Francisco José Ruiz-Ruiz

Comparison of Risk Prediction With the CKD-EPI and MDRD Equations in Acute Decompensated Heart Failure

BACKGROUND Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate (eGFR) more accurately than the Modification of Diet in Renal Disease (MDRD) equation. The aim of this study was to evaluate whether CKD-EPI equations based on serum creatinine and/or cystatin C (CysC) predict risk for adverse outcomes more accurately than the MDRD equation in a hospitalized cohort of patients with acute decompensated heart failure (ADHF). METHODS AND RESULTS A total of 526 subjects with ADHF were studied. Blood was collected within 48 hours from admission. eGFR was calculated with the use of MDRD and CKD-EPI equations. The occurrences of mortality and heart failure (HF) hospitalization were recorded. Over the study period (median 365 days [interquartile range 238-370]), 305 patients (58%) died or were rehospitalized for HF. Areas under the receiver operator characteristic curves for CKD-EPI CysC and CKD-EPI creatinine-CysC equations were significantly higher than that for the MDRD equation, especially in patients with >60 mL min(-1) 1.73 m(-2). After multivariate adjustment, all eGFR equations were independent predictors of adverse outcomes (P < .001). However, only CKD-EPI CysC and CKD-EPI creatinine-CysC equations were associated with significant improvement in reclassification analyses (net reclassification improvements 10.8% and 12.5%, respectively). CONCLUSIONS In patients with ADHF, CysC-based CKD-EPI equations were superior to the MDRD equation for predicting mortality and/or HF hospitalization especially in patients with >60 mL min(-1) 1.73 m(-2), and both CKD-EPI equations improved clinical risk stratification.

Prognostic value of serum cystatin C and N-terminal pro b-type natriuretic peptide in patients with acute heart failure

BACKGROUND Cystatin C (CysC) is a good prognostic marker in heart failure. However, there is not much information of CysC combined with other biomarkers in acute heart failure (AHF). AIM To assess prognostic value of CysC and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients hospitalized for AHF with no apparent deterioration of renal function. DESIGN Prospective, multicenter, observational study. METHODS CysC and NTpro-BNP were measured in patients consecutively admitted with a diagnosis of AHF. Patients with, NTpro-BNP concentration above 900 pg/mL and serum creatinine below 1.3mg/dL, were included for statistical analysis. End-point of the study was all-cause mortality during a 12-month follow-up. RESULTS 526 patients with AHF and NTpro-BNP concentration above 900 pg/mL were included in the study. From this group, 367 patients (69.8%) had serum creatinine below 1.3mg/dL. Receiver operating characteristic (ROC) curves were used to determine the best cut-off value for CysC. Patients with a concentration of CsyC above 1.25mg/dL had a 37.8% mortality rate, vs. 13.6% for those below cut-off (p<0.001). After Cox proportional hazard model, age, CysC, low total cholesterol and HF with preserved ejection fraction remained significantly associated with all-cause mortality during one-year follow-up. CONCLUSIONS In AHF and normal or slightly impaired renal function, performance of CysC may be superior to NT-proBNP. Hence, CysC may be the preferred biomarker in the assessment of patients with AHF and slightly impaired renal function.

Melatonin’s role in preventing toxin-related and sepsis-mediated hepatic damage: A review

The liver is a central organ in detoxifying molecules and would otherwise cause molecular damage throughout the organism. Numerous toxic agents including aflatoxin, heavy metals, nicotine, carbon tetrachloride, thioacetamide, and toxins derived during septic processes, generate reactive oxygen species followed by molecular damage to lipids, proteins and DNA, which culminates in hepatic cell death. As a result, the identification of protective agents capable of ameliorating the damage at the cellular level is an urgent need. Melatonin is a powerful endogenous antioxidant produced by the pineal gland and a variety of other organs and many studies confirm its benefits against oxidative stress including lipid peroxidation, protein mutilation and molecular degeneration in various organs, including the liver. Recent studies confirm the benefits of melatonin in reducing the cellular damage generated as a result of the metabolism of toxic agents. These protective effects are apparent when melatonin is given as a sole therapy or in conjunction with other potentially protective agents. This review summarizes the published reports that document melatonins ability to protect hepatocytes from molecular damage due to a wide variety of substances (aflatoxin, heavy metals, nicotine, carbon tetrachloride, chemotherapeutics, and endotoxins involved in the septic process), and explains the potential mechanisms by which melatonin provides these benefits. Melatonin is an endogenously-produced molecule which has a very high safety profile that should find utility as a protective molecule against a host of agents that are known to cause molecular mutilation at the level of the liver.

Cystatin C–based CKD-EPI Equations and N-Terminal Pro-B-Type Natriuretic Peptide for Predicting Outcomes in Acutely Decompensated Heart Failure

In patients with acute decompensated heart failure (ADHF), both natriuretic peptides and renal impairment predict adverse outcomes. Our aim was to evaluate the complementary prognosis role of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and the newly developed Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equations based on cystatin C (CysC) for glomerular filtration rate (GFR) estimation in ADHF patients.

Neumonitis secundaria a metotrexate

Methotrexate (MTX) is a folic acid antagonist that inhibits cellular reproduction. MTX has been shown to be an effective anti-inflammatory agent. Acute interstitial pneumonitis is the main pulmonary side effect during MTX treatment. We report a case of MTX pneumonitis in a 56-year old woman with autoimmune thrombocytopenia who presented with subacute nonproductive cough, dyspnea at rest, fever, and malaise. Chest roentgenogram demonstrated bilateral diffuse interstitial and alveolar infiltration. Infectious diseases were ruled out and methotrexate-induced pneumonitis was suspected. MTX was discontinued and methylprednisolone was prescribed. Patient improved progressively. After eight weeks, radiologic abnormalities and symptoms had disappeared.

Renal function measurements and mortality in patients with acute heart failure.

heart failure Juan-Ignacio Pérez-Calvo ⁎, Francisco José Ruiz-Ruiz , Sergio Manzano-Fernández , José Luis Morales-Rull , Francisco Javier Carrasco-Sánchez , Beatriz Amores-Arriaga , Inmaculada Paez-Rubio , Domingo Pascual-Figal c,2 a Servicio de Medicina Interna, Hospital Clínico Universitario “Lozano Blesa”, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain b Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain c Servicio de Cardiología, Hospital Universitario “Virgen de la Arrixaca”, Facultad de Medicina, Universidad de Murcia, Murcia, Spain d Servicio de Medicina Interna, Hospital Universitario “Arnau de Vilanova”, Lérida, Spain e Servicio de Medicina Interna, Hospital “Juan Ramón Jiménez”, Huelva, Spain

Prostatic tuberculosis: case report

CONTEXT Tuberculosis of the prostate has mainly been described in immunocompromised patients. However, it can exceptionally be found as an isolated lesion in immunocompetent patients. CASE REPORT We report a case of prostatic tuberculosis in a young, healthy and immunocompetent patient with unremarkable findings from intravenous urographic examination. Computed tomography showed an abscess in the prostate and Mycobacterium tuberculosis was isolated in a urine culture. Treatment with isoniazid, rifampin and pyrazinamide was successful.

Influencia de la edad en la mortalidad de pacientes con insuficiencia cardiaca

OBJECTIVE: Heart failure (HF) is one of the most frequent diagnosis in Internal Medicine Units. High age of patients is an important characteristic in these admissions. Our objective was to evaluate how age interact with mortality, to medium-term, in HF after a decompensated episode. METHOD: Through the patient medical record we obtained data about patients hospitalised in a Internal Medicine Unit, with HF diagnosis, for a year (from September 2000 to August 2001) and their survival at 1st January 2003. 215 patients were reviewed. RESULTS: During follow-up, 60 patients died (27.9% of overall). In elderly patients, we observed a higher number of women and less use of echocardiography and treatment with beta-blockers and warfarin (in patients with atrial fibrillation). In Cox proportional-hazards model, age (OR 1.043 IC 95% 1.002-1.085), days of hospitalization (OR 1.04 IC 95% 1.003-1.078), diabetes mellitus (OR 2.51 IC 95% 1.37-4.60) and do not prescribe warfarin in patients with atrial fibrillation (OR 2.71 IC 95% 1.10-6.60) were independent prognostic factors. CONCLUSIONS: Age was an important prognostic factor in patients with HF. Clinical trials should be done in patients with these characteristics. So, we can know better clinical evolution of HF in this population.

Diagnóstico a primera vistaFiebre y dolor abdominal en paciente con múltiples lesiones hepáticasFever and abdominal pain in a patient with multiple hepatic masses

Mujer de 50 anos, sin antecedentes de interes, que acudio al servicio de urgencias por fiebre, vomitos y dolor en el epigastrio y el hipocondrio derecho de 72h de evolucion. A su llegada se observo una temperatura de 38,6 1C e hipotension arterial (90/ 55mmHg) sin taquicardia. A la exploracion abdominal destacaba la existencia de dolor a la palpacion en el hipocondrio derecho con defensa muscular. El resto de la exploracion fisica no mostro alteraciones relevantes. En las exploraciones complementarias solicitadas destacaba la existencia de leucocitosis (22,6 10/l) y una cifra de hemoglobina de 11,6 g/dl con un hematocrito del 32,7%. El resto de parametros analiticos estaban en rango de normalidad (incluida gasometria arterial). Ni la radiografia de torax ni la de abdomen mostraron alteraciones significativas. En la ecografia abdominal se observo la existencia de multiples masas hepaticas, una de estas contenia aire en su interior. Se realizo una tomografia computarizada (TC) abdominal (fig. 1) y se cursaron hemocultivos. En la TC abdominal se observo la existencia de multiples masas hepaticas compatibles con metastasis, asi como la existencia de una metastasis necrosada con aire en su interior y la presencia de un pneumoperitoneo con aire en el espacio perigastrico y ligamento falciforme.

Fiebre y dolor abdominal en paciente con múltiples lesiones hepáticas

Mujer de 50 anos, sin antecedentes de interes, que acudio al servicio de urgencias por fiebre, vomitos y dolor en el epigastrio y el hipocondrio derecho de 72h de evolucion. A su llegada se observo una temperatura de 38,6 1C e hipotension arterial (90/ 55mmHg) sin taquicardia. A la exploracion abdominal destacaba la existencia de dolor a la palpacion en el hipocondrio derecho con defensa muscular. El resto de la exploracion fisica no mostro alteraciones relevantes. En las exploraciones complementarias solicitadas destacaba la existencia de leucocitosis (22,6 10/l) y una cifra de hemoglobina de 11,6 g/dl con un hematocrito del 32,7%. El resto de parametros analiticos estaban en rango de normalidad (incluida gasometria arterial). Ni la radiografia de torax ni la de abdomen mostraron alteraciones significativas. En la ecografia abdominal se observo la existencia de multiples masas hepaticas, una de estas contenia aire en su interior. Se realizo una tomografia computarizada (TC) abdominal (fig. 1) y se cursaron hemocultivos. En la TC abdominal se observo la existencia de multiples masas hepaticas compatibles con metastasis, asi como la existencia de una metastasis necrosada con aire en su interior y la presencia de un pneumoperitoneo con aire en el espacio perigastrico y ligamento falciforme.