Multi-source datasets acquired over Toulouse (France) in 2021 for urban microclimate studies during the CAMCATT/AI4GEO field campaign.

The CAMCATT-AI4GEO extensive field experiment took place in Toulouse, a city in the southwest of France, from 14th to 25th June 2021 (with complementary measurements performed on the 6 September 2021). Its main objective was the acquisition of a new reference dataset on an urban site to support the development and validation of data products from the future thermal infrared (TIR) satellite missions such as TRISHNA (CNES/ISRO), LSTM (ESA) and SBG (NASA). With their high spatial (between 30-60m) and temporal (2-3 days) resolutions, the future TIR satellite data will allow a better investigation of the urban climate at the neighbourhood scale. However, in order to validate the future products of these missions such as LST, air temperature, comfort index and Urban Heat Island (UHI), there is a need to accurately characterise the organisation of the city in terms of 3D geometry, spectral optical properties and both land surface temperature and emissivity (LST and LSE) at several scales. In this context, the CAMCATT-AI4GEO field campaign provides a set of airborne VISNIR-SWIR (Visible Near InfraRed - ShortWave InfraRed) hyperspectral imagery, multispectral thermal infrared (TIR) imagery and 3D LiDAR acquisitions, together with a variety of ground data collected, for some of them, simultaneously to the flight. The ground dataset includes surface reflectance measured spectrally with ASD spectroradiometers and in six spectral bands spreading from shortwave to thermal infrared and for two viewing angles with a SOC410-DHR handheld reflectometer. It is completed with LST and LSE retrieved from thermal infrared radiance acquired in six spectral bands with CIMEL radiometers. It also includes meteorological data coming from four radio soundings (one of which was taken during the flight), data routinely collected at the Blagnac airport reference station as well as air temperature and humidity acquired using instrumented cars following two different itineraries. In addition, a link is provided to access the data routinely collected by the network of weather stations set up by Toulouse Metropole in the city and its surroundings. This data paper describes this new reference urban dataset which can be useful for many applications such as calibration/validation of at-surface radiance, LST and LSE data products as well as higher level products such as air temperature or comfort index. It also provides valuable opportunities for other applications in urban climate studies, such as supporting the validation of microclimate models.

Intermediate snowpack melt-out dates guarantee the highest seasonal grasslands greening in the Pyrenees.

In mountain areas, the phenology and productivity of grassland are closely related to snow dynamics. However, the influence that snow melt timing has on grassland growing still needs further attention for a full understanding, particularly at high spatial resolution. Aiming to reduce this knowledge gap, this work exploits 1 m resolution snow depth and Normalized Difference Vegetation Index observations acquired with an Unmanned Aerial Vehicle at a sub-alpine site in the Pyrenees. During two snow seasons (2019-2020 and 2020-2021), 14 NDVI and 17 snow depth distributions were acquired over 48 ha. Despite the snow dynamics being different in the two seasons, the response of grasslands greening to snow melt-out exhibited a very similar pattern in both. The NDVI temporal evolution in areas with distinct melt-out dates reveals that sectors where the melt-out date occurs in late April or early May (optimum melt-out) reach the maximum vegetation productivity. Zones with an earlier or a later melt-out rarely reach peak NDVI values. The results obtained in this study area, suggest that knowledge about snow depth distribution is not needed to understand NDVI grassland dynamics. The analysis did not reveal a clear link between the spatial variability in snow duration and the diversity and richness of grassland communities within the study area.

Identificación y cuantificación del efecto fin de semana y festivos en la atención del síndrome coronario agudo en el Sistema Nacional de Salud / The effect of weekends and public holidays on the care of acute coronary syndrome in the Spanish National Health System

Introducción y objetivos Analizar si el ingreso en fin de semana o festivo (IFSF), frente al ingreso en días laborables, influye en el tratamiento (angioplastia, intervención coronaria percutánea [ICP]) y los resultados (mortalidad hospitalaria) de los pacientes hospitalizados por síndrome coronario agudo en el Sistema Nacional de Salud. Métodos Estudio observacional retrospectivo de pacientes ingresados por infarto agudo de miocardio con elevación del segmento ST (IAMCEST) o con síndrome coronario agudo sin elevación del segmento ST (SCASEST) en los hospitales del Sistema Nacional de Salud durante el periodo 2003-2018. Resultados Se seleccionaron 438.987 episodios de IAMCEST y 486.565 de SCASEST, de los cuales fueron IFSF el 28,8 y el 26,1% respectivamente. El IFSF se mostraba como un factor de riesgo de mortalidad hospitalaria en los modelos ajustados por riesgo del IAMCEST (OR=1,05; IC95%, 1,03-1,08; p<0,001) y del SCASEST (OR=1,08; IC95%, 1,05-1,12; p <0,001). La tasa de ICP en el IAMCEST fue más de 2 puntos porcentuales mayor en los pacientes ingresados en días laborables durante el periodo 2003-2011 y similar o incluso más baja en 2012-2018, sin cambios significativos para el SCASEST. El IFSF se mostró como factor de riesgo estadísticamente significativo tanto para el IAMCEST como para el SCASEST. Conclusiones El IFSF puede aumentar el riesgo de muerte hospitalaria en un 5% (IAMCEST) y un 8% (SCASEST). La persistencia del riesgo de mayor mortalidad hospitalaria tras ajustar por la realización de ICP y las demás variables explicativas probablemente indique dficiencias en el tratamiento durante el fin de semana respecto de los días laborables (AU)

Introduction and objectives To analyze whether admission on weekends or public holidays (WHA) influences the management (performance of angioplasty, percutaneous coronary intervention [PCI]) and outcomes (in-hospital mortality) of patients hospitalized for acute coronary syndrome in the Spanish National Health System compared with admission on weekdays. Methods Retrospective observational study of patients admitted for ST-segment elevation myocardial infarction (STEMI) or for non–ST-segment elevation acute coronary syndrome (NSTEACS) in hospitals of the Spanish National Health system from 2003 to 2018. Results A total of 438 987 episodes of STEMI and 486 565 of NSTEACS were selected, of which 28.8% and 26.1% were WHA, respectively. Risk-adjusted models showed that WHA was a risk factor for in-hospital mortality in STEMI (OR, 1.05; 95%CI,1.03-1.08; P < .001) and in NSTEACS (OR, 1.08; 95%CI, 1.05-1.12; P < .001). The rate of PCI performance in STEMI was more than 2 percentage points higher in patients admitted on weekdays from 2003 to 2011 and was similar or even lower from 2012 to 2018, with no significant changes in NSTEACS. WHA was a statistically significant risk factor for both STEMI and NSTEACS. Conclusions WHA can increase the risk of in-hospital death by 5% (STEMI) and 8% (NSTEACS). The persistence of the risk of higher in-hospital mortality, after adjustment for the performance of PCI and other explanatory variables, probably indicates deficiencies in management during the weekend compared with weekdays (AU)

Macrolide resistance in Mycoplasma genitalium in Catalonia, Spain: a 1 year prospective study.

BACKGROUND: Mycoplasma genitalium is an emergent cause of sexually transmitted disease (STD). The first-line treatment is azithromycin, but macrolide resistance is increasing due to mutations in the 23S rRNA gene. OBJECTIVES: To determine the rates of M. genitalium infection and macrolide resistance in an area adjacent to Barcelona. METHODS: This 1 year prospective study was performed in a heterogenous population that included both low- and high-risk patients. M. genitalium was detected in all specimens sent to our institution for STD detection. Epidemiological and relevant clinical data were collected in the positive cases. Characterization of macrolide-associated resistance was performed by 23S rDNA sequencing. RESULTS: Of the 3540 patients included, 132 (3.7%) were positive for M. genitalium. Another sexually transmitted bacteria was detected in 20.4% of the M. genitalium cases, and Chlamydia trachomatis (11%) was the most frequently co-detected microorganism. Only 61.4% of patients received an adequate initial treatment against M. genitalium. The test of cure (TOC) was performed in 42% of patients, and therapeutic failure was detected in 10 cases. The rate of macrolide resistance was 12.6% and the most prevalent mutation was A2058G. There was an association between macrolide resistance and a previous history of M. genitalium detection (P < 0.001). CONCLUSIONS: Our results support the contribution of the previous use of macrolides in resistant strains. Given the difficulties in performing TOC in all patients, the inclusion of macrolide resistance in the detection test should be mandatory.

Improving multi-technique monitoring using Sentinel-1 and Cosmo-SkyMed data and upgrading groundwater model capabilities.

Aquifer-systems have become a strategic source of fresh water in the present climatic conditions, especially under stress in arid regions like the Iberian Mediterranean Arc. Understanding the behavior of groundwater reservoirs is crucial to their well-management and mitigation of adverse consequences of overexploitation. In this work, we use space geodetic measurements from satellite interferometric synthetic aperture radar (InSAR) and Global Positioning System (GPS) data, covering the period 2011-2017, to predict and validate the ground surface displacement over the fastest subsiding basin due to groundwater withdrawal in Europe (>10 cm/year). The 2D decomposition of InSAR displacements from Cosmo-SkyMed and Sentinel-1 satellites allows us to detect horizontal deformation towards the basin center, with a maximum displacement of 1.5 cm/year. InSAR results were introduced in a newly developed methodology for aquifer system management to estimate unknown pumping rates for the 2012-2017 period. This study illustrates how the combination of InSAR data, groundwater flow and deformation models can be used to improve the aquifer-systems sustainable management.

RECALMIN. Four years of growth of the internal medicine units of the Spanish National Health System (2013-2016). / RECALMIN. Cuatro años de evolución de las Unidades de Medicina Interna del Sistema Nacional de Salud (2013-2016).

OBJECTIVES: To compare the structure, resources and activity of the internal medicine units (IMUs) of the Spanish National Health System (SNHS) in 2013 and 2016. To analyse the differences between IMUs in 2016 by hospital size. MATERIAL AND METHODS: We conducted a comparison of 2 descriptive cross-sectional studies of IMUs in general acute care hospitals of the Spanish National Health System, with data referring to 2013 and 2016. The variables were collected via an ad hoc questionnaire (RECALMIN survey). RESULTS: Between 2013 and 2016, the demand for care increased dramatically (with an annual average of 11% in hospital discharges and 16% in first consultations), and comorbidity slightly increased (2%). During this period, the mean productivity of IMUs increased 16.7% (0.6±0.3 vs. 0.7±0.3; P=.09), and the mean stay decreased 10% (9±2.2 vs. 8.1±2.1 days; P=.001). Progress in implementing good practices and systematic care for complex chronic patients was scarce. Both surveys found variability among IMUs and marked differences among IMUs of hospitals of different sizes. CONCLUSIONS: IMUs responded to the increased burden of care they supported during 2013-2016 by improving their efficiency and productivity; however, advances in implementing good practices, including care for chronic complex patients, were scare. The significant variability in the indicators of structure, activity and management models found in 2013 remained in 2016.

El valor clínico de la respuesta hipertensiva exagerada al ejercicio / The clinical value of an exaggerated hypertensive response to exercise

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RECALMIN II. Eight years of hospitalisation in Internal Medicine Units (2007-2014). What has changed? / RECALMIN II. Ocho años de hospitalización en las Unidades de Medicina Interna (2007-2014). ¿Qué ha cambiado?

OBJECTIVES: To analyse the evolution of care provided by the internal medicine units (IMU) of the Spanish National Health System from 2007 to 2014. MATERIAL AND METHODS: We analysed all discharges from the IMU of the Spanish National Health System in 2007 and 2014, using the Minimum Basic Data Set. We compared the risk factors by episode, mortality and readmissions between the two periods. We prepared specific fits for the risk for mortality and readmissions in heart failure, pneumonia and chronic obstructive pulmonary disease, as well as the Charlson index for all activity. RESULTS: Discharges from the IMU between the two periods increased 14%. The average patient age increased by 2.8 years (71.2±17.1 vs. 74±16.2; p<.001), with a marked increase in comorbidity (Charlson index, 4±3.7 vs. 4.7±3.9; p<.001; 24% increase in risk factors per episode). The adjusted mortality rates decreased slight but significantly, with a slight increase in readmissions. CONCLUSIONS: During the analysed period, there was an increase of almost 3 years in the mean age of patients treated in the IMU of the Spanish National Health System, with a marked increase in comorbidity. These results should lead to a more appropriate assignment of nurse workloads and an increased implementation of good practices in clinical management.

Prehipertensión en el paciente joven / Prehypertension in young patients

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Inter- and intra-patient variability in breakthrough pain episodes of opioid-treated patients with underlying chronic pain. An observational, prospective and multicenter study / Variabilidad inter- e intra-individual en pacientes con dolor irruptor tratados con opioides. Estudio observacional, prospectivo y multicéntrico

Objective: Since, to date, there are few epidemiological data assessing the diversity in the characteristics of breakthrough pain episodes, the present study was performed to assess the intra-individual variability in the episodes of breakthrough pain in patients with underlying chronic pain controlled with opioids. Methods: An observational, prospective and multicenter study (CADI study) was conducted in the context of the routine clinical practice of Spanish pain specialists recruiting opioidtreated patients with underlying chronic pain. Data were recorded in three visits (baseline, at 7 and 28 days post-inclusion) and by the patient on a patient´s diary card, specifically designed to characterise the first 8 breakthrough pain episodes (type, intensity –using 100 mm Visual Analog Scale– and duration of pain), to assess the intra-individual and inter-individual variability in the intensity, duration and typology of episodes of breakthrough pain. Results: 50 opioid-treated patients were recruited (23 with oncologic pain and 27 with non oncologic pain, mean age of 61.1 years, 62 % females). For all three parameters, inter-patient variability was higher than intra-patient variability throughout the episodes. Nevertheless, we found intra-patient variability in maximum pain intensity, pain intensity at the end of the episode, pain relief and duration of the episode. Conclusions: This is the first study to quantify the intrapatient variability of breakthrough pain. The results show a great variability in terms of intensity and duration of the episode and its typology. Although inter-patient variability is higher, the intra-patient variability is important enough to be taken into account in optimizing the approach and treatment selection (AU)

Objetivos: Debido a los pocos datos epidemiológicos existentes que evalúen la diversidad de las características de los episodios de dolor irruptivo, se realizó el presente estudio, cuyo principal objetivo fue evaluar la variabilidad intraindividual de las crisis de dolor irruptivo en pacientes con dolor crónico controlado con opioides. Métodos: Este estudio observacional, prospectivo y multicéntrico (estudio CADI) se llevó a cabo en el contexto de la práctica clínica habitual, en Unidades del Dolor de España, con la participación de pacientes tratados con opioides para el dolor crónico. Los datos fueron registrados en tres visitas (basal, a los 7 y 28 días después de la inclusión) y por el propio paciente, en un Diario del Paciente, específicamente diseñado para caracterizar los primeros 8 episodios de dolor irruptivo (tipo, intensidad −utilizando la Escala Analógica Visual (EVA)− y duración del dolor) con el objetivo de evaluar la variabilidad intraindividual e interindividual en la intensidad, duración y tipología de los episodios de dolor irruptivo. Resultados: Se reclutaron 50 pacientes, 23 con dolor oncológico y 27 con el dolor no oncológico (edad media de 61,1 años; 62 % de mujeres). Aunque para los tres parámetros medidos, la variabilidad entre pacientes fue mayor que la variabilidad intrapaciente, la variabilidad intraindividual fue significativa en la evaluación de la máxima intensidad del dolor, la intensidad del dolor al final del episodio, el alivio del dolor y la duración del episodio de dolor irruptivo. Conclusiones: Este es el primer estudio que cuantifica la variabilidad intraindividual del dolor irruptivo. Los resultados muestran una gran variabilidad en cuanto a la intensidad y la duración del episodio y su tipología. Aunque la variabilidad entre pacientes es mayor, la variabilidad intrapaciente es lo suficientemente importante como para ser tenida en cuenta para la mejor aproximación y selección del tratamiento (AU)

Prevalence of masked uncontrolled hypertension according to the number of office blood pressure measurements / Prevalencia de hipertensión arterial enmascarada no controlada de acuerdo con el número de medidas de la tensión arterial en consulta

Introduction and objectives. The reported prevalence of masked uncontrolled hypertension (MUCH) varies because many studies are not comparable as they use different measurement methodologies. To evaluate the influence of the number of office blood pressure readings on the prevalence of MUCH we conducted a cross-sectional, multicenter study in treated hypertensive patients. Patients and methods. We carried out an observational, cross-sectional, multicenter study in 33 Spanish hospital-based hypertension units, involving 35 investigators and 12 Autonomous Communities. Six blood pressure readings and a 24-h ambulatory blood pressure monitoring were performed in treated hypertensive patients. The means of the first 3 readings (P123), the 2nd, 3rd and 4th readings (P234), the 3rd, 4th and 5th readings (P345) and the last 3 readings (P456) were compared with mean 24-h blood pressure. MUCH was defined as office blood pressure <140/90mmHg and 24-h blood pressure ≥130/80mmHg, considering the first 3 readings (MUCH123), the 2nd, 3rd and 4th readings (MUCH234), the 3rd, 4th and 5th readings (MUCH345) and the last 3 readings (MUCH456). Results. We included 498 hypertensive patients. Mean (standard deviation) office blood pressure measurements were: (P123) 141(18)/82(11); (P234) 139(17)/81(11); (P345) 138(17)/81(11) and (P456) 137(16)/80(10) mmHg. Mean 24-h blood pressure was 127(13.8)/75(9.5) mmHg. The correlation coefficients between ambulatory and office systolic/diastolic blood pressure were (P123):0.48/0.50; (P234):0.50/0.52; (P345):0.50/0.54; and (P456):0.50/0.55 (p<0.001, all). The prevalences of MUCH123, MUCH234, MUCH345 and MUCH456 were 14.5%, 18.9%, 19.5% and 21.1%, respectively. Conclusions. The prevalence of MUCH diagnosis depends on the serial office blood pressure readings, being much higher for the last three blood pressure readings. Discarding the first and second office blood pressure measures seems to be the most accurate method for diagnosing MUCH (AU)

Introducción y objetivos. Los datos sobre prevalencia de hipertensión arterial enmascarada no controlada (HTAE) son muy variables, ya que los registros obtenidos en diferentes estudios no son comparables al emplear diferentes métodos de medición. Se llevó a cabo un estudio transversal y multicéntrico en pacientes hipertensos tratados para evaluar la influencia de la cantidad de lecturas de la presión arterial en consulta sobre la prevalencia de la HTAE. Pacientes y métodos. Se realizó un estudio observacional, transversal y multicéntrico en 33 unidades de hipertensión en hospitales españoles, con la participación de 35 investigadores y 12 comunidades autónomas. Se realizaron 6 lecturas de la presión arterial y un control de la presión arterial ambulatoria de 24h en pacientes hipertensos tratados. Se compararon las medias de las 3 primeras lecturas (P123), de las lecturas 2, 3 y 4 (P234), de las lecturas 3, 4 y 5 (P345) y de las 3 últimas lecturas (P456) con la media de la presión arterial a las 24h. Teniendo en cuenta las 3 primeras lecturas (HTAE123), las lecturas segunda, tercera y cuarta (HTAE234), tercera, cuarta y quinta (HTAE345) y las últimas 3 lecturas (HTAE456); definimos la HTAE como una presión arterial en consulta <140/90mmHg y una presión arterial de 24h ≥130/80mmHg. Resultados. Se incluyeron 498 pacientes hipertensos. La media de las mediciones (desviación estándar) de presión arterial en consulta fueron: (P123) 141 (18)/82 (11); (P234) 139 (17)/81 (11); (P345) 138 (17)/81 (11) y (P456) 137 (16)/80 (10) mmHg. La presión arterial media a las 24h fue de 127 (13.8)/75 (9.5) mmHg. Los coeficientes de correlación entre presión sistólica/presión diastólica ambulatoria y en consulta fueron (P123): 0.48/0.50; (P234): 0.50/0.52; (P345): 0.50/0.54; y (P456): 0.50/0.55 (p<0.001 de todos). Las prevalencias de HTAE123, HTAE234, HTAE345 y HTAE456 fueron 14.5%, 18.9%, 19.5% y 21.1%, respectivamente. Conclusiones. La prevalencia de diagnóstico de HTAE depende de las series de lecturas de la presión arterial en consulta, siendo esta mucho más alta en las 3 últimas lecturas. Si descartamos la primera y segunda lecturas, la medida de la presión arterial en consulta parece ser el método más preciso para el diagnóstico de la HTAE (AU)

Prevalence of masked uncontrolled hypertension according to the number of office blood pressure measurements.

INTRODUCTION AND OBJECTIVES: The reported prevalence of masked uncontrolled hypertension (MUCH) varies because many studies are not comparable as they use different measurement methodologies. To evaluate the influence of the number of office blood pressure readings on the prevalence of MUCH we conducted a cross-sectional, multicenter study in treated hypertensive patients. PATIENTS AND METHODS: We carried out an observational, cross-sectional, multicenter study in 33 Spanish hospital-based hypertension units, involving 35 investigators and 12 Autonomous Communities. Six blood pressure readings and a 24-h ambulatory blood pressure monitoring were performed in treated hypertensive patients. The means of the first 3 readings (P123), the 2nd, 3rd and 4th readings (P234), the 3rd, 4th and 5th readings (P345) and the last 3 readings (P456) were compared with mean 24-h blood pressure. MUCH was defined as office blood pressure <140/90mmHg and 24-h blood pressure ≥130/80mmHg, considering the first 3 readings (MUCH123), the 2nd, 3rd and 4th readings (MUCH234), the 3rd, 4th and 5th readings (MUCH345) and the last 3 readings (MUCH456). RESULTS: We included 498 hypertensive patients. Mean (standard deviation) office blood pressure measurements were: (P123) 141(18)/82(11); (P234) 139(17)/81(11); (P345) 138(17)/81(11) and (P456) 137(16)/80(10) mmHg. Mean 24-h blood pressure was 127(13.8)/75(9.5) mmHg. The correlation coefficients between ambulatory and office systolic/diastolic blood pressure were (P123):0.48/0.50; (P234):0.50/0.52; (P345):0.50/0.54; and (P456):0.50/0.55 (p<0.001, all). The prevalences of MUCH123, MUCH234, MUCH345 and MUCH456 were 14.5%, 18.9%, 19.5% and 21.1%, respectively. CONCLUSIONS: The prevalence of MUCH diagnosis depends on the serial office blood pressure readings, being much higher for the last three blood pressure readings. Discarding the first and second office blood pressure measures seems to be the most accurate method for diagnosing MUCH.

Influencia del patrón circadiano de la presión arterial en la mortalidad de una cohorte de nonagenarios. Valoración a los tres años de seguimiento / Influence of the circadian pattern of blood pressure in mortality of a nonagenarian cohort. Evaluation at three years of follow-up

ObjetivoEstudiar la influencia de los patrones circadianos de PA y otros factores relativos a la valoración geriátrica en la mortalidad de una cohorte de nonagenarios, después de un seguimiento de 3 años.Pacientes y métodosSe estudia de manera prospectiva a 43 personas que forman parte de la cohorte NonaSantfeliu. Se realizó un estudio de monitorización ambulatoria de la PA de 24h. Se recogieron datos sociodemográficos, de la valoración geriátrica global y de la comorbilidad. Los nonagenarios fueron seguidos durante al menos 36 meses o hasta su fallecimiento.ResultadosSe trataba de 26 mujeres (62%) y 16 hombres, con una media de 93,7±2 años al inicio del estudio. Veinte pacientes fallecieron durante los 3 años de seguimiento (tasa de mortalidad del 47,6%). No se apreciaron diferencias significativas en cuanto a la mortalidad entre los diferentes patrones circadianos de PA por monitorización ambulatoria de la presión arterial de 24h (p=0,16). La única diferencia estadísticamente significativa que presentan los pacientes que fallecieron respecto a los supervivientes a los 3 años, era que tenían una peor puntuación en el miniexamen cognitivo de Lobo.ConclusionesNo se apreciaron diferencias significativas en cuanto a mortalidad entre los diferentes patrones circadianos de presión arterial de pacientes nonagenarios El estudio muestra que el tener una mayor puntuación en la valoración cognitiva es el mejor predictor de mortalidad después de 3 años de seguimiento, independientemente del patrón circadiano de la monitorización ambulatoria de la presión arterial de la PA(AU)

ObjectiveTo study the influence of the circadian patterns of blood pressure and other factors related to geriatric evaluation in mortality of a nonagenarian cohort after a 3-year follow-up.Patients and methodsA total of 43 persons who formed a part of a Nona Santfeliu cohort were studied prospectively. A 24-hour ambulatory blood pressure monitoring (ABPM) study was performed. Sociodemographic, global geriatric evaluation and comorbidity data were collected. The nonagenarian subjects were followed-up for at least 36 months or until death.ResultsThe study was formed by 26 women (62%) and 16 men, with a mean of 93.7±2 years at the onset of the study. Twenty patients died during the three years of follow-up (47.6% mortality rate). There were no significant differences regarding mortality between the different 24-hour ABPM BP circadian patterns (p=0.16). The only statistically significant difference presented by the patients who died regarding those surviving at three years was that they the score had been worse on the cognitive mini-exam of Lobo.ConclusionsNo statistically significant differences were found regarding mortality between the different circadian patterns of blood pressure of nonagenarian patients. The study shows that having a higher score on the cognitive evaluation is the best mortality predictor after three years of follow-up, regardless of the circadian pattern of ABPM of the BP(AU)

Combination therapy with sildenafil and bosentan reverts severe pulmonary hypertension and allows heart transplantation: case report.

INTRODUCTION: Severe pulmonary hypertension with no response to vasodilators on an acute hemodynamic study is a contraindication to cardiac transplantation. The development of oral pulmonary vasodilators improves the prognosis in these patients. We present the case of a patient whose admission to the waiting list for cardiac transplantation was possible after 6 months of combination therapy with Sildenafil and Bosentan. CASE REPORT: The patient was a 50-year-old man with severe dilated alcohol-induced cardiomyopathy. A pretransplantation study, including a right hemodynamic analysis, revealed irreversible pulmonary hypertension, with 59 mm Hg mean pulmonary artery pressure and 6.4 Wood IU pulmonary vascular resistance, with no response to acute vasodilators with nitric oxide or prostacyclin. Initially, heart transplantation was not possible and the patient started treatment with oral Sildenafil. After 6 months there was no improvement in echocardiographic or hemodynamic parameters, and combination therapy with Bosentan was started. With the combination therapy, the patient progressively improved clinically and hemodynamically, the pressures becoming normal at the sixth month, at which time he was included on the waiting list for a heart transplantation. Eight months later he received a graft with a good posttransplantation course, no right ventricular failure in the acute phase, and absence of pulmonary hypertension on echocardiogrphic and invasive studies. CONCLUSION: Combinations of an oral pulmonary vasodilator with diverse action mechanisms may represent an alternative for patients with irreversible pulmonary hypertension who do not respond to monotherapy.

Sirolimus experience in heart transplantation.

INTRODUCTION: Sirolimus is a potent, nonnephrotoxic immunosuppressant with antiproliferative activity in nonimmune cells. Recent data support the conversion in late renal failure secondary to calcineurin inhibitors (CNIs), with limited experience in de novo regimens in patients with predictive factors of postoperative renal impairment. OBJECTIVE: We evaluated our experience of sirolimus-based immunosuppression administered to 25 heart transplant recipients. METHODS: A retrospective analysis of 25 heart transplant recipients who received sirolimus included 17 conversions due to late CNI-related chronic renal dysfunction, six patients with a de novo regimen, and two patients who developed posttransplant pulmonary neoplasms. The conversion from CNI to sirolimus was started with 2 mg, with an average time after transplantation of 78 +/- 43 months and a mean baseline serum creatinine level of 2.1 +/- 0.45 mg/dL. The mean clinical follow-up was 17 +/- 9 months postconversion, and included echocardiography and laboratory studies. In the de novo group successive endomyocardial biopsies were performed during the first semester. RESULTS: Serum creatinine fell from 2.1 +/- 0.45 mg/dL to 1.8 +/- 0.51 mg/dL (P = .012). Mean sirolimus levels were 15 +/- 9 ng/mL (doses 2.2 +/- 0.4 mg). This improvement continued until 3 months (creatinine 1.5 +/- 0.35 P < .01)/sirolimus levels 11.7 +/- 5 ng/mL [1.9 +/- 0.7 mg]), with maintenance at 6 months (1.58 +/- 0.3 mg/dL/14 +/- 4 ng/mL [1.85 +/- 0.7 mg]) and 1-year postconversion (1.53 +/- 0.39 mg/dL; P = .019/10.7 +/- 2.5 ng/mL [1.5 +/- 0.7 mg]). De novo, after a mean follow-up of 13 months (range 3 to 35), sirolimus appeared to increase the incidence of a moderate histological grade of rejection without hemodynamic compromise. Side effects were common (63%), including peripheral edema, skin eruptions, and pericardial effusion. Only one patient discontinued treatment, due to intestinal intolerance. Four patients died during follow-up: two because of lung neoplasms and two because of progressive graft vessel disease. CONCLUSION: Sirolimus improved late CNI-related chronic renal dysfunction. Kidney function was preserved using a de novo CNI-free immunosuppressive regimen for recent cardiac transplant recipients.

Satisfacción en pacientes con reconstrucción mamaria con colgajo D. I. E. P / Patient’s satisfaction after diep flap reconstruction

La reconstrucción mamaria tras mastectomía se realiza primordialmente para proporcionar calidad de vida a la paciente. Este estudio se desarrolló para valorar la satisfacción y calidad de vida de las pacientes reconstruidas mediante colgajo D.I.E.P. (Deep Inferior Epigastric Perforator)y evaluar el resultado estético de la reconstrucción. Treinta y tres pacientes, de 51 reconstrucciones mamarias con colgajo DIEP realizadas entre enero de 2000 y noviembre de 2004 fueron preguntadas acerca de aspectos generales relativos a la cirugía, imagen corporal y sensación subjetiva. El resultado de imagen corporal fue evaluado por dos observadores externos, un cirujano plástico y una enfermera, además de por la propia paciente. Para valorar la reconstrucción mamaria, se utilizó una escala de 4 puntos. La satisfacción general de nuestro estudio fue más elevada que la observada en estudios precedentes. Hemos conseguido una valoración alta en simetría, dentro de los parámetros objetivos y en integridad corporal entre los subjetivos. Hemos encontrado una correlación alta entre las respuestas de los observadores comparada con las respuestas de las propias pacientes. Por último, hemos visto una fuerte correlación entre integridad corporal y satisfacción general (AU)

Breast reconstructions after breast cancer surgery are primarily performed to improve patient’s quality of life. This study investigates patient’s satisfaction and quality of life with breast reconstruction after deep inferior epigastric perforator (D.I.E.P.) flap surgery and to evaluate the aesthetic result of the breast reconstruction. Thirty-three patiens, from fifty-one DIEP breast reconstruction made between January 2000 and December 2004 were answered about three questionnaires concerning to general aspect, body image, and subjective sensation. The body image outcome was also evaluated by one plastic surgeon and a nurse. The panel evaluated breast reconstruction on 4 subescales. General satisfaction in our study was higher than in previous ones. We have received a high degree of symmetry in the objetive evaluation and a high score in body integrity in the subjective evaluation. We have found a stronger correlation between clinical observer answers compared with patient´s assessment and a strong correlation between body integrity and general satisfaction outcome (AU)

La hipertensión arterial en la población anciana / Essential hypertension in elderly population

Se estima que la prevalencia de hipertensión arterial (HTA) en la población española mayor de 60 años es superior al 65%, a expensas principalmente de una elevación de la presión arterial sistólica. Es conocido que la HTA es el factor de riesgo más importante para el desarrollo de una enfermedad cardiovascular (cardiopatía isquémica, insuficiencia cardíaca, ictus) y que ésta sigue siendo la primera causa de muerte en la población occidental. La necesidad de tratamiento de la HTA en la población anciana es un hecho ya ampliamente demostrado en numerosos ensayos clínicos aleatorizados y controlados con placebo, en los que el tratamiento antihipertensivo se asocia a una reducción del riesgo de presentar una complicación cardiovascular. Sin embargo, el tratamiento de la HTA en el anciano puede resultar una tarea complicada por la necesidad de tener presente en su manejo clínico una serie de características propias de este grupo de pacientes, como son una farmacocinética alterada, la comorbilidad, o la polifarmacia. Por otra parte, todavía no existen estudios suficientes en el caso de la población más anciana (mayor de 85 años) y, en este sentido, el tratamiento individualizado es el que debiera realizarse en nuestra práctica clínica habitual

The prevalence of essential hypertension in Spanish population elder than 60 years is about 65%. These data are particularly due to an elevated prevalence of isolated systolic hypertension in elderly people. It is known that essential hypertension is the most important risk factor for developing a cardiovascular disease (coronary heart disease, cardiac failure, stroke). Cardiovascular diseases continue to be the leading causes of illness and death among adults from developed countries. Several studies have demonstrated the beneficial effects of antihypertensive treatment in hypertensive elderly people. Indeed, antihypertensive treatment and control of high blood pressure are associated with lower risk for developing cardiovascular diseases. However, managing of high blood pressure in elderly population can be difficult since most of these people have comorbidities that could influence the therapy. On the other hand there are some issues that remains unanswered in this group of population, such as how aggressively these patients should be treated, and also evidence enough for treating oldest old patients (those aged > 85 years)