Showing papers in "Medicina Clinica in 2018"
TL;DR: La mortalidad, los anos de vida ajustados por discapacidad (AVAD), los factores de riesgo y el progreso hacia los objetivos de desarrollo sostenible (ODS) a partir of los datos de GBD 2016 en Espana are presented.
Abstract: Resumen Antecedentes y objetivo El estudio de la carga global de las enfermedades, conocido como GBD por sus siglas en ingles (global burden of disease), mide la salud poblacional en todo el mundo de forma anual y sus resultados estan disponibles por pais. Utilizamos las estimaciones GBD para resumir el estado de salud poblacional en Espana en 2016 y describir las tendencias en morbimortalidad de 1990 a 2016. Material y metodos GBD 2016 estima la carga debida a 333 enfermedades y lesiones, y a 84 factores de riesgo. La lista de causas de GBD es jerarquica e incluye 3 categorias de nivel superior: 1) enfermedades transmisibles, maternas, neonatales y nutricionales; 2) enfermedades no transmisibles (ENT), y 3) accidentes. Se presentan la mortalidad, los anos de vida ajustados por discapacidad (AVAD), los factores de riesgo y el progreso hacia los objetivos de desarrollo sostenible (ODS) a partir de los datos de GBD 2016 en Espana. Resultados En 2016 en Espana hubo 418.516 muertes, de una poblacion total de 46,5 millones, y el 80,5% de ellas ocurrieron en personas de 70 anos o mas. Las ENT fueron la principal causa de muerte (92,8%), con 388.617 (intervalo de incertidumbre del 95% 374.959-402.486), seguidas de los accidentes (3,6%), con 15.052 (13.902-17.107), y de las enfermedades transmisibles (3,5%), con 14.847 (13.208-16.482) muertes. Las 5 principales causas especificas de muerte fueron la cardiopatia isquemica (CI), con el 14,6% de todas las muertes, la enfermedad de Alzheimer y otras demencias (13,6%), el accidente cerebrovascular (7,1%), la enfermedad pulmonar obstructiva cronica (6,9%) y el cancer de pulmon (5,0%). Se observaron incrementos notables en la mortalidad de 1990 a 2016 en otros canceres, infecciones respiratorias del tracto inferior, enfermedad renal cronica y otras enfermedades cardiovasculares, entre otros. Por el contrario, los accidentes de trafico bajaron del puesto 8 al 32 y la diabetes del 6 al 10. Los dolores de espalda y cervicales se convirtieron en la causa principal de AVAD en Espana en 2016, superando a la CI, mientras que la enfermedad de Alzheimer paso del puesto 9 al 3. Los mayores cambios en AVAD se observaron para accidentes de trafico, que cayeron de la posicion 4 a la posicion 16, y los trastornos congenitos, de la 17 a la 35; por el contrario, los trastornos orales aumentaron, pasando del puesto 25 al 17. En general, fumar es, con mucho, el factor de riesgo mas relevante en Espana, seguido de presion arterial alta, indice de masa corporal alto, consumo de alcohol y glucemia alta en ayunas. Finalmente, Espana obtuvo 74,3 sobre 100 puntos en la clasificacion del indice ODS en 2016, y los principales determinantes de salud nacionales relacionados con los ODS fueron el consumo de alcohol, el tabaquismo y la obesidad infantil. Se proyecta un aumento a 80,3 puntos en 2030. Conclusion Los dolores de espalda y cervical fueron el contribuyente mas importante de discapacidad en Espana en 2016. Hubo un aumento notable de la carga poblacional debida a la enfermedad de Alzheimer y otras demencias. El tabaco sigue siendo el riesgo para la salud mas importante que debe abordarse en Espana.
97 citations
TL;DR: Primary cholangitis (cirrhosis) is a chronic cholestatic disease with an unquestionable female predominance and Ursodeoxycholic acid is the specific treatment with an excellent response in more than 60% of patients.
Abstract: Primary cholangitis (cirrhosis) is a chronic cholestatic disease with an unquestionable female predominance. It is characterised by inflammation of the small and medium size bile ducts, and can eventually progress to cirrhosis. Most patients remain asymptomatic and are diagnosed by the casual finding of an anicteric biochemical cholestasis with increased alkaline phosphatase. The pathogenesis is unknown and of presumed autoimmune origin in genetic susceptible subjects. M2-type antimitochondrial antibodies, and specific antinuclear antibodies (gp210 and Sp100) are typical and specific of the disease. The positivity of these antibodies and a biochemical cholestasis are sufficient for diagnosis, without the need for liver biopsy. Ursodeoxycholic acid is the specific treatment with an excellent response in more than 60% of patients. When this optimal response is not observed, it can be combined with new agents, but those that have shown to be effective are those that improve cholestasis such as fibrates and obeticholic acid.
85 citations
TL;DR: Low back and neck pain became the number one cause of DALYs in Spain in 2016, just surpassing IHD, while Alzheimer disease moved from 9th to 3rd position, and smoking is by far the most relevant risk factor in Spain.
Abstract: Background and objectives The global burden of disease (GBD) project measures the health of populations worldwide on an annual basis, and results are available by country We used the estimates of the GBD to summarise the state of health in Spain in 2016 and report trends in mortality and morbidity from 1990 to 2016 Material and methods GBD 2016 estimated disease burden due to 333 diseases and injuries, and 84 risk factors The GBD list of causes is hierarchical and includes 3 top level categories, namely: (1) communicable, maternal, neonatal, and nutritional diseases; (2) non-communicable diseases (NCDs), and (3) injuries Mortality and disability-adjusted life-years (DALYs), risk factors, and progress towards the sustainable development goals (SDGs) are presented based on the GBD 2016 data in Spain Results There were 418,516 deaths in Spain in 2016, from a total population of 465 million, and 805% of them occurred in those aged 70 years and older Overall, NCDs were the main cause of death: 388,617 (95% uncertainty interval 374,959–402,486), corresponding to 928% of all deaths They were followed by 36% due to injuries with 15,052 (13,902–17,107) deaths, and 35% communicable diseases with 14,847 (13,208–16,482) deaths The 5 leading specific causes of death were ischaemic heart disease (IHD, 146% of all deaths), Alzheimer disease and other dementias (136%), stroke (71%), chronic obstructive pulmonary disease (69%), and lung cancer (50%) Remarkable increases in mortality from 1990 to 2016 were observed in other cancers, lower respiratory infections, chronic kidney disease, and other cardiovascular disease, among others On the contrary, road injuries moved down from 8th to 32nd position, and diabetes from 6th to 10th Low back and neck pain became the number one cause of DALYs in Spain in 2016, just surpassing IHD, while Alzheimer disease moved from 9th to 3rd position The greatest changes in DALYs were observed for road injuries dropping from 4th to 16th position, and congenital disorders from 17th to 35th; conversely, oral disorders rose from 25th to 17th Overall, smoking is by far the most relevant risk factor in Spain, followed by high blood pressure, high body mass index, alcohol use, and high fasting plasma glucose Finally, Spain scored 743 of 100 points in the SDG index classification in 2016, and the main national drivers of detrimental health in SDGs were alcohol consumption, smoking and child obesity An increase to 803 points is projected in 2030 Conclusion Low back and neck pain was the most important contributor of disability in Spain in 2016 There has seen a remarkable increase in the burden due to Alzheimer disease and other dementias Tobacco remains the most important health issue to address in Spain
61 citations
TL;DR: The management of this tumour has improved over the past 2 decades: patients at risk are included in a surveillance program, a prognostic staging system has been created and, finally, new treatments particularly aimed at patients with advanced HCC have been developed.
Abstract: Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide with over 740,000 new cases per year and the third leading cause of cancer-related death, with a growing incidence in recent years. This tumour usually arises in patients with an underlying chronic liver disease. The management of this tumour has improved over the past 2 decades: patients at risk are included in a surveillance program, a prognostic staging system has been created and, finally, new treatments particularly aimed at patients with advanced HCC have been developed. This fact has resulted in a greater interest in this tumour and several scientific societies have developed clinical practice guidelines for the management of patients with this disease. In this article, we review the current and future prospects of this tumour.
28 citations
28 citations
TL;DR: Telehealth was associated with better quality of life and similarity of effects to telephone intervention call for careful endorsement of telemedicine.
Abstract: Background and objective To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. Patients and methods 472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline. Results EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08–0.30), but was not different to telephone support (diff: 0.04, −0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p Conclusions Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562 ).
26 citations
TL;DR: This multi-disciplinary symposium will bring experts from Mental Health and Emergency Medicine along with public officials to discuss the opioid crisis and several potential clinical and political approaches to begin to address it.
Abstract: The opioid epidemic took front and center stage as our #1 Public Health crisis when it was reported that more than 50,000 people died of drug overdoses in the US last year, more than handgun homicides and MVC’s combined. The blame game started and emergency physicians appear to often be in the center of the controversy. This multi-disciplinary symposium will bring experts from Mental Health and Emergency Medicine along with public officials to discuss the opioid crisis and several potential clinical and political approaches to begin to address it. Featured Speaker: Corey Waller, MD, MS , Senior Medical Director for Education and Policy Camden Coalition of Healthcare Providers “The Opioid Epidemic and ED Crowding: Finding Pragmatic Solutions.” Perspectives and Updates from Public Officials: Randall Williams, MD, Director of the Missouri Department of Health and Senior Services Holly Rehder, Missouri House of Representatives District 148 Rachel Winograd, Ph. D, Assistant Research Professor, Missouri Institute of Mental Health, University of Missouri-Saint Louis
24 citations
TL;DR: La busqueda identifico un total of 18 articulos, que describian la sintomatologia, el constructo de sindrome clinico judicial, su prevalencia, etiopatogenia y aspectos of prevencion y abordaje, y los datos disponibles subrayan la relevancia del impacto of las reclamaciones sobre los facultativos.
Abstract: Resumen Las reclamaciones por presunto defecto de praxis resultan una preocupacion relevante para los facultativos, sin embargo, el impacto que las mismas tienen sobre estos recibe escasa atencion. Se presenta una revision sistematica de la literatura cientifica mediante la busqueda en la base de datos MEDLINE, sin limite temporal, de manuscritos en castellano, ingles o frances, sobre la reaccion de los facultativos ante una reclamacion por negligencia. Se evaluo su calidad metodologica y analizaron sus resultados. La busqueda identifico un total de 18 articulos, en su mayoria sin analisis de muestra empirica, que describian la sintomatologia, el constructo de sindrome clinico judicial, su prevalencia, etiopatogenia y aspectos de prevencion y abordaje. La literatura medica al respecto resulta muy escasa y con una pobre fundamentacion empirica. Sin embargo, los datos disponibles subrayan la relevancia del impacto de las reclamaciones sobre los facultativos y urgen a instaurar medidas de prevencion y abordaje del denominado sindrome clinico judicial.
20 citations
TL;DR: ADR were responsible for 6% of admissions to an acute geriatric unit, and over 75% of these admissions were considered avoidable, and Associated risk factors were being female, inappropriate medication, polypharmacy, renal insufficiency and sedative use.
Abstract: Objective To determine prevalence of admissions due to an adverse drug reaction (ADR) and determine whether or not admission was avoidable, and what drugs and risk factors were implicated. Design Cross-sectional observational study. Study sample All patients hospitalized in an acute geriatric unit during the period January 2001 to December 2010 were studied. Measurement To determine whether admissions were due to ADR, we used the World Health Organization-Uppsala Monitoring Centre criteria and the Naranjo scale. Beers criteria were used to detect potentially inappropriate medication. Results A total of 3292 patients (mean age 84.7 years, 60.1% women) were studied. Of these, 197 (6%) were admissions for ADR and nearly three quarters (76.4%, 152 cases) were considered avoidable admissions. The five most frequent drugs associated with admissions for ADR were digoxin, nonsteroidal anti-inflammatory drugs, benzodiazepines, diuretics and antibiotics. Independent risk factors for admissions for ADR were being female (OR 1.84; 95% CI: 1.30–2.61), inappropriate medication according to Beers criteria (OR 4.20; 95% CI: 2.90–6.03), polypharmacy (>5 drugs) (OR 1.50; 95% CI: 1.04–2.13), glomerular filtration rate Conclusion ADR were responsible for 6% of admissions to an acute geriatric unit, and over 75% of these admissions were considered avoidable. Associated risk factors were being female, inappropriate medication, polypharmacy, renal insufficiency and sedative use.
19 citations
TL;DR: Direct oral anticoagulants showed a favourable benefit-risk balance in their safety and efficacy profile, in prevention of thromboembolic events in patients with atrial fibrillation and in the prevention and treatment of venous thromBoembolism and acute coronary syndrome.
Abstract: Vitamin K antagonists were the only choice for chronic oral anticoagulation for more than half a century. Over the past few years, direct oral anticoagulants have emerged, including one direct thrombin inhibitor (dabigatran etexilate) and three factor Xa inhibitors (apixaban, edoxaban and rivaroxaban). In randomised controlled trials comparing direct oral anticoagulants with traditional vitamin K antagonists, the direct oral anticoagulants all showed a favourable benefit-risk balance in their safety and efficacy profile, in prevention of thromboembolic events in patients with atrial fibrillation and in the prevention and treatment of venous thromboembolism and acute coronary syndrome. In 2008, dabigatran was the first direct oral anticoagulant approved by the European Medicine Agency. Subsequently, rivaroxaban, apixaban and edoxaban were also authorised. This article reviews the evidence related to the use of these drugs.
19 citations
TL;DR: La identificacion de anomalias citogeneticas recurrentes asociadas a distintos patrones de presentacion clinica de leucemia mieloide aguda ha llevado a la incorporacion of diversos marcadores geneticos that influyen en the toma of decisiones clinicas.
Abstract: Resumen La leucemia mieloide aguda es la forma mas frecuente de leucemia aguda, cuya incidencia aumenta con la edad. La enfermedad deriva de una stem cell hematopoyetica maligna multipotente transformada que adquiere alteraciones genomicas sucesivas. La identificacion de anomalias citogeneticas recurrentes asociadas a distintos patrones de presentacion clinica de leucemia mieloide aguda ha llevado a la incorporacion de diversos marcadores geneticos que influyen en la toma de decisiones clinicas. Ademas, las implicaciones que dichas anomalias pueden tener en las respuestas a los tratamientos y en las tasas de recaida y de supervivencia se han incorporado en la reciente clasificacion molecular y de la Organizacion Mundial de la Salud y de la European Leukemia Net, con el objetivo de crear categorias pronosticas que ayuden a racionalizar mejor el diagnostico, pronostico, la reevaluacion de la enfermedad y la combinacion de protocolos terapeuticos, con la finalidad de aumentar la supervivencia.
TL;DR: The recognition of anti-NMDAR encephalitis is important because, despite its severity, most patients respond to immunotherapy.
Abstract: The encephalitis associated with antibodies against the N-methyl-D-aspartate receptor (NMDAR) is characterized by the presence of antibodies against the GluN1 subunit of this receptor, resulting in symptoms that are similar to those observed in models of genetic or pharmacologic reduction of NMDARs. Patients are usually young adults, predominantly women, and children who develop, in a sequential manner, rapidly progressive symptoms including psychosis, abnormal movements, autonomic dysfunction, and coma. Epileptic seizures are variable and can occur throughout the course of the disease. The disease is often mistaken as viral encephalitis, primary psychiatric disorders, drug abuse, or neuroleptic malignant syndrome. About 50% of young women have an ovarian teratoma; in young girls and men the presence of a tumour is infrequent. In some patients, the disease is triggered by herpes simplex encephalitis. The recognition of anti-NMDAR encephalitis is important because, despite its severity, most patients respond to immunotherapy.
TL;DR: The identification of recurrent cytogenetic anomalies associated with different patterns of acute myeloid leukaemia clinical presentation has led to the incorporation of genetic markers in clinical decision-making and into the World Health Organisation's recent molecular classification and stratification and the European Leukaemia Net.
Abstract: Acute myeloid leukaemia is the most common form of acute leukaemia, and its incidence increases with age. The disease derives from a transformed multipotent malignant haematopoietic stem cell that acquires consequent genomic alterations. The identification of recurrent cytogenetic anomalies associated with different patterns of acute myeloid leukaemia clinical presentation has led to the incorporation of genetic markers in clinical decision-making. In addition, the observation that these anomalies may mark therapeutic responses and relapse and survival rates have been incorporated into the World Health Organisation's recent molecular classification and stratification and the European Leukaemia Net, with the aim of creating prognostic categories that help rationalise better diagnosis, prognosis, re-evaluation of the disease and the combination of therapeutic protocols in order to increase the survival rate of these patients.
TL;DR: Agarre et al. as mentioned in this paper described 14 publications of the linfogranuloma venereo (LGV) in Spain between 2005 and 2015, with caracteristicas similares to las de los cases of the VIH in Europe.
Abstract: Resumen El linfogranuloma venereo (LGV) era infrecuente en Europa hasta 2003, cuando surgieron brotes en hombres que tenian relaciones sexuales con hombres (HSH) Esta enfermedad es de declaracion obligatoria nacional a partir de 2015 El objetivo es describir los casos de LGV publicados entre 2005 y 2015 en Espana Se identificaron 14 publicaciones con casos en 7 comunidades autonomas La mayoria fueron HSH, espanoles, entre 30 y 45 anos y con sintomatologia rectal El serovar mas frecuente fue el L2 Mas del 60% de los casos en HSH estaban coinfectados con el VIH y casi la mitad presentaba otras infecciones concurrentes Tras la descripcion del primer caso publicada en 2005, el LGV se ha distribuido ampliamente en Espana, con caracteristicas similares a las de los casos descritos en Europa La puesta en marcha de la vigilancia estatal del LGV permitira conocer su magnitud y tendencia y caracterizar los casos, lo que es clave para su control
TL;DR: Different aspects related to globalization together with the great capacity of the arthropod vectors to adapt to a changing world favour the emergence and reemergence of numerous infectious diseases transmitted by them.
Abstract: Resumen Diferentes aspectos relacionados con la globalizacion junto a la gran capacidad de los artropodos vectores para adaptarse a un mundo cambiante propician la emergencia y reemergencia de numerosos procesos infecciosos transmitidos por los mismos Dipteros (culicidos y flebotomos), garrapatas, pulgas y piojos, entre otros, provocan un variado espectro de enfermedades con gran importancia en Salud Publica En esta revision se repasan las diferentes afecciones transmitidas por artropodos vectores, haciendo un especial hincapie en el riesgo existente para contraerlas en Espana en funcion de diferentes parametros, como la presencia del artropodo y la circulacion o posible circulacion de los agentes causales
TL;DR: La falta de adherencia al tratamiento of las pacientes with LES fue alta y parece estar influida by factores clinicos y psicopatologicos.
Abstract: Resumen Antecedentes y objetivo El incumplimiento terapeutico constituye un importante problema asistencial en pacientes con lupus eritematoso sistemico (LES). Conocer los factores asociados de este puede ser de gran utilidad en el ambito clinico. El objetivo de esta investigacion fue analizar la influencia de las variables sociodemograficas, clinicas y psicologicas sobre la adherencia al tratamiento en una muestra espanola de mujeres con LES. Pacientes y metodo En este estudio transversal-observacional se evaluo el grado de adherencia al tratamiento, el estado clinico y psicopatologico, el estres psicologico y la autoeficacia en mujeres con LES. La muestra se dividio en 2 grupos: adherentes y no adherentes. Mediante un analisis de regresion logistica se identificaron los factores asociados a la falta de adherencia en esta poblacion. Resultados Se evaluaron 72 pacientes (edad media: 36,7 ± 12,2 anos). El 63,9% no tuvieron adherencia. Un bajo nivel educativo, estar desempleada, vivir en pareja y el consumo de alcohol se asociaron a una baja adhesion al tratamiento. Se encontraron diferencias entre el grupo adherente y el no adherente en las subescalas psicopatologicas de somatizacion, obsesion-compulsion e indices psicopatologicos generales, asi como en el estres percibido, obteniendo puntuaciones mas altas las pacientes adherentes. El uso de antiinflamatorios no esteroideos (AINE), tener artrosis y mayor alteracion psicopatologica fueron predictores significativos de la adherencia al tratamiento, explicando entre el 35 y el 47% de la variabilidad de esta. Conclusiones La falta de adherencia al tratamiento de las pacientes con LES fue alta y parece estar influida por factores clinicos y psicopatologicos.
TL;DR: A systematic review of studies investigating the impact of different renal function variables on the AHF prognosis found that creatinine, blood urea nitrogen (BUN), the BUN/creatinine quotient, chronic kidney disease, the formula to estimate the glomerular filtration rate, criteria of acute renal injury and new biomarkers of renal damage such as neutrophil gelatinase-associated lipocalin (NGAL and cystatin c).
Abstract: The interaction between acute heart failure (AHF) and renal dysfunction is complex. Several studies have evaluated the prognostic value of this syndrome. The aim of this systematic review, which includes non-selected samples, was to investigate the impact of different renal function variables on the AHF prognosis. The categories included in the studies reviewed included: creatinine, blood urea nitrogen (BUN), the BUN/creatinine quotient, chronic kidney disease, the formula to estimate the glomerular filtration rate, criteria of acute renal injury and new biomarkers of renal damage such as neutrophil gelatinase-associated lipocalin (NGAL and cystatin c). The basal alterations of the renal function, as well as the acute alterations, transient or not, are related to a worse prognosis in AHF, it is therefore necessary to always have baseline, acute and evolutive renal function parameters.
TL;DR: Arthropod-borne disease are reviewed, with special emphasis on the existing risk to contract them in Spain according to different parameters, such as the presence of arthropod and the circulation or the possible circulation of the causative agents.
Abstract: Different aspects related to globalization together with the great capacity of the arthropod vectors to adapt to a changing world favour the emergence and reemergence of numerous infectious diseases transmitted by them. Diptera (mosquitoes and sandflies), ticks, fleas and lice, among others, cause a wide spectrum of diseases with relevance in public health. Herein, arthropod-borne disease are reviewed, with special emphasis on the existing risk to contract them in Spain according to different parameters, such as the presence of arthropod and the circulation or the possible circulation of the causative agents.
TL;DR: A low educational level, being unemployed, living with a partner and alcohol abuse were associated with low treatment adherence, and the use of non-steroidal anti-inflammatory drugs, suffering arthrosis and scoring higher in dimensions of psychopathology were significant predictors of treatment adherence.
Abstract: Background and objective Non-adherence to treatment is usually a clinical problem in patients with systemic lupus erythematosus (SLE). Increasing the knowledge of predictors of treatment adherence can be meaningful in the clinical setting. The main objective of the present study was to analyze the influence of sociodemographic, clinical and psychological variables on the degree of treatment adherence in a sample of Spanish women with SLE. Patients and method This is an observational–transversal study. All participants were evaluated for the degree of treatment adherence, their clinical status, psychopathological manifestations, the level of perceived stress and self-efficacy. The sample was divided into two groups (adherent vs non-adherent). The factors associated with a lack of adherence in this sample were analyzed by means of logistic regression. Results This study comprises 72 women with SLE (average age = 36.72 ± 12.2 years). Almost 64% of patients with SLE were non-adherent to treatment. The results showed that a low educational level, being unemployed, living with a partner and alcohol abuse were associated with low treatment adherence. There were significant mean differences between groups in psychopathological subscales of somatization, obsession–compulsion and general psychopathological indices. There were also mean differences between groups for the level of perceived stress. The use of non-steroidal anti-inflammatory drugs, suffering arthrosis and scoring higher in dimensions of psychopathology were significant predictors of treatment adherence, explaining between 35% and 47% of its variability. Conclusions Including the clinical and psychopathological manifestations as important aspects in the clinical reasoning of health professionals could improve the adherence to treatment of patients with SLE.
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TL;DR: Medical therapy has improved significantly, especially with the development of infliximab and adalimumab, but the prevalence of the disease is increasing, more patients are being identified at a younger age, and many still develop complications that require surgical intervention.
Abstract: Crohn’s disease is one of the two commonly seen inflammatory bowel diseases. As opposed to ulcerative colitis, which only directly affects the colon and rectum, Crohn’s disease can affect any part of the intestinal tract. It can also involve the full thickness of the bowel wall, which accounts for many of the complications seen with the disease. Surgery is not curative but is reserved for the treatment of complications that are refractory to medical management. The etiology is unknown but it is increasingly clear that most patients have a genetic predisposition, though what purported environmental triggers are involved is less clear. Medical therapy has improved significantly, especially with the development of infliximab and adalimumab, but the prevalence of the disease is increasing, more patients are being identified at a younger age, and many still develop complications that require surgical intervention.
TL;DR: During the one-year follow-up, the presence of AF does not influence mortality or readmissions in patients with HFpEF.
Abstract: Introduction and objectives The impact of atrial fibrillation (AF) on the prognosis of heart failure with preserved ejection fraction (HFpEF) is still the subject of debate. We analysed the influence of AF on the prognosis on mortality and readmission in patients with HFpEF. Methods Prospective observational study in 1971 patients with HFpEF, who were admitted for acute heart failure. Patients were divided into 2 groups according to the presence or absence of AF. We analysed mortality, readmissions and combined mortality/readmissions at one-year follow-up. Results A total of 1177 (59%) patients had AF, mean age 80.3 (7.8) years and 1233 (63%) were women. Patients with HFpEF and AF were older, female, greater valvular aetiology and lower comorbidity measured by the Charlson index. At the one-year follow-up, 430 (22%) patients had died and 840 (43%) had been readmitted. In the 2 groups analysed, there was no difference in all-cause mortality (22 vs. 21%; p = 0.739, AF vs. no-AF, respectively) or cardiovascular causes (9.6 vs. 8.2%; p = 0.739, AF vs. no-AF, respectively). In the multivariable analysis, factors associated with higher mortality were: age, male, valvular aetiology, uric acid, and comorbidity. In the analysis of the subgroup with HFpEF with AF, the presence of chronic AF compared to de novo AF was associated with higher mortality (HR 1716; 95% CI 1099–2681; p = 0.018). Conclusions In patients with HFpEF, the presence of AF is frequent. During the one-year follow-up, the presence of AF does not influence mortality or readmissions in patients with HFpEF.
TL;DR: Non-invasive diagnostic methods such as elastography or serological markers are increasingly used as a good alternative for the early diagnosis of the degree of fibrosis.
Abstract: Chronic liver diseases constitute a major health problem. Chronic liver inflammation, defined by the degree of hepatic fibrosis, is asymptomatic in a significant percentage of patients; hence, the disease often remains undiagnosed until it has reached very advanced phases and, frequently, when the damage is irreversible. Ideally, patients should be screened during the initial phases of chronic inflammation, thus allowing for the effective management of the natural evolution of the disease by stopping or delaying its course. Standard diagnostic methods (transaminase determination or abdominal ultrasonography) do not allow for the early diagnosis of the degree of fibrosis. A liver biopsy is the invasive method of choice to screen for fibrosis, however, due to its limitations, non-invasive diagnostic methods such as elastography or serological markers are increasingly used as a good alternative for the early diagnosis of the degree of fibrosis.
TL;DR: This review has been made from different patient profiles that practitioners will find in usual practice; from patients with hip fracture with cognitive impairment, limitation of their day-to-day living activities and comorbidities, to active patients without any limitations; patients with vertebral fractures and non-vertebral fractures where secondary prevention is highly important.
Abstract: Treatment of osteoporosis should be directed primarily towards secondary prevention of fractures. The occurrence of drug-related adverse effects for the treatment of osteoporosis has led to a reevaluation of the indications, the duration of treatment and even withdrawal of some drugs from the market. This review has been made from different patient profiles that practitioners will find in usual practice; from patients with hip fracture with cognitive impairment, limitation of their day-to-day living activities and comorbidities, to active patients without any limitations; patients with vertebral fractures and non-vertebral fractures where secondary prevention is highly important. In general, antiresorptive drugs (alendronate and risedronate) will be the first choice. Zoledronate or denosumab will be indicated in cases of digestive intolerance, poor adherence or an increased risk of hip fracture. Teriparatide will be indicated to patients with 2or more previous vertebral fractures or very low bone density.
TL;DR: Main symptoms of the disease are polyarthritis, hand oedema, Raynaud's phenomenon, sclerodactyly, myositis and oesophageal hypomobility.
Abstract: Mixed connective tissue disease (MCTD) is a systemic autoimmune rheumatic disease (SARD) characterised by the combination of clinical manifestations of systemic lupus erythematosus (SLE), cutaneous systemic sclerosis (SSc) and polymyositis-dermatomyositis, in the presence of elevated titers of anti-U1-RNP antibodies. Main symptoms of the disease are polyarthritis, hand oedema, Raynaud's phenomenon, sclerodactyly, myositis and oesophageal hypomobility. Although widely discussed, most authors today accept MCTD as an independent entity. Others, however, suggest that these patients may belong to subgroups or early stages of certain definite connective diseases, such as SLE or SSc, or are, in fact, SARD overlap syndromes.
TL;DR: La aplicacion topica de 1 g de ATX reduce significativamente the perdida de sangre en pacientes intervenidos of artroplastia total of rodilla, en mayor magnitud que the aplica intravenosa y the no administracion.
Abstract: Resumen Introduccion y objetivo La administracion de acido tranexamico (ATX) es efectiva reduciendo la perdida de sangre en la artroplastia de rodilla. Con el fin de evitar los efectos adversos de la administracion intravenosa, se ha propuesto el uso topico del mismo. Nuestro objetivo es evaluar la eficacia y seguridad de ATX topico para reducir la hemorragia postoperatoria en la artroplastia de rodilla. Material y metodos Un total de 90 pacientes intervenidos de artroplastia total de rodilla unilateral fueron incluidos en un estudio prospectivo y aleatorizado. Todas las intervenciones fueron llevadas a cabo bajo anestesia espinal, con isquemia preventiva y bajo el mismo regimen postoperatorio. Los pacientes fueron divididos en 3 grupos en funcion de la administracion del ATX: grupo A (n = 30) 1 g de ATX topico; grupo B (n = 30) 1 g de ATX intravenoso, y grupo C o control (n = 30), al que no se administro ningun farmaco. Se analizaron los parametros de perdida de sangre y debito de drenajes en los 3 grupos. Resultados Los resultados mostraron que el descenso del nivel de hemoglobina fue menor en el grupo A (1,95 dl) respecto el grupo B (2,25 g/dl) y el grupo C (2,96 g/dl), p Conclusiones La aplicacion topica de 1 g de ATX reduce significativamente la perdida de sangre en pacientes intervenidos de artroplastia total de rodilla, en mayor magnitud que la aplicacion intravenosa y la no administracion.
TL;DR: El tratamiento se basa en el bloqueo de the formacion del complejo de ataque de membrana, molecula final de the via alternativa del complemento, con eculizumab, that ha revolucionado la historia natural de the enfermedad.
Abstract: Resumen El sindrome hemolitico uremico (SHU) se caracteriza por una anemia hemolitica microangiopatica con deterioro de funcion renal. Actualmente se clasifica en SHU asociado a toxina Shiga y SHU atipico, y el mecanismo comun consiste en un dano grave del endotelio vascular que origina una microangiopatia trombotica. Dentro del SHU atipico se engloban formas primarias, secundarias y debidas a enfermedades metabolicas. En la gran mayoria de casos de SHU atipico, la hiperactividad de la via alternativa del complemento juega un papel patogenico central. El tratamiento se basa en el bloqueo de la formacion del complejo de ataque de membrana, molecula final de la via alternativa del complemento, con eculizumab, que ha revolucionado la historia natural de la enfermedad. La recidiva de la enfermedad en el trasplante es frecuente y con muy mal pronostico para la supervivencia renal.
TL;DR: La prevalencia oferta de uso de farmacos anticolinergicos (FA) en pacientes de edad avanzada que consultan por perdida cognitiva y el empeoramiento anual en el indice de Barthel, en the indice of Lawton y Brody y en el MMSE fue de −4 (4,5), −0,3 (0,4) and −1 ( 0,9),
Abstract: Resumen Objetivo Describir la prevalencia de uso de farmacos anticolinergicos (FA) en pacientes de edad avanzada que consultan por perdida cognitiva. Valorar la repercusion cognitiva y funcional de estos farmacos. Pacientes y metodos Revision retrospectiva de historias clinicas de pacientes visitados en 2015 y 2016. Se identificaron FA con la Anticholinergic Cognitive Burden Scale. La funcion cognitiva se exploro mediante el Mini Mental State Examination (MMSE) y la funcional con el indice de Barthel y el indice de Lawton y Brody. Se comparo la diferencia de las puntuaciones de las escalas en un ano entre los pacientes expuestos a anticolinergicos con los no expuestos. Resultados Muestra de 610 pacientes (edad media = 81,1 anos), 71% mujeres. El 37,2% estaban tomando algun FA. La diferencia media (desviacion estandar [DE]) de los expuestos respeto a los no expuestos, el empeoramiento anual en el indice de Barthel, en el indice de Lawton y Brody y en el MMSE fue de −4 (4,5), −0,3 (0,4) y −1 (0,9), respetivamente. Conclusiones Un tercio de los pacientes que consultan por perdida cognitiva estan tomando algun FA. Los pacientes expuestos muestran una tendencia mayor a empeorar funcionalmente.
TL;DR: La positividad de estos anticuerpos y una colestasis bioquimica son suficientes para el diagnostico, sin necesidad de biopsia hepatica, y el acido ursodeoxicolico es el tratamiento especifico.
Abstract: Resumen La colangitis (cirrosis) biliar primaria es una enfermedad colestasica cronica de predominio claramente femenino. Se caracteriza por una inflamacion de los conductos biliares intrahepaticos de pequeno y mediano calibre, y puede progresar hasta una cirrosis. La mayoria de los pacientes permanecen asintomaticos y se diagnostican por el hallazgo fortuito de una colestasis bioquimica anicterica con aumento de fosfatasa alcalina. La patogenia es desconocida y de presunto origen autoinmune en sujetos con una predisposicion genetica. La presencia de anticuerpos antimitocondriales de tipo M2 y de anticuerpos antinucleares especificos (gp210 y Sp100) es tipica de la enfermedad. La positividad de estos anticuerpos y una colestasis bioquimica son suficientes para el diagnostico, sin necesidad de biopsia hepatica. El acido ursodeoxicolico es el tratamiento especifico, con una excelente respuesta en mas del 60% de los pacientes. Cuando no se observa esta optima respuesta se puede combinar con nuevos agentes, pero los que han mostrado eficacia son los que mejoran la colestasis, como los fibratos y el acido obeticolico.