Infections in newly diagnosed Spanish patients with systemic lupus erythematosus: data from the RELES cohort.

OBJECTIVES: Using data of patients from the inception cohort Registro Español de Lupus Eritematoso Sistémico (RELES), we aimed to analyse the incidence of severe infection in the first two years of follow-up and how predictors of infection change during the course of systemic lupus erythematosus (SLE). MATERIAL AND METHODS: The study included 282 patients. Markers of lupus activity, prednisone doses and immunosuppressive therapy were compared between patients with and without infections in the first and second year of the disease. Drug therapy administered during the first month of follow-up has been considered as a potential predictor of infections during the first year and medications administered during the first year have been considered potential predictors of infections during the second. RESULTS: Nineteen patients (6.4%) had a documented episode of major infection during the first year of follow-up and 16 patients (5.67%) during the second. The following variables were associated with infections during the first year: hypocomplementaemia at diagnosis ( p < 0.01), nephritis at diagnosis ( p = 0.03), SLEDAI score ( p < 0.01), prednisone >30 mg/day ( p = 0.01), methylprednisolone pulses ( p = 0.05) and mycophenolate use ( p = 0.02). The independent variables in the final model were hypocomplementaemia (odds ratio (OR) 4.41, 95% confidence interval (CI) 0.96-20.20, p = 0.05) and a dose of prednisone >30 mg/day (OR 6.60, 95% CI 1.34-32.42, p = 0.02). The following variables were associated with infections during the second year: dose of prednisone > 7.5 mg/day ( p = 0.05), methylprednisolone pulses ( p = 0.07), duration of therapy with antimalarials ( p = 0.09), therapy with mycophenolate ( p = 0.01), therapy with cyclophosphamide ( p = 0.05). The independent variables in the final model were a dose of prednisone >7.5 mg/day (OR 4.52, 95% CI 0.99-21, p = 0.054) and duration of therapy with antimalarials as a protective factor (OR 0.99, 95% CI 0.99-1.00, p = 0.053). CONCLUSIONS: The low incidence of early infections in the RELES cohort is partially explained by the extended use of antimalarials and by the general avoidance of prolonged high doses of prednisone. Patients with high baseline activity are at a higher risk of infection during the first months but therapy with medium-high doses of prednisone is the main predictor of infectious events. Thus, every effort should be made to limit oral glucocorticoid use from the very beginning of the SLE course.

Interstitial lung disease in systemic sclerosis: data from the spanish scleroderma study group.

OBJECTIVES: To evaluate the clinical characteristics of patients with interstitial lung disease (ILD) in the setting of a large cohort of systemic sclerosis (SSc) patients, and to analyse the differences according to the SSc subtype (following the modification of classification criteria of the American College of Rheumatology for SSc proposed by LeRoy and Medsger), factors are associated with moderate-to-severe impairment of lung function, as well as mortality and causes of death. METHODS: A descriptive study was performed, using the available data from the Spanish Scleroderma Study Group. RESULTS: Twenty-one referral centers participated in the registry. By April 2014, 1374 patients with SSc had been enrolled, and 595 of whom (43%) had ILD: 316 (53%) with limited cutaneous SSc (lcSSc), 240 (40%) with diffuse cutaneous SSc (dcSSc), and 39 (7%) with SSc sine scleroderma (ssSSc). ILD in the lcSSc and the ssSSc subsets tended to develop later, and showed a less impaired forced vital capacity (FVC) and a ground glass pattern on high-resolution computed tomography (HRCT) less frequently, compared with the dcSSc subset. Factors related to an FVC < 70% of predicted in the multivariate analysis were: dcSSc, positivity to anti-topoisomerase I antibodies, a ground glass pattern on HCRT, an active nailfold capillaroscopy pattern, lower DLco, older age at symptoms onset, and longer time between symptoms onset and ILD diagnosis. Finally, SSc-associated mortality and ILD-related mortality were highest in dcSSc patients, whereas that related to pulmonary arterial hypertension was highest in those with lcSSc-associated ILD. CONCLUSIONS: Our study indicates that ILD constitutes a remarkable complication of SSc with significant morbidity and mortality, which should be borne in mind in all three subgroups (lcSSc, dcSSc, and ssSSc).

First clinical symptom as a prognostic factor in systemic sclerosis: results of a retrospective nationwide cohort study.

The objective of the study is to determine the importance of the mode of onset as prognostic factor in systemic sclerosis (SSc). Data were collected from the Spanish Scleroderma Registry (RESCLE), a nationwide retrospective multicenter database created in 2006. As first symptom, we included Raynaud's phenomenon (RP), cutaneous sclerosis, arthralgia/arthritis, puffy hands, interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), and digestive hypomotility. A total of 1625 patients were recruited. One thousand three hundred forty-two patients (83%) presented with RP as first symptom and 283 patients (17%) did not. Survival from first symptom in those patients with RP mode of onset was higher at any time than those with onset as non-Raynaud's phenomenon: 97 vs. 90% at 5 years, 93 vs. 82% at 10 years, 83 vs. 62% at 20 years, and 71 vs. 50% at 30 years (p < 0.001). In multivariate analysis, factors related to mortality were older age at onset, male gender, dcSSc subset, ILD, PAH, scleroderma renal crisis (SRC), heart involvement, and the mode of onset with non-Raynaud's phenomenon, especially in the form of puffy hands or pulmonary involvement. The mode of onset should be considered an independent prognostic factor in systemic sclerosis and, in particular, patients who initially present with non-Raynaud's phenomenon may be considered of poor prognosis.

A logistic regression model predicting high axillary tumour burden in early breast cancer patients

Purpose. As elective axillary dissection is loosing ground for early breast cancer (BC) patients both in terms of prognostic and therapeutic power, there is a growing interest in predicting patients with (nodal) high tumour burden (HTB), especially after a positive sentinel node biopsy (SNB) because they would really benefit from further axillary intervention either by complete lymph-node dissection or axillary radiation therapy. Methods/patients. Based on an analysis of 1254 BC patients in whom complete axillary clearance was performed, we devised a logistic regression (LR) model to predict those with HTB, as defined by the presence of three or more involved nodes with macrometastasis. This was accomplished through prior selection of every variable associated with HTB at univariate analysis. Results. Only those variables shown as significant at the multivariate analysis were finally considered, namely tumour size, lymphovascular invasion and histological grade. A probability table was then built to calculate the chances of HTB from a cross-correlation of those three variables. As a suggestion, if we were to follow the rationale previously used in the micrometastasis trials, a threshold of about 10% risk of HTB could be considered under which no further axillary treatment is warranted. Conclusions. Our LR model with its probability table can be used to define a subgroup of early BC patients suitable for axillary conservative procedures, either sparing completion lymph-node dissection or even SNB altogether (AU)

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A logistic regression model predicting high axillary tumour burden in early breast cancer patients.

PURPOSE: As elective axillary dissection is loosing ground for early breast cancer (BC) patients both in terms of prognostic and therapeutic power, there is a growing interest in predicting patients with (nodal) high tumour burden (HTB), especially after a positive sentinel node biopsy (SNB) because they would really benefit from further axillary intervention either by complete lymph-node dissection or axillary radiation therapy. METHODS/PATIENTS: Based on an analysis of 1254 BC patients in whom complete axillary clearance was performed, we devised a logistic regression (LR) model to predict those with HTB, as defined by the presence of three or more involved nodes with macrometastasis. This was accomplished through prior selection of every variable associated with HTB at univariate analysis. RESULTS: Only those variables shown as significant at the multivariate analysis were finally considered, namely tumour size, lymphovascular invasion and histological grade. A probability table was then built to calculate the chances of HTB from a cross-correlation of those three variables. As a suggestion, if we were to follow the rationale previously used in the micrometastasis trials, a threshold of about 10% risk of HTB could be considered under which no further axillary treatment is warranted. CONCLUSIONS: Our LR model with its probability table can be used to define a subgroup of early BC patients suitable for axillary conservative procedures, either sparing completion lymph-node dissection or even SNB altogether.

Profesionalismo: valores y competencias en formación sanitaria especializada / Professionalism: values and competences in specialized medical training

Objetivo. Conocer la percepción de los profesionales sanitarios implicados en la docencia de la formación sanitaria especializada (tutores, residentes y colaboradores docentes) sobre los principales valores y competencias que desarrollan habitualmente en su trabajo. Métodos. Se diseñó un cuestionario para ser autocumplimentado, con 4 secciones y 51 variables (escala 1-10). Se distribuyó entre los profesionales de un hospital universitario y 9 centros de salud. Resultados. Respondieron 287 profesionales. Participación: 97% de los tutores (n=59), 38% de los residentes (n=61) y 56% de otros profesionales sanitarios (97 con faceta docente y 70 sin ella). El coeficiente alfa de Cronbach fue de 0,945. Los 3valores mejor puntuados fueron la responsabilidad por cumplir con el propio trabajo (8,7 puntos), la integridad ética (8,6 puntos) y el respeto hacia el equipo de profesionales con el que trabajan (8,3 puntos). Las 3competencias mejor puntuadas fueron la comunicación con pacientes y familiares (8,16 puntos), el liderazgo para motivarse a uno mismo (7,9 puntos) y el trabajo en equipo (7,8 puntos). Los valores recibieron, de media, 0,7 puntos más que las competencias (IC 95%: 0,5-0,9). No se observaron diferencias entre tutores y residentes, aunque sí entre médicos y enfermeras, y entre hombres y mujeres. Conclusiones. La percepción sobre los valores y las competencias es compartida por tutores, residentes y colaboradores docentes. Sobre esta percepción influyó la categoría profesional y el sexo, pero no la edad ni trabajar en el hospital o en atención primaria (AU)

Objective. To determine the perception of healthcare professionals (tutors, residents and teaching collaborators) involved in specialist medical training on the core values and skills to develop their tasks. Methods. A tailor-made questionnaire aimed at healthcare professionals in 9health care centres and a referral hospital. Questionnaire: 4 sections and 51 variables (scale 1-10). Results. A total of 287 professionals participated, which included 97% tutors (n=59), 38% residents (n=61), and 56% others (97 teaching collaborators and 70 not associated with teaching). The alfa Cronbach coefficient was 0.945. Best rated values were work compliance (8.7 points), ethics in professional practice (8.6 points), and respect for their team (8.3 points). The best rated competence was communication with patients and families (8.1 points), followed by self-motivating leadership (7.9 points), and the practical application of medical and healthcare theoretical knowledge (7.8 points). The values received, on average, 0.7 points above competences (95% CI: 0.5-0.9). There were no differences between tutors and residents, although differences were found between doctors and nurses, and between males and females. Conclusion. Most of the professionals (tutors, residents, and teaching collaborators) share the same perception of the values and competencies that influence their professional development. This perception was influenced by the professional category and gender, but not age or working in a hospital or primary health care (AU)

[Professionalism: Values and competences in specialized medical training]. / Profesionalismo: valores y competencias en formación sanitaria especializada.

OBJECTIVE: To determine the perception of healthcare professionals (tutors, residents and teaching collaborators) involved in specialist medical training on the core values and skills to develop their tasks. METHODS: A tailor-made questionnaire aimed at healthcare professionals in 9health care centres and a referral hospital. Questionnaire: 4 sections and 51 variables (scale 1-10). RESULTS: A total of 287 professionals participated, which included 97% tutors (n=59), 38% residents (n=61), and 56% others (97 teaching collaborators and 70 not associated with teaching). The alfa Cronbach coefficient was 0.945. Best rated values were work compliance (8.7 points), ethics in professional practice (8.6 points), and respect for their team (8.3 points). The best rated competence was communication with patients and families (8.1 points), followed by self-motivating leadership (7.9 points), and the practical application of medical and healthcare theoretical knowledge (7.8 points). The values received, on average, 0.7 points above competences (95% CI: 0.5-0.9). There were no differences between tutors and residents, although differences were found between doctors and nurses, and between males and females. CONCLUSION: Most of the professionals (tutors, residents, and teaching collaborators) share the same perception of the values and competencies that influence their professional development. This perception was influenced by the professional category and gender, but not age or working in a hospital or primary health care.

First month prednisone dose predicts prednisone burden during the following 11†months: an observational study from the RELES cohort.

AIM: To study the influence of prednisone dose during the first month after systemic lupus erythematosus (SLE) diagnosis (prednisone-1) on glucocorticoid burden during the subsequent 11 months (prednisone-2-12). METHODS: 223 patients from the Registro Español de Lupus Eritematoso Sistémico inception cohort were studied. The cumulative dose of prednisone-1 and prednisone-2-12 were calculated and recoded into a four-level categorical variable: no prednisone, low dose (up to 7.5 mg/day), medium dose (up to 30 mg/day) and high dose (over 30 mg/day). The association between the cumulative prednisone-1 and prednisone-2-12 doses was tested. We analysed whether the four-level prednisone-1 categorical variable was an independent predictor of an average dose >7.5 mg/day of prednisone-2-12. Adjusting variables included age, immunosuppressives, antimalarials, methyl-prednisolone pulses, lupus nephritis and baseline SLE Disease Activity Index (SLEDAI). RESULTS: Within the first month, 113 patients (51%) did not receive any prednisone, 24 patients (11%) received average low doses, 46 patients (21%) received medium doses and 40 patients (18%) received high doses. There was a strong association between prednisone-1 and prednisone-2-12 dose categories (p<0.001). The cumulative prednisone-1 dose was directly associated with the cumulative prednisone-2-12 dose (p<0.001). Compared with patients on no prednisone, patients taking medium (adjusted OR 5.27, 95% CI 2.18 to 12.73) or high-dose prednisone-1 (adjusted OR 10.5, 95% CI 3.8 to 29.17) were more likely to receive prednisone-2-12 doses of >7.5 mg/day, while patients receiving low-dose prednisone-1 were not (adjusted OR 1.4, 95% CI 0. 0.38 to 5.2). If the analysis was restricted to the 158 patients with a baseline SLEDAI of ≥6, the model did not change. CONCLUSION: The dose of prednisone during the first month after the diagnosis of SLE is an independent predictor of prednisone burden during the following 11 months.

Bloodstream infections caused by Escherichia coli producing AmpC ß-lactamases: epidemiology and clinical features.

The aim of the study was to investigate the epidemiology and clinical features of bloodstream infections due to Escherichia coli producing AmpC ß-lactamases (AmpC-Ec-BSI). In a multi-centre case-control study, all third-generation-cephalosporin-resistant Escherichia coli BSI (3GC-Ec-BSI) isolates were analysed. Acquired bla AmpC (bla ac-AmpC) detection was done by polymerase chain reaction (PCR) and sequencing. Chromosomal bla AmpC (bla c-AmpC) expression was quantified by real-time PCR. Cases were patients with AmpC-Ec-BSI. Controls were patients with cephalosporin-susceptible E. coli BSI, matched 1:1 by sex and age. Demographics, comorbidities, intrinsic and extrinsic risk factors for antimicrobial resistance, clinical presentation and outcomes were investigated. Among 841 E. coli BSI, 17 were caused by AmpC-Ec (2 %). Eleven isolates (58.8 %) had bla ac-AmpC and six were bla c-AmpC overproducers. The mean age of cases was 66.2 years and 71 % were men. Cases were more frequently healthcare-related (82 vs. 52 % controls, p < 0.05) and presented more intrinsic and extrinsic risk factors. At least one risk factor was present in 94.1 % of cases vs. 41.7 % of controls (p = 0.002). Severity and length of stay (LOS) were higher among cases (mean Pitt Score 2.6 vs. 0.38 in controls, p = 0.03; LOS 17.5 days vs. 6 in controls, p = 0.02). Inappropriate empirical therapy (IET) was administered to 70.6 % of cases and 23.5 % of controls (p < 0.003). No differences were found in terms of cure rate at the 14th day and mortality. Bloodstream infections due to AmpC-Ec (mostly plasmid-mediated) are infrequent in our area. AmpC-Ec-BSI affects mainly patients with intrinsic risk factors and those with previous antibiotic exposure. A high proportion received IET.

Valoración pronóstica de mortalidad y hospitalizaciones en pacientes ambulatorios con EPOC avanzada. Utilidad del índice CODEX / Prognostic assessment of mortality and hospitalizations of outpatients with advanced chronic obstructive pulmonary disease. Usefulness of the CODEX index

Objetivos: Validar el índice CODEX en pacientes ambulatorios con EPOC avanzada. Pacientes y métodos: Se estudió a todos los pacientes con EPOC controlados en una unidad de pacientes crónicos respiratorios. Se calcularon los índices BODEX y CODEX y su relación con mortalidad, hospitalizaciones o ambas, y se realizó un análisis por número de eventos (mortalidad o reingresos), mediante el análisis de riesgos proporcionales de Cox. Resultados: Se incluyó a 80 pacientes (90% varones) con una edad media de 73,4 años. El seguimiento medio fue de 656 días con un rango intercuartílico (25-75%) de 417-642 días. Un total de 17 pacientes fallecieron (21%) y 57 (71,3%) requirieron hospitalización por EPOC. El índice CODEX se relacionó significativamente con la mortalidad (p<0,008; HR: 1,56; IC 95%: 1,1-2,15), el ingreso hospitalario (p<0,01; HR: 1,35; IC 95%: 1,13-1,62) y la variable combinada (p<0,03; HR: 1,27; IC 95%: 1,1-1,5). El BODEX no se asoció con la mortalidad (p=0,17), pero sí con los ingresos (p<0,001; HR: 1,4; IC 95%: 1,15-1,73) y la variable combinada (p<0,03; HR: 1,2; IC 95%: 1,02-1,34). Durante el seguimiento se produjeron 187 eventos. Tanto el índice CODEX (p<0,001; HR:1,17; IC 95%:1,1-1,27) como el BODEX (p<0,02; HR: 1,12; IC 95%: 1,02-1,23) se relacionaron con el número de eventos, aunque tras ajustar por la interacción entre ambos índices solo el CODEX conservó la significación estadística para la variable combinada por pacientes (p<0,03) y en el análisis por número de eventos (p<0,001). Conclusiones: Tanto el CODEX como el BODEX son útiles en la predicción de ingresos hospitalarios, aunque la capacidad pronóstica del CODEX es superior al BODEX tanto en mortalidad como en ingresos hospitalarios

Objectives: To validate the CODEX index in outpatients with advanced chronic obstructive pulmonary disease (COPD). Patients and methods: We studied all patients with COPD treated in a chronic respiratory disease unit. We calculated the BODEX and CODEX indices and their relationship with mortality, hospitalisations or both and performed an analysis by number of events (mortality and/or readmissions), using the Cox proportional hazards analysis. Results: We included 80 patients (90% men) with a mean age of 73.4 years. The mean follow-up was 656 days, with an interquartile range (25-75%) of 417-642 days. Seventeen patients died (21%) and 57 (71.3%) required hospitalisation for COPD. The CODEX index was significantly related to mortality (P<.008; HR: 1.56; 95% CI: 1.1-2.15), hospitalisations (P<.01; HR: 1.35; 95% CI: 1.13-1.62) and the combined variable (P<.03; HR: 1.27; 95% CI: 1.1-1.5). The BODEX index was not associated with mortality (P=.17) but was associated with hospitalisation (P<.001; HR: 1.4; 95% CI: 1.15-1.73) and the combined variable (P<.03; HR: 1.2; 95% CI: 1.02-1.34). There were 187 events during follow-up. Both the CODEX (P<.001; HR: 1.17; 95% CI: 1.1-1.27) and BODEX (P<.02; HR: 1.12; 95% CI: 1.02-1.23) indices were related to the number of events. However, after adjusting for the interaction between the 2 indices, only the CODEX index maintained statistical significance for the combined variable for patients (P<.03) and in the analysis by number of events (P<.001). Conclusions: Both the CODEX and BODEX indices are useful for predicting hospitalisations, although the prognostic ability of the CODEX index is greater than that of the BODEX index, both for mortality and hospitalisations

Prognostic assessment of mortality and hospitalizations of outpatients with advanced chronic obstructive pulmonary disease. Usefulness of the CODEX index. / Valoración pronóstica de mortalidad y hospitalizaciones en pacientes ambulatorios con EPOC avanzada. Utilidad del índice CODEX.

OBJECTIVES: To validate the CODEX index in outpatients with advanced chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: We studied all patients with COPD treated in a chronic respiratory disease unit. We calculated the BODEX and CODEX indices and their relationship with mortality, hospitalisations or both and performed an analysis by number of events (mortality and/or readmissions), using the Cox proportional hazards analysis. RESULTS: We included 80 patients (90% men) with a mean age of 73.4 years. The mean follow-up was 656 days, with an interquartile range (25-75%) of 417-642 days. Seventeen patients died (21%) and 57 (71.3%) required hospitalisation for COPD. The CODEX index was significantly related to mortality (P<.008; HR: 1.56; 95% CI: 1.1-2.15), hospitalisations (P<.01; HR: 1.35; 95% CI: 1.13-1.62) and the combined variable (P<.03; HR: 1.27; 95% CI: 1.1-1.5). The BODEX index was not associated with mortality (P=.17) but was associated with hospitalisation (P<.001; HR: 1.4; 95% CI: 1.15-1.73) and the combined variable (P<.03; HR: 1.2; 95% CI: 1.02-1.34). There were 187 events during follow-up. Both the CODEX (P<.001; HR: 1.17; 95% CI: 1.1-1.27) and BODEX (P<.02; HR: 1.12; 95% CI: 1.02-1.23) indices were related to the number of events. However, after adjusting for the interaction between the 2 indices, only the CODEX index maintained statistical significance for the combined variable for patients (P<.03) and in the analysis by number of events (P<.001). CONCLUSIONS: Both the CODEX and BODEX indices are useful for predicting hospitalisations, although the prognostic ability of the CODEX index is greater than that of the BODEX index, both for mortality and hospitalisations.

Can 3D power Doppler identify levator ani vascularization at its pubic insertion?

INTRODUCTION AND HYPOTHESIS: The levator ani is the most important muscle in the pelvic floor. This pilot study using 3D power Doppler aimed to identify normal vascularization of the puborectalis/pubovisceralis muscle at its insertion in nulliparous and premenopausal women. METHODS: Forty nulliparous and premenopausal women were evaluated at the Gynecological Unit of a tertiary hospital. All women underwent a translabial ultrasound (US) with 3D power Doppler. Pubic insertion of the puborectalis/pubovisceralis muscle was assessed in the axial plane, and vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were calculated bilaterally. Volumes were analyzed offline by two independent observers, and interobserver agreement and correlation between variables was calculated. RESULTS: A high, statistically significant, correlation was found between the three US indices on each side (p < 0.005). No correlation was found between the US index and either of the demographic parameters of body mass index [(BMI), p > 0.241], or age (p > 0.398). The degree of correlation between the same index on the different sides was not statistically significant. CONCLUSION: Puborectalis/pubovisceralis muscle vascularization at its insertion can be identified using 3D Doppler US, but values differ substantially from those of the contralateral side.

Polineuropatía periférica y síndrome de Churg-Strauss / Peripheral polyneuropathy and Churg-Strauss syndrome

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No evidence of association between functional polymorphisms located within IL6R and IL6ST genes and systemic sclerosis.

Systemic sclerosis (SSc) is a complex autoimmune disease which genetic component has not been yet completely understood. IL6 encodes a cytokine with a crucial role in the development of autoimmunity and fibrosis and its actions mainly are controlled by IL-6 receptor (IL-6R). We aimed to investigate whether the functional genetic variants rs8192284 and rs2228044 previously associated with several autoimmune diseases, located within the IL-6 receptor (IL-6R) subunits IL6R and IL6ST genes, respectively, are involved in the susceptibility to SSc and/or its major clinical subphenotypes. A Spanish cohort including 1013 SSc patients and 1375 controls was genotyped using the TaqMan® allelic discrimination technology. SSc patients were subdivided according to the major clinical forms, autoantibody status and presence of fibrotic lung affection. Our data showed no influence of the selected variants in global SSc susceptibility (rs8192284: P=0.67, odds ratios (OR)=0.98; rs2228044: P=0.99, OR=1.00). Similarly, the clinical/autoantibody subphenotype analyses did not yielded significant results. Our data suggest that the analyzed polymorphisms may not play a significant role in the SSc susceptibility.

Bacteriemias en la población de mayores de 80 años / Bloodstream infection in the up to 80 year-old-patients

Introducción. El objetivo de nuestro estudio fue describir las características de las bacteriemias detectadas en pacientes de más de 79 años, e identificar posibles factores relacionados con la mortalidad. Material y métodos. Estudio de cohortes, retrospectivo, en el que se incluye a todos los pacientes de más de 17 años de edad con bacteriemia detectada entre los años 2004-2007. Se recogieron variables demográficas, comorbilidades, foco de la bacteriemia, agente causante, gravedad y mortalidad intrahospitalaria. Los pacientes fueron clasificados en 3 franjas de edad: de 18 a 64 años (G1), de 65 a 79 (G2) y ≥80 años (G3). Resultados. Se analizaron 1.594 episodios de bacteriemia (35% en G1, 35% en G2 y 29% en G3). En el G3, el 47% presentó insuficiencia renal, el 83% neoplasia sólida, el 2% inmunosupresión, el 5% desnutrición y el 38% úlceras por decúbito. Estas proporciones fueron del 27, 30, 5, y 2%, respectivamente en G2, y del 15, 16, 12 y 5%, en G1 (p<0,01). El foco urinario representó el 28, 43 y 44% en G1, G2 y G3, respectivamente (p<0,01) y el biliar, 6, 11 y 16% (p<0,01). E. coli representó el 32% en G1, el 44% en G2 y el 51% en G3. La mortalidad en cada grupo de edad fue del 9, 16 y 21%. En el análisis multivariado, la mortalidad en los ≥80 años se relacionó con la insuficiencia renal, la desnutrición, la presencia de úlceras y el shock. Conclusiones. Las bacteriemias en el anciano son sobretodo de origen urinario. La mortalidad en estos casos depende sobre todo del estado basal del paciente y no tanto de su edad(AU)

Introduction. The aim of our study was to describe the characteristics of bacteremia detected in patients over 79 years and to identify possible factors associated with the mortality. Methods. A retrospective cohort study, which included all patients over 17 years of age with bacteremia detected between 2004-7 was performed. Demographic variables, comorbidities, source of bacteremia, causing microorganism, severity and hospital mortality were recorded. Patients were classified into three age groups: 18 to 64 years (G1), 65 to 79 (G2) and ≥80 years (G3). Results. We analyzed 1594 episodes of bacteremia (35% in G1, 35% in G2 and 29% in G3). In G3, 47% had renal failure, 83% solid neoplasm, 2% immunosuppression 5% malnutrition and 38% decubitus ulcers. These proportions were 27, 30, 5 and 2%, respectively in G2, and 15, 16, 12 and 5% in G1 (P<.01). The urinary focus accounted for 28%, 43% and 44% in G1, G2 and G3, respectively (P<.01) and biliary focus 6, 11 and 16% (P<.01), in each group. E. coli accounted for 32% in G1, 44% in G2 and 51% in G3. Mortality in each age group was 9, 16 and 21%. In multivariate analysis, mortality in the ≥80 years was associated with renal failure, malnutrition, the presence of ulcers and shock. Conclusions. Bacteremia in the elderly are mainly of urinary origin. Mortality in these cases depends primarily on the patient's baseline status rather than their age(AU)

[Bloodstream infection in the up to 80 year-old-patients]. / Bacteriemias en la población de mayores de 80 años.

INTRODUCTION: The aim of our study was to describe the characteristics of bacteremia detected in patients over 79 years and to identify possible factors associated with the mortality. METHODS: A retrospective cohort study, which included all patients over 17 years of age with bacteremia detected between 2004-7 was performed. Demographic variables, comorbidities, source of bacteremia, causing microorganism, severity and hospital mortality were recorded. Patients were classified into three age groups: 18 to 64 years (G1), 65 to 79 (G2) and ≥80 years (G3). RESULTS: We analyzed 1594 episodes of bacteremia (35% in G1, 35% in G2 and 29% in G3). In G3, 47% had renal failure, 83% solid neoplasm, 2% immunosuppression 5% malnutrition and 38% decubitus ulcers. These proportions were 27, 30, 5 and 2%, respectively in G2, and 15, 16, 12 and 5% in G1 (P<.01). The urinary focus accounted for 28%, 43% and 44% in G1, G2 and G3, respectively (P<.01) and biliary focus 6, 11 and 16% (P<.01), in each group. E. coli accounted for 32% in G1, 44% in G2 and 51% in G3. Mortality in each age group was 9, 16 and 21%. In multivariate analysis, mortality in the ≥80 years was associated with renal failure, malnutrition, the presence of ulcers and shock. CONCLUSIONS: Bacteremia in the elderly are mainly of urinary origin. Mortality in these cases depends primarily on the patient's baseline status rather than their age.

Four-dimensional sonographic evaluation of avulsion of the levator ani according to delivery mode.

OBJECTIVE: To determine the frequency of avulsion of the levator ani muscle in primiparous women according to delivery mode, using introital four-dimensional ultrasonography. METHODS: We performed a prospective observational study at a tertiary obstetric unit. One hundred and eighty primiparous women were included and divided into three groups: normal vaginal delivery without episiotomy, forceps delivery and Cesarean section groups. Between 40 and 120 days after delivery, four-dimensional ultrasonography was performed in order to evaluate the integrity of the levator ani muscle. The operator was blinded to all clinical data and was not aware of delivery mode. The influence of other variables associated with delivery such as birth weight, body mass index, maternal age and use of epidural anesthesia was also studied. RESULTS: Avulsion of the puborectalis component of the levator ani muscle was detected on ultrasonography in 61.7% of women who had undergone a forceps delivery, compared with 13.3% of those who had had a normal vaginal delivery and 0% of those who had had a Cesarean section. Bilateral avulsion was observed in 12/60 (20.0%) of the forceps group and in 2/60 (3.3%) of the normal vaginal delivery group (P < 0.001). Other variables did not seem to influence prevalence. CONCLUSIONS: Forceps delivery is associated with an increased rate of avulsion of the puborectalis component of the levator ani muscle. The effect of forceps use is independent of other delivery-related variables.