ABSTRACT
Introducción: El interferón (IFN) tipo I es una citoquina que juega un rol fundamental en la patogenia del Lupus Eritematoso Sistémico (LES). Diferentes niveles de esta citoquina podrían explicar la heterogeneidad de esta patología y ser útil para evaluar la actividad de la misma. Objetivos: Determinar los niveles de IFN tipo I sérico en pacientes con LES y evaluar su utilidad como biomarcador de actividad. Material y Métodos: 16 pacientes con LES (ACR 1997) y 16 controles. Métodos: Actividad de la enfermedad (SLEDAI-2K), daño orgánico (SLICC), IFN tipo I (HEK-Blue-IFNα/β), anticuerpos anti-DNAdc (Inmunofluorescencia Indirecta), anticuerpos anti-ENA (ELISA), C3-C4 (Inmunoturbidimetría). Estadística: InfoStat/Instat/MedCalc. Valores de p<0,05 fueron considerados estadísticamente significativos. Resultados: Se observó un aumento de la concentración de IFN en el grupo LES con respecto al control (p<0,05). Los pacientes con valores de IFN superiores al punto de corte, se asociaron con la presencia de anticuerpos anti-DNAdc (OR:13,33; p<0,05). Pacientes con hipocomplementemia y aquellos con puntaje de SLEDAI-2K mayor a 8 presentaron mayores niveles de IFN comparados con pacientes con complemento normal y menor puntaje de índice, respectivamente (p<0,05). Conclusiones: Estos resultados sugieren la importancia que podría tener la determinación de IFN tipo I para el monitoreo de la actividad del LES.
Introduction: Type I interferon (IFN) is a cytokine that plays a fundamental role in the pathogenesis of Systemic Lupus Erythematosus (SLE). Different levels of this cytokine could explain the heterogeneity of this pathology and be useful to evaluate its activity. Objectives: To determine the serum type I IFN levels in patients with SLE and evaluate its usefulness as a biomarker of activity. Material and Method: 16 patients with SLE (ACR 1997) and 16 controls. Methods: Disease activity (SLEDAI-2K), organ damage (SLICC), type I IFN (HEK-Blue-IFNα/β), anti-dsDNA antibodies (Indirect Immunofluorescence), anti-ENA antibodies (ELISA), C3-C4 (Immunoturbidimetry). Statistics: InfoStat/Instat/MedCalc. P values <0.05 were statistically significant. Results: An increase in IFN concentration was observed in the SLE group respect to the control (p <0.05). Patients with IFN values above the cut-off point were associated with the presence of anti-dsDNA antibodies (OR: 13.33; p<0.05). Hypocomplementemic patients and those with a SLEDAI-2K score greater than 8 had higher IFN levels compared to patients with normal complement and a lower index score, respectively (p<0.05). Conclusions: These results suggest the importance that the determination of IFN type I could have for the monitoring of SLE activity.
Subject(s)
Humans , Lupus Erythematosus, Systemic , Interferon Type I , AntibodiesABSTRACT
Se describe el caso de una mujer de 35 años que presenta polineuropatía desmielinizante inflamatoria crónica como compromiso neurológico en su diagnóstico inicial de lupus eritematoso sistémico (LES). Si bien el compromiso neurológico es de una prevalencia variable en lupus, la asociación que se describe no es frecuente y tiene importantes connotaciones en el tratamiento.
We described a 35 years old female, who developed Chronic inflammatory demyelinating polyneuropathy as neurologic commitment during the early diagnosis in Systemic Lupus Erithematosus (SLE). While the neuropsychiatric commitment has a variable prevalence in SLE, the association that we describe is infrequent and it has important concerns during its treatment.
Subject(s)
Polyneuropathies , Therapeutics , Diagnosis , Lupus Erythematosus, SystemicABSTRACT
Se describe el caso de una mujer de 35 años que presenta polineuropatía desmielinizante inflamatoria crónica como compromiso neurológico en su diagnóstico inicial de lupus eritematoso sistémico (LES). Si bien el compromiso neurológico es de una prevalencia variable en lupus, la asociación que se describe no es frecuente y tiene importantes connotaciones en el tratamiento.
We described a 35 years old female, who developed Chronic inflammatory demyelinating polyneuropathy as neurologic commitment during the early diagnosis in Systemic Lupus Erithematosus (SLE). While the neuropsychiatric commitment has a variable prevalence in SLE, the association that we describe is infrequent and it has important concerns during its treatment.
Subject(s)
Humans , Female , Polyneuropathies , Therapeutics , Lupus Erythematosus, SystemicABSTRACT
Introduction: Antiphospholipid Antibodies (APA) are detected in 30 and 40% of patients with Systemic lupus erythematosus (SLE). Antiphospholipid Syndrome nephropathy (APSN) is one of renal manifestations of APS. Histological lesions of APSN have been described in SLE. Objective: To evaluate the prevalence of APA in patients with lupus nephritis (LN), its clinical and laboratory association and the presence of APSN in renal biopsies from LN patients. Patients and Methods: We retrospectively studied 28 patients with SLE diagnosis according to ACR criteria, who underwent renal biopsies with diagnosis of LN. These patients attended to our rheumatology unit for the last 2 years. Demographic, clinical and serological data were collected at the time of the first biopsy. APA (Anticardiolipin Ig G, Ig M and lupus anticoagulant) were considered positivewhen they were positive in two opportunities during the follow up. Renal biopsies were classified according to NL classification 2004. Histological features of APSN were analyzed by 2 different pathologists who were blind to clinical data. P value <0.05 was considered statistically significant. Results: Mean age was 31 years old (17-53), 86% were female and mean SLE duration was 47 months (1-180). 54% of patients were positive for APA. There was not association between APA and first creatinine level, hypertension, amount of proteinuria and active sediment. Class II LN was most frequently associated with APA. Glomerular collapse and focal cortical atrophy (FCA) were associatedwith APA (p<0.008, p<0.005). Conclusions: APA were present in 54% of patients with LN. There was not association between APA and clinical features or histological type of LN. The main histological features of APSN were glomerular collapse and FCA
Subject(s)
Antibodies, Antiphospholipid , Antiphospholipid Syndrome , Kidney Diseases , Lupus Nephritis , Thrombosis , Data Interpretation, StatisticalABSTRACT
A 66 years female, who was since last year under astenia, arthralgias, pimply lesions in spread plates and tests showing eritrosedimentation over 100 mm, anemi, leucocitosis with neutrofilia, policlonal hypergammaglobulinemia, slight proteinuria and IgE on 900. This patient was sporadically treated with corticoids. When made the medical consult had lost 34lb., was under anorexy, as well as dyspepsia. Hemoglobyn 6.9 gr/dl, leucocytes 20000/mm3, neutrofils at 90%, proteinogram the same as former, with hypoalbuminemia. She was taking prednisona, 16 mg/day. When examined showed depress of conscience, astenia, and dermic lesions already quoted. 4 cm nonpainful right axillary adenopaty adhered to deep planes. Medulogram with increased iron, hyperegenerative. Ganglionar biopsia: linfoid hyperplasic process linked to inmune response. Toracoabdominal tomography with adenomegalia in torax and retroperitoneo. Skin biopsia: neutrofilic vasculitis. The patient suspends the 16 mg of prednisona and fever as well as generalized adenopatias come up. After laying aside other ethiologies, and understanding as Castleman Multicentric disease, it is started to supply prednisona 1 mg/kg of weight with a clinical and biochemical fast and outstanding response. After 7 months it was progressively suspended the esteroids and 60 days later, the process fall back; for that, corticoids are restarted, with a good evolution. The illness of Castleman although it is not very frequent, it should be considered as differential diagnosis in those clinical cases that are accompanied with important general commitment, linphadenopaties and respons to steroid therapy.
Mujer de 66 años que un año previo a la consulta presentaba astenia, artralgias, lesiones pruriginosas y eritematosas en placa diseminadas. Eritrosedimentación mayor de 100mm, anemia, leucocitosis con neutrofilia, hipergammaglobulinemia policlonal, proteinuria leve e IgE de 900. Fue tratada esporádicamente con corticoides. Llega a la consulta con pérdida de 15kg de peso, anorexia y dispepsia. Hemoglobina 6.9gr/dl, leucocitos 20000/mm3, neutrófilos 90%, proteinograma similar al previo mas hipoalbuminemia. Recibía prednisona 16mg;día. Al examen bradipsíquica, asténica, lesiones dérmicas ya descritas, adenopatía axilar derecha de 4cm no dolorosa adherida a planos profundos. Medulograma con hierro aumentado, hiperregenerativa. Biopsia ganglionar: proceso hiperplásico linfoide relacionado a respuesta inmune. Tomografía tóracoabdominal con adenomegalias en medias tino y retroperitoneo. Biopsia de piel: vasculitis neutrofílica. Suspende el corticoide y aparece fiebre y adenopatías generalizadas. Tras descartar otras etiologías, se interpreta como Enfermedad de Castleman. Inicia prednisona a lmg/kg/ día con favorable, rápida y llamativa respuesta clínica y bioquímica. Luego de 7 meses se suspende de manera progresiva los esteroides, y a los 60 días presenta recaída por lo que se reinicia la terapéutica con una nueva favorable evolución. La enfermedad de Castleman si bien es poco frecuente, debe ser considerada como diagnóstico diferencial en aquellos cuadros clínicos que se acompañan de importante compromiso general. adenomegalias y respuesta a terapia con corticoides.
Subject(s)
Aged , Female , Humans , Castleman Disease/pathology , Skin/pathology , Antineoplastic Agents, Hormonal/therapeutic use , Biopsy , Diagnosis, Differential , Castleman Disease/drug therapy , Prednisolone/therapeutic useABSTRACT
Upper gastrointestinal bleeding--UGB-, as a complication, is well studied at intensive care units (ICU), but is less known in non ICU settings. Objectives: To determine incidence and risk factors of this entity at clinical hospitalization. MATERIALS AND METHODS: A case-control study of patients with gastric ulcer disease diagnosed by endoscopy who presented with melena and hematemesis. Ten controls were taken for each case, matching sex, age and prophylaxis for gastric hemorrhage. Demographic data and other know risks factors were analyzed. RESULT: We found ten bleeding case among 35070 discharges (incidence: 2.8/10000 discharges). Mortality was not increased but the number of transfusion was higher in the bleeding group. We found an assocciation betwen UGB and systemic inflammatory response syndrome--SIRS-(OR: 9.22 IC 95% 2.98-28.17) and diabetes (OR: 7.8 IC 95% 2.3-26.8). The rest of the factors studied did not rich a statistical significance. CONCLUSIONS: UGB during clinical hospitalization is a rare complication that requires an increased staying at hospital and a great number of transfusions. It may be probably associated in a positive way with diabetes and SIRS.
La hemorragia digestiva alta durante la internación es una complicación estudiada en unidades de cuidados críticos, pero se sabe poco de esta complicación en sala común. Objetivos: determinar la incidencia y factores de riesgo de esta patología en sala común. Materiales y Métodos: Estudio casocontrol. Definimos casos, pacientes con endoscopía digestiva realizada por melena o hematemesis, con diagnóstico de enfermedad ulcerosa, se tomaron 10 controles por caso, controlando edad, sexo y uso de profilaxis ulcerosa. Se analizaron datos demográficos y factores de riesgo conocidos para esta patología y se determinó la incidencia en sala común. Resultados: Se produjeron 10 episodios de sangrado sobre 35070 altas (Incidencia 2.8110.000 altas). No hubo mayor mortalidad en los casos pero si requirieron mayor número de transfusiones (1.2 versus (vs) 0.07 paquetes de glóbulos rojos sedimentados en el grupo control. P=O.OOl) y tuvieron una mayor estadía hospitalaria (13.6 vs 6.8 días en el grupo control. P=O.OOl). Existió una asociación significativa entre hemorragia digestiva y presentar SIRS (aR: 9.22 IC95%: 2.9828.17) o Diabetes (aR: 7.8 IC95%: 2.326.8), el resto de los factores no alcanzaron significancia estadística. Conclusión: La hemorragia digestiva durante la internación es una entidad poco frecuente que requiere mayor estadía hospitalaria y necesidad de transfusiones. Asociada posiblemente en forma positiva al ingreso con SIRS, Diabetes, leucocitosis y taquicardia.