Retinol-binding protein 4 (RBP4), a potential biomarker of frailty in HIV-infected people on stable antiretroviral therapy.

OBJECTIVES: A quantitative biomarker for identification of pre-frail and frail persons is still lacking. This study aimed to identify biomarker predictors of frailty in HIV-infected patients. METHODS: A cross-sectional study of HIV-infected patients who had been on antiretroviral therapy (ART) for at least 1 year and who presented an undetectable viral load (< 50 HIV-1 RNA copies/mL) at baseline was carried out. For each frail patient, up to four pre-frail and robust patients were randomly selected. The frailty status assessment was based on the five-item criteria described by Fried et al. Sociodemographic, anthropometric, biochemical and HIV-related characteristics were evaluated. Multiple potential biomarkers of frailty and a biological age biomarker were analysed. RESULTS: A total of 73 HIV-infected patients on ART for at least 1 year were evaluated. The patients were categorized as robust (n = 33), pre-frail (n = 32) and frail (n = 8) using the Fried criteria. All patients were on ART, with 100% undetectable viral load (< 50 copies/mL) at baseline. No significant differences in demographic, clinical or analytical characteristics were observed among patients in the different categories based on Fried criteria, with the exception of the veterans aging cohort study index (VACS). Similarly, no differences were observed in HIV-related characteristics, although nucleoside reverse transcriptase inhibitor (NRTI) use was less common in frail persons. The distribution of biomarker values varied according to frailty status, with frail persons having higher levels of interleukin (IL)-8, IL-18, CXC chemokine ligand 10 (CXCL10) and retinol-binding protein 4 (RBP4). In multivariable analysis, the assocation of frailty with RBP4 showed a tendency to statistical significance (odds ratio 1.0; 95% confidence interval 0.99-1.00; P < 0.05). CONCLUSIONS: Differential biomarker expression was present according to Fried status. Longitudinal studies will clarify the utility of these biomarkers as targets for diagnostic or therapeutic intervention.

Septic shock in a patient infected with Rickettsia sibirica mongolitimonae, Spain.

In 1996, the first human case of infection by Rickettsia sibirica subsp. mongolitimonae was described in France. Subsequently, other human cases were reported in the same country. The acronym LAR (lymphangitis-associated rickettsiosis) has been proposed to designate this disease because lymphangitis is one of the main clinical manifestations. Later, a few more cases were described in Portugal, South Africa, Egypt, Greece and Spain. We report a case of R. sibirica mongolitimonae infection as a cause of septic shock in a Spanish patient living in La Rioja (northern Spain). In addition, the broad clinical spectrum of this tick-borne disease is discussed.

Rickettsia slovaca infection: DEBONEL/TIBOLA.

This study describes the epidemiological, clinical, and microbiological characteristics of a new tick-borne disease in Spain-Dermacentor-borne necrosis erythema lymphadenopathy (DEBONEL). The clinical presentations include an eschar at the site of the tick bite, surrounded by an erythema and painful regional lymphadenopathy. The disease appears during the colder months and its vector is Dermacentor marginatus (D. marginatus). From January 1990 to December 2004, 54 patients presented at Hospital of La Rioja with these clinical and epidemiological data. The ratio of females to males was 32/22. The average age was 37 years. In all cases tick bites were located on the upper body (90% on the scalp). The median incubation period was 4.7 days. Signs and symptoms were mild in all cases. Only a small number of patients presented mild and nonspecific abnormalities in a complete blood cell count and mild elevation of erythrocyte sedimentation rates and C-protein reactive and liver enzyme levels. Serological evidence of acute rickettsiosis was observed in 19 patients (61%). In 29% sera tested by polymerase chain reactions (PCRs) were positive. The sequence obtained from a PCR product revealed 98% identity with Rickettsia sp. strains RpA4, DnS14, and DnS28. All ticks removed from patients were PCR-positive. Sequencing showed 8 of them identified as R. slovaca and 2 as Rickettsia sp. strains RpA4, DnS14, and DnS28.

Effect of antibiotic treatment in patients with DEBONEL/TIBOLA.

DEBONEL/TIBOLA is a tick-borne acute/sub-acute infection transmitted in our environment by Dermacentor marginatus and mainly caused by Rickettsia slovaca. The aim of our study was to know the effect of starting early treatment in the course of the DEBONEL/TIBOLA.

Equimosis y disnea en un varón de 66 años / Ecchymosis and dyspnea in a 66-year old male

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Utilidad de la troponina-I, CPK-MB y mioglobina en el diagnóstico del infarto de miocardio y de los procesos de necrosis muscular de origen no cardiaco / Use of troponin-I, CPK-MB and myoglobin in the diagnosis of myocardial infarct and processes of muscular necrosis of non-cardiac origin

Fundamento. El dolor torácico es uno de los motivos de consulta más frecuentes en una Unidad de Urgencias. La descripción clínica y el ECG son fundamentales para su análisis, pero cuando no aportan datos típicos se presenta un serio problema diagnóstico. Nuestro objetivo es analizar parámetros bioquímicos introducidos recientemente para comprobar si es posible discriminar entre entidades que cursan con necrosis miocárdica y aquellas otras en las que la necrosis es de músculo estriado. Material y métodos. Hemos analizado la troponina-I y la relación entre la CPK-MB y la CPK total en el suero de 45 pacientes que acudieron al Servicio de Urgencias con diversos procesos de músculo estriado en los que la CPK total estaba elevada y en 50 pacientes con infarto agudo de miocardio. El suero ha sido analizado mediante un inmunoensayo por fluorescencia con anticuerpos monoclonales. Resultados. La troponina-I resultó elevada por encima del valor normal en los 50 pacientes con infarto de miocardio y en 4 de los 45 del grupo muscular. La ratio CPK/MB/CPK total estaba elevada de forma significativamente más alta en el grupo de infartos respecto al grupo muscular. En todos los pacientes de este último grupo la relación fue menor del 5 por ciento. Conclusiones. La troponina-I se eleva por encima del valor normal y es muy sensible en el infarto de miocardio. La relación CPK/MB/CPK total discrimina entre procesos de necrosis muscular (valor 5 por ciento). El aumento de troponina-I apoya el diagnóstico de lesión miocárdica cuando el dolor es sugestivo de origen coronario pero la ratio no alcanza el 5 por ciento. (AU)

[Use of troponin-I, CPK-MB and myoglobin in the diagnosis of myocardial infarct and processes of muscular necrosis of non-cardiac origin]. / Utilidad de la troponina-I, CPK-MB y mioglobina en el diagnóstico del infarto de miocardio y de los procesos de necrosis muscular de origen no cardiac.

BACKGROUND: Thoracic pain is one of most frequent reasons for consultations at an Emergency Unit. Clinical description and the ECG are fundamental for its analysis, but a serious diagnostic problem arises when these do not provide typical data. Our aim is to analyse recently introduced biochemical parameters in order to test whether it is possible to discriminate between entities that are associated with myocardial necrosis and those others in which necrosis is due to striated muscle. MATERIAL AND METHODS: We analysed troponin-I and the relation between CPK-MB and total CPK in the serum of 45 patients who attended the Emergency Services with different processes of striated muscle in whom the total CPK was elevated, and 50 patients with acute myocardial infarct. The serum was analysed through an immunotest by fluorescence with monoclonal antibodies. RESULTS: Troponin-I proved to be above the normal value in the 50 patients with myocardial infarct an in 4 of the 45 in the muscular group. The total CPK/MB/CPK ratio was significantly higher in the infarct group than in the muscular group. In all of the patients of this latter group the relation was less than 5%. CONCLUSIONS: Troponin-I rises above the normal value and is very sensitive in a myocardial infarct. The total CPK/MB/CPK relation discriminates between processes of muscular necrosis (value <5%) and processes with myocardial infarct (that are generally associated with value >5%). The increase of troponin-I supports the diagnosis of myocardial lesion when the pain suggests a coronary origin but the ratio does not reach 5%.

Incidence of pericardial effusion in pulmonary tuberculosis.

Tuberculosis (TB) is one cause of pericardial disease. In order to know the incidence of tuberculous pericardial effusion (TPE) in patients with pulmonary tuberculosis (PT), the factors associated with their presence and whether human immunodeficiency virus (HIV) patients have a higher risk, we analyzed different parameters and performed an echocardiography to evaluate the presence of TPE. The incidence of TPE was 14.1%, and the presence of pleural effusion was associated with TPE (OR 24.39). HIV patients do not have a higher risk of TPE, independently of immunosuppression. It is necessary to eliminate the presence of TPE in patients with PT, mainly in those with pleural effusion.

[Muscular tumors of the digestive tract: an analysis of 53 cases]. / Tumores musculares del tubo digestivo: análisis de 53 casos.

We present 53 cases of gastrointestinal smooth tumors (43 leiomyomas and 10 leiomyosarcomas) which have being diagnosed in Virgen del Camino Hospital during a period of 17 years. The aim of the research is to know the incidence of such tumors, their clinical presentation, the usefulness of radiologic and endoscopic studies for their diagnosis, as soon as to make a bibliographic revision of new diagnostic and therapeutic methods. This kind of tumor had an incidence of 3.1 cases per year. The symptomatology because of which the patients consulted depended on the location and the size of the tumors, though 18% of the cases were asymptomatic and were found in surgical operations. Endoscopic biopsy had a diagnostic sensibility of 28%; it didn't obstruct later exeresis. It has to be emphasized that, according to our bibliographic revision, there is a growing importance of endoscopic echography, not only as for diagnosis, but also as for non surgical treatment of this kind of tumor. Endoscopic resection can be a valid alternative for exeresis of small tumors (less than 2 cm according to some authors); haemorrhage is the most frequent complication, though it can be easily controlled.