Hipotiroidismo subclínico y embarazo / Sub-clinical hypothyroidism and pregnancy

El hipotiroidismo subclínico se define como una concentración sérica elevada de tirotropina (TSH), con T4 libre normal. En el embarazo, se ha descrito efectos deletéreos tales como riesgo aumentado de aborto espontáneo y déficit cognitivo del niño en mujeres con esta condición; además, se debe considerar la posible progresión a hipotiroidismo clínico. Se ha planteado el rol de la autoinmunidad mediante la presencia de anticuerpos anti-tiroperoxidasa (AntiTPO), describiéndose este como factor de riesgo para desenlaces adversos. No se ha comprobado la utilidad del tamizaje universal con TSH, siendo el enfoque actualmente el estudio de pacientes de riesgo. El tratamiento se inicia según los resultados de la cuantificación deTSH y AntiTPO, siendo el fármaco de elección la levotiroxina.El seguimiento es conmediciones deTSH.

Sub-clinical hypothyroidism is defined to be raised plasma thyrotropin (TSH) with normal levels of free T4. Detrimental effects such as increased abortion risk and newborns with cognitive deficit have been reported in pregnancies with this condition. Possible progression to clinical hypothyroidism must be considered. A possible auto-immune mechanism mediated by anti-thyroperoxidase (AntiPO) has been postulated where AntiPO should be considered a risk factor for adverse outcomes. Universal screening using TSH has not been found to be of use and at present only high risk women are screened. Women are treated with levothyroxine, the dose depending on the TSH andAntiPO levels, and follow up is done bymonitoringTSHlevels.

Clinical and Serological Features of Sjogren Syndrome in Patients with Rheumatoid Arthritis.

Background: It is uncertain whether the Sjogren Syndrome (SS) associated with Rheumatoid Arthritis (RA) represents a clinical entity similar to primary SS (pSS) or merely a manifestation in the clinical spectrum of RA. In the present study, we sought to determine the clinic and serologic features of SS associated with RA in comparison to the RA features using well defined SS classification criteria. Methods: RA patients successively referred for a biologic infusion were questioned on oral and ocular dryness. Schirmer’s test and unstimulated salivary flow were performed in each patient. Patients with subjective oral or ocular dryness and/or 1 abnormal objective test underwent a minor salivary gland biopsy. The diagnosis of secondary SS was based on the criteria of European- American consensus group criteria for SS. Clinical and biological parameters of SS and RA (with measure of disease activity and health status of RA, search for Raynaud’s phenomenon, anti-CCP, RF anti-SSA-positivity and beta2-microglobulin level) were then compared between patients with/without sSS. Results: Among the 76 patients prospectively assessed, 11(14.1%) fulfilled the European- American consensus group criteria for secondary SS. Median age and RA disease duration were similar in patients with sSS as in patients with RA only (63.0 v 59.2, p=0;33; 18.2 vs 13.9, p= 0.12). Median DAS28-ESR and HAQ were not significantly different between patients with sSS and patient with RA only (4.0 vs 4.1, p= 0.8; 0.84 vs 0.81, p=0.7). Patients with sSS had more frequently a Raynaud’s phenomenon (27.2 vs 1.5%, p=0.01). RF and anti-CCP-positivity were similar in the 2 groups. The prevalence of anti-SSA antibodies was comparable in the 2 groups (p=1). Median beta2-microglobulin levels were higher in sSS than RA only (2.4 vs 1.9 mg/l, p= 0.02). Conclusion: 14% of patients with RA had secondary SS in the present study. Conversely to previous reports, secondary SS did not modify the clinical and biologic pattern of RA.

Autoinmunidad inducida por drogas: a propósito de un caso / Drug-induced auto-immunity: on account of a case

Se presenta el caso de una paciente de 35 años con antecedentes de enfermedad de Basedow-Graves, en tratamiento con propiltiouracilo (PTU), consumidora de pasta base y cocaína, que ingresa por fenómenos trombóticos en extremidades. Presenta en forma brusca falla respiratoria severa, que requiere manejo en UCI. Al laboratorio inmunológico destacan: ANA (+), AntiDNA (+), Anti-Ro (+), Anti-cardiolipinas IgG (+). Se realiza una revisión de las entidades autoinmunes más frecuentes asociadas al uso de drogas.

It presents the case of a 35-year old patient with a history of Basedow Graves disease, under treatment with Propiltiouracile (PTU), crack and cocaine user, who was admitted on thrombotic phenomena in her limbs. She presents sudden severe respiratory failure that requires handling at ICU. Under immunologic lab tests, the following stand out: ANA (+), Anti-DNA (+), Anti-Ro (+), Anti-cardiolipines IgG (+). A checkup is made of the most frequent auto-immune entities associated to drug abuse.

Parotiditis crónica recurrente o síndrome de Sjõgren primario juvenil?: reporte de un caso / Chronic recurrent parotiditis or juvenile primary Sjõgren?: a case report

Introduction: Chronic Recurrent Parotiditis is a recurrent swelling of the parotid gland, of multiple etiology. In some cases it may be an early manifestation of Sjõgren's syndrome. Objective: A comparison of both diseases, in light of the clinical, radiological, histological and laboratory findings in a patient suffering from a chronic recurrent parotiditis suggestive of Sjõgren's syndrome. Case Report: A 14 years old girl, seen in Oral Maxillary Medicine consultation at "Hospital Universitario de Maracaibo", for a year's history of multiple episodes of parotid swelling. Glandular involvement was confirmed clinically. While dental cavities and thick saliva were observed, the absence of oral dryness and ocular manifestations resulted in a diagnosis of Chronic Recurrent Parotitis at the time. Due to multiple recurrent dental cavities, high recurrence of the swelling episodes, and poor response to treatment, Sjõgren's syndrome was suspected. Lower lip minor salivary gland biopsy, specific antibodies, sialometry and Schirmer's test were requested, finding enough positive criteria for the diagnosis of Sjõgren's syndrome. Conclusions: Among children and teenagers with CRT with treatment failure, the presence of Sjõgren's syndrome must be evaluated, even in the absence of oral and ocular symptoms.

Introducción: La parotiditis crónica recurrente es una inflamación recidivante de la glándula, producida por diversos factores, sin embargo, ésta en algunos casos puede presentarse como primera manifestación del síndrome de Sjõgren. Objetivo: Describir la relación existente entre los signos y síntomas de ambas patologías, evaluando los hallazgos clínicos, radiográficos, histológicos y de laboratorio encontrados en un paciente con antecedentes de parotiditis crónica recurrente y criterios positivos para Síndrome de Sjõgren. Presentación del caso: Paciente femenino de 14 años de edad, atendida en la consulta de Medicina Bucal del Hospital Universitario de Maracaibo por presentar múltiples aumentos de volumen parotídeo de 1 año de evolución. Clínicamente se confirmó los cambios glandulares, observándose además caries y salivación espesa, sin sequedad bucal ni molestias oculares, llegando al diagnóstico de Parotiditis Crónica Recurrente. Ante las múltiples caries avanzadas, la marcada recurrencia de los episodios inflamatorios y respuesta inadecuada al tratamiento, se solicitó biopsia de glándula salival menor de labio inferior, anticuerpos específicos para el síndrome de Sjõgren, sialometría y test de Schirmer, encontrando criterios positivos suficientes para diagnosticar este Síndrome. Conclusión: En pacientes niños y adolescentes con PCR en los cuales a pesar del tratamiento indicado no se logre prolongar el tiempo entre las recurrencias ni disminuir el aumento de tamaño de la glándula satisfactoriamente, debe ser evaluada la presencia del Síndrome de Sjõgren, aún en ausencia de síntomas oculares y bucales.