Revista clinica espanola最新文献

Point 8 of the Declaration of Helsinki requires that the rights and interests of research participants must always prevail over the scientific interests of the research. Recently, it has been proposed that point 8 be modified to indicate the opposite, that is, that it is acceptable for scientific interests to prevail over the interests of the participants. This article argues against this change. What happened with the masked placebo-controlled trials of experimental vaccines against SARS-CoV-2 is held up as an example. When the high efficacy of the vaccines became evident, questions arose as to what should be done, whether to keep the trials masked until data on long-term efficacy, immunogenicity, and safety were obtained or to unmask the trials and offer the vaccine that had been shown to be efficacious to participants who received the placebo. The latter was the correct approach, which translates point 8 into practice.

Backgroud and objectives: As patients with diabetes are at a significantly higher risk of cardiovascular diseases than those without diabetes, it is important to gain a clinical understanding of the differential effects of smoking cessation on several risk factors between patients with and without diabetes.

Materials and methods: Patients who participated in a smoking cessation program received an assessment of the outcomes of interest. The outcomes were changes in metabolic parameters and renal function from baseline to 6-month follow-up after the smoking cessation program.

Result: A total of 1954 patients joined the smoking cessation program, and 1381 patients were in the smoking cessation failure (SCF) group and 573 were in the smoking cessation success (SCS) group. The decrease in HbA1c after smoking cessation was only observed in patients with diabetes. Smoking cessation was also associated with a significant decrease in LDL cholesterol in patients with diabetes. In terms of renal function, smoking cessation was associated with an improvement in eGFR, and the trend was similar in patients with and without diabetes.

Conclusion: Successful smoking cessation was associated with improvement in renal function. Moreover, it was associated with improvements in HbA1c and LDL cholesterol in patients with diabetes, despite significant weight gain.

Background: Patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD) have a high risk of hospital admission and mortality. This study evaluated the benefit of a care model, characterized by comprehensive and continuous care (UMIPIC program) in patients with HF and a history of COPD.

Methods: A total of 5644 patients were prospectively recruited, of which 1320 had a history of COPD between March 2008 and March 2020. They were divided into 2 follow-up groups at the time of discharge, one in follow-up in the UMIPIC program (435 patients) and another treated conventionally (885 patients). The baseline characteristics of each group were analyzed and patients in each group were selected by propensity score matching and admissions and mortality were evaluated during 12 months of follow-up, after an episode of hospitalization for HF.

Results: The UMIPIC group, compared to the conventional group in the matched cohort, had a lower rate of admissions for HF (21% vs 30 respectively; hazard ratio [HR] = 0.64; 95% confidence interval [95% CI]: 0.54-0.84; p = 0.002) and mortality (28% vs 36%, respectively; HR = 0.68; 95% CI: 0.51-0.90; p = 0.008). From a therapeutic point of view, patients with HF and a history of COPD who were followed in the UMIPIC program received a higher percentage of beta-blockers (64% vs 54%; p < 0.05) and direct-acting anticoagulants (17% vs 9%: p < 0.05) than those followed conventionally.

Conclusions: The implementation of the UMIPIC care program for patients with HF and a history of COPD, based on comprehensive and continuous care, reduces both admissions and mortality at one year of follow-up. The prescription of beta-blockers and direct-acting anticoagulants was also higher during follow-up in the UMIPIC program.

Vennous thromboembolism (VTE) is a common complication associated to greater mortality in patients with cancer. Its etiology is multifactorial and depends on the characteristics and co-morbidities of the patient, the tumor type and extension, and the oncological treatment. The management of VTE is more complex in patients with cancer due to an increased risk of recurrence and major bleeding complications during anticoagulation compared to the general non-oncological population. The above differences have led to the development of specific clinical trials to assess the efficacy and safety of anticoagulant therapy in patients with cancer. The present clinical guidelines are intended to provide general recommendations on the management of cancer-associated VTE according to updated according to the most recent scientific evidence.