Temporal trends and outcomes of heart transplantation in Spain (2002-2021): propensity score matching analysis to compare patients with and without type 2 diabetes.

BACKGROUND: The impact of Type 2 Diabetes (T2D) on the outcomes of heart transplantation (HT) has not yet been clearly established. The objectives of this study were to examine the trends in the prevalence of T2D among individuals who underwent a HT in Spain from 2002 to 2021, and to compare the clinical characteristics and hospitalization outcomes between HT recipients with and without T2D. METHODS: We used the national hospital discharge database to select HT recipients aged 35 and older. The International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10) were used to identify patients with and without T2D. We also recorded comorbidities, complications of HT, and procedures. Propensity score matching (PSM) and Cox regression were used to analyze the effect of T2D on in-hospital mortality (IHM). RESULTS: Between 2002 and 2021, a total of 4429 HTs (T2D, 19.14%) were performed in Spain. The number of HTs in patients with T2D decreased from 2002 to 2005 (n = 171) to 2014-2017 (n = 154), then rose during 2018-2021 (n = 186). Complications of HT increased in patients with and without T2D over the study period (26.9% and 31.31% in 2002-2005 vs. 42.47% and 45.01% in 2018-2021, respectively). The results of the PSM showed that pneumonia and Gram-negative bacterial infections were less frequent in patients with T2D and that these patients less frequently required hemodialysis, extracorporeal membrane oxygenation (ECMO), and tracheostomy. They also had a shorter hospital stay and lower IHM than patients without diabetes. The variables associated with IHM in patients with T2D were hemodialysis and ECMO. IHM decreased over time in people with and without T2D. The Cox regression analysis showed that T2D was associated with lower IHM (HR 0.77; 95% CI 0.63-0.98). CONCLUSIONS: The number of HTs increased in the period 2018-2021 compared with 2002-2005 in patients with and without T2D. Over time, complications of HT increased in both groups studied, whereas IHM decreased. The presence of T2D is associated with lower IHM.

Hospitalizations for Food-Induced Anaphylaxis Between 2016 and 2021: Population-Based Epidemiologic Study.

BACKGROUND: Food-induced anaphylaxis (FIA) is a major public health problem resulting in serious clinical complications, emergency department visits, hospitalization, and death. OBJECTIVE: This study aims to assess the epidemiology and the trends in hospitalizations because of FIA in Spain between 2016 and 2021. METHODS: An observational descriptive study was conducted using data from the Spanish National Hospital discharge database. Information was coded based on the International Classification of Diseases, Tenth Revision. The study population was analyzed by gender and age group and according to food triggers, clinical characteristics, admission to the intensive care unit, severity, and in-hospital mortality. The annual incidence of hospitalizations because of FIA per 100,000 person-years was estimated and analyzed using Poisson regression models. Multivariable logistic regression models were constructed to identify which variables were associated with severe FIA. RESULTS: A total of 2161 hospital admissions for FIA were recorded in Spain from 2016 to 2021. The overall incidence rate was 0.77 cases per 100,000 person-years. The highest incidence was found in those aged <15 years (3.68), with lower figures among those aged 15 to 59 years (0.25) and ≥60 years (0.29). Poisson regression showed a significant increase in incidence from 2016 to 2021 only among children (3.78 per 100,000 person-years vs 5.02 per 100,000 person-years; P=.04). The most frequent food triggers were "milk and dairy products" (419/2161, 19.39% of cases) and "peanuts or tree nuts and seeds" (409/2161, 18.93%). Of the 2161 patients, 256 (11.85%) were hospitalized because FIA required admission to the intensive care unit, and 11 (0.51%) patients died in the hospital. Among children, the most severe cases of FIA appeared in patients aged 0 to 4 years (40/99, 40%). Among adults, 69.4% (111/160) of cases occurred in those aged 15 to 59 years. Multivariable logistic regression showed the variables associated with severe FIA to be age 15 to 59 years (odds ratio 5.1, 95% CI 3.11-8.36), age ≥60 years (odds ratio 3.87, 95% CI 1.99-7.53), and asthma (odds ratio 1.71,95% CI 1.12-2.58). CONCLUSIONS: In Spain, the incidence of hospitalization because of FIA increased slightly, although the only significant increase (P=.04) was among children. Even if in-hospital mortality remains low and stable, the proportion of severe cases is high and has not improved from 2016 to 2021, with older age and asthma being risk factors for severity. Surveillance must be improved, and preventive strategies must be implemented to reduce the burden of FIA.

Effects of a recent volcanic eruption on the isolated population of the iconic red-billed chough in La Palma, Canary Islands.

The effects of volcanic eruptions on ecosystems, particularly on oceanic islands, have been widely studied because of their important role in land formation, climate patterns and biological processes. Although these phenomena can lead to habitat loss, population decline and even species extinction, their effects on isolated populations, especially vertebrates, are not fully understood due to the paucity of pre-eruption data and in situ observations. Here, we assess the impact of the recent eruption of the Tajogaite volcano in La Palma, Canary Islands, on a unique population of red-billed choughs (Pyrrhocorax pyrrhocorax), an emblematic bird species that symbolises the natural heritage of the island. Pre- and post-eruption surveys showed that the eruption did not significantly affect the overall size or distribution of the population, although the number of choughs decreased after the eruption in the northern and central roosts, and increased in the southern ones. Although the eruption resulted in the release of toxic gases and ash, the observed changes in chough distribution and numbers could be attributed to environmental variability and the use of different foraging areas by individuals rather than direct effects of the volcano. The high mobility of choughs may have allowed them to avoid the negative effects of the volcano in the immediate aftermath of the eruption. Future studies are recommended to assess the long-term effects of volcanic ash on feeding habitats and the possible accumulation of contaminants, such as heavy metals, in the food chain. This will allow not only to monitor the presence of these compounds in ecosystems, but also to understand the response of this species to environmental changes and ensure its conservation.

Early life movements and mortality of Egyptian vultures: Implications for transcontinental conservation.

Understanding the movements and mortality of individuals across different life stages is crucial for the effective conservation of wild populations. We used data from 32 Egyptian vultures (Neophron percnopterus) tagged with GPS transmitters as nestlings in three Iberian breeding areas to study their dependence period, migration routes, movements in Africa, and mortality at each stage. Our results show no significant differences in the timing of nest departure or the duration of the dependence period between individuals of different sexes or breeding nuclei. Most juveniles migrated to sub-Saharan Africa in their first year, but some (3 of 32, 9.4%) remained in the Iberian Peninsula. Individuals that migrated to Africa did so annually, while those remaining in Iberia never migrated to the Sahel, indicating distinct migratory and non-migratory strategies. Non-migratory individuals consistently moved northward during the breeding season to their natal territories. Siblings did not coordinate their migration strategy or timing. All juveniles showed extensive overlap in the vast areas used in Africa, where females arrived before males, and in the Iberian Peninsula. Our study also revealed that no juveniles died immediately after fledging, but that none of the tagged individuals lived more than 7 years or were recruited as breeders. Although most casualties occurred during the longer stay in the Sahel, the mortality rate was highest during the few days of the first migration. Our results show that despite small variations in movement patterns between breeding nuclei and sexes, Egyptian vultures face similar challenges during the years before recruitment as breeders, mostly determined by their migratory strategy. These findings are relevant for designing conservation strategies, both in breeding areas and, more importantly, in wintering areas and along migration pathways. Such strategies will significantly impact the entire Iberian population of this endangered species.

Clinical Characteristics and Outcomes of Patients Hospitalized with Epidermolysis Bullosa: A Retrospective Population-Based Observational Study in Spain (2016-2021).

(1) Background: Epidermolysis bullosa (EB) comprises a group of rare skin diseases. We assessed diagnostic procedures, comorbidity profiles, length of hospital stay (LOHS), costs, and in-hospital mortality (IHM) associated with EB. (2) Methods: A retrospective, population-based observational study was performed using the Spanish National Hospital Discharge Database. Hospitalized patients with EB in Spain were identified for the period 2016 to 2021. (3) Results: A total of 677 hospitalizations were identified among 342 patients with a diagnosis of EB. Fifty percent of patients had at least one readmission during the 6-year follow-up. Notably, rehospitalizations were more common among patients aged 2-17 years. The most prevalent comorbidity was digestive disorders, which were associated with the frequency of esophageal dilatation procedures and percutaneous endoscopic gastrostomy. The longest LOHS was recorded for the 0- to 1-year age group. IHM increased with age, and the difference was statistically significant. The prevalence of malignant neoplasm was 36.88%, with cutaneous squamous cell carcinoma being the most frequent. The overall cost per hospitalized patient was estimated to be EUR 10,895.22 (SD EUR 13,394.81), with significant variations between age groups. (4) Conclusions: Readmissions are very frequent among people with EB. We observed a higher LOHS in the 0- to 1-year age group, while the highest rates of IHM were observed in patients older than 50 years. There was a substantial prevalence of comorbidities, namely, digestive disorders, infectious diseases, and especially cancer.

Use of Cardiac Procedures in People with Diabetes during the COVID Pandemic in Spain: Effects on the In-Hospital Mortality.

We aimed to assess the effect of the COVID-19 pandemic in Spain on people with diabetes undergoing cardiac procedures, such as coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), open surgical valve replacement (OSVR), and transcatheter valve implantation (TCVI). We compared the year 2019 with the year 2020. We conducted an observational study using data from the Spanish National Hospital Discharge Database from 1 January 2019 to 31 December 2020. In 2020, a total of 21,067 cardiac procedures were performed on people with diabetes compared with 24,675 in the previous year. The use of CABG, PCI, OSVR and TCVI decreased from 2019 to 2020 by 13.9%, 14.8%, 21.4% and 2.9%, respectively. In 2020, patients had a significantly higher mean Charlson Comorbidity Index than in 2019 for all the cardiac procedures analyzed. In-hospital mortality (IHM) was higher (p > 0.05) for all the procedures in the year 2020. Over the entire period, female sex was a significant risk factor for IHM among those who underwent CABG, PCI and OSVR (OR 1.94, 95%CI 1.41-2.66; OR 1.19, 95%CI 1.05-1.35; and OR 1.79, 95%CI 1.38-2.32, respectively). The sensitivity analysis including two more years, 2017 and 2018, confirmed that female patients and comorbidity were risk factors for IHM in patients with diabetes regardless of whether it was during the pandemic era or before. We conclude that the frequency of cardiac procedures among people with diabetes declined in 2020. IHM did not change significantly in the COVID-19 era.

Trends and Outcomes in Lung Transplantation in Patients with and without Idiopathic Pulmonary Fibrosis in Spain during the Period 2016-2020.

(1) Background: This paper aims to assess temporal trends (2016-2020) in incidence, patient's characteristics, complications, length of hospital stay (LOHS) and in-hospital mortality (IHM) among patients with and without idiopathic pulmonary fibrosis (IPF) undergoing lung transplantation (LTx). We also analyse the effect of the COVID-19 pandemic on LTx in these populations. (2) Methods: A retrospective, population-based observational study was conducted using the Spanish National Hospital Discharge Database. Multivariable adjustment was conducted with logistic regression to analyse the IHM. (3) Results: We identified 1777 admissions for LTx during the study period, of which 573 (32.2%) were performed in patients with IPF. The number of hospital admissions for LTx rose from 2016 to 2020, both in patients with and without IPF, but a marked reduction was observed from year 2019 to year 2020. Over time, the proportion of single LTx decreased and bilateral LTx increased significantly in both groups. The incidence of LTx complications increased significantly over time along with the increase in the incidence of IPF. No significant differences in the incidence of complications or in the IHM between patients with and without IPF were found. Suffering any complication of the LTx and pulmonary hypertension were conditions positively associated with IHM in patients with and without IPF. The IHM remained stable from 2016 to 2020 in both study populations and was not affected by the COVID pandemic. (4) Conclusions: Patients with IPF account for almost a third of all lung transplants. The number of LTx increased over time in patients with and without IPF, but a marked reduction was observed from 2019 to 2020. Although the proportion of LTx complications increased significantly over time in both groups, the IHM did not change. IPF was not associated with increased complications or IHM after LTx.

Prevalence of Pain in COPD Patients and Associated Factors: Report From a Population-based Study.

OBJECTIVES: To assess the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and migraine among Spanish adults with chronic obstructive pulmonary disease (COPD) compared with non-COPD patients matched by age and sex; and to identify predictors for each of these types of pains among COPD sufferers. MATERIALS AND METHODS: A cross-sectional study conducted with data collected from the European Health Interview Surveys for Spain (EHSS) conducted in years 2009/2010 (n=22,188) and 2014 (n=22,842). Data were analyzed using multivariable logistic models. RESULTS: The prevalence of COPD among patients aged 35 years or above were 7.6% (n=1328) for the EHSS 2009 and 5.4% (n=1008) for the EHSS 2014. We matched 2251 COPD patients with age and sex controls. The prevalence of all types of pain were significantly higher among those suffering COPD than those without COPD. For CNP the figures were 40.5% versus 26.1%, for CLBP 44.8% versus 28.4%, and for migraine 22.5% versus 13.2%. Multivariable analysis showed that COPD was associated to a 1.21 (95% confidence interval [CI], 1.02-1.45) higher risk of CNP, 1.38 (95% CI, 1.16-1.64) of CLBP, and 1.36 (95% CI, 1.12-1.65) of migraine. Associated factors with the presence of these types of pain among COPD patients included younger age (not for CLBP), female sex (not for CLBP), "fair/poor/very poor" self-rated health (not for migraine), high blood pressure (not for CNP), mental disorders, obesity (not for migraine), and use of pain medication. DISCUSSION: The prevalence of CNP, CLBP, and migraine was significantly higher among COPD patients in comparison with controls. Associated factors to suffering these types of pain in patients with COPD included age, sex, self-rated health, certain comorbidities including mental disorders, obesity, and using pain medication.

Association of type 2 diabetes with in-hospital complications among women undergoing breast cancer surgical procedures. A retrospective study using the Spanish National Hospital Discharge Database, 2013-2014.

OBJECTIVES: To compare the type of surgical procedures used, comorbidities, in-hospital complications (IHC) and in-hospital outcomes between women with type 2 diabetes mellitus (T2DM) and age-matched women without diabetes who were hospitalised with breast cancer. In addition, we sought to identify factors associated with IHC in women with T2DM who had undergone surgical procedures for breast cancer. DESIGN: Retrospective study using the National Hospital Discharge Database, 2013-2014. SETTING: Spain. PARTICIPANTS: Women who were aged ≥40 years with a primary diagnosis of breast cancer and who had undergone a surgical procedure. We grouped admissions by T2DM status. We selected one matched control for each T2DM case. MAIN OUTCOME MEASURES: The type of procedure (breast-conserving surgery (BCS) or mastectomy), clinical characteristics, complications, length of hospital stay and in-hospital mortality. RESULTS: We identified 41 458 admissions (9.23% with T2DM). Overall, and in addition to the surgical procedure, we found that comorbidity, hypertension and obesity were more common among patients with T2DM. We also detected a higher incidence of mastectomy in women with T2DM (44.69% vs 42.42%) and a greater rate of BCS in patients without T2DM (57.58% vs 55.31%). Overall, non-infectious complications were more common among women with T2DM (6.40% vs 4.56%). Among women who had undergone BCS or a mastectomy, IHC were more frequent among diabetics (5.57% vs 3.04% and 10.60% vs 8.24%, respectively). Comorbidity was significantly associated with a higher risk of IHC in women with diabetes, independent of the specific procedure used.province CONCLUSIONS: Women with T2DM who undergo surgical breast cancer procedures have more comorbidity, risk factors and advanced cancer presentations than matched patients without T2DM. Mastectomies are more common in women with T2DM. Moreover, the procedures among women with T2DM were associated with greater IHC. Comorbidity was a strong predictor of IHC in women with T2DM.

[Metabolic factors in school children population associated with adult cardiovascular mortality. Four provinces' study]. / Factores metabólicos en la población escolar asociados a mortalidad cardiovascular en los adultos. Estudio Cuatro Provincias.

BACKGROUND: Environmental factors in early stages of life may contribute to adult cardiovascular disease. We have examined certain anthropometric and biochemical variables in children aged 6-7 years from four Spanish provinces with high differences in mortality due to ischemic heart disease (IHD). PATIENTS AND METHOD: We performed a cross-sectional survey of 1,255 children (50.3% males) attending schools in Cádiz and Murcia provinces with a relatively high IHD mortality and Madrid and Orense provinces with a relatively low IHD mortality. Weight, body mass index (BMI) and prevalence of obesity were analyzed, and plasma glucose and lipid levels were measured by standardized methods. RESULTS: Compared with children in the two low-IHD-mortality provinces, those in the two high-IHD-mortality provinces had greater weight (p < 0.05) and BMI (p < 0.01) and higher prevalence of obesity (p < 0.01). Moreover, they had significantly higher (p < 0.01) plasma glucose, triglyceride and apo A-I levels. CONCLUSIONS: The higher prevalence of overweight and obesity, along with higher plasma glucose and triglyceride levels, in provinces with high coronary artery disease mortality indicates that children from these provinces are metabolically different from those in provinces with low coronary artery disease mortality. These alterations may thus contribute to the different IHD mortality in adulthood.

[Coronary disease risk attributable to cardiovascular risk factors in the Spanish population]. / Riesgo coronario atribuible a los factores de riesgo cardiovascular en población española.

INTRODUCTION AND OBJECTIVES: The proportion of the ischemic heart disease (IHD) burden attributable to cardiovascular risk factors in Spain has traditionally been extrapolated from populations in other countries. The aim of this study was to estimate the IHD risk attributable to smoking, hypercholesterolemia, hypertension, diabetes and excess weight using data from studies carried out in the Spanish population. METHODS: Data on the prevalence of cardiovascular risk factors in the general population were obtained from a meta-analysis of 48 cross-sectional studies carried out in Spain, and data on corresponding prevalences among IHD patients were derived from the PRIAMHO II and PREVESE II multicenter hospital registries. Crude and adjusted relative risks of IHD were obtained from follow-up data collected over 5 years in a primary-care cohort of 6124 adults without cardiovascular disease. The crude and adjusted population attributable fractions for various risk factors were calculated for both sexes combined and for men and women separately. RESULTS: Among men, 42.5% (95% confidence interval [CI] 6.8%-59.6%) of the adjusted incidence of IHD was attributable to overweight, 33.9% (95% CI 22.6%-41.0%) to smoking, 19.4% (95% CI 8.2%-26.5%) to hypercholesterolemia, and 15.5% (95% CI 1.6%-24.6%) to hypertension. Among women, 36.5% (95% CI -8.0%-56.3%) of IHD cases were attributable to overweight, 24.8% (95% CI 12.0%-31.9%) to diabetes, and 20.1% (95% CI 6.1%-28.6%) to hypercholesterolemia. CONCLUSIONS: The cardiovascular risk factors found to contribute most to IHD in the Spanish population were excess weight in both sexes, followed by smoking in men.