Upper gastrointestinal bleeding secondary to late gastric metastasis of renal cell carcinoma.

Clear cell renal cell carcinoma is the most common renal neoplasm in adults. It has a relatively slow growth pattern that delays diagnosis until the onset of local, paraneoplastic or metastasis-related manifestations, and an unpredictable behavior ranging from aggressive tumors with poor short-term prognosis to late recurrence cases where metastases are identified years after nephrectomy, the latter scenario being the subject of the case we herein report.

Active search for hepatitis C patients in primary care.

INTRODUCTION: undiagnosed active hepatitis C virus (HCV) infections are an obstacle to achieve the WHO (World Health Organization) hepatitis C elimination goal by 2030. One of the possible strategies to identify these patients is the active search for patients in primary care (PC). METHODS: patient medical records in PC were reviewed with a "hepatitis C" open case in the last five years. Cases with an incomplete diagnostic study (due to the absence of active infection confirmation) or those who did not start or finish treatment were included. A blood analysis was recommended to prove the existence of an active infection. The one-step diagnosis (OSD) was implemented to assess viremia in all patients with a new serologic diagnosis. RESULTS: of 253 cases with a "hepatitis C" open case in their medical records, 24.1 % (61) did not finish the diagnostic study or did not follow the treatment. Four were not suitable candidates to finish the study. Of the other 57, 92.9 % accepted the diagnostic test. Active infections were confirmed in 40 patients (75.4 %) and the treatment was completed in all of them. CONCLUSIONS: active searching for patients with hepatitis C in PC together with the OSD are effective measures to detect hidden infections and to increase the number of treatments, thus contributing to the elimination of hepatitis C.

Genetic variation at the CCR5/CCR2 gene cluster and risk of psoriasis and psoriatic arthritis.

OBJECTIVES: Inflammation plays a major role in psoriasis (Ps). The variation at several genes that encode components of the inflammatory pathways have been linked to the risk for Ps. Our objective was to examine the association between Ps and three polymorphisms at the chemokine receptors CCR5 and CCR2. METHODS: A total of 382 Ps patients and 500 healthy controls from Spain were genotyped for the CCR5-32bp deletion (DeltaCCR5), the rs1799988 (CCR5 promoter), and the CCR2-I64V (rs1799864) polymorphisms. RESULTS: Allele and genotype frequencies did not differ between patients and controls for any of the three polymorphisms. However, the frequency of the CCR2-64I carriers was significantly higher in the patients who developed arthritis (n=81) compared to patients without arthritis (p=0.0007). CONCLUSIONS: Our work suggests that the genetic variation at the CCR2/CCR5 genes did not contribute to the risk for Ps, but CCR2 polymorphisms could modulate the risk for arthritis in patients with psoriasis.

Apolipoprotein epsilon4 allele is associated with psoriasis severity.

Many reports provided strong evidence of the influence of genetic factors in the pathogenesis of psoriasis (Ps). A higher prevalence of lipid disorders in psoriatic patients has been reported. Because apolipoprotein E (apoE) is involved in lipid metabolism, APOE gene variants could be candidates to influence Ps-risk. However, data about the potential influence of the APOE genotypes in Ps are inconclusive. Our objective was to investigate the relationship between the common APOE-epsilon2/epsilon3/epsilon4 variation and Ps in a Caucasian population. Our study involved 331 unrelated Ps-patients and 400 healthy controls. Patients and controls were genotyped for the APOE-epsilon2/epsilon3/epsilon4 polymorphism, and allele and genotype frequencies were statistically compared between the two groups and between patients according to disease severity. Mean lipid values were also compared between the APOE genotypes. Allele and genotype frequencies did not differ between patients and controls. APOE-epsilon4 carriers were significantly more frequent in patients with severe Ps compared to controls (P = 0.003) and to non-severe Ps (P = 0.017). No significant difference in mean lipid values was found between the APOE genotypes. The APOE-epsilon4 allele could be a risk factor for developing a severe form of psoriasis.

Lack of association between angiotensin I-converting enzyme insertion/deletion polymorphism and psoriasis or psoriatic arthritis in Spain.

Data on the potential influence of the angiotensin-converting enzyme (ACE) insertion/ deletion (I/D) genotype on psoriasis are contradictory. Our aim was to investigate the relationship between the ACE gene I/D polymorphism and psoriasis/psoriatic arthritis. To investigate this, a genetic association study was conducted among 268 unrelated patients with psoriasis and 272 controls. The distribution of DD, ID, and II genotypes did not significantly differ between psoriatic patients and controls (DD: 39.6% vs. 34.2%; ID: 46.3% vs. 53.3%; II: 14.1% vs. 12.5%). In conclusion, the ACE polymorphism is not likely to be associated with either psoriasis or psoriatic arthritis in this study.