A systematic review of expanded prostate cancer index composite (EPIC) quality of life after surgery or radiation treatment.

INTRODUCTION: The Expanded Prostate Cancer Index Composite (EPIC) is a validated and widely adopted instrument that measures patient quality of life. This study aims to describe and compare patient quality of life in the bowel, urinary, and sexual domains across different prostate cancer treatments. MATERIALS AND METHODS: A systematic review of English articles published prior to 2012 was conducted. Peer reviewed articles reporting longitudinal EPIC data in a statistically analyzable form with clearly defined time points were included. Articles were assessed by content experts to ensure optimal treatment quality. Screening of studies and extraction of data were completed using a predefined data abstraction tool. Data on bowel, urinary, and sexual domains were documented. Scores in each domain range from a low of 0 to a high of 100. RESULTS: Twenty-six articles, representing 8302 patients, were included. All treatments were associated with short term or long term reductions in urinary, bowel, and sexual domains. Surgery patients had better post-treatment bowel quality of life; however, average declines were small regardless of treatment. Post-treatment urinary incontinence scores were lower for surgery patients; while radiation patients had worse urinary irritation. Average urinary bother and function were similar between treatment groups at 18 months post-treatment. Surgery patients had better baseline sexual function. A greater decline in sexual function was observed in surgery patients compared to radiation patients. CONCLUSIONS: Prostate cancer treatments have different impacts on patient quality of life and function. The magnitude of difference between treatment-related adverse effects may be important to patients when choosing therapy.

Pilot study on quality of life and sexual function in men-who-have-sex-with-men treated for prostate cancer.

INTRODUCTION: There is limited data on post-treatment quality of life (QoL) for men-who-have-sex-with-men (MSM) with prostate cancer (PCa). QoL in MSM may not be reflected by assessment tools designed for the heterosexual population. AIMS: Our goals were to evaluate post-treatment QoL in PCa patients who are MSM, and to investigate the utility of current QoL assessment tool. METHODS: PCa patients treated with surgery and/or radiation were recruited from the local MSM community. Each participant completed the Expanded Prostate Cancer Index Composite (EPIC) questionnaire, Male Sexual Health Questionnaire (MSHQ), and a questionnaire focused on insertive and receptive roles of anal intercourse. MAIN OUTCOME MEASURES: Response scores were calculated based on questionnaire design and compared by treatment modality. RESULTS: Seven participants treated with surgery (mean age 58) and eight participants treated with radiation (mean age 67) were recruited. No participant in the surgical group received androgen deprivation therapy (ADT) while two in radiation group were treated with ADT. The sample size of this study did not permit formal statistical analysis, although potential differences in Urinary and Bowel Domains from EPIC and Ejaculation Scale from MSHQ were observed. More participants from the radiation group seemed to be able to maintain both insertive and receptive anal intercourse roles after treatment compared to participants who received surgery. CONCLUSIONS: While the two validated assessment tools suggested similar QoL scores including sexual function for both surgical and radiation groups, post-treatment sexual function related to anal intercourse may be better in the radiation group, as compared to the surgical group. Larger studies in PCa patients from MSM community are warranted to verify these data.

[Infective endocarditis by Rhizobium radiobacter. A case report]. / Endocarditis infecciosa por Rhizobium radiobacter. Reporte de un caso.

Rhizobium radiobacter is a Gram-negative, nitrogen-fixing bacterium, which is found mainly on the ground. It rarely causes infections in humans. It has been associated with bacteremia, secondary to colonization of intravascular catheters, in immunocompromised patients. The aim of this paper was to report the case of an infective endocarditis caused by R. radiobacter, in a 47-year-old male, diagnosed with chronic kidney disease stage 5, on replacement therapy with hemodialysis and who attended the medical center with fever of two weeks duration. The patient was hospitalized and samples of peripheral blood were taken for culture. Empirical antibiotic therapy was started with cefotaxime plus vancomycin. The transthoracic echocardiogram revealed fusiform vegetation on the tricuspid valve, with grade III-IV/IV regurgitation. On the seventh day after the start of antibiotic therapy, the patient had a clinical and paraclinical improvement. The bacterium identified by blood culture was Rhizobium radiobacter, ceftriaxone-resistant and sensitive to imipenem, amikacin, ampicillin and ampicillin/sulbactam. Because of the clinical improvement, it was decided to continue treatment with vancomycin and additionally, with imipenem. At 14 days after the start of antibiotic therapy, the patient was discharged with outpatient treatment with imipenem up to six weeks of treatment. The control echocardiogram showed the absence of vegetation on the tricuspid valve. This case suggests that R. radiobacter can cause endocarditis in patients with intravascular catheters.

Endocarditis infecciosa por Rhizobium radiobacter: Reporte de un caso / Infective endocarditis by Rhizobium radiobacter: A case report

Rhizobium radiobacter es una bacteria Gram-negativa, fijadora de nitrógeno que se encuentra principalmente en el suelo. Rara vez causa infecciones en humanos. Ha sido asociada a bacteriemia secundaria a colonización de catéteres intravasculares en pacientes inmunocomprometidos. El objetivo de este trabajo es informar un caso de endocarditis infecciosa por R. radiobacter. Se trata de paciente masculino, de 47 años de edad, con diagnóstico de enfermedad renal crónica estadio 5 en tratamiento sustitutivo con hemodiálisis, quien acude a centro asistencial por presentar fiebre de dos semanas de evolución. Es hospitalizado, se toman muestras de sangre periférica para hemocultivo y se inicia antibioticoterapia empírica con cefotaxime más vancomicina. El ecocardiograma transtorácico revelo vegetación fusiforme en válvula tricúspide con regurgitación grado III-IV/IV. Al séptimo día del inicio de la antibioterapia el paciente presenta mejoría clínica y paraclínica. La bacteria identificada por hemocultivo es Rhizobium radiobacter resistente a ceftriaxona y sensible a imipenem, amikacina, ampicilina y ampicilina/sulbactam. Debido a la mejoría clínica se decide continuar tratamiento con vancomicina y se anexa imipenem. A los 14 días de iniciada la antibioterapia el paciente es dado de alta con tratamiento ambulatorio con imipenen hasta cumplir seis semanas de tratamiento. En el ecocardiograma control se evidencio ausencia de la vegetación en la válvula tricúspide. Este caso sugiere que R. radiobacter puede ser una causa de endocarditis en pacientes portadores de catéteres intravasculares.

Rhizobium radiobacter is a Gram-negative, nitrogen-fixing bacterium, which is found mainly on the ground. It rarely causes infections in humans. It has been associated with bacteremia, secondary to colonization of intravascular catheters, in immunocompromised patients. The aim of this paper was to report the case of an infective endocarditis caused by R. radiobacter, in a 47-year-old male, diagnosed with chronic kidney disease stage 5, on replacement therapy with hemodialysis and who attended the medical center with fever of two weeks duration. The patient was hospitalized and samples of peripheral blood were taken for culture. Empirical antibiotic therapy was started with cefotaxime plus vancomycin. The transthoracic echocardiogram revealed fusiform vegetation on the tricuspid valve, with grade III-IV/IV regurgitation. On the seventh day after the start of antibiotic therapy, the patient had a clinical and paraclinical improvement. The bacterium identified by blood culture was Rhizobium radiobacter, ceftriaxone-resistant and sensitive to imipenem, amikacin, ampicillin and ampicillin/ sulbactam. Because of the clinical improvement, it was decided to continue treatment with vancomycin and additionally, with imipenem. At 14 days after the start of antibiotic therapy, the patient was discharged with outpatient treatment with imipenem up to six weeks of treatment. The control echocardiogram showed the absence of vegetation on the tricuspid valve. This case suggests that R. radiobacter can cause endocarditis in patients with intravascular catheters.

Tejido adiposo epicárdico y su asociación con niveles plasmáticos de adrenomedulina en pacientes con síndrome metabólico / Epicardial adipose tissue and its association to plasma adrenomedullin levels in patients with metabolic syndrome

Estudiar la asociación del espesor del tejido adiposo epicárdico (TAE) con los niveles plasmáticos de adrenomedulina en pacientes con síndrome metabólico (SM). Metodología Se seleccionaron 21 sujetos, 12 de sexo femenino y 9 de masculino, entre 22 y 58 años, con diagnóstico de SM según la Federación Internacional de Diabetes (IDF), y 19 controles, comparables en edad y sexo. Se midieron glicemia, lípidos y adrenomedulina plasmática. Se determinaron espesor del TAE, masa del ventrículo izquierdo y espesor íntima-media carotídeo mediante ecocardiografía transtorácica. Resultados No hubo diferencias estadísticamente significativas en edad, sexo y talla entre ambos grupos, y el peso, IMC, circunferencia abdominal (CA), presión arterial sistólica (PAS) y diastólica (PAD) fueron significativamente más altos (p=0,0001) en el grupo con SM. Este grupo presentó niveles significativamente más altos de glicemia (p=0,001), colesterol total (p=0,01), C-LDL (p=0,03), C-VLDL (p=0,005), triglicéridos (p=0,002), cociente Tg/C-HDL (p=0,0001) y adrenomedulina (3,49±1,21 vs 1,69±0,92 ng/mL; p=0,0001) y más bajos de C-HDL (p=0,02) que el grupo control. El espesor del TAE en los pacientes con SM fue significativamente más alto que en el grupo control (8,45±3,14 vs 5,43±0,96mm; p=0,0001), y mostró una correlación positiva con IMC (r=0,347; p=0,02), CA (r=0,350; p=0,02), PAD (r=0,346; p=0,02) y adrenomedulina (r=0,741; p=0,0001). En el análisis de regresión lineal múltiple, la adrenomedulina fue la variable explicativa del espesor del TAE (R2=0,550; p=0,0001).Conclusión En este limitado grupo de pacientes existe una asociación significativa entre espesor de TAE y niveles plasmáticos de adrenomedulina, los cuales pudieran ser utilizados como biomarcadores de SM (AU)

Objective: To assess the association between epicardial adipose tissue thickness (EAT) and plasma adrenomedullin plasma levels in patients with metabolic syndrome (MS).Methods: Twenty-one patients (12 females and 9 males) with MS according to the International Diabetes Federation guidelines, aged 22-58 years, were enrolled into the study and compared to19 age-matched control subjects without MS. Plasma glucose, lipid, and adrenomedullin levelswere assessed. EAT, left ventricular mass, and carotid intima-media thickness were evaluatedby transthoracic two-dimensional echocardiography. Results: No statistically significant differences were found between the groups in age, sex,and height. Body weight, abdominal circumference (AC), body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly higher (p = 0.0001)in MS patients; this group also showed significantly higher glucose (p = 0.001), total cholesterol(p = 0.01), LDL-C (p = 0.03), VLDL-C (p = 0.005), triglyceride (p = 0.002), Tg/HDL ratio(p = 0.0001), and plasma adrenomedullin (3.49±1.21 vs 1.69±0.92 ng/mL; p = 0.0001) levels and lower HDL-C (p = 0.02) levels as compared to the control group. EAT was significantly thickerin MS patients compared to the control group (8.45±3.14 vs 5.43±0.96; p = 0.0001), showed a positive correlation to BMI (r = 0.347; p = 0.02), AC (r = 0.350; p = 0.02), DBP (r = 0.346;p = 0.02), and adrenomedullin levels (r = 0.741; p = 0.0001). In multiple linear regression analysis, adrenomedullin was the only parameter associated to EAT (R2 = 0.550; p = 0.0001).Conclusion: In this small patient group, a statistically significant association was found between EAT and plasma adrenomedullin levels, which may be considered as a potential biomarker of MS (AU)

[Epicardial adipose tissue and its association to plasma adrenomedullin levels in patients with metabolic syndrome]. / Tejido adiposo epicárdico y su asociación con niveles plasmáticos de adrenomedulina en pacientes con síndrome metabólico.

OBJECTIVE: To assess the association between epicardial adipose tissue thickness (EAT) and plasma adrenomedullin plasma levels in patients with metabolic syndrome (MS). METHODS: Twenty-one patients (12 females and 9 males) with MS according to the International Diabetes Federation guidelines, aged 22-58 years, were enrolled into the study and compared to 19 age-matched control subjects without MS. Plasma glucose, lipid, and adrenomedullin levels were assessed. EAT, left ventricular mass, and carotid intima-media thickness were evaluated by transthoracic two-dimensional echocardiography. RESULTS: No statistically significant differences were found between the groups in age, sex, and height. Body weight, abdominal circumference (AC), body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly higher (p=0.0001) in MS patients; this group also showed significantly higher glucose (p=0.001), total cholesterol (p=0.01), LDL-C (p=0.03), VLDL-C (p=0.005), triglyceride (p=0.002), Tg/HDL ratio (p=0.0001), and plasma adrenomedullin (3.49±1.21 vs 1.69±0.92 ng/mL; p=0.0001) levels and lower HDL-C (p=0.02) levels as compared to the control group. EAT was significantly thicker in MS patients compared to the control group (8.45±3.14 vs 5.43±0.96; p=0.0001), showed a positive correlation to BMI (r=0.347; p=0.02), AC (r=0.350; p=0.02), DBP (r=0.346; p=0.02), and adrenomedullin levels (r=0.741; p=0.0001). In multiple linear regression analysis, adrenomedullin was the only parameter associated to EAT (R(2)=0.550; p=0.0001). CONCLUSION: In this small patient group, a statistically significant association was found between EAT and plasma adrenomedullin levels, which may be considered as a potential biomarker of MS.

Troponina I como predictor de eventos cardiovasculares mayores en pacientes con angina inestable o infarto agudo del miocardio sin onda Q / Troponin I like bigger predictor of cardiovascular events in patient with unstable angina or sharp heart attack of the myocardium without wave Q

En pacientes con síndromes coronarios agudos, es deseable identificar un marcador sérico sensible que esté estrechamente relacionado con el grado de lesión miocárdica, provea información pronóstica y pueda ser medido rápidamente. Estudiamos el valor pronóstico de los niveles de troponina cardíaca I en pacientes con angina inestable o infarto del miocardio sin onda Q. En una investigación de campo (in situ), prospectiva y aplicada, muestras sanguíneas de 51 pacientes sintomáticos fueron analizadas para troponina cardíaca I, un marcador sérico no detectable en personas saludables. La relación entre eventos cardiovasculares mayores al mes y los niveles de troponina cardíaca I fueron determinadas antes y después de ajustar las características basales. Los eventos cardiovasculares mayores al mes fueron significativamente mayor en los 18 pacientes con niveles de troponina cardíaca I de al menos 1,0 ng/ml (10 complicaciones, o 19,61 por ciento) que en los 17 pacientes con troponina cardíaca I entre 0,4 y 1,0 ng/ml (6 complicaciones, o 11,77 por ciento; P< 0,001) y los 16 pacientes con niveles de troponina cardíaca I menor de 0,4 ng/ml (1 complicación, o 1,96 por ciento; P< 0,001). Hubo aumento estadísticamente significativo en las complicaciones cardíacas mayores con el incremento de los niveles de troponina cardíaca I (P< 0,001). En pacientes con angina inestable o infarto del miocardio sin onda Q, los niveles de troponina cardíaca I proporciona información pronóstica útil y permite la identificación temprana de pacientes con riesgo aumentado de eventos cardiovasculares mayores al mes