DEP11 - Artículos de revista

Disruption of Radiological Surveillance Following a Global Health Crisis in Resected Lung Cancer

Thu, 01 Jan 2026 00:00:00 GMT

Objectives Radiological surveillance after curative-intent lung cancer resection is essential for early detection of recurrence and second primary tumors. Large-scale health emergencies can compromise oncologic follow-up. This study quantifies the impact of a health crisis on radiological surveillance in a national cohort of resected lung cancer patients. Methods A time-segmented observational cohort study was performed using data from the prospective, multicenter GEVATS registry. Surveillance density (CT/month) was evaluated across three predefined periods: pre-pandemic (baseline), state of alarm (maximum healthcare restrictions), and post-alarm (recovery phase). The population at risk was updated for each period. Subgroup analyses during the post-alarm phase assessed prioritization according to neoadjuvant treatment, pathological stage, age, and comorbidity. Results Among 2382 eligible patients, surveillance density declined progressively from the pre-pandemic period (0.157 ± 0.079 CT/month) to the state of alarm (0.098 ± 0.071 CT/month). In the post-alarm phase, density dropped sharply to 0.023 ± 0.018 CT/month (equivalent to one CT every 3.6 years), representing a 76.5% reduction compared with the state-of-alarm period (p < 0.001). This under-surveillance was generalized, with no significant differences by pathological stage (p = 0.084), age (p = 0.564), or comorbidity (p = 0.872). Only prior neoadjuvant therapy was associated with a slightly higher density (p = 0.040). Conclusions A prolonged health crisis resulted in a profound and persistent reduction in radiological surveillance after lung cancer resection, without evidence of risk-based prioritization. These findings support the need for contingency frameworks within clinical guidelines to preserve continuity of oncologic follow-up during future health emergencies.

Epidemiological Surveillance of Surgical Site Infection and its Risk Factors in Cardiac Surgery: A Prospective Cohort Study

Fri, 01 Jan 2016 00:00:00 GMT

Introduction and objectives: Surgical site infection in cardiac surgery is uncommon. The aim of the present study was to examine the incidence of this infection, compare it with national and international data, and evaluate its risk factors. Methods: This prospective cohort study included patients who underwent valve surgery or coronary revascularization during a 6-year period. The incidence of surgical site infection was studied. Associations between risk factors and infection were evaluated using odds ratios (OR). The infection rate was compared with Spanish and American data using the standardized infection ratio. Results: A total of 1557 patients were included. The overall cumulative incidence of infection was 4% (95% confidence interval [95%CI], 3.6%-5.6%), 3.6% in valve surgery (95%CI, 2.5%-4.7%) and 4.3% in coronary revascularization (95%CI, 2.3%-6.3%). Risk factors for surgical site infection in valve surgery were diabetes mellitus (OR=2.8; P<.05) and obesity (OR=6.6; P<.05). Risk factors for surgical site infection in coronary revascularization were diabetes mellitus (OR=2.9; P<.05) and reoperation for bleeding (OR=8.8; P<.05). Conclusions: Diabetes mellitus and obesity favor surgical site infection in valve surgery, whereas diabetes mellitus and reoperation for bleeding favor surgical site infection in coronary revascularization. Infection surveillance and control programs permit evaluation and comparison of infection rates in cardiac surgery.

Impact of ventilator-associated pneumonia on mortality and epidemiological features of patients with secondary peritonitis

Fri, 01 Jan 2016 00:00:00 GMT

Background: Despite the significant impact of nosocomial infections on the morbidity and mortality of patients staying in the intensive care unit (ICU), no study over the past 20 years has focused specifically on VAP following secondary peritonitis. The objective of the present study was to determine in-hospital mortality and epidemiological features attributed to ventilator-associated pneumonia (VAP) following secondary peritonitis. Methods: Prospective observational study involved 418 consecutive patients admitted in the ICU. Univariate and multivariate analyses were performed to identify risk factors associated with mortality and development of VAP. Results: The incidence of VAP following secondary peritonitis was 9.6 %. Risk factors associated with the development of VAP were hospital-acquired peritonitis, requiring >48 h of mechanical ventilation, and SOFA score. The onset of VAP was late in majority of patients. VAP was developed about 16.8 days after the initiation of the peritonitis. Etiological microorganisms responsible for the peritonitis were different than for VAP. The 90-day in-hospital mortality rate was 47.5 % of VAP patients. Independent factors associated with 30- to 90-day in-hospital mortality were VAP and SOFA. Conclusions: In light of the impact on morbidity and mortality in the ICU, more attention should be given to the concurrent features among VAP and secondary peritonitis.

New Method for the Automated Assessment of Corneal Nerve Tortuosity Using Confocal Microscopy Imaging

Sat, 01 Jan 2022 00:00:00 GMT

An automated tool for corneal nerve fiber tortuosity quantification from in vivo confocal microscopy (IVCM) is described and evaluated. The method is a multi-stage process based on the splitting of the corneal nerve fibers into individual segments, whose endpoints are an extreme or intersection of white pixels on a binarized image. Individual segment tortuosity is quantified in terms of the arc-chord ratio. Forty-three IVCM images from 43 laser-assisted in situ keratomileusis (LASIK) surgery patients were used for evaluation. Images from symptomatic dry eye disease (DED) post-LASIK patients, with (n = 16) and without (n = 7) ocular pain, and non-DED post-LASIK con- trols (n = 20) were assessed. The automated tortuosity measure was compared to a manual grading one, obtaining a moderate correlation (Spearman’s rank correlation coefficient = 0.49, p = 0.0008). The new tortuosity index was significantly higher in post-LASIK patients with ocular pain than in control patients (p = 0.001), while no significant differences were detected with manual measurement (p > 0.28). The tortuosity quantification was positively correlated with the ocular surface disease in- dex (OSDI) and a numeric rating scale (NRS) assessing pain (p = 0.0012 and p = 0.0051, respectively). The results show good performance of the proposed automated methodology for the evaluation of corneal nerve tortuosity.

A New Surgical Site Infection Risk Score: Infection Risk Index in Cardiac Surgery

Tue, 01 Jan 2019 00:00:00 GMT

Various scoring systems attempt to predict the risk of surgical site infection (SSI) after cardiac surgery, but their discrimination is limited. Our aim was to analyze all SSI risk factors in both coronary artery bypass graft (CABG) and valve replacement patients in order to create a new SSI risk score for such individuals. A priori prospective collected data on patients that underwent cardiac surgery (n = 2020) were analyzed following recommendations from the Reporting of studies Conducted using Observational Routinely collected health Data (RECORD) group. Study participants were divided into two periods: the training sample for defining the new tool (2010–2014, n = 1298), and the test sample for its validation (2015–2017, n = 722). In logistic regression, two preoperative variables were significantly associated with SSI (odds ratio (OR) and 95% confidence interval (CI)): diabetes, 3.3/2–5.7; and obesity, 4.5/2.2–9.3. The new score was constructed using a summation system for punctuation using integer numbers, that is, by assigning one point to the presence of either diabetes or obesity. The tool performed better in terms of assessing SSI risk in the test sample (area under the Receiver-Operating Characteristic curve (aROC) and 95% CI, 0.67/055–0.76) compared to the National Nosocomial Infections Surveillance (NNIS) risk index (0.61/0.50–0.71) and the Australian Clinical Risk Index (ACRI) (0.61/0.50–0.72). A new two-variable score to preoperative SSI risk stratification of cardiac surgery patients, named Infection Risk Index in Cardiac surgery (IRIC), which outperforms other classical scores, is now available to surgeons. Personalization of treatment for cardiac surgery patients is needed

Predicting cardiac surgery–associated acute kidney injury: The CRATE score

Fri, 01 Jan 2016 00:00:00 GMT

Purpose: Acute kidney injury (AKI) is a frequent complication after cardiac surgery and is associated with increased mortality. The aim was to design a nondialytic AKI score in patients with previously normal renal function undergoing cardiac surgery. Methods: Data were collected on 909 patients who underwent cardiac surgery with cardiopulmonary bypass be- tween 2012 and 2014. A total of 810 patients fulfilled the inclusion criteria. Patients were classified as having AKI based on the RIFLE criteria. Postoperative AKI occurred in 137 patients (16.9%). Several parameters were recorded preoperatively, intraoperatively, and at intensive care unit admission, looking for a univariate and multivariate asso- ciation with AKI risk. A second data set of 741 patients, from 2 different hospitals, was recorded as a validation cohort. Results: Four independent risk factors were included in the CRATE score: creatinine (odds ratio [OR], 9.66; 95% con- fidence interval [CI], 4.77-19.56; P b .001), EuroSCORE (OR, 1.40; CI, 1.29-1.52; P b .001), lactate (OR, 1.03; CI, 1.01- 1.04; P b .001), and cardiopulmonary bypass time (OR, 1.01; CI, 1.01-1.02; P b .001). The accuracy of the model was good, with an area under the curve of 0.89 (CI, 0.85-0.92). The CRATE score retained good discrimination in valida- tion cohort, with an area under the curve of 0.81 (95% CI, 0.78-0.85). Conclusions: CRATE score is an accurate and easy to calculate risk score that uses affordable and widely available var- iables in the routine care surgical patients.

Procalcitonin cannot be used as a biomarker of infection in heart surgery patients with acute kidney injury

Fri, 01 Jan 2016 00:00:00 GMT

Purpose: We intended to assess how acute kidney injuy impacts on procalcitonin levels in cardiac surgery pa- tients, with or without infection, and whether procalcitonin might be used as a biomarker of infection in acute kidney injuy. Material and Methods: A case–control study was designed which included patients that had had cardiac surgery between January 2011 and January 2015. Every patient developing severe sepsis or septic shock (n = 122; 5.5%) was enrolled. In addition, consecutive cardiac surgery patients during 2013 developing systemic inflammatory response syndrome (n = 318) were enrolled. Those recruited 440 patients were divided into 2 groups, according to renal function. Results: Median procalcitonin levels were significantly higher during the 10 postoperative days in the acute kid- ney injury patients. Regression analysis showed that postoperatory day, creatinine, white blood cells and infec- tion were significantly (P b .0001) associated to serum procalcitonin level. In patients with creatinine ≥2, median procalcitonin levels were similar in infected and non-infected patients. Only when creatinine was less than 2 mg/L, the median procalcitonin levels were significantly higher in patients with infection, as compared to those with no infection. Conclusions: In acute kidney injuy patients, high procalcitonin levels are a marker of acute kidney injuy but will not be able to differentiate infected from non-infected patients.

Mitochondrial DNA haplogroups are associated with severe sepsis and mortality in patients who underwent major surgery

Thu, 01 Jan 2015 00:00:00 GMT

Objective: To analyse whether mitochondrial DNA (mtDNA) haplogroups are associated with severe sepsis and mortality after major surgery. Methods: We performed a case-control study on 240 cardiac or abdominal surgery patients developing severe sepsis (Case-group) and 267 cardiac or abdominal surgery patients without severe sepsis and with systemic inflammatory response syndrome (SIRS, Control-group). Furthermore, a longitudinal substudy was performed for analysing the survival in septic patients. Only European white patients within the N macro-cluster were included. Results: Case-group underwent cardiac surgery had lower frequencies of cluster HV (p Z 0.005) and haplogroup H (p Z 0.005) and higher frequencies of cluster JT (p Z 0.028) than Control-group; but no significant differences were found for abdominal surgery. Besidesboth cluster HV and haplogroup H were associated with decreased odds of severe sepsis (adjusted odds ratio (aOR) Z 0.45 (95%CI Z 0.25; 0.82); p Z 0.009 and aOR Z 0.48 (95% CI Z 0.26; 0.87); p Z 0.015, respectively) among patients underwent cardiac surgery. In Case-group, 45.4% (109/240) patients died with a survival median of 39 (95%CI Z 31.4; 46.62) days. When the clusters were examined, 41% (55/134) patients within cluster HV died versus 71.4% (10/14) patients within cluster IWX (p Z 0.018). Additionally, patients within cluster IWX had an increased risk of death (adjusted hazard ratio (aHR) Z 2.22; (95% CI Z 1.14; 4.34); p Z 0.019). Conclusions: European mitochondrial haplogroups might be related to the onset of severe sepsis in patients who underwent major cardiac surgery, but not in patients underwent major abdominal surgery. Besides, mtDNA haplogroups could have influence on mortality in septic patients.

Transcriptomic correlates of organ failure extent in sepsis

Wed, 01 Jan 2014 00:00:00 GMT

Objectives: Sepsis is characterised by the frequent presence of organ failure and marked immunologic alterations. We studied the association between the extent of organ failure and the transcriptomic response of septic patients. Methods: Gene expression profiles in the blood of 74 surgical patients with sepsis were compared with those of 30 surgical patients with no sepsis. Differentially expressed genes were assessed for their correlation with the sequential organ failure (SOFA) score. Results: The expression levels of a group of genes participating in the cell cycle (HIST1H1C, CKS2, CCNA2, CDK1, CCNB2, CIT, CCNB1, AURKA, RAD51), neutrophil protease activity (ELANE, ADORA3, MPO, MMP8, CTSG), IL-1R and IL-18R response correlated directly with SOFA and mortality. Genes involved in T cell (LCK, CD3G, CD3D, ZAP70, ICOS, CD3E, CD28, IL2RB, CD8B, CD8A, CD40LG, IL23A, CCL5, SH2D1A, ITK, CD247, TBX21, GATA3, CCR7, LEF1, STAT4) and NK cell immunity (CD244, KLRK1, KLRD1) were inversely associated with SOFA and mortality. Conclusions: The extent of organ failure in sepsis correlates directly with the existence of imbalanced innate and adaptive responses at the transcriptomic level. Quantification of the expression levels of the genes identified here could contribute to the simultaneous assessment of disease severity and immunological alterations in sepsis.

Evolution of neutrophil apoptosis in septic shock survivors and nonsurvivors

Sun, 01 Jan 2012 00:00:00 GMT

Purpose: The aims were to analyze the temporal evolution of neutrophil apoptosis, to determine the differences in neutrophil apoptosis among 28-day survivors and nonsurvivors, and to evaluate the use of neutrophil apoptosis as a predictor of mortality in patients with septic shock. Materials and Methods: Prospective multicenter observational study carried out between July 2006 and June 2009. The staining solution study included 80 patients with septic shock and 25 healthy volunteers. Neutrophil apoptosis was assessed by fluorescein isothiocyanate (FITC)–conjugated annexin V and aminoactinomycin D staining. Results: The percentage of neutrophil apoptosis was significantly decreased at 24 hours, 5 days, and 12 days after the diagnosis of septic shock (14.8% ± 13.4%, 13.4% ± 8.4%, and 15.4% ± 12.8%, respectively; P b .0001) compared with the control group (37.6% ± 12.8%). The difference in apoptosis between 28-day surviving and nonsurviving patients was nonsignificant (P N .05). The mortality rate at 28 days was 53.7%.The crude hazard ratio for mortality in patients with septic shock did not differ according to the percentage of apoptosis (hazard ratio, 1.006; 95% confidence interval, 0.98-1.03; P = .60). Conclusions: During the first 12 days of septic shock development, the level of neutrophil apoptosis decreases and does not recover normal values. No differences were observed between surviving and nonsurviving patients.

Is adding dry needling to a standard care protocol beneficial in patients with chronic neck pain? A randomized placebo-controlled trial

Mon, 01 Jan 2024 00:00:00 GMT

Purpose: To evaluate the short-term effects of adding a dry needling therapy to a standard care protocol based on education, exercise and electrotherapy, compared to a sham procedure and to a standard care protocol in isolation in patients with chronic neck pain. Material and methods: A randomized placebo-controlled trial was performed. The participants in the dry needling group received a standard care protocol based on patient education, therapeutic exercise and electrotherapy, as well as two sessions of dry needling in the upper trapezius, levator scapulae, and/or sternocleidomastoid muscles. The participants in the sham dry needling group received the same standard care protocol and two sessions of sham dry needling. The participants in the control group received the same standard care protocol. The outcomes measured were pain intensity, pressure pain threshold, neck disability, range of movement, activation of deep cervical flexor muscles, kinesiophobia, pain catastrophizing, anxiety, and depression. Results: No significant group by time interactions were found for any of the outcome variables except for lower cervical spine range of movement (F = 3.79; p = 0.030). Conclusion: The addition of two sessions of dry needling in the superficial neck muscles to a standard protocol did not yield superior results compared to either the standard care alone or the standard care plus sham dry needling in patients with chronic neck pain in any outcome except for cervical range of movemen

Validation of the international classification of functioning, disability, and health (ICF) core sets for musculoskeletal conditions in a primary health care setting from physiotherapists’ perspective using the Delphi method

Sat, 01 Jan 2022 00:00:00 GMT

Purpose: To analyze the possibilities of using ICF core sets for musculoskeletal conditions in primary care physiotherapy units of the Health Service of "Castilla y León" (Spain). Methods: A three-round Delphi study was conducted by physiotherapists working in a primary care setting. The data obtained were linked to second-level ICF categories and their relevance was assessed by the participants. The most relevant categories were compared with those present in the existing ICF core sets for musculoskeletal conditions. Results: Eighty-four physiotherapists participated in the survey. The consensus was reached for 45 ICF categories and 5 personal factors after the survey. Thirty-five of these categories were present in the Comprehensive Core Set for post-acute Musculoskeletal Conditions. In addition, 35 categories present in the core set were not considered relevant from the participants' perspective. Conclusions: Physiotherapists mainly considered movement-related categories as relevant. The ICF core set for post-acute musculoskeletal conditions comprises many of these categories and can therefore be taken as a basis for the adoption of ICF in the clinical context. Relevance: Primary care physiotherapists should be aware of the advantages of using ICF in their clinical settings.Implications for RehabilitationThis study shows which body functions and structures, activities and participation, environmental factors, and personal characteristics are relevant from primary care physiotherapists' perspective assessing persons with musculoskeletal conditions.The Comprehensive ICF Core Set for Subacute Musculoskeletal Conditions includes most of the categories identified in this study, but they need to be refined to fully represent the primary care physiotherapists' perspective.The results of this study support the use of the Comprehensive ICF Core Set for Subacute Musculoskeletal Conditions as a basis for operationalizing ICF in this clinical setting.

Measurement Properties of Patient-Reported Outcome Measures for Measuring Fatigue in Individuals With Spinal Cord Injury: A Systematic Review

Wed, 01 Jan 2025 00:00:00 GMT

Objective: To systematically review the measurement properties of patient-reported outcome measures (PROMs) for measuring fatigue in people with spinal cord injury (SCI) to recommend the most suitable PROM for use in research/clinical practice. Data sources: This systematic review was conducted following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline for systematic reviews of PROMs version 2.0. PubMed, EMBASE, Web of Science, and SCOPUS were systematically searched up to September 2024. Study selection: Two independent reviewers evaluated articles that examined any (subscale of) PROM that measure fatigue in people with SCI, and reported information about the development of the PROM or the evaluation of at least one measurement property. Data extraction: Data were extracted following the COSMIN guideline. The methodological quality of the included studies was evaluated with the Risk of Bias checklist and the results for each study were rated with the Criteria for good measurement properties. The evaluation of each PROM was conducted by summarizing the results of all the studies per measurement property. The quality of evidence was analyzed per measurement property per PROM using the the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Data synthesis: Seventeen articles describing 18 (subscales of) PROMs for measuring fatigue were included. There were only 3 high quality studies on measurement properties of PROMs measuring fatigue in people with SCI. The Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue SF7a and 8a were rated as sufficient with moderate quality of evidence for content validity. Sufficient ratings with high quality evidence were obtained for structural validity and internal consistency for the PROMIS Fatigue SF8a. For measurement invariance sufficient ratings with low or very low quality evidence were obtained for PROMIS Fatigue SF7a and 8a, respectively. The other PROMs showed limited quality of evidence in the measurement properties studied. Conclusions: The PROMIS Fatigue SF7a and 8a are the most suitable options to assess fatigue in adults with SCI in research and clinical practice.

Plasma Troponins as Markers of Myocardial Damage during Cardiac Surgery with Extracorporeal Circulation

Mon, 01 Jan 2007 00:00:00 GMT

All types of cardiac surgery involve considerable injury to the myocardium. However, it is difficult to differentiate, in the immediate post-operative state, between ischemic alterations associated with the cardiac surgery itself and the pathological alterations of a peri-operative myocardial infarction. The diagnosis of damaged myocardium, classically performed with the enzymatic markers creatine kinase (CK) and its muscle fraction (CK-MB), has become more precise with the option of measuring cardiac troponins T and I. We measured these markers in 58 patients undergoing elective cardiac surgery with extra-corporeal circulation (ECC). The patients included 37 cases undergoing valve surgery, 14 for coronary revascularization, 6 for mixed procedures, and 1 for closure of an inter-atrial communication. The markers were measured in plasma at baseline (at anesthesia initiation), 5 min post-ECC commencement, following aorta de-clamping, during the surgical closure, and 6, 18 and 42 hrs after surgery. All the markers were increased significantly relative to the baseline values. Troponin I, CK and CK-MB values peaked between 6 and 18 hrs after surgery, troponin T between 18 and 42 hrs, and myoglobin at the surgical closure. The values of all markers were higher in patients undergoing coronary surgery compared to those in patients undergoing valve surgery. In the evaluation of myocardial damage after surgery, the measurement of classical markers such as CK and myoglobin remain valid, but other markers such as troponins provide significant additional diagnostic benefit and, thus, need to be included in the routine biochemical measurements for monitoring myocardial damage associated with the surgical procedure

Procalcitonin cannot be used as a biomarker of infection in heart surgery patients with acute kidney injury

Fri, 01 Jan 2016 00:00:00 GMT

Purpose: We intended to assess how acute kidney injuy impacts on procalcitonin levels in cardiac surgery patients, with or without infection, and whether procalcitonin might be used as a biomarker of infection in acute kidney injuy. Material and methods: A case-control study was designed which included patients that had had cardiac surgery between January 2011 and January 2015. Every patient developing severe sepsis or septic shock (n = 122; 5.5%) was enrolled. In addition, consecutive cardiac surgery patients during 2013 developing systemic inflammatory response syndrome (n = 318) were enrolled. Those recruited 440 patients were divided into 2 groups, according to renal function. Results: Median procalcitonin levels were significantly higher during the 10 postoperative days in the acute kidney injury patients. Regression analysis showed that postoperatory day, creatinine, white blood cells and infection were significantly (P < .0001) associated to serum procalcitonin level. In patients with creatinine ≥2, median procalcitonin levels were similar in infected and non-infected patients. Only when creatinine was less than 2 mg/L, the median procalcitonin levels were significantly higher in patients with infection, as compared to those with no infection. Conclusions: In acute kidney injuy patients, high procalcitonin levels are a marker of acute kidney injuy but will not be able to differentiate infected from non-infected patients

Epidemiological Surveillance of Surgical Site Infection and its Risk Factors in Cardiac Surgery: A Prospective Cohort Study

Fri, 01 Jan 2016 00:00:00 GMT