Annular erythema in primary Sjogren's syndrome: description of 43 non-Asian cases.

OBJECTIVE: The objective of this paper is to evaluate the prevalence and characterize the main epidemiological, clinical and immunological features of annular erythema (AE) in non-Asian patients with primary Sjögren's syndrome (SS). METHODS: We carried out a retrospective study searching for AE in 377 Spanish patients with primary SS fulfilling the 2002 American-European criteria. In addition, we searched PubMed (1994-2012) using the MeSH terms "annular erythema" and "primary Sjögren's syndrome" for additional cases. All cases with AE reported in patients with SS associated with systemic lupus erythematosus were excluded. RESULTS: In our Spanish cohort, we found 35 (9%) patients diagnosed with AE. All were white females, with a mean age of 47 years at diagnosis of AE. AE preceded diagnosis of SS in 27 (77%) patients. Cutaneous AE lesions involved principally the face and upper extremities. All patients reported photosensitivity, with cutaneous flares being reported during the warmest months in 93% of patients. Immunological markers consisted of anti-Ro/La antibodies in 31 (89%) patients. In the literature search, we identified eight additional non-Asian patients with primary SS diagnosed with AE. In comparison with 52 Asian patients, the 43 non-Asian patients with AE related to primary SS were more frequently women (100% vs 78%, p=0.008), and cutaneous lesions were less frequently reported in the face (55% vs 81%, p=0.045) and more frequently in the neck (40% vs 14%, p=0.041). Immunologically, non-Asian patients had a lower frequency of anti-Ro antibodies and a higher frequency of negative Ro/La antibodies, although the differences were not statistically significant. CONCLUSION: AE is not an exclusive cutaneous feature of Asian patients with primary SS. In addition to the characteristic cutaneous expression, AE has a very specific clinical and immunological profile: often presenting before the fulfillment of SS criteria, overwhelmingly associated with anti-Ro antibodies but weakly associated with other immunological markers and the main systemic SS-related features.

Bronchiectasis in primary Sjögren's syndrome: prevalence and clinical significance.

OBJECTIVES: To analyse the prevalence and clinical significance of bronchiectasis in a large series of patients with primary Sjögren's syndrome (SS) and evaluate its impact on disease expression and outcomes. METHODS: The study cohort included 507 patients with primary SS. Bronchiectasis were diagnosed according to pulmonary computed tomography (CT). As a control group, we included 37 consecutive SS patients evaluated by pulmonary CT during the same study period without pulmonary involvement. RESULTS: Fifty primary SS patients had bronchiectasis according to the pulmonary CT. Nine patients were excluded due to non-autoimmune processes and 41 were classified as bronchiectasis associated with primary SS (40 women, mean age of 64 years). All cases of bronchiectasis were of the cylindrical type and were located in the inferior lobes in 29 cases (71%). Patients with bronchiectasis were older at diagnosis of SS (60.39 vs. 52.54 years, p=0.022) and had a higher frequency of hiatus hernia (41% vs. 16%, p=0.024) in comparison with controls. Immunologically, patients with bronchiectasis had a lower frequency of anti-Ro/SS-A antibodies (27% vs. 54%, p=0.022) but a higher frequency of anti-smooth muscle--SMAantibodies (82% vs. 60%, p=0.043). During follow-up, patients with bronchiectasis had a higher frequency of respiratory infections (56% vs. 3%, p<0.001) and pneumonia (29% vs. 3%, p=0.002) in comparison with those without. CONCLUSIONS: Patients with primary SS and bronchiectasis are characterised by an older age, a high frequency of hiatus hernia, a specific immunologic pattern (low frequency of anti-Ro/SS-A and high frequency of anti-SMA) and during follow-up a much higher frequency of respiratory infections and pneumonia.

Venous thromboembolism in patients with advanced cancer under palliative care: additional risk factors, primary/secondary prophylaxis and complications observed under normal clinical practice.

We analyzed the principal risk factors of venous thromboembolism (VTE) (immobilization, recent surgery and previous VTE), prophylaxis with low-molecular weight heparin (LMWH) and complications (i.e. severe bleeding, recurrence and death). Patients with advanced cancer under palliative care (PC) and with VTE, were reviewed during the three years before the study. 71 Patients were diagnosed with VTE. 88.7% were outpatients. The risk factors present were: immobilizations in 28 patients (39.4%), recent surgery in 5 (7%) and previous VTE in 23 (32.5%). Prophylaxis was used in 4 (14.3%) patients with immobilization, no patient with recent surgery, and 10 (43.4%) patients with previous VTE. After diagnosis, all patients received treatment with LMWH in therapeutic dosage. The complications observed were: 6 recurrences (8.5%), 11 VTE-related deaths (15.5%), and bleeding events occured in 8 cases (11.3%), 4 (5.6%) of whom suffered severe bleeding; of these patients, 3 (4.2%) died as a result of the bleeding events. In PC patients with advanced cancer, VTE is a serious complication that conditions control of symptoms. The presence of other risk factors, immobilization and previous VTE, is common and LMWH prophylaxis is limited in clinical practice. The risks vs benefits of anticoagulation need to be counterbalanced.

[Admissions and mortality changes in a third-level care Hospital Internal Medicine Department (1996-2000). Influence of the modifications in the HIV infection treatment]. / Evolución de los ingresos y la mortalidad en un Servicio de Medicina Interna de un hospital de tercer nivel (1996-2000). Influencia de las modificaciones en el tratamiento de la infección por el VIH.

OBJECTIVE: To analyze the impact of highly active anti-retroviral therapy (HAART) on the admissions and mortality of patients with human immunodeficiency virus (HIV) infection and of all patients cared in an Internal Medicine Department. METHODS: A retrospective study with analysis of admissions and deaths in the Internal Medicine Department of a third-level care hospital between January 1996 and December 2000. HAART was introduced starting in 1997. Age, gender, main diagnosis at discharge, diagnosis related group (DRG) weight, death cause, and hospital stay were assessed globally and annually. RESULTS: During the study period 7,580 admissions took place, of which 939 were secondary to HIV infection related diseases. The incidence of HIV-related admissions declined in 32.9% and the case-fatality rate in 67.8% between 1996 and 2000, with increase at the same time of the number of patients with noninfectious respiratory pathology and of overall number of patients with infections. Average hospital stay of patients cared in the Internal Medicine Department remained stable, with reduction of 31.5% of that of the group with HIV infection starting in 1997. DRG complexity in this group decreased 0.56 points. CONCLUSIONS: The introduction of HAART has been associated to a reduction in the incidence of admissions, in the complexity of the diagnoses, and in the mortality in the group of patients with HIV infection. At the same time there was an increased in the number of patients with respiratory and infectious pathology different from that related to HIV.

Evolución de los ingresos y la mortalidad en un Servicio de Medicina Interna de un hospital de tercer nivel (1996-2000). Influencia de las modificaciones en el tratamiento de la infección por el VIH / Admissions and mortality changes in a third-level care Hospital Internal Medicine Department (1996-2000). Influence of the modifications in the HIV infection treatment

Objetivo. Analizar la repercusión de la terapia antirretroviral de gran actividad (TARGA) sobre los ingresos y mortalidad de los pacientes con infección por el virus de la inmunodeficiencia humana (VIH) en particular y sobre un Servicio de Medicina Interna en general. Métodos. Estudio retrospectivo que analiza los ingresos y éxitus producidos en el Servicio de Medicina Interna de un hospital de especialidades entre enero de 1996 y diciembre de 2000. La TARGA se introdujo a partir de 1997. Se valoraron edad, género, diagnóstico principal al alta, peso del grupo relacionado con el diagnóstico (GDR), causa de la muerte y estancia hospitalaria de forma global y distribuidas anualmente. Resultados. Durante el período se produjeron 7.580 ingresos, de los cuales 939 estuvieron producidos por patologías relacionadas con la infección por el VIH. El número de ingresos por VIH disminuyó en un 32,9% y la tasa de letalidad en un 67,8% entre 1996 y 2000, aumentando el volumen de pacientes con patología respiratoria no infecciosa e infecciones en general. La estancia media de los pacientes ingresados en el servicio se mantuvo estable, disminuyendo la del grupo con infección por el VIH un 31,5% a partir de 1997. La complejidad de los GDR en este grupo disminuyó 0,56 puntos. Conclusiones. La introducción de la TARGA se ha relacionado con una disminución en el número de ingresos, complejidad de los diagnósticos y fallecimientos en el grupo de pacientes con infección por el VIH. Ese lugar ha sido ocupado por enfermos con patología respiratoria e infecciosa diferente a la relacionada con el VIH

Objective. To analyze the impact of highly active anti-retroviral therapy (HAART) on the admissions and mortality of patients with human immunodeficiency virus (HIV) infection and of all patients cared in an Internal Medicine Department. Methods. A retrospective study with analysis of admissions and deaths in the Internal Medicine Department of a third-level care hospital between January 1996 and December 2000. HAART was introduced starting in 1997. Age, gender, main diagnosis at discharge, diagnosis related group (DRG) weight, death cause, and hospital stay were assessed globally and annually. Results. During the study period 7,580 admissions took place, of which 939 were secondary to HIV infection related diseases. The incidence of HIV-related admissions declined in 32.9% and the case-fatality rate in 67.8% between 1996 and 2000, with increase at the same time of the number of patients with noninfectious respiratory pathology and of overall number of patients with infections. Average hospital stay of patients cared in the Internal Medicine Department remained stable, with reduction of 31.5% of that of the group with HIV infection starting in 1997. DRG complexity in this group decreased 0.56 points. Conclusions. The introduction of HAART has been associated to a reduction in the incidence of admissions, in the complexity of the diagnoses, and in the mortality in the group of patients with HIV infection. At the same time there was an increased in the number of patients with respiratory and infectious pathology different from that related to HIV