Warm autoimmune hemolytic anemia: experience from a single referral center in Mexico City

BACKGROUND: Autoimmune hemolytic anemia (AIHA) is characterized by an autoimmune-mediated destruction of red blood cells. Warm AIHA (wAIHA) represents 60% of AIHA cases and is associated with the positive detection of IgG and C3d in the direct antiglobulin test (DAT). This study aimed to assess the clinical and laboratorial differences between primary and secondary wAIHA patients from a referral center in Mexico City. METHODS: All patients diagnosed with wAIHA in our institution from January 1992 to December 2015 were included and received corticosteroids as the first-line treatment. We analyzed the response to the first-line treatment, relapse-free survival, and time to splenectomy. RESULTS: Eighty-nine patients were included. Secondary wAIHA represented 55.1% of the cases. At diagnosis, secondary wAIHA patients showed a DAT mixed pattern more frequently than primary wAIHA patients (36.7 vs. 17.5%, P<0.001). In the survival analysis, patients with secondary wAIHA had a lower time to response (18 vs. 37 days, P=0.05), median disease-free survival (28.51 vs. 50.95 weeks, P=0.018), and time to splenectomy (43.5 vs. 61 wks, P=0.029) than those with primary wAIHA. Due to economic constraints, rituximab was considered as the third-line treatment in only two patients. CONCLUSION: Secondary wAIHA may benefit from a longer low-dose steroid maintenance period mainly due to its shorter time to relapse and time to splenectomy than primary wAIHA.

Complicaciones intrahospitalarias de meningitis purulenta del adulto adquirida en la comunidad / In-hospital complications of purulent meningitis, community acquired in the adult

Con el fin de determinar las complicaciones intrahospitalarias de la meningitis purulenta del adulto adquirida en la comunidad, se revisaron 40 expedientes de pacientes mayores de 13 años, admitidos y/o egresados de nuestra institución por dicho diagnóstico a lo largo de 84 meses. Diez y siete mujeres y 23 hombres fueron incluídos, con un promedio de 5.71 casos al año. No se logró aislamiento del agente causal en 31 pacientes (77.5 y el germen predominante en el resto fue el S.Pneumoniae. Las complicaciones neurológicas registradas más frecuentemente fueron: Disfunción de pares craneales 45 (específicamente VII, VIII, VI,X,II y III en orden decreciente),signos cerebrales focales 37; convulsiones 30, edema cerebral 25, hidrocefalia 15 y fiebre prolongada 27. La neumonía fue la complicación sistémica más frecuente. Un caso de endocarditis de válvula aórtica fue documentado. Los resultados demuestran cómo la meningitis en nuestro medio cursa frecuentemente con complicaciones cuya presencia deben buscarse activamente. Un estudio prospectivo para determinar el período de tiempo que tales complicaciones necesitan para resolverse es necesario en nuestro departamento