Hemorragia digestiva e insuficiencia cardiaca como forma de presentación de mieloma múltiple

AL cardiac amyloidosis is caused by extracellular deposition of immunoglobulin light chains in the heart. It is a multisystemic disease that can affect multiple organs, and around 10% of the cases are associated with multiple myeloma. The presence of AL amyloidosis is an independent factor of poor prognosis, not only for symptomatic multiple myeloma but also for latent multiple myeloma. We present below an unusual case of IgA-lambda multiple myeloma that manifested with recurrent gastrointestinal bleeding and heart failure.La amiloidosis cardiaca AL está causada por el depósito extracelular de cadenas ligeras de inmunoglobulinas en el corazón. Se trata de una enfermedad multisistémica que puede afectar a múltiples órganos y alrededor del 10% de los casos se asocia a mieloma múltiple. La presencia de amiloidosis AL es un factor independiente de mal pronóstico, no solo para el mieloma múltiple sintomático sino también para el mieloma múltiple latente. A continuación, presentamos un caso inusual de mieloma múltiple IgA-lambda que debutó con hemorragias digestivas de repetición e insuficiencia cardiaca

Hepatitis B seroprevalence in 10-25-year-olds in Mexico - the 2012 national health and nutrition survey (ENSANUT) results

Objectives: To estimate hepatitis B virus (HBV) seroprevalence from natural infection or vaccination in 10–25-year-olds in Mexico, using the 2012 National Health and Nutrition Survey (ENSANUT). Methods: Randomly selected serum samples (1,581) from adolescents and young adults, representative of 38,924,584 Mexicans, were analyzed to detect hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs) and hepatitis B core antibody (anti-HBc). Weighted HBV seroprevalence in the Mexican population and association with sociodemographic variables were calculated. Results: Overall weighted seroprevalence from natural infection (positive for anti-HBs and anti-HBc) was 0.23% (95% confidence interval [95% CI] 0.10–0.52). No HBsAg was detected, indicating no acute or chronic infection. Vaccine-derived immunity (positive ≥ 10.0 mIU/ml for anti-HBs and negative to anti-HBc) was 44.7% (95% CI: 40.2–49.4) overall; lower in persons aged 20–25 years (40.83%) than in persons aged 10–19 years (47.7%). Among the population analyzed, 54.2% (95% CI: 49.6–58.8) were seronegative to HBV (negative for all three markers) and no sociodemographic risk factors were identified. Conclusions: HBV seroprevalence from natural infection was low. Vaccination-induced immunity was higher among Mexican adolescents than young adults, possibly due to vaccination policies since 1999