Evaluación de las visitas a urgencias previas a un diagnóstico de VIH: oportunidades perdidas / Evaluation of emergency department visits prior to an HIV diagnosis: Missed opportunities

Objetivo: Existe una elevada tasa de infección oculta y diagnóstico tardío en el VIH. Los servicios de urgencias hospitalarios (SUH) son un punto importante de atención sanitaria. El presente trabajo tiene el objetivo conocer el número de oportunidades perdidas para el diagnóstico de VIH que ocurren en los SUH. Método: Estudio multicéntrico de cohortes retrospectivo que incluyó a todos los pacientes diagnosticados de infección por el VIH en el año 2019 en 27 hospitales españoles de 7 comunidades autónomas diferentes. Se revisaron todos los episodios de consulta en los SUH en los 5años previos al diagnóstico para conocer el motivo de consulta y si este representaba una oportunidad perdida para el diagnóstico de VIH. Resultado: Se incluyeron 723 pacientes, y 352 de ellos (48,7%; IC95%: 45,1-52,3%) presentaron al menos una visita a un SUH durante los 5años anteriores al diagnóstico (mediana2; p25-p75: 1-4). Ciento dieciocho pacientes (16,3%; IC95%: 13,8-19,2%) presentaron oportunidad perdida de diagnóstico. Las principales consultas fueron consumo de drogas (145 [15%]), infecciones de transmisión sexual (91 [9,4%]) y solicitud de profilaxis de VIH postexposición (39 [4%]). Ciento cincuenta y cinco (42,9%) de los 352 tenían menos de 350CD4/mm3 cuando se estableció el diagnóstico de VIH. En los pacientes con visitas previas a urgencias, el tiempo medio hasta el diagnóstico desde esta visita fue de 580 (DE647) días. Conclusiones: El 16% de los pacientes diagnosticados de VIH perdieron la oportunidad de ser diagnosticados en los 5años previos al diagnóstico, lo que pone de manifiesto la necesidad de implementar medidas de cribado en los SUH diferentes a las actuales para mejorar estos resultados.(AU)

Objective: There is a high rate of occult infection and late diagnosis in HIV. Hospital emergency departments (ED) are an important point of health care. The present work aims to know the number of missed opportunities for HIV diagnosis occurring in the ED. Method: Retrospective multicenter cohort study that included all patients diagnosed with HIV infection in 2019 in 27 Spanish hospitals in 7 different autonomous communities. All ED consultation episodes in the 5years prior to diagnosis were reviewed to find out the reason for consultation and whether this represented a missed opportunity for HIV diagnosis. Result: Seven hundred twenty-three patients were included, and 352 (48.7%; 95%CI: 45.1%-52.3%) had at least one ED visit during the 5years prior to diagnosis (median2; p25-p75: 1-4). One hundred and eighteen patients (16.3%; 95%CI: 13.8%-19.2%) had a missed diagnostic opportunity. The main consultations were drug use (145 [15%]), sexually transmitted infections (91 [9.4%]) and request for post-exposure HIV prophylaxis (39 [4%]). One hundred and fifty-five (42.9%) of the 352 had less than 350CD4/mm3 when the HIV diagnosis was established. In patients with previous ED visits, the mean time to diagnosis from this visit was 580 (SD647) days. Conclusions: Sixteen percent of patients diagnosed with HIV missed the opportunity to be diagnosed in the 5years prior to diagnosis, highlighting the need to implement ED screening measures different from current ones to improve these outcomes.(AU)

Evaluation of emergency department visits prior to an HIV diagnosis: Missed opportunities.

OBJECTIVE: There is a high rate of occult infection and late diagnosis in HIV. Hospital emergency departments (ED) are an important point of health care. The present work aims to know the number of missed opportunities for HIV diagnosis occurring in the ED. METHOD: Retrospective multicenter cohort study that included all patients diagnosed with HIV infection in 2019 in 27 Spanish hospitals in 7 different autonomous communities. All ED consultation episodes in the 5 years prior to diagnosis were reviewed to find out the reason for consultation and whether this represented a missed opportunity for HIV diagnosis. RESULT: Seven hundred twenty-three patients were included, and 352 (48.7%, 95%CI: 45.1%-52.3%) had at least one ED visit during the 5 years prior to diagnosis (median 2, p25-p75: 1-4). One hundred and eighteen patients (16.3%, 95%CI: 13.8%-19.2%) had a missed diagnostic opportunity. The main consultations were drug use [145 (15%)], sexually transmitted infections [91 (9.4%)] and request for post-exposure HIV prophylaxis [39 (4%)]. One hundred and fifty-five (42.9%) of the 352 had less than 350 CD4/mm3 when the HIV diagnosis was established. In patients with previous ED visits, the mean time to diagnosis from this visit was 580 (SD 647) days. CONCLUSIONS: Sixteen percent of patients diagnosed with HIV missed the opportunity to be diagnosed in the 5 years prior to diagnosis, highlighting the need to implement ED screening measures different from current ones to improve these outcomes.

Predicting malignancy in small testicular lesions.

Introduction: Small testicular lesions ≤20 mm (STL) detected by ultrasound (US), usually non-palpable, have been reported to be benign in up to 80% of cases. Thus, partial orchiectomy with or without frozen section examination and surveillance has been advocated for these kinds of lesions. We seek to report the proportion of benign lesions in testicular tumors ≤20 mm detected by US in our population and explore the predicting factors of malignancy. Material and methods: A retrospective descriptive study of orchiectomies performed for testicular tumors in patients older than 15 years between 2005 and 2019 was performed, including all patients with lesions ≤20 mm on US imaging. Results: A total of 70 patients with STL were included (mean age 34.6 ±10.8 years). Overall, 69% of the lesions were malignant while the smallest lesions (≤10 mm) showed 61% of cancer. Moreover, in the subgroup of non-palpable lesions ≤10 mm, 50% were malignant. Multifocal tumors were found in 18 subjects with a malignancy rate of 88%. There was a significant association between maximum size on US, multifocality and malignancy. Neither tumor markers nor palpability foretold a malignant lesion. A predictive model including size and multifocality was created showing a positive predictive value of 83.3%. Conclusions: US maximum size and multifocality were predictors of malignancy in STL. However, even the smallest lesions showed a 50% chance of being malignant, thus surgery with or without intraoperative biopsy is warranted in most cases.

Fruit Peels as a Sustainable Waste for the Biosorption of Heavy Metals in Wastewater: A Review.

One of the environmental challenges that is currently negatively affecting the ecosystem is the continuous discharge of untreated industrial waste into both water sources and soils. For this reason, one of the objectives of this qualitative study of exploratory-descriptive scope was the review of scientific articles in different databases-Scopus, Web of Science, and Science Direct-published from 2010 to 2021 on the use of fruit peels as a sustainable waste in the removal of heavy metals present in industrial wastewater. For the selection of articles, the authors used the PRISMA guide as a basis, with which 210 publications were found and 93 were compiled. Considering the reported work, a content analysis was carried out using NVivo 12 Plus and VOSviewer 1.6.17 software. The results show that the fruits mentioned in these publications are lemon, banana, mango, tree tomato, pineapple, passion fruit, orange, coconut, avocado, apple, lulo, and tangerine. However, no studies were found with lulo and tree tomato peels. On the other hand, the heavy metals removed with the selected fruit peels were Pb+2, Cr+3, Cr+6, Ni+2, Cd+2, As+5, Cu+2, and Zn+2.

Desorption of Coffee Pulp Used as an Adsorbent Material for Cr(III and VI) Ions in Synthetic Wastewater: A Preliminary Study.

Some of the diverse agro-industrial waste generated in primary or secondary stages have proved to be promising biomaterials for treating aqueous effluents contaminated, in this case, with heavy metals. Therefore, it is necessary to know their optimal operating conditions and the regeneration or reusability of the solid by-product, an aspect related to desorption. Considering the above, this article presents the findings of a preliminary study related to the desorption process of coffee pulp without physicochemical modification (Castilla variety), an agricultural waste used as a sorbent of Cr(III and VI) ions in synthetic wastewater. The desorption efficiency of four eluting agents at defined concentrations (0.10M)-HC1, HNO3, H2SO4, and EDTA-was evaluated in a time interval of 1 to 9 days. Likewise, the proposals for the sorption and/or desorption mechanisms proposed and reported in the literature with respect to the use of biosorbents derived from the coffee crop are presented. With respect to the results, the coffee pulp used in previous studies of the adsorption of chromium species mentioned (optimal conditions in synthetic water of particle size 180 µm, dose 20 g·L-1, agitation 100 RPM, room temperature, time of 90 to 105 min) showed efficiencies in the removal of Cr(III) and Cr(VI) of 93.26% and 74.80%, respectively. Regarding the extracting substances used, H2SO4 0.10 M was the one that presented the highest desorption percentage in both chromic species, with a desorption of 45.75% Cr(VI) and 66.84% Cr(III) in periods of 5 and 9 days, respectively, with agitation of 100 RPM and room temperature. Finally, the dissemination of preliminary results on the desorption of coffee pulp contaminated with chromic species without physicochemical modification is novel in this study, as similar work with this specific material has not yet been reported in the literature. On the other hand, the limitations of the study and future research are related to the evaluation at different concentrations and of other extractor solutions that allow improving the efficiency of desorption of these chemical species in a shorter time from the coffee pulp (with and without modification) as well as the reuse cycles. As a result, the desorption of coffee pulp used as an adsorbent material in real water could help researchers identify the possible interfering factors that affect the process (foreign anions and cations, organic matter, environmental conditions, among others).

First-in-human experience of preload regulation with percutaneous transluminal caval flow regulation in heart failure with reduced ejection fraction patients.

AIMS: This study aims to investigate the acute haemodynamic effects of percutaneous transluminal flow regulation (PTCR®) with an inferior vena cava regulator balloon in heart failure patients. Preload reduction in heart failure has been achieved with high potency diuretics. However, no study has been conducted in humans to assess the effect of inferior vena cava intermittent occlusion for preload reduction. METHODS AND RESULTS: Six patients were included in the study: four men (55 ± 6 years old) and two women (63 ± 4 years old). Baseline evaluations included Doppler echocardiogram, coronary angiogram, and right heart catheterization. Caval balloon was kept inflated for 30 min, and right catheterization and control echocardiogram were performed while the balloon was still inflated. The balloon was then deflated and removed. Right haemodynamic variables were evaluated before balloon insertion and with the inflated balloon. The mean right atrial pressure decreased by 42.59% (P = 0.005); systolic right ventricular pressure decreased by 30.19% (P < 0.003); mean pulmonary arterial pressure decreased by 25.33% (P < 0.043); mean pulmonary capillary wedge pressure decreased by 31.37% (P > 0.016); and cardiac output increased by 9.92% (P < 0.175). CONCLUSIONS: The haemodynamic and echocardiographic changes obtained in our study using PTCR® suggest that this innovative approach can play a beneficial role in the heart failure treatment.

Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension.

The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.

Recommendations for home blood pressure monitoring in Latin American countries: A Latin American Society of Hypertension position paper.

Out-of-office blood pressure (BP) monitoring appears to be a very useful approach to hypertension management insofar it allows to obtain multiple measurements in the usual environment of each individual, allows the detection of hypertension phenotypes, such as white-coat and masked hypertension, and appears to have superior prognostic value than the conventional office BP measurements. Out-of-office BP can be obtained through either home or ambulatory monitoring, which provide complementary and not identical information. Home BP monitoring yields BP values self-measured in subjects' usual living environment; it is an essential method for the evaluation of almost all untreated and treated subjects with suspected or diagnosed hypertension, best if combined with telemonitoring facilities, also allowing long-term monitoring. There is also increasing evidence that home BP monitoring improves long-term hypertension control rates by improving patients' adherence to prescribed treatment. In Latin American Countries, it is widely available, being relatively inexpensive, and well accepted by patients. Current US, Canadian, Japanese, and European guidelines recommend out-of-office BP monitoring to confirm and refine the diagnosis of hypertension.

Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper-accessibility, clinical use and cost effectiveness of ABPM in Latin America in year 2020.

Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long-term follow-up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24-h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on ABPM are available. However, despite the available evidence on the advantages of ABPM for the diagnosis and management of hypertension in LA, availability of ABPM is often restricted to cities with large population, and access to this technology by lower-income patients is sometimes limited by its excessive cost. The authors hope that this document might stimulate health authorities in each LA Country, as well as in other countries in the world, to regulate ABPM access and to widen the range of patients able to access the benefits of this technique.

MASked-unconTrolled hypERtension management based on office BP or on ambulatory blood pressure measurement (MASTER) Study: a randomised controlled trial protocol.

INTRODUCTION: Masked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM. METHODS AND ANALYSIS: MASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP <140/90 mm Hg, and at least one of the following: daytime ABP ≥135/85 mm Hg; night-time ABP ≥120/70 mm Hg; 24 hour ABP ≥130/80 mm Hg), and will be randomised to a management strategy based on OBPM (group 1) or on ABPM (group 2). Patients in group 1 will have OBP measured at 0, 3, 6, 12, 18, 24, 30, 36, 42 and 48 months and taken as a guide for treatment; ABPM will be performed at randomisation and at 12, 24, 36 and 48 months but will not be used to take treatment decisions. Patients randomised to group 2 will have ABPM performed at randomisation and all scheduled visits as a guide to antihypertensive treatment. The effects of MUCH management strategy based on ABPM or on OBPM on CV and renal intermediate outcomes (changing left ventricular mass and microalbuminuria, coprimary outcomes) at 1 year and on CV events at 4 years and on changes in BP-related variables will be assessed. ETHICS AND DISSEMINATION: MASTER study protocol has received approval by the ethical review board of Istituto Auxologico Italiano. The procedures set out in this protocol are in accordance with principles of Declaration of Helsinki and Good Clinical Practice guidelines. Results will be published in accordance with the CONSORT statement in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: NCT02804074; Pre-results.

Etnografia de práticas de serviço social: fenomenologia, holismo e poder / Ethnography of social service practices: phenomenology, holism and power

Com base numa etnografia realizada profissionais de Serviço Social em diversos serviços de protecção social e de desenvolvimento social local no norte de Portugal, o artigo propõe uma reflexão crítica sobre os limites do holismo etnográfico e evidencia as possibilidades da abordagem fenomenológica, considerando para tal os processos intersubjectivos e de poder inerentes à compreensão cultural. O acompanhamento destas profissionais no terreno, em contextos de trabalho, permitiu-nos compreender, a partir de uma perspectiva fenomenológica, como as mesmas constroem, mobilizam e recontextualizam o saber profissional no decurso das práticas e interacções dos seus quotidianos laborais. Por outro lado, mostrou-nos como as dinâmicas interaccionais entre quem faz a etnografia e os sujeitos sob observação fomentam processos de reflexão e de compreensão entre estes últimos que se entrecruzam com incrementos de estatuto e poder, não só no quadro da relação etnográfica, mas também no âmbito das relações com demais actores da ecologia profissional.

Drawn from an ethnography conducted with social workers working in welfare and local community development services in northern Portugal, the paper proposes a critical reflection on the limits of holism and on the prospects offered by the phenomenological approach as well as the implied intersubjective process of cultural comprehension. A series of professional ethnographies allowed the researchers to perceive how social workers constructed, mobilized and recontextualized professional knowledge in the course of everyday practice and social interaction. The phenomenological approach allowed perceiving how the participating social workers intersubjectively built their professional knowledge, either in the course of professional social interaction or while reflecting on and interpreting their own interactions with others. In this course, we discuss how the interactional rapport between ethnographers and observed social workers bolsters a process of power relativization that leads to professional empowerment.

Hypertension types defined by clinic and ambulatory blood pressure in 14 143 patients referred to hypertension clinics worldwide. Data from the ARTEMIS study.

OBJECTIVE: The Ambulatory blood pressure Registry TEleMonitoring of hypertension and cardiovascular rISk project was designed to set up an international registry including clinic blood pressure (CBP) and ambulatory blood pressure (ABP) measurements in patients attending hypertension clinics in all five continents, aiming to assess different daily life hypertension types. METHODS: Cross-sectional ABP, CBP and demographic data, medical history and cardiovascular risk profile were provided from existing databases by hypertension clinics. Hypertension types were evaluated considering CBP (≥140/90 mmHg) and 24-h ABP (≥130/80 mmHg). RESULTS: Overall, 14 143 patients from 27 countries across all five continents were analyzed (Europe 73%, Africa 3%, America 9%, Asia 14% and Australia 2%). Mean age was 57 ±â€Š14 years, men 51%, treated for hypertension 46%, cardiovascular disease 14%, people with diabetes 14%, dyslipidemia 33% and smokers 19%. The prevalence of hypertension was higher by CBP than by ABP monitoring (72 vs. 60%, P < 0.0001). Sustained hypertension (elevated CBP and ABP) was detected in 49% of patients. White-coat hypertension (WCH, elevated CBP with normal ABP) was more common than masked hypertension (elevated ABP with normal CBP) (23 vs. 10%; P < 0.0001). Sustained hypertension was more common in Europe and America and in elderly, men, obese patients with cardiovascular comorbidities. WCH was less common in Australia, America and Africa, and more common in elderly, obese women. Masked hypertension was more common in Asia and in men with diabetes. Smoking was a determinant for sustained hypertension and masked hypertension. CONCLUSION: Our analysis showed an unbalanced distribution of WCH and masked hypertension patterns among different continents, suggesting an interplay of genetic and environmental factors, and likely also different healthcare administrative and practice patterns.

Deficiencia de hierro y/o anemia en la insuficiencia cardíaca, ¿tratar o no tratar? / Iron deficiency and / or anemia in heart failure, Try or not try?

El déficit de hierro con o sin anemia está siendo reconocido cada vez más como una comorbilidad importante en los pacientes con Insuficiencia Cardíaca (IC). Aunque la deficiencia de hierro es fácilmente diagnosticada por medio de dos marcadores (ferritina sérica y saturación de transferrina), es subdiagnosticada en estos pacientes y pudiera afectar hasta el 50% de los mismos. Aún antes del inicio de la anemia, los pacientes con IC y déficit de hierro muestran disminución en el rendimiento físico y cognitivo con una mala calidad de vida. Más aún, la deficiencia de hierro es un factor de riesgo, independiente de la anemia, de evolución desfavorable (muerte o trasplante cardíaco) en los pacientes con IC crónica. Varios estudios aleatorios controlados han mostrado mejoría en la capacidad de ejercicio, clase funcional de la New York Heart Association y calidad de vida luego de la corrección del déficit de hierro. Diversos factores contribuyen al desarrollo de este déficit, incluyendo edad avanzada, falla renal, hemodilución, inflamación crónica y severidad de la IC. Una variedad de mecanismos se han postulado para explicar la asociación de déficit de hierro e IC y su corrección, como un blanco terapéutico, está ganando una mayor atención(AU)

Iron deficit with or without anemia is being increasingly recognized as an important comorbidity in patients with heart failure. Although iron deficiency is easily diagnosed with two biomarkers (serum ferritin and transferrin saturation), it is underdiagnosed in these patients and could affects up to 50% of them. Even before the onset of anemia, heart failure patients with iron deficiency have decreased physical and cognitive performances and a poorer quality of life. Moreover, iron deficiency is a risk factor, independent of anemia, of unfavorable outcome (death or heart transplantation) in patients with chronic heart failure. Several randomized controlled studies have shown improvement in exercise capacity, New York Heart Association functional class and quality of life after correction of iron deficiency. Different factors contribute to the development of iron deficiency, including increasing age, renal insufficiency, hemodilution, chronic inflammation, and heart failure severity. A variety of mechanisms have been implicated in the association between iron deficiency and heart failure, and its correction as a therapeutic target in these patients is gaining increased attention(AU)

La verdadera eficiencia de las Unidades de Memoria. ¿Qué falla? / Alzheimer disease and the delay of its diagnosis

Introducción: El deterioro cognitivo es un problema de salud pública extraordinariamente prevalente en la población general. Las Unidades de Memoria son necesarias dada la necesidad de llevar a cabo una aproximación holística tanto a pacientes como a cuidadores. Sin embargo, los datos disponibles son controvertidos tanto respecto a la demora en el diagnóstico como al tratamiento de nuestros pacientes. Pacientes y métodos: Llevamos a cabo un estudio epidemiológico retrospectivo en la Unidad de Estudio de la Cognición y la Conducta, en el Servicio de Neurología del Hospital Clínico San Carlos de Madrid. Se revisaron 620 historias clínicas y se seleccionaron aquellos pacientes con enfermedad de Alzheimer (EA) según criterios NINCSADRDA, desde 2008 a 2011. Se analizaron variables como la edad, el sexo, la dominancia manual, el nivel educativo, la presencia de un cuidador, GDS (Global Deterioration Scale) y meses transcurridos desde los primeros síntomas hasta el diagnóstico. El análisis estadístico se llevó a cabo mediante SPSS versión 19. Describimos la correlación entre variables como la edad, el sexo, el nivel educativo y la presencia de un cuidador con el GDS y los meses de demora diagnóstica. Resultados: Evaluamos 229 personas con EA (67,7 % mujeres, 32,3 % hombres). La distribución de GDS fue: GDS 4: 45,4 %; GDS 5: 28,4 %; GDS 6: 21,0 %; GDS 7: 5,2 %. La mediana de edad fue de 81 años (hombres, 80; mujeres, 81). La mediana de nivel educativo fue de 5 años (hombres, 7; mujeres, 5).El 87,8 % tenían un cuidador (GDS 4: 35,7 %, GDS 5: 67,9 %, GDS 6: 96,4 %, GDS7: 100 %). La mediana de meses de demora diagnóstica fue de 36 en hombres y de 30 en mujeres (GDS 4: 24, GDS 5: 36, GDS 6: 48 y GDS 7: 51 meses). Teniendo en cuenta la situación social, la mediana de meses de demora diagnóstica fue de 24 en aquellos pacientes que vivían solos y de 36 en pacientes con cuidador. No hubo diferencias entre personas con más de 6 años de nivel educativo o con menos de 6 (mediana de meses: 36, en ambos casos). Con clu - siones: Las Unidades de Memoria son necesarias para la realización de un diagnóstico precoz y el inicio de un tratamiento óptimo. Sin embargo, hoy en día existe un gran retraso en el área a la hora de poder llevar a cabo estos objetivos. El diagnóstico de EA se realiza tarde en los hombres y en pacientes con mejor soporte social en nuestro medio(AU)

Background: Cognitive impairment is a prevalent public health problem in general population. Memory Clinics are necessary in order to implement a holistic approach to patients and caregivers. However, data report many controversial aspects about the delay of diagnosis and treatment of our patients. Methods: retrospective epidemiological study was carried out. We reviewed 620 medical histories selecting those patients diagnosed of Alzheimer disease (AD) (NINCS-ADRDA criteria) in BCU-HCSC from 2008 to 2011. We analyzed age, sex, handness, educational level, caregiver, GDS and time (months) from first symptoms till diagnosis. We made a statistical analysis using SPSS 19 version. We describe the correlation between factors like age, sex, educational level and caregiver presence with GDS and months from first symptoms at the time of diagnosis. Results:We evaluated 229 AD (67.7% women, 32.3 % men). The distribution of GDS score was: GDS 4: 45.4 %, GDS 5: 28.4 %, GDS 6: 21.0 %, GDS 7: 5.2 %. The median age was 81(men 80, women 81) The median of educational level was 5 years (men 7, women 5). 87.8 % had a caregiver (GDS 4: 35.7 %, GDS 5: 67.9 %, GDS 6: 96.4%, GDS7: 100 %). The median of months from first symptoms to diagnosis was 36 in men and 30 in women (GDS4: 24, GDS 5: 36, GDS 6: 48 and GDS 7: 51 months). Regarding the social situation, the median of months from first symptoms till diagnosis was 24 for patients who live alone and 36 for patients with caregiver. There was no diference between people with more than 6 years of educational level and less of six years (median of 36 months in both cases). Conclusions: Memory clinics are necessary in order to make an early diagnosis and implement an optimal treatment for AD patients. However, nowadays there is a great delay in our area in order to make an optimal medical approach of these patients. Alzheimer diagnosis is made later in men and patients with better social support(AU)

Results of adrenal surgery. Data of a Spanish National Survey.

PURPOSE: Given the availability of laparoscopy and the rising detection of incidentalomas, indications for adrenalectomy may be changing. The Endocrine Surgery Section of the Spanish Association of Surgeons designed a survey to assess its indications, techniques, and results in Spanish Surgical Departments. METHODS: Collected data included hospital and department type, yearly hospital volume of procedures; location studies and preoperative preparation performed, indications, surgical approach and instruments used, and results in terms of morbidity and overall hospital stay. The analysis included a comparison between results of high- or low-volume centers and surgeons, using the Student's t test for quantitative and chi-square test for qualitative variables. Level of significance was set at 0.05. RESULTS: Nineteen centers returned the questionnaire, including 155 adrenalectomies performed in 2008. Most frequent indications were pheochromocytoma (23.2%), aldosteronoma (16.7%), incidentaloma (12.2%), metastasis (10.3%), Cushing adenoma (9.6%), and carcinoma (3.8%). Laparoscopy was performed in 83.9% of cases (9.4% required conversion to laparotomy). Four patients required urgent reoperation. Average hospital stay: 4.6 days (3.3 days after laparoscopy, 7 days after laparotomy). High-volume centers had a greater proportion of laparoscopically treated cases (p = 0.008), more malignant lesions treated (p = 0.03), a shorter overall stay (p < 0.0001), and a shorter stay after laparotomic adrenalectomy (p = 0.01). High-volume surgeons had similar results, and less in-hospital morbidity (p = 0.02). CONCLUSIONS: In Spain, adrenalectomy is performed in hospitals of varying complexity. Laparoscopic approach is the rule, with good results in terms of morbidity and stay. High-volume centers and surgeons had best results in terms of use of minimally invasive surgery and hospital stay.

Time-weighted vs. conventional quantification of 24-h average systolic and diastolic ambulatory blood pressures.

BACKGROUND: Conventional calculation of mean 24-h ambulatory blood pressure (BP), SBP and DBP based on the average of all BP readings disregards the fact that a larger number of measurements is usually scheduled during the daytime than at night, an imbalance possibly leading to an overestimation of 24-h average BP. The aim of our study was to quantify this possible bias and to explore its determinants. METHODS: Four hundred and fifty untreated individuals were subdivided into three groups (150 individuals each) with three different ambulatory blood pressure measurement schedules for day/night: group I, four (day)/two (night) readings/h; group II, four (day)/three (night) readings/h; and group III, with BP readings every 30 min throughout 24 h. Hourly and 24-h averages were computed. The conventional 24-h averages of all SBP and DBP values were compared with the averages of hourly SBP and DBP mean values (time-weighted quantification). The difference between 24-h conventional and 24-h time-weighted BP was computed in each group and related to the degree of nocturnal BP dip and to the ratio between the number of readings of day and night. RESULT: In the three groups, 24-h conventional and 24-h time-weighted BP values were highly correlated (r > 0.99), 24-h conventional SBP and DBP being significantly higher (P < 0.01) than the corresponding 24-h time-weighted values in groups I and II but not in group III (Bland-Altman analysis). The bias magnitude was related to the day/night ratio in number of readings and to nocturnal BP dip in groups I and II (P < 0.01) but not in group III. CONCLUSION: The higher number of readings/h during daytime leads to an overestimation of conventional 24-h average BP, particularly in individuals with preserved nocturnal BP dipping. This can be avoided either by scheduling the same number of readings/h throughout 24 h or by performing a time-weighted quantification of 24-h BP. The clinical implications of these different approaches deserve further investigation.

Clinical bioequivalence of a dose of clopidogrel Leti Cravid tablets 75 mg versus clopidogrel Sanofi Plavix tablets 75 mg administered on a daily dose for 7 days on healthy volunteers: a clinical trial.

Patients undergoing percutaneous coronary intervention procedures, as in patients with coronary disease, should receive treatment indefinitely with acetylsalicylic acid and clopidogrel. New brands of clopidogrel have been developed at lower costs, for helping to avoid premature suspension of antiplatelet therapy, as Cravid Leti Laboratories clopidogrel. Its effectiveness and safety must be compared with Plavix international standard. A prospective, comparative, cross-over, and randomized study was conducted in healthy volunteers. Each group received 1 tablet of Clopidogrel Leti or Clopidogrel Sanofi, 75 mg in a single dose daily for 7 days, followed by 7-day washout period before administration of second treatment. Platelet aggregation was measured at the start of each period and at 7 days of treatment through optical aggregometry, using an optical aggregometer 490-2D Chrono-Log, with a self-calibration system working with platelet-rich plasma with readings 0%-100% of light transmission. An important decrease of platelet aggregation was observed in both groups at 7 days of treatment of more than 50%, independent of adenosine diphosphate reactive (Helena and Chrono-Log) used for aggregation (P < 0.05). The relationship between the mean and 90% confidence interval ratio obtained with the 2 different adenosine diphosphate brands were between 80% and 125%, therefore, it can be considered that both brands are bioequivalent and perfectly exchangeable.