Systemic phenotype of sarcoidosis associated with radiological stages. Analysis of 1230 patients.

BACKGROUND: To analyze the association between Scadding radiological stages of sarcoidosis at diagnosis and the disease phenotype (epidemiology, clinical presentation and extrathoracic involvement) in one of the largest cohorts of patients with sarcoidosis reported from southern Europe. METHODS: The SARCOGEAS-Study Group includes a multicenter database of consecutive patients diagnosed with sarcoidosis according to the WASOG 1999 criteria. Extrathoracic disease at diagnosis was defined according to the 2014 instrument and the clusters proposed by Schupp et al. RESULTS: We analyzed 1230 patients (712 female, mean age 47 yrs.) who showed the following Scadding radiologic stages at diagnosis: stage 0 (n = 98), stage I (n = 395), stage II (n = 500), stage III (n = 195) and stage IV (n = 42). Women were overrepresented in patients presenting with extrathoracic/extrapulmonary disease, while the diagnosis was made at younger ages in patients presenting with BHL, and at older ages in those presenting with pulmonary fibrosis (q values <0.05). Multivariable adjusted analysis showed that patients presenting with pulmonary involvement (especially those with stages II and III) had a lower frequency of concomitant systemic involvement in some specific extrathoracic clusters (cutaneous-adenopathic/musculoskeletal, ENT and neuro-ocular/OCCC) but a higher frequency for others (hepatosplenic), in comparison with patients with extrapulmonary involvement (stages 0 and I). The presence of either BHL or fibrotic lesions did not influence the systemic phenotype of patients with pulmonary involvement. CONCLUSIONS: The key determinant associated with a differentiated systemic phenotype of sarcoidosis at diagnosis was interstitial pulmonary involvement rather than the individual Scadding radiological stage.

HIV/antiretroviral therapy-related lipodystrophy syndrome (HALS) is associated with higher RBP4 and lower omentin in plasma.

Very little information is available on the involvement of newly characterized adipokines in human immunodeficiency virus (HIV)/antiretroviral therapy (ART)-associated lipodystrophy syndrome (HALS). Our aim was to determine whether apelin, apelin receptor, omentin, RBP4, vaspin and visfatin genetic variants and plasma levels are associated with HALS. We performed a cross-sectional multicentre study that involved 558 HIV type 1-infected patients treated with a stable highly active ART regimen, 240 of which had overt HALS and 318 who did not have HALS. Epidemiologic and clinical variables were determined. Polymorphisms in the apelin, omentin, RBP4, vaspin and visfatin genes were assessed by genotyping. Plasma apelin, apelin receptor, omentin, RBP4, vaspin and visfatin levels were determined by enzyme-linked immunosorbent assay in 163 patients (81 with HALS and 82 without HALS) from whom stored plasma samples were available. Student's t test, one-way ANOVA, chi-square test, Pearson and Spearman correlations and linear regression analysis were used for statistical analyses. There were no associations between the different polymorphisms assessed and the HALS phenotype. Circulating RBP4 was significantly higher (p < 0.001) and plasma omentin was significantly lower (p 0.001) in patients with HALS compared to those without HALS; differences in plasma levels of the remaining adipokines were nonsignificant between groups. Circulating RBP4 concentration was predicted independently by the presence of HALS. Apelin and apelin receptor levels were independently predicted by body mass index. Visfatin concentration was predicted independently by the presence of acquired immunodeficiency syndrome. HALS is associated with higher RBP4 and lower omentin in plasma. These two adipokines, particularly RBP4, may be a link between HIV/ART and fat redistribution syndromes.

A study of fatty acid binding protein 4 in HIV-1 infection and in combination antiretroviral therapy-related metabolic disturbances and lipodystrophy.

OBJECTIVE: The aim of the study was to determine circulating levels of fatty acid binding protein 4 (FABP-4) in a cohort of HIV-1-infected patients treated with combination antiretroviral therapy (cART) and to investigate the relationships between FABP-4 levels and insulin resistance, dyslipidaemia, lipodystrophy and levels of proinflammatory adipocytokines in these patients. METHODS: A total of 282 HIV-1-infected patients treated with stable cART for at least 1 year (132 with lipodystrophy and 150 without) and 185 uninfected controls (UCs) were included in the study. Anthropometric parameters were determined. Plasma levels of FABP-4, soluble tumour necrosis factor receptors 1 and 2 (sTNF-R1 and sTNF-R2), interleukin-18 (IL-18), IL-6, adiponectin and leptin were also analysed. Insulin resistance was determined using the homeostasis model assessment of insulin resistance (HOMA-IR). Subcutaneous adipose tissue mRNA expression of proinflammatory cytokines was assessed in 38 patients (25 with lipodystrophy and 13 without) by real-time polymerase chain reaction (PCR). RESULTS: The plasma FABP-4 concentration was significantly higher in patients with lipodystrophy than in those without (P=0.012). FABP-4 concentration was positively correlated with body mass index (BMI), HOMA-IR, and the concentrations of insulin, total cholesterol, triglycerides, sTNF-R1, leptin and IL-18, but showed a negative correlation with high-density lipoprotein (HDL) cholesterol and adiponectin concentrations. After adjusting for age, sex and BMI, the odds ratio (OR) for risk of lipodystrophy was found to be significantly increased for those with the highest levels of FABP-4 [OR 0.838, 95% confidence interval (CI) 0.435-1.616 for medium FABP-4 vs. OR 2.281, 95% CI 1.163-4.475 for high FABP-4]. In a stepwise regression model, FABP-4 was independently associated with HOMA-IR after controlling for clinical and inflammatory parameters (P=0.004). Moreover, a positive relationship was observed in patients with lipodystrophy between subcutaneous adipose tissue CD68 expression and FABP-4 plasma levels (r=0.525; P=0.031). CONCLUSIONS: cART-treated HIV-1-infected patients with lipodystrophy have a systemic overproduction of FABP-4, which is closely linked to insulin resistance and inflammatory markers in subcutaneous adipose tissue.

Clinical response to ertapenem in severe community-acquired pneumonia: a retrospective series in an elderly population.

To evaluate in routine hospital practice the clinical response to ertapenem in comparison with other parenteral antibiotics in the treatment of community-acquired pneumonia (CAP), clinical records from patients with severe CAP treated with ertapenem from July 2002 to June 2006 in seven Spanish hospitals were retrospectively reviewed. Patients were classified according to the Pneumonia Severity Index (PSI). Each ertapenem-treated patient was matched with two patients in the same hospital treated with other antibiotics, according to age (difference 76 years). Comorbidities were present in 193 patients (95.5%). No differences were found in median hospital stay (7 days for ertapenem vs. 10 days for comparators, p 0.066). A slightly higher clinical response rate was obtained for ertapenem vs. comparators (88.7% vs. 77.1%; p 0.0465; OR 2.25; 95% CI 0.99-5.12), with significant differences in clinical response in patients coming from nursing homes (95.8% ertapenem vs. 63.8% comparators; p 0.0034) but not in non-institutionalized patients (85.4% ertapenem vs. 84.5% comparators; p 0.929). The higher clinical response to ertapenem vs. comparators in severe CAP was due to its significantly higher efficacy in healthcare-associated CAP in patients coming from nursing homes.

Consejo breve para la prevención del tabaquismo en escolares de 2º a 4º de Educación Secundaria Obligatoria de Zaragoza / No disponible

Se realizó una intervención en el ámbito escolar para administrar consejo breve antitabacoa escolares de la Educación Secundaria Obligatoria (ESO) en Zaragoza durante los cursos2006-2007 y 2007-2008. Los objetivos del estudio fueron medir la efectividad del consejobreve apoyado por material escrito y estudiar la progresión del tabaquismo. El estudióincluyó una encuesta autoadministrada y una coximetría, así como una reevaluación un añodespués.Se estudiaron 15 centros escolares, 8 del grupo intervención y 7 de control. Se administróconsejo apoyado con un folleto frente al control en el que no se utilizaba el folleto. Laasignación a los grupos no fue aleatoria.Se evaluaron 1.720 estudiantes entre los dos cursos 2006-07 y 2007-08 de los cuales51,95% fueron hombres y 48,5% mujeres. La edad media fue 14,6 años (desviación estándar[DE] = 1,36) y fueron fumadores el 19,7%. Entre las mujeres fueron fumadoras el24,7% frente al 18,3% de los hombres (p < 0,0001). No hubo diferencias significativas parael tabaquismo según grupo de intervención o control. La progresión del tabaquismo crecióun 8,8% en el grupo intervención frente a un 12% en el de control entre 2.º y 3.º. Las diferenciasfueron 3% para el grupo intervención frente al 1,1% en el de control entre 3.º y 4.º,no siendo estas diferencias estadísticamente significativas. Conclusiones: el porcentaje de fumadores en escolares de ESO es del 19,7%. La escaladade consumo se produce entre 2.º y 3.º. No se demostró una mayor efectividad del consejobreve mediante el uso de un folleto(AU)

Authors report a community school study about smoking adolescent behaviour, 8º, 9º,and 10 º year in Zaragoza (Spain). The study was implemented in the 2006-2007 and 2007-2008 courses respectively. The study’s objectives were to asses the effectiveness of smokingcounselling with the aid of a specifically designed leaflet. The study also included an evaluationof expired CO. The authors surveyed on smoking behaviour as well as on personaldetails of the students.The study includes 8 intervention schools and 7 control schools. Allocation wasn’t randomizeddue to logistic reasons. The interventional group received advice against smokingby means of spoken counsel from a professional supported by a leaflet. The control grouponly received the spoken counsel. The expired CO was assessed in each group. The counselwas repeated in each group one year later to the same students.In all 1,720 students were assessed: 51.95% men and 48.5% women. The median ageof the students was 14.6 years SD: 1.36. The authors found that 19.7% of the students weresmokers. The distribution of smokers by sex was 24.7% of women versus 15.3% of men X2= 24.1 p < 0.0001. Smoking behaviour between interventional or control group wasn’t statisticallydifferent.Conclusions: There wasn’t any evidence of effectiveness in using a leaflet added to thespoken counsel. Prevalence of smoking was very high: 19.7% among adolescents of Zaragoza.The study shows a increase of smoking between 8º and 10º(AU)

Estudio epidemiológico sobre el consumo de tabaco en adolescentes de 2º y 3º de ESO en Zaragoza / No disponible

Objetivo: analizar el consumo de tabaco en adolescentes de Zaragoza de 2.º y 3.º de laEducación Secundaria Obligatoria (ESO).Material y métodos: población diana: adolescentes de 2.° y 3.° de ESO. Ámbito: centros escolares.Consejo impartido de forma grupal por profesionales de Atención Primaria: pediatras ymédicos de familia. Marco: 14 centros escolares de la ciudad de Zaragoza. Participación voluntariay de asignación no aleatoria de los Centros. Muestra: 881 adolescentes. Actividad en elGrupo Intervención: consejo grupal apoyado con material escrito específico; folleto encuesta decinco preguntas y coximetría. Reevaluación: encuesta y coximetría un año después a los mismoscentros y en los cursos 3.° y 4.° de ESO.Resultados principales: se objetivó un porcentaje de fumadores de un 18,8% en el totalde la muestra (IC 95% 16,3%-21,6%). La media de edad de los fumadores es de 14,8 años yla de los no fumadores de 14,2 años. El consumo de las mujeres es mucho mayor que el delos hombres, 24,6% frente al 14%. El ascenso en las cifras de consumo es mayor en las mujeres,alcanzando porcentajes de un 40% a los 16 años. Un 34% de los 166 fumadores piensanno fumar el próximo año. Los centros públicos tienen unas cifras de consumo superior al delos concertados y al de los privados (13,6% tanto para centros privados como concertados, y 22,9% para los públicos), siendo estas diferencias significativas (X2=11,5; p=0,003). Sin embargo,si analizamos el caso de las mujeres de 3.° de ESO vemos que estas diferencias sonmenores y no alcanzan significación estadística. El patrón de consumo en fin de semana esmás acentuado para los hombres que para las mujeres. Cuando las lecturas de monóxido decarbono superan los valores de 5 partes por millón (ppm) la probabilidad de ser fumador esde alrededor del 80%

Objective: to evaluate the adolescent smoking habit in a whole group at school by primary health care practitioners.Target population: students of 2nd and 3rd level of High Education (Obligatory SecondaryEducation). Scenary: 14 High Schools in Zaragoza city. The recruitment was not randomisedand students have participated voluntarily. Professionals: General Pactitioners and Pediatricians.Sample: 881 students. Activities: groupal antismoking advice, leaflet, five questions inquiryand coximetry. Reevaluation: one year later inquiry and coximetry.Main results: the authors report 18.80% (CI 95% 16.3%-21.6%) of smokers in all thesample. Women smoke more than men 24.60% versus 14%. Smoking is a crescent phenomenonin young women 40% at sixteen years of age. 34% of smokers do not have the intention ofsmoking next year. Students in Public High Schools smoke more than students in Private andConcerted High Schools, 22.90% versus 13.70% (X2=11.5; p=0.003). Otherwise women behavein a similar way in both kinds of schools. Smoker students are 14.8 years old and no smokerstudents are 14.2 years old. The patern of consume of men is mainly at weekends. When coximetryis more than 5 ppm, the probability of being a smoker is 80%

Varón de 76 años con polimialgia y el signo del halo / 76 year old male with polymyalgia and halo sign

No disponible

No disponible

Clinical characterization of breakthrough bacteraemia: a survey of 392 episodes.

BACKGROUND: Few data are available on the clinical features of patients who develop breakthrough bacteraemia, understood as positive blood cultures despite appropriate antibiotic therapy. OBJECTIVES: To determine the clinical significance and outcome of a large series of breakthrough bacteraemia. DESIGN: Retrospective analysis of a prospectively collected database. SETTING: Two university-affiliated hospitals in Catalonia, Spain. SUBJECTS: A total of 392 individuals who suffered an episode of breakthrough bacteraemia recorded between 1997 and 2002. INTERVENTIONS: Demographic characteristics, underlying diseases, origin of infection, sources of infection, microorganisms isolated, McCabe and Jackson prognostic criteria, and mortality were analysed. RESULTS: Breakthrough bacteraemia was detected in 392 of 6324 (6.1%) episodes of bacteraemia. Eighty per cent of episodes were nosocomial. The most frequent source of infection in breakthrough bacteraemia was endovascular (70%). Coagulase-negative staphylococci, Staphylococcus aureus, and Pseudomonas aeruginosa were the most significant microorganisms involved. Nosocomial acquisition together with selected sources (central venous catheter, endocarditis and other endovascular foci), underlying conditions (neutropenia, polytraumatism, allogenic bone marrow and kidney transplantation), and particular microbial aetiologies (S. aureus, P. aeruginosa and polymicrobial) were independently associated with increased risk for developing breakthrough bacteraemia. Crude mortality rate was greater in patients with breakthrough bacteraemia (16% vs. 12.3%; P<0.05), and this condition was an independent predictor of death (OR 1.4, 95% CI, 1-1.9; P=0.04). CONCLUSIONS: In view of a case of breakthrough bacteraemia it is mandatory to search for an endovascular focus. Empiric treatment should be directed to cover S. aureus, coagulase-negative staphylococci and nonfermentative Gram-negative bacilli. Breakthrough bacteraemia is an independent predictor of death.

Dynamic evaluation of a fixed bed anaerobic digestion process in response to organic overloads and toxicant shock loads.

This paper details a dynamic evaluation of a 1 m3 fixed bed anaerobic digestion reactor in response to organic overloads and toxicant shock loads. Raw industrial wine distillery wastewater was used as a reference substrate and several disturbances were applied to the process: (i) organic overloads with and without pH regulation in the feeding line, (ii) adding of ammonia in the input wastewater. The purpose of this study was to assess, using on-line instrumentation, the robustness of a fixed bed anaerobic digester. Anaerobic digestion processes have the reputation of being difficult to operate and prone to process instability due to external disturbances and the objective of this study was to demonstrate the possibility of such a reactor configuration for industrial use.

[Antipyretic poisoning]. / Intoxicaciones por antitérmicos.

OBJECTIVE: To establish the current incidence of poisoning caused by oral antipyretics in the Spanish pediatric population. METHODS: From January 1998 to December 2000, all cases of poisoning due to antipyretic ingestion in children aged up to 14 years old were recorded and tabulated in the Poison Control Center. RESULTS: A total of 13,044 cases of drug poisoning were recorded. Acetaminophen accounted for 11.0 %, acetylsalicylic acid (ASA) for 3 % and ibuprofen for 1.5 % of the cases (p < 0.001). The risk of acetaminophen poisoning was 5.6 higher than that of ibuprofen poisoning (RR: 5.6; 95 % CI: 4.8-6.5). Seventy three percent of poisonings occurred in children aged 1-3 years old. Poisonings were considered serious in 9.4 % of those produced by acetaminophen, 2 % of those produced by ASA and 1 % of those produced by ibuprofen (p < 0.001). Information from the Poison Control Center were requested mainly by emergency department physicians (78.9 %), followed by pediatricians (15.4 %), other physicians (4.7 %) and nursing staff (1 %). CONCLUSIONS: Because of their frequency and potential toxicity, drug and household product poisonings in childhood are a significant public health problem. Among the antipyretics evaluated, acetaminophen was the most frequently associated with poisoning and with severe intoxications. We recommend several preventive strategies to reduce the incidence of drug poisoning in childhood.

Intoxicaciones por antitérmicos / Antipyretic poisoning

Objetivo: Conocer la incidencia actual de las intoxicaciones producidas por fármacos antitérmicos orales en la población infantil española. Métodos: Se han recogido y tabulado en el Servicio de Información Toxicológica todos los casos de intoxicaciones por ingesta de productos antitérmicos en niños de hasta 14 años, durante el período de tiempo comprendido entre enero de 1998 y diciembre de 2000. Resultados: De las 13.044 intoxicaciones medicamentosas registradas en ese período de tiempo, el 11,0% estuvieron causadas por paracetamol, el 3,0% por ácido acetilsalicílico y el 1,5% por ibuprofeno (p < 0,001). El riesgo de presentar una intoxicación por paracetamol fue 5,6 veces mayor que el de presentar una intoxicación por ibuprofeno (RR, 5,6; IC 95%, 4,8-6,5). El 73,2% de las intoxicaciones debidas a estos 3 fármacos antipiréticos se produjeron en niños de 1 a 3 años. Se consideraron graves el 9,4% de las intoxicaciones producidas por paracetamol, el 2,0% de las producidas por ácido acetilsalicílico y el 1,0% de las producidas por ibuprofeno (p < 0,001). El médico de urgencia fue el que con mayor frecuencia (78,9%) solicitó información al Servicio de Información Toxicológica, seguido del pediatra (15,4%), otros médicos (4,7%) y ayudante técnico sanitario (1,0%). Conclusiones: En la población pediátrica, las intoxicaciones medicamentosas constituyen un importante problema de salud pública, tanto por su incidencia como por los posibles daños que pueden producir. De los fármacos antipiréticos evaluados, el paracetamol es el que ocasiona mayor número de intoxicaciones. Asimismo, son más frecuentes las intoxicaciones por paracetamol consideradas más graves que las producidas por ibuprofeno o ácido acetilsalicílico. Se recomienda una serie de estrategias en prevención dirigidas a reducir la incidencia de intoxicaciones por medicamentos en la infancia (AU)

Lessons from the "Euro-Lupus Cohort".

The "Euro-Lupus Cohort" is composed by 1,000 patients with systemic lupus erythematosus (SLE) that have been followed prospectively since 1991. These patients have been gathered by a European consortium - the "Euro-Lupus Project Group". This consortium was originated as part of the network promoted by the "European Working Party on SLE", a working group created in 1990 in order to promote research in Europe on the different problems related to this disease. The "Euro-Lupus Cohort" provides an updated information on the SLE morbidity and mortality characteristics in the present decade as well as defines several clinical and immunological prognostic factors.

[Paraneoplastic syndromes with peripheral nerve involvement]. / Síndromes paraneoplásicos con afectación nerviosa periférica.

OBJECTIVE: To review the paraneoplastic complications described affecting the peripheral nervous system. DEVELOPMENT: Different types of tumors, especially secretory carcinomas and some lymphomas may affect the peripheral nerves, and this may often precede clinical signs of the tumor. Depending on the clinical features we may consider sensory neuropathies, motor neuropathies, senso-motor neuropathies, autonomic neuropathies, mononeuritis, and neuromyotonia. They may present in an isolated form or as part of a more generalized involvement of the nervous system. CONCLUSIONS: The presence of certain anti-Hu antibodies, which act against nerves or antibodies which attack the voltage-dependent potassium channels in a peripheral nervous system disorder make one suspect a paraneoplastic origin.

Transverse myelitis as a first manifestation of systemic lupus erythematosus: a case report.

Transverse myelitis as a first manifestation of systemic lupus erythematosus (SLE) is very uncommon. No pathognomonic clinical or biochemical characteristics exist, and therefore an early diagnosis is often difficult. Therapy with intravenous pulses of methylprednisolone and cyclophosphamide has been shown to improve the prognosis. However, morbidity and mortality rates in transverse myelitis are still high due to the fact that complications such as opportunistic infections and pulmonary embolism are still frequent causes of death. We report a woman with relapsing transverse myelitis which was the first manifestation of SLE. A good response to pulse methylprednisolone and cyclophosphamide therapy was obtained but she died later as a result of a pulmonary embolism. We conclude that intravenous pulse methylprednisolone and cyclophosphamide therapy improve the prognosis of transverse myelitis associated with SLE but that a careful follow-up is needed to avoid complications due to the illness itself or secondary to the therapy.