Sacubitril-valsartan in heart failure and multimorbidity patients.

AIMS: The poor control of symptoms in patients with advanced heart failure with reduced ejection function (HFrEF) can limit the functionality of patients. Sacubitril-valsartan, compared with enalapril, has been shown to reduce mortality and hospitalization, and nowadays, there is still little evidence about the improvement on functionality. The aim of our study is to analyse the improvement of the functional class and the 6 min walking test (6MWT) in patients with multiple pathologies and advanced heart failure. METHODS AND RESULTS: From September 2016 to March 2018, 65 multimorbidity patients with severe symptomatic HFrEF were initiated to receive sacubitril-valsartan. Mean age was 78.6 ± 7.4 years, and 68% were male. The Charlson co-morbidity index was 8 points. Seventy-four per cent had New York Heart Association (NYHA) Functional Class IV. After the treatment, patients were able to achieve 55.68 m or more on 6MWT, and 91% presented an improvement in the NYHA functional class. CONCLUSIONS: Sacubitril-valsartan relieves symptoms and improves functional class prognostic risk of patients with advanced HFrEF and co-morbidity.

Factors associated to institutionalization and mortality over three years, in elderly people with a hip fracture-An observational study.

OBJECTIVE: To identify the factors associated to institutionalization and mortality in elderly patients with hip fractures (HF). DESIGN: Thirty-six months observational study. SETTING: A post-acute rehabilitation ward. PARTICIPANTS: subjects living in the community or in nursing-home, above the age of 65, with HF. MEASUREMENTS: The following were registered: comorbidity, intra-hospital complications, Barthel index, walking ability and Mini Mental State Examination, as well as blood samples upon admission and discharge. Destination upon discharge was recorded as well as mortality during hospital stay and over the three-year follow up. RESULTS: a total of 430 subjects were included in the study. Twenty-three patients (5.3%) died during their stay in hospital and 152 (35.3%) during follow up after discharge. Forty-five patients (10.5%) were institutionalized upon discharge. In adjusted analysis, the factors that predict intra-hospital mortality are higher comorbidity (OR, 1.46; 95%CI, 1.06-2.01), and the number of complications (OR, 1.71; 95%CI, 1.16-2.64). Factors that predict mortality in the long term are age (HR 1.04; 95%CI, 1.01-1.06), comorbidity (HR 1.19, 95% CI, 1.09-1.30), the number of complications (HR 1.17, 95%CI, 1.05-1.31). The factors that predicted new institutionalization were age (OR 1.04, 95%CI, 0.98-1.09), living alone (OR 3.95, 95%CI, 1.38-11.3), and length of hospital stay (OR 1.02 95%CI, 1.00-1.03). CONCLUSIONS: Mortality 3 years after a hip fracture and institutionalization are associated to age, the loss of autonomy in walking, a worse cognitive status and living alone before the fracture. Identification of and, when possible, intervention upon these factors can improve care of elderly people with hip fractures.

Enfermedad tromboembólica venosa en pacientes con Enfermedades Autoinmunes en el Hospital Reina Sofía de Tudela / Venous thromboembolism in patients with autoimmune disorders a small Hospital

Introducción: Los pacientes con Enfermedades Autoinmunes Sistémicas (EAS) tienen alto riesgo de desarrollar Enfermedad Tromboembólica Venosa (ETV). El comportamiento clínico una vez empiezan con el tratamiento anticoagulante acaba de ser descrito por el grupo RIETE durante este año. Material y métodos: Creamos una base de datos en el Hospital Reina Sofía para comparar las tasas de recurrencias, sangrado mayor y muerte durante el tratamiento anticoagulante de acuerdo a la presencia o ausencia de EAS. Resultados: No se detectan diferencias significativas en las características basales de los pacientes salvo en la presencia de ETV idiopática y de anticuerpos antifosfolípidos. Los enfermos con EAS presentan mayores tasas de recurrencia estando bajo tratamiento anticoagulante y similares tasas de hemorragia y mortalidad. Conclusiones: En un escenario local y más homogéneo de partida que el observado en el RIETE, los enfermos con EAS presentan mayor tendencia a recurrir estando en tratamiento anticoagulante que los enfermos sin esta condición. (AU)

Background: Patients with Autoimmune Disorders (AD) are at increased risk for venous thromboembolism (VTE). The natural history of VTE in these patients has been consistently evaluated by RIETE investigators this year. Methods: We used a newly created database in Reina Sofía´s Hospital to compare the rates of VTE recurrences, major bleeding and death during the course of anticoagulation according to the presence or absence of autoimmune disorders. Results: No significant differences were detected in the baseline characteristics of patients except for the presence of idiopathic VTE and antiphospholipid antibodies. Patients with AD presented higher rates of recurrence while being under anticoagulant treatment and similar rates of bleeding and mortality. Conclusions: In a more local and homogeneous starting scenario than what was observed in the RIETE, patients with AD have a greater tendency to recur while being on anticoagulant treatment than patients without this condition. (AU)

[Pneumonia in the elderly. Factors related with the mortality during the episode and after the discharge]. / Neumonía en el anciano. Factores relacionados con la mortalidad durante el episodio y tras el alta hospitalaria.

BACKGROUND AND OBJECTIVE: Pneumonia in the elderly (PIE) is a growing disease that causes great morbidity and mortality with frequent admissions to hospital and increasing health costs. The objective of our study was yo analyze the characteristics of PIE in an internal medicine hospital ward, the influence of quality of life (Katz index and scale of Karnofsky) on its evolution and after the discharge and the factors of poor prognosis during the episode of PIE and throughout the ambulatory follow-up. PATIENTS AND METHOD: All the patients suffering from PIE admitted to the internal medicine ward of our hospital during a two years period were included in the study (125). Five of them were referred from geriatric centers. Mean age was 77.9 years (range = 65-95). The most frequent chronic disease was COPD (53.6%) and 10.4% were taking oral corticosteroids. We studied the association of several factors laboratory, clinical and radiological with the evolution of PIE and after discharge. RESULTS: Patients rated high on the indicators of quality of life used (78.4% scored 5 or greater on the Katz index and 76% scored 80 or greater on the scale of Karnofsky) and their comorbidity was low (44% lesser than or equal to 1 and 6.4% greater than or equal to 5). Fever above 38 C was recorded in 40% of cases. Mean APACHE score was 12.8. 21.6% patients had pleural effusion and 20% had multilobar involvement. Overall mortality was 8.8% (11 patients). Fifteen patients suffered major complications during admission. One hundred patients out of the 114 who survived the episode of PIE were followed up on an ambulatory basis. Thirty of those died within 12 months after discharge. CONCLUSIONS: In our study, a poorer quality of life and a higher APACHE score were related to a greater mortality during the episode of PIE. After hospital discharge, a greater mortality was associated with a poor quality of life, comorbidity and low concentrations of albumin.

[Seroprevalence of Lyme disease in Navarra, Spain]. / Seroprevalencia de la enfermedad de Lyme en Navarra.

BACKGROUND AND OBJECTIVE: To establish the seroprevalence of infection by Borrelia burgdorferi in Navarre (Spain). PATIENTS AND METHOD: Serum samples of 1,429 individuals considered representative of the population of Navarre were analyzed. The individuals were recruited from a list issued by the government of Navarre. The subjects were stratified according to three variables: age, sex and the health zone to which they belonged. In all cases a written informed consent was obtained. RESULTS: The global seroprevalence in Navarre was 4.4%. Being a stockbreeder (13.2%) in contact with cows and sheep was found to be a risk factor after the analysis of different variables such as sex, age, contact with cattle, profession, living in rural areas, a prior history of having been bitten by a tick or the size of the city. CONCLUSIONS: Navarre provides suitable conditions for the prevalence and development of Lyme disease, with a global seroprevalence or 4.4%. No differences were found between the different areas analyzed, while being a stockbreeder represents a risk factor.

[Control of cardiovascular risk factors in patients with stroke attended in primary care in Spain. ICTUSCARE study]. / Control de los factores de riesgo cardiovascular en pacientes con ictus atendidos en Atención Primaria en España. Estudio ICTUSCARE.

BACKGROUND: The aim of this cross-sectional, multicenter survey was: 1) To investigate the level of control of cardiovascuar risk factors in patients with a previous stroke. 2) To know the pharmacological therapy used to attain the control. PATIENTS AND METHODS: Data obtained from a total of 955 patients were included in the analysis.. There were evaluated cardiovascular risk factors, parameters related to the degree of control, analytical parameters, antropometric and pharmacological indicated treatment. RESULTS: The majority (61%) had suffered an ischemic stroke and 97.7% presented at least one associated cardiovascular risk factor, being hypertension (84.8%) and dyslipidemia (61.8%) the most frequent. Other factors were abdominal obesity (42.9%), diabetes mellitus (35.6%) and smoking (25.1%). Only 1.2% of the patients presented an adequate control of all cardiovascular risk factors. Only 17.6% had a well controlled blood pressure and in 29.8% LDL-cholesterol was well controlled. In 50.2% of diabetic patients HbA1c was well controlled. Angiotensin receptor blockers were the most widely used antihypertensive drugs (57.6%) while thiazide diuretics were prescribed in 33.4%. Statins were prescribed in 72.8% of patients and metformin, aspirin and acenocumarol in 30.2%, 57.3%, and 15.0% respectively. CONCLUSIONS: In conclusion, in patients with a past history of stroke arterial hypertension is the most common cardiovascular risk factor and the control of these factors requires an improvement.

Seroprevalencia de la enfermedad de Lyme en Navarra / No disponble

Fundamento y objetivo: Establecer la seroprevalencia de infección por Borrelia burgdorferi en Navarra (España). Pacientes y método: Se han analizado 1.429 sueros de un listado representativo de la población, aportado por el gobierno de Navarra, estratificado por tres variables: edad, sexo y área de salud, previo consentimiento informado.Resultados: La seroprevalencia global en Navarra de infección por Borrelia burgdorferi es de un 4,4%, habiendo encontrado como factor de riesgo la profesión de ganadero (13,2%) entre las variables analizadas (sexo, edad, contacto con animales, profesión, contacto con medio rural, recuerdo del antecedente de picadura de garrapata o tamaño de la población.) Conclusiones:En Navarra se dan las condiciones adecuadas para el mantenimiento y desarrollo de la enfermedad de Lyme, con una seroprevalencia global del 4,4%. No se han encontrado diferencias entre las diferentes zonas analizadas y sí, como factor de riesgo, la profesión de ganadero (AU)

No disponible

Control de los factores de riesgo cardiovascular en pacientes con ictus atendidos en Atención Primaria en España. Estudio ICTUSCARE / Control of cardiovascular risk factors in patients with stroke attended in primary care in Spain. ICTUSCARE study

Fundamento: 1) Conocer el grado de control de los factores de riesgo cardiovascular en pacientes con ictus. 2) Analizar el tratamiento farmacológico indicado a los pacientes con ictus.Pacientes y método: Estudio epidemiológico, transversal y multicéntrico. Se incluyeron un total de 975 pacientes con ictus, de los cuales 20 pacientes se excluyeron por incumplir criterios de selección, siendo valorables un total de 955 pacientes. Se evaluaron los factores de riesgo cardiovascular, parámetros relacionados con el grado de control, parámetros analíticos, antropométricos y tratamiento farmacológico indicado.Resultados: Los pacientes incluidos en el estudio habían padecido mayoritariamente un ictus isquémico (61%). El 97,7% de los pacientes presentaron algún factor de riesgo cardiovascular (FRCV) siendo los más frecuentes la hipertensión arterial (84,8%) y dislipemia (61,8%), seguido de obesidad abdominal (42,9%), diabetes mellitus (35,6%) y tabaquismo (25,1%). Sólo el 1,2% de los pacientes presentaban control multifactorial. El 17,6% presentaban control de la presión arterial, el 29,8% del colesterol LDL, el 74,9% no presentaba hábito tabáquico y el 50,2% de los pacientes diabéticos presentaba control de la Hb1Ac. Los tratamientos antihipertensivos más frecuentes fueron los ARA II (57,6%) y los diuréticos tiazídicos (33,4%), de los hipolipemiantes las estatinas (72,8%), de los antidiabéticos la metformina (30,2%), de los antiagregantes el AAS (57,3%) y de los anticoagulantes el acenocumarol (15,0%). El 85,9% de los pacientes estaban antiagregados.Conclusiones: Los pacientes que han sufrido un ictus presentan como FRCV más prevalente la hipertensión arterial. El control de los FRCV en los pacientes que han presentado un ictus es deficiente (AU)

Background: The aim of this cross-sectional, multicenter survey was: 1) To investigate the level of control of cardiovascuar risk factors in patients with a previous stroke. 2) To know the pharmacological therapy used to attain the control. Patients and methods: Data obtained from a total of 955 patients were included in the analysis.. There were evaluated cardiovascular risk factors, parameters related to the degree of control, analytical parameters, antropometric and pharmacological indicated treatment. Results: The majority (61%) had suffered an ischemic stroke and 97.7% presented at least one associated cardiovascular risk factor, being hypertension (84.8%) and dyslipidemia (61.8%) the most frequent. Other factors were abdominal obesity (42.9%), diabetes mellitus (35.6%) and smoking (25.1%). Only 1.2% of the patients presented an adequate control of all cardiovascular risk factors. Only 17.6% had a well controlled blood pressure and in 29.8% LDL-cholesterol was well controlled. In 50.2% of diabetic patients HbA1c was well controlled. Angiotensin receptor blockers were the most widely used antihypertensive drugs (57.6%) while thiazide diuretics were prescribed in 33.4%. Statins were prescribed in 72.8% of patients and metformin, aspirin and acenocumarol in 30.2%, 57.3%, and 15.0% respectively.Conclusions: In conclusion, in patients with a past history of stroke arterial hypertension is the most common cardiovascular risk factor and the control of these factors requires an improvement (AU)

Situación inmune en el anciano con neumonía durante el episodio agudo y tras el alta / Immune status in the elderly with pneumonia during the acute episode and after discharge

Objetivo: analizar la situación inmunológica básica de la neumonía en el anciano (NEA) durante el ingreso y a los 6 meses tras el alta, y su relación con la mortalidad. Material y métodos: estudio prospectivo en pacientes mayores de 65 años con NEA que ingresaron en el Servicio de Medicina Interna en el Hospital Virgen del Camino (Pamplona) en 2 años. Se estudian los datos epidemiológicos, clínicos, etiológicos, analíticos y antropométricos en el ingreso, y la evolución de la NEA al año del alta. Se determinan linfocitos totales, linfocitos T CD4, CD8, CD4/CD8, inmunoglobulinas, complemento (C3, C4, CH50), anticuerpos antinucleares (ANA), factor reumatoide e interleucina 6 (IL-6) en sangre periférica, así como multitest durante el ingreso. A los 6 meses del alta se estudian: linfocitos totales, linfocitos T, CD4, CD8, CD4/CD8 e IL-6. Para realizar las comparaciones entre los diversos parámetros, se aplica un nivel de significación de p < 0,05. Resultados: en el período estudiado se admitió a 125 pacientes con una edad media de 77,9 años (65-95). Fallecieron 11 pacientes (8,8%) durante el ingreso. En el seguimiento ambulatorio durante un año falleció un 30%. Los pacientes que fallecieron tuvieron menos linfocitos totales (p = 0,01), linfocitos T (p = 0,005), CD4 (p = 0,002), C3 (p = 0,001) y C4 (p = 0,001) que los que sobrevivieron. Los ANA estaban presentes en mayor proporción entre los fallecidos (p = 0,017). No se encontraron relaciones evidentes entre los parámetros inmunológicos estudiados y la mortalidad ambulatoria. Los linfocitos totales, linfocitos T, CD4 y los CD8 se recuperan significativamente a los 6 meses tras el alta. En cambio, los valores de IL-6 disminuyen a los 6 meses respecto al ingreso (p = 0,009). Conclusiones: las variables relacionadas con mayor mortalidad durante la NEA fueron: linfocitos totales, linfocitos T, CD4, CD8, C3, C4 y ANA. Se describe un aumento significativo de los valores de inmunidad celular a los 6 meses del alta

Objective: to analyze immune status in elderly patients with pneumonia during admission and at 6 months after discharge, as well as its association with mortality. Material and methods: we performed a prospective study in patients aged > 65 years old with pneumonia admitted to the Internal Medicine Department of the Hospital Virgen del Camino (Pamplona) over a 2-year period. Epidemiological, etiological, laboratory and anthropometric data were studied at admission and 1 year after discharge. Total lymphocytes, T lymphocytes, CD4, CD8, CD4/CD8, immunoglobulins, complement (C3, C4, CH50), antinuclear antibodies (ANA), rheumatoid factor and interleukin-6 (IL-6) in peripheral blood, as well as the multitest during admission, were studied. The following variables were studied 6 months after discharge: total lymphocytes, T lymphocytes, CD4, CD8, CD4/CD8, and IL-6. For the comparison of variables, a significance level of p < 0.05 was set. Results: during the study period, 125 patients with a mean age of 77.9 years (65-95) were admitted. Eleven patients (8.8%) died during admission. During the 1-year outpatient follow-up, 30% died. Patients who died had lower total lymphocyte (p = 0.01), T lymphocyte (p = 0.005), CD4 (p = 0.002), C3 (p = 0.001) and C4 (p = 0.001) levels than those who survived. Higher ANA concentrations were found among patients who died (p = 0.017). No clear associations were found between the immunological parameters studied and outpatient mortality. Levels of total lymphocytes, T lymphocytes, CD4 and CD8 were significantly increased at 6 months after discharge. In contrast, IL-6 levels were lower at 6 months after discharge than on admission (p = 0.009). Conclusions: the variables related to higher mortality in pneumonia in the elderly were total lymphocytes, T-lymphocytes, CD4, CD8, C3, C4 and ANA. Values of cellular immunity were significantly increased 6 months after discharge

Síndrome general tras un viaje a la India / Illness after a trip to India

No disponible