Peri-operative Hemi-diaphragmatic Variations After Brachial Plexus Block Above the Clavicle: A Prospective Observational Study of the Contralateral Side.

OBJECTIVE: Hemi-diaphragm palsy after brachial plexus block above the clavicle (BPBAC) occurs frequently, but few patients develop post-operative pulmonary complications (PPC). We hypothesized that contralateral hemidiaphragm function increases after BPBAC. This contralateral function preserves global diaphragmatic function, avoiding PPC in the case of ipsilateral hemi-diaphragm palsy. METHODS: This prospective observational cohort study included 64 adult patients undergoing shoulder surgery with planned BPBAC (interscalene brachial plexus block and supraclavicular block). The Thickening Fraction (TF) was measured by ultrasound in both hemi-diaphragms, ipsilateral (TF ipsilateral) and contralateral (TFcontralateral) to the BPBAC, before and after the surgery. TFglobal is the sum of TFipsilateral and TFcontralateral. PPC were defined as occurrences of dyspnea, tachypnea, SpO2 <90% or SpO2/FiO2 <315. RESULTS: TFcontralateral increased significantly (an average of 40%) after BPBAC (p = 0.001), and TFipsilateral decreased (an average of 72%). After BPBAC, 86% of patients had a decreased TFipsilateral and 59% of patients an increased TFcontralateral at post-operatively. Only 17% of patients have PPC. CONCLUSION: After BPBAC, global diaphragm function decreases because of ipsilateral hemi-diaphragm reduction, but less than expected because of increased contralateral hemi-diaphragm function. As a part of diaphragm function, contralateral hemi-diaphragm function must be checked.

Hipotiroidismo primario, insulinorresistencia y la aterosclerosis carotídea subclínica / Primary hypothyroidism, insulin resistance, and subclinical carotid atherosclerosis

Introducción: El hipotiroidismo es considerado un factor de riesgo de enfermedad cardiovascular por su relación con la dislipidemia, la hipertensión arterial y la cardiopatía isquémica. En Cuba, después de la diabetes, ocupa el segundo lugar en la prevalencia de las enfermedades endocrinas. Objetivo: Identificar si existe relación entre la presencia de hipotiroidismo primario e insulinorresistencia y la aterosclerosis carotídea subclínica. Métodos: Se realizó un estudio analítico, multicéntrico, de corte transversal, en 150 pacientes divididos en dos grupos de comparación: 1) hipotiroidismo primario (n=75) y 2) insulinorresistencia sin hipotiroidismo (n=75) a los cuales se les realizaron procederes de laboratorio y ecográficos. Los pacientes fueron atendidos en las consultas de endocrinología de Hospital Clínico Quirúrgico 10 de Octubre, Hospital Miguel Enríquez y del Instituto Nacional de Endocrinología. Resultados: En el grupo con hipotiroidismo, los valores medios de índice de masa corporal, colesterol total, hormona estimulante de la tiroides y grosor íntima-media carotideo fueron significativamente mayores respecto a los insulinorresistentes. El HOMA-IR fue significativamente mayor en el grupo con insulinorresistencia. El valor de TSH 8805; 4,20 µmol/L mostró sensibilidad de 95,5 por ciento y especificidad de 73,3 por ciento en la predicción de aumento del GIMC. El HOMA-IR 8805;3,10 tuvo sensibilidad de 95,5 por ciento y especificidad de 73,1 por ciento. Conclusiones: El hipotiroidismo y la insulinorresistencia son predictores independientes de aterosclerosis carotídea subclínica(AU)

Introduction: Hypothyroidism is considered a risk factor for cardiovascular disease due to its relationship with dyslipidemia, high blood pressure and ischemic heart disease. In Cuba, after diabetes, it ranks second in the prevalence of endocrine diseases. Objective: To identify if there is a relationship between the presence of primary hypothyroidism and insulin resistance and subclinical carotid atherosclerosis. Methods: An analytical, multicenter, cross-sectional study was carried out in 150 patients separated into two comparison groups: 1) primary hypothyroidism (n = 75) and 2) insulin resistance with no hypothyroidism (n = 75). They underwent laboratory and ultrasound procedures. The patients were treated at the endocrinology consultations from 10 de Octubre Clinical Surgical Hospital, Miguel Enríquez Hospital and the National Institute of Endocrinology. Results: The hypothyroidism group showed mean values of body mass index, total cholesterol, thyroid-stimulating hormone and carotid intima-media thickness significantly higher compared to insulin-resistant drugs. HOMA-IR was significantly higher in the insulin resistance group. TSH value #8805; 4.20 µmol / L showed 95.5 and 73.3 percent specificity in predicting GIMC increase. HOMA-IR #8805; 3.10 had 95.5 percent sensitivity and 73.1 percent specificity. Conclusions: Hypothyroidism and insulin resistance are independent predictors of subclinical carotid atherosclerosis(AU)

Trends from 1995 to 2006 in the prevalence of self-reported cardiovascular risk factors among elderly Spanish diabetics.

AIM: In this study, we examined the trends from 1995 to 2006 in cardiovascular risk factors (CVRF) in Spaniards aged 65 years or older with diabetes. METHODS: We looked at the individual data from adults aged > or =65 years from the Spanish National Health Surveys of 1995 (n=1117), 1997 (n=1111), 2001 (n=4328), 2003 (n=6134) and 2006 (n=7835). Those classified as having diabetes had answered the two following questions in the affirmative: Has your doctor told you that you currently have diabetes? Have you taken any medication to treat diabetes in the last two weeks? The CVRF of interest included high blood pressure (HBP), high cholesterol levels, obesity (BMI > or =30 kg/m(2)), smoking and sedentarity, which were estimated and compared for prevalence by survey year, age group and gender. Progression over time was analyzed using logistic-regression models. RESULTS: During the study period, the prevalences of all of the CVRF of interest were significantly higher among the elderly with diabetes compared with those without diabetes, except for current smoking, which was less frequent. The percentages of diabetic patients with HBP and obesity increased from 49.6 and 17.1%, respectively, in 1995 to 64 and 30.6%, respectively, in 2006 (adjusted ORs: 1.95 for HBP; 2.22 for obesity). CONCLUSION: Overall, the self-reported prevalence of CVRF among elderly patients with diabetes did not improve during 1995-2006 but, instead, showed significant increases in self-reported obesity and HBP. This lack of improvement calls for further investigations, and the dedicated attention of both healthcare providers and the diabetic patients themselves.