The CORCOBIA study: Cut-off points of Alzheimer's disease CSF biomarkers in a clinical cohort.

INTRODUCTION: The analysis of the core biomarkers of Alzheimer's Disease (AD) in the cerebrospinal fluid (CSF) is recommended in the clinical units where it is available. Because of the absence of universal validated values, the determination of specific cut-off points for each center and its population is recommended. The main objective of the CORCOBIA study was to determine the cut-off points of core AD CSF biomarkers for several centers (Parc de Salut Mar, Barcelona and Hospital General de Granollers), which work with the same reference laboratory (Laboratori de Referència de Catalunya). METHODS: Prospective study including cognitively unimpaired individuals (CU, n = 42), subjects with amnestic mild cognitive impairment (aMCI, n = 35) and patients with dementia due to Alzheimer's Disease (AD, n = 48), in whom clinical and neuropsychological assessment, neuroimaging, APOE genotyping and lumbar puncture to analyse amyloid beta peptides (Aß42, Aß40), total tau (tTau) and phosphorylated Tau (pTau181) using the Lumipulse G600II (Fujirebio) was performed. The values of sensitivity (SE), specificity (SP), predictive values and area under the curve (AUC) were calculated, determining the cut-off point according to the Youden index by comparing the CU and AD groups. RESULTS: The resulting cut-offs and their AUC were the following: Aß42 750 pg/mL (AUC 0.809); Aß42/Aß40 0.062 (AUC 0.78); pTau181 69.85 pg/mL (AUC 0.81); tTau 522.0 pg/mL (AUC 0.79); Aß42/tTau 1.76 (AUC 0.86); Aß42/pTau181 10.25 (AUC 0.86). CONCLUSIONS: The determination of cut-off points of core AD CSF biomarkers for the participating centers allows a better diagnostic accuracy. The ratio CSF Aß42/pTau181 shows the highest AUC and better balance between sensitivity and specificity.

El fill amagat. Un embaràs que dona llum a un fill anterior en l'ombra / No disponible

No disponible

Fractura en silla de montar inveterada en paciente sin traumatismo previo / Inveterate pelvic ring fracture in patient without prior trauma

La osteoporosis es una enfermedad silenciosa, que debuta en muchas ocasiones con fracturas que se localizan sobre todo en columna vertebral. Se ha considerado interesante publicar este caso no solo por su excepcionalidad, sino también para resaltar que se debe considerar la fractura por insuficiencia ósea de pelvis en el diagnóstico diferencial de la lumbalgia y coxalgia, que con tanta frecuencia vemos en las consultas de Rehabilitación (AU)

Osteoporosis is a silent disease, which often initiates with fractures located mainly in the spine. It has been consider to be of interest to publish this clinical case not only because it is exceptional, but also to consider the insufficiency fracture of the pelvis in the differential diagnosis of the low back and hip pain. This is a very common pathology in the Rehabilitation clinic (AU)

[Detecting adverse drug events during the hospital stay]. / Detección de acontecimientos adversos producidos por medicamentos durante la estancia hospitalaria.

INTRODUCTION: The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage. METHODS: Multi-centre, prospective observational study lasting four months, performed in five hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identified by direct observation and the use of previously defined alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classified according to the taxonomy that the Ruiz-Jarabo 2000 group defined, and coordinated by ISMP-Spain. RESULTS: We included 1,550 patients, 159 of whom experienced at least one ADE (10.3 %). The preventability percentage was 51.6 %, which represented 5.3 % of the total sample. The endocrine system (34.8 %) and the cardiovascular system (20.7 %) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5 % of all ADEs. 9.3 % of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3 %) resulted from omitting a necessary medication. Only 4.4 % of preventable ADEs are considered to be serious. CONCLUSIONS: There is a high incidence rate of ADEs during patients' hospital stay (10.3 %), and half of them (51.6 %) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs.

Detección de acontecimientos adversos producidos por medicamentos durante la estancia hospitalaria / Detecting adverse drug events during the hospital stay

Introducción: El objetivo principal ha sido determinar la incidencia de acontecimientos adversos producidos por medicamentos (AAM) en pacientes hospitalizados y evaluar su porcentaje de prevención. Métodos: Estudio multicéntrico, prospectivo y observacional de 4 meses de duración, realizado en cinco hospitales de distinto nivel asistencial. Se incluyó a todos los pacientes adultos que ingresaron por más de 48 h en alguna de las unidades seleccionadas y requirieron tratamiento farmacológico. La identificación de los AAM se realizó mediante la observación directa y la utilización de unas señales de alerta, previamente definidas. Se utilizó el algoritmo de Karch-Lasagna, para determinar la relación de causalidad, y el cuestionario de Schumock y Thornton adaptado por Otero et al para evaluar la evitabilidad del AAM. Los AAM prevenibles se clasificaron siguiendo la taxonomía definida por el Grupo Ruiz-Jarabo 2000, coordinado por el ISMP-España. Resultados: Se incluyó a 1.550 pacientes, de los que 159 presentaron, al menos, un AAM (10,3 %). La tasa de evitabilidad fue del 51,6 %, lo que representa un 5,3 % de la muestra total. El sistema endocrino (34,8 %) y el cardiovascular (20,7 %) fueron los más afectados por los AAM prevenibles. Los antibióticos representaron el 16,5 % de todos los AAM. En cuanto a los AAM prevenibles, el 9,3 % de ellos se desencadenaron por la utilización de opiáceos. La gran mayoría de los AAM evitables fue consecuencia de la omisión de un medicamento necesario (36,3 %). Sólo un 4,4 % de los AAM evitables se consideró graves. Conclusiones: La incidencia de pacientes con AAM durante la estancia hospitalaria es alta (10,3 %), y la mitad de ellos (51,6 %) se podría haber prevenido. La implantación de un sistema automático de alertas y ciertas prácticas de mejoras en los puntos conflictivos del circuito sanitario ayudarían a la detección y la prevención de los AAM evitable (AU)

Introduction: The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage. Methods: Multi-centre, prospective observational study lasting four months, performed in five hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identifi ed by direct observation and the use of previously defi ned alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classifi ed according to the taxonomy that the Ruiz-Jarabo 2000 group defi ned, and coordinated by ISMP-Spain. Results: We included 1,550 patients, 159 of whom experienced at least one ADE (10.3 %). The preventability percentage was 51.6 %, which represented 5.3 % of the total sample. The endocrine system (34.8 %) and the cardiovascular system (20.7 %) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5 % of all ADEs. 9.3 % of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3 %) resulted from omitting a necessary medication. Only 4.4 % of preventable ADEs are considered to be serious. Conclusions: There is a high incidence rate of ADEs during patients’ hospital stay (10.3 %), and half of them (51.6 %) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs (AU)

Eficacia de un programa de escuela de espalda hospitalario / Efficacy of a hospital back school program

Introducción. Las escuelas de espalda sonuna de las intervenciones utilizadas en los programas derehabilitación. El objetivo de nuestro estudio es describirlas características del programa de espalda del Hospital deSan Juan y valorar su eficacia.Material y métodos. Se incluyeron 897 pacientes con dorsalgiay/o lumbalgia, durante el período de enero de 2004 adiciembre de 2006. El programa se desarrolló en 6 sesionescolectivas a lo largo de 3 meses. Se completaron los testsde la ganancia de flexión lumbar protegida (medida como ladistancia en centímetros manos-suelo) y la mejoría subjetivaen actividades de la vida diaria (AVD) (nada, insuficienteo suficiente).Resultados y conclusiones. Completaron el protocolo261 pacientes. El programa mejora el dolor raquídeo medidocon la escala visual analógica (EVA) del dolor en 0,61 mm(intervalo de confianza [IC] 95 %: 0,32-0,9) y la ganancia deflexión lumbar protegida en 5,13 cm (IC 95 %: 4,21-6,05). Lamayoría de los pacientes mejoraron de forma suficiente(51,7 %) sin requerir ningún otro tipo de tratamiento fisioterápico.Estas mejorías encontradas fueron estadísticamen tesignificativas (p < 0,000)(AU)

Introduction. Back school is one of the interventionsused in the Rehabilitation programs. The aim of ourstudy is to describe the characteristics of a program of rachialgiaof San Juan’s Hospital, as well as its effectiveness.Methods. Eight-hundred and ninety-seven patients withdorsalgia and/or lumbalgia were included, during the periodJanuary 2004-December 2006. The program was developedin 6 collective sessions of three months’ duration. The test ofVisual Analogue Scale of the pain, the gain in flexion lumbarprotected (measured in cm as the distance between handsand ground) and the subjective improvement in activity dailylife (nothing, inadequate or sufficient) were completed.Results and conclusions. Two-hundred and sixty-one patientscompleted the protocol. The program improved 0.61 mm (IC95 % ± 0.29) of Visual Analogue Scale measuring spinal pain;5.13 cm (IC 95 % ± 0.92) improvement in protected lumbarflexion. Most patients improved sufficiently (51.7 %), withoutrequiring any other type of physiotherapy treatment. Theseimprovements were statistically significant (p < 0.000)(AU)

Afectación renal en las gammapatías monoclonales benignas: ¿una entidad infradiagnosticada? / No disponible

La nefropatía de las gammapatías monoclonales es debida principalmente al depósito de cadenas ligeras. Aunque se presenta sobre todo en cuadros malignos, también se ha descrito en pacientes cuya gammapatía es considerada «benigna». Se describen las características clínicas e histológicas de 9 casos de nefropatía por depósitos de cadenas ligeras diagnosticadas en el contexto de una gammapatía monoclonal sin datos de malignidad. Tres hombres y seis mujeres con edad media de 59,2 ± 12. Todos los pacientes presentaban al diagnóstico proteinuria y grados variables de insuficiencia renal con creatinina sérica media de 315 ±187. Dos requirieron diálisis desde el inicio. La histología renal mostró patrón nodular en 4 casos, mesangiocapilar en 3, lesiones sólo tubulares en 1 y mesangial en otro. Los depósitos renales más frecuentes fueron los constituidos por cadenas kappa (67%). Los tratamientos aplicados fueron: Prednisona en monoterapia (tres casos) o asociada aquimioterapia (melfalan, clorambucil o ciclofosfamid). En dos casos se añadieron recambios plasmáticos o autotrasplante de médula ósea, respectivamente. Tras un seguimiento medio de 4,89 ± DE: 3,69 años observamos desaparición de la proteinuria en más del 50% de los pacientes y estabilización o mejoría de la función renal en 3. Dos deellos necesitaron terapia renal substitutiva desde el inicio y existió progresión del fallo renal hasta los requerimientos dialíticos en los cuatro restantes. En caso de gammapatía monoclonal, incluso de carácter benigno, debe buscarse una posible afectación renal. La comprobación del depósito renal de cadenas ligeras debe hacer plantearse un tratamiento precoz, ya que la evolución a la insuficiencia renal terminal es frecuente (AU)

Renal involvement is observed frequently in association with malignant gammopathies, mainly those related to light chain deposition, although has also been described in non-malignant monoclonal gammopathy. This study reports the clinicopathological findings and outcome in 9 patients with nephropaty secondary to monoclonal immunoglobulin deposit in absence of malignancy. They were three men and six women and they were 59.2± 12 years old. All patients presented proteinuria and different levels of renal insufficiency (mean creatin in = 315 ± 187 micromol/L) at the moment of diagnostic. Two patients required dialysis at the time of renal biopsy. The pathology studies revealed a nodular sclerosing glomerulopathy in four cases, mesangiocapilary glomerulonephritis in three cases, only tubular lesions in one and mesangial lesions in the other one. The treatment applied was: Prednisone alone (two cases), with chemotherapy associated (melfalan in two, clorambucil in one and ciclophosphamide in another one). One patient received plasmapheresis and mycophenolate and another patient undergone a bone marrow authotransplant associated to mycophenolate and prednisone. One of the two patients who required dialysis at the moment of presentation was not treated. After a follow-up of more than 4years (4.89 ± DE: 3.69) renal function improved or remained stable in three patients and proteinuria was dissapaired in more than 50% of patients. Four patients had a worsening of renal function and they required dialysis during the time of follow-up (in 2.4 years ± DE: 4.3). In any case malignitation was observed. Chemotherapy stabilized or improved renal function in 3 of nine patients (33%) with non-malignant monoclonal gammopathy Non-malignant monoclonal gammopathy could go unnoticed. Appearance of abnormalities in renal routine tests deserves more in-depth diagnostic procedures, including renal biopsy. Evolution to end stage renal disease could probably be avoided or reduced in severity with early detection and treatment of this entity (AU)

[Renal involvement in benign monoclonal gammopathies: an underdiagnosed condition]. / Afectación renal en las gammpatías monoclonales benignas: una entidad infradiagnosticada?

Renal involvement is observed frequently in association with malignant gammopathies, mainly those related to light chain deposition, although has also been described in non-malignant monoclonal gammopathy. This study reports the clinicopathological findings and outcome in 9 patients with nephropaty secondary to monoclonal immunoglobulin deposit in absence of malignancy. They were three men and six women and they were 59.2+/-12 years old. All patients presented proteinuria and different levels of renal insufficiency (mean creatinin = 315+/-187 micromol/L) at the moment of diagnostic. Two patients required dialysis at the time of renal biopsy. The pathology studies revealed a nodular sclerosing glomerulopathy in four cases, mesangiocapilary glomerulonephritis in three cases, only tubular lesions in one and mesangial lesions in the other one. The treatment applied was: Prednisone alone (two cases), with chemotherapy associated (melfalan in two, clorambucil in one and ciclophosphamide in another one). One patient received plasmapheresis and mycophenolate and another patient undergone a bone marrow authotransplant associated to mycophenolate and prednisone. One of the two patients who required dialysis at the moment of presentation was not treated. After a follow-up of more than 4 years (4.89 +/-DE: 3.69) renal function improved or remained stable in three patients and proteinuria was disappeared in more than 50% of patients. Four patients had a worsening of renal function and they required dialysis during the time of follow-up (in 2,4 years +/- DE: 4,3). In any case malignitation was observed. Chemotherapy stabilized or improved renal function in 3 of nine patients (33%) with non-malignant monoclonal gammopathy. Non-malignant monoclonal gammopathy could go unnoticed. Appearance of abnormalities in renal routine tests deserves more in-depth diagnostic procedures, including renal biopsy. Evolution to end stage renal disease could probably be avoided or reduced in severity with early detection and treatment of this entity.

Análisis comparativo de los factores terapéuticos grupales en la esquizofrenia. Parte II. Resultados y discusión / Comparative analysis of group therapeutic Factoes in schizophrenia. Part II. Results and discussion

Los resultados obtenidos muestran que la mayoría de Factores Terapéuticos Grupales (FTG) son valorados por los tres grupos de forma similar (La Cohesión Grupal y El Aprendizaje interpersonal (AIP) "Output" han sido los más valorados por los pacientes), mientras que otros parecen tener alguna especificidad respecto al pronóstico del paciente o el contexto donde se realizan los grupos. Encontramos algunos predictores "débiles" de dos FTG: La Identificación y el Insight.Tanto la Cohesión Grupal como los aspectos más conductuales del Aprendizaje Interpersonal son Factores Terapéuticos que trascienden las diferencias de contexto, duración de la terapia, gravedad clínica ... etc. La Identificación, como expresión de un mecanismo primario de defensa es comparativamente, mucho más valorada por los pacientes en crisis . La Instalación de Esperanza es un Factor muy importante para los dos grupos de mal pronóstico, probablemente con connotaciones diferentes en cada uno de ellos. Y finalmente, en los enfermos más estables, con mejor pronóstico clínico y en tratamiento ambulatorio la Comprensión de Sí mismo es tan importante como para los grupos de pacientes no esquizofrénicos (AU)

Análisis comparativo de los factores terapéuticos grupales en la esquizofrenia. Parte I. Introducción y métodos / Comparative analysis of group therapeutic factors in schizophrenia. Part I. Introduction and methods

Los Factores Terapéuticos Grupales (FTG) son los mecanismos de cambio, mediante los cuales, entre otros factores, el paciente obtiene un beneficio terapéutico. Son intrínsecos al grupo y dependen de las interrelaciones entre sus miembros. Nuestro objetivo es conocer las diferencias de los FTG en distintos contextos y momentos evolutivos de la enfermedad esquizofrénica y buscar predictores de los FTG. Comparamos 3 grupos de pacientes: Grupo I (n=10, ambulatorio, buen pronóstico clínico); Grupo 11 (n=13, ambulatorio, mal pronóstico clínico); Grupo 111 (n=20, hospitalario). N total = 43. Utilizamos el cuestionario de l. Yalom (Q-sort) para evaluar los FTG. Estudiamos distintas variables sociodemográficas, clínicas y pronósticas mediante escalas validadas y conocidas. Realizamos una aproximación psicométrica a los instrumentos de medida utilizados y no validados. (Cuestionario de Factores Terapéuticos de 1. Yalom y Cuestionario de Insihtg de M. González de Chávez) Para el análisis de datos utilizamos el paquete estadístico SPSS Los resultados y discusión se describen en la PARTE 11 del artículo con el mismo nombre. (AU)

Surgical wound infections: prospective study of 4,468 clean wounds.

A prospective four-year study on the infection rate of clean operative wounds is presented. From January 1982 to June 1985, a nurse epidemiologist and a medical team assessed 4,468 operative procedures, from the day of surgery to the patients' discharge from the hospital. The infection rate was 3.2%. A higher incidence of wound infection was detected in patients requiring emergency operations (5.1%), in drained wounds (5.4%), and in patients with conditions thought to predispose to infection, such as advanced cancer, hepatic cirrhosis, diabetes, nephrotic syndrome, previous splenectomy, and treatment with immunosuppressive drugs (7.8%). Age over 65 did not influence infection rates. There were up to tenfold differences in infection indices between surgeons performing the same clean procedures. The continued monitoring of clean wound infection rates allowed the early detection and control of infection outbreaks. Providing periodic information on infection rates to the different surgical services was associated with decreasing infection rates over time.