Proteína C Reactiva como marcador de riesgo en cirugía de tumores cerebrales

INTRODUCCIÓN: La incidencia de los tumores cerebrales presenta un ascenso progresivo, debido a un aumento tanto en población, como en la esperanza de vida. En medicina, la monitorización de las concentraciones plasmáticas de las proteínas de fase aguda, proporcionan una valiosa información en las patologías que cursan con fenómenos inflamatorios, pudiendo ser utilizada no sólo en el diagnóstico sino también para monitorizar la evolución de la enfermedad y la aparición de complicaciones. La proteína C reactiva fue la primera proteína de fase aguda descrita, y en la actualidad se considera un marcador muy sensible de inflamación y daño tisular. Existen en la literatura varios estudios sobre sus niveles y la posible relación con la intensidad del edema HIPOTESIS: Los valores de Proteína C Reactiva (PCR) pre y postoperatorios servirán como indicador de riesgo de mala evolución en pacientes sometidos a intervenciones neuroquirúrgicas por procesos tumorales. MATERIAL Y METODOS: para la realización de nuestro estudio se ha tomado una muestra de 124 pacientes consecutivos, intervenidos de tumores cerebrales de forma programada e ingresados en el postoperatorio inmediato en el Servicio de Medicina Intensiva, del Hospital Universitario Miguel Servet de Zaragoza entre los años 2013 y 2014. No se incluyeron aquellos pacientes menores de edad. Se realizó una determinación de PCR previo a la intervención, y otra determinación postoperatoria a las 24 horas de la cirugía, durante su estancia en UCI. Los datos han sido analizados y procesados estadísticamente mediante hoja de cálculo y programa estadístico con el que se han realizado test de contraste de hipótesis. RESULTADOS: las condiciones basales de nuestro estudio fueron similares a la de otros estudios. La prevalencia de neoplasia previa fue 34%, un 20% de los pacientes presentaban Diabetes Mellitus y un 60% Dislipemia. Valores elevados de PCR preoperatoria se correlacionan con Diabetes Mellitus, probablemente por la mayor predisposición a fenómenos inflamatorios en estos pacientes No se encontraron diferencias entre los valores de PCR preoperatoria y postoperatoria en las complicaciones infecciosas ni neurológicas, probablemente por la baja incidencia de estas complicaciones en nuestra muestra. Existe relación inversa entre los valores de PCR postoperatoria y la presencia de hemorragia, que podría indicar que a mayores tiempos de hemostasia se controlarían mejor los sangrados por lo que la PCR postoperatoria se elevaría menos. CONCLUSIONES: Los niveles de PCR postoperatorios son mayores que los preoperatorios tras la cirugía de tumor cerebral. Los niveles PCR preoperatorio y postoperatorio no sirven como predictor de complicaciones en los pacientes sometidos a cirugía por tumores cerebrales de forma programada

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Residential proximity to industrial pollution sources and colorectal cancer risk: a multicase-control study (MCC-Spain)

Background: Colorectal cancer is the third most frequent tumor in males and the second in females worldwide. In Spain, it is an important and growing health problem, and epidemiologic research focused on potential risk factors, such as environmental exposures, is necessary. Objectives: To analyze the association between colorectal cancer risk and residential proximity to industries, according to pollution discharge route, industrial groups, categories of carcinogens and other toxic substances, and specific pollutants released, in the context of a population-based multicase-control study of incident cancer carried out in Spain (MCC-Spain). Methods: MCC-Spain included 557 colorectal cancer cases and 2948 controls in 11 provinces, frequency matched by sex, age, and region of residence. Distances were computed from subjects' residences to each of the 134 industries located in the study area. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance (from 1 km to 3 km) to industrial facilities, adjusting for matching variables and other confounders. Results: Excess risk (OR; 95%CI) of colorectal cancer was detected near industries overall for all distances analyzed, from 1 km (2.03; 1.44-2.87) to 3 km (1.26; 1.00-1.59). In general, industries releasing pollutants to air showed higher excess risks than facilities releasing pollution to water. By industrial sector, excess risk (OR; 95%CI) was found near (≤3 km) production of metals (2.66; 1.77-4.00), surface treatment of metals (1.48; 1.08-2.02), glass and mineral fibers (2.06; 1.39-3.07), organic chemical industry (4.80; 3.20-7.20), inorganic chemical industry (6.74; 4.38-10.36), food/beverage sector (3.34; 2.38-4.68), and surface treatment using organic solvents (6.16; 4.06-9.36). By pollutants, the main excess risks (OR; 95%CI) were found near (≤3 km) industries releasing nonylphenol (9.19; 5.91-14.28), antimony (5.30; 3.45-8.15), naphthalene (3.11; 2.16-4.49), organotin compounds (2.64; 1.76-3.98), manganese (2.53; 1.63-3.93), dichloromethane (2.52; 1.74-3.66), and vanadium (2.49; 1.59-3.91). Conclusions: Our results support the hypothesis that residing in the proximity of industries may be a risk factor for colorectal cancer.This study was funded by: Scientific Foundation of the Spanish Association Against Cancer (Fundación Científica de la Asociación Española Contra el Cáncer (AECC) – EVP-1178/14); Spain's Health Research Fund (Fondo de Investigación Sanitaria - FIS 12/01416); Carlos III Institute of Health (ISCIII) grants, cofunded by ERDF funds–a way to build Europe– (grants PI08/0533, PI08/1359, PI08/1770, PS09/00773-Cantabria, PS09/01286-Leon, PS09/01662-Granada, PS09/01903-Valencia, PS09/02078-Huelva, PI11/00226, PI11/01403, PI11/01810, PI11/01889-FEDER, PI11/02213, PI12/00150, PI12/00265, PI12/00488, PI12/00715, PI12/01270, PI14/00613, PI14/01219, PI15/00069, PI15/00914, PI15/01032, PI17-00092); the Fundación Marqués de Valdecilla (API 10/09); the Junta de Castilla y León (LE22A10-2); the Conselleria de Sanitat of the Generalitat Valenciana (AP_061/10); the Consejería de Salud of the Junta de Andalucía (PI-0571-2009, PI-0306-2011, salud201200057018tra); the Catalan Government DURSI grant 2014SGR647; the European Commission grants FOOD-CT-2006-036224-HIWATE; the Recercaixa (2010ACUP 00310); Agency for Management of University and Research Grants (AGAUR) of the Catalan Government grant 2017SGR72

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved