Short-Term Blood Pressure Variability Relates to the Presence of Subclinical Brain Small Vessel Disease in Primary Hypertension.

Blood pressure (BP) variability is associated with stroke risk, but less is known about subclinical cerebral small vessel disease (CSVD). We aimed to determine whether CSVD relates to short-term BP variability independently of BP levels and also, whether they improve CSVD discrimination beyond clinical variables and office BP levels. This was a cohort study on asymptomatic hypertensives who underwent brain magnetic resonance imaging and 24-hour ambulatory BP monitoring. Office and average 24-hour, daytime and nighttime BP levels, and several metrics of BP variability (SD, weighted SD, coefficient of variation, and average real variability [ARV]) were calculated. Definition of CSVD was based on the presence of lacunar infarcts and white matter hyperintensity grades. Multivariate analysis and integrated discrimination improvement were performed to assess whether BP variability and levels were independently associated with CSVD and improved its discrimination. Four hundred eighty-seven individuals participated (median age, 64; 47% women). CSVD was identified in 18.9%, related to age, male sex, diabetes mellitus, use of treatment, ambulatory BP monitoring-defined BP levels, and ARV of systolic BP at any period. The highest prevalence (33.7%) was found in subjects with both 24-hour BP levels and ARV elevated. BP levels at any period and ARV (24 hours and nocturnal) emerged as independent predictors of CSVD, and discrimination was incrementally improved although not to a clinically significant extent (integrated discrimination improvement, 5.31%, 5.17% to 5.4%). Ambulatory BP monitoring-defined BP levels and ARV of systolic BP relate to subclinical CSVD in hypertensive individuals.

Gender differences and woman-specific trends in acute stroke: results from a hospital-based registry (1986-2009).

OBJECTIVE: We assessed gender differences and women-specific secular trends in stroke. METHODS: Data from 2318 women and 2274 men with first-ever stroke collected from the Sagrat Cor Hospital Stroke Registry of Barcelona between 1986 and 2009 were analyzed. RESULTS: Patient's age increased significantly from a mean of 74.5 years in 1986-1992 to 81.2 years in 2004-2009 (P < 0.001). Patients aged ≥ 85 years increased from 18.5% to 38.5% (P = 0.0001) as were patients with hypertension, atrial fibrillation, and cardioembolic stroke. The in-hospital death decreased from 17.6% to 11% (P = 0.02), median length of hospital from 14 to 9 days (P = 0.0001) and prolonged hospital stay (> 12 days) from 59.7% to 33.7% (P = 0.0001). Lacunar infarction was more frequent in men (21.5% vs. 16.2%, P = 0.0003) and cardioembolic infarction in women (26% vs. 15.6%, P = 0.0001). Acute stroke in women continues to be a severe disease with high risk of death in the immediate post-stroke phase (13.5%) and low probability of early full neurological recovery (13.9% vs. 11.8%, P = 0.029). CONCLUSION: Women differ from men in the distribution of risk factors and stroke subtype, stroke severity, and outcome. An increase in the patient's age, hypertension, atrial fibrillation and cardioembolic infarction, as well as a decrease mortality and length of hospitalization over a 24-year period was recorded.

Resultados de una encuesta nacional dirigida a especialistas sobre la evaluación clínica de pacientes con incontinencia fecal / Results of national survey of specialists on the clinical evaluation of faecal incontinence

Introducción La incontinencia fecal es un trastorno de elevada prevalencia en la población general. El objetivo del estudio fue conocer qué sistemas de evaluación de gravedad de incontinencia fecal se utilizan en España, y conocer si hay diferencias en su utilización entre los especialistas que atienden a estos pacientes. Material y métodos Se envió una encuesta a todos los hospitales de la red pública de salud del Estado español para conocer la actitud y la opinión de los especialistas en cirugía general y digestiva y en gastroenterología respecto a la evaluación clínica de los pacientes con incontinencia fecal. Resultados Obtuvimos 99 encuestas cumplimentadas (65 de especialistas en cirugía general y digestiva y 34 de gastroenterología). Sólo el 41,8% utiliza sistemáticamente un diario defecatorio para la evaluación de estos pacientes (el 46,8% en cirugía frente al 32,3% en gastroenterología; p=0,05). El sistema de puntuación de Wexner es el más empleado en la actividad clínica (el 85,9% en cirugía frente al 50% en gastroenterología; p=0,001). Los aspectos considerados más relevantes al evaluar a estos pacientes fueron: tipo de incontinencia fecal, frecuencia de los escapes y calidad de vida. El 85,5% de los sujetos encuestados consideran que lo que debería mejorar es que los sistemas de evaluación fueran universalmente aceptados por todos los especialistas y el 98,9%, que sería de gran utilidad realizar un plan de información para el uso homogéneo de sistemas de evaluación de pacientes con incontinencia fecal en España (AU)

Introduction Faecal incontinence is a high prevalence disease in the general population. The aims of this study were to analyse which severity grading systems of faecal incontinence are used in Spain and to find out if there are differences in their use among specialists who manage these patients. Material and methods A postal questionnaire survey was sent to all hospitals of the National Health Service in Spain in order to study the attitudes and opinions of general surgery and gastroenterology specialists regarding the clinical evaluation of patients with faecal incontinence. Results Ninety-nine questionnaires were returned fully completed (65 surgeons and 34 gastroenterologists). Only 41.8% of responders used a diary card systematically (46.8% surgeons vs. 32.3% gastroenterologists; p=0.05). The Wexner score is the most widely grading system used in clinical practice (85.8% surgeons vs. 50% gastroenterologists; p=0.01). The most relevant issues in the evaluation of these patients were considered: Type of faecal incontinence, frequency of leakage and quality of life. Finally, 85.5% of those questioned said that the universal acceptance of severity grading systems by all specialists would be an improvement, and 98.9% considered it useful to start a national plan of information regarding clinical evaluation of faecal incontinence in Spain. Conclusions There is variability in how faecal incontinence is evaluated among specialists in Spain (AU)

[Results of national survey of specialists on the clinical evaluation of faecal incontinence]. / Resultados de una encuesta nacional dirigida a especialistas sobre la evaluación clínica de pacientes con incontinencia fecal.

INTRODUCTION: Faecal incontinence is a high prevalence disease in the general population. The aims of this study were to analyse which severity grading systems of faecal incontinence are used in Spain and to find out if there are differences in their use among specialists who manage these patients. MATERIAL AND METHODS: A postal questionnaire survey was sent to all hospitals of the National Health Service in Spain in order to study the attitudes and opinions of general surgery and gastroenterology specialists regarding the clinical evaluation of patients with faecal incontinence. RESULTS: Ninety-nine questionnaires were returned fully completed (65 surgeons and 34 gastroenterologists). Only 41.8% of responders used a diary card systematically (46.8% surgeons vs. 32.3% gastroenterologists; p = 0.05). The Wexner score is the most widely grading system used in clinical practice (85.8% surgeons vs. 50% gastroenterologists; p = 0.01). The most relevant issues in the evaluation of these patients were considered: Type of faecal incontinence, frequency of leakage and quality of life. Finally, 85.5% of those questioned said that the universal acceptance of severity grading systems by all specialists would be an improvement, and 98.9% considered it useful to start a national plan of information regarding clinical evaluation of faecal incontinence in Spain. CONCLUSIONS: There is variability in how faecal incontinence is evaluated among specialists in Spain.