[Tecuide. Telemonitoring of patients with dementia and their caregivers]. / Tecuide. Telemonitorización de pacientes con deterioro cognitivo y sus cuidadores.

INTRODUCTION: Given the growing increase in dementia, the need to control these patients, together with the rise of new technologies, makes a change in the current control system imperative. MATERIAL AND METHOD: We have carried out a single-center, clinical study with two groups, a control group of 72 patients/caregivers, who followed the usual controls in consultations, and another telematic group of 76 patients/caregivers, who followed the controls through of the Tecuide platform. The platform had a survey part to detect problems in patients and caregiver claudication, another training part and another chat for direct communication when the caregiver needed it and also served to respond when a problem was detected. RESULTS: After a year of monitoring with the platform we have obtained: a)in patients, reduce behavioral disorders and use of drugs, increase physical exercise and delay institutionalization (DS not found); b)in caregivers there is an improvement in satisfaction with respect to the control of patients with cognitive impairment, and c)in terms of resources, visits to emergency services and dementia consultations have decreased, although admissions to the psychogeriatric unit have increased. CONCLUSIONS: The use of Tecuide as a telematic tool in the control of patients with cognitive impairment does not seem to be inferior to the usual controls in consultations and improves caregiver satisfaction.

Relationship of arterial stiffness and baseline vascular burden with new lacunes and microbleeds: A longitudinal cohort study.

INTRODUCTION: Arterial stiffness may have a significant impact on the development of cerebral small vessel disease (cSVD). PATIENTS AND METHODS: We obtained pulse wave velocity (24-h PWV) by means of ambulatory blood pressure monitoring (ABPM) in patients with a recent small subcortical infarct (RSSI). Patients with known cardiac or arterial embolic sources were excluded. Lacunes, microbleeds, white matter hyperintensities and enlarged perivascular spaces at baseline were assessed in a brain MRI and included in a cSVD score. A follow-up MRI was obtained 2 years later and assessed for the appearance of new lacunes or microbleeds. We constructed both unadjusted and adjusted models, and subsequently selected the optimal models based on the area under the curve (AUC) of the predicted probabilities. RESULTS: Ninety-two patients (mean age 67.04 years, 69.6% men) were evaluated and 25 had new lacunes or microbleeds during follow-up. There was a strong correlation between 24-h PWV and age (r = 0.942, p < 0.001). cSVD was associated with new lacunes or microbleeds when adjusted by age, 24-h PWV, NT-proBNP and hypercholesterolemia (OR 2.453, CI95% 1.381-4.358). The models exhibiting the highest discrimination, as indicated by their area under the curve (AUC) values, were as follows: 1 (AUC 0.854) - Age, cSVD score, 24-h PWV, Hypercholesterolemia; 2 (AUC 0.852) - cSVD score, 24-h PWV, Hypercholesterolemia; and 3 (AUC 0.843) - Age, cSVD score, Hypercholesterolemia. CONCLUSIONS: cSVD score is a stronger predictor for cSVD progression than age or hemodynamic parameters in patients with a RSSI.

Morbimortality after 1321 consecutive CRS+HIPEC procedures: seeking excellence in surgery for peritoneal surface malignancy

Purpose Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) treatment has classically presented a percentage of associated complications that have limited its expansion. The aim of this study is to describe the morbimortality results obtained from a referral center implemented with the support of a governmental health agency and directed by a surgical team experienced in CRS for Peritoneal Surface Malignancies (PSM). Methods Data from the Peritoneal Carcinomatosis Program of Catalonia (PCPC) prospective database, including patients who underwent CRS + HIPEC between September 2006 and January 2021, were analyzed. Results A total of 1151 consecutive patients underwent 1321 CRS + HIPEC procedures. Colonic origin of peritoneal metastasis was the most frequent (47.3%). Median PCI was 7 and most patients had CC0-1 (96.1%). Multivisceral resection was performed in 44% of all patients, 57% required digestive anastomosis. Median hospital stay was 11 days (range 6–144 days). High-grade complications occurred in 20% of all patient, most of them surgical complications. Anastomotic leak occurred in 0.6% of all cases. The overall in-stay and 30-day mortality rate was 0.4%. The low-rate of complications and the high rate of complete CRS were achieved from the beginning of the PCPC. Median overall survival was 54.7 months, with a 5-year survival rate of 47.5%. Conclusions Implementation of a CRS + HIPEC referral program for the treatment of PSM with preferably an experienced surgical team enables acceptable rates of severe morbidity (20%) and mortality (< 1%) (AU)

Morbimortality after 1321 consecutive CRS + HIPEC procedures: seeking excellence in surgery for peritoneal surface malignancy.

PURPOSE: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) treatment has classically presented a percentage of associated complications that have limited its expansion. The aim of this study is to describe the morbimortality results obtained from a referral center implemented with the support of a governmental health agency and directed by a surgical team experienced in CRS for Peritoneal Surface Malignancies (PSM). METHODS: Data from the Peritoneal Carcinomatosis Program of Catalonia (PCPC) prospective database, including patients who underwent CRS + HIPEC between September 2006 and January 2021, were analyzed. RESULTS: A total of 1151 consecutive patients underwent 1321 CRS + HIPEC procedures. Colonic origin of peritoneal metastasis was the most frequent (47.3%). Median PCI was 7 and most patients had CC0-1 (96.1%). Multivisceral resection was performed in 44% of all patients, 57% required digestive anastomosis. Median hospital stay was 11 days (range 6-144 days). High-grade complications occurred in 20% of all patient, most of them surgical complications. Anastomotic leak occurred in 0.6% of all cases. The overall in-stay and 30-day mortality rate was 0.4%. The low-rate of complications and the high rate of complete CRS were achieved from the beginning of the PCPC. Median overall survival was 54.7 months, with a 5-year survival rate of 47.5%. CONCLUSIONS: Implementation of a CRS + HIPEC referral program for the treatment of PSM with preferably an experienced surgical team enables acceptable rates of severe morbidity (20%) and mortality (< 1%).

Feasibility of a wearable inertial sensor to assess motor complications and treatment in Parkinson's disease.

BACKGROUND: Wearable sensors-based systems have emerged as a potential tool to continuously monitor Parkinson's Disease (PD) motor features in free-living environments. OBJECTIVES: To analyse the responsivity of wearable inertial sensor (WIS) measures (On/Off-Time, dyskinesia, freezing of gait (FoG) and gait parameters) after treatment adjustments. We also aim to study the ability of the sensor in the detection of MF, dyskinesia, FoG and the percentage of Off-Time, under ambulatory conditions of use. METHODS: We conducted an observational, open-label study. PD patients wore a validated WIS (STAT-ONTM) for one week (before treatment), and one week, three months after therapeutic changes. The patients were analyzed into two groups according to whether treatment changes had been indicated or not. RESULTS: Thirty-nine PD patients were included in the study (PD duration 8 ± 3.5 years). Treatment changes were made in 29 patients (85%). When comparing the two groups (treatment intervention vs no intervention), the WIS detected significant changes in the mean percentage of Off-Time (p = 0.007), the mean percentage of On-Time (p = 0.002), the number of steps (p = 0.008) and the gait fluidity (p = 0.004). The mean percentage of Off-Time among the patients who decreased their Off-Time (79% of patients) was -7.54 ± 5.26. The mean percentage of On-Time among the patients that increased their On-Time (59% of patients) was 8.9 ± 6.46. The Spearman correlation between the mean fluidity of the stride and the UPDRS-III- Factor I was 0.6 (p = <0.001). The system detected motor fluctuations (MF) in thirty-seven patients (95%), whilst dyskinesia and FoG were detected in fifteen (41%), and nine PD patients (23%), respectively. However, the kappa agreement analysis between the UPDRS-IV/clinical interview and the sensor was 0.089 for MF, 0.318 for dyskinesia and 0.481 for FoG. CONCLUSIONS: It's feasible to use this sensor for monitoring PD treatment under ambulatory conditions. This system could serve as a complementary tool to assess PD motor complications and treatment adjustments, although more studies are required.

Risk Factors Involved in the High Incidence of Bladder Cancer in an Industrialized Area in North-Eastern Spain: A Case-Control Study.

Bladder cancer (BC) is the most common of the malignancies affecting the urinary tract. Smoking and exposure to occupational and environmental carcinogens are responsible for most cases. Vallès Occidental is a highly industrialized area in north-eastern Spain with one of the highest incidences of BC in men. We carried out a case-control study in order to identify the specific risk factors involved in this area. Three hundred and six participants were included (153 cases BC and 153 controls matched for age and sex): in each group, 89.5% (n = 137) were male and the mean age was 71 years (range 30-91; SD = 10.6). There were no differences between groups in family history, body mass index, or dietary habits. Independent risk factors for CV were smoking (OR 2.08; 95% CI 1.30-3.32; p = 0.002), the use of analgesics in nonsmokers (OR 10.00; 95% CI 1.28-78.12; p = 0.028), and profession (OR: 8.63; 95% CI 1.04-71.94; p = 0.046). The consumption of black and blond tobacco, the use of analgesics in nonsmokers, and occupational exposures are risk factors for the development of BC in this area, despite the reduction in smoking in the population and the extensive measures taken in the last few decades in major industries to prevent exposure to occupational carcinogens.

NT-proBNP, cerebral small vessel disease and cardiac function in patients with a recent lacunar infarct.

NT-proBNP is produced from both atria and ventricles and it is increased in patients with cardiac disease. NT-proBNP is also associated with cerebral small vessel disease(cSVD) but there are no studies that had carried out a systematic evaluation of cardiac function in this specific setting. We conducted a prospective observational study in 100 patients within 30 days after a recent lacunar infarct by means of brain MRI, 24 h ambulatory blood pressure monitoring, transthoracic echocardiography, and plasmatic NT-proBNP. Global cSVD burden was quantified using a validated visual score (0 to 4) and dichotomized into 2 groups (0-2 or 3-4). Age (73.8 vs 63.5 years) and NT-proBNP (156 vs 76 pg/ml) were increased in patients with SVD 3-4, while daytime augmentation index normalized for the heart rate of 75 bpm (AIx75) (22.5 vs 25.6%) was decreased. The proportion of patients with left atrial enlargement, left ventricular hypertrophy, or septal e' velocity <7 cm/s was not different between both groups. NT-proBNP was increased in patients with left atrial enlargement (126 vs 88 pg/ml). In multivariate analysis, age (OR 1.129 CI 95% 1.054-1.209), daytime AIx75 (OR 0.91 CI 95% 0.84-0.987,) and NT-proBNP (OR 1.007 CI 95% 1.001-1.012,) were independently associated with cSVD score 3-4. In conclusion, as well as in other patients with cSVD we found an association between NT-proBNP and cSVD. This association was independent of cardiac function.

Systematic review of population-based bladder cancer registries: How criteria heterogeneity affects the comparison of incidences.

BACKGROUND: The population-based registry of bladder cancer (BC) raises specific problems intrinsic to the tumor, as the inclusion of noninfiltrating, potentially malignant and multiple tumors. We performed a systematic review (PRISMA guidelines) of population-based BC registries to obtain information on their geographic areas involved, last dates of real incidence of BC, and rules coding used in BC for uncertain behavior, in situ and multiple tumors. METHODS: Using MEDLINE and Google Scholar, we identified scientific publications of in the last 10 years in English or Spanish, whether they were related to a national or international cancer registry, provided information on registry rules, and provided data on the incidence of BC. RESULTS: After the first screening, a total of 194 references were obtained. After a second analysis, three registries were selected: International Agency for Research on Cancer (IARC) is a world registry providing real incidence of BC in the period 2008-2012. Surveillance, Epidemiology, and End Results (SEER) Program registered incidence until 2017 in more than 90% of the US population. Spanish Network of Cancer Registries (REDECAN) unifies 14 Spanish registries (27.4% of the population) with real incidence data from 2010 to 2015. The coding and inclusion rules have been modified, but currently, most registries include BC in situ and uncertain behavior tumors. Whenever a new case occurs 36 months after a previous diagnosis, SEER registers those as multiple incident cancers in the same location, while IARC and REDECAN only allow one cancer per location during the lifespan of the patient. CONCLUSIONS: Comparison of the incidence of BC among different population-based cancer registries is prone to bias due to the methodological differences regarding the inclusion of carcinomas in situ, indeterminate, and multiple tumors. A good cancer registry could provide better surveillance strategies for BC patients.

Environmental Factors Involved in the High Incidence of Bladder Cancer in an Industrialized Area in North-Eastern Spain.

Background: Bladder cancer (BC) is the most common of those affecting the urinary tract, and a significant proportion of the cases are attributable to tobacco use as well as occupational and environmental factors. Objective: The aim of this study is to estimate the current incidence of BC in an industrialized area in northeastern Spain and to analyze its time trends over three decades from an ecological perspective. Methods: Patients diagnosed with histologically confirmed primary BC, during 2018-2019, in an area in northeastern Spain (430,883 inhabitants) were included. Crude and age-standardized incidence rates were estimated per 100,000 person-years based on the number of individuals getting their first diagnosis. An exploratory time trend analysis was carried out to describe the evolution in tobacco use and occupational or environmental risk factors and the incidence of BC in the same area from the 1990s. Results: 295 patients were included (age 72.5 ± 10.3 years; 89.8% men). The crude rate was 62.6 (95% CI: 51.9-73.2) for men and 6.8 (95% CI: 3.4-10.3) for women. The annual rate adjusted to the European Standard Population was 85.3 (95% CI:75.0-95.5) for men and 7.0 (95% CI:4.5-9.5) for women. From 1994 to 2018, the prevalence of smokers decreased in men (42.3% to 30.9%) as well as in the active population working in the industry (44.36% to 22.59%). Nevertheless, the car fleet, especially diesel, has increased considerably. The annual mean concentrations of air (PM10, PM2.5, O3, and NO2) and water (nitrates, arsenic, trihalomethanes) pollutants were within the regulatory limit values, but not the maximum levels. Conclusions: The incidence of BC is one of the highest in men but not in women, despite the decrease in tobacco use and industrial activity (perhaps related to high latency after carcinogen exposure cessation) and despite the control of environmental pollution (the maximum regulatory limit probably needs to be lowered). Finally, a similar exposure to the carcinogen would result in a gender-specific differential incidence.

Prophylactic intracameral cefazolin and postoperative topical moxifloxacin after cataract surgery: endophthalmitis risk reduction and safety results in a 16-year study.

PURPOSE: This large retrospective observational study describes the evolution of the rates of postoperative endophthalmitis in cataract surgery in a 16-year period, and compares them before and after two different changes in the prophylaxis protocol of a general hospital in Barcelona, Spain. METHODS: This study included all the phacoemulsification procedures performed from January 2002 to December 2017. In January 2004, intracameral cefazolin at the end of the surgery was added to the prophylaxis protocol of cataract surgery. In January 2011, topical postoperative ofloxacin was replaced by topical moxifloxacin. Cumulative incidences of postoperative endophthalmitis before and after the addition of intracameral cefazolin and the change of ofloxacin by moxifloxacin as postoperative topical treatment were compared. RESULTS: The study included 55,984 surgeries. In the period after the introduction of intracameral cefazolin (2004-2010), the cumulative incidence of endophthalmitis was 0.047% (95% CI 0.019-0.099%), significantly lower than in the previous period. From January 2011 to December 2017, after the postoperative change of topical ofloxacin by moxifloxacin, the cumulative incidence dropped to 0.0037% (95% CI 0.000468-0.01862%), with a relative risk reduction between both periods of 91.3%. CONCLUSION: An intracameral bolus of cefazolin was a very effective prophylaxis of endophthalmitis in cataract surgery. The continuous surveillance and prophylaxis protocol revision over time further reduced the incidence of this complication to extremely low levels.

Rasagiline and safinamide as a dopamine-sparing therapy for Parkinson's disease.

OBJECTIVES: To evaluate whether the prescription of monoamine oxidase B inhibitors (MAOB-I), rasagiline and safinamide, contributes to the reduction of levodopa and/or dopamine agonists (DA) dose in order to minimize adverse effects. MATERIALS AND METHODS: A total of 724 patients with Parkinson's disease (PD) have been prospectively included in our database since the year 2000, representing a total of 5124 visits. For each patient and visit, antiparkinsonian treatment was recorded. In the presence of rasagiline and safinamide, we analysed the evolution of levodopa equivalent dose (LED) and LED for DA (LED-DA). RESULTS: The data obtained from the 1664 visits between 2006 and 2010 (321 patients) and the 1709 visits between 2014 and 2018 (403 patients) were analysed in order to assess the impact of the introduction of rasagiline and safinamide, respectively. The annual mean LED remained stable without statistically significant differences. In the first period (impact of rasagiline), the annual mean LED-DA in 2010 was significantly higher than in 2006 (P = 0.001). In the second period (impact of safinamide), the annual mean LED-DA in 2018 was significantly lower than in 2014 (P = 0.002). A repeated-measure analyses of LED-DA including only patients who had taken safinamide showed a statistically significant decrease in LED-DA (P = 0.027). CONCLUSIONS: The introduction of MAOB-I in the overall treatment of PD as part of routine clinical practice has not helped to reduce annual mean LED. However, safinamide reduces annual mean LED-DA and may be linked to a reduction in dose-dependent adverse effects in the long term.

[A new artificial intelligence tool for assessing symptoms in patients seeking emergency department care: the Mediktor application]. / Experiencia de Mediktor®: un nuevo evaluador de síntomas basado en inteligencia artificial para pacientes atendidos en el servicio de urgencias.

OBJECTIVES: To analyze agreement between diagnoses issued by the Mediktor application and those of an attending physician, and to evaluate the usefulness of this application in patients who seek emergency care. MATERIAL AND METHODS: Prospective observational study in a tertiary care university hospital emergency department. Patients with medical problems and surgical conditions (surgery and injuries) who did not require immediate emergency care responded to the Mediktor questions on a portable computer tablet. The software analyzed the answers and provided a list of 10 possible preliminary diagnoses in order of likelihood. The patient and the attending physician were blinded to the list to so that the usual care process would not be altered. The level of agreement between the physician's diagnosis and the Mediktor diagnosis was analyzed. RESULTS: A total of 1015 patients were included; 622 cases were considered valid for study. Cases were excluded if the patients did not meet the inclusion criteria, they did not have a discharge diagnosis, they had a final diagnosis expressed as a symptom or their final diagnosis was not included in the Mediktor database. The physician's diagnosis (the gold standard) coincided with one of the 10 MEDIKTOR diagnoses in 91.3% of the cases, with one of the first 3 diagnoses in 75.4%, and with the first diagnosis in 42.9%. Sensitivity was over 92% and specificity over 91% in the majority of common diagnostic groups; the κ statistic ranged from 0.24 to 0.98. CONCLUSION: The Mediktor application is a reliable diagnostic aid for the most prevalent problems treated in a hospital emergency department. The general public finds it easy to use.

OBJETIVO: Analizar la concordancia entre los diagnósticos emitidos por Mediktor® con el realizado por el médico responsable, así como valorar la utilidad de este dispositivo en pacientes que acuden a un servicio de urgencias (SU). METODO: Estudio observacional prospectivo realizado en el SU de un hospital terciario universitario. A los pacientes con patologías médicas y quirúrgicas (cirugía y traumatología) que no precisaban asistencia médica inmediata se les entregó una tableta digital para responder al interrogatorio de Mediktor®. Según las respuestas, el software adjudicaba un listado de 10 prediagnósticos ordenados por probabilidad, que se ocultaban al paciente y al médico responsable, para no modificar el proceso habitual. Posteriormente se analizó el grado de coincidencia entre el diagnóstico médico y los diagnósticos ofrecidos por Mediktor®. RESULTADOS: 1.015 pacientes fueron incluidos, de los que 622 se consideraron casos válidos para el estudio. Se excluyeron los pacientes que no cumplían los criterios de inclusión, sin diagnóstico al alta, con diagnóstico final expresado como síntoma y aquellos con diagnósticos no incluidos en Mediktor®. Las coincidencias entre el diagnóstico médico (patrón oro) y los diez diagnósticos de Mediktor® fueron de un 91,3%, en los tres primeros diagnósticos de un 75,4% y en el primer diagnóstico de un 42,9%. Según los grupos de diagnósticos más frecuentes, se objetivó una sensibilidad > 92% y una especificidad > 91% en la mayoría de ellos, con un índice kappa que osciló entre el 0,24 y el 0,98. CONCLUSIONES: Mediktor® es una herramienta fiable para ayudar al diagnóstico de las enfermedades más prevalentes de un SU y fácil de utilizar por el público en general.

Experiencia de Mediktor(R): un nuevo evaluador de síntomas basado en inteligencia artificial para pacientes atendidos en el servicio de urgencias / A new artificial intelligence tool for assessing symptoms in patients seeking emergency department care: the Mediktor application

Objetivo. Analizar la concordancia entre los diagnósticos emitidos por MediktorR con el realizado por el médico responsable, así como valorar la utilidad de este dispositivo en pacientes que acuden a un servicio de urgencias (SU). Método. Estudio observacional prospectivo realizado en el SU de un hospital terciario universitario. A los pacientes con patologías médicas y quirúrgicas (cirugia y traumatologia) que no precisaban asistencia médica inmediata se les entrego una tableta digital para responder al interrogatorio de MediktorR. Según las respuestas, el software adjudicaba un listado de 10 prediagnosticos ordenados por probabilidad, que se ocultaban al paciente y al médico responsable, para no modificar el proceso habitual. Posteriormente se analizó el grado de coincidencia entre el diagnóstico médico y los diagnósticos ofrecidos por MediktorR. Resultados. 1.015 pacientes fueron incluidos, de los que 622 se consideraron casos válidos para el estudio. Se excluyeron los pacientes que no cumplían los criterios de inclusión, sin diagnostico al alta, con diagnostico final expresado como síntoma y aquellos con diagnósticos no incluidos en MediktorR. Las coincidencias entre el diagnostico medico (patrón oro) y los diez diagnósticos de MediktorR fueron de un 91,3%, en los tres primeros diagnósticos de un 75,4% y en el primer diagnóstico de un 42,9%. Según los grupos de diagnósticos más frecuentes, se objetivo una sensibilidad > 92% y una especificidad > 91% en la mayoría de ellos, con un índice kappa que oscilo entre el 0,24 y el 0,98. Conclusiones. MediktorR es una herramienta fiable para ayudar al diagnóstico de las enfermedades más prevalentes de un SU y fácil de utilizar por el público en general (AU)

Objectives. To analyze agreement between diagnoses issued by the Mediktor application and those of an attending physician, and to evaluate the usefulness of this application in patients who seek emergency care. Methods. Prospective observational study in a tertiary care university hospital emergency department. Patients with medical problems and surgical conditions (surgery and injuries) who did not require immediate emergency care responded to the Mediktor questions on a portable computer tablet. The software analyzed the answers and provided a list of 10 possible preliminary diagnoses in order of likelihood. The patient and the attending physician were blinded to the list to so that the usual care process would not be altered. The level of agreement between the physician's diagnosis and the Mediktor diagnosis was analyzed. Results. A total of 1015 patients were included; 622 cases were considered valid for study. Cases were excluded if the patients did not meet the inclusion criteria, they did not have a discharge diagnosis, they had a final diagnosis expressed as a symptom or their final diagnosis was not included in the Mediktor database. The physician's diagnosis (the gold standard) coincided with one of the 10 MEDIKTOR diagnoses in 91.3% of the cases, with one of the first 3 diagnoses in 75.4%, and with the first diagnosis in 42.9%. Sensitivity was over 92% and specificity over 91% in the majority of common diagnostic groups; the κ statistic ranged from 0.24 to 0.98. Conclusions. The Mediktor application is a reliable diagnostic aid for the most prevalent problems treated in a hospital emergency department. The general public finds it easy to use (AU)

Sjögren's syndrome-associated interstitial lung disease: a multicenter study / Enfermedad pulmonar instersticial asociada a síndrome de Sjögren: estudio multicéntrico

Primary Sjögren syndrome (PSS) is a chronic inflammatory autoimmune disease. Interstitial lung disease (ILD) can be an extraglandular complication. Objective. To evaluate the clinical characteristics of patients diagnosed with PSS with ILD. Methods. Multicentre cohort study with 25 patients diagnosed with PSS and ILD. Data of PSS, prognostic factors, pulmonary involvement variables, complementary tests that suggest a worse diagnosis and treatment given were collected. EULAR index was measured for Sjögren's syndrome. Results. We identified 25 patients. In 15/25 the diagnosis of ILD was done before the diagnosis of PSS. The histopathological patterns found were: 12 NSIP, 5 UIP, 4 OP, 2 LIP. PFRs showed restrictive pattern. The majority of the patients received glucocorticoid therapy, antimalarial or immunosuppressive treatment. Conclusions. Patients affected with PSS must be screened to catch a precocious diagnosis of ILD. The majority of the patients were diagnosed of ILD before being diagnosed of PSS. Multicenter cohorts are increasingly demanded and a multidisciplinary management is needed (AU)

El síndrome de Sjögren primario (SSP) es una enfermedad inflamatoria autoinmune. La enfermedad pulmonar intersticial (EPI) puede ser una complicación extraglandular. Objetivo. Evaluar las características clínicas de los pacientes diagnosticados de SSP con EPI. Métodos. Estudio de cohortes multicéntrico con 25 pacientes diagnosticados de SSP y EPI. Se recopilaron datos propios del SSP, factores pronóstico, variables de medida de la afectación pulmonar, pruebas complementarias que sugieren un peor pronóstico, así como el tratamiento recibido. Se calculó el índice EULAR para el síndrome de Sjögren. Resultados. Se identificaron 25 pacientes. Quince de ellos fueron diagnosticados de EPI antes que de SSP. Los patrones histopatológicos encontrados fueron 12 con neumonía intersticial inespecífica, 5 con neumonía intersticial común, 4 con neumonía organizada, 2 con neumonía intersticial linfocítica. Las pruebas de función respiratoria mostraron un patrón restrictivo. La mayoría de los pacientes recibió un tratamiento con glucocorticoides, antipalúdicos o inmunodepresores. Conclusiones. Los pacientes afectados por SSP deben ser sometidos a pruebas para detectar un diagnóstico precoz de EPI. La mayoría de los pacientes fueron diagnosticados de EPI antes que de SSP. Los estudios de cohortes multicéntricos son cada vez más demandados y se precisa una gestión multidisciplinar (AU)

Comparison of the risk prediction systems POSSUM and P-POSSUM with the Surgical Risk Scale: A prospective cohort study of 721 patients.

INTRODUCTION: The outcomes of surgery are subject to variability and difficult to be accurately predicted. Different score systems have been developed to estimating the risk of undergoing a surgical procedure. The aim of this study was to assess the predictive ability of POSSUM and P-POSSUM scoring systems, compared to the Surgical Risk Scale (SRS), in Spanish patients undergoing general surgery. PATIENTS AND METHODS: In this prospective observational study, 721 consecutive patients needing a surgical procedure were included. Observed morbidity and mortality after surgery were compared to the expected ones obtained by applying POSSUM, P-POSSUM and SRS. RESULTS: Mean age was 59.2 years (standard deviation (SD): 17.4 years), 43.5% were women. 616 (85.5%) patients underwent elective general surgery and 105 (14.5%) emergency surgery. The 30-day morbidity was 15.4%. The reintervention rate was 2.1% and mortality was 2.1%. The discrimination ability was excellent in predicting mortality. The Area Under the Curve (AUC) values were: POSSUM: AUC = 0.97, C.I.95%: 0.948-0.992, p < 0.0001; P-POSSUM: AUC = 0.966, C.I.95%: 0.941-0.991, p < 0.0001; SRS: AUC = 0.91, C.I.95%:0.853-0.967, p < 0.0001. POSSUM was also discriminative in the prediction of morbidity (AUC = 0.772, C.I.95%: 0.719-0.826, p < 0.0001). POSSUM predicted morbidity and mortality were higher than the observed ones (p = 0.01 and p = 0.04). Predicted and observed mortality were very similar for P-POSSUM (p = 0.93) and SRS (p = 0.37). CONCLUSIONS: Expected morbidity and mortality determined by POSSUM score showed values significantly above the observed ones. P-POSSUM and SRS systems were effective in predicting mortality. The SRS application is simple and may contribute to appropriate medical decision making.

Sjögren's syndrome-associated interstitial lung disease: A multicenter study.

UNLABELLED: Primary Sjögren syndrome (PSS) is a chronic inflammatory autoimmune disease. Interstitial lung disease (ILD) can be an extraglandular complication. OBJECTIVE: To evaluate the clinical characteristics of patients diagnosed with PSS with ILD. METHODS: Multicentre cohort study with 25 patients diagnosed with PSS and ILD. Data of PSS, prognostic factors, pulmonary involvement variables, complementary tests that suggest a worse diagnosis and treatment given were collected. EULAR index was measured for Sjögren's syndrome. RESULTS: We identified 25 patients. In 15/25 the diagnosis of ILD was done before the diagnosis of PSS. The histopathological patterns found were: 12 NSIP, 5 UIP, 4 OP, 2 LIP. PFRs showed restrictive pattern. The majority of the patients received glucocorticoid therapy, antimalarial or immunosuppressive treatment. CONCLUSIONS: Patients affected with PSS must be screened to catch a precocious diagnosis of ILD. The majority of the patients were diagnosed of ILD before being diagnosed of PSS. Multicenter cohorts are increasingly demanded and a multidisciplinary management is needed.

Agomelatine for Depression in Parkinson Disease: Additional Effect on Sleep and Motor Dysfunction.

Depression and sleep disorders are among the most prevalent nonmotor symptoms of Parkinson disease (PD). Because agomelatine acts as a MT1 and MT2 agonist and as a 5HT2c antagonist, this study was designed to assess the efficacy of agomelatine in treating depressive symptoms in PD patients, and the potential changes both in sleep quality and motor symptoms. Depressed patients with PD were treated with agomelatine for 6 months, and they were evaluated with an array of scales. Completed nocturnal video-polysomnography was performed at baseline and week 12. The efficacy analysis population included 24 patients (12 men). The mean (SD) age was 75.2 (8.3) years. The mean (SD) daily dose of agomelatine was 25.00 (10.43) mg at 24 weeks. No changes in dopamine replacement therapy were made. There was a significant decrease in the 17-item Hamilton Depression Scale score over the course of the study (P < 0.0005). The Scales for Outcomes in Parkinson disease Sleep Questionnaire showed a statistically significant improvement over time in each of its subscales: nighttime sleep (P < 0.005), last month nighttime sleep (P < 0.0005), and daytime sleepiness (P < 0.0005). Surprisingly, changes over time in the motor subscale of Unified Parkinson Disease Rating Scale were statistically significant (P < 0.0005). Periodic limb movements and awakenings measured by polysomnography improved significantly (P < 0.005 and P < 0.05, respectively). We concluded that the use of agomelatine in PD depressed patients may have a considerable therapeutic potential because of its dual action for treating both symptoms of depression and disturbed sleep given its secondary beneficial effects regarding the reduction of extrapyramidal symptoms.

Importancia del índice tobillo-brazo en la reclasificación del riesgo cardiovascular de varones hipertensos asintomáticos de mediana edad / The relevance of the ankle-arm index to the reclassification of cardiovascular risk in asymptomatic hypertensive middle-aged males

Fundamento y objetivo: El índice tobillo-brazo permite detectar riesgo y enfermedad cardiovascular subclínica, diagnosticando enfermedad arterial periférica y calcificación arterial. Los varones hipertensos asintomáticos, con edades entre 45-55 años y baja sospecha de riesgo, podrían ser un importante grupo poblacional para beneficiarse de esta técnica. El objetivo del presente estudio ha sido comparar la frecuencia de índice tobillo-brazo patológico (enfermedad arterial periférica subclínica y calcificación arterial) entre varones hipertensos y no hipertensos en esta franja de edad, asintomáticos y con baja sospecha de riesgo. Pacientes y método: Un total de 244 varones asintomáticos (122 hipertensos y 122 o hipertensos) entre 45-55 años de edad y REGICOR < 10 fueron seleccionados voluntariamente mediante muestreo consecutivo. Se practicó anamnesis, exploración física, analítica e índice tobillo-brazo a todos los pacientes. Resultados: Se detectó índice tobillo-brazo patológico en el 9,8% (12 pacientes) de los hipertensos y en el 1,6% (2 pacientes) de los no hipertensos (p = 0,006). En el análisis multivariante la hipertensión arterial se asoció significativamente (p = 0,026) con índice tobillo-brazo patológico (odds ratio [OR] 5,9; intervalo de confianza del 95% [IC 95%] 1,2-28,3), tabaquismo (p = 0,018) (OR 2,7; IC 95% 1,2-6,2) y obesidad abdominal (p = 0,005) (OR 2,8; IC 95% 1,3-5,9). Conclusiones: El grupo poblacional propuesto parece constituir un segmento primordial para detectar riesgo y enfermedad cardiovascular subclínica mediante el índice tobillo-brazo en sujetos con baja sospecha. Será necesario, sin embargo, realizar estudios de prevalencia de índice tobillo-brazo patológico en dicha población para valorar su eficiencia (AU)

Background and objective: The ankle-brachial index allows for the detection of subclinical cardiovascular disease and risk, by diagnosing peripheral arterial disease and arterial calcification. Asymptomatic hypertensive men, between 45-55 years and with the suspicion of low risk, could be an important population group to benefit from this technique. The aim of the study was to compare the frequency of abnormal ankle-brachial index (subclinical peripheral arterial disease and arterial calcification) between asymptomatic hypertensive and non-hypertensive men, of the same age and suspicion of low risk. Patients and methods: Two hundred and forty-four asymptomatic men (122 hypertensive and 122 non-hypertensive), between 45 and 55 years and an REGICOR index < 10, were voluntarily recruited using consecutive sampling. Complete anamnesis, physical examination, laboratory tests and ankle-brachial index determination were carried out on all patients. Results: We detected abnormal ankle-brachial index values in 9.8% (12 cases) of the hypertensive subjects and in 1.6% (2 cases) of non-hypertensive subjects (P = .006). In the multivariate analysis, hypertension was significantly associated with an abnormal ankle-brachial index (P < .026) (odds ratio [OR] 5.9, 95% confidence interval [95% CI] 1.2-28.3), smoking (P = .018) (OR 2.7; 95% CI 1.2-6.2) and abdominal obesity (P = .005) (OR 2.8; 95% CI 1.3-5.9). Conclusions: The population group analyzed in this study might be considered as an overriding segment for detecting subclinical cardiovascular disease and risk with the ankle-brachial index. Further studies are needed to establish the prevalence of abnormal ankle-brachial index in this population in order to assess its efficiency (AU)

Proteínas mediadoras de la respuesta inflamatoria como predictores de resultados adversos postoperatorios en pacientes quirúrgicos octogenarios: estudio prospectivo observacional / Inflammatory markers as predictors of postoperative adverse outcome in octogenarian surgical patients: An observational prospective study

INTRODUCCIÓN: La utilidad de proteínas mediadoras de la inflamación (alfa-1 glucoproteína e interleucina-6) en la predicción de complicaciones en personas mayores intervenidas quirúrgicamente no está suficientemente establecida. OBJETIVO: Determinar si los niveles preoperatorios de estos marcadores de inflamación se correlacionan con complicaciones postoperatorias en pacientes ancianos, obteniendo las bases para la elaboración de un sistema de predicción de riesgo quirúrgico. MÉTODOS: Estudio prospectivo observacional en pacientes mayores de 80 años, intervenidos quirúrgicamente de procedimientos de cirugía general. Se determinaron preoperatoriamente: edad, sexo, tipo de cirugía, existencia de malignidad, comorbilidades asociadas, el estado físico, mental y nutricional de los pacientes. También marcadores de inflamación: proteína C reactiva, interleucina-6, alfa-1-ácido glucoproteína. Se registraron las complicaciones postoperatorias. Se realizó un análisis multivariante para la obtención de un modelo de predicción de riesgo. RESULTADOS: Se incluyó Se incluyó a 225 pacientes. De ellos, 55 pacientes (24,4%) presentaron complicaciones, con una mortalidad del 5,3%. En el análisis multivariante, las variables interleucina-6, alfa-1-ácido glucoproteína y la presencia de malignidad se asociaron de forma independiente con la existencia de morbilidad. Se utilizaron estas variables para el cálculo de riesgo (R) de morbilidad postoperatoria ajustado por edad. El modelo mostró una sensibilidad del 22,2%, con 94,8% de especificidad, y un porcentaje de correctos clasificados del 78,3%. Área bajo la curva ROC: 0,781 (95% CI: 0,703-0,858). CONCLUSIONES: La valoración conjunta preoperatoria de la existencia de malignidad, niveles de alfa-1-ácido glucoproteína e interleucina-6 puede ser de utilidad en el cálculo del riesgo quirúrgico en ancianos

INTRODUCTION: The value of inflammatory proteins, interleukin-6 and alpha-1-acid glycoprotein as prognostic factors in elderly people undergoing surgery has not been determined yet. Objective To know whether preoperatively determined inflammatory markers may predict the postoperative outcome of elderly patients undergoing surgery. A scoring system for predicting postoperative morbidity was assessed. METHODS: Hospital-based observational prospective study, with geriatric surgical patients. Preoperative determination of following data: age, gender, scheduled or urgent operation, comorbid diseases, malignancy, physical, mental and nutritional profile. Biochemical markers of inflammation, C Reactive Protein, interleukin-6, and alpha-1-acid glycoprotein were also studied. Preoperative data and postoperative complications were recorded. Binary logistic regression analysis was used to obtain a morbidity risk prediction model. RESULTS: A total of 225 patients were included. Fifty-five patients (24.4%) had postoperative complications, with a mortality rate of 5.3%. Binary logistic regression analysis showed an independent relation between morbidity and the variables malignancy, alpha-1-acid glycoprotein and interleukin-6. The risk (R) of postoperative morbidity adjusted by age was calculated. The model showed a 22.2% sensitivity, 94.8% specificity, and a percentage of correct classification of 78.3%. The area under the ROC curve was 0.781 (95% CI: 0.703-0.858). CONCLUSIONS: An age-adjusted equation for predicting 30-day morbidity that included malignancy, serum IL-6 and alpha 1-acid glycoprotein levels may be useful for risk assessment in octogenarian surgical patients

[The relevance of the ankle-arm index to the reclassification of cardiovascular risk in asymptomatic hypertensive middle-aged males]. / Importancia del índice tobillo-brazo en la reclasificación del riesgo cardiovascular de varones hipertensos asintomáticos de mediana edad.

BACKGROUND AND OBJECTIVE: The ankle-brachial index allows for the detection of subclinical cardiovascular disease and risk, by diagnosing peripheral arterial disease and arterial calcification. Asymptomatic hypertensive men, between 45-55 years and with the suspicion of low risk, could be an important population group to benefit from this technique. The aim of the study was to compare the frequency of abnormal ankle-brachial index (subclinical peripheral arterial disease and arterial calcification) between asymptomatic hypertensive and non-hypertensive men, of the same age and suspicion of low risk. PATIENTS AND METHODS: Two hundred and forty-four asymptomatic men (122 hypertensive and 122 non-hypertensive), between 45 and 55 years and an REGICOR index<10, were voluntarily recruited using consecutive sampling. Complete anamnesis, physical examination, laboratory tests and ankle-brachial index determination were carried out on all patients. RESULTS: We detected abnormal ankle-brachial index values in 9.8% (12 cases) of the hypertensive subjects and in 1.6% (2 cases) of non-hypertensive subjects (P=.006). In the multivariate analysis, hypertension was significantly associated with an abnormal ankle-brachial index (P<.026) (odds ratio [OR] 5.9, 95% confidence interval [95% CI] 1.2-28.3), smoking (P=.018) (OR 2.7; 95% CI 1.2-6.2) and abdominal obesity (P=.005) (OR 2.8; 95% CI 1.3-5.9). CONCLUSIONS: The population group analyzed in this study might be considered as an overriding segment for detecting subclinical cardiovascular disease and risk with the ankle-brachial index. Further studies are needed to establish the prevalence of abnormal ankle-brachial index in this population in order to assess its efficiency.