ABSTRACT
OBJECTIVES: To assess the prevalence of the main causes of morbi-mortality in the antiphospholipid syndrome (APS) during a 10-year-follow-up period and to compare the frequency of early manifestations with those that appeared later. METHODS: In 1999, we started an observational study of 1000 APS patients from 13 European countries. All had medical histories documented when entered into the study and were followed prospectively during the ensuing 10â years. RESULTS: 53.1% of the patients had primary APS, 36.2% had APS associated with systemic lupus erythematosus and 10.7% APS associated with other diseases. Thrombotic events appeared in 166 (16.6%) patients during the first 5-year period and in 115 (14.4%) during the second 5-year period. The most common events were strokes, transient ischaemic attacks, deep vein thromboses and pulmonary embolism. 127 (15.5%) women became pregnant (188 pregnancies) and 72.9% of pregnancies succeeded in having one or more live births. The most common obstetric complication was early pregnancy loss (16.5% of the pregnancies). Intrauterine growth restriction (26.3% of the total live births) and prematurity (48.2%) were the most frequent fetal morbidities. 93 (9.3%) patients died and the most frequent causes of death were severe thrombosis (36.5%) and infections (26.9%). Nine (0.9%) cases of catastrophic APS occurred and 5 (55.6%) of them died. The survival probability at 10â years was 90.7%. CONCLUSIONS: Patients with APS still develop significant morbidity and mortality despite current treatment. It is imperative to increase the efforts in determining optimal prognostic markers and therapeutic measures to prevent these complications.
Subject(s)
Antiphospholipid Syndrome/mortality , Lupus Erythematosus, Systemic/mortality , Thrombosis/mortality , Abortion, Spontaneous/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/epidemiology , Child , Child, Preschool , Cohort Studies , Epilepsy/etiology , Female , Fetal Growth Retardation/epidemiology , Humans , Infant , Infant, Newborn , Infections/etiology , Infections/mortality , Ischemic Attack, Transient/etiology , Livedo Reticularis/etiology , Longitudinal Studies , Lupus Erythematosus, Systemic/complications , Male , Middle Aged , Pregnancy , Pregnancy Outcome/epidemiology , Premature Birth/epidemiology , Prospective Studies , Pulmonary Embolism/etiology , Pulmonary Embolism/mortality , Stroke/etiology , Stroke/mortality , Thrombocytopenia/etiology , Thrombosis/etiology , Venous Thrombosis/etiology , Venous Thrombosis/mortality , Young AdultABSTRACT
Mujer de 67 años con antecedentes de hipertensión arterial, dislipemia y diabetes tipo 2 de 6 años de evolución que consulta por fiebre, expectoración purulenta y dolor en costado derecho. Sigue tratamiento con metformina 850mg/12h, glimepirida 4mg/día, candesartan 16mg/día, atorvastatina 10mg/día y ácido acetilsalicílico 100mg/día. En la exploración física destaca presión arterial 90/50mmHg, temperatura 38,6°C, frecuencia cardíaca 112 lpm, frecuencia respiratoria 24rpm, peso 85kg, talla 1,68 m, crepitantes en base pulmonar derecha y ligeros edemas pretibiales. En la analítica se objetiva leucocitosis, glucemia 348mg/dl, urea 70mg/dl, creatinina 1,5mg/dl y HbA1c 8,4%. La radiografía de tórax muestra una condensación en lóbulo inferior derecho. Se inicia tratamiento antibiótico, manteniendo dieta oral desde su ingreso. En relación al tratamiento de la hiperglucemia de esta paciente ¿cuál es la mejor estrategia para su manejo en planta y qué evidencias existen al respecto?(AU)
A 67-year-old woman with a history of hypertension, hyperlipidemia and 6 years of evolution of type 2 diabetes mellitus presented with fever, purulent sputum and right chest pain. She was on treatment with metformin 850mg/bid, glimepiride 4mg/day, candesartan 16mg/day, atorvastatin 10mg/day and acetylsalicylic acid 100mg/day. Standing out in the physical examination was blood pressure 90/50mmHg, temperature 38.6°C, pulse 112/min, respirations 24/min, weight 85kg, height 1.68 m. She had crackling rales in the right lung-base and edema in lower limbs. The blood analysis showed leukocytosis, glucose 348mg/dl, urea 70mg/dl, creatinine 1.5mg/dl and HbA1c 8.4%. A chest x-ray revealed condensation in the lower lobe of the right lung. Antibiotic treatment was begun, maintaining an oral diet from admission. What is the best strategy regarding the treatment of this patient's hyperglycemia, its management and what evidence is there on this subject?(AU)
Subject(s)
Humans , Female , Middle Aged , Hyperglycemia/complications , Hyperglycemia/diagnosis , Hyperglycemia/therapy , Diabetes Complications/diagnosis , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Heart Rate/physiology , Respiratory Rate/physiology , Radiography, Thoracic , Day Care, Medical/methods , Hospitalization/trends , Activities of Daily Living/classificationABSTRACT
A 67-year-old woman with a history of hypertension, hyperlipidemia and 6 years of evolution of type 2 diabetes mellitus presented with fever, purulent sputum and right chest pain. She was on treatment with metformin 850 mg/bid, glimepiride 4 mg/day, candesartan 16 mg/day, atorvastatin 10mg/day and acetylsalicylic acid 100mg/day. Standing out in the physical examination was blood pressure 90/50 mmHg, temperature 38.6 °C, pulse 112/min, respirations 24/min, weight 8 5 kg, height 1.68 m. She had crackling rales in the right lung-base and edema in lower limbs. The blood analysis showed leukocytosis, glucose 348 mg/dl, urea 70 mg/dl, creatinine 1.5mg/dl and HbA1c 8.4%. A chest x-ray revealed condensation in the lower lobe of the right lung. Antibiotic treatment was begun, maintaining an oral diet from admission. What is the best strategy regarding the treatment of this patient's hyperglycemia, its management and what evidence is there on this subject?
