[Cholestasis, delirium and pulmonary nocardiosis in a man with systemic lupus erythematosus of late onset]. / Colestasis, delirium y nocardiosis pulmonar en un varón con lupus eritematoso sistémico de inicio tardío.

A case is presented of a 64-year-old male patient who was admitted because of delirium, jaundice, a pattern of cholestasis in the liver profile and a right lung mass in the context of a constitutional syndrome and weight loss in the last eight months. The lung mass was punctured and the culture of the obtained material developed white colonies, identified by mass spectrometry (MALDI-TOF) as Nocardia cyriacigeorgica. Regarding the clinical diagnosis, it was considered as systemic lupus erythematosus (SLE), on the basis of fulfilling 8 criteria according to SLICC 2012 group, and 24 points according to EULAR/ACR 2019. The liver biopsy showed a mixt cellular infiltrate in portal spaces, with absence of interphase hepatitis and presence of peripheral ductular reaction. These findings were interpreted as liver compromise relate to SLE. Delirium was also considered as a neurological manifestation related to SLE on the basis of ruling out other causes. After being treated with antibiotics and documenting a reduction in the size of the lung mass he received cyclophosphamide in intravenous pulses, achieving normalization of his liver profile and his state of consciousness, and a progressively weight recovering. A year after he was in good health. The report of this case is justified because of the rare presenting form of late onset SLE, as well as the concomitant pulmonary nocardiosis in the absence of previous immunosuppressant treatment.

Se presenta el caso de un varón de 64 años que fue internado por delirium asociado a ictericia con patrón de colestasis en el hepatograma, y una masa en el pulmón derecho en el contexto de pérdida de peso y síndrome constitucional de 8 meses de evolución. Se realizó punción de la masa pulmonar cuyo cultivo desarrolló colonias blanquecinas identificadas como Nocardia cyriacigeorgica por espectrometría de masas (MALDI-TOF MS). Se llegó al diagnóstico de lupus eritematosos sistémico (LES) por presentar 8 de los criterios de acuerdo con el grupo SLICC 2012 y 24 puntos de acuerdo a los criterios EULAR/ACR 2019. La biopsia hepática mostró leve y variable infiltrado inflamatorio mixto en espacios porta, con ausencia de hepatitis de interfase y presencia de reacción ductular periférica. Se interpretaron estos hallazgos como vinculados a hepatopatía por LES. El delirium fue interpretado como afectación neurológica por LES en base al descarte de otras enfermedades. Recibió tratamiento antibiótico y tras constatarse reducción del tamaño de la masa pulmonar se administraron pulsos de ciclofosfamida intravenosa. Evolucionó favorablemente, con normalización del hepatograma y el estado de conciencia, y recuperación del peso en forma progresiva. Al año se lo encontró en buen estado de salud. Justifica el reporte del caso la rara forma de presentación del LES de comienzo tardío, así como la nocardiosis pulmonar concomitante sin tratamiento inmunosupresor previo.

Polypharmacy and Drug Interactions in the COVID-19 Pandemic.

The COVID-19 pandemic generated a great impact on health systems. We compared evolution, polypharmacy, and potential drug-drug interactions (P-DDIs) in COVID-19 and non-COVID-19 hospitalizations during first wave of pandemic. Prescriptions for hospitalized patients ≥ 18 years (COVID-19 and non-COVID-19 rooms) between April and September 2020 were included. The computerized medical decision support system SIMDA and the physician order entry system Hdc.DrApp.la were used. Patients in COVID-19 rooms were divided into detectable and non-detectable, according to real-time reverse transcription polymerase chain reaction (RT-PCR). Number of drugs, prescribed on day 1, after day 1, and total; polypharmacy, excessive polypharmacy, and P-DDIs were compared. 1,623 admissions were evaluated: 881 COVID-19, 538 detectable and 343 non-detectable, and 742 non-COVID-19. Mortality was 15% in COVID-19 and 13% in non-COVID-19 (RR [non-COVID-19 vs. COVID-19]: 0.84 [95% CI] [0.66-1.07]). In COVID-19, mortality was 19% in detectable and 9% in non-detectable (RR: 2.07 [1.42-3.00]). Average number of drugs was 4.54/patient (SD ± 3.06) in COVID-19 and 5.92/patient (±3.24) in non-COVID-19 (p<0.001) on day 1 and 5.57/patient (±3.93) in COVID-19 and 9.17/patient (±5.27) in non-COVID-19 (p<0.001) throughout the hospitalization. 45% received polypharmacy in COVID-19 and 62% in non-COVID-19 (RR: 1.38 [1.25-1.51]) and excessive polypharmacy 7% in COVID-19 and 14% in non-COVID-19 (RR: 2.09 [1.54-2.83]). The frequency of total P-DDIs was 0.31/patient (±0.67) in COVID-19 and 0.40/patient (±0.94) in non-COVID-19 (p=0.022). Hospitalizations in the COVID-19 setting are associated with less use of drugs, less polypharmacy and less P-DDIs. Detectable patients had higher mortality.

Development and Implementation of the Hdc.DrApp.la and SIMDA Programs to Reduce Polypharmacy and Drug-drug Interactions in Patients Hospitalized in Internal Medicine.

OBJECTIVES: We evaluated polypharmacy and possible drug-drug interactions (p-DDIs) in hospitalized patients before and after using the SIMDA Computerized Medical Decision Support System (CMDSS). MATERIALS AND METHODS: We included the prescriptions of ≥ 18 years hospitalized patients in the internal medicine department. We developed and implemented the Hdc.DrApp Physician Order Entry System and the CMDSS SIMDA, which detects p-DDIs and signals dosage adjustment based on renal function. To evaluate the impact of the CMDSS, we made a comparison Before (Survey) / After (Intervention): Survey between Oct/22/2019, and Mar/21/2020, and Intervention between Apr/4/2020 and Sep/3/2020. We analyze prescriptions from the first day and after the first day. We compared the number of drugs, polypharmacy (≥ 5 drugs), excessive polypharmacy (≥ 10 drugs), and p-DDIs. We evaluated differences with the X2 test, Yates correction, Fisher's exact test, ANOVA, and post hoc tests according to their characteristics. RESULTS: We evaluated 2,834 admissions: Survey 1,211 and Intervention 1,623. The number of drugs per patient was 6.02 (± 3.20) in Survey and 5.17 (± 3.22) in Intervention (p < 0.001) on the first day and 9.68 (± 5.60) in Survey and 7.22 (± 4.93) in Intervention (p < 0.001) throughout the hospitalization. Polypharmacy was present in 64% of the Survey and 53% of Interventions (RR: 0.83 (0.78-0.88); and excessive polypharmacy in 14% of the Survey and 10% of Intervention (RR: 0.73, 0.60-0.90). The frequency of total p-DDIs was 1.91/patient (± 4.11) in Survey and 0.35 (± 0.81) in the Intervention (p < 0.001). CONCLUSIONS: We developed and implemented the Hdc.DrApp and SIMDA systems that were easy to use and allowed us to quantify and reduce polypharmacy and p-DDIs.

Type-I Cryoglobulinaemia Associated to Monoclonal Gammapathy of Undetermined Significance.

Cryoglobulins are immunoglobulins that undergo reversible precipitation at cold temperatures. Monoclonal type-I cryoglobulinaemia is the least frequent and is associated to hematological diseases such as multiple myeloma, Waldenström's macroglobulinaemia, chronic lymphocytic leukaemia and lymphoma. We describe the case of a 60-year-old female patient, who suffered from burning pain in her feet for ten months before her admission. The patient presented intermittent distal cyanosis that progressed to digital ischaemia. She also reported paresthesia in her hands, difficulty in writing, and a 26-kg-weight loss. At the physical examination, it was identified livedo reticularis, palpable purpura, and painful ecchymotic lesions in her calves and feet. Moreover, peripheral pulses were palpable and symmetrical. It was observed an atrophy of the right first dorsal interosseous and both extensor digitorum brevis, as well as a distal bilateral apalesthesia and allodynia. Both Achilles reflexes were absent. Laboratory tests revealed anemia, high erythrosedimentation rate and C-reactive protein. Serum protein electrophoresis showed a monoclonal IgG-Kappa gammopathy. The results also evidenced the presence of Bence-Jones proteinuria. The bone marrow biopsy revealed less than 10% of plasma cells, and skin biopsy informed leukocytoclastic vasculitis. The patient was treated with high-dose intravenous steroids and cyclophosphamide. The treatment showed that the skin lesions had improved, pain disappeared and motor deficit stopped its progression.

Duración de la oxigenoterapia en pacientes con neumonía adquirida en la comunidad / Duration of oxygen therapy in patients with community acquired pneumonia

La neumonía adquirida en la comunidad (NAC) constituye una causa frecuente de hospitalización y mortalidad en pacientes internados. Distintas escalas pronósticas como el CURB-65 o el Indice de Severidad de la Neumonía (PSI) son utilizados al valorar la admiisión hospitalaria de un paciente con NAC. La hipoxemia es una complicación frecuente de la neumonía. A pesar de esto, hasta nuestro conocimiento, el tiempo requerido de oxigenoterapia en pacientes con NAC hospitalizados en una sala general no ha sido evaluada. Los objetivos del presente estudioi fueron: evaluar los días de oxigenoterapia en pacientes con NAC y su correlación con el puntaje de PSI obtenido en la admisión. Cuarenta y seis pacientes fueron evaluados en forma prospectiva. El promedio general de días de utilización de oxigenoterapia fue de 6,25±5.93 días. Los mayores de 60 años requirieron 2 días más de oxigenoterapia que los más jóvenes (6.7±3.57 vs 4.3±2.70 días, p: 0,07). La media del PSI fue de 135,76±29,94 puntos para mayores de 60 años y 63±30 puntos para los más jóvenes equivalente a las clases de riesgo V y II respectivamente. Los días de oxigenoterapia fueron 7,38±4,09 días para los pacientes de clase V y 3.5±3,53 días para los pacientes de clase I. El coeficiente de correlación lineal entre puntaje PSI y días de oxigenoterapia fue de 0,34 equivalente a una correlación positiva baja. Futuras investigaciones, que incluyan un mayor número de pacientes, serán necesarias en pos de encontrar herramientas pronósticas sobre oxigenoterapia en NAC (AU)

Duration of oxygen therapy in patients with community-acquired pneumonia and its relationship with the Pneumonia Severity Index (PSI). Community-acquired pneumonia (CAP) is one of the most common cause of morbidity and mortality in hospitalized patients. Mayor decision of admission to the hospital, included severity of illness score (CURB-65) or prognostics models such as the Pneumonia Severity Index (PSI). Decreased of arterial PO2 un blood gas analysis, occurred in many patients with pneumonia. However, the mean duration of oxygen utilization in patients with CAP has not been evaluated. The goals of the present study were to evaluate the duration in days of oxygen therapy in patients with CAP and correlate the duration of this therapy with the PSI score obtained on admission of the patients. Forty-six patients were prospectively studied. Mean duration of oxygen therapy was 6.25±5,93 days. Patients older than 60 years required 2 days more of oxygen therapy compared with younger population (6,7±3,57 vs 4,3±2,70 days, p: 0,07), Mean PSI was 135,76±29,94 points for patients older than 60 years (class V) and 64±30 points for patients younger than 60 years (class II). Duration of oxygen therapy was 7,38±4,09 days for patients in Class V and 3,50±3,53 days for patients in Class I. Pearson correlation coefficient between PSI and days of oxygen therapy was 0,34, equivalent to a low positive linear correlation. Future studies of larger populations in the duration and utilization of oxygen treatment in hospitalized patients with CAP (AU)

[Chronic inflammatory demyelinating polyneuropathy in a diabetic patient with syphilis]. / Polineuropatía desmielinizante inflamatoria crónica en paciente diabética con sífilis.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a disorder characterized by motor symptoms such as weakness in both proximal and distal muscles with globally diminished or absent reflexes. Insulin neuritis is referred as an acute pain in the extremities, due to the damage of peripheral nerves affecting mainly small fibers, in diabetic patients treated with insulin who achieved rapid glycemic control. Pain is unusual in classic CIDP. We report the case of a 54-year-old female patient with type II diabetes mellitus, and a recent onset of insulin therapy, who presented at the emergency room with a 2-month history of weakness and hyperalgesia of extremities. Physical examination showed marked pain and proximal and distal allodynia in the 4 limbs, with reduced muscle strength of the proximal muscles and patellar and achillear areflexia. Electrophysiological study showed sensory and motor polyneuropathy with a demyelinating predominance. Treatment with recombinant human immunoglobin was started, and the patient presented a total remission of the condition. Complementary studies confirmed weak serum positivity of GM1, GD1a, GD1b and anti-asialo GM1. Prior to hospital discharge, results of positive serum VDRL and FTA-Abs were received. VDRL in cerebrospinal fluid was negative, so neurosyphilis was ruled out, and treatment with benzathine penicillin was indicated.

Polineuropatía desmielinizante inflamatoria crónica en paciente diabética con sífilis / Chronic inflammatory demyelinating polyneuropathy in a diabetic patient with syphilis

La polineuropatía desmielinizante inflamatoria crónica (PDIC) se presenta generalmente con síntomas motores, debilidad tanto en los músculos proximales como en los distales con reflejos globalmente disminuidos o ausentes. La neuritis insulínica es un trastorno caracterizado por dolor agudo de las extremidades, y daño de los nervios periféricos con afectación predominante de las fibras pequeñas, en los pacientes diabéticos sometidos a un rápido control glucémico. El dolor es raro en la PDIC clásica. Describimos el caso de una mujer de 54 años con diabetes mellitus (DB) tipo II, en tratamiento reciente con insulina, que consultó por un cuadro de debilidad e hiperalgesia de los cuatro miembros de dos meses de evolución. Al examen físico presentaba dolor de intensidad 10/10 y alodinia en los cuatro miembros, a niveles proximal y distal, con fuerza muscular reducida de los músculos proximales y arreflexia patelar y aquilea bilateral. Se realizó un estudio electrofisiológico, el cual mostró una polineuropatía sensitiva y motora desmielinizante. Se indicó tratamiento con inmunoglobina humana recombinante, con total remisión del cuadro. Estudios realizados posteriormente demostraron positividad débil de los anticuerpos GM1, GD1a, GD1b y anti-asialo GM1. Previo al alta hospitalaria se recibieron los resultados de VDRL sérica positiva, y FTA-Abs. VDRL en líquido cefalorraquídeo fue negativa por lo que se descartó neurosífilis, indicándose tratamiento con penicilina benzatínica.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a disorder characterized by motor symptoms such as weakness in both proximal and distal muscles with globally diminished or absent reflexes. Insulin neuritis is referred as an acute pain in the extremities, due to the damage of peripheral nerves affecting mainly small fibers, in diabetic patients treated with insulin who achieved rapid glycemic control. Pain is unusual in classic CIDP. We report the case of a 54-year-old female patient with type II diabetes mellitus, and a recent onset of insulin therapy, who presented at the emergency room with a 2-month history of weakness and hyperalgesia of extremities. Physical examination showed marked pain and proximal and distal allodynia in the 4 limbs, with reduced muscle strength of the proximal muscles and patellar and achillear areflexia. Electrophysiological study showed sensory and motor polyneuropathy with a demyelinating predominance. Treatment with recombinant human immunoglobin was started, and the patient presented a total remission of the condition. Complementary studies confirmed weak serum positivity of GM1, GD1a, GD1b and anti-asialo GM1. Prior to hospital discharge, results of positive serum VDRL and FTA-Abs were received. VDRL in cerebrospinal fluid was negative, so neurosyphilis was ruled out, and treatment with benzathine penicillin was indicated.

Case Report: Penile Squamous Cell Carcinoma Associated With Severe Hypercalcemia and High Levels of Parathyroid Hormone-related Peptide Expressed in Metastatic Skin Tissue.

It is known that high levels of parathyroid hormone-related protein (PTHrP) correlate with a bad prognostic in malignancies. Here we present a patient with advanced penile cancer (PC) without antecedents of human papillomavirus infections and bone metastases but with severe hypercalcemia. By quantitative polymerase chain reaction, we observed high levels of PTHrP messenger RNA in metastatic cutaneous tissue. This is the first reported case in Argentina of hypercalcemia induced by PTHrP in human PC. Furthermore, the association of PTHrP and this disease through quantitative polymerase chain reaction allows us to consider this molecular technique as a novel tool for diagnosis in patients with PC.

Pancitopenia y aplasia medular asociada a abatacept en una paciente con Artritis Reumatoide / Pancytopenia and medular aplasia associated to abatacept in a patient with rheumatoid arthritis

El tratamiento de pacientes con artritis reumatoide (AR) debe ser temprano y agresivo para prevenir el daño articular y la discapacidad. Los fármacos no biológicos modificadoes de enfermedad, como el metotrexato, han sido utilizados par controlar la actividad de la enfermedad y para prevenir el daño de las articulaciones. Existen pacientes con AR resistentes al tratamiento con fármacos modificadores de la enfermedad y otros que no responden adecuadamente a la terapia con inhibidores de factores de necrosis tumoral. Nosotros describimos el caso de una paciente de sexo femenino de 77 años que se presentó al servicio de emergencias con fiebre, mucositis y mal estado general luego de recibir una dosis de abatacept. A su ingreso el laboratorio demostró: glóbulos blancos 500 cel/mm3, neutrófilos 150 cel/mm3, plaquetas 21000 cel/mm3, hematocrito 29%, VCM 81, LDH 314 UI/L, función renal y hepatograma normales. En el examen clínico se objetivaron ulceras y lesiones ampollares en mucosa yugal. El medulograma evidenció hipocelularidad, con disminución de las tres series. El informe anatomopatológico fue de médula ósea hipoplásica. Recibió tratamiento con factor estimulante de colonias de neutrófilos, ácido fólico y metilprednisona, con resolución del cuadro a los 3 días de instituido el tratamiento. Hasta nuestro conocimiento esta es la primera comunicación de pancitopenia asociada a abatacept es una paciente con artritis AR intolerante a metotrexato

Treatment of patient with rheumatoid arthritis (RA) should be early and aggressive to prevent joint injury and disability. Disease-modifying antirheumatic drugs (DMARDs) like methotrexate has been used as initial treatment toward the disease activity and to prevento joint damage. Some patients with RA are resistant to initial therapy with nonbiiologic DMARDs or TNF inhibitiors. We described a 77 years old women who presented to the emergency room with fever andoral lesions after been treated with abatacept. On examination patient appeared ill. She had oral ulcers. laboratory testing showed white cells count 500 cells per mm3, hematocrit 29 %, platelets count 21000 cells per mm3, LDH 314 U/l. Renal and liver functions were normal. Bone marrow showed decreased in the three cells lineages. Patient was treated with granulocyte colony-stimulating factor, folic acid, and prednisone. Patient improved her physical and laboratory features three days after admission. This case showed the rare association between pancytopenia and abatacept in a patient with RA

[Association between diabetic ketoacidosis and acromegaly]. / Asociación entre cetoacidosis diabética y acromegalia.

Diabetes mellitus occurs in nearly 10% of patients with acromegaly and is secondary to insulin resistance caused by high levels of growth hormone. Diabetes ketoacidosis has been described as a rare complication of acromegaly, resulting from a relative insulin deficiency caused by growth hormone excess. We described the case of a 38 year-old man who presented to the emergency room with a 6-week history of polydipsia, polyuria, polyphagia and weight loss. He also had nausea, vomiting and abdominal pain from two days before admission. His plasma glucose level was 880 mg/dl, plasma osmolarity 368 mOsm/l, arterial pH 7.06 and serum bicarbonate 8.6 mEq/l. At the clinical examination, he had features of acromegaly. Magnetic resonance imaging showed a pituitary macro adenoma and growth hormone dosages were abnormally high. After tumor removal, plasma glucose levels became normal. This case shows the rare association between diabetic ketoacidosis and acromegaly. Surgery, in this case, was the definite modality of treatment.

Asociación entre cetoacidosis diabética y acromegalia / Association between diabetic ketoacidosis and acromegaly

La diabetes mellitus ocurre en cerca del 10% de los pacientes con acromegalia y es secundaria a la insulino resistencia causada por altos niveles de hormona de crecimiento. La cetoacidosis diabética ha sido descripta como una rara complicación de la acromegalia, resultado de una relativa deficiencia de insulina causada por exceso de hormona de crecimiento. Describimos el caso de un hombre de 38 años de edad que se presentó en el servicio de emergencias con historia de polifagia, polidispsia y poliuria con pérdida de peso de 6 semanas de evolución. Agregó en las últimas 48 horas náuseas, vómitos y dolor abdominal. A su ingreso, la glucosa plasmática fue 880 mg/dl, osmolaridad plasmática 368 mOsm/l, pH arterial 7.06 y bicarbonato plasmático 8.6 mEq/l. No tenía antecedentes personales ni familiares de diabetes. No se encontraron causas precipitantes de cetoacidosis. En el examen clínico presentaba características compatibles con acromegalia. La resonancia magnética nuclear mostró un macroadenoma pituitario y los dosajes de hormona de crecimiento fueron elevados. Luego de la resección del tumor, los niveles de glucosa plasmáticos resultaron normales. Este caso mostró la rara asociación de acromegalia con cetoacidosis diabética. La cirugía fue la modalidad definitiva de tratamiento.

Diabetes mellitus occurs in nearly 10% of patients with acromegaly and is secondary to insulin resistance caused by high levels of growth hormone. Diabetes ketoacidosis has been described as a rare complication of acromegaly, resulting from a relative insulin deficiency caused by growth hormone excess. We described the case of a 38 year-old man who presented to the emergency room with a 6-week history of polydipsia, polyuria, polyphagia and weight loss. He also had nausea, vomiting and abdominal pain from two days before admission. His plasma glucose level was 880 mg/dl, plasma osmolarity 368 mOsm/l, arterial pH 7.06 and serum bicarbonate 8.6 mEq/l. At the clinical examination, he had features of acromegaly. Magnetic resonance imaging showed a pituitary macro adenoma and growth hormone dosages were abnormally high. After tumor removal, plasma glucose levels became normal. This case shows the rare association between diabetic ketoacidosis and acromegaly. Surgery, in this case, was the definite modality of treatment.

[Vitamin D deficit in hospitalized patients]. / Déficit de vitamina D en pacientes hospitalizados.

We prospectively studied 60 consecutive patients in order to evaluate the prevalence of vitamin D deficiency. All of them were inpatients, and were evaluated from October 2013 through May 2014. Levels of 25 OH vitamin D were classified as sufficient (> 30 ng/ml), mild to moderate deficiency (15 to 30 ng/ml) and severe deficiency (< 15 ng/ml). The mean age was 72.1 ± 19.5 years; 43 were females and 17 males. Five percent of the patients had normal values of vitamin D, 31.6% had mild to moderate deficit and 63.3% had severe deficit of the vitamin. Severe deficit was associated with hypoalbuminemia, compared with mild to moderate deficit and with sufficient values (2.98 g/dl vs. 3.52 g/dl and vs. 4.39 g/dl, respectively, p: 0.012) and low levels of serum calcium (8.35 mg/dl vs. 8.61 mg/dl and 9.8 mg/dl, respectively, p: 0.003). Although there was a trend of low vitamin D levels with increasing age, female sex, immobilization, higher levels of glucose and glycated haemoglobin, more duration of hospitalization, we didn't find any statistically significance difference between groups. Vitamin D deficiency is common in hospitalized patients. It correlates with low levels of serum albumin and calcium. Improving diagnosis and recognition of this condition may enable us to improve the management of this deficit.

Déficit de vitamina D en pacientes hospitalizados

El objetivo de este estudio fue investigar la frecuencia del déficit de vitamina D en una población adulta de pacientes internados en una sala de clínica médica. Se evaluaron 60 pacientes internados entre los meses de octubre de 2013 y mayo de 2014. El nivel de 25 OH vitamina D, determinado por electroquimioluminiscencia, se clasificó como suficiente (> 30 ng/ml) (GS), déficit leve a moderado (15 a 30 ng/ml) (DL) y déficit grave (< 15 ng/ml) (DG). La edad media fue de 72.1 ± 19.5 años; 43 eran mujeres y 17 varones. Presentaron valores normales de vitamina D el 5%, DL el 31.6% y DG el 63.3%. El DG se asoció con hipoalbuminemia, comparado contra DL y GS (2.98 g/dl vs. 3.52 g/dl y 4.39 g/dl, respectivamente, p: 0.012) y con menor calcemia (8.35 mg/dl con DG vs. 8.61 mg/dl con DL y 9.8 mg/dl con GS, p: 0.003). El grupo con DG se asoció con mayor edad promedio, sexo femenino, mayores niveles de glucemia y de hemoglobina glicosilada, mayor postración e internaciones más prolongadas, aunque la diferencia no fue estadísticamente significativa. El déficit de vitamina D es muy frecuente en pacientes hospitalizados, en especial con hipoalbuminemia y con bajos valores de calcio. Reconocer el diagnóstico de esta condición permitirá mejorar el manejo de este déficit.(AU)

We prospectively studied 60 consecutive patients in order to evaluate the prevalence of vitamin D deficiency. All of them were inpatients, and were evaluated from October 2013 through May 2014. Levels of 25 OH vitamin D were classified as sufficient (> 30 ng/ml), mild to moderate deficiency (15 to 30 ng/ml) and severe deficiency (< 15 ng/ml). The mean age was 72.1 ±19.5 years; 43 were females and 17 males. Five percent of the patients had normal values of vitamin D, 31.6% had mild to moderate deficit and 63.3% had severe deficit of the vitamin. Severe deficit was associated with hypoalbuminemia, compared with mild to moderate deficit and with sufficient values (2.98 g/dl vs. 3.52 g/dl and vs. 4.39 g/dl, respectively, p: 0.012) and low levels of serum calcium (8.35 mg/dl vs. 8.61 mg/dl and 9.8 mg/dl, respectively, p: 0.003). Although there was a trend of low vitamin D levels with increasing age, female sex, immobilization, higher levels of glucose and glycated haemoglobin, more duration of hospitalization, we didn’t find any statistically significance difference between groups. Vitamin D deficiency is common in hospitalized patients. It correlates with low levels of serum albumin and calcium. Improving diagnosis and recognition of this condition may enable us to improve the management of this deficit.(AU)

Déficit de vitamina D en pacientes hospitalizados

El objetivo de este estudio fue investigar la frecuencia del déficit de vitamina D en una población adulta de pacientes internados en una sala de clínica médica. Se evaluaron 60 pacientes internados entre los meses de octubre de 2013 y mayo de 2014. El nivel de 25 OH vitamina D, determinado por electroquimioluminiscencia, se clasificó como suficiente (> 30 ng/ml) (GS), déficit leve a moderado (15 a 30 ng/ml) (DL) y déficit grave (< 15 ng/ml) (DG). La edad media fue de 72.1 ± 19.5 años; 43 eran mujeres y 17 varones. Presentaron valores normales de vitamina D el 5%, DL el 31.6% y DG el 63.3%. El DG se asoció con hipoalbuminemia, comparado contra DL y GS (2.98 g/dl vs. 3.52 g/dl y 4.39 g/dl, respectivamente, p: 0.012) y con menor calcemia (8.35 mg/dl con DG vs. 8.61 mg/dl con DL y 9.8 mg/dl con GS, p: 0.003). El grupo con DG se asoció con mayor edad promedio, sexo femenino, mayores niveles de glucemia y de hemoglobina glicosilada, mayor postración e internaciones más prolongadas, aunque la diferencia no fue estadísticamente significativa. El déficit de vitamina D es muy frecuente en pacientes hospitalizados, en especial con hipoalbuminemia y con bajos valores de calcio. Reconocer el diagnóstico de esta condición permitirá mejorar el manejo de este déficit.

We prospectively studied 60 consecutive patients in order to evaluate the prevalence of vitamin D deficiency. All of them were inpatients, and were evaluated from October 2013 through May 2014. Levels of 25 OH vitamin D were classified as sufficient (> 30 ng/ml), mild to moderate deficiency (15 to 30 ng/ml) and severe deficiency (< 15 ng/ml). The mean age was 72.1 ±19.5 years; 43 were females and 17 males. Five percent of the patients had normal values of vitamin D, 31.6% had mild to moderate deficit and 63.3% had severe deficit of the vitamin. Severe deficit was associated with hypoalbuminemia, compared with mild to moderate deficit and with sufficient values (2.98 g/dl vs. 3.52 g/dl and vs. 4.39 g/dl, respectively, p: 0.012) and low levels of serum calcium (8.35 mg/dl vs. 8.61 mg/dl and 9.8 mg/dl, respectively, p: 0.003). Although there was a trend of low vitamin D levels with increasing age, female sex, immobilization, higher levels of glucose and glycated haemoglobin, more duration of hospitalization, we didn’t find any statistically significance difference between groups. Vitamin D deficiency is common in hospitalized patients. It correlates with low levels of serum albumin and calcium. Improving diagnosis and recognition of this condition may enable us to improve the management of this deficit.

Alteraciones hidroelectrolíticas en pacientes tratados con diuréticos / Electrolytes disturbances in patients treated with diuretics

a) Introducción y objetivos: Los diuréticos son fármacos que han demostrado su utilidad en el trtamiento de la hipertensión arterial. Los objetivos de este estudio fueron analizar la prevalencia de las alteraciones hidroelectrolíticas en pacientes ambulatorios tratados con diuréticos y su asociación con el tipo de diuréticos utilizados. b) Métodos: Se evaluaron en forma prospectiva 93 pacientes adultos mayores de 31 años. La edad promedio fue de 66.3 años. La tensión arterial media fue de 127/76 mmHg. Se analizaron los siguientes parámetros: sodio, potasio, cloro, magnesio, bicarbonato, urea plasmática, creatinina sérica, calcio, fosforo y ácido úrico en sangre. c) Resultados: De los 93 pacientes, el 96 por ciento recibían diuréticos por hipertensión arterial. De ellos 64 por ciento recibían tiazidas, 11 por ciento indapamida, 6 por ciento furosemida, 5 por ciento clortalidona y 4 por ciento la combinación de tiazidas y amiloride. la alteración más frecuente encontrada fue la hiperazoemia en 28 por ciento, hiponatremia en 8.6 por ciento, hipokalemia en 4.3 por ciento de los casos. No presentaron hiponatremia ni hipokalemia ninguno de los pacientes tratados con indapamida. Los valores de cloro se encontraron por debajo de su valor normal en 11 por ciento, no observándose cambios significativos en los valores de calcio, fosforo, magnesio y ácido úrico. Once pacientes presentaron valores elevados de bicarbonato. d) Conclusiones: La alteración hidroelectrolítica más frecuentemente encontrada en nuestra población fue la hiperazoemia seguida de hiponatremia, siendo infrecuente la hipokalemia. Los diuréticos constituyen importantes herramientas terapéuticas en el manejo de la hipertensión arterial. Su utilización es segura y efectiva como monoterapia en pacientes con hipertensión arterial.(AU)

a) Background and Objectives: Diretics have demonstrated their utility for the management of hypertension. The goals of this study were to analyze the prevalence of electrolytes disturbances in ambulatory patients treated with diretics and the type of diuretics used. b) Methods: We prospectively evaluated 93 adults patients older than 31 years old. their mean age was 66.3 years and mean arterial blood pressure was 127/76 mmHg. The varialbes evaluated were: sodium, potassium, chlorine, magnesium, bicarbonte, blood urea nitrogen (BUN) serum cretinine, calcium, phosphorus and uric acid. c) Results: Ninety six percent of the patients received diuretics for the management of hypertension. Sixty four percent of the patients were treated with hydrochlorothiazide, 11 percent indapamide, 6 percent furosemide, 5 percent clortalidone and 4 percent the combination of thiazide with amiloride. The most common abnormality was increased blood urea nitrogen (BUN) seen in 28 percent of the patients, hyponatremia in 8.6 percent and hypokalemia in 4.3 percent. The majority of our patients were treated with thiazides. No patients treated with indapamide had hypnatremia or hypokalemia. The chlorine value was below the normal range in 11 percent of our patients. We havent seen significant changes in serum calcium, phosphorus, and magnesium. Bicarbonate was elevated in 11 of 30 patients. d) Conclusions: In summary, the most common abnormality ound in our population was the increased BUN. Hyponatremia was mild and hypokalemia was exceptinal. Diuretics are important therapeutic tools for tretment of hypertension. The use of these drugs are safe and effective for the treatment of patients with hypertension.(AU)

Alteraciones hidroelectrolíticas en pacientes tratados con diuréticos / Electrolytes disturbances in patients treated with diuretics

a) Introducción y objetivos: Los diuréticos son fármacos que han demostrado su utilidad en el trtamiento de la hipertensión arterial. Los objetivos de este estudio fueron analizar la prevalencia de las alteraciones hidroelectrolíticas en pacientes ambulatorios tratados con diuréticos y su asociación con el tipo de diuréticos utilizados. b) Métodos: Se evaluaron en forma prospectiva 93 pacientes adultos mayores de 31 años. La edad promedio fue de 66.3 años. La tensión arterial media fue de 127/76 mmHg. Se analizaron los siguientes parámetros: sodio, potasio, cloro, magnesio, bicarbonato, urea plasmática, creatinina sérica, calcio, fosforo y ácido úrico en sangre. c) Resultados: De los 93 pacientes, el 96 por ciento recibían diuréticos por hipertensión arterial. De ellos 64 por ciento recibían tiazidas, 11 por ciento indapamida, 6 por ciento furosemida, 5 por ciento clortalidona y 4 por ciento la combinación de tiazidas y amiloride. la alteración más frecuente encontrada fue la hiperazoemia en 28 por ciento, hiponatremia en 8.6 por ciento, hipokalemia en 4.3 por ciento de los casos. No presentaron hiponatremia ni hipokalemia ninguno de los pacientes tratados con indapamida. Los valores de cloro se encontraron por debajo de su valor normal en 11 por ciento, no observándose cambios significativos en los valores de calcio, fosforo, magnesio y ácido úrico. Once pacientes presentaron valores elevados de bicarbonato. d) Conclusiones: La alteración hidroelectrolítica más frecuentemente encontrada en nuestra población fue la hiperazoemia seguida de hiponatremia, siendo infrecuente la hipokalemia. Los diuréticos constituyen importantes herramientas terapéuticas en el manejo de la hipertensión arterial. Su utilización es segura y efectiva como monoterapia en pacientes con hipertensión arterial.

a) Background and Objectives: Diretics have demonstrated their utility for the management of hypertension. The goals of this study were to analyze the prevalence of electrolytes disturbances in ambulatory patients treated with diretics and the type of diuretics used. b) Methods: We prospectively evaluated 93 adults patients older than 31 years old. their mean age was 66.3 years and mean arterial blood pressure was 127/76 mmHg. The varialbes evaluated were: sodium, potassium, chlorine, magnesium, bicarbonte, blood urea nitrogen (BUN) serum cretinine, calcium, phosphorus and uric acid. c) Results: Ninety six percent of the patients received diuretics for the management of hypertension. Sixty four percent of the patients were treated with hydrochlorothiazide, 11 percent indapamide, 6 percent furosemide, 5 percent clortalidone and 4 percent the combination of thiazide with amiloride. The most common abnormality was increased blood urea nitrogen (BUN) seen in 28 percent of the patients, hyponatremia in 8.6 percent and hypokalemia in 4.3 percent. The majority of our patients were treated with thiazides. No patients treated with indapamide had hypnatremia or hypokalemia. The chlorine value was below the normal range in 11 percent of our patients. We haven't seen significant changes in serum calcium, phosphorus, and magnesium. Bicarbonate was elevated in 11 of 30 patients. d) Conclusions: In summary, the most common abnormality ound in our population was the increased BUN. Hyponatremia was mild and hypokalemia was exceptinal. Diuretics are important therapeutic tools for tretment of hypertension. The use of these drugs are safe and effective for the treatment of patients with hypertension.

Déficit de Vitamina D en mujeres adultas de la Ciudad de Buenos Aires / Vitamin D deficit in adult women living in Buenos Aires City

El déficit de vitamina D se asocia con importante morbilidad. El objetivo de este estudio fue investigar la frecuencia de este déficit en una población de mujeres adultas y su asociación con distintas variables. Se evaluaron 224 mujeres mayores de 30 años atendidas en tres consultorios de clínica médica de la Ciudad de Buenos Aires entre octubre de 2006 y marzo de 2008. El nivel de 25 OH vitamina D, por radioinmunoanálisis, se clasificó como suficiente (> 30 ng/ml), déficit leve (entre 20 y 30 ng/ml) y déficit grave (< 20 ng/ml). La edad media fue de 58.3 ± 12.9 años; 77% eran posmenopáusicas. Presentaron déficit leve de vitamina D el 29.9% y déficit grave el 26.8%. El déficit grave se asoció con mayor edad promedio (62 años vs. 56 años, p = 0.003), con falta de exposición al sol (25.8 ng/ml vs. 31.7 ng/ml, p < 0.005), con mayor peso promedio (70 kg vs. 61 kg, p < 0.05), con inactividad física (27.8 ng/ml vs. 31.04 ng/ml, p = 0.0007) y con menor calcemia (9.26 mg/dl vs. 9.51 mg/dl, p < 0.01). No se asoció con tabaquismo ni con los valores de fósforo, creatinina ni TSH plasmáticas. El déficit de vitamina D es frecuente, en especial en mujeres añosas, sedentarias, poco expuestas al sol, obesas y con bajos niveles de calcio.

Vitamin D deficiency is a common cause of morbidity. We prospectively studied 224 consecutive female patients in order to evaluate the prevalence of vitamin D deficiency and to assess the utility of various clinical and biochemical markers in predicting the deficiency. All of them were outpatients, 30 years old or older, and were evaluated from October 2006 through March 2008. Levels of 25 OH vitamin D > 30 ng/ml were considered sufficient. Mild deficiency was considered between 20 and 30 ng/ml and severe deficiency < 20 ng/ml. The mean age was 58 ± 12.9 years; 77% were menopausal. Twenty nine percent of the patients had mild deficit and 26.8% had severe deficit of the vitamin. Severe deficit was associated with increasing age (62 vs. 56 years, p = 0.003), absence of sun exposure (25.82 ng/ml vs. 31.7 ng/ml, p < 0.005), obesity (70 vs. 61 kg, p < 0.05), absence of physical activity (27.8 ng/ml vs. 31.04 ng/ml, p = 0.0007) and slightly low levels of serum calcium (9.26 mg/dl vs. 9.51 mg/dl, p 0.01). We did not find any association between smokers and non-smokers patients, levels of serum phosphorus, creatinine and TSH. Vitamin D deficiency is a common disorder. It correlates with older age, absence of physical activity, sun exposure, obesity and slightly low levels of serum calcium. Improving diagnosis of this condition may enable us to improve the management of this disease.

[Vitamin D deficit in adult women living in Buenos Aires City]. / Déficit de Vitamina D en mujeres adultas de la Ciudad de Buenos Aires.

Vitamin D deficiency is a common cause of morbidity. We prospectively studied 224 consecutive female patients in order to evaluate the prevalence of vitamin D deficiency and to assess the utility of various clinical and biochemical markers in predicting the deficiency. All of them were outpatients, 30 years old or older, and were evaluated from October 2006 through March 2008. Levels of 25 OH vitamin D > 30 ng/ml were considered sufficient. Mild deficiency was considered between 20 and 30 ng/ml and severe deficiency < 20 ng/ml. The mean age was 58 +/- 12.9 years; 77% were menopausal. Twenty nine percent of the patients had mild deficit and 26.8% had severe deficit of the vitamin. Severe deficit was associated with increasing age (62 vs. 56 years, p = 0.003), absence of sun exposure (25.82 ng/ml vs. 31.7 ng/ml, p < 0.005), obesity (70 vs. 61 kg, p < 0.05), absence of physical activity (27.8 ng/ml vs. 31.04 ng/ml, p = 0.0007) and slightly low levels of serum calcium (9.26 mg/dl vs. 9.51 mg/dl, p 0.01). We did not find any association between smokers and non-smokers patients, levels of serum phosphorus, creatinine and TSH. Vitamin D deficiency is a common disorder. It correlates with older age, absence of physical activity, sun exposure, obesity and slightly low levels of serum calcium. Improving diagnosis of this condition may enable us to improve the management of this disease.