Frequência de anticorpos irregulares identificados em pacientes atendidos em um hemonúcleo no sudoeste do Paraná no ano de 2017 / Frequency of irregular antibodies identified in patients treated at the hemotherapy service in southwest of Paraná in 2017

Quando um indivíduo é exposto a antígenos eritrocitários não próprios, ocorre uma resposta imunológica, que leva à produção de anticorpos irregulares voltados contra esses antígenos. Esse processo é conhecido como aloimunização eritrocitária e acontece em decorrência de transfusões de sangue ou gestações incompatíveis. Na medicina transfusional a pesquisa de anticorpos irregulares é fundamental, pois a falha na detecção de um aloanticorpo pode provocar reações transfusionais, aloimunizações, anemias hemolíticas autoimunes e doença hemolítica perinatal. Este estudo tem por objetivo analisar a frequência de anticorpos irregulares de pacientes atendidos no Hemocentro Regional de Francisco Beltrão, Paraná, no ano de 2017. Os dados foram coletados a partir da revisão de registros em arquivos do Laboratório de Imunohematologia do Hemonúcleo. Foram avaliados dados de 49 protocolos de pacientes que apresentaram dificuldades transfusionais no ano de 2017. Dentre os pesquisados, 37 pacientes (75,5%) apresentaram anticorpos irregulares. Dentre os anticorpos anti-eritrocitários observados neste estudo, evidenciou-se a presença de doze pacientes com anti-D (27,2%), seis pacientes com anti-K (13,6%), quatro pacientes com anti-C (9,0%) e em seis pacientes (13,6%) foi observada a presença de autoanticorpos. Este estudo indica que, nos pacientes transfundidos, os anticorpos mais frequentes foram os aloanticorpos Anti-D do Sistema Rh, provavelmente devido ao seu alto grau de imunogenicidade. A prevalência desses anticorpos é semelhante a vários estudos encontrados na literatura.

When an individual is exposed to not-self red blood cell antigens, an immune response occurs, which leads to the production of irregular antibodies directed against these antigens. This process is known as erythrocyte alloimmunization and occurs as a result of blood transfusions or incompatible pregnancies. In transfusion medicine, the search for irregular antibodies is essential, since failure to detect an alloantibody can cause transfusion reactions, alloimmunizations, autoimmune hemolytic anemias, and perinatal hemolytic disease. This study aims at analyzing the frequency of irregular antibodies of patients seen at the Regional Blood Center of Francisco Beltrão, Paraná, in 2017. The data were collected from the review of records in files of the Immunohematology Laboratory of Hemonúcleo. Data from 49 protocols of patients who had transfusion difficulties in 2017 were evaluated. Among those surveyed, 37 patients (75.5%) had irregular antibodies. Among the anti-erythrocyte antibodies observed in this study, the presence of twelve patients with anti-D (27.2%), six patients with anti-K (13.6%), four patients with anti-C (9.0 %), and in six patients (13.6%) with the presence of autoantibodies were observed. This study indicates that, in transfused patients, the most frequent antibodies were the Rh System Anti-D alloantibodies, probably due to their high degree of immunogenicity. The prevalence of these antibodies is similar to several studies found in the literature.

A Never-Ending Story Of Rheumatoid Arthritis

There are distinct Rheumatic disorders, still Rheumatoid arthritis (RA) is believed to be very prevailing. RA is an empathic disorder described over integral redness, constant inflammation, and the existence of auto-antibodies. In RA, inflammation in joints, loss of motion of joint stiffness, joint tenderness are most common in patients. Deformity of joints can be prevented by early diagnosis and treatment. The extremity of the disease can be reduced by combining the drugs and improved weight more profiled than single medication. Treat-to-target progress results in a superior-conclusion in RA, and the ACR, EULAR, and other specialized systems have supported treat-to-target as a basic curative strategy for RA. The novel methods used in RA have upgraded the development of the disorder and maximum people helpful in cancellation of clinical manifestations if the identification of disorder takes place before time. This review article is written after studying most of the journal’s articles, which were published between 1997-2019.

Study of paediatric systemic lupus erythematosus in tertiary care center in South India

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation and the presence of circulating autoantibodies directed against self-antigens. The reported prevalence of SLE in children and adolescents (1-6/100,000) is lower than that in adults (20-70/100,000). The study among pediatric population' were few and hence this study from south India was undertaken. Objective of this study was to study the clinical and immunological profile of children with systemic lupus erythematosus (SLE). To study the Distribution of Renal Lesions according to ISN/RPS Classification of Lupus Nephritis'Methods: Retrospective hospital based observational study in tertiary level centre in Bengaluru (BMCRI). Medical records of children with SLE admitted in Pediatric department from the period of 2010-2019 through the hospital information system were analyzed. Clinico pathological features and immunological profile were compared with other studies.Results: Among 25 patients studied male to female ratio was1:2.5. The mean patient's age at the time of presentation was13.2 year, the youngest child being 7 year. The mean duration of disease before diagnosis was 1year, most common systems involved were haematological (92%), followed by kidney (88%), GIT (72%), mucocutaneous (68%) cases. 19 (91%) cases were ANA positive and two ANA negatives. Anti-ds DNA was positive in 18(85%) patients, 5 were anti smith antibody positive. Diffuse proliferative glomerulonephritis (ISN/RPS class IV) was the most commonly seen histological pattern, seen in 9(56%) patients, 4(25%) patient had focal and segmental proliferative glomerulonephritis (ISN/RPS class III) and 2(12%) had membranous glomerulonephritis (grade ISN/RPS class V).Conclusions: SLE can present with diverse, unpredictable clinical manifestations, the primary diagnosis can often be missed if the index of suspicion is not high, since childhood SLE does not present with classical manifestations.

Encefalitis autoinmunes: Un nuevo diagnóstico para una antigua enfermedad / Autoimmune encephalitis. New diagnosis for an old condition

Las encefalitis autoinmunes son un nuevo grupo de enfermedades de gran trascendencia clínica y terapéutica debido a la buena respuesta en gran parte de los casos a la terapia inmunomoduladora indicada, con un gran porcentaje de curación, sin secuelas neurológicas importantes (cognitivo, motor, crisis o movimientos involuntarios). En el año 2007 se demostró la presencia de auto anticuerpos neuronales en la patogenia de este grupo de enfermedades, con síntomas psicóticos y de movimientos involuntarios como indicadores de la enfermedad. La presente revisión enfatiza el salto crucial y el cambio de paradigmas suscitados tras el descubrimiento de estas encefalitis asociadas a anticuerpos.

Autoimmune encephalitis is a new group of diseases of great clinical and therapeutic importance due to the good response in most cases to the immunomodulatory therapy indicated, with a large percentage of healing without significant neurological effects (cognitive, motor, seizures or involuntary movements). Since 2007, the presence of neuronal autoantibodies in the pathogenesis of this group of diseases has been demonstrated, with psychotic symptoms and involuntary movements as clinical markers of the disease. The present review emphasizes the crucial leap and change of paradigms arising after the discovery of these encephalitis associated with antibodies.

The immune characteristics in primary immune thrombocytopenia patients with abnormal auto-antibodies / 实用医学杂志

Objective To investigate the immune status characteristics of primary ITP patients with abnor-mal auto-antibodies. Methods A total of 110 patients were enrolled in our study,who were admitted in Fu-Xing Hospital affiliated to Capital Medical University from January 2001 to July 2015.According to whether the patients have autoimmune diseases and the presence of auto-antibodies,we divided the patients into 3 groups,including the primary ITP with abnormal auto-antibodies(PITP-ANA)group,the primary ITP(PITP)group and the second-ary ITP(SITP)group.We compared the T-cell subsets,regulatory T cells,B lymphocytes,changes of immunoglob-ulin and bone marrow biopsy and cytology of patients among the three groups,retrospectively. Results The per-centage of CD3+T cells(61.72 ± 10.60)% in PITP-ANA group was lower than that in PITP group(69.57 ± 11.99)%. The percentage of CD8+T lymphocyte(24.00 ± 7.67)% was significantly lower than that of PITP group (30.59 ± 11.08)%(P<0.05).The proportion of Treg in PITP group,PITP-ANA group and SITP group were(6.12 ± 1.41)%,(7.50 ± 2.76)% and(8.49 ± 2.47)%,respectively,with statistically significant differences.The ra-tio of CD19+T cell in PITP-ANA group(25.75 ± 9.98)%was significantly higher than that in PITP group(16.16 ± 8.19)%(P < 0.01). The concentration of IgG、IgA、κ light chain and λ light chain in PITP group,PITP-ANA group and SITP group showed an upward trend and the highest level was in the SITP group,with statistically signifi-cant differences among the three groups. A variety of abnormal auto-antibodies could be found in both PITP-ANA group and SITP group. Conclusions We consider that the immune function abnormity of patients in PITP-ANA group were worse than that in PITP group,because the concentration of immunoglobulin,the percentage of B lym-phocyte and Treg ratio are higher in than those in PITP group.

Experimental systemic lupus erythematosus mouse model induced by pristane / 药物评价研究

Objective To establish the systemic lupus erythematosus (SLE) mouse model through pristaneip injection and validate the model comprehensively.Methods Female BALB/c mice of 6-8 weeks were randomly divided into two groups.Animals in model group were injected with 0.5 mL pristane by ip injection while in control group with 0.5 mL normal saline.Anti-systemic lupus erythematosus antibodies (anti-SLE) and anti-double strand DNA antibodies (anti-dsDNA) were checked before injection and monthly thereafter.Proteinuria was detected before injection and every month thereafter.All mice were bled to death 6 months after injection.Kidneys were excised to observe the histopathologic evidence of glomerulonephritis.Results The concentration of anti-dsDNA and anti-SLE antibody in sera was higher of model group than that of control group two months after pristane injection,and the concentration of antibody gradually increased within 6 months.At the sixth months,the protein concentration of urine in most model group mice was ++++.The histopathology and imunoflorescence of kidney sections indicated typical evidence of glomerulonephritis in model group.Conclusion The murine lupus model can be successfully established in female BALB/e mouse with a single ip injection of 0.5mL ofpristane.

Importancia de indicar e interpretar las pruebas de autoanticuerpos / Significance of Indicating and Interpreting Autoantibody Tests

La aceptación y la relevancia de los autoanticuerpos se evidencia por su creciente incorporación en los criterios diagnósticos y de clasificación de las enfermedades autoinmunes. Una de las preocupaciones actuales, derivadas del uso ampliado de los autoanticuerpos, es la conservación del uso adecuado, en contraposición con el uso indiscriminado que genera un aumento de resultados falsos positivos que conducen a costosos errores en el diagnóstico, seguimiento, e incluso, tratamiento del paciente. Este artículo intenta resumir las circunstancias en que es oportuno ordenar las pruebas de autoanticuerpos, y cómo interpretarlas para preservar su utilidad clínica y refrenar los gastos de salud(AU)

The acceptance and relevance of auto-antibodies is evidenced by their increasing incorporation into the diagnostic and classification criteria of autoimmune diseases. One of the current concerns arising from the widespread use of auto-antibodies is the observance of adequate use, as opposed to its undiscriminating use that results in an increase of false positive results leading to costly errors in diagnosis, follow-up, and even treatment of the patient. This article attempts to summarize the circumstances when it is timely to order autoantibody tests, and how to interpret them to preserve their clinical utility and control health expenditures(AU)

Clinical & immunological profile of newly diagnosed patients with youth onset diabetes mellitus.

Background & objectives: There has been a rise in the incidence of diabetes mellitus in the younger population of India. There are limited data available on the immunological profile of youth onset diabetes mellitus (DM) especially in type 2. Therefore, this study was undertaken to evaluate the clinical and immunological profile of youth onset DM in north India. Methods: Fifty one consecutive patients of 8-35 yr of age with diabetes mellitus attending the Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, and Hormone Care and Research Center at Ghaziabad, Uttar Pradesh, India, were included in the study. All subjects were tested for glutamic acid decarboxylase (GAD), an islet cell antigen ICA512/IA2, and insulin antibodies. GAD and ICA512/IA2 were done by ELISA and insulin autoantibodies were tested by radioimmunoassay (RIA) method. These patients were also screened for hepatitis A to E, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) as trigger factors for onset of type 1 DM. Results: of the total 51 patients, 38 were men and 13 were women. The mean age and BMI of the subjects was 19.7 (±7) years and 21 (± 5) kg/m2, respectively. Twenty patients were below the age of 18 yr and their height was more than 75th percentile of Indian standards. All patients were symptomatic and 12 of these presented with ketoacidosis. only 48 per cent (n=24) were positive for GAD, 14 per cent (n=7) for ICA512/IA-2, and 28% (n=14) were positive for insulin antibody. Five of these patients had evidence of hepatitis E virus infection. None of the subjects had evidence of active CMV or EBV infection. Interpretation & conclusions: About half of the youth onset diabetes mellitus patients from north India had presence of pancreatic autoimmunity in the form of GAD, ICA512/IA2, and insulin antibodies or a combination of antibodies suggestive of having type 1 DM. Further studies need to be done on a large sample size in different parts of the country.

Celiac disease screening in Brazilian patients with osteoporosis / Pesquisa de doença celíaca em pacientes brasileiros com osteoporose

Objective : To analyze if it is worthwhile to screen Brazilian osteoporotic patients for celiac disease (CD).Subjects and methods : One hundred patients with osteoporosis and 97 controls were evaluated for IgA-EmA (IgA anti-endomysial antibodies) by indirect immunofluorescence method and IgG-anti-tTG (tissue transglutaminase) by ELISA assay. Positive patients were invited to have gastrointestinal endoscopy with jejunal biopsy.Results : Two patients had positive IgG-anti-tTG test and one of them also showed positive IgA-EmA. Only the latter had a positive duodenal biopsy for CD. None of the controls were positive for either auto-antibodies.Conclusion : We observed low prevalence of CD in osteoporotic Brazilian patients. This finding does not support routine screening for CD in patients with osteoporosis in our geographic region. Arq Bras Endocrinol Metab. 2014;58(3):270-3.

Objetivo : Analisar a necessidade de investigar doença celíaca (DC) em pacientes brasileiros com osteoporose. Sujeitos e métodos : No total, cem pacientes com osteoporose e 97 controles foram pesquisados IgA-EmA (IgA antiendomísio) pelo método de imunofluorescência indireta e IgG-anti-tTG (transglutaminase tecidual) pelo teste de ELISA. Os pacientes positivos foram convidados a realizar endoscopia gastrointestinal com biópsia jejunal. Resultados : Duas pacientes foram positivas para o teste IgG-anti-tTG. Destas, somente uma também foi positiva para IgA-EmA. Esta última possuía achados de biópsia jejunal sugestivos de DC. Nenhum dos controles foi positivo para nenhum dos anticorpos. Conclusão : Foi observada baixa prevalência de DC nos pacientes brasileiros com osteoporose. Esse achado não oferece suporte para pesquisa rotineira de DC em pacientes com osteoporose em nossa região geográfica. Arq Bras Endocrinol Metab. 2014;58(3):270-3 .

Avaliação da estimulação ventricular direita crônica em crianças e adultos jovens com bloqueio atrioventricular congênito isolado / Evaluation of chronic right ventricular pacing in children and young adults with isolated congenital complete atrioventricular block

Introdução: O bloqueio atrioventricular congênito isolado (BAVCi) é raro e tem múltiplas apresentações clínicas. O implante de marca-passo cardíaco permanente (MP) é o tratamento de escolha, resultando em evolução clínica satisfatória para a maioria dos casos, porém, aproximadamente 10% deles apresentam remodelamento ventricular e insuficiência cardíaca grave. Objetivos: Estudar a evolução tardia de crianças e adultos jovens com BAVCi e estimulação crônica do ventrículo direito (VD), visando determinar: a prevalência de sinais clínicos e laboratoriais de insuficiência cardíaca e de remodelamento ventricular; a capacidade funcional; a qualidade de vida e fatores preditores de alterações clínicas, funcionais ou ecocardiográficas. Métodos: Estudo transversal realizado em coorte de portadores de BAVCi e MP implantado antes de 21 anos de idade com estimulação no VD há mais de um ano. Todos os indivíduos foram submetidos a avaliação clínica e laboratorial, da capacidade funcional, da qualidade de vida e a ecocardiograma. Mães e sujeitos da pesquisa foram investigados para doenças reumatológicas. Os dados foram armazenados no sistema REDCap (Research Electronic Data Capture) e analisados pelos programas SAS (Statistical Analysis System), SPSS (Statistical Package for the Social Sciences) e R Studio. A análise dos dados incluiu: análise univariada para pesquisa de associações entre variáveis preditoras e desfechos, coeficiente de correlação de Pearson e modelo de regressão linear multivariado. Resultados: De março/2010 a dezembro/2013, foram avaliados 63 indivíduos, 68% do sexo feminino, com idade de 1 a 40 anos, com MP por 13,4 ± 6,5 anos e estimulação do VD por 10,0 ± 5,4 anos. O modo de estimulação era atrioventricular em 55,6%, o percentual de estimulação de VD de 97,9 ± 4,2% e a duração do complexo QRS estimulado de 152,4 ± 20,1 ms. A maioria (88,9%) era assintomática e não utilizava medicamentos de ação cardiovascular. Maior tempo de MP...

Introduction: Isolated congenital atrioventricular block (iCAVB) is a rare condition with multiple clinical presentations. Permanent cardiac pacing is the most effective therapy for this population resulting in satisfactory long-term outcomes. However, approximately 10% of patients may have ventricular remodeling and severe heart failure. Objectives: To study the long-term effects of chronic right ventricular (RV) pacing in children and young adults with iCAVB in order to determine: prevalence of clinical and laboratory signs of heart failure and ventricular remodeling, functional capacity, quality of life and predictors of clinical, functional or echocardiographic abnormalities. Methods: Cross-sectional study of a cohort of iCAVB patients with <= 21 years old at initial pacemaker (PM) implantation and single or dual-chamber pacing in a unique RV site for a minimum of one year. All subjects underwent clinical and laboratory assessment, functional capacity, quality of life and echocardiogram. Mothers and research subjects were investigated for rheumatic diseases. Data were stored in REDCap (Research Electronic Data Capture) system and analyzed by SAS (Statistical Analysis System), SPSS (Statistical Package for the Social Sciences) and R Studio programs. Data analysis included: univariate analysis for associations between predictor variables and outcomes, Pearson correlation coefficient and linear regression multivariate model. Results: Between March/2010 and December/2013, we evaluated 63 subjects aged 1-40 years old, 68% female, under PM for 13.4 ± 6.5 years and under RV pacing for 10.0 ± 5.4 years. Pacing mode was atrioventricular in 55.6%, percentage of RV pacing was 97.9 ± 4.2% and paced QRS duration was 152.4 ± 20.1 ms. Overall, the majority (88.9%) were asymptomatic and did not use cardiovascular drugs. Longer time under PM (P= 0.013), or even under RV pacing (P= 0.005), higher age at study inclusion (P= 0.032) and lower left ventricular...

Muscarinic antibodies and heart rate responses to dynamic exercise and to the Valsalva maneuver in chronic chagasic patients / Anticorpos muscarínicos e resposta da frequência cardíaca ao exercício dinâmico e a manobra de Valsalva na doença de Chagas crônica

We have studied the cardiac chronotropic responses to the Valsalva maneuver and to dynamic exercise of twenty chronic chagasic patients with normal left ventricular function and no segmental wall abnormalities by two-dimensional echocardiogram. The absolute increase in heart rate of the patients (Δ = 21.5 ± 10 bpm, M±SD) during the maneuver was significantly diminished when compared to controls (Δ = 31.30 ± 70, M±SD, p = 0.03). The minimum heart rate (58.24 ± 8.90 vs. 62.80 ± 10, p = 0.68) and the absolute decrease in heart rate at the end of the maneuver (Δ = 38.30 ± 13 vs. Δ = 31.47 ± 17, p = 0.10) were not different from controls. The initial heart rate acceleration during dynamic exercise (Δ = 12 ± 7.55 vs. Δ = 19 ± 7.27, M±SD, p = 0.01) was also diminished, but the heart rate recovery during the first ten seconds was more prominent in the sero-positive patients (Median: 14, Interquartile range: (9.75-17.50 vs. 5(0-8.75, p = 0.001). The serum levels of muscarinic cardiac auto-antibodies were significantly higher in the chagasic patients (Median: 34.58, Interquartile Range: 17-46.5, Optical Density) than in controls (Median: 0, Interquartile Range: 0-22.25, p = 0.001) and correlated significantly and directly (r = 0.68, p = 0.002) with early heart rate recovery during dynamic exercise. The results of this investigation indirectly suggest that, the cardiac muscarinic auto-antibodies may have positive agonist effects on parasympathetic heart rate control of chagasic patients.

Foram estudadas as respostas cronotrópicas cardíacas à manobra de Valsalva e ao exercício dinâmico de vinte pacientes chagásicos com função ventricular esquerda normal e sem alterações da contractilidade segmentar por ecocardiografia bidimensional. O aumento absoluto da frequência cardíaca dos pacientes (Δ = 21,5 ± 10 bpm, M ± DP) durante a manobra de Valsalva foi significativamente menor quando se comparava ao grupo controle (Δ = 31,30 ± 70, p = 0,03). A frequência cardíaca mínima (58,24 ± 8,90 vs 62,80 ± 10, p = 0,68) e a diminuição da frequência cardíaca absoluta no final da manobra (Δ = 38,30 ± 13 vs Δ = 31,47 ± 17, p = 0,10) não foram diferentes em comparação com o grupo controle. A aceleração inicial da frequência cardíaca durante o exercício dinâmico (Δ = 12 ± 7,55 vs Δ = 19 ± 7,27, p = 0,01) também foi menor, mas a recuperação da frequência cardíaca, durante os primeiros dez segundos, foi maior no grupo sero-positivos [mediana:14 (intervalo interquartil: 9,75-17,50) vs 5 (0 - 8,75), p = 0,001]. Os níveis séricos de auto-anticorpos muscarínicos cardíacos foram significativamente maiores nos pacientes chagásicos do que no grupo controle [(mediana: 34,58 densidade óptica (intervalo interquartil 17 - 46,5) vs (mediana: 0, intervalo interquartil 0 - 22,25) p = 0,001] e a correlação é significativa e direta (r = 0,68, p = 0,002) com o início da recuperação da frequência cardíaca durante o exercício dinâmico. Os resultados desta investigação sugerem que indiretamente, os auto-anticorpos muscarínicos cardíacos, podem ter ação agonista positiva sobre o controle parassimpático da frequência cardíaca dos pacientes chagásicos.

Hepatitis autoinmune en un paciente con hepatitis B crónica, a propósito de un caso / Topic Review: Autoimmune hepatitis in a patient with chronic hepatitis B. A case report

La hepatitis es una enfermedad viral que azota a gran parte de la población mundial y cuya etiología es multifactorial, por lo que se ha clasificado a fin de hacer más conveniente su estudio de la A a la E, separándolas según sus características. Existe además la hepatitis autoinmune (HAI), entidad de etiología no conocida que gana mayor prevalencia e incidencia cada año. Se cuenta con pocos reportes en la literatura que relacionen la presentación de una hepatitis viral más una hepatitis autoinmune en un mismo paciente. Sin embargo, algunos estudios han comprobado que dicha relación es una posibilidad; lo que dificulta su orientación diagnóstica, terapéutica, tratamiento y pronóstico. Se presenta un caso de hepatitis B crónica en la que se superpuso una hepatitis autoinmune, a fin de realizar una revisión del tema y sus dificultades diagnósticas.

Hepatitis is a viral disease that affects a large portion of the world's population, which has a multifactorial etiology, thus to facilitate its study has been classified from A to E according with the characteristic. Additionally to viral hepatitis also occurs the autoimmune hepatitis, a disease of unknown etiology of which prevalence and incidence are increasing every year. There is few reports in the literature that describe the possibility of finding viral hepatitis and autoimmune hepatitis in one patient at the same time. Nevertheless some studies have indicated that there is possible correlation between them, situation that make difficult its diagnosis, therapeutic approach, treatment and prognosis. A case of chronic B hepatitis with overlapped autoimmune hepatitis is reported aiming to, get a topic review and diagnostic difficulties.

No significant effect of iodinated contrast after single percutaneous coronary intervention on thyroid function and auto-antibodies / 中华内分泌代谢杂志

The effect of iodinated contrast on thyroid function and auto-antibodies after a single percutaneous coronary intervention (PCI) was explored.In 96 patients with randomly selected PCI,serum TSH,T3,T4,thyroid peroxidase antibody (TPOAb),thyroglobulin antibody (TgAb) were determined preoperatively as well as by 3-6 months postoperatively.After PCI,the level of TSH,T3,T4,showed no significant changes; TgAb,TPOAb which were positive preoperatively,after 3-6 months were statistically increased(P＜0.05).Iodinated contrast in PCI has no significant influence on thyroid function and auto-antibodies after 3-6 months.

Artrite reumatoide: uma visão atual / Rheumatoid arthritis: a current view

INTRODUÇÃO: A artrite reumatoide (AR) é uma doença autoimune inflamatória e crônica que afeta aproximadamente 1 por cento da população adulta mundial. A doença caracteriza-se pela inflamação do tecido sinovial de múltiplas articulações, levando a destruição tecidual, dor, deformidades e redução na qualidade de vida do paciente. Sua etiologia é complexa e em grande parte desconhecida, porém estudos demonstram a influência de fatores genéticos e ambientais em sua patogênese. Devido à forte influência genética, familiares de pacientes com AR formam um grupo de risco para o desenvolvimento da doença, principalmente em sua forma mais grave. Apesar de seu elevado potencial incapacitante, o curso da AR pode ser modificado por meio do diagnóstico precoce e do manejo adequado do paciente. No entanto, o diagnóstico precoce da AR é ainda bastante difícil diante da heterogeneidade das manifestações clínicas da doença, o que acaba retardando a implantação terapêutica. O tratamento da AR baseia-se no uso de anti-inflamatórios não esteroidais (AINEs), corticosteroides, drogas antirreumáticas modificadoras do curso da doença (DMARD) e agentes imunobiológicos. Além da terapia medicamentosa, também são adotadas medidas como educação do paciente e terapias psico-ocupacionais. Atualmente, estudos têm se voltado à identificação de fatores preditores de doença mais grave, como autoanticorpos como fator reumatoide (FR) e anticorpo antipeptídio cíclico citrulinado (anti-CCP), que constituem importantes marcadores imunológicos de diagnóstico e prognóstico da AR. DISCUSSÃO E CONCLUSÃO: Apesar dos significativos avanços tanto no entendimento como no diagnóstico e no tratamento da AR, ainda persistem inúmeros desafios a serem superados.

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease, which affects approximately 1 percent of the world's adult population. It is characterized by the inflammation of synovial tissue from multiple articulations, leading to tissue destruction, pain, deformities and reduced quality of life. RA etiology is complex and largely unknown, although studies support the influence of genetic and environmental factors on its pathogenesis. Due to its major genetic component, relatives from RA patients are part of the risk group, mainly as to the development of the most severe forms. In spite of its high disability risk, RA development can be affected through early diagnosis and adequate therapy. Nonetheless, its early diagnosis is still very demanding due to the heterogeneity of its clinical presentations, which delays therapeutic approach. RA treatment includes non-steroidal anti-inflammatory drugs, corticosteroids, disease-modifying antirheumatic drugs (DMARD), and immunobiologic agents. Furthermore, raising patient's awareness and developing psyco/occupational therapies are also part of the therapeutic approach. Currently, several studies focus on the identification of predictive factors for severe RA such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) autoantibodies, which are major immunological diagnostic and prognostic markers for RA. DISCUSSION AND CONCLUSION: Despite the fact that there has been substantial progress in the investigation, diagnosis and treatment of RA, there are still several challenges to be overcome.

Monoclonal auto-antibodies and sera of autoimmune patients react with Plasmodium falciparum and inhibit its in vitro growth

The relationship between autoimmunity and malaria is not well understood. To determine whether autoimmune responses have a protective role during malaria, we studied the pattern of reactivity to plasmodial antigens of sera from 93 patients with 14 different autoimmune diseases (AID) who were not previously exposed to malaria. Sera from patients with 13 different AID reacted against Plasmodium falciparum by indirect fluorescent antibody test with frequencies varying from 33-100 percent. In addition, sera from 37 AID patients were tested for reactivity against Plasmodium yoelii 17XNL and the asexual blood stage forms of three different P. falciparum strains. In general, the frequency of reactive sera was higher against young trophozoites than schizonts (p < 0.05 for 2 strains), indicating that the antigenic determinants targeted by the tested AID sera might be more highly expressed by the former stage. The ability of monoclonal auto-antibodies (auto-Ab) to inhibit P. falciparum growth in vitro was also tested. Thirteen of the 18 monoclonal auto-Ab tested (72 percent), but none of the control monoclonal antibodies, inhibited parasite growth, in some cases by greater than 40 percent. We conclude that autoimmune responses mediated by auto-Ab may present anti-plasmodial activity.

Anticuerpos antitiroperoxidasa y antitransglutaminasa en familiares de primer grado de personas con diabetes tipo 1 y su relación con algunas características clínicas, bioquímicas e inmunológicas / Antithyroperoxidase and antitransglutaminase antibodies in first degree relatives of type 1 diabetes persons and its relation to some clinical, biochemical and immunological features

Los anticuerpos antitiroperoxidasa (AcTPO) y antitransglutaminasa (ATGt) son útiles marcadores de enfermedad tiroidea autoinmune y enfermedad celíaca, respectivamente. Su presencia en familiares de primer grado de personas con diabetes tipo 1 no se ha descrito en Cuba. Objetivo: determinar las frecuencias de los AcTPO y ATGt en familiares de primer grado de personas con diabetes tipo 1 y su relación con algunas características clínicas, bioquímicas e inmunológicas. En un grupo de 285 sujetos se realizó la medición del AcTPO y en 262 individuos la de ATGt. Se incluyeron casos entre los 2 y 65 años de edad. Se registraron datos sobre edad, sexo, color de la piel, antecedentes personales, historia familiar de obesidad, diabetes tipo 2, enfermedad tiroidea y enfermedad celíaca. Se interrogaron síntomas y exploraron signos clínicos de enfermedad celíaca y enfermedad tiroidea autoinmune. Se determinó glucemia, insulinemia, AcTPO, ATGt y autoanticuerpos asociados a diabetes tipo 1 (AGAD y AIA-2), así como la resistencia a la insulina mediante el índice HOMA-IR. RESULTADOS: las frecuencias de AcTPO y ATGt positivos fueron 5,3 y 1,9 por ciento, respectivamente. La historia familiar de enfermedad tiroidea, el temblor muscular fino y el exoftalmos se relacionaron con la presencia de AcTPO. Malabsorción intestinal, diarrea persistente, dolor abdominal recurrente y antecedente personal de hepatopatía se asociaron con la presencia de ATGt. Se encontró asociación entre los ATGt y el AIA-2. La resistencia a la insulina no se asoció con la presencia de AcTPO ni de ATGt. En los familiares de primer grado de personas con diabetes tipo 1 las frecuencias de AcTPO y ATGt son bajas. Algunos antecedentes, síntomas y signos vinculados con enfermedad celíaca y enfermedad tiroidea autoinmune pueden ser indicadores prácticos previos a la indicación de estos autoanticuerpos(AU)

The antithyroperoxidase (TPOAb) and antitransglutaminase (tTGAb) antibodies are useful markers of autoimmune thyroid disease and celiac disease, respectively. Its presence in first-degree relatives of type 1 diabetes patients has not been described in Cuba. Objetive: to determine the TPOAb and tTGAb frequencies in first-degree relatives of type 1 diabetes patients and its relation to some clinical, biochemical and immunological features. In a group of 285 subjects we measured TPOAb and in 262 subjects we measured tTGAb. The cases included aged between 2 and 65. Data were registered on age, sex, skin color, personal backgrounds, and a family history of obesity, type 2 diabetes, thyroid disease and celiac disease. Symptoms were look for and clinical signs of celiac disease and autoimmune thyroid disease were explored. Fasting glucose, fasting insulin, TPOAb, tTGAb and type 1 diabetes associated autoantibodies (AGAD and AIA-2) were determined as well as the insulin resistance according the HOMA-IR index. RESULTS: the frequencies of positive TPOAb and tTGAb were of 5,3 and 1,9 percent, respectively. The family history of thyroid disease, slight muscular tremor and exophthalmos are related to presence of TPOAb. Intestinal malabsorption, persistent diarrhea, recurrent abdominal pain and personal background of liver disease were associated with presence of tTGAb. There was an association between tTGAb and AIA-2. Insulin resistance was not associated with the presence of both antibodies. In first-degree relatives of type 1 diabetes patients, frequencies of TPOAb and tTGAb are low. Some backgrounds, symptoms and signs linked to celiac disease and autoimmune thyroid disease may be practical indicators previous to perform these autoantibodies(AU)

Determinación de autoanticuerpos contra lipoproteínas de baja densidad oxidadas y nativas en el suero de pacientes sometidos a coronariografía en el CIMEQ / Determination of auto-antibodies to native and oxidized low-density lipoproteins (LDL) in serum of patients underwent coronariography in the Medical-Surgical Research Center (MSRC)

La oxidación de las lipoproteínas de baja densidad (LDLox) es un evento importante en el desarrollo y progresión de la aterosclerosis y la respuesta inmune contra estas moléculas puede modular la aterogénesis. La relación entre los autoanticuerpos anti-LDLox y la cardiopatía isquémica (CI) es aún controversial. En el presente estudio se determinaron los valores de las IgM e IgG anti-LDLox, en 20 pacientes a quienes se les indicó una coronariografía por alguna razón en la consulta de cardiología. Se tomó como grupo control a 10 voluntarios jóvenes sanos trabajadores del Centro de Inmunología Molecular. Los niveles de anticuerpos de tipo IgM contra las LDLox no fueron diferentes entre los pacientes sin evidencia de CI y los sujetos jóvenes sanos. En cambio, los niveles de IgM anti-LDLox de estos grupos fueron estadísticamente superiores a los del grupo de pacientes con evidencia de CI. Nuestros resultados, aunque preliminares, sustentan la hipótesis de que este tipo de autoanticuerpos pudiera estar inversamente asociado con la presencia de aterosclerosis

Low-density lipoprotein (LDL) oxidation is an important event in atherosclerosis development. The relationship between oxidized LDL (oxLDL) autoantibodies and coronary artery disease (CAD) remains controversial. IgM and IgG autoantibodies to oxLDL were measured in twenty patients undergoing clinically indicated coronary angiography, and in ten young healthy volunteers from the Center of Molecular Immunology. The levels of IgM autoantibodies to oxLDL did not differ between no CAD patients and healthy subjects, but the levels of IgM autoantibodies to oxLDL of these two groups were higher compared with the one of CAD patient group. Our results, although preliminary, supports the hypothesis that this kind of Abs might be inversely associated with the presence of atherosclerosis

Auto antibodies against oxidized low density lipoproteins and lipid peroxidation in patients with essential hypertension

Lipid peroxidation has been suggested to play a key role in the oxidative modification of LDL (oxd-LDL) which stimulate the production of auto antibodies by Bcells and anti-oxd LDL antibodies are produced. These antibodies could represent a biological marker of oxidative stress and serve as markers of atherosclerosis. Essential hypertension is a major risk factor for atherosclerosis, recently border line hypertension also has been shown to be a risk factor for atherosclerosis. The aim of this study is to examine the correlation between oxd -LDL antibodies and lipid peroxidation in patient with essential hypertension. Blood samples were collected from patients with essential hypertension (n=155) and healthy individuals (n=160) levels of Malonaldihyde (MDA), Total cholesterol, Triglycerides, HDL and LDL were estimated by spectrophotometry and levels of Oxd- LDL antibodies were obtained by ELISA. Plasma levels of MDA, anti-oxdLDL antibodies, Total cholesterol and LDL Cholesterol is higher in patients than those in controls. Among patients concentration of MDA, total cholesterol and LDL cholesterol were not significantly different, however the concentration of anti-oxd LDL were higher in essential hypertensive patients (p=0.003). Significant positive correlation was observed between plasma levels of MDA, total cholesterol, LDL cholesterol and the concentration of anti-oxdLDL in patients but not in the controls. In conclusion High concentrations of anti-oxdLDL and MDA suggest an increase in oxidative stress that would contribute to the development of atherosclerosis. The observed correlation of MDA with anti-oxdLDL indicates the relationship between free radicals and atherosclerosis in essential hypertension.

Linfadenopatia e lúpus eritematoso sistêmico / Lymphadenopathy and systemic lupus erythematosus

A linfadenopatia no lúpus eritematoso sistêmico (LES) é um achado benigno encontrado comumente em jovens, com atividade cutânea e sintomas constitucionais, apresentando boa resposta à corticoterapia. O achado mais frequente à biópsia é a hiperplasia folicular reacional. Relatamos o caso de um paciente que, desde os 13 anos de idade, apresentava surtos recorrentes de linfadenopatia, acompanhados de hepatoesplenomegalia, febre e emagrecimento. Na evolução, apareceram artrite, hipertensão arterial, proteinúria, miocardiopatia e neuropatia periférica. Foi amplamente investigado sem esclarecimento diagnóstico e submetido a tratamento empírico de tuberculose. Somente após cinco anos de evolução firmou-se o diagnóstico de LES e recebeu tratamento específico. O diagnóstico precoce nestes casos é difícil, pois a investigação laboratorial pode ainda não demonstrar presença de autoanticorpos ou hipocomplementemia.

Lymphadenopathy is a benign finding in systemic lupus erythematosus (SLE), commonly seen in young patients with cutaneous involvement and constitutional symptoms, with good response to corticosteroids. Reactive follicular hyperplasia is the most frequent finding in biopsies. We report the case of a patient with recurrent episodes of lymphadenopathy associated with hepatosplenomegaly, fever, and weight loss since the age of 13 years. The patient also developed arthritis, hypertension, proteinuria, cardiomyopathy, and peripheral neuropathy. His condition was investigated extensively without diagnostic clarification; he was treated, empirically, for tuberculosis. The patient received a diagnosis of SLE only five years after the original presentation and received the specific treatment. Early diagnosis in those cases is difficult because laboratorial exams may not show the presence of auto-antibodies and low complement levels.

Approach to diagnosis of auto-immune hepatitis.

Auto-immune hepatitis (AIH) is one of the chronic liver diseases, seen predominantly in women, resulting from dysregulated immune mechanisms not yet clearly defined. Based on a combination of clinical and laboratory parameters with both positive and negative weights, the International AIH Group devised a scoring system in 1993. The system was modified in 1999 and has proven useful for both diagnostic and research purposes. This review deliberates on the clinical, immunological and histological features of this entity.