Síndrome de desgaste proteico energético en la enfermedad renal crónica avanzada: prevalencia y características clínicas específicas / Protein-energy wasting syndrome in advanced chronic kidney disease: prevalence and specific clinical characteristics

Introducción: El desgaste proteico energético (DPE) se asocia a mayor mortalidad y difiere dependiendo del estadio de la enfermedad renal y de la técnica de diálisis. Su prevalencia en pacientes sin diálisis se encuentra poco estudiada y oscila entre el 0 y el 40,8%. Objetivo: Evaluar el estado nutricional según criterios de DPE y por valoración global subjetiva (VGS) de un colectivo de pacientes españoles con enfermedad renal crónica avanzada (ERCA). Pacientes y métodos: Estudio transversal de 186 pacientes (101 hombres) con edad media de 66,1±16 años. Se realizó evaluación nutricional mediante: VGS, criterios de DPE, registro dietético de 3 días, parámetros antropométricos y bioimpedancia vectorial. Resultados: Un 30,1% presentaba DPE, con diferencias significativas entre hombres y mujeres (22,8 vs. 33,8%; p<0,005) y un 27,9% tenía valores de VGS en rangos de desnutrición. Sin diferencia entre los 2 métodos estudiados. Los hombres presentaron mayores niveles de proteinuria, porcentaje de masa muscular e ingesta de nutrientes. Las mujeres tuvieron mayores niveles de colesterol total, HDL y porcentaje de masa grasa. Las características de los pacientes con DPE fueron: bajos valores de albúmina y recuento total de linfocitos, elevada proteinuria, baja masa grasa, baja masa muscular y cociente Na/K elevado. El análisis multivariante mostró asociación de DPE con proteinuria (OR: 1,257; IC 95%: 1,084-1,457; p=0,002), porcentaje de ingesta lipídica (OR: 0,903; IC 95%: 0,893-0,983; p=0,008), recuento total de linfocitos (OR: 0,999; IC 95%: 0,998-0,999; p=0,001) y el índice de masa celular (OR: 0,995; IC 95%: 0,992-0,998). Conclusión: Existe malnutrición en población española con ERCA, medida por diferentes herramientas. Consideramos conveniente adecuar nuevos elementos diagnósticos a los criterios de DPE (AU)

Introduction: Protein-energy wasting (PEW) is associated with increased mortality and differs depending on the chronic kidney disease (CKD) stage and the dialysis technique. The prevalence in non-dialysis patients is understudied and ranges from 0 to 40.8%. Objective: To evaluate the nutritional status of a group of Spanish advanced CKD patients by PEW criteria and subjective global assessment (SGA). Patients and methods: Cross-sectional study of 186 patients (101 men) with a mean age of 66.1±16 years. The nutritional assessment consisted of: SGA, PEW criteria, 3-day dietary records, anthropometric parameters and bioelectrical impedance vector analysis. Results: The prevalence of PEW was 30.1%, with significant differences between men and women (22.8 vs. 33.8%, p < 0.005), while 27.9% of SGA values were within the range of malnutrition. No differences were found between the 2methods. Men had higher proteinuria, percentage of muscle mass and nutrient intake. Women had higher levels of total cholesterol, HDL and a higher body fat percentage. The characteristics of patients with PEW were low albumin levels and a low total lymphocyte count, high proteinuria, low fat and muscle mass and a high Na/K ratio. The multivariate analysis found PEW to be associated with: proteinuria (OR: 1.257; 95% CI: 1.084-1.457, p=0.002), percentage of fat intake (OR: 0.903; 95% CI: 0.893-0.983, p=0.008), total lymphocyte count (OR: 0.999; 95% CI: 0.998-0.999, p=0.001) and cell mass index (OR: 0.995; 95% CI: 0.992-0.998). Conclusion: Malnutrition was identified in Spanish advanced CKD patients measured by different tools. We consider it appropriate to adapt new diagnostic elements to PEW criteria (AU)

Protein-energy wasting syndrome in advanced chronic kidney disease: prevalence and specific clinical characteristics. / Síndrome de desgaste proteico energético en la enfermedad renal crónica avanzada: prevalencia y características clínicas específicas.

INTRODUCTION: Protein-energy wasting (PEW) is associated with increased mortality and differs depending on the chronic kidney disease (CKD) stage and the dialysis technique. The prevalence in non-dialysis patients is understudied and ranges from 0 to 40.8%. OBJECTIVE: To evaluate the nutritional status of a group of Spanish advanced CKD patients by PEW criteria and subjective global assessment (SGA). PATIENTS AND METHODS: Cross-sectional study of 186 patients (101 men) with a mean age of 66.1±16 years. The nutritional assessment consisted of: SGA, PEW criteria, 3-day dietary records, anthropometric parameters and bioelectrical impedance vector analysis. RESULTS: The prevalence of PEW was 30.1%, with significant differences between men and women (22.8 vs. 33.8%, p < 0.005), while 27.9% of SGA values were within the range of malnutrition. No differences were found between the 2methods. Men had higher proteinuria, percentage of muscle mass and nutrient intake. Women had higher levels of total cholesterol, HDL and a higher body fat percentage. The characteristics of patients with PEW were low albumin levels and a low total lymphocyte count, high proteinuria, low fat and muscle mass and a high Na/K ratio. The multivariate analysis found PEW to be associated with: proteinuria (OR: 1.257; 95% CI: 1.084-1.457, p=0.002), percentage of fat intake (OR: 0.903; 95% CI: 0.893-0.983, p=0.008), total lymphocyte count (OR: 0.999; 95% CI: 0.998-0.999, p=0.001) and cell mass index (OR: 0.995; 95% CI: 0.992-0.998). CONCLUSION: Malnutrition was identified in Spanish advanced CKD patients measured by different tools. We consider it appropriate to adapt new diagnostic elements to PEW criteria.

Actividad laboral en una cohorte de pacientes con carcinoma de pulmón / Employment in a cohort of lung cancer patients

Introducción: La actividad laboral en el cáncer de pulmón es un aspecto psicosocial que ha recibido poca atención hasta el momento actual por distintos motivos, a pesar de considerarse una dimensión de la calidad de vida para todo paciente oncológico. Objetivos: Analizar la reinserción y adaptación al entorno laboral en una cohorte de pacientes con un carcinoma de pulmón para describir los factores que influyen en la vuelta al trabajo de estos enfermos. Pacientes y métodos: El estudio incluyó 35 pacientes consecutivos diagnosticados de un cáncer de pulmón y que estaban empleados en el momento del diagnóstico. El cuestionario incluyó aspectos epidemiológicos, clínicos y laborales (32 variables en total) que se relacionaron con la reincorporación al mundo laboral. También se incluyeron percepciones subjetivas de los enfermos respecto a este tema. Resultados: El 96,9% de los pacientes pasaron a inactivos tras comenzar el tratamiento de la enfermedad y un 85,7% lo seguían estando tras éste. La presencia de secuelas fue la variable con mayor influencia en la inactividad laboral. Conclusiones: Éste es el primer estudio exploratorio en nuestro país acerca de la reinserción laboral de los pacientes diagnosticados de un carcinoma de pulmón (AU)

Background: Cancer affects many dimensions determining quality of life, including work. However, the importance of work to cancer survivors has received little attention. Aim: Employment and work-related disability were investigated in a cohort of lung cancer patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 35 lung cancer patients who were employed at diagnosis. The questionnaire included cancer-related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face and 32 variables were recorded. Results: 96,9 per cent of patients were unable to work after diagnosis, but 85,7% returned to work at the end of treatment. Most of the problems reported in the study were linked to the sequelae of their disease and related treatments. Conclusions: This is the first exploratory study in Spain about labour reintegration in lung cancer patients. Further studies are necessary (AU)

Comparison of prognostic gene profiles using qRT-PCR in paraffin samples: a retrospective study in patients with early breast cancer.

INTRODUCTION: Gene profiling may improve prognostic accuracy in patients with early breast cancer, but this technology is not widely available. We used commercial assays for qRT-PCR to assess the performance of the gene profiles included in the 70-Gene Signature, the Recurrence Score and the Two-Gene Ratio. METHODS: 153 patients with early breast cancer and a minimum follow-up of 5 years were included. All tumours were positive for hormonal receptors and 38% had positive lymph nodes; 64% of patients received adjuvant chemotherapy. RNA was extracted from formalin-fixed paraffin-embedded (FFPE) specimens using a specific kit. qRT-PCR amplifications were performed with TaqMan Gene Expression Assays products. We applied the three gene-expression-based models to our patient cohort to compare the predictions derived from these gene sets. RESULTS: After a median follow-up of 91 months, 22% of patients relapsed. The distant metastasis-free survival (DMFS) at 5 years was calculated for each profile. For the 70-Gene Signature, DMFS was 95% -good prognosis- versus 66% -poor prognosis. In the case of the Recurrence Score, DMFS was 98%, 81% and 69% for low, intermediate and high-risk groups, respectively. Finally, for the Two-Gene Ratio, DMFS was 86% versus 70%. The 70-Gene Signature and the Recurrence Score were highly informative in identifying patients with distant metastasis, even in multivariate analysis. CONCLUSION: Commercially available assays for qRT-PCR can be used to assess the prognostic utility of previously published gene expression profiles in FFPE material from patients with early breast cancer. Our results, with the use of a different platform and with different material, confirm the robustness of the 70-Gene Signature and represent an independent test for the Recurrence Score, using different primer/probe sets.

Concordancia entre alumnos y profesores en las puntuaciones de exámenes teóricos / Concordance between students and academic staff regarding the scoring of theory exams

Objetivo: explorar la habilidad en autovaloración de su proceso de aprendizaje de estudiantes universitarios de Enfermería y Fisioterapia. Sujetos y método: estudio descriptivo. La población objeto de estudio fueron los estudiantes de Enfermería y de Fisioterapia de la Escuela Universitaria “Salus Infirmorum” de Madrid. La recogida de datos se realizó al concluir cada prueba teórica, cuando se suministraba a cada estudiante una hoja de autocalificación. Otras variables: sexo, asignatura y tipo de convocatoria. Se consideró falta de concordancia significativa entre las 2 puntuaciones (la del estudiante y la adjudicada por el profesor) una diferencia entre ambas e1. Para medir concordancia entre 2 variables cualitativas que guardan ordinalidad se ha utilizado el estadístico tau-b de Kendall. Los datos cuantitativos se correlacionaron entre sí mediante el coeficiente de Rho-Spearman. Resultados: hubo concordancia el 59% de los casos, infracalificación de los alumnos en 18,5% de los cuestionarios y supracalificación en 22,5%. Si bien el porcentaje de concordancia fue similar en varones y mujeres, es superior la proporción de hombres que se supracalificaron (34% vs 19,8%). Los alumnos que obtuvieron notas más bajas, obtuvieron nivel de concordancia bajo (41%), alta proporción de supracalificaciones (56%) y baja tasa de infracalificaciones (2%). Para los alumnos de alto rendimiento académico se observó el fenómeno contrario: supracalifiación de 0,7% e infracalificación del 77%. Conclusiones: los estudiantes son razonablemente exactos en su puntuación. Si bien con escasa diferencia, los varones presentaron mayor tendencia a supracalificarse y las alumnas a infracalificarse. Los alumnos que han mostrado mayor nivel de rendimiento académico, incurren en mayor proporción de infracalificaciones y los de inferior nivel, mayor porcentaje de supracalificaciones

Objective: to explore the ability of nursing and phisiotherapy university students to self-assess their learning process. Subjects and methods: descriptive study. The study population was composed of nursing and phisiotherapy students from the “Salus Infirmorum” university nursing school in Madrid. Data were collected at the end of each theory test, after completion of a self-assesment sheet by each student. Other variables were: sex, subject, and type of call. A difference between the teacher and the student score of e1 was found to be significant. The Kendall tau-b technique was used to measure concordance between 2 qualitative variables that keep ordinality. Quantitative data were correlated among themselves by using the Rho-Spearman coefficient. Results: there was concordance in 59% of cases, underscoring of the students in 18.5% of the respondents and overscoring in 22,5% of respondents. Even though the percentage of concordance was similar between men and women, the proportion of men that overscored themselves was higher (34% vs 19,8%). Students who obained the lowest scores, obtained a low concordance level (41%), a high proportion of overscoring (56%) and a low rate of underscoring (2%). For students with the highest academmic performance, the opposite effect was observed: overscoring in 0,7% and underscoring in 77%. Conclusions: students were reasonably accurate in their scoring. Although with scarce difference, male students presented a greater tendency so overscore themselves and female students to underscore themselves. The students that showed the highest academic performance, incurred in a higher proportion of underscoring and those with a lower academic performance, a greater percentage of overscoring