79 research outputs found
Pacientes de edad avanzada con insuficiencia cardíaca ingresados en un servicio de medicina interna : valoración de la función renal
Objectius: analitzar comorbiditats de pacients hospitalaris ≥65 anys amb Insuficiència Cardíaca (IC). Adequació tractament farmacològic. Impacte Insuficiència Renal (IR). Metodologia: estudi descriptiu transversal de 150 pacients ingressats en Medicina Interna Hospital Vall d'Hebron entre juny'2007-gener'2010. Resultats: hipertensió arterial: 84%; obesitat: 32,1%; cardiopatia isquèmica: 41,3%; fracció d'ejecció del ventricle esquerre (FEVI) conservada: 70%. 53 pacients sense antagonistes de l'enzim convertidor de l'angiotensina, 105 sense βBloquejants i 55 sense antialdosterònics. Prevalença IR: 70%. Factors de risc: HTA, sexe femení. IC+IR+anèmia: 66 pacients, 2 tractament amb eritropoetina. Conclusions: IC de causa hipertensiva, amb FEVI conservada. Mala adequació tractament. Elevada prevalença IR. Importància Síndrome cardiorenal.Objetivos: analizar comorbilidades de pacientes hospitalarios ≥65 años con Insuficiencia Cardíaca (IC). Adecuación tratamiento farmacológico. Impacto Insuficiencia Renal (IR). Metodología: estudio descriptivo transversal de 150 pacientes ingresados en Medicina Interna Hospital Vall d'Hebron entre junio'2007-enero'2010. Resultados: hipertensión arterial: 84%; obesidad: 32,1%; cardiopatía isquémica: 41,3%; fracción de eyección del ventrículo izquierdo (FEVI) conservada: 70%. 53 pacientes sin antagonistas del enzima convertidor de la angiotensina, 105 sin βBloqueantes y 55 sin antialdosterónicos. Prevalencia IR: 70%. Factores de riesgo: HTA, sexo femenino. IC+IR+anemia: 66 pacientes, 2 tratamiento con eritropoyetina. Conclusiones: IC de causa hipertensiva, con FEVI conservada. Mala adecuación tratamiento. Elevada prevalencia IR. Importancia Síndrome cardiorenal
Capilaroscopia en el Síndrome de Sjögren Primario
La Síndrome de Sjögren primària (SSp) és una malaltia inflamatòria crònica autoimmune que afecta a les glàndules exocrines. Cursa amb símptomes de sequedat generalitzada i un terç dels pacients presenten afecció extraglandular, incloent Fenomen de Raynaud. Per investigar l'existència d'un patró capilaroscòpic típic o suggestiu de SSp es va practicar videocapilaroscòpia a 107 pacients, analitzant posteriorment les possibles relacions entre les alteracions trobades i el perfil immunològic i /o l'afecció sistèmica. No es va trobar un patró capilaroscòpic característic del SSp, però vàrem trobar mes alteracions capilaroscòpicas en els pacients amb afecció extraglandular, suggerint una utilitat pronòstica de la capilaroscòpiaEl Síndrome de Sjögren primario (SSp) es una enfermedad inflamatoria crónica autoinmune que afecta a las glándulas exocrinas. Cursa con síntomas de sequedad generalizada y un tercio de pacientes presentan afección extraglandular, incluyendo Fenómeno de Raynaud. Para investigar la existencia de un patrón capilaroscópico típico o sugestivo de SSp se practicó videocapilaroscopia a 107 pacientes, analizando posteriormente las posibles relaciones entre las alteraciones halladas y el perfil inmunológico y/o la afección sistémica. No se halló un patrón capilaroscópico característico del SSp, pero se hallaron más alteraciones capilaroscópicas en los pacientes con afección extraglandular, sugiriendo una utilidad pronostica de la capilaroscopia
Anemia en pacientes de edad avanzada con insuficiencia cardíaca ingresados en un servicio de medicina interna
Introducción: la anemia es una entidad muy prevalente en pacientes con insuficiencia cardíaca (IC) y se asocia a mayor morbimortalidad. Objetivos: analizar las comorbilidades de pacientes hospitalizados de ≥ 65 años con IC. Estudiar el impacto de la anemia sobre esta población y comparar esta comorbilidad respecto a aquéllos que no la presentan en relación a la valoración geriátrica integral (VGI), así como la adecuación del tratamiento farmacológico en la IC. Pacientes y métodos: estudio descriptivo observacional transversal de una cohorte de 150 pacientes ingresados en el Servicio de Medicina Interna del Hospital Vall d'Hebron, entre junio de 2007 y enero de 2010, mediante entrevista clínica y recogida de datos de la historia clínica. Resultados: en la muestra prevalecían las mujeres (62%), los pacientes con hipertensión (84%), los que tenían la FEVI conservada (66,4%) y los pacientes con anemia (61,3%), de los cuales el 60,9% presentaban anemia inflamatoria y el 35,9% anemia ferropénica. Los pacientes con anemia tuvieron peor valor de MNA (p=0,017, con un RR de 2,7), mayor diferencial de Barthel (p=0,021) y peor valor de albuminemia (p=0,001). Asimismo, se observó que 53 pacientes con indicación según las guías clínicas de tratamiento con IECA o ARA II no lo seguían, y hasta 105 pacientes en el caso de los betabloqueantes (BB). Conclusiones: los pacientes con anemia presentaban pero estado nutricional, y mayor empeoramiento del índice de Barthel. Respecto al tratamiento de la IC, destacaba el gran número de pacientes sin tratamiento con IECA, ARA II o BB, que deberían llevarlo según las guías de práctica clínica
Poliangeitis amb Granulomatosis eosinofílica i asma al·lèrgica; dues monedes amb una mateixa cara?
La síndrome de Churg-Strauss o Poliangeitis amb Granulomatosis eosinofílica (EGPA), clàssicament s'ha vinculat a un substrat asmàtic d'origen al·lèrgic. No obstant, l'evidència en aquest sentit és equívoca. L'objectiu d'aquest treball és identificar diferències clíniques i serològiques entre pacients amb EGPA i pacients asmàtics al·lèrgics, i determinar el perfil al·lèrgic d'un grup de pacients diagnosticats d'EGPA. Es comparen dos grups de pacients: un grup de diagnosticats d'EGPA, i un altre amb asma al·lèrgic. Malgrat les similituds clíniques entre els dos grups, les reaccions immunoal·lèrgiques no semblen intervenir en la fisiopatologia de la majoria dels casos d'EGPA
Intravenous Cyclophosphamide Pulse Therapy in the Treatment of Systemic Sclerosis-Related Interstitial Lung Disease: A Long Term Study
Interstitial lung disease (ILD) frequently complicates systemic sclerosis (SSc). Cyclophosphamide (CYC) is a promising immunosuppressive therapy for SSc-related ILD. Our objective was to investigate the effectiveness of an intravenous CYC (iv CYC) pulse regime in SSc-related ILD during treatment and thereafter. In a prospective observational study ten consecutive patients with SSc-related ILD were treated with iv CYC in a pulse regime lasting from 6 to 24 months. Clinical status, pulmonary functional testing (PFT) and high resolution computed tomography (HRCT) of the chest were evaluated at enrolment and 6, 12 and 24 months thereafter. After treatment withdrawal, patients were followed up every 6 months with PFT and chest HRCT to monitor lung disease. Clinical improvement was apparent in 8 out of 10 patients. The median values of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and diffusion lung capacity for carbon monoxide (DLCO) as well as ground-glass pattern on HRCT did not change significantly after 6, 12 and 24 months of therapy. The follow-up continued in 8 out of 10 patients after treatment withdrawal for a median of 26.5 months (range: 12-48 months). The final median FVC was 54.5% of predicted value (interquartile range, IQR= 31.6%-94%). Only one patient suffered a FVC deterioration greater than 10%, even though less than 160 ml. The final median DLCO was 68% of predicted value (IQR=38.3-83.6%). Only 2 patients who developed pulmonary arterial hypertension deteriorated their DLCO values of more than 15%. An iv CYC pulse regimen over 24 months may stabilize pulmonary activity in patients with SSc-related ILD during the course of treatment and for a median of 26.5 months thereafter
Clinical characteristics and outcome of Spanish patients with ANCA-associated vasculitides Impact of the vasculitis type, ANCA specificity, and treatment on mortality and morbidity
The aim of this study was to describe the clinical characteristics of ANCA-associated vasculitides (AAV) at presentation, in a wide cohort of Spanish patients, and to analyze the impact of the vasculitis type, ANCA specificity, prognostic factors, and treatments administered at diagnosis, in the outcome. A total of 450 patients diagnosed between January 1990 and January 2014 in 20 Hospitals from Spain were included. Altogether, 40.9% had granulomatosis with polyangiitis (GPA), 37.1% microscopic polyangiitis (MPA), and 22% eosinophilic granulomatosis with polyangiitis (EGPA). The mean age at diagnosis was 55.6±17.3 years, patients with MPA being significantly older (P<0.001). Fever, arthralgia, weight loss, respiratory, and ear-nose-throat (ENT) symptoms, were the most common at disease onset. ANCAs tested positive in 86.4% of cases: 36.2% C-ANCA-PR3 and 50.2% P-ANCA-MPO. P-ANCA-MPO was significantly associated with an increased risk for renal disease (OR 2.6, P<0.001) and alveolar hemorrhage (OR 2, P=0.010), while C-ANCA-PR3 was significantly associated with an increased risk for ENT (OR 3.4, P<0.001) and ocular involvement (OR 2.3, P=0.002). All patients received corticosteroids (CS) and 74.9% cyclophosphamide (CYC). The median follow-up was 82 months (IQR 100.4). Over this period 39.9% of patients suffered bacterial infections and 14.6% opportunistic infections, both being most prevalent in patients with highcumulated doses of CYC and CS (P<0.001). Relapses were recorded in 36.4% of cases with a mean rate of 2.5±2.3, and were more frequent in patients with C-ANCA-PR3 (P=0.012). The initial disease severity was significantly associated with mortality but not with the occurrence of relapses. One hundred twenty-nine (28.7%) patients (74 MPA, 41 GPA, 14 EGPA) died. The mean survival was 58 months (IQR 105) and was significantly lower for patients with MPA (P<0.001). Factors independently related to death were renal involvement (P=0.010), cardiac failure (P=0.029) and age over 65 years old (P<0.001) at disease onset, and bacterial infections (P<0.001). An improved outcome with significant decrease in mortality and treatment-related morbidity was observed in patients diagnosed after 2000, and was related to the implementation of less toxic regimens adapted to the disease activity and stage, and a drastic reduction in the cumulated CYC and CS dose
Tocilizumab in refractory Caucasian Takayasu's arteritis: a multicenter study of 54 patients and literature review
Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice.
Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZMONO) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZCOMBO) was performed.
Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5-50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0-31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5-50.0) to 5.0 (0.0-5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0-14.0) months. Twenty-three (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZCOMBO were younger [38.0 (27.0-46.0) versus 45.0 (38.0-57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0-38.0) versus 6.0 (1.0-23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7-5.6) versus 1.3 (0.3-3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal.
Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.Funding: This work was partially supported by RETICS Programs, RD08/0075 (RIER), RD12/0009/0013 and RD16/0012 from “Instituto de Salud Carlos III” (ISCIII) (Spain)
AN ATYPICAL CASE OF GIANT CELL ARTERITIS (HORTON'S DISEASE) ASSOCIATED WITH FACIAL SWELLING, CONFUSION, AND PERICARDITIS IN AN ELDERLY WOMAN
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