[Influencia de la pandemia de la COVID-19 en la distribución de la bronquiolitis aguda en España.] / Influencia de la pandemia de la COVID-19 en la distribución de la bronquiolitis aguda en España.

OBJECTIVE: Bronchiolitis is the leading cause of hospitalization in children under one year of age, with annual epidemics. Since the onset of the SARS-CoV-2 coronavirus disease pandemic (COVID-19), there has been a change in the transmission of other respiratory viruses. Our aim in this paper was to describe how COVID-19 had affected the distribution of acute bronchiolitis in our country. METHODS: We conducted a retrospective descriptive study of the cases of bronchiolitis treated in a sample of Spanish hospitals belonging to four autonomous communities. A chi-square test and Student's t- test were used to compare epidemiological and demographic variables between patients attending the hospital with bronchiolitis during January 2021-June 2021 with patients attending the hospital in the previous three years (2018-2020). RESULTS: We analyzed 6,124 cases of bronchiolitis (58.8% males and 41.2% females). The mean age was 0.5 years (SD: 0.4). In 2020, we observed a decrease of bronchiolitis cases compared to 2019 of 67%. During 2020 and 2021, the epidemic season started in January-February and peaked in June. During the first half of 2021, the highest percentage of admissions for bronchiolitis associated with RSV infection was observed in hospitals in central Spain corresponding to the Autonomous Community of Madrid (78.5% of admissions). CONCLUSIONS: The COVID-19 pandemic significantly modifies the seasonality of bronchiolitis. In our country, the flow and distribution of the disease are not uniform. It starts in the center of Spain and ends on the coast.

OBJETIVO: La bronquiolitis es la primera causa de hospitalización en menores de un año, presentándose en forma de epidemias anuales. Desde el inicio de la pandemia por la enfermedad causada por el coronavirus SARS-CoV-2 (COVID-19) se ha producido un cambio en la transmisión de otros virus respiratorios. Nuestro objetivo en este trabajo fue describir cómo había afectado la pandemia de la COVID-19 a la distribución de la bronquiolitis aguda en nuestro país. METODOS: Realizamos un estudio descriptivo retrospectivo de los casos de bronquiolitis atendidos en una muestra de hospitales españoles que pertenecían a cuatro comunidades autónomas. Empleado el test chi-cuadrado y la prueba t de Student comparamos variables epidemiológicas y demográficas de los casos de bronquiolitis atendidos durante enero de 2021 y junio 2021, con los tres años anteriores (2018-2020). RESULTADOS: Analizamos 6.124 casos de bronquiolitis (58,8% varones y 41,2% mujeres). La media de edad fue de 0,5 años (DE: 0,4). En 2020 observamos un descenso de casos de bronquiolitis con respecto a 2019 del 67%. Durante 2020 y 2021 la temporada epidémica empezó en enero-febrero y alcanzó su pico máximo en junio. Durante el primer semestre de 2021, el porcentaje más elevado de ingresos por bronquiolitis asociados a infección VRS fue observado en hospitales del centro de España correspondientes a la Comunidad Autónoma de Madrid (78,5% de los ingresos). CONCLUSIONES: La pandemia por la COVID-19 modifica de manera significativa la estacionalidad de la bronquiolitis. En nuestro país, el flujo y distribución de la enfermedad no es uniforme, comenzado por el centro peninsular y, por último, la zona litoral.

Povidone-Iodine as a Pre-Procedural Mouthwash to Reduce the Salivary Viral Load of SARS-CoV-2: A Systematic Review of Randomized Controlled Trials.

The use of pre-procedural rinses has been investigated to reduce the number of viral particles and bacteria in aerosols, potentially decreasing the risk of cross-infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during medical and dental procedures. This review aims to confirm whether there is evidence in the literature describing a reduction in salivary load of SARS-CoV-2 when povidone-iodine (PVP-I) is used as a pre-intervention mouthwash. An search of the MEDLINE, Embase, SCOPUS, and the Cochrane library databases was conducted. The criteria used followed the PRISMA® Statement guidelines. Randomized controlled trials investigating the reduction of salivary load of SARS-CoV-2 using PVP-I were included. Ultimately, four articles were included that met the established criteria. According to the current evidence, PVP-I is effective against SARS-CoV-2 in saliva and could be implemented as a rinse before interventions to decrease the risk of cross-infection in healthcare settings.

[Cardiovascular prevention according to CEIPC: a critical appraisal]. / La prevención según el Comité Español Interdisciplinario para la Prevención Cardiovascular: una valoración crítica.

We present a critical appraisal of the adaptation to the 4th European Guidelines on Cardiovascular Disease Prevention in Clinical Practice carried out by The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention (CEIPC), which is based on: 1) the removal, by the CEIPC, of important restrictions on the start of drug therapy that are contained in the European guide 2) the existence of internal contradictions and differing recommendations regarding the goals of LDL in the several publications of the CEIP adaptation; and 3) and the almost total lack of necessary discussion about risk tables in Spain. Therefore, it makes a critical appraisal of some of the most important clinical recommendations shared by the CEIPC and the European guide that are not supported by clinical evidence, like the implicit proposal of using the estimated cardiovascular risk as a target for treatment, the criteria to begin the antihypertensive drug therapy and therapeutic goals for blood pressure, LDL-cholesterol and HbA1c. The public health administration and also the scientific society must ensure transparency and independence in the drafting of documents endorsed by them, including the management and declaration of potential conflicts of interest among editors and group members. The public health administration and also the scientific society must guarantee a framework of honesty and transparency in the documents endorsed by them, with a complete declaration of the authors conflict of interests.

Influencia de la pandemia dela COVID-19 en la distribución de la bronquiolitis aguda en España / Influence of the pandemic of COVID-19 in distribution of acute bronchiolitis in Spain

Fundamentos: La bronquiolitis es la primera causa de hospitalización en menores de un año, presentándose en forma de epidemias anuales. Desde el inicio de la pandemia por la enfermedad causada por el coronavirus SARS-CoV-2 (COVID-19) se ha producido un cambio en la transmisión de otros virus respiratorios. Nuestro objetivo en este trabajo fue describir cómo había afectado la pandemia de la COVID-19 a la distribución de la bronquiolitis aguda en nuestro país. Métodos: Realizamos un estudio descriptivo retrospectivo de los casos de bronquiolitis atendidos en una muestra de hospitales españoles que pertenecían a cuatro comunidades autónomas. Empleado el test chi-cuadrado y la pruebat de Student comparamos variables epidemiológicas y demográficas de los casos de bronquiolitis atendidos durante enero de 2021 y junio 2021, con los tres años anteriores (2018-2020). Resultados: Analizamos 6.124 casos de bronquiolitis (58,8% varones y 41,2% mujeres). La media de edad fue de 0,5 años (DE: 0,4). En 2020 observamos un descenso de casos de bronquiolitis con respecto a 2019 del 67%. Durante 2020 y 2021 la temporada epidémica empezó en enero-febrero y alcanzó su pico máximo en junio. Durante el primer semestre de 2021, el porcentaje más elevado de ingresos por bronquiolitis asociados a infección VRS fue observado en hospitales del centro de España correspondientes a la Comunidad Autónoma de Madrid (78,5% de los ingresos). Conclusiones: La pandemia por la COVID-19 modifica de manera significativa la estacionalidad de la bronquiolitis. En nuestro país, el flujo y distribución de la enfermedad no es uniforme, comenzado por el centro peninsular y, por último, la zona litoral.(AU)

Background: Bronchiolitis is the leading cause of hospitalization in children under one year of age, with annual epidemics. Sincethe onset of the SARS-CoV-2 coronavirus disease pandemic (COVID-19), there has been a change in the transmission of other respiratory viruses. Our aim in this paper was to describe how COVID-19 had affected the distribution of acute bronchiolitis in our country. Methods: We conducted a retrospective descriptive study of the cases of bronchiolitis treated in a sample of Spanish hospitals belonging to four autonomous communities. A chi-square test and Student’s t- test were used to compare epidemiological and demographicvariables between patients attending the hospital with bronchiolitis during January 2021-June 2021 with patients attending the hospital in the previous three years (2018-2020). Results: We analyzed 6,124 cases of bronchiolitis (58.8% males and 41.2% females). The mean age was 0.5 years (SD: 0.4). In 2020, weobserved a decrease of bronchiolitis cases compared to 2019 of 67%. During 2020 and 2021, the epidemic season started in January-February and peaked in June. During the first half of 2021, the highest percentage of admissions for bronchiolitis associated with RSVinfection was observed in hospitals in central Spain corresponding to the Autonomous Community of Madrid (78.5% of admissions).Conclusions: The COVID-19 pandemic significantly modifies the seasonality of bronchiolitis. In our country, the flow and distri-bution of the disease are not uniform. It starts in the center of Spain and ends on the coast.(AU)

Prevalence of aphthous stomatitis in patients with inflammatory bowel disease after the treatment with monoclonal antibodies: a systematic review and meta-analysis

Background: Currently, the most frequently employed therapies in the treatment of inflammatory bowel diseases (IBD), i.e., Crohn's Disease (CD), Ulcerative Colitis (UC) or unclassified IBD (IBD-U) are monoclonal anti-TNFs and anti-integrin therapies, such as vedolizumab (VDZ). Forty-seven per cent of these patients present extra-intestinal manifestations, the second most prevalent being aphthous stomatitis (AS). The present study aims to investigate which of the two therapies is associated with a lower prevalence of AS after treatment. Material and methods: An electronic search of the MEDLINE (via PubMed), Web of Science, SCOPUS, LILACS and OpenGrey databases was carried out. The criteria used were those described by the PRISMA Statement. The search was not temporarily restricted and was updated to January 2022. The quality assessment was analyzed using the JBI Prevalence Critical Appraisal Tool. Results: After searching, 7 studies were included that met the established criteria. Of these, 6 analysed the prevalence of AS in CD patients and 4 in UC. A total of 1,744 patients were analysed (CD=1,477 patients; 84.69%; UC=267; 15.31%). The greatest reduction in AS prevalence was observed after anti-TNF therapy. The effect of these therapies on the prevalence of AS in patients with IBD-U could not be determined. Conclusions: Both biologic therapies achieve a reduction in the prevalence of AS in IBD patients (CD and UC). However, the best results were obtained in patients treated with anti-TNFs, possibly because VDZ is often used in patients who do not respond adequately to previous treatment with anti-TNFs and because of its intestinal specificity. (AU)

[Blood pressure goals in diabetes. A critical appraisal]. / Objetivos del tratamiento antihipertensivo en la población diabética. Una revisión crítica.

In this article we review the evidence supporting the need to achieve a target blood pressure (BP) under 130-80 mm Hg in diabetic patients, as recent international guidelines recommend (JNC VII, ESH-ESC and ADA). We have analyzed the explicit arguments used in these guidelines, 3 clinical trials designed to determine which is the best BP in diabetics (HOT, UKPDS-38 and ABCD) as well as other potentially misleading clinical trials. In our opinion, neither these 3 specific clinical trials nor other trials quoted in the guidelines (due to results and methodology employed) can answer the question of the best goal of pharmacological treatment for hypertension in diabetics. On the other hand, international agreements are not sufficiently rigorous regarding both the sources mentioned and the direct interpretation of the data provided. We conclude that there is not enough evidence to support the goal pressure below 130/80 mm Hg in patients with diabetes. We insist in the need of individualization of therapy in patients and consider that a under 140/85 mm Hg goal pressure in diabetics is perfectly supported by current evidence.

La prevención cardiovascular según CEIPC: una valoración crítica / Cardiovascular prevention according to CEIPC: a critical appraisal

Se realiza una valoración crítica de la adaptación que ha realizadoel Comité Español Interdisciplinario para la Prevención Cardiovascular(CEIPC) de la Cuarta Guía Europea de Prevención Cardiovascularen la Práctica Clínica, que se fundamenta en: 1) la eliminaciónpor parte del CEIPC de importantes restricciones para el iniciodel tratamiento farmacológico que contiene la guía europea; 2) laexistencia de contradicciones internas y de distintas recomendacionesen las distintas publicaciones de la adaptación CEIPC respecto alos objetivos de LDL; y 3) la casi total ausencia de la necesaria discusiónsobre las tablas de riesgo en España. Además se realiza unavaloración crítica de algunas de las recomendaciones clínicas másimportantes que CEIPC y guía europea comparten y que no se sustentanen evidencias, como la propuesta implícita de la utilizacióndel riesgo cardiovascular estimado como objetivo de tratamiento, loscriterios de inicio del tratamiento farmacológico antihipertensivo ylos objetivos terapéuticos de presión arterial, LDL-colesterol yHbA1c. Sociedades científicas y Administración Pública han degarantizar la transparencia e independencia en la redacción de losdocumentos avalados por ellas, que incluya el manejo y declaraciónde los potenciales conflictos de interés de redactores y miembros degrupos(AU)

We present a critical appraisal of the adaptation to the 4th EuropeanGuidelines on Cardiovascular Disease Prevention in ClinicalPractice carried out by The Spanish Interdisciplinary Committee forCardiovascular Disease Prevention (CEIPC), which is based on: 1)the removal, by the CEIPC, of important restrictions on the start ofdrug therapy that are contained in the European guide 2) the existenceof internal contradictions and differing recommendations regardingthe goals of LDL in the several publications of the CEIP adaptation;and 3) and the almost total lack of necessary discussion about risktables in Spain. Therefore, it makes a critical appraisal of some of themost important clinical recommendations shared by the CEIPC andthe European guide that are not supported by clinical evidence, likethe implicit proposal of using the estimated cardiovascular risk as atarget for treatment, the criteria to begin the antihypertensive drugtherapy and therapeutic goals for blood pressure, LDL-cholesteroland HbA1c. The public health administration and also the scientificsociety must ensure transparency and independence in the drafting ofdocuments endorsed by them, including the management and declarationof potential conflicts of interest among editors and group members.The public health administration and also the scientific societymust guarantee a framework of honesty and transparency in the documentsendorsed by them, with a complete declaration of the authorsconflict of interests(AU)

Excesos clínicos de la conferencia de consenso sobre hipertensión arterial / Clinical over doing of consensus conference about hypertension

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Estatinas en prevención primaria: riesgo, objetivos, eficacia y evidencias / Statins on primary prevention: risk, objectives, efficacy, and evidence

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Reducir el riesgo cardiovascular en una tabla no equivale a reducir acontecimientos cardiovasculares / Reducing cardiovascular risk in a table is not equivalent to reducing cardiovascular events

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Objetivos del tratamiento antihipertensivo en la población diabética. Una revisión crítica / Blood pressure goals in diabetes. A critical appraisal

En este artículo se analizan las razones en las que se han apoyado las últimas versiones de los principales consensos internacionales sobre hipertensión arterial (JNC-VII, ESH-ESC) y diabetes (ADA) para recomendar como objetivo del tratamiento antihipertensivo en la población diabética cifras de presión arterial por debajo de 130/80 mmHg. Para ello se revisan tanto sus argumentos explícitos como, de una forma extensa, los 3 ensayos clínicos diseñados para estudiar este aspecto (HOT, UKPDS-38 y ABCD), así como otros ensayos a los que erróneamente se apela como apoyo. Como ilustración, se exponen también los argumentos ofrecidos en una selección de revisiones y de guías de práctica clínica. Del análisis de los 3 ensayos específicos, así como de los otros aducidos lateralmente en los consensos, se desprende que, por metodología y resultados, no ofrecen una respuesta óptima ni definitiva a la pregunta de cuál debe ser el objetivo del tratamiento farmacológico de la hipertensión en los diabéticos. Por otra parte, los grandes consensos internacionales no son suficientemente rigurosos ni en la cita de fuentes ni en la interpretación directa de los datos proporcionados por los estudios. En definitiva, de la lectura conjunta de ensayos y documentos puede concluirse que no existen evidencias que sustenten un cumplimiento rígido de la recomendación de situar la presión arterial en hipertensos diabéticos por debajo de 130/80 mmHg. Más bien hay que destacar la necesidad de individualizar el tratamiento y que son perfectamente acordes con las evidencias actuales una cifras de presión arterial inferiores a 140/85 mmHg, así como insistir en la flexibilidad de estos límites (AU)