Seguridad de las drogas biológicas y sintéticas dirigidas utilizadas en pacientes con enfermedades reumáticas inmunomediadas. Datos del registro BIOBADASAR 3.0 / Safety of biological and targeted synthetic drugs in patients with immune-mediated rheumatic diseases. Data from the BIOBADASAR 3.0 registry

Introducción: conocer la seguridad de las drogas actualmente disponibles para el tratamiento de las enfermedades reumáticas es muy importante al momento de tomar decisiones terapéuticas objetivas e individualizadas en la consulta médica diaria. Asimismo, datos de la vida real amplían el conocimiento revelado por los ensayos clínicos. Objetivos: describir los eventos adversos (EA) reportados, estimar su frecuencia e identificar los factores relacionados con su desarrollo. Materiales y métodos: se utilizaron datos BIOBADASAR, un registro voluntario y prospectivo de seguimiento de EA de tratamientos biológicos y sintéticos dirigidos en pacientes con enfermedades reumáticas inmunomediadas. Los pacientes son seguidos hasta la muerte, pérdida de seguimiento o retiro del consentimiento informado. Para este análisis se extrajeron datos recopilados hasta el 31 de enero de 2023. Resultados: se incluyó un total de 6253 pacientes, los cuales aportaron 9533 ciclos de tratamiento, incluyendo 3647 (38,3%) ciclos sin drogas modificadoras de la enfermedad biológicas y sintéticas dirigidas (DME-b/sd) y 5886 (61,7%) con DME-b/sd. Dentro de estos últimos, los más utilizados fueron los inhibidores de TNF y abatacept. Se reportaron 5890 EA en un total de 2701 tratamientos (844 y 1857 sin y con DME-b/sd, respectivamente), con una incidencia de 53,9 eventos cada 1000 pacientes/año (IC 95% 51,9-55,9). La misma fue mayor en los ciclos con DME-b/sd (71,1 eventos cada 1000 pacientes/año, IC 95% 70,7-77,5 versus 33,7, IC 95% 31,5-36,1; p<0,001). Las infecciones, particularmente las de la vía aérea superior, fueron los EA más frecuentes en ambos grupos. El 10,9% fue serio y el 1,1% provocó la muerte del paciente. El 18,7% de los ciclos con DME-b/sd fue discontinuado a causa de un EA significativamente mayor a lo reportado en el otro grupo (11,5%; p<0,001). En el análisis ajustado, las DME-b/sd se asociaron a mayor riesgo de presentar al menos un EA (HR 1,82, IC 95% 1,64-1,96). De igual manera, la mayor edad, el mayor tiempo de evolución, el antecedente de enfermedad pulmonar obstructiva crónica, el diagnóstico de lupus eritematoso sistémico y el uso de corticoides se asociaron a mayor riesgo de EA. Conclusiones: la incidencia de EA fue significativamente superior durante los ciclos de tratamientos que incluían DME-b/sd.

Introduction: knowing the efficacy and safety of the drugs currently available for the treatment of rheumatic diseases is very important when making objective and individualized therapeutic decisions in daily medical consultation. Likewise, real-life data extends the knowledge revealed by clinical trials. Objectives: to describe the reported adverse events (AEs), estimate their frequency and identify factors associated to them. Materials and methods: BIOBADASAR data were used, which is a voluntary, prospective follow-up registry of AEs of biological and synthetic treatments in patients with immune-mediated rheumatic diseases. Patients are followed until death, loss of followup, or withdrawal of informed consent. To carry out this analysis, the data collected up to January 31, 2023 was extracted. Results: a total of 6253 patients were included, who contributed with 9533 treatment periods, including 3647 (38.3%) periods without b/ts-DMARDs and 5886 (61.7%) with b/ts-DMARDs. Among the latter, the most used were TNF inhibitors and abatacept. A total of 5890 AEs were reported in a total of 2701 treatments (844 and 1857 without and with b/ts-DMARDs, respectively), with an incidence of 53.9 events per 1000 patients/ year (95% CI 51.9-55.9). It was higher during the periods with b/ts-DMARDs (71.1 events per 1000 patients/year, 95% CI 70.7-77.5 vs 33.7, 95% CI 31.5-36.1, p<0.001). Infections, particularly those of the upper respiratory tract, were the most frequent AEs in both groups. 10.9% were severe and 1.1% were associated with the death of the patient. 18.7% of the periods with b/ts-DMARDs were discontinued due to an AE, significantly higher than that reported in the other group (11.5%; p<0.001). In the adjusted analysis, b/ts-DMARDs were associated with a higher risk of presenting at least one AE (HR 1.82, 95% CI 1.64-1.96). Similarly, older age, longer evolution time, history of chronic obstructive pulmonary disease, diagnosis of systemic lupus erythematosus, and use of corticosteroids were associated with a higher risk of AE. Conclusions: the incidence of AEs was significantly higher during those treatment periods that included DME-b/sd.

Colangiopancreatografía retrógrada endoscópica asistida por enteroscopia de doble balón en un paciente con gastrectomía total y reconstrucción en Y-de-Roux: reporte de caso / Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in a patient with total gastrectomy and roux-en-y reconstruction: A case report

Resumen La colangiopancreatografía retrógrada endoscópica (CPRE) es un procedimiento útil en el manejo de enfermedades biliopancreáticas. Los pacientes con alteración anatómica del tracto gastrointestinal representan un desafío técnico por múltiples razones. Con técnicas como la enteroscopia de doble balón (EDB) es posible realizar una CPRE en estos pacientes. El caso que se presenta es el primero de este tipo publicado en Colombia sobre una paciente con gastrectomía total con reconstrucción en Y-de-Roux y coledocolitiasis.

Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable procedure in managing biliopancreatic diseases. Patients with anatomical alteration of the gastrointestinal tract represent a technical challenge for multiple reasons. With techniques such as double-balloon enteroscopy (DBE), it is possible to perform ERCP in these patients. The case was first published in Colombia on a female patient with total gastrectomy with Roux-en-Y reconstruction and choledocholithiasis.

Vasculitis reumatoidea como manifestación extraarticular en dos casos / Rheumatoid vasculitis as an extra articular manifestation in two cases

La vasculitis reumatoidea es un proceso inflamatorio poco frecuente que confiere una morbilidad y mortalidad significativa en pacientes con artritis reumatoidea (AR). Presenta una incidencia de 0,7 a 5,4% de los casos de AR y hasta un 40% de mortalidad a 5 años, siendo la manifestación extraarticular de mayor gravedad1,2. Se caracteriza por el desarrollo de vasculitis necrotizante; ocurre típicamente en pacientes masculinos con AR seropositiva de larga data, nodular y erosiva, tabaquistas y, en general, tiene mal pronóstico. Se presenta una serie de casos, paciente masculino y femenino con AR y manifestaciones extraarticulares, necrosis digital y compromiso multiorgánico, interpretados como cuadros de vasculitis reumatoidea, realizando tratamiento de referencia con inmunosupresores.

Rheumatoid vasculitis is a rare inflammatory process that confers significant morbidity and mortality in patients with rheumatoid arthritis (RA); it has an incidence of 0.7 to 5.4% of RA cases and up to 40% mortality at five years, making it the most serious of all the extra-articular manifestations of RA1,2. It is characterized by the development of necrotizing vasculitis, it typically occurs in male patients with long-standing seropositive RA, erosive nodular, smokers and generally has a poor prognosis. A series of cases is presented, male and female with RA and extra-articular manifestations, digital necrosis and multiorgan system involvement, interpreted as rheumatoid vasculitis, undergoing treatment with immunosuppressants.

Evolución clínica y niveles de anti-S SARS-CoV-2 en enfermedades reumáticas y COVID-19 / Clinical evolution and levels of anti S SARS-CoV-2 IgG in rheumatic disease and COVID-19

Resumen Existen controversias sobre la respuesta humoral al virus SARS-CoV-2 y la seroconversión en pacientes con enfermedades autoinmunes. Hay pocas publicaciones sobre la clínica y la evolución de COVID-19 en este último grupo. El objetivo fue examinar las características clínicas y evolutivas asociadas a COVID-19 y el porcentaje de seroconversión en personas con enfermedades reumáticas. Se incluyeron 53 pacientes principalmente con artritis reumatoide y lupus. La mayoría de sexo femenino y edad promedio 48 ± 14 años. La sintomatología fue fiebre (56%), anosmia (35.8%), disnea (34%), cefalea (30.2%) y tos (30.2%). Duración de infección 12 ± 7 días. Casi la mitad de los pacientes fueron hospitalizados (23, 43.4%), 5 en unidad de cuida dos críticos (9.4%) y 3 murieron (5.6%). La prevalencia de uso de esteroides fue de 56.6% (30), con una dosis media 8 mg/d, y 17 (32%) usaban biofármacos inmunosupresores. Hubo correlación entre edad y la necesidad de internación con un riesgo de 9.4% por año. No hubo diferencias con otras variables. Se determinó la presencia en suero de inmunoglobulina IgG contra la proteína S del SARS-CoV-2 en 23/53 pacientes (43.4%), con niveles detectables en 15 (62.2%). Se evaluaron 23 sin enfermedades autoinmunes del tejido conectivo que padecieron COVID-19, 12 tuvieron anticuerpos detectables. La muerte en este grupo de enfermedades reumatológicas fue baja, similar a la comunicada en la población general. Más de la mitad presentó anticuerpos específicos contra el virus independientemente de la medicación utilizada.

Abstract Controversies still exist regarding the humoral response to the virus SARS-CoV-2 in convalescent patients and seroconversion in patients with autoimmune diseases. There are few reports on the clinical and evo lution of COVID-19 in the latter group. The objective was to examine the clinical and evolutionary characteristics associated with COVID-19 and the percentage of seroconversion in people with rheumatic diseases. Fifty-three patients were included, mainly with rheumatoid arthritis and lupus. The majority were female and average age 48 ± 14 years. Symptoms: fever (56%), anosmia (35.8%), dyspnea (34%), headache (30.2%) and cough (30.2%). Duration of infection 12 ± 7 days. Almost half of the patients were hospitalized (23, 43.4%), 5 in critical care units (9.4%) and 3 died (5.6%). The prevalence of steroid use was 56.6% (30), with an average dose of 8 mg/d, and 17 (32%) used immunosuppressive biopharmaceuticals. There was a correlation between age and the need for hospitalization with a risk of 9.4% per year. There were no differences with other variables. The presence in serum of IgG immunoglobulin against SARS-CoV-2 protein S was determined in 23/53 patients (43.4%), with detectable levels in 15 (62.2%), and in the 23 without autoimmune connective tissue diseases who suffered from COVID-19, 12 had detectable antibodies. Death in this group of rheumatic diseases was low, similar to the general population. More than half had specific antibodies against the virus regardless of the medication used.

Tratamiento endoscópico de adenomas de la papila menor: reporte de dos casos / Endoscopic treatment of minor papilla adenomas: Report on two cases

Resumen Existen numerosas publicaciones sobre resección endoscópica de lesiones de la papila mayor, pero solo se han presentado series de casos individuales de resección de lesiones de la papila menor. En el presente artículo se describe el éxito técnico y la seguridad de la resección endoscópica de dos lesiones adenomatosas de la papila menor.

Abstract There are various publications on endoscopic resection of major papilla lesions, but only individual case series of resection of minor papilla lesions have been reported. This article describes the technical success and safety of endoscopic resection of two adenomatous lesions of the minor papilla.

Embolia pulmonar aérea secundaria a colangiopancreatografía retrógrada endoscópica en una paciente con trasplante hepático. Reporte de caso / Case report of a pulmonary air embolism secondary to endoscopic retrograde cholangiopancreatography in a liver transplant patient

Resumen La colangiopancreatografía retrógrada endoscópica (CPRE) es uno de los recursos terapéuticos más importantes para el manejo de las complicaciones biliares del trasplante hepático. Sin embargo, se pueden presentar varias complicaciones: pancreatitis aguda, hemorragia, perforaciones, infecciones y eventos adversos cardiopulmonares. La embolia aérea es una complicación muy infrecuente, severa y potencialmente fatal. Se reporta un caso de embolia aérea post-CPRE en una mujer de 55 años con antecedente de trasplante hepático y estenosis de la anastomosis biliar. Se discute la presentación clínica, el diagnóstico, el tratamiento y los posibles mecanismos involucrados en esta complicación.

Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most important therapeutic resources for management of biliary complications of liver transplantation. However, several complications including acute pancreatitis, hemorrhage, perforations, infections and cardiopulmonary adverse events can occur. Air embolisms occur very infrequently but are severe and potentially fatal complications. We report a case of post-ERCP embolism in a 55-year-old woman with a history of liver transplantation and stenosis of the biliary anastomosis. The clinical presentation, the diagnosis, the treatment and the possible mechanisms involved in this complication are discussed.

Campylobacter species in chilean patients with chronic periodontitis / Espécies de Campylobacter em pacientes chilenos com periodontite crônica

The purpose of this study is to identify the presence of Campylobacter species (C. rectus, C. concisus, C. gracilis and C. ureolyticus) in Chilean patients with chronic periodontitis, and to establish the relationship of these microorganisms with the periodontal conditions of smoker and non-smoker patients. Subgingival plaque samples were collected from four periodontal-affected tissue sites of 15 smoker and 15 non-moker patients with chronic periodontitis. A sample per quadrant was obtained, with a probing depth of 6 mm and an insertion loss of >3 mm in each patient. Polymerase chain reaction (PCR) was performed with the specific 16S rDNA primers for the molecular detection of C. rectus and C. gracilis, specific cpn60 primers for C. concisus and hsp60 primers gene for C. ureolyticus. Campylobacter species showed an overall prevalence of 93.3% in periodontal patients, while C. rectus was the most frequent one (80%), followed by C. concisus (66.7%), C. gracilis (33.3%), and C. ureolyticus (10%). Only C. gracilis showed a statistically significant (p = 0.002) association with chronic periodontitis among samples from smoker and nonsmoker patients. A high prevalence of the Campylobacter genus in the analyzed populations (93.3%) was found, being C. rectus the most frequent (80%) species. Besides, C. gracilis showed a statistically significant association between smoker state and chronic periodontitis.

O objetivo deste estudo é identificar a presença de espécies de Campylobacter (C. rectus, C. concisus, C. gracilis e C. ureolyticus) em pacientes chilenos com periodontite crônica, e estabelecer a relação desses microrganismos com as condições periodontais de pacientes fumantes e não fumantes. Amostras de placa subgengival foram coletadas de quatro locais de tecido periodontal afetado de 15 pacientes fumantes e 15 não fumantes com periodontite crônica. Obteve-se uma amostra por quadrante, com profundidade de sondagem 6 mm e perda de inserção > 3 mm em cada paciente. A reação em cadeia da polimerase (PCR) foi realizada com os primers específicos 16S rDNA para a detecção molecular de C. rectus e C. gracilis, primers específicos de cpn60 para C. concisus e gene primers de hsp60 para C. ureolyticus. As espécies de Campylobacter apresentaram uma prevalência geral de 93,3% nos pacientes periodontais, enquanto C. rectus foi o mais frequente (80%), seguido por C. concisus (66,7%), C. gracilis (33,3%) e C. ureolyticus (10%). Apenas C. gracilis apresentou associação estatisticamente significante (p = 0,002) com a periodontite crônica entre as amostras de pacientes fumantes e não fumantes. Observou-se alta prevalência do gênero Campylobacter nas populações analisadas (93,3%), sendo C. reto as espécies mais frequentes (80%). Além disso, C. gracilis mostrou associação estatisticamente significante entre estado de fumante e periodontite crônica.

Pancitopenia y aplasia medular asociada a abatacept en una paciente con Artritis Reumatoide / Pancytopenia and medular aplasia associated to abatacept in a patient with rheumatoid arthritis

El tratamiento de pacientes con artritis reumatoide (AR) debe ser temprano y agresivo para prevenir el daño articular y la discapacidad. Los fármacos no biológicos modificadoes de enfermedad, como el metotrexato, han sido utilizados par controlar la actividad de la enfermedad y para prevenir el daño de las articulaciones. Existen pacientes con AR resistentes al tratamiento con fármacos modificadores de la enfermedad y otros que no responden adecuadamente a la terapia con inhibidores de factores de necrosis tumoral. Nosotros describimos el caso de una paciente de sexo femenino de 77 años que se presentó al servicio de emergencias con fiebre, mucositis y mal estado general luego de recibir una dosis de abatacept. A su ingreso el laboratorio demostró: glóbulos blancos 500 cel/mm3, neutrófilos 150 cel/mm3, plaquetas 21000 cel/mm3, hematocrito 29%, VCM 81, LDH 314 UI/L, función renal y hepatograma normales. En el examen clínico se objetivaron ulceras y lesiones ampollares en mucosa yugal. El medulograma evidenció hipocelularidad, con disminución de las tres series. El informe anatomopatológico fue de médula ósea hipoplásica. Recibió tratamiento con factor estimulante de colonias de neutrófilos, ácido fólico y metilprednisona, con resolución del cuadro a los 3 días de instituido el tratamiento. Hasta nuestro conocimiento esta es la primera comunicación de pancitopenia asociada a abatacept es una paciente con artritis AR intolerante a metotrexato

Treatment of patient with rheumatoid arthritis (RA) should be early and aggressive to prevent joint injury and disability. Disease-modifying antirheumatic drugs (DMARDs) like methotrexate has been used as initial treatment toward the disease activity and to prevento joint damage. Some patients with RA are resistant to initial therapy with nonbiiologic DMARDs or TNF inhibitiors. We described a 77 years old women who presented to the emergency room with fever andoral lesions after been treated with abatacept. On examination patient appeared ill. She had oral ulcers. laboratory testing showed white cells count 500 cells per mm3, hematocrit 29 %, platelets count 21000 cells per mm3, LDH 314 U/l. Renal and liver functions were normal. Bone marrow showed decreased in the three cells lineages. Patient was treated with granulocyte colony-stimulating factor, folic acid, and prednisone. Patient improved her physical and laboratory features three days after admission. This case showed the rare association between pancytopenia and abatacept in a patient with RA

Ictericia obstructiva benigna y maligna: utilidad clínica del CA 19-9 / Benign and malignant obstructive jaundice: clinical ultility of CA 19-9

Introducción: Se estableció como objetivo determinar la utilidad clínica del marcador tumoral CA 19-9 en ictericia obstructiva de origen benigno y maligno en pacientes adultos que acuden al servicio de gastroenterología del Hospital Universitario de Caracas. Pacientes y métodos: se estableció como muestra a todos los pacientes que fueron hospitalizados en el Servicio de Gastroenterología del Hospital Universitario de Caracas con ictericia obstructiva, a los cuales se les realizó la determinación del CA 19-9 antes y siete días después del drenaje de la vía biliar a través de una colangiopancreatografía retrógrada endoscópica y se determinó la variación de los valores de CA 19-9 y si este valor permitió diferenciar entre ambas etiologías. Resultados: Los valores de CA 19-9 no se modificaron de forma significativa después del drenaje biliar en la patología benigna ni en la maligna. Se obtuvo un nuevo punto de corte para el CA 19-9 (47U/L), manteniendo la sensibilidad, pero aumentando la especificidad. Conclusiones:No se puede utilizar la variación del CA 19-9 después del drenaje biliar como elemento diagnóstico para diferenciar entre enfermedad benigna o maligna biliopancreática.

Aim: to determinate the clinical utility of the tumor marker CA 19-9 in obstructive jaundice of benign and malignant origin in adult patients who comes to the service of gastroenterology of the Caracas University Hospital.Patients and methods: was stablish as sample every patient who undergo hospitalization in the service of gastroenterology Caracas University Hospital with obstructive jaundice in which was determinate the CA 19-9 before and seven days after the drainage of the biliary pathway with endoscopic retrograde colangiopancreatography and was determinate the variation of the results of the CA 19-9 and if this result can differentiate between both etiologies. Results: the values of CA19-9 did not modified in significant way after the biliary drainage in the benign and malignant pathology. It was obtained a new cohort point of the CA 19-9 (47U/L), keeping the sensitivity, but increasing the specificity. Conclusions: it can’t be used the variation of the CA 19-9 after the biliary drainage as diagnostic element to differentiate between benign and malignant pathology..

Enhancing adherence of Arcobacter butzleri after serial intraperitoneal passages in mice / Enhancing adherence of Arcobacter butzleri after serial intraperitoneal passages in mice.

We investigated the possibility of enhancing the adherence capacity of four low-adherent Arcobacter butzleri strains after serial intraperitoneal passage (i.p.) in mice. All the strains enhanced their adherence capacity after the first passage, increasing their adhesion rates after each passage. These results suggest that i.p. passage enhances the expression of adherence in A. butzleri strains.

Subtyping of Chilean Methicillin-Resistant Staphylococcus aureus strains carrying the staphylococcal cassette chromosome mec type I

The cassette chromosome mec (SCCmec) present in methicillin-resistant Staphylococcus aureus (MRSA) has two essential components, the ccr gene complex and the mec gene complex. Additionally, SCCmec has non-essential components called J regions which are used for MRSA subtyping. This study was performed to determine subtypes MRSA strains carrying SCCmec type I based on polymorphism of regions located downstream of the mecA gene. A total of 98 MRSA strains carrying SCCmec type I isolated from patients hospitalized at the County Hospital of Valdivia (Chile) between May 2007 and May 2008, were analyzed by multiplex PCR designed to amplify the mecA gene and 7 DNA hypervariable regions located around the mecA gene. MRSA strains were classified into seventeen genotypes accordingly to amplification patterns of DNA hypervariable regions. Five genotypes showed amplification patterns previously described. The remaining twelve genotypes showed new amplification patterns. Genotypes 18 and Genotype 19 were the most frequently detected. Regions HVR, Ins117 and pI258 stand out as being present in more than 60% of tested isolates. The acquisition of hypervariable regions by MRSA is a continuous horizontal transfer process through which the SCCmec have been preserved intact, or even may give rise to new types and subtypes of SCCmec. Therefore it is possible to infer that most MRSA strains isolated at the County Hospital of Valdivia (Chile) were originated from two local clones which correspond to Genotype 18 and Genotype 19.