Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the [email protected] Study

Introduction: atherosclerosis, blood vessel disease, is the main cause of cardiovascular disease associated with aging; comprising modifiable risk factors that increase because of this when it exists.Objective: to evaluate atherogenic markers and metabolic syndrome in older adults, with cardiovascular risk living in urban areas, Pinar del Río province. Methods: observational, descriptive and cross-sectional study, from the service of Clinical Laboratory at Abel Santamaría Cuadrado Teaching General Hospital  Pinar del Río with 60 years old and older patients from the urban areas, during the period 2013 - 2014. The target group included 588 patients. The sample comprised 100 patients who have at least two risk factors previously established for this study.Results: ample predominance of women (61.0 %), the risk factors of higher incidence were hypertension 67 %, and sedentary lifestyle 65 %, followed by obesity 48 %, diabetes mellitus 40 % along with smoking habit 32 %, obese with increased diameters of waist circumference 48 %, and dyslipidemia 49 %, those with high glycemic values in fasting 50 % of the sample. It was considered that 63 % of the patients studied suffer from metabolic syndrome.Conclusions: a high number of white-skin women, the predominant risk factors were hypertension followed by sedentary lifestyle, obesity, diabetes mellitus and smoking habit. Approximately half of the sample was obese with increased diameters of the waist circumference, a large part suffered from dyslipidemia and half of them showed high fasting blood glucose levels. The prevalence of metabolic syndrome was detected.IIntroducción: aterosclerosis, enfermedad de los vasos sanguíneos, principal causa de enfermedad cardiovascular vinculada al envejecimiento, con factores de riesgo modificables que se incrementan cuando esta existe.Objetivo: evaluar marcadores aterogénicos y síndrome metabólico en adultos mayores, con riesgo cardiovascular residentes en zonas urbanas de la provincia Pinar del Río.Métodos: estudio observacional, descriptivo, transversal, servicio de Laboratorio Clínico Hospital General Docente “Abel Santamaría Cuadrado” Pinar del Río, pacientes de 60 años y más de zonas urbanas, durante período 2013 - 2014. Universo de 588 pacientes. Muestra de 100 pacientes que posean mínimo de dos factores de riesgo establecidos con anterioridad para este estudio.Resultados: amplio predominio de las mujeres (61 %). Factores de riesgo de mayor incidencia hipertensión arterial 67 %, y sedentarismo 65 %, seguidos por obesidad 48 %, diabetes mellitus 40 % y hábito de fumar 32 %, obesos con diámetros aumentados de la circunferencia de la cintura 48 %, presentaban dislipidemia 49 % y tenían elevados valores de glucemia en ayunas el 50 % de la muestra. Se consideró que 63 % de los pacientes estudiados presentaron síndrome metabólico.Conclusiones: elevado número de mujeres de piel blanca, con factor de riesgo predominante de hipertensión arterial seguido por sedentarismo, obesidad, diabetes mellitus y hábito de fumar. Alrededor de la mitad de la muestra fueron obesos con diámetros aumentados de la circunferencia de la cintura, gran parte presentaban dislipidemia y la mitad altos valores de glucemia en ayunas. Se detecta prevalencia de síndrome metabólico

Impact of COVID-19 infection on the outcome of patients with ischemic stroke

BACKGROUND AND PURPOSE: We evaluated whether stroke severity, functional outcome, and mortality are different in patients with ischemic stroke with or without coronavirus disease 2019 (COVID-19) infection. METHODS: A prospective, observational, multicentre cohort study in Catalonia, Spain. Recruitment was consecutive from mid-March to mid-May 2020. Patients had an acute ischemic stroke within 48 hours and a previous modified Rankin Scale (mRS) score of 0 to 3. We collected demographic data, vascular risk factors, prior mRS score, National Institutes of Health Stroke Scale score, rate of reperfusion therapies, logistics, and metrics. Primary end point was functional outcome at 3 months. Favourable outcome was defined depending on the previous mRS score. Secondary outcome was mortality at 3 months. We performed mRS shift and multivariable analyses. RESULTS: We evaluated 701 patients (mean age 72.3±13.3 years, 60.5% men) and 91 (13%) had COVID-19 infection. Median baseline National Institutes of Health Stroke Scale score was higher in patients with COVID-19 compared with patients without COVID-19 (8 [3–18] versus 6 [2–14], P=0.049). Proportion of patients with a favourable functional outcome was 33.7% in the COVID-19 and 47% in the non-COVID-19 group. However, after a multivariable logistic regression analysis, COVID-19 infection did not increase the probability of unfavourable functional outcome. Mortality rate was 39.3% among patients with COVID-19 and 16.1% in the non-COVID-19 group. In the multivariable logistic regression analysis, COVID-19 infection was a risk factor for mortality (hazard ratio, 3.14 [95% CI, 2.10–4.71]; P<0.001). CONCLUSIONS: Patients with ischemic stroke and COVID-19 infection have more severe strokes and a higher mortality than patients with stroke without COVID-19 infection. However, functional outcome is comparable in both groups

Surgery for gastroesophageal reflux disease: a comparative study between the open and laparoscopic approaches Cirugía de la enfermedad por reflujo gastroesofágico: estudio comparativo entre los abordajes abierto y laparoscópico

Objective: given the demonstrated effectiveness of medical treatment together with the eminent acceptance of the laparoscopic approach, the indications of surgery in the treatment of gastroesophageal reflux disease (GERD) are currently subject to continuous controversy. To participate in this debate, we have the following work hypothesis: "The results of the 360&ordm; short and floppy laparoscopic fundoplication are superior to those of open surgery". Clinical design: prospective, clinical, non-randomized study. Patients: our work was developed between November 1991 and December 1998 by means of a prospective, non-randomized clinical rehearsal with two groups of patients: -Group I (n = 75): 360&deg; short and floppy laparoscopic fundoplication in Hospital Dr. Peset, Valencia (Spain). -Group II (n = 28): 360&deg; short and floppy, open fundoplication in Hospital General, Valencia (Spain). We evaluated the preoperative parameters and found no differences, which allows us to know that both groups were comparable. Results: the analysis of peroperative results (morbidity and surgical time) and of clinical follow-up (every three months and later annually) and instrumental follow-up (TEGD, upper digestive endoscopy, pHmetry and manometry) show no differences, while the postoperative analysis shows statistically significant (s.s.) differences regarding recovery (pain, oral intake, hospital stay and return to previous activities). Conclusions: the results of the 360&deg; short and floppy laparoscopic fundoplication are similar to those of the open approach, but favor the former approach with a better postoperative tolerance.Objetivo: en la actualidad, dada la efectividad demostrada del tratamiento médico junto con la eminente aceptación del abordaje laparoscópico, las indicaciones de la cirugía en el tratamiento de la enfermedad por reflujo gastroesofágico son causa de continua controversia. Para participar en este debate, nos planteamos la siguiente hipótesis de trabajo: "Los resultados de la funduplicatura de 360&deg; corta y holgada por vía laparoscópica son superiores a los de la vía abierta". Diseño clínico: estudio clínico prospectivo no aleatorizado. Pacientes: el trabajo se desarrolló entre noviembre de 1991 y diciembre de 1998, mediante un ensayo clínico prospectivo no aleatorio de dos grupos de pacientes: -Grupo I (n = 75): funduplicatura de 360&deg;, corta y holgada por laparoscopia en el Hospital Universitario Dr. Peset de Valencia. -Grupo II (n = 28): funduplicatura 360&deg;, corta y holgada por vía abierta en el Hospital General Universitario de Valencia. Comparamos, sin hallar diferencias, los parámetros preoperatorios lo que nos permite conocer que los dos grupos son homologables. Resultados: el análisis de los resultados peroperatorios (morbilidad y tiempo quirúrgico) y del seguimiento clínico (a los tres meses y posteriormente de forma anual) e instrumental (TEGD, endoscopia digestiva alta, pHmetría y manometría) no demuestran diferencias; mientras que en el postoperatorio inmediato existen diferencias estadísticamente significativas (e.s.) en lo referente a la recuperación (dolor, tolerancia, estancia y reincorporación a las actividades previas). Conclusiones: los resultados de la funduplicatura de 360&deg; corta y holgada por vía laparoscópica son similares a los de la vía abierta, beneficiándose la primera de una mejor tolerancia postoperatoria

Applicability of the SPAN-100 index in a prospective and contemporary cohort of patients treated with intravenous rtPA in Catalonia

Background: Prognostic scales can be helpful for selecting patients for reperfusion treatment. This study aims to assess the prognostic ability of the recently published SPAN-100 index in a large cohort of stroke patients treated with intravenous thrombolysis (IV rtPA). Methods: Using data from the prospective registry of all reperfusion treatments administered in Catalonia, we selected patients treated with IV rtPA alone between 2011 and 2012. The SPAN-100 index was calculated as the sum of age (years) and NIHSS score, and patients in the cohort were classified as SPAN-100 positive [≥100] or SPAN-100 negative [<100]. We measured raw and adjusted rates of symptomatic intracerebral haemorrhage (SICH), mortality, and 3-month functional outcome (mRS 0-2) for each SPAN-100 category. Area under the ROC curve was calculated to predict the main outcome measures. Results: We studied 1685 rtPA-treated patients, of whom 1405 (83%) were SPAN-100 negative. The SICH rates adjusted for sex, pre-stroke mRS, hypertension, diabetes, dyslipidaemia, ischaemic heart disease, heart failure, atrial fibrillation, prior TIA/stroke and time to thrombolysis did not differ between groups, but likelihood of functional independence (mRS 0-2) at 3 months was nearly 8 times higher in the SPAN-100 negative group than in the positive group. Furthermore, the 3-month mortality rate was 5 times higher in the SPAN-100 positive group. ROC curve analysis showed high specificities for predicting both functional independence and 3-month mortality for a cut-off point of 100. Conclusion: The SPAN-100 index is a simple and straightforward method that may be useful for selecting candidates for rtPA treatment in doubtful cases, and for informing patients and their relatives about likely outcomes. Resumen: Introducción: Las escalas pronósticas pueden ayudar a seleccionar pacientes para tratamientos de reperfusión. Objetivo: aplicar el índice SPAN-100 en una cohorte de pacientes tratados con rtPA por vía intravenosa y evaluar su capacidad pronóstica. Métodos: Se utilizaron datos del registro prospectivo de reperfusión de Cataluña y se seleccionaron casos consecutivos que recibieron rtPA por vía intravenosa aislado en 2011-2012. A partir del sumatorio de edad y NIHSS se categorizó la cohorte en SPAN-100 positivos [≥ 100] y SPAN-100 negativos [< 100 puntos]. Se determinaron las tasas crudas y ajustadas de hemorragia sintomática (HICS), muerte e independencia funcional (ERm 0-2) a partir del índice SPAN-100 y se calculó la curva ROC para la predicción de las principales medidas de resultado. Resultados: De los 1.685 casos incluidos, 1.405 (83%) eran SPAN-100 negativos. La tasa de HICS ajustada por sexo, ERm preictus, hipertensión, diabetes, dislipemia, cardiopatía isquémica, insuficiencia cardíaca, fibrilación auricular, ictus/AIT previos y tiempo hasta la trombólisis no fue diferente según las dos categorías pero la probabilidad de tener una ERm 0-2 al 3. er mes fue hasta casi 8 veces mayor entre los SPAN-100 negativos. El riesgo de muerte al 3. er mes fue 5 veces superior en los SPAN-100 positivos. El análisis ROC mostró especificidades altas tanto en la predicción de independencia funcional como mortalidad al 3. er mes cuando el punto de corte era de 100. Conclusiones: El índice SPAN-100 es un índice sencillo y de fácil aplicación que puede guiar la selección de pacientes para trombólisis cuando existen dudas razonables y asesorar al paciente/familia acerca de los resultados esperables. Keywords: Stroke, Prognosis, Thrombolysis, Risk prediction, Mortality, Functional independence, Palabras clave: Ictus, Pronóstico, Trombólisis, Predicción de riesgo, Mortalidad, Independencia funciona

Aplicabilidad del índice SPAN-100 en una cohorte prospectiva y contemporánea de pacientes tratados con rtPA por vía intravenosa en Cataluña

Resumen: Introducción: Las escalas pronósticas pueden ayudar a seleccionar pacientes para tratamientos de reperfusión. Objetivo: aplicar el índice SPAN-100 en una cohorte de pacientes tratados con rtPA por vía intravenosa y evaluar su capacidad pronóstica. Métodos: Se utilizaron datos del registro prospectivo de reperfusión de Cataluña y se seleccionaron casos consecutivos que recibieron rtPA por vía intravenosa aislado en 2011-2012. A partir del sumatorio de edad y NIHSS se categorizó la cohorte en SPAN-100 positivos [≥ 100] y SPAN-100 negativos [< 100 puntos]. Se determinaron las tasas crudas y ajustadas de hemorragia sintomática (HICS), muerte e independencia funcional (ERm 0-2) a partir del índice SPAN-100 y se calculó la curva ROC para la predicción de las principales medidas de resultado. Resultados: De los 1.685 casos incluidos, 1.405 (83%) eran SPAN-100 negativos. La tasa de HICS ajustada por sexo, ERm preictus, hipertensión, diabetes, dislipemia, cardiopatía isquémica, insuficiencia cardíaca, fibrilación auricular, ictus/AIT previos y tiempo hasta la trombólisis no fue diferente según las dos categorías pero la probabilidad de tener una ERm 0-2 al 3. er mes fue hasta casi 8 veces mayor entre los SPAN-100 negativos. El riesgo de muerte al 3. er mes fue 5 veces superior en los SPAN-100 positivos. El análisis ROC mostró especificidades altas tanto en la predicción de independencia funcional como mortalidad al 3. er mes cuando el punto de corte era de 100. Conclusiones: El índice SPAN-100 es un índice sencillo y de fácil aplicación que puede guiar la selección de pacientes para trombólisis cuando existen dudas razonables y asesorar al paciente/familia acerca de los resultados esperables. Abstract: Background: Prognostic scales can be helpful for selecting patients for reperfusion treatment. This study aims to assess the prognostic ability of the recently published SPAN-100 index in a large cohort of stroke patients treated with intravenous thrombolysis (IV rtPA). Methods: Using data from the prospective registery of all reperfusion treatments administered in Catalonia, we selected patients treated with IV rtPA alone between 2011 and 2012. The SPAN-100 index was calculated as the sum of age (years) and NIHSS score, and patients in the cohort were classified as SPAN-100 positive [≥ 100] or SPAN-100 negative [< 100]. We measured raw and adjusted rates of symptomatic intracerebral haemorrhage (SICH), mortality, and 3-month functional outcome (mRS 0-2) for each SPAN-100 category. Area under the ROC curve was calculated to predict the main outcome measures. Results: We studied 1685 rtPA-treated patients, of whom 1405 (83%) were SPAN-100 negative. The SICH rates adjusted for sex, pre-stroke mRS, hypertension, diabetes, dyslipidaemia, ischaemic heart disease, heart failure, atrial fibrillation, prior TIA/stroke and time to thrombolysis did not differ between groups, but likelihood of functional independence (mRS 0-2) at 3 months was nearly 8 times higher in the SPAN-100 negative group than in the positive group. Furthermore, the 3-month mortality rate was 5 times higher in the SPAN-100 positive group. ROC curve analysis showed high specificities for predicting both functional independence and 3-month mortality for a cut-off point of 100. Conclusion: The SPAN-100 index is a simple and straightforward method that may be useful for selecting candidates for rtPA treatment in doubtful cases, and for informing patients and their relatives about likely outcomes. Palabras clave: Ictus, Pronóstico, Trombólisis, Predicción de riesgo, Mortalidad, Independencia funcional, Keywords: Stroke, Prognosis, Thrombolysis, Risk prediction, Mortality, Functional independenc

Video assisted esophagectomy for esophageal cancer

Video assisted surgery for esophageal cancer is an advanced surgical technique. It is being adopted with a concept of minimally invasive surgery. Since there are several options of the operative procedure for thoracic esophageal cancer, there are several laparoscopic approaches. The first VATS esophagectomy through a right thoracoscopic approach and the first transhiatal esophagectomy were reported in early 1990's. Mediastinoscope-assisted esophagectomy is also reported as a substitute of the blunt dissection of the esophagus. Moreover, video assisted Ivor-Lewis esophagectomy by right thoracotomy with intrathoracic anastomosis has also been tried. Furthermore, laparoscopic gastric mobilization and gastroplasty is also widely accepted as a substitution for open laparotomy. This article serves to review the literature on laparoscopic approaches for esophageal cancer

Fatty liver index as a predictor for type 2 diabetes in subjects with normoglycemia in a nationwide cohort study.

Our aim was to evaluate whether fatty liver index (FLI) is associated with the risk of type 2 diabetes (T2DM) development within the Spanish adult population and according to their prediabetes status; additionally, to examine its incremental predictive value regarding traditional risk factors. A total of 2260 subjects (Prediabetes: 641 subjects, normoglycemia: 1619 subjects) from the [email protected] cohort study were studied. Socio-demographic, anthropometric, clinical data and survey on habits were recorded. An oral glucose tolerance test was performed and fasting determinations of glucose, lipids and insulin were made. FLI was calculated and classified into three categories: Low ( 60). In total, 143 people developed diabetes at follow-up. The presence of a high FLI category was in all cases a significant independent risk factor for the development of diabetes. The inclusion of FLI categories in prediction models based on different conventional T2DM risk factors significantly increase the prediction power of the models when all the population was considered. According to our results, FLI might be considered an early indicator of T2DM development even under normoglycemic condition. The data also suggest that FLI could provide additional information for the prediction of T2DM in models based on conventional risk factors