Long-term Prognosis After Lung Transplantation: A Monocentric Study in 510 Patients.

INTRODUCTION: Lung transplantation is the final treatment option in patients with respiratory failure. Morbidity and mortality rates associated with the management of complications is high despite advances. Postoperative complications include acute transplant rejection, bronchiolitis obliterans, and infections. Because of that, the success of this treatment option depends on the correct choice of donor and candidates to receive a transplant. OBJECTIVE: This study aims to perform a survival analysis of transplanted patients in our center and determine predictive variables of mortality. PATIENTS AND METHODS: This study is a retrospective assessment of data collected from 510 patients at the Hospital University Reina Sofía from October 1993 to December 31, 2016. Patients who were retransplanted were excluded. We collected data regarding basal characteristics of the donors and candidates to receive a transplant. We analyzed the impact in terms of future survival of basal variables from donor and donor recipients. RESULTS: Five hundred ten patients were included (average age 44 ± 17 years, 69% male), with a maximum follow-up period of 21.6 years (average follow-up 4.52 years, interquartile ratio: 0.13 to 6.97 years). Two hundred twenty-seven patients died (54.3% of the total amount). The influence of donor's basal characteristics on mortality was analyzed; moreover, the relationship between basal variables and survival were analyzed using univariate analysis. Available variables were analyzed through multivariate analysis. CONCLUSION: Lung transplantation is a treatment option with an acceptable risk of morbidity and mortality. Increased awareness of features of evolution could help to reduce postoperative complications.

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010-2013).

OBJECTIVE: To describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs. DESIGN: A retrospective, descriptive, epidemiological study. SETTING: This study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period. PARTICIPANTS: We selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period. MAIN OUTCOME MEASURES: We calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI. RESULTS: During the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93). CONCLUSIONS: The incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.

Analysis of the Incidence of Noncutaneous Neoplasia After Lung Transplantation and Its Impact on Prognosis.

INTRODUCTION: Increased survival in lung transplant recipients, the need for immunosuppressive therapy, and many risk factors before and after transplantation enhance the development of malignancies. This study sought to analyze the incidence of noncutaneous tumors after lung transplantation in our hospital, the risk factors for malignancy, and its impact on prognosis. PATIENTS AND METHODS: A retrospective analysis of clinical records of patients after lung transplantation in our hospital from October 1993 to December 2014. RESULTS: The study population included 443 patients. In total, 35 neoplasia developed in 33 patients (9.6%). Twelve cases were posttransplant lymphoproliferative disorders (PTLDs), 7 localized in the native lung, 7 gynecologic neoplasia (2 in the breast, 4 in the vulva, and 1 in the cervix), 3 in the colon, 2 in the nervous system (one was an astrocytoma), 2 in the prostate, 1 in the kidney, and 1 in the esophagus. The average time between transplantation and malignancy detection was 52.7 ± 45.4 months, being earlier in patients with PTLDs than in non-PTLD. Eleven patients who developed malignancy (all patients with neoplasia in native lung and in cervix, 1 in the colon, 1 PTLD, and 1 in the nervous system) died as a result of it. The only factor associated with an increased risk of malignancy in our population was smoking history. CONCLUSIONS: Almost 10% of lung transplant recipients developed some type of noncutaneous neoplasia and the most frequently diagnosed were PTLDs. Lung neoplasia compromised most survival in these patients.

Relating land cover and spatial distribution of nephropathia epidemica and Lyme borreliosis in Belgium.

Lyme borreliosis (LB) and nephropathia epidemica (NE) are zoonoses resulting from two different transmission mechanisms and the action of two different pathogens: the bacterium Borrelia burgdorferi and the Puumala virus, respectively. The landscape configuration is known to influence the spatial spread of both diseases by affecting vector demography and human exposure to infection. Yet, the connections between landscape and disease have rarely been quantified, thereby hampering the exploitation of land cover data sources to segment areas in function of risk. This study implemented a data-driven approach to relate land cover metrics and an indicator of NE/LB risk at different scales of observation of the landscape. Our results showed the suitability of the modeling approach (r² > 0.75, ρ < 0.001) and highlighted the relevance of the scale of observation in the set of landscape attributes found to influence disease risk as well as common and specific risk factors of NE and LB.

[Results of the treatment of high energy tibial pylon fractures]. / Resultados del tratamiento de las fracturas del pilón tibial por alta energía.

BACKGROUND: Several treatment are available for these injuries. In developed countries they are currently treated with minimally invasive plates. This paper describes the results obtained using external fixators in patients with tibial pylon fractures. METHODS: A retrospective, cross-sectional study was conducted from 1999 to 2009 at Querétaro General Hospital. A total of 39 patients were operated on; 18 met the inclusion criteria; follow-up ranged from 1 to 9 years. RESULTS: Of the 18 patients enrolled, 22% were females and 78% males. The most frequent fracture was 43 A2 of the AO classification accounting for 67%. Mean age was 41.2 years +/- 9.3, mean healing time was 14.9 weeks +/- 7.26, with p = 0.005; mean follow-up was 4.1 +/- 4.9 years. Twenty-two percent were Gustilo type II open fractures; 78.2% required open reduction plus an external fixator; 22.8% underwent closed reduction plus external fixator; the mean score in the SF-36 scale was 78.05 +/- 14.76. Only one patient required another surgery; 94.4% returned to their usual daily activities. Among the latter, 77.7% had normal gait, 22.2% had full range of motion, 72.2% had a pain score of four in the VAS and 27.7% were pain free. CONCLUSIONS: The use of external fixators for the definitive management of these fractures is effective, as it helps avoid additional surgeries (up to 35%) and has a shorter healing time.

Bone mineral density in patients with chronic obstructive pulmonary disease who are candidates for lung transplant.

UNLABELLED: INTRODUCTIóN: After cystic fibrosis, lung transplantation (LT) patients with prior chronic obstructive pulmonary disease (COPD) are most susceptible to loss of bone mineral density (BMD). OBJECTIVES: To determine the prevalence of BMD loss among COPD patients being evaluated as LT candidates, seeking to identify, their risk profile. PATIENTS AND METHODS: This cross-sectional study included COPD patients who were LT candidates evaluated from January 2007 to December 2009. To identify patients at risk of fracture, BMD at the femoral neck and lumbar spine was assessed by bone densitometry. For categorization, we followed the World Health Organization criteria. To evaluate the risk profile, we recorded data on age, sex, smoking, lung function forced expiratory volume in 1 second, distance covered in the 6-minute walk test, body mass index, and degree of dyspnea. We recorded individual data as well as grouped them the multidimensional BODE (Body mass index Obstruction Dyspnea Exercise capacity) index. RESULTS: The study cohort consisted of 64 patients (51 men and 13 women). The overall prevalence of low BMD in any of the explored territories was 84.4%, affecting 88.2% of men and 69.2% of women. Osteoporosis was identified in 56.2% of patients, reaching a serious degree in 11/64 (17.2%). No significant differences were observed in any evaluated parameter when patients were separated into those with normal versus pathological BMD. When patients with osteopenia and osteoporosis were compared, we observed that the former showed a lower exercise capacity (P=.023) and a higher BODE index (P=.002). CONCLUSIONS: The prevalence of a low BMD level was increased among male patients with a worse BODE index, especially due to a reduced exercise capacity.

Lung transplantation for bronchiolitis obliterans after allogenic bone marrow transplantation.

INTRODUCTION: Bronchiolitis obliterans (BO) occurring after allogeneic bone marrow transplant (ABMT) may be an expression of lung damage of multifactorial origins. At present, it is not a usual condition for lung transplant (LT), accounting for <1% of all indications in the international registry. We sought, to describe the clinical features and outcomes of patients undergoing LT for BO after ABMT in our group. PATIENTS AND METHODS: We undertook a cross-sectional study of patients with an indication for LT due to BO after ABMT from the beginning of our program. We recorded the type of transplant, patient age, clinical course, functional outcome, and survival. RESULTS: Among 313 LT, 13 cases (4.2%) were due to BO, including 3 after ABMT (0.96%). ABMT was indicated after bone marrow aplasia in 2 cases and acute myeloid leukemia in the other patient. The patients were 2 men (both 35 years old) and 1 woman, aged 25 years. All subjects received double elective LT at 24, 20, and 9 years post ABMT. At the time of LT, all displayed severe obstructive ventilatory defects with a forced expiratory volume in 1 second (FEV1)<30% and partial respiratory insufficiency. The initial immunosuppression was cyclosporine, mycophenolate mofetil, and steroids in all cases. Two of the subjects required changes in the immunosuppressive regimen: 1 due to chronic graft rejection with subsequent functional recovery and the other due to hematologic and neurologic toxicity. After 96, 37, and 9 months, all the patients were alive with baseline dyspnea of functional class 0 and a FEV1 of about 68%. CONCLUSION: LT is an effective therapy in terms of lung function and survival for patients with respiratory failure secondary to the development of BO after ABMT.

Bone mineral density in lung transplant candidates.

INTRODUCTION: The loss of bone mineral density (BMD) affects more than half of the patients on the waiting list for lung transplantation (LT), increasing their disease burden. OBJECTIVE: To describe the prevalence of BMD loss among patients evaluated as candidates for LT. PATIENTS AND METHODS: We included all hospitalized patients evaluated as LT candidates over the last 3 years, excluding pediatric subjects under 17 years of age. We estimated BMD in the femoral neck and lumbar spine. Categorization used the World Health Organization criteria. RESULTS: Among 156 patients, 64 (41%) had chronic obstructive pulmonary disease (COPD) with only 2 (3.1%) having densitometry before referral; 55 (35.3%), interstitial lung disease (ILD) with 9 (16.4%) BMD values; and 21 (13.5%) cystic fibrosis (CF) with only 3 (14.3%) with BMD screening. The 116 patients (74.4%) who had BMD below normal values included 84.4% of COPD, 67.3% of the ILD, and 81% of the CF patients. The detection of these patients allowed us to initiate preventive treatment depending on the degree of risk of bone fracture. Half of the patients evaluated were eventually included on the LT waiting list, with 70% of them finally receiving a transplant. CONCLUSIONS: Bone mineral loss was highly prevalent among this population but its investigation before referral for LT was scarce. Its identification allows primary or secondary prophylaxis to be started, seeking to reduce the risk of bone fracture after transplantation.

Leucoencefalopatía posterior reversible: una observación poco frecuente / Reversible posterior leukoencephalopathy syndrome: an unusual observation

La leucoencefalopatía posterior reversible es un síndrome clinicorradiológico que se presenta con cefaleas, vómitos, alteración de la conciencia, trastornos visuales y convulsiones. Su etiología es múltiple, y entre sus causas más frecuentes está la hipertensión arterial. Se produce como consecuencia de un fracaso en la autorregulación del flujo sanguíneo cerebral que origina un edema preferentemente de la sustancia blanca en las regiones posteriores del cerebro. Tras la orientación clínica, la confirmación diagnóstica se realiza por medio de las imágenes obtenidas por resonancia magnética. Presentamos el caso de un niño de 7 años de edad que desarrolló una leucoencefalopatía reversible asociada a hipertensión (AU)

Reversible posterior leukoencelopathy syndrome is a clinicalradiological syndrome that presents itself with headaches, vomiting, and loss of consciousness, seizures and visual disturbances. The etiology is multiple and the most frequent is arterial hypertension. It is produced as consequence of a failure of the auto regulation of the cerebral blood flow, which causes an edema mainly of a white substance in the posterior regions of the brain. After the clinical suspicion the confirmation of the diagnosis is made by means of the MRI. We present a 7 years old boy who developed a reverse leucoencephalopathy associated with hypertension (AU)

[The role of models in economic evaluation of healthcare]. / Papel de los modelos en las evaluaciones económicas en el campo sanitario.

INTRODUCTION: The information on which decision-making in healthcare is based --especially information on new drugs or technologies-- comes mainly from phase III clinical trials, which are carried out according to clinical efficacy criteria. Placebos are frequently used as comparators. Therefore, no clinical or economic evidence is usually available to assess the new product or technology in real-life practice (effectiveness). Efficiency is seldom evaluated either. METHODS: The clinical evidence generated by clinical trials usually evaluates intermediate, not final clinical variables. This makes decision-making difficult, both for clinicians or health-care managers in areas as varied as financing drugs or technology, inclusion of these in a therapeutic formulary or in clinical pathways. CONCLUSION: To obtain clinical and economic information, modelling techniques have been developed in the field of health economics. This study reviews the justification of the use of models, their characteristics, methodological requirements and steps followed for their construction and resolution, while Markov models are explained.

[Management of vaccinations and prophylaxis of international travellers from community pharmacy (VINTAF study)]. / Seguimiento desde la farmacia comunitaria de la vacunación y la quimioprofilaxis de los viajeros internacionales. Estudio VINTAF.

OBJECTIVES: To improve and evaluate the travel advice by community pharmacists. DESIGN: Cross-sectional and prospective study. SETTING: Community pharmacies from Asturias, Barcelona, Madrid and Valencia. PARTICIPANTS: 483 travellers to high health risk countries who visit the community pharmacies and were agreed with the aims of the study. METHOD: Community pharmacists gave information regarding immunization and prophylaxis about travel-related disease according to the destination, type and duration of travel and other features of the tourist (age, taking medicines, diseases, etc.). MAIN MEASUREMENTS: Destination, adherence to the prophylaxis and vaccinations recommended, adverse effects and diseases the tourists have in the travel and one month after they are back. RESULTS: Only 6.3% of the travellers were effective vaccinated and took prophylaxis (all vaccines and prophylaxis according to the destination). 36.2% of the travellers experienced an illness while abroad. The commonest disease were travellers' diarrhoea (15.7%). The pharmacists were the only source of information about sunscreens, repellents, and other sanitary goods. CONCLUSIONS: The community pharmacists can give accurate information regarding immunization and prophylaxis about international travels. It is necessary to improve the communication between family physician, the tropical travel clinic and community pharmacists in order to improving compliance. It is necessary keep the bureaucratic barriers away to get this kind of drugs. The international tourists still travel without the necessary vaccines and prophylaxis to the high health risk areas.

Seguimiento desde la farmacia comunitaria de la vacunación y la quimioprofilaxis de los viajeros internacionales. Estudio VINTAF / Management of vaccinations and prophylaxis of international travellers from community pharmacy (VINTAF study)

Objetivos. Mejorar la captación de viajeros a zonas de riesgo sanitario por los farmacéuticos comunitarios y evaluar dicha actuación sanitaria. Diseño. Estudio observacional prospectivo. Emplazamiento. Farmacias comunitarias de Asturias, Barcelona, Madrid y Valencia. Participantes. Un total de 483 viajeros a zonas de riesgo que iban a las farmacias participantes y que dieron su consentimiento verbal para participar en el estudio. Intervenciones. Asesoramiento por parte de los farmacéuticos comunitarios a los viajeros sobre las vacunas, la quimioprofilaxis y el botiquín de viaje necesarios según el destino, la duración y las características de los viajeros (medicación concomitante, embarazo, comorbilidades, edad, etc.).Mediciones principales. Destino y duración del viaje, cumplimiento de vacunas y/o quimioprofilaxis recomendadas, reacciones adversas a ellas. Problemas de salud durante el viaje y al mes del regreso. Resultados. El 6,3 por ciento de los viajeros estaba protegido correctamente (todas las vacunas y quimioprofilaxis que necesitaban). El 36,2 por ciento de los viajeros tuvieron algún problema de salud durante el viaje, siendo la diarrea el más frecuente (15,7 por ciento). El botiquín de viaje fue recomendado sobre todo por el farmacéutico comunitario (89-95 por ciento).Conclusiones. Los farmacéuticos convenientemente formados están capacitados para asesorar a los viajeros sobre las vacunas, la quimioprofilaxis y el botiquín de viaje necesarios. Hay que mejorar la coordinación con los departamentos de medicina exterior y los médicos de familia correspondientes. Conviene disminuir las trabas burocráticas (visado de inspección) para la obtención de estos medicamentos. Los viajeros internacionales aún no van correctamente vacunados a las zonas de riesgo sanitario (AU)

Tratamiento con metadona durante el embarazo: repercusión en el recién nacido / Treatment with methadone during pregnancy: repercussion in the newborn

El objetivo de este estudio es conocer el perfil epidemiológico de las madres en tratamiento con metadona durante la gestación y caracterizar el síndrome de abstinencia en el recién nacido. Se revisan los aspectos maternos, perinatales y neonatales de 30 recién nacidos de madres en tratamiento con metadona que ingresaron en nuestra Unidad de Neonatología desde enero de 1995 hasta mayo de 2001.Los antecedentes más frecuentes en las madres estudiadas son: edad cercana a los 29 años, familia monoparental, con más de dos embarazos y frecuentes antecedentes de abortos, sin control obstétrico durante la gestación. El parto es generalmente eutócico y los test de Apgar, también suelen estar acordes a la normalidad. El neonato presenta bajo peso al nacimiento y el síndrome de abstinencia con casi total seguridad (29 de 30). El síndrome de abstinencia es de inicio precoz e intensidad y duración elevadas. Menos de tres horas de sueño y el llanto agudo son los síntomas más comunes al inicio y los más frecuentes en aparecer son los generales y neurológicos (AU)

Displasia campomélica / Camptomelic dysplasia

La Displasia campomélica es un cuadro clínico caracterizado por la curvatura y acortamiento simétrico de extremidades inferiores, facies peculiar y generalmente mortal por insuficiencia respiratoria.Esta enfermedad se asocia en el 50 por ciento de las ocasiones a disgenesia gonadal con un fenotipo femenino y un cariotipo XY. Se trata de un proceso genéticamente determinado y ligado a mutaciones del gen SOX9.Presentamos el caso clínico de un recién nacido mujer, de 37 semanas de edad gestacional, diagnosticado prenatalmente de displasia ósea, con fenotipo y estudio radiológico compatible con las características de esta enfermedad. Destaca la concordancia entre el fenotipo femenino y su fórmula cromosómica XX.Durante su estancia presentó distress respiratorio progresivo, falleciendo a los 27 días de edad por fallo multiorgánico (AU)

Role of biliary phosphatidylcholine in bile acid protection and NSAID injury of the ileal mucosa in rats.

BACKGROUND & AIMS: We explored the role of biliary phosphatidylcholine (PC) in protection of the intestinal mucosa against bile salt (BS)-induced intestinal injury and how this property may be blocked by indomethacin (Indo), a nonsteroidal anti-inflammatory drug (NSAID) that is secreted into the bile. METHODS: We performed in vivo studies in which bile was collected over a 2-hour period after rats were intragastrically administered Indo (25 mg/kg) or an equivalent volume of saline (controls). The bile samples (some of which were supplemented with PC) were then instilled into a loop of distal ileum of anesthetized rats. After a 30-minute exposure period, we measured the hemoglobin concentration of the ileal loop fluid, as an index of bleeding, and mucosal contact angles, as an index of surface hydrophobicity. A similar in vivo experiment was performed in which model bile containing 5 mmol/L each of the BS, sodium deoxycholate, PC, or Indo, alone and in combination, was instilled into ileal loops. In our in vitro test system, human erythrocytes were exposed to the above biliary constituents, and hemolysis was measured spectrophotometrically. RESULTS: Bile from Indo-pretreated rats decreased the surface hydrophobicity and induced bleeding of ileal loops in comparison with control bile, and both NSAID-induced changes were reversed if PC was added to the bile. Similarly, synthetic BS caused gastrointestinal bleeding, decreased ileal contact angles, and induced erythrocyte hemolysis, all of which were reversed by addition of equimolar PC. This protective role of PC in both the in vivo and in vitro systems was partially blocked by Indo, although the NSAID had no effect on these properties on its own. CONCLUSIONS: These findings support the hypothesis that PC protects the intestinal mucosa against injurious actions of BS, possibly by forming less toxic mixed micelles. Indo and perhaps other NSAIDs that enter the bile may damage the mucosa, not by a direct action, but by competing for the available protective PC molecules.

Oral rehydration solution therapy in the management of children with rotavirus diarrhea.

Rotavirus infections are the most common cause of gastroenteritis among children younger than 3 years of age and are associated with sporadic outbreaks of diarrhea in elderly and immunocompromised patients. Oral rehydration solutions (ORS) are formulated to correct dehydration and acidosis. Currently, ORS do not promote intestinal healing; however, investigators are examining the role of nutrition in promoting intestinal healing. This article reviews the composition of several ORS in human medicine and summarizes our current knowledge of the nutritional treatment of rotavirus diarrhea and intestinal healing.

Percutaneous liver biopsy in children: impact of ultrasonography and spring-loaded biopsy needles.

BACKGROUND: Percutaneous liver biopsy is a valued tool of pediatric hepatology. Recent advances in technology have incorporated spring-loaded biopsy needles and ultrasonography in percutaneous liver biopsy. METHODS: To determine the frequency of complications after liver biopsy and whether variables such as needle selections (Jamshidi, Monopty, or ASAP) and ultrasound guidance could predict complications, medical records were retrospectively reviewed of all patients who underwent percutaneous liver biopsy during a 7-year period. Available data were collected from 123 patients who had undergone a total of 249 percutaneous liver biopsies. All patients with evidence of mild clotting abnormalities (8.83%) received platelets, cryoprecipitate, or fresh-frozen plasma. RESULTS: There was a 6.83% incidence of overall complications, and a 2.4% incidence of major complications. The mortality rate was 0.4%. Ultrasound localization did not diminish the risk of bleeding during biopsy. There was no significant difference in the change of hematocrit between the aspiration (Jamshidi) and spring-loaded (Monopty) needles. However, in patients less than 5 years of age, the change of hematocrit was significantly higher (P < 0.05) with the 15- or 18-gauge ASAP needle (Microvasive, Quincy, MA, U.S.A.) than with either the Jamshidi (Allegience Healthcare, Columbia, MD, U.S.A.) or Monopty (Bard Technologies, Covington, GA, U.S.A.) needles. CONCLUSION: Percutaneous liver biopsy is safe, using either aspiration or spring-loaded needles. Ultrasound guidance may not be helpful except in patients who underwent segmental liver transplantation.

[Malignant schwannoma of the neck]. / Schwannoma maligno de cuello.

Malignant schwannoma (MS) is a tumor of the peripheral nervous system, extremely rare when settled in head and neck. Conversely these two are preferable locations for benign schwannomata. We report a feminine patient, 74-year-old, with a right laterocervical massa, evolving in 3 months, surgically removed and postoperative radiotherapeutic treatment, which remains asymptomatic since one year and a half.