Clinical Characteristics and Microorganisms Isolated in Community-Acquired Pneumonia in the COVID-19 Period.

Introduction: Community-acquired pneumonia is a leading cause of mortality and hospital admissions. The aetiology remains unknown in 30-65% of the cases. Molecular tests are available for multiple pathogen detection and are under research to improve the causal diagnosis. Methods: We carried out a prospective study to describe the clinical characteristics and aetiology of community-acquired pneumonia during the COVID-19 pandemic and to assess the diagnostic effectivity of the microbiological tests, including a molecular test of respiratory pathogens (FilmArray™ bioMérieux). Results: From the 1st of February 2021 until the 31st of March 2022, 225 patients were included. Failure in microorganism identification occurred in approximately 70% of patients. Streptococcus pneumoniae was the most common isolate. There were 5 cases of viral pneumonia. The tested FilmArray exhibited a low positivity rate of 7% and mainly aided in the diagnosis of viral coinfections. Conclusions: Despite our extensive diagnostic protocol, there is still a low rate of microorganism identification. We have observed a reduction in influenza and other viral pneumoniae during the COVID-19 pandemic. Having a high NEWS2 score on arrival at the emergency department, an active oncohematological disease or chronic neurological conditions and a positive microbiological test result were related to worse outcomes. Further research is needed to determine the role of molecular tests in the microbiological diagnosis of pneumonia.

Una paciente con fenómeno de Raynaud del pezón e hipertiroidismo / A patient with Raynaud's phenomenon of the nipple and hyperthyroidism

Introducción: el fenómeno de Raynaud del pezón es una patología poco frecuente. Puede presentarse asociada a hipertiroidismo o enfermedades autoinmunes del tejido conectivo. Presentamos un caso asociado a hipertiroidismo.Caso clínico: mujer, de 39 años, que consulta por dolor en pezón que se agrava con la lactancia 1 mes después del parto. Se diagnosticó fenómeno de Raynaud del pezón, que mejoró con la toma de nifedipino. Tres meses después, la paciente presentó fiebre. El análisis de sangre mostró hormona estimulante del tiroides (TSH) 0,0008 mU/L (normal: 0,55-4,75 mU/L) y T4 libre 48 pg/mL (normal: 2,30-4,20 pg/mL). Los anticuerpos antitiroglobulina fueron > 500 UI/mL. La T3, los anticuerpos antiperoxidasa (TPO) y la inmunoglobulina estimulante del tiroides fueron normales. Se diagnosticó tiroiditis posparto (TPP). Dos meses después, los niveles de TSH y T4 libre volvieron a la normalidad.Conclusión: nuestra paciente presenta una TPP asociada a un fenómeno de Raynaud.(AU)

Introduction: Raynaud's phenomenon of the nipple is a rare pathology. It can occur associated with hyperthyroidism or autoimmune connective tissue diseases.We report a case associated with hyperthyroidism.Case study: a 39-year-old woman consulted for nipple pain, which worsened with breastfeeding, one month after childbirth. Raynaud's phenomenon of the nipple was diagnosed, which improved with nifedipine. Three months later the patient developed fever. Blood test revealed thyroid stimulating hormone (TSH) 0.0008 mU/L (normal 0.55-4.75 mU/L) and free T4 48 pg/mL (normal 2.30-4.20 pg/mL). Antithyroglobulin antibodies were >500 IU/mL. T3, antiperoxidase antibodies (TPO), and thyroid-stimulating immunoglobulin were normal. Postpartum thyroiditis (PPT) was diagnosed. Two months later, TSH and free T4 levels returned to normal.Conclusion: our patient presented PPT associated with Raynaud's phenomenon.(AU)

Impacto de la fragilidad y COVID-19 en una cohorte de gente mayor de la ciudad de Barcelona / Frailty impact on COVID-19 disease in an older cohort from the city of Barcelona

Objetivo: Describir la incidencia y mortalidad de COVID-19, durante la primera ola, en la población de personas mayores de Barcelona, según sus niveles previos de fragilidad. Diseño: Estudio de cohortes retrospectivo. Emplazamiento y participantes: Población de 65 o más años asignada a los centros de Atención Primaria de Barcelona del Institut Català de la Salut, seguidos entre marzo y junio de 2020. Mediciones principales: Fragilidad calculada al inicio a partir de la historia clínica informatizada. Resultados durante el seguimiento: diagnóstico de COVID-19, posible o confirmado con PCR y mortalidad por todas las causas. Resultados: Se analizaron 251788 mayores de 64 años. Un 61,3% tenían algún nivel de fragilidad, 27,8% moderada o grave. La incidencia de COVID-19 fue de 3,13 casos por 100 habitantes (N = 7883) y la mortalidad por COVID-19 fue del 21,5% (N =1 691). Tanto la incidencia como la mortalidad por COVID-19 fueron superiores a mayor edad, en hombres, a mayor privación y a mayor nivel de fragilidad. Los individuos con fragilidad leve, moderada y grave tuvieron un hazard ratio ajustado de enfermedad por COVID-19 de 1,47, 2,08 y 3,50 respectivamente. Entre los sujetos con COVID-19, aquéllos con fragilidad leve, moderada y grave tuvieron un hazard ratio ajustado de mortalidad por COVID-19 de 1,44, 1,69 y 2,47 respectivamente. Conclusiones: Consideramos necesario el abordaje de la fragilidad también en situación de pandemia, dado que es una condición tratable y a su vez factor de riesgo de COVID-19 más grave, donde el papel de la Atención Primaria es primordial, por su accesibilidad y longitudinalidad.(AU)

Objetive: To describe the incidence and mortality of the first wave of COVID-19 in the elderly population of Barcelona, according to their previous levels of frailty. Design: Retrospective cohort study. Setting and participants: Population aged 65 or over assigned to the Barcelona Primary Care centres of the Institut Català de la Salut, followed between March and June 2020. Main measurements: Frailty was calculated at baseline from the computerised medical records. Results during follow-up: diagnosis of COVID-19, possible or confirmed with PCR and all-cause mortality. Results: 251788 patients over 64 years of age were analysed, 61.3% had some level of frailty, 27.8% moderate or severe. The incidence of COVID-19 was 3.13 cases per 100 inhabitants (N=7883) and the mortality from COVID-19 was 21.5% (N=1691). Both the incidence and mortality from COVID-19 were higher at older age, in men, at greater deprivation and at a higher level of frailty. Individuals with mild, moderate, and severe frailty had an adjusted Hazard Ratio (HR) for COVID-19 disease of 1.47, 2.08, and 3.50, respectively. Among subjects with COVID-19, those with mild, moderate, and severe frailty had an adjusted HR for COVID-19 mortality of 1.44, 1.69, and 2.47, respectively. Conclusions: We consider it necessary to address frailty also in a pandemic situation, since it is a treatable condition and in turn a more serious risk factor for COVID-19, where the role of primary care is essential, due to its accessibility and longitudinal character.(AU)

[Frailty impact on COVID-19 disease in an older cohort from the city of Barcelona]. / Impacto de la fragilidad y COVID-19 en una cohorte de gente mayor de la ciudad de Barcelona.

Objetive To describe the incidence and mortality of the first wave of COVID-19 in the elderly population of Barcelona, according to their previous levels of frailty. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Population aged 65 or over assigned to the Barcelona Primary Care centres of the Institut Català de la Salut, followed between March and June 2020. MAIN MEASUREMENTS: Frailty was calculated at baseline from the computerised medical records. Results during follow-up: diagnosis of COVID-19, possible or confirmed with PCR and all-cause mortality. RESULTS: 251788 patients over 64 years of age were analysed, 61.3% had some level of frailty, 27.8% moderate or severe. The incidence of COVID-19 was 3.13 cases per 100 inhabitants (N=7883) and the mortality from COVID-19 was 21.5% (N=1691). Both the incidence and mortality from COVID-19 were higher at older age, in men, at greater deprivation and at a higher level of frailty. Individuals with mild, moderate, and severe frailty had an adjusted Hazard Ratio (HR) for COVID-19 disease of 1.47, 2.08, and 3.50, respectively. Among subjects with COVID-19, those with mild, moderate, and severe frailty had an adjusted HR for COVID-19 mortality of 1.44, 1.69, and 2.47, respectively. CONCLUSIONS: We consider it necessary to address frailty also in a pandemic situation, since it is a treatable condition and in turn a more serious risk factor for COVID-19, where the role of primary care is essential, due to its accessibility and longitudinal character.

Incidence, Clinical Characteristics, Risk Factors and Outcomes of Acute Coronary Syndrome in Patients With COVID-19: Results of the UMC-19-S1010.

BACKGROUND: There is a lack of knowledge about the real incidence of acute coronary syndrome (ACS) in patients with COVID-19, their clinical characteristics, and their prognoses. OBJECTIVE: We investigated the incidence, clinical characteristics, risk factors, and outcomes of ACS in patients with COVID-19 in the emergency department. METHODS: We retrospectively reviewed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments between March and April 2020 (the first wave of COVID-19). We formed 2 control groups: COVID-19 patients without ACS (control A) and non-COVID-19 patients with ACS (control B). Unadjusted comparisons between cases and control subjects were performed regarding 58 characteristics and outcomes. RESULTS: We identified 110 patients with ACS in 74,814 patients with COVID-19 attending the ED (1.48% [95% confidence interval {CI} 1.21-1.78%]). This incidence was lower than that observed in non-COVID-19 patients (3.64% [95% CI 3.54-3.74%]; odds ratio [OR] 0.40 [95% CI 0.33-0.49]). The clinical characteristics of patients with COVID-19 associated with a higher risk of presenting ACS were: previous coronary artery disease, age ≥60 years, hypertension, chest pain, raised troponin, and hypoxemia. The need for hospitalization and admission to intensive care and in-hospital mortality were higher in cases than in control group A (adjusted OR [aOR] 6.36 [95% CI 1.84-22.1], aOR 4.63 [95% CI 1.88-11.4], and aOR 2.46 [95% CI 1.15-5.25]). When comparing cases with control group B, the aOR of admission to intensive care was 0.41 (95% CI 0.21-0.80), while the aOR for in-hospital mortality was 5.94 (95% CI 2.84-12.4). CONCLUSIONS: The incidence of ACS in patients with COVID-19 attending the emergency department was low, around 1.48%, but could be increased in some circumstances. Patients with COVID-19 with ACS had a worse prognosis than control subjects with higher in-hospital mortality.

Immunological and genetic kinetics from diagnosis to clinical progression in chronic lymphocytic leukemia.

BACKGROUND: Mechanisms driving the progression of chronic lymphocytic leukemia (CLL) from its early stages are not fully understood. The acquisition of molecular changes at the time of progression has been observed in a small fraction of patients, suggesting that CLL progression is not mainly driven by dynamic clonal evolution. In order to shed light on mechanisms that lead to CLL progression, we investigated longitudinal changes in both the genetic and immunological scenarios. METHODS: We performed genetic and immunological longitudinal analysis using paired primary samples from untreated CLL patients that underwent clinical progression (sampling at diagnosis and progression) and from patients with stable disease (sampling at diagnosis and at long-term asymptomatic follow-up). RESULTS: Molecular analysis showed limited and non-recurrent molecular changes at progression, indicating that clonal evolution is not the main driver of clinical progression. Our analysis of the immune kinetics found an increasingly dysfunctional CD8+ T cell compartment in progressing patients that was not observed in those patients that remained asymptomatic. Specifically, terminally exhausted effector CD8+ T cells (T-betdim/-EomeshiPD1hi) accumulated, while the the co-expression of inhibitory receptors (PD1, CD244 and CD160) increased, along with an altered gene expression profile in T cells only in those patients that progressed. In addition, malignant cells from patients at clinical progression showed enhanced capacity to induce exhaustion-related markers in CD8+ T cells ex vivo mainly through a mechanism dependent on soluble factors including IL-10. CONCLUSIONS: Altogether, we demonstrate that the interaction with the immune microenvironment plays a key role in clinical progression in CLL, thereby providing a rationale for the use of early immunotherapeutic intervention.

A case-control emergency department-based analysis of acute pancreatitis in Covid-19: Results of the UMC-19-S6.

BACKGROUND/PURPOSE: We investigated the incidence, risk factors, clinical characteristics and outcomes of acute pancreatitis (AP) in patients with COVID-19 attending the emergency department (ED), before hospitalization. METHODS: We retrospectively reviewed all COVID patients diagnosed with AP in 62 Spanish EDs (20% of Spanish EDs, COVID-AP) during the COVID outbreak. We formed two control groups: COVID patients without AP (COVID-non-AP) and non-COVID patients with AP (non-COVID-AP). Unadjusted comparisons between cases and controls were performed regarding 59 baseline and clinical characteristics and four outcomes. RESULTS: We identified 54 AP in 74 814 patients with COVID-19 attending the ED (frequency = 0.72‰, 95% CI = 0.54-0.94‰). This frequency was lower than in non-COVID patients (2231/1 388 879, 1.61‰, 95% CI = 1.54-1.67; OR = 0.44, 95% CI = 0.34-0.58). Etiology of AP was similar in both groups, being biliary origin in about 50%. Twenty-six clinical characteristics of COVID patients were associated with a higher risk of developing AP: abdominal pain (OR = 59.4, 95% CI = 23.7-149), raised blood amylase (OR = 31.8; 95% CI = 1.60-632) and vomiting (OR = 15.8, 95% CI = 6.69-37.2) being the strongest, and some inflammatory markers (C-reactive protein, procalcitonin, platelets, D-dimer) were more increased. Compared to non-COVID-AP, COVID-AP patients differed in 23 variables; the strongest ones related to COVID symptoms, but less abdominal pain was reported, pancreatic enzymes raise was lower, and severity (estimated by BISAP and SOFA score at ED arrival) was higher. The in-hospital mortality (adjusted for age and sex) of COVID-AP did not differ from COVID-non-AP (OR = 1.12, 95% CI = 0.45-245) but was higher than non-COVID-AP (OR = 2.46, 95% CI = 1.35-4.48). CONCLUSIONS: Acute pancreatitis as presenting form of COVID-19 in the ED is unusual (<1‰ cases). Some clinically distinctive characteristics are present compared to the remaining COVID patients and can help to identify this unusual manifestation. In-hospital mortality of COVID-AP does not differ from COVID-non-AP but is higher than non-COVID-AP, and the higher severity of AP in COVID patients could partially contribute to this increment.

Analysis of Cell Subsets in Donor Lymphocyte Infusions from HLA Identical Sibling Donors after Allogeneic Hematopoietic Cell Transplant.

Donor lymphocytes infusions (DLIs) are a major therapeutic approach to treat relapse and mixed chimerism after allogeneic hematopoietic cell transplant (alloHCT). The impact of the composition regarding different cell subsets in the development of graft-versus-host disease (GVHD) is not fully understood. We performed a cell subsets analysis of 56 DLIs from fully HLA-compatible identical matched sibling donors (MSDs) in 36 alloHCT patients and studied its association with GVHD. A median of one DLI was infused per patient. Fourteen patients (38%) developed GVHD. The cell composition analysis of the first DLI (DLI1) showed that a high dose of B cells (P = .03) and CD27+ B cells (P < .01) was associated with GVHD. We identified DLI dose cutoff points for several cell populations above which GVHD was more frequent (CD8+ TN >3 × 106 cells/kg, CD27+ B cells >2.6 × 106/kg, CD27+ NK >0.35 × 106 cells/kg, and mononuclear cells >0.83 × 108/kg). Noteworthy, the proportion of CD4+ naive T cells (TN) or unselected TN was not linked with GVHD and a DLI1 containing a higher dose of regulatory T cells was not protective for GVHD. We studied several transplant clinical variables and did not find any association with GVHD. Altogether, this study provides a comprehensive analysis of the cell populations in a DLI from MSDs and identifies potential key cell subsets, which provides insight for the understanding of GVHD after DLI.

Bloqueo del sistema renina-angiotensina-aldosterona en pacientes con enfermedad renal diabética avanzada / The renin-angiotensin-aldosterone system blockade in patients with advanced diabetic kidney disease

Antecedentes y objetivos: La enfermedad renal diabética es la primera causa de enfermedad renal crónica terminal en nuestro medio. El bloqueo del sistema renina-angiotensina aldosterona (BSRAA) enlentece la progresión de la enfermedad renal diabética. Nuestros objetivos son: estudiar pacientes tratados con BSRAA, comparando su evolución según el filtrado glomerular, su perfil de seguridad y si se asocia a una progresión mayor de la enfermedad renal crónica. Materiales y métodos: Estudio retrospectivo de 197 pacientes con enfermedad renal diabética. Se dividieron en tres grupos según tratamiento: pacientes que no recibieron BSRAA (no BSRAA), pacientes que en algún momento lo recibieron (BSRAA discontinuado) y pacientes que recibieron BSRAA (BSRAA mantenido). Se estudiaron características clínicas y analíticas: función renal, ionograma, hemoglobina glicosilada, filtrado glomerular según CKD-EPI y MDRD. Analizamos su evolución (basal, año y 3 años) en relación con el grupo de tratamiento, supervivencia, factores de riesgo y pronóstico renal. Resultados: Los pacientes no BSRAA presentaron en el momento basal peor función renal y edad más avanzada (p<0,05) en comparación con los que recibieron BSRAA. Los pacientes que recibieron BSRAA no mostraron mayor toxicidad, ni más progresión de la enfermedad renal crónica, y no evidenciamos diferencias en el pronóstico renal. La mortalidad fue mayor en pacientes no BSRAA, de mayor edad y peor función renal (p<0,05). En el análisis multivariado los factores de riesgo de mortalidad fueron edad avanzada y peor función renal. Conclusiones: El tratamiento con BSRAA es más frecuente en pacientes con FGe≥30mL/min/1,73m2. No observamos diferencias en la evolución de la función renal entre los tres grupos. La mayor mortalidad observada en pacientes que no recibieron BSRAA se relacionó con la edad avanzada y peor función renal (AU)

Background and objectives: Diabetic kidney disease is the leading cause of end-stage chronic kidney disease. The renin-angiotensin-aldosterone system (RAAS) blockade has been shown to slow the progression of diabetic kidney disease. Our objectives were: to study the percentage of patients with diabetic kidney disease treated with RAAS blockade, to determine its renal function, safety profile and assess whether its administration is associated with increased progression of CKD after 3 years of follow-up. Materials and methods: Retrospective study. 197 diabetic kidney disease patients were included and divided into three groups according to the treatment: patients who had never received RAAS blockade (non-RAAS blockade), patients who at some point had received RAAS blockade (inconstant-RAAS blockade) and patients who received RAAS blockade (constant-RAAS blockade). Clinical characteristics and analytical variables such as renal function, electrolytes, glycosylated haemoglobin and glomerular filtration rate according to chronic kidney disease -EPI and MDRD formulas were assessed. We also studied their clinical course (baseline, 1 and 3 years follow-up) in terms of treatment group, survival, risk factors and renal prognosis. Results: Non-RAAS blockade patients had worse renal function and older age (p<0.05) at baseline compared to RAAS blockade patients. Patients who received RAAS blockade were not found to have greater toxicity or chronic kidney disease progression and no differences in renal prognosis were identified. Mortality was higher in non-RAAS blockade patients, older patients and patients with worse renal function (p<0.05). In the multivariate analysis, older age and worse renal function were risk factors for mortality. Conclusions: Treatment with RAAS blockade is more common in diabetic kidney disease patients with eGFR≥30ml/min/1.73m2. In our study, there were no differences in the evolution of renal function between the three groups. Older age and worse renal function were associated with higher mortality in patients who did not receive RAAS blockade (AU)

The renin-angiotensin-aldosterone system blockade in patients with advanced diabetic kidney disease. / Bloqueo del sistema renina-angiotensina-aldosterona en pacientes con enfermedad renal diabética avanzada.

BACKGROUND AND OBJECTIVES: Diabetic kidney disease is the leading cause of end-stage chronic kidney disease. The renin-angiotensin-aldosterone system (RAAS) blockade has been shown to slow the progression of diabetic kidney disease. Our objectives were: to study the percentage of patients with diabetic kidney disease treated with RAAS blockade, to determine its renal function, safety profile and assess whether its administration is associated with increased progression of CKD after 3 years of follow-up. MATERIALS AND METHODS: Retrospective study. 197 diabetic kidney disease patients were included and divided into three groups according to the treatment: patients who had never received RAAS blockade (non-RAAS blockade), patients who at some point had received RAAS blockade (inconstant-RAAS blockade) and patients who received RAAS blockade (constant-RAAS blockade). Clinical characteristics and analytical variables such as renal function, electrolytes, glycosylated haemoglobin and glomerular filtration rate according to chronic kidney disease -EPI and MDRD formulas were assessed. We also studied their clinical course (baseline, 1 and 3 years follow-up) in terms of treatment group, survival, risk factors and renal prognosis. RESULTS: Non-RAAS blockade patients had worse renal function and older age (p<0.05) at baseline compared to RAAS blockade patients. Patients who received RAAS blockade were not found to have greater toxicity or chronic kidney disease progression and no differences in renal prognosis were identified. Mortality was higher in non-RAAS blockade patients, older patients and patients with worse renal function (p<0.05). In the multivariate analysis, older age and worse renal function were risk factors for mortality. CONCLUSIONS: Treatment with RAAS blockade is more common in diabetic kidney disease patients with eGFR≥30ml/min/1.73m2. In our study, there were no differences in the evolution of renal function between the three groups. Older age and worse renal function were associated with higher mortality in patients who did not receive RAAS blockade.

Cell-derived microparticles and vascular pregnancy complications: a systematic and comprehensive review.

OBJECTIVE: To assess current studies on the relationship between cell-derived microparticles (cMP) and recurrent miscarriages (RM) and pre-eclampsia (PE), and review the relationships between cMP and inflammatory and clot pathways, antiphospholipid antibodies (aPL), cytokines, and pregnancy complications. DESIGN: Systematic and comprehensive review of the literature from January 2000 to January 2012. SETTING: Vall d'Hebron University Hospital. PATIENT(S): Women with recurrent miscarriages or PE, healthy nonpregnant women, and healthy pregnant women. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Comparison of cMP numbers and types among groups. RESULT(S): Platelet and endothelial cMP are increased in women with normal pregnancies compared with nonpregnant healthy women. Only five case-control studies regarding cMP and RM and 16 on cMP and PE were found to match our objective. Three of five articles referring to RM showed differences in cMP numbering, and 13 of 16 on cMP and PE showed differences in some type of cMP compared with controls. CONCLUSION(S): Cell-derived microparticles were raised in normal pregnancy. Recurrent miscarriage seems to be related to endothelial and platelet cell activation and/or consumption. An increase in almost all cMP types was observed in PE. A relationship between cMP and endothelial activation and proinflammatory status seems to exist.

Circulating cell-derived microparticles in severe preeclampsia and in fetal growth restriction.

PROBLEM: The behavior of the circulating microparticles (cMP) in severe preeclampsia (PE) and fetal growth restriction (FGR) is disputed. METHOD OF STUDY Non-matched case-control study. Seventy cases of severe PE/HELLP/FGR were compared to 38 healthy pregnant women. Twenty healthy non-pregnant women acted as a control. cMP were analyzed using flow cytometry. Results are given as total (annexin-A5-ANXA5+), platelet (CD41+), leukocyte (CD45+), endothelial (CD144+CD31+//CD41-), and CD41-negative cMP/µL of plasma. Antiphospholipid antibodies (aPL) were analyzed through usual methods. RESULTS: Platelet and endothelial cMP increased in healthy pregnant women. PE whole group (PE±FGR) showed an increase in endothelial and CD41-negative, but not in platelet-derived, cMP. Comparing PE whole group versus healthy pregnant, we found cMP levels of endothelial and CD41- had increased. The cMP results obtained in PE group were similar to those of the PE whole group. Comparing PE group to isolated FGR, significant CD41-negative cMP increase was found in PE. According to its aPL positivity, a trend to decrease in leukocyte and endothelial-derived cMP was found in PE group. CONCLUSION: Normal pregnancy is accompanied by endothelial and platelet cell activation. Endothelial cell activation has been shown in PE but not in isolated FGR. In PE, aPL may contribute to endothelial and possibly to leukocyte cell activation.

[Sensitivity, specificity, positive and negative predictive values of the criteria for indicating a bone densitometry in the evaluation of medical techniques and research in Cataluña]. / Sensibilidad, especificidad y valor predictivo positivo y negativo de los criterios de indicación de densitometría ósea de la agencia de evaluación de tecnologías e investigación médicas de cataluña.

UNLABELLED: The Catalan Agency for Health Technology Assessment and Research (AETIM) proposed, in 2001, criteria for performing a bone densitometry (BD) for use in the consultations of the public health system. OBJECTIVE: To determine the sensitivity, specificity, positive predictive value and negative predictive value of the criteria to indicate BD. MATERIAL AND METHODS: Five groups of volunteers (premenopausal women aged 46 to 65 years, postmenopausal women aged 46 to 65 years, postmenopausal women aged> 65 years and men 46 to 65 years and> 65 years) underwent BD and a questionnaire on risk factors. The results obtained with the AETIM criteria are related to criteria for indication of BD proposed by the World Health Organization (1999 and 2003 criteria), the National Osteoporosis Foundation (1998 amd 2010 criteria) and the International Committee of Clinical Guidelines on Osteoporosis. RESULTS: Criteria from the Catalan Agency have low sensitivity to detect both low bone mass (T index<-1) and osteoporosis (T index<-2.5), specificity varied according to the group. The positive predictive value is low, but the negative predictive value for osteoporosis is high in all groups (except for postmenopausal women aged> 65 years). The remaining criteria have a high negative predictive value and, in women, good sensitivity and low specificity, especially for identifying patients with osteoporosis. CONCLUSION: Catalan Agency criteria are useful for selecting patients who would not need BD, but lack sufficient sensitivity to identify individuals with low bone mass. The other criteria also have a high negative predictive value for osteoporosis, and a better sensitivity.

Sensibilidad, especificidad y valor predictivo positivo y negativo de los criterios de indicación de densitometría ósea de la agencia de evaluación de tecnologías e investigación médicas de cataluña / Sensitivity, specificity, positive and negative predictive values of the criteria for indicating a bone densitometry in the evaluation of medical techniques and research in cataluña

Objetivo. La Agencia de Evaluación de Tecnologías e Investigación Médicas (AETIM) de Cataluña propuso en 2001 unos criterios de indicación de densitometría ósea (DO) para su uso en la consultas del sistema sanitario público. El objetivo fue conocer la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de los criterios de indicación de DO de la AETIM. Material y método. Cinco grupos de voluntarios (mujeres premenopáusicas de 46 a 65 años, posmenopáusicas de 46 a 65 años y posmenopáusicas de > 65 años, y varones de 46 a 65 años y de > 65 años) a los que se realizó DO y una encuesta sobre factores de riesgo. Se calcularon la sensibilidad, la especificidad, el VPP y el VPN de los criterios de la AETIM, y los resultados se compararon con los criterios de indicación de DO propuestos por la Organización Mundial de la Salud (en 1999 y 2003), la National Osteoporosis Foundation (en 1998 y 2010) y el Comité Internacional de Guías Clínicas en Osteoporosis. Resultados. Los criterios de la AETIM tienen una baja sensibilidad tanto para detectar baja masa ósea (índice T<−1) como osteoporosis (índice T<−2,5); la especificidad varía según el grupo. El VPP es bajo, pero el VPN para osteoporosis es alto en todos los grupos (excepto el de mujeres posmenopáusicas > 65 años). El resto de los criterios tienen un VPN alto y, en mujeres, buena sensibilidad y muy baja especificidad, especialmente para identificar pacientes con osteoporosis. Conclusiones. Los criterios de la AETIM son útiles para seleccionar pacientes a los que no sería necesario realizar una DO, pero carecen de sensibilidad suficiente para identificar individuos con baja masa ósea. El resto de criterios tienen también un VPN alto para osteoporosis y una sensibilidad algo mejor (AU)

The Catalan Agency for Health Technology Assessment and Research (AETIM) proposed, in 2001, criteria for performing a bone densitometry (BD) for use in the consultations of the public health system. Objective. To determine the sensitivity, specificity, positive predictive value and negative predictive value of the criteria to indicate BD. Material and methods. Five groups of volunteers (premenopausal women aged 46 to 65 years, postmenopausal women aged 46 to 65 years, postmenopausal women aged> 65 years and men 46 to 65 years and> 65 years) underwent BD and a questionnaire on risk factors. The results obtained with the AETIM criteria are related to criteria for indication of BD proposed by the World Health Organization (1999 and 2003 criteria), the National Osteoporosis Foundation (1998 amd 2010 criteria) and the International Committee of Clinical Guidelines on Osteoporosis. Results. Criteria from the Catalan Agency have low sensitivity to detect both low bone mass (T index<−1) and osteoporosis (T index<−2.5), specificity varied according to the group. The positive predictive value is low, but the negative predictive value for osteoporosis is high in all groups (except for postmenopausal women aged> 65 years). The remaining criteria have a high negative predictive value and, in women, good sensitivity and low specificity, especially for identifying patients with osteoporosis. Conclusion. Catalan Agency criteria are useful for selecting patients who would not need BD, but lack sufficient sensitivity to identify individuals with low bone mass. The other criteria also have a high negative predictive value for osteoporosis, and a better sensitivity (AU)

¿Es suficiente el estudio de las micropartículas circulantes endoteliales para valorar el estado inflamatorio asociado a la pre-eclampsia? / Is the endothelial circulating microparticles analysis enough to assess the inflammatory status related to preeclampsia?

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Blink rate, blink amplitude, and tear film integrity during dynamic visual display terminal tasks.

PURPOSE: The present study aimed at investigating the influence of the level of dynamism of two different visual display terminal tasks on spontaneous eyeblink rate, blink amplitude, and tear film integrity. MATERIAL AND METHODS: A total of 25 healthy, young volunteers participated in the study. Blink rate and blink amplitude were recorded in silent primary gaze conditions and while subjects were playing two computer games of similar cognitive demands but different rate of visual information presentation. For each experimental condition, tear volume was evaluated by measuring meniscus height and with the red phenol thread test. Fluorescein and non-invasive break-up time tests, as well as the observation of interference patterns and the estimation of the dry area extension, were employed to assess tear stability. RESULTS: Statistically significant differences were revealed in blink rate (F = 595.85, p < 0.001) and blink amplitude (χ(2) = 34.00, p < 0.001), with blink rate during fast- and slow-paced game play decreasing to almost 1/3 and 1/2 of baseline levels, respectively, and with a larger percentage of incomplete blinks during dynamic tasks. Fluorescein and non-invasive break-up time tests and dry area extension were able to differentiate between experimental conditions in general (F = 408.42, p < 0.001; F = 163.49, p < 0.001; χ(2) = 20.74, p < 0.001), as well as between fast- and slow-paced games, thus suggesting that tear quality was more affected than tear volume. CONCLUSIONS: Blink rate, blink amplitude, and tear film stability were compromised during the most dynamic visual display terminal task, suggesting a negative influence of not only the cognitive aspects of the task, but also of the rate at which new visual information is presented. Frequent breaks and blinking awareness training are recommended for visual display terminal users requiring prolonged periods of visually demanding dynamic computer play or work.

Circulating cell-derived microparticles in women with pregnancy loss.

PROBLEM: To analyze cell-derived microparticles (cMP) in pregnancy loss (PL), both recurrent miscarriages (RM) and unexplained fetal loss (UFL). METHOD OF STUDY: Non-matched case-control study was performed at Vall d'Hebron Hospital. Cell-derived microparticles of 53 PL cases, 30 with RM, 16 with UFL, and 7 (RM + UFL), were compared to 38 healthy pregnant women. Twenty healthy non-pregnant women act as controls. Cell-derived microparticles were analyzed through flow cytometry. Results are given as total annexin (A5+), endothelial-(CD144+/CD31+ CD41-), platelet-(CD41+), leukocyte-(CD45+) and CD41- c-MP/µL of plasma. Antiphospholipid antibodies (aPLA) were analyzed according to established methods. RESULTS: Comparing PL versus healthy pregnant, we observed a significant endothelial cMP decrease in PL. When comparing RM subgroup with controls, we observed significant decreases in endothelial cMP. When comparing the PL positive for aPLA versus PL-aPLA-negative, no cMP numbering differences were seen. CONCLUSION: Pregnancy loss seems to be related to endothelial cell activation and/or consumption. A relationship between aPLA and cMP could not be demonstrated.

Circulating microparticles, lupus anticoagulant and recurrent miscarriages.

Pregnancy is a pro-inflammatory/hypercoagulable state. Impairment of trophoblastic invasion and placental microthrombi are involved mechanisms in the pathogenesis of recurrent miscarriages (RM). Although in RM related to antiphospholipid antibodies (aPL) non-thrombotic mechanism seems to play an important role as well, we focused this review on the thrombotic mechanisms of RM related to aPL. Thus, in cases of RM related to aPL, placental injury produces inflammatory changes in endothelial cells. Endothelial dysfunction has been shown by increased plasma levels of ICAM-1/VCAM-1 and E-selectin. In RM associated with aPL, the thrombogenic mechanisms included different pathways: protein C inhibition, annexin-5 displacement, blocking of beta(2)GP1 anticoagulant activity and tissue factor upregulation. A new marker/causative agent of RM by itself or in relation to lupus anticoagulant (LA) has risen: circulating microparticles. Microparticles are a heterogeneous group of small, membrane-coated vesicles with a diameter of 0.1-1 microm. Microparticles are released from the cellular membrane during cell activation/apoptosis. Exposition of phospholipids in the outer membrane leaflet could explain the role of microparticles in the thrombotic events. Microparticles have been associated with RM. Microparticles are increased in women with RM when compared with healthy pregnant women. A relationship between aPL and activated endothelial cells (EC) occurs, as well as between EC and circulating microparticles. Interestingly, microparticles induced coagulation in vitro via tissue factor, especially in plasmas with LA. Finally, the relationship between EC, microparticles, LA and RM is revised.