Simple open-heart surgery protocol for sickle-cell disease patients: a retrospective cohort study comparing patients undergoing mitral valve surgery

OBJECTIVESSickle-cell disease (SCD) patients are considered to be at high risk from open-heart surgery. This study assessed the role of a simple sickling-prevention protocol.METHODSPerioperative non-specific and SCD-specific morbidity and 30-day mortality are investigated in a retrospective cohort study on patients undergoing isolated mitral valve surgery. Patients with and without SCD were compared. In the SCD cohort, a bundle of interventions was applied to limit the risk of sickling: ‘on-demand’ transfusions to keep haemoglobin levels of around 7–8 g/dl, cardiopulmonary bypass (CPB) with higher blood flow and perfusion temperature, close monitoring of acid–base balance and oxygenation.RESULTSTwenty patients with and 40 patients without SCD were included. At baseline, only preoperative haemoglobin levels differed between cohorts (8.1 vs 11.8 g/dl, P < 0.001). Solely SCD patients received preoperative transfusions (45.0%). Intraoperative transfusions were significantly larger in SCD patients during CPB (priming: 300 vs 200 ml; entire length: 600 vs 300 ml and 20 vs 10 ml/kg). SCD patients had higher perfusion temperatures during CPB (34.7 vs 33.0°C, P = 0.01) with consequently higher pharyngeal temperature, both during cooling (34.1 vs 32.3°C, P = 0.02) and rewarming (36.5 vs 36.2°C, P = 0.02). No mortality occurred, and non-SCD-specific complications were comparable between groups, but one SCD patient suffered from perioperative cerebrovascular accident with seizures, and another had evident haemolysis.CONCLUSIONSSCD patients may undergo open-heart surgery for mitral valve procedures with an acceptable risk profile. Simple but thoughtful perioperative management, embracing ‘on-demand’ transfusions and less-aggressive CPB cooling is feasible and probably efficacious.     

The adolescent onset anorexia nervosa study (ANABEL): Design and baseline results

The anorexia nervosa adolescent longitudinal biomarker assessment study (ANABEL) is a 2‐year longitudinal study.

Objective

Evaluate several clinical, biochemical, immunological, psychological, and family variables and their interactions in adolescent onset eating disorders (EDs) patients and their 2‐year clinical and biological outcome. This article illustrates the framework and the methodology behind the research questions, as well as describing general features of the sample.

Methods

A longitudinal study of 114 adolescents with EDs seeking treatment was performed. Only adolescents were selected during 4 years (2009–2013). The variables were collected at different times: baseline, 6, 12, 18, and 24 months of the start of treatment. Diagnoses were completed through the semi‐structured Kiddie‐Schedule for Affective Disorders and Schizophrenia interview.

Results

At baseline, the mean age was 15.11 (SD = 1.36). The mean ED duration was 10 months (SD = 5.75). The mean body mass index was 16.1 (SD = 1.8). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis at baseline for restrictive anorexia nervosa was 69.6%, 17.4% for purgative anorexia nervosa, and 24.3% for other specified feeding disorder. At 12 months, 19.4% were in partial remission, whereas at 24 months, 13.8% had fully recovered and 29.2% had partially recovered.

Conclusions

There was an acceptable physical and psychopathological improvement during the first year of treatment, with recovery being more evident during the first 6 months.

     

Cómo identificar la inactividad física en atención primaria: validación de las versiones catalana y española de 2 cuestionarios breves

ObjectiveThe Brief Physical Activity Assessment Tool (BPAAT) and the General Practice Physical Activity Questionnaire (GPPAQ) are valid and reliable assessment tools to identify “inactive” patients in primary care. No similar tools exist for the Spanish population. The study aimed to evaluate the reliability and validity of the Catalan and Spanish versions (CBPAAT-CGPPAQ; CBPAAT-EGPPAQ) of such tools.DesignValidation study of the linguistic and cultural adaptation of two questionnaires into Catalan/Spanish. Setting: Centres of Primary Care.ParticipantsThe load for administering the questionnaires was evaluated by 7 general practitioners and 44 patients. Construct validity and reliability was assessed in 105 patients (58 years old ± 20; 37% men) without any contraindication for physical activity (PA).Main variablesAfter carrying out the translation and back-translation, construct validity was assessed against the International Physical Activity Questionnaire (IPAQ short form). Reliability was assessed administering the questionnaires again within 14 to 28 days.ResultsThe validity of the CBPAAT-EBPAAT showed a moderate percentage agreement, correctly classifying over 80% and 83% of the “inactive” cases. Reliability was also good, correctly classifying over 86% and 88% of the cases. The validity of the CGPPAQ-EGPPAQ showed a moderate percentage agreement, correctly classifying over 70% and 60% of the “inactive” cases. Reliability was good, correctly classifying over 82% and 72% of the cases.ConclusionsThe CBPAAT-CGPPAQ and EBPAAT-EGPPAQ are valid instruments to identify “inactive” patients that should receive advice on PA.     

Location of persisting mycobacteria in a Guinea pig model of tuberculosis revealed by r207910

The lengthy chemotherapy of tuberculosis reflects the ability of a small subpopulation of Mycobacterium tuberculosis bacteria to persist in infected individuals. To date, the exact location of these persisting bacteria is not known. Lung lesions in guinea pigs infected with M. tuberculosis have striking similarities, such as necrosis, mineralization, and hypoxia, to natural infections in humans. Guinea pigs develop necrotic primary lesions after aerosol infection that differ in their morphology compared to secondary lesions resulting from hematogenous dissemination. In infected guinea pigs conventional therapy for tuberculosis during 6 weeks reduced the bacterial load by 1.7 logs in the lungs and, although this completely reversed lung inflammation associated with secondary lesions, the primary granulomas remained largely unaffected. Treatment of animals with the experimental drug R207910 (TMC207) for 6 weeks was highly effective with almost complete eradication of the bacteria throughout both the primary and the secondary lesions. Most importantly, the few remnants of acid-fast bacilli remaining after R207910 treatment were to be found extracellular, in a microenvironment of residual primary lesion necrosis with incomplete dystrophic calcification. This zone of the primary granuloma is hypoxic and is morphologically similar to what has been described for human lung lesions. These results show that this acellular rim may, therefore, be a primary location of persisting bacilli withstanding drug treatment.     

Influence of physical inactivity in psychophysiolocigal state of breast cancer survivors

Physical inactivity has been postulated as mediator of the relationship between cancer‐related symptoms and psychoneurobiological alterations. The aim of the study was to evaluate the influence of physical inactivity level on mood state, fitness level as well as on salivary markers of the hypothalamic–pituitary–adrenal axis (cortisol) and the SNS (α‐amylase) in breast cancer survivors. One hundred and eight breast cancer survivors (stages I–IIIa) participated in this cross‐sectional study. Data were gathered on the following: Minnesota Leisure Time Physical Activity Questionnaire, profile of mood state, 6‐min walk test, force handgrip, blood pressure, salivary cortisol concentration and salivary α‐amylase activity. For our analysis, two groups were formed based on physical activity level measured as energy expenditure during diary leisure activities of the participants at the moment of the study, a physical inactivity level group (<3 METs × h/week) and an adequate physical activity level group (>3 METs × h/week). Fitness level was significantly higher in the active than the inactive group, while anger, fatigue, depression, confusion, mood disturbance, diastolic blood pressure and salivary α‐amylase activity were significantly greater in the inactive than the active group. These results suggest that physical inactivity induces a worse psychoneurobiological state in inactive than in active breast cancer survivors.