Fiebre de origen desconocido: presentación atípica de enfermedad de Parkinson

We present a 74-year-old female patient who was admitted to the hospital for evaluation of fever and deterioration of her general condition. Complementary tests focused on the differential diagnosis of fever of unknown origin were negative. Given the progressive neurological worsening with bradypsychia, bradylalia, mutism, rigidity, and symptoms of severe dysautonomia, a provocation test with levodopa was performed on suspicion of parkinsonism. The patient's evolution after treatment was very favorable, with disappearance of the fever, the neurological and other dysautonomia symptoms.Presentamos una paciente de 74 años que ingresa para estudio de fiebre y deterioro del estado general. Las pruebas complementarias enfocadas al diagnóstico diferencial de fiebre de origen desconocido fueron negativas. Dado el progresivo empeoramiento neurológico con bradipsiquia, bradilalia, mutismo, rigidez y de los síntomas de disautonomía severa, se realizó un ensayo de provocación con levodopa ante la sospecha de parkinsonismo. La evolución de la paciente tras el tratamiento fue muy favorable, con desaparición de la fiebre, los síntomas neurológicos y de disautonomía.

Development of a predictive model of hospitalization in primary care patients with heart failure

BACKGROUND: Heart failure (HF) is the leading cause of hospitalization in people over age 65. Predictive hospital admission models have been developed to help reduce the number of these patients. AIM: To develop and internally validate a model to predict hospital admission in one-year for any non-programmed cause in heart failure patients receiving primary care treatment. DESIGN AND SETTING: Cohort study, prospective. Patients treated in family medicine clinics. METHODS: Logistic regression analysis was used to estimate the association between the predictors and the outcome, i.e. unplanned hospitalization over a 12-month period. The predictive model was built in several steps. The initial examination included a set of 31 predictors. Bootstrapping was used for internal validation. RESULTS: The study included 251 patients, 64 (25.5%) of whom were admitted to hospital for some unplanned cause over the 12 months following their date of inclusion in the study. Four predictive variables of hospitalization were identified: NYHA class III-IV, OR (95% CI) 2.46 (1.23-4.91); diabetes OR (95% CI) 1.94 (1.05-3.58); COPD OR (95% CI) 3.17 (1.45-6.94); MLHFQ Emotional OR (95% CI) 1.07 (1.02-1.12). AUC 0.723; R2N 0.17; Hosmer-Lemeshow 0.815. Internal validation AUC 0.706.; R2N 0.134. CONCLUSION: This is a simple model to predict hospitalization over a 12-month period based on four variables: NYHA functional class, diabetes, COPD and the emotional dimension of the MLHFQ scale. It has an acceptable discriminative capacity enabling the identification of patients at risk of hospitalization.This study was financed by the Health Research Fund (FIS), grant no. PI 14/01677 and co-financed with ERDF funds from the European Union: REDISSEC - Project ISCIII (Red de Investigación en Enfermedades Crónicas del Servicio de Salud - Instituto de Salud Carlos III) concession no. RD16/0001/0004. The Foundation for Biosanitary Research and Innovation in Primary Health Care (FIIBAP) financed the costs of publishing the article. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

Development of a predictive model of hospitalization in primary care patients with heart failure

Background Heart failure (HF) is the leading cause of hospitalization in people over age 65. Predictive hospital admission models have been developed to help reduce the number of these patients. Aim To develop and internally validate a model to predict hospital admission in one-year for any non-programmed cause in heart failure patients receiving primary care treatment. Design and setting Cohort study, prospective. Patients treated in family medicine clinics. Methods Logistic regression analysis was used to estimate the association between the predictors and the outcome, i.e. unplanned hospitalization over a 12-month period. The predictive model was built in several steps. The initial examination included a set of 31 predictors. Bootstrapping was used for internal validation. Results The study included 251 patients, 64 (25.5%) of whom were admitted to hospital for some unplanned cause over the 12 months following their date of inclusion in the study. Four predictive variables of hospitalization were identified: NYHA class III-IV, OR (95% CI) 2.46 (1.23–4.91); diabetes OR (95% CI) 1.94 (1.05–3.58); COPD OR (95% CI) 3.17 (1.45–6.94); MLHFQ Emotional OR (95% CI) 1.07 (1.02–1.12). AUC 0.723; R2N 0.17; Hosmer-Lemeshow 0.815. Internal validation AUC 0.706.; R2N 0.134 Conclusion This is a simple model to predict hospitalization over a 12-month period based on four variables: NYHA functional class, diabetes, COPD and the emotional dimension of the MLHFQ scale. It has an acceptable discriminative capacity enabling the identification of patients at risk of hospitalization.This study was financed by the Health Research Fund (FIS), grant no. PI 14/01677 and co-financed with ERDF funds from the European Union: REDISSEC - Project ISCIII (Red de Investigación en Enfermedades Crónicas del Servicio de Salud - Instituto de Salud Carlos III) concession no. RD16/0001/0004. The Foundation for Biosanitary Research and Innovation in Primary Health Care (FIIBAP) financed the costs of publishing the articl

Calidad de vida de los profesionales en el modelo de gestión clínica de Asturias

ResumenObjetivoAnalizar la calidad de vida profesional en el modelo de gestión clínica de Asturias y comprobar si hay diferencias en los centros donde el modelo lleva implantado más tiempo o en función del ámbito asistencial (atención primaria o especializada).MétodosSe aplicó el CVP-35 (35 preguntas), anónimo y autocumplimentado, con tres preguntas adicionales. Se realizó un análisis descriptivo, univariado y bivariado, de las preguntas por separado y según las subescalas «Apoyo directivo» (AD), «Cargas de trabajo» (CT) y «Motivación intrínseca» (MI), siendo las principales variables independientes el ámbito asistencial y el tiempo como unidad o área de gestión clínica.ResultadosDe la población de estudio, 2572 profesionales, respondieron 1395 (54%) (el 67% en primaria y 51% en especializada). El 87% llevaba 5 años o más en su puesto. Para el 33% era su primer año en gestión clínica. El ítem con mayor puntuación fue la capacitación para el trabajo (8,39±1,42) y el más bajo los conflictos con los compañeros (3,23±2,2). Primaria obtiene resultados más altos en AD y calidad de vida en el trabajo, y especializada en CT. Respecto a la gestión clínica, las mejores puntuaciones se obtienen en las de 3 años y las peores en las de primer año. Las diferencias son especialmente favorables a la gestión clínica en especializada: las que más tiempo llevan perciben menos CT y más MI y calidad de vida.ConclusionesLlevar más tiempo en el modelo de gestión clínica se asocia con mejores percepciones en la calidad de vida profesional, sobre todo en atención especializada.AbstractObjectiveTo evaluate professional quality of life in our clinical governance model by comparing differences according to the time since the model's implementation (1-3 years) and the setting (primary or hospital care).MethodsA cross-sectional descriptive study was performed. The 35-item, anonymous, self-administered Professional Quality of Life Questionnaire, with three additional questions, was applied. A minimum sample size for each clinical governance unit/area (CGU/CGA) was calculated. Descriptive, univariate and bivariate analyses were performed using the 35 items separately. The subscales of «management support», «workload» and «intrinsic motivation» were used as dependant variables, and the setting and time since implementation of the CGU/CGA as independent variables.ResultsOf the study population of 2572 professionals, 1395 (54%) responded (67% in primary care and 51% in hospital care). A total of 87% had been working for 5 years or more in their positions. Thirty-three percent had worked for less than a year in clinical governance. The item with the highest score was job training (8.39±1.42) and that with the lowest was conflicts with peers (3.23±2.2). Primary healthcare professionals showed better results in management support and quality of life at work and hospital professionals in workload. The clinical governance model obtained the best scores at 3 years and the worst at 1 year. These differences were especially favorable for clinical governance in hospitals: professionals working longer perceived a lower workload and more intrinsic motivation and quality of life.ConclusionsA longer time working in the clinical governance model was associated with better perception of professional quality of life, especially in hospital care

Psychometric Characteristics and Sociodemographic Adaptation of the Corrigan Agitated Behavior Scale in Patients With Severe Mental Disorders

Background: Severe mental disorder (SMD) is understood in a first approximation as a disorder of thought, emotion, or behavior of long duration, which entails a variable degree of disability and social dysfunction. One of the most widely used assessment scales for agitated behavior, in its English version, is the Corrigan Agitated Behavior Scale (ABS); several studies have demonstrated solid psychometric properties of the English version, with adequate internal consistency. Objective: The objective of this study was to evaluate the psychometric properties of the Spanish version of the ABS Corrigan scale, in a sample of patients with severe mental disorders. The psychometric analyses of the Spanish version of the ABS Corrigan included tests of the reliability and validity of its internal structure. Results: The structure of the factorial loads of the analyzed elements is consistent with the hypothesized three-dimensional construction referred to in the original ABS. The results suggest that the reliability and validity of the three dimensions are acceptable (First 0.8, Second 0.8, and Third 0.7). The internal consistency of the Spanish version of the complete ABS and of each of the three domains that compose it is high, with values very close to those found in the original version, with approximate figures of 0.9. Conclusion: In our study, the three domains aim to explain 64.1% of the total variance of the scale, which exceeds the 50% found in the original version

Psycho-emotional disorders as incoming risk factors for myocardial infarction with non-obstructive coronary arteries

  Background: There is an emerging field underlying the myocardial infarction (MI) with non-obstruc­tive coronary arteries (MINOCA). The aim of this study was to evaluate the impact of psycho-emotional disorders and social habits in MINOCA patients. Methods: The study included 95 consecutive patients diagnosed of MINOCA and 178 patients with MI and obstructive lesions. MINOCA patients were included when they fulfilled the three main criteria: accomplishment of the Third Universal Definition of Myocardial Infarction, absence of obstructive coronary arteries and no clinically overt specific cause for the acute presentation. Results: MINOCA patients had a higher frequency of previous psychiatric illnesses than the obstructive coronary arteries group (29.7% vs. 12.9%, p = 0.001). MINOCA patients recognized emotional stress in 75.7% of the cases, while only 32.1% of the obstructive related group did (p < 0.001). The relation­ship remained after excluding takotsubo syndrome from the analysis (26 cases, 27.4%): psychiatric diseases (27.9% vs. 12.9%, p < 0.01) and recognition of emotional stress (70.8% vs. 32.1%, p < 0.001). Social habits which could act as stress modulating showed no significant relation with MINOCA. Conclusions: Psycho-emotional disorders are related to MINOCA and they could act as risk fac­tor. This relationship is maintained after excluding takotsubo from the analysis. (Cardiol J 2018; 25, 1: 24–31

Remoción de carga orgánica en lixiviados por medio de un biofiltro empacado con residuos estabilizados

Los sitios de disposición final de residuos sólidos mal operados, causan afectaciones en su entorno y generan problemas de salud pública; estos sitios en general, son concebidos como pasivos ambientales. En el presente estudio se extrajeron residuos sólidos con edad superior a 8 años de la zona clausurada del relleno sanitario de la ciudad de Tuxtla Gutiérrez, Chiapas, México. Los residuos se caracterizaron con los parámetros de humedad, sólidos totales y sólidos volátiles, encontrando una alta estabilidad biológica en los mismos. Posteriormente, con el objetivo de evaluar el potencial biológico en el tratamiento de lixiviados, estos materiales fueron utilizados como lecho de empaque dentro de un biofiltro semi-aeróbico. Durante los ocho meses de monitoreo, el biofiltro registró eficiencias de remoción en DQO entre 60 y 90%, y alrededor de 60% en color, con cargas hidráulicas del orden de los 10-11 L/m3-d. Estos resultados representan de las primeras investigaciones en México usando como material de empaque residuos estabilizados, demostrando con ello, que los biofiltros pueden ser utilizados como una alternativa atractiva para el pretratamiento de lixiviados de rellenos sanitarios

Genetic complexity impacts the clinical outcome of follicular lymphoma patients

© The Author(s) 2021.Follicular lymphoma (FL) is the second most common non-Hodgkin lymphoma (NHL, 20–30%) after diffuse large B-cell lymphoma (DLBCL). Despite the introduction of rituximab and the high response rate to first-line treatment, approximately 20% of the FL patients relapse or progress within 2 years of receiving first-line therapy. Therefore, the major challenge is finding biomarkers that identify high-risk patients at diagnosis.This work was partially supported by the Instituto de Salud Carlos III (ISCIII), Spanish Ministry of Economy and Competitiveness PI15/01393, PI18/00410, CIBERONC-CB16/12/00233, and “Una manera de hacer Europa” (Innocampus; CEI-2010-1-0010)”, the Education Council or Health Council of the Junta de Castilla y León (CAS102P17, GRS 1180/A/15), Spanish Association Against Cancer (AECC; PROYE18020BEA), and Gilead Sciences (GLD17/00334). CJ, MES, and AMe are supported by the ISCII (CD19/00030, CPII18/00028, and FI19/00320). MGA, IPC, and CJ were supported by the Spanish Society of Hematology Foundation (FEHH). All Spanish funding is co-sponsored by the European Union FEDER program

Real‐world evidence of tisagenlecleucel for the treatment of relapsed or refractory large B‐cell lymphoma

Tisagenlecleucel (tisa-cel) is a second-generation autologous CD19-targeted chimeric antigen receptor (CAR) T-cell therapy approved for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). The approval was based on the results of phase II JULIET trial, with a best overall response rate (ORR) and complete response (CR) rate in infused patients of 52% and 40%, respectively. We report outcomes with tisa-cel in the standard-of-care (SOC) setting for R/R LBCL. Data from all patients with R/R LBCL who underwent leukapheresis from December 2018 until June 2020 with the intent to receive SOC tisa-cel were retrospectively collected at 10 Spanish institutions. Toxicities were graded according to ASTCT criteria and responses were assessed as per Lugano 2014 classification. Of 91 patients who underwent leukapheresis, 75 (82%) received tisa-cel therapy. Grade 3 or higher cytokine release syndrome and neurotoxicity occurred in 5% and 1%, respectively; non-relapse mortality was 4%. Among the infused patients, best ORR and CR were 60% and 32%, respectively, with a median duration of response of 8.9 months. With a median follow-up of 14.1 months from CAR T-cell infusion, median progression-free survival and overall survival were 3 months and 10.7 months, respectively. At 12 months, patients in CR at first disease evaluation had a PFS of 87% and OS of 93%. Patients with an elevated lactate dehydrogenase showed a shorter PFS and OS on multivariate analysis. Treatment with tisa-cel for patients with relapsed/refractory LBCL in a European SOC setting showed a manageable safety profile and durable complete responses

Peripheral T-cell lymphoma: Molecular profiling recognizes subclasses and identifies prognostic markers

Peripheral T-cell lymphoma (PTCL) is a clinically aggressive disease, with a poor response to therapy and a low overall survival rate of approximately 30% after 5 years. We have analyzed a series of 105 cases with a diagnosis of PTCL using a customized NanoString platform (NanoString Technologies, Seattle, WA) that includes 208 genes associated with T-cell differentiation, oncogenes and tumor suppressor genes, deregulated pathways, and stromal cell subpopulations. A comparative analysis of the various histological types of PTCL (angioimmunoblastic T-cell lymphoma [AITL]; PTCL with T follicular helper [TFH] phenotype; PTCL not otherwise specified [NOS]) showed that specific sets of genes were associated with each of the diagnoses. These included TFH markers, cytotoxic markers, and genes whose expression was a surrogate for specific cellular subpopulations, including follicular dendritic cells, mast cells, and genes belonging to precise survival (NF-κB) and other pathways. Furthermore, the mutational profile was analyzed using a custom panel that targeted 62 genes in 76 cases distributed in AITL, PTCL-TFH, and PTCL-NOS. The main differences among the 3 nodal PTCL classes involved the RHOAG17V mutations (P < .0001), which were approximately twice as frequent in AITL (34.09%) as in PTCL-TFH (16.66%) cases but were not detected in PTCL-NOS. A multivariate analysis identified gene sets that allowed the series of cases to be stratified into different risk groups. This study supports and validates the current division of PTCL into these 3 categories, identifies sets of markers that can be used for a more precise diagnosis, and recognizes the expression of B-cell genes as an IPI-independent prognostic factor for AITL