Riesgo de hemorragia digestiva alta y baja asociada al tratamiento con AINEs, antiagregantes plaquetarios y anticoagulantes orales: Estudio de casos y controles.

Introducción y objetivos: El tratamiento con antiinflamatorios no esteroideos (AINEs), ácido acetil salicílico (AAS) y anticoagulantes orales (ACOs) se asocia a un aumento del riesgo de hemorragia digestiva, sobre todo a nivel gastrointestinal alto. En los últimos años, los casos de hemorragia digestiva alta (HDA) han disminuido y los de hemorragia digestiva baja (HDB) han aumentado. Nuestro objetivo primario es cuantificar y comparar el riesgo relativo de HDA y HDB ligado a estos fármacos. Material y métodos: Se trata de un estudio de casos y controles en el que se recogieron datos de pacientes hospitalizados por hemorragia digestiva (n= 532) en 2 hospitales de Zaragoza (España). Los controles se emparejaron por sexo, edad y hospital con los casos. Se consideró el consumo de un fármaco como reciente cuando tuvo lugar en los 7 días previos al ingreso. La asociación de las variables estudiadas se calculó mediante un análisis de regresión logística binaria y la fuerza de asociación se expresó en términos de Odds Ratio (OR). Resultados: El uso de AINEs, AAS, otros antiagregantes (AP) y ACOs se asoció con un aumento del riesgo de hemorragia digestiva. El riesgo con la toma de ACOs fue 2 veces mayor (OR 4,611; IC 95% 2,621-8,112) que con el AAS (OR 1,550; IC 95% 0,928-2,590) y con AINEs (OR 2,486; IC 95% 1,493-4,141) y superior al presentado con el uso de otros AP (OR 3,576; IC 95% 1,536-8,326). Los AINEs se asociaron a un aumento del riesgo de HDA (OR 3,909; IC 95% 1,748-8,564), mientras que el AAS a dosis bajas (OR 2,043; IC 95% 1,180-3,539), otros AP (OR 3,455; IC 95% 1,342-8,892) y los ACOs (OR 3,458; IC 95% 1,938-6,190) se asociaron a un aumento del riesgo de HDB. Conclusiones: El número de pacientes hospitalizados por HDB es mayor que por HDA. La toma de ACOs parece ser el factor de riesgo que más se asocia al sangrado. Tanto los ACOs como el AAS y otros AP presentan mayor riesgo de sangrado a nivel gastrointestinal bajo, mientras que los AINEs presentan mayor riesgo de HDA

The excess insulin requirement in severe COVID‐19 compared to non‐COVID‐19 viral pneumonitis is related to the severity of respiratory failure and pre‐existing diabetes

Funder: National Institute of Health Research Academic Clinical FellowshipAbstract: Introduction: Severe COVID‐19 has been anecdotally associated with high insulin requirements. It has been proposed that this may be driven by a direct diabetogenic effect of the virus that is unique to SARS‐CoV‐2, but evidence to support this is limited. To explore this, we compared insulin requirements in patients with severe COVID‐19 and non‐COVID‐19 viral pneumonitis. Methods: This is a retrospective cohort study of patients with severe COVID‐19 admitted to our intensive care unit between March and June 2020. A historical control cohort of non‐COVID‐19 viral pneumonitis patients was identified from routinely collected audit data. Results: Insulin requirements were similar in patients with COVID‐19 and non‐COVID‐19 viral pneumonitis after adjustment for pre‐existing diabetes and severity of respiratory failure. Conclusions: In this single‐centre study, we could not find evidence of a unique diabetogenic effect of COVID‐19. We suggest that high insulin requirements in this disease relate to its propensity to cause severe respiratory failure in patients with pre‐existing metabolic disease

Effect of programmed exercise on insulin sensitivity in postmenopausal women

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.OBJECTIVE:: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effect of programmed exercise for at least 12 weeks, in postmenopausal women on insulin sensitivity-related outcomes (ISROs), including fasting insulin, C-peptide, insulin growth factor (IGF-1) and IGF-binding protein (IGFBP-3), Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), and anthropometric variables. METHODS:: Searches were conducted in PubMed-Medline, Embase, Scopus, Web of Science, and Cochrane Library from inception through May 3, 2016, for studies published in all languages. Extracted data included characteristics of the study design, study participants, intervention, and outcome measures. Types of exercise were classified into “mid-term exercise intervention” (MTEI, 3-4 months exercise duration) and a “long-term exercise intervention” (LTEI, 6-12 months exercise duration). Risk of bias in RCTs was evaluated with the Cochrane tool. We used random-effects models for meta-analyses. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS:: Seven RCTS (n?=?580) evaluating the effects of programmed exercise on ISROs were included. In three RCTs, MTEI significantly lowered insulin levels (mean difference [MD] −6.50?pmol/L, 95% confidence interval [CI] −11.19, −1.82, P?=?0.006) and HOMA-IR values (MD −0.18, 95% CI −0.34, −0.03, P?=?0.02) when compared with controls. LTEI had no significant effect on insulin levels (P?=?0.19) or HOMA-IR values (P?=?0.68) in four and three RCTs, respectively. There were no significant differences between exercise intervention versus controls in circulating IGF-1, glucose, triglycerides with both MTEI and LTEI, and in IGFBP-3 with LTEI. There were significant reductions in body mass index (BMI, kg/m) (MD −1.48, 95% CI −2.48, −0.48, P?=?0.004) and in body fat percentage (MD −2.99, 95% CI −4.85, −1.14, P?=?0.01) after MTEI; and in waist circumference after both MTEI (MD −1.87, 95% CI −3.02, −0.72, P?=?0.001) and LTEI (MD −3.74, 95% CI −6.68, −0.79). Heterogeneity of effects among studies was moderate to low. CONCLUSION:: Exercising for 3 to 4 months significantly lowered insulin levels and HOMA-IR values, BMI waist circumference, and percentage body fat mass; exercising for 6 to 12 months lowered waist circumference in postmenopausal women.Revisión por pare