Search

We present the case of a 45-year-old woman who was hospitalized due to severe macrocytic anemia and renal failure. The patient presented a morbid obesity. The immunological study showed anti-ENA anti-SSA (Ro52) positive, with negative antinuclear antibodies. Also in the proteinogram (serum immunofixation) the presence of monoclonal bands IgG lambda and IgG kappa, monoclonal component 7.2% (4.68g/L), with elevation of free light chains (kappa 95.94mg/L (3.3-19.4), evidenced, lambda 145.17mg/L (5.71-26.3)). The bone marrow study showed an infiltration of 5% of plasma cells and positive for AA amyloid. Finally, a percutaneous renal biopsy was performed, which again showed amyloid infiltration. In the genetic study, 2 mutations of the family Mediterranean fever gene (MEFV) have been identified. Secondary AA amyloidosis has been described associated with obesity, in addition to a percentage of cases of unknown etiology., (Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

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., (Copyright © 2016 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

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)., (Copyright © 2013 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.)

Background: Distal radius fractures in young, working-age patients are frequent and are associated with potential disability in case of inappropriate treatment. Our hypothesis is that there is no difference between patients treated with a volar plate and those treated with closed reduction and external fixation., Methods: We studied 69 patients with complex distal radius fractures. They were prospectively and randomly assigned to treatment with a volar plate or an external fixator: they were followed-up and assessed at one year using two scales, the Visual Analog Scale (VAS) and the McDermid et al. Functionality Scale., Results: Both groups showed good results at one year. Measurements in the pain Visual Analog Scale and disability measured with the McDermid et al. scale were not statistically significant. Higher scores mean greater disability. Scores above 20 were considered as failures. We found 2 cases with complications in the F group; one with material dislodgement and one with malunion, without significant differences., Conclusions: Both treatments show good results in the medium-term; no differences were found between both groups regarding pain and residual disability. Complications were few and they were addressed conservatively; they were less frequent with open reduction and internal fixation. When ranges of motion and the complication rate were compared, the volar plate showed a statistically significant difference in a decreased complication risk.

Background: Postpartum depression is a serious, common, treatable condition, with broad repercussions in mother and family life, but frequently under diagnosed. A screening tool, the Edinburgh Postnatal Depression Scale (EPDS) could improve the detection rate of depressive symptoms., Aim: To assess the efficacy of EPDS in the detection rates for depressive symptoms in the postpartum period. To evaluate the feasibility of routine use of this screening scale in a Family Medicine Center., Material and Methods: The medical records of women attended during 2002, were reviewed to detect the registry of depressive symptoms or request for psychiatric consultations for depression. During 2003, the EPDS was applied to a sample of 110 women. To confirm the postpartum depression diagnosed using the instrument, a structured psychiatric interview was administered to these women., Results: The medical records of 110 women aged 24+/-7 years were reviewed and the instrument was applied to 110 women aged 26+/-7 years. In the first group, the spontaneous detection rate for depressive symptoms was 4.6% (5/110). In 26.4% of women in whom the instrument was applied, depressive symptoms were found and 15% had a postpartum depression. The application rate of the scale was 88% and the rate of acceptance by mothers was 100%., Conclusions: The EPDS improves significantly the detection rates of postpartum depressive symptoms, and it is well accepted by health professionals and mothers.