A new approach to prostate cancer screening.

Prostate cancer screening based on prostate-specific antigen (PSA) testing has been a matter of controversy. Although screening for prostate cancer was effective in reducing mortality, it resulted in overdiagnosis, which translated into unnecessary treatments and numerous adverse effects. As a result, recommendations from scientific societies became increasingly restrictive. In the recent years, new approaches to prostate cancer screening have been proposed. These new approaches are aimed at solving the controversy between widespread screening vs. no screening, and reconsidering PSA testing as a screening tool with a good benefit/risk balance. In this context, the European Association of Urology submitted a proposal to the European Commission for prostate cancer screening to be performed as a function of baseline PSA concentrations. The European Commission recently recommended the implementation of organized prostate cancer screening programs for men aged ≤70 years based on PSA values in combination with follow-up magnetic resonance imaging.

LDH/ADA ratio in pleural fluid for the diagnosis of infectious pleurisy.

Pleural effusion (PE) is a common medical concern, often requiring thoracentesis for a definitive diagnosis. An elevated pleural fluid adenosine deaminase (ADA) may indicate tuberculosis, but this is not always the case. This study aimed to evaluate the accuracy of biomarkers determined in pleural fluid and propose a new diagnostic strategy for PE in patients with high levels of ADA in pleural fluid. This retrospective analysis studied patients with PE who received thoracentesis for the first time with an ADA level of > 33 U/L in the pleural fluid analysis at two tertiary hospitals from March 2019 to March 2023. Demographic and clinical data, as well as pleural fluid biomarkers and their ratios, were studied and compared between different PE groups, and a decision tree was developed. During the study period, 259 patients were enrolled, with four different types of PE: parapneumonic (PPE) 155, tuberculosis (TPE) 41, malignant (MPE) 50, and miscellaneous 13. Biomarkers and their ratios performed well in the differential diagnosis of PE, with the LDH/ADA ratio distinguishing between PPE and non-PPE with sensitivity and specificity of 98.06% and 98.08%, respectively. The combination of LDH/ADA ratio, ADA, and mononuclear cell percentage was identified as important factors for creating a decision tree with an overall accuracy of 89.96%. The pleural fluid LDH/ADA ratio was a useful diagnostic for distinguishing PPE from non-PPE, and a decision tree with an accuracy of 89.96% was created to differentiate the four forms of PE in clinical situations.

Comparison of C Reactive Protein and Procalcitonin Levels in Cerebrospinal Fluid and Serum to Differentiate Bacterial from Viral Meningitis.

GOALS: It is unclear whether C reactive protein (CRP) and procalcitonin (PCT) levels in cerebrospinal fluid (CSF) improve the accuracy compared to their serum levels for the differential diagnosis of infectious meningitis. The aim of this study was to compare the accuracy of CRP and PCT levels in CSF and serum in order to differentiate between bacterial and viral meningitis. PROCEDURES: CRP and PCT levels were measured in CSF and serum from patients with bacterial or viral meningitis. The diagnostic accuracy was determined using receiver operating characteristic curves (ROC), calculating the area under the ROC curve (AUC). RESULTS: Thirty patients were included in this study, 18 of whom had bacterial meningitis and 12 viral meningitis. The AUCs to differentiate bacterial from viral meningitis using serum CRP, CSF CRP, serum PCT and CSF PCT were 0.926; 0.898; 0.963; and 0.694 respectively. Serum CRP and PCT exhibited 100% and 88.9% sensitivity, 83.3% and 100% specificity with a cut-off =14.0 mg/L and 0.18 µg/L respectively. CONCLUSIONS: Levels of CRP and PCT in CSF did not present greater accuracy in differentiating bacterial from viral meningitis compared to serum levels. Serum CRP and PCT showed a high diagnostic accuracy, therefore its quantification is recommended in all patients with suspected infectious meningitis.

Sedación con midazolam sin efectos neurotóxicos / Sedation with midazolam without neurotoxic effects

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Efecto neuroprotector del sevoflurano en anestesia general / Neuroprotective effect of sevoflurane in general anaesthesia

Introducción y objetivo: El objetivo fue evaluar el daño cerebral producido por el sevoflurano inhalado mediante la determinación de la proteína S100B sérica antes y después de una exposición a este fármaco como único agente anestésico. Pacientes y método: Se incluyeron pacientes pediátricos sometidos a resonancia magnética nuclear bajo anestesia general con sevoflurano inhalado a dosis baja. A todos los pacientes se les extrajo una muestra de sangre venosa, antes (muestra basal) y después de la anestesia general (muestra postexposición). Se determinó la concentración de la proteína S100B sérica en la muestra basal (S100Bb) y en la muestra postexposición (S100Bp). Resultados: Se incluyeron 72 pacientes entre 2 y 13 años (mediana = 6), 28 niños y 44 niñas. Los valores de S100Bp (mediana = 66,5 ng/l) fueron significativamente inferiores (p = 0,0059) a los de S100Bb (mediana = 84,0 ng/l). La mediana de las diferencias entre S100Bp y S100Bb resultó −11,0 ng/l. Conclusiones: El sevoflurano inhalado a dosis bajas produce un descenso de la proteína S100B sérica, por lo que este fármaco podría tener un efecto neuroprotector a nivel del sistema nervioso central (AU)

Introduction and objective: The aim of this study was to evaluate the brain damage caused by inhaled sevoflurane, by determining the concentration of serum S100B protein before and after the exposure to this drug as the only anaesthetic agent. Patients and method: Paediatric patients undergoing general anaesthesia for the conduct of a nuclear magnetic resonance were included in the study. A venous blood sample was taken from each patient before (basal sample) and after (post-exposure sample) administering the general anaesthesia. The concentration of serum S100B protein was determined in the basal (S100Bb) and post-exposure sample (S100Bp). Results: A total of 72 patients were included in the study, with a mean patient age of 2 to 13 years (median = 6), 28 males and 44 females. S100Bp values (median = 66.5 ng/L) were significantly lower (P = .0059) than those of S100Bb (median = 84.0 ng/L). The median of the difference between S100Bp and S100Bb was −11.0 ng/L. Conclusions: Inhaled sevoflurane at low doses causes a decrease of serum S100B protein levels, hence, this drug could have a neuroprotective effect in the central nervous system (AU)

Neuroprotective effect of sevoflurane in general anaesthesia. / Efecto neuroprotector del sevoflurano en anestesia general.

INTRODUCTION AND OBJECTIVE: The aim of this study was to evaluate the brain damage caused by inhaled sevoflurane, by determining the concentration of serum S100B protein before and after the exposure to this drug as the only anaesthetic agent. PATIENTS AND METHOD: Paediatric patients undergoing general anaesthesia for the conduct of a nuclear magnetic resonance were included in the study. A venous blood sample was taken from each patient before (basal sample) and after (post-exposure sample) administering the general anaesthesia. The concentration of serum S100B protein was determined in the basal (S100Bb) and post-exposure sample (S100Bp). RESULTS: A total of 72 patients were included in the study, with a mean patient age of 2 to 13 years (median=6), 28 males and 44 females. S100Bp values (median=66.5ng/L) were significantly lower (P=.0059) than those of S100Bb (median=84.0ng/L). The median of the difference between S100Bp and S100Bb was -11.0ng/L. CONCLUSIONS: Inhaled sevoflurane at low doses causes a decrease of serum S100B protein levels, hence, this drug could have a neuroprotective effect in the central nervous system.

Daño cerebral postanestesia general / Brain damage after general anesthesia

Fundamento y objetivo: La proteína S100B es un marcador sérico de daño cerebral. El objetivo fue evaluar el daño cerebral producido por la anestesia general mediante la determinación de la concentración de proteína S100B sérica antes y después de la anestesia general. Pacientes y método: Se incluyeron pacientes con intervención quirúrgica programada de amigdalectomía por hipertrofia amigdalar. En la consulta de preanestesia se extrajo una muestra de sangre venosa (muestra basal). Los pacientes fueron sometidos a anestesia general utilizando los siguientes fármacos anestésicos intravenosos: midazolam, fentanilo y propofol; y sevoflurano inhalado. Al finalizar la intervención quirúrgica y con el paciente aún en quirófano, se extrajo una segunda muestra de sangre venosa (muestra postexposición). Se determinó en suero la concentración de la proteína S100B en la muestra basal (S100Bb) y en la muestra postexposición (S100Bp), mediante inmunoanálisis de electroquimioluminiscencia en el MODULAR E-170 (Roche Diagnostics). Resultados: Se incluyeron 76 pacientes, 46 varones y 30 hembras, con edades entre 3 y 14 años (mediana 5 años). En todos los pacientes, los niveles de proteína S100B sérica aumentaron tras la anestesia general. Los valores obtenidos de S100Bp (mediana 164,0 ng/l) fueron significativamente mayores que los obtenidos de S100Bb (mediana 94,5 ng/l). La mediana de la diferencia entre S100Bp y S100Bb fue de 58,0 ng/l. Mediante el test de Wilcoxon se encontraron diferencias estadísticamente significativas entre S100Bb y S100Bp (p < 0,0001). Conclusiones: La concentración de proteína S100B sérica aumentó significativamente tras la anestesia general. Esto indica que la anestesia general puede producir daño cerebral (AU)

Background and objective: S100B protein is a serum marker of cerebral damage. The objective was to evaluate the brain damage caused by general anaesthesia, by determining the concentration of serum S100B protein before and after of general anaesthesia. Patients and method: Patients with chronic adenotonsillar hypertrophy and indications for tonsillectomy were included. A venous blood sample was taken from the patients before general anaesthesia (basal sample). The patients were anaesthetised using the following intravenous anaesthetic drugs: midazolam, fentanyl and propofol; and inhaled sevoflurane. A second venous blood sample (postoperative sample) was taken from patients after the surgery, in the operating room. The concentration of serum S100B protein was determined in the basal sample (S100Bb) and postoperative sample (S100Bp) by immunoassay electro-chemiluminescence in MODULAR E-170 (Roche Diagnostics). Results: Seventy-six patients were included, 46 males and 30 females, aged between 3 to 14 (median 5 years). In all the patients, serum S100B protein levels increased after general anaesthesia. The values of S100Bp (median 164.0 ng/L) were significantly higher than the values of S100Bb (median 94.5 ng/L). The median of the difference between S100Bp and S100Bb was 58.0 ng/L. There were statistically significant differences between S100Bb and S100Bp using the Wilcoxon test (P < .0001). Conclusions: The concentration of serum S100B protein increased significantly after general anaesthesia. This indicates that general anaesthesia may cause brain damage (AU)

[Brain damage after general anesthesia]. / Daño cerebral postanestesia general.

BACKGROUND AND OBJECTIVE: S100B protein is a serum marker of cerebral damage. The objective was to evaluate the brain damage caused by general anaesthesia, by determining the concentration of serum S100B protein before and after of general anaesthesia. PATIENTS AND METHOD: Patients with chronic adenotonsillar hypertrophy and indications for tonsillectomy were included. A venous blood sample was taken from the patients before general anaesthesia (basal sample). The patients were anaesthetised using the following intravenous anaesthetic drugs: midazolam, fentanyl and propofol; and inhaled sevoflurane. A second venous blood sample (postoperative sample) was taken from patients after the surgery, in the operating room. The concentration of serum S100B protein was determined in the basal sample (S100Bb) and postoperative sample (S100Bp) by immunoassay electro-chemiluminescence in MODULAR E-170 (Roche Diagnostics). RESULTS: Seventy-six patients were included, 46 males and 30 females, aged between 3 to 14 (median 5 years). In all the patients, serum S100B protein levels increased after general anaesthesia. The values of S100Bp (median 164.0 ng/L) were significantly higher than the values of S100Bb (median 94.5 ng/L). The median of the difference between S100Bp and S100Bb was 58.0 ng/L. There were statistically significant differences between S100Bb and S100Bp using the Wilcoxon test (P<.0001). CONCLUSIONS: The concentration of serum S100B protein increased significantly after general anaesthesia. This indicates that general anaesthesia may cause brain damage.

Nuevo caso de disfunción neurológica y microdeleción 15q11.2 / Neurological dysfunction and 15q11.2 microdeletion: report of a new case

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Serum lactate dehydrogenase in combination with free-to-total serum prostate specific antigen ratio for diagnosis of prostate cancer.

BACKGROUND: Evaluate the utility of serum lactate dehydrogenase (LDH) in combination with free-to-total serum prostate specific antigen ratio (%fPSA), for diagnosis of prostate cancer (PC) with serum total prostate specific antigen (PSA) levels in the intermediate range of 4 to 10 ng/mL. METHODS: The following variables were analysed: PSA, %fPSA, and LDH. Two categories of patients were included in the analysis: NOT PC and PC. RESULTS: We studied 134 patients, 112 had NOT PC and 22 had PC. We defined the following multivariable score (S): S = A + B, where A and B are coefficients of LDH and %fPSA, respectively. AUC values were 0.719 (p = 0.0036), 0.749 (p = 0.0082), and 0.816 (p = 0.0001) for %fPSA, LDH, and S, respectively. Using the proposed S increases by 18% specificity compared to only using the %fPSA parameter. CONCLUSIONS: LDH in combination with %fPSA improves diagnostic performance for detection of PC compared to using only %fPSA.

Nueva mutación en una familia española con síndrome de hiperferritinemia hereditaria y cataratas / New mutation in a Spanish family with hereditary hyperferritinemia-cataract syndrome

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Rendimiento diagnóstico de la determinación del antígeno carcinoembrionario en el líquido pleural / Diagnostic value of carcino embryonic antigen measurement in pleural fluid

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[Treatment indication with endothoracic drainage tube in parapneumonic effusions by partial pressure of carbon dioxide measurement in pleural fluid]. / Indicación de tratamiento con tubo de drenaje endotorácico en derrames pleurales paraneumónicos, según la presión parcial de anhídrido carbónico de líquido pleural.

BACKGROUND AND OBJECTIVE: Parapneumonic effusions with pH < 7.20 or glucose < 0.40 g/l or lactate dehydrogenase (LDH) > 1000 U/l have indication of treatment with endothoracic drainage tube (EDT). The aim of the present study was to determine the accuracy of partial pressure of carbon dioxide (pCO2) measurement in pleural fluid for the subsequent treatment indication with EDT in parapneumonic effusions, by analyzing the area under curve ROC (AUC) and determining the optimal cut off value. PATIENTS AND METHOD: 207 pleural fluids were studied. Glucose, LDH, pCO2, and pH were measured, and data concerning the etiology of pleural effusion and whether EDT treatment was needed were collected after patients were discharged from hospital. RESULTS: Forty-six out of 207 pleural fluids studied were parapneumonic effusions. Thirty-two were treated with EDT. AUC values were 0.888 (p < 0.0001), 0.890 (p < 0.0001), 0.816 (p < 0.0001), and 0.801 (p < 0.0001) for pCO2, pH, glucose, and LDH, respectively. No significant differences were found among them. Optimal cut off value for pCO2 was 48.6 mmHg, exhibiting 90.6% sensitivity and 78.6% specificity. All parapneumonic effusions showing pCO2 > 60.9 mmHg were treated with EDT. Remarkably, 3 out of 46 parapneumonic effusions (6.5%) that had been improperly treated following pH, glucose or LDH values, were correctly treated following pCO2. CONCLUSIONS: pCO2 determination in pleural fluid appears to be the best way to decide the indication of EDT in parapneumonic effusions.

Indicación de tratamiento con tubo de drenaje endotorácico en derrames pleurales paraneumónicos, según la presión parcial de anhídrido carbónico de líquido pleural / Treatment indication with endothoracic drainage tube in parapneumonic effusions by partial pressure of carbon dioxide measurement in pleural fluid

FUNDAMENTO Y OBJETIVO: Los derrames pleurales paraneumónicos (DPP) con un pH menor de 7,20 o glucosa menor de 0,40 g/l o lactatodeshidrogenasa (LDH) mayor de 1.000 U/l tienen indicación de tratamiento con tubo de drenaje endotorácico (TDE). El objetivo del presente estudio ha sido medir la exactitud que presenta la determinación de la presión parcial de anhídridocarbónico (pCO2) del líquido pleural para la indicación de tratamiento con TDE en los DPP mediante el cálculo del área bajo la curva (ABC) de eficacia diagnóstica, además de determinar su punto de corte óptimo.PACIENTES Y MÉTODO: Se analizaron 207 líquidos pleurales, en los que se determinaron pCO2, pH,glucosa y LDH. Se recogió asimismo el diagnóstico etiológico del derrame pleural con que sedio el alta hospitalaria al paciente y si fue necesario tratamiento con TDE.RESULTADOS: De los 207 líquidos pleurales estudiados, 46 fueron DPP, de los que 32 requirieron tratamiento con TDE. La ABC obtenida de la pCO2 fue 0,888 (p < 0,0001); la del pH, 0,890 (p < 0,0001); la de la glucosa, 0,816 (p < 0,0001), y la de la LDH, 0,801 (p < 0,0001). Las diferencias de las ABC carecieron de significación estadística. El punto de corte óptimo de la pCO2 resultó un valor superior a 48,6 mmHg, con una sensibilidad del 90,6% y una especificidad del 78,6%. Todos los DPP con una pCO2 mayor de 60,9 mmHg fueron tratados con TDE. De los 46 DPP, 3 (6,5%) serían tratados incorrectamente según el pH, la glucosa o la LDH; en cambio, hubieran sido correctamente tratados según la pCO2.CONCLUSIONES: La pCO2 de líquido pleural presenta una exactitud para la indicación de tratamientocon TDE similar al pH, la glucosa y la LDH, y mejora el criterio de indicación de tratamiento con TDE en los DPP

BACKGROUND AND OBJECTIVE: Parapneumonic effusions with pH < 7.20 or glucose < 0.40 g/l or lactate dehydrogenase (LDH) > 1000 U/l have indication of treatment with endothoracic drainage tube (EDT). The aim of the present study was to determine the accuracy of partial pressureof carbon dioxide (pCO2) measurement in pleural fluid for the subsequent treatment indication with EDT in parapneumonic effusions, by analyzing the area under curve ROC (AUC) and determining the optimal cut off value.PATIENTS AND METHOD: 207 pleural fluids were studied. Glucose, LDH, pCO2, and pH were measured, and data concerning the etiology of pleural effusion and whether EDT treatment was needed were collected after patients were discharged from hospital.RESULTS: Forty-six out of 207 pleural fluids studied were parapneumonic effusions. Thirty-two were treated with EDT. AUC values were 0.888 (p < 0.0001), 0.890 (p < 0.0001), 0.816 (p < 0.0001), and 0.801 (p < 0.0001) for pCO2, pH, glucose, and LDH, respectively. No significantdifferences were found among them. Optimal cut off value for pCO2 was 48.6 mmHg, exhibiting 90.6% sensitivity and 78.6% specificity. All parapneumonic effusions showing pCO2 > 60.9 mmHg were treated with EDT. Remarkably, 3 out of 46 parapneumonic effusions (6.5%) that had been improperly treated following pH, glucose or LDH values, were correctly treated following pCO2.CONCLUSIONS: pCO2 determination in pleural fluid appears to be the best way to decide the indication of EDT in parapneumonic effusions