[Anemia prevalence in heart failure. GESAIC study results]. / Prevalencia de la anemia en la insuficiencia cardiaca. Resultados del estudio GESAIC.

INTRODUCTION AND OBJECTIVES: There is a great variability in the prevalence of anemia in heart failure (HF) according to cohort based studies where the majority of patients have depressed left ventricular ejection fraction (LVEF). Our study has aimed to evaluate the prevalence of anemia in HF within the usual hospital clinical practice. METHODS: An initial analysis was made of a prospective cohort of inpatients with HF admitted during 3 months in 15 Internal Medicine Services including all health system levels. We used the World Health Organization (WHO) criteria to define anemia (hemoglobin [Hb] < 12 g/l in women and < 13 g/l in men) and a value > or = 45% as preserved LVEF. RESULTS: A total of 391 patients with an average age of 77.9 +/- 9.4; 239 women (61.1%). The 52.7% of the cases had anemia. Regarding multiple associated factors to anemia in the bivariant analysis, the regression model indicated the following variables: preserved LVEF (odds ratio [OR] 3.03), not being HF debut (OR 1.85), glomerular filtration (OR 0.97), functional class III-IV of the New York Heart Association (NYHA) (OR 0.53), arterial vascular disease (OR 0.41), antiaggregant treatment (OR 0.56) and treatment with nitrites (OR 0.48). CONCLUSION: Prevalence of anemia in HF is very high in usual clinical practice, that most frequently occurs in subjects with preserved LVEF.

[Analysis of a series of 55 patients with biopsy proven giant cell temporal arteritis]. / Análisis de una serie de 55 pacientes con arteritis de células gigantes confirmada por biopsia.

INTRODUCTION: Our main aim with this study is to establish the epidemiologic and clinical features, treatment response and complications of a group composed of 55 patients with biopsy proven temporal arteritis in a local hospital. MATERIAL AND METHODS: Retrospective study based on clinical records revision of patients diagnosed of giant cell arteritis (GCA) made by temporal artery biopsy between 1989 and 2001. RESULTS: The approximated annual incidence of GCA in our area is 4.1 cases per 100,000 persons over the age of 50. The mean age at diagnostic was 74 years and the 78,2% were women. The most common symptom at diagnostic was headache (81.5%) followed by systemic manifestations (74.1%) and later we found jaw claudication (32,7%), visual impairment (30.2%), isquemic manifestations (17%). Polymyalgia rheumatica was associated to GCA in 49.1% of cases. The temporal artery explorations was abnormal in the 76.9% of patients. The mean initial dose of corticoids was 69 mg prednisone per day, with a half dose reduction time of .5 months. In spite of that, 24,1% of patients relapsed during the first year. The 38% of patients did some complications during the corticosteroid treatment. The ESR was lower 50 mm in 12.7% of patients; it was anaemia in the 37.7% and thrombocytosis in 32,1%. In these last patients we detected a relation between thrombocytosis and specific visual impairment. CONCLUSIONS: The incidence of GCA in our area is low. The results of our series aren't different from others publicated before in clinical manifestations, there is a prevalence of female sex and there is a relation between specific visual impairment and the presence of thrombocytosis.

Análisis de una serie de 55 pacientes con arteritis de células gigantes confirmada por biopsia / Analysis of a serie of 55 patients with biopsy proven giant cell temporal arteritis

Introducción: Descripción de las características epidemiológicas, clínicas, respuesta al tratamiento y complicaciones de una serie de 55 pacientes con arteritis de células gigantes(ACG) confirmada por biopsia en un hospital comarcal. Material y métodos: Estudio retrospectivo de los pacientes diagnosticados de ACG por biopsia de arteria temporal en el periodo comprendido entre 1989 y 2001 en nuestro centro. Resultados: La incidencia anual aproximada calculada en nuestra área sería de 4,1 casos por 100.000 habitantes mayor de 50 años. La edad media al diagnóstico fue de 74 años y un 78,2 por ciento eran mujeres. El síntoma más frecuente al diagnóstico fue la cefalea (81,5 por ciento), seguido de las manifestaciones sistémicas (74,1 por ciento), a más distancia se encontraba la claudicación mandibular (32,7 por ciento), trastornos visuales (30,2 por ciento), manifestaciones isquémicas (17 por ciento). La polimialgia reumática se asoció a ACG en el 49,1 por ciento. La palpación de arteria temporal fue anormal en el 76,9 por ciento de los pacientes. La dosis media de inicio de tratamiento fue de 69 mg prednisona /dia, con una media de tiempo de reducción a mitad de dosis fue de 3,5 meses. Un 24,1 por ciento de los pacientes presentaron un rebrote durante el primer año. Un 38 por ciento de los pacientes presentaron complicaciones durante el tratamiento corticoideo. La VSG fue inferior a 50 mm en el 12,7 por ciento de los pacientes, existía anemia en el 37,7 por ciento y trombocitosis en el 32,1 por ciento. En estos últimos se detectó una tendencia a la relación con presencia de alteraciones visuales específicas. Conclusiones: La incidencia de ACG en nuestra área estaría dentro de las zonas de baja incidencia. Los resultados de nuestra serie no difieren de otras descritas previamente en la literatura en cuanto a las manifestaciones clínicas de los pacientes, existe un claro predominio del sexo femenino y se detecta una tendencia a la relación de alteraciones visuales específicas con presencia de trombocitosis (AU)

Transverse myelitis in systemic lupus erythematosus: two cases with magnetic resonance imaging.

Transverse myelitis is one of the most serious neurological complications occurring in the course of systemic lupus erythematosus. We describe two lupus patients, with transverse myelitis, one of whom had associated optic neuritis. In both, magnetic resonance imaging of the spinal cord showed an abnormal signal. In one case a good response to steroid and immunosuppressive therapy was observed; the other case failed to improve despite the therapy applied.

Raynaud's phenomenon and positive antinuclear antibodies in a malignancy.

Both Raynaud's phenomenon and the presence of antinuclear antibodies are uncommon features of malignant disease and the association of both with a malignancy extremely rare. The case is reported of a 78 year old woman who presented with Raynaud's phenomenon and positive antinuclear antibodies related to adenocarcinoma of unknown primary site.

[False positive serological tests for Borrelia burgdorferi in patients with primary antiphospholipid syndrome]. / Serología falsamente positiva frente a Borrelia burgdorferi en pacientes con síndrome antifosfolípido primario.

Serological tests for Borrelia burgdorferi were carried out in a series of 27 patients with primary antiphospholipid syndrome (PAPLS). The results showed a 14% prevalence of false positive Lyme disease serology in this patient population. In patients with PAPLS and false positive serologic tests for Borrelia burgdorferi neurological involvement was significantly more common (p = 0.012, Fisher's exact test) than in patients with PAPLS without that finding. We insist on the possibility that patients with PAPLS may have false positive serological tests for Borrelia burgdorferi as measured by IFI with the resulting diagnostic error. In these cases, confirmation by other techniques such as ELISA or immunoblotting is recommended.