Supervivencia a largo plazo del ictus isquémico / Long-term survival of ischemic stroke

Objetivo. El ictus isquémico es una enfermedad vascular grave, cuyo pronóstico a largo plazo no conocemos en toda su dimensión. Hemos estudiado la supervivencia a largo plazo y sus factores pronósticos tras un primer episodio de ictus agudo de origen isquémico (cardioembólico y aterotrombótico). Pacientes y métodos. Estudio de cohortes retrospectivo de pacientes que han requerido ingreso por un primer episodio de ictus isquémico. El ictus se clasificó en aterotrombótico, cardioembólico, lacunar e indeterminado. Los enfermos fueron seguidos durante 10 años. Resultados. Se incluyeron 415 pacientes (varones: 60%), con una edad media de 68,4 años. La media de seguimiento fue de 66 meses (IC del 95%: 24-108 meses). La supervivencia global a los 10 años fue del 55,4% (54,9-55,9) (aterotrombótico, 57,5% vs cardioembólico, 43,7%; p=0,002). En el análisis multivariante las variables relacionadas con la mortalidad fueron la mayor edad, presencia de insuficiencia renal crónica, dislipemia, antecedentes de insuficiencia cardiaca, fibrilación auricular, presentación con hemiplejía, y los signos de isquemia aguda y de edema perilesional en el TAC realizado en el ingreso hospitalario. Se asociaron a un mejor pronóstico la afectación del territorio de la arteria cerebral media derecha y el tratamiento con estatinas. Conclusiones. La supervivencia tras un ictus isquémico a los 10 años es algo superior al 40%, y tiene mejor pronóstico el ictus aterotrombótico que el cardioembólico(AU)

Objective. Ischemic stroke is a serious vascular disease whose long term prognosis in all of its dimensions is not known. We have studied the long-term survival and its predictors after a first episode of acute ischemic stroke (atherothrombotic and cardioembolic). Patients and methods. A retrospective cohort study was made of patients with a first episode of ischemic stroke. The ictus was classified into atherothrombotic, cardioembolic, lacunar and undetermined. Patients were followed up for 10 years. Results. A total of 415 cases (60% men) with mean age of 68.4 years, were included. Mean follow-up was 66 months (95% CI: 24-108 months). Overall survival at 10 years was 55.4% (54.9-55.9) (atherothrombotic, 57.7% vs cardioembolic, 43.7%, P=.002). In the multivariate analysis, variables related to mortality in acute ischemic stroke were age, chronic renal failure, dyslipidemia, history of heart failure, atrial fibrillation (AF), presenting as hemiplegia, signs of acute ischemia and perilesional edema in the brain scan on hospital admission. Involvement of the territory of right middle cerebral artery and treatment with statins were associated to a better prognosis. Conclusions. Survival of patients after ischemic stroke at ten year is over 40%, and atherothrombotic stroke as a better prognosis than cardioembolic one(AU)

[Long-term survival of ischemic stroke]. / Supervivencia a largo plazo del ictus isquémico.

OBJECTIVE: Ischemic stroke is a serious vascular disease whose long term prognosis in all of its dimensions is not known. We have studied the long-term survival and its predictors after a first episode of acute ischemic stroke (atherothrombotic and cardioembolic). PATIENTS AND METHODS: A retrospective cohort study was made of patients with a first episode of ischemic stroke. The ictus was classified into atherothrombotic, cardioembolic, lacunar and undetermined. Patients were followed up for 10 years. RESULTS: A total of 415 cases (60% men) with mean age of 68.4 years, were included. Mean follow-up was 66 months (95% CI: 24-108 months). Overall survival at 10 years was 55.4% (54.9-55.9) (atherothrombotic, 57.7% vs cardioembolic, 43.7%, P=.002). In the multivariate analysis, variables related to mortality in acute ischemic stroke were age, chronic renal failure, dyslipidemia, history of heart failure, atrial fibrillation (AF), presenting as hemiplegia, signs of acute ischemia and perilesional edema in the brain scan on hospital admission. Involvement of the territory of right middle cerebral artery and treatment with statins were associated to a better prognosis. CONCLUSIONS: Survival of patients after ischemic stroke at ten year is over 40%, and atherothrombotic stroke as a better prognosis than cardioembolic one.

[Agranulocytosis from metamizole: a potential problem for the British population]. / Agranulocitosis por metamizol: un potencial problema en la población británica.

OBJECTIVE: Analyze the clinical and epidemiological features of this adverse effect and assess its incidence in the general population, especially in the British one. METHODS: A descriptive, retrospective analysis of all the patients discharged at Hospital Costa del Sol (Marbella) with a main diagnosis of dipyrone-related agranulocytosis in the Minimum Basic Data Set (MBDS) from January 1998 to December 2003. Neutropenia was defined as severe (neutrophils lower than 500/ml), moderate (500-1000/ml) and mild (1000-1500/ml). RESULTS: 13 patients developed dipyrone-related agranulocytosis, 8 of them foreign (61.5%) and 5 from United Kingdom. The rate of events was 8.33/106 inhabitants/year. With regard to British population registered in the area, the estimated rate of events was 20.4 cases/106 inhabitants/year. CONCLUSION: Dipyrone-related agranulocytosis is an adverse effect more frequent in British population, and its use must be avoided.

Agranulocitosis por metamizol: un potencial problema en la población británica / Agranulocytosis from metamizole: a potential problem for the British population

Material y métodos: Hemos estudiado a 90 pacientes ambulatorios con IC (61 hombres, edad 66±12) y 30 sujetos control apareados por edad y género. Resultados: Se encontró un aumento en los niveles urinarios de BNP en los pacientes con fracción de eyección (FE)≤40% comparados con los de FE>40% (p<0,0001) y con los controles (p<0,0001). Se obtuvieron correlaciones significativas entre los niveles urinarios de BNP y los parámetros funcionales del ventrículo izquierdo. Se realizó un análisis multivariado y el mejor modelo asociado con los niveles urinarios de BNP incluyó a los niveles de BNP en plasma (p<0,0001), FE (p=0,02) y volúmenes del ventrículo izquierdo (p<0,0001). La curva ROC para la detección de FE≤40% usando BNP urinario mostró un área bajo la curva de 0,74±0,05, (p<0,0001). A partir de la curva ROC, el punto óptimo de corte (2,30 pg/ml) tuvo una sensibilidad del 60% y una especificidad del 90%. Finalmente, se realizó una regresión binaria logística para la detección de FE≤40%, y los niveles urinarios de BNP mostraron un buen valor predictivo con una odds-ratio de 21. Discusión: Los niveles urinarios de BNP se correlacionan con los parámetros funcionales del ventrículo izquierdo, demostrando que este marcador biológico es útil para el diagnóstico de la disfunción ventricular izquierda en pacientes con insuficiencia cardiaca (AU)

Background: It was aimed to compare urine B-type natriuretic peptide (BNP) according to left ventricular systolic dysfunction and to investigate its diagnostic value in heart failure (HF) patients. Material and methods: A total of 90 HF outpatients (61 men, age 66±12) and 30 age- and gender-matched controls were studied. Results: An increase in urine BNP was observed in patients with EF≤ 40% compared to EF> 40% (p<0.0001), and controls (p<0.0001). Significant correlations between urinary BNP and left ventricular functional parameters were obtained. A multivariate regression analysis was performed and the best model associated with urine BNP included plasma BNP (p<0.0001), EF (p=0.02) and LV volume indexes (p<0.0001). The ROC for detection of EF≤40% using urine BNP levels showed an area under the curve of 0.74±0.05, (p<0.0001). From the ROC curve, the optimal cut-off value (2.30 ng/l) had a 60% sensitivity and 90% specificity. Finally, we performed a binary logistic regression for detection of EF≤40%, and urine BNP was shown to be a strong predictor with an odds ratio of 21. Discussion: Urine BNP levels correlated with left ventricular functional parameters. This biomarker is a useful tool for detecting and diagnosing left ventricular systolic dysfunction in heart failure (AU)

Niveles elevados de inmunoglobulina E y papulosis linfomatoide (subtipo B) como antecedentes de linfoma linfocítico B bien diferenciado / Elevated levels of IgE and lymphomatoid papulosis (subtype B) as background of well-differentiated lymphocyte B cell lymphoma

No disponible

Perforación ileal secundaria a infección por citomegalovirus / Ileal perforation secondary to cytomegalovirus infection

No disponible

[Endophthalmitis and multiple brain abscess in a patient with endocarditis due to Streptococcus agalactiae]. / Endoftalmitis y abscesos cerebrales múltiples en un paciente con endocarditis por Streptococcus agalactiae.

Endogenous endophthalmitis is a rare disease caused by hematogenic germ spread from an internal focus. Infections due to Streptococcus agalactiae are infrequent in adults although new cases had been described recently associated to inmunodepression. We present a patient with endocarditis due to Streptococcus agalactiae, endophthalmitis and multiple brain abscess. We also review the literature.

[Pattern of blood levels of erythropoietin and proinflammatory cytokines in patients with anemia of chronic disorders secondary to infection]. / Perfil de los niveles séricos de eritropoyetina y citocinas proinflamatorias en pacientes con anemia de trastornos crónicos secundaria a infección.

OBJECTIVE: To evaluate the pattern of erythropoietin (EPO) and some proinflammatory cytokines in the anemia of chronic disorders (ACD) secondary to infection. METHODS: Sequential determination in serum of interleukin-1 beta (IL-1 beta), necrosis tumoral factor alpha (TNF-alpha), gamma interferon (IFN-gamma), interleukin-6 (IL-6), and erythropoietin (EPO) in 25 patients with chronic bacterial infectious diseases and ACD criteria. We evaluated the relationship of these mediators with the anemia and the iron metabolism. RESULTS: Serum EPO levels significatively decreased compared with initial values, and the last control was in normal rank (18.04 +/- 19.10 vs. 8.56 +/- 4.72 UI/mL; p < 0.001; normal rank: 4-15 mUI/mL). In the first control, there was a negative and non significative correlation between the EPO levels and the hemoglobin concentration (r = -0.115, NS), reaching significance in the last control (r = -0.446; p < 0.05). There was negative correlation between the hematocrit and TNF-alpha levels (r = 0.467; p < 0.05) and between the haemoglobin values and the log of serum TNF-alpha (r = 0.424; p < 0.001). An inverse correlation between the IL-6 levels and both, the hemoglobin concentration and the serum iron was found, and there was a direct correlation between this cytokine values and the EPO levels. CONCLUSIONS: Blunted response of erythropoietin and the action of TNF may contribute to the pathogenesis of ACD secondary to infection. Positive correlation between IL-6 and EPO suggest a proerythropoietic action of IL-6 in response to the anemia.

Endoftalmitis y abscesos cerebrales múltiples en un paciente con endocarditis por Streptococcus agalactiae / Endophthalmitis and multiple brain abscess in a patient with endocarditis due to streptococcus agalactiae

La endoftalmitis endógena es una rara entidad asociada a diseminación bacteriana hematógena desde un foco séptico interno. Las infecciones en adultos causadas por Streptococcus agalactiae son muy infrecuentes aunque cada vez se describen más casos, sobre todo en relación a situaciones de inmunodepresión. Presentamos un caso excepcional de endocarditis por Streptococcus agalactiae que se complicó con abscesos cerebrales múltiples y endoftalmitis. Asimismo revisamos la literatura publicada al respecto. (AU)

Perfil de los niveles séricos de eritropoyetina y citocinas proinflamatorias en pacientes con anemia de trastornos crónicos secundaria a infección / Pattern of erythropoietin and proinflammatory cytokines in serum from patients with anemia of chronic disorders secondary to infection

Objetivo: Evaluar el comportamiento de la eritropoyetina (EPO) y determinadas citocinas proinflamatorias en la anemia de trastornos crónicos (ATC) de origen infeccioso. Métodos: Determinación secuencial en suero mediante enzimoinmunoanálisis de interleucina-1 beta (IL-1 ), factor de necrosis tumoral alfa (TNF- ), interferón gamma (IFN-), interleucina-6 (IL-6) y eritropoyetina (EPO) en 25 pacientes con enfermedades de origen bacteriano, curso clínico prolongado y criterios de ATC. Se analizó la relación de estos mediadores con la anemia y con el metabolismo del hierro. Resultados: Los niveles de EPO experimentaron un descenso significativo respecto al nivel inicial, normalizándose en el control tardío (18,04 ± 19,10 vs 8,56 ± 4,72 UI/mL; p < 0,001; rango normal: 4-15 mUI/mL). Inicialmente, existía correlación inversa no significativa entre los niveles de EPO y la concentración de hemoglobina (r = - 0,115, NS), alcanzándose significación estadística en el control tardío (r = -0,446; p < 0,05). Existía correlación inversa entre el hematocrito y los niveles del TNF- (r = 0,467; p < 0,05) y entre la hemoglobina y la transformación logarítmica del TNF (r = 0,424; p < 0,001). La IL-6 mostró correlación inversa con la hemoglobina (r = 0,366; p < 0,05) y con la sideremia (r = 0,614; p < 0,001), mientras que se correlacionó directamente con los niveles de la EPO (r = 0,297; p < 0,05). Conclusiones: Una deficiente respuesta de la eritropoyetina y la acción del TNF pueden implicarse en la patogenia de la ATC de origen infeccioso. La correlación positiva entre la IL-6 y la EPO sugiere una implicación proeritropoyética de la primera en respuesta a la anemia (AU)

[HIV infection in old age: an epidemiological and clinical study in 42 patients in the Community of Madrid]. / Infección por el VIH en la edad geriátrica: estudio epidemiológico y clínico en 42 pacientes de la Comunidad de Madrid.

A cross-sectional study was conducted at diagnosis of HIV infection in 42 patients aged > or = 60 years attended in two hospitals in the Madrid Community. Clinical and epidemiologic characteristics were retrospectively analyzed. Mean age was 64 years, 38 patients (90.4%) were males, and 24 (57.1%) met the AIDS criteria at diagnosis. Risk behaviour: 14 (33.3%) heterosexuals, 13 (30.9%) homosexuals, 3 (7.1%) bisexuals, 3 (7.1%) had received blood derivatives, 2 (4.7%) transfused patients, 1 (2.3%) parenteral drug abuser, 1 (2.3%) others and 5 (11.9%), unknown. In 18 (42.8%) patients there was a delay of diagnosis of 7.5 +/- 1.2 months (range: 1.5-24 months). These patients had lymphocyte counts lower than those diagnosed without delay (102 +/- 20 vs 262 +/- 67.10(9)/l, p < 0.01). Patients without AIDS criteria had a likelihood of 15.4% of progression towards AIDS at one year. The survival rate of patients with AIDS at one year was 50.1%. Patients with AIDS and diagnostic delay had a survival rate at one year lower than that in patients without diagnostic delay (30.7% vs 77.8%, p = 0.03). In summary, a predominant sexual transmission was found in our series. Delay of diagnosis entails a greater clinical and immunologic deterioration and a lower survival at one year. Early diagnosis and therapy with anti-retroviral agents might induce a longer survival in these patients.