Predicting short-term mortality in patients with acute exacerbation of chronic heart failure: The EAHFE-3D scale. / Predicción de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada: escala EAHFE-3D.

INTRODUCTION AND OBJECTIVES: Prognostic scales are needed in acute exacerbation of chronic heart failure to detect early mortality. The objective of this study is to create a prognostic scale (scale EAHFE-3D) to stratify the risk of death the very short term. PATIENTS AND METHOD: We used the EAHFE database, a multipurpose, multicenter registry with prospective follow-up currently including 6,597 patients with acute heart failure attended at 34 Spanish Emergency Departments from 2007 to 2014. The following variables were collected: demographic, personal history, data of acute episode and 3-day mortality. The derivation cohort included patients recruited during 2009 and 2011 EAHFE registry spots (n=3,640). The classifying variable was all-cause 3-day mortality. A prognostic scale (3D-EAHFE scale) with the results of the multivariate analysis based on the weight of the OR was created. The 3D-EAHFE scale was validated using the cohort of patients included in 2014 spot (n=2,957). RESULTS: A total of 3,640 patients were used in the derivation cohort and 102 (2.8%) died at 3 days. The final scale contained the following variables (maximum 165 points): age≥75 years (30 points), baseline NYHA III-IV (15 points), systolic blood pressure<110mmHg (20 points), room-air oxygen saturation<90% (30 points), hyponatremia (20 points), inotropic or vasopressor treatment (30 points) and need for noninvasive mechanical ventilation (20 points); with a ROC curve of 0.80 (95% CI 0.76-0.84; P<.001). The validation cohort included 2,957 patients (66 died at 3 days, 2.2%), and the scale obtained a ROC curve of 0.76 (95% CI 0.70-0.82; P<.001). The risk groups consisted of very low risk (0-20 points), low risk (21-40 points), intermediate risk (41-60 points), high risk (61-80 points) and very high risk (>80 points), with a mortality (derivation/validation cohorts) of 0/0.5, 0.8/1.0, 2.9/2.8, 5.5/5.8 and 12.7/22.4%, respectively. CONCLUSIONS: EAHFE-3D scale may help to predict the very short term prognosis of patients with acute heart failure in 5 risk groups.

[Evaluation of the degree of adherence to the Mediterranean diet in patients with heart failure: DIME-EAHFE study]. / Valoración del grado de adherencia a la dieta mediterránea en pacientes con insuficiencia cardiaca: Estudio DIME-EAHFE.

BACKGROUND: Analyze the adherence to the Mediterranean diet (MeD) by patients with heart failure (HF) Method. We included consecutive patients diagnosed with HF in 4 hospitals. The data collected included epidemiologi-cal, comorbidities, basal situation and usual treatment. Adherence to the MeD was assessed by telephone interview with the MEDAS-14 questionnaire. RESULTS: A total of 411 patients were included: age 77 (15) years, 56% women, with a high number of risk factors and cardiovascular comorbidity, 58.9% of patients had an adequate adherence to MeD. Of the 14 dietetic items in the ME-DAS-14 the low adherence to the recommended quantity of wine (≥7 glasses/week, 14 %) and nuts (≥3 rations/week, 17%) was of note. The MEDAS-14 score was 8.9 (1.7) points. Adequate adherence to the MeD was observed in 59% of the patients. CONCLUSION: The MEDAS-14 questionnaire identified aspects which may be improved in the diet of patients with HF.

Assessment of the knowledge and perception of support of patients with heart failure SOPICA study IN SPAIN.

OBJECTIVE: To understand the perceptions of patients with heart failure (HF) concerning their disease, treatment and support, as well as the specialists who provide care after a decompensation, and to determine whether there is a relationship between the type of specialist involved in the follow-up and the medium-term prognosis. METHODS: A multicentre, prospective cohort study consecutively included patients with acute HF in the emergency department. The patients were interviewed by telephone 91-180days after their emergency department visit. We investigated the relationship between the type of specialist who performed the follow-up and the emergency department visits or hospitalisations using Cox regression models, with progressive adjustment by groups of potential confounders of these relationships. RESULTS: We interviewed 785 patients. Thirty-three percent (95%CI: 30%-36%) considered their disease mild, 64% (60%-67%) required help from third parties for daily activities, 65% (61%-68%) had no recent therapeutic changes, and 69% (67%-72%) received the same treatment in the exacerbations. The perceived support varied significantly depending on the factor under consideration (from greater to lesser: family, hospital, emergency department, health centre, religion and patient associations; p<.05 in all comparisons). Thirty-nine percent (36%-43%) of the patients with decompensations consulted directly with the emergency department, with no prior changes in treatment. At discharge, general practitioners (74%, 71%-77%) and cardiologists (74%, 70%-77%) were the most involved in the follow-up, although the specialty was not related to the prognosis. CONCLUSION: There are various aspects of the perception of patients with HF concerning their disease that are susceptible to future interventions. Patient follow-up involves various specialties, but all achieve similar results in the medium term.

En-bloc resection of the distal fibula for aneurysmal bone cyst.

A 21-year-old woman who presented with a voluminous aneurysmal bone cyst in the distal left fibula was treated with en-bloc resection. After 30 months of follow-up, the stability and range of motion of the left ankle were similar to that of the contralateral ankle.

[Eccrine pore carcinoma: an infrequent skin tumour with a high incidence in Navarra]. / Porocarcinoma ecrino: un tumor cutáneo infrecuente con alta incidencia en Navarra.

Eccrine pore carcinoma is an infrequent malign skin tumour that derives from the eccrine sweat glands, it fundamentally affects persons of advanced age, its growth is slow and it is predominantly located in the lower extremities. Its high malignancy and its potentiality for giving rise to distant metastasis makes it necessary to carry out aggressive surgical treatments with lymphadenectomies of the ganglion chains. There are no more than 300 tumours of this type described in the literature. Our study examines 9 cases detected in Navarra in the last ten years and analyses its clinical and histopathological behaviour. The chosen surgical treatment was extirpation with safety margins of 2 cm; we did not carry out prophylactic lymphadenectomies. At present the survival rate of patients is 100% and only in one of the series has a lymphatic metastasis been detected.

[Evaluation of the Program for the Prevention and Control of Tuberculosis during the period January 1993 - June 1996]. / Evaluación del Programa de Vigilancia y Control de la Tuberculosis durante el periodo enero 1993 - junio 1996.

In 1992 a Technical Commission was formed in Navarra with the participation of different specialists who drew up the Program of Vigilance and Control of Tuberculosis. We present the results of the evaluation of this program for the period from January 1993 to June 1996. In the 3.5 years of the study, 419 cases of tuberculosis were found, 317 belonging to respiratory forms and 102 to extra-respiratory forms. The annual rate of incidence of total tuberculosis, 22.8 cases per 100,000 inhabitants observed in Navarra, is the lowest of those registered at the level of the Autonomous Communities according to the TIR study of the SEPAR (acronym for Spanish Society of Pneumology and Thoracic Surgery) in 1996, and the second lowest, after Castilla-La Mancha, according to the multicentric study of the National Centre of Epidemiology. In Navarra the highest rates of incidence are produced in those over 65 years of age, following the pattern observed in the more developed countries. 13.9% of the patients with respiratory tuberculosis showed co-infection by HIV, and besides more than 90% of these were users of intravenous drugs. The percentage of immigrants, prisoners and the destitute observed in the Navarra series is lower than that found in areas such as Madrid, Barcelona or Zaragoza. 91% of the cases of respiratory tuberculosis showed bacteriological confirmation and 98% of the cases were diagnosed and treated in specialised care. Outstanding were the high follow-up of the cases until discharge and the high percentage of cures achieved, some 85.4%.

[Socioeconomic inequalities in mortality in Pamplona and Logroño (cities in the North of Spain) in the 1996-2007 period]. / Desigualdades socioeconómicas en la mortalidad en Pamplona y Logroño en el periodo 1996-2007.

BACKGROUND: The objective of this study was to describe inequalities in mortality in the cities of Logroño and Pamplona, using a socioeconomic privation index by census tract. METHODS: Deaths were geocoded using the mailing address of the Death Statistics Bulletin and, in its absence, that of the Spanish Municipal Register or the Spanish Health Card. The socioeconomic variables used to construct the deprivation index were obtained from the Spanish Population and Housing Census of 2001. Census tracts were grouped by socioeconomic deprivation quintiles. In each quintile, age-adjusted mortality rates were computed by sex and age group (0-64, ≥ 65). RESULTS: In both cities, higher mortality rates were observed in the geographical areas with higher socio-economic deprivation. This was particularly evident among men under 65 for whom a positive gradient between mortality and the deprivation index was observed. The areas with higher deprivation reached a relative risk (RR) of 1.61 (CI 95%, 1, 33-1, 92) and 1.77 (CI 95%, 1, 55-2 01) in Pamplona and Logroño respectively. Among women under 65, a RR of 1.44 (CI 95%, 1, 18-1, 74) and 1.48 (CI 95%, 1, 10-1, 95) were shown for the most depressed areas of Pamplona and Logroño respectively. CONCLUSIONS: The study highlighted inequalities in mortality associated with socioeconomic deprivation in the cities of Logroño and Pamplona. Also showed was the utility of analysing socio-economic indicators and mortality by small areas in order to identify inequality in health.

Desigualdades socioeconómicas en la mortalidad en Pamplona y Logroño en el periodo 1996-2007 / Socioeconomic inequalities in mortality in Pamplona and Logroño (cities in the North of Spain) in the 1996-2007 period

Fundamento. Describir las desigualdades en mortalidad en Logroño y Pamplona, ciudades del norte de España, utilizando un indicador de privación socioeconómica por secciones censales. Métodos. Para geocodificar la residencia de los fallecidos en base a las unidades censales se utilizó la dirección postal del Boletín Estadístico de Defunción y en su defecto la del Padrón Municipal o Tarjeta Sanitaria. Las variables socioeconómicas que componen el índice de privación se obtuvieron del Censo de Población y Vivienda de 2001. Se agruparon las secciones censales por quintiles de menor a mayor privación socioeconómica y se calcularon tasas ajustadas para la mortalidad total y para una lista de causas por sexo, grupo de edad (0-64,≥ 65) y quintil del índice de privación socioeconómico. Resultados. La comparación de la mortalidad de las zonas con menor privación socioeconómica respecto a zonas geográficas con mayor privación mostró en ambas ciudades una mayor mortalidad principalmente entre los hombres menores de 65 años. En este subgrupo se observó un gradiente positivo entre la mortalidad y el índice de privación. Las zonas situadas en el quintil de mayor privación alcanzaron un riesgo relativo (RR) de 1,61 (IC 95%, 1,33-1,92) en Pamplona y de 1,77 (IC 95%, 1,55-2,01) en Logroño. Las mujeres menores de 65 años mostraron un RR de 1,44 (IC 95%, 1,18-1,74) y de1,48 (IC 95%, 1,10-1,95) en las zonas situadas en el quintil de mayor privación de Pamplona y Logroño, respectivamente. Conclusiones. El estudio evidenció desigualdades en mortalidad asociadas a la privación socioeconómica en las ciudades de Logroño y Pamplona. También mostró la utilidad de los indicadores socioeconómicos y de mortalidad a nivel de área pequeña para identificar desigualdades en salud (AU)

Background. The objective of this study was to describe inequalities in mortality in the cities of Logroño and Pamplona, using a socioeconomic privation index by census tract. Methods. Deaths were geocoded using the mailing address of the Death Statistics Bulletin and, in its absence, that of the Spanish Municipal Register or the Spanish Health Card. The socioeconomic variables used to construct the deprivation index were obtained from the Spanish Population and Housing Census of 2001. Census tracts were grouped by socioeconomic deprivation quintiles. In each quintile, age-adjusted mortality rates were computed by sex and age group (0-64, ≥ 65). Results. In both cities, higher mortality rates were observed in the geographical areas with higher socio-economic deprivation. This was particularly evident among men under65 for whom a positive gradient between mortality and the deprivation index was observed. The areas with higher deprivation reached a relative risk (RR) of 1.61 (CI 95%, 1,33-1, 92) and 1.77 (CI 95%, 1, 55-2 01) in Pamplona and Logroño respectively. Among women under 65, a RR of 1.44 (CI95%, 1, 18-1, 74) and 1.48 (CI 95%, 1, 10-1, 95) were shown for the most depressed areas of Pamplona and Logroño respectively. Conclusions. The study highlighted inequalities in mortality associated with socioeconomic deprivation in the cities of Logroño and Pamplona. Also showed was the utility of analysing socio-economic indicators and mortality by small areas in order to identify inequality in health (AU)

Estudio de la inmunidad celular in situ en eritema discrómico perstans y vitiligo / Study in situ of the cellular immunity in erythema dyschromicum perstans and vitiligo

El Eritema Discrómico Perstans (EDP) y el Vitiligo son dos dermatosis pigmentarias cutáneas de etiología desconocida. En el presente estudio los infiltrados leucocitarios de EDP (n=10) y de Vitiligo (n=5) fueron estudiados, usando la técnica de la inmunoperoxidasa de avidinabiotina (ABC) y anticuerpos monoclonales que reconocen las siguientes subpoblaciones celulares: T-Supresor-Citotóxico (CD8=Leu-2), T-cooperadores (CD4=OKT4), T-Supresores (Leu-15), Pan T (Leu-4), Macrófagos (Leu-M3) y células de Langerhans (CD1=Leu-6); y marcadores celulares para antígeno la, Gamma Interferón, Interleucina-2 y receptor para Interleucina-2. El análisis inmunocitoquímico mostró una acumulación selectiva de células T-Citotóxicas Leu-4+, Leu-2+, Leu-15-en la epidermis tanto de EDP como de lesiones recientes de Vitiligo. Además, un aumento en el número de células de Langerhans epidérmicas Leu-6 se observó en algunos de los casos de EDP y de Vitiligo. La relación CD4/CD8 en las lesiones y en la piel no envuelta para ambos desórdenes no mostró diferencias significativas, no obstante valores menores que uno se apreciaron sólo en los infiltrados de piel lesionada. Los macrófagos en los infiltrados dérmicos de EDP se encontraban generalmente yuxtapuestos al pigmento melánico. Los linfocitos que expresaban en su superficie antígenos tipo TAC, IL-2 y Gamma Interferón, fueron muy pocas en los infiltrados dérmicos. Algunas células NK se encontraban también presentes en la epidermis enferma. Estas observaciones morfológicas sugieren una importante participación de la inmunidad celular en la discromia de diversos desórdenes pigmentarios cutáneos

Manifestaciones dermatológicas en pacientes transplantados renales / Dermatologic manifestations in renal transplanted patients

Se revisaron las historias clínicas de 121 pacientes transplantados renales desde un punto de vista clínico, sobre las afecciones dermatológicas que ellos presentaron después del transplante renal. La mayoría de estas estuvieron relacionadas con la inmunosupresión a que son sometidos estos pacientes. Ninguno de nuestros pacientes presentó neoplasias cutáneas frecuentes en este tipo de pacientes. Pensamos que los dermatólogos que trabajan en hospitales donde puedan evaluar pacientes similares deben pensar en las entidades que ellos presentan con mayor frecuencia

Uso del tegasorb y su tolerancia en la terapéutica de las úlceras en miembros inferiores / Use and tolerance of tegasorb in the treatment of ulcers in legs

Estudio sobre la efectividad y tolerancia del Tegasorb en el tratamiento de 8 úlceras crónicas de variada etiología en 6 pacientes del Servicio de Dermatología del Hospital Vargas. Nuestros resultados sugieren que el tegasorb es una alternativa terapéutica de gran efectividad y de pocos efectos colaterales, sobre todo en úlceras de escasa profundidad. El estudio se realiza mediante la observación simple durante un período de cuatro semanas