Describimos el caso de un paciente varón de 3 años de edad, que desde los 15 meses presentaba un cuadro clínico consistente en ronquidos intensos, despertares frecuentes, esfuerzo respiratorio ...intenso durante el sueño y retraso del desarrollo pondoestatural. Se le practicó una adenoidectomía a los 18 meses de edad, con mejoría inicial de los síntomas, que sin embargo reaparecieron a los 3 meses de la cirugía. Se le realizó una segunda adenoidectomía, acompañada esta vez de amigdalectomía, sin mejoría significativa de la clínica. Se le efectuó una polisomnografía, que resultó diagnóstica de síndrome de apneas-hipopneas durante el sueño de carácter grave, con un índice de apneas-hipopneas de 45. Tras comenzar tratamiento con presión positiva continua de la vía aérea mejoró la calidad del sueño, pero persistieron algunos de los síntomas, fundamentalmente el ronquido. Para normalizar su patrón respiratorio durante el sueño requirió, finalmente, una tercera adenoidectomía.
We report the case of a 3-year-old boy who had experienced intense snoring, frequent awakenings, intense respiratory effort during sleep, and delayed growth starting at the age of 15 months. He underwent adenoidectomy at 18 months. Symptoms initially improved but reappeared 3 months after surgery. He underwent a second adenoidectomy, this time with tonsillectomy, but there was no significant clinical improvement. Polysomnography revealed severe sleep apnea-hypopnea with an apnea–hypopnea index of 45. Continuous positive airway pressure improved sleep quality, although some symptoms, mainly snoring, persisted. A third adenoidectomy was necessary to normalize his breathing pattern during sleep.
Describimos el caso de un paciente varón de 3 años de edad, que desde los 15 meses presentaba un cuadro clínico consistente en ronquidos intensos, despertares frecuentes, esfuerzo respiratorio ...intenso durante el sueño y retraso del desarrollo pondoestatural. Se le practicó una adenoidectomía a los 18 meses de edad, con mejoría inicial de los síntomas, que sin embargo reaparecieron a los 3 meses de la cirugía. Se le realizó una segunda adenoidectomía, acompañada esta vez de amigdalectomía, sin mejoría significativa de la clínica. Se le efectuó una polisomnografía, que resultó diagnóstica de síndrome de apneas-hipopneas durante el sueño de carácter grave, con un índice de apneas-hipopneas de 45. Tras comenzar tratamiento con presión positiva continua de la vía aérea mejoró la calidad del sueño, pero persistieron algunos de los síntomas, fundamentalmente el ronquido. Para normalizar su patrón respiratorio durante el sueño requirió, finalmente, una tercera adenoidectomía.
There is a significant lack of scientific evidence on the role of SAHS in the elderly despite the increasing ageing of the population. The objective of the present study is to analyse the current ...healthcare situation in Spain on the diagnosis and treatment of sleep apnoea in the elderly population (≥65 years) and its progress over the last few years.
Cross-sectional study. Healthcare information was collected on the diagnosis and treatment of patients of both sexes, ≥65 years old suspected of having SAHS and referred to sleep units (SU) between 2002 and 2008.
There were 51,229 sleep studies performed in 16 SU. Of these, 24.3% were performed on subjects ≥65 years old (64.9% men), of which 71.5% had an apnoea-hypopnoea index (AHI) > 10 (68.6% treated with CPAP). There were no differences over time as regards mean age, mean AHI or percentage of studies done. A significant decrease was observed in the number of CPAP prescribed to men ≥65 years from 2002 to 2005 (
P=.01) which subsequently increased up to 2008 (
P=.01). This phenomenon was not observed in women ≥65 years.
Despite the lack of evidence on the subject, healthcare activity due to suspected SAHS in the elderly population is intense; therefore it should be a priority to start clinical studies that may be able to answer key questions on the diagnosis and treatment of SAHS in this age group
Existe una importante falta de evidencia científica sobre el papel del SAHS en edades avanzadas a pesar del envejecimiento progresivo de la población. El objetivo del presente estudio es analizar el panorama asistencial actual en nuestro país sobre el diagnóstico y tratamiento del SAHS en individuos ≥65 años y su evolución a lo largo de los últimos años.
Estudio de corte trasversal. Fue recogida información asistencial sobre el diagnóstico y tratamiento de pacientes con sospecha de SAHS de ambos sexos con ≥65 años remitidos a las unidades de sueño (US) entre 2002 y 2008.
Fueron incluidos 51.229 estudios de sueño de 16 US. El 24,3% de los estudios fue realizado en individuos ≥65 años (64,9% varones), de los que el 71,5% mostró un IAH ≥ 10 (68,6% tratados con CPAP). No hubo cambios significativos a lo largo del tiempo en la edad media, IAH medio o porcentaje de estudios realizados. Se observó una disminución significativa en el número de CPAP prescritas en varones ≥ 65 años desde 2002 al 2005 (p = 0,01) que aumentó posteriormente hasta 2008 (p = 0,01). Este fenómeno no fue observado en mujeres ≥ 65 años.
A pesar de la escasa evidencia científica sobre el tema, la actividad asistencial por sospecha de SAHS en individuos de edades avanzadas es intensa por lo que se hace prioritaria la puesta en marcha de estudios clínicos que den respuesta a preguntas clave sobre el diagnóstico y el tratamiento del SAHS en esta franja de edad.
Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and ...in-hospital mortality in non-critically patients hospitalized with COVID-19.
This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140-180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality.
Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140-180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31-1.73) (BG 140-180 mg/dL; HR 1.48; 95%CI: 1.29-1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality.
Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes.
KEY MESSAGE
Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19.
Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19.
Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes.
To analyze national trends in the rates of hospitalizations (all-cause and by principal discharge diagnosis) in total diabetic population of Spain.
We carried out a nation-wide population-based study ...of all diabetic patients hospitalized between 1997 and 2010. All-cause hospitalizations, hospitalizations by principal discharge diagnosis, mean age, Charlson Comorbidity Index, readmission rates and length of hospital stay were examined. Annual rates adjusted for age and sex were analyzed and trends were calculated.
Over 14-years-period, all-cause hospitalizations of diabetic patients increased significantly, with an average annual percentage change of 2.5 (95%CI: 1.5–3.5; Ptrend < 0.01). The greatest increase was observed in heart failure (5.4; 95%CI: 4.8–6.0; Ptrend < 0.001), followed by neoplasms (4.9; 95%CI: 3.6–5.8; Ptrend < 0.001), pneumonia (2.7; 95%CI: 2.0–4.0; Ptrend < 0.001), stroke (2.4; 95%CI: 1.6–3.4; Ptrend < 0.001), chronic obstructive pulmonary disease (2.0; 95%CI: 1.4–3.4; Ptrend < 0.001) and coronary artery disease (1.6; 95%CI: 1.1–2.3; Ptrend < 0.01). The adjusted number of all-cause hospitalizations of patients with diabetes per 100,000 inhabitants increased 2.6-fold. The increase in hospitalizations was significantly higher among patients ≥75 years old. Males experienced a greater increase in all-cause, neoplasm, heart failure, chronic obstructive pulmonary disease, and pneumonia hospitalizations (p < 0.01 for all). Hospitalized diabetic patients were progressively older and had more comorbidities, higher readmission rates and shorter hospital stays (p < 0.05 for all).
Hospitalizations of diabetic patients more than doubled in Spain during the study period. Heart failure and neoplasms experienced the greatest annual increases and remained the principal causes of hospitalization, probably associated with advanced age and comorbidities of hospitalized diabetics. Coronary and cerebrovascular diseases experienced a lower annual increase, suggesting an improvement in cardiovascular care in diabetes in Spain.
•Patients with diabetes mellitus are admitted to hospital more often.•Hospitalizations of patients with diabetes have gradually increased over time.•Heart failure and neoplasms are the main causes of hospitalizations for diabetics.•Hospitalized diabetic patients are progressively older and have more comorbidities.•Hospitalization trends for coronary and cerebrovascular disease are less pronounced.
We report the first case of late presentation of familial aortic coarctation, a rare cause of hypertension. Diagnosis of familial aortic coarctation in the elderly is exceptional, given that in the ...absence of endovascular or surgical repair patients do not usually survive beyond 50 years of age. Our case concerns a 72-year-old woman with hypertension of long evolution, control of which improved markedly after endovascular repair of the coarctation. Her son had undergone surgery for repair of aortic coarctation at the age of 23 years.
The quenching of the fluorescence of 1-pyrene-carboxaldehyde by iodide ions has been studied in the presence of micellar solutions of CTAC and SDS. In the presence of the latter surfactant, the ...fluorophore accumulates at the micelles whereas the quencher is repelled from the aggregates. Consequently, a decrease of the quenching is observed when the concentration of micelles increases. In the CTAC case, both the 1-pyrene-carboxaldehyde and the iodide ions accumulate on the micelles, so that a maximum in the quenching is observed (see Fig. 3). These facts can be formally rationalized using the pseudophase model. However, the meaning of the parameters appearing in the equations of this model are, for photochemical quenching processes, different from those corresponding to ground state reactions. The quantitative analysis of the parameters has been carried out employing a formulation previously developed by us, which is extended here in order to take into account the particular characteristics of micellar solutions.
The quenching of the fluorescence of 1-pyrene-carboxaldehyde by iodide ions has been studied in the presence of micellar solutions of CTAC and SDS. In the presence of the latter surfactant, the ...fluorophore accumulates at the micelles whereas the quencher is repelled from the aggregates. Consequently, a decrease of the quenching is observed when the concentration of micelles increases. In the CTAC case, both the 1-pyrene-carboxaldehyde and the iodide ions accumulate on the micelles, so that a maximum in the quenching is observed (see Fig. 3). These facts can be
formally
rationalized using the pseudophase model. However, the meaning of the parameters appearing in the equations of this model are, for photochemical quenching processes, different from those corresponding to ground state reactions. The quantitative analysis of the parameters has been carried out employing a formulation previously developed by us, which is extended here in order to take into account the particular characteristics of micellar solutions.
Applicability of the pseudophase model to photochemical reactions in the presence of receptors (micelles) in spite of the fact that the equilibrium condition between free and bound reactants does not hold.
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