Extensively drug-resistant Pseudomonas Aeruginosa outbreak in a burn unit: management and solutions.

Infections are still the main cause of mortality in burn patients. Multidrug resistant bacteria can cause outbreaks in critical care and burn units. We describe an outbreak of infection by extensively drug-resistant Pseudomonas aeruginosa in the Burn Unit of a University Hospital in Barcelona (Spain) between April and July 2016. A descriptive study of all cases, a bacterial colonization screening of all admitted patients and a microbiological environmental study were performed in order to detect a possible common focus. Contact isolation and cohortization of healthcare workers of all infected or colonized patients were applied. Environmental control measures were instituted for possible sources of infection. The outbreak was caused by a strain of P. aeruginosa only sensitive to colistin. Ten patients were infected or colonized and two of them died. The same strain was detected in several taps and drains in different rooms of the Unit. After applying control measures, changing faucets and drains, carrying out thermal disinfection of the hot water installation of the unit, disinfecting the rooms with ultraviolet radiation and placing antibacterial filtration devices in all the taps among other measures, an effective control of the outbreak was achieved.

Les infections sont toujours une cause majeure de mortalité chez les brûlés. Des épidémies à bactéries multirésistantes (BMR) dans les CTB sont régulièrement rapportées. Nous décrivons une épidémie due à Pseudomonas æruginosa BMR, sensible uniquement à la colimycine, survenue dans le CTB d'un hôpital universitaire de Barcelone entre avril et juillet 2016. Elle a touché 10 patients dont 2 sont morts. Une étude de chaque cas, un dépistage chez tous les entrants et une étude environnementale ont été réalisées, afin de trouver d'éventuelles similitudes. Un isolement contact et un cohorting ont été mis en place. Des mesures de contrôle de l'environnement ont été implémentées. La souche incriminée a été retrouvée dans plusieurs robinets et siphons du service. Cette épidémie a été résolue après, outre les mesures précitées, changement des robinets et des siphons (avec mise en place d'ultrafiltres sur les robinets), choc thermique du réseau d'adduction d'eau, désinfection terminale UV des chambres.

Viajeros atendidos en un centro de vacunación internacional. ¿Está aumentando el riesgo en el viajero pediátrico? / Travelers attending an international vaccine center. Is the risk for the pediatric traveler increasing?

Introducción: Existe la percepción de que están aumentando los viajeros pediátricos, fundamentalmente a expensas del grupo de viajeros conocidos como visiting friends and relatives (VFR). Las características demográficas y de los viajes en este grupo de viajeros confieren un mayor riesgo y condicionan una mayor complejidad en las recomendaciones vacunales y profilácticas. Objetivo: Analizar la evolución en el tiempo de los diferentes grupos de viajeros pediátricos. Describir las características demográficas y del viaje en la población pediátrica y analizar si los VFR difieren de los no VFR en cuanto a los factores que puedan conferir un mayor riesgo. Metodología: Estudio descriptivo transversal de las características de los niños viajeros atendidos en la Unidad de Vacunación Internacional del Hospital Universitario Vall d’Hebron entre julio de 2002 y febrero de 2009. Resultados: Se atendieron 692 niños, con una edad media de 8 años (DE 5,4). Se observó un aumento en el número de viajeros pediátricos y una tendencia al incremento de niños VFR en los primeros años que posteriormente se mantuvo estable. En los viajeros VFR la edad media fue menor, confirmándose una menor previsión antes del viaje y una mayor duración del mismo en este grupo de viajeros. Se actualizó el calendario vacunal al 29,2% y se recomendó profilaxis antipalúdica al 52% de los viajeros. Conclusión: A pesar del aumento progresivo de viajes internacionales y del aumento inicial de los viajeros VFR, el porcentaje de este grupo de viajeros se mantuvo estable en los últimos años. La escasa percepción del riesgo entre la población inmigrante señala la necesidad de promover una adecuada consulta previa al viaje en este colectivo (AU)

Introduction: There is a perception that the number of pediatric travelers is increasing, mainly due to the so-called visiting friends and relatives (VFRs) group. Both the demographic and trips characteristics in this group may lead to an increased risk and a greater complexity in vaccinations and other preventive recommendations. Objective: To analyze the outcomes of different groups of pediatric travelers. To describe the demographic and travel characteristics within the pediatric population, and to analyze whether the VFRs differ from non-VFRs with regards to the factors that may contribute to a greater risk. Methodology: A cross sectional descriptive study of the characteristics of pediatric travelers treated in the International Pre-travel Consultation Unit of the University Hospital Vall d’Hebron, from July 2002 to January 2009. Results: Of the 692 children analyzed, with a mean age of 8 years (SD 5.4), an increase in the overall number of travelers was identified, along with an initial increase in the number of VFR children in the early years of the study, although later on, the numbers of this group stabilized. The mean age of the VFR travelers was also found to be lower. A lack of planning prior to the start of the travel was also noted in the VFRs group, as well as longer trip durations. A routine vaccine was administered to 29.2% of children, and malaria prophylaxis was recommended for 52% of travelers. Conclusion: Despite the progressive increase in international travel and the initial increase in VFR travelers, the percentage of this group has remained stable in recent years. However, the perception of a low risk among the immigrant population suggests the need to encourage an adequate pre-travel consultation within this group (AU)

[Travelers attending an international vaccine center. Is the risk for the pediatric traveler increasing?]. / Viajeros atendidos en un centro de vacunación internacional. ¿Está aumentando el riesgo en el viajero pediátrico?

INTRODUCTION: There is a perception that the number of pediatric travelers is increasing, mainly due to the so-called visiting friends and relatives (VFRs) group. Both the demographic and trips characteristics in this group may lead to an increased risk and a greater complexity in vaccinations and other preventive recommendations. OBJECTIVE: To analyze the outcomes of different groups of pediatric travelers. To describe the demographic and travel characteristics within the pediatric population, and to analyze whether the VFRs differ from non-VFRs with regards to the factors that may contribute to a greater risk. METHODOLOGY: A cross sectional descriptive study of the characteristics of pediatric travelers treated in the International Pre-travel Consultation Unit of the University Hospital Vall d'Hebron, from July 2002 to January 2009. RESULTS: Of the 692 children analyzed, with a mean age of 8 years (SD 5.4), an increase in the overall number of travelers was identified, along with an initial increase in the number of VFR children in the early years of the study, although later on, the numbers of this group stabilized. The mean age of the VFR travelers was also found to be lower. A lack of planning prior to the start of the travel was also noted in the VFRs group, as well as longer trip durations. A routine vaccine was administered to 29.2% of children, and malaria prophylaxis was recommended for 52% of travelers. CONCLUSION: Despite the progressive increase in international travel and the initial increase in VFR travelers, the percentage of this group has remained stable in recent years. However, the perception of a low risk among the immigrant population suggests the need to encourage an adequate pre-travel consultation within this group.

The importance of the day of the week and duration of data collection in prevalence surveys of nosocomial infections.

In a national prevalence survey setting, we studied whether the day of week selected for data collection, and the number of days needed to complete the survey, were associated with the prevalence of hospital-acquired infection (HAI). The EPINE (Estudio de Prevalencia de las Infecciones Nosocomiales en España) database (1990-2002) was analysed for the purposes of the study. Adjusting for the admission day in the week, the number of intrinsic risk factors, the number of extrinsic risk factors and the prevalence length of stay, a 'weekend effect' was confirmed in this study. The day of the week selected for data collection was related to the presence of infection in the surveyed patients, showing for the period of Saturday-Monday a higher prevalence of patients with HAI (adjusted OR 1.08, 95%CI 1.05-1.10). There was a crude positive trend between number of weeks and prevalence, but the number of days involved in data collection was finally not associated with the prevalence of HAI, once adjustment for hospital size was made. The percentage of repeated records increased linearly with hospital size, and the frequency of infections was higher within this group (OR 2.8, 95%CI 2.6-3.0). The results of this study highlight the need for encouraging hospitals to shorten the time spent in obtaining a prevalence survey. If it is impossible to carry out the survey within the limits of one day, data collection should then be limited to that period of the week, Tuesday to Friday.

[Predictors factors about functional decline in community-dwelling older persons]. / Factores predictores del deterioro funcional geriátrico.

OBJECTIVES: The goal of this work was to prove the usefulness of simple standard geriatrics tools as a predictors of basic daily activities or quality of life decline in one year in older patients apparent healthy to apply in primary care. DESIGN: Prospective study of a randomised sample of 100 patients. SETTING: Urban primary care center. PATIENTS: A systematic sample of 100 patients of 75 years old or older, with Barthel index > or =90, Karnofsky scale > or =70 and without any neoformation process evaluated prospectively. MEASUREMENTS: A comprehensive geriatric assessment was done that include: physical performance, neural-psychologist performance, organic assessment, social assessment. After 12 month were assessed again basic activities of daily living (Barthel) and quality of life (Karnofsky). To estimate the odds ratio (OR) of association we used logistic regression models. RESULTS: The alterations in cognition trials (Pfeiffer >2) and in instrumental activities of daily living (Lawton <7) showed predictors about decline in basic activities of daily living (OR=4.66; CI, 1.33-16.22), (OR=4.89; CI, 1.65-14.48). The alterations in instrumental activities of daily living (Lawton <7) and in performance tests (abbreviated Guralnik test <4) showed predictors about decline in quality of life (OR=4.31; CI, 1.62-11.44), (OR=7.41; CI, 1.54-35.62). CONCLUSION: In primary care geriatric assessment tools based in instrumental activities of daily living, cognition and performance tests predict decline in basic activities of daily living and quality of life.

Factores predictores del deterioro funcional geriátrico / Predictors factors about functional decline in community-dwelling older persons

Objetivo. Demostrar la utilidad de sencillos instrumentos geriátricos como predictores del deterioro de las actividades básicas de la vida diaria (ABVD) o pérdida de calidad de vida al año en ancianos con un estado de salud previo aparentemente bueno, para poder ser aplicado en atención primaria de la salud (APS).Diseño. Estudio prospectivo. Emplazamiento. Centro de atención primaria urbano. Participantes. Muestra sistemática de 100 ancianos con edad >= 75 años, índice de Barthel (IB) >= 90, escala de Karnofsky (EK) >= 70 y ausencia de proceso neoplásico. Mediciones principales. Se les aplicó un protocolo de valoración geriátrica integral que incluía variables biopsicosociales y funcionales. Tras 12 meses se revaloraron las ABVD (IB) y la calidad de vida (EK).Se realizó la estimación de las odds ratio (OR) de asociación mediante modelos de regresión logística múltiples. Resultados. Las alteraciones en las pruebas de cognición (test de Pfeiffer > 2) y en las actividades instrumentales de la vida diaria (AIVD) (índice de Lawton [IL] < 7) se mostraron predictoras del deterioro en las ABVD (OR = 4,66; intervalo de confiaza [IC], 1,33-16,22, y OR = 4,89; IC, 1,6514,48, respectivamente).Las alteraciones en las AIVD (IL < 7) y las alteraciones en las pruebas de rendimiento (test de Guralnik abreviado < 4) se mostraron predictores del deterioro de la calidad de vida (OR = 4,31; IC, 1,62-11,44, y OR = 7,41; IC, 1,54-35,62, respectivamente).Conclusiones. En APS, los instrumentos de valoración geriátrica centrados en las AIVD, la cognición y las pruebas de rendimiento predicen el deterioro en las ABVD y en calidad de vida (AU)

[Primary Sjögren's syndrome: clinical and immunological characteristics of 114 patients]. / Síndrome de Sjögren primario: características clínicas e inmunológicas de 114 pacientes.

BACKGROUND: To analyze the clinical and immunological characteristics of a series of 114 patients with primary Sjögren's syndrome (PSS), and to evaluate the different diagnostic criteria and the association to lymphoproliferative disorders. PATIENTS AND METHOD: We included 114 patients (108 female and 6 male) with a diagnosis of PSS. All patients fulfilled the 1993 European Community criteria for the diagnosis of PSS and 76 patients fulfilled the San Diego Criteria. RESULTS: Mean age was 51 years with a mean follow-up of 7.3 years. The commonest clinical manifestation at onset (70%) was xerostomia/xerophtalmia (sicca syndrome). Extra glandular involvement was articular in 42% of cases, neurologic (35%), respiratory (21%) and hepatic (13%). Eleven patients (9%) developed vasculitis, and three (2%) developed a lympho-proliferative disorder. No statistically significant differences regarding symptoms at onset, frequency of glandular or extra glandular manifestations and severity of disease were observed between the two diagnostic criteria groups. HCV infection was associated with vasculitis (p < 0.001; OR: 20.6; CI 95%, 3.2-129) and lymphoproliferative disorders (p < 0.001). CONCLUSIONS: The clinical evolution of PSS does not vary when using different diagnostic criteria (San Diego and European Community criteria). A subset of patients with vasculitis and lymphoproliferative diseases is found to have an associated HCV infection.

Abnormalities of erythrocyte membrane fluidity, lipid composition, and lipid peroxidation in systemic sclerosis: evidence of free radical-mediated injury.

OBJECTIVE: To elucidate whether oxidative injury occurs in systemic sclerosis (SSc) and whether it affects the erythrocyte membrane (EM) properties. METHODS: EM fluidity and lipid composition (cholesterol:phospholipid molar ratio [C:PL], fatty acid composition) were studied in 52 patients with SSc and in 53 subjects without SSc (32 with primary Raynaud's phenomenon [RP] and 21 healthy subjects [controls]). Fluidity was measured as the fluorescence anisotropy of the hydrophobic fluorescent probe DPH (1,6-diphenyl-1,3,5-hexatriene). Lipid peroxidation products were determined as thiobarbituric acid-reactive substances (TBARS). RESULTS: EM fluidity was significantly lower in SSc patients than in primary RP patients and controls (P < 0.001). The EM C:PL molar ratio was significantly higher in SSc patients than in primary RP patients and controls (P < 0.05). Levels of EM polyunsaturated n6 fatty acids (PUFA n6) were significantly lower in SSc patients than in primary RP patients and controls (P < 0.001). TBARS were significantly increased in SSc patients compared with primary RP patients and controls (P < 0.001). Multiple regression analyses indicated that the reduced EM fluidity was partly due to its greater C:PL molar ratio, lower PUFA n6 content, and higher TBARS levels. EM fluidity was lower among patients with nailfold capillary loss (P < 0.001) and digital ischemic ulcers (P < 0.05). EM lipid peroxidation products were higher among patients with pulmonary involvement (bibasal pulmonary fibrosis [P < 0.05] and reduced levels of diffusing capacity for carbon monoxide [P < 0.001]) and among patients who were positive for anti-topoisomerase I antibodies (P < 0.05) or negative for anticentromere antibodies (P < 0.001). CONCLUSION: Our findings support the idea that oxidative injury occurs in SSc and that, through lipid peroxidation, it induces structural and functional changes of the EM that may contribute to the development of the microvascular abnormalities that are seen in the disease.

Comparison of high and low doses of trimethoprim-sulfamethoxazole for primary prevention of toxoplasmic encephalitis in human immunodeficiency virus-infected patients.

To evaluate the influence of the dose of co-trimoxazole prophylaxis on the risk of toxoplasmosis in human immunodeficiency virus (HIV)-infected patients, we performed a nested case-control study of 32 patients with toxoplasmosis (case patients) and 64 patients without toxoplasmosis (control patients) who were matched by CD4 cell count and Toxoplasma gondii serostatus; these patients were from a cohort of 521 HIV-infected patients who underwent a diagnostic neuroimaging study between March 1993 and January 1997. Twenty-seven (84.4%) of 32 case patients and 33 (51.6%) of 64 control patients received low doses of co-trimoxazole, a finding associated with an adjusted odds ratio (OR) of 9.36 (95% confidence interval [CI], 2.05-42.75) and indicating 89% protective efficacy for high doses. Fifteen (46.9%) of 32 case patients and 16 (25%) of 64 control patients were exposed to rifampin (adjusted OR, 3.38; 95% CI, 1.08-10.61). These results indicate that high doses of co-trimoxazole appear to be more effective than low doses for lowering the risk of toxoplasmosis in HIV-infected patients and that rifampin therapy may reduce the efficacy of co-trimoxazole.

Cigarette smoking and male lung cancer risk with special regard to type of tobacco.

BACKGROUND: The mortality rate from lung cancer (LC) increased sharply in Spain between 1957 and 1986. This increase has been related to a previous increase in cigarette smoking. Certain features of cigarette smoking which were frequent among Spanish smokers (use of black tobacco and use of cigarettes without filter) have been related to a higher risk of LC. METHODS: A hospital-based case-control study was conducted between December 1986 and June 1990. The 325 male patients with lung cancer included in the study (cases) were compared with 325 age-matched male controls without LC. Occupation and lifetime tobacco consumption were requested using a structured questionnaire. The LC odds ratios (OR) and 95% CI were estimated with multiple logistic regression. RESULTS: Lung cancer risk increased with cigarette consumption and duration of the habit. After adjusting for lifetime cigarette consumption and for socioeconomic level, LC risk was greater among black tobacco smokers than among exclusive blond tobacco smokers (OR = 5.0, 95% CI: 2.0-12.7); LC risk among long-term (> or =20 years) filter-tipped cigarette users was lower compared to all other smokers (OR = 0.4, 95% CI: 0.2-0.7). CONCLUSIONS: The main results of the study (a higher LC risk among black tobacco users than in exclusive blond tobacco users, and a lower LC risk among long-term filter-tipped cigarette smokers than all other smokers) have been consistent with previous case-control studies and with ecologic studies which took into account past exposure levels.

Clinical, radiographic and HLA associations as markers for different patterns of psoriatic arthritis.

OBJECTIVE: The aim of this study was to examine whether the five clinical forms of psoriatic arthritis (PsA) identified by Moll and Wright (Semin Arthritis Rheum 1973;3:55-78) could be clearly distinguished, especially as the disease evolved over time, to analyse whether radiographic features or HLA associations could define subsets with greater precision and to identify predictors of disease outcome. METHODS: Seventy-three patients (37 males and 36 females) were followed for a median time of 8 yr (range 1-16 yr). A standard clinical protocol was used to assess patients at each visit and two clinical scores. based on the joint areas involved, were defined to evaluate the mode of onset and the evolution of arthritis. X-ray films of the hands, feet and sacroiliac joints were taken and the patients were divided into two categories according to the presence or absence of erosions and an X-ray erosion score was also used. Three classification methods were used to define the different clinical subsets. HLA-A, B and DR antigens were tested by standard microlymphocytotoxicity assays. A multiple linear regression model was used in the statistical analysis. RESULTS: The five classical clinical subsets defined by Moll and Wright did not remain since distinct peripheral arthritis patterns tended to evolve over time. Only two discrete groups were identified, axial disease (AD) (sacroilitis with or without peripheral arthritis) in 29% of cases and peripheral disease (PD) without sacroilitis in 71%. AD was positively associated with the duration of arthritis (P < 0.04), presence of mutilation (P < 0.02) and the joint area score over disease evolution (JASE) (P < 0.02). There were erosions in 71% of the patients. Erosions correlated with the presence of mutilation (P < 0.007) and with the JASE (P < 0.0005). HLA-B27 was found in 43% of patients with AD, but only in 11% of PD patients (P < 0.01). No other clear HLA correlations were found. CONCLUSIONS: Despite the relatively small number of patients, this longitudinal study suggests that only two clinical subsets can be clearly defined in PsA, AD and PD; these are primarily determined on clinical grounds although HLA-B27 is strongly associated with AD. The evolution of PD pattern with time means that narrower peripheral arthritis subsets are of little clinical use.

[Antibiotic prescription in acute respiratory infections in adults: its variability and appropriateness in 10 Spanish hospitals]. / Prescripción antibiótica en las infecciones respiratorias agudas del adulto: su variabilidad e idoneidad en diez hospitales españoles.

OBJECTIVE: To report the variability in antibiotic prescribing habits for patients diagnosed of non-specified acute respiratory infections (ARI) (according to the International Classification of Diseases 9MC) at Emergency Departments of ten Spanish hospitals, and to evaluate the appropriateness of antimicrobial prescription for such patients, after specifically elaborating some reference patterns for appropriate antimicrobial use. DESIGN: Descriptive study of variability in clinical practice by means of a prospective series of cases. Study of appropriateness by means of elaborating reference standards for appropriate use and comparison with the data from the descriptive study with such standards. DURATION: six months. SETTING: Emergency Department in ten Spanish hospitals from different autonomic communities: Andalucía, Islas Canarias, Castilla-León, Cataluña, Galicia, Madrid, Murcia and Valencia for a 6-month period. PATIENTS: Patients with the diagnosis of community ARI attended at emergency departments. SAMPLE SIZE: 903 cases. INTERVENTIONS: Collection of cases in a unified database with the following variables: age, sex, ARI type, diagnosis of comorbidity, prescribed antimicrobial, hospital admission and type of prescriber. A panel of experts was commissioned to elaborate the gold standards for the appropriate use of antibiotics or the lack of indication for the different locations of ARI. RESULTS: The adjusted proportion of the inappropriate prescription for the group with laryngo-tracheal-influenza-rhinopharyngitis-multiple ARI or non specified infections was 67.9%. CONCLUSIONS: Concerning antibiotic prescription, significant inter-center variability and relevant heterogeneity were observed.

Comparison of patients with anterior wall healed myocardial infarction with and without exercise-induced ST-segment elevation.

To assess the extent of myocardial necrosis and ischemia in patients with anterior wall healed myocardial infarction depending on whether ST-segment elevation was present on precordial leads during exercise testing, 62 consecutive patients (49 men and 13 women, age [mean +/- SD] 56 +/- 11 years) with anterior wall infarcts were assessed with exercise technetium-99m (Tc-99m) methoxy-isobutyl-isonitrile single-photon emission computed tomography and quantification of the extent of necrosis and ischemia on polar maps: 22 patients had > or = 1 mm ST-segment elevation during exercise, and 40 did not. The extent of the necrosis in the anteroseptal (p = 0.001) and apical (p = 0.002) regions, the extent of ischemia in the lateral region (p = 0.003) on polar maps, and the frequency of ventricular aneurysm as shown by cardiac catheterization (p = 0.001) were significantly greater in patients with ST-segment elevation. In a multiple logistic regression model, both extent of necrosis in the anteroseptal region (odds ratio 10.8; 95% confidence interval 2.7 to 44.0) and extent of ischemia in the lateral region (odds ratio 7.25; 95% confidence interval 1.6 to 32.7) were associated with exercise-induced ST-segment elevation. These data suggest that ST-segment elevation in anterior infarctions is associated with wider necrosis in the anteroseptal and apical regions, with a wider extent of ischemia in the lateral region and a higher frequency of ventricular aneurysm. Consequently, it cannot be used as a marker of viability.

[Comorbidity, hospitalization, and drug use for non-exacerbated chronic disease in the elderly population]. / Comorbilidad, ingreso hospitalario y consumo de fármacos por enfermedad crónica no reagudizada en población anciana.

OBJECTIVES: To evaluate the prevalence of comorbidity among elderly hospitalized patients and its influence on discharge diagnosis and medication due to non-exacerbated chronic disease (NECD). To evaluate the impact of hospital admission on the use of drugs due to NECD since admission to the month of discharge. METHODS: A study was made of 85 patients aged 65 years or older collected during two consecutive months. The study protocol consisted of a questionnaire on comorbidity, study of drug consume, discharge diagnosis and follow-up for one month post discharge. RESULTS: Patients had a mean of 6.4 chronic diseases; significant differences were observed regarding discharge report (mean: 2.1). The number of drugs due to NECD prior to admission (mean: 2.9), at discharge (1.5) and one month after discharge (1.9) showed significant differences between those prior to admission, at discharge, and one month after discharge (p < 0.0001). Hospital admission involved a decrease (p < 0.0001) in the number of patients with polypharmacy criteria (more than four drugs), which persisted one month after discharge (p < 0.01), and in the prescription of polyvitaminic compounds, nonsteroid antiinflammatory drugs, antiaggregants, peripheral vasodilators and antacids (p < 0.03). CONCLUSIONS: A relevant under-reporting of chronic diseases in the discharge report, particularly of those without exacerbations, as well as quantitative (decrease) and qualitative changes in the prescription due to NECD, maintained by the general practitioner one month after discharge. A higher awareness regarding chronic disease is necessary, as well as chronic disease is necessary, as well as establishing communication channels between Primary and Specialized Care.

Comprehensive noninvasive assessment of cardiac involvement in limited systemic sclerosis.

OBJECTIVE: To assess cardiovascular abnormalities in patients with limited systemic sclerosis (SSc), using noninvasive cardiac techniques. METHODS: Sixty-three patients with limited SSc were prospectively evaluated with Doppler echocardiography and thallium-201 perfusion scintigraphy after a cold-stress test and radionuclide ventriculography. RESULTS: In the patients with limited SSc, there was a significantly high prevalence of abnormal left- and right-diastolic function parameters (P = 0.001 and P = 0.0002, respectively), thickening of papillary muscles (46%; P = 0.003), and mild mitral regurgitation (49%; P < 0.0001), compared with controls. Systolic pulmonary arterial hypertension was detected in 9 patients (14%), and pericardial effusion in 11 patients (18%). In 64% of patients with limited SSc, an ischemic response was detected on the thallium cold-stress scan; similarly, an ischemic response was detected in 57% of patients with primary Raynaud's phenomenon (P < 0.0001 versus controls). CONCLUSION: Although the frequency of cardiovascular symptoms was low in patients with limited SSc, a significant rate of cardiovascular abnormalities was found by noninvasive cardiac techniques.

[Relationship between coffee and blood cholesterol in a sample of working women]. / Relación entre el café y el colesterol plasmático en una población laboral femenina.

BACKGROUND: Experimental studies have demonstrated that unfiltered coffee increases cholesterolemia. In Spain, filtered coffee is mainly consumed and its effect on cholesterolemia is controversial. METHODS: The relationship between coffee intake and the serum levels of total cholesterol was transversally studied in a population of 609 women between 18 to 65 years in age. The questionnaire and analyses were carried out in the context of periodic health examination. RESULTS: The consumption of coffee was positively associated with cholesterolemia in subjects under 30 years of age (p < 0.01) and in the group from 30 to 45 years in age (p < 0.05). This association was found to be statistically significant on multivariant analysis (multiple lineal regression) after adjusting for age, body mass index, cholesterol consumed in the diet, smoking, alcohol consumption and physical activity. CONCLUSIONS: Coffee was found to increase cholesterolemia in the female population and therefore a reduction in coffee intake would be recommendable in hypercholesterolemic subjects.