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Medicine (Baltimore) ; 95(9): e2891, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26945378


The aim of the study was to profile those patients included in the RELESSER registry with histologically proven renal involvement in order to better understand the current state of lupus nephritis (LN) in Spain. RELESSER-TRANS is a multicenter cross-sectional registry with an analytical component. Information was collected from the medical records of patients with systemic lupus erythematosus who were followed at participating rheumatology units. A total of 359 variables including demographic data, clinical manifestations, disease activity, severity, comorbidities, LN outcome, treatments, and mortality were recorded. Only patients with a histological confirmation of LN were included. We performed a descriptive analysis, chi-square or Student's t tests according to the type of variable and its relationship with LN. Odds ratio and confidence intervals were calculated by using simple logistic regression. LN was histologically confirmed in 1092/3575 patients (30.5%). Most patients were female (85.7%), Caucasian (90.2%), and the mean age at LN diagnosis was 28.4 ±â€Š12.7 years. The risk for LN development was higher in men (M/F:47.85/30.91%, P < 0.001), in younger individuals (P < 0.001), and in Hispanics (P = 0.03). Complete response to treatment was achieved in 68.3% of patients; 10.35% developed ESRD, which required a kidney transplant in 45% of such cases. The older the patient, the greater was the likelihood of complete response (P < 0.001). Recurrences were associated with persistent lupus activity at the time of the last visit (P < 0.001) and with ESRD (P < 0.001). Thrombotic microangiopathy was a risk factor for ESRD (P = 0.04), as for the necessity of dialysis (P = 0.01) or renal transplantation (P = 0.03). LN itself was a poor prognostic risk factor of mortality (OR 2.4 [1.81-3.22], P < 0.001). Patients receiving antimalarials had a significantly lower risk of developing LN (P < 0.001) and ESRD (P < 0.001), and responded better to specific treatments for LN (P = 0.014). More than two-thirds of the patients with LN from a wide European cohort achieved a complete response to treatment. The presence of positive anti-Sm antibodies was associated with a higher frequency of LN and a decreased rate of complete response to treatment. The use of antimalarials reduced both the risk of developing renal disease and its severity, and contributed to attaining a complete renal response.

Nefrite Lúpica/epidemiologia , Sistema de Registros , Adolescente , Adulto , Feminino , Humanos , Nefrite Lúpica/terapia , Masculino , Recidiva , Estudos Retrospectivos , Reumatologia , Espanha/epidemiologia , Adulto Jovem
J Int AIDS Soc ; 17(4 Suppl 3): 19597, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25394101


INTRODUCTION: Traditional screening system focus on classic risk factors "lost" a substantial proportion of HIV-infected patients. Several organizations such as CDC or USPS Task Force favour universal screening for HIV infection for good cost-effectiveness profile. In a previous study prevalence of HIV infection in patients attending our infectious diseases department was high (5.4%). OBJECTIVE: To determine prevalence of HIV infection in patients aged 20-55 years in primary care (PC). MATERIAL AND METHODS: A propsective observational study was undertaken between February and June 2013. We performed a screening of HIV infection type "Opt-out" (offering voluntary rejection) in 4 PC centers (32 Physicians) in San Juan-Alicante. Sample size (n=318) for a prevalence of 1% and a confidence level of 97% was calculated. Nevertheless, other PC physician not recruiting patients performed HIV testing according clinical risk factors. RESULTS: HIV testing was offered to 508 patients. Mean age 38.9±10 years (58.5% female). Overall, 430 (83.8%) agreed to participate. Finally, 368 patients (71.7% of total) were tested for HIV. No patient had a positive result (100% ELISA HIV negative). However, following clinical practice, 3 patients were diagnosed of HIV in the same period by non-recruiting physicians. In 2 cases, serology was performed at the patient's request and in one case by constitutional syndrome. The 3 patients were MSM. CONCLUSIONS: 1) In our study, we detected no new cases of HIV infection through universal screening. 2) Our screened population could be lower-risk because of high percentage of women included (58.5%). 3) Performing HIV opt-in screening (clinical practice), we detected 3 cases in the same period, all having HIV risk factors (MSM). 4) These results suggest that opt-out screening should be developed in high-risk populations. It is still to be determined what is the best screening strategy in low-risk populations such as ours.

Psiquiatr. biol. (Internet) ; 20(3): 44-46, jul.-sept. 2013. tab
Artigo em Espanhol | IBECS | ID: ibc-116060


El síndrome de Sturge-Weber (SSW) es una anomalía congénita de origen desconocido caracterizada por angioma cutáneo, glaucoma congénito, calcificaciones intracraneales, crisis epilépticas, retraso intelectual y hemiparesia contralateral. Desde el punto de vista psiquiátrico el SSW se asocia típicamente a cuadros afectivos, trastornos adaptativos y alteraciones conductuales. Los síntomas psicóticos son poco frecuentes y suelen caracterizarse por la presencia de delirios de contenido paranoide. El presente artículo hace una pequeña revisión sobre las características clínicas y los criterios diagnósticos clásicos de este síndrome y presenta un caso clínico de una mujer de 48 años aquejada del SSW que muestra episodios psicóticos con delirios y alucinaciones auditivas y visuales que precisaron ingreso hospitalario. La paciente tenía una conciencia parcial de enfermedad y mejoró con el uso de un antipsicótico vía parenteral (palmitato de paliperidona). El presente caso tiene importancia clínica y puede servir para que otros profesionales sepan cómo diagnosticar y tratar dicho síndrome (AU)

Sturge-Weber syndrome (SWS) congenital anomaly of unknown origin, and is characterised by cutaneous angioma, congenital glaucoma, intracranial calcifications, epileptic seizures, intellectual retardation, and contralateral hemiparesis. From a psychiatric point of view, SWS is typically associated with affective symptoms, adaptive disorders, and behavioural changes. Psychotic symptoms are uncommon and are usually characterised by the presence of a paranoid-type delirium. This article presents a short review of the clinical characteristics and classic diagnostic criteria of this syndrome, as well as presenting a case of a 48 year-old women suffering from SWS who had psychotic episodes with delirium and auditory and visual hallucinations that required hospital admission. The patient was partially aware of the disease, and improved with the use of parenteral antipsychotics (paliperidone palmitate). The case presented is of clinical importance and may enable other professionals to know how to diagnose and treat this syndrome (AU)

Humanos , Feminino , Pessoa de Meia-Idade , Síndrome de Sturge-Weber/diagnóstico , Síndrome de Sturge-Weber/tratamento farmacológico , Síndrome de Sturge-Weber/psicologia , Delírio/complicações , Delírio/terapia , Delusões/complicações , Delusões/diagnóstico , Diagnóstico Diferencial , Comportamento Paranoide/fisiopatologia , Comportamento Paranoide/terapia , Transtornos Paranoides/complicações , Transtornos Paranoides/fisiopatologia , Transtornos Paranoides/terapia , Transtorno da Personalidade Paranoide/complicações
Int J Qual Health Care ; 22(1): 31-8, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19969551


OBJECTIVE: To evaluate the appropriateness of phacoemulsification procedures performed in four Spanish regions, applying criteria developed by means of RAND/UCLA methodology. DESIGN: Prospective observational study. SETTING: Seventeen public teaching hospitals in four regions of Spain. PARTICIPANTS: Patients on waiting list to undergo cataract extraction by phacoemulsification. INTERVENTION: Cataract surgery by phacoemulsification. MAIN OUTCOME MEASURE: Level of appropriateness of each intervention, according to criteria developed by means of the RAND/UCLA appropriateness methodology. RESULTS: Among the 5442 analysed patients the indication of phacoemulsification was appropriate in 69.6%, inappropriate in 7.3% and uncertain in 23.0%. Presence of ocular comorbidity, lack of cataract-induced visual function limitation, anticipated postoperative visual acuity of <0.5, preoperative visual acuity of >0.1 and high surgical complexity were associated with inappropriateness. CONCLUSIONS: Some clinical characteristics, when present, make it especially important to obtain a careful assessment of the risks and benefits of surgery. Consideration of these characteristics may improve the appropriateness of phacoemulsification.

Facoemulsificação/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Socioeconômicos , Espanha
Acta Otorrinolaringol Esp ; 58(4): 151-5, 2007 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-17428411


OBJECTIVE: Bithermal caloric tests are among those most commonly used in vestibular function studies and require a properly systematized approach. Irrigation sequence varies between laboratories. Our objective is to study the effect of irrigation sequence on the percentage of vestibular paresis. MATERIAL AND METHOD: We analysed 1214 records, 77.51% cold to hot sequences (C-H) and the rest hot to cold (H-C). We considered results above 24% of vestibular asymmetry to be pathological. RESULTS: In general, 33.36% of the records were pathological. Groups compared showed that H-C sequence had more significant (P <0.001) pathological results than C-H (46.52% vs 29.54%). CONCLUSION: Irrigation sequence has a significant influence on the outcome of caloric tests to for the detection of vestibular paresis. More studies are needed to confirm the best irrigation sequence.

Testes Calóricos , Paresia/diagnóstico , Paresia/fisiopatologia , Irrigação Terapêutica , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/fisiopatologia , Adulto , Idoso , Eletronistagmografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravação de Videoteipe
Acta otorrinolaringol. esp ; 58(4): 151-155, abr. 2007. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-053746


Objetivo: La prueba calórica bitérmica es una de las pruebas más utilizadas para el estudio funcional vestibular. Su realización requiere una adecuada sistematización. La secuencia de realización de las irrigaciones varía de unos centros a otros. Nuestro objetivo es analizar el efecto de las variaciones de la secuencia de irrigación en el porcentaje de paresias canaliculares (%PC). Material y método: Analizamos un total de 1.214 registros; en el 77,51 % practicamos secuencias frías-calientes (F-C) y en el resto, calientes-frías (C-F). Consideramos patológicas respuestas por encima del 24 % de asimetría entre ambos oídos. Resultados: En total, el 33,36 % de los registros resultaron patológicos. Al comparar entre secuencias, las C-F mostraban un %PC significativamente (p < 0,001) superior a las F-C (el 46,52 y el 29,54 %). Conclusiones: La secuencia de irrigación condiciona la capacidad de la prueba para detectar paresias canaliculares. Consideramos necesarios más estudios para establecer cuál es en nuestro medio el método más adecuado

Objective: Bithermal caloric tests are among those most commonly used in vestibular function studies and require a properly systematized approach. Irrigation sequence varies between laboratories. Our objective is to study the effect of irrigation sequence on the percentage of vestibular paresis. Material and method: We analysed 1214 records, 77.51 % cold to hot sequences (C-H) and the rest hot to cold (H-C). We considered results above 24 % of vestibular asymmetry to be pathological. Results: In general, 33.36 % of the records were pathological. Groups compared showed that H-C sequence had more significant (P< .001) pathological results than C-H (46.52 % vs 29.54 %). Conclusion: Irrigation sequence has a significant influence on the outcome of caloric tests to for the detection of vestibular paresis. More studies are needed to confirm the best irrigation sequence

Humanos , Adulto , Idoso , Feminino , Masculino , Doenças Vestibulares/diagnóstico , Testes de Função Vestibular/métodos , Paresia/diagnóstico , Testes Calóricos , Paresia/fisiopatologia , Doenças Vestibulares/fisiopatologia , Microscopia de Vídeo , Nistagmo Fisiológico/fisiologia
Diabetes ; 54(3): 694-701, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15734845


Pancreatic islet formation is a highly regulated process that is initiated at the end of gestation in rodents. Endocrine precursor cells first form within the epithelium of duct-like structures and then delaminate from the epithelium, migrate, and cluster during the early stages of islet formation. The molecular mechanisms that regulate endocrine cell migration and islet formation are not well understood. Cell culture studies suggest that matrix metalloproteinases (MMPs) 2 and 9 are required for islet formation. To address whether MMP2 and MMP9 function are essential for endocrine cell migration and islet formation in vivo, we analyzed pancreas development in MMP2/MMP9 double-deficient mice. Our results show that islet architecture and function are unperturbed in these knockout mice, demonstrating that both MMP2 and MMP9 functions are dispensable for islet formation and endocrine cell differentiation. Our studies also show that a number of other MMPs are expressed at the time islet formation is initiated. This observation suggests that other MMPs may substitute for MMP2 and MMP9 loss in pancreatic tissue. However, islet formation is unaffected in transgenic mice with modified tissue inhibitor of metalloproteinase-1 (TIMP1) levels, suggesting that MMP activity may contribute little to islet morphogenesis in vivo.

Ilhotas Pancreáticas/fisiologia , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Animais , Diferenciação Celular , Expressão Gênica , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 2 da Matriz/fisiologia , Metaloproteinase 9 da Matriz/genética , Metaloproteinase 9 da Matriz/fisiologia , Camundongos , Camundongos Knockout , Camundongos Transgênicos , Fatores de Tempo , Inibidor Tecidual de Metaloproteinase-1/genética , Inibidor Tecidual de Metaloproteinase-1/metabolismo