Impacto del confinamiento por COVID-19 en la prescripción de benzodiacepinas / Impact of COVID-19 lockdown on the prescription of benzodiazepines

Objetivo: Evaluar el efecto del confinamiento por COVID-19 sobre la prescripción de benzodiacepinas según edad, sexo y zona básica de salud. Diseño: Estudio observacional longitudinal. Emplazamiento: Atención primaria. Área V de Salud del Principado de Asturias. Participantes: Mayores de 15 años a los que se prescribieron benzodiacepinas entre 2017 y 2020. Mediciones principales: Diferencia de las medias de dosis diaria definida por 1.000 habitantes (DHD) mensual de benzodiacepinas entre el periodo definido como preconfinamiento y el confinamiento. Además, se ajusta la diferencia por edad, sexo y zona básica de salud, así como por la interacción entre ellas. Resultados: La DHD media preconfinamiento fue 131,3 y 139,5 durante el confinamiento; en el análisis crudo, esta diferencia fue estadísticamente significativa (IC 95% 4,1 a 12,1). Se objetivó un aumento de DHD media en el grupo de 60-74 años (IC 95% 2,28 a 21,42) y en el de 90 años o más (IC 95% 21,31 a 40,63), así como en las mujeres (IC 95% 3,51 a 14,59). Finalmente, se observó una disminución de DHD media en las zonas básicas V11 (IC 95% -29 a -0,66) y V14 (IC 95% -54,28 a -25,04). Conclusiones: Determinados subgrupos muestran un cambio en la tendencia de dispensación de benzodiacepinas sin poder atribuirse completamente al confinamiento. Creemos que pueda existir una inercia terapéutica en la prescripción de psicofármacos, según las características biopsicosociales del paciente, que es importante detectar para evitar la medicalización de cuadros psicológicos.(AU)

Objective: To evaluate the effect of COVID-19 lockdown on the prescription of benzodiazepines by gender, age and district health departments. Design: Longitudinal observational study. Location: Primary care. Asturias (Spain) health district V. Participants: People over 15 years of age with filled benzodiazepine prescriptions in between 2017 and 2020. Main measurements: Benzodiazepine DHD (defined daily dose per 1000 habitants) mean difference between the period defined as pre-lockdown and lockdown. Additionally, the difference was adjusted for gender, sex and district health department and also with the interaction among them. Results: DHD mean pre-lockdown was 131.3 and 139.5 in the lockdown; this difference was significant in the global analysis (95% CI: 4.1–12.1). There was an increase in the DHD mean in the 60–74 age group (95% CI: 2.28–21.42), in the group over 90 years old (95% CI: 21.31–40.63) and in women (95% CI: 3.51–14.59). Finally, a decrease in the DHD mean of V11 (95% CI: -29 to -0.66) and V14 (95% CI: -54.28 to -25.04) district health departments was observed.Conclusions: Certain subgroups show a change in the pattern of benzodiazepine prescription without being able to relate this to the lockdown. We believe that there could be some inertia in the prescription of psychiatric medication according to the biopsychosocial characteristics of the patients; it is important to detect this in order to avoid the medicalization of psychological disorders.(AU)

[Impact of COVID-19 lockdown on the prescription of benzodiazepines]. / Impacto del confinamiento por COVID-19 en la prescripción de benzodiacepinas.

OBJECTIVE: To evaluate the effect of COVID-19 lockdown on the prescription of benzodiazepines by gender, age and district health departments. DESIGN: Longitudinal observational study. LOCATION: Primary care. Asturias (Spain) health district V. PARTICIPANTS: People over 15 years of age with filled benzodiazepine prescriptions in between 2017 and 2020. MAIN MEASUREMENTS: Benzodiazepine DHD (defined daily dose per 1000 habitants) mean difference between the period defined as pre-lockdown and lockdown. Additionally, the difference was adjusted for gender, sex and district health department and also with the interaction among them. RESULTS: DHD mean pre-lockdown was 131.3 and 139.5 in the lockdown; this difference was significant in the global analysis (95% CI: 4.1-12.1). There was an increase in the DHD mean in the 60-74 age group (95% CI: 2.28-21.42), in the group over 90 years old (95% CI: 21.31-40.63) and in women (95% CI: 3.51-14.59). Finally, a decrease in the DHD mean of V11 (95% CI: -29 to -0.66) and V14 (95% CI: -54.28 to -25.04) district health departments was observed. CONCLUSIONS: Certain subgroups show a change in the pattern of benzodiazepine prescription without being able to relate this to the lockdown. We believe that there could be some inertia in the prescription of psychiatric medication according to the biopsychosocial characteristics of the patients; it is important to detect this in order to avoid the medicalization of psychological disorders.

Postoperative enteral immunonutrition in head and neck cancer patients: Impact on clinical outcomes / Uso de inmunonutrición enteral en el postoperatorio de pacientes con cáncer de cabeza y cuello: impacto en los resultados clínicos

Background: Head and neck cancer patients have a high rate of complications during the postoperative period that could increase their morbidity rate. Arginine has been shown to improve healing and to modulate inflammation and immune response. The aim of our study was to assess whether use of arginine-enriched enteral formulas could decrease fistulas and length of stay (LoS). Methods. A retrospective study was conducted in patients who had undergone head and neck cancer surgery and were receiving enteral nutrition through a nasogastric tube in the postoperative period between January 2012 and May 2018. The differences associated to use of immunoformula vs. standard formulas were analysed. Sociodemographic, anthropometric, and nutritional intervention variables, as well as nutritional parameters, were recorded during the early postoperative period. Occurrence of complications (fistulas), length of hospital stay, readmissions, and 90-day mortality were recorded. Results: In a univariate analysis, patients who received nutritional support with immunonutrition had a lower fistula occurrence rate (17.91% vs. 32.84%; p = 0.047) and a shorter mean LoS [28.25 (SD 16.11) vs. 35.50 (SD 25.73) days; p = 0.030]. After adjusting for age, energy intake, aggressiveness of surgery and tumour stage, fistula occurrence rate and LoS were similar in both groups irrespective of the type of formula. Conclusions: Use of arginine-enriched enteral nutrition appears to decrease the occurrence of fistulas in the postoperative period in patients with head and neck cancer, with a resultant reduction in length of hospital stay. However, the differences disappeared after adjusting for age, tumour stage, or aggressiveness of the surgery

Introducción: El postoperatorio de los pacientes con cáncer de cabeza y cuello presenta una alta tasa de complicaciones. Esta circunstancia podría aumentar la morbilidad en estos pacientes. La arginina ha demostrado mejorar la curación y modular la inflamación y la respuesta inmune. Nuestro planteamiento es valorar si el uso de fórmulas de alimentación enteral enriquecidas con arginina podría reducir la aparición de fístulas y la duración de la estancia hospitalaria. Métodos: Estudio retrospectivo en pacientes intervenidos de cáncer de cabeza y cuello que recibieron nutrición enteral a través de una sonda nasogástrica en el periodo postoperatorio entre enero de 2012 y mayo de 2018. Se analizaron las diferencias asociadas a la utilización de inmunofórmula vs. fórmulas estándar. Se recogieron variables sociodemográficas, antropométricas, de intervención nutricional y de parámetros nutricionales durante el postoperatorio inmediato, así como la aparición de complicaciones (fístulas), la duración de la estancia hospitalaria, los reingresos y la mortalidad a 90 días. Resultados: En el análisis univariante los pacientes que recibieron apoyo nutricional con inmunonutrición presentaron menor tasa de aparición de fístulas (17,91 vs. 32,84%; p = 0,047) y menor estancia hospitalaria (28,25 [DE 16,11] vs. 35,50 [DE 25,73] días; p = 0,030). Después de ajustar por edad, aporte calórico, agresividad de la cirugía y estadio del tumor, la incidencia de fístula y la estancia hospitalaria fueron similares entre los grupos, independientemente del tipo de fórmula. Conclusiones: El uso de nutrición enteral enriquecida con arginina en pacientes con cáncer de cabeza y cuello intervenidos podría reducir el desarrollo de la fístula y la duración de la estancia hospitalaria; sin embargo, las diferencias observadas desaparecen después de ajustar por edad, estadio tumoral o agresividad de la cirugía

Postoperative enteral immunonutrition in head and neck cancer patients: Impact on clinical outcomes.

BACKGROUND: Head and neck cancer patients have a high rate of complications during the postoperative period that could increase their morbidity rate. Arginine has been shown to improve healing and to modulate inflammation and immune response. The aim of our study was to assess whether use of arginine-enriched enteral formulas could decrease fistulas and length of stay (LoS). METHODS: A retrospective study was conducted in patients who had undergone head and neck cancer surgery and were receiving enteral nutrition through a nasogastric tube in the postoperative period between January 2012 and May 2018. The differences associated to use of immunoformula vs. standard formulas were analysed. Sociodemographic, anthropometric, and nutritional intervention variables, as well as nutritional parameters, were recorded during the early postoperative period. Occurrence of complications (fistulas), length of hospital stay, readmissions, and 90-day mortality were recorded. RESULTS: In a univariate analysis, patients who received nutritional support with immunonutrition had a lower fistula occurrence rate (17.91% vs. 32.84%; p=0.047) and a shorter mean LoS [28.25 (SD 16.11) vs. 35.50 (SD 25.73) days; p=0.030]. After adjusting for age, energy intake, aggressiveness of surgery and tumour stage, fistula occurrence rate and LoS were similar in both groups irrespective of the type of formula. CONCLUSIONS: Use of arginine-enriched enteral nutrition appears to decrease the occurrence of fistulas in the postoperative period in patients with head and neck cancer, with a resultant reduction in length of hospital stay. However, the differences disappeared after adjusting for age, tumour stage, or aggressiveness of the surgery.

Experiencia clínica con distintas dosis iniciales de tolvaptán en SIADH / Clinical experience with different initial doses of tolvaptan in SIADH

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Efectos tiroideos del tratamiento con biotina / Thyroid effects of treatment with biotin

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Secondary Hyperparathyroidism in Patients with Biliopancreatic Diversion After 10 Years of Follow-up, and Relationship with Vitamin D and Serum Calcium.

BACKGROUND: Secondary hyperparathyroidism (SHPT) is a matter of concern after biliopancreatic diversion (BPD). The aim of this study was to investigate the relationship between SHPT, 25(OH)D, and calcium after BPD. DESIGN: A retrospective analysis in obese patients after BPD performed between 1998 and 2016. METHODS: Patients with at least 1 year of follow-up were included. SHPT was considered when PTH > 65 pg/mL in the absence of an elevated corrected calcium. 25(OH)D (ng/mL) status was defined as: deficiency < 20, insufficiency 20-29.9, and sufficiency ≥ 30. RESULTS: In total, 321 patients were included (76.6% women), with mean age 43.0 (10.5) years. Median follow-up was 6.0 (IQR 3.0-9.0) years. Mean body mass index was 49.8 (7.0) kg/m2. SHPT increased to a maximum of 81.9% in the ninth year of follow-up (95% CI: 1.5-9.1). Two years after surgery, 33.9% of patients with 25(OH)D sufficiency had SHPT (p = 0.001). Corrected calcium levels were lower in patients with PTH > 65 pg/mL when compared with PTH < 65 pg/mL; 1 year: 8.96 vs 9.1 mg/dL and 5 years: 8.75 vs 9.12 mg/dL (p < 0.01). After surgery, patients with PTH > 65 pg/mL and 25(OH)D sufficiency had lower corrected calcium levels when compared with subjects with PTH and 25(OH)D in normal range. Two years: 9.0 vs 9.2 mg/dL (p < 0.05) and 4 years: 8.9 vs 9.2 mg/dL (p < 0.01). CONCLUSIONS: Once 25(OH)D is sufficient, the increase in PTH persists associated with a decrease in serum corrected calcium. It is important to ensure a sufficient calcium intake in these patients in order to avoid SHPT and osteomalacia in the future.

Repercusiones clínicas de la disfagia y la desnutrición en el paciente con ictus / Clinical repercussions of dysphagia and malnutrition in the stroke patient

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Influencia de los anticuerpos antiperoxidasa tiroidea en los valores de TSH de gestantes y en las complicaciones materno-fetales / Influence of thyroid peroxidase antibodies on TSH levels of pregnant women and maternal-fetal complications

Introducción: Los anticuerpos antiperoxidasa tiroidea (ATPO) en la gestación pueden influir en el desarrollo de hipotiroidismo subclínico gestacional (HSG). Ambas entidades parecen asociarse a complicaciones maternas y fetales. Los objetivos de este estudio son analizar si existe relación entre los valores de TSH y ATPO durante el embarazo, los posibles efectos sobre complicaciones gestacionales y perinatales, y valorar si los ATPO detectables, pero no positivos, influyen en el desarrollo de HSG. Metodología: Estudio prospectivo realizado en el área sanitaria del Complejo Asistencial Universitario de León (CAULE), donde se realiza cribado universal para disfunción tiroidea gestacional entre la semana 7-13 de gestación. Se recogieron datos de TSH, ATPO, obstétricos y neonatales de los partos de 2016. Se considera ATPO positivo si≥35UI/ml. En estudio previo se estableció valor TSH>3,72 mU/L como corte para HSG. Resultados: Se analizaron registros correspondientes a 1.980 partos en CAULE, 21 abortos y 18 partos fuera del centro. Se realizó cribado a 1.670 gestantes (84,34%): 142(8,50%) tuvieron ATPO positivos. La detección de ATPO positivo se asoció con el diagnóstico de HSG (p<0,01) y con media de TSH significativamente mayor (3,51 vs. 2,46mU/L; p=0,03). No encontramos diferencias significativas en las complicaciones gestacionales o neonatales. En el grupo con ATPO indetectable (<10Ul/ml) la media de TSH fue ligeramente inferior que en el grupo con valores de ATPO 10-35UI/ml, pero sin diferencias significativas (p=0,89). Conclusión: La presencia de ATPO positivo se asocia con valores de TSH más elevados y con mayor riesgo de HSG, pero no incrementa la tasa de complicaciones materno-fetales

Introduction: During pregnancy, thyroid peroxidase (TPO) antibodies may increase the risk of developing subclinical hypothyroidism (SCH). Both conditions appear to be associated to maternal-fetal complications. The objectives of this study were to analyze if a relationship exists between TSH and TPO levels during pregnancy and the potential effects on gestational and perinatal complications, and to assess whether detectable, but not positive, TPO levels have an impact on development of gestational SCH. Methods: A prospective study was conducted at the Leon Health Area (CAULE), where universal screening for gestational thyroid dysfunction is performed between weeks 7-13 of pregnancy. Data on TSH and TPO levels and gestational and perinatal complications were collected for all 2016 deliveries. Positive TPO antibodies were defined as values≥35IU/mL. In a previous study, a TSH level>3.72mU/L was established as the cut-off value for gestational SCH. Results: Records corresponding to 1,980 deliveries at CAULE, 21 abortions, and 18 deliveries outside the hospital were analyzed. Of the 1,670 pregnant women screened (84.34%), 142 (8.50%) had positive TPO antibodies and their presence was associated to diagnosis of SCH (P<0.01) and to significantly higher mean TSH levels (3.51mU/L vs. 2.46mU/L, P=0.03). There were no significant differences in gestational or neonatal complications. In the group with undetectable TPO antibodies (<10lU/mL), the mean TSH levels was slightly lower than in the group with TPO values ranging from 10-35 IU/mL, but the difference was not significant (P=0.89). Conclusion: Presence of positive TPO antibodies is associated to higher TSH levels and higher risk of gestational SCH, but does not increase the rate of maternal-fetal complications

Influence of thyroid peroxidase antibodies on TSH levels of pregnant women and maternal-fetal complications. / Influencia de los anticuerpos antiperoxidasa tiroidea en los valores de TSH de gestantes y en las complicaciones materno-fetales.

INTRODUCTION: During pregnancy, thyroid peroxidase (TPO) antibodies may increase the risk of developing subclinical hypothyroidism (SCH). Both conditions appear to be associated to maternal-fetal complications. The objectives of this study were to analyze if a relationship exists between TSH and TPO levels during pregnancy and the potential effects on gestational and perinatal complications, and to assess whether detectable, but not positive, TPO levels have an impact on development of gestational SCH. METHODS: A prospective study was conducted at the Leon Health Area (CAULE), where universal screening for gestational thyroid dysfunction is performed between weeks 7-13 of pregnancy. Data on TSH and TPO levels and gestational and perinatal complications were collected for all 2016 deliveries. Positive TPO antibodies were defined as values≥35IU/mL. In a previous study, a TSH level>3.72mU/L was established as the cut-off value for gestational SCH. RESULTS: Records corresponding to 1,980 deliveries at CAULE, 21 abortions, and 18 deliveries outside the hospital were analyzed. Of the 1,670 pregnant women screened (84.34%), 142 (8.50%) had positive TPO antibodies and their presence was associated to diagnosis of SCH (P<0.01) and to significantly higher mean TSH levels (3.51mU/L vs. 2.46mU/L, P=0.03). There were no significant differences in gestational or neonatal complications. In the group with undetectable TPO antibodies (<10lU/mL), the mean TSH levels was slightly lower than in the group with TPO values ranging from 10-35 IU/mL, but the difference was not significant (P=0.89). CONCLUSION: Presence of positive TPO antibodies is associated to higher TSH levels and higher risk of gestational SCH, but does not increase the rate of maternal-fetal complications.