Tratamiento antidepresivo y asociación con el ingreso urgente en unidades médicas en pacientes de 65 años o mayores / Association of antidepressant treatment with emergency admission to medical units for patients 65 years or older

Introducción. Existe una creciente evidencia acerca de la interrelación entre presencia de depresión en la tercera edad y riesgo de ingreso hospitalario médico. Objetivo. Determinar el impacto del tratamiento antidepresivo (ATD) como factor protector de ingreso hospitalario desde Urgencias en personas mayores. Método. Se incluyó a personas de 65 años o mayores que acudieron por cualquier motivo a Urgencias de la Corporació Sanitària i Universitària Parc Taulí de Sabadell (Barcelona) entre enero y octubre del 2012. Se obtuvieron datos sociodemográficos básicos, consumo de alcohol y tabaco, antecedentes y tratamiento actual. Se realizó el cálculo de tamaño muestral y una aleatorización simple. Posteriormente se realizó un análisis estadístico descriptivo y pruebas paramétricas. Resultados. Se evaluó a 674 pacientes (53% mujeres), con una edad media de 78,45 años. Un 27,6% de los casos (71% mujeres) recibían tratamiento antidepresivo. Del total de 337 pacientes ingresados (50%), 83 individuos (24,6%) utilizaban previamente ATD, mientras que entre los no ingresados, utilizaban ATD el 30,6%. Tras el análisis comparativo, se objetivó una relación significativa negativa entre recibir ATD y riesgo de ingreso solo en aquellos pacientes de 75 años o mayores (sig. 0,012). Conclusiones. En nuestro estudio, el tratamiento antidepresivo se relaciona con una disminución del riesgo de ingreso hospitalario urgente por enfermedad médica en personas de 75 años o mayores. El tratamiento de la depresión en personas mayores podría tener efecto protector general frente a la severidad de las enfermedades atendidas en Urgencias en nuestra población y puede suponer un criterio de calidad en orden a prevenir complicaciones (AU)

Introduction. There is increasing evidence relating the presence of depression in seniors and the risk of hospital admission in medical departments from the Emergency Services. Objective. To determine the impact of antidepressant treatment (ATD) as a protective factor for emergency hospitalization in older people. Method. All patients aged 65 and over who required urgent attention for medical reasons at the Emergency Department of the Corporació Sanitària i Universitària Parc Taulí (Sabadell, Barcelona, Spain) for the period between January and October 2012 were included in the study. Sociodemographic variables, alcohol and tobacco use, medical history and psychopharmacological treatment were obtained. The necessary sample size was calculated and a simple randomization was performed. Subsequently, a descriptive statistical analysis and parametric tests were conducted. Results. A total of 674 patients (53% women) were evaluated, with a mean age of 78.45 years, and 27.6% of the cases (71% women) were receiving ATD. Among the 333 admitted patients (50%), 83 individuals (24.6%) had previously received ATD; this contrasts with the 103 cases (30.6%) of prior ATD treatment among the patients who were not admitted. After comparative analysis, the relationship between previous use of ATD and being admitted to hospital was not statistically significant in our global sample. This relationship was only statistically significant among the group aged 75 and over (neg. sig. 0.012). Conclusions. In our study, ATD was associated with a decreased risk of hospital admission for urgent medical conditions in people aged 75 and over. Treating depression may protect the elderly against admission to the Emergency department and may potentially be a quality criterion in preventing complications in this population (AU)

Association of antidepressant treatment with emergency admission to medical units for patients 65 years or older. / Tratamiento antidepresivo y asociación con el ingreso urgente en unidades médicas en pacientes de 65 años o mayores.

INTRODUCTION: There is increasing evidence relating the presence of depression in seniors and the risk of hospital admission in medical departments from the Emergency Services. OBJECTIVE: To determine the impact of antidepressant treatment (ATD) as a protective factor for emergency hospitalization in older people. METHOD: All patients aged 65 and over who required urgent attention for medical reasons at the Emergency Department of the Corporació Sanitària i Universitària Parc Taulí (Sabadell, Barcelona, Spain) for the period between January and October 2012 were included in the study. Sociodemographic variables, alcohol and tobacco use, medical history and psychopharmacological treatment were obtained. The necessary sample size was calculated and a simple randomization was performed. Subsequently, a descriptive statistical analysis and parametric tests were conducted. RESULTS: A total of 674 patients (53% women) were evaluated, with a mean age of 78.45 years, and 27.6% of the cases (71% women) were receiving ATD. Among the 333 admitted patients (50%), 83 individuals (24.6%) had previously received ATD; this contrasts with the 103 cases (30.6%) of prior ATD treatment among the patients who were not admitted. After comparative analysis, the relationship between previous use of ATD and being admitted to hospital was not statistically significant in our global sample. This relationship was only statistically significant among the group aged 75 and over (neg. sig. 0.012). CONCLUSIONS: In our study, ATD was associated with a decreased risk of hospital admission for urgent medical conditions in people aged 75 and over. Treating depression may protect the elderly against admission to the Emergency department and may potentially be a quality criterion in preventing complications in this population.

Predicting the Development of Tuberculosis with the Tuberculin Skin Test and QuantiFERON Testing.

RATIONALE: The identification of patients with latent tuberculosis infection, who are at higher risk to develop active disease, is an important component of disease control. OBJECTIVES: We aim to compare the usefulness of the QuantiFERON-TB Gold in-tube assay and the tuberculin skin test to predict the development of active tuberculosis during follow-up, using positive and negative predictive values, positive likelihood ratios, and stratified level of risk. METHODS: The study included contacts of tuberculosis cases diagnosed between 2007 and 2009. All contacts included were from the first circle of exposure. Tuberculin skin test and QuantiFERON test were performed and a chest radiograph was obtained during the contact's study. MEASUREMENTS AND MAIN RESULTS: A total of 1,335 contacts were followed up for 4 years: a smear-positive index case was identified for 937 contacts, of whom 15 developed active tuberculosis and had initially presented with positive tuberculin skin test/QuantiFERON results, a normal chest radiograph, and no symptoms. The positive predictive value was 4% for QuantiFERON and 2% for the tuberculin skin test (when ≥5 mm). The probability of developing active disease was 2.36 times higher with a positive QuantiFERON, and 1.3 times higher with a positive tuberculin skin test. The positive predictive value was 17%, and the positive likelihood ratio was 7.53 for untreated contacts with a positive QuantiFERON. Stratifying according to initial QuantiFERON results showed a 6.36 times higher risk of developing active tuberculosis for patients with a QuantiFERON result greater than or equal to 10 IU/ml. Among bacillus Calmette-Guérin-vaccinated patients, a tuberculin skin test induration greater than or equal to 15 mm correlated better with a positive QuantiFERON. CONCLUSIONS: QuantiFERON results were more accurate than tuberculin skin test results in predicting tuberculosis. Although all contacts with QuantiFERON-positive results are at risk of developing tuberculosis, those with a tuberculin skin test induration greater than or equal to 15 mm and QuantiFERON greater than or equal to 10 IU/ml are at highest risk. This has important implications in the clinical management of tuberculosis contacts.

Investigación de un caso de infección neonatal por Enterobacter sakazakii asociada a un preparado en polvo para lactantes / Investigation of a neonatal case of Enterobacter sakazakii infection associated with the use of powdered infant formula

Introducción Se describe la investigación de un caso de meningitis por Enterobacter sakazakii en una unidad de prematuros con el objetivo de identificar la fuente de infección y los posibles factores contribuyentes. Material y métodos Se realizó el análisis de los posibles riesgos asociados a la infección. En las muestras del preparado en polvo de los lotes que se utilizaron en la alimentación de los neonatos se investigó la presencia de E. sakazakii y su grado de contaminación inicial. Las cepas de E. sakazakii aisladas en sangre y heces del neonato, y en las muestras del preparado en polvo se caracterizaron mediante el biotipo, antibiotipo y pulsotipo. Resultados La alimentación del neonato infectado se había realizado exclusivamente con un preparado en polvo para lactantes prematuros. E. sakazakii se detectó en una muestra abierta y otras 2 no abiertas de un único lote de los analizados. Las cepas de E. sakazakii aisladas en el preparado en polvo y las aisladas en el neonato infectado presentaron el mismo biotipo, patrón de resistencias antimicrobianas y patrón de PFGE. Como factores contribuyentes se identificaron la inadecuada reconstitución del preparado y el excesivo tiempo de conservación antes de su administración. Conclusiones La infección por E. sakazakii en el neonato de la unidad de prematuros se originó por el consumo de un preparado en polvo para lactantes prematuros contaminado durante su fabricación, como resultado de una inadecuada preparación y conservación del producto una vez reconstituido (AU)

Introduction The aim of this study was to describe the investigation of a case of meningitis in a neonatal intensive care unit in order to identify the source of infection and the associated risk factors. Material and methods An analysis was carried out on the possible risk factors associated with the infection. E. sakazakii was detected in the batch of the powdered infant formula used during the feeding of the neonate and the initial level of contamination of the microorganism was estimated. The strains of E. sakazakii previously isolated in blood and faeces of the infected neonate and those isolated in infant formula were characterised by biotype, pulsotype and antimicrobial susceptibility. ResultsE. sakazakii was detected in one opened and two unopened cases of a single batch of powdered infant formula. The E. sakazakii strains isolated in the samples of the product and those isolated in the infected neonate showed the same biochemical, antibiotic susceptibility and PFGE pattern. Conclusions The case of meningitis in the neonatal intensive care unit occurred as a result of the use of a powered infant formula contaminated with E. sakazakii at manufacturing level, and an inadequate preparation and storing of the reconstituted product were identified as risk factors (AU)

Cateterización bilateral de los senos petrosos inferiores: utilidad en el síndrome de cushing / Bilateral catheterization of inferior petrosal sinous: utility in cushing’ syndrome

Objetivo: Presentar la experiencia de los autores en el cateterismo bilateral y simultáneo de los senos petrosos inferiores (SPI) en pacientes con síndrome de Cushing dependientes de la hormona adrenocorticotropa (ACTH ). Material y método: Un estudio retrospectivo desde enero de 2003 hasta septiembre de 2009 con nueve pacientes (dos hombres y siete mujeres) diagnosticados con síndrome de Cushing y ACTH dependientes. Se cateterizaron simultáneamente los senos petrosos inferiores, estudiando la ACTH basal y tras un estímulo con la CRH, a fin de medir los gradientes intrahipofisarios y en sangre periférica. La sospecha diagnóstica se realizó por concentraciones inapropiadas y persistentemente elevadas de cortisol plasmático y del cortisol libre urinario; así como por ausencia de supresión con la dexametasona. En todos, salvo uno, las pruebas de imagen fueron negativas. Resultados: La cateterización fue exitosa y sin complicaciones. Hubo un diagnóstico definitivo en todos los casos. Conclusión: En los pacientes seleccionados, la cateterización de los SPI fue un procedimiento eficiente en el diagnóstico diferencial del síndrome de Cushing y en la localización intrahipofisaria de la secreción de ACTH.

Objective: The aim of this study is to present our experience on bilateral and simultaneous inferior petrous sinus catheterization, on those patients with ACTH -dependent Cushing’s sydrome. We describe the procedure and our results. Material and Method: A retrospective study was held between January 2003 and September 2009, including nine patients (2 men, 7 women) presenting ACTH -dependentCushing’s syndrome. Simultaneous inferior petrosal sinus catheterization was performed in all of them, sampling basal ACTH and after CRH stimulation. ACTH levels gradient in different pituitary locations and peripheral blood levels was recorded. Diagnosis was suggested when inappropriate and maintained hypercortisolemia. High urinary free cortisol levels and no response to dexamethasone suppressionwere detected. Eight out of nine patients had a prior negative imaging test result. Results: Inferior petrosal sinus bilateral catheterization was successfully performed in all cases, with no evidence of further complications. The results showed definitive diagnosis in all cases. In four patients ACTH levels gradient was lateralized to the left, leading to a specific surgical approach. One patient presented pituitary ACTH -secreting adenoma. Two other patients showed ectopic ACTH production, one showedsuprarenal adenoma secreting ACTH and other one showed response to pituitary stimulation without side lateralisation, presenting a histological diagnosis of pituitary hyperplasia. Conclusion: Petrosal sinus catheterization is shown to be an efficient procedure to manage Cushing’s syndrome differential diagnosis and to obtain specific anatomical information.

CD20-negative T-cell-rich B-cell lymphoma as a progression of a nodular lymphocyte-predominant Hodgkin's lymphoma treated with rituximab: a molecular analysis using laser capture microdissection.

Rituximab is a chimeric anti-CD20 monoclonal antibody. It has shown efficacy in patients with B-cell non-Hodgkin lymphoma and also in CD20-positive Hodgkin lymphoma. Recently, CD20-negative tumors have been described after Rituximab therapy. We report a 34-year-old man with a history of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), treated with different chemotherapy regimens, including anthracyclines and Rituximab. After 4 years in complete remission, he developed a CD20-negative T-cell-rich B-cell lymphoma (TCRBCL) presenting as multiple lung lesions. This case shows the difficulties in the diagnosis of CD20-negative lymphomas when the number of tumor cells is low and when they are found in a predominant T-cell context. Using anti-CD79a as a B-cell marker is mandatory to overcome the difficulties in identifying these tumors. Moreover, this case illustrates the usefulness of laser capture microdissection to obtain purified cell populations for molecular studies in lymphomas with relative paucity of tumor cells, as well as the need to analyze different IgH gene regions to decrease the rate of false-negative results in PCR clonality studies.