Desenlaces maternos y neonatales relacionados con edad materna avanzada / Maternal and neonatal outcomes in advanced maternal age

Resumen OBJETIVO: Describir los desenlaces maternos y perinatales en embarazadas de edad avanzada. MATERIALES Y MÉTODOS: Estudio de dos cohortes, prospectivo y retrospectivo efectuado con base en la información de expedientes clínicos de pacientes atendidas en el Complexo Hospitalario Universitario de Ourense entre 2017 y 2018. Se establecieron dos cohortes: la cohorte A con edad mayor o igual a 40 años y la cohorte B con edad menor de 40 años. Se realizaron pruebas paramétricas y no paramétricas para determinar la asociación potencial entre las variables de estudio (χ2, t de Student, U de Mann-Whitney). RESULTADOS: Las pacientes de la cohorte A (n = 207) tuvieron significación estadística: índice de masa corporal mayor al inicio del embarazo (p = 0.028), mayor cantidad de embarazos previos (p = 0.001), a expensas de mayor cantidad de abortos (p < 0.001), estados hipertensivos del embarazo (p = 0.03), prematurez (p = 0.009), retraso en el crecimiento intrauterino (p = 0.006), macrosomía fetal (p = 0.04), inducciones (p < 0.001), cesáreas programadas o intraparto y hemorragia posparto (p = 0.001). No se encontraron diferencias en la paridad, amenorrea al parto, diabetes pregestacional-gestacional, peso fetal medio, Apgar, pH de la arteria umbilical y cantidad de recién nacidos con requerimiento de ingreso a la unidad de Neonatología. CONCLUSIONES: La edad materna avanzada es un factor de riesgo importante de morbilidad materna y perinatal. La mayor tasa de complicaciones descritas refleja la importancia del control exhaustivo del embarazo y vigilancia periparto minuciosa.

Abstract OBJECTIVE: To describe the maternal and perinatal results in pregnant women with advanced age. MATERIALS AND METHODS: A cohort study was conducted with prospective follow-up and retrospective data collection of the Clinical History of the University Hospital Complex of Ourense between 2017 and 2018. Two cohorts were established, cohort A with age greater than and equal to 40 years and the cohort B with age under 40 years. Parametric and non-parametric tests were performed to determine the potential association between the study variables (Chi-Square, Student's T, Mann-Whitney U). RESULTS: The cohort A patients (n = 207) presented with statistical significance: body mass index higher at the beginning of pregnancy (p = 0.028), higher number of previous pregnancies (p = 0.001), but at the expense of a higher number of abortions (p <0.001), hypertensive states of pregnancy (p = 0.03), prematurity (p = 0.009), intrauterine growth retardation (p = 0.006), fetal macrosomia (p = 0.04), inductions (p < 0.001), of both scheduled and intrapartum caesarean sections and postpartum hemorrhage (p = 0.001). No differences were found in parity, amenorrhea at delivery, pregestational / gestational diabetes, mean fetal weight, Apgar score, umbilical artery pH and number of newborns who required admission to the Neonatal Unit. CONCLUSIONS: Advanced maternal age is an important risk factor for maternal and perinatal morbidity. The higher rate of complications described reflects the importance of thorough pregnancy control and careful peripartum surveillance.

[Depression and burden in the caretaking of elderly]. / Depresión y sobrecarga en el cuidado de personas mayores.

OBJECTIVE: Informal care affects the quality of life and emotional health. Objective: To analyze the relationship between burden and depression in caregivers measured by Zarit's Scale and GHQ-28 and the global functional deterioration of the elderly measured by OARS-MFAQ. METHODS: Descriptive observational cross-sectional study in Primary Health Care at Ourense city. 104 people (>65 years old) and their caregivers were interviewed. Descriptive analysis and logistic regression were used to analyze the characteristics that increase the probability to suffer burden and depression. RESULTS: 82.7% of caregivers were women with an average age of 63.64 years (95% CI: 61.05-66.23) and 10.3% were over 80 years old. 32.2% had an overload, associated with taking care of younger people (p=0.043), being a couple of an elder (p=0.003) being older (p=0.031) and the risk of depression which were all found as factors associated with burden, measured by GHQ (p<0.001). Having good perception of the vision (p=0.038), rejecting the use of a cane (p=0.002) or wheelchair (p=0.015) were also associated with factors contributing to burden. CONCLUSIONS: Informal caregivers are women around their sixties, and although they do not feel overburdened for caring, they have depression, more likely the more severe the burden is, and it is related with the perception of economic deficiencies for the caring.

OBJETIVO: Los cuidados informales afectan a la calidad de vida y a la salud emocional. El objetivo de este trabajo fue analizar la relación entre la carga y la depresión en los cuidadores/as medida con Escala de Zarit y GHQ-28 y el deterioro funcional global del anciano medido mediante OARS-MFAQ. METODOS: Estudio transversal descriptivo por entrevistas a 104 personas mayores de 65 años y sus cuidadores/as informales en la ciudad de Ourense. Se realizó un análisis descriptivo y una regresión logística de las variables que influyen en la depresión y la sobrecarga por cuidar ancianos. RESULTADOS: El 82,7% de cuidadores/as eran mujeres con edad media de 63,64 años (IC 95%: 61,05-66,23) y el 10,3% mayor de 80 años. El 32,2% presentaba sobrecarga encontrándose como factores asociados a la misma, cuidar de ancianos más jóvenes (p=0,043), ser pareja del anciano (p=0,003), tener mayor edad (p=0,031) y el riesgo de depresión medida con GHQ (p<0,001). Tener buena percepción de la visión (p=0,038), rechazar el uso de bastón (p=0,002) o silla de ruedas (p=0,015) también se asoció con la sobrecarga. CONCLUSIONES: Las cuidadoras informales son mujeres en torno a 60 años. Aunque no sientan sobrecarga por cuidar, tienen depresión, que es más probable cuanto más severa es la carga y esta se relaciona con la percepción de carencias económicas básicas para el cuidado.

Depresión y sobrecarga en el cuidado de personas mayores / Depression and burden in the caretaking of elderly

OBJETIVO: Los cuidados informales afectan a la calidad de vida y a la salud emocional. El objetivo de este trabajo fue analizar la relación entre la carga y la depresión en los cuidadores/as medida con Escala de Zarit y GHQ-28 y el deterioro funcional global del anciano medido mediante OARS-MFAQ. MÉTODOS: Estudio transversal descriptivo por entrevistas a 104 personas mayores de 65 años y sus cuidadores/as informales en la ciudad de Ourense. Se realizó un análisis descriptivo y una regresión logística de las variables que influyen en la depresión y la sobrecarga por cuidar ancianos. RESULTADOS: El 82,7% de cuidadores/as eran mujeres con edad media de 63,64 años (IC 95%: 61,05-66,23) y el 10,3% mayor de 80 años. El 32,2% presentaba sobrecarga encontrándose como factores asociados a la misma, cuidar de ancianos más jóvenes (p=0,043), ser pareja del anciano (p=0,003), tener mayor edad (p=0,031) y el riesgo de depresión medida con GHQ (p<0,001). Tener buena percepción de la visión (p=0,038), rechazar el uso de bastón (p=0,002) o silla de ruedas (p=0,015) también se asoció con la sobrecarga. CONCLUSIONES: Las cuidadoras informales son mujeres en torno a 60 años. Aunque no sientan sobrecarga por cuidar, tienen depresión, que es más probable cuanto más severa es la carga y esta se relaciona con la percepción de carencias económicas básicas para el cuidado

OBJECTIVE: Informal care affects the quality of life and emotional health. Objective: To analyze the relationship between burden and depression in caregivers measured by Zarit's Scale and GHQ-28 and the global functional deterioration of the elderly measured by OARS-MFAQ. METHODS: Descriptive observational cross-sectional study in Primary Health Care at Ourense city. 104 people (>65 years old) and their caregivers were interviewed. Descriptive analysis and logistic regression were used to analyze the characteristics that increase the probability to suffer burden and depression. RESULTS: 82.7% of caregivers were women with an average age of 63.64 years (95% CI: 61.05-66.23) and 10.3% were over 80 years old. 32.2% had an overload, associated with taking care of younger people (p=0.043), being a couple of an elder (p=0.003) being older (p=0.031) and the risk of depression which were all found as factors associated with burden, measured by GHQ (p<0.001). Having good perception of the vision (p=0.038), rejecting the use of a cane (p=0.002) or wheelchair (p=0.015) were also associated with factors contributing to burden. CONCLUSIONS: Informal caregivers are women around their sixties, and although they do not feel overburdened for caring, they have depression, more likely the more severe the burden is, and it is related with the perception of economic deficiencies for the caring

Morbilidad y mortalidad a largo plazo en mujeres con antecedente de desprendimiento prematuro de placenta normoinserta / Long-term morbidity and mortality in women with a history of premature placental abruption normoinserta

Resumen OBJETIVOS: Analizar las consecuencias a largo plazo del desprendimiento prematuro de placenta normoinserta, principalmente la incidencia de enfermedad cardiovascular y secundariamente otras causas de morbilidad y mortalidad (diabetes, neoplasias o trastornos psiquiátricos). MATERIALES Y MÉTODOS: Estudio de casos y controles, con recolección retrospectiva de datos de pacientes embarazadas que acudieron al Complexo Hospitalario Universitario de Ourense entre 1996 y 2008. El criterio de inclusión en el grupo casos fue el antecedente de desprendimiento prematuro de placenta normoinserta. El grupo control lo integraron pacientes con parto anterior y posterior al grupo de casos y que no habían sufrido desprendimiento de placenta. Las historias clínicas se analizaron mediante la recolección de datos de la "gestación índice" y se realizó el seguimiento a largo plazo para establecer el diagnóstico de hipertensión arterial, diabetes mellitus, enfermedad cardiovascular, neoplasias o alteraciones psiquiátricas. Para el análisis estadístico se requirió el programa SPSS15.0. Se consideró estadísticamente significativo el valor de p < 0.05. RESULTADOS: Se estudiaron 198 mujeres: 66 en el grupo de casos y 132 en el grupo control. Durante el seguimiento (15.8 ± 3.58 años), la incidencia de diabetes mellitus y dislipidemia fue mayor en el grupo de casos, pero sin significación estadística. No se encontraron diferencias en la incidencia de hipertensión arterial, síndrome metabólico, enfermedad cardiovascular ni trastorno ansioso-depresivo. En el grupo de casos se encontró una alta tasa de enfermedad neoplásica. CONCLUSIONES: No existe relación entre desprendimiento prematuro de placenta y enfermedad cardiovascular. Se carece de una explicación que justifique la alta tasa de patología tumoral en este grupo de pacientes.

Abstract OBJECTIVE: To analyze if women with a history of premature placental abruption have a long-term increase in morbidity and mortality. MATERIALS AND METHODS: Case-control study with retrospective data collection of pregnant women from the Hospital University Complex of Ourense between 1996 and 2008. The criteria for inclusion in the case group were the history of placental abruption. The control group was constituted by the women with previous and subsequent delivery to the case group and who had not presented placental abruption. The clinical histories were analyzed with data collection of the index pregnancy and a long-term follow-up was carried out to detect the subsequent diagnosis of arterial hypertension, diabetes mellitus, cardiovascular disease, as well as neoplastic and psychiatric pathology. The statistical study was carried out using the SPSS15.0 computer program. Values of p < 0,05 were considered significant results. RESULTS: A total of 198 women were studied, of which 66 belong to the case group and 132 to the control group. In the follow-up period (15,8±3,58 years) the incidence of diabetes mellitus and dyslipidemia was higher in the case group, but without statistical significance. No differences were found in the incidence of hypertension, metabolic syndrome, cardiovascular disease or anxiety-depressive illness. In the case group, a high rate of oncological pathology was found. CONCLUSIONS: We found no relationship between the history of placental abruption and cardiovascular disease. We lack an explanation that justifies the high rate of tumor pathology in this group of women.

[Incidence of hypophosphatemia in not critically ill patients with enteral feeding]. / Incidencia de hipofosfatemia en pacientes ingresados no críticos con nutrición enteral.

BACKGROUND: Up to 30-40% of the patients starting artificial nutritional support develop hypophosphatemia. In general, patients with mild and moderate hypophosphatemia do not have symptoms, but severe hypophosphatemia is the hallmark of refeeding syndrome. AIM: To determine the incidence of hypophosphatemia in not critically ill patients receiving enteral feeding. MATERIAL AND METHODS: Prospective study. We assessed during seven days 181 not critically ill patients started on enteral artificial nutrition support during seven days. RESULTS: 51.9% of the patients were considered to be at risk of developing refeeding syndrome (United Kingdom National Institute for Health and Clinical Excellence criteria). The incidence of hypophosphatemia was 31.5%, but only 1.1% of the patients developed severe hypophosphatemia. Older age and lower plasma proteins were significantly associated with hypophosphatemia. CONCLUSION: The incidence of severe hypophosphatemia in our study is low, so we can't offer robust conclusions about the risk of hypophosphatemia in the type of patients receiving enteral nutrition.

INTRODUCCIÓN: se ha descrito una incidencia de hipofosfatemia en pacientes con soporte nutricional especializado (SNE) de hasta el 30-40%. La hipofosfatemia leve y la moderada son generalmente asintomáticas, mientras que la severa es el hecho fundamental del síndrome de realimentación. OBJETIVO: evaluar la incidencia y gravedad de la hipofosfatemia en pacientes hospitalizados no críticos con nutrición enteral (NE).MATERIAL Y MÉTODOS: se diseñó un estudio observacional y prospectivo en condiciones de práctica clínica habitual. Se recogieron datos clínicos, antropométricos y analíticos de 181 pacientes a los que se les inició nutrición enteral. El seguimiento fue de siete días.RESULTADOS: el 51,9% de los pacientes estaban en riesgo de desarrollar síndrome de realimentación según las guías del United Kingdom National Institute for Health and Clinical Excellence (NICE). La incidencia de hipofosfatemia fue del 31,5% y la de la hipofosfatemia severa, del 1,1%. De todos los parámetros clínicos, antropométricos y analíticos analizados, solo la edad y unas proteínas séricas más bajas se correlacionaron de forma estadísticamente significativa con el aumento en la incidencia de hipofosfatemia. CONCLUSIÓN: la incidencia de hipofosfatemia grave en nuestra serie es muy baja, lo que hace imposible extraer conclusiones específicas para este grupo de pacientes.

Incidencia de hipofosfatemia en pacientes ingresados no críticos con nutrición enteral / Incidence of hypophosphatemia in not critically ill patients with enteral feeding

Introducción: se ha descrito una incidencia de hipofosfatemia en pacientes con soporte nutricional especializado (SNE) de hasta el 30-40%. La hipofosfatemia leve y la moderada son generalmente asintomáticas, mientras que la severa es el hecho fundamental del síndrome de realimentación. Objetivo: evaluar la incidencia y gravedad de la hipofosfatemia en pacientes hospitalizados no críticos con nutrición enteral (NE). Material y métodos: se diseñó un estudio observacional y prospectivo en condiciones de práctica clínica habitual. Se recogieron datos clínicos, antropométricos y analíticos de 181 pacientes a los que se les inició nutrición enteral. El seguimiento fue de siete días. Resultados: el 51,9% de los pacientes estaban en riesgo de desarrollar síndrome de realimentación según las guías del United Kingdom National Institute for Health and Clinical Excellence (NICE). La incidencia de hipofosfatemia fue del 31,5% y la de la hipofosfatemia severa, del 1,1%. De todos los parámetros clínicos, antropométricos y analíticos analizados, solo la edad y unas proteínas séricas más bajas se correlacionaron de forma estadísticamente significativa con el aumento en la incidencia de hipofosfatemia. Conclusión: la incidencia de hipofosfatemia grave en nuestra serie es muy baja, lo que hace imposible extraer conclusiones específicas para este grupo de pacientes (AU)

Background: Up to 30-40% of the patients starting artificial nutritional support develop hypophosphatemia. In general, patients with mild and moderate hypophosphatemia do not have symptoms, but severe hypophosphatemia is the hallmark of refeeding syndrome. Aim: To determine the incidence of hypophosphatemia in not critically ill patients receiving enteral feeding. Material and methods: Prospective study. We assessed during seven days 181 not critically ill patients started on enteral artificial nutrition support during seven days. Results: 51.9% of the patients were considered to be at risk of developing refeeding syndrome (United Kingdom National Institute for Health and Clinical Excellence criteria). The incidence of hypophosphatemia was 31.5%, but only 1.1% of the patients developed severe hypophosphatemia. Older age and lower plasma proteins were significantly associated with hypophosphatemia. Conclusion: The incidence of severe hypophosphatemia in our study is low, so we can’t offer robust conclusions about the risk of hypophosphatemia in the type of patients receiving enteral nutrition (AU)

Suicide notes: Clinical and linguistic analysis from the perspective of the Interpersonal Theory of Suicide

Background and Objectives: Studying suicide notes is a strong methodology in suicidology and one of the most relevant theoretical frameworks is the Interpersonal Theory of Suicide proposed by Joiner. This study analyzed 80 suicide notes collected in Chile searching for the risk factors proposed by the theory and its implications. The clinical and sociodemographic characteristics of the notes' authors were analyzed too. Methods: The suicide notes were classified according to the presence or absence of the suicide risk factors proposed by the Interpersonal Theory of Suicide and were analyzed linguistically with the Linguistic Inquiry and Word Count program. Results: One or both interpersonal risk factors indicated by the theory were identified in 60% of the notes. The “lack of belonging” factor was the most common risk factor, and various linguistic profiles in the suicide notes were found according to the presence or absence of this factor. Conclusions: We confirmed the relevance of the interpersonal risk factors proposed as issues present in a high percentage of notes and found linguistic differences according to its presence or absence in the suicide notes (AU)

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Linguistic analysis of suicide notes in Spain

Background and Objectives: Text analysis software like “Linguistic Inquiry and Word Count” (LIWC) has been used for the analysis of suicide notes and suicidal texts in English. This is the first analysis of suicide notes using this method in Spanish and, as far as we know, its first application to suicide notes in Europe. To compare the sociodemographic and forensic characteristics of a consecutive sample of suicide victims studying the differences between those who left suicidal note and those who did not. To study a sample of suicidal notes from Spain using LIWC, comparing it’s linguistic features by gender, age and environment. Methods: 144 consecutive suicide cases were analyzed. 23 suicide notes obtained from this sample were processed using LIWC, the results were compared by gender, age and environment of the author. Results: People who left suicide notes were younger than non- writers; more frequently single, divorced or widowed and emotional troubles were reported as frequent triggers. Suicide notes written by women were significantly longer, had more emotional content, tentative expressions, denials, pronouns in first person plural and verbs in past and future tenses. Urban cases showed higher emotional expression and word complexity whereas rural cases showed a higher use of social words. Conclusions: Our study shows some differences between people who left suicide note and those who didn’t and confirms the LIWC ability to detect differences in suicidal speech by gender and by the rural/ urban background of its authors (AU)

Características clínicas y supervivencia de los pacientes nunca fumadores con cáncer de pulmón / Clinical Characteristics and Survival in Never Smokers With Lung Cancer

Introducción y objetivo: Analizar la frecuencia, las características clínicas y la supervivencia de los pacientes con cáncer de pulmón nunca fumadores comparándolas con los pacientes fumadores. Pacientes y métodos: Estudio retrospectivo de pacientes diagnosticados de cáncer de pulmón mediante citohistología de 1999 al 2011. Se estimó la supervivencia por el método de Kaplan-Meier. Para estimar la relación entre las variables se usó la prueba de χ2. Resultados: Se diagnosticaron 2.161 pacientes, 396 (18,3%) nunca fumadores. En este grupo la edad media (± desviación estándar) fue de 72,85 ± 10,52, el 64,6% mujeres y el 35,4% hombres. Según la citohistología, el 55,6% eran adenocarcinoma, el 20,5% epidermoide, el 15% de célula pequeña, el 2,7% de célula grande y el 6,2% otros subtipos. El diagnóstico se hizo en estadio avanzado ( IV ) en el 61,4% de pacientes, y el 14,4% recibieron tratamiento quirúrgico. La supervivencia fue del 12,4%, sin diferencias entre los 2 grupos. En el grupo de nunca fumadores las mujeres tuvieron mejor supervivencia que los hombres. Conclusiones: El 18,3% fueron pacientes nunca fumadores. Se diagnosticaron mayoritariamente en mujeres, estadios avanzados y estirpe histológica adenocarcinoma. No hubo diferencias de supervivencia con el grupo de fumadores

Introduction and objective: To analyze the frequency, clinical characteristics and survival of patients with lung cancer (LC) who have never smoked in comparison to patients who smoke. Patients and methods: A retrospective study in patients diagnosed with LC by cytohistology between 1999 and 2011. Survival was estimated by the Kaplan-Meier method. The χ2 test was used to estimate the relationship between the variables. Results: A total of 2161 patients were diagnosed with LC, 396 (18.3%) of whom had never smoked. The mean age (±standard deviation) in this group was 72.85±10.52; 64.6% were women and 35.4% men. According to the cytohistology, 55.6% were adenocarcinoma, 20.5% squamous cell, 15% small cell, 2.7%large cell and 6.2% other subtypes. The diagnosis was made in advanced stage (IV) in 61.4%, and 14.4% of the patients received surgical treatment. Survival was 12.4%, with no differences between the two groups. In the group of never smokers, women had better survival than men. Conclusions: Of the patients diagnosed with LC, 18.3% had never smoked. It was diagnosed mainly in women, at advanced stages and the most common histological type was adenocarcinoma. There were no survival differences compared to the group of smokers

Clinical characteristics and survival in never smokers with lung cancer.

INTRODUCTION AND OBJECTIVE: To analyze the frequency, clinical characteristics and survival of patients with lung cancer (LC) who have never smoked in comparison to patients who smoke. PATIENTS AND METHODS: A retrospective study in patients diagnosed with LC by cytohistology between 1999 and 2011. Survival was estimated by the Kaplan-Meier method. The χ(2) test was used to estimate the relationship between the variables. RESULTS: A total of 2161 patients were diagnosed with LC, 396 (18.3%) of whom had never smoked. The mean age (±standard deviation) in this group was 72.85±10.52; 64.6% were women and 35.4% men. According to the cytohistology, 55.6% were adenocarcinoma, 20.5% squamous cell, 15% small cell, 2.7% large cell and 6.2% other subtypes. The diagnosis was made in advanced stage (iv) in 61.4%, and 14.4% of the patients received surgical treatment. Survival was 12.4%, with no differences between the two groups. In the group of never smokers, women had better survival than men. CONCLUSIONS: Of the patients diagnosed with LC, 18.3% had never smoked. It was diagnosed mainly in women, at advanced stages and the most common histological type was adenocarcinoma. There were no survival differences compared to the group of smokers.

Síndrome de apnea-hipopnea del sueño en pacientes normopeso: características y comparación con pacientes con sobrepeso y obesidad / Obstructive Sleep Apnea in Normal Weight Patients: Characteristics and Comparison With Overweight and Obese Patients

Objetivo: Conocer la frecuencia del síndrome de apnea-hipopnea del sueño (SAHS)y del síndrome metabólico (SM) en normopeso y sus características. Determinar si existen diferencias epidemiológicas con aquellos con sobrepeso u obesidad. Métodos: Se estudiaron todos los pacientes con sospecha de SAHS remitidos al laboratorio del sueño desde enero a diciembre 2009. Se diagnosticó de SAHS cuando el índice de apnea-hipopnea (IAH) era > 5 y existía clínica. Se diagnosticó el SM según los criterios de la International Diabetes Federation (IDF). Los pacientes se distribuyeron en 3 grupos según el índice de masa corporal (IMC): normopeso (< 25 kg/m2), sobrepeso (25-29,9 kg/m2) y obesidad (≥ 30 kg/m2). Resultados: Se estudiaron 475 pacientes: 7,60% normopeso y 56,40% obesos. De los normopeso, la mayoría eran mujeres, roncadores, no fumadores, no consumían alcohol y eran significativamente más jóvenes y con menor perímetro de cuello y abdomen. Se diagnosticó de SAHS al 90,10%: normopeso 77,70%. En pacientes con SAHS y normopeso la mayoría eran SAHS leve, existiendo diferencias entre diagnóstico de SAHS e IMC categorizado. Se diagnosticó de SM al 64,40%: 33,33% normopeso, encontrando mayor probabilidad de SM al aumentar el IMC. La prevalencia de SAHS y SM simultáneamente en normopeso fue del 22% y en obesos del 70,52%. El SAHS en normopeso se relacionó con el sexo y la edad. No se encontró relación entre SM y SAHS, y tampoco entre malformación otorrinolaringológica y SAHS. Se trató con CPAP a 8 pacientes normopeso con SAHS. Conclusiones: La frecuencia de SAHS en normopeso era menor que en los sobrepeso y obesos. La frecuencia de SAHS y SM simultáneamente en normopeso frente a obesos fue menor. Los pacientes normopeso eran con más frecuencia mujeres, más jóvenes y sin hábitos tóxicos. Los factores predictores de SAHS en normopeso eran sexo y edad, sin que existiera relación entre SM y SAHS (AU)

Objective: To determine the frequency of obstructive sleep apnoea (OSA) and metabolic syndrome (MS) in normal weight patients and their characteristics, and to compare these with overweight and obese patients. Methods: We studied all patients with suspected OSA referred to the sleep laboratory from January to December 2009. OSA was diagnosed when the apnoea-hypopnoea index (AHI) was >5 and symptoms were present. MS was diagnosed according to International Diabetes Federation (IDF) criteria. The patients were distributed into 3 groups according to body mass index (BMI): normal weight (<25 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). Results: We studied 475 patients: 7.60% normal weight and 56.4% obese. Most patients in the normal weight group were women, snorers, non-smokers, non-drinkers and were significantly younger and with a smaller neck and waist circumference than obese and overweight patients. OSA was diagnosed in 90.10%: 77.70% normal weight. OSA in these patients was mostly mild, and there were differences between the diagnosis of OSA and the BMI classified. MS was diagnosed in 64.40%: 33.33% normal weight. There was a higher probability of MS as the BMI increased. OSA and MS frequency in normal weight patients was 22% and in obese patients was 70.52%. OSA in normal weight patients was related with gender and age. There was no relationship between OSA and MS, or between otorhinolaryngological malformations and OSA in normal weight patients. Eight normal weight patients with OSA were treated with continuous positive airway pressure (CPAP) therapy. Conclusions: The frequency of OSA in normal weight patients was lower than in overweight and obese patients. The frequency of concomitant OSA and MS was lower in normal weight patients than in obese subjects. Normal weight patients were mostly women, younger and had no toxic habits. In normal weight patients, age and gender were predictive factors for OSA, but OSA and MS were not related (AU)

Obstructive sleep apnea in normal weight patients: characteristics and comparison with overweight and obese patients.

OBJECTIVE: To determine the frequency of obstructive sleep apnoea (OSA) and metabolic syndrome (MS) in normal weight patients and their characteristics, and to compare these with overweight and obese patients. METHODS: We studied all patients with suspected OSA referred to the sleep laboratory from January to December 2009. OSA was diagnosed when the apnoea-hypopnoea index (AHI) was >5 and symptoms were present. MS was diagnosed according to International Diabetes Federation (IDF) criteria. The patients were distributed into 3 groups according to body mass index (BMI): normal weight (<25kg/m(2)), overweight (25-29.9kg/m(2)) and obese (≥30kg/m(2)). RESULTS: We studied 475 patients: 7.60% normal weight and 56.4% obese. Most patients in the normal weight group were women, snorers, non-smokers, non-drinkers and were significantly younger and with a smaller neck and waist circumference than obese and overweight patients. OSA was diagnosed in 90.10%: 77.70% normal weight. OSA in these patients was mostly mild, and there were differences between the diagnosis of OSA and the BMI classified. MS was diagnosed in 64.40%: 33.33% normal weight. There was a higher probability of MS as the BMI increased. OSA and MS frequency in normal weight patients was 22% and in obese patients was 70.52%. OSA in normal weight patients was related with gender and age. There was no relationship between OSA and MS, or between otorhinolaryngological malformations and OSA in normal weight patients. Eight normal weight patients with OSA were treated with continuous positive airway pressure (CPAP) therapy. CONCLUSIONS: The frequency of OSA in normal weight patients was lower than in overweight and obese patients. The frequency of concomitant OSA and MS was lower in normal weight patients than in obese subjects. Normal weight patients were mostly women, younger and had no toxic habits. In normal weight patients, age and gender were predictive factors for OSA, but OSA and MS were not related.

[Malnutrition in patients with cancer; four years experience]. / Desnutrición en pacientes con cáncer; una experiencia de cuatro años.

OBJECTIVE: To analyze the prevalence and degree of malnutrition among patients with cancer who were sent to an Oncological Nutrition visit. MATERIAL AND METHODS: It is an observational crosssectional descriptive study. First nutrition visit data of all patientes aged ≥ 18 with cancer who were evaluated from march of 2008 to february of 2012 were used. A total of 997 patients were studied using the Patient-Generated Subjective Global Assessment. RESULTS: 69% of the patients had lost more than 5% of their usual weight within the previous 3 months, the patients with the highest frequency of weight loss were those with digestive cancer. Eating problems were encountered by the 81.2% of the patients, the most frequent problem being anorexia (53.3%) and the median number of symptoms was 3. Patient-Generated Subjective Global Assessment shows a malnutrition prevalence of 72.9% (29.9% with moderate malnutrition and 43% with severe malnutrition). Malnutrition was related to the type of cancer and the stage of the disease and was not related to age, gender neither usual body mass index. CONCLUSIONS: Malnutrition prevalence among patients who were evaluated in our consulting-room is high. Nutritional evaluation is very important to detect patients at risk of malnutrition or with malnutrition and helps to choose the nutritional treatment.

Objetivo: Analizar la prevalencia y el grado de desnutrición de los pacientes con cáncer remitidos a una consulta específica de Nutrición Oncológica. Material y métodos: Se trata de un estudio transversal, observacional y descriptivo basado en los datos recogidos en la primera consulta de nutrición de todos los pacientes mayores de edad con cáncer evaluados en el período comprendido entre el 1 de marzo de 2008 y el 29 de febrero de 2012. Se incluyeron 997 pacientes, a los que se les realizó la Valoración Global Subjetiva Generada por el Paciente. Resultados: El 69% de los pacientes habían perdido más de un 5% de su peso habitual en los 3 meses previos, siendo esto más frecuente entre los portadores de tumores digestivos. El 81,2% de los pacientes tenían dificultades para alimentarse, el síntoma más frecuente era la anorexia (53,3%) y la mediana de síntomas por paciente 3. La Valoración Global Subjetiva Generada por el Paciente muestra una prevalencia de desnutrición del 72,9% (29,9% desnutrición moderada y 43% desnutrición severa). La desnutrición se relacionó con el tipo de tumor y con el estadío, pero no con la edad, el sexo ni con el Índice de Masa Corporal habitual. Conclusiones: La prevalencia de desnutrición en los pacientes con cáncer evaluados en nuestra consulta es elevada. La valoración nutricional es básica para identificar a aquellos pacientes con desnutrición o riesgo de desnutrición y orientar la necesidad de tratamiento nutricional.

Desnutrición en pacientes con cáncer; una experiencia de cuatro años / Malnutrition in patients with cancer; four years experience

Objetivo: Analizar la prevalencia y el grado de desnutrición de los pacientes con cáncer remitidos a una consulta específica de Nutrición Oncológica. Material y métodos: Se trata de un estudio transversal, observacional y descriptivo basado en los datos recogidos en la primera consulta de nutrición de todos los pacientes mayores de edad con cáncer evaluados en el período comprendido entre el 1 de marzo de 2008 y el 29 de febrero de 2012. Se incluyeron 997 pacientes, a los que se les realizó la Valoración Global Subjetiva Generada por el Paciente. Resultados: El 69% de los pacientes habían perdido más de un 5% de su peso habitual en los 3 meses previos, siendo esto más frecuente entre los portadores de tumores digestivos. El 81,2% de los pacientes tenían dificultades para alimentarse, el síntoma más frecuente era la anorexia (53,3%) y la mediana de síntomas por paciente 3. La Valoración Global Subjetiva Generada por el Paciente muestra una prevalencia de desnutrición del 72,9% (29,9% desnutrición moderada y 43% desnutrición severa). La desnutrición se relacionó con el tipo de tumor y con el estadío, pero no con la edad, el sexo ni con el Índice de Masa Corporal habitual. Conclusiones: La prevalencia de desnutrición en los pacientes con cáncer evaluados en nuestra consulta es elevada. La valoración nutricional es básica para identificar a aquellos pacientes con desnutrición o riesgo de desnutrición y orientar la necesidad de tratamiento nutricional (AU)

Objective: To analyze the prevalence and degree of malnutrition among patients with cancer who were sent to an Oncological Nutrition visit. Material and methods: It's an observational cross-sectional descriptive study. First nutrition visit data of all patientes aged > 18 with cancer who were evaluated from march of 2008 to february of 2012 were used. A total of 997 patients were studied using the Patient-Generated Subjective Global Assessment. Results: 69% of the patients had lost more than 5% of their usual weight within the previous 3 months, the patients with the highest frequency of weight loss were those with digestive cancer. Eating problems were encountered by the 81.2% of the patients, the most frequent problem being anorexia (53.3%) and the median number of symptoms was 3. Patient-Generated Subjective Global Assessment shows a malnutrition prevalence of 72.9% (29.9% with moderate malnutrition and 43% with severe malnutrition). Malnutrition was related to the type of cancer and the stage of the disease and wasn't related to age, gender neither usual body mass index. Conclusions: Malnutrition prevalence among patients who were evaluated in our consulting-room is high. Nutritional evaluation is very important to detect patients at risk of malnutrition or with malnutrition and helps to choose the nutritional treatment (AU)

Risk factors associated with the development of ischemic colitis.

AIM: To ascertain the role of cardiovascular risk factors, cardiovascular diseases, standard treatments and other diseases in the development of ischemic colitis (IC). METHODS: A retrospective, case-control study was designed, using matched data and covering 161 incident cases of IC who required admission to our hospital from 1998 through 2003. IC was diagnosed on the basis of endoscopic findings and diagnostic or compatible histology. Controls were randomly chosen from a cohort of patients who were admitted in the same period and required a colonoscopy, excluding those with diagnosis of colitis. Cases were matched with controls (ratio 1:2), by age and sex. A conditional logistic regression was performed. RESULTS: A total of 483 patients (161 cases, 322 controls) were included; mean age 75.67 ± 10.03 years, 55.9% women. The principal indications for colonoscopy in the control group were lower gastrointestinal hemorrhage (35.4%), anemia (33.9%), abdominal pain (19.9%) and diarrhea (9.6%). The endoscopic findings in this group were hemorrhoids (25.5%), diverticular disease (30.4%), polyps (19.9%) and colorectal cancer (10.2%). The following variables were associated with IC in the univariate analysis: arterial hypertension (P = 0.033); dyslipidemia (P < 0.001); diabetes mellitus (P = 0.025); peripheral arterial disease (P = 0.004); heart failure (P = 0.026); treatment with hypotensive drugs (P = 0.023); angiotensin-converting enzyme inhibitors; (P = 0.018); calcium channel antagonists (P = 0.028); and acetylsalicylic acid (ASA) (P < 0.001). Finally, the following variables were independently associated with the development of IC: diabetes mellitus [odds ratio (OR) 1.76, 95% confidence interval (CI): 1.001-3.077, P = 0.046]; dyslipidemia (OR 2.12, 95% CI: 1.26-3.57, P = 0.004); heart failure (OR 3.17, 95% CI: 1.31-7.68, P = 0.01); peripheral arterial disease (OR 4.1, 95% CI: 1.32-12.72, P = 0.015); treatment with digoxin (digitalis) (OR 0.27, 95% CI: 0.084-0.857, P = 0.026); and ASA (OR 1.97, 95% CI: 1.16-3.36, P = 0.012). CONCLUSION: The development of an episode of IC was independently associated with diabetes, dyslipidemia, presence of heart failure, peripheral arterial disease and treatment with digoxin or ASA.

Up to twenty-five-year survival after aortic valve replacement with size 19 mm valves.

Long-term survival was investigated in 202 patients who underwent isolated aortic valve replacement (AVR) with 19 mm valves. There were 171 women with a mean age of 69+/-9 years and 31 men with a mean age of 64+/-13 years. Patients had a mean body surface area of 1.61+/-0.13 m(2). Patient-prosthesis mismatch was moderate in 196 and severe in six patients. The mean follow-up for all patients was 78 months. There were 79 late deaths. The actuarial survival rates for all patients were 95+/-1% at 1 year, 75+/-2% at 5 years, 56+/-2% at 10 years, 41+/-2% at 15 years, 34+/-3% at 20 years and 34+/-2% at 25 years. Patients over 70 years old had a lower survival rate (P=0.0001). There were significant differences between ejection fraction (EF) >55% and EF <55% (P=0.0305). AVR with 19 mm valves appeared to provide satisfactory mid-term survival. Age and low EF were risk factors for shorter survival.