Poder diagnóstico y pronóstico de los biomarcadores para mejorar el manejo de la neumonía adquirida en la comunidad en los servicios de urgencias

Objectives

To analyse the usefulness and performance of several biomarkers [C-reactive protein (CRP), mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT)] and lactate in predicting short- and medium-term mortality compared with the prognostic severity scales (PSS) usually employed for community-acquired pneumonia (CAP) and in assessing the aetiological suspicion of infection by Streptococcus pneumoniae and bacteraemia.

Methods

Observational, prospective and analytical study was conducted on patients who were diagnosed with CAP in our emergency department (ED). The data collected included socio-demographic and comorbidity variables, Charlson index, priority level according to the Spanish Triage System (STS), stage in the Pneumonia Severity Index (PSI) and in the CURB-65 (confusion, urea, respiratory rate, blood pressure and age ≥ 65 years), criteria of severe CAP, microbiological studies, and biomarkers determinations. The patients were followed-up for 180 days to calculate the prognostic power and the diagnostic performance for bacteraemia and aetiology.

Results

A total of 127 patients were finally enrolled in the study. The 30-day mortality was 10.3% (13), and 22.6% (28) at 180 days. Blood cultures were positive in 29 patients (23%) and S. pneumoniae was identified as the responsible pathogen in 28 cases (22.2%). The area under the ROC curve (AUC-ROC) for lactate and MR-proADM to predict 30-day mortality was 0.898 (95% CI: 0.824-0.973; P < .0001) and 0.892 (95% CI: 0.811-0.974; P < .0001), respectively, and for MR-proADM at 180 days it was 0.921 (95% CI: 0.874-0.968; P < .0001). The AUC-ROC for PCT to predict bacteraemia was 0.952 (95% CI: 0.898-1.000; P < .0001) and, considering a cut-off value ≥ 0.95 ng/ml, the negative predictive value (NPV) and the likelihood ratio (LR+) were 97.8% and 9.03, respectively. Using a PCT cut-off value > 0.85 ng/ml, the NPV and the LR+ were 96.6% and 5.89%, respectively, to predict a S. pneumoniae infection.

Conclusions

MR-proADM and lactate showed a similar or even better performance for 30-day intra-hospital mortality than PSI, CURB-65, STS and CAP severity criteria in patients diagnosed with CAP (P > .05). Furthermore, the MR-proADM capacity to predict 180-day mortality was higher than PSS and the rest of biomarkers (P > .05), and its AUC-ROC increased if it was used in combination with PSI, CURB65 and STS. The determination of PCT has a remarkable diagnostic performance to rule out bacteraemia and to orientate the aetiology towards a S. pneumoniae infection.     

Efecto de la hipoxia sobre el metabolismo de la glucosa en pacientes no diabéticos con síndrome de apnea obstructiva del sueño

Aim

Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia and insulin resistance. Our aim is to investigate the effect of OSAS on the fasting plasma glucose, glycosylated hemoglobin (HbA_1c), and C reactive protein (CRP) in nondiabetic patients.

Material and methods

Blood parameters of consecutive 90 non diabetic patients whom polysomnografic evaluations were done in our sleep laboratory was evaluated. Among these 61 patients with normal fasting blood glucose were classified due to their apne-hipopnea index (AHI) as mild (n = 16, 26.2%), moderate (n = 18, 29.5%) and severe (n = 27, 44.2%) OSAS. The fasting plasma glucose, HbA_1c and CRP were measured.

Results

Mean age of the patients was 47.7 ± 11.2 years, 72% male. HbA_1c, fasting glucose levels show positive correlation with BMI (r = .503, P = .00; r = .258, P = .045). No relation of HbA_1c to apnea index nor AHI was detected while positive corelation of fasting glucose and CRP was detected (r = .262, P = .042; r = .258, P = .045). HbA_1c, fasting glucose and CRP levels show negative correlation with minimum SpO₂ levels (by order of r = –.302, P = .018; r = –.368, P = .004; r = –.365, P = .004). HbA1c, fasting glucose levels and CRP levels show positive correlation with mean desaturation index (time duration in which SpO₂ < 90% by pulse oxymeter) (r = .263, P = .041; r = .311, P = .015; r = .283, P = .027).

Conclusions

Although no relation in between increased HbA_1c or glucose levels and severity of OSAS was detected in nondiabetic OSAS patients, the correlation with the night hypoxia was detected. This could also show the effect of night time hypoxia on glucose metabolism in OSAS patients.     

Aumento de la expresión de las moléculas CD11c y CD103 en neutrófilos de sangre periférica tratados con una formulación de ribosomas bacterianos y proteoglicanos de Klebsiella pneumoniae

Aim

To evaluate the effect of a preparation with bacterial ribosomes and proteoglycans from Klebsiella pneumoniae «R» on the in vitro expression of CD11c and CD103 molecules in neutrophils from peripheral blood.

Methods

Isolation of neutrophils from peripheral blood with Ficoll-Paque, incubation with R and detection of CD11c and CD103 through flow cytometry.

Results

Six hours after the incubation period, CD11c expression increased significantly compared with the control with 125 and 500 μg/ml of R (P = .017 and P = .006, respectively). CD103 expression induced with 125 μg/ml of R after 6 hours was significantly higher than that observed after 4 hours at the same concentration (P = .014) and that found with 62.5 μg/ml (P = .017) of R.

Conclusions

The increased expression of CD11c and CD103 induced by R in the neutrophils could contribute to the R mechanism against respiratory pathogens.     

Ancho de distribución eritrocitaria y predicción adicional del riesgo de hemorragia mayor en el síndrome coronario agudo sin elevación del ST

Introduction and objectives

Red cell distribution width has been linked to an increased risk for in-hospital bleeding in patients with non–ST-segment elevation acute coronary syndrome. However, its usefulness for predicting bleeding complications beyond the hospitalization period remains unknown. Our aim was to evaluate the complementary value of red cell distribution width and the CRUSADE scale to predict long-term bleeding risk in these patients.

Methods

Red cell distribution width was measured at admission in 293 patients with non–ST-segment elevation acute coronary syndrome. All patients were clinically followed up and major bleeding events were recorded (defined according to Bleeding Academic Research Consortium Definition criteria).

Results

During a follow-up of 782 days [interquartile range, 510-1112 days], events occurred in 30 (10.2%) patients. Quartile analyses showed an abrupt increase in major bleedings at the fourth red cell distribution width quartile (> 14.9%; P = .001). After multivariate adjustment, red cell distribution width > 14.9% was associated with higher risk of events (hazard ratio = 2.67; 95% confidence interval, 1.17-6.10; P = .02). Patients with values ≤ 14.9% and a CRUSADE score ≤ 40 had the lowest events rate, while patients with values > 14.9% and a CRUSADE score > 40 points (high and very high risk) had the highest rate of bleeding (log rank test, P < .001). Further, the addition of red cell distribution width to the CRUSADE score for the prediction of major bleeding had a significant integrated discrimination improvement of 5.2% (P < .001) and a net reclassification improvement of 10% (P = .001).

Conclusions

In non–ST-segment elevation acute coronary syndrome patients, elevated red cell distribution width is predictive of increased major bleeding risk and provides additional information to the CRUSADE scale.Full English text available from: www.revespcardiol.org/en     

Distribución de fenotipos clínicos en pacientes con enfermedad pulmonar obstructiva crónica por humo de biomasa y por tabaco

Introduction

Exposure to biomass smoke is a risk factor for chronic obstructive pulmonary disease (COPD). It is unknown whether COPD caused by biomass smoke has different characteristics to COPD caused by tobacco smoke.

Objective

To determine clinical differences between these two types of the disease.

Methods

Retrospective observational study of 499 patients with a diagnosis of COPD due to biomass or tobacco smoke. The clinical variables of both groups were compared.

Results

There were 122 subjects (24.4%) in the biomass smoke group and 377 (75.5%) in the tobacco smoke group. In the tobacco group, the percentage of males was higher (91.2% vs 41.8%, P < .0001) and the age was lower (70.6 vs 76.2 years, P < .0001). Body mass index and FEV₁% values were higher in the biomass group (29.4 ± 5.7 vs 28.0 ± 5.1, P = .01, and 55.6 ± 15.6 vs 47.1 ± 17.1, P < .0001, respectively). The mixed COPD-asthma phenotype was more common in the biomass group (21.3% vs 5%, P < .0001), although this difference disappeared when corrected for gender. The emphysema phenotype was more common in the tobacco group (45.9% vs 31.9%, P = .009). The prevalence of the chronic bronchitis and exacerbator phenotypes, the comorbidity burden and the rate of hospital admissions were the same in both groups.

Conclusion

Differences were observed between COPD caused by biomass and COPD caused by tobacco smoke, although these may be attributed in part to uneven gender distribution between the groups.     

Experiencia y desarrollo de la técnica de lobectomía por cirugía torácica videoasistida: estudio comparativo con cirugía convencional en estadio i de cáncer de pulmón no microcítico

Background

Surgical treatment of stage I non-small cell lung cancer (NSCLC) can be performed either by thoracotomy or by employing video-assisted thoracic surgery (VATS). The aim of this study was to compare long and short-term results of conventional surgery (CS) vs. VATS lobectomy in the treatment of stage I NSCLC.

Materials and methods

We performed a retrospective, analytical study of patients undergoing surgery for stage I NSCLC during the period January 1993 to December 2005. The variables analyzed were overall survival, recurrence, distant metastasis, morbidity, mortality and hospital stay. During this period, 256 anatomic lung resections were performed: 141 by CS and 115 by VATS.

Results

There were statistically significant differences in: (i) mean hospital stay in patients with no complications (VATS group: 4.3 days vs. CS group: 8.7 days, P = .0001); (ii) mean hospital stay in patients with complications (VATS: 7.2 days vs. CS: 13.7 days, P = .0001), and (iii) morbidity (VATS: 15.6% vs. CS: 36.52%, P = .0001). No statistically significant differences were found in: (i) mortality (VATS: 2.17% vs. CS: 1.7%, P = .88); (ii) 5-year overall survival (VATS: 68.1% vs. CS: 63.8%), and (iii) local recurrence and distant metastasis (P = .82).

Conclusions

VATS lobectomy is a safe and effective approach, with a shorter hospital stay and lower morbidity than CS; no statistically significant differences were observed in survival in patients undergoing surgery for stage I NSCLC.     

Análisis combinado de dos ensayos aleatorizados de comparación de stents con recubrimiento de titanio-óxido nítrico con stents liberadores de fármacos en el IAMCEST

Introduction and objectives

We performed a pooled analysis based on patient-level data from the TITAX-AMI and BASE-ACS trials to evaluate the outcome of titanium-nitride-oxide-coated bioactive stents vs drug-eluting stents in patients with ST-segment elevation myocardial infarction at 2-year follow-up.

Methods

The TITAX-AMI trial compared bioactive stents with paclitaxel-eluting stents in 425 patients with acute myocardial infarction. The BASE-ACS trial compared bioactive stents with everolimus-eluting stents in 827 patients with acute coronary syndrome. The primary endpoint for the pooled analysis was major adverse cardiac events: a composite of cardiac death, recurrent myocardial infarction, or ischemia-driven target lesion revascularization at 2-year follow-up.

Results

The pooled analysis included 501 patients; 245 received bioactive stents, and 256 received drug-eluting stents. The pooled bioactive stent group was associated with a risk ratio of 0.85 for major adverse cardiac events (95% confidence interval, 0.53-1.35; P = .49) compared to the pooled drug-eluting stent group. Similarly, the pooled bioactive stent group was associated with a risk ratio of 0.71 for cardiac death (95% confidence interval, 0.26-1.95; P = .51), 0.44 for recurrent myocardial infarction (95% confidence interval, 0.20-0.97; P = .04), and 1.39 for ischemia-driven target lesion revascularization (95% confidence interval, 0.74-2.59; P = .30), compared to the pooled drug-eluting stent group. These results were confirmed by propensity-score adjusted analysis of the combined datasets.

Conclusions

In patients with ST-segment elevation myocardial infarction, bioactive stents were associated with lower rates of recurrent myocardial infarction compared to drug-eluting stents at 2-year follow-up; yet, the rates of cardiac death and ischemia-driven target lesion revascularization were similar.Full English text available from: www.revespcardiol.org/en     

Efecto de la infección por Clostridium difficile sobre la estancia hospitalaria. Estudio de cohortes

Introduction

Clostridium difficile is responsible for a spectrum of diseases known as “Clostridium difficile infection” (CDI). It is currently the leading cause of nosocomial diarrhea in developed countries. This infection has been associated with both increased hospital stay and mortality, and to a greater likelihood of readmission. In our country these undesirable effects have not yet been characterized. Our objective was to quantify the increase in hospital stay attributable to infection by C. difficile.

Methods

A retrospective cohort study matched by age, sex and admission date, was conducted in a tertiary care university hospital during an outbreak of nosocomial transmission of CDI.

Results

The cohort study included 38 infected, and 76 non-infected patients. Patients who developed CDI showed a higher proportion of malnutrition at admission (OR = 10.3; 3.6 to 29.6), were exposed to a wider range of antibiotics (mean difference = 1.5; 0.7-2.2), had a higher mortality (31.6% vs. 6.6% of controls, P < .001), and a longer hospital stay (median 31.5 days versus 5.5 days for controls, P < .001). After adjustment, infection by C. difficile was associated with an increase in hospital stay of 4 days (P < .001).

Conclusions

C. difficile infection has important consequences on the length of hospital stay, and therefore on health costs.     

Endocarditis infecciosa en 2 hospitales universitarios españoles que difieren en su localización y en la presencia de servicio quirúrgico

Objectives

To assess possible differences in clinical presentation, microbiology, morbidity and mortality of infective endocarditis between two Spanish hospitals, one on the mainland that has cardiac surgery and one in the Canary Islands without this service.

Method

A total of 229 patients consecutively diagnosed of endocarditis between 2005 and 2012, including pediatric population, were studied in the Reina Sofía Hospital (Córdoba, n = 119) and Nuestra Señora de Candelaria Hospital (Tenerife, n = 110). We compared the clinical, microbiological and echocardiographic data and analyzed mortality differences by binary logistic regression analysis.

Results

There were no differences in underlying heart disease, proportion of surgery, or the microbiological profile. The proportion of infections attributable to catheter was higher in the Canary Islands hospital (13.6% vs 3.4%). Mortality was also higher (31.8% vs 18.5%, P = .020), although this difference was no longer significant in the multivariate analysis (OR = 1.85; 95% CI, 0.70-4.87; P = .213). Age (OR = 1.04/year; 95% CI, 1.01-1.07; P = .006), cardiac complications (OR = 5.05; 95% CI, 1.78-14.34; P = .002), persistent sepsis (OR = 4.89; 95% CI, 2.09-11.46; P < .001), and emergent surgery (OR = 4.43, 95% CI, 1.75-11.19; P = .002) were independent predictors of death. Time to surgery, length of stay in the hospital without a surgical service (20 [13-30.5] vs 13 [6-25] days; P = .019) was not associated with outcome.

Conclusions

There are differences in the presentation of endocarditis between two distant hospitals in Spain. The different hospital mortality can not be directly related to the presence of a surgery service.     

Evolución del uso de la ventilación mecánica no invasiva en enfermedad pulmonar obstructiva crónica en una región española, 1997-2010

Introduction

Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain).

Subjects and methods

A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression.

Results

We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC] = −3.4, 95% CI: − 4.8; −2.0, P <.05) and in the group without ventilatory intervention (APC = −4.2%, −5.6; −2.8, P <.05); upward trend in the use of NIV (APC = 16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC = −4.5%, −10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC = 0.5, −1.3; 2.4) and in the group without intervention (APC = 0.1, −1.6; 1.9); downward trend with statistical significance in the NIV group (APC = −7.1, −11.7; −2.2, P <.05) and not statistically significant in the IMV group (APC = −0,8, −6, 1; 4.8). The mean stay did not change substantially.

Conclusions

The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay.     

Erradicación de un brote nosocomial de infecciones por Acinetobacter baumannii multirresistente tras el ajuste de cargas de trabajo y refuerzo de precauciones específicas

Introduction

During 2009, an outbreak of multidrug-resistant Acinetobacter baumannii (MDR A. baumannii) infections was detected in a 27-bed intensive care unit, resulting in 25 cases being infected.

Methods

A matched case-control study was conducted to identify risk factors for infection. The colonization pressure, or the proportion of other patients colonized by MDR A. baumannii, was estimated. TISS-28 and Omega scores of each patient were calculated to evaluate nursing work requirements. Conditional logistic regression analyses were carried out.

Results

Breakdowns in hand washing and glove use were observed. Infected patients (cases) were more likely than paired controls to have had longer exposure to invasive devices and antimicrobial treatment. The independent risk factors identified by the multivariate analysis were, mechanical ventilation [odds ratio (OR) = 1.03; 95% confidence interval (CI), 1.01-1.05; P = .01], and exposure to an infected or colonized patient [OR = 1.7; 95% CI, 1.1-2.6; P = .02). A combined infection control strategy was implemented, including strict compliance with isolation precautions, grouping of patients, reinforcing cleaning and disinfection of surfaces, and a decrease in work load. Subsequently, a sharp reduction in the incidence MDR A. baumannii infections was shown. Therapeutic activity scores were significantly higher for cases than for controls.

Conclusion

The results suggest patient-to-patient transmission of MDR A. baumannii. Reinforcement of specific procedures and work load adjustment were essential to eradicate this outbreak.     

Evaluación de la utilización de una consulta de diagnóstico rápido de cáncer de pulmón. Tiempos de demora diagnóstica y terapéutica

Objective

To analyze the results obtained in a lung cancer screening program since its inception five years ago regarding correct referrals, diagnostic and therapeutic delay times and days of hospitalization. To compare the diagnostic-therapeutic delays and hospital stays with those obtained in patients evaluated with the standard system.

Patients and methods

Included for study were all those patients evaluated in our Lung Cancer Screening Program (LCSP) in the last five years. For the cases with LC, we recorded the dates the patients were referred to a specialist, the first consultation, diagnostic tests, stage, start of treatment and days of hospitalization. We compared these same data with lung cancer patients who did not partake in the LCSP and were diagnosed between October 2008 and October 2010.

Results

We evaluated 179 patients remitted to the LCSP, which represented 26.7% of the consultations; 166 (92.7%) of the referrals were correct, out of which 44.5% were LC. In 75.6% of these, the entire study was completed in the outpatient setting, and more than 85% of the cases met the current recommendations related with diagnostic-therapeutic delays. When these results were compared with the non-LCSP group (n = 151), differences were found in the data for hospitalizations: there was a lower percentage of hospitalizations (P < .0001) and shorter hospital stays (P < .0001) in the LCSP group. There were no differences between the two groups for diagnostic or therapeutic delays.

Conclusion

In our setting, lung cancer screening programs allow for cancer studies to be carried out in the outpatient consultations in a large percentage of cases, and within the time periods recommended by current guidelines. In spite of this fact, we have detected that these programs are underused.     

Enfermedades de declaración obligatoria: conocimiento y notificación en el ámbito hospitalario

Introduction

Notifiable infectious diseases represent a public health hazard, which is why they are under surveillance and must be reported. We tried to assess hospital physicians’ knowledge of hospital physicians on notifiable infectious diseases and their self-reported attitudes to notification.

Methods

An observational study was conducted using a questionnaire with 11 multiple choice questions, two yes/no questions and one short-answer question. It was distributed to all senior doctors and residents in 19 medical and surgical departments.

Results

A total of 248 questionnaires were sent out, with a response rate of 79.84%. More than three-quarters (76.3%) of the respondents were senior doctors. As regards specific knowledge about whether a particular disease is a notifiable disease, 29.5% identified correctly 100% of the named diseases, 3.2% could not identify any of them. All urgent named notifiable infectious diseases were correctly identified by 25.3% of physicians. Statistically significant differences were found in the knowledge of notifiable diseases knowledge in medical and surgical departments, as well as for senior doctors (P = .047) and residents (P = .035). A high percentage of medical services (40%) and surgical (70%) department reported never failing to notify. When asked about the causes of under-reporting, 72% did not know whether notification was mandatory or not, and 88% did not know what diseases must be notified.

Conclusions

Although many respondents are aware that diseases notification is part of their daily activity, many of them admit under-reporting. There is insufficient knowledge about what diseases are considered notifiable infectious diseases and how to notify them.     

Prevalencia de anemia asociada a la enfermedad pulmonar obstructiva crónica. Estudio de las variables asociadas

Background

Anaemia is one of the extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD). Its real prevalence, physiopathology and clinical repercussion are unknown. The objectives of our study were: to determine the prevalence of anaemia in patients with stable COPD not attributable to other causes and to establish the relationship of anaemia with clinical, prognostic and inflammatory markers with an important role in COPD.

Methods

The study included stable COPD patients with no other known causes of anaemia. The following tests were carried out: respiratory function tests; serum determination of erythropoietin and inflammatory markers: high sensitivity C-reactive protein (hs-CRP), fibrinogen, interleukin 6 (IL-6), interleukin 8 (IL-8) and tumour necrosis factor α (TNF-α). Body mass index (BMI), Charlson and BODE indices, the number of exacerbations in the previous year, dyspnoea and quality of life were also calculated.

Results

One hundred and thirty patients were included. Anaemia prevalence was 6.2%. Mean haemoglobin value in anaemic patients was 11.9 ± 0.95 g/dL. Patients with anaemia had a lower BMI (P = .03), higher Charlson index (P = .002), more elevated erythropoietin levels (P = .016), a tendency to present a lower FEV₁% value (P = .08) and significantly lower IL-6 values when compared to non-anaemic patients (P = .003).

Conclusions

In our series, the anaemia associated with COPD was less prevalent than that published in the literature to date, and was related to certain clinical and inflammatory markers.     

La distensión de la región isquémica predice una mayor inducibilidad de fibrilación ventricular tras la oclusión coronaria en el modelo porcino

Introduction and objectives

Distension of the ischemic region has been related to an increased incidence of spontaneous ventricular arrhythmias following coronary occlusion. This study analyzed whether regional ischemic distension predicts increased ventricular fibrillation inducibility after coronary occlusion in swine.

Methods

In 18 anesthetized, open-chest pigs, the left anterior descending coronary artery was ligated for 60 min. Myocardial segment length in the ischemic region was monitored by means of ultrasonic crystals. Programmed stimulation was applied at baseline and then continuously between 10 and 60 min after coronary occlusion.

Results

Coronary occlusion induced a rapid increase in end-diastolic length in the ischemic region, which reached 109.4% (0,9%) of baseline values 10 min after occlusion (P<.001). On average, 6.6 (0,5) stimulation protocols were completed and 5.4 (0,6) ventricular fibrillation episodes induced between 10 and 60 min of coronary occlusion. Neither baseline serum potassium levels nor the size of the ischemic region were significantly related to ventricular fibrillation inducibility. In contrast, the increase in end-diastolic length 10 min after coronary occlusion was associated directly (r=0,67; P=.002) with the number of induced ventricular fibrillation episodes and inversely (r=–0,55; P=.018) with the number of extrastimuli needed for ventricular fibrillation induction.

Conclusions

Regional ischemic expansion predicts increased ventricular fibrillation inducibility following coronary occlusion. These results highlight the potential influence of mechanical factors, acting not only on the triggers but also on the substrate, in the genesis of malignant ventricular arrhythmias during acute ischemia.Full English text available from: www.revespcardiol.org/en     

Utilización de glucosa en los músculos de pacientes con enfermedad pulmonar obstructiva crónica

Introduction

Muscle dysfunction is one of the most extensively studied manifestations of COPD. Metabolic changes in muscle are difficult to study in vivo, due to the lack of non-invasive techniques. Our aim was to evaluate metabolic activity simultaneously in various muscle groups in COPD patients.

Methods

Thirty-nine COPD patients and 21 controls with normal lung function, due to undergo computed axial and positron emission tomography for staging of localized lung lesions were included. After administration of 18-fluordeoxyglucose, images of 2 respiratory muscles (costal and crural diaphragm, and rectus abdominus) and 2 peripheral muscles (brachial biceps and quadriceps) were obtained, using the standard uptake value as the glucose metabolism index.

Results

Standard uptake value was higher in both portions of the diaphragm than in the other muscles of all subjects. Moreover, the crural diaphragm and rectus abdominus showed greater activity in COPD patients than in the controls (1.8 ± 0.7 vs 1.4 ± 0.8; and 0.78 ± 0.2 vs 0.58 ± 0.1; respectively, P < .05). A similar trend was observed with the quadriceps. In COPD patients, uptake in the two respiratory muscles and the quadriceps correlated directly with air trapping (r = 0.388, 0.427 and 0.361, respectively, P < .05).

Conclusions

There is greater glucose uptake and metabolism in the human diaphragm compared to other muscles when the subject is at rest. Increased glucose metabolism in the respiratory muscles (with a similar trend in their quadriceps) of COPD patients is confirmed quantitatively, and is directly related to the mechanical loads confronted.     

Tratamiento y control de los factores de riesgo según el riesgo coronario en la población española del estudio DARIOS

Introduction and objectives

The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 years being treated and controlled in relation to their level of coronary risk.

Methods

Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure <140/90 mmHg and glycohemoglobin <7%. In hypercholesterolemia, we applied both the European Societies and Health Prevention and Promotion Activities Programme criteria.

Results

We enrolled 27 903 participants (54% women). Drug treatments were being administered to 68% of men and 73% of women with a history of hypertension (P < .001), 66% and 69% respectively, of patients with diabetes (P = .03), and 39% and 42% respectively, of those with hypercholesterolemia (P < .001). Control was good in 34% of men and 42% of women with hypertension (P < .001); 65% and 63% respectively, of those with diabetes (P = .626); 2% and 3% respectively, of patients with hypercholesterolemia according to European Societies criteria (P = .092) and 46% and 52% respectively, of those with hypercholesterolemia according to Health Prevention and Promotion Activities Programme criteria (P < .001). The proportion of uncontrolled participants increased with coronary risk (P < .001), except in men with diabetes. Lipid-lowering treatments were more often administered to women with ≥10% coronary risk than to men (59% vs. 50%, P = .024).

Conclusions

The proportion of well-controlled participants was 65% at best. The European Societies criteria for hypercholesterolemia were vaguely reached. Lipid-lowering treatment is not prioritized in patients at high coronary risk.Full English text available from: www.revespcardiol.org     

La maladie de Behçet chez la femme

Purpose

Behçet's disease (BD) is a multisystemic inflammatory disease characterized, on the one hand, by the frequency of benign mucocutaneous and articular manifestations, and on the other hand by the severity of ocular, neurological, vascular and digestive manifestations which may threaten functional or vital prognosis. The male BD predominance is obvious in many retrospective studies and a few studies only have focused on BD in women.

Methods

In this study, we report the epidemiological, clinical, outcome and therapeutic data of a series of 71 female BD compared to a series of 111 male BD. This retrospective study was conducted in the internal medicine department of Monastir university hospital over a 19-year period (1990 to 2008), including all patients followed-up and treated for BD.

Results

The comparison of clinical manifestations of BD between men and women showed the predominance of erythema nodosum (P = 0.016), necrotic pseudofolliculitis (P = 0.001), and joint involvement (P = 0.009) in women, while genital ulcers (P = 0.039), ocular involvement (P = 0.003) and vascular (P = 0.002) involvement were more common in men.

Conclusion

Our results confirmed the results of previous studies regarding the benign nature of BD in women compared to men.