Hereditary Pancreatitis Related to SPINK-1 Mutation. Is There an Increased Risk of Developing Pancreatic Cancer?

It is thought that many of the idiopathic pancreatitis could have a genetic base. Approximately 50% of them correspond to CFTR (cystic fibrosis transmembrane conductance regulator gene) and SPINK-1 (serine protease inhibitor Kazal type 1) mutations. A recent study compares patients with acute pancreatitis and SPINK-1 mutation with patients with idiopathic acute pancreatitis. The study highlights a 12-fold increased risk of developing pancreatic cancer with SPINK-1 mutation versus the control group. Nonetheless, authors conclude that only specific pN34s mutation is related to pancreatic cancer. This relation is controversial, and international consensus guidelines for the follow-up in chronic pancreatitis with pancreatic cancer still do not recommend follow-up in SPINK-1 p. N34S mutation. We believe that developing prospective studies in which subgroups of patients with SPINK-1 mutation benefit from closer follow-ups would be necessary.

Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study.

The aim of this study was to know the prevalence and severity of COVID-19 in patients treated with long-term macrolides and to describe the factors associated with worse outcomes. A cross-sectional study was conducted in Primary Care setting. Patients with macrolides dispensed continuously from 1 October 2019 to 31 March 2020, were considered. Main outcome: diagnosis of coronavirus disease-19 (COVID-19). Secondary outcomes: symptoms, severity, characteristics of patients, comorbidities, concomitant treatments. A total of 3057 patients met the inclusion criteria. Median age: 73 (64-81) years; 55% were men; 62% smokers/ex-smokers; 56% obese/overweight. Overall, 95% of patients had chronic respiratory diseases and four comorbidities as a median. Prevalence of COVID-19: 4.8%. This was in accordance with official data during the first wave of the pandemic. The most common symptoms were respiratory: shortness of breath, cough, and pneumonia. Additionally, 53% percent of patients had mild/moderate symptoms, 28% required hospital admission, and 19% died with COVID-19. The percentage of patients hospitalized and deaths were 2.6 and 5.8 times higher, respectively, in the COVID-19 group (p < 0.001). There was no evidence of a beneficial effect of long-term courses of macrolides in preventing SARS-CoV-2 infection or the progression to worse outcomes in old patients with underlying chronic respiratory diseases and a high burden of comorbidity.

Incidence of COVID-19 in patients under chronic treatment with hydroxychloroquine.

OBJECTIVE: To analyze the incidence of Covid-19 in patients who are chronic users of hydroxychloroquine. PATIENTS AND METHODS: Cross-sectional retrospective observational multicenter study in health areas and districts from Castilla La-Mancha and Andalucia. Of the 4451 participants included in the first recruitment, 3817 with valid data were selected. The main variable of the study is the presence or absence of Covid-19 infection by clinical, serological or polymerase chain reaction diagnosis. Sociodemographic and clinical variables and treatment and concomitant comorbidities were recorded. RESULTS: 169 (4,45%) patients had Covid-19 infection, of which 12 (7.1 %) died and 32 (18.9%) required hospital admission. Previous respiratory pathology was related to Covid-19 infection (P < .05). Maculopathy appears in 5.3% of patients and is significantly related to the dose of hydroxychloroquine consumed (P < .05). CONCLUSION: There is no relationship between chronic use of hydroxychloroquine and the incidence of Covid-19.

OBJETIVO: Analizar la incidencia de la enfermedad del coronavirus 19 (COVID-19) en pacientes consumidores crónicos de hidroxicloroquina. PACIENTES Y MÉTODOS: Estudio multicéntrico observacional retrospectivo transversal en Áreas de Salud de Castilla La-Mancha y distritos sanitarios de Andalucía. De los 4.451 participantes incluidos en el primer reclutamiento se seleccionaron 3.817 sujetos con datos válidos. La variable principal del estudio ha sido la presencia o ausencia de infección por la COVID-19 por diagnóstico clínico, serológico o por reacción en cadena de la polimerasa. Se registraron variables sociodemográficas, clínicas y tratamientos y comorbilidades concomitantes. RESULTADOS: Ciento sesenta y nueve (4,45%) pacientes presentaron infección por la COVID-19, de los cuales fallecieron 12 (7,1%) y 32 (18,9%) requirieron ingreso hospitalario. La enfermedad respiratoria previa se relacionó con la infección por la COVID-19 (p < 0,05). La maculopatía aparece en un 5,3% de los pacientes y está relacionada significativamente con la dosis de hidroxicloroquina consumida (p < 0,05). CONCLUSIÓN: No existe relación entre consumo crónico de hidroxicloroquina e incidencia de la COVID-19.

Incidencia de la COVID-19 en pacientes en tratamiento crónico con hidroxicloroquina / Incidence of COVID-19 in patients under chronic treatment with hydroxychloroquine

Objetivo: Analizar la incidencia de la enfermedad del coronavirus 19 (COVID-19) en pacientes consumidores crónicos de hidroxicloroquina.Pacientes y métodosEstudio multicéntrico observacional retrospectivo transversal en Áreas de Salud de Castilla La-Mancha y distritos sanitarios de Andalucía. De los 4.451 participantes incluidos en el primer reclutamiento se seleccionaron 3.817 sujetos con datos válidos. La variable principal del estudio ha sido la presencia o ausencia de infección por la COVID-19 por diagnóstico clínico, serológico o por reacción en cadena de la polimerasa. Se registraron variables sociodemográficas, clínicas y tratamientos y comorbilidades concomitantes.ResultadosCiento sesenta y nueve (4,45%) pacientes presentaron infección por la COVID-19, de los cuales fallecieron 12 (7,1%) y 32 (18,9%) requirieron ingreso hospitalario. La enfermedad respiratoria previa se relacionó con la infección por la COVID-19 (p<0,05). La maculopatía aparece en un 5,3% de los pacientes y está relacionada significativamente con la dosis de hidroxicloroquina consumida (p<0,05).ConclusiónNo existe relación entre consumo crónico de hidroxicloroquina e incidencia de la COVID-19. (AU)

Objective: To analyze the incidence of Covid-19 in patients who are chronic users of hydroxychloroquine.Patients and methodsCross-sectional retrospective observational multicenter study in health areas and districts from Castilla La-Mancha and Andalucia. Of the 4451 participants included in the first recruitment, 3817 with valid data were selected. The main variable of the study is the presence or absence of Covid-19 infection by clinical, serological or polymerase chain reaction diagnosis. Sociodemographic and clinical variables and treatment and concomitant comorbidities were recorded.Results169 (4,45%) patients had Covid-19 infection, of which 12 (7.1%) died and 32 (18.9%) required hospital admission. Previous respiratory pathology was related to Covid-19 infection (P<.05). Maculopathy appears in 5.3% of patients and is significantly related to the dose of hydroxychloroquine consumed (P<.05).ConclusionThere is no relationship between chronic use of hydroxychloroquine and the incidence of Covid-19. (AU)

[Incidence of COVID-19 in patients under chronic treatment with hydroxychloroquine]. / Incidencia de la COVID-19 en pacientes en tratamiento crónico con hidroxicloroquina.

OBJECTIVE: To analyze the incidence of Covid-19 in patients who are chronic users of hydroxychloroquine. PATIENTS AND METHODS: Cross-sectional retrospective observational multicenter study in health areas and districts from Castilla La-Mancha and Andalucia. Of the 4451 participants included in the first recruitment, 3817 with valid data were selected. The main variable of the study is the presence or absence of Covid-19 infection by clinical, serological or polymerase chain reaction diagnosis. Sociodemographic and clinical variables and treatment and concomitant comorbidities were recorded. RESULTS: 169 (4,45%) patients had Covid-19 infection, of which 12 (7.1%) died and 32 (18.9%) required hospital admission. Previous respiratory pathology was related to Covid-19 infection (P<.05). Maculopathy appears in 5.3% of patients and is significantly related to the dose of hydroxychloroquine consumed (P<.05). CONCLUSION: There is no relationship between chronic use of hydroxychloroquine and the incidence of Covid-19.

Utilidad del ultrasonido: Relleno de bomba intratecal en el manejo de dolor crónico. Reporte de caso / Usefulness of ultrasound: intrathecal pump refill in the management of chronic pain. A case report

Abstract Intrathecal administration for the treatment of patients with difficult to manage chronic pain represents a therapeutic breakthrough that reduces adverse effects and improves the patient's quality of life. However, the use and refill of infusion pumps entails certain risks. A difficult access to the refill port and the potential for subcutaneous infiltration are rare but potentially fatal complications. The use of ultrasonography as real-time guidance for the localization of the port has been suggested. The case of a patient with a diagnosis of ankylosing spondylitis and chronic pain, with neuroplasticity phenomena in the management of analgesia with opioid intrathecal infusion pump and the need for frequent refill is discussed. An ultrasound-guided static method using coordinates was used for a successful, free of complications refill. The technique described for the refill of intrathecal infusion pumps is a practical and innovative approach which, through adequate training, may reduce the risks and complications during the procedure in patients requiring frequent refills.

Resumen La vía de administración intratecal en el tratamiento de pacientes con dolor crónico de difícil manejo representa un avance terapéutico que disminuye efectos adversos y mejora su calidad de vida. Sin embargo, el uso y recarga de bombas de infusión presenta riesgos. Un acceso difícil al puerto de recarga y la posible infiltración subcutánea son complicaciones infrecuentes, pero potencialmente fatales. El uso de ultrasonografía como guía en tiempo real o para localización del puerto ha sido propuesto. Se presenta el caso de un paciente con diagnóstico de espondilitis anquilosante y dolor crónico con fenómenos de neuroplasticidad en manejo analgésico con bomba de infusión intratecal de opioides y necesidad de recarga frecuente, en quien se aplicó un método estático mediante coordenadas utilizando ultrasonido para guiar la recarga de forma exitosa y sin complicaciones. La técnica descrita para la recarga de bombas de infusión intratecal es una manera práctica e innovadora que, con el entrenamiento adecuado, puede disminuir los riesgos y complicaciones durante el procedimiento en pacientes con requerimiento de recarga frecuente.

[Prevalence of Hypothyroidism in Andalusia, Spain, Determined by Thyroid Hormone Comsumption]. / Prevalencia de hipotiroidismo en Andalucía según el consumo de hormona tiroidea en 2014.

OBJECTIVE: Hypothyroidism is the most common condition linked to a hormone deficiency, nevertheless data on its prevalence are scarce in Spain. For that reason, we have estimated its prevalence through the registration of patients who had used thyroid hormones in Andalusia (South Spain). METHODS: Data of patients who had withdrawn levothyroxine under the public system during 2014 from the base of the Andalusian Health Service were considered. Prevalence were calculated with confidence intervals of 95% for each management area, stratified by sex and age groups, and differences between them were evaluated. RESULTS: 321,368 people (98% older than 18 years and 83% female) were identified as levothyroxine users and a prevalence of hypothyroidism of 3.95% (95%CI:3.94-3.96) was estimated for the general population. The condition was more common in females, in the older 18 years 7.81% (95%CI:7.80 to 7.82) compared to males 1.75% (95%CI:1.73-1.77) with a ratio of 4.5-fold. It increases in the population of women older than 45 years, 10.32% (95%CI:10.30-0.32) and in the over 60 years 11.37% (95%CI: 11.35-11.40). The prevalence in adult women in the western provinces is 7.38% (95%CI:7.36-7.40), in the eastern provinces 8.59% (95%CI:8.57-8.62) and in coastal areas 6.70% (95%CI: 6.68-6.72) compared to the mountainous ones, which is 8.91% (95%CI:8.88-8.94). CONCLUSIONS: The results denote a high prevalence of hypothyroidism in the adult population of Andalusia compared to the nearby countries, with a clear increased associated with females and age. Furthermore, the prevalence of the illness presents also a geographically-related variability.

Prevalencia de hipotiroidismo en Andalucía según el consumo de hormona tiroidea en 2014 / Prevalence of hypothyroidism in Andalusia, Sapin, determined by thyroid hormone comsumption

Fundamento: El hipotiroidismo es la condición más común ligada a un déficit hormonal. A pesar de ello existe una escasez de datos en España sobre su su prevalencia. El objetivo fue estimar la prevalencia en Andalucía a través del registro de pacientes que consumieron hormona tiroidea durante el año 2014. Método: Se recuperaron los datos de las personas que habían retirado de la farmacia levotiroxina con cargo al sistema público durante 2014 de la base de datos del Servicio Andaluz de Salud. Se calcularon las prevalencias con sus intervalos de confianza del 95% para cada Área de Gestión, estratificadas por sexo y grupos etarios. Resultados: Se identificaron 321.368 personas (98% mayores de 18 años y 83% mujeres) consumidoras de levotiroxina y se estimó una prevalencia de hipotiroidismo del 3,95% (IC95%: 3,943,96) para población general. La condición era más común en la mujer, en mayores de 18 años un 7,81% (IC95 7,80 a 7,82) comparada con el hombre 1,75% (IC95 1,73 a 1,77) con una razón de 4,5. Aumenta en la población de mujeres mayores de 45 años, 10,32% (IC95 10,30 a 10,32) y más en las mayores de 60 años 11,37% (IC95%: 11,35 a 11,40). La prevalencia en mujer adulta de las provincias occidentales fue 7,38% (IC95%: 7,36-7,40), en las orientales de 8,59% (IC95%: 8,57-8,62) y en las áreas costeras fue de 6,70% (IC95%: 6,68-6,72) frente a las montañosas que fue 8,91% (IC95%: 8,88-8,94). Conclusión: Los resultados indican una elevada prevalencia de hipotiroidismo en la población adulta de Andalucía, con un claro predominio de la mujer y un incremento con la edad. Además, la prevalencia de la enfermedad también presenta una importante variabilidad geográfica (AU)

Background: Hypothyroidism is the most common condition linked to a hormone deficiency, nevertheless data on its prevalence are scarce in Spain. For that reason, we have estimated its prevalence through the registration of patients who had used thyroid hormones in Andalusia (South Spain). Method: data of patients who had withdrawn levothyroxine under the public system during 2014 from the base of the Andalusian Health Service were considered. Prevalence were calculated with confidence intervals of 95% for each management area, stratified by sex and age groups, and differences between them were evaluated. Results: 321,368 people (98% older than 18 years and 83% female) were identified as levothyroxine users and a prevalence of hypothyroidism of 3.95% (95%CI:3.94-3.96) was estimated for the general population. The condition was more common in females, in the older 18 years 7.81% (95%CI:7.80 to 7.82) compared to males 1.75% (95%CI:1.73-1.77) with a ratio of 4.5-fold. It increases in the population of women older than 45 years, 10.32% (95%CI:10.30- 0.32) and in the over 60 years 11.37% (95%CI: 11.35-11.40). The prevalence in adult women in the western provinces is 7.38% (95%CI:7.36-7.40), in the eastern provinces 8.59% (95%CI:8.57-8.62) and in coastal areas 6.70% (95%CI: 6.68-6.72) compared to the mountainous ones, which is 8.91% (95%CI:8.88- 8.94). Conclusion: The results denote a high prevalence of hypothyroidism in the adult population of Andalusia compared to the nearby countries, with a clear increased associated with females and age. Furthermore, the prevalence of the illness presents also a geographically-related variability (AU)

Evaluación de la técnica anestésica con remifentanilo y midazolam en el legrado obstétrico / Evaluation of the anesthesic technology (skill) with remifentanilo and midazolam in the obstetric legrado

El legrado uterino obstétrico es un procedimiento muy frecuente, realizado de manera ambulatoria. La anestesia para procedimientos ambulatorios debe propender por la seguridad, la satisfacción del paciente y una rápida recuperación sin efectos secundarios, como náuseas y vómito o dolor en el periodo postoperatorio. El uso de opioides de acción ultracorta no se ha estudiado como posibilidad anestésica para este tipo de procedimientos. Objetivos. El siguiente estudio prospectivo pretende evaluar, según la satisfacción, la viabilidad de la analgesia intravenosa con remifentanilo y el control de la ansiedad con midazolam. Métodos. En esta serie de casos prospectiva se incluyeron pacientes programadas para legrado obstétrico ambulatorio. Durante el procedimiento se administró midazolam como ansiolítico a dosis de 0,03 mg/kg y bolos intraoperatorios de remifentanilo, 0,5 a 1 mg/kg, a discreción del anestesiólogo. Para la analgesia postoperatoria se administró dipirona, 50 mg/kg. Se evaluó la satisfacción del paciente y del cirujano, los consumos analgésicos y las variables hemodinámicas, así como la necesidad de soporte respiratorio, las náuseas, el vómito y el dolor en el postoperatorio. Resultados. La efectividad de la técnica fue mayor de 88 por cien, la satisfacción de las pacientes y la del cirujano fueron buenas: 9,5 y 8,8, respectivamente en una escala donde 10 es óptimo. No se presentaron cambios hemodinámicos relevantes ni complicaciones respiratorias. Conclusión. La técnica empleada es viable, logra una adecuada satisfacción, sin efectos adversos mayores, y podría ser aplicable a otros procedimientos de carácter similar. Este estudio abre el espacio y plantea interrogantes susceptibles de posterior investigación, con diferente diseño y un mayor número de pacientes.