Can Achilles tendinosis be treated effectively with lidocaine and glucose infiltrations, and if so, is the effect lasting? A longitudinal, observational on 27 consecutive patients.

OBJECTIVE: Our aim was to add to the small but growing body of evidence on the effectiveness of ultrasound-guided Achilles intratendinous hyperosmolar dextrose prolotherapy and introduce a novel, preceding step of paratenon hydrodissection with lidocaine in patients with chronic Achilles tendinosis resistant to rehabilitation therapy. METHODS: We conducted a longitudinal, observational study on 27 consecutive patients diagnosed with Achilles tendinosis, in whom conservative treatment, ie, physiotherapy or shock wave therapy, had failed. A 2% lidocaine paratenon anesthesia and hydrodissection was followed by ultrasound-guided, intratendinous injections of 25% glucose every 5 weeks. Visual analogue scales (VAS) were used for pain assessment at rest, for activities of daily living, and after moderate exercise at the begining and at the end of the treatment. Moreover, tendon thickness and vascularisation were recorded at baseline and final treatment consultation. Effectiveness was estimated from scoring and relative pain reduction using a 95% CI. The non-parametric Wilcoxon test and a general linear model for repeated measures were applied. Statistical significance was established as p < 0.05. RESULTS: A median of 5 (1-11) injection consultations per patient were required. Pain scores decreased significantly in all three conditions (p < 0.001). Relative reductions were 75% in pain at rest (95% CI;61-93%), 69% in pain with daily living activities (95% CI; 55-83%), and 70% in pain after moderate exercise (95% CI; 57-84%). Tendon neo-vascularisation was significantly reduced (p < 0.001). We did not observe significant changes in tendon thickness (p = 0.083). CONCLUSIONS: Achilles tendinosis treatment with paratenon lidocaine hydrodissection and subsequent prolotherapy with hyperosmolar glucose solution is safe, effective, inexpensive, and virtually painless with results maintained over time.

Efficacy of Human Papillomavirus Vaccination 4 Years After Conization for High-Grade Cervical Neoplasia.

OBJECTIVE: The aim of the study was to estimate human papillomavirus (HPV) vaccination efficacy in reducing recurrence risk within 4 years after conization for high-grade cervical neoplasia. MATERIALS AND METHODS: From January 2012 to June 2015, we performed a longitudinal, observational study (case-series study) on patients diagnosed with cervical intraepithelial neoplasia 2-3 neoplasia. Efficacy was estimated by a 95% CI of the relative risk, relative risk reduction, attributable risk, and number needed to treat. Parametric and nonparametric tests were used as appropriate to compare 160 vaccinated with 171 nonvaccinated patients. To estimate the hazard ratio of the vaccinated status, patients were subjected to multivariable analyses based on the Cox proportional hazard model. To compare recurrence-free survival, a Kaplan-Meier model and a log-rank test were applied. RESULTS: The overall recurrence was 9.4% in the nonvaccinated and 2.5% in the vaccinated group (p = .009). Vaccination was associated with a significant decrease in the relative risk (73.5%, 95% CI = 21.8%-90.9%) with a mean number needed to treat of 14 patients per relapse prevented. Although positive conization margins were related to the highest recurrence risk, not being vaccinated independently increased this risk 3.5-fold in a 4-year follow-up (p = .025). Cumulative recurrence-free rates differed significantly between both groups (log-rank test: p = .009). CONCLUSIONS: Our study corroborates the benefits of HPV vaccination, recommends a closer and longer follow-up in nonvaccinated women, and offers a 4-year prognosis for patients undergoing conization for high-grade cervical lesions.

The COPD Comorbidome in the Light of the Degree of Dyspnea and Risk of Exacerbation.

The BODE group designed a bubble chart, analogous to the solar system, which depicts the prevalence of each disease and its association with mortality and called it a "comorbidome". Although this graph was used to represent mortality and, later, the risk of needing hospital admission, it was not applied to visualize the association between a set of comorbidities and the categories of the GOLD 2017 guidelines, neither according to the degree of dyspnea nor to the risk of exacerbation. For the purpose of knowing to which extent each comorbidity associates with each of the two conditions-most symptomatic group (groups B and D) and highest risk of exacerbation (groups C and D)-we performed a analysis based on the comorbidome. 439 patients were included. Cardiovascular comorbidity (especially cardiac and renal disease) is predominantly observed in patients with a higher degree of dyspnea, whereas bronchial asthma and stroke occur more frequently in subjects at higher risk of exacerbation. This is the first time that the comorbidome is presented based on the categories of the GOLD 2017 document, which we hope will serve as a stimulus for scientific debate.

Health Status in Patients with COPD According to GOLD 2017 Classification: Use of the COMCOLD Score in Routine Clinical Practice.

The COMCOLD score was developed to quantify the impact of comorbidities on health status in patients with chronic obstructive pulmonary disease (COPD). The objective of this study is to evaluate the association between health status in outpatients with COPD according to COMCOLD score and the GOLD 2017 groups according to symptoms (B and D vs. A and C) and exacerbations (C and D vs. A and B). 439 patients were included. The average score was 2.4 ± 3. 48% of cases had a COMCOLD score >0. The most symptomatic patients (B and D vs. A and C) had a higher score: 3 ± 3.3 vs. 1.3 ± 2.1 (p < 0.001), in contrast with the groups with a higher risk of exacerbation (C and D vs. A and B) in which there was no significant difference: 3 ± 3.5 vs. 2.2 ± 3.0 (p = 0.055). The most symptomatic patients (B and D) showed a greater prevalence of depression, peripheral artery disease and heart disease with an adjusted OR of 3.04 [CI95%: 1.36; 6.86], 2.49 [CI95%: 1.17; 5.29], and 4.41 [CI95%: 2.50; 7.75], respectively. Moreover, no relationship was found between the comorbidities defined by the COMCOLD score and the GOLD 2017 groups with the greatest risk of exacerbation (C and D). The greatest effect on health status was found in those patients with COPD belonging to the most symptomatic groups (B and D), with depression, peripheral artery disease, and heart disease being the main comorbidities involved.

Impacto del índice de masa corporal sobre la capacidad predictiva del dispositivo COPD-6 en la detección de obstrucción al flujo aéreo / Impact of body mass index on the predictive capacity of the COPD-6 device in the detection of airflow obstruction

Fundamento y objetivo: El dispositivo portátil COPD-6 se ha validado como herramienta de cribado de obstrucción al flujo aéreo a través del cociente FEV1/FEV6. Sin embargo, hasta la fecha no se ha evaluado el impacto del índice de masa corporal (IMC) sobre su capacidad para predecir dicha obstrucción. El objetivo del estudio ha sido valorar la capacidad predictiva del COPD-6 para detectar obstrucción al flujo aéreo en función del IMC del paciente. Material y método: Estudio observacional transversal realizado bajo los criterios de la práctica clínica habitual. Se incluyeron 223 sujetos a los que se les realizó espirometría convencional y COPD-6. Se analizó el area under the curve (AUC, «área bajo la curva») ROC del FEV1/FEV6 en la detección de obstrucción para el total de los pacientes y en función del IMC (IMC<30kg/m2e IMC≥30kg/m2). Se calcularon la sensibilidad y la especificidad, los valores predictivos negativo y positivo, así como la razón de verosimilitud para determinar el punto de corte del cociente FEV1/FEV6 del COPD-6 con mayor capacidad predictiva. Resultados: El COPD-6 permite descartar obstrucción al flujo aéreo con AUC de la curva ROC estimada de 88% (IC 95% 83-93). El punto de corte FEV1/FEV6 de 0,74-0,76 muestra la mejor capacidad predictiva. Sin embargo, dicha capacidad se ve alterada en función del IMC, con un incremento de falsos positivos en sujetos con IMC≥30kg/m2 al utilizar un mismo punto de corte para toda la muestra. Conclusión: La elección del punto de corte del cociente FEV1/FEV6 para la detección de obstrucción debe adaptarse al IMC del paciente (AU)

Background and objective: The portable COPD-6 device has been validated as a screening tool for airflow obstruction through the quantification of the FEV1/FEV6 ratio. To date, however, the impact of body mass index (BMI) on its ability to predict airflow obstruction has not been evaluated. The aim of the study was to assess the predictive ability of COPD-6 to detect airflow obstruction based on the patient's BMI. Material and method: A prospective and open cohort study in which 223 subjects who underwent conventional spirometry and COPD-6 were included. The area under the curve ROC (AUC) of FEV1/FEV6was analysed in the detection of obstruction for all patients in addition to BMI (BMI<30kg/m2and BMI≥30kg/m2). Sensitivity and specificity, negative and positive predictive value as well as likelihood ratio were calculated to determine the cut-off point of COPD-6 FEV1/FEV6 ratio with greater predictive capacity. Results: The COPD-6 allows ruling out airflow obstruction with AUC of the estimated ROC curve of 88% (95% CI 83-93). The cut-off point FEV1/FEV6 of 0.74-0.76 shows the best predictive capacity. However, this capacity is altered according to BMI with an increase in false positives in subjects with BMI≥30kg/ m2 when using the same cut-off point for the whole sample. Conclusion: The choice of cut-off point FEV1/FEV6 for the detection of obstruction should be adjusted to the patient's BMI (AU)

Impacto de la vacunación neumocócica de polisacáridos conjugados 13-valente en las exacerbaciones de pacientes con enfermedad pulmonar obstructiva crónica con obstrucción al flujo aéreo moderada-muy grave / Impact of 13-valent pneumococal conjugate polysaccharide vaccination on exacerbations rate of COPD patients with moderate to severe obstruction

Introducción. Uno de los principales microorganismos descritos como causante de las exacerbaciones de la enfermedad pulmonar obstructiva crónica (EPOC) es Streptococcus pneumoniae. El objetivo de este estudio es evaluar el impacto de la administración de la vacuna neumocócica de polisacáridos conjugados 13-valente (VNC13) en pacientes con EPOC en lo que respecta al desarrollo de exacerbaciones y el posible efecto diferencial según perfil del paciente. Material y métodos. Estudio observacional prospectivo de 18 meses de seguimiento de pacientes con EPOC y FEV1 ≤ 65%. Variables principales: estado de vacunación con VNC13, fenotipo 'exacerbador' o 'no exacerbador', número de exacerbaciones, ingresos y fallecimientos. Se realizó un análisis estadístico descriptivo según la naturaleza de la variable y un análisis inferencial con IC95%, contrastes bivariados y análisis multivariante. Nivel de significación 5%. Se emplearon los paquetes estadísticos EPIDAT 3.0 y SPSS versión 21.0. Resultados. 121 pacientes fueron incluidos. El 24% se etiquetaron como fenotipo exacerbador. Un 36% estaban vacunados con VNC13. Durante el seguimiento, el 68% de los pacientes presentaron al menos una exacerbación y un 27% requirió ingreso. Observamos similitud (p> 0,05) en el número de exacerbaciones y fallecimientos, sin embargo el porcentaje de ingresos en los vacunados fue del 18% frente a 32% en el grupo de no vacunados. En el ajuste multivariado (controlando por el fenotipo del paciente) se observa un ORajustado de 2,77 de riesgo de ingreso en el grupo no vacunado (p=0,044). Conclusiones. La falta de vacunación con VNC13 en pacientes con EPOC casi triplica el riesgo de ingreso hospitalario (AU)

Introduction. One of the major microorganisms described as the cause of exacerbations of chronic obstructive pulmonary disease (COPD) is Streptococcus pneumoniae. The aim of this study is to evaluate the impact of 13-valent pneumococcal conjugate polysaccharide vaccine (PCV13) in COPD patients with regard to the development of exacerbations and the possible differential effect according to the patient’s phenotype. Material and methods. Prospective observational study of patients with COPD and FEV1 ≤ 65% and 18-month follow-up. Main variables: vaccination status with PCV13, phenotype 'exacerbator' or 'non-exacerbator', number of exacerbations, hospitalization and deaths. A descriptive statistical analysis was performed according to the nature of the variable and an inferential analysis with CI95%, bivariate contrasts, and multivariate analysis. Significance level 5%. The statistical packages EPIDAT 3.0 and SPSS version 21.0 were used. Results. 121 patients were included. Twenty-four percent were labeled as phenotype exacerbator. 36% were vaccinated with PCV13. During follow-up, 68% of patients had at least one exacerbation and 27% required hospitalization. We observed similarity (p> 0.05) in the number of exacerbations and deaths; however, the percentage of hospitalization in the vaccinated was 18%, compared to 32% in the non-vaccinated group. In the multivariate adjustment (controlling for the phenotype), an adjusted OR of 2.77 risk of hospitalization was observed in the non-vaccinated group (p = 0.044). Conclusions. Non-vaccination with PCV13 almost triples the risk of hospitalization in patients with COPD (AU)

Impact of body mass index on the predictive capacity of the COPD-6 device in the detection of airflow obstruction. / Impacto del índice de masa corporal sobre la capacidad predictiva del dispositivo COPD-6 en la detección de obstrucción al flujo aéreo.

BACKGROUND AND OBJECTIVE: The portable COPD-6 device has been validated as a screening tool for airflow obstruction through the quantification of the FEV1/FEV6 ratio. To date, however, the impact of body mass index (BMI) on its ability to predict airflow obstruction has not been evaluated. The aim of the study was to assess the predictive ability of COPD-6 to detect airflow obstruction based on the patient's BMI. MATERIAL AND METHOD: A prospective and open cohort study in which 223 subjects who underwent conventional spirometry and COPD-6 were included. The area under the curve ROC (AUC) of FEV1/FEV6 was analysed in the detection of obstruction for all patients in addition to BMI (BMI<30kg/m2 and BMI≥30kg/m2). Sensitivity and specificity, negative and positive predictive value as well as likelihood ratio were calculated to determine the cut-off point of COPD-6 FEV1/FEV6 ratio with greater predictive capacity. RESULTS: The COPD-6 allows ruling out airflow obstruction with AUC of the estimated ROC curve of 88% (95% CI 83-93). The cut-off point FEV1/FEV6 of 0.74-0.76 shows the best predictive capacity. However, this capacity is altered according to BMI with an increase in false positives in subjects with BMI≥30kg/ m2 when using the same cut-off point for the whole sample. CONCLUSION: The choice of cut-off point FEV1/FEV6 for the detection of obstruction should be adjusted to the patient's BMI.

Does the new staging system proposed for mycosis fungoides and Sézary syndrome provide reliable agreement for T1 and T2 disease?

BACKGROUND: Patch or plaque stages in mycosis fungoides (MF) have different prognoses. The recent staging system proposed for MF discriminates between patches and plaques based upon clinical features. OBJECTIVE: To estimate interdermatologist agreement on the morphological evaluation of MF lesions. METHODS: Twenty-four patients with MF were enrolled. Two dermatologists evaluated every lesion face to face and independently with respect to the patch-plaque status. Cohen's κ was used to determine the rate of agreement. RESULTS: Agreement was 67% with respect to the patch or plaque status [95% confidence interval (CI) = 49-85%; p < 0.001]. Current systemic treatment (56%; p = 0.01) was associated with lower agreement. Younger age at diagnosis [odds ratio (OR) 1.03 (95% CI 1.02-1.05)], younger age at enrolment [OR 1.03 (95% CI 1.02-1.04)] and time on systemic treatment [OR 1.02 (95% CI 1.01-1.04)] were independent risk factors for disagreement (p < 0.001). CONCLUSION: The new system for MF staging carries a significant risk of disagreement regarding patch and plaque subsets.