Mortality of Spanish soccer referees and coaches: a retrospective cohort study.

There is evidence that elite soccer players live longer than general population, but there is no information on soccer coaches and referees. We aimed to analyze the longevity of both professionals, comparing them with soccer players and with general population. In this retrospective cohort study, a total of 328 male Spanish soccer coaches, 287 referees, and 1230 soccer players, all born before 1950, were divided in two cohorts, matched 2:1 with coaches and referees. We compared the survival of the cohorts with the Kaplan-Meier estimator and significance with the log-rank test. We calculated hazard ratios of death for coaches and referees compared with male Spanish general population of the same period. Differences in survival among cohorts were found, but they did not reach statistical significance. The estimated median survival time was 80.1 years (95% CI 77.7-82.4) for referees, 78 years (95% CI 76.6-79.3) for coaches, 78.8 years (95% CI 77.6-80) for referees matched with players, and 76.6 years (95% CI 75.3-77.9) for coaches matched with players. Both coaches and referees had lower mortality than general population, but this advantage disappeared after 80 years of age. We found no differences in longevity among Spanish elite soccer referees, coaches and players born before 1950. Both coaches and referees had lower mortality than general population, but this advantage disappeared after 80 years of age.

Clinical validation of the Neonatal Skin Condition Score with Portuguese newborns.

OBJECTIVE: Clinically validate the Neonatal Skin Condition Score - Portuguese version with Portuguese newborns, verifying if the risk of skin injury in this population is influenced by their condition. METHOD: Observational, cross-sectional and methodological study, conducted from 2018 to 2021. The Neonatal Skin Risk Assessment Scale - Portuguese version and Neonatal Skin Condition Score were used in data collection. Of the latter, content validation and sensitivity of the items were improved. MANOVA was used to evaluate whether the effect of independent variables (intrinsic and extrinsic factors) on dependent variables (score of both scales) was statistically significant. Non-random sampling (n=167). RESULTS: The items showed good sensitivity. MANOVA revealed that the factors had a significant effect on the scores of the two scales. CONCLUSION: The comparison of the scales shows clinical validity, revealing that better skin condition corresponds to a lower risk of injury, and the two scales can be applied concomitantly.

Efficacy and Safety of Two-Drug Regimens with Dolutegravir plus Rilpivirine or Lamivudine in HIV-1 Virologically Suppressed People Living with HIV.

BACKGROUND: The high effectiveness and safety of the two-drug (2DRs) strategy using dolutegravir (DTG) plus lamivudine (3TC) have led to international guidelines recommending their use for treatment-naive HIV patients. In virologically suppressed patients, de-escalating from 3DRs to DTG plus either rilpivirine (RPV) or 3TC has shown high rates of virological suppression. OBJECTIVES: This study aimed to compare the real-life data of two multicenter Spanish cohorts of PLWHIV treated with DTG plus 3TC (SPADE-3) or RPV (DORIPEX) as a switch strategy, not only in terms of virological suppression, safety, and durability but also in terms of immune restoration. The primary endpoint was the percentage of patients with virological suppression on DTG plus 3TC and DTG plus RPV at weeks 24 and 48. The secondary outcomes included the proportion of patients who experienced the protocol-defined loss of virological control by week 48; changes in immune status in terms of CD4+ and CD8+ T lymphocyte counts and the CD4+/CD8+ ratio; the rate, incidence, and reasons for discontinuation of treatment over the 48-week study period; and safety profiles at weeks 24 and 48. METHODS: We conducted a retrospective, observational, multicenter study of 638 and 943 virologically suppressed HIV-1-infected patients in two cohorts who switched to 2DRs with DTG plus RPV or DTG plus 3TC. RESULTS: The most frequent reasons for starting DTG-based 2DRs were treatment simplification/pill burden or drug decrease. The virological suppression rates were 96.9%, 97.4%, and 99.1% at weeks 24, 48, and 96, respectively. The proportion of patients with virological failure over the 48-week study period was 0.01%. Adverse drug reactions were uncommon. Patients treated with DTG+3TC increased CD4, CD8, and CD4/CD8 parameters at 24 and 48 weeks. CONCLUSIONS: We conclude that DTG-based 2DRs (combined with 3TC or RPV) in clinical practice were effective and safe as a switching strategy, with a low VF and high viral suppression rates. Both regimens were well tolerated, and ADR rates were low, including neurotoxicity and induced treatment discontinuations.

Dolutegravir Plus 3TC in Virologically Suppressed PLWHIV: Immunological Outcomes in a Multicenter Retrospective Cohort in Spain during the COVID-19 Pandemic.

Dolutegravir (DTG) based dual therapies for treating PLWHIV are a standard of care nowadays. Switching to DTG and lamivudine (3TC) safety and efficacy were proven in TANGO randomized clinical trial. This multicenter retrospective study included 1032 HIV virologically suppressed patients switching to DTG+3TC from 13 Spanish hospitals. DTG+3TC provided high rates of undetectable viral load over 96%, corresponding to 96.6% (889/921) at 24 weeks, 97.5% (743/763) at 48 weeks, and 98.3% (417/425) at 96 weeks. No significant differences are evident when comparing the total population according to sex, presence of comorbidity, or presence of AIDS. The analysis for paired data showed an increase in CD4+ cell count. A statistically significant increase in CD4+ lymphocyte count was found in those without comorbidities in the three-time series analyzed [average increase at 24 weeks: 48.7 (SD: 215.3) vs. 25.8 (SD: 215.5), p-value = 0.050; a mean increase at 48 weeks: 75.1 (SD: 232.9) vs. 42.3 (SD: 255.6), p-value = 0.003; a mean increase at 96 weeks: 120.1 (SD: 205.0) vs. 63.8 (SD:275.3), p-value = 0.003]. In conclusion, our cohort demonstrates that DTG+3TC is an effective treatment strategy for virologically-suppressed PLWHIV independent of age, sex, and HIV stage, as well as a safe and durable strategy.

Clinical validation of the Neonatal Skin Condition Score with Portuguese newborns / Validación clínica de la Neonatal Skin Condition Score con recién nacidos portugueses / Validação clínica da Neonatal Skin Condition Score com recém-nascidos portugueses

ABSTRACT Objective: Clinically validate the Neonatal Skin Condition Score - Portuguese version with Portuguese newborns, verifying if the risk of skin injury in this population is influenced by their condition. Method: Observational, cross-sectional and methodological study, conducted from 2018 to 2021. The Neonatal Skin Risk Assessment Scale - Portuguese version and Neonatal Skin Condition Score were used in data collection. Of the latter, content validation and sensitivity of the items were improved. MANOVA was used to evaluate whether the effect of independent variables (intrinsic and extrinsic factors) on dependent variables (score of both scales) was statistically significant. Non-random sampling (n=167). Results: The items showed good sensitivity. MANOVA revealed that the factors had a significant effect on the scores of the two scales. Conclusion: The comparison of the scales shows clinical validity, revealing that better skin condition corresponds to a lower risk of injury, and the two scales can be applied concomitantly.

RESUMEN Objetivo: Validar clínicamente el Neonatal Skin Condition Score - versión portuguesa con recién nacidos portugueses, comprobando si el riesgo de lesión cutánea en esta población está influenciado por su condición. Método: Estudio observacional, transversal y metodológico, realizado de 2018 a 2021. En la recolección de datos se utilizaron el Neonatal Skin Condition Score - versión portuguesa y el Neonatal Skin Condition Score. De estos últimos, se mejoró la validación del contenido y la sensibilidad de los ítems. La MANOVA se utilizó para evaluar si el efecto de variables independientes (factores intrínsecos y extrínsecos) sobre variables dependientes (puntuación de ambas escalas) fue estadísticamente significante. Muestreo no aleatorio (n=167). Resultados: Los artículos mostraron buena sensibilidad. La MANOVA reveló que los factores tuvieron un efecto significante en las puntuaciones de las dos escalas. Conclusión: La comparación de las escalas muestra validez clínica, revelando que una mejor condición de la piel corresponde a un menor riesgo de lesión, y las dos escalas se pueden aplicar concomitantemente.

RESUMO Objetivo: Validar clinicamente a Neonatal Skin Condition Score - versão portuguesa com recém-nascidos portugueses, verificando se o risco de lesão da pele nessa população é influenciado pela sua condição. Método: Estudo observacional, transversal e metodológico, realizado de 2018 a 2021. Na coleta de dados, utilizaram-se a Neonatal Skin Risk Assessment Scale - versão portuguesa e a Neonatal Skin Condition Score. Desta última, realizou-se a validação de conteúdo e a estimação da sensibilidade dos itens. Utilizou-se a MANOVA para avaliar se o efeito das variáveis independentes (fatores intrínsecos e extrínsecos) sobre as dependentes (escoredas duas escalas) era estatisticamente significante. Amostragem não aleatória (n=167). Resultados: Os itens apresentaram boa sensibilidade. A MANOVA revelou que os fatores tiveram efeito significante sobre os escores das duas escalas. Conclusão: A comparação das escalas evidencia validade clínica, demonstrando que melhor condição da pele corresponde a menor risco de lesão, podendo as duas escalas ser aplicadas concomitantemente.

Impact of pharmacological treatment of gestational diabetes on the mode of delivery and birth weight: a nationwide population-based study on a subset of singleton pregnant Portuguese women.

AIMS: To access the impact of increasing use of metformin on cesarean section and large for gestational age rates, when compared to insulin. METHODS: A retrospective observational study was developed using data from the Portuguese National Registry, between 2011 and 2019, of 5038 Portuguese women with single pregnancies and gestational diabetes treated with metformin and/or insulin. Three groups were defined according to the therapeutic regimen adopted: g1-insulin in monotherapy (n = 3027[60.1%]); g2-metformin in monotherapy (n = 1366[27.1%]); g3-metformin and insulin (n = 645[12.8%]). Multivariate analysis was adjusted for statistically significant covariates. RESULTS: The cesarean section rate in g1 was similar to g2 (g1:36.9% vs. g2:37%, p = 0.982), although g3 was associated with cesarean delivery (g3:43.6% vs. g1:36.9%, p = 0.005; g3:43.6% vs. g1:37.0%, p = 0.002), with no differences reported in the multivariate analysis adjusted for year of delivery and pregestational body mass index. A delivery of a large for gestational age newborn was less frequently observed in g2 than in g1 (g2:4.1% vs. g1:5.4%, p = 0.044) and in g3 (g2:4.1% vs. g3:9.1%, p < 0.001), and in g1, when compared to g3 (g1:5.4% vs. g3:9.1%, p < 0.001). In the multivariate analysis, g2 showed lower odds of delivering a large for gestational age newborn, compared to g1 (ß = -0.511, OR = 0.596, CI95% = 0.428-0.832, p < 0.001). CONCLUSIONS: The use of metformin was not associated with higher cesarean section rates, compared to insulin. Instead, it was suggested a protective role of metformin on large gestational age rates. The concomitant use of dual therapy suggests more complex pregnancies, requiring closer surveillance that mitigate serious perinatal and obstetrical outcomes.

Testing conditional multivariate rank correlations: the effect of institutional quality on factors influencing competitiveness.

Joint distribution between two or more variables could be influenced by the outcome of a conditioning variable. In this paper, we propose a flexible Wald-type statistic to test for such influence. The test is based on a conditioned multivariate Kendall's tau nonparametric estimator. The asymptotic properties of the test statistic are established under different null hypotheses to be tested for, such as conditional independence or testing for constant conditional dependence. Two simulation studies are presented: The first shows that the estimator proposed and the bandwidth selection procedure perform well. The second presents different bivariate and multivariate models to check the size and power of the test and runs comparisons with previous proposals when appropriate. The results support the contention that the test is accurate even in complex situations and that its computational cost is low. As an empirical application, we study the dependence between some pillars of European Regional Competitiveness when conditioned on the quality of regional institutions. We find interesting results, such as weaker links between innovation and higher education in regions with lower institutional quality. Supplementary Information: The online version contains supplementary material available at 10.1007/s11749-022-00806-1.

Loss of structural balance in stock markets.

We use rank correlations as distance functions to establish the interconnectivity between stock returns, building weighted signed networks for the stocks of seven European countries, the US and Japan. We establish the theoretical relationship between the level of balance in a network and stock predictability, studying its evolution from 2005 to the third quarter of 2020. We find a clear balance-unbalance transition for six of the nine countries, following the August 2011 Black Monday in the US, when the Economic Policy Uncertainty index for this country reached its highest monthly level before the COVID-19 crisis. This sudden loss of balance is mainly caused by a reorganization of the market networks triggered by a group of low capitalization stocks belonging to the non-financial sector. After the transition, the stocks of companies in these groups become all negatively correlated between them and with most of the rest of the stocks in the market. The implied change in the network topology is directly related to a decrease in stock predictability, a finding with novel important implications for asset allocation and portfolio hedging strategies.

Mortality of Spanish Former Elite Soccer Players and Coaches.

We analyzed whether male Spanish elite soccer players live longer than the general population. Secondly, we compared their mortality with a cohort of soccer players who continued working as soccer elite coaches after retirement. Using age and calendar-date adjusted life tables, we analyzed the mortality hazard ratio of 1333 Spanish male players born before 1950, and who played in elite leagues from 1939, compared with the Spanish population. Using Cox proportional hazards model we compared their mortality with a cohort of 413 players who continued as coaches. Players showed significantly lower mortality than the general population, but this advantage decreased with advanced age, disappearing after 80 years. Coaches showed a similar pattern. Comparing players versus coaches, date of birth and years as professional were associated with survival, but debut age and player position were not. Unadjusted median survival time was 79.81 years (IQR 72.37-85.19) for players and 81.8 years (IQR 74.55-86.73) for coaches. Kaplan-Meier estimator adjusted for covariables showed no difference between cohorts (p=0.254). In conclusion, former Spanish male players showed lower mortality than the general population, but this effect disappeared after 80 years of age. Continuing their career as coaches after retirement from playing did not confer major benefits.

[Effect of confinement during COVID-19 outbreak on sleep quality in Galicia.] / Efecto del confinamiento por la pandemia de COVID-19 sobre la calidad del sueño en Galicia.

OBJECTIVE: Stressful situations may have a negative effect on population's mental health, including impaired sleep quality. Thus, we analysed the effect on sleep during the confinement due to the COVID-19 outbreak, in a Galicia population sample, measuring subjective sleep satisfaction, and insomnia intensity and incidence. METHODS: Through an adapted questionnaire from the Cuestionario Oviedo de Sueño, distributed telematically and printed, using a convenience sampling in Galicia, we compared sleep situation, before and during the first two weeks of confinement for COVID-19. We compared the results of the questionnaire before and during confinement with the Wilcoxon signed-rank test and McNemar's test. RESULTS: In 451 analysed subjects, there was about half point decrease in sleep satisfaction (in a 1 to 7 scale), three points increase in insomnia score (9 to 45 scale) and an increase from 23.1 to 36.3% in the insomnia incidence (p<0.001 for all the comparisons). There existed less affectation in the insomnia incidence in elderly above 65 years (from 21.7 to 26.1%, p=1) and in subjects that telecommuted (unchanged 28.1% incidence, p=1). In a post-hoc analysis of a health workers subgroup, sleep affectation was similar to that of others workers. CONCLUSIONS: Confinement situation in COVID-19 outbreak context in our environment has caused important alterations in the population's sleep quality, increasing the symptoms and incidence of insomnia.

OBJETIVO: Las situaciones de estrés pueden tener repercusiones sobre la salud mental de la población, que pueden incluir alteraciones en la calidad del sueño. Por ello analizamos el efecto sobre el sueño durante el confinamiento por la pandemia del COVID-19 en una muestra de población española, midiendo la satisfacción subjetiva con el sueño, y la intensidad e incidencia de insomnio. METODOS: Mediante un cuestionario adaptado a partir del Cuestionario Oviedo de Sueño, distribuido de forma telemática e impresa, a través de un muestreo de conveniencia en Galicia, se comparó la situación del sueño en la población, antes y durante los primeros quince días del confinamiento por el COVID-19. La comparación de los resultados del cuestionario antes y durante el confinamiento se realizó con la prueba de rangos con signo de Wilcoxon y el test de McNemar. RESULTADOS: En los 451 sujetos analizados, se encontró una disminución de medio punto en la satisfacción del sueño (en una escala de 1 a 7), un incremento de tres puntos en la puntuación de insomnio (escala de 9 a 45) y un incremento del 23,1 al 36,3% en la incidencia de insomnio (p<0,001 para todas las comparaciones). Existió menor afectación en la incidencia de insomnio en los mayores de 65 años (pasó del 21,7 al 26,1%, p=1), y en los sujetos que se encontraban realizando teletrabajo (se mantuvo en el 28,1%, p=1). En un análisis post-hoc de un subgrupo de personal sanitario, la afectación del sueño fue similar a la de otros trabajadores. CONCLUSIONES: La situación de confinamiento en el contexto de la pandemia del COVID-19 en nuestro entorno ha provocado alteraciones importantes en la calidad del sueño de la población, incrementando los síntomas y la incidencia de insomnio.

Área de preservação permanente em processo de revegetação com espécies arbóreas e adubos verdes / Permanent preservation area revegetated with tree species and green manures

RESUMO O objetivo principal do presente trabalho foi diagnosticar a situação da área em estudo, incluindo o corpo hídrico que é abastecido pelo Córrego Samambaia. Foram realizadas medições de altura e diâmetro das espécies arbóreas, durante 12 meses. Além disso, ocorreram coletas de amostras da água da represa para análise dos parâmetros: pH, condutividade, fósforo total e metais pesados. Nos meses de julho e dezembro de 2014, foram realizadas análises de turbidez, cor, demanda bioquímica de oxigênio (DBO) e oxigênio dissolvido (OD). Foram também realizadas análises físico-químicas do solo. No monitoramento realizado de setembro de 2013 a agosto de 2014, algumas plantas tiveram boa resposta em relação ao uso dos adubos verdes; porém, outras tiveram alta mortandade durante o estudo, como foi o caso do pequi. A competição entre espécies exóticas e nativas foi reduzida, o que aumentou, em geral, a sobrevivência das espécies nativas do bioma do Cerrado. Elementos tais como manganês não apresentaram diferença significativa em todos os tratamentos nos períodos de avaliação. Os valores de macro e microporos foram parecidos, mas a área apresentou diferenças quanto à textura do solo analisado. Quanto aos testes de resistência à penetração (RP) feitos em áreas com e sem adubo verde, os maiores valores foram encontrados na área sem as espécies leguminosas, onde o solo estava mais compactado. Parâmetros como condutividade elétrica da água apresentaram-se estáveis durante os 12 meses de estudo. Os resultados para OD e DBO estão fora do preconizado pela Resolução nº 357 do Conselho Nacional do Meio Ambiente.

ABSTRACT The main objective of this paper was to diagnose the situation of the study area, including the water body that is fueled by Córrego Samambaia. Measurements of height and diameter of tree species were made for 12 months. In addition, dam water samples were collected and the following parameters were analyzed: pH, conductivity, total phosphorus and heavy metals. In July and December of 2014, turbidity, color, biochemical oxygen demand (BOD) and dissolved oxygen (DO) analyzes were made. Physico-chemical analyses of soil were also carried out. Monitoring carried out from September 2013 to August 2014 showed some plants with good response in relation to the use of green manures, but others showed high mortality during the study, as the pequi. The competition between alien and native was reduced, which increased overall survival. Elements such as manganese showed no significant difference in all treatments during evaluation's period. Macro and micropores values were similar, but for texture, the area showed some differences. For penetration resistance tests (PR) made in an area with and without green manure, the largest PR values were found in the one without legumes species. Parameters such as electric conductivity were stable during the 12 months of study. The results for DO and BOD are outside the recommended by the Resolution 357 of the National Environmental Council.

Um olhar sobre a pele do recém-nascido: o cuidado de enfermagem promotor da integridade cutânea em neonatologia / A look at the newborn's skin: nursing care that promotes skin integrity in neonatology

O percurso formativo concretizado permitiu desenvolver processos de prestação de cuidados à criança, jovem e família em resposta às necessidades do seu crescimento e desenvolvimento, no sentido da maximização da sua saúde e em situações complexas relacionadas com o ciclo de vida e condições de doença, atendendo às especificidades desenvolvimentais das diferentes etapas da idade pediátrica, e adequando às particularidades dos contextos em que se encontrem. Considerando a variedade de situações vivenciadas pela criança, jovem e família, o enfermeiro especialista em saúde da criança e do jovem aspira a promoção do mais elevado estado de saúde e bem-estar, traduzindo a sua intervenção um nível avançado de segurança, competência e satisfação desta díade. As aprendizagens desenvolvidas contribuíram para a apropriação de competências científicas, técnicas e humanas para a conceção, gestão, prestação e supervisão de cuidados de enfermagem especializados à criança, jovem e família. Os cuidados à pele constituem uma ampla e complexa gama de ações concertadas que, pelo respeito pela dignidade humana preservam a saúde e bem-estar, concorrendo para a construção de uma relação de ajuda terapêutica e holística. Este cuidado ganha especial relevo quando os seus beneficiários são a população pediátrica, particularmente os recém-nascidos que experienciam processos de saúde-doença numa Unidade de Cuidados Intensivos Neonatais. Refiro-me a seres vulneráveis, imaturos e gravemente doentes, que vivenciam hospitalizações difíceis, prolongadas, permeadas de tecnologia de ponta, dispositivos complexos e procedimentos invasivos constantes, contudo necessários para garantir a sua sobrevivência. Considerando a fragilidade da pele desta população e o risco de lesões cutâneas durante a hospitalização, o enfermeiro encontra-se numa posição privilegiada para proteger este órgão, reconhecendo que desempenha funções fundamentais no desenvolvimento harmonioso do recém-nascido. O foco de atenção é dirigido à preservação da integridade da pele, através de cuidados assentes numa abordagem holística, alicerçada na filosofia de cuidados pediátricos e nos seus pilares, os cuidados centrados na família, não traumáticos e promotores do desenvolvimento. A prática de enfermagem avançada e especializada neste âmbito inclui a avaliação padronizada da condição da pele do recémnascido, através de um instrumento de avaliação válido e fiável para os neonatos portugueses, aliada a cuidados especializados à pele, sustentados na melhor evidência disponível.

The finished training pathway has enabled the development of processes to provide care for the child, youth and family, in response to growth and developmental needs, in order to maximize their health in complex situations, related to the life cycle and illness conditions, in order to the developmental specificities of the different stages of the pediatric age, and adapting to the particularities of the contexts in which they stay. Considering the variety of situations experienced by the child, youth and family, the nurse specialist in the health of the child and the youth aims to promote the highest state of health and well-being, translating their intervention into an advanced level of safety, competence and satisfaction of this dyad. The learning developed contributed to the appropriation of scientific, technical and human skills for the conception, management, delivery and supervision of specialized nursing care for the child, the youth and the family. Skin care is a wide and complex range of concerted actions that, by respect for human dignity, preserve health and well-being, and contributing to the construction of a therapeutic and holistic help relationship. This care gains special prominence when its beneficiaries are the pediatric population, particularly newborns who experience health-disease processes in a neonatal intensive care unit. I am referring to vulnerable, immature and seriously ill beings who experience difficult and prolonged hospitalizations, permeated by cutting-edge technology, complex devices and constant invasive procedures, however necessary to ensure their survival. Considering the fragility of the skin of this population and the risk of skin lesions during hospitalization, the nurse is in a privileged position to protect this organ, recognizing that it plays a fundamental role in the harmonious development of the newborn. The focus of attention is directed to the preservation of skin integrity, through care based on a holistic approach, based on the philosophy of pediatric care and its pillars, family-centered, non-traumatic care and development promoters. The advanced and specialized nursing practice in this field includes the standardized assessment of the condition of the newborn's skin, through a valid and reliable evaluation instrument for the Portuguese neonates, combined with specialized skin care, supported on the best available evidence

Reversible splenial lesion syndrome (RESLES): what's in a name?

BACKGROUND: The presence of transient lesions involving the splenium of the corpus callosum (SCC) has been described in patients with encephalitis or encephalopathy of varied etiology. We have termed it RESLES (reversible splenial lesion syndrome). PURPOSE: To describe 3 additional patients (2 encephalitis, 1 hypoglycemia) and review the literature to define this syndrome, its etiology, presentation, prognosis, and possible pathophysiological mechanisms. METHODS: Search of the MEDLINE database from 1966 through 2007. English language article titles and abstracts were screened and the appropriate articles reviewed. Additional articles cited by original references were also reviewed. RESULTS: RESLES is caused by antiepileptic drug withdrawal, infection, high-altitude cerebral edema (HACE), or metabolic disorders (hypoglycemia and hypernatremia). Complete resolution after a variable lapse is the rule. Clinical presentation is nonspecific, without evidence of callosal disconnection syndromes. Neuroimaging shows a nonenhancing, round-shaped lesion centered in the SCC that disappears after a variable lapse. Diffusion studies reveal DW hypersignal with low ADC values, suggestive of cytotoxic edema. Only HACE-related cases and 1 patient with pregabalin withdrawal showed high ADC values, consistent with vasogenic edema. CONCLUSION: RESLES is a distinct clinicoradiological syndrome of varied etiology and benign course except in those patients with an underlying severe disorder.

[Prevalence of asymptomatic peripheral artery disease detected by the ankle-brachial index in patients with cardiovascular disease. MERITO II study]. / Prevalencia de enfermedad arterial periférica asintomática, estimada mediante el índice tobillo-brazo, en pacientes con enfermedad vascular. Estudio MERITO II.

BACKGROUND AND OBJECTIVE: Patients with polyvascular disease have an increased rate of cardiovascular events and death. Their identification would define a subgroup of the population at very high risk, who would be candidates to intensified preventive measures. The objective of the present study was to evaluate the prevalence of subclinical peripheral artery disease in subjects with a previous diagnosis of vascular disease in other territories. PATIENTS AND METHOD: Subjects with a coronary or a cerebrovascular event between 3 months and 5 years, and who were attended at internal medicine outpatient clinics from Spain were included in the study. All patients had a clinical history, a physical examination, a blood and urine analysis, and a measurement of the ankle-brachial index (ABI). RESULTS: A total of 1203 patients (64% males; mean age: 74.3 years), were included in the study. A previous coronary event was reported in 55.4% of the participants, cerebrovascular disease in 38%, and a clinical history of disease in both territories in 6.7%. The prevalence of a low ABI (< 0,9) was 33.8%, 32.4% and 53.9% for each group, respectively. In a multivariate analysis, factors associated with a low ABI were age, smoking habit, diabetes, a reduced glomerular filtration rate, systolic blood pressure and the presence of clinical disease in both territories upon inclusion. The sensitivity of both, the Edinburgh questionnaire and pulse palpation for detecting and ABI below 0.9, were low. CONCLUSIONS: Prevalence of a low ABI is elevated in asymptomatic patients with coronary or cerebrovascular disease, particularly if there are clinical manifestations in both territories.

Prevalencia de enfermedad arterial periférica asintomática, estimada mediante el índice tobillo-brazo, en pacientes con enfermedad vascular. Estudio MERITO II / Prevalence of asymptomatic peripheral artery disease detected by the ankle-brachial index in patients with cardiovascular disease. MERITO II study

FUNDAMENTO Y OBJETIVO: Los pacientes con enfermedad arterial en varios territorios presentan unaelevada tasa de complicaciones vasculares y de mortalidad. Su identificación permitiría definir a unsubgrupo de la población de muy alto riesgo, candidatos a recibir medidas preventivas más enérgicas.El objetivo del presente estudio ha sido estimar la prevalencia de enfermedad arterial periféricasubclínica en personas con antecedentes de enfermedad vascular en otros territorios arteriales.PACIENTES Y MÉTODO: Se incluyó en el estudio a pacientes con historia de enfermedad coronaria y/ocerebrovascular entre los 3 meses y los 5 años previos, atendidos en consultas de medicina internarepartidas por toda la geografía nacional. Se les realizaron anamnesis, exploración física, analíticasanguínea y urinaria, y se les determinó el índice tobillo-brazo (ITB).RESULTADOS: Se estudió a 1.203 pacientes (64% varones), con una edad media de 74,3 años. El55,4% tenía antecedentes de enfermedad coronaria, un 38% de enfermedad cerebrovascular y un6,7% de afectación en ambos territorios. La prevalencia de ITB bajo (< 0,9) fue del 33,8, el 32,4y el 53,9% para cada grupo, respectivamente. En el análisis multivariante los factores que se asociaroncon un ITB bajo fueron la edad, el tabaquismo, la diabetes, una tasa reducida de filtradoglomerular, la presión arterial sistólica y el haber presentado afectación de ambos territorios vasculares.La sensibilidad del cuestionario de Edimburgo y de la palpación de pulsos para detectar lapresencia de un ITB inferior a 0,9 fue baja.CONCLUSIONES: La prevalencia de un ITB bajo es elevada en pacientes asintomáticos con enfermedadcoronaria o cerebrovascular, especialmente si presentan afectación conjunta de ambos territorios

BACKGROUND AND OBJECTIVE: Patients with polyvascular disease have an increased rate of cardiovascularevents and death. Their identification would define a subgroup of the population at very highrisk, who would be candidates to intensified preventive measures. The objective of the presentstudy was to evaluate the prevalence of subclinical peripheral artery disease in subjects with a previousdiagnosis of vascular disease in other territories.PATIENTS AND METHOD: Subjects with a coronary or a cerebrovascular event between 3 months and 5years, and who were attended at internal medicine outpatient clinics from Spain were included inthe study. All patients had a clinical history, a physical examination, a blood and urine analysis,and a measurement of the ankle-brachial index (ABI).RESULTS: A total of 1203 patients (64% males; mean age: 74.3 years), were included in the study. Aprevious coronary event was reported in 55.4% of the participants, cerebrovascular disease in 38%,and a clinical history of disease in both territories in 6.7%. The prevalence of a low ABI (< 0,9) was33.8%, 32.4% and 53.9% for each group, respectively. In a multivariate analysis, factors associatedwith a low ABI were age, smoking habit, diabetes, a reduced glomerular filtration rate, systolic bloodpressure and the presence of clinical disease in both territories upon inclusion. The sensitivity of both,the Edinburgh questionnaire and pulse palpation for detecting and ABI below 0.9, were low.CONCLUSIONS: Prevalence of a low ABI is elevated in asymptomatic patients with coronary or cerebrovasculardisease, particularly if there are clinical manifestations in both territories

[Value of the ankle-brachial index in cardiovascular risk stratification of patients without known atherotrombotic disease. MERITO study]. / Modificación de la estratificación del riesgo vascular tras la determinación del índice tobillo-brazo en pacientes sin enfermedad arterial conocida. Estudio MERITO.

BACKGROUND AND OBJECTIVES: Peripheral arterial disease detected by measurement of ankle-brachial index enables the identification of asymptomatic patients with target organ damage. We have investigated the prevalence of peripheral arterial disease (ankle-brachial index < 0.9), and its potential clinical-therapeutic impact, in patients without known atherotrombotic disease from internal medicine practices. PATIENTS AND METHOD: It was a multicenter, cross-sectional, observational study. Outpatients aged 50 through 80 years, with either diabetes or a SCORE risk estimation of at least 3%, were enrolled. RESULTS: A total of 1,519 subjects (58% men) were evaluated, 917 with diabetes (61%). The mean age (standard deviation) was 66.2 (8.3) years. The prevalence of an ankle-brachial index < 0.9 was 26.19%. In multiple logistic regressions the risk factors associated to an ankle-brachial index < 0.9 were age, sedentary lifestyle, smoking, macroalbuminuria, and heart rate. There was a significant relationship between the ankle-brachial index and the SCORE risk estimation. With respect to the therapeutic aims of the patients with an ankle-brachial index < 0.9, only 21% were taking antiplatelet drugs, 26% showed low density lipoproteins-cholesterol values < 100 mg/dl (53% < 130 mg/dl), and 16% displayed recommended blood pressure levels. CONCLUSIONS: Measurement of ankle-brachial is useful to reclassify as high risk a significant proportion of patients without known previous atherotrombotic disease. The ankle-brachial index should be incorporated into routine cardiovascular evaluation, particularly in subjects with diabetes or a score risk assessment > or = 3%.

Modificación de la estratificación del riesgo vascular tras la determinación del índice tobillo-brazo en pacientes sin enfermedad arterial conocida. Estudio MERITO / Value of the ankle-brachial index in cardiovascular risk stratification of patients without known atherotrombotic disease. MERITO study

Fundamento y objetivos: La detección de enfermedad arterial periférica mediante el índice tobillo-brazo (ITB) permite identificar a pacientes asintomáticos con lesión establecida. Investigamos la prevalencia de enfermedad arterial periférica (ITB < 0,9) en pacientes de consultas de medicina interna y su potencial repercusión terapéutica. Pacientes y método: Se ha realizado un estudio multicéntrico, transversal y observacional, en el que se incluyó a pacientes de entre 50 y 80 años de edad sin enfermedad arterial conocida, que presentaban diabetes mellitus o una puntuación de SCORE del 3% o mayor. Resultados: Se evaluó a 1.519 pacientes (un 58% varones), con una edad media (desviación estándar) de 66,2 (8,3) años, de los cuales el 61% presentaba diabetes. Del total de la muestra, el ITB fue menor de 0,9 en el 26,19%, sin diferencias entre diabéticos (26,22%) y no diabéticos (26,15%). En el análisis multivariante, los parámetros que se asociaron a un ITB menor de 0,9 fueron la edad, la macroalbuminuria, el consumo de tabaco, la frecuencia cardíaca y el sedentarismo. Se objetivó una relación significativa entre las categorías de riesgo establecidas por la fórmula SCORE y el ITB. Considerando a los pacientes con un ITB menor de 0,9, sólo el 21% recibía medicación antiagregante, el 26% presentaba cifras de colesterol unido a lipoproteínas de baja densidad menores de 100 mg/dl (un 53% con concentraciones inferiores a 130 mg/dl) y el 16% tenía controlada la presión arterial. Conclusiones: La determinación del ITB permite reclasificar en alto riesgo a una significativa proporción de pacientes sin enfermedad arterial previa conocida. El ITB debe incluirse en la evaluación sistemática del riesgo vascular, al menos en los pacientes con diabetes o una puntuación SCORE del 3% o mayor

Background and objectives: Peripheral arterial disease detected by measurement of ankle-brachial index enables the identification of asymptomatic patients with target organ damage. We have investigated the prevalence of peripheral arterial disease (ankle-brachial index = 3%