[Comparative analysis: Effectiveness of nicotine addiction treatment in people with psychiatric comorbidity]. / Análisis comparativo: Efectividad del tratamiento antitabáquico en la población con comorbilidad psiquiátrica.

OBJECTIVE: To determine whether or not nicotine addiction treatment was less effective in psychiatric than in the healthy population. MATERIAL AND METHODS: A retrospective, descriptive and comparative cohort study was conducted in Albacete University Hospital during years 2008-2012 on all patients that attended the Tobacco Cessation Unit. The statistical tests used were Chi-squared, likelihood ratio, and the Student t test. Statistical significance P≤.05. RESULTS: The study included a total of 1,484 patients, of which 48.6% were female. The mean age was 46.8 years, and the mean age of starting smoking was 17.6 years. The mean number of previous attempts to quit was 1.48, and mean number of cigarettes smoked was 25.39. They had a mean Fagerström score of 6.04, a Richmond score of 8.13, and a mean carbon monoxide level of 16.65ppm. Most patients were referred from Primary Care (38.7%) and Chest Diseases department (33%), and the type of tobacco smoked was "light" in 75.8%. There was 15% with chronic obstructive pulmonary disease, 8% with asthma, and 9.4% with obstructive sleep apnoea syndrome. Furthermore, there was respiratory disease in 28.7%, cardiovascular disease in 4.6%, and both in 3.5%. Hiatus hernia was present in 7.2%, thyroid disease in 3.8%, hypertension in 19%, diabetes in 10.7%, and dyslipidaemia in 29.4%, Drugs were used by 7.1%, and 12.6% consumed alcohol. There was 39.3% psychiatric comorbidity (PC), and were comparable except in gender, age of onset, Fagerström, Richmond, source of referral, asthma, hiatus hernia, thyroid disease, hypertension, as well as drugs and treatment. Drug treatment was completed by 22.3% in the PC group, with no significant difference. There were differences in success (P=.008), but not in failure and relapse rates. CONCLUSION: Anti-smoking treatment in psychiatric patients is effective. An increase in the probability of treatment success is observed in patients without psychiatric comorbidity.

Development of Interpretable Predictive Models for BPH and Prostate Cancer.

BACKGROUND: Traditional methods for deciding whether to recommend a patient for a prostate biopsy are based on cut-off levels of stand-alone markers such as prostate-specific antigen (PSA) or any of its derivatives. However, in the last decade we have seen the increasing use of predictive models that combine, in a non-linear manner, several predictives that are better able to predict prostate cancer (PC), but these fail to help the clinician to distinguish between PC and benign prostate hyperplasia (BPH) patients. We construct two new models that are capable of predicting both PC and BPH. METHODS: An observational study was performed on 150 patients with PSA ≥3 ng/mL and age >50 years. We built a decision tree and a logistic regression model, validated with the leave-one-out methodology, in order to predict PC or BPH, or reject both. RESULTS: Statistical dependence with PC and BPH was found for prostate volume (P-value < 0.001), PSA (P-value < 0.001), international prostate symptom score (IPSS; P-value < 0.001), digital rectal examination (DRE; P-value < 0.001), age (P-value < 0.002), antecedents (P-value < 0.006), and meat consumption (P-value < 0.08). The two predictive models that were constructed selected a subset of these, namely, volume, PSA, DRE, and IPSS, obtaining an area under the ROC curve (AUC) between 72% and 80% for both PC and BPH prediction. CONCLUSION: PSA and volume together help to build predictive models that accurately distinguish among PC, BPH, and patients without any of these pathologies. Our decision tree and logistic regression models outperform the AUC obtained in the compared studies. Using these models as decision support, the number of unnecessary biopsies might be significantly reduced.

Unidad Diagnóstica y pronóstica del microrna-21 en el cáncer colorrectal / Diagnostic and prognostic utility of serum microrna-21 in colorectal cancer

INTRODUCCIÓN. Los microRNAs son estructuras moleculares de 20-22 nucleótidos con actividad post-transcripional que están implicados en la carcinogénesis mediante una regulación genética post-transcripcional. Presentamos un estudio prospectivo donde se determina la expresión sérica de microRNA-21 en pacientes con diagnóstico de adenocarcinoma de colon. MATERIAL Y MÉTODOS. Estudio de cohorte prospectivo de al menos 100 pacientes con diagnóstico de adenocarcinoma de colon, y de al menos 60 pacientes con apendicitis aguda como grupo control. Se realizó el análisis de microRNA-21 sérico mediante PCR de las muestras sanguíneas de los pacientes obtenidas de forma preoperatoria. RESULTADOS. La comparación de la expresión del microRNA-21 sérico fue mayor en los pacientes con cáncer colorrectal que en los pacientes del grupo control, siendo el área bajo la curva de 0,603. En el análisis univariante, la expresión del miR- 21 se relaciona de forma estadísticamente significativa con la recidiva local (p=0,025) y con la mortalidad (p=0,029). En el análisis multivariante también se puso de manifiesto que las expresiones mayores (sobreexpresiones) de miR-21 se relacionaban con una reducción del riesgo derecidiva del 51%, mientras que dicha sobreexpresión se relacionaba con una reducción de mortalidad del 50%. CONCLUSIONES. La expresión del microRNA-21 sérico podría ser considerado como un potencial marcador diagnóstico para el cáncer colorrectal. La expresión sérica del microRNA-21 se correlaciona con la recidiva y mortalidad en el cáncer colorrectal. Nuestros resultados sugieren que el miR-21 sérico es un prometedor marcador diagnóstico y pronóstico, y pone de manifiesto su potencial utilidad clínica en el cáncer colorrectal (AU)

BACKGROUND. MicroRNAs (miRNAs) are small, noncoding RNAs that are involved in carcinogenesis through postranscriptional gene regulatory activity. Few studies have focused on the detection of miR-21 in serum rather than in tissue. The currentstudy aimed to measure serum miR-21 expression levels and to evaluate their association with the outcome of colorectal cancer (CRC). METHODS. Blood samples were collected from almost 100 CRC patients undergoing surgery with curative intent, and almost 60 control patients. The expression levels of miR-21 were measured using a quantitative reverse transcription polymerase chain reaction (qRT-PCR). RESULTS. Serum microRNA-21 expression was higher in colorectal cancer patients than in control patients, with a ROC curve of 0.603. A univariate analysis revealed that lower expression levels of serum miR-21 were associated with higher local recurrence (p=0.025) and mortality (p=0.029). A logistic regression analysis demonstrated that the relative overexpression of miR-21 (expression >1) was associated with a 51% reduction in the risk of recurrence. A Cox regression analysis identified that a relative increase in miR-21 expression (>1) was associated with a 50% reduction in the risk of mortality. CONCLUSIONS. Serum microRNA-21 expression could be considered as a potential diagnostic marker for colorectal cancer. The expression level of serum miR-21 correlates with the recurrence and mortality of CRC patients. Our results suggest that circulating serum miR-21 is a promising diagnostic and prognostic tumour marker, and they highlight the potential clinical utility of miR-21 in colorectal cancer (AU)

[Serum microRNA-21 usefulness in inflammatory pathology of the colon]. / Utilidad de la determinación sérica de microRNA-21 en la enfermedad inflamatoria del colon.

BACKGROUND: MicroRNAs are 20-22 nucleotide molecular structures with post-transcriptional activity that are involved in the immune response, as well as in the inflammatory pathways of different cells and tissues. AIMS: We present herein a prospective study in which serum microRNA-21 expression was determined in patients diagnosed with acute appendicitis as a model of bowel inflammation. MATERIAL AND METHODS: A prospective cohort study of patients diagnosed with acute appendicitis was conducted. Serum microRNA-21 was analyzed through the PCR of blood samples taken from the patients prior to surgery. MicroRNA-21 values were compared with the analytic variables (leukocytes, hemoglobin, hematocrit, platelets, prothrombin activity, glucose, urea, and creatinine) and the anatomopathologic variables (normal appendix, phlegmonous, gangrenous, and perforated acute appendicitis). RESULTS: A total of 60 patients with acute appendicitis diagnosis were consecutively included in the study from June to October 2009. Sixty-six percent of the patients were men (40 men and 20 women), with a mean age of 26.2±14.8 years. The mean absolute level of microRNA-21 was 24.8±0.93, whereas the mean microRNA-21 gene expression was 1.04±0.28. No correlation between the analytic and anatomopathologic parameters evaluated was observed (P=.47). CONCLUSIONS: It is necessary to continue to search for the most appropriate microRNAs, so that their determination in serum can lead to greater precision in establishing the diagnosis and outcome of inflammatory disorders of the bowel.

Implicaciones clínicas de la determinación histológica de los micrornas en el cáncer colorrectal / Clinical implication of histological determination of micrornas in colorectal cancer

Los microRNAs son estructuras moleculares con actividad post-transcripcional que están implicados en la regulación de la expresión genética. Diversos estudios ponen de manifiesto la participación de los microRNAs con distintas funciones fisiológicas, así como con el proceso de la oncogénesis. La expresión de los microRNAs puede verse alterada en las neoplasias por su interacción bien con los genes supresores de tumores, bien con los oncogenes. Se ha llevado a cabo una revisión bibliográfica en PubMed acerca de la evidencia publicada sobre la determinación histológica de los microRNAs y la relación existente con el diagnóstico y el pronóstico del cáncer colorrectal. A pesar de ser preciso nuevos estudios clínicos que especifiquen la relación de los microRNAs con el cáncer colorrectal, se ha evidenciado una relación de estas estructuras con el diagnóstico y pronóstico de esta neoplasia (AU)

MicroRNAs are short non-coding RNA molecules involved in the regulation of gene expression. Several studies demonstrate the involvement of microRNAs with different physiological functions and oncogenesis. The expression of microRNAs may be altered in tumors by their interaction with tumor suppressor genes or with oncogenes. A literature review in PubMed was made about the evidence on the histological determination of microRNAs and the relationship with the diagnosis and prognosis of colorectal cancer. Although further clinical studies focusing on serum microRNAs are required to determine the relationship of microRNAs in colorectal cancer, the relationship of these structures with the diagnosis and prognosis of this neoplasm has been shown (AU)

Carcinogénesis del cáncer colorrectal / Colorectal cancer carcinogenesis

El cáncer colorrectal representó en el año 2008 el tercer tumor más diagnosticado en España, siendo la segunda neoplasia que causó más fallecimientos. El conocimiento del proceso carcinogenético de este tipo de enfermedad permitirá el descubrimiento de nuevas terapéuticas que conlleven menores tasas de incidencia y mortalidad. El continuo avance en la enfermedad tumoral hace que esta revisión sea una puesta al día en el conocimiento de la carcinogénesis del cáncer colorrectal (AU)

In 2008, colorectal cancer represented the third most commonly diagnosed tumor in Spain, and the second tumor that caused ore deaths. Knowledge of the carcinogenetic process of this disease will allow the discovery of new therapies involving lower rates of incidence and mortality. The continuous progress in tumor disease makes this review an update on the knowledge of colorectal cancer carcinogenesis (AU)

Calidad de vida en pacientes con disfunción eréctil / Quality of life in patients with erectile dysfunction

Introducción: La disfunción eréctil (DE) es un problema de salud importante que afecta a la calidad de vida de millones de personas, hecho que ha adquirido importancia, tanto en estudios individuales como poblacionales, en la calidad de la atención médica y eficacia de las intervenciones a nivel de salud pública. Objetivos: Valorar la calidad de vida y comorbilidades de pacientes, con y sin DE, en atención primaria. Material y método: Pacientes: los participantes se captaron en los centros de salud incluidos en el estudio. Se reclutó una muestra de 210 varones, de los cuales 31 no pudieron concluir el estudio por diversos motivos (n final = 179). Análisis de variables: la variable principal, de carácter cualitativo, es la ausencia o presencia de DE. Las variables secundarias se distribuyen según 3 campos: demográficas, bioquímicas y comorbilidades con fármacos asociados, además de las variables de grado de DE y calidad de vida, mediante el cuestionario de salud sexual del varón y el cuestionario de satisfacción con la vida, respectivamente. Análisis estadístico: estudio de observación, descriptivo y analítico, de sección transversal. Variables cuantitativas: comparación entre medias con la prueba t de Student para grupos independientes o la U de Mann-Whitney si las condiciones de normalidad (aplicación del test de Kolmogorov-Smirnoff o de Shapiro-Wilks) no se cumplían. Variables cualitativas: prueba de χ2. Resultados: De las 210 personas seleccionadas, completaron correctamente la encuesta 179 (85,2%). La edad media fue de 64,5 ± 11,6 años. Respecto de las variables demográficas, el incremento de los años aumenta la incidencia de DE, llegando al 95% entre 71-86 años. En las variables bioquímicas, se encontró una relación significativa entre la ausencia o existencia de DE con el índice aterogénico y su variable recodificada en riesgo aterogénico alto y bajo (p < 0,04)...(AU)

Introduction: Erectile dysfunction (ED) is an important health problem that affects the quality of life of millions of persons, a fact that has acquired importance both in individual and population studies, quality of medical care and efficacy of the interventions on the public health level. Objectives: To evaluate quality of life and comorbidities of patients with and without ED in Primary Care. Material and methods: Patients: The participants were obtained in the health care centers included in the study. A sample of 210 males were recruited, 31 of whom did not complete the study for different reasons (final no. =179). Analysis of variables: The principal variable, having qualitative character, is the absence or presence of ED. The secondary variables are distributed according to 3 fields: demographic, biochemical and comorbidities with associated drugs as well as the variables grade of ED and quality of life, by questionnaire Sexual Health Inventory for Men and Fugl-Meyer Life Satisfaction Checklist respectively. Statistical analysis: Observation, descriptive and analytic, cross-sectional study. Quantitative variables: comparison between means with Student's T test for independent groups of Mann-Whitney U Test if the normality conditions (application of Kolmogorov-Smirnoff or Shapiro-Wilks test) are not met. Qualitative variables: Chi square test. Results: Of the 210 persons selected, 179 (85.2%) completed the survey correctly. Mean age was 64.5 ± 11.6 years. Regarding the demographic variables, increased age increased the incidence of ED, reaching 95% between 71-86 years. In the biochemical variables, a significant relation was found between absence or existence of ED, with the atherogenic index and its variable recodified in high and low atherogenic risk (p< 0.04). The same occurs with the HDL-cholesterol, transaminase GPT and GGT levels...(AU)

Microrna-21 y cáncer colorrectal / Microrna - 21 and colorectal cancer

Introducción. Los microRNAs son estructuras moleculares con actividad post-transcripcional que están implicados en la regulación de la expresión genética. Diversos estudios ponen de manifiesto la participación de los microRNAs con distintas funciones fisiológicas, así como con el proceso de la oncogénesis. La expresión de los microRNAs puede verse alterada en las neoplasias por su interacción bien con los genes supresores de tumores, bien con los oncogenes. Discusión. Llevamos a cabo una revisión de la literatura sobre el microRNA-21, poniendo de manifiesto la evidencia existenteentre el microRNA-21 y la enfermedad neoplásica, de forma especial con el cáncer colorrectal. Conclusiones. El estado actual de los microRNAs hace necesario continuar con la investigación existente entre la etiopatogenia de las neoplasias y los microRNAs. El conocimiento de la verdadera implicación de los microRNAs en la fisiopatología de la enfermedad neoplásica, permitirá ampliar las supuestas aplicaciones clínicas del miR-21 no sólo a la determinación del pronóstico del cáncer colorrectal, sino también desde el punto de vista diagnóstico al poder diferenciar las lesiones de la mucosa colónica (AU)

Introduction. MicroRNAs are molecular structures with post-transcriptional activity, involved in the gene expression regulation. Several studies have demonstrated the involvement of microRNAs in different physiological functions, as well as in the oncogenesis process. The expression of microRNAs may be altered in the tumors by either interaction with tumor suppressor genes or oncogenes. Discussion. A review of the medical literature on microRNA-21 has been conducted, showing the evidence between microRNA-21 and neoplastic disease, specially with colorectal cancer. Conclusion. The current status of microRNAs makes necessary to continue the investigation of the pathogenesis of cancer and microRNAs. The knowledge of the involvement of microRNAs in the pathophysiology of neoplastic disease, will allow to extend the supposed clinical applications of miR-21 not only to the determination of the prognosis of colorectal cancer, but also for the differential diagnosis of processes of colonic mucosae (AU)

[Subclinical hypothyroidism and cardiovascular risk factors]. / Hipotiroidismo subclínico y factores de riesgo cardiovascular.

OBJECTIVE: To determine the prevalence of subclinical hypothyroidism in the general population of an urban health center and describe the clinical characteristics and cardiovascular risk factors in patients with subclinical hypothyroidism. METHODS: An observational study, retrospective, reviewing the medical histories of patients sampled from June 2005 until July 2007. We analyzed the following variables; facts: age and sex. Family history thyroid disease and other diseases. Personal History: cardiovascular pulmonary autoimmune, alterations gynecology obstetric diabetes, hypertension (HT) dislipemia, obesity, psychiatric alterations and haematological. Laboratory data: novel TSH, free T4, antiperoxidase antibodies, total cholesterol and its fractions. RESULTS: The prevalence of the sample of 100 patients collected over 8 months was 3.8% in the general population over 14 years, of which 79 were women and 21 were men. 13% were type 2 diabetics, 23% had HT and 40% had dyslipidemia. Overweight and obesity were present in 26%. The average level of TSH was 6.92 ± 2.29 µU/ml and the average level of free T4 was 1.16 ± 0.16 ng/ml. CONCLUSIONS: Prevalence subclinical hypothyroidism was 3.8%. especially in women with a mean age of 46. The incidence of cardiovascular risk factors in the subjects studied is higher in DM (13%), similar to general population in terms of dyslipidemia (40%) and obesity (23%) and lowest in hypertension (23%). In our study we observed a common pattern in the management of subclinical hypothyroidism, requiring the implementation and promotion of practice guidelines in primary care.

[Education on nutrition: from the university to specialized care]. / Formación en Nutrición: de la universidad a la especialidad.

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence.

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department.

OBJECTIVE: To determine the real importance of anamnesis, physical examination, and various tests in the assessment of acute abdominal pain. METHODS: A retrospective observational study with patients complaining of abdominal pain at the Emergency Department, Altiplano Health Area (Murcia) was performed. In our study we considered the following variables: socio-demographic data, history of previous surgery, symptoms, place and type of pain. Imaging tests were labeled as positive, negative, or inconclusive for assumed diagnoses, which were retrospectively assessed by an external radiologist who was unaware of the patient s final diagnosis. RESULTS: Our study includes 292 patients with a mean age of 45.49 years; 56.8% of these patients were women. Regarding the frequency of the different acute abdomen diagnoses, appendicitis was the main cause (approx. 25%), followed by cholecystitis (10%). We found a significant diagnostic correlation between pain location in the right hypochondrium (RHC) and a diagnosis with cholecystitis. This location was also significant for acute appendicitis (up to 74%). Regarding clinical signs, we only observed a significant correlation between fever and viscera perforation, and between Murphy s sign and cholecystitis. Sensitivity and specificity found in relation to the psoas sign were similar to those seen in other series, 16 and 95% respectively, and slightly lower than the Blumberg or rebound sign, which we found to be around 50 and 23%, respectively. CONCLUSIONS: a) Anamnesis and physical examination offer limited accuracy when assessing acute abdomen; b) ultrasound scans offer a low diagnostic agreement index for appendicitis; and c) laparoscopy may prove useful for diagnosis, and is also a possible treatment for acute abdominal pain despite its low diagnostic efficiency.

[Hepatotoxicity in the critically ill patient. The liver under an acute severe insult]. / Hepatotoxicidad en el paciente crítico. El hígado bajo agresión aguda grave.

The liver plays an essential role in the metabolism of most of the nutrients since it is a mainly metabolic organ carrying out a series of physiological and metabolic processes related with protein and energy metabolism. The intestinal tract is considered a key element in the development of Multiorgan Dysfunction (MOD) or failure by loosing its barrier function (impaired permeability) against toxins, bio-products and occasionally intraluminal bacteria secondary to hypoxia, one of the main pathophysiogenic mechanisms being the insufficient blood flow to splacnic organs. Liver dysfunction and/or impairment of liver function test are a common event in critically ill patients. They may be due to previous liver cirrhosis or to more immediate causes of liver failure such as sepsis, drugs, liver transplant or any of the multiple etiologies for hepatitis.

[Clinical importance of bacterial translocation]. / Importancia clínica de la translocación bacteriana.

The gastrointestinal tract is colonized by a huge number of microorganisms that we call intestinal flora. Although the bowel provides a functional barrier between these organisms and the host, bacterial translocation is not an infrequent event in healthy people. However, in critically ill patients, carriers of different morbid entities, bacterial translocation may favor infections and increased morbimortality. There are several proposed mechanisms explaining the etiology, genesis, and ways for this entity, and frequently the results from both in vitro and animal experimental investigations are controversial and difficult to apply to humans. Many diseases have been linked or are implicated in the translocation phenomenon, although studies with insufficient methodology, reduced populations, and conflicting results still leave open questions and others with no logical answer. This problem is also reflected when studying and assessing different therapeutic strategies used as well as on the methods used to detect translocation.

[I + D + i: from research to management]. / I + D + i: de la investigación a la gestión.

The project of the European Commission Towards a European Space of Research, presented in the year 2000, aims at increasing the impact on R+ D and defining the scientific policy for Europe. The materialization of this project implies commitment and support from member States, the coordination of research activities between each one of them, and the development of modern management systems and methods. In Spain, R+ D + i activities include (regional, national, and international) Programs, Plans, and Actions on R + D and the participation in relevant Contracts with enterprises, the Administration, or both. In this setting, several general aspects of the National Plan on R + D + i (2004-2007) and of the 7th European Framework Program of the EU are presented and some issues on biomedical research, the role of universities in scientific production, the relevance of knowledge as a significant resource, and the need of managing the latter as a source of competitive advantage are commented.

Importancia de la cirugía mayor ambulatoria en la formación del cirujano / No disponible

No disponible

[Pathophysiology of neuromuscular impairments in the critically ill patient]. / Fisiopatología de las alteraciones neuromusculares en el paciente crítico.

OBJECTIVE: to analyze the causes and manifestations of muscle weakness that critically ill patients develop during their staying at the ICU, and literature review. DEVELOPMENT: in the early 1980s, a mixed axonal polyneuropathy was described in septic critically ill patients, which clinically manifested by muscle weakness of variable severity, leading to quadriplegia and/or ventilator dependency in its most severe presentation. Almost at the same time, an acute intensive care myopathy was described in asthmatic patients admitted to the ICU for asthma exacerbation. Later on, this myopathy was also observed in transplanted, septic, or burnt patients. Several authors consider acute intensive care myopathy as the main cause of muscle weakness in the ICU. CONCLUSIONS: in this article, we describe the clinical presentation, etiopathogenesis, diagnosis, and treatment of polyneuropathy of the critically ill patient and of acute intensive care myopathy. Both clinical pictures may be differentiated, with neurophysiological studies and eventually muscle biopsy being of great help. Although some authors rather include these conditions under the name of polyneuromyopathy, we propose the general denomination of Acute Neuromuscular Syndrome of the Critically Ill Patient, a more descriptive term no presupposing a single mechanism or etiology.

[Peripheral parenteral nutrition]. / Nutrición periférica.

The Target of this review is to provide an up-to-date overview of the advantages and disadvantages of Peripheral Parenteral Nutrition (PPN), including techniques, indications and results. The new generation catheters, together with a better knowledge of the intermediary metabolism, give us the opportunity to use PPN in many clinical situations for short periods of time. PPN is an alternative to Total Parenteral Nutrition (TPN) and is also a complement to enteral nutrition and to the oral route. Progress in the design of catheters and their materials, in infusion techniques and better knowledge of optimal nutrients has made PPN into an effective, safe and useful therapy in the treatment of patients for certain periods of time.