[Determination of the missrreporting of energy intake by Goldberg and Black in the FACSA cohort. Pilot study.] / Determinación de la infradeclaración de la ingesta de energía por el método de Goldberg y Black en la cohorte FACSA. Estudio piloto.

Introduction: Introduction: the Goldberg and Black method estimates dietary underreporting in epidemiological food consumption studies. This method compares the self-reported energy intake of the subjects with the estimate of their total energy expenditure. Objective: to evaluate underreporting and overreporting at individual and group levels in Health Sciences students. Material and methods: the study was cross-sectional and prospective; the participants recorded their food consumption through two dietary records, one on the weekend and the other on the weekdays. They previously answered to sign an informed consent letter, after which the physical activity questionnaire (IPAQ) they were also weighed and measured, and then the basal metabolic rate (BMR) was estimated, It calculated later the declared intake (EI)/BMR ratio, and finally, the cut-off points to determine under-declarers, over declarators and plausible declarators. Results: we found 14.81 % underreporting at the individual level and 44.44 % at the group level. The subjects with a higher BMI and those who performed strenuous physical activity were the ones who underreported the most. The subjects underreported performed moderate and severe physical activity at the group level. Conclusions: it is crucial to carry out this methodology to verify the results of dietary evaluation since underreporting affects the estimation of nutrient intake and can alter the associations between diet and diseases in epidemiological studies.

Introducción: Introducción: el método de Goldberg y Black se utiliza para estimar la infradeclaración dietética en los estudios epidemiológicos de consumo de alimentos. Este método se basa en la comparación de la ingesta de energía autodeclarada por los sujetos con la estimación de su gasto energético total. Objetivo: evaluar la infradeclaración y sobredeclaración a nivel individual y grupal en estudiantes de Ciencias de la salud. Material y métodos: el estudio fue transversal y prospectivo; los participantes registraron el consumo de alimentos por medio de dos registros dietéticos, uno de fin de semana y otro de entre semana. Previamente se les solicitó la firma de una carta de consentimiento informado y después se les aplicó el cuestionario de actividad física (IPAQ). También se les peso y midió, luego se estimó la tasa metabólica basal (BMR), posteriormente se calculó la relación de la ingesta declarada (EI)/BMR y, por último, se eligieron los puntos de corte para determinar quiénes eran infradeclaradores, sobredeclaradores y declaradores plausibles. Resultados: se encontró un 14,81 % de infradeclaración a nivel individual y un 44,44 % a nivel grupal. Los sujetos con mayor IMC y los que realizaban actividad física intensa son los que mayor infradeclaración reportan y, a nivel grupal, los sujetos que realizan actividad física moderada e intensa también fueron infradeclaradores. Conclusiones: es crucial llevar a cabo esta metodología para verificar los resultados de la evaluación dietética ya que la infradeclaración afecta a la estimación de la ingesta de nutrientes y puede alterar las asociaciones entre dieta y enfermedades en los estudios epidemiológicos.

Registro de actividades de la Sociedad Española de Angiología y Cirugía Vascular, año 2019 / Registry of activities of the Spanish Society of Angiology and Vascular Surgery, year 2019

Objetivo: describir la actividad asistencial del año 2019 de los servicios/unidades de angiología y cirugía vascular en España. Pacientes y métodos: estudio transversal con encuesta a 107 centros sobre procedimientos quirúrgicos y exploraciones vasculares realizados en 2019. Análisis descriptivo de resultados y comparación de la ratio de actividad /100 000 habitantes con 2018. Resultados: respondieron 44 servicios (41,1 %), 4 de ámbito privado. De los 42 servicios docentes, respondieron 29 (65,9 %), un 65,9 %. En los servicios que respondieron se produjeron 26 960 ingresos, el 46,4 % urgentes y el 53,5 % programados (estancia media: 6,8 días). En la mayoría de sectores no hubo cambios significativos en la ratio/100 000 habitantes, salvo un aumento moderado (10,7 frente a 9,4) en el sector distal, tanto en procedimientos quirúrgicos (3,3 frente a 2,8) como en endovasculares (7,3 frente a 6,6). Descenso moderado de procedimientos endovasculares en los troncos supraaórticos (1,4 frente a 1,6). Hubo una disminución moderada de procedimientos quirúrgicos en aorta torácica (0,17 frente a 0,20) y abdominal (2,38 frente a 2,78), que contrastó con un aumento moderado en procedimientos endovasculares abdominotorácicos (0,40 frente a 0,35). En las arterias viscerales se encontró una disminución relevante de procedimientos endovasculares (0,89 frente a 1,16) y un aumento moderado de los quirúrgicos (0,99 frente a 0,89). En el sector aortoilíaco hubo un aumento moderado de procedimientos endovasculares (6,8 frente a 5,8). En 2019 también se encontró una disminución relevante en el número de procedimientos endovasculares relacionados con los accesos de hemodiálisis (1,2 frente a 1,5), un descenso moderado en el número de amputaciones mayores (6,9 frente a 7,8) y un descenso relevante de actividad sobre las malformaciones (0,32 frente a 0,59). Se encontró un aumento moderado en la actividad global sobre el sector venoso con respecto a la de 2018 (93,3 vs. 80,3)...(AU)

Introduction and objective: to describe the healthcare activity of the Angiology and Vascular Surgery services/units in Spain in 2019.Patients and methods: cross-sectional study with a survey of 107 centers on surgical procedures and vascularexplorations performed in 2019. Descriptive analysis of results and comparison of the activity ratio / 100,000inhabitants with 2018.Results: 44 services responded (41.1 %), with only 4 being private. Of the 42 teaching services, 29 (65.9 %) respon-ded, representing 65.9 % of the total. In the services that responded, there were 26,960 admissions, 46.4 % urgentand 53.5% scheduled, with an average stay of 6.8 days. Global surgical activity in arterial surgery in 2019 was similarto that of 2018. In most sectors there were no significant changes in the ratio / 100,000 inhabitants, except for amoderate increase (10.7 vs. 9.4) in the distal sector , finding the increase in both surgical procedures (3.3 vs. 2.8) andendovascular procedures (7.3 vs. 6.6). Furthermore, a moderate decrease in endovascular procedures was foundin the supra-aortic trunks (1.4 vs. 1.6). There was a moderate decrease in surgical procedures in the thoracic aorta(0.17 vs. 0.20) and abdominal (2.38 vs. 2.78), which contrasted with a moderate increase in thoraco-abdominalendovascular procedures (0.40 vs. to 0.35). In visceral arteries, a relevant decrease in endovascular procedures wasfound (0.89 vs. 1.16) and a moderate increase in surgical procedures (0.99 vs. 0.89). In the aorto-iliac sector therewas a moderate increase in endovascular procedures (6.8 vs. 5.8). In 2019, a relevant decrease was also found inthe number of endovascular procedures related to hemodialysis accesses (1.2 vs. 1.5), and a moderate decreasein the number of major amputations (6.9 vs. 7.8)...(AU)

[The registers of pediatric patients with home artificial nutrition. The Spanish experience]. / Los registros de pacientes pediátricos con nutrición artificial en el domicilio. La experiencia española.

Introduction: Background: the number of infants and children who receive artificial nutrition at home has been steadily increasing over the last decades, as better outcomes for children with chronic conditions have been achieved. In order to evaluate the need of resources to implement the technique it is necessary to know how many patients benefit from home artificial nutrition. This information can be estimated from the register of patients, when available. Methods: in this paper the characteristics of all registers were reviewed, especially those devoted to pediatric patients. Results: only two pediatric registers are active in 2023: the Canadian register and the Spanish one. NADYA register from the Spanish Society for Clinical Nutrition and Metabolism (SENPE) and the recent REPAFI, form the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition. The most valuable register from the British Society, BANS, stopped providing information in 2018. Conclusion: despite the fact of acknowledging the importance of having gathered information on the prevalence and incidence of home artificial nutrition, to fit resources to necessities, the number of active registers is quite short.

Introducción: Introducción: el número de pacientes pediátricos que reciben nutrición artificial en el domicilio (NAD) ha crecido en los países occidentales en la medida que ha mejorado el pronóstico de algunas enfermedades graves potencialmente letales. Con el fin de poder estimar la cantidad de recursos necesarios para implementar esta técnica, es necesario conocer el volumen real de pacientes que precisan NAD. Una manera aproximada de conocer estas necesidades puede establecerse a partir de los datos de los registros nacionales de pacientes. Métodos: se revisan las características de los registros de pacientes pediátricos con NAD, tanto los activos como los que no han continuado en el tiempo, con especial atención a los registros españoles. Resultados: solo dos registros de pacientes permanecen activos en 2023, el registro canadiense y los registros españoles de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE), a través del registro NADYA y el de la Sociedad Española de Gastroenterología Hepatología y Nutrición Pediátrica, registro REPAFI. El registro más completo de la Sociedad Británica, BANS, dejó de publicar resultados en 2018. Conclusiones: a pesar de reconocer la importancia de presentar datos actualizados de prevalencia e incidencia del uso de la NAD, con el fin de adecuar los recursos a las necesidades, el número de registros activos de pacientes pediátricos es excepcional.

Agregación masiva de la estrella de mar Luidia bellonae (Paxillosida: Luidiidae) en Bahía de Banderas, Jalisco, Pacífico Mexicano / Massive aggregation of sea star Luidia bellonae (Paxillosida: Luidiidae) in Bahía de Banderas, Jalisco, Mexican Pacific

Resumen Introducción: En el Pacífico central mexicano son escasos los trabajos sobre ecología de asteroideos. Estas especies generalmente se distribuyen de forma aleatoria, aunque en algunas ocasiones pueden encontrarse en grupos o agregaciones. En Los Arcos, al sur de Puerto Vallarta, en Bahía de Banderas, México, se observó Luidia bellonae por primera vez en una agregación masiva en 2021. Objetivo: Reportar por primera vez el registro de esta especie en esta región del Pacífico mexicano, así como el evento de agregación masiva. Métodos: Se realizaron transectos y recorridos para cuantificar la densidad y medir los ejemplares de la estrella en Los Arcos, Bahía de Banderas, durante 2021, 2022 y 2023. Resultados: Se encontraron densidades promedio de 2.65 ind/m2 y hasta 7 ind/m2. En total en el área aproximada de 900 m2 se registraron 630 individuos. Los ejemplares midieron (R) entre 2 y 12 cm, y en su mayoría midieron entre 4 y 8 cm. Conclusiones: L. bellonae estaba reportada en distintos sitios en algunos estados del Pacífico mexicano, sin embargo no estaba registrada para Bahía de Banderas ni Los Arcos, ni tampoco en la cantidad que se reporta aquí, por lo que este es el primer registro para la especie con una presencia masiva para el Pacífico mexicano. La aparición de la gran cantidad de ejemplares de L. bellonae en Los Arcos en 2021 pudo haber sido resultado de una combinación de factores, entre ellos la baja temperatura del agua, con valores hasta de 15 ºC y la alta cantidad de nutrientes. Este hallazgo demuestra la necesidad de más estudios sobre los equinodermos y especies marinas para entender la influencia que tienen las condiciones ambientales en su ciclo de vida.

Abstract Introduction: In the central Mexican Pacific, there are few studies on asteroid ecology. These species are generally distributed randomly, although in some cases groups or aggregations can be found. In Los Arcos, south of Puerto Vallarta, in Bahía de Banderas, Mexico, Luidia bellonae was observed for the first time in a massive aggregation in 2021. Objective: To report the new record of this species in this region of the Mexican Pacific and its massive aggregation event. Methods: Transects and surveys were carried out to quantify the density and measure the sea star individuals in Los Arcos, Bahía de Banderas during 2021, 2022, and 2023. Results: Average densities of 2.65 ind/m2 and up to 7 ind/m2 were found. In total, in the approximate area of 900 m2, 630 individuals were registered. The specimens measured (R) between 2 and 12 cm, and most measured between 4 and 8 cm. Conclusions: L. bellonae has been reported in different places in some states of the Mexican Pacific; however, it was not registered for Bahía de Banderas nor Los Arcos, nor in the amount reported here, therefore this is the first record for the species with a massive presence for the Mexican Pacific. The appearance of the large number of L. bellonae specimens in Los Arcos in 2021 could have been the result of a combination of factors, including the low water temperature, with values up to 15 ºC, and the high amount of nutrients. This finding demonstrates the need for more studies on echinoderms and marine species to understand the influence of environmental conditions on their life cycle.

[Evaluation of a coding guide on social determinants of health in primary care consultations: A mixed study]. / Evaluación de una guía de codificación de determinantes sociales de la salud en las consultas de atención primaria: Estudio mixto.

OBJECTIVE: To evaluate a coding guide for social determinants of health in primary care consultations as an effective tool in the professional's daily workflow. DESIGN: Mixed sequential explanatory study. Formed by a quantitative part (experimental) and a qualitative part (descriptive-evaluative). LOCATION: All the primary care teams of the Central Catalonia Management (32 teams). PARTICIPANTS AND SETTING: All nursing, social work and medical professionals working in the 32 primary care teams of the Catalan Institute of Health in Central Catalonia from February 2023 to July 2023. METHODS: A social determinants of health coding guide was developed. This guide was created in a multidisciplinary and multicenter manner. Purposive sampling. Quantitatively, the number of diagnoses recorded by the experimental group versus the control group was counted. Qualitatively, a thematic analysis was carried out from a socio-constructivist perspective. RESULTS: The results were significant and satisfactory. Using a quantitative methodology, the effectiveness of the use of the guide was assessed. A significant increase in the use of the social determinants was observed in the intervention group vs. the control group, with a percentage of post-intervention use of 19.53% in the control group and 32.26% in the intervention group (P < .001). The number of diagnoses recorded increased from 312 to 1322 in the intervention group, while it remained the same in the control group. The main factors identified through qualitative methodology that may explain the effectiveness of the guideline were: 1) the effectiveness of the guideline among primary care professionals, 2) the appropriateness of the guideline by assessing its usefulness and practicality, 3) feasibility and 4) specific contributions to the improvement of the guideline. CONCLUSIONS: The social determinants of health coding guide is effective, appropriate and can be implemented in the workflow of primary health care professionals for good recording of the social determinants of health.

The evolution of incisional hernia repair in Spain. A comparative analysis of results from the EVEREG registry.

BACKGROUND: The aim of this study was to assess the utility of the EVEREG registry in evaluating the evolution of surgical treatment for incisional hernia and its outcomes in Spain by comparing data from 2 study periods. METHODS: A retrospective comparative analysis of hernia surgeries performed between 2011 and 2015 (first period) and between 2017 and 2022 (second period) was conducted using data collected from the EVEREG registry. RESULTS: Statistically significant differences were observed in the second cohort, including: a decrease in minimally invasive procedures (11.7% vs 8.2%; P < .001), an increase in emergency surgeries for males (31.7% vs 41.2%; P = .017), an increase in trocar hernia repairs (16% vs 26.2%; P < .0001), a reduction in suture repairs (2.8% vs 1.5%; P < .0001), and an increase in retromuscular techniques (36.4% vs 52.4%; P < .001) in open surgery with mesh. In elective surgery, there was a decrease in the average length of stay (4.9 vs 3.8 days; P < .0001), the percentage of complications (27.9% vs 24.0%; P < .0001), reoperations (3.5% vs 1.4%; P < .0001), and mortality (0.6% vs 0.2%; P = .002). Long-term outcomes included a decrease in recurrences after 12 months (20.7% vs 14.5%; P < .0001) and in chronic pain (13.7% vs 2.5%; P < .0001) and chronic infections (9.1% vs 14.5%; P < .0001) after 6 months. CONCLUSION: In recent years, there has been a significant improvement in the outcomes of incisional hernia treatment. The registry serves as a fundamental tool for assessing the evolution of hernia treatment and enables the identification of key areas for improvement and the evaluation of treatment outcomes.

Demographic, functional and clinical characteristics in hip fracture patients according to mental status of the Spanish National Hip Fracture Registry.

OBJECTIVE: To describe the differences according to mental status at admission on the care process and 30-day outcomes in hip fracture patients, mainly regarding the use of rehabilitation resources and anti-osteoporotic medication, by analysing data from the Spanish National Hip Fracture Registry (RNFC, "Registro Nacional de Fracturas de Cadera" in Spanish). METHODS: We analysed prospectively collected data from a cohort of patients admitted participating in the Spanish National Hip Fracture Registry (RNFC) in 76 Spanish hospitals between 2017 and 2019. We classified participants using Short Portable Mental Status Questionnaire (SPMSQ), defining two groups: patients with ≤2 SPMSQ score and patients with >2 SPMSQ score. RESULTS: Of 21,254 patients was recorded SPMSQ in 17,242 patients, 9052 were >2 SPMSQ score (52.6%). These were older (87.7 vs. 85.3 years; p<0.001), had worse mobility (no-independent walking ability 26.0% vs. 4.5%; p<0.001) and were more likely to be living in nursing homes (35.3% vs. 9.6%; p<0.001). They were more likely to be treated nonoperatively (3.8% vs. 1.5%; p>0.001), less early mobilisation (57.5% vs. 68.9%; p<0.001) and suffered higher in-hospital mortality (5.2% vs. 2.7%; p<0.001). At discharge, they received less anti-osteoporotic medication (37.9% vs. 48.9%; p<0.001) and returned home less often (29.8%% vs. 51.2%; p<0.001). One month after fracture, patients with >2 SPMSQ score had poorer mobility (no-independent walking ability 44.4% vs. 24.9%; p<0.001) and were newly institutionalised in a nursing home more (12.6% vs. 12.0%; p<0.001) and were more likely to die by one-month post-fracture (9.5% vs. 4.6%; p<0.001). CONCLUSION: RNFC patients with >2 SPMSQ score were more vulnerable and had poorer outcomes than patients with ≤2 SPMSQ score, suggesting that they need specialised care in-hospital and in the recovery phase.

Strategies used by nurses regarding underreporting of rural work accidents due to pesticide use / Estrategias utilizadas por los enfermeros en relación con el subregistro de accidentes laborales rurales causados por el uso de plaguicidas / Estratégias utilizadas por enfermeiros sobre subnotificações de acidentes de trabalho rural por uso de agrotóxicos

ABSTRACT Objective: To learn the strategies used regarding underreporting of pesticide use in rural areas. Methods: A qualitative study was carried out in eight primary healthcare units in rural areas and two emergency care units in a municipality in southern Brazil. Data collection took place in 2023 through interviews. Twenty professional nurses participated. The data was submitted to content analysis. Results: The strategies identified were lifelong and continuing education for the professionals who carry out the notification, active search and training of workers who deal directly with this type of substance, computerizing the notification by filling in the forms online, and carrying out research on the subject. Final considerations: Nurses play an important role in reporting occupational accidents caused by the use of pesticides, improving occupational safety in rural areas.

RESUMEN Objetivo: Conocer las estrategias utilizadas para el subregistro del uso de plaguicidas en áreas rurales. Métodos: Estudio cualitativo realizado en ocho unidades de atención primaria en áreas rurales y dos unidades de atención de emergencia en un municipio del sur de Brasil. La recopilación de datos se realizó en 2023 mediante entrevistas. Participaron 20 profesionales de enfermería. Los datos fueron sometidos a análisis de contenido. Resultados: Las estrategias identificadas fueron la educación continua y permanente de los profesionales que realizan la notificación, la búsqueda activa y la capacitación de los trabajadores que tratan directamente con este tipo de sustancia, la informatización de la notificación mediante el llenado de los formularios en línea y la realización de investigaciones sobre el tema. Consideraciones finales: Los enfermeros desempeñan un papel importante en la notificación de accidentes laborales causados por el uso de plaguicidas, mejorando la seguridad laboral en las zonas rurales.

RESUMO Objetivo: Conhecer as estratégias utilizadas acerca das subnotificações por uso de agrotóxicos no meio rural. Método: Estudo qualitativo realizado em oito unidades básicas de regiões rurais e duas unidades de pronto atendimento de um município do sul do Brasil. A coleta de dados deu-se em 2023, por entrevistas. Participaram 20 profissionais enfermeiros. Os dados foram submetidos à análise de conteúdo. Resultados: Apontaram como estratégias a realização da educação permanente e continuada dos profissionais que realizam a notificação, a busca ativa e a capacitação dos trabalhadores que lidam diretamente com esse tipo de substância, a informatização da notificação por meio do preenchimento das fichas online e a realização de pesquisas acerca da temática. Considerações Finais: Os enfermeiros desempenham um papel importante na notificação de acidentes de trabalho pelo uso de agrotóxicos, melhorando a segurança ocupacional no meio rural.

Evaluación de la calidad de las estadísticas vitales de niños menores de cinco años. Colombia, 2000-2018

Introducción: Las estadísticas vitales son fundamentales para conocer las condiciones de salud de la población y diseñar intervenciones. De su calidad depende la precisión y validez de las métricas derivadas y la relevancia de las decisiones de política pública. Objetivo: Evaluar la calidad de las estadísticas vitales de niños menores de cinco años en Colombia, entre 2000 y 2018. Métodos: Estudio descriptivo y exploratorio. Se analizó la calidad de los registros de nacidos vivos y defunciones publicados por el DANE, utilizando los criterios recomendados por las Naciones Unidas: exactitud (precisión), cobertura (compleción) y oportunidad. Resultados: Se encontraron registros de nacimientos y defunciones con datos perdidos en categorías que indican gradiente social. El 8,2 % de los registros de defunción tenían como causa básica de muerte códigos poco útiles para la toma de decisiones en salud pública. El 97,8 % de los nacidos vivos fueron registrados durante el mismo año de ocurrencia. El subregistro de la mortalidad infantil se estimó en un 28,9 %, con diferencias entre territorios. Conclusiones: La calidad de las estadísticas vitales en niños menores de cinco años de Colombia mejoró en los 19 años evaluados, en particular en exactitud y oportunidad. Sin embargo, persisten problemas en la asignación de la causa básica de muerte y en el subregistro, con diferencias importantes entre territorios. Mejorar la calidad del sistema de estadísticas vitales debe ser un imperativo ético, en especial para comprender las poblaciones de áreas geográficas históricamente invisibilizadas en el país.

Introduction: Vital statistics are essential to identify the health conditions of a population and design interventions. Vital statistics are essential to understand population health and design public health interventions. The accuracy and validity of the derived metrics and the relevance of public policy decisions depend on its quality. Objetive: To evaluate the quality of the vital statistics of children under five years of age in Colombia, between 2000 and 2018. Methods: A descriptive and exploratory study was carried out and the quality of records of live births and deaths published by DANE was analyzed using the criteria suggested by the United Nations: accuracy (precision), opportunity, and coverage (completeness). Results: Of the death records, 8.2% show codes useless for public health purposes as underlying cause of death. Of the live births, 97.8% were registered during the same year of occurrence. We estimated the underregistration of infant mortality at 28.9%, with differences between territories. Conclusions: The quality of vital statistics of children under five years of age has improved in Colombia in the 19 years analyzed, particularly in accuracy and opportunity. However, problems persist in assigning the underlying cause of death and in underregistration, with significant differences between territories. Improving the quality of the vital statistics system must be an ethical imperative, especially to understand the populations of geographic areas historically invisible in the country.

Intensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis / Controle intensivo da glicose em adultos em estado grave: um protocolo de revisão sistemática e metanálise de dados individuais de pacientes

ABSTRACT Objective: The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults. Data sources: MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available. Methods: Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge. Primary endpoint: In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used. Discussion: This systematic review with aggregate and individual patient data will address the clinical question, 'what is the best blood glucose target for critically ill patients overall?' Protocol version 0.4 - 06/26/2023 PROSPERO registration: CRD42021278869

RESUMO Objetivo: Não está claro qual é a meta ideal de concentração de glicose no sangue em pacientes em estado grave. Realizaremos uma revisão sistemática e uma metanálise com dados agregados e de pacientes individuais de estudos controlados e randomizados, comparando o controle intensivo da glicose com o controle liberal da glicose em adultos em estado grave. Fontes de dados: MEDLINE®, Embase, Cochrane Central Register of Clinical Trials e registros de ensaios clínicos (Organização Mundial da Saúde, clinical trials.gov). Os autores dos estudos qualificados serão convidados a fornecer dados individuais de pacientes. Os dados publicados em nível de ensaio qualificado que não apresentem alto risco de viés serão incluídos em uma metanálise de dados agregados se os dados individuais de pacientes não estiverem disponíveis. Métodos: Critérios de inclusão: ensaios clínicos controlados e randomizados que recrutaram pacientes adultos, com meta de glicemia ≤ 120mg/dL (≤ 6,6mmol/L) comparada a uma meta de concentração de glicemia mais alta com insulina intravenosa em ambos os grupos. Estudos excluídos: aqueles com meta de glicemia no limite superior no grupo de intervenção > 120mg/dL (> 6,6mmol/L), ou em que o controle intensivo de glicose foi realizado apenas no período intraoperatório, e aqueles em que a perda de seguimento excedeu 10% até a alta hospitalar. Desfecho primário: Mortalidade intra-hospitalar durante a admissão hospitalar. Desfechos secundários: Mortalidade e sobrevida em outros momentos, duração da ventilação mecânica invasiva, agentes vasoativos e terapia de substituição renal. Utilizaremos metanálise bayesiana de efeito randômico e modelos bayesianos hierárquicos para dados individuais de pacientes. Discussão: Essa revisão sistemática com dados agregados e de pacientes individuais abordará a questão clínica: Qual é a melhor meta de glicose no sangue de pacientes graves em geral? Protocolo versão 0.4 - 26/06/2023 Registro PROSPERO: CRD42021278869

Registro ARGEN-IAM-ST: infarto de miocardio con elevación del segmento ST en el "nuevo" adulto mayor / ARGEN-IAM-ST Registry: ST-elevation myocardial infarction in "new" older adults

RESUMEN Introducción: La Organización Mundial de la Salud (OMS) considera adulto mayor (AM) a las personas que tienen 60 años o más. Es sabido que la mortalidad por infarto agudo de miocardio (IAM) aumenta a edades más avanzadas, pero siempre se han utilizado umbrales de edad mayores que el propuesto por la OMS, por lo cual describir las características y evolución intrahospitalaria de este subgrupo (de acuerdo con la definición de la OMS) se torna relevante. Objetivos: 1) conocer la prevalencia de los AM según la OMS, con IAM con elevación del segmento ST en Argentina y 2) com- parar sus características, tratamientos de reperfusión y mortalidad con los adultos jóvenes. Material y métodos: Se analizaron los pacientes ingresados en el Registro Nacional de Infarto (ARGEN-IAM-ST). Se compara- ron las características clínicas, tratamientos y evolución de los AM y los adultos jóvenes. Resultados: Se incluyeron 6676 pacientes, de los cuales 3626 (54,3%) eran AM. Los AM fueron más frecuentemente mujeres (37,6% vs. 31,4%, p <0,001), hipertensos (67,8% vs. 47%, p <0,001), diabéticos (26,1% vs. 19,9%, p <0,001), dislipidémicos (45,4% vs. 37%, p <0,001), y tuvieron más antecedentes coronarios (16% vs. 10,3%, p <0,001). El tiempo a la consulta de los AM fue mayor (120 min vs. 105 min, p <0,001) con similar tiempo total de isquemia (314 min vs. 310 min, p = 0,33). Recibi- eron menos tratamiento de reperfusión (89,9% vs. 88,6%, p = 0,04) y más angioplastia primaria (91 % vs. 87,4%, p <0,001). Tuvieron más insuficiencia cardíaca (27,3% vs. 18,5%, p <0,001), similar incidencia de sangrado (3,7 vs. 3,1%, p = 0,33) y una mortalidad significativamente mayor (11,4% vs. 5,5%, p <0,001). Ser AM fue predictor independiente de mortalidad. Conclusiones: Más de la mitad de los IAM en nuestro país ocurren en AM. Los pacientes mayores tienen menor probabilidad de recibir reperfusión, más insuficiencia cardíaca y el doble de la mortalidad que los pacientes menores de 60 años.

ABSTRACT Background: The World Health Organization (WHO) defines an Older Adult (OA) as any individual aged 60 or older. It is known that mortality due to acute myocardial infarction (AMI) increases with age, but age thresholds higher than those proposed by the WHO have been consistently used; therefore, describing the characteristics and in-hospital progress of this subgroup of patients, in accordance with the WHO definition, becomes relevant. Objectives: 1) To know the prevalence of OA with acute ST-elevation myocardial infarction (STEMI) in Argentina according to the WHO, and 2) to compare their characteristics, reperfusion treatments, and mortality against those in young adults. Methods: Patients included in the National Registry of ST- Elevation Myocardial Infarction (Registro Nacional de Infarto con Elevación del ST, ARGEN-IAM-ST) were analyzed. Clinical features, therapies, and progress were compared in OA versus young adults. Results: A total of 6676 patients were enrolled, 3626 of which (54.3%) were OA. OA were mostly female (37.6% vs 31.4%, p <0.001), had hypertension (67.8% vs 47%, p <0.001), diabetes (26.1% vs 19.9%, p <0.001), dyslipidemia (45.4% vs 37%, p <0.001), and a longer coronary artery disease history (16% vs 10.3%, p < 0.001). The time to consultation in OA was longer (120 min vs 105 min, p <0.001), with a similar total ischemic time (314 min vs 310 min, p = 0.33). They received less reperfu- sion treatment (89.9% vs 88.6%, p = 0.04) and more primary angioplasty (91% vs 87.4%, p <0.001). Heart failure was more common in OAs (27.3% vs 18.5%, p <0.001), with a similar bleeding incidence (3.7% vs 3.1%, p = 0.33), and significantly higher mortality (11.4% vs 5.5%, p<0.001). Being an OA was an independent mortality predictor. Conclusions: More than half the cases of AMI in our country occur in OA. Older patients are less likely to receive reperfusion, more likely to have heart failure, and show twice the rate of mortality as compared to patients under 60.

Descompresión neurovascular en neuralgia trigeminal: resultado funcional / Neurovascular decompression in trigeminal neuralgia: Functional outcome

Resumen Introducción : La afección más frecuente del V nervio craneal es la neuralgia del trigémino (NT), se caracteriza por dolor orofacial unilateral, paroxístico, distribuyén dose en una o más divisiones del nervio trigémino. El objetivo de presente trabajo es demostrar la eficacia y seguridad de la cirugía descompresiva neurovascular (DNV). Métodos : Estudio analítico retrospectivo, pacientes intervenidos para DNV por NT (n: 155), desde enero de 2006 - 2022, mediante un abordaje retrosigmoideo y seguimiento clínico-radiológico, cuyo registro intraope ratorio fue en sistema 3D (n: 42). Resultados : 83.3% (n=35) presentó NT clásica y 16.7% (n = 7) idiopática. La mayoría con afectación del lado derecho 59.5% (n = 25) y el dolor paroxístico con 81% (n = 34). La compresión de origen arterial representó 76.2% (n: 32) de los casos, la arteria cerebelosa superior representó la primera causa de compresión neurovas cular (CNV) en un 52.4% (n:22) en la zona de salida del nervio trigémino. Se analizó la validez del protocolo de resonancia magnética (RM) seleccionado para esta serie; evidenciando una alta sensibilidad de la RM con 97%, y una especificidad del 86%. Conclusión : Se demostró la sensibilidad y especi ficidad de los estudios de resonancia magnética (RM) de alta definición y con protocolos especiales para la evaluación de la NT, como paraclínico estándar de oro. La DNV ofreció resultados seguros, un alto porcentaje de los pacientes se calificaron como exitosos. El registro 3D permitió analizar en retrospectiva con una visión idéntica a la del cirujano durante el intraoperatorio, el tipo de CNV.

Abstract Introduction : The most frequent pathology of the fifth cranial nerve is trigeminal neuralgia (TN), characterized by unilateral orofacial pain, of a paroxysmal nature, with distribution in one or more divisions of the trigeminal nerve. The main objective of this work is to demonstrate the efficacy and safety of neurovascular decompressive surgery (NVD). Methods : Retrospective analytical study, patients operated on for NVD by TN (n: 155), from January 2006 - 2022, using a retrosigmoid approach and clinical-radiological follow-up, whose intraoperative recording was in 3D system (n: 42). Results : 83.3% (n=35) presented classic NT and 16.7% (n = 7) idiopathic. The right side prevailed with 59.5% (n = 25) and paroxysmal pain with 81% (n=34) of rep resentation in the entire series. Compression of arte rial origin represented 76.2% (n: 32) of the cases, the superior cerebellar artery represented the first cause of neurovascular compression (NVC) in 52.4% (n: 22) in the exit zone of the trigeminal nerve. The validity of the magnetic resonance imaging (MRI) protocol selected for this series was analyzed; evidencing a high sensitivity of MRI with 97%, and a specificity of 86%. Conclusion : The sensitivity and specificity of high-definition MRI studies and with special protocols for the evaluation of TN, as gold standard paraclinical, were presented. The DNV offered safe results, a high percent age of the patients were described as successful. The 3D recording allowed retrospective analysis with a vision identical to that of the surgeon during the intraoperative period, the type of NVC.

Registro español de hemodinámica y cardiología intervencionista. XXXII informe oficial de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2022) / Spanish cardiac catheterization and coronary intervention registry. 32nd official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2022)

Introducción y objetivos: Se presenta el informe de actividad del año 2022 de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC). Métodos: Se invitó a todos los laboratorios de hemodinámica a participar en el registro. La recogida de datos se realizó a través de un cuestionario telemático. Una empresa externa realizó el análisis de datos, revisados por la junta directiva de la ACI-SEC. Resultados: Participaron 111 centros. El número de estudios diagnósticos aumentó un 4,8% con respecto a 2021, y el número de intervenciones coronarias percutáneas (ICP) se mantuvo estable. Las ICP sobre tronco coronario izquierdo aumentaron un 22%. El abordaje radial sigue siendo preferencial para las ICP (94,9%) y se observa un incremento de uso del balón farmacoactivo. El uso de técnicas de imagen intracoronaria se ha incrementado y se utilizan en el 14,7% de las ICP. También aumenta el uso de guía de presión (el 6,3% con respecto a 2021) y técnicas de modificación de placa. Sigue creciendo la ICP primaria, el tratamiento más frecuente (97%) en el infarto agudo de miocardio con elevación del segmento ST. La mayoría de los procedimientos no coronarios mantienen su tendencia creciente; destacan los implantes percutáneos de válvula aórtica, el cierre de orejuela, la técnica borde-a-borde mitral/tricuspídea, la denervación renal y el tratamiento de la enfermedad de la arteria pulmonar. Conclusiones: El Registro español de hemodinámica y cardiología intervencionista de 2022 demuestra un incremento en la complejidad de la enfermedad coronaria y un crecimiento notable de los procedimientos en cardiopatía estructural valvular y no valvular.(AU)

Introduction and objectives: This article presents the annual activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) for the year 2022. Methods: All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company in collaboration with the members of the board of the ACI-SEC. Results: A total of 111 centers participated. The number of diagnostic studies increased by 4.8% compared with 2021, while that of percutaneous coronary interventions (PCI) remained stable. PCIs on the left main coronary artery increased by 22%. The radial approach continued to be preferred for PCI (94.9%). There was an upsurge in the use of drug-eluting balloons, as well as in intracoronary imaging techniques, which were used in 14.7% of PCIs. The use of pressure wires also increased (6.3% vs 2021) as did plaque modification techniques. Primary PCI continued to grow and was the most frequent treatment (97%) in ST-segment elevation myocardial infarction. Most noncoronary procedures maintained their upward trend, particularly percutaneous aortic valve implantation, atrial appendage closure, mitral/tricuspid edge-to-edge therapy, renal denervation, and percutaneous treatment of pulmonary arterial disease. Conclusions: The Spanish cardiac catheterization and coronary intervention registry for 2022 reveals a rise in the complexity of coronary disease, along with a notable growth in procedures for valvular and nonvalvular structural heart disease.(AU)

Impact of SARS-CoV-2 infection in patients with cardiac amyloidosis: Results of a multicentre registry / Impacto de la infección por SARS-CoV-2 en pacientes con amiloidosis cardiaca: resultados de un registro multicéntrico

Background Descriptions on impact of SARS-CoV-2 infection in patients with cardiac amyloidosis (CA) are lacking. Our aim was to describe the prognosis of those patients. Methods Retrospective observational study of unvaccinated patients with CA who developed SARS-CoV-2 infection enrolled in eleven centres (March 2020 to May 2021). Descriptive analysis of basal characteristics, hospitalization, mortality, and severe clinical course was performed. Comparisons to a population-based control group were made. Results Forty-one patients were identified. Most patients had wild-type transthyretin CA (61%) and were on NYHA Class II–III (80.5%). CA patients were commonly hospitalized (73.2%) and those were more symptomatic than outpatients (p=0.035). The 24.4% of CA patients died as consequence of SARS-CoV-2 infection. Patients with CA had an increased risk of hospitalization [OR 6.23 (3.05–12.74), p<0.001] and mortality [OR 2.18 (1.01–4.68), p=0.047] when compared to control population after adjustment by age and sex. After a medium follow-time of 311 days, 41.5% of the CA cohort died. Conclusions SARS-CoV-2 infection is associated with high mortality and hospitalization rates in patients with CA, which exceed that expected by their sex and advanced age (AU)

Antecedentes El impacto de la infección por SARS-CoV-2 en pacientes con amiloidosis cardíaca (AC) es desconocido. El principal objetivo de este estudio es describir el pronóstico de estos pacientes. Métodos Estudio observacional retrospectivo de pacientes con AC no vacunados que desarrollaron infección por SARS-CoV-2 identificados en 11 centros (marzo 2020/mayo 2021). Se realiza un análisis descriptivo de características basales, hospitalización, mortalidad y curso clínico grave, y se comparan los resultados con una cohorte poblacional. Resultados Cuarenta y un pacientes fueron identificados. La mayoría eran AC por transtirretina wild-type (61%) y estaban en clase NYHA II-III (80,5%). La mayoría de los pacientes fueron hospitalizados (73,2%), los cuales tenían peor clase funcional que los ambulatorios (p=0,035). El 24,4% de los pacientes fallecieron como consecuencia de la infección. Los pacientes con AC tenían un mayor riesgo de hospitalización (OR: 6,23; 3.05-12.74; p<0,001) y fallecimiento (OR: 2,18; 1,01-4,68; p=0,047) que la cohorte poblacional tras ajuste por sexo y edad. Tras un seguimiento medio de 311 días, el 41,5% de los pacientes fallecieron. Conclusiones La infección por SARS-CoV-2 presenta alto riesgo de mortalidad y hospitalización en pacientes con AC, mayor que la esperada por su sexo y edad (AU)

Implicaciones jurídicas de los sistemas de notificación y registro de eventos adversos en la esfera sanitaria / [Legal implications of notification and registration systems for adverse events in the healthcare sphere]

La notificación de eventos adversos constituye uno de los instrumentos esenciales de cara a la consecución de mejoras significativas en materia de seguridad del paciente. El presente trabajo pretende concretar las implicaciones jurídicas de las pautas sentadas a nivel internacional (OMS, Consejo de Europa y UE) de cara al establecimiento de un marco legal nacional favorable a la notificación de eventos adversos en la esfera sanitaria. (AU)

The reporting of adverse events is one of the key elements in achieving significant improvements in the field of patient safety. Based on international guidelines (WHO, Council of Europe and EU) this paper aims to analyse their juridical implications when settling a national legal framework for reporting adverse events in the sphere of healthcare. (AU)

Denegación de cambio de sexo registral: comentario al Auto del Magistrado del Registro Civil Único de Las Palmas de Gran Canaria de 18/09/2023 / [Denial of change of registration sex: comment to the Order of the Magistrate of the Single Civil Registry of Las Palmas de Gran Canaria of 09/18/2023]

El presente trabajo analiza el Auto 1045/2023, de fecha 18 de septiembre. Resolución que iba a suponer, a la postre, la denegación de la solicitud de un ciudadano que había pretendido, amparándose en Ley 4/2023, del 28 de febrero, una rectificación registral de la mención relativa al sexo, de varón a mujer, conservando su nombre. (AU)

This work analyzes Auto 1045/2023, dated September 18th. This resolution was going to result in the denial of a citizen’s request who, relying on Law 4/2023, dated February 28th, had sought a registry correction regarding gender, from male to female, while retaining his name. (AU)

Surgery for inflammatory bowel disease in Spain: How are we doing? Initial results of a nationwide prospective registry.

INTRODUCTION: Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), requires a multidisciplinary approach, and surgery is commonly needed. The aim of this study was to evaluate the types of surgery performed in these patients in a nationwide study by hospital type, global postoperative complications, and quality of life after surgery. METHODS: A prospective, multicenter, national observational study was designed to collect the results of surgical treatment of IBD in Spain. Demographic characteristics, medical-surgical treatments, postoperative complications and quality of life were recorded with a one-year follow-up. Data were validated and entered by a surgeon from each institution. RESULTS: A total of 1134 patients (77 centers) were included: 888 CD, 229 UC, and 17 indeterminate colitis. 1169 surgeries were recorded: 882 abdominal and 287 perianal. Before surgery, 81.6% of the patients were evaluated by a multidisciplinary committee, and the mean preoperative waiting time for elective surgery was 2.09 ± 2 meses (P > .05). Overall morbidity after one year of follow-up was 16%, and the major complication rate was 36.4%. Significant differences were observed among centers in complex CD surgeries. Overall quality of life improved after surgery. CONCLUSIONS: There is heterogeneity in the surgical treatment of IBD among Spanish centers. Differences were observed in patients with highly complex surgeries. Overall quality of life improved with surgical treatment.

Open vs. minimally invasive sublay incisional hernia repair. Is there a risk of overtreatment? EVEREG registry analysis.

INTRODUCTION: Incisional hernia (IH) is a very common surgical procedure. Registries provide real world data. The objective is to analyze the open and minimally invasive (MIS) sublay technique (with or without associated components separation [CS]) in IH cases from the EVEREG registry and to evaluate the evolution over time of the techniques. METHODS: All patients in EVEREG from July 2012 to December 2021 were included. The characteristics of the patients, IH, surgical technique, complications and mortality in the first 30 days were collected. We analyzed Group 1 (open sublay vs MIS sublay, without CS), Group 2 (open sublay vs MIS sublay, with CS) and Group 3 where the evolution of open and MIS techniques was evaluated over time. RESULTS: 4867 IH were repaired using a sublay technique. Group 1: 3739 (77%) open surgery, mostly midline hernias combined (P = .016) and 55 (1%) MIS, mostly lateral hernias (LH) (P = .000). Group 2: 1049 (21.5%) open surgery and 24 (0.5%) MIS. A meaningful difference (P = .006) was observed in terms of transverse diameters (5.9 (SD 2.1) cm for the MIS technique and 10.11 (SD 4.8) for the open technique). The LH MIS associated more CS (P = .002). There was an increase in the use of the sublay technique over time (with or without CS). CONCLUSION: Increased use of the sublay technique (open and MIS) over time. For some type of hernia (LH) the MIS sublay technique with associated CS may have represented an overtreatment.