High-Risk Obesity Phenotypes: Target for Multimorbidity Prevention at the ROFEMI Study.

Background: Describe the profile of patients with obesity in internal medicine to determine the role of adiposity and related inflammation on the metabolic risk profile and, identify various "high-risk obesity" phenotypes by means of a cluster analysis. This study aimed to identify different profiles of patients with high-risk obesity based on a cluster analysis. Methods: Cross-sectional, multicenter project that included outpatients attended to in internal medicine. A total of 536 patients were studied. The mean age was 62 years, 51% were women. Patients were recruited from internal medicine departments over two weeks in November and December 2021 and classified into four risk groups according to body mass index (BMI) and waist circumference (WC). High-risk obesity was defined as BMI > 35 Kg/m2 or BMI 30−34.9 Kg/m2 and a high WC (>102 cm for men and >88 cm for women). Hierarchical and partitioning clustering approaches were performed to identify profiles. Results: A total of 462 (86%) subjects were classified into the high-risk obesity group. After excluding 19 patients missing critical data, two profiles emerged: cluster 1 (n = 396) and cluster 2 (n = 47). Compared to cluster 1, cluster 2 had a worse profile, characterized by older age (77 ± 16 vs. 61 ± 21 years, p < 0.01), a Charlson Comorbidity Index > 3 (53% vs. 5%, p < 0.001), depression (36% vs. 19%, p = 0.008), severe disability (64% vs. 3%, p < 0.001), and a sarcopenia score ≥ 4 (79% vs. 16%, p < 0.01). In addition, cluster 2 had greater inflammation than cluster 1 (hsCRP: 5.8 ± 4.1 vs. 2.1 ± 4.5 mg/dL, p = 0.008). Conclusions: Two profiles of subjects with high-risk obesity were identified. Based on that, older subjects with obesity require measures that target sarcopenia, disability, psychological health, and significant comorbidities to prevent further health deterioration. Longitudinal studies should be performed to identify potential risk factors of subjects who progress from cluster 1 to cluster 2.

Linfoma no Hodgkin T como complicación infrecuente de la micosis fungoide tumoral / T-cell non-Hodgkin lymphoma as a rare mycosis fungoide complication

No disponible

Síndrome de Ortner y disfagia por aurícula izquierda gigante en el paciente anciano / Dysphagia and Ortner syndrome due to a giant left atrium in the elderly

No disponible

Pancreatitis aguda severa y precoz por liraglutide / Liraglutide-induced severe early acute pancreatitis

Los agonistas GLP-1 presentan como efectos secundarios más frecuentes las náuseas y vómitos que son de carácter leves y moderados, siendo transitorios y dosis dependiente sin necesidad de suspender el fármaco en la mayoría de casos. Estos efectos ocurren más frecuentemente con exenatide y raramente con liraglutide, sin conocer un caso clínico de tal severidad y sobre todo precocidad. Se describe una mujer de 55 años caucasiana con diabetes mellitus tipo 2 de larga evolución asociadas que presentó cuadro de dolor abdominal, náuseas, vómitos incoercibles e hiperlipasemia de aparición súbita tras la primera dosis de titulación de liraglutide, completando solo 2 dosis en 48 horas, consultando en urgencias donde se apreció fracaso renal agudo y descompensación hiperosmolar que requirió su ingreso en unidad de cuidados intensivos. Al emplear la escala de probabilidad de reacción a fármaco de Naranjo obtenemos dicha reacción como probable, sin encontrar otras alternativas justificables clinicamente.

The most frequent side effects seen with GLP-1 agonists are mild and moderate nausea and vomiting, which are typically transient and dose-dependent, in most cases not requiring discontinuation of the drug. These effects occur most frequently with exenatide, and rarely with liraglutide; no clinical cases with such a severity -and especially with such an early occurrence- had been previously reported. The case herein described is that of a 55-year-old Caucasian female with a long-standing Type 2 diabetes mellitus, who presented with sudden abdominal pain, nausea, relentless vomiting an increased lipase serum levels after the first dosage of liraglutide, after completing only 2 dosages in 48 hours. The patient was seen at the emergency room, where she was diagnosed acute renal failure and hyperosmolar decompensation that required admission at the intensive care unit. According to Naranjo’s odds scale, the reaction was considered to be likely related to the drug; no other alternatives were considered to be clinically justified.

Endemic fungal infections in inflammatory bowel disease associated with anti-TNF antibody therapy.

Patients with inflammatory bowel disease are susceptible to complications from pharmacologic treatment of their disease. Tumor necrosis factor (TNF)-α inhibitors are being used increasingly in the treatment of inflammatory bowel disease and can be associated with adverse events, including common infections, and rarely the development of serious life-threatening opportunistic infections. TNF-α inhibitors have the ability to prevent an effective patient granulomatous response, and this may be associated with an increased risk of developing mycobacterial and certain fungal infections, including histoplasmosis, blastomycosis, and coccidioidomycosis, endemic in several parts of the United States. The concern for invasive fungal infection was realized during clinical trials and further demonstrated after the marketing of TNF-α inhibitors. Because of this awareness, the Food and Drug Administration developed an adverse event-reporting system to capture cases of infections associated with the use of TNF-α inhibitors. These opportunistic fungi have a great degree of regional variability, and it has been very difficult to quantify the incidence of infection in patients treated with TNF-α inhibitors. Currently, there are no formal guidelines regarding the use of TNF-α inhibitors and these fungal infections. Considering that gastroenterologists have embraced the use TNF-α inhibitors as a valuable armamentarium in the treatment of inflammatory bowel disease, they must be aware of therapy-related infectious complications, including appropriate diagnostic, therapeutic, and preventive strategies. In this article, we explore the association of these fungal entities in relation to the TNF-α inhibitor therapy by considering information provided in the gastroenterology, infectious diseases, rheumatology, and transplant literature. Finally, we provide some recommendations on diagnosis and treatment.

Pancreatitis aguda asociada a angioedema hereditario / Acute pancreatitis associated with hereditary angioedema

El angioedema hereditario (AH) es un proceso infrecuente, de carácter recurrente, potencialmente mortal, originado por el déficit o disfunción de factor C1 inhibidor. El dolor abdominal secundario a edema intestinal es relativamente frecuente en pacientes con AH pero tras una revisión de la literatura solo se han informado seis casos de pancreatitis aguda asociado a angioedema hereditario (AU)

Hereditary angioedema (HAE) is an infrequent, recurrent, and potentially lethal disorder caused by a deficiency of C1 inhibitor or its activity. Abdominal pain secondary to bowel edema is common in these patients. However, a thorough literature search yielded only six previously reported cases of pancreatitis associated with this entity (AU)

[Acute pancreatitis associated with hereditary angioedema]. / Pancreatitis aguda asociada a angioedema hereditario.

Hereditary angioedema (HAE) is an infrequent, recurrent, and potentially lethal disorder caused by a deficiency of C(1) inhibitor or its activity. Abdominal pain secondary to bowel edema is common in these patients. However, a thorough literature search yielded only six previously reported cases of pancreatitis associated with this entity.

Linfoma de tipo B difuso de células grandes primario rectal que simula un adenocarcinoma de recto / Primary diffuse large B-cell lymphoma of the rectum simulating a rectal adenocarcinoma

El linfoma colorrectal es una entidad extremadamente infrecuente, representando menos del 0,5% del total de las neoplasias colorrectales primarias. La localización colorrectal supone el 15–20% del total de los linfomas gastrointestinales, tras el estómago y el intestino delgado. Debido a la inespecificidad de los síntomas, la enfermedad suele estar avanzada en el momento del diagnóstico. Primordial interés tienen los criterios de Dawson para diferenciar la afectación colorrectal primaria de la afectación del tracto gastrointestinal secundaria a un linfoma sistémico, dadas sus diferentes connotaciones pronósticas y terapéuticas. Presentamos el caso de un linfoma no hodgkiniano tipo B de localización rectal, de difícil diagnóstico, tratado con esquema poliquimioterapéutico con ciclofosfamida, adriamicina, vincristina, prednisona y rituximab, cuya evolución fue desfavorable (AU)

Colorectal lymphoma is an extremely infrequent entity, representing less than 0.5% of all primary colorectal neoplasms. Colorectal localization accounts for 15–20% of all gastrointestinal lymphomas, after the stomach and small intestine. Because the symptoms are non-specific, this disease is usually diagnosed in the advanced stages. Dawson's criteria are highly useful in the differential diagnosis between primary colorectal involvement and gastrointestinal tract involvement secondary to systemic lymphoma, which is important due to the distinct prognosis and treatment of these entities. We report the case of a B-cell non-Hodgkin's lymphoma that was difficult to diagnose and was treated with R-CHOP polychemotherapy. Outcome was poor (AU)

[Primary diffuse large B-cell lymphoma of the rectum simulating a rectal adenocarcinoma]. / Linfoma de tipo B difuso de células grandes primario rectal que simula un adenocarcinoma de recto.

Colorectal lymphoma is an extremely infrequent entity, representing less than 0.5% of all primary colorectal neoplasms. Colorectal localization accounts for 15-20% of all gastrointestinal lymphomas, after the stomach and small intestine. Because the symptoms are non-specific, this disease is usually diagnosed in the advanced stages. Dawson's criteria are highly useful in the differential diagnosis between primary colorectal involvement and gastrointestinal tract involvement secondary to systemic lymphoma, which is important due to the distinct prognosis and treatment of these entities. We report the case of a B-cell non-Hodgkin's lymphoma that was difficult to diagnose and was treated with R-CHOP polychemotherapy. Outcome was poor.

Microbiology and outcome of iliopsoas abscess in 124 patients.

To describe the microbiology and outcome of iliopsoas abscess (IPA) in a large case series, we analyzed 124 cases of IPA collected from 1990 through 2004 in 11 hospitals in Spain. Twenty-seven (21.8%) patients had primary and 97 (78.2%) had secondary IPA. The main sources of infection were bone (50.5%), gastrointestinal tract (24.7%), and urinary tract (17.5%). A definitive microbial diagnosis was achieved in 93 (75%) cases. Abscess culture was the most frequent procedure leading to microbial diagnosis, followed by blood cultures. Staphylococcus aureus, Escherichia coli, and Bacteroides species were the most frequent microbial causes: S. aureus was the most common organism in patients with primary abscesses (42.9%) and with abscesses of skeletal origin (35.2%), whereas E. coli was the leading organism in those with abscesses of urinary (61.5%) and gastrointestinal (42.1%) tracts. Mycobacterium tuberculosis was found in 15 patients, 4 of them associated with human immunodeficiency virus (HIV) infection. Twenty (21.5%) cases had polymicrobial infections; these were more common among patients with abscesses of gastrointestinal origin. Information on clinical outcome was available for 120 patients; 19 (15.8%) had a relapse and 6 (5%) died due to complications related to the IPA. Patients who died were older and more likely to have bacteremia and E. coli isolated from cultures. In conclusion, secondary IPA is more prevalent than primary IPA. Among those with secondary IPA, most abscesses are secondary to a skeletal source. A bacterial etiology can be identified in most cases. The overall prognosis of patients with this condition is good.