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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2017;149:508-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Late diagnosis of pseudohypoparathyroidism 1b" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "508" "paginaFinal" => "509" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pseudohipoparatiroidismo 1b de diagnóstico tardío" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paloma Iglesias Bolaños, Sonsoles Gutierrez Medina, Laura Bartolomé Hernandez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Paloma" "apellidos" => "Iglesias Bolaños" ] 1 => array:2 [ "nombre" => "Sonsoles" "apellidos" => "Gutierrez Medina" ] 2 => array:2 [ "nombre" => "Laura" "apellidos" => "Bartolomé Hernandez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775317304943" "doi" => "10.1016/j.medcli.2017.06.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317304943?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617306952?idApp=UINPBA00004N" "url" => "/23870206/0000014900000011/v1_201712130718/S2387020617306952/v1_201712130718/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020617307106" "issn" => "23870206" "doi" => "10.1016/j.medcle.2017.10.033" "estado" => "S300" "fechaPublicacion" => "2017-12-07" "aid" => "4236" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2017;149:505-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Warthin-like variant of thyroid papillary carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "505" "paginaFinal" => "506" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma papilar de tiroides variante Warthin-like" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2185 "Ancho" => 2917 "Tamanyo" => 1506029 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histology of Warthin-like papillary carcinoma. (1–3) Haematoxylin–eosin staining, at various magnifications ×10, ×15 and ×30, respectively. The images show a thyroid parenchyma with intense chronic lymphoplasmacytic inflammatory infiltrate (*), which disassociates the thyroid follicles, together with the neoplasm (**) consisting of connective axes lined by cells with large eosinophilic cytoplasm and nuclei with clefts in the nuclear membrane. The surrounding stroma has an intense lymphoplasmacytic inflammatory infiltrate with formation of primary germinal centre lymphoid aggregates. (4) Immunohistochemical staining for cytokeratin 19. The neoplasm (**) shown is intensely positive for cytokeratin 19, characteristic of papillary carcinoma.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Antonio Sánchez Fuentes, Antonio Ríos, José Manuel Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Pedro Antonio" "apellidos" => "Sánchez Fuentes" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Ríos" ] 2 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775317306383" "doi" => "10.1016/j.medcli.2017.07.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317306383?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617307106?idApp=UINPBA00004N" "url" => "/23870206/0000014900000011/v1_201712130718/S2387020617307106/v1_201712130718/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Prognostic value of interleukin-6 for death in patients with sepsis" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "507" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luís Martí Arjona, Asunción Moreno Camacho" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Luís" "apellidos" => "Martí Arjona" "email" => array:1 [ 0 => "lmartiarjona@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Asunción" "apellidos" => "Moreno Camacho" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Infecciones, Hospital Clínic, Barcelona, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor pronóstico de la interleucina-6 en la mortalidad de los pacientes con sepsis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the original article by Luis Alberto Pallás et al<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> regarding the prospective study in patients with sepsis, in whom interleukin-6 (IL-6) and other biomarkers are applied, demonstrating, in a significant way, the high predictive and prognostic power in patients meeting sepsis criteria.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The author quotes from two of our articles,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> which we published a few years ago, comparing their results with ours, regarding the age of the patient and the increase of IL-6 levels with respect to mortality. We are pleased to note interesting similarities between his results and ours, despite notable differences in the sample of patients included.</p><p id="par0015" class="elsevierStylePara elsevierViewall">IL-6 behaves pleiotropically in the body, through endocrine, paracrine and autocrine mechanisms, and is subject to a delicate balance in the inflammatory and anti-inflammatory response. IL-6 is a promoter in the reaction of Acute Phase Proteins, and hepatic precursor of C-reactive protein (CRP). In the same way, it stimulates the synthesis of ACTH in the pituitary gland, with the production of glucocorticoids, which in turn will establish, a negative <span class="elsevierStyleItalic">feedback</span> in the genesis of IL-6, and other cytokines. This balance of the immune and neuroendocrine axes will provide a response on the host regarding the SIRS process. In the elderly patient, there is a qualitative and quantitative deficiency of endogenous pyrogens and the synthesis of prostaglandin E2 among others, and therefore there is a proliferation of cell clones with low affinity for cytotoxic and humoral cell expansion. Their values increase at the beginning of sepsis and consecutively at 3, 5 and 7 days by means of <span class="elsevierStyleItalic">peak levels</span> during the febrile phases, being very useful in the critical patient at 28 days of hospital stay.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> It is a very versatile cytokine in the context of inflammation and in sepsis, being the most widely used cytokine in longitudinal studies to measure morbidity and mortality in the elderly.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Several studies in patients with sepsis and severe trauma showed that the IL-10/TNF-α ratio worsened prognosis in these patients and increased mortality, other studies using the IL-6/IL-10 ratio were predictors of septic <span class="elsevierStyleItalic">shock</span> and multiorgan failure.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Most of these cytokines, as well as various chemokines (IL-8), act in a paracrine manner at the site of the infection, by being subject to an intense blockade of their natural antagonists, such as IL-1 beta and TNF-α, the latter is considered a cytokine with catabolic, neurotoxic and pro-atherosclerotic activity with more deleterious effects on the various inflammatory and systemic mechanisms involved in senile involution.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In our study, IL-6 was significantly higher in patients who died on the fourth day of hospital stay with respect to survivors.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> We are quoted by Kumar et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> in one of their studies, with similar results with respect to IL-6 and mortality in the elderly with sepsis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The current scenario regarding detection and progression of the patient with SIRS is plural and, at times, ambiguous. The unique genetic characteristics of the host and its previous status will, likely, become the future keys to stop the relentless progression of sepsis in this new century.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Louis Pasteur's maxim remains in force «The germ is nothing. The terrain (soil) is everything».</p><p id="par0045" class="elsevierStylePara elsevierViewall">We wish to congratulate Dr. Pallás et al. for their work, and hope they can continue with this line of studies.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-04-20" "fechaAceptado" => "2017-05-11" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martí Arjona L, Moreno Camacho A. Valor pronóstico de la interleucina-6 en la mortalidad de los pacientes con sepsis. Med Clin (Barc). 2017;149:507.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic value of interleukin 6 for death of patients with sepsis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.A. Pallás Beneyto" 1 => "L.O. Rodríguez" 2 => "C. Saiz Sánchez" 3 => "O. Cotell Simón" 4 => "D. Bautista Rentero" 5 => "V. Miguel Bayarri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2016.06.001" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)." 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"fecha" => "2008" "volumen" => "26" "paginaInicial" => "146" "paginaFinal" => "149" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cytokine profile in elderly patients with sepsis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.T. Kumar" 1 => "U. Sudhir" 2 => "K. Punith" 3 => "R. Kumar" 4 => "V.N. Ravi Kumar" 5 => "M.Y. Rao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0972-5229.56052" "Revista" => array:7 [ "tituloSerie" => "Indian J Crit Care Med." "fecha" => "2009" "volumen" => "13" "paginaInicial" => "74" "paginaFinal" => "78" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19881187" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109798004975" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014900000011/v1_201712130718/S238702061730699X/v1_201712130718/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014900000011/v1_201712130718/S238702061730699X/v1_201712130718/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061730699X?idApp=UINPBA00004N" ]
