Improvement of mood and sleep quality in patients with primary hyperparathyroidism after parathyroidectomy: A prospective case-control study.

BACKGROUND: Primary hyperparathyroidism can impact patient quality of life with psychopathological symptoms like mood and sleep disturbances. In the latest recommendations published according to the primary hyperparathyroidism surgical consensus, these neuropsychological symptoms continue to be excluded. This study aims to assess the negative effects of mood and sleep on patients with primary hyperparathyroidism compared to healthy controls and analyze their improvement after surgery. METHODS: Prospective case-control study of patients with primary hyperparathyroidism. The Beck questionnaire and Pittsburgh Sleep Quality Index were used. The control group consisted of healthy people matched by age and sex. Preoperative results were compared with results at 3 and 12 months after surgery and compared with the control group. Statistical analysis consisted of the Kolmogorov-Smirnov test and Student's t test for correlations. RESULTS: Forty-nine patients who underwent parathyroidectomy were analyzed. In relation to depression, differences were observed between the results of the preoperative period and 3 months after surgery, with a significant decrease in depression score (16.80 ± 9.98 vs 13.08 ± 10.76; P = .001). This improvement was maintained after 1 year (P < .001). Regarding the quality of sleep, there were no differences 3 months after the intervention, but there were differences at 12 months (9.48 ± 4.76 vs 8.27 ± 4.38; P = .032). The dimensions of the Pittsburgh Sleep Quality Index were analyzed, observing significant differences only in daytime dysfunction after 3 months and 12 months after surgery (1.02 ± 0.99 vs 0.69 ± 0.82; P = .01 and 1.04 ± 0.98 vs 0.60 ± 0.76; P = .004). CONCLUSION: Mood changes and sleep quality improve after primary hyperparathyroidism surgery, although at different postoperative times, with this improvement being more pronounced in mood. This assessment should be taken into account in the preoperative consultation of patients with primary hyperparathyroidism.

Mycobacterial infection after COVID-19 pneumonia / Infección por micobacterias tras neumonía por COVID-19

A 69-year-old man with a history of hypertrophic cardiomyopathy and major depressive disorder was admitted to the Emergency Department with fever, weakness, and shortness of breath. He was diagnosed with acute respiratory distress syndrome due to COVID-19 and received oxygen and steroids during a one-month hospital stay. After discharge, he continued steroids and home oxygen therapy for nearly two years. CT scans revealed bronchiectasis and ground glass opacities related to COVID-19. He developed pulmonary nodules and M. intracellulare infection, which were treated with rifampicin, ethambutol, and azithromycin. After six months of treatment, the patient showed clinical and radiological improvement (AU)

Un hombre de 69 años con antecedentes de miocardiopatía hipertrófica y trastorno depresivo mayor acudió a urgencias por fiebre, debilidad y dificultad respiratoria. Se le diagnosticó síndrome de distrés respiratorio agudo debido a COVID-19 y fue ingresado en planta de neumología, donde recibió oxígeno y esteroides durante 1 mes. Después del alta continuó con esteroides y oxigenoterapia domiciliaria durante casi 2 años. Las tomografías objetivaron bronquiectasias y opacidades en vidrio deslustrado relacionadas con la COVID-19. Desarrolló nódulos pulmonares e infección por Mycobacterium intracellulare, siendo tratado con rifampicina, etambutol y azitromicina. Después de 6 meses de tratamiento, el paciente mostró mejoría clínica y radiológica (AU)

Longitudinal Study of Therapeutic Adherence in a Cystic Fibrosis Unit: Identifying Potential Factors Associated with Medication Possession Ratio.

Cystic fibrosis (CF) is a genetic and multisystemic disease that requires a high therapeutic demand for its control. The aim of this study was to assess therapeutic adherence (TA) to different treatments to study possible clinical consequences and clinical factors influencing adherence. This is an ambispective observational study of 57 patients aged over 18 years with a diagnosis of CF. The assessment of TA was calculated using the Medication Possession Ratio (MPR) index. These data were related to exacerbations and the rate of decline in FEV1 percentage. Compliance was good for all CFTR modulators, azithromycin, aztreonam, and tobramycin in solution for inhalation. The patients with the best compliance were older; they had exacerbations and the greatest deterioration in lung function during this period. The three variables with the highest importance for the compliance of the generated Random Forest (RF) models were age, FEV1%, and use of Ivacaftor/Tezacaftor. This is one of the few studies to assess adherence to CFTR modulators and symptomatic treatment longitudinally. CF patient therapy is expensive, and the assessment of variables with the highest importance for a high MPR, helped by new Machine learning tools, can contribute to defining new efficient TA strategies with higher benefits.

Impact of the SARS-CoV-2 Virus Pandemic on Patients with Bronchiectasis: A Multicenter Study.

BACKGROUND: Infection by SARS-CoV-2 has unquestionably had an impact on the health of patients with chronic respiratory airway diseases, such as COPD and asthma, but little information is available about its impact on patients with bronchiectasis. The objective of the present study was to analyze the effect of the SARS-CoV-2 pandemic on the state of health, characteristics, and clinical severity (including the number and severity of exacerbations) of patients with non-cystic fibrosis bronchiectasis. METHODS: This study was multicenter, observational, and ambispective (with data collected before and during the SARS-CoV-2 pandemic), and included 150 patients diagnosed with non-cystic fibrosis bronchiectasis. RESULTS: A significant drop was observed in the number and severity of the exacerbations (57% in all exacerbations and 50% in severe exacerbations) in the E-FACED and BSI multidimensional scores, in the pandemic, compared with the pre-pandemic period. There was also a drop in the percentage of sputum samples positive for pathogenic microorganisms in general (from 58% to 44.7%) and, more specifically, Pseudomonas aeruginosa (from 23.3% to 13.3%) and Haemophilus influenzae (from 21.3% to 14%). CONCLUSIONS: During the SARS-CoV-2 period, a significant reduction was observed in the exacerbations, severity, and isolations of pathogenic microorganisms in patients with bronchiectasis.

Treatment of Pulmonary Disease of Cystic Fibrosis: A Comprehensive Review.

Cystic fibrosis (CF) is a genetic disease that causes absence or dysfunction of a protein named transmembrane conductance regulatory protein (CFTR) that works as an anion channel. As a result, the secretions of the organs where CFTR is expressed are very viscous, so their functionality is altered. The main cause of morbidity is due to the involvement of the respiratory system as a result of recurrent respiratory infections by different pathogens. In recent decades, survival has been increasing, rising by around age 50. This is due to the monitoring of patients in multidisciplinary units, early diagnosis with neonatal screening, and advances in treatments. In this chapter, we will approach the different therapies used in CF for the treatment of symptoms, obstruction, inflammation, and infection. Moreover, we will discuss specific and personalized treatments to correct the defective gene and repair the altered protein CFTR. The obstacle for personalized CF treatment is to predict the drug response of patients due to genetic complexity and heterogeneity of uncommon mutations.

Personalized approaches to bronchiectasis.

Introduction: Interest in bronchiectasis is increasing due to its rising prevalence, associated with aging populations and the extended use of high-resolution chest tomography (HRCT), and the resulting high morbidity, mortality, and demand for resources.Areas covered: This article provides an extensive review of bronchiectasis as a complex and heterogeneous disease, as well as examining the difficulty of establishing useful clinical phenotypes. In keeping with the aims of 'precision medicine', we address the disease of bronchiectasis from three specific perspectives: severity, activity, and impact. We used PubMed to search the literature for articles including the following keywords: personalized medicine, bronchiectasis, biomarkers, phenotypes, precision medicine, treatable traits. We reviewed the most relevant articles published over the last 5 years.Expert opinion: This article reflects on the usefulness of these three dimensions in 'control panels' and clinical fingerprinting, as well as approaches to personalized medicine and the treatable features of bronchiectasis non-cystic fibrosis.

Synergic Effect of Metal and Fluorine Doping on the Structural and Electrical Properties of La5.4MoO11.1-Based Materials.

Cationic and anionic frameworks of La5.4MoO11.1 proton conductors have been modified by means of metal (Ti4+, Zr4+, and Nb5+) and fluorine (F-) doping. This synergic effect leads to the stabilization of high-symmetry and single-phase polymorphs. The materials have been fully characterized by structural techniques, such as X-ray and neutron powder diffraction and transmission electron microscopy. The fluorine content was determined by ion chromatography. Impedance spectroscopy analysis under different atmospheres (dry and wet N2 and O2 and wet 5% H2-Ar) showed an improvement in the electronic conductivity under reducing conditions, making these materials potential candidates for hydrogen separation membranes.

Metal-Doping of La5.4MoO11.1 Proton Conductors: Impact on the Structure and Electrical Properties.

La5.4MoO11.1 proton conductors with different metal doping (Ca2+, Sr2+, Ba2+, Ti4+, Zr4+, and Nb5+) have been prepared and structurally and electrically characterized. Different polymorphs are stabilized depending on the doping and cooling rate used during the synthesis process. The most interesting results are obtained for Nb-doping, La5.4Mo1- xNb xO11.1- x/2, where single compounds are obtained in the compositional range 0 ≤ x ≤ 0.2. These materials are fully characterized by structural techniques such as X-ray and neutron powder diffraction and transmission electron microscopy, which independently confirm the changes of polymorphism. Scanning electron microscopy and impedance spectroscopy measurements in dry/wet gases (N2, O2, and 5% H2-Ar) showed an enhancement of the sinterability and electrical properties of the materials after Nb-doping. Conductivity measurements under very reducing conditions revealed that these materials are mixed ionic-electronic conductors, making them potential candidates for hydrogen separation membranes.

[Advanced gastric carcinoma in the proximal third and half of the stomach: clinical and pathological characteristics and survival prognosis factors]. / Carcinoma avanzado del tercio proximal-medio del estómago: cuadro clínico-patológico y factores pronósticos de sobrevida.

PURPOSE: To identify the clinical and pathological characteristics and prognosis factors for five-year survival in patients with advanced gastric carcinoma in the proximal third and half of the stomach undergoing gastrectomy with limited and extended lymphadectomy. MATERIAL AND METHODS: This retrospective study analyzed information from 39 patients with histological diagnosis of advanced gastric adenocarcinoma in the upper third and half of the stomach (U-M) who underwent gastrectomy with limited (D0-D1) and extended (D2-D3) lymphadectomy at the Belén Hospital in Trujillo between January 1, 1966 and December 31, 2000. RESULTS: The mean age of the U-M group was 55.56+/-16.24 years. There were 27 males (69.2%) and 12 females (30.8%) (M:F ratio was 2.3:1). The most frequent symptoms were abdominal pain (94.9%) and weight loss (61.5%). The most common evidence was pallor (61.5%). The independent prognosis factors statistically related to survival were: depth of T2 invasion (p=0.017), presence of remote metastasis (p=0.013), clinic stage I-II (p=0.005), Borrmann lesions I-II (p=0.05) and surgery with healing intention (p=0.003). The actuarial 5-year survival rate for all the series reached 13.6%. CONCLUSIONS: Early detection and the feasibility of gastrectomy with preservation of the pancreas tail should be considered in patients with advanced gastric carcinoma in the proximal third and half of the stomach in order to improve their survival.

Carcinoma avanzado del tercio proximal - medio estómago: Cuadro clínico-patológico y factores pronósticos de sobrevida / Advanced gastric carcinoma in the proximal third and half of the stomach: clinical and pathological characteristics and survival prognosis factors

Objetivos: Identificar el cuadro clínico-patológico y factores pronósticos de sobrevida quinquenal de pacientes con carcinoma gástrico avanzado del tercio proximal-medio (U-M) sometidos a gastrectomía con linfadenectomía limitada y extendida. Material y Métodos: El presente estudio retrospectivo analizó información de una serie de 39 pacientes con diagnóstico histológico de adenocarcionoma gástrico avanzado del tercio superior y medio del estómago (U-M) y que fueron sometidos a gastrectomía con linfadenectomía limitada (DO-D1) y extendida (D2-D3) y en el Hospital Belén de Trujillo entre el 1º de enero de 1966 al 31 de diciembre del 2000. Resultados: La edad promedio del grupo U-M fue de 55.56 + 16.24 años. Hubo 27 varones (69.2 por ciento) y 12 mujeres (30.8 por ciento) (proporción H.M=2.3:1). Los síntomas más frecuentes fueron dolor abdominal (94.9 por ciento) y pérdida de peso (59.0 por ciento). El signo más común fue la palidez (61.5 por ciento). Los factores pronósticos independientes estadísticamente relacionados con la sobrevida fueron: profundidad de la invasión T2 (p=0.017), presencia de metástasis a distancia (P=0.013), el estadío clínico I-II (p=0.005), lesiones Bormann I-II (p=0.005) y la cirugía con intención curativa (p=0.003). La sobrevida actuarial en la serie total a los 5 años fue de 13.6 por ciento. Conclusiones: La detección temprana y la disponibilidad de una gastrectomía con preservación de la cola del páncreas tendrían que ser considerados en pacientes con carcinoma gástrico avanzado del tercio proximal y medio y así mejorar su sobrevida.

[Five-year survival prognosis factors in patients with resectable advanced serosa exposed gastric carcinoma]. / Factores pronósticos de sobrevida quinquenal de pacientes con carcinoma gástrico avanzado resecable con serosa expuesta.

PURPOSE: To identify the main five-year survival prognosis factors in patients with resectable advanced serosa exposed gastric carcinoma, who have undergone radical gastric resection with limited and extended lymphadenectomy. MATERIAL AND METHODS: This retrospective study examined 137 patients with resectable advanced serosa exposed gastric carcinoma, in the Belén Hospital, Trujillo, Peru, between 1991 and 2000. RESULTS: The average age of the total series was 58.1 +/- 14.8 year (ranging from 20 to 84 years). This series was formed by 137 patients, of which 77 (56.2%) were male and 60 (43.8%) were female (M:F ratio=1.3:1). The univariate analysis using the log-rank test, showed that the following variables were significantly associated with five-year survival: lack of palpable mass (p=0.0308), serum haemoglobin concentration of 10 g/dl or higher (p=0.05) neoplasias located in the distal third of the stomach (p=0.0001) regional ganglionic condition N0-N1 (p=0.03), clinical stage II (p=0.0327) ganglionic dissection D2-D3 (p=0.0366) and curative intended surgery (p=0.000). The actual survival rate of the entire series after 5 years was of 16.3%. In the group subjected to lymphadenectomy D0-D1 (n=105) survival rate after 5 years was of 12.6%, while in the group subjected to D2-D3 (n=32) it was of 30.2% (p=0.0366). Five-year survival rate in patients who underwent curative intended surgery (n=56) was of 33.4% and those who had palliative surgery (n=81) had a five-year survival rate of 3.1% (p=0.000). CONCLUSIONS: Early detection, availability of curative surgery and the use of extended lymphadenectomy are factors that have an influence on the survival rate. These parameters should be considered for the staging of patients and their subsequent post-surgery assisting treatment.

Factores pronósticos de sobrevida quinquenal de pacientes con carcinoma gástrico avanzado resecable con serosa expuesta / Five-year survival prognosis factors in patients with resectable advanced serosa exposed gastric carcinoma

Objetivos: Identificar los principales factores pronósticos de sobrevida quinquenal en pacientes con carcinoma gástrico avanzado resecable con serosa expuestas sometidos a gastrectomía radical con linfadenectomía limitada y extendida. Material y Métodos: Este estudio retrospectivo evaluó 137 pacientes con adenocarcinoma gástrico avanzado resecable con serosa expuesta atendidos en el Hospital Belén, Trujillo, Perú, entre 1991 y 2000. Resultados: La edad media de la serie total fue de 58.1± 14.8 años (límites, 20 a 84 años). La presente serie estuvo constituida por 137 pacientes,de los cuales 77 (56.2 por ciento) fueron varones y 60 (43.8 por ciento) mujeres (proporción M:F,1.3:1. En el análisis univariado usando el test de log-rank, las siguientes variables estuvieron asociadas significativamente con la sobrevida quinquenal: ausencia de masa palpable (p = 0.0308), hemoglobina sérica mayor o igual a 10 g/dl (p = 0.059, neoplasias ubicadas en el tercio distal del estómago (p = 0.0001), estado ganglionar regional NO-N1 (p = 0.03), estadio clínico II (p = 0.0327), disección ganglionar D2-D3 ( p = 0.0366) y cirugía con intención curativa (p = 0.000). La tasa de sobrevida actuarial de toda la serie a los 5 años fue de 16.3 por ciento. En el grupo sometido a linfadenectomía D0-D1 (n= 105) la sobrevida a los 5 años fue de 12.6 por ciento; en cambio en el grupo sometido a D2-D3 (n = 32) fue de 30.2 por ciento (p = 0.0366). En los pacientes que tuvieron cirugía con intención curativa (n = 56) la sobrevida quinquenal fue de 33.4 por ciento respectivamente y los que tuvieron resección paliativa (n = 81) fue 3.1 por ciento (p<0.0001). Conclusiones: La detección precoz, la disponibilidad de resección curativa y el uso de linfadenectomía extendida son factores que influyen en la sobrevida; parámetros que deberían ser considerados para estratificación de pacientes y su posterior tratamiento adyuvante postoperatorio.