[COVID-19 and cardiovascular and kidney disease: Where are we? Where are we going?] / COVID-19 y enfermedad cardiovascular y renal: ¿Dónde estamos? ¿Hacia dónde vamos?

The SARS-CoV-2 pandemic is a global health emergency and we need to know more about it. Patients with cardiovascular risk and previous kidney risk have been identified as especially vulnerable for greater morbidity and mortality when they suffer from COVID-19. A considerable proportion of patients can develop a vascular lesion in the context of the disease that entails a greater lethality. Cardiovascular and renal complications represent a problem and, probably in the near future, may pose a threat to patients who have survived COVID-19. As physicians, we cannot forget that during an epidemic like this, other chronic diseases are present, and patients continue to require care. We are obliged to monitor even more intensely their treatments and control degree. Furthermore, we must not forget that urgent situations continue to arise in this pandemic situation and require prompt attention. In this current situation, it is very likely that many patients, out of fear, have not sought medical attention. The situation during the epidemic and the uncertainty of the post-COVID-19 period, requires intensification in the control and monitoring of cardiovascular and kidney disease in our patients. Primary care constitutes a key level of care for the care of the population with cardiovascular disease. Likewise, and in the face of this new health scenario, we need to promote the prevention and control measures that emanate from the studies currently underway. Now, more than ever, we need research, crucial to improve the cardiovascular and renal prognosis of our patients.

[Importance of the detection of dysphagia in geriatric patients]. / Importancia de la detección de la disfagia en pacientes geriátricos.

INTRODUCTION: Oropharyngeal dysphagia is one of the lesser known geriatric syndromes, despite its enormous impact on functional capacity, quality of life, and health of those affected. MATERIAL AND METHODS: A descriptive and prospective study was conducted by the Geriatric Department of Barbastro Hospital (Huesca), from March 2012 to October 2014, as biannual and annual reviews in October 2015. This study included all patients on whom a volume-viscosity clinical examination (MECV-V test) was performed to suspecting dysphagia. RESULTS: The study included 266 patients with a mean age of 82.35±12.3 years, and with a mean Barthel index score of 20.5±25.4, and mean Charlson index of 1.77±1.6. The test was performed in 105 cases after stroke (40%), 53 in dementia (20%), 24 in Parkinsonism (9%), and for other different reasons in 80 (31%). Dysphagia was diagnosed in 228 (86%) cases. Enteral nutrition was given in 25 (10.9%) cases. The test results were shown in the discharge report in 45% of the tests with positive result. The mean survival obtained after test in the patients who died was 230.8±256.5 days. Differences in survival at 12 months were found in patients with positive test, without finding a clear relationship with functional status and comorbidity. CONCLUSIONS: Dysphagia has a significant mortality, and the use of thickeners after its detection should be properly reported.

[Thermoplastic mask in radiotherapy: a source of anxiety for the patient?]. / Le masque de contention en radiothérapie : une source d'anxiété pour le patient ?

PURPOSE: The thermoplastic mask often used to immobilize patients in radiotherapy can cause varying levels of stress and anxiety. This study aimed at evaluating the anxiety related to the use of radiotherapy masks and the coping strategies adopted by patients. PATIENTS AND METHODS: Nineteen patients treated with radiotherapy mask for head and neck cancer, a brain tumour or a lymphoma, were met twice by a psychologist, either after the making of the mask and the first course of radiotherapy, or in the middle and at the end of treatment. Thirty-four semi-structured interviews were treated using a thematic content analysis and 13 patients answered to anxiety (STAI-YB) and coping (WCC) scales. RESULTS: The STAI-YB anxiety scores related to wearing the masks were low during the radiotherapy treatment period, and were confirmed by the remarks of patients recorded during the semi-structured interviews. Most patients had a positive perception of the mask, and considered it as a friend or protection. Twelve out of the 13 patients admitting to anxiety benefited from problem focused coping strategies. CONCLUSIONS: Thermoplastic mask-related anxiety is low and possibly lies in the positive representation patients have about the mask. The explanations provided by health professionals on the radiotherapy mask possibly have a very positive effect on this perception.

Management of malignant insulinoma.

AIM: Malignant insulinoma is an infrequent functional endocrine tumor of the pancreas. Adequate therapy is a demanding challenge for oncologists and endocrinologists. OBJECTIVE: To evaluate the results of multidisciplinary management of malignant insulinoma. MATERIALS AND METHODS: Retrospective review of patients with malignant insulinoma treated from 1995 to 2011. RESULTS: Seven patients with malignant insulinoma were included: four males and three females; median age was 61.8 years (range 37-78). Six tumors were sporadic and one was diagnosed in a patient with a type 1 multiple endocrine neoplasia (MEN-1). Surgery was performed in six cases and one patient was considered unresectable. Hypoglycemias persisted in all cases and somatostatin analogs, glucocorticoids and diazoxide were used. Two patients received everolimus. Other techniques were chemoembolization and internal radiation therapy with yttrium-90. Successful liver transplant was done in the patient with MEN-1. CONCLUSION: Hypoglycemia management is complex and requires multiple therapies. Further evaluations will be necessary to determine the best treatment.

Levels of C3 in patients with severe, morbid and extreme obesity: its relationship to insulin resistance and different cardiovascular risk factors.

OBJECTIVE: Increased C3 has been related to body mass index (BMI) and insulin resistance, although there are not sufficient studies in subjects with morbid obesity. The purpose of this study was to evaluate the levels of C3 as a function of the BMI in subjects of both sexes, with severe, morbid and extreme obesity, and their possible relationship to insulin resistance or associated diseases such as diabetes, hypertension and dyslipidemia. SUBJECTS: The study included a total of 316 patients (110 men and 206 women) with severe obesity (17.1%), morbid obesity (54.4%) and extreme obesity (28.4%), with an average BMI of 46.70+/-7.37 kg/m2. MEASUREMENTS: The glucose and insulin levels were determined baseline, and 2 h after a 75 g of oral glucose load. The homeostasis model of assessment for insulin resistance (HOMA-IR) was calculated. A lipid profile (total cholesterol, triglycerides, high-density lipoprotein cholesterol, apolipoprotein AI and apolipoprotein B100) was obtained and C3 levels determined by nephelometry. RESULTS: When distributing the patients by quartiles of BMI, we found a progressive increase in the levels of C3, and no significant differences in the rest of analytical variables studied were found; the mean values of C3 were 127.78+/-29.7 mg/dl.A significant correlation was found between C3 and the BMI (r=0.263, P<0.001), baseline insulin (r=0.237, P=0.001) and HOMA-IR (r=0.237, P=0.001). High blood pressure was found in 111 patients, type 2 diabetes in 74 patients and dyslipidemia in 139 cases. When distributing the levels of C3 according to the number of associated risk factors (hypertension, diabetes and dyslipidemia), we found significant differences between these patients and those who presented no associated diseases (P<0.01). CONCLUSION: A relationship between C3 and the progressive increase of BMI in subjects with severe, morbid or extreme obesity was established. This increase in C3 was closely related to insulin levels and the values for HOMA-IR. Furthermore, we also found an increase in C3 as more diseases related to insulin resistance, such as diabetes, hypertension and dyslipidemia, were associated with the obesity.

[Carbohydrate metabolism derangements in patients with morbid obesity: weight loss impact]. / Estudio del metabolismo hidrocarbonado en pacientes con obesidad mórbida: influencia de la pérdida de peso.

OBJECTIVE: Examination of carbohydrate metabolism derangements in patients with morbid obesity and the influence of weight reduction through nutritional intervention. Assessment of gender influence on carbohydrate metabolism derangements and on response to diet. PATIENTS AND METHOD: 59 patients with morbid obesity were studied with anthropometric assessment and with carbohydrate metabolism assessment through an oral glucose overload and measurement of insulin resistance, before and after a dietary intervention alternating diets of very low caloric content with conventional low-calorie diets. RESULTS: A very significant global weight reduction in both sexes was observed (95% confidence interval [CI], 26.9 to 39.8 kg in males, and 13.5 to 20.3 kg in women). A significant improvement in basal blood glucose was found in both sexes (95% CI: males, 0.44 to 46.5 mg/dl; women, 9.5 to 32.8 mg/dl), and in 120 minute oral glucose tolerance test (OGTT) blood glucose in women (95% CI: 3.5 to 52.9 mg/dl). Both males and women showed significant improvement in basal insulinemia (95% CI: males, 1.6 to 14.2 microU/ml; women, 3.9 to 8.5 microU/ml) and in sex hormone-binding globulins (SHBG) (95% CI: males, -30.1 to -13.3 nmol/l; women, -54 to -19.4 nmol/l). Both males and women showed an improvement of sensitivity to insulin measured with HOMA (HOMAIR) (95% CI: males, 1.46 to 3.59; women, 0.67 to 2.24). CONCLUSION: In patients with morbid obesity carbohydrate metabolism derangements are common. Weight reduction led to a significant reduction of these derangements.

The relation between obesity, abdominal fat deposit and the angiotensin-converting enzyme gene I/D polymorphism and its association with coronary heart disease.

OBJECTIVE: To analyse the relation between overweight, obesity and fat distribution with I/D polymorphism of the angiotensin-converting enzyme (ACE) gene and its association with coronary heart disease (CHD). DESIGN: Cross-sectional, case-control study. SUBJECTS: A total of 185 cases (141 males) who had suffered at least one episode of CHD and 182 controls (127 males). MEASUREMENTS: Body mass index, waist circumference, blood pressure, plasma total cholesterol, triglycerides, HDL cholesterol and fasting glucose were measured with standard methods, genotyping the I/D polymorphism of ACE gene. RESULTS: Obesity and abdominal fat deposit are associated with CHD in women, but not independently. We have found an association between obesity and abdominal fat deposit with the ACE gene I/D polymorphism in subjects with CHD. Subjects with CHD and DD or ID genotypes have significantly higher prevalence of obesity and abdominal fat deposit and higher values of weight and waist circumference. In addition, the DD and ID genotypes increased crude OR of obesity. The DD and ID genotypes of the ACE gene I/D polymorphism and BMI are independently associated with CHD. CONCLUSION: There is a relation between the type and grade of obesity with the genotypes of the ACE gene I/D polymorphism in subjects with CHD.

[Malnutrition evaluation in obese patients of both sexes on a very low caloric content diet]. / Evaluación de la malnutrición en pacientes obesos de ambos sexos tratados con dieta de muy bajo contenido calórico.

We have evaluated the effectiveness of a very low caloric content diet (VLCD) during 6 weeks in patients with severe obesity (grades II and III). Twenty-seven men and 61 women were selected for evaluation of anthropometric (weight, body mass index [BMI], waist, hip, C/c, fatty weight and intra-abdominal fatty area) and biochemical (creatinine-height index [CHI], albumin, transferrin, retinol binding protein [RBP], prealbumin, C3, and lymphocytes count) malnutrition parameters, at the beginning and after 6 weeks of treatment with VLCD. In men we found a significant decrease of weight, BMI, waist, hip, fatty weight, and intra-abdominal fatty area. In women the decrease of weight, BMI, hip, and fatty weight was also significant. We found baseline malnutrition in 7.4% of men and in 14.7% of women, and after the treatment in 22.2% of men and in 34.4% of women (p < 0.05). With regard to the biochemical parameters of protein malnutrition, only men showed significant decrease in the CHI and only women showed significant decrease in transferrin, RBP, prealbumin, and C3. In conclusion, we can state that different types of VLCD are effective for weight loss in severe obese subjects. However, within a period of follow-up of 6 weeks we have detected the presence of protein malnutrition, especially in women, being in these patients affected the visceral compartment while in men the muscular compartment is affected.

Transient rise in intact parathyroid hormone concentration after surgery for parathyroid adenoma.

OBJECTIVE: Our goal was to describe the course of parathyroid hormone (PTH) after surgery for primary hyperparathyroidism (PHPT). PTH levels drop to low values after parathyroidectomy for PHPT. However, in some patients, a rebound transient increase in PTH concentrations can occur. Study design and setting A prospective study included 72 patients who underwent surgical exploration for PHPT. A single adenoma was found in 57 patients (79.1%), 2 adenomas were found in 2 (2.7%), and parathyroid hyperplasia was found in 13 (18.05%). The postoperative PTH secretion was studied in those patients who had an adenoma excised. RESULTS: This phenomenon was noted in 18 (31.6%) patients between 4 and 12 weeks, although total calcium concentrations were normal (9.3 +/- 0.6 mg/dL). Before surgery these patients had a more remarkable hyperparathyroidism (clinical and biochemical) than the others, but differences were not significant. CONCLUSION: Postoperative increases in PTH concentration can occur after successful parathyroidectomy. These increases are transient and do not indicate persistent or recurrent disease.

Voltammetric analysis of heterogeneity in metal ion binding by humics.

The complexation of Cd, Pb, and Cu by fulvic acids at a fixed pH and ionic strength is studied by means of different voltammetric techniques at any metal-to-ligand ratio. When using Reverse Pulse Polarography (RPP) the complex species are electrochemically labile and not subject to significant electrodic adsorption. RPP titrations of fulvic acid with metal ions are interpreted on the basis of a recently proposed analytical expression for limiting currents valid for fully labile heterogeneous complexation. The voltammetric data are transformed into the corresponding binding curve, i.e., the fraction of occupied sites vs free metal concentration. Finally, the competition between metal ions and protons in their interaction with the fulvic binding sites as well as the concomitant polyelectrolytic effects are analyzed in terms of the NICCA-Donnan model. The results show that voltammetric techniques can be applied to the studies of heterogeneous complex systems in a broad range of metal-to-ligand ratios.

Implementation of a chemical equilibrium constraint in the multivariate curve resolution of voltammograms from systems with successive metal complexes.

A multivariate curve resolution (MCR) method, using a constrained alternating least squares (ALS) procedure with a new chemical equilibrium constraint, was applied to differential-pulse polarograms of successive metal complexes. This new restriction imposes the fulfillment of a chemical model defined by a set of stability constants that are optimised along the iterative ALS procedure. The reliability of the method was tested with simulated data and with polarograms measured for the systems Zn(II) + glutathione and Cd(II) + 1,10-phenanthroline. These systems respectively yield two and three successive and electroactive complexes, which are inert from the electrochemical point of view, that is, the complexes virtually do not dissociate during the measurement. Although the presence of electrode adsorption could induce overestimation of some concentrations and losses of linearity between concentrations and signals, the results showed that the proposed method can yield satisfactory estimations of the stability constants in this kind of system. The performance of the new method is compared with the performances obtained using MCR-ALS without the equilibrium constraint and using traditional curve fitting least-squares approaches.

[Nutritional status assessment in diabetes mellitus secondary to chronic alcoholic pancreatitis]. / Valoración del estado nutricional en la diabetes mellitus secundaria a pancreatitis crónica alcohólica.

BACKGROUND: Diabetes mellitus secondary to alcoholic chronic pancreatitis (DM-ACP) represents 0.5-2% of all cases of diabetes mellitus (DM) and shows predominantly symptoms related to malnutrition instead of cardinal clinical signs of diabetes. The aim of this study was to try to further characterize the features of the malnutrition in patients with pancreatic insufficiency. PATIENTS MATERIAL AND METHODS: We selected 40 patients (39 males and 1 female) meeting clinical, functional and morphological diagnostic criteria of DM-ACP which received a nutritional assessment that included estimation on fat and proteic body compartments being classified as caloric, proteic or mixed malnutrition. RESULTS: 29 patients (72.5%) showed some kind of malnutrition. The most frequent type was mixed (proteic-caloric) malnutrition found in 19 of them (47.5%). Caloric malnutrition was present in 6 (15%) and mainly proteic in 4 (10%). Only 11 patients with DM-ACP in our series showed a normal nourishment state. CONCLUSIONS: Large prevalence of mixed malnutrition in DM-ACP patients may be related to malabsorption of macronutrients (especially proteins and fat) due to exocrine insufficiency and misuse of nutrients as a result of the characteristic hypoinsulinemia showed by these patients.

[Effect of enalapril on microalbuminuria and lipid profile of normotensive type I diabetes mellitus patients]. / Influencia de enalapril sobre la microalbuminuria y el perfil lipídico en pacientes con diabetes mellitus tipo I normotensos.

A longitudinal study for six months was conducted to demonstrate the influence of enalapril therapy on microalbuminuria in a group of patients with IDDM without arterial hypertension. An evaluation was also considered of its possible activity on other biochemical parameters, particularly plasma lipid levels. Thirty-four patients with IDDM were selected, with a mean age of 26.1 +/- 7.2 years and a mean clinical course of 11.8 +/- 5.6 years. Arterial blood pressure (ABP) was confirmed lower than 140/85 mmHg in all cases. Patients were administered 5 mg/day of enalapril and if a decrease in microalbuminuria higher than 25% was not achieved at the end of the first month of therapy, the dose was doubled (10 mg/day). No significant differences were found in ABP and in HbA1c throughout the study period. Albumin excretion in the initial period was 125.1 +/- 79.28 mg/24 h, at one month in the follow-up 47.6 +/- 44.1 mg/24 h, at three months 23.8 +/- 18.1 mg/24 h, and at the end of the 6th month 15.33 +/- 6.9 mg/24 h, all differences being significant. Renal function parameters and Na+ and K+ measurements remained unchanged for the follow-up period. No significant changes were detected for lipid and lipoprotein values for the length of the study. We conclude that therapy with enalapril in insulin-dependent diabetic patients without hypertension has an important effect on microalbuminuria during the first month of therapy; a stabilization in the normal range was reached in the third and sixth months of follow-up. No changes in arterial blood pressure nor in renal function were observed. Plasma lipid values were in the normal range throughout the study. Therefore, treatment for microalbuminuria with the ACEI assayed was efficient, in absence of arterial hypertension and irrespective of the metabolic control obtained. Future long-term studies are needed to evaluate the possible delay in the emergence of renal insufficiency.