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Introduction This study aimed to describe utilization patterns, persistence, resource utilization and costs in patients with type 2 diabetes mellitus initiating treatment with glucagon-like peptide 1 receptor agonists in routine clinical practice in Spain. Methods This retrospective study of medical records in the Big-Pac database identified adults starting treatment with once-weekly (QW) dulaglutide, exenatide-QW or once-daily liraglutide between 1 November 2015 and 30 June 2017. Patients were followed for up to 18 months from treatment initiation. Data on clinical characteristics of patients, treatment patterns, average daily dose and costs were obtained for the three cohorts. Persistence over the 18-month period was evaluated using Kaplan–Meier curves. All analyses were descriptive. Results A total of 1402 patients were included in this study (dulaglutide [n = 492], exenatide-QW [n = 438] or liraglutide [n = 472]); 52.8% were men, and the mean (SD) age was 62 (11) years, glycated haemoglobin (HbA1c) was 8.1% (1.2) and body mass index was 35.5 (3.2) kg/m2 at treatment initiation. Persistence at 18 months was 59.1% (95% confidence interval [CI] 54.8–63.4) for dulaglutide, 45.7% (95% CI 41.0–50.4) for exenatide-QW and 46.6% (95% CI 42.1–51.1) for liraglutide. The average (SD) dose was 1.2 (0.4) mg/week for dulaglutide, 1.9 (0.3) mg/week for exenatide-QW and 1.1 (0.3) mg/day for liraglutide. The average reduction in HbA1c levels at 1 year was − 0.68% for patients who initiated dulaglutide, − 0.54% for patients who initiated exenatide-QW and − 0.50% for patients who initiated liraglutide. The mean (SD) total annual health care costs were €4072 (1946) for dulaglutide, €4418 (2382) for exenatide-QW and €4382 (2389) for liraglutide. Conclusion Results suggest that patients who started treatment with dulaglutide had higher persistence over 18 months, presented lower HbA1c levels at 12 months and incurred lower annual total healthcare costs than patients who initiated exenatide-QW or liraglutide. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-021-01039-5., Plain Language Summary Type 2 diabetes has a major impact on patients psychologically and socially, as well as on healthcare costs. The glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are drugs that help maintain blood sugar at healthy levels. They are often used as the first injectable drugs if oral treatments are no longer effective. This study aimed to analyse the use of GLP-1 RAs, and the costs involved, among patients with type 2 diabetes who started treatment with once-weekly dulaglutide, once-weekly exenatide or liraglutide in routine clinical practice in Spain. An electronic database of medical records was used to obtain data from 1402 patients who started treatment with these drugs and were followed for a 1.5-year period. Results of this study suggest that patients who were prescribed dulaglutide stayed on their treatment longer and could reduce their blood sugar levels more efficiently, and at a lower cost, than those who received once-weekly exenatide or liraglutide. These findings could be helpful to physicians prescribing these drugs when considering how to improve the management of type 2 diabetes. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-021-01039-5.

YouTube has become a large source of health information, and it has the capacity to influence users: for instance, regarding their vaccination habits. The aim of our study was to analyze the characteristics of the videos published on YouTube about the meningococcal B vaccine (4CMenB, Bexsero®). A search was made on YouTube using the keyword “Bexsero.” The association between the authorship of videos (health professionals or others) and the rest of the variables (tone of the message and vaccination recommendations, among others) was evaluated using the Chi-square test. In total, 77 videos were analyzed; 74% supported the use of the vaccine, and the most frequently mentioned vaccination recommendations were in epidemic outbreaks (28.6%) and in children (18.2%). Depending on the type of authorship, significant differences were observed regarding the tone of the message and the frequency with which the videos discussed effectiveness, dosage, adverse effects, and vaccination recommendations. There is a difficulty in obtaining information on vaccination recommendations. Recommendations are very diverse since there is a great heterogeneity in the official recommendations for the use of this vaccine, depending on the country the information is from.

Resumen Objetivo Determinar la comorbilidad y las potenciales interacciones-farmacologicas (IFs) entre los antivirales de accion-directa pangenotipicos (AADp) y la medicacion-concomitante asociada a los pacientes con hepatitis C cronica (HCC) en practica clinica habitual en Espana. Metodos Diseno observacional retrospectivo. Se incluyeron pacientes ≥ 18 anos con diagnostico de HCC, en tratamiento antiviral y visitados durante el ano 2017. Se diferenciaron 2 grupos en funcion de la edad ( www.hep-druginteractions.org ). Los AADp analizados fueron: a) sofosbuvir/velpatasvir (SOF/VEL); b) glecaprevir/pibrentasvir; y c) sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX). Analisis-estadistico bivariante: p Resultados Se reclutaron 3.430 pacientes, edad-media de 56,9 anos y el 60,3% varones. El promedio del indice Charlson fue 0,8 puntos. Distribucion por rangos de edad: 18-49 (28,9%) y ≥ 50 anos (71,1%). El promedio de medicamentos fue: 3,1 (DE: 2,6) por paciente. El porcentaje total de potenciales IFs fue: 8,6% debil, 40,5% clinicamente significativas y 10,0% medicacion contraindicada. Estas interacciones fueron mayores en los pacientes ≥ 50 anos (8,6%; 43,8% y 12,4%, respectivamente, p Conclusiones Los sujetos con HCC presentan una elevada comorbilidad y consumo de medicacion concomitante, especialmente en pacientes mayores, circunstancia que repercute en una mayor exposicion a potenciales IFs. Aunque la tasa de IFs fue considerable con las 3 combinaciones analizadas, SOF/VEL mostro una menor proporcion clinicamente relevante.

To determine the comorbidity and potential for drug-drug interactions (DDIs) among pangenotypic direct-acting-antivirals (pDAAs) and the concomitant medications associated with chronic hepatitis C (CHC) patients in routine clinical practice in Spain.Retrospective observational study. Included patients were ≥18 years, diagnosed with CHC, on antiviral treatment and required medical attention during 2017. Two groups were differentiated according to age ranges (50 and ≥50 years). The variables collected were: age, gender, general/specific comorbidity, concomitant medication and potential DDIs (www.hep-druginteractions.org). The pDAAs analysed were: a) Sofosbuvir/Velpatasvir (SOF/VEL), b) Glecaprevir/Pibrentasvir (GLE/PIB) and c) Sofosbuvir/Velpatasvir/Voxilaprevir (SOF/VEL/VOX). Bivariate statistical analysis, P.05.3,430 patients with a mean age of 56.9 years and 60.3% males were enrolled. The average Charlson index was 0.8. Age range distribution: 18-49 years (28.9%) and ≥50 years (71.1%). The average number of medications per patient/year was 3.1 (SD 2.6). The total percentage of potential DDIs was: 8.6% minor DDIs, 40.5% clinically significant DDIs and 10.0% contraindicated medication. These DDIs were greater in patients ≥50 years (8.6%, 43.8% and 12.4%, respectively, P.001). For all ages, SOF/VEL showed a lower percentage of: minor interactions (1.3% vs. 6.6% and 5.9%, P.001); clinically significant interactions (53.4%, vs. 77.4% and 66.3%, P.001) and contraindicated medication (1.7% vs. 8.3% and 10.7%, P.001) compared to GLE/PIB and SOF/VEL/VOX, respectively.Patients with CHC present high comorbidity and concomitant medication use, particularly elderly patients, thus implying a greater exposure to potential DDIs. Although the DDI rate was considerable with the three combinations analysed, SOF/VEL showed a lower number of clinically significant interactions.

There are different indications for the placement of a pleural drainage. It is indicated in a massive pneumothorax or a pleural effusion, and a tunnelled indwelling pleural catheter is put in place. As in any procedure, complications may occur. A broken catheter is a rare one, and when it occurs, it has to be removed by thoracoscopic surgery. This article describes the first case of a removal of a fractured pleural catheter in a preterm newborn with a bilateral pneumothorax using interventional radiology. We propose an alternative way less invasive that could enable a shorter recovery time with fewer complications.

Background Many factors involved in the onset and clinical course of the ongoing COVID-19 pandemic are still unknown. Although big data analytics and artificial intelligence are widely used in the realms of health and medicine, researchers are only beginning to use these tools to explore the clinical characteristics and predictive factors of patients with COVID-19. Objective Our primary objectives are to describe the clinical characteristics and determine the factors that predict intensive care unit (ICU) admission of patients with COVID-19. Determining these factors using a well-defined population can increase our understanding of the real-world epidemiology of the disease. Methods We used a combination of classic epidemiological methods, natural language processing (NLP), and machine learning (for predictive modeling) to analyze the electronic health records (EHRs) of patients with COVID-19. We explored the unstructured free text in the EHRs within the Servicio de Salud de Castilla-La Mancha (SESCAM) Health Care Network (Castilla-La Mancha, Spain) from the entire population with available EHRs (1,364,924 patients) from January 1 to March 29, 2020. We extracted related clinical information regarding diagnosis, progression, and outcome for all COVID-19 cases. Results A total of 10,504 patients with a clinical or polymerase chain reaction–confirmed diagnosis of COVID-19 were identified; 5519 (52.5%) were male, with a mean age of 58.2 years (SD 19.7). Upon admission, the most common symptoms were cough, fever, and dyspnea; however, all three symptoms occurred in fewer than half of the cases. Overall, 6.1% (83/1353) of hospitalized patients required ICU admission. Using a machine-learning, data-driven algorithm, we identified that a combination of age, fever, and tachypnea was the most parsimonious predictor of ICU admission; patients younger than 56 years, without tachypnea, and temperature 39 ºC without respiratory crackles) were not admitted to the ICU. In contrast, patients with COVID-19 aged 40 to 79 years were likely to be admitted to the ICU if they had tachypnea and delayed their visit to the emergency department after being seen in primary care. Conclusions Our results show that a combination of easily obtainable clinical variables (age, fever, and tachypnea with or without respiratory crackles) predicts whether patients with COVID-19 will require ICU admission.

Pulmonary arterial hypertension is a very infrequent disease, with a variable etiology and clinical expressivity, making sometimes the clinical diagnosis a challenge. Current classification based on clinical features does not reflect the underlying molecular profiling of these groups. The advance in massive parallel sequencing in PAH has allowed for the describing of several new causative and susceptibility genes related to PAH, improving overall patient diagnosis. In order to address the molecular diagnosis of patients with PAH we designed, validated, and routinely applied a custom panel including 21 genes. Three hundred patients from the National Spanish PAH Registry (REHAP) were included in the analysis. A custom script was developed to annotate and filter the variants. Variant classification was performed according to the ACMG guidelines. Pathogenic and likely pathogenic variants have been found in 15% of the patients with 12% of variants of unknown significance (VUS). We have found variants in patients with connective tissue disease (CTD) and congenital heart disease (CHD). In addition, in a small proportion of patients (1.75%), we observed a possible digenic mode of inheritance. These results stand out the importance of the genetic testing of patients with associated forms of PAH (i.e., CHD and CTD) additionally to the classical IPAH and HPAH forms. Molecular confirmation of the clinical presumptive diagnosis is required in cases with a high clinical overlapping to carry out proper management and follow up of the individuals with the disease. Instituto de Salud Carlos III (España) | Ref. FISPI18/01233 Xunta de Galicia | Ref. ED481A-2018/304

Our purpose was to assess a possible association of inflammatory, lipid and mineral metabolism biomarkers with coronary artery ectasia (CAE) and to determine a possible association of this with acute atherotrombotic events (AAT). We studied 270 patients who underwent coronary angiography during an acute coronary syndrome 6 months before. Plasma levels of several biomarkers were assessed, and patients were followed during a median of 5.35 (3.88&ndash, 6.65) years. Two interventional cardiologists reviewed the coronary angiograms, diagnosing CAE according to previously published criteria in 23 patients (8.5%). Multivariate binary logistic regression analysis was used to search for independent predictors of CAE. Multivariate analysis revealed that, aside from gender and a diagnosis of dyslipidemia, only monocyte chemoattractant protein-1 (MCP-1) (OR = 2.25, 95%CI = (1.35&ndash, 3.76) for each increase of 100 pg/mL, p = 0.001) was independent predictor of CAE, whereas mineral metabolism markers or proprotein convertase subtilisin/kexin type 9 were not. Moreover, CAE was a strong predictor of AAT during follow-up after adjustment for other clinically relevant variables (HR = 2.67, 95%CI = (1.22&ndash, 5.82), p = 0.013). This is the first report showing that MCP-1 is an independent predictor of CAE, suggesting that CAE and coronary artery disease may share pathogenic mechanisms. Furthermore, CAE was associated with an increased incidence of AAT.

Objective: To analyze the characteristics of YouTube videos in Spanish on the basic measures to prevent coronavirus disease 2019 (COVID-19). Methods: On 18 March 2020, a search was conducted on YouTube using the terms “Prevencion Coronavirus” and “Prevencion COVID-19”. We studied the associations between the type of authorship and the country of publication with other variables (such as the number of likes and basic measures to prevent COVID-19 according to the World Health Organization, among others) with univariate analysis and a multiple logistic regression model. Results: A total of 129 videos were evaluated; 37.2% were produced in Mexico (25.6%) and Spain (11.6%), and 56.6% were produced by mass media, including television and newspapers. The most frequently reported basic preventive measure was hand washing (71.3%), and the least frequent was not touching the eyes, nose, and mouth (24.0%). Hoaxes (such as eating garlic or citrus to prevent COVID-19) were detected in 15 videos (10.9%). In terms of authorship, papers produced by health professionals had a higher probability of reporting hand hygiene (OR (95% CI) = 4.20 (1.17–15.09)) and respiratory hygiene (OR (95% CI) = 3.05 (1.22–7.62)) as preventive measures. Conclusion: Information from YouTube in Spanish on basic measures to prevent COVID-19 is usually not very complete and differs according to the type of authorship. Our findings make it possible to guide Spanish-speaking users on the characteristics of the videos to be viewed in order to obtain reliable information.

Pneumococcal vaccination is recommended for chronic kidney disease (CKD) patients. We evaluated the impact of implementing a hospital vaccine consultation on their vaccination coverages. A sample was drawn from consecutive cases referred to our clinic between November 2014 and June 2018. 101 patients were analyzed: 4 had received the pneumococcal conjugated vaccine 13-valent at the time of the first appointment, whereas 93 had received it after being seen (RR (95%-CI) = 23.3 (8.88-60.85)). Moreover, 5 had received the pneumococcal polysaccharide vaccine 23-valent at the time of the first appointment, whereas 90 had received it after being seen (RR (95%-CI) = 18.0 (7.64-42.42)). Implementing a hospital-based vaccine consultation represents an effective intervention to improve pneumococcal vaccination coverage in these patients.

Background The internet is a large source of health information and has the capacity to influence its users. However, the information found on the internet often lacks scientific rigor, as anyone may upload content. This factor is a cause of great concern to scientific societies, governments, and users. Objective The objective of our study was to investigate the information about the prevention of coronavirus disease 2019 (COVID-19) on the internet. Methods On February 29, 2020, we performed a Google search with the terms “Prevention coronavirus,” “Prevention COVID-19,” “Prevención coronavirus,” and “Prevención COVID-19”. A univariate analysis was performed to study the association between the type of authorship, country of publication, and recommendations to avoid COVID-19 according to the World Health Organization (WHO). Results In total, 80 weblinks were reviewed. Most of them were produced in the United States and Spain (n=58, 73%) by digital media sources and official public health organizations (n=60, 75%). The most mentioned WHO preventive measure was “wash your hands frequently” (n=65, 81%). A less frequent recommendation was to “stay home if you feel unwell” (n=26, 33%). The analysis by type of author (official public health organizations versus digital media) revealed significant differences regarding the recommendation to wear a mask when you are healthy only if caring for a person with suspected COVID-19 (odds ratio [OR] 4.39). According to the country of publication (Spain versus the United States), significant differences were detected regarding some recommendations such as “wash your hands frequently” (OR 9.82), “cover your mouth and nose with your bent elbow or tissue when you cough or sneeze” (OR 4.59), or “stay home if you feel unwell” (OR 0.31). Conclusions It is necessary to urge and promote the use of the websites of official public health organizations when seeking information on COVID-19 preventive measures on the internet. In this way, users will be able to obtain high-quality information more frequently, and such websites may improve their accessibility and positioning, given that search engines justify the positioning of links obtained in a search based on the frequency of access to them.

Introduction and objectives Hereditary pulmonary veno-occlusive disease (PVOD) has been associated with biallelic mutations in EIF2AK4 with the recent discovery of a founder mutation in Iberian Romani patients with familial PVOD. The aims of this study were phenotypical characterization and survival analysis of Iberian Romani patients with familial PVOD carrying the founder p.Pro1115Leu mutation in EIF2AK4 , according to their tolerance to pulmonary vasodilators (PVD). Familial genetic screening was conducted, as well as assessment of sociocultural determinants with a potential influence on disease course. Methods Observational study of Romani patients with familial PVOD included in the Spanish Registry of Pulmonary Arterial Hypertension. Genetic screening of EIF2AK4 was performed in index cases and relatives between November 2011 and July 2016 and histological pulmonary examination was carried out in patients who received a lung transplant or died. The patients were divided into 2 groups depending on their tolerance to PVD, with comparison of baseline characteristics and survival free of death or lung transplant. Results Eighteen Romani patients were included: 9 index cases and 9 relatives. The biallelic founder mutation in EIF2AK4 was found in all affected cases and 2 unaffected relatives. Family screening showed 34.2% of healthy heterozygotes, high consanguinity, young age at childbirth, and frequent multiparity. Prognosis was bleak, with significant differences depending on tolerance to PVD. Conclusions We describe 2 phenotypes of hereditary PVOD depending on tolerance to PVD, with prognostic impact and familial distribution. Consanguinity may have a negative impact on the transmission of PVOD, with familial genetic screening showing high effectiveness.

Background and objective Pulmonary thromboendarterectomy surgery is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension; extremely high pulmonary vascular resistance constitutes a risk factor for hospital mortality. The objective of this study was to analyze the immediate and long-term results of the surgical treatment of chronic thromboembolic pulmonary hypertension in patients with very severe pulmonary hypertension. Material and methods Since February 1996, we performed 160 pulmonary thromboendarterectomies. We divided the patient population in 2 groups: group 1, which included 40 patients with pulmonary vascular resistance ≥ 1090 dyn/s/cm −5 , and group 2, which included the remaining 120 patients. Results Hospital mortality (15 vs. 2.5%), reperfusion pulmonary edema (33 vs. 14%) and heart failure (23 vs. 3.3%) were all higher in group 1; however, after one year of follow-up, there were no significant differences in the clinical, hemodynamic and echocardiographic conditions of both groups. Survival rate after 5 years was 77% in group 1 and 92% in group 2 ( p = 0.033). After the learning curve including the 46 first patients, there was no difference in hospital mortality (3.8 vs. 2.3%) or survival rate after 5 years (96.2% in group 1 and 96.2% in group 2). Conclusions Pulmonary thromboendarterectomy is linked to significantly higher morbidity and mortality rates in patients with severe chronic thromboembolic pulmonary hypertension. Nevertheless, these patients benefit the same from the procedure in the mid-/long-term. In our experience, after the learning curve, this surgery is safe in severe pulmonary hypertension and no level of pulmonary vascular resistance should be an absolute counter-indication for this surgery.

Background Studies in different autoimmune pathologies report a lower response rate (immunogenicity) to vaccinations than in the general population. Our objective is to analyze the immunogenicity of the vaccine against hepatitis B virus (HBV) in patients with multiple sclerosis (MS). Methods In a single prospective cohort of MS patients with negative HBV serology, hepatitis B (rDNA) B vaccine was administered at 0, 1 and 6 months. Immunogenicity was analyzed by the determination of antibodies to surface antigens of HBV. We considered a patient as a responder if antibodies level was higher than 10 IU/L. Posterior analysis of immunogenicity was conducted by demographic variables (e.g. MS phenotype, EDSS) and use of disease-modifying drugs (DMTs). Results Vaccination study of 251 patients: 160 of them were sero-negative (63.7%). Patients vaccinated: 99. Overall response: 74.1%. No significant relationship by sex (female 77.6% responders, male 68.8%) and MS phenotype (relapsing forms 74.3% responders, secondary progressive 50%). Variables associated with significantly lower immunogenicity were: age (>55 years), EDSS score (median: non-responders=3.0, responders=1.0), number of relapses and treatment with fingolimod (28.6% responders, n=7). Anti-CD20 therapies showed lower vaccine response (50%), but were not very represented in our sample (n=2). Immunogenicity with other DMTs: interferon/glatiramer 69.6% (n=23), teriflunomide 71.4% (n=14), dimethylfumarate 92.3% (n=13), natalizumab 100% (n=7). Conclusion The overall immunogenicity of our sample is lower than that reported in the general population (74 vs >86%), as in other autoimmune diseases. Preliminary data show a lower immunogenicity with older age, higher EDSS score, number of relapses and fingolimod use.

Pulmonary veno-occlusive disease is a rare cause of pulmonary hypertension which is part, together with pulmonary capillary hemangiomatosis, of the special designation (subgroup 1') within pulmonary hypertension group 1 in the latest classification of the pulmonary hypertension World Symposium. Recent discovery that gene mutations in eukaryotic translation initiation factor 2 alpha kinase 4 (EIF2AK4) are responsible for inherited forms of pulmonary veno-occlusive disease has changed the role of genetic testing, acquiring relevant importance in the diagnosis of these patients. Despite the advances in genetic, cellular and molecular basis knowledge in the last decade, pulmonary veno-occlusive disease remains as a rare aetiology of pulmonary hypertension without any effective medical treatment approved and poor outcomes. This document aims to review the advances occurred in the understanding of pulmonary veno-occlusive disease in the last years.

BACKGROUND Abnormalities of fibroblast growth factor-23 (FGF-23) plasma levels predict adverse outcomes in patients with coronary artery disease. However, FGF-23 has a different behaviour in the presence of type 2 diabetes mellitus (T2D). We explored whether the presence of T2D affects the predictive power of FGF-23. METHODS In 704 patients with stable coronary artery disease, FGF-23, calcidiol, parathormone (PTH) and phosphate plasma levels were prospectively assessed. The primary outcome was the development of acute ischemic events (acute coronary syndrome, stroke or transient ischemic attack), heart failure or death. RESULTS One hundred seventy-three (24.6%) patients had T2D, without differences in age, sex or estimated glomerular filtration rate as compared with non-diabetic patients. Serum PTH was lower and phosphate higher in T2D than in non-diabetic patients, without differences in FGF-23 or calcidiol levels. During follow-up (2.15 ± 0.99 years), 26 (15.2%) T2D and 51 (9.6%) non-diabetic patients developed the outcome (p = 0.048). T2D patients who developed the outcome had higher FGF-23 [112.0 (59.9, 167.6) vs 68.9 (54.2, 93.0) RU/mL; p = 0.002], PTH [71.3 (47.3, 106.6) vs 51.9 (40.8, 66.2) pg/mL; p = 0.004) and phosphate (3.53 ± 0.71 vs 3.25 ± 0.50 mg/dL; p = 0.017) levels than T2D subjects who remained stable. These differences were not significant in non-diabetic patients. By multivariable Cox proportional hazard model, FGF-23 predicted independently the outcome in T2D patients [hazard ratio = 1.277; 95% CI (1.132, 1.442)] but not in those without T2D. CONCLUSIONS FGF-23 plasma levels predict adverse cardiovascular outcomes in coronary artery disease patients who have T2D but not in those without T2D. This finding should be confirmed in larger studies. Copyright © 2016 John Wiley & Sons, Ltd.

REHAP investigators., [Introduction] REHAP is a voluntary, observational Spanish registry of patients with pulmonary arterial hypertension. We analyzed the experience (use and effectiveness) with inhaled iloprost (inh-ILO) in real-life conditions during a 3-year period., [Methods] Patients included were those with PAH ≥14 years recruited during 1998–2016 who had received inh-ILO. Variables were collected at the beginning of treatment (0 ± 3 months) and 12 ± 3/36 ± 6 months follow-up. Effectiveness was assessed in the intent-to-treat population as changes in functional class and/or physical performance and transplant-free survival from the beginning of treatment. Stopping inh-ILO-related survival was also assessed. Subanalyses included treatment strategy (first-line therapy –monotherapy or upfront combination- or sequential therapy) and risk of clinical worsening/death., [Results] Inh-ILO was the most frequently used prostanoid in Spain, rendering 267 patients eligible for analysis. Median age was 54 years; 61% were WHO FC III. Sixty (23%) patients started inh-ILO as monotherapy, 27 (10%) as upfront combination and 180 (67%) sequentially. At 3-year follow-up significant clinical improvements were observed; however, transplant-free survival rate was 54%, being poorer in patients at high risk (63% vs. 85% in low risk patients; P, [Conclusion] Data from the REHAP collected during 3 years shows that inh-ILO has low effectiveness independently of the treatment strategy used, with a 3-year survival rate of 54% despite significant clinical improvements, probably due to the use in high-risk patients. Discontinuation rate was as high as 75%., We express our gratitude to Actelion, Ferrer, GlaxoSmithKline (GSK) and Merck Sharp & Dohme (MSD) for supporting the REHAP Registry with an unrestricted educational grant.

Purpose Nuclear imaging is an important preclinical research tool to study infectious diseases in vivo and could be extended to investigate complex aspects of malaria infections. As such, we report for the first time successful radiolabeling of a novel antibody specific to Plasmodium-infected erythrocytes (IIIB6), its in vitro assessment and molecular imaging in nude mice. Procedures In vitro confocal microscopy was used to determine the stage-specificity of Plasmodium-infected erythrocytes recognised by IIIB6. To enable micro-positron emission tomography (PET)/X-ray computed tomography (CT) imaging, IIIB6 was conjugated to Bz-DFO-NCS and subsequently radiolabeled with zirconium-89. Healthy nude mice were injected with [89Zr]IIIB6, and pharmacokinetics and organ uptake were monitored over 24 h. This was followed by post-mortem animal dissection to determine the biodistribution of [89Zr]IIIB6. Results IIIB6 recognised all the relevant stages of Plasmodium falciparum-infected erythrocytes (trophozoites, schizonts and gametocytes) that are responsible for severe malaria pathology. [89Zr]IIIB6-radiolabeling yields were efficient at 84–89 %. Blood pool imaging analysis indicated a pharmacological half-life of 9.6 ± 2.5 h for [89Zr]IIIB6. The highest standard uptake values were determined at 2–6 h in the liver followed by the spleen, kidneys, heart, stomach and lung, respectively. Minimal activity was present in muscle and bone tissues. Conclusion In vitro characterization of IIIB6 and pharmacokinetic characterization of [89Zr]IIIB6 revealed that this antibody has potential for future use in Plasmodium-infected mouse models to study malaria in a preclinical in vivo setting with PET/CT imaging

Background: The knowledge of hereditary predisposition has changed our understanding of Pulmonary Arterial Hypertension. Genetic testing has been widely extended and the application of Pulmonary Arterial Hypertension specific gene panels has allowed its inclusion in the diagnostic workup and increase the diagnostic ratio compared to the traditional sequencing techniques. This is particularly important in the differential diagnosis between Pulmonary Arterial Hypertension and Pulmonary Venoocclusive Disease. Methods: Since November 2011, genetic testing is offered to all patients with idiopathic, hereditable and associated forms of Pulmonary Arterial Hypertension or Pulmonary Venoocclusive Disease included in the Spanish Registry of Pulmonary Arterial Hypertension. Herein, we present the clinical phenotype and prognosis of all Pulmonary Arterial Hypertension patients with disease-associated variants in TBX4. Results: Out of 579 adults and 45 children, we found in eight patients from seven families, disease-causing associated variants in TBX4. All adult patients had a moderate-severe reduction in diffusion capacity. However, we observed a wide spectrum of clinical presentations, including Pulmonary Venoocclusive Disease suspicion, interstitial lung disease, pulmonary vascular abnormalities and congenital heart disease. Conclusions: Genetic testing is now essential for a correct diagnosis work-up in Pulmonary Arterial Hypertension. TBX4-associated Pulmonary Arterial Hypertension has marked clinical heterogeneity. In this regard, a genetic study is extremely useful to obtain an accurate diagnosis and provide appropriate management. This project was founded by Project "Bases Gene´tico Moleculares de la Medicina de Precisio´n en la Hipertensio´n Arterial Pulmonar". Funder: Instituto Carlos III. Ministerio de Economı´a y Competitividad. https://www.isciii.es/Paginas/Inicio.aspx Award number: PI 18/01233 Grant Recipient: P E-S

INTRODUCTION Children with asthma experience recurrent respiratory symptoms and exacerbations due to multiple environmental factors. The aim of this study was to describe the prevalence and triggers of asthma exacerbations and their management in a cohort of pediatric patients attended in an emergency department (ED). METHODS We performed an observational, retrospective, single-center study in the pediatric ED of Hospital Universitario La Paz, Madrid, Spain in 2015. Children with asthma exacerbations attending the ED were included after a thorough search using our institutional computer database. Pollen and atmospheric mold spore counts and pollution data were collected for that period from official websites. Multiple logistic regression was used to assess the association between daily pollution (NO2, PM10, ozone, pollen, and molds) and admissions to the ED because of asthma. RESULTS During 2015, a total of 50 619 patients were attended in the ED of our hospital. Of these, 2609 (5%) were diagnosed with asthma exacerbation/bronchospasm. The patient had to be admitted to hospital in 21.7% of cases. The main triggers of asthma exacerbations were respiratory infection in 1841 cases (70.6%). A significant correlation was found between grass pollen counts and ED admissions (P

Introducción: la prevalencia de la diabetes mellitus tipo 2 se ha incrementado, siendo una de las primeras causas de hospitalización y de muerte en la población mayor de 45 años. Objetivo: describir las características demográficas y clínicas de los pacientes con diabetes tipo dos hospitalizados en el servicio de medicina interna durante el periodo comprendido entre octubre de 2010 y agosto de 2012 en el hospital de San José, Bogotá, Colombia. Material y métodos: se reporta una serie de casos de pacientes adultos diabéticos tipo 2 hospitalizados, independiente del motivo de ingreso. Se determinaron características demográficas, variables asociadas con la diabetes (tiempo de evolución, tratamiento, control por médico especialista y complicaciones crónicas), estancia hospitalaria, complicaciones intrahospitalarias y mortalidad. Resultados: 318 pacientes, 283 diabéticos conocidos y 35 con diabetes de novo, edad promedio 65 años ( DE 13.7). La principal causa de admisión fue enfermedad infecciosa (43%), seguido de descompensación metabólica (21%). El 81% se encontraba fuera de las metas de control metabólico. La neuropatía (68%) y la nefropatía diabética (66%) son las complicaciones crónicas más frecuentes. El 71% presentaban hipertensión arterial. Los pacientes con un mal control metabólico tuvieron una estancia hospitalaria mayor a 10 días de 17.5% respecto a 12% de aquellos con buen control metabólico. Se presentaron 17 defunciones ( 5.3%) principalmente por complicaciones infecciosas. Conclusiones: un importante número de pacientes diabéticos a su ingreso se encuentran fuera de metas de control metabólico, con una alta prevalencia de complicaciones crónicas y una mayor estancia hospitalaria. Contrario a reportes de la literatura, los pacientes diabéticos de novo no presentaron complicaciones intrahospitalarias. Introduction: the prevalence of type 2 diabetes has increased, being one of the leading causes of hospitalization and death in the population over 45 years. Objective: to describe the demographic and clinical characteristics of patients with type 2 diabetes hospitalized in the internal medicine service during the period between October 2010 and August 2012 in the Hospital San José, Bogotá, Colombia. Material and methods: a series of cases of adult patients with type 2 diabetes independent from the reason for its hospitalization, is reported. Demographic characteristics, variables associated with diabetes (time of evolution, treatment, control by specialist and chronic complications), hospital stay, hospital complications and mortality were determined. Results: 318 patients, 283 known diabetics and 35 with de novo diabetes, mean age 65 years (SD 13.7). The leading cause of hospitalization was infectious disease (43%), followed by metabolic decompensation (21%). 81% was outside the goal of metabolic control. Neuropathy (68%)and diabetic nephropathy (66%) are the most common chronic complications. 71% had arterial hypertension. 17.5% of patients with poor metabolic control had a hospital stay longer to 10 days compared to 12% of those with good metabolic control. 17 deaths (5.3%) occurred mainly due to infectious complications. Conclusions: A significant number of diabetic patients on admission are outside metabolic control goals, with a high prevalence of chronic complications and longer hospital stay. Contrary to literature reviews, de novo diabetic patients showed no hospital complications.

Infective aneurysms are rare due to the antimicrobial advances and the early treatment of systemic infections. They represent a diagnostic and therapeutic challenge. The treatment for these cases is generally characterised by excision and reconstruction using an autologous vein graft. We describe a case of a 66-year-old man who presented an 8 cm infected popliteal aneurysm where urgent surgical approach was performed. The vascular continuity was restored with a basilic vein. Clinical follow-up showed no signs of recurrent infection and patent bypass without any anastomotic pseudoaneurysm after a year.

We read with great interest the study by Hadinnapola et al1 evaluating the phenotype of eukaryotic translation initiation factor 2 alpha kinase 4 ( EIF2AK4 ) mutation carriers in a nationwide cohort of pulmonary arterial hypertension patients. We were surprised by the small number of familial cases (1/14 patients) as compared with previous reports. There is no mention of known consanguinity, frequent in autosomal recessive diseases. Our group described a founder homozygote mutation in EIF2AK4 in 18 Iberian Romani patients among 5 unrelated families with hereditary pulmonary veno-occlusive disease (PVOD). …

In secondary prevention patients, ATP III recommends strict lipid goals (LDL cholesterol

Thrombosis is frequent in patients with Behçet's disease (BD), although the exact cause remains uncertain. Some single nucleotide polymorphism (SNP) (G1691A in factor V gene, also called factor V Leiden [FVL], G20210A in prothrombin gene and C677T in methyltetrahydrofolate reductase [MTHFR] gene) have been associated with thrombosis and ocular involvement in BD with controversial results.To assess the effects of FVL, prothrombin and MTHFR SNP variants in patients with BD and thrombosis and ocular involvement by means of a systematic review and meta-analysis.We retrieved studies analyzing the genotype of the above-mentioned polymorphism among patients with BD. A meta-analysis was conducted in a random effects model and calculations of odds ratio (OR) and confidence intervals (CI) were done. Sensitivity analysis and tests for heterogeneity of the results were performed.27 previous studies analyzed the association of BD and thrombosis with the FVL, prothrombin and MTHFR polymorphisms. A significant association was found between the possession of the AA or GA genotypes of FVL polymorphism among patients with BD and the presence of any thrombosis (OR=2.51; 95% CI: 1.68, 3.74; P0.00001). In addition, a significant association was found between the possession of the GA or AA genotypes and the presence of BD (OR=2.67; 95% CI: 1.93. 3.72; P0.00001) when cases with BD and healthy controls were compared. This association was not found when studies from Turkey were excluded. No association was found between prothrombin and MTHFR SNPs and thrombosis in BD, and no association between any SNP and ocular involvement was shown either.Factor V Leiden could be responsible for some thrombotic events in at least Turkish patients. However, this relationship has to be demonstrated from a pathogenic point of view.

One of the particular characteristics of Parkinson's disease (PD) is the wide clinical variation as regards the treatment that can be found in the same patient. This occurs with specific treatment for PD, as well as with other drug groups that can make motor function worse. For this reason, the perioperative management of PD requires experience and above all appropriate planning. In this article, the peculiarities of PD and its treatment are reviewed, and a strategy is set out for the perioperative management of these patients. Resumen: Una de las características singulares de la enfermedad de Parkinson (EP) es la gran variabilidad clínica en relación con el tratamiento que puede acontecer en un mismo paciente. Esto sucede tanto con el tratamiento específico para la EP como con otra serie de fármacos que pueden empeorar la función motora. Por esta razón, el manejo perioperatorio de la EP requiere experiencia y sobre todo una planificación adecuada. En este artículo se revisan las peculiaridades de la EP y su tratamiento, y se plantea una estrategia para el perioperatorio de estos pacientes. Keywords: Parkinson's disease, Perioperative management, Perioperative risks, Palabras clave: Enfermedad de Parkinson, Manejo perioperatorio, Riesgos perioperatorios

Introduction and objectives Epistaxis has been known since antiquity. However, we have limited epidemiological data at our disposal. The aim of this study was to know the main epidemiological characteristics of the cases of epistaxis admitted and to determine the factors associated with the recurrence of bleeding. Methods A retrospective study was conducted including admissions for epistaxis in the ENT department of our hospital during the period between January 2003 and December 2008. We analysed the distribution by gender, age, location and time of year. The aetiological causes identified included systemic and local factors. We analyzed the variables related to bleeding recurrence. Results We evaluated 178 cases of epistaxis: 68% of patients were male (121/178), compared to 32% of women (57/178). The median age (p25–p75) was 65 (53–75) years. Epistaxis was most noticeable during the months of January and April. Among the systemic causes, hypertension (56%), anti-platelet treatment (23%), and anti-coagulant therapies (18.5%) predominated. Local factors were much less numerous than general ones (11% vs 68%). Recurrent bleeding was present in 14% of cases (25/178) and only the posterior location was shown to influence this variable (P Conclusions The typical pattern of the patients admitted to our department for epistaxis is a middle-aged or elderly male with underlying co-morbidity and posterior epistaxis.

Se trata de una mujer joven que consultó por dolor abdominal intenso de tres horas de evolución acompañado de náuseas y vómito que no mejoró con analgésicos ni antiespasmódicos, por lo cual acudió al médico que le formuló aines, antiespasmódicos y analgésicos sin obtener mejoría. Se interconsultó al gastroenterólogo quien realizó endoscopia de vías digestivas altas diagnosticando severa pangastritis. Recibió medicación con omeprazole y ranitidina sin aliviarse. Los laboratorios clínicos de cuadro hemático, parcial de orina, glicemia, creatinina y nitrógeno ureico no revelaron alteraciones. Un día después notaron trastornos neurológicos y cuadro convulsivo que se estudió con TAC cerebral en tres ocasiones, interpretados como normales. Los análisis del líquido cefaloraquídeo en varias oportunidades permanecen dentro de los parámetros usuales. Se cultivan con el interés de encontrar una causa infecciosa con datos negativos. En laboratorios seriados aparece hiponatremia severa, por lo cual se remite al endocrinólogo y la estudian para trastorno suprarenal cuyos resultados son normales. Se interconsulta a nefrología que ordena estudiar y descartar neuropatía. En la unidad de cuidados intensivos se maneja con anticonvulsionantes, analgésicos, antipiréticos, solución salina y antibióticos. Como no hay respuesta a la terapia indicada y los resultados del laboratorio fueron negativos para enfermedad infecciosa del sistema nervioso central o renal, le practicaron estudios ecocardiográficos con resultados normales y hemocultivos negativos. Se consulta al servicio de medicina interna que después de revisar la historia clínica realiza un examen físico detenido y analizar todos los estudios, ayudas paraclínicas y la opinión de los distintos especialistas, considera descartar porfiria intermitente aguda. Se traslada de nuevo a la UCI con resultados en orina positivos para el diagnóstico propuesto. Abreviaturas: PF, porfiria.

Background:We conducted a phase 1 trial in patients with locally advanced cervical cancer by injecting 0.5 ml of the CK2-antagonist CIGB-300 in two different sites on tumours to assess tumour uptake, safety, pharmacodynamic activity and identify the recommended dose.Methods:Fourteen patients were treated with intralesional injections containing 35 or 70 mg of CIGB-300 in three alternate cycles of three consecutive days each before standard chemoradiotherapy. Tumour uptake was determined using 99 Tc-radiolabelled peptide. In situ B23/nucleophosmin was determined by immunohistochemistry.Results:Maximum tumour uptake for CIGB-300 70-mg dose was significantly higher than the one observed for 35 mg: 16.1±8.9 vs 31.3±12.9 mg (P=0.01). Both, AUC 24h and biological half-life were also significantly higher using 70 mg of CIGB-300 (P

Lung cancer, a steadily growing problem, ranks as the first cause of tumor-related deaths in developed countries. The relation between lung cancer and smoking makes it a potentially avoidable disease. Found mainly in men, it has made alarming gains among women. The main prognostic factor is the possibility of receiving curative surgery; however, in real practice the diagnosis usually comes when the disease has reached an advanced stage, when only 20% can be treated surgically. Nonsurgical treatments based on chemo- and radiotherapy have not advanced appreciably in recent years, and 5-year survival is poor, estimated at only around 7% to 12% in Spain. Attempts must be made to improve preventive measures and early diagnosis in order to improve the prognosis for lung cancer patients.

Objective Mortality due to lung cancer in Spain is increasing continuously. The aim of the present study was to collect information on the hospital incidence of lung cancer, as well as information on clinical management, in different regions of Spain. Material and methods A prospective observational study of patients diagnosed with lung cancer in 2003 was carried out in 13 centers in 9 autonomous communities. Epidemiological, clinical, diagnostic, and therapeutic variables were assessed. Results Of a total population of 2 726 601 inhabitants (1 346 483 men and 1 380 118 women), 1064 male and 125 female lung cancer patients were included. The incidence standardized to the world population varied between 42.4/100 000 and 61.8/100 000 in men and between 1.5/100 000 and 8.6/100 000 in women. Overall, 51% were aged over 70 years, and 97.5% of the men and 32% of the women were smokers or ex-smokers. Cytologic or histologic confirmation was obtained for 93.1% of the cases (20.8% of which were small cell lung cancers and 79.2% were non-small cell lung cancers). The main initial symptoms were cough, chest pain, and weight loss. In 13.7%, lung cancer was suspected because of abnormal chest x-ray. The percentage with clinical TNM stages I and II ranged from 6.3% to 26.9%. The most common stage was stage IV in all centers. The percentage of patients undergoing surgery ranged from 2.5% to 20.6%, with a mean of 14.8% (19.9% of whom were patients with non-small cell lung cancer); 27% received palliative treatment only. Conclusions The proportion of women suffering from lung cancer increased with respect to previous studies, with notable differences among regions. Despite diagnostic improvements, the percentage of patients undergoing surgery is low, though interregional variation is considerable.

Introducción: la falla cardiaca (FC) es una de las principales causas de morbimortalidad a nivel mundial, la cual ha experimentado aumento gradual de su incidencia sin variación importante en su desenlace en las dos últimas décadas. En Colombia muy pocos estudios evalúan factores asociados a mortalidad por falla cardiaca.Métodos: estudio de cohorte prospectivo en el que se incluyeron pacientes con diagnóstico de falla cardiaca descompensada al momento del ingreso a urgencias, entre febrero de 2010 y marzo de 2013. Se calculó el tamaño de muestra y se realizó un análisis multivariado para la evaluación de los factores de riesgo asociados a mortalidad intrahospitalaria y a 30 días.Resultados: se incluyeron 462 pacientes. La mortalidad hospitalaria fue de 8.9% y a 30 días de 13.8%, en el modelo multivariado para el desenlace mortalidad intrahospitalaria se observó que la única variable con significancia estadística fue el BUN ≥43 mg/dL (OR, 3.45 [IC 95% 1.54-7.74], p= 0.003). Para la mortalidad a 30 días, la estancia hospitalaria >5 días (OR, 2.23 [IC 95% 1.20-4.12], p= 0.011), el BUN ≥43 mg/dL (OR, 2.55 [IC 95% 1.31-4.94], p= 0.005) y el NT-proBNP ≥ 4630 pg/dL (OR, 2.47 [IC 95% 1.30-4.70], p= 0.006).Conclusiones: la mortalidad intrahospitalaria de los pacientes con falla cardiaca descompensada en la población evaluada fue alta. En los análisis multivariados, se encontró que el BUN ≥ 43 mg/dL fue el único factor de riesgo independiente asociado a mortalidad intrahospitalaria; mientras que la mortalidad a 30 días se relacionó además con el NT-proBNP y la estancia hospitalaria superior a cinco días. Introduction: heart failure is one of the main causes of morbidity and mortality worldwide; it has experienced a gradual increase in incidence with no significant variation in outcome in the last two decades. In Colombia there are no studies to evaluate risk factors for mortality, which is the subject of this study.Methods: prospective cohort study in which patients with diagnosis of decompensated heart failure on admission to the emergency department between February 2010 and March 2013 were included. The sample size was calculated and a multivariate analysis was performed to evaluate the risk factors associated with in-hospital and 30-day mortality.Results: 462 patients were included. Hospital mortality was 8.9% and 30-day mortality 13.8%; in the multivariate model for hospital mortality outcome was observed that the only variable with statistic significance was BUN ≥ 43 mg/dL (OR, 3.45 [95% CI 1.54- 7.74], p = 0.003). For 30-day mortality, hospital stay > 5 days (OR, 2.23 [95% CI 1.20-4.12], p = 0.011), BUN ≥43 mg/dL (OR, 2.55 [95% CI 1.31-4.94] , p = 0.005) and NT-proBNP ≥ 4630 pg/dL (OR, 2.47 [95% CI 1.30-4.70], p = 0.006)Conclusions: in-hospital mortality in patients with decompensated heart failure in the study population was high. In multivariate analysis, it was found that BUN ≥ 43 mg/dL was the only inde-pendent risk factor associated with hospital mortality, while the 30-day mortality was also associated with NT-proBNP and hospital stay greater than five days.

The primary objective of this study was to describe and compare clinical and musculoskeletal (MS) ultrasound (US) features between psoriatic arthritis (PsA) patients treated with full and tapered dosage of biologic (b) disease-modified antirheumatic drugs (DMARDs). The secondary objective was to compare clinical and MSUS features between PsA patients treated with bDMARDs with and without concomitant synthetic (s) DMARDs. We evaluated 102 patients with PsA treated with bDMARDs. The bDMARD dosage tapering had been made in patients with a maintained remission or minimal disease activity (MDA) according to their attending rheumatologist and with the patient acceptance. The bDMARD tapering consisted of the following: increase the interval between doses for subcutaneous bDMARDs or reduction of the dose for intravenous bDMARDs. The clinical evaluation consisted of a dermatologic and rheumatologic assessment of disease activity. The presence of B-mode and Doppler synovitis, tenosynovitis, enthesopathy, and paratenonitis was investigated by a rheumatologist blinded to drug dosage, clinical assessments, and laboratory results. Seventy-four (72.5 %) patients received full dosage of bDMARDs and 28 (27.5 %) received tapered dosage. The duration with biologic therapy and with current biologic therapy was significantly higher in patients with tapered dosages (p = 0.008 and p = 0.001, respectively). We found no significant differences between clinical, laboratory, and US variables, both for BM and CD between patients with full and tapered dosage and between patients with and without concomitant sDMARD. Clinical assessment, MSUS variables, and MDA status are similar in patients receiving full and tapered dosage of bDMARDs.

Purpose The objective of this study is to determinate the relationship between the accurate information related to the diagnosis and the information that the patients know about it

La fiebre de origen desconocido se ha convertido en una entidad de alto costo que requiere disponibilidad de varias pruebas diagnósticas. Objetivo: describir las características clínicas y etiológicas de los pacientes con fiebre de origen desconocido. Materiales y métodos: estudio descriptivo tipo serie de casos, retrospectivo, de hospitalizados en el servicio de medicina interna por fiebre de origen desconocido, entre junio 1 de 2009 y marzo 31 de 2012, en los Hospitales de San José y el Infantil Universitario de San José. Resultados: población total 36 pacientes, edad promedio 42.6 años (DE 19.4), 58.3% hombres, 25% estudiantes universitarios, 66% diagnosticados en el Hospital de San José. Las etiologías más frecuentes fueron: enfermedades infecciosas (30.5%), colagenosis (19.4%), neoplásicas (11.1%), miscelánea (2.7%), no se encontró la causa en 36%. Conclusión: en nuestro estudio los pacientes fueron jóvenes con pocos antecedentes médicos. La patología infecciosa fue la más frecuente, seguida de enfermedades inflamatorias y fue imposible el diagnóstico etiológico en 36%. En algunos casos no se solicitaron exámenes que se consideran útiles. Se hace necesario tener en cuenta esta información para mejorar el abordaje diagnóstico de estos pacientes. Abreviaturas: FOD, fiebre de origen desconocido.

La deficiencia de vitamina B 12 es la causa más frecuente de anemia después del origen ferropénico. Objetivo: establecer el perfil sociodemográfico y clínico en anemia megaloblástica. Materiales y métodos: serie de pacientes hospitalizados con anemia megaloblástica entre enero 2010 y diciembre 2011 en los hospitales de San José e Infantil Universitario de San José, Bogotá DC. Resultados: 17 casos, 11 en hombres. Edad promedio 59 años (DE: 15.8 años, rango: 37-82), 88% casados, estrato dos 76.4%, pensionados 17%, con ingresos de dos salarios mínimos legales vigentes mensuales 94.1% y conviven con más de dos personas 75.4%. Siete pacientes (41.1%) con déficit combinado de ácido fólico y vitamina B12, de vitamina B 12 tres (17.6%) y de ácido fólico dos (14.2%). Las manifestaciones más frecuentes fueron anorexia (70.5%), piel seca (62.5%), glositis atrófica (29,4%) e ictericia (23.5%). Se observó asociación con enfermedad autoinmune en 17.6%, neoplasias de origen no hematológico 11.7% y consumo crónico de alcohol 35.3%. Conclusión: la mayoría pertenecieron a estrato socioeconómico bajo, con ingresos limitados y familias constituidas por más de dos personas. Las manifestaciones más frecuentes fueron digestivas, dermatológicas y neurológicas. Se encontró déficit combinado de vitamina B12 y ácido fólico, exclusivo de ácido fólico asociado con consumo crónico de alcohol y solo de vitamina B 12. Abreviaturas: AM, anemia megaloblástica.

Objectives To analyse the clinical utility and economic impact of conventional transbronchial needle aspiration (TBNA) in patients with diagnosis of bronchogenic carcinoma (BC) and mediastinal lymphadenopathies in thoracic computed tomography (CT). To assess the predictive factors of valid aspirations. Patients and methods Retrospective observational study between 2006 and 2011 of all TBNA performed in patients with final diagnosis of BC and accessible hilar or mediastinal lymphadenopathies on thoracic CT. Results We performed TBNA on 267 lymphadenopathies of 192 patients. In 34.9% of patients, two or more lymph nodes were biopsied. Valid aspirations were obtained in 153 patients (79.7%) that were diagnostic in 124 patients (64.6%). Multivariate analysis showed that factors associated with valid or diagnostic results are the diameter of the lymph node and the number of lymph nodes explored. TBNA was the only endoscopic technique that provided the diagnosis of BC in 54 patients (28.1%). Staging mediastinoscopy was avoided in 67.6% of patients. The prevalence of mediastinal lymph node involvement was 74.4%, sensitivity of TBNA was 86.2% and negative predictive value was 63.6%. Including mediastinoscopy and other avoided diagnostic techniques, TBNA saved 451.57 € per patient. Conclusions TBNA is a clinically useful, cost-effective technique in patients with BC and mediastinal or hilar lymphadenopathies. It should therefore be performed on a regular basis during diagnostic bronchoscopy of these patients.

Introducción: la falla cardíaca es una de las principales causas de consulta en urgencias y de mortalidad intrahospitalaria. Objetivo: describir el riesgo de esta última mediante dos instrumentos, a quienes ingresaron con falla cardíaca descompensada al servicio de medicina interna del Hospital de San José de Bogotá DC. Métodos: se reclutaron 155 pacientes entre marzo de 2010 y febrero de 2011, aplicando el score de riesgo GWTG-HF y el nomograma de predicción de riesgo del estudio OPTIMIZE, describiendo variables clínicas y demográficas. Se reporta la mortalidad esperada y la observada. Resultados: la edad promedio fue 72.5 (DE 12.1) años. Se documentó muerte intrahospitalaria en 7,7% (n 12). Para la estratificación de riesgo se incluyeron 146 casos. El 64,3% se clasificó en riesgo de 1 a 5% por la herramienta de la AHA y 50,7% uti­ lizando el nomograma OPTIMIZE HF. Más de la mitad de los fallecidos tenían bajo riesgo (1 % a 5 % ). No se encontró concordancia entre los métodos (Lin 0.07). Entre los fallecidos los niveles de pro BNP mayores de 12.500 pg/ml y la arritmia al ingreso fueron reportados con frecuencia. Estas variables no son tenidas en cuenta por los instrumentos utilizados. Conclusión: el uso de índices de riesgo para muerte intrahospitala­ ria puede ser una herramienta útil, pero se requieren otros estudios para aplicarlos en nuestra población.

The purpose of this study was to evaluate the coverage rates for influenza vaccination among health-care personnel (HCP), and if the reasons for accepting influenza vaccine by HCP and the frequency of vaccine-related adverse events (AEs) in 2010-2011 were different compared to 2009-2010. The AEs were detected by telephoning the worker one week after the vaccination. The coverage for seasonal vaccination in 2009-2010 was 31.0%, whereas that for 2009 pandemic influenza (H1NI) was 22.2% and 24.4% (p0.05) in 2010-2011. The most frequent reason for being vaccinated during the three campaigns was to "protect my health". Over 80.5% of the HCP reported 2009 pandemic influenza (H1N1) vaccine-related AEs compared to the 25.3% and 25.4% reporting seasonal vaccine-related AEs in 2009-2010 and 2010-2011 respectively (p0.05). None of the AEs were severe. Specific measures should be implemented in our country to recover and improve poor vaccination coverage.

Fundamento. El consumo de tabaco constituye un importante problema de salud pública a nivel mundial. Nuestro objetivo fue estimar la mortalidad atribuible al tabaquismo y su impacto sobre la mortalidad prematura en España en el año 2006. Material y métodos. Estudio descriptivo, transversal, realizado en población española > 35 años en 2006. El número de defunciones por edad, sexo y causa se obtuvo de las estadísticas vitales del Instituto Nacional de Estadística. La prevalencia de tabaquismo por edad y sexo se obtuvo de la encuesta nacional de salud. Los riesgos relativos de muerte utilizados estaban ajustados por edad, raza, nivel estudios, estado civil, tipo trabajo, consumo frutas/verduras y otros factores de confusión específicos de ciertas enfermedades. La proporción y el número de muertes atribuibles al tabaco, por sexo y grupo de edad, fueron estimadas a partir de la fracción etiológica poblacional. Asimismo, se calcularon los años potenciales de vida perdidos (APVP). Resultados. En 2006, el tabaquismo ocasionó 58.573 muertes (45.028 varones; 13.545 mujeres), que constituyeron el 16,15% de todos los fallecimientos (23,94% en hombres; 7,76% en mujeres). Según la causa, las muertes atribuibles se distribuyeron en 25.500 neoplasias malignas, 19.117 enfermedades cardiovasculares y 13.956 enfermedades respiratorias. El cáncer de tráquea-bronquios-pulmón en hombres y otras cardiopatías en mujeres fueron las que más contribuyeron a dicha mortalidad (33,9% y 30,9% de la misma). Los APVP fueron 211.251,8 (176.765,3 en hombres; 34.486,5 en mujeres). Conclusiones. El consumo de tabaco contribuye muy notoriamente a la mortalidad en España. El impacto que este hábito tiene en nuestra sociedad representa una carga inaceptable.

The present study was undertaken to examine early postnatal mortality in rat pups following exposure to butyl benzyl phthalate (BBP) during pregnancy. Seventeen pregnant rats were given 750 mg/kg bw/day of BBP by oral gavage on gestation days 13, 14, and 15, and the volume of each dose was adjusted to 5 ml/kg body weight. Four rats were given olive oil only and served as control. Natural birth was allowed to take place. One hundred and eighty-three pups were born to the experimental rats and 46 pups to the control group. Close observation of the newborn pups during the first 3 h of life revealed that all the pups in both the control and experimental groups were born alive. Only six pups from the experimental group (3.2%) died within this time period. These and four control pups were fixed and decalcified. Histological examination of the thoracic cavity of the newborn rats in both groups revealed no differences in the position or size of any of the heart chambers, ductus arteriosus, or great vessels. However, the lungs of the six experimental pups that died showed athelectasia and bronchi dilatation. The results therefore suggest that exposure to BBP of rats during pregnancy does not produce significant postnatal mortality in their offspring.

Introducción: la utilidad del Gram y cultivo de esputo para el manejo y seguimiento de los pacientes con neumonía adquirida en la comunidad (NAC) es aun controversial. Objetivo: describir la frecuencia de cambio del manejo antibiótico de acuerdo con el resultado del cultivo de esputo en enfermos hospitalizados con NAC. Tipo de estudio: descriptivo de corte transversal. Métodos: pacientes ingresados al servicio de medicina interna del Hospital de San José con diagnóstico clínico y radiológico de NAC que no requirieran manejo en UCI. Se incluyeron 86 casos en un período de cuatro meses a quienes se les aplicó al ingreso la escala de pronóstico CURB 65, la presencia o no de comorbilidades, la positividad del Gram y cultivo de esputo, la estancia hospitalaria y el cambio de antibiótico de acuerdo con el resultado del cultivo de esputo si la muestra era significativa. Resultados: el promedio de edad de la población fue 58.8 años (DS 21.7). El 45% tenía comorbilidades al ingreso y el 37% algún tipo de complicación asociada con la NAC. En la escala de CURB-65 el 52% tenía un punto, dos puntos el 27%, tres el 3.5 % y con cuatro el 2%. La respuesta a la terapia antibiótica se observó en el 85% y la frecuencia del cambio antibiótico según el reporte de cultivo ocurrió en el 10% (6/62). La mediana de días de estancia hospitalaria fue de cinco. El 95% egresó del hospital y el 5% restante fue trasladado a otro servicio. Conclusiones: el Gram y cultivo de esputo son ayudas diagnósticas de bajo costo y útiles en pacientes con NAC clasificados según las escalas de severidad de alto riesgo o neumonías severas, en donde el aislamiento del germen es crucial para dirigir la terapia antibiótica; en neumonías no severas no han demostrado mayor utilidad ya que pocas veces hay aislamiento del germen y no generan cambios en el manejo del paciente. Se debe asegurar la adecuada toma y procesamiento para aumentar la probabilidad de aislamiento. Abreviaturas: NAC, neumonía adquirida en la comunidad; DS, desviación estándar; EPOC, enfermedad pulmonar obstructiva crónica; EN, enfermedad neurológica; PSI, índice de severidad pulmonar.

La neumonía adquirida en la comunidad (NAC) continúa siendo una enfermedad grave. Más de 5.6 millones de casos ocurren al año y cerca de 1.1 millón requieren hospitalización. En el Hospital de San José se encontró durante los dos últimos años un alto porcentaje de NAC como causa de ingreso al servicio de medicina interna (37.5%). Dadas las implicaciones de la presencia de esta enfermedad, es importante conocer los gérmenes causantes y la sensibilidad a los distintos antibióticos utilizados. Realizamos un estudio descriptivo de una serie de 159 pacientes que ingresaron con diagnóstico de NAC, de abril 1 de 2003 a noviembre 30 de 2005. De ellos, 63 hombres (49.62%) y 96 mujeres (60.37%). se catalogaron 86 como NAC IIIA (54.1%), 66 como NAC IIIB (41.5%), 6 NAC IVA (3.8%) y un paciente como NAC IVB (0.6%). Se aisló el germen casual en el 8.8% de las muestras tomadas, el más frecuente Klebsiella pneumoniae (3.1%), seguido en menor porcentaje por Streptococcus pneumoniae, Staphylococcus aureus, Staphylococcus hominis y Pseudomona aeruginosa. Abreviaturas: NAC, neumonía adquirida en la comunidad; NAC I, II, III A, III B, IV A, IV B, ver Tabla 2; EPOC, enfermedad pulmonar obstructiva crónica, DM, diabetes melitis, IRC, insuficiencia renal crónica; ICC, insuficiencia cardíaca congestiva.

La gota es una enfermedad muy conocida y dentro de su gran espectro de signos y síntomas, existen unos que en pocas ocasiones se han logrado documentar; tal es el caso que hoy presentamos. Se trata de un paciente con gota que padece úlceras en miembros inferiores de larga evolución. Al ser conocido en el servicio de medicina interna de esta institución, se le realiza una biopsia de las lesiones descritas, confirmando paniculitis por gota, siendo este el quinto caso reportado en la literatura mundial.