Es útil el SPPB como método de screening de capacidad funcional en pacientes con enfermedad renal crónica avanzada?.

Introduction and objective: One of the consequences of the CKD, is the deterioration of the functional capacity, being able to manifest from different stages of the disease, until renal replacement therapy. The objective of this study was to determine the functionality of patients with CKD through functional capacity test, valuing the usefulness of the SPPB as a screening test in parallel. Materials and methods: It assessed the functional capacity of patients with CKD, using the test SPPB, 6MM, TUTG and STS. Also found the muscle strength with manual dynamometry. Results: Of 121 patients who came to the CKD query, 118 presented a minimum functionality to perform tests of functional capacity, a 71.2% of the patients were able to perform 4 tests, a 28.8% only could make the SPPB test. To a 71.43% of patients who presented a low score in SPPB, not could follow assessed them with the rest of the test, while the 92.31% of which had a high score, continued with the rest of the evidence. To differentiate by age ranges, the majority of young patients have minimal limitations, finding higher rates of disability in older age ranges. A good score in SPPB meant to present good functional capacity and allowed to continue evaluating the patient, obtaining better results with the rest of test and more muscle strength. A good nutritional better status and body composition was a better functionality. Conclusion: In the absence of a consensus of what is the best method of determining the functional capacity of the kidney patient, and to assess all patients, propose to use the test SPPB as screening method, and depending on the result used as the rest of the test to more complete if it is necessary to studyIntroducción y objetivo: Una de las consecuencias de la ERC, es el deterioro de la capacidad funcional, pudiéndose manifestar desde distintos estadios de la enfermedad, hasta el tratamiento renal sustitutivo. El objetivo de este estudio fue determinar la funcionalidad de los pacientes con ERCA, mediante test de capacidad funcional, valorando de forma paralela la utilidad del SPPB como test de cribado. Materiales y métodos: Se evaluó la capacidad funcional de pacientes ERCA, utilizando los test SPPB, 6MM, TUTG y STS. También se determinó la fuerza muscular con dinamometría manual. Resultados: De 121 pacientes que acudieron a la consulta ERCA, 118 presentaron una mínima funcionalidad para poder realizar pruebas de capacidad funcional, un 71,2% de los pacientes fueron capaces de realizar los 4 test, un 28,8% solo pudo realizar el test SPPB. A un 71,43% de pacientes que presentaron una puntuación baja en SPPB, no se les pudo seguir evaluando con el resto de test, mientras que el 92,31% de los que presentaron una puntuación alta, continuaron con el resto de pruebas. Al diferenciar por rangos de edad, la mayoría de los pacientes jóvenes presentaban mínimas limitaciones, encontrando tasas más altas de discapacidad en rangos de edad mayores. Una buena puntuación en SPPB supuso presentar buena capacidad funcional y permitió seguir evaluando al paciente, obteniendo mejores resultados con el resto de test y más fuerza muscular. Una buena composición corporal y mejor estado nutricional supuso una mejor funcionalidad. Conclusión: A falta de un consenso de cuál es el mejor método de determinar la capacidad funcional del paciente renal, y para poder evaluar a todos los pacientes, proponemos utilizar el test SPPB como método de screening, y en función del resultado utilizar el resto de los test para realizar estudio más completo si es necesari

Association of the polycystic ovary syndrome with genomic variants related to insulin resistance, type 2 diabetes mellitus, and obesity

7 pages, 2 tables.-- Results from this work were presented at the 85th Annual Meeting of The Endocrine Society, Philadelphia, PA, June 2003.We have evaluated the possible association of polycystic ovary syndrome (PCOS) with 15 genomic variants previously described to influence insulin resistance, obesity, and/or type 2 diabetes mellitus. Seventy-two PCOS patients and 42 healthy controls were genotyped for 15 variants in the genes encoding for paraoxonase (three variants), plasma cell differentiation antigen glycoprotein, human sorbin and SH3 domain containing 1, plasminogen activator inhibitor-1, peroxisome proliferator-activated receptor-gamma2, protein tyrosine phosphatase 1B (two variants), adiponectin (two variants), IGF1, IGF2, IGF1 receptor, and IGF2 receptor. Compared with controls, PCOS patients were more frequently homozygous for the -108T variant in paraoxonase (36.6% vs. 9.5%; P = 0.002) and homozygous for G alleles of the ApaI variant in IGF2 (62.9% vs. 38.1%; P = 0.018). Paraoxonase is a serum antioxidant enzyme and, because -108T alleles result in decreased paraoxonase expression, this increase in oxidative stress might result in insulin resistance. G alleles of the ApaI variant in IGF2 may increase IGF2 expression, and IGF2 stimulates adrenal and ovarian androgen secretion. In conclusion, the paraoxonase -108 C-->T variant and the ApaI polymorphism in the IGF2 gene are associated with PCOS and might contribute to increased oxidative stress, insulin resistance, and hyperandrogenism in this prevalent disorder.This work was supported by grants from the Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo, Spain (FIS 00/0414, 02/0741, and 02/0578 and RGDM G03/212) and from the Consejería de Educación, Comunidad de Madrid, Spain (CAM 08.6/0024/2000 and 08.6/0010/2001).Peer reviewe

Early Triassic-Anisian continental sediments from SE Iberian ranges: sedimentological and mineralogical features

Depto. de Mineralogía y PetrologíaFac. de Ciencias GeológicasTRUEpu

Differential gene expression profile in omental adipose tissue in women with polycystic ovary syndrome

10 pages, 2 figures, 5 tables.CONTEXT: The polycystic ovary syndrome (PCOS) is frequently associated with visceral obesity, suggesting that omental adipose tissue might play an important role in the pathogenesis of the syndrome. OBJECTIVE: The objective was to study the expression profiles of omental fat biopsy samples obtained from morbidly obese women with or without PCOS at the time of bariatric surgery. DESIGN: This was a case-control study. SETTINGS: We conducted the study in an academic hospital. PATIENTS: Eight PCOS patients and seven nonhyperandrogenic women submitted to bariatric surgery because of morbid obesity. INTERVENTIONS: Biopsy samples of omental fat were obtained during bariatric surgery. MAIN OUTCOME MEASURE: The main outcome measure was high-density oligonucleotide arrays. RESULTS: After statistical analysis, we identified changes in the expression patterns of 63 genes between PCOS and control samples. Gene classification was assessed through data mining of Gene Ontology annotations and cluster analysis of dysregulated genes between both groups. These methods highlighted abnormal expression of genes encoding certain components of several biological pathways related to insulin signaling and Wnt signaling, oxidative stress, inflammation, immune function, and lipid metabolism, as well as other genes previously related to PCOS or to the metabolic syndrome. CONCLUSION: The differences in the gene expression profiles in visceral adipose tissue of PCOS patients compared with nonhyperandrogenic women involve multiple genes related to several biological pathways, suggesting that the involvement of abdominal obesity in the pathogenesis of PCOS is more ample than previously thought and is not restricted to the induction of insulin resistance.This work was supported by PI020578, PI020741, PI050341, PI050551, RCMN C03/08, and RGDM 03/212 from Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, and Grants 08.6/0021/2003 and GR/SAL/0137/2004 from the Consejería de Educación y Cultura, Comunidad de Madrid, Spain.Peer reviewe

La reinserción laboral en los pacientes con cáncer colorrectal

Aim: Employment and work-related disability were investigated in a cohort of colorectal cancer patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 73 colorectal cancer patients who were employed at diagnosis. The questionnaire included cancer-related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face. The study was approved by the Ethical Committee of La Paz Hospital. All patients gave consent to participate. Results: Eighty six per cent of patients were unable to work after diagnosis, but 55% returned to work at the end of treatment. The age, having a metastatic illness and the sequelae of the disease or its treatment were independently associated with the ability to work after the end of treatment. Almost all patients told their employers and co-workers about their disease. Conclusions: This is the fi rst exploratory study in Spain about labour reintegration in colorectal cancer. Further studies are necessary.Objetivo: Analizar los factores que infl uyen en la vuelta al trabajo en una cohorte de enfermos con cáncer colorrectal y los posibles problemas de discriminación que pueden tener. Pacientes y métodos: El estudio incluyó 73 pacientes consecutivos diagnosticados de un cáncer colorrectal y empleados en el momento del diagnóstico. Los pacientes rellenaron un cuestionario que incluía aspectos demográficos, clínicos y laborales. El estudio fue aprobado por el Comité Ético y de Investigación Clínica del Hospital La Paz. Todos los pacientes dieron su consentimiento para participar en el estudio y para la utilización de los datos de su historia clínica. Resultados: El 86% de los pacientes pasaron a inactivos tras comenzar el tratamiento de la enfermedad y un 45% lo seguían estando tras éste. No hubo diferencias en la influencia de las distintas variables analizadas con respecto a la actividad laboral tras el diagnóstico. Sin embargo, la edad avanzada, el tener un estadio IV de la enfermedad y la presencia de secuelas derivadas del tumor o del tratamiento de éste, sí infl uyeron en la reinserción laboral una vez fi nalizado el tratamiento específico. La mayoría de los pacientes no creían que el tener la enfermedad les perjudicaría en su puesto de trabajo y, en casi todos los casos, tanto sus compañeros como sus jefes conocían que tenían un tumor. Conclusiones: Éste es el primer estudio exploratorio en nuestro país acerca de la reinserción laboral de los pacientes diagnosticados de una neoplasia maligna colorrectal. Son necesarios más trabajos para poder establecer las medidas adecuadas para la mejora de este proceso

Protein-energy wasting syndrome in advanced chronic kidney disease: Prevalence and specific clinical characteristics

Introduction: Protein-energy wasting (PEW) is associated with increased mortality and differs depending on the chronic kidney disease (CKD) stage and the dialysis technique. The prevalence in non-dialysis patients is understudied and ranges from 0 to 40.8%. Objective: To evaluate the nutritional status of a group of Spanish advanced CKD patients by PEW criteria and subjective global assessment (SGA). Patients and methods: Cross-sectional study of 186 patients (101 men) with a mean age of 66.1 ± 16 years. The nutritional assessment consisted of: SGA, PEW criteria, 3-day dietary records, anthropometric parameters and bioelectrical impedance vector analysis. Results: The prevalence of PEW was 30.1%, with significant differences between men and women (22.8 vs. 33.8%, p &lt; 0.005), while 27.9% of SGA values were within the range of malnutrition. No differences were found between the 2 methods. Men had higher proteinuria, percentage of muscle mass and nutrient intake. Women had higher levels of total cholesterol, HDL and a higher body fat percentage. The characteristics of patients with PEW were low albumin levels and a low total lymphocyte count, high proteinuria, low fat and muscle mass and a high Na/K ratio. The multivariate analysis found PEW to be associated with: proteinuria (OR: 1.257; 95% CI: 1.084–1.457, p = 0.002), percentage of fat intake (OR: 0.903; 95% CI: 0.893–0.983, p = 0.008), total lymphocyte count (OR: 0.999; 95% CI: 0.998–0.999, p = 0.001) and cell mass index (OR: 0.995; 95% CI: 0.992–0.998). Conclusion: Malnutrition was identified in Spanish advanced CKD patients measured by different tools. We consider it appropriate to adapt new diagnostic elements to PEW criteria.Introducción: El desgaste proteico energético (DPE) se asocia a mayor mortalidad y difieredependiendo del estadio de la enfermedad renal y de la técnica de diálisis. Su prevalenciaen pacientes sin diálisis se encuentra poco estudiada y oscila entre el 0 y el 40,8%.Objetivo: Evaluar el estado nutricional según criterios de DPE y por valoración global subje-tiva (VGS) de un colectivo de pacientes espa˜noles con enfermedad renal crónica avanzada(ERCA).Pacientes y métodos: Estudio transversal de 186 pacientes (101 hombres) con edad media de66,1 ± 16 a˜nos. Se realizó evaluación nutricional mediante: VGS, criterios de DPE, registrodietético de 3 días, parámetros antropométricos y bioimpedancia vectorial.Resultados: Un 30,1% presentaba DPE, con diferencias significativas entre hombres y mujeres(22,8 vs. 33,8%; p < 0,005) y un 27,9% tenía valores de VGS en rangos de desnutrición. Sindiferencia entre los 2 métodos estudiados. Los hombres presentaron mayores niveles deproteinuria, porcentaje de masa muscular e ingesta de nutrientes. Las mujeres tuvieronmayores niveles de colesterol total, HDL y porcentaje de masa grasa. Las característicasde los pacientes con DPE fueron: bajos valores de albúmina y recuento total de linfocitos,elevada proteinuria, baja masa grasa, baja masa muscular y cociente Na/K elevado.El análisis multivariante mostró asociación de DPE con proteinuria (OR: 1,257; IC 95%:1,084-1,457; p = 0,002), porcentaje de ingesta lipídica (OR: 0,903; IC 95%: 0,893-0,983; p = 0,008),recuento total de linfocitos (OR: 0,999; IC 95%: 0,998-0,999; p = 0,001) y el índice de masacelular (OR: 0,995; IC 95%: 0,992-0,998)

The prognostic value of multiparameter flow cytometry minimal residual disease assessment in relapsed multiple myeloma

Letter to the editor.-- et al.This study was supported by the Cooperative Research Thematic Network grants RD12/0036/0058 of the Red de Cancer (Cancer Network of Excellence); Instituto de Salud Carlos III, Spain, Instituto de Salud Carlos III/Subdirección General de Investigación Sanitaria (FIS: PI060339; 06/1354; 02/0905; 01/0089/01-02; PS09/01897/01370; G03/136; Sara Borrell: CD13/00340); and Asociación Española Contra el Cáncer (GCB120981SAN), Spain. The study was also supported internationally by the International Myeloma Foundation Junior Grant Proposal and the Multiple Myeloma Research Foundation research fellow award.Peer Reviewe

Clinical aspects of visceral leishmaniasis caused by L. infantum in adults. Ten years of experience of the largest outbreak in Europe: what have we learned?

BACKGROUND: An outbreak of leishmaniasis caused by Leishmania infantum was declared in the southwest of the Madrid region (Spain) in June 2009. This provided a unique opportunity to compare the management of visceral leishmaniasis (VL) in immunocompetent adults (IC-VL), patients with HIV (HIV-VL) and patients receiving immunosuppressants (IS-VL). METHODS: A cohort of adults with VL, all admitted to the Hospital Universitario de Fuenlabrada between June 2009 and June 2018, were monitored in this observational study, recording their personal, epidemiological, analytical, diagnostic, treatment and outcome variables. RESULTS: The study population was made up of 111 patients with VL (10% HIV-VL, 14% IS-VL, 76% IC-VL). Seventy-one percent of the patients were male; the mean age was 45 years (55 years for the IS-VL patients, P = 0.017). Fifty-four percent of the IC-VL patients were of sub-Saharan origin (P = 0.001). Fever was experienced by 98% of the IC-VL patients vs 73% of the LV-HIV patients (P = 0.003). Plasma ferritin was > 1000 ng/ml in 77% of the IC-VL patients vs 17% of the LV-HIV patients (P = 0.007). Forty-two percent of patients fulfilled the criteria for haemophagocytic lymphohistiocytosis. RDT (rK39-ICT) serological analysis returned sensitivity and specificity values of 45% and 99%, respectively, and ELISA/iIFAT returned 96% and 89%, respectively, with no differences in this respect between patient groups. Fourteen (13.0%) patients with VL experienced treatment failure, eight of whom were in the IC-VL group. Treatment with < 21 mg/kg (total) liposomal amphotericin B (LAB) was associated with treatment failure in the IC-VL patients [P = 0.002 (OR: 14.7; 95% CI: 2.6-83.3)]. CONCLUSIONS: IS-VL was more common than HIV-VL; the lack of experience in dealing with IS-VL is a challenge that needs to be met. The clinical features of the patients in all groups were similar, although the HIV-VL patients experienced less fever and had lower plasma ferritin concentrations. RDT (rK39-ICT) analysis returned a good specificity value but a much poorer sensitivity value than reported in other scenarios. The patients with HIV-VL, IS-VL and IC-VL returned similar serological results. Current guidelines for treatment seem appropriate, but the doses of LAB required to treat patients with HIV-VL and IS-VL are poorly defined.This work received financial support from the Red de Investigación Cooperativa en Enfermedades Tropicales (RICET) (RD12/0018/0008; RD16/0027/0017) (ISCIII) and the FEDER.S

Returning to work in colorectal cancer patients

Aim: Employment and work-related disability were investigated in a cohort of colorectal cancer patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 73 colorectal cancer patients who were employed at diagnosis. The questionnaire included cancer-related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face. The study was approved by the Ethical Committee of La Paz Hospital. All patients gave consent to participate. Results: Eighty six per cent of patients were unable to work after diagnosis, but 55% returned to work at the end of treatment. The age, having a metastatic illness and the sequelae of the disease or its treatment were independently associated with the ability to work after the end of treatment. Almost all patients told their employers and co-workers about their disease. Conclusions: This is the fi rst exploratory study in Spain about labour reintegration in colorectal cancer. Further studies are necessary