Predicting factors of health-related quality of life in octogenarians: a 3-year follow-up longitudinal study.

PURPOSE: The proportion of very old people is rising, and so, describing their health-related quality of life (HRQoL) is an important point of interest. The aim of this study was to analyse the predictive factors on HRQoL throughout a 3-year follow-up period, in a community-based cohort of octogenarian people. METHODS: From 290 subjects aged 85 and over, sociodemographic and geriatric data, including levels of frailty phenotype assessment, and HRQoL using the EuroQol 5D3L (EQ-5D) instrument were collected. A longitudinal analysis was performed by generalized estimating equations (jointly testing the bivariate effect of variables and its time dependence) and regression mixed models to evaluate the adjusted effect of variables on HRQoL after a 3-year follow-up. RESULTS: In the EQ-5D baseline assessment, the average visual analogue self-rating scale value was 63.82 (SD ± 19.45), the EQ-5D index was 0.67 (0.34) and the most significant issues were pain/discomfort (61.2 %), depression (45.3 %) and mobility (44.6 %). The third year index was 0.55 (0.38). Independent predictive factors of a lower HRQoL identified by the regression mixed models were female gender (marginal effect ME = -0.101; p = 0.003), being pre-frail (ME = -0.142; p = 0.011) or frail (ME = -0.071; p = 0.030), having heart failure (ME = -0.081; p = 0.037) and having a high social risk score (ME = -0.020; p = 0.015). In contrast, higher functional status (ME = 0.050; p < 0.001) and nutritional score (ME = 0.013; p = 0.011) appeared to be predictive factors of an enhanced HRQoL. The adjusted effect of "time of follow-up" had no statistical significance. CONCLUSION: Frail individuals at baseline have a significant lower HRQoL, whereas a higher functional status and nutritional status are independent predicting factors of an enhanced HRQoL after 3 years of follow-up. These findings may encourage clinicians in order to asses HRQoL.

Low expression of ZHX2, but not RCBTB2 or RAN, is associated with poor outcome in multiple myeloma.

RAN, ZHX2 and RCBTB2 (CHC1L) expression was evaluated by quantitative real time reverse transcription polymerase chain reaction in plasma cells from 85 monoclonal gammopathies: 58 symptomatic multiple myeloma (MM) (52 untreated, six relapsed), eight smouldering MM, five monoclonal gammopathy of undetermined significance, four plasma cell leukaemias and 10 myeloid cell lines. ZHX2 was weakly expressed in high-risk/proliferative disease compared to low-risk or indolent disease. High ZHX2 expression was associated with better response and longer survival after high-dose therapy. RCBTB2 expression was weaker in hyperdiploid versus non-hyperdiploid cases while RAN was more expressed in symptomatic MM and cell lines.

Alcohol, vino y salud: mitos y realidades / Alcohol, wine, and health: myths and realitie

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Consultas de viajes internacionales en Palencia / Consultations on international travel in Palencia

Objetivos: estudiar las características de las consultas realizadasen la Unidad de Viajes Internacionales de Palenciadurante el año 2004 y describir el grado de cumplimiento delas recomendaciones preventivas, los efectos adversos referidosdespués de la administración de vacunas y quimioprofilaxisantipalúdica y los problemas de salud que los viajerosrefirieron en su viaje.Material y métodos: estudio observacional descriptivotransversal. Los datos se obtuvieran mediante dos encuestas(personal antes del viaje y telefónica después del viaje) querecogían variables sociodemográficas, características del viaje,estado de salud, vacunaciones previas, recomendacionespreventivas y cumplimiento de éstas, efectos adversos postvacunalesy postquimioprofilaxis antipalúdica, coste del tratamientopreventivo y problemas de salud acontecidos duranteel viaje. Los resultados se expresaron medianteestadística descriptiva y se utilizó el test de Ji Cuadrado parala comparación de variables cualitativas. Se calcularon OddsRatios y sus intervalos de confianza al 95%.Resultados: se atendieron 596 viajeros durante 2004. Seconsiguió contactar telefónicamente con 474 después delviaje (79%). El continente mayoritariamente elegido por losviajeros fue el latinoamericano (41%) y el 60% decidió realizarsu viaje organizado. La vacuna contra tétanos-difteria(50,4%) y la mefloquina (Lariam®) (55,9%), fueron la vacunay el antipalúdico más recomendados, respectivamente. Losefectos secundarios a la toma de antipalúdicos fueron máscomunes con la mefloquina (un 67,8%). El 40,3% de losviajeros tuvo problemas de salud durante el viaje y el 20,3%al regreso del mismo. La diarrea (44,5%) fue el síntoma másfrecuentemente referido durante el viaje debido, en un 25%,a la alimentación.Conclusiones: es necesaria la visita a una Unidad de ViajesInternacionales con tiempo suficiente de antelación a la realizacióndel viaje para la toma de medidas preventivas. Lamayoría de los viajeros siguieron los consejos recomendados,siendo el problema de salud más frecuente la diarrea

Objectives: to study the characteristics of the consultationsmade at the International Travel Unit of Palencia in 2004and to describe the extent of adhesion/compliance to preventiverecommendations, the adverse effects reported afterthe administration of vaccines and antipaludic chemoprophylaxisand the health problems reported by travellersin their journeys.Material and methods: cross-sectional descriptive observationalstudy. Data were obtained by means of two polls (apersonal interview before the trip and a telephone interviewafter the trip) which compiled sociodemographic variables,characteristics of the trip, previous vaccinations, preventiverecommendations and their compliance, post vaccine adverseeffects, antipaludic post chemoprophylaxes, costs of thepreventive treatment and health problems that occurredduring the trip. The results were analysed by descriptive statisticsand the Chi square test for the comparison of variables.Odds Ratios and their interval confidence intervalswere calculated at 95%.Results: 596 travellers were attended in 2004. 474 (79%)were reached on the telephone after the trip. The SouthAmerican continent was chosen by the majority of travellers(41%) and 60% decided for an organised trip. Vaccinationagainst tetanus/diphtheria (50,4%) and mefloquine(Lariam®) (55,9%) were the most recommended vaccine andantipaludic agent, respectively.Side effects secondary to the intake of antipaludic agentswere more common with mefloquine (67,8%). 40,3% ofthe travellers had health problems during their trip and 20,3upon their return. Diarrhoea (44,5%) was the most commonlyreferred health problem during their journey due tothe food they ate in 25% of subjects.Conclusions: people intending to travel should visit the InternationalTravel Unit with sufficient time in advance to takethe necessary precautions and get advice. Most travellersfollowed the recommendations given to them, being diarrhoea the most common problem (AU)

Fibroadenoma of the breast: analysis of associated pathological entities--a different risk marker in different age groups for concurrent breast cancer.

BACKGROUND: Fibroadenoma, one of the most common benign breast lesions, has a characteristic age-specific incidence and is associated with other pathological entities in 50% of cases. The clinical or imaging diagnosis of fibroadenoma may be erroneous, and in some cases is found to be invasive cancer. The clustering of such entities, their correlation with age, and the risk of synchronous breast malignancy are uncertain. OBJECTIVE: To explore the possibility of any significant clustering of fibroadenoma-associated benign breast diseases and to assess the possible risk of concomitant breast cancer. METHODS: We analyzed the pathological results of 147 women undergoing excisional biopsies for fibroadenoma diagnosed pre-operatively either by clinical examination and imaging (n = 17) or by radiology alone (n = 30). The inter-relationships among all entities associated with fibroadenoma were studied by hierarchical cluster analysis. The correlation of the various pathologies with the risk of invasive breast cancer in relation to the patient's age was also evaluated. RESULTS: Fibroadenoma-associated pathologies were found in 48% of the cases: sclerosing adenosis (23%), duct ectasia (17.7%), apocrine metaplasia (15.6%), florid fibrocystic disease (12.9%), duct papillomatosis (11.6%), infiltrating duct carcinoma (5.4%), duct carcinoma in situ (3.4%), and 1 case of lobular carcinoma in situ (0.6%). An orderly internal hierarchy and three significant clusters emerged: a) epithelial apocrine metaplasia, duct ectasia and sclerosing adenosis (similarity coefficients 16.0, 11.0 and 8.0 respectively); b) papillomatosis, florid fibrocystic disease and calcifications (similarity coefficients of 6.0, 4.0 and 2.0 respectively); and c) infiltrating duct carcinoma and duct carcinoma in situ (similarity coefficients of 1.8 and 1.6 respectively). Seven of the eight patients with breast cancer were older than 40 years. CONCLUSIONS: In about half of the cases fibroadenoma was associated with other pathological entities clustered in an orderly hierarchy. The rarity of synchronous breast cancer in the younger age group and its more common association with fibroadenoma in the older age groups dictate a different approach to each. The finding of fibroadenoma in women older than 40 indicates the need for surgical excision.

[Tuberculosis trends in Palencia]. / Evolución de la tuberculosis en Palencia.

OBJECTIVES: To describe the most important epidemiological characteristics and the tendency of the incidence of tuberculosis in Palencia from 1986 to 1999. DESIGN: Descriptive study. SETTING: Palencia province. PATIENTS: 1158 cases of pulmonary tuberculosis and 177 cases of extrapulmonary tuberculosis. MEASUREMENTS AND RESULTS: We reviewed the Obligatory Diseases Declaration and their epidemiological characteristics. We used descriptive statistics, 2 and Student tests, sensibility and positive predictive tests. There were 1158 cases of pulmonary tuberculosis and 177 of other tuberculosis. Tuberculosis was more frequent in men (69.2%). The most affected groups of age were 20-29 years old (20.6%) and 20-49 years old (48.2%). The group of age between 60 and 79 years old reported an incidence of 21.8%. 33 of 100 notified cases of AIDS had extrapulmonary tuberculosis and 18% had pulmonary tuberculosis. CONCLUSIONS: Tuberculosis is an important problem of public health. It's more common in young men and its epidemiological characteristics are similar to AIDS sickness in our environment.

In vivo molecular imaging of met tyrosine kinase growth factor receptor activity in normal organs and breast tumors.

Molecular imaging techniques allow visualization of specific gene products and their physiological processes in living tissues. In this study, we present a new approach for molecular imaging of endogenous tyrosine kinase receptor activity. Met and its ligand hepatocyte growth factor scatter factor (HGF/SF), which mediate mitogenicity, tumorigenicity, and angiogenesis, were used as a model. HGF/SF and Met play a significant role in the pathogenesis and biology of a wide variety of human epithelial cancers and, therefore, may serve as potential targets for cancer prognosis and therapy. We have shown previously that in vitro activation of Met by HGF/SF increases oxygen consumption. In this study, we demonstrate that Met activation in vivo by HGF/SF alters the hemodynamics of normal and malignant Met-expressing tissues. Tumor-bearing BALB/C mice were i.v. injected with HGF/SF and imaged using magnetic resonance imaging (MRI) and Doppler ultrasound. Organs and tumors expressing high levels of Met showed the most substantial alteration in blood oxygenation levels as measured by blood oxygenation level depended (BOLD)-MRI. No significant alteration was observed in tumors or organs that does not express Met. In the liver, which expresses high levels of Met, MRI signal alteration of about 60% was observed. In the kidneys, signal alteration was approximately 30%, and no change was observed in muscles. The extent of MRI signal alteration was also in correlation with HGF/SF doses. Injection of 7 and 170 ng/g body weight resulted in signal alteration of 5% and 30%, respectively, in tumors. Doppler ultrasound measurements demonstrated that these MRI changes are at least partially attributable to altered blood flow. These hemodynamic alterations, measured by MRI and Doppler ultrasound, were used in this study for the molecular imaging of Met activity in vivo. This novel molecular imaging technique may be used for in vivo diagnosis, prognosis, and therapy of Met-expressing tumors.

Evolución de la tuberculosis en Palencia / Tuberculosis evolution in Palencia

Objetivos. Estudiar las características de la enfermedad tuberculosa desde 1986 hasta 1999.Diseño. Estudio descriptivo. Emplazamiento. Provincia de Palencia. Pacientes. Un total de 1.158 casos de tuberculosis pulmonar y 177 casos de tuberculosis extrapulmonar. Mediciones y resultados principales. Las fuentes de datos rastreadas fueron los partes de declaración numérica y nominal notificados al Sistema de Enfermedades de Declaración Obligatoria. El análisis estadístico se realizó con los diferentes parámetros de la estadística descriptiva, los tests estadísticos de 2 y t de Student, tests de sensibilidad y valor predictivo positivo y coeficiente kappa. Se notificaron 1.158 casos de tuberculosis pulmonar y 177 de tuberculosis extrapulmonar desde 1986 hasta 1999. Por sexo, la tuberculosis fue significativamente (p < 0,001) más frecuente en varones (69,2 por ciento). Por grupos de edad, la máxima incidencia se registró entre los 20 y 29 años (20,6 por ciento) y entre los 20 y 49 años (48,2 por ciento). Hubo un aumento de incidencia entre 60 y 79 años (21,8 por ciento de los casos). Treinta y tres de cada 100 casos notificados de sida presentaron tuberculosis diseminada o extrapulmonar y 18, tuberculosis pulmonar. Conclusiones. La tuberculosis es un importante problema de salud pública, más frecuente en el varón joven, circunstancias epidemiológicas coincidentes con la infección VIH en nuestro medio (AU)

Cuida'l: un ensayo clínico que evaluará la eficacia de una intervención en cuidadores de pacientes demenciados / CUIDA'L: a clinical trial to evaluate the efficacy of an intervention among carers of demented patients

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The use of magnetic resonance imaging in the differential diagnosis between starch and fecal peritonitis.

Granulomatous peritonitis, caused by the starch from the surgeons' gloves, is a hypersensitivity reaction that can complicate abdominal surgery and mimic other causes of peritonitis. The diagnosis of this entity is difficult to make, and relies on a high index of suspicion. We suggest the use of magnetic resonance imaging to facilitate the diagnosis of this condition, based on an experimental animal model. 84 rats were subjected to laparotomy, and the abdominal cavity was exposed to either saline solution, talc solution, starch solution or fecal material by creating a cecal perforation. TI-weighted magnetic resonance images, with and without gadolinum enhancement, were taken after 3, 5 and 10 days. The animals were then sacrificed and the abdominal contents were evaluated both macroscopically and microscopically. Both talc and starch caused gross adhesions involving the entire abdominal viscera, and microscopy revealed signs of inflammation and fibrosis. Starch induced reactive granulomas. The adhesions in the cases of fecal peritonitis were confined to the area of the perforation. MR images of the starch peritonitis group was remarkable for a diffuse pathological process with enhancement of the omentum and the peritoneum after gadolinum injection. The MR readings of the fecal peritonitis group showed a localized process with no diffuse enhancement of the peritoneum. The striking differences between the magnetic resonance images of starch and fecal peritonitis in rats suggest that this modality is both sensitive and specific in diagnosing starch peritonitis in a rat model. Early non-invasive diagnosis of these separate entities would ease the establishment of the appropriate treatment. We are currently investigating the use of MRI imaging in suspected starch peritonitis in humans.

Myelodysplastic syndrome: a search for minimal diagnostic criteria.

We have evaluated dyshemopoietic features in bone marrow (BM) samples obtained from healthy people aged over 50 without peripheral blood (PB) cytopenia patients and compared them with MDS patients. Control group displayed BM features of dyserythropoiesis and dysgranulopoiesis in up to 15 and 27% of the considered cell elements (P90) respectively, overlapping in part with MDS patients. Interobserver agreement in dyshemopoietic features was highest for BM blast cell and pathological sideroblast counts. An algorithm based on BM blast cell and pathological sideroblast counts that has been verified on 613 patients from different Spanish centers may be of help to improve reproducibility in Myelodysplastic syndrome (MDS) diagnosis.

[Epidemic outbreak of tularemia in Palencia]. / Brote epidémico de tularemia en Palencia.

BACKGROUND: Tularemia can become a health problem after its recent emergence in Spain. OBJECTIVE: To describe the clinico-epidemiologic characteristics of a tularemia outbreak occurred in Palencia (October 1997 to March 1998). DESIGN: Case-control study. MATERIAL AND METHODS: A clinico-epidemiologic survey was conducted. The Chi square test and the Student "t" test were used and a logistic regression analysis was made. The diagnosis was made by serology (microagglutination or macroagglutination) or culture. RESULTS: There were 151 cases; 74.5% of cases were confirmed or likely. The ulceroglandular was the most common clinical form of the disease (49%) and 23.2% of patients required hospital admission; 93.4% of patients had exposure to hares, and 86.7% of them handled them. Higher risk practices included skinning (adjusted OR: 3.9; 95% CI [1.03-14.7]; p = 0.04) and cutting/cooking (adjusted OR: 2.7; 95% CI [1.01-6.7]; p = 0.03). Streptomycin therapy was used for 51.6% of cases. CONCLUSIONS: The clinico-epidemiologic surveillance of this disease in Spain is necessary.

Posttransfusion hepatitis after induction chemotherapy in acute nonlymphoblastic leukemia: implications for long-term management and outcome.

BACKGROUND: The purpose of this study was to evaluate 1) the incidence of hepatitis and its influence on the clinical management of and outcome in acute nonlymphoblastic leukemia (ANLL) patients in first complete remission and 2) the impact of routine hepatitis C virus screening on the incidence of hepatitis in these patients. STUDY DESIGN AND METHODS: Clinical and blood bank charts were reviewed for 65 consecutive ANLL patients between 1985 and 1993 who achieved complete remission after a course of daunomycin and cytarabine (cytarabine: 200 mg/m2/day x 7 days in continuous infusion; daunomycin: 60 mg/m2/day for the first 3 days of the 7, as a bolus). RESULTS: Only 43 percent of patients who developed hepatitis completed the scheduled therapy. Hepatitis did not decrease the probability of relapse (66 +/- 9% vs. 66 +/- 11%), but patients with changes in planned treatment, due to hepatitis or other causes, tended to have a higher relapse rate than patients without changes in consolidation therapy (56.5% vs. 40.4%; p = 0.10). This did not result in a decrease in disease-free survival, however, because of the higher number of treatment-related deaths in the patients without hepatitis (who completed the therapy). Over the period from 1985 through 1989, the 6-month actuarial probability of developing hepatitis was 42 percent. However, since 1989, when hepatitis C screening of blood donors was implemented, the incidence was reduced to 12.5 percent (p < 0.05), in spite of greater transfusion support (172 +/- 46 vs. 89 +/- 53, p < 0.01). No new cases of hepatitis were observed after the introduction of second-generation hepatitis C virus assays. CONCLUSION: Hepatitis precludes the use of consolidation therapy in about half of ANLL patients, resulting, in the experience described here, in a trend toward a higher rate of relapse. Hepatitis C virus screening of blood components reduces the incidence of hepatitis in ANLL patients.

[Platelet function after allogeneic bone marrow transplantation in Wiskott-Aldrich syndrome]. / Estudio de la función plaquetaria después del trasplante alogénico de medula ósea en el síndrome de Wiskott-Aldrich.

PURPOSE: To assess the platelet characteristics and functionalism in the Wiskott-Aldrich syndrome (WAS) after allogeneic BMT using cyclophosphamide and busulphan for conditioning. MATERIAL AND METHODS: Two WAS patients underwent allogeneic BMT. Platelet aggregation was studied prior to and after BMT, along with the intraplatelet amount of ADP and ATP. RESULTS: Platelet count, size and aggregation wholly recovered after BMT. The post-transplant content of platelet nucleotides was normal. CONCLUSIONS: Platelet function can be totally restored with cyclophosphamide/busulphan conditioned BMT in WAS. Platelet defects in this disease are due to defective thrombopoiesis.