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2.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(5): 317-325, mayo 2020. tab
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-5371

RESUMO

INTRODUCCIÓN: La incidencia del microcarcinoma papilar de tiroides (MCPT) está aumentando en los últimos años, especialmente en pacientes intervenidos por enfermedad tiroidea presumiblemente benigna. El objetivo de este estudio es analizar las diferencias entre el MCPT de diagnóstico incidental y de diagnóstico clínico preoperatorio, así como su pronóstico a largo plazo. MATERIAL Y MÉTODOS: La población a estudio la constituyen los pacientes con diagnóstico histológico de MCPT. Se excluyeron los pacientes con cirugía tiroidea previa, con otras enfermedades tiroideas o extratiroideas malignas sincrónicas y localización ectópica del MCPT. Se compararon 2 grupos: pacientes con diagnóstico incidental (grupo 1) y con diagnóstico clínico (grupo 2). Se realizó un análisis multivariante de los factores diferenciadores. RESULTADOS: El MCPT de diagnóstico clínico presentó mayor frecuencia de hipotiroidismo (4,6% vs.18,9%; p = 0,004), invasión extracapsular (5,7% vs.17,6%; p = 0,018), adenopatías metastásicas (1,1% vs.18,9%; p < 0,001) y tiroiditis linfocitaria (5,7% vs.27%; p < 0,001). En el análisis multivariante la presencia de adenopatías metastásicas (OR: 22,011; IC 95%: 2,621-184,829; p = 0,004) y la tiroiditis linfocitaria (OR: 4,949; IC 95%: 1,602-15,288; p = 0,005) se asociaron con el diagnóstico clínico del MCPT. Durante un seguimiento medio de 119,8 ± 65,1 meses se detectó una recidiva en el grupo 2 (0 vs.1,4%; p = 0,460). Ningún paciente falleció debido a la enfermedad. CONCLUSIONES: El MCPT de diagnóstico clínico, aunque presenta características histopatológicas más agresivas (invasión extracapsular y de adenopatías metastásicas), su pronóstico a largo plazo es similar al MCPT incidental. La presencia de adenopatías metastásicas y tiroiditis linfocitaria fueron factores independientes asociados al MCPT de diagnóstico clínico


INTRODUCTION: The incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent years, especially in patients operated on for presumably benign thyroid disease. The aim of this study was to analyze the differences between PTMC incidentally diagnosed and PTMC clinically diagnosed, as well as its long-term prognosis. MATERIAL AND METHODS: The study population consisted of patients with a histological diagnosis of PTMC. Patients with previous thyroid surgery, other synchronous thyroid or extrathyroid malignancies and an ectopic location of PTMC were excluded. Two groups were compared: patients with PTMC incidentally diagnosed (group 1) and patients with PTMC clinically diagnosed (group 2). A multivariate analysis of differentiating factors was performed. RESULTS: PTMC clinically diagnosed had a high frequency of hypothyroidism (4.6% vs.18.9%; P = .004), extrathyroidal extension (5.7% vs.17.6%; P = .018), metastatic lymph nodes (1.1% vs.18.9%; P < .001) and lymphocytic thyroiditis (5.7% vs.27%; P < .001). In the multivariate analysis, metastatic lymph nodes (OR: 22.011, IC 95%: 2.621-184.829; P = .004) and lymphocytic thyroiditis (OR: 4.949; IC 95%: 1.602-15.288; P = .005) were associated with the clinical diagnosis of PTMC. During a mean follow-up of 119.8 ± 65.1 months, one recurrence was detected in group 2 (0% vs.1,4%; P = .460). No patient died due to the disease. CONCLUSIONS: PTMC clinically diagnosed, although it has more aggressive histopathological characteristics (extrathyroidal extension and metastatic lymph nodes), presents a long-term prognosis similar to the PTMC incidentally diagnosed. The presence of metastatic lymph nodes and lymphocytic thyroiditis were independent factors associated with PTMC clinically diagnosed

3.
Arch. esp. urol. (Ed. impr.) ; 73(4): 257-267, mayo 2020. tab, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-5726

RESUMO

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz. MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p < 0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG


INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC: 0.919). SS risk factors (p < 0.05) were the history of cancer, immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows an early identification of patients with OU subsidiary of been complicated with SS

4.
J Neuroinflammation ; 17(1): 161, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434524

RESUMO

BACKGROUND: Human cytomegalovirus (HCMV) infection has been recently associated with a low risk of multiple sclerosis (MS), yet the basis behind this observation remains uncertain. In this study, we aimed to determine in MS patients whether HCMV induces modifications in the peripheral B cell compartment. METHODS: HCMV serostatus was determined in 73 MS patients (55 relapsing-remitting MS (RRMS); 18 progressive MS (PMS)) and 30 healthy controls, assessing their B cell immunophenotype and cytokine production (GM-CSF, IL-6, IL-10, and TNFα) by flow cytometry. RESULTS: HCMV seropositivity in untreated MS patients (n = 45) was associated with reduced switched memory B cells, contrasting with an opposite effect in PMS. Expansions of transitional B cells were observed in HCMV(+) IFNß-treated RRMS patients but not in HCMV(-) cases (p < 0.01), suggesting that HCMV may influence the distribution of B cell subsets modulating the effects of IFNß. Considering the B cell functional profile, HCMV(-) PMS displayed an increased secretion of proinflammatory cytokines (IL-6, TNFα) as compared to HCMV(+) PMS and RRMS cases (p < 0.001). CONCLUSIONS: Our study reveals an influence of HCMV infection on the phenotype and function of B cells, promoting early differentiation stages in RRMS and reducing the proinflammatory cytokine profile in advanced MS forms, which might be related with the putative protective role of this virus in MS.

5.
Cir Esp ; 2020 May 15.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32423606

RESUMO

INTRODUCTION: Physicians, especially surgeons, are significatively affected by burnout. Duty-hour violation, as well as discrimination, abuse and sexual harassment may contribute to burnout. A study about this topic has been published in residents from United States, demonstrating a high incidence of burnout. Our objective is to know which is the situation in Spain and to compare it with United States. METHODS: Cross-sectional observational study carried out in January-February 2020, based on the responses to a validated survey administered to General Surgery residents in Spain. RESULTS: There are 931 General Surgery Residents. 739 have entered in the survey and 452 (61.2%) eventually responded to it. In any occasion during the training period, 55.1% reported discrimination based on their gender, 8.8% reported racial discrimination, 73.9% reported verbal/psychological abuse, 7.1% reported physical abuse and 16.4% reported sexual harassment. Attending surgeons are the most frequent source of sexual harassment and physical and verbal abuse, whereas patients are the most frequent cause of gender discrimination. Burnout symptoms were reported by 47.6% of residents and 4.6% reported suicidal thoughts. 98% of residents reported duty-hour violations and 47% of them do not have the day off after to be on call. Both of these issues are burnout predictive factors. CONCLUSIONS: Mistreatment (discrimination, abuse and harassment) occurs among General Surgery residents during their training period in our country. Every kind of mistreatment is more frequent in Spain than in the United States, with the exception of racial discrimination. It is associated with exceeding weekly duty-hour. It is necessary to know these problems and to avoid them in order to improve work environment of General Surgery training period.

6.
Artigo em Inglês | MEDLINE | ID: mdl-32429234

RESUMO

The aim of this study was to analyze the implementation of a sports-educational program in prisons where the Real Madrid Foundation's Social-Sports Program is carried out. For that purpose, a survey of 468 inmates was conducted at 21 prisons in Spain where the Real Madrid Foundation implements its program (441 men (94.23%) and 27 women (5.77%)). Inmates stated that the program had had a favorable influence on their life in prison and considered that their participation in the program might have a significant influence on the likelihood of them continuing to play sports when they are released. In addition, inmates felt that they had learned a great deal about the contents relating to football and the values they had worked on, and that the program had had a very positive effect on their overall development as a person.

7.
Forensic Sci Int ; 312: 110306, 2020 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-32408040

RESUMO

The continuous emergence of NPS over the last years poses a series of novel challenges for forensic analysts. Most of those new compounds are synthesized with minimal chemical modifications to the structure of already known chemicals in order to avoid regulations. Some of these new compounds may undergo chemical changes during analysis leading to misidentification and detrimental legal consequences. GC-MS is one of the most widely used analytical techniques employed by forensic laboratories all over the world for drug analysis. Nevertheless, thermolabile NPS, such as 25I-NBOH can generate artefacts in the traditional GC-MS analysis. In this paper, we describe the fragmentation mechanism of the 25I-NBOH into a major peak corresponding to 2C-I and a minor one corresponding to the associated ortho-phenolic benzyl ether (o-PBE), which exact identity is directly linked with the solvent used for the analysis. Also, a series of method adjustments is displayed, encompassing variation on the injector temperature, split ratio and flow ratio, although with no success to prevent 25I-NBOH thermo degradation in the GC injector. Furthermore, differential scanning calorimetry and thermogravimetric analysis demonstrated that 25I-NBOH's thermal stability is due to a smaller temperature window between fusion and decomposition points. Finally, we perform derivatization experiments and demonstrate how to overcome 25I-NBOH degradation in the GC/MS analysis.

10.
Rev Esp Salud Publica ; 942020 May 28.
Artigo em Espanhol | MEDLINE | ID: mdl-32463027

RESUMO

OBJECTIVE: The diseases' declaration is a fundamental tool in public health. It's essential to know the magnitude of the problem and decide properly how to solve it. The active finding of cases allows us to know cases that weren't registered by means of the passive declaration. In this study, we intend to analyze whether tuberculosis (TB) cases detected by Tuberculosis Units (TBU) by active finding are different to those reported passively by health professionals. METHODS: Data from the Galician Registry of Tuberculosis (SITUB) were collected analyzing the 2,753 TB cases detected between 2014 and 2018. Confidence intervals were compared and the data were analyzed with Chi square or T-Student tests as required. RESULTS: 44.67% of TB cases of were detected by TBU by active finding. A higher proportion was detected by active finding in bacilliferous, patients with positive culture, pulmonary location and alcoholism. It was lower in HIV (-) and in pediatric cases (under 15 years). Although the proportion of the type of declaration varied depending on the TBU or age, no changes were detected when segregating by TBU or in people over 15 years old. CONCLUSIONS: If active finding wasn't perform, almost half of the cases would be lost. We observed differences in the characteristics of the patients according to the way they have been detected, although we don't know their possible cause. Therefore, the detection of cases by active finding it's an important public health tool.

11.
Cir. Esp. (Ed. impr.) ; 98(5): 251-259, mayo 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-187152

RESUMO

Debido a la actual pandemia de enfermedad respiratoria denominada enfermedad por coronavirus 2019 (COVID-19) causada por el virus denominado SARS-CoV-2, numerosos pacientes con confirmación o sospecha de COVID-19 precisarán tratamiento quirúrgico electivo inaplazable o urgente. Estas situaciones requieren la adopción de medidas especiales da cara a minimizar la posibilidad de contagio entre pacientes, la exposición del personal sanitario y el desarrollo de complicaciones postoperatorias. En el presente documento se explican las principales medidas a tener en cuenta en caso de atención a pacientes COVID-19 o sospecha tanto durante su evaluación como en caso de requerir tratamiento quirúrgico


Due to the current pandemic of respiratory disease known as coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus, many patients with confirmed or suspected COVID-19 infection will require elective surgery, surgery that cannot be postponed, or emergency surgical treatment. In these situations, special measures need to be adopted in order to minimize the possibility of transmission between patients, exposure of healthcare personnel and the development of postoperative complications. This document explains the main principles to consider when managing confirmed or suspected COVID-19 patients during evaluation as well as when surgical treatment is required


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/normas , Centros Cirúrgicos/normas , Equipamentos de Proteção/normas , Procedimentos Cirúrgicos Operatórios/normas , Betacoronavirus , Sociedades Médicas , Espanha
14.
Mediators Inflamm ; 2020: 8294560, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32410867

RESUMO

Objective: To assess the efficacy of biologic drugs, beyond tumor necrosis factor- (TNF-) α inhibitors, in the management of noninfectious refractory scleritis, either idiopathic or associated with systemic immune-mediated disorders. Patients and Methods. This is a retrospective study assessing the efficacy of several biologic agents (rituximab, anakinra, tocilizumab, and abatacept) and the small molecule tofacitinib in the treatment of scleritis through assessment of scleral inflammation and relapses, as well as treatment impact on best-corrected visual acuity (BCVA) and safety profile. Results: Fourteen patients (19 eyes) were enrolled in the study. Scleritis inflammatory grading significantly improved from baseline to 3 months (p = 0.002) and from baseline to the last follow-up visit (p = 0.002). Scleritis relapses significantly decreased between the 12 months preceding and following biologic therapy (p = 0.007). No differences regarding BCVA were observed (p = 0.67). Regarding adverse events, only one patient developed pneumonia and septic shock under rituximab treatment. Conclusions: Our results, though limited to a low number of patients, highlight the effectiveness of different biologic therapies in the treatment of noninfectious refractory scleritis, showing to control scleral inflammation and allowing a significant reduction in the number of relapses.

15.
Clin Chim Acta ; 2020 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-32417213

RESUMO

BACKGROUND-AIM: Appropriately defined reference values are of vital importance for the correct interpretation of laboratory results. However, the implementation of in-house reference intervals by traditional methods is rare due to difficulties in the selection of reference individuals, so indirect methods are often alternatively used. Parathyroid hormone (PTH) is a crucial hormone for the metabolism of calcium and phosphorus whose result can lead to erroneous diagnoses and medical actions if adequate reference intervals are not readily available. Our goal was to obtain reference values ​​for adult population for PTH by using data mining. Based on possible new reference intervals, we also aimed to perform a retrospective evaluation of the individuals mistakenly classified. METHODS: Retrospective observational study between 2014-2019. All requests from individuals aged ≥18 years were considered if PTH was requested together with serum creatinine, 25-hydroxyvitamin D, calcium, albumin and phosphate (within their respective reference intervals). PTH was measured on the Cobas e411 platform (Roche). Requests were grouped by age and sex. Differences among partitions were assessed by the Harris-Boyd's test and reference intervals were determined by the non-parametrical calculation of percentiles 2.5 and 97.5. RESULTS: A total of 2279 laboratory requests were included. Reference intervals for PTH were seen to be sex-independent, but age-dependent reference intervals were needed: 18-39, 40-59 and >60 years. Based on the reference intervals obtained, up to 20.1% of individuals were misclassified. CONCLUSIONS: Appropriateness of PTH reference intervals would lead to a reduction in the number of additional tests and avoid wrong medical actions, thus improving not only patient safety, but also the healthcare system as a whole.

16.
Chin J Integr Med ; 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32418180

RESUMO

OBJECTIVE: To determine whether topical applications of thiosulfinate-enriched Allium sativum extract (TASE) can accelerate acute cutaneous wound healing (WH) in a murine model. METHODS: Keratinocyte viability and in vitro wound closure were assessed in keratinocyte cultures. Effects of topical TASE (0.5 µg/mL of allicin in 97% ethanol) on acute cutaneous WH were determined in a murine model of acute cutaneous wound. Twelve mice were alternately assigned to the vehicle- and TASE-treated groups (n=6 per group). Expression levels of mRNA for keratinocyte differentiation marker-related proteins (filaggrin, loricrin and involucrin) and lipid synthetic enzymes (elongation of very long chain fatty acids protein 4 (ELOVL4), fatty acid synthase (FA2H), 3-hydroxy- 3-methyl-glutaryl-coenzyme A reductase (HMGCoA), and serine palmitoyltransferase (SPT)) were assessed using real-time quantitative polymerase chain reaction on day 3 and 8 after wounding, while transepidermal water loss (TEWL) rates were measured in wounded areas. RESULTS: TASE accelerated WH both in vivo (40% vs. 22% reduction in wound area, P<0.01) and in vitro (90% vs. 65% reduction in wound area, P<0.01). Moreover, topical applications of TASE upregulated the expression levels of epidermal mRNA for ELOVL4, HMGCoA, SPT, filaggrin, loricrin and involucrin (P<0.05 vs. vehicle-treated controls) on day 3 after wounding. Likewise, TASE significantly lowered TEWL rates in comparison with vehicle alone on day 8 (33.06±2.09 g/(m2·h) vs. 24.60±2.04 g/(m2·h), P<0.01). CONCLUSIONS: Topical applications of TASE stimulated keratinocyte proliferation and formation of epidermal permeability barrier function, leading to acceleration of acute cutaneous WH. Topical products containing TASE could be used to manage acute cutaneous WH.

17.
J Arthroplasty ; 2020 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-32389403

RESUMO

BACKGROUND: Mechanically assisted crevice corrosion (MACC) at modular junctions can cause a spectrum of adverse local tissue reactions (ALTRs) in patients who have undergone total hip arthroplasty (THA). The purpose of this study is to describe the presentation, treatments, and related complications of a cohort of patients presenting with late instability following metal-on-polyethylene THA due to underlying MACC and ALTR. METHODS: This multicenter retrospective case series presents 17 patients (12 women, mean age 62.6, range 42-73) presenting with late instability secondary to ALTR and MACC. All patients had a metal (Cobalt Chrome)-on-polyethylene bearing surface. Patients experienced a mean 2.7 dislocations (range 1-6) at mean 4.3 years (range 0.4-17.0) following their index surgery. Serum metal levels (n = 12) demonstrated a greater elevation of cobalt (mean 6.9, range 0.13-20.88 ng/mL) than chromium (mean 1.9, range 0.13-3.23 ng/mL). RESULTS: Patients were revised for instability at a mean of 6.8 years (range 2.1-19.4) following their index surgery. ALTR was encountered in every case and the modular head-neck junction demonstrated visible corrosion. An exchange of the CoCr head to a ceramic head with a titanium sleeve and placement of a constrained liner was performed for a majority of patients (n = 15, 88.2%). Five patients (29.4%) had complications postoperatively including peroneal palsy (n = 2), periprosthetic joint infection (n = 2), and ALTR recurrence (n = 1). CONCLUSION: Recurrent instability in the setting of otherwise well-positioned THA components and without another obvious cause should raise concern for ALTR as a potential underlying etiology.

18.
Vet Rec ; 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32414910

RESUMO

BACKGROUND: Epiploic foramen entrapment (EFE) of small intestine is a severe cause of strangulating small intestinal obstruction (SSI) with long-term survival seeming lower than for other causes of SSI in horses. Different techniques via laparoscopy or laparotomy for epiploic foramen (EF) closure have been developed. METHODS: This study describes a technique of peroperative mesh closure of the EF in clinical cases and their long-term follow up. RESULTS: In the study period of 5.5 years, 36 horses were admitted to the clinic with EFE. Of these, 17 horses had peroperative mesh closure, with resection anastomosis in 4 cases and enterotomy in 4 other cases. Fifteen of these survived to discharge. Long-term follow-up (one to three years, median three years) was favourable in all 15 horses not showing recurrence of EFE nor other related signs of colic. Laparoscopic evaluation of the EF was performed in two cases and showed integration of the mesh. One horse was euthanased 3.5 years after mesh placement for an unrelated cause and the mesh was well adherent obliterating the EF. CONCLUSION: Mesh closure of EF during emergency coeliotomy did not cause short-term complications even in horses with resection or enterotomy and may reduce the risk of recurrence of EFE in horses.

19.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32402688

RESUMO

INTRODUCTION AND OBJECTIVES: This study aimed to compare stress echocardiography (SE) and multidetector computed tomography (MCT) in patients admitted to a chest pain unit to detect acute coronary syndrome (ACS). METHODS: A total of 203 patients with ≥ 1 cardiovascular risk factor, no ischemic electrocardiogram changes and negative biomarkers were randomized to SE (n=103) or MTC (n=100). The primary endpoint was a combination of hard events (death and nonfatal myocardial infarction), revascularizations, and readmissions during follow-up. The secondary endpoint was the cost of the 2 strategies. RESULTS: Invasive angiography was performed in 61 patients (34 [33%] in the SE group and in 27 [27%] in the MCT group, P=.15). A final diagnosis of ACS was made in 53 patients (88% vs 85%, P=.35). There were no significant differences between groups in the primary endpoint (42% vs 41%, P=.91), or in hard events (5% vs 7%, P=.42). There were no significant differences in overall cost, but costs were lower in patients with negative SE than in those with negative MCT (€557 vs €706, P <.02). CONCLUSIONS: No significant differences were found in efficacy and safety for the stratification of patients with a low to moderate probability of ACS admitted to a chest pain unit. The cost of the 2 strategies was similar, but cost was significantly lower for SE on comparison of negative studies.

20.
Eur J Clin Invest ; : e13272, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32406060

RESUMO

BACKGROUND: A more complete assessment of coronary artery disease (CAD) can be performed by Coronary computed tomography angiography (CCTA). The aim was to assess the prevalence, distribution and characteristics of coronary artery disease (CAD) and the reclassification of cardiovascular risk by CCTA in an asymptomatic Spanish population. DESIGN: We included, in a cross-sectional study, 501 random subjects from asymptomatic population, aged 35 and 75. Risk factors, target organ damage and cardiovascular risk were assessed. CCTA was offered to measure the coronary artery calcium score(CACs), segment involvement score(SIS) and segment stenosis score(SSS). The offer was accepted by 220 subjects (44%), with a mean age of 58±14 years, 56% of them male. RESULTS: The mean CACs was 119.6±381.7 (median (IQR) (0 (0-61.55)), with higher scores in males (191.9±493.1) than females (26.1±73.3)(p <0.01). CCTA revealed coronary atherosclerosis in 89 cases, 40% (CI95%:34% to 46%) in global, 51% in male and 25% in female, of which 13 had obstructive lesions (5.9%). Mean SIS was 1.5±2.5 and SSS 1.2±3.1. When the CACs was included in the CAD risk scale, there was a reclassification of 24%, and when using the SIS percentile, it was 38%, with a 9% increase in risk in both cases. CONCLUSIONS: The prevalence of CAD in asymptomatic Spanish population was 40%, with greater proportion among males. The incorporation of CACs and SIS in the assessment of cardiovascular risk, allows reclassifying subjects who are at low or moderate risk and thus identify those with high cardiovascular risk and also the other way.

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