Comparison of two prognostic scores (BSI and FACED) in a Spanish cohort of adult patients with bronchiectasis and improvement of the FACED predictive capacity for exacerbations

Bronchiectasis (BE) is a chronic and heterogeneous respiratory disease that requires a multidimensional scoring system to properly assess severity. The aim of this study was to compare the severity stratification by 2 validated scores (BSI and FACED) in a BE cohort and to determine their predictive capacity for exacerbations and hospitalizations. Moreover, we proposed a modified version of FACED which was created to better predict the risk of exacerbations in clinical practice. We performed a prospective cohort study including BE patients >18 years old with a follow-up period of 1-year. One-hundred eighty-two patients (40% males; mean age 68) were studied. Patients were stratified according to the number of exacerbations during the follow-up, and according to BSI and FACED scores. BSI classified most of our patients as severe 99 (54.4%) or moderate 47 (25.8%), while FACED mainly classified as mild 108 (59.3%) or moderate 61 (33.5%). BSI and FACED showed an area under ROC curve (AUC) for exacerbations of 0.808 and 0.734; and for hospitalizations (due to BE exacerbations) of 0.893 and 0.809, respectively. Subsequently, we modified FACED by adding previous exacerbations (Exa-FACED) and this new score classified patients as mild 48.4%, moderate 34.6% and severe 17.0%, with an improved AUC for exacerbations (0.760) and hospitalizations (0.820). Despite previous validations of BSI and FACED, they classified our patients very differently. As expected, FACED showed poor prognostic capacity for exacerbations. We support the Exa-FACED score to predict the risk future exacerbations for been easy to use in clinical practice

Influence of early neurological complications on clinical outcome following lung transplant

BACKGROUND. Neurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied. METHODS. We investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014. RESULTS. Fifty-one patients (46.8%) presented at least one neurological complication. Critical illness polyneuropathy-myopathy (31 cases) and phrenic nerve injury (26 cases) were the two most prevalent complications. These two neuromuscular complications lengthened hospital stays by a median period of 35.5 and 32.5 days respectively. However, neurological complications did not affect patients' survival. CONCLUSIONS. The real incidence of neurological complications among lung transplant recipients is probably underestimated. They usually appear in the first two months after surgery. Despite not affecting mortality, they do affect the mean length of hospital stay, and especially the time spent in the Intensive Care Unit. We found no risk factor for neurological complications except for long operating times, ischemic time and need for transfusion. It is necessary to develop programs for the prevention and early recognition of these complications, and the prevention of their precipitant and risk factors

Factores asociados con mortalidad de pacientes afectos de Meningitis Bacteriana Adquirida en la Comunidad

Introducción: La meningitis bacteriana es responsable de un elevada morbimortalidad en todo el mundo. Es una emergencia neurológica y su manejo rápido es crucial. El objetivo del estudio es la búsqueda de factores de riesgo asociados con mortalidad en los pacientes afectos de meningitis bacteriana comunitaria. Pacientes y Métodos: estudio retrospectivo de pacientes con meningitis bacteriana comunitaria ingresados en el departamento de medicina intensiva de un hospital de III nivel. Resultados: Fueron 36 los pacientes incluidos. Fallecieron 6. Las medianas de edad y de APACHE II  fueron 59 años y  19 respectivamente.  En el análisis estadístico se objetivó que el shock séptico estaba presente en el 7.69% en los pacientes que sobrevivieron, mientras que en el grupo de los fallecidos fue de un 60% ( OR 18, p= 0.025).  Conclusiones: El shock es un factor asociado a mal pronóstico en pacientes afectos de meningitis bacteriana comunitaria Palabras clave: menigitis bacteriana comunitaria DOI: http://dx.doi.org/10.17268/rmt.2021.v16i02.0

Influence of early neurological complications on clinical outcome following lung transplant

Sistema Nerviós Autònom; Risc de malalties cardiovasculars; Procediments mèdics quirúrgics i invasiusSistema nervioso autónomo; Riesgo de enfermedad cardiovascular; Procedimientos médicos quirúrgicos e invasivosAutonomic Nervous System; Cardiovascular disease risk; Surgical and invasive medical proceduresBackground Neurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied. Methods We investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014. Results Fifty-one patients (46.8%) presented at least one neurological complication. Critical illness polyneuropathy-myopathy (31 cases) and phrenic nerve injury (26 cases) were the two most prevalent complications. These two neuromuscular complications lengthened hospital stays by a median period of 35.5 and 32.5 days respectively. However, neurological complications did not affect patients’ survival. Conclusions The real incidence of neurological complications among lung transplant recipients is probably underestimated. They usually appear in the first two months after surgery. Despite not affecting mortality, they do affect the mean length of hospital stay, and especially the time spent in the Intensive Care Unit. We found no risk factor for neurological complications except for long operating times, ischemic time and need for transfusion. It is necessary to develop programs for the prevention and early recognition of these complications, and the prevention of their precipitant and risk factors.JG is the recipient of a grant from the Spanish Fondo de Investigaciones Sanitarias (FIS PI13-01272-FEDER)

El càncer de coll d'úter sota el microscòpi

 Treball de recerca realitzat per un alumne d’ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l’any 2010. L’objectiu del treball ha estat estudiar i analitzar els diferents aspectes del càncer de cèrvix en profunditat, sobretot l'estudi citològic com a part del diagnòstic. L’ estudi teòric ha permès analitzar les generalitats de tots els tipus de càncer i la zona on es localitza el càncer de coll d'úter. Posteriorment, l’observació de les cèl•lules a través del microscopi ha permès deduir el tipus de cèl•lula o lesió de vint mostres diferents a partir de les característiques analitzades. S’han realitzat fotografies de les cèl•lules observades