Focal and segmental glomerulosclerosis in adults: early clinical course and prognostic factors for short-term outcome / Glomeruloesclerosis focal y segmentariaenadultos: evoluciónclínicatemprana y factorespronósticos de resultados a cortoplazo

ABSTRACT Background: Primary focal and segmental glomerulosclerosis progresses to end-stage renal disease in every other patient, and therefore determinants of its long-term outcome have been extensively studied. Immediate response to treatment has been regarded as a positive prognostic predictor and short-term manifestation of the disease could affect its determinants. Therefore, we have sought to assess the early clinical course of primary adult focal and segmental glomerulosclerosis and analyze its prognostic factors. Methods: We have retrospectively assessed clinical course of primary focal and segmental glomerulosclerosis ("not otherwise specified" histological variant) in 84 adults. Renal function was expressed as serum creatinine concentration and equilibrated glomerular filtration rate (MDRD equation). Proteinuria was expressed as protein to urinary creatinine ratio, assessed in the morning voiding sample. The evaluation of these parameters was performed every 3 months after diagnosis. Statistical analysis was achieved using package Statistica. Results: As result of treatment, complete remission of proteinuria, was attained in 30 subjects (35.7%), partial remission in 37 persons (44%), whereas in 17 patients protein excretion rate remained unchanged (20.2%). The severity of glomerular injury, at initial presentation of the disease, correlated with its early (12 months) outcome: patients attaining early complete remission have had the lowest initial proteinuria, higher serum albumin and total protein concentrations than those who have failed to achieve remission. Pharmacotherapy with prednisone, but not with calcineurin inhibitors or mycophenolate mofetil was demonstrated to significantly affect achievement of remission. Conclusions: Early remission of proteinuria in response to treatment is feasible in 44% of patients with primary focal and segmental glomerulosclerosis, it is best achieved in subjects presenting with mild glomerular injury, and in patients treated with prednisone. Higher serum albumin and total protein concentrations predict better response to induction of remission.

RESUMEN Antecedentes: La glomeruloesclerosis focal y segmentaria se convierteennefropatía terminal enuno de cada dos pacientes, por lo que losfactoresdeterminantes de susdesenlaces a largo plazohansidoobjeto de muchosestudios. La respuestainmediata al tratamiento se considera un factor pronóstico favorable, y las manifestaciones a cortoplazo de la enfermedadpuedenafectarlosfactoresdeterminantes. Portodoello, hemosbuscadoevaluar la evoluciónclínicatemprana de la glomeruloesclerosis focal y segmentariaprimaria, y analizarsusfactorespronósticos. Material y métodos: Hemosrealizado un estudioretrospectivo para evaluar la evoluciónclínica de la glomeruloesclerosis focal y segmentariaprimaria (variantehistológica "sin otraespecificación") en 84 pacientesadultos. Se evaluó la función renal a través de la creatininasérica y filtrado glomerular equilibradocalculadomediante la ecuación MDRD. La proteinuria se expresócomorelaciónproteína/creatininaurinaria, evaluadaen la muestramiccionalmatutina. La evaluación de estosparámetros se realizócada 3 mesesdespués del diagnóstico. El análisisestadístico se logróutilizando el paqueteStatistica. Resultados: Como resultado del tratamiento, se obtuvounaremisióncompleta de la proteinuria en 30 sujetos (35,7%), unaremisiónparcialen 37 personas (44%), mientras que, en 17 pacientes, la tasa de excreción de proteínas se mantuvo sin cambios (20,2%). En la presentacióninicial de la enfermedad, la gravedad de la lesión glomerular se correlacionó con suresultadotemprano (12 meses): lospacientes que lograronunaremisióncompletatempranamostraronlosnivelesmásbajos de proteinuria inicial, y concentracionesmásaltas de albúminasérica y proteínastotales que aquellos que no alcanzaron la remisión. Se demostró que la farmacoterapia con prednisona -pero no con inhibidores de calcineurina o micofenolato de mofetilo- condiciona de forma significativa el logro de la remisión. Conclusiones: La remisióntemprana de la proteinuria enrespuesta al tratamientoesfactibleen el 44% de lospacientes con glomeruloesclerosis focal y segmentariaprimaria; se obtienenmejoresresultadosensujetos que presentanunalesión glomerular leve y enpacientestratados con prednisona. Las concentracionesmásaltas de albúminasérica y proteínastotalespredicenunamejorrespuesta para inducir la remisión.

Factors Affecting the Prognosis of Women with Liver Dysfunction in the Third Trimester of Pregnancy / 中山大学学报(医学科学版)

@#【Objective】To explore the effects of liver dysfunction in the third trimester of pregnancy on maternal outcomes and identify the factors affecting the maternal prognosis.【Methods】We collected the clinical data of 1 113 women with liver dysfunction in the third trimester of pregnancy （case group） and 1 113 normal pregnancies （control group） from the Third Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2018. We compared the rates of cesarean section，premature delivery，placental abruption，postpartum hemorrhage and maternal mortality in the two groups，conducted the univariate and multivariate analysis for the case group and determined the prognostic risk factors by using Logistic regression. Receiver operating characteristic（ROC）curve analysis was applied to estimate the value of each independent risk factor for predicting liver dysfunction-related maternal mortality. 【Results】The rates of cesarean section，premature delivery，placental abruption，postpartum hemorrhage in the case group were higher than those in the control group（P < 0.05），and the odds ratios（ORs）were 3.59 ，7.81 ，10.68 and 2.93 ，respectively. The maternal mortality in the case group（1.2%）was higher than that in the control group（0.0%）（P < 0.05）. Logistic analysis revealed that high total bilirubin（TBIL），low prothrombin activity（PTA）and low fasting plasma glucose（FPG）were independent risk factors for liver dysfunction- related maternal mortality. The ROC curve analysis indicated that when TBIL was 235.4 μmol/L，the Youden′ s index in maximum was 0.331 with sensitivity of 0.818 and specificity of 0.513. When PTA was 20.5% ，the Youden′ s index in maximum was 0.366 with sensitivity of 0.821 and specificity of 0.545. When FPG was 3.11 mmol/L，the Youden′s index in maximum was 0.405 with sensitivity of 0.769 and specificity of 0.636.【Conclusion】Liver dysfunction in the third trimester of pregnancy has adverse effects on maternal outcomes. TBIL ，PTA and FPG are the factors affecting the maternal prognosis and may have certain predictive value for maternal death.

Caracterización clínica, patológica y epidemiológica de pacientes con carcinoma diferenciado de tiroides / Clinical, pathological and epidemiological characterization of patients with thyroid differentiated carcinoma

Introducción: El diagnóstico y tratamiento de pacientes con nódulo de tiroides son un desafío clínico, instrumental, imagenológico y patológico, y a pesar de que no representan un problema de salud en Cuba, afecta a un grupo importante de la población, fundamentalmente en edad laboral. Objetivo: Determinar las características clínicas, patológicas y epidemiológicas de pacientes con carcinoma bien diferenciado de tiroides. Métodos: Se realizó un estudio descriptivo y transversal de 30 pacientes con cáncer bien diferenciado de tiroides, operados en el Hospital Oncológico Conrado Benítez García de Santiago de Cuba, desde enero de 2014 hasta julio de 2017 y que recibieron tratamiento oncoespecífico, para lo cual se revisaron las historias clínicas y los informes de biopsia de cada uno. Resultados: En la serie predominaron las mujeres de 40-49 años de edad, los afectados de piel mestiza y negra, el aumento de volumen de la glándula, los nódulos hipoecogénicos, el tumor papilar, además de la infiltración capsular y la permeabilización vascular entre los factores pronósticos histológicos más comunes. Conclusiones: Existen elementos clínicos, epidemiológicos e imagenológicos para diagnosticar un presunto carcinoma bien diferenciado de tiroides.

Introduction: The diagnosis and treatment of patients with thyroid node are a clinical, instrumental, imagenological and pathological challenge, and although they does not represent a health problem in Cuba, they affect an important populational group, fundamentally in working periods. Objective: To determine the clinical, pathological and epidemiological characteristics of patients with well differentiated carcinoma of thyroid. Method: A descriptive and cross-sectional study of 30 patients with well differentiated cancer of thyroid, operated in Conrado Benítez García Oncological Hospital belonging to Santiago de Cuba was carried out from January, 2014 to July, 2017 and who received onchospecific treatment , for which the medical records and the biopsy reports were reviewed from each patient. Results: In the series the 40-49 year-old women , those patients affected of mestizo and black skin, the increase of the gland volume, the hypoechogenic nodules and the papillary tumor prevailed, besides the capsular infiltration and the vascular permeabilization among the most common histological prognosis factors. Conclusions: Clinical, epidemiological and imagenological elements exist to diagnose a presumed well differentiated carcinoma of thyroid.

Factores pronósticos de supervivencia en pacientes con reanimación cardiopulmonar en un servicio de emergencias / Survival prognosis factors in patients with cardiopulmonary reanimation in an emergency service

Introducción: Los factores que influyen en que el paciente sobreviva luego de una reanimación cardiopulmonar hasta el alta hospitalaria no han sido descritos con certeza. Objetivo: Identificar los factores relacionados con la supervivencia al alta hospitalaria en pacientes que recibieron reanimación cardiopulmonar en un servicio de emergencias. Métodos: Se realizó un estudio analítico de cohortes, prospectivo, en 76 pacientes que recibieron reanimación cardiopulmonar en la Unidad de Cuidados Intensivos Emergentes del Hospital Provincial Docente Clínico-Quirúrgico Saturnino Lora Torres de Santiago de Cuba, de enero del 2016 a igual mes del 2018. Resultados: En el análisis univariado los factores que de manera independiente se asociaron a la supervivencia fueron el origen cardíaco (76,5 por ciento), el trazado electrocardiográfico de fibrilación ventricular-taquicardia ventricular sin pulso (64,7 por ciento), la no prolongación de la ventilación y la ausencia de sepsis (con 88,2 por ciento cada uno). Conclusiones: Se identificaron la recuperación neurológica y la no necesidad de drogas vasoactivas como los factores que influyeron directamente en la sobrevida hasta el alta hospitalaria

Introduction: The factors influencing in the survival of the patient after a cardiopulmonary reanimation up to the hospital discharge have not been described with accuracy. Objective: To identify the factors related to the survival at discharge in patients who received cardiopulmonary reanimation in an emergency service. Methods: An analytic cohorts prospective study was carried out in 76 patients who received cardiopulmonary reanimation in the Intensive Care Emergent Unit from Saturnino Lora Torres Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, from January, 2016 to same month of 2018. Results: In the univariate analysis the associated factors to survival in an independent way were the heart origin (76.5 percent), the pattern of ventricular fibrillation/ ventricular tachicardia without pulse (64.7 percent), the non-continuation of ventilation and the sepsis absence (with 88.2 percent each of them). Conclusions: The neurological recovery and unnecessary use of vasoactive drugs were identified as the directly influencing factors in the survival up to the hospital discharge

The effect of perioperative fluid therapy on early postoperative pulmonary complications after orthotopic liver transplantation / 中华外科杂志

Objective@#To investigate the effect of perioperative fluid therapy on early postoperative pulmonary complication (PPC) after orthotopic liver transplantation (OLT).@*Methods@#The clinical data of 132 patients who underwent OLT in the First Affiliated Hospital of Xi′an Jiaotong University from April 2016 to December 2017 were analyzed retrospectively. These patients included 96 males and 36 females, aged (47.3±9.6) years (range: 24-69 years). Based on the clinical manifestations, laboratory and imaging findings of patients in ICU and PPC occurrence within 7 days after OLT surgery, the patients were divided into 2 groups: non-PPC group and PPC group. Univariate and multivariate logistic regression analyses were used to evaluate the association between perioperative variables and PPC. The Kaplan-Meier method was used to estimate cumulative survival of recipients with or without PPC within 2-years.@*Results@#During the follow-up, 11 patients (8.3%) died and 72 patients (54.5%) developed PPC after operation. There were 34 cases, 6 cases, 3 cases, 4 cases, 15 cases, 6 cases and 4 cases of only pleural effusion, only pulmonary edema, only pneumonia, pleural effusion with pneumonia, pleural effusion with pulmonary edema, pleural effusion with atelectasis, and pleural effusion with pneumonia and pneumonia in PPC, respectively. Univariate analysis showed that the preoperative factors (model for end-stage liver disease score), the intra-operative factors (duration of surgery, total infusion volume, total blood products) and the postoperative cumulative fluid balance within the first 24 h, 48 h, and 72 h were the prognosis factors of PPC (P<0.05). At least two out of the first three postoperative days with a fluid balance of ≤-500 ml was a protective factor. Using multivariate analysis by Logistic regression, only the red blood units >10 U (OR=3.55, 95% CI: 1.35-9.26, P=0.010) and the cumulative fluid intake >12 L (OR=2.98, 95% CI: 1.14-7.80, P=0.026) within the first 72 h after operation were independent prognosis factors of PPC after OLT. Kaplan-Meier analysis showed that the cumulative survival rate was lower in PPC group than that in non-PPC group (χ2=6.590, P=0.01).@*Conclusion@#Massive red blood cell transfusion and the cumulative fluid volume >12 L during perioperative 72 hours are independent prognosis factors of PPC after OLT.

Factores pronóstico de mortalidad asociados al síndrome de insuficiencia respiratoria aguda por ventilación mecánica / Mortality prognosis factors associated with the acute respiratory failure due to mechanical ventilation

Se realizó una investigación descriptiva, de serie de casos, de 31 pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, de enero de 2014 a igual mes de 2017, quienes presentaron el síndrome de insuficiencia respiratoria aguda, con vistas a describir los factores pronóstico de mortalidad por esta causa. En la serie predominaron el sexo masculino, la edad promedio de 57 años y la hipertensión arterial como enfermedad crónica asociada. La mayoría de los pacientes recibía ventilación mecánica previa al diagnóstico, en la modalidad controlada por volumen, y en un menor número se aplicaron maniobras de incorporación alveolar. La insuficiencia respiratoria moderada de causa extrapulmonar figuró en pacientes con ventilación prolongada, en tanto la complicación más frecuente fue la disfunción multiorgánica, que además resultó la principal causa de muerte. Finalmente, no se encontró relación directa entre la presencia de estos factores pronóstico de mortalidad y la probabilidad de fallecer.

A descriptive investigation, of cases series, in 31 patients admitted in the Intensive Care Unit of Saturnino Lora Torres Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, was carried out from January, 2014 to same month in 2017, who presented acute respiratory failure, with the aim of describing the mortality prognosis factors for this cause. In the series the male sex, the average age 57 year-old and hypertension prevailed as associated chronic diseases. Most of the patients received mechanic ventilation previous to the diagnosis, in the modality controlled through volume, and in a lower number maneuvers of alveolar incorporation were applied. The moderate respiratory failure of extrapulmonar cause was present in patients with prolonged ventilation, as long as the most frequent complication was the multiple organs dysfunction which was also the main cause of death. Finally, there was no direct relationship between the presence of these mortality factors prognosis and the probability of dying.

Análisis estadístico implicativo en la determinación de factores pronósticos del estado nutricional del paciente grave al egreso / Statistical analysis involving the determination of prognosis factors for the nutritional state of the severely ill patient at discharge

Se realizó un estudio de casos y controles, no balanceado, anidados en una cohorte, de pacientes atendidos en la Unidad de Cuidados Intensivos e Intermedios del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, con la doble finalidad de identificar los factores pronósticos que incidieron en el estado nutricional al egreso de estos y además evaluar la utilidad del análisis estadístico implicativo en la identificación de dichos factores. En el procesamiento de los datos se emplearon dos técnicas: la regresión logística, con la cual se identificaron como factores de mal pronóstico la ventilación mecánica, la infección intrahospitalaria, el tratamiento quirúrgico y la estadía prolongada; y el análisis estadístico implicativo, con el que se detectaron el estado nutricional al ingreso, la infección intrahospitalaria, la ventilación mecánica y la estadía prolongada. El análisis estadístico implicativo mostró mayor probabilidad de identificar factores pronósticos, con buenos resultados en los indicadores de eficacia estimados

An unbalanced cases and control study, nested in a cohort, of patients assisted in the Intensive and Intermediate Care Unit of Saturnine Lora Torres Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba was carried out, with the double purpose of identifying the prognosis factors that impacted in the nutritional state at their discharge and also to evaluate the usefulness of the statistical analysis for the identification of these factors. In the processing of data two techniques were used: the logistical regression analysis, with which the mechanical ventilation, the intrahospital infection, the surgical treatment and the prolonged stay were identified as bad prognosis factors; and the statistical analysis, with which the nutritional state at admission, the intrahospital infection, the mechanical ventilation and the prolonged stay were detected. The statistical analysis showed a higher probability of identifying prognosis factors, with good results in the effectiveness calculated indicators

Progress of predicting response to immunosuppressive therapy in aplastic anemia / 中华实用儿科临床杂志

Aplastic anemia is a severe hematological disease characterized by bone marrow failure and pancyto-penia.Immunosuppressive therapy(IST)with antithymocyte globulin(ATG)and cyclosporine A(CSA)is the first -line treatment for patients who lack an HLA -matched sibling.One third of the patients has no response to IST and the high risk of ATG -related adverse effects may lead to ATG -related death.So it is necessary to explore the predictive marker of response to IST.A defined predictive marker may make the selection of treatment more reasonable and further improve the long -term efficacy.The relevant literatures were analyzed and summarized in recent years,in order to pro-vide a reference for clinical treatment and a baseline for prospective studies.

The analysis of prognostic factors for postoperative patients with foot drop caused by lumbar degenerative disease / 中国脊柱脊髓杂志

Objectives:To analyze the clinical result and the prognostic factors for postoperative patients with foot drop caused by lumbar degenerative disease.Methods:2341 patients who suffered from lumbar degenerative disease and underwent lumbar surgery from January 2011 to January 2016 were reviewed,among which 125 cases suffered from foot drop and caused by lumbar spinal stenosis(LSS) or lumbar disc herniation (LDH).Among the 125 patients,108 cases were enrolled with complete follow-up.All patients underwent modified PLIF and nerve roots decompression.The mean follow-up period was 2.4±1.5 years(range,1.4-5.2 years).Patients whose tibialis anterior(TA) muscle strength recovered to grade 4 or grade 5,the ankle could move freely,with a relative normal gait,could be considered as recovery.The following indexes were included in the single factor analysis by Log-rank test:age,gender,type of lumbar degeneration,duration of palsy,preoperative tibialis anterior strength,physical sensation disorder of affected lower limbs,number of affected limbs,preoperative VAS score,cauda equine syndrome,affected levels and history of trauma.Cox regression analysis was used to analyze the prognostic factors of surgical treatment effect.Results:Among 108 cases of patients with foot drop,59 cases were cured,the recovery rate was about 54.6％.Among them,44 cases were LSS,and 15 cases were cured,the rate was 34.1％;64 cases were LDH,44 cases were cured,the rate was 68.7％.The single factor analysis showed that age,type of lumbar degeneration,duration of palsy,preoperative TA muscle strength and number of affected limbs had significant relation with prognosis (P＜0.05).The Cox regression analysis showed the following indexes were the prognostic factors of foot drop:age,type of lumbar degeneration,duration of palsy and preoperative TA muscle strength(P＜0.05).Conclusions:Age,type of degeneration,duration of palsy and preoperative TA muscle strength are significantly related to the prognosis of foot drop caused by lumbar degenerative disease.Patiets with younger age,shorter duration,stronger TA muscle strength recover better;compared with LSS,foot drop caused by LDH recover better.

Factores pronósticos de mortalidad por peritonitis secundaria en pacientes ingresados en una unidad de cuidados intensivos / Mortality prognosis factors due to secondary peritonitis in patients admitted in an intensive care unit

Se realizó un estudio observacional y analítico, de casos y controles, de 77 pacientes con peritonitis agudas secundarias, ingresados en la Unidad de Cuidados Intensivos del Hospital Clinicoquirúrgico Universitario "Dr. Ambrosio Grillo Portuondo" de Santiago de Cuba, en el período de enero del 2014 a igual mes del 2016, para identificar los factores pronósticos de mortalidad en ellos. Entre los principales resultados se obtuvo un predominio de las perforaciones como causa de muerte y del sexo femenino entre los fallecidos. Se encontró una elevada especificidad para el índice de Mannheim y no existió asociación entre la edad, la necesidad de repetir la laparotomía, la presencia de sepsis y las enfermedades metabólicas y las inmunosupresoras con la probabilidad de morir. Los factores pronósticos con significación estadística relacionados con la probabilidad de morir por una peritonitis secundaria, fueron el estado físico, el tiempo preoperatorio y la disfunción múltiple de órganos.

An observational and analytic cases and controls study of 77 patients with acute secondary peritonitis, admitted in the Intensive Care Unit of "Dr. Ambrosio Grillo Portuondo" University Clinical Surgical Hospital in Santiago de Cuba was carried out, in the period of January, 2014 to same month of 2016, to identify the prognosis factors of mortality in them. A prevalence of perforations as cause of death and prevalence of the female sex in the dead patients were obtained among the main results. A high specificity for the Mannheim index was found and association didn't exist between the age, the necessity to repeat laparotomy, the sepsis presence and the metabolic and immunosuppressive diseases with the probability of dying. The prognosis factors with statistical significance related to the probability of dying due to a secondary peritonitis were the physical status, the preoperative time and the multiple organs dysfunction.

Carcinomas de cabeza y cuello, experiencia de un centro oncológico del estado de Durango, México / Head and neck carcinomas, experience of a cancer center in the state of Durango, Mexico

Antecedentes: los carcinomas de cabeza y cuello son relativamente frecuentes, presentan diversos tipos histológicos y características clínicas, mismas que se asocian con una variedad de riesgos de mortalidad. Objetivo: El propósito de este trabajo fue examinar en un periodo de cinco años carcinomas de cabeza y cuello tratados en el Centro Estatal de Cancerología. Material y métodos: Este estudio se realizó de manera retrospectiva, se revisaron factores de riesgo y tratamientos, se hicieron análisis univariados y multivariados para evaluar factores pronóstico y supervivencia. Resultados: Se obtuvieron un total de 32 expedientes que cumplían con las características del estudio, el periodo de seguimiento fue de 2 a 32 meses. La variante histológica predominante fue carcinoma epidermoide, el tratamiento primario más común fue cirugía. Conclusiones: La supervivencia en los carcinomas de cabeza y cuello disminuye en pacientes en etapas clínicas avanzadas, edad e historia de tabaquismo y/o alcoholismo, la mayoría de ellos muere por progresión de enfermedad y metástasis.

Introduction: carcinomas of the head and neck are relatively common.They include diff erent histological types and present a rangeof clinical characteristics, and are associated with diverse risks of mortality. Objective: To perform a casuistic review of cases of head andneck carcinomas over a period of fi ve years at a State Cancer Center.Material and method: A retrospective study was conducted, in whichrisk factors and treatments were analyzed. Univariate and multivariatestatistical analyses were performed for the purpose of evaluatingprognostic and survival factors. Results: A total of 32 fi les were foundto meet the criteria required by the study. Patient follow-up ranged from2 to 32 months. The predominant histological variant identifi ed wasthe squamous cell carcinoma, while the most common primary treatment was surgery. Conclusions: This study shows that survival fromhead and neck carcinomas decreases in patients who are in advancedclinical stages, particularly those of a certain age with a history ofsmoking and/or alcohol use, most of whom die from the progression and metastasis of the disease.

Analysis of the clinical characteristics and its prognostic factors for hilar cholangiocarcinoma with exaire-sis / 实用肿瘤学杂志

Objective To investigate the clinical characteristics and its prognostic factors for hilar cholangiocarcinoma with exairesis .Methods The clinical data of 58 cases of hilar cholangiocarcinoma were ret-rospectively analyzed .The Kaplan-Meier method was used to estimate the overall survival and disease specific survival rates for these patients .And the factors that may influence the prognosis and survival of patients were an -alyzed using univariate(log-rank test)and multivariate Cox proportional hazard models .Results The median survival time was 22 months for all patients .The 1-,3-and 5-year survival rates were 76%,40%and 21%, respectively.Univariate analysis showed that preoperative albumin (P=0.002),intraoperative blood loss (P=0.039),surgical method(P =0.006),histologic differentiation(P =0.001),portal vein encroached(P =0.014),surgical margin(P=0.020)were correlated factors for postoperative survival duration .Multivariate analy-sis by Cox Proportional Hazard Model showed that surgical method (P=0.022),histologic differentiation(P=0.020)were independent prognostic factors for patients with Hilar cholangiocarcinoma excised .Conclusion Low albumin leve,intraoperative blood loss more than 500 mL,low degree of tumor differentiation,portal vein en-croached ,radical surgery ,positive surgical margin are risk factors for total survival of Hilar cholangiocarcinoma .

Enfermedad de parkinson: criterios diagnósticos, factores de riesgo y de progresión, y escalas de valoración del estadio clínico / Parkinson's disease: diagnostic criteria, risk factors and progression, and assessment scales clinical stage

La enfermedad de Parkinson es la segunda enfermedad degenerativa más común en el mundo después del Alzheimer. En Colombia hay una prevalencia estimada de 4,7 (IC95%: 2,2 a 8,9) por 1,000 habitantes y se detecta con mayor frecuencia en personas mayores de 60 años, lo que representa un alto costo para las familias y para el sistema de salud. Actualmente se utilizan para el diagnóstico los criterios del Banco de Cerebros del Reino Unido, sin embargo, hay otros criterios que pueden ser útiles para proyectos de investigación. Se ha demostrado que hay múltiples factores de riesgo y de progresión asociados con la enfermedad, y que deben tenerse en cuenta durante la evaluación clínica, la cual debería siempre realizarse en conjunto con las escalas de seguimiento.

Parkinson's disease is the second most common degenerative disease in the world after Alzheimer's disease. Colombia has an estimated prevalence of 470 (95% CI 2.2 to 8.9) per 1,000 people, more frequently found in people over 60 years, which represents a high financial burden imposed on families and health care system. The criteria currently used for the diagnostic are those compiled in the Brain Bank of the UK; however, other criteria may be useful for research. There are multiple risk and progression factors which have been proven to have an association with parkinson's disease, and that should be considered during clinical assessment, which should always be carried out additionally with follow scales.

The prognosis research of gerontal patients with lung squamous carcinoma in surgical therapy / 重庆医学

Objective To explore influence factors of gerontal patients with lung squamous carcinoma after surgical therapy . Methods 210 gerontal patients with lung squamous carcinoma were accepted surgical therapy and adjuvant therapy ,and were fol-lowed up .The survival rates of 1 ,3 and 5 years after the surgery were evaluated by Kaplan-Meier ,and influence factors were ana-lyzed by Cox regression .Results The 1 ,3 and 5 years survival rates were 89 .0% ,68 .6% and 56 .2% ,respectively .The survival rates were significantly influenced by the smoking history ,the abnormal degree of mediastinal lymph node ,TNM stage ,the class number of lymph node dissection ,and the class number of mediastinal lymph node dissection(P<0 .05) .The smoking history(χ2 =16 .198 ,P=0 .000) ,the abnormal degree of mediastinal lymph node(χ2 =8 .873 ,P=0 .003) ,TNM stage(χ2 =18 .718 ,P=0 .000) , and the class number of mediastinal lymph node dissection (χ2 =4 .897 ,P=0 .027) were the influence factors of prognostic .Conclu-sion The accurate TNM staging and mediastinal lymph node with image examination could be more appropriate to operative indica-tions ,meanwhile ,if smoking was controlled ,the class number of mediastinal lymph node dissection was more .These could be bene-ficial to the survival .

Factores pronósticos en la hemorragia cerebral intraparenquimatosa / Prognosis factors in the cerebral intraparenchymal hemorrhage

Se realizó un estudio descriptivo y prospectivo de 116 pacientes con hemorragia cerebral intraparenquimatosa, comprobada a través de la tomografía axial computarizada, con vistas a precisar los factores pronósticos predeterminados y su influencia sobre la mortalidad en la casuística. Entre los principales resultados sobresalió el predominio de los grupos de 41-50 y 51-60 años (57,7 % entre ambos), la hipertensión arterial como antecedente patológico personal (79,3 %), así como la ocurrencia de hemorragias en los hemisferios cerebrales (45,6 %). En la serie, 49,1 % de sus integrantes presentaban hematomas con volumen de hasta 30 mL y 7,7 % con el doble de ese contenido. Se observó una relación directa entre el volumen de sangre en el parénquima cerebral por encima de 60 mL y el pronóstico final de los afectados.

A descriptive and prospective study of 116 patients with cerebral intraparenchymal hemorrhage, shown through the computerized axial tomography (CAT) was carried out, aimed at specifying the predetermined prognosis factors and their influence on the mortality in the case material. Among the main results there were: the prevalence of the 41-50 and 51-60 year groups (57,7 % between both), hypertension as personal pathological history (79,3%), as well as the occurrence of hemorrhages in the cerebral hemispheres (45,6 %). In the series, 49,1 % of the patients presented haematomas with volume of up to 30 mL and 7,7 % with the double of that content. A direct relation was observed between the blood volume in the cerebral parenchyma above 60 mL and the final prognosis of those affected.

Factores pronósticos de mortalidad por sepsis severa en unidades de cuidado crítico del área metropolitana de Bucaramanga / Association between prognosis factors and mortality in Bucaramanga

Objetivo: El objetivo del presente artículo fue evaluar los factores de riesgo para mortalidad por sepsis severa en cuatro instituciones de cuidado crítico de la ciudad, estudiando variables socio-demográficas, clínicas y microbiológicas. Materiales y métodos: Estudio de cohorte de 150 pacientes admitidos a unidad de cuidado crítico de cuatro unidades del área metropolitana de Bucaramanga, con diagnóstico de sepsis severa o choque séptico. Fueron estudiados mediante un cuestionario sobre variables socio-económicas, clínicas y microbiológicas. Se realizó análisis bivariado con pruebas t de student y chi cuadrado. El análisis multivariado mediante regresión de Cox con el tiempo al evento como variable de desenlace. Resultados: Los pacientes sobrevivientes tuvieron un promedio de edad de 64 años y los no sobrevivientes de 67 años, sin que se demostraran diferencias estadísticas entre los dos grupos de pacientes. No se encontraron diferencias en cuanto al género. El factor de riesgo más importante asociado a mortalidad por sepsis fueron las complicaciones durante la hospitalización, incluso luego de ajustar por el puntaje SOFA inicial, el sitio de infección y los indicadores de respuesta inflamatoria como la hiperlactatemia e hiperbilirrubinemia. Conclusiones: Se encontraron tres modelos de riesgo para mortalidad por sepsis con otras complicaciones durante la hospitalización como el factor de riesgo más relevante y el control glicémico como el factor de protección más importante. [Niño ME, Torres D, Cárdenas ME, Godoy AP, Moreno N, Sanabria V, et al. Factores pronósticos de mortalidad por sepsis severa en unidades de cuidado critico del área metropolitana de Bucaramanga. MedUNAB 2012; 15:7-13].

Objective: We evaluated cases of severe sepsis to search prognosis factors of mortality in our area. Methods: Cohort study of 150 patients admitted in critical care unit from four clinical centers of the city with severe sepsis or shock septic. We analyzed socio-demographic characteristics, clinical and microbiological factors. Bivariate analysis and cox regression model was realized for found prognosis factors. Results: Patients who survived was 64 years old compared with no surviving patients who was 67 years old, there are not differences in sex between them. A risk factor for mortality was complications in hospital after ajust for sofa score, infection site, hyperlactatemia and hyperbilirrubinemia. Conclusion: We found three models of risk for mortality by sepsis, with other complications in hospital as an important factor and glicemic control as a most important protection factor of mortality. [Niño ME, Torres D, Cárdenas ME, Godoy AP, Moreno N, Sanabria V, et al. Association between prognosis factors and mortality in Bucaramanga MedUNAB 2012; 15:7-13].

Prognosis Factors of Clostridium difficile Associated Diarrhea / 감염과화학요법

BACKGROUND: Clostridium difficile associated diarrhea (CDAD) has a wide range of clinical manifestations. The prognostic factors of CDAD are not fully understood. MATERIALS AND METHODS: A retrospective cohort study of 115 patients with CDAD from Aug. 2002 to Dec. 2003 was conducted to evaluate prognostic factors of CDAD. Bacteriologic factors were determined by detecting the binary toxin gene, tcd A, tcd A rep and tcd B gene. Poor prognosis was defined as diarrhea more than 10 days even with classic treatment, recurrence, death, and moribund discharge. RESULTS: Approximately 79% of isolated strains were toxin A+/B+ strains and 21% were toxin A-/B+ strains. There was no difference in prognosis between toxin A+ and toxin A- strains. 39 (33.9%) cases showed poor prognosis and 76 (66.1%) cases showed good prognosis. Univariate analyses revealed that the poor prognostic factors were old age over 70 years old, male, the number of antibiotics used after onset of symptom, the administration of carbapenems, aminoglycosides, glycopeptides after onset of symptom, history of DM and stroke, and high Charlson comorbidity index. Multiple logistic regression analysis identified old age over 70 years old (odds ratio=3.378, P=0.009) and the administration of carbapenems after onset of symptom (odds ratio 7.210, P< 0.001) as the independent poor prognostic factors. CONCLUSION: Old age over 70 and the administration of carbapenems after onset of symptom were the poor prognostic factors for CDAD caused by none-binary toxin producing strains.

Prognosis Factors of Clostridium difficile Associated Diarrhea / 감염과화학요법

BACKGROUND: Clostridium difficile associated diarrhea (CDAD) has a wide range of clinical manifestations. The prognostic factors of CDAD are not fully understood. MATERIALS AND METHODS: A retrospective cohort study of 115 patients with CDAD from Aug. 2002 to Dec. 2003 was conducted to evaluate prognostic factors of CDAD. Bacteriologic factors were determined by detecting the binary toxin gene, tcd A, tcd A rep and tcd B gene. Poor prognosis was defined as diarrhea more than 10 days even with classic treatment, recurrence, death, and moribund discharge. RESULTS: Approximately 79% of isolated strains were toxin A+/B+ strains and 21% were toxin A-/B+ strains. There was no difference in prognosis between toxin A+ and toxin A- strains. 39 (33.9%) cases showed poor prognosis and 76 (66.1%) cases showed good prognosis. Univariate analyses revealed that the poor prognostic factors were old age over 70 years old, male, the number of antibiotics used after onset of symptom, the administration of carbapenems, aminoglycosides, glycopeptides after onset of symptom, history of DM and stroke, and high Charlson comorbidity index. Multiple logistic regression analysis identified old age over 70 years old (odds ratio=3.378, P=0.009) and the administration of carbapenems after onset of symptom (odds ratio 7.210, P< 0.001) as the independent poor prognostic factors. CONCLUSION: Old age over 70 and the administration of carbapenems after onset of symptom were the poor prognostic factors for CDAD caused by none-binary toxin producing strains.

Impacto pronóstico de la anemia en insuficiencia cardiaca aguda / Prognostic impact of anemia in acute heart failure

Background and aim. Studies performed on selected patients in other countries have shown that anemia is frequently associated with heart failure and results in a worse prognosis. We sought to determine the prognosis significance of hemoglobin I anemia in patients with acute heart failure which required management with hospital admission. Material and Methods. We analysed 412 patients diagnosed with acute heart failure as outlined in the criteria of the European Society of Cardiology (ESC). We measured hemoglobin within the first 24 hours and obtained demographic, clinical and biochemical variables. Anemia was defined in accordance with OMS criteria. The main variable was all-cause mortality. The association between all-cause mortality and hemoglobin I anemia was determined using the multiple regression Cox model. Results. During follow-up (median six months) we observed 101 all-cause mortality events. In the multivariate analysis, hemoglobin was an independent predictive variable adjusted by covariates (HR 1.15, IC 95% [1.04-1.25], p = 0.014). Anemia (hemoglobin < 13 g/dL) was also found to be an independent predictive variable adjusted by covariates (HR 2.06, IC al 95% [1.28-3.33], p = 0.003). Conclusions. Hemoglobin and anemia (hemoglobin < 13 g/dL) are consistently associated with short-term, poorer survival in patients with acute heart failure.

Fundamento y objetivo. La anemia en la insuficiencia cardiaca aguda es un hallazgo frecuente y parece implicar un peor pronóstico. Sin embargo, la mayor parte de estos datos provienen de series extranjeras y población seleccionada. Nuestro objetivo fue conocer en nuestro medio y en población no seleccionada el grado de asociación entre las cifras de hemoglobina al ingreso y la mortalidad por todas las causas a corto plazo tras un ingreso hospitalario por insuficiencia cardiaca aguda. Material y métodos. Incluimos consecutivamente 412 enfermos ingresados en el Servicio de Cardiología diagnosticados de insuficiencia cardiaca aguda según la Sociedad Europea de Cardiología (ESC). Se determinó la hemoglobina al ingreso, así como un conjunto de variables epidemiológicas, clínicas y bioquímicas de contrastado valor pronóstico. La asociación entre mortalidad por todas las causas para la hemoglobina y anemia se determinó mediante un modelo de riesgos proporcionales de Cox. Resultados. Durante el seguimiento de la muestra (mediana seis meses) se registraron 101 muertes por cualquier causa. El descenso de 1 g/dL de hemoglobina se asoció de manera independiente con la mortalidad (IR 1.15, IC 95% [1.04-1.25], p = 0.014). De esta misma manera, la presencia de anemia (hemoglobina < 13 g/dL) al ingreso se asoció de manera independiente con la mortalidad total (IR 2.06, IC 95% [1.28-3.33], p = 0.003). Conclusiones. En pacientes ingresados por insuficiencia cardiaca aguda la hemoglobina (continua o dicotomizada según criterios OMS/ WHO) se asoció de manera independiente e intensa con un desenlace fatal a corto plazo.

Does Age Influence the Poor Prognosis after Aneurysmal SAH Surgery in Elderly Patients?

OBJECTIVE: The incidence of aneurysmal subarachnoid hemorrhage has been increasing. At the same time, surgical results for elderly patients are unsatisfactory and no guidelines of treatment are available. We carried out a study comparing variable factors and surgical results between young and old age groups to find ways to improve prognosis. METHODS: A retrospective study was carried out on 754 patients who were operated on between 1990 and 2004 by the same surgeon in our hospital. The patients were divided into seven groups according to age: 93 patients below 40 years of age (Group I), 419 patients aged 40~59 (Group II), 115 patients aged 60~64 (Group III), 82 patients aged 65~69 (Group IV), 28 patients aged 70~74 (Group V), 12 patients aged 75~79 (Group VI) and 5 patients over the age of 80 (Group VII). We then checked their medical history, Fisher's grade, Hunt-Hess grade, postoperative complications, and Glasgow Outcome Scale. RESULTS: Age was not a statistically significant factor among patients below 70 years of age (P value> or =0.05). But for those aged 70 and older, the age factor had a statistical value (P value< or =0.001). In addition, there was a close correlation between Hunt-Hess grade IV and V patients, and those with vasospasm, and hydrocephalus after surgery, with poor prognosis in elderly patients as well as young patients (P value< or =0.001). CONCLUSION: Advanced age (under the age of 70) dose not precluded adequate surgical treatment in patient with AN SAH, and we should be also alert to preventable causes of delayed neurological deterioration for improving the outcome in all elderly groups.