Primary Cilia as a Tumor Marker in Pituitary Neuroendocrine Tumors.

Pituitary neuroendocrine tumors (PitNETs) account for approximately 15% of all intracranial neoplasms. Although they usually appear to be benign, some tumors display worse behavior, displaying rapid growth, invasion, refractoriness to treatment, and recurrence. Increasing evidence supports the role of primary cilia (PC) in regulating cancer development. Here, we showed that PC are significantly increased in PitNETs and are associated with increased tumor invasion and recurrence. Serial electron micrographs of PITNETs demonstrated different ciliation phenotypes (dot-like versus normal-like cilia) that represented PC at different stages of ciliogenesis. Molecular findings demonstrated that 123 ciliary-associated genes (eg, doublecortin domain containing protein 2, Sintaxin-3, and centriolar coiled-coil protein 110) were dysregulated in PitNETs, representing the upregulation of markers at different stages of intracellular ciliogenesis. Our results demonstrate, for the first time, that ciliogenesis is increased in PitNETs, suggesting that this process might be used as a potential target for therapy in the future.

Outcomes of atherothrombotic transient ischemic attack and minor stroke in an emergency department: results of an outpatient management program.

STUDY OBJECTIVE: Management of patients with transient ischemic attack varies widely. The aim of this study is to analyze the outcomes of patients with transient ischemic attacks or minor stroke managed in the emergency department (ED) on an outpatient basis and to identify risk factors associated with stroke recurrence. METHODS: We prospectively analyzed 97 patients with transient ischemic attack or minor stroke who were treated with a standard diagnostic and therapeutic protocol in the ED by emergency physicians. Factors in previous reports were analyzed in relation with a new neurologic event at 90 days or the presence of a severe extracranial carotid stenosis. RESULTS: Incidence of recurrent transient ischemic attack or stroke was 7.2% at 24 hours, 9.3 % at 1 week, and 23.7 % at 3 months. Overall incidence of moderate to severe stroke was 0%, 1%, and 5% at the same points, and in outpatients was 0%, 0%, and 4.2%. ABCD2 scoring in these patients predicted stroke rates of 6% at 7 days and 9.9% at 90 days. CONCLUSION: Patients with transient ischemic attack of atherothrombotic origin can be safely treated at the ED with an exhaustive diagnostic and therapeutic protocol. The rates of stroke recurrence obtained in our study are comparable with those in previous studies that show low recurrence risk.

Alternative CPAP methods for the treatment of secondary serious respiratory failure due to pneumonia by COVID-19.

INTRODUCTION: The use of devices that provide continuous positive pressure in the airway has shown improvement in various pathologies that cause respiratory failure. In the COVID 19 pandemic episode the use of these devices has become widespread, but, due to the shortage of conventional CPAP devices, alternative devices have been manufactured. The objective of this study is to describe the use of these devices, as well as their efficacy. MATERIAL AND METHODS: Data are collected from patients admitted for Pneumonia due to COVID 19 at the IFEMA Field Hospital. Data are collected from 23 patients with respiratory failure and need for ventilatory support. RESULTS: Study carried out on a total of 23 patients, dated admission to IFEMA. Alternative CPAP was used in five patients (21.7%), while ventilatory support with a reservoir mask or Ventimask Venturi effect was used in the remaining 18 patients (78.3%). A progressive increase in saturation is observed in those patients in whom alternative CPAP was used (from 94% on average to 98% and 99% on average after 30 and 60 min with the mask, respectively), although this change was not significant (p = 0.058 and p = 0.122 respectively). No significant change in RF was observed at the beginning and end of the measurement in patients who used alternative CPAP (p = 0.423), but among those who did not use alternative CPAP (p = 0.001). A statistically significant improvement in the variable oxygen saturation / fraction inspired by oxygen is observed in patients who used alternative CPAP (p = 0.040). CONCLUSION: The use of these devices has helped the ventilatory work of several patients by improving their oxygenation parameters. To better observe the evolution of patients undergoing this therapy and compare them with patients with other types of ventilatory support, further studies are necessary.

INTRODUCCIÓN: El uso de dispositivos que aportan presión positiva continua en la vía aérea ha demostrado mejoría en diversas patologías que producen insuficiencia respiratoria. En el episodio de pandemia por COVID 19 el uso de estos dispositivos se ha generalizado, pero, debido a la escasez de dispositivos convencionales de CPAP, se han fabricado dispositivos alternativos. El objetivo de este estudio es describir el uso de estos dispositivos, así como su eficacia. MATERIAL Y MÉTODOS: Se recogen datos de pacientes ingresados por Neumonía por COVID 19 en el Hospital de campaña de IFEMA. Se recogen datos de pacientes con insuficiencia respiratoria y necesidad de soporte ventilatorio. RESULTADOS: Estudio realizado sobre un total de 23 pacientes, con fecha ingreso en IFEMA. Se empleó CPAP alternativa en cinco pacientes (21,7%), mientras que en los 18 pacientes restantes (78,3%) se usó soporte ventilatorio con mascarilla reservorio o Ventimask efecto Venturi. Se observa un aumento progresivo de la saturación en aquellos pacientes en los que se empleó CPAP alternativa (de 94% de promedio a 98% y 99% de promedio tras 30 y 60 minutos con la máscara, respectivamente), aunque este cambio no resultó significativo (p = 0,058 y p = 0,122 respectivamente). No se observó un cambio significativo de frecuencia respiratoria al inicio y final de la medición en pacientes que usaron CPAP alternativa (p = 0,423) pero si entre los que no la usaron (p = 0,001). Se observa una mejoría estadísticamente significativa en la variable Saturación de oxigeno / Fracción inspirado de oxígeno en los pacientes que usaron CPAP alternativa (p = 0,040). CONCLUSIÓN: El uso de estos dispositivos ha ayudado al trabajo ventilatorio de varios pacientes mejorando sus parámetros de oxigenación. Para observar mejor la evolución de los pacientes sometidos a esta terapia y compararlos con pacientes con otro tipo de soporte ventilatorio, son necesarios más estudios en los que se aleatorice su uso.

[Alternative CPAP methods for the treatment of secondary serious respiratory failure due to pneumonia by COVID-19]. / Métodos alternativos de CPAP para el tratamiento de insuficiencia respiratoria grave secundaria a neumonía por COVID-19.

INTRODUCTION: The use of devices that provide continuous positive pressure in the airway has shown improvement in various pathologies that cause respiratory failure. In the COVID-19 pandemic episode the use of these devices has become widespread, but, due to the shortage of conventional continuous positive airway pressure (CPAP) devices, alternative devices have been manufactured. The objective of this study is to describe the use of these devices, as well as their efficacy. MATERIAL AND METHODS: Data are collected from patients admitted for pneumonia due to COVID-19 at the IFEMA Field Hospital. Data are collected from 23 patients with respiratory failure and need for ventilatory support. RESULTS: Study carried out on a total of 23 patients, dated admission to IFEMA. Alternative CPAP was used in five patients (21.7%), while ventilatory support with a reservoir mask or Ventimask Venturi effect was used in the remaining 18 patients (78.3%). A progressive increase in saturation is observed in those patients in whom alternative CPAP was used (from 94% on average to 98 and 99% on average after 30 and 60 minutes with the mask, respectively), although this change was not significant (p = 0.058 and p = 0.122, respectively). No significant change in RF was observed at the beginning and end of the measurement in patients who used alternative CPAP (p = 0.423), but among those who did not use alternative CPAP (p = 0.001). A statistically significant improvement in the variable oxygen saturation / fraction inspired by oxygen is observed in patients who used alternative CPAP (p = 0.040) CONCLUSION: The use of these devices has helped the ventilatory work of several patients by improving their oxygenation parameters. To better observe the evolution of patients undergoing this therapy and compare them with patients with other types of ventilatory support, further studies are necessary.

Systematic testing for venous thromboembolism in hospitalized patients with COVID-19 and raised D-dimer levels.

Background: Hospitalized patients with COVID-19 and raised D-dimer levels have high rates of venous thromboembolism (VTE). Methods: We used data from hospitalized patients with COVID-19 that were tested for pulmonary embolism (PE) or deep vein thrombosis (DVT) because of raised D-dimer levels. We aimed to identify patients at increased risk for VTE. Results: From March 25 to July 5th, 2020, 1,306 hospitalized patients with COVID-19 and raised D-dimer levels underwent testing for VTE in 12 centers. In all, 171 of 714 (24%) had PE, and 161 of 810 (20%) had DVT. The median time elapsed from admission to VTE testing was 12 days, and the median time from D-dimer measurement to testing 2 days. Most patients with VTE were men (62%), mean age was 62 â€‹± â€‹15 years, 45% were in an intensive care unit. Overall, 681 patients (52%) received VTE prophylaxis with standard doses, 241 (18%) with intermediate doses and 100 (7.7%) with therapeutic doses of anticoagulants. On multivariable analysis, patients with D-dimer levels >20 times the upper normal range (19% of the whole cohort) were at increased risk for VTE (odds ratio [OR]: 3.24; 95%CI: 2.18-4.83), as were those with a platelet count <100,000/µL (OR: 4.17; 95%CI: 1.72-10.0). Conclusions: Hospitalized patients with COVID-19 and D-dimer levels >20 times the upper normal range were at an increased risk for VTE. This may help to identify what patients could likely benefit from the use of higher than recommended doses of anticoagulants for VTE prophylaxis.

[Nasogastric enteral nutrition in severe acute pancreatitis]. / Nutrición por sonda nasogástrica en la pancreatitis aguda grave.

BACKGROUND AND OBJECTIVE: To establish the nasogastric enteral nutrition tolerance in patients with severe acute pancreatitis. PATIENTS AND METHOD: A total of 12 patients with severe acute pancreatitis (> or = 3 Ranson criteria; C-reactive protein > 210 mg/dl) and adverse clinical course were included during 2006. When we verified the disease severity, nasogastric (10 F) enteral nutrition was initiated. We used a low fat semi-elemental feed (Dietgrif) in a slow infusion rate. We evaluated the enteral nutrition tolerance and the adverse events. RESULTS: The patient (4 women and 8 men) mean age (standard deviation) was 70 (11) years and the mean hospital stay was 86 days (range: 14-405 days). The etiology of pancreatitis was: gallstones 8, alcohol abuse one and unknown 3. All patients had medical and/or pancreatic complications. Seven had significant pancreatic necrosis detected in the abdominal computed tomography. Three patients were admitted in the critical care unit and 2 died. The nasogastric enteral nutrition was well tolerated in 8 out of 12 patients (67%) regardless of their medical or pancreatic complications. Only in 3 patients we had initially to discontinue the feeding because of ileus and total parenteral nutrition was provisionally necessary. Enteral nutrition was impossible in one patient because of duodenal stenosis. CONCLUSIONS: Nasogastric enteral nutrition is well tolerated in patients with severe acute pancreatitis and it is an alternative to others nutritional routes.

Mortality and complications in very old patients (90+) admitted to departments of internal medicine in Spain.

SUMMARY: Patients over 90 years of age (the "very elderly") account for an increasing number of admissions to departments of internal medicine (IM). The aim of this study was to analyse the demographic data, hospitalization characteristics, medical complications, and predictors of mortality in patients over 90 admitted to IM departments. MATERIAL AND METHODS: All patients admitted to IM departments in Spain between the years 2005 and 2007 were analysed. Clinical and demographic data were compared with records from "younger elderly" patients (65-90). RESULTS: During the study period, there were 1,567,659 patient admissions to IM departments in Spain, and 90,679 (5.8%) were older than 90. Hospital mortality occurred in 22.3% of very elderly patients. The main predictors for hospital death were pressure ulcer (Odds Ratio [OR] 1.55, CI95% 1.45-1.66), thromboembolic disease (OR 1.83, CI95% 1.61-2.09), nosocomial pneumonia (OR 2.53, CI95% 2.39-2.69), hip fracture (OR 2.20, CI95% 1.53-3.18), male gender (OR 1.06, CI95% 1.03-1.10), age (OR 1.05, CI95% 1.04-1.06), dementia (OR 1.13, CI95% 1.08-1.18), cancer (OR 1.60, CI95% 1.51-1.71), acute respiratory failure (OR 1.83, CI95% 1.76-1.89), acute infectious disease (OR 2.30, IC95% 2.11-2.52), and Charlson comorbidity index (OR 1.21, CI95% 1.16-1.26). CONCLUSIONS: Very elderly patients represent a large and growing fraction of the total admissions to IM departments in Spain. They are at higher risk for complications during their hospital stay and mortality rate is double that of the younger elderly.

Prevalence of the notification of malnutrition in the departments of internal medicine and its prognostic implications.

BACKGROUND & AIMS: Detection and notification of malnutrition are essential to adopt a support plan and take costs into account. The aim of this study was to describe how often discharge sheets from Internal Medicine (IM) units include malnutrition among diagnoses (notification frequency) using the International Classification of Diseases, 9th Revision Clinical Modification -ICD-9. Factors associated with this diagnosis and its prognostic implications are also assessed. MATERIAL AND METHODS: The Minimum Basic Data Set from the Spanish hospitals (Ministry of Health and Consumer Affairs) was revised, and patients with diagnosis of malnutrition (ICD-9: 260-263.9) were identified. RESULTS: 1,567,659 patients were analysed (21,804-1.4%- with malnutrition). These patients were older (72.4 vs 70.8 years of age), had a greater degree of comorbidity (Charlson >2: 28% vs 23.5%), and resided in nursing homes more often (3.9% vs 1.9%) than the non-undernourished. The malnutrition associated diagnoses were: dementia, cancer, HIV infection and chronic renal failure. Mortality (19.5% vs 9.8%), hospital stay (18.1 vs 9.8 days), costs (5228.46 vs 3537.8 €) and relative weights applied to each Diagnosis Related Group (2.6 vs 1.1) were higher (p < 0.001 for all comparisons). CONCLUSIONS: Notification of malnutrition in IM departments is low, below the prevalence described in inpatients. This diagnosis is associated with an increase in morbidity, mortality and costs.