NUEVA ETAPA EN LA REVISTA ELECTRÓNICA DE AUTOPSIA: LA AUTOPSIA UNE A LA ANATOMÍA PATOLOGÍA Y A LA PATOLOGÍA FORENSE

Once años después de que viera la luz la Revista Electrónica de Autopsia / Electronic Journal of Autopsy (REA/EJA), en este 2014 iniciamos una nueva etapa con un nuevo equipo editorial fruto de la suma de esfuerzos entre el Club de Autopsias de la Sociedad Española de Anatomía Patológica (SEAP) y la Sociedad Española de Patología Forense (SEPAF).En el cuatrienio 2009-2011, bajo la Presidencia del Dr. Aurelio Ariza, la SEAP inicia el acercamiento a la Sociedad Española de Citología (SEC) y a la SEPAF. La fructífera colaboración entre SEAP y SEPAF ha puesto en marcha una sinergia muy positiva pasando de la ignorancia mutua hasta la alianza estratégica. El congreso nacional de la SEAP y SEC (Sevilla 2009) y los congresos conjuntos SEAP-SEC-SEPAF (Zaragoza 2011 y Cádiz 2013) han proporcionado un impulso decidido en esa dirección [1].Fue en el último Congreso de Cádiz en el que se sentaron las bases para que la colaboración mucho más estrecha en el ámbito de la autopsia y es esta práctica milenaria la que está sirviendo de punto de unión entre patólogos clínicos y forenses. La autopsia, a pesar del arsenal de exploraciones complementarias disponibles en la medicina actual, sigue siendo una fuente inagotable de información y conocimiento y este conocimiento tiene que ponerse al servicio de las especialidades clínicas y finalmente de la sociedad a la que todos nos debemos. Esta idea no es nueva y se encuentra indisolublemente unida al origen de la anatomía patológica. En el famoso teatro anatómico de Padua (Italia) realizado en 1584 bajo los auspicios del anatomista Fabrizio D´Acquapendente se puede leer esta inscripción grabada en la piedra sobre la puerta de entrada “Mors ubi gaudet sucurrere vitae”. Esta frase mantiene la misma vigencia después de más de cuatro siglos ya que “la sala de autopsias sigue siendo el lugar donde la muerte se alegra de ayudar a la vida” [2].Pero paradójicamente, como se ponía de manifiesto en la Editorial del primer número de la REA/EJA, la tasa de autopsia ha descendido estrepitosamente en la mayor parte de los hospitales del mundo hasta llegar a alcanzar, en algunos sitios, cifras verdaderamente “alarmantes” [3]. Esta situación paradójica está convirtiendo a la autopsia forense casi en el único referente de la patología autópsica. Por ello, en muchos hospitales de España los residentes de anatomía patológica realicen una rotación externa por los servicios de patología forense para formarse adecuadamente en la práctica de las autopsias.Con este objetivo de integración entre SEAP y SEPAF, a partir de este número de la REA/EJA hemos constituido un Comité Editorial paritario y representativo de los dos mundos: autopsia clínica y autopsia forense. El objetivo que nos hemos marcado para los próximo años es aumentar progresivamente el número de artículos en cada volumen hasta llegar a una periodicidad trimestral. La edición digital y un proceso editorial on line permiten que los contenidos de la revista puedan verse actualizados con gran rapidez evitando así el retraso que supone la edición impresa. También estamos trabajando para dar la máxima visibilidad a la REA/EJA y que sus contenidos aparezcan indizados en el mayo número posible de bases de datos. En este sentido acabamos de firmar un acuerdo con EBSCO para que los contenidos de la revista puedan ser consultados y descargados en esta prestigiosa base de datos [4]. Otra novedad es que se podrán enviar artículos no solo en Español sino también en Inglés y Portugués con la obligatoriedad de que en estos dos últimos idiomas el resumen y las palabras clave aparezcan en Español.Pero, evidentemente, el trabajo y el impulso del Comité Editorial no tendrán ningún valor si los auténticos protagonistas de esta historia, es decir vosotr@s no dais contenido a la revista enviando artículos que son el auténtico motor que mueve a cualquier publicación científica. Por tanto, esperamos las aportaciones de todos los que desde diferentes ámbitos nos dedicamos a esta apasionante actividad, tanto desde la patología clínica o forense como desde aquellas otras disciplinas afines que son indispensables para poder interpretar adecuadamente los hallazgos de la autopsia: toxicólogos, biólogos, microbiólogos, antropólogos, odontólogos, entomólogos, etc.En nombre del Comité Editorial, os envío un cordial salud

Comprehensive analysis and insights gained from long-term experience of the Spanish DILI Registry

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER); Agencia Española del Medicamento; Consejería de Salud de Andalucía.Background & Aims: Prospective drug-induced liver injury (DILI) registries are important sources of information on idiosyncratic DILI. We aimed to present a comprehensive analysis of 843 patients with DILI enrolled into the Spanish DILI Registry over a 20-year time period. Methods: Cases were identified, diagnosed and followed prospectively. Clinical features, drug information and outcome data were collected. Results: A total of 843 patients, with a mean age of 54 years (48% females), were enrolled up to 2018. Hepatocellular injury was associated with younger age (adjusted odds ratio [aOR] per year 0.983; 95% CI 0.974-0.991) and lower platelet count (aOR per unit 0.996; 95% CI 0.994-0.998). Anti-infectives were the most common causative drug class (40%). Liver-related mortality was more frequent in patients with hepatocellular damage aged ≥65 years (p = 0.0083) and in patients with underlying liver disease (p = 0.0221). Independent predictors of liver-related death/transplantation included nR-based hepatocellular injury, female sex, higher onset aspartate aminotransferase (AST) and bilirubin values. nR-based hepatocellular injury was not associated with 6-month overall mortality, for which comorbidity burden played a more important role. The prognostic capacity of Hy's law varied between causative agents. Empirical therapy (corticosteroids, ursodeoxycholic acid and MARS) was prescribed to 20% of patients. Drug-induced autoimmune hepatitis patients (26 cases) were mainly females (62%) with hepatocellular damage (92%), who more frequently received immunosuppressive therapy (58%). Conclusions: AST elevation at onset is a strong predictor of poor outcome and should be routinely assessed in DILI evaluation. Mortality is higher in older patients with hepatocellular damage and patients with underlying hepatic conditions. The Spanish DILI Registry is a valuable tool in the identification of causative drugs, clinical signatures and prognostic risk factors in DILI and can aid physicians in DILI characterisation and management. Lay summary: Clinical information on drug-induced liver injury (DILI) collected from enrolled patients in the Spanish DILI Registry can guide physicians in the decision-making process. We have found that older patients with hepatocellular type liver injury and patients with additional liver conditions are at a higher risk of mortality. The type of liver injury, patient sex and analytical values of aspartate aminotransferase and total bilirubin can also help predict clinical outcomes

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

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