No abstract

Iron is necessary for the normal development of multiple vital processes. Iron deficiency (ID) may be caused by several diseases, even by physiological situations that increase requirements for this mineral. One of its possible causes is a poor dietary iron intake, which is infrequent in developed countries, but quite common in developing areas. In these countries, dietary ID is highly prevalent and comprises a real public health problem and a challenge for health authorities. ID, with or without anemia, can cause important symptoms that are not only physical, but can also include a decreased intellectual performance. All this, together with a high prevalence, can even have negative implications for a community’s economic and social development. Treatment consists of iron supplements. Prevention of ID obviously lies in increasing the dietary intake of iron, which can be difficult in developing countries. In these regions, foods with greater iron content are scarce, and attempts are made to compensate this by fortifying staple foods with iron. The effectiveness of this strategy is endorsed by multiple studies. On the other hand, in developed countries, ID with or without anemia is nearly always associated with diseases that trigger a negative balance between iron absorption and loss. Its management will be based on the treatment of underlying diseases, as well as on oral iron supplements, although these latter are limited by their tolerance and low potency, which on occasions may compel a change to intravenous administration. Iron deficiency has a series of peculiarities in pediatric patients, in the elderly, in pregnant women, and in patients with dietary restrictions, such as celiac disease.

Adherence to therapy in inflammatory bowel disease patients is not satisfactory, and worse in patients treated with mesalazine. Optimizing the information on the disease and giving the medication in one or two daily doses could enhance therapeutic adherence.

Background The vertebral osteonecrosis (VON) is much less known and less frequently diagnosed than peripheral osteonecrosis. VON is considered as result of delayed consolidation of a compression fracture due to ischemia, which creates a cavity within the vertebral body that could get filled with gas and appearing in X-rays as a radiolucent linear or semilunar shadow known as the vacuum cleft sign. This sign could be more easily recognized in CT, and could get secondarily filled with fluid as detected by MRI. Several risk factors have been associated including trauma and osteoporosis, but it is important make a correct differentiation between VON and simple compression facture, because former is more associated with severe pain and neurological complications. Objectives To analyze the clinical and radiological characteristics in a series of 18 patients with VON. Methods Methods: We carried out a descriptive, observational, transversal study from the clinical records of 18 consecutive patients diagnosed with VON, referred to a monographic consultation of osteoporosis in a university hospital between April 2009 and November 2011. Analyzed data were demography, risk factors, clinical manifestations, radiological findings (X-rays, CT and MRI), treatment and outcome. Results Mean age of patients was 78.9 years, with 15 women (83.3%). Most frequent clinical complaint was acute back pain in 14 patients (77.7%), irradiated in 6 (33.3%). 61.1% referred moderated to severe pain, requiring third step analgesia in 38.8%. The mean time elapsed since pain onset until diagnosis was 7.3 months. Trauma history was detected in 55.5%, osteoporosis and previous compression fractures in 44.4%, vitamin D3 deficiency in 38.8%, chronic liver disease in 11.1%, previous use of systemic corticosteroids, intestinal malabsorption or neoplasm in 16.6, and radiotherapy or chemotherapy in 5.5%, respectively. Most frequent location of VON were T12 (44.4%) and L1 (16.6%), with multiple affected vertebrae in 4 cases (22.2%). The vacuum cleft sign was evident by X-rays in 15 cases and by CT in 3/5. MRI was done in 15 patients and most frequent findings were intravertebral liquid sign in 9 cases, empty and interface signs in 3 cases for each one. It was also found posterior wall displacement in 11 cases, with associated myelopathy in 2 (11.1%). There was clinical neurological involvement in 3 cases, one of them with paraparesis. The management was surgical in 1 case, vertebral cementation in 2 and orthopaedic in 15 (back brace). A HIV-infected patient presented concomitant osteonecrosis in peripheral locations too. Conclusions VON is an important differential diagnose of compression fracture because occurs in older people who have an increased prevalence of osteoporosis too. VON has an important delay in diagnosis because most of the specialists do not take it in account and the vacuum cleft sign is not always easy to identify in X-rays, appearing in some cases only with hyperextension. There are some clinical characteristics that could guide to ...

Background Lupus arthropathy has different compromise levels, not always progressive, that includes asymptomatic forms, deforming, erosive or even resorptive arthropathy. Until now, the ultrasonography (US) is useful to assess inflammatory status in patients with chronic or episodic arthritis. Recent studies have shown that inflammatory activity is demonstrable by US in other types of arthropathy. Objectives To perform an US assessment of non-deforming forms of SLE arthropathy and its relationship with other clinical findings. Methods 76 medical records of SLE patients without deforming arthropathy were revised. Epidemiological, clinical and laboratory data were collected. A complementary medical interview were performed to all patients in order to review clinical and historical data. US protocol applied to all patients included both carpal joint (dorsal and ventral), 2nd and 3rd metacarpophalangeal (MCP) of both hands, 2nd and 3rd flexor tendons of both hands at its passage through the MCP joints. US studies were perform to assess the existence or absence of synovitis, effusion, tendinosis and power doppler signal (PDS). For the statistical analysis, x2 and T student tests were used where appropriate. Results We identified three groups of joint involvement according to clinical data: (1) Asymptomatic patients n=15, (2) patients with intermittent or continuous arthralgias n=40, and (3) patients with arthritis n=21. Times of disease from diagnosis were different in the three groups. A 66,67% of patients from group 1 was diagnosed with 3 or more analytical criteria and 33,3% with 3 or more clinical criteria. The inverse proportion was found in group 2 and 3. All those comparissons were statistically significant. The clinical response to NSAID, hydroxycloroquine, metotrexate and glucocorticoids were similar among the groups. Synovial effusion and PDS were present in 33 and 40% respectively in group 1. Synovial effusion was present in 15% and 61,9% of group 2 and 3 respectively. Conclusions (1) We have demonstrated ecographic inflammatory activity in SLE patients that in our cohort reaches 40% of the asymptomatic patients. These results widely surpass other series results probably because we have considered positive any PDS level of intensity and not only the clinically significant. (2) In patients without clinical arthritis, there is enough ecographic evidence of it in more than one third of patients. (3) There is an association between SLE diagnoses based in clinical criteria with inflammatory, clinical and ecographic joints manifestations. Disclosure of Interest None Declared