Quality of Life and Related Factors in Patients Undergoing Renal Replacement Therapy at the Hospital General Universitario de Ciudad Real: Cross Sectional Descriptive Observational Study.

Background: The aim of the present study was to determine the relationship between the quality of life of patients on renal replacement therapy and the Symptomatology they presented. Methods: Cross-sectional descriptive observational study: quality of life was assessed by means of the KDQOL-SF questionnaire, Symptomatology by the Palliative Care Outcome Scale-Symptoms Renal questionnaire, and sociodemographic and clinical data of patients in the Hemodialysis Unit (HD) of the Hospital General Universitario de Ciudad Real (HGUCR) by means of personal interviews and clinical history data. Results: A total of 105 patients participated in the study, 63 (60.57%) men and 42 (40.38%) female. The mean age was 62.5 dt (14.84) years. Of these, 43 (41%) were on peritoneal dialysis and 62 (59%) were on hemodialysis. The mean quality of life score was 44.89 dt (9.73). People on hemodialysis treatment presented a better quality of life than those on PD treatment: 49.66 dt (9.73) vs. 38.13 dt (9.12) t = 7.302, p < 0.001. A higher score on the symptom impairment scale (post-renal) correlated with worse scores on the total quality of life score: r = -0.807, p < 0.001. It was observed that those who improved the distress symptom scored better on the total quality of life questionnaire: 50.22 dt (8.44) vs. 46.42 dt (9.05), p < 0.001. Conclusions: The presence and management of the large number of symptoms that appear as side effects, such as distress or depression, could determine changes in some components of quality of life.

COVID 19, una nueva etapa de liderazgo perdido / COVID 19, a new stage of lost leadership

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Burnout y su relación con el estrés percibido y la satisfacción laboral en profesionales sanitarios de Atención Primaria de una Comunidad Autónoma / Burnout and its connection with perceived stress and job satisfaction in primary healthcare professionals in an Autonomous Community

Objetivo: Evaluar la prevalencia de burnout y sus componentes en profesionales sanitarios de Atención Primaria de Castilla-La Mancha, así como su relación con el estrés percibido y la satisfacción laboral. Diseño: Estudio descriptivo observacional transversal. Emplazamiento: Estudio multicéntrico realizado en equipos de Atención Primaria de seis Áreas Sanitarias de Castilla-La Mancha. Participantes: Todos los profesionales de medicina y enfermería de Atención Primaria de las Áreas Sanitarias participantes. Mediciones Principales: Incluidas las siguientes variables: características de participantes (sociodemográficas/laborales), características lugar de trabajo, estrés percibido (Perceived Stress Scale), burnout (Maslach Burnout Inventory) y satisfacción laboral (cuestionario Font-Roja). Resultados: La prevalencia de burnout fue del 20,7 % (IC 95 %: 16,6-24,7). Un 53,3 % presentó alterada al menos una subescala. El 38,9 % mostró alto grado de despersonalización, 28,2 % agotamiento emocional y 8,0 % baja realización personal. La puntuación de estrés percibido fue significativamente superior al aumentar el grado de burnout en las tres subescalas (p<0,001). Mediante regresión logística, las variables asociadas a burnout fueron: mayor puntuación escala estrés percibido (OR: 1,20; IC95 %: 1,12-1,28), menor puntuación en escala satisfacción (OR: 8,42; IC 95 %: 1,96-36,10), contar con mayor número de pacientes en cupo (OR: 1,01; IC 95 %: 1,00-1,02) y no ser tutor de residentes (OR: 2,88; IC 95 %: 1,06-8,25). Conclusiones: El burnout afecta a uno de cada cinco profesionales de Atención Primaria de nuestra Comunidad Autónoma, siendo la despersonalización la subescala más alterada. Los profesionales con burnout presentan puntuaciones superiores de estrés percibido e inferiores de satisfacción laboral. Otras variables relacionadas con el puesto de trabajo también se asocian con la presencia de burnout

Objective: To evaluate the prevalence of burnout and its components in health care providers in primary care of Castilla-La Mancha, as well as its relation with perceived stress and job satisfaction. Design: Descriptive, observational cross-sectional study. Location: Multicenter study carried out by Primary Care Teams of six health areas of Castilla-La Mancha. Participants: Every health care professional (doctors and nurses) of the six health areas of Castilla-La Mancha. Main measurements: The variables included were: features of the participants (sociodemographic/occupational), work place features, perceived stress (Perceived-Stress-Scale), burnout (Maslach-Burnout-Inventory) and job satisfaction (Font-Roja test). Results: Prevalence of burnout: 20.7 % (CI 95 %: 16.6 - 24.7). About 53.3 % had at least one altered subscale. 38.9 % showed high level of depersonalization, 28.2 % emotional exhaustion and 8.0 % low personal fulfillment. Perceived stress score was significantly higher as the level of burnout increased in all three subscales (p<0.001). By using logistic regression, burnout associated variables were: Higher score in perceived stress scale (OR: 1.20; CI 95 %: 1.12-1.28), lower score in satisfaction scale (OR: 8.42; CI 95 %: 1.96-36.10), having more patients in their quota (OR: 1.01; CI 95 %:1.00-1.02) and no resident supervision (OR: 2.88; CI 95 %: 1.06-8.25). Conclusion: Burnout affects one in five primary care providers in our Autonomous Community, being depersonalization the most altered subscale. Professionals with burnout present higher perceived stress and lower job satisfaction. Other job-related variables are also associated with the presence of burnout

Sumando por Atención Prmaria, una necesidad para comenzar a cambiar de rumbo / Joining efforts for Primary Care, a necessity for starting to change the course

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Comparison of different predictive tools of axillary status in breast cancer with micrometastatic sentinel node.

AIM: To compare the performance of six different nomograms and one score in the prediction of non-sentinel lymph node status in a subset of women with breast cancer and micrometastatic sentinel nodes (SN). MATERIAL AND METHODS: Twenty-five patients were included in the study. Five different nomograms not specifically designed for micrometastatic SN, one recently published nomogram specially developed for this type of patients and one score were analyzed, and the corresponding receiver operating characteristic curves were obtained. The area under the curve (AUC) was calculated, as well as the false negative and false positive results and their corresponding rates (FNR and FPR) for a cutoff of ≤10% or ≤4 points. RESULTS: The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram showed the best performance in this low-risk group of patients (AUC 0.900, FPR 64%, FNR 0%), followed by the French nomogram. CONCLUSIONS: The MSKCC nomogram seems to have the highest accuracy in the identification of patients with low risk of further axillary disease in the subgroup of women with micrometastatic SN.

Glycolytic activity with 18F-FDG PET/CT predicts final neoadjuvant chemotherapy response in breast cancer.

The purpose of the present study is to explore the relation between glycolytic metabolism assessed by (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) and final neoadjuvant chemotherapy (NC) response in locally advanced breast tumors. Of women with breast cancer, 126 were prospectively evaluated. All patients underwent (18)F-FDG PET/CT previous to NC. Standard uptake value (SUV) max was calculated in the primary tumor. After NC, residual primary tumor specimen was histopathologically classified according to Miller and Payne tumor regression grades (TRG), from G1 to G5 and in response groups as good responders (G4 or G5), partial responders (G2 or G3), and non-responders (G1). Furthermore, residual lesions were classified following a binary assessment as responders (G4 or G5) and non-responders (the rest of cases). The relationship between SUV max with TRG and response groups was evaluated. Of tumors, 127 were assessed (a patient had bilateral breast lesions). TRG were as follows: G1 (27), G2 (27), G3 (32), G4 (11), and G5 (30). Forty-one were classified as good responders, 59 as partial responders, and 27 as non-responders. For the binary assessment, 41 lesions were classified as responders and 86 as non-responders. We found statistical differences (p=0.02) between the mean SUV max and TRG with greater SUV values for G5 compared to the other TRG. Good responders showed greater mean SUV max ± SD compared to partial responders and non-responders (10.51 ± 6.64 for good responders, 6.94 ± 5.81 for partial responders, and 5.23 ± 2.76 for non-responders; p=0.001). Baseline tumor metabolism assessing by FDG PET/CT was associated with the final histopathologic status after neoadjuvant chemotherapy, with greater SUV max values for good responders compared to the less responder cancers.

18F-FDG retention index and biologic prognostic parameters in breast cancer.

AIM: To analyze the correlation between [(18)F]-fluoro-2-deoxy-D-glucose (F-FDG) uptake assessed by positron emission tomography/computed tomography (PET/CT) in breast tumors and histopathologic and immunohistochemical prognostic factors. MATERIAL AND METHODS: Sixty-eight women with breast cancer were prospectively evaluated. PET/CT was requested in the initial staging previous to neoadjuvant chemotherapy (multicentric study).All the patients underwent a standard (18)F-FDG PET/CT followed by a delayed acquisition, 1 hour (PET-1) and 3 hours (PET-2) after FDG administration. Both examinations were evaluated qualitatively and semiquantitatively (SUV(max) values) in PET-1 (SUV-1) and in PET-2 (SUV-2). The percentage variation of the standard uptake values (retention index) between PET-1 and PET-2 was calculated.Clinical and metabolic stages were assessed according to TNM classification. All biologic prognostic parameters, such as the receptor status, p53 and c-erbB-2 expression, proliferation rate (Ki-67), and grading were determined from tissue of the primary tumor. Metabolic, clinical, and biologic parameters were correlated. RESULTS: A positive relationship was found between the SUV(max), tumor size, clinical, and metabolic stages. SUV-1 and SUV-2 values showed significant statistical correlation (P < 0.05) with PET stage and tumor size assessed by PET. On the contrary, the retention index showed relation with clinical stage (P < 0.05).When related to the biologic parameters, retention index showed the best results, with positive and significant relation (P < 0.05), with histologic grade, and Ki-67 and c-erbB-2 expression. Isolated SUV values only showed significant relation to Ki-67 expression. CONCLUSION: The retention index showed the best relation with biologic and clinical parameters compared with isolated SUVmax values for what could be a predictive marker of tumor biologic behavior.

Value of 4-dimensional 18F-FDG PET/CT in the classification of pulmonary lesions.

UNLABELLED: Our aim was to evaluate the effect of 4-dimensional (4D) (18)F-FDG PET/CT in the detection of pulmonary lesions. METHODS: Fifty-seven pulmonary lesions were prospectively assessed in 37 patients (26 men and 11 women) with a mean age of 66.3 y. Twenty-nine of these patients had a history of neoplasm. All patients underwent 3-dimensional (3D) total-body PET/CT and 4D thoracic PET/CT (synchronized with respiratory movement). Maximum standardized uptake value (SUVmax) was obtained for each lesion in both studies. For the 4D studies, we selected the SUVmax in the respiratory period with the highest uptake ("best bin") and the average value over all bins ("average gated"). SUVmax percentage difference between 3D and 4D PET/CT and the relationship of this value to the diameter and location of the lesions were calculated. Statistical parameters were calculated for 3D and 4D PET/CT. RESULTS: Fifty-four of 57 lesions showed an increase of SUVmax in the 4D study with respect to the 3D study. The mean SUVmax was 3.1 in the 3D study. 4D PET/CT studies showed a mean SUVmax of 4.5 for the best-bin study and 3.9 for the average gated study. The percentage difference in mean SUVmax between 3D and 4D studies (best bin and averaged gated) was 72.9% and 48.8%, respectively. The smaller the lesion, the greater was the SUVmax percentage difference (P < 0.05). However, no statistical differences dependent on the location of the lesions were observed. Final diagnosis showed that 37 lesions were malignant. The sensitivity, specificity, positive predictive value, and negative predictive value were 37.8%, 95%, 93%, and 45%, respectively, for 3D studies and 70.3%, 70%, 81.2%, and 56%, respectively, for 4D best-bin studies. CONCLUSION: Characterization of malignant lung lesions was better with 4D PET/CT than with standard PET/CT.

Disfonía y lumbalgia como presentación de sarcoma granulocítico. Primera manifestación de leucemia mieloide aguda / Dysphonia and lumbago as signs of granulocytic sarcoma. Initial manifestation of acute myeloid leukaemia

El sarcoma granulocítico o cloroma es un tumor de células primitivas de la serie granulocítica que se desarrolla en una localización extramedular. Ha sido descrito en pacientes con leucemia aguda y en síndromes mieloproliferativos crónicos en transformación leucémica, en un porcentaje bajo de casos, generalmente como forma de presentación. Su diagnóstico se basa en la sospecha, casi siempre dificultosa si no se considera dentro del diagnóstico diferencial, dado que habitualmente sus manifestaciones clínicas se refieren a la zona afectada enmascarando la etiología de los mismos. Presentamos el caso de un varón de 78 años que es derivado al servicio de urgencias hospitalarias desde su centro de atención primaria para valoración de disfonía, lumbalgia y malestar general de un mes de evolución, sin respuesta a tratamiento convencional (AU)

Granulocytic sarcoma or chloroma is an extramedullar tumor consisting of primitive granulocytic cells. It has been described in patients with acute leukaemia and chronic myeloproliferative syndromes transforming into leukaemia. It is rare and generally an initial manifestation of leukaemia. Diagnosis is based on suspicion and is always difficult if it is not considered in the differential diagnosis procedure because the clinical manifestations in the affected area often mask their aetiology. We contribute the case of a 78 year old man who was referred to the hospital emergency department from his primary care centre for evaluation. He had suffered from dysphonia, lumbago and general malaise for a month and had not responded to conventional treatment (AU)

Eficacia de la terapia de resincronización en sujetos con insuficiencia cardiaca grados III-IV de la NYHA refractarios a tratamiento farmacológico / Effectiveness of resynchronization therapy in pharmacological treatment-resistant patients with NYHA class III-IV heart failure

Objetivos: Determinar, a partir de una revisión sistemática de ámbito internacional basada en ensayos clínicos con asignación aleatoria, si la terapia de resincronización cardiaca, tanto con estimulación aislada como estimulación asociada a desfibrilación, tiene algún efecto sobre la mortalidad en los pacientes en insuficiencia cardiaca grados III-IV refractaria al tratamiento farmacológico pleno, con una fracción de eyección baja(< 35%) y con un QRS ancho (> 120 ms).Método: Revisión sistemática que evalúa terapia de resincronización cardiaca en pacientes descritos anteriormente. Para ello se han evaluado todos los ensayos clínicos controlados con asignación aleatoria que comparaban resincronización cardiaca frente a terapia convencional. Resultados: Se identificaron 2.417 referencias. Se seleccionaron 2.139 resúmenes de los que 896 eran potencialmente relevantes. Cumplieron criterios generales de inclusión62 estudios. Finalmente 10 cumplían estrictamente los criterios de selección. Conclusiones: En nuestro estudio, cuando comparamos resincronización frente a tratamiento farmacológico aislado, constatamos que la mortalidad total presenta una reducción relativa de riesgo del 29% (RR 0,71 con IC al 95% 0,59 a 0,85). Cuando analizamos la mortalidad por insuficiencia cardiaca en el subanálisis de resincronización frente a tratamiento farmacológico aislado como grupo control, encontramos una reducción significativa (37 eventos en el grupo de resincronización frente a los 66 del grupo de tratamiento farmacológico). Destacamos que esta diferencia para la mortalidad específica debe interpretare como clínicamente relevante (RR 0,55 con IC al 95% 0,38 a 0,81).Conclusión: En pacientes con insuficiencia cardiaca avanzada, la resincronización cardiaca, respecto al tratamiento farmacológico convencional, mejora significativamente la mortalidad total y específica (AU)

Objectives: To assess whether cardiac resynchronization therapy with single stimulation or associated with defibrillation has any effect on pharmacological treatment-resistant subjects with class III-IV heart failure, low ejection fraction(< 35%) and wide QRS (> 120 msec), using an systematic international review based on randomised clinical trials. Method: Systematic search and review of relevant literature on cardiac resynchronization in subjects with the abovementioned characteristics. Randomized controlled clinical trials assessing the effectiveness of cardiac resynchronization therapy versus conventional therapy were reviewed. Results: Among 2417 references identified 2139 abstracts were selected; 896 being considered potentially relevant; 62studies fulfilled our inclusion criteria; and 10 of them were included in the study. Conclusions: Global mortality showed a relative reduction of risk of 29% (RR 0.71; 95% CI 0.59 to 0.85) when comparing resynchronization with only pharmacological treatment. On analysing mortality due to heart failure within the subanalysis of resynchronization versus only pharmacological treatment as control group, a significant reduction was found (37 mortality events in resynchronization group versus 66 in control group). This difference in specific mortality should be interpreted as clinically relevant (RR 0.55; 95% CI 0.38 to 0.81). In patients with advanced heart failure a significant improvement is observed in total, and specific mortality on comparing cardiac resynchronization with conventional pharmacological treatment (AU)

Estudio epidemiológico de la Obesidad y el Sobrepeso en una poblacion pediatrica de medio rural de Castilla-La Mancha / Epidemiological study of obesity and excess weight in a pediatric population in a rural setting in Castilla-La Mancha

Objetivos. Conocer la prevalencia y la evolución de la obesidad y el sobrepeso en la población pediátricade nuestro medio de trabajo y si factores como la edad, sexo o hipertensión arterial están asociados a la obesidad/sobrepeso.Diseño y participantes. Se realizó un estudio retrospectivo de seguimiento de una cohorte de todoslos niños nacidos en 1992 en la Zona Básica de Salud de Calzada de Calatrava (n = 92). Las fuentesutilizadas fueron las historias clínicas, recogiéndose las siguientes mediciones: peso, talla e IMC decada paciente en la revisiones correspondientes a recién nacido, 2 años, 6-7 años, 10-11 años y 14-15 años, más tensión arterial de las dos últimas revisiones.Resultados. La prevalencia de Obesidad en nuestra población a los 14 años fue de 9,8% según criteriosde Cole1 et al y de 18,3 % según criterio de Hernández2 et al. Respecto a la alteración en 1ª toma detensión arterial durante la revisión de los 11 y 14 años, encontramos una relación estadísticamentesignifi cativa entre padecer hipertensión arterial y obesidad a los 14 años.Conclusiones. Con nuestro estudio hemos comprobado que en nuestra población se está produciendoun aumento alarmante de obesidad y sobrepeso, al igual que se refl eja en las publicaciones consultadas. La condición de obesidad infantil puede favorecer la presencia de otros factores de riesgo cardiovascular como la hipertensión. Creemos que la obesidad y el sobrepeso son un problema real e instaurado en la población española

Objectives. To determine the prevalence and trends in obesity and excess weight in the pediatricpopulation in our work setting and whether factors such as age, sex or blood pressure are associatedwith obesity/excess weight.Design and participants. A retrospective follow up study was carried out on a cohort of all the childrenborn in 1992 in the Basic Health Area of Calzada de Calatrava (n = 92). The sources used were clinicalrecords, and the following measurements were recorded: weight, height and BMI for each patient inthe check ups carried out at birth, 2 years, 6-7 years, 10-11 years and 14-15 years, and blood pressurein the last two check ups.Results. The prevalence of obesity at 14 years old in our population was around 9.8% according tocriteria of Cole1 et al and 18.3 % according to the criteria of Hernandez2 et al. With regards the alterationin blood pressure at the fi rst measurements, during the 11-year and 14-year check ups, we founda statistically signifi cant association between high blood pressure and obesity at 14 years old.Conclusions. With our study we have shown there to be an alarming increase in obesity and excessweight in our population, in accordance with the literature consulted. Childhood obesity can also favourother cardiovascular risk factors such as high blood pressure. We consider that obesity and excessweight are a real and established problem in the Spanish population