[Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)]. / Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015).

The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics.

Impact of SGLT2 Inhibitors on Very Elderly Population with Heart Failure with Reduce Ejection Fraction: Real Life Data.

(1) Background: The validation of new lines of therapy for the elderly is required due to the progressive ageing of the world population and scarce evidence in elderly patients with HF with reduced ejection fraction (HFrEF). The purpose of our study is to analyze the effect of SGLT2 inhibitors (SGLT2i) in this subgroup of patients. (2) Methods: A single-center, real-world observational study was performed. We consecutively enrolled all patients aged ≥ 75 years diagnosed with HFrEF and for treatment with SGLT2i, and considered the theoretical indications. (3) Results: A total of 364 patients were recruited, with a mean age of 84.1 years. At inclusion, the mean LVEF was 29.8%. Median follow-up was 33 months, and there were 122 deaths. A total of 55 patients were under SGLT2i treatment. A multivariate Cox logistic regression test for all-cause mortality was performed, and only SGLT2i (HR 0.39 [0.19-0.82]) and glomerular filtration rate (HR 0.98 [0.98-0.99]) proved to be protective factors. In parallel, we conducted a propensity-score-matched analysis, where a significant reduction in all-cause mortality was associated with the use of SGLT2i treatment (HR 0.39, [0.16-0.97]). (4) Conclusions: Treatment with SGLT2i in elderly patients with HFrEF was associated with a lower rate of all-cause mortality. Our data show that SGLT2i therapy could improve prognosis in the elderly with HFrEF in a real-world study.

Diabetes mellitus and cardiovascular risk: an update of the recommendations of the Diabetes and Cardiovascular Disease Working Group of the Spanish Society of Diabetes (SED, 2021). / Diabetes mellitus y riesgo cardiovascular: actualización de las recomendaciones del Grupo de Trabajo de Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2021).

This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. The consensus has been developed by a multidisciplinary team made up of members of the Cardiovascular Risk Group of the Spanish Diabetes Society (SED). The work is a necessary update as, since the last review three years ago, there have been many clinical trials that have studied the cardiovascular outcomes of numerous drugs in the diabetic population. We believe that this guideline update may be of interest to all clinicians treating patients with diabetes.

Prognostic significance of telomerase reverse transcriptase promoter gen mutations in high grade meningiomas / Importancia pronóstica de las mutaciones del gen promotor de la transcriptasa inversa de la telomerasa en los meningiomas de alto grado

Introduction: Mutations in the promoter region of telomerase reverse transcriptase occur frequently in meningiomas. Objective: To estimate the prognostic importance of telomerase reverse transcriptase mutations in Colombian patients with grades II and III meningioma. Materials and methods: This was a multicenter retrospective cohort study of patients diagnosed with refractory or recurrent WHO grades II and III meningiomas, recruited between 2011 and 2018, and treated with systemic therapy (sunitinib, everolimus ± octreotide, and bevacizumab). Mutation status of the telomerase reverse transcriptase promoter was established by PCR. Results: Forty patients were included, of which telomerase reverse transcriptase mutations were found in 21 (52.5%), being C228T and C250T the most frequent variants with 87.5 % and 14.3 %, respectively. These were more frequent among patients with anaplastic meningiomas (p=0.18), with more than 2 recurrences (p=0.04); and in patients with parasagittal region and anterior fossa lesions (p=0.05). Subjects characterized as having punctual mutations were more frequently administered with everolimus, sunitinib and bevacizumab drug series (p=0.06). Overall survival was 23.7 months (CI95% 13.1-34.2) and 43.4 months (CI95% 37.5-49.3; p=0.0001) between subjects with and without mutations, respectively. Multivariate analysis showed that the number of recurrences and the presence of telomerase reverse transcriptase mutations were tthe only variables that negatively affected overall survival. Conclusions: Mutations in telomerase reverse transcriptase allows the identification of high-risk patients and could be useful in the selection of the best medical treatment.

Introducción. En los meningiomas, ocurren con frecuencia mutaciones en la región promotora de la transcriptasa inversa de la telomerasa. Objetivo. Estimar la importancia pronóstica de las mutaciones de la transcriptasa inversa de la telomerasa en pacientes colombianos con meningiomas de grados II y III. Materiales y métodos. Es un estudio de cohorte, retrospectivo y multicéntrico, que incluyó pacientes con diagnóstico de meningioma persistente o recidivante, de grados II y III, según la clasificación de la OMS, reclutados entre el 2011 y el 2018, con tratamiento sistémico (sunitinib, everolimus con octreótido o sin él, y bevacizumab). El estado de la mutación del promotor de la transcriptasa inversa de la telomerasa se determinó por medio de la PCR. Resultados. Se incluyeron 40 pacientes, en 21 (52,5 %) de los cuales se encontraron mutaciones en la transcriptasa inversa de la telomerasa, siendo las variantes más frecuentes la C228T (87,5 %) y la C250T (14,3 %). Estas fueron más frecuentes entre los pacientes con meningiomas anaplásicos (p=0,18), en aquellos con más de dos recurrencias (p=0,04), y en los que presentaron lesiones en la región parasagital y la fosa anterior (p=0,05). Los sujetos caracterizados por tener alteraciones puntuales fueron tratados con mayor frecuencia con la serie de medicamentos everolimus, sunitinib y bevacizumab (p=0,06). Tras el inicio del tratamiento médico, la supervivencia global fue de 23,7 meses (IC95% 13,1-34,2) en los pacientes con mutaciones y, de 43,4 meses (IC95% 37,5-49,3), entre aquellos sin mutaciones (p=0,0001). Los resultados del análisis multivariado demostraron que, únicamente, el número de recurrencias y la presencia de mutaciones en el gen de la transcriptasa inversa de la telomerasa, fueron factores que afectaron negativamente la supervivencia global. Conclusiones. Las mutaciones en el gen promotor de la transcriptasa inversa de la telomerasa permiten identificar los pacientes con alto riesgo, cuya detección podría ser de utilidad para seleccionar el mejor esquema terapéutico.

Nutrients and Dietary Approaches in Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease: A Narrative Review.

Cardiovascular disease (CVD) is the most common cause of morbidity and mortality in developed countries. The prevalence of CVD is much higher in patients with type 2 diabetes mellitus (T2DM), who may benefit from lifestyle changes, which include adapted diets. In this review, we provide the role of different groups of nutrients in patients with T2DM and CVD, as well as dietary approaches that have been associated with better and worse outcomes in those patients. Many different diets and supplements have proved to be beneficial in T2DM and CVD, but further studies, guidelines, and dietary recommendations are particularly required for patients with both diseases.

Development and validation of the Spanish abbreviated version of the Transsexual Voice Questionnaire for Male-to-Female Transsexuals. / Desarrollo y validación de la versión abreviada del Transsexual Voice Questionnaire for Male-to-Female Transsexuals en español.

OBJECTIVE: The aim of this study was to create and validate an abbreviated version of the Spanish Transsexual Voice Questionnaire for Male-to-Female Transsexuals (SvTVQMtF). SETTING: The study was conducted by two referral hospitals for voice feminization surgery and by a university department of psychology and speech therapy, all in Spain. SUBJECTS AND METHODS: We prospectively studied 51 male-to-female transsexuals who underwent voice feminization surgery between January 2017 and December 2018. The SvTVQMtF was completed before and after surgery, and the 10 items with the greatest variation were selected by clinical consensus of an expert panel to develop the short version of the SvTVQMtF (SvTVQMtF-10). The correlation between the total score and the score for each item on the SvTVQMtF and the SvTVQMtF-10 was studied. The internal consistency of the SvTVQMtF-10 was analysed. RESULTS: Good correlation (Pearson coefficient above .90) was found between the two questionnaires. A significant correlation was found between the total SvTVQMtF-10 score and the score for each item. A significant negative correlation was found between the SvTVQMtF and fundamental frequency after voice feminization surgery. Cronbach's α was .79. CONCLUSION: The SvTVQMtF-10 is a valid short version of the SvTVQMtF and can be used to quantify voice-related quality of life in MtF transsexuals.

Comparison of cricothyroid approximation and glottoplasty for surgical voice feminization in male-to-female transsexuals.

OBJECTIVE: To compare voice feminization and quality of life (QoL) of Male-to-Female Transsexuals (MtF Ts) after cricothyroid approximation (CTA) or glottoplasty (GL). STUDY DESIGN: Retrospective study. METHODS: Fifty-three MtF Ts were studied between 2007 and 2016. Voice assessment was based on fundamental frequency (F0 ), perceptual rating on GBRAS Hirano scale (Grade, Breathiness, Roughness, Asthenia, Strain), QoL related to voice on the Voice Handicap Index-10 Spanish validated version (VHI-10 Sv) and self-perceived femininity of the voice (SpFv), and overall satisfaction with the surgical technique (Sst) on a visual analogue scale (VAS). Demographic data and complications related to surgery were also recorded. RESULTS: Twenty-eight MtF Ts underwent CTA and 23 GL. The mean age was 35 years. The median follow-up period was 40 months. Mean F0 improved after surgery for both groups, but this increase was 27 Hz higher after GL than after CTA (P < 0.05). After CTA, F0 decreased over time but remained stable after GL. The GBRAS score did not change after CTA; the roughness item and total score increased from 0 to 1 after GL (P < 0.05). VHI-10 Sv scores decreased similarly in both groups. SpFv increase was higher after GL. The Sst was mild and similar in both groups. One case of severe dysphonia (4%) resulting from a big and fibrous sinequia occurred after GL. CONCLUSION: Both CTA and GL increase F0 , improving QoL in MtF Ts. However, F0 increase is higher and more long-lasting after GL. More risk of postoperative roughness is described after GL. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:2101-2109, 2018.

Translation, Cultural Adaptation, and Preliminary Evaluation of the Spanish Version of the Transgender Voice Questionnaire for Male-to-Female Transsexuals (TVQ MtF).

OBJECTIVE: This study aimed to perform translation, cross-cultural adaptation, and validation of the Spanish version of the Transsexual Voice Questionnaire for Male-to-Female Transsexuals (TVQ MtF). STUDY DESIGN: This is a prospective study. SETTING: The study was conducted by the Gender Identity Unit and the Voice Unit of a tertiary hospital referral center for surgical feminization of the voice. SUBJECTS AND METHODS: The study had two parts: translation and adaptation of the TVQ MtF with the following actions: translation (with authorization and consensus of the authors of the original questionnaire), back-translation, pretesting, and final version; and preliminary study of the psychometric properties (feasibility, internal consistency, test-retest reliability, construct validity, discriminant validity, and ceiling and floor effects). Thirty male-to-female transsexual women filled out the questionnaire, and 18 of the 30 filled out the questionnaire approximately 2 weeks after filling it out for the first time. RESULTS: Feasibility was 100%. Cronbach α was 0.976. The intraclass correlation coefficient was 0.885. The Spearman correlation coefficient between TVQ MtF and the physical component of SF-12 v2 was 0.102 (P value = 0.592) and between TVQ MtF and the mental component was -0.263 (P value = 0.161). A ceiling effect was not found. A floor effect was found in two questionnaires (6.7%). CONCLUSION: Feasibility, internal consistency, and reliability outcomes in our study support the validity of the authorized Spanish version of the TVQ MtF.

Diabetes mellitus and cardiovascular risk: Update of the recommendations of the Diabetes and Cardiovascular Disease working group of the Spanish Diabetes Society (SED, 2018). / Diabetes mellitus y riesgo cardiovascular. Actualización de las recomendaciones del Grupo de Trabajo de Diabetes y Riesgo Cardiovascular de la Sociedad Española de Diabetes (SED, 2018).

This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors in diabetes mellitus. The consensus is made by members of the Cardiovascular Risk Group of the Spanish Diabetes Society. We have proposed and updated interventions on lifestyle, pharmacological treatment indicated to achieve therapeutic objectives according to the levels of HbA1c, degree of obesity, hypertension, hyperlipidemia, heart failure, platelet antiagregation, renal insufficiency, and diabetes in the elderly, as well as new biomarkers of interest in the evaluation of cardiovascular risk in individuals with diabetes mellitus. The work is an update of the interventions and therapeutic objectives in addition, it is noted the need for the inclusion of specialists in Endocrinology, Metabolism and Nutrition in Cardiac Rehabilitation Units for the control and monitoring of this population.

Importancia pronóstica de las mutaciones del gen promotor de la transcriptasa inversa de la telomerasa en los meningiomas de alto grado / Prognostic significance of telomerase reverse transcriptase promoter gen mutations in high grade meningiomas

Introducción. En los meningiomas, ocurren con frecuencia mutaciones en la región promotora de la transcriptasa inversa de la telomerasa. Objetivo. Estimar la importancia pronóstica de las mutaciones de la transcriptasa inversa de la telomerasa en pacientes colombianos con meningiomas de grados II y III. Materiales y métodos. Es un estudio de cohorte, retrospectivo y multicéntrico, que incluyó pacientes con diagnóstico de meningioma persistente o recidivante, de grados II y III, según la clasificación de la OMS, reclutados entre el 2011 y el 2018, con tratamiento sistémico (sunitinib, everolimus con octreótido o sin él, y bevacizumab). El estado de la mutación del promotor de la transcriptasa inversa de la telomerasa se determinó por medio de la PCR. Resultados. Se incluyeron 40 pacientes, en 21 (52,5 %) de los cuales se encontraron mutaciones en la transcriptasa inversa de la telomerasa, siendo las variantes más frecuentes la C228T (87,5 %) y la C250T (14,3 %). Estas fueron más frecuentes entre los pacientes con meningiomas anaplásicos (p=0,18), en aquellos con más de dos recurrencias (p=0,04), y en los que presentaron lesiones en la región parasagital y la fosa anterior (p=0,05). Los sujetos caracterizados por tener alteraciones puntuales fueron tratados con mayor frecuencia con la serie de medicamentos everolimus, sunitinib y bevacizumab (p=0,06). Tras el inicio del tratamiento médico, la supervivencia global fue de 23,7 meses (IC95% 13,1-34,2) en los pacientes con mutaciones y, de 43,4 meses (IC95% 37,5-49,3), entre aquellos sin mutaciones (p=0,0001). Los resultados del análisis multivariado demostraron que, únicamente, el número de recurrencias y la presencia de mutaciones en el gen de la transcriptasa inversa de la telomerasa, fueron factores que afectaron negativamente la supervivencia global. Conclusiones. Las mutaciones en el gen promotor de la transcriptasa inversa de la telomerasa permiten identificar los pacientes con alto riesgo, cuya detección podría ser de utilidad para seleccionar el mejor esquema terapéutico.

Introduction: Mutations in the promoter region of telomerase reverse transcriptase occur frequently in meningiomas. Objective: To estimate the prognostic importance of telomerase reverse transcriptase mutations in Colombian patients with grades II and III meningioma. Materials and methods: This was a multicenter retrospective cohort study of patients diagnosed with refractory or recurrent WHO grades II and III meningiomas, recruited between 2011 and 2018, and treated with systemic therapy (sunitinib, everolimus ± octreotide, and bevacizumab). Mutation status of the telomerase reverse transcriptase promoter was established by PCR. Results: Forty patients were included, of which telomerase reverse transcriptase mutations were found in 21 (52.5%), being C228T and C250T the most frequent variants with 87.5 % and 14.3 %, respectively. These were more frequent among patients with anaplastic meningiomas (p=0.18), with more than 2 recurrences (p=0.04); and in patients with parasagittal region and anterior fossa lesions (p=0.05). Subjects characterized as having punctual mutations were more frequently administered with everolimus, sunitinib and bevacizumab drug series (p=0.06). Overall survival was 23.7 months (CI95% 13.1-34.2) and 43.4 months (CI95% 37.5-49.3; p=0.0001) between subjects with and without mutations, respectively. Multivariate analysis showed that the number of recurrences and the presence of telomerase reverse transcriptase mutations were the only variables that negatively affected overall survival. Conclusions: Mutations in telomerase reverse transcriptase allows the identification of high-risk patients and could be useful in the selection of the best medical treatment.

[Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)]. / Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015).

The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics.

Ultrasound-guided injection of polidocanol microfoam in the management of venous leg ulcers.

BACKGROUND: Venous leg ulceration is a frequent and severe complication of lower limb venous insufficiency. Compression therapy is associated with a protracted course of healing and multiple recurrences. Minimally invasive surgery (subfascial endoscopic perforating surgery) is only possible in a subset of patients with leg ulcers. Low-cost and noninvasive therapeutic procedures are needed as alternative treatments. OBJECTIVE: To evaluate the efficacy and safety of sclerosant in microfoam in treating venous leg ulceration. DESIGN: A retrospective study of medical records, pretreatment and posttreatment color photographs, and echo Doppler in patients with venous leg ulceration. All patients were evaluated at 6 months after therapy, 70% were also evaluated at 2 years, 25% at 3 years, and 14% at 4 or more years after treatment. They were assessed for complete (100%) ulcer healing, time to wound closure, and recurrence. SETTING: Private vascular surgery clinic in Granada and dermatology department at a hospital in Pamplona, Spain. PATIENTS: Over 115 months, 116 consecutive patients (mean age [range], 57 [25-85] years) treated with ultrasound-guided injection of polidocanol microfoam (UIPM). INTERVENTIONS: To reduce venous hypertension, UIPM was used to selectively and progressively sclerose sources of incompetence. The number of sessions per patient varied between 1 and 17 (mean, 3.6). MAIN OUTCOME MEASURES: Complete ulcer healing, defined as full reepithelialization of the wound with absence of drainage. Recurrence was defined as epithelial breakdown in the healed limb. RESULTS: At 6-months' follow-up, treatment with UIPM achieved complete healing in 83% of patients (96/116), with median time to healing of 2.7 months; 7 patients were never cured, and 1 patient was lost to follow-up. There were recurrences in 10 patients. CONCLUSIONS: The use of UIPM to selectively and progressively sclerose incompetent veins produced by venous hypertension is highly effective to achieve a stable ulcer healing with minimal invasion, even in elderly patients. Recurrences are easily treatable with this approach. This technique may become a first-line treatment in the management of leg venous ulcers.

Nutritional Status and Obesity Prevalence in People with Gender Dysphoria.

Gender dysphoria is a condition that involves a failure to adapt and a body dissatisfaction that makes these individuals especially susceptible to eating disorders. The aim of this paper was to ascertain the nutritional status, dietary behaviour and lifestyle and their effect on overweight/obesity prevalence of the people with gender dysphoria. METHODS: A longitudinal study on 157 individuals from the Gender Disorder Unit at the Ramón y Cajal Hospital (Madrid) who are undergoing hormonal treatment has been carried out. Usual dietary intake, physical activity habits and socioeconomic parameters were evaluated. The anthropometric parameters determined were weight, height, body-mass index (BMI), waist and hip circumference and body fat content. RESULTS: The mean of the population eats a large number of servings of food, which leads to high levels of energy intake: 3,614.32 ± 1,314 kcal/day. These intakes are related to the physical activity performed. The average diet among this population is unbalanced, with a high consumption of fats, especially saturated fats and cholesterol. The breakfast is skipped by 16% of the population. Together with cross-hormone treatment, this dietary habitsand lifestylelead to an increase in body fat, especially in the female to male group whose overweight andobesity prevalence increase (22.72% vs 34.85%). CONCLUSION: This population suffers a change of their nutritional status due to a variation in their eating behaviour and lifestyle. This increase in the obesity prevalencemake it susceptible to chronic diseases and cardiovascular disorders. It is therefore necessary to include nutrition education courses in the comprehensive treatment programme (anatomical, psychological, etc.) for these individuals.

Correlación de la leucocitosis y lesión intracraneal en pacientes con traumatismo craneoencefálico / Correlation of leukocytosis and intracranial injury in patients with traumatic brain injury / Correlação de leucocitose e lesão intracraniana em pacientes com traumatismo crânioencefálico

Resumen: El daño microvascular difuso se asocia a pérdida de la autorregulación vascular cerebral y a pérdida de integridad de la barrera hematoencefálica. El TCE (traumatismo craneoencefálico) está asociado a un aumento en los niveles séricos de catecolaminas. Las catecolaminas son responsables de los depósitos de neutrófilos. Las catecolaminas aumentan la cuenta leucocitaria, introduciendo las células marginadas al pool circulante. La respuesta de fase aguda también se caracteriza por leucocitosis al ingreso, por lo que es probable que la cuenta de células blancas sirva como indicador adicional al diagnóstico y pronóstico del trauma de cráneo. Material y métodos: Estudio de cohorte prospectivo longitudinal. Se incluyeron pacientes atendidos con TCE, se recopilaron estudios de imagen y de laboratorio. Resultados: De los pacientes atendidos con hemorragia subaracnoidea (HSA), se encontró a su ingreso una media de leucocitos de 17,718 10^3/µl y de 13,970 10^3/µl a las 24 horas del trauma, con una p = 0.000 y 0.001, respectivamente. En pacientes con hematoma subdural (HSD) se observó a su ingreso una media de leucocitos de 18,212 10^3/μl y de 13,319 10^3/µl a las 24 horas, con una p = 0.000 y 0.003, respectivamente. En pacientes con contusión hemorrágica se detectó a su ingreso una media de leucocitos de 13,225 10^3/µl y de 12,501 10^3/µl a las 24 horas, una p = 0.091 y 0.027, respectivamente. En pacientes con hematoma epidural (HE) se observó a su ingreso una media de leucocitos de 16,527 10^3/µl y de 13,240 10^3/µl a las 24 horas, con una p = 0.000 y 0.019, respectivamente.

Abstract: Diffuse microvascular damage is associated with loss of cerebral vascular self-regulation and loss of integrity of the blood-brain barrier. Traumatic brain injury is associated with an increase in serum levels of catecholamines. Catecholamines are responsible for neutrophil deposits. Catecholamines increase the leukocyte count by introducing the marginal cells into the circulating pool. The acute phase response is also characterized by leukocytosis on admission. Therefore, the white cell count is likely to serve as an additional indicator to the diagnosis and prognosis of TBI. Material and methods: Longitudinal prospective cohort study. Patients treated in the emergency room with TBI were included, blood test and imaging studies were collected. Results: Of the patients treated with subarachnoid hemorrhage (SAH), a mean of leukocytes on entry of 17,718 10^3/µl on admission and 13,970 10^3/µl on 24 hours of trauma, with p = 0.000 and 0.001. In patients with subdural hematoma, a mean number of leukocytes was found at 18,212 10^3/µl and 13,319 10^3/µl at 24 hours, with p = 0.000 and 0.003. For patients with hemorrhagic contusion, leukocytes were found on admission on average 13,225 10^3/µl and at 12,501 10^3/µl at 24 hours, a p = 0.091 and 0.027. In patients with epidural hematoma, a mean of 16,527 10^3/µl leukocytes was found on admission, at 24 hours 13,240 10^3/µl, with p = 0.000 and 0.019.

Resumo: O dano microvascular difuso está associado à perda da autorregulação vascular cerebral e à perda da integridade da barreira hematoencefálica. O TCE está associado a um aumento nos níveis séricos de catecolaminas. As catecolaminas são responsáveis pelos depósitos de neutrófilos. As catecolaminas aumentam a contagem de leucócitos introduzindo as células marginais no pool circulante. A resposta de fase aguda também é caracterizada por leucocitose na admissão. Assim, a contagem de células brancas provavelmente servirá como um indicador adicional do diagnóstico e prognóstico do trauma craniano. Material e metodos: Estudo de coorte prospectivo longitudinal. Incluiram-se pacientes atendidos com TCE, foram coletados estudos de imagem e laboratório. Resultados: Dos pacientes atendidos com hemorragia subaracnoide (HSA), uma média de leucócitos de 17,718 10^3/µl na admissão e 13,970 10^3/µl em 24 horas após o trauma. Com P = 0.000 e 0.001, respectivamente. Em pacientes com hematoma subdural (HSD), encontramos uma média de leucócitos na admissão de 18,212 10^3/µl e 13,319 10^3/µl às 24 horas, com p = 0.000 e 0.003. Para os pacientes com contusão hemorrágica, encontramos na admissão uma média de leucócitos de13,225 10^3/µl e às 24 horas de 12,501 10^3/µl, com p = 0.091 e 0.027. Nos pacientes com hematoma epidural (HE) foi encontrada uma média de 16,527 10^3/µl leucócitos à admissão, às 24 horas 13,240 10^3/µl, com p = 0.000 e 0.019.

[Anthropometric measures of central abdominal fat and discriminant capacity for metabolic syndrome in a Spanish population]. / Índices antropométricos estimadores de la distribución adiposa abdominal y capacidad discriminante para el síndrome metabólico en población española.

INTRODUCTION: The metabolic syndrome (MS) carries an increased risk of cardiovascular disease and diabetes mellitus. Insulin resistance is probably the mechanism underlying the changes detected in lipid and carbohydrate metabolism in these patients, who have, as a common anthropometric feature, a predominantly increased abdominal fat distribution. PATIENTS AND METHODS: A total of 3316 patients were studied, of whom 63.40% were female and 36.60 male, with a mean age of 42.36±14.63 years, and a body mass index (BMI) of 32.76±6.81kg/m(2). Weight, height and waist circumference (CC) were measured using standard techniques. The waist/height (ICA) was calculated using two indicators, expressed as waist in cm divided by height in m(2), and as waist divided by height, both in cm. The prevalence of metabolic syndrome in the sample was 33.70%. In order to assess the predictive ability of BMI, ICA and CC to detect the existence of MS, receiver operating curves (ROC) were constructed and the areas under the curve (AUC) calculated for each anthropometric parameter. RESULTS: An AUC of 0.724 (95%CI: 0.706 to 0.742), P<.001, was obtained for CC, 0.709 (95%CI: 0.691 to 0.728), P<.001 for ICA with height in m(2), and 0.729 (95%CI: 0.711 to 0.747), P<.001 for ICA with height in cm, and for the BMI it was 0.680 (95%CI 0.661-0.699), P<.001. CONCLUSIONS: Anthropometric indices that assess abdominal fat distribution have a better predictive capacity for detecting MS, compared to total adiposity indicators such as BMI.