Elevated serum IL-6 levels predict treatment interruption in patients with moderate to severe psoriasis: a 6-year real-world cohort study

Abstract Background: Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. Objective: The authors evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. Methods: The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-α, tumor necrosis factor-α, and inter-leukin (IL)-2, IL-4, IL-6, IL-10, and IL-17A were measured using a cytometric bead array; clinical data were assessed. The authors calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. Results: The authors included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI 1.01-1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI 1.29-3.08; p = 0.002) were associated with treatment interruption. Study limitations: The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation. Conclusions: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting biomarker candidate for predicting psoriasis treatment response.

vitíligo, estrés psicológico y bioquímica del cerebro: Una revisión sistemática desde la neurociencia

Objetivo: El propósito de este estudio es establecer los mecanismos de la actividad Bioquímica a través del Estrés Psicológico que influyen en la enfermedad del vitiligo desde una perspectiva neurocientifica, mediante una revisión sistemática de la literatura de los últimos 5 años. Método: La búsqueda sistemática se llevó a cabo en las bases de datos Scopus, PubMed y Web of Science para identificar los estudios que describan la enfermedad de Vitiligo, el estrés psicológico y la bioquímica del cerebro, se establecieron criterios de inclusión y exclusión para la selección de los artículos, así mismo, se evaluó su calidad y pertinencia. Resultados: La revisión sistemática arrojó 15.503 artículos, 70 fueron preseleccionados de acuerdo a lo informado en el resumen y validados para lectura completa. Para la síntesis narrativa se utilizaron 23 artículos científicos. Conclusión: La enfermedad de vitiligo guarda una estrecha relación con el estrés psicológico y está acompañado de un desequilibrio bioquímico que conduce a un proceso inflamatorio y destructivo de los melanocitos de la piel.

Objective: The purpose of this study is to establish the mechanisms of biochemical activity through psychological stress that influence vitiligo disease from a neuroscientific perspective, through a systematic review of the literature of the last 5 years. Method: Systematic search was carried out in the Scopus, PubMed and Web of Science databases to identify studies describing Vitiligo disease, psychological stress and brain biochemistry, inclusion and exclusion criteria were established for the selection of articles, their quality and relevance were evaluated. Results: The systematic review yielded 15,503 articles, of which 70 were pre-selected as reported in the summary and validated for full reading. For the narrative synthesis 23 scientific articles were used. Conclusion: Vitiligo disease is closely related to psychological stress and is accompanied by a biochemical imbalance that leads to an inflammatory and destructive process of skin melanocytes.

Actividad y discapacidad en pacientes cubanos con artritis reumatoide como factores que influyen en la sexualidad

Introducción: La artritis reumatoide es una enfermedad autoinmune de carácter inflamatorio y crónico. La afectación en la esfera sexual es frecuente, compromete a ambos sexos y se relaciona con factores como el dolor, la discapacidad y el consumo de medicamentos. Esta afectación no ha sido suficientemente abordada en la literatura a pesar de su prevalencia, y en Cuba no se han reportado hasta el momento estudios relacionados sobre este tema de investigación. Objetivo: Determinar el impacto de la artritis reumatoide en la sexualidad y su relación en la actividad y la discapacidad. Métodos: Se realizó un estudio monocéntrico, transversal, descriptivo. Se incluyeron los pacientes con un diagnóstico de artritis reumatoide en el período comprendido de septiembre de 2019 a junio de 2021. Se utilizó el cuestionario Qualisex para evaluar el impacto de la artritis reumatoide en la sexualidad. Resultados: En el estudio doscientos veintiséis pacientes fueron incluidos, la media de edad fue de 53,38 años (DE ± 12,22) el 82,7 % fueron mujeres. Al responder el autocuestionario Qualisex el 73,9 % de los sujetos presentaron afectación en la sexualidad. No se estableció una relación significativa entre la afectación en la esfera sexual y el tiempo de evolución. A diferencia de los niveles altos de actividad y discapacidad. Conclusiones: En la población estudiada se presentó afectación en la sexualidad, no obstante, esta no se relacionó con el tiempo de evolución de la artritis reumatoide. Se encontró asociación entre la actividad de la enfermedad y la capacidad funcional con la afectación en la esfera sexual.

Introduction: Rheumatoid arthritis is a chronic, inflammatory autoimmune disease. Disorders in the sexual sphere is frequent, it affects both sexes and it is related to factors such as pain, disability and medication consumption. This condition has not been sufficiently addressed in the literature despite its prevalence and in Cuba no studies related to the topic under study have been reported to date. Objective: To determine the impact of rheumatoid arthritis on sexuality and its relationship with activity and disability. Methods: A monocentric, cross-sectional and descriptive study was carried out on patients with a diagnosis of rheumatoid arthritis, from September 2019 to June 2021. The Qualisex questionnaire was used to evaluate the impact of rheumatoid arthritis on sexuality. Results: Two hundred twenty-six patients were included, the mean age was 53.38 years (SD ± 12.22) and 82.7% were women. When answering the Qualisex self-questionnaire, 73.9% of the subjects had effects in their sexuality. No significant relationship was established between the involvement in the sexual sphere and the time of evolution. Conclusions: The impact on sexuality in the studied population was not related to the duration of rheumatoid arthritis. On the other hand, an association was found between disease activity and functional capacity with effects in the sexual sphere.

Pénfigo foliáceo, variedad seborreica, reporte de caso / Pemphigus foliaceus, seborrheic variety, case report

Presentación del caso. Se expone el caso de un paciente masculino de 48 años de edad, sin antecedentes médicos conocidos, que presentó múltiples lesiones en forma de placas eritematocostrosas fácilmente descamativas, inicialmente en tórax anterior, que se esparcían sobre el rostro y cuero cabelludo sin afectar las mucosas. Intervención terapéutica. El manejo hospitalario se basó fundamentalmente en el uso de esteroides tópicos y sistémicos, así como el manejo de las infecciones sobreagregadas a las lesiones dermatológicas y el apoyo psicológico del paciente. Se tomó biopsia de piel donde se evidenció la presencia de acantólisis, confirmando el diagnóstico de esta enfermedad autoinmunitaria. Evolución clínica. Luego del tratamiento se logró una reducción de las múltiples lesiones descamativas, el control de la infección local y la recuperación de la piel del paciente, la cual a pesar de aún presentar cicatrices se encontraba con sus funciones restituidas

Case presentation. a 48-year-old male with no known medical history who presented multiple lesions in the form of easily desquamative erythematous and crusted plaques, initially on the anterior thorax, which spread over the face and scalp without affecting the mucous membranes. Treatment. In-hospital management was mainly based on topical and systemic steroids, the management of infections superadded to the dermatologic lesions, and psychological support for the patient. A skin biopsy was taken where acantholysis was evidenced, confirming the autoimmune disease diagnosis. Outcome.After treatment, the multiple scaly lesions were reduced, the local infection was controlled, and the patient's skin recovered although it still had scars, its functions were restored

Diabetes tipo 1 y Miastenia Gravis / Type-1 Diabetes and Myasthenia Gravis

Introducción: El desarrollo de la tolerancia inmunológica frente a los autoantígenos se denomina autotolerancia. La Diabetes Mellitus tipo 1A (1ADM) es un trastorno metabólico secundario a la destrucción autoinmune de las células beta pancreáticas e insulitis. La miastenia grave (MG) es una enfermedad autoinmune causada por el bloqueo postsináptico de la placa mioneural por AAcs contra los receptores de acetilcolina (ACRA) o contra moléculas de la membrana postsináptica. La asociación entre DM1A y MG se puede observar en el síndrome poliglandular tipo III, caracterizado por enfermedad autoinmune de la glándula tiroides asociada con otras entidades autoinmunes. Método: Reporte de Casos, cuatro pacientes entre 7-19 años, con asociación de MG y DM1A atendidos en el Hospital Garrahan. Conclusión: La Tiroiditis de Hashimoto y la Enfermedad Celíaca son las enfermedades autoinmunes relacionadas más frecuentemente con DM1A en nuestra población. La bibliografía describe la asociación de MG y Tiroiditis de Hashimoto y su coexistencia con DM1A se describe en el Síndrome Poliglandular III. En este trabajo presentamos 4 casos de DM1A asociado con MG fuera de dicho síndrome (AU)

Introduction: The development of immune tolerance to autoantibodies (AAbs) is referred to as self-tolerance. Type 1A Diabetes Mellitus (1ADM) is a metabolic disorder secondary to autoimmune destruction of pancreatic beta cells and insulitis. Myasthenia gravis (MG) is an autoimmune disease caused by postsynaptic blockade of the myoneural plate by AAbs against acetylcholine receptors (Acra) or against postsynaptic membrane molecules. The association between 1ADM and MG may be observed in polyglandular syndrome type III, characterized by autoimmune disease of the thyroid associated with other autoimmune conditions. Methods: Case report; four patients between 7-19 years old, with an association of MG and 1ADM seen at the Garrahan Hospital. Conclusion: Hashimoto's thyroiditis and celiac disease are autoimmune diseases most frequently related to 1ADM in our population. In the literature, the association of MG and Hashimoto's thyroiditis has been described and its coexistence with 1ADM is reported in polyglandular syndrome III. In this study we present 4 cases of 1ADM associated with MG unrelated to this syndrome. (AU)

Increased risk of atrial fibrillation in patients with psoriasis: A meta-analysis of observational studies

Background: Several epidemiological studies have shown that psoriasis increases the risk of developing atrial fibrillation but evidence of this is still scarce. Aims: Our objective was to systematically review, synthesise and critique the epidemiological studies that provided information about the relationship between psoriasis and atrial fibrillation risk. Methods: We searched through PubMed, EMBASE and the bibliographies for articles published between 1 January 2000, and 1 November 2017, that reported on the association between psoriasis and atrial fibrillation. All abstracts, full-text articles and sources were reviewed with duplicate data excluded. Summary relative risks (RRs) with 95% CI were pooled using a random effects model. Results: We identified 252 articles, of these eight unique abstracts underwent full-text review. We finally selected six out of these eight studies comprising 11,187 atrial fibrillation patients. The overall pooled relative risk (RR) of atrial fibrillation was 1.39 (95% CI: 1.257–1.523, P < 0.0001) with significant heterogeneity (I2 = 80.316, Q = 45.723, ?2 = 0.017, P < 0.0001) for the random effects model. In subgroup analysis, the greater risk was found in studies from North America, RR 1.482 (95% CI: 1.119–1.964, P < 0.05), whereas a moderate risk was observed in studies from Europe RR 1.43 (95% CI: 1.269–1.628, P < 0.0001). Limitations: We were only able to include six studies with 11,178 atrial fibrillation patients, because only a few such studies have been published. Conclusion: Our results showed that psoriasis is significantly associated with an increased risk of developing atrial fibrillation. Therefore, physicians should monitor patient’s physical condition on a timely basis.

Serum Vitamin D Level in Psoriasis: A Prospective Study in a Tertiary Care Centre of Eastern India

Background: Psoriasis is a systemic, inflammatory, chronic autoimmune disease characterized by multiple discoid plaques over body with silvery scales associated with cardiovascular diseases, obesity, diabetes mellitus, hypertension, and hyperlipidemia. Recently, association between psoriasis and Vitamin D level has also been reported. Our aim of study was to evaluate the association of vitamin D and its association with the severity of Psoriasis Materials and methods: 60 patients diagnosed with psoriasis, in our outpatient department from January 2021 to December 2021, were included the study. 58 age, gender- and skin phototype- matched healthy controls were included in the study. Results: The serum vitamin D level in patients and in the control group ranged from 7 to 24 ng/ml (mean: 13.04 �32 ng/ml) and from 16 to 65 ng/ml (mean: 23.91�08 ng/ml), respectively. The circulating vit D levels were less in patients compared to control. The analysis showed statistical significance (P< 0.05) between the two groups. Conclusion: Our results showed decreased level of vitamin D in patients suffering from psoriasis when compared to healthy controls. Vitamin D supplementation can be useful in psoriasis management.

Small molecule inhibitors of RORγt for Th17 regulation in inflammatory and autoimmune diseases / 药物分析学报

As a ligand-dependent transcription factor,retinoid-associated orphan receptor γt(RORyt)that controls T helper(Th)17 cell differentiation and interleukin(IL)-17 expression plays a critical role in the pro-gression of several inflammatory and autoimmune conditions.An emerging novel approach to the therapy of these diseases thus involves controlling the transcriptional capacity of RORyt to decrease Th17 cell development and IL-17 production.Several RORyt inhibitors including both antagonists and inverse agonists have been discovered to regulate the transcriptional activity of RORyt by binding to orthosteric-or allosteric-binding sites in the ligand-binding domain.Some of small-molecule inhibitors have entered clinical evaluations.Therefore,in current review,the role of RORyt in Th17 regulation and Th17-related inflammatory and autoimmune diseases was highlighted.Notably,the recently developed RORyt inhibitors were summarized,with an emphasis on their optimization from lead compounds,ef-ficacy,toxicity,mechanisms of action,and clinical trials.The limitations of current development in this area were also discussed to facilitate future research.

A Case Report of Fabry Disease Associated with Dermatomyositis / 罕见病研究

Fabry disease is an X-linked lysosomal storage disease, and its pathogenesis is the deficient of α-galactosidase A (α-Gal A) activity caused by GLA mutation, which leads to accumulation of the glycosphingolipid globotriaosylceramide (Gb-3) and other glycosphingolipids in the lysosome of cells, resulting in the dysfunction of relevant tissues and organs. We report the clinical characteristics of a case of Fabry disease with dermatomyositis. The patient, a 61-year-old male, presented with intermittent amaurosis, limb weakness and dyspnea on exertion. Based on the low α-Gal A activity and positive anti-myositis antibodies, diagnosis of Fabry disease with dermatomyositis were confirmed. We reviewed the relevant literature and found that co-existence of Fabry disease and autoimmune diseases was very rare, but it is not rare for patients with Fabry disease to have some autoimmune antibody positive, suggesting that Fabry disease and autoimmune diseases may be related in pathogenesis.

Cellular nanovesicles for therapeutic immunomodulation: A perspective on engineering strategies and new advances

Cellular nanovesicles which are referred to as cell-derived, nanosized lipid bilayer structures, have emerged as a promising platform for regulating immune responses. Owing to their outstanding advantages such as high biocompatibility, prominent structural stability, and high loading capacity, cellular nanovesicles are suitable for delivering various immunomodulatory molecules, such as small molecules, nucleic acids, peptides, and proteins. Immunomodulation induced by cellular nanovesicles has been exploited to modulate immune cell behaviors, which is considered as a novel cell-free immunotherapeutic strategy for the prevention and treatment of diverse diseases. Here we review emerging concepts and new advances in leveraging cellular nanovesicles to activate or suppress immune responses, with the aim to explicate their applications for immunomodulation. We overview the general considerations and principles for the design of engineered cellular nanovesicles with tailored immunomodulatory activities. We also discuss new advances in engineering cellular nanovesicles as immunotherapies for treating major diseases.

Pharmacological importance of Kunxian Capsule in clinical applications and its adverse effects: A review / 中草药·英文版

Kunxian Capsule (KX) is a popular Chinese patent medicine for the treatment of rheumatoid arthritis, nephrotic syndrome, systemic lupus erythematosus, Henoch-Schönlein purpura, ankylosing spondylitis, psoriatic arthritis and eczema. However, there is scarcity of comprehensive information on the significance of KX in the clinical application and its side effects. Hence, it is aimed to provide a review of the significance of KX, with a focus on the pharmacological effects, clinical applications, and its adverse reactions. This review was based on the published literatures in PubMed, China National Knowledge Infrastructure and WanFang database. The articles were collected by two independent authors with no time limits applied until November 30, 2022. The search term includes Kunxian Capsule and/or clinical effect, pharmacology, disease, therapy, adverse effects and quality control. KX has been shown to be effective in the treatment of autoimmune arthritis by inhibiting inflammatory responses and inducing apoptosis. Many studies suggest that KX has anti-inflammatory and analgesic properties that aid in the improvement of joint functions. KX dispels wind, removes dampness, invigorates the kidneys, and promotes blood circulation, thereby curing various diseases. However, studies also suggest KX-related adverse reactions in multiple systems. Overall, this review highlights the scientific basis of KX in curing or preventing various diseases and provides novel insights for further research and clinical applications.

Recent Advances in SARS-CoV-2-Induced Immune Thrombocytopenia --Review / 中国实验血液学杂志

SARS-CoV-2-induced immune thrombocytopenia (SARS-CoV-2-induced ITP) is an autoimmune disease secondary to virus infections. Its diagnosis is often based on exclusion of other possible causes of thrombocytopenia in COVID-19 patients. Common laboratory examinations include coagulation function, thrombopoietin and drug-dependent antibodies. Since both bleeding and thrombosis risks are seen in SARS-CoV-2-induced ITP patients, individual remedy is essential for the treatment of this disease. Because thrombopoietin receptor agonist(TPO-RA) has the side effect of accelerating thrombosis and may aggravate the pulmonary embolism symptoms of patients, it should be used for refractory SARS-CoV-2-induced ITP patients only. This review briefly summarizes the recent research progress in the pathogenesis, diagnosis and treatment of SARS-CoV-2-induced ITP.

Effect of curcumin on the expression of NOD2 receptor and pro-inflammatory cytokines in fibroblast-like synoviocytes (FLSs) of rheumatoid arthritis (RA) patients

Abstract Background Previous studies has shown that nucleotide-binding and oligomerization domain-containing protein 2 (NOD2) is expressed in Fibroblast-like synoviocytes (FLSs) of rheumatoid arthritis (RA) patients which is stimulated by muramyl dipeptide (MDP) present in the joint environment and induces inflammation via the NF-κB pathway. Also, other studies have shown that curcumin inhibits proliferation, migration, invasion, and Inflammation and on the other hand increases the apoptosis of RA FLSs. In this study, we aim to evaluate the effect of curcumin, a natural antiinflammatory micronutrient, on the expression of NOD2 and inflammatory cytokines. Methods Synovial membranes were collected from ten patients diagnosed with RA and ten individuals with traumatic injuries scheduled for knee surgery. The FLSs were isolated and treated with 40 μM curcumin alone or in combination with 20.3 μM MDP for 24 h. mRNA was extracted, and real-time PCR was performed to quantitatively measure gene expression levels of NOD2, p65, IL-6, TNF-α, and IL-1β. Results The study findings indicate that administering MDP alone can significantly increase the mRNA expression levels of IL-6 and IL-1β in the trauma group and TNF-α in the RA group. Conversely, administering curcumin alone or in combination whit MDP can significantly reduce mRNA expression levels of P65 and IL-6 in FLSs of both groups. Moreover, in FLSs of RA patients, a single curcumin treatment leads to a significant reduction in NOD2 gene expression. Conclusion This study provides preliminary in vitro evidence of the potential benefits of curcumin as a nutritional supplement for RA patients. Despite the limitations of the study being an investigation of the FLSs of RA patients, the results demonstrate that curcumin has an anti-inflammatory effect on NOD2 and NF-κB genes. These findings suggest that curcumin could be a promising approach to relieve symptoms of RA.

Infarto agudo de miocardio en mujer joven con diagnóstico de lupus eritematoso sistémico / Acute myocardial infarction in a young woman with systemic lupus erythematosus

Resumen Se presenta un caso de infarto agudo de miocardio con elevación del segmento ST en una paciente de 22 años de edad, con LES, HTA y nefropatía a la cual se le realizó angioplastia coronaria exitosa a tercio medio de arteria descendente anterior. Evolucionó sin signos de insuficiencia cardiaca, sin embargo, debido al retraso en el diagnóstico presentó deterioro grave de la función ventricular. El infarto agudo de miocardio con elevación del ST es un evento muy poco frecuente en mujeres pre menopáusicas pero, en comparación con la población general las pacientes con lupus eritematoso sistémico presentan al menos un 50% más de riesgo de padecerlo independientemente de la edad. En esta población, las etiologías más frecuentes son la vasculitis, la aterosclerosis precoz y la trombosis secundaria a síndrome antifosfolipídico. A su vez, en contexto de lupus, se han descripto condiciones como la presencia de nefritis lúpica, que favorecen aún más a la aparición del infarto de miocardio, constituyendo subgrupos de mayor riesgo. El incremento del riesgo de IAM en los pacientes con LES debe tenerse en cuenta y hay que sospechar como diagnóstico diferencial del dolor precordial aún en mu jeres jóvenes, incluso menores de 25 años, población categorizada como de bajo riesgo cardiovascular según los scores y criterios tradicionales. Esto evitaría las demoras en el diagnóstico y tratamiento con consecuencias pronósticas adversas como la necrosis miocárdica extensa y su impacto negativo sobre la función sistólica ventricular como ocurrió en esta paciente.

Abstract We repor a case of acute ST elevation myocardial infarction in a 22-year-old patient with SLE, hypertension and nephropathy who underwent successful coronary angioplasty to a middle third of the left an terior descending artery. She evolved without signs of heart failure however, due to the delay in diagnosis, she presented severe deterioration of ventricular function. ST segment elevation myocardial infarction is a very rare event in young premenopausal women, but compared to the general population, patients with lupus have at least a 50% higher risk of suffering it regardless their age. In this population, the most frequent causes are vasculitis, early atherosclerosis and secondary thrombosis to antiphospholipid syndrome. In the context of lupus, conditions such as the presence of nephritis have been described as favoring the appearance of myocardial infarction, constituting subgroups of higher risk. The increased risk of AMI in patients with SLE must be taken into account and must be suspected as a differential diagnosis of precordial pain in young women, even those under 25 years of age, a population categorized as having low CV risk according to traditional scores. This would avoid delays in diagnosis and treatment with adverse consequences such as extensive myocardial necrosis and its impact on ventricular systolic function, as occurred in this patient.

Debut con síntomas psicóticos de encefalopatía de Hashimoto: reporte de caso / Debut with psychotic symptoms of Hashimoto encephalopathy: A case report

La encefalopatía de Hashimoto es una enfermedad rara reportada por primera vez en 1966 con una prevalencia de 2,1/1000 habitantes. Se presenta el caso de una mujer de 42 años, sin antecedentes médicos de importancia, quien inició un cuadro de manera súbita con alteración de conciencia, alucinaciones visuales y delusiones. En los exámenes de laboratorio se tuvo anticuerpos antiperoxidasa tiroidea mayor a 600 U/ml, tiroxina 0,93, hormona estimulante de la tiroides 1,60 U/ml, resonancia magnética con lesiones focales subcorticales bilaterales de aspecto desmielinizante inespecífico, electroencefalograma sin particularidades. Se realizó el diagnóstico de encefalopatía de Hashimoto y el cuadro remitió luego del tratamiento con corticoides. El artículo resalta la importancia de realizar una evaluación integral de los pacientes con sintomatología psiquiátrica atípica y ahondar en el diagnóstico de exclusión.

Hashimoto's encephalopathy is a rare disease, first reported in 1966, with a prevalence of 2.1 in 1000 inhabitants. We present the case of a 42- year- old woman, with no relevant medical history, who suddenly started having symptoms of altered consciousness, visual hallucinations and de-lusions. Laboratory tests showed anti- thyroperoxidase antibodies greater than 600 U/ml, thy-roxin 0.93 U/ml, and thyroid stimulating hormone 1.60 U/ml. Magnetic resonance imaging showed bilateral subcortical focal lesions with a nonspecific demyelinating appearance. The electroencephalogram was nonspecific. The diagnosis of Hashimoto encephalopathy was made, and symptoms remitted after treatment with steroids. This article highlights the importance of conducting a comprehensive evaluation of patients with atypical psychiatric symptoms and a thorough differential diagnosis.

Apendicitis aguda en una gestante lúpica / Acute appendicitis in pregnant lupus

El lupus eritematoso sistémico es una enfermedad autoinmune que se caracteriza por un proceso inflamatorio crónico y el aumento de la producción de autoanticuerpos como mecanismos patogénicos. Se presenta con mayor frecuencia en pacientes femeninas y en edad fértil. La gestación en pacientes con esta enfermedad se considera como una condición de extrema precaución, ya que existe influencia de la gestación en la actividad clínica del lupus y del lupus en la evolución de la gestación. Las complicaciones quirúrgicas, como es el caso de una apendicitis aguda, aportan mayor riesgo al binomio madre-feto. El objetivo del presente trabajo es comunicar la experiencia de tratamiento de una paciente de 31 años de edad, con diagnóstico de lupus eritematoso sistémico y a quien a las 35,6 semanas de gestación se le presentó un cuadro de apendicitis aguda que no solo provocó la actividad de la enfermedad, sino que causó la interrupción de la gestación. La paciente y el recién nacido presentaron una evolución favorable sin complicaciones posteriores.

Systemic lupus erythematosus is an autoimmune disease that includes the presence of a chronic inflammatory process and increased production of autoantibodies as etiopathogenic mechanisms. As a disease, it occurs more frequently in female patients and those of childbearing age. Pregnancy in patients with this disease is considered an element of extreme caution since there is an influence of pregnancy on the clinical activity of lupus and lupus on the evolution of pregnancy. The presence of surgical complications, as is the case of acute appendicitis, brings greater risk to the mother-fetus binomial. The objective of this report is to communicate the treatment experience of a 31-year-old patient, diagnosed with systemic lupus erythematosus and who at 35.6 weeks of gestation presented acute appendicitis that not only causes disease activity, but it generates the need to interrupt the pregnancy. The patient and the newborn had a favorable evolution, with no subsequent complications.

Gravedad de colecistitis aguda en paciente lúpica con COVID-19 / Severity of acute cholecystitis in a lupus patient with COVID-19

Las enfermedades reumáticas constituyen un grupo de afecciones cuyo mecanismo patogénico se enfoca en la persistencia de un proceso inflamatorio que origina manifestaciones articulares y sistémicas. Aunque no es frecuente, en ocasiones el proceso inflamatorio genera complicaciones graves que requieren intervención quirúrgica como es el caso de la colecistitis aguda. Se presenta el caso de una paciente femenina de 36 años de edad, con diagnóstico de lupus eritematoso sistémico de 5 años de evolución que ingresa con COVID-19 y a los 6 días de hospitalización comienza con un cuadro franco de abdomen agudo que requirió intervención quirúrgica de urgencia. Se presenta el cuadro por la coexistencia de la enfermedad reumática, la infección por COVID-19 y el evento agudo secundario al proceso inflamatorio que causan ambas afecciones(AU)

Rheumatic diseases constitute a group of conditions whose etiopathogenic mechanism focuses on the persistence of an inflammatory process that generates joint and systemic manifestations. Although it is not frequent, sometimes the inflammatory process generates serious complications that require surgical intervention, as is the case with acute cholecystitis. The case of a 36-year-old female patient is presented, with a diagnosis of systemic lupus erythematosus of 5 years of evolution who was admitted due to symptoms compatible with COVID-19 and after 6 days of hospitalization she began with a clear picture of acute abdomen that required emergency surgical intervention. The picture is presented due to the coexistence of rheumatic disease, COVID-19 infection and the acute event secondary to the inflammatory process that both conditions generate(AU)

Manifestaciones ginecológicas en el curso de las enfermedades reumáticas / Gynecological manifestations in the course of rheumatic diseases

Introducción: Las enfermedades reumáticas se caracterizan por la presencia de manifestaciones articulares y extraarticulares. Entre estas últimas, uno de los sistemas menos estudiados es el reproductor. Objetivo: Caracterizar las manifestaciones ginecológicas que con mayor frecuencia se presentan en el curso de las enfermedades reumáticas. Métodos: Se realizó una investigación básica, no experimental, descriptiva y longitudinal que incluyó un total de 117 pacientes femeninas con diagnóstico de varias enfermedades reumáticas según los criterios del Colegio Americano de Reumatología. La muestra quedó conformada por 108 pacientes. Durante la realización del estudio se identificó la incidencia de manifestaciones ginecológicas en las pacientes reumáticas y el tipo de manifestación que se notifica con mayor frecuencia. Resultados: Pacientes con un promedio de edad de 61,19 años, predominio de procedencia urbana (61,11 por ciento) y con diagnóstico de artritis reumatoide (61,11 por ciento). El 39,81 por ciento de ellas refirió tiempo de evolución de la enfermedad entre 3 y 5 años. El 62,04 por ciento de las pacientes presentó algún tipo de manifestación extraarticular ginecológica. La secreción vaginal (50,75 por ciento), vulvovaginitis (25,37 por ciento), cervicitis (20,90 por ciento) y la dispareunia (14,92 por ciento) fueron las de mayor frecuencia de presentación. Conclusiones: Las manifestaciones ginecológicas son frecuentes en las pacientes con enfermedades reumáticas. Las manifestaciones ginecológicas de origen inflamatorio fueron las de mayor presentación y fueron más frecuente en la artritis reumatoide y el lupus eritematoso. En la esclerosis sistémica las manifestaciones neoplásicas fueron las más frecuentes(AU)

Introduction: Rheumatic diseases are characterized by the presence of articular and extra-articular manifestations. Within the latter, one of the least studied systems. Objective: To characterize the gynecological manifestations that most frequently occur in the course of rheumatic diseases. Methods: A basic, non-experimental, descriptive and longitudinal research was carried out that included a total of 117 female patients diagnosed with various rheumatic diseases according to the criteria of the American College of Rheumatology. The sample was made up of 108 patients. During the study, the incidence of gynecological manifestations in rheumatic patients and the type of manifestation that is most frequently reported were identified. Result: average age of 61.19 years, predominance of patients of urban origin (61.11%) and with a diagnosis of rheumatoid arthritis (61.11 percent). 39.81 percent of the patients reported disease evolution time between three and five years. 62.04% of the patients presented some type of extra-articular gynecological manifestation. Vaginal secretion (50.75 percent), vulvovaginitis (25.37 percent), cervicitis (20.90 percent) and dyspareunia (14.92 percent) were the ones with the highest frequency of presentation. Conclusions: Gynecological manifestations are frequently found in patients with rheumatic diseases. Gynecological manifestations of inflammatory origin were those with the highest frequency of presentation and were more frequent in rheumatoid arthritis and lupus erythematosus. In systemic sclerosis, neoplastic manifestations were the most frequent(AU)

Update on the diagnosis, management and treatment of fever of unknown origin: review article and case report / Actualización en el diagnóstico, manejo y tratamiento de la fiebre de origen desconocido: artículo de revisión y reporte de caso

INTRODUCTION Actually, there are more than 200 different causes of unknown fever, it is necessary for the doctor to identify the most prevalent causes of unknown fever in our Clinical boar. PRESENTATION A 52-year-old male patient with no history of chronic diseases, which was received in the Emergency Service of the Hospital San Pablo, Coquimbo, on 02/03/20 began a clinical picture characterized by fever up to 39 ºC associated with diaphoresis, evaluated several times in primary health care without response to symptomatic treatment. He denies dyspnea, cough, sputum production, headache, muscle weakness, myalgia, fainting, decreased visual acuity, nausea, vomiting, chest pain, abdominal pain, diarrhea, constipation, altered bowel movements, weight loss, dysuria, bladder tenesmus, pain lumbar, skin lesions. As relevant information, the patient reports having taken amoxicillin/clavulanate for 2 days on his own account. DISCUSSION Physicians should be aware of the rare extent of an unusual presentation of knowledge origin fever, probably associated with Still disease, as well as medical options for treatment. The literature does not conclude on a gold standard for the method of approach. CONCLUSION In our case, the etiological agent that could cause Fever of unknown origin (FUO) was Sars cov-2 given the presence of elevated inflammatory factors and acute phase proteins and the presence of neutrophilic infiltration

Actividad física y estado nutricional en pacientes reumáticos durante la pandemia de COVID-19 / Physical activity and nutritional status in rheumatic patients during the COVID-19 pandemic

RESUMEN Introducción: El control de las enfermedades reumáticas constituye un reto para los profesionales de la salud. Existen diversos factores que pueden influir en su control, el estado nutricional y la realización de actividades físicas sistemáticamente son algunos de ellos. Objetivo: Evaluar el comportamiento del estado nutricional y la práctica de actividades físicas en pacientes con enfermedades reumáticas durante la pandemia de COVID-19. Métodos: Investigación básica, no experimental, descriptiva y transversal que incluyó como población de estudio una cohorte de 63 pacientes con diagnóstico de enfermedades reumáticas según criterios del Colegio Americano de Reumatología. Se identificaron las características generales de los pacientes, la determinación del estado nutricional y la actividad física, y se utilizó la prueba de correlación de Sperman para identificar la posible relación existente entre las variables de estudio. Resultados: El promedio de edad fue de 53,36 años, con predominio de pacientes femeninas (82,54 %), con artritis reumatoide (53,97 %) y adherentes farmacológicos (96,82 %). Después de terminado el confinamiento existió aumento de pacientes con sobrepeso (41,27 %) y obesidad (9,52 %). Se encontró disminución de la frecuencia de realización de actividades físicas, con predominio de pacientes que realizan actividades físicas menos de tres veces por semana; el 14,28 % refiere que nunca hace ejercicios. Conclusiones: Se identificó que durante el periodo de confinamiento por la COVID-19 existieron variaciones negativas del estado nutricional y de la frecuencia de realización de actividades físicas de los pacientes con ER que pudiera estar relacionado con la actividad clínica de este tipo de enfermedades.

ABSTRACT Introduction: The control of rheumatic diseases constitutes a challenge for health professionals. There are multiple factors that can influence its control, nutritional status and systematic physical activity are some of them. Objective: To evaluate the behavior of the nutritional status and the practice of physical activities in patients with rheumatic diseases during the COVID-19 pandemic. Methods: Basic, non-experimental, descriptive and cross-sectional research that included as a study population a cohort of 63 patients diagnosed with rheumatic diseases according to the criteria of the American College of Rheumatology. The general characteristics of the patients, the rheumatic diseases included in the research, the main digestive manifestations identified, and the Sperman correlation test was used to identify the possible relationship between the study variables. Results: Mean age of 53.36 years, with a predominance of female patients (82.54%), with rheumatoid arthritis (53.97%) and pharmacological adherents (96.82%). After the confinement was over, there was an increase in overweight (41.27%) and obese (9.52%) patients. A decrease in the frequency of physical activities was found with a predominance of patients who perform physical activities less than 3 times a week; 14.28% report that they never exercise. Conclusions: It was identified that during the period of confinement by COVID-19 there were negative variations in the nutritional status and frequency of physical activities of patients with RD that could be related to the clinical activity of this type of disease.