Kaposi sarcoma-associated herpesvirus complement control protein (KCP) and glycoprotein K8.1 are not required for viral infection in vitro or in vivo.

Kaposi sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus-8, is the causal agent of Kaposi sarcoma, a cancer that appears as tumors on the skin or mucosal surfaces, as well as primary effusion lymphoma and KSHV-associated multicentric Castleman disease, which are B-cell lymphoproliferative disorders. Effective prophylactic and therapeutic strategies against KSHV infection and its associated diseases are needed. To develop these strategies, it is crucial to identify and target viral glycoproteins involved in KSHV infection of host cells. Multiple KSHV glycoproteins expressed on the viral envelope are thought to play a pivotal role in viral infection, but the infection mechanisms involving these glycoproteins remain largely unknown. We investigated the role of two KSHV envelope glycoproteins, KSHV complement control protein (KCP) and K8.1, in viral infection in various cell types in vitro and in vivo. Using our newly generated anti-KCP antibodies, previously characterized anti-K8.1 antibodies, and recombinant mutant KSHV viruses lacking KCP, K8.1, or both, we demonstrated the presence of KCP and K8.1 on the surface of both virions and KSHV-infected cells. We showed that KSHV lacking KCP and/or K8.1 remained infectious in KSHV-susceptible cell lines, including epithelial, endothelial, and fibroblast, when compared to wild-type recombinant KSHV. We also provide the first evidence that KSHV lacking K8.1 or both KCP and K8.1 can infect human B cells in vivo in a humanized mouse model. Thus, these results suggest that neither KCP nor K8.1 is required for KSHV infection of various host cell types and that these glycoproteins do not determine KSHV cell tropism. IMPORTANCE: Kaposi sarcoma-associated herpesvirus (KSHV) is an oncogenic human gamma-herpesvirus associated with the endothelial malignancy Kaposi sarcoma and the lymphoproliferative disorders primary effusion lymphoma and multicentric Castleman disease. Determining how KSHV glycoproteins such as complement control protein (KCP) and K8.1 contribute to the establishment, persistence, and transmission of viral infection will be key for developing effective anti-viral vaccines and therapies to prevent and treat KSHV infection and KSHV-associated diseases. Using newly generated anti-KCP antibodies, previously characterized anti-K8.1 antibodies, and recombinant mutant KSHV viruses lacking KCP and/or K8.1, we show that KCP and K8.1 can be found on the surface of both virions and KSHV-infected cells. Furthermore, we show that KSHV lacking KCP and/or K8.1 remains infectious to diverse cell types susceptible to KSHV in vitro and to human B cells in vivo in a humanized mouse model, thus providing evidence that these viral glycoproteins are not required for KSHV infection.

[Use of physical restraints in the elderly in an emergency department. Analysis of clinical, environmental and health care team organization factors associated with decision making]. / Uso de sujeciones físicas en ancianos atendidos en un servicio de urgencias. Análisis de los factores clínicos, del entorno y de la organización del equipo sanitario asociados en la toma de decisiones.

OBJETIVE: To determine the influence of different factors involved in the decision to apply physical restraints (PR) in the management the elderly people with conduct disorders in an emergency department (ED) METHODS: A prospective observational study was conducted in the ED of the Hospital Universitario Severo Ochoa (Leganés, Madrid). We included 125 elderly people with disruptive behaviors and collected clinical, patient handling, organizational and environmental variables. Individuals who had undergone PR were analyzed to learn what factors were related to the final decision to restrain. RESULTS: 32.8% of the participants underwent PR. The aspects that most influenced the decision to restrain were those related to the organization and environment: specific staff training decreased the probability of restraint by 50% (P<.05) and good support from the whole team reduced the risk of using SF by up to 75% (P<.0005). Related patient handling factors such as verbal restraint, pain relief, family accompaniment and early mobilization significantly reduced the use of PR (P<.05). The only patient-dependent clinical aspect that increased the risk of SF was male sex (P<.05). Other factors unrelated to the probability of applying PR were, among others, nurse-patient ratio, type of behavior, age, or functional/cognitive status. CONCLUSIONS: Exclusively clinical factors of the patient had little influence on the decision to restrain the elderly in an ED. However, environmental, organizational, and behavioral handling variables could favor more respectful alternatives and thus reduce the use of PR in the elderly with disruptive behaviors in the ED.

Targeting HER2/HER3 co-mutations in metastatic breast cancer: Case reports of exceptional responders to trastuzumab and pertuzumab therapy.

BACKGROUND: Overexpression of HER2 plays an important role in cancer progression and is the target of multiple therapies in HER2-positive breast cancer. Recent studies have also highlighted the presence of activating mutations in HER2, and HER3 that are predicted to enhance HER2 downstream pathway activation in a HER2-dependent manner. METHODS: In this report, we present two exceptional responses in hormone receptor-positive, HER2-nonamplified, HER2/HER3 co-mutated metastatic breast cancer patients who were treated with the anti-HER2-directed monoclonal antibodies, trastuzumab and pertuzumab. RESULTS: Both patients acheived exceptional responses to treatment, suggesting that combined trastuzumab, pertuzumab, and endocrine therapy could be a highly effective therapy for these patients and our observations could help prioritize trastuzumab deruxtecan as an early therapeutic choice for patients whose cancers have activating mutations in HER2.

Association between occupational exposure and chronic obstructive pulmonary disease and respiratory symptoms in the Spanish population.

INTRODUCTION: The aim of this study was to analyze the impact of occupational exposure on chronic obstructive pulmonary disease (COPD) and respiratory symptoms in the general Spanish population. METHODS: This was a study nested in the Spanish EPISCAN II cross-sectional epidemiological study that included participants who had completed a structured questionnaire on their occupational history, a questionnaire on respiratory symptoms, and forced spirometry. The data were analyzed using Chi-square and Student's t tests and adjusted models of multiple linear regression and logistic regression. RESULTS: We studied 7502 subjects, 51.1% women, with a mean age of 60±11 years. Overall, 53.2% reported some respiratory symptoms, 7.9% had respiratory symptoms during their work activity, 54.2% were or had been smokers, and 11.3% (851 subjects) met COPD criteria on spirometry. A total of 3056 subjects (40.7%) reported exposure to vapors, gases, dust or fumes (VGDF); occupational exposure to VGDF was independently associated with the presence of COPD (OR 1.22, 95% CI: 1.03-1.44), respiratory symptoms (OR 1.45, 95%: CI 1.30-1.61), and respiratory symptoms at work (OR 4.69, 95% CI: 3.82-5.77), with a population attributable fraction for COPD of 8.2%. CONCLUSIONS: Occupational exposure is associated with a higher risk of COPD and respiratory symptoms in the Spanish population. These results highlight the need to follow strict prevention measures to protect the respiratory health of workers.

Effectiveness of Treatment Approaches in COVID-19 Pneumonia: A Comparative Evaluation between a Specialized Center and Conventional Hospitals.

BACKGROUND: The early stages of the COVID-19 pandemic overwhelmed general hospitals in Spain. In response, a dedicated hospital for COVID-19 care, the Hospital de Emergencias Enfermera Isabel Zendal (HEEIZ), was established. This study aimed to compare clinical outcomes of COVID-19 patients treated at the specialized HEEIZ with those at conventional general hospitals (CGHs) in Madrid, Spain. METHODS: The study was a prospective, observational cohort study including COVID-19 patients admitted to the HEEIZ and 14 CGHs (December 2020 to August 2021). Patients were assigned based on hospital preference. Clinical data were collected and analyzed using multivariate regression to assess primary and secondary outcomes, including hospital mortality, need of invasive mechanical ventilation (IMV), and pharmacological treatments. RESULTS: The HEEIZ cohort (n = 2997) was younger and had lower Charlson comorbidity scores than the CGH cohort (n = 1526). Adjusted HEEIZ hospital mortality was not significantly higher compared with CGHs (OR: 1.274; 95% CI: 0.781-2.079; p = 0.332). CONCLUSIONS: During the study period, patients admitted to the HEEIZ showed no significant differences in clinical outcomes, compared with patients admitted at CGHs. These results might support the use of specialized centers in managing pandemic surges, allowing CGHs to handle other needs.

Decreased Expression of EC-SOD and Fibulin-5 in Alveolar Walls of Lungs From COPD Patients

Introduction: The aim of this study is to analyze the expression of the main oxidant scavenger superoxide dismutase (EC-SOD), its main binding protein Fibulin-5 and several oxidative and nitrosative-derived products in the lung of COPD patients and controls.Materials and methods: Lung tissue samples from 19 COPD patients and 20 control subjects were analyzed. The architecture of elastic fibres was assessed by light and electron microscope histochemical techniques, and levels of EC-SOD and fibulin-5 were analyzed by immunohistochemistry and RT-PCR. The impact of oxidative stress on the extracellular matrix was estimated by immunolocalization of 4-hydroxynonenal (4-HNE), malondialdehyde (MDA) and 3-nitrotyrosine (3-NYT) adducts.Results: Alveolar walls of COPD patients exhibited abnormal accumulations of collapsing elastic fibres, showing a pierced pattern in the amorphous component. The semiquantitative analysis revealed that COPD patients have a significantly reduced expression of both EC-SOD and fibulin-5 (0.59±0.64 and 0.62±0.61, respectively) in alveolar, bronchiolar and arteriolar walls compared to control subjects (1.39±0.63 and 1.55±0.52, respectively, p<0.05). No significant changes in mRNA levels of these proteins were observed between groups. Among the oxidation markers, malondialdehyde was the best in distinguishing COPD patients.Conclusions: COPD patients show a reduced expression of EC-SOD and fibulin-5 in the lung interstitium. Paralleling the reduction of EC-SOD levels, the decrease of fibulin-5 expression in COPD lungs supports the hypothesis of an impaired pulmonary antioxidant response in COPD patients. (AU)

Recomendaciones para el manejo de la hiperpotasemia en urgencias / Recommendations for the management of hyperkalemia in the emergency department

La hiperpotasemia es un trastorno electrolítico frecuente en los servicios de urgencias y un manejo adecuado impacta en el pronóstico de los pacientes. Este requiere de la integración de datos clínicos y analíticos sobre el estado de la función renal, la hidratación, el equilibrio ácido-base y la afectación cardiaca. Además, es necesaria una precisa toma de decisiones sobre la corrección de la concentración de potasio en el tiempo indicado para cada caso. Por estos mo- tivos la SEMES (Sociedad Española de Medicina de Urgencias y Emergencias), la SEC (Sociedad Española de Cardiología) y la SEN (Sociedad Española de Nefrología) unen esfuerzos en consensuar definiciones y tratamientos que podrían mejorar el abordaje de estos pacientes en los servicios de urgencias hospitalarios. El calcio intravenoso, la insulina con glucosa y el salbutamol siguen siendo los tratamientos que se emplean en la hiperpotasemia aguda. Los diuréticos de asa y tiazídicos también pueden ayudar en pacientes no depleccionados, y la hemodiálisis puede ser necesaria en hiperpotasemias graves en el contexto de insuficiencia renal. Los efectos secundarios y la baja tolerabilidad de las resinas de intercambio iónico están haciendo que caigan en desuso mientras que los nuevos intercambiadores catiónicos gastrointestinales van ganando su espacio e incluso podrían tener algún valor en el tratamiento agudo. Es fundamental el ajuste del tratamiento evitando retirar fármacos que, a pesar de favorecer la hiperpotasemia, mejoren el pronóstico a largo plazo, por lo que es imperativo buscar alternativas válidas para cada grupo de pacientes, asegurando después un estrecho seguimiento. (AU)

Hyperkalemia, a common electrolyte disorder, is seen often in emergency departments. Patient outcomes are impacted by proper management, which requires consideration of both clinical and laboratory findings in relation to kidney function, hydration, the acid–base balance, and heart involvement. Delicate decisions about the timing of potassium level correction must be tailored in each case. For these reasons the Spanish Society of Emergency Medicine (SEMES), the Spanish Society of Cardiology (SEC), and the Spanish Society of Nephrology (SEN) joined forces to come to a consensus on defining the problem and recommending treatments that improve hospital emergency department management of hyperkalemia. Intravenous calcium, insulin and glucose, and salbutamol continue to be used to treat acute hyperkalemia. Either loop or thiazide diuretics can help patients if volume is not depleted, and dialysis may be necessary if there is kidney failure. Ion-exchange resins are falling into disuse because of adverse effects and poor tolerance, whereas novel gastrointestinal cation-exchange resins are gaining ground and may even be of some use in managing acute cases. It is essential to adjust treatment rather than discontinue medications that, even if they favor the development of hyperkalemia, will improve a patient’s long-term prognosis. Valid alternative treatment approaches must therefore be sought for each patient group, and close follow-up is imperative. (AU)

Composición química de la miel de abeja y su relación con los beneficios a la salud

RESUMEN En la actualidad existe un incremento en la tendencia al consumo de alimentos saludables. Uno de ellos es la miel de abeja, reconocida desde la antigüedad por sus propiedades medicinales. Resulta importante profundizar en la información relativa a la composición química de la miel y cómo la misma influye en sus propiedades biológicas. Para ello se realizó esta revisión, que ofrece información y análisis de las características fisicoquímicas de la miel, sus componentes bioactivos y los mecanismos de acción. Fueron utilizados valores de los estándares de calidad y de otros componentes, como vitaminas, minerales, enzimas, ácidos orgánicos, proteínas, flavonoides y ácidos fenólicos con alta actividad antioxidante. Se resumen aspectos principales de las características funcionales de la miel, que le aportan su potencial biológico, energético, antioxidante, antiséptico y modulador de la respuesta inmune, para la acción contra determinadas enfermedades y, fundamentalmente, en la actividad preventiva. Elementos de esta naturaleza brindan información que puede ser utilizada en la promoción de una buena salud y en el desarrollo de nuevas investigaciones.

ABSTRACT Currently there is an increase in the tendency of the healthy food consumption. One of them is bee honey, recognized since ancient times for its medicinal properties. It is important to deepen in information regarding to chemical composition of honey and how it influences on its biological properties. For that was carried out this review that offers information and analyzes physicochemical characteristics of bee honey, its bioactive components and action mechanisms. Values of quality standards and of other components, as vitamins, minerals, enzymes, organic acids, proteins, flavonoids and phenolic acids with high antioxidant activity were used. Main aspects of the honey functional characteristics are summarized. They give it their biological, energetic, antioxidant, antiseptic and immune response modulating potential for the action against certain diseases and, mainly, in the preventive activity. Elements of this nature provide information that can be used in the promotion of good health and in the development of new research.

Clinical and laboratory characteristics of Brazilian versus non-Brazilian primary antiphospholipid syndrome patients in AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) clinical database and repository

Abstract Background: Antiphospholipid syndrome (APS) is characterized by episodes of thrombosis, obstetric morbidity or both, associated with persistently positive antiphospholipid antibodies (aPL). Studying the profile of a rare disease in an admixed population is important as it can provide new insights for understanding an autoimmune disease. In this sense of miscegenation, Brazil is characterized by one of the most heterogeneous populations in the world, which is the result of five centuries of interethnic crosses of people from three continents. The objective of this study was to compare the clinical and laboratory characteristics of Brazilian vs. non-Brazilian primary antiphospholipid syndrome (PAPS) patients. Methods: We classified PAPS patients into 2 groups: Brazilian PAPS patients (BPAPS) and PAPS patients from other countries (non-BPAPS). They were compared regarding demographic characteristics, criteria and non-criteria APS manifestations, antiphospholipid antibody (aPL) profile, and the adjusted Global Antiphospholipid Syndrome Score (aGAPSS). Results: We included 415 PAPS patients (88 [21%] BPAPS and 327 [79%] non-BPAPS). Brazilian patients were significantly younger, more frequently female, sedentary, obese, non-white, and had a higher frequency of livedo (25% vs. 10%, p < 0.001), cognitive dysfunction (21% vs. 8%, p = 0.001) and seizures (16% vs. 7%, p = 0.007), and a lower frequency of thrombocytopenia (9% vs. 18%, p = 0.037). Additionally, they were more frequently positive for lupus anticoagulant (87.5% vs. 74.6%, p = 0.01), and less frequently positive to anticardiolipin (46.6% vs. 73.7%, p < 0.001) and anti-ß2-glycoprotein-I (13.6% vs. 62.7%, p < 0.001) antibodies. Triple aPL positivity was also less frequent (8% vs. 41.6%, p < 0.001) in Brazilian patients. Median aGAPSS was lower in the Brazilian group (8 vs. 10, p < 0.0001). In the multivariate analysis, BPAPS patients still presented more frequently with livedo, cognitive dysfunction and sedentary lifestyle, and less frequently with thrombocytopenia and triple positivity to aPL. They were also less often white. Conclusions: Our study suggests a specific profile of PAPS in Brazil with higher frequency of selected non-criteria manifestations and lupus anticoagulant positivity. Lupus anticoagulant (not triple positivity) was the major aPL predictor of a classification criteria event.

Aprendiendo con el COVID-19: ¿qué pasa con la anticoagulación? / Learning with COVID-19: what about anticoagulation?

La infección por SARS-CoV-2 (COVID-19) se relaciona con un aumento del riesgo de enfermedad tromboembólica. Algunos autores recomiendan la anticoagulación en dosis terapéuticas de, al menos, los pacientes más graves, práctica no exenta de riesgos, por lo que otros consensos solo recomiendan la profilaxis tromboembólica. La recomendación generalizada en pacientes previamente anticoagulados es el cambio del anticoagulante oral por heparina de bajo peso molecular (HBPM). Presentamos dos pacientes ingresados por COVID-19 sin datos de gravedad, en los que se sustituyó la anticoagulación (acenocumarol en un caso y rivaroxabán en el otro) por HBPM a dosis terapéuticas, presentando ambos sangrados abdominales. Estos sangrados son una complicación infrecuente en pacientes anticoagulados, pero la concurrencia de dos casos en un breve espacio de tiempo en el contexto de la pandemia por COVID-19 nos plantea que aún no se dispone de una evidencia clara sobre la anticoagulación terapéutica en la infección por SARS-CoV-2

Infection caused by SARS-CoV-2 (COVID-19) is associated with an increased risk of thromboembolic disease. Some authors recommend anticoagulation at therapeutic doses for, at least, the most severely ill patients; this practice is not free of risks, which is why only thromboembolic prophylaxis is recommended by other consensuses. In the case of previously anticoagulated patients, changing the oral anticoagulant for a low molecular weight heparin (LMWH) is generally recommended. We present the cases of two patients admitted due to COVID-19, without serious clinical data, in whom anticoagulation (acenocoumarol and rivaroxaban, respectively) was replaced by LMWH at therapeutic doses, both presenting abdominal bleeding. This type of bleeding is an infrequent complication in anticoagulated patients, but the concurrence of two cases in a short period of time in the context of the COVID-19 pandemic leads us to consider that there is not yet any clear evidence on therapeutic anticoagulation in SARS-CoV-2 infection

Recomendaciones y uso de los hipoglucemiantes no insulínicos en los pacientes con insuficiencia cardíaca o eventos cardiovasculares / Recommendations and management of non-insulin hypoglycemic agents in patients with heart failure or cardiovascular events

RESUMEN Tanto la diabetes mellitus como la insuficiencia cardíaca son dos enfermedades que frecuentemente van de la mano. Los resultados de recientes estudios sobre disminución de mortalidad, hospitalización por insuficiencia cardíaca y aparición de eventos cardiovasculares, que han demostrado ciertos hipoglucemiantes no insulínicos, han hecho que cambien las recomendaciones en cuanto al tratamiento de la diabetes mellitus. El objetivo clásico del tratamiento de la diabetes, centrado en la reducción de la hemoglobina glicada para reducir el daño microvascular, aunque siga siendo importante, puede que haya pasado a un segundo plano, ahora que disponemos de fármacos que podrían disminuir también el daño macrovascular.

ABSTRACT Both diabetes mellitus and heart failure often go hand in hand. The results of recent studies on decreased mortality, heart failure hospitalization and the occurrence of cardiovascular events, which have shown certain non-insulin hypoglycemic agents, have brought about changes in the diabetes treatment recommendations. The classic goal of diabetes treatment, focused on reducing glycated hemoglobin to reduce microvascular damage, although still important, may have faded into the background, since we have drugs that could also reduce macrovascular damage.

Association between occupational exposure and chronic obstructive pulmonary disease and respiratory symptoms in the Spanish population

Introduction: The aim of this study was to analyze the impact of occupational exposure on chronic obstructive pulmonary disease (COPD) and respiratory symptoms in the general Spanish population.MethodsThis was a study nested in the Spanish EPISCAN II cross-sectional epidemiological study that included participants who had completed a structured questionnaire on their occupational history, a questionnaire on respiratory symptoms, and forced spirometry. The data were analyzed using Chi-square and Student's t tests and adjusted models of multiple linear regression and logistic regression.ResultsWe studied 7502 subjects, 51.1% women, with a mean age of 60±11 years. Overall, 53.2% reported some respiratory symptoms, 7.9% had respiratory symptoms during their work activity, 54.2% were or had been smokers, and 11.3% (851 subjects) met COPD criteria on spirometry. A total of 3056 subjects (40.7%) reported exposure to vapors, gases, dust or fumes (VGDF); occupational exposure to VGDF was independently associated with the presence of COPD (OR 1.22, 95% CI: 1.03–1.44), respiratory symptoms (OR 1.45, 95%: CI 1.30–1.61), and respiratory symptoms at work (OR 4.69, 95% CI: 3.82–5.77), with a population attributable fraction for COPD of 8.2%.ConclusionsOccupational exposure is associated with a higher risk of COPD and respiratory symptoms in the Spanish population. These results highlight the need to follow strict prevention measures to protect the respiratory health of workers. (AU)

Calidad de vida en la tercera edad desde la Universidad del Adulto Mayor / Quality of life in the elderly from the University of the Elderly

Se realizó una revisión bibliográfica sobre la calidad de vida del adulto mayor en la Universidad de Guantánamo, con el objetivo de valorar el papel de la Cátedra de la Universidad del adulto mayor como vía para elevar la calidad de vida de esta franja poblacional. El envejecimiento poblacional es una realidad social que requiere la búsqueda de alternativas encaminadas a atender las necesidades de los adultos mayores en aras de elevar su calidad de vida; varias son las opciones puestas en práctica por el sectorial de salud en coordinación con otros organismos y organizaciones para tal fin. La Universidad del Adulto Mayor le proporciona a esta franja poblacional una nueva manera de ver la vida y de vivirla(AU)

A literature review on the quality of life of the elderly was conducted at the University of Guantanamo, with the objective of assessing the role of the Chair of the University of the elderly as a way to raise the quality of life of this population. Population aging is a social reality that requires the search for alternatives aimed at meeting the needs of older adults in order to raise their quality of life. There are several options put into practice by the health sector in coordination with other organizations and organizations for this purpose. The University of the Elderly provides this new population with a new way of seeing life and living it(AU)

Exposición a radiación diagnóstica en pacientes con enfermedad de Crohn: estudio retrospectivo en un hospital medio y sus factores predictivos / Ionizing diagnostic radiation exposure in patients with Crohn's disease: a retrospective study in a medium hospital and its predictive factors

Introducción. La exposición a radiación ionizante procedente de pruebas médicas puede ser responsable del 0,5-2% de los cánceres a nivel mundial. Debido al curso crónico en brotes y al comienzo temprano de la enfermedad de Crohn (EC), estos pacientes requieren múltiples exploraciones radiológicas ionizantes. Objetivo. Estimar la cantidad de radiación ionizante que reciben nuestros pacientes con EC así como identificar aquellos factores de riesgo asociados a recibir una dosis de radiación debida a su enfermedad (DEED)>50mSv. Material y métodos. Estudio de cohorte retrospectivo (2001-2014). Población: pacientes con EC. Dosis de riesgo >50mSv. Para el cálculo de dosis efectiva total y DEED se recogieron las exploraciones radiológicas a las que fueron sometidos. Para la identificación de factores predictivos asociados a recibir una DEED > 50mSv se realizó mediante regresión logística uni- y multivariante utilizando la dosis >50mSv como variable dependiente. Resultados. De los 267 pacientes con EC analizados, el 24,6% recibieron una dosis efectiva total >50mSv y el 15,2% una DEED >50mSv. En el análisis multivariante las variables que de forma independiente se asociaron a recibir una DEED >50mSv fueron la cirugía mayor (OR= 2,1; IC95% [1,1-3,8]; p=0,019) y la gravedad (OR=20,1; IC95% [2,7-148,4]; p<0,001). Conclusiones. Los pacientes con EC están más expuestos a recibir una DEED de riesgo, por lo que sería conveniente monitorizar la DE recibida para anticipar nuestra actuación con el fin de evitar llegar a dicha dosis. La ecografía y la entero-RNM son alternativas a considerar en estos casos, aunque su accesibilidad está limitada en algunos centros (AU)

Introduction. It is estimated that diagnostic medical radiation exposure may be responsable for 0.5-2% of cancers worldwide. Because of the relapsing course of Crohn's disease (CD), these patients usually requiere multiple ionizing radiation test. Objective. Stimating the total cumulative effective dose received by our CD patients and identifying the risk factors associated with the exposure to a cumulative effective dose due to the disease (CEED) > 50mSv. Materials and methods. Retrospective cohort study (2001-2014). Population: patients with CD. Risk dose >50mSv. For calculating de cumulative effective dose and the CEED, all the ionizing test done were taken. For identifying predictive factors for receiving a CEDD >50mSv, an univariate and a multivariate logistic regression analyses were performed using a >50mSv dose as dependent variable. Results. Of the 267 patients analyzed the 24.6% of them received a cumulative effective dose > 50mSv and the 15.2% a CEED>50mSv. In the multivariate analysis, the following variables were identified as independent predictors associated with a CEDD >50mSv: major surgery (OR= 2.1; IC95% [1.1-3.8]; p=.019) and severity (OR= 20.6; IC95% [4.5-94.8]; p<.01). Conclusions. Patients with CD are more at risk of receiving risk CEED, so it would be advisable to monitor the cumulative effective dose received to anticipate our intervention in order to avoid reaching that dose. The ultrasounds and abdominal resonance enterography are alternatives in these cases, although their accessibility is limited in some centers (AU)

Respuesta de los autores: Empleo de diuréticos y empagliflozina: ¿contraindicados? / Diuretics and empagliflozin use: authors' reply

No disponible

Bacteriemia por Raoultella planticola en el contexto de una pancreatitis aguda complicada con colangitis aguda / Bacteremia with Raoultella planticola in the setting of acute pancreatitis complicated with acute cholangitis

No disponible

Multimedia. Cirugía bucal. Generalidades / Multimedia. Bucal surgery. Generalities

Constituye un reto sincronizar el proceso docente educativo con el trabajo asistencial en la educación médica superior.La creación de materiales didácticos en formato electrónico permite el desarrollo de proyectos y experiencias innovadoras, que facilita el proceso enseñanza aprendizaje, sin violar los principios bioéticos. El trabajo consiste en un proyecto de Multimedia como medio de enseñanza que facilite al estudiante de Estomatología la información necesaria para el aprendizaje de la Cirugía Bucal. La confección de esta multimedia tuvo como finalidad proporcionar un material educativo didáctico de consulta y de apoyo a la docencia con una metodología de enseñanza más flexible, que le permita al estudiante optimizar el tiempo de que dispone para la formación de las habilidades quirúrgicas, imprescindibles, antes de ejercer las complejas técnicas en el paciente. Se revisaron los programas de esta asignatura y de acuerdo a los objetivos se seleccionaron los temas necesarios, incluyendo algunos que ya el estudiante debe tener vencidos y que no se dispone del tiempo para reafirmarlos, pero son imprescindibles para la base teórico-práctica de la asignatura. Se diseñó una estructura bien organizada metodológicamente escogiendo las formas de enseñanzas y las imágenes adecuadas. Esta estructura se insertó en una plataforma apropiada para su mejor realización y comprensión. La digitalización se hizo mediante escáner o por descarga desde los sitios Web; en otros casos, como sucedió con la mayoría de las imágenes, se fotografiaron imágenes de radiografías u otros gráficos y/o se diseñaron, editaron u optimizaron con herramientas profesionales. Los medios se organizaron y compilaron con la aplicación Crheasoft, para obtener una obra Multimedia auto ejecutable soportada(AU)

It constitutes a challenge to synchronize the teaching educational process with the clinic work in the superior medical education. The creation of didactic materials in electronic format allows the development of projects and innovative experiences that facilitates the teaching-learning process, without violating bioethical principles. The work consists on a Multimedia project as a teaching medium that facilitates the necessary information for the learning of the Buccal Surgery to the Stomatology student. The making of this multimedia had as purpose to provide an educational didactic material of consultation and of support to the teaching with a methodology of a more flexible teaching that allows the student to optimize the time that they dispose for the formation of the surgical indispensable abilities, before exercising the complex technics in a patient. The programs of this subject were revised and according to the objectives the necessary topics were selected, including some that the student should already have conquered and that doesn't have the time to reaffirm them, but are indispensable for the theoretical-practical base of the subject. A very methodologically organized structure was designed choosing the forms of teachings and the appropriate images. This structure was inserted in an appropriate platform for its best realization and understanding. The digitization was done by means of scanner or by downloading from the internet; in other cases, like it happened to most of the images, images of x-rays or other graphics were photographed and/or they were designed, edited or optimized with professional tools. The medium were organized and compiled with the application Crheasoft, to obtain a supported Multimedia autoexecutable(AU)

Frecuencia y manejo de diabetes mellitus y de hiperglucemia en urgencias: Estudio GLUCE-URG / Frequency and management of diabetes and hyperglycemia at emergency departments: the GLUCE-URG Study

Introducción: La hiperglucemia es un hallazgo habitual en los Servicios de Urgencias Hospitalarios así como la atención de pacientes diabéticos, pero existen pocos datos sobre su frecuencia, manejo y repercusión posterior en función de la valoración que se le haya dado en dichos servicios. Objetivos: Determinar la frecuencia de diabetes mellitus y de hiperglucemia en los pacientes que ingresan desde Urgencias. En segundo lugar, describir el manejo en Urgencias de la hiperglucemia, y analizar la influencia que pudiera tener en la evolución y en el manejo del paciente durante su ingreso. Pacientes y métodos: Durante 3 semanas consecutivas se incluyeron todos los pacientes ingresados desde el Servicio de Urgencias del Hospital Universitario Severo Ochoa. La hiperglucemia se definió como 2 determinaciones de glucosa ≥ 180mg/dl, separadas al menos 8 h y en las primeras 48 h de estancia hospitalaria. Resultados: El 36,6% de los pacientes que ingresaron desde el Servicio de Urgencias eran diabéticos, y de ellos el 58% presentaban hiperglucemia precoz y mantenida. Por otro lado, el 27% de los pacientes que ingresaban desde urgencias presentaban hiperglucemia (78,3% de pacientes diabéticos y 21,7% sin diabetes conocida). La hiperglucemia de los pacientes que ya eran diabéticos era significativamente más intensa que la hiperglucemia de los no diabéticos conocidos (p<0,01). La estancia media en planta fue de 8±6,4 días, sin que se observaran diferencias entre los distintos grupos. En urgencias no se solía mencionar la hiperglucemia dentro de la lista de diagnósticos mientras que en el informe de alta desde planta existía mayor probabilidad de que se hiciera referencia a la hiperglucemia en los pacientes con diabetes previa que en las nuevas hiperglucemias (p<0,001, OR 2,5). Conclusiones: La prevalencia de pacientes diabéticos que ingresan desde Urgencias es muy alta. Además, a pesar de que la hiperglucemia es muy frecuente en los pacientes que ingresan desde el Servicio de Urgencias, se tiende a subestimar su importancia. En base a nuestros resultados, creemos que la implantación de medidas que ayuden a aportar mayor visibilidad al diagnóstico de hiperglucemia podrían ayudar en la mejora de la aplicación de los protocolos establecidos desde los Servicios de Urgencias Hospitalarios (AU)

Introduction: Hyperglycemia is a common finding at hospital emergency rooms in diabetic patients, but few data are available on its frequency, management, and subsequent impact based on the assessment made at Emergency rooms. Objectives: To ascertain the frequency of diabetes mellitus and hyperglycemia in patients admitted from Emergency rooms. Second, to describe management of hyperglycemia at Emergency rooms, and to analyze its potential impact on the course and management of patients during admission. Patients and methods: All patients admitted from the Emergency room for three consecutive weeks were enrolled. Hyperglycemia was defined as two blood glucose measurements ≥ 180mg/dl in the first 48hours after admission. Results: 36.6% of patients admitted from the Emergency room were diabetic, and 58% of these had early, sustained hyperglycemia. On the other hand, 27% of patients admitted from the Emergency room had hyperglycemia (78.3% of diabetic patients and 21.7% with no known diabetes). Diabetic patients with hyperglycemia had higher blood glucose levels than non-diabetic patients (p<.01). Average hospital stay was 8±6.4 days, with no differences between the groups. Hyperglycemia is rarely reported as a diagnosis in the emergency rooms discharge report. In standard hospitalization, this diagnosis appears more commonly in patients with known diabetes (OR 2.5 p<.001). Conclusions: Prevalence of diabetic patients admitted from emergency rooms is very high. In addition, although hyperglycemia is very common in patients admitted from emergency rooms, there is a trend to underestimate its significance. Based on our results, we think that implementation of measures to give greater visibility to diagnosis of hyperglycemia could help improve application of established protocols (AU)

Documento de consenso sobre el manejo al alta desde urgencias del paciente diabético / Managing the discharge of diabetic patients from the emergency department: a consensus paper

El 80-90% de los pacientes atendidos en los servicios de urgencias son dados de alta desde los mismos, y por tanto los facultativos de urgencias son los responsables del tratamiento al alta en dichos pacientes. Se estima que la frecuencia de diabetes mellitus en urgencias es de un 30-40% y en muchos casos dicha diabetes está descompensada o con un mal control metabólico previo, por lo que es necesario establecer pautas de tratamiento antidiabético adecuadas de cara al alta que contribuyan a un adecuado control metabólico de dichos pacientes y favorezca un mejor pronóstico a corto plazo tras el alta, así como mantener una continuidad con la atención ambulatoria por parte de otras especialidades y contribuir a una mejoría del pronóstico a largo plazo. El presente documento es por tanto un consenso de expertos de tres sociedades científicas implicadas directamente en la atención del paciente diabético, que pretende facilitar la valoración del tratamiento al alta desde urgencias en cuanto a la diabetes se refiere y su continuidad asistencial ambulatoria (AU)

Eighty to 90% of patients attended in emergency departments are discharged to home. Emergency department physicians are therefore responsible for specifying how these patients are treated afterwards. An estimated 30% to 40% of emergency patients have diabetes mellitus that was often decompensated or poorly controlled prior to the emergency. It is therefore necessary to establish antidiabetic treatment protocols that contribute to adequate metabolic control for these patients in the interest of improving the short-term prognosis after discharge. The protocols should also maintain continuity of outpatient care from other specialists and contribute to improving the long-term prognosis. This consensus paper presents the consensus of experts from 3 medical associations whose members are directly involved with treating patients with diabetes. The aim of the paper is to facilitate the assessment of antidiabetic treatment when the patient is discharged from the emergency department and referred to outpatient care teams (AU)

Registro español de pacientes con déficit de alfa-1 antitripsina: evaluación de la base de datos y análisis de la población incluida / Spanish registry of patients with alpha-1 antitrypsin deficiency: database evaluation and population analysis

Introducción y objetivo: El Registro español de pacientes con déficit de alfa-1 antitripsina (REDAAT) se formó con el objetivo de mejorar el conocimiento sobre del DAAT. En este trabajo se evalúa el registro y se analiza la población de pacientes incluida en él. Métodos: Dispone de una base de datos alojada en la Web: www.redaat.es. Su base de datos recoge información clínica y funcional de individuos portadores de los fenotipos PiSZ, ZZ y variantes raras. Resultados: En la actualidad reúne información sobre 511 individuos procedentes de 103 centros sanitarios, gracias a la colaboración de 124 médicos. De ellos, 348 (74,2%) son homocigotos Pi*ZZ y 100 (19,5%) heterocigotos Pi*SZ. Existe una mayor concentración de casos en hospitales universitarios de tercer nivel. El 81% de los casos tiene enfermedad pulmonar y en menor proporción el DAAT se detectó por cribado familiar o enfermedad hepática. Se dispone de datos de seguimiento en el 45% de los casos, y un 35% recibieron tratamiento sustitutivo con alfa-1 antitripsina. Conclusiones: El REDAAT es una herramienta útil para obtener información de calidad sobre esta enfermedad minoritaria en condiciones de práctica clínica habitual, aunque obtener datos de seguimiento es difícil y no es posible conocer la representatividad de la muestra incluida

Introduction and objective: REDAAT, the Spanish Registry of Patients with Alpha-1 Antitrypsin Deficiency, was set up in order to improve knowledge of this disease. This study is an evaluation of the registry and an analysis of its patient population. Methods: The registry has a database hosted on the website www.redaat.es. It collects clinical and functional data on patients with PiSZ, ZZ phenotypes and other rare variants. Results: Thanks to the collaboration of 124 physicians, the registry currently contains information on 511 individuals from 103 healthcare centers. Of these 511, 348 (74.2%) are Pi*ZZ homozygotes, and 100 (19.5%) are Pi*SZ heterozygotes. More cases are seen in tertiary level hospitals. A total of 81% of the cases have respiratory disease, and a lower proportion of AATD cases were detected by family screening or liver disease. Follow-up data are available for 45% of the cases, and 35% received alpha-1 antitripsin replacement therapy. Conclusions: The REDAAT registry is a useful tool for obtaining quality information about this minority disease in routine clinical practice conditions, although it is difficult to obtain follow-up data, and the representativeness of the sample included cannot be determined