Revista Colombiana de Reumatología (English Edition)最新文献

Introduction

The Mexican health-care system is a mixture of governmental and private institutions. The osteoporosis screening algorithm has a multiple case start-point, the most common being medical referral; however, self-screening is available where patients can arrange a bone densitometry themselves.

Objective

The aim of this study is to evaluate the impact of self-screening for osteoporosis and osteopenia among a Mexican population.

Materials and methods

A retrospective observational study was performed as a secondary outcome from an institutional cohort of patients who attended an osteoporosis center. We divided the cohort into two groups: self-referred patients and medical-referred patients.

Results

The overall prevalence of osteoporosis between the two groups was 1160 (self-referred n = 44; 29.5% vs medical-referred n = 227; 22.5%; p = .057) (OR (Odds Ratio); 95% CI (Confidence Interval): 1.44; .98–2.12) and the prevalence of osteopenia was (n = 122; 81.9% vs n = 811; 80.2%; p = .633) (OR (Odds Ratio); 95% CI (Confidence Interval): 1.11; .71–1.73).

Conclusion

There was no statistical difference between the self-referred and the medically referred patients in the overall diagnosis of osteoporosis and/or osteopenia. Nevertheless, the incidence of osteoporosis and osteopenia as an outcome for the self-referred patients was not lower than that of those with a medical referral.

The leading complication of antiphospholipid syndrome (APS) is arterial and venous thrombotic diathesis, which usually manifests as deep vein thrombosis or cerebrovascular events. However, it can occur in any blood vessel, rarely including the adrenal vessels. This can be the first manifestation of APS, and it is frequently bilateral and triggers adrenal insufficiency (Addison’s disease). It has been proposed that the initial phenomenon is thrombosis of the adrenal veins leading to infarction. Bilateral involvement is usually irreversible and requires permanent hormone replacement therapy. Unilateral involvement is even more infrequent and appears to have a better prognosis. We report the case of a 35-year-old female patient with a history of APS (repeated spontaneous abortions, livedo reticularis, presence of antiphospholipid antibodies and lupus anticoagulant), who presented with right adrenal infarction during the puerperium and whose clinical manifestation was sudden and severe lumbar pain. The diagnosis was made with contrast enhanced tomography. The patient made satisfactory progress, with no evidence of adrenal insufficiency.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect any organ or system, including the central nervous system (CNS). Cerebrovascular disease is included in its spectrum of manifestations, notable for its morbidity and mortality and associated disability. However, this presentation is very rare as an initial manifestation of SLE, particularly subdural haematoma. We present the case of a 57-year-old male patient who was admitted to a primary care centre with headache accompanied by alarm signs, documenting staggered subdural collections in the right frontal region together with a pontine intraparenchymal hemorrhage on the same side, in the context of severe pancytopenia. In the course of its evolution and complementary tests in the search for the etiology of pancytopenia, after excluding the most common causes, an autoimmune origin was concluded in the context of SLE with atypical clinical presentation.

Rowell syndrome is a rare disease which consists of lesions of lupus erythematosus and erythema multiforme in patients with a characteristic immunological pattern, given by the presence of positive antinuclear antibodies in a mottled pattern and the absence of infectious and/or pharmacologic triggers. We present a case of a 23-year-old woman with a 4-year history of recurrent episodes of vesicles and blisters, of soft consistency and erythematous base on upper and lower limbs, affecting the oral and nasal mucosa; associated with chilblains, Raynaud's phenomenon, ulcers in oral and nasal mucosa and polyarthralgia; skin biopsy reported erythema multiforme, with negative direct immunofluorescence and positive speckled pattern antinuclear antibodies, findings that fulfil the diagnostic criteria of Zeitouni et al. (2000) and Torchia et al. (2012) for the diagnosis of Rowell's syndrome.

Madelung’s deformity is a type of wrist abnormality due to premature closure of the distal radius physis. It can be associated with a wide spectrum of pathologies, and 2 main groups have been differentiated, true-Madelung and pseudo-Madelung deformity, the presence of Vickers ligament and/or an anomalous radiotriquetral ligament being features of the former. We present the case of a child with a bilateral Madelung deformity, in the context of a Léri-Weill syndrome.

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by protean clinical manifestations. Shrinking lung syndrome (SLS) is a rare pulmonary complication of this disease. It is characterized by progressive dyspnea, pleuritic chest pain, and decreased lung volume without signs of parenchymal disease. We report the observation of a 71-year-old patient with systemic lupus for 46 years, whose SLS is evoked by unexplained chronic dyspnea, convincing imaging, and respiratory functional exploration.

Brodie's abscess is a bone infection which usually presents as a subacute course. Surgical debridement followed by intravenous antibiotics has been the classical therapeutical approach. This report describes a case of a 12-year-old boy who presented with clinical, analytical, and radiological features of subacute osteomyelitis affecting distal tibia, and who was successfully managed with a prolonged course of exclusively oral antibiotics avoiding a surgical procedure. An exclusively oral antibiotherapy approach for Brodie's abscess could provide comparable success rates to surgical debridement followed by intravenous antibiotics in selected pediatric patients.

Clinical case

A 57-year-old patient with active inhaled cocaine consumption consulted for asthenia, sweating and elevated inflammatory parameters. A positive result was obtained in anti-neutrophil cytoplasmic antibodies (ANCA) type PR 3, without evidence of uptake on positron emission tomography with fluorodeoxyglucose (PET-CT). The study was completed with a renal biopsy that demonstrated a focus of acute tubular necrosis within an area of lymphoplasmacytic interstitial infiltrate with the absence of proliferative signs. The presumptive diagnosis of vasculitis associated with the consumption of toxins, cocaine adulterated with levamisole, was established.

Discussion

Since 2010, cases of levamisole-adulterated cocaine-induced vasculitis have been reported, frequently manifesting with skin lesions, the appearance of purpuric lesions on the ears being typical. The presence of renal involvement associated with pauci-immune glomerulonephritis has been described. Treatment will be abstinence from toxins; however, steroids or immunosuppressive drugs may become necessary without consensus in the clinical practice guidelines on their indication.

Introduction

During the colonial period, despite scarce knowledge and resources, doctors and apothecaries developed medical prescriptions mainly of vegetable origin for the management of multiple diseases, including gout.

Objective

To contextualise and describe the use of medical prescription in the early 19th century in the New Kingdom of Granada for the treatment of gout.

Material and methods

A documentary search of medical prescription was carried out in the Cipriano Rodríguez Santamaría Historical Archive of the Octavio Arizmendi Posada Library of the University of La Sabana. Subsequently, an open literature review was carried out in the ScienceDirect, ClinicalKey, and Scielo databases in English and Spanish.

Results

Pistacia lentiscus, the basis of the recipe described, has a high content of terpenes, tannins, flavonoids, and coumarins, which generate anti-inflammatory, antimicrobial, antioxidant, antibiotic, antiviral, and anti-atherogenic effects, among others.

Conclusion

Mastic, one of the components of these recipes, possesses anti-inflammatory and antioxidant properties, which could explain its relative efficacy in the treatment of gout in the 19th century.