Nodulosis reumatoideos en una paciente adulta con factor reumatoide negativo / Rheumatoid Nodulosis in an Adult Patient Negative for Rheumatoid Factor

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Optimization of a novel method for the organic chemical characterization of atmospheric aerosols based on microwave-assisted extraction combined with stir bar sorptive extraction.

A practical analytical methodology based on coupling microwave-assisted extraction-stir bar sorptive extraction-thermal desorption-gas chromatography-mass spectrometry (MAE-SBSE-TD-GC-MS) was developed and validated for the characterization of several SVOC in atmospheric particulate matter (PM). The high enrichment capacity of SBSE makes it a powerful tool for improving detection limits and MAE has been useful for overcoming the long extraction times and high volumes of extraction solvent used in traditional methodologies. Relative to Soxhlet extraction followed by GC-MS analysis (EPA Methods 3540 and 8270C), the MAE-SBSE-TD-GC-MS methodology resulted with approximately 10(4) times better detection limits. Detection limits ranged from 0.3 to 8.3 pg m(-3) for pp'-DDD and decachlorobyphenyl, respectively in PM2.5, 24 m3 air sample. The performance of the optimized methodology gave good precisions, with R.S.D. less than 30% for most of the standards, and linearity within the range tested of 0.1-15 microg L(-1). Analysis of real PM samples resulted in the identification of compounds in the ng L(-1) range.

Glucación no enzimática de la antitrombina. Implicaciones en el riesgo trombótico de pacientes con diabetes mellitus / Non-enzymatic antithrombin glycation. Association with atherothrombotic risk in diabetic patients

Introducción/objetivos. La glucación no enzimática incorpora azúcares a los residuos lisina y arginina de proteínas, lo que puede alterar su función. La glucación de la antitrombina, un potente anticoagulante natural, podría asociarse con el riesgo trombótico observado en situaciones de hiperglucemia, como la diabetes mellitus. Nuestro objetivo fue estudiar el efecto de la glucación de la antitrombina y determinar si es relevante en las complicaciones trombóticas de la diabetes mellitus. Métodos. 1. Glucación no enzimática in vitro de antitrombina plasmática y purificada con metilglioxal y glucosa. 2. Se analizó el efecto de diferentes compuestos sobre la glucación no enzimática de la antitrombina in vitro. 3. Estudio de 101 pacientes diabéticos. En todas las muestras se analizaron los valores antigénicos, la actividad anti-FXa, las características conformacionales y la afinidad a la heparina de la antitrombina. Resultados. La glucación no enzimática in vitro de la antitrombina con metilglioxal o glucosa no ocasiona modificaciones conformacionales significativas en la molécula, pero induce su transformación a una forma con baja afinidad por la heparina, que explica la pérdida significativa de su actividad (valor < 40% del basal). Este efecto se previene con heparina, aminoguanidina y catequina. Los pacientes diabéticos muestran menores valores antigénicos y funcionales de antitrombina (80%) que los sujetos controles, pero esta disminución no se correlaciona con la glucemia ni con los valores de hemoglobina glucosilada. Conclusiones. La glucación de residuos lisina y arginina localizados en el sitio de unión a la heparina de la antitrombina reduce significativamente su actividad anticoagulante, aunque puede ser protegida por la heparina, la aminoguanidina y la catequina. Sin embargo, la relevancia de la glucación de la antitrombina en pacientes diabéticos es apenas perceptible debido a la lenta acción glucante de la glucosa, y a la reducida vida media de la antitrombina (AU)

Introduction/Aims. Non-enzymatic glycation of proteins can impair their function by incorporating sugars into their lysine and arginine residues. Glycation of antithrombin, a powerful anticoagulant, might be associated with the thrombotic risk observed in hyperglycemic conditions such as diabetes mellitus. Our aim was to study the effects of antithrombin glycation and determine its significance in the thrombotic complications observed in diabetes. Methods. 1) In vitro study of non-enzymatic glycation of purified and plasma antithrombin by their incubation with methylglyoxal and glucose. 2) The effect of different compounds on the in vitro glycation of antithrombin was analyzed. 3) We studied 101 diabetic patients. Antigen levels, anti-FXa activity, conformational features and antithrombin affinity to heparin were determined. Results. In vitro non-enzymatic glycation of antithrombin with methylglyoxal or glucose caused no significant conformational change in the molecule, but induced the transformation to a low heparin-affinity form, which explains the significant loss of activity observed (< 40% of basal). This effect was prevented by heparin, aminoguanidine and catechin. Diabetic patients presented lower antigenic and antithrombin functional levels (80%) than controls. However, no correlation between activity or antigen levels of antithrombin and glycemia or glycosylated hemoglobin was found in diabetic patients. Conclusions. In vitro glycation of lysine and arginine residues located in the heparin-binding site of antithrombin significantly reduces its anticoagulant activity. Interestingly, heparin, aminoguanidine and catechin prevented this effect. However, the non-enzymatic glycation of antithrombin in diabetic patients seems to be mild, since the action of glucose is very slow and the half life of antithrombin in plasma is short (AU)

Efecto de atorvastatina sobre los valores de fibrinógeno en pacientes con diabetes mellitus tipo y 2 dislipemia / Effect of atorvastatin on plasma fibrinogen levels in patients with type 2 diabetes mellitus and dyslipidemia

Introducción La diabetes mellitus tipo 2 se asocia con un aumento de riesgo de enfermedad cardiovascular. Estudios prospectivos indican que valores elevados de fibrinógeno se relacionan con mayor riesgo de episodios cardiovasculares. Por este motivo, se ha examinado el efecto del tratamiento de la hiperlipemia con atorvastatina sobre el valor del fibrinógeno en pacientes con diabetes mellitus tipo 2. Pacientes y métodos Se ha evaluado el fibrinógeno basal y tras 6 meses de tratamiento con 20 mg al día de atorvastatina en 45 pacientes con diabetes mellitus tipo 2 no fumadores con hiperlipemia. Se obtuvieron datos clínicos y analíticos. Resultados Los valores de fibrinógeno disminuyeron significativamente tras tratamiento con atorvastatina (media = ­0,60 g/l; p < 0,001). Se observa una correlación entre los valores basales de fibrinógeno y microalbuminuria (r = 0,349; p < 0,05). La reducción del fibrinógeno se correlacionó de forma significativa con los valores basales de fibrinógeno (r = 0,407; p < 0,05) y la hemoglobina glucosilada basal (r = 0,369; p < 0,05) pero no se relacionó con la disminución del colesterol ligado a lipoproteínas de baja densidad (cLDL). Conclusión Hemos comprobado una disminución de las concentraciones plasmáticas de fibrinógeno en diabéticos tipo 2 con dislipemia tras tratamiento con atorvastatina, que es independiente de la reducción del cLDL. Effect of atorvastatin on plasma fibrinogen levels in patients with type 2 diabetes mellitus and dyslipidemia (AU)

Introduction Type 2 diabetes mellitus is associated with an augmented risk for cardiovascular disease. Prospective studies indicate that fibrinogen levels are associated with an increased risk for cardiovascular events. Therefore, we tested the effect of atorvastatin on fibrinogen levels in patients with type 2 diabetes mellitus. Patients and methods Fibrinogen was evaluated at baseline and after 6 months of therapy with 20 mg atorvastatin daily in 45 non-smoking patients with type 2 diabetes mellitus and hyperlipidemia. Clinical and biochemical data were obtained. Results Fibrinogen levels were significantly decreased after treatment with atorvastatin compared with baseline (mean change: ­0.60 g/L; p < 0.001). A correlation between baseline fibrinogen levels and microalbuminuria was found (r = 0.349; p < 0.05). Fibrinogen reduction was significantly correlated with baseline fibrinogen levels (r = 0.407, p < 0.05) and baseline glycosylated hemoglobin values (r = 0.369, p < 0.05). Conversely, no significant correlation was found between fibrinogen reduction and change in low-density lipoprotein (LDL)-cholesterol. Conclusion Plasma fibrinogen levels decreased in patients with type 2 diabetes and hyperlipidemia treated with atorvastatin. This decrease was largely independent of LDL-cholesterol reduction (AU)

[Impact of a clinical pathway for the diabetic foot in a general hospital]. / Impacto de una vía clínica para el pie diabético en un hospital general.

OBJECTIVE: The ulcers, infections and isquemia of the foot are the main causes of hospitalisation of the diabetic patient and, very frequently, they are reason for the amputation of the limb. The objective of this investigation consists of evaluating the results of a multidisciplinary clinical pathway designed by the set of specialists of different departments from our hospital, as well as of the associated personnel of infirmary, implied in the management of this pathology. PATIENTS AND METHODS: We have analysed the evolution of a series of clinical and socio-economic indicators comparing, in the patients admitted with diagnose of complicated diabetic foot, the previous period to the implantation of the clinical pathway years 1998, 1999 and 2000) with the later period to this implantation (years 2001 and 2002). It is evaluated in each group: the percentage of greater and smaller amputations, mortality, the average stay, the percentage of readmitances in 30 days, the percentage of arteriographies, the percentage of patients controlled by rehabilitation, and the economic cost of the individual processes, as well as the global cost. In the group including in the clinical pathway it was carried out, in addition, a satisfaction survey. The statistical comparison was made by means of the Chi square test. RESULTS: We did not find differences as far as the average stay, nor to intrahospitable mortality. If we found a clear increase in the percentage of arteriographies (of the 3.5% passage to 13%), and in the percentage of patients controlled by rehabilitation (of the 19.8% passage to the 84.3%). The rate of greater amputations of the patients not including in the clinical pathway change from 17.4% to 9.7% after the implantation of this route. The rate of readmitances to 30 days diminished from 9.3 to 6,5%. The global economic cost and the average cost by patient have been inferior after the implantation of the clinical route. The survey of satisfaction of this last group offered a global satisfaction of 95%. CONCLUSIONS: The results suggest that the approach to the diagnose and treatment on the complicated diabetic foot by means of this multidisciplinary clinical pathway improves the evolution of the hospitalised patient, diminishing the number of greater amputations, without extending the average stay and maintaining, or even diminishing, the global economic cost.

Impacto de una vía clínica para el pie diabético en un hospital general / Impact of a clinical pathway for the diabetic foot in a general hospital

Objetivo: Las úlceras, infecciones y la isquemia del pie son las principales causas de hospitalización del paciente diabético y con mucha frecuencia el motivo de la amputación del miembro inferior. El objetivo de esta investigación consiste en evaluar los resultados de una vía clínica multidisciplinaria diseñada por el conjunto de especialistas de distintos departamentos de nuestro hospital, así como del personal de enfermería asociado, implicados en el tratamiento de esta patología. Pacientes y métodos: Hemos analizado la evolución de una serie de indicadores clínicos y socioeconómicos comparando, en los pacientes ingresados con el diagnóstico de pie diabético complicado, el periodo previo a la implantación de la vía clínica (años 1998, 1999 y 2000) con el periodo posterior a dicha implantación (años 2001 y 2002). Se evalúa en cada grupo: el porcentaje de amputaciones mayores y menores realizadas, la mortalidad intrahospitalaria, la estancia media, el porcentaje de reingresos en 30 días, el porcentaje de arteriografías realizadas, el porcentaje de pacientes controlados por rehabilitación, y el coste económico de los procesos individuales, así como el costo global. En el grupo incluido en la vía clínica se llevó a cabo además una encuesta de satisfacción. La comparación estadística se realizó mediante la Chi cuadrado. Resultados: No encontramos diferencias ni en la estancia media, ni en la mortalidad intrahospitalaria. Si encontramos un claro aumento en el porcentaje de arteriografías (del 3,5 por ciento se paso al 13 por ciento) y en el porcentaje de pacientes controlados por rehabilitación (del 19,8 por ciento se paso al 84,3 por ciento).La tasa de amputaciones mayores de los pacientes no incluidos en la vía clínica paso de 17,4 por ciento a 9,7 por ciento tras la implantación de dicha vía. La tasa de reingresos a 30 días disminuyó de 9,3 a 6,5 por ciento. El coste económico global y el coste medio por paciente ha sido inferior tras la implantación de la vía clínica. La encuesta de satisfacción de este último grupo ofreció una satisfacción global del 95 por ciento. Conclusiones: Los resultados obtenidos sugieren que la aproximación al diagnóstico y tratamiento al pie diabético complicado mediante esta vía clínica multidisciplinaria mejora la evolución del paciente hospitalizado, disminuyendo el número de amputaciones mayores, sin prolongarse la estancia media y manteniendo, o incluso disminuyendo, el coste económico global (AU)

Drug-related Henoch-Schönlein Purpura.

We report the case of a patient with Henoch-Schönlein Purpura related to a treatment with cefuroxime and diclofenac who presented important systemic manifestations including a glomerulonephritis with IgA mesangial deposits. Skin testing with beta lactam antibiotics and diclofenac were negative in immediate and late reaction as well as RAST test to penicillins G and V. No cautious administration of drugs was done because of the illness severity. Although a reaction to diclofenac could not be excluded we thought that the more probably implicated drug was cefuroxime because the patient referred a purpuric rash after the intake of cephradine for a mastitis, ten years ago.

Anatomical and functional cardiac abnormalities in type I diabetes.

To analyse the anatomy and systolic and diastolic cardiac function in a group of type I diabetics with no other abnormality and to correlate it with the duration of the disease, the presence of complications, the control of the diabetes and the abnormalities in the autonomous nervous system, 125 type I diabetics and 50 age- and sex-matched healthy controls were studied. In 112 diabetics, an echocardiographic image which enabled us to calculate the thickness, cavity dimensions and systolic function rates was obtained. A Doppler echocardiograph was done in all patients to measure 9 parameters of diastolic function. The autonomic nervous system was evaluated by the response to 4 cardiovascular reflexes. Two control groups and 4 study groups were established, based on duration and on the presence and number of microangiopathic complications. The results showed a significant increase in the septal and posterior wall thickness, although without differences between the study groups. There were no differences in the analysis of systolic function. The abnormalities in diastolic function were significant in all the groups, but greater in the groups with microangiopathy. Overall, for groups 1-4, respectively, the incidence of anatomical abnormalities was 9.6%, 17%, 28% and 57% (average 22%); systolic 0%, 0%, 4% and 4.7% (average 2.2%); and diastolic 15%, 21%, 60% and 80% (average 44%). Only 13 diabetics from group 4 presented with cardiac autonomic neuropathy. No correlation between these alterations and the glycaemic control or the duration of the disease was found, although there was a correlation between the presence or absence of complications and the anatomic and diastolic abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiac anatomical and functional changes in a group of young type I diabetics with microangiopathy]. / Alteraciones anatómicas y funcionales cardíacas en un grupo de jóvenes diabéticos tipo I con microangiopatía.

BACKGROUND: There are conflicting data concerning the alteration of cardiac function in diabetics without another type of accompanying pathology. Therefore this study was designed with the aim to analyze the anatomical and functional changes and relate them with the time and control of diabetes. METHODS: Fifty-four type I diabetics with a mean age of 33.5 years and 25 healthy controls paired by age and sex were studied. The patients were rigourously selected excluding any disease or treatment other than insulin and the presence of demonstrated microangiopathy was required. M-mode and bidimensional echocardiographic studies were carried out in 46 patients to calculate thickness, cavity dimension and systolic function rates. Doppler-echo studies analyzing 9 parameters of diastolic function were performed in all the 54 patients studied. RESULTS: The results obtained demonstrated significant differences in the thickness of the posterior wall and the septum in the diabetics in comparison with the normal subjects. No differences were observed in the parameters of systolic function with the diastolic parameters being significant. Considered globally 41% of the patients demonstrated structural alterations, 4% systolic and 70% diastolic. The only significant correlation was established between the diastolic alteration and the time of evolution of the diabetes. The autonomic alteration which some patients presented did not vary the results obtained. CONCLUSIONS: In this group of selected diabetic structural and cardiac diastolic alterations appeared being attributed only to the diabetes itself in relation to the length of time of the same and possibly to the microangiopathy.

[The cardiac anatomical and functional changes in a group of young type-1 diabetics without microangiopathy]. / Alteraciones anatómicas y functionales cardíacas en un grupo de jóvenes diabéticos tipo I sin microangiopatía.

We study 71 type I diabetics and 25 controls, trying to analyze the anatomical and functional changes due to diabetes. The diabetics, with a mean age of 18.4 +/- 8.2 years, were strictly selected excluding any disease and treatment besides insulin. In 66, and echocardiographic M mode and 2D study was done to calculate wall thickness, cavity dimensions and systolic function indexes; in all, Eco-Doppler analyzing 9 diastolic function indexes. The results showed an increase in septal thickness in diabetics (p less than 0.01 in diastole and less than 0.001 in systole). There was no difference in systolic function or posterior wall thickness, having the diabetics a significant increase of the T 1/2 (p less than 0.001), a decrease of the deceleration of E and the ratio E/A (p less than 0.001). As a group, 12.5% of the diabetics had anatomical abnormalities, and 18.3% diastolic abnormalities at least in two indexes. The only significant correlation was established between the evolution time and the T 1/2 (p less than 0.01). We conclude that in this group of selected diabetics, the anatomical and functional abnormalities found were only imputable to the diabetic abnormality.