Hostility and helper T-cells in patients with bulimia nervosa.

OBJECTIVE: The study aimed to analyze the correlation between lymphocyte counts and several psychopathological variables associated with psychological instability (depression, hostility, impulsivity, self-defeating personality traits, and borderline personality symptoms) in patients with bulimia nervosa (BN). METHOD: Sixty BN patients were assessed, using specific scales for eating pathology, general psychopathology, impulsivity, depression, and borderline personality features. Lymphocyte and lymphocyte subset counts were performed. Plasma cortisol at 8:00, before and after administration of 1 mg of dexamethasone at 23:00, was determined. The influence of body weight, and the use of tobacco, alcohol, and caffeine was controlled. The relationship between each isolated variable and the number of immune cells was analyzed. In a second step, supplementary post-hoc analysis of the variables was introduced to confirm the accuracy of the psychopathological assessment. RESULTS: Hostility was negatively correlated with the number of helper T-cells (CD4+). Patients with high hostility had lower CD4+ cell counts and lower CD4+/CD8+ ratios. In the post-hoc control study, hostility was significantly related with other "interpersonal" items. CONCLUSIONS: These results support the idea that hostility, as an expression of disturbed interpersonal relationships, could play a role as a modulator of immune activity in patients with BN.

Frecuencia e incidencia de la tromboembolia venosa en un hospital general / Frequency and incidence of venous thromboembolism in a general hospital

El objetivo de este estudo fue determinar la frecuencia y la incidencia de la tromboembolia venosa (TEV), objetivamente diagnosticada, en un hospital universitario argentino. Se utilizó un diseño retrospectivo, obsevacional y longitudinal. Se analizaran las historias clínicas de todos los pacientes mayores de 16 años que habítan egresado o fallecido en las unidades de internación clínica, obstétrica y quirúrgica del Hospital de Clínicas José de San Martin con el diagnóstico de TEV durante un período de 24 meses. La frecuencia y laincidencia de TEV fueron 0.92% y 0.40% ( intervalo de confianza de 95% (IC 95%) : 0.37 a 0.42%) respectivamente. La incidencia más alta de TEV se presentó en la novena década de la vida ( 0.80%; IC 95%: 0.78% a ).82% ). Solamente el 31% de los pacientes que desarrollaron TEV durante la interación habían recebido tromboprofilaxis con heparina. La mortalidad intra hospitalaria global de los pacientes con TEV fue 19%.

Pre-endoscopic prognostic factors in non-varicose upper gastrointestinal bleeding. Development of a predictive algorithm.

OBJECTIVE: Upper gastrointestinal or digestive bleeding (UDB) is a common problem requiring hospitalization and implying important morbidity-mortality. The aim of the present study is to identify clinical and laboratory factors predictive of a serious course of non-varicose UDB, based on the development of a simple algorithm for application in the clinical setting. METHODS: A longitudinal study was made of 803 hospitalized patients with non-varicose UDB. Clinical and laboratory parameters were recorded in the Emergency Service before endoscopy. A first non-conditional logistic regression model was developed, including those variables exhibiting a greater capacity for predicting a serious outcome. This model was posteriorly simplified to facilitate clinical application. The prognostic performance was estimated by calculating the area under the ROC curve. RESULTS: The initial predictive model included 11 variables, with an area under the ROC curve of 0.74 (95%CI: 0.71-0.77), while in the second model these same variables were dichotomized, exhibiting an area under the ROC curve of 0.74 (95%CI: 0.70-0.77). Based on the corresponding regression coefficients, the prognostic variables were classified as either major (shock, liver disease, anticoagulant therapy, urea/creatinine ratio > 62) or minor (hematocrit < 33%, renal failure, presentation as hematemesis and melenas, systolic arterial pressure < 110 mmHg, regular alcohol consumption, a history of UDB, and a patient age of > 75 years). UDB was predicted to take an unfavorable course in the presence of one major factor or two minor factors. CONCLUSIONS: The proposed algorithm includes pre-endoscopy clinical and laboratory variables, and allows early classification of patients with non-varicose UDB in terms of their possible clinical course.

Comparative incidence of upper gastrointestinal bleeding associated with individual non-steroidal anti-inflammatory drugs.

OBJECTIVE: The existence of two isoforms of cyclo-oxygenase (COX), COX-1 and COX-2, is now well established. Because inhibition of COX-1 by nonsteroidal anti-inflammatory drugs (NSAIDs) is linked to gastrointestinal (GI) damage, agents with a better COX-2/COX-1 inhibition ratio may have less GI toxicity. The aim of this study was to compare the incidence of upper gastrointestinal bleeding (UGIB) in association with specific NSAIDs including the new "COX-2 preferential" inhibitors. PATIENTS Y METHOD: Individual incidence of NSAID-related UGIB in a health-authority area was estimated, based on cases of UGIB, sales of non-aspirin NSAIDs, and data of used doses in community subjects, during a four-year period. Comparisons were made by calculating individual rate-ratio (RR) and 95% confidence interval (CI) taking as a reference the specific NSAID with the lowest incidence of UGIB. RESULTS: The incidence of UGIB associated with thirteen specific NSAIDs included in the study varied greatly, from 1.7 per 1,000 person-years for aceclofenac to 25.8 per 1,000 person-years for ketorolac. The use of "COX-1 preferential" inhibitors versus "COX-2 preferential" inhibitors was associated with a RR of 5.3 (95% CI, 2.78-10.04), and between NSAIDs with "COX-1-COX-2 mixed" inhibition RR was 2.2 (95% CI, 1.13-4.28). CONCLUSIONS: Our results show that there are differences in GI toxicity according to specific NSAIDs. A substantial reduction in number of cases of UGIB could result from the use of NSAIDs with a "COX-2 preferential" inhibition.

Epidemiologic aspects on nonvariceal upper gastrointestinal bleeding in a mediterranean region: incidence and sociogeographic and temporal fluctuations.

AIM: The objectives of this study were to know the incidence of acute nonvariceal upper gastrointestinal bleeding (UGIB) in a Mediterranean region, and to analyze variations due to sociodemographic (age, gender and Primary Care district) and time factors (trend and seasonality). MATERIAL AND METHODS: Longitudinal study during 4 years (April 1995 to March 1999) including all cases of nonvariceal UGIB admitted to the reference hospital of a Health authority area of the Valencian Community, divided into 17 Primary Care districts. Incidence was modeled by Poisson regression. RESULTS: Incidence for the whole period was 108 cases per 100,000 persons-year (95% CI: 100-115). Almost half of the cases (44.9%) were associated to the previous use of nonsteroidal anti-inflammatory drugs (NSAIDs). Incidence was significantly higher for males and older people. Variations of incidence by Primary Care Districts were only significant for NSAID-related UGIB. In the time series analysis, we found a negative trend and a clear seasonality with higher incidence in autumn and winter compared with spring and summer. When relating the seasonality with UGIB, a significant seasonal pattern was only found for UGIB caused by duodenal ulcer, and disappeared in subjects with previous use of NSAIDs. CONCLUSIONS: In our region, nonvariceal UGIB has a significant incidence, but slightly below that reported by other studies carried out in our country. The highest incidence of UGIB was observed in males, and increased sharply with age. In the time series analysis, a negative trend and a clear seasonal pattern that is absent in cases of previous use of NSAIDs, were found.

Influence of nonsteroidal anti-inflammatory drugs on clinical course in upper gastrointestinal tract bleeding.

UNLABELLED: To establish the influence of nonsteroidal anti-inflammatory drugs (NSAIDs) on the clinical course of upper gastrointestinal bleeding (UGIB), we designed a longitudinal cohort study to assess the effect of prior use of these drugs on several outcome variables in patients with UGIB. RESULTS: 164 (46.6%) of 352 patients with UGIB consumed NSAIDs in the week previous to the onset of bleeding. This group had significantly fewer previous episodes of peptic ulcer and UGIB (p < 0.01), more associated comorbidity, and increased use of steroids (p < 0.05). On endoscopic examination, gastric ulcer was the most frequent lesion in patients with NSAIDs as compared to duodenal ulcer in patients without NSAID use (p < 0.0001). There were no differences in the multivariate analysis between groups regarding lowest hemoglobin level, need for transfusion, stability of bleeding, surgical or endoscopic management, depth of lesions and hospital stay. CONCLUSIONS: a relevant proportion of patients admitted for UGIB had used NSAIDs during the previous week. The most frequent lesion in this group was gastric ulcer. In our study the clinical course of NSAID-associated UGIB was similar to that in other nonvariceal types of bleeding.

[Prognostic factors and mortality among adult patients with acute leukemia and infection]. / Factores pronósticos y mortalidad en pacientes adultos con leucemia aguda e infección.

In order to define mortality rates and clinical findings with prognostic value in febrile infections among our adult patients with acute leukemia we prospectively studied--during a 34 months period--177 episodes of clinical suspected infection which occurred in 49 patients. By means of univariate analysis and a subsequent multiple logistic regression study, the association between 27 clinical and microbiological data and febrile episode survival rates were evaluated. Both the overall mortality rate and the specific one for febrile episodes were high (44.9% and 12.7% respectively). An age over 30 years old (p = 0.025), fever lasting more than five days (p = 0.025), lung involvement (p = 0.001) and fungal isolation in a culture specimen (p = 0.005) were all associated with a higher episode mortality. However, only an age older than 30 years (adjusted odds ratio, A.O.R. = 1.118; 95% confidence interval, C.I.95% = 1.015-1.232; p = 0.025) and pneumonia (A.O.R. = 1.454; C.I.95% = 1.288-1.642; p < 0.001) remained as independent predictors of a greater mortality in the multivariate analysis. Although fever of unknown origin was associated with a better prognosis (p = 0.024) two other variables--viral infections (A.O.R. = 0.642; C.I.95% = 0.421-0.979; P = 0.041) and the isolation of two or more etiologic agents (A.O.R. = 0.795; C.I.95% = 0.651-0.972; p = 0.027)--had a protective value with the multiple regression analysis.

[Chemotherapy schedules and bacteremia in adult patients with acute leukemia]. / Esquemas de quimioterapia y bacteriemias en pacientes adultos con leucemia aguda.

In a study undertaken to evaluate fluoroquinolone prophylaxis in afebrile granulocytopenic patients, an unexpected association between chemotherapy schedule and a later development of bacteremia--during the subsequent febrile neutropenic episodes--was found. Twenty five febrile neutropenic episodes consecutive to chemotherapy for acute leukemia were studied. Patients received either etoposide and mitoxantrone or citarabine--in standard, intermediate or high doses--combined with daunomicin or mitoxantrone. Microbiologic data analysis showed an increased incidence of bacteremia with combined anthracycline and intermediate or high dose citarabine administration, when compared to etoposide and mitoxantrone use (p = 0.000387). Both groups developed similarly fast and severe neutropenias and equivalent grades of digestive mucositis. Chemotherapy schedule was the only factor associated with a consecutive bacteremia--or not--during the subsequent neutropenic episode. We conclude that effects other than bone marrow aplasia and digestive mucositis may be relevant in infectious susceptibility induced by cytostatic drugs.

Profilaxis con fluoroquinolonas en pacientes neutropénicos / Prophylaxis with fluoroquinolones in patients with neutropenia

Para evaluar si el uso profiláctico de fluoroquinolona disminuye la incidencia y morbimortalidad de los episodios febriles durante la neutropenia, realizamos un estudio prospectivo, aleatorio y controlado en pacientes adultos con leucemia aguda (A.A.), con neutropenia secundaria a quimioterapia citotóxica y ambulatórios. Veinticinco episódios de neutropenia ocurridos en 14 pacientes fueron asignados aleatoriamente a recibir quinolonas (norfloxacina 800 mg/día o ciporfloxacina 1000 mg/dia), o a no recibir antibióticos profilácticos (grupo control). No hubo diferencias significativas entre ambos grupos en sexo, edad, tipo o estadio de la L.A., esquemas de quimioterapia empleados, duración y severidad de la neutropenia con fiebre (p = 0,0448), a una disminución del número de infecciones por bacilos gran negativos (p = 0,037), y a un aumento de las infecciones por Estreptococos (p = 0,0857). No hubo disminución significativa en la mortalidad, incidencia de infecciones severas, proporción de episodios de neutropenia sin fiebre, requerimiento de Anfotericina B, e incidencia de infecciones micóticas en el grupo con quinolonas respecto del control. Se concluye que la profilaxis con fluoroquinolonas no disminuyó la morbimortalidad infecciosa en estos pacientes

Lymphoscintigraphic study in a case of rheumatoid arthritis-related lymphoedema.

Lymphoedema of the upper limbs is a rare extraarticular manifestation of rheumatoid arthritis (RA). Herein we report a patient with RA who presented two episodes of lymphoedema in the hands and forearms coinciding with flares of polyarthritis. Lymphoscintigraphy showed lymphatic-ectasia. The oedema improved with slow-acting drug treatment.

Porfiria cutánea tarda en dos pacientes con trasplante renal / Cutanea tarda porphyria in 2 patients with kidney transplantation

Two patients who developed porphyria cutanea tarda, six and eight years after a successful renal transplantation are reported. There was no history, in either of them, of alcohol abuse, blood transfusion, iron or estrogen therapy and any hemodialysis in the last years. There is no evidence to support that a renal allograft is capable to develop porphyria cutanea tarda. Nevertheless, it would be interesting to consider its possible influence, due to the longer survival of these patients.

[Prophylaxis with fluoroquinolones in patients with neutropenia]. / Profilaxis con fluoroquinolonas en pacientes neutropénicos.

In order to evaluate whether the prophylactic use of fluoroquinolones diminishes the incidence of infections and/or mortality during neutropenia, we undertook a prospective, aleatory and controlled study in non-hospitalized adult patients with acute leukemia and chemotherapy-induced neutropenia including twenty five episodes of neutropenia including twenty five episodes of neutropenia which had occurred in 14 patients who were randomly selected either to receive or not quinolones (norfloxacin 800 mg daily or ciprofloxacin 1000 mg daily). Both groups were similar in terms of sex, age, underlying disease, chemotherapy for hematologic malignancy, duration and severity of neutropenia. The use of quinolones was associated with a delay in the fever onset during neutropenia (p = 0.0448), a decrease in the proportion of neutropenic febrile days (p = 0.0456), a decrease of infections caused by gram-negative bacilli (p = 0.037) and an increase of Streptococcus infections (p = 0.0857). There was no significant decrease in mortality, incidence of severe infections, proportion of neutropenic episodes without fever, empiric use of amphotericin B or fungal infections between both groups. The results of this study demonstrate that the prophylactic use of fluoroquinolones does not diminish the infectious morbidity and/or mortality in these patients.

[Cutanea tarda porphyria in 2 patients with kidney transplantation]. / Porfiria cutánea tarda en dos pacientes con trasplante renal.

Two patients who developed porphyria cutanea tarda, six and eight years after a successful renal transplantation are reported. There was no history, in either of them, of alcohol abuse, blood transfusion, iron or estrogen therapy and any hemodialysis in the last years. There is no evidence to support that a renal allograft is capable to develop porphyria cutanea tarda. Nevertheless, it would be interesting to consider its possible influence, due to the longer survival of these patients.