Percutaneous tibial nerve stimulation in patients with severe low anterior resection syndrome: randomized clinical trial.

BACKGROUND: Treatment of low anterior resection syndrome (LARS) is challenging. Percutaneous tibial nerve stimulation (PTNS) can improve select bowel disorders. An RCT was conducted to assess the efficacy of PTNS compared with sham stimulation in patients with severe LARS. METHOD: This was a multicentre, double-blind RCT. Patients with major LARS score were allocated to receive PTNS or sham therapy (needle placement simulation without nerve stimulation). The study included 16 sessions of 30 min once a week for 12 consecutive weeks, followed by four additional sessions once a fortnight for the following 4 weeks. The primary endpoint was efficacy of PTNS defined by the LARS score 12 months after treatment. Secondary endpoints included faecal incontinence, quality of life (QoL), and sexual function. RESULTS: Between September 2016 and July 2018, 46 eligible patients were assigned randomly in a 1 : 1 ratio to PTNS or sham therapy. Baseline characteristics were similar. LARS scores were reduced in both groups, but only patients who received PTNS maintained the effect in the long term (mean(s.d.) score 36.4(3.9) at baseline versus 30.7(11.5) at 12 months; P = 0.018; effect size -5.4, 95 per cent c.i. -9.8 to -1.0), with a mean reduction of 15.7 per cent at 12-month follow-up. The faecal incontinence score was improved after 12 months in the PTNS group (mean(s.d.) score 15.4(5.2) at baseline versus 12.5(6.4) at 12 months; P = 0.018). No major changes in QoL and sexual function were observed in either group. There was no therapy-associated morbidity. Three patients discontinued the study, but none owing to study-related issues. CONCLUSION: PTNS has positive effects in some patients with major LARS, especially in those with faecal incontinence. Registration number: NCT02517853 (http://www.clinicaltrials.gov).

[Intensive care to facilitate organ donation. ONT-SEMICYUC recommendations]. / Cuidados intensivos orientados a la donación de órganos. Recomendaciones ONT-SEMICYUC.

Intensive care to facilitate organ donation (ICOD) is defined as the initiation or continuation of life-sustaining measures, such as mechanical ventilation, in patients with a devastating brain injury with high probability of evolving to brain death and in whom curative treatment has been completely dismissed and considered futile. ICOD incorporates the option to organ donation allowing a holistic approach to end-of-life care, consistent with the patients wills and values. Should the patient not evolve to brain death, life-supportive treatment must be withdrawal and controlled asystolia donation could be evaluated. ICOD is a legitimate practice, within the ethical and legal regulations that contributes increasing the accessibility of patients to transplantation, promoting health by increasing deceased donation by 24%, and with a mean of 2.3 organs transplanted per donor, and collaborating with the sustainability of health-care system. This ONT-SEMICYUC recommendations provide a guide to facilitate an ICOD harmonized practice in spanish ICUs.

Estimulación transcutánea del nervio tibial posterior en el tratamiento de la incontinencia urinaria de urgencia refractaria, de origen idiopático y neurógenico / Transcutaneous stimulation of the posterior tibial nerve for treating refractory urge incontinence of idiopathic and neurogenic origin

Objetivo: Evaluar la eficacia del tratamiento con la estimulación transcutánea del nervio tibial posterior (T-PTNS) en pacientes con incontinencia urinaria de urgencia, de origen neurógenico o no neurógenico, refractaria a las opciones terapéuticas de primera línea. Material y métodos: Se incluyeron 65 pacientes con incontinencia urinaria de urgencia refractaria a tratamiento médico. Antes de T-PTNS se realizó anamnesis, estudio urodinámico y potenciales evocados somatosensoriales (PESS), estudiando el estado funcional urólogico mediante un diario miccional. El tratamiento consistió en 10 sesiones semanales de T-PTNS de 30 minutos de duración. Resultados: Un 57,7% de los pacientes presentaban PESS tibiales anormales y en un 42% PESS pudendos anormales. Se objetivó una mejoría sintomática estadísticamente significativa en todos los parámetros clínicos tras el tratamiento con T-PTNS, y en el 66% se evidenció una mejora global, independientemente del género, presencia de alteraciones neurológicas de base, hiperactividad detrusoriana en el estudio urodinámico o trastornos en los PESS. No se produjeron efectos adversos durante el tratamiento. Conclusiones: T-PTNS es un tratamiento efectivo y bien tolerado en pacientes con incontinencia de urgencia refractaria a terapias de primera línea, y debería ser ofrecida precozmente en la estrategia de tratamiento. Son necesarios nuevos estudios para identificar los parámetros óptimos de estimulación, los protocolos de tratamiento más efectivos y la eficacia a largo plazo, así como su aplicabilidad a pacientes con un sustrato neurogénico

Objective: To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. Material and methods We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30 minutes. Results: Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. Conclusions: TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrated

[Carbapenem resistance in Pseudomonas aeruginosa isolated from urine cultures: prevalence and risk factors]. / Resistencia a carbapenemas en Pseudomonas aeruginosa aisladas en urocultivos: prevalencia y factores de riesgo.

OBJECTIVE: Pseudomonas aeruginosa is a non-fermentative gram-negative bacillus with a great ability to develop resistance to multiple antibiotics, including carbapenems, which is a growing problem worldwide. The aim of this study was to analyse the prevalence of carbapenem-resistant P. aeruginosa (CRPA) in urine cultures and to determine the risk factors associated with the development of carbapanem resistance. METHODS: Positive urine cultures to P. aeruginosa between September 2012 and September 2014 were identified. We excluded repetitive cultures from the same patient. We created a database with different variables, including antimicrobial resistance. The prevalence of carbapenem resistance and the risk factors for growth of CRPA were analysed. RESULTS: Ninety-one patients with positive urine cultures to P. aeruginosa were included. The prevalence of CRPA was 22%. The risk factors to CRPA infection in the univariate analysis were: congestive heart failure (p=0.02), previous treatment with ampicillin (p=0.04), meropenem (p=0.04), piperacillin-tazobactam (p=0.01), trimethoprim-sulfamethoxazole (p= 0.01) and previous treatment with more than one antibiotic (p<0.01). Only congestive heart failure (p<0.01) and previous treatment with more than one antibiotic (p<0.01) showed statistically significant differences in the multivariate analysis. CONCLUSIONS: The prevalence of CRPA in urine cultures is high in our population. We should assess the presence of risk factors as previous treatment with more than one antibiotic or comorbidities such as heart failure, in order to select an appropriate empirical treatment in patients with severe urinary tract infections.

Transcutaneous stimulation of the posterior tibial nerve for treating refractory urge incontinence of idiopathic and neurogenic origin. / Estimulación transcutánea del nervio tibial posterior en el tratamiento de la incontinencia urinaria de urgencia refractaria, de origen idiopático y neurógenico.

OBJECTIVE: To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. MATERIAL AND METHODS: We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30minutes. RESULTS: Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. CONCLUSIONS: TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrate.

Toxicological evaluation of an Allium-based commercial product in a 90-day feeding study in Sprague-Dawley rats.

Proallium AP(®) is a commercial Allium extract intended to be used in active food packaging as the antibacterial and antioxidant effects of some organosulfur compounds are well known. However, there is little information on its toxicity and the Scientific Committee on Food (UE) requires the safety assessment of substances used in food contact materials. Thus, the aim of this study was to conduct for the first time a subchronic oral toxicity study of Proallium AP(®) with groups of 10 males and 10 females Sprague-Dawley rats fed a diet containing 0, 25, 100, 400 mg/kg/d for 90 days. No treatment-related clinical signs or mortality were noted. Besides, no treatment-related effects with regard to any of the toxicological biomarkers considered were observed, including biochemical, haematological and histopathology parameters. In conclusion, the non-observed-adverse-effect-level (NOAEL) for Proallium AP(®) in rats was determined to be a dietary dose of 400 mg/kg/d under the present experimental conditions, a value 500-fold higher than the exposure derived from its potential use in active packaging.

Información incluida en las fichas técnicas de los primeros medicamentos homeopáticos "sin indicaciones" de uso humano autorizados y registrados en España / Information included in the summary of product characteristics of the first homeopathic medicinal products "without therapeutic indications" for human use registered in Spain

No disponible

Información incluida en las fichas técnicas de los primeros medicamentos homeopáticos «sin indicaciones» de uso humano autorizados y registrados en España / Information included in the summary of product characteristics of the first homeopathic medicinal products «without therapeutic indications» for human use registered in Spain

No disponible

Appendix to dialysis centre guidelines: recommendations for the relationship between outpatient haemodialysis centres and reference hospitals. Opinions from the Outpatient Dialysis Group. Grupo de Trabajo de Hemodiálisis Extrahospitalaria.

INTRODUCTION: The different clinical guidelines backed by the Spanish Society of Nephrology (SEN) attempt to homogenise the monitoring of renal patients. However, this effort to homogenise treatment has been obstructed in the case of renal replacement therapy patients on haemodialysis due to, among other reasons, the existence of several different dialysis providers, with private centres located in many cities, each with their own reference hospitals and different criteria for treatment based on the existing outsourcing services agreements with the public health service, which also differ between regions. A good relationship between a private dialysis centre and its reference hospital would lead to equal treatment for all dialysis patients, at least at that particular town. The SEN, through the efforts of the Grupo de Trabajo de Hemodiálisis Extrahospitalaria (Outpatient Haemodialysis Group), has prioritised a close relationship and good communication between reference hospitals and dialysis centres in order to guarantee proper continuity of the health care given to these patients. STRATEGIES FOR IMPROVEMENT: Conditions for referring patients from one centre to another. A patient that starts a haemodialysis programme should be referred from a reference hospital with a definitive vascular access for optimising treatment, with a full report updated within 24-48 hours before the transferral, including essential information for providing proper nephrological treatment: primary pathology, recent viral serology (including hepatitis B and C virus [HBV and HCV] and human immunodeficiency virus [HIV]), parameters for anaemia and calcium-phosphorus metabolism, and ions, date of the first session of dialysis, and the number and dates of blood transfusions received. Furthermore, patients referred from the dialysis centre to the hospital, whether for programmed visits or emergency hospitalisation, should be accompanied by an updated report indicating the primary diagnoses, recent events, viral serology and laboratory analyses, updated haemodialysis and treatment regimens used, and the reason for transferral to the hospital. A single, digital clinical history that is accessible by both institutions would facilitate this situation, although this option is not completely available to all centres and hospitals. There are also legal issues to resolve in this aspect. Continued care for dialysis patients. Good communication between dialysis centres and hospitals is fundamental for achieving a proper level of care for dialysis patients, and not only with the nephrology department. The interconsultations of dialysis patients at each private centre, as well as the requests for diagnostic tests, should be able to be requested by the centre directly. The results and reports from these interconsultations should also be sent to the centre. It would also be best if the reference hospitals and their private dialysis centres shared common treatment protocols. These protocols should include basic aspects of the treatment of renal patients (anaemia, mineral metabolism, vascular accesses including catheter infections, etc., and laboratory tests), transplant protocols, complementary tests, and other components specific to each area. Not only would this generalise and unify the approach taken with dialysis patients regardless of where they are treated, it would also facilitate access to data on all patients regarding clinical trials and research studies. Access to medication. Dialysis patients require medications that are only given in the hospital setting, which is normally provided by the reference hospital, as per the agreement between institutions. It would also be recommendable that any other medications not included in the agreement (antibiotics, urokinase, nutritional supplements, etc.) be dispensed in a similar manner. Access to kidney transplant. The management of the transplant waiting list, once a patient starts renal replacement therapy, should be controlled from the dialysis centre, as in any other procedure. As such, the nephrologists from each centre should be familiar with the existing protocols and new developments in this context, and should participate in meetings with nephrology and urology departments in each hospital. The transplant protocol at each town/region should be followed for all patients, whether dialysis is undergone in a hospital or private centre. Characteristics of the work at dialysis centres. The doctor attending patients at each dialysis centre must be a specialist in nephrology. This complicated issue must be a requirement for agreements within the regional health system in order to guarantee a proper and equitable treatment of patients that receive dialysis in private centres. Only in the case of an absence of a nephrologist should a general practitioner be used, and this doctor must have adequate training in haemodialysis. This training should also be standardised. Over 75% of nephrologists that work at these centres are alone during the workday, and 40% never see another colleague during the whole shift. The administrators of these centres should seek out protocols that provide professional contact, both with the hospital staff and nephrologists from other centres, which would facilitate an exchange of ideas. Training. The nephrologists at each centre have the right and the obligation to perform research and to continuously expand their training, so as to develop and improve health care provision. Since the majority of patients in haemodialysis programmes are treated in outpatient centres that depend on reference hospitals, we might suggest a minimal rotation of nephrology residents in private outpatient dialysis centres, once accreditation has been given for providing this training.

Eficacia, coste-efectividad y efectos sobre la calidad de vida de la suplementación nutricional / Efficacy, cost-effectiveness, and effects on quality of life of nutritional supplementation

El presente artículo resume los resultados y conclusiones presentados en el Simposio “Suplementación nutricional: evidencias y experiencias” celebrado en el XXIII Congreso Nacional de la SENPE (2008).La malnutrición calórico-proteica, que puede afectar al 30-50% de los pacientes hospitalizados, aumenta el tiempo de hospitalización y el coste de la atención médica en aquellos que la padecen. Un importante volumen de evidencias científicas avala que la administración de suplementos nutricionales (SN) mejora el estado nutricional o previene la aparición de malnutrición en pacientes que no cubren sus necesidades nutricionales con la dieta convencional o con la dieta adaptada, sin que, por ello, se produzca desplazamiento de la ingesta. Todo ello viene reforzado por los resultados que evidencian el papel de los SN en la mejora de parámetros tanto nutricionales como funcionales. La revisión de la literatura existente en determinados contextos clínicos (geriatría uoncología), evidencia que los SN reducen la aparición de complicaciones propias, tanto de la patología de base como del estado de desnutrición, así como que favorecen la reducción de la estancia hospitalaria y de la mortalidad. A pesar de ello, son necesarios más estudios sobre la eficacia de los SN orales en los que se realice un seguimiento más prolongado de lo que ofrecen las publicaciones disponibles actualmente. Más allá de su eficacia, los SN constituyen una intervención terapéutica segura y sin efectos adversos clínicos relevantes que, según la literatura, mejoran la funcionalidad del paciente y su calidad de vida. Cabe añadir que los SN pueden ser coste-efectivos en ciertos perfiles de paciente (ancianos malnutridos o en riesgo de desnutrición y en pacientes quirúrgicos hospitalizados). La revisión de la literatura evidencia la necesidad de realizar más estudios, con la metodología (..) (AU)

This article summarizes the main results and conclusions presented in the Symposium “Nutritional supplementation: evidences and experiences” that took place in the XXIIIrd SENPE Congress (2008).Protein energy malnutrition, that can affect 30-50%of hospitalized patients, increases both time of hospitalization and costs of medical care of this kind of patients. There is a lot of scientific evidences demonstrating that the use of nutritional supplementation improves nutritional status or prevents malnutrition in those patients who do not meet their nutritional needs with a conventional diet or an adapted one with no replacing intake from normal food. This is strengthened by the results that demonstrate the rol of nutritional supplements improving nutritional and functional parameters. Current bibliographic reviews focused on certain clinical frameworks (i.g. geriatrics, oncology),prove that nutritional supplements reduce complications related to pathology and to nutritional status, and also reduce length of hospitalization and mortality. More studies regarding to efficacy of oral nutritional supplements are needed. These studies should be carried out with a period of follow-up longer than the current published studies have. As well as effective, nutritional supplements become a save therapeutic intervention with no important adverse events that, according to bibliography, improve patient’s functionality and quality of life. It is worth mentioning that nutritional supplements can be effective on certain kind of patients, for instance, malnourished elderly or elderly in risk of malnourishment, and hospitalized surgical patients. Scientific literature refers that it is necessary to carry out more studies, with an accurate methodology, which assess the effect of nutritional supplements on quality of life and its cost-effectiveness on malnourished patients regarding specific clinical situations (..) (AU)

[Efficacy, cost-effectiveness, and effects on quality of life of nutritional supplementation]. / Eficacia, coste-efectividad y efectos sobre la calidad de vida de la suplementación nutricional.

This article summarizes the main results and conclusions presented in the Symposium "Nutritional supplementation: evidences and experiences" that took place in the XXIIIrd SENPE Congress (2008). Protein energy malnutrition, that can affect 30-50% of hospitalized patients, increases both time of hospitalization and costs of medical care of this kind of patients. There is a lot of scientific evidences demonstrating that the use of nutritional supplementation improves nutritional status or prevents malnutrition in those patients who do not meet their nutritional needs with a conventional diet or an adapted one with no replacing intake from normal food. This is strengthened by the results that demonstrate the rol of nutritional supplements improving nutritional and functional parameters. Current bibliographic reviews focused on certain clinical frameworks (i.g. geriatrics, oncology), prove that nutritional supplements reduce complications related to pathology and to nutritional status, and also reduce length of hospitalization and mortality. More studies regarding to efficacy of oral nutritional supplements are needed. These studies should be carried out with a period of follow-up longer than the current published studies have. As well as effective, nutritional supplements become a save therapeutic intervention with no important adverse events that, according to bibliography, improve patient's functionality and quality of life. It is worth mentioning that nutritional supplements can be effective on certain kind of patients, for instance, malnourished elderly or elderly in risk of malnourishment, and hospitalized surgical patients. Scientific literature refers that it is necessary to carry out more studies, with an accurate methodology, which assess the effect of nutritional supplements on quality of life and its cost-effectiveness on malnourished patients regarding specific clinical situations. That would allow physicians to make clinical decisions based on evidences and cost analysis.

Luz solar, vitamina D y tuberculosis / Sunlight, vitamin D and tuberculosi

La helioterapia fue utilizada de forma empírica desde la medicina antigua hasta el siglo XX para tratar múltiples enfermedades, entre ellas la tuberculosis y la Vit Dexplicó algunas de las acciones de la luz solar. En 1983, se descubrió el receptor de Vit. D y su presencia en células inmunitarias sugirió las acciones inmunitarias de la Vit. D y su posible aplicación en la patología humana. Reiteradamente se han comunicado niveles séricos descendidos de Vit. D en enfermos con tuberculosis activa o latente, aunque estos ensayos transversales no pudieron probar el sentido de la causa-efecto. Además, estudios experimentales han probado que la Vit. D mejora la defensa frente a M. tuberculosis. Recientemente se comunicó que los macrófagos infectados por M. tuberculosis, a través de los receptoresTLR1,2, activan la respuesta innata y además la producción local de Vit. D activa (1,25-OH) lo que explicaría la hipercalcemia y la calcificación del granuloma caseoso características de la tuberculosis. A la vista de estos datos, se ha aconsejado administrar Vit. D como terapéutica coadyuvante de la tuberculosis y en las formas resistentes. Sin embargo, los ensayos clínicos no han sido concluyentes por fallos metodológicos. Por otra parte, preocupa la conocida acción hipercalcemiante de la Vit. D y su modulación de los linfocitos Th1 que son fundamentales frente a microorganismos intracelulares, como M. tuberculosis. Sería recomendable la realización de potentes ensayos clínicos para aclarar si la terapia con Vit. D es útil y cuál es la dosis óptima a utilizar en cada situación (AU)

The heliotherapy was empirically used since antique medicine till XX century for treating many diseases, included tuberculosis, and the discovery of Vit. D has explained the effect of sunlight. The vitamin D receptor (VDR) was discovered in 1983, and their presence in immune cell suggested the immune role of Vit. D and its use in human pathology were considered. Low Vit. D serum levels were consistently reported in patients with active and latent tuberculosis, but these cross assays were enabling to prove the cause-effect sense. In other way, experimental studies proved that Vit. D increases the protection against tuberculosis. Recently, it was observed that macrophage cells infected with M. tuberculosis by TLR 2,1 receptors enhances simultaneously the innate immune response and the local production of active Vit. D (1,25-OH), that has explained the hypercalcemia and the calcification of the granulomas, two characteristic facts of tuberculosis disease. On view these findings, Vit. D has been advised as an adjuvant treatment of tuberculosis and for resistant cases. Nevertheless, the clinical assays have been not conclusive due to methodological fails. Besides, there is concern about the known hypercalcemicaction of Vit. D and because it modulates the function of Th1 lymphocytes, that are essential for the defense against intracellular microorganisms, as M. tuberculosis. The Vit. D (..) (AU)

[Importance of PSA velocity and PSA density in the prediction of prostate cancer in TURP or open prostatectomy specimen of patients with previous negative prostate biopsy]. / Importancia de la velocidad y la densidad de PSA en la predicción de cáncer de próstata en la pieza de RTU o adenomectomía de pacientes con biopsia prostática previa negativa.

PURPOSE: To determine variables related to the finding of prostate cancer (PC) in patients who underwent surgery following at least one negative prostate biopsy (PB). MATERIALS AND METHODS: A retrospective study of 170 patients who underwent transurethral resection of the prostate (TURP) or open prostatectomy between 1999 and 2007, following one or more negative PB sets. A multivariate logistic regression analysis was carried out in order to determine variables related to the finding of PC. The predictive capacity of PSA, PSA-density and PSA-velocity was assessed by means of ROC curves and the area under the curve (AUC). Sensitivity, specificity and predictive values were determined for several PSA-density and PSA-velocity cut-off points. RESULTS: Open prostatectomy was carried out on 104 patients (61.18%) and TURP on 66 (38.82%). PC was detected in the surgical specimen of 16 patients (9.41%). Variables associated with the finding of PC in the surgical specimen were PSA-density (OR: 1.47; 95% CI: 1.22-6.64; p: 0.007) and PSA-velocity (OR: 2.87; 95% CI: 1.60-5.12: p < 0.001). The AUCs were 0.746, 0.793 and 0.832, for PSA, PSA-density and PSA-velocity, respectively. The most sensitive PSA-density and PSA-velocity cut-off points in detecting PC were 0.15 and 1 ng/ml/year, respectively. Patients without PC showed a median PSA reduction of 9.35 ng/ml (-2.40 - 35.40), following surgery. CONCLUSIONS: PSA-density and PSA-velocity in particular, allow for the prediction of the presence of PC in the TURP or open prostatectomy specimen of patients with previously negative PBs. Diagnostic TURP could prove useful in patients with clinical suspicion of PC, susceptible to curative treatment, with PSA-velocity > 1l ng/ml/year and one or more negative saturation biopsies.

Importancia de la velocidad y la densidad de PSA en la predicción de cáncer de próstata en la pieza de RTU o adenomectomía de pacientes con biopsia prostática previa negativa / Importance of PSA velocity and PSA density in the prediction of prostate cancer in TURP or open prostatectomy specimen of patients with previous negative prostate biopsy

Objetivo: Determinar variables relacionadas con el hallazgo de cáncer de próstata (CaP) en pacientes sometidos a cirugía prostática tras al menos una biopsia prostática (BP) negativa. Material y métodos: Estudio retrospectivo de 170 pacientes sometidos a resección transuretral de próstata (RTUP) o adenomectomía entre 1999 y 2007, después de una o más BPs negativas. Se realizó un análisis multivariado de regresión logística para identificar variables relacionadas con la presencia de CaP. La capacidad predictiva de PSA, PSA densidad y PSA velocidad se determinó mediante curvas ROC y su área bajo la curva (ABC). Se analizó la sensibilidad, especificidad y valores predictivos para diversos puntos de corte de PSA densidad y PSA velocidad. Resultados: Se realizó adenomectomía en 104 pacientes (61,18%) y RTUP en 66 (38,82%). Se detectó CaP en la pieza quirúrgica de 16 pacientes (9,41%). Las variables asociadas al hallazgo de CaP en la pieza quirúrgica fueron PSA densidad (OR:1,47;95% IC:1,22-6,64; p:0,007) y PSA velocidad (OR:2,87;95% IC:1,60-5,12; p<0,001). Las ABC ROC fueron 0,746, 0,793 y 0,832, para PSA, PSA densidad y PSA velocidad, respectivamente. Los puntos de corte de PSA densidad y PSA velocidad con mayor sensibilidad y especificidad en la detección de CaP fueron 0,15 y 1 ng/ml/año, respectivamente. Los pacientes sin CaP mostraron una reducción mediana de PSA de 9,35 ng/ml (-2,40 – 35,40), después de la cirugía. Conclusiones: El PSA densidad y el PSA velocidad en particular, permiten predecir la presencia de CaP en la pieza de RTUP o adenomectomía, de pacientes con BPs previas negativas. La RTUP diagnóstica podría ser recomendada en pacientes con sospecha clínica de CaP, susceptibles de tratamiento curativo, con PSA velocidad >1ng/ml/año y una o más biopsias de saturación previas negativas (AU)

Purpose: To determine variables related to the finding of prostate cancer (PC) in patients who underwent surgery following atleast one negative prostate biopsy (PB).Materials and methods: A retrospective study of 170 patients who underwent transurethral resection of the prostate (TURP)or open prostatectomy between 1999 and 2007, following one or more negative PB sets. A multivariate logistic regression analysis was carried out in order to determine variables related to the finding of PC. The predictive capacity of PSA, PSA-density and PSA-velocity was assessed by means of ROC curves and the area under the curve (AUC). Sensitivity, specificity and predictive values were determined for several PSA-density and PSA-velocity cut-off points. Results: Open prostatectomy was carried out on 104 patients (61.18%) and TURP on 66 (38.82%). PC was detected in the surgical specimen of 16 patients (9.41%). Variables associated with the finding of PC in the surgical specimen were PSA-density(OR:1.47;95% CI:1.22-6.64; p:0.007) and PSA-velocity (OR:2.87;95% CI:1.60-5.12; p<0.001). The AUCs were 0.746, 0.793 and 0.832, for PSA, PSA-density and PSA-velocity, respectively. The most sensitive PSA-density and PSA-velocity cut-off points indetecting PC were 0.15 and 1ng/ml/year, respectively. Patients without PC showed a median PSA reduction of 9.35 ng/ml (-2.40– 35.40), following surgery. Conclusions: PSA-density and PSA-velocity in particular, allow for the prediction of the presence of PC in the TURP or open prostatectomy specimen of patients with previously negative PBs. Diagnostic TURP could prove useful in patients with clinical suspicion of PC, susceptible to curative treatment, with PSA-velocity >1ng/ml/year and one or more negative saturation biopsies (AU)

[Bilateral corneal ulceration as a result of caloric-protein malnutrition and vitamin A deficit in a patient with chronic alcoholism, chronic pancreatitis and cholecystostomy]. / Ulcera corneal bilateral como consecuencia de malnutrición calórico- protéica y déficit de vitamina A en un paciente con alcoholismo crónico, pancreatitis crónica y colecistostomía.

Since the discovery of vitamins, there has been an increasing interest at relating vitamins with particular diseases. In particular, for vitamin A its singular importance has been determined in multiple vital functions, and its relationship with diseases, both in deficit and in excess, is nowadays completely demonstrated. In developed countries, vitamin deficiency-related diseases have been greatly reduced; however, in some patients with particular features they must be kept in mind. This is the case of a 45 year-old man, with a history of chronic alcoholism, non insulin-dependent diabetes meIlitus and cholecystectomy with a high biliary drainage secondary to emphysematous cholecystitis and perivesicular abscess. He complains of bilateral ocular pain, photophobia, and decreased visual acuity besides a history of pasty, sticky and foul-smelling feces. He is admitted in the Ophthalmology Department and bilateral corneal ulceration is diagnosed. A consultation to the Nutrition Department is made because of cachexia. Severe caloric and mil protein hyponutrition is observed with a BMI of 18.2 and a 23% weight loss for the last 6 months, fat-soluble vitamins (A, D and E) deficit, mild fat malabsorption, and macrocytic and hypochromic anemia. The patient's diet is supplemented with a special hyperproteinic and hypercaloric diet for diabetics, deficient vitamins and pancreatic enzymes to improve absorption are administered, and glycemia is controlled with insulin. Four months later, the patient is assessed and has a BMI of 20, anemia has resolved and from an ophthalmologic viewpoint the course is favorable, the ulcers improve and visual acuity is almost completely recovered. In chronic alcoholic patients with a low dietary intake and clinical complications with nutritional repercussions (pancreatitis that produces malabsorption or cholecystectomy with biliary percutaneous drainage) we should not forget that micronutrients deficits may explain the etiology of other associated diseases, in the present case corneal ulceration.

International conference on the healthy effect of virgin olive oil.

1. Ageing represents a great concern in developed countries because the number of people involved and the pathologies related with it, like atherosclerosis, morbus Parkinson, Alzheimer's disease, vascular dementia, cognitive decline, diabetes and cancer. 2. Epidemiological studies suggest that a Mediterranean diet (which is rich in virgin olive oil) decreases the risk of cardiovascular disease. 3. The Mediterranean diet, rich in virgin olive oil, improves the major risk factors for cardiovascular disease, such as the lipoprotein profile, blood pressure, glucose metabolism and antithrombotic profile. Endothelial function, inflammation and oxidative stress are also positively modulated. Some of these effects are attributed to minor components of virgin olive oil. Therefore, the definition of the Mediterranean diet should include virgin olive oil. 4. Different observational studies conducted in humans have shown that the intake of monounsaturated fat may be protective against age-related cognitive decline and Alzheimer's disease. 5. Microconstituents from virgin olive oil are bioavailable in humans and have shown antioxidant properties and capacity to improve endothelial function. Furthermore they are also able to modify the haemostasis, showing antithrombotic properties. 6. In countries where the populations fulfilled a typical Mediterranean diet, such as Spain, Greece and Italy, where virgin olive oil is the principal source of fat, cancer incidence rates are lower than in northern European countries. 7. The protective effect of virgin olive oil can be most important in the first decades of life, which suggests that the dietetic benefit of virgin olive oil intake should be initiated before puberty, and maintained through life. 8. The more recent studies consistently support that the Mediterranean diet, based in virgin olive oil, is compatible with a healthier ageing and increased longevity. However, despite the significant advances of the recent years, the final proof about the specific mechanisms and contributing role of the different components of virgin olive oil to its beneficial effects requires further investigations.

Evaluación de un programa de nutrición parenteral domiciliaria en pacientes oncológicos terminales / Assessment of home parenteral nutrition programme in terminal oncological patients

A pesar de que el cáncer constituye en la mayoría de las series publicadas la patología de base más frecuente para la indicación de Nutrición Parenteral Domiciliaria (NPD), su utilización en pacientes terminales sigue siendo objeto de controversias. Nuestro objetivo ha sido revisar la evolución de los pacientes con cáncer tratados con NPD procedentes del Hospital La Paz con el fin de estudiar su indicación, evolución y complicaciones. Revisamos un total de 9 pacientes oncológicos terminales que habían sido tratados con NPD entre enero de 2000 y diciembre del 2002. Con una edad media de 60,4 años (44-81), el cáncer de base más frecuente era el adenocarcinoma gástrico (44%). La obstrucción intestinal en el contexto de una carcinomatosis peritoneal fue el motivo de indicación en el 89% de los casos y la mediana de supervivencia de 71 días (23-131). La infección del catéter representó la complicación más frecuente con 1,4 episodios/paciente. La existencia de un Equipo de Soporte Domiciliario facilitó el seguimiento de los pacientes, estimándose la NPD como tratamiento proporcionado en el 67% de los casos. El 56% de los pacientes no estaban suficientemente informados de su enfermedad de base. Aunque la NPD es un recurso terapéutico más, del que podemos disponer en algunos pacientes oncológicos terminales, debemos afinar la indicación lo más posible teniendo en cuenta una serie de "garantías sistemáticas" que incluyen el cumplimiento de los criterios clínicos pertinentes, el consentimiento informado y la colegiación en la decisión de todos los profesionales implicados en el seguimiento del paciente. Proponemos un algoritmo de actuación para ayudar a mejorar el proceso de toma de decisiones en estos pacientes (AU)

Background and goals: The assessment of the acceptance of the diets served at the hospital allows the introduction of adjustments to improve the quality of the service provided to hospitalized patients by preventing the complications derived from incorrect nutrition and enhancing their stay in hospital. The goal of the present study was to analyze the acceptance of the menus offered by the Hospital's catering service. Scope of the study: Menus provided by the catering service of the "Sant Joan de Reus" University Hospital. Material and methods: A total of 160 tray meals consumed were assessed, all chosen at random and corresponding to standard diets and special diets, including puréed food. The assessment was made by two dieticians in the hospital´s kitchens. A visual scale was used with the following scores: 0 for a full plate, 1 for residual food amounting to over 75%, 2 from 50% to 75%, 3 more than or equal to 25% and 4 for empty plates. Results: A total of 68 trays containing a standard diet were analyzed, together with 34 containing special diets and 41 with puréed food. The remains on 36 different courses from the standard diet were analyzed. The mean acceptance score was 3.01 ± 1.30 in the case of the first courses, 3.24 ± 1.11 in second courses and 3.53 ± 0.96 for the desserts. As for special diets, a total of 27 different courses were analyzed. The mean acceptance score was 2.87 ± 1.38 in the case of the first courses, 3.02 ± 1.27 in second courses and 3.49 ± 1.22 for the desserts. The first courses of puréed diets received the worst score of all the dishes served, although the overall mean score was good, 2.76 ± 1.5. Conclusions: In general, a good level of acceptance has been observed for the set meals served in the hospital. Knowing which courses have lower acceptance scores allows changes to be proposed to the hospital menus, with their replacement by others with foreseeably better acceptance (AU)