Queratopatía cristalina por cadenas kappa en gammapatía monoclonal / Crystalline keratopathy due to kappa chains in a monoclonal gammopathy

Caso clínico: Se muestra una queratopatía cristalina en un paciente cuyo estudio sistémico permitió el diagnóstico de una gammapatía monoclonal por cadenas kappa de inmunoglobulina G (IgG). Se presentan los signos corneales y la investigación diagnóstica que se llevó a cabo para establecer esta importante asociación. Discusión: La investigación sistémica de un paciente con depósitos corneales constató una gammapatía monoclonal IgG-kappa. Los cristales corneales pueden ser la manifestación inicial en un paciente con gammapatía monoclonal, un hallazgo clínico poco frecuente aunque muy significativo (AU)

Case report: The following case shows corneal crystal formation in a patient in whom thee systemic work-up led to the diagnosis of a monoclonal gammopathy with increased monoclonal immunoglobulin G (IgG). We present the corneal signs and subsequent haematological investigations undertaken to establish this important association. Discussion: Systemic work-up of a patient with corneal deposits showed a monoclonal gammopathy with increased monoclonal immunoglobulin (IgG-type kappa). Corneal crystals, a rare, but significant, clinical finding, may be the initial presentation in a patient with monoclonal gammopathy (AU)

[Crystalline keratopathy due to kappa chains in a monoclonal gammopathy]. / Queratopatía cristalina por cadenas kappa en gammapatía monoclonal.

CASE REPORT: The following case shows corneal crystal formation in a patient in whom thee systemic work-up led to the diagnosis of a monoclonal gammopathy with increased monoclonal immunoglobulin G (IgG). We present the corneal signs and subsequent haematological investigations undertaken to establish this important association. DISCUSSION: Systemic work-up of a patient with corneal deposits showed a monoclonal gammopathy with increased monoclonal immunoglobulin (IgG-type kappa). Corneal crystals, a rare, but significant, clinical finding, may be the initial presentation in a patient with monoclonal gammopathy.

[Evidence based ophthalmology: critical appraisal skills on clinical trials on treatments]. / Oftalmología basada en evidencias: evaluación crítica de los ensayos clínicos sobre tratamiento.

PURPOSE: To analyse and provide the tools to answer three questions that must be asked about a clinical trial on treatments: evaluation of validity (internal validity, so that results are not biased); clinical importance of these results and their application to individual patients. We provide simple statistics tools, clinical trial design, and clinical epidemiology for the evaluation and analysis of clinical trials on treatments. METHODS: Review of the medical literature. RESULTS: For the evaluation of papers on treatment and for using a treatment efficiently, we need to know if the clinical trials that support it are trustworthy, if the treatment has clinical importance and if it can be applied to my patients. CONCLUSIONS: It is of paramount importance to check that the sample of the clinical assay has been correctly randomized, because randomization is necessary to comply with mathematical laws of application of statistical tests. Follow-up of patients must be complete in order to measure precision of results and evaluate the efficacy of treatment.

Oftalmología basada en evidencias: evaluación crítica de los ensayos clínicos sobre tratamiento / Evidence based ophthalmology: critical appraisal skills on clinical trials on treatments

Objetivo: Analizar y proporcionar las herramientas para contestar a las tres preguntas quedebe responder un ensayo clínico aleatorizado (ECA) sobre tratamiento: la evaluación de lavalidez de los resultados (o validez interna, que garantiza que los resultados del estudio noestán sesgados); la importancia clínica de dichos resultados y si se pueden aplicar a pacientesindividuales. Suministraremos una serie de conocimientos sencillos de estadística,diseño de investigaciones y epidemiología clínica que nos permitirán evaluar y analizar losECA de tratamiento.Método: Revisión de la literatura.Resultados: Para evaluar artículos sobre tratamiento y para utilizar eficientemente un tratamientonecesitamos saber si los resultados de los ECA que los recomiendan son fiables,si tienen importancia clínica y si se pueden aplicar dichos resultados a mis pacientes.Conclusiones: Es absolutamente fundamental comprobar que en el ensayo clínico exista unadistribución aleatoria, ya que el muestreo aleatorio es imprescindible para que se cumplanlos requisitos matemáticos de aplicación de las pruebas estadísticas. El seguimiento de lospacientes debe ser completo y debe medir la magnitud de los resultados y su precisiónpara así poder medir la eficacia del tratamiento(AU)

Purpose: To analyse and provide the tools to answer three questions that must be askedabout a clinical trial on treatments: evaluation of validity (internal validity, so that resultsare not biased); clinical importance of these results and their application to individualpatients. We provide simple statistics tools, clinical trial design, and clinical epidemiologyfor the evaluation and analysis of clinical trials on treatments.Methods: Review of the medical literature.Results: For the evaluation of papers on treatment and for using a treatment efficiently, weneed to know if the clinical trials that support it are trustworthy, if the treatment hasclinical importance and if it can be applied to my patients.Conclusions: It is of paramount importance to check that the sample of the clinical assayhas been correctly randomized, because randomization is necessary to comply withmathematical laws of application of statistical tests. Follow-up of patients must becomplete in order to measure precision of results and evaluate the efficacy of treatment(AU)