RECALMIN IV. Evolución de la actividad de las unidades de medicina interna del Sistema Nacional de Salud (2008-2021) / RECALMIN IV. Evolution in the activity of internal medicine units of the National Health System (2008-2021)

Objetivos Analizar la estructura, la actividad y los resultados de los servicios y unidades de medicina interna (UMI) del Sistema Nacional de Salud (SNS). Analizar los retos para la especialidad y realizar propuestas de políticas de mejora. Comparar los resultados de la encuesta RECALMIN 2021 con las anteriores oleadas de encuestas a las UMI (2008, 2015, 2017, 2019). Material y métodos Estudio descriptivo transversal entre las UMI en hospitales generales de agudos del SNS con datos referidos a 2020, comparándolos con los anteriores estudios. Las variables de estudio fueron recogidas mediante un cuestionario ad hoc. Resultados Entre 2014 y 2020 aumentó la frecuentación hospitalaria y las altas dadas por las UMI (promedio anual de 4 y 3,8%, respectivamente), así como las tasas interconsultas hospitalarias y primeras consultas (promedio anual: 2,1% en ambos casos). En 2020 aumentaron notablemente las consultas no presenciales. La mortalidad ajustada por riesgo y la estancia hospitalaria no mostraron cambios significativos en 2013-2020. Los progresos en la implantación de buenas prácticas y de una atención sistemática al paciente crónico complejo fueron escasos. Una constante en las encuestas RECALMIN es la variabilidad entre UMI en recursos y actividad, sin encontrarse diferencias estadísticamente significativas en relación con los resultados. Conclusiones Existe un notable margen de mejora en el funcionamiento de las UMI. La reducción de la variabilidad no justificada en la práctica clínica y las desigualdades en los resultados en salud deben ser un reto para los responsables de las UMI y para la Sociedad Española de Medicina Interna (AU)

Aims This work aims to analyze the structure, activity, and outcomes of internal medicine units and departments (IMU) of the Spanish National Health System (SNHS) and to analyze the challenges for the specialty and propose policies for improvement. It also aims to compare the results from the 2021 RECALMIN survey with IMU surveys from previous years (2008, 2015, 2017, 2019). Methods This work is a cross-sectional, descriptive study of IMUs in acute care general hospitals of the SNHS that compares data from 2020 with previous studies. The study variables were collected through an ad hoc questionnaire. Results Between 2014 and 2020, hospital occupancy and discharges by IMU increased (annual mean of 4% and 3.8%, respectively), as did hospital cross-consultation and initial consultation rates (2.1% in both cases). E-consultations increased notably in 2020. Risk-adjusted mortality and length of hospital stay did not show significant changes from 2013-2020. Progress in the implementation of good practices and systematic care for complex chronic patients was limited. A consistent finding in RECALMIN surveys was the variability among IMUs in terms of resources and activity, though no statistically significant differences were found in regard to outcomes. Conclusions There is considerable room for improvement in the operation of IMUs. The reduction in unjustified variability in clinical practice and inequities in health outcomes are a challenge for IMU managers and the Spanish Society of Internal Medicine (AU)

RECALMIN IV. Evolution in the activity of internal medicine units of the National Health System (2008-2021).

AIMS: This work aims to analyze the structure, activity, and outcomes of internal medicine units and departments (IMU) of the Spanish National Health System (SNHS) and to analyze the challenges for the specialty and propose policies for improvement. It also aims to compare the results from the 2021 RECALMIN survey with IMU surveys from previous years (2008, 2015, 2017, 2019). METHODS: This work is a cross-sectional, descriptive study of IMUs in acute care general hospitals of the SNHS that compares data from 2020 with previous studies. The study variables were collected through an ad hoc questionnaire. RESULTS: Between 2014 and 2020, hospital occupancy and discharges by IMU increased (annual mean of 4% and 3.8%, respectively), as did hospital cross-consultation and initial consultation rates (2.1% in both cases). E-consultations increased notably in 2020. Risk-adjusted mortality and length of hospital stay did not show significant changes from 2013-2020. Progress in the implementation of good practices and systematic care for complex chronic patients was limited. A consistent finding in RECALMIN surveys was the variability among IMUs in terms of resources and activity, though no statistically significant differences were found in regard to outcomes. CONCLUSIONS: There is considerable room for improvement in the operation of IMUs. The reduction in unjustified variability in clinical practice and inequities in health outcomes are a challenge for IMU managers and the Spanish Society of Internal Medicine.

Disección coronaria espontánea en España: un estudio sobre bases administrativas realizado a partir del Conjunto Mínimo Básico de Datos español / Spontaneous coronary artery dissection in Spain: a study using the minimum data set of the Spanish National Health System

Introducción y objetivos La disección coronaria espontánea (DCE) es una causa poco común de infarto agudo de miocardio (IAM). En este estudio se comparan la mortalidad y los reingresos hospitalarios de los pacientes con IAM-DCE e IAM de otras etiologías (IAM-NDCE). Métodos Se calcularon las razones de mortalidad hospitalaria y de reingresos a los 30 días estandarizadas por riesgo (RAMER y RARER respectivamente) utilizando el Conjunto Mínimo Básico de Datos del Sistema Nacional de Salud español (2016-2019). Resultados Se hallaron 806 eventos de IAM-DCE y 119.425 de IMA-NDCE. Los IAM-DCE se produjeron en pacientes más jóvenes y más frecuentemente mujeres que los IAM-NDCE. La mortalidad bruta fue menor (el 3 frente al 7,6%; p<0,001) y la RAMER, mayor (el 7,6±1,7 frente al 7,4±1,7%; p=0,019) en los IAM-DCE. Tras emparejamiento por puntuación de propensión (806 parejas), la mortalidad fue similar en ambos grupos (AdjOR=1,15; IC95%, 0,61-2,2; p=0,653). La tasa bruta de reingresos de los pacientes con IAM-DCE a 30 días fue similar (el 4,6 frente al 5%; p=0,67), mientras que la RARER fue menor (el 4,7±1 frente al 4,8±1%; p=0,015). Tras el emparejamiento por puntuación de propensión (715 parejas), la tasa de ingresos fue similar en ambos grupos (AdjOR=1,14; IC95%, 0,67-1,98; p=0,603). Conclusiones La mortalidad hospitalaria y los reingresos a los 30 días de los pacientes con IAM-DCE es similar a la de los IAM-NDCE cuando el riesgo se ajusta a las características basales de la población. Estos datos resaltan la necesidad de optimizar el manejo, tratamiento y seguimiento clínico de los pacientes con DCE (AU)

Introduction and objectives Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI). We sought to compare the results on in-hospital mortality and 30-day readmission rates among patients with AMI-SCAD vs AMI due to other causes (AMI-non-SCAD). Methods Risk-standardized in-hospital mortality (rIMR) and risk-standardized 30-day readmission ratios (rRAR) were calculated using the minimum dataset of the Spanish National Health System (2016-2019). Results A total of 806 episodes of AMI-SCAD were compared with 119 425 episodes of AMI–non-SCAD. Patients with AMI-SCAD were younger and more frequently female than those with AMI–non-SCAD. Crude in-hospital mortality was lower (3% vs 7.6%; P<.001) and rIMR higher (7.6±1.7% vs 7.4±1.7%; P=.019) in AMI-SCAD. However, after propensity score adjustment (806 pairs), the mortality rate was similar in the 2 groups (AdjOR, 1.15; 95%CI, 0.61-2,2; P=.653). Crude 30-day readmission rates were also similar in the 2 groups (4.6% vs 5%, P=.67) whereas rRAR were lower (4.7±1% vs 4.8%±1%; P=.015) in patients with AMI-SCAD. Again, after propensity score adjustment (715 pairs) readmission rates were similar in the 2 groups (AdjOR, 1.14; 95%CI, 0.67–1.98; P=.603). Conclusions In-hospital mortality and readmission rates are similar in patients with AMI-SCAD and AMI–non-SCAD when adjusted for the differences in baseline characteristics. These findings underscore the need to optimize the management, treatment, and clinical follow-up of patients with SCAD (AU)

Efficacy of continuous versus intermittent administration of nanoformulated benznidazole during the chronic phase of Trypanosoma cruzi Nicaragua infection in mice.

BACKGROUND: Benznidazole and nifurtimox are effective drugs used to treat Chagas' disease; however, their administration in patients in the chronic phase of the disease is still limited, mainly due to their limited efficacy in the later chronic stage of the disease and to the adverse effects related to these drugs. OBJECTIVES: To evaluate the effect of low doses of nanoformulated benznidazole using a chronic model of Trypanosoma cruzi Nicaragua infection in C57BL/6J mice. METHODS: Nanoformulations were administered in two different schemes: one daily dose for 30 days or one dose every 7 days, 13 times. RESULTS: Both treatment schemes showed promising outcomes, such as the elimination of parasitaemia, a reduction in the levels of T. cruzi-specific antibodies and a reduction in T. cruzi-specific IFN-γ-producing cells, as well as an improvement in electrocardiographic alterations and a reduction in inflammation and fibrosis in the heart compared with untreated T. cruzi-infected animals. These results were also compared with those from our previous work on benznidazole administration, which was shown to be effective in the same chronic model. CONCLUSIONS: In this experimental model, intermittently administered benznidazole nanoformulations were as effective as those administered continuously; however, the total dose administered in the intermittent scheme was lower, indicating a promising therapeutic approach to Chagas' disease.

Awareness on oral cancer among patients attending dental school clinics in Brazil.

BACKGROUND: Oral cancer is considered a public health problem worldwide. Dental schools may play an important role in educating patients about oral cancer. This study aimed at evaluating the knowledge of patients attending clinics at two dental schools in Brazil. MATERIAL AND METHODS: From March 2017 to April 2017, 251 patients who were attending clinics at two dental schools in Recife, Brazil, were included in the study. Patients were contacted in the waiting rooms of the clinic. Each participant completed a self-administered questionnaire, which consists of 21 questions, including socio-demographic and specific information on the disease. Data were analyzed using descriptive statistics, and a chi-square test (with a 5% significance level) was used to assess the correlation between the variables, education and family income and other variables. RESULTS: Most participants were women (64.9%) with a mean age of 42.72 years. Most participants were knowledgeable about oral cancer and identified tobacco use (48.6%), alcohol consumption (25.1%), and solar radiation (12%) as the primary risk factors for the disease. Only 36.7% of the participants reported having received counselling on oral cancer, of which 18.3% received the information from a dentist. All patients with an income higher than six minimum wages were aware about oral cancer (p = 0.001). CONCLUSIONS: These findings emphasize the importance of educational programs in dental schools as well providing integrated services for patients seeking care at school clinics, including population's awareness on oral cancer.

Component-resolved diagnosis and beyond: Multivariable regression models to predict severity of hazelnut allergy.

BACKGROUND: Component-resolved diagnosis (CRD) has revealed significant associations between IgE against individual allergens and severity of hazelnut allergy. Less attention has been given to combining them with clinical factors in predicting severity. AIM: To analyze associations between severity and sensitization patterns, patient characteristics and clinical history, and to develop models to improve predictive accuracy. METHODS: Patients reporting hazelnut allergy (n = 423) from 12 European cities were tested for IgE against individual hazelnut allergens. Symptoms (reported and during Double-blind placebo-controlled food challenge [DBPCFC]) were categorized in mild, moderate, and severe. Multiple regression models to predict severity were generated from clinical factors and sensitization patterns (CRD- and extract-based). Odds ratios (ORs) and areas under receiver-operating characteristic (ROC) curves (AUCs) were used to evaluate their predictive value. RESULTS: Cor a 9 and 14 were positively (OR 10.5 and 10.1, respectively), and Cor a 1 negatively (OR 0.14) associated with severe symptoms during DBPCFC, with AUCs of 0.70-073. Combining Cor a 1 and 9 improved this to 0.76. A model using a combination of atopic dermatitis (risk), pollen allergy (protection), IgE against Cor a 14 (risk) and walnut (risk) increased the AUC to 0.91. At 92% sensitivity, the specificity was 76.3%, and the positive and negative predictive values 62.2% and 95.7%, respectively. For reported symptoms, associations and generated models proved to be almost identical but weaker. CONCLUSION: A model combining CRD with clinical background and extract-based serology is superior to CRD alone in assessing the risk of severe reactions to hazelnut, particular in ruling out severe reactions.

Validation of Recipes for Double-Blind Placebo-Controlled Challenges With Milk, Egg White, and Hazelnut.

BACKGROUND: The double-blind, placebo-controlled food challenge (DBPCFC) is considered the definitive diagnostic test for food allergy. Nevertheless, validated recipes for masking the foods are scarce, have not been standardized, and differ between centers. Sensory evaluation techniques such as the triangle test are necessary to validate the recipes used for DBPCFC. METHODS: We developed 3 recipes for use in DBPCFC with milk, egg white, and hazelnut and used the triangle test to validate them in a 2-phase study in which 197 volunteers participated. In each phase, participants tried 3 samples (2 active-1 placebo or 2 placebo-1 active) and had to identify the odd one. In phase 1, the 3 samples were given simultaneously, whereas in phase 2, the 3 samples of foods that failed validation in phase 1 were given sequentially. A visual analog scale (VAS) ranging from 1 to 10 was used to evaluate how much participants liked the recipes. RESULTS: In phase 1, the egg white recipe was validated (n=89 volunteers, 38.9% found the odd sample, P=.16). Milk and hazelnut recipes were validated in phase 2 (for both foods, n=30 participants, 36.7% found the odd sample, P=.36). Median VAS scores for the 3 recipes ranged from 6.6 to 9.7. CONCLUSIONS: We used sensory testing to validate milk, egg white, and hazelnut recipes for use in DBPCFC. The validated recipes are easy to prepare in a clinical setting, provide the equivalent of 1 serving dose, and were liked by most participants.

Balanced secretion of anti-CEA × anti-CD3 diabody chains using the 2A self-cleaving peptide maximizes diabody assembly and tumor-specific cytotoxicity.

Adoptive transfer of genetically engineered human cells secreting bispecific T-cell engagers has shown encouraging therapeutic effects in preclinical models of cancer. However, reducing the toxicity and improving the effectiveness of this emerging immunotherapeutic strategy will be critical to its successful application. We have demonstrated that for gene-based bispecific antibody strategies, two-chain diabodies have a better safety profile than single-chain tandem scFvs (single-chain variable fragments), because their reduced tendency to form aggregates reduces the risk of inducing antigen-independent T-cell activation. Here, we demonstrate that the incorporation of a 2A self-processing peptide derived from foot-and-mouth disease virus conveying co-translational cleavage into a two-chain anti-CD3 × anti-CEA diabody gene enables near-equimolar expression of diabody chains 1 and 2, and thus increases the final amount of assembled diabody. This was found to maximize diabody-mediated T-cell activation and cytotoxicity against carcinoembryonic antigen-positive tumor cells.

Validation of recipes for double-blind placebo-controlled challenges with milk, egg white, and hazelnut

Background: The double-blind, placebo-controlled food challenge (DBPCFC) is considered the definitive diagnostic test for food allergy. Nevertheless, validated recipes for masking the foods are scarce, have not been standardized, and differ between centers. Sensory evaluation techniques such as the triangle test are necessary to validate the recipes used for DBPCFC. Methods: We developed 3 recipes for use in DBPCFC with milk, egg white, and hazelnut and used the triangle test to validate them in a 2-phase study in which 197 volunteers participated. In each phase, participants tried 3 samples (2 active-1 placebo or 2 placebo-1 active) and had to identify the odd one. In phase 1, the 3 samples were given simultaneously, whereas in phase 2, the 3 samples of foods that failed validation in phase 1 were given sequentially. A visual analog scale (VAS) ranging from 1 to 10 was used to evaluate how much participants liked the recipes. Results: In phase 1, the egg white recipe was validated (n=89 volunteers, 38.9% found the odd sample, P=.16). Milk and hazelnut recipes were validated in phase 2 (for both foods, n=30 participants, 36.7% found the odd sample, P=.36). Median VAS scores for the 3 recipes ranged from 6.6 to 9.7. Conclusions: We used sensory testing to validate milk, egg white, and hazelnut recipes for use in DBPCFC. The validated recipes are easy to prepare in a clinical setting, provide the equivalent of 1 serving dose, and were liked by most participants (AU)

Introducción: La provocación oral doble ciego controlada con placebo (PODCCP) es la prueba diagnóstica definitiva en alergia a alimentos. A pesar de ello hay pocas recetas validadas, que además no están estandarizadas y difieren entre centros. Para poder validar recetas para PODCCP es necesario utilizar pruebas sensoriales como el test del triángulo. Métodos: Se han desarrollado tres recetas para PODCCP con leche, clara de huevo y avellana, que se han validado mediante el test del triángulo en un estudio en dos fases con 197 voluntarios. En cada fase los participantes probaban 3 muestras (2 activo-1 placebo o 2 placebo-1 activo) y debían identificar la diferente. En la fase 1 las 3 muestras se presentaban simultáneamente, mientras que en la fase 2 las muestras de las recetas no validadas en la fase 1 eran presentadas secuencialmente a los voluntarios. Los participantes evaluaron de 1 a 10 su apreciación de las recetas en una escala visual analógica (EVA). Resultados: En la fase 1 la receta de clara de huevo fue validada (n=90 sujetos, 38,9% identificaron la muestra diferente, p=0,16). Las recetas de leche y avellana fueron validadas en la fase 2 (cada receta fue probada por 30 sujetos, y en cada una el 36,7% identificaron la muestra diferente, p=0,36). La mediana de la puntuación en la EVA de las 3 recetas osciló entre 6,6 y 9,7. Conclusiones: Hemos validado mediante pruebas sensoriales recetas para PODCCP con leche, clara de huevo y avellana. Las recetas validadas son fáciles de realizar en el entorno asistencial, proporcionan una cantidad equivalente a una ración y fueron apreciadas por la mayoría de los participantes (AU)

Dental treatment in children with asthma - a review.

This article aims to explain the effects of long-term use of asthma medications. It will discuss the effects of asthma on the oral cavity, as well considerations for the dentist when treating asthmatic patients. It will also explain how to manage asthma in the dental setting and provide advice on maintaining oral health for asthmatic patients.

Prevalencia de patología cardíaca en la enfermedad de Chagas: años 2004-2012. Programa y Red de Chagas de CABA / Prevalence of cardiac pathology in Chagas disease: 2004 -2012. Program and Chagas CABA network

El Instituto Universitario de Ciencias de las Salud ha mostrado un particular compromiso con la formación de sus estudiantes en la estrategia de Atención Primaria de la Salud, con las prácticas asistenciales dedicadas al 1er nivel de atención ambulatoria y a las patologías prevalentes en ese ámbito. Del mismo modo se han desenvuelto las actividades de formación en investigación. Como exponente de esa orientación, la revista Ciencias de la Salud publicó en el Vol. 2, N°1, 2011:4-9, el artículo “Prevalencia de la Enfermedad de Chagas” de Érica G. Morais, que había obtenido el premio “Futuros Líderes”, otorgado por el Curso Anual Internacional de Investigación en Ciencias de la Salud (IUCS-AMA, Prof. Carlos Álvarez Bermúdez). Aquella investigación formaba parte de un proyecto más amplio realizado en el Hospital Teodoro Álvarez entre 2004 y 2012, en el que participaron un conjunto de investigadores, que compartieron la autoría de la actual publicación. El Dr. Jorge Mitelman, Prosecretario de Ciencia y Técnica del IUCS e integrante de ese equipo, preparó además una reseña sobre la jornada del INCOSUR, realizada en abril del presente año, describiendo asimismo el proceso de desarrollo de la Ciudad de Buenos Aires, como área no endémica, para encarar las consecuencias de la enfermedad de Chagas

Assignment of tumor subtype by genomic testing and pathologic-based approximations: implications on patient's management and therapy selection

BACKGROUND: Breast cancer subtypes can be identified by genomic testing or pathology-based approximations. However, these classifications are not equivalent and the clinical relevance of both classifications needs to be fully explored. METHODS: Ninety-four patients were randomized to neoadjuvant single agent doxorubicin or docetaxel. Tumor subtype was assessed by pathology-based classification and by gene expression using the PAM50 plus the claudin-low predictor (CLP). Kappa Cohen's coefficient (κ) was used to test the agreement between methods. Multivariate Cox proportional hazards analyses were used to determine the significance of each methodology in the prediction of prognosis. Likelihood ratio statistics of both classifications were evaluated. RESULTS: The agreement between pathology-based classification and PAM50 was moderate [κ = 0.551, 95 % confidence interval (95 % CI) 0.467-0.641]. Tumor subtype assessed by both classifications were prognostic for overall survival (OS) and relapse-free survival (P < 0.05). However, PAM50 + CLP provided more prognostic information, in terms of OS, than the pathology-based classification (P < 0.05). Patients with triple negative tumors as well as basal-like tumors had worse OS when first treated with doxorubicin (HR = 5.98, 95 % CI 1.25-28.67, and HR = 5.02, 95 % CI 0.96-26.38, respectively). However, claudin-low tumors did not show significant differences in OS according to neoadjuvant treatment branch. Indeed, we found that claudin-low tumors treated with pre-operative doxorubicin had significantly better OS than basal-like tumors treated with neoadjuvant doxorubicin (adjusted HR = 0.16, 95 % CI 0.04-0.69, P = 0.014). CONCLUSIONS: The assignment of tumor subtype can differ depending on the methodology, which might have implications on patient's management and therapy selection (AU)

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Assignment of tumor subtype by genomic testing and pathologic-based approximations: implications on patient's management and therapy selection.

BACKGROUND: Breast cancer subtypes can be identified by genomic testing or pathology-based approximations. However, these classifications are not equivalent and the clinical relevance of both classifications needs to be fully explored. METHODS: Ninety-four patients were randomized to neoadjuvant single agent doxorubicin or docetaxel. Tumor subtype was assessed by pathology-based classification and by gene expression using the PAM50 plus the claudin-low predictor (CLP). Kappa Cohen's coefficient (κ) was used to test the agreement between methods. Multivariate Cox proportional hazards analyses were used to determine the significance of each methodology in the prediction of prognosis. Likelihood ratio statistics of both classifications were evaluated. RESULTS: The agreement between pathology-based classification and PAM50 was moderate [κ = 0.551, 95 % confidence interval (95 % CI) 0.467-0.641]. Tumor subtype assessed by both classifications were prognostic for overall survival (OS) and relapse-free survival (P < 0.05). However, PAM50 + CLP provided more prognostic information, in terms of OS, than the pathology-based classification (P < 0.05). Patients with triple negative tumors as well as basal-like tumors had worse OS when first treated with doxorubicin (HR = 5.98, 95 % CI 1.25-28.67, and HR = 5.02, 95 % CI 0.96-26.38, respectively). However, claudin-low tumors did not show significant differences in OS according to neoadjuvant treatment branch. Indeed, we found that claudin-low tumors treated with pre-operative doxorubicin had significantly better OS than basal-like tumors treated with neoadjuvant doxorubicin (adjusted HR = 0.16, 95 % CI 0.04-0.69, P = 0.014). CONCLUSIONS: The assignment of tumor subtype can differ depending on the methodology, which might have implications on patient's management and therapy selection.

Evolución a los 2 años de edad corregida de una cohorte de recién nacidos con peso inferior o igual a 1.500 g de los hospitales pertenecientes a la red neonatal SEN1500 / Outcome at two years corrected age of a cohort of very low birth weight infants from hospitals within the neonatal SEN1500 network

Objetivo: Describir la evolución 4.944 niños que completaron el seguimiento a los 2 años de edad corregida de un total de 10.456 nacidos entre los años 2002-2007 con peso ≤ 1.500 g y dados de alta en los hospitales pertenecientes a la red SEN1500, de los cuales 522 fueron excluidos por presentar algún tipo de malformación. El número de niños evaluados supone un 49,76% del total de niños dados de alta sin malformaciones en el conjunto de hospitales integrantes de la red. Métodos: Estudio retrospectivo de los datos recogidos prospectivamente en la base de datos SEN1500. Se compararon los datos de crecimiento somatométrico a los 2 años de edad corregida en los grupos según el peso al nacimiento y el sexo. Se analizaron entre estos grupos las alteraciones motoras, la incidencia de parálisis cerebral, las alteraciones visuales y auditivas y el desarrollo neuromadurativo anormal para la edad de gestación. Se estudió la asociación de parálisis cerebral con factores perinatales. Resultados: El 44,2% de los niños seguidos a los 2 años tuvieron un peso < 2 desviaciones estándar; presentaron peor evolución en todos los parámetros somatométricos los niños con peso al nacimiento ≤ 1.000 g. El 6,96% de los niños tuvo algún tipo de dificultad motora, estando el 4,56% de ellos diagnosticados de parálisis cerebral. Su incidencia fue mayor entre los varones con peso ≤ 1.000 g. Hubo una incidencia de alteraciones visuales del 5,21%, siendo ciegos de uno o ambos ojos el 0,5% de los niños. La parálisis cerebral se asoció con retinopatía del prematuro grave, hemorragia intraventricular grave y leucomalacia periventricular, en especial la leucomalacia periventricular quística (AU)

Objective: To describe growth and neurodevelopmental status of 4,944 children who completed a follow-up at two years of corrected age out of the 10,456 newborns with weight ≤1500 g born between the years 2002-2007 and discharged from hospitals within the network SEN1500. A total of 522 newborns were excluded as they had some type of malformation. The total number of children assessed represents the 49.76% of children discharged alive and without malformations. Methods: A retrospective review was conducted using prospectively collected data in the SEN1500 database. We compared growth data at two years of corrected age according to birth weight and sex. Motor impairment, incidence of cerebral palsy, visual and hearing disabilities, and abnormal neurodevelopment for gestational age were analysed between groups. We studied the associations between cerebral palsy (CP) and perinatal factors. Results: At 2 years of age 44.2% of children had a weight < 2 SD for corrected age. Children with birth weight ≤1000 g showed worse outcomes in growth. Some type of motor impairment was observed in 6.96% of the infants, and 4.56% of them were diagnosed with CP. The incidence was higher among males with birth weight ≤1000 g. There was an incidence of 5.21% of visual disability, with 0.5% of children being blind in one or both eyes. Cerebral palsy was associated with retinopathy of prematurity, severe intraventricular haemorrhage, and periventricular leukomalacia, in particular cystic periventricular leukomalacia (AU)

Advancing allele group-specific amplification of the complete HLA-C gene--isolation of novel alleles from three allele groups (C*04, C*07 and C*08).

A variety of strategies have been designed for sequence-based HLA typing (SBT) and for the isolation of new human leucocyte antigen (HLA) alleles, but unambiguous characterization of complete genomic sequences remains a challenge. We recently reported a simple method for the group-specific amplification (GSA) and sequencing of a full-length C*04 genomic sequence in isolation from the accompanying allele. Here we build on this strategy and present homologous methods that enable the isolation of HLA-C alleles belonging to another two allele groups. Using this approach, which can be applied to sequence-based typing in some clinical settings, we have successfully characterized three novel HLA-C alleles (C*04:128, C*07:01:01:02, and C*08:62).

[Outcome at two years corrected age of a cohort of very low birth weight infants from hospitals within the neonatal SEN1500 network]. / Evolución a los 2 años de edad corregida de una cohorte de recién nacidos con peso inferior o igual a 1.500g de los hospitales pertenecientes a la red neonatal SEN1500.

OBJECTIVE: To describe growth and neurodevelopmental status of 4,944 children who completed a follow-up at two years of corrected age out of the 10,456 newborns with weight ≤1500g born between the years 2002-2007 and discharged from hospitals within the network SEN1500. A total of 522 newborns were excluded as they had some type of malformation. The total number of children assessed represents the 49.76% of children discharged alive and without malformations. METHODS: A retrospective review was conducted using prospectively collected data in the SEN1500 database. We compared growth data at two years of corrected age according to birth weight and sex. Motor impairment, incidence of cerebral palsy, visual and hearing disabilities, and abnormal neurodevelopment for gestational age were analysed between groups. We studied the associations between cerebral palsy (CP) and perinatal factors. RESULTS: At 2 years of age 44.2% of children had a weight <2 SD for corrected age. Children with birth weight ≤1000g showed worse outcomes in growth. Some type of motor impairment was observed in 6.96% of the infants, and 4.56% of them were diagnosed with CP. The incidence was higher among males with birth weight ≤1000g. There was an incidence of 5.21% of visual disability, with 0.5% of children being blind in one or both eyes. Cerebral palsy was associated with retinopathy of prematurity, severe intraventricular haemorrhage, and periventricular leukomalacia, in particular cystic periventricular leukomalacia.

Histerectomía total laparoscópica asistida por robot: experiencia de Clínica Indisa / Robot-assisted total laparoscopic hysterectomy

Se comunica la experiencia y los resultados obtenidos de 110 casos de histerectomía total laparoscópica asistida por robot entre junio de 2010 y abril de 2013 en Clínica Indisa. Parámetros evaluados: diagnóstico, edad, índice de masa corporal (IMC), tiempo de instalación de trócares (TT), tiempo operatorio (TO), conversión a laparotomía, sangrado, dolor postoperatorio, estadía hospitalaria y complicaciones postoperatorias. Los diagnósticos preoperatorios más frecuentes fueron: miomatosis y adenomiosis. El promedio de edad fue de 45 años y de IMC 25,8 kg/m2, 7 por ciento de las pacientes con IMC mayor de 35. TT promedio de 14 min y TO fue de 81 min. No hubo conversión a laparotomía. Sangrado promedio de 17 ml. A las 48 horas pos intervención el 100 por ciento de las pacientes presentó un test de EVA de 0-2. Promedio de estadía hospitalaria fue 1,6 días. Hubo tres complicaciones postoperatorias: una neumonía, un desgarro vulvar y una dehiscencia de la cúpula vaginal. Conclusión: La histerectomía total laparoscópica asistida por robot es una técnica segura y ofrece ventajas al paciente y cirujano...

We reports the experience and results obtained after 110 total robot assisted laparoscopic hysterectomy from June 2010 to April 2013 at Indisa Clinic. Parameters evaluated: diagnostic, age, body mass index (BMI), trocars installation time (TT), intervention time (TO), conversion to laparotomy, bleeding, post operatory pain, hospital stay, and post operatory complications. The most frequent preoperatory diagnostic were uterine fibroid and adenomyosis. The age average was 45 years and BMI 25.8 Kg/m2 and 7 percent was over 35. TT average 14 min and TO 81 min. There were no conversions to laparotomy. Bleeding average was 17 ml. At 48 hours, 100 percent of patients had an EVA test of 0-2. The average of hospital stay was 1.6 days. Only three complications occurred: one pneumonia, one vulvar tear and one vaginal cuff dehiscence. Conclusion: robot assisted laparoscopy hysterectomy appears to be a safe surgical technique that offers benefits to the patient and also to the surgeon...

Análisis de la utilidad del Clinical Risk Index for Babies por estratos de peso como predictor de muerte hospitalaria y de hemorragia intraventricular grave en la Red Neonatal Española SEN 1500 / Usefulness of Clinical Risk Index for Babies based on birth weight in predicting hospital death and severe intraventicular hemorrhage in the SEN 1500 Spanish neonatal network

Objetivo: Evaluar la utilidad del CRIB (Clinical Risk Index for Babies) para predecir la muerte hospitalaria y la hemorragia intraventricular (HIV) grave en recién nacidos (RN) menores de 1.500g estratificados por grupos de peso en la Red Neonatal Española SEN 1500. Pacientes y métodos: Se realizó un estudio de cohortes prospectivo. Se registraron datos de morbimortalidad, incluido el CRIB, en los RN menores de 1.500g de peso ingresados en 68 unidades de cuidados intensivos neonatales desde enero de 2002 a diciembre de 2006. Se analizaron datos globales y datos estratificados por grupos de peso (inferior a 501g, entre 501 y 750g, entre 751 y 1.000g, entre 1.001 y 1.250g y entre 1.251 y 1.500g). Se procesaron modelos multivariados y se elaboraron curvas de eficacia diagnóstica ROC (receiver operating characteristics) para estimar el poder de predicción mediante el AUC (area under the curve ‘área bajo la curva’). Resultados: Se registraron datos de 10.608 pacientes, de los cuales 6.953 (65,5%) pesaron entre 1.001 y 1.500g, y 3.655 (34,5%) pesaron menos de 1.001g. La media de peso fue de 1.116g (desviación estándar [DE] de 267) y la media de edad gestacional fue de 29,5 semanas (DE de 2,9). El 34,3% fueron de bajo peso para la edad gestacional. Recibió corticoides prenatales el 78,2%. El 36% fueron partos múltiples. Se observaron casos de HIV grave en el 8,5%. La mortalidad global fue del 15,6%. Tanto las variables cualitativas (sexo y corticoides prenatales) como las cuantitativas (peso al nacer, edad gestacional e índice CRIB) resultaron significativas para los 2 desenlaces. El CRIB fue el mejor predictor de mortalidad en todos los estratos de peso (p<0,001), excepto en el intervalo de 501 a 750g en el que no se encontraron diferencias con la edad gestacional (p = 0,648). El peso presentó la menor AUC para todos los grupos, salvo en el de 1.251 a 1.500g, en el que no hubo diferencia entre peso y edad gestacional (p = 0,519).En la predicción de HIV grave, edad gestacional y CRIB presentaron capacidades discriminativas similares y mayores que el peso (p<0,001). Sólo en el grupo de 751 a 1.000g, la edad gestacional fue mejor predictora (p = 0,029). Conclusiones: El CRIB es el mejor predictor de muerte hospitalaria en los RN de peso inferior a 1.500g. En los RN de peso comprendido entre 501 y 750g, su capacidad de predicción es similar a la de la edad gestacional. El CRIB y la edad gestacional presentan capacidades predictivas similares de HIV grave en los RN menores de 1.500g. En los RN de peso comprendido entre 751 y 1.000g la edad gestacional es mejor predictora (AU)

Objective: To evaluate the usefulness of the Clinical Risk Index for Babies (CRIB) in predicting hospital mortality and severe intraventricular hemorrhage (IVH) in very low birth weight infants stratified by weight groups, in the Spanish neonatal network SEN 1500. Patients and methods: A prospective cohort study was made. Morbidity-mortality data and CRIB were collected in newborns weighing below 1500g and admitted to 68 neonatal intensive care units between January 2002 and December 2006. Data were analyzed globally and stratified by weight groups (<501g, 500–750g, 751–1000g, 1001–1250g, 1251–1500g). Multivariate models were generated and ROC curves were plotted for estimating predictive values. Results: A total of 10,608 patients were analyzed. The mean weight was 1116g (SD 267), and gestational age 29.5 weeks (SD 2.9). Low birth weight for gestational age was 34.3% and the multiple birth rate 36%. Prenatal corticoids were given in 78.2%. Severe intraventricular hemorrhage was diagnosed in 8.5%. Gender, prenatal corticoids, birth weight, gestational age and CRIB proved significant for the outcomes. CRIB showed the highest predictive accuracy in all strata (P<0.001) except in the 501–750g group, where it was similar to gestational age. Body weight showed the lowest AUC in all groups, except in the 1251–1500g group, where it was no different to gestational age. Gestational age and CRIB yielded greater AUC values than weight (P<0.001) in all groups. No significant differences were found between CRIB and gestational age, except in the 751–1000g group, where gestational age was greater (P=0.029). Conclusions: The CRIB is the best predictor among newborns below 1500g, except in the 501–750g group, where CRIB is similar to gestational age. Body weight is the worst predictor, except in the group 1251–1500g, where it is similar to gestational age. The accuracies of CRIB and gestational age in the prediction of IVH are similar, and both superior to body weight. This similarity persists in all the groups, except in the 751-1000g interval, where gestational age is a better predictor (AU)

[Usefulness of Clinical Risk Index for Babies based on birth weight in predicting hospital death and severe intraventicular hemorrhage in the SEN 1500 Spanish neonatal network]. / Análisis de la utilidad del Clinical Risk Index for Babies por estratos de peso como predictor de muerte hospitalaria y de hemorragia intraventricular grave en la Red Neonatal Española SEN 1500.

OBJECTIVE: To evaluate the usefulness of the Clinical Risk Index for Babies (CRIB) in predicting hospital mortality and severe intraventricular hemorrhage (IVH) in very low birth weight infants stratified by weight groups, in the Spanish neonatal network SEN 1500. PATIENTS AND METHODS: A prospective cohort study was made. Morbidity-mortality data and CRIB were collected in newborns weighing below 1500 g and admitted to 68 neonatal intensive care units between January 2002 and December 2006. Data were analyzed globally and stratified by weight groups (< 501 g, 500-750 g, 751-1000 g, 1001-1250 g, 1251-1500 g). Multivariate models were generated and ROC curves were plotted for estimating predictive values. RESULTS: A total of 10,608 patients were analyzed. The mean weight was 1116 g (SD 267), and gestational age 29.5 weeks (SD 2.9). Low birth weight for gestational age was 34.3% and the multiple birth rate 36%. Prenatal corticoids were given in 78.2%. Severe intraventricular hemorrhage was diagnosed in 8.5%. Gender, prenatal corticoids, birth weight, gestational age and CRIB proved significant for the outcomes. CRIB showed the highest predictive accuracy in all strata (P < 0.001) except in the 501-750 g group, where it was similar to gestational age. Body weight showed the lowest AUC in all groups, except in the 1251-1500 g group, where it was no different to gestational age. Gestational age and CRIB yielded greater AUC values than weight (P < 0.001) in all groups. No significant differences were found between CRIB and gestational age, except in the 751-1000 g group, where gestational age was greater (P = 0.029). CONCLUSIONS: The CRIB is the best predictor among newborns below 1500 g, except in the 501-750 g group, where CRIB is similar to gestational age. Body weight is the worst predictor, except in the group 1251-1500 g, where it is similar to gestational age. The accuracies of CRIB and gestational age in the prediction of IVH are similar, and both superior to body weight. This similarity persists in all the groups, except in the 751-1000 g interval, where gestational age is a better predictor.

Intranasal vaccination with poly(lactide-co-glycolide) microparticles containing a peptide T of Ole e 1 prevents mice against sensitization.

BACKGROUND: Biodegradable microparticles, in particular poly(lactide-co-glycolide) (PLGA), have been shown as potential delivery vehicles for intranasal (i.n.) vaccines in animal models. OBJECTIVES: To evaluate whether i.n. administration of PLGA microparticles containing a peptide with the major T cell epitope of Ole e 1, the main allergen of olive pollen, prevented mice from allergic sensitization to the whole protein. METHODS: Peptide-PLGA microparticles were prepared by a solvent evaporation double emulsion method. Microparticles in a size range of 0.8 mum were evaluated for peptide loading and in vitro antigen release. Stability and immunogenicity of the entrapped peptide were retained, as determined by dot blot and ELISA inhibition. BALB/c mice were intranasally treated with peptide-PLGA microparticles for 3 consecutive days, 1 week before sensitization/challenge to Ole e 1. Blood, lungs and spleen were collected and analysed for immune response. Biodistribution of microparticles was investigated using confocal microscopy. RESULTS: I.n. pretreatment of BALB/c mice with peptide-PLGA microparticles before sensitization to Ole e 1 led to a significant inhibition of serum allergen-specific IgE and IgG1 antibody levels, but a marked increase of specific IgG2a antibodies as compared with sham-pretreated mice. Moreover, IL-5 and IL-10 levels in spleen cell cultures were suppressed in peptide-PLGA pretreated mice. The airway histopathologic parameters associated with inflammation were significantly suppressed by the pretreatment. CONCLUSION: These results demonstrate that i.n. immunization with peptide T-PLGA microparticles is effective in preventing subsequent allergic sensitization to Ole e 1. Our data indicate that peptide-PLGA microparticles may be promising candidates for the design of nasal vaccines against allergic diseases in humans.