Dosis altas de corticoides sistémicos en pacientes ingresados por exacerbación de enfermedad pulmonar obstructiva crónica. Un estudio de cohortes / High doses of systemic corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease. A cohort study

Objetivos. Evaluar el efecto de las dosis altas de corticoides en pacientes ingresados por exacerbación de una enfermedad pulmonar obstructiva crónica (EPOC). Pacientes y métodos. Estudio de cohortes prospectivo de enfermos hospitalizados con EPOC entre enero y marzo de 2015, agrupados en función de la dosis de glucocorticoides recibida (punto de corte: 40mg de prednisona/día). Se compararon los resultados de estancia hospitalaria, y de reingreso y mortalidad a los 3 meses del alta. Resultados. Se analizaron 87 pacientes. La mediana de la dosis diaria recibida fue de 60mg de prednisona/día (rango intercuartílico: 46,67-82,33mg/día); la vía de administración fue endovenosa en el 96,6% de los casos. Se estableció un riesgo relativo (RR) de estancia superior a 8 días de 1,095 [intervalo de confianza (IC) 95%: 0,597-2,007; p=0,765] cuando se usaban dosis de esteroides superiores a 40mg/día. Además, en estos pacientes la hazard ratio (HR) para el reingreso durante los 3 meses siguientes al alta fue de 0,903 [IC 95%: 0,392-2,082; p=0,811] y la mortalidad de 1,832 (IC 95%: 0,229-16,645; p=0,568]. Ni el RR ni las HR observadas variaron de forma estadísticamente significativa tras el ajuste por factores de confusión. Conclusiones. Una dosis superior a 40mg diarios de prednisona en pacientes ingresados por exacerbación de EPOC no se asocia a una menor estancia hospitalaria ni a una disminución del reingreso y de la mortalidad a los 3 meses (AU)

Objectives. To assess the effect of high doses of corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease (COPD). Patients and methods. A prospective cohort study was conducted on patients hospitalized with COPD between January and March 2015, grouped according to the glucocorticoid dosage administered (cutoff, 40mg of prednisone/day). We compared the results of hospital stay, readmission and mortality at 3 months of discharge. Results. We analysed 87 patients. The median daily dose was 60mg of prednisone (interquartile range, 46.67-82.33mg/day), and the administration route was intravenous in 96.6% of the cases. We established a relative risk (RR) for hospital stays longer than 8 days of 1.095 (95% CI 0.597-2.007; P=.765) when steroid dosages greater than 40mg/day were employed. In these patients, the hazard ratio (HR) for readmission in the 3 months after discharge was 0.903 (95% CI 0.392-2.082; P=.811), and the mortality was 1.832 (95% CI 0.229-16.645; P=.568). Neither the RR nor the HR varied in a statistically significant manner after adjusting for confounding factors. Conclusions. A daily dose greater than 40mg of prednisone in patients hospitalised for COPD exacerbation was not associated with a shorter hospital stay or a reduction in readmissions or mortality at 3 months (AU)

Chylothorax linked to goiter solved by transcervical total thyroidectomy without sternotomy / Quilotorax provocado por un bocio resuelto mediante tiroidectomía total con abordaje cervical sin esternotomía

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[The influence of stereotypes on obesity perception]. / Influencia de los estereotipos en la percepción de la obesidad.

BACKGROUND AND OBJECTIVES: The prejudice biases the categorization processes, which implies assigning particular characteristics beyond the objective data available. The stereotype occupies the categorical content by adding what is lacking to what we little know. From a mere physical datum ("he/she is fat") we categorize the obese individual on the basis of our own believes, intimately fusing the stereotype and categorization. SETTING, POPULATION, AND INTERVENTIONS: We included 138 students and 47 patients with anorexia or bulimia that assigned qualifying adjectives of the personality of obese people by using a list of epithets. This same list was provided to 49 obese patients in order to be used to define their own personality. RESULTS: We analyzed the most frequently used epithets and the corresponding scales of personality by applying the X2 test to determine the differences between the adjectives and the scales in the samples. We considered a p value<0.05 as being statistically significant, by using the SPSS v.13 software. Obese people define their personality very differently than the control group and the group of patients does. While obese people more frequently use "positive" adjectives, the other groups tend to use adjectives with more "negative" connotations. It seems that the stereotypes introduce a perception bias regarding the personality characteristics. The fear to overweight-obesity or the fact of "weight gaining" of patients would explain some of the findings of this work. Patients attribute obese people some personality characteristics altogether more negative than those attributed by the people in the control group. CONCLUSIONS: Knowing the influence of the stereotypes on obesity perception is essential to approach the patient with no prejudice regarding his/her treatment. The personality characteristics attributed to obese people are far from how these people really perceive themselves.

Liquen plano esofágico: hallazgos clínicos, endoscópicos, endosonográficos e histológicos / Esophageal lichen planus: clinical, endoscopic, endosonographic and histological findings

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Masa submucosa rectal y meningitis aguda: presentación de un meningocele sacro anterior / Submucous rectal mass and acute meningitis: presentation of an anterior sacral meningocele

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Linfoma no-Hodgkin intraoral. Presentación de 4 casos clínicos / Intraoral no-Hodgkin lymphoma. Presentation of 4 clinical cases

Los linfomas no-Hodgkin (LNH) incluyen un grupo heterogéneo de malignidades de histogénesis linforreticular. La mayoría de casos inician en los nódulos linfáticos, aunque existe también la forma extraganglionar. En la cavidad oral el LNH tiene baja incidencia. Puede afectar a los maxilares y/o tejidos blandos como manifestación primaria o secundaria de la enfermedad. Presentamos una revisión de la literatura y cuatro casos clínicos de LNH intraoral, con el propósito de describir sus características clínicas e histológicas. Los dos primeros casos son linfomas intraorales primarios, un tercero asociado a infección VIH y por último una manifestación oral como parte de la diseminación de la enfermedad (AU)

The non-Hodgkin lymphomas (NHL) represent an heterogeneous group of malignancies of lymphoreticular histogenesis. In most cases, they initially arise within lymph nodes but so-called extranodal lymphomas are also found. The NHL has low incidence in the oral cavity. It may involve bone and/or soft tissues as a primary or secondary manifestation. We present a review of the literature and four clinical cases of intraoral NHL. The first couple of cases are primary forms, the third one is associated to HIV infection and the last one is an oral presentation as a component of more widely disseminated disease (AU)