Adjunctive Dexmedetomidine in Alcohol Withdrawal Syndrome: A Systematic Review and Meta-analysis of Retrospective Cohort Studies and Randomized Controlled Trials.

OBJECTIVE: To investigate whether dexmedetomidine (DEX), as adjunctive therapy to benzodiazepine (BZD), is superior to BZD alone in critically ill patients with alcohol withdrawal syndrome (AWS). DATA SOURCES: PubMed Central, Cochrane CENTRAL, ClinicalTrials.gov and Google Scholar were used as search databases. Specific keywords and MeSH terms were "dexmedetomidine," "benzodiazepine," and "alcohol withdrawal syndrome." The last search was on September 16, 2022. STUDY SELECTION AND DATA EXTRACTION: Randomized controlled trials (RCTs) and nonrandomized/cohort studies exploring the use of DEX in the management of AWS were included. A total of 12 studies were included in the systematic review and 7 in the meta-analysis. DATA SYNTHESIS: The intensive care unit length of stay (ICU LOS) was found to have a mean difference (MD) of 48.06 [37.48, 58.64], P = <0.001 for the cohort subgroup, significantly favoring the DEX arm, but, in contrast, pooled RCT data showed a result of -20.07 [-36.86, -3.28], P = 0.02, a shorter ICU LOS for the DEX arm. Bradycardia and hypotension incidence significantly favored the BZD arm in both subgroups. This study compares the effectiveness of adjunctive DEX in clinical practice and aims to help providers in critical decision-making by compiling and analyzing the best current available evidence of its use in AWS. CONCLUSIONS: Based on low to very low level of evidence, adjunctive DEX showed no significant difference for ICU LOS when compared with BZD alone. Pooled randomized trials potentially show a benefit but are similarly limited by their low quality of evidence.

Lupus nephritis with preserved kidney function associated with poorer cardiovascular risk control: A call for more awareness / Nefropatía lúpica con función renal conservada, asociada a un peor control del riesgo cardiovascular: llamada de atención y concienciación

Background: Despite the improvement in the prognosis of lupus nephritis (LN), the cardiovascular morbimortality remains high. The early recognition and remission of flares, while trying to avoid the metabolic adverse effects of medication, must be mandatory. Aim: The aim of our study was to assess the cardiovascular (CV) risk profile in a cohort of lupus patients with preserved kidney function after a nephritis episode, compared to patients without a nephritis flare. Methods: 130 patients diagnosed of SLE (32 with previous nephritis flare and 98 without) were studied in order to evaluate the CV risk profile, despite the preserved kidney function. Results: The most prevalent risk factors were sedentary lifestyle (57.6%), overweight/obesity (38.3%) and dyslipidemia (36%), followed by smoking (32%) and hypertension (16%). Though more than a half (53.1%) was taking CV medication, a high percentage did not reach a therapeutic target value, especially regarding obesity (11.5%) and cholesterol levels (LDL-C of 16%). The prevalence of dyslipidemia (53.1% vs 30.6%), smoking (46.6% vs 27.5%), left ventricular hypertrophy (LVH) (21.4% vs 6.4%) and lower HDL-C (48.6 mg/dL vs 55.4 mg/dL) were significantly different in the group with previous nephritis flare. Moreover, young patients with lupus nephritis, received more pulses of corticosteroids and cyclophosphamide, had higher prevalence of hypertension, LVH, higher proteinuria, hospital admissions and waist circumference, constituting the subgroup of patients with greater aggregation of CV risk factors. Conclusions: Patients with previous nephritis flare showed a poor control of CV risk factors despite the preserved renal function, these patients would require a closer therapeutic management

Antecedentes: A pesar de la mejora en el pronóstico de la nefropatía lúpica (NL), la morbimortalidad cardiovascular sigue siendo elevada. El reconocimiento precoz y la remisión de los brotes, a la vez que los intentos de evitar los efectos metabólicos adversos de la medicación, deben ser de obligado cumplimiento. Objetivo: El objetivo de nuestro estudio fue valorar el perfil de riesgo cardiovascular (RCV) en una cohorte de pacientes de lupus, con función renal conservada tras un episodio nefrítico, en comparación con los pacientes sin brote nefrítico. Métodos: Se estudiaron 130 pacientes diagnosticados de LES (32 con brote nefrítico previo y 98 sin brote), a fin de evaluar el perfil del RCV, a pesar de la función renal conservada. Resultados: Los factores de riesgo con mayor prevalencia fueron el estilo de vida sedentario (57,6%), el sobrepeso/obesidad (38,3%) y la dislipidemia (36%), seguidos del tabaquismo (32%) y la hipertensión (16%). Aunque más de la mitad de los pacientes (53,1%) recibían medicación CV, un elevado porcentaje de ellos no alcanzaba un valor diana terapéutico, especialmente en lo concerniente a obesidad (11,5%) y niveles de colesterol (LDL-C del 16%). La prevalencia de dislipidemia (53,1 vs. 30,6%), tabaquismo (46,6 vs. 27,5%), hipertrofia ventricular izquierda (HVI) (21,4 vs. 6,4%) y bajo HDL-C (48,6 vs. 55,4 mg/dl) fue significativamente diferente en el grupo con brote nefrítico previo. Además, los pacientes jóvenes con nefropatía lúpica recibieron más pulsos de corticosteroides y ciclofosfamida, tuvieron mayores valores de prevalencia hipertensión, HVI, proteinuria, ingresos hospitalarios y perímetro de cintura, constituyendo el subgrupo de pacientes con mayor acumulación de factores de RCV. Conclusiones: Los pacientes con brotes nefríticos previos reflejaron un peor control de los factores de RCV a pesar de la función renal conservada, por lo que estos pacientes requerirían una gestión terapéutica más cercana

Lupus nephritis with preserved kidney function associated with poorer cardiovascular risk control: A call for more awareness.

BACKGROUND: Despite the improvement in the prognosis of lupus nephritis (LN), the cardiovascular morbimortality remains high. The early recognition and remission of flares, while trying to avoid the metabolic adverse effects of medication, must be mandatory. AIM: The aim of our study was to assess the cardiovascular (CV) risk profile in a cohort of lupus patients with preserved kidney function after a nephritis episode, compared to patients without a nephritis flare. METHODS: 130 patients diagnosed of SLE (32 with previous nephritis flare and 98 without) were studied in order to evaluate the CV risk profile, despite the preserved kidney function. RESULTS: The most prevalent risk factors were sedentary lifestyle (57.6%), overweight/obesity (38.3%) and dyslipidemia (36%), followed by smoking (32%) and hypertension (16%). Though more than a half (53.1%) was taking CV medication, a high percentage did not reach a therapeutic target value, especially regarding obesity (11.5%) and cholesterol levels (LDL-C of 16%). The prevalence of dyslipidemia (53.1% vs 30.6%), smoking (46.6% vs 27.5%), left ventricular hypertrophy (LVH) (21.4% vs 6.4%) and lower HDL-C (48.6mg/dL vs 55.4mg/dL) were significantly different in the group with previous nephritis flare. Moreover, young patients with lupus nephritis, received more pulses of corticosteroids and cyclophosphamide, had higher prevalence of hypertension, LVH, higher proteinuria, hospital admissions and waist circumference, constituting the subgroup of patients with greater aggregation of CV risk factors. CONCLUSIONS: Patients with previous nephritis flare showed a poor control of CV risk factors despite the preserved renal function, these patients would require a closer therapeutic management.

Aspectos psicológicos y sociológicos en la alimentación de los deportistas / Psychological and sociological aspects in feeding of the sports

Con el presente artículo queremos describir mediante una revisión bibliográfica los aspectos que caracterizan los hábitos alimentarios en los deportistas y su relación con la optimización del rendimiento y el mantenimiento del estado de salud del deportista. Los factores que influyen en la educación alimentaria del deportista son varios: hábitos alimentarios de la infancia y adolescencia, suplementación en el deporte, trastornos del comportamiento alimentario y deportistas de alto rendimiento deportivo. Se valora principalmente la ingesta de nutrientes y alimentaria de estos, pero se necesitan conocer sus prácticas alimentarias durante entrenamiento-competición. Cobra importancia las recomendaciones de alimentación no realizadas por dietistas-nutricionistas, sino por padres y/o entrenadores que pueden ser incorrectas y perjudicar al deportista. Por ello, ha de considerar la valoración dietético-nutricional para conocer el contexto social del deportista, ayudándonos a realizar la mejor intervención en la mejora de la salud y rendimiento deportivo mediante la alimentación (..) (AU)

In this article, we describe a literature review about the aspects that characterize the food habits in athletes, the athletic performance and the maintenance of health of the athlete. The factors that influence the athlete’s nutritional education are many: food habits of childhood and adolescence, sports supplements, eating disorders and athletes performance. Primarily, the studies evaluated dietary intake of athletes, but they need to (..) (AU)

Com esse estudo pretendemos descreve a través de uma revisão bibliográfica os aspectos de caracterizam os hábitos alimentares de esportistas e a relação com a otimização do rendimento esportivo e a manutenção do estado de saúde dos esportistas. Os fatores que influem na educação alimentar dos esportistas são vários: hábitos alimentares na infância e adolescência, suplementação no esporte, transtornos do comportamento alimentar e esportistas de alto rendimento esportivo. Valoriza principalmente a ingestão de nutriente y alimentar de estes, mas necessita conhecer suas praticas alimentares durante o treinamento e competição. Ganha importância às recomendações de alimentação não realizada por nutricionistas, e sim pelos (..) (AU)

Investigation of TLR5 and TLR7 as candidate genes for susceptibility to systemic lupus erythematosus.

OBJECTIVES: The aim of this study was to evaluate the relevance of genetic variants of TLR5 (rs5744168) and TLR7 (rs179008) gene in systemic lupus erythematosus (SLE) in a Spanish population. MATERIAL AND METHODS: Our study population consisted of 752 SLE patients and 1107 healthy controls. All individual were of Spanish Caucasian origin. The TLR5 and TLR7 polymorphisms were genotyped using a PCR system with pre-developed TaqMan allelic discrimination assay. RESULTS: No statistically significant differences were observed when the allele and genotype distribution of TLR5 rs5744168 and TLR7 rs179008 polymorphisms was compared between SLE patients and healthy controls. A significant increase frequency in the CC genotype of the TLR5 rs5744168 polymorphism among SLE patients without nephritis was found (93% vs. 87% in SLE patients with nephritis, p=0.03, OR=2.11 95%CI 0.93-3.51). However, this difference did not reach statistical significance in the allele frequencies (p=0.08). CONCLUSION: These results suggest that the tested variations of TLR5 and TLR7 genes do not confer a relevant role in the susceptibility or severity to SLE in the Spanish population.

No evidence for genetic association of interferon regulatory factor 3 in systemic lupus erythematosus.

The aim of this study was to determine the potential role of three IRF3 gene polymorphisms (rs2304204, rs7251 and rs2304207) with systemic lupus erythematosus (SLE). Our study population consisted of 610 patients with SLE and 730 healthy controls. All individual were of Spanish Caucasian origin. The IRF3 polymorphisms were genotyped using a PCR system with pre-developed TaqMan allelic discrimination assay. No statistically significant differences were found when allele and genotype distribution of rs2304204, rs7251 and rs2304207 polymorphisms were compared between patients with SLE and controls [overall P values: rs7251, P = 0.06; rs2304204, P = 0.26 and rs2304207, P = 0.36, by chi-squared test on a 3 x 2 contingency table. Overall allelic P values: rs7251, P = 0.8, OR (95%CI) = 1.03 (0.87-1.22); rs2304204, P = 0.2, OR (95%CI) = 1.12 (0.93-1.34) and rs2304207, P = 0.8, OR (95%CI) = 1.02 (0.82-1.26)]. In addition, no evidence of association with haplotypes and clinical features of SLE was found. Our data suggest that the IRF3 polymorphisms do not appear to play a major role in the susceptibility or severity of SLE in a Spanish population.

Síndrome de Wünderlich como primera manifestación de angiolipomatosis renal bilateral / Wünderlich's syndrome as first manifestation of renal bilateral angiolipomatosis

No disponible

Nuevo caso de infección por VIH-2 en la Comunidad Valenciana / New case of HIV-2 in the Valencia Community

No disponible

No disponible

Utilidad de los marcadores tumorales en el diagnóstico de neoplasia asociada a trombosis venosa profunda idiopática / Usefulness of the tumor markers in the diagnose of idiopathic deep venous thrombosis associated cancer

Objetivo: Valorar la utilidad para el diagnóstico de neoplasia de la determinación de un perfil amplio de marcadores tumorales (MT) junto a la evaluación inicial de los pacientes con trombosis venosa profunda (TVP) idiopática. Material y métodos: Estudio prospectivo de 48 pacientes con diagnóstico de TVP idiopática. Se determinó en suero a todos los pacientes: antígeno carcinoembronario, alfa-fetoprotetína, CA 19.9, CA 125, beta2-microglobulina, antígeno de células escamosas, enolasa neuronal específica, antígeno prostático específico en los varones y CA15.3 en las mujeres. Los pacientes fueron evaluados para neoplasia durante el ingreso y seguidos a los 6 y 12 meses. Resultados: La edad media fue de 65 años. En 23 pacientes (48 por ciento) se detectó al menos un marcador elevado. Se diagnosticaron 8 neoplasias (16 por ciento), 4 en el grupo con marcadores elevados y 4 en el grupo con marcadores normales. No apreciamos diferencias significativas en las incidencias de neoplasia entre ambos grupos. Sin embargo, de los 4 casos de neoplasias diagnosticadas en el grupo con marcadores elevados, solo 1 se consideró verdadero positivo puesto que en las otras el marcador elevado no resultó congruente con la neoplasia. Seis neoplasias se diagnosticaron durante el ingreso hospitalario y dos durante el seguimiento. Se obtuvo una sensibilidad del 12 por ciento, una especificidad del 52 por ciento, un valor predictivo positivo del 5 por ciento y un valor predictivo negativo del 75 por ciento. Conclusiones: La incidencia de neoplasia fue similar a la comunicada por otros autores. Encontramos poca sensibilidad y especificidad, y escaso valor predictivo positivo con numerosos falsos positivos. Sin embargo, el valor predictivo del resultado negativo fue del 75 por ciento, con lo que la mayoría de los pacientes con un perfil completo normal de MT y asintomáticos no tuvieron neoplasia al diagnóstico ni durante el tiempo de seguimiento (AU)

[Usefulness of the tumor markers in the diagnosis of idiopathic deep venous thrombosis associated cancer]. / Utilidad de los marcadores tumorales en el diagnóstico de neoplasia asociada a trombosis venosa profunda idiopática.

OBJECTIVE: To evaluate a wide detection of tumor markers practiced during admission for the diagnosis of cancer in patients with idiopathic deep venous thrombosis. MATERIAL AND METHODS: Prospective study including 48 patients with documented DVT who lacked a predisposing cause to DVT. It was determined in serum: carcinoembryonic antigen, alphafetoprotein, CA 19-9, CA 125, beta-2-microglobulin, SCC (squamous cell antigen), NSE (neuron-specific enolase), PSA (prostate-specific antigen) in the males and CA15-3 in the women. The patients were evaluated for cancer during admission and followed up at 6 and 12 months. RESULTS: The age was 65 years. A positive tumor marker at least was detected in 23 patients (48%). A cancer was diagnosed in 8 patients (16%), 4 in the group with elevated tumor markers and 4 in the group with normal tumor markers. We don't find significant differences in cancer incidence between both groups. However, of the 4 cases of cancer diagnosed in the group with elevated markers only 1 was considered true positive since in the others three cases the elevate tumor marker was not appropriated with the cancer diagnosed. Six tumors were diagnosed during admission and two during follow-up period. According to these results was obtained a sensitivity of 12%, a specificity of 52%, a positive predictive value of 5% and a negative predictive value of 75%. CONCLUSIONS: The cancer incidence is similar to previous series. We have found a poor sensitivity, specificity and positive predictive value. However, the negative predictive value was of 75% and the patients who were normals for results of all tumor markers and was asymptomatic during admission hadn't a subsequent cancer diagnosis.

[Primary Kaposi's sarcoma of the penis in a patient with acquired immunodeficiency syndrome]. / Sarcoma de Kaposi primario de pene en un paciente con síndrome de inmunodeficiencia adquirida.

Presentation of one case of a 40 year-old, homosexual, AIDS diagnosed male with extrapulmonary tuberculosis (lymphatic nodes) and prior history of gonococcal urethritis, brain toxoplasmosis, molluscum contagiosum and pneumonia by Pneumocystis carinii. A purpura-type lesion with inflammatory features appeared in the foreskin which was diagnosed as primary Kaposi's sarcoma of the penis. The article explains the clinical signs and symptoms, laboratory data, histological findings, and it reviews the literature.

Pirifibrate in the treatment of hyperlipoproteinemias: a multicenter study.

Pirifibrate, a new hypolipemic substance, was studied in a multicenter trial for three months in 151 patients diagnosed as having type IIa, IIb or IV hyperlipoproteinemia (HLP). The patients admitted into the study had not received any hypolipemic medication for four weeks immediately before the study. We observed falls of between 24.3% and 20.0% in the average levels of plasma cholesterol in types IIa and IIb HLP. The triglycerides showed a decrease in average values, which varied between 31.0% and 38.6% in types IIb and IV HLP. The alpha-lipoproteins always increased in three types of HLP studied, while the pre-beta-lipoproteins showed a fall in averages in types IIb and IV HLP. The beta-lipoprotein levels were reduced in type IIa HLP and reached statistical significance.