La hipertensión arterial, ¿factor de riesgo para el síndrome serotoninérgico? / Systemic hypertension: a risk factor for serotonin syndrome?

La relación entre la serotonina y la hipertensión arterial sistémica es controvertida. Se presenta un caso de síndrome serotoninérgico grave por toma de fluoxetina, sin ingesta previao concomitante de drogas reconocidas como precipitantes de síndrome serotoninérgico. Se trata de un hipertenso controlado con cuatro fármacos anihipertensivos. Revisamos la fisiopatología del síndrome serotoninérgico y la relación entre la serotonina yla hipertensión arterial. Concluimos que habrá que considerar a la hipertensión arterial como posible factor de riesgo para el desarrollo de síndrome serotoninérgico (AU)

The relationship between serotonin and systemic hypertension is controversial. We present a case of severe serotonin syndrome in a hypertensive patient controlled with four antihypertensive drugs. The patient had taken no other known drugs related to the serotonin syndrome apart from fluoxetine. The pathophysiology of serotonin syndrome and the relationship between serotonin and systemic hypertension, have been reviewed. We conclude that systemic hypertension will have to be considered as a possible risk factor for the development of serotonin syndrome (AU)

Anticoagulación oral en nonagenarios / Oral anticoagulation in nonagenarians

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Alteraciones metabólicas, VIH y enfermedad vascular / Metabolic alterations, AIDS and vascular disease

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Características funcionales, cognitivas ycomorbilidad de ancianos ingresados / Functional, cognitive and comorbidity characteristics of the hospitalized elderly subjects

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[The Sister Joseph's nodule-like manifestation of carcinoma of unknown origin: presentation of one case]. / Nódulo de la hermana María José como manifestación de cáncer de origen desconocido: presentación de un caso.

The Sister Joseph's nodule represents an umbilical cutaneous metastasis. It is related to one intraabdominal neoplasia habitually. We presents a 71-year-old male, with the Sister Joseph's nodule, detected in the context of unknown origin carcinoma. The fine needle aspiration cytology (FNAC) of the Sister Joseph's nodule showed carcinoma. We comments the usefulness diagnosis of this clinical sign and the poor prognosis that it represents.

Miocarditis por fiebre Q: presentación de un caso / Myocarditis for Q fever: presentation of one case

La miocarditis por Coxiella burnetii es una forma rara depresentación clínica de la fiebre Q aguda, y, al igual que la pericarditis,sola o asociadas, se detecta en alrededor del uno porciento de los casos de fiebre Q aguda. Se presenta un caso demiocarditis por fiebre Q aguda, en un varón de 55 años, que ingresócon clínica de insuficiencia cardíaca congestiva, tras síndromefebril autolimitado. La ecocardiografía reveló un ventrículoizquierdo muy dilatado con hipoquinesia difusa y fracciónde eyección del 45 por ciento. El cateterismo cardíaco confirmódichos hallazgos, siendo las coronarias normales. El estudio serológicofue compatible con fiebre Q aguda. La evolución contratamiento con furosemida, espirolactona, captopril, acenocumaroly doxiciclina fue favorable, y la ecocardiografía al cabode 11 meses puso de manifiesto importante mejoría de las alteracionescardíacas, persistiendo en dicho momento criterios serológicosde fiebre Q aguda

The myocarditis by Coxiella burnetii is a rare form of clinicalpresentation of acute Q fever, and, with the pericarditis, onlyor in association, is detected in one per cent of cases of acute Qfever. A case of myocarditis by acute Q fever is showed, in a man55-year-old who was admitted with congestive heart failure clinical,after self-limited febrile syndrome. The echocardiographyrevealed a very dilated left ventricle with a global decreaseof the mobility and ejection fraction of 45 percent. Thecardiac catheterization confirmed these findings. The coronaryarteries were normal. The serologic study was compatible withacute Q fever. The evolution with treatment with furosemide,spirolactone, captopril, acenocumarol and doxycycline was favourable,and the echocardiography after 11 months showedimportant improvement of the cardiac alterations, persisting inthis moment serology of acute Q fever

Nódulo de la hermana María José como manifestación de cáncer de origen desconocido: presentación de un caso / The sister Joseph´s nodule like manifestation of unknown origin carcinoma: presentation of one case

El nódulo de la hermana María José representa una metástasis cutánea umbilical, relacionada habitualmente con una neoplasia intraabdominal. Se presenta un paciente de 71 años, con el nódulo de la hermana María José, detectado en el contexto de un carcinoma de origen desconocido, que fue diagnosticado por punción aspiración con aguja fina (PAAF) de dicho nódulo. Se comenta la utilidad diagnóstica de dicho signo clínico, y el pobre pronóstico que representa

The Sister Joseph's nodule represents an umbilical cutaneous metastasis. It is related to one intraabdominal neoplasia habitually. We presents a 71-year-old male, with the Sister Joseph's nodule, detected in the context of unknown origin carcinoma. The fine needle aspiration cytology (FNAC) of the Sister Joseph's nodule showed carcinoma. We comments the usefulness diagnosis of this clinical sign and the poor prognosis that it represents

La terapia hormonal sustitutiva: mandan las evidencias / Hormone Replacement Therapy: Evidence is in Command

La terapia hormonal sustitutiva se ha venido utilizando durante décadas no sólopara el control de las manifestaciones del síndrome menopáusico, situación parala que ha demostrado efectividad, sino también, basado en los resultados de diversosestudios observacionales, como intervención preventiva de las enfermedadescardiovasculares, osteoporosis, deterioro cognitivo y demencias, hastaconvertirse en una de las actividades preventivas más frecuentes. Los recientesensayos clínicos randomizados y controlados, especialmente el Women’s HealthInitiative (WHI), han venido a demostrar no sólo la ausencia de beneficio en laprotección cardiovascular –indicación aparentemente más beneficiosa-, sino inclusoun ligero incremento del riesgo coronario y de ictus, con mayor riesgo decarcinoma invasivo de mama, enfermedad tromboembólica y demencia, perocon beneficio en la protección de la fractura osteoporótica y, en menor medida,del carcinoma de colon. En esta revisión se analizan las evidencias actuales sobrelos riesgos y beneficios de la terapia hormonal sustitutiva

Hormone replacement therapy has been successfully used for decades not onlyto control menopausal symptoms, for which is has been proven effective, but also,based on several observational studies, as a primary intervention for cardiovasculardiseases, osteoporosis, cognitive impairment and dementias. As a result,it has become one of the most frequently used preventive measures. Recent randomizedand controlled studies, the WHI in particular, have shown, however,that while hormone replacement therapy does offer protection against osteoporoticbone fractures and, to a lesser extent, colon carcinoma, it does not offercardiovascular protection, supposedly the most beneficial aspect of treatment,observing actually a slight increment of the risk of coronary heart disease,stroke, invasive breast cancer, thromboembolic disease and dementia. In thisreview the current evidences about risk and benefits of hormone replacement therapyare analysed

Nocardiosis in a tertiary care hospital on the island of Gran Canaria.

Background: Nocardiosis is an uncommon but serious infection increasingly found in immunosuppressed persons. We describe 14 cases of nocardial infection seen at a tertiary hospital. Methods: All positive Nocardia cultures isolated from 1991 to 2002 were included. We analyzed predisposing factors, epidemiological and clinical features, laboratory and radiological findings, site(s) of infection, antimicrobial susceptibility pattern, treatment, and outcome. Factors related to mortality were analyzed. Results: Nineteen patients with a Nocardia isolate were identified and 14 were finally included. The most common predisposing factors included pulmonary diseases (71.4%), diabetes mellitus (35.7%), systemic diseases (28.6%) and immunosuppressive therapy (28.6%). The site of infection was pulmonary in 12 cases (85.71%), cutaneous or subcutaneous in one case (7.1%), and disseminated in another case (7.1%). The predominant clinical symptom was purulent expectoration (71.4%) while the predominant radiological pattern was a reticulonodular infiltrate (6/12, 50%). Relapse was observed in one case (7.7%) and death in three cases (23.1%). Diabetes mellitus was associated with the mortality rate (p=0.035). Treatment was highly individualized, but trimethoprim (TMP)-sulfamethoxazole (SMX) was the combination most often used. Conclusions: Nocardiosis should be part of the differential diagnosis for patients presenting with pulmonary symptoms, soft tissue infection, or brain abscess.

Feocromocitoma torácico: presentación de un caso / Thoracic pheochromocytoma: report of one case

Un varón de 54 años ingresó en nuestro hospital para estudio de hipertensión arterial, diabetes y una masa torácica posterior. Había presentado en el curso de los dos meses anteriores crisis de cefaleas, palpitaciones y sudación, y tras crisis hipertensiva se detecta masa torácica en la radiografía de tórax y se decide ingreso para completar estudio. Se realizan diversas técnicas de imagen y estudio bioquímico, concluyéndose que la masa es un feocromocitoma torácico. Tras exéresis de la misma se controla la tensión arterial, desaparece la diabetes y un año después de la cirugía permanece asintomático (AU)

[Diagnostic usefulness of Alcohol Use Disorders Identification Test (AUDIT) for detecting hazardous alcohol consumption in primary care settings]. / Utilidad diagnóstica del cuestionario Alcohol Use Disorders Identification Test (AUDIT) para detectar el consumo de alcohol de riesgo en atención primaria.

BACKGROUND: To evaluate the diagnostic usefulness of AUDIT (Alcohol Use Disorders Identification Test) for detecting hazardous alcohol consumption in primary care settings, to assess the potential differences according to age or sex and to compare its diagnostic value with that of other conventionally used measures (CAGE questionnaire and biological markers). PATIENTS AND METHOD: This is a descriptive cross-sectional study for evaluation of diagnostic tests with 500 participating patients randomly selected among those attending a family health care center. Data about alcohol intake were collected using a semistructured interview, considering as hazardous alcohol consumption a weekly intake of 35 SDUs (standard drink unit) or above for men and 21 for women. AUDIT and CAGE questionnaires were administered and blood levels of GGT, MCV, AST, ALT, alkaline phosphatase, platelets, tryglicerides and uric acid were determined. For each one of those sensitivity, specificity, global value, predictive values, positive and negative probability ratio were calculated as well as ROC analysis for the questionnaires. RESULTS: Sensitivity of AUDIT in detecting current hazardous drinkers was 89%, specificity was 93% and area under ROC was 0.98 (95% CI, 0.96-0.99). Its sensitivity was found to be lower in the female group (60 vs. 78%) as well as for age group under 60 years (86 vs. 100%). CAGE questionnaire showed a sensitivity of 48% and a specificity of 97%. Biological markers offered sensitivities lower than 40% and specificities over 90%. CONCLUSIONS: AUDIT is a useful tool for detecting hazardous alcohol consumption in ambulatory care. Its sensitivity being lower for women and its diagnostic usefulness significantly exceeding that of other screening measures commonly used.

[Genetic polymorphism of vitamin D receptor and osteoporosis]. / Polimorfismo genético del receptor de la vitamina D y osteoporosis.

BACKGROUND: Genetic factors condition an important part of bone mass. The role of vitamin D receptor polymorphism (VDR) as genetic marker of osteoporosis is a matter of discussion. We have studied the possible influence of VDR on bone remodelling, calciotropic hormones, on the presence of osteoporosis and osteoporotic bone fractures. PATIENTS, CONTROL POPULATION AND METHODS: A case-control study. We have studied a total of 127 postmenopausal Canarian women from Canary Islands, Spain; 66 healthy controls and 61 with the diagnosis of osteoporosis, which was made by clinical, radiological and densitometric criteria. 17 osteoporotic women have had a fracture: Colles, hip or vertebral (spinal deformity index) fracture. VDR were determined by PCR directed to demonstrate the presence (b) or absence (B) of a restriction target for Bsml in intron 7. We analyzed some biochemical markers of bone remodelling: serum levels of alkaline phosphatase, tartrate resistant acid phosphatase and urine ratios of calcium/creatinine and hydroxyproline/creatinine. We also determined calciotropic hormones: parathyroid hormone and calcitonin. Bone mass was measured by DEXA and TC. RESULTS: There were no significant differences in either biochemical bone remodelling markers or in bone mass between the three genotypes: bb, Bb and BB, either in controls or in osteoporotic women with the exception of alkaline phosphatase which had a significative increase compared to control in women with unfavorable alleles distribution (bB and BB). Distribution of genotypes was similar between controls and osteoporotic women, with or without fractures. CONCLUSIONS: In Canarian women, VDR genotype is not associated with changes in biochemical markers of bone remodelling or in bone mass or with the presence of osteoporosis or osteoporotic fractures.

Reduction of serum cholesterol and low-density lipoprotein cholesterol levels in a juvenile population after isocaloric substitution of whole milk with a milk preparation (skimmed milk enriched with oleic acid).

OBJECTIVE: To study the effects of serum lipid levels by isocaloric substitution of whole milk intake in a group of children with a milk preparation (fat-free milk enriched with oleic acid containing a small amount of cholesterol) that is frequently consumed in our community. DESIGN: A crossover clinical trial was carried out with random selection. There were 88 children of both sexes, ranging in age from 3 to 9 years, selected at a Primary Care Center. The children were divided into two homogeneous groups. The first group consumed whole milk for the first 7-month study period, whereas the second group drank the milk substitute. At the end of the first test period, serum lipid levels were measured. Then the type of diet was reversed: Group 1 children consumed the milk substitute whereas Group 2 children drank whole milk. The rest of their intake did not vary throughout the study. At the end of the second 7-month period we measured serum lipid levels again. The levels of serum lipid evaluated were total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, Apoprotein A1, Apoprotein B, and lipoprotein (a). For the statistical analysis the nonpaired and paired t tests were used. RESULTS: The mean level of cholesterol after taking whole milk was 4.53 mmol/L (175.26 mg/dl), and the mean level after taking the milk preparation was 4.2 mmol/L (162.65 mg/dl), which indicates a 7.2% decrease. The mean level of low-density lipoprotein cholesterol after whole milk intake was 2.73 mmol/L (106.1 mg/dl), whereas after consuming the milk preparation it was 2.47 mmol/L (96.1 mg/dl), which indicates a decrease of 9.5%. Triglycerides were reduced from 0.83 mmol/L (73.53 mg/dl) after whole milk to 0.72 mmol/L (63.79 mg/dl) after the milk substitute, which suggests a 13.25% decrease. High-density lipoprotein cholesterol, apoprotein A1, apoprotein B, and lipoprotein (a) did not undergo any significant change. CONCLUSIONS: To reduce serum levels of total cholesterol and low-density lipoprotein cholesterol, without reducing caloric intake, it may be beneficial to substitute the whole milk customarily consumed by children with a milk preparation of fat-free milk enriched with oleic acid.

[Distribution of habits related to health in a female Canarian population]. / Distribución de hábitos relacionados con la salud en una población femenina canaria.

BACKGROUND: To compare several anthropometric variables, obesity and some life-style (tobacco, coffee and alcohol consumption and physical activity during leisure time) in women 45 years old and older. METHODS: From the 1991 electoral roll, we obtained a population of 1221 women aged more than 45 years living in the island of Gran Canaria. A questionnaire and a physical examination including weight and height with light clothes was performed in every woman. Obesity was defined according to the Quetelet index, and weight (in kg) divided by height (in m) at square. RESULTS: Rural women aged more than 45 years old are heavier, have a larger corporal surface, have a higher Quetelet index, smoke less and do greater activity during leisure time than urban women the same age. We found no differences either in alcohol or coffee consumption. CONCLUSIONS: There are statistically significant differences between women that live in rural and urban habitats. Anthropometric variables (weight, corporal surface, Quetelet index) show higher values in rural women than in urban ones. On the other hand, tobacco consumption and sadentarism have a higher prevalence in the urban women compared to rural ones.