Partículas en suspensión PM10, NO2 y agudizaciones de enfermedad respiratoria crónica / Particulate matter PM10, NO2 and exacerbations of chronic respiratory diseases

Objetivos Las nuevas directrices de la Organización Mundial de la Salud recomiendan estudios con exposición simultánea a varios contaminantes atmosféricos. El objetivo principal ha sido conocer la fuerza de la asociación entre diferentes concentraciones de PM10 y NO2 y la agudización de enfermedad respiratoria (AER), en concreto del asma y la enfermedad pulmonar obstructiva crónica. Material y métodos Estudio transversal retrospectivo. La población analizada estuvo compuesta por adultos atendidos en un SUAP en determinados días lag+1 de 2019, siendo los días posteriores a las fechas en las que se registran elevaciones de PM10 por encima del valor límite diario. Se han elaborado 3 índices (1: niveles elevados de PM10 y NO2; 2: nivel elevado de PM10 y nivel bajo de NO2, y 3: niveles bajos de PM10 y NO2) y un modelo de regresión logística para cada uno de ellos, con la AER como variable de resultado, y la adición progresiva de variables de ajuste (sexo, edad, tabaco, índice de Charlson, estación, precipitación, viento y temperatura). Resultado Se analizaron 461 personas, 17 con AER. Los modelos 1 y 2 presentaron valores muy similares en la OR ajustada (4,28 [IC95% 1,05-17]), R2 (0,88) y el área bajo la curva ROC (>0,72). En ambos se mantuvo la significación tras incluir las variables de ajuste, mientras que el modelo 3 solo permitió la precipitación. La inclusión del índice de Charlson y el consumo de tabaco en los 3 modelos suponía la pérdida de la significación de la combinación PM10/NO2 respecto a la AER. Conclusiones Los niveles elevados de PM10 presentan relación con la AER y tienen mayor impacto que el NO2, siendo el consumo de tabaco y las comorbilidades los principales precipitantes de las AER (AU)

Objectives The new World Health Organization guidelines recommend studies with simultaneous exposure to multiple air pollutants. The main objective has been to analyze the strength of the association between different concentrations of PM10 and NO2 and the exacerbation of chronic respiratory diseases (ECRD), specifically asthma and chronic obstructive pulmonary disease. Material and methods Retrospective cross-sectional study. The population analyzed were adults treated in an urgent and primary health care center on certain lag+1 days in 2019. Three indices have been developed (1: high levels of PM10 and NO2; 2: high level of PM10 and low level of NO2, and 3: low levels of PM10 and NO2) and a logistic regression model for each of them, with ECRD as the outcome variable, and the progressive addition of adjustment variables (sex, age, tobacco, Charlson index, season, precipitation, wind and temperature). Results Four hundred and sixty-one people were analyzed, 17 with ECRD. Models 1 and 2 presented very similar values in the adjusted OR (4.28 [95% CI 1.05–17]), R2 (0.88) and the area under the ROC curve (>0.72). In both of them the significance was maintained after including the adjustment variables, while model 3 only allowed the addition of precipitation. The inclusion of the Charlson index and the tobacco consumption in the 3 models implied the loss of statistical significance of the PM10/NO2 combination regarding ECRD. Conclusions High levels of PM10 are related to ECRD and have a greater impact than NO2, with tobacco use and comorbidities being the main precipitants of ECRD (AU)

[Particulate matter PM10, NO2 and exacerbations of chronic respiratory diseases]. / Partículas en suspensión PM10, NO2 y agudizaciones de enfermedad respiratoria crónica.

OBJECTIVES: The new World Health Organization guidelines recommend studies with simultaneous exposure to multiple air pollutants. The main objective has been to analyze the strength of the association between different concentrations of PM10 and NO2 and the exacerbation of chronic respiratory diseases (ECRD), specifically asthma and chronic obstructive pulmonary disease. MATERIAL AND METHODS: Retrospective cross-sectional study. The population analyzed were adults treated in an urgent and primary health care center on certain lag+1 days in 2019. Three indices have been developed (1: high levels of PM10 and NO2; 2: high level of PM10 and low level of NO2, and 3: low levels of PM10 and NO2) and a logistic regression model for each of them, with ECRD as the outcome variable, and the progressive addition of adjustment variables (sex, age, tobacco, Charlson index, season, precipitation, wind and temperature). RESULTS: Four hundred and sixty-one people were analyzed, 17 with ECRD. Models 1 and 2 presented very similar values in the adjusted OR (4.28 [95% CI 1.05-17]), R2 (0.88) and the area under the ROC curve (>0.72). In both of them the significance was maintained after including the adjustment variables, while model 3 only allowed the addition of precipitation. The inclusion of the Charlson index and the tobacco consumption in the 3 models implied the loss of statistical significance of the PM10/NO2 combination regarding ECRD. CONCLUSIONS: High levels of PM10 are related to ECRD and have a greater impact than NO2, with tobacco use and comorbidities being the main precipitants of ECRD.

Radiologic assessment of abdominal aortic calcifications, atherosclerotic burden levels and statistical bias affecting the reliability.

INTRODUCTION: AAC-8 and AAC-24 are two widely used scales to evaluate abdominal aortic calcification (AAC) on X-ray images. Levels of ≥3 (AAC-8) and ≥5 points (AAC-24) are of high relevance since they are associated with greater risk of cardiovascular events. Given that it is unknown, our aim was to determine the reliability of both scales at those levels of atherosclerotic burden. METHODS: The sample (93 subjects, 67.3 ± 9.7 years, BMI 28.8 ± 3.8, 57.6% smokers, 64.1% with hypertension) was classified according to quartiles of calcification. Six clinicians evaluated AAC independently with both scales on lateral lumbar spine X-ray images. We analyzed inter-rater agreement with the intraclass correlation coefficient (ICC) and the Bland-Altman scatterplots. RESULTS: We assessed 15 pairs of raters. Scores in both scales were significantly correlated with cardiovascular risk (r = 0.31 and r = 0.32; p < 0.005). Agreement was very high in the first quartile and moderate in the rest (p < 0.05). At cut-off points, ICC = 0.70 (95%CI, 0.54-0.86) and ICC = 0.68 (95%CI, 0.60-0.85) with AAC-8 and AAC-24. With the Bland-Altman method, mean of the differences ranged between 0 and 0.4 (AAC-8), and between 0.2 and 1 (AAC-24), while 95% limits of agreement showed values between 2.9 and 4.4 (AAC-8), and between 6 and 11.2 (AAC-24). Analyzing entire scales, ICC = 0.97 (95%CI, 0.97-0.98) and ICC = 0.98 (95%CI, 0.97-0.98) for AAC-8 and AAC-24, respectively. CONCLUSION: Both scales presented only moderate reliability at levels of atherosclerotic burden. Analyzing quartiles with ICC and the Bland-Altman plot showed concordant results. High global ICC values traditionally reported with both scales are likely biased. IMPLICATIONS FOR PRACTICE: AAC predicts subsequent vascular morbidity and mortality and should implicate evaluation of cardiovascular risk. Optimal visualisation of AAC and its correct assessment are mandatory in order to maximize patient care.

Necrosis avascular de ambas cabezas femorales en un paciente VIH+ / Avascular necrosis of the femoral heads in a HIV patient

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Exactitud y concordancia entre glucómetros: un estudio en condiciones habituales de práctica clínica / Accuracy and reliability between glucose meters: a study under normal clinical practice conditions

Introducción. Los glucómetros demuestran habitualmente una gran exactitud, y en la práctica, la glucemia capilar y la glucemia plasmática (GP) son utilizadas indistintamente. Sin embargo, numerosas variables pueden afectar la validez de estos aparatos. El objetivo de este estudio fue conocer la exactitud y la concordancia de 3 glucómetros utilizados en las consultas de un EAP. Material y métodos. De 59 participantes se obtuvieron una muestra de sangre venosa y una gota de sangre capilar, que fue analizada en 3 glucómetros: 2 FreeStyle® Optium (OP1 y OP2) y un Accu-Chek® Aviva. El valor de referencia fue la GP y fueron analizados asimismo el hematocrito y los niveles plasmáticos de urea, bilirrubina, ácido úrico y triglicéridos. Se utilizaron la regresión de Passing-Bablok para la exactitud, y el coeficiente de correlación intraclase y el método Bland-Altman para la concordancia. Se ha considerado el estándar actual (American Diabetes Association) de un error tolerado de±5%. Resultados. La diferencia de medias±desviación estándar (mg/dL) y el error sistemático fueron: 5,8±7 y 5,8% (OP1); 6,2±8 y 5,9% (OP2); 8,3±8 y 6,3% (Accu-Chek®). El par más concordante fue OP1/OP2, con un coeficiente de correlación intraclase=0,97, sesgo=−0,4mg/dL y una amplitud de los límites de acuerdo con el 95%=28,6mg/dL. Se observaron los mayores grados de exactitud y de concordancia en rangos glucémicos elevados (GP≥126mg/dL). Conclusiones. Aunque mostraron una diferencia de medias clínicamente aceptable respecto a la GP, los 3 glucómetros incumplieron el estándar actual de la American Diabetes Association. Es recomendable la realización periódica de controles de calidad de estos dispositivos (AU)

Introduction. The glucose meters usually show a high accuracy, and in clinical practice, capillary and plasma glucose (PG) are used interchangeably. However, many variables can affect the validity of these devices. The aim of this study was to determine the accuracy and reliability of 3 glucose meters that are currently used in a primary care centre. Material and methods. A sample of venous blood and a drop of capillary blood were obtained from 59 participants. The drop was analysed in 3 glucose meters: 2 FreeStyle® Optium (OP1 and OP2), and one Accu-Chek® Aviva. The PG acted as the reference value, and the haematocrit and plasma levels of urea, bilirubin, uric acid and triglycerides were also analysed. We used the Passing-Bablok regression for accuracy and the intraclass correlation coefficient and the Bland-Altman method for reliability. The current American Diabetes Association standard of a total error of±5% was applied. Results. Differences in mean±standard deviation (mg/dL) and the systematic error were 5.8±7 and 5.8% (OP1); 6.2±8 and 5.9% (OP2); 8.3±8 and 6.3% (Accu-Chek®). The OP1/OP2 pair showed the highest level of reliability, with an intraclass correlation coefficient=0.97, bias=−0.4mg/dL, and a width of the 95% limits of agreement of 28.6mg/dL. The highest levels of accuracy and reliability were observed in high glucose ranges (PG≥126mg/dL). Conclusions. Despite their clinically acceptable mean difference compared to the PG, the 3 glucose meters did not fulfill the current American Diabetes Association standard. The regular performance of quality control tests of these devices is recommended (AU)

[Accuracy and reliability between glucose meters: A study under normal clinical practice conditions]. / Exactitud y concordancia entre glucómetros: un estudio en condiciones habituales de práctica clínica.

INTRODUCTION: The glucose meters usually show a high accuracy, and in clinical practice, capillary and plasma glucose (PG) are used interchangeably. However, many variables can affect the validity of these devices. The aim of this study was to determine the accuracy and reliability of 3 glucose meters that are currently used in a primary care centre. MATERIAL AND METHODS: A sample of venous blood and a drop of capillary blood were obtained from 59 participants. The drop was analysed in 3 glucose meters: 2 FreeStyle® Optium (OP1 and OP2), and one Accu-Chek® Aviva. The PG acted as the reference value, and the haematocrit and plasma levels of urea, bilirubin, uric acid and triglycerides were also analysed. We used the Passing-Bablok regression for accuracy and the intraclass correlation coefficient and the Bland-Altman method for reliability. The current American Diabetes Association standard of a total error of±5% was applied. RESULTS: Differences in mean±standard deviation (mg/dL) and the systematic error were 5.8±7 and 5.8% (OP1); 6.2±8 and 5.9% (OP2); 8.3±8 and 6.3% (Accu-Chek®). The OP1/OP2 pair showed the highest level of reliability, with an intraclass correlation coefficient=0.97, bias=-0.4mg/dL, and a width of the 95% limits of agreement of 28.6mg/dL. The highest levels of accuracy and reliability were observed in high glucose ranges (PG≥126mg/dL). CONCLUSIONS: Despite their clinically acceptable mean difference compared to the PG, the 3 glucose meters did not fulfill the current American Diabetes Association standard. The regular performance of quality control tests of these devices is recommended.

Un electrocardiograma inquietante: ondas T negativas en precordiales izquierdas de un deportista afroamericano / A disturbing electrocardiogram: inverted T waves in the left precordial leads of an African-American athlete

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Colecistitis alitiásica en un consumidor de heroína por vía intravenosa / Acalculous cholecystitis in an intravenous heroin consumer

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Fiabilidad en la evaluación radiológica de la calcificación aórtica abdominal mediante la escala de 24 puntos / Reliability of radiologic evaluation of abdominal aortic calcification using the 24-point scale

Objetivo. La calcificación de la aorta abdominal se asocia a un incremento en el riesgo de morbilidad cardiovascular, y disponer de un método de cuantificación de la misma es clínicamente trascendente. La escala de 24 puntos (AAC-24) es el método estándar para su evaluación en la radiología simple lateral de columna lumbar. El objetivo del estudio ha sido conocer el nivel de acuerdo intra e interobservador que aporta esta escala, teniendo en cuenta la heterogeneidad de la distribución de las calcificaciones en el diseño del análisis estadístico. Material y métodos. Se analizó la concordancia intraobservador (sobre radiografías de 81 pacientes, con una separación de 4 años) y la concordancia interobservador (sobre radiografías de 100 pacientes, con tres evaluadores), utilizando simultáneamente la correlación intraclase y el método gráfico de Bland-Altman. Resultados. El coeficiente de correlación intraclase fue de 0,93 (intervalo de confianza al 95% [IC95%]: 0,6-0,9) y 0,91 (IC95%: 0,8-0,9), intra e interobservador, respectivamente, con un incremento del coeficiente en el tercil de mayor discrepancia. La diferencia de medias osciló entre 0,3 y-1,2 puntos. La amplitud entre los límites de acuerdo, entre 4,7 y 9,4 puntos. Se observó un aumento significativo de las diferencias en relación con el aumento progresivo de la calcificación. Conclusiones. La valoración de la calcificación de la aorta abdominal en radiología simple lateral de columna lumbar mediante la escala AAC-24 es un método fiable y reproducible, observándose un mayor grado de concordancia intra e interobservador en las fases iniciales de la calcificación (AU)

Objective. Calcification of the abdominal aorta is associated with increased cardiovascular morbidity, so a reliable method to quantify it is clinically transcendent. The 24-point scale (AAC-24) is the standard method for assessing abdominal aortic calcification on lateral plain films of the lumbar spine. The aim of this study was to determine the intraobserver and interobserver agreements for the AAC-24, taking into account the heterogeneity of the distribution of the calcifications in the design of the statistical analysis. Material and methods. We analyzed the intraobserver agreement (in plain films from 81 patients, with a four-year separation between observations) and the interobserver agreement (in plain films from 100 patients, with three observers), using both intraclass correlation and Bland-Altman plots. Results. The intraobserver intraclass correlation coefficient was 0.93 (95% confidence interval [CI95%]: 0.6-0.9), and the interobserver intraclass correlation coefficient was 0.91 (CI95%: 0.8-0.9) with an increase in the coefficient in the tercile with the greatest discrepancy. The difference in means ranged from 0.3 to 1.2 points, and the distance between the limits of agreement ranged from 4.7 to 9.4 points. These differences increased significantly as the calcification progressed. Conclusions. Using the AAC-24 on lateral plain films of the lumbar spine is a reliable and reproducible method of assessing calcification of the abdominal aorta; both intraobserver and interobserver agreement are higher during the initial phases of calcification (AU)

Reliability of radiologic evaluation of abdominal aortic calcification using the 24-point scale.

OBJECTIVE: Calcification of the abdominal aorta is associated with increased cardiovascular morbidity, so a reliable method to quantify it is clinically transcendent. The 24-point scale (AAC-24) is the standard method for assessing abdominal aortic calcification on lateral plain films of the lumbar spine. The aim of this study was to determine the intraobserver and interobserver agreements for the AAC-24, taking into account the heterogeneity of the distribution of the calcifications in the design of the statistical analysis. MATERIAL AND METHODS: We analyzed the intraobserver agreement (in plain films from 81 patients, with a four-year separation between observations) and the interobserver agreement (in plain films from 100 patients, with three observers), using both intraclass correlation and Bland-Altman plots. RESULTS: The intraobserver intraclass correlation coefficient was 0.93 (95% confidence interval [CI95%]: 0.6-0.9), and the interobserver intraclass correlation coefficient was 0.91 (CI95%: 0.8-0.9) with an increase in the coefficient in the tercile with the greatest discrepancy. The difference in means ranged from 0.3 to 1.2 points, and the distance between the limits of agreement ranged from 4.7 to 9.4 points. These differences increased significantly as the calcification progressed. CONCLUSIONS: Using the AAC-24 on lateral plain films of the lumbar spine is a reliable and reproducible method of assessing calcification of the abdominal aorta; both intraobserver and interobserver agreement are higher during the initial phases of calcification.

Predicción de uso de consultas en el anciano a partir de las variables de género, edad, comorbilidad y visita previa / Prediction of use of consultations in the elderly from the variables of gender, age, comorbidity and prior visit

Introducción. En el anciano se conocen numerosas variables asociadas a la utilización de consultas, si bien hay discrepancias sobre su efecto como predictoras de nuevas visitas. El objetivo del estudio ha sido conocer la capacidad predictiva de un modelo de uso de consultas en población >= 65 años atendida en AP. Material y métodos. Se estudian 207 pacientes. Las variables de resultado son «Visitas al centro de salud» y «Visitas a urgencias del hospital», analizadas asimismo como predictiva una de otra. Otras variables predictivas son la edad, el género y la comorbilidad. Mediante regresión múltiple se elaboran 14 modelos multivariantes, expresándose el valor del coeficiente R2, la reducción de la varianza que aporta cada variable y su significación estadística. Resultados. La capacidad predictiva mejora al estratificar, alcanzando el máximo rendimiento en el modelo «Visitas a urgencias en pacientes sin comorbilidad» (R2=0,251,p<0,000). Ambos tipos de visitas se correlacionan significativamente con la edad, la comorbilidad y entre ambas. Son las variables más predictivas, con una capacidad explicativa que llega al 17,6%, mientras que la comorbilidad alcanza el 11,8%. Conclusiones. Aunque los modelos son precisos, las variables analizadas son insuficientes para predecir el uso de consultas en el anciano, pues tan sólo explican un 25% de la variabilidad final. Dentro de esa capacidad explicativa, se observa que una visita previa es un potente predictor de una visita futura, especialmente en 3 estratos: mujeres, < 75 años y pacientes sin comorbilidad. La edad y la comorbilidad son más predictoras de futuras visitas en hombres que en mujeres (AU)

Introduction. Several variables associated with the use of health services by the elderly are already known, although there is disagreement on their effect as predictors of new visits. The aim of this study was to determine the prediction power of a model of use of consultations in people ¡Ý 65years attended in primary care. Material and methods. A total of 207 patients of both genders were studied. Outcome variables were visits to the primary care centre and visits to hospital emergency services, both also analysed as predictive of one another. Other predictive variables were age, gender and comorbidity. A multiple regression analysis was performed using 14 multivariate models. Results. The predictive ability improved with stratification and reached the highest performance in the model ¡°Visits to hospital emergency services in patients without comorbidity¡± (R2=0,251, P<.000). Both types of visits were significantly correlated with age, comorbidity, and between themselves. These were the most predictive variables (up to 17.6%), whereas comorbidity contributed up to 11.8%. Conclusions. Despite the accuracy of the models, these variables are insufficient to predict new consultations in the elderly, because they hardly explain 25% of the final variability. Within the predictive ability, it was shown that a prior visit is a powerful predictor of a future visit, particularly in three strata: women, < 75years and patients without comorbidity. Age and comorbidity are stronger predictors of future visits in men than in women (AU)

Epilepsia y marcapasos: una curiosa asociación / Epilepsy and pacemakers: an interesting association

Algunos pacientes epilépticos pueden presentar alteraciones del ritmo cardiaco potencialmente mortales durante una crisis comicial y, de modo inverso, algunas arritmias cardiacas pueden provocar crisis epilépticas. Presentamos el caso de un varón de 71 años diagnosticado de epilepsia generalizada primaria y portador de un marcapasos definitivo por bloqueo trifascicular, que desarrolló crisis convulsivas coincidentes con una disfunción intermitente de su dispositivo cardiaco, que fue evidenciada mientras se realizaba un ECG. Los clínicos deben considerar que, aunque de forma infrecuente, la disfunción de un marcapasos puede ser la causa de una crisis convulsiva. En estos pacientes un ECG normal no debe ser suficiente para descartar esta disfunción y, si la sospecha clínica es alta, debe indicarse una revisión reglada del marcapasos (AU)

Some epileptic patients may have potentially fatal cardiac rhythm disorders during seizures, and inversely, some cardiac arrhythmias may induce seizures. We present the case of a 71-year-old man diagnosed with primary generalized epilepsy who had a permanent pacemaker because of a trifascicular block. He developed generalized seizures coinciding with intermittent dysfunction of the cardiac device, which we observed while performing an electrocardiogram (ECG). Clinicians should keep in mind that, although it is uncommon, a pacemaker dysfunction may be the cause of seizures. In these patients, a normal ECG may not be enough to rule out this dysfunction, and if there is a high clinical suspicion, a standard pacemaker revision should be performed (AU)