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Estadística dels centres hospitalaris de Catalunya 2023: resum de resultats
Get PDFHospitals; Estadístiques; CatalunyaHospitals; Statistics; CataloniaHospitales; Estadísticas; CataluñaAnualment es du a terme l’Estadística d’establiments sanitaris amb règim d’internat (EESRI) amb els objectius de donar compliment als plans estadístics, tant de Catalunya com de l’Estat espanyol. Posa a disposició de tots els professionals de la salut, les estadístiques relacionades amb la planificació i la gestió de recursos i de serveis hospitalaris, com la perspectiva assistencial o de la recerca. És una bona font d’informació per poder aproximar-se a la realitat de l’activitat hospitalària catalana
Individualization of Donor Nerve Selection With Intraoperative Nerve Monitoring in Axillary Nerve Neurotization
Get PDFAxillary nerve; Brachial plexus; Intraoperative nerve monitoringNervi axil·lar; Plexe braquial; Monitorització nerviosa intraoperatòriaNervio axilar; Plexo braquial; Monitorización nerviosa intraoperatoriaPurpose
This study aimed to evaluate the use of intraoperative nerve conduction studies in radial to axillary nerve transfers using the motor branches to the triceps. We hypothesized that morphological characteristics might not fully express a donor nerve’s suitability for transfer and that choosing the donor branch based on nerve action potential (NAP) amplitudes would lead to better functional outcomes.
Methods
This retrospective analysis included 17 patients who underwent radial to axillary nerve transfer. The specific triceps motor branch used as donor and the site of neurorrhaphy were chosen based on intraoperative NAP amplitudes independently of morphological criteria, such as size matching or arc of rotation.
Results
We found a moderate correlation between the NAP amplitude of the transferred branch and shoulder abduction strength at the end of the follow-up. The branch to the lateral head of the triceps was the most often selected as a donor. Outcomes were satisfactory in 14 out of 17 patients.
Conclusions
The findings suggest that reinnervation is enhanced when the choice of the donor branch is individualized and based on functional metrics like NAP, instead of anatomical characteristics. The study supports the role of intraoperative nerve monitoring as an objective and predictable method to refine donor branch selection in radial to axillary nerve transfer.
Type of study/level of evidence
Therapeutic IV
Fetal TEI Index in Pregnancies with Intrahepatic Cholestasis of Pregnancy: A Case-Control Study
Get PDFIntrahepatic cholestasis of pregnancy; Bile acids; Ursodeoxycholic acidColestasis intrahepática del embarazo; Ácidos biliares; Ácido ursodesoxicólicoColèstasi intrahepàtica de l'embaràs; Àcids biliars; Àcid ursodesoxicòlicObjectives
First, to explore differences in fetal cardiac function in patients with and without intrahepatic cholestasis of pregnancy (ICP) based on the TEI index. Second, to explore a potential correlation between TEI index and bile acid levels in pregnant women with ICP. Third, to study changes in the TEI index of fetuses from pregnant women with ICP after administration of ursodeoxycholic acid (UDCA).
Study Design
This is a prospective observational case-control study conducted at Hospital Clínico San José and Clínica RedSalud Vitacura, both in Santiago, Chile, between April 2018 and October 2020. ICP was defined as palmar-plantar pruritus of nocturnal predominance for more than 1 week associated with a total bile acid level above 10 μmol/L. Control cases were women with pregnancies scheduled for induction or elective cesarean section between 37 and 40 weeks of gestation according to current protocols. Differences in the TEI index between cases and controls were assessed by the Wilcoxon test. The correlation between the TEI index and bile acid levels was assessed by the Spearman correlation test. Changes in TEI index before and after administration of UDCA were analyzed by the paired samples Wilcoxon test.
Results
A total of 181 pregnant women were included in the study, 109 women with ICP and 72 controls. The median gestational age at inclusion was 35.9 weeks (interquartile range [IQR], 33.0–38.9). The median TEI index was 0.31 (IQR, 0.29–0.36); this was significantly longer in fetuses of women with ICP ([0.34, IQR, 0.30–0.38] vs. [0.30, IQR, 0.28–0.31], p < 0.001). There was a significant correlation between bile acid levels and TEI index (0.584, p < 0.001). In 21 fetuses, the TEI index was measured a second time, 2 weeks later, following UDCA administration. The median TEI index decreased significantly following UDCA administration (0.40 ms before treatment [IQR, 0.36–0.42] vs. 0.33 after treatment [IQR, 0.32–0.38], p = 0.001), p = 0.001).
Conclusion
The TEI index is increased in fetuses of women with ICP. TEI index was significantly correlated with bile acid levels, and administration of UDCA significantly reduced the TEI index
Guia pràctica per al desplegament de l'atenció integrada en l'entorn domiciliari
Get PDFAtenció integrada; Atenció centrada en el pacient; Entorn domiciliariIntegrated care; Patient-centered care; Home environmentAtención integrada; Atención centrada en el paciente; Entorno domiciliarioL’atenció integrada (AI) en l’entorn domiciliari té la missió d’oferir un abordatge preventiu, de resposta adequada i d’intervenció proactiva integral, integrada i amb capacitat de resposta per atendre i donar suport a les persones que tinguin necessitat d’atenció domiciliària (AD), a les seves famílies, a la unitat de convivència i l’entorn proper, d’acord amb les seves preferències, valors i voluntats, i que garanteixi la intensitat de suport i d’atenció necessària, així com continuïtat en l’atenció.La atención integrada (AI) en el entorno domiciliario tiene la misión de ofrecer un abordaje preventivo, de respuesta adecuada y de intervención proactiva integral, integrada y con capacidad de respuesta para atender y apoyar a las personas que tengan necesidad de atención domiciliaria (AD), a sus familias, a la unidad de convivencia y al entorno cercano, de acuerdo con sus preferencias, necesaria, así como continuidad en la atención
Palbociclib and trastuzumab for HER2-positive metastatic breast cancer: final overall survival results of cohort A and B of SOLTI-1303-PATRICIA trial
Get PDFHR-positive/HER2-positive; Biomarkers; Gene expression profilingHR-positiu/HER2-positiu; Biomarcadors; Perfils d'expressió gènicaHR-positivo/HER2-positivo; Biomarcadores; Perfil de expresión génicaBackground
The SOLTI-1303-PATRICIA trial (NCT02448420) is a phase II study investigating palbociclib and trastuzumab, with or without endocrine therapy, in hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC). This manuscript presents final overall survival (OS) results and biomarker analyses.
Patients and methods
Patients previously treated with trastuzumab and two to four regimens were eligible. For estrogen receptor (ER)-negative disease (cohort A), patients received palbociclib and trastuzumab. For ER-positive disease, patients were randomized 1 : 1 to cohort B1 (no additional therapy) or B2 (letrozole). OS and long-term progression-free survival (PFS) were pre-defined secondary endpoints. Kaplan–Meier curves and stratified Cox models were used.
Results
Among 71 patients, median OS was 29.8 months [95% confidence interval (CI) 20.9-38.0 months]; 4-year OS rates were 13.3% (A), 35.7% (B1), and 32.3% (B2). PAM50 luminal subtypes showed better OS than non-luminal subtypes (38.0 versus 26.6 months). Exploratory biomarker analyses found luminal-related genes associated with better long-term survival, while basal and proliferation-related genes were linked to resistance. Higher luminal A, luminal B, and previously reported chemo-endocrine scores correlated with favorable prognoses.
Conclusions
These findings highlight the relevance of gene expression profiling in HER2-positive breast cancer and support biomarker-driven patient selection. Long-term PATRICIA results validate the potential of non-chemotherapy-based approaches in HR-positive/HER2-positive MBC.This work was supported by a grant from Pfizer (no grant number), which also provided palbociclib. Pfizer had no role in the management of this trial. All decisions and responsibilities for the trial were managed solely by the sponsor, the SOLTI Group
Full informatiu del Sistema d’Informació per a la Vigilància d’Infeccions a Catalunya – 2025/08
Get PDFVigilància d'infeccions; Epidemiologia; Assistència sanitàriaInfection surveillance; Epidemiology; Health careVigilancia de infecciones; Epidemiología; Asistencia sanitariaL’objectiu de l’informe de la xarxa Sistema d’Informació per a la Vigilància d’Infeccions a Catalunya (SIVIC) és tenir un sistema de vigilància creat per seguir no només els casos més greus sinó també els casos comunitaris de diverses infeccions respiratòries, com són Covid-19, grip, virus sincitial respiratori i enterovirus, entre d’altres
Beyond maximum grade: tolerability of immunotherapies, cellular therapies, and targeted agents in haematological malignancies
Get PDFTolerability; Immunotherapy; Haematological malignanciesTolerabilidad; Inmunoterapia; Neoplasias hematológicasTolerabilitat; Immunoteràpia; Neoplàsies hematològiquesThe increasing use of immunotherapeutic approaches, cellular therapies, and targeted agents is rapidly and profoundly changing the treatment paradigms of haematological malignancies. These novel therapies are increasingly incorporated into earlier lines of treatment. Some are administered for a fixed duration, often with curative intent, whereas others are administered chronically for disease control. The associated acute, mid-term, and long-term toxic effects can differ markedly from conventional cytotoxic chemotherapy and radiotherapy. Accumulating clinical experience and data enable identification of class-specific effects and development of consensus-based guidelines for toxicity management. In this third paper in the Series on adverse event reporting, we build on our emerging understanding of toxicity profiles of novel treatments to propose an actionable framework for improved assessment, reporting, and critical appraisal of treatment tolerability. We discuss recent insights regarding second cancers and the relevance of infectious complications, explore tolerability aspects of time-limited treatments, and suggest approaches to address gaps in tolerability assessment.PJB is supported through an Excellence Stipend of the Else Kröner Fresenius Foundation. ERSC receives research funding from Arnold Ventures. MMH is supported by U24HL138660 from the US National Heart, Lung and Blood Institute (NHLBI) and National Cancer Institute and U24CA076519 from the National Cancer Institute, the NHLBI and the National Institute of Allergy and Infectious Diseases
From indication to initiation of invasive intracranial pressure monitoring time differences between neurosurgeons and intensive care physicians: can intracranial hypertension dose be reduced? TIMING-ICP, a multicenter, observational, prospective study
Get PDFIntensive care physicians; Intracranial hypertension; NeurosurgeonsMédicos de cuidados intensivos; Hipertensión intracraneal; NeurocirujanosMetges de cures intensives; Hipertensió intracranial; NeurocirurgiansBackground
The duration of episodes of intracranial hypertension is related to poor outcome, hence the need for prompt diagnosis. Numerous issues can lead to delays in the implementation of invasive intracranial pressure (ICP) monitoring, thereby increasing the dose of intracranial hypertension to which the patient is exposed. The aim of this prospective, observational, multicenter study was to assess the magnitude of this delay, evaluating the time required for initiation of invasive ICP monitoring, from indication (T1) to initiation of the maneuver (T2) when performed by neurosurgeons compared to intensive care physicians.
Methods
We evaluated the impact of the operator performing the maneuver (neurosurgeon vs. intensivist) on the T2-T1 time interval, where T1 represents the time at which indication for invasive ICP monitoring is declared, and T2 the time at which the maneuver starts, defined as the skin incision. The effect of the operator performing the maneuver was evaluated through a parametric survival model. Both intraparenchymal catheters (IPCs) and external ventricular drains (EVDs) were considered as invasive ICP monitoring devices. Invasive monitoring could be performed in intensive care unit (ICU) or in operating room (OR).
Results
A total of 112 patients were included into the final analysis; 39 IPCs were placed by intensivists within the ICU, and a total of 73 IPCs and EVDs by neurosurgeons both within the ICU and OR settings. The mean difference in T2-T1 time for IPCs placement in the ICU was 69 min (CI 50.1–94.8) in the intensivist group and 145 min (CI 103.4–202.9) in neurosurgeon group. The mean difference between these groups, 76 min, was found to be statistically significant (p-value = 0.0021). In the group treated by neurosurgeons, no statistically significant differences were found in timing between the ICU and the OR.
Conclusions
Invasive ICP monitoring performed with IPCs in ICU begins earlier when performed by intensivists rather than neurosurgeons. This finding suggests the possibility to obtain a prompt diagnosis of intracranial hypertension when intensivists intervein directly at patient’s bedside. Further studies are needed to confirm these findings and investigate their effect on outcome
Quality of life and psychological status in people with acromegaly in relation to disease-related facial changes
Get PDFAcromegaly; Facial changes; PsychologyAcromegalia; Cambios faciales; PsicologíaAcromegàlia; Canvis facials; PsicologiaThe diagnosis of acromegaly is often delayed, leading to facial disfigurements that persist despite endocrine cure. We aimed to study the relationship between facial modifications, Quality of Life (QoL), and psychologic status in patients with acromegaly.
Sixty-five patients in remission or with hormonal disease control participated (29 women and 36 men; mean age 57.4±13.5 years). The following variables were assessed: a) Quality of life using AcroQoL; b) Anxiety level with the STAI Questionnaire; c) Self-esteem by the Rosemberg Scale; and d) Facial acromegaly phenotypic changes evaluated from photographs by 8 experienced endocrinologists using a Likert scale.
The overall AcroQoL score showed mid-range values, with better scores for men (72.3 vs 56.6, p=0.022). AcroQoL physical domain was also higher for men (59.0 vs 34.9, p=0.006). In the psychological domain, men tended to score better (65.7 vs 54.5, p=0.069), particularly in the appearance subdimension (53.8 vs 38.8, p=0.07), while women had worse anxiety scores (p=0.009). Global self-esteem was high (2.7 ± 0.6 for a maximal value of 3), without sex differences. A trend towards a negative correlation between self-esteem and facial scores was observed (rs= -0.559, p=0.074), indicating a low psychological impact.
In controlled acromegaly, QoL is relatively preserved in both genders, although men have better anxiety scores. Facial changes have a weak but persistent negative impact on psychological status, with greater intensity observed in women.This research was funded by the Instituto de Salud Carlos III grant PMP15/00027, co-funded by the European Regional Development Fund - European Union; and PMP22/00021, funded by the European Union-NextGenerationEU, both to Manel Puig-Domingo
Long-Term Impact of Peritoneal Dialysis Ultrafiltration on Cardiorenal Patients
Get PDFCardiorenal syndrome; Diuretic resistance; Heart failureSíndrome cardiorenal; Resistència diürètica; Insuficiència cardíacaSíndrome cardiorrenal; Resistencia diurética; Insuficiencia cardíacaBackground: Heart failure (HF) prevalence is increasing, and its prognosis worsens in the presence of other comorbidities. Up to 70% of patients develop cardiorenal syndrome (CRS), which is associated with diuretic resistance or kidney deterioration over time. Peritoneal dialysis (PD) for ultrafiltration (PD-UF) could be a potential therapeutic option in CRS, although its long-term outcomes have not been described. Methods: Retrospective registry study of the Catalan Renal Registry on patients with PD-UF indication between 2013 and 2022. Baseline clinical characteristics and follow-up until December/2022 was studied. Results: Of the 1,874 incident patients on PD, 198 (10.6%) were PD-UF, 73.2% of the patients were male, and the mean age was 70.7 ± 9.3 years. Median estimated glomerular filtration rate (eGFR) at start was 22.6 (IQR: 14.8–32.8) mL/min×1.73 m2 and 75.0% have an eGFR above 15 mL/min×1.73 m2. Previous history of ischemic heart disease, arrhythmia, or cardiac surgery was recorded, and 57.6% of patients had ≥2 of these pathologies. The most common HF etiology was ischemic heart disease in 21.7% of patients. Median overall patient survival was 21 (IQR: 17.3–24.3) months. Technique survival at 1 year was 94.8%, and 27 patients were transferred to other renal replacement therapy (hemodialysis or kidney transplantation). In the Cox multivariate analysis, age ≥75 years (HR: 1.76 [95% CI: 1.20–2.59]), mild frailty (HR: 2.18 [95% CI: 1.17–2.59]), severe frailty (HR: 17.62 [95% CI: 1.20–55.48]), and the burden of cardiac disease (2 categories HR: 2.17 [95% CI: 1.05–4.47]; 3 categories HR: 2.26 [95% CI: 1.05–4.89]) were associated with poor overall survival. Technique survival was associated with eGFR (<30 mL/min×1.73 m2 HR: 5.64 [95% CI: 1.32–24.18]) and body mass index (<20 kg/m2 HR: 6.53 [95% CI: 1.06–40.12]) at baseline. Conclusion: PD-UF is a feasible option in patients with advanced HF and CRS. The complexity of this population increases with older age, frailty, and higher cardiac burden.M.J.S. received research funding from the Carlos III Health Institute (PI21/01292, PI24/01510). J.L.R. received a Rio Hortega grant from the Instituto de Salud Carlos III (CM23/00213). The authors are also recipients of other research grants from Instituto de Salud Carlos III (AC22/00029) and the Fundació la Marató de TV3 (202017-10, 202037-31, and 202133-30). The Nephrology and Transplantation group is part of the RICORS2040 network (RD21/0005/0016 and RD24/0004/0031) and is recognized as a consolidated group by the Catalan Management Agency for University and Research Grants (2021 SGR 00883)