A 70-year-old woman with systemic lupus erythematosus and a six-week history of fever

Mujer de 70 años de edad con antecedentes personales de lupus eritematoso sistémico y trasplante renal por nefritis lúpica que consulta en Urgencias por fiebre de 6 semanas de evolución y poliartralgias. Tenía un gato y refería arañazos ocasionales. En la exploración física presentaba fiebre de 38.2ºC y un nódulo eritematoso no doloroso en la pantorrilla izquierda. En la analítica mostraba leve alteración de los reactantes de fase aguda. Se realizó un TAC toracoabdominal que mostró adenopatías inguinales derechas significativas. La serología de Bartonella fue positiva (IgG 1/64), y se confirmó el diagnóstico de enfermedad por arañazo de gato con una PCR positiva para Bartonella henselae en el cultivo de la herida. Se inició tratamiento con doxiciclina y claritromicina con resolución completa del cuadro.A 70-year-old female with a history of systemic lupus erythematosus who had received a kidney transplant four years before due to lupus nephritis presented to the emergency room with a six-week history of fever and polyarthralgias. She owned a cat and admitted occasional scratches. Physical examination revealed a temperature of 38.2ºC and a nontender erythematous nodule on the left calf region. Laboratory tests revealed slight alteration of acute phase reactants. CT scan of the thorax and abdomen showed enlarged lymph nodes in the right inguinal region. Bartonella serology was positive (IgG 1/64), and a positive result of polymerase chain reaction assays for Bartonella henselae in the exudate of the skin lesion confirmed the diagnosis of cat scratch disease. Treatment was started with doxycycline and clarithromycin with complete resolution of symptom

39-year-old women with severe headache

Paciente de 39 años que acude a urgencias por presentar un cuadro de cefalea intensa, holocraneal, con foto y sonofobia intensas, acompañada de febrícula. En la exploración física únicamente destacaban leves roncus en base de hemitórax izquierdo. Las pruebas complementarias iniciales fueron normales. Tras un estudio exhaustivo y fundamentalmente una insistencia en la anamnesis por órganos y aparatos, finalmente se llegó al diagnóstico.A 39-year-old comes to the emergency department because of severe headache, holocraneal, with photo and sonophoby, associated with febricula. In the physical examination, we found only rhonchus in the left lung. Initial complementary tests were normal. After an exhaustive study, principally a correct anamnesis, we could finally get to the diagnosis

Systemic phenotype related to primary Sjögren's syndrome in 279 patients carrying isolated anti-La/SSB antibodies

OBJECTIVES: To evaluate the systemic phenotype associated with the presence of isolated anti-La/SSB antibodies in a large international registry of patients with primary Sjögren's syndrome (pSS) fulfilling the 2002 classification criteria.METHODS: The Big Data Sjögren Project Consortium is an international, multicentre registry created in 2014. Baseline clinical information from leading centres on clinical research in SS of the 5 continents was collected. Combination patterns of anti-Ro/SSA-La/SSB antibodies at the time of diagnosis defined the following four immunological phenotypes: double positive (combined Ro/SSA and La/SSB,) isolated anti-Ro/SSA, isolated anti-La/SSB, and immunonegative.RESULTS: The cohort included 12,084 patients (11,293 females, mean 52.4 years) with recorded ESSDAI scores available. Among them, 279 (2.3%) had isolated anti-La/SSB antibodies. The mean total ESSDAI score at diagnosis of patients with pSS carrying isolated anti-La/SSB was 6.0, and 80.4% of patients had systemic activity (global ESSDAI score ≥1) at diagnosis. The domains with the highest frequency of active patients were the biological (42.8%), glandular (36.8%) and articular (31.2%) domains. Patients with isolated anti-La/SSB showed a higher frequency of active patients in all ESSDAI domains but two (articular and peripheral nerve) in comparison with immune-negative patients, and even a higher absolute frequency in six clinical ESSDAI domains in comparison with patients with isolated anti-Ro/SSA. In addition, patients with isolated anti-La/SSB showed a higher frequency of active patients in two ESSDAI domains (pulmonary and glandular) with respect to the most active immunological subset (double-positive antibodies). Meanwhile, systemic activity detected in patients with isolated anti-La/SSB was overwhelmingly low. Even in ESSDAI domains where patients with isolated anti-La/SSB had the highest frequencies of systemic activity (lymphadenopathy and muscular), the percentage of patients with moderate or high activity was lower in comparison with the combined Ro/SSA and La/SSB group.CONCLUSIONS: Patients carrying isolated La/SSB antibodies represent a very small subset of patients with a systemic SS phenotype characterised by a significant frequency of active patients in most clinical ESSDAI domains but with a relative low frequency of the highest severe organ-specific involvements. Primary SS still remains the best clinical diagnosis for this subset of patients

Systemic phenotype related to primary Sjögren's syndrome in 279 patients carrying isolated anti-La/SSB antibodies

OBJECTIVES: To evaluate the systemic phenotype associated with the presence of isolated anti-La/SSB antibodies in a large international registry of patients with primary Sjögren's syndrome (pSS) fulfilling the 2002 classification criteria.METHODS: The Big Data Sjögren Project Consortium is an international, multicentre registry created in 2014. Baseline clinical information from leading centres on clinical research in SS of the 5 continents was collected. Combination patterns of anti-Ro/SSA-La/SSB antibodies at the time of diagnosis defined the following four immunological phenotypes: double positive (combined Ro/SSA and La/SSB,) isolated anti-Ro/SSA, isolated anti-La/SSB, and immunonegative.RESULTS: The cohort included 12,084 patients (11,293 females, mean 52.4 years) with recorded ESSDAI scores available. Among them, 279 (2.3%) had isolated anti-La/SSB antibodies. The mean total ESSDAI score at diagnosis of patients with pSS carrying isolated anti-La/SSB was 6.0, and 80.4% of patients had systemic activity (global ESSDAI score ≥1) at diagnosis. The domains with the highest frequency of active patients were the biological (42.8%), glandular (36.8%) and articular (31.2%) domains. Patients with isolated anti-La/SSB showed a higher frequency of active patients in all ESSDAI domains but two (articular and peripheral nerve) in comparison with immune-negative patients, and even a higher absolute frequency in six clinical ESSDAI domains in comparison with patients with isolated anti-Ro/SSA. In addition, patients with isolated anti-La/SSB showed a higher frequency of active patients in two ESSDAI domains (pulmonary and glandular) with respect to the most active immunological subset (double-positive antibodies). Meanwhile, systemic activity detected in patients with isolated anti-La/SSB was overwhelmingly low. Even in ESSDAI domains where patients with isolated anti-La/SSB had the highest frequencies of systemic activity (lymphadenopathy and muscular), the percentage of patients with moderate or high activity was lower in comparison with the combined Ro/SSA and La/SSB group.CONCLUSIONS: Patients carrying isolated La/SSB antibodies represent a very small subset of patients with a systemic SS phenotype characterised by a significant frequency of active patients in most clinical ESSDAI domains but with a relative low frequency of the highest severe organ-specific involvements. Primary SS still remains the best clinical diagnosis for this subset of patients

Factores de riesgo cardiovascular y aterosclerosis subclínica en pacientes con Síndrome de Sjörden primario

En los últimos años se ha demostrado la existencia de una aterosclerosis acelerada en distintas enfermedades inflamatorias crónicas (lupus eritematoso sistémico, artritis reumatoide, entre otras) como consecuencia tanto de una mayor frecuencia de factores de riesgo cardiovascular clásicos, como de una importante implicación de factores de riesgo cardiovascular emergentes directamente relacionados con la propia actividad inflamatoria. De acuerdo con esto, existe un interés creciente en el estudio del riesgo cardiovascular en este grupo de enfermedades, por su importante implicación pronóstica. Se estima que el síndrome de Sjögren es la enfermedad autoinmune sistémica más prevalente, aunque por su expresión paucisintomática y heterogénea se encuentra infradiagnosticada. En la misma línea de lo expuesto en el párrafo anterior, la enfermedad cardiovascular constituye la principal causa de muerte en pacientes con síndrome de Sjögren primario, si bien existen en la actualidad pocas series que hayan analizado de forma pormenorizada los factores de riesgo cardiovascular y la ateromatosis subclínica en estos pacientes. El objetivo principal de este estudio fue el de establecer la prevalencia de aterosclerosis subclínica determinada mediante la velocidad de onda de pulso en mujeres con síndrome de Sjögren primario, en comparación con un grupo control de mujeres sanas de características similares. Los objetivos secundarios fueron por una parte comparar los factores de riesgo cardiovascular clásicos y emergentes entre los dos grupos, y por otra determinar qué factores se asocian de forma independiente con la presencia de aterosclerosis subclínica en los pacientes con síndrome de Sjögren primario.Tesis Univ. Granada. Programa Oficial de Doctorado en: Medicina Clínica y Salud Públic

Breastfeeding experiences during the COVID-19 pandemic in Spain:a qualitative study.

The pandemic caused by COVID-19 has affected reproductive and perinatal health both through the infection itself and, indirectly, as a consequence of changes in medical care, social policy or social and economic circumstances. The objective of this study is to explore the impact of the pandemic and of the measures adopted on breastfeeding initiation and maintenance. A qualitative descriptive study was conducted by means in-depth semi-structured interviews, until reaching data saturation. The study was conducted between the months of January to May 2021. Participants were recruited by midwives from the Primary Care Centres of the Andalusian provinces provinces of Seville, Cádiz, Huelva, Granada, and Jaén. The interviews were conducted via phone call and were subsequently transcribed and analysed by means of reflexive inductive thematic analysis, using Braun and Clarke's thematic analysis. A total of 30 interviews were conducted. Five main themes and ten subthemes were developed, namely: Information received (access to the information, figure who provided the information), unequal support from the professionals during the pandemic (support to postpartum hospitalization, support received from Primary Health Care during the postpartum period), social and family support about breastfeeding (support groups, family support), impact of confinement and of social restriction measures (positive influence on breastfeeding, influence on bonding with the newborn), emotional effect of the pandemic (insecurity and fear related to contagion by coronavirus, feelings of loneliness). The use of online breastfeeding support groups through applications such as WhatsApp®, Facebook® or Instagram® has provided important breastfeeding information and support sources. The main figure identified that has provided formal breastfeeding support during this period was that of the midwife. In addition, the social restrictions inherent to the pandemic have exerted a positive effect for women in bonding and breastfeeding, as a consequence of the increase in the time spent at their homes and in the family nucleus co-living