Impact of the implementation of a Sepsis Code Program in medical patient management: a cohort study in an Internal Medicine ward.

OBJECTIVE: Sepsis is the main cause of death in hospitals and the implementation of diagnosis and treatment bundles has shown to improve its evolution. However, there is a lack of evidence about patients attended in conventional units. METHODS: A 3-year retrospective cohort study was conducted. Patients hospitalized in Internal Medicine units with sepsis were included and assigned to two cohorts according to Sepsis Code (SC) activation (group A) or not (B). Baseline and evolution variables were collected. RESULTS: A total of 653 patients were included. In 296 cases SC was activated. Mean age was 81.43 years, median Charlson comorbidity index (CCI) was 2 and 63.25% showed some functional disability. More bundles were completed in group A: blood cultures 95.2% vs 72.5% (p <0.001), extended spectrum antibiotics 59.1% vs 41.4% (p < 0.001), fluid resuscitation 96.62% vs 80.95% (p < 0.001). Infection control at 72 hours was quite higher in group A (81.42% vs 55.18%, odds ratio 3.55 [2.48-5.09]). Antibiotic was optimized more frequently in group A (60.77% vs 47.03%, p 0.008). Mean in-hospital stay was 10.63 days (11.44 vs 8.53 days, p < 0.001). Complications during hospitalization appeared in 51.76% of patients, especially in group B (45.95% vs 56.58%, odds ratio 1.53 [1.12-2.09]). Hospital readmissions were higher in group A (40% vs 24.76%, p < 0.001). 28-day mortality was significantly lower in group A (20.95% vs 42.86%, odds ratio 0.33 [0.23-0.47]). CONCLUSIONS: Implementation of SC seems to be effective in improving short-term outcomes in IM patients, although therapy should be tailored in an individual basis.

[Potential biomarkers predictors of mortality in COVID-19 patients in the Emergency Department]. / Potenciales biomarcadores predictores de mortalidad en pacientes COVID-19 en el Servicio de Urgencias.

OBJECTIVE: Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk. METHODS: Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score. RESULTS: A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%). CONCLUSIONS: Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days.

Efectividad de un paquete de medidas para reducir las bacteriemias asociadas a catéter venoso central / Effectiveness of a bundle of measures for reducing central line-associated bloodstream infections

INTRODUCCIÓN: Las infecciones asociadas a catéter son la principal causa de bacteriemia nosocomial. El objetivo principal fue demostrar una posible disminución en las tasas de bacteriemia asociada a catéter venoso central (BACVC) del entorno perioperatorio tras implementar un paquete de medidas. El objetivo secundario fue determinar qué factores se asociaban a mayor riesgo de BACVC tras la implementación del paquete de medidas. MÉTODOS: El paquete de medidas consistió en: subclavia como acceso de elección, desinfección con clorhexidina alcohólica 2%, paño estéril de cuerpo entero, funda estéril para ecógrafo y check-list de inserción. La incidencia acumulada (IA) y densidad de incidencia (DI) de BACVC se compararon antes y después de la intervención. La asociación entre las características de pacientes o CVC y BACVC se resumieron mediante odds ratio e intervalos de confianza al 95%, obtenidos mediante regresión logística múltiple, ajustado por edad, sexo, comorbilidades y días con CVC. RESULTADOS: Antes de la implementación del paquete de medidas entre enero-noviembre de 2016 la IA de BACVC fue 5,05% y de DI 5,17‰. En el mismo periodo de 2018 la IA de BACVC fue 2,28% y de DI 2,27‰, suponiendo una reducción del 54% en IA (p = 0,072) y del 56% en DI (p = 0,068). En el análisis multivariable se asociaron a mayor riesgo de BACVC: reemplazo del CVC (OR: 11,01; IC 95%: 2,03-59,60, p = 0,005), 2 o más cateterizaciones (OR: 10,05; IC 95%: 1,77-57,16; p = 0,009) y nutrición parenteral (OR: 23,37; IC 95%: 4,37-124,91; p < 0,001). CONCLUSIONES: Las tasas de BACVC disminuyeron tras implementar el paquete de medidas de inserción. El reemplazo del CVC, 2 o más cateterizaciones y la nutrición parenteral se asociaron a BACVC tras implementar el paquete de medidas

INTRODUCTION: Catheter-associated infections are the main cause of nosocomial bacteremia. The main objective of this study was to demonstrate a possible decrease in CLABSI rates in perioperative environment after the implementation of a bundle of measures. Secondary objective was to determine which factors were associated with an increased risk of CLABSI, after the implementation of the bundle. METHODS: Insertion bundle consisted of: subclavian vein as access of choice, disinfection with alcoholic 2% chlorhexidine, central-line full body drapes, sterile ultrasound probe-cable covers and insertion check-list. Cumulative Incidence (CI) and Incidence Density Rate (IR) of CLABSIs were compared before and after the intervention. Associations between patient or CVC characteristic and CLABSI were summarized with odds ratios and 95% confidence interval, obtained from multiple logistic regression, adjusting for age, sex, comorbidities and days with CVC. RESULTS: Before implementing the bundle, from January to November 2016, CI of CLABSI was 5.05% and IR was 5.17 ‰. In the same period of 2018, CI of CLABSI was 2.28% and IR was 2.27 ‰, which means a reduction of 54.8% in CI (P=.072) and of 56% in IR (P=.068) In multivariable analyses, replacement of CVC was associated with a higher risk of CLABSI (OR 11.01, 95%CI 2.03-59.60, P=.005), as well as 2 or more catheterizations (OR 10.05, 95%CI 1.77-57.16, P=.009), and parenteral nutrition (OR 23.37, 95%CI 4.37-124.91, P<.001). CONCLUSIONS: CLABSI rates decreased after the implementation of the insertion bundle. CVC replacement, 2 or more catheterizations and parenteral nutrition were associated with CLABSI after bundle implementation

Effectiveness of a bundle of measures for reducing central line-associated bloodstream infections. / Efectividad de un paquete de medidas para reducir las bacteriemias asociadas a catéter venoso central.

INTRODUCTION: Catheter-associated infections are the main cause of nosocomial bacteremia. The main objective of this study was to demonstrate a possible decrease in CLABSI rates in perioperative environment after the implementation of a bundle of measures. Secondary objective was to determine which factors were associated with an increased risk of CLABSI, after the implementation of the bundle. METHODS: Insertion bundle consisted of: subclavian vein as access of choice, disinfection with alcoholic 2% chlorhexidine, central-line full body drapes, sterile ultrasound probe-cable covers and insertion check-list. Cumulative Incidence (CI) and Incidence Density Rate (IR) of CLABSIs were compared before and after the intervention. Associations between patient or CVC characteristic and CLABSI were summarized with odds ratios and 95% confidence interval, obtained from multiple logistic regression, adjusting for age, sex, comorbidities and days with CVC. RESULTS: Before implementing the bundle, from January to November 2016, CI of CLABSI was 5.05% and IR was 5.17 ‰. In the same period of 2018, CI of CLABSI was 2.28% and IR was 2.27 ‰, which means a reduction of 54.8% in CI (P=.072) and of 56% in IR (P=.068) In multivariable analyses, replacement of CVC was associated with a higher risk of CLABSI (OR 11.01, 95%CI 2.03-59.60, P=.005), as well as 2 or more catheterizations (OR 10.05, 95%CI 1.77-57.16, P=.009), and parenteral nutrition (OR 23.37, 95%CI 4.37-124.91, P<.001). CONCLUSIONS: CLABSI rates decreased after the implementation of the insertion bundle. CVC replacement, 2 or more catheterizations and parenteral nutrition were associated with CLABSI after bundle implementation.

Pro-adrenomedulina preoperatoria como predictor de la necesidad de soporte orgánico postoperatorio en pacientes programados para cirugía abdominal mayor / Pre-Operative pro-adrenomedullin as a predictor of postoperative requirement of organ support in patients scheduled for major abdominal surgery. A prospective observational pilot study

INTRODUCCIÓN: La región medial de la pro-adrenomedulina (MR-Pro-ADM) es un marcador de gravedad en un amplio espectro de enfermedades como la sepsis y la disfunción cardiovascular. Su utilidad como predictor de morbimortalidad en pacientes quirúrgicos aún no se ha dilucidado. Examinamos en este estudio la capacidad del valor preoperatorio de la MR-Pro-ADM para predecir la necesidad de soporte orgánico postoperatorio (SOP). MÉTODO: Estudio observacional prospectivo piloto, en un solo centro, que incluyó a pacientes adultos programados para cirugía abdominal mayor. La capacidad de la MR-Pro-ADM para predecir la necesidad de SOP se determinó por el análisis del área bajo la curva receiver operating characteristic (AUROC). Se realizó un análisis multivariante de regresión logística para determinar si el nivel de MR-pro-ADM identificado se asocia de forma independiente para la necesidad de SOP. RESULTADOS: Se reclutaron un total de 59 pacientes programados para cirugía abdominal mayor. La incidencia de SOP fue del 13,6%. Para la asociación entre los niveles de la MR-Pro-ADM y la incidencia de SOP se obtuvo un área bajo la curva ROC de 0,85 (IC 95%: 0,74-0,96; p = 0,002). El valor preoperatorio de la MR-Pro-ADM con la mejor combinación de sensibilidad y especificidad para predecir el SOP fue de 0,87nmol/l. Los pacientes con niveles séricos preoperatorios de la MR-Pro-ADM≥0,87nmol/l tuvieron una incidencia significativamente mayor de SOP (33,3 vs. 4,9%; p = 0,007). Niveles séricos preoperatorios de MR-Pro-ADM≥0,87nmol/l mostraron ser un factor independiente de riesgo en la necesidad de SOP (p = 0,001; OR: 9,758; IC 95%: 1,73-54,78) en el análisis multivariante. CONCLUSIÓN: El valor sérico preoperatorio de la MR-Pro-ADM puede ser un biomarcador útil del riesgo perioperatorio y de la necesidad de SOP en pacientes adultos programados para cirugía abdominal mayor

BACKGROUND: Mid-Regional-Pro-Adrenomedullin (MR-Pro-ADM) is a marker of severity in a wide spectrum of pathological conditions such as sepsis, and cardiovascular dysfunction. Its usefulness as a predictor of morbidity and mortality in surgical patients has yet to be elucidated. We examined the ability of preoperative MR-Pro-ADM in predicting Postoperative Requirement of Organ Support (PROS). METHODS: One centre, pilot, prospective observational cohort study, enrolling adult patients scheduled for major abdominal surgery. The accuracy of the MR-Pro-ADM to predict PROS was determined by area under the receiver operating characteristic curve (AUROC) analysis. An univariate analysis was performed to identify the association of PROS and the MR-Pro-ADM value with the best combination of sensitivity and specificity. A multivariate analysis was performed to identify preoperative MR-Pro-ADM as independent risk factor for PROS. RESULTS: A total of 59 patients scheduled for major abdominal surgery were enrolled. The incidence of PROS was 13.6%. The association of MR-Pro-ADM levels with the incidence of PROS, was determined by an area under the ROC curve of 0.85 (95% CI: 0.74-0.96, p = 0.002). The preoperative value of MR-Pro-ADM with the best combination of sensitivity and specificity to predict PROS was 0.87 nmol/l. Patients with preoperative serum levels of MR-Pro-ADM≥0.87 nmol/l had a significantly higher incidence of PROS (33.3% vs 4.9%, p = 0.007). MR-Pro-ADM≥0.87 nmol/l was shown to be an independent risk factor for PROS (p = 0.001; OR 9.758; IC 1.73-54.78) in the multivariate analysis. CONCLUSION: The preoperative serum level of MR-Pro-ADM may be a useful biomarker of perioperative risk and to predict postoperative requirement of organic support (PROS) in adult patients scheduled for major abdominal surgery

Pre-Operative pro-adrenomedullin as a predictor of postoperative requirement of organ support in patients scheduled for major abdominal surgery. A prospective observational pilot study. / Pro-adrenomedulina preoperatoria como predictor de la necesidad de soporte orgánico postoperatorio en pacientes programados para cirugía abdominal mayor.

BACKGROUND: Mid-Regional-Pro-Adrenomedullin (MR-Pro-ADM) is a marker of severity in a wide spectrum of pathological conditions such as sepsis, and cardiovascular dysfunction. Its usefulness as a predictor of morbidity and mortality in surgical patients has yet to be elucidated. We examined the ability of preoperative MR-Pro-ADM in predicting Postoperative Requirement of Organ Support (PROS). METHODS: One centre, pilot, prospective observational cohort study, enrolling adult patients scheduled for major abdominal surgery. The accuracy of the MR-Pro-ADM to predict PROS was determined by area under the receiver operating characteristic curve (AUROC) analysis. An univariate analysis was performed to identify the association of PROS and the MR-Pro-ADM value with the best combination of sensitivity and specificity. A multivariate analysis was performed to identify preoperative MR-Pro-ADM as independent risk factor for PROS. RESULTS: A total of 59 patients scheduled for major abdominal surgery were enrolled. The incidence of PROS was 13.6%. The association of MR-Pro-ADM levels with the incidence of PROS, was determined by an area under the ROC curve of 0.85 (95% CI: 0.74-0.96, p=0.002). The preoperative value of MR-Pro-ADM with the best combination of sensitivity and specificity to predict PROS was 0.87 nmol/l. Patients with preoperative serum levels of MR-Pro-ADM≥0.87 nmol/l had a significantly higher incidence of PROS (33.3% vs 4.9%, p=0.007). MR-Pro-ADM≥0.87 nmol/l was shown to be an independent risk factor for PROS (p=0.001; OR 9.758; IC 1.73-54.78) in the multivariate analysis. CONCLUSION: The preoperative serum level of MR-Pro-ADM may be a useful biomarker of perioperative risk and to predict postoperative requirement of organic support (PROS) in adult patients scheduled for major abdominal surgery.

Ability to predict the development of surgical site infection in cardiac surgery using the Australian Clinical Risk Index versus the National Nosocomial Infections Surveillance-derived Risk Index.

Surgical site infection (SSI) is a major infectious complication that increases mortality, morbidity, and healthcare costs. There are scores attempting to classify patients for calculating SSI risk. Our objectives were to validate the Australian Clinical Risk Index (ACRI) in a European population after cardiac surgery, comparing it against the National Nosocomial Infections Surveillance-derived risk index (NNIS) and analyzing the predictive power of ACRI for SSI in valvular patients. All the patients that who underwent cardiac surgery in a tertiary university hospital between 2011 and 2015 were analyzed. The patients were divided into valvular and coronary groups, excluding mixed patients. The ACRI score was validated in both groups and its ability to predict SSI was compared to the NNIS risk index. We analyzed 1,657 procedures. In the valvular patient group (n: 1119), a correlation between the ACRI score and SSI development (p < 0.05) was found; there was no such correlation with the NNIS index. The area under the receiver-operating characteristic curve (AUC) was 0.64 (confidence interval [CI] 95%, 0.5-0.7) for ACRI and 0.62 (95% CI, 0.5-0.7) for NNIS. In the coronary group (n: 281), there was a correlation between ACRI and SSI but no between NNIS and SSI. The ACRI AUC was 0.70 (95% CI, 0.5-0.8) and the NNIS AUC was 0.60 (95% CI, 0.4-0.7). The ACRI score has insufficient predictive power, although it predicts SSI development better than the NNIS index, fundamentally in coronary artery bypass grafting (CABG). Further studies analyzing determining factors are needed.

Valoración de bronquiectasias en pacientes con asma / No disponible

Introducción: Las bronquiectasias (BQ) son la consecuencia final de muchas enfermedades, entre las que se encuentra el asma, sin embargo han sido poco estudiadas. El objetivo principal de este estudio fue evaluar la presencia de BQ mediante una tomografía computarizada de alta resolución (TCAR) en un subgrupo de pacientes con asma mediante el sistema de clasificación de Bhalla. Asimismo, se comparó si existían diferencias clínicas entre los asmáticos que presentaban o no BQ y si estas se relacionaban con las puntuaciones obtenidas en la escala de Bhalla modificada. Material y métodos: Una TCAR pulmonar se realizó a pacientes con asma, durante un periodo de reclutamiento de 2 años, que cumplían las siguientes condiciones: tres o más exacerbaciones respiratorias al año, historia de expectoración habitual o hemoptoica en alguna ocasión, o asma de larga evolución. Los escáneres fueron evaluados por 2 radiólogos siguiendo la puntuación de Bhalla modificada. Resultados: Se observaron BQ en 48 pacientes de los 65 estudios realizados; el 88% de las BQ fueron cilíndricas y el 62% bilaterales, siendo los lóbulos más afectos los lóbulos inferiores y el lóbulo medio. En todos los enfermos que padecían reflujo gastroesofágico (RGE) se evidenciaron BQ. Los enfermos con BQ mostraron peor FVC (p=0,04) y FEV1 (p=0,05) y mayor frecuencia de rinitis. La puntuación total obtenida por la puntuación de Bhalla modificada se relacionó con la media del porcentaje del valor FEV1/FVC (p=0,01), con el número de exacerbaciones (p=0,01), y con la presencia de colonización bacteriana (p=0,001). Conclusiones: Una alta proporción de pacientes asmáticos de control difícil muestran BQ, que suelen ser cilíndricas y bilaterales. Los enfermos con BQ presentan peor función pulmonar. La puntuación total mediante el sistema de Bhalla se relaciona con la presencia de colonización bacteriana y con el número de exacerbaciones

Introduction: Bronchiectasis (BQ) are the final consequence of many diseases, including asthma is, however this has been inconsiderate. The main objective was to evaluate the presence of BQ by high resolution computerized tomography (HRCT) in a subgroup of patients with asthma using a modified Bhalla score. We compared also whether there were clinical differences between asthmatics who presented or not BQ and clinical variables were associated with modified Bhalla scores. Material and methods: Pulmonary HRCT was performed in patients with asthma during a recruitment period of 2 years, who had the following conditions: three or more respiratory exacerbations per year history of coughing or hemoptysis usual on occasion, asthma longstanding and images suggestive of BQ in the chest radiograph. The HRCT were evaluated by 2 radiologists according to the modified Bhalla score. Results: We observed 48 patients with BQ in 65 studies, 88% were cylindrical and bilateral in 62%. The more affected were the lower and middle lobes. All patients suffering from gastroesophageal reflux had evident BQ. Patients with BQ showed worse FEV1 (p = 0.04), FVC (p=0.05) and rhinitis more often. The total modified Bhalla score was related to the average percentage of FEV1/FVC value (p=0.01), the number of exacerbations (p = 0.01), and the presence of bacterial colonization (p = 0.01). Conclusions: A high proportion of patients with difficult asthma clinic have BQ. Usually these BQ are bilateral and cylindrical and the patients with BQ present worse respiratory functional state. Bhalla total score correlated with the presence of bacterial colonization and the number of exacerbations

Correlaciones entre marcadores de grasa abdominal obtenidos por densitometría y técnicas antropométricas convencionales en mujeres postmenopausicas con síndrome metabólico / Correlations between markers of abdominal fat obtained by dxa and anthropometric conventional techniques in postmenopausal women with metabolic syndrome

El presente estudio pretende identificar correlaciones estadísticamente significativas entre parámetros de masa grasa abdominal obtenidos por densitometría (DXA) y otros de tipo cineantropométrico (índices de distribución de masa grasa) y bioquímico (perfil lipídico) en mujeres postmenopausicas con síndrome metabólico. Se diseño un estudio de cohortes histórico que incluyó a un total de 1326 mujeres post-menopausicas con edad > 45 años que se habían sometido rutinariamente a DXA para conocer su densidad mineral ósea entre Enero de 2006 y Enero de 2011. Se utilizó un DXA tipo Lunar DPX-L para determinar la masa grasa abdominal en las regiones de interés L1-L4 y L3-L4. Además del DXA, se obtuvo de cada participante la correspondiente anamnesis, bioquímica, tensión arterial e índices de distribución de masa grasa mediante técnicas antropométricas convencionales. Se utilizó la clasificación NCEP-ATP-III para el diagnóstico de síndrome metabólico. Este protocolo fue aprobado por un Comité de Ética Institucional. La mayor fuerza de asociación se estableció entre el porcentaje de masa grasa L1-L4 obtenido por DXA y el perímetro de la cintura (r= 0,77; p= 0,0016) además de con colesterol-HDL (r= -0,58; p= 0,0290). Finalmente se concluye que el perímetro de la cintura y los niveles de colesterol-HDL podrían recomendarse como predictores del comportamiento de la masa grasa abdominal de regiones de interés L1-L4 y L3-L4 obtenidas por DXA en mujeres postmenopausicas con síndrome metabólico.

The current study was conducted to identify potential correlations between abdominal fat mass obtained by DXA and several parameters obtained by anthropometric conventional techniques as well as lipid profile in postmenopausal women with MS. This historical cohort study included a total of 1326 postmenopausal women aged > 45 years old who had routinely undergone DXA to measure their bone mineral density between January 2006 and January 2011. The regions of interest envisaged in our study by using DXA were the lumbar regions L1-L4 and L4-L5. At the same time, they underwent a complete medical examination including personal medical history assessment, biochemical blood analysis, blood pressure measurements and anthropometrical evaluation. Metabolic syndrome was diagnosed attending to the criteria established by National Cholesterol Education Program Adult Treatment Panel III (NECP-ATP-III). This protocol was approved by an Institutional Ethics Committee. Several significant correlations were found between DXA and indices of body fat distribution as well as lipid profile. The strongest correlations were found between fat mass L1-L4 and waist circumference (r= 0.77; p= 0.0016) and levels of HDL-cholesterol (r= -0.58; p= 0.0290). It was concluded that waist circumference and HDL-cholesterol may be recommended to predict fat mass in regions of interest L1-L4 and L3-L4 in postmenopausal women with MS.

Central obesity measurements predict metabolic syndrome in a retrospective cohort study of postmenopausal women / Obesidad abdominal determinada por DEXA como predictor de síndrome metabólico en mujeres postmenopáusicas

Introduction: The various diagnostic classifications in the literature concur as regards the important role of abdominal obesity in the onset and progression of metabolic syndrome. Accordingly, this study was aimed at clarifying whether central obesity measurements assessed by dual X-ray absorptiometry (DXA) may predict metabolic syndrome in Spanish postmenopausal women. Material and methods: This historical cohort study included a total of 1326 postmenopausal women aged > 45 years old who had routinely undergone DXA to measure their bone mineral density between January 2006 and January 2011. The regions of interest (ROI) envisaged in our study by using DXA were the lumbar regions L1-L4 and L4-L5. At the same time, they underwent a complete medical examination including personal medical history assessment, biochemical blood analysis, blood pressure measurement and anthropometrical evaluation. Metabolic syndrome was diagnosed attending to the criteria established by National Cholesterol Education Program Adult Treatment Panel III (NECP-ATP-III). Results: During the observation period, 537 women, representing 40.5% of the total studied, met the diagnostic criteria for metabolic syndrome. L1-L4 and L4-L5 abdominal fat mass determinations were associated with the development of metabolic syndrome in all regression models tested, showing an increasing gradient from the lowest to highest quintile. Conclusion: Central adiposity measurements assessed by DXA, especially L1-L4 region of interest, could be considered a powerful predictor of metabolic syndrome in postmenopausal women (AU)

Introducción: En la actualidad se acepta la importancia de la masa grasa abdominal en la fisiopatología del síndrome metabólico tal y como reconocen las diferentes clasificaciones diagnósticas disponibles. Nuestro objetivo fue analizar la utilidad como predictores de síndrome metabólico de marcadores de grasa abdominal obtenidos por DEXA en mujeres postmenopausicas aprovechando su participación en screening rutinarios para el estudio de la densidad mineral ósea. Material y método: El presente estudio de cohortes histórico incluyó a un total de 1326 mujeres post-menopausicas con edad > 45 años que se habían sometido rutinariamente a DEXA para conocer su densidad mineral ósea entre Enero de 2006 y Enero de 2011. Además del DEXA, se obtuvo de cada participante la correspondiente anamnesis, bioquímica, tensión arterial e índices de distribución de masa grasa mediante técnicas antropométricas convencionales. Se utilizó la clasificación NCEP-ATP-III para el diagnóstico de síndrome metabólico. Este protocolo fue aprobado por un Comité de Ética Institucional. Resultados: Durante el periodo de observación, 537 mujeres, el 40.5% del total de las estudiadas, cumplió los criterios diagnósticos de síndrome metabólico. Los parámetros de masa grasa abdominal obtenidos mediante DEXA fueron significativamente mayores en mujeres postmenopáusicas con síndrome metabólico. Finalmente, la masa grasa abdominal de regiones de interés L1-L4 y L3-L4 obtenidas por DEXA se relacionaron con el desarrollo de síndrome metabólico en los modelos de regresión ensayados. Conclusión: La masa grasa abdominal determinada por DEXA, especialmente la región L1-L4, podría recomendarse como predictor de síndrome metabólico en este grupo (AU)

Central obesity measurements predict metabolic syndrome in a retrospective cohort study of postmenopausal women.

INTRODUCTION: The various diagnostic classifications in the literature concur as regards the important role of abdominal obesity in the onset and progression of metabolic syndrome. Accordingly, this study was aimed at clarifying whether central obesity measurements assessed by dual X-ray absorptiometry (DXA) may predict metabolic syndrome in Spanish postmenopausal women. MATERIAL AND METHODS: This historical cohort study included a total of 1326 postmenopausal women aged > 45 years old who had routinely undergone DXA to measure their bone mineral density between January 2006 and January 2011. The regions of interest (ROI) envisaged in our study by using DXA were the lumbar regions L1-L4 and L4-L5. At the same time, they underwent a complete medical examination including personal medical history assessment, biochemical blood analysis, blood pressure measurement and anthropometrical evaluation. Metabolic syndrome was diagnosed attending to the criteria established by National Cholesterol Education Program Adult Treatment Panel III (NECP-ATP-III). RESULTS: During the observation period, 537 women, representing 40.5% of the total studied, met the diagnostic criteria for metabolic syndrome. L1-L4 and L4-L5 abdominal fat mass determinations were associated with the development of metabolic syndrome in all regression models tested, showing an increasing gradient from the lowest to highest quintile. CONCLUSION: Central adiposity measurements assessed by DXA, especially L1-L4 region of interest, could be considered a powerful predictor of metabolic syndrome in postmenopausal women.

Introducción: En la actualidad se acepta la importancia de la masa grasa abdominal en la fisiopatología del síndrome metabólico tal y como reconocen las diferentes clasificaciones diagnósticas disponibles. Nuestro objetivo fue analizar la utilidad como predictores de síndrome metabólico de marcadores de grasa abdominal obtenidos por DEXA en mujeres postmenopausicas aprovechando su participación en screening rutinarios para el estudio de la densidad mineral ósea. Material y método: El presente estudio de cohortes histórico incluyó a un total de 1326 mujeres post-menopausicas con edad > 45 años que se habían sometido rutinariamente a DEXA para conocer su densidad mineral ósea entre Enero de 2006 y Enero de 2011. Además del DEXA, se obtuvo de cada participante la correspondiente anamnesis, bioquímica, tensión arterial e índices de distribución de masa grasa mediante técnicas antropométricas convencionales. Se utilizó la clasificación NCEP-ATP-III para el diagnóstico de síndrome metabólico. Este protocolo fue aprobado por un Comité de Ética Institucional. Resultados: Durante el periodo de observación, 537 mujeres, el 40.5% del total de las estudiadas, cumplió los criterios diagnósticos de síndrome metabólico. Los parámetros de masa grasa abdominal obtenidos mediante DEXA fueron significativamente mayores en mujeres postmenopáusicas con síndrome metabólico. Finalmente, la masa grasa abdominal de regiones de interés L1-L4 y L3-L4 obtenidas por DEXA se relacionaron con el desarrollo de síndrome metabólico en los modelos de regresión ensayados. Conclusión: La masa grasa abdominal determinada por DEXA, especialmente la región L1-L4, podría recomendarse como predictor de síndrome metabólico en este grupo.

Risk assessment model for first-cycle chemotherapy-induced neutropenia in patients with solid tumours.

Chemotherapy-induced neutropenia, the major dose-limiting toxicity of chemotherapy, is directly associated with concomitant morbidity, mortality and health-care costs. The use of prophylactic granulocyte colony-stimulating factors may reduce the incidence and duration of chemotherapy-induced neutropenia, and is recommended in high-risk patients. The objective of this study was to develop a model to predict first-cycle chemotherapy-induced neutropenia (defined as neutropenia grade>or=3, with or without body temperature>or=38 degrees C) in patients with solid tumours. A total of 1194 patients [56% women; mean age 58+/-12 years; 94% Eastern Cooperative Oncology Group (ECOG) status

Valor pronóstico de determinados marcadores biológicos en la supervivencia global y la respuesta al tratamiento del cáncer de mama con metástasis pleurales / Prognostic value of specific biological markers in the global survival rate and response to treatment of breast cancer with pleural metastasis

Objetivo: 1. Estudiar qué tipo de marcadores biológicos tienen valor pronóstico en la supervivencia global y la respuesta al tratamiento en el cáncer de mama, a partir del descubrimiento de metástasis pleurales. 2. Examinar la influencia de la aplicación de talco intrapleural. 3. Establecer un esquema de abordaje terapéutico en base a los diferentes factores pronósticos. Pacientes y métodos: estudiamos una serie de 126 pacientes con cáncer de mama y afectación pleural metastásica. Se examinaron exhaustivamente los factores clásicos del cáncer de mama. Así mismo se calcularon el intervalo libre de enfermedad (ILE), el intervalo entre la aparición del derrame pleural y el abordaje toracoscópico del mismo, el intervalo entre la realización de la pleurodesis con talco y el exitus y el intervalo desde el diagnóstico del tumor primario hasta el exitus. Los factores biológicos (polimorfismos)fueron estudiados a partir del ADN de muestras de sangre periférica o líquido pleural crio conservado. Resultados: el derrame pleural era en el 77% de los casos la primera manifestación de recidiva de la enfermedad. El intervalo libre de enfermedad (ILE) fue de 57,9 meses (13,6-83,3). La supervivencia(expresada como mediana) desde el momento del diagnóstico del tumor primario fue de 77,5 meses (0,83-384). La media de seguimiento tras el talcaje fue de 14,6 meses. Encontramos correlación entre la edad temprana de presentación del cáncer de mama (..) (AU)

Objective: 1. To study what type of biological markers have prognostic value in the global survival rate and response to treatment of breast cancer, regarding discovery of pleural metastases. 2. To examine the influence of the application of intrapleural talc. 3. To establish a therapeutic approach outline based on the different prognosticfactors. Patients and methods: we studied a series of 126 patients with breast cancer and pleural metastasis. The classic factors of breast cancer were thoroughly examined. Also, we calculated the disease-free interval(DFI), the interval between the appearance of the pleural effusion and its thoracoscopic approach, the interval between pleurodesis with talc and death and the interval between the diagnosis of the first tumour and death. The biological factors (polymorphisms) were studied starting with the DNA of peripheral blood samples or cryopreservation of pleural liquid samples. Results: the pleural effusion was the first manifestation of a relapse of the disease in 77% of the cases. The disease-free interval (DFI) was57.9 months (13.6-83.3). The survival rate (expressed as median)from the diagnosis of the first tumour was 77.5 months (0.83-384).The average follow-up after the application of talc was 14.6 months. We found a correlation between the appearance of breast cancer(p=0.003) at a young age and the presence of the A2/A2 allele(homozygote of the CYP-17).Conclusions: the ideal profile for candidates for pleurodesis is those patients with an age >50 years, long DFI, short interval of time between the appearance of the pleural effusion and the application oftalc, absence of other metastasis at the time of thoracoscopy, positive ER (estrogen receptors) and PR (progesterone receptors) and a percentage of lymph nodes infiltrated/extracted less than 50%. The presence of mutated GSTM1 will be related with a more effective (..) (AU)

Spanish Society of Medical Oncology consensus on the use of erythropoietic stimulating agents in anaemic cancer patients

Treatment of anaemia is a very important aspect in the management of cancer patients. In order to carry out a consensus process about the use of erythropoietic stimulating agents (ESAs) in cancer patients, the Spanish Society of Medical Oncology (SEOM) elaborated a working group which coordinated a panel of medical oncology specialists. This working group has reviewed the main issues about the use of ESAs. In addition a consensus meeting was held in Madrid on 25 April 2007. The following conclusions were made: Since ESA treatment increases the haemoglobin (Hb) level and decreases the red blood cell (RBC) transfusion requirements, ESAs should be used within the approved indications in patients undergoing chemotherapy treatment, beginning at a Hb level below 11 g/dl and maintaining it around 12 g/dl, with iron supplements if necessary. Neither increasing the ESA dose in nonresponders nor the use of ESAs in the treatment of chronic cancer-related anaemia is recommended (AU)

No disponible

[Treatment of indolent non-Hodgkin's lymphomas]. / Tratamiento de los linfomas no hodgkinianos indolentes.

Non-Hodgkin's Lymphomas (NHLs) are a heterogeneous group of entities with different pathologies. A total of 80% of these lymphomas are B-cell origin and only 20% T-cell. B-cell lymphomas express CD-20 antigen, a specific target for the current treatment with monoclonal antibodies. Indolent lymphomas in localized stages (I and II) account for 20%, only 10% being in pathological stages. The possibilities for cure with radiotherapy and/or chemotherapy are approximately 50-70%. Advanced stages (IIB, III and IV) of phenotype B types account for 80-90% of the cases and are candidates for systemic treatments with immunochemotherapy for those of phenotype B. Rescue treatment is one of the most important problems in this type of lymphomas, many of them needing second line treatments, with survival rates under five years, in spite of the 50% response rate. In these cases, immunochemotherapy includes more aggressive regimens, high-dose chemotherapy and combined chemoimmunoradiotherapy.

Encefalopatía subaguda con respuesta a esteroides sin evidencia de enfermedad autoinmune tiroidea: un caso de meningoencefalitis autoinmune no vasculítica / Sub-acute encephalopathy that responds to sterorids without any evidence of autoinmune thyroid disease a case of non-vasculitic autoimmune nm

Aim. To report a case of sub-acute encephalopathy with all the extension study negative and with response to steroid therapy. Case report. The study involves a 22-year-old female with no relevant past history who presented symptoms of sub-acute encephalopathy consisting in behavioural disorders, generalised seizures and bradypsychia, which gradually progressed to a state of low-level consciousness. While she was in hospital all kinds of diagnostic tests were conducted, the results of which were either normal or negative; the electroencephalogram was repeatedly abnormal and detection of protein 14-3-3 in cerebrospinal fluid was positive. Empirical corticoid therapy was begun with clinical and electrophysiological improvements and the patient recovered completely without any sequelae. Conclusions. With no evidence of autoimmune thyroid disease, although non-specific autoimmunity was present, the patient was diagnosed as having non-vasculitic autoimmune meningoencephalitis (AU)

Objetivo. Presentar un caso de encefalopatía subaguda con todo el estudio de extensión negativo y con respuesta a terapia esteroidea. Caso clínico. Mujer de 22 años sin antecedentes de interés que presentó un cuadro de encefalopatía subaguda consistente en alteraciones del comportamiento, crisis generalizadas y bradipsiquia, que evolucionó progresivamente a un estado de bajo nivel de conciencia. Durante su ingreso se realizaron todo tipo de pruebas diagnósticas, que fueron normales o negativas; el electroencefalograma fue repetidamente anormal y se detectó positividad de la proteína 14-3-3 en el líquido cefalorraquídeo. Se inició corticoterapia empírica con mejoría clínica y electrofisiológica, y recuperación ad integrum sin secuelas. Conclusiones. Sin la evidencia de enfermedad autoinmune tiroidea, aunque con presencia de autoinmunidad no específica, se diagnosticó a la paciente meningoencefalitis autoinmune no vasculítica (AU)

[Sub-acute encephalopathy that responds to steroids without any evidence of autoimmune thyroid disease: a case of non-vasculitic autoimmune meningoencephalitis]. / Encefalopatía subaguda con respuesta a esteroides sin evidencia de enfermedad autoinmune tiroidea: un caso de meningoencefalitis autoinmune no vasculítica.

AIM: To report a case of sub-acute encephalopathy with all the extension study negative and with response to steroid therapy. CASE REPORT: The study involves a 22-year-old female with no relevant past history who presented symptoms of sub-acute encephalopathy consisting in behavioural disorders, generalised seizures and bradypsychia, which gradually progressed to a state of low-level consciousness. While she was in hospital all kinds of diagnostic tests were conducted, the results of which were either normal or negative; the electroencephalogram was repeatedly abnormal and detection of protein 14-3-3 in cerebrospinal fluid was positive. Empirical corticoid therapy was begun with clinical and electrophysiological improvements and the patient recovered completely without any sequelae. CONCLUSIONS: With no evidence of autoimmune thyroid disease, although non-specific autoimmunity was present, the patient was diagnosed as having non-vasculitic autoimmune meningoencephalitis.

Tratamiento de los linfomas no hodgkinianos indolentes / Treatment of indolent non-Hodgkin’s Lymphomas

Los linfomas no hodgkinianos (LNH) son un conjunto muy heterogéneo de procesos con distintas características clínicas y anatomopatológicas. El 80% de estos linfomas son de origen B y sólo un 20% T. Los B expresan el antígeno CD20, una diana clave para el tratamiento actual con anticuerpos monoclonales. En el grupo de linfomas indolentes, los estadios clínicos localizados (estadios I y II) representan el 20%, siendo sólo estadios patológicos un 10%. Las posibilidades de curación se sitúan en un 50-70% con radioterapia y/o quimioterapia. Los estadios avanzados III-IV, incluyendo el IIB, representan el 80-90% de los casos y son candidatos a tratamientos sistémicos con inmunoquimioterapia para los de fenotipo B. El tratamiento de rescate es uno de los problemas más importantes en estos linfomas, muchos requieren tratamiento de segunda línea, con supervivencias inferiores a cinco años, a pesar del 50% de respuestas. Contempla protocolos más agresivos de inmunoquimioterapia, incluyendo las altas dosis y radioinmunoquimioterapia (AU)

Non-Hodgkin’s Lymphomas (NHLs) are a heterogeneous group of entities with different pathologies. A total of 80% of these lymphomas are B-cell origin and only 20% T-cell. B-cell lymphomas express CD-20 antigen, a specific target for the current treatment with monoclonal antibodies. Indolent lymphomas in localized stages (I and II) account for 20%, only 10% being in pathological stages. The possibilities for cure with radiotherapy and/or chemotherapy are approximately 50-70%. Advanced stages (IIB, III and IV) of phenotype B types account for 80-90% of the cases and are candidates for systemic treatments with immunochemotherapy for those of phenotype B. Rescue treatment is one of the most important problems in this type of lymphomas, many of them needing second line treatments, with survival rates under five years, in spite of the 50% response rate. In these cases, immunochemotherapy includes more aggressive regimens, high-dose chemotherapy and combined chemoim-munoradiotherapy (AU)

Bax expression in untreated breast cancer: an immunocytometric study of 255 cases.

BACKGROUND: Bax is one of the main effectors of apoptosis in breast cancer. However, in contrast with the antiapoptotic protein Bcl-2, which has been extensively studied in this tumor, there are relatively few clinical studies on the biological role of Bax in breast cancer. MATERIALS AND METHODS: The expression of the apoptosis-related Bax gene was studied in a series of 255 previously untreated breast cancers by means of immuno-flow cytometry. Additionally, and by the same method, the expression of the Bcl-2, VEGF and Nup88 genes were also studied. As variables of the study for the final statistical analysis, the histological variety of the tumors, histological and nuclear grade, the expression of hormone receptors, p53, Ki-67 or c-erb-B2, axillary node invasion, tumor size and DNA-ploidy were also included. RESULTS: The expression of the proapoptotic Bax protein was significantly associated with the expression of Nup88 (p<0.0001), VEGF (p=0.0014) and Bcl-2 (p=0.0063), all measured by the same method. An inverse correlation with c-erb-B2 expression, which almost attained statistical significance (p=0.058) was also registered. CONCLUSION: This study adds evidence to the little explored link between apoptosis and angiogenesis. Furthermore, it discloses a previously unreported relationship between Bax and Nup88 expression.

[Mitochondrial encephalopathy due to complex I deficiency. Brain tissue biopsy findings and clinical course following pharmacological]. / Encefalopatia mitocondrial por deficit del complejo I. Hallazgos en la biopsia cerebral y evolucion clinica tras tratamiento farmacologico.

INTRODUCTION: Mitochondrial encephalomyopathies belong to a heterogeneous group of diseases with a range of neurological symptoms caused by a dysfunction somewhere in the nervous system. They may arise from mutations of the mitochondrial DNA or nuclear DNA in the genes that code for the subunits of the respiratory chain. The results obtained from using different drugs to treat these diseases vary widely. CASE REPORT: A 33-year-old female with a history of migraine with aura, who was admitted to hospital because of epileptic seizures. Neuroimaging tests showed left-side occipital insult and a biopsy study of a sample of brain tissue revealed gliosis and vacuolisation of the white matter. Lactic acid levels in blood were normal. No ragged red fibres were seen in the muscle biopsy, but there was evidence of a complex I deficiency in the respiratory chain. After establishing treatment with coenzyme Q and riboflavin, the patient had no further episodes of neurological disorders. CONCLUSIONS: The absence of elevated levels of lactate, ragged red fibres in the muscle biopsy or the negative results for mutations in the genetic study do not rule out the possible existence of a mitochondrial disease. The gliosis and vacuolisation of the white matter with respect to the neurons that were found in the results of the brain tissue biopsy must lead us to consider a mitochondrial disease.