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Camacho A, Ariza MJ, Amigó N, Macías Guillén P, Sánchez Chaparro MÁ, Valdivielso P. A case of hypocholesterolemia under study. Clin Investig Arterioscler 2023; 35:244-247. [PMID: 37302939 DOI: 10.1016/j.arteri.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
Primary hypocholesterolemia (or hypobetalipoproteinemia) is a rare disorder of lipoprotein metabolism that may be due to a polygenic predisposition or a monogenic disease. Among these, it is possible to differentiate between symptomatic and asymptomatic forms, in which, in the absence of secondary causes, the initial clinical suspicion is plasma ApoB levels below the 5th percentile of the distribution by age and sex. Here we describe the differential diagnosis of a case of asymptomatic hypocholesterolemia. We studied proband's clinical data, the lipid profile of the proband and her relatives and the clinical data of the family relevant to carry out the differential diagnosis. We performed a genetic study as the diagnostic test. The information obtained from the differential diagnosis suggested a heterozygous hypobetalipoproteinemia due to PCSK9 loss-of-function variants. The diagnostic test revealed, in the proband, the presence of a heterozygous PCSK9 frame-shift variant of a maternal origin. Plasma levels of LDL cholesterol and PCSK9 of the patient and her relatives were compatible with the segregation of the variant revealed. In conclusion, the diagnostic test performed confirmed the suspected diagnosis of the proband as asymptomatic familial hypobetalipoproteinemia due to a loss-of-function variant in the PCSK9 gene.
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Affiliation(s)
- Ana Camacho
- Servicio de Medicina Interna, Hospital Infanta-Elena, Huelva, España
| | - María José Ariza
- Laboratorio de Lípidos y Arteriosclerosis, Departamento de Medicina y Dermatología, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España.
| | - Nuria Amigó
- Biosfer Teslab Metabolomics Interdisciplinary Laboratory, Instituto de Investigación Sanitaria Pere Virgili (IISPV) , Reus, Tarragona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, España
| | - Patricia Macías Guillén
- Laboratorio de Lípidos y Arteriosclerosis, Departamento de Medicina y Dermatología, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España
| | - Miguel Ángel Sánchez Chaparro
- Laboratorio de Lípidos y Arteriosclerosis, Departamento de Medicina y Dermatología, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España; Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Pedro Valdivielso
- Laboratorio de Lípidos y Arteriosclerosis, Departamento de Medicina y Dermatología, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España; Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
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Ilarraza-Lomelí H, Rojano-Castillo J, Carazo G, Flores S, Barrera-Ramírez C, Rius-Suárez MD, Ortega-Aranda H. Cardiovascular evaluation using exercise testing performed with face masks during the COVID-19 pandemic. Arch Cardiol Mex 2021; 91:12-17. [PMID: 34968377 PMCID: PMC10161863 DOI: 10.24875/acm.21000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE COVID-19 pandemic is associated with high incidence and fatality, however, non-communicable diseases remain a global public health problem with even greater morbidity and mortality. At present, there is a lag in diagnosis and treatment of patients with heart disease, particularly the performance of exercise testing (ET), due to the fear of aerosol generation and viral dissemination. Although some centers carry out the tests with the use of masks, the information is still superficial and preliminary. The objective of the study was to describe the ergometric performance observed when performing exercise tests during the COVID-19 (PANDEMIC-G) pandemic and to highlight the differences with those results carried out in another time, when there was no COVID-19 (NO PANDEMIC). METHOD A cross-sectional study was carried out. PANDEMIC-G patients underwent ET between March 2020 and December 2020, once a biological triage was done and all of them wore N95 masks. They were compared to NO PANDEMIC patients that performed an ET between March 2019 and December 2019. Demographic and ergometric variables were presented and analyzed according to their type. All p < 0.05 were considered stochastically significant. RESULTS A total of 361 ET were studied: 209 (58%) belonged to NO PANDEMIC and 152 (42%) to PANDEMIC-G. The number of ET stopped by dyspnea was greater in PANDEMIC-G (117) than in NO PANDEMIC (8). Exercise tolerance did not show significant changes. Systolic blood pressure, double product, and myocardial oxygen utilization were higher in PANDEMIC-G ET (p < 0.01). CONCLUSIONS In the COVID-era, fewer stress tests were performed, which were suspended more frequently due to dyspnea. Higher values of systolic blood pressure and myocardial oxygen utilization were observed in PANDEMIC-G as well.
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Affiliation(s)
- Hermes Ilarraza-Lomelí
- Cardiac Rehabilitation and Physical Medicine Service, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City.,Yestli Comprehensive Cardiology Unit, Mexico City
| | - Jessica Rojano-Castillo
- Cardiac Rehabilitation and Physical Medicine Service, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City.,Yestli Comprehensive Cardiology Unit, Mexico City
| | - Gonzalo Carazo
- Cardiac Rehabilitation and Physical Medicine Service, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City
| | - Saray Flores
- Cardiac Rehabilitation and Physical Medicine Service, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City
| | - Carlos Barrera-Ramírez
- Department of Cardiology, Hospital Universitario de Saltillo, Saltillo, Coahuila, Mexico
| | - María D Rius-Suárez
- Cardiac Rehabilitation and Physical Medicine Service, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City.,Yestli Comprehensive Cardiology Unit, Mexico City
| | - Hannah Ortega-Aranda
- Cardiac Rehabilitation and Physical Medicine Service, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City
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March-Villalba JA, López Salazar A, Romeu Magraner G, Serrano Durbá A, Valero Escribá ML, Ortega Checa M, Domínguez Hinarejos C, Boronat Tormo F. Analysis of pain perception associated with urodynamic testing in children over 3 years old. Actas Urol Esp 2021; 45:232-238. [PMID: 33632554 DOI: 10.1016/j.acuro.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/26/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To measure the tolerance of urodynamic testing (UDT) in the pediatric patient by means of the Visual Analog Scale (VAS). To analyze which clinical and UDT-related variables influence pain perception. MATERIAL AND METHODS Cross-sectional study of 139 pediatric patients undergoing UDT (December 2013 - May 2018). INCLUSION CRITERIA understanding and expressing their experience after UDT (preschool and school age). No adolescents were included. Measurement instrument Visual Analog Scale (0-10). Other clinical and UDT-associated variables were obtained. STATISTICAL ANALYSIS Mann-Whitney U test, Kruskal Wallis test. Spearman's rank correlation analysis (rs). Multivariate analysis through ordinal logistic regression. Significance p < 0.05. RESULTS Mean age 7.7 years (SD 2.4), median VAS score, 2 (2-6). In 41% (n = 57), the score was ≥ 4 (moderate pain). Multivariate analysis. Explanatory variables for obtaining a high VAS score: high APUDT score (identifying patient anxiety prior to UDT), sensory-motor alteration in the lower limbs, difficult bladder catheterization and the appearance of pain during the filling phase. Age and duration of the UDT have not influenced the VAS score. CONCLUSIONS Although the UDT has resulted in 40% of the pediatric patients in our study expressing discomfort or pain, it is a well-tolerated test. The variables that have influenced on pain perception were patient's anxiety prior to UDT, a sensory-motor alteration located in the lumbosacral metameres, difficult bladder catheterization and the appearance of pain during bladder filling.
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Affiliation(s)
- J A March-Villalba
- Sección de Urología Pediátrica. Hospital Universitario y Politécnico de la Fe, Valencia, España.
| | - A López Salazar
- Sección de Urología Pediátrica. Hospital Universitario y Politécnico de la Fe, Valencia, España
| | - G Romeu Magraner
- Sección de Urología Pediátrica. Hospital Universitario y Politécnico de la Fe, Valencia, España
| | - A Serrano Durbá
- Sección de Urología Pediátrica. Hospital Universitario y Politécnico de la Fe, Valencia, España
| | - M L Valero Escribá
- Enfermería de la Sección de Urología Funcional y Reconstructiva. Hospital Universitario y Politécnico de La Fe, Valencia, España
| | - M Ortega Checa
- Enfermería de la Sección de Urología Funcional y Reconstructiva. Hospital Universitario y Politécnico de La Fe, Valencia, España
| | - C Domínguez Hinarejos
- Sección de Urología Pediátrica. Hospital Universitario y Politécnico de la Fe, Valencia, España
| | - F Boronat Tormo
- Servicio de Urología. Hospital Universitario y Politécnico de La Fe, Valencia, España
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Pérez-Castañeda AI, Vázquez-de Anda GF, Cerecero-Aguirre P, Rivas-Ruíz R, Delaye-Aguilar MG, Talavera JO. Sensitivity and specificity of increased pulse pressure as a diagnostic test for K/DOQI stage III-b CKD. GAC MED MEX 2020; 156:424-429. [PMID: 33372928 DOI: 10.24875/gmm.m20000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Increased pulse pressure (IPP) is associated with an estimated glomerular filtration ≤ 60/mL/min/1.73 m2; thus, it can be useful as a diagnostic test to identify people with K/DOQI stage III-b chronic kidney disease (CKD). Objective To determine the usefulness of IPP as a diagnostic test for K/DOQI stage III-b CKD. Method Diagnostic test study that included adult patients without comorbidities, registered in the Health Workers Cohort. The CKD-EPI formula was used to calculate glomerular filtration. Pulse pressure was determined by subtracting diastolic from systolic blood pressure. Sensitivity, specificity, positive predictive value, negative predictive value and prevalence were calculated using standard formulas. A ROC curve was generated to determine the area under the curve. Results A total of 6,215 patients were included. An IPP ≥ 50 mmHg was observed to have a sensitivity of 74 %, specificity of 70 %, positive predictive value of 1 %, negative predictive value of 100 % and a prevalence of 1 %. The inflection point in the ROC curve to identify K/DOQI III-b CKD was 0.71. Conclusion An IPP ≥ 50 mmHg is useful as a diagnostic test to identify people with K/DOQI stage III-b CKD.
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Affiliation(s)
- Ana I Pérez-Castañeda
- Multidisciplinary Health Clinic, Universidad Autónoma del Estado de México, State of Mexico. Mexico
| | | | | | - Rodolfo Rivas-Ruíz
- Clinical Research Training Center, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City. Mexico
| | - María G Delaye-Aguilar
- Multidisciplinary Health Clinic, Universidad Autónoma del Estado de México, State of Mexico. Mexico
| | - Juan O Talavera
- Clinical Research Training Center, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City. Mexico
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Reyes-Urueña J, Fernàndez-López L, Force L, Daza M, Agustí C, Casabona J. Level of impact on the public health of universal human immunodeficiency virus screening in an Emergency Department. Enferm Infecc Microbiol Clin 2015; 35:434-437. [PMID: 26341042 DOI: 10.1016/j.eimc.2015.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to determine the prevalence of HIV and the acceptability of rapid testing in an emergency department (ED), Barcelona (6/07/2011 to 8/03/2013). METHOD A convenience sample was used, depending on nurse availability in the ED. Participants signed an informed consent. Results were confirmed by conventional methods. RESULT A total of 2,140 individuals were offered testing, and 5% rejected taking part (107/2,140). Three subjects (3/2,033 [0.15%]) had confirmed reactive test. Individuals with a higher education were more likely to perform a rapid HIV test in ED (P<.005). CONCLUSION A low prevalence of new HIV diagnoses was found among participants, although there was a high acceptability rate to perform rapid testing in the ED.
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Affiliation(s)
- Juliana Reyes-Urueña
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Barcelona, España
| | - Laura Fernàndez-López
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP), Madrid, España; Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Barcelona, España.
| | - Luis Force
- Unidad Funcional de Enfermedades Infecciosas, Hospital de Mataró, Consorci Sanitari del Maresme (CSdM), Mataró, Barcelona, España
| | - Manel Daza
- Servei d'Urgències, Hospital de Mataró, Mataró, Barcelona, España
| | - Cristina Agustí
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP), Madrid, España; Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Barcelona, España
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP), Madrid, España; Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Barcelona, España; Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Universidad Autónoma de Barcelona, Bellaterra, Cerdanyola, Barcelona, España
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Valdevenito J, Águila F, Naser M, Manríquez V, Wenzel C, Díaz J. Urodynamic study in women with pure stress urinary incontinence. Actas Urol Esp 2015; 39:98-103. [PMID: 25189329 DOI: 10.1016/j.acuro.2014.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe the results of urodynamic study in women with pure stress urinary incontinence symptoms, including the characteristics of the overactive detrusor. No other clinical assessments were taken into account. MATERIAL AND METHODS A retrospective study in women with urinary incontinence consecutively evaluated by urodynamic study. From a total of 710 women, only 108 (15%) with pure stress urinary incontinence symptoms were selected. Women with prior urinary incontinence surgery, pelvic organ prolapse (stage ≥iii), pelvic radiotherapy, using medication active on the lower urinary tract and neurological diseases were excluded. Infusion rate was 70 ml/min. Detrusor overactivity was induced only by cough. A standardized cough stress test with progressive cough intensity was carried out. RESULTS Reference urodynamic values for stress incontinent women are described. Urodynamic stress incontinence was observed in 79 women (73.1%), detrusor overactivity in 4 (3.7%) and mixed urodynamic diagnosis in 15 (13.8%). Test was inconclusive in 10 patients (9.2%). Two women had detrusor overactivity incontinence (1.9%). One patient had detrusor overactivity induced by cough without urodynamic stress incontinence (0.9%). There was an association between detrusor overactivity and nocturia ≥2 (P=.002; odds ratio: 3.74; 95% confidence interval: 1.22-11.39). One woman had a bladder outlet obstruction (0.9%). CONCLUSIONS In women with pure stress urinary incontinence, without knowing the outcome of other clinical assessments, urodynamic study can provide useful information to define the proper therapy.
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