[Pressure digit sign in patients with knee osteoarthritis]. / Signo de digito-presión en pacientes con osteoartritis de rodilla.

INTRODUCTION: it is estimated that 302 million people worldwide are affected by osteoarthritis, corresponding to 60% osteoarthritis (OA) of the knee, which responsible 80% of disability in older adults, hence the importance of the association of the sign with the early inflammatory process in OA. OBJECTIVE: to determine the association of digital pressure sign in patients with and without osteoarthritis of the knee. MATERIAL AND METHODS: this was an observational, comparative cross-sectional study, carried out in patients with and without a diagnosis of knee OA, to whom the digital pressure sign was determined. The sample was calculated with the formula for two proportions, obtaining a total of 40 participants per group, obtained by non-probabilistic sampling for convenience. The statistical analysis included frequencies, percentages, 2 and OR. The bioethics regulations in force were respected. RESULTS: the study included 80 participants, with a median age of 48.9 years (RQI 46-53.7), 73.1% were predominantly female sex (38), and a statistically significant association was found between patients with OA and the presence of digital pressure sign, 2 4.62 and p value = 0.41, OR of 2.65. CONCLUSIONS: the presence of digital pressure sign increases the probability of having OA 2.65 times more.

INTRODUCCIÓN: se estima que 302 millones de personas en el mundo son afectadas por osteoartritis, correspondiendo 60% a osteoartritis (OA) de rodilla, causante de 80% de discapacidad en adultos mayores, de ahí la importancia de la asociación del signo de digito-presión con el proceso inflamatorio temprano en OA. OBJETIVO: determinar la asociación del signo de digito-presión en pacientes con y sin osteoartritis de rodilla. MATERIAL Y MÉTODOS: estudio observacional, transversal comparativo, realizado en pacientes con y sin diagnóstico de OA de rodilla, a quienes se les determinó el signo de digito-presión; la muestra se calculó con la fórmula para dos proporciones que determinó un total de 40 participantes por grupo, obtenidos por muestreo no probabilístico por conveniencia; el análisis estadístico incluyó frecuencias, porcentajes, 2 y OR. Se respetó la reglamentación de bioética vigente. RESULTADOS: el estudio incluyó a 80 participantes, con una mediana de edad de 48.9 años (RIQ 46-53.7), predominó el sexo femenino en 73.1% (38). Se encontró asociación estadísticamente significativa entre pacientes con OA y la presencia del signo de digito-presión, 2 4.62 y p = 0.41, OR de 2.65. CONCLUSIONES: la presencia del signo de digito-presión aumenta 2.65 veces más la probabilidad de tener OA.

Diferencias en función del sexo en las características clínicas y resultados del ensayo clínico CLOROTIC (combinación de diuréticos de asa con tiazidas en la insuficiencia cardiaca descompensada) / Sex differences in clinical characteristics and outcomes in the CLOROTIC (combining loop with thiazide diuretics for decompensated heart failure) trial

ObjetivoEvaluar si existen diferencias en los resultados del ensayo clínico CLOROTIC según el sexo. Métodos Subanálisis del ensayo CLOROTIC, que evaluó la eficacia y la seguridad de añadir hidroclorotiazida (HCTZ) o placebo a furosemida intravenosa en pacientes con insuficiencia cardiaca aguda (ICA). Los resultados primarios y secundarios incluyeron cambios en el peso y la disnea a las 72 y 96horas, medidas de la respuesta diurética y la mortalidad y reingresos a los 30 y 90días. Se evaluó la influencia del sexo en los resultados primarios y secundarios y de seguridad. Resultados De los 230 pacientes incluidos, 111 (48%) eran mujeres, que tenían más edad y valores más elevados de fracción de eyección ventricular izquierda. Los hombres tenían más cardiopatía isquémica, enfermedad pulmonar obstructiva crónica y mayor valor de péptidos natriuréticos. La adición de HCTZ a furosemida se asoció con una mayor pérdida de peso a las 72/96horas y mejor respuesta diurética a las 24horas en comparación con el placebo, sin diferencias significativas según el sexo (ningún valor de p para la interacción fue significativo). El deterioro de la función renal fue más frecuente en mujeres (OR: 8,68; IC95%: 3,41-24,63) que en varones (OR: 2,5; IC95%: 0,99-4,87), p=0,027. No hubo diferencias en la mortalidad ni en los reingresos a los 30/90días. Conclusión La adición de HCTZ a furosemida intravenosa es una estrategia eficaz para mejorar la respuesta diurética en la ICA sin diferencias según el sexo. Sin embargo, el deterioro de la función renal es más frecuente en las mujeres. (AU)

Aims The addition of hydrochlorothiazide (HCTZ) to furosemide improved the diuretic response in patients with acute heart failure (AHF) in the CLOROTIC trial. Our aim was to evaluate if there were differences in clinical characteristics and outcomes according to sex. Methods This is a post hoc analysis of the CLOROTIC trial, including 230 patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The primary and secondary outcomes included changes in weight and patient-reported dyspnoea 72 and 96h after randomization, metrics of diuretic response and mortality/rehospitalizations at 30 and 90days. The influence of sex on primary, secondary and safety outcomes was evaluated. Results One hundred and eleven (48%) women were included in the study. Women were older and had higher values of left ventricular ejection fraction. Men had more ischemic cardiomyopathy and chronic obstructive pulmonary disease and higher values of natriuretic peptides. The addition of HCTZ to furosemide was associated to a greatest weight loss at 72/96h, better metrics of diuretic response and higher 24-h diuresis compared to placebo without significant differences according to sex (all P-values for interaction were not significant). Worsening renal function occurred more frequently in women (OR: 8.68; 95%CI: 3.41-24.63) than men (OR: 2.5; 95%CI: 0.99-4.87), P=.027. There were no differences in mortality or rehospitalizations at 30/90days. Conclusion Adding HCTZ to intravenous furosemide is an effective strategy to improve diuretic response in AHF with no difference according to sex, but worsening renal function was more frequent in women. (AU)

Diferencias en función del sexo en las características clínicas y resultados del ensayo clínico CLOROTIC (combinación de diuréticos de asa con tiazidas en la insuficiencia cardiaca descompensada) / Sex differences in clinical characteristics and outcomes in the CLOROTIC (combining loop with thiazide diuretics for decompensated heart failure) trial

ObjetivoEvaluar si existen diferencias en los resultados del ensayo clínico CLOROTIC según el sexo. Métodos Subanálisis del ensayo CLOROTIC, que evaluó la eficacia y la seguridad de añadir hidroclorotiazida (HCTZ) o placebo a furosemida intravenosa en pacientes con insuficiencia cardiaca aguda (ICA). Los resultados primarios y secundarios incluyeron cambios en el peso y la disnea a las 72 y 96horas, medidas de la respuesta diurética y la mortalidad y reingresos a los 30 y 90días. Se evaluó la influencia del sexo en los resultados primarios y secundarios y de seguridad. Resultados De los 230 pacientes incluidos, 111 (48%) eran mujeres, que tenían más edad y valores más elevados de fracción de eyección ventricular izquierda. Los hombres tenían más cardiopatía isquémica, enfermedad pulmonar obstructiva crónica y mayor valor de péptidos natriuréticos. La adición de HCTZ a furosemida se asoció con una mayor pérdida de peso a las 72/96horas y mejor respuesta diurética a las 24horas en comparación con el placebo, sin diferencias significativas según el sexo (ningún valor de p para la interacción fue significativo). El deterioro de la función renal fue más frecuente en mujeres (OR: 8,68; IC95%: 3,41-24,63) que en varones (OR: 2,5; IC95%: 0,99-4,87), p=0,027. No hubo diferencias en la mortalidad ni en los reingresos a los 30/90días. Conclusión La adición de HCTZ a furosemida intravenosa es una estrategia eficaz para mejorar la respuesta diurética en la ICA sin diferencias según el sexo. Sin embargo, el deterioro de la función renal es más frecuente en las mujeres. (AU)

Aims The addition of hydrochlorothiazide (HCTZ) to furosemide improved the diuretic response in patients with acute heart failure (AHF) in the CLOROTIC trial. Our aim was to evaluate if there were differences in clinical characteristics and outcomes according to sex. Methods This is a post hoc analysis of the CLOROTIC trial, including 230 patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The primary and secondary outcomes included changes in weight and patient-reported dyspnoea 72 and 96h after randomization, metrics of diuretic response and mortality/rehospitalizations at 30 and 90days. The influence of sex on primary, secondary and safety outcomes was evaluated. Results One hundred and eleven (48%) women were included in the study. Women were older and had higher values of left ventricular ejection fraction. Men had more ischemic cardiomyopathy and chronic obstructive pulmonary disease and higher values of natriuretic peptides. The addition of HCTZ to furosemide was associated to a greatest weight loss at 72/96h, better metrics of diuretic response and higher 24-h diuresis compared to placebo without significant differences according to sex (all P-values for interaction were not significant). Worsening renal function occurred more frequently in women (OR: 8.68; 95%CI: 3.41-24.63) than men (OR: 2.5; 95%CI: 0.99-4.87), P=.027. There were no differences in mortality or rehospitalizations at 30/90days. Conclusion Adding HCTZ to intravenous furosemide is an effective strategy to improve diuretic response in AHF with no difference according to sex, but worsening renal function was more frequent in women. (AU)

Sex differences in clinical characteristics and outcomes in the CLOROTIC (combining loop with thiazide diuretics for decompensated heart failure) trial.

AIMS: The addition of hydrochlorothiazide (HCTZ) to furosemide improved the diuretic response in patients with acute heart failure (AHF) in the CLOROTIC trial. Our aim was to evaluate if there were differences in clinical characteristics and outcomes according to sex. METHODS: This is a post-hoc analysis of the CLOROTIC trial, including 230 patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The primary and secondary outcomes included changes in weight and patient-reported dyspnoea 72 and 96 h after randomization, metrics of diuretic response and mortality/rehospitalizations at 30 and 90 days. The influence of sex on primary, secondary and safety outcomes was evaluated. RESULTS: One hundred and eleven (48%) women were included in the study. Women were older and had higher values of left ventricular ejection fraction. Men had more ischemic cardiomyopathy and chronic obstructive pulmonary disease and higher values of natriuretic peptides. The addition of HCTZ to furosemide was associated to a greatest weight loss at 72/96 h, better metrics of diuretic response and higher 24-h diuresis compared to placebo without significant differences according to sex (all p-values for interaction were not significant). Worsening renal function occurred more frequently in women (OR [95%CI]: 8.68 [3.41-24.63]) than men (OR [95%CI]: 2.5 [0.99-4.87]), p = 0.027. There were no differences in mortality or rehospitalizations at 30/90 days. CONCLUSION: Adding HCTZ to intravenous furosemide is an effective strategy to improve diuretic response in AHF with no difference according to sex, but worsening renal function was more frequent in women. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov: NCT01647932; EudraCT Number: 2013-001852-36.

Don Quijote de la Mancha y la descripción del sueño bifásico en la literatura española / Don Quixote de la Mancha and the description of biphasic sleep in Spanish literature

Introducción: El sueño bifásico o segmentado es el hábito de dormir un primer y un segundo sueño separados por una vigilia. El historiador Ekirch describe que así se dormía en los tiempos preindustriales antes de la potente iluminación artificial. Se basó en textos en diferentes idiomas, desde la Antigüedad hasta el siglo xx, pero llama la atención la ausencia de fuentes en español. Objetivo: Se revisó la literatura española en busca de referencias al sueño bifásico usando como palabras clave ‘primer sueño’ y ‘a los primeros gallos’. Desarrollo: En la segunda parte de Don Quijote de la Mancha (capítulo 68), Cervantes describe el sueño bifásico con notable acierto, correlacionando los biotipos de Quijote y Sancho con sus temperamentos y hábitos de sueño y alimentarios. Curiosamente, Ekirch cita el capítulo, pero no el sueño bifásico. En esta revisión reproduzco 11 textos en español (siglos xiii a xix), mayormente obras clásicas, que lo refieren, disponiendo sus fases en coincidencia con las horas en que se dividía la noche en la era preindustrial: 20:00-21:00 a 00:00, primer sueño; 00:00 a 03:00, vigilia; 03:00 a 06:00, segundo sueño. La Celestina aporta datos significativos. Estudios recientes probaron que este hábito es fisiológico y se adapta al estilo de vida que lo requiere. Conclusiones: Se identifican y citan por primera vez referencias al sueño bifásico en la literatura española, confirmando la hipótesis de Ekirch. El Quijote lo describe con mayor amplitud y agudeza.(AU)

Introduction: Biphasic or segmented sleep is the habit of sleeping a first and a second sleep separated by a watching. The historian A Ekirch found that this was how people slept in pre-industrial times before the powerful artificial lighting. He is based on texts in different languages, from Antiquity to the 20th century, but the absence of sources in Spanish is striking. Aim: Review the Spanish literature searching references of the biphasic sleep using the keywords ‘first sleep’ and ‘at the first cockcrow’. Development: In the Second Part of Don Quixote de la Mancha (Chapter 68), Cervantes describes biphasic sleep with remarkable success, correlating the biotypes of Quixote and Sancho with their temperaments and sleeping and eating habits. Strangely, Ekirch cites the chapter, but not biphasic sleep. In this review I reproduce eleven texts in Spanish (13th to 19th centuries), mostly classical works, which refer to it by arranging its phases in a way that coincides with the hours in which the night was divided in the pre-industrial era: 20:00-21:00 to 00:00, first sleep, 00:00 to 03:00, wakefulness; 03:00 to 06:00, second sleep. La Celestina provides significant data too. Recent studies proved that this habit is physiological, and it adapts to the lifestyle that requires it. Conclusions: References to biphasic sleep in Spanish literature are identified and cited for the first time, confirming Ekirch’s hypothesis. In Don Quixote, Cervantes describes it with great breadth and sharpness.

[Don Quixote de la Mancha and the description of biphasic sleep in Spanish literature]. / Don Quijote de la Mancha y la descripción del sueño bifásico en la literatura española.

INTRODUCTION: Biphasic or segmented sleep is the habit of sleeping a first and a second sleep separated by a watching. The historian A Ekirch found that this was how people slept in pre-industrial times before the powerful artificial lighting. He is based on texts in different languages, from Antiquity to the 20th century, but the absence of sources in Spanish is striking. AIM: Review the Spanish literature searching references of the biphasic sleep using the keywords 'first sleep' and 'at the first cockcrow'. DEVELOPMENT: In the Second Part of Don Quixote de la Mancha (Chapter 68), Cervantes describes biphasic sleep with remarkable success, correlating the biotypes of Quixote and Sancho with their temperaments and sleeping and eating habits. Strangely, Ekirch cites the chapter, but not biphasic sleep. In this review I reproduce eleven texts in Spanish (13th to 19th centuries), mostly classical works, which refer to it by arranging its phases in a way that coincides with the hours in which the night was divided in the pre-industrial era: 20:00-21:00 to 00:00, first sleep, 00:00 to 03:00, wakefulness; 03:00 to 06:00, second sleep. La Celestina provides significant data too. Recent studies proved that this habit is physiological, and it adapts to the lifestyle that requires it. CONCLUSIONS: References to biphasic sleep in Spanish literature are identified and cited for the first time, confirming Ekirch's hypothesis. In Don Quixote, Cervantes describes it with great breadth and sharpness.

TITLE: Don Quijote de la Mancha y la descripción del sueño bifásico en la literatura española.Introducción. El sueño bifásico o segmentado es el hábito de dormir un primer y un segundo sueño separados por una vigilia. El historiador Ekirch describe que así se dormía en los tiempos preindustriales antes de la potente iluminación artificial. Se basó en textos en diferentes idiomas, desde la Antigüedad hasta el siglo xx, pero llama la atención la ausencia de fuentes en español. Objetivo. Se revisó la literatura española en busca de referencias al sueño bifásico usando como palabras clave 'primer sueño' y 'a los primeros gallos'. Desarrollo. En la segunda parte de Don Quijote de la Mancha (capítulo 68), Cervantes describe el sueño bifásico con notable acierto, correlacionando los biotipos de Quijote y Sancho con sus temperamentos y hábitos de sueño y alimentarios. Curiosamente, Ekirch cita el capítulo, pero no el sueño bifásico. En esta revisión reproduzco 11 textos en español (siglos xiii a xix), mayormente obras clásicas, que lo refieren, disponiendo sus fases en coincidencia con las horas en que se dividía la noche en la era preindustrial: 20:00-21:00 a 00:00, primer sueño; 00:00 a 03:00, vigilia; 03:00 a 06:00, segundo sueño. La Celestina aporta datos significativos. Estudios recientes probaron que este hábito es fisiológico y se adapta al estilo de vida que lo requiere. Conclusiones. Se identifican y citan por primera vez referencias al sueño bifásico en la literatura española, confirmando la hipótesis de Ekirch. El Quijote lo describe con mayor amplitud y agudeza.

Utilidad pronóstica de la presión de pulso en pacientes con insuficiencia cardiaca con fracción de eyección preservada: Registro RICA / Prognostic utility of pulse pressure in patients with heart failure with preserved ejection fraction: The RICA Registry

Background and aims The prognostic role of pulse pressure (PP) in heart failure (HF) patients with preserved left ventricular ejection fraction (LVEF) is not well understood. Our aim was to evaluate it in acute and stable HF. Material and methods This work is a retrospective observational study of patients included in the RICA registry between 2008 and 2021. Blood pressure was collected on admission (decompensation) and 3 months later on an outpatient basis (stability). Patients were categorized according to whether the PP was greater or less than 50mmHg. All-cause mortality was assessed at 1year after admission. Results A total of 2291 patients were included, with mean age 80.1±7.7 years. 62.9% were women and 16.7% had a history of coronary heart disease. In the acute phase, there was no difference in mortality according to PP values, but in the stable phase PP<50mmHg was independently associated with all-cause mortality at 1-year follow-up (HR 1.57, 95% CI 1.21−2.05, p=0.001), after adjusting for age, sex, New York Heart Association functional class, previous HF, chronic kidney disease, valvular heart disease, cerebrovascular disease, score on the Barthel and Pfeiffer scales, hemoglobin and sodium levels. Conclusion Low stable-phase PP was associated with increased all-cause mortality in HF patients with preserved LVEF. However, PP was not useful as a prognostic marker of mortality in acute HF. Further studies are needed to assess the relationship of this variable with mortality in HF patients (AU)

Antecedentes y objetivo El papel pronóstico de la presión de pulso (PP) en pacientes con insuficiencia cardiaca (IC) con fracción de eyección de ventrículo izquierdo (FEVI) preservada no es bien conocido. Nuestro objetivo fue evaluarlo en fases de descompensación y de estabilidad. Material y métodos Estudio observacional retrospectivo de pacientes incluidos en registro RICA entre 2008 y 2021. La presión arterial se recogió al ingreso (descompensación) y a los 3 meses (estabilidad). Se calculó la PP y los pacientes se categorizaron según PP mayor/igual vs menor de 50mmHg. Se evaluó la mortalidad por todas las causas al año del ingreso. Resultados Se incluyeron 2.291 pacientes, con edad media 80,1±7,7 años. El 62,9% eran mujeres y un 16,7% tenían antecedentes de cardiopatía isquémica. En fase aguda, no hubo diferencias en la mortalidad según los valores de PP, pero en fase estable una PP<50mmHg se asoció de forma independiente con mortalidad por todas las causas al año de seguimiento (HR 1,57, IC 95% 1,21-2,05; p=0,001), una vez controlado por edad, sexo, NYHA, IC previa, enfermedad renal crónica, valvulopatía, enfermedad cerebrovascular, Barthel, Pfeiffer, hemoglobina y sodio. Conclusione Una PP baja en fase estable se asoció con mayor mortalidad por todas las causas en pacientes con IC con FEVI preservada. Sin embargo, la PP no demostró ser un factor pronóstico en fase de descompensación. Se necesitan más estudios que valoren la relación de esta variable con la mortalidad en los pacientes con IC (AU)

Prognostic utility of pulse pressure in patients with heart failure with preserved ejection fraction: The RICA Registry.

BACKGROUND AND AIMS: The prognostic role of pulse pressure (PP) in heart failure (HF) patients with preserved left ventricular ejection fraction (LVEF) is not well understood. Our aim was to evaluate it in acute and stable HF. MATERIAL AND METHODS: This work is a retrospective observational study of patients included in the RICA registry between 2008 and 2021. Blood pressure was collected on admission (decompensation) and 3 months later on an outpatient basis (stability). Patients were categorized according to whether the PP was greater or less than 50mmHg. All-cause mortality was assessed at 1year after admission. RESULTS: A total of 2291 patients were included, with mean age 80.1±7.7 years. 62.9% were women and 16.7% had a history of coronary heart disease. In the acute phase, there was no difference in mortality according to PP values, but in the stable phase PP<50mmHg was independently associated with all-cause mortality at 1-year follow-up (HR 1.57, 95% CI 1.21-2.05, p=0.001), after adjusting for age, sex, New York Heart Association functional class, previous HF, chronic kidney disease, valvular heart disease, cerebrovascular disease, score on the Barthel and Pfeiffer scales, hemoglobin and sodium levels. CONCLUSIONS: Low stable-phase PP was associated with increased all-cause mortality in HF patients with preserved LVEF. However, PP was not useful as a prognostic marker of mortality in acute HF. Further studies are needed to assess the relationship of this variable with mortality in HF patients.

Valor pronóstico a corto plazo de la proteína C reactiva en ancianos con insuficiencia cardíaca aguda / The short-term prognostic value of C-reactive protein in elderly patients with acute heart failure

Introducción y objetivos: la proteína C reactiva (PCR) plasmática ha sido evaluada como marcador pronóstico en insuficiencia cardíaca aguda (ICA). Sin embargo, no está confirmado que posea validez pronóstica cuando la población de ICA analizada está constituida por pacientes de edad avanzada. Métodos: analizamos los valores plasmáticos de PCR en todos los pacientes ingresados en servicios de medicina interna por ICA de cualquier tipo. Evaluamos la asociación existente entre dichos valores, las características clínicas basales de los pacientes y las tasas de mortalidad y reingreso por cualquier causa a los 3 meses del alta. Para las comparaciones se estratificó a los pacientes en terciles de valor de PCR bajo, medio y alto (< 2,24mg/l, 2,25-11,8mg/l y>11,8mg/l, respectivamente). Resultados: se incluyó a 1.443 pacientes, con una mediana de edad de 80 años (rango intercuartílico 73-85); de ellos, 680 (47%) eran hombres, con una carga de comorbilidad moderada; el 60,1% presentaba fracción de eyección del ventrículo izquierdo preservada (> 50%). El análisis multivariante confirmó la existencia de una asociación independiente entre valores elevados de PCR al ingreso y la presencia de infección respiratoria, presión sistólica baja y función renal alterada. Tres meses después del ingreso índice, un total de 142 pacientes (9,8%) habían fallecido y 268 (18,6%) habían reingresado o habían muerto. Los valores de la PCR en el momento del ingreso no se correlacionaron con la tasa de mortalidad por cualquier causa a los 3 meses (p=0,79), ni con la tasa a los 3 meses de reingreso por cualquier causa (p=0,96) o con la combinación de ambos acontecimientos (p=0,96). Sin embargo, los valores altos de la PCR se asociaron a estancias hospitalarias más prolongadas (p<0,001). Conclusión: nuestro estudio no confirma la existencia de una asociación entre los valores de PCR plasmáticos presentes en el ingreso en los ancianos con ICA con un mayor riesgo de mortalidad o reingreso a los 3 meses

Introduction and objectives: plasma c-reactive protein (crp) has been tested as a prognostic marker in acute heart failure (ahf). Whether its measurement really provides significant prognostic information when applied to elderly patients with ahf episodes remains unclear. Methods: we measured the plasma crp values of patients admitted because of any type of ahf to internal medicine services. We evaluated the association of these values with the patients' baseline clinical characteristics and their 3-month posdischarge all-cause mortality or readmission rates. For comparison purposes, we divided the sample in tertiles of low, medium and high crp values (<2,24mg/l, 2,25-11,8mg/l and>11,8mg/l). Results: we included 1443 patients with a median age of 80 years (interquartile range 73-85); 680 (47%) were men, with a moderate comorbid burden. 60.1% had preserved left ventricular ejection fraction (> 50%). Multivariate analysis confirmed an independent association between higher crp values and the presence of respiratory infection, lower systolic blood pressure and deteriorated renal function upon admission. Three months after the index admission, a total of 142 patients (9.8%) had died, and 268 (18.6%) had either been readmitted or died. admission crp values did not correlate with 3-month all-cause mortality (P=0.79), 3-month all-cause readmission (P=0.96) or the combination of both events (P=0.96). However, higher crp values were associated with a longer length of stay (P<0.001). Conclusion: our study does not confirm an association between admission plasma crp values in elderly ahf patients and subsequent higher 3-month mortality or readmission risks

The short-term prognostic value of C-reactive protein in elderly patients with acute heart failure. / Valor pronóstico a corto plazo de la proteína C reactiva en ancianos con insuficiencia cardíaca aguda.

INTRODUCTION AND OBJECTIVES: Plasma c-reactive protein (crp) has been tested as a prognostic marker in acute heart failure (ahf). Whether its measurement really provides significant prognostic information when applied to elderly patients with ahf episodes remains unclear. METHODS: We measured the plasma crp values of patients admitted because of any type of ahf to internal medicine services. We evaluated the association of these values with the patients' baseline clinical characteristics and their 3-month posdischarge all-cause mortality or readmission rates. For comparison purposes, we divided the sample in tertiles of low, medium and high crp values (<2,24mg/l, 2,25-11,8mg/l and>11,8mg/l). RESULTS: We included 1443 patients with a median age of 80 years (interquartile range 73-85); 680 (47%) were men, with a moderate comorbid burden. 60.1% had preserved left ventricular ejection fraction (> 50%). Multivariate analysis confirmed an independent association between higher crp values and the presence of respiratory infection, lower systolic blood pressure and deteriorated renal function upon admission. Three months after the index admission, a total of 142 patients (9.8%) had died, and 268 (18.6%) had either been readmitted or died. admission crp values did not correlate with 3-month all-cause mortality (P=0.79), 3-month all-cause readmission (P=0.96) or the combination of both events (P=0.96). However, higher crp values were associated with a longer length of stay (P<0.001). CONCLUSION: Our study does not confirm an association between admission plasma crp values in elderly ahf patients and subsequent higher 3-month mortality or readmission risks.

Impact of prealbumin on mortality and hospital readmission in patients with acute heart failure.

BACKGROUND: Prealbumin is a maker of nutritional status and inflammation of potential prognostic value in acute heart failure (HF). The aim of this study is to evaluate if low prealbumin levels on admission predict mortality and readmissions in patients with acute HF. METHOD: We conducted a prospective observational cohort study including 442 patients hospitalized for acute HF. Patients were classified in two groups according to prealbumin levels: "normal" prealbumin (>15mg) and "low" prealbumin (≤15mg/dL). End-points were mortality and readmissions (all-cause and HF-related) and the combined end-point of mortality/readmission at 180days. RESULTS: Out of 442 patients, 159 (36%) had low and 283 (64%) had normal prealbumin levels Mean age was 79.6 (73.9-84.2, p=0,405) years and 183 (41%, p=0,482) were males. After a median 180days of follow-up, 108 (24%, p=0,021) patients died and 170 (38%, p=0,067) were readmitted. Mortality was higher in the low prealbumin group. The combined end-point was more frequent in the low prealbumin group (57% vs. 50%, p=0.199). In the multivariate analysis the following variables were associated with mortality or readmission: older age, exacerbated chronic HF, higher comorbidity, low systolic blood pressure and hemoglobin values and higher pro brain natriuretic peptide levels. CONCLUSIONS: Low prealbumin is common (36%) in patients with acute heart failure and it is associated with a higher short-term mortality.

Resultados funcionales de la aplicación de toxina botulínica tipo A contra antiinflamatorios orales en la rehabilitación de síndrome de hombro doloroso por lesión del mango de los rotadores / Functional results of type a botulinum toxin versus oral antiinflammatory agents in the rehabilitation of painful shoulder syndrome caused by rotator cuff lesion

Las enfermedades del mango de los rotadores se caracterizan por signos inespecíficos, síntomas y alteraciones de la anatomía, su etiología es multifactorial y pueden abarcar desde tendinitis hasta rupturas masivas de espesor completo del tendón del manguito de los rotadores, las cuales comprometen la biomecánica normal del hombro afectado. Normalmente suceden en mayores de 40 años; sin embargo, el asociado a trauma depende del mecanismo de lesión y no tiene relación directa con la edad de aparición de los síntomas. Se han descrito factores vasculares en el daño al tendón del manguito de los rotadores, en patologías que afectan a la microcirculación; sin embargo, estudios recientes no han demostrado que el tendón bajo observación directa presente datos de hipovascularidad. La toxina botulínica tipo A realiza su acción mediante bloqueo de la liberación de acetilcolina en la placa neuromuscular; en las articulaciones provoca liberación de la tensión capsular así como la disminución de factores pro inflamatorios tales como la interleucina-1; aunque existen pocos artículos sobre su utilidad intraarticular, en los grupos musculares y tendinosos, además de tener un efecto miorrelajante existen diversas publicaciones que apoyan su utilidad en el manejo del dolor y su utilidad en la rehabilitación de este grupo de pacientes; en dosis bajas, ha sido ampliamente utilizada. Material y métodos: Se trata de un estudio prospectivo, experimental y longitudinal en el cual se realizó seguimiento a 24 pacientes con diagnóstico de síndrome de hombro doloroso demostrado por pruebas clínicas y de gabinete debido a lesiones del mango de los rotadores, sin criterios de reparación quirúrgica inmediata, o ya reparados, a los cuales a 12 pacientes se les aplicará toxina botulínica tipo A en el espacio subacromial de forma peri-tendón del tendón conjunto del manguito de los rotadores, así como en puntos de dolor y contractura muscular en hombro, con una dosis total de 200 UI de toxina botulínica tipo A, mientras que al grupo control, de 12 pacientes, se le administraron antiinflamatorios vía oral por seis semanas, tipo Cox 2, Celecoxib 100 mg cápsulas una cada 12 horas; a los dos grupos se les sometió a un programa de rehabilitación ya establecido, el cual fue supervisado cada dos semanas y hasta las seis semanas de evolución; se realizaron valoraciones subjetivas y objetivas valorando la presencia de dolor, el nivel funcional y la movilidad posible mediante la escala de valoración funcional de hombro de Constant y la escala visual análoga. Resultados: Grupo de Celecoxib Promedio de escala de Constant inicial fue de 60 puntos, el inmediato a la primera dosis se mantuvo en 60 puntos, a las dos semanas de tratamiento con Celecoxib se encontró un puntaje de Constant promedio de 66 puntos y a las seis semanas el promedio fue de 70.33 puntos, siendo el valor de la p > 0.005. Grupo de toxina botulínica 200 UI máximo en hombro afectado, 50 UI subacromial y 150 en puntos de dolor además de asociarlo a programa de ejercicios de rehabilitación supervisados en consultorio. El promedio de la escala de Constant inicial fue de 58 puntos, el inmediato a la primera dosis se elevó a 70.83 puntos, a las dos semanas posteriores a infiltración y seguimiento de ejercicios en consultorio fue de puntaje Constant promedio de 77.16 puntos y a las seis semanas el promedio fue de 78.5 puntos, siendo el valor de la p < 0.005 (p = 0.00045). En cuanto a la escala visual análoga se observó que en el grupo de Celecoxib existió una disminución de dicha escala a las seis semanas con una p < 0.005.

Rotator cuff conditions are characterized by unspecific signs, as well as anatomic alterations and symptoms. They have a multifactorial etiology and may include everything from tendinitis to massive, full thickness tears of the rotator cuff tendon that compromise the normal biomechanics of the involved shoulder. They usually occur in people over 40 years of age but lesions resulting from trauma may vary according to the mechanism of injury and are not directly related with the age at onset of symptoms. Vascular factors have been described as related with rotator cuff tendon damage in conditions affecting the microcirculation. However, recent studies have not proven that the tendon under direct observation shows hypovascularity. Type A botulinum toxin acts by blocking the release of acetylcholine in the neuromuscular plate; in the joints it releases capsular tension and reduces proinflammatory factors such as interleukin-1 (IL-1). There are only a few papers on its intraarticular benefit; in muscle and tendon groups it not only has a muscle relaxant effect, but several publications support its utility for pain management. It has been widely used in the rehabilitation of this group of patients at low doses. Material and methods: Prospective, investigational and longitudinal study involving the follow-up of 24 patients with a diagnosis of painful shoulder syndrome proven clinically and with imaging tests, and caused by rotator cuff lesions. The patients either did not meet the criteria for immediate surgical repair or had already undergone such a repair. Type A botulinum toxin was applied to 12 patients in the subacromial space around the rotator cuff conjoint tendon, as well as in the painful spots and in the muscle contracture in the shoulder. The total dose of Type A botulinum toxin was 200 IU. The control group, also composed of 12 patients, was given a COX-2 oral antiinflammatory agent for 6 weeks (Celecoxib, 100 mg BID). Both groups followed a pre-established rehabilitation program for a total of 6 weeks and were supervised every 2 weeks. Subjective and objective assessments were made including pain, performance level and possible mobility, using Constant's functional shoulder assessment and the visual analog scale (VAS). Results: Celecoxib group: Mean initial Constant scale score was 60; after the first dose it remained unchanged. After 2 weeks of treatment with Celecoxib the mean Constant score was 66; by 6 weeks it was 70.33, with p > 0.005. The botulinum toxin group received a maximum dose of 200 IU in the affected shoulder, 50 IU were administered subacromially and 150 in the painful spots. This treatment was combined with rehabilitation exercises supervised at the doctor's office. The mean initial Constant scale score was 58; immediately after the first dose it went up to 70.83. Two weeks after the injection and the supervision of rehabilitation exercises at the office, the mean Constant scale score was 77.16; at six weeks it was 78.5, with p < 0.005 (p = 0.00045). The VAS in the Celecoxib group decreased at six weeks with p < 0.005.

Comparison of Fenton and Fenton-like oxidation for the treatment of cosmetic wastewater.

The treatment of cosmetic wastewaters by Fenton (Fe²âº/H2O2) and Fenton-like (Fe³âº/H2O2) oxidation has been studied. From batch and continuous experiments it has been proved that both versions of the Fenton process lead to quite similar results in terms of chemical oxygen demand (COD) and total organic carbon reduction although the COD shows a slightly higher rate in the early stages of reaction. COD reductions of around 55% after 2 h reaction time and 75-80% with 4 h residence time were reached in batch and continuous experiments, respectively, conducted at pH around 3, ambient temperature (20 °C), with 200 mg/L of Fe dose and an initial H2O2/COD weight ratio corresponding to the theoretical stoichiometric value. Achieving the locally allowable limit of COD for industrial wastewater discharge into the municipal sewer system takes no more than 30 min reaction time under those conditions by both Fenton systems. However, the Fenton-like process, where iron is fed as Fe(3+), would be preferable for industrial applications since the ferric sludge resulting upon final neutralization of the effluent can be recycled to the process. A second-order kinetic equation with respect to COD fitted fairly well the experimental results at different temperatures, thus providing a simple practical tool for design purposes.

[Functional results of type A botulinum toxin versus oral anti-inflammatory agents in the rehabilitation of painful shoulder syndrome caused by rotator cuff lesion]. / Resultados funcionales de la aplicación de toxina botuínica tipo A contra antiinflamatorios orales en la rehabilitación de síndrome de hombro doloroso por lesión del mango de los rotadores.

UNLABELLED: Rotator cuff conditions are characterized by unspecific signs, as well as anatomic alterations and symptoms. They have a multifactorial etiology and may include everything from tendinitis to massive, full thickness tears of the rotator cuff tendon that compromise the normal biomechanics of the involved shoulder. They usually occur in people over 40 years of age but lesions resulting from trauma may vary according to the mechanism of injury and are not directly related with the age at onset of symptoms. Vascular factors have been described as related with rotator cuff tendon damage in conditions affecting the microcirculation. However, recent studies have not proven that the tendon under direct observation shows hypovascularity. Type A botulinum toxin acts by blocking the release of acetylcholine in the neuromuscular plate; in the joints it releases capsular tension and reduces proinflammatory factors such as interleukin-1 (IL-1). There are only a few papers on its intraarticular benefit; in muscle and tendon groups it not only has a muscle relaxant effect, but several publications support its utility for pain management. It has been widely used in the rehabilitation of this group of patients at low doses. Material and methods: Prospective, investigational and longitudinal study involving the follow-up of 24 patients with a diagnosis of painful shoulder syndrome proven clinically and with imaging tests, and caused by rotator cuff lesions. The patients either did not meet the criteria for immediate surgical repair or had already undergone such a repair. Type A botulinum toxin was applied to 12 patients in the subacromial space around the rotator cuff conjoint tendon, as well as in the painful spots and in the muscle contracture in the shoulder. The total dose of Type A botulinum toxin was 200 IU. The control group, also composed of 12 patients, was given a COX-2 oral antiinflammatory agent for 6 weeks (Celecoxib, 100 mg BID). Both groups followed a pre-established rehabilitation program for a total of 6 weeks and were supervised every 2 weeks. Subjective and objective assessments were made including pain, performance level and possible mobility, using Constant's functional shoulder assessment and the visual analog scale (VAS). RESULTS: Celecoxib group: Mean initial Constant scale score was 60; after the first dose it remained unchanged. After 2 weeks of treatment with Celecoxib the mean Constant score was 66; by 6 weeks it was 70.33, with p > 0.005. The botulinum toxin group received a maximum dose of 200 IU in the affected shoulder, 50 IU were administered subacromially and 150 in the painful spots. This treatment was combined with rehabilitation exercises supervised at the doc tor's office. The mean initial Constant scale score was 58; immediately after the first dose it went up to 70.83. Two weeks after the injection and the supervision of rehabilitation exercises at the office, the mean Constant scale score was 77.16; at six weeks it was 78.5, with p < 0.005 (p = 0.00045). The VAS in the Celecoxib group decreased at six weeks with p < 0.005.

Oxidation of cosmetic wastewaters with H(2)O(2) using a Fe/gamma-Al(2)O(3) catalyst.

A catalyst based on Fe supported on gamma-Al(2)O(3) has been prepared and tested for catalytic wet peroxide oxidation (CWPO) of cosmetic wastewaters. The influence of the main operating conditions (space-time, temperature, and H(2)O(2) dose) have been investigated. Working with this self-made Fe/gamma-Al(2)O(3) catalyst at 85 degrees C, with a space-time of 9.4 kg(cat) h/kg(COD) and a dose of H(2)O(2), corresponding to 0.5 times the theoretical stoichiometric H(2)O(2)/COD ratio, a substantial COD reduction (around 80%) has been reached with a complete consumption of H(2)O(2). The locally allowable limit of COD for industrial wastewaters discharge to the municipal sewer system can be achieved at lower temperature and space-time. The catalyst showed a high stability in 100 h time on stream tests, where COD and TOC reductions around 82 and 60%, respectively, were maintained working at 85 degrees C and 9.4 kg(cat) h/kg(COD) space-time. Fe leaching from the catalyst upon that time on stream was lower than 3% of the initial load.

[Methotrexate-associated lymphoproliferative disorder presenting as oral ulcers in a patient with rheumatoid arthritis]. / Ulceras orales como manifestación clínica de proceso linfoproliferativo asociado a metotrexato en una paciente con artritis reumatoide.

Methotrexate-associated lymphoproliferative disorders are a heterogeneous group of lymphoid proliferations or lymphomas that develop in patients with autoimmune diseases treated using methotrexate. These lymphoproliferative disorders are often associated with Epstein-Barr virus infection and occasionally regress after the withdrawal of methotrexate therapy. The lymphoproliferative disorder in this case was diffuse large B-cell lymphoma, unusually presenting as oral ulcers in a 79-year-old woman on treatment with methotrexate for longstanding rheumatoid arthritis. Latent membrane protein 1 positivity was detected by immunohistochemistry and Epstein-Barr-virus encoded small RNA positivity by chromogenic in situ hybridization. Clonality was confirmed by immunohistochemistry (kappa light-chain restriction), polymerase chain reaction (monoclonal immunoglobulin H gene rearrangement), and capillary electrophoresis (GeneScan). Staging procedures were negative. Withdrawal of methotrexate therapy led to complete remission within 6 weeks, and the patient is alive and disease-free 18 months after the diagnosis was made. The oral cavity is not often involved in the initial presentation of methotrexate-associated lymphoproliferative disorders, and presentation with intraoral ulcers is very rare. We have performed a review of the literature on methotrexate-associated lymphoproliferative disorders presenting as ulcers in the oral cavity.

Úlceras orales como manifestación clínica de proceso linfoproliferativo asociado a metotrexato en una paciente con artritis reumatoide / Methotrexate-Associated Lymphoproliferative Disorder Presenting As Oral Ulcers in a Patient With Rheumatoid Arthritis

Los procesos linfoproliferativos asociados a metotrexato son un grupo heterogéneo de proliferaciones linfoides o linfomas que se desarrollan en pacientes con enfermedades autoinmunes tratados con metotrexato. Con frecuencia, se asocian a infección por el virus de Epstein-Barr (VEB) y, ocasionalmente, involucionan al suspender el metotrexato. Se presenta un caso de proceso linfoproliferativo tipo linfoma B difuso de célula grande, con una presentación clínica inusual de úlceras orales, afectando a una paciente de 79 años, con artritis reumatoide de larga evolución en tratamiento con metotrexato. Se detectó positividad para LMP-1 (proteína latente de membrana-1) y EBER (Epstein-Barr encoded RNA) por inmunohistoquímica e hibridación in situ cromogénica, respectivamente. Se confirmó la clonalidad del infiltrado por inmunohistoquímica (restricción de cadenas ligeras), PCR (reordenamiento monoclonal del gen IgH) y electroforesis capilar (GeneScan). El estudio de extensión fue negativo. La suspensión del metotrexato condujo a la remisión completa en 6 semanas. Dieciocho meses después del diagnóstico la paciente continúa libre de enfermedad. Los procesos linfoproliferativos asociados a metotrexato raramente afectan primariamente a la cavidad oral y, sólo excepcionalmente, se manifiestan en forma de úlceras. Se revisa la literatura relativa a procesos linfoproliferativos asociados a metotrexato con presentación clínica de úlceras orales (AU)

Methotrexate-associated lymphoproliferative disorders are a heterogeneous group of lymphoid proliferations or lymphomas that develop in patients with autoimmune diseases treated using methotrexate. These lymphoproliferative disorders are often associated with Epstein-Barr virus infection and occasionally regress after the withdrawal of methotrexate therapy. The lymphoproliferative disorder in this case was diffuse large B-cell lymphoma, unusually presenting as oral ulcers in a 79-year-old woman on treatment with methotrexate for longstanding rheumatoid arthritis. Latent membrane protein 1 positivity was detected by immunohistochemistry and Epstein-Barr-virus encoded small RNA positivity by chromogenic in situ hybridization. Clonality was confirmed by immunohistochemistry (K light-chain restriction), polymerase chain reaction (monoclonal immunoglobulin H gene rearrangement), and capillary electrophoresis (GeneScan). Staging procedures were negative. Withdrawal of methotrexate therapy led to complete remission within 6 weeks, and the patient is alive and disease-free 18 months after the diagnosis was made. The oral cavity is not often involved in the initial presentation of methotrexate-associated lymphoproliferative disorders, and presentation with intraoral ulcers is very rare. We have performed a review of the literature on methotrexate-associated lymphoproliferative disorders presenting as ulcers in the oral cavity (AU)

Queratodermia acuagénica: tres nuevos casos y revisión de la literatura / Aquagenic keratoderma: 3 new cases and a review of the literature

La queratodermia acuagénica es una rara variante de queratodermia adquirida y transitoria, que se desencadena o intensifica con la inmersión en el agua de las palmas o las plantas. Se caracteriza por pápulas blanquecinas o translúcidas, con una depresión puntiforme central, confluentes en placas edematosas, de aspecto macerado. Aparece a los pocos minutos de la exposición al agua y remite al poco tiempo del secado. Se presentan tres nuevos casos de queratodermia acuagénica que afectan a un varón de 28 años con antecedentes de enfermedad de Behçet, una mujer de 18 años y un varón de 20 años. Se discuten la clínica, la histopatología, el tratamiento y la evolución de las lesiones de los casos descritos en la literatura (AU)

Aquagenic keratoderma is a rare type of transient acquired keratoderma that is triggered or exacerbated by immersion of the palms or soles in water. It is characterized by whitish or translucent papules with central punctate depressions that coalesce in macerated edematous plaques. It appears within a few minutes of exposure to water and subsides soon after drying. We describe 3 new cases of aquagenic keratodermain a 28-year-old man with a history of Behçet disease, an 18-year-old woman, and a 20-year-old man. We discuss the clinical and histopathologic features, treatment options, and course of the lesions in the cases described in the literature (AU)