Early Desaturation During 6-Minute Walk Test is a Predictor of Mortality in COPD.

BACKGROUND: Oxygen desaturation during exercise is mainly observed in severe cases of chronic obstructive pulmonary disease (COPD) and is associated with a worse prognosis, but little is known about the type of desaturation that causes the greatest risk of mortality. MATERIAL AND METHODS: We studied all of the 6-min walk tests performed periodically at a tertiary hospital over a period of 12 years in patients with moderate or severe COPD. We classified patients as non-desaturators if they did not suffer a drop in oxygen saturation (SpO2 < 88%) during the test, early desaturators if the time until desaturation was < 1 min, and non-early desaturators if it was longer than 1 min. The average length of follow-up per patient was 5.6 years. RESULTS: Of the 319 patients analyzed, 126 non-desaturators, 91 non-early desaturators and 102 early desaturators were identified. The mortality analysis showed that early desaturators had a mortality of 73%, while it was 38% for non-early desaturators and 28% for non-desaturators, with a survival of 5.9 years compared to 7.5 years and 9.6 years, respectively (hazard ratio of 3.50; 95% CI 2.3-5.3; p < 0.0001). CONCLUSIONS: The early desaturation seen in patients with chronic obstructive pulmonary disease is associated with greater mortality and is likely responsible for the poor prognosis shown globally in patients who desaturate. The survival of patients with early desaturation is almost 4 years less with respect to non-desaturators, and they, thus, require closer observation.

Evaluation of neutropenia secondary to mycophenolate mofetil associated with valganciclovir in liver transplant patients.

OBJECTIVE: Immunosuppressive drugs are necessary to avoid or reduce the risk of rejection of transplanted organs. The immunosuppression generated may result in these patients needing  antibiotics and antivirals to be prescribed to them in conjunction with their immunosuppressants to avoid the risk of infection. This has generated an increase in neutropenia in patients treated with mycophenolate mofetil in combination with valganciclovir. The purpose of this study is to estimate the risk of neutropenia attributable to combination treatment of mycophenolate mofetil with valganciclovir in patients with a transplanted liver. METHOD: This is a retrospective cohort study. It included patients who received a liver transplant between 2012 and 2017 and who were treated with mycophenolate mofetil or with a combination of mycophenolate mofetil and valganciclovir. Minimum follow-up was 100 days posttransplantation. Children under 16 years of age and patients who died during follow-up were excluded. Binary logistic regression analysis was used to determine the association of neutropenia with sex, age, diabetes, creatinine at baseline and at discharge, and concomitant treatment of mycophenolate mofetil with valganciclovir. Relative risk and 95% CI were calculated using logistic regression coefficients. RESULTS: 144 patients were analyzed, 87 were treated with mycophenolate mofetil and 57 received mycophenolate mofetil and valganciclovir together. An overall risk of neutropenia of 37% [95% CI (29- 45)] was observed. The risk was significantly higher in patients who received the combination of mycophenolate mofetil and valganciclovir (56%) than in those treated with mycophenolate mofetil alone (24%), p = 0.001. Binarylogistic-regression analysis revealed that concomitant use of mycophenolate mofetil with valganciclovir was associated with an increased risk of neutropenia: Relative risk = 4.97, 95% CI [2.25-11.00]. CONCLUSIONS: Our study shows that concomitant use of mycophenolate mofetil and valganciclovir increases the risk of neutropenia in patients with a transplanted liver.

Objetivo: Los fármacos inmunosupresores son necesarios para evitar o reducir el riesgo de rechazo de órganos trasplantados. La inmunosupresión generada puede dar lugar a que estos pacientes necesiten recibir antibióticos y antivíricos con los inmunosupresores para evitar el riesgo de infecciones. Esto ha generado un incremento de neutropenia en pacientes tratados conjuntamente con micofenolato de mofetilo y valganciclovir. El objetivo de este estudio es estimar el riesgo de neutropenia atribuible al tratamiento concomitante de micofenolato de ofetilo y valganciclovir en pacientes trasplantados hepáticos.Método: Estudio de cohorte retrospectiva. Se incluyeron pacientes receptores de hígado entre 2012 y 2017 tratados con micofenolato de mofetilo o con la combinación de micofenolato de mofetilo y valganciclovir, con al menos 100 días de seguimiento postrasplante. Se excluyeron menores de 16 años y pacientes fallecidos durante el seguimiento. El análisis de regresión logística binaria se utilizó para determinar la asociación del riesgo de neutropenia con el sexo, edad, diabetes, creatinina basal y al alta, y tratamiento concomitante de micofenolato de mofetilo y valganciclovir. El riesgo relativo y los IC 95% se calcularon mediante los coeficientes de regresión logística.Resultados: Un total de 144 pacientes fueron analizados, 87 se trataron con micofenolato de mofetilo y 57 recibieron conjuntamente micofenolato de mofetilo y valganciclovir, observándose un riesgo de neutropenia del 37%, IC 95% [29-45]. Este riesgo fue significativamente mayor en pacientes que recibieron la combinación de micofenolato de mofetilo y valganciclovir (56%) respecto a los tratados solo con micofenolato de mofetilo (24%), p = 0,001. El análisis de regresión logística binaria reveló que el uso concomitante de micofenolato de mofetilo y valganciclovir se asociaba a un mayor riesgo de neutropenia: riesgo relativo = 4,97, IC 95% [2,25-11,00].Conclusiones: Nuestro estudio demuestra que el uso concomitante de micofenolato de mofetilo y valganciclovir aumenta el riesgo de neutropenia en pacientes trasplantados hepáticos.

The Genomics and Metagenomics of Asthma Severity (GEMAS) Study: Rationale and Design.

Asthma exacerbations are a major contributor to the global disease burden, but no significant predictive biomarkers are known. The Genomics and Metagenomics of Asthma Severity (GEMAS) study aims to assess the role of genomics and the microbiome in severe asthma exacerbations. Here, we present the design of GEMAS and the characteristics of patients recruited from March 2018 to March 2020. Different biological samples and demographic and clinical variables were collected from asthma patients recruited by allergy and pulmonary medicine units in several hospitals from Spain. Cases and controls were defined by the presence/absence of severe asthma exacerbations in the past year (oral corticosteroid use, emergency room visits, and/or asthma-related hospitalizations). A total of 137 cases and 120 controls were recruited. After stratifying by recruitment location (i.e., Canary Islands and Basque Country), cases and controls did not differ for most demographic and clinical variables (p > 0.05). However, cases showed a higher proportion of characteristics inherent to asthma exacerbations (impaired lung function, severe disease, uncontrolled asthma, gastroesophageal reflux, and use of asthma medications) compared to controls (p < 0.05). Similar results were found after stratification by recruitment unit. Thereby, asthma patients enrolled in GEMAS are balanced for potential confounders and have clinical characteristics that support the phenotype definition. GEMAS will improve the knowledge of potential biomarkers of asthma exacerbations.

[CONCORDANCE IN THE RESULTS OF CONTROL INTAKE PERFORMANCE OF 72 H BY DIFFERENT HEALTH PROFESSIONALS IN A TERTIARY HOSPITAL]. / CONCORDANCIA EN LOS RESULTADOS TRAS LA REALIZACIÓN DE UN CONTROL DE INGESTAS DE 72 H POR DIFERENTE PERSONAL SANITARIO EN UN HOSPITAL DE TERCER NIVEL.

INTRODUCTION: the nutritional screening CIPA is positive when it fulfills one of the following parameters: Control food Intake (CI) 72 h < 50%; albumin < 3 g/dl; Body Mass Index (BMI) < 18,5 kg/m2 or Mid-Upper Arm Circumference (MUAC) ≤ 22,5 cm (if BMI cannot be determined). The only parameter no totally objective is the CI so that this study seeks to reinforce its validity. OBJECTIVES: analyze the existing concordance among different health professionals when assessing a CI of 72 h. MATERIALS AND METHOD: retrospective study of patients admitted in hospitalization wards (February-October 2014). Variables considered: age, sex, health service, CI of 72 h and type of diet. The aim of CI is to assess the amount of food consumed, differing between superior or inferior intakes to 50%. It is analyzed the concordance of the results CI determined by a doctor, a nurse and a nutritionist (gold-standard) by the coefficient Kappa (K). Subsequently the sensitivity (S) and specificity (Sp) of positive CI were computed. RESULTS: 176 control of food intake were analyzed. Age 63.70 } 14.46 years; 42% women. Units: Digestive (22.2%), Pneumology (42%), Internal Medicine (21.6%), Nephrology (9.1%), others (5.1%). Type of diet: basal (23%), therapeutic (67%), consistency (4%), progressive (3.4%), others (2.3%). It was compared the nursing CI vs. nutritionist (K = 0.798; p < 0.001), and the doctor vs. nutritionist (K = 0.823; p < 0.001). The S and Sp of nursing vs. nutritionist was 84% and 97% while between the doctor and the nutritionist was 84% and 98% respectively. CONCLUSIONS: the concordance of the results of a CI of 72 hours (intakes < or > to 50%) performed in patients hospitalized by a doctor, nurse, and nutritionist is high, minimizing subjectivity to this parameter. The CI is helpful for its use within the routine clinical practice, and particularly within the nutritional screenings, such as CIPA.

Introducción: el cribado nutricional CIPA es positivo cuando se cumple uno de los siguientes parametros: Control de Ingestas (CI) 72 h < 50%; albumina < 3 g/dl; Indice de Masa Corporal (IMC) < 18,5 kg/m2 o Circunferencia del Brazo (CB) ≤ 22,5 cm (si no se puede determinar IMC). El unico parametro no totalmente objetivo es el CI, por lo que este estudio busca reforzar la validez del mismo. Objetivos: analizar la concordancia existente entre diferentes profesionales sanitarios a la hora de evaluar un CI de 72 h. Material y métodos: estudio prospectivo de pacientes ingresados en plantas de hospitalizacion (febrero-octubre de 2014). Variables recogidas: edad, sexo, servicio medico, CI de 72 h y tipo de dieta. El objetivo del CI es valorar la cantidad de alimento consumido, diferenciando entre ingestas superiores o inferiores al 50%. Se analiza la concordancia de los resultados del CI dictaminados por un medico, una enfermera y un nutricionista (gold-standar) mediante el coeficiente Kappa (K). Posteriormente se calculo la sensibilidad (S) y la especificidad (E) de los CI positivos. Resultados: se analizaron 176 controles de ingestas. Edad: 63,70 } 14,46 anos; 42% mujeres. Servicios: Digestivo (22,2%), Neumologia (42%), Medicina Interna (21,6%), Nefrologia (9,1%), Otros (5,1%). Tipo de dieta: basal (23,3%), terapeutica (67%), consistencia (4%), progresion (3,4%), otros (2,3%). Se comparo el CI de enfermeria vs. nutricionista (K = 0,798; p < 0,001), y del medico vs. nutricionista (K = 0,823; p < 0,001). La S y E de enfermeria vs. nutricionista fue de 84% y 97%, mientras que entre medico y nutricionista fue de 84% y 98%, respectivamente. Conclusiones: la concordancia de los resultados de un CI de 72 horas (ingestas < o > al 50%) realizado en pacientes hospitalizados por un medico, una enfermera y un nutricionista es alta, restando subjetividad a este parametro. El CI resulta util para su uso dentro de la practica clinica habitual y, en concreto, dentro de cribados nutricionales, como el CIPA.

[Presentation of the "CDC de Canarias" cohort: objectives, design and preliminary results]. / Presentación de la cohorte "CDC de Canarias": objetivos, diseño y resultados preliminares.

BACKGROUND: The Canary Islands rank first in Spain with respect to the ischaemic heart disease and diabetes mortality rates. The Islands female population leads the country in deaths from breast cancer. The "CDC de Canarias" is a general population cohort study in order to analyse the prevalence and incidence of these diseases and the exposure to their risk factors (RF) in the adult population of the archipelago. METHODS: Prospective study with a random sampling of the general population, in which 6,729 individuals participated between 2000 and 2005 (aged 18-75). Anthropometric measurements were taken, and blood was drawn for the storage of serum and genetic samples. The following information was gathered through a questionnaire: eating habits, physical activity, personal and family medical history, exposure to occupational or environmental risk factors, smoking, etc. RESULTS: The prevalence of obesity is close to 30%, without differences between sexes, however, more male subjects were overweight than women (45 vs. 33%; p <0.001) and also presented a greater prevalence of diabetes (12 vs. 10%; p =0.005), high blood pressure (43 vs. 33%; p <0.001), excessive intake of alcohol (13 vs. 2%; p <0.001) and lack of sun protection (46 vs. 18%; p <0.001). Exposure to low levels of HDL cholesterol is more frequent in women (37 vs. 30%; p <0.001) as is also the case with a sedentary life style (71 vs. 55%; p <0.001). The exposure to the risk factors studied, including poverty, is greater in advanced age groups, except for smoking (26%) which is greater in the younger subjects. The estimate of relative risks of exposure to cardiovascular and cancer risk factors is higher in low-income social classes. CONCLUSIONS: The current adult population of the Canaries presents a high prevalence of exposure to risk factors for cardiovascular disease, diabetes and cancer, among which overweight, obesity and lack of exercise stand out particularly.

Main pigmentary features and melanocortin 1 receptor (MC1R) gene polymorphisms in the population of the Canary Islands.

BACKGROUND: Sun exposure, light skin pigmentation, and melanocortin 1 receptor (MC1R) gene variants are independent risk factors for skin cancer. The Canary Islands have a sunny and temperate climate, but data regarding the phenotypic and genotypic risk factors among the population are lacking. METHODS: The main phenotypic features (skin color, hair color, eye color, and freckling) of 5116 healthy individuals are described. The genotypic findings of six MC1R gene variants (V60L, D84E, R150C, R160W, R163Q, and T314T) in 116 healthy individuals from a population-based cohort with at least three generations of Canary Islands' ancestry are evaluated. The variants were analyzed by SNaPshot. RESULTS: Fifty per cent of the population showed at least one phenotypic risk factor (fair skin, 34.3%; freckling, 17.4%; green or blue eyes, 16.8%; red or blonde hair, 7.8%), although brown skin (65.7%), dark eyes (83.2%), and dark hair (92.2%) prevailed. Forty-three per cent of the individuals showed at least one of the MC1R variants studied. Allelic frequencies for V60L, D84E, R150C, R160W, R163Q, and T314T were 9.1%, 1.7%, 3.0%, 0.8%, 3.0%, and 8.2%, respectively. CONCLUSION: A significant proportion of the population showed risk factors for skin cancer. The inhabitants of the Canary Islands are phenotypically and genotypically close to Mediterranean populations.

[Coronary risk in the population of the Canary Islands, Spain, using the Framingham function]. / Estimación del riesgo coronario en la población de Canarias aplicando la ecuación de Framingham.

BACKGROUND AND OBJECTIVE: Although ischemic cardiopathy mortality in the Canary Islands is among the highest in Spain, the specific coronary risk for its population has not been estimated. This study presents the first cardiovascular risk charts for the Canarian adult population and compares them with those previously published on Gerona, Spain. SUBJECTS AND METHOD: A cross-sectional study of 4915 subjects, aged 25-74, that had been enrolled in the cohort study CDC of the Canary Islands. The standardized prevalence of obesity, overweight, smoking, hypertension and diabetes were estimated with the information obtained from personnel interviews, physical exams and blood samples. Those prevalences were used to calibrate the Framingham coronary function and to elaborate coronary risk charts. RESULTS: The crude prevalence of obesity was 30% (95% confidence interval [CI], 28.7-31.3), overweight 39% (95% CI, 37.6-40.4), smoking 26% (95% CI, 24.8-27.2), hypertension 40% (95% CI, 38.6-41.4) and diabetes 12% (95% CI, 11.1-12.9). In most of the factors, these prevalences were higher than Gerona's population in every age group and gender. On average, the estimated coronary risk of the islanders was 89% higher than Gerona's risk (94% higher in males and 87% in females), which is concordant with the distance between both populations in the national mortality statistics. CONCLUSIONS: The high prevalence of obesity and other factors in the Canarian population implies important coronary risks and it explains the position of the Canary Islands in the Spanish statistics of ischemic cardiopathy mortality. The use of these calibrated risk charts would be helpful to intensify the prevention of cardiovascular diseases.