Assessment of liver steatosis in chicken by using acoustic radiation force impulse imaging: preliminary results.

OBJECTIVE: To evaluate acoustic radiation force impulse (ARFI) imaging as a non-invasive tool for quantification of the grades of liver steatosis in chickens. METHODS: We used two different diets: a standard diet (SD group) and a hyperlipidaemic diet (HD group). The ARFI technique was performed in all the animals in the right hepatic lobe and shear wave velocity (SWV) was measured and expressed in metres per second (m/s). Plasma lipid levels were analysed. Steatosis was quantified by using semiquantitative analysis. Statistical analysis was used and Pearson's correlation coefficient was calculated. RESULTS: Mean SWV was 0.94 ± 0.16 m/s (range 0.8-1.3 m/s) in the SD group and 1.91 ± 0.25 m/s (range 1.3-2.2 m/s) in the HD group (p < 0.001). The lowest SWVs (≤1.3 m/s) corresponded to the chickens in the SD group, with 100% of the animals returning a score of 0, whereas the range of SWV in the HD group chickens was between 1.6 and 2.2 m/s. A substantial correlation was observed between SWVs with histological semiquantitative analysis of steatosis (r = 0.85, p < 0.001). CONCLUSION: ARFI imaging is a non-invasive diagnostic tool that allows discrimination between the grades of liver steatosis in chickens.

[Pancreatic tuberculosis with duodenal fistula]. / Tuberculosis pancreática con fistulización a duodeno.

Tuberculosis is a common infection worldwide. In developed countries, the incidence of this disease was low until a few years ago. However, due to the rise in immigration and HIV infection, the frequency of tuberculosis has recently shown a marked increase. Although the most frequent location of tuberculosis infection continues to be respiratory, infection in other sites, such as musculoskeletal, genitourinary, neurological and abdominal areas, has recently become more common. Abdominal infection, the most frequently described extrapulmonary localization, commonly affects the spleen, liver, ileocecal region, peritoneum, and regional lymph nodes. Tuberculosis of the pancreas is considered a rare entity.

Right ventricular dysfunction in acute pulmonary embolism: NT-proBNP vs. troponin T. / Disfunción del ventrículo derecho en la embolia pulmonar aguda: NT-proBNP frente a troponina T.

BACKGROUND AND OBJECTIVE: Dysfunction of the right ventricle (RV) is a parameter of severity in acute pulmonary embolism (PE). Echocardiographic assessment is not always possible in accident and emergency, hence the need to predict the presence of RV dysfunction using easily measurable parameters. To analyse the value of NT-proBNP and troponin T as markers of RV dysfunction in patients with acute PE. Secondarily, to assess the relationship between RV failure and clinical parameters related to PE. MATERIAL AND METHOD: Analytical, observational, cross-sectional and retrospective study comparing the values NT-proBNP, troponin T and presenting symptoms of PE among patients with and without RV dysfunction. RESULTS: One hundred seventy-two patients (52 with RV failure,120 without) were included. All symptoms occurred with similar frequency between the 2groups except dyspnea and syncope (more common in the group with RV failure). Both NT-proBNP and troponin T had significantly higher values in the group of patients with RV dysfunction. However, in the multivariate analysis, NT-proBNP had a higher explanatory value for RV failure than troponin T. CONCLUSION: NT-proBNP is a diagnostic parameter of RV dysfunction with higher sensitivity in the context of acute PE.

Effect of diet/atorvastatin on atherosclerotic lesions associated to nonalcoholic fatty liver disease in chickens.

Comparative histological examination of both liver and the supra-aortic arteries have not previously examined the consequences of atherosclerosis and nonalcoholic fatty liver disease (NAFLD), and their response to diet and atorvastatin therapy. This study evaluates the effects of diet alone or in combination with atorvastatin therapy on the progression/regression of atherosclerosis and its correlation with NAFLD. This research was performed on a cohort of chickens on standard (SD) or hyperlipidemic diets (HD), either with or without atorvastatin therapy. The development of atherosclerotic lesions was assessed by histology, immunohistochemistry and quantitative image analysis and correlated with liver histology. The lowest levels of atherosclerotic lesions were found in animals on the HD for 3 months, followed by 3 months of SD in combination with oral atorvastatin. There was a strong association between the histologic findings of atherosclerosis and those of NAFLD. These studies show that standard diet and atorvastatin therapy can positively affect both arterial and hepatic lesions, influencing the regression of the changes. These results support the hypothesis that NAFLD and atherosclerosis may be actually two aspects of a shared disease and suggest the possibility of regression of both disorders with dietary and pharmacologic manipulations.

Multidisciplinary management of Paget-Schroetter syndrome. A case series of eight patients.

Paget-Schroetter syndrome (PSS) in the context of upper extremity deep venous thrombosis (DVT) is an uncommon but potentially very serious condition affecting young, healthy adults, in which secondary post-thrombotic syndrome (PTS) can be a complication with major implications. The best treatment option remains controversial, with current guidelines recommending anticoagulation for at least 3 months. However, an incidence of PTS of approximately 50% after 6 months, 30% after 1 year and 25% after 2 years has been found using this therapeutic approach. Consequently, specialized units recommend local thrombolysis and early decompressive surgery. We describe a series of eight cases treated in this way. None of the patients showed signs of complications, and an early return to regular activities with no PTS was observed in 90% of cases.

[Design and validation of a clinical simulation method for teaching nurses to use the Emergency Severity Index for triage]. / Diseño y validación de un modelo pedagógico basado en simulación clínica dirigido a la formación de enfermería en el sistema de triaje estadounidense Emergency Severity Index.

OBJECTIVES: To design and validate a clinical simulation method for training nurses to use the Emergency Severity Index (ESI) for triage. MATERIAL AND METHODS: Descriptive, cross-sectional study carried out in the emergency department of Hospital Clínico Universitario Virgen de la Arrixaca in Murcia, Spain. The educational intervention had 3 phases focused on theory, skills, and application. The participants, who were nurses with at least a year's experience in the emergency department, numbered 55, 43, and 32 in each phase, respectively. They undertook training in ESI for triage (phase 1), participated in simulations with patient-actors (phase 2), and applied their acquired skills (phase 3). We used Cohen's K and the intraclass correlation coefficient (ICC) to compare the nurses' triage assignments to gold-standard triage assignments. RESULTS: We had data for 1100, 799, and 410 observations of performance in each phase, respectively. Agreement statistics between the nurses' performance and the gold standard were 0.68, 0.67, and 0.68 (Cohen's K) and 0.870, 0.836, and 0.811 (ICC) in each phase, respectively. These results reflect good agreement. CONCLUSION: This study supports the relevance of clinical simulations for training nurses to implement structured triage, and in particular to use the ESI. We can state that this study opens the door to further research into whether the reliability of triage can be improved by using this approach, specifically whether it can facilitate better interobserver agreement.

OBJETIVO: Diseñar y validar un modelo pedagógico articulado en torno a técnicas de simulación clínica, dirigido a formar al personal de enfermería en el sistema de triaje norteamericano Emergency Severity Index (ESI). METODO: Estudio descriptivo, transversal, realizado en el servicio de urgencias del Hospital Clínico Universitario Virgen de la Arrixaca (Murcia). Se ha estructurado en tres fases (conocimiento teórico, adquisición de habilidades y aplicabilidad), con una muestra de 55, 43 y 32 participantes respectivamente (enfermeros con experiencia mínima de 1 año en urgencias) a los que, tras una formación en triaje ESI, participaron en sesiones de simulación de triaje con pacientes-actores y, en la última fase, con pacientes reales en un escenario real. Para analizar el grado de concordancia entre el nivel adjudicado por los enfermeros y el patrón oro se utilizó el índice kappa de Cohen (K) y coeficiente de correlación intraclase (CCI). RESULTADOS: En las tres fases se obtuvieron 1.100, 799 y 410 observaciones con un grado de acuerdo, según el índice K de Cohen, de 0,68, 0,67 y 0,68, y un CCI, de 0,870, 0,836 y 0,811, respectivamente. Los resultados obtenidos expresan un grado de acuerdo y concordancia bueno. CONCLUSIONES: Este trabajo establece la pertinencia de la simulación clínica como herramienta docente en los programas de formación en técnicas de triaje estructurado y, en especial, en el sistema de triaje ESI. A partir de los resultados de fiabilidad obtenidos (concordancia interobservador), podemos afirmar que se abre una nueva vía de investigación para demostrar si esta nueva técnica es capaz de mejorar la fiabilidad en la toma de decisiones de triaje.

[Evidence of the validity of the Emergency Severity Index for triage in a general hospital emergency department]. / Evidencias de validez del sistema de triaje Emergency Severity Index en un servicio de urgencias de un hospital general.

OBJECTIVES: To determine whether the Emergency Severity Index (ESI) is valid for triage according to evidence based on classifying real patients in a general referral hospital's emergency department. MATERIAL AND METHODS: Observational, cross-sectional descriptive study carried out in the emergency department of Hospital Clínico Universitario Virgen de la Arrixaca in Murcia. Thirty-two nurses used the ESI algorithm to triage 410 patients as they arrived seeking care. The results were compared to a gold standard (a triage expert's opinion, which was later confirmed by an expert committee after discussion, if necessary, of cases for which opinions were not unanimous). We calculated sensitivity, specificity, under- and over-triage rates, as well as descriptive statistics about resource assignment, exitus, patients who left without being seen, destination on discharge, and times. RESULTS: ESI was highly correlated with resources (ρ = -0.717, P < .01) and moderately correlated with destination on discharge (ρ = -0.437, P < .01). Regarding time spent in the department, we found that patients assigned ESI levels 1 and 2 had significantly longer stays, and those assigned ESI levels 4 and 5 had significantly shorter stays (p < 0,001). Interobserver agreement was good or very good, indicating that this triage tool is reliable. CONCLUSION: This pilot of the ESI triage algorithm in the emergency department of a referral hospital found evidence supporting the system's validity.

OBJETIVO: Obtener evidencias de validez del sistema de triaje Emergency Severity Index (ESI) en una experiencia con pacientes reales en el servicio de urgencias (SU) de un hospital general. METODO: Estudio observacional, descriptivo, transversal, realizado en el SU del Hospital Clínico Universitario Virgen de la Arrixaca (Murcia). Participaron 32 enfermeros que realizaron 410 experiencias de triaje (utilizando el algoritmo del sistema de triaje ESI) en pacientes reales que acudieron a urgencias. Los resultados se compararon con un patrón oro representado inicialmente por la opinión de un experto en triaje y corroborado posteriormente por un comité de expertos tras una discusión de consenso en los casos en que fue requerido (opiniones no unánimes). Se calculó la sensibilidad, la especificidad, subtriaje, sobretriaje y los estadísticos descriptivos de las variables recursos, fallecimiento/fuga, destino y tiempo de estancia. RESULTADOS: Los recursos y el destino con el nivel ESI arrojaron correlaciones altas para la primera Rho = ­0,717, p < 0,01 y moderadas para la segunda Rho = ­0,437, p < 0,01. En el tiempo de estancia según el nivel ESI se observó que los pacientes con niveles ESI 1 y 2 fueron los que permanecieron más tiempo, y con niveles 4 y 5 los que menos, y estas diferencias fueron estadísticamente significativas (p < 0,001). El acuerdo interobservador fue bueno o muy bueno y refuerza la fiabilidad de la herramienta. CONCLUSIONES: Se han obtenido evidencias de validez en la aplicación piloto del sistema de triaje ESI en un hospital de referencia.

Intracellular retention of hepatic serpins caused by severe hyperlipidemia.

BACKGROUND: High levels of circulating lipids contribute to both the development of non-alcoholic liver steatosis (NALS) and peripheral arterial disease, leading to increased thrombotic risk. However, the effects of hyperlipidemia on hepatic proteins have barely been studied. Antithrombin is a hepatic serpin with anticoagulant and anti-inflammatory roles. The conformational flexibility of antithrombin renders it susceptible to both, genetic and posttranslational modifications. Thus, mutations and environmental factors have been shown to alter this molecule. METHODS: We used a chick model to assess the effects of hyperlipidemic diets (HD) on this conformationally sensitive molecule. We determined antithrombin activity in plasma and evaluated the histological and immunohistological features of livers from these animals. RESULTS: A HD for 6 months led to a significant intrahepatic retention and aggregation of antithrombin, which correlated with hepatic steatosis, as revealed by immunohistological analysis. Accordingly, a decrease in circulating antithrombin activity (48.71 +/- 6.35%) was observed. Other hepatic proteins, including heparin cofactor II, another anticoagulant serpin, also accumulated intracellularly. Atorvastatin and reversion to a normal diet after 3 months partially protected livers from these deleterious effects. CONCLUSIONS: Our results support that hyperlipidemia-induced NALS causes a significant intracellular aggregation of hemostatic serpins in liver, which determines a decrease in their circulating levels.