Estudio descriptivo de las cavidades pleurales residuales complicadas tratadas en un Servicio de Cirugía Torácica

Introducción: Las cavidades pleurales residuales se definen como espacios pleurales causados por una falta de reexpansión pulmonar principalmente secundario a infecciones pleurales o cirugías torácicas. Estas pueden cronificarse y complicarse si no logran resolverse con los tratamientos de primera línea (drenaje torácico, fibrinolíticos o decorticación quirúrgica). Material y Métodos: Estudio descriptivo retrospectivo de los pacientes con cavidades pleurales residuales complicadas (CPRC) en el Servicio de Cirugía Torácica del Complejo Hospitalario Universitario de Albacete desde noviembre del 2004 hasta mayo del 2015. Resultados: Sesenta y tres pacientes fueron diagnosticados, con una mayor frecuencia en hombres (n=57; 90,5%). Del total de pacientes intervenidos en este periodo, el 16,27% de cirugías fueron secundarias a esta patología. La patología infecciosa fue la más frecuente (n=35; 55,6%) y dentro de la post-quirúrgica la neumonectomía (n=8; 42,1%), con una media de días desde la intervención quirúrgica hasta el diagnóstico de 190,7 días. En 43 pacientes (68,3%) el cultivo del líquido pleural fue positivo. En 17 pacientes (27%) se asoció a una fístula broncopleural. De los 63 pacientes, 16 (25,4%) recibieron un único tratamiento quirúrgico (25,4%), mientras que 47 (74,6%), precisaron más de un tratamiento. En 39 casos (61,9%) la cavidad pleural complicada se resolvió por medio de los tratamientos, mientras que no lo hizo en 24 (38,1%) pacientes. Conclusiones: A pesar de ser una patología poco frecuente continua presente en la actualidad, principalmente como complicación postquirúrgica o infecciosa. Los tratamientos descritos hasta la fecha no revelan una alta eficacia.Introduction: Residual pleural cavities are pleural spaces caused by a lack of pulmonary reexpansion mainly secondary to pleural infections or thoracic surgeries. If they can not be solved with first line treatments (thoracic drainage, fibrinolytics or surgical decortication), these can become cronic and complicate. Material and Methods: Retrospective descriptive study of patients with complicated residual pleural cavities at the Thoracic Surgery Service of the “Complejo Hospitalario Universitario de Albacete” from November 2004 to May 2015. Results: Sixty-three patients were diagnosed, showing that incidence was more frequent in men (n=57; 90.5%). 16.27% of the surgeries treated within this period were secondary to this pathology. The infectious pathology was the most frequent (n = 35; 55.6%), whereas within the postoperative group, it was pneumonectomy (n = 8; 42.1%), with 190.7 days in average from surgical intervention to the diagnosis. In 43 patients (68.3%), the pleural fluid culture was positive. In 17 patients (27%), it was associated with a bronchopleural fistula. From the 63 patients, 16 (25.4%) received a single surgical treatment (25.4%), while 47 (74.6%) required more than one treatment. In 39 cases (61.9%), the complicated pleural cavity was resolved, whereas in 24 (38.1%) patients it wasn’t. Conclusions: Despite it being a rare pathology, it is still present today, mainly as a post-surgical or infectious complication. To date, the treatments described haven’t exhibited high efficacy

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.</p

Biology

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Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions. © Copyright