Conocimiento de la enfermedad asmática como factor protector de neumonía / Knowledge of asthmatic disease as a pneumonia protective factor

Objetivo: Evaluar si el conocimiento de la enfermedad asmática puede ser un factor protector frente al riesgo de neumonía adquirida en la comunidad (NAC) en las personas con asma mayores de 18 años que reciben tratamiento inhalado. Método: Estudio observacional de casos y controles en población con asma. Se reclutaron 123 personas con asma diagnosticadas de neumonía por criterios clínicos y radiológicos (casos) y 246 personas con asma no diagnosticados de neumonía durante el último año (controles), apareados por edad. El principal factor de estudio fue la valoración del conocimiento sobre la enfermedad asmática mediante un cuestionario ad hoc, de 7 preguntas con 2 posibles respuestas (conoce, no conoce). Resultados: El análisis bivariado muestra que el conocimiento de la enfermedad asmática tiene una asociación estadísticamente significativa como factor protector de NAC. En el análisis multivariante muestra una asociación del conocimiento de la enfermedad asmática como factor protector de NAC (OR = 0,24), independientemente de la edad, nivel de estudios, funcionalidad y gravedad del asma. Conclusiones: Un buen conocimiento de la enfermedad asmática permite reducir el riesgo de NAC en pacientes asmáticos con tratamiento inhalado

Objective: To assess whether knowledge of asthmatic disease may be a protective factor against the risk of community-acquired pneumonia (CAP) in people with asthma over the age of 18 who receive inhaled treatment. Method: observational study of cases and controls in a population with asthma. One hundred and twenty-three people with asthma diagnosed with pneumonia were recruited according to clinical and radiological criteria (cases), and 246 people with asthma not diagnosed with pneumonia during the past year (controls), matched by age. The main study factor was the assessment of knowledge about asthmatic disease through an ad hoc questionnaire, with seven questions and two possible answers (known, unknown). Results: the bivariate analysis shows that knowledge of asthmatic disease has a statistically significant association as a protective factor of CAP. In the multivariate analysis, it shows an association of knowledge of asthmatic disease as a protective factor of CAP (OR=.24), regardless of age, level of studies, functionality, and severity of asthma. Conclusions: A good knowledge of asthmatic disease reduces the risk of CAP in asthmatic patients using inhaled treatment

Knowledge of asthmatic disease as a pneumonia protective factor. / Conocimiento de la enfermedad asmática como factor protector de neumonía.

OBJECTIVE: To assess whether knowledge of asthmatic disease may be a protective factor against the risk of community-acquired pneumonia (CAP) in people with asthma over the age of 18 who receive inhaled treatment. METHOD: observational study of cases and controls in a population with asthma. One hundred and twenty-three people with asthma diagnosed with pneumonia were recruited according to clinical and radiological criteria (cases), and 246 people with asthma not diagnosed with pneumonia during the past year (controls), matched by age. The main study factor was the assessment of knowledge about asthmatic disease through an ad hoc questionnaire, with seven questions and two possible answers (known, unknown). RESULTS: the bivariate analysis shows that knowledge of asthmatic disease has a statistically significant association as a protective factor of CAP. In the multivariate analysis, it shows an association of knowledge of asthmatic disease as a protective factor of CAP (OR=.24), regardless of age, level of studies, functionality, and severity of asthma. CONCLUSIONS: A good knowledge of asthmatic disease reduces the risk of CAP in asthmatic patients using inhaled treatment.

Salud bucodental y riesgo de neumonía en pacientes asmáticos con tratamiento inhalado / Oral health and risk of pneumonia in asthmatic pacients with inhaled treatment

Introducción y objetivo: El asma es una enfermedad crónica que precisa tratamiento inhalado y que, a su vez, es factor de riesgo (FR) de neumonía. En la cavidad orofaríngea existen numerosas especies de bacterias que podrían ser arrastradas a nivel broncoalveolar. Objetivo: determinar si la salud bucodental es un FR de neumonía adquirida en la comunidad (NAC) en pacientes asmáticos que realizan tratamiento inhalado y determinar si la frecuencia de utilización de los dispositivos de inhalación y el tipo de fármaco inhalado son FR de NAC. Pacientes y método: Estudio de casos y controles en población asmática con tratamiento inhalado. Se seleccionaron 126 pacientes asmáticos diagnosticados de neumonía por criterios clínicos y radiológicos (casos) y 252 asmáticos no diagnosticados de neumonía durante el último año (controles), emparejados por edad. El principal factor de estudio fue la puntuación del General Oral Health Assessment Index (GOHAI). Resultados: El análisis bivariado muestra una asociación estadísticamente significativa de la NAC con un índice de GOHAI≤57 puntos (mala salud bucodental) (OR 1,69), el tratamiento anticolinérgico (OR 2,41), realizar 6 o más inhalaciones al día (OR 3,23), el uso de cámara (OR 1,62), el FEV1 (OR 0,98), una alteración de la funcionalidad (OR 2,08) y los trastornos psiquiátricos o la depresión (OR 0,41). El análisis multivariante muestra una asociación independiente de realizar 6 o más inhalaciones al día (OR 2,74) y de las alteraciones de la funcionalidad (OR 1,67). Conclusiones: Los resultados evidencian que una mala salud bucodental podría ser un FR de NAC

Introduction and objective: Asthma is a chronic disease requiring inhaled treatment and in addition it is a risk factor (RF) of pneumonia. In the oropharyngeal cavity there are numerous species of bacteria that could be dragged to the bronco-alveolar level. Objective: to decide whether oral health is a community acquired pneumonia (CAP) RF in asthmatic patients who are taking inhaled treatment, and determining whether the frequency of use of inhalation devices and the type of inhaled drug are CAP RF. Patients and method: Case-control study in asthmatic population with inhaled treatment. We recruited 126 asthmatic patients diagnosed with pneumonia by clinical and radiological criteria (cases) and 252 asthmatics not diagnosed with pneumonia during the last year (controls), matched by age. The main factor of study was the General Oral Health Assessment Index (GOHAI) score. Results: Bivariated analysis showed a statistically significant association of CAP with a GOHAI score≤57 points (poor oral health) (OR 1.69), anticholinergic treatment (OR 2.41), 6 or more inhalations (3.23), chamber use (OR 1.62), FEV1 (OR 0.98), altered functionality (OR 2.08) and psychiatric disorders or depression (OR 0.41). The multivariated analysis shows an independent association of performing 6 or more inhalations per day (OR 2.74) and functional impairment (OR 1.67). Conclusions: The results suggest that poor oral health may be a CAP RF

Oral health and risk of pneumonia in asthmatic pacients with inhaled treatment. / Salud bucodental y riesgo de neumonía en pacientes asmáticos con tratamiento inhalado.

INTRODUCTION AND OBJECTIVE: Asthma is a chronic disease requiring inhaled treatment and in addition it is a risk factor (RF) of pneumonia. In the oropharyngeal cavity there are numerous species of bacteria that could be dragged to the bronco-alveolar level. OBJECTIVE: to decide whether oral health is a community acquired pneumonia (CAP) RF in asthmatic patients who are taking inhaled treatment, and determining whether the frequency of use of inhalation devices and the type of inhaled drug are CAP RF. PATIENTS AND METHOD: Case-control study in asthmatic population with inhaled treatment. We recruited 126 asthmatic patients diagnosed with pneumonia by clinical and radiological criteria (cases) and 252 asthmatics not diagnosed with pneumonia during the last year (controls), matched by age. The main factor of study was the General Oral Health Assessment Index (GOHAI) score. RESULTS: Bivariated analysis showed a statistically significant association of CAP with a GOHAI score≤57 points (poor oral health) (OR 1.69), anticholinergic treatment (OR 2.41), 6 or more inhalations (3.23), chamber use (OR 1.62), FEV1 (OR 0.98), altered functionality (OR 2.08) and psychiatric disorders or depression (OR 0.41). The multivariated analysis shows an independent association of performing 6 or more inhalations per day (OR 2.74) and functional impairment (OR 1.67). CONCLUSIONS: The results suggest that poor oral health may be a CAP RF.

Cytokeratin 5/6 fingerprinting in HER2-positive tumors identifies a poor prognosis and trastuzumab-resistant basal-HER2 subtype of breast cancer.

There is an urgent need to refine the prognostic taxonomy of HER2+ breast carcinomas and develop easy-to-use, clinic-based prediction algorithms to distinguish between good- and poor- responders to trastuzumab-based therapy. Building on earlier studies suggesting that HER2+ tumors enriched with molecular and morpho-immunohistochemical features classically ascribed to basal-like tumors are highly aggressive and refractory to trastuzumab, we investigated the prognostic and predictive value of the basal-HER2+ phenotype in HER2-overexpressing tumors. Our retrospective cohort study of a consecutive series of 152 HER2+ primary invasive ductal breast carcinomas first confirmed the existence of a distinct subgroup co-expressing HER2 protein and basal cytokeratin markers CK5/6, the so-called basal-HER2+ phenotype. Basal-HER2+ phenotype (≥10% of cells showing positive CK5/6 staining), but not estrogen receptor status, was significantly associated with inferior overall survival by univariate analysis and predicted worsened disease free survival after accounting for strong prognostic variables such as tumor size at diagnosis in stepwise multivariate analysis. In the sub-cohort of HER2+ patients treated with trastuzumab-based adjuvant/neoadjuvant therapy, basal-HER2+ phenotype was found to be the sole independent prognostic marker for a significantly inferior time to treatment failure in multivariate analysis. A CK5/6-based immunohistochemical fingerprint may provide a simple, rapid, and accurate method for re-classifying women diagnosed with HER2+ breast cancer in a manner that can improve prognosis and therapeutic planning in patients with clinically aggressive basal-HER2+ tumors who are not likely to benefit from trastuzumab-based therapy.

An improved axillary staging system using the OSNA assay does not modify the therapeutic management of breast cancer patients.

The one-step nucleic acid amplification (OSNA) assay is a molecular procedure that can identify deposits of breast cancer (BC) cells in the sentinel lymph node (SLN). We examined the consistency of the OSNA assay with a classic hematoxylin-eosin (H&E)-based immunohistochemistry (IHC) study and evaluated how OSNA-based axillary staging might impact the therapeutic management of BC patients. SLN biopsy results were considered to be positive in 60 patients (40%) in the OSNA group (N = 148) and in 43 (28%) patients in the IHC cohort (N = 153, p = 0.023). There was no difference in the macrometastasis (22% for OSNA, 15% for H&E, p = 0.139) or micrometastasis (19% for OSNA, 13% for H&E, p = 0.166) rates, but we found statistically significant differences in the number of isolated tumor cells (1% for OSNA, 11% for H&E, p < 0.001). There were no differences in the administration rate of adjuvant systemic therapy between the OSNA (66% in the SLN(+) patients) and the H&E (74% in the SLN(+) patients) groups (p = 0.159). The OSNA assay allows for the detection of SLN metastases more precisely than conventional pathologic methods but does not alter the therapeutic management of SLN(+) BC patients.

Prevalencia del síntoma ansiedad en pacientes con demencia en una unidad de psicogeriatría y tratamiento farmacológico asociado / No disponible

La ansiedad es uno de los síntomas que aparece frecuentemente en los pacientes con demencia, si bien su prevalencia varía en función del tipo y fase de la misma, del sexo del individuo e incluso del grado de autonomía funcional. La ansiedad suele tener una repercusión importante sobre la calidad de vida del enfermo y sus cuidadores, lo que justifica la instauración de medidas no farmacológicas y a menudo, también farmacológicas. Ahora bien, la utilización de medicamentos en la población geriátrica y particularmente en los dementes es compleja, por la mayor sensibilidad a los fármacos y mayor susceptibilidad de padecer efectos no deseados. La instauración de tratamientos farmacológicos necesariamente conlleva a una revisión crítica y sistemática de su beneficio/riesgo de acuerdo a los objetivos terapéuticos que han sido predefinidos (AU)

Anxiety is a symptom that occurs frequently in patients with dementia, although their prevalence varies depending on the type and stage of it, the sex of the individual and even the degree of functional autonomy. Anxiety often has a significant impact on the quality of life of patients and their caregivers, which justifies the introduction of non-pharmacological measures and often also drugs. However, the use of drugs in the elderly, particularly in dementia is complex, because has a greater drug sensitivity and susceptibility to unwanted effects. The introduction of drug therapies necessarily leads a systematic critical review of the benefit/risk according therapeutic goals that have been predefined (AU)

Synchronous solid neuroendocrine breast carcinoma and abdominal lymphoma: A case report and review of the literature.

Neuroendocrine tumors (NETs) are frequently associated with second primary malignancies (SPMs). Earlier studies have demonstrated that NETs are highly associated with synchronous or metachronous gastrointestinal and genitourinary SPMs. We report, for the first time, a case of pure NE breast carcinoma (NEBC) exhibiting all of the World Health Organization (WHO)-categorized morphological and phenotypic NE features (i.e., round solid nests of spindle cells, plasmacytoid cells, large clear or mucinous signet-ring cells with a peripheral palisading tendency and immunohistochemical positivity for the NE markers synaptophysin and chromogranin in more than 50% of the tumor cell population) along with synchronous abdominal non-Hodgkin's lymphoma. In the present study, we review the diagnosis, clinicopathological features and histogenetic profiling of NEBC and discuss the literature relevant to the clinical and anatomopathological management of this case. This previously unreported case of synchronous solid NEBC and abdominal lymphoma, together with earlier studies showing that primary symptoms are caused by SPMs in a significant subgroup of NET patients, strongly supports the notion that NETs should be cautiously considered to be index tumors. Therefore, risk-adapted clinicopathological follow-up with systematic investigation is strongly recommended.

Fisiopatología de la enfermedad de Parkinson. ¿Ayudará la PET de carga amiloidea a la predicción de la demencia en la enfermedad de Parkinson? / Pathophysiology of Parkinson's disease. Will amyloid load PET scanning help to predict dementia in Parkinson's disease?

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Efficacy of long-term continuous subcutaneous apomorphine infusion in advanced Parkinson's disease with motor fluctuations: a multicenter study.

Continuous subcutaneous apomorphine infusion (CSAI) is, at present, an alternative option for advanced Parkinson's disease (PD) with motor fluctuations. We studied the evolution of patients with PD and severe motor fluctuations long-term treated with CSAI. We reviewed data from 82 patients with PD (mean age, 67 +/- 11.07; disease duration, 14.39 +/- 5.7 years) and severe motor fluctuations referred to 35 tertiary hospitals in Spain. These patients were long-term treated (for at least 3 months) with CSAI and tolerated the procedure without serious side effects. We compared the baseline data of these 82 patients (before CSAI) with those obtained from the last follow-up visit of each patient. The mean follow-up of CSAI was 19.93 +/- 16.3 months. Mean daily dose of CSAI was 72.00 +/- 21.38 mg run over 14.05 +/- 1.81 hours. We found a statistically significant reduction in off-hours, according to self-scoring diaries (6.64 +/- 3.09 vs. 1.36 +/- 1.42 hours/day, P < 0.0001), total and motor UPDRS scores (P < 0.0001), dyskinesia severity (P < 0.0006), and equivalent dose of antiparkinsonian therapy (1,405 +/- 536.7 vs. 800.1 +/- 472.9 mg of levodopa equivalent units P < 0.0001). CSAI is an effective option for patients with PD and severe fluctuations, poorly controlled by conventional oral drug treatment.

Síndrome de piernas inquietas y neuroacantocitosis / Restless legs syndrome and neuroacanthocytosis

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[Differential diagnosis of parkinsonism using dopamine transporters brain SPECT]. / Contribución de la SPECT cerebral de transportadores de dopamina en el diagnóstico diferencial de los parkinsonismos.

BACKGROUND AND OBJECTIVE: Parkinsonism is a group of neurological disorders characterized by extrapiramidal signs. Often, the differential diagnosis between parkinsonism, essential tremor and drug-induced parkinsonism is difficult. The aim of the study was to evaluate the utility of (123I)-FP-CIT SPECT in patients with movement disorders. PATIENTS AND METHOD: 52 patients were referred from the neurology department to characterize those with parkinsonism. Patients were clinically evaluated and those with Parkinson's disease were assessed using the rating scale Hoehn & Yahr and the UPDRS motor score. Subsequently, a (123I)-FP-CIT SPECT was performed with a qualitative analysis. RESULTS: All patients with essential tremor and drug-induced parkinsonism had a normal SPECT. All patients with parkinsonism displayed SPECT defects, except for four who had a normal SPECT result. Two of them were categorized as vascular parkinsonisms, one patient had a Shy-Drager's syndrome and the another one had probably a Parkinson's disease. The sensitivity and specificity were 90.47% (38/42; CI95%, 81.59%-99.35%) and 100% (10/10; CI95%, 69.15%-100%), respectively. CONCLUSIONS: (123I)-FP-CIT SPECT is an effective tool to study the integrity of the dopaminergic nigrostriatal system. Moreover, it permits to characterize the different types of parkinsonism.

Contribución de la SPECT cerebral de transportadores de dopamina en el diagnóstico diferencial de los parkinsonismos / Differential diagnosis of parkinsonism using dopamine transporters brain SPECT

FUNDAMENTO Y OBJETIVO: Los parkinsonismos son un grupo de enfermedades neurológicas que se caracterizan por presentar una clínica extrapiramidal. A menudo, el diagnóstico diferencial entre los síndromes parkinsonianos, el temblor esencial y los parkinsonismos farmacológicos puede resultar difícil. El objetivo del estudio ha sido evaluar el rendimiento diagnóstico de la tomografía computarizada por emisión de fotón único (SPECT) en la caracterización de los trastornos del movimiento utilizando un trazador que se une a los transportadores presinápticos de la dopamina (123I-FPCIT). PACIENTES Y MÉTODO: Se incluyó a 52 pacientes, remitidos de la consulta de neurología con un síndrome parkinsoniano. Se realizó una evaluación clínica basada en la exploración neurológica a todos los pacientes y, en los pacientes con enfermedad de Parkinson, según los estadios de Hoehn & Yahr y la escala UPDRS. A todos los pacientes se les realizó una SPECT cerebral con 123 I-FP-CIT. La catalogación final de los pacientes se correlació con los resultados de la SPECT con 123 I-FP-CIT. RESULTADOS: Todos los pacientes con diagnóstico de temblor esencial y/o parkinsonismo farmacológico mostraron una SPECT normal. El resto de los pacientes diagnosticados de un síndrome parkinsoniano presentaron una SPECT alterada, en un grado variable, a excepción de 4 que tenían una SPECT normal y estaban diagnosticados de un parkinsonismo vascular (2 casos), síndrome de Shy-Drager (1 caso) y una probable enfermedad de Parkinson (1 caso). La sensibilidad fue del 90,47 por ciento (38/42; intervalo de confianza del 95 por ciento, 81,59-99,35 por ciento) y la especificidad del 100 por ciento (10/10; 69,15-100 por ciento). CONCLUSIONES: La SPECT con 123 I-FP-CIT es una herramienta útil para el estudio de la integridad del sistema dopaminérgico nigroestriado, que permite la caracterización de los diversos síndromes parkinsonianos (AU)