Procedural sedation and analgesia during enzymatic debridement of burn patients.

Procedural sedation and analgesia (PSA) is a widely used strategy in various fields to carry out numerous diagnostic and therapeutic procedures. However, there is limited information on its efficacy and safety during enzymatic debridement of burn patients with Nexobrid®. The aim of our study was to describe the U-type PSA procedure in a series of patients requiring enzymatic debridement. We carried out a retrospective, descriptive study involving 28 patients requiring enzymatic debridement of a limb, trunk or multiple locations, who had been admitted to the Burn Unit of the University Hospital Complex of A Coruña (Spain). Of these, 17 patients (not requiring invasive mechanical ventilation [IMV]) received intravenous PSA and two received local/regional anesthesia. Among those patients who received PSA, the most frequently used sedative during the application and removal of Nexobrid® was ketamine following premedication with midazolam (median Ramsay sedation score = 3; range = 2-4). The most common type of analgesics prescribed for the debridement procedure was opioids. Three patients required rescue analgesia because of the intensity of their pain (Visual Analogue Scale [VAS] ≥ 4). The patients did not experience any of the complications analyzed. In our case series, U-type PSA proved to be a satisfactory and safe support strategy for enzymatic debridement of burn patients not requiring IMV due to another cause.

L'analgésie-sédation (AS) est largement utilisée au cours d'actes diagnostiques et thérapeutiques. Cependant, nous ne disposons que de peu de données concernant son efficacité et son innocuité et son efficacité durant le débridement enzymatique par Nexobrid® chez les brûlés. Nous décrivons ici une série rétrospective de 28 patients hospitalisés dans le CTB de La Corogne (Espagne) ayant bénéficié d'un débridement enzymatique du tronc, des membres ou de localisations multiples sous analgo-analgésie séquentielle avec rétrocontrôle. Parmi ces patients, 17 n'étaient pas ventilés et ont reçu une AS intraveineuse, 2 ont bénéficié d'anesthésie locale ou locorégionale. L'agent hypnotique le plus utilisé lors de la mise en place et du retrait de Nexobrid® était la kétamine (après prémédication par midazolam). Le score de sédation (Ramsay) médian était de 3 (interquartiles 2 et 4). Les opiacés étaient les analgésiques les plus fréquents. Trois patients ont eu besoin d'analgésie supplémentaire, indiquée par une EVA ≥ 4. Aucune complication n'a été retrouvée. Dans cette série, l'analgoanalgésie séquentielle avec rétrocontrôle apparaît comme un moyen efficace et sûr d'assurer l'analgésie pendant un débridement enzymatique chez des brûlés en ventilation spontanée.

Cross-sectional study about impact of parental smoking on rhinitis symptoms in children.

OBJECTIVE: Assess the prevalence of rhinitis and exposure to environmental tobacco smoke (ETS) of children in our community and its relationship with symptoms of rhinitis METHODS (DESIGN, SETTING, PARTICIPANTS, MAIN OUTCOME MEASURES): Cross-sectional study using questionnaire on rhinitis of the International Study of Asthma and Allergies in Childhood, in children (6-7 years) and adolescents (13-14 years). Categories: "rhinitis ever", "recent rhinitis", "recent rhinoconjunctivitis", "severe rhinoconjunctivitis". Parental smoking: (i) neither parent smokes; (ii) only the mother smokes; (iii) only the father smokes; and (iv) both parents smoke. Odds ratio of the prevalence of symptoms of rhinitis according to ETS exposure was calculated using logistic regression. RESULTS: 10 690 children and 10 730 adolescents. The prevalence of "rhinitis ever" in children: 29.4%, "recent rhinitis" 24%, "recent rhinoconjunctivitis" 11.5% and "severe rhinoconjunctivitis" 0.1%. In adolescents: 46.2%, 34.5%, 16.2% and 0.2%, respectively. Environmental tobacco smoke exposure in the home occurred in 51% of cases. Parental smoking was associated with a higher prevalence of forms of rhinitis in adolescents when only the mother was a smoker. In children when both parents were smokers. CONCLUSION: Rhinitis is highly prevalent in our community. Environmental tobacco smoke exposure is still very common. The relationship between ETS and rhinitis symptoms in children of this community is not as robust as that found for asthma.

Trends on epidemiological, virological, and clinical features among newly diagnosed HIV-1 persons in Northwest Spain over the last 10 years.

To describe temporal trend and characteristics of newly HIV-diagnosed patients in a medical care area in Northwest Spain over the last 10 years. All newly diagnosed patients for HIV-infection from 2004 to 2013 at a reference medical care area in Northwest of Spain were identified. Epidemiological, virological, immunological, and clinical data, as well as HIV genotype and drug resistance information were recorded. A total of 565 newly HIV-diagnosed patients were identified. The number of new cases increased in the last 5 years (66 cases/year). Overall, 53.1% had a median CD4 counts < 350 cells/µl and 33.6% had an AIDS defining criteria. Non-B variants were found in 34.4% of patients being subtype F (25.8%) the most common non-B subtype. The rate of transmitted drug resistance (TDR) over the study period was 3.7%, but a decreased to 2.6% was observed in the last 5 years. The most prevalent TDR mutations were: T215 revertants (1.5%), K219QENR (1.2%), for NRTIs; K103N (1.9%), for NNRTIs; L90M (0.3%), for PIs. Overall, 73.2% of patients started antiretroviral treatment and 9.9% of patients died during follow-up. The number of newly HIV diagnosed patients increased since year 2009. There is a high prevalence of late diagnosis (53%) and 33% had an AIDS defining criteria. Interestingly, the most prevalent non-B subtype in our population was F (25.8%). These findings support the need to facilitate the access for HIV testing to reduce the rate of late HIV diagnosis, improve the clinical outcome and prevent HIV transmission.

Obesity and asthma: An association modified by age

Background: Some studies indicate some causal relationship between obesity and asthma, while others show inconsistent results. Our objective was to evaluate the prevalence of asthma according to obesity in children. Methods: A cross-sectional study, following the ISAAC study methodology, was conducted on two randomly selected groups consisting of 6---7 year-old children (n = 7485) and 13-14 year-old adolescents (n = 8496).The asthma symptoms and potential risk factors were determined from the questionnaire. Overweight and obesity were defined based on the body mass index. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) and 95%confidence intervals. Results: Obesity was associated with an increase in wheezing ever (OR: 1.35) and exercise induced asthma (OR: 1.62) in the 6-7 year-old group. No significant relationship was observed in the adolescent population. Conclusion: Obesity was associated with a higher prevalence of asthma in young children, but not in adolescents (AU)

Truck traffic related air pollution associated with asthma symptoms in young boys: a cross-sectional study.

OBJECTIVES: The aim of this study was to evaluate the influence of intensity of truck traffic on asthma symptomatology, and its relationship with age and gender. STUDY DESIGN: A cross-sectional study was conducted on children and adolescents from Galicia (North-West Spain). METHODS: Following the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC): children from schools randomly selected, answered a self-administered questionnaire included questions on asthma symptoms and some risk factors. The association between self-reported truck traffic on the street of residence and symptoms of asthma were investigated by logistic regression adjusted for body mass index, maternal education and parental smoking. RESULTS: Almost 40% of children in Galicia are exposed to the frequent and constant passing of heavy goods vehicles. The odds of 6-7 year-old boys having severe or exercise induced asthma is tripled when they live in streets with the constant passing of heavy goods vehicles, compared with those living in streets where these vehicles never pass. In adolescents and 6-7 year-old girls, no relationship was observed between truck traffic and asthma symptoms. CONCLUSIONS: The results of this study appear to support a distinct effect of truck traffic on asthma symptoms depending on the age and sex of the exposed population, being more harmful for young males.

Obesity and asthma: an association modified by age.

BACKGROUND: Some studies indicate some causal relationship between obesity and asthma, while others show inconsistent results. Our objective was to evaluate the prevalence of asthma according to obesity in children. METHODS: A cross-sectional study, following the ISAAC study methodology, was conducted on two randomly selected groups consisting of 6-7 year-old children (n=7485) and 13-14 year-old adolescents (n=8496). The asthma symptoms and potential risk factors were determined from the questionnaire. Overweight and obesity were defined based on the body mass index. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals. RESULTS: Obesity was associated with an increase in wheezing ever (OR: 1.35) and exercise-induced asthma (OR: 1.62) in the 6-7 year-old group. No significant relationship was observed in the adolescent population. CONCLUSION: Obesity was associated with a higher prevalence of asthma in young children, but not in adolescents.

Valoración de actividades básicas de la vida diaria y de deterioro cognitivo en centenarios: concordancia entre las escalas utilizadas / Assessment of basic activities of daily living and cognitive impairment in centenarians: correlation between the scales used

Objetivo. Analizar la concordancia entre escalas de actividades básicas de la vida diaria (ABVD) y de deterioro cognitivo en centenarios. Método. Entrevista domiciliaria a todos los centenarios de nuestra área, cumplimentándose tres escalas de ABVD (índice de Katz [IK], índice de Barthel [IB] e índice de incapacidad física de la Cruz Roja [IFCR]), y dos de valoración de deterioro cognitivo (miniexamen cognoscitivo [MEC], y el índice de incapacidad psíquica de la Cruz Roja [IPCR]). Se valoró la concordancia mediante el índice kappa. Resultados. Se entrevistó a 80 centenarios, 26 hombres y 64 mujeres, media de edad, 100,8±1,3 años. Más de la mitad de los centenarios presentaron independencia funcional o dependencia leve, siendo los hombres independientes con más frecuencia (IB 70±34,4 frente a 50,4±36,3; p=0,005). Al valorar deterioro cognitivo, los resultados fueron discordantes, aunque los hombres presentaron menos deterioro cognitivo que las mujeres (MEC, 16,5±9,1 vs. 11,6±8,1; p=0,008). Los tres cuestionarios que miden ABVD (IK, IB, IFCR) clasificaron uniformemente a los centenarios; el IK y el IB clasifican igual al 95% de los centenarios (kappa, 0,899), el IB y el IFCR al 97,5% (kappa, 0,95) y el IK e IFCR al 97,5% (kappa, 0,95). La concordancia en los cuestionarios de deterioro cognitivo fue muy baja; se clasificaron igual al 58,8% de los centenarios (kappa, 0,295). Conclusiones. Cualquiera de las tres escalas de ABVD es útil en pacientes centenarios. Sin embargo, está por definir cómo valorar el deterioro cognitivo(AU)

Objective. To analyse the concordance between different scales used to assess basic activities of daily living and cognitive impairment in centenarians. Method. A domiciliary interview was carried out with all centenarians in our area. Three scales of basic activities of daily living (Katz index [KI], Barthel index [BI], Red Cross physical impairment index [RCPI]), and two of cognitive impairment assessment(Mini cognoscitive test [MCT], Red Cross psychic impairment index [RCPI]) were completed. Results. A total of 80 centenarians were interviewed, 26 men and 64 women, mean age 100.8±1.3. More than half of centenarians had functional independence or slight dependence. Men were more frequently independent than women (BI 70±34.4 vs. 50.4±36.3; P=.005). The results of cognitive impairment tests were discordant, although men had less cognitive impairment than women (MCT 16.5±9.1 vs. 11.6±8.1; P=.008). The three scales of basic activities of daily living uniformly classified the centenarians, with a high level of concordance between them: KI and BI similarly classified up to 95% of the centenarians (Kappa 0.899), BI and RCPI to 97.5% (kappa 0.95), KI and RCPI to 97.5% (Kappa 0.95). Nevertheless, the concordance between the cognitive impairment measured by RCPI and MCT was low; only 58.8% of centenarians were equally classified (Kappa 0.295). Conclusions. Any of three scales analysed for assessment of basic activities of daily living is useful in centenarians. Nevertheless, the best way to assess cognitive impairment in these patients needs to be defined(AU)

[Assessment of basic activities of daily living and cognitive impairment in centenarians: correlation between the scales used]. / Valoración de actividades básicas de la vida diaria y de deterioro cognitivo en centenarios: concordancia entre las escalas utilizadas.

OBJECTIVE: To analyse the concordance between different scales used to assess basic activities of daily living and cognitive impairment in centenarians. METHOD: A domiciliary interview was carried out with all centenarians in our area. Three scales of basic activities of daily living (Katz index [KI], Barthel index [BI], Red Cross physical impairment index [RCPI]), and two of cognitive impairment assessment(Mini cognoscitive test [MCT], Red Cross psychic impairment index [RCPI]) were completed. RESULTS: A total of 80 centenarians were interviewed, 26 men and 64 women, mean age 100.8±1.3. More than half of centenarians had functional independence or slight dependence. Men were more frequently independent than women (BI 70±34.4 vs. 50.4±36.3; P=.005). The results of cognitive impairment tests were discordant, although men had less cognitive impairment than women (MCT 16.5±9.1 vs. 11.6±8.1; P=.008). The three scales of basic activities of daily living uniformly classified the centenarians, with a high level of concordance between them: KI and BI similarly classified up to 95% of the centenarians (Kappa 0.899), BI and RCPI to 97.5% (kappa 0.95), KI and RCPI to 97.5% (Kappa 0.95). Nevertheless, the concordance between the cognitive impairment measured by RCPI and MCT was low; only 58.8% of centenarians were equally classified (Kappa 0.295). CONCLUSIONS: Any of three scales analysed for assessment of basic activities of daily living is useful in centenarians. Nevertheless, the best way to assess cognitive impairment in these patients needs to be defined.

Mitochondrial DNA haplogroups and serum levels of proteolytic enzymes in patients with osteoarthritis.

OBJECTIVE: To analyse the influence of mitochondrial DNA haplogroups, as well as the radiographic grade, on serum levels of proteolytic enzymes in patients with osteoarthritis (OA). METHODS: Serum levels of metalloproteinase-1 (MMP-1), MMP-3, MMP-13, myeloperoxidase and cathepsin K were analysed in 73 patients with OA and 77 healthy controls carrying the haplogroups J, U and H, by ELISA. Knee and hip radiographs were classified according to Kellgren and Lawrence (K/L) scoring from grade 0 to grade IV. Non-parametric and multiple regression analyses were performed to test the effects of clinical variables, including gender, age, smoking status, diagnosis, haplogroups and radiological K/L grade on serum levels of these enzymes. RESULTS: A significant influence of the haplogroups on the serum levels of MMP-3 and MMP-13 was detected (p=0.027 and p=0.035, respectively). Patients with OA with haplogroup H showed higher serum levels of MMP-3 than healthy controls. Serum levels of MMP-13 were significantly higher in patients with OA (p<0.001), and carriers of the haplogroup J showed lower levels than H carriers. Besides, levels of MMP-13 were proportionally higher in radiological groups B (K/L grade II and III) and C (K/L grade IV) than in group A (K/L grade 0 and I) (p=0.005). CONCLUSIONS: This study shows that haplogroups have a significant influence on serum levels of MMP-3 and MMP-13. The influence of the haplogroups on serum levels of MMP-3 is clearly dependent on the diagnosis, whereas the influence of the haplogroups on serum levels of MMP-13 is independent of diagnosis.

Mediterranean diet and asthma in Spanish schoolchildren.

There is still debate on the effect of dietetic factors on the prevalence or severity of asthma, as well as the interaction with other factors. We have analysed the prevalence and severity of asthma according to adherence to the Mediterranean diet (MD), its association with obesity and family life style. We performed a cross-sectional study on 14,700 children and adolescents in six health areas in our region. We used the International Study of Asthma and Allergies in Childhood questionnaire to collect asthma symptoms, dietary habits, anthropometric parameters, parental smoking habits and maternal education level. The diet pattern was analysed using a Mediterranean Diet Score. In the logistic regression we analysed the influence of adhering to the MD on the prevalence and severity of asthma, adjusted for the other parameters included. Greater adherence to the MD is associated with a higher risk of severe asthma (odds ratios = 2.26, 95% CI: 1.21-4.22) in girls of 6-7 yr. There was no significant relationship for the other asthma categories in the population studied. The results of our study do not support a protective effect of the MD on the prevalence or severity of asthma.

Analysis of the factors determining survival of alcoholic withdrawal syndrome patients in a general hospital.

AIM: To investigate the clinical variables associated with the risk of dying and the causes of death during the course of alcoholic withdrawal syndrome (AWS) in a general hospital. METHODS: Cohort study of AWS patients admitted to Xeral Hospital in Lugo, Spain between 1987 and 2003. The characteristics of patients who died were contrasted with those who survived. The different clinical, epidemiological and biochemical variables reflective of alcohol consumption habits, basal health status and presentation features of the syndrome and its complications were all recorded. RESULTS: There were 539 episodes of hospitalization for AWS in 436 patients (mean age 45.0, SD 12.0, 91.3% males), 71.1% of whom presented with delirium tremens. A total of 29 patients died, yielding a 6.6% mortality rate (95% confidence interval, CI: 4.2-9.1%). Eighteen patients (62%) died after being admitted to the intensive care unit (ICU). The following independent variables were associated with the risk of dying in a multivariate logistic regression model: cirrhosis [odds ratio (OR) 4.8 (95% CI 1.5-14.6), P = 0.006]; presenting with delirium tremens at diagnosis [OR 3.5 (95% CI 1.3-8.9), P = 0.008]; the existence of an underlying chronic pathology other than liver disease [OR 2.5 (95% CI 1-6.1), P = 0.01]; and the need for orotracheal intubation [OR 2.9 (95% CI 1.1-7.9), P = 0.03], especially if pneumonia requiring ICU is added [OR 8 (95% CI 3-21.3), P < 0.001]. Receiver operating characteristic analysis revealed an area under the curve of 0.818 (95% CI 0.742-0.894). CONCLUSIONS: The factors determining survival after admission to a general hospital for alcoholic withdrawal syndrome depend on the intensity of clinical manifestations (delirium tremens, ICU, orotracheal intubation) and the presence of associated comorbidity.

Mitochondrial DNA haplogroups modulate the serum levels of biomarkers in patients with osteoarthritis.

OBJECTIVE: To analyse the influence of mitochondrial DNA (mtDNA) haplogroups on serum levels of molecular biomarkers in patients with osteoarthritis (OA). METHODS: Serum levels of molecular biomarkers of cartilage metabolism (collagen type II markers: C-terminal neoepitope generated by the collagenase-mediated cleavage of collagen type II triple helix (C2C), collagen type II (Coll2-1, and its nitrated form, Coll2-1NO(2)), procollagen type II (CPII)), synovial metabolism (hyaluronic acid (HA)) and cartilage and synovial turnover (cartilage glycoprotein 39 (YKL-40)) were analysed in 73 patients with OA and 77 healthy controls using ELISAs. All participants had been previously genotyped for the mtDNA haplogroups J, U and H. Non-parametric and multivariate analysis were performed to test the effects of the clinical variables, including gender, age, smoking status, diagnosis, mtDNA haplogroups and radiological Kellgren and Lawrence (K/L) grade on the serum levels of the molecular markers. RESULTS: Non-parametric analysis found increased serum levels of HA in patients with OA, while the values for C2C and the C2C/CPII ratio were significantly higher in the healthy controls. A multiple regression analysis showed a relationship between the mtDNA haplogroups and serum levels of the typical collagen type II markers. Carriers of the mtDNA haplogroup H had higher levels while carriers of the mtDNA haplogroup J showed lower levels. Statistically significant interactions between mtDNA haplogroups and diagnosis and between mtDNA haplogroups and radiological K/L grade in the serum levels of molecular markers were also found. CONCLUSION: A new role for mtDNA haplogroups emerges from this work. The results suggest that the mtDNA haplogroups interact significantly with the serum levels of OA-related molecular markers, suggesting the possibility of their use as a complementary assay with these molecular markers.

Risk factors for delirium tremens in patients with alcohol withdrawal syndrome in a hospital setting.

BACKGROUND: The clinical expressions of alcohol withdrawal syndrome (AWS) may vary and the factors determining these variations are not well-known. It would be useful to have a set of clinical tools capable of predicting which patients are likely to develop the more severe forms of the syndrome. AIM: To analyse the clinical variables associated with the development of delirium tremens (DTs) in patients who were admitted to a general hospital with AWS. METHODS: Cohort study of AWS patients admitted to the Xeral Hospital in Lugo, Spain, between 1987 and 2003. The characteristics of patients with the syndrome who did not develop delirium tremens were contrasted with those who did. Cases presenting with DTs at diagnosis were excluded. The different clinical, epidemiological and biochemical variables reflective of alcohol consumption habits, basal health status and presentation features of syndrome were all recorded. RESULTS: Data from 156 episodes of AWS that coursed without DTs were compared with 147 cases that coursed with it. Three independent variables for development of DTs were identified in a multivariate logistic regression model: number of seizures [1 or 2: OR 2.2 (CI 95% 1.2-3.8), p=0.005; 3 or more: OR 2.6 (CI 95% 1.04-6.8), p=0.04]; systolic blood pressure >150 mm Hg [OR 1.9 (CI 95% 1.1-3.8), p=0.03] and axillary temperature >38 degrees C [OR 1.9 (CI 95% 1.05-3.5), p=0.01]. ROC analysis revealed an area under the curve of 0.679. CONCLUSION: Three clinical findings (seizures, blood pressure and temperature) can aid in identifying patients with AWS who are likely to develop DTs. The model's predictive capacity is not high.

[Prevalence of malnutrition in medical and surgical wards of a university hospital]. / Prevalencia de malnutrición en los servicios médicos y quirúrgicos de un hospital universitario.

INTRODUCTION: Malnutrition is frequently found in hospitals, where is related to poor outcomes. There are contradictory data about if prevalence of malnutrition is greater in surgical or medical patients. The aim of this study is to know the prevalence of malnutrition in both groups of patients. METHODS: The nutritional status of 189 patients from medical and surgical wards was assessed with Subjective Global Assessment, and data about sex, age, length of hospital stay, mortality, diseases, and wards of admission were collected. Qualitative variables were compared with chi-square test, and independent quantitative variables with Student's t test. P < 0.05 was accepted as significative. RESULTS: The prevalence of malnutrition was 40.2%. Malnourished patients have lost 7.3% of their weight, 67.1% referred a diminished oral intake, and 53.9% anorexia. Malnutrition was significatively associated to male sex, greater length of stay, and cancer. Prevalence and severity of malnutrition were similar in medical and surgical wards, and malnourished patients just differed in diseases (chronic diseases in medical; surgical procedures and cancer in surgery). CONCLUSIONS: Malnutrition is equally prevalent in medical and surgical wards, probably due to different but highly frequent risk factors, and is related to a longer hospital stay.

Prevalencia de malnutrición en los servicios médicos y quirúrgicos de un hospital universitario / Prevalence of malnutrition in medical and surgical wards of a university hospital

Introducción: La malnutrición es frecuente en los hospitales y se asocia a peores resultados clínicos. Existen datos contradictorios sobre si la prevalencia de malnutrición es mayor en los servicios médicos o quirúrgicos. Estudiamos la prevalencia de este trastorno en pacientes de ambos tipos de servicio. Métodos: Se evaluó el estado nutricional de 189 pacientes de servicios médicos y quirúrgicos mediante la Valoración Global Subjetiva, y se recogieron datos sobre su sexo, edad, estancia hospitalaria, mortalidad, patología y servicio de ingreso. Las variables cualitativas se compararon mediante chi-cuadrado, y las variables cuantitativas independientes mediante el test t de Student. Consideramos significativa una p < 0,05.Resultados: La prevalencia de malnutrición fue 40,2%.Los pacientes malnutridos habían perdido un 7,3% de peso, el 67,1% habían reducido su ingesta oral, y el 53,9% referían anorexia. La malnutrición se asoció significativamente al sexo masculino, a una estancia hospitalaria más larga, y a padecer enfermedades crónicas o cáncer. La prevalencia y gravedad de malnutrición fueron similares en servicios médicos y quirúrgicos, pero presentaron distintas patologías de base (enfermedades crónicas en los servicios médicos, intervenciones y cáncer en los quirúrgicos).Conclusiones: La malnutrición es igual de frecuente entre pacientes médicos y quirúrgico, probablemente debido a diferentes pero igualmente frecuentes factores de riesgo, y se asocia a una estancia hospitalaria más larga

Introduction: Malnutrition is frequently found in hospitals, where is related to poor outcomes. There are contradictory data about if prevalence of malnutrition is greater in surgical or medical patients. The aim of this study is to know the prevalence of malnutrition in both groups of patients. Methods: The nutritional status of 189 patients from medical and surgical wards was assessed with Subjective Global Assessment, and data about sex, age, length of hospital stay, mortality, diseases, and wards of admission were collected. Qualitative variables were compared with chi-square test, and independent quantitative variables with Student’s t test. P < 0.05 was accepted as significative. Results: The prevalence of malnutrition was 40.2%.Malnourished patients have lost 7.3% of their weight, 67.1% referred a diminished oral intake, and 53.9% anorexia. Malnutrition was significatively associated to male sex, greater length of stay, and cancer. Prevalence and severity of malnutrition were similar in medical and surgical wards, and malnourished patients just differed in diseases (chronic diseases in medical; surgical procedures and cancer in surgery).Conclusions: Malnutrition is equally prevalent in medical and surgical wards, probably due to different buthighly frequent risk factors, and is related to a longer hospital stay

Prevalencia del síndrome metabólico en una población de pacientes con sobrepeso y obesidad / Prevalence of the metabolic syndrome in a population with overweight and obesity

Objetivo: Estimar la prevalencia del síndrome metabólico en una población gallega de pacientes con sobrepeso y obesidad, utilizando las 3 definiciones más actuales: la del tercer informe del Grupo de Expertos sobre la Detección, Evaluación y Tratamiento de la Hipercolesterolemia en Adultos del Programa Nacional de Educación sobre el Colesterol (ATP III), la de la Organización Mundial de la Salud (OMS) y la del Grupo Europeo para el Estudio de la Resistencia a la Insulina (EGIR). Pacientes y métodos: Durante un período comprendido entre los años 1996 y 2003 se valoró, en la consulta de endocrinología, una población gallega de 634 pacientes con sobrepeso u obesidad, con una edad media de 38,27 ± 15,95 años, con una distribución de 416 mujeres (65,6%) y 218 varones (34,4%). Resultados: La prevalencia del síndrome metabólico aplicando la definición de la ATP III fue del 27,6%; teniendo en cuenta los criterios del EGIR fue del 15,7% y empleando los criterios de la OMS fue del 35,8%. Si aplicásemos como criterio el valor de glucemia en ayunas de 100 mg/dl en vez de 110, se observaría, como es de esperar, un incremento en la prevalencia del síndrome metabólico con respecto al valor inicial del 32,97%, según la definición de la ATP III; de un 22,29% utilizando la definición de la EGIR, y del 28,77% empleando la clasificación de la OMS. Conclusiones: Estos resultados muestran que en una población de pacientes con sobrepeso u obesidad, la prevalencia del síndrome metabólico es más alta que en la población general. Estos hallazgos pueden tener implicaciones relevantes a la hora de plantear un diagnóstico temprano de la enfermedad cardiovascular y de la diabetes mellitus de estos pacientes, con objeto de intervenir terapéuticamente de forma temprana disminuyendo así sus complicaciones metabólicas y cardiovasculares (AU)

Objective: To estimate the prevalence of the metabolic syndrome in a Galician population (Spain) of patients with overweight and obesity, using the 3 definitions more current: the National Cholesterol Education Program Expert Panel on Detection Evaluation, and Treatment Panel III (ATP III), the World Health Organization (WHO) and the European Group for the Study of Insulin Resistance (EGIR). Patients and methods: For a period between the years 1996-2003, a Galician population of 634 patients with overweight and obesity was evaluated at the Endocrinology Department. The mean age of the patients was 38.27 ± 15.95 years, with a sex distribution of 416 (65.6%) females and 218 (34.4%) males. Results: The prevalence of the metabolic syndrome according to the ATP III definition was 27.6%; when using the EGIR definition it was 15.7% and according to the OMS criteria, it was 35.8%. When considering the value of fast glucose of 100 mg/dl as a criterion, instead of 110 mg/dL, we would observe an increase of the prevalence of metabolic syndrome over the initial value was observed. This increase is about 32.97% according the ATP II definition, 22.29% if the EGIR definition is applied and the increase was of 28.77% when the OMS criteria are considered. Conclusions: These results show that the prevalence of the metabolic syndrome in a population of patients with overweight or obesity is higher than in general population. These findings could have relevant implications when trying to make a precocious diagnosis of the vascular diseases and diabetes mellitus in these patients, in order to treat early so as to reduce their metabolic and cardiovascular complications (AU)

Acne is not a stigma of HIV infection: a review of 36 patients.

INTRODUCTION: Several diseases with follicular occlusion have been described in HIV-infected patients and can appear isolated or associated with each other in an independent disease named 'HIV-associated follicular syndrome'. Worsening of cutaneous lesions during the course of infection in patients with previous acne vulgaris, late onset or severe forms of acne have been reported in HIV-infected patients. PATIENTS AND METHODS: A prospective study of 335 HIV-infected patients was performed in our hospital. A meticulous dermatological exploration in all patients was made, and multiple data were stored into a Microsoft Access 97 program. Patients diagnosed as having acne were considered separately, and we studied their characteristics. A statistical analysis with SPSS 9.0 (Statistical Package for the Social Sciences) was performed. RESULTS: Thirty-six patients (10.8%) were diagnosed as having acne. Papulopustular lesions were the most frequent clinical presentation. Most lesions were localized on the face or on the back, and 80% of patients had mild to moderate acne; 40% of them required no treatment and the remainder was treated with topical measures, oral antibiotics and isotretinoin. 85% of cases reported the onset of acne during adolescence or before HIV infection and without any relationship with this disease. No relation between acne intensity and stage of HIV infection was observed. A multivariate analysis showed that the most important variable was age. DISCUSSION: In contrast to previous reports, no greater intensity or modifications in acne lesions were observed in our HIV-infected patients during the course of the disease. In the majority of cases, cutaneous lesions started before HIV infection, during adolescence, and the most important factor for suffering from acne was young age. In contrast to data reported in the literature, no relation of acne lesions to CD4 lymphocyte count or AIDS case criteria was found in our patients. CONCLUSIONS: Acne in HIV-infected patients has characteristics similar to those in non-HIV-infected patients. The age is the most important factor for the appearance of lesions that usually develop during adolescence. Acne lesions are not modified by HIV infection, and no relationship with the severity of HIV infection has been observed.

Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: patient prognosis and risk-factors for colonisation and infection.

Between October 2001 and August 2002, 30 hospital patients became infected or colonised by a multiresistant (including to carbapenems) epidemic strain of Acinetobacter baumannii (AbMR) in a hospital outbreak. This study analysed the risk-factors associated with acquisition of this epidemic strain and investigated the prognosis of patients infected by AbMR, with the aim of elucidating factors which lead to mortality. A case-control study of the acquisition of AbMR in patients infected or colonised in the hospital outbreak was performed. Independent risk-factors leading to death were studied by logistic regression analysis. Multivariate analysis of the risk-factors for colonisation/infection with AbMR revealed an independent association with the presence of an arterial catheter (OR, 1.13; 95% CI, 1.03-1.25) and administration of imipenem as monotherapy (OR, 11.12; 95% CI, 2.33-53.09). Multivariate analysis of the prognostic features leading to mortality revealed a significant association with hypotension or shock (OR, 24.63; 95% CI, 1.56-387.56) at the time of bacterial isolation.

Function of cryopreserved pig aortas.

OBJECTIVES: This paper analyzes the influence of storage in the gas phase or liquid phase on grafts, together with the thawing method (15 degrees C/min or 100 degrees C/min) on the postthawing activity of pig cryopreserved arterial grafts (aortas). MATERIALS AND METHODS: Obtainment of arterial grafts (aortas) was from pigs with an ischemic time not greater than 2 h. Each aorta was divided into five fragments and assigned randomly to one control group of fresh aorta and four groups of cryopreserved aortas: group 1: gas phase/slow thawing; group 2: gas phase/rapid thawing; group 3: liquid phase/slow thawing; and group 4: liquid phase/rapid thawing. After the incubation in antibiotic solution, the cryopreservation in RPMI medium +10% DMSO was carried out and the level of cooling used was a reduction of 1 degrees C/min. The contraction and relaxation responses of the fresh and frozen/thawed arteries were carried out in organ baths. RESULTS: After thawing, the sensitivity to various agonists and maximal responses to the endothelium-dependent and independent relaxant agents were decreased. The maximal responses to the tested vasoconstrictors (KCl and noradrenaline) were, respectively, 13% and 24% of the responses obtained in unfrozen aortas. The endothelium-independent relaxant responses to sodium nitroprusside (SNP) were reduced and important reductions of the endothelium-dependent relaxant responses to acetylcholine were produced. CONCLUSIONS: The cryopreservation of pig aortas under the conditions used in this study led to a decrease in the contractility of the pig aortas, as well as a decrease in the endothelium-independent relaxant responses. On the other hand, no apparent preservation of the endothelium-dependent relaxant responses was observed.

Histological features with clinical impact in chronic allograft nephropathy: review of 66 cases.

UNLABELLED: The histological features of chronic allograft nephropathy (CAN) are variable, since it is related to multiple donor and recipient factors. The main histological parameters in CAN are interstitial fibrosis, tubular atrophy, chronic vasculopathy and glomerulosclerosis. There have been many attempts to relate chronic deterioration of renal function with histologic features. MATERIALS AND METHODS: We reviewed 66 kidney transplant patients (43 men/23 women) with renal failure 6 months after transplant. The clinical data included donor and recipient age, cold ischemia time, delayed graft function (DGF), creatinine clearance, proteinuria, HLA compatibility, CMV infection, cholesterol levels, diastolic and systolic blood pressure. Banff criteria were used to grade histological parameters. The relation between clinical and histological data were analyzed using chi square, Student t, Mann Whitney and Kruskal-Wallis tests as appropriate. The cumulative graft and patient survival rates were calculated by the Kaplan-Meier method. RESULTS: The survival rate of patients with creatinine clearances >3 mg/dL at the time of the biopsy was worse than that of patients with creatinine <3 mg/dL (P =.001; log rank 20.1). We found an association between the grade of arteriosclerosis and the diastolic blood pressure (P =.017). The creatinine level was greater among patients with tabulitis than those without tubulitis (P =.06). In addition to our results we review the literature especially related to the histological feature of CAN in an attempt to detect histological findings predictive of the long term outcome of kidney allografts.