ABSTRACT
OBJECTIVES: To investigate if HDL cholesterol (HDL-c) could be a biomarker of the degree of severity according to prognostic prediction scores in community-acquired pneumonia (CAP) or the development of clinical complications such as pleural effusion. METHODS: We included in a retrospective study 107 patients admitted to the hospital that fulfilled diagnostic criteria for CAP between the 30th October 2011 and 1st September 2012. HDL-c levels at admission, CAP prognosis scores (PSI and CURB65) and clinical outcomes were recorded for the study. RESULTS: Basal HDL-c levels were not statistically different according to prognostics scores neither PSI nor CURB-65. Significantly lower levels of HDL-c were also associated to the development of septic shock and admission to the intensive care unit. HDL-c were inversely correlated with acute phase reactants CRP (r = -0.585, P < 0.001), ESR (r = -0.477, P < 0.001), and leukocytes cell count (r = -0.254, P < 0.009). Patients with pleural effusion showed significant lower levels of HDL-c [28.9 (15.5) mg/dl vs. 44.6 (21.1) mg/dl]; P = 0.007. HDL-c is a good predictor of the presence of pleural effusion in multivariate analyses and using ROC analyses [AUC = 0.712 (0.591-0.834), P = 0.006]. HDL-c levels of 10 mg/dl showed a sensitivity of 97.6 % and a specificity of 82.4 % for the presence of pleural effusion. CONCLUSION: Monitoring HDL-c in CAP is an useful serum marker of acute phase response, clinical outcome and the presence of pleural effusion.
ABSTRACT
OBJECTIVE: To evaluate the effectiveness of a nursing intervention (personal and ongoing dietary counselling) on the treatment of obese patients. DESIGN: A quasi-experimental intervention study (prospective, randomized, with a control group and non-blind). SETTING: At the Primary Care level: carried out in two General Medical practices in the city of Valls. PATIENTS AND METHODS: A total of 64 obese patients (Body Mass Index > 27) who had not carried out any hypocaloric dieting in the previous 30 days were included in the study. The patients were drawn from both practices. In a random manner, 32 were assigned to the control group and 32 to the intervention group. There were 7 losses: people who did not attend all the appointments. INTERVENTIONS: A standard diet was distributed to the intervention group. They had a fortnightly appointment in the nursing station, where their data were recorded and they received personal dietary counselling. The control group patients were only handed and explained the diet; and given appointments at 2 and 4 months in order to check their weight. MAIN MEASUREMENTS AND RESULTS: The average weight loss at 2 months was 3.9 kg in the intervention group and 2.2 kg in the control group (SD p < 0.05). At four months, the weight loss was 2.9 kg in the control group and 4.5 kg in the intervention group (no SD). CONCLUSIONS: Given the scant difference between the weight losses observed in both groups, the conclusion is that, although they are effective, the efficiency of these types of intervention is low. The resources required are excessive, considering that at the end a weight loss at 2 months of little relevance and at 4 months of no significance, in comparison with the control group, is obtained.
Subject(s)
Counseling , Diet, Reducing , Obesity/diet therapy , Adult , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Prospective Studies , Time Factors , Weight LossABSTRACT
Authors present clinical data of two sisters with a very similar clinical disease, one of which was diagnosed as CSID with ADA deficiency. The different manifestations of the disease are reviewed and the importance of establishing an early diagnosis is underlined, not only for early treatment of the patient, but for genetic counselling as well.
