[Comparison of different strategies for short-term death prediction in the infected older patient]. / Comparación de distintas estrategias para la predicción de muerte a corto plazo en el paciente anciano infectado.

OBJECTIVE: The aim of this study was to determine the utility of a post hoc lactate added to SIRS and qSOFA score to predict 30-day mortality in older non-severely dependent patients attended for infection in the Emergency Department (ED). METHODS: We performed an analytical, observational, prospective cohort study including patients of 75 years of age or older, without severe functional dependence, attended for an infectious disease in 69 Spanish ED for 2-day three seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event.The antimicrobial susceptibility data and extended-spectrum beta-lactamase (ESBL) production in isolates recovered from intra-abdominal (IAI) (n=1,429) and urinary tract (UTI) (n=937) infections during the 2016- 2017 SMART study in 10 Spanish hospitals were analysed. RESULTS: We included 739 patients with a mean age of 84.9 (SD 6.0) years; 375 (50.7%) were women. Ninety-one (12.3%) died within 30 days. The AUC was 0.637 (IC 95% 0.587-0.688; p<0.001) for SIRS ≥ 2 and 0.698 (IC 95% 0.635-0.761; p<0.001) for qSOFA ≥ 2. Comparing receiver operating characteristic (ROC) there was a better accuracy of qSOFA vs SIRS (p=0.041). Both scales improve the prognosis accuracy with lactate inclusion. The AUC was 0.705 (IC95% 0.652-0.758; p<0.001) for SIRS plus lactate and 0.755 (IC95% 0.696-0.814; p<0.001) for qSOFA plus lactate, showing a trend to statistical significance for the second strategy (p=0.0727). Charlson index not added prognosis accuracy to SIRS (p=0.2269) or qSOFA (p=0.2573). CONCLUSIONS: Lactate added to SIRS and qSOFA score improve the accuracy of SIRS and qSOFA to predict short-term mortality in older non-severely dependent patients attended for infection. There is not effect in adding Charlson index.

[Microbiología, sensibilidad antibiótica y factores asociados a bacteriemia en la prostatitis aguda]. / Microbiology, antibiotic susceptibility, and bacteraemia associated factors in acute prostatitis.

OBJECTIVE: The aim of the study was to analyze the characteristics of patients with acute prostatitis presenting to the Emergency Department, the microbiological findings, antibiotic susceptibility, and bacteraemia associated factors. METHODS: Observational and cohort study with prospective follow-up including patients with acute prostatitis presenting to the Emergency Department from January-December 2012. Data were collected for demographic variables, comorbidities, microbiological findings, antibiotic treatment and outcome. RESULTS: Two hundred and forty one episodes of acute prostatitis were included. Mean age was 62.9 ± 16 years, a history of prostate adenoma was reported in 54 cases (22.5%) and prior manipulation of the lower urinary tract in 40 (17%). Mean symptoms duration was 3.38 ± 4.04 days, voiding symptoms were present in 176 cases (73%) and fever in 154 (64%). Seventy patients (29%) were admitted to the hospital and 3 died. From 216 urine cultures, 128 were positive (59%) and 24 (17.6%) out of 136 blood cultures. Escherichia coli was the main pathogen (58.6% of urine cultures and 64% of blood cultures) with resistant strains to fluoroquinolones, cotrimoxazole and amoxicillin/clavulanic in 27.7%, 22.9% and 27.7% of cases respectively. In the univariate analysis, only chills were associated to bacteraemia (p=0.013). At 30-day follow-up, patients with bacteraemia returned more frequently to the Emergency Department (p=0.037) and were more often admitted to the hospital (p=0.003). CONCLUSIONS: Patients with acute prostatitis discharged from the Emergency Department need clinical follow-up and monitoring of microbiological findings in order to assure an adequate antibiotic treatment. Return to Emergency Department and admission to the hospital were significantly more frequent among patients with bacteraemia.

Aromatase activity and estradiol in human breast cancer: its relationship to estradiol and epidermal growth factor receptors and to tumor-node-metastasis staging.

PURPOSE: The present report attempts to clarify whether there is a relationship between aromatase activity (ARAC) and estradiol (E2), hormonal receptors, E2 receptor (ER), and epidermal growth factor receptor (EGFR), as well as with tumor stage and histopathology in human breast cancers. MATERIALS AND METHODS: We studied 225 breast carcinomas, 67 of which were premenopausal and 158 postmenopausal. In each sample, ARAC, EGFR, ER, and E2 were quantified. ARAC was quantified by Thompson and Siiterii's method, EGFR was quantified with a two-point assay method using radioactive iodine (125I)-EGF as ligand, and ER was measured by the Scatchard method using 3H-E2. E2 was quantified by radioimmunoassay in the diethylether tumor extract. RESULTS: ARAC was found in 64% of the cancers studied. There is a strong direct association between ARAC and tumor size in postmenopausal patients (P = .001). In the postmenopausal group, the proportion of ARAC-positive (ARAC+) tumors is significantly higher among ER-positive (ER+) than ER-negative (ER-) ones (P less than .001). ER+ tumors also have significantly higher levels of E2 than do ER- ones (P less than .0001); similarly, ARAC+ tumors have significantly higher levels of E2 than do ARAC- ones (P less than .0001). There is a significant multiple linear correlation between the log of the levels of ARAC, ER, and EGFR and the log of tumor E2 (P less than .0001). The correlation coefficients obtained show that ARAC and ER have a positive effect on tumor E2. CONCLUSION: The results obtained suggest the importance of tumor ARAC in the tumoral levels of E2 and reinforce the possible biologic significance of tumor ARAC, especially in postmenopausal breast carcinoma patients.

Epidermal growth factor in human breast cancer, endometrial carcinoma and lung cancer. Its relationship to epidermal growth factor receptor, estradiol receptor and tumor TNM.

Epidermal growth factor (EGF) and its receptor (EGFR) were measured in 60 breast cancers (BC), 6 benign mammary tumors (BM), 8 samples of normal breast (NB), 6 endometrial carcinomas (EC) and 30 lung cancers (LC). EGF was measured in plasma, saliva and urine from 20 patients with BC, before and after tumor excision, and in 8 patients with metastatic disease. The median EGF in BM and BC was significantly higher (P < 0.05) than in NB. No significant correlation between EGF and EGFR was found in BC. Neither tumor excision nor the spreading of the disease significantly modified the EGF concentrations in biological fluids. In LC there was an inverse relationship between EGF and EGFR (rs = -0.36; P = 0.09), which disappeared in normal lung. It is concluded that EGF may play a role in malignant transformation; however, the weak correlation between EGF and EGFR lessens the importance of EGF in either autocrine or paracrine stimulation of tumor growth.

Predicting outcome in acute stroke: a comparison between QEEG and the Canadian Neurological Scale.

OBJECTIVE: To determine and compare the predictive value of quantitative EEG (QEEG) and the Canadian Neurological Scale (CaNS), in patients with an acute cerebral stroke. METHODOLOGY: Twenty-eight patients were studied with the diagnosis of acute ischemic middle cerebral artery stroke, within the first 72 hours of clinical evolution. Thirty-seven EEGs and clinical evaluations were collected: 13 during the first 24 hours after stroke onset, 9 between 24-48 hours and 15 between 48-72 hours. The QEEG studied variables were: the Z values (maximum, minimum and the Z medians from the 5 nearest points to each one) of absolute energies (AE) from the 4 classic frequencies bands. The clinical scale showed a smaller percent of correct prognosis than QEEG variables. CONCLUSIONS: QEEG was demonstrated to be a powerful tool to predict the degree of residual functional disabilities after an acute ischemic stroke and showed a higher prognostic value than CaNS when they are performed within the first 72 hours of brain infarct.

Radiation-Induced Leiomyosarcoma after Breast Cancer Treatment and TRAM Flap Reconstruction.

The development of a radiation-induced sarcoma (RIS) in the post mastectomy thoracic treatment volume is an infrequent, but recognized, event. Its frequency is rising in relation with increasing survival of breast cancer patients treated with adjuvant radiation therapy, and is associated with poor prognosis despite treatment. We present a case of leiomyosarcoma in a patient who underwent mastectomy followed by radiotherapy for invasive ductal carcinoma. A delayed TRAM flap reconstruction was performed 10 years after and a rapid growing mass under the reconstructed flap appeared, on routine follow-up, twenty years later. This report analyzes the diagnostic and therapeutic approach of patients with RIS.

QEEG prognostic value in acute stroke.

The objective of our study is to determine the predictive value of QEEG in patients suffering from an acute ischemic cerebral stroke. Twenty-eight patients were studied within the first 72 hours of clinical evolution of middle cerebral artery territory ischemic stroke. Thirty-seven QEEG recordings were obtained: 13 in the first 24 hours after cerebral stroke onset, 9 between 24-48 hours and 15 between 48-72 hours. Absolute Energies (AE) were the QEEG selected variables for statistical analysis: first, AE Z values were calculated using the Cuban QEEG norms, then the maximum and minimum AE Z values were selected within each frequency band and total power. The medians of the five neighboring Z values were also chosen. Regression models were estimated using the RANKIN scores as dependent variables and the selected QEEG variables as independent, then outcome predictions at hospital discharge and 3 months later were calculated. Percentages of concordance and errors between the estimated and real outcome scores were obtained. Alpha and theta AE were the best predictor for short-term outcome and delta AE for long-term outcome. We conclude that QEEG performed within the first 72 hours of ischemic stroke might be a powerful tool predicting short- and long-term outcome.

A new, fast, and simple DNA extraction method for HLA and VNTR genotyping by PCR amplification.

In the present study a new DNA extraction method is described. The new protocol, which uses caprylic acid for isolating DNA, is technically simple and very fast, as it enables us to obtain DNA from peripheral blood in only 10 minutes. Moreover, DNA preparations obtained with this procedure can be effectively used for HLA class II and variable number tandem repeat genotyping by polymerase chain reaction, so the new method is well suited for routine clinical use in any type of analysis requiring DNA typing for individual characterization.

A new microplate red blood cell monolayer technique for screening and identifying red blood cell antibodies.

A new method has been developed to immobilize red blood cells in wells of microplates using a cell fixation buffer. This method has been employed for detecting and identifying red blood cell antibodies with greater sensitivity than haemagglutination antiglobulin tests, without loss of specificity. This method decreases the amount of test erythrocytes and anti-human globulin reagents employed per test, consequently lowering the cost.

Detection of Aspergillus antigen and anti-Aspergillus precipitating antibodies by a new method: the radial immunoelectro-osmophoresis (RIEOP).

A new method of Immunoprecipitation-in-gel, the Radial Immunoelectro-osmophoresis (RIEOP) has been applied to detect precipitating anti-Aspergillus fumigatus antibodies and to study the antigens present in various antigenic extracts of this fungus. The results obtained with this method have been compared with those obtained when applying the Comparative Double Diffusion (CDD) and the Immunoelectro-osmophoresis (IEOP). The data presented prove that the RIEOP method is more sensitive than CDD and the IEOP in: (1) detecting precipitating anti-Aspergillus antibodies, since (a) precipitating bands are detected with higher serum dilutions, and (b) when using undiluted serum, the number of precipitating bands obtained by RIEOP is higher; and (2) studying antigens present in the antigenic extracts, since (a) the number of antigens detected by RIEOP is higher than that by CDD, and (b) identity/non-identity reactions can be studied among the antigens present in the various extracts.

Surgery for fracture of the calcaneus. 5 (2-8) year follow-up of 20 cases.

20 displaced intraarticular fractures of the calcaneus were treated by open reduction and internal fixation. Results were evaluated according to a standardized protocol. With an average follow-up of 5 (2-8) years, results were excellent or good in 15 cases and fair or poor in 5 cases. An accurate radiographic study and CT scanning are essential for understanding these fractures. We feel that restoring calcaneal shape as anatomic as possible, getting an appropriate reduction of the posterior joint surface by a surgical procedure with early mobilization, and delayed weight bearing would be a good option in treatment of these fractures.

[A fast and simple method for obtaining specific anti-von Willebrand factor IgG]. / Un método rápido y sencillo para la obtención de IgG específica anti factor von Willebrand.

Date expired commercial F.VIII concentrates (1.000 I.U. in 15 ml) were chromatographed through a Sepharose 4B in Tris-HCI (0.15 M, pH = 7.4) column. The void volume of this column was found to constitute an enriched vWF preparation. Half a milliliter of this preparation (protein content: 200 micrograms/ml) was mixed (1: 3) with Freund's complete adyuvant and administered to two rabbits by intramuscular route. A total of 3 doses were administered at days 1, 15 and 21 and the 2 animals were bled at day 30. The serum samples so obtained were pooled and analysed (DGD and IEP) for anti-vWF and anti-NHP activity. Strong anti-vWF specificity could be demosntrated. However, since a weak anti-fibrinogen and anti-IgG contaminant activity was also detected, the pool was filtered through a column containing normal human plasma coupled to a periodate activated Sephacryl S-1.000 immunoadsorbent. The filtrate, which was found to contain only a strong anti-vWF activity, was again processed by affinity chromatography through another Sephacryl immunoadsorbent containing a commercial F.VIII concentrate of the same lot employed for purifying the vWF. The eluate so obtained demonstrated to be constituted only by a pure rabbit IgG with strong anti-vWF specificity and was completely devoid of activity against any other human plasmastic protein. The method was found to be rapid, simple and economic, yielding as much as 5 mg of specific IgG for every 10 ml of antiserum so processed.

A monolayer coagglutination microplate technique for typing red blood cells.

BACKGROUND AND OBJECTIVES: Serologic agglutination tests have the disadvantage of lack of an objective endpoint that can be easily read and quantitated. We have developed a new method for ABO and Rh typing based on producing a red blood cell (RBC) monolayer on microplates and the mixed hemagglutination reaction. MATERIALS AND METHODS: We have employed a new red cell fixation buffer to prepare the RBC monolayer. As the technique for grouping, we used a mixed agglutination reaction between the RBC monolayer and the RBCs to be typed. RESULTS: Compared with an automated hemagglutination system in 34,519 samples, the method is shown to be more sensitive, free of false positive reactions, and cost-effective. CONCLUSIONS: The microplate coagglutination method is accurate and lower in cost than conventional methods.

A new method for phenotyping red blood cells using microplates.

BACKGROUND AND OBJECTIVES: The supply of phenotyped red blood cells (RBC) for patients with several RBC antibodies presents a difficult task to hospital blood banks and regional blood centers. The aim of this study was to establish a low-cost typing system to allow extensive phenotyping of regular blood donors for clinically significant RBC antigens. MATERIALS AND METHODS: We developed a new buffer that greatly intensifies the antigen-antibody reaction and thus reduces the quantity of serum needed for phenotyping. The procedure was carried out on microplates. RESULTS: A total of 20,435 regular blood donors have been typed to date. For 752 units required for transfusion, 3,584 phenotyping tests were performed, validating the results by tube or gel typing methods; agreement was achieved in all cases. CONCLUSION: This technique seems adequate for phenotyping a large number of RBC units at very low cost, thus facilitating the availability of phenotyped blood.

[ELISA method for the determination of factor VII antigen]. / Método ELISA para la determinación del antígeno del factor VII.

The low plasma concentration of clotting factor VII makes it difficult to assay its antigenic fraction by the conventional methods of precipitation with specific antigens. Simple and peroxidase-conjugated antisera are currently available from commercial sources, thus allowing one to determine F VII:Ag by enzyme immunoassay. An ELISA method has been developed in this laboratory which provides sensitivity limits about 0.1% of the plasma concentration of F VII and correlates significantly with its functional activity (r = 0.603, n = 44, p less than 0.001). This technique can be highly helpful in characterising molecular variants of F VII, as well as in detecting acquired deficiencies of this factor.

Evaluación de la utilidad de la tinción de Gramdel esputo para el manejo de la neumonía en urgencias / Is sputum Gram staining useful in the emergency department’s management of pneumonia?

Objetivo: Evaluar la utilidad de la tinción de Gram del esputo (TGE) en el manejo de la neumonía adquirida en la comunidad (NAC) en el servicio de urgencias (SU).Método: Estudio descriptivo y retrospectivo entre octubre 2005 y noviembre 2007 de pacientes con NAC ingresados en el hospital tras su valoración en el SU. Se han analizado las variables demográficas, índice de Fine, TGE, antigenuria, cultivos y antibioterapia inicial. Se ha calculado la sensibilidad, la especificidad y los valores predictivos positivo y negativo de la TGE. Resultados: Se ha revisado 608 casos de neumonía (edad media 70,7, 64,3% hombres).Se obtuvo muestras de esputo en 168 pacientes (27,6%). La TGE mostró diplococos Gram positivos en 74 casos (DCGP), cocobacilos Gram negativos (CBGN) en 26, bacilos Gram negativos en 15, cocos Gram positivos en racimo o cadenas en 11 y presencia de polimorfonucleares sin predominio de microorganismos en 42. Se aisló Streptococcus pneumoniae en 57 casos y Haemophilus influenzae en 19. El hallazgo de DCGP o CBGN mostró una sensibilidad del 47,1% y 73% y una especificidad del 94,2%y 95% para la infección neumocócica y por Haemophilus respectivamente. Ceftriaxona fue el tratamiento más frecuente en pacientes con DGCP y levofloxacino en CBGN. Conclusiones: La TGE tiene un valor limitado en el manejo de la NAC del adulto en el SU con resultados variables según la infecciones por lo que resulta poco útil para orientarla antibioterapia inicial (AU)

Objective: To assess the utility of sputum Gram stains in the management of community-acquired pneumonia (CAP) in the emergency department. Methods: Descriptive, retrospective study of patients with CAP admitted to hospital after evaluation in the emergency department between October 2005 and November 2007. We analyzed patient variables; the Fine index; the results of Gram staining of sputum smears, urine antigen tests, and blood cultures; and the antibiotic therapy initially prescribed. The sensitivity, specificity, and positive and negative predictive values of the Gram stain results were calculated.Results: A total of 608 cases of CAP (mean age, 70.7 years; 64.3% men) were included. Sputum cultures were obtained for 168 patients (27.6%). Gram-negative diplococcal infection was demonstrated in 74 cases, gram-negative coccobacilliin 26, gram-negative stains in 15, gram-positive cocci in clusters or chains in 11, and polymorphonuclear cells with nopredominating microorganisms in 42. Streptococcus pneumoniae was isolated in 57 patients and Haemophilus influenza in 19. The sensitivity of a finding of gram-positive diplococci was 47.1% for pneumococcal infection, with a specificity of94.2%. The sensitivity of a finding of gram-negative coccobacilli was 73% for H. influenza e infection, with a specificity of95%. Ceftriaxone and levofloxacin were the most frequently assigned treatments in patients with diplococcal and H.influenzae infections, respectively. Conclusions: Gram staining of sputum is of limited value in the emergency department’s management of CAP in adult patients. As the results vary according to pathogen, they are of little use in choosing the antibiotic treatment (AU)