Diagnostic value of serum immunoglobulin free light chains ratio in monoclonal gammopathies of undetermined significance [Valor diagnóstico del cociente de cadenas ligeras libres de inmunoglobulinas en suero en las gammapatías monoclonales de significado incierto]
Bermudo C.,Hospital Universitario Virgen Macarena |
Cardenas M.C.,Servicio de Analisis Clinicos |
Cortes M.,Hospital Universitari Santa Creu i Sant Pau |
Fernandez M.,Servicio de Analisis Clinicos |
And 6 more authors.
Revista del Laboratorio Clinico | Year: 2012
Background: Measurement of immunoglobulin free light chains provides relevant clinical information for the diagnosis, prognosis and monitoring of multiple myeloma (MM) and monoclonal gammopathies of undetermined significance (MGUS). We evaluated the negative predictive value (NPV) of a serum free kappa to lambda (κ/λ) ratio included within the described reference range (0.26-1.65) and also set cut-off points for the ratio in order to ensure a 100% NPV. Methods: Serum concentration of free light chains was measured by nephelometry in 157 individuals diagnosed as having MM or MGUS, and the free κ/λ ratio was calculated. Results: The area under the curve of the free κ/λ ratio was 0.885 in the kappa type gammopathies subgroup, and 0.879 for the lambda subgroup. The NPV for a free κ/λ ratio between 0.26 and 1.65 was 92%. Using cut-off points of 0.36 and 1.0 for the ratio, achieved a 100% NPV. Conclusions: A change from the cut-off point 0.26-1.65 to 0.36-1.0 for the free κ/λ ratio could be useful in order to avoid performing a bone marrow aspirate in patients with MGUS clinical and laboratory criteria. © 2011 AEBM, AEFA y SEQC. Source
Bermejo F.,Hospital Universitario Of Fuenlabrada |
Garrido E.,Hospital Universitario Ramon y Cajal |
Chaparro M.,Hospital Universitario La Paz |
Chaparro M.,CIBER ISCIII |
And 11 more authors.
Inflammatory Bowel Diseases | Year: 2012
Background: Management of abdominal abscesses (AA) in Crohn's disease (CD) always includes antibiotics, and some type of drainage is added according to the response and other considerations. Our aim was to assess the efficacy of different therapeutic approaches to spontaneous AA in CD. Methods: All cases of AA in CD were identified from the databases of five university hospitals. Postoperative cases were excluded. Therapeutic success was defined as abscess resolution and nonreappearance within 1 year of follow-up. Results: We identified 128 cases in 2236 patients (cumulative incidence 5.7%). Initial therapy included medical therapy with antibiotics alone (42.2%), antibiotics plus percutaneous drainage (23.4%), and antibiotics plus surgical drainage (34.4%). The highest final efficacy corresponded to surgery (91%) as compared with antibiotic therapy alone (63%) or percutaneous drainage (30%). Failure of initial therapy was predicted by immunomodulators at diagnosis (odds ratio [OR] 8.45; 95% confidence interval [CI] 1.16-61.5; P = 0.03), fistula detectable in imaging techniques (OR 5.43; 95% CI 1.18-24.8; P = 0.02), and abscess size (OR 1.65; 95% CI 1.07-2.54; P = 0.02) only for patients treated with antibiotic therapy alone. Percutaneous drainage was associated with 19% of complications (enterocutaneous fistulas 13%); surgery was associated with 13% of postoperative complications (enterocutaneous fistulas 7.7%). Following abscess resolution, 60% of patients were started on thiopurines, 9% on biologics, and in 31% baseline therapy was not modified. Conclusions: Management of spontaneous AA in CD with antibiotics alone seems to be a good option for small abscesses, especially those without associated fistula and appearing in immunomodulator-naïve patients. Surgery offers better results in the remaining clinical settings, although percutaneous drainage can avoid operative treatment in some cases. Copyright © 2011 Crohn's & Colitis Foundation of America, Inc. Source
Echeverria P.,Hospital Universitari Germans Trias i Pujol |
Echeverria P.,Autonomous University of Barcelona |
Domingo P.,Hospital Universitari Santa Creu i Sant Pau |
Llibre J.-M.,Hospital Universitari Germans Trias i Pujol |
And 17 more authors.
BioMed Research International | Year: 2014
Background. There are conflicting data on the prevalence of coronary events and the quality of the management of modifiable cardiovascular risk factors (CVRF) in HIV-infected patients. Methods. We performed a retrospective descriptive study to determine the prevalence of coronary events and to evaluate the management of CVRF in a Mediterranean cohort of 3760 HIV-1-infected patients from April 1983 through June 2011. Results. We identified 81 patients with a history of a coronary event (prevalence 2.15%); 83% of them suffered an acute myocardial infarction. At the time of the coronary event, CVRF were highly prevalent (60.5% hypertension, 48% dyslipidemia, and 16% diabetes mellitus). Other CVRF, such as smoking, hypertension, lack of exercise, and body mass index, were not routinely assessed. After the coronary event, a significant decrease in total cholesterol P = 0.025 and LDL-cholesterol P = 0.004 was observed. However, the percentage of patients who maintained LDL-cholesterol > 100 mg/dL remained stable (from 46% to 41%, P = 0.103). Patients using protease inhibitors associated with a favorable lipid profile increased over time P = 0.028. Conclusions. The prevalence of coronary events in our cohort is low. CVRF prevalence is high and their management is far from optimal. More aggressive interventions should be implemented to diminish cardiovascular risk in HIV-infected patients. © 2014 Patricia Echeverría et al. Source