BackgroundPremorbid metabolic syndrome (pre-MetS) is a cluster of cardiometabolic risk factors characterised by central obesity, elevated fasting glucose, atherogenic dyslipidaemia and hypertension without established cardiovascular disease or diabetes. Community pharmacies are in an excellent position to develop screening programmes because of their direct contact with the population.The main aim of the study was to determine the prevalence of pre-MetS in people who visited community pharmacies for measurement of any of its five risk factors to detect the presence of other risk factors. The secondary aims were to study the presence of other cardiovascular risk factors and determine patients’ cardiovascular risk.MethodsCross-sectional, descriptive, multicentre study. Patients meeting selection criteria aged between 18 and 65 years who visited participating community pharmacies to check any of five pre-MetS diagnostic factors were included.The study involved 23 community pharmacies in Catalonia (Spain). Detection criteria for pre-MetS were based on the WHO proposal following IDF and AHA/NHBI consensus. Cardiovascular risk (CVR) was calculated by Regicor and Score methods. Other variables studied were smoking habit, physical activity, body mass index (BMI), and pharmacological treatment of dyslipidemia and hypertension. The data were collected and analysed with the SPSS programme. Comparisons of variables were carried out using the Student’s T-test, Chi-Squared test or ANOVA test. Level of significance was 5% (0.05).ResultsThe overall prevalence of pre-MetS was 21.9% [95% CI 18.7-25.2]. It was more prevalent in men, 25.5% [95% CI 22.1-28.9], than in women, 18.6% [95% CI 15.5-21.7], and distribution increased with age. The most common risk factors were high blood pressure and abdominal obesity. About 70% of people with pre-MetS were sedentary and over 85% had a BMI ≥25 Kg/m2. Some 22.4% had two metabolic criteria and 27.2% of patients with pre-MetS had no previous diagnosis.ConclusionsThe prevalence of pre-MetS in our study (21.9%) was similar to that found in other studies carried out in Primary Care in Spain. The results of this study confirm emergent cardiometabolic risk factors such as hypertension, obesity and physical inactivity.Our study highlights the strategic role of the community pharmacy in the detection of pre-MetS in the apparently healthy population.
The authors compared stretch-evoked somatosensory evoked potentials (SEP) of 18 type 3 Gaucher disease (GD3) patients (two with progressive myoclonus epilepsy [PME]) with 22 age-matched normal controls and six patients with type 1 (nonneuronopathic) Gaucher disease (GD1). The mean P1-N2 SEP amplitude in GD3 patients was significantly larger than the SEP in controls and in GD1 patients, and there was a significant negative correlation between SEP amplitude and the IQ of GD3 patients. The authors conclude that abnormal cortical inhibition is a unifying feature of GD3 patients and correlates with the degree of cognitive deficit.
ObjectiveEarly paracentesis (EP) for rapid diagnosis of spontaneous bacterial peritonitis is considered best practice in the care of admitted patients with cirrhosis and ascites, but inpatient paracentesis is frequently not performed or delayed. We developed a quality improvement (QI) initiative aimed at increasing the proportion of admitted patients with cirrhosis who undergo paracentesis and EP.Design Pre–post study of a QI initiative.Setting A tertiary care hospital in a major metropolitan area.Patients Hospitalised patients with cirrhosis and ascites.InterventionsWe targeted care providers in the emergency department (ED) by raising awareness of the importance of EP, developing criteria to identify patients at highest risk of SBP who were prioritised for EP by ED providers and restructuring the ED environment to enable timely paracentesis.Results76 patients meeting inclusion criteria were admitted during the postintervention 9-month study period. Of these, 91% (69/76) underwent paracentesis during admission versus 71 % (77/109) preintervention (p=0.001). 81% (56/69) underwent EP within 12 hours of presentation or after a predefined acceptable reason for delay versus 48% (37/77) preintervention (p=0.001). There were no significant differences in in-hospital mortality or length of stay before and after intervention.ConclusionA multidisciplinary QI intervention targeting care in the ED successfully increased the proportion of patients with cirrhosis and ascites undergoing diagnostic paracentesis during admission and EP within 12 hours of presentation.
BACKGROUND The evolution of ischemic stroke is different according to sex and is one of the main causes of death in women. In the literature, it is not clear if this is due to biological differences or to disparities in medical care. Previous studies have shown that women are less likely to receive acute treatment, and stroke center type is an important predictor of door-to-needle times. We investigated whether women are attended in a similar way to men in the telestroke network with specialized stroke physicians. METHODS A prospective registry of ischemic strokes recorded in the centralized Andalusian telestroke network (CATI) was analyzed, focusing on sex differences. Demographic data, clinical characteristics (risk factors), neuroimaging data, treatment intervals, and clinical results (the modified Rankin Scale [mRS] score) were collected. Functional outcomes were evaluated using the mRS at 90 days. RESULTS A total of 3009 suspected stroke patients were attended to in the telestroke network in the last three years, of which 42.74% were women. A total of 69.54% of the men and 63.85% of the women were diagnosed with ischemic stroke (p=0.002). Women were older (p>0.001) and less independent upon arrival (p=0.006) than men. There was no difference in the treatment received or in the treatment intervals between the groups. Importantly, there was no difference in mRS scores at 3 months between sexes. However, at follow-up, women had fewer imaging tests (p = 0.018) and fewer outpatient visits (p<0.001) than men. CONCLUSIONS No significant difference between men and women has been found in the acute treatment of stroke in a large telestroke network. However, the same is not true for the follow-up and management of patients after the acute phase. This fact supports that strict adherence to protocols, training, and specialization of care and providing equal attention prevents sex differences in stroke treatment and functional outcomes.
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