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OBJECTIVES: Autoantibodies and, specifically antinuclear antibodies (ANA), are the hallmark of systemic autoimmune diseases (AID). In the last decades, there has been great technical development to detect these autoantibodies along with an increased request for this test by clinicians, while the overall pre-test probability has decreased. In this study, we compare the diagnostic performance of three different methods for ANA screening (indirect immunofluorescence [IIF], addressable laser bead immunoassay [ALBIA], and fluorescence enzyme immunoassay [FEIA]). METHODS: Serum samples at baseline visit from 2,997 participants from the Camargo Cohort, a population with an overall low pre-test probability for systemic AID, were analyzed with the three methods. Participants have a minimum follow-up of 10 years and the development of autoimmune diseases was collected from clinical records. RESULTS: The highest frequency of positive ANA was observed by IIF assay. However, ALBIA showed high sensitivity for AID. Likewise, solid phase assays (SPA) presented higher specificity than IIF for AID. ANA prevalence with any method was significantly higher in females and overall increased with age. Triple positivity for ANA was significantly related to the presence of anti-dsDNA-SSA/Ro60, Ro52, SSB/La, RNP, Scl-70, and centromere-specificities. No association was found for anti-Sm - RNP68, or ribosomal P - specificities. Noteworthy, triple positivity for ANA screening was associated with diagnosis of systemic AID both at baseline visit and follow-up. CONCLUSIONS: ANA detection by IIF may be better when the pre-test probability is high, whereas SPA techniques are more useful in populations with an overall low pre-test probability for systemic AID.
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Anticuerpos Antinucleares , Enfermedades Autoinmunes , Femenino , Humanos , Autoanticuerpos , Enfermedades Autoinmunes/diagnóstico , Técnica del Anticuerpo Fluorescente Indirecta/métodos , Inmunoensayo/métodosRESUMEN
Spinal osteoarthritis has been suggested as a risk factor for vertebral fractures. However, results are conflicting: most of the data are focused on the lumbar region, and referred to postmenopausal women, whereas data for men are scarce. The aim of this study is to assess the relationship between spinal osteoarthritis and vertebral fractures in men over 50 years of age. We conducted a cross-sectional study, nested in a prospective population-based cohort, including 507 community-dwelling men, 93 of them with at least one vertebral fracture. Vertebral fractures, osteophytosis, and disc space narrowing (DSN) were assessed by lateral thoracic and lumbar radiographs. Anthropometric, clinical, and densitometric variables were also analyzed. A multiple logistic regression model was performed. Eighty-five percent of vertebral fractures were located at the thoracic spine. Osteophytosis and DSN showed a bimodal distribution, with major frequency peaks at mid- and distal lumbar spine. The three distributions overlapped around the T9 vertebra. We did not find any relationship between lumbar osteoarthritis and vertebral fractures. Nevertheless, thoracic osteophytosis (OR, 1.84; 95 % CI, 1.05-3.17; p = 0.03) and DSN (OR, 2.52; 95 % CI, 1.43-4.46; p = 0.001) were found to be independently associated with prevalent vertebral fractures, after adjusting for confounders. Our results suggest a positive relationship between radiologic osteoarthritic changes at the thoracic spine and prevalent vertebral fractures in men more than 50 years of age. Osteoarthritis may act as a local risk factor, in addition to other mechanical factors, resulting in a greater propensity to fracture, especially at the mid-thoracic region.
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Vértebras Lumbares , Osteoartritis de la Columna Vertebral , Fracturas de la Columna Vertebral , Osteofitosis Vertebral , Vértebras Torácicas , Anciano , Estudios Transversales , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/metabolismo , Masculino , Persona de Mediana Edad , Osteoartritis de la Columna Vertebral/complicaciones , Osteoartritis de la Columna Vertebral/diagnóstico por imagen , Osteoartritis de la Columna Vertebral/epidemiología , Osteoartritis de la Columna Vertebral/metabolismo , Estudios Prospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/epidemiología , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/metabolismo , Osteofitosis Vertebral/diagnóstico por imagen , Osteofitosis Vertebral/epidemiología , Osteofitosis Vertebral/etiología , Osteofitosis Vertebral/metabolismo , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/metabolismoRESUMEN
Autoantibodies are the hallmark of autoimmunity, and specifically, antinuclear antibodies (ANA) are one of the most relevant antibodies present in systemic autoimmune diseases (AID). In the present study, we evaluate the relationship between ANA and sociodemographic and biobehavioral factors in a population with a low pre-test probability for systemic AID. ANA were determined in serum samples at baseline visit from 2997 participants from the Camargo Cohort using indirect immunofluorescence assay, and two solid phase assays (SPA), addressable laser bead immunoassay, and fluorescence enzyme immunoassay. Sociodemographic and biobehavioral features of the subjects were obtained at baseline visit using a structured questionnaire. The prevalence of ANA positive results was significantly higher when indirect immunofluorescence assay was used as screening method in comparison with SPAs, being higher in females, older subjects, and those with higher C-reactive protein levels. Considering biobehavioral features, the prevalence was higher in those individuals with a sedentary lifestyle, and in ex- and non-alcohol users. Moreover, considering the relevance of the antibody load using ANA Screen, the prevalence of the antibody load also increased with age, especially in females. In conclusion, the prevalence of ANA varies depending on sociodemographic and biobehavioral features of the subjects, which could be relevant specifically in a population with a low pre-test probability for systemic AIDs.
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BACKGROUND: Legionella is a well known but infrequent cause of bacterial endocarditis. METHODS: We report a case of endocarditis caused by Legionella spp. We reviewed previously reported cases in PubMed, Google Scholar and in references included in previous reports, and summarized relevant clinical data. RESULTS: A 63-year-old man with a history of aortic valve replacement developed persistent fever and monoarthritis. Transesophageal echocardiography showed perivalvular abscess. He died during surgery. Blood and valve cultures were negative. Legionella spp. was demonstrated with 16S-rRNA PCR from the resected material. Twenty cases of Legionella endocarditis have been reported. Harboring a prosthetic valve was the main risk factor. Prognosis was favorable, both for patients treated with or without surgical valve replacement. Overall mortality was <10%. CONCLUSIONS: Legionella is an infrequent cause of endocarditis. It frequently requires surgical treatment. Prognosis is good. Molecular techniques are likely to become the gold standard for diagnosis.
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Endocarditis Bacteriana , Endocarditis , Prótesis Valvulares Cardíacas , Legionella , Absceso/complicaciones , Endocarditis Bacteriana/microbiología , Prótesis Valvulares Cardíacas/efectos adversos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To assess the association between the atherogenic index of plasma (AIP) and the trabecular bone score (TBS) in postmenopausal women. Furthermore, to analyze its relationship with bone mineral density (BMD), and serum concentrations of 25OHD, PTH, and bone turnover markers. STUDY DESIGN: Cross-sectional study nested in a population-based cohort of 1,367 postmenopausal women aged 44-94 years. Participants were classified according to TBS values (<1.230, between 1.230-1.310 and >1.310) and regarding a widely accepted cut-off point of ≥0.11 for AIP. We analyzed TBS, BMD, serum levels of 25OHD, PTH, P1NP, CTX, and clinical covariates. A multivariate analysis was performed to assess the adjusted association between AIP and TBS. RESULTS: The mean age of participants was 63±10 years. Women with TBS values <1.230 were older, had greater BMI, greater prevalence of fractures after the age of 40 years, more years since menopause, higher values of AIP, and significantly lower levels of HDL-C, serum phosphate, and 25OHD. AIP values ≥0.11 were not associated with the presence of densitometric osteoporosis (OR=0.83, 95%CI 0.58-1.18; p = 0.30) but, in multivariate analysis, AIP values ≥0.11 were related to a degraded microarchitecture after controlling for age, BMI, smoking, diabetes status, ischemic heart disease, statin use, GFR, a fragility fracture at over 40 years of age and lumbar osteoporosis by DXA, with an adjusted OR=1.61 (95%CI 1.06-2.46; p = 0.009). CONCLUSIONS: AIP is significantly and independently associated with a degraded bone microarchitecture as measured by TBS. In this sense, AIP might be a useful tool in the overall assessment of bone metabolism in postmenopausal women.
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Aterosclerosis/epidemiología , Densidad Ósea , Hueso Esponjoso/patología , Vértebras Lumbares/patología , Fracturas Osteoporóticas/epidemiología , Posmenopausia , Absorciometría de Fotón , Adulto , Anciano , Anciano de 80 o más Años , Aterosclerosis/sangre , Aterosclerosis/patología , Estudios de Casos y Controles , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Fracturas Osteoporóticas/patología , España/epidemiologíaRESUMEN
Coronavirus disease 2019 (COVID-19) is currently a major public health problem. The development of pulmonary fibrosis secondary to acute respiratory distress syndrome (ARDS) is one of the expected sequelae. In this case series, we describe five instances of the use of anakinra in late-phase COVID-19 pneumonia in hospitalized patients with pulmonary fibrosis and refractory respiratory failure fulfilling ARDS criteria. The study demonstrates that anakinra has promising efficacy and safety in late-phase COVID-19 infection in patients with ARDS and refractory hypoxaemia, and suggests its potential application as antifibrotic therapy in these patients. LEARNING POINTS: Up to one third of patients with severe COVID-19 pneumonia progress to acute respiratory distress syndrome (ARDS).Pulmonary fibrosis is a known consequence of ARDS.Our study shows promising results regarding the efficacy and safety of anakinra used in late-phase COVID-19 infection in patients with pulmonary fibrosis secondary to ARDS.
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BACKGROUND: The role of vitamin D status in COVID-19 patients is a matter of debate. OBJECTIVES: To assess serum 25-hydroxyvitamin D (25OHD) levels in hospitalized patients with COVID-19 and to analyze the possible influence of vitamin D status on disease severity. METHODS: Retrospective case-control study of 216 COVID-19 patients and 197 population-based controls. Serum 25OHD levels were measured in both groups. The association of serum 25OHD levels with COVID-19 severity (admission to the intensive care unit, requirements for mechanical ventilation, or mortality) was also evaluated. RESULTS: Of the 216 patients, 19 were on vitamin D supplements and were analyzed separately. In COVID-19 patients, meanâ ±â standard deviation 25OHD levels were 13.8â ±â 7.2 ng/mL, compared with 20.9â ±â 7.4 ng/mL in controls (Pâ <â .0001). 25OHD values were lower in men than in women. Vitamin D deficiency was found in 82.2% of COVID-19 cases and 47.2% of population-based controls (Pâ <â .0001). 25OHD inversely correlates with serum ferritin (Pâ =â .013) and D-dimer levels (Pâ =â .027). Vitamin D-deficient COVID-19 patients had a greater prevalence of hypertension and cardiovascular diseases, raised serum ferritin and troponin levels, as well as a longer length of hospital stay than those with serum 25OHD levels ≥20 ng/mL. No causal relationship was found between vitamin D deficiency and COVID-19 severity as a combined endpoint or as its separate components. CONCLUSIONS: 25OHD levels are lower in hospitalized COVID-19 patients than in population-based controls and these patients had a higher prevalence of deficiency. We did not find any relationship between vitamin D concentrations or vitamin deficiency and the severity of the disease.
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COVID-19/sangre , Deficiencia de Vitamina D/epidemiología , Vitamina D/análogos & derivados , Anciano , COVID-19/diagnóstico , COVID-19/mortalidad , COVID-19/terapia , Estudios de Casos y Controles , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/diagnósticoRESUMEN
BACKGROUND: The role of vitamin D status in COVID-19 patients is a matter of debate. OBJECTIVES: To assess serum 25-hydroxyvitamin D (25OHD) levels in hospitalized patients with COVID-19 and to analyze the possible influence of vitamin D status on disease severity. METHODS: Retrospective case-control study of 216 COVID-19 patients and 197 population-based controls. Serum 25OHD levels were measured in both groups. The association of serum 25OHD levels with COVID-19 severity (admission to the intensive care unit, requirements for mechanical ventilation, or mortality) was also evaluated. RESULTS: Of the 216 patients, 19 were on vitamin D supplements and were analyzed separately. In COVID-19 patients, meanâ ±â standard deviation 25OHD levels were 13.8â ±â 7.2 ng/mL, compared with 20.9â ±â 7.4 ng/mL in controls (Pâ <â .0001). 25OHD values were lower in men than in women. Vitamin D deficiency was found in 82.2% of COVID-19 cases and 47.2% of population-based controls (Pâ <â .0001). 25OHD inversely correlates with serum ferritin (Pâ =â .013) and D-dimer levels (Pâ =â .027). Vitamin D-deficient COVID-19 patients had a greater prevalence of hypertension and cardiovascular diseases, raised serum ferritin and troponin levels, as well as a longer length of hospital stay than those with serum 25OHD levels ≥20 ng/mL. No causal relationship was found between vitamin D deficiency and COVID-19 severity as a combined endpoint or as its separate components. CONCLUSIONS: 25OHD levels are lower in hospitalized COVID-19 patients than in population-based controls and these patients had a higher prevalence of deficiency. We did not find any relationship between vitamin D concentrations or vitamin deficiency and the severity of the disease.
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COVID-19/diagnóstico , Vitamina D/sangre , Anciano , COVID-19/mortalidad , COVID-19/patología , COVID-19/terapia , Estudios de Casos y Controles , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Mortalidad , Pronóstico , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , SARS-CoV-2/patogenicidad , Índice de Severidad de la Enfermedad , España/epidemiología , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/mortalidad , Deficiencia de Vitamina D/terapiaRESUMEN
There is growing evidence of a link between lipid and bone metabolism, although data on this association in European men are scarce. This cross-sectional study from a community-based prospective cohort aims to explore the association of serum lipids with different aspects of bone metabolism in Spanish men. Demographic and anthropometric measurements, biochemical parameters including serum lipids, bone remodelling markers and calciotropic hormones, bone mineral density (BMD) assessed by dual X-ray absorptiometry and heel quantitative ultrasound, and prevalent vertebral and non-vertebral fractures, were evaluated in 289 men. Calciotropic hormones or bone markers were not associated with serum lipids. Serum total (TC) and LDL cholesterol, as well as LDL/HDL ratio were positively correlated to BMD at lumbar spine and hip. No significant correlation was noted for triglycerides or HDL. We observed a positive association between triglycerides, LDL/HDL ratio and BUA, and between TC/HDL ratio and both, QUI and BUA. BMD at the femoral neck and total hip was significantly higher in men with hypercholesterolemia after controlling for all the covariates (p=0.007). We did not observe any association between serum lipids and prevalent vertebral fractures. However, we found that TC (p=0.03) and LDL (p=0.04) were lower in subjects with non-vertebral fractures. In conclusion, we have found that a more unfavorable lipid profile (mainly higher LDL-C levels) is associated with higher BMD at lumbar spine and hip in Spanish men. Moreover, we did not observe any association between hypercholesterolemia and prevalent vertebral fractures, but we found lower serum TC and LDL-C levels in men with prevalent non-vertebral fractures.
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Densidad Ósea/fisiología , Huesos/metabolismo , Metabolismo de los Lípidos/fisiología , Absorciometría de Fotón , Anciano , Albúminas/análisis , Fosfatasa Alcalina/sangre , Calcio/sangre , Colesterol/sangre , Estudios de Cohortes , Colágeno Tipo I/sangre , Estudios Transversales , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Péptidos/sangre , Estudios Prospectivos , Triglicéridos/sangre , Vitamina D/análogos & derivados , Vitamina D/sangreRESUMEN
BACKGROUND: Legionella is a well known but infrequent cause of bacterial endocarditis. METHODS: We report a case of endocarditis caused by Legionella spp. We reviewed previously reported cases in PubMed, Google Scholar and in references included in previous reports, and summarized relevant clinical data. RESULTS: A 63-year-old man with a history of aortic valve replacement developed persistent fever and monoarthritis. Transesophageal echocardiography showed perivalvular abscess. He died during surgery. Blood and valve cultures were negative. Legionella spp. was demonstrated with 16S-rRNA PCR from the resected material. Twenty cases of Legionella endocarditis have been reported. Harboring a prosthetic valve was the main risk factor. Prognosis was favorable, both for patients treated with or without surgical valve replacement. Overall mortality was <10%. CONCLUSIONS: Legionella is an infrequent cause of endocarditis. It frequently requires surgical treatment. Prognosis is good. Molecular techniques are likely to become the gold standard for diagnosis.
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Wnt ligands are important regulators of skeletal homeostasis. Wnt10B tends to stimulate the differentiation of common mesenchymal precursors toward the osteoblastic lineage, while inhibiting adipocytic differentiation. Hence, we decided to explore the association of WNT10B allelic variants with bone mineral density and osteoporotic fractures. A set of tag SNPs capturing most common variations of the WNT10B gene was genotyped in 1438 Caucasian postmenopausal women, including 146 with vertebral fractures and 432 with hip fractures. We found no association between single SNPs and spine or hip bone mineral density (BMD). In the multilocus analysis, some haplotypes showed a slight association with spine BMD (P = 0.03), but it was not significant after multiple-test correction. There was no association between genotype and vertebral or hip fractures. Transcripts of WNT10B and other Wnt ligands were detected in human bone samples by real-time PCR. However, there was no relationship between genotype and RNA abundance. Thus, WNT10B is expressed in the bone microenvironment and may be an important regulator of osteoblastogenesis, but we have not found evidence for a robust association of common WNT10B gene allelic variants with either BMD or fractures in postmenopausal women.
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Densidad Ósea/fisiología , Fracturas Espontáneas/genética , Osteoporosis Posmenopáusica/genética , Polimorfismo de Nucleótido Simple , Posmenopausia/genética , Proteínas Proto-Oncogénicas/genética , Proteínas Wnt/genética , Anciano , Huesos/diagnóstico por imagen , Huesos/metabolismo , Femenino , Fracturas Espontáneas/etiología , Predisposición Genética a la Enfermedad , Fracturas de Cadera/etiología , Fracturas de Cadera/genética , Fracturas de Cadera/metabolismo , Humanos , Desequilibrio de Ligamiento , Persona de Mediana Edad , Osteoporosis Posmenopáusica/complicaciones , Radiografía , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/genética , Fracturas de la Columna Vertebral/metabolismoRESUMEN
Methotrexate is one of the most widely used drugs in rheumatology due to its high efficacy-to-toxicity. However, patients treated with this drug are sometimes elderly, which increases toxicity risks, as well as mistakes in taking the medication. The case is presented of an 87 year-old patient, on multiple medications, with a history of cognitive impairment and low social support, who suffered acute methotrexate toxicity. A description is also presented on the characteristics of the toxicity cases due this drug admitted to this hospital in the last 7 years.
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Antirreumáticos/envenenamiento , Metotrexato/envenenamiento , Anciano de 80 o más Años , Femenino , Humanos , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
BackgroundLegionella is a well known but infrequent cause of bacterial endocarditis.MethodsWe report a case of endocarditis caused by Legionella spp. We reviewed previously reported cases in PubMed, Google Scholar and in references included in previous reports, and summarized relevant clinical data.ResultsA 63-year-old man with a history of aortic valve replacement developed persistent fever and monoarthritis. Transesophageal echocardiography showed perivalvular abscess. He died during surgery. Blood and valve cultures were negative. Legionella spp. was demonstrated with 16S-rRNA PCR from the resected material. Twenty cases of Legionella endocarditis have been reported. Harboring a prosthetic valve was the main risk factor. Prognosis was favorable, both for patients treated with or without surgical valve replacement. Overall mortality was <10%.ConclusionsLegionella is an infrequent cause of endocarditis. It frequently requires surgical treatment. Prognosis is good. Molecular techniques are likely to become the gold standard for diagnosis.
IntroducciónLegionella es una causa bien conocida, aunque infrecuente, de endocarditis bacteriana.MétodosA continuación, presentamos un caso de endocarditis por Legionella spp. Hemos revisado los casos publicados hasta la fecha en PubMed, Google Scholar y otras referencias incluidas en las comunicaciones previas, y resumimos aquí los datos clínicos relevantes. Un varón de 63 años con historia de recambio valvular aórtico desarrolló fiebre y monoartritis por lo que se realizó un ecocardiograma transesofágico que demostró un absceso perivalvular. Se decidió tratamiento quirúrgico, y el paciente falleció durante la cirugía. Los cultivos tanto de sangre como valvulares fueron negativos. El análisis mediante 16S rRNA PCR del material valvular resecado durante la cirugía demostró Legionella spp. Se han publicado un total de veinte casos de endocarditis por Legionella en la literatura médica. El principal factor de riesgo observado fue la presencia de una válvula protésica. El pronóstico fue bueno tanto para los pacientes tratados de manera conservadora como para aquellos sometidos a recambio valvular quirúrgico. La mortalidad global fue <10%.ConclusionesLegionella es una causa infrecuente de endocarditis. Generalmente requiere tratamiento quirúrgico. El pronóstico es bueno. Las técnicas moleculares podrían convertirse en el método de referencia para su diagnóstico.
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Humanos , Masculino , Adulto , Ciencias de la Salud , Endocarditis Bacteriana , Legionella , Cultivo de Sangre , Microbiología , Enfermedades Transmisibles , Estudios de Casos y ControlesRESUMEN
During a 13-month period, 513 patients who were scheduled to undergo cardiac surgery were prospectively observed for surgical site infection during hospitalization after surgery and for 1 month after hospital discharge. Fifty-three patients showed evidence of surgical site infection (during hospitalization for 31 patients and after discharge for 22). Multivariate analysis identified that risk factors for surgical site infection differed between infections that occurred during hospitalization and those that occurred after discharge.
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Procedimientos Quirúrgicos Cardíacos/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Anciano , Femenino , Hospitalización , Hospitales Comunitarios , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , España/epidemiología , Infección de la Herida Quirúrgica/etiologíaRESUMEN
Se presenta un estudio observacional retrospectivo de todos los pacientes mayores 90 ingresados en un Servicio de Medicina Interna durante el año 2017, siendo seguidos durante un año para recabar los datos de mortalidad. Se incluyeron 932 pacientes, con una media de edad de 93,1 años (67,6% mujeres). La mediana de la estancia resultó de 7 días. Un 21,7% fallecieron durante el ingreso hospitalario. El porcentaje de reingresos en los primeros 30 días tras el alta fue del 8,4% y la mortalidad al año fue del 55,3%. Los pacientes nonagenarios representan un alto porcentaje de los ingresos en un Servicio de Medicina Interna; sin embargo, su estancia hospitalaria fue similar a la del resto de los pacientes ingresados y el número de reingresos precoces fue bajo. Sin embargo, su mortalidad al año fue elevada, especialmente durante el primer mes tras el alta. (AU)
Retrospective observational study of 90 years patients or older who were admitted to an Internal Medicine Service during 2017. Also followed up for one year after going home to collect mortality data. 932 patients were included, with a mean age of 93.1 years (67.6% women). The median stay was 7 days. In-hospital mortality was 21.7%. Readmissions in the first 30 days after discharge was 8.4% and mortality at one year was 55.3%. Nonagenarian represent a high percentage of patients in an Internal Medicine Service. The hospital stay was similar to other patients and the number of early readmissions was low. However, the mortality at first year was high, especially during the first month after discharge. (AU)
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Humanos , Anciano de 80 o más Años , Anciano de 80 o más Años , Hospitalización , Medicina Interna , Mortalidad , ComorbilidadRESUMEN
STUDY OBJECTIVES: To assess the incidence and risk factors for nosocomial infection after lung surgery. DESIGN: Prospective cohort study. SETTING: Service of thoracic surgery of an acute-care teaching hospital in Santander, Spain. PATIENTS: Between June 1, 1999, and January 31, 2001, all consecutive patients undergoing lung surgery were prospectively followed up for 1 month after discharge from the hospital to assess the development of nosocomial infection, the primary outcome of the study. INTERVENTIONS: During the hospitalization period, patients were visited on a daily basis. Postdischarge surveillance was based on visits to the surgeon. MEASUREMENTS AND RESULTS: We studied 295 patients (84% men; mean age, 60.9 years), 89% of whom underwent resection operations. Ninety episodes of nosocomial infection were diagnosed in 76 patients, including pneumonia (n = 10), lower respiratory tract infection (n = 47), wound infection (n = 16; one third were detected after hospital discharge), urinary tract infection (n = 9), and bacteremia (n = 8; three fourths were catheter-related bacteremia). Twenty patients had severe infections (pneumonia or empyema), with a mortality rate of 60%. COPD (adjusted odds ratio [OR], 2.70; 95% confidence interval [CI], 1.52 to 4.84), duration of surgery with an increased risk for each additional minute (Mantel-Haenzel chi(2) test for trend, p = 0.037), and ICU admission (OR, 3.69; 95% CI, 1.94 to 7.06) were independent risk factors for nosocomial infection. The use of an epidural catheter was a protective factor (OR, 0.45; 95% CI, 0.22 to 0.95). There were no differences according to the use of amoxicillin/clavulanate or cefotaxime for surgical prophylaxis. CONCLUSIONS: Nosocomial infections are common after lung surgery. One third of wound infections were detected after hospital discharge. The profile of a high-risk patient includes COPD as underlying disease, prolonged operative time, and postoperative ICU admission.
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Infección Hospitalaria/epidemiología , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Pulmonares/efectos adversos , Infecciones Bacterianas/clasificación , Infecciones Bacterianas/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neumonía/epidemiología , Procedimientos Quirúrgicos Pulmonares/mortalidad , Infecciones del Sistema Respiratorio/epidemiología , Factores de Riesgo , España , Infección de la Herida Quirúrgica/epidemiologíaRESUMEN
Castleman's disease is a rare disorder characterized by two distinct entities with similar histology but different time course and therapeutic response. Multicentric plasma cell variant is highly associated with infection by human herpesvirus 8 (HHV-8), but the pathogenesis of the hyaline vascular variant is currently unknown. We report a pregnant patient who develops a localized axillary hyaline-type Castleman's disease in which HHV-8 DNA sequences were detected in the lymph node lesions by nested PCR. In addition, the PCR multiplex also showed positivity for EBV. Immunohistochemical studies confirmed the presence of both viruses. Our results provide the first evidence of the presence of HHV-8 and EBV sequences in localized Castleman's disease, suggesting a possible role of the association of these herpes virus in the pathogenesis of this type of disorder. This case highlights that searching for HHV-8 and EBV sequences in cases of localized Castleman's disease is strongly advised.
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Enfermedad de Castleman/virología , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Herpesviridae/complicaciones , Herpesvirus Humano 4/aislamiento & purificación , Herpesvirus Humano 8/aislamiento & purificación , Complicaciones Infecciosas del Embarazo/virología , Adulto , Anticuerpos Antivirales/sangre , Axila , Biopsia , Enfermedad de Castleman/inmunología , Enfermedad de Castleman/patología , Enfermedad de Castleman/cirugía , ADN Viral/análisis , Infecciones por Virus de Epstein-Barr/inmunología , Femenino , Infecciones por Herpesviridae/inmunología , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/inmunología , Herpesvirus Humano 8/genética , Herpesvirus Humano 8/inmunología , Humanos , Ganglios Linfáticos/patología , Ganglios Linfáticos/virología , Neovascularización Patológica/etiología , Neovascularización Patológica/fisiopatología , Reacción en Cadena de la Polimerasa , Embarazo , Complicaciones Infecciosas del Embarazo/inmunología , Complicaciones Infecciosas del Embarazo/patología , Complicaciones Infecciosas del Embarazo/cirugíaRESUMEN
OBJECTIVE: The aims of the study were to analyze whether there is an association between serum PTH and the prevalence of vertebral fractures and its possible dependence on vitamin D status, and to assess the influence of serum 25-hydroxyvitamin D (25OHD) in the relationship between PTH and bone mineral density (BMD) or bone turnover markers (BTMs). DESIGN, PARTICIPANTS, AND SETTING: A total of 820 postmenopausal women were recruited after excluding those with any known condition that could influence serum PTH levels, except for a possible low serum 25OHD. Serum PTH and 25OHD concentrations, as well as vertebral fracture prevalence, BMD, and BTM (CTX and PINP) values were recorded. Serum PTH levels were divided into tertiles, and women were grouped into those in the highest tertile (>58 pg/ml) and those below. Serum 25OHD levels were stratified in 3 categories (<20, 20-30, and >30 ng/ml). RESULTS: Vertebral fracture prevalence was greater in women with PTH above 58 pg/ml (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.04-2.84). After stratifying by 25OHD, this difference was only significant in women below 20 ng/ml (OR, 2.00; 95% CI, 1.02-3.87), those with 25OHD between 20 and 30 ng/ml showing a trend toward this (OR, 1.99; 95% CI, 0.92-4.36). Differences in BMD or BTM between women above and below 58 pg/ml of PTH were also observed only in those below 20 ng/ml. CONCLUSION: Elevated PTH levels are associated with increased prevalence of vertebral fractures, low bone mass, or higher BTM only in the presence of hypovitaminosis D. An adequate nutritional status in the vitamin appears to protect the bone from the deleterious effect of a high PTH.
Asunto(s)
Biomarcadores/sangre , Densidad Ósea/fisiología , Remodelación Ósea/fisiología , Hormona Paratiroidea/sangre , Posmenopausia/sangre , Fracturas de la Columna Vertebral/sangre , Vitamina D/sangre , Anciano , Biomarcadores/metabolismo , Calcio/sangre , Femenino , Humanos , Persona de Mediana Edad , Estado Nutricional , Posmenopausia/metabolismo , Prevalencia , Factores de Riesgo , Fracturas de la Columna Vertebral/epidemiología , Fracturas de la Columna Vertebral/etiología , Columna Vertebral/metabolismo , Columna Vertebral/patologíaRESUMEN
BACKGROUND AND OBJECTIVE: Age seems to modify the relationship between hypothyroidism and cardiovascular disease (CVD). Although hypothyroidism in very elderly subjects has been associated with longevity, subclinical hypothyroidism in people ≤ 65 years seems to be related with an increased cardiovascular risk (CVR). The aim of this study was to determine the explanatory power of plasmatic TSH (pTSH) for the CVD, in different strata determined by age (≤ 55, 56-74, ≥ 75 years), sex and CVR factors. PATIENTS AND METHODS: Six hundred and sixty-four men and women were differentiated into 18 strata and their explanatory models were developed using the multiple linear regression analysis. The dependent variable is the abdominal aortic calcification (AAC) according to the AAC-24 scale. The independent variables are: pTSH, age, smoking, BMI, SBP, DBP, fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol and C-reactive protein. RESULTS: Age is the main explanatory factor of AAC. The highest explanatory value of the ß-standardized coefficient of the pTSH is observed in males ≤ 55 years (ß=0.235, P=.043) and in females ≥ 75 years (ß=0.405, P=.042). With increasing age, the prediction power improves in women and decreases in men. In men ≥ 75 years there is a negative correlation between pTSH and AAC (rho-Spearman=-0.213, P=.049). CONCLUSIONS: A positive association is observed between pTSH and CVD in males ≤ 55 years and in women ≥ 75 years. The combination of multiple regression and the stratified analysis shows the complex influence of age in the relation between both variables.
Asunto(s)
Enfermedades Cardiovasculares/sangre , Tirotropina/sangre , Edad de Inicio , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Aneurisma de la Aorta Abdominal/epidemiología , Proteína C-Reactiva/análisis , Calcinosis/epidemiología , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Estudios Transversales , Dislipidemias/epidemiología , Femenino , Humanos , Hiperglucemia/epidemiología , Hipertensión/epidemiología , Hipotiroidismo/sangre , Hipotiroidismo/epidemiología , Inflamación/sangre , Inflamación/epidemiología , Modelos Lineales , Masculino , Persona de Mediana Edad , Modelos Cardiovasculares , Osteoporosis/sangre , Osteoporosis/epidemiología , Posmenopausia/sangre , Factores de Riesgo , Fumar/epidemiología , España/epidemiologíaRESUMEN
OBJECTIVE: Our objective was to know the extent to which a fall in bone turnover markers is influenced by serum 25-hydroxyvitamin D (25OHD) levels in patients on alendronate (ALN) treatment. DESIGN, PARTICIPANTS, AND SETTING: A total of 140 postmenopausal osteoporotic women were randomized to receive either ALN or ALN plus 25OHD(3) (ALN+VitD) over a 3-month period. Serum 25OHD, PTH, C-terminal telopeptide of type I collagen (CTX), and amino-terminal propeptide of type I collagen (P1NP) were measured at baseline and at the end of the 3 months. RESULTS: 25OHD rose four times above baseline levels in the ALN+VitD group, whereas no changes were seen in the ALN group. Administering ALN resulted in a significant decline in both serum CTX (53 ± 24%) and P1NP (46 ± 19%). After ALN+VitD, the fall in CTX amounted to 61 ± 20% (P = 0.06 compared with ALN) and P1NP to 50 ± 23% (P = 0.35). When patients were divided into those below and above 20 ng/ml of baseline serum 25OHD, in those below, CTX decreased by 48 ± 26% in the ALN group and by 61 ± 17% in the ALN+VitD group (P = 0.015). For P1NP, the corresponding figures were 43 ± 20 and 50 ± 23% (P = 0.2). In patients above 20 ng/ml, no differences were seen regarding CTX (58 ± 21% decrease in the ALN group and 60 ± 23% in the ALN+VitD group; P = 0.7) or P1NP (49 ± 18 and 50 ± 20%; P = 0.9). CONCLUSIONS: Administration of 25OHD(3) is not an indispensable requirement for bisphosphonates to develop their bone antiresorptive effect. In fact, in patients with vitamin D sufficiency, no benefit is observed when the vitamin is added. However, in patients with vitamin D deficiency, an approximately 25% greater fall in the bone resorption marker CTX is seen with its administration.