Post-COVID-19 syndrome, inflammation and insulin resistance: a retrospective cohort study.

BACKGROUND: COVID-19-induced diabetes is a novel and enigmatic disease. Our aim was to evaluate a possible relationship between post-COVID-19 syndrome (PCS) and increased insulin resistance (IR) in non-diabetic outpatients after mild COVID-19. METHODS: Repeated measures design. Three evaluations [1E (pre-COVID, baseline), 2E (3 months post-COVID) and 3E (21 months post-COVID)] were performed, directed to PCS+ and PCS- subjects. Triglyceride-glucose (TyG) index ≥8.74 was considered IR, and albumin-to-globulin ratio (AGR) <1.50, inflammation. RESULTS: We analyzed 112 individuals (median [IQR] age=44 [20] years, 58% women, 36 PCS+, 76 PCS-). PCS+ with very low basal IR (TyG <7.78, lowest quartile) showed a reduced inflammatory burden (basal AGR=1.81 [0.4] vs. 1.68 [0.2] in 2E; P=0.23), and increased TyG across evaluations (from basal 7.62 [0.2] to 8.29 [0.5]; P=0.018]. Conversely, PCS+ subjects with high basal TyG (TyG ≥8.65, highest quartile) did not show significant variations in TyG, but a greater inflammatory load (basal AGR=1.69 [0.3] vs. 1.44 [0.3] in 2E; P=0.10). In multivariable models addressing groups with reduced basal IR (TyG <8.01), PCS has been a consistent predictor for TyG, after adjusting for confounders. Partial correlation and multivariable analyses showed similarities involving acute polysymptomatic COVID-19 and PCS regarding IR. CONCLUSIONS: PCS was associated with increased IR, being more evident when the baseline degree of IR was very low. PCS and increased IR were separately associated with inflammation. Acute polysymptomatic COVID-19 and PCS could be clinical expressions of underlying inflammatory state, which in turn may also trigger IR.

Índice trabecular óseo y niveles de 25-hidroxivitamina D en las complicaciones microvasculares de la diabetes mellitus tipo 2 / Trabecular bone score and 25-hydroxyvitamin D levels in microvascular complications of type 2 diabetes mellitus

Antecedentes y objetivo:La enfermedad microvascular (EMV) diabética ha sido asociada con una fragilidad ósea incrementada. El objetivo fue analizar la relación entre la EMV y la microestructura trabecular -evaluada mediante el índice trabecular óseo (trabecular bone score, TBS)- en pacientes diabéticos tipo 2 (DM2). Adicionalmente, conocer la relación entre la vitamina D y la EMV.Pacientes y métodos:Diseño transversal analítico, que incluyó varones > 50 años y mujeres postmenopáusicas con DM2, participantes en una cohorte poblacional. Se clasificó como EMV+ la presencia de nefropatía, neuropatía y/o retinopatía. Fueron analizadas variables clínicas, de laboratorio, el TBS, la 25-hidroxivitamina D [25(OH)D] y la densidad mineral ósea (DMO). Se realizaron análisis bivariable y multivariable.Resultados:Fueron evaluados 361 pacientes (51,1% mujeres), de 63,8 (9) años. De ellos, 92 tenían EMV, con un peor control metabólico, mayor duración de la DM2, menor TBS (1,235 [0,1] vs. 1,287 [0,1]; p=0,003) y menores niveles de 25(OH)D (18,3 [7] vs. 21,6 [8] ng/mL; p=0,0001). No hubo diferencias entre EMV+ y EMV- en la DMO ni en los marcadores P1NP y β-CTX. Tras ajustar por confusores, incluyendo HbA1c y duración de la DM2, el TBS en EMV+ fue 1,252 (IC 95% 1,230-1,274) vs. 1,281 (IC 95% 1,267-1,295) en EMV- (p=0,034). La EMV se asoció a un nivel de 25(OH)D < 20 ng/mL con una OR ajustada=1,88 (IC 95% 1,06-3,31; p=0,028).Conclusiones:Los pacientes con EMV presentaron un TBS significativamente menor, tras ajustar por confusores. El análisis multivariable mostró asimismo una asociación significativa entre un nivel bajo de 25(OH)D y la EMV prevalente. (AU)

Background and objective:Diabetic microvascular disease (MVD) has been associated with increased bone fragility. The objective was to analyse the relationship between MVD and trabecular microstructure -assessed by the trabecular bone score (TBS)- in type 2 diabetic (T2D) patients. A second aim was to know the relationship between vitamin D and MVD.Patients and methods:Cross-sectional study, which included men >50 years and postmenopausal women participating in a population-based cohort, diagnosed with T2D. The presence of nephropathy, neuropathy and/or retinopathy was classified as MVD+. Clinical and laboratory variables, TBS, 25(OH)D and BMD by DXA, were evaluated. Bivariate and multivariate analysis were performed.Results:We evaluated 361 patients (51.1% women), 63.8 (9) years old. Of them, 92 were MVD+ and presented poorer metabolic control, longer duration of T2D, lower TBS [1.235 (.1) vs. 1.287 (.1); p=.007] and lower levels of 25(OH)D [18.3 (7) vs. 21.6 (8) ng/ml; p=.0001). There were no differences between MVD+ and MVD- with regard to BMD or P1NP and β-CTX markers. After adjusting for confounders, including HbA1c and duration of T2D, the TBS value in MVD+ was 1.252 (95% CI 1.230-1.274) vs. 1.281 (95% CI 1.267-1.295) in MVD- (p=.034). MVD was associated with a 25(OH)D level <20 ng ml with an adjusted OR of 1.88 (95% CI 1.06-3.31; p=.028).Conclusions:The MVD+ patients presented a significantly lower TBS, after adjusting for confounders. Furthermore, multivariable analysis showed a significant relationship between a low 25(OH)D level and a prevalent MVD. (AU)

Trabecular bone score and 25-hydroxyvitamin D levels in microvascular complications of type 2 diabetes mellitus. / Índice trabecular óseo y niveles de 25-hidroxivitamina D en las complicaciones microvasculares de la diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: Diabetic microvascular disease (MVD) has been associated with increased bone fragility. The objective was to analyse the relationship between MVD and trabecular microstructure -assessed by the trabecular bone score (TBS)- in type 2 diabetic (T2D) patients. A second aim was to know the relationship between vitamin D and MVD. PATIENTS AND METHODS: Cross-sectional study, which included men >50 years and postmenopausal women participating in a population-based cohort, diagnosed with T2D. The presence of nephropathy, neuropathy and/or retinopathy was classified as MVD+. Clinical and laboratory variables, TBS, 25(OH)D and BMD by DXA, were evaluated. Bivariate and multivariate analysis were performed. RESULTS: We evaluated 361 patients (51.1% women), 63.8 (9) years old. Of them, 92 were MVD+ and presented poorer metabolic control, longer duration of T2D, lower TBS [1.235 (.1) vs. 1.287 (.1); p=.007] and lower levels of 25(OH)D [18.3 (7) vs. 21.6 (8) ng/ml; p=.0001). There were no differences between MVD+ and MVD- with regard to BMD or P1NP and ß-CTX markers. After adjusting for confounders, including HbA1c and duration of T2D, the TBS value in MVD+ was 1.252 (95% CI 1.230-1.274) vs. 1.281 (95% CI 1.267-1.295) in MVD- (p=.034). MVD was associated with a 25(OH)D level <20 ng ml with an adjusted OR of 1.88 (95% CI 1.06-3.31; p=.028). CONCLUSIONS: The MVD+ patients presented a significantly lower TBS, after adjusting for confounders. Furthermore, multivariable analysis showed a significant relationship between a low 25(OH)D level and a prevalent MVD.

[Health-related quality of life in hypertension: a gender-differentiated analysis in population of Cantabria.] / Calidad de vida relacionada con la salud (CVRS) en la hipertensión arterial: un análisis diferenciado por género sobre población de Cantabria.

OBJECTIVE: Hypertension is a major public health problem due to its high prevalence and morbi-mortality. It is associated with a worse health-related quality of life (HRQOL). The aim has been to know the HRQOL of the hypertensive population in a gender-differentiated analysis. METHODS: Cross-sectional study. Hypertensive patients attended in Primary Care were enrolled in the study. We evaluated HRQOL (using the EuroQol-5D questionnaire), four covariates related to hypertension (degree of control, duration of disease, use of antihypertensive drugs and target organ damage -TOD-), and sociodemographic, lifestyle and clinical variables. Bivariate analysis was performed and two multivariate models were developed, with the EuroQol-5D index (iEQ) as the dependent variable. RESULTS: We analyzed 198 women (55.7%) and 157 men. Significantly, females had a lower educational level, spent more time alone, consumed more psychotropic medication, their iEQ was lower [0.887 (0.2) vs. 0.914 (0.1); p=0.0001] and scored worse in self-care, usual activities, pain / discomfort and anxiety / depression. In women, no variable related to hypertension presented a significant association with the iEQ after adjusting for confounders, and functional capacity was the most important covariate (ß=0.35; p=0.0001). In males, TOD (ß=0.18) and duration of the disease (ß=0.16) were significantly associated with the iEQ, with the consumption of psychotropic medication being the most relevant covariate in the regression model (ß=0.42; p=0.005). CONCLUSIONS: Notable differences in HRQOL of women and men with hypertension have been noted. Detecting these differences allows us to know the frailest states of our patients.

OBJETIVO: La hipertensión arterial (HTA), por su elevada prevalencia y morbimortalidad, es un importante problema de Salud Pública. Se asocia a una peor calidad de vida relacionada con la salud (CVRS). El objetivo de este trabajo fue conocer la CVRS de la población hipertensa en un análisis diferenciado por género. METODOS: Se realizó un estudio transversal. Partici-paron cinco cupos de Medicina de Familia. Se evaluó la CVRS (mediante el cuestionario EuroQol-5D), cuatro variables relacionadas con la HTA (grado de control, duración de la enfermedad, uso de fármacos antihipertensivos y lesión de órgano diana -LOD-), variables sociodemográficas, de estilo de vida y clínicas. Se realizó análisis bivariado y se elaboraron dos modelos multivariados, con el índice EuroQol-5D (iEQ) como variable dependiente. RESULTADOS: Fueron analizadas 198 mujeres (55,7%) y 157 varones. Las mujeres, significativamente, tenían menor nivel educativo, pasaban más tiempo solas, consumían más psicofármacos, su iEQ fue menor (0,887 [0,2] frente a 0,914 [0,1]; p=0,0001) y puntuaron peor en cuidado personal, actividades cotidianas, dolor/malestar y ansiedad/depresión. En las mujeres, tras ajustar por confusores, ninguna variable relacionada con la HTA presentó una asociación significativa con el iEQ, y la capacidad funcional fue la variable más importante (ß=0,35; p=0,0001). En los varones, la LOD (ß=0,18) y la duración de la HTA (ß=0,16) se asociaron significativamente con el iEQ, siendo el consumo de psicofármacos la variable más relevante del modelo de regresión (ß=0,42; p=0,005). CONCLUSIONES: Se observan notables diferencias en la CVRS de las mujeres y los varones con HTA. Detectar dichas diferencias permite conocer los perfiles más frágiles de nuestros pacientes.

Trabecular bone score and bone turnover markers in men with DISH: Data from the Camargo Cohort study.

OBJECTIVE: Diffuse idiopathic skeletal hyperostosis (DISH) has been associated with an increased risk of vertebral fracture. To date, no studies have investigated the relationship between DISH and bone microstructure assessed by the trabecular bone score (TBS). METHODS: Cross-sectional study, nested in a prospective population-based cohort. All men (968) aged≥50 years were included. Clinical covariates, DISH, TBS, serum bone turnover markers and bone mineral density (BMD) were analyzed. RESULTS: Mean age of participants was 65 ± 9 years. 207 (21.6%) had DISH. DISH subjects were older, had higher body mass index (BMI) and abdominal perimeter, lower glomerular filtration rate (GFR), and higher prevalence of metabolic syndrome (MetS) than non-DISH (NDISH) subjects. Bone mineral density at the lumbar spine (LS-BMD) was significantly higher in the DISH group. TBS values were 1.317 [1.303-1.331] for DISH and 1.334 [1.327-1.341] for NDISH subjects, after adjusting by age, BMI, abdominal perimeter, arterial hypertension, diabetes mellitus, MetS, GFR, serum alkaline phosphatase (ALP), LS and femoral neck BMD (p = 0.03). Serum ALP levels were higher in DISH subjects, showing an inverse correlation with TBS that remained significant after adjusting by age and BMI. CONCLUSIONS: TBS values were significantly lower in men with DISH irrespective of age, BMI and BMD, suggesting that the presence of DISH might be related to a worse trabecular microstructure.

Calidad de vida relacionada con la salud (CVRS) en la hipertensión arterial: un análisis diferenciado por género sobre población de cantabria / Health-related quality of life in hypertension: a gender-differentiated analysis in population of Cantabria

OBJETIVO: La hipertensión arterial (HTA), por su elevada prevalencia y morbimortalidad, es un importante problema de Salud Pública. Se asocia a una peor calidad de vida relacionada con la salud (CVRS). El objetivo de este trabajo fue conocer la CVRS de la población hipertensa en un análisis diferenciado por género. MÉTODOS: Se realizó un estudio transversal. Participaron cinco cupos de Medicina de Familia. Se evaluó la CVRS (mediante el cuestionario EuroQol-5D), cuatro variables relacionadas con la HTA (grado de control, duración de la enfermedad, uso de fármacos antihipertensivos y lesión de órgano diana -LOD-), variables sociodemográficas, de estilo de vida y clínicas. Se realizó análisis bivariado y se elaboraron dos modelos multivariados, con el índice EuroQol-5D (iEQ) como variable dependiente. RESULTADOS: Fueron analizadas 198 mujeres (55,7%) y 157 varones. Las mujeres, significativamente, tenían menor nivel educativo, pasaban más tiempo solas, consumían más psicofármacos, su iEQ fue menor (0,887 [0,2] frente a 0,914 [0,1]; p = 0,0001) y puntuaron peor en cuidado personal, actividades cotidianas, dolor/malestar y ansiedad/depresión. En las mujeres, tras ajustar por confusores, ninguna variable relacionada con la HTA presentó una asociación significativa con el iEQ, y la capacidad funcional fue la variable más importante (beta=0,35; p = 0,0001). En los varones, la LOD (beta=0,18) y la duración de la HTA (beta=0,16) se asociaron significativamente con el iEQ, siendo el consumo de psicofármacos la variable más relevante del modelo de regresión (beta=0,42; p = 0,005). CONCLUSIONES: Se observan notables diferencias en la CVRS de las mujeres y los varones con HTA. Detectar dichas diferencias permite conocer los perfiles más frágiles de nuestros pacientes

OBJECTIVE: Hypertension is a major public health problem due to its high prevalence and morbi-mortality. It is associated with a worse health-related quality of life (HRQOL). The aim has been to know the HRQOL of the hypertensive population in a gender-differentiated analysis. METHODS: Cross-sectional study. Hypertensive patients attended in Primary Care were enrolled in the study. We evaluated HRQOL (using the EuroQol-5D questionnaire), four covariates related to hypertension (degree of control, duration of disease, use of antihypertensive drugs and target organ damage -TOD-), and sociodemographic, lifestyle and clinical variables. Bivariate analysis was performed and two multivariate models were developed, with the EuroQol-5D index (iEQ) as the dependent variable. RESULTS: We analyzed 198 women (55.7%) and 157 men. Significantly, females had a lower educational level, spent more time alone, consumed more psychotropic medication, their iEQ was lower [0.887 (0.2) vs. 0.914 (0.1); p = 0.0001] and scored worse in self-care, usual activities, pain / discomfort and anxiety / depression. In women, no variable related to hypertension presented a significant association with the iEQ after adjusting for confounders, and functional capacity was the most important covariate (Beta=0.35; p = 0.0001). In males, TOD (Beta=0.18) and duration of the disease (Beta=0.16) were significantly associated with the iEQ, with the consumption of psychotropic medication being the most relevant covariate in the regression model (Beta=0.42; p = 0.005). CONCLUSIONS: Notable differences in HRQOL of women and men with hypertension have been noted. Detecting these differences allows us to know the frailest states of our patients

Factores asociados a la infección por Clostridium difficile en un servicio de hospitalización domiciliaria / Factors associated to Clostridium difficile infection in a hospital-based home care service

Antecedentes y objetivo: No hay datos relativos a los factores de riesgo asociados a la infección por Clostridium difficile (ICD) en los servicios de hospitalización domiciliaria (SHD) del sistema sanitario español. Pacientes y métodos: Estudio casos-controles. Los casos fueron pacientes ingresados en un SHD entre 1 de enero de 2011 y el 31 de diciembre de 2016, que desarrollaron ICD. Los controles procedían de la misma población, con sospecha clínica de ICD y toxina CD(-). Se analizaron 82 variables. Resultados: Fueron evaluados 17 casos y 95 controles, sin diferencias por sexo, edad o comorbilidad. Se registró diarrea en el 94% y 92%, y un porcentaje de exitus del 18% y 1%, respectivamente (p=0,001). La hemiplejia/paraplejia se asoció significativamente con la ICD (odds ratio [OR] ajustada=26,4; IC 95%: 2,9-235,6; p=0,003), mientras que la enfermedad respiratoria crónica y el uso de cefalosporinas presentaron una significación marginal (OR ajustadas de 2,9 [0,8-10,3] y 3,1 [0,8-11,3], ambas p=0,08). Conclusiones: Las acciones en el SHD frente a la ICD deberían incluir una reducción en el uso de antibióticos de riesgo -según lo observado, las cefalosporinas- especialmente ante ciertas comorbilidades, como una hemiplejia/tetraplejia o una enfermedad respiratoria crónica

Background and objective: There are no data related to the risk factors associated with CDI in a Hospital-Based Home Care Service (HBHCS) of the Spanish health system. Patients and methods: Case-control study. The cases were patients admitted to the HBHCS between 01/01/2011 and 31/12/2016 who developed CDI. The controls came from the same population, with suspected CDI and CD(-) toxin. We analysed 82 variables. Results: We analysed 17 cases and 95 controls, without differences in sex, age or comorbidity. Diarrhoea was noted in 94% and 92%, and a percentage of deaths of 18% and 1%, respectively (P=.001). The presence of hemiplegia/paraplegia (adjusted odds ratio [OR]=26.4, 95% CI 2.9-235.6, P=.003) showed a significant relationship with CDI, while chronic respiratory disease and the use of cephalosporins did so with marginal significance (adjusted OR=2.9, 95% CI 0.8-10.3 and 3.1, 95% CI 0.8-11.3, respectively, both P=.08). Conclusions: Actions in the HBHCS directed towards CDI should include a reduction in the use of high-risk antibiotics -according to our results, cephalosporins- especially in patients with specific comorbidities, such as hemiplegia/tetraplegia or a chronic respiratory disease

Interobserver agreement using Schlapbach graded scale for diffuse idiopathic skeletal hyperostosis (DISH): can we reduce the cut-off point of vertebral affection?

Resnick-Niwayama criteria for diagnosing DISH depict an advanced stage, and a new reduced cut-off point with three contiguous vertebrae affected (two bone bridges) has been proposed. The aim has been to know the interobserver agreement by using a graded scale of DISH in which grade II matches with the new proposed cut-off point and grade III matches with the first criterion of Resnick-Niwayama. Males ≥ 50 years and postmenopausal women included in a population-based prospective study (the Camargo Cohort) were analyzed. Sample size was obtained according to an expected kappa of 0.95 and an accuracy of ± 8%. Three physicians applied independently Schlapbach graded scale (ranged from grade 0, no ossification, to grade III, ≥ 3 consecutive bone bridges) on the lateral radiographs of thoracic and lumbar spine of participants. We calculated inter- and intra-observer agreement and correlation. One hundred and fifty eight radiographs (79 patients, 68 ± 9 years) were assessed. Kappa values (95% confidence interval) for grades 0, I, II, and III were 0.63 (0.50-0.77), 0.49 (0.37-0.62), 0.32 (0.17-0.47), and 0.69 (0.60-0.77), respectively. Weighted kappa for the three pairs of raters were 0.87 (0.82-0.93), 0.84 (0.77-0.91), and 0.81 (0.72-0.90). Grade III was the image that generated greater agreement, while a significant decrease was noted in grade II, the new proposed criterion. The simultaneous presence of an incomplete DISH and osteoarthritis, in a thoracic spinal segment with peculiar anatomical characteristics (reduced disk spaces, kyphotic curve), is thought to be a major cause of variability in the results.

Factors associated to Clostridium difficile infection in a hospital-based home care service. / Factores asociados a la infección por Clostridium difficile en un servicio de hospitalización domiciliaria.

BACKGROUND AND OBJECTIVE: There are no data related to the risk factors associated with CDI in a Hospital-Based Home Care Service (HBHCS) of the Spanish health system. PATIENTS AND METHODS: Case-control study. The cases were patients admitted to the HBHCS between 01/01/2011 and 31/12/2016 who developed CDI. The controls came from the same population, with suspected CDI and CD(-) toxin. We analysed 82 variables. RESULTS: We analysed 17 cases and 95 controls, without differences in sex, age or comorbidity. Diarrhoea was noted in 94% and 92%, and a percentage of deaths of 18% and 1%, respectively (P=.001). The presence of hemiplegia/paraplegia (adjusted odds ratio [OR]=26.4, 95% CI 2.9-235.6, P=.003) showed a significant relationship with CDI, while chronic respiratory disease and the use of cephalosporins did so with marginal significance (adjusted OR=2.9, 95% CI 0.8-10.3 and 3.1, 95% CI 0.8-11.3, respectively, both P=.08). CONCLUSIONS: Actions in the HBHCS directed towards CDI should include a reduction in the use of high-risk antibiotics -according to our results, cephalosporins- especially in patients with specific comorbidities, such as hemiplegia/tetraplegia or a chronic respiratory disease.

Uso de contenciones en el anciano. La perspectiva de familiares y cuidadores / Applying physical restraints in the elderlu: relatives' and caregivers' perspective

Objetivo. Las contenciones físicas en el anciano se usan tradicionalmente para prevenir caídas, evitar interferencias con dispositivos invasivos o controlar la agitación. Son muy cuestionadas, por la pérdida de dignidad y el riesgo de complicaciones graves. El objetivo del estudio ha sido explorar los conocimientos y actitudes ante las contenciones en el anciano en el ámbito doméstico, dada la escasez de datos en este aspecto. Método. Estudio transversal-descriptivo, con utilización de un cuestionario con preguntas sobre conocimientos y actitudes ante las contenciones, sobre una muestra de cuidadores profesionales y familiares de ancianos dependientes. Se calculó el α de Cronbach para valorar la consistencia interna del cuestionario y en el análisis de los resultados se utilizó el chi cuadrado. Resultados. Se analizaron 134 cuestionarios cumplimentados (78 % mujeres, 22 % varones; 74 % familiares, 26 % cuidadores; 52 % con paciente institucionalizado, 48 % con paciente en domicilio). Dos preguntas clave presentaron un porcentaje de fallos > 50 %. Acerca de las actitudes, respondió afirmativamente que «utilizaría la contención en un familiar» el 93 % de mujeres y el 79 % de varones (p = 0.09), mientras que «considera la contención una forma de maltrato» el 7 % de mujeres y el 25 % de varones (p = 0.01). Conclusiones. Se ha observado un notable desconocimiento, tanto en familiares como en cuidadores, sobre las indicaciones y las consecuencias de la contención. Asimismo, los resultados sugieren una actitud más tolerante hacia la contención en las mujeres, respecto a los varones. Según estos resultados, es conveniente establecer programas formativos sobre las contenciones, dirigidos al ámbito doméstico (AU)

Objective. Physical restraints in the elderly are traditionally used to prevent falls, interference with invasive devices or controlling agitation. However, it is questionable whether this practice is justifiable, due to loss of dignity and risk of leading to severe complications. Data about restraints in the domestic environment are scarce. Our aim was to survey relatives' and caregivers' knowledge and attitudes towards the use of physical restraints in the elderly. Method. Cross-sectional study with a convenience sample. An anonymous questionnaire about knowledge and attitudes was used. It was directed to professional caregivers and relatives of dependent elders. Cronbach's alpha was calculated to assess the internal consistency and chi-squared test was performed to compare proportions. Results. 134 questionnaires were analyzed. 78 % of respondents were female and 22 % male; 74 % were relatives and 26 % were caregivers. In 52 % of the cases, the older person was institutionalized and in 48% of the cases, was cared for at home. Two key questions showed > 50 % errors. Regarding attitudes, 93 % females and 79 % males (p = 0.09) answered that if necessary, they would apply a physical restraint to a relative. 7 % female and 25 % male (p = 0.01) respondents considered restraints as a form of abuse. Conclusions. We have observed a remarkable lack of knowledge on indications and consequences of physical restraints. It is also noticeable that women presented a more tolerant attitude towards the use of restraints. It is necessary to perform restraint-reduction programs directed to relatives and caregivers (AU)

Relación entre hiperostosis esquelética idiopática difusa, calcificación de la aorta abdominal y las alteraciones metabólicas asociadas: datos de la Cohorte Camargo / Relationship between diffuse idiopathic skeletal hyperostosis, abdominal aortic calcification and associated metabolic disorders: Data from the Camargo Cohort

Antecedentes y objetivo: La hiperostosis esquelética idiopática difusa (DISH, del inglés diffuse idiopathic skeletal hyperostosis) y la calcificación aórtica abdominal (CAA) se asocian a un incremento del riesgo cardiovascular. El objetivo fue analizar una posible relación entre ambas, así como las alteraciones metabólicas asociadas a la DISH. Pacientes y método: Estudio transversal-analítico, incluido en una cohorte poblacional. La DISH (criterios de Resnick-Niwayama) y la CAA (mediante la escala AAC-24) fueron evaluadas sobre imágenes de radiología simple. Se evaluaron asimismo otras 40 variables clínicas mediante correlaciones y regresión multivariante. Resultados: Fueron analizados 987 varones ≥ 50 años, con una edad media = 65, 5±9 años. Las prevalencias de DISH y CAA fueron del 21,6% y del 58,7%, respectivamente. El sujeto con DISH tenía mayor edad (68,1±9 vs. 63,8±9 años; p=0,0001) y con mayor frecuencia presentaba síndrome metabólico (SM) (55,6 vs. 36,6%; p=0,0001). La CAA fue de 3,7±5 puntos en sujetos con DISH frente a 3,3±5 en sujetos sin DISH (p=0,25), y se asoció a un riesgo incrementado de DISH prevalente (OR cruda=1,4 [IC95%: 1,01-1,9]; p=0,04), que desapareció al ajustar por edad (OR ajustada=1,1 [IC95%: 0,8-1,5]; p=0,47). No se observó asociación de la DISH con la hipertensión arterial, diabetes mellitus o dislipidemia, pero mantuvieron una relación significativa tras ajustar por confusores la edad (OR=2,2 [IC95%: 1,6-3]; p=0,0001), el IMC (OR=1,5 [IC95%: 1,1-2]; p=0,007), el perímetro abdominal (OR=1,5 [IC95%: 1,04-2,3]; p=0,03) y el SM (OR=1,7 [IC95%: 1,1-2,4]; p=0,005). Conclusiones: No se ha podido demostrar una asociación consistente entre la DISH y la CAA, presentando ambas una débil relación dependiente de la edad. La DISH ha mostrado unas asociaciones significativas con la edad, el IMC, el perímetro abdominal y el SM (AU)

Background and objective: Diffuse idiopathic skeletal hyperostosis (DISH) and abdominal aortic calcification (AAC) are related to an increased cardiovascular risk. The aim of this study was to analyse a possible relationship between both entities and also the association between metabolic disorders and DISH. Patients and method: Analytic cross-sectional study in a population-based cohort. DISH (with Resnick-Niwayama criteria) and AAC (with AAC-24 scale) were assessed on plain x-ray images. Interaction terms between DISH and forty clinical covariates were also investigated, through correlation analysis and multivariate regression. Results: Nine hundred eighty-seven males aged≥50 years, with a mean age=65,5±9 years, were evaluated. Prevalence rates of DISH and AAC were 21.6% and 58.7%, respectively. DISH+ subjects were older (68.1±9 vs. 63.8±9 years; P=.0001) and more likely to be affected by metabolic syndrome (MS) (55.6% vs. 36.6%; P=.0001). In DISH+ subjects, the AAC was 3.7±5 points, whereas in DISH− subjects it was 3.3±5 (P=.25). AAC was associated with an increased risk of prevalent DISH (unadjusted OR=1.4 [CI95%: 1.01-1.9]; P=.04), that disappeared when it was adjusted for age (adjusted OR=1.1 [CI95%: 0.8-1.5];P=.47]. No association was found between DISH and hypertension, diabetes or dyslipidaemia; however, age (OR=2.2 [CI95%: 1.6-3]; P=.0001), BMI (OR=1.5 [CI95%: 1.1-2]; P=.007), waist circumference (OR=1.5 [CI95%: 1.04-2,3]; P=.03) and MS (OR=1.7 [CI95%: 1.1-2.4]; P=.005) showed a significant relationship with DISH after adjusting for confounders. Conclusions: The study was not able to demonstrate a consistent association between DISH and AAC, proving only a weak and age-dependent relationship between them. DISH proved to be significantly associated with age, BMI, waist circumference and MS (AU)

Relationship between diffuse idiopathic skeletal hyperostosis, abdominal aortic calcification and associated metabolic disorders: Data from the Camargo Cohort. / Relación entre hiperostosis esquelética idiopática difusa, calcificación de la aorta abdominal y las alteraciones metabólicas asociadas: datos de la Cohorte Camargo.

BACKGROUND AND OBJECTIVE: Diffuse idiopathic skeletal hyperostosis (DISH) and abdominal aortic calcification (AAC) are related to an increased cardiovascular risk. The aim of this study was to analyse a possible relationship between both entities and also the association between metabolic disorders and DISH. PATIENTS AND METHOD: Analytic cross-sectional study in a population-based cohort. DISH (with Resnick-Niwayama criteria) and AAC (with AAC-24 scale) were assessed on plain x-ray images. Interaction terms between DISH and forty clinical covariates were also investigated, through correlation analysis and multivariate regression. RESULTS: Nine hundred eighty-seven males aged≥50 years, with a mean age=65,5±9 years, were evaluated. Prevalence rates of DISH and AAC were 21.6% and 58.7%, respectively. DISH+ subjects were older (68.1±9 vs. 63.8±9 years; P=.0001) and more likely to be affected by metabolic syndrome (MS) (55.6% vs. 36.6%; P=.0001). In DISH+ subjects, the AAC was 3.7±5 points, whereas in DISH- subjects it was 3.3±5 (P=.25). AAC was associated with an increased risk of prevalent DISH (unadjusted OR=1.4 [CI95%: 1.01-1.9]; P=.04), that disappeared when it was adjusted for age (adjusted OR=1.1 [CI95%: 0.8-1.5];P=.47]. No association was found between DISH and hypertension, diabetes or dyslipidaemia; however, age (OR=2.2 [CI95%: 1.6-3]; P=.0001), BMI (OR=1.5 [CI95%: 1.1-2]; P=.007), waist circumference (OR=1.5 [CI95%: 1.04-2,3]; P=.03) and MS (OR=1.7 [CI95%: 1.1-2.4]; P=.005) showed a significant relationship with DISH after adjusting for confounders. CONCLUSIONS: The study was not able to demonstrate a consistent association between DISH and AAC, proving only a weak and age-dependent relationship between them. DISH proved to be significantly associated with age, BMI, waist circumference and MS.

A propósito de un caso de paraganglioma / A propos of a case of paraganglioma

Los paragangliomas son tumores neuroendocrinos que surgen de los paraganglios autonómicos extraadrenales, los cuales son pequeños órganos formados por células derivadas de la cresta neural embrionaria con capacidad de secretar catecolaminas. Los paragangliomas están estrechamente relacionados con los feocromocitomas porque son indistinguibles a nivel celular, y a menudo comparten las mismas manifestaciones clínicas, como hipertensión, cefalea episódica, sudoración y taquicardia. El diagnóstico de estos tumores es importante por su riesgo de malignización, por las implicaciones de otras neoplasias asociadas, y para la posibilidad de realizar estudios genéticos para detección de otros casos dentro de una misma familia. El objetivo de este artículo es desarrollar un resumen sobre la epidemiología, manifestaciones clínicas, pruebas diagnósticas y tratamiento de estos tumores. Se presenta el caso de un joven de raza negra diagnosticado de un paraganglioma(AU)

Paragangliomas are neuroendocrine tumors emerging from the extra-adrenal autonomic paraganglia, which are small organs formed by embryonic neural crest-derived cells with catecholamine-secreting capacity. Paragangliomas are closely linked to pheochromocytomas because they cannot be differentiated at cell level and often share the same clinical manifestations such as hypertension, episodic headache, sweating and tachycardia. The diagnosis of these tumors is important because of risk of becoming malignant, the implications of other related neoplasias and the possibility of making genetic studies to detect other cases in the same family. The objective of this article was to make an abstract about epidemiology, clinical manifestations, diagnostic tests and treatment of these tumors. This is the case of a young Black female who was diagnosed with paraganglioma(AU)

La Escala de Norton como predictor de la calidad de vida relacionada con la salud en el anciano institucionalizado / The Norton Scale as predictor of health-related quality of life in institutionalized elderly

OBJETIVO: Una puntuación baja en la Escala de Norton (EdN), además de señalar el riesgo de aparición de una úlcera por presión, parece ser pronóstica de otros eventos adversos en el anciano. Por otro lado, la calidad de vida relacionada con la salud (CVRS) es un indicador con utilidades clínicas y, asimismo, predictivas. El objetivo ha sido analizar la relación entre la EdN y la CVRS en un análisis diferenciado por género. MÉTODO: Cincuenta y una mujeres y 39 varones de ≥ 65 años, institucionalizados, fueron estudiados mediante entrevista personal y registros médicos. Fueron evaluadas la EdN y la CVRS -mediante el cuestionario EuroQol-5D-, además de la edad, el índice de masa corporal, las caídas, el consumo de psicotropos, la función cognitiva, y los índices de Charlson, Barthel y Tinetti. Se elaboraron 2 modelos de regresión, con el EuroQol-5D como variable dependiente. RESULTADOS: La EdN mostró el mismo resultado en ambos sexos, con un valor de mediana (rango intercuartílico) de 19 (2). Las mujeres refirieron una peor CVRS, con un EuroQol-5D = 0,78, frente a 0,87 en los varones (p = 0,02). La EdN se correlacionó significativamente con la CVRS en las mujeres (r = 0,57; p < 0,001), pero no en los varones (r = 0,15; p = 0,36). Con el ajuste multivariante, la EdN presentó un valor beta = 0,54 (p = 0,02) en las mujeres y beta = 0,35 (p = 0,14) en los varones. CONCLUSIONES: La EdN ha sido la variable de mayor impacto sobre la CVRS en las mujeres, siendo dicha asociación independiente de la edad, la comorbilidad y el resto de las variables analizadas. En los varones, la relación fue más débil y no alcanzó la significación estadística

OBJECTIVE: A low Norton Scale (NS) score predicts pressure ulcer risk and several adverse outcomes in the elderly. On the other hand, health-related quality of life (HRQOL) is an indicator with clinical and predictive utilities. The aim was to assess the relationship between NS and HRQOL, in a gender analysis. Method: Fifty-one women and 39 men, institutionalized and aged ≥ 65 years, were evaluated through personal interview and medical records. The NS, HRQOL -with EuroQol-5D-, age, body mass index, falls, use of psychoactive drugs, cognitive function and Charlson, Barthel and Tinetti indexes, were assessed. Two regression models were developed, with EuroQol-5D as dependent variable. RESULTS: The NS showed the same score in both sexes, with a median (interquartile range) value of 19 (2). Women presented a worse HRQOL, with an EuroQol-5D = 0.78, whereas it was 0.87 in men (P = .02). The NS score was correlated with HRQOL in women (r = 0.57; P < .001) but not in men (r = 0.15;P = .36). After adjusting for confounders, the NS showed a beta value of 0.54 (P = .02) in women and beta = 0.35 (P = .14) in men. CONCLUSIONS: The NS has shown to be the strongest factor on HRQOL in women, regardless of age, comorbidity and the rest of covariates. Conversely, the relationship was weaker and non-significant in men

[The Norton Scale as predictor of health-related quality of life in institutionalized elderly]. / La Escala de Norton como predictor de la calidad de vida relacionada con la salud en el anciano institucionalizado.

OBJECTIVE: A low Norton Scale (NS) score predicts pressure ulcer risk and several adverse outcomes in the elderly. On the other hand, health-related quality of life (HRQOL) is an indicator with clinical and predictive utilities. The aim was to assess the relationship between NS and HRQOL, in a gender analysis. METHOD: Fifty-one women and 39 men, institutionalized and aged≥65 years, were evaluated through personal interview and medical records. The NS, HRQOL -with EuroQol-5D-, age, body mass index, falls, use of psychoactive drugs, cognitive function and Charlson, Barthel and Tinetti indexes, were assessed. Two regression models were developed, with EuroQol-5D as dependent variable. RESULTS: The NS showed the same score in both sexes, with a median (interquartile range) value of 19 (2). Women presented a worse HRQOL, with an EuroQol-5D=0.78, whereas it was 0.87 in men (P=.02). The NS score was correlated with HRQOL in women (r=0.57; P<.001) but not in men (r=0.15; P=.36). After adjusting for confounders, the NS showed a ß value of 0.54 (P=.02) in women and ß=0.35 (P=.14) in men. CONCLUSIONS: The NS has shown to be the strongest factor on HRQOL in women, regardless of age, comorbidity and the rest of covariates. Conversely, the relationship was weaker and non-significant in men.

[Health-Related Quality of Life as an Explanatory Variable of Primary Care Consultations: sex Differences]. / Calidad de vida relacionada con la salud como variable explicativa del consumo de consultas en atención primaria: un análisis por sexo.

BACKGROUND: It is well known the inverse relationship between health-related quality of life (HRQoL) and the use of consultations. However, most studies deal sex as a confounding variable rather than to explicitly investigate sex differences. The study aims to know the influence of HRQoL of the elderly on the use of Primary Care consultations in a sex analysis. METHODS: Throughout 2013, 191 women and 155 men aged 65 years or older were enrolled in the study and assessed with interviews and analysis of medical records. We used the EuroQol-5D to assess the HRQoL and several demographic, clinical and social support variables were also analyzed. Two multiple linear regression models were developed. RESULTS: HRQoL showed a negative correlation with the use of consultations (Spearman's rho=-0,22; p=0,0001) and a crude OR value of 1,85 (95% CI:1,2-2,9). The association remained significant after adjusting for demographic [OR=1,99 (95% CI: 1,2-3,2)], clinical [OR=1,79 (95% CI: 1,1-2,9)] or social support covariates [OR=1,83 (95% CI: 1,1-2,9)]. In regression analysis, the values of standardized coefficient (ß) related to HRQoL were 0,22 (95% CI:-36,7- -6,9) in females and 0,03 (95% CI:-15,6-23,1) in males. CONCLUSIONS: In women ≥ 65 years, HRQoL shows the greatest explanatory power of use of consultations, after adjusting for demographic, clinical and social support covariates. By contrast, its influence on men is negligible.

Calidad de vida relacionada con la salud como variable explicativa del consumo de consultas en atención primaria: un análisis por sexo / Health-Related Quality of Life as an Explanatory Variable of Primary Care Consultations: Sex Differences

Fundamentos: Es conocida la asociación inversa que existe entre la calidad de vida relacionada con la salud (CVRS) y el consumo de consultas. Sin embargo, el sexo es considerado habitualmente como variable de confusión, y son escasos los estudios que han analizado explícitamente las diferencias de sexo en esta cuestión. El objetivo fue conocer la influencia de la CVRS sobre el uso de consultas de Atención Primaria en las personas >65 años, en un análisis diferenciado por sexo. Métodos: La selección de participantes se realizó a lo largo de 2013, 191 mujeres y 155 varones de ≥65 años fueron estudiados mediante entrevista y análisis de historias clínicas. Se utilizó el Cuestionario EuroQol-5D y fueron analizadas variables demográficas, clínicas y de apoyo social. Se elaboraron 2 modelos de regresión múltiple, uno dirigido a las mujeres y otro a los varones. Resultados: La CVRS se correlacionó de forma negativa con el consumo de consultas (Rho-Spearman=-0,22; p=0,0001), con una OR cruda de 1,85 (IC95%: 1,2-2,9). La asociación se mantuvo significativa al ajustar tanto por variables demográficas [OR=1,99 (IC95%: 1,2–3,2)], como por variables clínicas [OR=1,79 (IC95%: 1,1-2,9)] o de apoyo social [OR=1,83 (IC95%: 1,1–2,9)]. En el análisis de regresión, los valores del coeficiente estandarizado (β) asociado a la CVRS fueron 0,22 (IC95%: -36,7– -6,9) en las mujeres, y 0,03 (-15,6–23,1) en los varones. Conclusiones: En las mujeres de ≥65 años la CVRS es la variable con mayor capacidad explicativa de consumo de consultas, tras ajustar por variables demográficas, clínicas y de apoyo social. Por el contrario, en los varones su influencia es prácticamente nula (AU)

Background: It is well known the inverse relationship between health-related quality of life (HRQoL) and the use of consultations. However, most studies deal sex as a confounding variable rather than to explicitly investigate sex differences. The study aims to know the influence of HRQoL of the elderly on the use of Primary Care consultations in a sex analysis. Methods: Throughout 2013, 191 women and 155 men aged 65 years or older were enrolled in the study and assessed with interviews and analysis of medical records. We used the EuroQol-5D to assess the HRQoL and several demographic, clinical and social support variables were also analyzed. Two multiple linear regression models were developed. Results: HRQoL showed a negative correlation with the use of con-sultations (Spearman´s rho=-0,22; p=0,0001) and a crude OR value of 1,85 (95% CI:1,2–2,9). The association remained significant after adjusting for demographic [OR=1,99 (95% CI: 1,2–3,2)], clinical [OR=1,79 (95% CI: 1,1–2,9)] or social support covariates [OR=1,83 (95% CI: 1,1–2,9)]. In regression analysis, the values of standardized coefficient (β) related to HRQoL were 0,22 (95% CI:-36,7– -6,9) in females and 0,03 (95% CI:-15,6–23,1) in males. Conclusions: In women ≥65 years, HRQoL shows the greatest explanatory power of use of consultations, after adjusting for demographic, clinical and social support covariates. By contrast, its influence on men is negligible (AU)

Relación entre la concentración plasmática de tirotropina y enfermedad cardiovascular (Cohorte Camargo) / Relationship between the plasmatic level of thyrotropin and cardiovascular disease (the Camargo Cohort)

Fundamentos y objetivo: La edad parece modificar la relación entre el hipotiroidismo y la enfermedad cardiovascular (ECV). Si bien en sujetos muy ancianos el hipotiroidismo se ha asociado a longevidad, en las personas de ≤65 años el hipotiroidismo subclínico parece relacionarse con un mayor riesgo cardiovascular (RCV). El objetivo del estudio ha sido conocer la capacidad explicativa de la tirotropina plasmática (TSHp) para la ECV en diferentes estratos de edad (≤55, 56-74, ≥75 años), sexo y factores de RCV. Pacientes y método: Un total de 664 varones y mujeres son diferenciados en 18 estratos. Mediante regresión lineal múltiple se elaboran los 18 modelos explicativos. La variable dependiente es la calcificación aórtica abdominal (CAA), según la escala AAC-24. Las variables independientes son: TSHp, edad, hábito tabáquico, índice de masa corporal, presión arterial sistólica, presión arterial diastólica, glucemia basal, colesterol total, colesterol unido a lipoproteínas de alta densidad, colesterol unido a lipoproteínas de baja densidad y proteína C reactiva. Resultados: La edad es la principal variable explicativa de CAA. El mayor valor del coeficiente β estandarizado de la TSHp se observa en varones≤55 años (β=0,235, p=0,043) y en mujeres≥75 años (β=0,405, p=0,042). Al incrementarse la edad, la capacidad explicativa de la TSHp para la CAA aumenta en las mujeres y disminuye en los varones. En varones≥75 años hay una correlación negativa entre TSHp y CAA (rho-Spearman=-0,213, p=0,049). Conclusiones: Se observa una asociación positiva entre la TSHp y ECV en varones≤55 años y en mujeres≥75 años. La combinación de la regresión múltiple y el análisis estratificado ha mostrado la compleja influencia de la edad en la relación entre ambas variables (AU)

Background and objective: Age seems to modify the relationship between hypothyroidism and cardiovascular disease (CVD). Although hypothyroidism in very elderly subjects has been associated with longevity, subclinical hypothyroidism in people≤65 years seems to be related with an increased cardiovascular risk (CVR). The aim of this study was to determine the explanatory power of plasmatic TSH (pTSH) for the CVD, in different strata determined by age (≤55, 56-74, ≥75 years), sex and CVR factors. Patients and methods: Six hundred and sixty-four men and women were differentiated into 18 strata and their explanatory models were developed using the multiple linear regression analysis. The dependent variable is the abdominal aortic calcification (AAC) according to the AAC-24 scale. The independent variables are: pTSH, age, smoking, BMI, SBP, DBP, fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol and C-reactive protein. Results: Age is the main explanatory factor of AAC. The highest explanatory value of the β-standardized coefficient of the pTSH is observed in males≤55 years (β=0.235, P=.043) and in females≥75 years (β=0.405, P=.042). With increasing age, the prediction power improves in women and decreases in men. In men≥75 years there is a negative correlation between pTSH and AAC (rho-Spearman=-0.213, P=.049). Conclusions: A positive association is observed between pTSH and CVD in males≤55 years and in women≥75 years. The combination of multiple regression and the stratified analysis shows the complex influence of age in the relation between both variables (AU)