Eje interleucina 12/interferón gamma en pacientes de tuberculosis en una región europea con alta incidencia de enfermedad / Interleukin-12/interferon-gamma axis in TB patients in a European

La integridad del eje interleucina 12/interferón gamma (IL-12/INF-g) es esencial para un correcto control de la infección por Mycobacterium tuberculosis. El objetivo del presente estudio fue evaluar si la alta incidencia de tuberculosis (TB) en Galicia (España) podría estar relacionada con una respuesta alterada en el eje IL-12/INF-g en los pacientes con TB. Se estudió a 20 enfermos con TB y 21 controles sanos: 7 con prueba de la tuberculina positiva (PT+) y 14 con prueba de la tuberculina negativa (PT–). El estudio del eje IL-12/INF-g se realizó mediante la determinación de los niveles de INF-g y la expresión celular de los receptores IL-12Rb1 e INF-gR1 en linfocitos y monocitos, respectivamente. Los ensayos se realizaron tanto a nivel basal, como tras estimulación mediante incubación in vitro de células mononucleares de sangre periférica con fitohemaglutinina (PHA) y derivado proteico purificado (PPD). Se analizaron y compararon las respuestas de los enfermos y de los controles sanos. La estimulación in vitro con PHA y PPD incrementó de forma significativa los niveles de INF-g, y la expresión celular de los marcadores IL-12Rb1 y INF-gR1 respecto a los niveles basales, tanto en el grupo de enfermos con TB, como en el de controles sanos (con PT+ y PT–). Todo ello es indicativo de una respuesta inmunitaria adecuada en todos los grupos, en los que la funcionalidad del eje IL-12/INF-g está conservada en los pacientes analizados con TB en Galicia. Aunque nuestro estudio no ha analizado todas las vías de alteración posibles del eje IL-12/INF-g, las altas tasas de enfermedad que históricamente se observan en esta comunidad no parecen estar causadas por una disfunción de la respuesta inmunitaria a este nivel (AU)

The integrity of the interleukin 12/interferon gamma (IL-12/INF-g) axis has been shown to be essential in the control of the Mycobacterium tuberculosis infection. The aim of this study was to assess whether the high incidence of tuberculosis (TB) in Galicia, Spain, could be related to an altered response in the IL-12/INF-g axis in patients with TB. We studied 20 TB patients and 21 healthy controls: 7 with positive Tuberculin Skin test (TST+) and another 14 with TST–. The study of the IL-12/INF-g axis was conducted by the analysis of INF-glevels (in serum and supernatants of non-activated and activated cells) and by the cellular expression of IL-12Rb1 and INF-gR1 in lymphocytes and monocytes, respectively. The assays were performed at baseline levels and after in vitro stimulation of peripheral blood mononuclear cells with phytohaemagglutin in (PHA) and purified protein derivative (PPD). Responses in patients and in healthy controls were analysed and compared. PHA and PPD in vitro stimulation significantly increased INF-gamma levels and the cellular expression of IL-12Rb1 and INF-gR1 receptors compared to baseline levels in both TB patients and healthy controls (either with positive or negative TST). Our results suggest that there is an adequate immune response in all groups. Although the IL-12/INF-g axis may have other abnormalities not analysed in this work, the functionality of the IL-12/INF-g axis is preserved in the patients analysed with TB in Galicia. The high rates of disease historically observed in this community does not seem to be caused by a malfunction of the immune response at this level (AU)

Venous thromboembolism and bleeding after total knee and hip arthroplasty. Findings from the Spanish National Discharge Database.

The impact of venous thromboembolism (VTE) and bleeding in patients undergoing major joint surgery has not been thoroughly studied. The Spanish National Discharge Database during the years 2005-2006 was used to assess the frequency and clinical impact of VTE and bleeding after elective total knee (TKA) or hip (THA) arthroplasty. Of 58,037 patients undergoing TKA, 0.18% (95% confidence interval [CI]: 0.15-0.22) were diagnosed with pulmonary embolism (PE), 0.57% (95% CI: 0.51-0.63) with deep-vein thrombosis (DVT), 1.20% (95% CI: 1.12-1.30) had bleeding complications, and 0.09% (95% CI: 0.07-0.12) died. Of 54 patients who died, 20.4% (95% CI: 10.7-35.4) had been diagnosed with PE, 3.70% (95% CI: 0.63-11.7) with DVT, and 13.0% (95% CI: 5.67-25.6) had bled. Of 31,769 patients undergoing elective THA, 0.23% (95% CI: 0.18-0.29) were diagnosed with PE, 0.44% (95% CI: 0.37-0.52) with DVT, 1.21% (95% CI: 1.10-1.34) bled, and 0.16% (95% CI: 0.12-0.21) died. Of 52 patients who died, 13.5% (95% CI: 6.08-24.8) had been diagnosed with PE, and 9.61% (95% CI: 3.52-21.3) had bled. On multivariable analysis, PE (odds ratio [OR]: 157; 95% CI: 75-328), DVT (OR: 6.3; 95% CI: 1.5-27) and bleeding (OR: 8.5; 95% CI: 3.6-20) were independent predictors for death after TKA. After THA, only PE (OR: 65; 95% CI: 26-160) and bleeding (OR: 6.4; 95% CI: 2.3-17) predicted the risk for death. Bleeding, DVT, and PE, arising after TKA were all independent predictors for death. Their increase in risk was, however, substantially higher for PE. After THA, only PE and bleeding independently predicted death.

Carcinoma de célula pequeña extrapulmonar en localización esofágica / Extrapulmonary small cell carcinoma located in the oesophagus

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Venous thromboembolism in nonagenarians. Findings from the RIETE Registry.

The balance between the efficacy and safety of anticoagulant therapy in patients aged >/=90 years with venous thromboembolism (VTE) is uncertain. RIETE is an ongoing, prospective registry of consecutive patients with acute, objectively confirmed, symptomatic VTE. We evaluated the efficacy and safety of anticoagulant therapy during the first three months in all patients aged >/=90 years. In addition, we tried to identify those at a higher risk for VTE. Of 21,873 patients enrolled from March 2001 to February 2008, 610 (2.8%) were aged >/=90 years. Of these, 307 (50%) presented with pulmonary embolism (PE), 240 (39%) had immobility >/=4 days, and 271 (44%) had abnormal creatinine levels. During the first three months of therapy, 140 patients aged >/=90 years (23%) died. Of these, 45 (32%) died of PE (34 of the initial episode, 11 of recurrent PE), 18 (13%) had fatal bleeding. Recent immobility >/=4 days was the most common risk factor for VTE (240 of 610 patients, 39%), but only 54 of them (22%) had received thromboprophylaxis. The most frequent causes for immobility were senile dementia, acute infection, trauma or decompensated heart failure. The duration of immobility was <4 weeks in 126 patients (52%), and most of them were bedridden at home. In conclusion, one in every four VTE patients aged >/=90 years died during the first three months of therapy. Of these, one in every three died of PE, one in every eight had fatal bleeding. Identifying at-risk patients may help to prevent some of these deaths.

Venous thromboembolism in Spain. Comparison between an administrative database and the RIETE registry.

BACKGROUND: The aim of this study was to validate the baseline characteristics of the RIETE cohort against the much larger national Spanish population-based database. METHODS: The RIETE is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute venous thromboembolism (VTE). We compared some baseline characteristics and death rates in the administrative database from the Spanish Ministry of Health (CMBD, Conjunto Mínimo Básico de Datos) with those in the RIETE registry. RESULTS: During the study period, data on 87,733 patients with VTE were collected from the CMBD and 8053 from the RIETE. There were no differences between the groups in gender, mean age, clinical presentation of the VTE event, or the presence of recent surgery; however, chronic lung disease, chronic heart failure, and pregnancy were slightly more common in patients in the CMBD. There were no differences in mortality rate in patients with deep vein thrombosis, but the 12% death rate in patients with pulmonary embolism in the CMBD was three times higher than the 4.1% found in the RIETE. However, when only considering patients with pulmonary embolism who had objective tests, the 4.8% death rate in the CMBD no longer differed from the mortality in the RIETE. CONCLUSIONS: Our data reveal that the information in the RIETE is very close to that observed in the CMBD, thus supporting the validity of the data in the RIETE.

[Tobacco advertising and printed mass media in Spain: a fatal attraction]. / Tabaco y medios de comunicación escritos en España: una atracción fatal.

OBJECTIVE: Tobacco advertising is a powerful factor in encouraging smoking initiation. We analyzed tobacco advertising in written mass media in Spain between 2002 and 2005. METHODS: We performed an annual cross-sectional study of advertisements in the 41 most widely disseminated written mass media (nearly 10 million readers). RESULTS: In the period studied, 37% of the media included tobacco advertising (an average of 4.35 million readers). Only 4% of the media included anti-drug campaigns (an average of 0.27 million readers). Tobacco advertising increased from 2.0 to 4.7% (overall) and from 4.3 to 8.0% (in media allowing tobacco advertising). Four out of every 10 readers and one out of eight Spaniards aged 15 years or older were exposed to tobacco advertising. Fifty-six percent of advertisements included young people. CONCLUSIONS: Tobacco advertising remains prominent in written mass media in Spain and was mainly directed at young people.

Tabaco y medios de comunicación escritos en España: una atracción fatal / Tobacco advertising and printed mass media in Spain: a fatal attraction

Objetivo: La publicidad del tabaco es un poderoso estímulo para iniciar su consumo. Se analizó dicha publicidad en medios escritos en España durante el período 2002-2005. Métodos: Estudio transversal anual de anuncios insertados en los 41 medios escritos de mayor difusión (cerca de 10 millones de lectores). Resultados: En dicho período un 37% de medios insertaron publicidad sobre el tabaco (lectores medios, 4,35 millones). Sólo un 4% de los medios incluyeron campañas antidroga (lectores medios, 0,27 millones). La publicidad del tabaco se incrementó tanto globalmente (del 2,0 al 4,7%) como en medios que la consintieron (del 4,3 al 8,0%). Ello significa que 4 de cada 10 lectores totales y 1 de cada 8 españoles > 15 años recibieron tal impacto publicitario. En el 56% de los anuncios se incluyeron jóvenes. Conclusiones: La publicidad del tabaco es alta en los medios escritos y está dirigida preferentemente a jóvenes

Objective: Tobacco advertising is a powerful factor in encouraging smoking initiation. We analyzed tobacco advertising in written mass media in Spain between 2002 and 2005. Methods: We performed an annual cross-sectional study of advertisements in the 41 most widely disseminated written mass media (nearly 10 million readers). Results: In the period studied, 37% of the media included tobacco advertising (an average of 4.35 million readers). Only 4% of the media included anti-drug campaigns (an average of 0.27 million readers). Tobacco advertising increased from 2.0 to 4.7% (overall) and from 4.3 to 8.0% (in media allowing tobacco advertising). Four out of every 10 readers and one out of eight Spaniards aged 15 years or older were exposed to tobacco advertising. Fifty-six percent of advertisements included young people. Conclusions: Tobacco advertising remains prominent in written mass media in Spain and was mainly directed at young people