Riesgo de eventos tromboembólicos en función del manejo de la terapia anticoagulante y antiagregante en pacientes sometidos a colangiopancreatografía retrógrada endoscópica / Risk of thromboembolic events in relation to the management of anticoagulant and antiagregant therapy in patients subjected to endoscopic retrograde cholangiopancreatography

Antecedentes y objetivosLas principales guías de práctica clínica recomiendan un adecuado manejo periprocedimiento de los fármacos antitrombóticos en caso de realización de técnicas invasivas. El principal objetivo de este estudio fue evaluar si existe mayor riesgo de eventos tromboembólicos por la supresión o la disminución de la dosis de anticoagulantes o antiagregantes en pacientes sometidos a una colangiopancreatografía retrógrada endoscópica (CPRE). Pacientes y métodos: Se realizó un estudio observacional prospectivo que incluyó 644CPRE realizadas con intención terapéutica durante el año 2019 en el Hospital Universitario Reina Sofía con un seguimiento de 30días posprocedimiento. Resultados: Seis pacientes presentaron un evento tromboembólico, no hallando diferencias entre la incorrecta retirada/reintroducción del tratamiento antitrombótico y una mayor proporción de eventos tromboembólicos o hemorrágicos tras el procedimiento (p>0,05). La incidencia de eventos trombóticos fue significativamente mayor en pacientes en tratamiento con heparina o apixabán (p=0,001), así como con antecedente de fibrilación auricular (p=0,05), valvulopatía reumática (p=0,037) y tromboembolismo pulmonar recurrente (p=0,035), siendo este además un factor de riesgo independiente. Asimismo, la incidencia de hemorragia en los 30días postesfinterotomía fue significativamente menor en aquellos con implantación de prótesis biliar (p=0,04).Conclusiones: El inadecuado manejo periprocedimiento de la terapia antitrombótica no se asocia a un aumento significativo de la incidencia de eventos tromboembólicos en los 30días posteriores a la CPRE. No obstante, se aconseja seguir las recomendaciones para una adecuada suspensión/reintroducción de fármacos antitrombóticos, realizando una vigilancia y un seguimiento estrechos tras el procedimiento en pacientes con factores que aumenten el riesgo trombótico.(AU)

Background and objectives: The main clinical practice guidelines recommend adequate periprocedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anticoagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. Patients and methods: A prospective observational study was carried out, which included 644ERCP performed with therapeutic intention during 2019 at the Reina Sofía University Hospital with follow-up during the 30days after the endoscopic intervention. Results: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P>.05). The incidence of thrombotic events was significantly higher in patients treated with heparin or apixaban (P=.001), as well as with a history of atrial fibrillation (P=.05), rheumatic valve disease (P=.037) and recurrent pulmonary embolism (P=.035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P=.04). Conclusions: Inadequate periprocedural management of antithrombotic therapy is not associated with a significant increase in the incidence of thromboembolic events in the 30days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis.(AU)

Risk of thromboembolic events in relation to the management of anticoagulant and antiagregant therapy in patients subjected to endoscopic retrograde cholangiopancreatography. / Riesgo de eventos tromboembólicos en función del manejo de la terapia anticoagulante y antiagregante en pacientes sometidos a colangiopancreatografía retrógrada endoscópica.

BACKGROUND AND OBJECTIVES: The main clinical practice guidelines recommend adequate periprocedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anticoagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. PATIENTS AND METHODS: A prospective observational study was carried out, which included 644ERCP performed with therapeutic intention during 2019 at the Reina Sofía University Hospital with follow-up during the 30days after the endoscopic intervention. RESULTS: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P>.05). The incidence of thrombotic events was significantly higher in patients treated with heparin or apixaban (P=.001), as well as with a history of atrial fibrillation (P=.05), rheumatic valve disease (P=.037) and recurrent pulmonary embolism (P=.035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P=.04). CONCLUSIONS: Inadequate periprocedural management of antithrombotic therapy is not associated with a significant increase in the incidence of thromboembolic events in the 30days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis.

Influence of a diet enriched with virgin olive oil or butter on mouse gut microbiota and its correlation to physiological and biochemical parameters related to metabolic syndrome.

The type of fat in the diet determinates the characteristics of gut microbiota, exerting a major role in the development of metabolic syndrome. We hypothesize that a diet enriched with extra virgin olive oil (EVOO) has a distinctive effect on the intestinal microbiome in comparison with an enriched butter diet (BT) and this effect is related to the physiological benefits exerted by EVOO. Swiss Webster mice were fed standard (SD) or two high fat diets enriched with EVOO or butter. Hormonal, physiological and metabolic parameters were evaluated. At the end of the feeding period, DNA was extracted from faeces and the 16S rRNA genes were pyrosequenced. Among the main significant differences found, BT triggered the highest values of systolic blood pressure, correlating positively with the percentage of Desulfovibrio sequences in faeces, which in turn showed significantly higher values in BT than in EVOO. EVOO had the lowest values of plasmatic insulin, correlating inversely with Desulfovibrio, and had the lowest plasmatic values of leptin which correlated inversely with Sutterellaceae, Marispirillum and Mucilaginibacter dageonensis, the three showing significantly higher percentages in EVOO. The lowest total cholesterol levels in plasma were detected in SD, correlating positively with Prevotella and Fusicatenibacter, both taxa with significantly greater presence in SD. These results may be indicative of a link between specific diets, certain physiological parameters and the prevalence of some taxa, supporting the possibility that in some of the proposed effects of virgin olive oil the modulation of intestinal microbiota could be involved.

Surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft

BACKGROUND: A coronally advanced flap with subepithelial connective tissue graft is the gold standard surgical treatment of gingival recessions, since it offers a higher probability of achieving complete root coverage compared with other techniques. However, optimum short- and middle-term clinical results have also been obtained with coronally advanced flaps alone. The aim of the present study was to evaluate the results obtained by the surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft. MATERIAL AND METHODS: The reduction of recession height was assessed, together with the gain in gingival attachment apical to the recession, and total reduction of recession, in a comparative study of two techniques. Twentytwo gingival recessions were operated upon: 13 in the control group (coronally advanced flap) and 9 in the test group (coronally advanced flap associated to subepithelial connective tissue graft). RESULTS: After 18 months, the mean reduction of recession height was 2.2 ± 0.8 mm in the control group and 2.3 ± 0.7 mm in the test group, with a mean gain in gingival attachment of 1.3 ± 0.9 mm and 2.3 ± 1.3 mm, respectively. In percentage terms, the mean reduction of recession height was 84.6 ± 19.6% in the control group and 81.7 ± 17.8% in the test group, with a mean gain in gingival attachment of 20.5 ± 37.4% and 184.4 ± 135.5%, respectively. CONCLUSIONS: Significant reduction of gingival recession was achieved with both techniques, though the mean gain in gingival attachment (in mm and as a %) was greater in test group

Surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft.

BACKGROUND: A coronally advanced flap with subepithelial connective tissue graft is the gold standard surgical treatment of gingival recessions, since it offers a higher probability of achieving complete root coverage compared with other techniques. However, optimum short- and middle-term clinical results have also been obtained with coronally advanced flaps alone. The aim of the present study was to evaluate the results obtained by the surgical treatment of localized gingival recessions using coronally advanced flaps with or without subepithelial connective tissue graft. MATERIAL AND METHODS: The reduction of recession height was assessed, together with the gain in gingival attachment apical to the recession, and total reduction of recession, in a comparative study of two techniques. Twenty-two gingival recessions were operated upon: 13 in the control group (coronally advanced flap) and 9 in the test group (coronally advanced flap associated to subepithelial connective tissue graft). RESULTS: After 18 months, the mean reduction of recession height was 2.2 ± 0.8 mm in the control group and 2.3 ± 0.7 mm in the test group, with a mean gain in gingival attachment of 1.3 ± 0.9 mm and 2.3 ± 1.3 mm, respectively. In percentage terms, the mean reduction of recession height was 84.6 ± 19.6% in the control group and 81.7 ± 17.8% in the test group, with a mean gain in gingival attachment of 20.5 ± 37.4% and 184.4 ± 135.5%, respectively. CONCLUSIONS: Significant reduction of gingival recession was achieved with both techniques, though the mean gain in gingival attachment (in mm and as a %) was greater in test group.

Intervención de Enfermería: herramienta clave para mejorar el estado nutricional en los pacientes con Insuficiencia renal crónica / Nursing Intervention: a key tool for improving the nutritional state in patients with chronic renal insufficiency

Los pacientes con Insuficiencia renal crónica y en tratamiento de hemodiálisis se ven sometidos a una restricción de alimentos. Esto, unido al envejecimiento y a los hábitos inadecuados, provoca un riesgo importante de desnutrición. Nuestro objetivo es mejorar el estado nutricional de los pacientes de nuestra unidad de diálisis, mediante la intervención de enfermería: Asesoramiento Nutricional de la Clasificación de Intervenciones de Enfermería. Se realizó un estudio trasversal descriptivo, en el cual estudiamos la población de nuestra unidad en un momento dado (variables antropométricas y analíticas). Aplicamos la intervención: Asesoramiento Nutricional y realizamos un estudio comparativo y correlacional a 12 meses pre y post intervención. Encontramos una mejora nutriconal en todos las variables excepto en linfocitos. Siendo está mejora significativa en las variables IMC y albúmina (AU)

Patients with chronic renal insufficiency who are undergoing haemodialysis are subject to food restrictions. This, together with aging and unsuitable habits, leads to a significant risk of malnutrition. Our aim is to improve the nutritional state of the patients in our dialysis unit, through nursing intervention: Nutritional Advising of the Nursing Interventions Classification. A descriptive transversal study was carried out, in which we studied the population of our unit at a given time (anthropometric and analytical variables). We applied the Nutritional Advising intervention and carried out a comparative and correlational study before and after the intervention. We found a nutritional improvement in all variables except lymphocytes. The improvement was significant in the variables of BMI and albumin (AU)

[Relation of the physical-sport activity practice and alcohol consumption of citizens older than 14 years old]. / Relación entre la práctica de actividad físico-deportiva y el consumo de alcohol de los ciudadanos de más de 14 años.

The aim of the current research is to ascertain any possible relationship that could exist between the alcohol consumption of the population and several sociodemographic variables, in addition to the influence of physical exercise/sports on the creation of healthy lifestyle habits. The sample comprised 1102 subjects from Almeria Spain, over 14 years of age, to whom we administered the "physical exercise/sporting habits and life styles" questionnaire, selecting the sections on physical exercise/sporting habits in leisure, fitness and state of health perception and alcohol consumption habits, related to attitudes, behavioural and sociodemographic variables. We used an innovative tool for data analysis in the sphere of physical exercise, known as the Bayesian networks, emphasizing a positive relationship between alcohol consumption and physical exercise/sporting activities, it being the active people, with an interest in physical exercise/sports, who have a good perception of their health and physical fitness who are the ones who make habitual and occasional use of this substance. The profile of the individual who does not drink alcohol is female, over 44 years of age, with no studies, housewives who have a poor perception of their health, and who do not do any physical exercise or plays sports, whereas the populations with health risks, are men between 15 and 44 years of age who have secondary school studies or a degree and who work in the public or private sector.