16 research outputs found
Malignant epithelioid hemangioendothelioma of the liver successfully treated with Sorafenib
Hepatic epithelioid hemangioendothelioma (HEH) is a rare disease of unknown etiology for which a standard systemic treatment has not been established. The common expression of vascular endothelial growth factor (VEGF) and its receptor in HEH provide a rationale for the reported use of antiangiogenic drugs, including bevacizumab, lenalidomide and thalidomide. We report a case of a young male patient with HEH who was treated with sorafenib for almost 2 years. Sorafenib was used instead of other VEGF inhibitors due to its convenient oral route, its dual antiangiogenic and antiproliferative activity, and its favorable safety profile. Sorafenib therapy resulted in durable stabilization with progressive calcification of liver tumors and minor but stable response of lung lesions
Linezolid-induced lactic acidosis in two liver transplant patients with the mitochondrial DNA A2706G polymorphism
Mitochondrial toxicity has been recently suggested to be the underlying mechanism of long-term linezolid-associated toxicity in
patients with 16S rRNA genetic polymorphisms. Here, we report for the first time two cases of lactic acidosis due to long-term
linezolid exposure in liver transplant recipients who presented an A2706G mitochondrial DNA polymorphism
Long-term outcome of critically III advanced cancer patients managed in an intermediate care unit
Background: To analyze the long-term outcomes for advanced cancer patients admitted to an intermediate care unit (ImCU), an analysis of a do not resuscitate orders (DNR) subgroup was made. Methods: A retrospective observational study was conducted from 2006 to January 2019 in a single academic medical center of cancer patients with stage IV disease who suffered acute severe complications. The Simplified Acute Physiology Score 3 (SAPS 3) was used as a prognostic and severity score. In-hospital mortality, 30-day mortality and survival after hospital discharge were calculated. Results: Two hundred and forty patients with stage IV cancer who attended at an ImCU were included. In total, 47.5% of the cohort had DNR orders. The two most frequent reasons for admission were sepsis (32.1%) and acute respiratory failure (excluding sepsis) (38.7%). Mortality in the ImCU was 10.8%. The mean predicted in-hospital mortality according to SAPS 3 was 51.9%. The observed in-hospital mortality was 37.5% (standard mortality ratio of 0.72). Patients discharged from hospital had a median survival of 81 (30.75-391.25) days (patients with DNR orders 46 days (19.5-92.25), patients without DNR orders 162 days (39.5-632)). The observed mortality was higher in patients with DNR orders: 52.6% vs. 23.8%, p 0 < 0.001. By multivariate logistic regression, a worse ECOG performance status (3-4 vs. 0-2), a higher SAPS 3 Score and DNR orders were associated with a higher in-hospital mortality. By multivariate analysis, non-invasive mechanical ventilation, higher bilirubin levels and DNR orders were significantly associated with 30-day mortality. Conclusion: For patients with advanced cancer disease, even those with DNR orders, who suffer from acute complications or require continuous monitoring, an ImCU-centered multidisciplinary management shows encouraging results in terms of observed-to-expected mortality ratios
Long daytime napping is associated with increased adiposity and type 2 diabetes in an elderly population with metabolic syndrome
Research examining associations between objectively-measured napping time and type
2 diabetes (T2D) is lacking. This study aimed to evaluate daytime napping in relation to T2D and
adiposity measures in elderly individuals from the Mediterranean region. A cross-sectional analysis of
baseline data from 2190 elderly participants with overweight/obesity and metabolic syndrome, in the
PREDIMED-Plus trial, was carried out. Accelerometer-derived napping was measured. Prevalence
ratios (PR) and 95% confidence intervals (CI) for T2D were obtained using multivariable-adjusted
Cox regression with constant time. Linear regression models were fitted to examine associations of
napping with body mass index (BMI) and waist circumference (WC). Participants napping ≥90 min
had a higher prevalence of T2D (PR 1.37 (1.06, 1.78)) compared with those napping 5 to <30 min per
day. Significant positive associations with BMI and WC were found in those participants napping
≥30 min as compared to those napping 5 to <30 min per day. The findings of this study suggest that
longer daytime napping is associated with higher T2D prevalence and greater adiposity measures in
an elderly Spanish population at high cardiovascular risk
Isotemporal substitution of inactive time with physical activity and time in bed: cross-sectional associations with cardiometabolic health in the PREDIMEDPlus study
Background: This study explored the association between inactive time and measures of adiposity, clinical parameters, obesity, type 2 diabetes and metabolic syndrome components. It further examined the impact of reallocating inactive time to time in bed, light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) on cardio-metabolic risk factors, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults.
Methods: This is a cross-sectional analysis of baseline data from 2189 Caucasian men and women (age 55-75 years, BMI 27-40 Kg/m2) from the PREDIMED-Plus study (http://www.predimedplus.com/). All participants had ≥3 components of the metabolic syndrome. Inactive time, physical activity and time in bed were objectively determined using triaxial accelerometers GENEActiv during 7 days (ActivInsights Ltd., Kimbolton, United Kingdom). Multiple adjusted linear and logistic regression models were used. Isotemporal substitution regression modelling was performed to assess the relationship of replacing the amount of time spent in one activity for another, on each outcome, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults.
Results: Inactive time was associated with indicators of obesity and the metabolic syndrome. Reallocating 30 min per day of inactive time to 30 min per day of time in bed was associated with lower BMI, waist circumference and glycated hemoglobin (HbA1c) (all p-values < 0.05). Reallocating 30 min per day of inactive time with 30 min per day of LPA or MVPA was associated with lower BMI, waist circumference, total fat, visceral adipose tissue, HbA1c, glucose, triglycerides, and higher body muscle mass and HDL cholesterol (all p-values < 0.05).
Conclusions: Inactive time was associated with a poor cardio-metabolic profile. Isotemporal substitution of inactive time with MVPA and LPA or time in bed could have beneficial impact on cardio-metabolic health
Evaluation of the quality of multiple-choice questions according to the students’ academic level
Background: One of the most important challenges in medical education is the preparation of multiple-choice
questions able to discriminate between students with diferent academic level. Average questions may be very easy
for students with good performance, reducing their discriminant power in this group of students. The aim of this
study was to analyze if the discriminative power of multiple-choice questions is diferent according to the students’
academic performance.
Methods: We retrospectively analyzed the difculty and discrimination indices of 257 multiple-choice questions
used for the end of course examination of pathophysiology and analyzed whether the discrimination indices were
lower in students with good academic performance (group 1) than in students with moderate/poor academic perfor‐
mance (group 2). We also evaluated whether case-based questions maintained their discriminant power better than
factual questions in both groups of students or not. Comparison of the difculty and discrimination indices between
both groups was based on the Wilcoxon test.
Results: Difculty index was signifcantly higher in group 1 (median: 0.78 versus 0.56; P< 0.001) and discrimination
index was signifcantly higher in group 2 (median: 0.21 versus 0.28; P< 0.001). Factual questions had higher discrimi‐
native indices in group 2 than in group 1 (median: 0.28 versus 0.20; P< 0.001), but discriminative indices of case-
based questions did not difer signifcantly between groups (median: 0.30 versus 0.24; P=0.296).
Conclusions: Multiple-choice question exams have lower discriminative power in the group of students with high
scores. The use of clinical vignettes may allow to maintain the discriminative power of multiple-choice questions
Map-aided software enhancement for autonomous GNSS complementary positioning system for railway
Independently on the business case addressed, one of the main drawbacks of the railway use cases that need continuous Global Navigation Satellite Systems data is the lack of availability for the 100% of the time of the journey. Additionally, the integrity assessment of the position estimation given is also mandatory for safety critical applications. Thus, tunnels and multipath effects are one of the most challenging situations for the continuous positioning systems. In this context, an autonomous on-board Complementary Positioning System has been proposed to overcome the limitation of Global Navigation Satellite System based positioning systems. This paper proposes a positioning enhancement solution by means of fusing data from the satellite navigation system and inertial measurement units. That hybrid solution provides higher availability and accuracy to the positioning specially on known blocked scenarios, such as tunnels, or urban canyons, by means of a novel environment aware map aided software technique named Known Blocked Scenarios algorithm... This paper describes the Complementary Positioning System and the field test carried out in a challenging environment to validate the enhancement proposed by the authors, which demonstrate the benefits that this system has in known harsh environments for railways
Linezolid-induced lactic acidosis in two liver transplant patients with the mitochondrial DNA A2706G polymorphism
Mitochondrial toxicity has been recently suggested to be the underlying mechanism of long-term linezolid-associated toxicity in
patients with 16S rRNA genetic polymorphisms. Here, we report for the first time two cases of lactic acidosis due to long-term
linezolid exposure in liver transplant recipients who presented an A2706G mitochondrial DNA polymorphism
Mortality Prediction in Patients Undergoing Non-Invasive Ventilation in Intermediate Care
Background
Intermediate Care Units (ImCU) have become an alternative scenario to perform Non-Inva-
sive Ventilation (NIV). The limited number of prognostic studies in this population support
the need of mortality prediction evaluation in this context.
Objective
The objective of this study is to analyze the performance of Simplified Acute Physiology
Score (SAPS) II and 3 in patients undergoing NIV in an ImCU. Additionally, we searched for
new variables that could be useful to customize these scores, in order to improve mortality
prediction.
Design
Cohort study with prospectively collected data from all patients admitted to a single center
ImCU who received NIV. The SAPS II and 3 scores with their respective predicted mortality
rates were calculated. Discrimination and calibration were evaluated by calculating the area
under the receiver operating characteristic curve (AUC) and with the Hosmer-Lemeshow
goodness of fit test for the models, respectively. Binary logistic regression was used to iden-
tify new variables to customize the scores for mortality prediction in this setting.
Patients
The study included 241 patients consecutively admitted to an ImCU staffed by hospitalists
from April 2006 to December 2013. Key Results
The observed in-hospital mortality was 32.4% resulting in a Standardized Mortality Ratio
(SMR) of 1.35 for SAPS II and 0.68 for SAPS 3. Mortality discrimination based on the AUC
was 0.73 for SAPS II and 0.69 for SAPS 3. Customized models including immunosuppres-
sion, chronic obstructive pulmonary disease (COPD), acute pulmonary edema (APE), lactic
acid, pCO2 and haemoglobin levels showed better discrimination than old scores with simi-
lar calibration power.
Conclusions
These results suggest that SAPS II and 3 should be customized with additional patient-risk
factors to improve mortality prediction in patients undergoing NIV in intermediate care
Sleep Duration is Inversely Associated with Serum Uric Acid Concentrations and Uric Acid to Creatinine Ratio in an Elderly Mediterranean Population at High Cardiovascular Risk
The aim of the study was to evaluate sleep duration and sleep variability in relation to serum uric acid (SUA) concentrations and SUA to creatinine ratio. This is a cross-sectional analysis of baseline data from 1842 elderly participants with overweight/obesity and metabolic syndromein the (Prevención con Dieta Mediterránea) PREDIMED-Plus trial. Accelerometry-derived sleep duration and sleep variability were measured. Linear regression models were fitted to examine the aforementioned associations. A 1 hour/night increment in sleep duration was inversely associated with SUA concentrations (β = 0.07, p = 0.047). Further adjustment for leukocytes attenuated this association (p = 0.050). Each 1-hour increment in sleep duration was inversely associated with SUA to creatinine ratio (β = 0.15, p = 0.001). The findings of this study suggest that longer sleep duration is associated with lower SUA concentrations and lower SUA to creatinine ratio