Estudio epidemiológico sobre la patología dermatológica del adolescente en el área oeste de Valladolid

Las patologías dermatológicas son habituales en el adolescente y pueden tener una influencia significativa en su calidad de vida. Para conocer la frecuencia de las mismas e investigar algunos aspectos como su relación con la dieta se ha realizado este estudio epidemiológico. Se obtuvieron datos epidemiológicos de un total de 77 adolescentes (entre 11 y 19 años) que acudían por primera vez a una consulta de dermatología. A 66 de ellos se les realizó una encuesta en la que se preguntaba por sus hábitos alimenticios, hábito tabáquico y el uso previo de antibioterapia tópica en el caso del acné. Concluimos que la patología más frecuente resultó ser el acné (46.8%), seguido de los nevus melanocíticos (19.5%) y la dermatitis atópica (11.7%). El porcentaje de pacientes con acné que había utilizado previamente antibiótico tópico fue del 54.8%, dato del que se infiere el abuso de estos fármacos en el tratamiento del acné. No se obtuvo una relación estadísticamente significativa entre el acné y los hábitos alimenticios por los que se preguntó en la encuesta. Creemos necesaria la realización de más estudios epidemiológicos sobre patología dermatológica en el adolescente ante la ausencia de los mismos en la literatura. Es necesaria la realización de estudios con un tamaño muestral mayor, así como el desarrollo de estrategias de educación para la salud y formación continuada en Atención PrimariaGrado en Medicin

Importancia del estudio sistemático de las palpitaciones

Palpitations are often attributed to states of anxiety or stress, forgetting that they can be a reflection of a serious underlying disease, which can compromise the patient´s lives. We present the case of a male who comes to the out-patient clinic referring only palpitations, finally being diagnosed with an infrequent and serious cardiological disease.Las palpitaciones se atribuyen con mucha frecuencia a estados de ansiedad o estrés, olvidando que pueden ser el reflejo de una enfermedad subyacente grave, que puede comprometer la vida de los pacientes. Se presenta el caso de un varón que acude a consulta refiriendo únicamente palpitaciones, siendo finalmente diagnosticado de una enfermedad cardiovascular poco frecuente y grave

Measurement of vegetations in infective endocarditis: An inaccurate method to decide the therapeutical approach

Background: The European Society of Cardiology and American Heart Association guidelines give a central role to the maximal vegetation diameter in the indication for surgery to prevent embolism in left sided infective endocarditis (LSIE). Vegetation measuring is likely to be inaccurate. The hypothesis herein, is that the vegetation diameter is not an appropriate surgical criterion given the variability of its measurement. Methods: Two trained echocardiographers independently measured the maximal vegetation diameter by transesophageal echocardiogram of 76 vegetations in 67 consecutive patients with definite infective endocarditis in an off-line workstation. The interobserver variability was calculated by the interclass correlation coefficient. The relationship between the strength of agreement for the cut-off points of 10 and 15 mm was also calculated. Finally, the number of patients whose surgical indication would have changed depending on which operator measured the vegetation was evaluated. Results: Interobserver interclass correlation coefficient in the measurement of the maximal longitudinal diameter of the vegetations was 0.757 (0.642–0.839). The strength of agreement of the interobserver analysis for the cut-off point of 10 mm was 0.533 (0.327–0.759). For the cut-off point of 15 mm it was 0.475 (0.270–0.679). If heart failure or uncontrolled infections had been absent, the surgical indication would have changed in a total of 33 patients (33/76; 43%) depending on which operator measured the vegetation. Conclusions: The variability in the measurements of the maximal longitudinal diameter by transesophageal echocardiogram is high. Surgical indications based on the cut-off points recommended by the international guidelines should be revised

Impact of the presence of heart disease, cardiovascular medications and cardiac events on outcome in COVID-19

Background: Cardiovascular risk factors and usage of cardiovascular medication are prevalent among coronavirus disease 2019 (COVID-19) patients. Little is known about the cardiovascular implications of COVID-19. The goal herein, was to evaluate the prognostic impact of having heart disease (HD) and taking cardiovascular medications in a population diagnosed of COVID-19 who required hospitalization. Also, we studied the development of cardiovascular events during hospitalization. Methods: Consecutive patients with definitive diagnosis of COVID-19 made by a positive real time- -polymerase chain reaction of nasopharyngeal swabs who were admitted to the hospital from March 15 to April 14 were included in a retrospective registry. The association of HD with mortality and with mortality or respiratory failure were the primary and secondary objectives, respectively. Results: A total of 859 patients were included in the present analysis. Cardiovascular risk factors were related to death, particularly diabetes mellitus (hazard ratio in the multivariate analysis: 1.810 [1.159– –2.827], p = 0.009). A total of 113 (13.1%) patients had HD. The presence of HD identified a group of patients with higher mortality (35.4% vs. 18.2%, p < 0.001) but HD was not independently related to prognosis; renin–angiotensin–aldosterone system inhibitors, calcium channel blockers, diuretics and beta-blockers did not worsen prognosis. Statins were independently associated with decreased mortality (0.551 [0.329–0.921], p = 0.023). Cardiovascular events during hospitalization identified a group of patients with poor outcome (mortality 31.8% vs. 19.3% without cardiovascular events, p = 0.007). Conclusions: The presence of HD is related to higher mortality. Cardiovascular medications taken before admission are not harmful, statins being protective. The development of cardiovascular events during the course of the disease is related to poor outcome

Uso de un sistema extracorpóreo de asistencia circulatoria de flujo continuo, corta duración e inserción quirúrgica como puente a trasplante

Introduction and objectives: We aimed to describe the clinical outcomes of the use of the CentriMag acute circulatory support system as a bridge to emergency heart transplantation (HTx). Methods: We conducted a descriptive analysis of the clinical outcomes of consecutive HTx candidates included in a multicenter retrospective registry who were treated with the CentriMag device, configured either for left ventricular support (LVS) or biventricular support (BVS). All patients were listed for high-priority HTx. The study assessed the period 2010 to 2020 and involved 16 transplant centers around Spain. We excluded patients treated with isolated right ventricular support or venoarterial extracorporeal membrane oxygenation without LVS. The primary endpoint was 1-year post-HTx survival. Results: The study population comprised 213 emergency HTx candidates bridged on CentriMag LVS and 145 on CentriMag BVS. Overall, 303 (84.6%) patients received a transplant and 53 (14.8%) died without having an organ donor during the index hospitalization. Median time on the device was 15 days, with 66 (18.6%) patients being supported for > 30 days. One-year posttransplant survival was 77.6%. Univariable and multivariable analyses showed no statistically significant differences in pre-or post-HTx survival in patients managed with BVS vs LVS. Patients managed with BVS had higher rates of bleeding, need for transfusion, hemolysis and renal failure than patients managed with LVS, while the latter group showed a higher incidence of ischemic stroke. Conclusions: In a setting of candidate prioritization with short waiting list times, bridging to HTx with the CentriMag system was feasible and resulted in acceptable on-support and posttransplant outcomes.Fundacion Mutua Madrilena (Madrid, Spain)5.9 JCR Q1 20220.593 SJR Q2 2023No data IDR 2022UE