Safety of SGLT2 inhibitors in very elderly diabetic type 2 patients in real life / Seguridad de los inhibidores de SGLT2 en pacientes diabéticos tipo 2 muy ancianos en la vida real

Introduction: Sodium glucose cotransporter 2 inhibitors (SGLT2i) are the latest antidiabetic treatments that reduces mortality and cardiovascular outcomes. Its use in real life in very elderly patients is limited by its possible side effects.Material and methods: We conducted a retrospective study of patients treated with SGLT2i in our community (La Rioja) since 2014. The safety (adverse effects) and prognosis (mortality, cardiac decompensation, and cardiovascular events) during the first 24 months of treatment were evaluated.Results: We included 235 patients treated with SGLT2i, 114 of them were men (48.5%), and the mean age was 79.6 ± 3.9 years. The most used SGLT2i was empagliflozin (55.7%). The mean Hb1Ac at the time of inclusion was 7.9 ± 1.4, showing a decrease in 47.7% of the included patients during the follow up. The initial values of creatinine and glomerular filtration rate at the time of inclusion (0.94 ± 0.3 and 68.3 ± 16.4) presented an improvement at 24 months of treatment (0.94 ± 0.27 and 68.2 ± 15.8). During follow-up, 94 adverse events were described in 84 patients, and 53 treatment suspensions. This adverse events were related with sex (p 0.004), dapagliflozin (p < 0.001) and initial Hb1Ac values (p 0.04). The most common adverse event were genitourinary infections (63), followed by acute kidney injury (9), being the latter the most frequent cause of treatment interruption. Symptomatic hypoglycaemia during the follow-up was related with treatment of insulin, age and Hb1Ac (p <0.01).Conclusions: Treatment with SGLT2i is a safe and well-tolerated treatment in very elderly patients in real life. Genitourinary infections are the most common adverse events, but those that less frequently cause treatment interruption. (AU)

Introducción: Los inhibidores del cotransportador de sodio y glucosa tipo 2 (SGLT2i) son los últimos tratamientos antidiabéticos que reducen la mortalidad y los resultados cardiovasculares. Su uso en la vida real en pacientes muy ancianos está limitado por sus posibles efectos secundarios.Material y métodos: Realizamos un estudio retrospectivo de pacientes tratados con iSGLT2 en nuestra comunidad (La Rioja) desde 2014. La seguridad (efectos adversos) y el pronóstico (mortalidad, descompensación cardiaca y eventos cardiovasculares) durante los primeros 24 meses de tratamiento fueron evaluado.Resultados: Se incluyeron 235 pacientes tratados con SGLT2i, 114 de ellos hombres (48,5%) y la edad media fue de 79,6 ± 3,9 años. El SGLT2i más utilizado fue la empagliflozina (55,7%). La Hb1Ac media en el momento de la inclusión fue de 7,9 ± 1,4, mostrando un descenso en el 47,7% de los pacientes incluidos durante el seguimiento. Los valores iniciales de creatinina y filtrado glomerular en el momento de la inclusión (0,94 ± 0,3 y 68,3 ± 16,4) presentaron una mejoría a los 24 meses de tratamiento (0,94 ± 0,27 y 68,2 ± 15,8). Durante el seguimiento se describieron 94 eventos adversos en 84 pacientes y 53 suspensiones del tratamiento. Estos eventos adversos se relacionaron con el sexo (p 0,004), dapagliflozina (p < 0,001) y valores iniciales de Hb1Ac (p 0,04). El evento adverso más frecuente fueron las infecciones genitourinarias (63), seguidas de la insuficiencia renal aguda (9), siendo esta última la causa más frecuente de interrupción del tratamiento. La hipoglucemia sintomática durante el seguimiento se relacionó con el tratamiento de insulina, la edad y la Hb1Ac (p <0,01).Conclusiones: El tratamiento con SGLT2i es un tratamiento seguro y bien tolerado en pacientes muy ancianos en la vida real. Las infecciones genitourinarias son los eventos adversos más frecuentes, pero los que con menor frecuencia provocan la interrupción del tratamiento. (AU)

Evaluation of bendopnea in severe obstructive sleep apnea syndrome

Background: Bendopnea is a symptom described in heart failure (HF) that is related to short-term prognosis; however, its frequency and characteristics in respiratory diseases such as OSAS is still unknown. This study was carried out to evaluate the prevalence of bendopnea in patients with severe obstructive sleep apnea syndrome (OSAS)MethodsWe conducted a study of 95 patients attending a sleep disorders unit with severe OSAS. Bendopnea was considered when shortness of breath occurred within 30s of bending forward.ResultsBendopnea was present in 33/95 of the patients included (34.7%). The median age was 62 years (52–71), 65 were men (68.4%), with a median weight of 92 (81–107) and BMI of 34kg/m2 (±7.1). The median duration of shortness of breath was 5s (2–10). The presence of bendopnea was related to age (p<.0001), obesity (p .004), respiratory diseases (p .01) and HF (p .03). Admission rate was higher in those with bendopnea without reaching statistical significance.ConclusionOne-third of patients with severe OSAS present bendopnea. This symptom is related to a higher prevalence of comorbidities (HF, obesity and other respiratory diseases). It is also related to a higher CT90. (AU)

Antecedentes: La bendopnea es un síntoma descrito en la insuficiencia cardiaca (IC), relacionado con un pronóstico a corto plazo; sin embargo, se desconocen su frecuencia y características en enfermedades respiratorias como el síndrome de apnea obstructiva del sueño (SAOS). Este estudio fue realizado para evaluar la prevalencia de bendopnea en pacientes con síndrome de apnea obstructiva del sueño severo.MétodosRealizamos un estudio de 95 pacientes que acudieron a la unidad de trastornos del sueño con SAOS severo. Se consideró bendopnea cuando se producía dificultad respiratoria dentro de un plazo de 30s desde que el paciente se inclinaba hacia adelante.ResultadosSe presentó bendopnea en 33 de los 95 pacientes incluidos (34,7%). La edad media fue de 62 años (52-71), de los cuales 65 eran varones (68,4%) con un peso medio de 92 (81-107) e IMC de 34kg/m2 (±7,1). La duración media de la dificultad respiratoria fue de 5s (2-10). La presencia de bendopnea guardó relación con la edad (p<0,0001), obesidad (p 0,004), enfermedades respiratorias (p 0,01) e IC (p 0,03). La tasa de ingreso fue superior en aquellos pacientes con bendopnea, sin alcanzar significación estadística.ConclusiónUn tercio de los pacientes con SAOS severo presentan bendopnea. Este síntoma guarda relación con una mayor prevalencia de comorbilidades (IC, obesidad y otras enfermedades respiratorias). También se correlaciona con mayor CT90. (AU)

Evaluation of bendopnea in severe obstructive sleep apnea syndrome.

BACKGROUND: Bendopnea is a symptom described in heart failure (HF) that is related to short-term prognosis; however, its frequency and characteristics in respiratory diseases such as OSAS is still unknown. This study was carried out to evaluate the prevalence of bendopnea in patients with severe obstructive sleep apnea syndrome (OSAS) METHODS: We conducted a study of 95 patients attending a sleep disorders unit with severe OSAS. Bendopnea was considered when shortness of breath occurred within 30s of bending forward. RESULTS: Bendopnea was present in 33/95 of the patients included (34.7%). The median age was 62 years (52-71), 65 were men (68.4%), with a median weight of 92 (81-107) and BMI of 34kg/m2 (±7.1). The median duration of shortness of breath was 5s (2-10). The presence of bendopnea was related to age (p<.0001), obesity (p .004), respiratory diseases (p .01) and HF (p .03). Admission rate was higher in those with bendopnea without reaching statistical significance. CONCLUSION: One-third of patients with severe OSAS present bendopnea. This symptom is related to a higher prevalence of comorbidities (HF, obesity and other respiratory diseases). It is also related to a higher CT90.

Tratamiento de la hipercolesterolemia familiar con iPCSK9 en un paciente diagnosticado de distrofia muscular congénita con contraindicación para la toma de estatinas / iPCSK9 treatment of Familial Hypercholesterolemia in a patient diagnosed as Congenital Muscular Dystrophy with contraindication for statin use

Las estatinas están contraindicadas en pacientes con miopatías. Hasta hace unos años, la alternativa en pacientes con hipercolesterolemia familiar que tenían distrofias musculares y no conseguían niveles adecuados de colesterol era la lipoaféresis. Cuando surgieron los inhibidores de PCSK9, se consiguió suspender la lipoaféresis en algunos de estos pacientes y mantenerlos con concentraciones plasmáticas de colesterol adecuadas. Presentamos el caso de un varón, diagnosticado en la infancia de distrofia muscular congénita. A los 27 años se remitió a la unidad de lípidos por hipercolesterolemia, donde tras estudio genético se confirmó una hipercolesterolemia familiar heterocigota. A pesar del tratamiento con dieta y ezetimiba continuó con cifras elevadas de cLDL por lo que se incluyó en programa de lipoaféresis. Con esto se alcanzaron niveles de cLDL de 70 mg/dl. Al disponer de los iPCSK9, se suspendió la lipoaféresis y se inició tratamiento con alirocumab 150 mg quincenal, con buena respuesta y manteniendo valores de cLDL en torno a 75 mg/dl

Statins are contraindicated in patients with myopathies. Until a few years ago, in those patients with Familial Hypercholesterolemia who also presented muscular dystrophies and didńt reach adequate cholesterol plasmatic levels, the next therapeutic ladder was lipoapheresis. When iPCSK9 first appeared, lipoapheresis could be suspended in some of these patients, sustaining nevertheless proper levels of cholesterol. We present the case of a 27 year-old male, diagnosed with Congenital Muscular Dystrophy in the early childhood. He was referred to the Unit of Lipidology presenting hypercholesterolemia which, after genetic test, was assessed as Heterozygous Familial Hypercholesterolemia. Despite of treatment with diet and ezetimibe, cLDL blood levels abide high, being consequently included in lipoapheresis programme, therewith obtained levels of cLDL of 70 mg/dl. In providing iPCSK9, lipoapheresis was withdrawn and treatment with alirocumab 150 mg fortnightly introduced, unveiling a positive response, and sustaining cLDL levels around 75 mg/dl

iPCSK9 treatment of Familial Hypercholesterolemia in a patient diagnosed as Congenital Muscular Dystrophy with contraindication for statin use. / Tratamiento de la hipercolesterolemia familiar con iPCSK9 en un paciente diagnosticado de distrofia muscular congénita con contraindicación para la toma de estatinas.

Statins are contraindicated in patients with myopathies. Until a few years ago, in those patients with Familial Hypercholesterolemia who also presented muscular dystrophies and didnt reach adequate cholesterol plasmatic levels, the next therapeutic ladder was lipoapheresis. When iPCSK9 first appeared, lipoapheresis could be suspended in some of these patients, sustaining nevertheless proper levels of cholesterol. We present the case of a 27 year-old male, diagnosed with Congenital Muscular Dystrophy in the early childhood. He was referred to the Unit of Lipidology presenting hypercholesterolemia which, after genetic test, was assessed as Heterozygous Familial Hypercholesterolemia. Despite of treatment with diet and ezetimibe, cLDL blood levels abide high, being consequently included in lipoapheresis programme, therewith obtained levels of cLDL of 70mg/dl. In providing iPCSK9, lipoapheresis was withdrawn and treatment with alirocumab 150mg fortnightly introduced, unveiling a positive response, and sustaining cLDL levels around 75mg/dl.

Assessment of bendopnea impact on decompensated heart failure.

AIMS: We have often found that patients with heart failure had shortness of breath when bending forward. The frequency of bendopnea in patients with decompensated heart failure (DHF), its repercussions on quality of life (QoL), and its prognosis have not yet been studied. This study was carried out to evaluate the characteristics, degree of limitation, and short-term prognosis of patients with bendopnea and DHF. METHODS AND RESULTS: We conducted a study of 250 patients admitted with DHF. Bendopnea was considered when shortness of breath occurred within 30 s of bending forward. It was present in 122 patients (48.8%). The mean time of onset was 13.4 ± 6.9 s. Patients with bendopnea presented a higher frequency of orthopnoea, paroxysmal nocturnal dyspnoea, oliguria, oedema, elevated jugular venous pressure, abdominal fullness, and worse functional class (P < 0.001). An enlargement of both atria was more frequent in these patients (P < 0.001). Pulmonary artery systolic pressure (PASP) was higher in the bendopnea group (P = 0.001). Body mass index and LVEF were not associated with presence of bendopnea. Subjective QoL limitation was present in 80.3% (36.1% mild, 44.2% moderate to severe limitation). Patients with bendopnea had a higher mortality rate (P = 0.025) and more advanced NYHA class (P < 0.001). Patients who died had a lower LVEF (P = 0.001), increased PASP (P = 0.08), and lower mean duration of shortness of breath than those who survived (P = 0.01). CONCLUSION: Bendopnea is related to advanced HF symptoms and it is associated with mortality in the short term and advanced NYHA functional class. This symptom produces moderate to severe limitation of QoL.

Alternativas sintomáticas en la aftosis oral recidivante / Symptom alternatives in recurrent oral aphthosis

No disponible

Validity of procalcitonin for the diagnosis of bacterial infection in elderly patients / Validez de la procalcitonina para el diagnóstico de infección bacteriana en pacientes ancianos

INTRODUCTION: PCT has been consolidated as a key tool in the diagnosis of bacterial infections in general population. Few studies have been conducted to determine the applicability of this test in elderly patients. METHODS: Study of validity of PCT on elderly patients. Two groups were formed; the first group was formed by patients aged 75 years or older, under bacterial infection criteria and PCT on the initial Lab test. The second group was formed by patients aged 75 years or older with any noninfectious disease; these patients were asked PCT in the initial Lab test. Sensitivity, specificity, positive and negative likelihood ratio were calculated.RESULTS:161 patients were included, 95 with probable bacterial infection and 66 without infection. Patients with probable bacterial infection criteria, 72% of them had PCT >0.5 ng/mL. Patients without infection, 8% of the patients had PCT >0.5 ng/mL. Sensitivity and specificity of PCT to bacterial infection with the cutoff value of 0.5 ng/mL was 72% and 92%, respectively. Conclusion PCT can be used in elderly patients to diagnose bacterial infections because it has proved good sensitivity and high specificity

INTRODUCCIÓN: La PCT se ha consolidado como una herramienta clave en el diagnóstico de las infecciones bacterianas en la población general. Pocos estudios se han realizado para determinar la aplicabilidad de esta prueba en pacientes ancianos. MÉTODOS: Estudio de validez de la PCT en población anciana. Se conformaron 2 grupos: un grupo con pacientes con edad igual o mayor de 75 años con criterios de probable infección bacteriana y a quienes se les hubiese realizado PCT en la analítica inicial. Otro grupo conformado por pacientes con edad igual o mayor de 75 años ingresados por patología no infecciosa; a estos pacientes se les solicitó PCT en la analítica de ingreso. Se calcularon: sensibilidad (S), especificidad (E), valor predictivo positivo (VPP), valor predictivo negativo (VPN), razones de verosimilitud positiva y el inverso de la razón de verosimilitud negativa (RVP y I-RVN). RESULTADOS: Se incluyeron 161 pacientes, 95 con probable infección bacteriana y 66 sin infección. De los pacientes con probable infección bacteriana, 72% tenían la PCT > 0,5 ng/mL. En el grupo sin infección, 8% tenían la PCT > 0,5 ng/mL. La S y E de la PCT fue de 72 y 92%, respectivamente. CONCLUSIÓN: La PCT se puede utilizar en pacientes ancianos de forma fiable porque posee una buena sensibilidad y alta especificidad para el diagnóstico de infección bacteriana

Validity of procalcitonin for the diagnosis of bacterial infection in elderly patients.

INTRODUCTION: PCT has been consolidated as a key tool in the diagnosis of bacterial infections in general population. Few studies have been conducted to determine the applicability of this test in elderly patients. METHODS: Study of validity of PCT on elderly patients. Two groups were formed; the first group was formed by patients aged 75 years or older, under bacterial infection criteria and PCT on the initial Lab test. The second group was formed by patients aged 75 years or older with any noninfectious disease; these patients were asked PCT in the initial Lab test. Sensitivity, specificity, positive and negative likelihood ratio were calculated. RESULTS: 161 patients were included, 95 with probable bacterial infection and 66 without infection. Patients with probable bacterial infection criteria, 72% of them had PCT >0.5 ng/mL. Patients without infection, 8% of the patients had PCT >0.5 ng/mL. Sensitivity and specificity of PCT to bacterial infection with the cutoff value of 0.5 ng/mL was 72% and 92%, respectively. CONCLUSION: PCT can be used in elderly patients to diagnose bacterial infections because it has proved good sensitivity and high specificity.