Satoyoshi's syndrome related muscle spasms: functional study.

Satoyoshi syndrome is a rare disease presumed to be immunologically mediated, characterized by muscle spasms, alopecia and diarrhea. We describe the case of a female in whom the muscle spasms were the predominant feature and we analyze the changes in cortical and in spinal excitability under the paired pulses paradigm. Hyperexcitability was present in the H-reflex study, thus suggesting that the spinal cord is the structure most likely responsible for the spasms. This is the first reported case in Spain.

[Prevalence of metabolic syndrome in the province of Albacete (Spain)]. / Prevalencia del síndrome metabólico en la provincia de Albacete.

OBJECTIVE: The primary objective of this study was to determine the prevalence of Metabolic Syndrome (MS) in people between 40-70 years of age in the province of Albacete (Spain). PATIENTS AND METHODS: A population-based, cross-sectional study was made of people between 40-70 years of age in three representative municipalities of the province of Albacete. A total of 425 subjects were included, with a mean age of 53.1 years (95% CI: 52.3-54). Women represented 50.4% of the series and males 49.6%. All participants were subjected to general laboratory testing, physical examination and the measurement of anthropometric parameters. MS was defined according to the ATP-III criteria. Prevalence of MS and its distribution according to the different epidemiological characteristics were calculated. RESULTS: Total prevalence of MS was 20.9% (88/421), with a mean age of 57 years (95% CI: 55.1-59). Prevalence was seen to increase with age, reaching up to one-third of all subjects over 60 years. Significant differences were observed in relationship to a background of ischemic heart disease, ultrasensitive C-reactive protein elevation and the detection of microalbuninuria in MS subjects. Arterial hypertension and abdominal obesity were the most prevalent criteria in MS subjects. CONCLUSIONS: Taking into consideration the important co-morbidity of MS, knowledge of the prevalence and characteristics of the syndrome in our setting and its early identification and intervention targeted to the different factors underlying MS will contribute to reduce the number of cardiovascular events associated with the syndrome.

[Vertebral osteomyelitis: description of a series of 103 cases and identification of predictive variables of the etiological group]. / Osteomielitis vertebral: descripción de una serie de 103 casos e identificación de variables predictivas del grupo etiológico.

BACKGROUND: Vertebral osteomyelitis (VO) is an infrequent disease that requires early antibiotic treatment to prevent serious disabling sequels. The aim of our study was to identify clinical variables capable to guide the initial treatment. PATIENTS AND METHODS: Our retrospective study involved 103 patients seen during a 13 years period, mostly (94%) diagnosed by magnetic resonance imaging. Patients were classified as having brucellar (50 patients), pyogenic (29 patients), tuberculous (20 patients), and other (4 patients) spondylitis. Clinical and laboratory variables entered into a multivariate analysis to identify those independently associated with each etiologic subgroup. RESULTS: Brucellar spondylitis was associated with epidemiological exposure (LR+: 14,9; LR-: 0,02), and with a blood neutrofil percentage < or = 65% (LR+: 6,6; LR-: 0,12). The presence of an underlying chronic disease (LR+: 29,5; LR-: 0,01), an erythrocyte sedimentation rate > or = 60 mm/h (LR+: 11,3; LR-: 0,07), and the absence of constitutional symptoms (LR+: 5,2; LR-: 0,18), were independent predictors of a pyogenic spondylitis. Finally, previous exposure or tuberculous disease (LR+: 11,2; LR-: 0,06), and a delay of > or = 8 weeks in first consulting (LR+: 10,6; LR-: 0,07) were associated with tuberculous spondylitis. CONCLUSION: The combination of a few clinical and laboratory variables facilitates the differential diagnosis between pyogenic, brucellar and tuberculous vertebral osteomyelitis, allowing the choice of the initial antibiotic treatment.

Prevalencia del síndrome metabólico en la provincia de Albacete / Prevalence of metabolic syndrome in the province of Albacete (Spain)

Objetivo. El objetivo principal del estudio es determinar la prevalencia del síndrome metabólico (SM) en personas entre 40 y 70 años en la provincia de Albacete. Pacientes y métodos. Se trata de un estudio transversal poblacional en personas entre 40 y 70 años en tres municipios representativos de la provincia de Albacete. La participación total del estudio fue de 425 individuos. La edad media de la muestra fue de 53,1 años (intervalo de confianza [IC] 95%: 52,3-54), con un 50,4% de mujeres y un 49,6% de hombres. A todos los participantes se les realizó una analítica general y una exploración física con medición de parámetros antropométricos. El SM se definió según los criterios del Adult Treatment Panel-III (ATP-III). En el análisis estadístico se calculó la prevalencia del SM, así como su distribución según sus características epidemiológicas. Resultados. La prevalencia total del SM fue del 20,9% (88/421), con una edad media de 57 años (IC 95%: 55,1-59). Su prevalencia aumenta con la edad, siendo de hasta un tercio de la población mayor de 60 años. Por otra parte, se han encontrado diferencias significativas con antecedentes de cardiopatía isquémica, elevación de la proteína C reactiva ultrasensible y la detección de microalbuminuria en los pacientes con SM. La hipertensión arterial y la obesidad abdominal fueron los criterios más prevalentes en los pacientes con SM. Conclusiones. Teniendo en cuenta la importante comorbilidad que este síndrome conlleva, el conocimiento de su prevalencia y sus características en nuestro medio, así como su identificación y la intervención precoz sobre los distintos factores que la componen, contribuirían a una disminución de eventos cardiovasculares que se relacionan con este síndrome

Objective. The primary objective of this study was to determine the prevalence of Metabolic Syndrome (MS) in people between 40-70 years of age in the province of Albacete (Spain). Patients and methods. A population-based, cross-sectional study was made of people between 40-70 years of age in three representative municipalities of the province of Albacete. A total of 425 subjects were included, with a mean age of 53.1 years (95% CI: 52.3-54). Women represented 50.4% of the series and males 49.6%. All participants were subjected to general laboratory testing, physical examination and the measurement of anthropometric parameters. MS was defined according to the ATP-III criteria. Prevalence of MS and its distribution according to the different epidemiological characteristics were calculated. Results. Total prevalence of MS was 20.9% (88/421), with a mean age of 57 years (95% CI: 55.1-59). Prevalence was seen to increase with age, reaching up to one-third of all subjects over 60 years. Significant differences were observed in relationship to a background of ischemic heart disease, ultrasensitive C-reactive protein elevation and the detection of microalbuninuria in MS subjects. Arterial hypertension and abdominal obesity were the most prevalent criteria in MS subjects. Conclusions. Taking into consideration the important co-morbidity of MS, knowledge of the prevalence and characteristics of the syndrome in our setting and its early identification and intervention targeted to the different factors underlying MS will contribute to reduce the number of cardiovascular events associated with the syndrome

Síndrome metabólico y enfermedad arterial periférica / Metabolic syndrome and peripheral arterial disease

No disponible

Osteomielitis vertebral: descripción de una serie de 103 casos e identificación de variables predictivas del grupo etiológico / Vertebral osteomyelitis: description of a series of 103 cases and identification of predictive variables of the etiological group

Fundamento. La osteomielitis vertebral (OV) es una patología infrecuente que requiere un tratamiento antibiótico precoz para prevenir secuelas invalidantes. El objetivo de este estudio es identificar variables clínicas que permitan orientar el tratamiento inicial. Pacientes y métodos. Estudio retrospectivo de una serie de 103 casos atendidos durante un período de 13 años diagnosticados en su mayoría (94%) mediante resonancia magnética nuclear. Se clasificaron como espondilitis brucelares (50 casos), piógenas (29 casos), tuberculosas (20 casos) y otras (4 casos). Los parámetros clínicos y de laboratorio se introdujeron en un análisis multivariante para identificar aquellos que se asociaban independientemente con cada grupo etiológico. Resultados. La espondilitis brucelar se asoció a antecedentes epidemiológicos de exposición (LR+: 14,9; LR­: 0,02), y a un porcentaje de neutrófilos en sangre ≤ 65% (LR+: 6,6; LR­: 0,12). La espondilitis piógena se asoció a la presencia de enfermedad crónica de base (LR+: 29,5; LR­: 0,01), una cifra de velocidad de sedimentación globular ≥ 60 mm/h (LR+: 11,3; LR­: 0,07) y ausencia de síntomas constitucionales (astenia, anorexia, adelgazamiento) (LR+: 5,2; LR­: 0,18). La espondilitis tuberculosa se asoció a antecedentes de tuberculosis o contacto tuberculoso (LR+: 11,2; LR­: 0,06) y a un tiempo de evolución en la primera consulta ≥ 8 semanas (LR+: 10,6; LR­: 0,07). Conclusión. La combinación de unas pocas variables clínicas y de laboratorio facilita el diagnóstico diferencial entre OV piógena, brucelar y tuberculosa, permitiendo orientar el tratamiento antibiótico inicial

Background. Vertebral osteomyelitis (VO) is an infrequent disease that requires early antibiotic treatment to prevent serious disabling sequels. The aim of our study was to identify clinical variables capable to guide the initial treatment. Patients and methods. Our retrospective study involved 103 patients seen during a 13 years period, mostly (94%) diagnosed by magnetic resonance imaging. Patients were classified as having brucellar (50 patients), pyogenic (29 patients), tuberculous (20 patients), and other (4 patients) spondylitis. Clinical and laboratory variables entered into a multivariate analysis to identify those independently associated with each etiologic subgroup. Results. Brucellar spondylitis was associated with epidemiological exposure (LR+: 14,9; LR­: 0,02), and with a blood neutrofil percentage ≤ 65% (LR+: 6,6; LR­: 0,12). The presence of an underlying chronic disease (LR+: 29,5; LR­: 0,01), an erythrocyte sedimentation rate ≥ 60 mm/h (LR+: 11,3; LR­: 0,07), and the absence of constitutional symptoms (LR+: 5,2; LR­: 0,18), were independent predictors of a pyogenic spondylitis. Finally, previous exposure or tuberculous disease (LR+: 11,2; LR­: 0,06), and a delay of ≥ 8 weeks in first consulting (LR+: 10,6; LR­: 0,07) were associated with tuberculous spondylitis. Conclusion. The combination of a few clinical and laboratory variables facilitates the differential diagnosis between pyogenic, brucelar and tuberculous vertebral osteomyelitis, allowing the choice of the initial antibiotic treatment

[Clinical trial comparing efficacy and safety of four highly active antiretroviral therapy (HAART) in antiretroviral-naive treatment with advanced HIV infection]. / Ensayo clínico comparativo de eficacia y seguridad de cuatro pautas de tratamiento antirretroviral de alta eficacia (TARGA) en pacientes naive con infección por VIH avanzada.

BACKGROUND: Comparison of efficacy and safety of four highly active antiretroviral therapy regimens (HAART) including two nucleoside analogues (NA) and a protease inhibitor (PI) in HIV positive patients with advanced infection and antiretroviral naive. PATIENTS AND METHODS: Multicenter, randomized and open labeled clinical trial in ten community hospitals of Castilla-La Mancha and Madrid. Regimen 1 contains zidovudine (AZT), lamivudine (3TC) and indinavir (IDV) regimen 2 includes AZT, 3TC and ritonavir (RTV), regimen 3 was didanosine (DDI), estavudine (D4T) and IDV, and regimen 4 included DDI, D4T and RTV. Decrease in viral load of HIV (VC) has been assessed as primary endpoint and as secondary one, the increase of the numbers of CD4 lymphocytes, percentage of disease progression, adverse reactions and adherence. Measurements were made at baseline visit and at 6, 12, 24, 36 and 48 weeks. RESULTS: A total of 98 patients with a mean baseline CD4 count of 122 x 10(6)/l (range of 5-340) and a baseline viral load of 5.1 log copies/ml were included. At 48 weeks, a mean increase of the CD4 and decrease of the viral load without significant difference between the 4 regimens (103 cells/2.62 log in regimen 1; 169 cells/2.86 log in regimen 2; 171 cells/2.56 log in regimen 3 and 141 cells/1.71 log in regimen 4) were observed in the analysis of the patients in treatment. Treatment was discontinued due to adverse reactions: 24% in regimen 1, 48% in regimen 2, 26% in regimen 3 and 32% in regimen 4, without significant difference. Analyzing by PI groups, 41% of the patients with RTV and 25% of those with IDV discontinued treatment due to adverse effects. There was withdrawal from treatment due to disease progression in 7% of the RTV patients and in 9% of IDV patients. CONCLUSIONS: In the HIV positive patients with advanced infection, efficacy between the four regimens of HAART is similar, but there is a tendency to require more withdrawal due to adverse effects in the RTV group than in those of IDV, the two used as single PI.

Ensayo clínico comparativo de eficacia y seguridad de cuatro pautas de tratamiento antirretroviral de alta eficacia (TARGA) en pacientes naive con infección por VIH avanzada / Clinical trial comparing efficacy and safety of four highly active antiretroviral therapy (HAART) in antiretroviral-naive treatment with advanced HIV infection

Introducción. Comparación de la eficacia y seguridad de cuatro pautas de terapia antirretroviral de gran actividad (TARGA) incluyendo dos análogos de nucleósidos (AN) y un inhibidor de proteasa (IP) en pacientes con el virus de la inmunodeficiencia humana (VIH) con infección avanzada y naive a antirretrovirales. Pacientes y método. Ensayo clínico, multicéntrico, randomizado y abierto en diez hospitales comunitarios de Castilla-La Mancha y Madrid. La pauta 1 contenía zidovudina (ZDV), lamivudina (3TC) e indinavir (IDV); la pauta 2 incluía ZDV, 3TC y ritonavir (RTV); la pauta 3 era didanosina (DDI), estavudina (D4T) e IDV, y la pauta 4 incluía DDI, D4T y RTV. Se ha valorado como variable principal de respuesta el descenso de la carga viral del VIH (CV), y como variables secundarias: el aumento del número de linfocitos CD4, el porcentaje de progresión de la enfermedad, las reacciones adversas y la adherencia. Las determinaciones se realizaron en la visita basal y a las 6, 12, 24, 36 y 48 semanas. Resultados. Se incluyeron 98 pacientes con una media de CD4 basal de 122 x 106/l (rango de 5-340) y una carga viral basal de 5,1 log copias/ml. A las 48 semanas, en el análisis de los pacientes en tratamiento se observó un incremento medio de los CD4 y una disminución de la carga viral sin diferencia significativa entre las 4 pautas (103 células/2,62 log en la pauta 1, 169 células/ 2,86 log en la pauta 2, 171 células/2,56 log en la pauta 3 y 141 células/1,71 log en la pauta 4). Interrumpieron el tratamiento por reacciones adversas: el 24% en la pauta 1, el 48% en la pauta 2, el 26% en la pauta 3 y el 32% en la pauta 4, sin diferencias significativas. Analizando por grupos de IP el 41% de los pacientes con RTV y el 25% de los pacientes con IDV suspendieron el tratamiento por efectos adversos. Se produjo retirada del tratamiento por progresión de la enfermedad en el 7% de los pacientes con RTV y en el 9% de los pacientes con IDV. Conclusiones. En los pacientes VIH positivos con infección avanzada la eficacia entre cuatro pautas de TARGA es similar, pero existe una tendencia a precisar mayor retirada por efectos adversos en los grupos de RTV que en los de IDV, los dos usados como IP único

Background. Comparison of efficacy and safety of four highly active antiretroviral therapy regimens (HAART) including two nucleoside analogues (NA) and a protease inhibitor (PI) in HIV positive patients with advanced infection and antiretroviral naive. Patients and methods. Multicenter, randomized and open labeled clinical trial in ten community hospitals of Castilla-La Mancha and Madrid. Regimen 1 contains zidovudine (AZT), lamivudine (3TC) and indinavir (IDV) regimen 2 includes AZT, 3TC and ritonavir (RTV), regimen 3 was didanosine (DDI), estavudine (D4T) and IDV, and regimen 4 included DDI, D4T and RTV. Decrease in viral load of HIV (VC) has been assessed as primary endpoint and as secondary one, the increase of the numbers of CD4 lymphocytes, percentage of disease progression, adverse reactions and adherence. Measurements were made at baseline visit and at 6, 12, 24, 36 and 48 weeks. Results. A total of 98 patients with a mean baseline CD4 count of 122 x 106/l (range of 5-340) and a baseline viral load of 5.1 log copies/ml were included. At 48 weeks, a mean increase of the CD4 and decrease of the viral load without significant difference between the 4 regimens (103 cells/2.62 log in regimen 1; 169 cells/2.86 log in regimen 2; 171 cells/2.56 log in regimen 3 and 141 cells/1.71 log in regimen 4) were observed in the analysis of the patients in treatment. Treatment was discontinued due to adverse reactions: 24% in regimen 1, 48% in regimen 2, 26% in regimen 3 and 32% in regimen 4, without significant difference. Analyzing by PI groups, 41% of the patients with RTV and 25% of those with IDV discontinued treatment due to adverse effects. There was withdrawal from treatment due to disease progression in 7% of the RTV patients and in 9% of IDV patients. Conclusions. In the HIV positive patients with advanced infection, efficacy between the four regimens of HAART is similar, but there is a tendency to require more withdrawal due to adverse effects in the RTV group than in those of IDV, the two used as single PI

Artritis séptica y endocarditis por Escherichia coli / Arthritis and endocarditis due to Escherichia coli

No disponible

[Pharmacological strategies in prevention of vascular injury]. / Estrategias farmacológicas en la prevención del daño vascular.

Atherosclerosis is the most prevalent disease in the industrialized world and is an important cause of morbidity-mortality. This revision analyzes the most important studies regarding prevention and treatment of this entity, whose pathophysiological base is found in injury in the endothelial wall. The present trend is aimed at combined and intensive action on the cardiovascular risk factors, giving special attention to the diabetic patients. Increasingly lower thresholds are being established for the early onset of medical and pharmacological control. In this sense, early use of a single tablet with various components (statins, aspirin, folic acid, diuretics, ACEI and beta blockers) capable of acting simultaneously on the principal factors is advised. However, more well designed prospective studies are needed to be able to conclude on action.

Estrategias farmacológicas en la prevención del daño vascular / Pharmacological strategies in prevention of vascular injury

La aterosclerosis es la enfermedad más prevalente en el mundo industrializado y es una causa importante de morbimortalidad. En esta revisión se analizan los estudios más importantes respecto a la prevención y tratamiento de esta entidad, cuya base fisiopatológica reside en el daño que se produce en la pared endotelial. La tendencia actual va dirigida a la actuación conjunta e intensiva sobre los factores de riesgo cardiovascular, con especial atención al paciente diabético, estableciéndose umbrales cada vez inferiores para el inicio temprano del control médico y farmacológico. En este sentido se aboga por el empleo precoz de una única pastilla con varios componentes (estatinas, aspirina, ácido fólico, diurético, inhibidores de la enzima de conversión de la angiotensina [IECA] y bloqueadores beta) capaz de actuar de forma simultánea sobre los principales factores. Sin embargo, se precisan más estudios prospectivos bien diseñados para poder concluir sobre modelos de actuación

Atherosclerosis is the most prevalent disease in the industrialized world and is an important cause of morbidity-mortality. This revision analyzes the most important studies regarding prevention and treatment of this entity, whose pathophysiological base is found in injury in the endothelial wall. The present trend is aimed at combined and intensive action on the cardiovascular risk factors, giving special attention to the diabetic patients. Increasingly lower thresholds are being established for the early onset of medical and pharmacological control. In this sense, early use of a single tablet with various componets (statins, aspirin, folic acid, diuretics, ACEI and beta blockers) capable of acting simultaneously on the principal factors is advised. However, more well designed prospective studies are needed to be able to conclude on action

Significado y utilidad diagnóstica de la eosinofilia en el derrame pleural / The significance and diagnostic usefulness of eosinophiliain pleural effusion

No disponible

Cuestionarios de disfunción espinal: una revisión crítica dirigida al clínico / Questionnaires of spinal dysfunction: a critical review addressed to the clinician

No disponible