Development and validation of a nomogram to predict kidney survival at baseline in patients with C3 glomerulopathy.

Background: C3 glomerulopathy is a rare and heterogeneous complement-driven disease. It is often challenging to accurately predict in clinical practice the individual kidney prognosis at baseline. We herein sought to develop and validate a prognostic nomogram to predict long-term kidney survival. Methods: We conducted a retrospective, multicenter observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. The dataset was randomly divided into a training group (n = 87) and a validation group (n = 28). The least absolute shrinkage and selection operator (LASSO) regression was used to screen the main predictors of kidney outcome and to build the nomogram. The accuracy of the nomogram was assessed by discrimination and risk calibration in the training and validation sets. Results: The study group comprised 115 patients, of whom 46 (40%) reached kidney failure in a median follow-up of 49 months (range 24-112). No significant differences were observed in baseline estimated glomerular filtration rate (eGFR), proteinuria or total chronicity score of kidney biopsies, between patients in the training versus those in the validation set. The selected variables by LASSO were eGFR, proteinuria and total chronicity score. Based on a Cox model, a nomogram was developed for the prediction of kidney survival at 1, 2, 5 and 10 years from diagnosis. The C-index of the nomogram was 0.860 (95% confidence interval 0.834-0.887) and calibration plots showed optimal agreement between predicted and observed outcomes. Conclusions: We constructed and validated a practical nomogram with good discrimination and calibration to predict the risk of kidney failure in C3 glomerulopathy patients at 1, 2, 5 and 10 years.

Longitudinal change in proteinuria and kidney outcomes in C3 glomerulopathy.

INTRODUCTION: The association between a change in proteinuria over time and its impact on kidney prognosis has not been analysed in complement component 3 (C3) glomerulopathy. This study aims to investigate the association between the longitudinal change in proteinuria and the risk of kidney failure. METHODS: This was a retrospective, multicentre observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients diagnosed with C3 glomerulopathy between 1995 and 2020 were enrolled. A joint modelling of linear mixed-effects models was applied to assess the underlying trajectory of a repeatedly measured proteinuria, and a Cox model to evaluate the association of this trajectory with the risk of kidney failure. RESULTS: The study group consisted of 85 patients, 70 C3 glomerulonephritis and 15 dense deposit disease, with a median age of 26 years (range 13-41). During a median follow-up of 42 months, 25 patients reached kidney failure. The longitudinal change in proteinuria showed a strong association with the risk of this outcome, with a doubling of proteinuria levels resulting in a 2.5-fold increase of the risk. A second model showed that a ≥50% proteinuria reduction over time was significantly associated with a lower risk of kidney failure (hazard ratio 0.79; 95% confidence interval 0.56-0.97; P < 0.001). This association was also found when the ≥50% proteinuria reduction was observed within the first 6 and 12 months of follow-up. CONCLUSIONS: The longitudinal change in proteinuria is strongly associated with the risk of kidney failure. The change in proteinuria over time can provide clinicians a dynamic prediction of kidney outcomes.

C3 glomerulopathy associated with monoclonal gammopathy: impact of chronic histologic lesions and beneficial effects of clone-targeted therapies.

BACKGROUND: C3 glomerulopathy associated with monoclonal gammopathy (C3G-MIg) is a rare entity. Herein we analysed the clinical and histologic features of a cohort of C3G-MIg patients. METHODS: We conducted a retrospective, multicentre, observational study. Patients diagnosed with C3G-MIg between 1995 and 2021 were enrolled. All had genetic studies of the alternative complement pathway. The degree of disease activity and chronicity were analysed using the C3G histologic index. Descriptive statistics and propensity score matching (PSM) analysis were used to evaluate the main outcome of the study [kidney failure (KF)]. RESULTS: The study group included 23 patients with a median age 63 of years [interquartile range (IQR) 48-70], and 57% were males. Immunoglobulin G kappa was the most frequent MIg (65%). The diagnosis of C3G-MIg was made in transplanted kidneys in seven patients (30%). Five (22%) patients had C3 nephritic factor and five (22%) had anti-factor H antibodies. One patient carried a pathogenic variant in the CFH gene. During a follow-up of 40 months (IQR 14-69), nine patients (39%) reached KF and these patients had a significantly higher total chronicity score on kidney biopsy. Patients who received clone-targeted therapy had a significantly higher survival compared with other management. Those who achieved haematological response had a significantly higher kidney survival. Outcome was remarkably poor in kidney transplant recipients, with five of them (71%) reaching KF. By PSM (adjusting for age, kidney function, proteinuria and chronicity score), no significant differences were observed in kidney survival between C3G patients with/without MIg. CONCLUSIONS: The C3G histologic index can be used in patients with C3G-MIg to predict kidney prognosis, with higher chronicity scores being associated with worse outcomes. Clone-targeted therapies and the development of a haematological response are associated with better kidney prognosis.

La mortalidad de los pacientes en hemodiálisis está asociada con su situación clínica al comienzo del tratamiento / Mortality of hemodialysis patients is associated with their clinical situation at the start of treatment

Introducción: Estudios previos han demostrado una elevada mortalidad de los pacientes en tratamiento con hemodiálisis, aunque en pocos de ellos se analiza la supervivencia de los que reciben exclusivamente este tratamiento. Nuestro objetivo fue analizar la mortalidad de los pacientes que recibieron tratamiento con hemodiálisis. Métodos: Se analizó la cohorte de pacientes que iniciaron tratamiento sustitutivo entre los años 2010 y 2012 en la comunidad de Castilla-La Mancha y permanecieron en tratamiento con hemodiálisis. Se estudiaron las variables edad, sexo, enfermedad renal primaria, acceso vascular, hemoglobina, índice de Charlson y albúmina sérica al comienzo del tratamiento y se realizó un seguimiento hasta final de 2017. Resultados: La mortalidad fue del 63,4% a los 5 años y del 76% al final del periodo de seguimiento, sin diferencias entre varones y mujeres, y se relacionó con una mayor edad, el comienzo urgente o en aquellos con enfermedad renal reagudizada, la utilización de catéteres o una albúmina inferior a 3,5g/dl. Conclusiones: La mortalidad en los pacientes que permanecen en diálisis es muy elevada y se asocia a factores no modificables como la edad pero también a otros que podemos prevenir o tratar, como el tipo de acceso vascular o el estado de nutrición al comienzo del tratamiento. (AU)

Introduction: Previous reports have shown very high mortality among hemodialyisis patients. Our goal was to analyze the mortality of patients in the Renal Registry of Patients who remained exclusively on hemodialysis treatment. Methods: The cohort of patients who started treatment in the community of Castilla-La Mancha between 2010 and 2012 and remained on hemodialysis treatment was analysed until the end of 2017. Age, sex, primary kidney disease, vascular access, hemoglobin, Charlson index and serum albumin were included. Results: Mortality rate was 63.4% after 5 years and 76% at the end of the study, with no difference between males and females, and was linked to an older age, urgent onset or in those with acute deterioration of chronic kidney disease, the use of catheters or albumin less than 3.5g/dl. Conclusions: Mortality in patients who remain on hemodialysis is very high and is associated with non-modifiable factors such as age but also others that we can prevent or treat such as type of vascular access or nutrition status at the beginning of treatment. (AU)

Vacunación de COVID-19 en grupos ginecológicos y obstétricos especiales / COVID-19 vaccination in special gynecological and obstetric groups

La pandemia por COVID-19 y las serias repercusiones que está teniendo han hecho que se agilice el desarrollo de un arma terapéutica fundamental para comenzar a erradicarla: las vacunas. Son un instrumento fundamental de prevención primaria que se administrará inicialmente a los grupos más vulnerables o con alto riesgo de exposición, ampliando el abanico de administración a otro tipo de población en fases posteriores. Puede surgir controversia a la hora de vacunar a grupos ginecológicos específicos, como son las gestantes, mujeres lactantes o pacientes con cáncer ginecológico. El propósito de este artículo es analizar la información disponible con respecto a la vacunación en estos grupos.(AU)

The COVID-19 pandemic and its serious repercussions are accelerating the development of a fundamental therapeutic strategy to begin eradicating this illness: vaccines. They are a fundamental instrument of primary prevention that will be administer initially to vulnerable groups or those with high risk of exposure, expanding in later phases the administration to another populations. There can be controversy in vaccinating some specific gynecological groups, like pregnant women, lactating women or patients with gynecological cancer. The purpose of this article is to analyze the information available regarding vaccination in these concrete groups.(AU)

Salud sexual en mujeres con cáncer de mama tratadas con Tamoxifeno / Sexual health in women with breast cancer treated with Tamoxifen

El cáncer de mama puede alterar ciertos componentes de la función sexual debidos a la enfermedad y los tratamientos empleados en su abordaje. OBJETIVO: Analizar si las pacientes con cáncer de mama en tratamiento con Tamoxifeno presentan disfunción sexual. MÉTODO: Estudio transversal, observacional para detectar disfunción sexual en pacientes con cáncer de mama en tratamiento con Tamoxifeno y comparar los resultados con población general. Se han analizado los casos de cáncer de mama diagnosticados en el Hospital Virgen de la Luz de abril de 2015 a abril 2016, seleccionando mujeres en tratamiento con Tamoxifeno, menores de 50 años y sexualmente activas, aplicándoseles un cuestionario de salud sexual, posteriormente se compararon los resultados obtenidos con un estudio realizado en población general. RESULTADOS: Se diagnosticaron 130 cánceres de mama en dicho periodo, siendo 34 susceptibles de estudio (26,15 %). Participaron 7 pacientes (20.6%), con edad media de 42,7 años (35-50) y pareja estable en el 85,7%. Se han objetivado trastornos moderados del deseo sexual en un 28,6% y de excitación en 14,28%, así como ausencia de iniciativa sexual en un 42,86%, trastorno de la lubricación vaginal en un 28,6% y problemas para la penetración vaginal en un 14,3 %, pero globalmente están satisfechas con su actividad sexual. Comparando con población general, llama la atención que un 14,2 % de éstas últimas muestra algún grado de insatisfacción sexual. CONCLUSIONES: No hay diferencias significativas en cuanto a disfunción sexual, aunque puede haber mayor ansiedad anticipatoria y disfunción del deseo sexual y lubricación vaginal en el grupo de Tamoxifeno, que probablemente no alcanzan la significación estadística por el tamaño muestral

Breast cancer can alter certain components of sexual function due to the disease and the treatments used. OBJECTIVE: To analyze if patients with breast cancer treated with Tamoxifen have sexual dysfuntion. METHOD: Cross-sectional, observational study to detect sexual dysfunction in patients with breast cancer with Tamoxifen treatment and compare it with general population. The cases of breast cancer at Virgen de La Luz Hospital from April 2015 to April 2016 have been analyzed, selecting women in treatment with tamoxifen, under 50 years and sexually active, applying a sexual health questionnarie and comparing them with general population. RESULTS: 130 breast cancers were diagnosed, 34 were susceptible to study (26,15%). Seven patients (20,6%) participated, with a mean age of 42,7 years (35-50) and stable partner in 85,7%. Moderate disorders of sexual desire have been observed in 28,6% and in arousal in 14,28%, as well as lack of sexual initiative in 42,86%, disorder of vaginal lubrication in 28,6% and problems with vaginal penetration in 14,3%, but overall they are satisfied with their sexual activity. Comparing with general population, it's striking that 14,2% of the last show some degree of sexual insatisfaction. CONCLUSIONS: There are no significant differences regarding sexual dysfunction, although there may be greater anticipatory anxiety, sexual desire dysfunction and vaginal lubrication in the Tamoxifen group, which probably do not reach statistical significance due to sample size

Mycophenolate Mofetil in C3 Glomerulopathy and Pathogenic Drivers of the Disease.

BACKGROUND AND OBJECTIVES: C3 glomerulopathy is a complement-mediated disease arising from abnormalities in complement genes and/or antibodies against complement components. Previous studies showed that treatment with corticosteroids plus mycophenolate mofetil (MMF) was associated with improved outcomes, although the genetic profile of these patients was not systematically analyzed. This study aims to analyze the main determinants of disease progression and response to this therapeutic regimen. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective, multicenter, observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients diagnosed with C3 glomerulopathy (n=81) or dense deposit disease (n=16) between January 1995 and March 2018 were enrolled. Multivariable and propensity score matching analyses were used to evaluate the association of clinical and genetic factors with response to treatment with corticosteroids and MMF as measured by proportion of patients with disease remission and kidney survival (status free of kidney failure). RESULTS: The study group comprised 97 patients (84% C3 glomerulopathy, 16% dense deposit disease). Forty-two patients were treated with corticosteroids plus MMF, and this treatment was associated with a higher rate of remission and lower probability of kidney failure (79% and 14%, respectively) compared with patients treated with other immunosuppressives (24% and 59%, respectively), or ecluzimab (33% and 67%, respectively), or conservative management (18% and 65%, respectively). The therapeutic superiority of corticosteroids plus MMF was observed both in patients with complement abnormalities and with autoantibodies. However, patients with pathogenic variants in complement genes only achieved partial remission, whereas complete remissions were common among patients with autoantibody-mediated forms. The main determinant of no remission was baseline proteinuria. Relapses occurred after treatment discontinuation in 33% of the patients who had achieved remission with corticosteroids plus MMF, and a longer treatment length of MMF was associated with a lower risk of relapse. CONCLUSIONS: The beneficial response to corticosteroids plus MMF treatment in C3 glomerulopathy appears independent of the pathogenic drivers analyzed in this study.

Nacer en los tiempos del COVID-19 / Born in the time of COVID-19

Nos hallamos ante una situación epidemiológica causada por un coronavirus del cual todavía desconocemos muchos datos. Pese a esa carencia de información, los sistemas sanitarios están implantando protocolos para intentar proteger no sólo a los pacientes, si no a los sanitarios que en ellos trabajan. Además, tampoco sabemos demasiado del impacto del COVID-19 sobre poblaciones teóricamente más vulnerables, como las gestantes, en las cual se hace más necesario si cabe adoptar protocolos de actuación lo más basados en la evidencia posible para no caer en una deshumanización en su atención

We are facing a epidemiological situation caused by a coronavirus for which we still don't know much data. Despite this lack of information, health systems are implementing protocols to try to protect the patients, and also its health workers. Furthermore, we also don't know too much about the theoric impact of COVID-19 on vulnerable populations, such pregnant women, in which it becomes more necessary if it possible to adopt evidence-based protocols and not to fall into dehumanized treatment

Extended distal pancreatectomy with thoracic wall resection after neoadjuvant FOLFIRINOX: Is there a limit of resection for pancreatic cancer after downstaging?

Indications and outcomes of extended pancreatectomies have been recently appraised by the International Study Group for Pancreatic Surgery. However, no definitive conclusions have been drawn, particularly in the setting of neoadjuvant treatments. We present here a case of 53-year-old man diagnosed with a bulky adenocarcinoma of the tail of the pancreas and infiltrating the adjacent organs and the thoracic wall. The patient was sent to neoadjuvant chemotherapy and he underwent 12 cycles of FOLFIRINOX. Since a significant radiological response was observed after chemotherapy, the patient was scheduled for extended distal pancreatectomy with en bloc resection of the thoracic wall, in order to achieve a radical resection. The surgery is herein described with all technical details. The patient was discharged after an uneventful early post-operative course and subsequently readmitted for a late grade B post-operative pancreatic fistula, which was ultimately treated successfully. Pathology showed complete response. When performed in centers with ample experience in pancreatic surgery, extended pancreatic resections represent a viable curative option with acceptable surgical outcomes. In this setting, challenging tailored resections should be considered to achieve negative margins, particularly following maximized effective downstaging strategies.

Evaluación del dolor en niños de 2, 4 y 6 meses tras la aplicación de métodos de analgesia no farmacológica durante la vacunación / Evaluation of pain in children of 2, 4 and 6 months after the application of non-pharmacological analgesia methods during vaccination

Introducción: Los niños pequeños tienen una percepción del dolor igual o incluso mayor que los adultos, lo que puede tener consecuencias a corto y largo plazo. Se han descrito intervenciones no farmacológicas para aliviar el dolor en los niños durante el acto de la vacunación. El objetivo de este estudio es valorar 3de estas intervenciones para reducir el dolor asociado a la vacunación: succión no nutritiva (SNN), amamantamiento (LM) y solución de glucosa al 50% (SG50). Material y métodos: Estudio prospectivo, no aleatorizado, de cohortes en niños de 2, 4 y 6 meses que reciben 2, 3 y 1 vacuna, respectivamente, según calendario vacunal sistemático. Se realizaron 3 intervenciones: SNN, LM y ofrecer 2ml de suero glucosado al 50% con SNN. La medición del dolor se efectuó con la escala LLANTO y con el tiempo de llanto. Resultados: Se incluyó a 387 niños. La media de la escala LLANTO a los 2 y 6 meses era significativamente menor en los niños amamantados que en los niños con SNN (p = 0,025 y p < 0,001, respectivamente) y en los que recibían SG50 (p = 0,025 y p = 0,001), sin significación estadística a los 4 meses (p = 0,21 y p = 0,27). No hubo diferencias significativas entre los niños con SNN y SG50 a los 2, 4 y 6 meses (p = 0,66; p = 0,93 y p = 0,45, respectivamente). El tiempo de llanto fue significativamente menor a los 6 meses en los niños amamantados que en los que recibieron SNN o SG50 (p = 0,013 y p = 0,017). Ningún niño amamantado (n = 129) presentó efectos secundarios. Conclusiones: En los niños nacidos a término, con peso adecuado a su edad gestacional, el amamantamiento disminuye el dolor cuando se administran 1 y 2 vacunas; cuando se administran 3 vacunas, la disminución es mínima. La administración de SG50 no tiene efecto analgésico adicional respecto a la vacunación de los niños en brazos de sus padres con SNN. La administración de LM durante la vacunación no tiene ningún efecto secundario

Introduction: Young children perceive pain as much, or even more than adults, and the pain may have short- and long-term consequences. The literature describes the use of non-pharmacological interventions to alleviate pain during vaccination. The aim of this study was to assess 3such interventions for analgesia during vaccination: non-nutritive sucking (NNS), breastfeeding (BF), and administration of a 50% dextrose solution (D50W). Materials and methods: A prospective, non-randomised cohort study was carried out on infants aged 2, 4 and 6 months that received 1, 2, or 3 vaccines, respectively, according to the routine immunisation schedule. There were 3 treatments: NNS, BF, and 2 mL of D50W combined with NNS. Pain was assessed using the LLANTO scale, and the duration of crying. Results: The study included 387 infants. The mean scores in the LLANTO scale at ages 2 and 6 months were significantly lower in breastfed infants compared to infants managed with NNS (P = .025 and P < .001, respectively), or infants given D50W (P = .025 and P = .001), and the difference was not statistically significant at age 4 months (P = .21 and P = .27). There were no significant differences between infants managed with NNS and D50W at 2, 4, and 6 months (P = .66, P = .93 and P = .45, respectively). The duration of crying was significantly lower at age 6 months in breastfeed infants compared to infants managed with NNS or D50W (P = .013 and P = .017). No breastfed child (n = 129) experienced side effects. Conclusions: In infants born to term with adequate weight for gestational age, breastfeeding reduces pain on the administration of 1 or 2 vaccines. When 3 vaccines are given, the reduction is minimal. Administration of D50W does not have any additional analgesic effect in infants compared to being held by a parent combined with NNS during vaccination. BF during vaccination is not associated with any side effects

Feeding Jejunostomy after esophagectomy cannot be routinely recommended. Analysis of nutritional benefits and catheter-related complications.

BACKGROUND: Patients undergoing esophagectomy for cancer usually deal with malnourishment which increases postoperative morbimortality. The objective of this paper is to analyze the nutritional benefits of feeding jejunostomy (FJ) for early postoperative enteral nutrition (EN) and directly-related complications. MATERIAL AND METHODS: Retrospective study of 100 patients undergoing esophagectomy for cancer between 2008 and 2016. RESULTS: FJ was placed in 47 patients. 82.98% reached EN requirements in FJ group, with a median EN re-start of 1.9 days and median days to objective requirements of 5 days. 51.06% developed directly-related FJ complication, 91.66% of them mild ones (gastrointestinal or catheter-related). 2 patients (4.25%) required re-intervention. No significant differences were shown in total protein and albumin seric levels during first postoperative week and in anastomotic leak rate between both groups (p > 0.05). CONCLUSIONS: Feeding jejunostomies are associated with a great number of complications although most are not life-threatening. Since its nutritional benefit is not proven FJ cannot routinely recommended after esophagectomy. However, the optimal pathway for EN reintroduction, including direct oral intake, is still a matter of debate.

[Evaluation of pain in children of 2, 4 and 6 months after the application of non-pharmacological analgesia methods during vaccination]. / Evaluación del dolor en niños de 2, 4 y 6 meses tras la aplicación de métodos de analgesia no farmacológica durante la vacunación.

INTRODUCTION: Young children perceive pain as much, or even more than adults, and the pain may have short- and long-term consequences. The literature describes the use of non-pharmacological interventions to alleviate pain during vaccination. The aim of this study was to assess 3such interventions for analgesia during vaccination: non-nutritive sucking (NNS), breastfeeding (BF), and administration of a 50% dextrose solution (D50W). MATERIALS AND METHODS: A prospective, non-randomised cohort study was carried out on infants aged 2, 4 and 6 months that received 1, 2, or 3 vaccines, respectively, according to the routine immunisation schedule. There were 3treatments: NNS, BF, and 2mL of D50W combined with NNS. Pain was assessed using the LLANTO scale, and the duration of crying. RESULTS: The study included 387 infants. The mean scores in the LLANTO scale at ages 2 and 6 months were significantly lower in breastfed infants compared to infants managed with NNS (P=.025 and P<.001, respectively), or infants given D50W (P=.025 and P=.001), and the difference was not statistically significant at age 4 months (P=.21 and P=.27). There were no significant differences between infants managed with NNS and D50W at 2, 4, and 6 months (P=.66, P=.93 and P=.45, respectively). The duration of crying was significantly lower at age 6 months in breastfeed infants compared to infants managed with NNS or D50W (P=.013 and P=.017). No breastfed child (n=129) experienced side effects. CONCLUSIONS: In infants born to term with adequate weight for gestational age, breastfeeding reduces pain on the administration of 1 or 2 vaccines. When 3 vaccines are given, the reduction is minimal. Administration of D50W does not have any additional analgesic effect in infants compared to being held by a parent combined with NNS during vaccination. BF during vaccination is not associated with any side effects.

Gemcitabine-induced hemolytic-uremic syndrome treated with eculizumab or plasmapheresis: two case reports
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BACKGROUND: Drug-induced hemolytic-uremic syndrome (HUS) has shown good response to eculizumab (ECU). We present 2 cases of patients with gemcitabine-induced HUS (GEM-HUS), one of whom was treated with ECU and the other with conventional treatment. Patient 1: A 74-year-old male with resected adenocarcinoma of the pancreas started adjuvant treatment with GEM, but after 5 months GEM was discontinued due to acute kidney injury and severe hypertension. Laboratory analyses identified microangiopathic hemolytic anemia (MHA) and thrombocytopenia. Plasmapheresis (Pph) was initiated but was stopped due to a severe adverse reaction. Treatment with ECU was initiated at the time of clinical progression requiring hemodialysis. After 7 doses of ECU, hemolysis and kidney function improved and the patient was able to stop hemodialysis. 1 month after the last dose of ECU serum creatinine (sCr) was 1.8 mg/dL. Patient 2: A 68-year-old male with resected urothelial carcinoma stopped GEM after 2 months due to hematologic toxicity. 1 month later the patient visited the emergency room due to minimal effort dyspnea, hypertension, and peripheral edema. Laboratory analyses showed decreased kidney function, MHA, and thrombocytopenia. Symptomatic treatment was started. After an initial recovery, kidney dysfunction, hemolysis, and thrombocytopenia progressed. Corticoid boluses were ineffective and hemodialysis was initiated. Eleven Pph treatments were necessary to recover hematologic data. The patient remained on hemodialysis for 2 months and evolved to stage IV chronic kidney disease. 8 months after hospital release, sCr was 3.5 mg/dL. CONCLUSION: ECU successfully improved kidney function in a patient with GEM-HUS, while conventional treatment did not.
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[Subclinical hypothyroidism and cardiovascular risk]. / HIPOTIROIDISMO SUBCLÍNICO Y RIESGO CARDIOVASCULAR.

OBJECTIVE: To assess whether subclinical hypothyroidism can behave as a cardiovascular risk factor or a modifier thereof, identifying epidemiological variables and estimated in a sample of patients diagnosed in the province of Albacete (Spain) cardiovascular risk. METHODOLOGY: Observational, descriptive study was carried out in Albacete during the first half of January 2012 in patients of both genders with subclinical hypothyroidism. The following variables were analyzed: Fasting glucose , total cholesterol , HDL cholesterol, LDL cholesterol , triglycerides , TSH , T4 , weight, height, Body Mass Index , blood pressure, a history of cardiovascular disease , cardiovascular risk factors and estimated cardiovascular risk. RESULTS: 326 patients younger than 65 years at 78% without cardiovascular risk factors in 48.61 %, with female predominance (79.2 %). The prevalence of cardiovascular risk factors was identified: smoking (33.2 %), diabetes mellitus (24.9%), hypertension (23.4 %), lipid abnormalities (28.9%) and atrial fibrillation (4,9%). No association between subclinical hypothyroidism and most lipid profile parameters that determine a pro- atherogenic profile, except with hypertriglyceridemia was found. Likewise, neither association with increased cardiovascular risk was found. DISCUSSION: The profile of patients with subclinical hypothyroidism is a middle-aged woman with no cardiovascular risk factors in half of cases. It has been found relationship between subclinical hypothyroidism and hypertriglyceridemia, but not with the other parameters of lipid profile, other cardiovascular risk factors or with increased risk. However, 25% of diabetics and 22% of non-diabetics are at moderate to high cardiovascular risk.

Objetivos: Valorar si el hipotiroidismo subclínico puede comportarse como un factor de riesgo cardiovascular o un modificador del mismo, identificando variables epidemiológicas y riesgo cardiovascular estimado en una muestra de sujetos diagnosticados en la provincia de Albacete. Método: Estudio observacional, descriptivo y transversal realizado en Albacete durante la primera quincena de enero de 2012 en pacientes de ambos géneros con hipotiroidismo subclínico. Se analizaron las siguientes variables: glucemia basal, colesterol total, colesterol HDL, colesterol LDL, triglicéridos, TSH, T4, peso, talla, I.M.C., tensión arterial, antecedentes de patología cardiovascular, factores de riesgo cardiovascular y riesgo cardiovascular estimado. Resultados: Se obtuvieron 326 pacientes, con predominio femenino (79,2 %), menores de 65 años en el 78% y sin factores de riesgo cardiovascular en el 48,61%. La prevalencia de los factores de riesgo cardiovascular identificados fué: tabaquismo (33,2%), diabetes mellitus (24,9%), hipertensión arterial (23,4%), alteraciones lipídicas (28,9%) y fibrilación auricular (4,9 %). No se encontró asociación entre hipotiroidismo subclínico y la mayoría de los parámetros del perfil lipídico que condicionan un perfil pro-aterogénico, salvo con la hipertrigliceridemia. Asimismo, tampoco se constató asociación con riesgo cardiovascular aumentado. Conclusiones: El perfil del paciente con hipotiroidismo subclínico es una mujer de mediana edad sin factores de riesgo cardiovascular en la mitad de casos. Se ha encontrado relación entre hipotiroidismo subclínico e hipertrigliceridemia, pero no con el resto de parámetros del perfil lipídico, otros factores de riesgo cardiovascular o con aumento de dicho riesgo. Sin embargo, un 25% de diabéticos y un 22% de no diabéticos están en situación de riesgo cardiovascular moderado-alto.

Hipotiroidismo subclínico y riesgo cardiovascular / Subclinical hypothyroidism and cardiovascular risk

Objetivos: Valorar si el hipotiroidismo subclínico puede comportarse como un factor de riesgo cardiovascular o un modificador del mismo, identificando variables epidemiológicas y riesgo cardiovascular estimado en una muestra de sujetos diagnosticados en la provincia de Albacete. Método: Estudio observacional, descriptivo y transversal realizado en Albacete durante la primera quincena de enero de 2012 en pacientes de ambos géneros con hipotiroidismo subclínico. Se analizaron las siguientes variables: glucemia basal, colesterol total, colesterol HDL, colesterol LDL, triglicéridos, TSH, T4, peso, talla, I.M.C., tensión arterial, antecedentes de patología cardiovascular, factores de riesgo cardiovascular y riesgo cardiovascular estimado. Resultados: Se obtuvieron 326 pacientes, con predominio femenino (79,2 %), menores de 65 años en el 78% y sin factores de riesgo cardiovascular en el 48,61%. La prevalencia de los factores de riesgo cardiovascular identificados fué: tabaquismo (33,2%), diabetes mellitus (24,9%), hipertensión arterial (23,4%), alteraciones lipídicas (28,9%) y fibrilación auricular (4,9 %). No se encontró asociación entre hipotiroidismo subclínico y la mayoría de los parámetros del perfil lipídico que condicionan un perfil pro-aterogénico, salvo con la hipertrigliceridemia. Asimismo, tampoco se constató asociación con riesgo cardiovascular aumentado. Conclusiones: El perfil del paciente con hipotiroidismo subclínico es una mujer de mediana edad sin factores de riesgo cardiovascular en la mitad de casos. Se ha encontrado relación entre hipotiroidismo subclínico e hipertrigliceridemia, pero no con el resto de parámetros del perfil lipídico, otros factores de riesgo cardiovascular o con aumento de dicho riesgo. Sin embargo, un 25% de diabéticos y un 22% de no diabéticos están en situación de riesgo cardiovascular moderado-alto (AU)

Objective: To assess whether subclinical hypothyroidism can behave as a cardiovascular risk factor or a modifier thereof, identifying epidemiological variables and estimated in a sample of patients diagnosed in the province of Albacete (Spain) cardiovascular risk. Methodology: Observational, descriptive study was carried out in Albacete during the first half of January 2012 in patients of both genders with subclinical hypothyroidism. The following variables were analyzed: Fasting glucose , total cholesterol , HDL cholesterol, LDL cholesterol , triglycerides , TSH , T4 , weight, height, Body Mass Index , blood pressure, a history of cardiovascular disease , cardiovascular risk factors and estimated cardiovascular risk. Results: 326 patients younger than 65 years at 78% without cardiovascular risk factors in 48.61 %, with female predominance (79.2 %). The prevalence of cardiovascular risk factors was identified: smoking (33.2 %), diabetes mellitus (24.9%), hypertension (23.4 %), lipid abnormalities (28.9%) and atrial fibrillation (4,9%). No association between subclinical hypothyroidism and most lipid profile parameters that determine a pro- atherogenic profile, except with hypertriglyceridemia was found. Likewise, neither association with increased cardiovascular risk was found. Discussion: The profile of patients with subclinical hypothyroidism is a middle-aged woman with no cardiovascular risk factors in half of cases. It has been found relationship between subclinical hypothyroidism and hypertriglyceridemia, but not with the other parameters of lipid profile, other cardiovascular risk factors or with increased risk. However, 25% of diabetics and 22% of non-diabetics are at moderate to high cardiovascular risk (AU)

Una causa infrecuente de dolor abdominal: el infarto de Omento / A rare cause of abdominal pain: omental infarction

El infarto de omento es un proceso raro, poco conocido, que puede simular otras causas de dolor abdominal y no suele constituir un diagnóstico de presunción. El omento o epiplón mayor es un repliegue peritoneal formado por cuatro capas de tejido adiposo, cuya función es limitar la diseminación de procesos infecciosos e inflamatorios. Se origina en la curvatura mayor del estómago, colgando caudalmente por delante del colon transverso e intestino delgado. Presentamos el caso de un varón de 29 años que consulta por dolor abdominal en fosa ilíaca izquierda (AU)

Omental infarction is a rare, little known process that can simulate other causes of abdominal pain and does not usually constitute a presumptive diagnosis. The greater omentum or epiploön, is a peritoneal fold made up of four layers. Its function is to restrict the spread of infectious or inflammatory processes. It originates in the greater curvature of the stomach and hangs in front of the transverse colon and small intestines. We report a case of a 29 year old man who complained of abdominal pain in the left iliac fossa (AU)