Influence of state-of-the-art laboratory techniques on the phenotyping of women with polycystic ovary syndrome in the clinical setting.

PURPOSE: Evidence-based guidelines for the management of polycystic ovary syndrome (PCOS) recommend clinical laboratories use liquid chromatography-tandem mass spectrometry (LC-MS/MS) for diagnosing biochemical hyperandrogenism. However, automated immunoassays are still mostly used in routine laboratories worldwide. Another hurdle for PCOS phenotyping in the clinical setting is ultrasound assessment of polycystic ovarian morphology. We address the impact of using state-of-the-art (LC-MS/MS) and of an anti-müllerian hormone (AMH) assay on the diagnosis of PCOS in routine practice. METHODS: In a cross-sectional study, we included 359 premenopausal women consecutively evaluated because of symptoms of functional androgen excess or hyperandrogenemia, and finally diagnosed with PCOS. Patients were submitted to routine phenotyping based on serum androgen measurements by immunoassays and an ovarian ultrasound when necessary. Samples of all patients were also assayed by LC-MS/MS for hyperandrogenemia and for circulating AMH. RESULTS: The observed agreement between immunoassays and LC-MS/MS in identifying hyperandrogenemia was poor [78.0%; k(95%CI): 0.366 (0.283;0.449)]. The observed agreement between ultrasound and increased AMH was 27.3% [(95%CI): 0.060 (0.005; 0.115)]. Using LC-MS/MS changed PCOS phenotypes in 60(15.8%) patients. Fifty-two (18.3%) individuals with hyperandrogenemia by routine immunoassays no longer presented with androgen excess by LC-MS/MS. Overall diagnostic agreement between routine assessment using immunoassays and ultrasound and that derived from LC-MS/MS and the addition of AMH to US was moderate [weighted κ (linear weights): 0.512 (0.416;0.608)]. CONCLUSIONS: Immunoassays used in routine practice are unacceptably inaccurate for phenotyping women with PCOS. Our data cast some doubts upon the interchangeability of serum AMH and ultrasound examination for the diagnosis of PCOS.

Postmenopausal onset of androgen excess: a diagnostic and therapeutic algorithm based on extensive clinical experience.

PURPOSE: Postmenopausal hyperandrogenism is a rare condition that requires identifying those women bearing a life-threatening tumor. We aimed to study diagnostic work-up and management of postmenopausal androgen excess, proposing an algorithm for clinical decision supporting. METHODS: We conducted an observational cross-sectional study and longitudinal follow-up including 51 consecutive menopausal patients reported for hyperandrogenism between 2003 and 2023 to our clinics. We assessed diagnostic testing accuracy and performance by receiver operating characteristic curves, their respective areas under the curve (AUCROC), and 95% confidence intervals (95%CI), for distinguishing between benign and malignant conditions, and androgen excess source. RESULTS: Most commonly, postmenopausal hyperandrogenism derived from benign conditions such as ovarian hyperthecosis (n = 9). However, four (8%) patients had borderline/malignant tumors arising at the ovaries (n = 3) or adrenals (n = 1). These latter were more likely to develop virilization than those with benign disorders [specificity(95%CI)]: 0.87 (0.69; 0.92)]. Circulating total testosterone [AUCROC(95%CI): 0.899 (0.795; 1.000)] and estradiol [AUCROC(95%CI): 0.912 (0.812; 1.000)] concentrations showed good performances for discriminating between both conditions. Transvaginal-ultrasonography found two out of three potentially malignant ovarian neoplasms, and another was apparent on a pelvic computed tomography scan. An adrenal computed tomography scan also located an androgen-secreting carcinoma. CONCLUSIONS: Clinical or biochemical features of an aggressive androgen-secreting tumor should lead to urgently obtaining a targeted imaging. At first, an abdominal-pelvic CT scan represents the best choice to perceive adrenal malignancy, and may identify aggressive ovarian tumors. When warning signs are lacking, a calm and orderly work-up allows properly addressing the diagnostic challenge of postmenopausal hyperandrogenism.

Detección de posible SCACEST (síndrome coronario agudo con elevación del st) mediante KARDIA 6l en la farmacia comunitaria / Detection of possible STEACS (st-elevation acute coronary syndrome) by KARDIA 6l in community pharmacy

PRESENTACION DEL CASO/ANTECEDENTES: Varón, 58 años, fumador activo, hipertenso, dislipémico, diabético insulino-dependiente. De vacaciones en nuestra Comunidad Autónoma, acude a nuestra farmacia refiriendo sensación de atragantamiento, falta de aire y nauseas de 2 horas de evolución, síntomas que van en ascenso, decidiendo consultar en la farmacia por la facilidad para el acceso a la misma y la saturación del Servicio de Urgencias en ese momento.TRATAMIENTO: irbesartan/HCTZ 300mg/25mg (1-0-0); pitavastatina 1 mg (0-0-1); metformina/sitagliptina 1000mg/50 mg (1-0-1); insulina glargina (Lantus) (0-0-18 UI); omeprazol 20 mg (1-0-0).EVALUACION: Tomamos Tensión Arterial: 170/95 mm Hg y realizamos electrocardiograma (ECG) con KARDIA de 6 canales con los siguientes hallazgos: ECG rítmico con QRS ancho y llamativa desnivelación del ST compatible con SCACEST. Al no disponer del resto de derivaciones no se puede asegurar la localización, pero impresiona de infero- posterior.El KARDIA es un monitor portátil de ECG ampliamente validado y único aprobado por la FDA que permite realizar ECG de 1 o 6 derivaciones según el modelo y muy útil como herramienta para detectar arritmias.INTERVENCION: Contactamos con el 061 que acude a la farmacia. Activan CÓDIGO INFARTO.- Administran AAS + ticagrelor + solinitrina iv.-Traslado de Emergencia a la Unidad de Hemodinámica del Hospital General.RESULTADO/SEGUIMIENTO: Yras varios días de ingreso en cardiología es dado de alta con el siguiente tratamiento: Irbesartan/HCTZ 300mg/25 mg (1-0-0); atorvastatina 80 mg (0-0-1); metformina/sitagliptina 1000mg/50 mg (1-0- 1); insulina glargina (Lantus) (0-0-18 UI); omeprazol 20 mg (1-0-0); AAS 100 mg (0-1-0); ticagrelor 90 mg (1-0-1); bisoprolol 2.5 mg (1-0-0). (AU)

Detección de episodio recurrente de fibrilación auricular silente en farmacia comunitaria / Detection of recurrent silent atrial fibrillation in community pharmacies

PRESENTACIÓN DEL CASO: paciente varón, de 68 años, bebedor habitual de 2-3 litros de cervezas diarias, asintomático en el momento actual. El paciente refiere estar anticoagulado con NACO (edoxaban 60 mg (1-0-0)), comenta haber sido cardiovertido eléctricamente hace algo más de un año por episodio de palpitaciones en el contexto de Fibrilación Auricular (FA) rápida de cronología inferior a 24 horas y dado de alta en ritmo sinusal, con flecainida 100 mg (1-0-0) como fármaco mantenedor del ritmo sinusal.EVALUACIÓN: la farmacia pone en marcha un Servicio Profesional Farmacéutico Asistencial (SPFA) de prevención de la enfermedad (detección de enfermedad oculta/riesgo de enfermedad) mediante una campaña gratuita de detección de FA silente. Al paciente le realizamos un electrocardiograma (ECG) con KARDIA de 1 CANAL, monitor portátil de ECG ampliamente validado y único aprobado por la FDA que permite realizar ECG de 1 o 6 derivaciones según el modelo y muy útil como herramienta para detectar arritmias. Se detecta una arritmia de QRS estrecho, no precedidos de Ondas P, con frecuencia ventricular adecuada a 68 sxm (sístoles por minuto): ACxFA (Arritmia Completa por Fibrilación Auricular) con respuesta ventricular adecuada en paciente correctamente anticoagulado y asintomático.INTERVENCION:1. No precisa actuación urgente por nuestra parte dado que es un paciente correctamente anticoagulado y con frecuencia ventricular adecuada en el momento actual. 2. Sí se le aporta el registro del KARDIA para consultar a su Médico de Atención Primaria (MAP) o Cardiólogo de zona en su próxima revisión por si precisa de otras pautas de actuación para evitar la aparición en el futuro de remodelación cardiaca por taqui-miocardiopatía por episodios recurrentes de FA silentes en paciente joven.3. Se le aporta consejo sanitario en relación a la evitación del consumo de alcohol, cardiotóxico conocido. (AU)

Detección de extrasistoles ventriculares y ráfagas de bigeminismo por cardiopatía hipertensiva mediante el uso de kardia 6l en farmacia comunitaria / Detection of ventricular extrasystoles and bigeminy bursts in hypertensive heart disease using kardia 6l in community pharmacies

PRESENTACION DEL CASO/ANTECEDENTES: mujer, 72 años, hipertensa mal controlada, dislipémica, diabética no insulino-dependiente, con mal seguimiento por su Médico de Atención Primaria (MAP) coincidiendo con la pandemia. Acude a nuestra farmacia refiriendo palpitaciones y molestias retroesternales inespecíficas, sin clara relación con el esfuerzo, recurrentes en los últimos días y sintomática a su llegada, que ceden durante su estancia en la farmacia. Tratamiento: losartán 100 mg (1-0-0); amlodipino 5 mg (0-0-1); metformina 850 mg (1-1-1), simvastatina 20 mg (0-0-1); famotidina 20 mg (1-0-0).EVALUACIÓN: tomamos Tensión Arterial: 160/85 mm Hg y realizamos electrocardiograma (ECG) con KARDIA6L. Hallazgos: ritmo sinusal con QRS estrecho, extrasístoles ventriculares, inicialmente aisladas y posteriormente bigeminadas. El KARDIA es un monitor portátil de ECG ampliamente validado y único aprobado por la FDA que permite realizar ECG de 1/6 derivaciones según el modelo y muy útil como herramienta para detectar arritmias.INTERVENCIÓN: Aunque el objetivo inicial del KARDIA en la farmacia es la detección de FA silente como causa tratable de isquemia embolígena en cualquier territorio vascular, dados los factores de riesgo cardiovascular de la paciente y la necesidad de descartar cardiopatía hipertensiva +/- isquémica como sustrato de extrasístoles ventriculares frecuentes derivamos a su MAP para valorar interconsulta con Cardiología, por posible PRM de Problema de salud insuficientemente tratado.RESULTADO/SEGUIMIENTO: 1. Queja formal desde el MAP al Distrito Sanitario por realizar un diagnóstico de sospecha y derivarle a la paciente, finalmente sin consecuencia legal. (AU)

Detección de fibrilación auricular silente en farmacia comunitaria / Detection of silent atrial fibrillation in community pharmacies

PRESENTACION DEL CASO/ANTECEDENTES: paciente varón de 70 años, asintomático, refiere ser fumador activo, hipertenso en tratamiento con enalapril 20 mg (1-0-0) con escaso seguimiento por no acudir a controles de salud.EVALUACIÓN: la farmacia pone en marcha un Servicio Profesional Farmacéutico Asistencial (SPFA) de prevención de enfermedad (detección de enfermedad oculta/riesgo de enfermedad) mediante una campaña gratuita de detección de Fibrilación Auricular (FA) silente. Al paciente le realizamos un electrocardiograma (ECG) con KARDIA de 1 CANAL y tomamos Tensión Arterial: 162/91 mm Hg. El KARDIA es un monitor portátil de ECG ampliamente validado y único aprobado por la FDA que permite realizar ECG de 1 o 6 derivaciones según el modelo y muy útil como herramienta para detectar arritmias.Se detecta una arritmia de QRS estrecho, no precedidos de Ondas P, con frecuencia ventricular adecuada a 71 sxm (sístoles por minuto): ACxFA (Arritmia Completa por Fibrilación Auricular) con respuesta ventricular adecuada en paciente no anticoagulado y asintomático.INTERVENCIÓN: tras detectar un PRM de problema de salud insuficientemente tratado, explicamos al paciente el alto riesgo embolígeno de la arritmia auricular que presenta y la necesidad de iniciar anticoagulación de urgencias.Se aconseja acudir al Servicio de Urgencias de zona para valoración y tratamiento por Médico de Urgencias lo antes posible a pesar de encontrarse asintomático.RESULTADO/SEGUIMIENTO: tras ser valorado por el Dispositivo de Urgencias de Atención Primaria es derivado al Servicio de Urgencias del Hospital de referencia para valoración y tratamiento.Es dado de alta con NACO (edoxaban 60 mg (1-0-0)) y un betabloqueante a dosis baja (bisoprolol 5 mg (1-0-0)) y citado de forma reglada para la Unidad de Arritmias del Hospital de referencia. (AU)

[Influence of constraint-induced movement therapy on childhood hemiparesis with moderate manual dexterity at 16 years of age: a systematic review]. / Influencia de la terapia de movimiento inducido por restricción en hemiparesia infantil con habilidad manual moderada de 2 a 16 años: revisión sistemática.

INTRODUCTION: The deficit of use on the upper limb affects, as well as the quality of movement, influences the execution of a functional grasp (action of grasping-releasing an object) and therefore, reduces the possibilities of execution of the child's daily activities diagnosed with infantile hemiplegia. Manual ability (finger movements, global and distal grasp, handling, precise movement, fluid...) could be a factor that determines whether the execution of constraint induced movement therapy favors the increase in functionality of the upper limb affected. AIM: To study the constraint induced movement therapy influence on the functionality of the affected upper limb in infantile hemiplegia with moderate manual ability from 2 to 16 years of age. PATIENTS AND METHODS: A bibliographic search of the works published between 2014 and 2019 was performed in the PubMed, PEDro and The Cochrane Library databases. RESULTS: After applying the inclusion/exclusion criteria, seven studies were obtained from a total of 203 to be analyzed, comparing constraint induced movement therapy with other interventions. CONCLUSIONS: The results comparison is complex due to the lack of unanimity in the doses application and evaluation tools of the affected segment. The exclusive application of constraint induced movement therapy allows greater benefits in functionality, at the level of manual ability on affected upper limb in infantile hemiplegia with moderate manual ability than conventional therapy or other therapies.

TITLE: Influencia de la terapia de movimiento inducido por restricción en hemiparesia infantil con habilidad manual moderada de 2 a 16 años: revisión sistemática.Introducción. El déficit de uso de la extremidad superior afectada, así como la calidad del movimiento, influyen en la ejecución de un agarre funcional (acción de agarrar-liberar un objeto) y, por tanto, reducen las posibilidades de ejecución de las actividades cotidianas del niño diagnosticado de hemiplejía infantil. La habilidad manual (movimientos de los dedos, agarre global y distal, manipulación, movimiento preciso, fluido…) podría ser un factor que determine si la ejecución de terapia de movimiento inducido por restricción favorece el incremento de la funcionalidad de la extremidad superior afectada. Objetivo. Estudiar la influencia de la terapia de movimiento inducido por restricción en la funcionalidad de la extremidad superior afectada en hemiplejía infantil con una habilidad manual moderada de 2 a 16 años. Pacientes y métodos. Se realizó una búsqueda bibliográfica de los trabajos publicados entre 2014 y 2019 en las bases de datos PubMed, PEDro y The Cochrane Library. Resultados. Tras aplicar los criterios de inclusión y exclusión, se obtuvieron siete estudios, de un total de 203, para ser analizados, en los que se compara la terapia de movimiento inducido por restricción con otras intervenciones. Conclusiones. La comparativa de resultados resulta compleja debido a la falta de unanimidad en la aplicación de dosis y herramientas de evaluación del segmento afectado. La terapia de movimiento inducido por restricción aplicada de manera exclusiva permite mayores beneficios en la funcionalidad en cuanto a destreza manipulativa de la extremidad superior afectada en hemiplejía infantil con habilidad manual moderada que la terapia convencional u otras terapias.

Evaluación de la densidad mineral ósea y de los parámetros de 3D-Shaper en la hipofosfatasia congénita del adulto / Agitated/inattentive children: explanatory models

Objetivo: Evaluar la densidad mineral ósea (DMO) y parámetros de 3D-Shaper a nivel de fémur proximal (FP) en adultos con hipofosfatasia (HPP) confirmada genéticamente y compararlos en aquellos sujetos con y sin fracturas. Material y métodos: Análisis transversal de datos densitométricos y de arquitectura ósea de la visita basal de un estudio longitudinal en el que se incluyeron pacientes con HPP. Se realizó un estudio densitométrico (Lunar Prodigy, GE iDXA) en FP y se empleó el software 3D-Shaper (version 2,7. Galgo Medical). Resultados: Se incluyeron 33 adultos con HPP con mutaciones en heterocigosis. Un 63,6% (21/33) fueron mujeres (42,9% postmenopáusicas), y 8 de los varones (66,6%) fueron mayores de 50 años. La media de edad fue 50,56±15,08 años, el 30,3% (10/33) tuvieron fracturas previas traumáticas, y un 15,2% (5/33), de estrés. La prevalencia de osteoporosis en CF fue del 11,8% (2/17) y de osteopenia, 82,4% (14/17). En premenopáusicas y varones jóvenes se detectó baja masa ósea para la edad en un 12,5% (2/16). Al comparar sujetos con fracturas de estrés y sin ellas, así como con traumáticas, no hubo diferencias en DMO. El 3D-Shaper mostró disminución del grosor cortical (mm) en pacientes con fracturas de estrés [1,8 (1,77-1,89)] frente a sujetos sin ellas [1,94 (1,87-2,03, p=0,03)] y en comparación con los que tuvieron fracturas traumáticas [1,97 (1,88-2,04), p=0,03]. Conclusión: Estos datos reflejan una discreta repercusión densitométrica en formas más leves del adulto. Estudios de arquitectura ósea pudieran resultar de interés para determinar pacientes susceptibles de presentar fracturas de estrés. (AU)

Objetivo: To evaluate bone mineral density (BMD) and 3D-Shaper parameters at the proximal femur (FP) level in adults with genetically confirmed hypophosphatasia (HPP) and to compare them in those subjects with and without fractures. Material and methods: Crosssectional analysis of densitometric data and bone architecture from the baseline visit of a longitudinal study in which patients with HPP were included. A densitometric study (Lunar Prodigy, GE iDXA) was carried out in FP using 3D-Shaper software (version 2.7. Galgo Medical). Results: 33 adults with HPP with heterozygous mutations were included. 63.6% (21/33) were women (42.9% postmenopausal), and 8 of the men (66.6%) were older than 50 years. The mean age was 50.56±15.08 years, 30.3% (10/33) had previous traumatic fractures and 15.2% (5/33) presented stress fractures. The prevalence of osteoporosis in CF was 11.8% (2/17) and of osteopenia, 82.4% (14/17). In premenopausal women and young men, low bone mass was detected for age in 12.5% (2/16). When comparing subjects with and without stress fractures, as well as traumatic ones, there were no differences in BMD. The 3D-Shaper showed a decrease in cortical thickness (mm) in patients with stress fractures [1.8 (1.77-1.89)] compared to subjects without them [1.94 (1.87-2.03, p=0.03)] and compared to those with traumatic fractures [1.97 (1.88-2.04), p=0.03]. Conclusions: These data reflect a discrete densitometric impact in milder forms of the adult. Bone architecture studies could be of interest in determining patients susceptible to stress fractures. (AU)

Nox1-derived oxidative stress as a common pathogenic link between obesity and hyperoxaluria-related kidney injury.

Specific relationships among reactive oxygen species, activation pathways, and inflammatory mechanisms involved in kidney injury were assessed in a combined model of obesity and hyperoxaluria. Male Wistar rats were divided into four groups: Control, HFD (high fat diet), OX (0.75% ethylene glycol), and HFD + OX (combined model) Changes in basal O2- levels were evaluated by chemiluminescence in renal interlobar arteries and renal cortex. Furthermore, the effect of different inhibitors on NADPH-stimulated O2- generation was assessed in renal cortex. Oxidative stress sources, and local inflammatory mediators, were also determined, in parallel, by RT-PCR, and correlated with measures of renal function, urinary biochemistry, and renal structure. Rats from the HFD group developed overweight without lipid profile alteration. Tubular deposits of crystals were seen in OX and severely enhanced in HFD + OX groups along with a significantly higher impairment of renal function. Basal oxidative stress was increased in renal cortex of OX rats and in renal arteries of HFD rats, while animals from the combined HFD + OX group exhibited the highest levels of oxidative stress in renal cortex, derived from xanthine oxidase and COX-2. NADPH oxidase-dependent O2- generation was elevated in renal cortex of the OX group and markedly enhanced in the HFD + OX rats, and associated to an up-regulation of Nox1 and a down-regulation of Nox4 expression. High levels of oxidative stress in the kidney, of OX and HFD + OX groups were also associated to an inflammatory response mediated by an elevation of TNFα, COX-2, NFκB1 MCP-1, and OPN. Oxidative stress is a key pathogenic factor in renal disease associated to hyperoxaluria and a common link underlying the exacerbated inflammatory response and kidney injury found under conditions of both obesity and hyperoxaluria. Nox1 pathway must be considered as a potential therapeutic target.

Anti-inflammatory effects of aloe vera on soy meal-induced intestinal inflammation in zebrafish.

Soybean meal is one of the most promising alternatives to replace fishmeal in the aquaculture industry. However, its ingestion triggers an intestinal inflammatory process that compromises fish health and nutrition. Therefore, finding strategies that reduce the deleterious effects of a soy protein-based diet are relevant. In this work we analyzed the effects of an aloe vera (Aloe barbadensis miller, AV) extract on intestinal inflammation and innate immunity of zebrafish by adding it to the water and by supplementing it in a soybean meal-based diet. To search for potential immunomodulatory effects of AV, we tested its effectiveness in two inflammation assays and compared fish fed with either fishmeal or soybean meal-based feed supplemented with AV. Our results show a strong anti-inflammatory effect of AV. Furthermore, while soy-based meal strongly induces the expression of inflammation markers, supplementation with AV reverted this effect. Finally, we show that fish fed with a soy meal diet are highly susceptible to bacterial infection, but that this condition is significantly reduced when the soy meal is supplemented with AV. Our results suggest that AV is a good candidate to be incorporated as an additive in farmed fish diets to facilitate the replacement of fishmeal by soybean meal, maintaining intestinal health.

Escotoma juncional. A propósito de un caso / Junctional scotoma. A case report

Mujer de 55 años que refiere pérdida visual progresiva en el ojo derecho presenta un escotoma juncional en un estudio campimétrico. Se practica resonancia magnética, que muestra un aneurisma de la arteria cerebral media derecha con compromiso quiasmático ipsolateral

The case concerns a 55 year-old female patient with progressive visual decrease in her right eye that showed a junctional scotoma in the visual field study. A magnetic resonance scan was performed, which showed a right middle cerebral artery aneurysm with ipsolateral chiasmatic involvement

Junctional scotoma. A case report. / Escotoma juncional. A propósito de un caso.

The case concerns a 55 year-old female patient with progressive visual decrease in her right eye that showed a junctional scotoma in the visual field study. A magnetic resonance scan was performed, which showed a right middle cerebral artery aneurysm with ipsolateral chiasmatic involvement.

NETs detection and quantification in paraffin embedded samples using confocal microscopy.

Detection and quantification of Neutrophil Extracellular Traps (NETs) in tissue samples has become a topic of great interest to understand their pathological role in various diseases. We describe a semi-automatic method of visualization and quantification of NETs in paraffin-embedded intracoronary thrombus aspirate samples. This study is based on colocalization of myeloperoxidase (MPO) and citrullinated histone 3 (H3Cit) as hallmark of the presence of NETs. For the analysis we used the confocal immunofluorescence microscopy technology to quantify the number of fields and the total area (in µm2) containing NETs in each thrombus sample. This observer-independent quantification method could be a useful tool to standardize the study of NETs in paraffin-embedded tissues, enabling comparison of results among different laboratories.

Neurorretinopatía autoinmune secundaria a infección por el virus del Zika / Autoimmune neuroretinopathy secondary to Zika virus infection

CASO CLÍNICO: Mujer de 40 años, infectada 6 meses antes de acudir a consulta por el virus del Zika. Dos semanas después comenzó con pérdida de agudeza visual (AV) progresiva e indolora que fue tratada con corticoides tópicos. Su AV mejoró, pero desde entonces refiere pérdida de campo visual (CV) y ceguera nocturna. En la exploración oftalmológica presenta graves secuelas compatibles con neurorretinopatía autoinmune. Dada la relación temporal con la infección por zika se diagnostica de neurorretinopatía autoinmune no paraneoplásica por zika. Se instaura terapia inmunosupresora con bolos de corticoides e infliximab. Discusión: El virus del Zika puede desencadenar una neurorretinopatía autoinmune no paraneoplásica. El diagnóstico es fundamentalmente clínico. Precisa tratamiento inmunosupresor, siendo de máxima importancia el diagnóstico precoz

CASE REPORT: A 40-year-old woman diagnosed with Zika virus infection 6 months before she arrived at this hospital. She referred to a progressive and painless vision loss, of 2 weeks onset after the infection diagnosis. She was treated with topical steroids. Previous visual acuity was recovered, but she still refers to reduced visual field and nyctalopia. Ophthalmologic examination revealed severe retinal sequels, compatible with autoimmune retinopathy. Based on the clinical features and the temporal relationship with Zika virus infection, non-para-neoplastic autoimmune retinopathy was diagnosed and managed with steroids and infliximab. DISCUSSION: Zika virus can trigger a non-para-neoplastic autoimmune retinopathy. The diagnosis is based on clinical features, and requires early immunosuppressive therapy

Glioma de alto grado imitando una encefalitis límbica en la PET/TC con 18F-FDG / High-grade glioma mimicking limbic encephalitis on 18F-FDG PET/CT scan

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Autoimmune neuroretinopathy secondary to Zika virus infection. / Neurorretinopatía autoinmune secundaria a infección por el virus del Zika.

CASE REPORT: A 40-year-old woman diagnosed with Zika virus infection 6 months before she arrived at this hospital. She referred to a progressive and painless vision loss, of 2 weeks onset after the infection diagnosis. She was treated with topical steroids. Previous visual acuity was recovered, but she still refers to reduced visual field and nyctalopia. Ophthalmologic examination revealed severe retinal sequels, compatible with autoimmune retinopathy. Based on the clinical features and the temporal relationship with Zika virus infection, non-para-neoplastic autoimmune retinopathy was diagnosed and managed with steroids and infliximab. DISCUSSION: Zika virus can trigger a non-para-neoplastic autoimmune retinopathy. The diagnosis is based on clinical features, and requires early immunosuppressive therapy.

Metabolic syndrome contributes to renal injury mediated by hyperoxaluria in a murine model of nephrolithiasis.

Metabolic syndrome (MS) individuals have a higher risk of developing chronic kidney disease through unclear pathogenic mechanisms. MS has been also related with higher nephrolithiasis prevalence. To establish the influence of MS on renal function, we designed a murine model of combined metabolic syndrome and hyperoxaluria. Four groups of male Sprague-Dawley rats were established: (1) control group (n = 10) fed with standard chow; (2) stone former group (SF) (n = 10) fed with standard chow plus 0.75% ethylene glycol administered in the drinking water; (3) metabolic syndrome group (MS) (n = 10), fed with 60% fructose diet; (4) metabolic syndrome + stone former group (MS + SF) (n = 10), 60% fructose diet and 0.75% EG in the drinking water. MS group showed a significant injury to renal function when hyperoxaluria was induced. It was demonstrated by a significant decrease of creatinine clearance (p < 0.001), with higher tubular damage (34.3%, CI 95% 23.9-44.7, p < 0.001), produced by deposition of crystals, and increased tubular synthesis of osteopontin as a response to tubular damage. Induction of hyperoxaluria in rats with MS causes severe morphological alterations with a significant impairment of renal function. This impairment is not produced in rats without MS. Therefore, this model can be useful for the study of the influence of MS in stone formation.

Imiquimod 5% tópico como terapia alternativa en carcinoma basocelular periocular en 2 pacientes con contraindicación quirúrgica / Topical imiquimod 5% as an alternative therapy in periocular basal cell carcinoma in two patients with surgical contraindication

CASO CLÍNICOS: Presentamos los casos de dos pacientes con carcinoma basocelular periocular palpebral, que recibieron imiquimod tópico al 5%, con buena respuesta. Ambos presentaban un estado funcional que desaconsejaba el tratamiento quirúrgico. CONCLUSIÓN: La crema de imiquimod al 5% ha demostrado ser una alternativa eficaz al tratamiento quirúrgico de tumores basocelulares perioculares, especialmente en aquellos casos en los que la cirugía no es posible

CLINICAL CASE: The cases are presented of two patients with periocular basal cell carcinoma of the eyelid who received topical imiquimod 5%, with a good response. Both had a functional state that contraindicated surgical treatment. CONCLUSION: Imiquimod cream 5% was shown to be an effective alternative to surgical treatment of periocular basal cell carcinoma, especially in those cases where surgery is not possible

Síndrome oculoglandular de Parinaud: a propósito de un caso / Parinaud’s oculoglandular syndrome: a case report

CASO CLÍNICO: Una mujer de 33 años consulta por conjuntivitis granulomatosa unilateral, adenopatías regionales homolaterales y fiebre. Se demuestra una infección por Bartonella henselae mediante inmunofluorescencia indirecta y se establece el diagnóstico de síndrome oculoglandular de Parinaud. La evolución después de tratamiento con doxiciclina oral es satisfactoria. Discusión: El síndrome oculoglandular de Parinaud es la manifestación ocular más frecuente de una infección por Bartonella henselae

CLINICAL CASE: 33-year old woman presents with unilateral granulomatous conjunctivitis, ipsilateral regional lymphadenopathy and fever. A Bartonella henselae infection is demonstrated by indirect immunofluorescence, and a diagnosis of a Parinaud’s oculoglandular syndrome is established. Outcome after treatment with oral doxycycline is satisfactory. Discussion: Parinaud’s oculoglandular syndrome is the most frequent ocular manifestation of a Bartonella henselae infection