Evaluation of bendopnea in severe obstructive sleep apnea syndrome.

BACKGROUND: Bendopnea is a symptom described in heart failure (HF) that is related to short-term prognosis; however, its frequency and characteristics in respiratory diseases such as OSAS is still unknown. This study was carried out to evaluate the prevalence of bendopnea in patients with severe obstructive sleep apnea syndrome (OSAS) METHODS: We conducted a study of 95 patients attending a sleep disorders unit with severe OSAS. Bendopnea was considered when shortness of breath occurred within 30s of bending forward. RESULTS: Bendopnea was present in 33/95 of the patients included (34.7%). The median age was 62 years (52-71), 65 were men (68.4%), with a median weight of 92 (81-107) and BMI of 34kg/m2 (±7.1). The median duration of shortness of breath was 5s (2-10). The presence of bendopnea was related to age (p<.0001), obesity (p .004), respiratory diseases (p .01) and HF (p .03). Admission rate was higher in those with bendopnea without reaching statistical significance. CONCLUSION: One-third of patients with severe OSAS present bendopnea. This symptom is related to a higher prevalence of comorbidities (HF, obesity and other respiratory diseases). It is also related to a higher CT90.

iPCSK9 treatment of Familial Hypercholesterolemia in a patient diagnosed as Congenital Muscular Dystrophy with contraindication for statin use. / Tratamiento de la hipercolesterolemia familiar con iPCSK9 en un paciente diagnosticado de distrofia muscular congénita con contraindicación para la toma de estatinas.

Statins are contraindicated in patients with myopathies. Until a few years ago, in those patients with Familial Hypercholesterolemia who also presented muscular dystrophies and didnt reach adequate cholesterol plasmatic levels, the next therapeutic ladder was lipoapheresis. When iPCSK9 first appeared, lipoapheresis could be suspended in some of these patients, sustaining nevertheless proper levels of cholesterol. We present the case of a 27 year-old male, diagnosed with Congenital Muscular Dystrophy in the early childhood. He was referred to the Unit of Lipidology presenting hypercholesterolemia which, after genetic test, was assessed as Heterozygous Familial Hypercholesterolemia. Despite of treatment with diet and ezetimibe, cLDL blood levels abide high, being consequently included in lipoapheresis programme, therewith obtained levels of cLDL of 70mg/dl. In providing iPCSK9, lipoapheresis was withdrawn and treatment with alirocumab 150mg fortnightly introduced, unveiling a positive response, and sustaining cLDL levels around 75mg/dl.

Assessment of bendopnea impact on decompensated heart failure.

AIMS: We have often found that patients with heart failure had shortness of breath when bending forward. The frequency of bendopnea in patients with decompensated heart failure (DHF), its repercussions on quality of life (QoL), and its prognosis have not yet been studied. This study was carried out to evaluate the characteristics, degree of limitation, and short-term prognosis of patients with bendopnea and DHF. METHODS AND RESULTS: We conducted a study of 250 patients admitted with DHF. Bendopnea was considered when shortness of breath occurred within 30 s of bending forward. It was present in 122 patients (48.8%). The mean time of onset was 13.4 ± 6.9 s. Patients with bendopnea presented a higher frequency of orthopnoea, paroxysmal nocturnal dyspnoea, oliguria, oedema, elevated jugular venous pressure, abdominal fullness, and worse functional class (P < 0.001). An enlargement of both atria was more frequent in these patients (P < 0.001). Pulmonary artery systolic pressure (PASP) was higher in the bendopnea group (P = 0.001). Body mass index and LVEF were not associated with presence of bendopnea. Subjective QoL limitation was present in 80.3% (36.1% mild, 44.2% moderate to severe limitation). Patients with bendopnea had a higher mortality rate (P = 0.025) and more advanced NYHA class (P < 0.001). Patients who died had a lower LVEF (P = 0.001), increased PASP (P = 0.08), and lower mean duration of shortness of breath than those who survived (P = 0.01). CONCLUSION: Bendopnea is related to advanced HF symptoms and it is associated with mortality in the short term and advanced NYHA functional class. This symptom produces moderate to severe limitation of QoL.

Validity of procalcitonin for the diagnosis of bacterial infection in elderly patients.

INTRODUCTION: PCT has been consolidated as a key tool in the diagnosis of bacterial infections in general population. Few studies have been conducted to determine the applicability of this test in elderly patients. METHODS: Study of validity of PCT on elderly patients. Two groups were formed; the first group was formed by patients aged 75 years or older, under bacterial infection criteria and PCT on the initial Lab test. The second group was formed by patients aged 75 years or older with any noninfectious disease; these patients were asked PCT in the initial Lab test. Sensitivity, specificity, positive and negative likelihood ratio were calculated. RESULTS: 161 patients were included, 95 with probable bacterial infection and 66 without infection. Patients with probable bacterial infection criteria, 72% of them had PCT >0.5 ng/mL. Patients without infection, 8% of the patients had PCT >0.5 ng/mL. Sensitivity and specificity of PCT to bacterial infection with the cutoff value of 0.5 ng/mL was 72% and 92%, respectively. CONCLUSION: PCT can be used in elderly patients to diagnose bacterial infections because it has proved good sensitivity and high specificity.