Value of NT-proBNP and Galectin-3 as Biomarkers in the Follow-Up of Asymptomatic Elderly Patients with Severe Aortic Stenosis.

Recognizing symptoms in elderly patients with severe aortic stenosis (AS) can be a challenge. Serum biomarkers such as Galectin-3 or N-terminal prohormone B-type natriuretic peptide (NT-proBNP) are involved in remodeling and heart failure (HF) development and could support the diagnosis of AS. We set out to test the usefulness of NT-proBNP and Galectin-3 in predicting events in this population. We designed a prospective observational case-control study, including 50 asymptomatic patients older than 70 years, diagnosed with severe degenerative AS, and 50 control individuals. The NT-proBNP and Galectin-3 levels were measured. A follow-up was carried out at 12 months to determine the occurrence of hospital admission for HF, all-cause mortality or the appearance of symptoms. The patients with severe AS had higher Galectin-3 and NT-proBNP concentrations. The area under the receiver operating characteristic curve of the NT-proBNP was 0.812 (95% CI, 0.646-0.832), and that of the Galectin-3 was 0.633 (95% CI, 0.711-0.913). NT-proBNP was a good predictor of events [HR 3.45 (95% CI 1.32-9.03), p = 0.011]. A Kaplan-Meier analysis showed that the probability of freedom from events was significant in patients who exhibited a combination of higher NT-proBNP and Galectin-3 levels (log-rank p = 0.032). Therefore, NT-proBNP was the most reliable predictor of events in asymptomatic patients with severe AS. A combination of NT-proBNP and Galectin-3 levels may be vital in the clinical follow-up of these patients and in the decision-making process.

Validación psicométrica del índice de Barthel en adultos mayores mexicanos / Psychometric validation of the Barthel index in Mexican older adults

Resumen: Objetivo: La población de adultos mayores en el mundo crece, estar al tanto de su salud ayuda a mejorar sus condiciones de vida, la independencia funcional a través de la capacidad de hacer actividades diarias básicas, es un buen indicador para conocer la salud y necesidad de atención médica. Una de las escalas más usadas para esto es el Índice de Barthel, por lo que el propósito de este trabajo fue validar esta escala psicométricamente, identificar si su estructura es la más adecuada a través de un análisis factorial confirmatorio. Materiales y métodos: Dos muestras adultos mayores de la CDMX participaron, 200 para estudiar las propiedades psicométricas y 276 para análisis factorial confirmatorio. Resultados: Se encontró una estructura con diez reactivos, adecuada confiabilidad en los coeficientes de consistencia interna pura Alpha Ordinal [Alpha=0.98, CI95% (0.96-0.98)] y Omega ordinal [Omega=0.99 CI95% (0.96-0.99)], y correcto ajuste [χ2(35) = 49.28, p=0.06, CFI=0.99, RMSEA=0.03 (IC95% 0,0.06)] Conclusiones: El índice de Barthel en autoreporte tiene propiedades psicométricas que lo hace una medida confiable y válida para el propósito de evaluar independencia funcional, en población geriátrica de la ciudad de México.

Abstract Objective: The population of older adults in the world grows and being aware of their health helps to improve their living conditions, functional independence through the ability to do basic daily activities is a good indicator to know the health and need of medical care. One of the most used scales for this is the Barthel Index, so the purpose of this work was to validate this scale psychometrically, to identify if its structure is the most appropriate through confirmatory factorial analysis. Materials and methods: Two older adult samples from CDMX participated, 200 to study psychometric properties and 276 for confirmatory factor analysis. Results: A structure with ten items, adequate reliability in the coefficients of pure internal consistency Alpha Ordinal [Alpha=0.98, CI95% (0.96- 0.98)] and Omega Ordinal [Omega=0.99 CI95% (0.96-0.99)], and correct fit [χ2(35) = 49.28, p=.06, CFI=0.99, RMSEA=0.03 (95% CI 0,.06)]. Conclusions: The Barthel index in self-report has psychometric properties that make it a reliable and valid measure for the purpose of evaluating functional independence in the geriatric population of Mexico City.

Cardiac complications in a geriatric population hospitalized with COVID-19: The OCTA-COVID cohort / Complicaciones cardiacas en una población geritrica hospitalizada por COVID-19: La cohorte OCTA-COVID

Purpose: The geriatric population is especially vulnerable to coronavirus disease (COVID-19) and its potential complications. We sought to analyze the incidence of cardiological complications in an elderly population hospitalized for COVID-19.Methods: A prospective observational longitudinal that included patients ≥75 years of age with diagnosis of COVID-19 admitted to the Geriatric Department from March to May 2020. Epidemiological, geriatric, clinical and laboratory test variables were collected. Cardiovascular events, including de novo atrial fibrillation (AF), acute coronary syndrome (ACS), congestive heart failure (CHF), pulmonary embolism and in-hospital death, were documented. A follow-up was carried out at 12 months through a telephone interview as well as using electronic medical records, collecting cardiac events and mortality.Results:305 patients were included; 190 (62.3%) were female, with median age of 87 years (interquartile range (82–91)). More than half of the patients had a history of cardiac disease, with AF being the most common and affecting 85 (27.9%) patients. During hospitalization, 112 (36.7%) patients died. Eighty-nine (29.2%) patients presented cardiac complications. Acute heart failure was the most prevalent (46; 15.1%), followed by new-onset AF (20; 6.5%), pulmonary embolism (17; 5.6%), and ACS (5; 1.6%). Patients with cardiac complications had a longer hospital stay (p<0.001). During follow-up, 29 (15.1%) died, and 40 (20.8%) patients had a cardiovascular event being CHF the most prevalent complication (16.7%). (AU)

Introducción: La población geriátrica es especialmente vulnerable a la enfermedad por coronavirus (COVID-19) y sus posibles complicaciones. Nos propusimos analizar la incidencia de complicaciones cardiológicas en una población anciana hospitalizada por COVID-19.Métodos: Estudio longitudinal observacional prospectivo que incluyó a pacientes≥75 años con diagnóstico de COVID-19 ingresados en el Servicio de Geriatría de marzo a mayo de 2020. Se recogieron variables epidemiológicas, geriátricas, clínicas y de laboratorio. Se documentaron eventos cardiovasculares, que incluyen fibrilación auricular (FA) de novo, síndrome coronario agudo, insuficiencia cardíaca congestiva, embolia pulmonar y muerte intrahospitalaria. Se realizó un seguimiento a los 12 meses, mediante entrevista telefónica y accediendo a la historia clínica electrónica, recogiendo eventos cardíacos y mortalidad.Resultados: Se incluyeron 305 pacientes; 190 (62,3%) eran mujeres, con una mediana de edad de 87 años (rango intercuartílico: 82-91). Más de la mitad de los pacientes tenían antecedentes de enfermedad cardíaca, siendo la FA la más frecuente y afectando a 85 (27,9%) pacientes. Durante la hospitalización fallecieron 112 (36,7%) pacientes. Ochenta y nueve (29,2%) pacientes presentaron complicaciones cardíacas. La insuficiencia cardíaca congestiva aguda fue la más prevalente (46; 15,1%), seguida de la FA de nueva aparición (20; 6,5%), la embolia pulmonar (17; 5,6%) y el síndrome coronario agudo (5; 1,6%). Los pacientes con complicaciones cardíacas tuvieron una estancia hospitalaria más prolongada (p<0,001). Durante el seguimiento fallecieron 29 pacientes (15,1%) y 40 (20,8%) presentaron un evento cardiovascular, siendo la insuficiencia cardíaca congestiva la complicación más prevalente (16,7%). (AU)

Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study.

BACKGROUND: Elderly COVID-19 patients have a high risk of pulmonary embolism (PE), but factors that predict PE are unknown in this population. This study assessed the Wells and revised Geneva scoring systems as predictors of PE and their relationships with D-dimer (DD) in this population. METHODS: This was a longitudinal, observational study that included patients ≥75 years old with COVID-19 and suspected PE. The performances of the Wells score, revised Geneva score and DD levels were assessed. The combinations of the DD level and the clinical scales were evaluated using positive rules for higher specificity. RESULTS: Among 305 patients included in the OCTA-COVID study cohort, 50 had suspected PE based on computed tomography pulmonary arteriography (CTPA), and the prevalence was 5.6%. The frequencies of PE in the low-, intermediate- and high-probability categories were 5.9%, 88.2% and 5.9% for the Geneva model and 35.3%, 58.8% and 5.9% for the Wells model, respectively. The DD median was higher in the PE group (4.33 mg/L; interquartile range (IQR) 2.40-7.17) than in the no PE group (1.39 mg/L; IQR 1.01-2.75) (p < 0.001). The area under the curve (AUC) for DD was 0.789 (0.652-0.927). After changing the cutoff point for DD to 4.33 mg/L, the specificity increased from 42.5% to 93.9%. CONCLUSIONS: The cutoff point DD > 4.33 mg/L has an increased specificity, which can discriminate false positives. The addition of the DD and the clinical probability scales increases the specificity and negative predictive value, which helps to avoid unnecessary invasive tests in this population.

Predictive Factors of Pulmonary Embolism in Older Patients with SARS-CoV-2: The OCTA-COVID-19 Study.

BACKGROUND: The risk of pulmonary embolism (PE) has not been studied in older patients affected by COVID-19. We aimed to assess PE incidence and risk factors in a population of older patients infected with SARS-CoV-2. METHODS: An ambispective, observational cohort study. A total of 305 patients ≥ 75 years old had the SARS-CoV-2 infection from March to May 2020. The incidence rate of PE was estimated as the proportion of new cases within the whole sample. Youden's index was used to assess the cutoff point of D-dimer. To select factors associated with the risk of PE, time-to-event analyses were performed using cause-specific hazard models. RESULTS: In total, 305 patients with a median age of 87 years (62.3% female) were studied; 67.9% were referred from nursing homes and 90.4% received any type of anticoagulation. A total of 64.9% showed frailty and 44% presented with dementia. The PE incidence was 5.6%. The cutoff value of a D-dimer level over 2.59 mg/L showed a sensitivity of 82.4% and specificity of 73.8% in discriminating a PE diagnosis. In the multivariate analysis, the factors associated with PE were previous oncological events and D-dimer levels. CONCLUSIONS: The PE incidence was 5.6%, and major risk factors for PE were oncological antecedents and increased plasma D-dimer levels.

Estenosis aórtica grave asintomática en la población geriátrica: papel de la fragilidad y la comorbilidad en la mortalidad / Asymptomatic aortic stenosis in a geriatric population. The role of frailty and comorbidity in mortality

Introducción y objetivos El pronóstico de la estenosis aórtica (EAo) grave asintomática en la población anciana, que a menudo asocia fragilidad y comorbilidades no ha sido estudiado. Se propuso analizar qué factores podrían influir en la mortalidad precoz esta población. Métodos Estudio ambispectivo de cohortes en 104 pacientes con edad ≥ 70 años y EAo grave asintomática. Se recogieron variables epidemiológicas, geriátricas, clínicas y ecocardiográficas y se compararon entre pacientes frágiles y no frágiles. Durante el seguimiento se recogió el tiempo desde el diagnóstico hasta la mortalidad. Resultados El 59,6% de los pacientes eran frágiles. El 69,4% de los pacientes frágiles fallecieron, con una mediana de supervivencia de 2,52 años (IC95%, 1,36-3,69). La tasa de supervivencia global al año en estos sujetos fue del 76%. En el análisis multivariante la edad (HR=2,47; IC95%, 1,00-6,12), el índice de Charlson ≥ 5 (HR=3,75; IC95%, 1,47-9,52) y la fragilidad (HR=6,67; IC95%, 1,43-9,52) se asociaron independientemente a la mortalidad. Un 8,7% de los pacientes presentaron un índice de Charlson ≥ 5 y tuvieron una mediana de supervivencia de 1,01 años (IC95%, 0,36-1,67). El área bajo la curva receiver operating characteristic del índice de Charlson fue 0,739 (IC95%, 0,646-0,832). Los valores ≥ 5 mostraron una elevada especificidad (100%) pero baja sensibilidad. Conclusiones Existe una elevada prevalencia de fragilidad en pacientes ancianos con EAo grave asintomáticos. La edad, un índice de Charlson ≥ 5 y la fragilidad son marcadores independientes de mortalidad, asociando un pronóstico desfavorable a corto plazo. (AU)

Introduction and objectives The prognosis of asymptomatic severe aortic stenosis (AS) has not been widely documented in elderly patients who are frequently frail and have comorbidities. We sought to analyze the factors that influence early mortality in geriatric patients with asymptomatic severe AS. Methods This ambispective cohort study included 104 patients aged 70 years or older with asymptomatic severe AS. Epidemiological, geriatric, clinical and echocardiographic variables were collected and compared between frail and nonfrail patients. During follow-up, the time from diagnosis to mortality and the causes of death were recorded. Results Overall, 59.6% of the patients were frail. During follow-up, 69.4% of the frail patients died, with a median time to mortality of 2.52 years (95%CI, 1.36-3.69). The overall 1-year survival rate in frail patients was 76%. On multivariate analysis, age (HR, 2.47; 95%CI, 1.00-6.12), a Charlson comorbidity index ≥ 5 (HR, 3.75; 95%CI, 1.47-9.52) and frailty (HR, 6.67; 95%CI, 1.43-9.52) were independently related to mortality. In total, 8.7% of the patients had a Charlson comorbidity index ≥ 5, and all these patients died during follow-up, with a median survival of 1.01 years (95%CI, 0.36-1.67). The area under the receiver operating characteristic curve of the Charlson index was 0.739 (95%CI, 0.646-0.832). In this population, values ≥ 5 showed high specificity (100%) but low sensitivity. Conclusions A high prevalence of frailty was present in geriatric patients with asymptomatic severe AS. Age, a Charlson index ≥ 5 and frailty were independent factors for mortality, conferring an unfavorable short-term prognosis. (AU)

Asymptomatic aortic stenosis in a geriatric population. The role of frailty and comorbidity in mortality.

INTRODUCTION AND OBJECTIVES: The prognosis of asymptomatic severe aortic stenosis (AS) has not been widely documented in elderly patients who are frequently frail and have comorbidities. We sought to analyze the factors that influence early mortality in geriatric patients with asymptomatic severe AS. METHODS: This ambispective cohort study included 104 patients aged 70 years or older with asymptomatic severe AS. Epidemiological, geriatric, clinical and echocardiographic variables were collected and compared between frail and nonfrail patients. During follow-up, the time from diagnosis to mortality and the causes of death were recorded. RESULTS: Overall, 59.6% of the patients were frail. During follow-up, 69.4% of the frail patients died, with a median time to mortality of 2.52 years (95%CI, 1.36-3.69). The overall 1-year survival rate in frail patients was 76%. On multivariate analysis, age (HR, 2.47; 95%CI, 1.00-6.12), a Charlson comorbidity index ≥ 5 (HR, 3.75; 95%CI, 1.47-9.52) and frailty (HR, 6.67; 95%CI, 1.43-9.52) were independently related to mortality. In total, 8.7% of the patients had a Charlson comorbidity index ≥ 5, and all these patients died during follow-up, with a median survival of 1.01 years (95%CI, 0.36-1.67). The area under the receiver operating characteristic curve of the Charlson index was 0.739 (95%CI, 0.646-0.832). In this population, values ≥ 5 showed high specificity (100%) but low sensitivity. CONCLUSIONS: A high prevalence of frailty was present in geriatric patients with asymptomatic severe AS. Age, a Charlson index ≥ 5 and frailty were independent factors for mortality, conferring an unfavorable short-term prognosis.

Escala de calidad de vida en adultos mayores mexicanos: Validación psicométrica / Quality of Life Scale in Mexican Elderly: Psychometric validation / Escala de qualidade de vida em idosos mexicanos: validado psicométrica / Échelle de qualité de vie des personnes âgées au Mexique : validation psychométrique

Resumen Objetivo: En particular en México, existe un escaso número de estudios sobre la calidad de vida del adulto mayor, y hay una amplia necesidad de contar con instrumentos validados, confiables y fáciles de aplicar en la práctica del médico familiar, por lo que el propósito de este trabajo fue desarrollar y validar psicométricamente una Escala de Calidad de Vida, con 15 reactivos con diez opciones tipo Likert de nada satisfecho a muy satisfecho. Materiales y métodos: Se trabajó con 446 adultos mayores de la Ciudad de México para la validación. Resultados: Se encontró una estructura con seis reactivos, adecuada confiabilidad y correcto ajuste [Chi cuadrada normada=3.58, Índice de Ajuste Comparativo de Bentler =0.96, Error Cuadrado de Aproximación Medio=0.07] para los adultos mayores mexicanos. Conclusiones: La población geriátrica está aumentando y conocer su salud es necesario a nivel mundial, para poder planear políticas públicas que mejoren su calidad de vida.

Abstract Objective: In Mexico, there is a few number of studies about the quality of life in elderly people, and there is a wide need for validated, reliable and easy to apply instruments in the practice of the family physician. Therefore, the purpose of this work was to develop and carry out a psychometric validation of a Quality of Life Scale of 15 items with ten Likert-Type response from not satisfied to very satisfied. Materials and methods: We worked with 446 elderly people from Mexico City for validation. Results: We found a structure with six items, adequate reliability, and correct adjustment [Normed Chi-Square = 3.58, Bentler's Comparative Fit Index= 0.96, Root Mean Square Error of Approximation = 0.07] for Mexican elderly. Conclusions: Geriatric population is increasing and knowing about their health is necessary worldwide in order to plan public policies that improve their quality of life.

Resumo Objetivo: No México, em particular, há um número limitado de estudos sobre a qualidade de vida dos idosos, e há uma grande necessidade de instrumentos validados, confiáveis e fáceis de aplicar na prática do médico de família, então o objetivo Este trabalho teve como objetivo desenvolver e validar psicometricamente uma Escala de Qualidade de Vida, com 15 itens com dez opções do tipo Likert de insatisfeito a muito satisfeito. Materiais e métodos: 446 idosos da Cidade do México foram usados para validação. Resultados: Uma estrutura com seis itens, confiabilidade adequada e ajuste correto [Qui quadrado normado = 3,58, Índice de ajuste comparativo de Bentler = 0,96, Erro Quadrático Médio de Aproximação = 0,07] foi encontrada para adultos mexicanos mais velhos. Conclusões: A população geriátrica está aumentando e conhecer sua saúde é necessário em todo o mundo para o planejamento de políticas públicas que melhorem sua qualidade de vida.

Résumé Objectif : Au Mexique, en particulier, il existe un nombre limité d'études sur la qualité de vie des personnes âgées et un grand besoin d'instruments validés, fiables et faciles á appliquer dans la pratique des médecins de famille. Par conséquent, le but de ce travail a été de développer et de valider psychométriquement une Échelle de Qualité de Vie, composée de 15 réactifs avec une échelle de Likert de dix options allant de "pas du tout satisfait" á "très satisfait". Matériels et méthodes : La validation a été réalisée avec 446 personnes âgées de la ville de Mexico. Résultats : Une structure de six réactifs, avec une fiabilité adéquate et un ajustement correct, a été identifiée pour les personnes âgées mexicaines [Chi carré normalisée = 3,58, Indice d'ajustement comparatif de Bentler = 0,96, Erreur quadratique moyenne = 0,07]. Conclusions : La population gériatrique augmente et il est nécessaire d'étudier sa santé dans le monde entier, afin de planifier des politiques publiques qui améliorent sa qualité de vie.

Control del asma desde la atención primaria con un enfoque de género y familia / Asthma control from primary care with a gender and family focus

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Relation of Interatrial Block to Cognitive Impairment in Patients ≥ 70 Years of Age (From the CAMBIAD Case-control Study).

The association between atrial fibrillation, stroke, and interatrial block (IAB) (P-wave duration ≥120 ms) is well recognized, particularly in the case of advanced IAB. We aimed to assess the association of IAB with mild cognitive impairment. Advanced Characterization of Cognitive Impairment in Elderly with Interatrial Block was a case-control multicenter study, conducted in subjects aged ≥70 years in sinus rhythm without significant structural heart disease. Diagnosis of mild cognitive impairment was performed by an expert geriatrician, internist, or neurologist in the presence of changes in cognitive function (Mini Mental State Examination score 20 to 25) without established dementia. A total of 265 subjects were included. Mean age was 79.6 ± 6.3 years and 174 (65.7%) were women; there were 143 cases with mild cognitive impairment and 122 controls with normal cognitive function. Compared with controls, cases had longer P-wave duration (116.2 ± 13.8 ms vs 112.5 ± 13.3 ms, p = 0.028), higher prevalence of IAB (73 [51.0%] vs 38 [31.1%], p = 0.001), higher prevalence of advanced IAB (28 [19.6%] vs 10 [8.2%], p = 0.002), and higher MVP ECG risk score (2.7 ± 1.4 vs 2.2 ± 1.3, p = 0.004). IAB was independently associated with mild cognitive impairment, both for partial (odds ratio 2.0, 95% CI: 1.1 to 3.9) and advanced IAB (odds ratio 2.8, 95% CI: 1.1 to 6.7). In conclusion, in subjects aged ≥70 years without significant structural heart disease, IAB is independently associated with mild cognitive impairment. This association is stronger in the case of advanced IAB.

Factores psicosociales influyentes en la actitud de estudiantes de medicina paraguayos hacia la donación de órganos / Influential psychosocial factors in the attitude of Paraguayan medical students towards organ donation

INTRODUCCIÓN: el trasplante de órganos es considerado el avance más significativo de la medicina moderna. Paraguay es uno de los países con las tasas más bajas de donación de órganos, alcanzando 7 donaciones por millón de personas. OBJETIVO: determinar los factores psicosociales que influyen en la actitud de estudiantes de Medicina paraguayos de una universidad pública hacia la donación de órganos. MATERIALES Y MÉTODOS: el estudio fue observacional analítico de corte transversal y muestreo no probabilístico por conveniencia entre abril a junio del 2017 en la Universidad Nacional de Asunción (Paraguay). RESULTADOS: los factores más frecuentes e influyentes fueron, un 37,6% (105) que manifestó informarse mediante Internet; consideran escasa la información sobre trasplantes en 61,6% (172); conscientes de la falta de órganos en 87,8% (245); aprobación de la donación pero sin estar registrados en las instituciones vinculadas por 86,37% (241). Asociación de estado civil, concepto de muerte encefálica y autopsia con la experiencia previa/favor/contra de la donación, alcanzaron valores significativos (p<0,05). CONCLUSIÓN: el estado civil, concepto de muerte encefálica y autopsia son factores influyentes y favorables en las actitudes sobre la donación en estudiantes de Medicina del Paraguay.

BACKGROUND: organ transplantation is considered the most significant advance in modern medicine. Paraguay is one of the countries with the lowest rates of organ donation, reaching 7 donators per million people. AIM: to determine the psychosocial factors that influence the attitude of Paraguayan medical students of a public university towards organ donation. METHODS: the study was cross-sectional analytical observational and non-probabilistic convenience sampling between April and June 2017 at the National University of Asunción (Paraguay). p<0.05 was considered as significant. RESULTS: 279 cases were analyzed; age rank between 18 and 30 years old (21.75 ± 2.12); female participation was greater 70.3% (196). The most frequent and influential factors were 37.6% (105) who reported being informed using the internet; 61.6% (172) consider information about organ transplant insufficient; they are aware of the lack of organ donators in 87.8% (245); they approve the organ donation, despite of being unregistered in the related institutions, about 86.37% (241). There is an association of marital status, concept of brain death and autopsy with previous experience / being in favor / being against donation (p<0.05). CONCLUSION: marital status, concept of brain death and autopsy are influential and favorable factors in attitudes about donation in medical students of Paraguay.

Adaptación y validación de la escala de impacto de fatiga / Adaptation and validation of the fatigue impact scale

Resumen: La fatiga es una sensación de cansancio físico con consecuencias adversas en la calidad de vida de las personas, por consiguiente, es importante contar con instrumentos confiables y válidos para medirla. Una de las escalas más utilizadas es la Escala de Impacto de Fatiga, sin embargo, hay versiones con una y tres dimensiones en diversas culturas. Por lo que el propósito de este trabajo fue traducir, adaptar de manera culturalmente relevante y comparar las estructuras de una y tres dimensiones de la Escala de Impacto de Fatiga, para identificar la más adecuada en población general de la Ciudad de México. Se trabajó con tres grupos diferentes de participantes; el primero para la traducción y adaptación conformado por siete jueces expertos en el idioma, el segundo para la validación psicométrica con 205 participantes de población general y, el tercero, para el análisis factorial confirmatorio con 406 habitantes de la Ciudad de México. Se probó la distribución, discriminación, confiabilidad y estructura de la escala, en un análisis exploratorio y confirmatorio, quedando una escala final de 10 reactivos con tres factores: física, mental y psicosocial que explican el 59% de varianza con buen ajuste (X2[21.7] =20,762, p = 0.522; CFI = 1; RMSEA = 0), con una confiabilidad α=0.93.

Abstract: Fatigue is a sensation of physical weariness with adverse consequences on the quality of life of people, therefore, it is important to have reliable and valid instruments to measure it. One of the most widely used is the Fatigue Impact Scale, however, there are one-and three-dimensional versions in several cultures. Therefore, the aim of this work was to translate, culturally relevant and compare the one and three-dimensional structures of the Fatigue Impact Scale to identify the most appropriate in the general population of Mexico City, with three different groups of participants. The first one for translation and adaptation made up with seven expert judges in the language; the second for psychometric validation with 205 participants from the general population, and the third, for confirmatory factor analysis with 406 inhabitants of Mexico City. The distribution, discrimination, reliability and structure of the scale were tested in an exploratory and confirmatory analysis, with a final scale of 10 items with three factors: physical, mental and psychosocial explaining the 59% variance with goodness of fit (X2[21.7] = 20.762, p = 0.522; CFI = 1; RMSEA = 0), with reliability α = 0.93.

Perfil epidemiológico de las pacientes obstétricas críticas atendidas en la Unidad de Cuidados Críticos del Hospital Nacional Daniel Alcides Carrión / Epidemiological profile of critical obstetrical patients treated in the Critical Care Unit at the National Hospital Daniel Alcides Carrion

Objetivos: Describir el Perfil epidemiológico de las pacientes obstétricas críticas atendidas en la unidad de cuidados críticos del Hospital Nacional Daniel Alcides Carrión. Material y métodos: Se realizó un estudio observacional, retrospectivo, transversal, de 90 pacientes femeninas, gestantes y puérperas, ingresadas a la unidad de cuidados críticos de HNDAC, Lima-Perú, durante el periodo enero 2012-diciembre 2013. Resultados: El 63.3 por ciento de las pacientes obstétricas críticas tuvo grado de instrucción secundaria. Hubo una mayor frecuencia de pacientes obstétricas con estado civil de convivencia (61.1 por ciento). El 7.8 por ciento de las pacientes obstétricas criticas eran hipertensos, seguido de diabetes (2.2 por ciento), y el 15.6 por ciento tuvieron otras comorbilidades. Hubo una mayor frecuencia de pacientes nulíparas (53.3 por ciento). El 68.9 por ciento de las pacientes obstétricas criticas tuvieron control prenatal. El 93.3 por ciento de las pacientes obstétricas criticas eran puérperas. El 91.2 por ciento de las pacientes obstétricas criticas tuvieron parto cesárea. El 20 por ciento de las pacientes obstétricas críticas recibieron transfusión. El 7.8 por ciento de las pacientes obstétricas críticas recibieron soporte ventilatorio. Hubo dos casos de muerte materna (2.2 por ciento). Las pacientes que presentaron morbilidad se caracterizaron por tener grado de instrucción secundaria (56.5 por ciento), convivientes (47.8 por ciento), nulíparas (52.2 por ciento), con control prenatal (56.5 por ciento), ser puérperas (95.7 por ciento). Conclusiones: El perfil epidemiológico de las pacientes obstétricas críticas atendidas en la unidad de cuidados críticos del Hospital Nacional Daniel Alcides Carrión se caracterizó por que la mayoría de pacientes tuvieron grado de instrucción secundaria, eran convivientes, nulíparas, con control prenatal, puérperas, cuyo parto termino en cesárea. Las pacientes que fallecieron se caracterizaron por ser puérperas, sin...

Cierre percutáneo de la orejuela izquierda. Una opción terapéutica alternativa a la anticoagulación en pacientes con fibrilación auricular y varices esofágicas / Percutaneous closure of left atrial appendage. A therapeutic option in patients with atrial fibrillation and esophageal varices and high risk of haemorrage

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Clinical and prognostic implications of atrial fibrillation in patients undergoing transcatheter aortic valve implantation.

AIM: To study a cohort of consecutive patients undergoing transcatheter aortic valve implantation (TAVI) and compare the outcomes of atrial fibrillation (AF) patients vs patients in sinus rhythm (SR). METHODS: All consecutive patients undergoing TAVI in our hospital were included. The AF group comprised patients in AF at the time of TAVI or with history of AF, and were compared with the SR group. Procedural, echocardiographic and follow-up variables were compared. Likewise, the CHA(2)DS(2)-VASC stroke risk score and HAS-BLED bleeding risk score and antithrombotic treatment at discharge in AF patients were compared with that in SR patients. RESULTS: From a total of 34 patients undergoing TAVI, 17 (50%) were allocated to the AF group, of whom 15 (88%) were under chronic oral anticoagulation. Patients in the AF group were similar to those in the SR group except for a trend (P = 0.07) for a higher logistic EuroSCORE (28% vs 19%), and a higher prevalence of hypertension (82% vs 53%) and chronic renal failure (17% vs 0%). Risk of both stroke and bleeding was high in the AF group (mean CHA(2)DS(2)-VASC 4.3, mean HAS-BLED 2.9). In the AF group, treatment at discharge included chronic oral anticoagulation in all except one case, and in association with an antiplatelet drug in 57% of patients. During a mean follow-up of 11 mo (maximum 32), there were only two strokes, none of them during the peri-procedural period: one in the AF group at 30 mo and one in the SR group at 3 mo. There were no statistical differences in procedural success, and clinical outcome (survival at 1 year 81% vs 74% in AF and SR groups, respectively, P = NS). CONCLUSION: Patients in AF undergoing TAVI show a trend to a higher surgical risk. However, in our cohort, patients in AF did not have a higher stroke rate compared to the SR group, and the prognosis was similar in both groups.

Ejercicio físico y tercera edad / Physical activity and third age

Se efectúa un análisis de los conocimientos que hasta la fecha hemos conseguido recopilar respecto a la relación actividad física y tercera edad, sintetizando las pruebas de valoración funcional más adecuadas para un examen previo, y las limitaciones y contraindicaciones que en cada caso concreto pueden plantearse por las circunstancias personales de un individuo en la tercera edad, según, su régimen previo de actividad física y su situación de salud, todo ello orientado a dotar de una base sólida a los profesionales de la geriatría en su quehacer cotidiano (AU)

Efecto del triflusal sobre la agregación y secreción de las plaquetas humanas: papel del óxido nítrico / Effect of Triflusal on Human Platelet Aggregation and Secretion: Role of Nitric Oxide

Introducción y objetivos. Recientes estudios in vitro realizados en nuestro laboratorio demostraron que el triflusal reduce la agregación plaquetaria mediante la estimulación de la producción de óxido nítrico (NO) por los neutrófilos. El objetivo de este trabajo fue evaluar si el tratamiento in vivo con triflusal también aumenta la capacidad de los neutrófilos de generar NO analizando el papel del NO liberado por los neutrófilos sobre la agregación y secreción plaquetaria. Métodos. El estudio se realizó en 12 voluntarios sanos de 32 ñ 6 años a los que se administró triflusal (600 mg/día) durante 5 días, extrayéndoles plaquetas y neutrófilos antes y después del tratamiento y midiéndoles su capacidad de producir NO, el porcentaje de agregación de sus plaquetas frente a ADP y la capacidad de liberar factor transformante del crecimiento (TGF- ). Resultados. Tras el tratamiento con triflusal se obtuvieron los siguientes resultados: a) aumento de la producción de NO en los neutrófilos; b) potenciación de la inhibición de la agregación plaquetaria en presencia de neutrófilos, efecto que se revertía al incubar los neutrófilos con un antagonista de L-arginina, L-NAME, y c) la presencia de neutrófilos redujo la liberación del TGF- por las plaquetas determinado como medida de secreción plaquetaria, por un mecanismo independiente del NO. Conclusiones. Nuestro estudio demuestra que el tratamiento con triflusal (600 mg/día/5 días) estimula la producción de NO por los neutrófilos. Tras el tratamiento con triflusal los neutrófilos inhiben la agregación y la secreción de las plaquetas. El efecto antiagregante plaquetario demostrado por los neutrófilos fue dependiente del NO, pero no así la inhibición de la desgranulación plaquetaria (AU)