Diagnostic performance of high sensitive troponin in non-ST elevation acute coronary syndrome. / Rendimiento diagnóstico de la troponina de alta sensibilidad en el síndrome coronario agudo sin elevación del segmento ST.

OBJECTIVE: To assess the diagnostic performance of high-sensitivity troponin T (hs-TnT) in patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS); confirm whether it shortens the time to diagnosis; and analyze the clinical consequences derived from its use. METHOD: A prospective, longitudinal observational study was carried out in 5 emergency care departments. Patients seen for chest pain with suspected of NSTE-ACS were consecutively included. Patient care followed the internal protocols of the center, based on the consensus guidelines of the European Society of Cardiology. Serial conventional cardiac troponin (cTn) and hs-TnT determinations were made. RESULTS: A total of 351 patients were included in the study. A final diagnosis of acute myocardial infarction (AMI) was established in 77 patients, with unstable angina in 102, and no acute coronary syndrome in 172 patients. The hs-TnT values were above percentile 99% in a large number of patients without AMI. In the initial determination, the diagnostic sensitivity of the hs-TnT was significantly greater than that of cTn (87.0% vs. 42.9%), which led to a negative predictive value of 95.1%. CONCLUSIONS: High-sensitivity troponin T improves diagnostic performance compared with conventional troponin assay, shortens the time to diagnosis, and identifies a larger number of patients with smaller myocardial infarctions.

[Bacteraemia in adult patients discharged from Emergency department]. / Bacteriemia en pacientes adultos dados de alta en el servicio de urgencias.

INTRODUCTION: Bacteraemia is a marker of severity of infectious processes. However, sometimes in Emergency Department blood cultures are drawn from patients who are discharged without results being available. MATERIAL AND METHODS: Prospective study of bacteraemia was conducted on adult patients from Emergency Department of tertiary university hospital from March 2014 to February 2015. Epidemiological, clinical and microbiological data were collected from patients admitted and discharged. After the detection of bacteraemia, the microbiology department telephoned the physician responsible (patients admitted) or Primary Care physician (patients discharged). RESULTS: A total of 429 episodes of bacteraemia were included, of which 13.52% were discharged. These patients were younger (68.5 vs 73.59 years, P=.0001), had a lower Charlson index (1.603 vs 2.309, P=.0013) and lower severity (septic shock 0 vs 34; P<.0001) than admitted patients. After the call to Primary Care, oral antibiotics were started in 10.3%, a change in oral antibiotic in 6.9%, 12% were admitted to hospital, and the rest of them continued same treatment. The 30-day mortality rate was 0%. CONCLUSIONS: There was a significant number of patients with bacteraemia were discharged from Emergency Department. To discharge a clinically stable patient with blood cultures taken in Emergency Department is safe, if there is a re-assessment of the patient if these cultures are positive.

[Non-invasive diagnosis of cardiac amyloidosis due to transthyretin. Case report]. / Diagnóstico no invasivo de amiloidosis cardiaca por transtirretina. Caso clínico.

Amyloidosis due to deposits of transthyretin (ATTR) is currently considered the most frequent form of cardiac amyloidosis and its incidence is increasing thanks to the advances in diagnostic imaging techniques. Some non-invasive diagnostic criteria have recently been published on this entity that due to the development of new drugs for the specific treatment of cardiac ATTR, have prognostic and therapeutic implications. That is why cardiac ATTR could cease to be a rare disease and become a frequent one, and become potentially treatable instead of incurable. We present the case of an 80-year-old male diagnosed with non-hereditary cardiac ATTR by means of gammagraphy with 99mTc diphosfonate scintigraphy (99mTc-DPD) following the new criteria of non-invasive diagnosis.

[Cerebellar syndrome as first manifestation of late onset systemic lupus erythematosus]. / Síndrome cerebeloso como primera manifestación de un lupus eritematoso sistémico de inicio tardío.

Clinical characteristics of a 70-year-old women affected by an erythematous systemic lupus (ESL) of late onset, whose first main manifestation was the compromise of the central nervous system as cerebellar syndrome and which exhibited a good response to treatment, is described. Pathogenic and diagnostic aspects of the neurological manifestations of ESL are described.

[Tuberculosis caused by Mycobacterium bovis: apropos of 2 cases]. / Tuberculosis causada por Mycobacterium bovis: a propósito de dos casos.

Infection by Mycobacterium bovis is currently a rare form of tuberculosis in developed countries, being its incidence lower than 1%. Its main mechanism of transmission is through the ingestion of contaminated milk. In this paper, two cases of tuberculosis by Mycobacterium bovis are described, one of lymphatic location by endogenous reactivation and another of pulmonary location, probably by a primary infection acquired through the inhalation route. We stress the risk of transmission of the disease through the respiratory route from infected animals and by person to person contagion.

[Acute HIV infection]. / Infección aguda por VIH.

OBJECTIVE: Primary HIV infection presents a non-specific and polymorphous clinical profile. We present two cases which show how a high level of clinical awareness can lead to an early diagnosis. DESIGN: A retrospective study of all the HIV positive patients treated in Zaragoza's Miguel Servet Hospital between 1985 and 1991 was carried out. Site. The medical records studied concerned the hospital as regards admissions and out-patient consultations. PATIENTS: The two cases which we contributed fulfilled the serologic criteria of acute HIV infection. MAIN MEASUREMENTS AND RESULTS: The man-woman relationship was 1/1. The only way of contagion found was heterosexual. Predominant clinical symptoms were cutaneous-mucous, with a prominent condition of oesophagitis produced by Candida. CONCLUSIONS: A high level of clinical awareness on the part of the Primary Care doctor can contribute significantly to the detection of new cases and controlling the HIV epidemic.

[Pulmonary fibrosis as a presentation form of the Jo-1 syndrome]. / Fibrosis pulmonar como forma de presentación del síndrome Jo-1.

Jo-1 syndrome is a disease recently described, included on the list of connective tissue diseases. Its clinical features are myositis and/or pulmonary fibrosis associated to the presence of precipitant antibodies against intracellular enzyme call histidine T-RNA synthetase. This antibody is related to pulmonary fibrosis associated to myositis and some scientist gave predictive value on the onset of pulmonary fibrosis in patients with myositis. However, isolated association of pulmonary fibrosis have been exceptionally described. A patient with severe interstitial pulmonary affliction and positive Jo-1 antibody without myositis is presented. The actual knowledge of the disease and its association is reviewed.