We want to know if the ultrasound examination of the Achilles tendon in spondyloarthritis is different compared to other rheumatic diseases.
We studied 97 patients divided into five groups: ...rheumatoid arthritis, spondyloarthritis, gout, chondrocalcinosis and osteoarthritis, exploring six elementary lesions in 194 Achilles entheses examined.
In our study the total index ultrasonographic Achilles is higher in spondyloarthritis with significant differences. The worst elementary spondyloarthritis lesions for discriminations against other pathologies were calcification.
This study aims to demonstrate the discriminant validity of Achilles enthesitis observed by ultrasound in spondyloarthritis compared with other rheumatic diseases that may also have ultrasound abnormalities such enthesis level.
Analizar si la exploración ecográfica del tendón de Aquiles es diferente en las espondiloartritis respecto de otras enfermedades reumáticas.
Se estudia a 97 pacientes divididos en 5 grupos: artritis reumatoide, espondiloartritis, gota, condrocalcinosis y artrosis, explorándose 6 lesiones elementales en las 194 entesis de Aquiles examinadas.
En nuestro estudio, el índice total ecográfico en tendón de Aquiles es mayor en el grupo de espondiloartritis con diferencias significativas. La lesión elemental que peor discrimina las espondilitis respecto de otras patologías es la presencia de calcificaciones.
Este estudio pretende demostrar la validez discriminante de la entesitis aquílea observada por ecografía en las espondiloartritis en comparación con otras enfermedades reumatológicas que también pueden presentar alteraciones ecográficas a nivel de dicha entesis.
Screening for Cushing's syndrome in obese patients; is it really necessary? Alhambra Expósito, María Rosa; Tenorio Jiménez, Carmen; Molina Puerta, María José ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
2014-May-01, 20140501, Volume:
29, Issue:
5
Journal Article
to be more frequent among patients with metabolic syndrome. Previous studies have suggested to perform a routine screening for CS in obese patients; however, more recent reports only recommend a ...case-finding approach in patients with uncontrolled diabetes and hypertension, despite appropriate treatment. Objective: The aim of this study was to evaluate the prevalence of unsuspected CS in morbidly obese patients in an outpatient’s clinic. Patients and methods: Retrospective case-note study. We reviewed the medical records of morbidly obese patients referred to our clinic prior to bariatric surgery between january 2001 and december 2011. All patients had a complete medical history including physical examination, and 399 underwent screening for CS as part of our pre-surgical protocol. As screening for autonomous cortisol secretion, we performed an overnight 1 mg Dexamethasone Suppression Test (DST). Serum cortisol < 1.8 μg/dl was the cut-off point for normal suppression. Results: 399 patients (308 female; mean age 41.9 ± 10.5 years; mean BMI 51.5 ± 8.4 kg/m2). In the retrospective analysis, prediabetes and diabetes mellitus were observed in 10.3% and 27.8% respectively. In 21 of 399 patients, screening was considered to be abnormal. Eight of these 21 patients had subsequent normal 24h Urinary Free Cortisol (UFC) levels (150 μg/24h). In 13 of 20 patients, we repeated an overnight 1mg DST, on suspicion of failing to take the dexamethasone correctly. Three patients failed to suppress their cortisol levels, two of them were on carbamazepine, which was considered to be a false positive result. The other patient with abnormal UFC levels was diagnosed with CS (0.26%), whose cause was a pituitary microadenoma. Conclusion: A low proportion of patients with morbid obesity were found to have CS. Our findings suggest that morbidly obese patients should not be routinely screened for CS.
L'estructura cristal•logràfica del receptor opioide ha estat una gran incògnita fins al seu recent descobriment. En aquesta tesi s'han realitzat aportacions al disseny racional de fàrmacs opioides, ...mitjançant la posada a punt de tècniques d'anàlisi proteòmica del receptor opioide i amb estudis de la seva interacció amb lligands peptídics endògens (encefalines i endorfines) i els seus anàlegs, per interpretar millor les conformacions dels lligands i el seu mode d'unió al centre actiu.
D'altra banda, s'han realitzat estudis de nous inhibidors dels enzims que degraden les encefalines (Endopeptidasa neutra i Aminopeptidasa-N). L’opiorfina (H-Gln-Arg-Phe-Ser-Arg-OH) mostra una potent activitat analgèsica en models animals de dolor després estimulació química i mecànica equipotent a la morfina per activació dels mecanismes endògens de regulació del sistema opioide. Aquesta se segrega en la saliva humana i actua com a inhibidor dual de NEP i AP-N, prolongant l’efecte de les encefalines. En aquesta part, s'han realitzat estudis de relació estructura-activitat (SAR) i conformacionals per millorar el disseny d'inhibidors d'aquests enzims.
The crystallographic structure of opioid receptors has been a great unknown until its recent discovery. This thesis has made contributions to the rational design of opioid drugs, by tuning proteomic analysis techniques on opioid receptors and studying their interactions with endogenous peptide ligands (enkephalins and endorphins) and its analogues to a better understanding of conformations of the ligands and their binding mode to the active center.
Furthermore, studies have been made about new inhibitors of enzymes which degrade enkephalins (NEP and aminopeptidase-N). Opiorphin (H-Gln-Arg-Phe-Ser-Arg-OH) exhibits potent analgesic activity in animal models of pain after chemical and mechanical stimulation equipotent to morphine, by activation of the endogenous opioid system. It is secreted in human saliva and acts as a dual inhibitor of NEP and AP-N. In this part, structure-activity relationship (SAR) and conformational studies have been made to improve the design of inhibitors of these enzymes.
Objective
The objective of this observational, descriptive, cross-sectional, multicentre study was to assess the perceived quality and grade of satisfaction expressed by patients with chronic ...arthropathies regarding the use of musculoskeletal (MSK) ultrasonography by rheumatologists as an integrated clinical care tool.
Methods
All Spanish rheumatology departments with MSK ultrasonography incorporated in their healthcare services were invited to participate in the study. A Spanish-language survey was offered to fill out anonymously to all consecutive patients with chronic arthropathies under follow-up in the rheumatology outpatient clinics who attended their centre for a period of 3 months. The survey consisted of three sections. The first section contained patients’ demographics, disease data, frequency of performing rheumatological ultrasound and information about who performed their ultrasound assessments. The second section consisted of 14 questions about patient’s experience and opinion on different aspects of the management, performance and perceived usefulness of performing ultrasound, to be answered on a Likert scale 1–5. The third section of the survey was addressed to the rheumatologist ultrasonographers.
Results
Nine hundred and four patients from 16 university hospital rheumatology departments completed the survey. All questions reached an overall favourable response ≥ 80%. Patients who reported usual ultrasound examinations in their rheumatology care and those in which it was their attending rheumatologist who performed the ultrasound assessments responded more favourably.
Conclusion
Our encouraging patient-centred results may be useful in facilitating the implementation of rheumatological ultrasound in rheumatology care worldwide.
Key Points
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This is the largest multicentre survey carried out in patients with chronic joint diseases designed to assess their experience and perceived benefits with the use of ultrasonography performed by rheumatologists in daily practice.
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Musculoskeletal ultrasound incorporated into rheumatology care was very well accepted and valued by most patients.
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The patients perceived that ultrasonography helps not only their rheumatologist but also themselves to better understand their condition.
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The patients believed that ultrasonography helps them accept and comply with the proposed treatment.
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