[Oscillometric devices vs. arterial Doppler in measuring the ankle-arm index for the diagnosis of peripheral arterial disease]. / Dispositivos oscilométricos frente a Doppler arterial en la medida del índice tobillo-brazo para el diagnóstico de la enfermedad arterial periférica.

INTRODUCTION: Peripheral arterial disease is a marker of vascular damage that is diagnosed by measuring the ankle-brachial index. The aim of this study was to determine the validity and agreement of the MESI ABPI-MD and Microlife WatchBP® office-ABI oscillometric devices with respect to the gold standard arterial Doppler. MATERIALS AND METHODS: Observational, cross-sectional, descriptive study of inpatients who underwent ABI measurement with the three devices. Values are considered normal between 1-1.4, indeterminate between 0.91-0.99 and pathological ≤0.9 and >1.4. RESULTS: A total of 187 patients (54.4% male) with a mean age of 66 years were included. The Doppler results were inferior to those of the oscillometric devices (median [IQR] 1.1 [0.2] vs. 1.2 [0.2], P<.05), with no significant differences between the automated devices (P=.29 for the right lower limb and P=.342 for the left lower limb). Both devices had high specificity (96.5-99.2%) and low sensitivity (29.5-45.4%). The correlation of the results was good-moderate for MESI and moderate for Microlife. The agreement between the two was acceptable-moderate. CONCLUSION: Automated oscillometric devices could be useful in asymptomatic patients as an alternative to arterial Doppler.

Efficacy of short-course colchicine treatment in hospitalized patients with moderate to severe COVID-19 pneumonia and hyperinflammation: a randomized clinical trial.

Some patients with COVID-19 pneumonia develop an associated cytokine storm syndrome that aggravates the pulmonary disease. These patients may benefit of anti-inflammatory treatment. The role of colchicine in hospitalized patients with COVID-19 pneumonia and established hyperinflammation remains unexplored. In a prospective, randomized controlled, observer-blinded endpoint, investigator-initiated trial, 240 hospitalized patients with COVID-19 pneumonia and established hyperinflammation were randomly allocated to receive oral colchicine or not. The primary efficacy outcome measure was a composite of non-invasive mechanical ventilation (CPAP or BiPAP), admission to the intensive care unit, invasive mechanical ventilation requirement or death. The composite primary outcome occurred in 19.3% of the total study population. The composite primary outcome was similar in the two arms (17% in colchicine group vs. 20.8% in the control group; p = 0.533) and the same applied to each of its individual components. Most patients received steroids (98%) and heparin (99%), with similar doses in both groups. In this trial, including adult patients with COVID-19 pneumonia and associated hyperinflammation, no clinical benefit was observed with short-course colchicine treatment beyond standard care regarding the combined outcome measurement of CPAP/BiPAP use, ICU admission, invasive mechanical ventilation or death (Funded by the Community of Madrid, EudraCT Number: 2020-001841-38; 26/04/2020).

Subcutaneous IL-6 Inhibitor Sarilumab vs. Standard Care in Hospitalized Patients With Moderate-To-Severe COVID-19: An Open Label Randomized Clinical Trial.

Background: The use of IL-6 blockers in COVID-19 hospitalized patients has been associated with a reduction in mortality compared to standard care. However, many uncertainties remain pertaining to optimal intervention time, administration schedule, and predictors of response. To date, data on the use of subcutaneous sarilumab is limited and no randomized trial results are available. Methods: Open label randomized controlled trial at a single center in Spain. We included adult patients admitted with microbiology documented COVID-19 infection, imaging confirmed pneumonia, fever and/or laboratory evidence of inflammatory phenotype, and no need for invasive ventilation. Participants were randomly assigned to receive sarilumab, a single 400 mg dose in two 200 mg subcutaneous injections, added to standard care or standard care, in a 2:1 proportion. Primary endpoints included 30-day mortality, mean change in clinical status at day 7 scored in a 7-category ordinal scale ranging from death (category 1) to discharge (category 7), and duration of hospitalization. The primary efficacy analysis was conducted on the intention-to-treat population. Results: A total of 30 patients underwent randomization: 20 to sarilumab and 10 to standard care. Most patients were male (20/30, 67%) with a median (interquartile range) age of 61.5 years (56-72). At day 30, 2/20 (10%) patients died in the sarilumab arm vs. none (0/10) in standard care (Log HR 15.11, SE 22.64; p = 0.54). At day 7, no significant differences were observed in the median change in clinical status (2 [0-3]) vs. 3 [0-3], p = 0.32). Median time to discharge (days) was similar (7 [6-11] vs. 6 [4-12]; HR 0.65, SE 0.26; p = 0.27). No significant differences were detected in the rate of progression to invasive and noninvasive mechanical ventilation. Conclusions and Relevance: Our pragmatic pilot study has failed to demonstrate the benefit of adding subcutaneous sarilumab to standard care for mortality by 30 days, functional status at day 7, or hospital stay. Findings herein do not exclude a potential effect of sarilumab in severe COVID-19 but adequately powered blinded randomized phase III trials are warranted to assess the impact of the subcutaneous route and a more selected target population. Trial Registration: www.ClinicalTrials.gov, Identifier: NCT04357808.

Clinical features and respiratory pathophysiology of COVID-19 patients ventilated in the prone position: a cohort study.

INTRODUCTION: There are few studies that have investigated the response to the prone position in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome (ARDS). We describe the characteristics and outcomes of those patients in a tertiary hospital in Spain. MATERIAL AND METHODS: This is an observational study in consecutive, mechanically ventilated COVID-19 patients. The primary endpoint was to describe the respiratory pathophysio-logy and clinical outcomes of COVID-19 patients treated by mechanical ventilation in the prone position. RESULTS: Of 84 patients mechanically ventilated in the prone position, 19 (22%) were successfully extubated and 43 (51%) were discharged from the ICU. The duration of mechanical ventilation and ICU length of stay were 11 days (IQR 8-16) and 15 days (IQR 9-25), respectively. On admission to ICU, 61% patients had a moderate ARDS according to the Berlin criteria. 76% had 4 lung quadrants affected. After intubation, the median PaO2/FiO2 was 105 (IQR 76-138), ventilatory ratio was 1.48 (IQR 1.16-1.88), and compliance was 33 mL cm H 2 O-1 (IQR 25-41). The median number of cycles in the prone position was 2 (1-3), with a median of total hours in the prone position of 76 (IQR 64-111).72 h after the first prone position cycle the median PaO2/FiO2 increase was up to 193 (IQR 152-251), but the compliance was similar to the basal level (34 mL cm H 2 O-1 [IQR 26-43]). However, the percentage of patients with normal compliance (> 50 mL cm H 2 O-1) increased with the prone position from 15% (n = 13) to 32% (n = 27) after 72 h. CONCLUSIONS: In our study, the COVID-19 patients with respiratory failure presented respiratory mechanics, gas exchange parameters, and a response to prone ventilation similar to those observed in other causes of ARDS.

Effectiveness and safety of first-line antiretroviral regimens in clinical practice: a multicentre cohort study.

OBJECTIVES: We compared 48 week effectiveness and safety of first-line antiretroviral regimens. METHODS: We analysed HIV treatment-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting the most commonly used antiretroviral regimens from 2014 to 2018. We used multivariable regression models to assess the impact of initial regimen on: (i) viral suppression (VS) (viral load <50 copies/mL); (ii) change in CD4 cell count; (iii) CD4/CD8 normalization (>0.4 and >1); (iv) CD4 percentage normalization (>29%); (v) multiple T-cell marker recovery (MTMR: CD4 > 500 cells/mm3 plus CD4 percentage >29% plus CD4/CD8 > 1); (vi) lipid, creatinine and transaminase changes; and (vii) discontinuations due to adverse events (AE). RESULTS: Among 3945 individuals analysed, the most frequently prescribed regimens were ABC/3TC/DTG (34.0%), TAF/FTC/EVG/CBT (17.2%), TDF/FTC + DTG (11.9%), TDF/FTC/EVG/CBT (11.7%), TDF/FTC/RPV (11.5%), TDF/FTC + bDRV (8.3%) and TDF/FTC + RAL (5.3%). At 48 weeks, 89.7% of individuals achieved VS with no significant differences by initial regimen. CD4 mean increase was 257.8 (249.3; 266.2) cells/mm3, and it was lower with TAF/FTC/EVG/CBT and TDF/FTC/RPV compared with ABC/3TC/DTG. CD4 percentage normalization was less likely with TAF/FTC/EVG/CBT, and MTMR was less likely with TAF/FTC/EVG/CBT and TDF/FTC + RAL. The proportion of discontinuations due to AE was higher with TDF/FTC + bDRV (9.7%), followed by TDF/FTC/EVG/CBT (9.5%) and TDF/FTC + DTG (7.9%). Compared with ABC/3TC/DTG, cholesterol and LDL mean increases were higher with TAF/FTC/EVG/CBT and lower with TDF/FTC + DTG, TDF/FTC/RPV and TDF/FTC + RAL. Higher mean increases in triglycerides were significantly associated with TAF/FTC/EVG/CBT. Regimens containing DTG showed higher creatinine increases. CONCLUSIONS: The significantly greater immunological response and safety of some combinations may be useful for making decisions when initiating treatment.

Synthesis and characterisation of magnetite nanoparticles using gelatin and starch as capping agents.

Nanoparticles of magnetite passivated with gelatin and starch were synthesised using a co-precipitation technique. The nanoparticles were characterised using ultraviolet-visible (UV-vis), dynamic light scattering (DLS), Zeta potential, transmission electron microscope (TEM), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR). The UV-vis spectra showed characteristic surface plasmon resonance of magnetite nanoparticles. The DLS results showed the nanoparticles to have average hydrodynamic diameters of 138 ± 2 and 283 ± 21 nm for particles passivated with gelatin and starch, respectively. The stability in a colloidal solution was greater in nanoparticles passivated with gelatin than nanoparticles obtained with starch, as can be seen by their Zeta potential value (-31 ± 2 and -16 ± 0.5 mV, respectively). According to the TEM evaluation, the use of gelatin allowed to obtain nanoparticles with a spherical morphology and an average size of 10 ± 2 nm. However, when using starch the nanoparticles exhibited diverse morphologies with an average size of 25 ± 7 nm. The XRD results confirmed the crystalline structure of the samples, which showed crystallite sizes of 14.90 and 24.43 nm for nanoparticles passivated with gelatin and starch, respectively. FTIR analysis proved the establishment of interactions between functional groups of biopolymers and magnetite nanoparticles.

Development of a checklist for patients with axial spondyloarthritis and psoriatic arthritis in daily practice: ONLY TOOLS project. / Desarrollo de un cuadro de actuación para la evaluación de pacientes con espondiloartritis axial y artritis psoriásica en la práctica diaria: proyecto ONLY TOOLS.

OBJECTIVE: To standardize clinical evaluation of patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA) using a checklist. METHODS: Qualitative study that included: 1) nominal group (18 experts); 2) literature reviews of measures used in the assessment of patients with axial SpA or PsA; and 3) focus groups, one with rheumatologists and another with patients, organized to become familiar with their opinion on medical assistance. Taking this into account, the experts selected the measures to be included in the checklist based on their relevance, feasibility, and the outcome type. RESULTS: The checklist includes measures for the evaluation of personal history, physical examination, activity and function, laboratory tests, imaging studies and treatments. It also defines risk factors of radiographic progression, predictors of the response to biological therapies, and comprises measures of excellence. CONCLUSIONS: This checklist for patients with axial SpA and PsA could help standardize daily clinical practice and improve clinical management and patient prognosis.

Differences between familial and sporadic early spondyloarthritis: results from the ESPERANZA cohort.

OBJECTIVES: To describe and evaluate clinical and imaging differences between patients with familial and sporadic early spondyloarthritis (SpA). METHODS: This was a cross-sectional study analysing the baseline dataset from ESPERANZA, a national programme developed for the early identification of patients with SpA. Patients fulfilling SpA ASAS classification criteria were included. Familial SpA was defined according to the ASAS/ESSG criteria as the presence in first- or second-degree relatives of any of the following: ankylosing spondylitis, psoriasis, uveitis, reactive arthritis, and inflammatory bowel disease. Socio-demographic and disease characteristics, disease activity, metrology and laboratory and imaging data were compared by descriptive and bivariate statistics. RESULTS: A total of 377 patients were included - 64% men, mean age 32, and mean disease duration 12 months. Out of these, 132 (35%) patients (101 axial and 31 peripheral SpA) were familial forms. In patients with axial SpA, statistically significant differences (p<0.05) were found between familial and sporadic forms regarding age at symptoms onset (29.4±9.2 vs. 31.5±10 years), HLA B27 positivity (83% vs. 71%), BASMI (1.2± 13 vs. 1.6 1.2) and sacroiliitis on magnetic resonance imaging (36% vs. 47%), respectively. In patients with peripheral SpA, there were no significant differences for any of the variables analysed. CONCLUSIONS: Familial axial SpA presents symptoms at a younger age, is more frequently HLA-B27 positive and shows better spinal mobility than sporadic axial SpA; this latter presenting sacroiliitis on MRI more frequently than familial axial SpA. Apparently, no differences exist in the expression of familial or sporadic peripheral SpA.

Cistadenoma seroso de páncreas. A propósito de 5 pacientes / Serous cystadenoma of the pancreas. A propos of 5 patients

Objetivo. Describir el curso clínico, tratamiento quirúrgico y evolución postoperatoria de un grupo de pacientes con cistadenoma seroso de páncreas. Diseño. Descripción de casos clínicos. Estudio retrospectivo. Sede Hospital de tercer nivel de atención. Pacientes y métodos. Se revisaron los expedientes clínicos de 5 pacientes que presentaron cistoadenoma seroso de páncreas; se analizaron los siguientes datos: edad, sexo, cuadro clínico, métodos de diagnóstico empleados, tratamiento quirúrgico utilizado, resultado histopatológico, morbilidad y mortalidad. Resultados. Cuatro de los 5 pacientes fueron mayores de 50 años; la sintomatología predominante fue dolor abdominal y masa palpable. El estudio diagnóstico más confiable fue la tomografía computada (TAC). En un paciente el cistoadenoma fue hallazgo de autopsia, en los 4 restantes fue posible la resección de la masa. En todos los casos se confirmó histopatológicamente la presencia de un cistoadenoma seroso. La evolución postopertoria fue satisfactoria en todos los casos

Tumores pancreáticos poco frecuentes: experiencia de 10 años / Infrequent pancreatic tumors: 10 years experience

Se informan tres casos de adenoma microquístico, un caso de tumor papilar y quístico, un caso de cistadenocarcinoma mucinoso, un caso de leiomiosarcoma y un casos de carcinoma insular no funcionante del páncreas. Se recalca la importancia de los aspectos clínicos, histológicos, inmunohistoquímicos, ultraestructurales, y de la citometría de flujo para poder identificar estas neoplasias tan poco frecuentes. Se hace una revisión de la literatura médica pertinente y se señalan los procedimientos de diagnóstico y tratamiento

Tumores pancreáticos poco frecuentes: experiencia de 10 años / Infrequent pancreatic tumors: 10 years experience

Se informan tres casos de adenoma microquístico, uno de tumor papilar y quístico, uno de cistadenocarcinoma mucinoso, uno de leiomiosarcoma insular no funcionante del páncreas. Se hace énfasis en los aspectos clínicos, histológicos, inmunohistoquímicos, ultraestructurales, citometría de flujo, para poder identificar estas neoplasias poco frecuentes. Se hace una revisión de la literatura médica y se señalan los procedimientos de diagnóstico y tratamiento.