Diarrea crónica refractaria y malabsorción secundaria a hipogammaglobulinemia común variable, infestación crónica por giardia lambila y gastrectomía total por adenocarcinoma gástrico: un manejo nutricional complejo

Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastrointestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis and common variable inmunodeficiency) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption.

Total antioxidant capacity of plasma in asymptomatic carrier state of Neisseria meningitidis

Reduction of the antioxidant capacity of plasma has been linked with the impairment of an effective immune response and so we hypothesized that the carriage rate of Neisseria meningitidis in asymptomatic subjects might correlate with the levels of antioxidants in plasma. To this end we took pharyngeal swabs from 339 children in Marquesado Basic Health Zone, Granada, Spain and in addition determined the total antioxidant capacity (TAC) in plasma samples from these subjects. The overall prevalence of N. meningitidis carriage was 5.9% (mean age 7.1 years) with rates of 10.3% in children aged 3 < or =years, 3.9% between 4 and 7 years and 2.4% in older subjects. Plasma TAC for the < or =3-year-olds was 0.13 for carriers and 1.10 for non-carrier controls (P=0.04), 0.13 for carriers aged 4-7 years (controls 0.63) and 0.28 for carriers aged >7 years (controls 0.52). We analysed the association between TAC in plasma (<0.37 - 2 S.D.) and the carrier state of N. meningitidis. In the carrier state, the odds ratio for this association (TAC in plasma <0.25) was 8.44 (95% CI 1.5-48.9). These findings may suggest a reduced immune response in the host favourable to nasopharyngeal persistence of meningococci.

Clinicopathologic correlations of renal microthrombosis and inflammatory markers in proliferative lupus nephritis.

INTRODUCTION Microthrombosis is often observed in lupus nephritis (LN) lesions, but its clinical significance is unknown. We evaluated the clinicopathologic correlations of renal microthrombosis and inflammatory markers in LN. METHODS Kidney biopsies from 58 patients with systemic lupus erythematosus (SLE) proliferative nephritis were analyzed with immunohistochemistry (IHC) for intravascular platelet aggregates (CD61), macrophagic infiltration (CD68), and activated complement deposition (C4d). Clinical data at the time of kidney biopsy and follow-up were analyzed with regard to pathologic IHC data. RESULTS Microthrombosis was present in 52% of the tissues. It was significantly more prevalent in patients with antiphospholipid antibodies (aPLs) (62% versus 42%). The presence of microthrombosis significantly correlated with higher macrophagic infiltration. Macrophagic infiltration but not microthrombosis was significantly correlated with C4d deposition. Only macrophagic infiltration showed a correlation with SLE and renal activity (proteinuria and active sediment), whereas neither the presence of CD61+ microthrombi nor the extent of C4d deposition correlated with LN severity or outcome. CONCLUSIONS Microthrombosis is associated with higher macrophagic infiltration in LN but does not seem to increase independently the severity of renal damage. Macrophagic infiltration was the best marker of SLE and renal activity in this LN series.

Calidad microbiológica de las aguas de baño del embalse Conde del Guadalhorce, de Málaga (España), 2000-2005.

Background. Determine the presence and evolution of indicators microorganisms of water pollution in “Conde del Guadalhorce” reservoir, Málaga city, Spain. A second objective was to analyze pollution degree and evaluate the sanitary quality of bathing water and compliance with European Directive 76/160/CE. Method. A total of 120 water samples were collected in two bathing freshwater sites during May to September sampling period between 2000 to 2005, and the numbers of total coliforms (CT), faecal coliforms (CF) and faecal streptococci (EF) were enumerated using the membrane filtration method. We used the log-normal distribution method and calculate the logarithmic means, percentile points, ratios CF:EF, ANOVA and Pearson correlations. Results. Only two samples overcome CF limit values at Camping sampling station during 2000 year. Ratios CF:EF values were higher (> 4) during 2000 to 2002, and lower (< 0,7) during 2003 to 2005. Significant differences (ANOVA F = 3,41, ∝ < 0,01) was only observed with EF during evaluated period. There was no significant difference between concentration means at bathing water sites (ANOVA, F = 3,395, ∝ < 0,01). The counts of CT and CF were significantly correlated in Kiosko water samples, while in Camping water, significant correlation (t = 0,632, p < 0,05) was only observed with EF at the Camping station during 2000, 2003 and 2005 years. Conclusions. “Conde del Guadalhorce” reservoir showed hygienic conditions for safety bathing. Globally, water bathing quality is good. CT, CF y EF indicators were agreed with UE Directive during 2000- 2005, with exception CF at Camping station in 2000 year. CT y CF concentrations at Camping were frecuently higher than Kiosko, it could be caused to swimmers abundance and recreational activities. There was a trend towards rising EF, it could be caused to faecal pollution source of animal origin, needed to research it.

Trends in yearly prevalence of third-generation cephalosporin and fluoroquinolone resistant Enterobacteriaceae infections and antimicrobial use in Spanish hospitals, Spain, 1999 to 2010.

Escherichia coli, Klebsiella pneumoniae, and Enterobacter spp. are a major cause of infections in hospitalised patients. The aim of our study was to evaluate rates and trends of resistance to third-generation cephalosporins and fluoroquinolones in infected patients, the trends in use for these antimicrobials, and to assess the potential correlation between both trends. The database of national point prevalence study series of infections and antimicrobial use among patients hospitalised in Spain over the period from 1999 to 2010 was analysed. On average 265 hospitals and 60,000 patients were surveyed per year yielding a total of 19,801 E. coli, 3,004 K. pneumoniae and 3,205 Enterobacter isolates. During the twelve years period, we observed significant increases for the use of fluoroquinolones (5.8%-10.2%, p<0.001), but not for third-generation cephalosporins (6.4%-5.9%, p=NS). Resistance to third-generation cephalosporins increased significantly for E. coli (5%-15%, p<0.01) and for K. pneumoniae infections (4%-21%, p<0.01) but not for Enterobacter spp. (24%). Resistance to fluoroquinolones increased significantly for E. coli (16%30%, p<0.01), for K. pneumoniae (5%-22%, p<0.01), and for Enterobacter spp. (6%-15%, p<0.01). We found strong correlations between the rate of fluoroquinolone use and the resistance to fluoroquinolones, third-generation cephalosporins, or co-resistance to both, for E. coli (R=0.97, p<0.01, R=0.94, p<0.01, and R=0.96, p<0.01, respectively), and for K. pneumoniae (R=0.92, p<0.01, R=0.91, p<0.01, and R=0.92, p<0.01, respectively). No correlation could be found between the use of third-generation cephalosporins and resistance to any of the latter antimicrobials. No significant correlations could be found for Enterobacter spp.. Knowledge of the trends in antimicrobial resistance and use of antimicrobials in the hospitalised population at the national level can help to develop prevention strategies.

Association between magnesium-deficient status and anthropometric and clinical-nutritional parameters in posmenopausal women.

Background: During menopause occurs weight gain and bone loss occurs due to the hormone decline during this period and other factors such as nutrition. Magnesium deficiency suggests a risk factor for obesity and osteoporosis. OBJECTIVE: To evaluate the clinical and nutritional magnesium status in a population of postmenopausal women, assessing intake and serum levels of magnesium in the study population and correlation with anthropometric parameters such as body mass index(BMI) and body fat, and biochemical parameters associated. SUBJECTS AND METHOD: The study involved 78 healthy women aged 44-76, with postmenopausal status, from the province of Grenade, Spain. The sample was divided into two age groups: group1, aged < 58, and group 2 aged >/= 58. Anthropometric parameters were recorded and nutritional intake was assessed by 72-hour recall, getting the RDAs through Nutriber(R) program. To assess the biochemical parameters was performed a blood sample was taken. Magnesium was analyzed by flame atomic absorption spectrophotometry (FAAS) in erythrocyte and plasma wet-mineralized samples. RESULTS: Our results show that 37.85% of the total subjects have an overweight status. Magnesium intake found in our population is insufficient in 36% of women,while plasma magnesium deficiency corresponds to 23% of the population and 72% of women have deficient levels of magnesium in erythrocyte. Positive correlations were found between magnesium intake and dietary intake of calcium, of phosphorus,and with prealbumin plasma levels, as well as with a lower waist / hip ratio Magnesium levels in erythrocyte were correlated with lower triglycerides and urea values. CONCLUSION: It is important to control and monitor the nutritional status of magnesium in postmenopausal women to prevent nutritional alterations and possible clinical and chronic degenerative diseases associated with magnesium deficiency and with menopause.

Development of a new tool for assessing health-related quality of life in patients with primary hyperparathyroidism.

BACKGROUND Several studies in recent years have evaluated Health Related Quality of Life (HRQoL) of patients with primary hyperparathyroidism (PHPT). No disease specific questionnaires are available to assess the impact of the disease. The aim of this research is to describe the development of a new disease specific Quality of Life (QoL) questionnaire for use specifically with PHPT patients. METHODS A conceptual model was developed describing the impact of the disease and its symptoms on QoL domains. A literature review was conducted to identify the most relevant domains. A focus group with experts was used to validate the domains; 24 patients were also interviewed to complement the information from the patient's perspective. A content analysis of the interviews was performed to identify items related with the impact of the disease, leading to PHPQoL-V.1 which was presented to a sample of 67 patients. Reliability was assessed by Cronbach's coefficient alpha and item-total score correlations. Validity was assessed by a factor analysis performed to determine the number of domains. Rasch analysis was carried out in order to refine the questionnaire items. RESULTS 259 items were extracted from the interviews that were subsequently reduced to 34 items. Cronbach's coefficient alpha was 0.92. The factor analysis extracted two domains (physical and emotional). After Rasch analysis the questionnaire PHPQoL-V.2 kept 16 items (9 physical and 7 emotional). The questionnaire was developed in a Spanish population and the final version was translated to English through translation and back-translation. CONCLUSION The first disease specific HRQoL questionnaire for PHPT patients (PHPQoL-16) has been developed. Validation studies designed to assess measurement properties of this tool are currently underway.

Adipose tissue concentrations of persistent organic pollutants and total cancer risk in an adult cohort from Southern Spain: preliminary data from year 9 of the follow-up.

There is an increasing trend in the incidence of cancer worldwide, and it has been accepted that environmental factors account for an important proportion of the global burden. The present paper reports preliminary findings on the influence of the historical exposure to a group of persistent organic pollutants on total cancer risk, at year 9 in the follow-up of a cohort from Southern Spain. A cohort of 368 participants (median age 51 years) was recruited in 2003. Their historical exposure was estimated by analyzing residues of persistent organic pollutants in adipose tissue. Estimation of cancer incidence was based on data from a population-based cancer registry. Statistical analyses were performed using multivariable Cox-regression models. In males, PCB 153 concentrations were positively associated with total cancer risk, with an adjusted hazard ratio (95% confidence interval) of 1.20 (1.01-1.41) for an increment of 100 ng/g lipid. Our preliminary findings suggest a potential relationship between the historical exposure to persistent organic pollutants and the risk of cancer in men. However, these results should be interpreted with caution and require verification during the future follow-up of this cohort.

Controversias en artroplastia total de rodilla

Total knee replacement (TKR) is an operation that has radically improved the quality of life of millions of people during the last decades. However, some technical details, concerning the surgical procedure, are still a matter of a strong debate. In this review of the literature, we have included the best evidence available of the last decade, related to TKR surgery like the use of tourniquet during operation, patellar resufacing, all-polyethilene tibial component, cemented or cementless fixation, mobile bearings, or posterior-stabilized versus cruciate-retaining prosthesis.

Estrategia de reducción de costes en la artroplastia total de rodilla

Aim: Assess the clinical utility of plain radiography in the first postoperative outpatient visit after total knee arthroplasty. Patients and Methods: 200 patients which underwent a total knee arthroplasty from January to May 2012 were analyzed retrospectively, they had two previous control radiographs at hospital discharge and two more at 4-6 weeks after surgery, which were compared, seeking for radiographics signs that would induce a therapeutic changes in the patient’s clinical course. Results: No radiographics signs were observed in the cases studied in the first postoperative visit one month after the surgery, consequently the patient’s treatment plan had no change. Discussion: Our results support those of other authors who have recognized the benefits of reducing the number of postoperative radiographs, improve the cost effectiveness of outpatients care and avoid an extra damage to the patient’s health. We believe that repeated use of serial radiographs in outpatient is simply a custom that has become law, to calm down the patient, and his surgeon, with no scientific evidence to support it use. Conclusions: Our results suggest that the plain AP and L radiographic projection at the first visit, one month later after a TKA, does not provide any clinic information, adds substantial cost to the heath-care system and unnecessary harms the patient.