Jose M. Ricart

Vacuna antigripal y personal sanitario: estrategias para aumentar las coberturas en un hospital de tercer nivel

BACKGROUND: The effectiveness of immunization of health-care workers (HCWs) to reduce nosocomial transmission of influenza is well established. The objective of this study is to evaluate HCWs vaccination rates in a tertiary hospital. PATIENTS AND METHOD: Data of influenza immunization rates among HCWs during two consecutive campaigns have been examined. A descriptive analysis of coverage by age, sex, occupation and job areas is performed. RESULTS: Vaccination rates ranged from 12.7 to 14.7%. Vaccine acceptance among medical residents was significantly higher than in other occupation categories (31.5 and 25.5%, respectively). HCWs at maternal and pediatric areas showed higher immunization rates. CONCLUSIONS: Despite active immunization campaigns, influenza vaccination rates among HCWs are quite low.BACKGROUND The effectiveness of immunization of health-care workers (HCWs) to reduce nosocomial transmission of influenza is well established. The objective of this study is to evaluate HCWs vaccination rates in a tertiary hospital. PATIENTS AND METHOD Data of influenza immunization rates among HCWs during two consecutive campaigns have been examined. A descriptive analysis of coverage by age, sex, occupation and job areas is performed. RESULTS Vaccination rates ranged from 12.7 to 14.7%. Vaccine acceptance among medical residents was significantly higher than in other occupation categories (31.5 and 25.5%, respectively). HCWs at maternal and pediatric areas showed higher immunization rates. CONCLUSIONS Despite active immunization campaigns, influenza vaccination rates among HCWs are quite low.

Fibrinolytic inhibitor levels and polymorphisms in Behçet disease and their association with thrombosis

This study aimed to assess the fibrinolytic inhibitors and their association with thrombosis in Behçet disease. Thrombin activatable fibrinolysis inhibitor (TAFI) (P < 0·001) and plasminogen activator inhibitor‐1 (PAI‐1) levels (P = 0·022) were significantly higher in 79 patients than in 84 controls. No significant differences were observed in CPB2 (TAFI) Thr325Ile and SERPINE1 (PAI1) 4G/5G polymorphism distribution between patients and controls. TAFI activity levels were significantly higher in patients with thrombosis than in those without thrombosis (P = 0·024). In conclusion, the increased TAFI levels in Behçet disease could contribute to the increased risk of thrombosis observed in these patients.

Enfermedad de Behçet: estudio de 74 pacientes

Fundamento y objetivo: La enfermedad de Behcet (EB) es una entidad clinica poco prevalente en Espana. Son escasos los articulos publicados sobre datos epidemiologicos y manifestaciones clinicas en nuestro pais. El objetivo del presente estudio ha sido conocer las caracteristicas de las manifestaciones clinicas de la EB en la Comunidad Valenciana. Pacientes y metodo: Se recogieron datos de los pacientes diagnosticados entre 1990 y 2005 de EB en los Hospitales Universitarios La Fe, General y Doctor Peset de Valencia. Todos los pacientes cumplian los criterios diagnosticos del Grupo de Estudio Internacional para el diagnostico de la EB. Las diferencias entre sexos se analizaron mediante el test de la *2. Resultados: Formaron el grupo de estudio 74 pacientes (40 varones y 34 mujeres). Las manifestaciones clinicas mas frecuentes fueron las aftas orales (98,5%) y genitales (82,4%), seguidas de las cutaneas (64,2%), oculares (42,5%), fiebre (39,4%) y vasculares (28,4%), con predominio de las trombosis venosas sobre las arteriales. Solo las manifestaciones gastrointestinales fueron mas frecuentes en el sexo femenino (p = 0,002). Las alteraciones vasculares y oculares fueron mas graves en los varones. En cuanto a la prevalencia de los factores de riesgo cardiovascular, el 32,4% de los pacientes eran fumadores, un 20,3% presentaba hiperlipemia; un 19%, hipertension; un 13,5%, obesidad, y un 9,5%, diabetes, aunque no se observo asociacion entre estos y los episodios tromboticos ni la uveitis posterior (p > 0,05). Conclusiones: Los resultados obtenidos fueron similares a los de otras areas geograficas. Destacan la mayor frecuencia de manifestaciones digestivas en mujeres y el predominio de los episodios tromboticos venosos sobre los arteriales. Los factores de riesgo cardiovascular no parecen desempenar un papel en el desarrollo de episodios tromboticos ni uveitis posterior en estos pacientes.

Mean platelet volume does not seem to relate to thrombosis or posterior uveitis in Behçet's disease

Behçets disease (BD) is a chronic inflammatory disorder in which thrombosis and posterior ocular involvement occur in about 30% of patients, whose ethiology is unknown. It has not been established whether mean platelet volume (MPV), a marker of platelet activation, is involved in the pathogenesis of thrombotic events and posterior uveitis in these patients. We aimed to analyze whether there are differences in MPV in BD patients when compared with controls and its relation with the presence of thrombosis and posterior uveitis. We determined MPV and platelet count, along with C-reactive protein (CRP) and cardiovascular risk factors (because of their influence on MPV) in 89 BD patients (of which 24 had thrombosis and 23 had posterior uveitis) and 89 sex- and age-matched healthy controls. BD patients showed statistically higher MPV than controls: 10.98 ± 1.19 fL vs. 10.60 ± 1.21 fL (P = 0.044) and higher CRP: 5.9 ± 8.9 mg/L vs. 1.4 ± 1.7 mg/L (P = 0.001). The percentage of hyperlipemia and diabetes was higher in cases than in controls (P = 0.032, P = 0.013, respectively). No differences in MPV were observed when comparing: patients with and without thrombosis: 11.8 ± 1.27 fL vs. 10.94 ± 1.28 fL (P = 0.654); with and without posterior uveitis: 10.76 ± 1.18 fL vs. 11.03 ± 1.30 fL P = 0.398; with CRP and cardiovascular risk factors (P > 0.05). MPV correlated negatively with platelet count (r = -308, P < 0.01), but not with CRP (r = -0.22, P = 0.772). MPV seems to relate to neither thrombosis nor posterior uveitis in BD patients.

Rheological alterations and thrombotic events in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is characterised by increased venous and arterial thrombotic risk. Nevertheless, how hemorheological alterations contribute to thrombotic risk remains a question of debate. We aimed to determine the rheological profile in 105 patients with SLE (24 with a thrombotic event) and 105 healthy controls. We determined blood viscosity and erythrocyte aggregation along with plasma lipids and fibrinogen. Although SLE patients showed lower blood viscosity at 230 s(-1) at a native hematocrit when compared with controls (p < 0.001), differences disappeared after adjusting the hematocrit to 45% (p = 0.095). When comparing SLE patients with and without thrombotic events, no differences in any rheological parameter were found (p > 0.05), except in fibrinogen which was higher in patients with thrombosis (p = 0.013). No differences in the rheological parameters were observed when venous and arterial thrombotic events were compared, although a tendency for higher fibrinogen was observed in patients with venous thrombosis (p = 0.053). Only hematocrit, fibrinogen and triglycerides were independent predictors of native blood viscosity in the multivariate regression analysis, even after adjusting for continuous variables and for tobacco and hypertension: beta coefficient: 0.727 p < 0.001; beta coefficient: 0.152 p = 0.003 and beta coefficient: 0.133 p = 0.015, respectively. The logistic regression analysis revealed that neither increased native blood viscosity (BVn > 4.33) nor increased erythrocyte aggregation (EA1 > 7.85) increased thrombotic risk: OR 0.636, CI 0.313-3.12, p = 0.578 and OR 2.01, CI 0.77-5.20, p = 0.152, respectively. However, hyperfibrinogenemia (Fbg > 342 mg/dL) increased thrombotic risk by around three times: OR 3.44 CI 1.32-8.96, p = 0.011. Our results suggest that the role of blood viscosity and erythrocyte aggregation in thrombotic risk in SLE patients fails to demonstrate any association.

Haematological, biochemical and inflammatory parameters in inactive Behçet's disease. Its association with red blood cell distribution width

Red blood cell distribution width (RDW) has been shown to be associated with disease activity in several inflammatory disorders. However only one study to show this has been conducted in patients with Behçets disease (BD). The aim of the present study was to analyse the association of RDW with BD and its main complications; i.e.; thrombosis and posterior uveitis. A second aim was to analyse the possible correlation between RDW and both haematological and inflammatory parameters. Eighty-nine patients with BD (48 males/41 females) and 94 controls (49 males/45 females) were included in the study. Patients were in an inactive phase of the disease, showing only minimum activity. RDW was statistically higher in patients than in controls (14.02 ± 1.32 vs. 13.15 ± 0.75; p < 0.001) as were CRP, fibrinogen, leucocytes and neutrophils (p < 0.001). No differences in haematimetric indices (MCV, MCH, MCHC) were observed (p > 0.05). RDW correlated negatively with haemoglobin, MCH and MCHC (p < 0.05), and directly with homocysteine (p < 0.01). No correlation was found between RDW and the several inflammatory parameters analysed (p > 0.05). The multivariate regression analysis revealed that haemoglobin and homocysteine were independent predictors of RDW (beta coefficient: -0.310; p = 0.003, beta coefficient: 0.379; p < 0.001, respectively). RDW >14 was associated with neither thrombosis nor uveitis (p = 0.935; p = 0.553, respectively). Our results indicate that BD patients show increased RDW when compared with controls. This increase seems to be related with haematimetric indices and with homocysteine levels. Lack of correlation with inflammatory markers may be due to the fact that patients were in an inactive phase of the disease.

Hemorheological profile in primary and secondary Raynaud's phenomenon. Influence of microangiopathy

Raynauds phenomenon (RP) is an episodic peripheral circulatory disorder characterized by local artery spams in subjects exposed to cold or emotional stress. It is not well-established whether RP patients show an altered rheological profile, mostly due to patient classification and clinical severity. We aimed to compare the hemorheological profile in patients with primary and secondary RP with a healthy control group. Eighteen primary RP, 22 secondary RP and 22 healthy controls, were included in the study. RP patients were also divided according to the presence of digital ulcers (7 with, 33 without). Biochemical and hemorheological variables were analyzed, including glucose, triglycerides, total-cholesterol, immunoglobulins, fibrinogen, plasma viscosity, erythrocyte aggregation, erythrocyte deformability and blood viscosity. Age was higher in secondary RP as compared with primary (p = 0.049), while glucose, triglycerides IgA, IgG and plasma viscosity were higher in secondary RP than in healthy subjects (p < 0.05). RP patients with digital ulcers presented higher IgA (p = 0.012), lower erythrocyte aggregation time (p = 0.008) and a trend for higher fibrinogen levels and plasma viscosity (p = 0.064, p = 0.069, respectively). The results of the present study indicate that secondary RP patients show a mild impairment of the rheological profile that aggravates with microangiopathy severity.

Thrombotic events in systemic lupus erythematosus. Its association with acquired and inherited thrombophilic defects

Systemic lupus erythematosus (SLE) is characterised by increased venous and arterial thrombotic risk. Although antiphospholipid antibodies (APAs) have been shown to be related with thrombotic tendency in these patients, in more than 40% of them, thrombosis occurs without the presence of such antibodies. We analysed the association of venous and arterial thrombotic events with acquired (anticardiolipin antibodies (ACAs) and lupus anticoagulant (LA)) and inherited (antithrombin (AT), protein C (PC), protein S (PS) deficiencies, factor V Leiden and the prothrombin G20210A mutation), thrombophilic risk factors in 86 SLE patients and 89 healthy controls. Patients showed a higher significant percentage of ACAs titres IgG>41 GPL u/ml and LA than controls (P=0.009; P<0.001, respectively), although no differences in AT, PC, PS deficiencies, factor V Leiden and prothrombin G20210A mutation was observed (P>0.05). When patients with and without thrombosis were compared, those with thrombosis showed a statistically higher percentage of ACAs IgG>41 GPL u/ml and LA (P=0.048; P=0.001, respectively), OR 4.33; 95% CI 1.01-18.50 and OR 11.57; 95% CI 3.28-40.75, respectively. When venous and arterial thrombotic events were considered separately, the presence of LA constituted a risk factor for arterial thrombosis (P=0.010), OR 11.33; 95% CI 1.86-68.89, as well as for venous thrombosis (P=0.005), OR 10.15; 95% CI 2.12-48.64, while ACAs IgG>41 GPL u/ml on their own, were not associated with arterial or venous thrombosis (P=0.142, P=0.233, respectively). In addition inherited thrombophilic risk factors AT, PC, PS deficiencies, factor V Leiden and PT G20210A mutation do not seem to increase thrombotic risk in SLE patients.

Increased circulating endothelial cells and microparticles in patients with psoriasis

INTRODUCTION Psoriasis is a chronic pathology characterized by increased inflammation that can be associated with changes in the vascular endothelium. We quantified the levels of circulating endothelial cells (CECs) and microparticles (MPs) in patients with psoriasis in order to analyze their relationship with endothelial and inflammation markers, subclinical atherosclerosis and microcirculation. METHODS We studied 20 patients and 20 controls. Circulating markers of endothelial damage (CEC, MPs and von Willebrand factor, vWF) and inflammation (E-selectin, E-sel; Interleukin-6, IL-6 and C-reactive protein, CRP) were determined. Subclinical atherosclerosis was assessed by carotid ultrasound to obtain intima-media thickness. Microcirculation was evaluated by nailfold capillaroscopy. RESULTS CECs, MPs, vWF, CRP and E-sel levels were significantly elevated in patients when compared with controls (p <  0.05). Ninety-four and fifty-three percentage of patients had CEC and MP levels higher than 99th percentile in controls. Forty-seven percent of patients simultaneously showed increased CEC and MP levels. MPs correlate with the inflammatory markers and with the intima-media thickness. CECs correlate with the capillaries loops per mm (p <  0.05). CONCLUSION Psoriasis patients show elevated CECs and MPs, as a sign of endothelial dysfunction, which correlates with inflammatory markers as well as subclinical atherosclerosis and some capillaroscopy findings.

Homocysteine levels in patients with primary and secondary Raynaud's phenomenon. Its association with microangiopathy severity.

The association between hyperhomocysteinemia (HHcy) and Raynauds phenomenon (RP) remains a matter of debate. In 18 primary RP, 23 secondary RP and 41 controls, we investigated homocysteine (Hcy) levels along with biochemical and inflammatory parameters. The Hcy levels in both primary and secondary RP were elevated when compared with controls (p < 0.05 and p < 0.01, respectively). As age was higher in secondary RP as compared with controls (p < 0.01), both primary and secondary RP were age-matched with a corresponding control group, and with Hcy maintaining its statistical significance (p < 0.05). No differences in creatinine, B12 vitamin or folic acid were observed between groups (p > 0.05), or in the prevalence of cardiovascular risk factors (p > 0.05). When patients were classified according to presence or absence of digital ulcers, as a sign of microangiopathy severity, the former showed higher Hcy levels than the latter (p = 0.035). Our results indicate that both primary and secondary RP patients show a mild increase in Hcy levels, which is not related to age, vitamin deficiencies or impaired renal function, but is related to microangiopathy severity. Therefore the association of HHcy and RP suggest that Hcy may contribute to endothelial dysregulation, which characterizes this disease. Specific studies should be designed to elucidate the pathogenesis of HHcy in these patients.