Va a tener un mieloma. Para diagnóstico, una muestra (médula ósea) y electroforesis para determinar el tipo de pico monoclonal. Luego, para extensión, valor pronóstico y decidir tratamientos, lo demás, pero una vez diagnosticado.

Acude al Servicio de Urgencias un hombre de 72 años con fractura patológica en fémur izquierdo. Tras la intervención quirúrgica, se realiza un estudio diagnóstico para averiguar la patología subyacente con los siguientes hallazgos: hemoglobina 9.5 g/dl, protenias totales 11 g/dl, (VN: 6-8 g/dl), albúmina sérica 2 g/dl, (VN 3.5-5,0 g/dl), beta 2 microglobulina 6 mg/l (VN 1,1-2,4 mg/l), creatinina sérica 1,8 mg/dl (VN: 0,1-1,4 mg/dl). Indique cuáles serían las pruebas diagnósticas necesarias para confirmar el diagnóstico más probable:

Serie ósea radiológica y aspirado de médula ósea.

Electroforesis sérica y urinaria y pruebas de función renal.

Aspirado de médula ósea y concentracion de calcio sérico.

Aspirado de médula ósea y electroforesis sérica y urinaria.

Biopsia de la fractura patológica y serie ósea radiológica.

Gasto urinario alto como predictor de hipoparatiroidismo tras tiroidectomía total.

Determinar la utilidad del gasto urinario alto como predictor temprano de bajo costo para hipoparatiroidismo posoperatorio. Se realizó un estudio retrospectivo unicéntrico a 1 año en adultos sometidos a tiroidectomía total en The American British Cowdray Medical Center I.A.P., calculando el gasto urinario en 24 horas, utilizando valores de calcio sérico corregido por albúmina con una tabla de correlación e identificando a los pacientes que recibieron calcio suplementario en las primeras horas de posoperatorio. Se dividieron en pacientes con hipoparatiroidismo posoperatorio y con valores normales de calcio en el primer día, diferenciando a los que recibieron suplementación oral de calcio profiláctico. Se estudiaron 47 pacientes, 19 (40%) en el grupo con hipocalcemia posoperatoria y 28 (59.5%) en el grupo sin hipocalcemia posoperatoria. La media de gasto urinario en las primeras 8 horas de posoperatorio fue mayor en el grupo de hipocalcemia posoperatoria en comparación con el grupo sin hipocalcemia, sin diferencia significativa (p = 0.392), y tampoco durante las primeras 16 horas (p = 0.435). En nuestro estudio no existe relación entre el incremento del gasto urinario y la predicción de hipoparatiroidismo posoperatorio. Se necesitan estudios con muestras de mayor tamaño y con un diseño metodológico más fuerte (prospectivo) para determinar si en realidad la diferencia obtenida puede figurar como predictor. to determine the usefulness of high urine output as a low-cost early predictor for postoperative hypoparathyroidism.. A study was conducted inside The American British Cowdray Medical Center I.A.P. for a year in adult patients who underwent total thyroidectomy divided in two groups: those with post-surgical hypocalcemia and without post-surgical hypocalcemia using the 24-hour calcium levels. Urinary output of each patient was verified searching for the relation between this measurement and the probability of developing post-surgical hypoparathyroidism. A total of 47 patients were studied, of whom 19 (40%) were classified with post-surgical hypocalcemia and 28 (59.5%) with no post-surgical hypocalcemia. The urinary output mean on the first 8 hours post-operatory was higher in the post-surgical hypocalcemia group in comparison with the group with no evidence of hypocalcemia, showing no significant difference (p = 0.392). Urinary output 16 hours post-surgical was no significant either (p = 0.435). In our study, there was no relation found between the increase of the urinary output and the post-surgical hypoparathyroidism prediction. Further studies with a bigger sample and a stronger methodologic design (prospective) are needed to determine if the difference obtained may be useful as a predictor.

Plasmablastic lymphoma: case report.

El linfoma plasmablástico es un linfoma no Hodgkin de alto grado. Se describe en pacientes con infección por el virus de la inmunodeficiencia humana (VIH), en receptores de trasplantes y en pacientes de edad avanzada. Se presenta en la cuarta década de la vida, siendo la cavidad oral el sitio más común de afección. Sus células neoplásicas expresan marcadores de células plasmáticas como CD138 y CD38. En su patogenia se ha implicado al virus de Epstein-Barr. La consideración más desafiante en el diagnóstico diferencial es el mieloma múltiple, ya que las características morfológicas e inmunofenotípicas de estas dos enfermedades son muy similares. El régimen EPOCH (etopósido, epirubicina, vincristina, ciclofosfamida y prednisona) asociado a tratamiento antirretroviral es la opción más eficaz, mejorando la supervivencia a 17 meses. Varón de 35 años con VIH y síntomas de disfunción orgánica asociada a mieloma. Se realizó electroforesis de proteínas y aspirado de médula ósea, descartándose mieloma múltiple. Continuando con el abordaje diagnóstico y con la sospecha de neoplasia ósea, se realizó una biopsia ósea que reportó linfoma plasmablástico CD138+ y Ki-67 80%, Epstein-Barr positivo. El paciente recibió quimioterapia con EPOCH y tuvo una sobrevida de 6 meses. La presencia de disfunción orgánica relacionada con mieloma motivó la búsqueda de dicha patología y se determinó la presencia de linfoma plasmablástico. La correlación clínica, bioquímica, inmunohistoquímica y radiográfica es esencial para el correcto diagnóstico. Plasmablastic lymphoma is a high grade non-Hodgkin lymphoma. It is described in patients with HIV infection, post-transplant and advanced age. It appears in the fourth decade of life and the oral cavity is the most common site of affection. Its neoplastic cells express markers of plasma cells such as CD138, CD38. In its pathogenesis the Epstein-Barr virus has been implicated. The most challenging consideration in the differential diagnosis is with multiple myeloma, since the morphological and immunophenotypic characteristics of these two entities are very similar. Treatment with EPOCH (etoposide, epirubicin, vincristine, cyclophosphamide and prednisone) associated with antiretroviral treatment is the most effective option, improving survival to 17 months. Male of 35 years with HIV and symptoms of organic dysfunction associated with myeloma. Protein electrophoresis and bone marrow aspiration were performed, ruling out multiple myeloma. Continuing with the diagnostic approach and with suspicion of bone neoplasia, a bone biopsy was performed with report of plasmablastic lymphoma CD 138+ and Ki-67 80%, Epstein-Barr positive. He received chemotherapy with EPOCH, with a six-month survival. The presence of organic dysfunction related to myeloma motivated the search for said pathology and the presence of plasmablastic lymphoma was determined; clinical, biochemical, immunohistochemical, and radiographic correlation are essential for correct diagnosis.

[Value of the determination of beta-2-microglobulin in the monitoring of myeloma. Apropos of 290 determinations].

The authors first established a correlation between serum 2 microglobulin (beta 2 m) and creatinine (beta 2m) mg/1) = 0.033 X creatinine (mumol/l) + 0.236) in order to be able to calculate the ratio of measured theoretical beta 2 m, as a function of cell production only. Comparison of this ratio with total tumour mass. calculated according to Durie and Salmon, for 290 estimations, gave a very significant correlation (r = 0.31; p less than 0.0001). This correlation was also significant for the 70 estimations made in cases of myelomas with little or no secretion (7 light chain, 1 non-secreting, 1 IgD and 1 IgM) where the estimation is of the greatest importance as an indication of the course.

[Uso de los valores de hormona paratiroidea intranodular obtenidos por punción con aguja fina como factor predictivo de hipoparatiroidismo posoperatorio].

Análisis de los valores de hormona paratiroidea (PTH) intranodular obtenidos por punción con aguja fina como factor predictivo de hipoparatiroidismo posoperatorio. De los 157 pacientes a los que se realizó la medición de la PTH intranodular, se estudiaron 37 que fueron intervenidos quirúrgicamente, estableciendo 15 variables para analizar: edad, sexo, tiempo de evolución, tamaño, cirugía de tiroides asociada, tratamiento preoperatorio con calcimiméticos, litiasis renal, densitometría ósea, aclaramiento de creatinina, calcio y PTH preoperatorios, PTH determinada tras punción con aguja fina, descenso de la PTH intraoperatoria, calcio posoperatorio y malignidad de la tumoración. Estas se compararon con la prueba de ji al cuadrado o el test exacto de Fisher, siendo significativa una p < 0.05, construyéndose así un análisis de regresión logística. El uso de calcimiméticos previo a la cirugía, la PTH preoperatoria > 88 pg/dl, el calcio preoperatorio > 12 mg/dl, los valores de PTH intranodular > 2700 pg/dl, el descenso de la PTH intraoperatoria a < 15 pg/dl y el calcio posoperatorio < 8,5 mg/dl fueron variables independientes significativas en el análisis univariante (p < 0.05) para la predicción del hipoparatiroidismo posoperatorio. Los valores de PTH intranodular pueden predecir qué pacientes tienen mayor riesgo de sufrir un hipoparatiroidismo posoperatorio. Este factor debe tenerse en cuenta durante el estudio y el seguimiento de los pacientes para identificar precozmente posibles complicaciones. To analize if parathyroid hormone (PTH) washout levels can be considered a predictive factor of postoperative hypoparathyroidism and determine its importance relative to other features already known as intraoperative PTH, Ca and PTH preoperative, and others. Of the 157 patients to whom a fine needle aspiration (FNA) biopsy with intranodular parathyroid hormone level measurement was performed (washout PTH) 37 who underwent surgery were studied. 15 variables were taken into account when selecting patients for this study: age, gender, evolution length, size, associated thyroid surgery, preoperative treatment with calcimimetics, presence of renal lithiasis, bone densitometry alterations, creatine clearance, preoperative calcium and PTH levels, PTH scores obtained by fine needle aspiration, intraoperative PTH decrease, postoperative calcium levels and tumour malignancy. We compare the nominal values, using the Chi squared or the exact Fisher test, where p < 0.05 was considered statistically significant and perform a logistic regression analysis. The use of calcimimetics prior to surgery, the preoperative PTH level above 88 pg/dl, the preoperative calcium above 12 mg/dl, washout PTH above 2700 pg/dl, intraoperative PTH level decrease below 15 pg/dl, and postoperative calcium levels under 8.5 mg/dl were all independently significant variables in the univariant analysis (p < 0.05) in order to establish an early postoperative hypoparathyroidism. The rest of the variables were not statistically significative. The PTH washout levels can predict the appearance of postoperative hypoparathyroidism. This factor must be taken into account during the study and follow-up to identify possible complications and establish an adequate treatment on time.

[Efficiency of high-flow dialyzers in removal of beta-2-microglobulin].

[corrected] Beta-2-microglobulin (beta 2M) is protein with a molecular weight of 11.800 Daltons. A 30-fold or greater increase is found in patients(pts) over 10 years (ys) on haemodialysis (HD). The main aim of study is to evaluate high-flux (HF) dialyzer efficacy on beta 2M removal. A sample of 15 pts was selected, 9 males and 6 females, aged 45.7 ys (31.60), mean duration on HD 156,3 months. All pts were dialyzed by standard bicarbonate HD. We used 2 type of HF membrane: cellulose diacetate (CDA) and polysulphone (PS). A blood sample for beta 2M was drown before HD, 20 minute after start of HD (for clearance beta 2M) and after HD. Average plasma beta 2M concentration was 53.15 mg/L (27-fold increase than normal values). Post/pre beta 2M ratio was 0.73 with clearance of 23.1 +/- 8.9 ml/min (QB = 250 ml/min, QD = 600 ml/min) for CDA dialyzers, and post/pre beta 2M ratio 0.51 with clearance of 31.9 +/- 4.5 ml/min(QB = 250 ml/min, QD = 600 ml/min) for PS dialyzer, respectively. The CDA membrane was able to remove 103 +/- 29 mg of beta 2M during a 4-hours HD session, and PS membrane 139 +/- 5,1 mg, respectively. The only HF membranes are efficient on beta 2M removal.

[In Process Citation].

Introducción y objetivos: el cobre (Cu) es un oligoelemento muy estudiado, pero poco se sabe de su evolución en los pacientes alimentados por gastrostomía endoscópica (GEP). Pretendemos evaluar la evolución del Cu sérico desde la gastrostomía hasta 12 semanas después de la intervención en estos pacientes alimentados con preparaciones domésticas.  Métodos: realizamos un estudio observacional prospectivo para evaluar el Cu sérico, la albúmina, la transferrina y el índice de masa corporal (IMC) en el momento de la GEP, tras 4 semanas y 12 semanas después de la intervención. Los datos incluyen edad, género, NRS 2002 y enfermedad subyacente: cánceres de cabeza y cuello (CCC) y disfagia neurológica (DN). Después de la intervención, estos pacientes fueron alimentados conpreparaciones domésticas. Resultados: 146 enfermos (89 hombres), entre 21-95 años: CCC-56, DN-90. Valores de Cu entre 42-160 μg/dl (normal: 70-140 μg/dl); normales 89% (n = 130); bajos 11% (n = 16), albúmina baja: 53% (n = 77), transferrina baja: 65% (n = 94), IMC bajo: 53% (n = 78). Después de 4 semanas: valores normales de Cu en 93% y bajos en 7%, albúmina baja en 34%, transferrina baja en 52%. Tras 12 semanas: valores normales de Cu en 95% y bajos en 5%, albúmina baja en 25%, transferrina baja en 32%. No encontramos diferencias significativas en el Cusérico cuando se compara edad, género, enfermedad subyacente, IMC, albúmina y transferrina. Conclusiones: la mayoría de los enfermos presentan Cu sérico normal en el momento de la gastrostomía. Para los enfermos con Cu sérico bajo antes del procedimiento, la alimentación con preparaciones domésticas parece suficiente para su normalización progresiva.

[On-line haemodiafiltration with sorbent-regenerated ultrafiltrate as replacement fluid: Beta2-microglobulin removal versus filtration fraction].

In order to encourage the removal of middle molecules in hemodiafiltration (HDF) techniques an attempt is made to maximize convective clearance by increasing the ultrafiltration rate. However, convective clearance is limited by the maximum filtration fraction (FF%) obtainable, by the pre- or post reinfusion method and by the convective surface and the capacity of the filter used. This study aimed to evaluate the effect of the FF% in the removal of Beta2-microglobulin (Beta2-m) during hemodiafiltration reinfusion (HFR) to identify the best ultrafiltration strategies; and therefore, a better removal of medium molecular weight solutes in this hemodiafiltrative technique recently introduced in clinical practice. Ten chronic uremic patients (eight males, two females; age 66 +/- 18 yrs) already on renal dialysis therapy (RDT) for 80 +/- 36 months, were subjected to four HFR sessions, with Td=240 +/- 10 min, Qb=312 +/- 18 and Qd=500 mL/min; the reinfusion rates (Qr) used were 43.6 +/- 7.2 mL/min (25-58) with FF% rates varying from 20-34 (24.2 +/- 3.8) for hematocritic levels of 34.6 +/- 4.2% at the start of the dialysis session. For each session the intradialytic reduction rates (RR%) of urea, creatinine (Cr), phosphate, uric acid and Beta2-m and its average clearance (KBeta2-m mL/min) were evaluated. The results obtained gave a RR% for urea of 69.4 +/- 5 (Kt/Veq=1.23 +/- 0.2) and for Cr, phosphate and uric acid values of, respectively, 61.2 +/- 5.4, 47.5 +/- 10 and 75.8 +/- 6.7. The intradialytic reductions in Beta2-m were 49.3 +/- 10.3% with a variability range from 29-69% and with average KBeta2-m values of 63.8 +/- 13.5 mL/min. The RR% of ss2-m and KBeta2-m were inversely correlated (p<0.01) to the FF% rate applied during the treatment; 75% of the HRF sessions in which we observed a reduction in Beta2-m levels >40% were those where a FF% between 20 and 26% was applied. CONCLUSIONS. From our study, it appears that in HFR the best ultrafiltration strategy from the convective sector in removing Beta2-m has FF% values in the range 20-26%. The occurrence of lower intradialytic reductions of Beta2-m with increasing FF% can be interpreted as a consequence of phenomena related to high intradialytic hemoconcentrations, to the excessive increase in the TMP and/or the increase in the protein cake with a consequent reduction in permeability and mass transfer. Although using a limited convective surface with a limited possibility of increasing the FF%, nevertheless, HFR seems capable of ensuring a satisfactory uremic toxin removal of low and medium molecular weight, which combined with the high biocompatibility deriving from the use of reinfused endogen, can be considered an effective dialytic strategy for preventing or retarding the complications in dialytic patients.

Evolución clínica de trabajadores con fractura de radio distal Fernández III. Tratamiento no complicado quirúrgico y no quirúrgico.

Las fracturas de radio distal Fernández III (FRDF III) son una urgencia muy frecuente. Las indicaciones quirúrgicas y no quirúrgicas persisten controversiales, así como el impacto funcional. Comparar la evolución clínica de los trabajadores con FRDF III, con manejo quirúrgico frente a no quirúrgico, no complicados, en un hospital especializado. Estudio comparativo, observacional y longitudinal en trabajadores con FRDF III unilateral cerrada, de ambos sexos, con evolución menor de 5 días. Se excluyeron pacientes con comorbilidad afectante de consolidación ósea y polifracturados. Se eliminaron aquellos con información incompleta, con complicaciones, con aparato de yeso modificado 5 días después de su colocación, con mala reducción-estabilización acorde a la AO. Se aplicó la Escala Funcional de Mayo para Muñeca (EFMM) a los 3 y 6 meses del tratamiento. Se utilizó la prueba t de Student. 159 pacientes, 34% mujeres, 66% hombres. Edad promedio 40.18 años. Manejo quirúrgico 42,5% (placa 8.7%, fijador 29%, fijador + clavillo 8.7%); no quirúrgico 33%. Diferencias significativas (p ≤ 0.05): EFMM 3 y 6 meses; a 3 meses: dolor, prensión; a 6 meses: movilidad; y días totales de incapacidad. El tratamiento quirúrgico muestra mejores resultados funcionales, destacando el dolor y la prensión a 3 meses, y la movilidad a 6 meses, con reincorporación laboral en menos tiempo. This fracture is a very frequent emergency. Surgical and non-surgical management are still controversial, such as functional impact. To compare clinical evolution of Fernandez III distal radius fractures, managed with surgically vs no surgical treatment, in a specialized hospital. Comparative, observational, longitudinal study, released on workers with unilateral Fernandez III closed distal radius fractures, both sex, with evolution less than 5 days. Those patients with pathologies getting difficult in bone consolidation, and with several fractures were excluded. Those with incomplete information, complicated, and whom paste were modified after 5 days, and with bad reduction or stabilization fracture according AO were eliminated. Mayo Functional Wrist Scale (EFMM) was applied at 3 and 6 months. Student-t test was applied. 159 patients recruited, 34% females, 66% males. Medium age 40 years old. Surgical treatment 42.5% (plaque 8.7%, external fixation 29%, external fixation and nails 8.7%). Non-surgical treatment 33%. Significative differences (p≤0.05): EFMM at 3 and 6 months; pain, grasp at 3 months; mobility at 6 months; total laboral inhability days. Surgical treatment shows better functional results, specially pain and grasp at 3 months, mobility at 6 months, and faster returning to work.

[Multiple myeloma with 5-year survival. Study of initial prognostic factors. Role of beta-2-microglobulin].

A series of 21 patients with multiple myeloma and a survival of more than 5 years was compared to another series of 70 cases of myeloma, which all died within less than 5 years. The statistical analysis of these two groups revealed six factors with a significant prognostic value. The population with a long term survival presented: a low incidence of large tumour masses (stage III according to Durie and Salmon's classification): 24 per cent compared with 72 per cent p less than 0.01); a frequency on asymptomatic or minimally symptomatic forms of 29 per cent versus 7 per cent in the control series (p less than 0.001); a haemoglobin level of 7.3 mmol/l versus 6.4 mmol/l (p less than 0.01); a low beta-2-microglobulin level (4 mg/l versus 11 mg/l) (p less than 0.02); a usually normal serum creatinine level (p less than 0.05). Retrospectively, the authors also observed that the response to treatment constituted an essential prognostic factor (69 per cent response compared with 20 per cent) (p less than 0.001). The serum calcium, the immunological type, the level of monoclonal component and the marrow plasmocytosis did not differ between the two groups. The authors consider all of these parameters, together with the calcitonin hypocalcaemia test to be useful in three situations: the therapeutic decision in minimally symptomatic patients, the choice between single agent or combination chemotherapy, the establishment of criteria of remission and suspension of treatment.

[Dolor óseo generalizado e hipercalcemia en un lactante mayor como síntoma inicial de linfoma linfoblástico de células B].

Introducción: Los linfomas no Hodgkin son neoplasias heterogéneas derivadas de las células linfohematopoyéticas. Es raro que se presenten antes de los 2 años de edad y la prevalencia es mayor en el sexo masculino. Caso clínico: Paciente de sexo masculino de 1 año y 11 meses que debutó con dolor en miembros inferiores y superiores, claudicación intermitente, deformidad ósea e hipotonía generalizada, por lo que se sospechaba artritis juvenil. Se trató con antiinflamatorios no esteroideos. Al no haber mejoría, ingresó a otro hospital con adenopatías y nodulaciones en la región escrotal y braquial, y hepatomegalia, por lo que se presumió la activación precoz de la pubertad con evidencia de hipercalcemia. Los estudios radiológicos indicaron una posible displasia ósea. Sin embargo, la tomografía por emisión de positrones detectó zonas compatibles con un proceso maligno. Se diagnosticó linfoma de precursores B. La hipercalcemia es una alteración metabólica que, en presencia de cáncer, se considera un síndrome paraneoplásico. Es un dato clínico excepcional que se puede observar en niños con leucemia linfoblástica aguda. Conclusiones: El dolor óseo en la edad pediátrica amerita una exploración física minuciosa para realizar un diagnóstico oportuno del cáncer infantil y mejorar el pronóstico del paciente.

[Prognostic effect of beta 2-microglobulin in multiple myeloma].

The aim of the present study was to compare the prognostic influence of beta 2-microglobulin (B2M) corrected according to renal function versus the uncorrected form and relate these values with other characteristics of the disease in a series of patients with multiple myeloma (MM). The serum levels of B2M were determined by the radioimmunoassay method (RIA) in 107 patients with newly diagnosed MM and the prognostic influence of B2M was statistically evaluated with univariant and multivariant analysis. The mean value of B2M obtained in patients with MM was 7.8 +/- 8.0 micrograms/ml, with a median of 5 micrograms/ml. Ninety percent of the patients studied presented serum values of B2M higher than the normal limit. The value of B2M corresponding to the median of the series (5 micrograms/ml) separated two groups of patients with different survival (48 vs 19 months) (p = 0.0001). Similarly, the most discriminative value of corrected B2M in agreement with creatinine (2.5 micrograms/ml) permitted the differentiation of two groups of patients although the differences in survival were less significant (36 vs 26 months, p = 0.03) demonstrating its lesser influence as a prognostic factor with respect to the uncorrected B2M. In contrast, a significant association was observed between high values of B2M and Bence Jones myeloma, clinical stage III, anemia, renal failure and intense involvement of the general state. Multivariant analysis demonstrated that B2M plays a greater prognostic role when used as a discrete rather than a continuous variable and that together with the degree of involvement of the general state, serum albumin and the proportion of plasma cells in the bone marrow, they make up the best set of variables for the prediction of prognosis in patients with MM. Beta 2-microglobulin is one of the most important independent prognostic factors in multiple myeloma with its prognostic value being greatest when used uncorrected according to the values of creatinine.

Single-dose systemic methotrexate vs expectant management for treatment of tubal ectopic pregnancy: a placebo-controlled randomized trial.

Methotrexate is used routinely worldwide for the medical treatment of clinically stable women with a tubal ectopic pregnancy. This is despite the lack of robust evidence to show its superior effectiveness over expectant management. The aim of our multicenter randomized controlled trial was to compare success rates of methotrexate against placebo for the conservative treatment of tubal ectopic pregnancy. This study took place in two early-pregnancy units in the UK between August 2005 and June 2014. Inclusion criteria were clinically stable women with a conclusive ultrasound diagnosis of a tubal ectopic pregnancy, presenting with a low serum beta human chorionic gonadotropin (β-hCG) level of < 1500 IU/L. Women were assigned randomly to a single systemic injection of either 50 mg/m<sup2</sup methotrexate or placebo. The primary outcome was a binary indicator for success of conservative management, defined as resolution of clinical symptoms and decline of serum β-hCG to < 20 IU/L or a negative urine pregnancy test without the need for any additional medical intervention. An intention-to-treat analysis was followed. We recruited a total of 80 women, 42 of whom were assigned to methotrexate and 38 to placebo. The arms of the study were matched in terms of age, ethnicity, obstetric history, pregnancy characteristics and serum levels of β-hCG and progesterone. The rates of success were similar for the two study arms: 83% with methotrexate and 76% with placebo. On univariate analysis, this difference was not statistically significant (χ<sup2</sup (1 degree of freedom) = 0.53; P = 0.47). On multivariate logistic regression, the serum level of β-hCG was the only covariate found to be significantly associated with outcome. The odds of failure increased by 0.15% for each unit increase in β-hCG (odds ratio, 1.0015 (95% CI, 1.0002-1.003); P = 0.02). In 14 women presenting with serum β-hCG of 1000-1500 IU/L, the success rate was 33% in those managed expectantly compared with 62% in those receiving methotrexate. This difference was not statistically significant and a larger sample size would be needed to give sufficient power to detect a difference in the subgroup of women with higher β-hCG. In women with successful conservative treatment, there was no significant difference in median β-hCG resolution times between study arms (17.5 (interquartile range (IQR), 14-28.0) days (n = 30) in the methotrexate group vs 14 (IQR, 7-29.5) days (n = 25) in the placebo group; P = 0.73). The results of our study do not support the routine use of methotrexate for the treatment of clinically stable women diagnosed with tubal ectopic pregnancy presenting with low serum β-hCG (< 1500 IU/L). Further work is required to identify a subgroup of women with tubal ectopic pregnancy and β-hCG ≥ 1500 IU/L in whom methotrexate may offer a safe and cost-effective alternative to surgery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Comparación entre una sola dosis de metotrexate sistémico y la conducta expectante en el tratamiento de casos de embarazo ectópico tubárico: un ensayo aleatorio controlado con placebo RESUMEN OBJETIVO: El metotrexate se utiliza de modo rutinario en todo el mundo para el tratamiento de las mujeres clínicamente estables con un embarazo ectópico tubárico. Esto sucede a pesar de la falta de evidencia rigurosa que demuestre que su eficacia es superior a la conducta expectante. El objetivo de este ensayo controlado aleatorio multicéntrico fue comparar las tasas de éxito del metotrexate con las de un placebo para el tratamiento cauteloso del embarazo ectópico tubárico. MÉTODOS: Este estudio se llevó a cabo en dos clínicas de control de gestación temprana en el Reino Unido entre agosto de 2005 y junio de 2014. Los criterios de inclusión fueron mujeres clínicamente estables con un diagnóstico ecográfico concluyente de embarazo ectópico tubárico, las cuáles presentaban una concentración sérica baja de la β hormona coriónica gonadotrópica (β-hCG) inferior a 1500 UI/L. Las mujeres fueron asignadas aleatoriamente a una sola inyección sistémica de 50 mg/m2 de metotrexate o a placebo. El resultado primario fue un indicador binario del éxito del tratamiento conservador, definido como la resolución de los síntomas clínicos y la disminución en el suero de la β-hCG a <20 UI/L o una prueba de embarazo negativa en orina sin la necesidad de ninguna intervención médica adicional. Se hizo un análisis por intención de tratar. Se reclutó un total de 80 mujeres; a 42 de ellas se les asignó el metotrexate y a 38 el placebo. Los grupos del estudio se realizaron en función de la edad, el origen étnico, los antecedentes obstétricos, las características del embarazo y los niveles séricos de la β-hCG y la progesterona. Las tasas de éxito fueron similares para los dos grupos de estudio: 83% con metotrexate y 76% con placebo. En el análisis univariante, esta diferencia no fue estadísticamente significativa (χ2 (1 grado de libertad) = 0,53; P = 0,47). En la regresión logística multivariante, el nivel sérico de la β-hCG fue la única covariable que se encontró significativamente asociada con el resultado. Las probabilidades de fracaso aumentaron en un 0,15% por cada unidad de aumento de la β-hCG (cociente de probabilidad 1,0015 (IC 95%, 1,0002-1,003); P = 0,02). La tasa de éxito en las 14 mujeres con un nivel sérico de la β-hCG de 1000-1500 UI/L fue del 33% en las tratadas con conducta expectante frente al 62% en las que recibieron metotrexate. Esta diferencia no fue estadísticamente significativa, por lo que se necesitaría un tamaño de muestra mayor, lo suficiente como para poder detectar diferencias en el subgrupo de mujeres con una β-hCG más elevada. En las mujeres en las que el tratamiento conservador tuvo éxito, no hubo una diferencia significativa en la mediana de los tiempos de resolución de la ß-hCG entre los grupos del estudio (17,5 (amplitud intercuartílica (IQR), 14-28,0) días (n = 30) en el grupo de metotrexate frente a 14 (IQR, 7-29.5) días (n = 25) en el grupo de placebo; P = 0,73). Los resultados de este estudio no apoyan el uso rutinario de metotrexate para el tratamiento de las mujeres clínicamente estables diagnosticadas con un embarazo ectópico tubárico que presenta un nivel sérico bajo la β-hCG (<1500 UI/L). Serán necesarios estudios adicionales para identificar un subgrupo de mujeres con embarazo ectópico tubárico y β-hCG ≥1500 UI/L para quienes el metotrexate puede ofrecer una alternativa segura y rentable en comparación con la cirugía. : : ,,。。 : 2005820146,2。,,β(beta human chorionic gonadotropin,β-hCG)<1500 IU/L。,(50 mg/m<sup2</sup )。,β-hCG<20 IU/L,。。 : 80,42,38。2、、、β-hCG。2:83%,76%。,[χ<sup2</sup (1)=0.53;P=0.47]。logistic,β-hCG。β-hCG,0.15%[,1.0015(95% CI,1.0002~1.003);P=0.02]。14β-hCG1000~1500 IU/L,33%,62%。,β-hCG。,2β-hCG(P=0.73),17.5[(interquartile range,IQR),14~28.0](n=30),14 (IQR,7~29.5)(n=25)。 : 、、β-hCG(<1500 IU/L)。,β-hCG>1500 IU/L、。.

[What values should be used to diagnose microalbuminuria in patients with diabetes mellitus?].

Diabetic nephropathy (DN) is a complication of diabetes mellitus (DM) associated with increased morbi-mortality. The identification of individuals at high risk for DN will make its prevention more effective. Urinary albumin excretion rate (UAER) is still the best marker for DN development and progression. It is also a major risk factor for macrovascular disease. High-normal albuminuria (< 20 microg/min) is still associated with development of micro- and macroalbuminuria. UAER has a continuous relationship with the development of renal and cardiovascular disease, without a cutoff point from which there is a highly increased risk. However, in clinical practice we need a reference value in order to guide the patient's treatment. Some evidence indicates values of UAER between 5 and 10 microg/min as a new cutoff point for the diagnosis of microalbuminuria. In conclusion, the association between UAER and the renal and cardiovascular outcomes seems to be continuous and is already present with UAER within the normal range. The adoption of a UAER value around 5 to 10 microg/min as risky could identify patients that should receive earlier and more aggressive treatment of modifiable risk factors.

Severity of preeclampsia: data from a high specialty hospital in Mexico City.

La severidad de la preeclampsia puede variar según la población en estudio. Identificar la frecuencia y el tipo de datos de severidad de la preeclampsia en pacientes atendidas en una unidad médica de alta especialidad de la Ciudad de México. Estudio observacional, retrospectivo y transversal de una serie de 100 pacientes embarazadas con preeclampsia grave atendidas en un hospital de tercer nivel de la Ciudad de México, del 1 de agosto al 31 de diciembre de 2018. Se registraron los datos de severidad de la preeclampsia descritos por el American College of Obstetricians and Gynecologists en 2013 y 2019. Las variables se ordenaron en cuantitativas y cualitativas. Se utilizó estadística descriptiva con el programa SPSS versión 20. Edad materna de 30.45 ± 6.95 años y edad gestacional de 33.03 ± 4.09 semanas. Datos cuantitativos: presión arterial sistólica ≥ 160 mmHg en el 78%, presión arterial diastólica ≥ 110 mmHg en el 35%, aspartato aminotransferasa > 70 U/l en el 33%, deshidrogenasa láctica > 600 U/l en el 32%, cuenta plaquetaria < 100,000 plaquetas/ml en el 30% y creatinina sérica > 1.1 mg/dl en el 8%. Datos cualitativos: cefalea en el 61%, dolor epigástrico en el 37%, hiperreflexia en el 33%, dolor en el hipocondrio derecho en el 8%, acúfenos en el 7%, fosfenos en el 7%, eclampsia en el 3%, visión borrosa en el 2%, hematoma hepático no roto en el 1% y amaurosis en 1%. No hubo ninguna muerte materna. Los datos de severidad más frecuentes -fueron cuantitativos (presión arterial sistólica y diastólica), relacionados con síntomas y signos neurológicos de vasoespasmo (cefalea, hiperreflexia) y con síntomas de origen hepático (dolor epigástrico, dolor en hipocondrio derecho). The severity of preeclampsia may vary according to the features of the population being studied. Identify the frequency and type of data related to severity of pre-eclampsia in patients treated in a highly specialized medical unit in Mexico City. Observational, retrospective and cross-sectional study, which included a series of 100 pregnant patients with severe pre-eclampsia, attended at a third level care center in Mexico City, from August 1 to December 31, 2018. Data collected on severity of preeclampsia corresponds to that described by the American College of Gynecology and Obstetrics in 2013 and 2019. Variables were ordered into quantitative and qualitative. Descriptive statistics were used with the SPSS version 20 program. Maternal age 30.45 ± 6.95 years and gestational age 33.03 ± 4.09 weeks. Quantitative data: systolic blood pressure ≥ 160 mm Hg was found in 78%, diastolic blood pressure ≥ 110 mmHg 35%, aspartate aminotransferase > 70 U/L 33%, lactic dehydrogenase > 600 U/L 32%, platelet count < 100,000 platelets/mL 30% and serum creatinine > 1.1 mg/dl 8%. Qualitative data: headache 61%, epigastric pain 37%, hyperreflexia 33%, pain in the right hypochondrium 8%, tinnitus 7%, phosphenes 7%, eclampsia 3%, blurred vision 2%, unbroken liver hematoma 1%, and amaurosis 1 %. No cases of maternal death occurred. Most frequent severity data were quantitative values (systolic and diastolic blood pressure) related to symptoms and neurological signs of vasospasm (headache, hyperreflexia), and to symptoms of hepatic origin (epigastric pain, pain in the right hypochondrium).

[Serum beta 2 microglobulin (beta 2M) following renal transplantation].

Although there was an important improvement in graft and patient survival the last 10 years, graft rejection continues to be a major barrier to the success of renal transplantation. Identification of a laboratory test that could help to diagnose graft rejection would facilitate the management of renal transplanted patients. PURPOSE--To evaluate the utility of monitoring serum beta 2M in recently transplanted patients. METHODS--We daily determined serum beta 2M levels in 20 receptors of renal grafts (10 from living related and 10 from cadaveric donors) and compared them to their clinical and laboratory evolution. RESULTS--Eight patients who presented immediate good renal function following grafting and did not have rejection had a mean serum beta 2M of 3.7 mg/L on the 4th day post transplant. The sensitivity of the test for the diagnosis of acute rejection was 87.5%, but the specificity was only 46%. Patients who presented acute tubular necrosis (ATN) without rejection had a progressive decrease in their serum levels of beta 2M, while their serum creatinine changed as they were dialyzed. In contrast, patients with ATN and concomitance of acute rejection or CSA nephrotoxicity presented elevated beta 2M and creatinine serum levels. CONCLUSION--Daily monitoring of serum beta 2M does not improve the ability to diagnose acute rejection in patients with good renal function. However, serum beta 2M levels seemed to be useful in diagnosing acute rejection or CSA nephrotoxicity in patients with ATN.

[La educación multimedia como apoyo en el manejo de pacientes con diabetes tipo 2. Estudio cuasi experimental].

Evaluar la eficacia de la educación a través de un sistema de información multimedia en el control del paciente con diabetes tipo 2. Ensayo clínico abierto aleatorizado. El grupo de intervención fue instruido para consultar una herramienta educativa multimedia en la sala de espera de los consultorios, misma que fue diseñada de acuerdo a las caracteristicas de la población y centrada en automonitoreo de indicadores, información sobre diabetes tipo 2 y nutrición. Se midieron en sangre venosa las concentraciones de glucosa, hemoglobina glucosilada (HbA1c), triglicéridos, colesterol total, colesterol ligado a lipoproteínas de alta densidad (HDL-c) y colesterol ligado a lipoproteínas de baja densidad. Con la t de Student pareada se evaluó el efecto de la intervención. Se incluyeron 2334 pacientes, 958 en el grupo de intervención y 1376 en el grupo control. Se observó en el grupo de intervención un incremento del HDL-c (de 40.45 a 47.40 mg/dl; p = 0.001) y una disminución de los triglicéridos (de 227.78 a 210.38 mg/dl; p = 0.001). En el grupo control disminuyeron los triglicéridos (de 232.64 a 210.84 mg/dl; p = 0.016). En ambos grupos se incrementó de forma significativa el colesterol total. No se observaron cambios en los valores de glucosa y HbA1c posterior a la intervención. La implementación de un sistema de información multimedia mejora el HDL-c y los triglicéridos del paciente con diabetes. Se requiere un reforzamiento continuo de la intervención educativa por parte del profesional de la salud para incidir en el control glucémico y otros indicadores del control metabólico. To evaluate the efficacy of education through a multimedia information system, in controlling patients with type 2 diabetes. Randomized open clinical trial. The intervention group was trained to consult an educative multimedia tool in the waiting room, which was developed according to the population characteristics and centered on monitoring indicators, information on type 2 diabetes and nutrition. Venous blood concentrations of glucose, glycated hemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured. Paired t Student was used to assess the effect of the intervention. 2,334 patients were included, 958 in the intervention group and 1,376 in the control group. In the intervention group, an increase in HDL-c values was observed (from 40.45 to 47.40 mg/dL; p=0.001) as well as a descent on triglycerides values (from 227.78 to 210.38 mg/dL; p=0.001). There was a reduction on triglycerides levels in the control group (from 232.64 to 210.84 mg/dL; p=0.016). There was a significative increase in total cholesterol values in both groups. There were no changes in the mean values of glucose and HbA1c after the intervention. Implementation of a multimedia information system improves HDL-c and triglycerides in patients with diabetes. There is a need for a continuous reinforcement of the educative intervention by health professionals to improve glycemic and other indicators in metabolic control.

[Urinary excretion of sodium and magnesium in idiopathic hypercalciuria].

We have studied urinary sodium and magnesium excretion in 30 normal subjects (15 women and 15 men, mean age 43 +/- 14 years, mean weight 74 +/- 18 Kg) and in 60 hypercalciuric stone-forming patients, 30 with renal hypercalciuria (HR) (15 women and 15 men, mean age 39 +/- 10 years, mean weight 71 +/- 16 Kg) and 30 with absorptive hypercalciuria (HA), (15 women and 15 men, mean age 41 +/- 13 years, mean weight 69 +/- 12 Kg). The diagnosis of hypercalciuria and the classification in HA and HR was made with our ambulatory study protocol. Hypercalciuria was defined by a daily calcium excretion above 300 mg (men) or 220 mg (women), and patients with fasting calcium to creatinine ratio, and calcium per 100 ml of glomerular filtrate average value above 0.11 were considered to have HR. Control subjects and hypercalciuric patients were maintained on a diet containing 1200 mg Ca, 800 mg P, 200 mg Mg and 100 mmol Na per day for a 7-day period. Two 24-hour urine samples were collected on days 6 and 7 of this diet. On the morning of day 8, following a 12-hour fast, 300 ml of distilled water was drunk and a 2-hour urine sample was collected. A blood sample was taken halfway this time. In all blood and urine samples, calcium, magnesium, sodium, phosphorus and creatinine were quantified. Creatinine clearance and calcium, sodium and magnesium per 100 ml of glomerular filtrate were calculated from these determinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Idiopathic Myointimal Hyperplasia of the Mesenteric Veins Is a Peculiar Venous Ischemia That May Be Diagnosed Before Surgery.

Idiopathic myointimal hyperplasia of the mesenteric veins is a segmental ischemia associated with noninflammatory hyperplasia of the intimal smooth muscle of the mesenteric veins. Owing to its rarity, timely diagnosis is often difficult. The goal of this study was to improve clinical practice in terms of the diagnosis of idiopathic myointimal hyperplasia of the mesenteric veins. This was a retrospective observational study. This study was conducted in a single institution with case collection from clinical archives. Data from 12 cases of idiopathic myointimal hyperplasia of the mesenteric veins were retrieved from 2006-2020. Most patients were elderly men, with a male-to-female ratio of 10:1. Clinical, endoscopic, radiologic, and pathologic characteristics of idiopathic myointimal hyperplasia of the mesenteric veins served as outcome measures. Radiologically, marked segmental mural thickening and poor enhancement involved the sigmoid colon and rectum in most cases, with extension to the descending colon in some cases. Typical cases showed obliteration of the inferior mesenteric veins and collateral vessels. Colonoscopic findings were reminiscent of ischemia or ulcerative colitis, but sharp demarcation from the uninvolved segment was the most distinguishing feature. Surgically resected specimens showed marked segmental mural thickening, edema, and mucosal discoloration grossly. Microscopically, thick-walled, tortuous veins were observed mainly in the submucosa and subserosa, and the submucosa was markedly thickened in all cases. The subserosal large veins showed myointimal hyperplasia, and pericolic fat necrosis was invariably observed. The most useful histologic finding in biopsy material was tortuous, arteriolized mucosal capillaries with occasional fibrinoid necrosis. This study was limited by its small number of cases and selection bias; there was also no prospective external validation. Radiologic and pathologic features of idiopathic myointimal hyperplasia of the mesenteric veins are distinct from those of ulcerative colitis or nonspecific ischemic colitis. Careful interpretation of endoscopic and radiologic images and generous biopsies with interpretation by experienced pathologists might lead to an early diagnosis and prevent unnecessary medical treatment. See Video Abstract at http://links.lww.com/DCR/B806. ANTECEDENTES:La hiperplasia miointimal idiopática de las venas mesentéricas es una isquemia segmentaria asociada con hiperplasia no inflamatoria del músculo liso de la íntima de las venas mesentéricas. Debido a su rareza, el diagnóstico oportuno suele ser difícil.OBJETIVO:Mejorar la práctica clínica con respecto al diagnóstico de hiperplasia miointimal idiopática de venas mesentéricas.DISEÑO:Estudio observacional retrospectivo.AJUSTES:Institución única, colección de casos de archivos clínicos.PACIENTES:Se recuperaron datos de 12 casos de hiperplasia miointimal idiopática de las venas mesentéricas durante el período 2006-2020. La mayoría de los pacientes eran hombres de edad avanzada, con una proporción de hombres a mujeres de 10:1.PRINCIPALES MEDIDAS DE RESULTADO:Características clínicas, endoscópicas, radiológicas y patológicas de la hiperplasia miointimal idiopática de las venas mesentéricas.RESULTADOS:Radiológicamente, se vio marcado engrosamiento mural afectando de manera segmentaria y escaso realce que comprometieron al colon sigmoides y al recto en la mayoría de los casos, con extensión al colon descendente en algunos casos. Los casos típicos mostraron obliteración de las venas mesentéricas inferiores y vasos colaterales. Los hallazgos colonoscópicos recordaban a la isquemia o la colitis ulcerosa, pero la demarcación nítida del segmento no afectado fue la característica más distintiva. Las piezas quirúrgicas mostraron un marcado engrosamiento mural de manera segmentaria, edema y decoloración de la mucosa de forma macroscópica. Microscópicamente, se observaron venas tortuosas de paredes engrosadas principalmente en la submucosa y subserosa y la submucosa se encontraba marcadamente engrosada en todos los casos. Las grandes venas subserosas mostraban hiperplasia de la mioíntima e invariablemente se observaba necrosis grasa pericólica. El hallazgo histológico más útil en el material de biopsia fueron los tortuosos capilares arteriolizados de la mucosa con necrosis fibrinoide ocasional.LIMITACIONES:Pequeño número de casos; sesgo de selección; sin validación externa prospectiva.CONCLUSIONES:Las características radiológicas y patológicas de la hiperplasia miointimal idiopática de las venas mesentéricas son distintas a las de la colitis ulcerosa o la colitis isquémica no específica. La interpretación cuidadosa de las imágenes endoscópicas y radiológicas y múltiples biopsias de manera generosa con la interpretación de patólogos experimentados pueden conducir a un diagnóstico temprano y prevenir tratamientos médicos innecesarios. Consulte Video Resumen en http://links.lww.com/DCR/B806. (Traducción-Dr Osvaldo Gauto).

[Unknown significance monoclonal gammopathy (USMG) and primary hyperparathyroidism (PH) on diferential diagnosis of hypercalcemia: case report].

The monoclonal gammopathy of undetermined significance (USMG) is a pre-malignant rare asymptomatic disease, defined by a concentration of immunoglobulin in serum monoclonal more than 3 g/dL and a proportion of plasma cells in bone marrow more than 10% in the absence of lytic bone lesions, anemia, hypercalcemia and renal failure related to monoclonal cell proliferation. Primary hyperparathyroidism (PH) is a relatively frequent disease, affecting approximately one in 1,000 individuals. Some studies suggest that the frequency of PH is increased in cancer, broadening the spectrum of etiology of hypercalcemia in these patients. We report here a case of a 63 years-old patient admitted for investigation of anemia, paresthesias, pain in the lower limbs and kidney failure. During investigation, there was hypercalcemia, serum monoclonal peak of IgA/lambda without criteria for multiple myeloma and with parathyroid adenoma. Patient was submitted to parathyroidectomy, which anatomicopathological revealed parathyroid adenoma. After surgery, levels of calcium and kidney function returned to normal.

Prevalence of hypoalbuminemia and nutritional issues in hospitalized elders.

to estimate the prevalence of hypoalbuminemia in hospitalized elders, related to socio-demographic variables, nutritional status and length of stay. crosscutting study with 200 patients hospitalized in a large hospital in the South of Brazil during three months. Evaluations, lab tests and interviews through questionnaires were performed. the average albuminemia was 2,9 ± 0,5g/dL. Hypoalbuminemia was diagnosed in 173 subjects (87%) and was absent in 27 (13%) that have normal albuminemia (p=0,000). After six days of hospitalization, the prevalence of low levels grew significantly to 90% (p=0,002), average 2,7 ± 0,5g/dL. Using the Mini Nutritional Assessment, it was observed that 41 patients were malnourished and from those, 40 had hypoalbuminemia. the prevalence of hypoalbuminemia proved to be high, in approx. nine in ten elders, and the nutritional status and the length of stay proved to be related to the decrease of serum albumin levels. Thus, it is suggested that monitoring albumin levels should be done to evaluate the risk that the patient has to develop malnutrition and other complications during hospital stays. estimar a prevalência de hipoalbuminemia em idosos hospitalizados, em relação às variáveis sociodemográficas, estado nutricional e tempo de internação. estudo transversal, com 200 pacientes internados em hospital de grande porte do sul do Brasil, durante o período de três meses. Foram realizadas avaliações, análise de exames laboratoriais e entrevista através de questionário. a média de albuminemia foi 2,9 ± 0,5g/dL. O diagnóstico de hipoalbuminemia, foi encontrado em 173 sujeitos (87%), e não revelado em 27 (13%), que apresentaram albuminemia normal (p=0,000). Constatou-se que após seis dias de internação a prevalência de níveis baixos aumentou significativamente para 90% (p=0,002), com média de 2,7 ± 0,5g/dL. Utilizando-se a Mini Avaliação Nutricional, observou-se que 41 pacientes estavam desnutridos, e que destes, 40 apresentavam hipoalbuminemia. a prevalência de hipoalbuminemia mostrou-se elevada, acometendo aproximadamente nove entre dez idosos, sendo que o estado nutricional, da mesma maneira que o tempo de internação , está relacionado à diminuição dos níveis de albumina sérica. Assim, sugere-se monitorar os níveis de albuminemia para avaliar o risco que o paciente tem de desenvolver desnutrição e demais complicações durante a internação hospitalar. estimar la prevalencia de hipoalbuminemia en ancianos hospitalizados, considerando las variables sociodemográficas, estado nutricional y tiempo de internación. estudio transversal, en 200 pacientes internados en hospital de gran porte del sur de Brasil, durante un período de tres meses. Fueron realizadas evaluaciones, análisis de exámenes de laboratorio y se realizó una entrevista usando un cuestionario. el promedio de albuminemia fue 2,9 ± 0,5g/dL. El diagnóstico de hipoalbuminemia, fue encontrado en 173 sujetos (87%), y no revelado en 27 (13%), que presentaron albuminemia normal (p=0,000). Se constató que después de seis días de internación la prevalencia de niveles bajos aumentó significativamente para 90% (p=0,002), con promedio de 2,7 ± 0,5g/dL. Utilizando la Mini Evaluación Nutricional, se observó que 41 pacientes estaban desnutridos, y que de estos, 40 presentaban hipoalbuminemia. la prevalencia de hipoalbuminemia se mostró elevada, afectando aproximadamente nueve entre diez ancianos, siendo que el estado nutricional, de la misma manera que el tiempo de internación, está relacionado a la disminución de los niveles de albúmina sérica. Así, se sugiere monitorizar los niveles de albuminemia para evaluar el riesgo que el paciente tiene de desarrollar desnutrición y demás complicaciones durante la internación hospitalaria.

[Arterial pressure and urinary excretion of albumin in adults with sickle cell disease].

The increase of urinary albumin excretion could be associated with morbidity in patients with sickle cell disease. The objective of this study was to evaluate the relation between blood pressure and urinary albumin excretion, and to estimate the prevalence of hypertension according to the level of urinary albumin excretion. A cross-sectional study was carried in 77 patients with sickle cell disease (48 patients with haemoglobin SS, 29 with haemoglobin SC) et 30 controls with haemoglobin AA. The patients with sickle cell disease were divided into 3 groups according to urinary albumin excretion: less than 30 mg daily (group I: normoalbuminuria); from 30 to 300 mg daily (group II: microalbuminuria); above 300 mg daily (group III: macroalbuminuria). All AA selected controls had normoalbuminuria (group IV). In normoalbuminuric patients, the average of blood pressure was significantly lower in patients with sickle cell disease than in controls (respectively 115.0 +/- 8.1 vs 132.1 +/- 15.1, p = 4.10(-6) for systolic pressure and 67.2 +/- 8.0 vs 78.8 +/- 9.8 mmHg, p = 10(-4) for diastolic pressure). There was a positive relation between urinary albumin excretion, even moderate (values < or = 300 mg daily) and blood pressure in SS patients (r = 0.40, p < 0.02 for systolic and r = 0.54, p < 0.01 for diastolic pressure) and in SC patients (r = 0.74, p < 0.001 and r = 0.58, p < 0.01). The prevalence of hypertension was 0% in group I, 25% in group II and 66% in group III. The positive association between blood pressure and urinary albumin excretion suggests that the latter should be taken into account in sickle cell disease's follow up.

Third trimester gestational anemia: frequency and severity according to maternal age.

La anemia es muy frecuente durante el embarazo y tiene repercusiones en la madre y en su hijo. Determinar la frecuencia y la gravedad de la anemia gestacional del tercer trimestre (hemoglobinemia < 11 g/dl), según la edad materna de los nacimientos atendidos en el Hospital Vicente Corral, entre septiembre de 2016 y febrero de 2017. Estudio transversal. Muestra: 428 gestantes. Criterios de inclusión: embarazadas con ≥ 27 semanas de gestación, reporte de hemoglobina y neonato vivo. Criterios de exclusión: embarazo gemelar, neonato con malformaciones congénitas mayores, madre con enfermedades crónicas. Análisis estadístico: para las variables cuantitativas se calcularon la mediana y los valores mínimo y máximo; para las variables cualitativas, las frecuencias absolutas y relativas; para establecer una asociación se utilizó la prueba de ji al cuadrado, y para la significancia estadística se consideró p < 0.05. La mediana de edad materna fue de 23 años y 4 meses. Hemoglobina en mujeres: anémicas 9.9 g/dl, no anémicas 12.2 g/dl (p = 0.000). Frecuencia de anemia: global 31.8%, en < 20 años 41.5%, en 20-34 años 26.5% y en > 35 años 35.6%. Gravedad de la anemia: leve 18.7%, moderada 12.6%, grave 0.5%. La edad materna influyó en la frecuencia de la anemia (ji al cuadrado de Pearson = 8.911, p = 0.012), pero no en su gravedad (ji al cuadrado de Pearson = 1.078, p = 0.898). Frecuencia de microcitosis: 36.9% en mujeres anémicas. El volumen corpuscular medio y la gravedad de la anemia mostraron asociación (p = 0.019). La frecuencia de la anemia en el tercer trimestre de la gestación fue alta, con predominio de la anemia leve. Afectó en especial a mujeres < 20 años y ≥ 35 años. Anemia is very frequent condition in pregnant women and it has repercussions for both mother and child. Determine the frequency and severity of third trimester gestational anemia (hemoglobinemia < 11 g/dL) according to maternal age, in women whose child was born at the Hospital Vicente Corral, between September 2016 and February 2017. Transversal study. Sample: 428 pregnant women. Inclusion criteria: pregnancy of ≥ 27 weeks, hemoglobin report and live neonate. Exclusion criteria: twin newborns, neonate with major congenital malformations, mother with chronic diseases. Statistical analysis: in the quantitative variables, median, minimum and maximum values were calculated; in qualitative variables, absolute and relative frequencies were obtained; to demonstrate association Chi square was used and for statistical significance p-valor < 0.05. Median for maternal age: 23 years 4 months. Hemoglobin: in anemic women 9.9 g/dl, in non-anemic 12.2 g/dl (p = 0.000). Anemia frequency: overall 31.8%, in < 20 years 41.5%, in women 20-34 years 26.5% and in > 35 years 35.6%. Severity of anemia: mild 18.7%, moderate 12.6, severe 0.5%. Maternal age influenced the frequency of anemia (Pearson’s Chi square = 8.911, p-value = 0.012), but not in its severity (Pearson’s Chi square = 1.078, p-value = 0.898). Microcytosis frequency was 36.9% in anemic women. The mean corpuscular volume was associated with the severity of the anemia (p-value = 0.019). The frequency of anemia in the third trimester of pregnancy was high, the mild anemia was predominant. It mainly affected women < 20 and > 35 years old.

[Alpha 1-microglobulin in the urine and serum in proteinuria and kidney insufficiency].

Alpha-1-microglobulin (alpha-1-m) is a low molecular weight glycoprotein (mw 25-33 KD) that is filtered through the glomeruli and reabsorbed in the proximal parts of the renal tubules where it is catabolized. Normal ranges were established for alpha-1-m (100 healthy controls) in serum (20-42 mg/l) and urine (3.5-8 mg/l). Alpha-1-m was then measured in 341 urine samples whose protein pattern had been classified as "pathologic" and "normal" according to microelectrophoresis. Increased alpha-1-m concentrations were found in 266 out of 280 pathologic urines (5% false negative) and in 3 out of 61 normal urines (4% false positive). Beta-2-microglobulin (beta-2-m), total protein or protein test strips showed a poorer correlation to the electrophoretic results. Measurement of alpha-1-m is, therefore, the most sensitive of these methods for the detection of proteinuria. In 90 patients with low molecular weight proteinuria and either with or without renal insufficiency alpha-1-m concentrations were determined in both urine and serum. While all patients had elevated urinary alpha-1-m concentrations, increased serum values were only found in renal insufficiency (Ccrea less than 100 ml/min). Independently of these results, we were also able to establish that increased alpha-1-m levels are found at decreased glomerular filtration rates (Ccrea less than 70 ml/min). Pathologic alpha-1-m concentrations therefore only allow the conclusion of isolated tubular impairment when the GFR is greater than 70 ml/min.(ABSTRACT TRUNCATED AT 250 WORDS)

Introducción: la gestación y lactancia están relacionadas con pérdidas temporales en la densidad mineral ósea (DMO) materna. Una suplementación con calcio podría resultar beneficiosa para evitar la pérdida de masa ósea del esqueleto materno. Otros nutrientes como los prebióticos han sido identificados como responsables de un incremento en la absorción de minerales, pudiendo condicionar la mineralización ósea.Objetivo: estudiar el efecto de la suplementación de la dieta materna con el prebiótico inulina enriquecida con oligofructosa, durante la gestación y la lactancia sobre el contenido mineral óseo (CMO) y la DMO al final del periodo de lactancia.Métodos: las ratas gestantes fueron alimentadas con dieta estándar (grupo CC), dieta fortificada en calcio (grupo Ca) o enriquecida con el prebiótico inulina enriquecida con oligofructosa (grupo Pre) hasta el final del periodo de lactancia. Posteriormente se evaluó el CMO y DMO por absorciometría de rayos X (DEXA) y el pH del contenido cecal.Resultados:en términos generales, el grupo Pre presenta los mayores valores absolutos de CMO y DMO de entre los tres grupos, siendo en la tibia significativamente diferentes en los grupos CC y Pre frente al grupo Ca. El pH del contenido cecal del grupo Pre es significativamente inferior al de los grupos CC y Ca.Conclusión:la suplementación con inulina enriquecida con oligofructosa, en condiciones nutricionales no deficientes en calcio, durante la gestación y la lactancia, ejerce una protección del esqueleto materno en las ratas y puede ser considerada como una estrategia nutricional para proteger la masa ósea materna en el periodo perinatal.

[Clinico-diagnostic usefulness of the determination of beta 2 microglobulin in pleural fluids. Preliminary results].

The authors evaluated by RIA the concentration of beta-2-microglobulin in pleural fluids of different origin (neoplastic, tuberculous, and others). They conclude that beta-2-microglobulin is not useful to make an etiological diagnosis.

La Renga discography

{| |Esquivando Charcos (1991) 1. "Somos Los Mismos de Siempre" 2. "Moscas Verdes, Para El Charlatán" 3. "Embrolos, Fatos y Paquetes" 4.''' "Luciendo Mi Saquito Blusero"5. "Voy a Bailar a La Nave del Olvido"6. "Buseca y Vino Tinto"7. "El Juicio del Ganso"8. "Negra Mi Alma, Negro Mi Corazón"9. "Blues de Bolivia" |--- |A Dónde Me Lleva La Vida (1994)1. "El Camino del Deshielo"2. "Cortala y Olvidala"3. "El Rito de Los Corazones Sangrando"4. "Blues Cardíaco"5. "Pis y Caca"6. "El Sátiro de La Mala Leche"7. "El Mambo de La Botella"8. "Debbie El Fantasma"9. "El Circo Romano"10. "2+2=3"11. "Triste Canción de Amor" |--- |Despedazado por Mil Partes (1996)1. "Desnudo Para Siempre (o Despedazado por Mil Partes)"2. "A La Carga Mi Rocanrol"3. "El Final Es En Donde Partí"4. "La Balada del Diablo y La Muerte"5. "Cuando Vendrán"6. "Psilocybe Mexicana"7. "Paja Brava"8. "Lo Fragil de La Locura"9. "Veneno"10. "El Viento Que Todo Empuja"11. "Hablando de La Libertad" |---

Fecal Incontinence and Neurogenic Bowel Dysfunction in Women With Traumatic and Nontraumatic Spinal Cord Injury.

In the literature on chronic spinal cord injury, neurogenic bowel dysfunction has not gained as much attention as bladder dysfunction, the traditional cause of morbidity and mortality. The purpose of this study was to investigate the prevalence of fecal incontinence and conditions associated with fecal incontinence in women with spinal cord injury. In this cross-sectional study, data were obtained from an electronic medical chart database containing standardized questionnaires. The study was conducted at the Clinic for Spinal Cord Injuries, Rigshospitalet, where patients from Eastern Denmark are followed every second year. Women who sustained a spinal cord injury between September 1999 and August 2016 and attended a consultation between August 2010 and August 2016 were included. If the bowel function questionnaire had never been answered, the woman was excluded. The newest completed questionnaire regarding bowel function, urinary bladder function, quality of life, neurologic level/completeness/etiology of injury, mobility status, and spousal relationship was obtained from each woman. Among the 733 identified women, 684 were included, of whom only 11% had a complete motor injury. A total of 35% experienced fecal incontinence, varying from daily to less than monthly, and 79% experienced bowel dysfunction. Fecal incontinence was associated with urinary incontinence and decreased satisfaction with life in general and psychological health. In the multivariate logistic regression analysis, the odds of daily-monthly fecal incontinence increased significantly with increasing age, myelomeningocele as etiology of injury, a more complete paraplegic injury, use of wheelchair permanently, and follow-up <3 months. There were missing data in the study, including 12% with no answer to the fecal incontinence question. Fecal incontinence is a severe problem that affects more than one third of women with spinal cord injury and is associated with decreased quality of life. The present study emphasizes that women with myelomeningocele, a more complete paraplegic injury, older age, short follow-up period, and permanent wheelchair use have an increased risk of fecal incontinence. See Video Abstract at http://links.lww.com/DCR/A985. INCONTINENCIA FECAL Y DISFUNCIÓN NEUROGÉNICA DEL INTESTINO EN MUJERES CON LESIÓN DE LA MEDULA ESPINAL TRAUMÁTICA Y NO TRAUMÁTICA: En la literatura sobre la lesión crónica de la médula espinal, la disfunción neurógena del intestino no ha ganado tanta atención como la disfunción de la vejiga, la causa tradicional de morbilidad y mortalidad. OBJETIVÓ:: Investigar la prevalencia de la incontinencia fecal y las condiciones asociadas con la incontinencia fecal en mujeres con lesión de la médula espinal. DISEÑO:: En este estudio transversal, los datos se obtuvieron de una base de datos de registros médicos electrónicos que contenía cuestionarios estandarizados. CONFIGURACIÓN:: Clínica para Lesiones de la Médula Espinal, Rigshospitalet, donde los pacientes del Este de Dinamarca son seguidos cada dos años. Mujeres que sufrieron una lesión en la médula espinal entre Septiembre de 1999 a Agosto de 2016 y asistieron a una consulta entre Agosto de 2010 a Agosto de 2016. Si nunca se había respondido el cuestionario de la función intestinal, se excluyó a la mujer. Se obtuvo el cuestionario más reciente y completo sobre la función intestinal, la función de la vejiga urinaria, la calidad de vida, el nivel neurológico/integridad/etiología de la lesión, el estado de movilidad y la relación con el cónyuge. Entre las 733 mujeres identificadas, se incluyeron 684, de las cuales solo el 11% tenía una lesión de motor completa. Un total de 35% experimentó incontinencia fecal que varió de diaria a menos de mensual, y el 79% experimentó disfunción intestinal. La incontinencia fecal se asoció con incontinencia urinaria y disminución de la satisfacción de vida en general y con la salud psicológica. En el análisis de regresión logística multivariable, las probabilidades de incontinencia fecal diaria-mensual aumentaron significativamente con el aumento de la edad, el mielomeningocele como etiología de la lesión, una lesión parapléjica más completa, el uso de silla de ruedas de forma permanente y el seguimiento <3 meses. Faltaban datos en el estudio, incluyendo el 12% sin respuesta a la pregunta sobre incontinencia fecal. La incontinencia fecal es un problema grave que afecta a más de un tercio de las mujeres con lesión de la médula espinal y se asocia con una disminución de calidad de vida. El presente estudio enfatiza que las mujeres con mielomeningocele, una lesión parapléjica más completa, mayor edad, corto período de seguimiento y uso de silla de ruedas permanente tienen un mayor riesgo de incontinencia fecal. Vea el Video del Resumen en http://links.lww.com/DCR/A985.

[Risk and prevention of diabetic nephropathy].

Diabetic nephropathy is one of the most frequent causes of end-stage renal disease (ESRD), and there has been a dramatic increase in the number of patients entering renal replacement therapy in the last few years. Moreover, diabetic nephropathy is associated with elevated cardiovascular morbidity and mortality. Prevention and treatment of diabetic nephropathy is based on optimal metabolic and blood pressure control, proteinuria reduction, and renin-angiotensin-aldosterone system (RAAS) inhibition. In the normoalbuminuric patient, optimal glycemic control (HbA1c below 7.0%) plays a fundamental role in the primary prevention of ESRD. Furthermore, blood pressure levels below 130/80 mmHg are strongly recommended. In the microalbuminuric stage, strict glycemic control (HbA1c below 7.0%) likely reduces the incidence of overt nephropathy, while blood pressure values less than 130/80 mmHg are recommended. Moreover, there is evidence that inhibition of RAAS, either by angiotensin-converting-enzyme inhibitors (ACE-I) or angiotensin-receptor blockers (ARB), reduces the development of overt nephropathy, regardless of the blood pressure levels. ACE-I are recommended as the drugs of choice in type 1 diabetes, while both ACE-I and ARB are considered first-choice drugs in type 2 diabetes. Once overt proteinuria has developed, it is uncertain whether glycemic control affects the progression of nephropathy, which is strongly influenced by blood pressure and proteinuria. Optimal blood pressure levels are < 130/80 mmHg in patients with proteinuria < 1 g/day and < 120/75 mmHg in patients with proteinuria > or =1 g/day. In type 1 diabetes there is consensus on the renoprotective role of ACE-I, while in type 2 diabetes, ARB have been shown to be more effective than conventional therapy or calcium-channel blockers in slowing the progression of nephropathy. Lastly, a multifactorial therapeutic approach based on optimal glycemic control, intensive antihypertensive therapy, inhibition of RAAS, statins and aspirin is pivotal in the prevention and treatment of diabetic nephropathy.

Implications of Pathologic Findings in Cytoreductive Surgery Specimens on Treatment of Colorectal Peritoneal Metastases: Results of a Prospective Multicentric Study.

A surgical peritoneal cancer index of >20 is often used to exclude patients from cytoreductive surgery for colorectal peritoneal metastases. The pathologic peritoneal cancer index in these patients may be <20. The purpose of this study was to compare the pathologic and surgical findings and to look at potential pathologic prognostic factors. This is a prospective observational study including patients undergoing cytoreductive surgery. The study was carried out at 3 peritoneal surface malignancy centers, 1 in France and 2 in India. One-hundred patients were included from July 1, 2018, to June 30, 2019. The pathologic peritoneal cancer index, peritoneal disease distribution, pathologic response to chemotherapy, factors affecting them and their relation with surgical findings, and potential prognostic value were explored. Ninety percent had colonic primaries. Fifty-one percent had left-sided tumors. The median surgical peritoneal cancer index was 4 (range, 0-35). Upper regions were involved in 32% and small bowel regions in 26%, and their involvement increased with a higher peritoneal cancer index (p < 0.001). The median pathologic peritoneal cancer index was 2 (range, 0-27) and was less than the surgical peritoneal cancer index in 57%. A pathologic complete response was obtained in 25%. Patients with pathologic complete response received more antiepidermal growth factor receptor therapy (p = 0.008); more leucovorin, 5-fluorouracil, and oxaliplatin; and folinic acid, fluorouracilirin, irinotecan hydrochloride, and oxaliplatin (p < 0.001). In 7 patients with a surgical peritoneal cancer index of >20, pathologic peritoneal cancer index was <20 in 4 patients. Disease in the primary tumor/anastomotic site was found in ≈80%. Survival outcomes are not available. Surgical peritoneal cancer index of >20 should not be the sole factor to exclude patients from surgery, especially in responders to systemic therapies. The pathologic peritoneal cancer index, pathologic response to systemic chemotherapy, and disease distribution in the peritoneal cavity should be meticulously documented. Correlation with survival will define their future prognostic value. The primary anastomotic site is a common site for peritoneal disease and should be carefully evaluated in all patients. See Video Abstract at http://links.lww.com/DCR/B490. IMPLICACIONES DE LOS HALLAZGOS PATOLÓGICOS EN MUESTRAS DE CIRUGÍA CITORREDUCTORA EN EL TRATAMIENTO DE METÁSTASIS PERITONEALES COLORRECTALES: RESULTADOS DE UN ESTUDIO PROSPECTIVO MULTICÉNTRICO: Una ICP quirúrgica de >20 se utiliza a menudo para excluir a los pacientes de la cirugía citorreductora por metástasis peritoneales colorrectales. La PCI patológica en estos pacientes puede ser <20.Comparar los hallazgos patológicos y quirúrgicos y observar los posibles factores pronósticos patológicos.Se trata de un estudio observacional prospectivo que incluye a pacientes sometidos a cirugía citorreductora.El estudio se llevó a cabo en tres centros de malignidad de la superficie peritoneal, 1 en Francia y 2 en India.Se incluyeron 100 pacientes desde el 1 de julio de 2018 al 30 de junio de 2019.No hubo intervención terapéutica.Se exploró la ICP patológica, la distribución de la enfermedad peritoneal, la respuesta patológica a la quimioterapia, los factores que la afectan y su relación con los hallazgos quirúrgicos y el valor pronóstico potencial.El noventa por ciento tenía lesiones primarias colónicas. El 51% tenía tumores del lado izquierdo. La mediana de la ICP quirúrgica 4 [0-35]. Las regiones superiores estuvieron involucradas en el 32% y las regiones del intestino delgado en un 26% y su participación aumentó con una ICP más alta (p <0,001). La mediana de la ICP patológica fue 2 [0-27] y fue menor que la ICP quirúrgica en el 57%. Se obtuvo respuesta patológica completa en el 25%. Los pacientes con respuesta patológica completa recibieron más terapia anti-EGFR (p = 0,008) y más FOLFOX y FOLFIRINOX (p <0,001). En 7 pacientes con una ICP quirúrgica de> 20, la ICP patológica fue menor de 20 en 4 pacientes. Se encontró enfermedad en el tumor primario/anastomósis en casi el 80%.Los resultados de supervivencia no están disponibles.La ICP quirúrgica de> 20 no debería ser el único factor para excluir a los pacientes de la cirugía, especialmente en los que responden a las terapias sistémicas. La PCI patológica, la respuesta patológica a la quimioterapia sistémica y la distribución de la enfermedad en la cavidad peritoneal deben documentarse meticulosamente. La correlación con la supervivencia definirá su valor pronóstico futuro. El sitio anastomótico primario es un sitio común de enfermedad peritoneal y debe evaluarse cuidadosamente en todos los pacientes. Consulte Video Resumen en http://links.lww.com/DCR/Bxxx. (Traducción-Dr. Gonzalo Hagerman).

[Evaluation of methods for rapid microalbuminuria screening in kidney diseased patients].

One of the criteria for chronic kidney disease detection is determination of microalbuminuria. This analysis was performed to evaluate accuracy of three useful methods for microalbuminuria detection in 24h urine collection and in the morning urine specimen calculated from urine albumin creatinine ratio, or with a dipstick in patients with different kidney diseases or kidney function. Microalbuminuria was detected in 74 patients referred to the Outpatient Nephrology Department for kidney function determination or regular nephrology checking. Albumin concentration determined using immunonephelometry was lower than 300 mg/day. Discriminates cutoff values for spot urine test strip and albumin creatinin ratio in predicting 24 h protein'threshold' excretion were determined using ROC analysis. Mean value of 24 h microalbuminuria was 80.3 mg/24 h, and value >30 mg/24 h was present in 71.8% of patient. Correlation coefficients between dipstick microalbuminuria or albumin/creatinine ratio in a spot urine specimen and 24 h microalbuminuria were 0.709 and 0.598 (p<0.0001). For pathological value of 24 h microalbuminuria >30 mg/24 h, the coresponding dipstick microalbuminuria value was > or = 20 mg/L (AUC 0.849, specificity 95%, positive predictive value 97.3%), and > or = 3.55 mg albumin/mmol creatinine ratio (AUC 0.914, specificity 90% and positive predictive value 95.5%). No difference was found between dipstick mikroalbuminuria and albumin/creatinine ratio value. In addition, albumin/creatinine ratio value from 24 h urine was similar to the value obtained from the spot urine sample. Obtained results indicated that albuminuria could be determined accurately in spot urine either with the Micral test strip or with albumin creatinine ratio.

[Not Available].

Introducción: la desnutrición intrahospitalaria se ha descrito hace más de 70 años como un problema frecuente. En México se reportan cifras de entre el 20% al 50%; sin embargo no se ha estudiado su prevalencia ni su asociación con la morbilidad y mortalidad hospitalaria.Objetivos: evaluar el estado nutricional y su relación con la morbimortalidad hospitalaria en pacientes mexicanos.Métodos: cohorte prospectiva de pacientes que ingresaron en un hospital de referencia para una estancia hospitalaria mayor de 5 días. Se capturó peso, talla, índice de masa corporal (IMC), estado nutricional de acuerdo con la valoración global subjetiva (VGS) a su ingreso y egreso hospitalario, así como diagnóstico médico, complicaciones y mortalidad. Los datos fueron analizados mediante la prueba T de Student, prueba Chi-cuadrado y prueba Exacta de Fisher.Resultados: se incluyeron 610 pacientes en total, con un promedio de edad de 50,8 ± 17,32 años, 267 mujeres (43,8%) y 343 hombres (56,2%). Del total, 154 fueron catalogados con sospecha de desnutrición o desnutrición (pacientes expuestos, 25,2%) y 456 bien nutridos (pacientes no expuestos, 74,8%), con una relación de 1 a 3. La morbilidad total de la cohorte tuvo un RR = 2,70, IC 95 % (2,06-3,55) y la mortalidad con un RR = 2,64, IC 95% (1,74-4,0), siendo ambas estadísticamente significativas (p = 0,001).Conclusiones: el diagnóstico de desnutrición al ingreso hospitalario constituye un factor de riesgo para el desarrollo de complicaciones y mortalidad. Este padecimiento al ingreso en comparación con el paciente que no presenta desnutrición incrementó el riesgo de mortalidad hasta en 2.64 veces.

[High sensitivity T troponin and CA-125 as prognostic biomarkers in patients with end stage renal disease in hemodialysis].

The end stage renal disease confers a high morbidity and mortality risk, mainly due to cardiovascular disease. The cardiac T troponin and carbohydrate antigen-125 (CA-125) are useful biomarkers to determine cardiovascular prognosis in order to start preventive treatment in the high risk patients. We included patients with end stage renal disease in hemodialysis treatment. Plasma high sensitivity cardiac T troponin (hs-TNT) and CA-125 were measured at the beginning of follow up. The patients with clinical evidence of an acute myocardial infarction were excluded. Twelve month after the measurement of the biomarkers the patients were called to assess the occurrence of major adverse cardiovascular events (MACE) and hospitalizations for any reason. Eighty seven patients were included. The mean age was 5815 years, and 76% were male. The hs-TNT was elevated in 95.4% of the patients and the median value was 49 ng/l (15.3 - 214.1). CA-125 median value was 13.7 U/ml (6.1 - 52.7). The patients that presented a MACE had higher CA-125 (p< 0.03) and hs-TNT (p <0.001); and all of them had a troponin value ≥ 69.37 ng/l. The prevalence of high hs-TNT was 95.4% and of CA-125 10%. MACE were significantly higher in patients with elevated biomarkers, conferring them prognostic utility in this group of patients.