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Presentamos el caso de un varón de 56 años con obesidad central e hipertensión arterial resistente refractaria a cuádruple terapia que, en su estudio, muestra una alternancia cíclica entre períodos de normofunción suprarrenal con períodos de hipercortisolismo, compatible con el diagnóstico de síndrome de Cushing cíclico. Este caso pone de manifiesto que es recomendable realizar determinaciones analíticas hormonales periódicas durante el seguimiento de pacientes con alta sospecha clínica de síndrome de Cushing, para descartar esta entidad muchas veces infradiagnosticada.

El mielolipoma suprarrenal es un tumor de lento crecimiento, compuesto por tejido graso y elementos hematopoyéticos, típicamente no secretor, aunque un bajo porcentaje asocia coexistencia con patología endócrina. Presentamos el caso de un varón de 35 años al que, durante el estudio de hipertensión arterial resistente, se le diagnostica de incidentaloma suprarrenal de gran tamaño con imagen congruente con mielolipoma suprarrenal, cuyas determinaciones analíticas eran anodinas sugiriendo un adenoma no funcionante. Tras la resección quirúrgica, el estudio anatomopatológico de dicha masa reveló células de feocromocitoma, productor de catecolaminas, que condiciona la resistencia de la hipertensión arterial del paciente.

Grupo de Trabajo de Riesgo Vascular de la SEMI., [ES ]En la actualidad la enfermedad vascular constituye un problema de salud de primer orden, no solo por su elevada prevalencia, sino también por la gran morbimortalidad y discapacidad que conlleva. El médico internista juega un papel central en el diagnóstico y tratamiento de la enfermedad vascular, así como en el control de los factores de riesgo vascular (RV) que la causan. De hecho, dentro del campo de acción del internista figura específicamente la atención clínica a enfermos en unidades de RV. En este artículo se recoge el documento de consenso para la formación de residentes en RV. Esta propuesta del Grupo de Trabajo de Riesgo Vascular de la Sociedad Española de Medicina Interna surge como respuesta de nuestra Sociedad a una necesidad específica formativa en RV. Pensamos que su implantación supondrá un beneficio importante, no solo para el médico internista en formación, sino también para la sociedad en su conjunto., [EN] Vascular disease is currently a major health problem, not only for its high prevalence but also for the considerable morbidity, mortality and disability that it entails. Medical internists play a central role in diagnosing and treating vascular disease and controlling the cardiovascular risk factors (CRFs) that cause it. In fact, the clinical care of patients in cardiovascular risk units is a specific characteristic of an internist's field of action. This article contains the consensus document for the training of residents in CRFs. This proposal by the Cardiovascular Risk Workgroup of the Spanish Society of Internal Medicine emerged as a response by our Society to the specific need for training in CRFs. Implementing this proposal would provide an important benefit, not only for medical internists in training but also for society as a whole.

Summary Background Elevated proinflammatory cytokines are associated with greater COVID-19 severity. We aimed to assess safety and efficacy of sarilumab, an interleukin-6 receptor inhibitor, in patients with severe (requiring supplemental oxygen by nasal cannula or face mask) or critical (requiring greater supplemental oxygen, mechanical ventilation, or extracorporeal support) COVID-19. Methods We did a 60-day, randomised, double-blind, placebo-controlled, multinational phase 3 trial at 45 hospitals in Argentina, Brazil, Canada, Chile, France, Germany, Israel, Italy, Japan, Russia, and Spain. We included adults (≥18 years) admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and pneumonia, who required oxygen supplementation or intensive care. Patients were randomly assigned (2:2:1 with permuted blocks of five) to receive intravenous sarilumab 400 mg, sarilumab 200 mg, or placebo. Patients, care providers, outcome assessors, and investigators remained masked to assigned intervention throughout the course of the study. The primary endpoint was time to clinical improvement of two or more points (seven point scale ranging from 1 [death] to 7 [discharged from hospital]) in the modified intention-to-treat population. The key secondary endpoint was proportion of patients alive at day 29. Safety outcomes included adverse events and laboratory assessments. This study is registered with ClinicalTrials.gov, NCT04327388; EudraCT, 2020-001162-12; and WHO, U1111-1249-6021. Findings Between March 28 and July 3, 2020, of 431 patients who were screened, 420 patients were randomly assigned and 416 received placebo (n=84 [20%]), sarilumab 200 mg (n=159 [38%]), or sarilumab 400 mg (n=173 [42%]). At day 29, no significant differences were seen in median time to an improvement of two or more points between placebo (12·0 days [95% CI 9·0 to 15·0]) and sarilumab 200 mg (10·0 days [9·0 to 12·0]; hazard ratio [HR] 1·03 [95% CI 0·75 to 1·40]; log-rank p=0·96) or sarilumab 400 mg (10·0 days [9·0 to 13·0]; HR 1·14 [95% CI 0·84 to 1·54]; log-rank p=0·34), or in proportions of patients alive (77 [92%] of 84 patients in the placebo group; 143 [90%] of 159 patients in the sarilumab 200 mg group; difference −1·7 [−9·3 to 5·8]; p=0·63 vs placebo; and 159 [92%] of 173 patients in the sarilumab 400 mg group; difference 0·2 [−6·9 to 7·4]; p=0·85 vs placebo). At day 29, there were numerical, non-significant survival differences between sarilumab 400 mg (88%) and placebo (79%; difference +8·9% [95% CI −7·7 to 25·5]; p=0·25) for patients who had critical disease. No unexpected safety signals were seen. The rates of treatment-emergent adverse events were 65% (55 of 84) in the placebo group, 65% (103 of 159) in the sarilumab 200 mg group, and 70% (121 of 173) in the sarilumab 400 mg group, and of those leading to death 11% (nine of 84) were in the placebo group, 11% (17 of 159) were in the sarilumab 200 mg group, and 10% (18 of 173) were in the sarilumab 400 mg group. Interpretation This trial did not show efficacy of sarilumab in patients admitted to hospital with COVID-19 and receiving supplemental oxygen. Adequately powered trials of targeted immunomodulatory therapies assessing survival as a primary endpoint are suggested in patients with critical COVID-19. Funding Sanofi and Regeneron Pharmaceuticals.

Patients with subaneurysmal aortic dilation (SAD, 25&ndash, 29 mm diameter) are likely to progress to true abdominal aortic aneurysm (AAA). Despite these patients having a higher risk of all-cause mortality than subjects with aortic size &lt, 24 mm, early diagnostic biomarkers are lacking. MicroRNAs (miRs) are well-recognized potential biomarkers due to their differential expression in different tissues and their stability in blood. We have investigated whether a plasma miRs profile could identify the presence of SAD in high cardiovascular risk patients. Using qRT-PCR arrays in plasma samples, we determined miRs differentially expressed between SAD patients and patients with normal aortic diameter. We then selected 12 miRs to be investigated as biomarkers by construction of ROC curves. A total of 82 significantly differentially expressed miRs were found by qPCR array, and 12 were validated by qRT-PCR. ROC curve analyses showed that seven selected miRs (miR-28-3p, miR-29a-3p, miR-93-3p, miR-150-5p, miR-338-3p, miR-339-3p, and miR-378a-3p) could be valuable biomarkers for distinguishing SAD patients. MiR-339-3p showed the best sensitivity and specificity, even after combination with other miRs. Decreased miR-339-3p expression was associated with increased aortic abdominal diameter. MiR-339-3p, alone or in combination with other miRs, could be used for SAD screening in high cardiovascular risk patients, helping to the early diagnosis of asymptomatic AAA.

Tomando como buque base un patrullero oceánico con un desplazamiento entre 2500 y 3000 toneladas, se desarrollará el concepto de plataforma multipropósito con el objetivo de analizar la viabilidad de emplear la plataforma del buque base y sus principales instalaciones para albergar diferentes configuraciones (patrullero oceánico, buque de apoyo a buceadores, buque hospital y de rescate, buque de inteligencia, buque oceanográfico, etc.). Se deberá diseñar el sistema de acoplamiento y desacoplamiento de los diferentes módulos sobre una plataforma multipropósito con el objetivo de poder variar la configuración del buque en puerto y en el menor tiempo posible. Se analizarán las repercusiones de las diferentes configuraciones sobre el proyecto del buque, en términos de arquitectura naval, propulsión, planta eléctrica y servicios auxiliares. Escuela Técnica Superior de Ingeniería Naval y Oceánica Universidad Politécnica de Cartagena

Objective:To describe the clinical presentation and evolution of a severe and rare adverse reaction to hydroclorothiazide.Design and method:We present the case of a 74-year-old woman with a personal history of permanent atrial fibrillation under treatment with acenocumarol, pacemaker carrier, rheuma

As the name suggests, the budget for the construction of a ship, in this case a Suezmax, means to specifically pre-suppose in economic terms, the activities and movements to carry out during the construction of said ship. The importance of this essential phase of the construction process lie one hand in budgeting a competitive price in the market, but without causing economic losses for the shipyard, in order to make a profit for the company. This study proposes the use of the Monte Carlo method to obtain a greater reliability in the valuation of the Suezmax vessel; in this case, the triangular method will be used, which starting point is based on results obtained from previous research and from which the most likely, most pessimistic and most optimistic ship budget is obtained in order to later perform a simulation. For the realization of said simulation the ship is divided into different items, that will be assigned an optimistic and pessimist percentage based on a likely budget, according to the degree of trust of the shipyard in said concept.The final scope will be the calculation of the management reserve used to rectify any unforeseen item(s) in the construction of the ship.

Fasting and postprandial triglyceride concentrations largely depend on dietary and lifestyle factors. Alcohol intake is associated with triglycerides, but the effect of alcohol on diurnal triglyceridemia in a free living situation is unknown. During three days, 139 men (range: 18–80 years) measured their own capillary triglyceride (cTG) concentrations daily on six fixed time-points before and after meals, and the total daily alcohol intake was recorded. The impact of daily alcohol intake (none, low, &lt, 10 g/day, moderate, 10–30 g/day, high, &gt, 30 g/day) on diurnal triglyceridemia was analyzed by the incremental area under the cTG curve (∆cTG-AUC) reflecting the mean of the six different time-points. Fasting cTG were similar between the alcohol groups, but a trend of increased cTG was observed in men with moderate and high alcohol intake after dinner and at bedtime (p for trend &lt, 0.001) which persisted after adjustment for age, smoking and body mass index. The ∆cTG-AUC was significantly lower in males with low alcohol intake (3.0 ± 1.9 mmol·h/L) (n = 27) compared to males with no (7.0 ± 1.8 mmol·h/L) (n = 34), moderate (6.5 ± 1.8 mmol·h/L) (n = 54) or high alcohol intake (7.2 ± 2.2 mmol·h/L) (n = 24), when adjusted for age, smoking and body mass index (adjusted p value &lt, 0.05). In males, low alcohol intake was associated with decreased diurnal triglyceridemia, whereas moderate and high alcohol intake was associated with increased triglycerides after dinner and at bed time.

[ABSTRACT]Different alcohol beverages have not the same effect on triglyceridemia, inflammation and oxidative stress but this results are controversial and scanty in some aspects. Our objective was to examine the effect of alcohol intake in diurnal triglyceridemia in general population in a free-living situation and its association to usCRP concentrations. Also, we analyse the effect of different alcohol beverages after a fat enriched diet on lipid profile, inflammatory factors and oxidative stress in healthy people in a controlled situation. During 3 days, 273 volunteers measured their own cTG concentrations on six fixed time-points daily and recorded their alcohol intake. The impact of daily alcohol intake (none, low 30g/day) on cTG was analyzed and stratified for gender. usCRP measurements were collected from 80 subjects from this cohort. Secondly, we have performed a cross-over design in five different weeks. 16 healthy young volunteers received the same oral fat-enriched diet (1486 kcal/m2) and 16 g/m2 of alcohol. In each week the alcoholic beverage was different (red wine, vodka, brandy ,rum). In the control phase, the caloric intake of alcohol was replaced with sugar and water. We measured the levels of serum lipids, usCRP, TNF-α, sPLA2, LPO and TAC. Fasting cTG were similar between the alcohol groups in males. In females fasting cTG were lowest in those with low and moderate alcohol intake and higher in women with high alcohol intake (p