ABSTRACT
To analyze the frequency and clinical phenotype of neurosarcoidosis (NS) in one of the largest nationwide cohorts of patients with sarcoidosis reported from southern Europe. NS was evaluated according to the Diagnostic Criteria for Central Nervous System and Peripheral Nervous System Sarcoidosis recently proposed by Stern et al. Pathologic confirmation of granulomatous disease was used to subclassify NS into definite (confirmation in neurological tissue), probable (confirmation in extraneurological tissue) and possible (no histopathological confirmation of the disease). Of the 1532 patients included in the cohort, 85 (5.5%) fulfilled the Stern criteria for NS (49 women, mean age at diagnosis of NS of 47.6 years, 91% White). These patients developed 103 neurological conditions involving the brain (38%), cranial nerves (36%), the meninges (3%), the spinal cord (10%) and the peripheral nerves (14%); no patient had concomitant central and peripheral nerve involvements. In 59 (69%) patients, neurological involvement preceded or was present at the time of diagnosis of the disease. According to the classification proposed by Stern et al., 11 (13%) were classified as a definite NS, 61 (72%) as a probable NS and the remaining 13 (15%) as a possible NS. In comparison with the systemic phenotype of patients without NS, patients with CNS involvement presented a lower frequency of thoracic involvement (82% vs 93%, q = 0.018), a higher frequency of ocular (27% vs 10%, q < 0.001) and salivary gland (15% vs 4%, q = 0.002) WASOG involvements. In contrast, patients with PNS involvement showed a higher frequency of liver involvement (36% vs 12%, p = 0.02) in comparison with patients without NS. Neurosarcoidosis was identified in 5.5% of patients. CNS involvement prevails significantly over PNS involvement, and both conditions do not overlap in any patient. The systemic phenotype associated to each involvement was clearly differentiated, and can be helpful not only in the early identification of neurological involvement, but also in the systemic evaluation of patients diagnosed with neurosarcoidosis.
Subject(s)
Brain/pathology , Central Nervous System Diseases/diagnosis , Central Nervous System/pathology , Peripheral Nerves/pathology , Sarcoidosis/diagnosis , Adult , Aged , Central Nervous System/diagnostic imaging , Central Nervous System Diseases/classification , Central Nervous System Diseases/pathology , Cohort Studies , Cranial Nerves/pathology , Female , Humans , Male , Meninges/pathology , Middle Aged , Sarcoidosis/classification , Sarcoidosis/complications , Sarcoidosis/pathology , Spinal Cord/pathologyABSTRACT
OBJECTIVE: To analyze whether immune-mediated diseases (IMDs) occurs in sarcoidosis more commonly than expected in the general population, and how concomitant IMDs influence the clinical presentation of the disease. METHODS: We searched for coexisting IMDs in patients included in the SARCOGEAS-cohort, a multicenter nationwide database of consecutive patients diagnosed according to the ATS/ESC/WASOG criteria. Comparisons were made considering the presence or absence of IMD clustering, and odds ratios (OR) and their 95% confidence intervals (CI) were calculated as the ratio of observed cases of every IMD in the sarcoidosis cohort to the observed cases in the general population. RESULTS: Among 1737 patients with sarcoidosis, 283 (16%) patients presented at least one associated IMD. These patients were more commonly female (OR: 1.98, 95% CI: 1.49-2.62) and were diagnosed with sarcoidosis at an older age (49.6 vs. 47.5years, P<0.05). The frequency of IMDs in patients with sarcoidosis was nearly 2-fold higher than the frequency observed in the general population (OR: 1.64, 95% CI: 1.44-1.86). Significant associations were identified in 17 individual IMDs. In comparison with the general population, the IMDs with the strongest strength of association with sarcoidosis (OR>5) were common variable immunodeficiency (CVID) (OR: 431.8), familial Mediterranean fever (OR 33.9), primary biliary cholangitis (OR: 16.57), haemolytic anemia (OR: 12.17), autoimmune hepatitis (OR: 9.01), antiphospholipid syndrome (OR: 8.70), immune thrombocytopenia (OR: 8.43), Sjögren syndrome (OR: 6.98), systemic sclerosis (OR: 5.71), ankylosing spondylitis (OR: 5.49), IgA deficiency (OR: 5.07) and psoriatic arthritis (OR: 5.06). Sex-adjusted ORs were considerably higher than crude ORs for eosinophilic digestive disease in women, and for immune thrombocytopenia, systemic sclerosis and autoimmune hepatitis in men. CONCLUSION: We found coexisting IMDs in 1 out of 6 patients with sarcoidosis. The strongest associations were found for immunodeficiencies and some systemic, rheumatic, hepatic and hematological autoimmune diseases.
Subject(s)
Autoimmune Diseases , Sarcoidosis , Sjogren's Syndrome , Cohort Studies , Female , Humans , Male , Odds Ratio , Sarcoidosis/complications , Sarcoidosis/diagnosis , Sarcoidosis/epidemiology , Sjogren's Syndrome/complications , Sjogren's Syndrome/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Glomerulonephritis/physiopathology , Antigen-Antibody Complex , Infectious Mononucleosis/complications , Herpesvirus 4, Human/pathogenicityABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Sjogren's Syndrome/pathology , Acute Kidney Injury/pathology , Cryoglobulinemia/diagnosis , Glomerulonephritis/diagnosis , Biopsy , Purpura/etiologySubject(s)
Acute Kidney Injury/etiology , Cryoglobulinemia/etiology , Glomerulonephritis/etiology , Kidney/pathology , Sjogren's Syndrome/complications , Acute Kidney Injury/pathology , Aged , Azathioprine/therapeutic use , Biopsy , Cryoglobulinemia/drug therapy , Early Diagnosis , Female , Glomerulonephritis/pathology , Humans , Immunosuppressive Agents/therapeutic use , Prednisone/therapeutic use , Pulmonary Fibrosis/diagnostic imaging , Pulmonary Fibrosis/etiology , Rituximab/therapeutic use , Sjogren's Syndrome/pathologyABSTRACT
Fundamentos: Conocer la adecuación del uso de fármacos gastroprotectores en pacientes en tratamiento con bajas dosis de aspirina. Pacientes y método: Analizamos 450 informes de alta de 4 servicios de medicina interna, evaluando la presencia de tratamiento de aspirina y la utilización de protectores gástricos, así como la adecuación del uso de estos últimos según las recomendaciones establecidas tras una revisión de la bibliografía. Resultados: Un total de 57 (63 por ciento) de las 91 prescripciones de aspirina llevaba asociada la prescripción de un gastroprotector. De éstos, 51 (90 por ciento) se consideraron adecuados. Sin embargo, en 24 pacientes (26 por ciento) estaba indicado asociar un gastroprotector, pero no se hizo. Conclusiones: En la cuarta parte de los pacientes analizados tratados con aspirina en bajas dosis y en los que era recomendable la prescripción del algún tipo de antiulceroso, éste no se administró (AU)
Subject(s)
Female , Male , Humans , Protective Agents/therapeutic use , Anti-Ulcer Agents/therapeutic use , Drug Combinations , Aspirin/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Platelet Aggregation Inhibitors/adverse effects , Stomach Diseases/prevention & control , Antacids/therapeutic use , Misoprostol/therapeutic use , Spain , Stroke/drug therapy , Myocardial Ischemia/drug therapy , Proton Pumps/therapeutic useSubject(s)
Hyperthyroidism/etiology , Seaweed , Adult , Antithyroid Agents/administration & dosage , Antithyroid Agents/therapeutic use , Humans , Hyperthyroidism/diagnosis , Hyperthyroidism/drug therapy , Male , Methimazole/administration & dosage , Methimazole/therapeutic use , Tablets , Time FactorsABSTRACT
No disponible
Subject(s)
Middle Aged , Adult , Male , Humans , Seaweed , Substance Withdrawal Syndrome , Magnetic Resonance Imaging , Time Factors , Tablets , Antithyroid Agents , Anti-Anxiety Agents , Methimazole , Alprazolam , Hyperthyroidism , Eosinophilia , Fasciitis , Follow-Up Studies , SeizuresABSTRACT
FUNDAMENTO: Conocer los factores que pueden influir en las estancias inadecuadas en un servicio de medicina interna. PACIENTES Y MÉTODO: Analizamos 1.046 estancias, evaluando su adecuación o no utilizando el protocolo de evaluación de la adecuación. RESULTADOS: Un total de 176 estancias se consideraron inadecuadas (16,8 por ciento). Un análisis de regresión logística reveló que los días de estancia, el día de la semana y el diagnóstico al ingreso son los tres principales determinantes de inadecuación de estancias. CONCLUSIONES: Detectamos la presencia de variables que influyen, al menos parcialmente, en el porcentaje de estancias inadecuadas (AU)
Subject(s)
Middle Aged , Aged , Male , Female , Humans , Hospitalization , Health Services Misuse , Sex Factors , Reproducibility of Results , Logistic Models , Pilot Projects , Prospective Studies , Age FactorsABSTRACT
FUNDAMENTO: Conocer los factores que pueden influir en los ingresos inadecuados en un servicio de medicina interna. PACIENTES Y MÉTODO: Analizamos 1.993 ingresos, evaluando su adecuación utilizando el Protocolo de Evaluación de la Adecuación. RESULTADO: Un total de 187 ingresos se consideraron inadecuados (9,4 por ciento). La probabilidad de ingreso inadecuado era mayor si el paciente tenía menos de 65 años (OR, 1,94; IC del 95 por ciento, 1,32-2,85) o si el ingreso era programado desde consultas externas (OR, 10,58. IC del 95 por ciento, 2,79-40,1). Además, el diagnóstico clínico influía en dicha inadecuación. CONCLUSIONES: La edad, el diagnóstico y la procedencia del ingreso influyen en la inadecuación de los ingresos producidos en nuestro servicio (AU)
Subject(s)
Middle Aged , Aged , Male , Female , Humans , Spain , Patient Admission , Internal Medicine , Health Services MisuseABSTRACT
No disponible