Musculoskeletal pain and muscular weakness as the main symptoms of adult hypophosphatasia in a Spanish cohort: clinical characterization and identification of a new ALPL gene variant.

INTRODUCTION: Hypophosphatasia (HPP) is a rare inherited disorder, caused by mutations in the alkaline phosphatase (ALPL) gene, which encodes for the tissue non-specific alkaline phosphatase (TNSALP) isoform of alkaline phosphatase (ALP). Adult HPP is one of the mild forms that presents with unspecific signs such as osteopenia, osteomalacia and muscle involvement. Our purpose was to identify and characterize possibly misdiagnosed adult HPP patients at a clinical and biochemical level. MATERIAL AND METHODS: At the laboratory of Miguel Servet University Hospital we retrospectively reviewed serum ALP levels in adults over a 48-month period. The clinical records of individuals with consistently low ALP levels were reviewed to exclude secondary causes. Those with persistent hypophosphatasemia were screened for symptoms of HPP. The study participants were evaluated at biochemical and genetic levels. RESULTS: We identified 705 ALP determinations (out of 384,000 processed) in 589 patients below the reference range (30 U/l). Only 21 patients with clinical signs and symptoms of HPP were selected for genetic testing. Finally, only 12 patients participated in the study, 83.3% of whom (10/12) harbored a pathogenic or likely pathogenic variant in a heterozygous state. The major symptoms of our cohort were the presence of musculoskeletal pain (100% of patients) and muscular weakness (83.3% patients). CONCLUSION: Mild HPP patients presenting with diffuse symptoms such as musculoskeletal pain may be undiagnosed or misdiagnosed as osteoporosis patients by routine diagnosis. It is important to identify these individuals, to avoid inappropriate treatment with antiresorptive drugs.

Successful control of Serratia marcescens outbreak in a neonatal unit of a tertiary-care hospital in Spain.

OBJECTIVE: Serratia marcescens is a Gram-negative bacterium that is found in hospital environments and commonly associated with outbreaks in neonatal units. One S. marcescens isolate was detected from a bloodstream culture from a neonate in our hospital that was followed by an outbreak. The aim of this study was to describe the molecular epidemiology of a S. marcescens outbreak in the neonatal unit. METHODS: In order to investigate the outbreak, weekly surveillance rectal swabs were submitted for culture from all patients admitted in this unit from August to September 2018. Environmental samples were obtained from potential sources in September 2018. Typing of isolates was performed by pulsed field gel electrophoresis (PFGE). In addition, we studied the in vitro activity of chlorhexidine against S. marcescens. RESULTS: During this period, 146 infants were hospitalised in our neonatal unit, of which 16 patients had a S. marcescens-positive sample. A total of 36 environmental surveillance samples were collected, and one sample from a stethoscope from an incubator of a colonized baby was positive for S. marcescens. All the 18 isolates, including the isolate from the stethoscope, belonged to a single PFGE cluster. We found that very low concentrations of chlorhexidine, even with application times close to 0 achieved significant reductions in the amount of S. marcescens. CONCLUSION: A unique clone of S. marcescens caused this outbreak, including isolates from patients and from one stethoscope. The outbreak was controlled with the early implementation of specific control measures.

Successful control of Serratia marcescens outbreak in a neonatal unit of a tertiary-care hospital in Spain.

OBJECTIVE: Serratia marcescens is a Gram-negative bacterium that is found in hospital environments and commonly associated with outbreaks in neonatal units. One S. marcescens isolate was detected from a bloodstream culture from a neonate in our hospital that was followed by an outbreak. The aim of this study was to describe the molecular epidemiology of a S. marcescens outbreak in the neonatal unit. METHODS: In order to investigate the outbreak, weekly surveillance rectal swabs were submitted for culture from all patients admitted in this unit from August to September 2018. Environmental samples were obtained from potential sources in September 2018. Typing of isolates was performed by pulsed field gel electrophoresis (PFGE). In addition, we studied the in vitro activity of chlorhexidine against S. marcescens. RESULTS: During this period, 146 infants were hospitalised in our neonatal unit, of which 16 patients had a S. marcescens-positive sample. A total of 36 environmental surveillance samples were collected, and one sample from a stethoscope from an incubator of a colonized baby was positive for S. marcescens. All the 18 isolates, including the isolate from the stethoscope, belonged to a single PFGE cluster. We found that very low concentrations of chlorhexidine, even with application times close to 0 achieved significant reductions in the amount of S. marcescens. CONCLUSION: A unique clone of S. marcescens caused this outbreak, including isolates from patients and from one stethoscope. The outbreak was controlled with the early implementation of specific control measures.

Bacteriemias por staphylococcus aureus: factores de riesgo asociados a la resistencia a meticilina / Bacteriemias caused by staphylococcus aureus: risk factors associated to methicillin resistance

INTRODUCCION: el objetivo del trabajo ha sido identificar los factores de riesgo que podrían favorecer la aparición de resistencia a meticilina en aislamientos de Staphylococcus aureus y aquellos que influirían en la mortalidad por las bacteriemias producidas por este patógeno. METODOS: se realizó un estudio observacional de casos y controles en los 57 pacientes diagnosticados de bacteriemia por Staphylococcus aureus en el Hospital de Barbastro. Para el análisis se utilizaron los test estadísticos de Chi cuadrado de Pearson, test de Fisher y regresión logística múltiple. RESULTADOS: del total de bacteriemias, 63,15% correspondieron a Staphylococcus aureus sensible a meticilina y 36,84% a Staphylococcus aureus resistente a meticilina. Se asociaron a resistencia a meticilina, la adquisición nosocomial de la infección, el uso previo de antibióticos y la edad mayor de 65 años. La mortalidad de los casos de bacteriemia por SARM y SAMS fue respectivamente del 28,57% y del 36,11%, siendo estas diferencias estadísticamente no significativas. Todos los aislamientos fueron sensibles in vitro a vancomicina. CONCLUSIONES: en nuestro sector sanitario, las estrategias más efectivas para disminuir la incidencia de bacteriemias por SARM serían el control y uso adecuado de antimicrobianos y la aplicación de programas de prevención de infecciones nosocomiales. En los pacientes con bacteriemia por Staphylococcus aureus, la resistencia a meticilina no se asocia a más mortalidad.

INTRODUCTION: the objective of this work has been to identify the risk factors that could favor the appearance of methicillin resistance in isolates of Staphylococcus aureus (SA) and those that would influence mortality due to bacteremia produced by this pathogen. METHODS: an observational case-control study was carried out in 57 patients diagnosed with bacteremia by SA at the Barbastro's Hospital. Pearson Chi square statistical test, Fisher test and multiple logistic regression were used for the analysis. RESULTS: of the total Bacteriemias, 63.15% corresponded to methicillin-sensitive Staphylococcus aureus (MSSA) and 36.84% to methicillin-resistant Staphylococcus aureus (MRSA). Nosocomial acquisition of the infection, previous use of antibiotics and the age over 65 years, were associated with methicillin resistance. The mortality of cases of MRSA and SAMS bacteremia was 28.57% and 36.1 1% respectively, these differences being statistically not significant. All isolates were sensitive in vitro to vancomycin. CONCLUSIONS: in our health sector, the most effective strategies to reduce the incidence of MRSA bacteremia would be the control and proper use of antimicrobials and the application of nosocomial infection prevention programs. Patients with SA bacteremia, are not associated with more mortality caused by MRSA.

Utility of myeloperoxidase in the differential diagnosis of acute coronary syndrome.

OBJECTIVES: To determine the usefulness of myeloperoxidase in discriminating between patients with acute coronary syndrome and patients with chest pain by other causes. METHODS: The study included all patients over 18 years of age who come consecutively to the emergency department from September 2015 to December 2015 with chest pain of non-traumatic origin. The initial patient evaluation was performed according to the study protocol for patients with suspected acute coronary syndrome (ACS) in our Emergency Department. This included the serial measurement of troponin, and in this case myeloperoxidase, with serialization on admission and at 6h. For the determination of myeloperoxidase (MPO), a single step sandwich enzyme immunoassay by Siemens, automated on a Dimension analyser, was used. RESULTS: Statistically significant differences were observed in the concentration of myeloperoxidase at time 0 among patients diagnosed with ACS: 505 (413)pmol/L, and non-ACS patients: 388 (195)pmol/L (p<.001), as well as at 6h (p<.001). An area under the curve ROC of 0.824 was obtained at 6h for ACS patients, with a confidence interval of 95% from 0.715 to 0.933 and a level of significance of p<.001. Statistically significant differences were also found in the concentration of myeloperoxidase at time 0 and at 6h among patients with ACS and patients with heart disease other than coronary artery disease. CONCLUSIONS: The concentration of MPO helps to differentiate between ACS and non-ACS patients, as well as between ACS patients and patients with heart diseases other than coronary artery disease.

Utility of myeloperoxidase in the differential diagnosis of acute coronary syndrome / Utilidad de la determinación de mieloperoxidasa en el diagnóstico diferencial del síndrome coronario agudo

Abstract Objectives: To determine the usefulness of myeloperoxidase in discriminating between patients with acute coronary syndrome and patients with chest pain by other causes. Methods: The study included all patients over 18 years of age who come consecutively to the emergency department from September 2015 to December 2015 with chest pain of non- traumatic origin. The initial patient evaluation was performed according to the study protocol for patients with suspected acute coronary syndrome (ACS) in our Emergency Department. This included the serial measurement of troponin, and in this case myeloperoxidase, with serialization on admission and at 6 h. For the determination of myeloperoxidase (MPO), a single step sandwich enzyme immunoassay by Siemens, automated on a Dimension analyser, was used. Results: Statistically significant differences were observed in the concentration of myeloperoxidase at time 0 among patients diagnosed with ACS: 505 (413) pmol/L, and non-ACS patients: 388 (195) pmol/L (p < .001), as well as at 6 h (p < .001). An area under the curve ROC of 0.824 was obtained at 6 h for ACS patients, with a confidence interval of 95% from 0.715 to 0.933 and a level of significance of p <.001. Statistically significant differences were also found in the concentration of myeloperoxidase at time 0 and at 6 h among patients with ACS and patients with heart disease other than coronary artery disease. Conclusions: The concentration of MPO helps to differentiate between ACS and non-ACS patients, as well as between ACS patients and patients with heart diseases other than coronary artery disease.

Resumen Objetivos: Conocer la utilidad de mieloperoxidasa (MPO) para discriminar entre pacientes con síndrome coronario agudo y dolor torácico de otras causas. Métodos: De septiembre a diciembre de 2015 se incluyeron todos los pacientes mayores de 18 años que acudieron de forma consecutiva al servicio de urgencias con dolor torácico de origen no traumático. La evaluación inicial del paciente se realizó de acuerdo con el protocolo de estudio para pacientes con sospecha de síndrome coronario agudo (SCA) en nuestro servicio de urgencias, que incluye la medición de troponina y en este caso MPO, con serialización al ingreso y a las 6 h. Para la determinación de MPO se utilizó un inmunoensayo enzimático de tipo sándwich, de una sola etapa de Siemens, automatizado en un equipo Dimension . Resultados: Se obtuvieron diferencias estadísticamente significativas en la concentración de MPO a tiempo 0 entre los pacientes con diagnóstico de SCA: 505 (413) pmol/l y los pacientes no SCA: 388 (195 pmol/l (p < 0.001), así como a las 6 h (p < 0.001). Se obtuvo a las 6 h un área bajo la curva ROC para pacientes con SCA de 0.824 con un intervalo de confianza del 95% de 0.715 a 0.933 y un grado de significación p < 0.001. También se obtuvieron diferencias estadísticamente significativas en la concentración de MPO tanto a tiempo 0 como a las 6 h entre pacientes con SCA y pacientes con enfermedad cardiaca diferente de enfermedad coronaria. Conclusiones: La concentración de MPO sirve para diferenciar entre pacientes SCA y pacientes que no son SCA, así como entre pacientes SCA y pacientes con otras enfermedades cardiacas diferentes a la enfermedad coronaria.

Utilidad de copeptina en el diagnóstico de síndrome coronario agudo en el departamento de urgencias de un hospital de tercer nivel / Usefulness of copeptin in the diagnosis of acute coronary syndrome in the emergency department of a tertiary hospital

Objetivos: Valorar la utilidad de copeptina (fragmento estable del precursor de vasopresina-arginina) en el diagnóstico diferencial del dolor torácico agudo de posible origen coronario. Material y métodos: Se han incluido en el estudio 82 pacientes que fueron evaluados inicialmente de acuerdo con el protocolo de pacientes con sospecha de síndrome coronario agudo (SCA) de nuestro Servicio de Urgencias, incluyendo la determinación de troponina y copeptina con seriación en admisión y a las 6 h. Resultados: Obtuvimos diferencias estadísticamente significativas en la concentración de copeptina a tiempo 0 entre los pacientes diagnosticados de SCASEST: 42,1±38,7pmol/L y los pacientes no SCASEST: 15,6±21,2pmol/L (p<0,01). Sin embargo, las diferencias no alcanzaron a ser estadísticamente significativas a las 6 h (p=0,093). El análisis del área bajo la curva ROC para la copeptina en los pacientes SCASEST a tiempo 0 fue de 0,713 con un intervalo de confianza del 95% de 0,592 a 0,834 y un grado de significación de p=0,001. Conclusiones: La concentración de copeptina representa un valor adicional en la diferenciación entre pacientes SCASEST y pacientes no SCASEST, así como entre pacientes SCA y pacientes con angina estable. El punto de corte de 10pmol/L proporciona los mejores valores de sensibilidad, valor predictivo negativo (VPN), cociente de probabilidad positivo (CPP) y cociente de probabilidad negativo (CPN) en el diagnóstico de pacientes SCASEST

Objectives: This study was conducted in order to evaluate the usefulness of copeptin (a stable fragment of the precursor of arginine vasopressin) in the differential diagnosis of acute chest pain of probable coronary origin. Material and methods: The study includes 82 patients who were initially evaluated according to the protocol of a patient with suspected acute coronary syndrome (ACS) in our Emergency Department, including the determination of troponin and copeptin with specimens taken on admission (time 0) and at 6h. Results: Statistically significant differences were observed in copeptin concentrations at time 0 among patients diagnosed with non-ST-segment elevation (NTEACS): 42.1±38.7pmol/L and non-NSTEACS patients: 15.6±21.2pmol/L (P<. 01). However, the differences did not reach statistical significance at 6h (P=.093). The analysis of the area under the ROC curve for Copeptin in NSTEACS patients at time 0 was 0.713, with a confidence interval of 95% from 0.592 to 0.834 and a significance level of P=.001. Conclusions: The concentration of copeptin represents an additional value in the differentiation between NSTEACS patients and non-NSTEACS patients, as well as between ACS patients and patients with stable angina. The cut-off point of 10pmol/L provides the best values for sensitivity, negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) in the diagnosis of NSTEACS patients

[Usefulness of copeptin in the diagnosis of acute coronary syndrome in the emergency department of a tertiary hospital]. / Utilidad de copeptina en el diagnóstico de síndrome coronario agudo en el departamento de urgencias de un hospital de tercer nivel.

OBJECTIVES: This study was conducted in order to evaluate the usefulness of copeptin (a stable fragment of the precursor of arginine vasopressin) in the differential diagnosis of acute chest pain of probable coronary origin. MATERIAL AND METHODS: The study includes 82 patients who were initially evaluated according to the protocol of a patient with suspected acute coronary syndrome (ACS) in our Emergency Department, including the determination of troponin and copeptin with specimens taken on admission (time 0) and at 6h. RESULTS: Statistically significant differences were observed in copeptin concentrations at time 0 among patients diagnosed with non-ST-segment elevation (NTEACS): 42.1±38.7pmol/L and non-NSTEACS patients: 15.6±21.2pmol/L (P<. 01). However, the differences did not reach statistical significance at 6h (P=.093). The analysis of the area under the ROC curve for Copeptin in NSTEACS patients at time 0 was 0.713, with a confidence interval of 95% from 0.592 to 0.834 and a significance level of P=.001. CONCLUSIONS: The concentration of copeptin represents an additional value in the differentiation between NSTEACS patients and non-NSTEACS patients, as well as between ACS patients and patients with stable angina. The cut-off point of 10pmol/L provides the best values for sensitivity, negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) in the diagnosis of NSTEACS patients.

Grosor íntima-media en una muestra de mediana-avanzada edad de la población general española / Intima-media thickness in a middle-old age sample of the Spanish general population

Objetivos: Determinar los valores de referencia del grosor íntima-media carotídeo (GIMc) en una muestra de mediana-avanzada edad de la población española y establecer el valor de GIMc para el percentil 75, valor por encima del cual es necesario controlar de manera más estricta el resto de los factores de riesgo cardiovascular de los pacientes. Establecer los valores de GIMc y el número de placas de ateroma en carótida en distintos subgrupos de edad y sexo y ver si existen diferencias entre ellos. Material y métodos: Se determinaron las variables lipídicas, las apolipoproteínas y el grosor íntima-media de ambas arterias carótidas comunes (GIMc), así como el número de placas ateroscleróticas en caso de que las hubiera en una muestra de 171 personas, representativa de la población general adulta de mediana-avanzada edad de Burgos. Resultados: La mediana de edad de nuestros pacientes fue de 63 años (rango intercuartílico = 20) y el percentil 75 del GIM carotídeo fue de 0,88 mm en varones y 0,81 mm en mujeres. Nuestro estudio pone en evidencia que los valores de GIMc aumentan significativamente con la edad y que son mayores en hombres que en mujeres en todos los grupos de edad, excepto en los individuos mayores de 74 años, donde los valores de mediana de GIMc son prácticamente iguales. La presencia o ausencia de placas de ateroma no fue estadísticamente diferente entre hombres y mujeres en los diferentes grupos de edad. Conclusiones: Este estudio poblacional presenta los valores de referencia de GIMc en una muestra de mediana-avanzada edad de la población española y muestra que la edad, el sexo masculino, la presión arterial sistólica y los antecedentes personales de enfermedad coronaria son los principales determinantes del grosor de la íntima media carotídea

Objectives: To ascertain reference values of carotid intima-media thickness (cIMT) in a middle and old-aged sample of the Spanish general population and to establish the 75th percentile above which it is necessary to control more strictly other cardiovascular risk factors. To determine cIMT values and the number of carotid plaques in age and sex subgroups, and whether there are differences between them. Material and methods: Lipids, apolipoproteins, number of carotid atherosclerotic plaques if any, and cIMT of both common carotid arteries were determined in 171 individuals, representative of the adult general population of Burgos (Spain). Results: The median age of the patients was 63 years (interquartile range = 20) and the 75th percentile of carotid IMT was 0,88 mm and 0,81 mm in men and women, respectively. This study shows that the values of cIMT median increase with age and are higher in men than in women in all age groups, except in individuals over 74 years where cIMT median values are similar. The presence or absence of atherosclerotic plaques was not statistically different between men and women at different ages. Conclusions: This population study shows the reference values of cIMT in a middle and old-aged sample of the Spanish population and shows that age, male gender, systolic blood pressure (SBP) and personal history of coronary heart disease are the main determinants of increased cIMT

[Intima-media thickness in a middle-old age sample of the Spanish general population]. / Grosor íntima-media en una muestra de mediana-avanzada edad de la población general Española.

OBJECTIVES: To ascertain reference values of carotid intima-media thickness (cIMT) in a middle and old-aged sample of the Spanish general population and to establish the 75(th) percentile above which it is necessary to control more strictly other cardiovascular risk factors. To determine cIMT values and the number of carotid plaques in age and sex subgroups, and whether there are differences between them. MATERIAL AND METHODS: Lipids, apolipoproteins, number of carotid atherosclerotic plaques if any, and cIMT of both common carotid arteries were determined in 171 individuals, representative of the adult general population of Burgos (Spain). RESULTS: The median age of the patients was 63 years (interquartile range = 20) and the 75th percentile of carotid IMT was 0,88 mm and 0,81 mm in men and women, respectively. This study shows that the values of cIMT median increase with age and are higher in men than in women in all age groups, except in individuals over 74 years where cIMT median values are similar. The presence or absence of atherosclerotic plaques was not statistically different between men and women at different ages. CONCLUSIONS: This population study shows the reference values of cIMT in a middle and old-aged sample of the Spanish population and shows that age, male gender, systolic blood pressure (SBP) and personal history of coronary heart disease are the main determinants of increased cIMT.

Efecto de la obstrucción de la vía biliar en la concentración de lipoproteína(a) / Effect of biliary obstruction on lipoprotein(a) concentration

Objetivos Este estudio se diseñó para establecer la correlación entre la concentración de lipoproteína(a) [Lp(a)], apolipoproteínas y lípidos con los parámetros bioquímicos de función hepática en un grupo de pacientes con colestasis reversible, así como la concentración de estos parámetros una vez resuelto el proceso de obstrucción biliar. Material y métodos Se incluyeron en el estudio de forma prospectiva 18 adultos mayores de 17 años con colestasis extrahepática y se determinaron los parámetros de función hepática, así como los parámetros del metabolismo lipídico y lipoproteico, especialmente Lp(a) antes y después de la desobstrucción. Resultados La concentración de Lp(a) previa a la desobstrucción se correlacionó inversamente de forma estadísticamente significativa con la concentración de gamma glutamil transpeptidasa (coeficiente de correlación [r] = -0,757; p = 0,018). La concentración de Lp(a) (mediana = 2,66 mg/dl; rango intercuartílico = 5,62) se elevó de forma estadísticamente significativa tras la desobstrucción (mediana = 9,72 mg/dl; rango intercuartílico = 28,76; p = 0,001). Hubo descensos estadísticamente significativos tras la desobstrucción en las concentraciones de colesterol total y triglicéridos y ascensos estadísticamente significativos en colesterol HDL y apolipoproteína A-1. Conclusiones: La concentración de Lp(a) se encuentra disminuida durante la colestasis, a pesar de existir una importante hipercolesterolemia simultánea. La colestasis ejerce un papel causal en el descenso de Lp(a), ya que la desobstrucción de la vía biliar recupera las concentraciones de Lp(a). Nuestro estudio apoya el concepto de que los ácidos biliares ejercen un efecto represor en la síntesis de Lp(a) y abre un mecanismo para el tratamiento de la hiper Lp(a)

Objectives: This study was appointed to determine the correlation between the concentration of lipoprotein(a) [Lp(a)], apolipoproteins and lipids with biochemical parameters of liver function in a group of patients with reversible cholestasis. We have also determined the concentration of these parameters once solved the biliary obstruction process. Material and methods: Eighteen adults over 17 years with extrahepatic cholestasis were included in the study on a prospective basis, and we determined in them biochemical liver function parameters and lipoprotein metabolism parameters, particularly Lp(a) before and after unblocking. Results: The concentration of Lp(a) prior to desobstruction was inverse and statistically significantly correlated with the concentration of gamma glutamyl transpeptidase (correlation coefficient [r] = -0.757, P = .018). The concentration of Lp(a) (median = 2.66 mg/dL, interquartile range = 5,62) showed a statistically significant increase (median = 9.72 mg/dL, interquartile range = 28.76, P < .001), once the unblocking was performed. Concentrations of total cholesterol and triglycerides had a statistically significant decrease, and HDL cholesterol and apolipoproteinA-1 showed a statistically significant increase once the unblocking was carried out. Conclusions: The concentration of Lp(a) is decreased during cholestasis, although there is a significant simultaneous hypercholesterolemia. Cholestasis has a causal role in lowering Lp(a), because the unblocking of bile duct recovers Lp(a) concentration. Our study supports the concept that bile acids exert a controlling effect on the synthesis of Lp(a) and open a mechanism for the treatment of hyper Lp(a)

Inflammatory response in mixed viral-bacterial community-acquired pneumonia.

BACKGROUND: The role of mixed pneumonia (virus+bacteria) in community-acquired pneumonia (CAP) has been described in recent years. However, it is not known whether the systemic inflammatory profile is different compared to monomicrobial CAP. We wanted to investigate this profile of mixed viral-bacterial infection and to compare it to monomicrobial bacterial or viral CAP. METHODS: We measured baseline serum procalcitonin (PCT), C reactive protein (CRP), and white blood cell (WBC) count in 171 patients with CAP with definite etiology admitted to a tertiary hospital: 59 (34.5%) bacterial, 66 (39.%) viral and 46 (27%) mixed (viral-bacterial). RESULTS: Serum PCT levels were higher in mixed and bacterial CAP compared to viral CAP. CRP levels were higher in mixed CAP compared to the other groups. CRP was independently associated with mixed CAP. CRP levels below 26 mg/dL were indicative of an etiology other than mixed in 83% of cases, but the positive predictive value was 45%. PCT levels over 2.10 ng/mL had a positive predictive value for bacterial-involved CAP versus viral CAP of 78%, but the negative predictive value was 48%. CONCLUSIONS: Mixed CAP has a different inflammatory pattern compared to bacterial or viral CAP. High CRP levels may be useful for clinicians to suspect mixed CAP.

[Effect of biliary obstruction on lipoprotein(a) concentration]. / Efecto de la obstrucción de la vía biliar en la concentración de lipoproteína(a).

OBJECTIVES: This study was appointed to determine the correlation between the concentration of lipoprotein(a) [Lp(a)], apolipoproteins and lipids with biochemical parameters of liver function in a group of patients with reversible cholestasis. We have also determined the concentration of these parameters once solved the biliary obstruction process. MATERIAL AND METHODS: Eighteen adults over 17 years with extrahepatic cholestasis were included in the study on a prospective basis, and we determined in them biochemical liver function parameters and lipoprotein metabolism parameters, particularly Lp(a) before and after unblocking. RESULTS: The concentration of Lp(a) prior to desobstruction was inverse and statistically significantly correlated with the concentration of gamma glutamyl transpeptidase (correlation coefficient [r] = -0.757, P = .018). The concentration of Lp(a) (median = 2.66 mg/dL, interquartile range = 5,62) showed a statistically significant increase (median = 9.72 mg/dL, interquartile range = 28.76, P < .001), once the unblocking was performed. Concentrations of total cholesterol and triglycerides had a statistically significant decrease, and HDL cholesterol and apolipoprotein A-1 showed a statistically significant increase once the unblocking was carried out. CONCLUSIONS: The concentration of Lp(a) is decreased during cholestasis, although there is a significant simultaneous hypercholesterolemia. Cholestasis has a causal role in lowering Lp(a), because the unblocking of bile duct recovers Lp(a) concentration. Our study supports the concept that bile acids exert a controlling effect on the synthesis of Lp(a) and open a mechanism for the treatment of hyper Lp(a).

LDL oxidation and its association with carotid artery intima-media thickness and other cardiovascular risk factors in a sample of Spanish general population.

We studied the association between oxidized low-density lipoproteins (OxLDLs) and early atherosclerosis, assessed by carotid artery intima-media thickness (cIMT), as well as with other known atherosclerosis risk factors in a sample of the general middle- and old-age population of Burgos (Spain). Circulating OxLDL showed a significant and independent association with the average cIMT of both carotid arteries but not with the absence or presence of ≥1 carotid atheroma plaques. Plasma OxLDL concentrations were associated with age, smoking, low-density lipoprotein-cholesterol, and triglycerides, independently of other variables. Our findings in an asymptomatic sample representative of the Spanish middle- and old-age population underscore the role of OxLDL in early atherosclerosis represented by the cIMT especially in older asymptomatic individuals, but this cannot be extended to more advanced atherosclerosis, represented by carotid plaques.

Lack of association between carotid intima-media thickness and apolipoprotein (a) isoforms in a sample of Spanish general population.

OBJECTIVES: The purpose of this study was to examine the relationship between apolipoprotein (a) isoforms and early atherosclerosis, assessed by carotid artery intima-media thickness in a sample of adults of the general population of Burgos, a city in the north of Spain. DESIGN AND METHODS: Lipids, lipoprotein (a), number of carotid atherosclerotic plaques, if any, and the intima-media thickness in the far wall of both common carotid arteries by B-mode ultrasound were determined in a group of 171 adults from the general population of Burgos, Spain. Apolipoprotein (a) isoforms were determined in a random subset of 119 subjects. RESULTS: Increasing age, male sex, and past personal cardiovascular history were significantly associated with increased left, right, or average intima-media thickness of both carotid arteries in multivariate analysis. No statistically significant association was found between apolipoprotein (a) isoforms and mean carotid intima-media thickness by bivariate or multivariate regression analysis. CONCLUSIONS: In this sample of the general Spanish population, no association was found between apolipoprotein (a) isoforms and carotid artery intima-media thickness.

The importance of right otitis media in childhood language disorders.

Studies relating chronic otitis media and language disorders in children have not reported consistent findings. We carried out the first selective study aimed at discerning the role of chronic right otitis media in children less than 3 years of age in language development. A total of 35 children were studied using a full linguistic protocol, auditory brainstem responses, and middle latency responses. Twelve children had a history of chronic exclusive right otitis media. Seventeen age-matched children were selected as controls. Also, three children having a history of chronic left otitis media were compared with three age-matched controls. Linguistic tests showed significant differences between patients and controls in phonetic, phonological, and syntax scores but not semantics. Correlation studies between linguistic scores and auditory evoked responses in the whole cohort showed a significant coefficient in phonetic and phonological domains. These results emphasize the causative effect of right ear chronic otitis media and indicate that it mainly impairs phonetic and phonological coding of sounds, which may have implications for prophylactic treatment of at-risk children.

Septic shock in pregnancy due to pyogenic sacroiliitis: a case report.

INTRODUCTION: Lower back pain due to sacroiliac joint dysfunction is a common symptom during pregnancy. However, infection of the sacroiliac joint is rare, even more so if no predisposing factors are present. CASE PRESENTATION: After the onset of unspecific acute pain in the left buttock region, a 31-year-old pregnant woman developed septic shock due to pyogenic sacroiliitis. The medical and obstetric management, treatment applied and patient's experience are described. CONCLUSION: The correct diagnosis and treatment of pyogenic sacroiliitis during pregnancy may avoid joint and bone destruction in addition to maternal and fetal complications.