Comparación entre técnicas inmunológicas y moleculares para el diagnóstico de la enfermedad de Chagas

Introduction

Chagas disease is caused by the parasite Trypanosoma cruzi. The disease involves an acute and chronic phases. The diagnosis has limitations, both in parasitological and immunological techniques. Molecular assays are an alternative, but these must be evaluated to determine its diagnostic usefulness. The aim of this study was to compare the effectiveness of immunological techniques with molecular assays in the diagnosis of Chagas disease in its different phases.

Methods

The immunological techniques used were ELISA, HAI and IFI and the molecular techniques used were PCR for amplification of kinetoplast minicircles, and satellite DNA of T. cruzi. Thirty-nine blood samples from patients in the acute phase of Chagas disease, and 42 samples from patients in the chronic phase were evaluated. In addition, 20 samples from healthy individuals and 10 patients with other diseases were also studied.

Results

With immunological techniques were positive, 69.2% of samples from patients in the acute phase, while in the chronic phase were positive 95.2%. Using molecular techniques 79.5% of samples from patients in the acute phase were positive, while 23.8% of the samples from patients in the chronic phase were positive. None of the samples from healthy individuals was positive for any technique, while two samples from patients with other diseases were positive by the immunological assays.

Conclusions

The diagnostic efficacy of molecular techniques is high in the acute phase of Chagas disease, while in the chronic phase the immunological techniques are more effective.     

Prevalencia y distribución del depósito pulmonar de amianto en población urbana española

Introduction

The purpose of the present study is to analyse the prevalence and distribution of asbestos lung residue in the Barcelona urban population.

Material and methods

Lung autopsy samples were obtained from 35 individuals who had lived in Barcelona. The close family were interviewed in order to rule out asbestos exposure. Samples were obtained from three areas of the right lung during the autopsy: upper lobe apex, lower lobe apex, and lower lobe base. The samples were treated to remove organic material. The inorganic residue was analysed using a light microscope. The results were expressed as asbestos bodies (AB) per gram of dry tissue. Levels greater than 1000 AB/g of dry tissue were considered as potentially causing disease.

Results

AB were detected in 29(83%) of the subjects, of which 86% had levels less than 300 AB/g. Only one individual (3%) had values greater than 1000 AB/g dry tissue. The asbestos residue was higher in the lower lung lobe in 17 individuals (48%) than in the rest, although no significant differences were seen as regards AB residue in the three lung areas studied.

Conclusions

The results of this study show that the urban population of Barcelona have asbestos levels in the lung that vary between 0 and 300 AB/g dry tissue. No differences in the asbestos residues were detected in the lung areas studied in this population.     

Dosificación de antibióticos en el tratamiento de las infecciones por SARM en pacientes con insuficiencia renal aguda sometidos a técnicas continuas de depuración extrarrenal

Acute renal failure is frequent in critically ill patients. In those patients who need renal replacement therapy, continuous techniques are an alternative to intermittent haemodialysis. Critically ill patients often have an infection, which can lead to sepsis and renal failure. An early and adequate antibiotic treatment at correct dosage is extremely important. Methicillin resistant Staphylococcus aureus (MRSA) is a frequent nosocomial pathogen that causes a high rate of morbidity and mortality in critically ill patients.     

Técnicas de imagen en la evaluación de la función y cicatriz tras el infarto

Imaging techniques are essential in the clinical evaluation of patients with a myocardial infarction. They are of value for both initial assessment of the ischemic injury and for detection of the subgroup of patients at higher risk of developing cardiovascular events during follow-up. Echocardiography remains the technique of choice for the initial evaluation, owing to its bedside capability to determine strong predictors, such as ventricular volumes, global and regional systolic function, and valvular regurgitation. New techniques for evaluating ventricular mechanics, mainly assessment of ventricular deformation, are revealing important aspects of post-infarction ventricular adaptation. The main alternative to echocardiography is cardiac magnetic resonance imaging. This technique is highly accurate for determining ventricular volumes and ventricular function and has the additional advantage of being able to characterize the myocardium and demonstrate changes associated with the ischemic insult such as necrosis/fibrosis, edema, microvascular obstruction, and intramyocardial hemorrhage. These features not only allow detection and quantification of the infarct size, but also reveal additional characteristics of the scar tissue with prognostic value.     

Papel del ambiente hospitalario y los equipamientos en la transmisión de las infecciones nosocomiales

The hospital environment is both a reservoir and source of infection for the hospital patient. Several areas around the patient should be considered: air, toilet water coming into contact with the patient, staff and medical devices, food, surfaces, and instruments contacting the patient's skin and mucosa, and sterile solutions. There are pathogens classically associated with each mode of transmission and environmental reservoir, but multi-resistant microorganisms have also been recently been associated with environmental acquisition.     

Eficacia de los programas de educación terapéutica y de rehabilitación respiratoria en el paciente con asma

Asthma is a chronic complex and heterogeneous disease, with great variability and has a huge impact, not only on patients who suffer the disease but also their families and society in general. The education of the asthmatic patient and their families is essential for therapeutic intervention. Through continuous, dynamic and adaptive education, changes in attitudes and behaviours of the patient and family can be achieved, and will undoubtedly lead to an improvement in their quality of life. Among other non-pharmacological interventions, respiratory rehabilitation is an alternative treatment, and is primarily aimed at patients with moderate to severe asthma. Although the latest clinical practice guidelines published in the scientific literature recommend two strategies for treatment, the results of relevant publications are diverse. The objective of this study was to describe the effectiveness of therapeutic and educational programs in respiratory rehabilitation of the asthmatic patient.     

Influencia de la positividad del anti-HBc en el donante en la selección del donante pulmonar

Introduction

The risk of hepatitis B virus (HBV) transmission through donor organs with HBsAg(−) and anti-HBc(+) serology has not been extensively studied in lung transplantation. The objectives of this study are to ascertain the influence of the anti-HBc(+) on the acceptance of the lung for transplantation, to comment on the published literature and to suggest an algorithm for action.

Methods

A survey conducted in the 7 Spanish lung transplantation teams. The updated search of the literature was performed using medical databases from 1994 to February 2012.

Results

All of the teams vaccinate the lung recipients against HBV, although none quantify the anti-HBs titers. When given an anti-HBc(+) donor, 3 teams change their strategy: one does not accept the offer, one selects the receptor from among patients in emergency status and another adds pharmacological prophylaxis. Only 3 publications refer to the serologic evolution of the receptors. At the moment there have been no reported cases of hepatitis B or HBsAg positivity post-transplant, but 4 out of the 50 anti-HBc(−) receptors changed to anti-HBc(+) in the follow-up.

Conclusions

The presence of anti-HBc in the donor influences the decision to accept a lung donor, although there is little information on its repercussions. To date, there has been no reported case of transmission of HBV, but post-transplant anti-HBc seroconversions have been described, which suggests contact with viral particles. Although rare, an anti-HBc(+) donor can harbor a hidden HBV infection. The risk of infection can be reduced with adequate anti-HBs titers or with appropriate pharmacological measures.     

Seguridad biológica en la preservación y el transporte de muestras biológicas obtenidas en el ámbito de las enfermedades respiratorias y destinadas a la investigación

Major advances in genomics and proteomics have prompted the creation of biological specimen collections and biobanks for use in biomedical research. These specimen collections and the wealth of data they generate will allow longitudinal studies to be conducted and subproducts such as DNA or RNA to be obtained. They may even be used in future studies.     

Prevalencia y características clínicas de la enfermedad arterial periférica en la población general del estudio Hermex

Introduction and objectives

To estimate the prevalence of peripheral arterial disease as measured on ankle-brachial index and evaluate the associated risk, clinical, and diagnostic factors.

Methods

Cross-sectional study conducted in a random population-based sample of 2833 individuals aged 25 to 79 years from Don Benito health area (Badajoz). Peripheral arterial disease was considered for ankle-brachial index<0.90. To identify symptomatic disease we used the Edinburgh questionnaire. The current screening recommendations, changes to other categories of estimated coronary risk associated with index measurements, and the association with risk factors were assessed.

Results

The prevalence of peripheral arterial disease was 3.7% (95% confidence interval, 3.0%-4.5%), 5.0% (3.9%-6.3%) in men and 2.6% (1.8%-3.5%) in women (P = .001). The cumulative prevalence in those aged 50, 60 and 70 years were 6.2%, 9.1%, and 13.1% respectively. The disease was symptomatic in 13.3% (6.8%-19.8%) of cases and 29.6% of asymptomatic patients were not detected as recommended for high-risk groups. The use of ankle-brachial index increased the number of individuals with high coronary risk by 32.7%. Peripheral arterial disease was positively associated with age, smoking, hypercholesterolemia, sedentary lifestyle, microalbuminuria and history of cardiovascular disease, and negatively with alcohol consumption.

Conclusions

The use of ankle-brachial index for peripheral arterial disease diagnosis is advisable because of the low prevalence of symptomatic cases and the associated change in estimated coronary risk. Screening groups should be adapted to the Spanish population. Smoking and hypercholesterolemia are major associated risk factors.     

Primera fase de validación del algoritmo europeo de evaluación funcional previa a la resección pulmonar: cuantificación del cumplimiento de las recomendaciones en la práctica clínica real

Objective

To quantify the degree of compliance with the recommendations of the clinical practice guidelines published in 2009 by the ERS and the ESTS regarding the preoperative assessment of risk of lung resection in daily clinical practice at a tertiary hospital.

Method

A prospective, observational study of real-time data collected from consecutive patients who had been referred for evaluation from September 2009 to December 2010. We recorded the presence or absence of the recommended studies included in the algorithm, their results and, when a test was missing, the reasons why it was not performed. Hospital mortality and cardio-respiratory morbidity rates are also presented.

Results

173 patients were evaluated. In 171 cases, lung resection was performed, with a mortality of 1.2% and a cardio-respiratory morbidity of 11.7%. The failure rate of the first level of the algorithm was 4.6% and for the second level (VO_2max test) it was 26%. The absence of exercise tests was mainly due to hospital structural problems and the patients’ inability to perform it. Out of the patients who performed the exercise testing, 31 reached a VO_2max of 20 ml/kg-min or more and underwent surgery without calculation of FEV₁ppo and DCLOppo; 35 patients required the calculation to determine their operability and in 2 cases the intervention was not recommended due to functional inoperability of the patient.

Conclusions

The validation process found lack of compliance with the proposed algorithm in 18.5% of the cases basically due to the absence of the exercise tests. The rate of adherence to the algorithm recommendations should be improved before performing any other validation studies.     

Desarrollo de indicadores para evaluar los programas de prevención del cáncer colorrectal en la población de riesgo alto. La experiencia de la Clínica de Alto Riesgo

Background/objective

In 2006, the High-Risk Colorectal Cancer (CRC) Clinic was set up in Barcelona, a new healthcare model aimed at individuals and/or patients with an increased risk of developing CRC. The aim of this study was to develop a set of indicators to evaluate CRC prevention programs in the high-risk population and to implement them in the CRC to confirm their feasibility and validity in identifying areas for improvement.

Methods

A literature search was performed and consensus techniques were applied with experts linked to the prevention programs in the distinct autonomous regions in Spain to propose a conceptual model for the evaluation and indicators. Users’ opinions were introduced through focus groups for the proposed set of indicators. All experts participating in the consensus meetings and Delphi study evaluated the importance of each indicator (from 1 to 10) and their degree of agreement (agree strongly, agree with modifications, or eliminate this indicator). Expert consensus was considered to have been reached when 80% strongly agreed or agreed with the inclusion of the indicator. In the implementation phase, we included users (with advanced colorectal adenocarcinoma, polyposis syndrome, CRC or a familial history of CRC) attending the program. Information was obtained from computerized medical histories and clinical documentation. In addition, health professionals linked to the program were surveyed. To calculate each indicator, its formula was computed and the indicator was then compared with a standard previously agreed on by the experts in the first phase.

Results

Expert consensus was reached in 30 indicators. In the implementation phase, 21 feasible indicators that showed the greatest simplicity and validity in identifying areas for improvement were calculated. Of these, two measured aspects related to accessibility, seven measured patient-centered care, five measured continuity of care, one measured patient safety and four evaluated clinical effectiveness. Overall, eight of the 17 indicators achieved the previously agreed standard of quality of care.

Conclusions

The robustness and importance of the proposed set of indicators is supported by the wide participation of experts from distinct specialties and the adequate agreement reached. The present study serves to identify areas for improvement in the program. Periodic measurement of these indicators will allow the changes produced in this program and their utility to be evaluated and will aid assessment of other CRC prevention programs in the high-risk population.     

Implantación electiva de stent recubierto en la coartación y recoartación en el joven y en el adulto

Introduction and objectives

Stent implantation is an effective therapy for aortic coarctation and recoarctation. However, in adolescents and adults, aortic wall rupture and dissection can occur, as well as aneurysms during follow-up. In order to reduce these complications, we electively implant covered stents.

Methods

Since 2005, we have performed the procedure using femoral access in 17 patients (2 adolescents and 15 adults), 16 electively and 1 as a rescue procedure. We used the Mullins technique in all cases, implanting a NuMED^® covered stent.

Results

Good stent apposition was achieved in all 17 procedures; 8 patients required a distal flare. Gradient was reduced from 40 (16) mmHg to 2 (2) mmHg (P<.001) and lumen diameter increased from 4 (2) mm to 19 (3) mm (P<.001). Two exceptional cases are discussed: one patient with aortic wall rupture who underwent a rescue procedure using a stent within a covered stent and another patient with total obstruction and intercostal aneurysm in whom the outcome was fatal at 48 h postprocedure (autopsy is shown). Four-year clinical follow-up included Doppler echocardiography; an additional imaging technique was required in 13 patients. All patients recovered well and there were no complications.

Conclusions

Covered stents are effective in treating coarctation and recoarctation in adolescents and adults, are the treatment of choice in patients with complex anatomy, and must be available in the operating room as a rescue device when implanting a conventional stent.Full English text available from:www.revespcardiol.org/en     

Efecto en los resultados de la intervención y los resultados clínicos a largo plazo de la predilatación de la rama lateral para lesiones coronarias en bifurcación tratadas con la técnica de stent condicional

Introduction and objectives

It is uncertain whether side branch predilatation before main vessel stenting is necessary. We evaluated the effect of side branch predilatation on outcomes in percutaneous coronary intervention for true nonleft main bifurcation determined by the Medina classification using the provisional approach.

Methods

Target vessel failures (composite of cardiac death, myocardial infarction, or target vessel revascularization) were compared between patients who underwent side branch predilatation (predilatation group, n = 175) and those who did not (nonpredilatation group, n = 662).

Results

Final kissing-balloon inflation (57.1% vs 35.8%; P < .001) was performed more frequently and the cross-over rate to a 2-stent technique (14.9% vs 5.1%; P < .001) was higher in the predilatation group. During a median follow-up of 21 months, the predilatation group had a higher incidence of target vessel failures (14.3% vs 6.8%; P = .002) and target vessel revascularization (12.0% vs 5.6%; P = .003), but not of cardiac death or myocardial infarction compared with the nonpredilatation group. On multivariate analysis, side branch predilatation was associated with a higher occurrence of target vessel failures (adjusted hazard ratio = 2.11; 95% confidence interval, 1.27-3.50; P = .004). These results remained consistent after a propensity score-matched population analysis (for target vessel failures, adjusted hazard ratio = 2.63; 95% confidence interval, 1.09-6.34; P = .0031) and they were also constant among the various subgroups, according to the bifurcation angle, calcification, and diameter stenosis of the side branch.

Conclusions

Side branch predilatation before main vessel stenting may be associated with an increased risk of repeat revascularization in patients with true nonleft main bifurcation treated by the provisional approach.Trial registration: ClinicalTrials.gov number: NCT00851526.Full English text available from: www.revespcardiol.org/en     

Efecto de la presión positiva continua en las vías aéreas y de la cirugía de las vías aéreas superiores sobre los biomarcadores en condensado de aire exhalado y en suero en pacientes con apnea del sueño

Introduction

Studies on inflammation biomarkers in serum and in exhaled breath condensate (EBC) in obstructive sleep apnea (OSA) have shown conflicting results. The objective of this study is to assess EBC and serum biomarkers in OSA patients at baseline and after continuous positive airway pressure (CPAP) or upper airway surgery (UAS).

Patients and methods

Nine OSA patients referred for UAS were matched for anthropometric characteristics and apnea-hypopnea index with 20 patients receiving CPAP. pH, nitrite (NO₂⁻), nitrate and interleukin 6 in EBC and NO₂⁻, nitrate, leukotriene B₄ and interleukin 6 in serum were determined. EBC and serum samples were collected at baseline and 3 months after CPAP or UAS.

Results

Patients’ mean body mass index was 30 (range 24.9-40) kg/m². EBC biomarker levels at baseline were within normal range and did not differ significantly after CPAP or UAS. No significant changes were observed in the serum concentration of the biomarkers determined after CPAP but the serum concentration of NO₂⁻ increased significantly at 3 months after UAS (P = .0078).

Conclusion

In mildly obese OSA patients, EBC biomarkers of inflammation or oxidative stress were normal at baseline and remained unchanged 3 months after UAS or CPAP. Although UAS was not effective in terms of reducing OSA severity, it was associated with an increase in serum NO₂⁻.     

Broncoscopia durante la ventilación mecánica no invasiva: revisión de técnicas y procedimientos

Non-invasive mechanical ventilation (NIMV) is used to treat acute respiratory failure by improving gas exchange abnormalities and reducing the signs of respiratory effort, dyspnea and the activity of accessory respiratory muscles. Bronchoscopy is a key technique in the study of respiratory diseases that is necessary to perform in acute and critical patients, often times only after orotracheal intubation (OTI) due to possible complications of the technique. In this review, we evaluate the evidence of NIMV use during bronchoscopy, concluding that its use should be considered in severe patients as an alternative that is capable of preventing the complications related with OTI and mechanical ventilation, especially in patients with chronic obstructive pulmonary disease and with a tendency towards developing hypercapnia.     

Patrón de inicio del seguimiento clínico en los pacientes con infección por el virus de la inmunodeficiencia humana en España

Objetive

To describe linkage to care among new HIV diagnoses in Spain; and to estimate factors associated to linkage to care within three months after diagnosis.

Methods

The distribution of the time elapsing between the date of HIV diagnosis and the date of first determination of CD4 (considered to be the date of linkage to care) was calculated among new HIV diagnoses in 2010 in the seven Autonomous Regions participating, where data on date of CD4 count was available. Linkage to care was considered «correct» if done within three months after diagnosis. Factors associated to correct linkage to care were estimated using logistic regression.

Results

A total of 1769 new HIV diagnoses were included. Of them, 83.1% had evidence of linkage to care within a year, and 75.7% were linked within three months after diagnosis. Being an injectable drug user (IDU) was the only factor inversely associated with linkage to care within 3 months (OR = 0.3; 95% CI: 0.2-0.6).

Conclusion

In Spain linkage to care after HIV diagnosis is good, but there is still room for improvement, especially among IDUs.