Impact and control of the COVID pandemic in an elite sports club: Real Madrid.

The incidence and risk factors for poor outcome in patients with COVID are well known, as are the protective measures in high-risk populations. In contrast, the epidemiological and clinical behavior of this disease in the population of elite athletes who are the paradigm of good health is poorly understood. Data on COVID in athletes are scarce and have focused preferentially on the consequences on sports performance of confinement measures and on the pathophysiological risks of infected athletes. Real Madrid is a large elite sports institution with facilities in the City of Madrid where 600 athletes train daily. The incidence of COVID during a study period of 671 days of observation in athletes, professional or amateur, working in the institution has been 0,74 per 1,000 days of exposure. The disease has been asymptomatic or oligosymptomatic in all athletes and did not require any hospital admissions. The different teams did not have to suspend any of its sportive commitments for COVID during the study period and there was no evidence of outbreaks of internal transmission between members of the different teams.

Cáncer de recto a nivel de la reflexión peritoneal. Exactitud de la RM preoperatoria y correlación anatomopatológica. Estudio prospectivo / Rectal cancer at the peritoneal reflection. Preoperative MRI accuracy and histophatologic correlation. Prospective study

Introducción Establecer la exactitud de la resonancia magnética (RM) para determinar la localización de los tumores rectales en relación con la reflexión peritoneal (RP) y su potencial afectación. Métodos Estudio prospectivo de 161 pacientes intervenidos por cáncer de recto. Las piezas quirúrgicas han sido analizadas mediante un método de doble tinción, superficie serosa con colorante naranja y grasa mesorrectal con tinta china, para comparar los resultados con la RM preoperatoria. Resultados Veintidós tumores se localizaron por encima, 65 a nivel y 74 por debajo de la RP. La RM clasificó la localización del tumor respecto a la RP de manera correcta en el 90,6% y fue capaz de detectar el 80,5% de los casos con infiltración de la RP. La RM presentó una exactitud del 92,5% para clasificar el tumor como intra o extraperitoneal. El 28,7% de los tumores por encima y a nivel de la RP presentaba anatomopatológicamente infiltración de la serosa peritoneal. Conclusiones La RM es una prueba precisa para determinar la localización de los tumores de recto en relación con la RP y su posible afectación. En el tallado macroscópico, el método de doble colorante es eficaz para determinar la afectación serosa (pT4a) y diferenciarla de la fascia mesorrectal (AU)

Introduction To investigate magnetic resonance imaging (MRI) accuracy for determining the location of rectal tumors with respect to the peritoneal reflection (PR) and its potential involvement Methods Prospective study of 161 patients ongoing surgery for rectal cancer. A double-ink method has been aplied to examine surgical specimen, orange ink for the serosal surface and indian ink for the mesorrectal margin, and assess preoperative MRI accuracy. Results Twenty-two tumors were located above, 65 at and 74 below PR. MRI accuracy was 90.6% for determining tumor's location with respect to the PR and 80.5% for defining peritoneal involvement. For classifying tumors according to their intra or extraperitoneal location an accuracy of 92.5% was set for MRI. Histophatologic peritoneal involvement was found in 28.7% of tumors located above or at the PR. Conclusions Magnetic resonance imaging accurately predicts the location of rectal tumors with respect to the PR and its potential involvement. The double-ink method is useful to assess serosal involvement (pT4a) and to distinguish mesorrectal fascia from the peritonealized surface (AU)

Accuracy of CT colonography in the preoperative staging of colon cancer: a prospective study of 217 patients.

AIM: The purpose of the present study was to evaluate the accuracy of computed tomography colonography (CTC) in the preoperative localization and TN staging of colon cancer. CTC can be an effective technique for preoperative evaluation of colon cancer and could facilitate the selection of high-risk patients who may benefit from neoadjuvant chemotherapy. METHOD: This was a prospective observational study conducted at a single tertiary-care centre. It involved 217 patients (225 tumours) who had colon cancer and underwent preoperative CTC and elective colectomy. The radiologist determined the TNM stage using postprocessing software with multiplanar images and virtual colonoscopy. The following criteria were analysed for every colon tumour: location, size and signs of direct colon wall invasion. The histopathological findings of the surgical colectomy specimens served as the reference standard for local staging. RESULTS: CTC detected all tumours and achieved an exact location in 208 cases (92.4%). CTC findings changed the surgical plan in 31 patients (14.3%) following colonoscopy. The accuracy in differentiating T3/T4 vs T1/T2 tumours was 87.1%, with a sensitivity and specificity of 88.5% and 84.1%, respectively (kappa = 0.71). For high-risk tumours (T3 ≥ 5 mm and T4), CTC showed an accuracy, sensitivity and specificity of 82.7%, 86% and 80%, respectively (kappa = 0.65). The accuracy of N-stage evaluation was 69.3%, the sensitivity 74% and the specificity 67.1% (kappa = 0.37). CONCLUSION: CTC provides accurate information for the assessment of tumour localization and T staging, allowing better surgical planning and also allows the selection of locally advanced tumours that may benefit from new treatments such as neoadjuvant chemotherapy.

Meningitis recurrente por defectos anatómicos: la bacteria indica su origen / Recurrent meningitis due to anatomical defects: The bacteria indicates its origin

Introducción: La meningitis recurrente es una patología infrecuente. Los factores predisponentes son alteraciones anatómicas o situaciones de inmunodeficiencia. Presentamos 4 casos en los que, excluida una inmunodeficiencia, el microorganismo responsable orientó al defecto anatómico causante de las recurrencias. Pacientes y métodos: Revisión retrospectiva de 4 casos clínicos con diagnóstico de meningitis bacteriana recurrente. Resultados: Caso 1: niño de 30 meses con hipoacusia unilateral, diagnosticado por resonancia magnética (RM) de malformación de Mondini tras 2 episodios de meningitis por Haemophilus influenzae. Reparación quirúrgica tras tercera recurrencia. Caso 2: niña de 14 años diagnosticada por RM de defecto de lámina cribiforme posterior a 3 episodios de meningitis por Streptococcus pneumoniae. Se coloca válvula de derivación ventrículo-peritoneal. Caso 3: niña con meningitis por Staphylococcus aureus a los 2 y 7 meses. La RM muestra seno dérmico occipital que requiere exéresis. Complicación con abscesos cerebelosos por coexistencia de quiste dermoide. Caso 4: niño con meningitis por Streptococcus bovis a los 9 días y porEnterococcus faecium, Klebsiella pneumoniae y Escherichia coli a los 7 meses, con crecimiento de Citrobacter freundii y E. faecium posteriormente. RM compatible con síndrome de Currarino. Incluye fístula rectal de LCR, que se repara quirúrgicamente. A los 4 pacientes se les habían realizado pruebas de imagen durante los primeros episodios de meningitis, informadas como normales. Conclusiones: En los pacientes con meningitis recurrentes se debe valorar la posibilidad de un defecto anatómico; el microorganismo aislado debe ayudar a localizarlo. Es imprescindible conocer la flora normal de los potenciales focos. El tratamiento definitivo es habitualmente quirúrgico (AU)

Introduction: Recurrent meningitis is a rare disease. Anatomical abnormalities and immunodeficiency states are predisposing factors. Four cases, in which immunodeficiency was excluded, are presented. The causal microorganism led to the detection of the anatomical defect responsible for the recurrences. Patients and methods: Retrospective review of 4 cases with clinical diagnosis of recurrent bacterial meningitis. Results: Case 1: a thirty month-old boy with unilateral hearing loss, diagnosed with Mondini abnormality by magnetic resonance imaging (MRI) after 2 episodes of Haemophilus influenzae meningitis. Surgical repair after third recurrence. Case 2: fourteen year-old girl diagnosed by MRI with cribriform plate defect after 3 episodes of meningitis due toStreptococcus pneumoniae. Ventriculoperitoneal shunt was placed. Case 3: girl with meningitis due to Staphylococcus aureus at 2 and 7 months. MRI shows occipital dermal sinus requiring excision. Complication with cerebellar abscesses because of a coexisting dermoid cyst. Case 4: child with meningitis due to Streptococcus bovis at 9 days andEnterococcus faecium, Klebsiella pneumoniae and Escherichia coli at 7 months, with positive cultures to Citrobacter freundii and E. faecium later on. Spinal MRI led to the diagnosis of Currarino syndrome with CSF fistula, which was surgically repaired. The 4 patients had undergone image studies reported as normal during the first episodes. Conclusions: In patients with recurrent meningitis the possibility of an anatomical defect should be considered. The isolated microorganism should help to locate it. It is essential to know the normal flora of the different anatomical sites. The definitive treatment is usually surgical (AU)

[Recurrent meningitis due to anatomical defects: The bacteria indicates its origin]. / Meningitis recurrente por defectos anatómicos: la bacteria indica su origen.

INTRODUCTION: Recurrent meningitis is a rare disease. Anatomical abnormalities and immunodeficiency states are predisposing factors. Four cases, in which immunodeficiency was excluded, are presented. The causal microorganism led to the detection of the anatomical defect responsible for the recurrences. PATIENTS AND METHODS: Retrospective review of 4 cases with clinical diagnosis of recurrent bacterial meningitis. RESULTS: Case 1: a thirty month-old boy with unilateral hearing loss, diagnosed with Mondini abnormality by magnetic resonance imaging (MRI) after 2 episodes of Haemophilus influenzae meningitis. Surgical repair after third recurrence. Case 2: fourteen year-old girl diagnosed by MRI with cribriform plate defect after 3 episodes of meningitis due to Streptococcus pneumoniae. Ventriculoperitoneal shunt was placed. Case 3: girl with meningitis due to Staphylococcus aureus at 2 and 7 months. MRI shows occipital dermal sinus requiring excision. Complication with cerebellar abscesses because of a coexisting dermoid cyst. Case 4: child with meningitis due to Streptococcus bovis at 9 days and Enterococcus faecium, Klebsiella pneumoniae and Escherichia coli at 7 months, with positive cultures to Citrobacter freundii and E. faecium later on. Spinal MRI led to the diagnosis of Currarino syndrome with CSF fistula, which was surgically repaired. The 4 patients had undergone image studies reported as normal during the first episodes. CONCLUSIONS: In patients with recurrent meningitis the possibility of an anatomical defect should be considered. The isolated microorganism should help to locate it. It is essential to know the normal flora of the different anatomical sites. The definitive treatment is usually surgical.

A broad spectrum of genomic changes in latinamerican patients with EXT1/EXT2-CDG.

Multiple osteochondromatosis (MO), or EXT1/EXT2-CDG, is an autosomal dominant O-linked glycosylation disorder characterized by the formation of multiple cartilage-capped tumors (osteochondromas). In contrast, solitary osteochondroma (SO) is a non-hereditary condition. EXT1 and EXT2, are tumor suppressor genes that encode glycosyltransferases involved in heparan sulfate elongation. We present the clinical and molecular analysis of 33 unrelated Latin American patients (27 MO and 6 SO). Sixty-three percent of all MO cases presented severe phenotype and two malignant transformations to chondrosarcoma (7%). We found the mutant allele in 78% of MO patients. Ten mutations were novel. The disease-causing mutations remained unknown in 22% of the MO patients and in all SO patients. No second mutational hit was detected in the DNA of the secondary chondrosarcoma from a patient who carried a nonsense EXT1 mutation. Neither EXT1 nor EXT2 protein could be detected in this sample. This is the first Latin American research program on EXT1/EXT2-CDG.

Neumonitis por taxanos en un servicio de neumología / No disponible

No disponible

Optimal timing for initiation of highly active antiretroviral therapy in treatment-naïve human immunodeficiency virus-1-infected individuals presenting with AIDS-defining diseases: the experience of the PISCIS Cohort.

In this prospective, multicentre cohort study, we analysed specific prognostic factors and the impact of timing of highly active antiretroviral therapy (HAART) on disease progression and death among 625 human immunodeficiency virus (HIV)-1-infected, treatment-naïve patients diagnosed with an AIDS-defining disease. HAART was classified as early (<30 days) or late (30-270 days). Deferring HAART was significantly associated with faster progression to a new AIDS-defining event/death overall (p 0.009) and in patients with Pneumocystis jiroveci pneumonia (p 0.017). In the multivariate analysis, deferring HAART was associated with a higher risk of a new AIDS-defining event/death (p 0.002; hazard ratio 1.83; 95% CI 1.25-2.68). Other independent risk factors for poorer outcome were baseline diagnosis of AIDS-defining lymphoma, age >35 years, and low CD4(+) count (<50 cells/µL).

microRNA profiling in duodenal ulcer disease caused by Helicobacter pylori infection in a Western population.

Although the connection of microRNAs (miRNAs) to some diseases is well established, their involvement in chronic infections such as Helicobacter pylori has received less attention. The aim was to compare miRNA expression profiling in patients with duodenal ulcer (DU) due to H. pylori infection with that in infected patients without DU and in uninfected patients. The miRNA expression profile was determined by microarrays in antral mucosal samples from well-characterized dyspeptic patients (n = 46). The most significant set of miRNAs was subsequently analysed in an independent validation group of patients (n = 42). Transcripts for IL8, IL12p40, IL12p35 and IL23p19, the signalling molecules MYD88, GATA6, SOCS2 and STAT6 and H. pylori virulence factors cagA and VacA were analysed. Microarray experiments showed that 17 miRNAs were deregulated in the mucosa of H. pylori-infected patients. No significant differences were observed between normal and DU patients. PCR confirmed the up-regulation of miR-9, miR-146a, miR-155 and miR-650 and the down-regulation of miR-96 and miR-204 in the independent validation set of patients. Importantly, miR-9, miR-96, miR-146a and miR-650 expression was specific to chronic-active gastritis. H. pylori-infected patients showed higher levels of IL8 and IL12p40 mRNAs and lower levels of GATA6 and SOCS2 mRNAs. The antral mucosa of patients with non-active or chronic-active gastritis showed significantly lower levels of GATA6, MYD88, SOCS2 and STAT6 mRNAs compared with patients without gastritis. The down-regulation of these factors was not correlated with the expression of any of the validated miRNAs. The exact role of the miRNA changes observed will require further study.

Clinical significance of methicillin-resistant Staphylococcus aureus colonization in residents in community long-term-care facilities in Spain.

Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in Spanish hospitals and community long-term-care facilities (LTCFs). This longitudinal study was performed in community LTCFs to determine whether MRSA colonization is associated with MRSA infections and overall mortality. Nasal and decubitus ulcer cultures were performed every 6 months for an 18-month period on 178 MRSA-colonized residents (86 490 patient-days) and 196 non-MRSA carriers (97 470 patient-days). Fourteen residents developed MRSA infections and 10 of these were skin and soft tissue infections. Two patients with respiratory infections required hospitalization. The incidence rate of MRSA infection was 0·12/1000 patient-days in MRSA carriers and 0·05/1000 patient-days in non-carriers (P=0·46). No difference in MRSA infection rate was found according to the duration of MRSA colonization (P=0·69). The mortality rate was 20·8% in colonized residents and 16·8% in non-carriers; four residents with MRSA infection died. Overall mortality was statistically similar in both cohorts. Our results suggest that despite a high prevalence of MRSA colonization in LTCFs, MRSA infections are neither frequent nor severe while colonized residents remain at the facility. The epidemiological impact of an MRSA reservoir is more relevant than the clinical impact of this colonization for an individual resident and supports current recommendations to control MRSA spread in community LTCFs.

Immunosuppressed patients with pandemic influenza A 2009 (H1N1) virus infection.

The purpose of this paper was to prospectively characterize the clinical manifestations and outcomes of confirmed influenza A 2009 (H1N1) virus infection in immunosuppressed patients with hospital admission and compare them with those of a general population. A multicenter prospective cohort study was carried out. All adult patients admitted to 13 hospitals in Spain with confirmed influenza A 2009 (H1N1) virus infection from June 12, 2009 to November 11, 2009 were included. Risk factors for complicated influenza infection were studied in immunosuppressed patients. Overall, 559 patients were included, of which 56 were immunosuppressed, nine with solid or hematological malignancies, 18 with solid-organ transplant recipients, 13 with corticosteroid therapy, and six with other types of immunosuppression. Clinical findings at diagnosis were similar in both groups. Nineteen immunosuppressed patients had pneumonia (33.9%). Immunosuppressed patients with pandemic influenza had bacterial co-infection more frequently (17.9% vs. 6.4%, p = 0.02), specifically, gram-negative bacilli and Staphylococcus aureus infections. Mortality was higher in immunosuppressed patients (7.1% vs. 1.8%, p < 0.05). The only modifiable risk factor of complicated influenza A 2009 (H1N1) was delayed antiviral therapy. In immunosuppressed patients, influenza A 2009 (H1N1) virus infection has higher mortality than in non-immunosuppressed individuals. Bacterial co-infection is common in complicated cases.

The postprandial inflammatory response after ingestion of heated oils in obese persons is reduced by the presence of phenol compounds.

SCOPE: Heating during the process of cooking alters the chemical properties of foods and may affect subsequent postprandial inflammation. We tested the effects of four meals rich in different oils subjected to heating on the postprandial inflammatory metabolism of peripheral blood mononuclear cells (PBMCs). METHODS AND RESULTS: Twenty obese participants received four breakfasts following a randomized crossover design, consisting of milk and muffins made with different oils (virgin olive oil (VOO), sunflower oil (SFO), and a mixture of seeds oil (SFO/canola oil) with added either dimethylpolysiloxane (SOD), or natural antioxidants from olive mill wastewater alperujo (phenols; SOP)), previously subjected to 20 heating cycles. Postprandial inflammatory status in PBMCs was assessed by the activation of nuclear NF-κB, the concentration in cytoplasm of the NF-κB inhibitor (IκB-α), the mRNA levels of NF-κB subunits and activators (p65, IKKß, and IKKα) and other inflammatory molecules (TNF-α, IL-1ß, IL-6, MIF, and JNK), and lipopolysaccharide (LPS) levels. VOO and SOP breakfasts reduced NF-κB activation, increased IκB-α, and decreased LPS plasma concentration. SFO increased IKKα, IKKß, p65, IL-1b, IL-6, MIF, and JNK mRNA levels, and plasma LPS. CONCLUSION: Oils rich in phenols, whether natural (VOO) or artificially added (SOP), reduce postprandial inflammation, compared with seed oil (sunflower).

Implicaciones pronósticas de la posibilidad de determinar con carácter urgente el péptido natriuréticotipo B en el servicio de urgencias en pacientes con insuficiencia cardiaca aguda: estudio PICASU-2 / Prognostic implications of emergency department determination of B-type natriuretic peptide in patients with acute heart failure: the PICASU-2 study

Objetivo: Investigar si la determinación del péptido natriurético tipo B (BNP) con carácter urgente en el servicio de urgencias hospitalario (SUH) a pacientes con insuficiencia cardiaca aguda (ICA) proporciona ventajas en cuanto a la evolución clínica a los pacientes en los que se determina o a los SUH que disponen de dicha posibilidad. Método: El estudio PICASU-2 es un estudio de carácter analítico, multicéntrico, retrospectivo y con seguimiento de cohortes que incluyó pacientes diagnosticados basales y de ICA. Para cada caso se consignaron los datos del episodio agudo. Como variables evolutivas se recogió la mortalidad intrahospitalaria y la mortalidad y la reconsulta a urgencias los 30 días siguientes. Los pacientes se dividieron entre los que se determinó BNP urgente y los que no. Los SUH se dividieron entre los que no tienen disponibilidad de determinar BNP urgente (tipo A), los que pueden hacerlo en casos seleccionados (tipoB) y los que lo hacen de forma generalizada (tipo C).Resultados: Participaron 19 SUH, que incluyeron 2.423 pacientes: en el 32,4% se determinó BNP, mientras que su distribución en SUH tipo A, B y C fue del 34,7%, 34,6%y 30,7%, respectivamente. La mortalidad intrahospitalaria fue 7,2%, la mortalidad a 30 días 8,1% y la reconsulta a 30 días 24%. Ni la determinación de BNP en un paciente concreto ni el hecho que el SUH lo tuviese a su disposición se asociaron a un mejor pronóstico, ni tampoco después de ajustar el modelo por las diferencias basales o del episodio agudo entre grupos. Estos mismos resultados se obtuvieron cuando se analizó el subgrupo de pacientes dados de alta directamente de urgencias (..) (AU)

Objective: To investigate whether hospital emergency department measurement of B-type natriuretic peptide (BNP) in patients with acute heart failure is beneficial in terms of patient outcomes and according to hospital category (availabilityor not of BNP testing in the emergency department).Methods: PICASU-2 is an analytical multicenter retrospective study of patients with acute heart failure according to the Framingham criteria, with follow-up of cohorts. Baseline Data and data pertaining to each acute heart failure episode were collected. Outcome measures were in-hospital mortality, 30-day mortality, and revisits to the emergency department within 30 days. Cases were classified as having a record of BNP measurement or not. Hospital emergency departments were classified as not having the resources for emergency BNP measurement (type A hospital), having thepossibility of testing selectively (type B), and testing for BNP more generally (>50% of patients) (type C).Results: Nineteen hospital emergency departments contributed data on 2423 patients, 32.4% of whom had BNPmeasurements; by hospital category, 34.7% of the patients were from type A facilities, 34.6% were from type B, and30.7% were from type C. In-hospital mortality was 7.2%, 30-day mortality was 8.1%, and 24% of the patients revisited (..) (AU)

Valor pronóstico de la determinación urgente del péptido natriurético tipo B en los servicios de urgencias en pacientes con insuficiencia cardiaca: estudio PICASU-1 / Prognostic value of emergency department testing for N-terminal fragment of brain natriuretic peptide in patients with acute heart failure: the PICASU-1 study

Objetivo: Conocer la utilidad del NT-proBNP en pacientes con insuficiencia cardiaca aguda (ICA) que consultaron en un servicio de urgencias hospitalario (SUH) para predecirla mortalidad y la reconsulta a dicho SUH. Método: El estudio PICASU-1 (ProBNP en Insuficiencia Cardiaca Aguda en los Servicios de Urgencias) es un estudio analítico, multicéntrico, con seguimiento de cohortes, que incluyó 641 pacientes con ICA atendidos en 9 SUH en los que se determinó NT-proBNP de forma urgente. Se recogieron 18 datos basales y 21 datos del episodio de ICA. Los datos evolutivos analizados fueron mortalidad intrahospitalaria y mortalidad y revisita a 30 días, y para cada una de estas variables se calculó el área bajo la curva (AUC) ROC deNT-proBNP. El análisis se repitió mediante curvas de supervivencia truncadas a 90 días. Resultados: NT-proBNP estaba más elevado en los fallecidos intrahospitalariamente y a los30 días de la consulta en el SUH (p < 0,001 para ambos), pero no hubo diferencias entre los que reconsultaron a los 30 días y los que no (p = 0,91). Resultados similares se observaron en el estudio mediante curvas de supervivencia a 90 días. NT-proBNP tuvo un poder discriminativo moderado para la mortalidad intrahospitalaria (AUC 0,75, p < 0,001) y a 30 días (AUC 0,71, p < 0,001), pero nulo para la reconsulta (AUC 0,50, p = 0,92). Similares resultados se obtuvieron en los 244 pacientes (38,3%) dados de alta directamente de lSUH: NT-proBNP superior en los fallecidos a 30 días (p < 0,01) y sin diferencias en los que reconsultaron (p = 0,50), y su poder discriminativo fue moderado para la mortalidad a 30días (AUC 0,72, p < 0,01) y nulo para la reconsulta (AUC 0,47, p = 0,50). Conclusión: El NT-proBNP es una herramienta útil para predecir a priori la probabilidad de fallecer de un paciente con ICA en concreto, pero tiene un valor nulo para determinar las posibilidades de reconsultar al SUH (AU)

Objective: To determine the usefulness of hospital emergency department testing for the N-terminal fragment of brainnatriuretic peptide (NT-proBNP) as a predictor of mortality and revisits in patients with acute heart failure (AHF). Methods: The PICASU-1 study (NT-proBNP in AHF in the Emergency Department) was an analytical multicenter cohort studythat included 641 patients with AHF attended at 9 emergency departments that were able to perform emergency NT-proBNPtests. Data collected included 18 variables related to the patient’s baseline situation and 21 variables related to the episode ofAHF. The area under the receiver operating characteristic curves (AUC) were calculated to assess the ability of NT-proBNP levelto predict in-hospital mortality, 30-day mortality, and revisiting. Ninety-day survival curves were also constructed. Results: Elevated NT-proBNP concentrations were found in patients who died in hospital and within 30 days ofemergency care (P<.001, both cases). No differences were seen between patients who revisited within 30 days and thosewho did not (P=.91). The 90-day survival curves gave similar results. NT-proBNP concentration had a moderate ability topredict mortality in-hospital (AUC, 0.75; P<.001) and within 30 days (AUC, 0.71; P<.001), but no predictive power forrevisiting (AUC, 0.50; P=.92). These results were consistent with those for the 244 patients who were discharged homefrom the emergency department (38.3%): the NT-proBNP levels were higher for those who died within 30 days (P<.01)but similar for revisiting and nonrevisiting patients (P=.50). In these patients, NT-proBNP level once again had moderate predictive power for 30-day mortality (AUC, 0.72; P<.01) but no association with revisiting (AUC, 0.47; P=.50). Conclusion: NT-proBNP testing seems useful for predicting the likelihood of death for a particular patient with AHF, butit has no ability to predict ED revisiting (AU)

Factors associated with severe disease in hospitalized adults with pandemic (H1N1) 2009 in Spain.

The risk factors for complications in patients with influenza A (H1N1)v virus infection have not been fully elucidated. We performed an observational analysis of a prospective cohort of hospitalized adults with confirmed pandemic influenza A (H1N1)v virus infection at 13 hospitals in Spain, between June 12 and November 10, 2009, to identify factors associated with severe disease. Severe disease was defined as the composite outcome of intensive-care unit (ICU) admission or in-hospital mortality. During the study period, 585 adult patients (median age 40 years) required hospitalization because of pandemic (H1N1) 2009. At least one comorbid condition was present in 318 (54.4%) patients. Pneumonia was diagnosed in 234 (43.2%) patients and bacterial co-infection in 45 (7.6%). Severe disease occurred in 75 (12.8%) patients, of whom 71 required ICU admission and 13 (2.2%) died. Independent factors for severe disease were age <50 years (OR, 2.39; 95% CI, 1.05-5.47), chronic comorbid conditions (OR, 2.93; 95% CI, 1.41-6.09), morbid obesity (OR, 6.7; 95% CI, 2.25-20.19), concomitant and secondary bacterial co-infection (OR, 2.78; 95% CI, 1.11-7) and early oseltamivir therapy (OR, 0.32; 95% CI 0.16-0.63). In conclusion, although adults hospitalized for pandemic (H1N1) 2009 suffer from significant morbidity, mortality is lower than that reported in the earliest studies. Younger age, chronic comorbid conditions, morbid obesity and bacterial co-infection are independent risk factors for severe disease, whereas early oseltamivir therapy is a protective factor.

Natural history of meticillin-resistant Staphylococcus aureus colonisation among residents in community long term care facilities in Spain.

The spread of meticillin-resistant Staphylococcus aureus (MRSA) is a major problem for both acute care hospitals and among residents in long term care facilities (LTCFs). We performed a cohort study to assess the natural history of MRSA colonisation in LTCF residents. Two cohorts of residents (231 MRSA carriers and 196 non-carriers) were followed up for an 18 month period, with cultures of nasal and decubitus ulcers performed every six months. In the MRSA carrier cohort, 110 (47.8%) residents had persistent MRSA colonisation for six months or longer, 44 (19.0%) had transient colonisation and nine (3.9%) were intermittently colonised. No risk factors for persistent MRSA colonisation could be determined. The annual incidence of MRSA acquisition was around 20% [95% confidence interval (CI): 14.3-25.5]. Antibiotic treatment was independently associated with MRSA acquisition (odds ratio: 2.27; 95% CI: 1.05-4.88; P=0.03). Just two clones were distinguishable by pulsed-field gel electrophoresis and multilocus sequence typing: CC5-MRSA IV, which is widely disseminated in Spanish hospitals, and ST22-MRSA IV. This study adds to the knowledge of the epidemiology of MRSA in community LTCFs, which are important components of long term care in Spain.

Olive oil and health: summary of the II international conference on olive oil and health consensus report, Jaén and Córdoba (Spain) 2008.

Olive oil (OO) is the most representative food of the traditional Mediterranean Diet (MedDiet). Increasing evidence suggests that monounsaturated fatty acids (MUFA) as a nutrient, OO as a food, and the MedDiet as a food pattern are associated with a decreased risk of cardiovascular disease, obesity, metabolic syndrome, type 2 diabetes and hypertension. A MedDiet rich in OO and OO per se has been shown to improve cardiovascular risk factors, such as lipid profiles, blood pressure, postprandial hyperlipidemia, endothelial dysfunction, oxidative stress, and antithrombotic profiles. Some of these beneficial effects can be attributed to the OO minor components. Therefore, the definition of the MedDiet should include OO. Phenolic compounds in OO have shown antioxidant and anti-inflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties. Observational studies from Mediterranean cohorts have suggested that dietary MUFA may be protective against age-related cognitive decline and Alzheimer's disease. Recent studies consistently support the concept that the OO-rich MedDiet is compatible with healthier aging and increased longevity. In countries where the population adheres to the MedDiet, such as Spain, Greece and Italy, and OO is the principal source of fat, rates of cancer incidence are lower than in northern European countries. Experimental and human cellular studies have provided new evidence on the potential protective effect of OO on cancer. Furthermore, results of case-control and cohort studies suggest that MUFA intake including OO is associated with a reduction in cancer risk (mainly breast, colorectal and prostate cancers).