Relació entre el risc de patir una lesió de trànsit i les malalties del subjecte conductor, analitzades des de l’àmbit de l’Atenció Primària

INTRODUCCIÓ: Lesions per trànsit (LT), evitables i problema de salut publica. Àmbit d’atenció primària (AP) lloc on investigar i actuar. Possible relació entre malalties cròniques del conductor i LT. MÈTODES: estudi descriptiu, transversal i multicèntric, conductors amb història clínica, Barcelona, 2009. 1900 enquestes personals, mostreig consecutiu. Variables sociodemogràfiques, sobre conducció i salut. RESULTATS: 57,3% homes, 8,5% conductors professionals, 12,5% havia patit una LT, 6% va precisar ajuda mèdica. 51,5% malalts crònics, predominant malalties cardiovasculars i limitacions visuals. CONCLUSIONS: No van trobar relacions significatives entre malalties cròniques i LT. Limitacions:imperfecció dels sistemes de registre, fiabilitat feble de dades autodeclarades, presencia de possibles factors de confusió.

Monitoring the decreasing trend of testicular cancer mortality in Spain during 2005-2019 through a Bayesian approach

Purpose : To assess time trends of testicular cancer (TC) mortality in Spain for period 1985-2019 for age groups 15-74 years old through a Bayesian age-period-cohort (APC) analysis. Methods: A Bayesian age-drift model has been fitted to describe trends. Projections for 2005-2019 have been calculated by means of an autoregressive APC model. Prior precision for these parameters has been selected through evaluation of an adaptive precision parameter and 95% credible intervals (95% CRI) have been obtained for each model parameter. Results: A decrease of -2.41% (95% CRI: -3.65%; -1.13%) per year has been found for TC mortality rates in age groups 15-74 during 1985-2004, whereas mortality showed a lower annual decrease when data was restricted to age groups 15-54 (-1.18%; 95% CRI: -2.60%; -0.31%). During 2005-2019 is expected a decrease of TC mortality of 2.30% per year for men younger than 35, whereas a leveling off for TC mortality rates is expected for men older than 35. Conclusions: A Bayesian approach should be recommended to describe and project time trends for those diseases with low number of cases. Through this model it has been assessed that management of TC and advances in therapy led to decreasing trend of TC mortality during the period 1985-2004, whereas a leveling off for these trends can be considered during 2005-2019 among men older than 35.

Monitoring the decreasing trend of testicular cancer mortality in Spain during 2005-2019 through a Bayesian approach

Purpose : To assess time trends of testicular cancer (TC) mortality in Spain for period 1985-2019 for age groups 15-74 years old through a Bayesian age-period-cohort (APC) analysis. Methods: A Bayesian age-drift model has been fitted to describe trends. Projections for 2005-2019 have been calculated by means of an autoregressive APC model. Prior precision for these parameters has been selected through evaluation of an adaptive precision parameter and 95% credible intervals (95% CRI) have been obtained for each model parameter. Results: A decrease of -2.41% (95% CRI: -3.65%; -1.13%) per year has been found for TC mortality rates in age groups 15-74 during 1985-2004, whereas mortality showed a lower annual decrease when data was restricted to age groups 15-54 (-1.18%; 95% CRI: -2.60%; -0.31%). During 2005-2019 is expected a decrease of TC mortality of 2.30% per year for men younger than 35, whereas a leveling off for TC mortality rates is expected for men older than 35. Conclusions: A Bayesian approach should be recommended to describe and project time trends for those diseases with low number of cases. Through this model it has been assessed that management of TC and advances in therapy led to decreasing trend of TC mortality during the period 1985-2004, whereas a leveling off for these trends can be considered during 2005-2019 among men older than 35.

Monitoring the decreasing trend of testicular cancer mortality in Spain during 2005-2019 through a Bayesian approach

Purpose : To assess time trends of testicular cancer (TC) mortality in Spain for period 1985-2019 for age groups 15-74 years old through a Bayesian age-period-cohort (APC) analysis. Methods: A Bayesian age-drift model has been fitted to describe trends. Projections for 2005-2019 have been calculated by means of an autoregressive APC model. Prior precision for these parameters has been selected through evaluation of an adaptive precision parameter and 95% credible intervals (95% CRI) have been obtained for each model parameter. Results: A decrease of -2.41% (95% CRI: -3.65%; -1.13%) per year has been found for TC mortality rates in age groups 15-74 during 1985-2004, whereas mortality showed a lower annual decrease when data was restricted to age groups 15-54 (-1.18%; 95% CRI: -2.60%; -0.31%). During 2005-2019 is expected a decrease of TC mortality of 2.30% per year for men younger than 35, whereas a leveling off for TC mortality rates is expected for men older than 35. Conclusions: A Bayesian approach should be recommended to describe and project time trends for those diseases with low number of cases. Through this model it has been assessed that management of TC and advances in therapy led to decreasing trend of TC mortality during the period 1985-2004, whereas a leveling off for these trends can be considered during 2005-2019 among men older than 35.

Monitoring the decreasing trend of testicular cancer mortality in Spain during 2005-2019 through a Bayesian approach

Purpose : To assess time trends of testicular cancer (TC) mortality in Spain for period 1985-2019 for age groups 15-74 years old through a Bayesian age-period-cohort (APC) analysis. Methods: A Bayesian age-drift model has been fitted to describe trends. Projections for 2005-2019 have been calculated by means of an autoregressive APC model. Prior precision for these parameters has been selected through evaluation of an adaptive precision parameter and 95% credible intervals (95% CRI) have been obtained for each model parameter. Results: A decrease of -2.41% (95% CRI: -3.65%; -1.13%) per year has been found for TC mortality rates in age groups 15-74 during 1985-2004, whereas mortality showed a lower annual decrease when data was restricted to age groups 15-54 (-1.18%; 95% CRI: -2.60%; -0.31%). During 2005-2019 is expected a decrease of TC mortality of 2.30% per year for men younger than 35, whereas a leveling off for TC mortality rates is expected for men older than 35. Conclusions: A Bayesian approach should be recommended to describe and project time trends for those diseases with low number of cases. Through this model it has been assessed that management of TC and advances in therapy led to decreasing trend of TC mortality during the period 1985-2004, whereas a leveling off for these trends can be considered during 2005-2019 among men older than 35.

Implicacions diagnòstiques del strem-1 (soluble triggering receptor expressed on myeloid cells) en malalts amb síndrom del distress respiratori agut (sdra) i patologia abdominal. estudi preliminar

Els pacients amb patologia abdominal aguda poden desenvolupar una insuficiència respiratòria secundària a la resposta inflamatòria generada o a una pneumònia nosocomial. El mesurament del “soluble *triggering receptor expressed on myeloid cells 1” (sTREM-1) en líquid alveolar, pleural, sinovial o cefalorraquidi ha demostrat la seva utilitat en el diagnòstic d'infecció. Es va determinar el sTREM-1 alveolar i peritoneal en pacients amb quadre abdominal agut més síndrom de distress respiratori agut (SDRA). Es va concloure que el sTREM-1 és útil per diagnosticar infeccions abdominals i pulmonars en aquests pacients i que la relació sTREM-1 alveolar/peritoneal podria ser útil per determinar el focus infecciós.

Milloria de l’aplicabilitat i la fiabilitat diagnòstica de l’elastografia per avaluar la rigidesa hepàtica en les malalties hepàtiques cròniques

L’elastografia de transició (ET) és un mètode no invasiu per avaluar la fibrosi hepàtica. El major problema és la baixa aplicabilitat (20% de resultats inadequats), relacionats amb obesitat del pacient i baixa experiència de l’explorador. En aquest estudi es planteja augmentar aplicabilitat i fiabilitat diagnòstica. L’estudi va incloure 868 registres. Amb una segona avaluació per personal experimentat i una tercera amb material específic es van obtenir registres adequats en la majoria dels prèviament inadequats. La fiabilitat diagnòstica va augmentar a la segona i tercera exploracions. Conclusió: La revaluació dels registres inadequats permet augmentar aplicabilitat i fiabilitat diagnòstica de la tècnica.

Determinación del volumen gástrico residual: en busca de la mejor evidencia

Introducción: La determinación del volumen gástrico residual es una práctica frecuente en pacientes críticos, pero hay falta de consenso acerca de la conveniencia de reintroducir o desechar el contenido gástrico aspirado (CGA). Objetivo: Determinar el grado de evidencia científica acerca de la eficacia de 2 intervenciones-reintroducción/rechazo- del CGA en pacientes críticos. Material y métodos: Revisión sistemática de la evidencia disponible acerca de la conveniencia de reintroducir o desechar el CGA. Proceso: a) establecimiento de los criterios de inclusión/exclusión; b) determinación de la estrategia de búsqueda (palabras clave e itinerarios); c) vaciado de las bases de datos: MEDLINE, CINAHL, CUIDEN, IME, SCIELO y COCHRANE. Búsqueda por método indirecto y vaciado manual de índices; d) lectura crítica independiente y contrastada, utilizando la plantilla CASPe, y e) contraste de resultados del análisis crítico. Resultados: Los itinerarios de búsqueda generan más de 800 referencias que, una vez depuradas, permiten seleccionar 54. Después de su lectura, sólo 4 se centran realmente en cuestiones relacionadas con la reintroducción/rechazo del CGA: 2 revisiones, un estudio observacional y un ECA de muestra pequeña. La heterogeneidad de estos estudios no permite emplear técnicas de metaanálisis. Por ello se analizan por separado los resultados de cada estudio. Mediante este proceso se obtiene un resultado final que demuestra un bajo grado de evidencia científica. Conclusiones: Hay escasa evidencia científica acerca de la conveniencia, la seguridad y los beneficios de ambas intervenciones. Es difícil establecer un protocolo de cuidados, por lo que se planteó realizar un estudio experimental para establecer las indicaciones y contraindicaciones de ambas intervenciones.

Revisión de conocimientos sobre el fracaso renal agudo en el contexto del paciente crítico

El fracaso renal agudo afecta entre un 1 y un 25% de los pacientes ingresados en unidades de cuidados intensivos, cifras que varían según la población y los criterios estudiados. Las complicaciones derivadas del fracaso renal agudo (hipervolemia, acidosis metabólica, hiperpotasemia, hemorragias) se tratan pero la mortalidad sigue siendo elevada a pesar de los avances tecnológicos de los últimos años ya que, habitualmente, el fracaso renal agudo está asociado a sepsis, insuficiencia respiratoria, heridas graves, complicaciones quirúrgicas o coagulopatías de consumo. El rango de mortalidad va desde un 30 a un 90%. Aunque no disponemos de una definición universalmente aceptada, la clasificación RIFLE aporta una herramienta operativa tanto para definir el grado de fracaso renal agudo como para homogeneizar el inicio de las técnicas de depuración extrarrenal y evaluar los resultados obtenidos. En consecuencia, las enfermeras que trabajan en una unidad de cuidados intensivos deben estar familiarizadas con esta afección, con su tratamiento (farmacológico o sustitutivo) y con la prevención de las posibles complicaciones. De igual manera han de ser capaces de detectar las manifestaciones de dependencia de cada una de las necesidades básicas e identificar los problemas de colaboración para conseguir un plan de cuidados individualizado.

Factors pronòstics de la hepatitis alcohòlica greu

La hepatitis alcohòlica (HAA) greu s’associa a una mortalitat precoç elevada. En els darrers anys s’han identificat nombrosos marcadors clínics i analítics que permeten valorar el pronòstic de la malaltia i en base als mateixos s’han elaborat diversos índexs pronòstics. L’objectiu del treball va ser identificar els factors pronòstics associats a la mortalitat de l’HAA i avaluar els diferents índexs pronòstics. Així, es varen estudiar de forma retrospectiva 66 episodis d’HAA greu que van ingressar a l’Hospital Germans Trias i Pujol de Badalona des de gener del 2000 fins al desembre del 2008.

Conditional BDNF release under pathological conditions improves Huntington's disease pathology by delaying neuronal dysfunction

Background Brain-Derived Neurotrophic Factor (BDNF) is the main candidate for neuroprotective therapy for Huntington's disease (HD), but its conditional administration is one of its most challenging problems. Results Here we used transgenic mice that over-express BDNF under the control of the Glial Fibrillary Acidic Protein (GFAP) promoter (pGFAP-BDNF mice) to test whether up-regulation and release of BDNF, dependent on astrogliosis, could be protective in HD. Thus, we cross-mated pGFAP-BDNF mice with R6/2 mice to generate a double-mutant mouse with mutant huntingtin protein and with a conditional over-expression of BDNF, only under pathological conditions. In these R6/2:pGFAP-BDNF animals, the decrease in striatal BDNF levels induced by mutant huntingtin was prevented in comparison to R6/2 animals at 12 weeks of age. The recovery of the neurotrophin levels in R6/2:pGFAP-BDNF mice correlated with an improvement in several motor coordination tasks and with a significant delay in anxiety and clasping alterations. Therefore, we next examined a possible improvement in cortico-striatal connectivity in R62:pGFAP-BDNF mice. Interestingly, we found that the over-expression of BDNF prevented the decrease of cortico-striatal presynaptic (VGLUT1) and postsynaptic (PSD-95) markers in the R6/2:pGFAP-BDNF striatum. Electrophysiological studies also showed that basal synaptic transmission and synaptic fatigue both improved in R6/2:pGAP-BDNF mice. Conclusions These results indicate that the conditional administration of BDNF under the GFAP promoter could become a therapeutic strategy for HD due to its positive effects on synaptic plasticity.

Obesity and the incidence of chronic diseases: a seemingly unrelated probit approach

Western societies can reduce avoidable mortality and morbidity by better understanding the relationship between obesity and chronic disease. This paper examines the joint determinants of obesity and of heart disease, diabetes, hypertension, and elevated cholesterol. It analyzes a broadly representative Spanish dataset, the 1999 Survey on Disabilities, Impairments and Health Status, using a health production theoretical framework together with a seemingly unrelated probit model approach that controls for unobserved heterogeneity and endogeneity. Its findings provide suggestive evidence of a positive and significant, although specification-dependent, association between obesity and the prevalence of chronic illness

Genetic evidence of heterogeneity in intrahepatic cholestasis of pregnancy

Background and aims: The aim of this study was to investigate the genetic aetiology of intrahepatic cholestasis of pregnancy (ICP) and the impact of known cholestasis genes (BSEP, FIC1, and MDR3) on the development of this disease. Patients and methods: Sixty nine Finnish ICP patients were prospectively interviewed for a family history of ICP, and clinical features were compared in patients with familial ICP (patients with a positive family history, n=11) and sporadic patients (patients with no known family history of ICP, n=58). For molecular genetic analysis, 16 individuals from two independently ascertained Finnish ICP families were genotyped for the flanking markers for BSEP, FIC1, and MDR3. Results: The pedigree structures in 16% (11/69) of patients suggested dominant inheritance. Patients with familial ICP had higher serum aminotransferase levels and a higher recurrence risk (92% v 40%). Both segregation of haplotypes and multipoint linkage analysis excluded BSEP, FIC1, and MDR3 genes in the studied pedigrees. Additionally, the MDR3 gene, previously shown to harbour mutations in ICP patients, was negative for mutations when sequenced in four affected individuals from the two families. Conclusions: These results support the hypothesis that the aetiology of ICP is heterogeneous and that ICP is due to a genetic predisposition in a proportion of patients. The results of molecular genetic analysis further suggest that the previously identified three cholestasis genes are not likely to be implicated in these Finnish ICP families with dominant inheritance.

Pure sensory neuropathy in patients with primary Sjogren's syndrome: clinical, immunological and electromyographic findings

A pure sensory neuropathy caused by lymphocytic infiltration of the dorsal root ganglia has been reported in a few patients with Sjögren's syndrome. The clinical, immunological, and electromyographic findings of five patients with this type of neuropathy and primary Sjögren's syndrome were reviewed. Typical clinical indications were the presence of a chronic asymmetrical sensory deficit, initial disease in the hands with a predominant loss of the vibratory and joint position senses, and an association with Adie's pupil syndrome or trigeminal sensory neuropathy. The simultaneous impairment of the central and peripheral evoked cortical potentials suggested that there was a lesion of the neuronal cell body. The neuropathy preceded the diagnosis of Sjögren's syndrome in four patients. Four patients were positive for Ro antibodies, but systemic vasculitis or malignancy was not found after a mean follow up of six years. These findings indicate that in patients with a sensory neuropathy the diagnosis of Sjögren's syndrome has to be considered, even if the patient denies the presence of sicca symptoms, and that appropriate tests must be carried out.

Neck pounding during sinus rhythm: a new clinical manifestation of dual atrioventricular nodal pathways

Objective To determine the clinical and electrophysiological characteristics of patients with paroxysmal palpitations and neck pounding during sinus rhythm. Methods Clinical, electrocardiographic, and electrophysiological characteristics of six patients with paroxysmal palpitations and neck pounding during sinus rhythm were studied in basal conditions and when symptomatic. Response to treatment was observed. Results Baseline ECGs were normal (four patients) or had first degree atrioventricular block with intermittent PR shortening. During symptoms, narrow QRS rhythms were seen without visible P waves (three patients) or with P waves partially hidden in the QRS complex (three patients). Dual atrioventricular nodal pathways were found in all five patients who had electrophysiological studies. In these patients the slow pathway conduction time was long enough (mean (SD), 425 (121)¿ms) for ventricular activation after slow pathway conduction during sinus rhythm to coincide with the next atrial depolarisation, causing neck pounding during exercise (four patients) or at rest (two patients). Tachycardia was not induced in any patient. Medical treatment aggravated symptoms in three patients. A pacemaker was successfully used in two. Conclusions Neck pounding during sinus rhythm is a clinical manifestation of dual atrioventricular nodal pathways. Medical treatment may aggravate symptoms but a pacemaker may offer definitive relief.