Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Study of the radiological impact caused by the extraction of the residue of a dicalcium phosphate industrial plant

In recent years, a decontamination project has been under way to remove the polluted sludge on the riverbed of the Ebro river, particularly in the area of Flix (Tarragona, Spain). This project started in 2011 and consists of the removal of the sludge and its treatment in a process that will eventually restore the river to its natural conditions. The sludge is a product of the historical dumping of contaminants by a chemical complex situated next to the river, and it contains a range of contaminants, such as heavy metals, semi- and volatile organic compounds, and radionuclides. Downstream of the complex, in the town of L’Ampolla, a drinking water treatment plant (DWTP) is located. This plant collects the water from the Ebro river and, after potabilisation, the plant supplies drinking water to the population of southern Catalonia. Due to the possible presence of radionuclides in the river water, it was considered important to monitor and control the radioactivity parameters regulated under current legislation for water consumption. For this reason, in this study, our aim is to evaluate if the decontamination work carried out in Flix has any effects on the radioactivity levels of both Ebro river and treated water, by means of the determination of gross alpha activity, gross beta activity and a group of gamma emitter radionuclides at three different sampling points in the period between 2008 and 2012. One sampling point was located a few kilometres from the Flix area and the other two were located before and after the DWTP, respectively. From the results obtained, it could be observed that no significant differences were obtained between the samples taken before and after the beginning of the decontamination process began, so it is important to highlight that this project has not affected the quality of the water supplied by the DWTP

Prescription of oral antidiabetic drugs in K/DIGO chronic kidney disease stage 3 and 4: a single centre report.

AIM: Evaluation of chronic kidney disease (CKD) is essential in order to prescribe properly oral antidiabetic drugs (OADs). The aim of our study was to report hypoglycemic drugs prescription to CKD in a cohort of type 2 diabetes mellitus (DM) outpatients. METHODS: This survey included 1686 outpatients with type 2 DM treated with OADs who were not taking insulin evaluated by a team of diabetologists. Glomerular filtration rate (GFR) was calculated by the CKD-EPI formula and subjects were classified in the K/DIGO stages. Main clinical parameters were also evaluated. RESULTS: Patients were aged 68±10 years, 57.1% were males, Body Mass Index was 30±5 kg/m2, glycated hemoglobin 8±1%, systolic and diastolic blood pressure values were 138±15/80±9 mmHg. Serum creatinine was 1.03±0.35 mg/dL and GFR 71±21 mL/min/1.73 m2. In 504 patients (30%) GFR was lower than 60 mL/min/1.73 m2. The different treatment groups had different GFR and hypoglycaemic drugs were prescribed differently in the different K/DIGO stages. The majority of subjects in stage 3A and 3B were treated with repaglinide, however a significant percentage of them were treated with metformin and sulfonylureas. Nearly half of subjects with CKD stage 4 were treated with metformin and sulfonylureas. CONCLUSION: In this report we found that nearly one third of patients with type DM 2 had CKD and in a significant percentage of them OADs were prescribed even if they were in K/DIGO CKD stage 3 and 4

Prevalence of headache and its interference in the activities of daily living in female adolescent students

OBJECTIVE: To describe the prevalence of headache and its interference in the activities of daily living (ADL) in female adolescent students.METHODS: This descriptive cross-sectional study enrolled 228 female adolescents from a public school in the city of Petrolina, Pernambuco, Northeast Brazil, aged ten to 19 years. A self-administered structured questionnaire about socio-demographic characteristics, occurrence of headache and its characteristics was employed. Headaches were classified according to the International Headache Society criteria. The chi-square test was used to verify possible associations, being significant p<0.05.RESULTS: After the exclusion of 24 questionnaires that did not met the inclusion criteria, 204 questionnaires were analyzed. The mean age of the adolescents was 14.0±1.4 years. The prevalence of headache was 87.7%. Of the adolescents with headache, 0.5% presented migraine without pure menstrual aura; 6.7%, migraine without aura related to menstruation; 1.6%, non-menstrual migraine without aura; 11.7%, tension-type headache and 79.3%, other headaches. Significant associations were found between pain intensity and the following variables: absenteeism (p=0.001); interference in ADL (p<0.001); medication use (p<0.001); age (p=0.045) and seek for medical care (p<0.022).CONCLUSIONS: The prevalence of headache in female adolescents observed in this study was high, with a negative impact in ADL and school attendance