Retinal vein occlusion in the general population after COVID-19 vaccination and infection / Obstrucción venosa retiniana en la población general después de la vacunación y de la COVID-19

Introduction Retinal vein occlusion (RVO) is mostly a consequence of vascular risk factors (VRF). COVID-19 vaccines have been related to vascular and thrombotic events (VTE). Objective To assess the RVO incidence in the general population in our health area and the possible relation with COVID-19 infection and vaccination. Methods Demographic features, classic VRF, thrombophilia data, COVID-19 status, and Framingham risk score were collected prospectively. Results 472 consecutive patients studied over 13 years with RVO were included (Valdecilla Cohort). Classic VRFs were present in 90%, antiphospholipid syndrome in 12.3%, and genetic thrombophilia in 13.5%. Ninety-one percent of RVO patients were vaccinated and 6.8% suffered COVID-19 infection. In the cohort, no patient had a new RVO after vaccination or infection. In the general population, 20 subjects had RVO after receiving the vaccine (0.006%). Overall, 8 cases occurred in the first-month post-vaccination and 12 after 30 days. In the early and late groups, there are 3 and 4 patients respectively, with a low-intermediate risk Framingham score. Twenty-nine patients in the cohort suffered SARS-CoV-2 infection, twenty-seven of them had RVO before infection. Two patients with low-risk Framingham scores had RVO after infection, one of them early (<1 month). Conclusion Vaccination and COVID-19 might be involved in the development of RVO in some cases, mainly in patients without VRF, thrombophilia, or chronic inflammatory conditions and with a lower Framingham score, especially in the first month after vaccination or infection (AU)

Introducción La oclusión venosa retiniana (OVR) es principalmente una consecuencia de los factores de riesgo vascular (FRV). Las vacunas contra la COVID-19 se han relacionado con eventos vasculares y trombóticos (EVT). Objetivo Evaluar la incidencia de OVR en la población general de nuestra área de salud y su posible relación con la COVID-19 y la vacunación. Métodos Se recopilaron prospectivamente las características demográficas, FRV clásicos, datos sobre trombofilia, padecimiento de la COVID-19 y puntuación de riesgo de Framingham. Resultados Se incluyeron 472 pacientes consecutivos con OVR, estudiados durante 13 años (Cohorte Valdecilla). Los FRV clásicos estaban presentes en el 90%, el síndrome antifosfolípido en el 12,3% y la trombofilia genética en el 13,5% de los casos. El 91% de los pacientes con OVR recibieron la vacuna frente a la COVID-19 y el 6.8% sufrió la infección. En la cohorte, ningún paciente tuvo una nueva OVR después de la vacunación o de la infección. En la población general, 20 sujetos presentaron OVR después de recibir la vacuna (0,006%). En general, 8 casos ocurrieron en el primer mes después de la vacunación y 12 después de 30 días. En los grupos precoz y tardío, 3 y 4 pacientes respectivamente, presentaban una puntuación de Framingham de riesgo bajo o intermedio. Veintinueve pacientes de la cohorte sufrieron infección por SARS-CoV-2 y 27 de ellos tuvieron una OVR antes de ésta. Dos pacientes con puntuaciones de Framingham de bajo riesgo presentaron una OVR después de la infección, uno de ellos precozmente (<1 mes). Conclusiones La vacunación y la COVID-19 podrían estar involucradas en el desarrollo de OVR en algunos casos, principalmente en pacientes sin FRV, trombofilia o procesos inflamatorios crónicos y con una puntuación de Framingham más baja, especialmente en el primer mes después de la vacunación o de la infección (AU)

Retinal vein occlusion in the general population after COVID-19 vaccination and infection.

INTRODUCTION: Retinal vein occlusion (RVO) is mostly a consequence of vascular risk factors (VRF). COVID-19 vaccines have been related to vascular and thrombotic events (VTE). OBJECTIVE: To assess the RVO incidence in the general population in our health area and the possible relation with COVID-19 infection and vaccination. METHODS: Demographic features, classic VRF, thrombophilia data, COVID-19 status, and Framingham risk score were collected prospectively. RESULTS: 472 consecutive patients studied over 13 years with RVO were included (Valdecilla Cohort). Classic VRFs were present in 90%, antiphospholipid syndrome in 12.3%, and genetic thrombophilia in 13.5%. Ninety-one percent of RVO patients were vaccinated and 6.8% suffered COVID-19 infection. In the cohort, no patient had a new RVO after vaccination or infection. In the general population, 20 subjects had RVO after receiving the vaccine (0.006%). Overall, 8 cases occurred in the first-month post-vaccination and 12 after 30 days. In the early and late groups, there are 3 and 4 patients respectively, with a low-intermediate risk Framingham score. Twenty-nine patients in the cohort suffered SARS-CoV-2 infection, twenty-seven of them had RVO before infection. Two patients with low-risk Framingham scores had RVO after infection, one of them early (<1 month). CONCLUSIONS: Vaccination and COVID-19 might be involved in the development of RVO in some cases, mainly in patients without VRF, thrombophilia, or chronic inflammatory conditions and with a lower Framingham score, especially in the first month after vaccination or infection.

Oclusión venosa retiniana en pacientes menores de 50 años. Análisis de factores de riesgo vascular, trombofilia, hallazgos ecográficos carotídeos y etiologías poco frecuentes / Retinal vein occlusion in patients under 50 years. Analysis of vascular risk factors, thrombophilia, carotid ultrasound findings and uncommon aetiologies

Introducción La oclusión venosa retiniana (OVR) se ha relacionado con factores de riesgo vascular y trombofilia. Métodos Se trata de un estudio de cohorte prospectivo de todos los pacientes diagnosticados de OVR y remitidos a una clínica de medicina interna de un hospital universitario terciario durante un período de 10 años. Se analizaron variables clínicas, de laboratorio y ecográficas de troncos supraaórticos y se compararon según la edad. Resultados Se incluyeron unos 309 pacientes diagnosticados de OVR, 25 de ellos menores de 50 años. La prevalencia de hipertensión arterial, dislipidemia, diabetes mellitus, hiperhomocisteinemia y placa carotídea fue significativamente mayor en pacientes > 50 años que en los menores. Sin embargo, la prevalencia de trombofilia hereditaria fue mayor en el grupo más joven (32 vs. 11,4%; p = 0,005). Se observaron enfermedades poco frecuentes relacionadas con la OVR como hepatitis C, talasemia menor, enfermedad de Lyme, vasculitis y perlebitis en pacientes jóvenes sin factores de riesgo vascular. Conclusión Sugerimos realizar un estudio genético de trombofilia en pacientes con OVR menores de 50 años, siendo siempre recomendable un control exhaustivo de los factores de riesgo vascular en todos los pacientes con OVR. Además, sugerimos tener en cuenta las enfermedades poco frecuentes relacionadas con la OVR, especialmente en pacientes jóvenes sin factores de riesgo vascular (AU)

Introduction Retinal vein occlusion (RVO) has been related to vascular risk factors and thrombophilia. Methods This is a prospective cohort study of all patients diagnosed with RVO and referred to an Internal Medicine clinic of a tertiary teaching hospital during a 10-year period. Clinical, laboratory and supra-aortic trunks ultrasound variables were analysed and compared according to age. Results Some 309 patients diagnosed with RVO were included, 25 of them younger than 50 years. The prevalence of high blood pressure, dyslipidaemia, diabetes mellitus, hyperhomocysteinemia, and carotid plaque was significantly higher in patients>50 years than in those below. However, the prevalence of inherited thrombophilia was higher in the younger group (32.0 vs 11.4%; p = 0.005). Uncommon diseases related to RVO such as hepatitis C, thalassemia minor, Lyme disease, vasculitis, and periphlebitis were observed in young patients without vascular risk factors. Conclusion We suggest performing a genetic thrombophilia study in RVO patients younger than 50 years, while an exhaustive control of vascular risk factors is always recommended in all RVO patients. Moreover, we suggest bearing in mind uncommon diseases related to RVO, especially in young patients without vascular risk factors (AU)

Retinal vein occlusion in patients under 50 years. Analysis of vascular risk factors, thrombophilia, carotid ultrasound findings and uncommon aetiologies.

INTRODUTION: Retinal vein occlusion (RVO) has been related to vascular risk factors and thrombophilia. METHODS: This is a prospective cohort study of all patients diagnosed with RVO and referred to an Internal Medicine clinic of a tertiary teaching hospital during a 10-year period. Clinical, laboratory and supra-aortic trunks ultrasound variables were analysed and compared according to age. RESULTS: Some 309 patients diagnosed with RVO were included, 25 of them younger than 50 years. The prevalence of high blood pressure, dyslipidaemia, diabetes mellitus, hyperhomocysteinemia, and carotid plaque was significantly higher in patients >50 years than in those below. However, the prevalence of inherited thrombophilia was higher in the younger group (32.0% vs 11.4%; p = 0.005). Uncommon diseases related to RVO such as hepatitis C, thalassemia minor, Lyme disease, vasculitis, and periphlebitis were observed in young patients without vascular risk factors. CONCLUSION: We suggest performing a genetic thrombophilia study in RVO patients younger than 50 years, while an exhaustive control of vascular risk factors is always recommended in all RVO patients. Moreover, we suggest bearing in mind uncommon diseases related to RVO, especially in young patients without vascular risk factors.

Efectos de la pandemia por SARS-CoV-2 en una cohorte de pacientes con obstrucción venosa retiniana / Effects of the COVID-19 pandemic on a cohort of patients with vein occlusion

Antecedentes y objetivos En diciembre de 2019 surgió una nueva enfermedad por coronavirus en humanos causada por el virus SARS-CoV-2, la COVID-19, que se ha asociado con fenómenos trombóticos. La obstrucción venosa retiniana (OVR) es principalmente una consecuencia de los factores de riesgo vascular (FRV). El objetivo de este estudio ha sido analizar los casos de infección por SARS-CoV-2 en una cohorte de pacientes con OVR (cohorte Valdecilla). Pacientes y métodos Entre diciembre de 2008 y 2020 hemos atendido 429 pacientes con OVR. Diez han padecido COVID-19, de los que uno no presentaba FRV ni trombofilia. Los otros 9 fueron diagnosticados de OVR antes de la infección: todos tenían FRV; 6 ateromatosis carotídea y 4 presentaban un síndrome antifosfolípido. La infección no causó en ellos fenómenos trombóticos. Conclusiones La OVR es una manifestación infrecuente de la COVID-19. En nuestra cohorte de pacientes con OVR la COVID-19 no indujo eventos trombóticos (AU)

Background and objectives A new coronavirus disease in humans, COVID-19, caused by SARS-CoV-2, emerged in December 2019. It has been associated with the development of thrombotic phenomena. Retinal vein occlusion (RVO) is mainly a consequence of vascular risk factors (VRF). This study aimed to analyze cases of COVID-19 in a cohort of patients with RVO (Valdecilla cohort). Patients and methods Between December 2008 and December 2020, 429 patients with RVO were attended to in our clinic. Ten patients had COVID-19, one of which did not have VRF or thrombophilia. The remaining nine patients had RVO prior to the infection and VRF, six had carotid atherosclerosis, and four had antiphospholipid syndrome. The infection did not cause thrombotic phenomena in any of them. Conclusions RVO is a rare manifestation of COVID-19. In our cohort of patients with RVO, COVID-19 disease did not lead to thrombotic events (AU)

Variabilidad en el rendimiento neuropsicológico en pacientes con síndrome coronario agudo / Variability in the neuropsychological performance of patients with acute coronary syndrome

Introducción: Existe un interés creciente por el estudio de la relación entre las cardiopatías, incluido el síndrome coronario agudo (SCA) y el deterioro cognitivo, y, aunque no se conocen con concreción los factores que median entre el SCA y el deterioro cognitivo, en el centro de este debate se encuentra el papel de la fracción de eyección del ventrículo izquierdo (FEVI). Objetivos: Determinar la presencia de deterioro cognitivo en pacientes con SCA y explorar su asociación con diversos factores –sociodemográficos, consumo de fármacos, rendimiento en pruebas funcionales cardíacas (en particular, la FEVI)–. Pacientes y métodos: Se recogieron variables sociodemográficas, médicas y neuropsicológicas en 80 pacientes con SCA que participaban en un programa de rehabilitación cardíaca. Se compararon sus puntuaciones en la batería neuropsicológica con los datos normativos poblacionales para determinar qué sujetos mostraban un rendimiento deficitario. Se realizaron análisis de regresión para determinar qué factores se asocian con el rendimiento en las pruebas neuropsicológicas. Resultados: En comparación con su grupo normativo, el 37,5% de los sujetos presentó una baja puntuación en tres o más test neuropsicológicos. La edad, un bajo nivel educativo y una FEVI baja explicaron hasta el 51% de la variabilidad en los resultados de las pruebas neuropsicológicas. Conclusiones: Los pacientes con SCA tienen más posibilidades de presentar un deterioro de funciones cognitivas, como la atención, la memoria y las funciones ejecutivas, junto con un enlentecimiento en la velocidad de procesamiento de la información. Una FEVI inferior al 50% podría ser un factor explicativo destacado de dicho deterioro cognitivo.

Introduction: There is a growing interest in the study of the relationship between heart disease, including acute coronary syndrome (ACS) and cognitive impairment, and although the factors mediating ACS and cognitive impairment are not well understood, the debate revolves around the role of the left ventricular ejection fraction (LVEF). Aims: To determine the presence of cognitive impairment in patients with ACS and explore its association with various factors, including sociodemographic, medication use and performance on cardiac function tests (in particular LVEF). Patients and methods: Sociodemographic, medical and neuropsychological variables were collected in 80 patients with ACS participating in a cardiac rehabilitation programme. Their scores on the neuropsychological battery were compared with normative population data to determine which subjects showed deficient performance. Regression analyses were conducted to determine which factors are associated with performance on neuropsychological tests. Results: Compared to their normative group, 37.5% of the subjects had low scores on three or more neuropsychological tests. Age, low educational level and low LVEF explained up to 51% of the variability in neuropsychological test results. Conclusions. Patients with ACS are more likely to have impaired cognitive functions, such as attention, memory and executive functions, along with a slower information processing speed. An LVEF below 50% could be a major explanatory factor for such cognitive impairment.(AU)

Effects of the COVID-19 pandemic on a cohort of patients with vein occlusion.

BACKGROUND AND OBJECTIVES: A new coronavirus disease in humans, COVID-19, caused by SARS-CoV-2, emerged in December 2019. It has been associated with the development of thrombotic phenomena. Retinal vein occlusion (RVO) is mainly a consequence of vascular risk factors (VRF). This study aimed to analyze cases of COVID-19 in a cohort of patients with RVO (Valdecilla cohort). PATIENTS AND METHODS: Between December 2008 and December 2020, 429 patients with RVO were attended to in our clinic. Ten patients had COVID-19, one of which did not have VRF or thrombophilia. The remaining nine patients had RVO prior to the infection and VRF, six had carotid atherosclerosis, and four had antiphospholipid syndrome. The infection did not cause thrombotic phenomena in any of them. CONCLUSIONS: RVO is a rare manifestation of COVID-19. In our cohort of patients with RVO, COVID-19 disease did not lead to thrombotic events.

Glaucoma primario de ángulo abierto y factores de riesgo aterosclerótico: hallazgos por eco-Doppler orbitario / Primary open angle glaucoma and atherosclerotic risk factors: orbital echo-Doppler findings

Objetivo: Determinar los hallazgos por eco-Doppler orbitario en pacientes con glaucoma primario de ángulo abierto según factores de riesgo aterosclerótico. Métodos: Se realizó un estudio observacional descriptivo y transversal en 300 órbitas de 150 pacientes con diagnóstico de glaucoma primario de ángulo abierto. A todos los casos se les realizó tonometría de contorno dinámico y tomografía de coherencia óptica. Se identificaron mediante interrogatorio y por el laboratorio clínico los factores de riesgo aterosclerótico: hipertensión arterial, tabaquismo, diabetes mellitus tipo 2, dislipidemia, obesidad y consumo excesivo de alcohol. Se les realizó ultrasonido orbitario y Doppler carotídeo, y solo en caso de resultar normales se procedió a evaluar mediante eco-Doppler las arterias oftálmica, central de la retina y ciliares posteriores temporales. Resultados: La edad media de los sujetos estudiados fue de 62,3 años. El 55,3 por ciento correspondió al sexo femenino y el 47,3 por ciento al color blanco de la piel. El número de factores de riesgo mostró una correlación lineal moderada, positiva y significativa con el índice de resistencia, mientras que con las velocidades dicha correlación resultó ser negativa. Todos los factores de riesgo expresaron efectos dañinos sobre la hemodinámica del flujo ocular, la presión intraocular y el grosor de las capas de fibras neurorretinianas temporales. Tras ajustar para la edad, esta negativa influencia continuó siendo relevante en la mayoría de los casos. Conclusiones: Los aspectos vasculares del glaucoma deben integrarse a la práctica clínica de esta afección, lo que ayudará a que el enfoque sea más completo, y redundará en un mejor pronóstico de la enfermedad(AU)

Objective: Determine the orbital echo-Doppler findings in patients with primary open angle glaucoma according to atherosclerotic risk factors. Methods: A cross-sectional observational descriptive study was conducted of 300 orbits of 150 patients diagnosed with primary open angle glaucoma. All the cases underwent dynamic contour tonometry and optical coherence tomography. Interrogation and clinical laboratory testing led to identification of the following atherosclerotic risk factors: arterial hypertension, smoking, diabetes mellitus type 2, dyslipidemia, obesity and excessive alcohol consumption. Orbital and carotid Doppler ultrasounds were performed, and only if they were normal they would be followed by echo-Doppler evaluation of the ophthalmic, central retinal and posterior temporal ciliary arteries. Results: Mean age of the study subjects was 62.3 years. 55.3 percent were female and 47.3 percent had white skin. The number of risk factors showed a moderate, positive and significant linear correlation with the resistive index, and a negative correlation with the velocities. All the risk factors expressed harmful effects on ocular flow hemodynamics, intraocular pressure and the thickness of temporal neuroretinal fibers. After adjusting for age, this negative influence continued to be relevant in most cases. Conclusions: The vascular aspects of glaucoma should be incorporated into the clinical management of this condition. This will make the approach more thorough and help achieve a better diagnosis(AU)

Brachial-ankle pulse wave velocity with a custom device.

BACKGROUND AND OBJECTIVES: The brachial-ankle pulse wave velocity (baPWV) is one of the most widely used arterial stiffness variables for assessing vascular risk. The abiPWV is a device that calculates various PWVs and the blood pressure ankle-brachial index (ABI). The device can also determine baPWV. The aim of this study was to calculate the baPWV with abiPWV, validate it with a reference device (VaSera) and study its clinical usefulness. PATIENTS AND METHODS: We studied 113 patients (mean age, 53 ±â€¯12 years), 59 (52%) of whom were women, and 10 (8.8%) of whom had a previous cardiovascular event. The participants were classified according to cardiovascular risk factors (CRFs) into group I (none), group II (1 or 2 CRFs) and group III (3 or more CRFs). The patients with a previous cardiovascular event were included in group III. All participants had their baPWV measured with abiPWV and VaSera. RESULTS: The baPWV correlation between the 2 devices was r = 0.93 (p < .001), and the percentage error calculated with the Bland-Altman analysis was 4.5%. The baPWV measured with abiPWV (in m/s) was as follows: group I, 10.5 ±â€¯1.6; group II, 13.8 ±â€¯2.9 (p < .001 when compared with group I); and group III, 14.1 ±â€¯2.7 (p < .001 when compared with group I). There were no differences between groups II and III. The results with VaSera were comparable to those of abiPWV. CONCLUSIONS: Measuring baPWV with the abiPWV is safe and has a similar clinical utility to that of VaSera. Incorporating this function into the options of abiPWV makes it a complete device for assessing arterial stiffness.

Velocidad de onda de pulso brazo-tobillo con un dispositivo propio / Brachial-ankle pulse wave velocity with a custom device

Antecedentes y objetivos La velocidad de onda de pulso brazo-tobillo (VOPbt) es una de las variables de rigidez arterial más empleada en la valoración del riesgo vascular. VOPITB es un dispositivo que calcula distintas VOP y el índice tobillo-brazo de presión arterial (ITB). Además, con sus registros se podría determinar la VOPbt. El objetivo de este estudio fue: calcular la VOPbt con VOPITB, validarlo con un equipo de referencia (VaSera) y estudiar su utilidad clínica. Pacientes y métodos Se estudiaron 113 pacientes, con edad media de 53±12años; 59 (52%) eran mujeres y 10 (8,8%) presentaban evento cardiovascular previo. Los participantes se estatificaron según factores de riesgo vascular (FRV) en: grupoI, ninguno; grupoII, uno o 2; y grupoIII, 3 o más FRV. Los pacientes con algún evento vascular previo se incluyeron en el grupoIII. A todos se les midió la VOPbt con VOPITB y VaSera. Resultados La correlación de VOPbt entre ambos equipos fue r=0,93 (p<0,001) y el porcentaje de error calculado con análisis de Bland-Altman: 4,5%. La VOPbt con VOPITB fue (m/s): grupoI, 10,5±1,6 comparado con grupoII, 13,8±2,9 (p<0,001) y grupoIII, 14,1±2,7 (p<0,001). No se observaron diferencias entre gruposII y III. Los resultados obtenidos con VaSera fueron equiparables a los de VOPITB. Conclusiones La medición de la VOPbt con el equipo VOPITB es segura y de utilidad clínica similar a la realizada con VaSera. La incorporación de esta función a las prestaciones de VOPITB lo convertirá en un dispositivo completo para valorar la rigidez arterial (AU)

Background and objectives The brachial-ankle pulse wave velocity (baPWV) is one of the most widely used arterial stiffness variables for assessing vascular risk. The abiPWV is a device that calculates various PWVs and the blood pressure ankle-brachial index (ABI). The device can also determine baPWV. The aim of this study was to calculate the baPWV with abiPWV, validate it with a reference device (VaSera) and study its clinical usefulness. Patients and methods We studied 113 patients (mean age, 53±12years), 59 (52%) of whom were women, and 10 (8.8%) of whom had a previous cardiovascular event. The participants were classified according to cardiovascular risk factors (CRFs) into groupI (none), groupII (1 or 2 CRFs) and groupIII (3 or more CRFs). The patients with a previous cardiovascular event were included in groupIII. All participants had their baPWV measured with abiPWV and VaSera. Results The baPWV correlation between the 2 devices was r=0.93 (P<.001), and the percentage error calculated with the Bland-Altman analysis was 4.5%. The baPWV measured with abiPWV (in m/s) was as follows: groupI, 10.5±1.6; groupII, 13.8±2.9 (P<.001 when compared with groupI); and groupIII, 14.1±2.7 (P<.001 when compared with groupI). There were no differences between groupsII and III. The results with VaSera were comparable to those of abiPWV. Conclusions Measuring baPWV with the abiPWV is safe and has a similar clinical utility to that of VaSera. Incorporating this function into the options of abiPWV makes it a complete device for assessing arterial stiffness (AU)

Brachial-ankle pulse wave velocity with a custom device. / Velocidad de onda de pulso brazo-tobillo con un dispositivo propio.

BACKGROUND AND OBJECTIVES: The brachial-ankle pulse wave velocity (baPWV) is one of the most widely used arterial stiffness variables for assessing vascular risk. The abiPWV is a device that calculates various PWVs and the blood pressure ankle-brachial index (ABI). The device can also determine baPWV. The aim of this study was to calculate the baPWV with abiPWV, validate it with a reference device (VaSera) and study its clinical usefulness. PATIENTS AND METHODS: We studied 113 patients (mean age, 53±12years), 59 (52%) of whom were women, and 10 (8.8%) of whom had a previous cardiovascular event. The participants were classified according to cardiovascular risk factors (CRFs) into groupI (none), groupII (1 or 2 CRFs) and groupIII (3 or more CRFs). The patients with a previous cardiovascular event were included in groupIII. All participants had their baPWV measured with abiPWV and VaSera. RESULTS: The baPWV correlation between the 2 devices was r=0.93 (P<.001), and the percentage error calculated with the Bland-Altman analysis was 4.5%. The baPWV measured with abiPWV (in m/s) was as follows: groupI, 10.5±1.6; groupII, 13.8±2.9 (P<.001 when compared with groupI); and groupIII, 14.1±2.7 (P<.001 when compared with groupI). There were no differences between groupsII and III. The results with VaSera were comparable to those of abiPWV. CONCLUSIONS: Measuring baPWV with the abiPWV is safe and has a similar clinical utility to that of VaSera. Incorporating this function into the options of abiPWV makes it a complete device for assessing arterial stiffness.

Retinal vein occlusion in solid organ transplant recipients. Study of 4 cases and literature review. / Obstrucción venosa retiniana en receptores de trasplante de órgano sólido. Estudio de 4 casos y revisión de la literatura.

Although retinal venous obstruction (RVO) has been primarily related to vascular risk factors and glaucoma, there are a few studies of RVO in patients with solid organ transplants. An analysis was performed on total of 331 patients who presented with RVO (branch RVO in 226 cases and central RVO in 105 cases) over a 10 year period, and the characteristics were compared with the 4 patients with a history of solid organ transplant (liver, renal, or bipulmonary) who presented with RVO. In this series, the onset of RVO in transplant patients occurred at earlier ages than in other patients with RVO (58 vs. 68 years, respectively), affected the central vein of the retina (100% vs. 32%), and was associated with diabetes mellitus (75% vs. 25%), as well as with steroidal (100% vs. 1%) and immunosuppressive (tacrolimus 75% vs. 0%) treatments.

Prevalence of abdominal aortic aneurysm in patients with high cardiovascular risk. / Prevalencia de aneurisma de aorta abdominal en pacientes con alto riesgo cardiovascular.

BACKGROUND: To determine the prevalence of abdominal aortic aneurysm (AAA) (arterial diameter ≥30mm), in patients with high or very high cardiovascular risk (CVR) and to evaluate their clinical features. PATIENTS AND METHODS: Observational, cross-sectional and multicentric study conducted in Spanish Internal Medicine Services. We enrolled men with age >55years and women >65years who had a high or very high CVR. RESULTS: The study included 659 patients. The prevalence of AAA was 8% (53 patients). 76.9% were male with a mean age of 71±8.7years. The multivariate analysis showed an association between AAA and age (OR: 1.06; 95%CI: 1.02-1.1; P<.01), male sex (OR: 5.6; 95%CI: 1.6-18.8; P=.01), active smoking (OR: 3.22; 95%CI: 1.16-8.93; P=.024) and peripheral arterial disease (OR: 3.51; 95%CI: 1.73-7.09; P<.01). Diabetes mellitus was an independent protective factor (OR: 0.41; 95%CI: 0.22-0.78; P=.06). Those with subaneurysmal dilatation of the abdominal aorta (diameter 25-29.9mm) presented similar features as patients with AAA. CONCLUSIONS: The prevalence of AAA in patients with high CVR is high. Ultrasound screening can be performed by general practitioners. Men >65years with elevated CVR could benefit, particularly in the presence of active smoking or peripheral arterial disease.

Neurocognitive disorder in hypertensive patients. Heart-Brain Study.

The relation between hypertension and cognitive impairment is an undisputable fact. The aims of this study were to determine the prevalence of cognitive impairment in hypertensive patients, to identify the most affected cognitive domain, and to observe the association with different parameters of hypertension and other vascular risk factors. A multicentre study was carried out, and 1281 hypertensive patients of both genders and ≥21 years of age were included. Data on the following parameters were obtained: cognitive status (Minimal Cognitive Examination), behavioural status (Hospital Anxiety and Depression Scale), blood pressure, anthropometry, and biochemical profile. The average age was 60.2±13.5 years (71% female), and the educational level was 9.9±5.1 years. Global cognitive impairment was seen in 22.1%, executive dysfunction in 36.2%, and semantic memory impairment in 48.9%. Cognitive impairment was higher in males (36.8% vs. 30.06%) within both the 70-79-year-old and the ≥80-year-old (50% vs. 40%) age groups. Abnormal Clock Drawing Test results were related to high pulse pressure (p<0.0036), and abnormal Mini-Boston Naming Test results to both high systolic blood pressure (p<0.052) and pulse pressure (p<0.001). The treated/uncontrolled hypertensive group showed abnormal results both in the Mini Mental State Examination (OR, 0.73; p=0.036) and the Mini-Boston Naming Test (OR, 1.36; p=0.021). Among patients without cognitive impairment (MMSE >24), 29.4% presented executive dysfunction, and 41.5% semantic memory impairment. Cognitive impairment was higher in hypertensive patients than in the general population. Executive functions and semantic memory were the most affected cognitive domains. High systolic blood pressure and pulse pressure were associated with abnormal results in cognitive tests.

Estado nutricional y factores de riesgo vascular en pacientes ingresados en el Centro de Atención al Diabético de La Habana / Nutritional state and vascular risk factors of patients admitted to the Center of Diabetic Care in Havana

Introducción: la obesidad y la diabetes constituyen una asociación frecuente y letal, que a su vez, también se relacionan con otros factores que incrementan el riesgo cardiovascular. Objetivo: caracterizar el estado nutricional e identificar factores de riesgo vascular en personas con diabetes ingresadas en el Centro de Atención al Diabético de La Habana. Métodos: estudio descriptivo transversal. Se revisaron 1 916 historias clínicas, y las variables estudiadas fueron: tipo de diabetes, índice de masa corporal, circunferencia de la cintura, hipertensión arterial, tabaquismo, hipercolesterolemia, control glucémico y excreción urinaria de albúmina. Resultados: el 88,2 por ciento de los pacientes tenían diabetes tipo 2; de ellos, 74,5 por ciento eran sobrepeso u obesos, 62,5 por ciento tenían circunferencia de cintura incrementada, hipertensión el 67,2 por ciento, descontrol glucémico el 55,2 por ciento, hipercolesterolemia el 50,6 pr ciento, tabaquismo el 44,4 pore ciento y excreción urinaria de albúmina el 27,6 por ciento. El 11,8 por ciento tenía diabetes tipo 1, de ellos 66,4 por ciento eran normopesos; con descontrol glucémico 57,5 por ciento, con sobrepeso u obesidad 33,7 por ciento, con excreción urinaria de albúmina el 31,4 por ciento, con hipercolesterolemia el 29,9 por ciento, con tabaquismo el 28,7 por ciento, con hipertensión el 23,9 por ciento y el 21,2 por ciento tenía incrementada la circunferencia de la cintura. Conclusiones: la mayoría de los pacientes tenían diabetes tipo 2 y sobrepeso, con predominio de la obesidad abdominal. La asociación de varios factores de riesgo fue muy frecuente, independientemente del tipo de diabetes. Se deben diseñar estrategias efectivas para el tratamiento integral de la diabetes y los factores de riesgo asociados(AU)

Introduction: obesity and diabetes is a frequent and lethal association that, in turn, is related to other factors increasing the cardiovascular risks. Objective: to characterize the nutritional state and to identify vascular risk factors in diabetic persons who were admitted to the Center of Diabetic Care in Havana. Methods: cross-sectional and descriptive study that reviewed 1 916 medical histories and the studied variables were type of diabetes, body mass index, waist circumference, blood hypertension, smoking, hypercholesterolemia, glycemic control and urinary excretion of albumin. Results: in the study group, 88.2 percent of patients suffered type 2 diabetes, 74.5 percent of them was overweighed or obese; 62.5 percent had increased waist circumference; 67.2 percent were hypertensive; 55.2 percent had no glycemic control; 50.6 percent had hypercholesterolemia; 44.4 percent were smokers and 27.6 percent had urinary excretion of albumin. Type 1 diabetes was present in 11.8 percent ; 66.4 percent of the latter were normoweighed; 57.5 percent had no glycemic; 33.7 percent were overweighed or obese; 31.4 percent showed urinary excretion of albumin; 29.9 percent hypercholesterolemia; 28.7 percent were smokers and 23.9 percent hypertensive whereas 21.2 percent had increased waist circumference. Conclusions: most of patients had type 2 diabetes and overweight, with abdominal obesity. The association of several risk factors was very common, regardless of the type of diabetes. Effective strategies must be designed to treat diabetes and the associated risk factors in a comprehensive way(AU)

Estado nutricional y factores de riesgo vascular en pacientes ingresados en el Centro de Atención al Diabético de La Habana / Nutritional state and vascular risk factors of patients admitted to the Center of Diabetic Care in Havana

Introducción: la obesidad y la diabetes constituyen una asociación frecuente y letal, que a su vez, también se relacionan con otros factores que incrementan el riesgo cardiovascular. Objetivo: caracterizar el estado nutricional e identificar factores de riesgo vascular en personas con diabetes ingresadas en el Centro de Atención al Diabético de La Habana. Métodos: estudio descriptivo transversal. Se revisaron 1 916 historias clínicas, y las variables estudiadas fueron: tipo de diabetes, índice de masa corporal, circunferencia de la cintura, hipertensión arterial, tabaquismo, hipercolesterolemia, control glucémico y excreción urinaria de albúmina. Resultados: el 88,2 por ciento de los pacientes tenían diabetes tipo 2; de ellos, 74,5 por ciento eran sobrepeso u obesos, 62,5 por ciento tenían circunferencia de cintura incrementada, hipertensión el 67,2 por ciento, descontrol glucémico el 55,2 por ciento, hipercolesterolemia el 50,6 pr ciento, tabaquismo el 44,4 pore ciento y excreción urinaria de albúmina el 27,6 por ciento. El 11,8 por ciento tenía diabetes tipo 1, de ellos 66,4 por ciento eran normopesos; con descontrol glucémico 57,5 por ciento, con sobrepeso u obesidad 33,7 por ciento, con excreción urinaria de albúmina el 31,4 por ciento, con hipercolesterolemia el 29,9 por ciento, con tabaquismo el 28,7 por ciento, con hipertensión el 23,9 por ciento y el 21,2 por ciento tenía incrementada la circunferencia de la cintura. Conclusiones: la mayoría de los pacientes tenían diabetes tipo 2 y sobrepeso, con predominio de la obesidad abdominal. La asociación de varios factores de riesgo fue muy frecuente, independientemente del tipo de diabetes. Se deben diseñar estrategias efectivas para el tratamiento integral de la diabetes y los factores de riesgo asociados(AU)

Introduction: obesity and diabetes is a frequent and lethal association that, in turn, is related to other factors increasing the cardiovascular risks. Objective: to characterize the nutritional state and to identify vascular risk factors in diabetic persons who were admitted to the Center of Diabetic Care in Havana. Methods: cross-sectional and descriptive study that reviewed 1 916 medical histories and the studied variables were type of diabetes, body mass index, waist circumference, blood hypertension, smoking, hypercholesterolemia, glycemic control and urinary excretion of albumin. Results: in the study group, 88.2 percent of patients suffered type 2 diabetes, 74.5 percent of them was overweighed or obese; 62.5 percent had increased waist circumference; 67.2 percent were hypertensive; 55.2 percent had no glycemic control; 50.6 percent had hypercholesterolemia; 44.4 percent were smokers and 27.6 percent had urinary excretion of albumin. Type 1 diabetes was present in 11.8 percent ; 66.4 percent of the latter were normoweighed; 57.5 percent had no glycemic; 33.7 percent were overweighed or obese; 31.4 percent showed urinary excretion of albumin; 29.9 percent hypercholesterolemia; 28.7 percent were smokers and 23.9 percent hypertensive whereas 21.2 percent had increased waist circumference. Conclusions: most of patients had type 2 diabetes and overweight, with abdominal obesity. The association of several risk factors was very common, regardless of the type of diabetes. Effective strategies must be designed to treat diabetes and the associated risk factors in a comprehensive way(AU)

Cardiovascular risk factors, nonvalvular atrial fibrillation and retinal vein occlusion. / Factores de riesgo vascular, fibrilación auricular no valvular y obstrucción venosa retiniana.

OBJECTIVES: To analyse the importance of cardiovascular risk factors, ultrasound findings in the supra-aortic trunk and the presence of anticoagulated nonvalvular atrial fibrillation (NVAF) in patients with retinal vein occlusion (RVO) and in a control group. PATIENTS AND METHODS: A cross-sectional study was conducted of all patients with RVO consecutively referred to the office of internal medicine, comparing them with a control group. We analysed clinical, electrocardiographic and ultrasound variables. RESULTS: We studied 212 patients (114 men and 98 women) with RVO and 212 controls (95 men and 117 women) of similar ages. Arterial hypertension, dyslipidaemia and diabetes mellitus were significantly more prevalent in the patients with RVO than in the controls (73.6 vs. 50%, 64.6 vs. 48.6% and 27.8 vs. 12.3%, respectively). We observed arteriosclerotic lesions in the supra-aortic trunk in 55% of the patients with RVO. The patients with RVO and NVAF had a greater burden of cardiovascular risk factors than the controls with NVAF. There were no differences in terms of the international normalised ratio or in the use of direct anticoagulants between the cases and controls with NVAF. CONCLUSIONS: Cardiovascular risk factors (especially arterial hypertension) and arteriosclerotic involvement of the supra-aortic trunk are highly prevalent in RVO. Anticoagulation does not appear to be effective in preventing RVO.

[Pharmacological therapeutic intervention in mild cognitive impairment]. / Intervención terapéutica farmacológica del deterioro cognitivo leve.

Mild cognitive impairment (MCI) is a syndrome encompassing affective and behavioural symptoms and various subtypes. MCI is a heterogeneous clinical entity with varied causes (degenerative, vascular, psychiatric, non-neurological disorders), and there is wide variation in symptoms and clinical course. There are multiple causes and consequently various treatments can be applied and should be combined with non-pharmacological measures. This article describes both preventive and therapeutic pharmacological interventions: control of vascular risk factors, avoidance of iatrogeny, use of nutraceuticals, CDP-choline, and Ginkgo biloba EGb 761®, and improvement in sense organs.

[Patterns of detection of mild cognitive impairment in nursing]. / Patrones de detección del deterioro cognitivo leve en enfermería.

Mild cognitive impairment (MCI) is characterized by an acquired cognitive loss that places individuals, mainly older adults, in an intermediate stage between normal cognitive functioning and dementia. This impairment has a high risk of progression to dementia and is suitable for screening, which allows more effective early intervention. Nursing professionals, especially community-based primary care nurses, play an important role in the detection and follow-up of MCI and in interventions for this condition. The first step should be to take a thorough history from both the patient and his or her carers, which should assess the changes occurring in the patient's daily, family and social life through functional patterns. In subsequent assessment of cognitive function, brief screening tests can be used such as the Mini Mental State Examination (MMSE) or other similar tests. Special attention should be paid to the presence of affective or depressive symptoms, sensory deficits, polypharmacy, decompensated cardiovascular risk factors, and rapid functional deterioration, given their particular influence on MCI. Finally, various nurse-led, non-pharmacological interventions that are effective in MCI can be recommended, based on cardiovascular risk factor control, physical exercise, and cognitive and psychosocial interventions.

Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases. / ¿Se ha producido un cambio en la etiología del ictus isquémico en las últimas décadas? Análisis y comparación de una base de datos de ictus actual frente a las históricas.

OBJECTIVES: We aimed to determine whether the aetiology of ischaemic stroke has changed in recent years and, if so, to ascertain the possible reasons for these changes. PATIENTS AND METHODS: We analysed the epidemiological history and vascular risk factors of all patients diagnosed with ischaemic stroke at Complejo Hospitalario Universitario de Albacete (CHUA) from 2009 to 2014. Ischaemic stroke subtypes were established using the TOAST criteria. Our results were compared to data from the classic Stroke Data Bank (SDB); in addition, both series were compared to those of other hospital databases covering the period between the two. RESULTS: We analysed 1664 patients (58% were men) with a mean age of 74 years. Stroke aetiology in both series (CHUA, SDB) was as follows: atherosclerosis (12%, 9%), small-vessel occlusion (13%, 25%), cardioembolism (32%, 19%), stroke of other determined aetiology (3%, 4%), and stroke of undetermined aetiology (40%, 44%). Sixty-three percent of the patients from the CHUA and 42% of the patients from the SDB were older than 70 years. Cardioembolic strokes were more prevalent in patients older than 70 years in both series. Untreated hypertension was more frequent in the SDB (SDB = 31% vs CHUA = 10%). The analysis of other databases shows that the prevalence of cardioembolic stroke is increasing worldwide. CONCLUSIONS: Our data show that the prevalence of lacunar strokes is decreasing worldwide whereas cardioembolic strokes are increasingly more frequent in both our hospital and other series compared to the SDB. These differences may be explained by population ageing and the improvements in management of hypertension and detection of cardioembolic arrhythmias in stroke units.