Diabetic Sarcopenia. A proposed muscle screening protocol in people with diabetes : Expert document.

OBJECTIVES: To propose the grounds for "diabetic sarcopenia" as a new comorbidity of diabetes, and to establish a muscle screening algorithm proposal to facilitate its diagnosis and staging in clinical practice. METHOD: A qualitative expert opinion study was carried out using the nominal technique. A literature search was performed with the terms "screening" or "diagnostic criteria" and "muscle loss" or "sarcopenia" and "diabetes" that was sent to a multidisciplinary group of 7 experts who, in a face-to-face meeting, discussed various aspects of the screening algorithm. RESULTS: The hallmark of diabetic sarcopenia (DS) is muscle mass atrophy characteristic of people with diabetes mellitus (DM) in contrast to the histological and physiological normality of muscle mass. The target population to be screened was defined as patients with DM with a SARC-F questionnaire > 4, glycosylated haemoglobin (HbA1C) ≥ 8.0%, more than 5 years since onset of DM, taking sulfonylureas, glinides and sodium/glucose cotransporter inhibitors (SGLT2), as well as presence of chronic complications of diabetes or clinical suspicion of sarcopenia. Diagnosis was based on the presence of criteria of low muscle strength (probable sarcopenia) and low muscle mass (confirmed sarcopenia) using methods available in any clinical consultation room, such as dynamometry, the chair stand test, and Body Mass Index (BMI)-adjusted calf circumference. DS was classified into 4 stages: Stage I corresponds to sarcopenic patients with no other diabetes complication, and Stage II corresponds to patients with some type of involvement. Within Stage II are three sublevels (a, b and c). Stage IIa refers to individuals with sarcopenic diabetes and some diabetes-specific impairment, IIb to sarcopenia with functional impairment, and IIc to sarcopenia with diabetes complications and changes in function measured using standard tests Conclusion: Diabetic sarcopenia has a significant impact on function and quality of life in people with type 2 diabetes mellitus (T2DM), and it is important to give it the same attention as all other traditionally described complications of T2DM. This document aims to establish the foundation for protocolising the screening and diagnosis of diabetic sarcopenia in a manner that is simple and accessible for all levels of healthcare.

Malnutrition and sarcopenia worsen short- and long-term outcomes in internal medicine inpatients.

PURPOSE: This work aims to describe patients hospitalized in internal medicine wards in terms of nutrition and sarcopenia. It also seeks to evaluate short- and long-term mortality related to malnutrition and sarcopenia. METHODS: This cross-sectional study collected data on consecutive patients admitted to a single center's internal medicine ward. Patients were recruited in May and October 2021. Malnutrition was determined by the Mini-Nutritional Assessment-Short Form (MNA-SF) and sarcopenia by the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F scale) and handgrip strength test. Patients who were hospitalized for >48 hours were excluded. RESULTS: The sample included 619 patients with a mean ± SD age of 76.0 ± 14.8 years of which 50.6% were women. Patients were classified into three groups based on malnutrition: group 1 (MNA-SF 12-14 points) (no risk) included 158 patients, group 2 (MNA-SF 8-12 points) (high risk) included 233 patients, and group 3 (MNA-SF 0-7 points) (malnourished) included 228 patients. Malnourished patients had more dysphagia, significantly lower protein and albumin levels, and significantly higher inflammatory marker levels and pressure ulcers. In-hospital mortality was significantly higher in groups 2 and 3 (p < .00001). The worst outcome (mortality and readmissions or mortality) was more common among malnourished patients (p = .0001). Inflammation, comorbidity, and sarcopenia were most closely associated with negative outcomes. CONCLUSION: Malnutrition upon admission is associated with worse short- and long-term outcomes in internal medicine inpatients. Sarcopenia, multimorbidity, and inflammation-measured by albumin, C-reactive protein, or their ratios-are key risk factors. Early identification of malnutrition and sarcopenia through active screening is important in caring for internal medicine patients.

Impact of the COVID-19 pandemic on stress and sleep in emergency room professionals.

AIMS AND OBJECTIVES: To analyze stress levels, sleep quality, sleepiness and chronotypes on emergency room (ER) professionals before and during the COVID-19. BACKGROUND: ER healthcare professionals are exposed to high stress levels, and they often present with poor sleep quality. DESIGN: Observational study conducted into two different phases (before the COVID-19 and during the first wave of the COVID-19). METHOD: Physicians, nurses and nursing assistants working in the ER were included. Stress, sleep quality, daytime sleepiness and chronotypes were assessed by the Stress Factors and Manifestations Scale (SFMS), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Horne and Österberg Morningness-Eveningness questionnaire, respectively. The first phase of the study was performed between December 2019 and February 2020, and the second between April and June 2020. The STROBE checklist was used to report the present study. RESULTS: In total, 189 ER professionals in the pre-COVID-19 phase and 171 (of the initial 189) during COVID-19 were included. The proportion of workers with a morning circadian rhythm increased during the COVID-19, and stress levels were significantly higher during COVID-19 compared to the previous phase (38.34 ± 10.74 vs. 49.97 ± 15.81). ER professionals with poor sleep quality presented higher stress in the pre-COVID-19 phase (40.60 ± 10.71 vs. 32.22 ± 8.19) and during COVID-19 (55.27 ± 15.75 vs. 39.66 ± 9.75). Similarly, workers with excessive sleepiness had higher stress in the pre-COVID-19 phase (42.06 ± 10.95 vs. 36.64 ± 10.24) and during COVID-19 (54.67 ± 18.10 vs. 48.44 ± 14.75). Positive associations were also found between the SFMS and the PSQI, as well as with the ESS in both phases of the study. CONCLUSIONS: Emergency room professionals had increased stress levels during the COVID-19 pandemic. Stress was particularly higher in those with poor sleep quality or with excessive daytime sleepiness. RELEVANCE TO CLINICAL PRACTICE: These results should aim to impulse the implementation of measures to improve the working conditions of ER professionals.

Comorbidities and their implications in patients with and without type 2 diabetes mellitus and heart failure with preserved ejection fraction. Findings from the rica registry.

AIM: To determine if patients with heart failure and preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM) have a higher comorbidity burden than those without T2DM, if other comorbidities are preferentially associated with T2DM and if these conditions confer a worse patient prognosis. METHODS AND RESULTS: Cohort study based on the RICA Spanish Heart Failure Registry, a multicentre, prospective registry that enrols patients admitted for decompensated HF and follows them for 1 year. We selected only patients with HFpEF, classified as having or not having T2DM and performed an agglomerative hierarchical clustering based on variables such as the presence of arrhythmia, chronic obstructive pulmonary disease, dyslipidemia, liver disease, stroke, dementia, body mass index, haemoglobin levels, estimated glomerular filtration rate and systolic blood pressure. A total of 1934 patients were analysed: 907 had T2DM (mean age 78.4 ± 7.6 years) and 1027 did not (mean age 81.4 ± 7.6 years). The analysis resulted in four clusters in patients with T2DM and three in the reminder. All clusters of patients with T2DM showed higher BMI and more kidney disease and anaemia than those without T2DM. Clusters of patients without T2DM had neither significantly better nor worse outcomes. However, among the T2DM patients, clusters 2, 3 and 4 all had significantly poorer outcomes, the worst being cluster 3 (HR 2.0, 95% CI 1.36-2.93, P = .001). CONCLUSIONS: Grouping our patients with HFpEF and T2DM into clusters based on comorbidities revealed a greater disease burden and prognostic implications associated with the T2DM phenotype, compared with those without T2DM.

Cardiovascular risk assessment after one-year acute ischemic stroke based on uric acid levels and renal dysfunction. A clinical study.

BACKGROUND: The role of serum uric acid (SUA) after stroke is controversial and can be influenced by renal disease. AIM: to analyse the role of SUA in the acute phase of stroke based on the presence/absence of kidney disease and cardiovascular outcome. METHODS: Retrospective cohort of a stroke registry followed-up for one year. The sample was divided according to the presence of renal disease defined by haematocrit, urea and gender (HUGE) formula, along with a SUA cut-off point obtained by receiver operating characteristic curves based on SUA levels and on the primary end-point occurrence. RESULTS: 500 patients (268, 53.6% males) were analysed. Renal disease was present in 14.8% patients. The SUA cut-off for patients with renal disease was 404.46 µmol/L and 344.98 µmol/L for the remainder. Patients with higher SUA levels had decreased neurological disabilities (p = 0.04) and higher comorbidity (p = 0.00). Over a period of 42.3 (19) weeks, a primary end-point occurred in 17.4% patients. In the adjusted Cox model, SUA was associated with the primary end-point (HR 1.45, 95%CI 1.17-1.81, p = 0.01). Separated by the presence/absence of renal disease, SUA levels were associated with the primary endpoint for patients with renal disease (HR 1.29, 95%CI 1.06-1.58, p = 0.01) and for all other patients (HR 1.42, 95%CI 1.2-1.7, p = 0.00). CONCLUSIONS: We observed a relationship between SUA levels and a negative cardiovascular outcome after ischaemic stroke both in patients with and without renal disease, with the worst outcomes occurring in patients with renal insufficiency.

Relationship between sleep habits and academic performance in university Nursing students.

BACKGROUND: Sleep disorders are composed of a group of diseases of increasing prevalence and with social-health implications to be considered a public health problem. Sleep habits and specific sleep behaviors have an influence on the academic success of students. However, the characteristics of sleep and sleep habits of university students as predictors of poor academic performance have been scarcely analyzed. In the present study, we aimed to investigate sleep habits and their influence on academic performance in a cohort of Nursing Degree students. METHODS: This was a cross-sectional and observational study. An anonymous and self-administered questionnaire was used, including different scales such as the 'Morningness and Eveningness scale', an author-generated sleep habit questionnaire, and certain variables aimed at studying the socio-familial and academic aspects of the Nursing students. The association of sleep habits and other variables with poor academic performance was investigated by logistic regression. The internal consistency and homogeneity of the 'sleep habits questionnaire' was assessed with the Cronbach's alpha test. RESULTS: Overall, 401 students (mean age of 22.1 ± 4.9 years, 74.8 % females) from the Nursing Degree were included. The homogeneity of the 'sleep habits questionnaire' was appropriate (Cronbach's alpha = 0.710). Nursing students were characterized by an evening chronotype (20.2 %) and a short sleep pattern. 30.4 % of the Nursing students had bad sleep habits. Regarding the academic performance, 47.9 % of the students showed a poor one. On multivariate logistic regression analysis, a short sleep pattern (adjusted OR = 1.53, 95 % CI 1.01-2.34), bad sleep habits (aOR = 1.76, 95 % CI 1.11-2.79), and age < 25 years (aOR = 2.27, 95 % CI 1.30-3.98) were independently associated with a higher probability of poor academic performance. CONCLUSIONS: Almost 1/3 of the Nursing students were identified as having bad sleep habits, and these students were characterized by an evening chronotype and a short sleep pattern. A short sleep pattern, bad sleep habits, and age < 25 years, were independently associated with a higher risk of poor academic performance. This requires multifactorial approaches and the involvement of all the associated actors: teachers, academic institutions, health institutions, and the people in charge in university residences, among others.

Early biomarkers of diabetic kidney disease. A focus on albuminuria and a new combination of antidiabetic agents.

AIMS: We aimed to determine the efficacy and safety of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists to prevent worsening urinary albumin-to-creatinine ratio as an early biomarker of diabetes kidney disease. METHODS: A total of 178 patients with type 2 diabetes and obesity received combination treatment with SGLT2i added to GLP1ra (n = 76), GLP1ra added to SGLT2i (n = 50) or GLP1ra plus SGLT2i from start (n = 52), according to investigators´ best clinical judgement. Major outcomes assessed at 26 weeks were changes in urine albumintocreatinine-ratio (UACR), estimated glomerular filtration rate (eGFR), glycated haemoglobin, body weight and systolic blood pressure. RESULTS: All patients (58.6% men, mean age 61.9 ± 10.0 years) completed the study. Baseline HbA1c, weight and eGFR levels were 8.2 ± 0.9%, 109.9 ± 19 kg and 83.3 ± 19.6 mL/min/m2 , respectively. At 26 weeks, we found significant reductions in HbA1c (1.16%), weight (5.17 kg) and systolic blood pressure (8.13 mmHg). The reduction in UACR was 15.14 mg/g (95% CI 8.50-22.4) (-24.6 ± 64.7%), which was greatest in the group of patients with SGLT2i added on to GLP1ra therapy (116.7 mg/g; 95% CI: 54-296.5 mg/g; P < .001. Patients with urinary albumin-to-creatinine ratio ≥30 mg/g, showed a higher declines (63.18 mg/g [95% CI 44.5-104.99]) (-56 ± 65.9%). The greatest reduction in urinary albumin-to-creatinine ratio was obtained when SGLT2i was added to GLP1ra (116.7 mg/g). The eGFR did not significantly change along the study period. CONCLUSION: Our results show the beneficial effect of GLP1ra and SGLT2i combination therapy on early biomarkers of diabetes kidney disease such as albuminuria and in other significant outcomes for diabetes control.

Prognostic Role of Hyponatremia in Heart Failure Patients Depending on Renal Disease: Clinical Evidence.

AIM: Hyponatremia is very often associated with renal disease in patients with heart failure (HF) and, when present, determines a poor outcome. We investigated the role of hyponatremia in HF patients in whom the presence or absence renal insufficiency was accurately predefined. METHODS: This was a cohort study based on the Spanish National Registry on Heart Failure (RICA), a multicenter, prospective registry that enrolls patients admitted for decompensated HF who were subsequently followed up for 1 year. We classified patients into 4 groups according to the presence or absence of renal disease defined by the hematocrit, urea, and gender formula (HUGE) and then according to the presence of hyponatremia (Na ≤135 mEq/L). RESULTS: A total of 3,478 patients were included. Hyponatremia was more prevalent in the group with renal disease (22.1%) than without (18.4%). During admission, both groups with hyponatremia had more complications than those with normal serum sodium. During the 1-year follow-up, patients with hyponatremia and renal disease had a significantly worse outcome (HF mortality and readmission), HR 1.87, 95% CI 1.54-2.29, p < 0.001, compared to those with hyponatremia without renal disease, HR 1.01, 95% CI 0.79-1.3, p = 0.94. CONCLUSIONS: Hyponatremia is more prevalent in patients with renal insufficiency, and outcome is poorest when both renal disease and hyponatremia coexist. Patients with hyponatremia without renal disease show no differences in outcome compared to those without hyponatremia.

Association between serum uric acid and carotid disease in patients with atherosclerotic acute ischemic stroke.

AIM: The role of serum uric acid in ischemic stroke is controversial. On the one hand, it has a role as neuroprotectant in acute phase, but on the other hand, it may promote atherosclerosis in carotid arteries. Our aim is to investigate the association of serum uric acid levels at admission of acute ischemic stroke patients with carotid disease. METHODS: Cross-sectional study of patients admitted due to acute ischemic stroke. Clinical and laboratory variables were recorded. The carotid disease was defined based on the findings of carotid echography intima to media thickness and stenosis. Patients were grouped according to these findings. Robust statistical methods were applied into analysis. RESULTS: A total of 245 patients were recruited through a stroke registry. Their values of serum uric acid were related to both carotid intima to media thickness and stenosis showing a positive relationship between serum uric acid levels and intima to media thickness by Pearson correlation ( p < 0.05). Similarly, after adjusting for all potential confounders, eGFR, glucose, age and serum uric acid levels, (OR 1.26 (95% CI 1.04 -1.52, p»0.01), were identified as independent predictors for having a intima to media thickness ≥1 mm. Similarly, by grouping patients in tertiles of the serum uric acid distribution, we found a predominantly greater carotid disease in the tertile with the highest levels of serum uric acid ( p < 0.005). CONCLUSION: Our study supports the hypotheses that serum uric acid levels have different roles in the case of ischemic stroke. Its effects on the vascular wall contribute to the development of atherosclerosis and carotid disease.

A new tool to assess patients' comfort during hospitalization: The Hospital Discomfort Risk questionnaire.

AIM: We aimed to develop a tool for the assessment of the risk of patient discomfort in Spanish hospital wards. BACKGROUND: Several studies described tools to assess comfort but most are long and complex. METHODS: Cross-sectional study performed in three phases ((a) initial design; (b) refinement and psychometric testing; and (c) internal validation of the Hospital Discomfort Risk [HDR] questionnaire). RESULTS: A voluntary expert panel proposed the HDR questionnaire. Internal consistency and factorial analysis were investigated in 270 (53.7% men, mean age 57.33 ± 18.7 years) inpatients. Based on the Cronbach's α, three items were removed to the final 8-item version of the questionnaire. The HDR questionnaire showed a good predictive ability for identifying the risk of discomfort (c-index: .897, 95% CI 0.854-0.930; p < .001). CONCLUSIONS: The HDR questionnaire could be useful for identifying inpatients at risk of discomfort, but further prospective studies should externally validate these results. IMPLICATIONS IN NURSING MANAGEMENT: Nurses are the healthcare professionals with better access to patients and the first in identifying complications of hospitalization. Patients' discomfort could be routinely assessed during hospitalizations using the HDR questionnaire. Nurse managers should play an important role in this accomplishment, by promoting its use and knowledge among the nurse staff.

Serum uric acid levels and outcome during admission in acute ischaemic stroke, depending on renal function.

BACKGROUND: The relationship between serum uric acid (SUA) levels and stroke is controversial. The discrepancies in the results could be due to the uneven setting of comorbidity. It is known that hyperuricaemia increases in parallel with the decline in renal function; however, there are few studies that adjust for renal disease. AIM: To investigate the relationship between SUA levels in the acute phase of ischaemic stroke according to the presence or absence of chronic kidney disease and clinical outcomes during admission. METHODS: Retrospective cross-sectional analysis of patients recruited through a unicentric stroke registry. The sample was divided according to its quartiles of SUA. Renal disease was defined based on the haematocrit, urea and Gender (HUGE) formula. The outcome was determined by the National Institutes of Health Stroke Scale (NIHSS) score. Statistically robust methods were used with R (version 3.3.2). RESULTS: A total of 412 patients (53.8% male) were analysed. The NIHSS score decreased as the SUA levels increased (p < 0.0009). Robust linear regression analysis showed a significant association between quantitative SUA levels and NIHSS score (p < 0.0003), even when patients were categorized according to renal function (p < 0.05). In an adjusted multivariate model, SUA levels showed an independent protective effect on the severity of stroke (OR = 0.67, 95% CI 0.51-0.88, p = 0.004). CONCLUSIONS: Our results support the hypothesis that hyperuricaemia plays a protective role in the prognosis of stroke, independently from renal function, and that even in patients with chronic kidney disease, it remains as a protective agent.

Cerebral venous thrombosis with subarachnoid hemorrhage: a case report.

Cerebral venous thrombosis (CVT) presenting as subarachnoid hemorrhage (SAH) is infrequent. We present the case of a man with CVT of the right transverse sinus who presented with a SAH in the right parietal sinus. In this case, we describe a hyper-homocysteinemia in a heterozygous patient for the methylenetetrahydrofolate reductase C667T mutation. Our report highlights the value of an early diagnosis of CVT, the importance of identifying possible causes that could be reversed with an appropriate treatment, and the controversy about the timing for starting anticoagulation therapy in such cases.

Glycemic control and prescription profiles in internal medicine inpatients: The role of frailty.

AIM: This work aims to characterize the clinical profile of individuals with frailty syndrome, diabetes mellitus (DM), and hyperglycemia during hospitalization in regard to glycemic control and treatment regimen. METHODS: This cross-sectional multicentric study included patients with DM or hyperglycemia at admission. Demographic data, blood glucose values, treatment administered during hospitalization, and treatment indicated at discharge were analyzed. The sample was divided into three groups according to score on a frailty questionnaire. Generalized additive models were used to describe the relationship between either glycemic variability (GV) or minimum capillary blood glucose and hypoglycemia. Models were adjusted for age, comorbidity, and sarcopenia. RESULTS: A total of 1,137 patients were analyzed. Patients with frailty syndrome had more comorbidity and sarcopenia, worse renal function, and lower albumin and lymphocyte levels. A GV between 21% and 60% was related to a higher probability of hypoglycemia, especially in patients with frailty. Regarding minimum capillary blood glucose, patients with frailty had the highest probability of hypoglycemia. This probability remained significant even in the group with frailty in which, with a reference value of 200 mg/dl, the adjusted odds ratio of a minimum capillary blood glucose of 151 mg/dL was 1.08 (95% confidence interval (1.12-1.05)). Baseline treatments showed a significant predominance of insulin use in the frailest groups. CONCLUSIONS: Patients with frailty had more sarcopenia and undernourishment. These patients were managed in a similar manner during hospitalization to patients without frailty, despite their higher risk of hypoglycemia according to GV or minimum capillary blood glucose levels.

The two different profiles in heart failure with preserved ejection fraction and type 2 diabetes mellitus: ischemic and diabetic.

OBJECTIVE: Two profiles of patients with heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM) can be discerned: those with ischemic and those with diabetic cardiomyopathy (DMC). We aim to analyze clinical differences and prognosis between patients of these two profiles. MATERIAL AND METHODS: This cohort study analyzes data from the Spanish Heart Failure Registry, a multicenter, prospective registry that enrolled patients admitted for decompensated heart failure and followed them for one year. Three groups were created according to the presence of T2DM and heart disease depending on the etiology (ischemic when coronary artery disease was present, or DMC when no coronary, valvular, or congenital heart disease; no hypertension; nor infiltrative cardiovascular disease observed on an endomyocardial biopsy). The groups and outcomes were compared. RESULTS: A total of 466 patients were analyzed. Group 1 (n = 210) included patients with ischemic etiology and T2DM. Group 2 (n = 112) included patients with DMC etiology and T2DM. Group 3 (n = 144), a control group, included patients with ischemic etiology and without T2DM. Group 1 had more hypertension and dyslipidemia; group 2 had more atrial fibrillation (AF) and higher body mass index; group 3 had more chronic kidney disease and were older. In the regression analysis, group 3 had a better prognosis than group 1 (reference group) for cardiovascular mortality and HF readmissions (HR 0.44;95%CI 0.2-1; p = .049). CONCLUSIONS: Patients with T2DM and HFpEF, who had the poorest prognosis, were of two different profiles: either ischemic or DMC etiology. The first had a higher burden of cardiovascular disease and inflammation whereas the second had a higher prevalence of obesity and AF. The first had a slightly poorer prognosis than the second, though this finding was not significant.

Temporal trends on the prevalence of renal disease and outcomes among patients with diabetes mellitus hospitalized by heart failure: findings from INCAex.

BACKGROUND: To assess 20-year time trends in the prevalence of diabetes mellitus (DM) among inpatients with heart failure (HF) and the influence of coexisting DM and kidney disease (KD) on outcomes. RESEARCH DESIGN AND METHODS: A retrospective study of patients was admitted due to HF, during the period 2000/2019. The period of follow-up was divided into three intervals according to the European Medical Agency approval of newer hypoglycemic drugs. We analyzed in-hospital mortality and outcomes during the follow-up period. RESULTS: A total of 4959 patients were included. Over time, prevalence of DM was significantly raising among women with HF (50 to 53.2%) and descending among men (50% to 46.8%, p = 0.02). Total mortality and readmissions were higher in patients with DM during the and second periods. However, no significant differences were found in the third-one (HR 1.14, 95% CI 0.94-1.39, p = 0.181). A protector role of oral hypoglycemic medications was observed in this last period. According to the presence of KD, the patients with both DM and KD were who presented most of the events. CONCLUSIONS: Over the time analyzed, the prevalence of DM raised among women and decreased among men. DM influenced the prognosis of HF except in the third period when more protective hypoglycemic drugs started to be used.

Mean platelet volume in acute phase of ischemic stroke, as predictor of mortality and functional outcome after 1 year.

BACKGROUND: Mean platelet volume (MPV) could be a predictor of prognosis after ischemic stroke. Our aim is to investigate the association of MPV with a greater mortality and morbidity (defined as readmissions) after 1 year of follow-up in patients with acute stroke, and with a poor functional outcome in these patients. METHODS: Patients with ischemic stroke (N = 379) were recruited and assessed for an average of 46.27 weeks. MPV was measured at admission. The sample was divided in thirds according with the tertiles of distribution of MPV. Univariate and multivariate analysis were performed. RESULTS: The median (interquartile range) of MPV by third was 10 (0.7), 11(0.4), and 12 (0.8) fentoliters. Patients within highest third had a significant higher risk of either death or readmission (odds ratio 1.3; 95% confidence interval 1.00-1.7; P < .048) compared with patients within the lowest third. Functional outcome, defined as a modified Rankin Scale score of 3 to 6, was significantly higher (P < .0004) by greater third of MPV. CONCLUSIONS: MPV may be an easily available predictor for the prognosis in patients with acute ischemic stroke.

Approach to obesity in the elderly population: a consensus report from the Diabetes, Obesity and Nutrition Working Group of SEMI (Spanish Society of Internal Medicine).

Obesity in the elderly not only impacts morbidity and mortality but their quality of life. This phenomenon has sparked extensive research and debate regarding treatment recommendations, primarly due to the lack evidence in this specific population. When addressing possible treatment recommendations for older adults with obesity, it is crucial to assess certain essential aspects such as functional status, sarcopenia, cognitive status, and others. Intentional weight loss in this population can be both effective and safe. The best weight loss plan for the elderly revolves around adopting a healthy lifestyle, which includes following a Mediterranean diet pattern and engaging in physical exercise, particularly strength training. Additionally, the use of weight loss medications, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RA) and novel glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists, can provide an additional stage of treatment. In selective candidates, bariatric surgery may also be considered. The objective of this document is to propose a comprehensive algorithm of recommendations for the management of obesity in the elderly (above the age of 65), based on scientific evidence and the expertise of members from the Diabetes, Obesity, and Nutrition Workgroup of the Spanish Society of Internal Medicine.

[Decreased muscle mass in type-2 diabetes. A hidden comorbidity to consider]. / La masa muscular disminuida en la diabetes de tipo 2. Una comorbilidad oculta que debemos tener en cuenta.

Introduction: Objectives: an expert report is presented on the situation of loss of muscle mass in people with type 2 diabetes mellitus (T2DM), with a proposal of what the clinical approach to this comorbidity should be, based on the evidence from the literature and clinical experience. Method: a qualitative expert opinion study was carried out using the nominal approach. A literature search on diabetes and muscle was made and submitted to a multidisciplinary group of 7 experts who through a face-to-face meeting discussed different aspects of the role of muscle mass in T2DM. Results: muscle mass must be taken into account in the clinical context of patients with T2DM. It has an enormous impact on patient function and quality of life, and is as important as adequate metabolic control of T2DM. Conclusions: in addition to drug therapy and diet adjustments, aerobic and strength activities are essential for maintaining muscle mass and function in diabetic patients. In concrete situations, artificial oral supplementation specific for muscle care could improve the situation of malnutrition and low muscle mass. Measures such as the walking speed test, chair test, or the SARC-F questionnaire, together with the Barthel index, constitute a first step to diagnose relevant impairment requiring intervention in patients with T2DM. This document seeks to answer some questions about the importance, assessment, and control of muscle mass in T2DM.

Introducción: Objetivos: informe de expertos para valorar la realidad de la pérdida de masa muscular en las personas con diabetes mellitus 2 (DM2) y proponer, en base a la evidencia de la bibliografía y la experiencia clínica, cómo debería ser el abordaje clínico de esta comorbilidad. Método: estudio cualitativo de opinión de expertos mediante metodología nominal. Se realizó una búsqueda bibliográfica sobre diabetes y músculos que se remitió a un grupo multidisciplinar de 7 expertos que, en reunión presencial, discutieron sobre diversos aspectos del papel de la masa muscular en la DM2. Resultados: la masa muscular debe tenerse en cuenta dentro del cuadro clínico del paciente con DM2. Repercute enormemente sobre la funcionalidad y la calidad de vida del paciente y es tan importante como el adecuado control metabólico de la DM2. Conclusión: además de la terapia farmacológica y la dieta adaptada, es imprescindible un patrón de actividad física aeróbica y de fuerza para el mantenimiento de la masa y la función muscular en el paciente diabético. En situaciones particulares, una suplementación oral artificial específica para el cuidado del músculo podría mejorar la situación de desnutrición y baja masa muscular. Medidas como el test de la velocidad de marcha, el test de la silla o el cuestionario SARC-F, junto a un índice de Barthel, son un primer paso para diagnosticar un deterioro relevante sobre el que actuar en el paciente DM2. Este documento pretende resolver algunos interrogantes sobre la importancia, la valoración y el control de la masa muscular en la DM2.

Sleep analysis of hospital and out-of-hospital emergency professionals.

INTRODUCTION: Sleep deprivation is associated with poorer cognitive functioning and a greater risk of serious diseases. Herein, we analyzed differences in the quality of sleep and excessive daytime sleepiness between hospital emergency services and out-of-hospital emergencies services, and investigated its association with sociodemographic and labor variables. METHOD: This is a cross-sectional observational study carried out between April 2019 and February 2020, including healthcare professionals from different emergency departments, who were evaluated through the following instruments: "Pittsburgh Sleep Quality Index" and "Epworth Sleepiness Scale". RESULTS: Four-hundred and four healthcare professionals were included (mean age 40.4 ± 11.1 years), predominantly women (61.4%) from hospital emergency departments (62.6%). A total of 65.3% of the workers had poor sleep quality and 27.7% had excessive sleepiness. Women had poorer sleep quality (p = 0.022) and higher sleepiness (p = 0.010) than men. Hospital emergency workers presented 2-fold increased risk of poor sleep quality (OR = 1.93, p = 0.003) and sleepiness (OR = 1.93, p = 0.009) than out-of-hospital emergency workers. The more optimistic were less likely to have poor sleep quality (OR = 0.73, p = 0.01) or sleepiness (OR = 0.70, p = 0.002). Nurses, emergency medical technicians and nursing assistants also had a higher risk of poor sleep quality compared to physicians (OR = 1.60; p = 0.043). CONCLUSIONS: Emergency healthcare professionals working in hospital emergency departments had a two-times higher risk of poor sleep quality and sleepiness than out-of-hospital emergency healthcare professionals.