Reacción leucemoide por cáncer de cabeza y cuello. A propósito de un caso

The leukemoid reaction is defined as a count of mature leukocytes greater than 50 x 109 cells/L. It is described a rare case of leukemoid reaction presented as paraneoplastic manifestation associated with epidermoid head and neck cancer, and which has been diagnosed after excluding other causes, and which implies a worse prognosis of the disease. The production mechanism is unknown although the current theories point to the production of stimulatory cytokines in the bone marrow.La reacción  leucemoide se define como un recuento de leucocitos maduros superior a 50 x 109 células/L. Describimos un caso poco frecuente de reacción leucemoide como manifestación paraneoplásica asociada a cáncer epidermoide de cabeza y cuello, diagnosticada al excluir otras causas y que conlleva un peor pronóstico de la enfermedad. El mecanismo de producción es desconocido, aunque las teorías actuales apuntan a la producción de citocinas estimulantes de la médula ósea

Pericarditis purulenta por Staphylococcus aureus sin foco en paciente con neoplasia pancreática

We present the case of a patient with a short-term fever and dyspnea, diagnosed with purulent pericarditis with bacteremia associated with Staphylococcus aureus, and no primary infectious focus found. As a casual finding, a pancreatic neoplasm was detected. After undergoing surgery, he developed hemodynamic instability and poor evolution despite intensive measures and died during the postoperative period.Presentamos el caso de un varón con cuadro febril y disnea de corta duración, diagnosticado de pericarditis purulenta con bacteriemia asociada por Staphylococcus aureus, en el que no se encontró foco primario infeccioso. Como hallazgo casual, se le diagnosticó de neoplasia pancreática. Tras someterse a intervención quirúrgica, comenzó con inestabilidad hemodinámica y mala evolución a pesar de las medidas intensivas, y falleció durante el posoperatorio

Comprensión medular como debut de sarcoma mieloide con amplia afectación ósea

Myeloid sarcoma is an extramedullary tumor usually found in patients with previous hematological neoplasms, with symptoms depending on the location of the lesions due to their mass effect. The main locations are lymph nodes and the skin. It requires a high clinical suspicion for its diagnosis and has a poor prognosis in the short-medium term. We present a clinical case of a 64-year-old man with no hematological history who consulted for bone pain and spinal cord compression, observing extensive bone involvement on MRI and PET-TC. He suffered a nosocomial infectious complication and died in the ICU awaiting histological diagnostic confirmation.El sarcoma mieloide es un tumor extramedular que suele encontrarse en pacientes con neoplasias hematológicas previas, con síntomas en función de la localización de las lesiones, debido al efecto masa que producen. Las principales localizaciones son ganglionares y cutáneas. Precisa una alta sospecha clínica para su diagnóstico, y presenta un mal pronóstico a corto y a medio plazo. Se presenta un caso clínico de un varón de 64 años sin antecedentes hematológicos que debuta con dolores óseos y compresión medular, observando amplia afectación ósea en una resonancia magnética nuclear (RMN) y una tomografía por emisión de positrones (PET-TAC). Sufre complicación infecciosa nosocomial y fallece en la UCI en esperas de confirmación diagnóstica histológica.

Sarcoidosis esplénica simulando metástasis

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. We present the case of a middle aged patient, diagnosed with sarcoidosis with lymph node involvement, pulmonary and probably central nervous system, which begins with a non-specific constitutional and clinical picture. Two radiological tests, PET-CT and splenic MRI, are performed, showing lesions compatible with the neoplastic process as the first diagnostic possibility. In spite of the firm clinical suspicion of splenic sarcoidosis, finally the diagnosis and therapeutic splenectomy is performed in the face of the contradiction of radiological reports. The result of the pathological anatomy was compatible with sarcoid granulomas.La sarcoidosis es una enfermedad granulomatosa multisistémica de etiología desconocida. Se presenta el caso de una paciente de mediana edad, diagnosticada de sarcoidosis con afectación ganglionar, pulmonar y probablemente del sistema nervioso central, que comienza con cuadro constitucional y clínica inespecífica. Se realizan dos pruebas radiológicas, PET-TC y RM esplénica, objetivando lesiones compatibles con proceso neoplásico como primera posibilidad diagnóstica. A pesar de la firme sospecha clínica de sarcoidosis esplénica, finalmente se decide la realización de esplenectomía diagnóstica y terapéutica ante la contradicción de los informes radiológicos. El resultado de la anatomía patológica fue compatible con granulomas de tipo sarcoideo

COVID-19 in Older Patients: Assessment of Post-COVID-19 Sarcopenia

(1) Background: Acute COVID-19 infections produce alterations in the skeletal muscle, leading to acute sarcopenia, but the medium- and long-term consequences are still unknown. The aim of this study was to evaluate: (1) body composition; (2) muscle strength and the prevalence of sarcopenia; and (3) the relationship between muscle strength with symptomatic and functional evolution in older patients affected by/recovered from COVID-19; (2) Methods: A prospective, longitudinal study of patients aged ≥65 years who had suffered from COVID-19 infection between 1 March and 31 May 2020, as confirmed by PCR or subsequent seroconversion. Persistent symptoms, as well as anthropometric, clinical, and analytical characteristics, were analyzed at 3 and 12 months after infection. The degree of sarcopenia was determined by dynamometry and with SARC-F; (3) Results: 106 participants, aged 76.8 ± 7 years, were included. At 3 months postinfection, a high percentage of sarcopenic patients was found, especially among women and in those with hospitalization. At 12 months postinfection, this percentage had decreased, coinciding with a functional and symptomatic recovery, and the normalization of inflammatory parameters, especially interleukin-6 (4.7 ± 11.6 pg/mL vs. 1.5 ± 2.4 pg/mL, p < 0.05). The improvement in muscle strength was accompanied by significant weight gain (71.9 ± 12.1 kg vs. 74.7 ± 12.7 kg, p < 0.001), but not by an increase in lean mass (49.6 ± 10 vs. 49.9 ± 10, p 0.29); (4) Conclusions: Older COVID-19 survivors presented a functional, clinical, and muscular recovery 12 months postinfection. Even so, it is necessary to carry out comprehensive follow-ups and assessments that include aspects of nutrition and physical activity.Funding for open access charge: Universidad de Málag

De-Intensification of Antidiabetic Treatment Using Canagliflozin in Patients with Heart Failure and Type 2 Diabetes: Cana-Switch-HF Study

Canagliflozin is a sodium-glucose co-transporter 2 inhibitor that reduces glycemia as well as the risk of cardiovascular events. Our main objective was to analyze antidiabetic treatment de-intensification and the glycemic efficacy of replacing antidiabetic agents (excluding metformin) with canagliflozin in patients with heart failure and type 2 diabetes with poor glycemic control. In this observational, retrospective, real-world study, we selected patients treated with metformin in combination with ≥2 non-insulin antidiabetic agents or metformin in combination with basal insulin plus ≥1 non-insulin antidiabetic agent. Non-insulin antidiabetic agents were replaced with canagliflozin. Patients were followed-up on at three, six, and 12 months after the switch and a wide range of clinical variables were recorded. A total of 121 patients were included. From baseline to 12 months, the number of antidiabetic agents (3.1 ± 1.0 vs. 2.1 ± 0.8, p < 0.05), basal insulin dose (20.1 ± 9.8 vs. 10.1 ± 6.5 units, p < 0.01), and percentage of patients who used basal insulin (47.9% vs. 31.3%, p < 0.01) decreased. The proportion of patients who used diuretics also declined significantly. In addition, we observed improvement in glycemic control, with an increase in the proportion of patients with glycated hemoglobin <7% from 16.8% at three months to 63.5% at 12 (p < 0.001). Canagliflozin use was also beneficial in terms of body weight, blood pressure, heart failure status, functional class, and cardiovascular-renal risk. There were also reductions in the number of emergency department visits and hospitalizations for heart failure. Moreover, canagliflozin was well-tolerated, with a low rate of drug-related discontinuation. Mounting evidence from randomized controlled trials and real-world studies point to the beneficial profile of sodium-glucose co-transporter type 2 inhibitors such as canagliflozin in patients with heart failure.This work was supported by PI15/00256 from the Institute of Health “Carlos III” (ISCIII), co-funded by the Fondo Europeo de Desarrollo Regional-FEDER. Maria Isabel Queipo-Ortuño was supported by the “Miguel Servet Type II” program (CPI18/00003, ISCIII, Spain, co-funded by the Fondo Europeo de Desarrollo Regional-FEDER) and by the “Nicolas Monardes” research program of the Consejería de Salud (C-0030-2018, Junta de Andalucía, Spain. Bruno Ramos Molina was supported by the “Miguel Servet Type I” program (CP19/00098, ISCIII, Spain, co-funded by the Fondo Europeo de Desarrollo Regional-FEDER). Lidia Sanchez-Alcoholado was the recipient of a predoctoral grant (PE-0106-2019) from the Consejería de Salud y Familia (co-funded by the Fondo Europeo de Desarrollo Regional-FEDER, Andalucia, Spain). Aurora Laborda-Illanes was the recipient of a predoctoral grant, PFIS-ISCIII (FI19-00112), co-funded by the Fondo Europeo de Desarrollo Regional-FEDER, Madrid, Spain.Ye

Statins and Peripheral Arterial Disease: A Narrative Review

Peripheral arterial disease (PAD) is a highly prevalent atherosclerotic condition. In patients with PAD, the presence of intermittent claudication leads to a deterioration in quality of life. In addition, even in asymptomatic cases, patients with PAD are at high risk of cardiac or cerebrovascular events. Treatment of PAD is based on lifestyle modifications; regular exercise; smoking cessation; and control of cardiovascular risk factors, including hypercholesterolemia. A growing number of studies have shown that statins reduce cardiovascular risk and improve symptoms associated with PAD. Current guidelines recommend the use of statins in all patients with PAD in order to decrease cardiovascular events and mortality. However, the prescribing of statins in patients with PAD is lower than in those with coronary heart disease. This review provides relevant information from the literature that supports the use of statins in patients with PAD and shows their potential benefit in decreasing lower limb complications as well as cardiovascular morbidity and mortality.Ye

Statin Therapy in Very Old Patients: Lights and Shadows

Atherosclerotic cardiovascular diseases (ASCVD) are the leading cause of death worldwide. High levels of total cholesterol-and of low-density lipoprotein cholesterol in particular-are one of the main risk factors associated with ASCVD. Statins are first-line treatment for hypercholesterolemia and have been proven to reduce major vascular events in adults with and without underlying ASCVD. Findings in the literature show that statins reduce coronary and cerebrovascular morbidity and mortality in middle-aged people, but their benefits in older adults are not as well-established, especially in primary prevention. Furthermore, many particularities must be considered regarding their use in old subjects, such as age-related changes in pharmacokinetics and pharmacodynamics, comorbidities, polypharmacy, and frailty, which decrease the safety and efficacy of statins in this population. Myopathy and a possible higher risk of falling along with cognitive decline are classic concerns for physicians when considering statin use in the very old. Additionally, some studies suggest that the relative risk for coronary events and cardiovascular mortality associated with high levels of cholesterol decreases after age 70, making the role of statins unclear. On the other hand, ASCVD are one of the most important causes of disability in old subjects, so cardiovascular prevention is of particular interest in this population in order to preserve functional status. This review aims to gather the current available evidence on the efficacy and safety of statin use in very old patients in both primary and secondary prevention.This work was supported by grants from the Instituto de Salud Carlos III, cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER [Centros de Investigación En Red (CIBER, CB06/03/0018)]. LC-P, JS-C and AL-S were supported by Rio Hortega program (CM20/00125, CM20/00212, and CM21/00110, respectively) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER. MM-U was supported by Consejeria de Salud, Junta de Andalucía (RH-0100-2020). MB-L was supported by Miguel Servet Type II program (CPII/00014) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER and Nicolas Monardes program (C1-0005-2020), supported by Consejeria de Salud, Junta de Andalucía.Ye