Utilidad de las queratinas séricas en el diagnóstico de las enfermedades hepáticas

A determinación de K18 (TPS) sérica engade información aos marcadores habituais de dano hepático. En contrapartida, o seu valor como marcador tumoral (o seu deseño orixinal como marcador sérico) verase comprometido nos pacientes con enfermidade hepática. Nesta tese estúdiase a súa utilidade no diagnóstico de pacientes nos pacientes con hepatite crónica por virus C, pacientes con abuso de alcohol, con fígado graxo non alcohólico, con hepatopatías autoinmunes e tamén nos pacientes con transplante hepático

Neutropenia febril

Most chemotherapy treatments have a negative effect in myelopoiesis and the integrity of gastrointestinal mucous membranes, increasing the risk of invasive translocation infections of bacteria and/or fungi. Neutropenic fever is a serious complication; its mortality rate varies from 11 % to 50 % in the case of severe sepsis or septic shock. It is essential to recognize this early and start empirical antibacterial therapy immediately. In patients with good prognosis criteria, outpatient treatment is an option to consider.La quimioterapia deprime la mielopoyesis y afecta a la integridad de las mucosas gastrointestinales aumentando el riesgo de infecciones sistémicas por translocación de bacterias y hongos. La neutropenia febril es una complicación grave cuya tasa de mortalidad es de hasta el 11%. Es fundamental reconocer precozmente este cuadro e iniciar antibioterapia empírica de inmediato. En pacientes sin datos de gravedad, el tratamiento ambulatorio es igual de eficaz y seguro que el hospitalario

Eculizumab in secondary atypical haemolytic uraemic syndrome

Background. Complement dysregulation occurs in thrombotic microangiopathies (TMAs) other than primary atypical haemolytic uraemic syndrome (aHUS). A few of these patients have been reported previously to be successfully treated with eculizumab. Methods. We identified 29 patients with so-called secondary aHUS who had received eculizumab at 11 Spanish nephrology centres. Primary outcome was TMA resolution, defined by a normalization of platelet count (>150 × 109/L) and haemoglobin, disappearance of all the markers of microangiopathic haemolytic anaemia (MAHA), and improvement of renal function, with a ≥25% reduction of serum creatinine from the onset of eculizumab administration. Results. Twenty-nine patients with secondary aHUS (15 drug-induced, 8 associated with systemic diseases, 2 with postpartum, 2 with cancer-related, 1 associated with acute humoral rejection and 1 with intestinal lymphangiectasia) were included in this study. The reason to initiate eculizumab treatment was worsening of renal function and persistence of TMA despite treatment of the TMA cause and plasmapheresis. All patients showed severe MAHA and renal function impairment (14 requiring dialysis) prior to eculizumab treatment and 11 presented severe extrarenal manifestations. A rapid resolution of the TMA was observed in 20 patients (68%), 15 of them showing a ≥50% serum creatinine reduction at the last follow-up. Comprehensive genetic and molecular studies in 22 patients identified complement pathogenic variants in only 2 patients. With these two exceptions, eculizumab was discontinued, after a median of 8 weeks of treatment, without the occurrence of aHUS relapses. Conclusion. Short treatment with eculizumab can result in a rapid improvement of patients with secondary aHUS in whom TMA has persisted and renal function worsened despite treatment of the TMA-inducing conditionWork in this report was funded by the Instituto de Salud Carlos III: REDinREN (RD 016/009 Feder Funds), the Fondo de Investigaciones Sanitarias (13/02502 and ICI14/00350), the Ministerio de Economia y Competitividad (SAF2015-66287R) and the Autonomous Region of Madrid (S2010/BMD-2316; Grupo de Investigación Complemento-CM). SRdeC is funded by the Seventh Framework Programme European Union Project EURenOmics (305608

Eosinofilia asociada a miopatía y diplopía

Patient presents in ER with symptoms and history indicative of infectious disease, with muscle pain and double vison being the main complaints. After several consultations, it is decided to admit the patient to the internal medicine ward, where following clinical investigation focused on a differential diagnosis of eosinophilia and myopathy. Paciente acude al servicio de urgencias con un cuadro compatible con patología infecciosa, siendo dolor muscular y visión doble las principales quejas. Tras consultar con diferentes servicios, se decide ingreso en el servicio de medicina interna, donde la investigación clínica se focaliza en un diagnóstico diferencial de eosinofilia y miopatía

Fusobacterium Nucleatum Empyema: An Atypical Presentation

A 40-year-old man presented to the emergency room and was evaluated in the internal medicine department for unexplained weight loss, asthenia, anorexia and night sweats over the previous 2 months. After a loculated pleural effusion was identified on thoracic computed tomography, purulent fluid was drained from the lung and Fusobacterium nucleatum was isolated. The patient was successfully treated for 27 days with amoxicillin-clavulanic acid. This was an atypical presentation of a common micro-organism implicated in lung infections

Miliary pattern, a classic pulmonary finding of tuberculosis disease

Introduction: The increase in age of the population and in the use of immunosuppressive treatment makes tuberculosis (TB) with hematogenous or lymphatic dissemination a current problem. Methods: We collected all the patients diagnosed with tuberculosis with miliary pulmonary pattern at the Santiago de Compostela University Teaching Hospital (NW Spain) from 1 January 2006 to 31 December 2015. Results: A total of 27 patients were included, 70.4% women, with a median age of 69.0 years old. A cause of immunosuppression was observed only in 51.9% of patients. The majority of the cases (65.0%) presented pulmonary affectation. The most frequently isolated species was Mycobacterium tuberculosis (88.9%). Multiresistance to first-line antituberculosis drugs was observed only in 3.7%. 92.6% of the patients received treatment with Isoniazid, Rifampicin and Pyrazinamine, associated in 48.1% of them with Ethambutol. Two patients died during admission and there were no recurrences in the 2-years follow-up. Conclusions: Miliary tuberculosis remains a current pathology. Most patients do not have a known cause of immunosuppression. The response to the typical treatment is usually good

Menigococcal endophthalmitis: A rare cause of endogenous endophthalmitis

Neisseria meningitidis is a rare but severe cause of endogenous endophthalmitis. We report a case of a 46-year-old woman who presented an endophthalmitis secondary to an infection by Neisseria meningitidis that caused with meningitis. She was treated with corticosteroids and systemic and topical antimicrobials, but she presented loss of visual acuity as a consequence. We also review the cases reported in medical literature, and find out that 75.7 % of patients presented diverse complications. The prevalence of complications is higher in patients who received local treatment in combination with antibiotics. Patients who received corticosteroids as treatment presented a similar rate of complications than patients who did not