Universidad San Jorge, Zaragoza, España
| | - E Vellone
- Departamento de Biomedicina y Prevención, Universidad de Roma Tor Vergata, Roma, Italia
| | - A Durante
- Departamento de Biomedicina y Prevención, Universidad de Roma Tor Vergata, Roma, Italia
| | - V Gea-Caballero
- Grupo de Investigación Emergente Acreditado en Arte y Ciencia del Cuidado GREIACC, Escuela de Enfermería La Fe (Valencia), IIS La Fe, Valencia, España.
| | - J I Pérez-Calvo
- Grupo de Investigación en Insuficiencia Cardiaca e Insuficiencia Fisiopatológica de la Interacción Cardiorrenal (IFICaR), Servicio de Medicina Interna, Hospital Clínico Lozano Blesa, Facultad de Medicina, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón-ISS, Zaragoza, España
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García-Abellán J, Del Río L, García JA, Padilla S, Vivancos MJ, Del Romero J, Asensi V, Hernando A, García-Fraile L, Masiá M, Gutiérrez F. Risk of cancer in HIV-infected patients in Spain, 2004-2015. The CoRIS cohort study. Enferm Infecc Microbiol Clin 2019; 37:502-508. [PMID: 30679001 DOI: 10.1016/j.eimc.2018.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/12/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cancer is a leading cause of death in individuals with HIV. METHODS The incidence of cancer in HIV patients of the CoRIS cohort in the 2004-2009 and 2010-2015 periods has been analysed and compared to the incidence in the Spanish general population, estimated from data of the Spanish Cancer Registry Network. RESULTS Between January 2004 and November 2015, 12,239 patients were included in CoRIS and 338 incident cancer cases were diagnosed. The overall incidence of cancer per 100,000 persons-year (95% CI) was 702.39 (629.51-781.42) with no significant differences between the 2periods. A 38% of the incident cancer cases were AIDS defining cancers (ADC) and 62% non-AIDS defining cancers (NADC). In the period 2010-2015, there was a significant decrease in the incidence of ADC (standardised incidence ratio [SIR]); 95% CI: 0.38; 0.21-0.66) and NADC predominated. Compared to the general population, the incidence of cancer was double in men with HIV. Higher relative risks were documented (SIR; 95% CI) for Hodgkin's lymphoma in both sexes (males: 8.37, 5.13-14.17; females: 21.83, 2.66-47.79), non-Hodgkin's lymphoma in males (5.30, 2.86-8.45) and cervical cancer (7.43, 3.15-13.87) and head and neck cancer (3.28, 1.21-5.82) in women. CONCLUSIONS The overall incidence of cancer in individuals with HIV is higher than in the Spanish general population, and it has remained stable since 2004 with a current predominance of NADC. These data suggest that additional efforts should be made in the prevention and the early detection of cancer in these patients.
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Affiliation(s)
- Javier García-Abellán
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche y Universidad Miguel Hernández, Alicante, España.
| | - Lorena Del Río
- Servicio de Oncología Médica, Hospital General Universitario de San Juan de Alicante y Universidad Miguel Hernández, Alicante, España
| | - José A García
- Instituto de Investigación Operativa, Universidad Miguel Hernández, Alicante, España
| | - Sergio Padilla
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche y Universidad Miguel Hernández, Alicante, España
| | - María Jesús Vivancos
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Víctor Asensi
- Servicio de Enfermedades Infecciosas, Hospital Central de Asturias, Oviedo, España
| | - Asunción Hernando
- Instituto de Investigación, Hospital Universitario Doce de Octubre. Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, España
| | - Lucio García-Fraile
- Servicio de Enfermedades Infecciosas, Hospital Universitario La Princesa, Madrid, España
| | - Mar Masiá
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche y Universidad Miguel Hernández, Alicante, España
| | - Félix Gutiérrez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche y Universidad Miguel Hernández, Alicante, España
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Sanllorente-Sebastián R, de Vicente-Lorenzo JM, Mediavilla-Herrera FJ, Gutiérrez-García S, Alario-Poza IS, Bustinza-Beaskoetxea Z. Case report: serratus intercostal plane block/BRILMA and sedation for mastectomy in a high risk patient. Rev Esp Anestesiol Reanim (Engl Ed) 2019; 66:46-48. [PMID: 30115502 DOI: 10.1016/j.redar.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 06/08/2023]
Abstract
Breast cancer surgery can benefit from regional anaesthesia techniques, which can be used as a sole anaesthetic procedure in some cases where risk for general anaesthesia is high. Regional anaesthesia allows early recovery, reduces postoperative opioid and non opioid analgesics consumption and helps early home discharge, reducing thus costs. We present a case of an 87-year-old woman with multiple comorbidities who underwent breast cancer surgery. The patient was successfully surgically treated under serratus intercostal plane block anaesthesia. We discuss the use and benefits of the serratus intercostal plane block in thoracic procedures.
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Affiliation(s)
| | - J M de Vicente-Lorenzo
- Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, España
| | - F J Mediavilla-Herrera
- Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, España
| | - S Gutiérrez-García
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Burgos, Burgos, España
| | - I S Alario-Poza
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Burgos, Burgos, España
| | - Z Bustinza-Beaskoetxea
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Burgos, Burgos, España
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Doria M, Viadé J, Palomera E, Pérez R, Lladó M, Costa E, Huguet T, Reverter JL, Serra-Prat M, Franch-Nadal J, Mauricio D. Short-term foot complications in Charcot neuroarthropathy: A retrospective study in tertiary care centres in Spain. ACTA ACUST UNITED AC 2018; 65:479-485. [PMID: 30108031 DOI: 10.1016/j.endinu.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. PATIENTS AND METHODS A retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events. RESULTS Signs of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1). CONCLUSIONS Almost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy.
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Affiliation(s)
- Montserrat Doria
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain; Diabetic Foot Unit, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Jordi Viadé
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain
| | | | - Ricard Pérez
- Department of Radiology, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Melcior Lladó
- Diabetic Foot Unit, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Elisabet Costa
- Department of Endocrinology and Nutrition, University Hospital Josep Trueta, Girona, Spain
| | - Teresa Huguet
- Diabetic Foot Unit, University Hospital Mutua, Terrassa, Spain
| | - Jordi Lluís Reverter
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain
| | | | - Josep Franch-Nadal
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Spain; Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Dídac Mauricio
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain; Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Spain; Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
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Abstract
In recent years, we have witnessed an increase in the number of cases of type 2 diabetes mellitus (DM2) in children and adolescents, which has paralleled the increase in the worldwide prevalence of obesity. Although screening the general population does not appear to be cost-effective, special attention should be paid to children with excess weight, obesity or other factors that predispose them to a state of insulin resistance. When faced with the diagnosis of childhood DM2, the presence of comorbidities (such as hypertension, dyslipidemia and microalbuminuria) should be assessed, and appropriate treatment and follow-up should be administered to prevent the onset of complications, given that the DM2 in this population group will last longer than that started in adulthood.
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Affiliation(s)
- M L Calero Bernal
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España; Grupo de trabajo de Diabetes y Obesidad de SEMI, España.
| | - J M Varela Aguilar
- Grupo de trabajo de Diabetes y Obesidad de SEMI, España; Servicio de Medicina Interna, Hospital Virgen del Rocío, Sevilla, España; CIBER de Epidemiología y Salud Pública, Sevilla, España
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Díaz AR, Navas PZ. Risk factors for trochanteric and femoral neck fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:134-141. [PMID: 29429857 DOI: 10.1016/j.recot.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/06/2017] [Accepted: 09/17/2017] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The differences between the two main types of fracture of proximal end of the femur, trochanteric and cervical fractures, are still a subject of study, and could be the key to a better understanding of its pathophysiology and prevention. The aim of this study is to determine whether epidemiological differences in the distribution of risk factors associated with hip fracture exist between these two entities. PATIENTS AND METHOD A descriptive cross-sectional study of 428 patients over the age of 65 admitted for trochanteric or cervical fractures in 2015, in which gender, age, previous diagnosis, external causes associated with fracture and place of the event were recorded. RESULTS There were 220 patients with a cervical fracture (51.4%) and 208 patients with a trochanteric fracture (48.6%). The average age was higher in the trochanteric fracture, observing a constant increase with age only in women with trochanteric fractures. Cervical fracture showed a significant association with cerebrovascular disease (p=0.039) and trochanteric fracture with accidental falls (p=0.047) and presence of 5-9 previous diseases (p=0.014). A regression analysis maintained this association in the case of a cerebrovascular disease (OR 2.6, 95%CI 1.1-6.4) and the presence of 5-9 diseases (OR 1.5, 95%CI 1.1-2.3). CONCLUSIONS Trochanteric fractures are associated with women patients of more advanced ages, 5-9 previous diseases and accidental falls. Cerebrovascular disease shows a higher prevalence in cervical fractures.
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Affiliation(s)
- A R Díaz
- Graduado en Medicina, Área de Traumatología, Facultad de Medicina, Málaga
| | - P Z Navas
- FEA COT, Unidad de Cadera, HCU Virgen de la Victoria, Facultad de Medicina, Málaga.
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Lecube A, Monereo S, Rubio MÁ, Martínez-de-Icaya P, Martí A, Salvador J, Masmiquel L, Goday A, Bellido D, Lurbe E, García-Almeida JM, Tinahones FJ, García-Luna PP, Palacio E, Gargallo M, Bretón I, Morales-Conde S, Caixàs A, Menéndez E, Puig-Domingo M, Casanueva FF. Prevention, diagnosis, and treatment of obesity. 2016 position statement of the Spanish Society for the Study of Obesity. Endocrinol Diabetes Nutr 2017; 64 Suppl 1:15-22. [PMID: 27543006 DOI: 10.1016/jendonu.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/18/2016] [Indexed: 05/23/2023]
Affiliation(s)
- Albert Lecube
- Servicio de Endocrinología y Nutrición, Unidad de Obesidad, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida, CIBERDEM (CIBER de Diabetes y Enfermedades Metabólicas Asociadas, ISCIII), Universitat de Lleida, Lleida, España.
| | - Susana Monereo
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Miguel Ángel Rubio
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, España
| | | | - Amelia Martí
- Departamento de Ciencias de la Alimentación y Fisiología, Universidad de Navarra, CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, España
| | - Javier Salvador
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, España
| | - Lluís Masmiquel
- Servicio de Endocrinología y Nutrición, Unidad de Obesidad, Hospital de Son Llàtzer, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IdISPa), Universitat de les Illes Balears, Palma de Mallorca, España
| | - Alberto Goday
- Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - Diego Bellido
- Servicio Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol (CHUF), SERGAS, Ferrol, A Coruña, España
| | - Empar Lurbe
- Departamento de Pediatría, Consorcio Hospital General. CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Universidad de Valencia, Valencia, España
| | - José Manuel García-Almeida
- Complejo Hospitalario de Málaga (Virgen de la Victoria), Hospital Quirón-Salud Málaga, Universidad de Málaga, Málaga, España
| | - Francisco José Tinahones
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Universidad de Málaga, Málaga, España
| | - Pedro Pablo García-Luna
- Unidad de Nutrición Clínica y Dietética, Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Enrique Palacio
- Servicio de Endocrinología y Nutrición, Hospital Universitario Nuestra Señora de Candelaria (HUNSC), Santa Cruz de Tenerife, España
| | - Manuel Gargallo
- Servicio de Endocrinología y Nutrición, Hospital Virgen de la Torre, Madrid, España
| | - Irene Bretón
- Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Salvador Morales-Conde
- Unidad de Innovación Cirugía Mínima Invasiva, Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Assumpta Caixàs
- Servicio de Endocrinología y Nutrición, Hospital Universitari Parc Taulí de Sabadell, Corporació Sanitària Parc Taulí, Institut de Recerca I3PT, Universitat Autònoma de Barcelona, Sabadell, España
| | - Edelmiro Menéndez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias (HUCA). Departamento de Medicina, Universidad de Oviedo, Oviedo, España
| | - Manel Puig-Domingo
- Servicio de Endocrinología y Nutrición, Hospital Germans Trias i Pujol, Badalona. Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
| | - Felipe F Casanueva
- Departamento de Medicina, Universidad de Santiago, Compejo Hospitalario Universitario de Santiago (CHUS), CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Santiago de Compostela, España
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López-Garrido MA, Antequera Martín-Portugués I, Becerra-Muñoz VM, Orellana-Figueroa HN, Sánchez-Lora FJ, Morcillo-Hidalgo L, Jiménez-Navarro MF, Gómez-Doblas JJ, de Teresa-Galván E, García-Pinilla JM. Prevalence of comorbidities and the prognostic value of the PROFUND index in a hospital cardiology unit. Rev Clin Esp 2017; 217:87-94. [PMID: 27908447 DOI: 10.1016/j.rce.2016.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/15/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of this study was to understand the prevalence of comorbidities and the usefulness of the PROFUND index for the prognostic stratification of patients with comorbidities in a hospital cardiology unit. PATIENTS AND METHODS We consecutively analysed all patients hospitalized in 2012 in the department of cardiology. We recorded the comorbidities, length of stay, hospital mortality, Charlson indices and PROFUND indices. In the patients with comorbidities, we also recorded the readmissions and mortality during a 1-year follow-up. RESULTS The study included 1,033 patients (mean age, 67±13.1 years; 35% women), 381 (36.9%) of whom had comorbidities, with a mean Charlson index of 6.4±1.7 and a mean PROFUND index of 2.5±2.5. Compared with the other patients, the patients with comorbidities were older (72 vs. 64 years, p<.001), had a higher mortality rate (2.9% vs. 1.1%, p=.046) and longer hospital stays (8±5.5 vs. 6±5.7 days, p<.001) and were more often admitted for heart failure (42.3% vs. 15.8%, p<.001). The PROFUND index was independently associated with overall mortality (hazard ratio [HR], 1.13; 95% CI: 1.01-1.27; p=.034) and with the presence of major adverse events during the 12-month follow-up (HR, 1.09; 95% CI: 1.01-1.18; p=.026). CONCLUSIONS A high percentage of patients hospitalized in the department of cardiology had comorbidities. These patients had a higher prevalence of cardiovascular risk factors, longer stays and greater hospital mortality. The PROFUND index independently predicted mortality and adverse events during the follow-up.
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Garay A, Ariza-Solé A, Formiga F, Lorente V, Sánchez-Salado JC, Salazar-Mendiguchía J, Roura G, Muntané G, Alegre O, Fuentes L, Gómez-Hospital JA, Cequier A. Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes? Rev Port Cardiol 2016; 35:637-644. [PMID: 27865674 DOI: 10.1016/j.repc.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Anemia is a common comorbidity in patients with acute coronary syndromes (ACS), and is associated with higher risk for both bleeding and ischemic complications. We aimed to assess the predictive ability of bleeding risk scores (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines [CRUSADE], Mehran and Acute Coronary Treatment and Intervention Outcomes Network [ACTION]) in ACS patients with anemia. METHODS All consecutive ACS patients were prospectively included. The primary outcome was in-hospital major bleeding according to the CRUSADE, Mehran and ACTION definitions. Anemia was defined as hemoglobin <130 g/l in men and <120 g/l in women. The predictive ability of the bleeding risk scores was assessed by binary logistic regression, calculating receiver operating characteristic (ROC) curves and their corresponding area under the curve (AUC). RESULTS We included 2255 patients, mean age 62.4 years. Anemia was present in 550 patients (24.4%). Patients with anemia had a significantly higher prevalence of comorbidities. The three bleeding risk scores adequately predicted major bleeding in the whole cohort. No significant differences were observed regarding the predictive ability of each of the scores in patients with and without anemia (CRUSADE: AUC 0.73 without anemia vs. 0.74 with anemia, p=0.913; ACTION: AUC 0.68 without anemia vs. 0.73 with anemia, p=0.353; Mehran: AUC 0.69 without anemia vs. 0.61 with anemia, p=0.210). Only the Mehran score showed significantly lower predictive ability in patients with hemoglobin <11 g/dl (AUC 0.51, p=0.044). CONCLUSIONS Anemia was a common comorbidity in patients with ACS from our series. Currently available bleeding risk scores showed an adequate predictive ability in patients with mild anemia.
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Affiliation(s)
- Alberto Garay
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Francesc Formiga
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victoria Lorente
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Gerard Roura
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Guillem Muntané
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Alegre
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lara Fuentes
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Angel Cequier
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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García Gonzalo MA, Santamaría Mas MI, Pascual Tomé L, Ibarguren Pinilla M, Rodríguez-Arrondo F. [Cross sectional study of comorbidities and concomitant medications in a cohort of human immunodeficiency virus-infected patients]. Aten Primaria 2016; 49:286-293. [PMID: 27720238 PMCID: PMC6876050 DOI: 10.1016/j.aprim.2016.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/09/2016] [Accepted: 06/03/2016] [Indexed: 12/23/2022] Open
Abstract
Objetivo Valorar la prevalencia de comorbilidades, tratamientos concomitantes y episodios adversos asociados a la medicación en una cohorte de pacientes con infección por VIH. Diseño Estudio transversal multicéntrico. Emplazamiento Consultas externas especializadas del servicio de Enfermedades Infecciosas o Medicina Interna de 3 hospitales de la comunidad autónoma del País Vasco. Participantes Durante 3 meses se seleccionaron de forma aleatoria pacientes con los siguientes criterios de inclusión: infección por VIH, edad superior a 18 años, tratamiento antirretroviral (TAR) desde al menos 6 meses y pauta de TAR estable las últimas 4 semanas. Se incluyeron 224 pacientes del total de 225 previstos. Mediciones principales Se recogieron mediante formulario datos epidemiológicos y antropométricos relativos a la infección por VIH, comorbilidades, tratamientos concomitantes y episodios adversos. Resultados El 95,5% de los pacientes presentaban alguna comorbilidad, siendo las más frecuentes: infección por VHC (51,3%), dislipidemias (37,9%), glucemia basal alterada o diabetes mellitus (21,9%) e hipertensión arterial (21,9%). El 69,2% tomaban alguna medicación concomitante al TAR: ansiolíticos (21,4%), antihipertensivos (19,6%), inhibidores de la bomba de protones (17,9%), estatinas (17%) o antidepresivos (16,5%). El 62,9% presentaban algún efecto adverso, los más frecuentes la alteración de la distribución de grasa corporal (32,6%) y digestivos (24,1%). Conclusiones Nuestros pacientes con infección por VIH son cada vez mayores, con mayor número de comorbilidades, con uso muy frecuente de tratamientos concomitantes y elevada prevalencia de episodios adversos. Esto obliga a un abordaje multidisciplinar y a una labor coordinada con atención primaria.
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Affiliation(s)
| | | | - Lidia Pascual Tomé
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián-Donostia, Gipuzkoa, España
| | - Maialen Ibarguren Pinilla
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián-Donostia, Gipuzkoa, España
| | - Francisco Rodríguez-Arrondo
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián-Donostia, Gipuzkoa, España.
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Tomé-Bermejo F, Santacruz Arévalo A, Ruiz Micó N. [Open reduction and internal fixation of displaced ankle fractures in patients older than 65 years of age. Analysis of results at five-year follow-up]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:99-105. [PMID: 26774637 DOI: 10.1016/j.recot.2015.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/07/2015] [Accepted: 11/12/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the long term outcome of surgical treatment for displaced ankle fractures in patients over 65 years of age, and determine the influence of age and comorbidity in the occurrence of complications. MATERIAL AND METHOD Retrospective descriptive study on 40 patients, with a mean age of 72.7 years (range: 65-88), who underwent open reduction and internal fixation for the treatment of a displaced ankle fracture. The patients were clinically evaluated according to the AOFAS criteria (functional outcome). Data collection also included the presence of comorbidities, radiographic evaluation, the occurrence of postoperative complications, and a questionnaire on satisfaction with treatment received. The mean follow-up was 5.73 years. RESULTS At the end of the follow-up, according to the AOFAS criteria, excellent/good results were obtained in 75% of the patients (n=30), with 38 patients referring to be quite/very happy with the result. Wound skin problems and metal work migration were the most common post-operative complications. No statistically significant relationship was found between increased age or a high number of comorbidities and an increased occurrence of postoperative complications (p>.05). Only 3 patients needed postoperative rehabilitation, and 95% of the patients (n=38) returned to their activities of normal daily living. CONCLUSIONS Surgical treatment of displaced ankle fractures in the elderly patient facilitates the early resumption of the activities of daily living.
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Affiliation(s)
- F Tomé-Bermejo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General de Villalba, Collado Villalba, Madrid, España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - A Santacruz Arévalo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Virgen de la Salud, Toledo, España
| | - N Ruiz Micó
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Virgen de la Salud, Toledo, España
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López C, Masiá M, Padilla S, Aquilino A, Bas C, Gutiérrez F. [Deaths due to non-AIDS diseases among HIV infected patients: A 14-year study (1998-2011)]. Enferm Infecc Microbiol Clin 2015; 34:222-7. [PMID: 26093959 DOI: 10.1016/j.eimc.2015.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/05/2015] [Accepted: 04/11/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to analyze the deaths caused by non-AIDS diseases in a cohort of HIV-infected patients treated between 1998 and 2011. PATIENTS AND METHODS Information on the causes of death was collected retrospectively, and then classified according to the deaths code (CoDe) algorithm. Patient characteristics and causes of death were compared for two periods: 1998-2004 and 2005-2011. RESULTS A total of 159 out of the 1070 patients cared for in study period died, 56 (35%) due to AIDS events and 86 (54%) due to non-AIDS events (NAEs); in 17 (11%) the cause of death could not be determined. Overall, the main causes of death were infections (32%), cancer (17%), and unnatural deaths (17%). There was lower mortality from AIDS-related conditions during the second period (18.5% vs 47%; P<.001) and higher mortality from NAEs (68% vs 45%; P=.006). There was a very sharp increase in non-AIDS-defining cancers (18.5% vs 2.1%, p=001), and increased deaths from cardiovascular disease (9.2% vs 2.1%, P=.06). Patients who died in the second period were older, and had a better immunological and virological status at cohort entry and before death. They received antiretroviral therapy (ART) more often and were more often virologically suppressed before death (61.5% vs 24%; P=.001). CONCLUSIONS Non-AIDS-defining cancers, unnatural deaths, and cardiovascular diseases are now major causes of death in patients with HIV. In recent years the majority of deceased patients are on ART and with virological suppression.
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Affiliation(s)
- Cristina López
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Alicante, España
| | - Mar Masiá
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Alicante, España.
| | - Sergio Padilla
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Alicante, España
| | - Ana Aquilino
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Alicante, España
| | - Cristina Bas
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Alicante, España
| | - Félix Gutiérrez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Alicante, España
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López Varela MV, Montes de Oca M, Halbert R, Muiño A, Tálamo C, Pérez-Padilla R, Jardim JRB, Valdivia G, Pertuzé J, Menezes AMB. Comorbidities and health status in individuals with and without COPD in five Latin American cities: the PLATINO study. Arch Bronconeumol 2013; 49:468-74. [PMID: 23856439 DOI: 10.1016/j.arbres.2013.05.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/15/2013] [Accepted: 05/15/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD), and have a significant impact on health status and prognosis. The PLATINO study provides data on self-reported comorbidities and perceived health status in COPD subjects. METHODS PLATINO is a population-based study on COPD prevalence in five Latin American cities. COPD diagnosis was defined by GOLD criteria (FEV1/FVC<.70 post-bronchodilator). Information was collected on the following comorbidities: heart disease, hypertension, diabetes, cerebrovascular disease, peptic ulcer and asthma. Health status was evaluated using the SF-12 questionnaire, derived from the question: «In general, would you say your health is excellent, very good, good, fair or poor?». A simple comorbidity score was calculated by adding the total number of comorbid conditions. RESULTS Of a total population of 5314individuals, 759 had COPD. Reported comorbidities by decreasing frequency were: any cardiovascular disease, hypertension, peptic ulcer, heart disease, diabetes, cerebrovascular disease, asthma and lung cancer. COPD patients had a higher comorbidity score and prevalence of lung cancer (P<.0001) and asthma (P<.0001), as well as a higher tendency to have hypertension (P=.0652) and cerebrovascular disease (P=.0750). Factors associated with comorbidities were age, body mass index (BMI) and female gender. The number of comorbidities increased as the health status deteriorated. CONCLUSIONS In the PLATINO population-based study, COPD individuals had an increased number of comorbidities. Age, female gender and higher BMI were the factors associated with comorbidity in these patients. Comorbid conditions were associated with impaired health status, independently of the COPD status.
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Affiliation(s)
- Maria Victorina López Varela
- Servicio de Neumología, Hospital Maciel, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
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