Cardiometabolic characterization in metabolic dysfunction-associated fatty liver disease

BackgroundTo better understand the patient's heterogeneity in fatty liver disease (FLD), metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed by international experts as a new nomenclature for nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the cardiovascular risk, assessed through coronary artery calcium (CAC) and epicardial adipose tissue (EAT), of patients without FLD and patients with FLD and its different subtypes. MethodsCross sectional study of 370 patients. Patients with FLD were divided into 4 groups: FLD without metabolic dysfunction (non-MD FLD), MAFLD and the presence of overweight/obesity (MAFLD-OW), MAFLD and the presence of two metabolic abnormalities (MAFLD-MD) and MAFLD and the presence of T2D (MAFLD-T2D). MAFLD-OW included two subgroups: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). The patients without FLD were divided into 2 groups: patients without FLD and without MD (non-FLD nor MD; reference group) and patients without FLD but with MD (non-FLD with MD). EAT and CAC (measured through the Agatston Score) were determined by computed tomography. ResultsCompared with the reference group (non-FLD nor MD), regarding EAT, patients with MAFLD-T2D and MAFLD-MUHO had the highest risk for CVD (OR 15.87, 95% CI 4.26-59.12 and OR 17.60, 95% CI 6.71-46.20, respectively), patients with MAFLD-MHO were also at risk for CVD (OR 3.62, 95% CI 1.83-7.16), and patients with non-MD FLD did not have a significantly increased risk (OR 1.77; 95% CI 0.67-4.73). Regarding CAC, patients with MAFLD-T2D had an increased risk for CVD (OR 6.56, 95% CI 2.18-19.76). Patients with MAFLD-MUHO, MAFLD-MHO and non-MD FLD did not have a significantly increased risk compared with the reference group (OR 2.54, 95% CI 0.90-7.13; OR 1.84, 95% CI 0.67-5.00 and OR 2.11, 95% CI 0.46-9.74, respectively). ConclusionMAFLD-T2D and MAFLD-OW phenotypes had a significant risk for CVD. MAFLD new criteria reinforced the importance of identifying metabolic phenotypes in populations as it may help to identify patients with higher CVD risk and offer a personalized therapeutic management in a primary prevention setting

Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach?

Background: While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strategy is challenging. Therefore, this study aimed to identify older adult patients suitable for a different ED approach as well as independent variables associated with poor short-term clinical outcomes. Methods: We included all patients >= 65 years attending 52 EDs in Spain over 7 days. Sociodemographic, comorbidity, and baseline functional status data were collected. The outcomes were 30 -day mortality, re -presentation, hospital readmission, and the composite of all outcomes. Results: During the study among 96,014 patients evaluated in the ED, we included 23,338 patients >= 65 years-mean age, 78.4 +/- 8.1 years; 12,626 (54.1%) women. During follow-up, 5,776 patients (24.75%) had poor outcomes after evaluation in the ED: 1,140 (4.88%) died, 4,640 (20.51) returned to the ED, and 1,739 (7.69%) were readmitted 30 days after discharge following the index visit. A model including male sex, age >= 75 years, arrival by ambulance, Charlson Comorbidity Index >= 3, and functional impairment had a C -index of 0.81 (95% confidence interval, 0.80-0.82) for 30 -day mortality. Conclusion: Male sex, age >= 75 years, arrival by ambulance, functional impairment, or severe comorbidity are features of patients who could benefit from approaches in the ED different from the common triage to improve the poor short-term outcomes of this population

Presentación: Orientarse en un nuevo mundo

Podría usted decirme qué camino debería seguir a partir de aquí» -preguntó Alicia. «Eso depende en gran medida de a dónde quieras ir»- dijo el gato. (Lewis Carroll, Las aventuras de Alicia en el país de las maravillas). Este texto de Carroll sugiere parte de lo que queremos decir. Sin duda hace falta saber a dónde se quiere ir, ya que esto indica el camino que debemos elegir. Pero el mismo camino nos va a enseñar otras muchas cosas. Quien tenga la experiencia de pasar unas horas navegando en Internet sabe bien que, a pesar de estar buscando algo concreto, casi siempre acaba entrando en algunos servidores y buscadores que le llaman la atención. No es muy diferente de la experiencia de consultar el catálogo y las fichas de una buena biblioteca y luego tener libre acceso a sus estantes abiertos. No es que valga todo, es que hay muchos caminos para objetivos más o menos similares. Es importante tener conciencia del camino y de la influencia que ejerce el propio camino sobre uno. Estas no son cosas nuevas, sino aspectos destacados ahora por las nuevas tecnologías pero que han sido el núcleo mismo del pensamiento filosófico desde la antigüedad clásica. Quizá hoy sean diferentes las metáforas pero la metaforización sigue las mismas pautas.Peer reviewe

Table_1_Cardiometabolic characterization in metabolic dysfunction–associated fatty liver disease.pdf

Supplementary Table 1. Cardiac function assessed through echocardiography of patients included in the study. Supplementary Table 2. Adjusted means of metabolic phenotypes of fatty liver disease with visceral adipose tissue and visceral adipose tissue/subcutaneous adipose tissue ratio. Supplementary Table 3. Associations between metabolic phenotypes of fatty liver disease and high indexed epicardial adipose tissue (>68.1 mL). Supplementary Table 4. Associations between metabolic phenotypes of fatty liver disease and moderate to severe coronary artery calcification (Agatston CAC score>100).[Background] To better understand the patient's heterogeneity in fatty liver disease (FLD), metabolic dysfunction–associated fatty liver disease (MAFLD) was proposed by international experts as a new nomenclature for nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the cardiovascular risk, assessed through coronary artery calcium (CAC) and epicardial adipose tissue (EAT), of patients without FLD and patients with FLD and its different subtypes.[Methods] Cross sectional study of 370 patients. Patients with FLD were divided into 4 groups: FLD without metabolic dysfunction (non-MD FLD), MAFLD and the presence of overweight/obesity (MAFLD-OW), MAFLD and the presence of two metabolic abnormalities (MAFLD-MD) and MAFLD and the presence of T2D (MAFLD-T2D). MAFLD-OW included two subgroups: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). The patients without FLD were divided into 2 groups: patients without FLD and without MD (non-FLD nor MD; reference group) and patients without FLD but with MD (non-FLD with MD). EAT and CAC (measured through the Agatston Score) were determined by computed tomography.[Results] Compared with the reference group (non-FLD nor MD), regarding EAT, patients with MAFLD-T2D and MAFLD-MUHO had the highest risk for CVD (OR 15.87, 95% CI 4.26-59.12 and OR 17.60, 95% CI 6.71-46.20, respectively), patients with MAFLD-MHO were also at risk for CVD (OR 3.62, 95% CI 1.83-7.16), and patients with non-MD FLD did not have a significantly increased risk (OR 1.77; 95% CI 0.67-4.73). Regarding CAC, patients with MAFLD-T2D had an increased risk for CVD (OR 6.56, 95% CI 2.18-19.76). Patients with MAFLD-MUHO, MAFLD-MHO and non-MD FLD did not have a significantly increased risk compared with the reference group (OR 2.54, 95% CI 0.90-7.13; OR 1.84, 95% CI 0.67-5.00 and OR 2.11, 95% CI 0.46-9.74, respectively).[Conclusion] MAFLD–T2D and MAFLD–OW phenotypes had a significant risk for CVD. MAFLD new criteria reinforced the importance of identifying metabolic phenotypes in populations as it may help to identify patients with higher CVD risk and offer a personalized therapeutic management in a primary prevention setting.Peer reviewe

Cardiometabolic characterization in metabolic dysfunction-associated fatty liver disease

BackgroundTo better understand the patient's heterogeneity in fatty liver disease (FLD), metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed by international experts as a new nomenclature for nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the cardiovascular risk, assessed through coronary artery calcium (CAC) and epicardial adipose tissue (EAT), of patients without FLD and patients with FLD and its different subtypes. MethodsCross sectional study of 370 patients. Patients with FLD were divided into 4 groups: FLD without metabolic dysfunction (non-MD FLD), MAFLD and the presence of overweight/obesity (MAFLD-OW), MAFLD and the presence of two metabolic abnormalities (MAFLD-MD) and MAFLD and the presence of T2D (MAFLD-T2D). MAFLD-OW included two subgroups: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). The patients without FLD were divided into 2 groups: patients without FLD and without MD (non-FLD nor MD; reference group) and patients without FLD but with MD (non-FLD with MD). EAT and CAC (measured through the Agatston Score) were determined by computed tomography. ResultsCompared with the reference group (non-FLD nor MD), regarding EAT, patients with MAFLD-T2D and MAFLD-MUHO had the highest risk for CVD (OR 15.87, 95% CI 4.26-59.12 and OR 17.60, 95% CI 6.71-46.20, respectively), patients with MAFLD-MHO were also at risk for CVD (OR 3.62, 95% CI 1.83-7.16), and patients with non-MD FLD did not have a significantly increased risk (OR 1.77; 95% CI 0.67-4.73). Regarding CAC, patients with MAFLD-T2D had an increased risk for CVD (OR 6.56, 95% CI 2.18-19.76). Patients with MAFLD-MUHO, MAFLD-MHO and non-MD FLD did not have a significantly increased risk compared with the reference group (OR 2.54, 95% CI 0.90-7.13; OR 1.84, 95% CI 0.67-5.00 and OR 2.11, 95% CI 0.46-9.74, respectively). ConclusionMAFLD-T2D and MAFLD-OW phenotypes had a significant risk for CVD. MAFLD new criteria reinforced the importance of identifying metabolic phenotypes in populations as it may help to identify patients with higher CVD risk and offer a personalized therapeutic management in a primary prevention setting

Incidencia y mortalidad por cáncer en Navarra, 1998-2002. Evolución en los últimos 30 años

Entre 1998-2002 se registraron 16.952 nuevos casos de cáncer en Navarra. En los hombres, los cánceres más frecuentemente diagnosticados fueron, por este orden próstata, pulmón, colon y recto, vejiga y estómago, que sumaron el 63,2% de todos los casos de cáncer. En mujeres las localizaciones de mama, colon y recto, cuerpo de útero, estómago y ovario sumaron el 57,6 % del total de los casos. En el mismo periodo, 1998-2002, fallecieron por cáncer 4.127 hombres y 2.470 mujeres. El 60 % de todas las muertes producidas por tumores malignos en hombres se debieron a las localizaciones de pulmón, próstata, colón y recto, estómago y vejiga. En las mujeres las localizaciones de colon y recto, mama, estómago, páncreas y pulmón, sumaron el 49% de las defunciones por cáncer. En los hombres de Navarra han aumentado las tasas de incidencia del cáncer de próstata, riñón y linfoma no Hodgkin. Cánceres evitables, como los relacionados con el hábito de fumar (pulmón, cavidad oral y faringe o páncreas), continúan en ascenso, y representan mayor riesgo global de morir por cáncer en el último periodo estudiado que en las décadas de los años 1970 y 1980. A partir de 1995 y hasta la actualidad, la mortalidad por cáncer pasó de ocupar el segundo lugar a ser la primera causa de muerte entre los hombres de Navarra. El riesgo global de muerte por cáncer en hombres se ha igualado al primer periodo estudiado 1975-77. Entre las mujeres el riesgo global de muerte por cáncer descendió un 25% entre 1975 y 2002, a costa fundamentalmente del cáncer de mama y de estómago. Los tumores relacionados con el hábito de fumar muestran incrementos tanto en la mortalidad como en la incidencia y emerge como un problema importante de salud entre las mujeres de Navarra. Ha aumentado la incidencia de cáncer de mama, en cambio en la mortalidad se sitúa en cifras inferiores a las del primer periodo 1975-77. El cáncer invasivo de cérvix se mantiene en tasas muy bajas respecto a muchos países europeos, incluida España. En ambos sexos han aumentado el cáncer colorrectal y el melanoma mientras que continúa el descenso de la incidencia y mortalidad por cáncer de estómago

Incidencia y mortalidad por cáncer en Navarra, 1998-2002. Evolución en los últimos 30 años

Entre 1998-2002 se registraron 16.952 nuevos casos de cáncer en Navarra. En los hombres, los cánceres más frecuentemente diagnosticados fueron, por este orden próstata, pulmón, colon y recto, vejiga y estómago, que sumaron el 63,2% de todos los casos de cáncer. En mujeres las localizaciones de mama, colon y recto, cuerpo de útero, estómago y ovario sumaron el 57,6 % del total de los casos. En el mismo periodo, 1998-2002, fallecieron por cáncer 4.127 hombres y 2.470 mujeres. El 60 % de todas las muertes producidas por tumores malignos en hombres se debieron a las localizaciones de pulmón, próstata, colón y recto, estómago y vejiga. En las mujeres las localizaciones de colon y recto, mama, estómago, páncreas y pulmón, sumaron el 49% de las defunciones por cáncer. En los hombres de Navarra han aumentado las tasas de incidencia del cáncer de próstata, riñón y linfoma no Hodgkin. Cánceres evitables, como los relacionados con el hábito de fumar (pulmón, cavidad oral y faringe o páncreas), continúan en ascenso, y representan mayor riesgo global de morir por cáncer en el último periodo estudiado que en las décadas de los años 1970 y 1980. A partir de 1995 y hasta la actualidad, la mortalidad por cáncer pasó de ocupar el segundo lugar a ser la primera causa de muerte entre los hombres de Navarra. El riesgo global de muerte por cáncer en hombres se ha igualado al primer periodo estudiado 1975-77. Entre las mujeres el riesgo global de muerte por cáncer descendió un 25% entre 1975 y 2002, a costa fundamentalmente del cáncer de mama y de estómago. Los tumores relacionados con el hábito de fumar muestran incrementos tanto en la mortalidad como en la incidencia y emerge como un problema importante de salud entre las mujeres de Navarra. Ha aumentado la incidencia de cáncer de mama, en cambio en la mortalidad se sitúa en cifras inferiores a las del primer periodo 1975-77. El cáncer invasivo de cérvix se mantiene en tasas muy bajas respecto a muchos países europeos, incluida España. En ambos sexos han aumentado el cáncer colorrectal y el melanoma mientras que continúa el descenso de la incidencia y mortalidad por cáncer de estómago.Between 1998-2002, 16,952 new cases of cancer were registered in Navarre. In men, the most frequently diagnosed cancers were in the following order: prostate, lung, colon and rectum, bladder and stomach, which accounted for 63.2%. In women, the sites were breast, colon and rectum, corpus uteri, stomach and ovary, which accounted for 57.6% of the cases. In the same period, 1998-2002, 4,127 men and 2,470 women died from cancer. Sixty percent of all deaths due to malign tumours in men were due to cancer of the lung, prostate, colon and rectum, stomach and bladder. In women this was due to cancers of colon and rectum, breast, stomach, pancreas and lung, which accounted for 49% of the cases. In men in Navarre there has been an increase in the incidence rates of cancer of the prostate, kidney and nonHodgkin lymphoma. Avoidable cancers such as those related to smoking (lung, oral cavity and pharynx or pancreas) continue to rise, and represent a greater global risk of dying from cancer in the latest period studied than in the decades of the 1970s and 1980s. From 1995 up to the present, mortality due to cancer has moved from occupying the second place to become the first cause of death among men in Navarre. The global risk of death due to cancer in men is now equal to the first period studied, 1975-1977. Amongst women the global risk of death due to cancer fell by 25% between 1975 and 2002, basically at the cost of breast and stomach cancer. Tumours related to smoking increased both in mortality and in incidence and appear as a significant health problem amongst women in Navarre. Breast cancer has increased in incidence, with lower mortality figures than those of the first period 1975-1977. Invasive cancer of the cervix remains at very low rates in comparison with many European countries, including Spain. In both sexes colorectal and skin cancer has increased, while the incidence and mortality of stomach cancer continues to fall

Cardiopulmonary resuscitation in adults over 80 : outcome and the perception of appropriateness by clinicians

OBJECTIVES: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN: Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE). SETTING: Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39–45, 201