Normal values in ambulatory oesophageal pH monitoring at two levels in Spain

AIM

Upper oesophageal pH monitoring may play a significant role in the study of extra-oesophageal GERD, but limited normal data are available to date. Our aim was to develop a large series of normal values of proximal oesophageal acidification.

METHODS

155 healthy volunteers (74 male) participated in a multi-centre national study including oesophageal manometry and 24 hours oesophageal pH monitoring using two electrodes individually located 5 cm above the LOS and 3 cm below the UOS.

RESULTS

130 participants with normal manometry completed all the study. Twelve of them were excluded for inadequate pH tests. Twenty-seven subjects had abnormal conventional pH. The remaining 91 subjects (37 M; 18-72 yrs age range) formed the reference group for normality. At the level of the upper oesophagus, the 95th percentile of the total number of reflux events was 30, after eliminating the meal periods 22, and after eliminating also the pseudo-reflux events 18. Duration of the longest episodes was 5, 4 and 4 min, respectively (3.5 min in upright and 0.5 min in supine). The upper limit for the percentage of acid exposure time was 1.35, 1.05 and 0.95%, respectively. No reflux events were recorded in the upper oesophagus in 8 cases.

CONCLUSION

This is the largest series of normal values of proximal oesophageal reflux that confirm the existence of acid reflux at that level in healthy subjects, in small quantity and unrelated to age or gender. Our data support the convenience of excluding pseudo-reflux events and meal periods from analysis.

Chemosensory species recognition may reduce the frequency of hybridization between native and introduced lizards

The introduction of alien species to islands by human activity can cause catastrophic consequences for small populations of island endemics. Hybridization between the endangered and endemic insular lizard Podarcis atrata (Boscá, 1916) from the Columbretes Islands (Mediterranean, Spain) and the common mainland lizard Podarcis hispanica (Steindachner, 1870) could potentially occur because mainland haplotypes have already been detected in the islands, the two species are closely genetically related, and the frequency of visitors to these islands is increasing. However, reproductive decisions of lizards are often mediated by species recognition mechanisms based on chemical cues. On the basis of this observation, even if some mainland P. hispanica lizards were introduced to the islands, interspecific recognition might make rare an eventual hybridization with the insular P. atrata. We examined interspecific chemical recognition between the insular P. atrata and the mainland P. hispanica. Our results showed that lizards of both sexes responded more strongly (i.e., directed a significantly higher number of tongue flicks) to scents of conspecific individuals than to scents of heterospecifics. Chemical recognition of conspecifics by endemic island P. atrata lizards may reduce the occurrence of hybridization with introduced mainland P. hispanica lizards and protect the insular gene pool.

[Effect of gastric bypass on the metabolic syndrome and on cardiovascular risk]

BACKGROUND

Obesity is associated with increased morbimortality cardiovascular. Individual with metabolic syndrome (MS) are a high risk of developing cardiovascular disease (CVD). The aim of this study was to determine the prevalence of the MS in morbidly obese patients enrolling in a bariatric surgery program and to evaluate the impact of weigh loss induced by gastric bypass on the MS and on the predicted 10-year cardiovascular risk.

MATERIAL AND METHODS

We studied 46 morbidly obese patients who underwent laparoscopic gastric bypass and were followed for 2 years. MS was defined following the IDF 2005 criteria and the insulin resistance (IR) was calculated by using HOMA index. Risk assessment for estimating 10-year ECV risk was carried out according to Framingham score.

RESULTS

Before surgery, 67.2% of patients had IR and 60,9% met the definition of the MS. 17.3% of patients had an elevated cardiovascular risk category. 2 years after gastric bypass, the percentage of excess body weight lost was 72%. All patients restored their HOMA index and only 1 patient (3.6%) had MS. Resolution of hypertension, disglucemia and dislipemia has been observed in 85%, 93.8% and 95.6% of patients. Estimated cardiovascular risk decreased from 4.5% at baseline to 1% at 2 years after surgery.

CONCLUSIONS

SM is common in morbidly obese patients. Bypass gastric is associated with an improvement or resolution in cardiovascular risk factors and IR and result in a significant reduction in MS prevalence and of predicted 10-year cardiovascular risk.

Clinical pathways as a healthcare tool: design, implementation and assessment of a clinical pathway for lower-extremity deep venous thrombosis

OBJECTIVE

To design, implement and assess a clinical pathway for lower-extremity deep venous thrombosis, and to compare the length of hospital stay in two different periods.

DESIGN

Development of the care pathway by a multidisciplinary team, followed by a controlled intervention study to compare two non-concomitant cohorts of patients corresponding to the years 2002 (before the implementation of the critical pathway) and 2004 (year of the implementation).

SETTING

Academic tertiary care hospital.

PARTICIPANTS

90 patients, 42 corresponding to the year 2004 and 48 to 2002, admitted to hospital with a diagnosis of lower-extremity deep venous thrombosis (DVT).

MAIN OUTCOME MEASURES

Length of hospital stay, hospitalisation costs and care indicators.

RESULTS

The mean length of hospital stay was 6.78 days in 2002 and 4.72 days in 2004. This means a reduction of 2.06 days (p<0.012). The reduction in the length of hospital stay in 2004 situates the hospital 1.98 days below the mean stay of our community (6.7 days) for the same diagnosis and year. The impact of the clinical pathway was assessed using the following indicators: implementation indicator 92.2%, compliance indicator 65%, adverse events indicator 2.5% and satisfaction indicator 67%. In comparison with costs incurred in year 2002, implementation of the clinical pathway resulted in a saving of euro427.33 per patient and a total saving of euro17,093.20.

CONCLUSIONS

The implementation of a lower-extremity DVT clinical pathway in our institution has help to reduce hospitalisation costs, due to a decreased length of hospital stay.

[Role of decompressive craniectomy in brain injury patient]

Second level therapeutic maneuvres for controlling intracranial hypertension (ICH) proposed by the European Brain Injury Consortium and the American Association of Neurological Surgeons include barbiturates, moderate hypothermia and decompressive craniectomy (DC). However, neither barbiturates nor hypothermia have been demonstrated to improve its outcome. DC could be a therapeutic option in the management of ICH without intracerebral masses. Therefore, our goal has been to review and analyze the clinical usefulness of DC in patients with brain injury in an attempt to deal with some concerns of the critical care physicians. Can DC improve patient outcome? Currently, there are no randomized and controlled clinical trials supporting or rejecting the practice of DC in adults. Most published reports provide level II of evidence. However, most of those studies have shown that the outcome is better in patients with DC. When should DC be performed? It should be performed early to prevent ICH from occurring more than 12 hours. What are the effects of DC on intracranial pressure and brain oxygenation? In most patients, ICP can be maintained below 25 mmHg after a DC. However, to improve brain oxygenation (PtiO(2)), the probe must be placed in the healthy area of the most severely damaged cerebral hemisphere. What is the suggested surgical procedure? Frontal-subtemporal-parietal-occipital craniectomies, including enlargement of the dura by duroplasty. And finally, what are the current contraindications of DC? Glasgow Coma Scale score 3 points post-resuscitation states with dilated and arreactive pupils, age > 65 years old, ICH > 12 hours, persistent (a-yv)DO(2) < 3.2% or PtiO(2) < 10 mmHg maintained from the moment of admission.

Final results of a prospective, observational study of the effectiveness of darbepoetin alfa administered every three weeks for the treatment of chemotherapy-induced anaemia in elderly patients

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Background: Cancer incidence is increasing in elderly but specific treatment data in this population is not often available. The objectives of this study were to evaluate the effectiveness and safety of darbepoetin alfa (DA) administered once every 3 weeks (Q3W) for the treatment of chemotherapy-induced anaemia (CIA) in elderly within routine clinical practice. Methods: Prospective, observational, single-arm, multicentre study performed in 28 centres across Spain. Eligible patients (pts):≥65 years, anaemic (haemoglobin [Hb] 11 g/dl), with non-myeloid malignancies, and scheduled to receive ≥9 weeks (wks) of chemotherapy. Pts were treated with a fixed dose of DA 500 μg Q3W and treatment stopped if Hb levels exceeded 13g/dl. Primary endpoint was hematopoietic response (Hb increase ≥2g/dl or Hb ≥12g/dl without transfusions in the previous 28 days). Secondary endpoints included percentage of pts achieving target Hb (>11g/dl from wk 5 till end of treatment without red blood cell transfusion within 28 days), changes in the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) scale and the incidence of adverse reactions. Results: Data were prospectively collected from 153 pts: women (56.86%), mean (SD) age 73.43 (5.77) years, ECOG Performance Status 0–1 (65.36%) with solid tumors (66.67%) and lymphoproliferative malignancies (33.33%) and stage III/IV (63.40%). Most pts (90.20%) had baseline Hb levels between 9–11g/dL. DA was administered for a median of 9.0 wks (range: 1–22.57). The Kaplan-Meier percentage (KM; 95% CI) of pts who achieved hematopoietic response was 69.70% (56.06–83.34) and 72.22% (57.5–86.94) for pts who achieved target Hb (>11g/dL). FACT-F median score at baseline was 29.00 and 33.00 at the end of the study. Only one (0.7%) non-serious adverse reaction (cutaneous eruption) was reported. Conclusions: These results suggest that DA given at 500 μg Q3W to elderly pts with non-myeloid malignancies is an effective and well-tolerated treatment for CIA.

[Table: see text]

Different contamination patterns of lineage I and II strains of Listeria monocytogenes in a Spanish broiler abattoir

The purpose of this study was to determine whether genetically similar or diverse strains of Listeria monocytogenes colonize the environment and carcasses in a single Spanish broiler abattoir over time. The study was composed of 5 surveys over a 1.5-yr period and included the monitoring of cleaning and disinfection procedures. Overall, a total of 212 samples were tested for the presence of L. monocytogenes, and 31% of the samples were found to be positive. Listeria monocytogenes was isolated from carcasses and product contact and noncontact sites in the evisceration and carcass classification areas of the abattoir. A total of 132 L. monocytogenes isolates were characterized by PCR-based serotyping and pulsed-field gel electrophoresis (PFGE) restriction analysis with the endonucleases ApaI and AscI. Molecular serotyping showed that L. monocytogenes isolates were of serotypes 1/2a and 1/2b. Isolates of serotype 1/2b (89.4%) were contaminating carcasses as well as environmental product contact and noncontact sites, whereas isolates of serotype 1/2a (10.6%) were recovered only from environmental product noncontact sites. A relatively low genetic diversity was found in this group of L. monocytogenes isolates from the abbatoir; only 14 different PFGE types (A1 to A14) were obtained. Nine pulsotypes belonging to serotype 1/2b (lineage I) were grouped in only one PFGE genetic cluster, whereas 5 pulsotypes belonging to serotype 1/2a (lineage II) were grouped into 4 PFGE genetic clusters. Two genetically related pulsotypes of serotype 1/2b (A1 and A2, 64.4% of the isolates) predominated and persisted in the abattoir. Our study indicated that a few strains of L. monocytogenes lineage I that were genetically very closely related might be specifically adapted to colonizing the evisceration zone of the abattoir and were predominant on carcasses over 1 yr. On the other hand, a genetically diverse group of lineage II strains were present in the abattoir environment, but never contaminated carcasses.

Acute pancreatitis in inflammatory bowel disease, with special reference to azathioprine-induced pancreatitis

BACKGROUND

Pancreatitis is a potentially severe condition. Patients with inflammatory bowel disease (IBD) seem to be at increased risk for acute pancreatitis.

AIM

To describe the incidence, main causes and possible predictive factors of acute pancreatitis in inflammatory bowel disease.

METHODS

Information was retrospectively extracted from the clinical records of patients followed in the IBD Units of nine hospitals in Madrid (n = 5073).

RESULTS

A total of 82 acute pancreatitis episodes were diagnosed (cumulative incidence, 1.6%); 98% of them were mild. Recurrent acute pancreatitis developed in 13% of patients. Most cases of acute pancreatitis (63.4%) were attributed to drug exposure [azathioprine/mercaptopurine (AZA/MP) n = 46, mesalazine (mesalamine) n = 6]; 20.7% were idiopathic, and 12.2% were biliary. Incidence of acute pancreatitis in patients treated with AZA/MP was 3.1%. In patients with acute pancreatitis, female gender (OR 3.4 95% CI: 1.3-9.3; P = 0.012) and Crohn's disease (CD) (OR 5.8 95% CI: 1.6-20.6; P = 0.007) were risk factors for AZA/MP-associated acute pancreatitis, the latter also when analysed only in patients treated with AZA/MP (n = 1477) (OR 5.2 95% CI: 1.8-14; P = 0.002).

CONCLUSIONS

The incidence of acute pancreatitis in our IBD patients (1.6%) is similar to that previously described. Drugs, mainly AZA/MP, are the leading cause. AZA-induced acute pancreatitis is always mild. Patients with CD are at a higher risk for AZA/MP-associated acute pancreatitis. The frequency of idiopathic acute pancreatitis is higher than expected, suggesting that part of these cases could be extraintestinal manifestations of IBD.

Efficiency of whole and skimmed powdered milk for trapping volatile compounds released from plastic containers in high-temperature applications

Plastic food containers used for high-temperature applications are not completely inert, and potentially harmful chemicals may be transferred to foodstuffs when such containers are heated. The aim of this work was to investigate the role of food fat content on the efficiency of trapping volatile organic compounds from heated plastic packaging. Relatively simple food matrices such as powdered skimmed and whole milk were evaluated with respect to their retention of several selected migrants: toluene, 1-octene, ethylbenzene, o-, m-, and p-xylene, styrene, and 1,4-dichlorobenzene released from containers made of polypropylene (random and copolymer), polycarbonate, and styrene-acrylonitrile copolymer, which are all commonly used in high-temperature applications. The analytical method (purge and trap gas chromatography and mass spectrometry) was optimized for each matrix. The developed procedure had detection limits of 0.01 to 1.2 ng, depending on the analyte and sample matrix, and both reproducibility and repeatability (expressed as relative standard deviation) were below 15%. This method was applied to the different plastic materials. The concentrations of the volatile compounds in both matrices were well below the established specific migration limits. Temperature and fat content of powdered milk were the most influential variables in mass transfer processes. These values were compared with those obtained with either Tenax TA (alternative test medium for fatty food simulants) or Porapak Q (another widely used sorbent). Similar results were found in skimmed powdered milk and Tenax TA, but significant differences were observed for whole powdered milk.

[Differentiating early dementia from major depression with the Spanish version of the Addenbrooke's Cognitive Examination]

INTRODUCTION

In clinical practice it is often difficult to establish whether cognitive impairment is secondary to an affective disorder or a dementing process.

AIM

To describe the cognitive performance on the Spanish version of the Addenbrooke's Cognitive Examination (ACE) of patients with early dementia and depression.

SUBJECTS AND METHODS

77 patients with early dementia (53 Alzheimer disease; 24 frontotemporal dementia), 17 patients with major depression and 54 healthy volunteers were tested with the Spanish version of the ACE.

RESULTS

Alzheimer disease and frontotemporal dementia groups were significantly lower than the control group and the major depression group. When the major depression group was compared with the control group no significant differences were found.

CONCLUSIONS

The cognitive performance in the ACE is different in patients with early dementia and patient with depression.

Development of flexible antimicrobial films using essential oils as active agents

The antimicrobial activity in the vapor-phase of laboratory-made flexible films of polypropylene (PP) and polyethylene/ethylene vinyl alcohol copolymer (PE/EVOH) incorporating essential oil of cinnamon ( Cinnamomum zeylanicum), oregano ( Origanum vulgare), clove ( Syzygium aromaticum), or cinnamon fortified with cinnamaldehyde was evaluated against a wide range of microorganisms: the Gram-negative bacteria Escherichia coli, Yersinia enterocolitica, Pseudomonas aeruginosa, and Salmonella choleraesuis; the Gram-positive bacteria Listeria monocytogenes, Staphylococcus aureus, Bacillus cereus, and Enterococcus faecalis; the molds Penicillium islandicum, Penicillium roqueforti, Penicillium nalgiovense, Eurotium repens, and A spergillus flavus and the yeasts Candida albicans, Debaryomyces hansenii, and Zigosaccharomyces rouxii. Films with a nominal concentration of 4% (w/w) of fortified cinnamon or oregano essential oil completely inhibited the growth of the fungi; higher concentrations were required to inhibit the Gram-positive bacteria (8 and 10%, respectively), and higher concentrations still were necessary to inhibit the Gram-negative bacteria. PP films were more effective than PE/EVOH films. The atmospheres generated by the antimicrobial films inside Petri dishes were quantitatively analyzed using headspace-single drop microextraction (HS-SDME) in combination with gas chromatography-mass spectrometry (GC-MS). The analyses showed that the oregano-fortified PP films released higher levels of carvacrol and thymol, and the cinnamon-fortified PP films released higher levels of cinnamaldehyde, during the first 3-6 h of incubation, than the corresponding PE/EVOH films. Shelf-life tests were also performed, demonstrating that the antifungal activities of the films persisted for more than two months after their manufacture. In addition, migration tests (overall and specific) were performed, using both aqueous and fatty simulants, to ensure that the films meet EU regulations regarding food contact materials. Following contact with the tested films, the substances that had migrated into the aqueous simulants were recovered by direct immersion-single drop extraction (DI-SDME) and then analyzed by GC-MS. The fatty stimulant (isooctane) was directly injected into the chromatographic system.

Reproductive risk factors of breast cancer in elderly population. A single centre study

21187

Background: Relationship between reproductive variables and cancer risk has been yet established. Protective effect of late age at menarche (≥ 11) and high parity (≥ 4) and the increased risk of nulliparous women, older age at first birth (AFB) (≥ 28) and older age at menopause (≥ 52) seems to act differently in pre vs. postmenopausal elderly women. The aim of this study was to describe recognized reproductive risk factors for breast cancer in a selected population of a single centre. Methods: A cross- sectional study of women diagnosed ≥ 70 years. We selected women with removed early breast cancer and on follow-up. No disease recurrences were allowed. Between January 2005 to June 2006. Described reproductive risk factors for breast cancer were collected. Tumour characteristics also. Results: 91 patients were recruited. Mean age at time of diagnosis: 76 (70–92); mean age at study 80 (71- 95). Reproductive factors: late age at menarche (12; 9–16; percentile 75: 14) and late age at menopause: 48 (29–56); 75% ≥ 52 years old were common. Nulliparous women were similar at described in other series (10%); parity 2 (0–9); percentile 75: 3;late AFB: 26 (19–40); percentile 75: 29 years. No one had taken hormonal treatment. Only 16% had familiar history of breast cancer and 9% personal history. Almost all (84%) had positive tumours for the oestrogen receptor and 76% for progesterone receptor. 91% had ductal histology and 54% had II stage. Conclusions: Discussion: unexpected associations between classical reproductive risk factors and breast cancer on elderly patients have been described in other series. It seems that late age at menarche and late age at menopause is common in elderly breast cancer population, as in our serie. Nulliparous elderly continue to have risk but seems that the protective effect of parity dissipated in these population. Older age at first birth (≥28) is consistently associated with increased breast cancer risk. Conclusion: our study is based on a high selected population and clearly has a selection bias. Our results cannot be generalized to other populations but describes our patients. The results therefore should be internally valid. And it seems to coincide with other studies.

No significant financial relationships to disclose.