Women with familial hypercholesterolemia phenotype are undertreated and poorly controlled compared to men.

Familial hypercholesterolemia (FH) is an autosomal dominant disease that has a prevalence of approximately 1/250 inhabitants and is the most frequent cause of early coronary heart disease (CHD). We included 1.343.973 women and 1.210.671 men with at least one LDL-c measurement from the Catalan primary care database. We identified 14.699 subjects with Familial hypercholesterolemia-Phenotype (FH-P) based on LDL-c cut-off points by age (7.033 and 919 women, and 5.088 and 1659 men in primary and secondary prevention, respectively). Lipid lower therapy (LLT), medication possession ratio (MPR) as an indicator of adherence, and number of patients that reached their goal on lipid levels were compared by sex. In primary and secondary prevention, 69% and 54% of women (P = 0.001) and 64% and 51% of men (P = 0.001) were on low-to-moderate-potency LLT. Adherence to LLT was reduced in women older than 55 years, especially in secondary prevention (P = 0.03), where the percentage of women and men with LDL-c > 1.81 mmol/L were 99.9% and 98.9%, respectively (P = 0.001). Women with FH-P are less often treated with high-intensity LLT, less adherent to LLT, and have a lower probability of meeting their LDL-c goals than men, especially in secondary prevention.

Critical Presentation of a Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection: A Case Report.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections have been reported; however, most cases are milder than the primary infection. We report the first case of a life-threatening critical presentation of a SARS-CoV-2 reinfection. METHODS: A 62-year-old man from Palamós (Spain) suffered a first mild coronavirus disease 2019 (COVID-19) episode in March 2020, confirmed by 2 independent SARS-CoV-2 nasopharyngeal polymerase chain reaction (PCR) assays and a normal radiograph. He recovered completely and tested negative on 2 consecutive PCRs. In August 2020, the patient developed a second SARS-CoV-2 infection with life-threatening bilateral pneumonia and Acute respiratory distress syndrome criteria, requiring COVID-19-specific treatment (remdesivir + dexamethasone) plus high-flow oxygen therapy. Nasopharyngeal swabs from the second episode were obtained for virus quantification by real-time PCR, for virus outgrowth and sequencing. In addition, plasma and peripheral blood mononuclear cells during the hospitalization period were used to determine SARS-CoV-2-specific humoral and T-cell responses. RESULTS: Genomic analysis of SARS-CoV-2 showed that the virus had probably originated shortly before symptom onset. When the reinfection occurred, the subject showed a weak immune response, with marginal humoral and specific T-cell responses against SARS-CoV-2. All antibody isotypes tested as well as SARS-CoV-2 neutralizing antibodies increased sharply after day 8 postsymptoms. A slight increase of T-cell responses was observed at day 19 after symptom onset. CONCLUSIONS: The reinfection was firmly documented and occurred in the absence of robust preexisting humoral and cellular immunity. SARS-CoV-2 immunity in some subjects is unprotective and/or short-lived; therefore, SARS-CoV-2 vaccine schedules inducing long-term immunity will be required to bring the pandemic under control.

El rastreo masivo de datos es una segunda oportunidad para mejorar el manejo de los pacientes con fenotipo de hipercolesterolemia familiar / Massive data screening is a second opportunity to improve the management of patients with familial hypercholesterolemia phenotype

Introducción: La Hipercolesterolemia Familiar (HF) es una enfermedad autósómica dominante con una prevalencia estimada entre 1/200-250. Se encuentra infra-tratada e infra-diagnosticada. El rastreo masivo de datos puede incrementar la detección de pacientes con HF. Métodos: Población a estudio: Residentes en la zona sanitaria de cobertura (N: 195.000 habitantes) y con al menos una determinación de colesterol ligado a lipoproteínas de baja densidad (C-LDL) realizada entre el 1 de Enero de 2010 y el 30 de Diciembre de 2019. Se seleccionaron los valores más altos de C-LDL. Criterios de exclusión: síndrome nefrótico, hipotiroidismo, tratamiento hipotiroideo o triglicéridos > 400 mg/dL. Se analizaron 7 algoritmos sugestivos de fenotipo de Hipercolesterolemia Familiar (F-HF).Se seleccionó el algoritmo más eficaz y de fácil traslación a la práctica clínica. Resultados: Partiendo de 6.264.877 asistencias y 288.475 pacientes tras aplicar los criterios de inclusión-exclusión se incluyeron 504.316 analíticas correspondiendo a 106.382 adultos y 10.509 < 18 años. El algoritmo seleccionado presentó una prevalencia de 0.62%.Se detectaron 840 pacientes con fenotipo de Hipercolestereolemia Familiar (F-HF) siendo el 55.8% mujeres y 178 <18 años, El 9.3% tenían antecedentes de enfermedad cardio-vascular (ECV) y 16.4% habían fallecido. El 65% de los pacientes en prevención primaria presentaron valores de C-LDL >130 mg/dL y el 83% en prevención secundaria valores >70mg/dL. Se obtuvo una ratio de 7.64 (1-18) pacientes con HF-P por médico solicitante de analítica.Conclusiones: El rastreo masivo de datos y el perfilado de pacientes son herramientas eficaces y fácilmente aplicables en práctica clínica para la detección de pacientes con HF.(AU)

Introduction: Familial Hypercholesterolemia (FH) is an autosomal dominant disease with an estimated prevalence between 1/200-250. It is under-treated and underdiagnosed. Massive data screening can increase the detection of patients with FH. Methods: Study population: Residents in the health coverage area (N: 195.000 inhabitants) and with at least one determination of cholesterol linked to low-density lipoproteins (LDL-C) carried out between January 1, 2010 and December 30, 2019. The highest LDL-C values were selected. Exclusion criteria: nephrotic syndrome, hypothyroidism, Hypothyroid treatment or triglycerides> 400 mg / dL. Seven algorithms suggestive of Familial Hypercholesterolemia Phenotype (HF-P) were analyzed, selecting the most efficient algorithm that could easily be translated into clinical practice. Results: Based on 6.264.877 assistances and 288.475 patients, after applying the inclusion-exclusion criteria, 504.316 tests were included, corresponding to 106.382 adults and 10.509 <18 years. The selected algorithm presented a prevalence of 0.62%. 840 patients with HF-P were detected, 55.8% being women and 178 <18 years old, 9.3% had a history of cardiovascular disease (CVD) and 16.4% had died. 65% of the patients in primary prevention had LDL-C values> 130 mg / dL and 83% in secondary prevention values> 70mg / dL. A ratio of 7.64 (1-18) patients with HF-P per analytical requesting physician was obtained. Conclusions. Massive data screening and patient profiling are effective tools and easily applicable in clinical practice for the detection of patients with FH.

Massive data screening is a second opportunity to improve the management of patients with familial hypercholesterolemia phenotype. / El rastreo masivo de datos es una segunda oportunidad para mejorar el manejo de los pacientes con fenotipo de hipercolesterolemia familiar.

INTRODUCTION: Familial Hypercholesterolemia (FH) is an autosomal dominant disease with an estimated prevalence between 1/200-250. It is under-treated and underdiagnosed. Massive data screening can increase the detection of patients with FH. METHODS: Study population: Residents in the health coverage area (N: 195.000 inhabitants) and with at least one determination of cholesterol linked to low-density lipoproteins (LDL-C) carried out between January 1, 2010 and December 30, 2019. The highest LDL-C values were selected. EXCLUSION CRITERIA: nephrotic syndrome, hypothyroidism, Hypothyroid treatment or triglycerides> 400 mg / dL. Seven algorithms suggestive of Familial Hypercholesterolemia Phenotype (HF-P) were analyzed, selecting the most efficient algorithm that could easily be translated into clinical practice. RESULTS: Based on 6.264.877 assistances and 288.475 patients, after applying the inclusion-exclusion criteria, 504.316 tests were included, corresponding to 106.382 adults and 10.509 <18 years. The selected algorithm presented a prevalence of 0.62%. 840 patients with HF-P were detected, 55.8% being women and 178 <18 years old, 9.3% had a history of cardiovascular disease (CVD) and 16.4% had died. 65% of the patients in primary prevention had LDL-C values> 130 mg / dL and 83% in secondary prevention values> 70mg / dL. A ratio of 7.64 (1-18) patients with HF-P per analytical requesting physician was obtained. CONCLUSIONS: Massive data screening and patient profiling are effective tools and easily applicable in clinical practice for the detection of patients with FH.

Impacto teórico en la enfermedad coronaria de usar un sistema informatizado de ayuda en la prescripción del tratamiento hipolipemiante / Theoretical impact on coronary disease of using a computerized clinical decision support system in the prescription of lipid-lowering treatment

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[Prosthetic joint infection: a prospective study in five Catalonian hospitals]. / Infección de prótesis articulares: estudio prospectivo en 5 hospitales de Cataluña.

BACKGROUND: Prosthetic joint infections are a cause of increasing morbidity and medical expenditure. OBJECTIVES: To determine the incidence and the clinical and the epidemiological characteristics of knee and hip prosthetic infections (PI) in patients undergoing elective surgery in five Catalonian hospitals. To determine the predictive factors of PI. METHODS: A total of 425 patients operated on between 8 January and 8 July 2001 were prospectively followed for a period of two years. The cumulative incidence, incidence rate and effect measures were determined. Logistic regression was used to identify variables associated with PI. RESULTS: Average age was 71 years and 63.1% were women. Antibiotic prophylaxis with cefazolin was given to 44.7% of the patients, with a mean duration of two days. Prophylaxis was administered during anesthesia induction in 75.6% of the patients. Among the total, 63.4% of the patients were ASA 2. Microbiological confirmation was obtained in all the infected patients; Staphylococcus epidermidis was found in 58%. Fourteen PI were diagnosed, 71% during the first 3 months, with a cumulative incidence of 3.29% and a 3-month incidence rate of 63 patients/10,000 patients/month. Diabetes mellitus was the only variable related to PI in the multivariate analysis: 3.18, 95% CI (1.1-9.9). CONCLUSIONS: The cumulative incidence of PI was slightly higher than that seen in other studies. Variations were observed in the antibiotic used for prophylaxis, and the place where it was administered. PI occurred 3.18 times more frequently in diabetic patients.

Infección de prótesis articulares: estudio prospectivo en 5 hospitales de Cataluña / Prosthetic joint infection: A prospective study in five Catalonian hospitals

Antecedentes. Las infecciones de prótesis (IP) articulares son causa de morbilidad y aumento del gasto. Objetivos. Conocer la incidencia y características clínicas y epidemiológicas de las IP de cadera y rodilla, en pacientes intervenidos en cinco hospitales. Identificar factores predictores. Métodos. Se identificaron prospectivamente 425 pacientes intervenidos entre el 8 de enero y el 8 de julio de 2001. Se realizó un seguimiento de 2 años. Se determinaron la incidencia acumulada (IA), tasa de incidencia (TI) y medidas de efecto. Para identificar variables relacionadas con la IP se realizó una regresión logística. Resultados. La edad media fue de 71 años; el 63,1% fueron mujeres. En el 44,7% se realizó profilaxis antibiótica con cefazolina, con una duración media de 2 días. Se administró durante la inducción anestésica en el 75,6%. El 63,4% de los pacientes tenían un ASA 2. Se obtuvo confirmación microbiológica en todos, aislándose Staphylococcus epidermidis en el 58%. Se diagnosticaron 14 IP, 71% de ellas en el primer trimestre; con una IA acumulada a los 2 años del 3,29%, una tasa de incidencia a los 3 meses de 63 casos por 10.000 sujetos/mes de exposición. En el análisis multivariado la diabetes mellitus fue la única variable relacionada con la IP (OR: 3,18; IC 95%: 1,1-9,9). Conclusiones. La IA de la IP es algo superior que en otros estudios. Se evidencia una variabilidad en el antibiótico utilizado en la profilaxis y en el lugar de administración. La IP es 3,18 veces más frecuente en pacientes diabéticos (AU)

Background. Prosthetic joint infections are a cause of increasing morbidity and medical expenditure. Objectives. To determine the incidence and the clinical and the epidemiological characteristics of knee and hip prosthetic infections (PI) in patients undergoing elective surgery in five Catalonian hospitals. To determine the predictive factors of PI. Methods. A total of 425 patients operated on between 8 January and 8 July 2001 were prospectively followed for a period of two years. The cumulative incidence, incidence rate and effect measures were determined. Logistic regression was used to identify variables associated with PI. Results. Average age was 71 years and 63.1% were women. Antibiotic prophylaxis with cefazolin was given to 44.7% of the patients, with a mean duration of two days. Prophylaxis was administered during anesthesia induction in 75.6% of the patients. Among the total, 63.4% of the patients were ASA 2. Microbiological confirmation was obtained in all the infected patients; Staphylococcus epidermidis was found in 58%. Fourteen PI were diagnosed, 71% during the first 3 months, with a cumulative incidence of 3.29% and a 3-month incidence rate of 63 patients/10,000 patients/month. Diabetes mellitus was the only variable related to PI in the multivariate analysis: 3.18, 95% CI (1.1-9.9). Conclusions. The cumulative incidence of PI was slightly higher than that seen in other studies. Variations were observed in the antibiotic used for prophylaxis, and the place where it was administered. PI occurred 3.18 times more frequently in diabetic patients (AU)