Estudio coste-efectividad del diagnóstico de trombosis venosa profunda en el medio hospitalario / Cost-effectiveness study of deep venous thrombosis diagnosis at the hospital setting

Introducción y objetivos: la trombosis venosa profunda (tVP) supone una importante carga económica. nuestro objetivo primario es comparar dos estrategias diagnósticas en cuanto a costes y a efectividad: la prueba del dímero d a todos los pacientes con sospecha con condicionarla a la probabilidad clínica pretest. el secundario, analizar el coste del diagnóstico en nuestro centro y los factores asociados a su presentación. Material y métodos: estudio prospectivo de los pacientes atendidos con sospecha de tVP de extremidad inferior entre mayo y octubre de 2019. Se analizaron las variables de la escala de Wells, el teP asociado, el dímero d, el resultado del eco Doppler y los costes (atención en urgencias, el reactivo del dímero d y la realización de un eco Doppler, obtenidos del Boletín oficial de la comunidad y de la unidad de cobros del hospital). el análisis estadístico se realizó con SPSS, pruebas de χ2 y el test exacto de Fisher. Resultados: se estudiaron 249 pacientes. 116 (46,59 %) presentaron tVP. La edad media fue de 70 años (21-95). aquellos con tVP presentaron con más frecuencia: sexo masculino (52,6 % frente a 39,8 %, p = 0,04), cáncer (29,3 % frente a 16,5 %, p = 0,016), dolor (80,2 % frente a 45,1 %, p < 0,001), edema (93,1 % frente a 57,1 %, p < 0,001), empastamiento (72,4 % frente a 14,3 %, p < 0,001), teP (25,9 % frente a 13,5 %, p = 0,014), menor diagnóstico alternativo (0,9 % frente a 62,4 %, p < 0,001) y menor obesidad (7,8 % frente a 18,8 %, p = 0,011). el gasto generado fue de 192,49 euros por paciente. Para el objetivo primario se analizaron a 144 pacientes (aquellos con dímero d). La estrategia 1 generó un gasto de 190,41 euros por paciente, con una sensibilidad del 100 % y una especificidad del 7,1 %; la estrategia 2, 188,51 euros por paciente, con una sensibilidad del 88,3 % y una especificidad del 78,5 %. ambas estrategias son un 1 % y un 2 % más económicas que el gasto generado, respectivamente...(AU)

Introduction and objective: deep venous thrombosis (dVt) is a significant economic burden. the study primaryendpoint is to compare two diagnostic strategies in terms of cost and effectiveness: d-dimer to all patients withsuspected dVt vs conditioning it to the pre-test clinical probability; the secondary endpoint is to analyze the costof dVt diagnosis in our center and the factors associated with its presentation. Material and methods: this was a prospective study of patients with suspected dVt of lower extremities con-ducted between may and october 2019. the variables of the Wells scale, associated Pte, d-dimer levels, dopplerechocardiography and costs (emergency care, d-dimer and doppler echocardiography obtained from the regionofficial Bulletin and the hospital billing unit) were analyzed. the statistical analysis was performed with SPSS, thechi-square test, and Fisher's exact test. Results: a total of 249 patients were studied, 116 of whom (46.59 %) presented with dVt. the mean age was70 years (21-95). those with dVt were predominantly men (52.6 % vs 39.8 %; p = .04), had cancer (29.3 %vs 16.5 %, p = 0.016), pain (80.2 % vs 45.1 %; p < .001), edema (93.1 % vs 57.1 %, p < .001), slurring (72.4 % vs14.3 %; p < .001), Pte (25.9 % vs 13.5 %, p = .014), less alternative diagnosis (0.9 % vs 62.4 %; p = .001) and lessobesity (7.8 % vs 18.8 %; p = .011). the cost generated was € 192.49 per patient. Regarding the primary endpoint,144 patients (those with d-dimer) were analyzed. Strategy #1 resulted in a cost of €190.41 per patient with100 % sensitivity and 7.1 % specificity; strategy # 2, resulted in a cost of €188.51/patient, with 88.3 % and 78.5 %sensitivity and specificity rates, respectively. Both strategies are 1 % and 2 % cheaper than the cost generated.Conclusion: the application of diagnostic algorithms for suspected dVt is cost-effective, so its use should begeneralized.(AU)

Conventional Hospitalization versus Sequential Outpatient Parenteral Antibiotic Therapy for Staphylococcus aureus Bacteremia: Post-Hoc Analysis of a Multicenter Observational Cohort.

It is not known whether sequential outpatient parenteral antimicrobial (OPAT) is as safe and effective as conventional hospitalization in patients with S. aureus bacteremia (SAB). A post-hoc analysis of the comparative effectiveness of conventional hospitalization versus sequential OPAT was performed in two prospective Spanish cohorts of patients with S. aureus bacteremia. The PROBAC cohort is a national, multicenter, prospective observational cohort of patients diagnosed in 22 Spanish hospitals between October 2016 and March 2017. The DOMUS OPAT cohort is a prospective observational cohort including patients from two university hospitals in Seville, Spain from 2012 to 2021. Multivariate regression was performed, including a propensity score (PS) for receiving OPAT, stratified analysis according to PS quartiles, and matched pair analyses based on PS. Four hundred and thirteen patients were included in the analysis: 150 in sequential OPAT and 263 in the full hospitalization therapy group. In multivariate analysis, including PS and center effect as covariates, 60-day treatment failure was lower in the OPAT group than in the full hospitalization group (p < 0.001; OR 0.275, 95%CI 0.129−0.584). In the PS-based matched analyses, sequential treatment under OPAT was not associated with higher 60-day treatment failure (p = 0.253; adjusted OR 0.660; % CI 0.324−1.345). OPAT is a safe and effective alternative to conventional in-patient therapy for completion of treatment in well-selected patients with SAB, mainly those associated with a low-risk source and without end-stage kidney disease.

Social, environmental, and COVID-19 pandemic-related effects on women's food security and health in Honduras.

The COVID-19 pandemic has disproportionally affected women in Honduras in terms of loss of employment and income opportunities, access to healthcare services, and increased poverty and food insecurity. The pre-pandemic gender inequalities in Honduras have resulted in harsher conditions for women since the onset of the pandemic. Early reports indicate that women have lost employment and incomes and have been burdened by other effects of the pandemic, such as more household work, childcare activities, and home schooling. Marginal groups such as indigenous women face greater challenges because of the structural and systemic inequalities which have existed for a long time. The impact of the COVID-19 pandemic has also differed across geographic areas and between rural and urban settings. In addition to the pandemic, the economic outlook for women in Honduras has worsened since the impact of Hurricanes Eta and Iota in November 2020, which displaced over a million people. The agricultural sector was devastated, and infrastructure was severely damaged. The recovery efforts have been slow because of the COVID-19 pandemic. This paper explores the root causes of gender inequalities and how it affects women's food security and health.

Prevalence, Incidence, and Risk Factors for Intestinal Colonization Due to Fluoroquinolone-Resistant ST131 Escherichia coli: a Longitudinal Study in Highly Dependent, Long-Term Care Facility Residents.

Escherichia coli ST131 clade C is an important driver for fluoroquinolone resistance (FQ-R). We conducted a prospective observational study in residents from two long-term care facilities (LTCFs) in Seville, Spain, in 2018. Fecal swabs and environmental samples were obtained. E. coli isolates were screened for clade C, FQ-R ST131 by PCR, and molecular typing by PFGE; representatives from pulsotypes were studied by whole-genome-sequencing (WGS) and assigned to lineages (cgSTs). Prevalence of colonization at each time point, incidence density, and risk factors for acquisition were studied. Seventy-six FQ-R ST131 E. coli isolates belonging to 34 cgSTs were obtained; 24 belonging to subclade C1 (116 isolates, 65.9%) and 10 to C2 (60, 34.1%). C1 lineages showed lower virulence scores than C2 (median [IQR], 19 [18 to 20] versus 21 [20 to 21.5], P = 0.001) and higher number of plasmids (4 [3 to 5] versus 2 [2 to 3], P = 0.01). aac(6')-Ib-cr and blaOXA-1 were less frequent in C1 than C2 (2 [8.3%] versus 6 [60%], P = 0.003 for both); ESBL genes were detected in eight (33.3%) C1 (5 blaCTX-M-27) and three (30%) C2 (all blaCTX-M-15). Of the 82 residents studied, 49 were colonized at some point (59.7%), with a pooled prevalence of 38.6%. Incidence density of new lineage acquisition was 2.22 per 100 resident weeks (1.28 and 0.93 C1 and C2 subclades, respectively). Independent risk factors for acquisitions were having a colonized roommate (HR = 4.21; 95% CI = 1.71 to 10.36; P = 0.002) and urinary or fecal incontinence (HR = 2.82; 95% CI = 1.21 to 6.56; P = 0.01). LTCFs are important reservoirs of clade C ST131 E. coli. The risk factors found suggest that cross-transmission is the most relevant transmission mechanisms. IMPORTANCE We aimed at investigating the microbiological and epidemiological features of clade C fluoroquinolone-resistant ST131 E. coli isolates colonizing highly dependent residents in long-term care facilities (LTCFs) during 40 weeks and the risk factors of acquisition. Isolates from C1 and C2 subclades were characterized in this environment. The clonality of the isolates was characterized and they were assigned to lineages (cgSTs), Resistance genes, virulence factors, and plasmids were also described. This study suggests that cross-transmission is the most relevant transmission mechanisms; however, environmental colonization might also play a role. We believe the data provide useful information to depict the epidemiology of these bacteria by merging detailed microbiological and epidemiological information.

Effect of Remote Ischemic Preconditioning on the Incidence of Contrast-Induced Nephropathy in Patients Undergoing Endovascular Aneurysm Repair (Remote Ischemic Preconditioning-Endovascular Aneurysm Repair Study).

BACKGROUND: Contrast-induced nephropathy (CIN) is a major inconvenience in the use of iodinated contrast media (ICM) and it is associated with a significant increase in morbidity and mortality and cost of hospitalization. Remote ischemic preconditioning (RIPC) is a noninvasive and cost-effective tissue protection technique that has showed to be beneficial in decreasing renal insult in patients receiving intravascular contrast. AIM: The primary outcome of this study is to evaluate the impact of RIPC on the incidence of CIN in patients undergoing endovascular aneurysm repair. METHODS: Patients suffering from aortic aneurysm were recruited prior to the administration of ICM. Randomization was used to assign patients into the control/RIPC groups. Biochemical parameters determined renal function before and after surgery in immediate (24-72 hr) and at 30 days of follow-up. RESULTS: Of the 120 patients included in the study, 98,3% were male. Mean age was 73 years (range: 56-87 years). Diabetes and chronic renal failure (considering estimated glomerular filtration [eGFR] <60) was present prior to administration of ICM in 29.16% and 38.33%, respectively. RIPC was applied in 50% (n = 60) of the patients. A total of 24.17% developed CIN regardless of fluidotherapy, RIPC, and other protective strategies. RIPC did not influence outcomes in terms of incidence on CIN, serum creatinine, urea, eGFR, or microalbuminuria in immediate postoperative period. However, the group of RIPC patients showed a statistically significant benefit in renal function in terms of serum creatinine (1.46 ± 0.3 vs. 1.03 ± 0.5; P < 0.001), urea (61.06 ± 27.5 mg/dL vs. 43.78 ± 12.9 mg/dL; P = 0.003), and an increase in eGFR (56.37 ± 23.4 mL/min/1.73 m2 vs. 72.85 ± 17.7 mL/min/1.73 m2; P = 0.004) at 30 days of follow-up. CONCLUSIONS: RIPC seems to be a reasonable, effective, and low-cost technique to alleviate effects of ICM on the renal parenchyma in endovascular aneurysm repair procedures during short-term postoperative period.

Readability of patient educational materials in venous thrombosis: analysis of the 2021 ESVS guidelines and comparison with other medical societies information.

BACKGROUND: In order for patients to comprehend health related information, it must be written at a level that can be readily understood by the intended population. During 2021 the European Society for Vascular Surgery (ESVS) published a sub-section about information for patients into its Guidelines on the Management of Venous Thrombosis. METHODS: Nine readability measures were used to evaluate the patient educational material regarding venous thrombosis published by seven medical societies: ESVS, Society for Vascular Medicine (SVM), Society for Vascular Surgery (SVS), Vascular Society for Great Britain and Ireland (VS), Australia and New Zealand Society for Vascular Surgery (ANZSVS), Canadian Society for Vascular Surgery (CSVS) and American Heart Association (AHA). RESULTS: The mean reading grade level (RGL) for all the 58 recommendations was 10.61 (range 6.4-14.5) and the mean Flesch Reading Ease (FRE) was 56.10 (51.3-62.9), corresponding to a "fairly difficult" reading level. The mean RGL of the ESVS recommendations (11.45, 95% CI, 9.90-13.00) was significantly higher than the others. Post-hoc analysis determined a significant difference between the ESVS and the SVS (10.86, 95% CI, 9.84-11.91) recommendations (P=0.005). All the patient's education information published by the medical societies presented a RGL higher than recommended. The fifteen sub-sections of the information for patients included into the ESVS clinical guidelines presented a mean RGL above 9.5 points, revealing that no one (0%) was written at or below the recommended GRL. The mean FRE was 47.63 (28.2-61.6), corresponding to a "difficult" reading level. CONCLUSIONS: Venous thrombosis patient educational materials produced by leading medical societies have readability scores that are above the recommended levels. The innovative patient's information included into the ESVS venous thrombosis guidelines represents an important advance in the amelioration of the medical information for patients, but their readability should be improved to adapt the understanding to the general population.

Impact of nutritional and inflammatory status in patients with critical limb-threatening ischemia.

BACKGROUND: A pro-inflammatory state and a poor nutritional status have been associated with severity and prognosis of patients with peripheral arterial disease (PAD). The clinical applicability of the different pre-operative nutritional and inflammatory biomarkers in patients with critical limb-threatening ischemia (CLTI) was analyzed. METHODS: A retrospective observational study was performed, that included all patients with CLTI revascularized from January 2016 to July 2019. The inflammatory state was calculated using neutrophil/lymphocyte (NLR), lymphocyte/monocyte (LMR) and platelet/lymphocyte ratios (PLR). For nutritional status, the Prognostic Nutritional Index (PNI) was calculated. Mortality and number of major amputations at 6 months and hospital length-of stay were studied. RESULTS: 310 patients were included. Higher levels of NLR and lower levels of PNI were associated with mortality (6.61±5.6 vs. 3.98±3.27, P=0.034; 40.33±7.89 vs. 45.73±7.48, P=0.05, respectively). Lower levels of PNI and LMR (42.57±7.82 vs. 45.44±7.65, P=0.036; 2.77±1.61 vs. 3.22±1.75, P=0.013, respectively) and higher levels of NLR (6.91±7.85 vs. 3.94±2.57, P=0.023) were associated with major amputations. The mean hospital length-of-stay was higher in patients with lower levels of PNI and LMR (P=0.000 and P=0.003) and higher levels of NLR and PLR (P=0.001 and P=0.002). A PNI<42.87 predicted short-term mortality with a 66.7% of sensitivity and a 66.8% of specificity (P=0.000). CONCLUSIONS: Our experience suggests that these inflammatory and nutritional biomarkers are independent predictors of short-term mortality and major amputations. In addition, our results suggest that PNI could be used to predict the short-term mortality with high sensitivity and specificity.

Off-Label Use of a Flared Endograft Limb for Treatment of a Complicated Anastomotic Abdominal Aortic Pseudoaneurysm: Reverse Deployment Throught Axillary Artery.

A case of complicated abdominal aortic pseudoaneurysm not suitable for open repair is described. It was treated by means of endovascular methods with a flared endograft limb. The uniqueness of this case is the absence of a suitable femoral access, requiring the deployment of the graft in a reversed configuration through axillary artery. The technique is described and the need of imaginative off label use of endovascular devices in such emergent cases is discussed.

Celiac trunk segmental arterial mediolysis: a rare cause of arteriopathy

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Celiac trunk segmental arterial mediolysis: a rare cause of arteriopathy.

A 50-year-old male patient, without a previous medical history, presented sudden severe abdominal pain with no alterations in the blood analysis. A CT-Angiography (CTA) was performed that showed a wall thickening of the celiac trunk extended to the hepatic artery with a filiform lumen and no involvement of the splenic artery. There were no signs of intestinal or liver ischemia, therefore no further radiological tests were performed. The proteinogram and serology were normal, with no immunological and acute phase reactant markers, excluding vasculitis. It appeared as an isolated lesion with no signs of arterial dissection or pseudoaneurysms of the remaining abdominal vessels or the aorta. Therefore, it was considered as a Segmental Arterial Mediolisis (SAM).

Doppler Ultrasound as a Unique Diagnosis Test in Peripheral Arterial Disease.

BACKGROUND: The aim of this study was to analyze duplex ultrasound (DUS) and intraoperative angiography concordance for diagnosis of lower limb peripheral artery disease and its value for surgical planning. MATERIALS AND METHODS: This was a prospective, observational study, including patients who underwent revascularization of the lower limbs during 2018, diagnosed by DUS only or combined with preoperative computed tomography (CT) angiography. The concordance between preoperative DUS or CT angiography and the intraoperative angiography was studied using the Cohen kappa coefficient (k). The degree of agreement between the DUS-based surgical plan and the final surgical technique was also evaluated. RESULTS: Fifty-one patients were included, with mean age of 71.8 ± 11.96 years (46-94); 23 had chronic kidney disease (45%). In 17 patients (34%), preoperative CT angiography was also performed. DUS showed a sensitivity of 100% (95% confidence interval (CI) [83.3-100%]), 80% (95% CI [50.21-100%,]), and 100% (95% CI [96.43-100%]) at the iliac, femoral, and popliteal sector, respectively, and a specificity of 93.55% (95% CI [83.29-100%]), 95.45% (95% CI [84.48-100%]), and 90.48% (95% CI [75.54-100%]) at the iliac, femoral, and popliteal sector, respectively. The positive predictive value for DUS was 60% (95% CI [7.06-100%]), 88.9% (95% CI [62.8-100%]), and 87.5% (95% CI [68.17-100%]) for the iliac, femoral, and popliteal sectors, respectively, whereas the negative predictive value was 100% (95% CI [98.28-100%]), 91.3% (95% CI [77.61-100%]), and 100% (95% CI, [97.37-100%]). The concordance between DUS and intraoperative angiography showed a k index of 0.587 (P = 0.000) in the iliac sector, 0.799 in the femoral sector (P = 0.000), and 0.699 in the popliteal sector (P = 0.000). The concordance between CT angiography/intraoperative angiography had a k index of 0.71 in the iliac sector (P = 0.0093), 0.566 in the femoral sector (P = 0.006), and 0.5 in the popliteal sector (P = 0.028). DUS-based surgical plan was accurate in 86% of cases (n = 44). CONCLUSIONS: Our experience suggests that DUS arterial mapping of the femoral and popliteal areas is better than CT angiography and can be considered as a unique preoperative imaging test during the surgical planning in patients undergoing a lower limb revascularization procedure.

Impacto de un programa de prevención de infecciones en la conducta de cirujanos y anestesistas en un hospital público / Impact of an infection prevention program on the behavior of surgeons and anesthetists in a public hospital

Introducción: El control de las infecciones de sitio quirúrgico (ISQ) es importante en los programas de vigilancia y control de infecciones nosocomiales. Hay evidencias de que hasta un 60% podrían evitarse. Nuestro objetivo fue determinar si el porcentaje de cumplimiento de las medidas de prevención de ISQ fue mayor luego de la implementación de un programa en un hospital público.Material y métodos: Estudio comparativo inter-sujeto, observacional, retrospectivo y transversal. Se analizaron fichas de registro de cumplimiento de medidas de prevención pre y post instrumentación del programa, que consistió en entrega de ropa quirúrgica al ingreso al quirófano, difusión de las recomendaciones de prevención de ISQ y auditoría diaria. Variables: categoría profesional, uso adecuado de barbijo, de ambo y de camisolín, higiene de manos quirúrgica, cambio de ropa cuando se mancha, y manejo de efectos personales dentro del quirófano. Los datos fueron analizados empleando VCCstat3.0. Se estimaron intervalos de confianza del 95%.Resultados: En el control de la categoría "Profesional" hubo diferencias significativas en todas las variables auditadas entre cirujanos y anestesistas. Por lo tanto, se realizó un análisis de las poblaciones por separado. Cirujanos y anestesistas mejoraron el cumplimiento de ambo adecuado, cambio de ropa cuando se mancha y manejo de efectos personales dentro del quirófano. Los anestesistas, además, presentaron mejoras significativas en el uso adecuado de barbijo e higiene de manos quirúrgica. Conclusiones: La instrumentación del programa fue exitosa. Es importante continuar con los esfuerzos de la mejora. El efecto en las tasas de ISQ es un dato a medir.

Introduction: Surgical site infections (SSI) occupy a prominent place in nosocomial infection surveillance and control programs. There is evidence that up to 60% could be avoided. Our objective was to determine if the percentage of compliance with surgical infection prevention measures is higher after the implementation of a program in a public hospital.Methods: Intersubject, observational, retrospective and cross-sectional comparative study. Record of compliance with prevention measures before and after instrumentation of the Program were analyzed. The Program consisted of: delivery of surgical clothing upon admission to the operating room, dissemination of SSI prevention recommendations, daily audit. Variables: professional category, proper use of surgical mask, scrubs, and surgical gowns, surgical hand hygiene, change of clothes when stained, and handling of personal effects within the operating room. The data were analyzed using VCCstat 3.0. 95% confidence intervals were estimated.Results: In the control "Professional Category" variable, there were significant differences in all audited variables between surgeons and anesthetists, therefore, a separate population analysis was performed.Surgeons and anesthetists improved the compliance of both adequate, change of clothes when stained and handling of personal effects within the operating room. The anesthetists also presented significant improvements in proper use of chinstrap and surgical hand hygiene.Discussion: Program implementation was successful. Continuous efforts in the continuation of improvement is important. The effect on ISQ rates is a fact to be measured

Enfermedad arterial periférica: la influencia de la etnia / Peripheral arterial disease: influence of ethnicity

INTRODUCCIÓN Y OBJETIVO: se han descrito diferencias en la prevalencia de la enfermedad arterial periférica (EAP) en distintas áreas geográficas. El objetivo es analizar los pacientes de Europa del este intervenidos en nuestro centro de isquemia crónica de extremidades inferiores y compararlos con los de origen español para describir cómo puede influir la etnia en el desarrollo de la EAP. MATERIALES Y MÉTODOS: se ha escogido una muestra de 337 pacientes intervenidos en nuestro centro desde el 2007 hasta el 2017 diagnosticados de isquemia arterial crónica de extremidades inferiores. Se han analizado los factores de riesgo cardiovascular (FRCV), la clínica al ingreso, las lesiones TASC y la estancia hospitalaria media. RESULTADOS: los pacientes de Europa del este representan el 7,7% de la muestra. La media de edad es de 67,9 años y un 79,8% son varones: el 70% presenta HTA; el 45,4%, DM; el 52,5%, DLP y el 40,7% son fumadores. Respecto a las comorbilidades, el 30,6% presenta cardiopatía isquémica; el 13,6%, EPOC y un 7,4%, accidentes cerebrovasculares. Los pacientes de Europa del este son más jóvenes (53,5 ± 10,53 frente a 69,09 ± 10,77; p = 0,0001), con menor prevalencia del resto de FRCV (HTA 30,7% frente al 73,3%, p = 0,001; DM 23,07% frente a 47,27%; p = 0,017; DLP 30,77% frente al 54,34%; p = 0,021). La prevalencia de fumadores es mayor (80,77% frente a 69,45%; p = 0,002). Presentan una clasificación Rutherford menor y un ITB más alto (3,19 ± 0,85 frente a 3,73 ± 1,19, p = 0,03, y 0,41 ± 0,21 frente a 0,26 ± 0,06, p = 0,028, respectivamente). La mayoría de los pacientes de Europa del este son claudicantes y presentan una estancia media superior que los pacientes claudicantes de origen español (12,31 frente a 6,3 días; p < 0,001). No existen diferencias significativas en el grado TASC. CONCLUSIONES: los pacientes de Europa del este intervenidos de isquemia arterial crónica de extremidades inferiores son más jóvenes, más fumadores y con menor prevalencia del resto de FRCV. La mayoría presenta claudicación intermitente y tiene una estancia hospitalaria media más elevada que los pacientes españoles

INTRODUCTION AND OBJECTIVE: differences in the prevalence of peripheral arterial disease (PAD) have been described in different geographical areas. These differences have been justified by life habits and socio-economic development of a country. The aim of this study is to analyze eastern Europe patients and Spanish patients, who underwent surgical procedures of lower limb chronic ischemia, to describe how can influence ethnicity in the PAD development. MATERIALS AND METHODS: a sample of 337 operated patients of lower extremities chronic ischemia in our center from 2007 to 2017 has been chose. Cardiovascular risk factors (CVRF), clinic at the beginning of admission, TASC lesions in imaging tests and hospitalization days were analyzed. RESULTS: eastern Europe patients represent 7.7% of the sample. The average age is 67.9 years (22-97) and 79.8% are males. 70% have HTA, 45.4% DM, 52.5% DLP and 40.7% are smokers. Regarding comorbidities: 30.6% have ischemic heart disease, 13.6% OCPD and 7.4% cerebrovascular disease. Eastern Europe patients are younger than Spanish patients (53.5 ± 10.53 vs. 69.09 ± 10.77) and with a lower prevalence of the rest of CVRF (HTA 30.7% vs. 73.3%; DM 23.07% vs. 47.27%; DLP 30.77% vs. 54.34%). In addition, the prevalence of smokers is higher (80.77% vs. 69.45%). They also present a lower Rutherford classification and a higher ABI (3.19 ± 0.85 vs. 3.73 ± 1.19 and 0.42 vs. 0.26, respectively). The average stay is higher in claudicants eastern Europe's patients (12.31 vs. 6.3 days). CONCLUSIONS: operated eastern European patients of lower limb chronic ischemia are young patients, smokers, and have a lower prevalence of the rest of CVRF. More than half of eastern Europe patients present intermittent claudication and they have a higher hospital stay than claudicant Spanish patients

Chile's role in global health diplomacy: a narrative literature review.

BACKGROUND: Global health diplomacy (GHD) has become an important field of investigation due to health concerns increasingly entering the foreign policy domain. Much of the existing academic writing focuses on North-South cooperation in global health, and emphasizes the role of security and economic interests by Northern countries as drivers of GHD. Chile presents a favourable environment for an expanded involvement in future GHD activities. However, there is little knowledge about what has been driving Chile's integration of health into foreign policy, and little effort to appropriate knowledge from international relations theories to better theoretically grasp the emergence of GHD. METHODS: To fill this knowledge gap, we conducted a narrative literature review of the driving forces behind Chile's integration of health into foreign policy. Drawing on a popular analytical framework used in international relations scholarship, we identified driving forces of the integration of health into Chile foreign policy at three levels of analysis. RESULTS: At the international/global level of analysis, the main driving forces were related to national security concerns and compliance with regulations of international organizations. At the regional level, GHD was driven by a commitment to regional solidarity through mutually beneficial cooperation in response to neoliberal reforms; health coordination in emergencies; and protection of indigenous peoples. Finally, at the domestic level, drivers identified include economic interests of various productive sectors and how health regulations might impact those; the high degree of social inequity which impacts on access to healthcare; and management of natural disasters. CONCLUSION: Health actions in the context of international relations in Chile are still mainly motivated by more traditional foreign policy interests rather than by a desire to satisfy health needs per se. This seems to conform with findings of existing GHD scholarship that emphasize the importance of security and economic interests as driving forces of GHD, and how health is often appropriated instrumentally within foreign policy settings to achieve other goals. But the review also reveals that in the context of South-South cooperation (and regional health diplomacy), solidarity and normative considerations can be important driving forces as well. Finally, the review demonstrates that there has been an evolution from chiefly domestically focused health policies (e.g. maternal and child nutrition treatment) towards internationally inspired integrated policies (e.g. maternal and child nutrition promotion aligned with international guidelines).

Histamine therapeutic efficacy in metastatic melanoma: Role of histamine H4 receptor agonists and opportunity for combination with radiation.

The aims of the work were to improve our knowledge of the role of H4R in melanoma proliferation and assess in vivo the therapeutic efficacy of histamine, clozapine and JNJ28610244, an H4R agonist, in a preclinical metastatic model of melanoma. Additionally, we aimed to investigate the combinatorial effect of histamine and gamma radiation on the radiobiological response of melanoma cells.Results indicate that 1205Lu metastatic melanoma cells express H4R and that histamine inhibits proliferation, in part through the stimulation of the H4R, and induces cell senescence and melanogenesis. Daily treatment with H4R agonists (1 mg/kg, sc) exhibited a significant in vivo antitumor effect and importantly, compounds reduced metastatic potential, particularly in the group treated with JNJ28610244, the H4R agonist with higher specificity. H4R is expressed in benign and malignant lesions of melanocytic lineage, highlighting the potential clinical use of histamine and H4R agonists. In addition, histamine increased radiosensitivity of melanoma cells in vitro and in vivo. We conclude that stimulation of H4R by specific ligands may represent a novel therapeutic strategy in those tumors that express this receptor. Furthermore, through increasing radiation-induced response, histamine could improve cancer radiotherapy for the treatment of melanoma.

Prevalencia y factores asociados a sobrepeso y obesidad infantil en escuelas públicas y privadas de Tegucigalpa, Honduras / Prevalence of pediatric overweight and obesity and associated factors in public and private schools in Tegucigalpa, Honduras

Objective: To compare the factors associated with overweight and obesity in children from public and private schools in the Kennedy colony, Tegucigalpa, Honduras. Materials and methods. We studied 3S7 schoolchildren between 6 and 11 years old. A survey was used to assess nutrition, food frequency, eating habits and practices, and physical activity. Students with overweight and obesity secondary to a basic pathology were excluded. The information was analyzed using Epi-info. We conducted a univariate and multivariate analyzes. Results: We found that 18% of the students were obese and 18% were overweight. Students from private schools were more frequently overweight and obese (46.3%) than those in public schools (33.2%). Fifty-three percent of public school students and 36.3% of private schools consumed homemade snacks. Over half (S8.S%) of public school students and 68.7% of private schools reported doing some kind of outdoor physical activity. Conclusion: Childhood overweight and obesity are prevalent health problems. Private school students, in our sample, were more overweight and obese than public school students. Physical activity performed by school children in public and private schools was adequate in most cases.

Objetivo: Comparar los factores asociados de sobrepeso y obesidad en los niños de escuelas públicas y privadas de la colonia Kennedy, Tegucigalpa, Honduras. Materiales y Métodos. Se estudiaron 357 escolares entre 6 y 11 años. Se realizó evaluación nutricional, frecuencia de consumo, hábitos y prácticas alimentarias y actividad física mediante encuesta. Se excluyeron escolares con sobrepeso y obesidad secundaria a una patología de base. La información fue analizada con el programa Epi-info, seguido de análisis variado y multivariado. Resultados: Se encontró un 18% de escolares con obesidad y 18% con sobrepeso. Los niños de escuelas privadas presentaron mayor frecuencia de sobrepeso y obesidad (46,3%) que los de escuelas públicas (33,2%). Más de la mitad (53,4%) de los estudiantes de escuelas públicas y 36,3% de las escuelas privadas consumieron consumen merienda elaborada en casa. Un 58,5% de estudiantes de escuelas públicas y un 68,7% de centros privados, realizaron algún tipo de actividad física al aire libre. Conclusión: El sobrepeso y la obesidad infantil son un problema de salud prevalente. En nuestra muestra, los estudiantes de escuelas privadas tenían mayor sobrepeso y obesidad que los de escuelas públicas. La actividad física realizada por los escolares de escuelas públicas y privadas fue adecuada en la mayoría de los casos.

Histamine H4 receptor: insights into a potential therapeutic target in breast cancer.

Breast cancer is the second most common cancer worldwide, and the leading cause of cancer death in women. Several studies underlined the critical role of histamine in breast cancer development and progression. This review addresses the latest evidence regarding the involvement of histamine and histamine receptors in breast cancer, focusing particularly in the histamine H4 receptor (H4R). Histamine concentration in breast cancer tissues was found to be higher than that in normal tissues of healthy controls by means of an increase in the activity of histidine decarboxylase (HDC), the enzyme involved in histamine production. The expression of H4R in different experimental models and human biopsies, the associated biological responses, as well as the in vivo treatment of experimental tumors with H4R ligands is reviewed. Evidence demonstrates that the H4R exhibits a key role in histamine-mediated biological processes such as cell proliferation, senescence and apoptosis in breast cancer. The polymorphisms of the H4R and HDC genes and their association with breast cancer risk and malignancy reinforce the critical (patho)physiological role of H4R in breast cancer. In addition, H4R agonists display anti-tumor effects in vivo in a triple negative breast cancer model. The findings support the exploitation of the H4R as a molecular target for breast cancer drug development.

Chlorpyrifos inhibits cell proliferation through ERK1/2 phosphorylation in breast cancer cell lines.

It is well known the participation of oxidative stress in the induction and development of different pathologies including cancer, diabetes, neurodegeneration and respiratory disorders among others. It has been reported that oxidative stress may be induced by pesticides and it could be the cause of health alteration mediated by pollutants exposure. Large number of registered products containing chlorpyrifos (CPF) is used to control pest worldwide. We have previously reported that 50 µM CPF induces ROS generation and produces cell cycle arrest followed by cell death. The present investigation was designed to identify the pathway involved in CPF-inhibited cell proliferation in MCF-7 and MDA-MB-231 breast cancer cell lines. In addition, we determined if CPF-induced oxidative stress is related to alterations in antioxidant defense system. Finally we studied the molecular mechanisms underlying in the cell proliferation inhibition produced by the pesticide. In this study we demonstrate that CPF (50 µM) induces redox imbalance altering the antioxidant defense system in breast cancer cells. Furthermore, we found that the main mechanism involved in the inhibition of cell proliferation induced by CPF is an increment of p-ERK1/2 levels mediated by H2O2 in breast cancer cells. As PD98059 could not abolish the increment of ROS induced by CPF, we concluded that ERK1/2 phosphorylation is subsequent to ROS production induced by CPF but not the inverse.

Enhancement of ionizing radiation response by histamine in vitro and in vivo in human breast cancer.

The radioprotective potential of histamine on healthy tissue has been previously demonstrated. The aims of this work were to investigate the combinatorial effect of histamine or its receptor ligands and gamma radiation in vitro on the radiobiological response of 2 breast cancer cell lines (MDA-MB-231 and MCF-7), to explore the potential molecular mechanisms of the radiosensitizing action and to evaluate the histamine-induced radiosensitization in vivo in a triple negative breast cancer model. Results indicate that histamine significantly increased the radiosensitivity of MDA-MB-231 and MCF-7 cells. This effect was mimicked by the H1R agonist 2-(3-(trifluoromethyl)phenyl)histamine and the H4R agonists (Clobenpropit and VUF8430) in MDA-MB-231 and MCF-7 cells, respectively. Histamine and its agonists enhanced radiation-induced oxidative DNA damage, DNA double-strand breaks, apoptosis and senescence. These effects were associated with increased production of reactive oxygen species, which correlated with the inhibition of catalase, glutathione peroxidase and superoxide dismutase activities in MDA-MB-231 cells. Histamine was able also to potentiate in vivo the anti-tumoral effect of radiation, increasing the exponential tumor doubling time. We conclude that histamine increased radiation response of breast cancer cells, suggesting that it could be used as a potential adjuvant to enhance the efficacy of radiotherapy.