Oral lesions in patients with primary Sjögren's syndrome. A case-control cross-sectional study.

BACKGROUND: To evaluate the presence of oral lesions in a group of patients with primary Sjögren's syndrome (pSS) and compare these results with a matched control group (CG). MATERIAL AND METHODS: An observational cross-sectional study was conducted. 61 pSS patients (60 women, 1 man, mean age 57.64±13.52) diagnosed according to the American European Criteria (2002), and 122 matched control patients (120 women, 2 men, mean age 60.02±13.13) were included. Demographic and medical data, oral lesions and salivary flow rate were collected. RESULTS: Compared with the controls, pSS patients were 3.95 more likely to have oral lesions (OR 3.95; 95% CI 2.06-7.58; p=0.0001). 57.4% pSS patients presented oral lesions compared to 25.4% in CG. The most common were candidiasis (13.1% vs 2.5%), traumatic lesions (13.1% vs 4.1%), apthae (8.2% vs 0), and fissuration of the tongue (8.2% vs 0.8%). pSS patients with oral lesions had lower salivary flow levels (stimulated and unstimulated), although these differences were not significant. Significant associations were found between the presence of oral lesions and systemic manifestations and history of parotid gland enlargement in pSS patients. CONCLUSION: pSS patients suffer more oral lesions than general population and these lesions may aggravate the pSS disease.

Clinical factors associated with discontinuation of ts/bDMARDs in rheumatic patients from the BIOBADASER III registry.

Biologic and targeted synthetic disease-modifying antirheumatic drugs (ts/bDMARDs) play a pivotal role in the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Persistence of therapy provides an index of a drug's overall effectiveness. The objective of the study was to identify factors associated with discontinuation of ts/bDMARDs in a real-world dataset. The study population comprised patients diagnosed with RA, PsA, and AS included in the BIOBADASER registry for whom follow-up data were available until November 2019. Patient features and treatment data were included in the analysis. The Kaplan-Meier method was used to study survival of the different drugs according to the reason for discontinuation. Factors associated with discontinuation were studied using Cox regression models and bivariate and multivariate analyses. P values of less than 0.05 were regarded as statistically significant. The study population comprised 4,752 patients who received a total of 8,377 drugs, of which 4,411 (52.65%) were discontinued. The Kaplan-Meier curves showed that survival for first-line treatment was greater in all 3 groups (p < 0.001). Patients with RA had a greater risk of discontinuation if they were younger (HR, 0.99; 95% CI 0.99-1.00), if they were receiving anti-TNFα agents (HR, 0.61; 95% CI 0.54-0.70), and if they had more comorbid conditions (HR, 1.09; 95% CI 1.00-1.17). Patients with PsA had a higher risk if they were women (HR, 1.36; 95% CI 1.15-1.62) and if they were receiving other ts/bDMARDs (HR, 1.29; 95% CI 1.05-1.59). In patients with AS, risk increased with age (HR, 1.01; 95% CI 1.00-1.02), as did the number of comorbid conditions (HR, 1.27; 95% CI 1.12-1.45). The factors that most affected discontinuation of ts/bDMARDs were line of treatment, age, type of drug, sex, comorbidity and the year of initiation of treatment. The association with these factors differed with each disease, except for first-line treatment, which was associated with a lower risk of discontinuation in all 3 diseases.

Yellow fever vaccine-associated viscerotropic disease and death in Spain.

Yellow fever vaccine-associated viscerotropic disease (YEL-AVD) is a recently described severe adverse event after yellow fever vaccination, and some cases have been reported in different countries [Anonymous. Effects of yellow fever and vaccination. Lancet 2001;358(9296):1907-9]. Herein we describe a YEL-AVD case in a young woman, who died after vaccination with 17D-204 strain. Clinical, serological and immunochemical analysis as well as virus detection, quantification, sequence analysis and cytokine release, were performed. Further investigations on yellow fever vaccine adverse events, and carefully analysis of the immune response elicited are important tasks for the future.

Validation of a methodology for inpatient pharmacotherapy follow-up / Validación de una metodología para el seguimiento farmacoterapéutico en paciente hospitalizado

Background: Pharmacotherapy follow-up is a practice in which the pharmacist assumes responsibilityfor the patient’s drug-related Problems. Its goal is to achieve positive clinical outcomes. Methods toperform pharmacotherapy follow-up have centered principally on ambulatory patients. Objective: Thepurpose of this study is to propose and validate a methodology for inpatient pharmacotherapy follow-up.Methods: A systematic review was performed. This consisted in a comprehensive search of databasescontaining studies published in English or Spanish during 1998 - 2008, and that sought to improve thetransfer of accurate information about Pharmacotherapy follow-up in inpatients. The key terms used toconduct the search were identified in consultation with clinical experts and included: Pharmacotherapyfollow-up methods, pharmacotherapy follow-up, drug therapy problems, and validation. A comparativetable was elaborated to differentiate and evaluate the advantages of each of the proposed methodologies.The information gathered allowed to propose a sequence of general steps for inpatient Pharmacotherapyfollow-up. To validate the methodology, a descriptive study was carried out with 32 randomly selectedpatients and was independently followed up by two pharmacists to assess the reproducibility of the process.Results: Pharmaceutical Care Practice: The Clinician’s Guide, proposed by Cipolle & Strand. AppliedTherapeutics: The Clinical Use of Drugs, the DÁDER method, and the IASER program, were selected.79 drug therapy problems (DTPs) were identified and resolved, where errors in necessity of medicationhad the highest incidence (46.6%), followed by effectiveness (24.5%) and safety (28.9%). The degree ofagreement among researchers in the identification and resolution of DTPs was quantified using the kappacoefficient, showing a high concordance (90% CI)...

Espiradenoma ecrino vascular gigante / Giant Vascular Eccrine Spiradenoma

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Hematocele crónico imitando un tumor testicular. Presentación de dos casos / Chronic hematocele simulating a testicular tumor. Report of two cases

Objetivo: El diagnóstico diferencial de masas escrotales incluye procesos inflamatorios, tumores malignos y lesiones traumáticas, incluyendo hematomas y hematocele crónico. Métodos/Resultados: Presentamos dos casos de hematocele crónico discutiéndose las características clínico-radiológicas de dichas lesiones y su diagnóstico diferencial. Conclusiones: El diagnóstico preoperatorio de hematocele puede ser difícil, ya que la sintomatología puede imitar una lesión quística o una neoplasia (AU)

Objective: Differential diagnosis of a testicular mass includes inflammatory conditions,malignant tumors and traumatic lesions, including hematomas and hematocele. Methods/Results: We report two cases of chronic hematocele. We discuss the clinico-radiologic characterisc and differential diagnosis. Conclusion: Hematocele is difficult to diagnose preoperatively because its symptoms may mimic cysts or neoplasms (AU)

Valoración de la eficacia de lercanidipino en el tratamiento de la hipertensión arterial ligera-moderada de pacientes mayores y menores de 65 años / Evaluation of the effectiveness of lercanidipine in the treatment of mild-to-moderate hypertension in patients under and over the age of 65

Introducción. Evaluar el perfil antihipertensivo clínico y de 24 horas, mediante monitorización ambulatoria de la presión arterial, de lercanidipino en dos grupos de pacientes: a) mayores de 65 años, y b) menores de 65 años. Material y métodos. Ciento cuarenta y dos pacientes con hipertensión ligera a moderada (presión arterial sistólica entre 140 y 180 mmHg y presión arterial diastólica entre 90 y 114 mmHg) mayores de 40 años fueron incluidos secuencialmente en el estudio tras una fase de lavado con placebo de dos semanas, asignándose 72 de ellos al grupo A y 70 al grupo B. Se comenzó con 10 mg/día de lercanidipino en una sola toma. Al cabo de 4 semanas esta dosis podía ser doblada si la presión arterial diastólica era mayor de 90 mmHg o había descendido menos de 10 mmHg. A las 8 semanas si no habían conseguido controlar la presión arterial por debajo de 140/90 mmHg eran excluidos del estudio y remitidos para su seguimiento en nuestra Unidad de Riesgo Cardiovascular. Se practicaron controles clínicos cada 15 días (toma de la presión arterial y recogida de efectos secundarios). En la visita basal y al finalizar el ensayo (6 meses) se les realizó monitorización ambulatoria de presión arterial de 24 horas, electrocardiograma y analítica. Resultados. El perfil de eficacia antihipertensiva fue en ambos grupos, A y B, similar, siendo a los 6 meses significativos los descensos de presión arterial sistólica y presión arterial diastólica tanto clínica como de 24 horas (de día y de noche) con respecto a los valores basales. Por otra parte se observó un mayor descenso de la presión arterial sistólica (p=0,017) en los pacientes del grupo A que en los del B cuando se utilizó la monitorización ambulatoria de presión arterial (de 141,01ñ 9,91 hasta 125,88ñ7,76 en A y desde 139,55ñ11,54 hasta 127,68ñ 10,07 en B). No hubo diferencias en la frecuencia cardíaca, valores analíticos ni en los efectos secundarios. Conclusiones. Lercanidipino presenta una eficacia antihipertensiva similar en ambos grupos, excepto en lo que hace referencia a la presión arterial sistólica, medida con la monitorización ambulatoria de la presión arterial, en que el descenso es mayor en los pacientes del grupo A que en los del B, con diferencia estadísticamente significativa. El perfil de eventos adversos generales y ligados a vasodilatación fue excelente (AU)