Sistema de puntuación HOSPITAL como predictor del reingreso en pacientes con insuficiencia cardiaca

El sistema de puntuación HOSPITAL es una herramienta que determina la probabilidad de reingreso a 30 días posteriores a su egreso. El objetivo fue establecer la capacidad discriminatoria de este sistema para predecir el reingreso de pacientes mayores de 18 años con diagnóstico de insuficiencia cardiaca con fracción de eyección ventricular izquierda menor o igual a 40% en los 30 días posteriores a su egreso, ingresados de enero a noviembre del 2016 en los hospitales San Juan de Dios y Pedro Bethancourt. Se realizó un estudio de pruebas diagnósticas con 56 expedientes clínicos, elaborando una curva ROC (Receiver Operating Characteristic), donde se estableció el área bajo la curva que calculó la capacidad discriminatoria y mediante el índice de Youden se estableció el punto de corte con mayor sensibilidad y especificidad. Se estimó el valor predictivo positivo, negativo y la razón de verosimilitud positiva y negativa para dicho punto de corte. Se encontró un área bajo la curva de .874 IC 95% [.784 – .964], con un punto de corte de mayor sensibilidad (92%) y especificidad (78%) de 6 puntos. Con valores predictivos negativo y positivos de 97% y 52% respectivamente y razón de verosimilitud positiva de 4.18 y negativa de 0.10. Este sistema posee capacidad discriminatoria para predecir el reingreso de pacientes con insuficiencia cardiaca dentro de los primeros 30 días posteriores a su egreso, clasificando a un paciente con baja probabilidad de reingreso si obtiene un puntaje menor a 6 y como alta probabilidad con un puntaje mayor a seis

Kann die 18F-FDG-PET/CT-Untersuchung die Panendoskopie zur Detektion von synchronen Zweitkarzinomen ersetzen?

Ziel der Arbeit war es, die Wertigkeit der 18F-FDG-PET/ CT-Untersuchung bezüglich synchroner Zweitkarzinome im Vergleich mit der Panendoskopie beim initialen Staging zu untersuchen. 311 Patienten wurden mit beiden Untersuchungsmethoden abgeklärt. Als Referenz galt die zytologische, histologische und/oder klinische oder radiologische Untersuchung. Die Prävalenz für synchrone Zweitkarzinome betrug mit der Panendoskopie 4,5%, während die Prävalenz mittels PET/ CT-Untersuchung 6,1% betrug. Die Sensitivität für die Panendoskopie betrug 74%, die Spezifität 99,7%, der positiv prädiktive Wert 93% und der negativ prädiktive Wert 98%. Die Sensitivität für die PET/CT-Untersuchung betrug 100%, die Spezifität 95,7% der positiv prädiktive Wert 59% und der negativ prädiktive Wert 100%. Die PET/CT-Untersuchung scheint der Panendoskopie überlegen zu sein. Bei bezüglich synchroner Zweitkarzinome unauffälligem PET/CT kann die Panendoskopie auf die Endoskopie und Beurteilung des Primärtumors beschränkt werden kann. Aufgrund der hohen Kosten und der grossen Anzahl falsch positiver Resultate, welche durch das PET/CT generiert werden, empfehlen wir die Durchführung dieser Untersuchung nur bei fortgeschrittenen Tumoren mit der Frage nach Fernmetastasen. Die Panendoskopie bleibt weiterhin der Goldstandar

Hodgkin's lymphoma in remission after first-line therapy: which patients need FDG-PET/CT for follow-up?

Background: The purpose of the study was to evaluate the impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) during follow-up of patients with Hodgkin's lymphoma. Patients and methods: Patients in complete remission or an unconfirmed complete remission after first-line therapy who received FDG-PET/CT during their follow-up were analyzed retrospectively. Confirmatory biopsy was mandatory in case of recurrence. Results: Overall, 134 patients were analyzed. Forty-two (31.3%) patients had a recurrence. The positive predictive value of FDG-PET/CT was 0.98. Single-factor analysis identified morphological residual mass [P = 0.0005, hazard ratio (HR) 3.4, 95% confidence interval (CI) 1.7-6.6] and symptoms (P 24 months). Conclusions: Asymptomatic patients without morphological residues and an early stage of disease do not need a routine FDG-PET/CT for follow-up. Asymptomatic patients with morphological residues should receive routine follow-up FDG-PET/CT for the first 24 months. Only patients with advanced initial stage do need a routine follow-up FDG-PET/CT beyond 24 month

Risk-adapted FDG-PET/CT-based follow-up in patients with diffuse large B-cell lymphoma after first-line therapy

Background: The purpose of this study was to evaluate the impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) during follow-up of patients with diffuse large B-cell lymphoma (DLBCL) being in complete remission or unconfirmed complete remission after first-line therapy. Patients and methods: DLBCL patients receiving FDG-PET/CT during follow-up were analyzed retrospectively. Confirmatory biopsy was mandatory in cases of suspected disease recurrence. Results: Seventy-five patients were analyzed and 23 (30%) had disease recurrence. The positive predictive value (PPV) of FDG-PET/CT was 0.85. Patients >60 years [P = 0.036, hazard ratio (HR) = 3.82, 95% confidence interval (CI) 1.02-7.77] and patients with symptoms indicative of a relapse (P = 0.015; HR = 4.1; 95% CI 1.20-14.03) had a significantly higher risk for relapse. A risk score on the basis of signs of relapse, age >60 years, or a combination of these factors identified patients at high risk for recurrence (P = 0.041). Conclusions: FDG-PET/CT detects recurrent DLBCL after first-line therapy with high PPV. However, it should not be used routinely and if only in selected high-risk patients to reduce radiation burden and costs. On the basis of our retrospective data, FDG-PET/CT during follow-up is indicated for patients 60 years with and without clinical signs of relaps

Following 411 Cochrane Protocols to Completion: A Retrospective Cohort Study

Cochrane reviews are regarded as being scientifically rigorous and are increasingly used by a variety of stakeholders. However, factors predicting the publication of Cochrane reviews have never been reported. This is important because if a higher proportion of Cochrane protocols with certain characteristics (e.g., funding) are being published, this may lead to inaccurate decisions. We examined the frequency of published and unpublished Cochrane reviews and protocol factors that predict the publication of Cochrane reviews.Retrospective cohort study of Cochrane protocols published in 2000 (Issues 2 to 4) and 2001 (Issue 1). The publication status of these reviews was followed up to Issue 1, 2008 in The Cochrane Library. Survival analysis of the time from protocol publication to the first review publication and protocol factors predicting the time to publication was conducted. There were 411 new Cochrane protocols in the cohort. After excluding 39; 71/372 (19.1%) were unpublished and 301/372 (80.9%) were published as full Cochrane reviews at the time of study analysis (January 2008). The median time to publication was 2.4 years (range: 0.15 to 8.96). Multivariate analyses revealed that shorter time to publication was associated with the review subsequently being updated (hazard ratio, HR: 1.80 [95% confidence interval, CI: 1.39 to 2.33 years]) and longer time to publication was associated with the review having two published protocols, indicating changes to the review plan (HR: 0.33 [95% CI: 0.12 to 0.90 years]).Only about 80% Cochrane protocols were published as full reviews after over 8 years of follow-up. The median time to publication was 2.4 years and some reviews took much longer. Strategies to decrease time to publication should be considered, such as streamlining the review process, increased support for authors when protocol amendments occur, and better infrastructure for updating Cochrane reviews

Echocardiography in the diagnosis left ventricular noncompaction

Echocardiography is the method of choice to establish a diagnosis and determine a treatment plan for patients with noncompaction of ventricular myocardium (NVM). The 2-dimentional echocardiography, 3-dimentional echocardiography, color Doppler echocardiography and contrast-enhanced echocardiography are of critical importance for diagnosis and family screening of NVM

18F-fluoro-deoxy-glucose focal uptake in very small pulmonary nodules: fact or artifact? Case reports

ABSTRACT: BACKGROUND: F-fluoro-deoxy-glucose (18F-FDG) positron emission tomography integrated/combined with computed tomography (PET-CT) provides the best diagnostic results in the metabolic characterization of undetermined solid pulmonary nodules. The diagnostic performance of 18F-FDG is similar for nodules measuring at least 1 cm and for larger masses, but few data exist for nodules smaller than 1 cm. CASE PRESENTATION: We report five cases of oncologic patients showing focal lung 18F-FDG uptake on PET-CT in nodules smaller than 1 cm. We also discuss the most common causes of 18F-FDG false-positive and false-negative results in the pulmonary parenchyma. In patient 1, contrast-enhanced CT performed 10 days before PET-CT did not show any abnormality in the site of uptake; in patient 2, high-resolution CT performed 1 month after PET showed a bronchiole filled with dense material interpreted as a mucoid impaction; in patient 3, contrast-enhanced CT performed 15 days before PET-CT did not identify any nodules; in patients 4 and 5, contrast-enhanced CT revealed a nodule smaller than 1 cm which could not be characterized. The 18F-FDG uptake at follow-up confirmed the malignant nature of pulmonary nodules smaller than 1 cm which were undetectable, misinterpreted, not recognized or undetermined at contrast-enhanced CT. CONCLUSION: In all five oncologic patients, 18F-FDG was able to metabolically characterize as malignant those nodules smaller than 1 cm, underlining that: 18F-FDG uptake is not only a function of tumor size but it is strongly related to the tumor biology; functional alterations may precede morphologic abnormalities. In the oncologic population, especially in higher-risk patients, PET can be performed even when the nodules are smaller than 1 cm, because it might give an earlier characterization and, sometimes, could guide in the identification of alterations missed on CT

Transient stability enhancement of a gridconnected wind farm using an adaptive neurofuzzy controlled-flywheel energy storage system

With the rapid growth of the wind energy systems in the past years and their interconnection with the existing power system networks, it has become very significant to analyse and enhance the transient stability of the wind energy conversion systems connected to the grid. This study investigates the transient stability enhancement of a grid-connected wind farm using doubly-fed induction machine-based flywheel energy storage system. A cascaded adaptive neuro-fuzzy controller (ANFC) is introduced to control the insulated gate bipolar transistor switches-based frequency converter to enhance the transient stability of the grid-connected wind farm. The performance of the proposed control strategy is analysed under a severe symmetrical fault condition on both a single-machine infinite bus model and the IEEE-39 bus New England test system. The transient performance of the system is investigated by comparing the results of the system using the proposed ANFCs with that of the black-box optimisation technique-based proportional-integral controllers. The validity of the system is verified by the simulation results which are carried out using PSCAD/EMTDC environment