Prepatellar bursitis: a rare manifestation of chronic brucellosis

Introduction: Bursitis is a rare complication of brucellosis that has only once been described in a country where disease has been eradicated in domestic animals. Case Presentation: A 63-year-old diabetic man presented with an 11-year history of painless swelling over his right knee. Magnetic resonance imaging (MRI) showed a large, multiloculated cyst overlying the knee joint. The patient underwent bursectomy which revealed caseous necrosis. Operative samples cultured Brucella abortus. The patient was treated with a combination of surgery and antimicrobials (doxycycline, rifampicin and gentamicin). His only risk factor for acquiring Brucella was drinking unpasteurized milk during childhood. Fifty eight cases of Brucella bursitis have been described in the English-language medical literature. Half have involved the prepatellar bursa. Only one case, from Australia, occurred in a country that has eradicated brucellosis in domestic animals. Although symptoms are often prolonged, local features of inflammation are usually absent. Diagnosis is primarily by bursal fluid culture. Treatment involves antimicrobials with or without aspiration or excision of the bursa. As the diagnosis was unexpected, several laboratory workers were exposed to the Brucella isolate before its identification. Follow up according to UK guidelines revealed no cases of occupationally acquired infection. Conclusion: Bursitis is an unusual manifestation of brucellosis. It is extremely rare outside countries where the infection is endemic, but the chronicity of symptoms and increase in global travel mean that patients with the condition may present in non-endemic settings. Clinicians should therefore consider the diagnosis in cases of unexplained chronic bursitis

Taxonomy and hierarchy of psychological abuse strategies in intimate partner relationships

This study focuses on the analysis from of a psychosocial perspective of the components of psychological abuse in intimate partner relationships. Following a review of studies on the subject, the main objective that emerged was the need for a new taxonomy of strategies of psychological abuse accompanied by the corresponding operational definitions. After the proposal of this new classification, a second objective emerged that consisted of submitting it for evaluation by a group of experts through a Delphi study, in which thirty-two experts from the academic and professional worlds participated. These experts were asked to assess the suitability of the system categories, and to grade quantitatively the severity of the impact made by each of the strategies on the global phenomenon of psychological abuse in couples. The results show that the experts ratified the new classification of strategies and their operational definitions, thus endorsing their content and construct validity. In addition, they classified the strategies based on their degree of severity; those of an emotional nature were considered the severest, followed by those related to the immediate context, with those of a cognitive type in third place, and lastly, the behavioural ones. Finally, we discuss the results, and their implications. Este estudio se centra en analizar los componentes del abuso psicológico en la violencia de pareja adulta y contra la mujer desde un enfoque psicosocial. Tras realizar una revisión de los estudios sobre el tema, se plantea como primer objetivo el proponer una nueva taxonomía de estrategias de abuso psicológico, acompañadas de sus respectivas definiciones operativas. A partir de esta nueva clasificación, se traza un segundo objetivo que se centra en someter esta clasificación al juicio de un grupo de expertos a través de un estudio Delphi, en el que han participado 32 expertos de los ámbitos académico - universitario y profesional. Estos expertos debían juzgar la adecuación del sistema de categorías, además de evaluar cuantitativamente la severidad que aporta cada una de las estrategias al fenómeno global del abuso psicológico en la pareja. Los resultados muestran que los expertos ratifican la nueva clasificación de estrategias y sus definiciones operativas, avalando así su validez de contenido y constructo. Además, jerarquizaron las estrategias de abuso, atribuyendo mayor severidad a las de tipo emocional, seguidas de las relacionadas con el contexto cercano, de las de tipo cognitivo y las de carácter conductual. Se discuten los resultados, sus limitaciones y las implicaciones que pueden derivarse de ellos

Prevalence of osteoporosis, estimation of probability of fracture and bone metabolism study in patients with newly diagnosed prostate cancer in the health area of Lugo

Este trabajo ha sido parcialmente presentado como póster con defensa en el 34.o Congreso de la Sociedad Española de Medicina Familiar y Comunitaria (semFYC).[Resumen] Objetivo. Estudiar la prevalencia de osteoporosis y probabilidad de fractura en pacientes diagnosticados de cáncer de próstata. Diseño. Estudio observacional, descriptivo y transversal. Emplazamiento. Estudio realizado desde atención primaria del área sanitaria de Lugo en colaboración con los servicios de Reumatología y Urología de nuestro hospital de referencia. Participantes. Pacientes diagnosticados de cáncer de próstata sin enfermedad metastásica ósea, desde enero a diciembre del año 2012. Mediciones principales. Se recogieron variables epidemiológicas, clínicas, analíticas y densitométricas implicadas en la osteoporosis. Se estimó la probabilidad de fractura mediante la herramienta FRAX®. Resultados. Ochenta y tres pacientes cumplieron los criterios de inclusión. Ninguno fue excluido. La edad media fue de 67 años. El índice de masa corporal fue de 28,28. Veinticinco pacientes (30,1%) presentaban fracturas osteoporóticas previas. Otros factores de riesgo prevalentes fueron el alcohol (26,5%) y el tabaco (22,9%). Ochenta y dos sujetos presentaban valores de vitamina D por debajo de lo normal (98,80%). La densitometría de cuello femoral mostró que el 8,9% presentaron osteoporosis y el 54% osteopenia. La media del riesgo de fractura en esta población, estimado con la herramienta FRAX®, fue del 2,63% para fractura de cuello femoral y del 5,28% para fractura principal. Utilizando los puntos de corte para el riesgo de fractura propuestos por Azagra et al., 24 pacientes (28,92%) tuvieron un valor de FRAX® para fractura principal sin DXA de más del 5%, y 8 sujetos (9,64%), ≥ 7,5%. Conclusiones. La prevalencia de osteoporosis en esta población fue muy elevada. Los factores de riesgo asociados a osteoporosis más frecuentes fueron: fractura osteoporótica previa, consumo de alcohol, hábito tabáquico y antecedente familiar de fractura previa. La probabilidad de fractura mediante la herramienta FRAX® de cuello femoral fue baja. La hipovitaminosis D fue muy frecuente (98,8%).[Abstract] Objective. To study the prevalence of osteoporosis and fracture probability in patients diagnosed with prostate cancer. Design. Observational descriptive transversal study. Site. Study performed from Primary Care of Lugo in collaboration with Rheumatology and Urology Services of our referral hospital. Participants. Patients diagnosed with prostate cancer without bone metastatic disease from January to December 2012. Main measurements. Epidemiologic, clinical, laboratory and densitometric variables involved in osteoporosis were collected. The likelihood of fracture was estimated by FRAX® Tool. Results. Eighty-three patients met the inclusion criteria. None was excluded. The average age was 67 years. The Body Mass Index was 28.28. Twenty-five patients (30.1%) had previous osteoporotic fractures. Other prevalent risk factors were alcohol (26.5%) and smoking (22.9%). Eighty-two subjects had vitamin D below normal level (98.80%). Femoral Neck densitometry showed that 8.9% had osteoporosis and 54% osteopenia. The average fracture risk in this population, estimated by FRAX®, was 2.63% for hip fracture and 5.28% for major fracture. Cut level for FRAX® major fracture value without DXA > 5% and ≥ 7.5% proposed by Azagra et al. showed 24 patients (28.92%) and 8 patients (9.64%) respectively. Conclusions. The prevalence of osteoporosis in this population was very high. The more frequent risk factors associated with osteoporosis were: previous osteoporotic fracture, alcohol consumption, smoking and family history of previous fracture. The probability of fracture using femoral neck FRAX® tool was low. Vitamin D deficiency was very common (98.8%)

Relapses in patients with Henoch-Schönlein purpura: Analysis of 417 patients from a single center

To further investigate into the relapses of Henoch?Schönlein purpura (HSP), we analyzed the frequency, clinical features, and predictors of relapses in series of 417 unselected patients from a single center. After a median follow-up of 12 (interquartile range [IQR]: 2?38) years, almost one-third of the 417 patients (n=133; 32%; 85men/48 women) had experienced at least 1 relapse. At the time of disease diagnosis, patients who later experienced relapses had less commonly infections than those who never suffered flares (30.8% vs 41.9%; P=0.03). In contrast, patients who experienced relapses had a longer duration of the first episode of palpable purpura than those without relapses (palpable purpura lasting >7 days; 80.0% vs 68.1%; P=0.04). Abdominal pain (72.3% vs 62.3%; P=0.03) and joint manifestations (27.8% vs 15.5%; P=0.005) were also more common in patients who later developed relapses. In contrast, patients who never suffered relapses had a slightly higher frequency of fever at the time of disease diagnosis (9.3% vs 3.8%; P=0.06). At the time of disease diagnosis, corticosteroids were more frequently given to patients who later had relapses of the disease (44% vs 32% in nonrelapsing patients; P=0.03). Relapses generally occurred soon after the first episode of vasculitis. The median time from the diagnosis of HSP to the first relapse was 1 (IQR: 1?2) month. The median number of relapses was 1 (IQR 1?3). The main clinical features at the time of the relapse were cutaneous (88.7%), gastrointestinal (27.1%), renal (24.8%), and joint (16.5%) manifestations. After a mean±standard deviation follow-up of 18.9±9.8 years, complete recovery was observed in 110 (82.7%) of the 133 patients who had relapses. Renal sequelae (persistent renal involvement) was found in 11 (8.3%) of the patients with relapses. The best predictive factors for relapse were joint and gastrointestinal manifestations at HSP diagnosis (odds ratio [OR]: 2.22; 95% confidence interval [CI]: 1.34?3.69, and OR: 1.60; 95% CI: 1.01?2.53, respectively). In contrast, a history of previous infection was a protective factor for relapses (OR: 0.60; 95% CI: 0.38?0.94). In conclusion, joint and gastrointestinal manifestations at the time of diagnosis of HSP are predictors of relapses

Development and validation of the scale of psychological abuse in intimate partner violence (EAPA-P)

Background: In the context of intimate partner violence, psychological abuse (PA) has progressively gained scientific relevance. Even so, a greater effort is needed to define and evaluate psychological intimate partner abuse. A new exhaustive and operative taxonomy of PA strategies leads to the contribution of a new evaluation instrument. Method: Participants were 101 women between 24 and 82 years old, who were abused by their partners and attended to in different municipal Catalan services, specialized in the topic. Results: The analyses have shown the suitability of a 19-item instrument divided into two factors: (1) direct PA strategies and (2) indirect PA strategies. The former includes strategies that affect the emotional, cognitive and behavioral dimension of the victim. The latter includes items that measure the amount of control and domination over the victim’s context. This scale has adequate psychometric properties in terms of score reliability and the validity of the relationship with other women’s health variables. Conclusions: The EAPA-P, created based on a new definition and taxonomy of the forms of PA, is presented as a valid instrument to detect and measure intimate partner PA

Cutaneous vasculitis in children: A nationwide epidemiological study in Spain [version 1; referees: 1 approved]

Background: Cutaneous vasculitis (CV) are a complex group of conditions in children, of which IgA vasculitis (IgAV) is the most common. The objectives of the current study are to describe the incidence of CV in Spain and to analyze the temporal trend in the last 11 years, as well as it seasonal distribution. Methods: Hospital discharges of patients aged 0-18 years with a diagnosis consistent with CV in Spain from 2005 to 2015 were collected from the Spanish National Institute of Statistics (INE) databases. Results: A total of 7304 patients from January 2005 to December 2015 were included; 6991 patients (95%) had a diagnosis of IgAV. The yearly incidence in the whole group was 7.7 per 100,000. Mean age at diagnoses was 6±3 years and 52% were male. The highest rate of admissions was found in the 5-9 year-old group, followed by those with 0-4 years of age (15.7 and 9.0 admissions per 100.000, respectively). Admissions due to CV followed an annual cyclic pattern, with the highest number of daily admissions during fall and winter months and the lowest number in summer months. There was an overall downwards trend of the number of hospital admissions during the period of study, in both males and females (p=0.01). Conclusions: We have estimated an incidence of a 7.7 cases per 100,000 CV in children in Spain. CV-related hospitalization rates have a marked seasonal pattern, with a peak in fall and winter and a nadir in summer months. Children between 5 and 9 years of age are most frequently affected. There is a decreasing trend in CV-related hospitalization, the causes of which should be further assessed

Anti-TNF-alpha-adalimumab therapy is associated with persistent improvement of endothelial function without progression of carotid intima-media wall thickness in patients with rheumatoid arthritis refractory to conventional therapy

To determine whether treatment with the anti-TNF-alpha blocker adalimumab yields persistent improvement of endothelial function and prevents from morphological progression of subclinical atherosclerosis in patients with rheumatoid arthritis (RA) refractory to conventional therapy, a series of 34 consecutive RA patients, attending hospital outpatient clinics and who were switched from disease modifying antirheumatic drug therapy to anti-TNF-alpha-adalimumab treatment because of severe disease, were assessed by ultrasonography techniques before the onset of adalimumab therapy (at day 0) and then at day 14 and at month 12. Values of flow-mediated endothelium-dependent vasodilatation at day 14 and at month 12 were significantly higher (mean ± standard deviation (SD): 6.1 ± 3.9%; median: 5.7% at day 14, and mean ± SD: 7.4 ± 2.8%; median: 6.9% at month 12) than those obtained at day 0 (mean: 4.5 ± 4.0%; median: 3.6%; P = 0.03 and P < 0.001, resp.). Endothelium-independent vasodilatation results did not significantly change compared with those obtained at day 0. No significant differences were observed when carotid artery intima-media wall thickness values obtained at month 12 (mean ± SD: 0.69 ± 0.21 mm) were compared with those found at day 0 (0.65 ± 0.16 mm) (P = 0.3). In conclusion, anti-TNF-alpha-adalimumab therapy has beneficial effects on the development of the subclinical atherosclerosis disease in RA

Severe leukocytoclastic vasculitis secondary to the use of a naproxen and requiring amputation: a case report

<p>Abstract</p> <p>Introduction</p> <p>Leukocytoclastic vasculitis (also known as hypersensitivity vasculitis and cutaneous necrotizing vasculitis) can present with various manifestations, which often delays the diagnosis and treatment. In order to show the importance of the early recognition of leukocytoclastic vasculitis, we present a case which occurred secondary to the use of a common pharmaceutical, naproxen. We were unable to find a case of leukocytoclastic vasculitis secondary to naproxen in the literature.</p> <p>Case presentation</p> <p>We present the case of a 33-year-old African American woman with below the knee and bilateral digital gangrene from hypersensitivity vasculitis secondary to the non-steroidal anti-inflammatory medication naproxen.</p> <p>Conclusion</p> <p>This is an original case report focusing on the rheumatologic management of leukocytoclastic vasculitis. However, other specialties, such as internal medicine, dermatology, infectious disease, general surgery and pathology, can gain valuable information by reviewing this case report. Reporting a case of leukocytoclastic vasculitis secondary to treatment with naproxen will advance our understanding of this disease etiology by adding yet another non-steroidal anti-inflammatory drug to the list of potential causes of leukocytoclastic vasculitis.</p

BAFF, APRIL and BAFFR on the pathogenesis of Immunoglobulin-A vasculitis

BAFF, APRIL and BAFF-R are key proteins involved in the development of B-lymphocytes and autoimmunity. Additionally, BAFF, APRIL and BAFFR polymorphisms were associated with immune-mediated conditions, being BAFF GCTGT>A a shared insertion-deletion genetic variant for several autoimmune diseases. Accordingly, we assessed whether BAFF, APRIL and BAFFR represent novel genetic risk factors for Immunoglobulin-A vasculitis (IgAV), a predominantly B-lymphocyte inflammatory condition. BAFF rs374039502, which colocalizes with BAFF GCTGT>A, and two tag variants within APRIL (rs11552708 and rs6608) and BAFFR (rs7290134 and rs77874543) were genotyped in 386 Caucasian IgAV patients and 806 matched healthy controls. No genotypes or alleles differences were observed between IgAV patients and controls when BAFF, APRIL and BAFFR variants were analysed independently. Likewise, no statistically significant differences were found in the genotype and allele frequencies of BAFF, APRIL or BAFFR when IgAV patients were stratified according to the age at disease onset or to the presence/absence of gastrointestinal (GI) or renal manifestations. Similar results were disclosed when APRIL and BAFFR haplotypes were compared between IgAV patients and controls and between IgAV patients stratified according to the clinical characteristics mentioned above. Our results suggest that BAFF, APRIL and BAFFR do not contribute to the genetic network underlying IgAV.Acknowledgements: We are indebted to the patients and healthy controls for their essential collaboration to this study. We also thank the National DNA Bank Repository (Salamanca) for supplying part of the control samples. This study was supported by European Union FEDER funds and `Fondo de Investigaciones Sanitarias´ (grant PI18/00042) from ‘Instituto de Salud Carlos III’ (ISCIII, Health Ministry, Spain). DP-P is a recipient of a Río Hortega programme fellowship from the ISCIII, co-funded by the European Social Fund (ESF, `Investing in your future´) (grant number CM20/00006). SR-M is supported by funds of the RETICS Program (RD16/0012/0009) (ISCIII, co-funded by the European Regional Development Fund (ERDF)). VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL 18/01). BA-M is a recipient of a `López Albo´ Post-Residency Programme funded by Servicio Cántabro de Salud. LL-G is supported by funds from IDIVAL (INNVAL20/06). OG is staff personnel of Xunta de Galicia (Servizo Galego de Saude (SERGAS)) through a research-staff stabilization contract (ISCIII/SERGAS) and his work is funded by ISCIII and the European Union FEDER fund (grant numbers RD16/0012/0014 (RIER) and PI17/00409). He is beneficiary of project funds from the Research Executive Agency (REA) of the European Union in the framework of MSCA-RISE Action of the H2020 Programme, Project 734899—Olive-Net. RL-M is a recipient of a Miguel Servet type I programme fellowship from the ISCIII, cofunded by ESF (`Investing in your future´) (grant number CP16/00033)

Full-vector archaeomagnetic dating of a medieval limekiln at Pinilla Del Valle site (Madrid, Spain)

Archaeomagnetic dating based on the full geomagnetic field vector was carried out on a limekiln excavated at Pinilla del Valle archaeological site (Madrid, Spain). The limekiln tradition in this area is largely documented by historical sources for recent centuries but the date of the studied kiln's last use was unknown. The combination of mean archaeomagnetic directional and absolute archaeointensity results shows that the kiln was last used between ad 1296 and 1413, in good agreement with two independent radiocarbon dates. This study provides the first archaeomagnetic evidence that the local limekiln tradition dates back to at least late medieval times. Furthermore, the inclusion of these data in the Iberian secular variation curve and geomagnetic field models will help to improve the archaeomagnetic dating technique.Spanish Ministry of Economy and Competitiveness, MINECO and the European Regional Development Fund (projects CGL2012-38481 and CGL2012-32149). AGacknowledges partial financial support given by PAPIIT IN-105214