Risk of Severe COVID-19 Infection in Patients With Inflammatory Rheumatic Diseases.

OBJECTIVE: To describe the cohort of patients with inflammatory rheumatic diseases (IRD) hospitalized due to SARS-CoV-2 infection in the Ramón y Cajal Hospital, and to determine the increased risk of severe coronavirus disease 2019 (COVID-19) in patients with no IRD. METHODS: This is a retrospective single-center observational study of patients with IRD actively monitored in the Department of Rheumatology who were hospitalized due to COVID-19. RESULTS: Forty-one (1.8%) out of 2315 patients admitted due to severe SARS-CoV-2 pneumonia suffered from an IRD. The admission OR for patients with IRD was 1.91 against the general population, and it was considerably higher in patients with Sjögren syndrome, vasculitis, and systemic lupus erythematosus. Twenty-seven patients were receiving treatment for IRD with corticosteroids, 23 with conventional DMARDs, 12 with biologics (7 rituximab [RTX], 4 anti-tumor necrosis factor [anti-TNF], and 1 abatacept), and 1 with Janus kinase inhibitors. Ten deaths were registered among patients with IRD. A higher hospitalization rate and a higher number of deaths were observed in patients treated with RTX (OR 12.9) but not in patients treated with anti-TNF (OR 0.9). CONCLUSION: Patients with IRD, especially autoimmune diseases and patients treated with RTX, may be at higher risk of severe pneumonia due to SARS-CoV-2 compared to the general population. More studies are needed to analyze this association further in order to help manage these patients during the pandemic.

Is it always necessary to perform an axillary lymph node dissection after neoadjuvant chemotherapy for breast cancer?

INTRODUCTION: Recent prospective studies support the feasibility of performing sentinel lymph node biopsy following neoadjuvant chemotherapy in initially fine-needle aspiration cytology or ultrasound-guided biopsy-proven node-positive breast cancer. The main aid is to identify preoperative features that help us predict a complete axillary response to neoadjuvant chemotherapy in these patients and thus select the candidates for sentinel lymph node biopsy post-neoadjuvant chemotherapy to avoid unnecessary axillary lymphadenectomy. MATERIALS AND METHODS: A retrospective observational study with a total of 150 patients, biopsy-proven node-positive breast cancer who underwent neoadjuvant chemotherapy followed by breast surgery and axillary lymphadenectomy were included and retrospectively analysed. A predictive model was generated by a multivariate logistic regression analysis for pathological complete response-dependent variable. RESULTS: The response of the primary lesion to neoadjuvant chemotherapy according to post-treatment magnetic resonance imaging, Her2/neu overexpression and a low estrogen receptor expression are associated with a higher rate of nodal pathologically complete response. The multivariant model generated a receiver operating characteristic curve with an area under the curve of 0.79 and a confidence interval of 0.72-0.87 at a 95% level of significance. CONCLUSIONS: This model could be a helpful tool for the surgeon to help in predicting which cases have a higher likelihood of achieving a pathologically complete response and therefore selecting those who may benefit from a post-neoadjuvant chemotherapy sentinel lymph node biopsy and avoid unnecessary axillary lymphadenectomy.

[Trained eye vs. gold standard]. / Ojo clínico vs. gold standard.

OBJECTIVE: To determine the degree of correlation between the clinical diagnosis prior to the minor surgery process and its concordance with the results of histopathology report, as well as to determine the surgical data of little clinical importance compared to that which is really necessary and cost-effective. MATERIAL AND METHOD: A descriptive, observational, retrospective and transversal study was conducted of the Minor Surgery Activities of a clinic in the Ciudad Real Health Centre I. RESULTS: A total of 124 surgical specimens were sent for clinical diagnostic comparison, of which, the main clinical diagnoses were: intradermal melanocytic nevi (34.67%), seborrheic keratosis (11.30%), and epidermoid or sebaceous cysts (10.48%). A correlation of 68% was obtained. The protocols of the work centre have been followed to carry out this study in relation to the confidentiality of the data. CONCLUSIONS: These results were analysed and compared with other similar works performed in the field of minor surgery in Primary Care, being able to affirm that there is a good correlation between the initial clinical diagnosis and the histopathology results.

The relationship between the cortisol awakening response, mood states, and performance.

This study examined the variation in the diurnal profile of cortisol, with an emphasis on the cortisol awakening response (CAR), in relation to mood states and performance during a professional swimming contest. Eleven athletes were examined during 2 consecutive days of competition and during a recreated event 2 weeks later that was matched to the time of the day and day of the week of the competition. On each day, salivary cortisol was determined upon awakening (07:00 hours); 30 and 60 minutes post-awakening; immediately before warming up for competition (16:00 hours); and 5 minutes (18:20 hours), 20 minutes (18:40 hours), and 40 minutes (19:00 hours) after competition. Psychometric instruments included the Profile of Mood States and self-reports of performance. Cortisol awakening responses did not differ between days of competition and control and were not related to performance on any day. However, a difference was observed in the concentration of cortisol before and after the contest between the competition and control days. Higher levels of cortisol before competition were associated with feelings of tension, anxiety, and hostility. The perceived demands of the day ahead might not produce the same magnitude of variation in the CAR in well-trained men. Explanations for this probably include better coping mechanisms and responses to the phase and time of competition.

Determination of the lactate threshold by means of salivary biomarkers: chromogranin A as novel marker of exercise intensity.

This study examined intra-individual variations in salivary lactate (sLac), alpha-amylase (sAA) and chromogranin A (sCgA) with reference to the accumulation of blood lactate (bLac) during incremental maximal exercise in swimmers. Samples of blood and saliva were collected simultaneously from 12 male professional athletes during an incremental test that consisted of eight series of 100 m in front crawl with increasing velocity (0.03 m s(-1) each) and 70-s intervals. The concentration of blood and salivary lactate was determined by an electro-enzymatic assay, whereas sAA and CgA were analysed by Western blotting. Inflection points in the concentration of bLAc, sLac, sAA and CgA were found in all subjects. The accumulation of lactate in saliva followed the same pattern observed in blood with a high correlation between the two (r = 0.91). Similar results were observed between the dynamics of sAA (r = 0.81) and sCgA (r = 0.82) in relation to bLac. These findings support the usefulness of saliva for the determination of the lactate threshold and provide the first demonstration of sCgA as a novel marker of exercise intensity in well-trained men.

Dermatofibrosarcoma protuberans mamario en un varón / Dermatofibrosarcoma protuberans in a man

El dermatofibrosarcoma protuberans (DFSP) es un tumor rarode la piel, localmente agresivo con elevado rango de recidivas ybaja incidencia de metástasis a distancia. Puede originarse comouna pequeña lesión asintomática y pasar desapercibido. La extirpacióncon amplios márgenes ha sido el tratamiento de elecciónaunque la cirugía micrográfica de Mohs puede ser el mejor tratamiento.Se presenta un paciente con un dermatofibrosarcomaprotuberans mamario y se revisa la literatura

Dermatofibrosarcoma protuberans is an uncommon tumorof the dermis (DFSP) is a locally agressive tumor with a highrecurrence rate but rare systemic metastasis. It may start as asmall asymtomatic lesion, which is likely ignored. Surgical excisionwith wide margins has been considered the standardtherapy though Mohs micrographic surgery may be the besttreatment option. We study the case of a man with DFSP inthe breast. Literature is also reviewed

[Clinical characteristics of children with chronic pain in a pediatric pain unit: oncologic pain versus non-oncologic pain]. / Análisis de las características clínicas de los pacientes con dolor crónico tratados por la unidad de dolor infantil: dolor oncológico frente a no oncológico.

BACKGROUND: Despite undoubted scientific advances in the field of chronic pain in children, there is no evidence of clinical application of this knowledge. OBJECTIVE: To describe the experience of a pediatric pain unit (PPU) specifically dedicated to the treatment of chronic pain in children. MATERIAL AND METHODS: We performed an analytic, observational, retrospective, cohort study of the clinical features of the first 42 patients treated for chronic pain in the PPU during a two-year period. The patients were assigned to two groups: an oncologic group and a non-oncologic group. ANOVA was used to analyze quantitative variables and the Chi-square test was used to analyze qualitative variables. RESULTS: No significant differences were found between the two groups in the demographic variables studied (age and sex). Concerning the type of treatment used, no significant differences were found in effectiveness or compliance. However, treatment duration was significantly longer in the non-oncologic group than in the oncologic group (74.2 days vs 37.5 days, p(0.008). The duration of non-oncologic chronic pain before attending the PPU (mean: 557 days) influenced the effectiveness (r 5 0.781; p 5 0.0001) and duration of treatment (r 5 0.61; p 5 0.0051). However, the duration of previous chronic oncologic pain was significantly shorter (mean: 34 days) and showed no influence on treatment effectiveness or duration. CONCLUSIONS: The pediatric population presents chronic pain syndromes that can be appropriately treated in a PPU with conventional, easy to manage analgesics. We recommend the establishment of pediatric pain units similar to those for adults, using a multidisciplinary approach to mitigate children's suffering.

Effect of GLP-1 on lipid metabolism in human adipocytes.

We have studied the effect of several doses of GLP-1, compared to that of insulin and glucagons, on lipogenesis, lipolysis and cAMP cellular content, in human adipocytes isolated from normal subjects. In human adipocytes, GLP-1 exerts a dual action, depending upon the dose, on lipid metabolism, being lipogenic at low concentrations of the peptide (ED50, 10(-12) M), and lipolytic only at doses 10-100 times higher (ED50, 10(-10) M); both effects are time- and GLP-1 concentration-dependent. The GLP-1 lipogenic effect is equal in magnitude to that of equimolar amounts of insulin; both hormones apparently act synergically, and their respective action is abolished by glucagon. The lipolytic effect of GLP-1 is comparable to that of glucagon, apparently additive to it, and the stimulated value induced by either one is neutralized by the presence of insulin. In the absence of IBMX, GLP-1, at 10(-13) and 10(-12) M, only lipogenic doses, does not modify the cellular content of cAMP, while from 10(-11) M to 10(-9) M, also lipolytic concentrations, it has an increasing effect; in the presence of IBMX, GLP-1 at already 10(-12) M increased the cellular cAMP content. In human adipocytes, GLP-1 shows glucagon- and also insulin-like effects on lipid metabolism, suggesting the possibility of GLP-1 activating two distinct receptors, one of them similar or equal to the pancreatic one, accounting cAMP as a second messenger only for the lipolytic action of the peptide.

Supervivencia del cáncer de mama a los 10 y 15 años en 1.147 enfermas tratadas con cirugía y tratamiento complementario / Ten and fifteen-year survival rates in 1147 breast cancer patients after surgery and adjuvant therapy

Introducción. Presentamos un trabajo retrospectivo de la supervivencia del cáncer de mama a los 10 y 15 años en relación con diversos factores pronósticos. Pacientes y método. Entre 1963 y 1998 hemos seleccionado a 1.147 pacientes, de las cuales 964 presentaban carcinoma infiltrante operable (en estadios T1-T3) con historia completa. Se han comparado dos series de 452 y de 512 enfermas, con una evolución media de 10 a 25 años. Las técnicas utilizadas han sido la mastectomía radical, modificada o ampliada (89,5 por ciento) y la cirugía conservadora (10,5 por ciento). También se ha utilizado la ovariectomía quirúrgica bilateral, la administración de andrógenos (serie 1) y antiestrógenos (serie 2). La radioterapia y quimioterapia postoperatorias se han empleado parcialmente en ambas series. Resultados. La supervivencia a 10 y 15 años ha sido similar en ambas series, siendo en estadio N negativo significativamente mayor en T1 (p = 0,01) y T2 (p = 0,04) con respecto a T3. En estadio N positivo también se obtiene una diferencia significativa en la supervivencia de T1 (p < 0,001) y T2 (p < 0,001) respecto a T3. Conclusión. El tratamiento del cáncer de mama debe ser realizado en estadio T1 o T2 por su supervivencia significativamente mayor (AU)