Interstitial disease associated with connective tissue disease and vasculitis.

Systemic autoimmune diseases comprise a complex, heterogeneous group of entities. Noteworthy among the pulmonary complications of these entities is interstitial involvement, which manifests with the same radiopathologic patterns as in idiopathic interstitial pneumonia. High-resolution computed tomography is the gold-standard imaging technique; it enables us to identify and classify the disease and to determine its extent, providing useful information about the prognosis. In this group of processes, the most common pattern of presentation is nonspecific interstitial pneumonia. It is essential for radiologists to work together in collaboration with other specialists to reach the correct diagnosis and enable appropriate, integrated treatment.

Secuestro pulmonar en varón joven con episodio de hemoptisis / Pulmonary sequestration in a young man with hemoptisis episode

Se describe el caso de un paciente de 37 años, que a raíz de un episodio de hemoptisis diagnosticamos un secuestro pulmonar, malformación congénita infrecuente del pulmón, diagnosticada principalmente durante los primeros años de vida. Habitualmente cursa de manera asintomática, pudiendo debutar de manera puntual en forma de hemoptisis en la edad adulta (AU)

We describe a case of a 37-year-old patient who, as a result of an episode of hemoptisis, we find out a lung malformation, a rare cause of adult hemoptisis. Pulmonary sequestration is a rare congenital malformation of the lung, diagnosed mainly during the early years of life and childhood, which usually takes place asymptomatically, but which can start on time in the form of hemoptisis in adulthood (AU)

Nuevas guías diagnósticas en la FPI. Visión del radiólogo / No disponible

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Síndrome de Tolosa-Hunt con remisión espontánea y recurrencia / Tolosa-Hunt syndrome with spontaneous remission and recurrence

No disponible

Association between -174G/C and -572G/C interleukin 6 gene polymorphisms and severe radiographic damage to the hands of Mexican patients with rheumatoid arthritis: a preliminary report.

Several interleukin 6 gene (IL6) polymorphisms are implicated in susceptibility to rheumatoid arthritis (RA). It has not yet been established with certainty if these polymorphisms are associated with the severe radiographic damage observed in some RA patients, particularly those with the development of joint bone ankylosis (JBA). The objective of the present study was to evaluate the association between severe radiographic damage in hands and the -174G/C and -572G/C IL6 polymorphisms in Mexican Mestizo people with RA. Mestizo adults with RA and long disease duration (>5 years) were classified into two groups according to the radiographic damage in their hands: a) severe radiographic damage (JBA and/or joint bone subluxations) and b) mild or moderate radiographic damage. We compared the differences in genotype and allele frequencies of -174G/C and -572G/C IL6 polymorphisms (genotyped using polymerase chain reaction-restriction fragment length polymorphism) between these two groups. Our findings indicated that the -174G/C polymorphism of IL6 is associated with severe joint radiographic damage [maximum likelihood odds ratios (MLE_OR): 8.03; 95%CI 1.22-187.06; P = 0.03], whereas the -572G/C polymorphism of IL6 exhibited no such association (MLE_OR: 1.5; 95%CI 0.52-4.5; P = 0.44). Higher anti-cyclic citrullinated peptide antibody levels were associated with more severe joint radiographic damage (P = 0.04). We conclude that there is a relevant association between the -174G/C IL6 polymorphism and severe radiographic damage. Future studies in other populations are required to confirm our findings.

The -174G/C Interleukin-6 Gene Promoter Polymorphism as a Genetic Marker of Differences in Therapeutic Response to Methotrexate and Leflunomide in Rheumatoid Arthritis.

Objective. To evaluate the association of -174G/C IL-6 polymorphism with failure in therapeutic response to methotrexate (MTX) or leflunomide (LEF). This prospective, observational cohort included 96 Mexican-Mestizo patients with moderate or severe rheumatoid arthritis (RA), initiating MTX or LEF, genotyped for IL-6 -174G/C polymorphism by PCR-RFLP. Therapeutic response was strictly defined: only if patients achieved remission or low disease activity (DAS-28 < 3.2). Results. Patients with MTX or LEF had significant decrement in DAS-28 (p < 0.001); nevertheless, only 14% and 12.5% achieved DAS-28 < 3.2 at 3 and 6 months. After 6 months with any of these drugs the -174G/G genotype carriers (56%) had higher risk of therapeutic failure compared with GC (RR: 1.19, 95% CI: 1.07-1.56). By analyzing each drug separately, after 6 months with LEF, GG genotype confers higher risk of therapeutic failure than GC (RR = 1.56; 95% CI = 1.05-2.3; p = 0.003), or CC (RR = 1.83; 95% CI = 1.07-3.14; p = 0.001). This risk was also observed in the dominant model (RR = 1.33; 95% CI = 1.03-1.72; p = 0.02). Instead, in patients receiving MTX no genotype was predictor of therapeutic failure. We concluded that IL-6 -174G/G genotype confers higher risk of failure in therapeutic response to LEF in Mexicans and if confirmed in other populations this can be used as promissory genetic marker to differentiate risk of therapeutic failure to LEF.

Association between bone turnover markers, clinical variables, spinal syndesmophytes and bone mineral density in Mexican patients with ankylosing spondylitis.

OBJECTIVES: To compare bone turnover marker (BTM) levels and bone mineral density (BMD) between patients with ankylosing spondylitis (AS) and healthy controls (HC) and to evaluate, in AS, the association between BTM levels and clinical variables, spinal syndesmophytes, and BMD using multivariate analysis. METHOD: Seventy-eight AS patients were compared with 58 HC matched by gender. Spinal syndesmophytes in AS and other characteristics were assessed. C-terminal telopeptide fragments of type I collagen (CTX), bone-specific alkaline phosphatase (BAP), osteocalcin (OC) serum levels, and BMD of the lumbar spine, femoral neck, and forearm were evaluated. RESULTS: AS males and females had lower BAP levels than their respective HC (p < 0.001 and p = 0.001). AS patients with bridging syndesmophytes had higher OC levels than AS patients either with non-bridging syndesmophytes (p = 0.001) or without spinal syndesmophytes (p < 0.001). OC and CTX levels correlated significantly with the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). In the multivariate linear regression adjusted by age, gender, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BMD in the lumbar spine, and C-reactive protein (CRP), we observed an association between BAP levels and anti-tumour necrosis factor (anti-TNF) use (p = 0.05) whereas OC levels were associated with mSASSS (p < 0.001) and anti-TNF use (p = 0.05), and CTX levels were exclusively associated with mSASSS (p = 0.03). In the logistic regression analysis, only OC levels were associated with the presence of syndesmophytes in AS [odds ratio (OR) 2.42, 95% confidence interval (CI) 1.19-5.75]. CONCLUSIONS: We observed an increase in OC levels in AS patients with syndesmophytes. BTM levels were associated with the severity of spinal damage. Future longitudinal studies should evaluate whether these BTMs should be included as tools to determine the prognosis and progression of spinal damage.

Antioxidant and haematological biomarkers in different groups of horses supplemented with polyunsaturated oil and vitamin E.

Oxidative stress has been correlated with pathologies that impair the performance of athlete horses. The aim of this study was to assess the effects of supplementation with a mixture of polyunsaturated oil and vitamin E on the antioxidant and haematological biomarkers of horses. Horses under maintenance care (n = 6) and horses in training (n = 10) received 100 and 300 ml of the oil mixture respectively. Supplementation was provided for a period of 8 weeks, together with isocaloric inclusion. Blood samples were collected at three time periods (pretest, after 4 weeks and after 8 weeks) to analyse the following: the red blood cell count (RBCc); haemoglobin (Hb); haematocrit (HT); leucocytes; lymphocytes; platelets; the mean corpuscular volume (MCV); the mean corpuscular haemoglobin concentration (MCHC); the standard deviation of the red blood cell distribution width (RDW-SD); the coefficient of variation of the red blood cell distribution width (RDW-CV); glutathione peroxidase (GPx); superoxide dismutase (SOD); uric acid (UrAc); total plasma proteins (TPP); and creatine kinase (CK). After the 8 weeks of supplementation, animals under maintenance care exhibited significant increases in SOD, UrAc, the white blood cell count (WBCc), the RDW-SD and the RDW-CV (p < 0.05). The animals in training exhibited increases in GPx, SOD and UrAc (p < 0.05). In conclusion, supplementation with polyunsaturated oil and vitamin E increases blood antioxidants among animals under maintenance and in training, with different trends, while contributing to the fight against oxidative stress in each group analysed.

Niño receptor de trasplante de progenitores hematopoyéticos con evolución complicada / Complicated evolution in a child with trasplantation of hematopoietic progenitors

Los pacientes oncológicos suponen un número importante de ingresos en UCIP, especialmente las neoplasias hematológicas, por su incidencia aumentada de fallo multiorgánico y necesidad de técnicas de soporte agresivo como la ventilación mecánica invasiva, la depuración extrarrenal y otras. La limitación del esfuerzo terapéutico cuando se producen situaciones de extrema gravedad siempre ha sido una posibilidad a considerar. El pronóstico en los últimos años se ha modificado, con un aumento de la supervivencia. Entre las complicaciones más frecuentes que sufren estos pacientes están las pulmonares, las cuales presentan mejor evolución debido a los avances en ventilación mecánica, como el uso de la ventilación no invasiva. El síndrome de obstrucción sinusoidal hepática es otra de las complicaciones más frecuentes. El caso que presentamos sirve para ilustrar que, a pesar de ser un reto en el manejo dentro de las UCIPs y presentar todavía una alta mortalidad, parece adecuado utilizar todos los tratamientos de soporte disponibles, individualizando cada caso según las circunstancias particulares

Cancer patients constitute a significant number of hospital admissions at the PICU, especially, hematopoietic malignancies for their increased incidence of organ failure and aggressive support techniques such as VMI and renal replacement therapy among others. Therapeutic withdrawal is always a possibility to consider in cases of special severity. In recent years, the prognosis has been improved, with increased survival. Pulmonary complications are usual on these patients. They have a better evolution thanks to the advances in mechanical ventilation, as the use of non-invasive ventilation. Sinusoidal hepatic obstruction syndrom is another usual complication. The present case illustrates that despite being a challenge the management of these patients in the PICU with a high mortality, it seems appropriate to use all available support treatments, on a case by case approach according to the particular circumstances

Trait anxiety mimics age-related cardiovascular autonomic modulation in young adults.

Anxiety produces maladaptive cardiovascular changes and accelerates biological aging. We evaluated cardiovascular reactivity in young and middle-aged individuals with varying anxiety scores to test the hypothesis that anxiety mimics cardiovascular aging by influencing cardiovascular autonomic modulation. The State-Trait Anxiety Inventory was used to classify healthy young individuals (20-29 years) into high (YHA, n=22;10 men) and low (YLA, n=21;10 men) anxiety, and to identify middle-aged individuals (50-60 years) with low anxiety (MLA, n=22;11 men). Heart rate, blood pressure (BP) and their variability (HRV and BPV, respectively) and baroreflex function were analyzed from beat-to-beat finger BP and electrocardiogram recordings collected during 5-min baseline, 6-min speech task (ST) and 3-min post ST recovery. Analyses of covariance showed significant differences (P<0.05) at baseline for HRV, BPV and barorelfex, and low-frequency power of systolic BP variability (LFSBP) was lower, whereas baroreflex and high frequency (HF) normalized units were higher in the YLA compared with YHA and MLA groups. Compared with YLA, YHA and MLA displayed attenuated vagal withdraw response (HF) to ST. BP and LFSBP responses to ST in YHA and MLA were higher compared with the YLA group. These findings suggest that anxiety could be linked to cardiovascular aging as it attenuates cardiac reactivity and exaggerates vascular responses to stress.

Experiencia de las Unidades de Trasplante en las comunidades ámbito de la Sociedad de Pediatría de Asturias, Cantabria y Castilla y León / Experience of the Transplant Units in the Pediatric Society in within the communities of Asturias, Cantabria and Castilla y León

Introducción: Durante las últimas dos décadas el trasplante de progenitores hematopoyéticos (TPH) se ha consolidado como un tratamiento de primera línea para diversas enfermedades congénitas y adquiridas de la infancia. Los avances en el campo y la experiencia acumulada en el manejo de las complicaciones del TPH han reducido la mortalidad y mejorado la calidad de vida de los supervivientes. El 10% de los pacientes trasplantados en España son niños. Objetivos: Analizar la experiencia de TPH pediátrico de las tres unidades de trasplante existentes en las Comunidades Autónomas pertenecientes a la Sociedad de Pediatría de Asturias, Cantabria y Castilla y León (SCCALP). Pacientes y métodos: Estudio retrospectivo de los trasplantes realizados en pacientes pediátricos (≤ 18 años de edad) en el Hospital Central de Asturias, Marqués de Valdecilla y Clínico de Salamanca, analizando especialmente los resultados de la última década. Resultados: Las tres unidades de TPH pediátrico de la SCCALP realizan todos los tipos de trasplante. La media de TPH por año y unidad en los últimos 10 años fue de 5. La indicación más frecuente de TPH fue una enfermedad maligna. Una proporción significativa de pacientes con enfermedades congénitas recibieron un TPH alogénico. La supervivencia global de los pacientes trasplantados fue del 55-65%. Conclusiones: Las indicaciones y resultados del TPH pediátrico en los centros de la SCCALP son comparables a los de otros centros de nuestro entorno. La colaboración entre los servicios de hematología y pediatría hace posible el funcionamiento de unidades mixtas de trasplante

Introduction: Hematopoietic stem cell transplantation (HSCT) has become a first line curative procedure in children and adolescents with a variety of malignant and non malignant life-threatening conditions. The enormous progress achieved in the field and the accumulated experience in the management of the complications related to the procedure in children have significantly reduced its mortality and improved the quality of life of the surviving patients. In Spain, up to 10% of the patients transplanted are children. Objective: To analyze the activity and results of pediatric HSCT in the centers of the Pediatric Society of Asturias, Cantabria and Castilla-León (SCCALP). Methods and patients: A retrospective analysis of the medical records of pediatric patients (aged ≤ 18 years) undergoing HSCT during the last 10 years at the HSCT Units of Salamanca, Oviedo and Santander. Results. HSCT centers of the SCCALP are allowed to perform all types of hematopoietic transplantation in children. A median of 5 procedures per year were performed at each unit over the last 10 years. The most common indication for a HSCT was a malignant disease while a significant proportion of patients with an inherited condition underwent an allogeneic transplantation. Overall survival for all patients was 55 to 65%. Conclusions: Indications and results of pediatric HSCT performed at the SCCALP centers are comparable to current practices. The procedure is safely performed in mixed (adult and pediatric) HSCT units when collaboration between the Hematologist and the Pediatrician is warranted

The -174G/C and -572G/C interleukin 6 promoter gene polymorphisms in mexican patients with rheumatoid arthritis: a case-control study.

OBJECTIVE: There is a lack of information about the genotype frequencies of IL-6 -174G/C and -572G/C polymorphisms in Mexicans with rheumatoid arthritis (RA). Therefore, the aim of this study was to evaluate the association of the IL-6 -174G/C and -572G/C polymorphisms in Mexican mestizo with RA. METHODS: We included 137 patients with RA and 102 healthy controls. Patients were assessed for clinical characteristics. IL-6 -174G/C and -572G/C polymorphisms were genotyped using PCR-RFLP analysis. Allele and genotype frequencies and the Hardy-Weinberg equilibrium were computed. Odds ratios (ORs) were computed to identify the risk for RA associated with the presence of GG genotype in comparison with the GC or CC genotypes. RESULTS: The genotype -174GG occurred at a higher frequency in cases and controls (77.4% versus 78.4%, P = 0.845). We found similar results for the genotype -572GG (54% in patients versus 60.8% in controls, P = 0.295). CONCLUSIONS: This is the first study to evaluate the association of -174G/C and -572G/C polymorphisms of the IL-6 gene with RA in Mexican mestizo patients. These two polymorphisms were not associated with RA in the studied sample. Additional studies are required to evaluate if these IL-6 polymorphisms have relevance to the development of more severe disease.

Prescription for antiresorptive therapy in Mexican patients with rheumatoid arthritis: is it time to reevaluate the strategies for osteoporosis prevention?

Glucocorticoids are frequently used in rheumatoid arthritis (RA) in order to alleviate symptoms of joint inflammation, retard erosions and to treat extra-articular manifestations, although these drugs may increase the risk of bone mineral loss and osteoporotic fractures. To date, in Mexico there are no studies that identify the frequency of patients with RA with corticosteroids, receiving therapy for osteoporosis. Therefore, we evaluated the prevalence and factors related to the prescription of antiresorptives in 520 Mexican patients with RA. We used a multivariate model to identify variables associated with antiresorptives prescription. We identified that although 79% of patients were under treatment with glucocorticoids, only 13% received antiresorptive agents as preventive therapy for osteoporosis. The multivariate analysis identified that higher proportions of antiresorptive drugs prescriptions were associated with female patients (OR 11.40, 95% CI: 1.5-84.3, P = 0.02), an age of 40 years or more (OR 3.22, 95% CI: 1.3-8.3, P = 0.02) and to consume a lower number of cointerventions with other drugs (OR 1.09, 95% CI: 1.0-1.2, P = 0.03). Corticosteroid treatment was not associated with the prescription of antiresorptives (P = 0.31). In conclusion, a low proportion of Mexicans with RA receive antiresorptive therapy independently regardless of whether they consume or not chronically corticosteroids. Additional strategies should be evaluated to encourage the prevention and early treatment for osteoporosis in patients with RA.

The ACTN3 R577X polymorphism is associated with inflammatory myopathies in a Mexican population.

BACKGROUND: The ACTN3 gene encodes the fast muscle protein α-actinin-3. The ACTN3 R577X polymorphism is a premature stop codon and results in absence of α-actinin-3 in 577XX homozygotes. The aim of this study was to determine the ACTN3 genotype in idiopathic inflammatory myopathies (IIMs). METHODS: We performed ACTN3 genotyping on 27 patients with dermatomyositis (DM), 10 with polymyositis (PM), and 85 healthy subjects. Muscle enzyme levels of creatine phosphokinase (CPK), lactic dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were recorded at the time of diagnosis and recruitment. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and the allele frequency was analysed. RESULTS: A total of 36% of healthy subjects had the ACTN3 577XX polymorphism (α-actinin-3 deficiency), 18% had the 577RR (homozygous wild type) genotype, and 46% 577RX (heterozygous). In DM/PM, 70% had the ACTN3 577XX polymorphism, 6% RR, and 24% RX [odds ratio (OR) 4.12, 95% confidence interval (CI) 1.67-10.33, p < 0.001]. In healthy subjects, the R allele was present in 41% and the X allele in 59% compared to 18% and 82%, respectively, in the IIM group (OR 3.21, 95% CI 1.57-6.66, p < 0.001). Thus, the ACTN3 577X allele seemed to increase the risk of developing IIM, and DM in particular, although this was not related to severity of expression of the phenotype. CONCLUSIONS: The ACTN3 577X allele appeared to increase the risk of developing IIM; 70% of IIM patients were deficient in α-actinin-3. By contrast, ACTN3 577XX patients seemed to have less severe disease as reflected in lower muscle enzyme levels.

Migraine-triggered hemifacial spasm: three new cases.

BACKGROUND: The occurrence of hemifacial spasm (HFS) during an episode of migraine has been seldom reported. Here we describe three new cases presenting with HFS in association with migraine attacks. CASE RESULTS: Three patients (one woman and two men, aged 31-36 years) developed HFS in close temporal relationship with migraine headaches. All of them started having the muscle spasms after pain onset. Two of them had electromyographic evidence of facial nerve damage, and continued having HFS once the pain abated. CONCLUSIONS: Migraine attacks may be associated with HFS. The appearance of HFS could be related to migraine activity. A mechanism of central hyperexcitability in connection with nociceptive inputs on the trigeminal nucleus caudalis and/or a dilation of vessels compressing the facial nerve at the root exit zone could lead to the development of HFS in predisposed patients. 'Migraine-triggered hemifacial spasm' could possibly be regarded as a complication of migraine.

Superflow in a toroidal Bose-Einstein condensate: an atom circuit with a tunable weak link.

We have created a long-lived (≈40 s) persistent current in a toroidal Bose-Einstein condensate held in an all-optical trap. A repulsive optical barrier across one side of the torus creates a tunable weak link in the condensate circuit, which can affect the current around the loop. Superflow stops abruptly at a barrier strength such that the local flow velocity at the barrier exceeds a critical velocity. The measured critical velocity is consistent with dissipation due to the creation of vortex-antivortex pairs. This system is the first realization of an elementary closed-loop atom circuit.

Caso de tórax presentado en la Sesión General de Lectura de Casos del XXX Uongreso Nacional de la SERAM, A Coruña. Mayo 2010 / No disponible

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Prevalencia de meningitis neumocócica en la provinciade Salamanca / Prevalence of pneumococcal meningitis in the province of Salamanca

La incidencia de meningitis neumocócica de forma globalha disminuido tras la introducción de la vacuna heptavalente.Sin embargo, los casos producidos por serotipos novacunales probablemente han aumentado.Objetivo: Estimar la prevalencia de meningitis neumocócicaen nuestra provincia y su evolución en los últimosaños.Material y métodos: Estudio prospectivo de las meningitisneumocócicas ingresadas en el Hospital Universitariode Salamanca en los años 2003 a 2008.Resultados: Se registraron 5 casos de meningitis, estimandouna prevalencia anual de 6/100.000 niños menoresde 5 años. Los serotipos aislados fueron el 7F en 3 ocasionesy el 19A en una. Comparando la prevalencia en los 3 primerosaños del estudio con el segundo trienio, ésta se incrementóen un 32%.Conclusiones: En la actualidad, las meningitis neumocócicasen nuestro medio están producidas por serotiposno vacunales, en especial el 7F y 19A. En los últimos añoshemos asistido a un aumento en la incidencia de las mismas (AU)

Pneumococcal meningitis, globally have decreased sinceheptavalent conjugate vaccine was introduced. However,cases due to nonvaccine serotypes have increased.Object: To know the prevalence of pneumococcal meningitisin our province and the evolution during last years.Methods: Prospective study of pneumococcal meningitisadmitted in the University Hospital of Salamanca during2003 to 2008.Results: Five cases of meningitis were recorded. Annualprevalence was estimated at 6 per 100.000 children < 5 years.Serotypes isolated were 7F in three patients and one 19A.Prevalence rate during first 3 years compared to last 3 yearsrised up to 32%.Conclusions: Nowdays, pneumococcal meningitis in ourprovince are due to nonvaccine serotypes, especially to 7F and19A. During last years incidence rates of these was increased (AU)