Estudio epidemiológico de la esclerosis múltiple en La Rioja

Resumen: Introducción La esclerosis múltiple (EM) es una enfermedad desmielinizante que causa gran discapacidad en jóvenes. Se han realizado múltiples estudios epidemiológicos en los que se ha constatado una prevalencia variable. El objetivo de este estudio era analizar la prevalencia de esta enfermedad en La Rioja (España) con variables como la edad, el sexo, la forma evolutiva, la clínica de inicio de la enfermedad, la EDSS y el número de brotes, el tratamiento modificador de la enfermedad y los motivos de su retirada, el cáncer y los antecedentes familiares, y la incidencia y la mortalidad. Métodos: Analizar los pacientes diagnosticados de EM según los criterios de McDonald 2005 o Poser, residentes en La Rioja, durante 10 años (2001-2011), recogidos a través del registro hospitalario, la Asociación de Esclerosis Múltiple y los registros personales de los neurólogos. Resultados: En La Rioja, existe una prevalencia de EM de 65 pacientes/100.000 habitantes y una incidencia de 3,5 casos/100.000 habitantes-año. El 67,6% de los pacientes presentan una EM remitente-recurrente. La edad media de inicio es 20-29 años (desde los 12 hasta los 70). La puntuación EDDS es mayoritariamente ≤ 2. Las EM sin tratamiento suponen el 47,6% y el tratamiento más usado son los interferones. Hallamos 4 tumores hematológicos y 7 familias con varios afectados por EM. Conclusiones: La prevalencia y la incidencia son similares a las halladas en el resto de España. La edad media de inicio de la forma primaria progresiva es ligeramente mayor que en otras publicaciones (40-49 años). En familias con varios miembros afectados, la EM podría tener un curso más agresivo. La discapacidad de estos pacientes sigue siendo muy elevada. Son necesarios más estudios epidemiológicos con métodos variables de recogida de datos para afianzar los hallazgos obtenidos en diferentes provincias acerca de la prevalencia. Abstract: Introduction: Multiple sclerosis is a demyelinating disease that causes severe disability in younger patients. Many epidemiology studies have confirmed a variable prevalence. The objective of this study was to analyse the prevalence of this disease in La Rioja (Spain), using such variables as age and sex; type of progression, initial form of the disease, EDSS and number of relapses; disease-modifying treatment and reasons for treatment withdrawal; personal and family history of cancer; and incidence and mortality. Methods: Analysis of patients in La Rioja diagnosed with MS (according to Poser criteria or the 2005 McDonald criteria) during a 10-year period (2001-2011). Data were collected from hospital records, multiple sclerosis associations, and personal records kept by neurologists. Results: The MS prevalence rate in La Rioja is 65 patients/100 000 inhabitants with an incidence rate of 3.5 cases/100 000 residents per year. Relapsing-remitting MS is present in 67.6% of the patient total. Mean age of onset is 20-29 years (range, 12 to 70). Most EDSS scores were mostly ≤ 2. Untreated MS cases account for 47.6% of the total and the most commonly used therapy is interferon. We detected 4 haematological tumours and 7 families with multiple members affected by MS. Conclusions: Prevalence and incidence are similar to those found in other regions Spain. The average age at onset age for primary progressive MS is slightly higher than in other papers (40-49 years). In families with multiple patients, MS may be more aggressive. Disability in these patients remains very severe. We require more epidemiology studies with a variety of data gathering methods to support findings for prevalence obtained in different provinces. Palabras clave: Prevalencia, Epidemiología, Esclerosis múltiple, España, Incidencia, La Rioja, Keywords: Prevalence, Epidemiology, Multiple sclerosis, Spain, Incidence, La Rioj

Epidemiological study of multiple sclerosis in La Rioja

Introduction: Multiple sclerosis is a demyelinating disease that causes severe disability in younger patients. Many epidemiology studies have confirmed a variable prevalence. The objective of this study was to analyse the prevalence of this disease in La Rioja (Spain), using such variables as age and sex; type of progression, initial form of the disease, EDSS and number of relapses; disease-modifying treatment and reasons for treatment withdrawal; personal and family history of cancer; and incidence and mortality. Methods: Analysis of patients in La Rioja diagnosed with MS (according to Poser criteria or the 2005 McDonald criteria) during a 10-year period (2001-2011). Data were collected from hospital records, multiple sclerosis associations, and personal records kept by neurologists. Results: The MS prevalence rate in La Rioja is 65 patients/100 000 inhabitants with an incidence rate of 3.5 cases/100 000 residents per year. Relapsing-remitting MS is present in 67.6% of the patient total. Mean age of onset is 20-29 years (range 12-70). Most EDSS scores were mostly ≤2. Untreated MS cases account for 47.6% of the total, and the most commonly used therapy is interferon. We detected four haematological tumours and seven families with multiple members affected by MS. Conclusions: Prevalence and incidence are similar to those found in other regions of Spain. The average age at onset age for primary progressive MS is slightly higher than in other papers (40-49 years). In families with multiple patients, MS may be more aggressive. Disability in these patients remains very severe. We require more epidemiology studies with a variety of data gathering methods to support findings for prevalence obtained in different provinces. Resumen: Introducción: La esclerosis múltiple (EM) es una enfermedad desmielinizante que causa gran discapacidad en jóvenes. Se han realizado múltiples estudios epidemiológicos en los que se ha constatado una prevalencia variable. El objetivo de este estudio era analizar la prevalencia de esta enfermedad en La Rioja (España) con variables como la edad, el sexo, la forma evolutiva, la clínica de inicio de la enfermedad, la EDSS y el número de brotes, el tratamiento modificador de la enfermedad y los motivos de su retirada, el cáncer y los antecedentes familiares, y la incidencia y la mortalidad. Métodos: Analizar los pacientes diagnosticados de EM según los criterios de McDonald 2005 o Poser, residentes en La Rioja, durante 10 años (2001-2011), recogidos a través del registro hospitalario, la Asociación de Esclerosis Múltiple y los registros personales de los neurólogos. Resultados: En La Rioja, existe una prevalencia de EM de 65 pacientes/100.000 habitantes y una incidencia de 3,5 casos/100.000 habitantes-año. El 67,6% de los pacientes presentan una EM remitente-recurrente. La edad media de inicio es 20-29 años (desde los 12 hasta los 70). La puntuación EDDS es mayoritariamente ≤ 2. Las EM sin tratamiento suponen el 47,6% y el tratamiento más usado son los interferones. Hallamos 4 tumores hematológicos y 7 familias con varios afectados por EM. Conclusiones: La prevalencia y la incidencia son similares a las halladas en el resto de España. La edad media de inicio de la forma primaria progresiva es ligeramente mayor que en otras publicaciones (40-49 años). En familias con varios miembros afectados, la EM podría tener un curso más agresivo. La discapacidad de estos pacientes sigue siendo muy elevada. Son necesarios más estudios epidemiológicos con métodos variables de recogida de datos para afianzar los hallazgos obtenidos en diferentes provincias acerca de la prevalencia. Keywords: Prevalence, Epidemiology, Multiple sclerosis, Spain, Incidence, La Rioja, Palabras clave: Prevalencia, Epidemiología, Esclerosis múltiple, España, Incidencia, La Rioj

Death in hospital following ICU discharge : insights from the LUNG SAFE study

Altres ajuts: Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic); Science Foundation Ireland Future Research Leaders Award; European Society of Intensive Care Medicine (ESICM), Brussels; St Michael's Hospital, Toronto; University of Milan-Bicocca, Monza, Italy.Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. Results: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration: ClinicalTrials.gov NCT02010073

Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study

Purpose: To evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification. Methods: Our primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24\ua0h. Secondary objectives included identifying factors associated with ARDS persistence and mortality, and the utility of day 2 ARDS reclassification. Results: Of 2377 patients fulfilling the ARDS definition on the first day of ARDS (day 1) and receiving invasive mechanical ventilation, 503 (24%) no longer fulfilled the ARDS definition the next day, 52% of whom initially had moderate or severe ARDS. Higher tidal volume on day 1 of ARDS was associated with confirmed ARDS [OR 1.07 (CI 1.01\u20131.13), P = 0.035]. Hospital mortality was 38% overall, ranging from 31% in resolved ARDS to 41% in confirmed ARDS, and 57% in confirmed severe ARDS at day 2. In both\ua0resolved and confirmed\ua0ARDS, age, non-respiratory SOFA score, lower PEEP and P/F ratio, higher peak pressure and respiratory rate were each\ua0associated with mortality. In confirmed ARDS, pH and the presence of immunosuppression or neoplasm were also associated\ua0with mortality. The increase in area under the receiver operating curve for ARDS reclassification on day 2 was marginal. Conclusions: ARDS, whether resolved or confirmed at day 2, has a high mortality rate. ARDS reclassification at day 2 has limited predictive value for mortality. The substantial mortality risk in severe confirmed ARDS suggests that complex interventions might best be tested in this population. Trial Registration: ClinicalTrials.gov NCT02010073. \ua9 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM

Correction to: Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study

Correction to: Intensive Care Med (2016) 42:1865\u20131876 DOI 10.1007/s00134-016-4571-

CMS : the TriDAS Project Technical Design Report; v.1, the Trigger Systems

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