Relación entre la dislipidemia y otros factores de riesgo cardiovasculares conocidos con la presencia de enfermedad cardiovascular en pacientes con enfermedad pulmonar obstructiva crónica de las Islas Canarias / Dyslipidaemia and other cardiovascular risk factors in relation to manifest cardiovascular disease in patients with chronic obstructive pulmonary disease in the Canary Islands

INTRODUCCIÓN: La enfermedad cardiovascular tiene un impacto negativo en el pronóstico vital de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC), siendo la dislipidemia (DLP) y la hipertensión arterial (HTA) los factores de riesgo más prevalentes. El objetivo del estudio fue: 1) evaluar la relación existente entre el diagnóstico de DLP y la presencia de enfermedad cardiovascular en pacientes con EPOC, y compararlo con otros factores conocidos de riesgo cardiovascular; y 2) determinar la relación entre las diferentes comorbilidades cardiovasculares y los grupos de gravedad según la clasificación GOLD 2017. MÉTODOS: Estudio observacional transversal de 454 pacientes con EPOC en seguimiento ambulatorio. Se calculó la prevalencia de cada una de las comorbilidades cardiovasculares y el riesgo de que cada uno de los factores de riesgo cardiovascular se presentase conjuntamente con una enfermedad vascular (RRij). RESULTADOS: El 66,7% de los pacientes eran dislipidémicos. La DLP mostró una mayor relación con la presencia de accidentes cerebrovasculares (ACV) (RRij 1.36; p = 0,0054), enfermedad renal crónica (ERC) (RRij 1.34; p = 0,00023) y arteriopatía periférica (AP) (RRij 1.38; p = 0,00015); la HTA se relacionó mayormente con ACV (RRij 1,41; p = 0,0014) y ERC (RRij 1,42; p < 0,0001); la DMT2 con AP (RRij 1,90; p = 0,0001), insuficiencia cardiaca (IC) (RRij 1,74; p = 0,0002) y ERC (RRij 1,76; p < 0,0001); la obesidad con IC (RRij 1,60; p = 0,0009) y ERC (RRij 1.54; p = 0,0001). CONCLUSIÓN: La DLP se relacionó con la presencia de ACV, ERC y AP. La HTA y DMT2 se relacionaban mayoritariamente con IC y ACV

INTRODUCTION: Cardiovascular disease has a negative impact on the vital prognosis of patients with chronic obstructive pulmonary disease (COPD), where dyslipidaemia (DLP) and arterial hypertension (AHT) are considered the most prevalent risk factors. The objective of this study was 1) to assess the relationship between diagnosed DLP and cardiovascular disease in COPD patients and compare it with other known cardiovascular risk factors and 2) to determine the relationship between the different cardiovascular comorbidities and the severity groups according to the GOLD 2017 classification. METHODS: A cross-sectional, observational study was performed in 454 outpatients with COPD during their follow up. We calculated the prevalence of each of the cardiovascular comorbidities and the probability of each of the cardiovascular risk factors to occur jointly with a vascular disease (RRij). RESULTS: A total of 66.7% of the patients had DLP, whereby DLP was related to cerebrovascular accidents (CVA) (RRij 1.36, P=.0054), chronic kidney disease (CKD) (RRij 1.34, P=.00023), and peripheral arterial disease (PAD) (RRij 1.38, P=.00015). AHT was mostly related to CVA (RRij 1.41, P=.0014) and CKD (RRij 1.42, P<.0001). Type 2 diabetes mellitus (T2DM) correlated with PAD (RRij 1.90, P=.0001), heart failure (HF) (RRij 1,74, P=.0002), and CKD (RRij 1.76, P<.0001), and obesity was associated with HF (RRij 1.60, P=.0009) and CKD (RRij 1.54, P=.0001). CONCLUSION: DLP was related to CVA, CKD, and PAD. AHT and T2DM are the conditions that mostly relate to HF and CVA

Dyslipidaemia and other cardiovascular risk factors in relation to manifest cardiovascular disease in patients with chronic obstructive pulmonary disease in the Canary Islands. / Relación entre la dislipidemia y otros factores de riesgo cardiovasculares conocidos con la presencia de enfermedad cardiovascular en pacientes con enfermedad pulmonar obstructiva crónica de las Islas Canarias.

INTRODUCTION: Cardiovascular disease has a negative impact on the vital prognosis of patients with chronic obstructive pulmonary disease (COPD), where dyslipidaemia (DLP) and arterial hypertension (AHT) are considered the most prevalent risk factors. The objective of this study was 1) to assess the relationship between diagnosed DLP and cardiovascular disease in COPD patients and compare it with other known cardiovascular risk factors and 2) to determine the relationship between the different cardiovascular comorbidities and the severity groups according to the GOLD 2017 classification. METHODS: A cross-sectional, observational study was performed in 454 outpatients with COPD during their follow up. We calculated the prevalence of each of the cardiovascular comorbidities and the probability of each of the cardiovascular risk factors to occur jointly with a vascular disease (RRij). RESULTS: A total of 66.7% of the patients had DLP, whereby DLP was related to cerebrovascular accidents (CVA) (RRij 1.36, P=.0054), chronic kidney disease (CKD) (RRij 1.34, P=.00023), and peripheral arterial disease (PAD) (RRij 1.38, P=.00015). AHT was mostly related to CVA (RRij 1.41, P=.0014) and CKD (RRij 1.42, P<.0001). Type 2 diabetes mellitus (T2DM) correlated with PAD (RRij 1.90, P=.0001), heart failure (HF) (RRij 1,74, P=.0002), and CKD (RRij 1.76, P<.0001), and obesity was associated with HF (RRij 1.60, P=.0009) and CKD (RRij 1.54, P=.0001). CONCLUSION: DLP was related to CVA, CKD, and PAD. AHT and T2DM are the conditions that mostly relate to HF and CVA.

Derrame pericárdico masivo tras infección por Neisseria meningitidis / Massive pericardial effussion after a Neisseria meningitidis infection

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[Incidence rate of adverse drug effects in a hospital emergency unit and its associated factors]. / Incidencia de resultados negativos de medicación en un servicio de urgencias hospitalario y factores asociados.

INTRODUCTION: Adverse drug effects (ADEs) are the reason for 0.86% to 38.2% of hospital emergency admissions, and a large percentage of them are avoidable. Rational prescription and pharmacotherapy monitoring decrease the appearance of such health problems. METHOD: Study performed in a tertiary hospital emergency unit with patients selected using a two-phase random sample. The information was obtained from a validated questionnaire and from the clinical history. The data were grouped according to the following cause-effect schema: 1-Potential risk factors for an ADE. 2-Effects likely to be caused by drugs. 3-Consequences of ADEs. 4-Potential confounding factors. The information obtained was evaluated by four independent evaluators using the Dader method. RESULTS: 840 patients were included in the study, and 33% of them came to the emergency unit due to an ADE. ADEs were more frequently observed in female patients, those with higher drug consumption, older patients, those with an underlying illness and in those from underprivileged backgrounds. The factors determining risk of an ADE are the quantity of drugs consumed, sex and the health practices index. DISCUSSION: One third of hospital emergency admissions were due to ADEs, and these were associated with the same factors found in other studies (number of drugs consumed, female sex, age and social background). In addition, we observed that ADEs are predominant in patients with low values on the health practices index, and in those with underlying illnesses.

Análisis del programa de detección precoz de la hipoacusia neonatal en nuestro centro / Analysis of the program of early detection of neonatal hearing loss in our hospital

Objetivos: Conocer los resultados del programa de detección precoz de hipoacusia en recién nacidos (RN) de nuestro hospital durante 2001 y 2004. Pacientes y métodos: Se realizaron otoemisiones acústicas (OEA) a 2.461 (2001) y 2.549 RN (2004); si éstas eran negativas, se repetían antes de un mes. Los RN con la segunda otoemisión negativa eran remitidos al servicio de otorrinolaringología (ORL), completándose su valoración mediante potenciales auditivos troncoencefálicos. Resultados: El 10% (n= 260) y el 5% (n= 145), respectivamente, no pasaron la primera OEA. Continuaron esta primera fase 234 (2001) y 144 (2004), y no pasaron la segunda OEA el 16% (n= 37) y el 24% (n= 35), generándose una remisión al servicio de ORL del 1,51 y el 1,37% cada año; 29 niños no completaron la fase diagnóstica. De los 72 RN con sospecha de hipoacusia, el 59,72% (n= 43) completó el programa, el 30,23%había estado ingresado, el 23,25% presentaba factores de riesgo y el 48,83% tenía OEA negativas bilaterales. En el servicio de ORL se confirmó la hipoacusia en 23 RN (53,48%): en un 57,14% era neurosensorial (un 62% en RN varones sin factores de riesgo; un 75% bilaterales y un 50% profundas) y en un 42,16% era de transmisión. Conclusiones: Nuestra incidencia global de hipoacusia neurosensorial y de transmisión es de 4,54/1.000 RN, y para la neurosensorial profunda de 1,87/1.000 RN. El 71% de los hipoacúsicos eran RN sanos y sin factores de riesgo, predominando los varones. La capacidad de detección de las OEA fue significativamente mayor en 2004; las remisiones a ORL fueron adecuadas, las pérdidas de seguimiento en la primera fase escasas, pero elevadas en la de confirmación (AU)

Objectives: To examine the results of the program of early detection of hearing loss in newborn infants (NB) in our hospital during 2001 and 2004.Patients and methods: Otoacoustic emissions (OAE) were evaluated in 2,461 (2001) and 2,549 NB (2004) and, if the results were negative, the evaluation was repeated before one month had elapsed. The NB with a second negative OAE test were sent to the otorhinolaryngology service (ORL), where their evaluation was completed, including assessment of the auditory brainstem response (ABR). Results: The first OAE test was negative in 260 (10%) and145 (5%) NB, respectively. In all, 234 (2001) and 144 (2004) continued this first stage; 37 (16%) and 35 (24%) NB, respectively, failed to pass the second OAE test, and 1.51% and 1.37%in each year were referred to ORL, whereas 29 children did not complete the diagnostic phase. Of the 72 NB with suspected auditory dysfunction, 59.72% (n= 43) completed the program, 30.23% had been admitted to the hospital, 23.25% had risk factors and 48.83% had bilateral negative results on OAE testing. The ORL service confirmed hearing loss in 23 NB (53.48%): sensorineural in 57.14% (62% were boys with no risk factors, and it was bilateral in 75% and profound in 50%) and conductive in 42.16%. Conclusions: Our overall incidence of sensorineural and conductive hearing loss was 4.54/1,000 NB, and that of deep sensorineural hearing loss was only 1.87/1,000 NB. In all, 71% of the infants with hearing loss were normal and had no risk factors ,and there was a male predominance. The capacity for detection of OAE was significantly greater in 2004; the referrals to ORL were appropriate, the rate of loss to follow-up was low in the first stage and elevated in the confirmation stage (AU)