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Background: Most patients with heterozygous familial hypercholesterolemia (FH) do not achieve current LDL-C goals proposed by European guidelines with conventional lipid-lowering therapy (LLT). Chronic use of PCSK9 inhibitors (PCSK9i) have shown to reduce LDL-C levels up to 61% on top of statins. Persistence to chronic LLT is important to reduce the burden of atherosclerotic cardiovascular disease (ASCVD). Purpose(s): To analyze persistence and effectiveness of PCSK9i in clinical practice setting in FH patients from the SAFEHEART register with longterm follow-up. Method(s): SAFEHEART is an open, long-term prospective study of a cohort of subjects with molecular diagnosis of FH. Follow-up is carried out every year through a standardized phone-call to collect clinical conditions, persistence to medications, lipid profile, and cardiovascular events. This study analyses subjects >=18 years of age on stable LLT who have received PCSK9i. Result(s): 696 individuals (46% females), median age 56.4 years (IQR 49- 66) started with PCSK9i (49% alirocumab and 51% evolocumab). Out of them 38% had history of ASCVD, and 89% were on maximum LLT. Median LDL-C at the moment of starting PCSK9i was 145 mg/dL (IQR, 123- 177), representing a poor 2016 & 2019 ESC/EAS guidelines achievement (3% and 0.1% respectively). After a median follow-up of 3.7 years (IQR, 2.3-4.8), 669 patients (96%) remained on PCSK9i treatment during entire follow-up. Only 27 patients (4%) discontinued, 5 temporarily (0.7%) and 22 permanently (3.2%). Most common reasons for PCSK9i treatment interruption were medical decision (n=6), adverse event (AE) (n=5), patient decision not related with AE (n=5) and comorbidity (n=5). Median time to permanent discontinuation was 15 months (IQR, 4-33). Median LDL-C levels observed and % of LDL-C reduction obtained after 1 year of treatment and in the last follow-up visit were: 63 mg/dL (IQR, 43- 88), 61 mg/dL (IQR, 44-82), 57.6% (IQR, 39.5-69) and 58% (IQR, 44-68), respectively. 2016 ESC/EAS guidelines LDL-C goals was achieved by 70% of patients at year 1 and 77% in the last follow-up visit after the introduction of PCSK9i (p<0.001). 2019 ESC/EAS goals were achieved by 44.5% and 48% (p=0.1). Conclusion(s): Long-term persistence to PCSK9i treatment in FH patients is very high (96%) and reasons for discontinuation are diverse. This study shows that COVID-19 pandemic did not affected persistence to treatment. Effectiveness in LDL-C reduction and LDL-C goal achievement improved significantly with introduction of PCSK9i in clinical practice setting.
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The objective is to review the behavior of the COVID-19 pandemic vs. the Spanish Influenza pandemic as well as the 2009 pandemic and the last two epidemiological seasons (2019 and 2020), observed in our country, as well as some studies regarding to general and pediatric morbidity and mortality. And in the same way, reduce the emotional burden and the panic generated by various social and even health media, in all people who can read this paper. © 2023 Instituto Nacional de Pediatria. All rights reserved.
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Collapsing Glomerulopathy (CG) is a rare entity presenting as nephrotic syndrome and rapidly progressive renal deterioration. It has been first identified among African-American patients and subsequently dubbed HIV-associated nephropathy after a number of patients with HIV were found to have CG. It has re-emerged recently among patients with COVID-19. To our knowledge, this is the first case of primary collapsing glomerulopathy in the country to be published. The case is a 36-year-old Filipino female admitted due to bipedal edema which started 2 weeks post-partum. She has no comorbidities and social history was negative for illicit drug use. Initial work up showed hypoalbuminemia and diffuse hepatic disease on ultrasound. She was referred to a gastroenterologist where albumin infusion and paracentesis was done but with no improvement. She developed anasarca and was admitted. Paracentesis obtained minimal ascitic fluid. Serum ascites albumin gradient was low and baseline laboratories showed high creatinine, hypoalbuminemia, and albuminuria. 24-hour urine protein was 11 grams, ANA and anti-DsDNA were negative and c3 and c4 levels were normal. Hepatitis profile was negative for infection. Abdominal CT scan revealed multiple hypoenhancing lesions. Tumor markers CA-125, CA 19-9 and CA 15-3 were high. Breast ultrasound showed simple breast cyst. Gynecology consult was called where pap smear was negative for atypical cells. Surgery service recommended monitoring for the pancreatic and breast lesions. Kidney biopsy was delayed due to new onset bacterial pneumonia. COVID-19 RT-PCR test was negative. Patient was discharged improved with no edema. On follow up, the kidney biopsy result came out to be collapsing glomerulopathy. HIV test was then done and was negative. Bipedal edema and albuminuria recurred. She was started on tacrolimus. She has been on regular follow up and currently has no edema, no proteinuria and normal creatinine level. This is an interesting case as the primary glomerular disease has been masked by the earlier laboratory findings which led us to think of liver disease then a paraneoplastic nephrotic syndrome. Ultimately, the renal biopsy revealed the diagnosis. This serves as an index case for primary collapsing glomerulopathy in a Filipino patient on remission after being treated with tacrolimus. © 2023 University of the Philippines Manila. All rights reserved.
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Introduction: Neutrophil extracellular traps (NETs) have recently been linked to an important role in the pathogenesis of Covid-19. Method(s): Prospective observational study of 91 hospitalized patients. We studied longitudinally the viral phase, early inflammatory and late, and the 4 most specific components of NETs: cell free-DNA (cfDNA), MPO-DNA and NE-DNA complexes and citrullinated Histone 3 (citH3). Result(s): We observed elevated levels vs controls of MPO-DNA and NE-DNA complexes and cfDNA at admission and in the 3 phases of the disease. CitH3 was elevated from the early inflammatory phase onwards. There was a significant correlation in survivors (r=0.798) and in all severity degrees between MPO and NE and between cfDNA and H3 cit (r=0.3), but not in the rest of combinations among the 4, nor in dead patients. We did not observe any correlation in any group between MPO or NE with citH3. There was an increase of only cfDNA levels in more severe patients. The area under the ROC curve for critical severity and mortality was high for cfDNA (0.7327 and 0.7482) and much poorer for the other 3 NETs markers. Conclusion(s): -We found evidence of neutrophil activation of NETs components in Covid-19, during the 3 phases of the disease, but without a clear relationship with severity and mortality. -cfDNA was related to severity and mortality, and its sources appeared to be more related to tissue damage than to NETs -The best correlation between them was MPO-NE, and these more neutrophil-specific markers reflect probably better NET formation. NETs role has maybe been overestimated using other less specific markers.
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Introduction: Most reports related to humoral immune response to COVID 19 vaccines in people with Multiple Sclerosis (pwMS) were performed on mRNA-based vaccines. Objective(s): to analyze the longitudinal humoral immune responses to adenovirus-based vaccines (Sputnik V and AZD1222) in pwMS under different diseases modifying therapies (DMTs) Methods: IgG anti- SARS-COV-2 spike titers in a cohort of 101 pwMS and 28 healthy controls (HC) were measured 6 weeks after vaccination using the COVID-AR kit according to the manufacture instructions. Both patients and controls received two or three doses of Sputnik, AZD1222 or a mixed schedule (MS) of both vaccines. The neutralizing capacity was evaluated by measuring antibody neutralizing titers using SARS COV-2 pseudotyped particles. Result(s): 60.5% of pwMS were female, mean EDSS: 2.49 +/-1.5, age: 36.6 +/-10.7, disease duration 7.6 +/- 5.1 years. DMTs: 45 pwMS were under fingolimod, 23 under dimethyl fumarate, 14 under cladribine and 19 under antiCD20 monoclonal antibodies. Vaccines: 35.7% Sputnik V, 51.9% AZD1222 and 12.4 % MS. No antibody response to a 2nd dose was found in 41.3% of pwMS under fingolimod and 73.6% under antiCD20. We found a correlation between lower lymphocyte count and lower antibody titers in pwMS under fingolimod (r: 0.67, 95% CI: 0.46-0.81, p=<=0.0001). A correlation was also found between the antibody titer and the last dose of antiCD20 (r: 0.49, 95% CI: 0.03-0.7, p=0.03). In March 2022, 57 pwMS received their 3nddose, 6 patients under fingolimod and 7 under antiCD20 remained without any antibody response. We did not find differences in the neutralization capacity with different DMT and or vaccines. Multivariate regression analysis showed antiCD20 (beta= -,349, 95% CI: -3655.6-369.01, p=0.017) and fingolimod (beta=-,399, 95% CI: -3363.8-250.9, p=0.023) treatments as independent factor associated with low antibody response (r2 adjusted=0.157). Conclusion(s): This is the first report of longitudinal humoral immune response of patients under adenovirus-based vaccines, specially Sputnik V, that demonstrate that these vaccines have similar results to those obtained with mRNA-based vaccines.
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Introduction: Multiple Sclerosis (MS) is a disabling chronic disease with clinical heterogeneity and uncertain prognosis. Evaluating the health-related quality of life (HRQoL) of patients is important for the multidisciplinary therapeutic approach including physical, psychic and social aspects that influence the wellbeing of people with consequences in the course of the disease. As of March 2020 due to the Coronavirus 2019 (COVID-19) pandemic and quarantine measures, habits and access to the health system have been substantially modified. Objective(s): Our aim was to evaluate depression level and HRQoL of MS patients and compare this results with pre-pandemic assessment (2019). Patients and Methods: A cross-sectional study was conducted between March and July 2021. Measuring instruments: Clinical, HRQoL: Multiple Sclerosis International Quality of Life questionnaire (MusiQol), Depression: Beck Depression Inventory II (BDI-II), and pandemic-related aspects using a ad-hoc questionnaire. The results of MusiQol and BDI-II were compared with those obtained from the 2019 evaluations. Parametric and nonparametric statistics were used, to define significance a value of p <0.05 was accepted. Result(s): We evaluated 62 patients. In the comparative analysis with 2019, a significant decrease in HRQoL was observed (z=- 2.21, p=0.03). The affected domains were activities of daily living, psychological well-being, and sexual and sentimental life. In contrast, no significant changes were observed in the assessment of depression using BDI-II (z=-0.39, p=0.69). Conclusion(s): HrQoL of MS patients is decreased compared to 2019. The pandemic itself, health and quarantine measures have negatively impacted on HRQoL, substantially impairing patients' performance in activities of daily living, psychological wellbeing, and sexual and sentimental life.
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Objective: The objective of the study was to evaluate the incidence of COVID-19 infections after vaccination in NMOSD patients included in RELACOEM, a LATAM registry of MS and NMOSD patients infected and vaccinated for COVID-19. Method(s): Retrospective cohort study developed between May 2021 to December 2021. The primary outcome was the appearance of infection during the follow up time (at least three months after complete vaccination (second dose)). Data was collected through the contact between the treating physician and the patient. Specific information was requested (vaccine received, dose, date, symptoms, COVID-19 infection, need for hospitalization, ventilatory assistance, treatment, and evolution). The primary objective of the analysis was to compare the incidence of breakthrough SARS-CoV-2 19 infections among the vaccinated pwMS in each DMT group. These conditions entail a PCR-confirmed test, and a time lag of at least 14 days from a full vaccination cycle (after the second vaccination dose). Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. Result(s): A total of 49 NMOSD patients from eight countries in LATAM were included. Mean age was 43.8 +/-13 years. The most frequent treatment use was rituximab in 29 (59.2%). The mean follow up after the second dose was 149 +/- 32 days. Most frequent first and second dose received was Pfizer (28.6%), followed by Sinopharm (24.5%). During follow up a total of 2 COVID-19 cases were observed for a total exposure time of 8627 days. Cumulative incidence was 4.1% (SE 0.87%) with an overall incidence density of 2.31 x 10.000 patients/day (95%CI 1.13-3.71). Both cases occurred in patients under rituximab (2/29, exposure time 4208, IR 4.7 x 10,000 patients/day 95%CI 3.5-5.1). No hospitalizations were reported for both cases. Conclusion(s): We observed an ID of COVID-19 infection after vaccination of 2.31 x 10.000 patients/day in NMOSD patients.
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The pandemic experienced in the last two years in the world has led people to be much more careful in their social relations, keeping their social distance and using hygienic prevention measures. However, when it is necessary to enter crowded closed environments, people feel insecure and are more afraid of contagion. This situation leads to the need for measures to control access to public places in order to prevent infection and to reinforce people’s confidence. Various devices and solutions exist to control access, ranging from card-based identification to biometric sensors. However, they have shortcomings detected during the pandemic, such as the need to touch elements or the types of computing used, which can compromise security and/or response times. The solution proposed in this article integrates the best of these by incorporating facial recognition using neural networks, the presence or absence of a mask and medical Internet of Things (IoT) devices to monitor pulse, blood oxygen and body temperature. All this technology is used to check whether the person’s access is safe for them and others. The data collection process in this system has proven to be efficient thanks to fog computing, which reduces latency times and prevents the user’s data from being accessed by third parties while maintaining their privacy. © 2022, Springer Nature Switzerland AG.
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Several cases of Guillain-Barré Syndrome (GBS) associated with COVID-19 vaccination have been reported, including the rare subtype known as Bilateral Facial Palsy with paresthesias (BFP). To date, it is not known whether a causal relationship may exist between the two. We report 9 cases of BFP in patients vaccinated against COVID-19 in the previous month. Nerve conduction studies revealed demyelinating polyneuropathy in 4 patients, and 5 presented bilateral, focal facial nerve involvement, exclusively. Ganglioside antibody panel was positive in 4 patients (anti-GM1=2, anti-GD1a=1 and anti-sulfatide=1). Seven patients received intravenous immunoglobulin treatment, one plasma exchange, and one patient died from sudden cardiac arrest following arrhythmia before treatment could be administered. Rates of BFP following COVID-19 vaccination, did not differ from those reported in previous series. Epidemiological studies are essential to determine whether a causal relationship may exist between this rare form of GBS and COVID-19 vaccination.
Subject(s)
COVID-19 Vaccines , Facial Paralysis , Guillain-Barre Syndrome , Paresthesia , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Facial Paralysis/diagnosis , Facial Paralysis/epidemiology , Guillain-Barre Syndrome/epidemiology , Humans , Paresthesia/diagnosis , Paresthesia/epidemiologyABSTRACT
Objective: Our objective was to assess the level of depression and HRQoL of MS patients and compare it with the 2019 pre-pandemic assessment. Background: Multiple Sclerosis (MS) is a disabling chronic disease with clinical heterogeneity and uncertain prognosis. Evaluating the health-related quality of life (HRQoL) of patients is important for the multidisciplinary therapeutic approach including physical, psychic and social aspects that influence the well-being of people with consequences in the course of the disease. As of March 2020 due to the Coronavirus 2019 (COVID-19) pandemic and quarantine measures, habits and access to the health system have been substantially modified. Design/Methods: A cross-sectional study was conducted. A virtual survey assessed HRQoL with the “Multiple Sclerosis International Quality of Life questionnaire” (MusiQol), depression with the Beck Depression Inventory II (BDI-II), and pandemic-related aspects using a questionnaire designed for this study. The results of MusiQol and BDI-II were compared with those obtained from the 2019 evaluations. Results: We evaluated 62 patients. In the comparative analysis with 2019, a significant decrease in HRQoL was observed (z=-2.21, p=0.03). The affected domains were activities of daily living, psychological well-being, and sexual and sentimental life. In contrast, no significant changes were observed in the assessment of depression using BDI-II (z=-0.39, p=0.69). Conclusions: HrQoL of MS patients is decreased compared to 2019. The pandemic itself, health and quarantine measures have negatively impacted HRQoL, substantially impairing patients' performance in activities of daily living, psychological well-being, and sexual and sentimental life.
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The most recent evidence indicates that chronic kidney disease is the comorbidity with the highest risk of developing severe disease due to SARS-CoV-2, coronavirus 2019 (COVID-19). Many scientific societies have advocated for vaccination of patients with chronic kidney disease as a priority, due to this high vulnerability. In Spain, the fifth update of the COVID-19 vaccination strategy published by the Interterritorial Health Council included CKD patients in group 7 (people with very high-risk conditions). This manuscript describes the types of vaccines according to mechanism of action, the vaccines currently approved by the European Medicines Agency (EMA) and information related to the vaccination process (preparation, administration and follow-up), as well as aspects to be taken into account in patients with CKD. © 2021, Sociedad Espanola de Enfermeria Nefrologica. All rights reserved.
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OBJECTIVE: To assess the impact of COVID-19 at nine nursing homes in Madrid, Spain, during the first wave of COVID-19 infection and lockdown period when preventive measures were taken to avoid transmission among residents. METHODS: Nine hundred forty-two residents and 846 staff members from nine nursing homes participated in the study (April 18 to June 20, 2020). All participants were tested for SARS-CoV-2 in the nasopharynx by PCR and for IgG antibodies detection. Microbiological status at sampling was defined as active infection (positive PCR ± presence of antibodies), past infection (negative PCR + presence of antibodies), or naïve participants (negative PCR + absence of antibodies). RESULTS: Laboratory results helped classify the residents as having active infection (n=224; 23.8%), past infection (n=462; 49.1%), or being naïve (n=256; 27.1%); staff members were actively infected (n=127; 15.1%), had had a past infection (n=290; 34.2%), or were naïve (n=429; 50.7%). Overall, the percentage of participants with COVID-19 was significantly higher in residents than in staff members (72.8% vs 49.2%; P=0.001). The clinical situation of residents vs staff at sampling was as follows: acute manifestations compatible with COVID-19 (7.3% vs 3.9%; P<0.01) and no manifestations of infection (92.7% vs 96.0%; P<0.01). A large proportion of both asymptomatic and symptomatic residents (69.4% vs 86.6%; P=0.015) had positive PCR results (mostly alongside positive IgG determinations). CONCLUSIONS: COVID-19 affects 75% of the residents in nursing homes in Madrid. The high impact in these settings, despite the strict restrictions adopted during the lockdown, demonstrates the ability of SARS-CoV-2 to cause outbreaks.
Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Humans , Immunoglobulin G , Incidence , Nursing Homes , SARS-CoV-2 , Spain/epidemiologyABSTRACT
Introduction: Las inflamaciones periféricas pueden exacerbar lesiones pre-existentes en el Sistema Nervioso Central en contexto de enfermedades neurodegenerativas, incluyendo la Esclerosis Múltiple (EM). Objetives: Analizar el efecto de la infección por COVID-19 como generador de inflamación periférica en un grupo de pacientes con EM. Methods: Análisis retrospectivo de 400 historias clínicas de pacientes con EM de un centro de referencia. A los pacientes que presentaron COVID-19 se les realizó una encuesta sobre la presencia o ausencia de exacerbación de síntomas previos de EM durante la infección y hasta tres meses posterior a ella. Se incluyó: tipo de síntoma, duración y comienzo de la exacerbación, vacunación previa contra COVID-19 y severidad de la enfermedad. Además, se incluyó información clínica y demográfica de las historias clínicas. Se realizó un análisis descriptivo e inferencial utilizando el GraphPad Prism V6. Results: 41 pacientes fueron incluidos, 58,5% fueron mujeres y la edad promedio fue de 42.9 ± 11.3. 90,2% presentaban la forma remitente-recurrente (EMRR), el promedio de años de evolución de EM fue de 9.6 ± 6.60 y el EDSS promedio fue de 2.4 ± 2.1. 25 pacientes (61%) tuvieron exacerbaciones de EM, 9,7% (n=4) presentaron síntomas compatibles con recaídas y 7,3% (n=3) requirieron corticoides. Encontramos diferencias significativas en el EDSS entre los pacientes que exacerbaron sus síntomas de EM y los que no (p=0,03). Al efectuar un análisis de regresión multivariada encontramos que el EDSS se asoció de forma independiente a la presencia de exacerbaciones de la EM en contexto de infección por SARS CoV2 (OR= 2.44, p =0.022). Conclusions: Este estudio preliminar sugiere que la infección por COVID-19 podría desencadenar exacerbaciones de síntomas de la EM. Se necesitan nuevos estudios que diluciden la relación entre COVID-19 y EM.
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Introduction: Hasta la fecha existe escasa información sobre la eficacia de las vacunas contra SARS-CoV-2 en pacientes con NMOSD y MOGAD. Objetives: Nuestro objetivo fue evaluar la respuesta humoral a las vacunas contra SARS-CoV-2 en NMOSD y MOGAD bajo drogas modificadoras de la enfermedad actualmente en uso. Methods: Se midió IgG del SARS-CoV-2 utilizando serología basada en proteínas anti-spike basal y al mes de la segunda dosis de las vacunas BNT162b2-COVID-19 o CoronaVac. Se midió el valor absoluto (VA) del título de anticuerpos IgG anti-spike (IgGsp). Se definió respuesta humoral protectora (RHP) a títulos post vacuna > 1.0. Results: Se incluyeron 8 (44.4%) MOGAD, 7 (38.8%) NMOSD IgG AQP4 positivo y 3 (16.6%) NMOSD IgG AQP4 negativo. Con respecto a las vacunas, 17% recibe BNT162b2-COVID-19 y 83% Coronavac. En los pacientes con MOGAD al momento de la vacunación, 3 están sin tratamiento, 3 en tratamiento esteroidal, 1 con azatioprina y 1 con gamaglobulina;para NMOSD 5 pacientes están en tratamiento con rituximab, 4 con prednisona y 1 con azatioprina. Duración de la enfermedad para MOGAD es 15.75 + 11.45 meses y 25.10 + 28.46 meses para NMOSD Con respecto a MOGAD, 75% de los pacientes presenta respuesta humoral a la vacunación en cambio sólo el 40% de los pacientes con NMOSD presentaron respuesta humoral protectora. Con respecto a los VA IgGsp, para MOGAD fue 263.40 + 28.85 para NMODS fue 36.94 + 67.72. No se encontraron diferencias significativas en edad, EDSS, duración de la enfermedad y rescuento absoluto de linfocitos. Con respecto a efectos adversos de la vacuna, se describe dolor local, cefalea y mialgia. Registramos 2 pacientes con recaída tras la vacunación en el grupo MOGAD. Conclusions: Se describe los primeros resultados de respuestas a las vacunas en pacientes con NMOSD y MOGAD. Nuestros resultados indican que los pacientes con terapia con rituximab presentan una menor respuesta humoral con respecto a los otros tratamientos, incluido uso de prednisona crónico. Se requiere mayor estudio para determinar respuesta protectora completa, incluida función de linfocitos T en estos pacientes.
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Introduction: Hasta la fecha existe escasa información sobre la eficacia de las vacunas contra SARS-CoV-2 en pacientes con esclerosis múltiple (pEM). Objetives: Nuestro objetivo fue evaluar la respuesta humoral a las vacunas contra SARS-CoV-2 en pEM bajo drogas modificadoras de la enfermedad (DME) de alta eficacia. Methods: Se midió IgG del SARS-CoV-2 utilizando serología basada en proteínas anti-spike y anti-nucleocápside basal y al mes de la segunda dosis de las vacunas BNT162b2-COVID-19 o CoronaVac. Se midió el valor absoluto (VA) del título de anticuerpos IgG anti-spike (IgGsp) y IgG anti-nucleocápside (IgGnc). Se definió respuesta humoral protectora (RHP) a títulos post vacuna > 1.0. Se compararon 4 grupos: pEM bajo tratamiento con cladribina, anti-CD20 (rituximab u ocrelizumab), alemtuzumab y se utilizó como grupo control a pEM sin tratamiento o bajo terapias inyectables (interferon o acetato de glatiramer). Results: Se incluyeron 16 (15%) y 90 (85%) pEM vacunados con BNT162b2-COVID-19 y CoronaVac respectivamente. Presentaron RHP IgGsp el 72.6%, 80%, 91.7%, 17.2% y 96.7%, en el total (N) de pacientes evaluados (106): grupo control (15), alemtuzumab (12), anti CD20 (29) y cladribina (30). Presentaron RHP IgGnc el 39.5%, 40%, 60%, 14.3% y 38.5% en el total de pacientes evaluados (38): grupo control (5), alemtuzumab (5), anti CD20 (7) y cladribina (13). Los VA de títulos de anticuerpos IgGsp fueron significativamente más bajos en los pEM en tratamiento con antiCD20 (7.42 ± 30.9) en comparación al grupo control (296.2 ± 640.9;p<0.01), cladribina (198.4 ± 399.9;p<0.01) y alemtuzumab (409.4 ± 717.8;p<0.01). Los pEM antiCD20 presentaron menor RHP IgGsp que cladribina (p<0.01) y alemtuzumab (p<0.01). No se encontraron diferencias significativas en el tiempo desde la última dosis entre los pEM antiCD20, cladribina y alemtuzumab (p=0.06). Hubo diferencias significativas entre menor edad y menor EDSS con RHP IgGsp (p=0.03 y p<0.01 respectivamente). Sin diferencias con el tipo de vacuna y tiempo desde la última. En el modelo de regresión logística sólo EDSS resultó ser un predictor significativo en RHP IgGsp (OR 0.50, IC95% 0.42 -0.83). Conclusions: Se encontró menor RHP IgGnc en comparación con IgGsp en todos los grupos evaluados. RHP IgGsp es menor en los pacientes con terapias anti CD20 y se desarrolla en terapias como cladribina, alemtuzumab y natalizumab, independiente de su última administración. Se requieren estudios de función de células T para los diferentes grupos, en especial antiCD20 para evaluar eficacia global de las vacunas.
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Introduction: Collapsing Glomerulopathy (CG) is a rare entity presenting as nephrotic syndrome and rapidly progressive renal deterioration. It has been first identified among African-American patients with nephrotic syndrome. Subsequently, it has been called HIV-associated nephropathy (HIVAN) after a number of patients with HIV were found to have CG. It has re-emerged recently among patients with COVID-19 dubbing it as the new HIVAN. In the Philippines, Focal Segmental Glomerulosclerosis (FSGS) is the second most common glomerular disease but with no available data on the subtypes.To our knowledge, this is the first case of collapsing glomerulopathy in the country to be published. Methods: This is a case report of primary Collapsing Glomerulopathy seen in our institution. Results: The case is a 36 year-old Filipino female admitted due to edema which started 2 weeks post-partum. She is gravida 3 para 3 (1203), with no complications in all the pregnancies. She had no known comorbidities. Social history was negative for intravenous or illicit drug use. She initially sought consult with her obstetrician where work up showed hypoalbuminemia and diffuse hepatic disease on ultrasound. She was referred to a gastroenterologist where albumin infusion and paracentesis was done but with no improvement. She developed anasarca and was admitted in our institution. Paracentesis was attempted but only minimal ascitic fluid was obtained. Serum ascites albumin gradient was low and baseline laboratories showed high creatinine at 146 mmol/L, hypoalbuminemia at 16 g/L and +3 albumin on urinalysis. Further testing showed a 24-hour urine protein of 11 grams. ANA and anti-DsDNA were negative and c3 and c4 levels were normal. Hepatitis profile was negative for infection. Abdominal CT scan revealed a hypoenhancing pancreatic tail lesion, breast cyst and nodule. Tumor markers showed high CA-125, CA 19-9 and CA 15-3. Breast ultrasound showed simple breast cyst. Gyneocology consult was called where pap smear done was negative for malignancy. Surgery service recommended observation and monitoring for the pancreatic and breast lesions. Kidney biopsy was delayed due to new onset bacterial pneumonia. COVID-19 RT-PCR test was negative. Kidney biopsy was done after lysis of fever. Pending pathologic diagnosis, patient was discharged clinically improved with no edema. She was sent home on prednisone, ARB, statin, fenofibrate and anti-platelet. On follow up at the outpatient clinic, the kidney biopsy result came out to be collapsing glomerulopathy, acute tubular injury, mild interstitial fibrosis and atrophy. HIV test was done and came out negative. Bipedal edema has recurred and albumin/creatinine ration was 731mg/g. She was then started on tacrolimus. She has been on regular follow up and currently has no edema and has ACR of 79mg/g and normal creatinine level. Conclusions: This is an interesting case as the primary glomerular disease has been masked by the initial laboratory findings. The ultrasound showed parenchymal liver disease. Further work-up revealed multiple lesions in the pancreas, breasts and lymph nodes with high tumor-markers which led us to think of paraneoplastic nephrotic syndrome. The renal biopsy revealed a rare diagnosis with no previous local data. This serves as an index case for primary collapsing glomerulopathy in a Filipino patient on remission after being treated with tacrolimus. No conflict of interest