Epidemiology of Immune-Mediated Glomerulopathies before and after SARS-CoV-2 Vaccination: A Tertiary Referral Hospital Experience.

BACKGROUND: Vaccination is a known trigger for the appearance of immune-mediated glomerulopathies (IMG). The appearance of IMG after SARS-CoV-2 vaccination with suspected causality has been described. Our aim is to analyze the incidence of IMG flares before and after SARS-CoV-2 vaccination in our center. METHODS: All persons with native kidney biopsy (KB) from January 2019 to March 2022 in our center were included in the study. We compared the incidence of IMG before and after the start of vaccination. We also collected information about whether the patients had received a SARS-CoV-2 vaccine or have suffered from COVID in the six weeks before the IMG. We also evaluated the analytical characteristics of the outbreaks. RESULTS: A total of 386 KB were studied. Of them, 86/218 (39.4%) were IMG performed pre- and 85/168 (50.6%) post-SV (029). The incidence of idiopathic nephrotic syndrome (INS), studied separately, was also significantly increased post-vaccination (n = 18 (10.7%)) compared to pre-vaccination (n = 11 (5%)) (p = 0.036). There were no differences in the incidence of vasculitis or IgA nephropathy. Up to 17 (20%) flares occurred 6 weeks before SARS-CoV-2 vaccination and only 2 (2.4%) within the first 6 weeks after SARS-CoV-2 infection. Within those 17 flares, the most common diagnosis was IgAN (n = 5 (29.4%)); a total of 14 (82.4%) received an mRNA vaccine and 9 (52.9%) took place after the 1st vaccine dose. There were 13 cases of minimal change disease (MCD) with debut/recurrence pre-SV and 20 MCD with debut/recurrence post-SV (p = 0.002). CONCLUSIONS: The incidence of IMG, INS and MCD flares in our center increased significantly after SARS-CoV-2 vaccination. Importantly, 20% of IMG flares took place within the first 6 weeks after receiving a vaccine dose, with the first dose being the riskiest one and IgAN the most frequent diagnosis.

Noninvasive Diagnosis of PLA2R-Associated Membranous Nephropathy: A Validation Study.

BACKGROUND AND OBJECTIVES: Kidney biopsy is the current gold standard to diagnose membranous nephropathy. Approximately 70%-80% of patients with primary membranous nephropathy have circulating anti-phospholipase A2 receptor antibodies. We previously demonstrated that in proteinuric patients with preserved eGFR and absence of associated conditions (e.g., autoimmunity, malignancy, infection, drugs, and paraproteinemia), a positive anti-phospholipase A2 receptor antibody test by ELISA and immunofluorescence assay confirms the diagnosis of membranous nephropathy noninvasively. These data have not been externally validated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The clinical and pathologic characteristics of patients with a positive anti-phospholipase A2 receptor antibody test at the Mayo Clinic, the University Hospital Vall D'Hebron (Barcelona), and the Columbia University Medical Center (New York) were retrospectively reviewed. Biopsy findings and presence or absence of a potential associated condition were assessed. RESULTS: From a total of 276 patients with positive anti-phospholipase A2 receptor serology, previously reported patients (n=33), kidney transplant recipients (n=9), pediatric patients (n=2), and patients without kidney biopsy (n=69) were excluded. Among the 163 remaining patients, associated conditions were identified in 47 patients, and 15 patients had diabetes mellitus. All 101 patients of the final cohort had a primary diagnosis of membranous nephropathy on kidney biopsy. In the 79 patients with eGFR≥60 ml/min per 1.73 m2, none of the biopsy findings altered diagnosis or management. Among the 22 patients with decreased eGFR, additional findings included superimposed acute interstitial nephritis (n=1). CONCLUSIONS: In patients with preserved eGFR and absence of associated conditions or diabetes, a positive anti-phospholipase A2 receptor test by either ELISA >20 RU/ml or a positive immunofluorescence assay confirms the diagnosis of membranous nephropathy, precluding the requirement for a kidney biopsy.

MRI and Targeted Biopsy Essential Tools for an Accurate Diagnosis and Treatment Decision Making in Prostate Cancer.

Prostate cancer (PCa) is one of the most frequent causes of cancer death worldwide. Historically, diagnosis was based on physical examination, transrectal (TRUS) images, and TRUS biopsy resulting in overdiagnosis and overtreatment. Recently magnetic resonance imaging (MRI) has been identified as an evolving tool in terms of diagnosis, staging, treatment decision, and follow-up. In this review we provide the key studies and concepts of MRI as a promising tool in the diagnosis and management of prostate cancer in the general population and in challenging scenarios, such as anteriorly located lesions, enlarged prostates determining extracapsular extension and seminal vesicle invasion, and prior negative biopsy and the future role of MRI in association with artificial intelligence (AI).

Neoadjuvant immunotherapy for muscle invasive urothelial bladder carcinoma: will it change current standards?

Immunotherapy, in the form of immune checkpoint inhibitors (ICI), has shown activity in metastatic urothelial bladder carcinoma, resulting in the approval of several ICI agents in the first- and second-line settings. This has led to an increased interest in studying their efficacy in the neoadjuvant setting for muscle invasive disease - an area of significant unmet need. This non-systematic review will look at the evidence supporting the use of ICI in the neoadjuvant setting for this tumor, results of early-phase studies, ongoing trials, and possible future applications for these drugs.

Infección por COVID-19 en una paciente con síndrome urticarial hipocomplementémico y vasculitis ANCA MPO en hemodiálisis tratada con omalizumab / COVID-19 in a patient with hypocomplementemic urticarial syndrome and MPO-ANCA vasculitis on hemodialysis treated with omalizumab

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[Identification of mycobacteria species through mass spectrometry (MALDI-TOF)]. / Identificación de especies de micobacterias mediante espectrometría de masas (MALDI-TOF).

BACKGROUND: Mycobacterial diseases are very important both clinically and epidemiologically. Mycobacterium tuberculosis complex (MTBc) infections confer higher morbidity and mortality rate than non-tuberculous mycobacteria (NTM) infections. Traditional species identification techniques are based on phenotypic characteristics which take a long time by laborious processes and in occasions are no conclusive. Currently, most used techniques are based on molecular methods, which are accurate but are expensive and complex. Matrix Assisted Laser Desorption/Ionization Time-of-Flight mass spectrometry (MALDI-TOF MS) is a simple, cheap and fast identification method based on comparing protein spectra with a reference database. AIM: To assess the performance of MALDI-TOF MS in the identification of MTBc and NTM, compared with molecular methods. METHODS: For that purpose, 28 isolates of 9 different species were analyzed through MALDI-TOF MS. RESULTS: 78.5% (22/28) of isolates were correctly identified, 100% (9/9) of rapidly growers NTM, 60% (9/15) of slow growing NTM and 100% (4/4) of MTBc. Every unidentified isolate (6/6) corresponded to M. avium/intracellulare complex. CONCLUSION: MALDI-TOF MS is fast, simple and cheaper than molecular methods and also has adequate accuracy.

Identificación de especies de micobacterias mediante espectrometría de masas (MALDI-TOF) / Identification of mycobacteria species through mass spectrometry (MALDI-TOF)

Resumen Introducción: Las enfermedades producidas por micobacterias son de gran importancia clínica y epidemiológica presentando el complejo Mycobacterium tuberculosis (MTBc) una morbi-mortalidad mayor que la producida por micobacterias no tuberculosas (MNTB). La identificación tradicional está basada en sus características fenotípicas mediante procesos laboriosos e incapaces en algunos casos de distinguir entre especies. Actualmente, la mayoría de las técnicas utilizadas se basan en métodos moleculares que tienen alta veracidad, pero son complejas y de alto costo. La espectrometría de masas con desorción/ionización láser asistida por una matriz asociada a tiempo de vuelo (MALDI-TOF MS) se basa en la comparación del espectro proteico producido con respecto al de una base de datos de referencia. Objetivo: Evaluar el rendimiento de MALDI-TOF MS en la identificación de micobacterias comparado con métodos moleculares: Material y Métodos: Se analizaron 28 aislados de nueve especies distintas mediante MALDI-TOF MS. Resultados: Se identificó correctamente 78,5% de las aislados (22/28), concordante en 100% (9/9) de MNTB de crecimiento rápido, 60% (9/15) en las MNTB de crecimiento lento y 100% (4/4) de MTBc. Todas las especies no identificadas (6/6) pertenecen al complejo M. avium/intracellulare. Conclusión: MALDI-TOD MS es una metodología rápida, fácil y de bajo costo, con adecuada veracidad respecto a los métodos moleculares.

Abstract Background: Mycobacterial diseases are very important both clinically and epidemiologically. Mycobacterium tuberculosis complex (MTBc) infections confer higher morbidity and mortality rate than non-tuberculous mycobacteria (NTM) infections. Traditional species identification techniques are based on phenotypic characteristics which take a long time by laborious processes and in occasions are no conclusive. Currently, most used techniques are based on molecular methods, which are accurate but are expensive and complex. Matrix Assisted Laser Desorption/Ionization Time-of-Flight mass spectrometry (MALDI-TOF MS) is a simple, cheap and fast identification method based on comparing protein spectra with a reference database. Aim: To assess the performance of MALDI-TOF MS in the identification of MTBc and NTM, compared with molecular methods. Methods: For that purpose, 28 isolates of 9 different species were analyzed through MALDI-TOF MS. Results: 78.5% (22/28) of isolates were correctly identified, 100% (9/9) of rapidly growers NTM, 60% (9/15) of slow growing NTM and 100% (4/4) of MTBc. Every unidentified isolate (6/6) corresponded to M. avium/intracellulare complex. Conclusion: MALDI-TOF MS is fast, simple and cheaper than molecular methods and also has adequate accuracy.

Developing a National Center of Excellence for Prostate Imaging.

PURPOSE OF REVIEW: The purpose of this review is to summarize the most current literature regarding the most important aspects to consider when developing a center of excellence for prostate imaging and biopsy. RECENT FINDINGS: Multiparametric MRI (mp-MRI) has changed the way we diagnose and treat prostate cancer. This imaging modality allows for more precise identification of areas suspicious in terms of harboring prostate cancer, enabling performance of targeted mp-MRI-guided biopsies that have been demonstrated to yield superior cancer detection rates. Centers worldwide are increasingly adopting this technology. However, obtaining results comparable with those findings published in the literature can be challenging. The imaging and biopsy process entails the need for a multidisciplinary team including a dedicated radiologist, urologist, and pathologist. Adequate mp-MRI interpretation for accurate lesion identification, acquaintance with the biopsy technique selected, and precise characterization of Gleason Score/Grade Groupings are equal determinants of accurate biopsy results. Furthermore, all specialists are required to attain appropriate learning curves to ensure optimal results. In this review, we characterize crucial aspects to consider when developing a center of excellence for prostate imaging and biopsy as well as insights regarding how to implement them.

Importancia y grado de conocimiento percibido por las enfermeras de Cantabria sobre farmacología, reacciones adversas medicamentosas e interacciones farmacológicas / Importance and level of knowledge perceived by nurses from Cantabria about pharmacology, adverse reactions to drugs, and drug-drug interactions

OBJETIVO: conocer la importancia y el grado percibido de conocimientos de las enfermeras de Cantabria sobre farmacología, reacciones adversas a medicamentos (RAM) e interacciones farmacológicas (IF); y determinar si existen diferencias en relación con sus características profesionales. MÉTODO: estudio descriptivo transversal. Se diseñó un cuestionario en papel autocumplimentado y anónimo de seis preguntas, tras revisión de la literatura, consenso y pilotaje de la herramienta. Mediante una muestra de conveniencia fueron encuestados profesionales enfermeros de hospitales, Atención Primaria (AP) y Atención Sociosanitaria (AS) de Cantabria. Se realizó estadística descriptiva y prueba de contraste de hipótesis con Chi cuadrado de Pearson. RESULTADOS: se recogieron 132 cuestionarios. El 72% y el 90,9% de los encuestados consideraban insuficiente la formación pregrado y postgrado en Farmacología, respectivamente. Se consideraba capacitado para reconocer RAM el 60% con una antigüedad < 6 años frente al 84,3% en >15 años (p= 0,01), y el 59,7% de eventuales frente al 77,1% de los fijos (p= 0,03). El 41,9% de los eventuales conocía las principales IF frente al 62,9% de los fijos (p= 0,02). La Enfermería hospitalaria fue el ámbito con mayor percepción de recibir una formación continuada adecuada en farmacología (p= 0,001). CONCLUSIONES: hay un importante déficit percibido de formación en farmacología. Existen ciertas características profesionales diferenciales: las enfermeras de hospitales, con contratos fijos y con una mayor experiencia, manifiestan mejores resultados respecto a los colectivos de enfermeras de AP, AS, eventuales y con menor experiencia laboral

OBJECTIVE: to understand the importance and perceived level of knowledge by nurses from Cantabria about pharmacology, adverse reactions to drugs (ARDs) and drug-drug interactions (DDIs); and to determine if there are differences according to their professional characteristics. METHOD: a cross-sectional descriptive study. A printed self-completion questionnaire was designed, anonymous and including six questions, after a literature review, consensus and pilot trial of the tool. Through convenience sampling, a survey was conducted on nursing professionals from hospitals, Primary Care (PC) and Healthcare and Social Work (HSW) from Cantabria. Descriptive statistics was conducted, as well as Hypothesis Contrast Test through Pearson's Chi Square. RESULTS: in total, 132 questionnaires were collected; 72% and 90.9% of participants considered insufficient the undergraduate and post-graduate training on Pharmacology, respectively. Sixty per cent (60%) with < 6-year seniority considered they were qualified to identify ARDs vs. 84.3% with >15 years (p= 0.01), and 59.7% of temporary workers vs. 77.1% of permanent workers (p= 0.03); 41.9% of temporary workers were aware of the main DDIs vs. 62.9% of permanent workers (p= 0.02). Hospital nursing was the setting with a higher perception of receiving an adequate continuous training on Pharmacology (p= 0.001). CONCLUSIONS: there is an important deficit perceived in terms of Pharmacology training. There are certain differentiating professional characteristics: hospital nurses with permanent contracts and higher experience show better results vs. the nurses in PC and HSW, temporary and with lower work experience

Experiencia inicial en seguridad, tolerancia y adherencia al uso de docetaxel en pacientes con cáncer de próstata castración sensibles en un centro oncológico nacional / Initial experience in safety, tolerance and adherence to the use of docetaxel in patients with sensitive castration prostate cancer in a national cancer center

INTRODUCCIÓN: El cáncer de próstata (PC) es una enfermedad de alta incidencia y prevalencia (90/100.00 habitantes) y constituye la segunda causa por muerte oncológica en hombres, fenómeno que acontece en su fase metastásica (mPC). El tratamiento estándar en esta etapa corresponde a la terapia de deprivación androgénica (TDA) que produce una respuesta oncológica favorable en términos de descenso del PSA y estabilización y/o regresión de las metástasis. Ésta primera etapa (castración sensible) dura en promedio 2 a 3 años, tras lo cual ocurre una independización tumoral del estímulo androgénico, fenómeno conocido como castración-resistencia (mCRPC). En esta etapa la quimioterapia (QMT) con docetaxel prolonga la sobrevida aproximadamente 4 meses, lo cual en conjunto con otros tratamientos de segunda línea (abiraterona, enzalutamida, etc.) logra alcanzar una sobrevida media desde el diagnostico de mCRPC de 24 meses. Diversos estudios (CHAARTED y STAMPEDE) han demostrado que el inicio de docetaxel junto con TDA en pacientes con mPC castración-sensible (mCSPC) prolongan sobrevida global hasta 17 meses, especialmente si hay alto volumen de enfermedad. El objetivo del estudio es describir las características clínicas, la respuesta oncológica inicial y el perfil de efectos adversos de pacientes con mCSPC sometidos a docetaxel. MATERIALES Y MÉTODOS: Estudio retrospectivo descriptivo entre mayo 2014 a Julio 2017. Se incluyeron pacientes ng/ml (rango 10,8 - 5550) y mediana de seguimiento 6 meses (rango 3 ­ 20). Catorce pacientes tenían Gleason > 8, 18 eran M+ de los cuales 9 eran viscerales. Solo uno recibió tratamiento local previo. La mediana de inicio de QMT fue 3,1 (0 ­ 6,1) meses post inicio TDA.Dieciséis pacientes completaron docetaxel y 4 siguen en curso. No hubo suspensión de QMT por efectos adversos. Los más frecuentes fueron diarrea (8/20), neuropatía (5/20) y vómitos (2/20). La mayoría fue grado 1 y solo tres presentaron complicaciones grado 3 (diarrea, leucopenia y trombocitopenia). No hubo complicaciones grado 4 -5. Diez pacientes alcanzaron un antígeno < 2 ng/ml a las 12 semanas post tratamiento y 7 presentaron recidiva bioquímica durante el seguimiento. Uno tuvo respuesta imagenológica completa, 10 respuesta parcial, 7 estabilidad y 2 mostraron progresión. CONCLUSIONES: El uso de Docetaxel en mCSPC es seguro, presenta escasos efectos adversos (la mayoría de intensidad leve) que no motivan suspensión. El tratamiento con docetaxel exhibe una respuesta prometedora en términos de control de PSA, sin embargo se requiere mayor seguimiento de esta cohorte para evaluar impacto en sobrevida. con mCSPC con enfermedad de alto volumen (metástasis óseas extra-axiales, viscerales o Gleason 9-10) y ECOG 0-1. Los pacientes recibieron TDA y seis ciclos de Docetaxel. Se registraron datos demográficos, clínicos, histopatológicos, PSA, imagenológicos (RECIST V1.1) y toxicidad (NCI CAE 4.0) RESULTADOS: Se incluyeron 20 pacientes, mediana de edad 63 años (rango 49 ­ 75). Mediana PSA de ingreso 267,5 ng/ml (rango 10,8 - 5550) y mediana de seguimiento 6 meses (rango 3 ­ 20). Catorce pacientes tenían Gleason > 8, 18 eran M+ de los cuales 9 eran viscerales. Solo uno recibió tratamiento local previo. La mediana de inicio de QMT fue 3,1 (0 ­ 6,1) meses post inicio TDA.Dieciséis pacientes completaron docetaxel y 4 siguen en curso. No hubo suspensión de QMT por efectos adversos. Los más frecuentes fueron diarrea (8/20), neuropatía (5/20) y vómitos (2/20). La mayoría fue grado 1 y solo tres presentaron complicaciones grado 3 (diarrea, leucopenia y trombocitopenia). No hubo complicaciones grado 4 -5. Diez pacientes alcanzaron un antígeno < 2 ng/ml a las 12 semanas post tratamiento y 7 presentaron recidiva bioquímica durante el seguimiento. Uno tuvo respuesta imagenológica completa, 10 respuesta parcial, 7 estabilidad y 2 mostraron progresión. CONCLUSIONES: El uso de Docetaxel en mCSPC es seguro, presenta escasos efectos adversos (la mayoría de intensidad leve) que no motivan suspensión. El tratamiento con docetaxel exhibe una respuesta prometedora en términos de control de PSA, sin embargo se requiere mayor seguimiento de esta cohorte para evaluar impacto en sobrevida.(AU)

INTRODUCTION: Prostate cancer is a disease with high incidence and prevalence (90/100.000 habitants) and the second cause of cancer related death in men. Standard treatment in this setting is androgen-deprivation therapy (TDA), which causes decrease in PSA levels and stabilization or regression of metastatic lesions. Responses in castration sensitive phase last in average 3 years, after which tumor is described to become independent from the androgenic stimuli, reaching a castration-resistance (mCRPC) state. At this point chemotherapy with docetaxel as well as second line treatments (abiraterone, enzalutamide, among others)have shown to improve survival in 4 months with mean survival from diagnosis of mCRPC of 24 months. Studies including CHAARTED and STAMPEDE have demonstrated that early treatment with docetaxel with ADT in patients with mCSPC prolongs overall survival, especially if high volume disease exists. This study describes the clinical characteristics, initial oncologic response and side effects profile of mCSPC treated with Docetaxel plus ADT. MATERIALS AND METHODS: Descriptive Retrospective study from May 2014 to July 2017. mCSPC patients with high volume disease (extra axial bone metastasis, visceral metastasis or Gleason 9-10) and ECOG 0-1 were included. Patients received ADT and 6 cycles of Docetaxel. Demographic, clinical and histopathological characteristicswere registered, together with PSA, radiologic data (RECIST V1.1) and toxicity (NCI CAE 4.0). RESULTS: 20 patients were included, median age 63 years (49-75 range). Median initial PSA 267,5 ng/ml (10,8-5550 range), and median follow up 6 months (3-20 range). Fourteen patients had Gleason > 8, 18presented bone metastasis and 9/14 viscerametastasis. Only 1 patient received previous local treatment. Median initialtime to initiation of Docetaxel post ADT was 3,1 (0-6,1) months.Sixteen patients completed docetaxel and 4 are still receiving treatment. There was no chemotherapy suspension due side effects. Most frequent side effects were diarrhea (8/20), neuropathy (5/20) and vomiting (2/20). Most were grade 1 and three patients presented grade 3 side effects (diarrhea, leukopenia and thrombocytopenia). No grade 4-5 side effects were reported.Ten patients reached PSA< 2 ng/m after 12 weeks of treatment, and 7 had biochemical relapse during follow up. One had complete radiologic response, 10 partial response, 7 remained stable and 2 showed progression of disease. CONCLUSION: The use of docetaxel in mCSPC isassociated to few side effects and none requiredsuspension of treatment. Treatment with Docetaxel exhibits promising results in terms of decrease in PSA, however longer follow up and greater number of patients are required to report benefits in overall survival.(AU)

La Escala de Norton como predictor de la calidad de vida relacionada con la salud en el anciano institucionalizado / The Norton Scale as predictor of health-related quality of life in institutionalized elderly

OBJETIVO: Una puntuación baja en la Escala de Norton (EdN), además de señalar el riesgo de aparición de una úlcera por presión, parece ser pronóstica de otros eventos adversos en el anciano. Por otro lado, la calidad de vida relacionada con la salud (CVRS) es un indicador con utilidades clínicas y, asimismo, predictivas. El objetivo ha sido analizar la relación entre la EdN y la CVRS en un análisis diferenciado por género. MÉTODO: Cincuenta y una mujeres y 39 varones de ≥ 65 años, institucionalizados, fueron estudiados mediante entrevista personal y registros médicos. Fueron evaluadas la EdN y la CVRS -mediante el cuestionario EuroQol-5D-, además de la edad, el índice de masa corporal, las caídas, el consumo de psicotropos, la función cognitiva, y los índices de Charlson, Barthel y Tinetti. Se elaboraron 2 modelos de regresión, con el EuroQol-5D como variable dependiente. RESULTADOS: La EdN mostró el mismo resultado en ambos sexos, con un valor de mediana (rango intercuartílico) de 19 (2). Las mujeres refirieron una peor CVRS, con un EuroQol-5D = 0,78, frente a 0,87 en los varones (p = 0,02). La EdN se correlacionó significativamente con la CVRS en las mujeres (r = 0,57; p < 0,001), pero no en los varones (r = 0,15; p = 0,36). Con el ajuste multivariante, la EdN presentó un valor beta = 0,54 (p = 0,02) en las mujeres y beta = 0,35 (p = 0,14) en los varones. CONCLUSIONES: La EdN ha sido la variable de mayor impacto sobre la CVRS en las mujeres, siendo dicha asociación independiente de la edad, la comorbilidad y el resto de las variables analizadas. En los varones, la relación fue más débil y no alcanzó la significación estadística

OBJECTIVE: A low Norton Scale (NS) score predicts pressure ulcer risk and several adverse outcomes in the elderly. On the other hand, health-related quality of life (HRQOL) is an indicator with clinical and predictive utilities. The aim was to assess the relationship between NS and HRQOL, in a gender analysis. Method: Fifty-one women and 39 men, institutionalized and aged ≥ 65 years, were evaluated through personal interview and medical records. The NS, HRQOL -with EuroQol-5D-, age, body mass index, falls, use of psychoactive drugs, cognitive function and Charlson, Barthel and Tinetti indexes, were assessed. Two regression models were developed, with EuroQol-5D as dependent variable. RESULTS: The NS showed the same score in both sexes, with a median (interquartile range) value of 19 (2). Women presented a worse HRQOL, with an EuroQol-5D = 0.78, whereas it was 0.87 in men (P = .02). The NS score was correlated with HRQOL in women (r = 0.57; P < .001) but not in men (r = 0.15;P = .36). After adjusting for confounders, the NS showed a beta value of 0.54 (P = .02) in women and beta = 0.35 (P = .14) in men. CONCLUSIONS: The NS has shown to be the strongest factor on HRQOL in women, regardless of age, comorbidity and the rest of covariates. Conversely, the relationship was weaker and non-significant in men

[The Norton Scale as predictor of health-related quality of life in institutionalized elderly]. / La Escala de Norton como predictor de la calidad de vida relacionada con la salud en el anciano institucionalizado.

OBJECTIVE: A low Norton Scale (NS) score predicts pressure ulcer risk and several adverse outcomes in the elderly. On the other hand, health-related quality of life (HRQOL) is an indicator with clinical and predictive utilities. The aim was to assess the relationship between NS and HRQOL, in a gender analysis. METHOD: Fifty-one women and 39 men, institutionalized and aged≥65 years, were evaluated through personal interview and medical records. The NS, HRQOL -with EuroQol-5D-, age, body mass index, falls, use of psychoactive drugs, cognitive function and Charlson, Barthel and Tinetti indexes, were assessed. Two regression models were developed, with EuroQol-5D as dependent variable. RESULTS: The NS showed the same score in both sexes, with a median (interquartile range) value of 19 (2). Women presented a worse HRQOL, with an EuroQol-5D=0.78, whereas it was 0.87 in men (P=.02). The NS score was correlated with HRQOL in women (r=0.57; P<.001) but not in men (r=0.15; P=.36). After adjusting for confounders, the NS showed a ß value of 0.54 (P=.02) in women and ß=0.35 (P=.14) in men. CONCLUSIONS: The NS has shown to be the strongest factor on HRQOL in women, regardless of age, comorbidity and the rest of covariates. Conversely, the relationship was weaker and non-significant in men.

Prevalencia de porcentaje de grasa corporal, obesidad abdominal y estado nutricional en una escuela primaria de mexicali baja california méxico / Prevalence of body fat, abdominal obesity and nutritional state in the students of an elementary school from mexicali baja california mexico

El objetivo de este estudio fue estimar la prevalencia del porcentaje de grasa corporal, obesidad abdominal y estado nutricional en los estudiantes de la Escuela Primaria Profesor Salvador Jiménez Gómez de Mexicali Baja California, México. Fueron evaluados 621 estudiantes, con un rango de edad de 6 a 13 años. A cada niño se le tomaron, medidas antropométricas de peso, talla, circunferencia de cintura, pliegue de tríceps y de pantorrilla; se utilizó el programa Epi Info Versión 3.3.2 para calcular el índice de masa corporal (IMC), estableciendo como obesidad un valor mayor o igual al percentil 95 y el sobrepeso un valor mayor o igual al percentil 85 y menor al 95 de acuerdo con la edad y sexo, tomando en cuenta la medición de circunferencia de cintura se determinó obesidad abdominal mayor o igual al percentil 90 de acuerdo con la edad y sexo; el porcentaje de grasa corporal de determino por la ecuación de slaughter. Las variables con prevalencias más altas resultaron las del estado nutricional, con donde el 19,1 por ciento de la población estudiada presentó sobrepeso y 25,1 por ciento obesidad. La prevalencia combinada de sobrepeso y obesidad en niños fue de 51,3 por ciento mientras que en niñas 37,4 por ciento. Los resultados encontrados en estos niños muestran claramente altas prevalencias de sobrepeso y obesidad. Inclusive más altas al promedio de los niños mexicanos. Concluyendo que en esta escuela es necesario tomar medidas, como poner en marcha programas de actividad física y nutrición orientados a frenar el problema del sobrepeso y obesidad.

The aim of this work was to estimate the prevalence of body fat, abdominal obesity and nutritional state in the students of the elementary school Salvador Jimenez Gomez in Mexicali Baja California. Mexico. Six hundred twenty-one children of 6 to 13 years old were studied, to determine the body fat, abdominal obesity and nutritional state, anthropometric measurements were taken and medial calf skinfolds, waist circumference, weight and height, body fat was determined according to the slaughter equation, abdominal obesity was determined 90 percentile according whit gender and age and Epi Info version 3.3.2 software was used to classify the overweight ( 85th percentile and < 95th percentile BMI for age and gender) and obesity ( 95th percentile BMI for age and gender) and through the body mass index (BMI). In our results, 19.1 percent of the students had overweight and 25.1 percent obesity. Combined overweight and obesity prevalence in boys was 51.3 percent while in girls was 37.4 percent. These results clearly show high prevalence of overweight and obesity in these children, in addition the children of this study were more overweight and obese than Mexican children average. It concludes that efforts should be made in this school to develop physical activity and nutrition programs to help stem rates of overweight and obesity.

[Presence of metallo beta-lactamases in imipenem-resistant Pseudomonas aeruginosa]. / Presencia de metalo-beta-lactamasas en Pseudomonas aeruginosa resistente a imipenem.

BACKGROUND: Metallo-beta-lactamases (MBL) confer high resistance to carbapenems in Pseudomonas aeruginosa (Psae). They are encoded in mobile elements of different genes (VIM, IMP, SMP, GIM), along with other resistance genes. AIM: To detect the presence of MBL in imipenem resistant Psae strains. MATERIAL AND METHODS: Fifty-nine imipenem resistant Psae strains isolated from January 2004 to August 2005 in a University Clinical Hospital, were included. The presence of MBL was studied by Etest (phenotypic) and genotypic polymerase chain reaction (PCR) methods. To rule out a nosocomial outbreak, MBL positive strains were studied by pulse field gel electrophoresis. RESULTS: The presence of MBL was detected in eleven strains. AH were type VIM and were not clonally related. There was no concordance between phenotypic and genotypic MBL detecting methods. All the strains were also multiresistant. CONCLUSIONS: The presence of MBL was detected in 19% of imipenem resistant Psae strains.

Presencia de metalo-ß-lactamasas en Pseudomonas aeruginosa resistente a imipenem / Presence of metal lo ß-lactamases in imipenem-resistant Pseudomonas aeruginosa

Background: Metallo-ß-lactamases (MBL) confer high resistance to carbapenems in Pseudomonas aeruginosa (Psae). They are encoded in mobile elements of different genes (VIM, IMP, SMP, GIM), along with other resistance genes. Aim: To detect the presence of MBL in imipenem resistant Psae strains. Material and methods: Fifty-nine imipenem resistant Psae strains isolated from January 2004 to August 2005 in a University Clinical Hospital, were included. The presence of MBL was studied by Etest (phenotypic) and genotypic polymerase chain reaction (PCR) methods. To rule out a nosocomial outbreak, MBL positive strains, were studied by pulse field gel electrophoresis. Results: The presente of MBL was detected in eleven strains. AH were type VIM and were not clonally related. There was no concordance between phenotypic and genotypic MBL detecting methods. AH the strains were also multiresistant. Conclusions: The presence of MBL was detected in 19 percent of imipenem resistant Psae strains.

Efecto del secado solar en los contenidos de humedad, carbohidratos, carotenoides totales e índice de peróxidos del mesocarpio de la palma coroba (attalea Spp) / Effect of solar drying on the contents of moisture, carbohydrates, total carotenoids and peroxide value of coroba palm (attalea spp) mesocarp

Se evaluó el efecto del secado solar en los contenidos de humedad, azúcares totales, almidón, carotenoides totales e índice de peróxidos del extracto lipídico del mesocarpio del fruto de la palma coroba. Se empleó el mesocarpio de frutos maduros recolectados en Caicara del Orinoco, Municipio Cedeño, Estado Bolívar, Venezuela. El secado se realizó en un prototipo de secador solar en las siguientes condiciones: temperatura externa 32°C, temperatura en el interior del secador 70°C, humedad relativa 80 por ciento, tiempo de secado 3h, carga 1kg de mesocarpio fresco distribuido en forma de capa de espesor de 2mm. Antes y después del secado se determinó: humedad, azucares totales, almidón, carotenoides totales e índice de peróxidos. Se observaron diferencias significativas (P<0,05) en los valores de carotenoides totales e índice de peróxidos. La evaluación de estos dos parámetros durante el almacenamiento a temperatura ambiente mostró cambios significativos (P<0,05); la degradación de los carotenoides totales siguió una cinética de primer orden (R2= 0,9515) con una constante de velocidad de 0,0208d-1 y tiempo de media reacción de 33,3d. El índice de peróxidos se mantuvo sin cambios significativos (P>0,05) durante 21 días.

Divertículo de Meckel en el paciente adulto. Experiencia en la Fundación Santa Fe de Bogotá / Meckel`s diverticulum in the adult patient. Experience in the Foundation Santa Fe of Bogota

OBJETIVOS: Establecer las características clínicas, evolución y manejo de los pacientes con diagnóstico definitivo de divertículo de Meckel manejados entre 1991 y 2003 por la sección de Cirugía General del Hospital Universitario de la Fundación Santa Fe de Bogotá. MATERIALES Y MÉTODOS: Mediante un estudio observacional descriptivo tipo serie de casos se revisaron las historias clínicas de los 13 pacientes que tuvieron como diagnóstico histopatológico un divertículo de Meckel desde 1991 hasta 2003 en la Fundación Santa Fe de Bogotá. RESULTADOS: Se encontró que el 69,2 por ciento de los pacientes eran hombres. Ocho pacientes fueron sintomáticos (61,5 por ciento). La edad promedio fue de 40,4 años. El síntoma predominante, en el grupo de pacientes sintomáticos debido a complicación del divertículo de Meckel, fue el dolor abdominal (50 por ciento) seguido por la hemorragia digestiva baja (33 por ciento). Ocho pacientes fueron sintomáticos; 6 de ellos con complicaciones asociadas al divertículo, siendo la más frecuente la obstrucción intestinal en un 50 por ciento de los casos. El tratamiento en un 53 por ciento de los casos fue la resección intestinal más anastomosis. Se encontró en cuatro de los 13 pacientes (30,7 por ciento) mucosa gástrica ectópica en el estudio histopatológico.CONCLUSIONES: El divertículo de Meckel es una patología, que aunque poco frecuente, debe considerarse en el diagnóstico diferencial en pacientes con dolor abdominal agudo y sangrado digestivo bajo. En la Fundación Santa Fe de Bogotá la presentación clínica del divertículo de Meckel es similar a la presentación clásica descrita en la literatura