Garcia-Domingo M.I.,Hospital Universitari Mutua Terrassa |
Pares D.,Hospital Del Mar |
Espin-Basany E.,Hospital de la Vall DHebron |
Biondo S.,Hospital de Bellvitge |
And 3 more authors.
Archives of Surgery
Objectives: To assess the prevalence of surgical site infection (SSI) after elective operations for colon and rectal cancer after the application of evidence-based preventive measures and to identify risk factors for SSI. Design: Prospective, observational, multicenter. Setting: Tertiary and community public hospitals in Catalonia, Spain. Patients: Consecutive patients undergoing elective surgical resections for colon and rectal cancer during a 9-month period. Main Outcome Measures: The prevalence of SSI within 30 days after the operations and risk factors for SSI. Results: Data from 611 patients were documented: 383 patients underwent operations for colon cancer and 228 underwent operations for rectal cancer. Surgical site infection was observed in 89 (23.2%) colon cancer patients (superficial, 12.8%; deep, 2.1%; and organ/space, 8.4%) and in 63 (27.6%) rectal cancer patients (superficial, 13.6%; deep, 5.7%; and organ/space, 8.3%). For colon procedures, the following independent predictive factors were identified: for incisional SSI, open procedure vs laparoscopy; for organ/space SSI, hyperglycemia at 48 hours postoperatively (serum glucose level, >200 mg/dL), ostomy, and National Nosocomial Infection System index of 1 ormore. In rectal procedures, no risk factors were identified for incisional SSI; hyperglycemia at 48 hours postoperatively (serum glucose level,>200 mg/dL) and temperature lower than 36°C at the time of surgical incision were associated with organ/space SSI. Conclusion: The prevalence of SSI in elective colon and rectal operations remains high despite the application of evidence-based preventive measures. ©2011 American Medical Association. All rights reserved. Source
Oriol A.,Institute Catala dOncologia |
Vives S.,Institute Catala dOncologia |
Hernandez-Rivas J.-M.,Hospital Clinico Universitario |
Tormo M.,Hospital Clinico Universitario |
And 16 more authors.
Background About one half of adults with acute lymphoblastic leukemia are not cured of the disease and ultimately die. The objective of this study was to explore the factors influencing the outcome of adult patients with relapsed acute lymphoblastic leukemia. Design and Methods We analyzed the characteristics, the outcome and the prognostic factors for survival after first relapse in a series of 263 adult patients with acute lymphoblastic leukemia (excluding those with mature B-cell acute lymphoblastic leukemia) prospectively enrolled in four consecutive risk-adapted PETHEMA trials. Results The median overall survival after relapse was 4.5 months (95% CI, 4-5 months) with a 5-year overall survival of 10% (95% CI, 8%-12%); 45% of patients receiving intensive second-line treatment achieved a second complete remission and 22% (95% CI, 14%-30%) of them remained disease free at 5 years. Factors predicting a good outcome after rescue therapy were age less than 30 years (2-year overall survival of 21% versus 10% for those over 30 years old; P<0.022) and a first remission lasting more than 2 years (2-year overall survival of 36% versus 17% among those with a shorter first remission; P<0.001). Patients under 30 years old whose first complete remission lasted longer than 2 years had a 5-year overall survival of 38% (95% CI, 23%-53%) and a 5-year disease-free survival of 53% (95% CI, 34%-72%). Conclusions The prognosis of adult patients with acute lymphoblastic leukemia who relapse is poor. Those aged less than 30 years with a first complete remission lasting longer than 2 years have reasonable possibilities of becoming long-term survivors while patients over this age or those who relapse early cannot be successfully rescued using the therapies currently available. © 2010 Ferrata Storti Foundation. Source
Martorell L.,Molecular Genetics Section |
Tondo M.,Molecular Genetics Section |
Garcia-Fructuoso F.,CIMA Clinic |
Naudo M.,Molecular Genetics Section |
And 4 more authors.
Fragile X mental retardation 1 (FMR1) permutation carriers, who are at risk of having children with fragile X Syndrome, were initially considered as clinically unaffected. However, recent clinical and molecular studies have shifted this point of view. The incidence of premutation in the general population is substantial. Apart from the welldocumented fragile X-associated tremor-ataxia and fragile X premature ovarian insufficiency, there is a broad constellation of symptoms including depression, anxiety, muscle pain, autoimmune and thyroid disease, chronic fatigue, and fibromyalgia that has been described, particularly in females with the premutation (55-200 repeats). Fibromyalgia (FM) is the most common cause of widespread pain and comprises a heterogeneous group of patients, affecting 2-3% of the general population. We analyzed the FMR1 gene in a cohort of females diagnosed with fibromyalgia in order to assess the incidence of premutated alleles. CGG repeat size was determined in 353 females suffering from FM and results were compared with a control group. Four permutated carriers in the FM group were detected. The observed incidence is higher than that described for a normal female population (1/88 vs 1/250). The early detection of permutation carriers for the FMR1 gene among individuals diagnosed with fibromyalgia is important and would be helpful in correct genetic counseling of patients and their families, who may be at risk of having children with fragile X syndrome, the most common known cause of inherited intellectual disability and autism. Our data should be cautiously interpreted based on just this study; nevertheless, screening for the FMR1 gene in FM patients at least with presentations suggestive of FMR1 gene-related disease seems recommendable. © Clinical Rheumatology 2012. Source
Nomdedeu J.,Hosptial de la Santa Creu i Sant Pau |
Hoyos M.,Hosptial de la Santa Creu i Sant Pau |
Carricondo M.,Hosptial de la Santa Creu i Sant Pau |
Esteve J.,Hospital Clinic |
And 10 more authors.
The study of genetic lesions in AML cells is helpful to define the prognosis of patients with this disease. This study analyzed the frequency and clinical impact of recently described gene alterations, isocitrate dehydrogenase 1 (IDH1) and isocitrate dehydrogenase 2 (IDH2) mutations, in a series of homogeneously treated patients with primary (de novo) AML. Two-hundred and seventy-five patients enrolled in the CETLAM 2003 protocol were analyzed. IDH1 and IDH2 mutations were investigated by well-established melting curve-analysis and direct sequencing (R140 IDH2 mutations). To establish the percentage of the mutated allele a pyrosequencing method was used. Patients were also studied for NPM, FLT3, MLL, CEBPA, TET2 and WT1 mutations. IDH1 or IDH2 mutations were identified in 23.3% AML cases and in 22.5% of those with a normal karyotype. In this latter group, mutations were associated with short overall survival. This adverse effect was even more evident in patients with the NPM or CEBPA mutated/FLT3 wt genotype. In all the cases analyzed, the normal allele was detected, suggesting that both mutations act as dominant oncogenes. No adverse clinical impact was observed in cases with TET2 mutations. IDH1 and IDH2 mutations are common genetic alterations in normal karyotype AML. Favourable genotype NPM or CEBPA mutated/FLT3 wt can be further categorized according to the IDH1 and IDH2 mutational status. © 2012 Elsevier Ltd. Source
Nutrition status on pediatric admissions in Spanish hospitals; DHOSPE study [Evaluación del estado nutricional de niños ingresados en el hospital en España; estudio DHOSPE (Desnutrición Hospitalaria en el Paciente Pediátrico en España)]
Moreno Villares J.M.,Hospital Universitario 12 Of Octubre |
Varea Calderon V.,Vicente Varea Calderon |
Bousono Garcia C.,Hospital Central de Oviedo |
Lama More R.,Hospital Universitario La Paz |
And 2 more authors.
Malnutrition among hospitalized patients has clinical implications and is associated with adverse outcomes: depression of the immune system, impaired wound healing, muscle wasting, longer length of stay, higher costs and increased mortality. Although the rate of malnutrition in hospitalized children varies in different studies, it seems to be lower than in adult population. Nevertheless, this is a population that has a higher risk of developing malnutrition during hospital stay. There is a need to find the most suitable nutrition screening tool for pediatric patients. Aim: As a first step, we have performed a nationwide study on the prevalence of malnutrition on admission, in order to further evaluate the results of employing a screening tool (STAMP). Material & methods: The study is a multicenter, transversal study performed in 32 Spanish hospital between June and September 2011 in patients under 17 admitted to a the hospital longer than 48 hours. Weight, height and STAMP questionnaire were done on admission and repeated at day 7, 14 or at discharge. Nutritional status was classified according to Waterlow index for height and for weight. The study was approved by the Ethics Research Committee in each hospital and informed consent obtained prior to be included in the study. Results: 991 patients were finally included. Mean age was 5.0 years (SD: 4.6), distributed uniformly among ages. Moderate to severe malnutrition was present in 7.8%, and overweight-obesity in 37.9%. We found a significant correlation between nutritional status and type of disease. There were no correlationship with age, or with plasmatic albumin levels. Comments: This is the first nationwide study on the prevalence of malnutrition on admission in pediatric patients. Malnutrition in pediatric patients was present in around 8% of admissions, slightly inferior to other series. The most likely explanation is that the study included patients from different types of hospitals, mimicking real life conditions. Source