IgA deficiente / IgA deficiency

El déficit selectivo de IgA se define como la ausencia parcial o total de IgA en el suero, con cifras normales en el resto de las inmunoglobulinas. Se presentó una paciente femenina de 1 año y 7 meses, de padres no consanguíneos, con antecedentes familiares negativos para enfermedades genéticas o defectos congénitos, e IgA deficiente. Los estudios inmunológicos mostraron un gran déficit de IgA, de ahí que el diagnóstico se definió como una inmunodeficiencia congénita, por déficit selectiva de IgA o inmunodeficiencia variable común (trastorno genético producto de una herencia monogénica); para lo cual se le realiza una cuantificación de la subclase de IgG y así determinar si es una mutación en un mismo gen defectuoso. La paciente evolucionó satisfactoriamente con los tratamientos recibidos; los valores de IgA permanecieron nulos, no siendo así con el resto de las inmunoglobulinas.

Selective IgA deficiency is defined as the partial or total absence of IgA in the serum, but normal levels in the rest of the immunoglobulins. We present a female patient aged 1 year and 7 months, of non-consanguineous parents, who had a negative family pathological history for genetic diseases or congenital defects and IgA deficiency. Immunological studies showed a high IgA deficiency, hence the diagnosis was defined as congenital immunodeficiency due to selective IgA deficiency or common variable immunodeficiency (genetic disorder resulting from monogenic inheritance); a quantification of the IgG subclass was also performed in order to determine if it was a mutation in the same defective gene. The patient evolved satisfactorily with the treatments received; the IgA values remained null, but this was not the case with the rest of the immunoglobulins.

Immediate adverse events to intravenous immunoglobulin in pediatric patients with inborn errors of immunity: A longitudinal study with a pre-infusion protocol

Introduction Immunoglobulin represents the main therapy for patients with inborn errors of immunity (IEI) and it is a safe procedure, but adverse events (AEs) can occur with variable frequencies. Objective To evaluate the frequency of immediate AEs to intravenous immunoglobulin (IVIG) regular therapy in a pediatric cohort with IEI after a pre-IVIG infusion protocol. Methods This was a longitudinal study from 2011 to 2019 at a tertiary pediatric hospital in Brazil. Results A total of 1736 infusions were studied in 70 patients with IEI, 46 (65.7%) of whom were males and whose median age was 5.8 years old (range: 6 mo - 18 yo). Seven different brands of IVIG were used with the median loading dose of 0.57g/kg (range: 0.23 - 0.88g/Kg). According to the protocol, pre-medication and step-up infusion rate, were performed in 1305 (75.2%) infusions. Immediate AEs were noted in 10 children (14.3%) and in 22 (1.2%) infusions. Skin reactions (rash or urticaria) were the most common AE with 14 episodes (0.8% of all infusions). Almost all AEs were mild (19/86.4%), with no severe ones being observed. The majority of the AEs (81.8%) was identified at a 0.04ml/kg/min infusion rate. Gender, age at first infusion, presence of infection on the infusion day and change of the IVIG brand were evaluated and none of them were associated with AEs. Conclusion The low frequency of immediate AEs in children with IEI highlights the safety and tolerability of intravenous immunoglobulin replacement with the procedures established at our center.

COVID-19 related multisystem inflammatory syndrome in children (MIS-C): A case series from Ethiopia

Background: One in hventy ofpeople qffected by the ongoing COVID-19 pandemic have been children and adolescents. A unique complication in this age group is the Multi-inflammatory syndrome associated Il'ith COVID-19 (MS-C). We report a single-center case series ofchildren diagnosed with MS-Cfrom Addis Ababa, Ethiopia. Case descriptions This case series describes the clinical presentation and treatment outcomes offour male patients presenting at a mean age of3 years and 11 months. Allfulfilled the World Health Organization case definition criteria for the Multi-inflammatomy syndrome associated 'Vith COVID-19. All "'ere not eligible for vaccinations against severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) at the time oftheir diagnosis. They were treated with varying combinations of intravenous immunoglobulin, aspirin, and corticosteroids, and all recovered upon completion oftheirfollow-up period. Conclusion: Cases of Multi-inflammatomy syndrome associated with COVID-19 are often misdiagnosed. This case series highlights when to consider such a diagnosis and its therapeutic options

Clinical characteristics and genetic analysis of four patients with central hypothyroidism due to IGSF1 gene variants / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical manifestations and genetic characteristics of patients with congenital central hypothyroidism due to variants of IGSF1 gene.@*METHODS@#Clinical data, results of genetic testing, and follow-up of four patients admitted to Children's Hospital of Soochow University during 2017 to 2021 were retrospectively analyzed.@*RESULTS@#All of the four patients were males. Patient 1 had presented neonatal jaundice, patients 2 and 3 were admitted for growth retardation during childhood, and thyroid function test indicated slightly low free thyroxine (FT4), patient 4 was found to have reduced FT4 in the neonatal period. Genetic testing revealed that all of the four patients have harbored pathogenic variants of the IGSF1 gene, which were all inherited from their mothers. The thyroid functions in all patients were well controlled with oral levothyroxine and regular follow-up.@*CONCLUSION@#Pathogenic variants of the IGSF1 gene probably underlay the congenital central hypothyroidism with a variety of clinical manifestations, and genetic testing can facilitate the diagnosis at an early stage.

Aplicaciones terapéuticas del eculizumab / Therapeutic applications of eculizumab

Introducción: El eculizumab es un anticuerpo monoclonal de tipo IgG diseñado para el tratamiento de la hemoglobinuria paroxística nocturna (HPN), en el que su diana farmacológica forma parte del sistema del complemento. Su mecanismo de acción ha permitido implementarlo en el tratamiento de enfermedades huérfanas, como el síndrome urémico hemolítico atípico (SUHa), trastorno del espectro de la neuromielitis óptica (TENMO) y miastenia gravis, cuya incidencia, es baja. Asimismo, es viable en el tratamiento de Guillain Barré y el síndrome antifosfolípido catastrófico (CAPS). Objetivo: Evidenciar aplicaciones terapéuticas del eculizumab y beneficios más significativos en algunos padecimientos. Materiales y métodos: Se realizó búsqueda bibliográfica en el periodo 2010-2021, en bases de datos: Google Scholar, Science Direct, PubMed y Scielo, utilizando como palabra clave "eculizumab". Posteriormente, se afinó la búsqueda utilizando palabras claves asociadas a enfermedades tratadas con este medicamento. Resultados: Se identificó el mecanismo de acción del fármaco y su efecto sobre la patogénesis de hemoglobinuria paroxística nocturna, síndrome urémico atípico, miastenia gravis generalizada refractaria, trastorno del espectro de la neuromielitis óptica, síndromes antifosfolípidos catastrófico y Guillain-Barré. Conclusiones: El eculizumab tiene una alta seguridad y capacidad para tratar y disminuir síntomas de diversas enfermedades que involucran el sistema del complemento.

Introduction: Eculizumab is an IgG type monoclonal antibody designed to treat paroxysmal nocturnal hemoglobinuria (PNH) and its pharmacological target is a member of the complement system. Its mechanism of action has permitted its use in the treatment of orphan diseases such as atypical hemolytic uremic syndrome (aHUS), neuromyelitis optic spectrum disorder (NMOSD), and myasthenia gravis, all of which have a low incidence. Likewise, eculizumab is a viable treatment for Guillain Barré and catastrophic antiphospholipid syndrome (CAS). Objective: To describe the therapeutic applications of eculizumab and its most significant benefits in some illnesses. Materials and methods: A bibliographic search was carried out during the 2010-2021 period in Google Scholar, Science Direct, PubMed and Scielo databases using the keyword eculizumab. Then, the search was refined by using keywords associated with diseases treated with this medication. Results: The mechanism of action of the antibody and its effect on the pathogenesis of paroxysmal nocturnal hemoglobinuria, atypical hemolytic uremic syndrome, refractory generalized myasthenia gravis, neuromyelitis optic spectrum disorder, catastrophic antiphospholipid syndrome, and Guillain Barré were identified. Conclusions: Eculizumab has high safety and capacity in treating and diminishing symptoms of diverse illnesses, which involve the complement system.

Neuropatía motora multifocal: ¿cómo diagnosticar un caballo de Troya? / Multifocal motor neuropathy: how to diagnose a trojan horse?

Introducción: La neuropatía motora multifocal con bloqueos de la conducción (NMMBC) es una enfermedad crónica inmunomediada, con un compromiso exclusivo de los nervios motores. Es importante diferenciarla de otras enfermedades que cursan con afectación motora, debido a que ésta es una enfermedad tratable. Cuadro clínico: Paciente varón de 56 años, con compromiso motor progresivo en el miembro superior del lado derecho desde el año 2016. El examen neurofisiológico demostró la presencia de múltiples bloqueos de la conducción nerviosa. Los anticuerpos antigangliósidos fueron negativos. Se indicó tratamiento con inmunoglobulina endovenosa en varios ciclos, con mejoría progresiva del cuadro. Discusión: Se discute el plan diagnóstico clínico y electrofisiológico, los diagnósticos diferenciales, las hipótesis fisiopatológicas y el tratamiento de esta enfermedad de rara ocurrencia

Introduction: Multifocal motor neuropathy with conduction blocks (NMMBC) is a chronic immunemediated disease that exclusively involves the motor nerves. It is important to differentiate it from other diseases that present with motor involvement, because this is a treatable disease. Clinical picture: A 56-year-old male patient, with progressive motor involvement in the right upper limb since 2016. A neurophysiological examination revealed multiple nerve conduction blocks. Antiganglioside antibodies were negative. Treatment with intravenous immunoglobulin was indicated for several cycles with progressive improvement of the condition. Discussion: Clinical and electrophysiological diagnostic plans, differential diagnoses, pathophysiological hypotheses, and treatment of this rare disease are discussed

Gammaglobulina subcutánea: Revisión sistemática / Subcutaneous gamma globulin: A systematic review

Las inmunodeficiencias primarias constituyen enfermedades determinadas genéticamente, caracterizadas por la alteración cuantitativa y/o funcional de distintos mecanismos implicados en la respuesta inmunitaria. Algunas de ellas se caracterizan por una alteración en la producción de anticuerpos, por lo que algunos pacientes se benefician con la administración supletoria de gammaglobulina, la cual se administra mayormente por vía endovenosa, siendo la vía subcutánea una alternativa terapéutica. La siguiente revisión sistemática tiene por objetivo determinar si la gammaglobulina subcutánea tiene alguna ventaja frente al clásico uso de gammaglobulina endovenosa, en pacientes pediátricos con inmunodeficiencias primarias, revisando la bibliografía disponible hasta la actualidad (AU)

Primary immunodeficiencies are genetically determined diseases characterized by the quantitative and/or functional alteration of different mechanisms involved in the immune response. Some of these diseases are characterized by an alteration in the antibody production and therefore some patients benefit from the supplementary administration of gamma globulin, which is mostly administered intravenously, with the subcutaneous route being a therapeutic alternative. The following systematic literature review aims to determine whether subcutaneous gamma globulin has any advantage over the classic use of intravenous gamma globulin in pediatric patients with primary immunodeficiencies (AU)

Experiencia en el uso de los protocolos Biomed-2 para el estudio de reordenamientos de TCR e inmunoglobulinas en proliferaciones linfoides en el Instituto Nacional de Cancerología, Colombia / Experience with the BIOMED-2 standardized polymerase chain reaction protocol for immunoglobulin and T- cell receptor clonality analysis in the Instituto Nacional de Cancerología, Colombia

Introducción. El consorcio europeo BIOMED-2 se creó para determinar si una población linfoide de difícil clasificación patológica es clonal. En Colombia, la implementación de estas pruebas comenzó en el 2015 en el Instituto Nacional de Cancerología E.S.E. (Bogotá). Objetivos. Determinar el comportamiento de las pruebas de reordenamiento clonal o clonalidad linfoide. y determinar las dificultades de su uso en nuestro medio verificando su adaptación local y los resultados en una serie retrospectiva de casos y consecutiva de proliferaciones linfoides sometidas a los protocolos BIOMED-2. Materiales y métodos. A partir de las historias clínicas, se recolectaron los datos clínicos e histológicos y los resultados de los análisis de los reordenamientos en todos los casos de proliferaciones linfoides sometidas a los protocolos BIOMED-2, entre febrero de 2015 y mayo de 2019. Resultados. Se hallaron 132 casos, de los cuales 47 se clasificaron mediante los protocolos de Biomed-2 como hiperplasias linfoides reactivas, 62 como linfomas T, 19 como linfomas B y 3 como neoplasias linfoides de linaje no establecido. Solo en un caso falló la extracción de ADN. Según estos resultados, la mayor dificultad diagnóstica para el patólogo fue el análisis de los infiltrados linfoides T, la mayoría (44) de los cuales correspondía a lesiones cutáneas. Conclusiones. Las pruebas de clonalidad pueden usarse en tejidos de diversa calidad en nuestro medio como ayuda en el diagnóstico de proliferaciones linfoides de difícil clasificación. Es importante hacerlas e interpretarlas de manera multidisciplinaria y considerar cada caso por separado.

Introduction: The European BIOMED-2 consortium was created to evaluate clonality in lymphoproliferations that are difficult to diagnose. In Colombia, the implementation of these tests began in 2015 at the Instituto Nacional de Cancerología E.S.E., Bogotá. Objectives: To determine the behavior of the rearrangement tests for lymphoid clonality and the difficulties of its implementation in our field through a series of retrospective and consecutive cases of lymphoid proliferation subjected to the BIOMED-2 protocols. Materials and methods: Clinical and histological data and the results of the rearrangement analysis of all cases of lymphoid proliferation subjected to the BIOMED-2 protocols between February 2015 and May 2019 were collected from clinical histories. Results: We recovered 132 samples from which 47 corresponded to reactive lymphoid hyperplasias, 62 to T lymphomas, 19 to B lymphomas, and three to lymphoid neoplasms of unestablished lineage. Only in one case did DNA extraction fail. According to these results, the greatest diagnostic difficulty for the pathologist was the analysis of T lymphoid infiltrates, most of which (44) were skin lesions. Conclusions: Clonality tests can be used in tissues of different quality to help in the diagnosis of lymphoid proliferations that are difficult to classify. It is important to implement and interpret them in an interdisciplinary way considering each case separately.

Prevalence of sensitization to Malassezia spp. in adults with atopic dermatitis and psoriasis and its correlation with disease severity / Prevalência da sensibilização a Malassezia spp. em pacientes adultos portadores de dermatite atópica e psoríase e sua correlação com a gravidade das doenças

Fundamentals: Atopic Dermatitis (AD) and Psoriasis (PS) share clinical and physiopathological similarities. Objective: Determine the prevalence of sensitization to Malassezia spp. in adults with AD and PS and its correlation with disease severity. Methods: A cross-sectional study was carried out from January 2016 to August 2017 with adults. Malassezia spp.-specific IgE dosages were measured, and skin scrapings for fungal culture performed. Parametric or nonparametric tests were used for analysis. Results: Median age of the 20 participants with AD was 29 years old, and the mean SCO-RAD was 45.35 ± 18.32. Malassezia spp.- specific IgE median dosage was 0.63 kU/l. M. furfur and M. sympodialis were isolated. Spearman's nonparametric correlation analysis showed no correlation between sensitization to Malassezia spp. and disease severity. The median age of the 36 participants with PS was 61 years old, the median body surface area affected was 22%, and Malassezia spp.-specific IgE median dosage was 0.00 kU/l. M. furfur and Malassezia spp. were identified. Study limitations: Assessing the sensitization to Malasseziaspp. was difficult due to the reduced number of participants in the study. Furthermore, there was no uniformity in the location to collect skin scrapings. The use of topical medication was not suspended before collecting skin specimens for mycological examination, therefore interfer-ing with fungal isolation. Conclusion: Sensitization to Malassezia spp. was only detected in the AD sample. Malassezia spp.-specific IgE test did not prove to be a marker for disease severity in our AD sample (AU)

Fundamentos: Dermatite atópica (DA) e psoríase apresentam similaridades clínicas e fisiopatológicas. Objetivos: Avaliar a frequência da sensibilização a Malasseziaspp. em adultos portadores de DA e psoríase e correlacionar à gra-vidade dos quadros clínicos. Métodos: De janeiro de 2016 a agosto de 2017, conduziu-se um estudo observacional em indivíduos adultos onde foram realizadas dosagem de IgE específica anti-Malassezia spp. e raspados das lesões para cultura micológica. Testes paramétricos ou não paramétricos foram utilizados para análise. Resultados: Nos 20 portadores de DA, a mediana da idade foi 29 anos. O valor médio do Scoring Atopic Dermatitis foi 45,35 ± 18,32. A mediana de IgE específica anti-Malasseziaspp. foi 0,63 kU/l. M. furfur e M. sympodialis foram isolados. A análise de correlação não-paramétrica de Spearman não mostrou correlação entre a sensibilização à Malassezia spp. e a gra-vidade. Nos 36 pacientes com psoríase, foram obtidas as seguintes medianas: idade 61 anos, comprometimento de superfície corpórea 22% e IgE específica anti-Malassezia spp. 0,00 kU/l. Houve identificação de M. furfur e Malasse-zia spp. Limitações do estudo: O número reduzido de participantes dificultou a avaliação da sensibilização por IgE a Malasseziaspp. Não houve uniformidade nos locais de coleta dos raspados cutâneos. Medicamentos tópicos não foram suspensos anteriormente ao exame micológico, prejudicando o isolamento dos fungos. Conclusões: Sensibili-zação a Malassezia spp. apenas ocorreu nos portadores de DA. O teste de IgE específica anti-Malassezia spp. não se mostrou um marcador de gravidade para a DA neste grupo (AU)

Síndrome inflamatorio multisistémico post COVID-19 con afectación miocárdica: reporte de caso / Clinical case: post-COVID multisystem inflammatory syndrome with myocardial involvement / Síndrome inflamatória multissistêmica pós-COVID com acometimento do miocárdio (SIMC): relato de caso

En abril de 2020, durante el pico de la pandemia COVID-19 producida por el coronavirus emergente SARS-CoV-2, en el Reino Unido se comunicaron casos de shock hiperinflamatorio de características similares a la enfermedad de Kawasaki y el síndrome de shock tóxico en un grupo de ocho niños. El Royal College of Pediatrics and Child Health lo denominó síndrome inflamatorio multisistémico pediátrico temporalmente asociado con COVID-19 (SIM-C). Actualmente, el SIM-C es una enfermedad infrecuente, solapada con otras entidades, que requiere una alta sospecha clínica para identificarlo oportunamente. El síndrome inflamatorio multisistémico temporal asociado con SARS-CoV-2 pediátrico (PIMST) es una nueva entidad clínica con un amplio espectro de presentación postexposición al virus, inmunomediado con hiperinflamación y activación de una tormenta de citoquinas. Ocurre típicamente entre la segunda y cuarta semana de evolución. Se describen marcadores de inflamación característicamente elevados, como son la ferritina, proteína C reactiva (PCR), velocidad de eritrosedimentación (VES), lactato deshidrogenasa y dímero-D, asociados a neutropenia, linfopenia y anemia. La Organización Mundial de la Salud (OMS) define: caso a menores de 19 años con fiebre ≥3 días, marcadores inflamatorios elevados, evidencia de infección por SARS-CoV-2 y ninguna otra etiología microbiana; con afectación de al menos dos sistemas: dermatológico (rash, conjuntivitis no exudativa, inflamación mucocutánea), hemodinámico (hipotensión, shock), cardíaco (disfunción de miocardio, pericardio, valvular o coronario), hematológico (coagulopatía), digestivo (vómitos, diarrea, dolor abdominal). Considerando la gravedad de esta nueva entidad, es necesario el reconocimiento oportuno y referencia temprana para atención especiaizada y tratamiento oportuno.

Summary: In April 2020, during the peak of the COVID-19 pandemic caused by the emerging coronavirus SARS-CoV-2, 8 children reported cases of hyperinflammatory toxic shock with characteristics similar to Kawasaki disease and syndrome in the United Kingdom. The Royal College of Pediatrics and Child Health has called it pediatric Multisystem Inflammatory Syndrome (MIS) temporally associated with COVID-19. Currently, MIS-C is a rare disease, overlapping with other conditions, which requires a high clinical suspicion for its timely identification. Pediatric SARS-CoV-2-associated temporary multisystem inflammatory syndrome (TMIS-C) is a new clinical entity with a broad spectrum of presentation after exposure to the virus, immune-mediated with hyperinflammation and activation of a cytokine storm. It typically occurs between the 2nd to 4th week of evolution. Characteristically elevated markers of inflammation are described, such as ferritin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactate dehydrogenase and D-dimer, associated with neutropenia, lymphopenia and anemia. The World Health Organization (WHO) defines it as: a case under 19 years of age with fever ≥ 3 days, elevated inflammatory markers, evidence of SARS-CoV-2 infection and no other microbial etiology; with involvement of at least 2 systems: dermatological (rash, non-exudative conjunctivitis, mucocutaneous inflammation), hemodynamic (hypotension, shock), cardiac (myocardial, pericardial, valvular, or coronary dysfunction), hematologic (coagulopathy), digestive (vomiting, diarrhea, abdominal pain) Considering the seriousness of this new entity, timely recognition and early referral for specialized care and timely treatment are key.

No mês de abril de 2020, durante o pico da pandemia de COVID-19 causada pelo emergente coronavírus SARS-CoV-2, 8 casos de crianças com choque hiperinflamatório com características semelhantes à doença e síndrome de Kawasaki foram relatados no Reino Unido. O Royal College of Pediatrics and Child Health nomeou-o como síndrome inflamatória multissistêmica pediátrica (MIS) temporariamente associada ao COVID-19. Atualmente, o SIM-C é uma doença rara, sobrepondo-se a outras entidades, o que requer alta suspeição clínica para sua identificação oportuna. A síndrome inflamatória multissistêmica temporária associada ao SARS-CoV-2 pediátrico (SIMT) é uma nova entidade clínica com amplo espectro de apresentação após exposição ao vírus, imunomediada com hiperinflamação e ativação de uma tempestade de citocinas. Geralmente ocorre entre a 2ª a 4ª semana de evolução. São descritos marcadores de inflamação caracteristicamente elevados, como ferritina, proteína C reativa (PCR), velocidade de hemossedimentação (VHS), lactato desidrogenase e D-dímero, associados a neutropenia, linfopenia e anemia. A Organização Mundial da Saúde (OMS) a define como: caso de menor de 19 anos com febre ≥ 3 dias, marcadores inflamatórios elevados, evidência de infecção por SARS-CoV-2 e nenhuma outra etiologia microbiana; com envolvimento de pelo menos 2 sistemas: dermatológico (erupção cutânea, conjuntivite não exsudativa, inflamação mucocutânea), hemodinâmica (hipotensão, choque), cardíaca (disfunção miocárdica, pericárdica, valvar ou coronariana), hematológica (coagulopatia), digestiva (vômitos, diarreia, dor abdominal) Considerando a gravidade dessa nova entidade, é necessário o reconhecimento oportuno e encaminhamento precoce para atendimento especializado e tratamento oportuno.

Pharmacokinetic study of anti-human T-cell porcine immunoglobulin combined with cyclosporine A immunosuppressive therapy in patients with severe aplastic anemia / 中华血液学杂志

Objective: To study the metabolic characteristics of anti-human T-cell porcine immunoglobulin (p-ATG) in patients with severe aplastic anemia (SAA) . Methods: For patients with SAA treated with p-ATG combined cyclosporine A (CsA) immunosuppressants between February 2017 and December 2017, the p-ATG dose was 20 mg·kg(-1)·d(-1) over 12 h of intravenous administration for 5 consecutive days. The blood concentration of p-ATG was detected by the three-antibody sandwich ELISA method, the pharmacokinetic analysis software was fitted, and the second-chamber model method was used to calculate the pharmacokinetic parameters and plot the pharmacokinetic curve. Adverse events were recorded and the hematologic reactions were determined at 6 months after treatment. Results: Sixteen patients with SAA treated with p-ATG were enrolled, including 8 females and 8 males, with a median age of 22 years (range, 12 to 49 years) and a median weight of 62.5 kg (range, 37.5 to 82.0 kg) . The pharmacokinetics of p-ATG could be evaluated in 14 cases. p-ATG is distributed in vivo as a two-chamber model, with an average drug concentration peak (T(max)) of (5.786±2.486) days, a peak concentration (C(max)) of (616±452) mg/L, and a half-life of (10.479±8.242) days. The area under the drug time curve (AUC) was (5.807±3.236) mg/L·d. Six months after treatment, 8 of 14 patients received a hematologic response; the AUC (0-t) of the effective group and ineffective groups was (7.50±3.26) mg/L·d vs (4.50±2.18) mg/L·d, and the C(max) was (627±476) mg/L vs (584±382) mg/L, respectively. Conclusion: The plasma concentration of p-ATG reached a peak after 5 days of continuous infusion, and then decreased slowly, with a half-life of 10.479 days, and the residual drug concentration was detected in the body 60 days after administration. A relationship between drug metabolism and efficacy and adverse reactions could not be determined.

Medicamento de Sinopharm basado en inmunoglobulina humana contra la COVID-19 / Sinopharm drug based on human immunoglobulin against COVID-19

ANTECEDENTES: El presente informe se efectúa a solicitud de la jefatura institucional del INS, que solicita opinión sobre el medicamento de Sinopharm basado en inmunoglobulina humana contra la COVID-19. El objetivo del presente informe es brindar la evidencia disponible sobre el medicamento de Sinopharm basado en inmunoglobulina humana contra la COVID-19. METODOS: Formulación de la pregunta PICO: ¿Cuál es la eficacia y seguridad del medicamento de Sinopharm basado en inmunoglobulina humana contra la COVID-19? Búsqueda y selección de la literatura científica: Se efectuó una búsqueda electrónica de las bases de datos MEDLINE/PubMed, Cochrane Library, Scopus y Embase sobre las ECA publicados sobre el medicamento de Sinopharm (o su subsidiaria China Natinal Biotech Group) basado en inmunoglobulina humana contra la COVID-19, con fecha límite 1 de diciembre de 2021. Asimismo, se buscó información en páginas web como Clinical Trials (https://clinicaltrials.gov/) y Chinese Clinical Trial Registry (https://www.chictr.org.cn/abouten.aspx). La búsqueda fue limitada a documentos desarrollados en idioma español o inglés. Resultados: - La búsqueda en las bases de datos mencionadas no presentó resultados sobre ECA sobre medicamentos elaborados por Sinopharm basados en inmunoglobulina humana. Evidencia disponible respecto el medicamento elaborado por Sinopharm basado en inmunoglobulina humana: No se ha encontrado evidencia sobre el medicamento elaborado por Sinopharm o su subsidiaria (China Nationa Biotech Group) basado en inmunoglobulina humana. Algunos ensayos clínicos muestran efectos terapéuticos de inmunoglobulina intravenosa sobre la mortalidad en pacientes con COVID-19 severo (1). Sin embargo, las revisiones sistemáticas indican que la evidencia disponible es de baja calidad y el tratamiento con inmunoglobulinas debe ser usado con precaución (2). CONCLUSIONES: Según los datos disponibles en la búsqueda electrónica, no se encontró evidencia sobre el medicamento elaborado por Sinopharm basados en inmunoglobulina humana. La evidencia disponible sobre terapias con inmunoglobulinas humanas es de baja calidad y debería ser usada con precaución.

Púrpura trombocitopénica idiopática (pti): su diagnóstico a través de lesiones en cavidad oral / Purple Idiopathic Thrombocytopenic (Itp): diagnosis through lesions in the oral cavity

La PTI es una alteración hemorrágica de instalación súbdita, adquirida, que se manifiesta inicialmente con petequias, equimosis o hematomas en piel y mucosas, sangrado nasal y gingival, sin causa aparente. La mucosa bucal puede ser el sitio donde las lesiones se observen con frecuencia y por primera vez. Se reporta el caso de un paciente masculino de 28 años de edad, con manifestaciones clínicas de un cuadro purpúrico, se describen signos, síntomas, terapéutica y manejo estomatológico (AU)

PTI is a hemorrhagic alteration of sudden installation, acquired, which manifests initially with petechiae, esquimosis or bruises on skin and mucosae, nasal and gingival bleeding without apparent cause. Bucal mucosae can be the site where lesions are observed with frequency, and for the first time. The case of a male patient with 28 years of age with clinical manifestationsofpurpuric syndrome is reported, signs, symptoms, therapeutic and stomatological handling are described (AU)

Revisiting prophylaxis of homeopathic interventions in COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused by novel beta-coronavirus has emerged as a cause of coronavirus pandemic (COVID-19) declared by Public Health Emergency of International Concern (PHEIC). Korean oriental medicine, Traditional Chinese Medicine (TCM), and Indian systems of medicine known as AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Sowa-Rigpa and Homeopathy) had implemented various prophylactic measures and interim treatment guidelines in prevention and treatment for COVID -19 cases. However, even though different approaches were implemented to break the epidemic chain, we have not reached herd effect or herd immunity in the Indian population. Therefore, in this ongoing COVID-19 pandemic, a specific study on immune markers of IL-6 (Interleukin-6), D-Dimer, Ferritine, CRP (C-reactive protein) with SARS CoV-2 specific IgG & IgM antibodies need to be investigated for generating hard-core evidence for homeoprophylaxis in terms of immunity response. Therefore, there seems to be a need to revisit the program of homeoprophylaxis in the COVID -19 pandemic.

Relação entre exercício físico e sistema imunológico / Relationship between exercise and the immune system

O corpo humano tende sempre a procurar um estado de homeostase, buscando o equilíbrio entre todos os sistemas. O exercício físico está presente na rotina diária de indivíduos, mesmo com objetivos diferentes, porém a influência no sistema imunológico não é muitas vezes abordada como fator relevante. O sistema imune é responsável por proteger o organismo contra infecções e doenças, podendo ser modulado perante a resposta de exercícios físicos regulares. Tendo em vista que, atualmente, existe uma preocupação maior em tornar e manter a imunidade eficiente, a prática regular e moderada do exercício pode contribuir para uma maior eficácia desse sistema, dessa forma, podendo ser considerada uma proteção ao corpo humano. O objetivo dessa revisão foi sintetizar os dados de estudos presentes na literatura que demonstram a influência do exercício físico na resposta do sistema imunológico, tornando possível compreender as alterações moleculares, fisiológicas, metabólicas e celulares que levam a um tipo específico de resposta do organismo humano.

The human body always tends to seek a homeostasis state, trying to balance all systems. Physical exercise is present in the routine of individuals even with different goals, but the influence in the immune system isnt a relevant factor. The immune system is responsible for protecting the human body against some infections and diseases, and could be modulated in response by some regular physical exercise. At the moment there is a greater concern to keep efficient immunity, a practice of regular and moderate exercise can contribute to a better effectiveness of this system, thus, it can be considered a form of protection to the human body. The objective of this review was to synthesize some data from any studies presented in the literature that demonstrate the influence of physical exercise on the immune system response. Making it possible to understand the molecular mechanisms, physiological, metabolic and cellular changes that turn to a specific type of response in the human body.

Kounis Syndrome: Case Report in Goiânia/BR

Abstract 22-year-old male patient with no heart disease, who was given an ambulatory medication with analgesics due to an acute renal crisis. After the drug administration, the patient presented dyspnea, cyanosis, and hemoptysis. There was suspicion of anaphylactic shock, which was treated, but there was no improvement in the clinical condition. The patient was referred to the Intensive Care Unit, where tests were performed showing elevated cardiac enzymes and Immunoglobulin E and Computed Tomography of Thoracic revealed alveolar hemorrhage. He developed clinical worsening and died after sepsis. The final diagnosis was of kounis syndrome due to the hypersensitivity reaction to the analgesics introduced in the patient, generating an acute coronary syndrome (ACS). The purpose of this case report was to highlight a syndrome that is little reported because it is not part of the differential diagnosis routines of ACS, but it generates important complications.

Research on the application of sport dance in colleges and universities in the healthy development of sports / Pesquisa sobre a aplicação da dança esportiva nas universidades no desenvolvimento saudável dos esportes / Estudio sobre la aplicación de la danza deportiva en las universidades en el desarrollo saludable de los deportes

ABSTRACT Introduction: Immunity is closely related to health. When the body's immunity is strong, it is healthy. On the contrary, various diseases appear. Sports dance is an entertainment and fitness sports project that integrates sports, music, aesthetics, and dance, the body movement dance as the necessary content and two-person or collective exercises as the primary form of exercise. Studies have shown that long-term adherence to Tai Chi exercise can significantly increase the serum immunoglobulin IgA, IgG, and IgM levels. Objective: The paper explores the effect of physical dance exercise on serum immunoglobulin and T lymphocyte subsets of college students. Methods: The thesis randomly selected 16 male and female students in the first-grade physical dance optional course of public physical education as the experimental group. They performed physical dance exercises three times a week, 40 minutes each time, and the training intensity was controlled at a heart rate of 135-150 beats/min. Ten weeks; besides, 16 male and female students in the first grade were selected as the control group, and no physical dance exercise was performed; all the subjects were drawn from the elbow venous blood on an empty stomach at the same time before and after the experiment to measure serum immunoglobulin and T lymph Cell subpopulation content. Results: After ten weeks of sports dance training, the serum immunoglobulin IgG of both men and women in the experimental group increased significantly (P<0.01), and the CD4+% and CD4+/CD8+ ratio of T lymphocyte subgroups showed extremely significant and significant increases (P <0.01, P<0.05), serum IgM tended to increase, IgA, CD8+% tended to decrease, but there was no significant change. Conclusions: Long-term physical dance exercise can improve the body's immune function. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: la inmunidad está estrechamente relacionado con la salud. Cuando la inmunidad del cuerpo es fuerte éste está sano. En caso contrario, aparecen diversas enfermedades. La danza deportiva é um projeto de entretenimiento y fitness que integra el deporte, la música, la estética y la danza, el movimiento corporal como contenido necesario y los ejercicios de das personas ou colectivos como forma principal de ejercicio. Los estudios han demonstraram que a adesão a largo plazo al ejercicio de Tai Chi pode aumentar também os niveles séricos de imunoglobulina IgA, IgG e IgM. Objetivo: O artigo explora o efeito do exercício físico de danza em subconjuntos de imunoglobulina sérica e linfocitos T de estudiantes universitários. Métodos: Para que a tese seja selecionada aleatoriamente, 16 ex-alunos e ex-alunos do curso optativo de danza física de primer grado de educação física pública como grupo experimental. Realizaron ejercicios de danza física tres veces por semana, 40 minutes cada vez, y la intensidad del entrenamiento se controló a una frecuencia cardíaca de 135-150 latidos/min. durante as semanas; además, se selecionar 16 alumnos y alumnas de primer grado como group de control, el que no realizó ningún ejercicio físico de danza. A todos os sujetos se les extrajo sangre venosa del codo com o estómago vacío, durante, antes e depois do experimento para medir o conteúdo da subpoblación de células T y de imunoglobulina sérica. Resultados: Después de diez semanas de entrenamiento de danza deportiva, la imunoglobulina IgG sérica de hombres y mujeres en el grupo experimental aumentó complementar (P <0,01), y la proporción CD4 +% y CD4 +/CD8 + de los subgrupos de linfocitos T mostró incrementos extremadamente provados. (P <0,01,P <0,05), la IgM sérica tendió a aumentar, la IgA, CD8 +% tendió a disminuir, mas nenhum hubo cambio projetado. Conclusiones: El ejercicio de danza física a largo plazo puede mejorar la función inmunológica del cuerpo. Nivel de evidencia II; Estudios terapéuticos: investigación de los results del tratamiento.

RESUMEN Introducción: la inmunidad está estrechamente relacionada con la salud. Cuando la inmunidad del cuerpo es fuerte éste está sano. En caso contrario, aparecen diversas enfermedades. La danza deportiva es un proyecto de entretenimiento y fitness que integra el deporte, la música, la estética y la danza, el movimiento corporal como contenido necesario y los ejercicios de dos personas o colectivos como forma principal de ejercicio. Los estudios han demostrado que la adherencia a largo plazo al ejercicio de Tai Chi puede aumentar significativamente los niveles séricos de inmunoglobulina IgA, IgG e IgM. Objetivo: El artículo explora el efecto del ejercicio físico de danza en subconjuntos de inmunoglobulina sérica y linfocitos T de estudiantes universitarios. Métodos: Para la tesis se seleccionaron aleatoriamente a 16 alumnos y alumnas del curso optativo de danza física de primer grado de educación física pública como grupo experimental. Realizaron ejercicios de danza física tres veces por semana, 40 minutos cada vez, y la intensidad del entrenamiento se controló a una frecuencia cardíaca de 135-150 latidos/min. durante diez semanas; además, se seleccionaron 16 alumnos y alumnas de primer grado como grupo de control, el que no realizó ningún ejercicio físico de danza. A todos los sujetos se les extrajo sangre venosa del codo con el estómago vacío, durante, antes y después del experimento para medir el contenido de la subpoblación de células T y de inmunoglobulina sérica. Resultados: Después de diez semanas de entrenamiento de danza deportiva, la inmunoglobulina IgG sérica de hombres y mujeres en el grupo experimental aumentó significativamente (P <0.01), y la proporción CD4 +% y CD4 + / CD8 + de los subgrupos de linfocitos T mostró incrementos extremadamente significativos. (P <0.01, P <0.05), la IgM sérica tendió a aumentar, la IgA, CD8 +% tendió a disminuir, pero no hubo cambios significativos. Conclusiones: El ejercicio de danza física a largo plazo puede mejorar la función inmunológica del cuerpo. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Hibridación de anticuerpos en la Covid-19 / Antibody hybridization in Covid-19

Introducción: El nuevo coronavirus tiene material genético. Esto permite a un receptor transformarse en el sitio de acción polibásica y es capaz de infectar a través de múltiples receptores de entrada y resaltar a las proteínas de tipo espiga (S). La proteína 'espiga' es una proteína de fusión viral de la Covid-19, es por ello que en la búsqueda terapéutica se establece las siguientes preguntas, ¿la hibridación de anticuerpos logrará ganar la guerra contra la pandemia de la Covid-19?; o ¿el plasma rico en anticuerpos puede mantener a las personas fuera de las unidades de cuidados intensivos? Estas preguntas radican en que los estudios actuales no establecen la verdadera utilidad de la terapia inmunológica. Objetivo: Presentar la utilidad de anticuerpos híbridos ante la actual pandemia de la Covid-19 y otros coronavirus. Métodos: Se desarrolló una revisión bibliográfica a partir de la evidencia existente acerca del panorama de la proteómica en el estudio del sistema inmune para combatir infecciones. Se utilizó un margen de tiempo entre el año 1999 al 2020. Se seleccionaron un total de 37 documentos que cumplen con los protocolos de inclusión en idioma inglés o español; en la búsqueda se utilizaron términos MeSH. Se escogieron estudios de orden observacional o analíticos; de carácter experimental, reporte de casos que dataran aspectos bioquímicos, biológicos, patológicos y clínicos del sistema inmune como blanco terapéutico ante la pandemia actual. El análisis documental fue realizado por el Grupo de Investigación en Salud de la Universidad del Cauca-Popayán, con apoyo y dirección de la Universidad de Houston, Texas (EEUU), con el apoyo de profesorado del Programa de Investigación Humana de la NASA. Resultados: La respuesta positiva para controlar esta pandemia está basada en los cuidados preventivos y en las posibles terapias innovadoras ante los nuevos coronavirus que logren transmitirse de animales a humanos. Se resalta el posible uso de anticuerpos de dominio único híbridos para frenar infecciones víricas nuevas. Conclusiones: Se resalta el posible uso de anticuerpos de dominio único híbridos para frenar infecciones víricas nuevas(AU)

Introduction: The new coronavirus has genetic material. This allows a receptor to transform into the polybasic site of action and it is capable of infecting through multiple entry receptors and highlighting spike-like (S) proteins. The spike protein is a viral fusion protein of Covid-19, which is why in the therapeutic search the following questions are established, will antibody hybridization succeed in winning the war against the Covid-19 pandemic? Or can antibody-rich plasma keep people out of intensive care units? These questions are that current studies do not establish the true utility of immune therapy. Objective: To settle the usefulness of hybrid antibodies to the current Covid-19 pandemic and other coronaviruses. Methods: A bibliographic review was developed from the existing evidence about the panorama of proteomics in the study of the immune system to fight infections. A time frame was used between 1999 and 2020. A total of 37 documents, in English or Spanish, that comply with the inclusion protocols were selected; MeSH terms were used in the search. Observational or analytical studies were chosen; experimental, case report dating biochemical, biological, pathological and clinical aspects of the immune system as a therapeutic target in the current pandemic. The documentary analysis was carried out by the Health Research Group of the Universidad del Cauca-Popayán, with the support and direction of the University of Houston, Texas (USA), with the support of faculty from NASA Human Research Program. Results: The positive response to control this pandemic is based on preventive care and possible innovative therapies for the new coronaviruses that manage to be transmitted from animals to humans. Conclusions: The possible use of hybrid single domain antibodies to stop new viral infections is highlighted(AU)