Relato de caso: tomografia computadorizada cardíaca no diagnóstico de miocárdio não-compactado / Case report: cardiac computed tomography in the diagnosis of non-compacted myocardium

INTRODUÇÃO: O Miocárdio Não-Compactado (MNC) é uma cardiomiopatia de fenótipo distinto caracterizada por proeminentes trabéculas e recessos do ventrículo esquerdo. É usualmente diagnosticado usando critérios diagnósticos morfológicos no ecocardiograma transtorácico (ECO). A ressonância magnética cardíaca (RCM), além de fornecer informações estruturais adicionais, é indicada para casos inconclusivos. Com critérios morfológicos atualizados, a tomografia computadorizada cardíaca (TCC) pode ser utilizada em casos inconclusivos ou na impossibilidade da realização de RMC. RELATO DE CASO: Paciente, sexo feminino, história de dispneia aos moderados esforços desde os 23 anos. Antecedente pessoal de hipertensão arterial desde os 30 anos. Aos 38 anos iniciou segmento em serviço terciário de cardiologia, realizando ECO e teste ergométrico sem alterações. Manteve segmento da hipertensão. Aos 52 anos foi internada por síndrome coronariana aguda e bloqueio de ramo esquerdo intermitente. Realizou coronariografia com ausência de processo ateromatoso coronariano e ventriculografia com hipocinesia difusa. ECO da ocasião com queda da fração de ejeção do ventrículo esquerdo (40%) e hipocinesia difusa. Evoluiu com bloqueio de ramo esquerdo fixo e piora progressiva de dispneia, até aos mínimos esforços. Aos 58 anos realizou novo ECO para avaliação de dissincronia ventricular, porém foram verificados critérios morfológicos sugestivos de MNC. Não disponível RMC no serviço, foi solicitada TCC, que demonstrou trabeculção miocárdica difusa com relação de espessura miocárdio não-compacta do/compactado de 5,2. Aos 62 anos realizou implante de ressincronizador cardíaco com cardioversores desfibriladores implantável, inviabilizando realização futura de RMC. Hoje com 69 anos, apresenta recuperação de função ventricular e dispneia aos moderados esforços. CONCLUSÃO: O relato de caso é importante para o auxílio na atualização dos critérios morfológicos da TCC para o diagnóstico do MNC. O MNC tem manifestações clínicas variadas e complicações potencialmente graves, tais como insuficiência cardíaca, tromboembolismo e arritmias. Seus critérios diagnósticos são exclusivamente por exames de imagem e estão em constante desenvolvimento e atualização, com baixa especificidade, pois outras patologias podem cursar com aumento de trabeculação, como cardiomiopatia dilatada. São consagrados o uso do ECO e da RMC, contudo deve-se atentar para utilização da TCC como auxílio diagnóstico, principalmente para ocasiões em que a RMC é indisponível ou contra-indicada.

Serial assessment of hepatic encephalopathy in patients hospitalised for acute decompensation of cirrhosis.

INTRODUCTION AND AIM: Hepatic encephalopathy (HE) is a frequent complication of cirrhosis, but the clinical and prognostic significance of the progression of mental status in hospitalised cirrhotics is unknown. We aimed to investigate the prognostic significance of serial evaluation of HE in patients hospitalised for acute decompensation (AD) of cirrhosis. MATERIALS AND METHODS: Patients (n=293) were evaluated for HE (West-Haven criteria) at admission and at day-3 and classified in two groups: (1) Absent or improved HE: HE absent at admission and at day-3, or any improvement at day-3; (2) Unfavourable progression: Development of HE or HE present at admission and stable/worse at day-3. RESULTS: Unfavourable progression of HE was observed in 31% of patients and it was independently associated with previous HE, Child-Pugh C and acute-on-chronic liver failure (ACLF). MELD score and unfavourable progression of HE were independently associated with 90-day mortality. The 90-day Kaplan-Meier survival probability was 91% in patients with MELD<18 and absent or improved HE and only 31% in subjects with both MELD≥18 and unfavourable progression of HE. Unfavourable progression of HE was also related to lower survival in patients with or without ACLF. Worsening of GCS at day-3 was observed in 11% of the sample and was related with significantly high mortality (69% vs. 27%, P<0.001). CONCLUSION: Among cirrhotics hospitalised for AD, unfavourable progression of HE was associated with high short-term mortality and therefore can be used for prognostication and to individualise clinical care.

End-of-life management in intensive care units: a multicentre observational prospective cohort study.

BACKGROUNDS: The study was conducted to evaluate intensive care unit (ICU) patients that ultimately died but could have met criteria for end-of-life management/palliative care (ELM-PC), and to analyse the application of components of palliative care, either "unperformed procedures" or elements of "futile/unnecessary treatment". METHODS: An observational prospective cohort in five ICUs in Southern Brazil. Adult patients who died were evaluated, searching for criteria for ELM-PC. The correct application of nine preselected items by the ICU team was studied. RESULTS: Among 253 admissions, 52 patients died; among these, 38.5% met criteria for ELM-PC. Among ELM-PC candidates (n = 20), the ELM-PC was started later (after day 3) in 60%, and only three patients received adequate palliative care. "Analgesia" and "daily family interviews" were the most correctly applied ELM-PC elements. "Terminal extubation/weaning" was not performed in any of the patients. A reduction in the lifespan from the onset of ELM-PC to death was observed in patients who underwent "correct" interventions - 66.6% died on the first day of ELM-PC. CONCLUSIONS: In a patient cohort from a low-medium-income country, one-third of patients who died in the ICU had criteria (indications) for ELM-PC; however, the palliative care was adequately performed for only 15% of patients, with great heterogeneity and delays regarding its initiation.

Síndrome de Dressler: inflamação pericárdica tardia após infarto agudo do miocárdio visualizada por ressonência magnética / Dressler's syndrome: late pericardial inflammation after acute myocardial infarction visualized by magnetic resonance imaging

A Síndrome Dressler é uma inflamação tardia do pericárdio, pós infarto do miocárdio. A causa exata da injuria miocárdica ainda é indefinida tendo como principal fator a auto-imunidade. Atualmente apresenta incidência de 0,5%, sendo maior a freqüência quanto mais extensa a área cardíaca acometida pela doença coronariana. Deve-se pensar em Dressler nos pacientes que se apresentam com dor torácica pleurítica, febre, astenia, leucocitose e atrito pericárdico algumas semanas após infarto agudo do miocárdio extenso. No presente relato, paciente masculino, 52 anos, com dor torácica que piorava ao tossir e na inspiração, seguido de dispnéia aos moderados esforços e edema de membros inferiores, quatro semanas após infarto agudo do miocárdio inferolateral tratado clinicamente. Teve seu diagnóstico sugerido pela ressonância magnética com realce tardio difuso na topografia do pericárdio visceral e derrame pericárdico importante. Sendo então implementada drenagem de Marfan associado ao tratamento clínico com colchicina. (AU)

Agenesia de óstio de coronária direita: relato de caso / Right coronary ostium agenesis: case report

Coronária única é uma rara anomalia que é frequente associada a outras alterações congênitas, tais como transposição de grandes vasos, fístula coronária e válvula aórtica bicúspide. Esta doença apresenta uma prevalência reportada de 0,024% a 0,066% dos pacientes submetidos a angiografia coronariana, sendo a maioria dos casos achados incidentais, entretanto pode levar a várias apresentações clínicas, como angina, infarto, síncope e morte súbita. No presente caso se trata de uma paciente de 53 anos com sintomas de angina há um ano onde a angiotomografia de coronárias revelou artéria circunflexa ampla que se estende pelo sulco atrioventricular direito, subgrupo L-I de Lipton, e drenagem do seio venoso coronariano para o átrio esquerdo. Este subgrupo é usualmente considerado benigno, contudo há relatos de pacientes que tinham a coronária direita originando do segmento distal da circunflexa que necessitaram de cirurgia de revascularização miocárdica. O reconhecimento desta rara anomalia é importante para evitar repetidas cateterizações coronarianas, para o correto diagnóstico e direcionamento do tratamento adequado. Mais relatos de caso são necessários para o entendimento das implicações clínicas desta anomalia. (AU)

Síndrome de Alcapa: apresentação tardia com ectasia de coronárias demonstrada em angiotomografia / Alcapa syndrome: late presentation with coronary ectasia demonstrated on CT angiography

Anomalia coronariana conhecida pela sigla em inglês ALCAPA traduz uma doença rara, um em trezentos mil nascidos, que resulta em miocardiopatia isquêmica. Nesta anomalia, o tronco da coronária esquerda emerge do tronco da artéria pulmonar e não do seio aórtico esquerdo. Aproximadamente 90% dos pacientes morrem no primeiro ano de vida devido insuficiência cardíaca ou arritmias ventriculares, os outros 10% podem ter uma apresentação mais tardia da doença graças a uma extensa rede de vasos colaterais emitidos pela coronária direita. Neste relato, paciente feminina, 26 anos, com queixa de angina CCS II e episódios de palpitações associadas à dispneia há cinco anos, com piora nos últimos cinco meses. Foi realizado ecocardiograma com fração de ejeção e câmaras cardíacas preservadas. Teste ergométrico com infradesnivelamento de ST de 4mm. Submetida então a angiotomografia de coronárias que diagnosticou ALCAPA com ectasia do sistema coronariano direito e esquerdo. Paciente foi encaminhada para tratamento cirúrgico e seguimento no ambulatório de cardiopatia congênita. (AU)

Prognostic Significance of The New Criteria for Acute Kidney Injury in Cirrhosis.

BACKGROUND: New criteria for acute kidney injury (AKI) in cirrhosis have been proposed, but its prognostic significance is unclear. This study aims to evaluate the prognostic significance of the AKI criteria in cirrhotic patients hospitalized for acute decompensation. MATERIAL AND METHODS: This is a prospective cohort study. AKI was defined as an increase in creatinine (Cr) levels ≥ 0.3 mg/dL in 48 h or ≥ 50% of the basal value in the last 7d. AKI was divided into stages 1 (elevation: < 2x basal), 2 (2 or 3x), and 3 (> 3x). RESULTS: In this study, 227 patients aged 53.9 ± 11.5 years were included, of whom 37% had AKI (28% AKI1, 5% AKI2, and 4% AKI3). Thirty percent of the patients died or were transplanted within 90 days from causes related to the presence of ascites at hospital admission and higher values of Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) scores, but not to the presence of AKI. In a regression analysis conducted to assess the effect of the final Cr level in patients with AKI, 90-day mortality was associated with ascites, higher CLIF-SOFA score, and AKI with final Cr level ≥ 1.5 mg/dL. The patients with AKI with Cr levels ≥ 1.5 mg/dL showed lower transplant-free survival rates than those without AKI, and those with AKI1 with final Cr level < 1.5 mg/dL. CONCLUSIONS: Early AKI was frequent and associated with 90-day mortality or transplantation only when the final Cr level was ≥ 1.5 mg/dL. Distinct approaches are needed for patients with AKI1 according to final Cr.

Hypercalcemia and acute renal insufficiency following use of a veterinary supplement / Hipercalcemia e insuficiência renal aguda após uso de suplemento veterinário

Abstract A previously healthy 24 yo male presented with a two-month history of epigastric pain, nausea, vomiting, fatigue and malaise. He reported abuse of different substances, including an injectable veterinary vitamin compound, which contains high doses of vitamin A, D and E, and an oily vehicle that induces local edema and enhances muscle volume. Serum creatinine was 3.1 mg/dL, alanine transaminase 160 mg/dL, aspartate transaminase 11 mg/dL, total testosterone 23 ng/dL, 25-OH-vitamin D >150 ng/mL (toxicity >100), 1,25-OH-vitamin D 80 pg/mL, vitamin A 0.7 mg/dL, parathormone <3 pg/mL, total calcium 13.6 mg/dL, 24-hour urinary calcium 635 mg/24h (RV 42-353). A urinary tract ultrasound demonstrated signs of parenchymal nephropathy. The diagnosis was hypercalcemia and acute renal failure secondary to vitamin D intoxication. He was initially treated with intravenous hydration, furosemide and prednisone. On the fifth day of hospitalization a dose of pamidronate disodium was added. The patient evolved with serum calcium and renal function normalization. Thirty days later he presented normal clinical and laboratory tests, except 25-OH-vitamin D that was persistently increased (107 ng/mL), as it may take several months to normalize. This case report is a warning of the risks related to the use of veterinary substances for aesthetics purposes.

Resumo Um paciente de 24 anos do sexo masculino, previamente hígido, apresentou-se com uma história de dois meses de dor epigástrica, náuseas, vômitos, fadiga e mal-estar. Ele relatava abuso de diferentes substâncias, incluindo um composto vitamínico veterinário injetável contendo altas doses de vitamina A, D e E, e um veículo oleoso que induz edema local com aumento de volume muscular. A creatinina sérica estava 3,1 mg/dL, alanina transaminase 160 mg/dL, aspartato transaminase 11 mg/dL, testosterona total 23 ng/dL, 25-OH-vitamina D > 150 ng/mL (toxicidade > 100), 1,25-OH-vitamina D 80 pg/mL, vitamina A 0,7 mg/dL, paratormônio < 3 pg/mL, cálcio total 13,6 mg/dL, cálcio urinário de 24h 635 mg/24h (VR 42-353). Uma ultrassonografia do trato urinário demonstrou sinais de nefropatia parenquimatosa. O diagnóstico foi hipercalcemia e insuficiência renal aguda secundária a intoxicação por vitamina D. Ele foi tratado inicialmente com hidratação intravenosa, furosemida e prednisona. No quinto dia de hospitalização uma dose de pamidronato dissódico foi adicionada. O paciente evoluiu com normalização do cálcio sérico e da função renal. Trinta dias depois ele apresentou testes clínicos e laboratoriais normais, exceto a 25-OH-vitamina D que estava persistentemente elevada (107 ng/mL), já que ela pode demorar vários meses para normalizar. Este relato de caso é um alerta aos riscos relacionados ao uso de substâncias veterinárias para fins estéticos.

From stable disease to acute-on-chronic liver failure: Circulating cytokines are related to prognosis in different stages of cirrhosis.

INTRODUCTION: Although both pro- and anti-inflammatory circulating cytokines are known to be elevated in liver cirrhosis, its clinical significance is not completely recognized. Our aim was to evaluate the prognostic significance of circulating cytokines interleukin (IL)-6, IL-17 and IL-10 in different stages of cirrhosis. METHODS: This prospective study included two cohorts: (1) stable cirrhosis attended in the Outpatient Clinic (n=118), and (2) subjects hospitalized for acute decompensation (AD) (n=130). Thirty healthy subjects served as control group. RESULTS: Patients with cirrhosis exhibited higher levels of cytokines as compared to controls. In stable cirrhosis, during a median follow-up of 17months, liver-related events occurred in 26 patients. Higher IL-10 levels and Child-Pugh B/C were independently associated with reduced event-free survival. In AD cohort, death after 90days of follow-up occurred in 39 patients and was independently associated with ascites, higher IL-6 and model for end-stage liver disease. IL-6 levels also showed higher AUROC than CRP for predicting bacterial infection in the AD cohort (0.831±0.043vs. 0.763±0.048, respectively). IL-17 decreased at third day of hospitalization only in patients who progressed to death. Higher IL-6 levels were observed in acute-on-chronic liver failure (ACLF) patients even in the absence of bacterial infection whereas IL-10 was higher only in subjects with infection-related ACLF. Higher IL-10 and IL-17 levels were associated with progression to death in ACLF. CONCLUSIONS: The pattern of immune response seems to vary according to the phase of cirrhosis and is related to prognosis, from stable disease to ACLF.

Prognostic significance of insulin-like growth factor-I serum levels in acute decompensation of cirrhosis.

CONTEXT: IGF-I serum levels are suppressed in cirrhosis, but its prognostic significance is unknown. OBJECTIVES: To investigate the prognostic value of IGF-I in patients admitted for acute decompensation of cirrhosis. MATERIALS AND METHODS: Cohort study that included 103 patients. IGF-I was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Ninety-day mortality was 26.2% and it was independently associated with MELD, age and IGF-I. The Kaplan-Meier survival probability at 90 days was 94.3% in patients with IGF-I ≥13 ng/mL and 63.2% for patients with IGF-I <13 ng/mL (p = .001). DISCUSSION AND CONCLUSION: IGF-I levels are independently associated with mortality in acute decompensation of cirrhosis.

Hypercalcemia and acute renal insufficiency following use of a veterinary supplement.

A previously healthy 24 yo male presented with a two-month history of epigastric pain, nausea, vomiting, fatigue and malaise. He reported abuse of different substances, including an injectable veterinary vitamin compound, which contains high doses of vitamin A, D and E, and an oily vehicle that induces local edema and enhances muscle volume. Serum creatinine was 3.1 mg/dL, alanine transaminase 160 mg/dL, aspartate transaminase 11 mg/dL, total testosterone 23 ng/dL, 25-OH-vitamin D >150 ng/mL (toxicity >100), 1,25-OH-vitamin D 80 pg/mL, vitamin A 0.7 mg/dL, parathormone <3 pg/mL, total calcium 13.6 mg/dL, 24-hour urinary calcium 635 mg/24h (RV 42-353). A urinary tract ultrasound demonstrated signs of parenchymal nephropathy. The diagnosis was hypercalcemia and acute renal failure secondary to vitamin D intoxication. He was initially treated with intravenous hydration, furosemide and prednisone. On the fifth day of hospitalization a dose of pamidronate disodium was added. The patient evolved with serum calcium and renal function normalization. Thirty days later he presented normal clinical and laboratory tests, except 25-OH-vitamin D that was persistently increased (107 ng/mL), as it may take several months to normalize. This case report is a warning of the risks related to the use of veterinary substances for aesthetics purposes.

Avaliação de isquemia miocárdica pela tomografia: perfusão e reserva de fluxo coronariano / Evaluation of myocardial ischemia by tomography: perfusion and reserve coronary flow

De acordo com a Organização Mundial de Saúde (OMS), as doenças cardiovasculares (DCV) são a primeira causa de morte no hemisfério ocidental, sendo que o Brasil esta entre os 10 países com maior mortalidade por DCV. Dados do Instituto Dante Pazzanese de Cardiologia (São Paulo) demonstram que 60% dessas vitimas são homens, com idade de 56 anos, em plena idade produtiva...

Clinical and laboratory characteristics of patients with thyroid diseases with and without alanine aminotransferase levels above the upper tertile – Cross-sectional analytical study

Objective Thyroid disease affects 6.6% of the general population. The liver is fundamental in metabolizing thyroid hormones, and hepatocytes are often affected in thyroid disease. We aimed to compare clinical and laboratory parameters among thyroid disease patients with alanine aminotransferase (ALT) levels above vs. below the upper tertile. Subjects and methods A retrospective cross-sectional analytical study was conducted in the endocrinology clinic at Polydoro Ernani de São Thiago University Hospital. Patients with thyroid disease between August 2012 and January 2014 were included in the study. Clinical and laboratory parameters were collected from medical records. Results One hundred patients were included, of which 14.0% were male, with a mean age of 49.1 ± 14.4 years. ALT levels ranged from 9 to 90 U/L, and the ALT upper tertile was defined as 0,64 times the upper normal limit (xUNL). Patients with ALT levels above the upper tertile exhibited a higher proportion of systemic arterial hypertension (SAH), a higher mean abdominal circumference and a higher frequency of elevated TSH levels than did patients with ALT levels below the upper tertile. In multivariate analysis, ALT ≥ 0.64 (xUNL) was independently associated with abdominal circumference (odds ratio [OR] = 0.087, 95% confidence interval [CI] 0012-0167, P = 0.022). ALT (xUNL) correlated positively with total cholesterol (r = 0.213, P = 0.042). Conclusions In patients with thyroid diseases, it was observed that those with ALT above the upper tertile are associated with abdominal circumference and ALT levels correlate with total cholesterol.

Clinical and laboratory characteristics of patients with thyroid diseases with and without alanine aminotransferase levels above the upper tertile - Cross-sectional analytical study.

Objective Thyroid disease affects 6.6% of the general population. The liver is fundamental in metabolizing thyroid hormones, and hepatocytes are often affected in thyroid disease. We aimed to compare clinical and laboratory parameters among thyroid disease patients with alanine aminotransferase (ALT) levels above vs. below the upper tertile. Subjects and methods A retrospective cross-sectional analytical study was conducted in the endocrinology clinic at Polydoro Ernani de São Thiago University Hospital. Patients with thyroid disease between August 2012 and January 2014 were included in the study. Clinical and laboratory parameters were collected from medical records. Results One hundred patients were included, of which 14.0% were male, with a mean age of 49.1 ± 14.4 years. ALT levels ranged from 9 to 90 U/L, and the ALT upper tertile was defined as 0,64 times the upper normal limit (xUNL). Patients with ALT levels above the upper tertile exhibited a higher proportion of systemic arterial hypertension (SAH), a higher mean abdominal circumference and a higher frequency of elevated TSH levels than did patients with ALT levels below the upper tertile. In multivariate analysis, ALT ≥ 0.64 (xUNL) was independently associated with abdominal circumference (odds ratio [OR] = 0.087, 95% confidence interval [CI] 0012-0167, P = 0.022). ALT (xUNL) correlated positively with total cholesterol (r = 0.213, P = 0.042). Conclusions In patients with thyroid diseases, it was observed that those with ALT above the upper tertile are associated with abdominal circumference and ALT levels correlate with total cholesterol.

Avaliação de isquemia miocárdica pela tomografia: perfusão e reserva de fluxo coronariano / Evaluation of myocardial ischemia by tomography: perfusion and reserve coronary flow

De acordo com a Organização Mundial de Saúde (OMS), as doenças cardiovasculares (DCV) são a primeira causa de morte no hemisfério ocidental, sendo que o Brasil esta entre os 10 países com maior mortalidade por DCV. Dados do Instituto Dante Pazzanese de Cardiologia (São Paulo) demonstram que 60% dessas vitimas são homens, com idade de 56 anos, em plena idade produtiva...

Escores de neuropatia periférica em diabéticos / Peripheral neuropathy scores in diabetic

OBJETIVO: Diabetes mellitus é uma doença crônica prevalente, associada a inúmeras complicações. A neuropatia periférica diabética é a mais comum, acometendo 50% dos diabéticos, mas muitas vezes não é diagnosticada. Por cursar com insensibilidade distal e alterações arquiteturais dos pés, predispõe a úlceras, podendo culminar no pé diabético com risco de amputação. O diabetes mellitus é responsável por 70% das amputações de membros, que poderiam ser prevenidas com o diagnóstico precoce da neuropatia periférica diabética. Sugere-se avaliar o grau de neuropatia em diabéticos por meio de escores, visando homogeneizar o diagnóstico, quantificar a prevalência e promover medidas preventivas. MÉTODOS: Realizou-se entrevista, exame físico e coleta de dados de diabéticos atendidos ambulatorialmente, para pontuação e qualificação no Escore de Sintomas Neuropáticos e no Escore de Comprometimento Neuropático, validados na língua portuguesa para avaliar neuropatia periférica diabética, além de análise das características clínicas e epidemiológicas associadas. RESULTADOS: Foram incluídos 116 pacientes, constatando-se neuropatia periférica diabética em 31,9%. Houve correlação significativa de neuropatia periférica diabética coma idade dos pacientes, mas não com as demais variáveis clínicas e laboratoriais. Os pacientes avaliados apresentaram médias de idade de 55±15 anos e tempo de diabetes de 14,8±10,9 anos, sendo predominantemente caucasianos, mulheres e portadores de diabetes mellitus tipo 2. Eram hipertensos 67,2% e 42,2%, obesos. CONCLUSÃO: A prevalência encontrada corrobora a literatura, embora poucos estudos tenham utilizado critérios similares para diagnosticar neuropatia periférica diabética. Empregando os escores padronizados, de baixo custo e fácil aplicação possibilitamos o diagnóstico precoce e embasado dessa entidade, sendo possível, com isso, reduzir a prevalência de graves complicações do pé diabético e disseminar informações a respeito.

OBJECTIVE: Diabetes mellitus is a prevalent chronic disease, associated with numerous complications. Diabetic peripheral neuropathy is the most common, affecting 50% of diabetics, although is often not diagnosed. Presenting with distal numbness and architectural alterations of the feet, it predisposes ulcers and may culminate in diabetic foot at risk for amputation. Diabetes mellitus is responsible for 70% of limb amputations, which could be prevented with early diagnosis of diabetic peripheral neuropathy. This study aims to evaluate the degree of neuropathy in diabetics through validated scores, in order to standardize the diagnosis, quantify the prevalence and promote preventive actions. METHODS: We performed an interview, physical examination and data collection of diabetic outpatients, for rating in the Neuropathy Symptom Score and the Neuropathy Disability Score, validated in Portuguese, to assess diabetic peripheral neuropathy, in addition to analysis of clinical and epidemiological associated characteristics. RESULTS: We included 116 patients and diabetic peripheral neuropathy was found in 31.9%. There was significant correlation diabetic peripheral neuropathy with age, but not with other clinical and laboratory variables. The mean age was 55±15 years, diabetes duration was 14.8±10.9 years and patients were predominantly Caucasian, women and had type 2 diabetes mellitus. Of the patients, 67.2 % were hypertensive and 42.2% obese. CONCLUSION: The prevalence found is supported by previous data, although few studies have used similar criteria to diagnose diabetic peripheral neuropathy. Employing the standard scores, of low cost and easy implementation, we enable early and accurate diagnosis of this condition, allowing to reduce the prevalence of severe diabetic foot complications and spread information about it.

Single-centre validation of the EASL-CLIF consortium definition of acute-on-chronic liver failure and CLIF-SOFA for prediction of mortality in cirrhosis.

BACKGROUND & AIMS: The idea of acute-on-chronic liver failure (ACLF) has emerged to identify those subjects with organ failure and high mortality rates. However, the absence of a precise definition has limited the clinical application and research related to the ACLF concept. We sought to validate the ACLF definition and the CLIF-SOFA Score recently proposed by the EASL-CLIF Consortium in a cohort of patients admitted for acute decompensation (AD) of cirrhosis. METHODS: In this prospective cohort study, patients were followed during their hospital stay and thirty and 90-day mortality was evaluated by phone call, in case of hospital discharge. All subjects underwent laboratory evaluation at admission. RESULTS: Between December 2010 and November 2013, 192 cirrhotic patients were included. At enrollment, 46 patients (24%) met the criteria for ACLF (Grades 1, 2 and 3 in 18%, 4% and 2% respectively). The 30-day mortality was 65% in ACLF group and 12% in the remaining subjects (P < 0.001). Logistic regression analysis showed that 30-day mortality was independently associated with ascites and ACLF at admission. The Kaplan-Meier survival probability at 90-day was 92% in patients without ascites or ACLF and only 22% for patients with both ascites and ACLF. The AUROC of CLIF-SOFA in predicting 30-day mortality was 0.847 ± 0.034, with sensitivity of 64%, specificity of 90% and positive likelihood ratio of 6.61 for values ≥9. CONCLUSION: In our single-centre experience the CLIF-SOFA and the EASL-CLIF Consortium definition of ACLF proved to be strong predictors of short-term mortality in cirrhotic patients admitted for AD.

Helicobacter pylori eradication in functional dyspepsia: HEROES trial.

BACKGROUND: Eradication of Helicobacter pylori in patients with functional dyspepsia continues to be a matter of debate. We studied eradication effects on symptoms and quality of life of primary care patients. METHODS: Helicobacter pylori -positive adult patients with functional dyspepsia meeting the Rome III International Consensus criteria were randomly assigned to receive omeprazole, amoxicillin trihydrate, and clarithromycin, or omeprazole plus placebo for 10 days. Endoscopy and H pylori tests were performed at screening and at 12 months. Outcome measures were at least 50% symptomatic improvement at 12 months using a validated disease-specific questionnaire (primary end point), patient global assessment of symptoms, and quality of life. RESULTS: We randomly assigned 404 patients (78.7% were women; mean age, 46.1 years); 201 were assigned to be treated with antibiotics (antibiotics group) and 203 to a control group. A total of 389 patients (96.3%) completed the study. The proportion of patients who achieved the primary outcome was 49.0% (94 of 192) in the antibiotics group and 36.5% (72 of 197) in the control group (P = .01; number needed to treat, 8). In the patient global assessment of symptoms, 78.1% in the antibiotics group (157 of 201) answered that they were better symptomatically, and 67.5% in the control group (137 of 203) said that they were better (P = .02). The antibiotics group had a significantly larger increase in their mean (SD) Medical Outcomes Study 36-Item Short Form Health Survey physical component summary scores than the control group did (4.15 [8.5] vs 2.2 [8.1]; P = .02). CONCLUSION: Helicobacter pylori eradication provided significant benefits to primary care patients with functional dyspepsia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00404534.

Un nuevo caso de leucemia prolinfocítica con fenotipo de células T supresoras / A new case of prolyphocytic leukemia with phenotype of suppressive T cells

Se comunica un paciente con leucemia prolinfocitica de origen T. La naturaleza de las células leucémicas se determinó mediante su capacidad de formar rosetas no inmunes, reactividad con anticuerpos monoclonales pan-T y el reordenamiento gel gen ß del receptor de las células T. El fenotipo supresor se comprobó mediante la alta reactividad con el anticuerpo monoclonal OKTS y la reacción negativa con el OKT4