High serum nitrates levels in non-survivor COVID-19 patients / Altas concentraciones séricas de nitratos en pacientes fallecidos por COVID-19

Objective: Higher blood nitrate and nitrite levels have been found in coronavirus disease 2019 (COVID-19) patients than in healthy subjects. The present study explores the potential association between serum nitrate levels and mortality in COVID-19 patients. Design: A prospective observation study was carried out. Setting: Eight Intensive Care Units (ICUs) from 6 hospitals in the Canary Islands (Spain). Patients: COVID-19 patients admitted to the ICU. Interventions: Determination of serum nitrate levels at ICU admission. Main variable of interest: Mortality at 30 days. Results: Non-surviving (n=11) compared to surviving patients (n=42) showed higher APACHE-II (p<0.001) and SOFA scores (p=0.004), and higher serum nitrate levels (p=0.001). Logistic regression analyses showed serum nitrate levels to be associated to 30-day mortality after controlling for SOFA (OR=1.021; 95%CI=1.006–1.036; p=0.01) or APACHE-II (OR=1.023; 95%CI=1.006–1.041; p=0.01). There were no differences in the area under the curve (AUC) for mortality prediction by serum nitrate levels (AUC=83%; 95%CI=73–92%; p<0.001), APACHE II (AUC=85%; 95%CI=75–96%; p<0.001) and SOFA (AUC=78%; 95%CI=63–92%; p=0.005) based on the DeLong method. The Kaplan–Meier analysis found patients with serum nitrates levels>68.4μmol/l to have a higher mortality rate (hazard ratio=138.8; 95%CI=22.3–863.9; p<0.001). Conclusions: The main novel finding was the association between serum nitrate levels and mortality in COVID-19 patients controlling for the SOFA or APACHE-II scores, though larger studies are needed to confirm this observation (AU)

Objetivo: Se han encontrado niveles más elevados de nitratos en la sangre de pacientes con enfermedad del coronavirus 2019 (COVID-19) que en sujetos sanos. Por lo tanto, el objetivo de estudio consistió en explorar la posible asociación entre los niveles séricos de nitratos y la mortalidad de pacientes por COVID-19. Diseño: Estudio observacional y prospectivo. Ámbito: Ocho unidades de cuidados intensivos (UCI) de 6 hospitales de las Islas Canarias (España). Pacientes: Pacientes COVID-19 ingresados en la UCI. Intervenciones: Se midieron los niveles séricos de nitratos al ingreso en la UCI. Variable de interés principal: Mortalidad a los 30 días. Resultados: Los pacientes fallecidos (n=11) comparados con los supervivientes (n=42) presentaron mayores APACHE-II (p<0,001), SOFA (p=0,004) y niveles séricos de nitratos (p=0,001). Los análisis de regresión logística mostraron una asociación entre los niveles séricos de nitratos al ingreso en la UCI y la mortalidad a los 30 días controlando por SOFA (OR:1.021; IC 95%:1.006-1.036; p=0,01) o APACHE-II (OR:1.023; IC 95%:1.006-1.041; p=0,01). No encontramos diferencias en el área bajo la curva (ABC) para la predicción de mortalidad entre los niveles séricos de nitratos (ABC:83%; IC 95%:73-92%; p<0,001), APACHE-II (ABC:85%; IC 95%:75-96%; p<0,001) y SOFA (ABC:78%; IC 95%:63-92%; p=0,005) con el método de DeLong. El análisis de Kaplan-Meier mostró que los pacientes que tenían niveles séricos de nitratos al ingreso en la UCI>68,4μmol/l presentaban mayor riesgo de fallecer (hazard ratio:138,8; IC 95%:22,3-863,9; p<0,001). Conclusiones: El principal nuevo hallazgo fue la asociación entre los niveles séricos de nitratos y la mortalidad de pacientes COVID-19 controlando por SOFA o APACHE-II; pero estudios de mayor tamaño muestral son necesarios para confirmar este resultado (AU)

High serum nitrates levels in non-survivor COVID-19 patients.

OBJECTIVE: Higher blood nitrate and nitrite levels have been found in coronavirus disease 2019 (COVID-19) patients than in healthy subjects. The present study explores the potential association between serum nitrate levels and mortality in COVID-19 patients. DESIGN: A prospective observation study was carried out. SETTING: Eight Intensive Care Units (ICUs) from 6 hospitals in the Canary Islands (Spain). PATIENTS: COVID-19 patients admitted to the ICU. INTERVENTIONS: Determination of serum nitrate levels at ICU admission. MAIN VARIABLE OF INTEREST: Mortality at 30 days. RESULTS: Non-surviving (n=11) compared to surviving patients (n=42) showed higher APACHE-II (p<0.001) and SOFA scores (p=0.004), and higher serum nitrate levels (p=0.001). Logistic regression analyses showed serum nitrate levels to be associated to 30-day mortality after controlling for SOFA (OR=1.021; 95%CI=1.006-1.036; p=0.01) or APACHE-II (OR=1.023; 95%CI=1.006-1.041; p=0.01). There were no differences in the area under the curve (AUC) for mortality prediction by serum nitrate levels (AUC=83%; 95%CI=73-92%; p<0.001), APACHE II (AUC=85%; 95%CI=75-96%; p<0.001) and SOFA (AUC=78%; 95%CI=63-92%; p=0.005) based on the DeLong method. The Kaplan-Meier analysis found patients with serum nitrates levels>68.4µmol/l to have a higher mortality rate (hazard ratio=138.8; 95%CI=22.3-863.9; p<0.001). CONCLUSIONS: The main novel finding was the association between serum nitrate levels and mortality in COVID-19 patients controlling for the SOFA or APACHE-II scores, though larger studies are needed to confirm this observation.

High serum nitrates levels in non-survivor COVID-19 patients.

OBJECTIVE: Higher blood nitrate and nitrite levels have been found in coronavirus disease 2019 (COVID-19) patients than in healthy subjects. The present study explores the potential association between serum nitrate levels and mortality in COVID-19 patients. DESIGN: A prospective observation study was carried out. SETTING: Eight Intensive Care Units (ICUs) from 6 hospitals in the Canary Islands (Spain). PATIENTS: COVID-19 patients admitted to the ICU. INTERVENTIONS: Determination of serum nitrate levels at ICU admission. MAIN VARIABLE OF INTEREST: Mortality at 30 days. RESULTS: Non-surviving (n=11) compared to surviving patients (n=42) showed higher APACHE-II (p<0.001) and SOFA scores (p=0.004), and higher serum nitrate levels (p=0.001). Logistic regression analyses showed serum nitrate levels to be associated to 30-day mortality after controlling for SOFA (OR=1.021; 95%CI=1.006-1.036; p=0.01) or APACHE-II (OR=1.023; 95%CI=1.006-1.041; p=0.01). There were no differences in the area under the curve (AUC) for mortality prediction by serum nitrate levels (AUC=83%; 95%CI=73-92%; p<0.001), APACHE II (AUC=85%; 95%CI=75-96%; p<0.001) and SOFA (AUC=78%; 95%CI=63-92%; p=0.005) based on the DeLong method. The Kaplan-Meier analysis found patients with serum nitrates levels>68.4µmol/l to have a higher mortality rate (hazard ratio=138.8; 95%CI=22.3-863.9; p<0.001). CONCLUSIONS: The main novel finding was the association between serum nitrate levels and mortality in COVID-19 patients controlling for the SOFA or APACHE-II scores, though larger studies are needed to confirm this observation.

Estimación de las proyecciones del cáncer de vejiga en España / Estimation of Bladder Cancer Projections in Spain

Introducción: Uno de los cánceres más frecuentes en el mundo es el de vejiga, que afecta según algunos autores a 5,4 millones de personas en los países más desarrollados. El objetivo de nuestro estudio es el de estimar las proyecciones del impacto de esta enfermedad en España, entre los años 2007 y 2022. Material y métodos: Se han utilizado los datos de mortalidad por cáncer de vejiga de la International Classification of Diseases 10th revision (ICD-10 C67) y los datos de la población entre1998 a 2007. Los datos fueron obtenidos del Instituto Nacional de Estadística (INE) español. La supervivencia relativa ha sido recogida del estudio EUROCARE. Se han estimado las proyecciones de incidencia, prevalencia y mortalidad mediante la utilización del programa estadístico Mortality-Incidence Analysis MODel (MIAMOD), y posteriormente, la regresión joinpoint que calcula el porcentaje anual de cambio (PAC).Resultados: Entre los años 1998 y 2022 se prevé en los varones una disminución de la prevalencia de 156,93 (tasa ajustada [TA] = 128,71) a 132,99 (TA = 84,68) casos por 100.000 habitantes/año en el año 2022. La tasa de incidencia disminuiría desde 30,2 (TA = 24,93) a 24,87 (TA = 15,88) y la mortalidad de 14,96 (TA = 12,25) a 12,08 (TA = 7,67). En las mujeres, se espera un incremento de la prevalencia de 21,18 (TA = 13,23) a 35,6 (TA = 21,46) casos por 100.000 habitantes/año. La incidencia de 4,8 (TA = 2,91) en 1998 a 7,79 (TA = 4,69), la mortalidad aumentará de 2,25 (TA = 1,32) a 3,37 (TA = 1,89) entre los años 1998 y 2022. En los varones, los PAC encontrados para la prevalencia, incidencia y mortalidad han sido respectivamente 0,69 (IC 95%:−6,9/8,9); 0,69 (IC 95%:−6,9/8,95) y−4,18 (IC 95%:−11,32/3,51), no son estadísticamente significativos. En las mujeres, el PAC para la prevalencia ha sido de−4,44 (IC 95%:−13,4/5,44) de 19,24 (IC 95%: 8,93/30,52) y de−3,28 (IC 95%:−20,26/17,20) para la mortalidad. Conclusiones: Debe de monitorizarse y a la vez prevenir este cáncer en función de los factores de riesgo controlables, especialmente en las mujeres. Conclusiones: Debe de monitorizarse y a la vez prevenir este cáncer en función de los factores de riesgo controlables, especialmente en las mujeres (AU)

Introduction: One of the most frequent cancers in the world is bladder cancer that affects, according to some authors, 5.4 million persons in the most developed countries. Our study has aimed to estimate the impact projections of this disease in Spain between 2007 and 2022. Material and methods: Mortality data for bladder cancer mortality was used International Classification of Diseases 10th revision (ICD-10 C67), and the population data from 1998 to 2007. The data were obtained from the National Institute of Statistics (INE). Relative survival was obtained form the EUROCARE study. The projections of incidence, prevalence, and mortality were estimated using the statistical program Mortality-Incidence Analysis MODel (MIAMOD) and after the joinpoint regression that calculates the Annual Percentage of Change (APC). Results: Between the years 1998 and 2022, it is foreseen that there will be a decrease in prevalence in the men, from 156.93 (adjusted rate AR=128.71) to 132.99 (AR=84.68) cases per 100,000 inhabitants/year in the year 2022. The incidence rate would decrease from 30.2 (AR=24.93) to 24.87 (AR=15.88) and mortality from 14.96 (AR=12.25) to 12.08 (AR=7.67). In women, an increase is expected in prevalence from 21.18 (AR=13.23) to 35.6 (AR=21.46) cases per 100.000 inhabitants/year. The incidence of 4.8 (AR=2.91) in 1998 to 7.79 (AR=4.69), Mortality will increase from 2.25 (AR=1.32) to 3.37 (AR=1.89) between the years 1998 and 2022.In men, the APCs found for prevalence, incidence and mortality were, respectively, 0.69 (95%CI%:−6.9/8.9); 0.69 (95% CI:−6.9/8.95) and−4.18 (95% CI:−11.32/3.51), these not being statistically significant. In women, the APC for prevalence was−4.44 (95% CI:−13.4/5.44). from 19.24 (95% CI: 8.93/30.52).and from−3.28 (95% CI:−20.26/17.20) for mortality. Conclusions: This cancer should be monitored and in turn prevented based on the controllable risk factors, especially in women (AU)

Estimation of bladder cancer projections in Spain.

INTRODUCTION: One of the most frequent cancers in the world is bladder cancer that affects, according to some authors, 5.4 million persons in the most developed countries. Our study has aimed to estimate the impact projections of this disease in Spain between 2007 and 2022. MATERIAL AND METHODS: Mortality data for bladder cancer mortality was used International Classification of Diseases 10th revision (ICD-10 C67), and the population data from 1998 to 2007. The data were obtained from the National Institute of Statistics (INE). Relative survival was obtained form the EUROCARE study. The projections of incidence, prevalence, and mortality were estimated using the statistical program Mortality-Incidence Analysis MODel (MIAMOD) and after the joinpoint regression that calculates the Annual Percentage of Change (APC). RESULTS: Between the years 1998 and 2022, it is foreseen that there will be a decrease in prevalence in the men, from 156.93 (adjusted rate AR=128.71) to 132.99 (AR=84.68) cases per 100,000 inhabitants/year in the year 2022. The incidence rate would decrease from 30.2 (AR=24.93) to 24.87 (AR=15.88) and mortality from 14.96 (AR=12.25) to 12.08 (AR=7.67). In women, an increase is expected in prevalence from 21.18 (AR=13.23) to 35.6 (AR=21.46) cases per 100.000 inhabitants/year. The incidence of 4.8 (AR=2.91) in 1998 to 7.79 (AR=4.69), Mortality will increase from 2.25 (AR=1.32) to 3.37 (AR=1.89) between the years 1998 and 2022. In men, the APCs found for prevalence, incidence and mortality were, respectively, 0.69 (95% CI%:-6.9/8.9); 0.69 (95% CI:-6.9/8.95) and -4.18 (95% CI:-11.32/3.51), these not being statistically significant. In women, the APC for prevalence was -4.44 (95% CI:-13.4/5.44). from 19.24 (95% CI:8.93/30.52).and from -3.28 (95% CI:-20.26/17.20) for mortality. CONCLUSIONS: This cancer should be monitored and in turn prevented based on the controllable risk factors, especially in women.

Estimación de las proyecciones de las tasas de incidencia, prevalencia y mortalidad por cáncer de próstata en Aragón (España) / Estimation of the Projections of Incidence Rates, Prevalence and Mortality Due to Prostate Cancer in Aragon (Spain)

Objetivo: El propósito de este estudio es proyectar la prevalencia de cáncer de próstata, las tasas de incidencia y la mortalidad durante el periodo de 15 años desde 2008 hasta 2022 para la región de Aragón, en España. Métodos: Mediante el programa MIAMOD se estimaron las proyecciones. La mortalidad por todas las causas y para el cáncer de próstata en el periodo de referencia, de 1998 a 2007, se obtuvieron del Instituto Nacional de Estadística. Resultados: Durante el periodo 2008 a 2022 las tasas de incidencia de cáncer de próstata por cada 100.000 habitantes disminuirán de 47,57 a 26,68 por 100.000 habitantes (tasas ajustadas 24,9 a 12,93) La mortalidad se reducirá de 21,89 a 11,73 (tasas ajustadas 10,89a 5,83) y la prevalencia de 277,07 casos por 100.000 habitantes a 125,09 (tasas ajustadas 165,54 a 63,41).Conclusiones: Estas proyecciones indican que la incidencia del cáncer de próstata y la mortalidad por la enfermedad disminuirá en Aragón (España) (AU)

Objective: The purpose of this study was to project prostate cancer prevalence, incidence rates and mortality over a 15-year period going from 2008 to 2022 for the Aragon region of Spain. Methods: The projections were calculated using the MIAMOD PROGRAM. All-cause mortality due to prostate cancer for the baseline period of 1998 to 2007 was obtained from the Spanish National Institute of Statistics. Results: The prostate cancer incidence rates for the period 2008 to 2022 per 100,000 persons are projected to decrease from 47.57 to 26.68/100,000 (adjusted rates 24.9 to 12.93). Mortality will decrease from 21.89 to 11.73 (adjusted rates 10.89 to 5.83) and prevalence from 277.07 cases/ 100,000 per year to 125.09 (adjusted rates 165.54 to 63.41). Conclusions: These projections indicate that the prostate cancer incidence and its mortality rate will decrease in Aragon (Spain) (AU)

[Estimation of the projections of incidence rates, prevalence and mortality due to prostate cancer in Aragon (Spain)]. / Estimación de las proyecciones de las tasas de incidencia, prevalencia y mortalidad por cáncer de próstata en Aragón (España).

OBJECTIVE: The purpose of this study was to project prostate cancer prevalence, incidence rates and mortality over a 15-year period going from 2008 to 2022 for the Aragon region of Spain. METHODS: The projections were calculated using the MIAMOD PROGRAM. All-cause mortality due to prostate cancer for the baseline period of 1998 to 2007 was obtained from the Spanish National Institute of Statistics. RESULTS: The prostate cancer incidence rates for the period 2008 to 2022 per 100,000 persons are projected to decrease from 47.57 to 26.68/100,000 (adjusted rates 24.9 to 12.93). Mortality will decrease from 21.89 to 11.73 (adjusted rates 10.89 to 5.83) and prevalence from 277.07 cases/ 100,000 per year to 125.09 (adjusted rates 165.54 to 63.41). CONCLUSIONS: These projections indicate that the prostate cancer incidence and its mortality rate will decrease in Aragon (Spain).

El cáncer en un área sanitaria / The incidence rates of cancer in a health area

INTRODUCCIÓN. El marco geográfico autonómico diseña áreas sanitarias en las que se puede realizar un análisis de salud con el fin de conocer sus necesidades. De acuerdo con ello, se ha estudiado el cáncer en el Área Sanitaria III de la provincia de Zaragoza ente 1998 y 2001. PACIENTES Y MÉTODOS. Se ha constituido un registro poblacional de cáncer del Área Sanitaria III de Zaragoza. Con estos datos se ha realizado un estudio epidemiológico descriptivo calculando las tasas de incidencia de cáncer. RESULTADOS. Las tasas de incidencia de cáncer para estos años ha sido de 471,9 (296,06 ajustada) por 100.000 habitantes, con 567 (317,3 ajustada) por 100.000 habitantes en hombres y 376,7 (215 ajustada) por 100.000 habitantes en mujeres. CONCLUSIONES. Las tasas de incidencia en esta zona son muy elevadas, y los resultados sugieren que es preciso mantener la campaña contra los cánceres dependientes del tabaco

INTRODUCCIÓN. The regional geographic frameworkhas health care areas in which health can be analyzed in orderto know their needs. In accordance with this, cancer incidencerates in health care area III of the province of Saragossa(Spain) were studied between the years 1998 and 2001.PATIENTS AND METHODS. As patients we used the casesof patients diagnosed with cancer in Health Area III inthe province of Saragossa obtained from the cancer registry.Then the incidence rates and adjusted rates of cancer werecalculated.RESULTS. The incidence rate of cancer for the years understudy was 471.9 (296.06 adjusted) per 100,000 inhabitants,with 567 (317.3 adjusted) per 100,000 for men and376.7 (215 adjusted) per 100,000 inhabitants for women.CONCLUSIONS. The incidence rates in this area are veryhigh. The results suggest that health education campaignsagainst tobacco-dependent cancers are needed (AU)

El comportamiento del cáncer por género. Su prevención / Behavior of cancer according to sex. Preventive measures

Propósito: Es conocido como el cáncer se distribuye de diferente manera entre el sexo masculino y femenino, sin embargo, poco se conoce en cuanto al Riesgo Relativo por la localización respecto a la incidencia y a la mortalidad. Objetivo: el objetivo de este trabajo es aportar los cálculos efectuados respecto al Riesgo Relativo (RR) Riesgo atribuible (RA) y Fracción etiológica del Riesgo (Fer) entre ambos sexos y para las distintas localizaciones del cáncer. Resultados: Los cánceres que representan un risgo evidente y alto en hombres respecto a mujeres (RR>2,50) son el cáncer de labio, esófago, laringe, pulmón, vejiga y localizaciones mal definidas. Conclusiones: La mayor parte de los cánceres en los que el género manifiesta más riesgo para el sexo masculino, son en nuestro medio debidos a factores de riesgo conocidos y evitables (AU)

[Delay in the diagnosis of cancer]. / Tiempos de demora en el diagnóstico del cáncer.

OBJECTIVE: A reduction in the time used to be able to diagnose an illness influences not only the well being of the patient but also the quality of the medical care. In this work, we have studied the amount of time needed to diagnose cancer. MATERIAL AND METHOD: Descriptive methods have been used: average, median, mode and standard deviation in order to know how long it takes to diagnose and treat cancer. The data have been taken from a hospital register. RESULTS: The longest time elapsed between the periods appears to be the one between the first symptoms and the date the diagnosis is made, which has been calculated to be 96 days on average. The remaining time periods studied showed a time lapse of about 26 days on median. DISCUSSION: The median has been taken as the measurement chosen to assess these time periods, which have been notably reduced in the last decade. CONCLUSIONS: The performance of the primary care doctor is of great importance, as he is normally the one who is faced with the precocious symptoms, as well as with the risk factors that persist in the patients. This doctor is therefore the one who can initiate both the early diagnosis and the medical education of the patients.

Tiempos de demora en el diagnóstico del cáncer / Delays In Cancer Diagnosis

Objetivo. El menor tiempo empleado en diagnosticar y tratar las enfermedades incide tanto en el bienestar del enfermo como en la calidad asistencial. En este trabajo se plantea el estudio de los tiempos de demora que intervienen en el diagnóstico del cáncer.Material y métodos. Se ha utilizado el método epidemiológico descriptivo y el análisis estadístico valorando: media, mediana, moda y desviación estándar, para medir los diferentes tiempos de demora. Los datos proceden de un registro hospitalario de cáncer, en el que habitualmente se recogen esos tiempos.Resultados. El mayor tiempo de demora entre los períodos considerados se estima que es el transcurrido entre los primeros síntomas y la fecha del diagnóstico de sospecha, que se estima en 96 días. Los restantes períodos de tiempo estudiados presentan una demora de alrededor de 26 días de mediana.Conclusiones. Es importante la actitud del médico de atención primaria, ya que habitualmente es quien se encuentra con los síntomas precoces, así como con los factores de riesgo persistentes en las personas. Por tanto, desempeña un papel muy importante en el diagnóstico precoz, a la vez que en la educación sanitaria de los pacientes. (AU)