Estudio de concordancia en el grado de fibrosis hepáticaestimada mediante los índices bioquímicos APRI y FORNS, y la elastografía de transición (Fibroscan®) en pacientes coinfectados por VIH-VHC / Grade of consistency existing in the grade of hepatic fibrosis calculated with the APRI and FORNS biochemistry indexes and transient elastography (Fibroscan®) in patients coinfected with HIV-HCV

Introducción. Existen métodos diagnósticos no invasivos de fibrosis hepática que se basan en determinaciones bioquímicas (como APRI o Forns) o en elastografía de transición. Este estudio se propone comparar la concordancia entre ellos en pacientes coinfectados por los virus de inmunodeficiencia humana y el de la hepatitis C. Pacientes y métodos. Se realizó elastografía, APRI y Forns a 331 pacientes para valorar la concordancia entre grados avanzados y bajos de fibrosis. Se estimaron los grados de concordancia existentes entre ellos mediante el coeficiente kappa. Resultados. Los pacientes que presentaron grados intermedios de fibrosis estimados por APRI y Forns (51 y 54% respectivamente) no fueron incluidos en el estudio. La concordancia de la elastografía en el grado avanzado frente al índice APRI fue del 65% y del 76% frente al Forns. Cuando la elastografía obtuvo estimaciones de grado bajo de fibrosis la concordancia con APRI fue del 89 y del 82,2% con Forns. La concordancia global fue del 85,5%, y con al menos un índice bioquímico del 72,1%. Conclusión. En los pacientes coinfectados por VIH y VHC la utilización de los índices bioquímicos APRI y Forns para estimar el grado de fibrosis hepática no logra clasificar adecuadamente a al menos la mitad de los pacientes. Sin embargo, en los pacientes clasificados como con fibrosis alta ó baja, la concordancia entre las estimaciones obtenidas mediante la elastografía y las derrivadas de los índices de APRI y de Forns es moderada-alta(AU)

Introduction. There are non-invasive diagnostic methods of liver fibrosis that are based on biochemical measurements (such as APRI or Forns) or on transient elastography. This study aims to compare the consistency between them in patients coinfected by the human immunodeficiency virus and the hepatitis C virus. Patients and methods. An elastography, APRI and Forns were performed for 331 patients to evaluate the consistency between the advanced and low grades of fibrosis. The grades of consistency existing between them were calculated with the kappa coefficient. Results. The grades of fibrosis calculated by APRI and by Forns provided intermediate results (51.1% and 54.7%, respectively), and these patients were not enrolled in the study. The consistency of the elastography in the advanced grade versus the APRI index was 65% and 75% for the Forns index. Results. When the elastography obtained low grade calculations of fibrosis, the consistency with APRI was 80% and 82.2% with Forns Global consistency was 85.5% and with at least one biochemistry index of 72.1%. Conclusion. In the HIV and HCV coinfected patients, the use of the APRI and Forns biochemistry indexes to calculate grade of liver fibrosis does not successfully classify at least half of the patients. However, in the patients classified as having high or low fibrosis, the consistency between the calculations obtained by elastography and those derived from the APRI and Forns indexes is moderate to high(AU)

Hepatopatía tóxica por amoxicilina/clavulánico / No disponible

Aproximadamente unos 1.000 medicamentos se asocian con lesión citotóxica hepática y/o colestasis. Larelación de causalidad entre la administración de amoxicilina/clavulánico y un cierto tipo de hepatitiscolestásica parece bien establecida.En un corto periodo de tiempo hemos diagnosticado 2 casos de hepatitis colestásica por oxicilina /clavulánico. Su conocimiento es importante a que antecedentes de ictericia colestásica y/o disfunción hepática ociada a este medicamento constituyen una contraindicación de utilización

Approximately 1000 drugs are associated with cytotoxic liver lesion and/or cholestasis. The causal relationshipbetween the administration of amoxicillin-clavulanic acid and a certain type of cholestatic hepatitisappears to be well established.In a short period of time, we have diagnosed two cases of cholestatic hepatitis induced by amoxicillin-clavulanic acid. It is important to be a familiar with this relationship since a history of cholestatic jaundiceand/or liver dysfunction associated with this drug constitutes a contraindication for its use

Bloqueo auriculoventricular de primer grado y síncope por consumo de derivados anfetamínicos

No disponible

Spontaneous brain hemorrhage associated with Lyme neuroborreliosis.

We present the case of a patient with late neuroborreliosis and a spontaneous temporal lobe hemorrhage. Although ischemic stroke and subarachnoid hemorrhage have been reported in association with Lyme disease, intraparenchymal brain hemorrhage has not been previously described in the course of this disease. The patient is a 48-year old male with a progressive spastic paraparesis of months' duration who presented acute headache, confusion, severe left hemiparesis with sensory deficit and homonymous hemianopsia. A cranial computed tomography scan showed an extensive right temporal lobe hemorrhage with subarachnoid invasion. Brain angiographic and angio-magnetic resonance imaging studies excluded hemorrhage-predisposing vascular abnormalities. Cerebrospinal fluid (CSF) studies disclosed mononuclear pleocytosis with elevated protein levels. Both serum and CSF anti-Borrelia titers were significantly increased, and serum Western Blot showed bands to protein 34 (ops B), 57, 59 and 62. The patient was treated with ceftriaxone for 4 weeks, with a favorable outcome. It is suspected that cause of the hemorrhage was parenchymatous Lyme-associated vascular damage and/or microaneurysmatic rupture.

Hemorragia cerebral espontánea asociada a neuroborreliosis de Lyme / Spontaneous brain hemorrhage associated with Lyme neuroborreliosis

Presentamos el caso de un paciente con neuroborreliosis tardía y una hemorragia espontánea en el lóbulo temporal derecho. Aunque el infarto isquémico cerebral y la hemorragia subaracnoidea han sido descritos en asociación con la enfermedad de Lyme, la hemorragia cerebral intraparenquimatosa no ha sido comunicada previamente en el curso de esta enfermedad. El paciente es un varón de 48 años de edad, que en el curso de una paraparesia espástica progresiva de meses de evolución presenta cefalea, confusión, hemiparesia izquierda con déficit sensitivo y hemianopsia homónima. Una tomografía axial computarizada reveló una hemorragia temporal derecha, extensa, con invasión subaracnoidea secundaria. Los estudios angiográficos y de angiorresonancia craneales no evidenciaron alteraciones vasculares potencialmente hemorrágicas. Estudios del líquido cefalorraquídeo (LCR) objetivaron una pleocitosis mononuclear con elevación de proteinorraquia. Los títulos de anticuerpos anti-Borrelia estaban elevados de forma significativa tanto en suero como en LCR, y el Western-Blot en suero reveló bandas a proteínas 34 (ops B), 57, 59 y 62. El paciente fue tratado con ceftriaxona durante 4 semanas, con buena evolución.Es probable que la causa de la hemorragia fuera una vasculopatía asociada a enfermedad de Lyme y/o rotura microaneurismática (AU)

[Study of consultation in an Internal Medicine Department]. / Estudio de la interconsulta en un Servicio de Medicina Interna.

Consultation in Internal Medicine is a common task of the attending labor of the internist in a general hospital and is a relevant link for intrahospital cohesion. In the present work the characteristics of 738 consultations, which represented all consultation request forms received at our Department during a nine-month period, were studied. A 55.4 percentage of consultation forms were requested urgently and 93.6% of them were answered on the same day. Most consultation parts received came from General Surgery and traumatology, with a predominance of cardiologic, pneumologic, infectious and multiple causes. The assessment of the urgency made by the internist coincided with the urgent request only in 38.3% of cases. A clinical follow-up was made for 33.3% of patients and 2% of them were transferred to the Internal Medicine Department. The consultation was repeated for 22.5% of the total of patients. Only in 23.1% of cases an oral link with the referring physician occurred. To remark the relevance of the consultation for the optimization of care quality to our patients and its influence on the inter-relationship between specialists in different fields of medicine.