Uso de sonda nasogástrica en pacientes sometidos a esofaguectomía: ¿Un gesto innecesario? / Nasogastric tube utilization after esophagectomy: an unnecessary gesture?

INTRODUCCIÓN: El empleo de una sonda descompresiva nasogástrica es aceptado como uno de los cuidados perioperatorios básicos tras una cirugía de resección esofágica. Sin embargo, con el desarrollo de los programas de rehabilitación multimodal en este campo y sin una evidencia clara que sustente su empleo, la indicación sistemática de dicha medida puede resultar controvertida. MATERIAL Y MÉTODOS: Estudio retrospectivo, descriptivo y comparativo de los casos intervenidos de esofaguectomía tipo Ivor-Lewis en nuestro centro desde enero de 2015 hasta diciembre de 2018 con colocación (Grupo S) o no de sonda (Grupo N) descompresiva en la plastia gástrica durante el postoperatorio. Se evaluaron variables epidemiológicas y diferencias entre los grupos en morbimortalidad postquirúrgica, estancia hospitalaria, inicio de la tolerancia oral y la necesidad de colocación de sonda nasogástrica. RESULTADOS: Un total de 43 pacientes fueron incluidos en este estudio con una mediana de edad de 61 años, siendo el 86% varones. El 46,5% eran hipertensos, el 25,5% presentaban enfermedad pulmonar y el 16,3% padecían diabetes mellitus. La mediana del tiempo de estancia hospitalaria fue de nueve días en el grupo S frente a 11,5 días del grupo N, sin diferencias en el inicio de la tolerancia oral. La tasa de dehiscencia anastomótica fue del 5% y del 0%, respectivamente. La mortalidad global fue del 2,3% en los primeros 90 días, sin diferencias entre los grupos y la necesidad de colocación de la sonda durante el postoperatorio se produjo únicamente en un paciente (4,3%) del grupo N. CONCLUSIONES: La no utilización de sonda nasogástrica durante el postoperatorio de una esofaguectomía tipo Ivor-Lewis es una medida segura y no está asociada a mayor número de complicaciones ni estancia hospitalaria, pudiendo mejorar la comodidad y la recuperación postoperatoria del paciente

INTRODUCTION: Nasogastric decompressive tube utilization has been accepted as one of the basic perioperative care measures after esophageal resection surgery. However, with the development of multimodal rehabilitation programs and without clear evidence to support their use, the systematic indication of this measure may be controversial. MATERIAL AND METHODS: Retrospective, descriptive and comparative study of patients who had undergone Ivor-Lewis esophagectomy in our center -from January 2015 to December 2018- with placement (Group S), or without placement (Group N) of a decompressive tube in gastroplasty during postoperative period. Epidemiological variables and differences between groups in post-surgical morbidity and mortality, hospital stay, onset of oral tolerance and the need for nasogastric tube placement were evaluated. RESULTS: A total of 43 patients were included in this study, with a median age of 61 years, being 86% male. 46.5% were hypertensive, 25.5% had lung disease and 16.3% had diabetes mellitus. The median length of hospital stay was 9 days in group S versus 11.5 days in group N, with no differences in the onset of oral tolerance. Anastomotic dehiscence rate was 5% and 0% respectively. The overall mortality was 2.3% in the first 90 days, without differences between the groups. Placement of nasogastric tube during postoperative period was required only in 1 patient (4.3%) of the group N. CONCLUSIONS: Non-use of nasogastric tube during postoperative period of an Ivor-Lewis esophagectomy is a safe measure, as it is not associated with a higher rate of complications or hospital stay. This fact may be able to improve patients' comfort and postoperative recovery

Nasogastric tube utilization after esophagectomy: an unnecessary gesture? / Uso de sonda nasogástrica en pacientes sometidos a esofaguectomía: ¿Un gesto innecesario?

INTRODUCTION: Nasogastric decompressive tube utilization has been accepted as one of the basic perioperative care measures after esophageal resection surgery. However, with the development of multimodal rehabilitation programs and without clear evidence to support their use, the systematic indication of this measure may be controversial. MATERIAL AND METHODS: Retrospective, descriptive and comparative study of patients who had undergone Ivor-Lewis esophagectomy in our center -from January 2015 to December 2018- with placement (Group S), or without placement (Group N) of a decompressive tube in gastroplasty during postoperative period. Epidemiological variables and differences between groups in post-surgical morbidity and mortality, hospital stay, onset of oral tolerance and the need for nasogastric tube placement were evaluated. RESULTS: A total of 43 patients were included in this study, with a median age of 61 years, being 86% male. 46.5% were hypertensive, 25.5% had lung disease and 16.3% had diabetes mellitus. The median length of hospital stay was 9 days in group S versus 11.5 days in group N, with no differences in the onset of oral tolerance. Anastomotic dehiscence rate was 5% and 0% respectively. The overall mortality was 2.3% in the first 90 days, without differences between the groups. Placement of nasogastric tube during postoperative period was required only in 1 patient (4.3%) of the group N. CONCLUSIONS: Non-use of nasogastric tube during postoperative period of an Ivor-Lewis esophagectomy is a safe measure, as it is not associated with a higher rate of complications or hospital stay. This fact may be able to improve patients' comfort and postoperative recovery.

Advanced-stage mycosis fungoides: role of the signal transducer and activator of transcription 3, nuclear factor-κB and nuclear factor of activated T cells pathways.

BACKGROUND: The malignant mechanisms that control the development of cutaneous T-cell lymphoma (CTCL) are beginning to be identified. Recent evidence suggests that disturbances in specific intracellular signalling pathways, such as RAS-mitogen-activated protein kinase, T-cell receptor (TCR)-phospholipase C gamma 1 (PLCG1)-nuclear factor of activated T cells (NFAT) and Janus kinase (JAK)-signal transducer and activator of transcription (STAT), may play an essential role in the pathogenesis of CTCL. OBJECTIVES: To investigate the mechanisms controlling disease development and progression in mycosis fungoides (MF), the most common form of CTCL. METHODS: We collected 100 samples that were submitted for diagnosis of, or a second opinion regarding, MF between 2001 and 2018, 80% of which were in the early clinical stages of the disease. Formalin-fixed paraffin-embedded tissues were used for histological review and to measure the expression by immunohistochemistry of surrogate markers of activation of the TCR-PLCG1-NFAT, JAK-STAT and NF-κB pathways. Folliculotropism and large-cell transformation were also examined. RESULTS: NFAT and nuclear factor kappa B (NF-κB) markers showed a comparable activation status in early and advanced stages, while STAT3 activation was more frequent in advanced stages and was associated with large-cell transformation. Consistently with this observation, STAT3 activation occurred in parallel with MF progression in two initially MF-negative cases. A significant association of NFAT with NF-κB markers was also found, reflecting a common mechanism of activation in the two pathways. Genomic studies identified nine mutations in seven genes known to play a potential role in tumorigenesis in T-cell leukaemia/lymphoma, including PLCG1, JAK3 and STAT3, which underlies the activation of these key cell-survival pathways. A higher mutational allele frequency was detected in advanced stages. CONCLUSIONS: Our results show that STAT3 is activated in advanced cases and is associated with large-cell transformation, while the activation of NFAT and NF-κB is maintained throughout the disease. These findings could have important diagnostic and therapeutic implications. What's already known about this topic? Mycosis fungoides is characterized by a clonal expansion of T cells in the skin. The mechanisms controlling disease development and progression are not fully understood. What does this study add? An association of the nuclear factor of activated T cells and nuclear factor kappa B pathways was found, which could reflect a common mechanism of activation. These pathways were activated in early and advanced stages at the same level. Signal transducer and activator of transcription 3 activation was associated with large-cell transformation and was more frequent in advanced stages. A genomic analysis of cutaneous T-cell lymphoma-associated genes was performed. Nine mutations were detected. What is the translational message? These results could have important implications for the treatment of MF in the near future.

High prevalence of non-alcoholic fatty liver disease among hidradenitis suppurativa patients independent of classic metabolic risk factors.

BACKGROUND: Some chronic inflammatory skin diseases, such as psoriasis, have been associated with an increased prevalence of non-alcoholic fatty liver disease (NAFLD). Nevertheless, this prevalence in hidradenitis suppurativa (HS) has not been assessed to date. OBJECTIVES: To determine the prevalence of NAFLD in patients with HS and the risk factors associated with this disorder. METHODS: This case-control study enrolled 70 HS patients and 150 age- and gender-matched controls who were evaluated by hepatic ultrasonography (US) and transient elastography (TE) after excluding other secondary causes of chronic liver disease. The diagnosis of NAFLD was established if US and/or TE were altered. RESULTS: The prevalence of NAFLD was significantly increased in patients with HS compared to controls (72.9% vs. 24.7%: P < 0.001). In the multivariable regression model adjusted for age, sex and classic metabolic risk factors for NAFLD, HS was significantly and independently associated with the presence of NAFLD [OR 7.75 confidence interval (CI) 2.54-23.64; P < 0.001]. CONCLUSIONS: Our results show a high prevalence of NAFLD in HS patients independent of classic metabolic risk factors. Therefore, we suggest HS patients to be evaluated for NAFLD and managed accordingly.

La cigarreta electrònica: un nou repte per als professionals de la salut / No disponible

No disponible

Whole-exome sequencing in splenic marginal zone lymphoma reveals mutations in genes involved in marginal zone differentiation.

Splenic marginal zone lymphoma (SMZL) is a B-cell neoplasm whose molecular pathogenesis remains fundamentally unexplained, requiring more precise diagnostic markers. Previous molecular studies have revealed 7q loss and mutations of nuclear factor κB (NF-κB), B-cell receptor (BCR) and Notch signalling genes. We performed whole-exome sequencing in a series of SMZL cases. Results confirmed that SMZL is an entity distinct from other low-grade B-cell lymphomas, and identified mutations in multiple genes involved in marginal zone development, and others involved in NF-κB, BCR, chromatin remodelling and the cytoskeleton.

MYC antagonizes the differentiation induced by imatinib in chronic myeloid leukemia cells through downregulation of p27(KIP1.).

Chronic myeloid leukemia (CML) progresses from a chronic to a blastic phase where the leukemic cells are proliferative and undifferentiated. The CML is nowadays successfully treated with BCR-ABL kinase inhibitors as imatinib and dasatinib. In the CML-derived K562 cell line, low concentrations of imatinib induce proliferative arrest and erythroid differentiation. We found that imatinib upregulated the cell cycle inhibitor p27(KIP1) (p27) in a time- and -concentration dependent manner, and that the extent of imatinib-mediated differentiation was severely decreased in cells with depleted p27. MYC (c-Myc) is a transcription factor frequently deregulated in human cancer. MYC is overexpressed in untreated CML and is associated to poor response to imatinib. Using K562 sublines with conditional MYC expression (induced by Zn(2+) or activated by 4-hydroxy-tamoxifen) we show that MYC prevented the erythroid differentiation induced by imatinib and dasatinib. The differentiation inhibition is not due to increased proliferation of MYC-expressing clones or enhanced apoptosis of differentiated cells. As p27 overexpression is reported to induce erythroid differentiation in K562, we explored the effect of MYC on imatinib-dependent induction of p27. We show that MYC abrogated the imatinib-induced upregulation of p27 concomitantly with the differentiation inhibition, suggesting that MYC inhibits differentiation by antagonizing the imatinib-mediated upregulation of p27. This effect occurs mainly by p27 protein destabilization. This was in part due to MYC-dependent induction of SKP2, a component of the ubiquitin ligase complex that targets p27 for degradation. The results suggest that, although MYC deregulation does not directly confer resistance to imatinib, it might be a factor that contributes to progression of CML through the inhibition of differentiation.

Increase in the prevalence of multiple sclerosis over a 17-year period in Osona, Catalonia, Spain.

The prevalence of multiple sclerosis in the south of Europe seems to be higher than previously considered. This study aimed to probe a possible increase in the prevalence of multiple sclerosis (MS) in Osona over the past 17 years. This was a cross-sectional study including MS-confirmed cases from several sources of information. Crude and adjusted prevalence rates were obtained. One hundred and twenty patients fulfilled the study criteria. The crude prevalence of MS was 79.9 (95% CI: 66.3-95.6) per 100,000 inhabitants and 91.2 (95% CI: 75.5-109.2) per 100,000 among Spanish born individuals. The prevalence of multiple sclerosis cases in Osona has increased over the past 17 years to being one of the highest reported in Spain.

[Multiple sclerosis epidemiological situation update: pertinence and set-up of a population based registry of new cases in Catalonia]. / Situación epidemiológica actual de la esclerosis múltiple: pertinencia y puesta en marcha de un registro poblacional de nuevos casos en Cataluña.

INTRODUCTION: The first epidemiological studies on multiple sclerosis (MS) around the world pictured a north to south latitudinal gradient that led to the first genetic and environmental pathogenic hypothesis. MS incidence seems to be increasing during the past 20 years based on recent data from prospective studies performed in Europe, America and Asia. This phenomenon could be explained by a better case ascertainment as well as a change in causal factors. The few prospective studies in our area together with the increase in the disease in other regions, justifies an epidemiological MS project in order to describe the incidence and temporal trends of MS. DEVELOPMENT: A prospective multicenter MS registry has been established according to the actual requirements of an epidemiological surveillance system. Case definition is based on the fulfillment of the McDonald diagnostic criteria. The registry setting is the geographical area of Cataluna (northeastern Spain), using a wide network of hospitals specialized in MS management. CONCLUSION: Recent epidemiological studies have described an increase in MS incidence. In order to contrast this finding in our area, we consider appropriate to set up a population based registry.

Situación epidemiológica actual de la esclerosis múltiple: pertinencia y puesta en marcha de un registro poblacional de nuevos casos en Cataluña / Multiple sclerosis epidemiological situation update: pertinence and set-up of a population based registry of new cases in Catalonia

Introducción. Los primeros estudios epidemiológicos de esclerosis múltiple (EM) de ámbito mundial caracterizaron un patrón geográfico latitudinal, con prevalencias más altas en las zonas más alejadas del ecuador. A raíz de esta distribución, se plantearon hipótesis causales de índole genética y ambiental. Según los datos de estudios prospectivos desarrollados en diversas regiones de Europa, América y Asia, la incidencia de la enfermedad ha aumentado a lo largo de los últimos 30 años, lo cual podría indicar una mejor detección de casos o un cambio en los factores causales subyacentes. Los escasos estudios prospectivos disponibles en nuestro entorno y el aumento de la enfermedad descrito en otras regiones justifican la pertinencia de un proyecto epidemiológico dirigido a conocer las tasas de incidencia y la tendencia temporal de EM. Desarrollo. De acuerdo con los requisitos actuales de un sistema de vigilancia epidemiológica, se ha establecido un registro prospectivo de carácter multicéntrico. Para la definición de nuevo diagnóstico se emplean los criterios establecidos por McDonald. El ámbito de aplicación es el territorio de Cataluña, a través una red de hospitales de referencia especializados en el manejo de EM, que notifican la información mediante un aplicativo informático conectado a internet. Conclusiones. Los estudios epidemiológicos de la EM de las últimas décadas han descrito un incremento de su incidencia. Para dimensionar este fenómeno en nuestro ámbito, creemos pertinente la puesta en marcha de un registro poblacional de la enfermedad en Cataluña (AU)

Introduction. The first epidemiological studies on multiple sclerosis (MS) around the world pictured a north to south latitudinal gradient that led to the first genetic and environmental pathogenic hypothesis. MS incidence seems to be increasing during the past 20 years based on recent data from prospective studies performed in Europe, America and Asia. This phenomenon could be explained by a better case ascertainment as well as a change in causal factors. The few prospective studies in our area together with the increase in the disease in other regions, justifies an epidemiological MS project in order to describe the incidence and temporal trends of MS. Development. A prospective multicenter MS registry has been established according to the actual requirements of an epidemiological surveillance system. Case definition is based on the fulfillment of the McDonald diagnostic criteria. The registry setting is the geographical area of Cataluña (northeastern Spain), using a wide network of hospitals specialized in MS management. Conclusion. Recent epidemiological studies have described an increase in MS incidence. In order to contrast this finding in our area, we consider appropriate to set up a population based registry (AU)

Indicadores de infección nosocomial / Nosocomial infection indicators

Los indicadores de infección nosocomial (IN) son una expresión de la calidad asistencial así como de la seguridad de los pacientes durante su estancia en el hospital. La cuantificación de los indicadores de infección se realiza mediante la aplicación de sistemas y/o programas de vigilancia. Los sistemas actuales de vigilancia de IN se basan tanto en estudios de prevalencia como de incidencia. En España se realiza desde el año 1990 el estudio de prevalencia EPINE, promovido por la Sociedad Española de Medicina Preventiva, Salud Pública e Higiene, que ha desarrollado 25 indicadores relacionados con IN en el conjunto de pacientes hospitalizados. Asimismo, desde el año 1994, se realiza el estudio de incidencia ENVIN-HELICS promovido por el Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias que ha desarrollado 9 indicadores relacionados con infección adquirida en unidades de cuidados intensivos (UCI) en pacientes críticos. La participación en ambos sistemas de vigilancia es voluntaria y ha crecido de forma progresiva año tras año. Los dos sistemas de vigilancia ofrecen resultados de diferentes realidades en el entorno de la IN son complementarios entre si y han contribuido a crear una formación y una sensibilización del personal sanitario ante la IN y la seguridad del paciente. Este artículo muestra los indicadores correspondientes al año 2007 obtenidos por ambos programas, así como los estándares de referencia (AU)

Nosocomial infection indicators are a reflection of healthcare quality and patient safety in hospitals. Infection indicators are calculated using surveillance programs and/or systems. Current nosocomial infection surveillance systems are based on both prevalence and incidence studies. Since 1990 the EPINE prevalence study, promoted by the Spanish Society for Preventive Medicine, Public Health and Hygiene, has developed 25 nosocomial infection indicators in hospital patients in Spain. And since 1994 the ENVIN-HELICS incidence study, promoted by the Infectious Diseases Working Group of the Spanish Society for Intensive and Critical Care Medicine and Coronary Units, has developed nine ICU-acquired infection indicators in critical patients. Participation in both surveillance systems is voluntary and has gradually increased over the years. These two control systems present the results of two different situations in the area of nosocomial infection and each complements the other; in addition, they have helped to train health professionals and to raise their awareness of nosocomial infection and patient safety. This article presents the indicators obtained in 2007 through both surveillance programs as well as their standards of reference (AU)

[Nosocomial infection indicators]. / Indicadores de infección nosocomial.

Nosocomial infection indicators are a reflection of healthcare quality and patient safety in hospitals. Infection indicators are calculated using surveillance programs and/or systems. Current nosocomial infection surveillance systems are based on both prevalence and incidence studies. Since 1990 the EPINE prevalence study, promoted by the Spanish Society for Preventive Medicine, Public Health and Hygiene, has developed 25 nosocomial infection indicators in hospital patients in Spain. And since 1994 the ENVIN-HELICS incidence study, promoted by the Infectious Diseases Working Group of the Spanish Society for Intensive and Critical Care Medicine and Coronary Units, has developed nine ICU-acquired infection indicators in critical patients. Participation in both surveillance systems is voluntary and has gradually increased over the years. These two control systems present the results of two different situations in the area of nosocomial infection and each complements the other; in addition, they have helped to train health professionals and to raise their awareness of nosocomial infection and patient safety. This article presents the indicators obtained in 2007 through both surveillance programs as well as their standards of reference.

MAP kinases and the control of nuclear events.

The mitogen-activated protein kinases (MAPKs) are a family of serine/threonine kinases that play an essential role in signal transduction by modulating gene transcription in the nucleus in response to changes in the cellular environment. They include the extracellular signal-regulated protein kinases (ERK1 and ERK2); c-Jun N-terminal kinases (JNK1, JNK2, JNK3); p38s (p38alpha, p38beta, p38gamma, p38delta) and ERK5. The molecular events in which MAPKs function can be separated in discrete and yet interrelated steps: activation of the MAPK by their upstream kinases, changes in the subcellular localization of MAPKs, and recognition, binding and phosphorylation of MAPK downstream targets. The resulting pattern of gene expression will ultimately depend on the integration of the combinatorial signals provided by the temporal activation of each group of MAPKs. This review will focus on how the specificity of signal transmission by MAPKs is achieved by scaffolding molecules and by the presence of structural motifs in MAPKs that are dynamically regulated by phosphorylation and protein-protein interactions. We discuss also how MAPKs recognize and phosphorylate their target nuclear proteins, including transcription factors, co-activators and repressors and chromatin-remodeling molecules, thereby affecting an intricate balance of nuclear regulatory molecules that ultimately control gene expression in response to environmental cues.

Etiología y Resistencias a los antibióticos en las infecciones de la localización quirúrgica tras cirugía abdominal / Etiology and antimicrobial resistance of surgical site infections after abdominal surgery

Las infecciones de la localización quirúrgica (ILQ) tras cirugía abdominal son una complicación frecuente. La resistencia de los microorganismos a los antimicrobianos ha aumentado progresivamente en los últimos años. El objetivo es describir la etiología de las ILQ, la frecuencia de resistencias de los microorganismos, y caracterizar los factores que se asocian a las ILQ por microorganismos resistentes (MR). MÉTODOS. Encuestas anuales de prevalencia de infecciones en los pacientes hospitalizados durante el periodo 1999-2005. Se seleccionaron todas las ILQ presentes en los pacientes que habían recibido cirugía abdominal. Se recogieron características demográficas de los pacientes, datos microbiológicos, y de potenciales factores de riesgo. RESULTADOS. Se identificaron un total de 3.564 ILQ en las que se aislaron 3.590 microorganismos. Los más frecuentes fueron: Escherichia coli (25,9%), Enterococcus faecalis (9,4%), Pseudomonas aeruginosa (7,0%) y Staphylococcus aureus (6,5%). Las resistencias a cefalosporinas de tercera generación oscilan entre el 2,5% para K. pneumoniae y el 30% para Enterobacter sp., y para las fluorquinolonas entre el 3,8% de K. pneumoniae y el 16,1% para E. coli (25% en el año 2005). S aureus es resistente a la oxacilina en el 38,2% de los aislados. Los principales factores asociados a infecciones por MR son el año de la encuesta, el tamaño del hospital, y el número de factores de riesgo intrínseco del paciente. CONCLUSIONES. Los microorganismos implicados en las ILQ han aumentado progresivamente sus resistencias antimicrobianas durante el periodo 1999 a 2005. El grado de resistencia a los antimicrobianos está condicionado por el nivel de riesgo intrínseco de los pacientes y el tamaño del hospital (AU)

Surgical site infection (SSI) is a common complication after abdominal surgery. Microorganism resistance to antimicrobials has been increasing progressively during the last years. The objective is to describe the aetiology of SSI, the frequency of antimicrobial resistance and to characterize the factors associated to SSI caused by resistant microorganims (RM).METHODS. A series of yearly prevalence surveys of hospitalized patients during the period 1999-2005 in Spain. Selection of all SSI developed by patients operated on by abdominal procedures. Information recorded included demographic characteristic of patients, microbiological data, and potential risk factors. RESULTS. A total 3,590 microorganisms corresponding to a 3,564 SSI were identified. The most frequent microorganisms isolated were Escherichia coli (25.9%), Enterococcus faecalis (9.4%), Pseudomonas aeruginosa (7.0%) and Staphylococcus aureus (6.5 %). Third generation cephalosporin resistance ranged from 2.5% (K. pneumoniae) and 30% (Enterobacter sp.). Fluorquinolone resistance ranged from 3.8% (K. pneumoniae) and 16.1% (E. coli) (25% for the year 2005). Methicillin resistant S. aureus reached 38% of isolates. The main factors associated to MR infections were year of the survey, size of the hospital and the number of intrinsic risk factors of the patients. CONCLUSIONS Microorganisms involved in SSI have been progressively increasing antimicrobial resistance during the period 1999 through 2005. Patient intrinsic risk and the size of the hospital condition the level of antimicrobial resistance (AU)

p73 cooperates with Ras in the activation of MAP kinase signaling cascade.

The p73 gene is capable of inducing cell cycle arrest, apoptosis, senescence, differentiation and to cooperate with oncogenic Ras in cellular transformation. Ras can be considered as a branch point in signal transduction, where diverse extracellular stimuli converge. The intensity of the mitogen-activated protein kinase (MAPK) cascade activation influences the cellular response to Ras. Despite the fundamental role of p53 in Ras-induced growth arrest and senescence, it remains unclear how the Ras/MEK/ERK pathway induces growth arrest in the absence of p53. We report here that oncogenic Ras stabilizes p73 resulting in p73 accumulation and enhancement of its activity. p73, in turn, induces a sustained activation of the MAP kinase cascade synergizing with oncogenic Ras. We also found that inhibition of p73 function modifies the cellular outcome to Ras activation inhibiting Ras-dependent differentiation. Here, we show for the first time that there is a signaling loop between Ras-dependent MAPK cascade activation and p73 function.

Nosocomial and community-acquired meticillin-resistant Staphylococcus aureus infections in hospitalized patients (Spain, 1993-2003).

A series of annual surveys on the prevalence of infections in hospitalized patients in Spain was undertaken from 1993 to 2003 to describe clinical and demographic characteristics, trends and geographical variations in the proportion of meticillin-resistant Staphylococcus aureus (MRSA). A total of 8312 S. aureus infections in patients from 296 acute care hospitals pertaining to 17 regions in Spain were observed during the study period. Overall, 23.8% of these organisms were reported as meticillin resistant. The proportion of MRSA varied widely across regions and during the study period. Patients with nosocomial infections (NIs) had a two-fold higher prevalence of MRSA (31%) than patients with community-acquired infections (CAIs) (14%; P<0.001). Nevertheless, there was an increasing trend in the prevalence of MRSA isolates, both in patients with NI (from 22% to 41%; P<0.001) and with CAI (from 7% to 28%; P<0.001) throughout the 11-year period. Geographical variations over the last three years (2001-2003) show a centripetal gradient, with the lowest MRSA prevalence in south-west Spain and the highest MRSA prevalence in the central regions. Almost five-fold differences in MRSA proportions were seen between regions (range 10.3-54.5%). Compared with bloodstream infections, infections in other sites were more likely to be caused by MRSA (adjusted odds ratios for surgical site, urinary tract, skin and respiratory infections of 1.2, 1.2, 1.5 and 2.1, respectively).

Prevalencia de infección por el virus de la hepatitis C en pacientes a las que se practicó cirugía obstétrica y ginecológica en un hospital de tercer nivel / Prevalence of hepatitis C virus infection in patients undergoing obstetric-gynecological surgery in a third level hospital

Introducción: La infección por el virus de la hepatitis C (VHC) es un importante problema de salud pública por su elevada incidencia, el curso progresivo de la enfermedad y su asociación con el carcinoma hepático. La transmisión nosocomial del VHC ha sido objeto de debate en nuestro medio. Este riesgo depende de la prevalencia de la infección en la población atendida y en el personal sanitario, de los procedimientos realizados y de la adecuación de las medidas de prevención. Objetivo: Determinar la prevalencia de la infección en las pacientes atendidas por un parto o intervenidas ginecológicamente en un hospital de tercer nivel, como parte de un estudio más amplio dirigido a estimar el riesgo de transmisión nosocomial del VHC. Material y métodos: Se incluyeron en el estudio 1.649 pacientes atendidas en estos servicios entre octubre de 1999 y mayo de 2001.Antes de la intervención, se realizó una encuesta epidemiológica sobre antecedentes y factores de riesgo de infección por VHC y una extracción sanguínea para el estudio serológico (técnicas de ELISA III y confirmación por RIBA III).Resultados: La prevalencia global de infección por el VHC fue del 0,97 por ciento (intervalo de confianza [IC] del 95 por ciento, 0,56-1,57), con cifras superiores en ginecología (1,75 por ciento; IC del 95 por ciento, 0,96-2,92) que en obstetricia (0,24 por ciento; IC del 95 por ciento, 0,03-0,84) (p = 0,004). La edad fue la variable más asociada a la presencia de infección. El 75 por ciento de los casos desconocían la presencia de la infección. Conclusión: La prevalencia de infección por VHC en las pacientes intervenidas en los servicios de ginecología y obstetricia en nuestro centro es similar a la de la población general. Se ha observado un infradiagnóstico importante de esta infección en la población atendida (AU)

Mortality and prognostic factors in Spanish patients with systemic sclerosis.

OBJECTIVE: To determine survival and mortality in a cohort of Spanish patients with scleroderma (systemic sclerosis, SSc) and to analyse whether survival is influenced by demographic, clinical or immunological variables or the extent of skin involvement. METHODS: The study included 79 patients diagnosed with SSc and taking part in a study to determine the extent of sclerosis, visceral involvement and immunological alterations. We studied the number of observed and expected deaths (the expected number being based on age- and sex-specific rates in the background population) and derived standardized mortality ratios with their 95% confidence intervals (CI). Cumulative survival after onset of the first symptom was estimated according to the Kaplan-Meier method. The Cox method was used to identify the prognostic factors. RESULTS: The mortality rate was 0.0249 deaths per person-year. Survival at 15 yr was 0.62 (95% CI 0.410-0.778). The standardized mortality ratio was 429.4% (95% CI 222-750). On crude analysis, lung involvement [forced vital capacity (FVC) <70%, pulmonary hypertension], SSc renal crisis, an active capillaroscopic pattern, pericardial effusion and age over 60 yr at diagnosis were associated with shorter survival. On multivariate analysis, only age at diagnosis over 60 yr, FVC <70% and SSc renal crisis were independent prognostic factors. CONCLUSIONS: The mortality rate associated with SSc showed a four-fold increase compared with the background population. Lung involvement and sclerodermal renal crisis were found to be independently associated with reduced survival.

[Public health functions, activities and structures: the role of large and middle-sized municipalities]. / Funciones, actividades y estructuras de salud pública: el papel de los municipios grandes y medianos.

OBJECTIVE: The aim of this paper was to analyze how public health functions are covered in large or medium-sized cities in Catalonia (Spain) by assessing the role, activities and structure of local services. METHODS: Data were collected through a questionnaire with items on public health functions and activities and on the structure of municipal services. The study population comprised the 43 cities of Catalonia with a population above 25,000 (3% of towns and 70% of the population). Answers were obtained from 28 cities (65%), covering 60% of the population of Catalonia and all towns with a population above 50,000 inhabitants. RESULTS: The public health function in which local governments were least active was need assessment while they were more active in policy development and service delivery assurance. For public health activities, the role of local governments was relatively greater in health protection while few municipal services were active in epidemiological surveillance and substance abuse. Municipal public health expenditure per resident/year was estimated at 1,063 pesetas (approximately 6 Euros). Among the public health personnel, 72% worked full-time while the remaining (mainly members of the corps of health officers serving local administration) worked part-time. Local governments often mixed within the same structure public health services and services, mainly consumer affairs, environmental or social services. CONCLUSIONS: Local governments showed significant activity in public health. The volume of resources involved and management capacity were considerable. In some cities, some public health activities were perceived as not covered.

[Protein-calorie malnutrition and lymphocytopenia as predictors of hospital infection in the elderly]. / Malnutrición caloricoproteica y linfocitopenia como predictores de infección hospitalaria en ancianos.

BACKGROUND: Clinical and epidemiological studies have established that malnutritionis a risk factor for infection in patients being submitted to surgery. To date no study has been carried out to establish the association between the nutritional condition and the incidence of hospital-acquired infections in patients in the medical area. We study the incidence of hospital-acquired infections in the elderly in an attempt to determine the rate of this infection and its association with protein-calorie malnutrition. Another aim of this study has been to determine the predictive value of the parameters used to evaluate the patient's state of nutrition and immunity. PATIENTS AND METHOD: We included 240 patients over 64 years old, 118 males and 122 females, admitted to the medical area of a general hospital. The nutritional and immunity condition of the patients was evaluated through determinations of weight, height, body mass index, hypoalbuminemia and total lymphocyte count. The psichophisical degree of dependence was evaluated through of Norton scale. The details on the hospital infections came from a clinical and microbiological follow-up of patients, in accordance with the criteria of the Centers for Disease Control of Atlanta. RESULTS: The frequency of protein-calorie malnutrition was 12.5% and the accumulated incidence of hospital-acquired infections was 19.6%. Functional incapacity of the elderly prior to hospitalization (odds ratio,4.70; 95% CI: 1.1-19.0) as well as the presence of certain extrinsicrisk factors (odds ratio, 2.35; 95% CI: 1.1-5.1) were, in addition to hypoalbuminemia (odds ratio, 3.60; 95% CI: 1.3-10.2) and lymphocytopenia(odds ratio, 2.67; 95% CI: 1.3-5.7), the independent variables that showed the most significant association with the incidence of hospital-acquired infections. CONCLUSIONS: The nutritional parameters associated with the immune system determinedgreater risk of hospital-acquired infections among elderly patients admitted to the medical area of a hospital. The initial evaluation of elderly patients hospitalitzed in accordance whit the psychophysical degree of dependence based on the Norton scale is useful to evaluate those patients who were at greater risk for hospital infections.