Mortality and cardiovascular risk in vasculitis ANCA. Importance of hypertension and renal function. Experience from southern Spain / Mortalidad y riesgo cardiovascular en vasculitis ANCA. Importancia de la hipertension y funcion renal. Experiencia del sur de España

Background: Cardiovascular disease (CVD) is one of the principal causes of death in antineutrophil cytoplasmic antibody-(ANCA)-associated vasculitis (AAV). Objectives: To evaluate the mortality and it's causes and CVD and its vascular risk factors (VRFs) in AAV patients in Andalusia. Methods: A multicenter cohort of 220 AAV patients followed-up from 1979 until June 2020 was studied in Andalussia, south of Spain. The information, including socio-demographic and clinical data was recorded retrospectively through chart review. Data was analysed using Chi2, ANOVA and Cox proportional hazards regresion as uni and multivariate test with a 95% confidence interval (CI). Results: During a mean ± standard deviation follow-up of 96.79 ± 75.83 months, 51 patients died and 30 presented at least one CVE. Independent prognostic factors of mortality were age (HR 1.083, p=0.001) and baseline creatinine (HR 4.41, p=0.01). Independent prognostic factors of CVE were age [hazard ratio (HR) 1.042, p=0.005] and the presence of hypertension (HTN) six months after diagnosis (HR 4.641, p=0.01). HTN, diabetes and renal failure, all of these important VRFs, are more prevalent in AAV patients than it is described in matched general population. Conclusions: Age and baseline renal function, but not CVEs, are predictors of mortality and age and early HTN are independent predictors for having a CVE. CVD screening in AAV patients is demanded.(AU)

Introducción: La enfermedad cardiovascular (ECV) es una de las principales causas de muerte en las vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos (ANCA) (VAA). Objetivos: Evaluar la mortalidad y sus causas, entre ellas la ECV y sus factores de riesgo vascular (FRV) en pacientes con VAA en Andalucía. Métodos: Se estudió una cohorte multicéntrica de 220 pacientes con VAA seguidos desde 1979 hasta junio de 2020 en Andalucía. La información, incluidos los datos sociodemográficos y clínicos, se registró retrospectivamente a través de la revisión de historias clínicas. Los datos se analizaron mediante Chi2, ANOVA y regresión de riesgos proporcionales de Cox de forma uni y multivariante con un intervalo de confianza (IC) del 95%. Resultados: Durante un seguimiento medio y desviación estándar de 96,79 ± 75,83 meses, 51 pacientes fallecieron y 30 presentaron al menos un ECV. Los factores pronósticos independientes de mortalidad fueron la edad (HR 1,083, p=0,001) y la creatinina basal (HR 4,41, p=0,01). Los factores pronósticos independientes de ECV fueron la edad [hazard ratio (HR) 1,042, p=0,005] y la presencia de hipertensión arterial (HTA) seis meses después del diagnóstico (HR 4,641, p=0,01). La prevalencia de HTA, diabetes e insuficiencia renal fue elevada o muy elevada en comparación con la población general emparentada, todos FRCV determinantes para el pronóstico de estos pacientes. Conclusiones: La edad y la función renal basal son predictores de mortalidad y la edad y la HTA de aparición precoz son predictores independientes de tener ECV. Se recomienda el cribado de FRCV en pacientes con vasculitis ANCA.(AU)

Mortality and cardiovascular risk in vasculitis ANCA. Importance of hypertension and renal function. Experience from southern Spain.

BACKGROUND: Cardiovascular disease (CVD) is one of the principal causes of death in antineutrophil cytoplasmic antibody-(ANCA)-associated vasculitis (AAV). OBJECTIVES: To evaluate the mortality and it's causes and CVD and its vascular risk factors (VRFs) in AAV patients in Andalusia. METHODS: A multicenter cohort of 220 AAV patients followed-up from 1979 until June 2020 was studied in Andalussia, south of Spain. The information, including socio-demographic and clinical data was recorded retrospectively through chart review. Data was analysed using Chi2, ANOVA and Cox proportional hazards regresion as uni and multivariate test with a 95% confidence interval (CI). RESULTS: During a mean ± standard deviation follow-up of 96.79 ± 75.83 months, 51 patients died and 30 presented at least one CVE. Independent prognostic factors of mortality were age (HR 1.083, p=0.001) and baseline creatinine (HR 4.41, p=0.01). Independent prognostic factors of CVE were age [hazard ratio (HR) 1.042, p=0.005] and the presence of hypertension (HTN) six months after diagnosis (HR 4.641, p=0.01). HTN, diabetes and renal failure, all of these important VRFs, are more prevalent in AAV patients than it is described in matched general population. CONCLUSIONS: Age and baseline renal function, but not CVEs, are predictors of mortality and age and early HTN are independent predictors for having a CVE. CVD screening in AAV patients is demanded.

The efficacy of romiplostim in the treatment of severe thrombocytopenia associated to Evans syndrome refractory to rituximab.

We present a case of a man diagnosed with systemic lupus erythematosus, associated antiphospholipid syndrome and Evans syndrome, who developed a severe thrombocytopenia refractory to treatment with first-line drugs, cyclophosphamide and rituximab, and who responded to romiplostim with a normalization of the platelet recount, which later enabled a therapeutic splenectomy to be performed.

Bloqueo auriculoventricular completo secundario a toxicidad cardíaca por cloroquina / Complete auriculoventricular block secondary to cardiac toxicity due to chloroquine

No disponible

Hiperhidrosis severa como forma de presentación de la acromegalia / Acromegaly presenting with severe hiperhidrosis

No disponible

[Quality of life, psychological and social aspects in patients with advanced HIV disease]. / Calidad de vida, aspectos psicológicos y sociales en pacientes con infección VIH avanzada.

OBJECTIVE: The advanced HIV infection carries an important physical, psychological and quality of life deterioration for patients. The introduction of new treatment strategies probably implies a global benefit for HIV patients. We carried out this study in order to know in HIV advanced patients; the clinical situation, the prevalence of psychological alterations (anxiety and depression), the quality of life and the impact of the introduction of new antiretroviral drugs about these variables. METHODS: This is a prospective observational study carried out between January of 1996 and June of 1997 with 52 advanced HIV patients (CD4 cells less than 200/microliter). We carried out 2 clinical interviews with an interval of 12 months being introduced after the first one a change of strategy of antiretroviral treatment. For evaluating the quality of life, the MOS SF-36 was used. The valuation of the anxiety and depression were carried out with the instruments STAI and Beck respectively. RESULTS: An important physical deterioration was found at the beginning of the study with 84.6% of polisymptomatic patients. We found a high prevalence of anxiety (76.9%) and depression (86.6%) that reaches criteria of graveness respectively in 75% and 25% of the cases. The quality of life was severely affected involving most of the dimensions of the SF-36 scale preserving the social function. The introduction of the change of therapeutic strategy produces a reduction of polisymptomtics patients to 54.8% (p = 0.05), of the graveness of the anxiety (p = 0.009) and depression (p = 0.05) and improving in the perception of general health (p = 0.03) and alterations of physical role (p = 0.02). CONCLUSIONS: The advanced HIV infection carries a high symptomatic load with a high prevalence of psychological dysfunctions and deterioration of the quality of life. The new strategies of HIV treatment induce a global improvement to the patients, but it makes necessary a better management of the psychological dysfunctions.

Calidad de vida, aspectos psicológicos y sociales en pacientes con infección VIH avanzada / Quality of life, psychological and social aspects in patients with advanced HIV disease

Fundamento: La infección VIH avanzada conlleva un importante deterioro físico, psíquico y de calidad de vida para el paciente. La introducción de nuevas estrategias de tratamiento probablemente impliquen un beneficio global para los pacientes. Se realiza este estudio con el objetivo de estudiar en pacientes VIH avanzados; la situación clínica, la prevalencia de alteraciones psicológicas(ansiedad y depresión), la calidad de vida y el impacto sobre estas variables de la introducción de nuevos fármacos antirretrovirales. Métodos: Estudio observacional prospectivo realizado entre enero de 1996 y junio de 1997 con 52 pacientes VIH avanzados (recuentos CD4 menores de 200 cel/µl). Se realiza 2 entrevistas clínicas con un intervalo de 12 meses introduciéndose tras la primera un cambio de estrategia de tratamiento antirretroviral. Para la valoración la calidad de vida se utiliza el MOS SF-36. Para la valoración de la ansiedad y depresión se utilizaron el STAI y la escala de Beck respectivamente. Resultados: Existe una importante deterioro físico al inicio del estudio con un 84,6 por ciento de pacientes polisintomáticos. Encontramos una elevada prevalencia de ansiedad (76,9 por ciento) y depresión (86,6 por ciento) que alcanza criterios de gravedad en el 75 por ciento y 25 por ciento de los casos respectivamente. La calidad de vida se ve comprometida severamente con afectación de la mayoría de las dimensiones del SF-36 conservándose la función social. La introducción del cambio de estrategia terapéutica produce una reducción de polisintomáticos a 54,8 por ciento (p=0,05), de la gravedad de la ansiedad (p=0,009) y depresión (p=0,05) y mejoría en la percepción de salud general (p=0,03) y alteraciones de rol físico (p=0,02).Conclusiones: La infección VIH avanzada conlleva una alta carga sintomática con una elevada prevalencia de trastornos de la esfera psicológica y deterioro de la calidad de vida. Las nuevas estrategias de tratamiento antirretroviral inducen una mejoría global a los pacientes, pero hace necesario un abordaje de los trastornos psicológicos (AU)

Objective: The advanced HIV infection carries an important physical, psychological and quality of life deterioration for patients. The introduction of new treatment strategies probably implies a global benefit for HIV patients. We carried out this study in order to know in HIV advanced patients; the clinical situation, the prevalence of psychological alterations (anxiety and depression), the quality of life and the impact of the introduction of new antiretroviral drugs about these variables. Methods: This is a prospective observational study carried out between January of 1996 and June of 1997 with 52 advanced HIV patients (CD4 cells less than 200 /µl). We carried out 2 clinical interviews with an interval of 12 months being introduced after the first one a change of strategy of antiretroviral treatment. For evaluating the quality of life, the MOS SF-36 was used. The valuation of the anxiety and depression were carried out with the instruments STAI and Beck respectively. Results: An important physical deterioration was found at the beginning of the study with 84.6% of polisymptomatic patients. We found a high prevalence of anxiety (76.9%) and depression (86.6%) that reaches criteria of graveness respectively in 75% and 25% of the cases. The quality of life was severely affected involving most of the dimensions of the SF-36 scale preserving the social function. The introduction of the change of therapeutic strategy produces a reduction of polisymptomtics patients to 54.8% (p=0.05), of the graveness of the anxiety (p=0.009) and depression (p=0.05) and improving in the perception of general health (p=0.03) and alterations of physical role (p=0.02). Conclusions: The advanced HIV infection carries a high symptomatic load with a high prevalence of psychological dysfunctions (AU)

Immunosuppressive treatment in severe connective tissue diseases: effects of low dose intravenous cyclophosphamide.

OBJECTIVE: To review our experience with low dose intravenous pulse cyclophosphamide in the treatment of patients with severe connective tissue diseases. PATIENTS: Ninety patients (68F:22M) with severe connective tissue diseases received a total of 883 cyclophosphamide pulses with 78 of 90 patients initially having weekly 500 mg pulses for a median of three (2-10) weeks. Diagnoses included: systemic lupus erythematosus (SLE) (n = 43); systemic vasculitides (n = 42); idiopathic inflammatory myopathies (n = 4); mixed essential cryoglobulinaemic vasculitis (n = 1). The median age was 48 (range 22-76) years with a median disease duration of 94 (18-250) months. RESULTS: Complete or partial remission was noted in 68 of 90 patients (75.5%) after a median follow up of 56 (5-213) months. At follow up significant median changes were noted in SLE patients: erythrocyte sedimentation rate (ESR) from 44 to 22 mm 1st hour; anti-dsDNA antibody concentrations from 81 to 48 IU/ml; proteinuria from 2.5 to 1.5 g/day; serum albumin from 36 to 40 g/l; complement C3 from 0.88 to 0.90 g/l, and C4 from 0.18 to 0.22 g/l. In the vasculitis patients significant median changes were seen in: ESR from 44 to 15 mm 1st hour; C reactive protein (CRP) from 16 to 5 g/dl; neutrophils from 8.55 to 4.3 x 10(9)/l; platelets from 340 to 261 x 10(3)/l, and haemoglobin from 12.6 to 13.2 g/dl. Patients with Churg-Strauss syndrome, Wegener's granulomatosis, and neuropsychiatric lupus showed the best initial response but 58% of Wegener's patients relapsed. Median corticosteroid doses were significantly reduced from 15 (5-60) mg to 10 (3-35) mg daily. Adverse events: infections (7 patients), neutropenia (5), lymphopenia (18), and haemorrhagic cystitis (1 intravenous and 2 oral cyclophosphamide), allergies to mesna (2). None of the women at risk had prolonged amenorrhoea. Five patients doubled their serum creatinine and five died from sepsis (2) or severe disease (3). CONCLUSION: Treatment of severe connective tissue diseases with 'low dose' intravenous cyclophosphamide pulses compares in efficacy with the higher monthly doses previously advocated. Treatment was well tolerated with fewer adverse effects and most significantly, there were no cases of premature ovarian failure.

[Human immunodeficiency virus infection in women]. / Infección por el virus de la inmunodeficiencia humana en mujeres.

From last years eighty's decade the number of women with HIV infection have significantly increased. To know the epidemiological and clinic trades in this group we studied retrospectively 476 HIV infected patients attending in a General Hospital from January 1986 to June 1993. Seventy nine (16.5%) were female and 397 male. The mean female group was 25.8 years, 61.9% were IVDUs and 30.4% heterosexual transmission. This last transmission route was more important between females than males (5%) (p < 0.001) and in 1992 the 55% of women been infected by this way. The mean CD4 count was 643 cel/ml in the female group at the diagnostic time and 21.7% developed antigenaemia without difference with the male group. 59.7% of women were no symptoms at the diagnosis time and 14.3% were AIDS, no differences with men, but more in the female group developed AIDS along following time 39.5% in front of 24.7% in the male group (p < 0.05). Disseminated Tuberculosis (DTB) (29.1%) and Wasting Syndrome (WS) (29.1%) were the more frecuent AIDS defining conditions in the female group. The more frecuent complications were: Oropharynx Candidiasis 39.1%, Esophagus Candidiasis 6.3%, WS 11%, DTB 12.65%, PCP 10.12% and Neoplasias 5.06%. Fourteen women became pregnant during HIV infection, no clinical nor immunological differences were observed in this group with the control. The treatment (66%) and following (46.8%), compliance was better between women than men. The rise of women with HIV infection, the poor development in this group described by some authors, so far gynecological aspect and vertical transmission makes HIV infection in women an major health problem.

[HTLV-II infection in parenteral drug addicts from western Andalucia]. / Infección por HTLV-II en adictos a drogas por vía parenteral de Andalucía occidental.

The epidemiology of retrovirus HTLV-II is scarcely known even though it appears to be narrowly related to parenteral drug addiction. In order to find out the prevalence of HTLV-II among IVDU in our area, the sera of 137 subjects who came to our center for clinical evaluation were analyzed. The presence of HTLV-I/II antibodies were determined via ELISA and the sera that were repeatedly reactive were confirmed by the Western blot technique which reveals infection by both retroviruses. Two sera were repeatedly positive by ELISA (1.45 percent). Western blot confirmed HTLV-II positivity in both sera. Serology for HIV-1 was positive in 52 sera (37.9%). The two HTLV-II positive sera were also positive for HIV-1. These results indicate that HTLV-II infection is already present in the IVDU population in our area, where, similar to what happens in the U.S. and Europe, this retrovirus is implicated in the majority of HTLV infections in IVDU.

[Tuberculous liver abscesses as the form of presentation of human immunodeficiency virus infection]. / Abscesos hepáticos tuberculosos como forma de presentación de la infección por el virus de la inmunodeficiencia humana.

In patients infected by the human immunodeficiency virus (HIV), it has been observed and increase in the incidence of extrapulmonary tuberculosis. Recently, the presence of abdominal tuberculous abscesses has been described as a manifestation of this form of tuberculous disease. However, hepatic abscesses by Mycobacterium tuberculosis are rare among patients infected by the HIV. In the literature, just two patients with this type of abscesses have been described as a form of presentation of the infection by the HIV. In this paper, we present the case of one patient with positive serology to the HIV and two tuberculous abscesses at the hepatic level as part of a disseminated tuberculosis. The main symptoms were fever and lumbar pain. We established the mycobacterial etiology of the abscesses using Ziehl-Neelsen's tinction and culture in Löwenstein's medium of the sample isolated from the abscesses. Abscess drainage under echographic control, in addition to antituberculous chemotherapy, resulted in a quick recovery of the patient, with disappearance of such abscesses as demonstrated by the ultrasonic study performed at three months.