Triglyceride to HDL Cholesterol Ratio for the Identification of MASLD in Obesity: A Liver Biopsy-Based Case-Control Study.

Associations between dyslipidemia and metabolic dysfunction-associated steatotic liver disease (MASLD) have been reported. Previous studies have shown that the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio may be a surrogate marker of MASLD, assessed by liver ultrasound. However, no studies have evaluated the utility of this ratio according to biopsy-proven MASLD and its stages. Therefore, our aim was to evaluate if the TG/HDL-C ratio allows for the identification of biopsy-proven MASLD in patients with obesity. We conducted a case-control study in 153 patients with obesity who underwent metabolic surgery and had a concomitant liver biopsy. Fifty-three patients were classified as no MASLD, 45 patients as metabolic dysfunction-associated steatotic liver-MASL, and 55 patients as metabolic dysfunction-associated steatohepatitis-MASH. A receiver operating characteristic (ROC) analysis was performed to assess the accuracy of the TG/HDL-C ratio to detect MASLD. We also compared the area under the curve (AUC) of the TG/HDL-C ratio, serum TG, and HDL-C. A higher TG/HDL-C ratio was observed among patients with MASLD, compared with patients without MASLD. No differences in the TG/HDL-C ratio were found between participants with MASL and MASH. The greatest AUC was observed for the TG/HDL-C ratio (AUC 0.747, p < 0.001) with a cut-off point of 3.7 for detecting MASLD (sensitivity = 70%; specificity = 74.5%). However, no statistically significant differences between the AUC of the TG/HDL-C ratio and TG or HDL-C were observed to detect MASLD. In conclusion, although an elevated TG/HDL-C ratio can be found in patients with MASLD, this marker did not improve the detection of MASLD in our study population, compared with either serum TG or HDL-C.

The role of PCSK9 in metabolic dysfunction-associated steatotic liver disease and its impact on bariatric surgery outcomes.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely tied to obesity. The degree ranges from steatosis (MASL) and steatohepatitis (MASH) to liver cirrhosis. PCSK9 controls cholesterol and lipid particle transport to the liver. PCSK9 might interfere with the pathophysiology of MASLD and bariatric surgery (BS) outcomes of patients with MASLD. OBJECTIVES: Evaluate the relationship between serum and hepatic PCSK9 levels with the degree of MASLD and the metabolic outcome of BS. SETTING: University Hospital, Spain. METHODS: A total of 110 patients with obesity undergoing BS were classified according to liver histology as controls, MAS, and MASH. PCSK9 levels in serum were measured before and 6 months after BS using enzyme-linked immunosorbent assay. PCSK9 protein and mRNA levels in liver tissue were analyzed by immunohistochemistry and reverse transcriptase-polymerase chain reaction, respectively. RESULTS: Hepatic PCSK9 protein levels were diminished in MASL and MASH compared with patients without MASLD and showed a strong negative association with MASLD severity scores. Liver PCSK9 mRNA was higher in MASH compared with controls and MASL and showed positive associations with MASLD severity scores. There were no differences in serum PCSK9 pre or postBS between the groups. Pre- and postsurgery serum PCSK9 positively correlated with cholesterol fold-changes and body mass index (BMI), cholesterol, and low-density lipoprotein -cholesterol fold-changes, respectively. PCSK9 fold-change positively correlated with BMI changes and was the sole variable explaining BMI fold changes in a regression model. CONCLUSIONS: PCSK9 mRNA and protein in the liver might be associated with the degree of MASLD. Serum PCSK9 may be associated with cholesterol and/or BMI fold changes. Serum changes of PCSK9 after BS could explain BMI loss outcome.

Servicios de ayuda en el hogar en Galicia, ¿un recurso para intervenir en la soledad? / Home Help Services in Galicia, a resource to intervening in loneliness?

La soledad es un factor social que afecta a personas de todas las edades, perjudicando su salud y aumentando la utilización de servicios sociosanitarios. Su abordaje requiere una perspectiva comunitaria integral, ya que es un sentimiento subjetivo con consecuencias complejas en la salud y en el bienestar. En una sociedad envejecida, la soledad se convierte en un problema de salud pública significativo, especialmente entre las personas mayores. Por ello, este estudio se centra en los servicios de ayuda en el hogar (Servicio de Axuda no Fogar, SAF) en Galicia y su papel en la lucha contra la soledad, con el objetivo de comprender este sentimiento entre las personas usuarias del SAF y recopilar sus opiniones para entender cómo abordarla y diseñar estrategias intersectoriales y participativas que permitan ayudar a disminuirla. Los resultados iniciales muestran que más del 50% de los usuarios del SAF se sienten solos. A través de la elaboración de un cuestionario propio y de mediciones utilizando la escala de soledad UCLA, el estudio destaca la importancia de la colaboración comunitaria y la necesidad de difundir los resultados para orientar intervenciones futuras. Se concluye que los SAF tienen un potencial significativo para mejorar el bienestar de los usuarios y abordar la soledad, un factor social determinante de la salud. (AU)

Loneliness is a social factor that impacts individuals of all ages, impairing their health and increasing the use of socio-health services. Tackling this requires a comprehensive community perspective, as it is a subjective feeling with complex consequences for health and well-being. In an aging society, loneliness becomes a significant public health issue, especially among the elderly. Therefore, this study focuses on Home Help Services (SAF) in Galicia and their role in responding to loneliness. The main aim is to understand this feeling among SAF users, gather their opinions on how to tackle this, and devise intersectoral and participatory strategies to reduce loneliness. Initial results reveal that over 50% of SAF users feel lonely. By means of a customized questionnaire and measurements using the UCLA Loneliness Scale, the study underscores the importance of community collaboration and the need to disseminate results to guide future interventions. It is concluded that SAF has significant potential to improve user well-being and tackle loneliness, a decisive social factor on health. (AU)

Lipidomic Analysis Reveals Alterations in Hepatic FA Profile Associated With MASLD Stage in Patients With Obesity.

CONTEXT: Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by the intracellular lipid accumulation in hepatocytes. Excess caloric intake and high-fat diets are considered to significantly contribute to MASLD development. OBJECTIVE: To evaluate the hepatic and serum fatty acid (FA) composition in patients with different stages of MASLD, and their relationship with FA dietary intake and MASLD-related risk factors. METHODS: This was a case-control study in patients with obesity undergoing bariatric surgery at a university hospital between January 2020 and December 2021. Participants were distributed in 3 groups: no MASLD (n = 26), steatotic liver disease (n = 33), and metabolic dysfunction-associated steatohepatitis (n = 32). Hepatic and serum FA levels were determined by gas chromatography-mass spectrometry. Nutritional status was evaluated using validated food frequency questionnaires. The hepatic expression of genes involved in FA metabolism was analyzed by reverse transcription quantitative polymerase chain reaction. RESULTS: The hepatic, but not serum, FA profiles were significantly altered in patients with MASLD compared with those without MASLD. No differences were observed in FA intake between the groups. Levels of C16:0, C18:1, and the C18:1/C18:0 ratio were higher, while C18:0 levels and C18:0/C16:0 ratio were lower in patients with MASLD, being significantly different between the 3 groups. Hepatic FA levels and ratios correlated with histopathological diagnosis and other MASLD-related parameters. The expression of genes involved in the FA metabolism was upregulated in patients with MASLD. CONCLUSION: Alterations in hepatic FA levels in MASLD patients were due to enhancement of de novo lipogenesis in the liver.

A novel model for predicting diabetes remission after bariatric surgery based on the measurement of C-peptide and creatinine in serum: A pilot study.

BACKGROUND AND AIMS: Bariatric surgery is effective for treating type 2 diabetes (T2D) in patients with obesity, although a significant proportion of these patients do not achieve diabetes remission after the surgery even after significant weight loss and metabolic improvement. C-peptide is a valuable marker of beta cell function and insulin secretion, but renal function must be considered when interpreting measurements in patients with T2D. The study aims to investigate the association of serum levels of C-peptide adjusted for creatinine with diabetes remission and glycemic target achievement after bariatric surgery in patients with obesity and T2D. METHODS AND RESULTS: Prospective data from a cohort of 84 patients with obesity and T2D submitted to Roux-en-Y gastric bypass (RYGB) were collected at baseline and at least a 6-month follow up. A multivariate binomial regression model showed that Ln(C-peptide/creatinine) and age were significantly associated with 6-month T2D remission. The area under the curve for the receiver operating characteristic analysis (AUROC) to predict remission was 0.87, and more accurate than the AUROC based on C-peptide levels alone (0.75). The same model was also able to predict achieving an HbA1c target of 7 % (53 mmol/mol) (AUROC 0.96). CONCLUSION: In conclusion, Ln(C-peptide/creatinine) ratio could be a useful tool in predicting T2D remission and target achievement after RYGB surgery, providing a more accurate reflection of beta cell function in bariatric patients.

Salubrízate, un proyecto de armonía con las personas y el entorno / Salubrízate: a project in harmony with the people and the environment

Introducción. Salubrízate es un grupo de procesos y activos comunitarios que realiza intervenciones de educación y promoción de la salud para el bienestar colectivo, en Ourense y alrededores desde el año 2018. Objetivo. El objetivo principal es conocer y responder a las inquietudes de salud de la ciudadanía. Métodos. Esta experiencia se basa en un modelo abierto a la participación, intersectorial y multidisciplinar, que tiene la capacidad de adaptarse a diversas circunstancias sanitarias o sociales, como la COVID. Se trabaja en cuatro áreas: hábitos saludables, bienestar emocional y social, entornos saludables y seguridad ciudadana. Tiene como recursos principales a las personas, los medios de comunicación colectiva como la radio y las redes sociales y diversas instituciones tanto sanitarias como sociales. Resultados. La repercusión de Salubrízate se está midiendo a través del alcance de cada uno de los proyectos llevados a cabo por el grupo, analizando también las debilidades que limitan el proyecto y sus fortalezas. (AU)

Introduction. Salubrízate is a group of community processes and assets that has been implementing health education and promotion interventions for collective well-being in Ourense and its surroundings since 2018.Aim. The main purpose is to be aware of the health concerns of citizens and respond to them.Methods. This experience is based on an intersectoral and multidisciplinary model open to participation, which can adapt to various health or social circumstances, such as COVID-19. The programme works on four areas: healthy habits, emotional and social well-being, healthy environments and citizen safety. Its key resources are people, mass media such as radio and social media and various health and social institutions.Results. The impact, strengths and limiting weaknesses of Salubrízate are being analysed by means of the scope of each project conducted by the group.

Hepatic and serum branched-chain fatty acid profile in patients with nonalcoholic fatty liver disease: A case-control study.

OBJECTIVE: Alterations in the hepatic lipidome are a crucial factor involved in the pathophysiology of nonalcoholic fatty liver disease (NAFLD). The aim of this study was to evaluate the serum and hepatic profile of branched-chain fatty acids (BCFAs) in patients with different stages of NAFLD. METHODS: This was a case-control study performed in 27 patients without NAFLD, 49 patients with nonalcoholic fatty liver, and 17 patients with nonalcoholic steatohepatitis, defined by liver biopsies. Serum and hepatic levels of BCFAs were analyzed by gas chromatography-mass spectrometry. The hepatic expression of genes involved in the endogenous synthesis of BCFAs was analyzed by real-time quantitative polymerase chain reaction (RT-qPCR). RESULTS: A significant increase in hepatic BCFAs was found in subjects with NAFLD compared with those without NAFLD; no differences were observed in serum BCFAs between study groups. Trimethyl BCFAs, iso-BCFAs, and anteiso-BCFAs were increased in subjects with NAFLD (either nonalcoholic fatty liver or nonalcoholic steatohepatitis) compared with those without NAFLD. Correlation analysis showed a relationship between hepatic BCFAs and the histopathological diagnosis of NAFLD, as well as other histological and biochemical parameters related to this disease. Gene expression analysis in liver showed that the mRNA levels of BCAT1, BCAT2, and BCKDHA were upregulated in patients with NAFLD. CONCLUSIONS: These results suggest that the increased production of liver BCFAs might be related to NAFLD development and progression.

Plasma short-chain fatty acid changes after bariatric surgery in patients with severe obesity.

BACKGROUND: Obesity has reached epidemic dimensions in recent decades. Bariatric surgery (BS) is one of the most effective interventions for weight loss and metabolic improvement in patients with obesity. Short-chain fatty acids (SCFA) are gut microbiota-derived metabolites with a key role in body weight control and insulin sensitivity. Although BS is known to induce significant changes in the gut microbiota composition, its impact on the circulating levels of certain metabolites produced by the gut microbiota such as SCFA remains poorly understood. OBJECTIVE: To determine the impact of BS on the circulating SCFA levels in patients with severe obesity. SETTING: University hospital. METHODS: An observational, prospective study was performed on 51 patients undergoing Roux-en-Y gastric bypass. Plasma samples were collected at baseline (1 day before surgery) and at 6 and 12 months after BS. Plasma SCFA levels were determined by liquid chromatography-mass spectrometry. RESULTS: The results revealed significant changes in the circulating levels of SCFA after BS. A marked increase in propionate, butyrate, isobutyrate, and isovalerate levels and a decrease in acetate, valerate, hexanoate, and heptanoate levels were observed 12 months after BS. Furthermore, the changes in the levels of propionate, butyrate, and isobutyrate negatively correlated with changes in body mass index, while those of isobutyrate correlated negatively with changes in the homeostatic model assessment for insulin resistance index. CONCLUSION: These results suggest that propionate, butyrate, and isobutyrate levels could be related to weight loss and improved insulin sensitivity in patients with severe obesity after BS.

Management of older hospitalized patients with type 2 diabetes using linagliptin: Lina-Older study.

BACKGROUND: Older patients managed with intensive antidiabetic therapy are more likely to be harmed. Our study's primary endpoint was to analyze the safety and efficacy of linagliptin in combination with basal insulin versus basal-bolus insulin in patients with 75 years of age or older hospitalized in medicine and surgery departments in real-world clinical practice. METHODS: We retrospectively enrolled non-critically patients ≥75 years with type 2 diabetes admitted to medicine and non-cardiac surgery departments with admission glycated hemoglobin <8%, admission blood glucose <240 mg/dL, and without at-home injectable therapies managed with our hospital's antihyperglycemic protocol (basal-bolus or linagliptin-basal regimens) between January 2016 and December 2018. To match each patient who started on the basal-bolus regimen with a patient who started on the linagliptin-basal regimen, a propensity matching analysis was used. RESULTS: Postmatching, 198 patients were included in each group. There were no significant differences in mean daily blood glucose levels after admission (P=0.203); patients with mean blood glucose 100-140mg/dL (P=0.134), 140-180mg/dL (P=0.109), or >200mg/dL (P=0.299); and number and day of treatment failure (P=0.159 and P=0.175, respectively). The total insulin dose and the number of daily injections were significantly lower in the linagliptin-basal group (both, P<0.001). Patients on the basal-bolus insulin regimen had more total hypoglycemic events than patients on the linagliptin-basal insulin regimen (P<0.001). CONCLUSIONS: The linagliptin-basal insulin regimen was an effective alternative with fewer hypoglycemic events and daily insulin injections than intensive basal-bolus insulin in very old patients with type 2 diabetes with mild-to-moderate hyperglycemia treated at home without injectable therapies.

Crohn's Disease, Host-Microbiota Interactions, and Immunonutrition: Dietary Strategies Targeting Gut Microbiome as Novel Therapeutic Approaches.

Crohn's disease (CD) is a complex, disabling, idiopathic, progressive, and destructive disorder with an unknown etiology. The pathogenesis of CD is multifactorial and involves the interplay between host genetics, and environmental factors, resulting in an aberrant immune response leading to intestinal inflammation. Due to the high morbidity and long-term management of CD, the development of non-pharmacological approaches to mitigate the severity of CD has recently attracted great attention. The gut microbiota has been recognized as an important player in the development of CD, and general alterations in the gut microbiome have been established in these patients. Thus, the gut microbiome has emerged as a pre-eminent target for potential new treatments in CD. Epidemiological and interventional studies have demonstrated that diet could impact the gut microbiome in terms of composition and functionality. However, how specific dietary strategies could modulate the gut microbiota composition and how this would impact host-microbe interactions in CD are still unclear. In this review, we discuss the most recent knowledge on host-microbe interactions and their involvement in CD pathogenesis and severity, and we highlight the most up-to-date information on gut microbiota modulation through nutritional strategies, focusing on the role of the microbiota in gut inflammation and immunity.

Recomendaciones sobre el uso de la telemedicina aplicada a la patología nutricional / Recommendations on the use of telemedicine as applied to nutritional pathology

Introducción: la telemedicina puede mejorar la calidad asistencial y el uso de recursos. La pandemia de COVID-19 ha hecho necesaria su implementación en la práctica habitual. Por ello, un grupo de endocrinólogos de la Comunidad Valenciana, Murcia y Baleares creó un comité para su desarrollo. Objetivos: establecer unas recomendaciones para mejorar la calidad de la consulta de patología nutricional y diseñar unos indicadores para su gestión. Metodología: se siguió la metodología Delphi con participación de 13 profesionales con el fin de alcanzar el mayor consenso. Para ello se circuló un cuestionario de 16 puntos en 3 rondas: en la primera se estableció el grado de consenso; en la segunda, los participantes tuvieron acceso a los resultados de la primera y respondieron a las cuestiones planteadas. Se consideró que había acuerdo si el consenso era ≥ 75 % de los participantes, y que existía acuerdo fuerte si este era ≥ 90 %. Además, se estableció la temática de los indicadores de calidad. En la tercera se desarrollaron dichos indicadores. Resultados: tras 3 rondas y una reunión de revisión se establecieron los sobre aspectos organizativos 5 recomendaciones con acuerdo fuerte; sobre los aspectos administrativos, 6 recomendaciones con acuerdo fuerte y 4 con acuerdo. Se seleccionaron 8 indicadores de calidad que se desarrollaron en formato de fichas. Conclusiones: este documento recopila una serie de recomendaciones sobre cuestiones, necesidades y requisitos a tener en cuenta para una consulta telemática de calidad al paciente con patología nutricional. Así mismo, se han desarrollado unos indicadores para mejorar la calidad asistencial (AU)

Introduction: telemedicine can improve the standards of clinical care and use of resources. The COVID-19 pandemic has required its implementation in routine practice. For this reason, a group of endocrinologists from Valencia, Murcia and the Balearic Islands created a committee for its development. Objectives: to establish recommendations in order to improve the quality of consultation in nutritional disorders, and to create indicators for its management. Methodology: the Delphi methodology was followed with the participation of 13 professionals in order to reach the widest consensus. A 16-item questionnaire was distributed within 3 rounds: in the first round, the degree of consensus was established; in the second round, the participants responded to the posed questions after having access to the first-round results. Agreement was considered if ≥ 75 % participants reached consensus, while strong agreement was considered if consensus was reached by ≥ 90 %. In addition, quality indicators were established. In a third round, these indicators were developed. Results: after 3 rounds and a revision 5 recommendations with strong agreement were established based on organizational aspects. Regarding administrative aspects, 6 recommendations with strong agreement were established while 4 recommendations reached the level of agreement. Eight quality indicators were selected and developed. Conclusions this document compiles a list of recommendations about needs and requirements to be taken into account for a quality telematic consultation in patients with nutritional disorders. In addition, health care quality indicators have been created and developed (AU)

Gut Microbiome Modification through Dietary Intervention in Patients with Colorectal Cancer: Protocol for a Prospective, Interventional, Controlled, Randomized Clinical Trial in Patients with Scheduled Surgical Intervention for CRC.

Colorectal cancer (CRC) is the third most common cancer and the second cause of cancer death worldwide. Several factors have been postulated to be involved in CRC pathophysiology, including heritable and environmental factors, which are the latest to be closely associated with nutritional habits, physical activity, obesity, and the gut microbiota. The latter may also play a key role in CRC prognosis and derived complications in patients undergoing surgery. This is a single-center, open, controlled, randomized clinical trial, in patients with scheduled surgical intervention for CRC. The primary objective is to assess whether a pre-surgical nutritional intervention, based on a high-fiber diet rich in polyunsaturated fatty acids (PUFAs), can reduce disturbances of the gut microbiota composition and, consequently, the rate of post-surgical complications in patients with CRC. Patients will be randomized in a 1:1 ratio after receiving a diagnosis of CRC. In the control arm, patients will receive standard nutritional recommendations, while patients in the intervention arm will be advised to follow a high-fiber diet rich in PUFAs before surgery. Participants will be followed up for one year to evaluate the overall rate of postsurgical complications, recurrences of CRC, response to adjuvant therapy, and overall/disease-free survival.

[Analysis of ageism during the pandemic, a global elder abuse]. / Análisis del edadismo durante la pandemia, un maltrato global hacia las personas mayores.

Ageism is a form of abuse which has negative influence on elderly people. Although COVID-19 affects people of all ages, it has increased ageism effects, reducing the access of the elderly to different resources, including health system. Ageism is associated to cost overruns, poorer health and early mortality. From «GdT atención al mayor de semFYC¼ we make a series of proposals to decrease it based on community activities that favour intergenerational relationships and ageing education allowing a correct integration of the elderly on society.

Análisis del edadismo durante la pandemia, un maltrato global hacia las personas mayores / Analysis of ageism during the pandemic, a global elder abuse

El edadismo es una forma de maltrato que tiene influencia negativa en las personas mayores. Aunque la COVID-19 afecta a personas de todos los grupos de edad, ha incrementado el efecto del mismo, limita el acceso de los mayores a diversos recursos, entre ellos, los sanitarios. El edadismo se asocia con sobrecostes, con peor salud y mortalidad precoz. Desde el «Grupo de Trabajo (GdT) de Atención al Mayor de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC)» realizamos una serie de propuestas para combatirlo basándonos en actividades comunitarias que favorezcan las relaciones intergeneracionales y la educación en envejecimiento que permitan una correcta integración de los mayores en la sociedad.(AU)

Ageism is a form of abuse which has negative influence on elderly people. Although COVID-19 affects people of all ages, it has increased ageism effects, reducing the access of the elderly to different resources, including health system. Ageism is associated to cost overruns, poorer health and early mortality. From «GdT atención al mayor de semFYC» we make a series of proposals to decrease it based on community activities that favour intergenerational relationships and ageing education allowing a correct integration of the elderly on society.(AU)

Corrigendum to 'A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation' [JHEP Reports 6 (2021)].

[This corrects the article DOI: 10.1016/j.jhepr.2021.100363.].

[Recommendations on the use of telemedicine as applied to nutritional pathology]. / Recomendaciones sobre el uso de la telemedicina aplicada a la patología nutricional.

Introduction: Introduction: telemedicine can improve the standards of clinical care and use of resources. The COVID-19 pandemic has required its implementation in routine practice. For this reason, a group of endocrinologists from Valencia, Murcia and the Balearic Islands created a committee for its development. Objectives: to establish recommendations in order to improve the quality of consultation in nutritional disorders, and to create indicators for its management. Methodology: the Delphi methodology was followed with the participation of 13 professionals in order to reach the widest consensus. A 16-item questionnaire was distributed within 3 rounds: in the first round, the degree of consensus was established; in the second round, the participants responded to the posed questions after having access to the first-round results. Agreement was considered if ≥ 75 % participants reached consensus, while strong agreement was considered if consensus was reached by ≥ 90 %. In addition, quality indicators were established. In a third round, these indicators were developed. Results: after 3 rounds and a revision 5 recommendations with strong agreement were established based on organizational aspects. Regarding administrative aspects, 6 recommendations with strong agreement were established while 4 recommendations reached the level of agreement. Eight quality indicators were selected and developed. Conclusions: this document compiles a list of recommendations about needs and requirements to be taken into account for a quality telematic consultation in patients with nutritional disorders. In addition, health care quality indicators have been created and developed.

Introducción: Introducción: la telemedicina puede mejorar la calidad asistencial y el uso de recursos. La pandemia de COVID-19 ha hecho necesaria su implementación en la práctica habitual. Por ello, un grupo de endocrinólogos de la Comunidad Valenciana, Murcia y Baleares creó un comité para su desarrollo. Objetivos: establecer unas recomendaciones para mejorar la calidad de la consulta de patología nutricional y diseñar unos indicadores para su gestión. Metodología: se siguió la metodología Delphi con participación de 13 profesionales con el fin de alcanzar el mayor consenso. Para ello se circuló un cuestionario de 16 puntos en 3 rondas: en la primera se estableció el grado de consenso; en la segunda, los participantes tuvieron acceso a los resultados de la primera y respondieron a las cuestiones planteadas. Se consideró que había acuerdo si el consenso era ≥ 75 % de los participantes, y que existía acuerdo fuerte si este era ≥ 90 %. Además, se estableció la temática de los indicadores de calidad. En la tercera se desarrollaron dichos indicadores. Resultados: tras 3 rondas y una reunión de revisión se establecieron los sobre aspectos organizativos 5 recomendaciones con acuerdo fuerte; sobre los aspectos administrativos, 6 recomendaciones con acuerdo fuerte y 4 con acuerdo. Se seleccionaron 8 indicadores de calidad que se desarrollaron en formato de fichas. Conclusiones: este documento recopila una serie de recomendaciones sobre cuestiones, necesidades y requisitos a tener en cuenta para una consulta telemática de calidad al paciente con patología nutricional. Así mismo, se han desarrollado unos indicadores para mejorar la calidad asistencial.

Clinical benefits of empagliflozin in very old patients with type 2 diabetes hospitalized for acute heart failure.

BACKGROUND: There is little evidence on the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors in older patients with heart failure. This work analyzed the clinical efficacy and safety of empagliflozin continuation in very old patients with type 2 diabetes hospitalized for acute decompensated heart failure. METHODS: We conducted a real-world observational study between September 2015 and June 2021. Patients ≥80 years were grouped by antihyperglycemic regimen: (1) continuation of preadmission empagliflozin combined with basal insulin regimen and (2) conventional basal-bolus insulin regimen. A propensity score matching analysis matched patients in both groups in a 1:1 manner. The primary outcome was differences in clinical efficacy measured by the visual analogue scale dyspnea score, NT-proBNP levels, diuretic response, and cumulative urine output. Safety endpoints such as adverse events, worsening heart failure, discontinuation of empagliflozin, length of hospital stay, and in-hospital deaths were also analyzed. RESULTS: After propensity score matching, 79 patients were included in each group. At discharge, the N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were lower in the empagliflozin continuation group than in the insulin group (1699 ± 522 vs. 2303 ± 598 pg/ml, p = 0.021). Both the diuretic response and cumulative urine output were greater in patients treated with empagliflozin than in patients with basal-bolus insulin during the hospitalization (at discharge: -0.14 ± -0.06 vs. -0.24 ± -0.10, p = 0.044; and 16,100 ± 1510 vs. 13,900 ± 1220 ml, p = 0.037, respectively). No differences were observed in safety outcomes. CONCLUSIONS: In very old patients with type 2 diabetes hospitalized for acute heart failure, continuing preadmission empagliflozin reduced NT-proBNP levels and increased diuretic response and urine output compared to a basal-bolus insulin regimen. The empagliflozin regimen also showed a good safety profile.

Experiencia de grupo terapéutico durante el confinamiento por COVID-19 en una unidad de agudos de psiquiatría / Therapeutic group experience during confinement by COVID-19 in an acute psychiatry unit

El presente trabajo consiste en la descripciónde las sesiones grupales que se efectuarondurante el confinamiento por COVID-19en la Unidad de Agudos 1 de Psiquiatría generaldel Hospital Sagrat Cor de Martorell,en Barcelona.Se planteó un grupo abierto con aquellospacientes ingresados que voluntariamenteaccedieran a participar, como una propuestaa la alta respuesta emocional del momento.Se efectuó una sesión grupal semanal de unahora de duración a lo largo de seis semanas.El equipo terapéutico quedó constituidotanto por profesionales de la unidad comode los provenientes de recursos ambulatoriostomando un carácter interdisciplinar. Participaronun total de 41 pacientes con unaheterogeneidad diagnóstica; trastornos dela personalidad (26,83%), trastorno bipolar(19.51%), esquizofrenia y otros trastornospsicóticos (19,51%) y trastornos depresivos(14,61%). El porcentaje restante (19,54%)corresponde a otros diagnósticos. El 46,34%del total de los pacientes ha presentadoconsumo de sustancias en comorbilidad. Seaprecian como temas principales: La aceptacióndel ingreso, la compresión de lasnormativas por COVID-19, el manejo de laangustia por el ingreso bajo las condicionesde confinamiento y el desarrollo de capacidadesde diálogo, responsabilidad y cuidadode los participantes. Se describieron en las terapeutas intervenciones más directivas alinicio de las sesiones a intervenciones deacompañamiento y facilitación a medida quese desarrollaba el grupo.ConclusionesLa actividad grupal permitió un espacio decontención emocional, seguridad, información,reflexión, educación e integración paralos participantes. (AU)

The present work consists of the descriptionof the group sessions that were carriedout during the confinement becauseof COVID-19 in the Acute Unit 1 of GeneralPsychiatry of the Hospital Sagrat Cor de Martorell,in Barcelona.An open group was proposed with thoseadmitted patients who voluntarily agreed toparticipate, as a proposal to the high emotionalresponse of the moment. A weeklyone-hour group session was held over sixweeks. The therapeutic team was constitutedby both professionals from the unit andthose from outpatient resources, adoptingan interdisciplinary character. The outstandingthemes extracted from the summariesof each session were described. A total of 41patients with diagnostic heterogeneity participated;personality disorders (26.83%), bipolar disorder (19.51%), schizophreniaand other psychotic disorders (19.51%) anddepressive disorders (14.61%). The remainingpercentage (19.54%) corresponds toother diagnoses. 46.34% of the total of patientshave presented substance use in comorbidity.The main themes are the management ofanxiety due to admission under confinementconditions; compression of regulations becauseof COVID-19; and the development ofa dialogue capacity, responsibility and careof the participants. More directive interventionswere described in the therapists at thebeginning of the sessions towards accompanimentinterventions as the group develops.ConclusionsThe group activity allowed a space foremotional containment, security, information,reflection, education and integrationfor the participants. (AU)

A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation.

BACKGROUND & AIMS: Prophylactic administration of platelets and fresh frozen plasma (FFP) has been recommended in patients with cirrhosis with low platelets and/or prolonged international normalized ratio (INR) without scientific evidence to support this practice. In this analysis, we evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation (EBL). METHODS: This is a multicenter retrospective analysis of consecutive EBL procedures in patients with cirrhosis at 4 hospitals in Spain from 01/2010-01/2017. FFP and/or platelet transfusion were given at the discretion of the physician if INR was >1.5 and/or platelet count <50x109/L. Patient demographics, endoscopic findings, bleeding events after EBL, and the use of prophylactic FFP or platelets were recorded. RESULTS: A total of 536 patients underwent 1,472 EBL procedures: 72% male; main etiology HCV and alcohol (72%); median MELD score 11; Child-Pugh A/B/C (59/33/8%). EBL procedures were performed for primary (51%) or secondary (49%) prophylaxis. A median of 2 procedures per patient were performed.1-4 FFP and/or platelets were administered in 41 patients (7.6%). The prophylactic transfusion protocol was followed in 16% and 28% of procedures with high INR and/or low platelets, respectively. Post-EBL bleeding occurred in 26 out of 536 patients (4.8%) and in 33 out of 1,472 procedures (2.2%). Bleeding was due to post-EBL ulcers in 21 patients and due to band dislodgment in 5. In 6 patients, bleeding occurred within 24 hours and in the remaining patients it occurred within 2 weeks after EBL. In those that bled, 7 met criteria for transfusion (2 for FFP and 5 for platelets), of whom only 1 received FFP and 4 received platelets; the remaining 19 patients did not meet criteria for transfusion. There was no association between INR or platelet count and bleeding events. Univariate and multivariate analysis revealed that Child-Pugh and MELD scores were risk factors for post-EBL bleeding. CONCLUSIONS: The incidence of post-EBL bleeding is low and is associated with advanced liver disease. Post-EBL bleeding was not related to baseline INR/platelet count and most outpatients with post-EBL bleeding did not meet criteria for prophylactic transfusion. LAY SUMMARY: Patients with chronic liver disease or cirrhosis and enlarged veins (varices) of the esophagus that can potentially bleed commonly need an endoscopy to treat these varices with elastic rubber bands (endoscopic band ligation). Some patients have low platelet counts or prolonged coagulation tests. This analysis of 4 centers evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation. The results showed that bleeding after band ligation is uncommon and that if bleeding occurs it does not seem to be related with coagulation tests or the administration of blood products to prevent bleeding after band ligation of esophageal varices.

Soledad y envejecimiento / Loneliness and ageing

El objetivo del estudio es conocer la prevalencia de soledad y aislamiento social en mayores de 65 años en Ourense y sus factores asociados. Métodos: estudio descriptivo trasversal, muestra aleatoria de personas mayores de 65 años a las que se realizó una entrevista entre junio de 2010 y junio de 2011. Tamaño muestral: 486 pacientes (soledad estimada del 35%). Se administró la escala OARS-MFAQ (Olders American Resource and Services Multidimensional Functional Assessment Questionnaire), que recoge variables sociodemográficas, recursos sociales, económicos, salud física, mental y la capacidad para llevar a cabo actividades básicas de la vida diaria (ABVD) y actividades instrumentales de la vida diaria (AIVD). Se les hizo la pregunta «¿Se encuentra usted sola/solo?», con cuatro posibles respuestas: siempre, a menudo, casi nunca, nunca. Resultados: se entrevistó a 572 personas de una edad media de 79 años (desviación estándar [DE]: 6,79). Soledad: 32,7%; vive sola/solo: 17%; sin contacto semanal: 18,9%; aislamiento social: 1,4%. Fueron factores asociados a la percepción de soledad: ser mujer, tener pensión y nivel educativo bajos, depresión, deterioro cognitivo, pérdida de visión, dependencia para las AVBD, tomar psicofármacos en los 6 meses previos y la necesidad de mejoras en la vivienda. La práctica de ejercicio regular constituyó un factor protector. Conclusiones: la soledad en nuestra población es similar a la descrita en otros ámbitos, se asocia a desigualdad de género, factores sociales y demográficos, depresión y deterioro cognitivo. Los profesionales de Atención Primaria deben identificarla y abordarla.(AU)

The aim of this research is to ascertain the prevalence of loneliness and social isolation in people aged over 65 in Ourense and its associated factors. Methods: descriptive cross-sectional study, random sample of people aged over 65 interviewed between June 2010 and June 2011. Sample size was 486 patients (estimated loneliness 35%). The OARS (Olders American Resource and Services Multidimensional Functional Assessment Questionnaire) scale was administrated. This includes sociodemo-graphic variables, socio-economic resources, physical and mental health and the ability to undergo BADL and IADL. The question “are you alone?” with four possible answers was also posed. Results: a total of 572 people were interviewed, aged on average 79 years old (SD: 6.79). Loneliness 32.7%; living alone 17.0%; no weekly contacts 18.9%; social isolation (living alone + no contacts) 1.4%. Feelings of loneliness were associated with sex (women), low pension and educational level, depression, cognitive impairment, vision loss, dependence for BADL, psychopharmacological treatment in the previous six months and the need for home improvements. Regular physical exercise was a protective factor. Conclusions: loneliness in our population is similar to the one reported in other areas. It is associated with sex inequalities, social and demographic factors, depression and cognitive impairment. Primary care professionals need to identify and tackle loneliness.(AU)