Infección pulmonar por micobacterias no tuberculosas / Lung infection with nontuberculous mycobacteria

Objetivo: Describir la epidemiología y hallazgos en tomografía computarizada (TC) de las infecciones pulmonares por micobacterias no tuberculosas (IPMNT) y su evolución según el tratamiento. Material y métodos: Estudio retrospectivo de 131 pacientes consecutivos con cultivos positivos para micobacterias no tuberculosas (MNT) entre 2005 y 2016. Se seleccionaron los que cumplían con los criterios diagnósticos de IPMNT. Se analizaron los datos epidemiológicos, clínicos, microbiológicos, radiológicos, el tratamiento recibido y la evolución en función de este. Resultados: Se incluyeron 34 pacientes con una edad media de 55 años, el 67,6% hombres. El 50% estaba inmunodeprimido (VIH positivos, el 58,8%); el 20,6% tenía EPOC; el 5,9%, neoplasias conocidas; el 5,9%, fibrosis quística; y el 29,4% no presentaba comorbilidades. El 20,6% presentaba antecedentes de tuberculosis y el 20,6% estaba infectado por otros microorganismos. Mycobacterium avium complex fue el germen más frecuentemente aislado (52,9%). Siete pacientes (20,6%) presentaron además infecciones por otros microorganismos. En la TC, los hallazgos más frecuentes fueron: nódulos (64,7%), patrón en árbol en brote (61,8%), nódulos centrolobulillares (44,1%), consolidaciones (41,2%), bronquiectasias (35,3%) y cavidades (32,4%). Se realizó un estudio comparativo de los hallazgos entre hombres y mujeres y entre pacientes inmunodeprimidos e inmunocompetentes. El 67,6% recibió antituberculostáticos (el 72% mostró mejoría) y el 20,6%, antibióticos convencionales (todos con mejoría radiológica). Conclusión: El diagnóstico de la IPMNT es complejo. Los hallazgos clínicos y radiológicos son inespecíficos y un porcentaje importante de pacientes puede presentar otras infecciones concomitantes.(AU)

Objective: To describe the epidemiology and CT findings for nontuberculous mycobacterial lung infections and outcomes depending on the treatment. Material and methods: We retrospectively studied 131 consecutive patients with positive cultures for nontuberculous mycobacteria between 2005 and 2016. We selected those who met the criteria for nontuberculous mycobacterial lung infection. We analyzed the epidemiologic data; clinical, microbiological, and radiological findings; treatment; and outcome according to treatment. Results: We included 34 patients (mean age, 55 y; 67.6% men); 50% were immunodepressed (58.8% of these were HIV+), 20.6% had COPD, 5.9% had known tumors, 5.9% had cystic fibrosis, and 29.4% had no comorbidities. We found that 20.6% had a history of tuberculosis and 20.6% were also infected with other microorganisms. Mycobacterium avium complex was the most frequently isolated germ (52.9%); 7 (20.6%) were also infected with other organisms. The most common CT findings were nodules (64.7%), tree-in-bud pattern (61.8%), centrilobular nodules (44.1%), consolidations (41.2%), bronchiectasis (35.3%), and cavities (32.4%). We compared findings between men and women and between immunodepressed and immunocompetent patients. Treatment was antituberculosis drugs in 67.6% of patients (72% of whom showed improvement) and conventional antibiotics in 20.6% (all of whom showed radiologic improvement). Conclusion: The diagnosis of nontuberculous mycobacterial lung infections is complex. The clinical and radiologic findings are nonspecific and a significant percentage of pateints can have other, concomitant infections.(AU)

Lung infection with nontuberculous mycobacteria.

OBJECTIVE: To describe the epidemiology and CT findings for nontuberculous mycobacterial lung infections and outcomes depending on the treatment. MATERIAL AND METHODS: We retrospectively studied 131 consecutive patients with positive cultures for nontuberculous mycobacteria between 2005 and 2016. We selected those who met the criteria for nontuberculous mycobacterial lung infection. We analysed the epidemiologic data; clinical, microbiological, and radiological findings; treatment; and outcome according to treatment. RESULTS: We included 34 patients (mean age, 55 y; 67.6% men); 50% were immunodepressed (58.8% of these were HIV+), 20.6% had COPD, 5.9% had known tumors, 5.9% had cystic fibrosis, and 29.4% had no comorbidities. We found that 20.6% had a history of tuberculosis and 20.6% were also infected with other microorganisms. Mycobacterium avium complex was the most frequently isolated germ (52.9%); 7 (20.6%) were also infected with other organisms. The most common CT findings were nodules (64.7%), tree-in-bud pattern (61.8%), centrilobular nodules (44.1 %), consolidations (41.2%), bronchiectasis (35.3%), and cavities (32.4%). We compared findings between men and women and between immunodepressed and immunocompetent patients. Treatment was antituberculosis drugs in 67.6% of patients (72% of whom showed improvement) and conventional antibiotics in 20.6% (all of whom showed radiologic improvement). CONCLUSION: The diagnosis of nontuberculous mycobacterial lung infections is complex. The clinical and radiologic findings are nonspecific and a significant percentage of pateints can have other, concomitant infections.

Evaluation of quality of care in trauma patients using international scoring systems. / Valoración de la calidad asistencial al traumatismo grave mediante comparación con estándares internacionales.

OBJECTIVE: To evaluate the ability of the TRISS and PS14 models to predict mortality rates in our medical system and population. DESIGN: A retrospective observational study was carried out over a 66-month period. BACKGROUND: The study was conducted in the Trauma Intensive Care Unit (ICU) of a third level hospital. PATIENTS: All severe trauma patients (Injury Severity Score≥16 and/or Revised Trauma Score <12) aged> 14 years were included. VARIABLES OF INTEREST: Medical care data were prospectively recorded. The "W" statistic (difference between expected and observed mortality for every 100 patients) and its significance were calculated for each model. Discrimination and calibration were evaluated by means of receiver operating characteristic (ROC) curves, and the Hosmer-Lemeshow test and GiViTI calibration belt, respectively. RESULTS: A total of 1240 patients were included. Survival at hospital discharge was 81.9%. The "W" scores for the TRISS, TRISS 2010 and PS14 models were+6.72 (P<.01), +1.48 (P=.08) and +2.74 (P<.01) respectively. Subgroup analysis revealed significant favorable results for some populations. The areas under the ROC curve for the TRISS, TRISS 2010 and PS14 models were 0.915, 0.919 and 0.914, respectively. There were no significant differences among them (P>.05). Both the Hosmer-Lemeshow test and GiViTI calibration belt demonstrated poor calibration for the three models. CONCLUSIONS: These models are suitable tools for assessing quality of care in a Trauma ICU, affording excellent discrimination but poor calibration. In our institution, survival rates higher than expected were observed.

Robust segmentation of retinal layers in optical coherence tomography images based on a multistage active contour model.

Optical Coherence Tomography (OCT) constitutes an imaging technique that is increasing its popularity in the ophthalmology field, since it offers a more complete set of information about the main retinal structures. Hence, it offers detailed information about the eye fundus morphology, allowing the identification of many intraretinal pathological signs. For that reason, over the recent years, Computer-Aided Diagnosis (CAD) systems have spread to work with this image modality and analyze its information. A crucial step for the analysis of the retinal tissues implies the identification and delimitation of the different retinal layers. In this context, we present in this work a fully automatic method for the identification of the main retinal layers that delimits the retinal region. Thus, an active contour-based model was completely adapted and optimized to segment these main retinal boundaries. This fully automatic method uses the information of the horizontal placement of these retinal layers and their relative location over the analyzed images to restrict the search space, considering the presence of shadows that are normally generated by pathological or non-pathological artifacts. The validation process was done using the groundtruth of an expert ophthalmologist analyzing healthy as well as unhealthy patients with different degrees of diabetic retinopathy (without macular edema, with macular edema and with lesions in the photoreceptor layers). Quantitative results are in line with the state of the art of this domain, providing accurate segmentations of the retinal layers even when significative pathological alterations are present in the eye fundus. Therefore, the proposed method is robust enough to be used in complex environments, making it feasible for the ophthalmologists in their routine clinical practice.

A duality principle for the multi-block entanglement entropy of free fermion systems.

The analysis of the entanglement entropy of a subsystem of a one-dimensional quantum system is a powerful tool for unravelling its critical nature. For instance, the scaling behaviour of the entanglement entropy determines the central charge of the associated Virasoro algebra. For a free fermion system, the entanglement entropy depends essentially on two sets, namely the set A of sites of the subsystem considered and the set K of excited momentum modes. In this work we make use of a general duality principle establishing the invariance of the entanglement entropy under exchange of the sets A and K to tackle complex problems by studying their dual counterparts. The duality principle is also a key ingredient in the formulation of a novel conjecture for the asymptotic behavior of the entanglement entropy of a free fermion system in the general case in which both sets A and K consist of an arbitrary number of blocks. We have verified that this conjecture reproduces the numerical results with excellent precision for all the configurations analyzed. We have also applied the conjecture to deduce several asymptotic formulas for the mutual and r-partite information generalizing the known ones for the single block case.

La linfogammagrafía prequirúrgica y el grado histológico del tumor se asocian a la detección quirúrgica del ganglio centinela / Preoperative lymphoscintigraphy and tumor histologic grade are associated with surgical detection of the sentinel lymph node

Objetivo. Estudiar qué variables implicadas en el proceso de la biopsia selectiva del ganglio centinela (BSGC) influyen en la detección intraoperatoria del ganglio centinela. Material y métodos. Estudio transversal prospectivo de 210 pacientes (edad media: 54 años) diagnosticadas de cáncer de mama a las que se les realizó BSGC. Se recogieron los datos clínicos y radiológicos, de la administración del radioisótopo, quirúrgicos, de anatomía patológica y de seguimiento, y se realizó un análisis descriptivo y asociativo mediante una regresión múltiple multivariante. Resultados. La vía de inyección del radioisótopo más utilizada fue la profunda aislada (72,7%). La mayoría de las lesiones fueron palpables (57,1%), se presentaron como nódulos (67,1%), fueron menores de 2 cm (64,8%), se localizaron en el cuadrante supero-externo (49,1%), se trataba de carcinomas ductales (85,7%), con infiltración (66,2%) y el grado de diferenciación histológica fue ii (44,8%). Con la gammagrafía prequirúrgica se detectó el ganglio centinela en el 97,6% de los casos, y en el quirófano el 95,7%. Se observó una recurrencia axilar. En el estudio asociativo, las variables «linfogammagrafía prequirúrgica» y «grado de diferenciación histológica del tumor» mostraron una asociación estadísticamente significativa con la detección del ganglio centinela en el quirófano. Conclusión. La probabilidad de no detectar el ganglio centinela durante la intervención quirúrgica es mayor en los pacientes con tumores de alto grado histológico o en las que no se ha conseguido verlo en la linfogammagrafía prequirúrgica (AI)

Objective. To study which variables involved in the process of selective sentinel node biopsy (SSNB) influence the intraoperative detection of the sentinel lymph node. Material and methods. This was a prospective cross-sectional study in 210 patients (mean age, 54 years) diagnosed with breast cancer who underwent SSNB. We recorded clinical, radiological, radioisotope administration, surgical, and histological data as well as follow-up data. We did a descriptive analysis of the data and an associative analysis using multivariable regression. Results. Deep injection alone was the most common route of radioisotope administration (72.7%). Most lesions were palpable (57.1%), presented as nodules (67.1%), measured less than 2 cm in diameter (64.8%), were located in the upper outer quadrant (49.1%), were ductal carcinomas (85.7%), were accompanied by infiltration (66.2%), and had a histologic grade of differentiation of ii (44.8%). Preoperative scintigraphy detected the sentinel node in 97.6% of cases and 95.7% were detected during the operation. One axillary relapse was observed. In the associative study, the variables «preoperative lymphoscintigraphy» and «histologic grade of differentiation of the tumor» were significantly associated with the detection of the sentinel lymph node during the operation. Conclusion. The probability of not detecting the sentinel lymph node during the surgical intervention is higher in patients with high histologic grade tumors or in patients in whom preoperative lymphoscintigraphy failed to detect the sentinel node (AU)

[Geriatric syndromes in patients with a non-recent hip fracture seen at a primary health care unit]. / Síndromes geriátricos en pacientes con fractura de cadera no reciente en una unidad de primer nivel de atención médica.

OBJECTIVE: To identify the frequency of geriatric syndromes in patients with a non- recent hip fracture seen at a primary health care unit in the state of Puebla, Mexico. MATERIAL AND METHODS: Cross-sectional study conducted in 376 patients with a non-recent hip fracture screened for geriatric syndromes. We included demographic variables, urinary incontinence, polypharmacy, sleep disorder, nutritional status, depression and autonomy. The two latter were assessed using the Yesavage geriatric depression scale and the Katz index. We used descriptive statistics. RESULTS: The total number of patients was 376; 219 (58%) were females and 157 (42%) were males; mean age was 72.57 years (65-95 +/- 7.08), and 98.7% had at least one geriatric syndrome. Depression was detected in 303 (80.9%), 282 (75%) were on polypharmacy, 262 (69.7%) had sleep disorders, 63 (16.8%) had experienced falls, 19 (5.1%) had urinary incontinence, 15 (4%) were obese, and 3 (0.8%) had loss of autonomy. CONCLUSION: 98.7% of the patients had at least one geriatric syndrome; females were the most affected sex; depression was the most frequent syndrome, followed by polypharmacy, sleep disorders, falls, urinary incontinence, obesity and loss of autonomy.

Preoperative lymphoscintigraphy and tumor histologic grade are associated with surgical detection of the sentinel lymph node.

OBJECTIVE: To study which variables involved in the process of selective sentinel node biopsy (SSNB) influence the intraoperative detection of the sentinel lymph node. MATERIAL AND METHODS: This was a prospective cross-sectional study in 210 patients (mean age, 54 years) diagnosed with breast cancer who underwent SSNB. We recorded clinical, radiological, radioisotope administration, surgical, and histological data as well as follow-up data. We did a descriptive analysis of the data and an associative analysis using multivariable regression. RESULTS: Deep injection alone was the most common route of radioisotope administration (72.7%). Most lesions were palpable (57.1%), presented as nodules (67.1%), measured less than 2 cm in diameter (64.8%), were located in the upper outer quadrant (49.1%), were ductal carcinomas (85.7%), were accompanied by infiltration (66.2%), and had a histologic grade of differentiation of ii (44.8%). Preoperative scintigraphy detected the sentinel node in 97.6% of cases and 95.7% were detected during the operation. One axillary relapse was observed. In the associative study, the variables "preoperative lymphoscintigraphy" and "histologic grade of differentiation of the tumor" were significantly associated with the detection of the sentinel lymph node during the operation. CONCLUSION: The probability of not detecting the sentinel lymph node during the surgical intervention is higher in patients with high histologic grade tumors or in patients in whom preoperative lymphoscintigraphy failed to detect the sentinel node.

[Quality of life in patients with functional knee impairment at a primary health care unit]. / Calidad de vida en pacientes con limitación funcional de la rodilla por gonartrosis. En una unidad de primer nivel de atención médica.

OBJECTIVE: To assess the quality of life of patients with functional knee impairment at a primary health care unit. MATERIAL AND METHODS: Descriptive study of 317 primary health care patients with functional impairment due to gonarthrosis. The WOMAC and SF-36 questionnaires were used to assess functional impairment and quality of life, respectively. We used chi2 and Kendall's Tau-b to prove the hypothesis. RESULTS: 317 patients, 137 (43%) males, 180 (57%) females, mean age 72.46, standard deviation +/- 6.76 with a range of 65-95. Mild functional impairment occurred in 222 (70%) patients; 52.37% of patients had a fair quality of life. When the association between functional impairment and quality of life was studied, chi2 was 106.78, with p = 0.00, the application of Kendall's Tau-b to show a relation was -0.502 with a significant p = 0.00, thus showing the relation between both variables. Both variables were dichotomized and the degree of dependence of quality of life from functional impairment was assessed; 120 (37.85%) patients had poor quality of life and mild functional impairment with chi2 = 75.50, p = 0.00, Kendall's Tau-b = -0.428, p = 0.00. CONCLUSION: The quality of life of patients with gonarthrosis ranges from fair to poor and is directly dependent on the degree of functional impairment.

Evaluación del tratamiento médico del embarazo ectópico con metotrexato / Evaluation of medical treatment with methotrexate in ectopic pregnancy

Objetivos Evaluar la eficacia del tratamiento médico con metotrexato en el embarazo ectópico. Material y métodos Estudio prospectivo observacional del uso y eficacia del tratamiento médico con metotrexato en las pacientes diagnosticadas de embarazo ectópico en el Hospital General Universitario de Ciudad Real durante los años 2008 y 2009. Se administró dosis única intramuscular a aquellas pacientes que cumplieron los criterios de inclusión. Se consideró fracaso del tratamiento médico cuando después del mismo fue necesario tratamiento quirúrgico. Se analizaron los costes económicos del tratamiento médico y quirúrgico. Resultados Se diagnosticaron 63 casos de embarazo ectópico. Cuarenta pacientes (63,5%) fueron tratadas con metotrexato, y 23 (36,5%) fueron directamente intervenidas quirúrgicamente (salpingectomía laparoscópica) por no cumplir criterios de inclusión en el protocolo de tratamiento médico. De las que recibieron metotrexato, 30 pacientes (82,5%) necesitaron sólo una dosis y 10 (17,5%) precisaron 2 dosis. El tratamiento con metotrexato tuvo éxito en 30 pacientes (75%) y fracasó en 10 (25%), realizándoseles una salpingectomía laparoscópica. El coste por proceso del tratamiento médico fue de 580 euros, menor que el coste del tratamiento quirúrgico laparoscópico, 3.465,8 euros. Conclusiones El tratamiento con metotrexato del embarazo ectópico en pacientes seleccionadas es igual de eficaz que el tratamiento clásico con laparoscopia con un menor coste económico y con una gran aceptación por parte de la paciente (AU)

Objectives: To evaluate the eficacy of medical treatment with methotrexate in ectopic pregnancy. Material and methods: We performed a prospective observational study of the use and effectiveness of medical treatment with methotrexate in patients diagnosed with ectopic pregnancy in the Ciudad Real University General Hospital from 2008 to 2009. A single intramuscular dose was administered in patients who met the inclusion criteria. Medical treatment was considered to have failed when surgery was required. We analyzed the economic costs of medical and surgical treatment. Results: We diagnosed 63 cases of ectopic pregnancy. Forty patients (63.5%) were treated with methotrexate, and 23 women (36.5%) who did not meet the criteria for inclusion in the protocol for medical treatment were treated surgically (laparoscopic salpingectomy).Among patients who received methotrexate, 30 (82.5%) required only one dose and 10(17.5%) required two doses. Methotrexate treatment was successful in 30 patients (75%) and failed in 10 (25%), who underwent a laparoscopic salpingectomy. The cost per case of medical treatment was 580 D, which was less than the cost of laparoscopic surgical treatment(3,465.8 D).Conclusions: Metho trexate treatment of ectopic pregnancy in selected patients is as effective as the standard treatment with laparoscopy with less cost and with high acceptance by patients (AU)

Perforación uterina secundaria a una mola invasiva aparecida sobre un coriocarcinoma / Uterine perforation due to a choriocarcinoma progressing to an invasive mole

Dentro de la enfermedad trofoblástica gestacional encontramos el coriocarcinoma, un tumor raro de gran agresividad local y a distancia, a pesar de lo cual presenta una alta tasa de curación. Presentamos el caso de una paciente joven con una perforación uterina y hemoperitoneo, secundario a un coriocarcinoma, surgido a partir de un aborto espontáneo que se transformó en mola invasiva. Tras intervenir quirúrgicamente a la paciente y tras un exhaustivo control, se consiguió la recuperación total de la misma, sin necesidad de añadir quimioterapia a su tratamiento. Realizamos una revisión de la literatura científica analizando los factores de riesgo de coriocarcinoma, sus técnicas diagnósticas y las opciones terapéuticas (AU)

Gestational trophoblastic disease includes choriocarcinoma, a singular and highly aggressive tumor both at local and distant sites. Nevertheless, the recovery rate is high. We report the case of a young patient with uterine perforation and hemoperitoneum secondary to a choriocarcinoma that developed after a spontaneous abortion and progressed to an invasive mole. After surgery and exhaustive follow-up, complete recovery was achieved with no need for chemotherapy. We review the scientific literature and analyze the risk factors for choriocarcinoma, diagnostic techniques and therapeutic options (AU)

Intoxicación por setas: síndrome orellánico / Mushroom poisoning: Orellanus syndrome

No disponible

Carcinoma de trompa de Falopio: revisión de casos en el Hospital General Universitario de Albacete / Primary fallopian tube carcinoma. Review of cases. Hospital General Albacete

Introducción: El carcinoma de trompa de Falopio primario (CTFP) constituye la neoplasia maligna menos frecuente del aparato genital femenino. Su incidencia es mayor entre la cuarta y la sexta década de la vida. Debido a su baja prevalencia y a su sintomatología inespecífica, el diagnóstico de esta enfermedad raramente se realiza antes de la cirugía. Objetivo: El principal objetivo de esta revisión ha sido conocer la forma de presentación y evolución del CTFP. Para ello se han analizado los casos de CTFP ocurridos en el Hospital General Universitario de Albacete desde el año 2000. Material y métodos: Hemos realizado un estudio descriptivo retrospectivo que incluye una serie de 5 casos de CTFP tratados en nuestro centro. Resultados: La edad media de las pacientes en el momento del diagnóstico es de 55 años. El síntoma más frecuente ha sido la hemorragia genital. En una de las pacientes, a pesar de que el diagnóstico de CTFP se realiza de manera post-operatoria, se sospechó un CTFP con las pruebas diagnósticas previas a la cirugía. El examen histopatológico reveló 3 casos de adenocarcinomas de tipo seroso y 2 de tipo endometrioide. La citología de líquido peritoneal fue positiva en el 80% de los casos. En cuanto al estadio clínico, 2 pacientes se encontraban en estadio I, 2 en estadio II y sólo un caso en estadio III. El seguimiento medio de estas pacientes ha sido de 31 meses, produciéndose recidiva en 3 de los 5 casos, a nivel local, dentro del primer año tras el diagnóstico. Conclusiones: ElCTFP, aunque es una entidad rara, no podemos olvidarlo ante una paciente con hidromenorrea, dolor abdominal, masa anexial y alteraciones citológicas cervicovaginales y/o endometriales (AU)

Introduction: Primary fallopian tube carcinoma (PFTC) is the rarest of all gynecologic cancers. It frequently occurs between fourth and sixth decade of life. Because of its low prevalence and its unspecific symptoms, PFTC is rarely diagnosed before surgery. Objetive: The main objective of this study is to analyze the patients who were diagnosed of PFTC in the General Hospital of Albacete between 2000 and 2009. Material and methods: We present a retrospective descriptive study involving 5 patients with PFTC treated in our hospital. Results: The average age of the patients at the moment of diagnosis is 55 years. The most frequent symptom has been the vaginal bleeding. In one of the patients, although the diagnosis of PFTC was done postoperative, we suspected PFTC with the preoperative study. Histopathological examination revealed 3 cases of serous adenocarcinoma and 2 cases of endometroid adenocarcinoma. Peritoneal cytology was positive in 80% of the cases. As far as the surgical staging is concerned, 2 patients were diagnosed in stage I, 2 patients in stage II and only one patient in stage III. The average follow has been 31 months, appearing recurrence in 3 of the 5 cases during the first year, as a local recurrence. Conclusion: Although PFTC is a very rare malignancy, it should be suspected in a patient with vaginal bleeding, abdominal pain, adnexal mass and abnormalities of cervical or endometrial cytologies (AU)

1/falpha noise and integrable systems.

In this paper, we show that there is a family of well-known integrable systems whose spectral fluctuations decay as 1/f(4), and thus do not follow the 1/f(2) law recently conjectured for integrable systems. We present a simple theoretical justification of this fact, and propose an alternative characterization of quantum chaos versus integrability formulated directly in terms of the power spectrum of the spacings of the unfolded spectrum.

[Usefulness of hyperbaric oxygen in the treatment of radionecrosis and symptomatic brain edema after LINAC radiosurgery]. / Eficacia del oxígeno hiperbárico en el tratamiento de la radionecrosis y el edemacerebral sintomáticos tras radiocirugía con acelerador lineal.

Radionecrosis with brain edema is a complication of radiosurgery. Three female patients harbouring a frontal pole, petrous and parasagital parietoocipital meningiomas respectively who had been treated with LINAC radiosurgery are presented. Those patients developed, between two and eight months later, a severe symptomatic radionecrosis with a huge brain edema resistant to the usual steroid therapy. Only after 40 sessions of hyperbaric oxygen, a good remission of the lesions was obtained. There are few cases reported in the literature with such a good outcome. Consequentely, this therapy must be taken into account to treat this type of radiosurgical complication before considering surgery.