[Utility of the Abeona Health® app for patient participation in the identification of chemotherapy-induced toxicity according to the CTCAE classification]. / Utilidad de la app Abeona Health® para la participación del paciente en la identificación de toxicidad inducida por quimioterapia según la clasificación CTCAE.

OBJECTIVE: Since 2003, the National Cancer Institute (NCI) of the United States of America has been one of the world leaders in classifying adverse effects (AEs). Currently, smartphones allow, among many other things, the monitoring of these AEs of chemotherapy from home to improve the safety and quality of life of patients. The aim was to perform a descriptive comparative analysis of the AEs content of the Abeona Health® app and the latest version of the CTCAE (Common Terminology Criteria for Adverse Events). METHODS: The Abeona Health® app and the CTCAE v5 guide were used. Subsequently, the most recurrent AEs in the existing chemotherapy treatment were analysed according to the NCI and the Spanish Society of Medical Oncology (SEOM) and finally, whether patients could identify them. RESULTS: The CTCAE v5 (collects 837 AEs), where two hundred and twenty-five are signs and symptoms. The NCI classifies fifty-five signs and symptoms as the most recurrent, and the SEOM sixteen, of which fifteen coincide with the NCI. The Abeona Health® application has seven AEs, all included in the CTCAE v5. Of these seven, six appear in the NCI lists of most recurrent AEs and four in the SEOM list, all identifiable by the patient. CONCLUSIONS: The Abeona Health® app is considered adequate for the patient participation in their self-care, although some fields could be expanded.

OBJECTIVE: Desde 2003, el Instituto Nacional del Cáncer (NCI) de los Estados Unidos de América ha sido uno de los líderes mundiales en la clasificación de los Efectos Adversos (EA). Actualmente, los teléfonos inteligentes permiten, entre otras muchas cosas, la monitorización de estos EA de la quimioterapia desde el domicilio para mejorar la seguridad y la calidad de vida de los pacientes. El objetivo de este estudio fue realizar un análisis comparativo descriptivo del contenido de los EA de la aplicación Abeona Health® y la última versión de los CTCAE (Common Terminology Criteria for Adverse Events). METHODS: Se utilizó la app Abeona Health® y la guía CTCAE v5. Posteriormente, se analizaron los EA más recurrentes en el tratamiento quimioterápico, según la NCI y la Sociedad Española de Oncología Médica (SEOM) y, finalmente, si los pacientes podían identificarlos. RESULTS: El CTCAE v5 recoge 837 EA, donde 225 son signos y síntomas. El NCI clasifica cincuenta y cinco signos y síntomas como los más recurrentes, y la SEOM dieciséis, de los cuales quince coinciden con el NCI. La aplicación Abeona Health® dispone de siete EA, y todos se incluyen en el CTCAE v5. De estos siete, seis aparecen en las listas de EA más recurrentes del NCI y cuatro en la de la SEOM, todos ellos identificables por el paciente. CONCLUSIONS: La app de Abeona Health® se considera adecuada para la participación del paciente en su autocuidado, si bien se podrían ampliar algunos campos.

Utilidad de la app Abeona Health® para la participación del paciente en la identificación de toxicidad inducida por quimioterapia según la clasificación CTCAE / Utility of the Abeona Health® app for patient participation in the identification of chemotherapy- induced toxicity according to the CTCAE classification

Fundamentos: Desde 2003, el Instituto Nacional del Cáncer (NCI) de los Estados Unidos de América ha sido uno de los líderes mundiales en la clasificación de los Efectos Adversos (EA). Actualmente, los teléfonos inteligentes permiten, entre otras muchas cosas, la monitorización de estos EA de la quimioterapia desde el domicilio para mejorar la seguridad y la calidad de vida de los pacientes. El objetivo de este estudio fue realizar un análisis comparativo descriptivo del contenido de los EA de la aplicación Abeona Health® y la última versión de los CTCAE (Common Terminology Criteria for Adverse Events). Métodos: Se utilizó la app Abeona Health® y la guía CTCAE v5. Posteriormente, se analizaron los EA más recurrentes en el tratamiento quimioterápico, según la NCI y la Sociedad Española de Oncología Médica (SEOM) y, finalmente, si los pacientes podían identificarlos. Resultados: El CTCAE v5 recoge 837 EA, donde 225 son signos y síntomas. El NCI clasifica cincuenta y cinco signos y síntomas como los más recurrentes, y la SEOM dieciséis, de los cuales quince coinciden con el NCI. La aplicaciónAbeona Health® dispone de siete EA, y todos se incluyen en el CTCAE v5. De estos siete, seis aparecen en las listas de EA más recurrentes del NCI y cuatro en la de la SEOM, todos ellos identificables por el paciente. Conclusiones: Laapp de Abeona Health® se considera adecuada para la participación del paciente en su autocuidado, si biense podrían ampliar algunos campos.(AU)

Bbackground: Since 2003, the National Cancer Institute (NCI) of the United States of America has been one of the world leaders in classifying adverse effects (AEs). Currently, smartphones allow, among many other things, the monitoring of these AEs of chemotherapy from home to improve the safety and quality of life of patients. The aim was to perform a descriptive comparative analysis of the AEs content of the Abeona Health® app and the latest version of the CTCAE (Common Terminology Criteria for Adverse Events). Methods: The Abeona Health® app and the CTCAE v5 guide were used. Subsequently, the most recurrent AEs in the existing chemotherapy treatment were analysed according to the NCI and the Spanish Society of Medical Oncology (SEOM) and finally, whether patients could identify them. Results: The CTCAE v5 (collects 837 AEs), where two hundred and twenty-five are signs and symptoms. The NCI classifies fifty-five signs and symptoms as the most recurrent, and the SEOM sixteen, of which fifteen coincide with the NCI. The Abeona Health® application has seven AEs, all included in the CTCAE v5. Of these seven, six appear in the NCI lists of most recurrent AEs and four in the SEOM list, all identifiable by the patient. Conclusions: TheAbeona Health® app is considered adequate for the patient participation in their self-care, although somefields could be expanded.(AU)

Investigating the impact of physical activity on mitochondrial function in Parkinson's disease (PARKEX): Study protocol for A randomized controlled clinical trial.

Parkinson's disease (PD) is characterized by the progressive dopaminergic neuron degeneration, resulting in striatal dopamine deficiency. Mitochondrial dysfunction and oxidative stress are associated with PD pathogenesis. Physical activity (PA) has been shown to ameliorate neurological impairments and to impede age-related neuronal loss. In addition, skin fibroblasts have been identified as surrogate indicators of pathogenic processes correlating with clinical measures. The PARKEX study aims to compare the effects of two different PA programs, analyzing the impact on mitochondrial function in patients' skin fibroblasts as biomarkers for disease status and metabolic improvement. Early-stage PD patients (n = 24, H&Y stage I to III) will be randomized into three age- and sex-matched groups. Group 1 (n = 8) will undergo basic physical training (BPT) emphasizing strength and resistance. Group 2 (n = 8) will undergo BPT combined with functional exercises (BPTFE), targeting the sensorimotor pathways that are most affected in PD (proprioception-balance-coordination) together with cognitive and motor training (Dual task training). Group 3 (n = 8) will serve as control (sedentary group; Sed). Participants will perform three sessions per week for 12 weeks. Assessment of motor function, quality of life, sleep quality, cognitive aspects and humor will be conducted pre- and post-intervention. Patient skin fibroblasts will be collected before and after the intervention and characterized in terms of metabolic remodeling and mitochondrial bioenergetics. Ethical approval has been given to commence this study. This trial is registered at clinicaltrials.gov (NCT05963425). Trial registration. https://classic.clinicaltrials.gov/ct2/history/NCT05963425.

OPTimizing Irradiation through Molecular Assessment of Lymph node (OPTIMAL): a randomized clinical trial.

BACKGROUND AND PURPOSE: In breast cancer (BC) patients, the involvement of four or more lymph nodes (LN) is an indication of regional irradiation. The optimal treatment strategy remains unclear when fewer nodes are involved and lymphadenectomy is not performed. We designed a clinical trial to show the non-inferiority of Incidental (INC) compared to intentional (INT) irradiation of axillary nodes in patients with early-stage BC and low burden LN involvement. MATERIALS AND METHODS: BC patients, cN0 (n = 487) undergoing breast conservation surgery and sentinel node biopsy, with total tumor load assessed by OSNA (One-Step Nucleic Acid Amplification) of 250-15,000 copies mRNA CK19/µL in sentinel LN were randomized to receive INC or INT nodal irradiation. The primary endpoint was 5-year disease-free survival (DFS). Secondary endpoints were locoregional recurrence (LRR), distant recurrence (DR), and acute and chronic toxicity (CT). RESULTS: Five-years DFS were 93.7% (INC) and 93.8% (INT) (difference 0.1% [one-sided 95% CI < 5.7%]; non-inferiority p = 0.075). Cumulative Incidences of LRR were 3.5% (INC) and 3.4% (INT) (difference of 0.1% [<4.8%]; p = 0.021), and 5% (INC) and 3.5% (INT) (difference 1.4% [<6.0%]; non-inferiority p = 0.101) for DR. CT was more Incident with INT (26.9%) than with INC (19.2%), though the difference was not statistically significant (HR 1.39 [95% CI: 0.92, 2.10]; p = 0.11). CONCLUSION: Intentional does not outperform incidental irradiation by more than 5.7% in terms of 5-year DFS, 4.8% for LRR, and 6% for DR. REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT02335957.

[Descriptive analysis of the mobile applications for registering and monitoring the adverse effects of antineoplastic drugs according to the evaluation methodology of iSYSCore and the Tic Salut Social Foundation.] / Análisis descriptivo de las aplicaciones móviles del registro y seguimiento de los efectos adversos de los antineoplásicos según la metodología de evaluación del iSYSCore y de la Fundación Tic Salut Social.

OBJECTIVE: The daily use of mobile healthcare applications is already a reality around the world. Their supply and demand forecasts continue to increase exponentially due to the multiple facilities and improvements that they can offer to health management and patient-centered care, especially for the chronically ill. However, this exponential growth in the offer confuses when choosing the best mobile application to use due to the lack of scientific evidence on whether they meet the safety criteria for patients and professionals. The objective of this work was to analyze mobile applications to record and monitor the adverse effects of Available Oral Antineoplastic Treatments, to have a guide on which of these applications could be recommended with certainty by health professionals to cancer patients. METHODS: A search of mobile applications was carried out on the Android and iOS platforms in Spanish and English. Subsequently, each application is analyzed according to the accreditation criteria of the iSYSCore (Internet Health and Society) and the Tic Salut Social Foundation. RESULTS: Twelve applications were found for monitoring the adverse effects of ANEOs, eight of which could be safely recommended by healthcare professionals where the scores of the Tic Salut Social Foundation range from 31 to 32 points out of 40 and those of iSYSCore from 31 to 36 points out of 47. CONCLUSIONS: The e-Onco Salud® application stands out for its ability to improve health management and empower patients in the management of their disease.

OBJETIVO: El uso cotidiano de las aplicaciones sanitarias móviles es ya una realidad en todo el mundo. Las previsiones de su oferta y demanda siguen aumentando exponencialmente debido a las múltiples facilidades y mejoras que pueden ofrecer en la gestión de la salud y a la atención centrada en el paciente, especialmente para los enfermos crónicos. No obstante, este crecimiento exponencial de la oferta confunde a la hora de elegir la mejor aplicación móvil a utilizar debido a la falta de evidencia científica sobre si cumplen los criterios de seguridad para pacientes y profesionales. El objetivo de este trabajo fue analizar aplicaciones móviles para registrar y monitorizar los efectos adversos de los tratamientos antineoplásicos orales (ANEOs) disponibles, para tener una guía sobre cuáles de estas aplicaciones podrían ser recomendadas con certeza por los profesionales de la salud a los pacientes con cáncer. METODOS: Se realizó una búsqueda de las aplicaciones móviles en las plataformas Android y iOS en lengua castellana y en inglés. Posteriormente, se analizó cada aplicación de acuerdo con los criterios de acreditación del iSYSCore (Internet Salud y Sociedad) y de la Fundación "Tic Salut Social". RESULTADOS: Se encontraron doce aplicaciones para el seguimiento de los efectos adversos de los ANEOs, siendo ocho las que podrían ser recomendadas con seguridad por los profesionales sanitarios donde las puntuaciones de la Fundación "Tic Salut Social" oscilan de 31 a 32 puntos de 40 y las de iSYSCore de 31 a 36 puntos de 47. CONCLUSIONES: Se destaca la aplicación e-Onco Salud® por su capacidad para mejorar la gestión sanitaria y empoderar a los pacientes en el manejo de su enfermedad.

Análisis descriptivo de las aplicaciones móviles del registro y seguimiento de los efectos adversos de los antineoplásicos según la metodología de evaluación del iSYScore y de la Fundación Tic Salut Social / Descriptive analysis of the mobile applications for registering and monitoring the adverse effects of antineoplastic drugs according to the evaluation methodology of iSYSCore and the Tic Salut Social Foundation

Fundamentos: El uso cotidiano de las aplicaciones sanitarias móviles es ya una realidad en todo el mundo. Las previsiones de su oferta y demanda siguen aumentando exponencialmente debido a las múltiples facilidades y mejoras que pueden ofrecer en la gestión de la salud y a la atención centrada en el paciente, especialmente para los enfermos crónicos. No obstante, este crecimiento exponencial de la oferta confunde a la hora de elegir la mejor aplicación móvil a utilizar debido a la falta de evidencia científica sobre si cumplen los criterios de seguridad para pacientes y profesionales. El objetivo de este trabajo fue analizar aplicaciones móviles para registrar y monitorizar los efectos adversos de los tratamientos antineoplásicos orales (ANEOs) disponibles, para tener una guía sobre cuáles de estas aplicaciones podrían ser recomendadas con certeza por los profesionales de la salud a los pacientes con cáncer. Métodos: Se realizó una búsqueda de las aplicaciones móviles en las plataformas Android y iOS en lengua castellana y en inglés. Posteriormente, se analizó cada aplicación de acuerdo con los criterios de acreditación del iSYSCore (Internet Salud y Sociedad) y de la Fundación “Tic Salut Social”. Resultados: Se encontraron doce aplicaciones para el seguimiento de los efectos adversos de los ANEOs, siendo ocho las que podrían ser recomendadas con seguridad por los profesionales sanitarios donde las puntuaciones de la Fundación “Tic Salut Social” oscilan de 31 a 32 puntos de 40 y las de iSYSCore de 31 a 36 puntos de 47. Conclusiones: Se destaca la aplicación e-Onco Salud® por su capacidad para mejorar la gestión sanitaria y empoderar a los pacientes en el manejo de su enfermedad.(AU)

Background: The daily use of mobile healthcare applications is already a reality around the world. Their supply and demand forecasts continue to increase exponentially due to the multiple facilities and improvements that they can offer to health management and patientcentered care, especially for the chronically ill. However, this exponential growth in the offer confuses when choosing the best mobile application to use due to the lack of scientific evidence on whether they meet the safety criteria for patients and professionals. The objective of this work was to analyze mobile applications to record and monitor the adverse effects of Available Oral Antineoplastic Treatments, to have a guide on which of these applications could be recommended with certainty by health professionals to cancer patients. Methods: A search of mobile applications was carried out on the Android and iOS platforms in Spanish and English. Subsequently, each application is analyzed according to the accreditation criteria of the iSYSCore (Internet Health and Society) and the Tic Salut Social Foundation. Results: Twelve applications were found for monitoring the adverse effects of ANEOs, eight of which could be safely recommended by healthcare professionals where the scores of the Tic Salut Social Foundation range from 31 to 32 points out of 40 and those of iSYSCore from 31 to 36 points out of 47. Conclusions: The e-Onco Salud® application stands out for its ability to improve health management and empower patients in the management of their disease.(AU)

Integración de la farmacovigilancia en la rutina del servicio de farmacia: nueve años de experiencia / Integrating pharmacovigilance into the routine of pharmacy department: experience of nine years

Objetivo: Describir un programa de farmacovigilancia llevado a cabo por un servicio de farmacia y analizar las sospechas de reacciones adversas a medicamentos recogidas. Método: Estudio observacional, longitudinal, de nueve años de duración (2008-2016). El programa de farmacovigilancia está liderado por el servicio de farmacia, que realiza farmacovigilancia prospectiva, retrospectiva, intensiva y voluntaria en el paciente hospitalizado y ambulatorio (urgencias, hospital de día, consultas externas y centros sociosanitarios). Las reacciones adversas se incorporan en la historia clínica electrónica del paciente y se añade una alerta que indica su presencia. Resultados: Se recogieron 2.631 reacciones adversas a medicamentos en 2.436 pacientes (52% varones) con una media [rango] de edad de 63,3 [0-98] años. El 92,8% de las reacciones fueron notificadas por el farmacéutico y el 7,2% por médicos, enfermería y técnicos. El 63,7% se notificaron en hospitalización, el 19,2% en urgencias, el 10,6% en consultas externas, el 6,2% en hospital de día y el 0,3% en radiología. Se observó un incremento de notificación por farmacovigilancia prospectiva e intensiva. Los grupos terapéuticos mayoritariamente implicados fueron: antineoplásicos (21,3%), antibacterianos (12,3%), antitrombóticos (7,7%), analgésicos (6,7%), corticosteroides (5,2%), psicolépticos (5,2%), diuréticos (4,9%), antivirales (4,9%), antiinflamatorios y antirreumáticos (4,2%) e inmunosupresores (3,3%). Las reacciones adversas detectadas afectaron mayoritariamente a la piel y anejos (19,7%) y al tracto gastrointestinal (19,1%). Respecto a su gravedad, el 38,7% fueron leves, el 30,8% graves y el 30,5% moderadas. El 60,9% de los pacientes se recuperaron de las reacciones adversas y el 31,7% se encontraban en proceso de recuperación. Se interrumpió el tratamiento en el 65% de los casos y el 56% de los pacientes recibieron tratamiento específico. Conclusiones: La incorporación del programa de farmacovigilancia en la rutina diaria del farmacéutico de hospital aporta un valor añadido a la seguridad de la farmacoterapia del paciente

Objective: To describe our pharmacovigilance program and to analyze the reported adverse drug reactions. Method: Observational longitudinal study conducted from 2008 to 2016. The Pharmacy Department leads the pharmacovigilance program and performs prospective, retrospective, intensive, and spontaneous reporting of inpatients and outpatients (emergencies, day hospital, external consultations, and nursing homes). Each adverse drug reaction is incorporated in the electronic health record of the patient along with an alert. Results: A total of 2,631 adverse drug reactions were reported in 2,436 patients. Of these patients, 52% were men with a mean age of 63.3 [0-98] years. A total of 92.8% drug events were reported by the pharmacists and 7.2% by doctors, nurses, and technicians. A total of 63.7% were reported in inpatients, 19.2% in emergencies, 10.6% in external consultations, 6.2% in the day hospital, and 0.3% in diagnostic radiology. There was an increase in adverse drug reactions detected by prospective and intensive pharmacovigilance. Principal therapeutic groups involved in adverse drug events were antineoplastic agents (21.3%), antibacterials (12.3%), antithrombotics (7.7%), analgesics (6.7%), corticosteroids (5.2%), psycholeptics (5.2%), diuretics (4.9%), anti virals (4.9%), antiinflammatories and antirheumatics (4.2%), and immunosupressants (3.3%). Adverse drug reactions mainly affected the skin and appendages (19.7%) and gastrointestinal tract (19.1%). Adverse drug reactions were mild (38.7%), severe (30.8%), and moderate (30.5%). In total, 60.9% of patients recovered from drug events and 31.7% were in recovery. The most frequent response was treatment interruption in 65% of cases and the patients received additional specific treatment in 56% of cases. Conclusions: The incorporation of the pharmacovigilance program within the daily routine of the hospital pharmacist provides added value to the safety and pharmacotherapy of the patient

Integrating pharmacovigilance into the routine of pharmacy department: experience of nine years.

OBJECTIVE: To describe our pharmacovigilance program and to analyze the reported adverse drug  reactions. METHOD: Observational longitudinal study conducted from 2008 to 2016. The Pharmacy Department  leads the pharmacovigilance program and performs prospective, retrospective, intensive, and  spontaneous reporting of inpatients and outpatients (emergencies, day hospital, external consultations, and nursing homes). Each adverse drug reaction is incorporated in the  electronic health record of the patient along with an alert. RESULTS: A total of 2,631 adverse drug reactions were reported in 2,436 patients. Of these patients,  52% were men with a mean age of 63.3 [0-98] years. A total of 92.8% drug events were reported by the pharmacists and 7.2% by doctors, nurses, and technicians. A total of 63.7% were reported in  inpatients, 19.2% in emergencies, 10.6% in external consultations, 6.2% in the day hospital, and  0.3% in diagnostic radiology. There was an increase in adverse drug reactions detected by  prospective and intensive pharmacovigilance. Principal therapeutic groups involved in adverse drug  events were antineoplastic agents (21.3%), antibacterials (12.3%), antithrombotics (7.7%),  analgesics (6.7%), corticosteroids (5.2%), psycholeptics (5.2%), diuretics (4.9%),  antivirals (4.9%),  antiinflammatories and antirheumatics (4.2%), and immunosupressants (3.3%). Adverse  drug reactions mainly affected the skin and appendages (19.7%) and gastrointestinal tract (19.1%).  Adverse drug reactions were mild (38.7%), severe (30.8%), and moderate (30.5%). In total, 60.9%  of patients recovered from drug events and 31.7% were in recovery. The most frequent response was reatment interruption in 65% of cases and the patients received additional specific treatment in 56%  of cases. CONCLUSIONS: The incorporation of the pharmacovigilance program within the daily routine of the  hospital pharmacist provides added value to the safety and pharmacotherapy of the patient.

Objetivo: Describir un programa de farmacovigilancia llevado a cabo por un servicio de farmacia y  analizar las sospechas de reacciones adversas a medicamentos recogidas.Método: Estudio observacional, longitudinal, de nueve años de duración (2008-2016). El programa  de farmacovigilancia está liderado por el servicio de farmacia, que realiza farmacovigilancia  prospectiva, retrospectiva, intensiva y voluntaria en el paciente hospitalizado y ambulatorio (urgencias, hospital de día, consultas externas y centros sociosanitarios). Las reacciones  adversas se incorporan en la historia clínica electrónica del paciente y se añade una alerta que indica  su presencia.Resultados: Se recogieron 2.631 reacciones adversas a medicamentos en 2.436 pacientes (52%  varones) con una media [rango] de edad de 63,3 [0-98] años. El 92,8% de las reacciones fueron  notificadas por el farmacéutico y el 7,2% por médicos, enfermería y técnicos. El 63,7% se notificaron  en hospitalización, el 19,2% en urgencias, el 10,6% en consultas externas, el 6,2% en hospital de día  y el 0,3% en radiología. Se observó un incremento de notificación por farmacovigilancia  prospectiva e intensiva. Los grupos terapéuticos mayoritariamente implicados fueron: antineoplásicos  (21,3%), antibacterianos (12,3%), antitrombóticos (7,7%), analgésicos (6,7%), corticosteroides  (5,2%), psicolépticos (5,2%), diuréticos (4,9%), antivirales (4,9%), antiinflamatorios y  antirreumáticos (4,2%) e inmunosupresores (3,3%). Las reacciones adversas detectadas afectaron mayoritariamente a la piel y anejos (19,7%) y al tracto gastrointestinal (19,1%). Respecto a su  gravedad, el 38,7% fueron leves, el 30,8% graves y el 30,5% moderadas. El 60,9% de los pacientes  se recuperaron de las reacciones adversas y el 31,7% se encontraban en proceso de recuperación. Se  interrumpió el tratamiento en el 65% de los casos y el 56% de los pacientes recibieron  tratamiento específico.Conclusiones: La incorporación del programa de farmacovigilancia en la rutina diaria del  farmacéutico de hospital aporta un valor añadido a la seguridad de la farmacoterapia del paciente.

Changes in zinc status and zinc transporters expression in whole blood of patients with Systemic Inflammatory Response Syndrome (SIRS).

INTRODUCTION: Critically ill patients develop severe stress, inflammation and a clinical state that may raise the utilization and metabolic replacement of many nutrients and especially zinc, depleting their body reserves. This study was designed to assess the zinc status in critical care patients with systemic inflammatory response syndrome (SIRS), comparing them with a group of healthy people, and studying the association with expression of zinc transporters. MATERIAL AND METHODS: This investigation was a prospective, multicentre, comparative, observational and analytic study. Twelve critically ill patients from different hospitals and 12 healthy subjects from Granada, Spain, all with informed consent were recruited. Data on daily nutritional assessment, ICU severity scores, inflammation, clinical and nutritional parameters, plasma and blood cell zinc concentrations, and levels of transcripts for zinc transporters in whole blood were taken at admission and at the seventh day of the ICU stay. RESULTS: Zinc levels on critical ill patient are diminish comparing with the healthy control (HS: 0.94 ±â€¯0.19; CIPF: 0.67 ±â€¯0.16 mg/dL). The 58% of critical ill patients showed zinc plasma deficiency at beginning of study while 50.0% of critical ill after 7 days of ICU stay. ZnT7, ZIP4 and ZIP9 were the zinc transporters with highest expression in whole blood. In general, all zinc transporters were significantly down-regulated (P < 0.05) in the critical ill population at admission in comparison with healthy subjects. Severity scores and inflammation were significantly associated (P < 0.05) with zinc plasma levels, and zinc transporters ZIP3, ZIP4, ZIP8, ZnT6, ZnT7. Expression of 11 out of 24 zinc transporters was analysed, and ZnT1, ZnT4, ZnT5 and ZIP4, which were downregulated by more than 3-fold in whole blood of patients. CONCLUSION: In summary, in our study an alteration of zinc status was related with the severity-of-illness scores and inflammation in critical ill patients since admission in ICU stay. SIRS caused a general shut-down of expression of zinc transporters in whole blood. That behavior was associated with severity and inflammation of patients at ICU admission regardless zinc status. We conclude that zinc transporters in blood might be useful indicators of severity of systemic inflammation and outcome for critically ill patients.

Trabajos de altura. Cuando un arnés sostiene la vida / Working at heights. When a harness is a life-saver

Los datos de siniestralidad actuales revelan que el índice de incidencia de accidentes con baja en jornada de trabajo en el sector de la construcción ha disminuido significativamente en los últimos años. Sin embargo, este indicador sigue siendo más elevado que en el resto de sectores de producción, en gravedad y número total. Dentro de los riesgos de los trabajadores de la construcción, están las caídas de altura, movimientos repetitivos, manejo de cargas, posturas forzadas, agentes químicos, radiaciones solares, etc. Caso Clínico: Hombre de 36 años, albañil desde hace 10 años. Ingresa por servicio de urgencias posterior a caída de altura, aproximadamente 7 metros desde una segunda planta, mientras instalaba una ventana presuntamente. Es traído a urgencias, donde se diagnostica fractura de fémur derecha y pelvis derecha, lesión uretral, hemotórax derecho y lesión de órganos internos con abundante contenido hemático intraabdominal. Por su gravedad, es llevado a quirófanos donde fallece. La vigilancia de las normas de prevención de riesgos laborales es fundamental en cualquier obra de construcción, por más sencilla que se presente la actividad o muy experimentado sea el obrero. También se manifiesta la importancia de una correcta atención de los pacientes politraumatizados, tomando en consideración que los trabajos de altura pueden realizarse en empresas o establecimientos donde el médico del trabajo debería ser el más capacitado para la atención inmediata. Es imprescindible un buen manejo de estas situaciones desde el punto de vista práctico, técnico y logístico por lo que sería recomendable el entrenamiento constante en dichas situaciones (AU)

The current workplace accident rate reveals that the prevalence rate with leave in the building industry has significantly decreased in the last years. However, this indicator is still higher than the rest of production sectors in terms of gravity and total number. Some of the risks among the construction workers are falls from a height, repetitive movements, handling of heavy loads, incorrect body postures, chemical agents, solar radiations, etc. Clinical Case: 36 year old man, builder for 10 years. He checks into the emergency room after an approximately 7-meter fall from the second floor, while presumably installing a window. He was taken to urgencies, where he was diagnosed fractures to the right femur and the right pelvic bone, a urethral injury, a right hemothorax and damaged internal organs with abundant hematic intra-abdominal content. Due to his critical condition, he was taken into surgery where he passed away. Monitoring the standards of the occupational risk prevention policy is essential in any building site, even if it seems an easy task or the worker is very experienced. It also highlights the importance of a correct medical care of polytraumatized patients, taking into consideration that working at heights could be performed in companies or establishments where the occupational physician should be the most qualified for the immediate care. A good handling of these situations from the practical, technical and logistical point of view is fundamental; thus the constant training in the above mentioned circumstances would be recommended (AU)

[Cervical thoracic duct cyst: An uncommon entity]. / Quiste cervical del conducto torácico: una rara entidad.

BACKGROUND: Cervical thoracic duct cysts are a rare anomaly. OBJECTIVE: To report a case of cervical thoracic duct cyst, and perform a literature review. CLINICAL CASE: A 78-year-old female, with a one-year history of a left-sided asymptomatic supraclavicular cystic mass. Computerized tomography revealed a cystic mass 42mm in diameter. We performed a fine needle aspiration puncture, obtaining a thick, milky, whitish liquid. The patient underwent surgery; finding a left-sided supraclavicular cystic mass, with some lymph vessels heading towards the jugulo subclavian venous junction. We performed a ligation of these lymph vessels and resection of the mass. The histopathologic study confirmed the diagnosis of thoracic duct cyst. CONCLUSION: Diagnosis of cervical thoracic duct cyst should be suspected with a cystic lesion in the left supraclavicular region, which when perforated exudes a very distinctive thick milky, whitish liquid with a high content of lymphocytes and triglycerides. Treatment should be complete removal with ligation of the lymphatic afferent vessels.

Pyridoxal-5'-phosphate deficiency is associated with hyperhomocysteinemia regardless of antioxidant, thiamine, riboflavin, cobalamine, and folate status in critically ill patients.

BACKGROUND & AIMS: Critically ill patients develop severe stress, inflammation and a clinical state that may raise the utilization and metabolic replacement of pyridoxal-5'-phosphate decreasing their body reserves. This study was designed to assess the nutritional pyridoxal-5'-phosphate status in critical care patients with systemic inflammatory response syndrome, comparing them with a group of healthy people, and studying it's association with factors involved in the pyridoxine and other B vitamins metabolism, as the total antioxidant capacity and Hcy as cardiovascular risk biomarker. METHODS: Prospective, multicentre, comparative, observational and analytic study. One hundred and three critically ill patients from different hospitals, and eighty four healthy subjects from Granada, Spain, all with informed consent. Data from daily nutritional assessment, ICU severity scores, clinical and nutritional parameters, antioxidant status and homocysteine levels was taken at admission and at the seventh day of the ICU stay. RESULTS: Thiamine, riboflavin, pyridoxine and folate status proved deficient in a large number of patients, being significantly lower in comparison with control group, and significantly decreased at 7th day of ICU stay. Higher homocysteine was observed in patients compared with control group (p < 0.05) where 31.5 and 26.8 percent of subjects presented hyperhomocysteinemia at initial and final of study, respectively. Antioxidant status was lower than control group in two periods analysed, and decreased at 7th day of ICU stay (p < 0.05) being associated with PLP deficiency. PLP deficiency was also correlated with hyperhomocysteinemia at two times measured (r. -0.73, p < 0.001; r. -0.69, p < 0.001, respectively), showing at day 7 an odds ratio of 6.62 in our multivariate model. CONCLUSION: Critically ill patients with SIRS show deficient B vitamin and low antioxidant statuses. Despite association found between PLP deficiency and low antioxidant status in critically ill patients, PLP deficiency was only associated with hyperhomocysteinemia regardless of antioxidant, riboflavin, cobalamine, and folate statuses in critically ill patients with SIRS at seventh day of ICU stay. PLP deficient patients presented about six times more risk of cardiovascular disease than non deficients.

IMBALANCES IN PROTEIN METABOLISM IN CRITICAL CARE PATIENT WITH SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AT ADMISSION IN INTENSIVE CARE UNIT.

BACKGROUND: trauma and severe infections cause remarkable metabolic changes in patient with SIRS from an adaptive response aimed to control the underlying disease, repairing damaged tissue, and to synthesize substrates. If the attack is intense and sustained and the patient has a compromised nutritional status, can evolve into multiple organ failure and death. OBJECTIVE: assessment of nutritional proteic status and the involvement of proteins and inflammatory factors in critically ill patients. METHOD: multicenter observational analytical study in critical ill patients at the admission in ICU. RESULTS AND DISCUSSION: patients showed disturbances in clinical nutritional parameters which confirm their hypercatabolic situation, showing malnutrition state at admission, where 42.9% had plasma levels below the reference prealbumin. Amino acid profile was situated below the reference values and 99% of patients had low plasma transferrin. Significant differences were observed in total protein, ferritin and transferrin parameters adjusted by CRP levels, being higher when patients presented high inflammation in the case of ferritin and the opposite for the rest of parameters. Adjusting APACHE and SOFA scores according to low, medium and high severity, results showed significant differences in creatinine, urea, and transferrin, being lower at high severity grade for the last one. CONCLUSION: critical illness is characterized by a high degree of stress and accelerated degradation of proteins that cause malnutrition, systemic inflammation and organ dysfunction, with a significant association between albumin, ferritin and transferrin.

Antecedentes: el trauma y las infecciones severas causan cambios metabólicos notables en los pacientes con SRIS como una respuesta adaptativa dirigida a controlar la enfermedad subyacente, la reparación del tejido dañado y para sintetizar sustratos. Si el ataque es intenso y sostenido y el paciente tiene un estado nutricional comprometido puede evolucionar a insuficiencia orgánica múltiple y muerte. Objetivo: evaluación del estado nutricional proteico y la participación de las proteínas y los factores inflamatorios en pacientes críticamente enfermos. Método: estudio analítico observacional multicéntrico en pacientes enfermos críticos en la admisión en la UCI. Resultados y discusión: los pacientes mostraron alteraciones en los parámetros nutricionales clínicos que confirman su situación hipercatabólica, mostrando malnutrición a la admisión en UCI, donde el 42,9% tenían niveles plasmáticos de prealbúmina por debajo de la referencia. Los aminoácidos se encuentran por debajo de los valores de referencia y el 99% de los pacientes presentaron bajos niveles plasmáticos de transferrina. Se observaron diferencias significativas en los niveles de proteína total, ferritina y transferrina ajustados por los niveles de PCR, siendo mayor cuando los pacientes presentaron altos valores de inflamación, en el caso de la ferritina, y lo opuesto para el resto de parámetros. Al estratificar por las puntuaciones APACHE y SOFA de acuerdo a la gravedad baja, media y alta, los resultados mostraron diferencias significativas en creatinina, urea y transferrina, siendo menor cuanto mayor era el grado de severidad para la transferrina. Conclusión: la enfermedad crítica se caracteriza por un alto grado de estrés y la degradación acelerada de proteínas que causan malnutrición, inflamación sistémica y la disfunción de órganos, con una asociación significativa entre albúmina, ferritina y transferrina.

Imbalances in protein metabolism in critical care patient with systemic inflammatory response syndrome at admission in intensive care unit / Alteración del metabolismo proteico en paciente crítico con síndrome de respuesta inflamatoria sistémica al ingreso en la unidad de cuidados intensivos

Background: trauma and severe infections cause remarkable metabolic changes in patient with SIRS from an adaptive response aimed to control the underlying disease, repairing damaged tissue, and to synthesize substrates. If the attack is intense and sustained and the patient has a compromised nutritional status, can evolve into multiple organ failure and death. Objective: assessment of nutritional proteic status and the involvement of proteins and inflammatory factors in critically ill patients. Method: multicenter observational analytical study in critical ill patients at the admission in ICU. Results and discussion: patients showed disturbances in clinical nutritional parameters which confirm their hypercatabolic situation, showing malnutrition state at admission, where 42.9% had plasma levels below the reference prealbumin. Amino acid profile was situated below the reference values and 99% of patients had low plasma transferrin. Significant differences were observed in total protein, ferritin and transferrin parameters adjusted by CRP levels, being higher when patients presented high inflammation in the case of ferritin and the opposite for the rest of parameters. Adjusting APACHE and SOFA scores according to low, medium and high severity, results showed significant differences in creatinine, urea, and transferrin, being lower at high severity grade for the last one. Conclusion: critical illness is characterized by a high degree of stress and accelerated degradation of proteins that cause malnutrition, systemic inflammation and organ dysfunction, with a significant association between albumin, ferritin and transferrin (AU)

Antecedentes: el trauma y las infecciones severas causan cambios metabólicos notables en los pacientes con SRIS como una respuesta adaptativa dirigida a controlar la enfermedad subyacente, la reparación del tejido dañado y para sintetizar sustratos. Si el ataque es intenso y sostenido y el paciente tiene un estado nutricional comprometido puede evolucionar a insuficiencia orgánica múltiple y muerte. Objetivo: evaluación del estado nutricional proteico y la participación de las proteínas y los factores inflamatorios en pacientes críticamente enfermos. Método: estudio analítico observacional multicéntrico en pacientes enfermos críticos en la admisión en la UCI. Resultados y discusión: los pacientes mostraron alteraciones en los parámetros nutricionales clínicos que confirman su situación hipercatabólica, mostrando malnutrición a la admisión en UCI, donde el 42,9% tenían niveles plasmáticos de prealbúmina por debajo de la referencia. Los aminoácidos se encuentran por debajo de los valores de referencia y el 99% de los pacientes presentaron bajos niveles plasmáticos de transferrina. Se observaron diferencias significativas en los niveles de proteína total, ferritina y transferrina ajustados por los niveles de PCR, siendo mayor cuando los pacientes presentaron altos valores de inflamación, en el caso de la ferritina, y lo opuesto para el resto de parámetros. Al estratificar por las puntuaciones APACHE y SOFA de acuerdo a la gravedad baja, media y alta, los resultados mostraron diferencias significativas en creatinina, urea y transferrina, siendo menor cuanto mayor era el grado de severidad para la transferrina. Conclusión: la enfermedad crítica se caracteriza por un alto grado de estrés y la degradación acelerada de proteínas que causan malnutrición, inflamación sistémica y la disfunción de órganos, con una asociación significativa entre albúmina, ferritina y transferrina (AU)

Oclusión intestinal por fitobezoar recidivante: resolución con tratamiento no operatorio mediante celulasa / Intestinal obstruction caused by recurrent phytobezoar: resolved with non-surgical treatment with cellulose

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Costes de los servicios sanitarios asociados al tratamiento del cáncer de mama precoz con radioterapia adyuvante / Healthcare costs associated with adjuvant radiation therapy for early breast cancer

Objetivo. Valorar el coste sanitario asociado a 6 técnicas de radioterapia (RT) adyuvante para el tratamiento del cáncer de mama precoz. Métodos. Estudio descriptivo del coste sanitario asociado al tratamiento con RT en el cáncer de mama mediante la previa identificación, por un grupo de oncólogos expertos formado por 6 facultativos especialistas en oncología radioterápica y un economista de la salud, del consumo de servicios sanitarios asociados a 6 técnicas de RT: RT tridimensional conformada (3DCRT) según fraccionamiento convencional (2 Gy/sesión) e hipofraccionamiento (2,6 Gy/sesión), irradiación parcial de la mama (IPM) mediante 3DCRT, braquiterapia de baja y alta tasa y RT intraoperatoria (RIO). Los servicios sanitarios que se incluyeron en el análisis fueron: estancia hospitalaria, consultas médicas y de enfermería, simulación, delimitación de volúmenes, aceptación y verificación del tratamiento, pruebas radiológicas (radiografías, tomografías y ecografías) y cálculos dosimétricos. Los costes se obtuvieron de los precios públicos vigentes en el Sistema Sanitario Público de Andalucía, actualizados a precios de 2013. Resultados. Se estimó un coste de 6.786,75 y 4.998,17 Euros para el tratamiento con 3DCRT según fraccionamiento convencional e hipofraccionamiento, respectivamente. Para las técnicas de IPM se obtuvo un coste de 4.066,10, 4.797,35, 4.376,97 y 7.715,43 Euros mediante 3DCRT, braquiterapia de baja y alta tasa, y RIO, respectivamente. Conclusiones. Se aprecia una variabilidad en el coste sanitario asociado a las distintas técnicas de RT adyuvante para el tratamiento del cáncer de mama precoz, siendo la IPM mediante 3DCRT la técnica de RT más económica. Es necesaria una actualización de los registros oficiales que además incluya las nuevas tecnologías incorporadas en los últimos años (AU)

Objective. To assess the healthcare costs associated with six radiation therapy (RT) techniques for the adjuvant treatment of early breast cancer. Methods. A team of six radiation oncologists and a specialist in health economics performed a descriptive cost analysis among the following RT techniques: 3-dimensional conformal RT (3DCRT) using either conventional fractionation (2 Gy/fraction) or hypofractionation (2,6 Gy/fraction), partial-breast irradiation (PBI) delivered with the use of 3DCRT or brachytherapy (high and low dose rate), and intraoperative RT (IORT). Treatment costs included hospitalization, medical (simulation, contouring, and verification and approval of treatment plans) and nursing consults, radiological examinations, and dosimetry calculation. Costs were obtained from the last update of public prices in the Andalusian Public Health System, updated to 2013. Results. The treatment cost for conventional fractionation with 3DCRT was 6,786.75 Euros, whereas the cost of the hypofractionated regimen using the same technology was 4,998.17 Euros. PBI costs were 4,066.10 Euros, 4,797.35 Euros, 4,376.97 Euros and 7,715.43 Euros for 3DCRT, low-dose rate brachytherapy, high-dose rate brachytherapy, and IORT, respectively. Conclusions. There is wide cost variation among RT techniques for the adjuvant treatment of early breast cancer. The technique with the lowest healthcare cost is PBI through 3DCRT. Official government prices should be updated and should also include the new technologies incorporated in recent years (AU)