Therapeutic drug monitoring in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a problem that directly affects the quality of life of patients suffering from this condition. Monitoring the serum level of infliximab (IFX) (TDM) is an important tool for guiding therapeutic decisions in IBD patients. The purpose of this study was to determine the significance of quantitatively measuring the serum level of IFX (TDM) and antibody to IFX (ATI). Methods and materials: Prospective observational study involving 40 IBD patients on IFX therapy, including 14 Proactive (week 06 of the induction phase) and 26 Reactive (maintenance phase). Immediately prior to the infusion, blood samples were drawn and measured using a Bulhlmann rapid test instrument. Serum concentrations of IFX were categorized as supratherapeutic (>7.0 micrograms/ml), therapeutic (between 3.0 and 7.0 micrograms/ml), and subtherapeutic (3.0 micrograms/ml). When the serum concentration of IFX was 3 mcg/ml (subtherapeutic), the ATI was measured. 25 patients with CD and 15 patients with UC were evaluated. Only three of the twenty patients with subtherapeutic serum levels had a positive ATI, and both were reactive; two had CD and one had UC. There was a statistically significant difference between reactive and proactive patients with respect to levels of CRP (p = 0.042), with proactive DNS patients suffering greater alterations in CRP and albumin. (AU)

Marcadores humorales y estudio ultrasonográfico en pacientes diabéticos con enfermedad hepática por acumulación de grasa / Humoral markers and ultrasonographic study in diabetic patients with liver disease due to fat accumulation

Introducción: La enfermedad hepática grasa no alcohólica se caracteriza por: una acumulación de grasa en el hígado en forma de triacilglicéridos, ausencia de inflamación, fibrosis y un consumo de menos de 30 grados de alcohol al día. Esta afección se asocia a la diabetes mellitus (sobre todo tipo 2), y se observa un creciente aumento en el número de consultas hospitalarias por esta causa. Objetivo: Determinar la relación de los marcadores humorales y el estudio ultrasonográfico en pacientes diabéticos con enfermedad hepática grasa no alcohólica. Métodos: Se realizó una investigación descriptiva y transversal en la Consulta Provincial de Hepatología del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro», en el período de marzo 2019 a diciembre 2020. El universo de estudio estuvo conformado por 89 pacientes (con edades mayores o iguales a 19 años, de ambos sexos); la muestra estuvo constituida por 66 pacientes que fueron seleccionados por muestreo no probabilístico. Resultados: Predominaron los pacientes con edades entre 40 y 59 años, masculinos, de piel blanca, y procedencia urbana. El grado de esteatosis predominante fue el grado 1 (leve). Los marcadores humorales (glicemia, gamma glutamil transpeptidasa, albúmina e índice de Ritis) fueron los más afectados patológicamente. Conclusiones: Los estudios ultrasonográficos mostraron una asociación estadísticamente significativa con alteración de los marcadores humorales de lesión hepática, lo cual puede alertar de una posible evolución desfavorable de esta enfermedad.

Introduction: non-alcoholic fatty liver disease is characterized by an accumulation of fat in the liver in the form of triacylglycerides, absence of inflammation, fibrosis and a consumption of less than 30 degrees of alcohol per day. This condition is associated with diabetes mellitus (especially type 2), and there is a growing increase in the number of hospital visits for this cause. Objective: to determine the relationship between humoral markers and ultrasonographic study in diabetic patients with non-alcoholic fatty liver disease. Methods: a descriptive and cross-sectional investigation was carried out in the provincial hepatology consultation at "Arnaldo Milián Castro" Clinical and Surgical University Hospital from March 2019 to December 2020. The study universe consisted of 89 patients (older than or equal to 19 years, of both genders); the sample consisted of 66 patients who were selected by non-probabilistic sampling. Results: white male patients aged between 40 and 59 years living in urban areas predominated. The predominant degree of steatosis was grade 1 (mild). Humoral markers (glycemia, gamma- glutamyl transpeptidase, albumin and De Ritis ratio) were the most pathologically affected. Conclusions: ultrasonographic studies showed a statistically significant association with changes in humoral markers of liver injury, which may alert to a possible unfavorable evolution of this disease.

Predictors of short-term mortality in HIV-infected patients admitted to intensive care unit / Fatores preditores de mortalidade de curto prazo em pacientes infectados com HIV admitidos em unidade de terapia intensiva

INTRODUCTIONn: Historically, complications of HIV infection have been related to admissions to the Intensive Care Unit (ICU). Despite therapeutic advances, the results of the analysis of prognostic factors in patients with HIV/AIDS have varied, including late diagnosis and failure to adhere to antiretroviral treatment. OBJECTIVE: To evaluate the predictors of short-term mortality in HIV-infected patients admitted to the ICU, as well as their sociodemographic and clinical characteristics. METHODS: A retrospective cohort study including patients admitted to the ICU of a teaching hospital from 2003 through 2012. Data were collected from medical records after the Institutional Review Board approval. RESULTS: 148 HIV-infected patients were identified and 131 were eligible. Among included patients, 42.75% were HIV new diagnoses and 5.34% had no information about the time of diagnosis. The main reasons for admission to the ICU were respiratory failure and sepsis while mortality was 70.23% between 2003 and 2012. Among the risk factors for mortality were low albumin, high APACHE, low CD4+ T lymphocyte count, and not using antiretroviral therapy. CONCLUSION: Despite the availability of diagnosis and treatment for HIV-infected individuals, the number of new cases of advanced Aids diagnosed in high-complexity services such as ICU is high, as well as the non-use of combination antiretroviral therapy. It is necessary to strengthen anti-HIV screening to detect and treat more cases in the early stages.

INTRODUÇÃO: Historicamente, as complicações da infecção pelo HIV estavam relacionadas às internações em Unidade de Terapia Intensiva (UTI). Apesar dos avanços terapêuticos, os fatores prognósticos em pacientes com HIV/AIDS têm variado, incluindo diagnóstico tardio e não adesão ao tratamento antirretroviral. OBJETIVO: Avaliar os fatores preditores de mortalidade a curto prazo em pacientes infectados pelo HIV internados em UTI, bem como suas características sociodemográficas e clínicas. MÉTODOS: Estudo de coorte retrospectivo incluindo pacientes internados na UTI de um hospital universitário entre 2003 a 2012. Os dados foram coletados dos prontuários médicos após a aprovação pelo Comitê de Ética em Pesquisa com Seres Humanos. RESULTADOS: 148 pacientes infectados pelo HIV foram identificados e 131 eram elegíveis. Entre os pacientes incluídos, 42,75% possuíam diagnósticos recente de HIV e 5,34% não possuíam informação sobre o momento do diagnóstico. Os principais motivos de admissão na UTI foram insuficiência respiratória e sepse, enquanto a mortalidade foi 70,23% entre 2003 e 2012. Entre os fatores de risco para mortalidade identificou-se albumina baixa, APACHE alto, baixa contagem de linfócitos T CD4+ e não uso de terapia antirretroviral. CONCLUSÃO: Apesar da disponibilidade de diagnóstico e tratamento para indivíduos infectados pelo HIV, é elevado o número de casos novos em estágio avançado de Aids diagnosticados em serviços de alta complexidade, como UTI, e o não uso de terapia antirretroviral combinada. É necessário fortalecer a triagem anti-HIV, bem como aumentar a repetição da testagem anti-HIV para detectar e tratar mais casos em estágios iniciais.

Prognostic Value of Pre-treatment Albumin/Fibrinogen Ratio in Patients with Diffuse Large B-cell Lymphoma / 中国实验血液学杂志

OBJECTIVE@#To investigate the value of pre-treatment albumin/fibrinogen ratio (AFR) on the prognosis of patients with diffuse large B-cell lymphoma (DLBCL).@*METHODS@#The data of DLBCL patients in the Affiliated Hospital of North Sichuan Medical College from April 2014 to March 2021 were retrieved, and 111 newly diagnosed patients who completed at least 4 cycles of R-CHOP or R-CHOP-like chemotherapy with complete data were included in the study. The clinical, laboratory examination and follow-up data of the patients were collected, and the receiver operating characteristic curve (ROC) was drawn according to patients' AFR before treatment and the survival status at the end of the follow-up, which could be used to preliminarily evaluate the predictive value of AFR for disease progression and patients' survival outcome. Furthermore, the correlation of AFR with the clinical and laboratory characteristics, progression-free survival (PFS) and overall survival (OS) was analyzed, and finally, univariate and multivariate Cox proportional hazard regression models were used to analyze factors affecting PFS and OS of DLBCL patients.@*RESULTS@#The ROC curve indicated that AFR level had a moderate predictive value for PFS and OS in DLBCL patients, with the area under the curve (AUC) of 0.616 (P =0.039) and 0.666 (P =0.004), respectively, and the optimal cut-off values were both 9.06 for PFS and OS. Compared with high-AFR (≥9.06) group, the low-AFR (<9.06) group had a higher proportion of patients with Lugano III-IV stage ( P <0.001), elevated lactate dehydrogenase (P =0.007) and B symptoms (P =0.038). The interim analysis of response showed that the overall response rate (ORR) in the high-AFR group was 89.7%, which was significantly higher than 62.8% in the low-AFR group (P =0.001). With a median follow-up of 18.5 (3-77) months, the median PFS of the high-AFR group was not reached, which was significantly superior to 17 months of the low-AFR group (P =0.009). Similarly, the median OS of high-AFR group was not reached, either, which was significantly superior to 48 months of the low-AFR group (P < 0.001). In multivariate Cox regression analysis, AFR <9.06 was an independent risk factor both for PFS and OS (HR PFS=2.047, P =0.039; HR OS=4.854, P =0.001).@*CONCLUSION@#Pre-treatment AFR has a significant value for the prognosis evaluation in newly diagnosed DLBCL patients.

High cut-off membranes in patients requiring renal replacement therapy: a systematic review and meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Whether high cut-off (HCO) membranes are more effective than high-flux (HF) membranes in patients requiring renal replacement therapy (RRT) remains controversial. The aim of this systematic review was to investigate the efficacy of HCO membranes regarding the clearance of inflammation-related mediators, β2-microglobulin and urea; albumin loss; and all-cause mortality in patients requiring RRT.@*METHODS@#We searched all relevant studies on PubMed, Embase, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure, with no language or publication year restrictions. Two reviewers independently selected studies and extracted data using a prespecified extraction instrument. Only randomized controlled trials (RCTs) were included. Summary estimates of standardized mean differences (SMDs) or weighted mean differences (WMDs) and risk ratios (RRs) were obtained by fixed-effects or random-effects models. Sensitivity analyses and subgroup analyses were performed to determine the source of heterogeneity.@*RESULTS@#Nineteen RCTs involving 710 participants were included in this systematic review. Compared with HF membranes, HCO membranes were more effective in reducing the plasma level of interleukin-6 (IL-6) (SMD -0.25, 95% confidence interval (CI) -0.48 to -0.01, P   =  0.04, I2  = 63.8%); however, no difference was observed in the clearance of tumor necrosis factor-α (TNF-α) (SMD 0.03, 95% CI -0.27 to 0.33, P  = 0.84, I2  = 4.3%), IL-10 (SMD 0.22, 95% CI -0.12 to 0.55, P  = 0.21, I2  = 0.0%), or urea (WMD -0.27, 95% CI -2.77 to 2.23, P  = 0.83, I2  = 19.6%). In addition, a more significant reduction ratio of β 2 -microglobulin (WMD 14.8, 95% CI 3.78 to 25.82, P  = 0.01, I2  = 88.3%) and a more obvious loss of albumin (WMD -0.25, 95% CI -0.35 to -0.16, P  < 0.01, I2  = 40.8%) could be observed with the treatment of HCO membranes. For all-cause mortality, there was no difference between the two groups (risk ratio [RR] 1.10, 95% CI 0.87 to 1.40, P  = 0.43, I2  = 0.0%).@*CONCLUSIONS@#Compared with HF membranes, HCO membranes might have additional benefits on the clearance of IL-6 and β 2-microglobulin but not on TNF-α, IL-10, and urea. Albumin loss is more serious with the treatment of HCO membranes. There was no difference in all-cause mortality between HCO and HF membranes. Further larger high-quality RCTs are needed to strengthen the effects of HCO membranes.

Screening the effective components in treating dampness stagnancy due to spleen deficiency syndrome and elucidating the potential mechanism of Poria water extract / 中国天然药物

Poria is an important medicine for inducing diuresis to drain dampness from the middle energizer. However, the specific effective components and the potential mechanism of Poria remain largely unknown. To identify the effective components and the mechanism of Poria water extract (PWE) to treat dampness stagnancy due to spleen deficiency syndrome (DSSD), a rat model of DSSD was established through weight-loaded forced swimming, intragastric ice-water stimulation, humid living environment, and alternate-day fasting for 21 days. After 14 days of treatment with PWE, the results indicated that PWE increased fecal moisture percentage, urine output, D-xylose level and weight; amylase, albumin, and total protein levels; and the swimming time of rats with DSSD to different extents. Eleven highly related components were screened out using the spectrum-effect relationship and LC-MS. Mechanistic studies revealed that PWE significantly increased the expression of serum motilin (MTL), gastrin (GAS), ADCY5/6, p-PKAα/β/γ cat, and phosphorylated cAMP-response element binding protein in the stomach, and AQP3 expression in the colon. Moreover, it decreased the levels of serum ADH, the expression of AQP3 and AQP4 in the stomach, AQP1 and AQP3 in the duodenum, and AQP4 in the colon. PWE induced diuresis to drain dampness in rats with DSSD. Eleven main effective components were identified in PWE. They exerted therapeutic effect by regulating the AC-cAMP-AQP signaling pathway in the stomach, MTL and GAS levels in the serum, AQP1 and AQP3 expression in the duodenum, and AQP3 and AQP4 expression in the colon.

Utilidad del sistema de recirculación de adsorbentes moleculares en la falla hepática: "diálisis hepática" / Usefulness of the molecular adsorbent recirculating system in liver failure: "liver dialysis"

INTRODUCCIÓN. La falla hepática ya sea aguda o crónica reagudizada representa un reto para el clínico ya que sus complicaciones conllevan una gran mortalidad, esto se ve aún más complicado ya que las opciones terapéuticas son limitadas, incluso muchas veces no se puede acceder a un programa de trasplante hepático oportuno que mejore la sobrevida de estos pacientes, es así que se ha desarrollado un sistema de "diálisis" hepática conocido como sistema de recirculación de adsorbentes moleculares el cual hace un efecto de detoxificación para eliminar sustancias que generan una noxa en el cuerpo humano. OBJETIVO. Entender la utilidad del sistema recirculante molecular adsorbente en la falla hepática, conocer sus indicaciones y complicaciones. METODOLOGÍA. Se realizó una revisión de la literatura con un enfoque descriptivo, retrospectivo cualitativo no experimental, de documentos que tratan sobre la utilización del sistema MARS para tratar la falla hepática, con evidencia desde el año 2004 hasta el 2021. La revisión bibliográfica se llevó a cabo en bases de datos como Pubmed, Embase, BVS, Google Scholar y Elsevier. RESULTADOS. Se identificaron 30 artículos que cumplieron criterios de inclusión de un grupo original de 343 artículos revisados. Se ha determinado que la evidencia sobre este sistema está compuesta sobre todo por reportes de caso y son pocos los ensayos controlados aleatorizados que empleen su uso, sin embargo, se ha podido determinar que este sistema es un puente al trasplante renal mientras se estabiliza al paciente en la Unidad de Cuidados Intensivos, disminuye los marcadores de falla hepática. CONCLUSIÓN. En Latinoamérica su uso es casi nulo de ahí la necesidad de entender el mecanismo de este novedoso sistema.

INTRODUCTION. Hepatic failure, whether acute or chronic, represents a challenge for the clinician since its complications entail a great mortality, this is even more complicated since the therapeutic options are limited, even many times it is not possible to access a timely liver transplant program to improve the survival of these patients, Thus, a hepatic "dialysis" system known as molecular adsorbent recirculation system has been developed, which has a detoxification effect to eliminate substances that generate a noxa in the human body. OBJECTIVE. To understand the usefulness of the molecular adsorbent recirculating system in liver failure, to know its indications and complications. METHODOLOGY. A literature review was performed with a descriptive, retrospective qualitative non-experimental qualitative approach, of papers dealing with the use of the MARS system to treat liver failure, with evidence from 2004 to 2021. The literature review was conducted in databases such as Pubmed, Embase, BVS, Google Scholar and Elsevier. RESULTS. Thirty articles were identified that met inclusion criteria from an original group of 343 articles reviewed. It has been determined that the evidence on this system is mainly composed of case reports and there are few randomized controlled trials that employ its use, however, it has been determined that this system is a bridge to renal transplantation while the patient is stabilized in the Intensive Care Unit, decreasing the markers of liver failure. CONCLUSIONS. In Latin America its use is almost null, hence the need to understand the mechanism of this novel system.

Diálisis de albúmina de paso único (SPAD) como soporte hepático extracorpóreo en paciente COVID-19 crítico. Caso clínico / Single-pass albumin dialysis as treatment of acute on chronic liver failure during COVID-19 pneumonia. report of one case

Liver transplantation is the only effective therapy to reduce the high mortality associated with acute liver failure and acute on chronic liver failure (ACLF). Single-pass albumin dialysis (SPAD) is an extracorporeal supportive therapy used as a bridge to liver transplantation or regeneration. We report a 44-year-old man with alcoholic cirrhosis admitted for critical COVID-19 pneumonia that evolves with ACLF. SPAD technique was performed completing six sessions, with a reduction of bilirubin and ammonia levels. He evolved with severe respiratory failure and refractory septic shock, dying. SPAD is a safe and efficient technique aimed to eliminate liver toxins, preventing multiorgan damage interrupting the process known as the "autointoxication hypothesis". It is easy to implement in any critical patient unit and has lower costs than other extracorporeal liver support therapies.

Techno-functional properties and antioxidant capacity of the concentrate and protein fractions of Leucaena spp. seeds / Propiedades tecno-funcionales y capacidad antioxidante del concentrado y fracciones proteicas de semillas de Leucaena spp

Introduction: The use of vegetable proteins as ingredients in food systems is based on their functional properties. The water and oil holding capacity, foaming, and emulsifying capacity/stability, and antioxidant assay of the protein fractions - albumins, globulins 7S/11S, glutelins and prolamins - isolated from Leucaena seed were evaluated. Objective: The objective of this study was to evaluate the functional properties and antioxidant capacity of the concentrate and protein fractions of ripe Leucaena spp. seeds. Materials and methods: Ripe Leucaena seeds were collected and evaluated in Oaxaca, Mexico (16°59'21''N 96°43'26''O) during the months of February-April 2021.The protein concentrate was isolated by isoelectric precipitation (pH=9, pH=4). The albumins, globulins, glutelins and prolamins were isolated based on their solubility properties in different extracting solutions. Results: Glutelins constituted the main protein fraction (75.88%). Prolamins were not found. The glutelins fractions showed the highest oil holding capacity (0.93±0.08 mL g-1). The albumins fraction had the highest water holding capacity (2.53±0.15 mL g-1), foaming capacity and foam stability (71.83±1.26 % and 70.00±0.00%, respectively) and antioxidant capacity (18.09±0.88%). The globulins exhibited the highest emulsifying capacity and emulsion stability (56.83±1.76% and 55.67±1.20%, respectively). Conclusions: The concentrate and protein fraction of Leucaena seeds showed different techno-functional and antioxidant properties of interest for the food industry, like those showed by other commercial vegetable proteins(AU)

Introducción: El uso de proteínas vegetales como ingredientes en sistemas alimentarios se basa en sus propiedades funcionales. Se evaluó la capacidad de retención de agua y aceite, la capacidad/estabilidad espumante y emulsionante y el ensayo antioxidante de las fracciones proteicas -albúminas, globulinas 7S/11S, glutelinas y prolaminas- aisladas de las semillas de Leucaena. Objetivo: El objetivo de este estudio fue evaluar las propiedades funcionales y la capacidad antioxidante del concentrado y las fracciones proteicas de las semillas maduras de Leucaena spp. Materiales y métodos: Las semillas maduras de Leucaena fueron recolectadas y evaluadas en Oaxaca, México (16°59'21''N 96°43'26''O) durante los meses de febrero-abril del año 2021. Se usó harina de Leucaena desgrasada para la preparación de las fracciones proteicas. El concentrado proteico se aisló por precipitación isoeléctrica (pH=9, pH=4). Las albúminas, globulinas, glutelinas y prolaminas se aislaron en función de sus propiedades de solubilidad en diferentes soluciones de extracción. Resultados: Las glutelinas constituyeron la principal fracción proteica (75,88%). No se encontraron prolaminas. La fracción de glutelinas mostró la mayor capacidad de retención de aceite (0.93±0,08 mL g-1). La fracción de albúminas presentó la mayor capacidad de retención de agua (2,53±0,15 mL g-1), capacidad espumante y estabilidad de la espuma (71,83±1,26% y 70,00±0,00%, respectivamente) y capacidad antioxidante (18,09±0,88%). Las globulinas mostraron la mayor capacidad emulsionante y estabilidad de la emulsión (56,83±1,76 y 55,67±1,20%, respectivamente). Conclusiones: El concentrado y las fracciones proteicas de las semillas de Leucaena mostraron diferentes propiedades tecno-funcionales y antioxidantes de interés para la industria alimentaria, similares a los reportados por diversas proteínas vegetales comerciales(AU)

Intercambio plasmático terapéutico por plasmafiltración: experiencia de 11 años de un centro / Therapeutic plasma exchange: experience in 102 patients

BACKGROUND: Therapeutic Plasma Exchange (TPE) is a procedure in which plasma and harmful macromolecules are separated from the rest of the blood components by centrifugation or filtration through membranes and are replaced with solutions with albumin and/or plasma. AIM: To communicate our experience using TPE by filtration. MATERIAL AND METHODS: Review of records of 655 TPE sessions performed in 102 patients aged 50 ± 18 years (64% women). The requirement of renal replacement therapy (RRT) and seven days and one year mortality were recorded. RESULTS: Forty five percent of patients had hypertension or diabetes. The main indications for TPE were pulmonary-renal syndrome (PRS) (62%) and antibody mediated graft rejection (29%), followed by neurological diseases (36%). Fifteen percent of patients required RRT for one year. Mortality at seven days and one year was 20 and 30%, respectively. Out of the total of deaths associated with kidney diseases, 88% corresponded to PRS and ANCA vasculitis. The main complications were thrombocytopenia in 41%, hypocalcemia in 18%, and hypotension in 16%. CONCLUSIONS: In our experience, TPE by filtration is a safe technique, with mild and preventable complications. Despite this, the reported mortality is high, which reflects the severity of the diseases that motivated the indication for TPE.

Comparison of C-reactive protein and C-reactive protein-to-albumin ratio in predicting mortality among geriatric coronavirus disease 2019 patients

SUMMARY OBJECTIVE: The aim of this study was to evaluate and compare C-reactive protein and C-reactive protein-to-albumin ratio performances in predicting mortality of geriatric patients who visited the emergency department. METHODS: The data of patients with COVID-19 and aged 65 years and above, who visited emergency department during the study period, were retrospectively analyzed. The data were obtained from an electronic-based hospital information system. The area under the receiver operating characteristic curve and the area under the curve were used to assess each cutoff value discriminatory for predicting mortality. RESULTS: The mean age of the population included in this study was 76 (71-82) years, while 52.7% were males. The sensitivity, specificity, and area under the curve values for C-reactive protein in terms of mortality were calculated as 71.01, 52.34, and 0.635%, respectively, while the sensitivity, specificity, and area under the curve values for C-reactive protein-to-albumin ratio were calculated as 75.74, 47.66, and 0.645%, respectively (p<0.001). In the pairwise comparison for the receiver operating characteristic curves of C-reactive protein and C-reactive protein-to-albumin ratio, no statistically significant difference was found. CONCLUSIONS: Geriatric patients are the "most vulnerable" patient group against the COVID-19. In this study, both C-reactive protein and C-reactive protein-to-albumin ratio were found to be successful in predicting mortality for geriatric COVID-19 patients.

Association of low birth weight and prematurity with blood pressure and biomarkers of renal and endocrine-pancreatic functions in adults without nephropathy or diabetes / Associação de baixo peso ao nascer com pressão arterial e biomarcadores de função renal e endócrino-pancreática em adultos sem diabetes e nefropatia

Introduction: Low birth weight (LBW), a proxy for hostile intrauterine environment, has been associated with these diseases in adulthood. In Brazil, there is scarce literature on the association of LBW with blood pressure (BP) or kidney and pancreatic functions in adults. The big ELSA-Brasil database allowed to explore whether: 1) pre-diabetic individuals could have kidney function impairment, detectable by renal biomarkers; 2) LBW is associated with less favorable BP levels and kidney and pancreatic function in adulthood compared to normal birth weight. Objectives: To analyze the association of LBW with BP and biomarkers of kidney and endocrine-pancreatic function in adults without DM or nephropathy. The specific objectives were: Paper 1: to review the literature on the prevalence of diabetic kidney disease (DKD) in pre-diabetic individuals. Paper 2: to assess serum Cystatin C (sCys C) as an early marker of kidney dysfunction in individuals without DM. Paper 3: to compare BP levels and kidney function biomarkers (estimated glomerular filtration rate - eGFR, albumin-creatinine ratio - ACR and sCys C) according to the presence of LBW and to analyze their associations with BP and kidney function biomarkers in individuals without DM or nephropathy. Paper 4: to compare markers of ß-cell function and insulin sensitivity (HOMA-ß, HOMA-IR, HOMA-AD, QUICKI, TyG and TG/HDL) according to the presence of LBW and to analyze LBW associations with markers of ß-cell function and insulin sensitivity. Methods: Cross-sectional analysis of ELSA-Brasil data includes 2 fronts: assessment of the LBW associations with BP and kidney function and with endocrine-pancreatic function. Individuals aged > 60 years, BMI < 18.5 kg/m², DM, kidney, thyroid and liver dysfunction were excluded. Sociodemographic data, lifestyle, birth weight and previous diseases were collected by questionnaires, and clinical and laboratory data in the HU/USP. Dependent variables were BP, biomarkers of kidney and pancreatic functions, and independent variable was LBW. Categorical variables were compared using the chi-squared test and continuous variables by Student t test or the Wilcoxon test. Multiple linear regression models were employed to analyze associations between LBW and the outcome variables. Directed acyclic graph (DAG) was used to make the minimum necessary adjustment to the models. The propensity score method was applied to homogenize differences in sample size. Results: Paper 1: Prevalence of DKD ranged from 4.5 to 26.0% in pre-diabetic individuals. Considering eGFR in isolation, the prevalence rates varied from 4.5 to 21.3%, based only on ACR from 7.0 to 26.0% and based on combined criteria the prevalence was between 12.3 and 17.7%. Paper 2: Pre-diabetic individuals had higher sCys C levels than normoglycemic ones [0.67 (0.41-0.95) vs 0.48 (0.31-0.81) mg/L, p<0.001] and lower eGFR (96.3±17.4 vs 100.6±17.1 mL/min/1.73m², p<0.001). Normoglycemic hyperfiltrating individuals had lower sCys C than normofiltrating ones (p=0.035). Comparing eGFR levels between groups, this gradually decreased as the sCys C and ACR parameters worsened (p-trend=0.06). Paper 3: The LBW group had higher systolic (p=0.015) and diastolic BP (p=0.014) and ACR values (p=0.031), and lower eGFR (p=0.015) than normal birth weight. The preterm group had higher mean BP levels, but no difference in kidney function was detected. In a regression model, BP levels were associated with LBW, but this association disappeared after adding prematurity, which remained associated with BP (p=0.017). Having applied propensity score matching, LBW was associated with ACR (p=0.003), but not with eGFR or BP levels. Paper 4: Individuals with LBW or normal birth weight reported similar BMI at the age 20 years and current BMI was slightly lower in the LBW group. Cardiometabolic and endocrine-pancreatic function parameters were within normal ranges. In regression analysis, log-transformed HOMA-ß, but not the other indexes, was associated with LBW (p=0.014) independent of sex, skin color, prematurity, and family history of DM. After applying propensity score matching LBW was associated with HOMA-AD and TG/HDL indexes. Discussion: Our findings suggest that individuals with near-normal glucose metabolism disturbance could have some impaired kidney function. Looking at early-life risk factors is relevant since their associations with BP and renal and pancreatic function biomarkers could already be identified even in healthy individuals, without DM and nephropathy. Prospective studies are needed to assess the predictive value aiming at proposing prevention measures.

Introdução: O baixo peso ao nascer (BPN), proxy de ambiente intrauterino hostil, tem sido associado a estas doenças no adulto. Em nosso meio, é escassa a literatura sobre associações de BPN com pressão arterial (PA) e função renal e endócrino-pancreática em adultos. O extenso banco de dados ELSA-Brasil permitiu explorar se: 1) indivíduos pré-diabéticos já poderiam apresentar acometimento renal, detectado de forma precoce por biomarcadores; 2) o BPN associar-se-ia no adulto à PA e marcadores de função renal e endócrino-pancreática mais desfavoráveis que nascidos de peso adequado. Objetivos: Analisar a associação do BPN com PA e marcadores de função renal e endócrino-pancreática em adultos sem DM e sem nefropatia. Os objetivos específicos foram: no Artigo 1, rever a literatura sobre a prevalência de doença renal diabética em indivíduos pré-diabéticos; Artigo 2, analisar a cistatina C sérica (sCys C) como marcador precoce de disfunção renal em indivíduos sem DM do ELSA-São Paulo; Artigo 3, comparar os valores de PA e de marcadores de função renal (taxa de filtração glomerular estimada - TFGe, razão albumina-creatinina - ACR e sCys C) segundo a presença de BPN e analisar sua associação com PA e marcadores de função renal, em indivíduios sem DM e nefropatia; Artigo 4, comparar os valores de marcadores de função de células ß e sensibilidade à insulina (HOMA-ß, HOMA-IR, HOMA-AD, QUICKI, TyG e TG/HDL), segundo a presença de BPN e analisar sua associação com marcadores de função de células ß e sensibilidade à insulina. Métodos: Análises transversais de dados do ELSA-Brasil contemplaram 2 frentes, associação do BPN com PA e função renal e com função pancreática. Foram excluídos indivíduos com >60 anos, IMC <18,5 kg/m², DM, disfunção renal, tireoidiana e hepática. Dados sociodemográficos e de saúde foram coletados por questionários e os clínico-laboratoriais no HU/USP. As variáveis dependentes foram PA, marcadores de função renal e pancreática e a independente o BPN. Variáveis categóricas foram comparadas pelo qui-quadrado e contínuas por teste t de Student ou Wilcoxon. Usou-se regressão linear múltipla para testar associações do peso ao nascer com desfechos e DAG para obter os mínimos ajustes necessários nos modelos. Aplicou-se o escore de propensão para homogeneizar diferenças nos tamanhos amostrais. Resultados: Artigo 1: Verificou-se prevalência de 4,5 a 26,0% de nefropatia diabética no pré-DM. Com base na TFGe, esta taxa variou de 4,5 a 21,3%, na albuminúria de 7,0 a 26,0% e quando combinadas de 12,3 a 17,7%. Artigo 2: Indivíduos com pré-DM tiveram maiores valores de sCys C que os normoglicêmicos [0,67 (0,41-0,95) vs 0,48 (0,31-0,81) mg/L, p<0,001] e menores de TFGe (96,3±17,4 vs 100,6±17,1 mL/min/1,73m², p<0,001). Normoglicêmicos hiperfiltrantes apresentaram valores menores de sCys C que os normofiltrantes (p=0,035). Comparando a TFGe entre os grupos, observou-se queda gradual à medida que pioravam a sCys C e ACR (p-trend=0,06). Artigo 3: O grupo com BPN apresentou níveis mais altos de PA sistólica (p=0,015), diastólica (p=0,014) e de ACR (p=0,031), e menores de TFGe (p=0,015) que o grupo nascido com peso normal. Os prematuros apresentaram níveis médios de PA mais altos que os nascidos com peso normal, mas não houve diferença em marcadores de função renal. À análise de regressão, níveis de PA sistólica e diastólica associaram-se com BPN, mas tal associação não se manteve após incluir prematuridade no modelo, a qual permaneceu associada com PA (p=0,017). Após aplicar escore de propensão, o BPN associou-se com ACR (p = 0.003) mas não com TFGe. Artigo 4: Indivíduos com BPN ou peso normal relataram valores similares de IMC aos 20 anos e o atual foi ligeiramente menor no grupo BPN. Seus dados cardiometabólicos e função endócrino-pancreática foram normais. Em análise de regressão, o HOMA-ß mas não outros índices associou-se ao BPN (p=0,014) independente do sexo, cor, prematuridade e história familiar de DM. Após aplicar o escore de propensão, BPN manteve associação com HOMA-AD e TG/HDL. Conclusão: Nossos achados sugerem que indivíduos com alterações iniciais do metabolismo da glicose já podem apresentar biomarcadores de função renal comprometidos. Atentar-se a eventos precoces da vida como o BPN e prematuridade é relevante, uma vez que associações com PA e biomarcadores de função renal e endócrino-pancreática já podem ser identificadas mesmo em indivíduos saudáveis sem DM e nefropatia. Estudos prospectivos são necessários para avaliar o valor preditivo vislumbrando propor medidas de prevenção.

A study on the correlation between smoking and non-enzymatic antioxidant factors of the saliva of healthy smokers and non-smokers / Estudo da correlação entre fumo e fatores antioxidantes não-enzimáticos na saliva de pacientes saudáveis fumantes e não fumantes

Objective: Smoking is among the most destructive habits which have numerous effects on the body.The chemical components of cigarettes destroy the anti-oxidant content of the saliva.In this study, the concentration of albumin and uric acid of healthy non-smokers and smokers was measured based on the frequency of smoking. Material and Methods:In this cross-sectional study, 26 heavy smokers, 27 normal smokers, and 29 non-smokers between the ages of 25 to 40 were selected.The subjects did not suffer from any systemic or periodontal conditions.Unstimulated saliva was collected by spitting. The level of salivary albumin was measured by Bromocresol Green, and the level of salivary uric acid was measured by the uricase method.The selected method of analysis, using SPSS software, was One-Way ANOVA. Results: Mean albumin content of saliva was 33.52 ± 1.52 mg/dl in non-smokers and 23.88 ± 8.93 mg/dl in heavy smokers.The mean uric acid concentration in non-smokers was 2.98 ± 0.79 µmol/L and in heavy smokers was 2.32 ± 0.77 mg/dL.The differences between levels of both salivary uric acid and salivary albumin were significant in heavy smokers and non-smokers(P=0.001). Conclusion: Based on the findings of this study, saliva concentrations of both Albumin and Uric Acid change based on the frequency of smoking.Decreased level of salivary albumin and decreased level of salivary uric acid can be considered as markers of the harmful effects of smoking on oral health. (AU)

Objetivo: Tabagismo está entre os hábitos mais deletérios, que causam inúmeros efeitos no organismo. Os componentes químicos do cigarro destroem os compostos anti-oxidantes da saliva. Neste estudo, a concentração de albumina e ácido úrico em pacientes saudáveis fumantes e não-fumantes foi mensurada e correlacionada coma frequência de fumo. Material e Métodos: Neste estudo transversal, 26 fumantes pesados, 27 fumantes moderados, e 29 não fumantes entre 25 e 40 anos foram incluídos. Os participantes não apresentavam nenhuma condição sistêmica ou periodontal. Saliva não estimulada foi coletada. Os níveis salivares de albumina foram avaliados por Verde de bromocresol, e o nível de ácido úrico foi mensurado pelo método de uricase. Os dados foram analisados utilizando-se One-way ANOVA no software SPSS. Resultados: A albumina salivar foi de 33.52 ±1.52 mg/dl nos não-fumantes e 23.88 ± 8.93 mg/dl nos fumantes pesados. A concentração média de ácido úrico em não-fumantes foi de 2.98 ± 0.79 µmol/L e em pacientes fumantes pesados de 2.32 ± 0.77 mg/dL. As diferenças entre os níveis de ambos, ácido úrico e albumina, foi significante entre fumantes pesados e não-fumantes (p=0.001). Conclusão: Baseados nos achados deste estudo, concentrações salivares de albumina e ácido úrico baseados na frequência de fumo. A diminuição dos níveis salivares de albumina e ácido úrico podem ser considerados marcadores dos efeitos nocivos do cigarro na saúde oral(AU)

Value of albumin RNAscope in situ hybridization in diagnosis and differential diagnosis of hepatocellular carcinoma / 中华病理学杂志

Objective: To investigate the utility of albumin RNAscope in situ hybridization in the diagnosis and differential diagnosis of hepatocellular carcinoma and its mimics. Methods: One hundred and fifty-two cases of hepatocellular carcinoma and its mimics and 33 cases of normal tissue were selected from the pathology database of the Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2013 to December 2019. Tissue microarrays were constructed and RNAscope in situ hybridization was performed to detect the expression of albumin mRNA. Results: No albumin mRNA expression was detected in normal tissues except for the liver. All hepatocellular carcinoma regardless of its degree of differentiation and primary or metastatic nature had detectable albumin mRNA, with strong and diffuse staining in 90.7% (49/54) of cases. While the positive rate of HepPar-1, Arg-1 or one of them by immunohistochemistry was 87.0% (47/54), 85.2% (46/54) and 92.6% (50/54) respectively. The positive rates of albumin mRNA in intrahepatic cholangiocarcinoma and biphenotypic hepatocellular carcinoma were 7/15 and 9/10, respectively. The former showed focal or heterogeneous staining, while the latter showed strong and diffuse staining. The positive rate of hepatoid adenocarcinoma was 8/19, and the albumin expression could be diffuse or focal. Sporadic cases of poorly differentiated gastric adenocarcinoma and metastatic colon adenocarcinoma showed focal staining of albumin mRNA. Conclusions: Detection of albumin mRNA by RNAscope in situ hybridization is of great value for the diagnosis and differential diagnosis of HCC, and the sensitivity may be improved by combining with HepPar-1 and Arg-1. It also offers different diagnostic clues according to different expression patterns.

Changes of Serum Complement C1q in Patients with Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To analyze the change of serum C1q in the course of multiple myeloma (MM) and its correlation with clinical characteristics.@*METHODS@#A total of 138 newly diagnosed MM patients in Zhongnan Hospital of Wuhan University from June 2016 to December 2019 were selected as research objects, during the same period 50 age-matched anemia patients, 50 lymphoma patients, 50 leukemia patients, and 50 myelodysplastic syndrome (MDS) patients were selected as control groups. All the patients met WHO disease classification, and were definitely diagnosed by pathology or bone marrow smear/biopsy. The changes of C1q between MM patients and control group, as well as in different therapeutic responses of MM patients before and after treatment were compared, also the difference of clinical characteristics among MM patients with different C1q level, so as to analyze risk factors which led to C1q decline.@*RESULTS@#The average value of C1q in MM patients was (128.18±51.24) mg/L, which was significantly lower than control group (P<0.01). The levels of white blood cell, platelet (PLT), hemoglobin (Hb), serum calcium, albumin, lactate dehydrogenase (LDH) in newly diagnosed high C1q group were significantly higher than those in low C1q group (P<0.05). Logistic analysis showed that the levels of PLT, Hb, albumin, and LDH in newly diagnosed high C1q group were higher than those in low C1q group (r=0.248, r=0.394, r=0.405, r=0.295). After treatment, the levels of C1q in MM patients with complete remission and very good partial remission were significantly higher than before treatment (P<0.05), while those with partial remission and stable disease also increased but not significantly (P>0.05).@*CONCLUSION@#The C1q level in MM patients is significantly lower than that in patients with other hematologic system diseases, and it increases with the remission of the disease after treatment.

Efficacy of laparoscopic proximal gastrectomy with double-tract reconstruction versus laparoscopic total gastrectomy with Roux-en-Y reconstruction for early upper gastric cancer / 中华胃肠外科杂志

Objective: To compare clinical efficacy between laparoscopic radical proximal gastrectomy with double-tract reconstruction (LPG-DTR) and laparoscopic radical total gastrectomy with Roux-en-Y reconstruction (LTG-RY) in patients with early upper gastric cancer, and to provide a reference for the selection of surgical methods in early upper gastric cancer. Methods: A retrospective cohort study method was carried out. Clinical data of 80 patients with early upper gastric cancer who underwent LPG-DTR or LTG-RY by the same surgical team at the Department of General Surgery, the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to January 2021 were retrospectively analyzed. Patients were divided into the DTR group (32 cases) and R-Y group (48 cases) according to surgical procedures and digestive tract reconstruction methods. Surgical and pathological characteristics, postoperative complications (short-term complications within 30 days after surgery and long-term complications after postoperative 30 days), survival time and nutritinal status were compared between the two groups. For nutritional status, reduction rate was used to represent the changes in total protein, albumin, total cholesterol, body mass, hemoglobin and vitamin B12 levels at postoperative 1-year and 2-year. Non-normally distributed continuous data were presented as median (interquartile range), and the Mann-Whitney U test was used for comparison between groups. The χ(2) test or Fisher's exact test was used for comparison of data between groups. The Mann-Whitney U test was used to compare the ranked data between groups. The survival rate was calculated by Kaplan-Meier method categorical, and compared by using the log-rank test. Results: There were no statistically significant differences in baseline data betweeen the two groups, except that patients in the R-Y group were oldere and had larger tumor. Patients of both groups successfully completed the operation without conversion to laparotomy, combined organ resection, or perioperative death. There were no significant differences in the distance from proximal resection margin to superior margin of tumor, postoperative hospital stay, time to flatus and food-taking, hospitalization cost, short- and long-term complications between the two groups (all P>0.05). Compared with the R-Y group, the DTR group had shorter distal margins [(3.2±0.5) cm vs. (11.7±2.0) cm, t=-23.033, P<0.001], longer surgery time [232.5 (63.7) minutes vs. 185.0 (63.0) minutes, Z=-3.238, P=0.001], longer anastomosis time [62.5 (17.5) minutes vs. 40.0 (10.0) minutes, Z=-6.321, P<0.001], less intraoperative blood loss [(138.1±51.6) ml vs. (184.3±62.1) ml, t=-3.477, P=0.001], with significant differences (all P<0.05). The median follow-up of the whole group was 18 months, and the 2-year cancer-specific survival rate was 97.5%, with 100% in the DTR group and 95.8% in the R-Y group (P=0.373). Compared with R-Y group at postoperative 1 year, the reduction rate of weight, hemoglobin and vitamin B12 were lower in DTR group with significant differences (all P<0.05); at postoperative 2-year, the reduction rate of vitamin B12 was still lower with significant differences (P<0.001), but the reduction rates of total protein, albumin, total cholesterol, body weight and hemoglobin were similar between the two groups (all P>0.05). Conclusions: LPG-DTR is safe and feasible in the treatment of early upper gastric cancer. The short-term postoperative nutritional status and long-term vitamin B12 levels of patients undergoing LPG-DTR are superior to those undergoing LTG-RY.

Comparison of postoperative mid-term and long-term quality of life between Billroth-I gastroduodenostomy and Billroth-II gastrojejunostomy after radical distal gastrectomy in patients with gastric cancer: a cohort study based on a case registry database / 中华胃肠外科杂志

Objective: The pattern of digestive tract reconstruction in radical gastrectomy for gastric cancer is still inconclusive. This study aims to compare mid-term and long-term quality of life after radical gastrectomy for distal gastric cancer between Billroth-I (B-I) and Billroth-II (B-II) reconstruction. Methods: A retrospective cohort study was conducted.Clinicopathological and follow-up data of 859 gastric cancer patients were colected cellected from the surgical case registry database of Gastrointestinal Surgery Center of Sichuan University West China Hospital, who underwent radical distal gastric cancer resection between January 2016 and December 2020. Inclusion criteria: (1) gastric cancer confirmed by preoperative gastroscopy and biopsy; (2) elective radical distal major gastrectomy performed according to the Japanese Society for Gastric Cancer treatment guidelines for gastric cancer; (3) TNM staging referenced to the American Cancer Society 8th edition criteria and exclusion of patients with stage IV by postoperative pathology; (4) combined organ resection only involving the gallbladder or appendix; (5) gastrointestinal tract reconstruction modality of B-I or B-II; (6) complete clinicopathological data; (7) survivor during the last follow-up period from December 15, 2021 to January 15, 2022. Exclusion criteria: (1) poor compliance to follow-up; (2) incomplete information on questionnaire evaluation; (3) survivors with tumors; (4) concurrent malignancies in other systems; (5) concurrent psychiatric and neurological disorders that seriously affected the objectivity of the questionnaire or interfered with patient's cognition. Telephone follow-up was conducted by a single investigator from December 2021 to January 2022, and the standardized questionnaire EORTC QLQ-C30 scale (symptom domains, functional domains and general health status) and EORTC QLQ-STO22 scale (5 symptoms of dysphagia, pain, reflux, restricted eating, anxiety; 4 single items of dry mouth, taste, body image, hair loss) were applied to evaluate postoperative quality of life. In 859 patients, 271 were females and 588 were males; the median age was 57.0 (49.5, 66.0) years. The included cases were divided into the postoperative follow-up first year group (202 cases), the second year group (236 cases), the third year group (148 cases), the fourth year group (129 cases) and the fifth year group (144 cases) according to the number of years of postoperative follow-up. Each group was then divided into B-I reconstruction group and B-II reconstruction group according to procedure of digestive tract reconstruction. Except for T-stage in the fourth year group, and age, tumor T-stage and tumor TNM-stage in the fifth year group, whose differences were statistically significant between the B-I and B-II reconstruction groups (all P<0.05), the differences between the B-I and B-II reconstruction groups in terms of demographics, body mass index (BMI), tumor TNM-stage and tumor pathological grading in postoperative follow-up each year group were not statistically significant (all P>0.05), suggesting that the baseline information between B-I reconstruction group and the B-II reconstruction group in postoperative each year group was comparable. Evaluation indicators of quality of life (EORTC QLQ-C30 and EORTC QLQ-STO22 scales) and nutrition-related laboratory tests (serum hemoglobin, albumin, total protein, triglycerides) between the B-I reconstruction group and B-II reconstruction group in each year group were compared. Non-normally distributed continuous variables were presented as median (Q(1),Q(3)), and compared by using the Wilcoxon rank sum test (paired=False). The χ(2) test or Fisher's exact test was used for comparison of categorical variables between groups. Results: There were no statistically significant differences in all indexes EORTC QLQ-30 scale between the B-I reconstruction group and the B-II reconstruction group among all postoperative follow-up year groups (all P>0.05). The EORTC QLQ-STO22 scale showed that significant differences in pain and eating scores between the B-I reconstruction group and the B-II reconstruction group were found in the second year group, and significant differences in eating, body and hair loss scores between the B-I reconstruction group and the B-II reconstruction group were found in the third year group (all P<0.05), while no significant differences of other item scores between the B-I reconstruction group and the B-II reconstruction group were found in postoperative follow-up of all year groups (P>0.05). Triglyceride level was higher in the B-II reconstruction group than that in the B-I reconstruction group (W=2 060.5, P=0.038), and the proportion of patients with hyperlipidemia (triglycerides >1.85 mmol/L) was also higher in the B-II reconstruction group (19/168, 11.3%) than that in the B-I reconstruction group (0/34) (χ(2)=0.047, P=0.030) in the first year group with significant difference. Albumin level was lower in the B-II reconstruction group than that in the B-I reconstruction group (W=482.5, P=0.036), and the proportion of patients with hypoproteinemia (albumin <40 g/L) was also higher in the B-II reconstruction group (19/125, 15.2%) than that in the B-I reconstruction group (0/19) in the fifth year group, but the difference was not statistically significant (χ(2)=0.341, P=0.164). Other nutrition-related clinical laboratory tests were not statistically different between the B-I reconstruction and the B-II reconstruction in each year group (all P>0.05). Conclusions: The effects of both B-I and B-II reconstruction methods on postoperative mid-term and long-term quality of life are comparable. The choice of reconstruction method after radical resection of distal gastric cancer can be based on a combination of patients' condition, sugenos' eoperience and operational convenience.

Marcadores hematológicos y bioquímicos para el diagnóstico precoz de bacteriemiascausadas por Enterobacteriaceae resistentes a los carbapenémicos / Haematological and biochemical markers for the early diagnosis of bacteremias caused bycarbapenem-resistant Enterobacteriaceae

INTRODUCCIÓN. Las bacteriemias causadas por Enterobacteriaceae resistentes a carbapenémicos se asocian con altas tasas de mortalidad a diferencia de las bacteriemias causadas por Enterobacteriaceae sensibles a carbapenémicos. Los hallazgos clínicos y de laboratorio son importantes para determinar los esquemas terapéuticos y su pronóstico; su diagnóstico precoz resulta esencial para un manejo adecuado. OBJETIVO. Relacionar valores de marcadores sanguíneos y bioquímicos en bacteriemias causadas por Enterobacteriaceae resistentes a carbapenémicos. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 427 y muestra de 224 datos de hemocultivos positivos para Enterobacteriaceae de pacientes atendidos en el Hospital de Especialidades Carlos Andrade Marín en el periodo mayo 2016 a julio 2018. Criterios de inclusión: i) al menos un hemocultivo positivo; ii) recuperación del aislado de CRE o CSE y iii) recolección simultanea de muestras de sangre y pruebas de laboratorio. Criterios de exclusión: i) bacteriemias polimicrobianas; ii) valores fuera de rango y iii) reportes sin valores numéricos. El análisis de datos se realizó mediante el programa estadístico International Business Machines Statistical Package for the Social Sciences versión 24.0. RESULTADOS. Se demostró que el recuento de leucocitos [OR 1,21 (95% IC: 1,03-1,43)], el recuento de plaquetas [OR 1,65 (95% IC: 1,37-1,98)] y el tiempo parcial de tromboplastina [OR 1,29 (95% IC: 1,04-1,60)] fueron buenas variables predictoras independientes, mediante análisis de regresión logística multivariante. CONCLUSIÓN. La trombocitopenia y el tiempo parcial de tromboplastina prolongado se asociaron con bacteremia causada por Enterobacteriaceae resistentes a carbapenémicos.

INTRODUCTION. Bacteremias caused by carbapenem-resistant Enterobacteriaceae are associated with high mortality rates in contrast to bacteremias caused by carbapenem-sensitive Enterobacteriaceae. Clinical and laboratory findings are important in determining therapeutic regimens and prognosis; early diagnosis is essential for appropriate management. OBJECTIVE. To relate blood and biochemical marker values in bacteremia caused by carbapenem-resistant Enterobacteriaceae. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 427 and sample of 224 blood culture data positive for Enterobacteriaceae from patients attended at the Carlos Andrade Marín Specialties Hospital in the period May 2016 to July 2018. Inclusion criteria: i) at least one positive blood culture; ii) recovery of CRE or CSE isolate and iii) simultaneous collection of blood samples and laboratory tests. Exclusion criteria: i) polymicrobial bacteremia; ii) out-of-range values and iii) reports without numerical values. Data analysis was performed using the statistical program International Business Machines Statistical Package for the Social Sciences version 24.0. RESULTS. Leukocyte count [OR 1.21 (95% CI: 1.03-1.43)], platelet count [OR 1.65 (95% CI: 1.37- 1.98)] and partial thromboplastin time [OR 1.29 (95% CI: 1.04-1.60)] were shown to be good independent predictor variables, by multivariate logistic regression analysis. CONCLUSION. Thrombocytopenia and prolonged partial thromboplastin time were associated with bacteremia caused by carbapenem-resistant Enterobacteriaceae.

Can blood urea Nitrogen-to-Albumin ratio predict mortality in patients with moderate-to-severe COVID-19 pneumonia hospitalized in the intensive care unit?

SUMMARY OBJECTIVE: Many laboratory parameters allow to follow up the course of the disease and reveal its clinical severity, particularly in patients with coronavirus disease 2019 (COVID-19) pneumonia. In this study, we aimed to investigate the role of the blood urea nitrogen-to-albumin ratio in predicting the mortality in COVID-19 patients with moderate-to-severe disease who are hospitalized in the intensive care unit. METHODS: A total of 358 patients who were hospitalized in intensive care unit at our hospital between November 1, 2020 and May 15, 2021 were included in this study. During their course of intensive care, surviving patients were included in Group 1 and nonsurviving patients in Group 2. RESULTS: There were no statistically significant differences between the two groups in terms of gender, smoking, and chronic obstructive pulmonary disease rates. In multivariate logistic regression analysis, advanced age (OR 1.038, 95%CI 1.014-1.064, p=0.002), neutrophil-to-lymphocyte ratio (OR 1.226, 95%CI 1.020-1.475, p=0.030), blood urea nitrogen-to-albumin ratio (OR 2.693, 95%CI 2.019-3.593, p<0.001), and chest computed tomography severity score (OR 1.163, 95%CI 1.105-1.225, p<0.001) values were determined as independent predictors for in-hospital mortality. CONCLUSION: In this study, we showed that the blood urea nitrogen-to-albumin ratio, which was previously shown as a predictor of mortality in patients with various pneumonia, was an independent predictor of mortality in patients with COVID-19 pneumonia.

Sarcopenia y albúmina sanguínea: revisión sistemática con metaanálisis / Sarcopenia and blood albumin: A systematic review with meta-analysis

Resumen La sarcopenia se caracteriza por la pérdida de musculatura durante el envejecimiento, lo que puede traer consecuencias para la salud. Se detecta de diversas formas, una de ellas, el uso de biomarcadores sanguíneos como la albúmina, aunque todavía no se ha establecido dicha asociación de forma definitiva. Esta revisión sistemática y metaanálisis resume el conocimiento sobre la asociación entre sarcopenia y albúmina sérica en los adultos mayores, centrada en la etiología y los factores de riesgo. La revisión se hizo utilizando el programa del Joanna Briggs Institute y la búsqueda incluyó las bases de datos Medline, Embase, CINAHL, y LILACS; la búsqueda manual estuvo a cargo de dos revisores de forma independiente. Para el metaanálisis, se utilizó el programa EpiDat, versión 3.1; las diferencias de medias en los puntajes de albúmina desagregados por sarcopenia se analizaron mediante el modelo de efectos aleatorios. El grado de heterogeneidad se evaluó con la prueba Q de DerSimonian y Laird. Se analizaron 630 artículos, de los cuales 14 se incluyeron en la revisión. En el metaanálisis, se evidenciaron mayores cantidades de albúmina sanguínea en los adultos mayores que no presentaron sarcopenia frente a los que sí, una diferencia con significación estadística. Aunque hay estudios en los que se explora la asociación entre albúmina y sarcopenia, persiste la necesidad de evaluar la asociación entre los marcadores biológicos, comparándolos entre sí para determinar cuáles pueden utilizarse en la detección de sarcopenia en el adulto mayor.

Abstract Sarcopenia is characterized by loss of muscle mass during aging, which can have consequences for the individuals' health. There are many ways to detect it, among them, with the use of blood biomarkers such as albumin, although the association between the two has not been confirmed yet. This review synthesizes the knowledge on the association between sarcopenia and serum albumin among elderly individuals through a systematic review and meta-analysis focused on the etiology and risk factors. We used the Joanna Briggs Institute software for the review and conducted a search in MEDLINE, Embase, CINAHL, and LILACS databases while two reviewers conducted an independent manual search. EpiDat, version 3.1 was used for the meta-analysis; mean differences with the albumin scores disaggregated by sarcopenia were analyzed by the random-effects model. The degree of heterogeneity was assessed with the DerSimonian and Laird Q test. We analyzed 630 articles and finally included 14 in the review. Higher blood albumin levels were found in the meta-analysis, which was statistically significant among the elderly adults who did not present sarcopenia compared to those who did. Although there are studies exploring the association between albumin and sarcopenia, there is a need to continue evaluating its association with biological markers and comparing them to verify which can be used to detect sarcopenia among the elderly.