Analysis of dyslipidemia in patients on chronic hemodialysis in Catalonia

Chronic hemodialysis patients show a high incidence and prevalence of cardiovascular disease of multifactorial etiology and an association between dyslipidemia and accelerated atherosclerosis. We analyzed characteristics of dyslipidemia in 1824 hemodialysis patients (59% men; mean age 65 +/- 15 years) in Catalonia and identified risk factors by logistic regression. Prevalence of dyslipidemia was high (63%). Most frequent lipid alterations were decreased HDL cholesterol (40%), hypertriglyceridemia (31%) and hypercholesterolemia (19%). Total cholesterol/HDL ratio was elevated in 23%. Body mass index (OR 1.08; 95% CI 1.05-1.11), diabetes mellitus (1.4; 1.09-1.79), ischemic heart disease (1.38, 1.08-1.75) and stroke (1.30; 1.0-1.69) were independent factors associated with dyslipidemia. Lengthy time (> 7 years) on dialysis (0.77; 0.59-0.99) and female sex (0.78; 0.64-0.96) were independent protective factors. A significant reduction in the risk of developing dyslipidemia was observed after the age of 50. Lipid-lowering drug use was low (19%), with statins being the most frequent (83%). The percentage of patients reaching target LDL levels according to individual cardiovascular risk (ATPIII) was unsatisfactory, particularly in high risk patients (52%). In light of the high prevalence of dyslipidemia and low adherence to target LDL goals, we conclude that strict control of dyslipidemia should be included in cardiovascular risk prevention strategies for chronic hemodialysis patients.     

BootstRatio: A web-based statistical analysis of fold-change in qPCR and RT-qPCR data using resampling methods

Real-time quantitative polymerase chain reaction (qPCR) is widely used in biomedical sciences quantifying its results through the relative expression (RE) of a target gene versus a reference one. Obtaining significance levels for RE assuming an underlying probability distribution of the data may be difficult to assess. We have developed the web-based application BootstRatio, which tackles the statistical significance of the RE and the probability that RE>1 through resampling methods without any assumption on the underlying probability distribution for the data analyzed. BootstRatio perform these statistical analyses of gene expression ratios in two settings: (1) when data have been already normalized against a control sample and (2) when the data control samples are provided. Since the estimation of the probability that RE>1 is an important feature for this type of analysis, as it is used to assign statistical significance and it can be also computed under the Bayesian framework, a simulation study has been carried out comparing the performance of BootstRatio versus a Bayesian approach in the estimation of that probability. In addition, two analyses, one for each setting, carried out with data from real experiments are presented showing the performance of BootstRatio. Our simulation study suggests that Bootstratio approach performs better than the Bayesian one excepting in certain situations of very small sample size (N≤12). The web application BootstRatio is accessible through http://regstattools.net/br and developed for the purpose of these intensive computation statistical analyses.     

Treating COPD in chronic patients in a primary-care setting

The aging of the populations in Western countries entails an increase in chronic diseases, which becomes evident with the triad of age, comorbidities and polymedication. chronic obstructive pulmonary disease represents one of the most important causes of morbidity and mortality, with a prevalence in Spain of 10.2% in the population aged 40 to 80. In recent years, it has come to be defined not only as an obstructive pulmonary disease, but also as a systemic disease. Some aspects stand out in its management: smoking, the main risk factor, even though avoidable, is an important health problem; very important levels of underdiagnosis and little diagnostic accuracy, with inadequate use of spirometry; chronic patient profile; exacerbations that affect survival and cause repeated hospitalizations; mobilization of numerous health-care resources; need to propose integral care (health-care education, rehabilitation, promotion of self-care and patient involvement in decision-making).     

Assessing predicted age-specific breast cancer mortality rates in 27 European countries by 2020

Background

We assessed differences in predicted breast cancer (BC) mortality rates, across Europe, by 2020, taking into account changes in the time trends of BC mortality rates during the period 2000–2010.

Methods

BC mortality data, for 27 European Union (EU) countries, were extracted from the World Health Organization mortality database. First, we compared BC mortality data between time periods 2000–2004 and 2006–2010 through standardized mortality ratios (SMRs) and carrying out a graphical assessment of the age-specific rates. Second, making use of the base period 2006–2012, we predicted BC mortality rates by 2020. Finally, making use of the SMRs and the predicted data, we identified a clustering of countries, assessing differences in the time trends between the areas defined in this clustering.

Results

The clustering approach identified two clusters of countries: the first cluster were countries where BC predicted mortality rates, in 2020, might slightly increase among women aged 69 and older compared with 2010 [Greece (SMR 1.01), Croatia (SMR 1.02), Latvia (SMR 1.15), Poland (SMR 1.14), Estonia (SMR 1.16), Bulgaria (SMR 1.13), Lithuania (SMR 1.03), Romania (SMR 1.13) and Slovakia (SMR 1.06)]. The second cluster was those countries where BC mortality rates level off or decrease in all age groups (remaining countries). However, BC mortality rates between these clusters might diminish and converge to similar figures by 2020.

Conclusions

For the year 2020, our predictions have shown a converging pattern of BC mortality rates between European regions. Reducing disparities, in access to screening and treatment, could have a substantial effect in countries where a non-decreasing trend in age-specific BC mortality rates has been predicted.

     

Anomalies of the long arm of chromosome 11 in human myelo- and lymphoproliferative disorders. I. Acute nonlymphocytic leukemia

In a series of 365 consecutive ANLL cases of which 45.1% had abnormal karyotypes, 13 cases were detected with a structural abnormality of the long arm of chromosome 11. Besides one isochromosome 11q, there were six deletions and six translocations. Of these 12 patients, seven had acute monocytic leukemia (FAB-type M5), two had an M4, two had an M2, and one case of secondary leukemia had an M3-like disorder. Similar results with regard to the type of leukemia were obtained upon analysis of 41 cases of ANLL with an 11q anomaly described in the literature. This study confirms that a high proportion of acute monocytic leukemias and a lesser proportion of acute myelomonocytic leukemias are characterized by an 11q anomaly, mostly involving bands q22 and/or q23. Acute monocytic leukemia with an 11q structural anomaly appears to have a poor prognosis.     

Development of a predictive model for early death in diabetic patients entering hemodialysis: a population-based study

The aim of this study was to investigate whether early death following the start of dialysis treatment can be explained by predialysis comorbid conditions, and to develop a prognostic model to predict early death in these patients. All patients with diabetes mellitus (DM) over 19 years of age entering hemodialysis in Catalonia in the 1997–2002 period (n = 1,365) were assessed from prospectively obtained data in the Catalan Renal Registry. Logistic regression was used to identify the risk factors associated with mortality at 3, 6 and 12 months of hemodialysis. Mortality at 3 months was found to be associated with age (RR: 1.53/10 years), low grades of functional autonomy, defined as “limited” (RR: 2.28) or “special care” (RR: 4.60), heart disease (RR: 2.23), and use of a catheter as the first vascular access (RR: 2.45). Malignant conditions and malnutrition were found to be additional significant risk factors for mortality at 12 months (RR: 1.68 and 1.74, respectively). Based on the multivariate analysis results, an individual prognostic model was formulated. This study confirms previous data suggesting that predialysis comorbid conditions are significantly associated with mortality in DM patients on dialysis and provides a prognostic model to help clinicians focus on various factors that may require attention before initiating this treatment.     

Relative survival of patients with uveal melanoma managed in a single center

To assess the 5-year relative survival of patients diagnosed with uveal melanoma (UM) in a single center. UM patients were recruited from 1995 to 2004 (N = 155) and were followed until December 2008. Relative survival (RS) methods were used to assess excess mortality. An RS regression model was fitted by sex, age, tumor origin, treatment, and tumor size to estimate the excess hazard rate (EHR) of death from UM. The overall 5-year RS was 90%, lower in women (84.6%) than in men (100%), lower in patients older than 60 years (88.8%) compared with those younger than or of 60 years of age (94.8%). Large tumors (80.8%) showed lower RS than medium (95.1%) and small ones (98.3%). Enucleated patients (80.5%) had lower RS compared with those who received brachytherapy (93.6%) and other treatments (94.7%). A significant EHR was found for women (EHR: 3.65), patients older than 60 years (EHR: 2.25), large-sized melanoma (EHR: 2.45), and during the third (EHR: 5.37) and fourth year (EHR: 3.01) of follow-up. This is the first Spanish study in a single center reporting RS among UM patients, taking into account clinical characteristics. Prognostic factors that explained RS among UM patients were sex, age, tumor size, and the year of follow-up. We also found a peak of excess mortality from the third until the fourth year after diagnosis, which warrants strict follow-up of these patients during this time interval.     

Reoperations after primary breast conserving surgery in women with invasive breast cancer in Catalonia,Spain: a retrospective study

Background

Although complete tumor resection is accepted as the best means to reduce recurrence, reoperations after lumpectomy are a common problem in breast cancer. The aim of this study was to assess the reoperation rates after primary breast conserving surgery in invasive breast cancer cases diagnosed in Catalonia, Spain, between 2005 and 2011 and to identify variations based on patient and tumour characteristics.

Methods

Women with invasive incident breast cancer identified from the Patient’s Hospital Discharge Database [174.0–174.9 codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) as the primary diagnosis] and receiving primary breast conserving surgery were included in the study and were followed up to 3 and 12 months by collecting information about repeat breast cancer surgery.

Results

Reoperation rates after primary breast conserving surgery decreased from 13.0 % in 2005 to 11.7 % in 2011 at 3 months and from 14.2 % in 2005 to 12.9 % in 2011 at 12 months’ follow-up. While breast conservation reoperations saw a slight, non-significant increase in the same period (from 5.7 to 7.3 % at 3 months, and from 6.0 to 7.5 % at 12 months), there was a significant decrease in radical reoperation (from 7.3 to 4.4 % at 3 months and from 8.2 to 5.4 % at 12 months). Overall, additional breast surgeries decreased among younger women.

Conclusions

Despite the rise of breast conserving surgery, reoperation rates following initial lumpectomy in Catalonia decreased by 10 % at 3 and 12 months’ follow-up, remaining low and almost unchanged. Ultimately, there was also a significant decrease in mastectomies.

     

Differential and enrichment media for selective culture and recognition of yeast species from clinical material

An enrichment medium was developed and evaluated for isolation of fluconazole-resistant minority yeast species in a hospital setting. The enrichment medium was made by adding fluconazole (10 µg/ml) to yeast nitrogen base/glucose broth. Under laboratory conditions the broth permitted detection of 20 of 20Candida krusei isolates and 20 of 20Candida glabrata isolates in mixtures withCandida albicans even when theCandida albicans cells outnumbered those of the other species by 1000:1. Results of culture on the enrichment medium were compared with those obtained on routine agar media and on a yeast differential agar which facilitates detection of mixed yeast species by their colony colours. Only oneCandida glabrata isolate was detected on the enrichment broth but not found on routine culture of 68 yeast-positive clinical specimens. However, bacterial over-growth in some broths may have retarded the appearance of other yeast isolates. On the yeast differential agar, 20 clinical specimens were found to contain mixtures of yeast species compared with only 2 on routine culture.