Variabilidad clínica del síndrome de ovario poliquístico / Clinical variability in polycystic ovary syndrome

Introducción: El síndrome de ovario poliquístico es la forma más común de anovulación crónica relacionada con exceso de andrógenos. La prevalencia oscila según el criterio diagnóstico utilizado entre 4-21 pòr ciento. Objetivo: Describir las características clínicas de las pacientes con síndrome de ovario poliquístico. Métodos: Se seleccionaron los consensos hasta ahora realizados y artículos originales de los último 10 años, disponibles en los siguientes buscadores: Pubmed, Medscape, Scielo, Bireme. Se consideraron otras publicaciones que por su importancia clínica no han sido replicados. Conclusiones: La variedad de fenotipos presentes en el SOP hace que las manifestaciones clínicas y factores de riesgo para otras morbilidades sean heterogéneas. La influencia que ejerce además su etiopatogenia, no completamente dilucidada, hace que el diagnóstico y por consiguiente el manejo actual de estas pacientes tenga un enfoque multidisciplinario, individualizado y enfocado a las prioridades e inconformidades que puedan afectar su calidad de vida(AU)

Introduction: Polycystic ovary syndrome (PCOS) is the most common form of chronic anovulation related to androgen excess. The prevalence ranges according to the diagnostic criteria used between 4-21 percent. Objective: To describe the clinical characteristics of patients with polycystic ovary syndrome. Methods: The consensuses and original articles of the last 10 years were selected, which were available in the following search engines: Pubmed, Medscape, Scielo, and Bireme. Other publications that due to their clinical importance have not been replicated were considered. Conclusions: The variety of phenotypes present in the polycystic ovary syndrome makes the clinical manifestations and risk factors for other morbidities heterogeneous. The influence exerted also by its etiopathogenesis, not completely elucidated, causes the diagnosis and therefore the current management of these patients to have a multidisciplinary approach which is individualized and focused on the priorities and nonconformities that may affect the patients' quality of life(AU)

Ventilación mecánica en España, 1998-2016: cambios en la desconexión de la ventilación mecánica / Mechanical ventilation in Spain, 1998-2016: changes in the disconnection of mechanical ventilation

Objetivo Evaluar los cambios en la desconexión de la ventilación mecánica en España desde 1998 hasta 2016. Diseño Análisis post-hoc de 4 estudios de cohorte. Ámbito Un total de 138 UCI. Enfermos Un total de 2.141 enfermos extubados de forma programada. Intervenciones Ninguna. Variables de interés principales Demográficas, motivo de ventilación mecánica, complicaciones, métodos para la desconexión, fracaso del primer intento de desconexión, duración de la desconexión, reintubación, traqueotomía post-reintubación, estancia y mortalidad en la UCI. Resultados Se observa un aumento significativo (p<0,001) en la presión de soporte como técnica de desconexión. Ha aumentado, a lo largo del tiempo, la probabilidad ajustada de utilizar la presión de soporte progresivamente decreciente frente a una prueba de ventilación espontánea, tanto para el primer intento de desconexión (referencia estudio de 1998: odds ratio 0,99 en 2004, 0,57 en 2010 y 2,43 en 2016) como para la desconexión difícil/prolongada (referencia estudio de 1998: odds ratio 2,29 en 2004, 1,23 en 2010 y 2,54 en 2016). La proporción de extubación tras el primer intento de desconexión ha aumentado con el tiempo. Hay una disminución del tiempo dedicado a la desconexión (desde un 45% en 1998 hasta un 36% en 2016). Sin embargo, no ha disminuido la duración en la desconexión difícil/prolongada (mediana 3 días en todos los estudios, p=0,435). Conclusiones Ha habido cambios significativos en el modo de desconexión de la ventilación mecánica, con un aumento progresivo del uso de la presión de soporte. Se han observado mínimos cambios en los desenlaces (AU)

Purpose To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. Design Post-hoc analysis of four cohort studies. Ambit 138 Spanish ICUs. Patients 2141 patients scheduled extubated. Interventions None. Variables of interest Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. Results There was a significant increase (p<0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p=0.435). Conclusions There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed (AU)

Mechanical ventilation in Spain, 1998-2016: Changes in the disconnection of mechanical ventilation.

PURPOSE: To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. DESIGN: Post-hoc analysis of four cohort studies. AMBIT: 138 Spanish ICUs. PATIENTS: 2141 patients scheduled extubated. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. RESULTS: There was a significant increase (p < 0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p = 0.435). CONCLUSIONS: There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.

Mechanical ventilation in Spain, 1998-2016: changes in the disconnection of mechanical ventilation. / Ventilación mecánica en España, 1998-2016: cambios en la desconexión de la ventilación mecánica.

PURPOSE: To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. DESIGN: Post-hoc analysis of four cohort studies. AMBIT: 138 Spanish ICUs. PATIENTS: 2141 patients scheduled extubated. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. RESULTS: There was a significant increase (p<0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p=0.435). CONCLUSIONS: There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.

Mechanical ventilation in Spain, 1998-2016: Epidemiology and outcomes. / Ventilación mecánica en España, 1998-2016: epidemiología y desenlaces.

PURPOSE: To evaluate changes in the epidemiology of mechanical ventilation in Spain from 1998 to 2016. DESIGN: A post hoc analysis of four cohort studies was carried out. SETTING: A total of 138 Spanish ICUs. PATIENTS: A sample of 4293 patients requiring invasive mechanical ventilation for more than 12h or noninvasive ventilation for more than 1h. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographic variables, reason for mechanical ventilation, variables related to ventilatory support (ventilation mode, tidal volume, PEEP, airway pressures), complications during mechanical ventilation, duration of mechanical ventilation, ICU stay and ICU mortality. RESULTS: There was an increase in severity (SAPSII: 43 points in 1998 vs. 47 points in 2016), changes in the reason for mechanical ventilation (decrease in chronic obstructive pulmonary disease and acute respiratory failure secondary to trauma, and increase in neurological disease and post-cardiac arrest). There was an increase in noninvasive mechanical ventilation as the first mode of ventilatory support (p<0.001). Volume control ventilation was the most commonly used mode, with increased support pressure and pressure-regulated volume-controlled ventilation. A decrease in tidal volume was observed (9ml/kg actual b.w. in 1998 and 6.6ml/kg in 2016; p<0.001) as well as an increase in PEEP (3cmH2O in 1998 and 6cmH2O in 2016; p<0.001). In-ICU mortality decreased (34% in 1998 and 27% in 2016; p<0.001), without geographical variability (median OR 1.43; p=0.258). CONCLUSIONS: A significant decrease in mortality was observed in patients ventilated in Spanish ICUs. These changes in mortality could be related to modifications in ventilation strategy to minimize ventilator-induced lung injury.

Pharmacological venous thromboembolism prophylaxis in radical prostatectomy. / Profilaxis farmacológica de la tromboembolia venosa en la prostatectomía radical.

BACKGROUND AND AIM: Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application. MATERIAL AND METHODS: Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed. RESULTS: The average age was 65.22years (48-78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24hours. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis. CONCLUSIONS: In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique.

Request of thyroid function tests from Primary Care in Spain.

BACKGROUND AND OBJECTIVES: Laboratory tests are crucial for diagnosis and monitoring of thyroid disorders. It is therefore necessary to study the pattern and variability in requests of thyroid function tests. The study objectives were to compare the inter-regional variability in the request of laboratory thyroid tests by general practitioners (GPs) in Spain, and to investigate the potential economic savings if the goals set for some suitability indicators were reached. METHODS: Test requests per 1,000 inhabitants and test ratios (free thyroxine (FT4)/thyrotropin (TSH), free triiodothyronine (FT3)/TSH, thyroglobulin antibody (TgAb)/peroxidase antibody (TPOAb)) were compared between the different areas, according to their setting, location, and management. The resulting savings if each department achieved the goals for indicator (0.25 for FT4/TSH, 0.1 for FT3/TSH) were estimated. RESULTS: Seventy-six laboratories covering a population of 17,679,195 inhabitants participated in the study. TSH was requested significantly less in urban-rural areas, and the requests for FT3/1,000 inhabitants, FT3/TSH, and TgAb/TPOAb were higher in departments with private management. The savings generated if specifications for the ratios of related tests were met would be 937,260.5 €. CONCLUSIONS: The high variability reported in requests for thyroid function and autoimmunity tests in Spain suggests the need for implementing strategies to improve use of such tests.