Dilatación de la aurícula izquierda en deportistas de alta competición y electrofisiología auricular / Left atrial enlargement in competitive athletes and atrial electrophysiology

Introducción y objetivos: Existe poca información sobre la dilatación de la aurícula izquierda (AI) y los parámetros electrocardiográficos en deportistas. Métodos: Estudio observacional multicéntrico en deportistas de competición y controles. La dilatación de la AI se definió como un volumen indexado por área de superficie corporal ≥ 34ml/m2. Se estudió su relación con parámetros electrocardiográficos auriculares. Resultados: Se incluyó en total a 356 sujetos: 308 deportistas de competición (media de edad, 36,4±11,6 años) y 48 controles (49,3±16,1 años). Los deportistas de competición tenían un mayor volumen medio indexado de la AI (29,8±8,6 frente a 25,6±8,0ml/m2; p=0,006) y una mayor prevalencia de dilatación de la AI (113 [36,7%] frente a 5 [10,4%]; p <0,001), sin diferencias relevantes en cuanto a la duración de la onda P (106,3±12,5 frente a 108,2±7,7 ms; p=0,31), la prevalencia de bloqueo interauricular (40 [13,0%] frente a 4 [8,3%]; p=0,36) ni la puntuación Morphology-Voltage-P-wave duration (1,8±0,84 frente a 1,5±0,8; p=0,71). El entrenamiento competitivo se asoció de manera independiente con la dilatación de la AI (OR=14,7; IC95%, 4,7-44,0; p < 0,001), pero no con la duración de la onda P (OR=1,02; IC95%, 0,99-1,04), el bloqueo interauricular (OR=1,4; IC95%, 0,7-3,1) o la puntuación Morphology-Voltage-P-wave duration (OR=1,4; IC95%, 0,9-2,2). Conclusiones: La dilatación de la AI es frecuente en deportistas de competición, pero no se acompaña de una modificación relevante en los parámetros electrocardiográficos (AU)

Introduction and objectives: There are scarce data on left atrial (LA) enlargement and electrophysiological features in athletes. Methods: Multicenter observational study in competitive athletes and controls. LA enlargement was defined as LA volume indexed to body surface area ≥ 34mL/m2. We analyzed its relationship with atrial electrocardiography parameters. Results: We included 356 participants, 308 athletes (mean age: 36.4±11.6 years) and 48 controls (mean age: 49.3±16.1 years). Compared with controls, athletes had a higher mean LA volume index (29.8±8.6 vs 25.6±8.0mL/m2, P=.006) and a higher prevalence of LA enlargement (113 [36.7%] vs 5 [10.4%], P <.001), but there were no relevant differences in P-wave duration (106.3±12.5ms vs 108.2±7.7ms; P=.31), the prevalence of interatrial block (40 [13.0%] vs 4 [8.3%]; P=.36), or morphology-voltage-P-wave duration score (1.8±0.84 vs 1.5±0.8; P=.71). Competitive training was independently associated with LA enlargement (OR, 14.7; 95%CI, 4.7-44.0; P <.001) but not with P-wave duration (OR, 1.02; 95%CI, 0.99-1.04), IAB (OR, 1.4; 95%CI, 0.7-3.1), or with morphology-voltage-P-wave duration score (OR, 1.4; 95%CI, 0.9-2.2). Conclusions: LA enlargement is common in adult competitive athletes but is not accompanied by a significant modification in electrocardiographic parameters (AU)

Changes in clinical, pulmonary function, quality of life and costs in a cohort of asthmatic patients followed for 10 years.

UNLABELLED: Few studies have comprehensively assessed the evolution asthma disease in recent years. OBJECTIVES: To determine changes in morbidity, lung function and quality of life and to establish the impact in terms of cost in a cohort of patients with asthma. METHODS: Prospective, descriptive and realistic study that included 220 asthma patients evaluated 10 years after their inclusion (1994-2004). For all the patients, data for symptoms, lung function, quality of life and financial cost were collected. RESULTS: There was a decrease in the frequency of health service visits, including: emergency room visits for asthma exacerbations, 0.3 (0.9) versus 0.6 (1) visits per patient per year (P=.003); a reduction in the severity of the disease, with a greater proportion of patients with mild asthma, 121 (54.8%) versus 94 (42.7%) (P=.001); a decrease (improvement in quality of life) in the total SGRQ, 30.1 (16.5) versus 37 (19.6) (P<.001); and reduced total costs, 1,464€ (3,415.8) compared to 2,267€ (4.174) per patient/year (P<.001), mainly due to indirect costs, 617.50€ (2855.9) compared to 1,320.10€ (3,685.3) per patient/year (P=.001). When assessing the changes observed according to asthma severity, no differences were observed between groups. CONCLUSIONS: The evolution of the morbidity and quality of life of asthma patients between 1994 and 2004 are clearly favorable. This improvement provided a significant reduction in the total costs of disease treatment.

Costs of asthma according to the degree of severity.

An increase in asthma-related morbidity and mortality has been reported recently, resulting in a substantial increase in the economic impact of this condition. Little information is available relating to the costs of asthma depending on the degree of severity of the disease. Total, direct and indirect costs generated by asthma patients who sought medical care for asthma control over a one-year period in a northern area of Spain were determined. Data were obtained from the patients themselves and severity of illness was classified into mild, moderate and severe according to the International Consensus Report on Diagnosis and Treatment of Asthma, 1992. The average total annual asthma-derived cost was estimated at US$2,879 per patient, with averages of US$1,336 in mildly asthmatic patients, US$2,407 in moderate asthma and US$6,393 in severe asthma. At all levels of severity, indirect costs were twice as high as direct costs, and at the same degree of severity, direct costs due to medication and hospitalization were higher among females than males. A minority of severe asthmatics incurred some 41% of the total costs. The cost of asthma was surprisingly high and varied substantially depending on the degree of severity of the disease. Further knowledge of the costs of asthma across various levels of severity will contribute to a better characterization of optimal intervention strategies for asthma care.

[Clinical characteristics and morbidity in stable asthma. A descriptive analysis of asthma in a Mediterranean community]. / Características clínicas y morbilidad en el asma estable. Análisis descriptivo del asma en una comunidad mediterránea.

UNLABELLED: Scarce clinical and epidemiological data related to asthma are available in Spain. OBJECTIVES: a) to determine the severity of disease and morbidity among symptomatic asthmatics, and b) to determine whether international recommendations for the treatment of asthma are being followed. A prospective descriptive study enrolling asthmatics older than 14 years of age who experienced symptoms within the past year. The study was performed in the Osona district, a semi-rural area north of Barcelona. Spirometric tests were given and case histories taken, including symptoms caused by the disease. The international guidelines analyzed were those published in 1992 by the National Institutes of Health for the International Consensus Report on Diagnosis and Treatment of Asthma. We studied 333 patients; 214 (64%) were women and 119 (36%) men. Asthma was mild in 140 (42%), moderate in 116 (35%) and severe in 77 (23%). The need for short-term oral corticosteroids, visits to primary care physicians, and missed work days were all significantly greater among patients with severe asthma than for those with mild or moderate asthma. However, 23% of the patients with mild asthma missed work at least once. Drugs used were beta-adrenergic agonists of short duration of effect (76%) and inhaled corticosteroids (66%). CONCLUSIONS: a) in most symptomatic asthma patients, disease is mild; b) although patients with severe asthma have higher rates or morbidity, patients with mild disease also have marked symptoms; c) the drugs used for treatment are in compliance with the 1992 international guidelines.

[Inhalation chambers: an alternative to the conventional inhalator?]. / Cámaras de inhalación: alternativa al inhalador convencional?

BACKGROUND: Aerosol inhalers constitute the most commonly used form of administration of medication by most of the patients with respiratory disease although incorrect usage is a demonstrated fact in many studies. A previous study demonstrated that, despite correct instruction by health care staff and the patients, 30% of the same use these inhalers incorrectly. In the present study, the efficacy of inhalation chambers (750 ml) and spacers (50 ml) versus the conventional inhaler was evaluated by quantification of bronchodilator response. METHODS: Fifty-six stable patients with chronic obstruction to air flow in habitual treatment with aerosol inhalers (AI) were studied. For this study 27 patients used the chamber and 29 the spacer. The patients using the maneuvers correctly (n = 42) and those that did not (n = 14) were studied together and separately. RESULTS: Patients using the inhaler incorrectly were found to benefit significantly from either of the procedures. Upon comparison of the chambers (750 ml) with the spacers (50 ml) a significant improvement was observed with the former. CONCLUSIONS: The response to bronchodilator treatment in patients not using aerosol inhalers correctly improves significantly upon use of either inhalation chambers or spacers with the former demonstrating the best results.

[A study of the tobacco habit in a general hospital]. / Estudio del hábito tabáquico en un hospital general.

Health professionals are the individuals with the greatest capacity to influence the population on smoking habit. Unfortunately, recent statistics, report that this professional group smoke as much if not more than the rest of the population, thus difficulting the reduction of this social problem. In order to evaluate smoking habit in our hospital, we presented a study on the prevalence and attitude of smoking habit in all the personnel working in our hospital. We were negatively surprised that after several public campaigns on the subject, the prevalence of smoking amongst the hospital personnel.

Anomalous coronary arteries: a report of 2 cases of single coronary artery.

One patient with chronic exertional angina, not significant electrocardiographic signs of myocardial ischemia at exercise stress test and recent onset of angina at rest underwent coronary arteriography. A second one with known severe aortic stenosis underwent cardiac catheterization and coronary arteriography because of effort chest pain and syncope. A single coronary artery originating respectively from the right and from the left sinus of Valsalva but without significant coronary stenosis was detected in both patients. This entity is a quite uncommon finding of relevant interest if surgical treatment is required and good prognosis if not associated with additional cardiac anomalies.