Síndrome de Sjögren y fracaso renal agudo tras cirugía oral / Sjögren’s syndrome and acute renal failure following oral surgery

El síndrome de Sjögren primario es una enfermedad inflamatoria multisistémica que suele cursar con lesiones de las glándulas exocrinas originando síntomas de sequedad oral y ocular. La expresión clínica también incluye manifestaciones generales, afección extraglandular y desarrollo de linfoma. La asociación de enfermedad renales frecuente. Habitualmente, la lesión observada corresponde a nefritis túbulo-intersticial. En cambio, es rara la afectación glomerular, así como los casos de fracaso renal agudo severo. Presentamos el caso de una mujer con síndrome de Sjögren primario que desarrolla un cuadro de insuficiencia renal aguda grave por glomerulonefritis crioglobulinémica con respuesta favorablea la terapia con esteroides, ciclofosfamida, plasmaféresisy rituximab (AU)

Primary Sjögren´s syndrome is a multisystemic inflammatory disorder that mainly affects the exocrine glands and usually presents as dryness of the mouth and eyes. The wide clinical pectrum of the disease includes general symptoms, extraglandular manifestations and lymphoma. The renalinvolvement is frequent. Interstitial nephritis is the most common renal manifestation, but glomerular involvement and acute renal failure may rarely occur. We describe acase of a female patient with primary Sjögren´s syndrome complicated by severe acute renal failure due to cryoglobulinaemic glomerulonephritis. Treatment with steroids, cyclophosphamide, plasma exchange and rituxim absuccessfully lead to recovery of acute renal failure (AU)

Monitorización de las concentraciones plasmáticas de vancomicina en pacientes en hemodiálisis / Monitorins of vancomycin plasma levels in patients undergoing hemodialysis

Objetivo: El objetivo del estudio es confirmar que los pacientesen hemodiálisis y en tratamiento con vancomicina, recibiendodosis de 1 g semanal o 500 mg/48 horas, alcanzan niveles plasmáticosóptimos (10-25 mcg/ml).Método: Se incluyeron 32 pacientes sobre un total de 34 episodiosde infección. La dosis más utilizada fue la de 1 g/semana(67,6% de los episodios de infección), frente a la de 500 mg/48horas (32,4%). Las membranas más frecuentemente empleadasfueron las de baja ultrafiltración (64,7%) frente a las de alta ultrafiltración(35,3%).La administración de vancomicina se realizó en infusión de unahora, durante la última hora de la sesión de hemodiálisis y lasmuestras plasmáticas se extrajeron antes del inicio de la sesión.Las muestras fueron analizadas por inmunoanálisis de polarizaciónde fluorescencia.Resultados: Los resultados de concentración promedio parala población total no alcanzaron en ningún momento los valoresóptimos (10-25 mg/ml). En el grupo que recibió 500 mg/48horas los valores promedio óptimos no se alcanzaron en ningunade las determinaciones y en el grupo de 1 g/semanal sólo sealcanzaron dichos valores en la cuarta determinación. Los nivelesplasmáticos promedio del antibiótico están por debajo de los valoresóptimos independientemente del tipo de membrana, baja oalta ultrafiltración, empleada.Conclusiones: A la vista de los resultados recomendamosmodificar las dosis de vancomicina en este grupo de pacientes yadministrar dosis de carga 20 mg/kg durante la última hora de lasesión de hemodiálisis y posteriormente dosis de mantenimientode 7 mg/kg después de cada sesión, así como monitorizar losniveles del fármaco en este grupo de pacientes

Objective: The aim of this study was to confirm whetherpatients undergoing dialysis and treated with vancomycin 1g/week or 500 mg/48 hours reach optimum plasma levels (10-25 mcg/ml).Method: Thirty two patients were included with a total numberof 34 infectious events. The most commonly used dose was 1g/week (67.6% of infectious events), versus 500 mg/48 hours(32.4%). Low ultrafiltration membranes were used more frequently(64.7%) than high ultrafiltration membranes (35.3%).Vancomycin was infused over an one-hour period during thelast hour of the hemodialysis session and plasma samples weredrawn prior to the beginning of the session. Samples were analyzedusing fluorescent polarization immunoassays.Results: Mean concentration results for the total populationdid not reach optimum values (10-25 mg/ml). In the group receiving500 mg/48 hours, optimum mean values were not reachedin any of the determinations, whereas in the group receiving 1g/week, optimum values were reached in the fourth determination.Mean plasma levels of the antibiotic were bellow optimumvalues, regardless the type of membrane used, either low or highultrafiltration.Conclusions: Based on the above results, we recommendtitration of the vancomycin dose in this group of patients and theadministration of a loading dose of 20 mg/kg during the last hourof the hemodialysis session, followed by a maintenance dose of 7mg/kg after each session, as well as the monitoring of the druglevels in this group of patients

[Monitoring of vancomycin plasma levels in patients undergoing hemodialysis]. / Monitorización de las concentraciones plasmáticas de vancomicina en pacientes en hemodiálisis.

OBJECTIVE: The aim of this study was to confirm whether patients undergoing dialysis and treated with vancomycin 1 g/week or 500 mg/48 hours reach optimum plasma levels (10-25 mcg/ml). METHOD: Thirty two patients were included with a total number of 34 infectious events. The most commonly used dose was 1 g/week (67.6% of infectious events), versus 500 mg/48 hours (32.4%). Low ultrafiltration membranes were used more frequently (64.7%) than high ultrafiltration membranes (35.3%).Vancomycin was infused over an one-hour period during the last hour of the hemodialysis session and plasma samples were drawn prior to the beginning of the session. Samples were analyzed using fluorescent polarization immunoassays. RESULTS: Mean concentration results for the total population did not reach optimum values (10-25 mg/ml). In the group receiving 500 mg/48 hours, optimum mean values were not reached in any of the determinations, whereas in the group receiving 1 g/week, optimum values were reached in the fourth determination. Mean plasma levels of the antibiotic were below optimum values, regardless the type of membrane used, either low or high ultrafiltration. CONCLUSIONS: Based on the above results, we recommend titration of the vancomycin dose in this group of patients and the administration of a loading dose of 20 mg/kg during the last hour of the hemodialysis session, followed by a maintenance dose of 7 mg/kg after each session, as well as the monitoring of the drug levels in this group of patients.

Comparación de los criterios para el diagnóstico de diabetes gestacional / Comparison of the threshold values used to diagnose gestational diabetes mellitus

El diagnóstico de diabetes gestacional es un tema controvertido, ya que existen diferentes recomendaciones de distintas Sociedades Cientificas. En el Hospital Virgen de la Luz, se realiza un primer test de screening [O'Sullivan] que en caso de ser positivo se verifica con una curva de 100 gramos de sobrecarga oral de glucosa sobre la que se aplican los criterios propuestos por el ‘National Diabetes Data Group’ [NDDG] [3]. Se ha llevado a cabo un estudio retrospectivo de cinco años de evaluación, aplicando sobre las curvas realizadas a las embarazadas con O'Sullivan positivo en este periodo de tiempo, tanto los criterios propuestos por el ‘National Diabetes Data Group’ como los propuestos por la ‘American Diabetes Association’ [ADA] [21 estudiando en los casos discrepantes [ADA positivo y NDDG negativo] si aparecieron alteraciones propias de la diabetes gestacional. La principal conclusión que se extrae es que sería conveniente sustituir los criterios aplicados en nuestro medio por los criterios ADA (AU)

Diagnosing Gestational Diabetes [GDM] is controversial and consensus among the different scientific associations is incomplete in our Hospital, a two stage screening process is used; a positive 1h 50 g oral glucose challenge test [GCT] is followed by a diagnostic 3 h 100 g oral glucose threshold test [OGTT] using the thres hold values set by the National Diabetes Data Group [NDDG] [3]. We have performed a 5- year retrospective study With GCT positive pregnancies applying both the NDDG and the American Diabetes Association [ADA] [2] threshold values to the subsequent OGTT to determine if the patients in the discrepant subgroup, ADA positive and NDDG negative were GDM symptomatic. Our results lead us to recommend the use of the ADA threshold values to avoid misinterpreting GDM symptoms by treating the patients in the discrepant group for gestational diabetes (AU)

[Cardiovascular risk factors in schoolchildren of the city of Cuenca]. / Factores de riesgo cardiovascular en escolares de la ciudad de Cuenca.

OBJECTIVE: To calculate the levels of different cardiovascular risk factors among 9 and 10 year old schoolchildren in the city of Cuenca. DESIGN: An observational crossover study (cross-sectional). SETTING: The community: three state schools in the city of Cuenca. PARTICIPANTS: 156 boys and 151 girls doing 4th and 5th year EGB (basic). MEASUREMENTS AND MAIN RESULTS: As well as socio-demographic variables, the following anthropometric variables were determined: weight, height, body mass index (Khosla-Lowe index), systolic and diastolic blood pressure. After collecting samples of venous blood after 12 to 14 hours fasting, overall cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were determined. The average levels of the lipidic parameters measured in mgrs/dl for men and women respectively were 182.4 and 187.2 for overall cholesterol, 110.9 and 117.0 for LDL-cholesterol, 60.9 and 58.1 for HDL-cholesterol and 53.4 and 61.3 for triglycerides. These differences were statistically significant in all the parameters except overall cholesterol. Neither the pressure levels nor the anthropometric variables showed significant differences between genders. CONCLUSIONS: The lipid levels found in our study for both for male and female schoolchildren display the highest cardiovascular risk levels yet observed in Spain. The blood pressure levels are also among the highest published in our country.