Pancreatic steatosis and iron overload increases cardiovascular risk in non-alcoholic fatty liver disease.

Objective: To assess the prevalence of pancreatic steatosis and iron overload in non-alcoholic fatty liver disease (NAFLD) and their correlation with liver histology severity and the risk of cardiometabolic diseases. Method: A prospective, multicenter study including NAFLD patients with biopsy and paired Magnetic Resonance Imaging (MRI) was performed. Liver biopsies were evaluated according to NASH Clinical Research Network, hepatic iron storages were scored, and digital pathology quantified the tissue proportionate areas of fat and iron. MRI-biomarkers of fat fraction (PDFF) and iron accumulation (R2*) were obtained from the liver and pancreas. Different metabolic traits were evaluated, cardiovascular disease (CVD) risk was estimated with the atherosclerotic CVD score, and the severity of iron metabolism alteration was determined by grading metabolic hiperferritinemia (MHF). Associations between CVD, histology and MRI were investigated. Results: In total, 324 patients were included. MRI-determined pancreatic iron overload and moderate-to severe steatosis were present in 45% and 25%, respectively. Liver and pancreatic MRI-biomarkers showed a weak correlation (r=0.32 for PDFF, r=0.17 for R2*). Pancreatic PDFF increased with hepatic histologic steatosis grades and NASH diagnosis (p<0.001). Prevalence of pancreatic steatosis and iron overload increased with the number of metabolic traits (p<0.001). Liver R2* significantly correlated with MHF (AUC=0.77 [0.72-0.82]). MRI-determined pancreatic steatosis (OR=3.15 [1.63-6.09]), and iron overload (OR=2.39 [1.32-4.37]) were independently associated with high-risk CVD. Histologic diagnosis of NASH and advanced fibrosis were also associated with high-risk CVD. Conclusion: Pancreatic steatosis and iron overload could be of utility in clinical decision-making and prognostication of NAFLD.

[Availability of open data related to COVID-19 in the web portals of the Spanish regions and the Ministry of Health.] / Análisis de la disponibilidad de información relacionada con la COVID-19 en los portales abiertos a nivel autonómico y nacional.

OBJECTIVE: Having certain open data means that this data is accessible and available to everyone, without legal or technical restrictions. The public sector produces a wide variety of information (social, economic, health, statistical) that is attractive, complete and reliable, coming directly from official sources. The aim of this study was to show the open data related to COVID-19 published by the regions of Spain and the Ministry of Health, and compare these data. METHODS: Each of the open portals was accessed and an observation of the published data was made, analyzing since when they were published and their periodicity in the update. The Tim Berners-Lee tool was used to classify the degree of reuse of the data. Regarding the statistical treatment, a frequency analysis was carried out, to analyze which data are given in a greater number of times. RESULTS: 15 regions publish open data related to COVID-19, as well as the Ministry of Health. The contents shown in the open data portals varied from one autonomous community to another, but the regions provided data confirmed by PCR. The data collection start date and the updating of the data varied. CONCLUSIONS: There is an enormous diversity among de regions in terms of the publication of COVID data, in relation to indicators, dates. It shows a great existence of data and in reusable format, but you have to go to many sources to obtain information of the epidemiological situation at a national level.

OBJETIVO: Disponer de determinados datos abiertos supone que estos datos sean accesibles y estén disponibles para todo el mundo, sin restricciones legales ni técnicas. El sector público produce una gran variedad de información (social, económica, sanitaria, estadística) que es atractiva, completa y fiable al proceder directamente de fuentes oficiales. El objetivo de este estudio fue mostrar los datos abiertos relacionados con la COVID-19 publicados por las comunidades autónomas (en adelante CC. AA.) y el Ministerio de Sanidad, y comparar estos datos. METODOS: Se accedió a cada uno de los portales abiertos y se realizó una observación de los datos publicados, analizando desde cuándo se publican y su periodicidad en la actualización. Se utilizó la herramienta de Tim Berners-Lee para la clasificación del grado de reutilización de los datos. En cuanto al tratamiento estadístico, se realizó un análisis de frecuencia, para analizar qué datos se dan en un mayor número de veces. RESULTADOS: 15 comunidades autónomas (CC. AA.) publicaron datos abiertos relacionados con la COVID-19 en diferentes formatos, así como el Ministerio de Sanidad. Los contenidos que se mostraron en los portales de datos abiertos variaron de una comunidad autónoma a otra, pero todas las CC.AA ofrecieron datos confirmados por PCR. Lo que variaba era la fecha de inicio de recogida de datos y la actualización de los mismos. CONCLUSIONES: Existe gran heterogeneidad entre las CC. AA., en cuanto a la publicación de la información de casos de COVID-19, en relación a indicadores, fechas, etc. Se pone de manifiesto una gran existencia de datos y en formatos reutilizables, pero hay que ir a muchas fuentes para obtener información sobre la situación epidemiológica a nivel nacional.

Higher levels of serum uric acid influences hepatic damage in patients with non-alcoholic fatty liver disease (NAFLD)

Background: recent evidence suggests a causal link between serum uric acid and the metabolic syndrome, diabetes mellitus, arterial hypertension, and renal and cardiac disease. Uric acid is an endogenous danger signal and activator of the inflammasome, and has been independently associated with an increased risk of cirrhosis. Aim and methods: six hundred and thirty-four patients from the nation-wide HEPAMET registry with biopsy-proven NAFLD (53% NASH) were analyzed to determine whether hyperuricemia is related with advanced liver damage in patients with non-alcoholic fatty liver disease (NAFLD). Patients were divided into three groups according to the tertile levels of serum uric acid and gender. Results: the cohort was composed of 50% females, with a mean age of 49 years (range 19-80). Patients in the top third of serum uric acid levels were older (p = 0.017); they had a higher body mass index (p < 0.01), arterial blood pressure (p = 0.05), triglyceridemia (p = 0.012), serum creatinine (p < 0.001) and total cholesterol (p = 0.016) and lower HDL-cholesterol (p = 0.004). According to the univariate analysis, the variables associated with patients in the top third were more advanced steatosis (p = 0.02), liver fibrosis (F2-F4 vs F0-1; p = 0.011), NASH (p = 0.002) and NAS score (p = 0.05). According to the multivariate logistic regression analysis, the top third of uric acid level was independently associated with steatosis (adjusted hazard ratio 1.7; CI 95%: 1.05-2.8) and NASH (adjusted hazard ratio 1.8; CI 95%: 1.08-3.0) but not with advanced fibrosis (F2-F4) (adjusted hazard ratio 1.09; CI 95%: 0.63-1.87). Conclusion: higher levels of serum uric acid were independently associated with hepatocellular steatosis and NASH in a cohort of patients with NAFLD. Serum uric acid levels warrants further evaluation as a component of the current non-invasive NAFLD scores of histopathological damage

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Higher levels of serum uric acid influences hepatic damage in patients with non-alcoholic fatty liver disease (NAFLD).

BACKGROUND: recent evidence suggests a causal link between serum uric acid and the metabolic syndrome, diabetes mellitus, arterial hypertension, and renal and cardiac disease. Uric acid is an endogenous danger signal and activator of the inflammasome, and has been independently associated with an increased risk of cirrhosis. AIM AND METHODS: six hundred and thirty-four patients from the nation-wide HEPAMET registry with biopsy-proven NAFLD (53% NASH) were analyzed to determine whether hyperuricemia is related with advanced liver damage in patients with non-alcoholic fatty liver disease (NAFLD). Patients were divided into three groups according to the tertile levels of serum uric acid and gender. RESULTS: the cohort was composed of 50% females, with a mean age of 49 years (range 19-80). Patients in the top third of serum uric acid levels were older (p = 0.017); they had a higher body mass index (p < 0.01), arterial blood pressure (p = 0.05), triglyceridemia (p = 0.012), serum creatinine (p < 0.001) and total cholesterol (p = 0.016) and lower HDL-cholesterol (p = 0.004). According to the univariate analysis, the variables associated with patients in the top third were more advanced steatosis (p = 0.02), liver fibrosis (F2-F4 vs F0-1; p = 0.011), NASH (p = 0.002) and NAS score (p = 0.05). According to the multivariate logistic regression analysis, the top third of uric acid level was independently associated with steatosis (adjusted hazard ratio 1.7; CI 95%: 1.05-2.8) and NASH (adjusted hazard ratio 1.8; CI 95%: 1.08-3.0) but not with advanced fibrosis (F2-F4) (adjusted hazard ratio 1.09; CI 95%: 0.63-1.87). CONCLUSION: higher levels of serum uric acid were independently associated with hepatocellular steatosis and NASH in a cohort of patients with NAFLD. Serum uric acid levels warrants further evaluation as a component of the current non-invasive NAFLD scores of histopathological damage.

The effects of metabolic status on non-alcoholic fatty liver disease-related outcomes, beyond the presence of obesity.

BACKGROUND: Metabolically healthy obesity (MHO) shows a reduced risk compared with obese patients with adverse metabolic conditions. Lean people suffering some metabolic derangements also have non-alcoholic fatty liver disease (NAFLD)-related outcomes compared with non-obese subjects with a few metabolic risks. AIM: To define the impact of the metabolic status on the NAFLD-related outcomes, beyond the presence of obesity. METHODS: We designed a multicentre cross-sectional study, including 1058 biopsy-proven NAFLD patients. Metabolically healthy status was strictly defined by the lack of metabolic risk factors (diabetes mellitus, low HDL, hypertriglyceridemia, arterial hypertension). Non-alcoholic steatohepatitis (NASH) and significant fibrosis (F2-F4) were identified by liver biopsy. Chronic kidney disease epidemiology collaboration equation was calculated for kidney function and the atherogenic index of plasma (AIP) for cardiovascular risk. RESULTS: Metabolically healthy (OR 1.88; P = 0.050) and unhealthy obesity (OR 3.47: P < 0.0001), and unhealthy non-obesity (OR 3.70; P < 0.0001) were independently associated with NASH together with homeostatic model assessment (HOMA), ALT, and platelets. Significant fibrosis was more frequently observed in the presence of adverse metabolic conditions in obese (OR 3.89; P = 0.003) and non-obese patients (OR 3.92; P = 0.002), and independently associated with platelets, albumin, ALT, HOMA, and age. The number of metabolic factors determined the risk of NASH and significant fibrosis. Glomerular filtration rate was lower in unhealthy (91.7 ± 18) than healthy metabolism (95.6 ± 17) (P = 0.007). AIP was higher in adverse metabolic conditions (P = 0.0001). Metabolically unhealthy non-obesity showed higher liver damage (NASH 55.8% vs 42.4%; P < 0.05; significant fibrosis 31.7% vs 11.4%; P < 0.0001) and cardiovascular risk (P < 0.0001) than healthy obesity. CONCLUSIONS: Metabolic unhealthy status showed a greater impact on NASH, significant fibrosis, kidney dysfunction, and atherogenic profile than obesity. However, metabolically healthy obesity was not a full healthy condition. We should focus our messages especially on patients with adverse metabolic conditions.

La experiencia de implantación del nuevo Registro de Atención Sanitaria Especializada y la transición a la CIE10 en los hospitales españoles. Proceso y resultados esperados / No disponible

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Effectiveness of spirometry as a motivational tool for smoking cessation: a clinical trial, the ESPIMOAT study.

BACKGROUND: Smoking is the main preventable cause of morbidity and mortality in our region, it being the main causative agent of chronic obstructive pulmonary disease. There still is no consensus on the use of spirometry as a strategy for smoking cessation, given that there is insufficient scientific evidence from high quality studies to recommend the use of this technique. METHODS/DESIGN: This is to be a randomized, multicentre, open-label clinical trial. A total of 444 smokers over 40 years of age will be recruited by 39 general practitioners from 22 health centers. Primary objective of this study is to assess the effectiveness of spirometry together with information regarding the test for smoking cessation after 1 year in smokers over 40 years of age with a more than 10 pack-year history and no previous diagnosis of chronic obstructive pulmonary disease. Groups of 45 patients who smoke will be randomly selected from the lists of the participating doctors. The names will be sent to the corresponding doctors who will contact candidate patients and assess whether they meet the selection criteria. Patients who meet these criteria will be randomly allocated to an intervention or control group. For patients in both groups, a nurse will conduct an interview and perform a spirometry test to measure forced vital capacity. Then, all patients will be referred for an appointment with their doctor for brief anti-smoking intervention, patients from the intervention group additionally being informed about the result of the spirometry test. After 1 year, smoking status will be assessed and, in those who report that they have quit smoking, abstinence will be confirmed by co-oximetry. Data will be analyzed on an intention-to-treat basis using the chi-squared test for outcomes and binary logistic regression if it is considered to be necessary to adjust for confounding variables. DISCUSSION: Performing a spirometry test and providing information on pulmonary function may increase awareness of the effect of smoking among smokers who are asymptomatic or have few symptoms and make them decide to quit. Specifically, in patients with chronic obstructive pulmonary disease it might increase levels of motivation to quit smoking in early stages of the disease. If this strategy were to be effective, it could be included in the health promotion activities offered in primary care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01821885.

Variabilidad en las recomendaciones clínicas en las carteras de servicios de atención primaria de las comunidades autónomas / Variability in the autonomous communities of the clinical recommendations in the Service Portfolios in Primary Care

Se analiza un conjunto de normas de calidad recogidas en las Carteras de Servicios de Atención Primaria. Se observa similitud en las distintas comunidades autónomas en el número y contenido de los controles en niños mayores de 2 años, periodicidad del cribado de factores de riesgo cardiovascular y del cribado de cáncer con mamografía. Se observa variabilidad en el número de controles recomendados en los 2 primeros años de vida (de 2 a 8), en la periodicidad del control de parámetros en las personas con factores de riesgo (por ejemplo, hemoglobina glucosilada en el diabético cada 2, 6 o 12 meses), en la periodicidad de citologías vaginales (cada 3 o 5 años) y en los periodos de edad en que se recomienda realizar citología (desde los 15, 20, 25 o 35 años hasta los 55 o 60) o mamografía (desde los 45 o 50 años hasta los 60 o 65)(AU)

The quality guidelines established in Primary Care Service Portfolios of Autonomous Communities were analysed. It was observed that there were similarities in the number and content of the controls in children over 2 years-old, time intervals of cardiovascular risk and breast cancer mammography screening. Variability was observed in the number of controls (from 2 to 8) recommended for infants less than 2 years old, in the time intervals of monitoring parameters of patients with risk factors (for example, glycosylated haemoglobin in the diabetic every 2, 6, or 12 months), in the time intervals in cervical cytology (every 3 or 5 years) and in the age periods of performing the cytology (from 15, 20, 25, or 30 years up to 55 or 60 years) or mammography (from 45 or 50 years up to 60 or 65 years)(AU)

Case-control study for colorectal cancer genetic susceptibility in EPICOLON: previously identified variants and mucins.

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer death in developed countries. Familial aggregation in CRC is also important outside syndromic forms and, in this case, a polygenic model with several common low-penetrance alleles contributing to CRC genetic predisposition could be hypothesized. Mucins and GALNTs (N-acetylgalactosaminyltransferase) are interesting candidates for CRC genetic susceptibility and have not been previously evaluated. We present results for ten genetic variants linked to CRC risk in previous studies (previously identified category) and 18 selected variants from the mucin gene family in a case-control association study from the Spanish EPICOLON consortium. METHODS: CRC cases and matched controls were from EPICOLON, a prospective, multicenter, nationwide Spanish initiative, comprised of two independent stages. Stage 1 corresponded to 515 CRC cases and 515 controls, whereas stage 2 consisted of 901 CRC cases and 909 controls. Also, an independent cohort of 549 CRC cases and 599 controls outside EPICOLON was available for additional replication. Genotyping was performed for ten previously identified SNPs in ADH1C, APC, CCDN1, IL6, IL8, IRS1, MTHFR, PPARG, VDR and ARL11, and 18 selected variants in the mucin gene family. RESULTS: None of the 28 SNPs analyzed in our study was found to be associated with CRC risk. Although four SNPs were significant with a P-value < 0.05 in EPICOLON stage 1 [rs698 in ADH1C (OR = 1.63, 95% CI = 1.06-2.50, P-value = 0.02, recessive), rs1800795 in IL6 (OR = 1.62, 95% CI = 1.10-2.37, P-value = 0.01, recessive), rs3803185 in ARL11 (OR = 1.58, 95% CI = 1.17-2.15, P-value = 0.007, codominant), and rs2102302 in GALNTL2 (OR = 1.20, 95% CI = 1.00-1.44, P-value = 0.04, log-additive 0, 1, 2 alleles], only rs3803185 achieved statistical significance in EPICOLON stage 2 (OR = 1.34, 95% CI = 1.06-1.69, P-value = 0.01, recessive). In the joint analysis for both stages, results were only significant for rs3803185 (OR = 1.12, 95% CI = 1.00-1.25, P-value = 0.04, log-additive 0, 1, 2 alleles) and borderline significant for rs698 and rs2102302. The rs3803185 variant was not significantly associated with CRC risk in an external cohort (MCC-Spain), but it still showed some borderline significance in the pooled analysis of both cohorts (OR = 1.08, 95% CI = 0.98-1.18, P-value = 0.09, log-additive 0, 1, 2 alleles). CONCLUSIONS: ARL11, ADH1C, GALNTL2 and IL6 genetic variants may have an effect on CRC risk. Further validation and meta-analyses should be undertaken in larger CRC studies.

[Variability in the autonomous communities of the clinical recommendations in the service portfolios in primary care]. / Variabilidad en las recomendaciones clínicas en las carteras de servicios de atención primaria de las comunidades autónomas.

The quality guidelines established in Primary Care Service Portfolios of Autonomous Communities were analysed. It was observed that there were similarities in the number and content of the controls in children over 2 years-old, time intervals of cardiovascular risk and breast cancer mammography screening. Variability was observed in the number of controls (from 2 to 8) recommended for infants less than 2 years old, in the time intervals of monitoring parameters of patients with risk factors (for example, glycosylated haemoglobin in the diabetic every 2, 6, or 12 months), in the time intervals in cervical cytology (every 3 or 5 years) and in the age periods of performing the cytology (from 15, 20, 25, or 30 years up to 55 or 60 years) or mammography (from 45 or 50 years up to 60 or 65 years).

Susceptibility genetic variants associated with colorectal cancer risk correlate with cancer phenotype.

BACKGROUND & AIMS: Ten common low-penetrant genetic variants have been consistently associated with colorectal cancer (CRC) risk; little is known about the correlation between these variants and CRC phenotype. Characterization of such a correlation would improve CRC management and prevention programs. We assessed the association between these genetic variants and CRC phenotype in patients and modeled pairwise combinations to detect epistasis. METHODS: The validation population corresponded to a prospective, multicenter, population-based cohort (EPICOLON I) of 1096 patients with newly diagnosed CRC. The replication set was an independent, prospective, multicenter Spanish cohort (EPICOLON II) of 895 patients with newly diagnosed CRC. For individual single nucleotide polymorphism (SNP) association analyses, a multivariate method using logistic regression was applied in EPICOLON I and subsequently prospectively validated in EPICOLON II. Interactions between SNPs were assessed using the likelihood ratio test. RESULTS: Validated results confirmed that the C allele on 8q23.3 (rs16892766) was significantly associated with advanced-stage tumors (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.15-1.90; P value = 4.9 x 10(-3)). The G allele on 8q24.21 (rs6983267) was more common in patients with a familial history of CRC (OR, 2.02; 95% CI, 1.35-3.03; P value = 3.9 x 10(-4)). The combination of rs6983267 on 8q24.21 and rs9929218 on 16q22.2 was associated with a history of colorectal adenoma (carriers of GG and AA, respectively; OR, 2.28; 95% CI, 1.32-3.93; P = 5.0 x 10(-4)). CONCLUSIONS: CRC susceptibility variants at 8q23.3, 8q24.21, and 16q22.2 appear to be associated with cancer phenotype. These findings might be used to develop screening and surveillance strategies.

Hipertransaminasemia en la enfermedad celíaca del adulto / Hypertransaminasemia in adult celiac disease

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El papel de la Atención Primaria en el Sistema Sanitario / The role of Primary Health Care in the Health Care System

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