Temporal relationship between sarcoidosis and malignancies in a nationwide cohort of 1942 patients.

PURPOSE: To investigate the phenotype of sarcoidosis according to the time when a malignancy is diagnosed (preexisting to the diagnosis of sarcoidosis, concomitant, or sequential) and to identify prognostic factors associated with malignancies in a large cohort of patients with sarcoidosis. METHODS: We searched for malignancies in the SARCOGEAS cohort, a multicenter nationwide database of consecutive patients diagnosed with sarcoidosis according to the ATS/ESC/WASOG criteria. Solid malignancies were classified using the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) nomenclature, and hematological malignancies using the 2016 WHO classification. We excluded patients with a biopsy-proven diagnosis of sarcoidosis based exclusively on demonstrating granulomas in tissues also involved by malignant cells. RESULTS: Out of 1942 patients with sarcoidosis, 233 (12%) developed 250 malignancies, including solid (n = 173), hematological (n = 57), and both types of malignancies (n = 3). Concerning the time interval between the diagnoses of both conditions, 83 (36%) patients were diagnosed with malignancy at least 1 year before sarcoidosis diagnosis, 22 (9%) had s synchronous diagnosis of both diseases, and 118 (51%) developed malignancies at least 1 year after the diagnosis of sarcoidosis (the remaining cases developed malignancies in different time intervals). The multivariate-adjusted model showed that individuals with sarcoidosis who developed a malignancy had an hazard ratio (HR) of 2.27 [95% confidence interval (CI), 1.62-3.17] for having an asymptomatic clinical phenotype at diagnosis of sarcoidosis and that spleen (presence vs. absence: HR = 2.06; 95% CI, 1.21-3.51) and bone marrow (presence vs. absence: HR = 3.04; 95% CI, 1.77-5.24) involvements were independent predictors for the development of all-type malignancies. No predictive factors were identified when the analysis was restricted to the development of solid malignancies. The analysis limited to the development of hematological malignancies confirmed the presence of involvement in the spleen (HR = 3.73; 95% CI, 1.38-10.06) and bone marrow (presence vs. absence: HR = 8.00; 95% CI, 3.15-20.35) at the time of sarcoidosis diagnosis as predictive factors. CONCLUSION: It is essential to consider the synchronous or metachronous timing of the diagnosis of malignancies in people with sarcoidosis. We found that half of the malignancies were diagnosed after a diagnosis of sarcoidosis, with spleen and bone marrow involvement associated with a four to eight times higher risk of developing hematological malignancies. Key messages What is already known on this topic Malignancies are one of the comorbidities more frequently encountered in people with sarcoidosis What this study adds Malignancies occur in 12% of patients with sarcoidosis Malignancy may precede, coincide with, or follow the diagnosis of sarcoidosis One-third were identified before sarcoidosis, and half were diagnosed after Spleen and bone marrow involvement are risk factors for developing hematological malignancies How this study might affect research, practice or policy Patients with sarcoidosis should be regularly monitored for neoplasms, informed of the increased risk, and educated on early detection. Those with spleen or bone marrow involvement must be closely followed.

Clinical characterization and outcomes of 85 patients with neurosarcoidosis.

To analyze the frequency and clinical phenotype of neurosarcoidosis (NS) in one of the largest nationwide cohorts of patients with sarcoidosis reported from southern Europe. NS was evaluated according to the Diagnostic Criteria for Central Nervous System and Peripheral Nervous System Sarcoidosis recently proposed by Stern et al. Pathologic confirmation of granulomatous disease was used to subclassify NS into definite (confirmation in neurological tissue), probable (confirmation in extraneurological tissue) and possible (no histopathological confirmation of the disease). Of the 1532 patients included in the cohort, 85 (5.5%) fulfilled the Stern criteria for NS (49 women, mean age at diagnosis of NS of 47.6 years, 91% White). These patients developed 103 neurological conditions involving the brain (38%), cranial nerves (36%), the meninges (3%), the spinal cord (10%) and the peripheral nerves (14%); no patient had concomitant central and peripheral nerve involvements. In 59 (69%) patients, neurological involvement preceded or was present at the time of diagnosis of the disease. According to the classification proposed by Stern et al., 11 (13%) were classified as a definite NS, 61 (72%) as a probable NS and the remaining 13 (15%) as a possible NS. In comparison with the systemic phenotype of patients without NS, patients with CNS involvement presented a lower frequency of thoracic involvement (82% vs 93%, q = 0.018), a higher frequency of ocular (27% vs 10%, q < 0.001) and salivary gland (15% vs 4%, q = 0.002) WASOG involvements. In contrast, patients with PNS involvement showed a higher frequency of liver involvement (36% vs 12%, p = 0.02) in comparison with patients without NS. Neurosarcoidosis was identified in 5.5% of patients. CNS involvement prevails significantly over PNS involvement, and both conditions do not overlap in any patient. The systemic phenotype associated to each involvement was clearly differentiated, and can be helpful not only in the early identification of neurological involvement, but also in the systemic evaluation of patients diagnosed with neurosarcoidosis.

Coexistence of immune-mediated diseases in sarcoidosis. Frequency and clinical significance in 1737 patients.

OBJECTIVE: To analyze whether immune-mediated diseases (IMDs) occurs in sarcoidosis more commonly than expected in the general population, and how concomitant IMDs influence the clinical presentation of the disease. METHODS: We searched for coexisting IMDs in patients included in the SARCOGEAS-cohort, a multicenter nationwide database of consecutive patients diagnosed according to the ATS/ESC/WASOG criteria. Comparisons were made considering the presence or absence of IMD clustering, and odds ratios (OR) and their 95% confidence intervals (CI) were calculated as the ratio of observed cases of every IMD in the sarcoidosis cohort to the observed cases in the general population. RESULTS: Among 1737 patients with sarcoidosis, 283 (16%) patients presented at least one associated IMD. These patients were more commonly female (OR: 1.98, 95% CI: 1.49-2.62) and were diagnosed with sarcoidosis at an older age (49.6 vs. 47.5years, P<0.05). The frequency of IMDs in patients with sarcoidosis was nearly 2-fold higher than the frequency observed in the general population (OR: 1.64, 95% CI: 1.44-1.86). Significant associations were identified in 17 individual IMDs. In comparison with the general population, the IMDs with the strongest strength of association with sarcoidosis (OR>5) were common variable immunodeficiency (CVID) (OR: 431.8), familial Mediterranean fever (OR 33.9), primary biliary cholangitis (OR: 16.57), haemolytic anemia (OR: 12.17), autoimmune hepatitis (OR: 9.01), antiphospholipid syndrome (OR: 8.70), immune thrombocytopenia (OR: 8.43), Sjögren syndrome (OR: 6.98), systemic sclerosis (OR: 5.71), ankylosing spondylitis (OR: 5.49), IgA deficiency (OR: 5.07) and psoriatic arthritis (OR: 5.06). Sex-adjusted ORs were considerably higher than crude ORs for eosinophilic digestive disease in women, and for immune thrombocytopenia, systemic sclerosis and autoimmune hepatitis in men. CONCLUSION: We found coexisting IMDs in 1 out of 6 patients with sarcoidosis. The strongest associations were found for immunodeficiencies and some systemic, rheumatic, hepatic and hematological autoimmune diseases.

Glomerulonefritis aguda por inmunocomplejos en mononucleosis infecciosa / Immuno complex mediated acute glomerulonephritis in a patient with infectious mononucleosis

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Síndrome de Sjogren y nefropatía mixta. La importancia de la precocidad en la biopsia renal / Sjogren syndrom and mixed nephropathy. Significance of early kidney biopsy

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Adecuación del uso de protectores gástricos en pacientes en tratamiento crónico con aspirina en bajas dosis / Appropiateness of use of gastroprotective agents in patients taking low-dose aspirin on a chronic basis

Fundamentos: Conocer la adecuación del uso de fármacos gastroprotectores en pacientes en tratamiento con bajas dosis de aspirina. Pacientes y método: Analizamos 450 informes de alta de 4 servicios de medicina interna, evaluando la presencia de tratamiento de aspirina y la utilización de protectores gástricos, así como la adecuación del uso de estos últimos según las recomendaciones establecidas tras una revisión de la bibliografía. Resultados: Un total de 57 (63 por ciento) de las 91 prescripciones de aspirina llevaba asociada la prescripción de un gastroprotector. De éstos, 51 (90 por ciento) se consideraron adecuados. Sin embargo, en 24 pacientes (26 por ciento) estaba indicado asociar un gastroprotector, pero no se hizo. Conclusiones: En la cuarta parte de los pacientes analizados tratados con aspirina en bajas dosis y en los que era recomendable la prescripción del algún tipo de antiulceroso, éste no se administró (AU)

Hipertiroidismo inducido por consumo de algas marinas / Hyperthyroidism secondary to kelp tablets ingestias

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Factores predictivos de estancias no adecuadas en un servicio de medicina interna / Predictive factors for inappropriate hospital stays in an internal medicine department

FUNDAMENTO: Conocer los factores que pueden influir en las estancias inadecuadas en un servicio de medicina interna. PACIENTES Y MÉTODO: Analizamos 1.046 estancias, evaluando su adecuación o no utilizando el protocolo de evaluación de la adecuación. RESULTADOS: Un total de 176 estancias se consideraron inadecuadas (16,8 por ciento). Un análisis de regresión logística reveló que los días de estancia, el día de la semana y el diagnóstico al ingreso son los tres principales determinantes de inadecuación de estancias. CONCLUSIONES: Detectamos la presencia de variables que influyen, al menos parcialmente, en el porcentaje de estancias inadecuadas (AU)

Factores asociados a ingresos inadecuados en un servicio de medicina interna / Factors associated with an inapropriate hospitalization in an internal medicine departament

FUNDAMENTO: Conocer los factores que pueden influir en los ingresos inadecuados en un servicio de medicina interna. PACIENTES Y MÉTODO: Analizamos 1.993 ingresos, evaluando su adecuación utilizando el Protocolo de Evaluación de la Adecuación. RESULTADO: Un total de 187 ingresos se consideraron inadecuados (9,4 por ciento). La probabilidad de ingreso inadecuado era mayor si el paciente tenía menos de 65 años (OR, 1,94; IC del 95 por ciento, 1,32-2,85) o si el ingreso era programado desde consultas externas (OR, 10,58. IC del 95 por ciento, 2,79-40,1). Además, el diagnóstico clínico influía en dicha inadecuación. CONCLUSIONES: La edad, el diagnóstico y la procedencia del ingreso influyen en la inadecuación de los ingresos producidos en nuestro servicio (AU)

Prevención primaria de enfermedad cardiovascular con ácido acetilsalicílico en pacientes hipertensos en España / Primary prevention of cardiovascular events by acetylsalicylic acid in patients with hypertension in Spain

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