[Use of MDRD equation to detect occult renal failure and reduce the risk of digitalis overdose]. / Utilidad de la ecuación MDRD para detectar insuficiencia renal oculta y disminuir el riesgo de sobredosificación digitálica.

INTRODUCTION: Digoxin overdose is closely related to Chronic Kidney Disease and creatinine dosage adjustment is usually needed. Our goal was to assess the advantages of serum creatinine and the MDRD equation to detect hidden renal insufficiency to reduce the overdose Digital risk. METHODS: We describe all digoxin samples processed and registered in our hospital laboratory database for a year. Patients under 18 years and samples below therapeutic ranges were excluded. Chi square (p<0.05), ROC curves and logistic regression analysis were conducted. SPSS software was used. RESULTS: Between 1228 digoxin samples taken to 679 patients (273 men, 77 +/- 10 years old , and 406 women 82 +/- 8 years old), 14% were over therapeutic range (28 men and 67 women). Significant differences were observed in over dosage between high creatinine group regarding to normal creatinine group (31% vs. 10% in men, 44% vs. 15% in women). ROC curves showed that the most accurate levels to predict digoxin over dosage were MDRD<56 ml/min/1.73 m(2) in men and MDRD<52 ml/min/1.73 m(2) in women. 68% of over dosage men had declines of MDRD levels, compared to 61% with high creatinine levels, 81% of over dosage women had declines of MDRD compared to 51% with elevated creatinine levels. CONCLUSIONS: Even in patients with normal creatinine levels, chronic kidney disease enhances digoxin over dose risk. Using the decline of glomerular filtration rate estimated by the MDRD equation is better than elevated creatinine levels to detect digoxin overdose, thus constituting a very useful tool to reduce the risk of overdose, especially among women.

Utilidad de la ecuación MDRD para detectar insuficiencia renal oculta y disminuir el riesgo de sobredosificación digitálica / No disponible

Introducción: la Enfermedad Renal Crónica plantea importantes problemas de sobredosificación digitálica y hace necesario el ajuste de dosis y la valoración de la función renal, que se realiza habitualmente mediante la creatinina sérica. Nuestro objetivo fue valorar las ventajas de la creatinina sérica y de la ecuación MDRD para detectar insuficiencia renal oculta y poder reducir el riesgo de sobredosificación digitálica. Material y métodos: estudio descriptivo transversal durante un año, en el que se analizaron las determinaciones de digoxina desde la base de datos del laboratorio. Se excluyeron pacientes infra dosificados y menores de 18 años. Se emplearon las pruebas chi cuadrado (p <0,05), curvas ROC, así como análisis de regresión logística, mediante el programa SPSS. Resultados: se realizaron 1.228 determinaciones de digoxina a 679 pacientes(273 varones 77 ± 10 años, y 406 mujeres 82 ± 8 años), de los que el14% estaba sobre dosificado (28 varones y 67 mujeres).Se observan diferencias significativas en sobredosificación en los que tienen creatininas elevadas respecto a creatinina normal (31 vs. 10% en varones, 44 vs. 15% en mujeres). Mediante curvas ROC, la mayor eficacia diagnóstica se obtendría envarones, con cifras de MDRD <56 ml/min/1,73 m2, y mujeres MDRD <52 ml/min/1,73 m2. El 68% de varones sobre dosificados tenían descensos de MDRD, frente al 61% con creatininas elevadas; el 81% de las mujeres sobredosificadas tenían descendido MDRD frente al 51% con elevación de creatinina. Conclusiones: cifras de creatinina normales esconden insuficiencias renales que aumentan el riesgo de sobredosificación. Utilizar el descenso de la tasa de filtrado glomerular estimado mediante la ecuación MDRD es mejor que utilizar las cifras decreatinina elevadas para detectar sobredosificación digitálica, por lo que constituye una herramienta muy útil para poder reducir el riesgo de sobredosificación, sobre todo en mujeres (AU)

Introduction: Digoxin overdose is closely related to Chronic Kidney Disease and creatinine dosage adjustment is usually needed. Our goal was to assess the advantages of serum creatinine and the MDRD equation to detect hidden renal insufficiency to reduce the overdose Digital risk. Methods: We describe all digoxin samples processed and registered in our hospital laboratory database for a year. Patients under 18 years and samples bellow therapeutic ranges were excluded. Chi square (p<0.05), ROC curves and logistic regression analysis were conducted. SPSS software was used. Results: Between 1228 digoxin samples taken to 679 patients (273 men, 77 ± 10 years old , and 406 women 82 ± 8 years old), 14% were over therapeutic range (28 men and 67 women). Significant differences were observed in over dosage between high creatinine group regarding to normal creatinine group (31% vs. 10% in men, 44% vs. 15% in women). ROC curves showed that the most accurate levels to predict digoxin over dosage were MDRD <56 ml/min/1.73m2 in men and MDRD <52 ml/min/1.73m2 in women. 68% of over dosage men had declines of MDRD levels, compared to 61% with high creatinine levels, 81% of over dosage women had declines of MDRD compared to 51% with elevated creatinine levels. Conclusions: Even in patients with normal creatinine levels, chronic kidney disease enhances digoxin over dose risk. Using the decline of glomerular filtration rate estimated by the MDRD equation is better than elevated creatinine levels to detect digoxin overdose, thus constituting a very useful tool to reduce the risk of overdose, especially among women (AU)

[A series of 618 cases of monoclonal gammopathies of undetermined significance: predictive factors of disappearance of monoclonal component or evolution to malignant gammopathies]. / Serie de 618 casos de gammapatías monoclonales de significado indeterminado (GMSI): factores predictivos de desaparición del componente monoclonal o de evolución a gammapatías malignas.

INTRODUCTION: How to identify monoclonal gammopathies of undeterminated significance (MGUS) at risk for progression has been studied for the last years. AIMS: To study the incidence of MGUS in a region with 300,000 inhabitants and factors which associate with a) monoclonal gammopathy disappearance (transient MGUS) b) evolution to malignant gammopathy. METHODS: Study of 618 MGUS. RESULTS: Incidence: 30/40 new cases a year with increase to 70 cases a years in the latest years of study. Age and gender: 71,4 y (32-100), male/female ratio 1.4. Associated pathology: infection 328, heart diseases 249, rheumatic diseases 211, liver diseases 108, cancer 80, neuropathy 43. Monoclonal proteins: IgG 407, IgM 78, IgD 2, biclonal 16, triclonal 1; no heavy chain 21, light chain Kappa 389. Variables (mean): monoclonal component: 14 g/l, ESR 32,5, bone marrow: 5,9% plasma cells beta2-microglobulin: 2,59 mg/l, albumin: 3,1g/l, bone survey: normal 39,5%. Evolution: transient MGUS 20 cases. Time to disappearance 2,6 months (1,4-4,6). Evolution to malignant gammopathy 24 cases, time to progression 3 years (IC 1,82-4,3). RESULTS: Several factors were associatedç with malignant transformation: heavy chain IgA (p < 0,002), ESR (p < 0,001), age < 70 (p < 0,05), bone marrow percentage of plasma cells (p < 0,002) y ostheoporosis (p < 0,005). A MGUS follow up model is suggested.

Zoonosis emergentes / Emerging zoonosis

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Serie de 618 casos de gammapatías monoclonales de significado indeterminado (GMSI): factores predictivos de desaparición del componente monoclonal o de evolución a gammapatías malignas / A series of 618 of monoclonal gammopathy of undeterminated significance: variables asocciated with disappearance and progression

Introducción. La identificación de las gammapatíasmonoclonales de significado incierto (GMSI) conriesgo elevado de progresión se viene estudiandoen los últimos años.Objetivos. Evaluar la incidencia de las GMSI enun área de 300.000 habitantes y sus factoresasociados: la desaparición del componentemonoclonal (CM), gammapatías transitorias (GMT) ysu evolución a gammapatías malignas (GMM).Métodos. Estudio de 618 GMSI.Resultados. Incidencia: 30-40 casos nuevos/año, conun incremento en los últimos años de hasta 70 casospor año. Edad y sexo: 71,4 años (32-100); relaciónH/F 1,4. Patología asociada: infecciosa 328,cardiológica 249, reumatoidea 211, hepática 108,neoplasia 80 y neuropatía 43. Características del CM:IgG 407, IgA 93, IgM 78, IgD 2, biclonales 16,triclonal 1 y ninguna cadena pesada 21. Cadenasligeras: kappa 389 casos. Variables (media): CM 14 g/l, VSG 32,5 mm, MO porcentaje de células plasmáticas 5,9%, ß2-microglobulina 2,59 mg/l, albúmina 3,1 g/l, serie ósea normal 39,5%. Evolución: GMT 20 casos. Tiempo medio de desaparición 2,6meses (1,4-4,6), GM transformadas a GMM 24 casosTiempo medio de progresión 3 años (IC 1,82-4,3).Resultados. Se identifican como factoresasociados a transformación a GMM: cadena pesadaIgA (p < 0,002), VSG (p < 0,001), edad < 70 años(p < 0,05), porcentaje de CP (p < 0,002) yosteoporosis (p < 0,005). Se propone un modelo de seguimiento de GMSI

Introduction. How to identify monoclonalgammopathies of undeterminated significance(MGUS) at risk for progression has been studied forthe last years. Aims. To study the incidence ofMGUS in a region with 300,000 inhabitants andfactors which associate with a) monoclonalgammopathy disappearance (transient MGUS)b) evolution to malignant gammopathy.Methods. Study of 618 MGUS.Results. Incidence: 30/40 new cases a year withincrease to 70 cases a years in the latest years ofstudy. Age and gender: 71,4 y (32-100),male/female ratio 1.4. Associated pathology:infection 328, heart diseases 249, rheumaticdiseases 211, liver diseases 108, cancer 80,neuropathy 43. Monoclonal proteins: IgG 407,IgM 78, IgD 2, biclonal 16, triclonal 1; no heavychain 21, light chain Kappa 389. Variables (mean):monoclonal component: 14 g/l, ESR 32,5, bonemarrow: 5,9% plasma cells ß2-microglobulin: 2,59 mg/l, albumin: 3,1g/l, bone survey: normal 39,5%. Evolution: transient MGUS 20 cases. Time to disappearance 2,6 months (1,4-4,6). Evolution to malignant gammopathy 24 cases, time to progression 3 years (IC 1,82-4,3).Results. Several factors were associatedçwith malignant transformation: heavy chain IgA (p < 0,002), ESR (p < 0,001), age < 70 (p < 0,05), bone marrow percentage of plasma cells (p < 0,002) y ostheoporosis (p < 0,005). A MGUS follow up model is suggested

Cadenas ligeras libres en suero. Utilidad clínica / Serum free light chains. Clinical utility

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Infradiagnóstico del déficit de hierro en pacientes ambulatorios debido al mal uso y a las limitaciones de los marcadores bioquímicos: utilidad del contenido de hemoglobina del reticulocito / Infradiagnosis of iron deficiency in ambulatory patients due to wrong use and biochemical markers limitations: utility of reticulocyte hemoglobin content

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Morbilidad hospitalaria en pacientes con infección por VIH / Hospital morbidity in HIV infected patients

Fundamento y objetivo: Con el aumento de la esperanza de vida en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) tras el tratamiento antirretroviral de gran actividad (TARGA), las causas de hospitalización han cambiado. Predominan ahora comorbilidades como la hepatopatía crónica, la patología cardiovascular o los efectos secundarios de los tratamientos. Nuestro objetivo es determinar las características clinicoepidemiológicas actuales de estos pacientes. Material y métodos: Estudio descriptivo y retrospectivo. Revisamos las historias clínicas de los ingresos de pacientes con infección por el VIH hospitalizados en los servicios médicos de nuestro hospital en el transcurso de un año. Resultados: Hubo 125 ingresos de 82 pacientes, un 77% varones y un 71% con infección por el virus de la hepatitis C (VHC). La edad media fue de 42 años. En el 64% la vía de transmisión fue la drogadicción parenteral. Un 36% recibían TARGA y un 51% reunían criterios sida. Los motivos de ingreso más frecuentes fueron la patologia respiratoria (32%) y las enfermedades definitorias de sida (EDS) con un 22%, de las que la tuberculosis (TBC) fue la más frecuente. Un 10% fueron ingresados en la Unidad de Cuidados Intensivos (UCI). La mortalidad fue del 11% pacientes/año. Conclusiones: La mayoría de los pacientes fueron varones, con coinfección por el VHC y usuarios de drogas vía parenteral, siendo las causas de ingreso más frecuentes las patologías respiratorias y las enfermedades oportunistas. La TBC permanece siendo la EDS más frecuente

Background and objetive: With the increasing life expectancy in human immunodeficiency virus (HIV) infected patients since the highly active antiretroviral therapy (HAART), other underlying comorbilities such as chronic liver patology, cardiovascular diseases or side effects of treatment may lead to hospitalization. The purpose of this study is to determine the clinical and epidemiological characteristics of these patients. Material and methods: A descriptive-retrospective study. We reviewed the clinical records of patients with HIV infection admitted in our medical departments through a year. Results: There were 125 hospitalizations of 82 patients. 77% were males and 71% had hepatitis C virus (HCV) infection. The median age was 42 years. 64% HIV infection had been acquired by sharing material for intravenous drug use. A 36% were receiving HAART and 51% had AIDS. The respiratory tract patology (32%) and AIDS-defining illnesses (22%) were the most frequent causes of hospitalization, and the main opportunistic disease was tuberculosis (TBC). Ten per cent were admitted in the Intensive Care Unit. Mortality rate was 11% patients/year. Conclusions: Most of the patients were male, drug users and HCV positive, and the admissions to hospital were mostly due to respiratory patology and opportunistic diseases. TBC remains like the most frequent AIDS-defining illness

[Hospital morbidity in HIV infected patients]. / Morbilidad hospitalaria en pacientes con infección por VIH.

BACKGROUND AND OBJECTIVE: With the increasing life expectancy in human immunodeficiency virus (HIV) infected patients since the highly active antiretroviral therapy (HAART), other underlying comorbilities such as chronic liver pathology, cardiovascular diseases or side effects of treatment may lead to hospitalization. The purpose of this study is to determine the clinical and epidemiological characteristics of these patients. MATERIAL AND METHODS: A descriptive-retrospective study. We reviewed the clinical records of patients with HIV infection admitted in our medical departments through a year. RESULTS: There were 125 hospitalizations of 82 patients. 77% were males and 71% had hepatitis C virus (HCV) infection. The median age was 42 years. 64% HIV infection had been acquired by sharing material for intravenous drug use. A 36% were receiving HAART and 51% had AIDS. The respiratory tract pathology (32%) and AIDS-defining illnesses (22%) were the most frequent causes of hospitalization, and the main opportunistic disease was tuberculosis (TBC). Ten per cent were admitted in the Intensive Care Unit. Mortality rate was 11% patients/year. CONCLUSIONS: Most of the patients were male, drug users and HCV positive, and the admissions to hospital were mostly due to respiratory patology and opportunistic diseases. TBC remains like the most frequent AIDS-defining illness.

Dolor abdominal y fiebre en paciente anticoagulado / Dolor and selective IgA deficiency

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Mieloma múltiple con manifestaciones cutáneas / Cutaneous manifestation in multiple myeloma

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No disponible