La albuminuria y la enfermedad polivascular mejoran la capacidad predictiva de los modelos multivariados después de un evento cardiovascular agudo. Cohorte AIRVAG / Albuminuria and polyvascular disease improve multivariate predictive models after an acute cardiovascular event. The AIRVAG cohort

Antecedentes y objetivos: En la enfermedad cardiovascular ateroesclerótica no existe consenso respecto a los instrumentos de estratificación del riesgo en su prevención secundaria. Nuestro objetivo consistía en comparar la capacidad discriminativa de las funciones de riesgo de Framingham, REGICOR, SCORE y REACH y las puntuaciones de riesgo Bohula-TIMI y SMART, así como en evaluar el posible valor añadido de otras variables clínicas en cuanto a la predicción de recurrencias en pacientes con enfermedad cardiovascular. Métodos: Se analizó una cohorte de 269 pacientes con enfermedad cardiovascular establecida (52,8% coronaria, 32% cerebrovascular, 15,2% arteriopatía periférica). Se compararon las funciones de supervivencia de los grupos de riesgo (bajo/intermedio/alto) según los valores de corte de uso habitual de cada función o puntuación y se calcularon las razones de riesgos instantáneos (RRI) correspondientes a cada una mediante regresión de Cox. Se calculó el Δ C de Harrell, el cat-IRN y el cIRN después de añadir nuevos factores predictivos a un modelo base que incluía edad, sexo, colesterol total, tabaquismo activo, hipertensión arterial y diabetes. Resultados: Al cabo de 6 años de seguimiento (mediana de 4,82 años) se habían producido 61 eventos (23%). Los grupos de riesgo alto tuvieron un mayor riesgo de recurrencia: SMART (RRI: 3,17 [1,55-6,5]), Framingham (RRI: 3,08 [1,65-5,75]), REGICOR (RRI: 2,71 [1,39-5,27]), SCORE (RRI: 2,14 [1,01-4,5], REACH (RRI: 5,74 [2,83-11,7]) y B-TIMI (RRI: 3,68 [0,88-15,3]). La enfermedad polivascular (3 territorios, RRI: 5,6 [2,2-14,25]), la albuminuria (RRI: 3,55 [2,06-6,11]) y la insuficiencia cardíaca (RRI: 3,11 [1,34-7,25]) también incrementaron el riesgo. La capacidad discriminativa (índice C de Harrell) fue baja, pero mejoró tras añadir la albuminuria y la enfermedad polivascular. Ambas variables también mejoraron el rendimiento del modelo base (cIRN: 0,326 [0,036; 0,607]) (AU)

Background and aims: There is no consensus regarding risk stratification tools for secondary prevention in atherosclerotic cardiovascular disease. Our aim was to compare the discriminative performance of the Framingham, REGICOR, SCORE, and REACH risk functions and the Bohula-TIMI and SMART risk scores, as well as to assess the potential added value of other clinical variables for the prediction of recurrent events in patients with established vascular disease. Methods: A cohort of 269 patients with established vascular disease (52.8% coronary, 32% cerebrovascular, 15.2% peripheral artery disease) was included. The survival functions of risk groups (low/medium/high) according to commonly used cutoff points for each function/score were compared, and hazard ratios (HR) for each were estimated using Cox regression. We calculated Δ Harrell's C statistic, cat-NRI, and cNRI after adding new predictors to a base model including age, sex, total cholesterol, current smoking status, hypertension, and diabetes. Results: After 6 years of follow-up (median 4.82 years), 61 events occurred (23%). High-risk groups had a higher risk of recurrent event: SMART (HR: 3.17 [1.55-6.5]), Framingham (HR: 3.08 [1.65-5.75]), REGICOR (HR: 2.71 [1.39-5.27]), SCORE (HR: 2.14 [1.01-4.5], REACH (HR: 5.74 [2.83-11.7]), B-TIMI (HR: 3.68 [0.88-15.3]). Polyvascular disease (3 territories HR: 5.6 [2.2-14.25]), albuminuria (HR: 3.55 [2.06-6.11]), and heart failure (HR: 3.11 [1.34-7.25]) also increased risk. Discrimination (Harrell's C) was low but improved after adding albuminuria and polyvascular disease. Both variables also improved the performance of the base model (cNRI: 0.326 [0.036; 0.607]). Conclusions: The Framingham, REGICOR, SCORE, and REACH functions and the B-TIMI and SMART scores showed low yet similar performance in secondary prevention. Albuminuria and polyvascular disease improved the predictive performance of major classical cardiovascular risk factors (AU)

Albuminuria and polyvascular disease improve multivariate predictive models after an acute cardiovascular event. The AIRVAG cohort.

BACKGROUND AND AIMS: There is no consensus regarding risk stratification tools for secondary prevention in atherosclerotic cardiovascular disease. Our aim was to compare the discriminative performance of the Framingham, REGICOR, SCORE, and REACH risk functions and the Bohula-TIMI and SMART risk scores, as well as to assess the potential added value of other clinical variables for the prediction of recurrent events in patients with established vascular disease. METHODS: A cohort of 269 patients with established vascular disease (52.8% coronary, 32% cerebrovascular, 15.2% PAD) was included. The survival functions of risk groups (low/medium/high) according to commonly used cutoff points for each function/score were compared, and hazard ratios for each were estimated using Cox regression. We calculated Δ Harrell's C statistic, cat-NRI, and cNRI after adding new predictors to a base model including age, sex, total cholesterol, current smoking status, hypertension, and diabetes. RESULTS: After six years of follow-up (median 4.82 years), 61 events occurred (23%). High-risk groups had a higher risk of recurrent event: SMART (HR: 3.17 [1.55-6.5]), Framingham (HR: 3.08 [1.65-5.75]), REGICOR (HR: 2.71 [1.39-5.27]), SCORE (HR: 2.14 [1.01-4.5], REACH (HR: 5.74 [2.83-11.7]), B-TIMI (HR: 3.68 [0.88-15.3]). Polyvascular disease (three territories HR: 5.6 [2.2-14.25]), albuminuria (HR: 3.55 [2.06-6.11]), and heart failure (HR: 3.11 [1.34-7.25]) also increased risk. Discrimination (Harrell's C) was low but improved after adding albuminuria and polyvascular disease. Both variables also improved the performance of the base model (cNRI.326 [.036; .607]). CONCLUSIONS: The Framingham, REGICOR, SCORE, and REACH functions and the B-TIMI and SMART scores showed low yet similar performance in secondary prevention. Albuminuria and polyvascular disease improved the predictive performance of major classical cardiovascular risk factors.

Expression of clec9a in the oral cancer microenvironment. A preliminary immunohistochemical pilot study.

BACKGROUND: The search for treatments to improve cancer survival has led to the emergence of immunotherapy and the study of the tumour microenvironment existing in neoplasms. This preliminary study aims to understand the clinical and pathological relationship of clec9a expression in oral cancer and to explore survival models for future studies. MATERIAL AND METHODS: Immunohistochemical study that included 26 patients with a diagnosis of oral squamous cell carcinoma (OSCC) in mobile tongue and floor of the mouth. Clinical and histopathological variables were recorded, and the biomarkers clec9a for dendritic cells and CD8 and CD4 for lymphocytes were used. RESULTS: Clec9a was expressed in 58% of the sample. It was more common in cases with low lymphoplasmacytic infiltration and in type 2 invasion patterns. It was significantly related to CD8 expression (p=0.055 and p=0.007). No prognostic risks were evident in the survival models studied (overall survival, disease-specific survival, disease-free survival). CONCLUSIONS: CLEC9A expression is present in the OSCC microenvironment and is mainly related to the presence of CD8 lymphocytes. The relationship of its expression with survival prognosis in OSCC could not be confirmed; however, this needs to be confirmed through future studies with larger sample size.

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010-2013).

OBJECTIVE: To describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs. DESIGN: A retrospective, descriptive, epidemiological study. SETTING: This study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period. PARTICIPANTS: We selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period. MAIN OUTCOME MEASURES: We calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI. RESULTS: During the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93). CONCLUSIONS: The incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.

Self-Management of Anaphylaxis Is Not Optimal.

BACKGROUND: Our objective was to ascertain the degree of adherence to recommendations made to patients with anaphylaxis, most of whom were attended in our allergy outpatient clinic. METHODS: A questionnaire was sent to 1512 patients who had experienced anaphylaxis and completed by 887. The chosen definition of anaphylaxis was that of the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network Symposium. We evaluated the prescription, purchase, and use of epinephrine auto-injectors and oral drugs, as well as the avoidance of allergens involved in previous anaphylaxis episodes. RESULTS: Most patients (94.53%) reported that they had received advice on avoidance of responsible allergens after their allergy workup. Epinephrine auto-injectors and oral drugs were prescribed according to the subtype of anaphylaxis. Only 30.74% of patients used the epinephrine auto-injector; 54.26% took oral medication. Most patients (88.3%) avoided the allergen. CONCLUSIONS: Despite general agreement that anaphylaxis occurring in the community should be treated with epinephrine auto-injectors, use of these devices to treat recurrences was low in our patients. Oral medication intake was more common than the epinephrine auto-injector in all subtypes. In order to increase adherence to epinephrine auto-injectors, it is necessary to think beyond the measures recommended during regular visits to allergy outpatient clinics.

Self-management of anaphylaxis is not optimal

Background: Our objective was to ascertain the degree of adherence to recommendations made to patients with anaphylaxis, most of whom were attended in our allergy outpatient clinic. Methods: A questionnaire was sent to 1512 patients who had experienced anaphylaxis and completed by 887. The chosen definition of anaphylaxis was that of the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network Symposium. We evaluated the prescription, purchase, and use of epinephrine auto-injectors and oral drugs, as well as the avoidance of allergens involved in previous anaphylaxis episodes. Results: Most patients (94.53%) reported that they had received advice on avoidance of responsible allergens after their allergy workup. Epinephrine auto-injectors and oral drugs were prescribed according to the subtype of anaphylaxis. Only 30.74% of patients used the epinephrine auto-injector; 54.26% took oral medication. Most patients (88.3%) avoided the allergen. Conclusions: Despite general agreement that anaphylaxis occurring in the community should be treated with epinephrine auto-injectors, use of these devices to treat recurrences was low in our patients. Oral medication intake was more common than the epinephrine auto-injector in all subtypes. In order to increase adherence to epinephrine auto-injectors, it is necessary to think beyond the measures recommended during regular visits to allergy outpatient clinics (AU)

Antecedentes: Guías clínicas y documentos de posicionamiento recomiendan planes de acción urgentes personalizados para los pacientes que han tenido anafilaxia. El cumplimiento de estos planes es generalmente bajo. Objetivo: Nuestro objetivo fue determinar el grado de adherencia a diferentes recomendaciones hechas a los pacientes con anafilaxia, que en la mayoría de los cuales fueron atendidos en la consulta externa de Alergia de nuestro hospital. Métodos: Se envió un cuestionario a 1.512 pacientes que habían sufrido un episodio previo de anafilaxia y este fue completado por 887. La definición elegida de anafilaxia fue la del Instituto Nacional de Alergias y Enfermedades Infecciosas y el Simposio de la Food Allergy and Anaphylaxis Network (NIAID-FAAN). Se evaluó la prescripción, la compra y el uso de auto-inyectores de adrenalina y medicamentos orales, así como la evitación de alérgenos implicados en los episodios de anafilaxia anteriores. Resultados: La mayoría de los pacientes (94,53%) informaron que habían sido aconsejados sobre la evitación de alérgenos responsables después de su evaluación alergológica. Los auto-inyectores de adrenalina y los medicamentos orales se prescribieron de forma diferente según el subtipo de anafilaxia. Sólo el 30.74% de los pacientes utilizaron el auto inyector de adrenalina y el 54,26% tomo la medicación oral. La mayoría de los pacientes (88,3%) evitaron el alérgeno. Conclusiones: A pesar del acuerdo general que los episodios de anafilaxia que ocurren en la comunidad deben ser tratados con autoinyectores de adrenalina, el uso de estos dispositivos para el tratamiento de las recurrencias fue baja en nuestros pacientes. La ingesta oral de medicamentos es más común que el auto inyector de adrenalina en todos los subtipos. Con el fin de aumentar la adherencia a autoinyectores de adrenalina, es necesario investigar más allá de las medidas recomendadas durante las visitas regulares a las consultas de Alergia (AU)

Recurrence of Anaphylaxis in a Spanish Series

Background: Anaphylaxis is a potentially fatal condition, and many patients experience recurrence. Objective: We report the incidence of first recurrence of anaphylaxis in our series and examine the risk factors associated with recurrence. Methods: A validated questionnaire was sent to 1512 patients and completed by 887. The chosen definition of anaphylaxis was that of the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network Symposium. We evaluated the incidence of first recurrence of anaphylaxis overall and by subtype (eg, drugs and foods) and attempted to determine associated risk factors. Results: The total incidence rate of the first recurrence of anaphylaxis (same subtype) was 3.2 episodes per 100 person-years (95%CI, 2.83-3.63). Incidence was lower in drug anaphylaxis (2.0 episodes per 100 person-years) than in latex and food anaphylaxis (8.6 and 5.6 episodes per 100 person-years, respectively). Cox and ordinal logistic regression models revealed that a first recurrence was less likely with drug anaphylaxis than with food anaphylaxis. The risk of experiencing 1 or more recurrences was higher for foods, exercise, and idiopathic causes than for the other subtypes. Conclusions: The incidence rate for a first recurrence of the same subtype of anaphylaxis was 2 to 6 times lower than that published by other authors. Recurrence of anaphylaxis is more common in subtypes with an increased prevalence of atopy (food, idiopathic, latex) than in other subtypes (drugs, Anisakis). Consequently, particular attention should be paid to prevention and care in this population (AU)

Antecedentes: Aunque la anafilaxia es una enfermedad potencialmente fatal, muchos pacientes sufren recurrencias de la misma. Objetivo: Nuestro objetivo fue conocer la incidencia de la primera recurrencia de la anafilaxia en nuestra serie y examinar los factores de riesgo asociados a la misma. Métodos: Un cuestionario validado fue enviado a 1512 pacientes y completado por 887. La definición de anafilaxia elegida fue la del Simposio NIAID-FAAN (National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network). Se evaluó la incidencia de la primera recurrencia de la anafilaxia en general y por subtipo (por ejemplo, medicamentos y alimentos) y se trató de determinar factores de riesgo asociados a la recurrencia. Resultados: La tasa de incidencia total de la primera recurrencia de la anafilaxia (el mismo subtipo) fue de 3,2 episodios por 100 personas año (95% CI, 2,83 a 3,63). La incidencia fue menor en la anafilaxia por medicamentos (2,0 episodios por 100 personas-año) que en la anafilaxia por látex y alimentos (8,6 y 5,6 episodios por 100 personas-año respectivamente). Los modelos de regresión de Cox y logística ordinal revelaron que la primera recurrencia fue menos probable con anafilaxia por medicamentos que con la anafilaxia alimentaria. El riesgo de sufrir una o más recurrencias fue mayor para los alimentos, el ejercicio, y anafilaxia idiopática que para los otros subtipos. Conclusiones: La tasa de incidencia de una primera recurrencia del mismo subtipo de anafilaxia fue 2-6 veces inferior a la publicada por otros autores. La recurrencia de la anafilaxia es más común en los subtipos con una mayor prevalencia de atopia (alimentos, idiopática, látex) que en los otros subtipos (medicamentos, Anisakis). Por lo tanto, se debería prestar especial atención a la prevención y atención de estas poblaciones (AU)

Incidence of anaphylaxis in the city of Alcorcon (Spain): a population-based study.

BACKGROUND: Relatively few studies have examined the incidence of anaphylaxis in the general population. OBJECTIVE: To report the incidence of anaphylaxis among the general population of the city of Alcorcon, Spain, using various public health care databases. METHODS: Episodes of anaphylaxis were recovered using validated alphanumeric strings in different fields of electronic clinical records used in the different public health settings in the city of Alcorcon (primary care, Emergency Department, hospitalized patients and Allergy Outpatient Clinic). Patients with anaphylaxis were tracked across the different clinical settings in Alcorcon. RESULTS: The incidence of anaphylaxis in Alcorcon was 103.37 episodes per 100 000 person-years (total standardized incidence rate of 112.2). There was a peak of 313.58 episodes in the 0-4 years age group and a different distribution of incidence rates (although non-significant) among different age groups between male patients and female patients. In most age groups, incidence tended to be higher for female patients aged over 10 years. Patients were attended at two or more levels in 76.78% of episodes, and a new evaluation was often made at a primary care centre (71.43%), Allergy Outpatient Clinic (75.6%), or both after the episode (58.93%). CONCLUSION AND CLINICAL RELEVANCE: This study revealed a higher rate of anaphylaxis than that in previous studies, although this incidence rate is probably lower than the real incidence rate. Studies exploring potential methodological, genetic and environmental factors accounting for these higher rates of anaphylaxis are required.

Incidence of anaphylaxis and subtypes of anaphylaxis in a general hospital emergency department.

BACKGROUND: The absence of large-scale international studies means that data on anaphylaxis in emergency departments in different geographic areas are still necessary. OBJECTIVE: To determine the incidence of anaphylaxis and subtypes of anaphylaxis and their distribution by age group in the emergency department of Hospital Universitario Fundación Alcorcon, Alcorcon (Madrid), Spain. METHODS: Our study was performed between 2004 and 2005. We used the definition of anaphylaxis established by the NIAID-FAAN Symposium. Patient information was collected from the electronic clinical records of the emergency department using alphanumeric strings to identify acute allergic illnesses. This strategy recovered 91.7% of all anaphylaxis episodes in a pilot study. RESULTS: We observed a crude cumulative incidence of 0.9 episodes of anaphylaxis per 1000 emergency episodes (95% confidence interval [CI], 0.8-1.1), and 0.8 episodes per 1000 people (95% CI, 0.7-0.9). Standardized cumulative incidence of anaphylaxis according to the Standardized European Population was 1.1 (95% CI, 0.9-1.2). On analyzing the 213 cases of anaphylaxis, we discovered that the main cause was food (28.6%), followed by drugs (28.2%), unknown causes (27.2%), Anisakis (10.8%), Hymenoptera venom (3.3%), exercise (2.4%), and latex (0.9%). Food-induced anaphylaxis was less frequent in all groups older than the 0-4 age group in both reference populations (people who attend the emergency department and the general population). CONCLUSIONS: The cumulative incidence of anaphylaxis in our emergency department is low. Anaphylaxis by foods is more frequent in the 0-4 year group than in the other age groups. Drugs and food are the most frequent causes of anaphylaxis in our emergency department.

Morbilidad asociada en recién nacidos pretérmino a partir del Conjunto Mínimo Básico de Datos (CMBD) durante el periodo 2004-2006 / Preterm newborn associated morbidity through the “Minimum Basic Data Set” (MBDS) during the 2004-2006 period

Introducción: La prematuridad es el principal factor de riesgo de morbilidad y mortalidad en el periodo perinatal. La mayoría de las publicaciones se refieren a niños extremadamente prematuros, y son escasas las que analizan globalmente la influencia de la prematuridad en el desarrollo de enfermedades específicas. Objetivos: Describir las características demográficas de los prematuros, estimar la incidencia de ingreso, identificar la morbilidad de estos recién nacidos prematuros tras el alta y reflejar la estancia media y la mortalidad. Métodos: Estudio longitudinal descriptivo retrospectivo-prospectivo sobre la incidencia de ingresos en niños nacidos pretérmino, utilizando los datos recogidos en el registro del Conjunto Mínimo Básico de Datos (CMBD) en un periodo de 3 años (2004-2006). El CMBD es una base de datos del Ministerio de Sanidad que recoge sistemáticamente los datos al alta hospitalaria de cada uno de los pacientes que ingresa, al menos, una noche en el hospital, y cubre más del 98% de los hospitales del Sistema Nacional de Salud español, en su mayoría públicos. Se han incluido 63.164 casos de altas hospitalarias de recién nacidos pretérmino (menores de 37 semanas). Para el análisis de la comorbilidad, se tuvo en cuenta el registro de los códigos según la Clasificación Internacional de Enfermedades, 9.ª Revisión Modificación Clínica (CIE-9-MC) en cualquiera de los 14 campos de diagnóstico (AU)

Resultados: La incidencia acumulada de niños prematuros que ingresan antes de los 30 primeros días de vida fue del 4,67% (2,53 y 2,14% en niños y niñas, respectivamente) sobre un total de 1.351.126 nacimientos, según el Instituto Nacional de Estadística (INE), en los tres años del periodo de estudio. El 41,71% de los ingresos prematuros tienen al menos un código que implica patología materna, gestacional o relacionada con el parto. El parto múltiple (20,24%), las cesáreas (10,92%) y la rotura prematura de membranas (5,6%) son los factores perinatales más frecuentes asociados a los prematuros ingresados. En cuanto a la morbilidad neonatal, destacan por su mayor frecuencia las ictericias perinatales (44,66%) y las patologías respiratorias (39,99%). Las anomalías congénitas (mayores y menores) en prematuros ingresados aparecen en el 14,20%.Morbilidad asociada en recién nacidos pretérmino a partir del Conjunto Mínimo Básico de Datos (CMBD) durante el periodo 2004-2006. Conclusiones: El grupo de patologías que acompaña con más frecuencia al ingreso, si omitimos las ictericias, son las respiratorias, mientras que las anomalías congénitas más frecuentes son las cardiacas, que se dieron en el 4,45% del total de ingresos. La mortalidad fue del 3,41%, y la estancia media de 19,57 días: en menores de 28 semanas de 52 días, y en mayores de 28 semanas de 17 días (AU)

Introduction: The prematurity is the main morbidity and mortality risk factor during the perinatal period. Most of the publications refer to extremely premature children and there are few publications that analyze the influence of prematurity birth on a global basis as regards to the development of specific diseases. Objectives: To describe the demographic characteristics of the preterm newborns, to assess the admission incidence to identify the morbidity of these pre-term newborns at discharge and to reflect the mean stay and the mortality. Methods: Descriptive longitudinal retrospective-prospective study about the incidence of admissions in preterm newborns using the data gathered in the Minimum Basic Data Set (MBDS) registry in a 3 years period (2004-2006). The MBDS is a database of the Ministry of Health that gathers systematically the data of the hospital discharge of each of the patients who are admitted, at least, one night at hospital and covers more than98% of the Spanish National Health System hospitals, most of them public hospitals. A total of 63,164 preterm newborns hospital discharges (born before week 37) were included. The code registry has been taken into account for the analysis of the comorbidity according to the International Classification of Diseases–Ninth Revision– Clinical Modification (ICD-9-CM) in any of the fourteen diagnosis fields (AU)

Results: The accumulated incidence of newborn childrenwho are admitted before the first 30 days of life was 4.67%(2.53% in boys and 2.14% in girls) over a total amount of1,351,126 births during the study period according to the NationalStatistical Institute (NSI). The 41.71% of the pretermnewborns admission have at least one code that implies a maternaland gestational pathology or related to the labour. Themultiple labour (20.24%), caesarean section (10.92%) and pretermmembrane rupture (5.6%) are the most frequent perinatalfactors associated to the admitted newborns. As regards to theneonatal morbidity, the perinatal jaundice (44.46%) and respiratorydiseases (39.99%) stand out. Congenital malformations(major and minor) among admitted preterm newborns are in theregion of 14.20%. Conclusion: The most frequent group of pathologies at admissionif we leave out the jaundice, are the respiratory diseases,while the most frequent congenital abnormalities are theheart disorders present in 4.45% of the admissions total. Themortality was 3.41%, and the mean stay of 19.57 days, beingin newborns before 28 weeks of 52 days and over 28 weekswas of 17 days(AU)

[Serum vitamin B12 levels in an adolescent population in Madrid]. / Concentración de vitamina B12 en suero en población puberal de la Comunidad de Madrid.

INTRODUCTION: Serum vitamin B12 concentration levels in children are essential to establish values in order to compare different regions or countries, and for considering e the possibility of supplementing diets with group B vitamins as a secondary prevention against cardiovascular diseases. MATERIAL AND METHODS: A cross-sectional epidemiological study was carried out to asses serum vitamin B12 levels in school children, 13-15 years of age, in Madrid. Folate and vitamin B12 vitamin determinations were performed on fasting blood samples. Genotype C677T of methylentetrahydrofolate reductase (MTHFR) enzyme was determined by PCR. RESULTS: The mean vitamin B12 level obtained in our study was 503 pmol/l; CI 95 % CI (478-528 pmol/l). The median was 471 pmol/l; interquartile range (IR) (337-632 pmol/l). No statistically significant differences were found by age or C677T genotype for MTHFR. Serum vitamin B12 concentrations were significantly higher in females. Prevalence of vitamin B12 deficiency (< 224 pmol/l) was 6 % in males and 4 % in females. CONCLUSIONS: Reference values for serum vitamin B12 concentrations in an adolescent population are presented. Prevalence of vitamin B12 deficiencies is higher in males.

Concentración de vitamina B12 en suero en población puberal de la Comunidad de Madrid / Serum vitamin B12 levels in an adolescent population in Madrid

Introducción: Disponer de datos sobre la concentración de vitamina B12 en suero en niños es imprescindible para establecer unos percentiles que permitan realizar comparaciones entre regiones o países y poder plantear la suplementación de la dieta con vitaminas del grupo B como prevención secundaria frente a las enfermedades cardiovasculares. Material y métodos: Se realizó un estudio epidemiológico descriptivo de tipo transversal, con el fin de estimar las concentraciones séricas de vitamina B12 en la población escolar entre 13 y 15 años en la Comunidad de Madrid. Se realizó una determinación de folato y vitamina B12 en las muestras de sangre obtenidas en ayunas. Se determinó el genotipo C677T de la enzima metilentetrahidrofolato reductasa por reacción en cadena de la polimerasa (PCR). Resultados: Las concentraciones medias de vitamina B12 obtenidos en nuestro estudio fueron de 503 pmol/l; intervalo de confianza del 95 % (IC 95 %) (478-528 pmol/l). La mediana fue de 471 pmol/l; rango intercuartílico (337-632 pmol/l). No se encontraron diferencias estadísticamente significativas por edad o genotipo C677T. La concentración sérica de vitamina B12 fue significativamente mayor en las mujeres. La prevalencia de valores deficitarios de vitamina B12 (< 224 pmol/l) fue del 6 % en varones y del 4 % en mujeres. Conclusiones: Se presentan valores de referencia de las concentraciones de vitamina B12 sérica en población adolescente. La prevalencia de déficit de vitamina B12 es mayor en varones (AU)

Introduction: Serum vitamin B12 concentration levels in children are essential to establish values in order to compare different regions or countries, and for considering e the possibility of supplementing diets with group B vitamins as a secondary prevention against cardiovascular diseases. Material and methods: A cross-sectional epidemiological study was carried out to asses serum vitamin B12 levels in school children, 13-15 years of age, in Madrid. Folate and vitamin B12 vitamin determinations were performed on fasting blood samples. Genotype C677T of methylentetrahydrofolate reductase (MTHFR) enzyme was determined by PCR. Results: The mean vitamin B12 level obtained in our study was 503 pmol/l; CI 95 % CI (478-528 pmol/l). The median was 471 pmol/l; interquartile range (IR) (337-632 pmol/l). No statistically significant differences were found by age or C677T genotype for MTHFR. Serum vitamin B12 concentrations were significantly higher in females. Prevalence of vitamin B12 deficiency (< 224 pmol/l) was 6 % in males and 4 % in females. Conclusions: Reference values for serum vitamin B12 concentrations in an adolescent population are presented. Prevalence of vitamin B12 deficiencies is higher in males (AU)

[Burden of hospitalizations attributable to rotavirus infection in children in the Autonomous Region of Madrid, Spain, period 1999-2000]. / Ingresos hospitalarios atribuibles a rotavirus en niños de la Comunidad de Madrid, período 1999-2000.

OBJECTIVE: To assess rotavirus infection requiring hospitalization in children aged < or = 5 years between 1999 and 2000 in the Autonomous Region of Madrid (Spain). MATERIAL AND METHOD: A retrospective study was conducted, based on the hospital data surveillance system (Conjunto Mínimo Básico de Datos [CMBD]) and on the Spanish national microbiological information system (Sistema de Información Microbiológica [SIM]). CMBD data for all hospital admissions in children aged < or = 5 years with a first-listed diagnosis of intestinal infectious disease (ICD-9-CM codes: 001-009) or non-infective gastroenteritis (ICD-9-CM code: 558) and the reports to the SIM of the major pathogen groups responsible for acute gastroenteritis were analyzed. RESULTS: The annual incidence of hospitalizations for acute gastroenteritis was 69 cases per 10,000 children aged < or = 5 years. Fourteen percent of the 32,541 infections produced by pathogens responsible for acute gastroenteritis reported to the SIM were rotavirus. The estimated annual incidence of hospitalizations due to rotavirus infections was 12 cases per 10,000 children aged (3/4) 5 years. The mean length of stay was 4.0 days, the annual mean number of days of hospitalization was 1,382 days, and the annual cost was 565,907 J. During the rotavirus epidemic months (December and January), the percentage of excess hospitalizations was 67 %. CONCLUSIONS: Rotavirus causes a significant proportion of hospital admissions due to acute gastroenteritis in children aged < or = 5 years in the Autonomous Region of Madrid.

Ingresos hospitalarios atribuibles a rotavirus en niños de la Comunidad de Madrid, período 1999-2000 / Burden of hospitalizations attributable to rotavirus infection in children in the Autonomous Region of Madrid, Spain, period 1999-2000

Objetivo Estudiar las hospitalizaciones atribuibles a infecciones por rotavirus en niños de hasta 5 años durante el período 1999-2000 en la Comunidad de Madrid. Material y método Estudio retrospectivo, utilizando como fuentes de información la base de datos hospitalaria Conjunto Mínimo Básico de Datos (CMBD) y el Sistema de Información Microbiológica (SIM). Se analizaron los datos del CMBD correspondientes a hospitalizaciones en niños de hasta 5 años con un diagnóstico principal al alta de enfermedad intestinal infecciosa (códigos CIE-9-MC 001-009) o gastroenteritis no infecciosa (código CIE-9-MC 558) y las notificaciones al SIM de los principales patógenos causantes de gastroenteritis aguda. Resultados La incidencia anual de hospitalizaciones por gastroenteritis aguda fue de 69 casos por 10.000 niños de hasta 5 años. El 14 % de los 32.541 casos de infección producidos por patógenos responsables de gastroenteritis agudas notificados al SIM fueron producidos por rotavirus. La proporción de casos de infección por rotavirus confirmada en laboratorio, extrapolada al número de hospitalizaciones por gastroenteritis aguda da como resultado una incidencia anual de hospitalizaciones atribuibles a rotavirus de 12 casos por 10.000 niños de hasta 5 años. La estancia media hospitalaria fue de 4,0 días, el número medio anual de días de hospitalización fue de 1.382 días y el coste de 565.907 euros. El exceso de hospitalizaciones durante los meses epidémicos para rotavirus (diciembre y enero) fue del 67 %. Conclusiones El rotavirus ocasiona una parte importante de los ingresos hospitalarios por gastroenteritis aguda en niños de hasta 5 años en la Comunidad de Madrid

Objective To assess rotavirus infection requiring hospitalization in children aged <= 5 years between 1999 and 2000 in the Autonomous Region of Madrid (Spain). Material and method A retrospective study was conducted, based on the hospital data surveillance system (Conjunto Mínimo Básico de Datos [CMBD]) and on the Spanish national microbiological information system (Sistema de Información Microbiológica [SIM]). CMBD data for all hospital admissions in children aged <= 5 years with a first-listed diagnosis of intestinal infectious disease (ICD-9-CM codes: 001-009) or non-infective gastroenteritis (ICD-9-CM code: 558) and the reports to the SIM of the major pathogen groups responsible for acute gastroenteritis were analyzed. Results The annual incidence of hospitalizations for acute gastroenteritis was 69 cases per 10,000 children aged ≤ 5 years. Fourteen percent of the 32,541 infections produced by pathogens responsible for acute gastroenteritis reported to the SIM were rotavirus. The estimated annual incidence of hospitalizations due to rotavirus infections was 12 cases per 10,000 children aged ¾ 5 years. The mean length of stay was 4.0 days, the annual mean number of days of hospitalization was 1,382 days, and the annual cost was 565,907 J. During the rotavirus epidemic months (December and January), the percentage of excess hospitalizations was 67 %. Conclusions Rotavirus causes a significant proportion of hospital admissions due to acute gastroenteritis in children aged ≤ 5 years in the Autonomous Region of Madrid

[Progressive primary tuberculosis with endobronchial involvement. Benefits of multislice helical computed tomography]. / Tuberculosis primaria progresiva con afectación endobronquial. Aportación de la TC multicorte.

OBJECTIVES: To assess computed tomography (CT) imaging findings in progressive primary tuberculosis and to determine the use of the multislice images obtained. PATIENTS AND METHODS: We report the case of a 37-day-old infant admitted to hospital because of persistent fever despite antimicrobial therapy. Thoracic X-ray and multislice helical CT (CT Light speed i1.6 GE) were performed with 3-dimensional and virtual endoscopy reconstructions. RESULTS: CT showed mediastinal and hilar necrotic lymph nodes, pulmonary parenchymal involvement with miliary pattern, and multiple cavitated consolidations. Endobronchial involvement was clearly visualized by virtual endoscopy and was confirmed by fiberoptic bronchoscopy. CONCLUSIONS: Virtual endoscopy is a new, less invasive alternative radiological technique to fiberoptic bronchoscopy that may influence the management of patients with tuberculosis with endobronchial involvement.

[Arterial gas embolism progressing to a massive stroke]. / Embolismo gaseoso arterial con evolución a accidente cerebrovascular masivo.

INTRODUCTION: Arterial gas embolism (AGE) is a main iatrogenic complication resulting from the use of invasive procedures. It is difficult to diagnose if it is not clinically suspected. CASE REPORT: A 67-year-old male patient, with a history of interventions involving a mitral prosthesis and a double aortocoronary bypass, who visited Emergency room with symptoms of a high temperature and general malaise. He was canalised peripherally and the electrocardiogram (ECG) showed an auricular fibrillation that had already been detected. While under observation he suffered a loss of consciousness, generalised hypotonia, conjugated gaze deviation towards the right, lower left facial paralysis and left Babinski positive. A new ECG showed ST segment elevation in V2-V5. A cranial computerised tomography (CAT) scan with no contrast revealed a number of serpiginous images caused by the presence of air in vascular structures. A second cranial CAT scan showed the disappearance of the visible air and signs of ischemic stroke in the territory of the right middle and posterior cerebral arteries and the left middle cerebral artery. Clinical-radiological findings suggested an AGE in the brain with massive stroke and acute myocardial infarct with similar causation. CONCLUSIONS: It is not clear what caused the air embolism in this patient but it can most probably be explained by air accidentally entering a peripheral vein. Carrying out an early cranial CAT scan can provide us with a diagnosis and a later CAT scan can evaluate the consequences of the embolism.

Embolismo gaseoso arterial con evolución a accidente cerebrovascular masivo / Arterial gas embolism progressing to a massive stroke

Introducción. El embolismo gaseoso arterial (EGA) es una complicación principalmente yatrogénica, causada por el uso de procedimientos invasivos. Su diagnóstico es difícil si no se sospecha clínicamente. Caso clínico. Varón de 67 años, con antecedente de intervención de prótesis mitral y doble derivación aortocoronaria, que acude a Urgencias con un síndrome febril y mal estado general. Se le canaliza una vía periférica, y en el electrocardiograma (ECG) muestra una fibrilación auricular ya conocida. Mientras estaba en observación, sufre pérdida de conciencia, hipotonía generalizada, desviación de la mirada conjugada a la derecha, parálisis facial inferior izquierda y Babinski izquierdo positivo. Un nuevo ECG muestra supradesnivel del segmento ST de V2 a V5. En la tomografía computarizada (TC) craneal sin contraste se observan múltiples imágenes serpiginosas por aire en estructuras vasculares. Una segunda TC craneal muestra la desaparición del aire visible y signos de accidente cerebrovascular isquémico en el territorio de las arterias cerebral media y posterior derechas y cerebral media izquierda. Los hallazgos clinicorradiológicos sugieren un EGA cerebral con infarto cerebral masivo, e infarto agudo de miocardio de origen similar. Conclusiones. La causa del embolismo aéreo en este paciente no está clara, y la más probable es la entrada accidental de aire en la vía venosa periférica. La realización de una TC craneal precoz puede dar el diagnóstico, y una TC tardía puede valorar las consecuencias del embolismo (AU)

Introduction. Arterial gas embolism (AGE) is a main iatrogenic complication resulting from the use of invasive procedures. It is difficult to diagnose if it is not clinically suspected. Case report. A 67-year-old male patient, with a history of interventions involving a mitral prosthesis and a double aortocoronary bypass, who visited Emergency room with symptoms of a high temperature and general malaise. He was canalised peripherally and the electrocardiogram (ECG) showed an auricular fibrillation that had already been detected. While under observation he suffered a loss of consciousness, generalised hypotonia, conjugated gaze deviation towards the right, lower left facial paralysis and left Babinski positive. A new ECG showed ST segment elevation in V2-V5. A cranial computerised tomography (CAT) scan with no contrast revealed a number of serpiginous images caused by the presence of air in vascular structures. A second cranial CAT scan showed the disappearance of the visible air and signs of ischemic stroke in the territory of the right middle and posterior cerebral arteries and the left middle cerebral artery. Clinical-radiological findings suggested an AGE in the brain with massive stroke and acute myocardial infarct with similar causation. Conclusions. It is not clear what caused the air embolism in this patient but it can most probably be explained by air accidentally entering a peripheral vein. Carrying out an early cranial CAT scan can provide us with a diagnosis and a later CAT scan can evaluate the consequences of the embolism (AU)

Estudio de farmacovigilancia para evaluar la seguridad y efectividad de doxazosina GITS en pacientes hipertensos que recibían tratamiento previo con doxazosina estándar / Post-marketing study to evaluate the safety and effectiveness of doxazosin GITS in hypertensive patients previously treated with doxazosin standard

Objetivo. Valorar la seguridad y efectividad de la nueva formulación GITS (gastrointestinal therapeutic system) en pacientes hipertensos tratados previamente con doxazosina estándar. Material y métodos. Estudio de farmacovigilancia, abierto y no controlado, multicéntrico en Atención Primaria. Se incluyeron pacientes diagnosticados de hipertensión arterial (HTA) esencial no controlada. Los pacientes podían estar en tratamiento farmacológico previo a la inclusión en el estudio y éste se mantuvo sin ser modificado a lo largo del mismo. El estudio en total tuvo una duración de 6 a 9 meses dividido en dos fases. La fase I tuvo una duración mínima de 3 meses y máxima de 6 meses en tratamiento con doxazosina estándar. La fase II se iniciaba al sustituir la doxazosina estándar por la formulación GITS y tenía una duración de 12 semanas. Las variables principales a estudio incluyen la presión arterial (PA), el control de la misma y la aparición de acontecimientos adversos. Resultados. Comenzaron el estudio un total de 4.512 pacientes y finalizan el estudio 3.537 (78,4 por ciento). El porcentaje de pacientes con monoterapia fue del 70,7 por ciento, el restante 29,3 por ciento seguía terapia combinada con otro antihipertensivo además de doxazosina. La reducción de la presión arterial sistólica (PAS) a lo largo de la fase I fue de 21,3 mmHg, en la fase II descendió 3,8 mmHg adicionales. Para la presión arterial diastólica (PAD) la reducción en la fase I fue de 13,3 mmHg y en la fase II fue de 2,7 mmHg más. El porcentaje de pacientes controlados al final de la fase I fue del 47,9 por ciento y en la fase II 63,4 por ciento. Un total de 322 sujetos presentaron un total de 343 (7,2 por ciento) acontecimientos adversos; de éstos, un 0,9 por ciento (37) fueron considerados graves (un 0,6 por ciento en la fase I y un 0,23 por ciento en la fase II). Conclusiones. La doxazosina en sus dos formulaciones es un fármaco efectivo y seguro para reducir la PA tanto en monoterapia como en combinación con otros antihipertensivos, y la sustitución de la formulación estándar por la GITS es segura y probablemente aumente la efectividad del tratamiento de la HTA y mejore la tolerabilidad (AU)