Abstract
BACKGROUND AND AIMS
Cardiovascular disease (CVD) is one of the principal causes of death in antineutrophil cytoplasmic antibody-(ANCA)-associated vasculitis (AAV), partly due to the vascular ...inflammation itself, the associated organic damage and the treatment 1. AAV has been associated with traditional risk factors, such as hypertension (HTN), diabetes mellitus (DM) or impared renal function 2, which also contribute to accelerated atherosclerosis.
However, there are not specific recommendations about CVD treatment in AAV patients 3, and the vascular risk scores used for general population have not been extrapolated yet. Our objective is to assess the frequency of cardiovascular events (CVE) and mortality in AAV patients and to explore the possible vascular risk factors (VRF) and the therapeutic intervention on them.
METHOD
A descriptive and retrospective study of a multidisciplinary cohort of AAV patients followed prospectively was performed in 12 hospitals of the 8 provinces of Autonomous Community of Andalusia. Factors that presumably may influence in CVD and mortality were collected. Two CV risk scores were measured 4, 5. The presence of a strategy carried out by clinicians on CV risk was analysed according guides ESC/ESH and KDIGO guides. Data was analysed using Chi-square, ANOVA and Cox proportional hazards regresion as uni and multivariate test with a 95% confidence interval.
RESULTS
A multicentre cohort of 220 AAV patients followed up from 1979 until June 2020 was studied, during a mean ± standard deviation follow-up of 96.79 ± 75.83 months. The mean age at diagnosis was 59.92 ± 16.25 years, 45% were female and all but one caucasians. Sociodemographic and clinical characteristics are shown in Table 1.
After AAV diagnosis, 30/224 (13%) patients presented at least one CVE (Figure 1A and B), 37% IHD, 43% CVA and 50% PVD. Independent prognostic factors of CVE were age (HR 1.042, P = .005) and the presence of hypertension (HTN) 6 months after diagnosis (HR 4.641, P = .01). Regarding classic VRFs, 81% had HTN 33% already presented it before diagnosis and 48% after (35% in the first 6 months). Thirty-four patients presented DM at the end of following 12% already presented it before diagnosis and 22% presented it after (16% in the first 6 months). The independent predictor for HTN at 6 months was renal involvement at BVAS baseline, and DM in the first 6 months for HTN at the end of following.
Attending to the ESC Vascular Risk scale, 8.4% presented low risk, 16.9% moderate, 29.8 high and 44.4% very high risk. According to the REGICOR scale, the mean value of suffering a CV event in the next 10 years was 4.6%±3.32%, with 59%, 34% and 7% of patients presenting low, moderate and high risk, respectively. Regarding VRF management strategies, just 14% of hypertensive patients, 16.2% of those that needed dyslipidemia treatment, and 8.6% of diabetic patients were not within the target guidelines recommendations.
Fifty-one patients (23%) died (Figure 1C and D), 23.5% due to infectuous disease, 19.6% to cancer, 17.6% to CVD,13.7% to AAV relapse and 13 due to organic deficit, other or an unknown cause. In our final model of multivariate analysis, just age and renal function at baseline were independent predictors of mortality. Independent prognostic factors of mortality were age (HR 1.083, P = .00) and baseline creatinine (HR 4.41, P = .01).
CONCLUSION
Age and early HTN are risk factors for having a CVE, and age and renal function are predictors of mortality. HTN are more frecuent in AAV patients than in general population. CVD screening in AAV patients is demanded. The REGICOR and ESC scores could be extrapolated as a predictor of cardiovascular risk in AAV patients.
We aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site ...infection (SSI) in patients scheduled for abdominal surgery.
We performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality.
We enrolled 740 subjects: 371 in the high FIO2 group and 369 in the low FIO2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO2 groups (relative risk RR: 0.94; 95% confidence interval CI: 0.59–1.50; P=0.90). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48–1.25; P=0.38) and myocardial ischaemia (0.6% n=2 vs 0% n=0; P=0.47) did not differ between groups.
An oxygenation strategy using high FIO2 compared with conventional FIO2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found.
NCT02776046.
To determine the frequency of avoidable adverse events (AAEs) in Primary Care (PC).
Retrospective cohort study.
Family medicine and paediatric clinics in Andalusia, Aragon, Castilla-La Mancha, ...Catalonia, Madrid, Navarre, and Valencia.
A review was performed on a designated sample of 2,397 medical records (95% confidence level and 2% accuracy). The sample was stratified by age group as regards the frequency of physician consultations and considering equal distribution of male and female patients.
Number and severity of identified AAEs from February 2018 to September 2019.
A total of 2,557 medical records were reviewed (1,928, 75.4% of adult patients, and 629, 24.6% paediatrics). A total of 182 (7.1%, 95% CI 6.1-8.1%) AAEs that affected 168 patients were identified, which included 7.6% (95% CI 6.4-8.8%) in adults and 5.7% (95% CI 3.9-7.5%) in paediatric patients. The number of AAEs in women was higher than in men (P = 0.006). The incidence of AAEs in boys and girls was similar (P = 0.3). Permanent damage was caused by AAEs in 6 (4.1%) adult patients.
Seeking formulas to increase patient safety in PC should remain a priority objective, particularly in female patients and in paediatrics. One in 24 AAEs causes serious and permanent damage in adults.
This study aimed to measure the frequency and severity of avoidable adverse events (AAEs) related to ignoring do-not-do recommendations (DNDs) in primary care.
A retrospective cohort study analyzing ...the frequency and severity of AAEs related to ignoring DNDs (7 from family medicine and 3 from pediatrics) was conducted in Spain. Data were randomly extracted from computerized electronic medical records by a total of 20 general practitioners and 5 pediatricians acting as reviewers; data between February 2018 and September 2019 were analyzed.
A total of 2557 records of adult and pediatric patients were reviewed. There were 1859 (72.7%) of 2557 (95% confidence interval CI, 71.0%-74.4%) DNDs actions in 1307 patients (1507 were performed by general practitioners and 352 by pediatricians). Do-not-do recommendations were ignored more often in female patients (P < 0.0001). Sixty-nine AAEs were linked to ignoring DNDs (69/1307 5.3%; 95% CI, 4.1%-6.5%). Of those, 54 (5.1%) of 1062 were in adult patients (95% CI, 3.8%-6.4%) and 15 (6.1%) of 245 in pediatric patients (95% CI, 3.1%-9.1%). In adult patients, the majority of AAEs (51/901 5.7%; 95% CI, 4.2%-7.2%) occurred in patients 65 years or older. Most AAEs were characterized by temporary minor harm both in adult patients (28/54 51.9%; 95% CI, 38.5%-65.2%) and pediatric patients (15/15 100%).
These findings provide a new perspective about the consequences of low-value practices for the patients and the health care systems. Ignoring DNDs could place patients at risk, and their safety might be unnecessarily compromised.
NCT03482232.
Abstract Introduction and objectives Some anthropometric measurements show a greater capacity than others to identify the presence of cardiovascular risk factors. This study estimated the magnitude ...of the association of different anthropometric indicators of obesity with hypertension, dyslipidemia, and prediabetes (altered fasting plasma glucose and/or glycosylated hemoglobin). Methods Cross-sectional analysis of information collected from 2022 participants in the PREDAPS study (baseline phase). General obesity was defined as body mass index ≥ 30 kg/m2 and abdominal obesity was defined with 2 criteria: a) waist circumference (WC) ≥ 102 cm in men/WC ≥ 88 cm in women, and b) waist-height ratio (WHtR) ≥ 0.55. The magnitude of the association was estimated by logistic regression. Results Hypertension showed the strongest association with general obesity in women (OR, 3.01; 95% CI , 2.24-4.04) and with abdominal obesity based on the WHtR criterion in men (OR, 3.65; 95%CI, 2.66-5.01). Hypertriglyceridemia and low levels of high-density lipoprotein cholesterol showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.49; 95%CI, 1.68-3.67 and OR, 2.70; 95%CI, 1.89-3.86) and with general obesity in men (OR, 2.06; 95%CI, 1.56-2.73 and OR, 1.68; 95%CI, 1.21-2.33). Prediabetes showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.48; 95%CI, 1.85-3.33) and with abdominal obesity based on the WC criterion in men (OR, 2.33; 95%CI, 1.75-3.08). Conclusions Abdominal obesity indicators showed the strongest association with the presence of prediabetes. The association of anthropometric indicators with hypertension and dyslipidemia showed heterogeneous results.
Streptococcus pneumoniae susceptibility to 12 antimicrobial agents was assessed using isolates collected from patients with invasive and non-invasive infections in a Spanish medical center. Two ...hundred and thirty-six invasive and 478 non-invasive pneumococcal isolates obtained between 1998 and 2004 were tested. Penicillin non-susceptible isolates were more likely to exhibit resistance to cephalosporins, macrolides, chloramphenicol, and tetracycline when compared to penicillin-susceptible isolates. Penicillin resistance was present in 8.1% of the invasive and 18.6% of the non-invasive isolates. Overall, antimicrobial resistance was greater in non-invasive versus invasive isolates in adults. Serogroups included in the 7-valent and 23-valent formulation accounted for approximately 92.8 and 88.3% of the invasive isolates in children 2 years old or younger and the elderly, respectively. The proportion of isolates not susceptible to penicillin, erythromycin, and/or tetracycline decreased significantly over the surveillance period. Local epidemiological data assisted in the clinical determination of treatment protocols and effective prevention strategies.
The morbidity and mortality rates associated with
Streptococcus pneumoniae remain very high worldwide. The virulence of this bacterium is largely dependent on its polysaccharide capsule, which is ...quite heterogeneous and represents a serious obstacle for designing effective vaccines. However, it has been demonstrated that numerous protein virulence factors are involved in the pathogenesis of pneumococcal disease. An important related finding from experimental animal models is that non-capsulated strains of pneumococci are protective against capsulated ones. Hence, new vaccine designs are focused on the surface proteins (e. g., PspA and PspC) and on the cytolysin, pneumolysin. Moreover, several virulence factors have potential value for pneumococcal diagnosis by urinalysis. In this paper, we review the virulence factors involved in bacteria-host interactions, and the new developments in vaccines and diagnostic methods.
Las tasas de morbimortalidad por
Streptococcus pneumoniae permanecen muy elevadas en todo el mundo. La cápsula polisacarídica es esencial para la virulencia y, por su heterogeneidad, es un serio obstáculo en la generación de una vacuna más eficaz. Sin embargo, se ha demostrado que múltiples factores de virulencia proteicos están implicados en la patogénesis de la enfermedad neumocócica. Un importante hallazgo es el hecho de que cepas no capsuladas de neumococo ofrezcan protección frente a cepas capsuladas, en modelos animales de experimentación. Por ello, el diseño de nuevas vacunas se ha centrado en proteínas de superficie, como PspA y PspC, y en la citolisina neumolisina. Además, varios factores de virulencia tienen valor potencial para el diagnóstico del neumococo en muestras de orina. En este trabajo, revisamos los factores de virulencia implicados en la interacción bacteria-huésped, y en el desarrollo de nuevas vacunas y métodos de diagnóstico.
Resumen Introducción y objetivos Algunas medidas antropométricas muestran mayor capacidad que otras para discriminar la presencia de factores de riesgo cardiovascular. Este trabajo estima la magnitud ...de la asociación de diversos indicadores antropométricos de obesidad con hipertensión, dislipemia y prediabetes (glucemia basal o glucohemoglobina alteradas). Métodos Análisis transversal de la información recogida en 2.022 sujetos del estudio PREDAPS (etapa basal). Se definió obesidad general como índice de masa corporal ≥ 30 kg/m2 y obesidad abdominal con 2 criterios: a) perímetro de cintura (PC) ≥ 102 cm en varones/PC ≥ 88 cm en mujeres, y b) índice cintura/estatura (ICE) ≥ 0,55. La magnitud de la asociación se estimó mediante regresión logística. Resultados La hipertensión arterial mostró la asociación más alta con la obesidad general en mujeres (OR = 3,01; IC95%, 2,24-4,04) y con la obesidad abdominal según el criterio del ICE en varones (OR = 3,65; IC95%, 2,66-5,01). La hipertrigliceridemia y los valores bajos de colesterol unido a lipoproteínas de alta densidad mostraron la asociación más alta con obesidad abdominal según el criterio del ICE en mujeres (OR = 2,49; IC95%, 1,68-3,67 y OR = 2,70; IC95%, 1,89-3,86) y la obesidad general en varones (OR = 2,06; IC95%, 1,56-2,73 y OR = 1,68; IC95%, 1,21-2,33). La prediabetes mostró la asociación más alta con obesidad abdominal según el criterio del ICE en mujeres (OR = 2,48; IC95%, 1,85-3,33) y con obesidad abdominal según el criterio del PC en varones (OR = 2,33; IC95%, 1,75-3,08). Conclusiones Los indicadores de obesidad abdominal mostraron la mayor asociación con la presencia de prediabetes. La relación de los indicadores antropométricos con hipertensión y con dislipemia mostró resultados heterogéneos.
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