Proteinograma de sueros felinos, una herramienta complementaria de casos clínicos

Las proteínas plasmáticas cumplen diversas funciones en los organismos vivos entre las que se pueden mencionar entre otras las de transporte, inmunológica, hormonal y enzimática. Las alteraciones de los valores de las distintas fracciones proteicas pueden a menudo asociarse a distintas patologías de los animales. La electroforesis es una prueba de laboratorio clínico, que permite la separación de las proteínas de acuerdo a sus características físicas. En este trabajo se realizó un estudio transversal de las fracciones proteicas de muestras de sueros de pacientes felinos con el objetivo de relacionar las variaciones en las fracciones del proteinograma de las muestras y correlacionar los patrones electroforéticos según la sintomatología y diagnósticos presuntivos o definitivos, agrupando los resultados de las pruebas según causas infecciosas-inflamatorias, metabólicas y neoplásicas. Se realizó la separación de las fracciones proteicas, albúmina, alfa globulinas (α), beta globulinas (β), gammaglobulinas (γ), y las subfracciones alfa 1 globulinas (α-1), alfa 2 globulinas (α-2), beta 1 globulinas (β-1) y beta 2 globulinas (β-2) mediante electroforesis en cintas de acetato de celulosa. Los animales utilizados en este estudio fueron clasificados en normales (no presentaron signos de afección alguna) y, según la patología predominante en las siguientes categorías: con enfermedad renal, con afección hepática o con enfermedad infecciosa/inflamatoria (leucocitosis, VIF+ y con presencia de Mycoplasma spp). Se observaron diferencias en las distintas fracciones proteicas analizadas en los distintos grupos de animales, por lo que la utilización de esta técnica podría ser útil como una herramienta más en el diagnóstico de diversas enfermedades, junto a una buena anamnesis, análisis de los signos clínicos del paciente, correcto examen clínico y la utilización de métodos complementarios acordes.Facultad de Ciencias Veterinaria

Proteinograma de sueros felinos, una herramienta complementaria de casos clínicos

Las proteínas plasmáticas cumplen diversas funciones en los organismos vivos entre las que se pueden mencionar entre otras las de transporte, inmunológica, hormonal y enzimática. Las alteraciones de los valores de las distintas fracciones proteicas pueden a menudo asociarse a distintas patologías de los animales. La electroforesis es una prueba de laboratorio clínico, que permite la separación de las proteínas de acuerdo a sus características físicas. En este trabajo se realizó un estudio transversal de las fracciones proteicas de muestras de sueros de pacientes felinos con el objetivo de relacionar las variaciones en las fracciones del proteinograma de las muestras y correlacionar los patrones electroforéticos según la sintomatología y diagnósticos presuntivos o definitivos, agrupando los resultados de las pruebas según causas infecciosas-inflamatorias, metabólicas y neoplásicas. Se realizó la separación de las fracciones proteicas, albúmina, alfa globulinas (α), beta globulinas (β), gammaglobulinas (γ), y las subfracciones alfa 1 globulinas (α-1), alfa 2 globulinas (α-2), beta 1 globulinas (β-1) y beta 2 globulinas (β-2) mediante electroforesis en cintas de acetato de celulosa. Los animales utilizados en este estudio fueron clasificados en normales (no presentaron signos de afección alguna) y, según la patología predominante en las siguientes categorías: con enfermedad renal, con afección hepática o con enfermedad infecciosa/inflamatoria (leucocitosis, VIF+ y con presencia de Mycoplasma spp). Se observaron diferencias en las distintas fracciones proteicas analizadas en los distintos grupos de animales, por lo que la utilización de esta técnica podría ser útil como una herramienta más en el diagnóstico de diversas enfermedades, junto a una buena anamnesis, análisis de los signos clínicos del paciente, correcto examen clínico y la utilización de métodos complementarios acordes.Facultad de Ciencias Veterinaria

Atlas de orina : Análisis de orina e interpretación de los resultados en caninos, felinos y equinos

Este material es uno de los pocos en la literatura veterinaria que interrelaciona la descripción anatómica, fisiopatología de la injuria renal y bioseguridad en esta área del laboratorio con las técnicas de realización del análisis de orina, interpretación de los resultados y fotos ilustrativas de colección propia para favorecer el reconocimiento de los elementos formes en el sedimento urinario, así como también la importancia del urocultivo y antibiograma. Por último, se describen diferentes casos clínicos que demuestran la utilidad del análisis de orina o urocultivo y la relevancia de una correcta interpretación de los resultados para arribar a un diagnóstico definitivo.Facultad de Ciencias Veterinaria

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit