Relationship between nailfold videocapillaroscopic findings and cardiovascular risk factors.

BACKGROUND: Nailfold Videocapillaroscopy (NVC) is a valuable tool in the differential diagnosis of Raynaud's phenomenon (RP), present in certain Rheumatic diseases (RD). Knowing that many people have cardiovascular risk factors (CVRF), the main objective was to demonstrate that CVRF and carotid plaques produce NVC alterations. METHODS: Cross-sectional unicentric study carried out from 2020 to 2023. Four groups were formed: subjects with RD and RP, participants with RD without RP, subjects with RP without RD and finally participants without RP or RD (study group). Each subject exhibiting CVRF presented only a single risk factor. The variables collected were: sociodemographic, CVRF (diabetes, tobacco, alcohol (ALC), obesity (OBE), dyslipidemia and arterial hypertension (AH)), diseases, RP, treatments, tortuosities and NVC alterations (ramified capillaries, enlarged capillaries, giant capillaries, haemorrhages and density loss) and carotid ultrasound (CU). RESULTS: 402 subjects were included (76 % women, mean age 51 ± 16 years), 67 % had CVRF, 50 % RP and 38 % RD. Tortuosities were present in 100 % of CVRF participants. A statistically significant association was found between the presence of CVRF and all the NVC alterations: ramified capillaries (OR = 95.6), enlarged capillaries (OR = 59.2), giant capillaries (OR = 8.32), haemorrhages (OR = 17.6) and density loss (OR = 14.4). In particular, an association was found between giant capillaries with AH (p = 0,008) and OBE (p ã€ˆ0,001), and haemorrhages and density loss with ALC and OBE (p < 0,001). On the other hand, 40 subjects presented CU plaques (9.9 %), associated with enlarged capillaries (OR = 8.08), haemorrhages (OR = 4.04) and ramified capillaries (OR = 3.01). The pathological intima-media thickness was also associated with haemorrhages (OR = 3.14). CONCLUSIONS: There is a clear association between CVRF and ultrasound atherosclerotic findings in carotid with NVC alterations. These findings are of special interest for a correct NVC interpretation and to avoid false positives in the diagnosis of primary and secondary RP.

Times to endovascular treatment following two triage models.

INTRODUCTION: Debate is ongoing regarding the best service model for achieving a prompt recanalization in LVO ischemic stroke with an indication for thrombectomy. We aim to assess differences between two of the existing models within our region. METHODS: We work in a cluster of three public hospitals (one hub and two spokes) forming a single functional neurology service in Madrid (Spain). Upon a LVO case out of regular hours, the interventional neuroradiologist drives to the hub hospital following the drive-the-doctor paradigm (DD). For any of the spokes, the patient is transferred to the nearest endovascular-capable hospital (drip-and-ship-DS) following the Madrid Stroke Plan. We compared times to endovascular procedures between cases managed under each model. RESULTS: Thirty-eight patients in the period April 2014-March 2021 meet the inclusion criteria (DD 27; DS 11). While baseline characteristics are comparable between groups, we observed a notable difference in the time delays favoring those managed under the DD model; with differences between median times of 105 min for hospital arrival-groin puncture (DD 140 [110-181]; DS 245 [222-310], p 0.0004); 122 min for CT-groin puncture (DD 100 [85-144]; DS 222 [200-255], p = 0.0001); and 98 min for hospital arrival-recanalization (DD 180 [140-209]; DS 278 [241-360], p = 0.0014). No differences were observed for NIHSS or mRS on discharge. CONCLUSIONS: Compared to the drip-and-ship, the drive-the-doctor triage model for patients with LVO ischemic stroke in primary centers seems to guarantee a shorter time to the start of the endovascular procedure and to recanalization in our region.

Databases and registers: useful tools for research, no studies.

There are many misunderstandings about databases. Database is a commonly misused term in reference to any set of data entered into a computer. However, true databases serve a main purpose, organising data. They do so by establishing several layers of relationships; databases are hierarchical. Databases commonly organise data over different levels and over time, where time can be measured as the time between visits, or between treatments, or adverse events, etc. In this sense, medical databases are closely related to longitudinal observational studies, as databases allow the introduction of data on the same patient over time. Basically, we could establish four types of databases in medicine, depending on their purpose: (1) administrative databases, (2) clinical databases, (3) registers, and (4) study-oriented databases. But a database is a useful tool for a large variety of studies, not a type of study itself. Different types of databases serve very different purposes, and a clear understanding of the different research designs mentioned in this paper would prevent many of the databases we launch from being just a lot of work and very little science.

Validation of a short cognitive tool for the screening of dementia in elderly people with low educational level.

AIM: To validate the 'Prueba Cognitiva de Leganés' (PCL) as a screening tool for cognitive impairment in elderly people with little formal education. METHODS: The PCL is a simple cognitive test with 32 items that includes two scores of orientation and memory and a global score of 0-32 points. It was applied to a population sample of 527 elderly people over 70 with low educational level, who were independently diagnosed by consensus between two neurologists as having normal cognitive function, age associated cognitive decline (AACD, IPA-OMS criteria) or dementia (DSM-IV criteria). Individuals with severe visual or hearing defects and those who rejected the exam were excluded from the study. The PCL was validated in a sample of 375 individuals: 300 normal, 42 with AACD and 33 with dementia. The sensitivity, specificity, accuracy and likelihood ratios, as well as the ROC curves for dementia and for AACD-dementia, were calculated. The confounding effect of sociodemographic variables was assessed by logistic regression analysis and convergent validity by partial correlations of the PCL with other cognitive tests. Inter-rater reliability was evaluated with the intraclass correlation coefficient. RESULTS: The PCL identified dementia (cut-off < or =22) and AACD-dementia (cut-off < or =26), with the following diagnostic parameters, respectively: sensitivity 93.9%-80%, specificity 94.7%-84.3%, positive likelihood ratio 17.8-5.1, negative likelihood ratio 0.06-0.24, and accuracy 94.6%-83.4%. The areas under the ROC curve were 0.985 (95% Confidence Intervals (CI) 0.967-0.995) and 0.904 (95% CI: 0.870-0.932) respectively. The intraclass correlation coefficient was 0.79 (0.74-0.83). CONCLUSION: The PCL is a simple instrument, which is both valid and reliable, for the screening of dementia in population samples of individuals with low educational level. This instrument could be useful in primary health care.

Unmet home care needs among community-dwelling elderly people in Spain.

BACKGROUND AND AIMS: Sociodemographic changes affecting the elderly population and the family role in providing home care call for reorganization of formal community care services. The aim of this study was to determine the prevalence of home care needs and the factors associated with unmet home care needs among community-dwelling elderly people in Spain. METHODS: The data were derived from a representative sample of community-dwelling elderly people living in a town of the metropolitan area of Madrid (N = 1135). Dependency for daily, weekly and monthly activities was based on disability in activities of daily living (ADL) and instrumental activities of daily living (IADL). Insufficient help was estimated as an indicator of unmet needs. Logistic regressions were fitted to identify correlates of unmet needs for each type of activity. RESULTS: Overall, 14, 39, and 50% of subjects reported dependency for daily, weekly and monthly activities, respectively. Of these, 40, 27, and 12% reported receiving inadequate assistance. Unmet needs were strongly associated with low monthly income, low educational level, living alone, and symptoms of depression. Families were the exclusive source of almost all assistance provided, few persons reporting the use of additional formal community care sources. CONCLUSIONS: There are considerable social and material inequalities in access to home care. In view of the poor coverage of the public system for home and personal care, these inequalities may widen in the near future. New public policy initiatives are needed to provide affordable formal family-support services.