Tendencias de la mortalidad por enfermedades cardiovasculares en Andalucía entre 1975 y 2004

Background: Cardiovascular diseases are ranked among the leading causes of death in the industrialized countries. This study is aimed at ascertaining the mortality trends by ischemic heart disease (IHD) and cerebrovascular diseases (CVD) in Andalusia within the 1975-2004 period. Method: Based on the official IHD and CVD death statistics and the related populations, the gross rates (GR) and age-adjusted rates (TS) and the Potential Years of Life Lost (PYLL) were calculated. To quantify the trends and their change points, a joinpoint regression analysis was made. Results: The number of IHD deaths for females rose from 2,086 deaths in 1975 to 3,336 in 2004, the TS having dropped from 74.29 to 50.94 deaths/100,000 females, the PYLL having dropped from 173.65 years to 90.56 years/100,000 females. The number of deaths for males rose from 2,854 deaths in 1975 to 4,085 in 2004, the TS having dropped from 147, 67 to 104.96 deaths /100,000 males. The PYLL showed a like behaviour from the first to the last year of the series, showing values of 716.46 and 460.04 years / 100,000 males. For the IHD in females, the number of deaths in absolute numbers dropped from 4,712 to 4,221, the TS having dropped from 166.00 to 62.08 deaths in females, and the PYLL from 338.08 to 87.63 years / 100,000 females. For males, the number of deaths dropped from 3,714 to 2,951, the TS from 206.88 deaths /100,000 males in 1975 to 76.12 /100,000 males in 2004, and the PYLL dropping from 533.12 to 182.38 years / 100,000 males. Conclusions: The trend in mortality due to IHD was not constant either among females or males, although it has always been a downward trend, the drop being statistically significant. The drop in the CVD has been such a major one that both the absolute numbers and the gross rates are lower for the most recent years that the first years in the series studied despite the aging of Andalusia’s population.

Carcinoma verrugoso de vagina. Presentacion de un caso

Verrucous carcinoma of the vagina is a rare neoplasm. This entity is a slow-growing, locally invasive but generally nonmetastasizing neoplasm, with a characteristic gross and microscopic appearance. We report a case of verrucous carcinoma of the vagina in a postmenopausal woman diagnosed 4 years after transvaginal hysterectomy for grade 4 uterine prolapse. We also discuss the differential diagnosis and treatment.Verrucous carcinoma of the vagina is a rare neoplasm. The differential diagnosis includes typical squamous cell carcinoma, warty carcinoma, and condyloma acuminatum. Surgery remains the most effective treatment.

Kallikrein genes are associated with lupus and glomerular basement membrane-specific antibody-induced nephritis in mice and humans.

Immune-mediated nephritis contributes to disease in systemic lupus erythematosus, Goodpasture syndrome (caused by antibodies specific for glomerular basement membrane [anti-GBM antibodies]), and spontaneous lupus nephritis. Inbred mouse strains differ in susceptibility to anti-GBM antibody-induced and spontaneous lupus nephritis. This study sought to clarify the genetic and molecular factors that maybe responsible for enhanced immune-mediated renal disease in these models. When the kidneys of 3 mouse strains sensitive to anti-GBM antibody-induced nephritis were compared with those of 2 control strains using microarray analysis, one-fifth of the underexpressed genes belonged to the kallikrein gene family,which encodes serine esterases. Mouse strains that upregulated renal and urinary kallikreins exhibited less evidence of disease. Antagonizing the kallikrein pathway augmented disease, while agonists dampened the severity of anti-GBM antibody-induced nephritis. In addition, nephritis-sensitive mouse strains had kallikrein haplotypes that were distinct from those of control strains, including several regulatory polymorphisms,some of which were associated with functional consequences. Indeed, increased susceptibility to anti-GBM antibody-induced nephritis and spontaneous lupus nephritis was achieved by breeding mice with a genetic interval harboring the kallikrein genes onto a disease-resistant background. Finally, both human SLE and spontaneous lupus nephritis were found to be associated with kallikrein genes, particularly KLK1 and the KLK3 promoter, when DNA SNPs from independent cohorts of SLE patients and controls were compared. Collectively, these studies suggest that kallikreins are protective disease-associated genes in anti-GBM antibody-induced nephritis and lupus.

Algoritmo para el diagnóstico precoz de la deficiencia de vitamina b12 en ancianos

BACKGROUND: The elderly population is particularly at risk for developing vitamin B12-deficiency. Serum cobalamin does not necessarily reflect a normal B12 status. The determination of methylmalonic acid is not available in all laboratories. Issues of sensitivity for holotranscobalamin and the low specificity of total homocysteine limit their utility. The aim of the present study is to establish a diagnostic algorithm by using a combination of these markers in place of a single measurement. METHODS: We compared the diagnostic efficiency of these markers for detection of vitamin B12 deficiency in a population (n = 218) of institutionalized elderly (median age 80 years). Biochemical, haematological and morphological data were used to categorize people with or without vitamin B12 deficiency. RESULTS: In receiver operating curves characteristics for detection on vitamin B12 deficiency using single measurements, serum folate has the greatest area under the curve (0.87) and homocysteine the lowest (0.67). The best specificity was observed for erythrocyte folate and methylmalonic acid (100% for both) but their sensitivity was very low (17% and 53%, respectively). The highest sensitivity was observed for homocysteine (81%) and serum folate (74%). When we combined these markers, starting with serum and erythrocyte folate, followed by holotranscobalamin and ending by methylmalonic acid measurements, the overall sensitivity and specificity of the algorithm were 100% and 90%, respectively. CONCLUSION: The proposed algorithm, which combines erythrocyte folate, serum folate, holotranscobalamin and methylmalonic acid, but eliminate B12 and tHcy measurements, is a useful alternative for vitamin B12 deficiency screening in an elderly institutionalized cohort.