Rotura de aorta abdominal en fibrosis retroperitoneal idiopática / Abdominal aortic rupture in idiopathic retroperitoneal fibrosis

Introducción: la fibrosis retroperitoneal (FRP) es una enfermedad poco frecuente que se caracteriza por la formación de tejido inflamatorio y fibroso en el espacio retroperitoneal, alrededor de la aorta abdominal y de las arterias ilÍacas, incluyendo con frecuencia los uréteres. Caso clínico: describimos el caso de un paciente de 90 años con diagnóstico de FRP tratado previamente con metilprednisona que acudió a urgencias por la rotura de un aneurisma inflamatorio de la aorta abdominal. Discusión: en las formas de FRP asociadas con aneurisma aórtico abdominal se recomienda tratamiento quirúrgico o endovascular cuando el diámetro aórtico es superior a 5,5 cm o tiene un crecimiento rápido (> 1 mm al mes), ya que el peligro de ruptura parecería no ser mayor que para los aneurismas ateroscleróticos. Sin embargo, no existen pautas ni algoritmos a seguir en el manejo vascular de pacientes con FRP y una aorta “no aneurismática” ante el fracaso del tratamiento con esteroides. Por otro lado, está descrito el riesgo de remodelación arterial y dilatación aórtica progresiva durante el tratamiento con esteroides. Aunque tales cambios suelen ser subclínicos, se han reportado casos que requirieron tratamiento quirúrgico por ruptura, como en nuestro paciente, en el que la complicación ocurrió a pesar de tener un diámetro aórtico máximo inferior a 4 cm.(AU)

Introduction: retroperitoneal fibrosis (RPF) is a rare disease characterized by the formation of inflammatory and fibrous tissue in the retroperitoneal space, around the abdominal aorta and iliac arteries, often including the ureters. Case report: we present a 90-year-old male patient with RPF treated with meprednisone, who attended to the emergency room due to a ruptured inflammatory abdominal aortic aneurysm.Discussion: in RPFs associated with abdominal aortic aneurism, endovascular or surgical treatment is recommended when the aortic diameter is larger than 5.5 cm or when it is rapidly growing (> 1 mm/month) because the danger of rupture would appear to be the same as atherosclerotic aneurysms. However, there are no guidelines or algorithms to follow the vascular management of patients with PRF and a "non-aneurysmal" aorta in the event of failure steroid treatment. On the other hand, the risk of arterial remodeling and progressive aortic dilatation during steroids treatment has been described. Although the changes are subclinical, there were reported cases in which the patients received surgical treatment due to the rupture, such as in our patient where a complication occurred despite having a maximum aortic diameter of less than 4 cm. Recently, a series of 6 patients with RPF non-aneurysmal abdominal aorta, that had not responded properly to medical treatment, received infrarenal abdominal aorta endovascular exclusion.(AU)

Eficacia del tratamiento de rehabilitación para el síndrome del túnel carpiano: un ensayo clínico controlado aleatorizado / Efficacy of rehabilitation treatment for carpal tunnel syndrome: A randomized controlled clinical trial

Introducción y objetivo El síndrome del túnel carpiano es la neuropatía del nervio mediano más frecuente. Existen múltiples tratamientos invasivos y no invasivos, incluyen férulas, ultrasonido terapéutico (UST) e infiltraciones con esteroides (IE) que han demostrado una mejora en los estudios de conducción nerviosa (ECN), sin embargo, se desconoce el efecto de los tratamientos conservadores combinados. El objetivo fue determinar la eficacia del tratamiento conservador para mejorar los ECN y las manifestaciones clínicas en pacientes con síndrome del túnel carpiano. Métodos Pacientes con diagnóstico de síndrome del túnel carpiano mediante ECN, sin enfermedades que afecten al nervio periférico. Todos firmaron consentimiento informado y fueron aleatorizados en 3 grupos de tratamiento (G1: férula+UST; G2: férula+IE; G3; férula+UST+IE). Participaron 3 médicos especialistas en rehabilitación (médico 1: realizó los ECN; médico 2: realizó evaluaciones clínicas; médico 3: realizó la IE). Tratamientos: UST (10 sesiones continuas de lunes a viernes durante dos semanas, 3MHz, 0,8W/cm2, 8min) aplicado por el mismo fisioterapeuta. Infiltración: dosis única, 1ml de metilprednisolona (40mg/ml) mezclado con 1ml de (0,5%) bupivacaína. Férula: férulas neutras volares hechas a la medida, de fibra de vidrio para uso nocturno. Resultados Se incluyeron 30 pacientes y 30 manos, con una edad de 50,5±7,5 años, todas ellas mujeres. Los grupos no tenían diferencias en las variables electrofisiológicas y clínicas al inicio del estudio. Tras la intervención (4 semanas) los grupos 2 y 3 mostraron mejoría en el ECN (p<0,05) siendo mayor en el grupo 3. En la evaluación final (8 semanas) todos los grupos mostraron una mejoría en las variables electrofisiológicas y clínicas. Conclusiones El tratamiento combinado de férula+UST+IE presenta resultados significativos en el ECN a las 4 semanas de seguimiento, en comparación a los otros dos grupos (AU)

Introduction and objective Carpal tunnel syndrome is the most common median nerve mononeuropathy. There are multiple conservative treatments, invasive (corticoid injections [CI]) and non-invasive (splinting, therapeutic ultrasound [TUS], laser, exercise). However, the treatment choice is controversial. The aim was to determine the efficacy of conservative treatment to improve the clinical and electrophysiological evaluations. Methods Outpatients referred whit carpal tunnel syndrome clinical diagnosis to perform nerve conduction study (NCS) were included, without chronic or metabolic diseases that affect the peripheral nerves, without carpal tunnel syndrome treatment and with mild or moderate axonotmesis or neuropraxia in NCS baseline. Patients who signed informed consent forms were randomized in three treatment groups (Group 1: TUS+splint; Group 2: CI+splint and Group 3: TUS+CI+splint) were referred for clinical evaluations. The NCS was performed in each patient at baseline, fourth and eighth weeks by the same physiatrist and the clinical evaluations were performed at baseline and the final follow-up. Results Thirty patients were included; mean age was 50.7±7.5 years and all of them females, without differences in NCS or clinical variables in the baseline evaluations. All groups exhibited improvement in some clinical and electrophysiological variables in the final evaluation, though only group 3 showed improvement on median/ulnar nerves sensory peak latency difference (1.2±0.4 vs. 0.4±0.4; p=0.001) starting in week four. Conclusions The conservative treatment in patients with CTS improves NCS and clinical variables, including the most sensitive electrophysiological test (medial/ulnar difference), though if we combined three treatments (splint+TUS+CI), the improvement was found to be faster and remarkable (AU)

Clinical Effect of Lamivudine Combined with Leflunomide and Methylprednisolone Tablets in the Treatment of Hepatitis B Virus-Associated Glomerulonephritis and Its Influence on Renal Function Indicators

Background: In this study, the clinical effect of lamivudine combined with leflunomide and methylprednisolone in the treatment of hepatitis B virus-associated glomerulonephritis (HBV-GN) and their influence on renal function indexes was explored. Methods: Patients with HBV-GN were selected for retrospective analysis and divided into the group B and group A, with 41 cases in each group. The group B was given leflunomide and methylprednisolone, whereas the group A was supplemented with lamivudine. The level of 24 h proteinuria (PRO), albumin (ALB), beta2-microglobulin (β2-MG), alanine aminotransferase (ALT), interferon-gamma (IFN-γ) and interleukin-4 (IL-4) in two groups was measured. The clinical efficacy, adverse reactions appetite, spirit, sleep and daily life scores of the two groups were recorded. Results: With the extension of treatment time to end of the treatment, the level of 24 h PRO, ALB and β2-MG in the group A significantly changed compared with that before treatment (p < 0.05). Moreover, the level of ALT, IFN-γ and IL-4 in the two groups significantly decreased compared with that before treatment, and the level of the three indexes in the group A decreased more significantly (p < 0.05). The total effective rate in the group A was higher than that in the group B (p < 0.05). The occurrence of adverse reactions showed no statistically significant difference between the two groups. After treatment, scores of appetite, spirit, sleep and daily living were increased in the two groups, and the increase in the group A was more significant than that in the group B (p < 0.05). Conclusions: Lamivudine combined with methylprednisolone and leflunomide treatment is conducive to clearing Hepatitis B virus (HBV) and improving renal function (AU)

Dexametasona frente a metilprednisolona ajustada al peso en pacientes con neumonía moderada-grave por SARS-CoV-2 / Dexamethasone versus weight-adjusted methylprednisolone in patients with moderate-severe SARS-CoV-2 pneumonia

Objetivos: Comparar el desenlace clínico (mortalidad y/o ingreso en UCI) a 30 días de los pacientes ingresados por neumonía moderada-grave por SARS-CoV-2 tratados con dexametasona tras el estudio RECOVERY frente aquellos tratados con metilprednisolona ajustada al peso.MétodosEstudio de cohortes retrospectivo de 65 pacientes con neumonía moderada-grave que recibieron 6 mg/día de dexametasona (grupo DXM) frente a 80 tratados con metilprednisolona ajustada al peso (grupo MTPN).ResultadosFallecieron 21 (32,3%) pacientes del grupo DXM vs. 8 (10%) del grupo MTPN (valor p < 0,001) y 29 (44,6%) del grupo DXM requirieron ingreso en UCI vs. 2 (2,5%) del grupo MTPN (valor p < 0,001). No hubo diferencias basales respecto a características sociodemográficas con un qSOFA medio superior en el grupo MTPN. La razón de riesgo para la mortalidad y el ingreso en UCI ajustada por edad, sexo y PCR al ingreso fue de 2,189 (1,082-4,426; IC 95%) y 10,589 (2,139-48,347; IC 95%) para el grupo DXM, respectivamente, vs. grupo MTPN.ConclusionesLa mortalidad e ingreso en UCI fue menor en pacientes tratados con metilprednisolona ajustada al peso frente a los tratados con dexametasona. (AU)

Objectives: To compare the 30-day outcome (mortality and/or ICU admission) of patients admitted for moderate-severe SARS-CoV-2 pneumonia treated with dexamethasone after the Recovery study versus those treated with weight-adjusted methylprednisolone.MethodsRetrospective cohort study of 65 patients with moderate-severe pneumonia who received dexamethasone 6 mg/day (DXM group) versus 80 treated with weight-adjusted methylprednisolone (MTPN group).ResultsTwenty-one (32.3%) patients in the DXM group died vs. 8 (10%) in the MTPN group (p-value < 0.001) and 29 (44.6%) in the DXM group required ICU admission vs. 2 (2.5%) of the MTPN group (p-value < 0.001). There were no baseline differences regarding sociodemographic characteristics with a higher mean qSOFA in the MTPN group. The hazard ratio for mortality and ICU admission adjusted for age, sex, and admission CRP was 2.189 (1.082–4.426; 95% CI) and 10.589 (2.139–48.347; 95% CI) for the DXM group, respectively, vs. MTPN group.ConclusionsMortality and admission to the ICU were lower in patients treated with weight-adjusted methylprednisolone compared to those treated with dexamethasone. (AU)

Corticosteroid safety in COVID-19 patients: a pharmacovigilance study / Seguridad de corticoesteroides en pacientes con COVID-19: un estudio de farmacovigilancia

The use of oral and intravenous corticosteroids as a treatment for SARS-CoV-2 infection has been shown to inhibit the exaggerated inflammatory response, reducing symptoms and days of hospitalization of patients. However, its use is controversial because not enough clinical studies have been made to verify the safety of the drugs. Objective: To assess the safety profile of corticosteroids treatment, at high and low doses, in suspected or confirmed patients with COVID-19, determining the most frequent side effects in patients, and assessing whether the administration of the drugs represents a greater benefit than the risk of presenting these effects. Methods: Ambispective study of active pharmacovigilance at a cohort of confirmed or suspected COVID-19 patients, treated with intravenous and oral corticosteroids. 366 patients were evaluated and divided into 3 groups: use of methylprednisolone (155 mg average) every 24 hours for 3 days, dexamethasone (6 mg) every 24 hours for 10 days, and a control group. Results: The distribution of the cases with hyperglycemia was 33 in high doses and 82 with low doses of corticosteroids and both high and low doses have a similar distribution in cases of infections. When evaluating the harshness and severity of hyperglycemia in the two groups with corticosteroids, it is observed that patients with high doses present more harsh (48%). In case of harshness and severity of infections it is observed that patients with high doses present more harsh (62%) and more severe (79%) cases than those who were administered low doses. (AU)

El uso de corticoides orales e intravenosos como tratamiento para la infección por SARS-CoV-2 ha demostrado inhibir la respuesta inflamatoria exagerada, reduciendo los síntomas y los días de hospitalización de los pacientes. Sin embargo, su uso es controvertido porque no se han realizado suficientes estudios clínicos para verificar la seguridad de los medicamentos. Objetivo: Evaluar el perfil de seguridad del tratamiento con corticoides, a dosis altas y bajas, en pacientes con sospecha o confirmación de COVID-19, determinando los efectos secundarios más frecuentes en los pacientes, y valorando si la administración de los fármacos representa un mayor beneficio que el riesgo de presentar estos efectos. Métodos: Estudio ambispectivo de farmacovigilancia activa en una cohorte de pacientes confirmados o sospechosos de COVID-19, tratados con corticoides intravenosos y orales. Se evaluaron 366 pacientes y se dividieron en 3 grupos: uso de metilprednisolona (155 mg promedio) cada 24 horas por 3 días, dexametasona (6 mg) cada 24 horas por 10 días y un grupo control. Resultados: La distribución de los casos con hiperglucemia fue de 33 casos usando dosis altas y 82 con dosis bajas de corticoides, tanto las dosis altas como las bajas tienen la misma distribución en los casos de infecciones. Al evaluar la severidad y gravedad de la hiperglucemia en los dos grupos con corticoides, se observa que los pacientes con dosis altas presentan mayor gravedad (48%). En caso de severidad y gravedad de las infecciones se observa que los pacientes con dosis altas presentan casos más graves (62%) y más severos (79%) que los que recibieron dosis bajas. (AU)

Predicting the response to methylprednisolone pulses in patients with SARS-COV-2 infection

Introduction: Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of this disease. Preliminary data from Recovery clinical trial raises hope by showing that treatment with dexamethasone at doses of 6mg/day shows a reduction on morbidity in patients requiring added oxygen therapy. However, both the start day or what kind of corticosteroid, are still questions to be clarified. Since the pandemic beginning, we have observed large differences in the type of corticosteroid, dose and initiation of treatment.Our objective is to assess the predictive capacity of the characteristics of patients treated with methylprednisolone pulses to predict hospital discharge.Materials and methodsWe presented a one-center observational study of a retrospective cohort. We included all patients admitted between 03/06/2020 and 05/15/2020 because of COVID-19. We have a total number of 1469 patients, of whom 322 received pulses of methylprednisolone. Previous analytical, radiographic, previous disease data were analyzed on these patients. The univariant analysis was performed using Chi-squared and the T test of Student according to the qualitative or quantitative nature of the variables respectively. For multivariate analysis, we have used binary logistic regression and ROC curves.ResultsThe analysis resulted statistically significant in dyspnea, high blood pressure, dyslipidemia, stroke, ischemic heart disease, cognitive impairment, solid tumor, C-reactive protein (CRP), lymphopenia and d-dimer within 5 days of admission. Radiological progression and FIO2 input are factors that are associated with a worst prognosis in COVID-19 that receive pulses of methylprednisolone. Multivariate analysis shows that age, dyspnea and C-reactive protein are markers of hospital discharge with an area below the curve of 0.816. (AU)

Introducción: Tratar la inflamación sistémica producida por el SARS-COV 2 (COVID-19) se ha convertido en un reto para el clínico. Los corticoides han sido el punto de inflexión en el tratamiento de esta enfermedad. Los datos preliminares del ensayo clínico Recovery alentan esperanza mostrando que con el tratamiento con dexametasona a dosis de 6 mg/día hay una disminución de la morbimortalidad en pacientes que requieren oxigenoterapia añadida. Sin embargo, tanto el día de inicio, o qué tipo de corticosteroide, son todavía preguntas por aclarar. Desde el inicio de la pandemia hemos observado grandes diferencias en cuanto al tipo de corticoide, dosis e inicio de tratamiento.Nuestro objetivo es valorar la capacidad predictiva de las características de los pacientes tratados con bolos de metilprednisolona para predecir el alta hospitalaria.Materiales y métodosPresentamos un estudio unicéntrico observacional de cohorte retrospectiva. Incluimos a todos los pacientes ingresados entre el 06/03/2020 y el 15/05/2020 por COVID-19. Contamos con un número total de 1469 pacientes, de los cuales 322 recibieron pulsos de metilprednisolona. De estos pacientes se analizaron los datos clínicos, analíticos, radiográficos, enfermedades previas. El análisis univariante se realizó mediante Chi cuadrado y el test t de Student según la naturaleza cualitativa o cuantitativa de las variables respectivamente. Para el análisis multivariante hemos empleado la regresión logística binaria y las curvas ROC.ResultadosEn el análisis resultó estadísticamente significativo la disnea, hipertensión arterial, dislipemia, accidente cerebrovascular, cardiopatía isquémica, deterioro cognitivo, tumor sólido, la proteína C reactiva (PCR), linfopenia y d-dímero a los 5 días de ingreso. (AU)

Trocleítis bilateral corticodependiente / Corticodependent bilateral trochleitis

La trocleítis es habitualmente una inflamación transitoria, unilateral y no incapacitante de la tróclea del oblicuo superior. Presentamos el caso de una trocleítis bilateral en mujer de 29 años de evolución tórpida. Tras estudio etiológico exhaustivo con pruebas de neuroimagen, análisis de autoinmunidad e infeccioso no se encontró ninguna causa subyacente. Precisó múltiples infiltraciones en ambos ojos con efecto parcial. Finalmente se decidió intervención quirúrgica para exploración visual de la tróclea, toma de biopsias e infiltración de metilprednisolona que resultaron eficaces en el alivio sintomático. Este caso es excepcional por su bilateralidad y severidad, suponiendo un desafío terapéutico para el equipo clínico (AU)

Trochleitis is usually a transient and non-disabling inflammation of the trochlea of superior oblique. The case is presented of a difficult to manage bilateral trochleitis in a 29-year-old woman. After an exhaustive aetiological study with neuro-imaging tests, as well as an analysis of autoimmunity and infection, no underlying cause was found. Multiple injections of corticosteroids were required in both eyes, with a partial effect. Surgical intervention was finally decided in order to visually examine the trochlea, take biopsies, and inject methylprednisolone. These were effective in relieving the symptoms. This case is exceptional due to it involving both eyes and its severity, and represented a therapeutic challenge for the clinical team (AU)

Dermatomiositis juvenil: a propósito de un caso / Juvenile dermatomyositis: a case report

La dermatomiositis juvenil es el subtipo más frecuente del grupo de las miopatías idiopáticas inflamatorias en la edad pediátrica. Clínicamente se caracteriza por la presencia de debilidad muscular proximal y simétrica con afectación cutánea característica. El diagnóstico clásicamente se ha basado en los criterios de Bohan y Peter (1975). Sin embargo, en 2017, el International Myositis Assessment and Clinical Studies Group (IMACS) ha publicado unos criterios de clasificación de las miopatías idiopáticas inflamatorias donde es posible clasificar a un paciente sin necesidad de biopsia. La patogenia de la enfermedad es compleja y no del todo conocida. Están involucrados el sistema inmune innato y adaptativo, donde juega un papel muy importante el interferón, y donde existen agentes externos como infecciones o factores medioambientales que actuarían como desencadenantes en sujetos genéticamente predispuestos. El tratamiento ha de ser intensivo desde el inicio, con el objetivo de controlar la enfermedad cutánea y muscular de forma precoz, minimizar complicaciones como la calcinosis, más frecuente en niños que en adultos, y mejorar el pronóstico a largo plazo. Presentamos el caso de una niña prepúber en cuyo debut de la enfermedad solo presentaba dolor e impotencia funcional en pierna izquierda, con antecedente de traumatismo de baja energía, sin elevación de enzimas musculares, lesiones cutáneas ni una biopsia muscular típica (AU)

uvenile dermatomyositis is the most common idiopathic inflammatory myopathy subtype in the paediatric age group. Clinically, it is characterized by proximal and symmetrical muscle weakness with characteristic skin lesions. Traditionally, the diagnosis has been based on the Bohan and Peter criteria (1975). However, the International Myositis Assessment and Clinical Studies Group (IMACS) published new classification criteria in 2017 that allow classification of the disease without a biopsy. The pathogenesis of the disease is complex and has not been fully elucidated. It involves innate and adaptive immunity, with interferon playing a key role, and external agents like infections or environmental factors acting as triggers of the disease in genetically predisposed people.Treatment must be intensive from the beginning to achieve early control of cutaneous and muscular disease, reduce complications such as calcinosis, which is more frequent in children than in adults, and improve long-term outcomes.We present the case of a prepubertal girl who had onset with pain and left leg dysfunction and reported a history of low-energy trauma, without muscle enzyme elevation, skin lesions or a typical muscle biopsy. (AU)

Diffuse alveolar hemorrhage in a patient with anti-neutrophil cytoplasm antibody-associated vasculitis successfully treated with immunoadsorption combined with methylprednisolone

IntroductionAnti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is a rare and life-threatening autoimmune disease. Immunoadsorption (IA) is a potential approach in treating AAV.Patients and methodsA 76-year-old male patient was admitted with hemoptysis and oliguria, progressed rapidly into pulmonary hemorrhaging, acute kidney damage, and multi-organ failure. He was diagnosed as MPO-ANCA-positive vasculitis by immunological detection and kidney biopsy in the case report. IA combined with methylprednisolone to induce and alleviate the disease effectively, and cyclophosphamide (0.2g every other day, a total of 1g for the first time, after the patients tolerated, 10mg/kg every 3 weeks for 6 months in total) combined with prednisone for maintenance therapy.Results and discussionAlthough both kidneys suffered severe deterioration requiring long-term hemodialysis replacement therapy, their pulmonary function was restored. Furthermore, clinical and serological symptoms of the disease were successfully controlled. Consequently, IA treatment may quickly remove IgG and ANCA to efficiently control clinical symptoms, especially in patients presenting with alveolar hemorrhaging and acute renal failure.

COVID-19 en paciente con atrofia muscular espinal: a propósito de un caso / COVID-19 in a patient with spinal muscular atrophy: a case report

La atrofia muscular espinal (AME) es una enfermedad autosómica recesiva poco común con una incidencia global de 4 a 10 casos por cada 100.000 recién nacidos. Se produce por la degeneración de las motoneuronas del asta anterior medular que ocasionan debilidad y atrofia muscular progresivas, pudiendo llevar a la dependencia y muerte prematura1,2. Actualmente no existe ningún tratamiento curativo para la AME y las intervenciones terapéuticas disponibles se basan en medidas de rehabilitación motora y tratamiento sintomático3,4. Nusinersen ha sido el primer fármaco autorizado para esta enfermedad, permitiendo la adquisición y desarrollo de funciones motoras y aumentando la supervivencia global de estos pacientes4. Presentamos el caso de un paciente que desde los cinco días tras el nacimiento presenta síntomas clínicos de AME, confirmándose su diagnóstico a los seis meses de edad. A los quince días del diagnóstico, inicia tratamiento con nusinersen recibiendo un total de siete dosis, hasta que en el test de control que se realiza por protocolo previa a la administración de la octava dosis, se detecta PCR positiva para SARS-CoV-2 y se decide su aislamiento. Sin embargo, a los dos días acude a Urgencias por insuficiencia respiratoria aguda requiriendo ingreso hospitalario, en el que se decide continuar la administración del fármaco que ha demostrado ser beneficioso en el curso de la patología de base. (AU)

Spinal muscular atrophy (SMA) is a rare autosomal recessive disease with an overall incidence of 4 to 10 cases per 100,000 newborns. It is caused by progressive degeneration of the anterior horn cells in the spinal cord, which cause weakness and muscle atrophy, potentially leading to dependence and early death1,2. There is currently no curative treatment for SMA and the therapeutic interventions available are based on motor rehabilitation measures and symptomatic treatment3,4. Nusinersen has been the first drug approved for this disease, allowing the acquisition and development of motor functions increasing the overall survival of these patients4. We present the case of a patient who, five days after birth, has shown SMA clinical symptoms, confirming the diagnosis at six months of age. Fifteen days later, he start treatment with nusinersen, receiving a total of seven doses, until the control test performed by protocol prior to administration of the eighth dose, positive PCR for SARS-CoV-2 was detected and isolation was decided. However, two days later, he went to the emergency room for acute respiratory failure, requiring hospital admission where it was decided to continue administering nusinersen, which has proven to be beneficial in the underlying pathology. (AU)

Manifestaciones articulares en la acromegalia: implicaciones diagnósticas y terapéuticas de la coexistencia de la artropatía acromegálica y artritis reumatoide / Articular manifestations in acromegaly: diagnostic and therapeutic implications of the coexistence of acromegalic arthropathy and rheumatoid arthritis

La presencia de artropatía en los pacientes con acromegalia puede ser debida a la recurrencia de la acromegalia o a la existencia de una enfermedad articular inflamatoria como la artritis reumatoide (AR). Existen pocas publicaciones que evalúen la coexistencia de AR y acromegalia. La presentación de dos casos con la coexistencia de AR y artropatía acromegálica permite evaluar las claves para su diagnóstico diferencial y sus implicaciones en el tratamiento. El diagnóstico de AR en los pacientes con acromegalia requiere de una alta sospecha clínica, por lo que debería ser considerado en aquellos casos en los que no se consiga un adecuado control de los síntomas. El retraso en el diagnóstico y tratamiento de la AR puede incrementar el daño articular y posiblemente empeora el pronóstico funcional de los pacientes

The presence of arthropathy in patients with acromegaly may suggest recurrence of acromegaly or the existence of an inflammatory joint disease such as rheumatoid arthritis (RA). Few publications have evaluated the coexistence of RA and acromegaly. Two cases were presented with a coexistence of RA and acromegalic arthopathy, which enabled us to evaluate the key factors in differential diagnoses and the implications for treatment. Diagnosis of RA in patients with acromegaly requires a high level of clinical suspicion, and should therefore be considered in cases where adequate symptom control is not achieved. Delay in the diagnosis and treatment of RA can increase joint damage and possibly worsen a patient's functional prognosis

Efficacy of methylprednisolone on pain, trismus and quality of life following surgical removal of mandibular third molars: a double-blind, split-mouth, randomised controlled trial / Eficacia de la metilprednisolona sobre el dolor, el trismo y la calidad de vida después de la extirpación quirúrgica de los terceros molares mandibulares: un ensayo controlado aleatorio, doble ciego, de boca dividida

Background: The objective of the present study was to compare the efficacy of different doses of methylpredniso-lone on postoperative sequelae and quality of life (QoL) following surgical removal of mandibular third molars(SRM3).Material and Methods: Fifty-two patients (16 men and 36 women, mean age 25.9 years, range: 18-39) with bilateralimpacted mandibular third molars were randomly allocated into intraoperative muscular injection of either 20mg,30mg, 40mg methylprednisolone or saline injection. Baseline measurements were obtained preoperatively andcompared with assessment after one day, three days, seven days and one month. Pain and trismus were estimatedby visual analog scale score and interincisal mouth opening, respectively. Subjective assessment of QoL includedOral Health Impact Profile (OHIP-14). Descriptive and generalized estimating equation analyses were made andexpressed as mean values with a 95% confidence interval.Results: Methylprednisolone revealed no significant differences in pain, trismus and QoL compared with placebo.Higher prevalence of postoperative pain and worsening in QoL were observed with increased age (P=0.00).Smoking and increased time of surgery decreased mouth opening in the early healing phase (P=0.00).Conclusions: The present study revealed no significant improvement of methylprednisolone on postoperative se-quelae and QoL following SRM3 compared with placebo.(AU)

SARS-CoV-2 and Aspergillus section Fumigati coinfection in an immunocompetent patient treated with corticosteroids / Coinfección de SARS-CoV-2 y Aspergillus sección Fumigati en un paciente inmunocompetente tratado con corticosteroides

BACKGROUND: Patients with severe viral pneumonia are likely to receive high-dose immunomodulatory drugs to prevent clinical worsening. Aspergillus species have been described as frequent secondary pneumonia agents in severely ill influenza patients receiving steroids. COVID-19 patients admitted to Intensive Care Unit (ICU) are receiving steroids as part of their treatment and they share clinical characteristics with other patients with severe viral pneumonias. COVID-19 patients receiving steroids should be considered a putative risk group of invasive aspergillosis. CASE REPORT: We are reporting a SARS-CoV-2/Aspergillus section Fumigati coinfection in an elderly intubated patient with a history of pulmonary embolism treated with corticosteroids. The diagnosis was made following the ad hoc definitions described for patients admitted to ICU with severe influenza, including clinical criteria (fever for 3 days refractory to the appropriate antibiotic therapy, dyspnea, pleural friction rub, worsening of respiratory status despite antibiotic therapy and need of ventilator support), a radiological criterion (pulmonary infiltrate) and a mycological criterion (several positive galactomannan tests on serum with ratio ≥0.5). In addition, Aspergillus section Fumigati DNA was found in serum and blood samples. These tests were positive 4 weeks after the patient was admitted to the ICU. The patient received voriconazole and after two month in ICU his respiratory status improved; he was discharged after 6 weeks of antifungal treatment. CONCLUSIONS: Severely ill COVID-19 patients would be considered a new aspergillosis risk group. Galactomannan and Aspergillus DNA detection would be useful methods for Aspergillus infection diagnosis as they allow avoiding the biosafety issues related to these patients

ANTECEDENTES: Los pacientes con neumonía viral grave reciben altas dosis de fármacos inmunomoduladores para prevenir el empeoramiento clínico. Los pacientes con influenza grave que reciben esteroides tienen neumonías secundarias causadas por Aspergillus con una frecuencia relativamente alta. Los pacientes con COVID-19 ingresados en la unidad de cuidados intensivos (UCI) reciben dicha medicación como parte de su tratamiento, y comparten con otro tipo de pacientes muchas de las características clínicas de otras neumonías virales graves. Estos pacientes deberían considerarse como un grupo de riesgo de aspergilosis invasiva. CASO CLÍNICO: Se presenta un caso de coinfección por SARS-CoV-2 y Aspergillus de la sección Fumigati en un paciente intubado de edad avanzada con antecedentes de embolia pulmonar y tratado con corticosteroides. El diagnóstico siguió las definiciones ad hoc descritas para pacientes ingresados en la UCI con gripe grave. El paciente cumplía varios criterios clínicos (fiebre durante 3 días refractaria al tratamiento antibiótico apropiado, disnea, fricción pleural, empeoramiento del estado respiratorio a pesar del tratamiento antibiótico y la necesidad de soporte respiratorio), el criterio radiológico (infiltrado pulmonar) y un criterio micológico (test de galactomanano positivo en suero, (ratio ≥0,5). Además, se detectó ADN de Aspergillus de la sección Fumigati en muestras de suero y sangre del paciente. Estas pruebas fueron positivas 4 semanas después de que el paciente ingresara en la UCI. El paciente recibió tratamiento con voriconazol, y después de 2 meses en la UCI mejoró su estado pulmonar; fue dado de alta después de 6 semanas de tratamiento antifúngico. CONCLUSIONES: Los pacientes gravemente enfermos con COVID-19 deberían considerarse un nuevo grupo de riesgo para la aspergilosis. La detección de galactomanano y ADN de Aspergillus son métodos útiles para el diagnóstico de infección por este hongo al evitar los problemas de bioseguridad en estos pacientes

Asociación entre el tratamiento esteroideo a dosis alta, la función respiratoria y el tiempo hasta el alta en pacientes con COVID-19: Estudio de cohortes / Association between high-dose steroid therapy, respiratory function, and time to discharge in patients with COVID-19: Cohort study

OBJETIVO: Analizar si existe asociación entre el uso de glucocorticoides a dosis altas y la evolución de la SAFI (saturación/fracción inspirada de oxígeno) o el tiempo hasta el alta, en pacientes hospitalizados por COVID-19. MÉTODOS: Estudio observacional sobre una cohorte de 418 pacientes ingresados en 3 hospitales comarcales de Cataluña (España). Como resultados primarios se estudiaron la evolución de la SAFI en las primeras 48h de tratamiento y el tiempo hasta el alta. Los resultados se compararon entre pacientes tratados y no tratados con glucocorticoides (metilprednisolona 1-2mg/kg/día o dexametasona 20-40mg/día), mediante el análisis de subcohortes emparejadas por múltiples factores clínicos y pronósticos, así como mediante modelos multivariantes de Cox, ajustados por diversos factores pronósticos. El uso simultáneo de diferentes tratamientos para la COVID-19 fue tenido en cuenta, tanto en el emparejamiento de subcohortes como en la regresión de Cox. RESULTADOS: Hubo 187 pacientes con glucocorticoides; de ellos, 25 pacientes pudieron ser emparejados con un número equivalente de pacientes control. En las subcohortes emparejadas, no se apreció diferencia en el tiempo hasta el alta (log-rank: p = 0,291), ni en el cambio en la SAFI a las 48h desde la basal (glucocorticoides: −0,04; controles: +0,37; p = 0,095). Los modelos multivariantes mediante regresión de Cox mostraron un tiempo hasta el alta significativamente más largo en pacientes tratados con glucocorticoides (hazard ratio: 7,26; IC 95%: 3,30-15,95). CONCLUSIONES: No hemos encontrado mejoría en la función respiratoria o tiempo hasta el alta, asociado al uso de glucocorticoides a dosis altas

OBJECTIVE: To analyze whether there is an association between the use glucocorticoids at high doses, and the evolution of saturation/fraction of inspired oxygen (SAFI) or time to discharge, in patients hospitalized with COVID-19. METHODS: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia, Spain. As primary outcomes, we studied the evolution of SAFI in the first 48hours of treatment and the time to discharge. The results were compared between patients treated and untreated with glucocorticoids (methylprednisolone 1-2mg/kg/day o dexamethasone 20-40mg/day) through sub-cohort analyses matched for multiple clinical and prognostic factors, as well as through Cox multivariate models adjusted for prognostic factors. The simultaneous use of different treatments for COVID-19 was taken into account, both in sub-cohorts matching and in Cox regression. RESULTS: There were 187 patients treated with glucocorticoids; of these, 25 patients could be matched with an equivalent number of control patients. In the analysis of these matched sub-cohorts, no significant difference was observed in time to discharge (log-rank: p = 0.291) or the increment in SAFI at 48hours of treatment (glucocorticoides: −0.04; controls: +0.37; p = 0.095). Multivariate models using Cox regression showed a significantly longer time to discharge in patients treated with glucocorticoids (hazard ratio: 7.26; 95% IC: 3.30-15.95). CONCLUSIONS: We have not found improvement in respiratory function or time until discharge, associated with the use of glucocorticoids at high doses

Anaphylaxis Due to Senna (Cassia angustifolia)

No disponible

Severe neutropenia and thrombocytopenia in a young adult: a case-report

We present the case of a 20-year-old male hospitalized with severe neutropenia and thrombocytopenia. After exclusion of other etiologies, it was concluded to be of autoimmune etiology. The prompt and sustained response of both cell lines to corticosteroids, reinforced this diagnosis. This case illustrates a very rare association of severe primary neutropenia and thrombocytopenia. The lack of serological marker makes this diagnosis delayed and resource-consuming

No disponible