Puntuación de la escala de Norton al ingreso y mortalidad en pacientes hospitalizados en Medicina Interna / Norton scale score on admission and mortality of patients hospitalised in Internal Medicine departments

Objetivo. Determinar la asociación entre la puntuación de la escala de Norton (que valora el riesgo de padecer úlceras por presión) y la mortalidad a corto, medio y largo plazo en los pacientes hospitalizados en Medicina Interna. Pacientes y métodos. Estudio de cohortes prospectivo, unicéntrico, de pacientes ingresados en los meses de octubre de 2010, y enero, mayo y octubre de 2011. Se recogieron la edad, sexo, índice de Barthel, escala de Norton, presencia de úlceras por presión, categoría diagnóstica mayor, estancia hospitalaria y peso del grupo relacionado de diagnóstico. Se dividió a los pacientes según las categorías de riesgo de la escala de Norton. El seguimiento fue de 3 años. Resultados. Se incluyeron 624 pacientes con una edad mediana (rango intercuartílico) de 79 (17) años y una puntuación mediana en la escala de Norton de 16 (7). Durante el ingreso fallecieron 74 (11,9%) pacientes, a los 6 meses 176 (28,2%), al año 212 (34,0%), y a los 3 años 296 (47,4%). La mortalidad fue mayor en las categorías de más riesgo en la escala de Norton. La puntuación en la escala de Norton se asoció de forma independiente con la mortalidad a los 6 meses (p<0,001), al año (p=0,005), y 3 años (p=0,002). Las áreas bajo la curva de la escala de Norton fueron 0,746 (IC95% 0,686-0,806), 0,735 (IC95% 0,691-0,780) y 0,751 (IC95% 0,713-0,789), respectivamente (p<0,001). Conclusiones. La escala de Norton es útil para predecir el pronóstico a corto, medio y largo plazo en pacientes ingresados en Medicina Interna

Objective. To determine the association between the Norton scale score (which assesses the risk of pressure ulcers) and mortality in the short, medium and long term in patients hospitalised in Internal Medicine departments. Patients and methods. A prospective, single-centre cohort study was conducted on patients hospitalised in the months of October 2010 and January, May and October 2011. Data was collected on age, sex, Barthel index, Norton scale, presence of pressure ulcers, major diagnostic category, hospital stay and weight of the diagnosis-related group. The patients were divided according to the risk categories of the Norton scale. The follow-up was 3 years. Results. The study included 624 patients with a median age (interquartile range) of 79 (17) years and a median Norton scale score of 16 (7). During hospitalisation, 74 (11.9%) patients died, 176 (28.2%) died at 6 months, 212 (34.0%) died at 1 year, and 296 (47.4%) died at 3 years. Mortality was greater in the higher risk categories of the Norton scale. The Norton score was independently associated with mortality at 6 months (p<.001), at 1 year (p=.005), and at 3 years (p=.002). The areas under the curve of the Norton scale were 0.746 (95% CI 0.686-0.806), 0.735 (95% CI 0.691-0.780) and 0.751 (95% CI 0.713-0.789), respectively (p<.001). Conclusions. The Norton scale is useful for predicting the prognosis in the short, medium and long term in patients hospitalized in internal medicine departments

Norton scale score on admission and mortality of patients hospitalised in Internal Medicine departments. / Puntuación de la escala de Norton al ingreso y mortalidad en pacientes hospitalizados en Medicina Interna.

OBJECTIVE: To determine the association between the Norton scale score (which assesses the risk of pressure ulcers) and mortality in the short, medium and long term in patients hospitalised in Internal Medicine departments. PATIENTS AND METHODS: A prospective, single-centre cohort study was conducted on patients hospitalised in the months of October 2010 and January, May and October 2011. Data was collected on age, sex, Barthel index, Norton scale, presence of pressure ulcers, major diagnostic category, hospital stay and weight of the diagnosis-related group. The patients were divided according to the risk categories of the Norton scale. The follow-up was 3 years. RESULTS: The study included 624 patients with a median age (interquartile range) of 79 (17) years and a median Norton scale score of 16 (7). During hospitalisation, 74 (11.9%) patients died, 176 (28.2%) died at 6 months, 212 (34.0%) died at 1 year, and 296 (47.4%) died at 3 years. Mortality was greater in the higher risk categories of the Norton scale. The Norton score was independently associated with mortality at 6 months (p<.001), at 1 year (p=.005), and at 3 years (p=.002). The areas under the curve of the Norton scale were 0.746 (95% CI 0.686-0.806), 0.735 (95% CI 0.691-0.780) and 0.751 (95% CI 0.713-0.789), respectively (p<.001). CONCLUSIONS: The Norton scale is useful for predicting the prognosis in the short, medium and long term in patients hospitalized in internal medicine departments.

Real-time quantification of human telomerase reverse transcriptase mRNA in the plasma of patients with prostate cancer.

The aim of this study was to evaluate the potential diagnostic value of quantitative analysis of human telomerase reverse transcriptase (hTERT) mRNA in plasma for noninvasive diagnosis of prostate cancer (PCa). Expression levels of hTERT were analyzed by real-time quantitative RT-PCR in 68 patients showing elevated prostate-specific antigen (PSA) levels and a control group of 44 healthy volunteers. Sensitivity and specificity were determined and compared to the corresponding PSA values. Median values for hTERT gene expression in the PCa patients (0.72 ng; range 0.01-12.86) were statistically significantly higher (P < 0.001) than in the control group (0.13 ng; 0.02-0.35). Patients with clinically confirmed prostatitis showed lower plasma hTERT expression than PCa patients (0.29; 0.01-66.07). At a cutoff value of 0.35 sensitivity and specificity for the diagnosis of PCa were 81% and 60%, respectively. We suggest that hTERT mRNA in plasma is a very specific and sensitive method that may aid to differentiate between malignant and nonmalignant prostate tissue and may be a useful marker (in combination with PSA) for early PCa diagnosis.

[The effects of enalapril on exercise capacity and right ventricular function in patients with chronic cor pulmonale]. / Efectos del enalapril sobre la capacidad de ejercicio y la función ventricular derecha en pacientes con cor pulmonale crónico.

BACKGROUND: Chronic cor pulmonale (CPC) in patients with chronic obstructive pulmonary disease (COPD) is a predictor of mortality. ACE inhibitors (ACEIs) improve the symptoms and reduce mortality of left ventricular or congestive failure, however their long term use in patients with CPC has not been tested. The aim of this study is to assess the effect on exercise tolerance and cardiorespiratory function of long term administration of enalapril in patients with CPC. METHODS: Placebo-controlled, double blind, randomized study. 28 patients (24 men and 4 women, mean age of 68.11 +/- 7.78, range 51-79) with CPC and without exacerbation of their respiratory symptoms at baseline were double blind randomised to receive enalapril or placebo for 6 months, added to their previous therapy. Respiratory function test, exercise tolerance ("six minutes walking test") and isotopic ventriculography were performed at baseline and at the end of the study. RESULTS: At baseline there were no differences in FEV1, FVC, FEV1/FVC and exercise tolerance. Both placebo and enalapril were well tolerated. At the end of the study, patients taking enalapril increased their exercise tolerance an 8.9% (19 m) vs 4.7% (33 m) in the placebo group (p 0.44; 95 percent confidence interval, -41.10 to 91.99). RVEF improved a 6.4% with enalapril but worsened a 7.09% in placebo group (p 0.15; 95 percent confidence interval, -12.87 to 2.10). CONCLUSIONS: Long term administration of enalapril do not improve neither exercise tolerance, nor right ventricular (RV) function, although given in increasingly doses is well tolerated and might prevent further worsening in RV systolic function.

Efectos del enalapril sobre la capacidad de ejercicio y la función ventricular derecha en pacientes con Cor pulmonale crónico / Effects of enalapril on exercise capacity and rigth ventricular function in patients with chronic cor pulmonale

Fundamentos: El Cor Pulmonale Crónico (CPC) en pacientes con limitación crónica al flujo aéreo es un predictor de mortalidad. Los IECA reducen la morbimortalidad en pacientes con fallo ventricular izquierdo o congestivo. Su efecto a largo plazo en pacientes con CPC no ha sido investigado. Nos propusimos investigar el efecto del enalapril sobre la capacidad de esfuerzo y función cardiorrespiratoria en pacientes con CPC. Métodos: Estudio prospectivo, doble ciego, randomizado, controlado con placebo. 28 pacientes (24 hombres y 4 mujeres, con edad media de 68,11 ñ 7,78, rango 51-79) con CPC, clinicamente estables, fueron randomizados para recibir enalapril o placebo, vía oral, durante 6 meses, añadido a su terapia habitual. Antes del inicio y a los 6 meses se realizaron test de función respiratoria, de tolerancia al esfuerzo ("test de 6 minutos caminando") y ventriculografía isotópica Resultados: No existían diferencias en los valores basales de FEV1, FVC, FEV1/FVC y tolerancia al esfuerzo. Al final del estudio los pacientes del grupo enalapril mostraban un incremento de tolerancia al ejercicio del 8,9 porciento (19 m) vs 4,7 porciento (33 m) los del grupo placebo (p 0,44; 95 porciento IC, -41,10 a 91,99). La fracción de eyección ventrícular derecha mejoró un 6,4 porciento con enalapril pero empeoró un 7,09 porciento con placebo (p 0,15; 95 porciento IC, -12,87 a 2,10). Conclusiones: La administración a largo plazo de enalapril en dosis crecientes aunque se tolera bien en el CPC no mejora significativamente la tolerancia al esfuerzo, ni la función ventricular derecha (AU)

[Achilles tendon size by high resolution sonography in healthy population. Relationship with lipid levels]. / Tamaño del tendón de Aquiles por ecografía de alta resolución en población sana. Relación con las concentraciones lipídicas.

BACKGROUND: Sonography is a useful technique for the study of the Achilles tendon, and specially in the detection of tendon xantomas. Normal sonographic size is not well established, and is essential in the clinical diagnosis of monogenic familial hypercholesterolemia (FH). Possible relationship between Achilles tendon size and plasma lipid concentrations in normolipidemic population is not known. SUBJECTS AND METHODS: The antero-posterior Achilles tendon diameter (ATD) was measured with high resolution sonography in 100 healthy subjects, 50 males and 50 females, 20-70 years old, 10 subjects for each decade of age and sex. ATD was correlated with age, gender, body mass index, physical activity and lipid and apolipoprotein B plasma concentrations. RESULTS: The ATD was significantly higher in males than in females, 5.32 (standard desviation [SD] 0.48) mm versus 4.91 (SD 0.47) mm (p < 0.01). In the multivariate analysis, ATD of males was positively associated with total plasma cholesterol (TC) level (p < 0.01). The ATD in females was positively associated with weight (p < 0.01). CONCLUSIONS: Normal ATD has been defined. Its range is relatively narrow and different in both sexes. Similarities in the histology between vascular and tendinous intersticium probably explain the relationship found between Achilles tendon and TC. Achilles tendon size could be a simple marker of lipid deposition in tissues.

[Study of smoking habit among the adult population of Aragón]. / Estudio del hábito tabáquico en población adulta aragonesa.

We determined the prevalence of tobacco consumption among the general population and established its distribution considering socioeconomical variables. We performed a cross-sectional study with 2781 subjects from 93 rural and urban areas, selected by randomized, census-based, multi-staged and stratified sampling. 40.9% of the population from Aragon are regular smokers (58.6 of men and 23% of women). Heavy smokers comprise 17.2% of the total (30.1% of men and 3.8% of women). The higher proportion of smokers in observed among single men over 40 and single women under 40. The percentage of smokers is lower among 20 to 29-years-old young people from high socio-economical than from low levels. In general, the mean percentage of smokers among men and, specially, among women from rural areas is higher than in the rural areas. In Aragon, tobacco is a risk factor affecting 41% of the adult population and, specially, young people, men, single persons from both sexes and living in urban areas. It seems that young people with a high socio-economical level are becoming smokers at a lower frequency.

[Idiopathic retroperitoneal fibrosis. An atypical case of multisystem presentation]. / Fibrosis retroperitoneal idiopática. Un caso atípico de presentación multisistémica.

Idiopathic retroperitoneal fibrosis (IRF) is a disease difficult to diagnose. It is considered by different authors of autoimmune origin given its similarity to other connective tissue diseases. We present the case of a female patient diagnosed by a postmortem study, of IRF with multiorgan involvement (lymph nodes, serose tissue, liver, spleen, adrenal glands, thyroid and kidneys) and atypical presentation, not finding other similar cases in the national literature.