Aldosterona e IL-17 en la génesis de la hipertensión arterial mineralocorticoídea, un estudio ex vivo / Aldosterone and il-17 in the genesis of mineralocorticoid arterial hypertension: an ex vivo study

Background: Treatment of dendritic cells (DC) with aldosterone induces the secretion of IL-6 and TGF-beta. The polarization of naïve T cells to helper 17 T lymphocytes with DCs pre-incubated with aldosterone, has been described in vivo, generating an IL-17 hyper-secreting phenotype, a cytokine associated with cardiac and renal fibrosis. There are mineralocorticoid receptors (MR) in immune cells and their activation may determine the inflammatory (M1) or adaptive (M2) macrophage phenotype. Aldosterone levels could regulate immunogenic gene expression in these cells, modulating the liberation of specific cytokines. Aim: To assess in humans the association of aldosterone levels and IL-17 with inflammatory markers in peripheral blood mononuclear cells (PBMC). Material and Methods: In blood samples of 176 participants aged 18 to 67 years (61 percent women) with a body mass index of 27.1 +/- 4.8 kg/m2, aldosterone, plasma renin activity (ARP), cortisol, C reactive protein, andIL-17 were measured. mRNA was isolated from PBMCs to measure the expression of MR RAC-1, HO-1, TLR-4, CD-14, NGAL and IL-17 by real time polymerase chain reaction. Results: Aldosterone correlated positively with ARP and the expression of CD-14 in PBMCs. Plasma levels of IL-17 were positively associated with the expression of MR, Rac1a and NGAL. Conclusions: Aldosterone and IL-17 levels were associated with inflammatory activation markers in PBMC, which could activate MRand promote a subclinical inflammatory status inducing hypertension.

Psicosis e hipotiroidismo o Mixedema madness: un caso demostrativo / Mixedema madness: report of one case

Cognitive impairment among patients with hypothyroidism is a well known condition, but its pathophysiology is not fully understood. Thyroid hormones may influence several processes in the brain, including cerebral perfusion, cerebral metabolism and neurotransmitter activity and could partially explain the neuropsychiatric manifestations of hypothyroidism. Acute psychosis is rare as a manifestation of hypothyroidism, but is potentially reversible. We report a 37 years old female without a previous history of psychiatric illness, presenting with an acute psychosis that required hospital admission. Her serum TSH was 122.2 uUI/mL (normal 0.3-4.2 uUI/mL), her total T4 was 1.1 ug/dL (normal 4.6-12 ug/dL), her free T4 was 0.1 ng/dL (VN 0.9-1.7 ng/dL), her total T3 was 30.5 ng/dlL (normal 84-201 ng/dL), and her antiTPO antibodies were 5464 UI/mL (normal < 12 UI/mL). Thyroid substitution was started with an important remission of psychotic symptoms. One month later, anti-psychotic medication was discontinued.

El tejido graso como modulador endocrino: cambios hormonales asociados a la obesidad / Adipose tissue as an endocrine modulator: hormonal changes associated with obesity

Adipose tissue not only stores fat, but secretes factors and hormones, which modify the regulation, metabolism and secretion of several other hormones. The objective of this review is to describe the hormonal disorders associated with increased adipose tissue, which acts as a modulator or disruptor of the endocrine physiology, with special reference to cortisol, androgens, growth hormone and thyroid axis, and discuss the implications for the management and treatment of these patients.

El tejido graso como modulador endocrino: Cambios hormonales asociados a la obesidad / Adipose tissue as an endocrine modulator: Hormonal changes associated with obesity

Adipose tissue not only stores fat, but secretes factors and hormones, which modify the regulation, metabolism and secretion of several other hormones. The objective of this review is to describe the hormonal disorders associated with increased adipose tissue, which acts as a modulator or disruptor of the endocrine physiology, with special reference to cortisol, androgens, growth hormone and thyroid axis, and discuss the implications for the management and treatment of these patients.

Neoplasia endocrina múltiple tipo 1 / Multiple endocrine neoplasia type 1

Multiple endocrine neoplasia type 1 (NEM1) is an uncommon autosomal dominant disease caused by an alteration of menin, a tumor suppression protein and is characterized by the presence of primary tumors in at least two different endocrine tissues. It is described as the “three P disease”since it involves mainly the pituitary, parathyroid and pancreas. However more than 20 different tumor locations have been described. Most tumors are benign and primary hyperparathyroidism is the first manifestation of the disease in 90 percent of cases enteropancreatic tumors appear in approximately 60 percent of patients and pituitary adenomas, usually prolactinomas, in 30 percent. Skin lesions, non functional adrenal adenomas and neuroendocrine tumors such as carcinoid are also part of the disease. We describe the pathogenesis, clinical presentation, diagnosis and treatment of NEM1.

Resistencia a la hormona tiroidea y embarazo: caso clínico / Thyroid hormone resistance syndrome and pregnancy: case report

Thyroid hormone resistance syndrome is a genetic disease determined by a mutation that modifies the configuration of the beta thyroid hormone receptor, affecting its T3 binding capacity. Increased T3 and T4, determined by a compensatory TSH elevation secondary to pituitary resistance, allows an euthyroid functional state in most of the cases. The coexistence of pregnancy and thyroid hormone resistance is uncommon. Therefore, the optimal diagnosis and treatment strategy has not been determined. We report a 32 years old woman with thyroid hormone resistance, that became pregnant. During her pregnancy, she wassupplemented with levothyroxine in doses of 50 to 60 ug/day and remained euthyroid. Fetal development and growth were normal.

Malaria: revisión retrospectiva de 12 casos no autóctonos en Chile / Malaria: Report of 12 non autochthonous cases

Malaria is a protozoan infection caused by four Plasmodia species transmitted by female Anopheles mosquito. Nearly 40% of the world population is at risk of acquiring the disease because of increasing resistance to treatment, climate changes and travels to endemic zones. We report twelve patients with diagnosis of malaria, supported by the identification of parasites on blood smear. All cases had traveled to endemic zones (Peru, Ecuador, Central America, Africa), but only three used chemoprophylaxis. Seven cases were infected with Plasmodium vivax and five cases with P. falciparum. Three of latter required intensive care. All patients were treated with standard drugs according to the severity and Plasmodium specie, with excellent results and no mortality.

Neumonía cavitada por Rhodococcus equi en paciente inmunocomprometido no infectado por virus de inmunodeficiencia humana: Caso clínico y revisión / Necrotizing pneumonia due to Rhodococcus equi in non HIV immunocompromised host: Case report and review

Rhodococcus equi, es un bacilo grampositivo intracelular que causa infecciones mayoritariamente en pacientes inmunodeprimidos. Reportamos el caso de una mujer de 52 años, en tratamiento de lupus eritematoso sistémico, con historia progresiva de 10 meses de evolución caracterizada por tos, disnea progresiva, expectoración muco-purulenta, ocasionalmente hemoptoica, fiebre intermitente, y pérdida de peso del 10 por ciento. Tuvo respuesta parcial a diversos cursos de tratamiento antimicrobiano y el seguimiento radiológico evidenció la aparición de múltiples focos de consolidación bilaterales, algunos de ellos nodulares. El estudio microbiológico de un lavado broncoalveolar y de una biopsia pulmonar percutánea permitió la identificación de R. equi y la histología de la biopsia pulmonar fue compatible. Recibió tratamiento antimicrobiano bi-asociado prolongado con buena respuesta clínica y radiológica. Se debe considerar este agente en el estudio de pacientes inmunocomprometidos que cursan con neumonías de evolución prolongada.

AngioTAC como método de diagnóstico y decisión quirúrgica en el tromboembolismo pulmonar crónico: Discusión a propósito de un caso / CT angiography as the diagnostic and decision making method used for surgical indication in pulmonary hypertension due to chronic thromboembolism: Report of one case

Pulmonary hypertension due to chronic pulmonary thromboembolism is frequently underdiagnosed and has a very poor prognosis if untreated. When the presence of central pulmonary artery thrombus is confirmed, thromboendarterectomy is the treatment of choice, with very good results. We report a 28 years old male with two previous episodes of deep venous thrombosis (DVT) who was admitted due to 8 months of progressive shortness of breath and a syncope. He underwent a CT pulmonary angiogram and an echocardiogram. Severe pulmonary hypertension was confirmed, secondary to a chronic pulmonary thromboembolism with an overlapped acute component. He received systemic thrombolysis with partial thrombus disappearance. Therefore a pulmonary thromboendarterectomy was performed and an inferior vena cava filter was placed. The patient was discharged with marked improvement in his functional capacity.

Bursitis tuberculosa: caso clínico / Tuberculous bursitis: clinical case

We report a previously healthy 51 years old woman with a one year history of pain in the left hip associated with a mass without fever or local inflammatory changes. Magnetic resonance imaging located the mass in the medial gluteal muscle. The pathological examination of the mass disclosed unspecific inflammatory changes. Due to worsening of pain, a left throchanteric bursitis was diagnosed two weeks later and a throchanteric bursectomy was performed, obtaining a second biopsy. Aerobic, anaerobic and fungal cultures were negative. Lowenstein-Jensen culture showed development of mycobacteria and a genetic probe confirmed the presence of Mycobacterium tuberculosis. The second biopsy also identified several granulomas with areas of caseation and the Ziehl-Nielsen stain was positive for acid fast bacilli. Osteoarticular tuberculosis, specially bursitis, shoulds be suspected in the presence of chronic pain associated with swelling

Artritis séptica por psychrobacter phenypyruvicus: primer caso clínico y revisión de la literatura / Septic arthritis due to psychrobacter phenylpyruvicus: first case and literature review

Reportamos el caso de un hombre de 70 años con antecedentes de diabetes mellitus tipo 2, hipertensión arterial y una insuficiencia renal en hemodiálisis, quien fue hospitalizado por una historia de fiebre durante tres semanas. Se le diagnóstico una artritis séptica de la cadera izquierda, practicándosele un aseo quirúrgico. Los cultivos mostraban crecimiento de un coco-bacilo Gram negativo fastidioso. El paciente fue re-hospitalizado debido a un compromiso de conciencia, un infarto agudo al miocardio y fiebre. La tocomografía axial computada y una resonancia magnética de cerebro estaban normales, al igual que el estudio de líquido cefaloraquídeo. La identificación final del cocobacilo correspondió a P. phenylpyruvicus (anteriormente M. phenylpyruvicus). Se inició tratamiento antimicrobiano con ceftriaxona. El paciente evolucionó en forma tórpida y falleció luego de dos semanas debido a un paro cardio-respiratorio. La familia Moraxellaceae forma parte de la flora normal tanto del tracto respiratorio como del tracto genito-urinario. Existen varias especies descritas en este género: Moraxella catarrhalis, Moraxella nonliquefaciens, Moraxella atlantae y P. phenylpyruvicus. Ocacionalmente constituye el agente de cuadros infecciosos severos. Existen sólo dos reporte de infecciones por P. phenylpyruvicus, un paciente con pie diabético y otro con endocardiatis infecciosas. Nuestro reporte constituye el primer caso de una artritis séptica causada por este microorganismo