Estado nutricional, obesidad y eventos en pacientes con fibrilación auricular / Nutrition status, obesity and outcomes in patients with atrial fibrillation

Introducción y objetivos Se ha descrito un efecto protector paradójico de la obesidad en pacientes con fibrilación auricular (FA) cuya mecanismo no está claro. El objetivo de este estudio fue determinar el impacto del estado nutricional y el índice de masa corporal (IMC) en el pronóstico de los pacientes con FA. Métodos Se realizó un estudio de cohortes retrospectivo de pacientes con FA entre 2014 y 2017 de una única área sanitaria en España. La escala CONUT se utilizó para evaluar el estado nutricional. La asociación del IMC y escala CONUT con la mortalidad se analizó por regresión de Cox. La asociación con eventos embólicos y hemorrágicos se evaluó mediante análisis de riesgos competitivos. Resultados Entre los 14.849 pacientes, se observó sobrepeso y obesidad en 42,6% y 46,0%, respectivamente, mientras que malnutrición en 34,3%. Durante un seguimiento medio de 4,4 años, 3.335 pacientes murieron, 984 pacientes sufrieron un evento embólico y 1.317 una hemorragia. El IMC se asoció inversamente con la mortalidad, embolias y hemorragias en el análisis univariado; sin embargo, esta asociación se perdió después del ajuste por edad, sexo, comorbilidades y escala CONUT (HR para el combinado de eventos 0,98; IC95%, 0,95-1,01; p=0,719). Por el contrario, la escala CONUT si se asoció con la mortalidad, la embolia y la hemorragia (HR = 1,15; IC95%, 1,14-1,17; p<0,001). Conclusiones El IMC no fue un predictor independiente de eventos en pacientes con FA, a diferencia del estado nutricional, que mostró una fuerte asociación con la mortalidad, la embolia y la hemorragia (AU)

Introduction and objectives A paradoxical protective effect of obesity has been previously reported in patients with atrial fibrillation (AF). The aim of this study was to determine the impact of nutritional status and body mass index (BMI) on the prognosis of AF patients. Methods We conducted a retrospective population-based cohort study of patients with AF from 2014 to 2017 from a single health area in Spain. The CONUT score was used to assess nutritional status. Cox regression models were used to estimate the association of BMI and CONUT score with mortality. The association with embolism and bleeding was assessed by a competing risk analysis. Results Among 14 849 AF patients, overweight and obesity were observed in 42.6% and 46.0%, respectively, while malnutrition was observed in 34.3%. During a mean follow-up of 4.4 years, 3335 patients died, 984 patients had a stroke or systemic embolism, and 1317 had a major bleeding event. On univariate analysis, BMI was inversely associated with mortality, embolism, and bleeding; however, this association was lost after adjustment by age, sex, comorbidities, and CONUT score (HR for composite endpoint, 0.98; 95%CI, 0.95-1.01; P=.719). Neither obesity nor overweight were predictors of mortality, embolism, and bleeding events. In contrast, nutritional status—assessed by the CONUT score—was associated with mortality, embolism and bleeding after multivariate analysis (HR for composite endpoint, 1.15; 95%CI, 1.14-1.17; P<.001). Conclusion BMI was not an independent predictor of events in patients with AF in contrast to nutritional status, which showed a strong association with mortality, embolism, and bleeding (AU)

Evaluación de los efectos de un dispositivo de entrenamiento de los músculos inspiratorios sobre la oxigenación muscular y la activación neuromuscular de los músculos respiratorios / [Evaluation of the effects of an inspiratory muscle training device on muscle oxygenation and neuromuscular activation of the respiratory muscles]

Objetivo: Comparar los cambios en la actividad electromiográfica y oxigenación muscular periférica de los músculos intercostales, en su condición de musculatura accesoria a la respiración, en pacientes con EPOC durante la realización de un test de marcha de 6 minutos (TM6M) con y sin el uso de un dispositivo FeelBreathe (FB).Material y métodos: Se seleccionaron a 20 sujetos diagnosticados de EPOC a los que se les realizaron dos TM6M separados al menos por 60 minutos. Aleatoriamente, cada uno de los pacientes realizó dos TM6M, uno usando el dispositivo FB y el otro sin FB (SFB) y se midieron durante la realización de ambos TM6M la actividad electromiográfica (EMG) obteniéndose la raíz de la media cuadrática (RMS), y por otro lado la oxigenación tisular de los músculos intercostales a través de la variable de oxihemoglobina (HbO2).Resultados: No hubo diferencias significativas en la distancia recorrida en ambos TM6M con FC a SFB. Tanto la RMS como la oxigenación tisular mostraron valores similares entre la condición FB vs. SFB al final de ambas pruebas (32,26 ± 101,94 μV vs 28,25 ± 87,02 μV; p = 0,16 y 70,63 ± 18,80 vs 70,74 ± 16,77; p = 0,975 respectivamente).Conclusiones: El estímulo de trabajo de la musculatura intercostal durante el TM6M con el dispositivo FB no compromete la aparición de la fatiga temprana por un exceso de activación o disminución de la oxigenación de dichos músculos al nivel de intensidad del TM6M. (AU)

Objective: To compare changes in electromyographic activity and peripheral muscle oxygenation of the intercostal muscles, in their condition as accessory muscles for respiration, in patients with COPD during a 6-minute walk test (6MWT) with and without the use of a FeelBreathe (FB) device.Material and methods: 20 subjects diagnosed with COPD who underwent two 6MTMs separated by at least 60 minutes were selected. Randomly, each of the patients underwent two 6MWT, one using the FB device and the other without FB (SFB) and electromyographic activity (EMG) was measured during the performance of both 6MWT, obtaining the root mean square (RMS), and on the other hand, tissue oxygenation of the intercostal muscles through the oxyhemoglobin (HbO2) variable.Results: There were no significant differences in the distance traveled in both 6MWT with HR to SFB. Both RMS and tissue oxygenation showed similar values between the FB condition vs. SFB at the end of both tests (32.26 ± 101.94 μV vs 28.25 ± 87.02 μV; p = 0.16 and 70.63 ± 18.80 vs 70.74 ± 16.77; p = 0.975 respectively).Conclusions: The work stimulus of the intercostal muscles during the 6MWT with the FB device does not compromise the appearance of early fatigue due to excessive activation or decreased oxygenation of these muscles at the intensity level of the 6MWT. (AU)

Caffeine attenuates liver damage and improves neurologic signs in a rat model of hepatic encephalopathy.

INTRODUCTION AND AIMS: Cirrhosis is the common outcome of liver diseases. It can be decompensated and lead to the development of complications, such as encephalopathy. Hyperammonemia that develops due to liver dysfunction is etiopathologically related to hepatic encephalopathy. Caffeine increases the activity of the urea cycle in the liver, augmenting ammonia degradation. By antagonizing adenosine receptors, it also has a hepatoprotective effect, impeding the formation of fibrosis, as well as having a stimulating effect on the central nervous system. The present study analyzed the effects of caffeine on the progression of cholestatic liver fibrosis and hepatic encephalopathy. MATERIALS AND METHODS: An experimental model of cholestatic liver fibrosis, through common bile duct ligature, and of hepatic encephalopathy, through the administration of a high-protein diet, was constructed. Male Wistar rats (n=32) were equally divided into 4 groups. The experiment lasted 28 days, with the administration of 50mg/kg/day of caffeine. Laboratory tests, histologic analyses of the liver and encephalon, open field tests (OFTs), and daily behavioral analyses were carried out. RESULTS: The ligated animals treated with caffeine had lower mean transaminase levels and improved histologic aspects of the liver and encephalon. The untreated ligated animals were clearly lethargic and apathetic at the last week of the experiment, confirmed by reduced exploratory activity during the OFT. CONCLUSION: Caffeine improved the microarchitecture of the liver and encephalon of the cirrhotic animals and prevented the decrease in exploratory behavior of the animals during the OFT.

Balance entre el efecto de los eventos embólicos frente a los hemorrágicos en la mortalidad de los pacientes ancianos con fibrilación auricular / Trade-off between the effects of embolic versus bleeding events on mortality in elderly patients with atrial fibrillation

Introducción y objetivos: La toma de decisiones clínicas sobre la anticoagulación de pacientes ancianos con fibrilación auricular (FA) requiere que se considere no solo la incidencia de eventos embólicos y hemorrágicos, sino también el riesgo de muerte tras esos efectos adversos. Nuestro objetivo es analizar el balance con respecto a la mortalidad entre los eventos embólicos y hemorrágicos en pacientes ancianos con FA. Métodos: Se analizó a todos los pacientes de 75 o más años de un área de salud española diagnosticados de FA entre 2014 y 2017 (n=9.365). El riesgo de muerte se estimó utilizando modelos de Cox que incluyeron los episodios embólicos y hemorrágicos como variables dependientes del tiempo. Resultados: Durante una mediana de seguimiento de 4,0 años, los eventos se asociaron con mayor mortalidad, tanto los embólicos (HR=2,39; IC95%, 2,12-2,69) como los hemorrágicos (HR=1,79; IC95%, 1,64-1,96). El riesgo de muerte fue un 33% mayor después de una embolia que después de una hemorragia (rRR=1,33; IC95%, 1,15-1,55), aunque con accidente isquémico transitorio el riesgo fue menor que con hemorragia (rRR=0,79; IC95%, 0,63-0,99). La mortalidad tras una hemorragia intracraneal fue similar que tras una embolia mayor (RR=1,00; IC95%, 0,75-1,29). Conclusiones: En los pacientes de edad avanzada con FA, los eventos embólicos parecen estar asociados con una mayor mortalidad que las hemorragias extracraneales, salvo los accidentes isquémicos transitorios. Con hemorragia intracraneal, el riesgo de muerte es similar al de una embolia mayor (AU)

Introduction and objectives: Clinical decision-making on anticoagulation in elderly patients with atrial fibrillation (AF) requires clinicians to consider not only the incidence of embolic and bleeding events, but also the risk of death following these adverse events. We aimed to analyze the trade-off between embolic and bleeding events with respect to mortality in elderly patients with AF. Methods: The study cohort comprised all patients aged ≥ 75 years from a Spanish health area diagnosed with AF between 2014 and 2017 (n=9365). The risk of death was investigated using Cox proportional hazards models, including embolic and bleeding events as time-dependent binary indicators. Results: During a median follow-up of 4.0 years, both embolic and bleeding events were associated with a higher risk of death (adjusted HR, 2.39; 95%CI, 2.12-2.69; and adjusted HR, 1.79; 95%CI, 1.64-1.96, respectively). The relative risk of death was 33% higher following an embolism than following a bleeding event (rRR, 1.33; 95%CI, 1.15-1.55), although for transient ischemic attack the risk was lower than for bleeding (rRR, 0.79; 95%CI, 0.63-0.99). The risk of death associated with intracranial hemorrhage was similar to that of major embolisms (RR, 1.00; 95%CI, 0.75-1.29). Conclusions: In elderly AF patients, embolic events appeared to be associated with a higher risk of mortality than extracranial bleeding, except for transient ischemic attacks, which have a better prognosis. For ICH, the mortality risk was similar to that of major embolism (AU)

Sun-related behaviors, attitudes and knowledge among paralympic sailors.

BACKGROUND: Overexposure to sunlight is the main cause of skin cancer. Outdoor sports increased sun exposure times. Sun protection behaviors and attitudes are utmost importance to reduce sun exposure. AIMS: To evaluate sun exposure habits, sun protection practices, and sun-related attitudes and knowledge among paralympic sailors. METHODS: This descriptive observational study analysed the answers of a validated self-reported questionnaire of habits, attitudes and knowledge related to sun exposure and skin cancer completed by 56 elite sailors with disabilities from 19 countries which taking part in 2019 Para World Sailing Championships. RESULTS: Three in four (76.8%) participants reported a history of sunburn in the previous season. Overall, participants showed an average for sport practice per week of 8.0 h (SD: 4.9). Participants reported a low adherence to sun protection practice, with the exception of using sunglasses (85.7%), sunscreen (83.9%) and hat (75%), having a very low rate (28.6%) of avoidance of midday sun and an inadequate sunscreen reapplication (33.9% reported "do not reapply" and 16.1% "reapply every one or 2 h"). Although 82.1% of participants reported to be worried about can get skin cancer out of the sun, they also presented excessive sun tanning attitudes (42.9% likes sunbathing and 57.1% sunbathing makes them feel well). The average score for sun-related knowledge was low (62.1 out 100 points; SD: 13.6). CONCLUSIONS: Awareness campaigns on sun risk are needed specifically directed at this target group, in order to improve their sun protection habits and reduce the rates of sunburn associated with sports practice.

Omalizumab for Severe Asthma: Beyond Allergic Asthma.

Different subsets of asthma patients may be recognized according to the exposure trigger and the frequency and severity of clinical signs and symptoms. Regarding the exposure trigger, generally asthma can be classified as allergic (or atopic) and nonallergic (or nonatopic). Allergic and nonallergic asthma are distinguished by the presence or absence of clinical allergic reaction and in vitro IgE response to specific aeroallergens. The mechanisms of allergic asthma have been extensively studied with major advances in the last two decades. Nonallergic asthma is characterized by its apparent independence from allergen exposure and sensitization and a higher degree of severity, but little is known regarding the underlying mechanisms. Clinically, allergic and nonallergic asthma are virtually indistinguishable in exacerbations, although exacerbation following allergen exposure is typical of allergic asthma. Although they both show several distinct clinical phenotypes and different biomarkers, there are no ideal biomarkers to stratify asthma phenotypes and guide therapy in clinical practice. Nevertheless, some biomarkers may be helpful to select subsets of atopic patients which might benefit from biologic agents, such as omalizumab. Patients with severe asthma, uncontrolled besides optimal treatment, notwithstanding nonatopic, may also benefit from omalizumab therapy, although currently there are no randomized double-blind placebo controlled clinical trials to support this suggestion. However, omalizumab discontinuation according to each patient's response to therapy and pharmacoeconomical analysis are questions that remain to be answered.

Efectos del entrenamiento de la musculatura respiratoria sobre el rendimiento. Revisión bibliográfica / Effects of respiratory muscles training on performance. Literature review

Actualmente, es aceptado por la comunidad científica que el sistema respiratorio puede limitar el ejercicio en personas con enfermedad pulmonar y/o cardiovascular. El objetivo del presente artículo es la revisión de algunos estudios realizados en relación al papel limitante del sistema respiratorio en el rendimiento físico de deportistas. Se realiza una breve descripción técnica de los dispositivos más utilizados para el entrenamiento de la musculatura respiratoria. Finalmente, se presentan los resultados más representativos, obtenidos por diversos investigadores y en distintas poblaciones, relacionados con el entrenamiento de la musculatura respiratoria y sus efectos en el rendimiento físico. Los resultados obtenidos en las distintas investigaciones consultadas sobre el entrenamiento de los músculos respiratorios son dispares, puesto que algunos han mostrado mejoras significativas, mientras otros no han mostrado grandes efectos en el rendimiento. En todos ellos se refleja cómo el sistema respiratorio es un factor limitante del rendimiento físico en deportistas y es preciso plantearse nuevas metodologías, protocolos y planificaciones en el entrenamiento deportivo. El entrenamiento de los músculos respiratorios, tanto mediante dispositivos umbral, de resistencia, o isocapnica, puede provocar mejoras en valores como la presión inspiratoria máxima y mejoras en el rendimiento de algunos deportes; sin embargo, son muy escasos los estudios que han encontrado mejoras en el consumo máximo de oxígeno (VO2max). Las discrepancias entre los estudios analizados pueden estar provocadas por diferencias en las intensidades y duración de los ejercicios utilizados, así como por diferencias en el diseño experimental y el nivel de condición física de los sujetos(AU)

It is currently accepted by the scientific community that the respiratory system may limit the exercise in people with lung disease and / or cardiovascular disease. The aim of this study is to review some studies about the limiting role of the respiratory system in the physical performance of athletes and the breath factors that can limit it. We make a brief technical description of the devices used for respiratory muscle training. Finally, we present the most representative results obtained by different researchers in different populations, related to respiratory muscle training and its effects on physical performance. Results obtained in different studies about respiratory muscles training are uneven as some have shown significant improvements, while others have shown no major effects on the performance. All of them reflect that respiratory system is a limiting factor in the physical performance of athletes and it is necessary to consider new methodologies, protocols and plans in sports training. Respiratory muscles training, either by a threshold device, resistance, or isocapnic, may cause improvements in the values of maximum inspiratory pressure and improvements in some sports performance, however, very few studies have found improvements in peak oxygen consumption. Disagreements between the analyzed studies may be caused due to differences in intensity and duration of the exercises used in the tests, as well as by differences between the experimental design and the physical fitness level of subjects(AU)

Hallazgo casual de vena cava superior izquierda persistente / No disponible

No disponible

The assessment of energy demand in the new Olympic windsurf board: Neilpryde RS:X.

The aim of this study was to evaluate the energy demands of sailing the new Neilpryde RS:X Olympic windsurf board. Ten skilled male subjects performed an exhaustive incremental treadmill test to determine their maximal physiological parameters. Thereafter, four tests were performed in a randomised order using two wind conditions, light [2-4 ms(-1) (4-8 knots)] and strong: [9-11 ms(-1)(16-22 knots)]. Oxygen consumption (VO2, ml min(-1) kg(-1)), blood lactate concentration ([la](b), mmol l(-1)), and time spent pumping (% total time) were recorded during 10 min of up-wind leg and during 6 min of down-wind leg. The results indicate that sailing on RS:X is associated with a high level of energy demand using both aerobic and anaerobic pathways whatever the wind conditions. During the down-wind leg, VO2, (ml min(-1) kg(-1)), [la](b) (mmol l(-1)), and time spent pumping (% total time) values for the light and strong wind conditions were 56.5 +/- 5.9 versus 55.5 +/- 3.6; 10.2 +/- 1.5 versus 9.6 +/- 2.3, and 69 +/- 5 versus 64 +/- 2%, respectively. In contrast, during up-wind leg the same parameters for light and strong wind were 53.9 +/- 4.5 versus 40.4 +/- 7.2; 9.7 +/- 2.8 versus 5.0 +/- 2.7 and 66 +/- 3 versus 37 +/- 8%, respectively. During the up-wind leg with strong wind conditions, less time was spent pumping (p < 0.05), mean oxygen consumption values were close to 60% VO2max and post-exercise blood lactate was less than 50% maximal lactate concentration. These results could be related to the time spent in pumping action, involving whole body activity. When sailing with the RS:X board, the physiological demand seems to be higher than with the previous official Olympic windsurf board [Mistral One Design (MOD)]. This difference could be mainly attributed to the specific biomechanical constraints induced by each board characteristic.

[Rhodococcus equi pneumonia in patients with AIDS]. / Pneumonia a Rhodococcus equi em doentes com SIDA.

Rhodococus equi infection is frequent in animals, but rare in humans. It usually appears as an opportunistic infection, occurring in clinical settings where a compromise of cellular immunity exists, such as in leukemia, neoplastic or transplanted patients. It is currently considered, as another opportunistic AIDS infection. Sixty six cases of Rhodococus equi pneumonia have been published until March 1996. The differential diagnosis includes TB and Staphyloccocal Pneumonia and is generally an infection which is difficult to treat, often resistant to Betalactamic drugs. Therapeutic options include an association of intracellular active antibiotics. The authors report the first Rhodococus equi pneumonia diagnosed in their Hospital and discuss the main difficulties in the diagnostic and therapeutic approach.

Effect of large doses of methylprednisolone on supratentorial intracranial tumors. A clinical and CAT scan evaluation.

We studied the action of high doses (500 mg/daily for 7 days) of methylprednisolone sodium succinate in 12 patients with supratentorial intracranial tumors. 10 tumors were malignant (5 gliomas and 5 metastases), and 2 benign (meningiomas). Clinical improvement ranged from moderate to marked after 24-48 h of therapy. In the 5 metastases, mean reduction of peritumoral edema was 27%, and in apparent tumor volume was 18%; in the gliomas, corresponding reductions were 31 and 15%. 1 of the meningioma cases showed a decrease in edema volume of 21%. These results indicate that methylprednisolone, at least for a short period of time, produces a definite decrease in apparent tumor size, in addition to the reduction of peritumoral edema.

Aspectos neuroquirurgicos y neuroendocrinos de las estenosis acueductales. / Neurosurgical and neuroendocrine aspects of the acqueduct stenosis

Se destaca la importancia del sindrome neurologico-neuroendocrino y neuroquirurgico de las estenosis acueductales, tratando de establecer un plan terapeutico racional a traves de la derivacion del LCR ya sea ventriculo-peritoneal por valvula o ventriculo-cisternal con la tecnica de Torkildsen, o la posibilidad de perforar el piso del 3er. ventriculo, acto seguido de una ventriculografia. La recuperacion de la funcion gonadal del hombre y de la mujer se logra con la resolucion del sindrome de hipertension endocraneana ya que el agrandamiento del 3er. ventriculo desplazaria. Uno de nuestros casos era una mujer que embarazo 6 anos despues de tratada con normalizacion de las estructuras ventriculares controladas por tomografia computada

Aspectos neuroquirurgicos y neuroendocrinos de las estenosis acueductales. / Neurosurgical and neuroendocrine aspects of the acqueduct stenosis

Se destaca la importancia del sindrome neurologico-neuroendocrino y neuroquirurgico de las estenosis acueductales, tratando de establecer un plan terapeutico racional a traves de la derivacion del LCR ya sea ventriculo-peritoneal por valvula o ventriculo-cisternal con la tecnica de Torkildsen, o la posibilidad de perforar el piso del 3er. ventriculo, acto seguido de una ventriculografia. La recuperacion de la funcion gonadal del hombre y de la mujer se logra con la resolucion del sindrome de hipertension endocraneana ya que el agrandamiento del 3er. ventriculo desplazaria. Uno de nuestros casos era una mujer que embarazo 6 anos despues de tratada con normalizacion de las estructuras ventriculares controladas por tomografia computada