Mycobacterium tuberculosis multi-drug-resistant strain M induces IL-17+ IFNγ- CD4+ T cell expansion through an IL-23 and TGF-ß-dependent mechanism in patients with MDR-TB tuberculosis.

We have reported previously that T cells from patients with multi-drug-resistant tuberculosis (MDR-TB) express high levels of interleukin (IL)-17 in response to the MDR strain M (Haarlem family) of Mycobacterium tuberculosis (M. tuberculosis). Herein, we explore the pathways involved in the induction of Th17 cells in MDR-TB patients and healthy tuberculin reactors [purified protein derivative healthy donors (PPD+ HD)] by the M strain and the laboratory strain H37Rv. Our results show that IL-1ß and IL-6 are crucial for the H37Rv and M-induced expansion of IL-17+ interferon (IFN)-γ- and IL-17+ IFN-γ+ in CD4+ T cells from MDR-TB and PPD+ HD. IL-23 plays an ambiguous role in T helper type 1 (Th1) and Th17 profiles: alone, IL-23 is responsible for M. tuberculosis-induced IL-17 and IFN-γ expression in CD4+ T cells from PPD+ HD whereas, together with transforming growth factor (TGF-ß), it promotes IL-17+ IFN-γ- expansion in MDR-TB. In fact, spontaneous and M. tuberculosis-induced TGF-ß secretion is increased in cells from MDR-TB, the M strain being the highest inducer. Interestingly, Toll-like receptor (TLR)-2 signalling mediates the expansion of IL-17+ IFN-γ- cells and the enhancement of latency-associated protein (LAP) expression in CD14+ and CD4+ T cells from MDR-TB, which suggests that the M strain promotes IL-17+ IFN-γ- T cells through a strong TLR-2-dependent TGF-ß production by antigen-presenting cells and CD4+ T cells. Finally, CD4+ T cells from MDR-TB patients infected with MDR Haarlem strains show higher IL-17+ IFN-γ- and lower IL-17+ IFN-γ+ levels than LAM-infected patients. The present findings deepen our understanding of the role of IL-17 in MDR-TB and highlight the influence of the genetic background of the infecting M. tuberculosis strain on the ex-vivo Th17 response.

The conjugated linoleic acid ester of estrone induces the mobilisation of fat in male Wistar rats.

We investigated whether the substitution of the fatty acid moiety in oleoyl-estrone (OE) by conjugated linoleic acid, i.e. conjugated linoleoyl-estrone (cLE) may help improve the antiobesity effects of OE. Overweight (17% fat) male rats were treated for 10 days with oral OE or cLE (10 nmol/g per day) and compared with controls receiving only the oily vehicle. Rat weight and food intake were measured daily. After killing by decapitation, body composition and main plasma parameters were analysed. cLE induced marked decreases in body weight, energy intake, carcass energy and body lipid, whilst sparing protein; the effects were not significantly different from those obtained with OE. Energy expenditure was unchanged, but energy intake decreased to 46% (OE) or 55% (cLE) of controls; whole body energy decreased by 29% (OE) or 24% (cLE) in the 10-day period studied. Plasma composition showed almost identical decreases in glucose and cholesterol elicited by OE and cLE, with a more marked decrease in triacylglycerols by OE and no effect of either on NEFA. OE decreased leptin and insulin levels, but the effects of cLE were more marked on both, with similar decreases in adiponectin. It can be concluded that cLE is a new drug of the OE family; its overall effects on energy were akin to those of OE, albeit fractionally less effective at the single dose tested. However, this lower potency on lipid mobilisation does not affect other effects, such as powerful hypercholesterolemic effects or the modulation of adiponectin. And last, but not least, cLE seems to produce a more marked decrease in leptin and insulin than OE, which may reflect a coordinate action of the conjugated linoleic acid moiety and the "OE effect" on target tissues. If that were the case, cLE may constitute an improvement over OE in its action on insulin resistance.

[Tuberculosis in the area of Lorca: to adapt or resist]. / Tuberculosis en la comarca de Lorca: adaptarse o resistir.

OBJECTIVE: We studied the epidemiological characteristic of tuberculosis in Lorca area, drug resistant and the effect of the immigration population (Ecuador) in this area. PATIENTS AND METHODS: A retrospective study for six years ago (1999, January to 2004, December) was realized. Epidemiological data, initial diagnostic probability, mycobacteria stain and cultive, drug resistance, treatment response, and epidemiological differences between immigrants and spain population were compared. RESULTS: Within 158 cases registered, 41.7 percent were immigrants with less than one year in Spain, the most part Ecuador population. We observed that extrapulmonar tuberculosis was lower initial diagnostic probability than pleural disease as well too haemoptisis, pleural pain and weight loss. It was identified positive micobacterial stain in 35.4 percent of respiratory samples. It was successfully results in 74 percent of cases and 13.9 percent of patients were lost, this result was frequently registered in immigrants, The isoniazide resistant in patients with not previous treatment was 5.3 percent and it was 9.5 percent in immigrants and 10.8 percent in Ecuador population. CONCLUSION: It is necessary improve: the diagnostic of extrapulmonar tuberculosis and avoid loss patient by programs of capture and then the successfully treatments raise. The isoniazide resistant in this area suggest that we must use initial four drug than tree and this manner not raise the drug resistant in the area.

Interferón alfa-2a pegilado como oportunidad de tratamiento para pacientes embarazadas con leucemia mieloide crónica / Pegylated interferon alfa-2a as a treatment opportunity for pregnant patients with chronic myeloid leukemia

La leucemia mieloide crónica (LMC) es una enfermedad que puede afectar a mujeres en edad fértil con intención de tener hijos. El tratamiento estándar para esta enfermedad neoplásica son los inhibidores de tirosina quinasa (TKIs), sin embargo, no están indicados en caso de embarazo. La estrategia farmacoterapéutica idónea, es intentar una discontinuación del tratamiento en las pacientes candidatas adecuadas que lleven unos 3 años de tratamiento con TKI y al menos 2 años en respuesta molecular mayor.Se presenta el caso de una paciente de 33 años diagnosticada de LMC que, tras 3 de tratamiento con dasatinib decide tener un hijo. Se intenta una actitud terapéutica de discontinuación, pero se produce, antes de la concepción, una progresión de la enfermedad, que se logra controlar con interferón alfa-2a pegilado y se mantiene durante el embarazo. Tras el nacimiento del bebé, se reinicia tratamiento con dasatinib y se vuelve a conseguir una respuesta molecular mayor. (AU)

Chronic myeloid leukemia (CML) is a disease that can affect women of childbearing age with the intention of having children. The standard treatment for this neoplastic disease is tyrosine kinase inhibitors (TKIs), however, they are not indicated in case of pregnancy. The ideal pharmacotherapeutic strategy is to attempt discontinuation of treatment in suitable candidate patients who have undergone 3 years of TKI treatment and at least 2 years in a higher molecular response.We present the case of a 33-year-old patient diagnosed with CML who, after 3 years of treatment with dasatinib, decides to get pregnant. A therapeutic discontinuation approach is attempted, but progression of the disease occurs before conception, which is controlled by pegylated interferon alpha-2a and is maintained during pregnancy. After the baby is born, dasatinib treatment is restarted and a higher molecular response is achieved again. (AU)

[Antibiotic susceptibility of Streptococcus pneumoniae in healthy carrier children in Murcia (Spain)]. / Sensibilidad de Streptococcus pneumoniae en niños portadores sanos en Murcia (España).

INTRODUCTION AND OBJECTIVES: Streptococcus pneumoniae (SP) is a human pathogen that involves a high use of antibiotics. The objective of the study was to determine the susceptibility to commonly used antibiotics and their associated risk factors, in order to promote rational use of antibiotics. PATIENTS AND METHODS: In A multicentre study was conducted in summer 2009 and winter 2010 on children attending paediatric clinics in the Region of Murcia. A nasopharyngeal sample was collected and an epidemiological questionnaire was completed. The study included 1562 children aged 1 and 4 years old. RESULTS: Almost one-third (31.3%, 489/1562) of children were nasal carriers. A sensitivity study was carried out on 376 isolates, of which 343 were serotyped. Almost two-thirds (61.7%, 964/1562) of children had received at least one dose of PCV7 (heptavalent pneumococcal conjugate vaccine), and 12.8% (44/343) of the isolates belonged to PCV7 serotypes. The prevalence rates of penicillin resistance (meningitis infections criteria CMI>0.06mg/L) were 28.1%; however, this percentage was 54% in PCV7 serotypes. None of the isolates had (MIC >2mg/L), so prevalence rates of susceptibility with non-meningitis infections criteria were 100%. There was a high percentage of erythromycin resistance (45.7%). The factors favouring resistance to penicillin and cefotaxime were the consumption of antibiotics in the previous month and the carrying of vaccine serotypes. On the other hand, the age of 4 years old was a protective factor of resistance. The 14, 35B, 19A, 15A, and 19F serotypes were less susceptible to penicillin. CONCLUSIONS: Both oral amoxicillin given to outpatients and intravenous penicillin or ampicillin to hospitalized patients are excellent options for the treatment of non-meningeal infections, as seen with pneumonia in these kinds of environments, where there is low incidence of isolates highly resistant to penicillin (CMI ≥ 2mg/L).

Fractionation and amino acid composition of an aspartic acid-containing thermal proteinoid population.

The heterogeneity of an aspartic acid-containing thermal polymer population has been studied by anion exchange chromatography, amino acid analysis of the resulting fractions and data processing by the principal components method. By using stepwise or continuous gradients of ionic strength both saw-toothed or bell-shaped elution profiles were obtained. This behaviour and the amino acid composition of analyzed fractions suggest a relatively high degree of heterogeneity in the polymer population although less than theoretically expected. This conclusion is compared with the findings reported in proteinoids made by similar procedures.

[Listeria monocytogenes pneumonia: a severe complication in a patient with neoplasia]. / Neumonía por Listeria monocytogenes: una severa complicación del paciente neoplásico.

Listeriosis is a infectious disease which can affect to immunosuppressed patients. We report a case of pneumonia by Listeria monocytogenes as unusual presentation, because the central nervous system infections are the most common clinical entities. Many cases reported had a underlying disease, most commonly Hodgkin's disease, and had received immunosuppressive therapy. In our case the patient was considered to be immunosuppressed by had received corticosteroids and had been diagnosed of stage IIIa squamous cell carcinoma 3 years ago. The illness began 48 hours before the admission to hospital, he had fever, mental confusion and the location of pneumonia was right lower lobe, 24 hours later the patient die.

[Recurrent fetal loss. A multifactorial problem?]. / Pérdida gestacional recurrente. Un problema multifactorial?

The fetal recurrent loss (P.F.R.), it is a clinical disturbance associated with multiple factors, that it are in a frustrating situation so much for the couples like for the doctor. The objective was to evaluate 39 couples with P.F.R. in order to establish the responsibility of each factor and proceed to treatment I specify, considering as success the get a pregnancy with viable product. The protocol included clinical history, histerosalpingography, ultrasound, analysis cromosomal, antibodies for TORCH and antiphospholipids, test endocrine specifies, genitals cultivation and biopsy of endometrial. 23% it of the fetal losses is due to only factor; 64.2% it is due to multiple factors and 12.8% they don't have apparent factor. The infectious factors, endocrine, anatomical and autoimmunity was the more constants. Pregnancy with viable product in the 82% was achieved of the cases. We concluded that the P.F.R. it is a problem that is due to multiple factors and that it require a diagnosis-therapeutic integral focus.

[A solitary kidney patient with diarrhea of 2 weeks duration]. / Paciente monorrena con diarrea de 2 semanas de evolución.

The case is presented of a 78 year old woman with a history of congenital right renal, who suffered from diarrhea of approximately 2 weeks duration and discomfort due to cramp in both legs. The laboratory results showed severe hyperkalemia, hyponatremia, and slightly elevated creatinine levels, with no symptoms associated with this finding and with the rest of the normal laboratory results. She was admitted to the intensive care unit for treatment, and when her results returned to normal she was transferred to internal medicine. Among the other tests performed, the ACTH was shown to be high, and a left adrenal adenoma was found in the MR scan. The final diagnosis was Addison's syndrome. She was treated with mineralocorticoids with follow-up by internal medicine as an outpatient.

[Adherence and toxicity to tyrosine kinase inhibitor therapy in chronic myeloid leukemia]. / Adherencia y toxicidad de los inhibidores de la tirosinquinasa en leucemia mieloide crónica.

OBJECTIVE: To analyze adherence and toxicity of tyrosine kinase inhibitor (TKIs) therapy in patients diagnosed with chronic myeloid leukemia (CML). METHOD: A 18-months retrospective observational study (January 2011-June 2012) which included all patients diagnosed with CML in a secondary hospital (550 beds) and were treated with imatinib, dasatinib or nilotinib. It was collected the following variables: sex, age at diagnosis, years of treatment and side effects. Adherence was evaluated using SMAQ questionnaire and recording dispensations. RESULTS: 25 patients were included and all but two (92.0%) experienced side effects to imatinib,83.3% to dasatinib and 66.7% to nilotinib. The average adherence was 71.3%. There was identified as possible parameters of lack of adherence the female patients (55.6 % vs. 66.7%, p = 0.586), older than 50 (55.6 % vs. 83.3 %, p = 0.125), more than four years of treatment (70.0 % vs. 57.1 %, p = 0.521) and the presence of certain side effects (gastrointestinal disorders and musculoeskeletal pain). CONCLUSIONS: Almost one third of patients were considered nonadherent to therapy. Although the sample size did not allow us to establish a statistically significant relation between adherence and the variables analyzed, the clinical relevance of these results show the importance of future studies with larger populations to confirm the trends established in this study.

Objetivo: Analizar la adherencia y la toxicidad del tratamiento con inhibidores de tirosinquinasa (TKIs) en pacientes diagnosticados de Leucemia Mieloide Crónica (LMC). Método: Estudio observacional retrospectivo de 18 meses de duración (enero 2011-junio 2012) en el que se incluyeron todos los pacientes diagnosticados de LMC en un hospital de se - gundo nivel (550 camas) en tratamiento con imatinib, dasatinib o nilotinib. Las variables recogidas fueron sexo, edad de diagnóstico, años de tratamiento y reacciones adversas. La adherencia se valoró mediante un sistema combinado basado en el autocuestionario SMAQ y el registro de dispensaciones. Resultados: Se incluyeron un total de 25 pacientes. El 92,0% experimentaron reacciones adversas a imatinib; 83,3% a dasatinib y 66,7% a nilotinib. La adherencia media fue de 71,3%. Se identificaron como posibles parámetros de falta de adherencia el sexo femenino (55,6% vs. 66,7%, p = 0,586), mayores de 50 años (55,6% vs. 83,3%, p = 0,125), más de cuatro años de duración de tratamiento (70,0% vs. 57,1%, p = 0,521) y la presencia de determinados efectos adversos (trastornos gastrointestinales y dolor musculoesquelético). Conclusiones: Casi un tercio de los pacientes en tratamiento fueron considerados no adherentes. A pesar de que el tamaño muestral no nos ha permitido establecer relaciones estadísticamente significativos entre la adherencia y las variables analizadas, la relevancia clínica de estos resultados muestran la importancia de realizar futuros estudios con poblaciones mayores que confirmen las tendencias establecidas en este estudio.

The impact of the type of hospital on survival of multiple myeloma patients: the MICORE study.

OBJECTIVE: To analyze the impact of the type of hospital in overall survival of multiple myeloma patients. PATIENTS AND METHOD: A survival analysis was performed of all patients (n=431) diagnosed in 5 public hospitals (4 community hospitals and one university hospital) during the period 1993-2006. RESULTS: Patients attended to in community hospitals differ significantly from those seen in the university hospital in the following variables: mean age (70 years [31-92] versus 67.9 (35-91), P=.038); percentage of stage iii patients (62.6% versus 69.1%, P=.033), and percentage of patients who had autologous stem cell transplant (8.2% versus 18.2%, P=.026). The variables associated with mortality in the multivariate analysis were age (P<.001), stage (iii versus i; P=.03) and renal failure (P=.04). The type of hospital did not reach statistical significance (hazard ratio of 0.72 (95% confidence interval 0.48-1.07), P=.1]. CONCLUSIONS: The type of hospital is not significantly associated with mortality in multiple myeloma patients. These data support our current model of health care, in which the community hospitals are responsible for the primary care of these patients, in a coordinated work with the university hospital.

Paracoccidioidomicosis en un hospital monovalente / PARACOCCIDIOIDIOMYCOSIS IN A SINGLE SPECIALITY HOSPITAL

La Paracoccidioidomicosis es la micosis endémica más frecuente en América latina en enfermos HIV negativos. Objetivo: analizar las características clínicas, epidemiológicas, evolución y tratamiento de los pacientes con diagnóstico de paracoccidioidomicosis asistidos en un hospital de referencia en enfermedades infecciosas en un período de 10 años. Materiales y métodos: Estudio descriptivo y retrospectivo. Se analizaron las historias clínicas de 70 pacientes con diagnóstico de paracoccidioidomicosis en el período comprendido entre Enero de 2001 y Diciembre de 2010. Resultados: se incluyeron 70 pacientes. Cincuenta y nueve presentaron la forma crónica de la enfermedad, siete la infanto-juvenil y solo cuatro resultaron positivos para el HIV. La mayoría de los enfermos fueron de nuestro país y habían nacido en Chaco y Misiones. Veintiséis eran oriundos de Paraguay. El 81,4% de los casos tuvieron compromiso pulmonar y el patrón radiológico hilio-fugal, en "alas de mariposa", fue el más frecuente. Se observaron lesiones cutáneo-mucosas en 38,57% de los enfermos. El examen directo en fresco de esputo y la escarificación de las lesiones mucocutáneas resultó ser la prueba más útil para el diagnóstico de esta micosis endémica. La serología fue positiva en el 81,3 % de los pacientes con formas crónicas y en el 42,8% de la forma infanto-juvenil. La mayoría de los enfermos fueron tratados con itraconazol; sólo dos fallecieron. Conclusión: El diagnóstico de la paracoccidioidomicosis se basa principalmente en el examen microscópico directo; los cultivos de muestras clínicas pueden fallar. La paracoccidioidomicosis debe incluirse en el diagnóstico diferencial de los pacientes que provengan de áreas endémicas y presenten compromiso de piel, mucosas o del aparato respiratorio asociado a un síndrome infeccioso inespecífico

Paracoccidioidomycosis is the most frequent endemic mycosis in Latin America in HIV negative patients. Objective: to analyze the clinical, epidemiological and treatment characteristics and the evolution of patients with diagnosis of paracoccidioidomycosis. Materials and methods: Descriptive and retrospective study. The clinical records of 70 patients with paracoccidioidomycosis were analyzed in the period between January 2001 and December 2010. Results: 70 patients were included. Fifty-nine presented the chronic form, seven had the juvenile (acute) clinical picture and only four were HIV positive. The majority of the Argentinian patients had been born in Chaco and Misiones provinces. Twenty-six were from Paraguay. 81.4% of the patients had lung involvement, the "butterfly wing" pattern was the most frequent. Muco cutaneous lessions were observed in 38.57% of the patients. Wet mount microscopy examination of sputum and mucocutaneous scarification proved to be the most useful tests for the disease diagnosis Serology tests were positive in 81.3% of patients with the chronic form and in 42.8% of those with the juvenile clinical presentation. Most of the patients were treated with itraconazole. Only two deceased. Conclusion: The diagnosis of paracoccidiodomycosis is mainly based on direct microscopic examination of clinical smears. Cultures of clinical samples may fail. Paracoccidioidomycosis should be included in the differential diagnosis of patients who come from the endemic area and present skin, mucous membranes or respiratory system compromise associated with a non-specific infectious syndrome

Effectiveness and use of linezolid in hospitalisation wards.

OBJECTIVE: To describe the use and effectiveness of linezolid as an alternative treatment for methicillin-resistant Staphylococcus aureus. METHOD: Demographic, clinical and safety data were collected from hospitalised patients. The information sources were the clinical records and the pharmacy programme. RESULTS: Thirty patients were treated with linezolid (median age 69.3, 63% male). The median duration of treatment was 8 days. The most prevalent indication was soft tissues and skin infections (46.7%). The indications were off-label in 40% of cases. Linezolid was used as a targeted therapy in 53%, especially for coagulase-negative Staphylococcus. Clinical healing occurred in 83.3%, and microbiological healing in 40%. Three patients (10%) experienced side effects from using linezolid. CONCLUSION: The effectiveness and safety of linezolid is similar to that described in the trials. Its off-label use and the high number of empirical treatments mean that new strategies must be developed.

Influence of oleoyl-estrone treatment on circulating testosterone. Role of 17beta-hydroxysteroid dehydrogenase isoenzymes.

Overweight male rats received oral oleoyl-estrone (OE) for 10 days, and were compared with controls. The expression of 17beta-hydroxysteroid dehydrogenase (17betaHSDH) isoenzymes, and other proteins related to sex hormone metabolism, were analyzed in testicle, liver, adrenals and two white adipose sites: subcutaneous inguinal and epididymal pads using a semiquantitative RT-PCR method. Androstenedione, testosterone, estrone and estradiol levels were measured by HPLC-MS/MS. Isoenzyme expressions were grouped according to their main physiological function (oxidative or reductive) and preferred substrate (androgen or estrogen). As expected, testicle was the main site for synthesis of testosterone and estradiol, and the liver the main organ oxidizing them to androstenedione and estrone. Overall oxidative capacity was 6.5-fold higher than the reductive, and estradiol synthesis and oxidation potential were higher than for testosterone. OE decreased serum androgens, and increased estrone, but not estradiol. This was due to decreased testicle ability to produce testosterone, because of smaller size and decreased 17betaHSDH3 expression, but also to lower availability of precursors. High estrone availability (from OE hydrolysis) does not translate into higher estradiol because of decreased testicle reductive 17betaHSDH expression and decreased aromatase. In consequence, we can assume that OE effects on androgens, and the hypothalamic-pituitary-gonadal axis are limited to testicles.

Combined effects of oral oleoyl-estrone and limited food intake on body composition of young overweight male rats.

OBJECTIVE: The combined effects of limited food intake and OE treatment have been analysed in order to determine whether hypocaloric diets enhance the slimming effects of OE on mature overweight male rats. Two levels of dietary limitation at 50 and 25% of a standard intake were established, roughly corresponding to the human LCDs and VLCDs. DESIGN: Wistar male rats (6 weeks old) were made overweight by a cafeteria diet. After transition to standard diet, they were subjected to food restriction: down to 50 or 25% with respect to the transition period. Half the animals were given daily oral gavages of 10 nmol/g oleoyl-estrone (OE), and the rest received only the vehicle during 10 days. MEASUREMENTS: Changes in weight and body composition: water, lipid, protein or gross energy were determined by comparing the final pool size with that of day 0, calculated from the initial body weight and the composition of untreated rats. Energy and nitrogen balances were estimated. Plasma levels of metabolites and hormones were also measured. RESULTS: OE induced changes in body composition similar to those elicited by a 50% reduction in food, with massive loss of lipid and energy. OE-treated rats ate less than the controls, but additional effects on body composition on reduced diet were minimal. OE improved metabolic homoeostasis: better maintained glycaemia, lower cholesterol and shallower hormonal changes, but at the expense of slightly increased protein mobilisation. CONCLUSIONS: The data presented suggest that no advantages are accomplished by combining OE treatment and hypocaloric diets compared with OE alone, at least under the experimental conditions tested, since the effects were not additive. Despite OE affecting food intake, mechanisms other than that are deemed responsible for the mobilisation of body fat, since intake alone cannot explain the effects on body weight, nor the metabolic and hormonal changes in OE-treated rats. It is concluded that the combination of food restriction and OE may result in unwanted increased protein mobilisation with no synergy between both slimming treatments.

Antiplatelet effect of pentoxifylline in human whole blood.

1. Pentoxifylline inhibits platelet aggregation in whole blood more than in platelet-rich plasma. 2. An inhibition of the erythrocyte uptake of adenosine contributes to the antiaggregatory effect of pentoxifylline.

Impacto del tipo de hospital en la supervivencia de pacientes con mieloma múltiple: estudio MICORE / The impact of the type of hospital on survival of multiple myeloma patients: the MICORE study

Objetivo. Analizar el impacto del tipo de hospital en la supervivencia global de los pacientes con mieloma múltiple. Pacientes y método. Análisis de supervivencia de todos los pacientes (n=431) diagnosticados en 5 hospitales públicos (4 comarcales y uno universitario), durante el periodo 1993-2006. Resultados. Los pacientes atendidos en los hospitales comarcales difieren significativamente de los atendidos en el hospital de referencia en las siguientes variables: edad media (70 años [rango 31-92] versus 67,9 [rango 35-91]; p=0,038), porcentaje de pacientes en estadio iii (62,6 versus 69,1%; p=0,033), y porcentaje de pacientes sometidos a trasplante autólogo de médula ósea (8,2 versus 18,2%; p=0,026). En el análisis multivariante, las variables asociadas de forma significativa con la mortalidad fueron la edad (p<0,001), el estadio (iii respecto a i; p=0,03) y la insuficiencia renal (p=0,04). El tipo de hospital no alcanzó significación estadística (hazard ratio de 0,72 [intervalo de confianza al 95% 0,48-1,07], p=0,1). Conclusiones. El tipo de hospital no se asocia de forma significativa con la mortalidad en pacientes con mieloma múltiple. Estos datos apoyan el actual modelo de atención a estos pacientes, en el que los hospitales comarcales son responsables de su manejo primario, de forma coordinada con el hospital universitario (AU)

Objective. To analyze the impact of the type of hospital in overall survival of multiple myeloma patients. Patients and method. A survival analysis was performed of all patients (n=431) diagnosed in 5 public hospitals (4 community hospitals and one university hospital) during the period 1993-2006. Results. Patients attended to in community hospitals differ significantly from those seen in the university hospital in the following variables: mean age (70 years [31-92] versus 67.9 (35-91), P=.038); percentage of stage iii patients (62.6% versus 69.1%, P=.033), and percentage of patients who had autologous stem cell transplant (8.2% versus 18.2%, P=.026). The variables associated with mortality in the multivariate analysis were age (P<.001), stage (iii versus i; P=.03) and renal failure (P=.04). The type of hospital did not reach statistical significance (hazard ratio of 0.72 (95% confidence interval 0.48-1.07), P=.1]. Conclusions. The type of hospital is not significantly associated with mortality in multiple myeloma patients. These data support our current model of health care, in which the community hospitals are responsible for the primary care of these patients, in a coordinated work with the university hospital (AU)

Efectividad y uso del linezolid en planta de hospitalización / Effectiveness and Use of Linezolid in Hospitalisation Wards

Objetivo Linezolid supone una alternativa frente a Staphylococcus aureus resistente a meticilina. Describir la utilización y efectividad de linezolid. Métodos Se recogieron datos demográficos, clínicos y de seguridad de los pacientes hospitalizados. Las fuentes de información fueron las historias clínicas y el programa de gestión de farmacia. Resultados Treinta pacientes recibieron tratamiento con linezolid (mediana de edad 69,5 años, 63% varones). La mediana de días con tratamiento fue de 8. La indicación más prevalente fue infección de piel y partes blandas (46,7%). En un 40%, las indicaciones no se ajustaban a las aprobadas por la agencia reguladora. Linezolid se utilizó como tratamiento dirigido (53%) mayoritariamente frente a Staphylococcus coagulasa-negativo. La curación clínica se obtuvo en el 83,3% de los casos, y curación microbiológica en el 40%. En 3 pacientes (10%) se describieron reacciones adversas asociadas al tratamiento. Conclusión La efectividad y seguridad de linezolid es parecida a la descrita en los ensayos. Su uso fuera de indicación y el elevado número de tratamientos empíricos debe plantearnos el desarrollo de estrategias (AU)

Objective To describe the use and effectiveness of linezolid as an alternative treatment for methicillin-resistant Staphylococcus aureus. Method Demographic, clinical and safety data were collected from hospitalised patients. The information sources were the clinical records and the pharmacy programme. Results Thirty patients were treated with linezolid (median age 69.3, 63% male). The median duration of treatment was 8 days. The most prevalent indication was soft tissues and skin infections (46.7%). The indications were off-label in 40% of cases. Linezolid was used as a targeted therapy in 53%, especially for coagulase-negative Staphylococcus. Clinical healing occurred in 83.3% and microbiological healing in 40%. Three patients (10%) experienced side effects from using linezolid. Conclusion The effectiveness and safety of linezolid is similar to that described in the trials. Its off-label use and the high number of empirical treatments mean that new strategies must be developed (AU)