Influence of the age at diagnosis in the disease expression of primary Sjögren syndrome. Analysis of 12,753 patients from the Sjögren Big Data Consortium.

OBJECTIVES: To analyse how the main components of the disease phenotype (sicca symptoms, diagnostic tests, immunological markers and systemic disease) can be driven by the age at diagnosis of primary Sjögren's syndrome (pSS). METHODS: By January 2021, the participant centres had included 12,753 patients from 25 countries that fulfilled the 2002/2016 classification criteria for pSS. The age at diagnosis was defined as the time when the attending physician confirmed fulfilment of the criteria. Patients were clustered according to age at diagnosis. 50 clusters with more than 100 observations (from 27 to 76 years) were used to study the influence of the age at diagnosis in the disease expression. RESULTS: There was a consistent increase in the frequency of oral dryness according to the age at diagnosis, with a frequency of <90% in patients diagnosed at the youngest ages and >95% in those diagnosed at the oldest ages. The smooth curves that best fitted a linear model were the frequency of dry mouth (adjusted R2 0.87) and the frequency of abnormal oral tests (adjusted R2 0.72). Therefore, for each 1-year increase in the age at diagnosis, the frequency of dry mouth increased by 0.13%, and the frequency of abnormal oral diagnostic tests by 0.11%. There was a consistent year-by-year decrease in the frequency of all autoantibodies and immunological markers except for cryoglobulins. According to the linear models, for each 1-year increase in the age at diagnosis, the frequency of a positive result decreased by 0.57% (for anti-Ro antibodies), 0.47% (for RF) and 0.42% (for anti-La antibodies). The ESSDAI domains which showed a more consistent decrease were glandular and lymph node involvement (for each 1-year increase in the age at diagnosis, the frequency of activity decreased by 0.18%), and constitutional, cutaneous, and haematological involvements (the frequency decreased by 0.09% for each 1-year increase). In contrast, other domains showed an ascending pattern, especially pulmonary involvement (for each 1-year increase in the age at diagnosis, the frequency of activity increased by 0.22%), and peripheral nerve involvement (the frequency increased by 0.09% for each 1-year increase). CONCLUSIONS: The influence of the age at diagnosis on the key phenotypic features of pSS is strong, and should be considered critical not only for designing a personalised diagnostic approach, but also to be carefully considered when analysing the results of diagnostic tests and immunological parameters, and when internal organ involvement is suspected at diagnosis.

Prognostic Factors of Death in 151 Adults With Hemophagocytic Syndrome: Etiopathogenically Driven Analysis.

OBJECTIVE: To characterize the etiologies and clinical features at diagnosis of patients with hemophagocytic lymphohistiocytosis (HLH) and correlate these baseline features with survival using an etiopathogenically guided multivariable model. PATIENTS AND METHODS: The Spanish Group of Autoimmune Diseases HLH Study Group, formed in 2013, is aimed at collecting adult patients with HLH diagnosed in internal medicine departments between January 3, 2013, and October 28, 2017. RESULTS: The cohort consisted of 151 patients (91 men; mean age, 51.4 years). After a mean follow-up of 17 months (range, 1-142 months), 80 patients died. Time-to-event analyses for death identified a worse survival curve for patients with neoplasia (P<.001), mixed microbiological infections (P=.02), and more than 1 infection (P=.01) and glucocorticoid monotherapy (P=.02). According to univariate analyses, platelets of less than 100,000/mm3 (hazard ratio [HR], 3.39; 95% CI, 1.37-8.40), leukopenia (HR, 1.81; 95% CI, 1.01-3.23), severe hyponatremia (HR, 1.61; 95% CI, 1.02-2.54), disseminated intravascular coagulation (HR, 1.87; 95% CI, 1.05-3.34), bacterial infection (HR, 1.99; 95% CI, 1.09-3.63), mixed microbiological infections (HR, 3.42; 95% CI, 1.38-8.46), and 2 or more infectious triggers (HR, 2.95; 95% CI, 1.43-6.08) were significantly associated with death. In contrast, peripheral adenopathies (HR, 0.63; 95% CI, 0.40-0.98) and the immunosuppressive drug/intravenous immunoglobulin/biological therapies (HR, 0.44; 95% CI, 0.20-0.96) were protective against all-cause mortality. Multivariable Cox proportional hazards regression analysis identified 2 or more infectious triggers (HR, 3.14; 95% CI, 1.28-7.68) as the only variable independently associated with death. CONCLUSION: The mortality rate of adult patients diagnosed with HLH exceeds 50%. Infection with more than 1 microbiological agent was the only independent variable associated with mortality irrespective of the underlying disease, epidemiological profile, clinical presentation, and therapeutic management.

Severe, life-threatening phenotype of primary Sjögren's syndrome: clinical characterisation and outcomes in 1580 patients (GEAS-SS Registry).

OBJECTIVES: To analyse the clinical features and outcomes of patients presenting with life-threatening systemic disease in a large cohort of Spanish patients with primary Sjögren's syndrome (SS). METHODS: The GEAS-SS multicentre registry was formed in 2005 with the aim of collecting a large series of Spanish patients with primary SS, and included more than 20 Spanish reference centres with substantial experience in the management of SS patients. By January 2018, the database included 1580 consecutive patients fulfilling the 2002 classification criteria for primary SS. Severe, life-threatening systemic disease was defined as an activity level scored as "high" in at least one ESSDAI domain. RESULTS: Among 1580 patients, 208 (13%) were classified as presenting a severe, potentially life-threatening systemic disease: 193 presented one ESSDAI domain classified as high, 14 presented two high scored domains and only one presented three high activity domains. The ESSDAI domains involved consisted of lymphadenopathy in 78 (37%) cases, CNS in 28 (13%), PNS in 25 (12%), pulmonary in 25 (12%), renal in 21 (10%), cutaneous in 19 (9%), articular in 18 (9%), haematological in 7 (3%) and muscular in 4 (2%). Patients with severe systemic disease were more frequently men (p=0.001) and had a higher frequency of anaemia (p<0.001), lymphopenia (p<0.001), rheumatoid factor (p=0.021), low C3 levels (p=0.015), low C4 levels (p<0.001) and cryoglobulins (p<0.001). From a therapeutic point of view, systemic patients received more frequently glucocorticoids (p<0.001), immunosuppressants (p<0.001), intravenous immunoglobulins (p=0.008) and rituximab (p<0.001). We found an overall mortality rate of 20% in severe systemic patients, a rate that reached to 33% in patients presenting two or more high systemic involvements; these patients had a higher frequency of low C4 levels (p=0.012) and cryoglobulins (p=0.001) in comparison with those with a single severe organ involved. CONCLUSIONS: 13% of patients with primary SS develop a potentially life-threatening systemic disease (mainly lymphoma, but also severe internal organ involvements including nervous system, the lungs and the kidneys). This subset of patients requires intensive therapeutic management with a mortality rate of nearly 20% of cases.

Ultrastructure of compatible and incompatible interactions in phloem sieve elements during the stylet penetration by cotton aphids in melon.

Resistance of the melon line TGR-1551 to the aphid Aphis gossypii is based on preventing aphids from ingesting phloem sap. In electrical penetration graphs (EPGs), this resistance has been characterized with A. gossypii showing unusually long phloem salivation periods (waveform E1) mostly followed by pathway activities (waveform C) or if followed by phloem ingestion (waveform E2), ingestion was not sustained for more than 10 min. Stylectomy with aphids on susceptible and resistant plants was performed during EPG recording while the stylet tips were phloem inserted. This was followed by dissection of the penetrated leaf section, plant tissue fixation, resin embedding, and ultrathin sectioning for transmission electron microscopic observation in order to study the resistance mechanism in the TGR. The most obvious aspect appeared to be the coagulation of phloem proteins inside the stylet canals and the punctured sieve elements. Stylets of 5 aphids per genotype were amputated during sieve element (SE) salivation (E1) and SE ingestion (E2). Cross-sections of stylet bundles in susceptible melon plants showed that the contents of the stylet canals were totally clear and also, no coagulated phloem proteins occurred in their punctured sieve elements. In contrast, electron-dense coagulations were found in both locations in the resistant plants. Due to calcium binding, aphid saliva has been hypothesized to play an essential role in preventing/suppressing such coagulations that cause occlusion of sieves plate and in the food canal of the aphid's stylets. Doubts about this role of E1 salivation are discussed on the basis of our results.

Characterization and risk estimate of cancer in patients with primary Sjögren syndrome.

BACKGROUND: The purpose of this study is to characterize the risk of cancer in a large cohort of patients with primary Sjögren syndrome (SjS). METHODS: We had analyzed the development of cancer in 1300 consecutive patients fulfilling the 2002 SjS classification criteria. The baseline clinical and immunological characteristics and systemic activity (ESSDAI scores) were assessed at diagnosis as predictors of cancer using Cox proportional hazards regression analysis adjusted for age at diagnosis and gender. The sex-and age-specific standardized incidence ratios (SIR) of cancer were estimated from 2012 Spanish mortality data. RESULTS: After a mean follow-up of 91 months, 127 (9.8%) patients developed 133 cancers. The most frequent type of cancer was B-cell lymphoma (including 27 MALT and 19 non-MALT B-cell lymphomas). Systemic activity at diagnosis of primary SjS correlated with the risk of hematological neoplasia and cryoglobulins with a high risk of either B-cell or non-B-cell lymphoma subtypes. Patients with cytopenias had a high risk of non-MALT B-cell and non-B-cell cancer, while those with low C3 levels had a high risk of MALT lymphomas and those with monoclonal gammopathy and low C4 levels had a high risk of non-MALT lymphomas. The estimated SIR for solid cancer was 1.13 and 11.02 for hematological cancer. SIRs for specific cancers were 36.17 for multiple myeloma and immunoproliferative diseases, 19.41 for Hodgkin lymphoma, 6.04 for other non-Hodgkin lymphomas, 5.17 for thyroid cancer, 4.81 for cancers of the lip and oral cavity, and 2.53 for stomach cancer. CONCLUSIONS: One third of cancers developed by patients with primary SjS are B-cell lymphomas. The prognostic factors identified at SjS diagnosis differed according to the subtype of B-cell lymphoma developed. Primary SjS is also associated with the development of some non-hematological cancers (thyroid, oral cavity, and stomach).

Azoarcus sp. CIB, an anaerobic biodegrader of aromatic compounds shows an endophytic lifestyle.

BACKGROUND: Endophytic bacteria that have plant growth promoting traits are of great interest in green biotechnology. The previous thought that the Azoarcus genus comprises bacteria that fit into one of two major eco-physiological groups, either free-living anaerobic biodegraders of aromatic compounds or obligate endophytes unable to degrade aromatics under anaerobic conditions, is revisited here. METHODOLOGY/PRINCIPAL FINDINGS: Light, confocal and electron microscopy reveal that Azoarcus sp. CIB, a facultative anaerobe ß-proteobacterium able to degrade aromatic hydrocarbons under anoxic conditions, is also able to colonize the intercellular spaces of the rice roots. In addition, the strain CIB displays plant growth promoting traits such nitrogen fixation, uptake of insoluble phosphorus and production of indoleacetic acid. Therefore, this work demonstrates by the first time that a free-living bacterium able to degrade aromatic compounds under aerobic and anoxic conditions can share also an endophytic lifestyle. The phylogenetic analyses based on the 16S rDNA and nifH genes confirmed that obligate endophytes of the Azoarcus genus and facultative endophytes, such as Azoarcus sp. CIB, locate into different evolutionary branches. CONCLUSIONS/SIGNIFICANCE: This is the first report of a bacterium, Azoarcus sp. CIB, able to degrade anaerobically a significant number of aromatic compounds, some of them of great environmental concern, and to colonize the rice as a facultative endophyte. Thus, Azoarcus sp. CIB becomes a suitable candidate for a more sustainable agricultural practice and phytoremediation technology.

Ver, oír y aprender. Una filmación educativa para la enseñanza de habilidades en exploración física / Watch, listen and learn. An educational film for teaching physical examination skills

Introducción: Hemos desarrollado un cortometraje educativo para la formación en exploración física de estudiantes de medicina de tercer año, sin experiencia previa en habilidades clínicas. Materiales y métodos: El estudio se ha realizado en el Servicio de Medicina Interna del Hospital Universitari Sagrat Cor de Barcelona durante dos años consecutivos. Se efectuaron evaluaciones sobre exploración física de los estudiantes antes y después de ver la película. La primera evaluación se llevó a cabo el primer día de estancia de los estudiantes en el hospital. A continuación, visualizaron la filmación y se les informó de que al cabo de 48 horas se efectuaría una segunda evaluación en la que deberían realizar una exploración física de acuerdo con lo que habían visto y oído en el cortometraje. Al final del período de seis semanas de estancia en el hospital se realizó una tercera evaluación. Todas las evaluaciones se llevaron a cabo por el mismo profesor, a partir de un listado de contenidos evaluativos elaborado previamente. Resultados: Después de ver la película, 48 horas después de su llegada al hospital, los estudiantes habían mejorado en las diferentes pruebas de exploración física, en una tasa media del 43,4%. Al cabo de seis semanas, se apreció un 14,3% de mejora en relación con la segunda evaluación del tercer día del curso. Conclusión: Un cortometraje es un buen medio para la formación en la exploración física normal, más rápido que otros sistemas de enseñanza y favorece la adopción de competencias estables

Introduction: We created a short educational film to teach third-year medical students on physical examination, without previous experience in clinical skills. Designed to be understood without other explanations than those which appear in the film, the students are shown the film on their first day in the hospital. Materials and methods: The study has been made in the Department of Internal Medicine at the University Hospital Sagrat Cor of Barcelona during two consecutives course years. We assess the educational possibilities of this resource testing student skills before and after watching the film. The first evaluation was held on the students' first day in the hospital and they were informed that 48 hours later they would be given a second evaluation where they had to do a physical exploration according to the film. At the end of the 6-week period in the internal medicine department the third evaluation was given. All of these explorations were performed by the same professor with a same check list. Results: After watching the film, 48 hours after their arrival, the students had improved in the different tests on physical exploration, at an average rate of 43.4%. At the end of the stage their progression was of 14.3% improvement in relation to the third day of the course. Conclusion: A short film is a good element for training in normal physical exploration, faster than other teaching systems, and also gives permanent skills

Elementos diagnósticos en medicina interna 2003-2010 / Diagnostics elements in internal medicine 2003-2010

Introducción. Desde el curso 2003-2004 impartimos en la Facultad de Medicina de la Universitat de Barcelona la asignatura optativa semipresencial 'Elementos diagnósticos en medicina interna', en la que se aborda el diagnóstico a través de análisis de laboratorio, pruebas funcionales, de imagen y electrocardiografía. Materiales y métodos. Tras las sesiones presenciales, el material docente se deposita en la página web o campus virtual de la asignatura, a partir del cual los estudiantes responden a seis cuestionarios. Resultados. En el curso 2008-2009 se matricularon 61 alumnos de cuarto a sexto curso. Veintisiete alumnos (44,26%) respondieron correctamente a más de la mitad de las preguntas, el 31,15% no alcanzó esta cifra y el 24,59% no completó el programa de evaluaciones. Las puntuaciones más altas se han dado de las pruebas funcionales respiratorias, y las más bajas, en la evaluación de la radiografía de tórax. Conclusiones. No es fácil la evaluación de competencias clínicas. El coste de realización de las pruebas y la resistencia de los estudiantes a ser evaluados quedan soslayados en esta experiencia, donde los estudiantes se matriculan voluntariamente. La sencillez del proyecto permitiría evaluar en competencias clínicas a todos los estudiantes de la facultad en los cursos clínicos cuando aún es posible la formación. Una vez comprobado que los estudiantes tienen una buena aceptación del sistema propuesto, se podría diseñar un sistema de acceso a créditos docentes y un plan de formación específica en las materias no superadas (AU)

Introduction. From the course 2003-2004, we give in the Faculty of Medicine of the University of Barcelona a matter called Diagnostics Elements in Internal Medicine, for the diagnostic through analysis of laboratory, functional proofs, of image and electrocardiogram. Materials and methods. All the educational material is deposited in the page web of the topic and through it the students answer the 6 questionnaires. Results. In the course 2008-2009, 61 students have choose the topic. 27 students (44,26%) answered correctly more than 50% of the questions. 31,15% did not achieve this figure and 24,59% did not complete the program of evaluations. The highest punctuations have given in respiratory functional proofs and the lowest in the evaluation of the thoracic X-ray. Conclusions. It's not easy the evaluation of clinical skills. The cost of realization of the proofs and the resistance of the students to be evaluated remain skewed in this experience where the students participate voluntarily. The simplicity of the project would allow evaluating in clinical skills all the students of the faculty in the clinical courses period when it still is possible the training. The students have a good acceptance of the system proposed, and it could design a system of access to educational credits and a plan of specific training in the no surpassed matters (AU)

Long-term implications of a single home-based educational intervention in patients with heart failure.

OBJECTIVE: The objective of the study was to evaluate the effectiveness of a single home-based educational intervention for patients admitted with heart failure. METHODS: There were 106 patients: 42 in the intervention group and 64 in the control group. Patients were randomly assigned to receive an intervention by nursing staff 1 week after discharge. Primary end points were readmissions, emergency department visits, deaths, costs, and quality of life. RESULTS: During the 24-month follow-up, there were fewer mean emergency department visits in the intervention group than in the control group (.68 vs 2.00; P = .000), fewer unplanned readmissions (.68 vs 1.71; P = .000), and lower costs (€ 671.56 = $974.63 = GBP598.42 per person vs € 2,154.24 = $3,126.01 = GBP1,919.64; P = .001). There was a trend toward fewer out-of-hospital deaths (14 [46.6%] vs 31 [55.3%]; P = .45) and improvement in quality of life. CONCLUSION: Patients with heart failure who receive a home-based educational intervention experience fewer emergency department visits and unplanned readmissions with lower healthcare costs.

Heparin-binding EGF-like growth factor in human serum. Association with high blood cholesterol and heart hypertrophy.

Heparin-binding epidermal growth factor-like growth factor (HB-EGF) belongs to the EGF family of growth factors which are ligands of the ErbB receptors. Studies in animals suggest the role of HB-EGF in several pathogenic processes such as atherosclerosis and heart hypertrophy. Here, we set up an assay to measure HB-EGF in human serum. Our ELISA determined serum HB-EGF in the range of 0.03-3 nM. It did not cross-react with EGF or with transforming growth factor-alpha. The mean serum HB-EGF was 0.26 nM (confidence interval: 0.13-0.39) in women and 0.28 nM (confidence interval: 0.09-0.47) in men. In a cohort of 121 healthy volunteers, we identified nine individuals with high serum HB-EGF (above 0.47 nM). These individuals had higher left ventricle mass (determined by Colour Doppler echocardiography) and greater total and low density lipoprotein cholesterol than control. On the basis of our results, we propose that increased serum HB-EGF is associated with heart hypertrophy and elevated blood cholesterol.

Overexpression of flavodoxin in bacteroids induces changes in antioxidant metabolism leading to delayed senescence and starch accumulation in alfalfa root nodules.

Sinorhizobium meliloti cells were engineered to overexpress Anabaena variabilis flavodoxin, a protein that is involved in the response to oxidative stress. Nodule natural senescence was characterized in alfalfa (Medicago sativa) plants nodulated by the flavodoxin-overexpressing rhizobia or the corresponding control bacteria. The decline of nitrogenase activity and the nodule structural and ultrastructural alterations that are associated with nodule senescence were significantly delayed in flavodoxin-expressing nodules. Substantial changes in nodule antioxidant metabolism, involving antioxidant enzymes and ascorbate-glutathione cycle enzymes and metabolites, were detected in flavodoxin-containing nodules. Lipid peroxidation was also significantly lower in flavodoxin-expressing nodules than in control nodules. The observed amelioration of the oxidative balance suggests that the delay in nodule senescence was most likely due to a role of the protein in reactive oxygen species detoxification. Flavodoxin overexpression also led to high starch accumulation in nodules, without reduction of the nitrogen-fixing activity.

A light and electron microscopy analysis of the events leading to male sterility in Ogu-INRA CMS of rapeseed (Brassica napus).

Ogura cytoplasmic male sterility (CMS) occurs naturally in radish and has been introduced into rapeseed (Brassica napus) by protoplast fusion. As with all CMS systems, it involves a constitutively expressed mitochondrial gene which induces male sterility to otherwise hermaphroditic plants (so they become females) and a nuclear gene named restorer of fertility that restores pollen production in plants carrying a sterility-inducing cytoplasm. A correlative approach using light and electron microscopy was applied to define what stages throughout development were affected and the subcellular events leading to the abortion of the developing pollen grains upon the expression of the mitochondrial protein. Three central stages of development (tetrad, mid-microspore and vacuolate microspore) were compared between fertile, restored, and sterile plants. At each stage observed, the pollen in fertile and restored plants had similar cellular structures and organization. The deleterious effect of the sterility protein expression started as early as the tetrad stage. No typical mitochondria were identified in the tapetum at any developmental stage and in the vacuolate microspores of the sterile plants. In addition, some striking ultrastructural alterations of the cell's organization were also observed compared with the normal pattern of development. The results showed that Ogu-INRA CMS was due to premature cell death events of the tapetal cells, presumably by an autolysis process rather than a normal PCD, which impairs pollen development at the vacuolate microspore stage, in the absence of functional mitochondria.

[Utility of the Minnesota Living With Heart Failure Questionnaire for assessing quality of life in heart failure patients]. / Utilidad del Minnesota Living With Heart Failure Questionnaire en la evaluación de la calidad de vida en enfermos con insuficiencia cardiaca.

The Minnesota Living With Heart Failure Questionnaire (MLWHFQ) was used to evaluate the quality of life of patients with heart failure, both before and 6 months after an educational intervention. The study included 99 patients (70 male) with a mean age of 78 years. Significant correlations were found between the MLWHFQ score and the SF-36 score (r=0.41, P=.01), the Barthel Index score (r=-0.23, P=.02), New York Heart Association functional class (r=0.37, P=.01), and the number of readmissions within 6 months (r=0.47, P< .002). Following the intervention, the MLWHFQ score decreased by 34 points (P=.0001). The MLWHFQ score appears to be a useful measure: there were good correlations with functional class and the SF-36 score, and the measure was sensitive to changes in health since there was also a correlation with the patients' prognosis.

Utilidad del Minnesota Living With Heart Failure Questionnaire en la evaluación de la calidad de vida en enfermos con insuficiencia cardiaca / Utility of the minnesota living with heart Failure Questionnaire for Assessing Quality of Life in Heart Failure Patients

Hemos estudiado la utilidad del Minnesota Living With Heart Failure Questionnaire (MLWHFQ) en la calidad de vida de los pacientes con insuficiencia cardiaca, aplicándolo antes y a los 6 meses de una intervención educativa. De los 99 pacientes (70 varones; media de edad, 78 años) hemos encontrado una correlación entre la puntuación del MLWHFQ y las del SF-36 (p = 0,01; r = 0,41), el índice de Barthel (p = 0,02; r = ­0,23), la clase funcional (p = 0,01; r = 0,37) y el número de ingresos en 6 meses (p < 0,002; r = 0,47). La intervención disminuye la puntuación del MLWHFQ 34 puntos (p = 0,0001). El MLWHFQ es un instrumento válido, pues se correlaciona con la clase funcional y con el SF-36, y es sensible a los cambios de salud, ya que se correlaciona con el pronóstico de los pacientes (AU)

The Minnesota Living With Heart Failure Questionnaire (MLWHFQ) was used to evaluate the quality of life of patients with heart failure, both before and 6 months after an educational intervention. The study included 99 patients (70 male) with a mean age of 78 years. Significant correlations were found between the MLWHFQ score and the SF-36 score (r=0.41, P=.01), the Barthel Index score (r=­0.23, P=.02), New York Heart Association functional class (r=0.37, P=.01), and the number of readmissions within 6 months (r=0.47, P<.002). Following the intervention, the MLWHFQ score decreased by 34 points (P=.0001). The MLWHFQ score appears to be a useful measure: there were good correlations with functional class and the SF-36 score, and the measure was sensitive to changes in health since there was also a correlation with the patients' prognosis (AU)

[Computed tomographic measurement of coronary artery calcification in the assessment of cardiovascular risk: a descriptive study]. / La determinación de calcio coronario con tomografía computarizada en la evaluación del riesgo cardiovascular: un estudio descriptivo.

INTRODUCTION AND OBJECTIVES: Measurement of coronary artery calcification (CAC) is used in the evaluation of cardiovascular risk. We investigated its usefulness by comparing CAC assessment with that of various risk charts. METHODS: We determined cardiovascular risk in patients without known atherosclerosis using the 1998 European Task Force (ETF), REGICOR (Registre Gironí del Corazón) and SCORE (Systematic Coronary Risk Evaluation) charts. CAC was assessed by computerized tomography and measurements were classified as low risk (i.e., score <1), intermediate risk (i.e., score 1-100), or high risk (i.e., score >100). RESULTS: The study included 331 patients (mean age 54 [8.5] years, 89% male). In 44.1%, CAC was detected (mean score 96 [278]). The degree of agreement between the cardiovascular risk derived from the CAC score and that derived from the SCORE and ETF charts was acceptable: kappa=.33 (P<.05) and kappa=.28 (P<.05), respectively, but agreement was poor with the REGICOR chart: kappa=.02 (P=.32). The SCORE and ETF charts, respectively, classified 45.0% and 38.3% of patients with a CAC score >100 as high risk, whereas the REGICOR chart did not classify any of these patients as high risk. Male sex, older age, smoking history, and a family history of coronary heart disease were all associated with the detection of CAC. CONCLUSIONS: Measurement of CAC demonstrated calcification in 44.1% of patients without known atherosclerosis. By regarding those with a CAC score > 100 as high-risk, 10.4% of patients evaluated using the SCORE chart would be reclassified as high risk, as would 11.6% of those evaluated using the ETF chart, and 18.9% of those evaluated using the REGICOR chart. Consequently, more patients would be eligible for preventative treatment.

La determinación de calcio coronario con tomografía computarizada en la evaluación del riesgo cardiovascular: un estudio descriptivo / Computed tomographic measurement of coronary artery calcification in the assessment of cardiovascular risk: a descriptive study

Introducción y objetivos. La cuantificación de calcio coronario (CCC) es una herramienta que evalúa el riesgo cardiovascular. Hemos valorado su utilidad mediante la comparación de distintas tablas de riesgo con la CCC. Métodos. Se midió el riesgo cardiovascular (Task Force Europea de 1998 [TFE], Registre Gironí del Cor [REGICOR] y Systematic Coronary Risk Evaluation [SCORE]) de individuos sin arterioesclerosis conocida. Se realizó una CCC con tomografía computarizada y se clasificaron en función de la CCC en riesgos bajo ( 100). Resultados. Se incluyó a 331 personas (edad media 54 ± 8,5 años, 89% varones). En el 44,1% se detectó calcio en la CCC (mediana 96 ± 278). El grado de acuerdo entre el riesgo cardiovascular calculado según CCC y las tablas SCORE y TFE fue aceptable (κ = 0,33; p 100, mientras que REGICOR no identificaría como de alto riesgo a ninguno de ellos. El sexo masculino, la edad avanzada, el tabaquismo y los antecedentes familiares de cardiopatía isquémica se asociaron con la detección de calcio coronario. Conclusiones. La CCC detectó calcio en el 44,1% de los pacientes sin historia de cardiopatía isquémica. Estos individuos con un índice de calcio coronario > 100 podrían reclasificarse como pacientes de riesgo alto, lo que ocurriría en el 10,4% de las personas analizadas con SCORE, el 11,6% con TFE y en el 18,9% con REGICOR e incrementaría el número de individuos candidatos a un tratamiento preventivo

Introduction and objectives. Measurement of coronary artery calcification (CAC) is used in the evaluation of cardiovascular risk. We investigated its usefulness by comparing CAC assessment with that of various risk charts. Methods. We determined cardiovascular risk in patients without known atherosclerosis using the 1998 European Task Force (ETF), REGICOR (Registre Gironí del Corazón) and SCORE (Systematic Coronary Risk Evaluation) charts. CAC was assessed by computerized tomography and measurements were classified as low risk (i.e., score 100). Results. The study included 331 patients (mean age 54 [8.5] years, 89% male). In 44.1%, CAC was detected (mean score 96 [278]). The degree of agreement between the cardiovascular risk derived from the CAC score and that derived from the SCORE and ETF charts was acceptable: κ=.33 (P100 as high risk, whereas the REGICOR chart did not classify any of these patients as high risk. Male sex, older age, smoking history, and a family history of coronary heart disease were all associated with the detection of CAC. Conclusions. Measurement of CAC demonstrated calcification in 44.1% of patients without known atherosclerosis. By regarding those with a CAC score > 100 as high-risk, 10.4% of patients evaluated using the SCORE chart would be reclassified as high risk, as would 11.6% of those evaluated using the ETF chart, and 18.9% of those evaluated using the REGICOR chart. Consequently, more patients would be eligible for preventative treatment

[Evaluation of a home-based intervention in heart failure patients. Results of a randomized study]. / Evaluación de una intervención domiciliaria en pacientes con insuficiencia cardíaca. Resultados de un estudio aleatorizado.

INTRODUCTION AND OBJECTIVES: Home-based interventions after hospital discharge in patients with heart failure (HF) have been shown to decrease readmission and mortality rates. The primary aim of this study was to determine the effect of a home-based educational intervention carried out by nursing staff on the readmission rate, emergency department visits, and healthcare costs. PATIENTS AND METHOD: Patients hospitalized with systolic HF were randomly assigned to receive either usual care or a single home-based educational intervention 1 week after discharge. RESULTS: Between July 2001 and November 2002, 70 patients entered the study: 34 in the intervention group and 36 in the control group. During the 6-month follow-up, there were fewer unplanned readmissions in the intervention group than in the control group (0.09 vs 0.94; P<.001), fewer emergency department visits (0.21 vs 1.33; P<.001), and fewer out-of-hospital deaths (2 vs 11; P<.01). Costs were also significantly lower in the intervention group (difference, ; 1190.9; P<.001). Moreover, patient-perceived health status, as indicated by scores on a quality-of-life questionnaire, increased significantly in the intervention group. CONCLUSIONS: In a cohort of patients with systolic HF who received a home-based educational intervention there were significant reductions in the unplanned readmission rate, mortality, and healthcare costs, and better quality of life. Some limitations of the study warrant validation of the resultats in further studies.

Evaluación de una intervención domiciliaria en pacientes con insuficiencia cardíaca. Resultados de un estudio aleatorizado / Evaluation of a home-based intervention in heart failure patients. Results of a randomized study

Introducción y objetivos. Conocida la eficacia de los programas domiciliarios para pacientes con insuficiencia cardíaca (IC), nos hemos propuesto evaluar las diferencias en los ingresos hospitalarios, las visitas al servicio de urgencias, los costes económicos y la calidad de vida tras una intervención educativa en el domicilio una semana después del alta, realizada por personal de enfermería. Pacientes y método. Los pacientes ingresados por IC sistólica en los servicios de cardiología y medicina interna fueron distribuidos, mediante tabla de números aleatorios, en un grupo que recibió intervención educativa y otro grupo control que fue atendido de forma convencional. Resultados. Desde julio de 2001 hasta noviembre de 2002 se distribuyó a 70 pacientes en los 2 grupos. A los 6 meses de seguimiento, el grupo de 34 pacientes que recibió la intervención educativa, comparado con el grupo de 36 pacientes que no la recibió, tuvo en promedio menos visitas a urgencias (0,21 frente a 1,33; p < 0,001), menos ingresos hospitalarios (0,09 frente a 0,94; p < 0,001) y con un menor coste por individuo (diferencia ajustada: 1.190,9 €; p < 0,001). La salud percibida mejoró de forma significativa en el grupo de intervención. También se observó una disminución significativa de la mortalidad (2 frente a 11; p < 0,01). Conclusiones. Los pacientes con IC sistólica que han recibido una intervención educativa domiciliaria tienen una significativa menor tasa de reingresos, mortalidad y coste, con una mejor calidad de vida. Algunas limitaciones del estudio hacen recomendable la replicación de las observaciones

Introduction and objectives. Home-based interventions after hospital discharge in patients with heart failure (HF) have been shown to decrease readmission and mortality rates. The primary aim of this study was to determine the effect of a home-based educational intervention carried out by nursing staff on the readmission rate, emergency department visits, and healthcare costs. Patients and method. Patients hospitalized with systolic HF were randomly assigned to receive either usual care or a single home-based educational intervention 1 week after discharge. Results. Between July 2001 and November 2002, 70 patients entered the study: 34 in the intervention group and 36 in the control group. During the 6-month follow-up, there were fewer unplanned readmissions in the intervention group than in the control group (0.09 vs 0.94; P<.001), fewer emergency department visits (0.21 vs 1.33; P<.001), and fewer out-of-hospital deaths (2 vs 11; P<.01). Costs were also significantly lower in the intervention group (difference, € 1190.9; P<.001). Moreover, patient-perceived health status, as indicated by scores on a quality-of-life questionnaire, increased significantly in the intervention group. Conclusions. In a cohort of patients with systolic HF who received a home-based educational intervention there were significant reductions in the unplanned readmission rate, mortality, and healthcare costs, and better quality of life. Some limitations of the study warrant validation of the resultats in further studies