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.

[Sweet's syndrome and intestinal inflammatory disease. A case report and review of the literature]. / Síndrome de Sweet y enfermedad inflamatoria intestinal. Aportación de un nuevo caso y revisión de la literatura.

Sweet's syndrome, or febrile neutrophilic dermatosis, is a process characterized by fever, red tender plaques, neutrophilia and neutrophilic dermal infiltrate with papilar edema in the absence of vasculitis. The association with intestinal inflammatory disease is inusual, a new case associated with ulcerative colitis is reported, and we perform a literature review of Sweet's associated intestinal inflammatory disease.

[Usefulness of transesophageal echocardiography in the detection of embolic risk in a case of Staphylococcus aureus endocarditis]. / Utilidad de la ecocardiografía transesofágica en la detección del riesgo embólico en un caso de endocarditis por Staphylococcus aureus.

Embolism is very frequently found in patients with infective endocarditis (IE), fundamentally in cerebral arteries. An early diagnosis and possible complications seem to be related to morbidity and mortality. Echocardiography has a considerable function in early diagnosis, and, also, when we evaluate the risk of major cerebral embolism. However there is no agreement in the second aspect: for some authors echocardiography only slightly aids, but others consider it of great value in identifying high-risk patients. We describe a patient who suffers infective endocarditis by Staphylococcus aureus with significant neurological complications in its evaluation. Vegetation was disclosed by transesophageal echocardiography (TEE), whereas transthoracic echocardiography (TTE) was unable to do so. This is why we underline the role of TEE in the diagnosis and description of vegetation features (size, mobility and implantation) which seem to be linked to the risk of cerebral complications.

[Acute recurrent pancreatitis and ampullary tumor: a case report]. / Pancreatitis aguda recidivante y tumor ampular: presentación de un caso.

A case of ampullary cancer, the first clinical manifestation of which was two episodes of acute pancreatitis is presented with review of the literature on the possible role of this type of cancer as a causal agent of episodes of acute pancreatitis. We support the use of ERCP in all patients with acute idiopathic pancreatitis with the aim of discarding the possibility of a tributary ampullary tumor of curative removal.