1
|
Pastor-Pérez FJ, Garrido-Bravo IP, Peñafiel-Verdú P, Fernández-Villa N, Manzano-Fernández S, Oliva-Sandoval MJ, Pérez-Martínez MT, Caro-Martínez C, Hernández-Vicente Á, Pascual-Figal DA. Withdrawal of drug therapy in responders to cardiac resynchronization therapy: rationale and design of the REMOVE trial. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00143-9. [PMID: 38701881 DOI: 10.1016/j.rec.2024.02.021] [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: 12/18/2023] [Accepted: 02/26/2024] [Indexed: 05/05/2024]
Abstract
Introduction and objectives Cardiac resynchronization therapy (CRT) is an effective treatment for patients with nonischemic dilated cardiomyopathy associated with left bundle branch block (LBBB). In these patients, the device can normalize left ventricular ejection fraction (LVEF). Nevertheless, it remains unclear whether CRT responders still require neurohormonal blockers. The aim of this study is to determine the long-term safety of withdrawing drug therapy in these patients. Methods The REMOVE trial (NCT05151861) is a prospective, multicenter, open-label and randomized 1:1 study designed to assess the effect of withdrawing neurohormonal blockers in patients with nonischemic dilated cardiomyopathy associated with left bundle branch block who recovered LVEF after CRT. The study will include a 12-month follow-up with the option to continue into the follow-up extension phase for up to 24 months. The primary endpoint is the recurrence of cardiomyopathy defined as any of the following criteria: a) a reduction in LVEF > 10% (provided the LVEF is < 50%); b) a reduction in LVEF > 10% accompanied by an increase > 15% in the indexed end-systolic volume relative to the previous value and in a range higher than the normal values, or c) decompensated heart failure requiring intravenous diuretic administration. In patients meeting the primary endpoint, drug therapy will be restarted. Conclusions The results of this study will help to enhance our understanding of CRT superresponders, a specific group of patients.
Collapse
Affiliation(s)
- Francisco J Pastor-Pérez
- Unidad de Insuficiencia Cardiaca y Trasplante, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosantiaria (IMIB)-Pascual Parrilla, El Palmar Murcia, España.
| | - Iris P Garrido-Bravo
- Unidad de Insuficiencia Cardiaca y Trasplante, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosantiaria (IMIB)-Pascual Parrilla, El Palmar Murcia, España
| | - Pablo Peñafiel-Verdú
- Unidad de Insuficiencia Cardiaca y Trasplante, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosantiaria (IMIB)-Pascual Parrilla, El Palmar Murcia, España
| | - Noelia Fernández-Villa
- Unidad de Insuficiencia Cardiaca y Trasplante, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosantiaria (IMIB)-Pascual Parrilla, El Palmar Murcia, España
| | - Sergio Manzano-Fernández
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosantiaria (IMIB)-Pascual Parrilla, El Palmar Murcia, España; Departamento de Medicina Interna, Universidad de Murcia, Murcia, España
| | - María José Oliva-Sandoval
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosantiaria (IMIB)-Pascual Parrilla, El Palmar Murcia, España
| | - María Teresa Pérez-Martínez
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosantiaria (IMIB)-Pascual Parrilla, El Palmar Murcia, España
| | - César Caro-Martínez
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosantiaria (IMIB)-Pascual Parrilla, El Palmar Murcia, España
| | | | - Domingo A Pascual-Figal
- Unidad de Insuficiencia Cardiaca y Trasplante, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosantiaria (IMIB)-Pascual Parrilla, El Palmar Murcia, España; Departamento de Medicina Interna, Universidad de Murcia, Murcia, España
| |
Collapse
|
2
|
Márquez-Pardo R, Baena-Nieto MG, Córdoba-Doña JA, Cruzado-Begines C, García-García-Doncel L, Aguilar-Diosdado M, Torres-Barea IM. Glycemic variability in diagnosis of gestational diabetes as predictor of pharmacological treatment. ENDOCRINOL DIAB NUTR 2024; 71:96-102. [PMID: 38493010 DOI: 10.1016/j.endien.2024.03.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/28/2023] [Indexed: 03/18/2024]
Abstract
INTRODUCTION To establish whether glycemic variability (GV) parameters used when gestational diabetes mellitus (GDM) has been diagnosed could help predict the probability that a patient will need pharmacological treatment, and to analyze the link of these parameters to the development of maternal-fetal complications. MATERIALS AND METHODS A prospective study of 87 women with GDM who underwent retrospective continuous glucose monitoring (CGM) for six days between weeks 26 and 32 of gestation, following diagnosis. The mean glycemia levels and GV variables were analyzed together with their link to maternal-fetal complications, and the need for pharmacological treatment. ROC (receiver operating characteristic) curves were developed to determine validity to detect the need for pharmacological treatment. RESULTS Patients with higher mean glycemia (p < 0.001) and continuous overlapping of net glycemic action in a period of n-hours (CONGAn) (p = 0.001) required pharmacological treatment. The ROC curves showed cut-off points of 98.81 mg/dL for mean glycemia, and 86.70 mg/dL for CONGAn, with 83.3% sensitivity and 67.8% specificity for both parameters. No relation between the GV parameters and development of maternal-fetal complications was observed. CONCLUSIONS The use of CGM, once GDM is diagnosed, enables us to identify those patients who would benefit from closer monitoring during gestation, and facilitate a speedier take-up of pharmacological treatment. However, prospective studies involving a higher number of patients are needed, as well as a cost assessment for recommending the use of CGM following GDM diagnosis.
Collapse
Affiliation(s)
- Rosa Márquez-Pardo
- Servicio de Endocrinología y Nutrición, Hospital Juan Ramón Jiménez, Huelva, Spain.
| | - María-Gloria Baena-Nieto
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | - Juan-Antonio Córdoba-Doña
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | - Concepción Cruzado-Begines
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | - Lourdes García-García-Doncel
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | | |
Collapse
|
3
|
Giner-Soriano M, Díaz Baena D, Ouchi D, Gomez-Lumbreras A, Morros R. [Pharmacological treatment of the heart failure according to the ventricular ejection fraction in primary care]. Aten Primaria 2022; 54:102362. [PMID: 35777241 PMCID: PMC9251560 DOI: 10.1016/j.aprim.2022.102362] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/07/2022] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Objetivo Aunque se dispone de mejores diagnósticos y tratamientos, la insuficiencia cardíaca (IC) es una causa importante de muerte en España. El objetivo de este estudio es describir el tratamiento y las características de la población con IC crónica, clasificada según la fracción de eyección del ventrículo izquierdo (FEVI). Diseño Estudio observacional de cohortes de base poblacional en atención primaria (AP). Emplazamiento Cataluña, 2014-2018. Participantes Se incluyeron pacientes adultos con diagnóstico incidente de IC clasificada según la FEVI. Intervención Análisis de los datos de salud registrados en la base de datos Sistema de Información para el Desarrollo de la Investigación en AP (SIDIAP). Variables principales Demográficas, FEVI, comorbilidades y uso de fármacos para la IC. Resultados Se incluyeron 10.130 pacientes; el 18,9% con FEVI < 40 (ICFEr), el 15,9% con FEVI 40-49 (ICFEi) y el 65,2% con FEVI ≥ 50 (ICFEp), este último grupo con mayor proporción de mujeres (57,5%) y una mayor edad media (80,2 años). La población con ICFEi era similar a la de ICFEr en edad, género, comorbilidades o tratamiento. Las comorbilidades más frecuentes eran la hipertensión (78.3%), la dislipemia (54%) y la fibrilación auricular (41,5%). Los tratamientos más frecuentes fueron los β-bloqueantes, con diferencias según la FEVI (FEVIr 1.515 [79,2%], FEVIi 1.142 [70,8%] y FEVIp 3.371 [51,0%]), seguido de los diuréticos de asa (65,7%). Conclusiones El tratamiento farmacológico de la IC varía en función de la FEVI. El tratamiento y las características poblacionales de los pacientes con ICFEi son similares a aquellos con ICFEr.
Collapse
Affiliation(s)
- Maria Giner-Soriano
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España
| | - Dioselina Díaz Baena
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; UCEVA Unidad Central del Valle del Cauca, Tuluá, Valle del Cauca, Colombia
| | - Dan Ouchi
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España
| | - Ainhoa Gomez-Lumbreras
- College of Pharmacy, Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, EE. UU..
| | - Rosa Morros
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| |
Collapse
|
4
|
Moral Peláez I, Brotons Cuixart C, Fernández Valverde D, Puig Palma M, Calvo Bonacho E, Martínez Muñoz P, Catalina Romero C, Quevedo Aguado LJ. External validation of the European and American equations for calculating cardiovascular risk in a Spanish working population. Rev Clin Esp 2021; 221:561-568. [PMID: 34147422 DOI: 10.1016/j.rceng.2020.12.008] [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: 11/04/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVE This work aims to externally validate the European and American models for calculating cardiovascular risk in the primary prevention. METHODS This is a cross-sectional study of a nation-wide cohort of individuals who are active in the work force. Workers without a medical history cardiovascular disease who attended occupational health check-ups between 2004 and 2007 were included. They were followed-up on until December 2017. RESULTS A total of 244,236 subjects participated. Of them, 24.5% were women and the mean age was 48.10 years (SD 6.26). According to the European SCORE risk chart, the mean risk was 1.70 (SD 1.81) for men and 0.37 (SD 0.53) for women. According to the North American PCE model, the mean risk was 6.98 (SD 5.66) for men and 1.97 (SD 1.96) for women. A total of 1177 events (0.51%) were registered according to the SCORE tool and 2,330 events (1.00%) were registered according to the PCE tool. The Harrell's C-statistic was 0.746 for SCORE and 0.725 for PCE. Sensitivity and specificity for the SCORE'S 5% cut-off point were 17.59% (95%CI 15.52%-19.87%) and 95.68% (95%CI 95.59%-95.76%). Sensitivity and specificity for the PCE's 20% cut-off point were 9.06% (95%CI 7.96%-10.29%) and 97.55% (95%CI 97.48%-97.61%), respectively. CONCLUSIONS The European SCORE and North American PCE models overestimate the risk in our population but with an acceptable discrimination. SCORE showed better validity indices than the PCE. The population's risk is continuously changing; therefore, it is important continue updating the equations to include information on current populations.
Collapse
Affiliation(s)
- I Moral Peláez
- Unidad de Investigación, Equipo de Atención Primaria Sardenya, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Unidad Docente ACEBA, Barcelona, Spain.
| | - C Brotons Cuixart
- Unidad de Investigación, Equipo de Atención Primaria Sardenya, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Unidad Docente ACEBA, Barcelona, Spain.
| | - D Fernández Valverde
- Unidad de Investigación, Equipo de Atención Primaria Sardenya, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Unidad Docente ACEBA, Barcelona, Spain
| | - M Puig Palma
- Unidad de Investigación, Equipo de Atención Primaria Sardenya, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Unidad Docente ACEBA, Barcelona, Spain
| | - E Calvo Bonacho
- Departamento de Proyectos Sanitarios, IBERMUTUA, Madrid, Spain
| | | | | | | |
Collapse
|
5
|
Gallardo Padilla M, León Falconi JL, Sánchez-Nebreda Arias R, Gómez Santos C, Muñoz Egea MDC, la Orden Izquierdo E. [Impact of the use of molecular techniques (PCR) on detection and eradication success against Helicobacter pylori]. An Pediatr (Barc) 2021; 96:S1695-4033(20)30502-6. [PMID: 33431330 DOI: 10.1016/j.anpedi.2020.11.016] [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: 09/18/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Helicobacter pylori (H. pylori) infection affects more than 50% of the world population. Increased antibiotic resistance is the main cause of treatment failure. The main objective was to analyze the eradication success after the application of the new ESPGHAN treatment recommendations and the introduction of PCR as a direct diagnosis technique, describe the evolution of the local pattern of antibiotic resistance, and assess the cost-effectiveness of PCR application, isolated or in conjunction with culture as a diagnostic strategy. PATIENTS AND METHODS retrospective descriptive study of all microbiological isolates of H. pylori in 2013-2019 in our center, by comparing the percentage of resistance and eradication success between the periods 2013-2016 and 2017-2019. Cost-effectiveness study of direct diagnostic tests, comparing 3 different options: culture and PCR; only culture; PCR only. RESULTS 192 patients were included, 98 were detected by culture (2013-2016) and 94 by culture and / or PCR (2017-2019). Antibiotic treatment was established in 153 patients, 90 in the first period (2011 ESPGHAN guidelines: eradication percentage 62.2%), 63 in the second (2017 ESPGHAN guidelines: eradication percentage: 73%). An increase in resistance to clarithromycin was observed, going from 16.3% (n=16) in the first period, to 53.2% (n=48) in 2017-2019 (98% detected by PCR, 60% by culture). There were no differences in the rest of antibiotic resistances. The isolated PCR application presented a cost-effectiveness analysis ratio (CEAR) of 71.91, compared to 92.16 for the culture and 96.35 for the culture and PCR combined. CONCLUSIONS the application of the ESPGHAN 2017 guidelines achieved greater eradication success, although less than that observed in previous publications, without reaching the target of at least 90%. An increase in resistance to macrolides was observed, without being able to discriminate whether it is a real increase or a greater diagnostic sensitivity of molecular techniques, with the isolated request for PCR being the most cost-effective strategy.
Collapse
Affiliation(s)
- Miguel Gallardo Padilla
- Unidad de Gastroenterología Pediátrica, Servicio de Pediatría, Servicio de Microbiología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Madrid.
| | - José Luis León Falconi
- Unidad de Gastroenterología Pediátrica, Servicio de Pediatría, Servicio de Microbiología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Madrid
| | - Rafael Sánchez-Nebreda Arias
- Unidad de Gastroenterología Pediátrica, Servicio de Pediatría, Servicio de Microbiología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Madrid
| | - Carmen Gómez Santos
- Unidad de Gastroenterología Pediátrica, Servicio de Pediatría, Servicio de Microbiología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Madrid
| | - María Del Carmen Muñoz Egea
- Unidad de Gastroenterología Pediátrica, Servicio de Pediatría, Servicio de Microbiología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Madrid
| | - Enrique la Orden Izquierdo
- Unidad de Gastroenterología Pediátrica, Servicio de Pediatría, Servicio de Microbiología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Madrid
| |
Collapse
|
6
|
Ocampo-Serna S, Gutiérrez-Segura JC, Vallejo-González S. Adult Gender Dysphoria with Coronary Disease. Case Report and Literature Review. Rev Colomb Psiquiatr (Engl Ed) 2020; 49:211-215. [PMID: 32888667 DOI: 10.1016/j.rcp.2018.10.003] [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] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 04/30/2018] [Accepted: 10/16/2018] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Gender dysphoria (GD) refers to a marked incongruity between gender identity and biological sex. GD generates a significant clinical discomfort for at least six months. METHODS Case report and non-systematic literature review. Case presentation A 56-year-old male-to-female patient, who had a history of coronary disease and a second thromboembolic event after hormone therapy (self-medicated). Once she had received acute management for the cardiovascular disease, she consulted for her GD. DISCUSSION GD requires multidisciplinary management. Cross-sex hormonal therapy is considered the main treatment. It has been documented that oral oestrogen preparations may increase the risk of thromboembolic events in patients over the age of 40, especially when they have cardiovascular risk factors. CONCLUSIONS Comprehensive treatment should be offered to everyone who has GD, to relieve psychological distress, decrease psychiatric comorbidity and improve quality of life. To date, there is little scientific evidence regarding cross-sex hormonal therapy in transgender women over the age of 40; we therefore recommend multidisciplinary, close and rigorous monitoring, in particular when they have cardiovascular risk.
Collapse
Affiliation(s)
- Sabina Ocampo-Serna
- Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia.
| | | | | |
Collapse
|
7
|
Ballesteros-Peña S, Fernández-Aedo I, Vallejo-de la Hoz G, Pérez-Llarena G, Echeandia-Lastra I. Validity of approaches to estimating weight in children attended in the emergency department. Emergencias 2020; 31:239-244. [PMID: 31347803] [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: 06/10/2023]
Abstract
OBJECTIVES To determine the validity of different ways of estimating body weight in children attended in the emergency department. MATERIAL AND METHODS Prospective cross-sectional study of a series of patients between 1 month and 14 years of age attended in 2 tertiary care hospitals in the Basque Country, Spain. We used 9 different ways to estimate body weight and compared the estimates to real weight by calculating the mean intraclass correlation coefficient, the mean difference between real and estimated weights, and the proportion of measurements within 10% and 20% of the real weight. RESULTS Five hundred fifteen pediatric patients were weighed and their weights estimated. All estimates had a high degree of agreement with real weight. A parent's weight estimate performed best: 86.5% of parental estimates were within 10% of the real weight. The next best estimate was achieved with the cardiopulmonary resuscitation (CPR) rule developed at Hospital del Niño Jesús: 65% of the estimates were within the 10% margin. Fewer than 40% of the weight estimates based on formulas using anthropometric measurements were within the 10% margin. CONCLUSION A parent's estimate of weight is a valid approximation in children of all ages. When this estimate is not available, the CPR rule of Hospital del Niño Jesús would be the method of choice.
Collapse
Affiliation(s)
- Sendoa Ballesteros-Peña
- Hospital de Basurto, Bilbao, España. Facultad de Medicina y Enfermería. Universidad del País Vasco/Euskal Herriko Unibertsitatea, Leioa, España
| | - Irrintzi Fernández-Aedo
- Facultad de Medicina y Enfermería. Universidad del País Vasco/Euskal Herriko Unibertsitatea, Leioa, España
| | - Gorka Vallejo-de la Hoz
- Facultad de Medicina y Enfermería. Universidad del País Vasco/Euskal Herriko Unibertsitatea, Leioa, España. Hospital de Galdakao-Usansolo, Galdakao, España
| | | | | |
Collapse
|
8
|
Rodríguez-Diez G, Márquez MF, Iturralde-Torres P, Molina-Fernández de L LG, Pozas-Garza G, Cordero-Cabra A, Rojel-Martínez U. Joint Mexican position document on the treatment of atrial fibrillation. Arch Cardiol Mex 2020; 90:69-76. [PMID: 31996856 DOI: 10.24875/acm.19000323] [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] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF) is a frequent arrhythmia; its prevalence is near 2% in the general population; in Mexico, more than one-half million people are affected. AF needs to be considered as a public health problem. Because AF is an independent risk factor associated with mortality, due to embolic events, heart failure, or sudden death; early diagnosis is of utmost importance. In unstable patients with a recent onset of AF, electrical cardioversion should be practiced. In stable patients, once thromboembolic measures have been taken, it is necessary to assess whether it is reasonable to administer an antiarrhythmic drug to restore sinus rhythm or performed electrical cardioversion. For recidivating cases of paroxysmal and persistent presentation, the most effective strategy is performed pulmonary vein isolation with either radiofrequency or cryoballoon energy. Permanent AF is that in which recovery of sinus rhythm is not possible, the distinguishing feature of this phase is the uncontrollable variability of the ventricular frequency and could be treated pharmacologically with atrioventricular (AV) nodal blockers or with a VVIR pacemaker plus AV nodal ablation. The presence of AF has long been associated with the development of cerebral and systemic (pulmonary, limb, coronary, renal, and visceral) embolism. The prevention of embolisms in "valvular" AF should perform with Vitamin K antagonists (VKA). For patients with AF not associated with mitral stenosis or a mechanical valve prosthesis, a choice can be made between anticoagulant drugs, VKA, or direct oral anticoagulants. Antiplatelet agents have the weakest effect in preventing embolism.
Collapse
Affiliation(s)
- Gerardo Rodríguez-Diez
- Unidad de Arritmias y Estimulación Cardiaca, Centro Médico Nacional Siglo XXI, Instituto de Seguridad Social y Servicios Sociales de los Trabajadores del Estado, Ciudad de México
| | - Manlio F Márquez
- Servicio de Electrocardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México
| | - Pedro Iturralde-Torres
- Servicio de Electrocardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México
| | | | - Gerardo Pozas-Garza
- Instituto de Cardiología y Medicina Vascular, Hospital Zambrano Hellion TEC-Salud, Nuevo Léon
| | - Alejandro Cordero-Cabra
- Servicio de Electrofisiología, Centro Médico Nacional de Occidente-Hospital de Especialidad, Instituto de Seguridad Social y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Guadalajara
| | - Ulises Rojel-Martínez
- Unidad de Arritmias y Estimulación Cardiaca, Centro Médico Sur de los Servicios Médicos de Salud de Puebla, Puebla, Mexico
| |
Collapse
|
9
|
Reyes-García R, Moreno-Pérez Ó, Tejera-Pérez C, Fernández-García D, Bellido-Castañeda V, de la Torre Casares ML, Rozas-Moreno P, Fernández-García JC, Marco Martínez A, Escalada-San Martín J, Gargallo-Fernández M, Botana-López M, López-Fernández J, González-Clemente JM, Jódar-Gimeno E, Mezquita-Raya P. Document on a comprehensive approach to type 2 diabetes mellitus. ACTA ACUST UNITED AC 2019; 66:443-458. [PMID: 30827909 DOI: 10.1016/j.endinu.2018.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/18/2018] [Revised: 10/21/2018] [Accepted: 10/31/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. PARTICIPANTS Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. METHODS The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. CONCLUSIONS This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists.
Collapse
Affiliation(s)
- Rebeca Reyes-García
- Unidad de Endocrinología y Nutrición, Hospital Universitario Torrecárdenas, Servicio de Endocrinología, Clínica San Pedro, Almería, España; Servicio de Endocrinología, Clínica San Pedro, Almería, España.
| | - Óscar Moreno-Pérez
- Sección de Endocrinología y Nutrición, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-FISABIO), Alicante, España
| | - Cristina Tejera-Pérez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, España
| | - Diego Fernández-García
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, España; Servicio Endocrinología y Nutrición, Hospital Vithas-Xanit, Benalmádena, Málaga, España
| | | | | | - Pedro Rozas-Moreno
- Servicio de Endocrinología y Nutrición. Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - José Carlos Fernández-García
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), CB06/03, Instituto de Salud Carlos III, Madrid, España
| | - Amparo Marco Martínez
- Endocrinología y Nutrición, Complejo Hospitalario de Toledo, Toledo, España; Hospital Quirón Salud Madrid, Madrid, España
| | - Javier Escalada-San Martín
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de Diabetes y Enfermedades Metabólicas, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | | | - Manuel Botana-López
- Sección de Endocrinología y Nutrición, Hospital Universitario Lucus Augusti, Lugo, España
| | - Judith López-Fernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Canarias, Departamento de Medicina, Universidad de La Laguna, Santa Cruz de Tenerife, España
| | - José Miguel González-Clemente
- Servicio de Endocrinología y Nutrición, Hospital Parc Taulí, Instituto I3PT-UAB, DIAMET, CIBERDEM-ISCIII, Sabadell, Barcelona, España
| | - Esteban Jódar-Gimeno
- Hospitales Universitarios Quirón Salud, Ruber Juan Bravo y San José, Facultad de Ciencias de la Salud, Universidad Europea de Madrid, Madrid, España
| | - Pedro Mezquita-Raya
- Unidad de Endocrinología y Nutrición, Hospital Universitario Torrecárdenas, Servicio de Endocrinología, Clínica San Pedro, Almería, España
| | | |
Collapse
|
10
|
Cano-García M, Millán-Gómez M, Sánchez-González C, Alonso-Briales JH, Muñoz-Jiménez LD, Carrasco-Chinchilla F, Domínguez-Franco A, Muñoz-García AJ, Bullones-Ramírez JA, Álvarez-Rubiera JM, de Mora-Martín M, de Teresa-Galván E, Hernández-García JM, Urbano-Carrillo CA, Jiménez-Navarro MF. Impact of Percutaneous Coronary Revascularization of Severe Coronary Lesions on Secondary Branches. ACTA ACUST UNITED AC 2018; 72:456-465. [PMID: 29859894 DOI: 10.1016/j.rec.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/17/2017] [Accepted: 04/10/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES To analyze the percutaneous revascularization strategy for severe lesions in the secondary branches (SB) (diameter ≥ 2mm) of major epicardial arteries compared with conservative treatment. METHODS This study analyzed patients with severe SB lesions who underwent percutaneous revascularization treatment compared with patients who received pharmacological treatment. The study examined the percentage of branch-related events (cardiovascular death, myocardial infarction attributable to SB, or the need for revascularization of the SB). RESULTS We analyzed 679 SB lesions (662 patients). After a mean follow-up of 22.2±10.5 months, there were no significant differences between the 2 treatment groups regarding the percentage of death from cardiovascular causes (1.7% vs 0.4%; P=.14), nonfatal acute myocardial infarction (AMI) (1.7% vs 1.7%; P=.96), the need for SB revascularization (4.1% vs 5.4%; P=.45) or in the total percentage of events (5.1% vs 6.3%; P=.54). The variables showing an association with event occurrence on multivariate analysis were diabetes (SHR, 2.87; 95%CI, 1.37-5.47; P=.004), prior AMI (SHR, 3.54; 95%CI, 1.77-7.30; P<.0001), SB reference diameter (SHR, 0.16; 95%CI, 0.03-0.97; P=.047), and lesion length (SHR, 3.77; 95%CI, 1.03-1.13; P<.0001). These results remained the same after the propensity score analysis. CONCLUSIONS The percentage of SB-related events during follow-up is low, with no significant differences between the 2 treatment strategies. The variables associated with event occurrence in the multivariate analysis were the presence of diabetes mellitus, prior AMI, and greater lesion length.
Collapse
Affiliation(s)
- Macarena Cano-García
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Mercedes Millán-Gómez
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Carlos Sánchez-González
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Juan H Alonso-Briales
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Luz D Muñoz-Jiménez
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Fernando Carrasco-Chinchilla
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Antonio Domínguez-Franco
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Antonio J Muñoz-García
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Juan A Bullones-Ramírez
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jesús M Álvarez-Rubiera
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Manuel de Mora-Martín
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - José M Hernández-García
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Cristóbal A Urbano-Carrillo
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Manuel F Jiménez-Navarro
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain.
| |
Collapse
|
11
|
Pérez-Deago B, Alonso-Porcel C, Elvira-Menendez C, Murcia-Olagüenaga A, Martínez-Ibán M. [Epidemiology and management of community acquired pneumonia: more than 10 years experience]. Semergen 2018; 44:389-394. [PMID: 29574009 DOI: 10.1016/j.semerg.2018.01.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the characteristics of patients diagnosed with Community Acquired Pneumonia in this basic health area, their management, outcomes, and use of prognostic scales driven by the few studies carried out from Primary Care on these aspects. MATERIAL AND METHODS Descriptive cross-sectional study on a population diagnosed with Community Acquired Pneumonia if three urban health centres, during the period January 2000 to 31 July 2103. RESULTS Out of a sample of 1,290 patients obtained, 56.1% were men, and the mean age of the population was 61.9 years. There were 22.7% smokers. More than half (59.9%) had a disease in the prognostic scales, with Diabetes Mellitus present in 20%, and 36.1% with pulmonary disease (17.6% COPD, 11.8% asthma). Just under half (43.2%) of the total patients were diagnosed in Primary Care. There was a diagnostic X-ray in 92.7% of the cases, and a follow-up X-ray in 59.4%. Prognostic scales were recorded in 2% of the cases. The most commonly used antibiotics were amoxicillin-clavulanic (30.7%) and levofloxacin (30.4%). Having prior disease increases the risk of re-treatment by 1.6 (95% CI; 1.1-2.2)]. The mortality risk is multiplied by 5.3 on having a previous disease (95% CI; 1.3-19.2). CONCLUSIONS In the Primary Care setting, Community Acquired Pneumonia is a common and potentially serious disease which, in half the cases, occurs in patients with associated comorbidity. As regards treatment and management, is highlighted the wide use made of amoxicillin-clavulanic, compared to the low use of amoxicillin, combined therapy, and prognostic scales.
Collapse
Affiliation(s)
- B Pérez-Deago
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | - C Alonso-Porcel
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España.
| | - C Elvira-Menendez
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | - A Murcia-Olagüenaga
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | | |
Collapse
|
12
|
Ahunca Velásquez LF. [Beyond Cognitive Impairment: Neuropsychiatric Symptoms in Neurodegenerative Dementias]. Rev Colomb Psiquiatr 2017; 46 Suppl 1:51-58. [PMID: 29037339 DOI: 10.1016/j.rcp.2017.05.006] [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] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 05/06/2017] [Indexed: 06/07/2023]
Abstract
As life expectancy increases, the number of people diagnosed with neurodegenerative dementia also increases. Although cognitive impairment is central in dementia, neuropsychiatric symptoms (NPS) are very important because they increase both direct and indirect costs by generating greater morbidity, caregiver distress, use of medication and institutionalisation. Furthermore, it is important to understand the nature of NPS, since they can vary across the different types of dementia and may provide useful clinical information regarding the aetiology of cognitive impairment. The first-line management of NPS in dementia is non-pharmacological; internal and external causes should first be identified and strategies developed to modify the behavioural patterns of the patient and their caregiver. In addition, changes in the patient's surroundings that may improve patient performance and behaviour should be encouraged. If these practices are not satisfactory, a pharmacological treatment approach is adopted that includes anti-dementia drugs, antipsychotics, antidepressants, mood stabilisers and benzodiazepines. However, psychoactive drugs do not offer sufficient efficacy and most of them have significant adverse effects, so each patient should be individually assessed, together with the implementation of non-pharmacological strategies, before deciding on pharmacological treatment for the management of NPS in dementia.
Collapse
|
13
|
Cardona-Muñoz EG, López-Alvarado A, Conde-Carmona I, Sánchez-Mejorada G, Pascoe-González S, Banda-Elizondo RG, García-Castillo A, González-Gálvez G, Velasco-Sánchez RG, Vidrio-Velázquez M, Leiva-Pons JL, Villeda-Espinosa E, Guerra-López A, Esturau-Santalo RM. Safety and efficacy of fimasartan in Mexican patients with grade 1-2 essential hypertension. Arch Cardiol Mex 2017; 87:316-325. [PMID: 28209359 DOI: 10.1016/j.acmx.2017.01.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/28/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To evaluate efficacy and safety of 60mg and 120mg Fimasartan (FMS) alone or combined with 12.5mg hydrochlorothiazide (HCTZ) in a Mexican population. METHODS A six month, treat-to-target, open study was conducted on subjects with grade 1-2 hypertension. The subjects were initially treated with 60mg FMS once daily. In week 8, those with Diastolic Blood Pressure (DBP) <90mmHg continued on the same FMS dose during the rest of the study, while those with DBP ≥90mmHg were randomised to either 120mg FMS or 60mg FMS + 12.5mg HCTZ once daily. In week 12, randomised subjects with DBP ≥90mmHg received 120mg FMS+12.5mg HCTZ, while those achieving target continued with their assigned treatment until the end of the study. RESULTS FMS 60mg (n=272) decreased both DBP and Systolic Blood Pressure (SBP) by 11.3±8.9 (p<.0001) and 16.0±14.1 (p<.0001)mmHg, respectively, with 75.4% of subjects reaching the treatment target. Subjects assigned to FMS 120mg, FMS 60mg+HCTZ 12.5mg, or FMS 120mg+HCTZ 12.5mg once daily, showed significant reductions in DBP and SBP with their assigned treatment. At the end of the study, 237/272 subjects (87.1%) achieved a DBP<90mmHg and an SBP<140mmHg. The most frequently reported adverse reactions included headache (3.7%), dry mouth (1.1%), transient liver enzyme increase (1.1%), and dizziness (0.7%). CONCLUSION Fimasartan is safe and effective in Mexican subjects with grade 1-2 essential hypertension.
Collapse
Affiliation(s)
- Ernesto G Cardona-Muñoz
- Investigación Clínica Especializada, Sociedad Civil, Guadalajara, Jalisco, Mexico; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | | | - Sara Pascoe-González
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | | | | | | | - José L Leiva-Pons
- Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, San Luis Potosí, Mexico
| | | | | | | |
Collapse
|
14
|
Torres-Degayón V, Montero-Pérez FJ, Torres-Murillo JM, Faus-Dáder MJ, Baena-Parejo MI, Calleja-Hernández MA. [Medication-related negative outcomes in patients with permanent atrial fibrillation attended in a hospital emergency department]. Emergencias 2016; 28:75-82. [PMID: 29105427] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To detect the frequency of negative outcomes associated with medication in patients with permanent atrial fibrillation (AF) who are attended in a hospital emergency department, and to assess type and severity of such outcomes related to AF medications as well as the rate of preventable negative outcomes. MATERIAL AND METHODS Descriptive, observational cross-sectional study in patients with permanent AF who were attended in the emergency department of a tertiary care hospital during a 3-month period. A pharmacist interviewed the patients to record demographic characteristics, health problems, degree of functional impairment, and current drug treatments. An emergency physician and a pharmacist reviewed the patients' questionnaires and medical histories and evaluated them using the Dader method of pharmacotherapeutic follow-up. RESULTS Of the 210 patients assessed, 198 entered the final analysis. They had a mean (SD) age of 80.5 (7.3) years, and 114 (57.5%) were women. One handred and thirty-four (67.7%) patients had medication-related negative outcomes; 61 (45.5%) of the outcomes were related to treatment for permanent AF. Twenty-four of these 61 patients (39.3%) had problems affecting safety; 36 (59%) of the problems were caused by drugs to control heart rate. Of the 73 patients with negative outcomes unrelated to AF medication, 34 (46.6%) were related to necessary medications and 38 (52.1%) were taking antibiotics. The frequencies of avoidable negative outcomes were significantly different between the group of patients with problems related to drug therapy for AF (where 55.7% were due to medications considered unnecessary) and those with problems unrelated to AF medications (where 78.1% were from avoidable medications) (P=.010). However, the level of seriousness was similar. CONCLUSION Nearly two-thirds of patients with permanent AF who come to the emergency department have a medication- related negative outcome that may or may not be related to AF treatment. Problems from drugs taken for reasons other than AF could more easily be avoided.
Collapse
Affiliation(s)
| | - Francisco Javier Montero-Pérez
- Unidad de Gestión Clínica de Urgencias, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC). Hospital Universitario "Reina Sofía" de Córdoba. Universidad de Córdoba, España
| | - José Manuel Torres-Murillo
- Unidad de Gestión Clínica de Urgencias, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC). Hospital Universitario "Reina Sofía" de Córdoba. Universidad de Córdoba, España
| | - María José Faus-Dáder
- Grupo de Investigación en Atención Farmacéutica, Universidad de Granada, Granada, España
| | - María Isabel Baena-Parejo
- Grupo de Investigación en Atención Farmacéutica, Universidad de Granada, Granada, España. Dirección General de Investigación y Gestión del Conocimiento, Junta de Andalucía
| | - Miguel Angel Calleja-Hernández
- Unidad de Gestión Clínica, Intercentros Interniveles de Farmacia de Granada, Complejo Hospitalario Universitario de Granada, Granada, España
| |
Collapse
|
15
|
Abstract
Acute heart failure is globally one of most frequent reasons for hospitalization and still represents a challenge for the choice of the best treatment to improve patient outcome. According to current international guidelines, as soon as patients with acute heart failure arrive at the emergency department, the common therapeutic approach aims to improve their signs and symptoms, correct volume overload, and ameliorate cardiac hemodynamics by increasing vital organ perfusion. Recommended treatment for the early management of acute heart failure is characterized by the use of intravenous diuretics, oxygen, and vasodilators. Although these measures ameliorate the patient's symptoms, they do not favorably impact on short- and long-term mortality. Consequently, there is a pressing need for novel agents in acute heart failure treatment with the result that research in this field is increasing worldwide.
Collapse
Affiliation(s)
- Salvatore Di Somma
- Emergency Department Sant'Andrea Hospital, Medical-Surgery Sciences and Translational Medicine, University La Sapienza, Rome, Italy.
| | - Laura Magrini
- Emergency Department Sant'Andrea Hospital, Medical-Surgery Sciences and Translational Medicine, University La Sapienza, Rome, Italy
| |
Collapse
|
16
|
Jurado López AR. [Pharmacological treatment of the premature ejaculation]. Semergen 2014; 40 Suppl 3:16-21. [PMID: 25953037 DOI: 10.1016/S1138-3593(15)30004-6] [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] [Indexed: 11/21/2022]
Abstract
Biomedical approach to premature ejaculation (PE) has permited a better phisiopatologycal knowledge and so the use of pharmacological agents for the treatment of this sexual dysfuncion. Most of the studies to evaluate the eficacy of these drugs were not carried at all the parameters which actually define PE: intravaginal ejaculatory latencie time (IELT) tested with watch, ejaculation control self perception cuantification (questionaries) and cuantification of generated consequences in patient and partner, if it existes. For this reason, it is difficult to analyse the scientific evidence and we use medicines with no approved indication for PE ("off label"). This text is a review of pharmacologycal agents with no approved indication (PDE type 5 inhibitors, α-blockers, tramadol, SSRI, clomipramine), and pharmacologycal agents developed to be used in the treatment of PE and having got indication in this sexual dysfunction or "on label" drugs (topic anesthesics, dapoxetine).
Collapse
|
17
|
Cunill R, Castells X. [Attention deficit hyperactivity disorder]. Med Clin (Barc) 2015; 144:370-5. [PMID: 24787685 DOI: 10.1016/j.medcli.2014.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 02/16/2014] [Accepted: 02/27/2014] [Indexed: 11/22/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders and can persist into the adulthood. ADHD has important social, academic and occupational consequences. ADHD diagnosis is based on the fulfillment of several clinical criteria, which can vary depending on the diagnostic system used. The clinical presentation can show great between-patient variability and it has been related to a dysfunction in the fronto-striatal and meso-limbic circuits. Recent investigations support a model in which multiple genetic and environmental factors interact to create a neurobiological susceptibility to develop the disorder. However, no clear causal association has yet been identified. Although multimodal treatment including both pharmacological and psychosocial interventions is usually recommended, no convincing evidence exists to support this recommendation. Pharmacological treatment has fundamentally shown to improve ADHD symptoms in the short term, while efficacy data for psychosocial interventions are scarce and inconsistent. Yet, drug treatment is increasingly popular and the last 2 decades have witnessed a sharp increase in the prescription of anti-ADHD medications coinciding with the marketing of new drugs to treat ADHD.
Collapse
|
18
|
Talero-Gutiérrez C, Sánchez-Torres JM, Velez-van-Meerbeke A. Learning skills and academic performance in children and adolescents with absence epilepsy. Neurologia 2013; 30:71-6. [PMID: 24332773 DOI: 10.1016/j.nrl.2013.10.011] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/20/2013] [Accepted: 10/13/2013] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Although cognitive and learning disorders have been described in patients with epilepsy, very few studies focus on specific disorders such as absence epilepsy. The aim of this study was to evaluate learning skills and academic performance in children and adolescents with absence epilepsy. METHODS Observational case-control study. Cases were chosen from the Central League against Epilepsy's clinic in Bogotá, Colombia. Controls were selected from a private school and matched with cases by age, school year, and sex. Medical history, seizure frequency, antiepileptic treatment, and academic performance were assessed. Academic abilities were tested with Batería de Aptitudes Diferenciales y Generales (BADyG) (a Spanish-language test of differential and general aptitudes). Data were analysed using Student t-test. RESULTS The sample consisted of 19 cases and 19 controls aged between 7 and 16. In 15 patients, seizures were controlled; all patients had received antiepileptic medication at some point and 78.9% were actively being treated. Although cases had higher rates of academic failure, a greater incidence of grade retention, and more therapeutic interventions than controls, these differences were not significant. Similarly, there were no significant differences on the BADyG test, except for the immediate memory subcategory on which cases scored higher than controls (P=.0006). CONCLUSION Children treated pharmacologically for absence epilepsy, whose seizures are controlled, have normal academic abilities and skills for their age.
Collapse
Affiliation(s)
- C Talero-Gutiérrez
- Grupo de Investigación en Neurociencias NeURos, Facultad de Medicina y Ciencias de la salud, Universidad del Rosario, Bogotá, Colombia.
| | - J M Sánchez-Torres
- Facultad de Pedagogía, Universidad Distrital Francisco José de Caldas, Bogotá, Colombia
| | - A Velez-van-Meerbeke
- Grupo de Investigación en Neurociencias NeURos, Facultad de Medicina y Ciencias de la salud, Universidad del Rosario, Bogotá, Colombia
| |
Collapse
|
19
|
Mejía-Lancheros C, Estruch R, Martínez-González MA, Salas-Salvadó J, Corella D, Gómez-Gracia E, Fiol M, Lapetra J, Covas MI, Arós F, Serra-Majem L, Pintó X, Basora J, Sorlí JV, Muñoz MA. Socioeconomic status and health inequalities for cardiovascular prevention among elderly Spaniards. ACTA ACUST UNITED AC 2013; 66:803-11. [PMID: 24773861 DOI: 10.1016/j.rec.2013.05.025] [Citation(s) in RCA: 5] [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: 04/12/2013] [Accepted: 05/22/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Although it is known that social factors may introduce inequalities in cardiovascular health, data on the role of socioeconomic differences in the prescription of preventive treatment are scarce. We aimed to assess the relationship between the socioeconomic status of an elderly population at high cardiovascular risk and inequalities in receiving primary cardiovascular treatment, within the context of a universal health care system. METHODS Cross-sectional study of 7447 individuals with high cardiovascular risk (57.5% women, mean age 67 years) who participated in the PREDIMED study, a clinical trial of nutritional interventions for cardiovascular prevention. Educational attainment was used as the indicator of socioeconomic status to evaluate differences in pharmacological treatment received for hypertension, diabetes, and dyslipidemia. RESULTS Participants with the lowest socioeconomic status were more frequently women, older, overweight, sedentary, and less adherent to the Mediterranean dietary pattern. They were, however, less likely to smoke and drink alcohol. This socioeconomic subgroup had a higher proportion of coexisting cardiovascular risk factors. Multivariate analysis of the whole population found no differences between participants with middle and low levels of education in the drug treatment prescribed for 3 major cardiovascular risk factors (odds ratio [95% confidence interval]): hypertension (0.75 [0.56-1.00] vs 0.85 [0.65-1.10]); diabetic participants (0.86 [0.61-1.22] vs 0.90 [0.67-1.22]); and dyslipidemia (0.93 [0.75-1.15] vs 0.99 [0.82-1.19], respectively). CONCLUSIONS In our analysis, socioeconomic differences did not affect the treatment prescribed for primary cardiovascular prevention in elderly patients in Spain. Free, universal health care based on a primary care model can be effective in reducing health inequalities related to socioeconomic status.
Collapse
Affiliation(s)
- Cília Mejía-Lancheros
- Departamento de Pediatría, Obstetricia, Ginecología y Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramón Estruch
- Departamento de Medicina Interna, IDIBAPS, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Nutrición Humana, IISPV, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Medicina Preventiva, Universidad de Valencia, Valencia, Spain
| | | | - Miquel Fiol
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Instituto de Ciencias de la Salud (IUNICS), Universidad de las Islas Baleares, Palma de Mallorca, Baleares, Spain
| | - José Lapetra
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Medicina de Familia, División de Atención Primaria de Sevilla, Centro de Salud Bellavista, Sevilla, Spain
| | - Maria I Covas
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Unidad de Lípidos e Investigación en Epidemiología Cardiovascular, Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, Spain
| | - Fernando Arós
- Departamento de Cardiología, Hospital Universitario Txagorritxu, Vitoria, Álava, Spain
| | - Lluís Serra-Majem
- Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Xavier Pintó
- Unidad de Lípidos y Riesgo Vascular, Medicina Interna, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Basora
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Unidad de Investigación en Atención Primaria de Tarragona, Institut Català de la Salut e IDIAP-Jordi Gol, Tarragona, Spain
| | - José V Sorlí
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Medicina Preventiva, Facultad de Medicina, Universidad de Valencia, Valencia, Spain; División de Atención Primaria, Instituto de la Salud de Valencia, Valencia, Spain
| | - Miguel A Muñoz
- Departamento de Pediatría, Obstetricia, Ginecología y Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, Spain; Unitat de Suport a la Recerca, División de Atención Primaria de Salud, Institut Català de la Salut e IDIAP-Jordi Gol, Barcelona, Spain.
| | | |
Collapse
|