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Background: Peripheral parenteral nutrition allows repletion of acute nutrient deficiencies and could prevent further nutrition deficits before and after colorectal surgery. A randomized open study was performed to evaluate the effect of perioperative peripheral parenteral nutrition (PPN) support on postoperative morbidity after colorectal cancer surgery within an enhanced recovery program. Methods: Patients were randomized into two groups: peripheral parenteral nutrition (PPN) (with Peri-Olimel N4-E) versus conventional fluid therapy (FT). Ninety-day postoperative complications, laboratory parameters, length of hospital stay, and compliance with the ERAS protocol were assessed. Results: A total of 158 patients were analysed. The overall 90-day complication rate was 38.6% (61 patients), and 24 patients had major complications (Clavien-Dindo III-V) (15.2%). In the multivariate analysis, the intervention (PPN vs. FC) showed a protective effect against postoperative complications (p = 0.0031, OR = 0.2 (CI: 0.08-0.87)). Following ordinal regression, PPN and early oral tolerance showed a protective effect, being less likely to develop complications or to move from minor to major complications. In patients with low compliance to ERAS during the first postoperative day, PPN showed a protective effect, preventing 28% of morbidity. Conclusions: Perioperative peripheral parenteral nutrition (PPN) support with Peri-Olimel N4-E in colorectal cancer surgery associated with early oral intake could reduce postoperative complications.

Background: A poor body composition (BC) has been identified as a risk factor for patients with colorectal cancer (CRC). This study was performed to assess the effect of early peripheral parenteral nutrition (PPN) on BC in patients undergoing CCR surgery within an enhanced recovery program. Methods: Patients with normal nutritional status were prospectively included between October 2016 and September 2019, randomized into two groups (PPN with periOlimel N4-E versus conventional fluid therapy) and subsequently classified according to their preoperative CT scan into high- or low-risk BC groups. Postoperative complications and length of hospital stay (LOS) were assessed. Results: Of the 156 patients analyzed, 88 patients (56.4%) were classified as having high-risk BC according to CT measurements. PPN led to a 15.4% reduction in postoperative complications in high-risk vs. 1.7% in low-risk BC patients. In the multivariate analysis, high-risk BC was related to an OR (95% CI) of 2 (p = 0.044) of presenting complications and of 1.9 (p = 0.066) for major complications, and was associated with an increase in LOS of 3.6 days (p = 0.039). Conclusions: The measurement of patients' BC can allow for the identification of target patients where PPN has been proven to be an effective tool to improve postoperative outcomes.

Introduction: Our aims were to investigate the adherence to national guidelines of initial antiretroviral therapy (ART) in the Spanish multicenter CoRIS cohort during the years 2010-2015, to identify the reasons for the prescription of nonrecommended treatments, and to explore the role of institutional constraints to guideline compliance. Methods: ART regimens were classified as recommended, alternative or nonrecommended according to the guidelines. Physicians were asked the reasons for prescribing nonrecommended regimens. Factors associated with the prescription of non recommended regimens were assessed using multivariable logistic regression. Results: During the study period, 586 (10.7%) of 5479 patients who started ART were given a regimen not recommended in the guidelines. The most frequent reasons for prescribing nonrecommended regimens were: enrolment in clinical trials (43.3%), comorbidities and/or interactions (10.2%), pregnancy (8.7%), and cost (7.7%). Among 37 participating centers, 16 (43%), treating 3561 patients, reported limitations related with the cost of ART, and 20 (54%), treating 1365 patients, reported restrictions for prescribing at least one recommended antiretroviral. In multivariable analysis, a higher risk of receiving nonrecommended regimens was associated with male gender, HIV acquisition by heterosexual transmission, low viral loads, initiation of treatment during the years 2011 to 2015, and initiation of treatment in a center with restricted access to at least one antiretroviral drug. Conclusions: Compliance to clinical guidelines was high. A high proportion of centres reported cost limitations for ART or restricted access to at least one recommended antiretroviral drug, with a significant impact on the choice of initial regimens. (C) 2019 Elsevier Espafia, S.L.U. and Sociedad Espaliola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.

Outcomes of people living with HIV (PLWH) developing non-AIDS events (NAEs) remain poorly defined. We aimed to classify NAEs according to severity, and to describe clinical outcomes and prognostic factors after NAE occurrence using data from CoRIS, a large Spanish HIV cohort from 2004 to 2013.

Although different factors have been implicated in the CD4/CD8 T-cell ratio recovery in HIV-infected patients who receive effective antiretroviral therapy (ART), limited information exists on the influence of the regimen composition. A longitudinal study carried out in a prospective, single-center cohort of HIV-infected patients. ART regimens including non-nucleoside reverse transcriptase inhibitors (NNRTI), protease inhibitors (PI), or integrase strand transfer inhibitors (INSTI) from patients who achieved long-term (=6-month duration) virological suppression (HIV-RNA < 400 copies/mL) from January 1998 to June 2014 were analyzed. The impact of ART composition on the changes of the CD4/CD8 T-cell ratio was modeled using a mixed linear approach with adjustment for possible confounders. A total of 1068 ART regimens from 570 patients were analyzed. Mean (SD) age of the patients was 42.15 (10.68) years and 276 (48.42%) had hepatitis C virus (HCV) coinfection. Five hundred fifty-eight (52.25%) regimens were PI-based, 439 (40.10%) NNRTI-based, and 71 (6.65%) INSTI-based; 487 (45.60%) were initial regimens, 476 (44.57%) simplification, and 105 (9.83%) salvage regimens. Median (IQR) number of regimens was 1 (1-2) per patient, of 29 (14-58) months duration, and 4 (3-7) CD4/CD8 measurements per regimen. The median baseline CD4/CD8 ratio was 0.42, 0.50, and 0.54, respectively, with the PI-, NNRTI-, and INSTI-based regimens (P = 0.0073). Overall median (IQR) increase of CD4/CD8 ratio was 0.0245 (-0.0352-0.0690) per year, and a CD4/CD8 ratio =1 was achieved in 19.35% of the cases with PI-based, 25.97% with NNRTI-based, and 22.54% with INSTI-based regimens (P = 0.1406). In the adjusted model, the mean CD4/CD8 T-cell ratio increase was higher with NNRTI-based regimens compared for PI-based (estimated coefficient for PI [95% CI], -0.0912 [-0.1604 to -0.0219], P = 0.009). Also, a higher CD4/CD8 baseline ratio was associated with higher CD4/CD8 increase in the adjusted model (P = 0.001); by contrast, higher age (P = 0.020) and simplification of ART regimen (P = 0.003) had a negative impact on the CD4/CD8 ratio. Antiretroviral regimen composition has a differential impact on the CD4/CD8 T-cell ratio; NNRTI-based regimens are associated with enhanced CD4/CD8 T-cell ratio recovery compared to PI-based antiretroviral regimens.

[Objectives]: We aimed to assess the usefulness of measuring serum levels of adalimumab (ADL) and anti-ADL antibodies in 57 patients with rheumatoid arthritis (RA) treated with ADL for at least 3 months in daily practice. [Methods]: All patients received concomitant disease-modifying anti-rheumatic drug (DMARD). Receiver-operator characteristics (ROC) analysis was used to obtain the cut-off value of ADL for low disease activity (DAS28-ESR ≤3.2). [Results]: Anti-ADL antibodies were detected in 4 (7%) patients with a mean (SD) DAS28 score of 4.6 (0.9). Patients with positive anti-ADL antibodies had significantly lower levels of ADL and higher DAS28 scores than those with negative antibodies. Patients with DAS28 ≤3.2 as compared with patients with DAS28 >3.2 showed significantly better SDAI score, higher serum concentrations of ADL and none of them showed anti-ADL antibodies. The cut-off of serum level of ADL for DAS28 11.3 mg/L. Patients in the medium group were closed to clinical remission (median DAS28 2.7) and patients in the high group were on clinical remission (DAS28 2.1). [Conclusion]: Serum levels of ADL should be maintained >4.3 mg/L. In patients with ADL levels >11.3 mg/L, a decrease of the dose of ADL or an increase in the interval between doses may be planned. The presence of anti-ADL antibodies was associated with a loss of clinical efficacy of ADL.

La osteopetrosis es un término que engloba a un grupo heterogéneo y poco frecuente de enfermedades heredables caracterizados por un aumento de la densidad ósea resultante de una anormal diferenciación o disfunción osteoclástica. Existen múltiples variantes de la enfermedad con presentación clínica heterogénea: desde el paciente asintomático hasta formas fatales en la infancia. En muchos casos el diagnóstico es guiado por los hallazgos característicos radiológicos, como en el caso que presentamos a continuación.

Trabajo presentado al 14th Annual European Congress of Rheumatology celebrado en Madrid (España) del 12 al 15 de junio de 2013.-- Grupo AIRE-MB.

Trabajo presentado al 39 Congreso Nacional de la Sociedad Española de Reumatología, celebrado en Tenerife del 22 al 24 de Mayo de 2013.

Trabajo presentado al 39 Congreso Nacional de la Sociedad Española de Reumatología, celebrado en Tenerife del 22 al 24 de Mayo de 2013., [Objetivos]: Conocer las características de los pacientes con osteoporosis grave y la prevalencia de fractura vertebral y/o de cadera de los pacientes procedentes del Registro de la Unidad de Densitometría Ósea de Reumatología (RUDOR) de la Marina Baixa. [Material y métodos]: De un total de 3.630 pacientes a los que se les realiza densitometría ósea (DMO) axial (lumbar y cadera), procedentes de la UDOR del Hospital Marina Baixa, desde su puesta en funcionamiento en el año 2010, se evalúa en este estudio a los pacientes con osteoporosis (OP) grave, definida por la presencia de fractura vertebral o cadera o un índice de T en DMO de columna lumbar o de cuello femoral de, [Resultados]: De 3.630 pacientes evaluados, 873 (24%) tenían OP lumbar o en cuello femoral y 403 de ellos (46%), OP grave. De los pacientes con OP grave: el 92% de los pacientes eran mujeres y el 47% no recibía tratamiento específico para OP; En el 62%, Reumatología había remitido al paciente para DMO, en el 23% Atención Primaria y el 5% restante Traumatología. [Conclusiones]: 1. La prevalencia de fractura vertebral conocida y de fractura de cadera en el total de nuestra muestra es de 6,6% y 2% y en pacientes con OP por DMO grave es del 11% y 4% respectivamente. 2. El 13% de los pacientes con OP grave recibe corticoides. 3. El 23% de los pacientes con fractura vertebral o de cadera tienen un Tscore en columna lumbar

Trabajo presentado al 14th Annual European Congress of Rheumatology celebrado en Madrid (España) del 12 al 15 de junio de 2013.-- Grupo AIRE-MB.

Trabajo presentado a la XIV Conferencia Española de Biometría celebrada en Ciudad Real del 22 al 24 de Mayo de 2013.-- Grupo AIRE-MB., We propose a set of Ordered Logistic Regressions to establish different risk patterns for Lumbar Spine Osteoporosis. Patterns are created by the additive combination of different risk factors which influence Osteoporosis significantly.

[ES] Objetivo: Describir los resultados del estudio comparativo entre las 2 versiones de un inmunoanálisis comercializado para la monitorización terapéutica de adalimumab (ADA) en artritis reumatoide (AR). Material y métodos: Se han analizado 140 muestras de suero de pacientes con AR tratados con ADA 40 mg cada 14 días con las 2 versiones del ensayo (V1 o anterior y V2 o actualizada). Resultados: Se obtuvo una buena correlación con las dos versiones. En general, V2 proporciona resultados más altos de concentración de ADA que V1 y presenta una mayor precisión en el rango de concentraciones próximas al nivel de decisión clínica, ajustándose más a la concentración real del fármaco en sangre. Además, permite la automatización completa, lo cual simplifica mucho el análisis, y reduce significativamente la variabilidad. Conclusión: La monitorización de ADA con la versión actualizada demostró tener ventajas técnicas significativas, pudiendo ser una herramienta más práctica para la toma de decisiones terapéuticas en pacientes con AR.

Trabajo presentado al 39 Congreso Nacional de la Sociedad Española de Reumatología, celebrado en Tenerife del 22 al 24 de Mayo de 2013.

Trabajo presentado al 39 Congreso Nacional de la Sociedad Española de Reumatología, celebrado en Tenerife del 22 al 24 de Mayo de 2013.