Monitoring pharmaceuticals and personal care products in water and fish from the Gulf of Urabá, Colombia.

Gulf of Urabá is considered a tourist zone of Antioquia Department attracts a large number of visitors to explore the aquatic ecosystem and beaches thus offering a large economic benefit. However, this region has been affected by various anthropogenic effects thus generating an environmental problematic that affect aquatic ecosystem. Over the years, several research has been evaluated pollutant such as pesticides, metals and physicochemical parameters, even our laboratory had found several toxic metals in fish from this same area. The presence of emerging pollutant in matrices such as seawater and fish from Gulf of Urabá have not been reported, and to the best of our knowledge, this is the first study. This work presents important aspects relating to sampling, monitoring and surveillance of seawater and several fish species caught in the area in order to determinate the content of emerging pollutant (triclosan, ibuprofen, diclofenac) using UPLC-QqQ/MS. In general, all three pharmaceuticals in different sampling sites were detected and total concentrations ranged from 0.10 to 1.54 µg/L in surface water. However, emerging pollutants content in fish muscle was not detected. In addition, a high variability in triclosan, ibuprofen and diclofenac concentrations according to the season of sampling was found. Regarding to seasonal variations, most emerging pollutant in the surface water had variation in levels both dry and wet season. Better removal was presented in the dry season, due to stronger irradiation and greater activity of microorganisms.

Síndrome pulmón-riñón secundario a vasculitis por cocaína/levamisol: reporte de caso / Pulmonary-renal syndrome secondary to cocaine-levamisole-induced vasculitis: a case report

El síndrome pulmón-riñón rara vez ha sido reportado como cuadro clínico de presentación de vasculitis causada por el consumo de cocaína contaminada con levamisol. Se reporta el caso de un paciente con este cuadro clínico y se señalan las dificultades que se presentaron durante el abordaje diagnóstico y terapéutico

Pulmonary-renal syndrome has rarely been reported as the clinical presentation of vasculitis caused by the consumption of cocaine adulterated with levamisole. We report the case of a patient in whom we detected the clinical manifestations and indicate the difficulties that arose in relation to the diagnostic and therapeutic approach

Diferencias entre los pacientes con sarcoidosis con y sin compromiso articular atendidos durante quince años en un hospital de tercer nivel de complejidad / Differences between patients with sarcoidosis with and without joint involvement treated for fifteen years in a third level hospital

INTRODUCCIÓN: La sarcoidosis es una enfermedad compleja, de etiología desconocida, de curso variable y con formas de presentación diversas. Nuestro objetivo fue caracterizar a todos nuestros pacientes con sarcoidosis con énfasis en su forma de presentación clínica y establecer diferencias entre los pacientes con sarcoidosis con y sin compromiso articular. MÉTODOS: Se revisaron las historias clínicas de todos los pacientes con diagnóstico de sarcoidosis que fueron atendidos en el Hospital Pablo Tobón Uribe de Medellín, Colombia, desde enero de 2002 hasta abril de 2017. RESULTADOS: Se encontraron 22 pacientes con sarcoidosis. Hubo síntomas articulares en 13 de ellos. Todos los pacientes con sarcoidosis articular, excepto uno, tuvieron compromiso cutáneo concomitante (92%), lo cual fue mucho menos frecuente en los pacientes sin compromiso articular (22%) (OR=4,2; p < 0,001). CONCLUSIONES: Los pacientes con sarcoidosis que tienen compromiso articular presentan una frecuencia mucho mayor de compromiso cutáneo concomitante. La ausencia de hallazgos en piel en un paciente con síntomas articulares disminuye la probabilidad de que se trate de sarcoidosis

INTRODUCTION: Sarcoidosis is a complex disease of unknown etiology, with a variable course and highly different forms of presentation. Our objective was to characterize all our patients with sarcoidosis with emphasis on their clinical presentation and to establish differences between patients with sarcoidosis with and without joint involvement. METHODS: We reviewed the medical records of all patients with a diagnosis of sarcoidosis who were treated at the outpatient or inpatient services of the Pablo Tobón Uribe Hospital in Medellín, Colombia, from January 2002 to April 2017. RESULTS: We identified 22 patients with sarcoidosis. There were joint symptoms in 13 of them. All but one of the patients with sarcoidosis affecting the joints had concomitant skin involvement (92%), which was much less frequent in patients without joint involvement (22%) (odds ratio=4.2; P<.001). CONCLUSIONS: Patients with sarcoidosis who have joint involvement have a much higher frequency of concomitant skin involvement. The absence of cutaneous findings in a patient with joint symptoms decreases the likelihood of sarcoidosis

Differences between patients with sarcoidosis with and without joint involvement treated for fifteen years in a third level hospital. / Diferencias entre los pacientes con sarcoidosis con y sin compromiso articular atendidos durante quince años en un hospital de tercer nivel de complejidad.

INTRODUCTION: Sarcoidosis is a complex disease of unknown etiology, with a variable course and highly different forms of presentation. Our objective was to characterize all our patients with sarcoidosis with emphasis on their clinical presentation and to establish differences between patients with sarcoidosis with and without joint involvement. METHODS: We reviewed the medical records of all patients with a diagnosis of sarcoidosis who were treated at the outpatient or inpatient services of the Pablo Tobón Uribe Hospital in Medellín, Colombia, from January 2002 to April 2017. RESULTS: We identified 22 patients with sarcoidosis. There were joint symptoms in 13 of them. All but one of the patients with sarcoidosis affecting the joints had concomitant skin involvement (92%), which was much less frequent in patients without joint involvement (22%) (odds ratio=4.2; P<.001). CONCLUSIONS: Patients with sarcoidosis who have joint involvement have a much higher frequency of concomitant skin involvement. The absence of cutaneous findings in a patient with joint symptoms decreases the likelihood of sarcoidosis.

Pulmonary-renal syndrome secondary to cocaine-levamisole-induced vasculitis: A case report. / Síndrome pulmón-riñón secundario a vasculitis por cocaína/levamisol: reporte de caso.

Pulmonary-renal syndrome has rarely been reported as the clinical presentation of vasculitis caused by the consumption of cocaine adulterated with levamisole. We report the case of a patient in whom we detected the clinical manifestations and indicate the difficulties that arose in relation to the diagnostic and therapeutic approach.

Autoantibodies production and immunological abnormalities after bariatric surgery.

OBJECTIVE: Bariatric surgery is a widely used procedure for the treatment of obesity. Our aim is to describe the main immunological changes in patients who undergo bariatric surgery. METHODS: A prospective study was conducted within a cohort of patients undergoing bariatric surgery and without previous evidence of systemic or organ-specific autoimmune diseases in whom 3 blood samples were collected - one day before surgery (Time 0), and 5 (Time 1) and 10 months (Time 2) after surgery. RESULTS: Thirty four obese patients underwent surgery (Time 0):30(88.24%) were women, mean age 38.3 years. When comparing Time 0 and Time 2, there were statistically significant changes in CD4+T cell count, with an increase from 1074/mL(IQR:860-1316) to 1217.5/mL(IQR:838-1510),p = 0.0002. The CD4/CD8 ratio increased from 2.2(IQR: 1.7-2.7) to 2.4(1.8-2.8), p = 0.0001. As for humoral variables, the C3 fraction of complement decreased from 164 ±â€¯40.6 mg/dL to 112.4 ±â€¯31.4 mg/dL(p < 0.001) and C4 decreased from 29.3 ±â€¯10.1 mg/dL to 22.5 ±â€¯7.1(p = 0.0009) at Time 2. Four patients with negative ANAs at baseline, showed positive ANAs at Time 2.One patient developed anti-citrullinated peptide antibodies >200 IU/mL at Time 2. CONCLUSIONS: Patients undergoing bariatric surgery show immunological changes which might eventually lead to develop an autoimmune disease.

Sublingual microcirculatory alterations in patients with stable systemic sclerosis / Alteraciones microcirculatorias sublinguales en pacientes con esclerosis sistémica estable

ABSTRACT Introduction: Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by fibrosis, inflammation, and microcirculatory alterations. Objective: To evaluate abnormalities in the sublingual microcirculation of SSc patients and to establish any differences compared to healthy controls. Methods: The sublingual microcirculation was determined using a Sidestream dark-field (SDF) imaging device (MicroScan; MicroVision Medical, Amsterdam, the Netherlands) in patients with SSc and controls. Results: Twelve patients with SSc (75% with diffuse cutaneous SSc) were evaluated (mean age: 52.08 ± 2.08 years). A group of 20 volunteers was used as the control. Significantly lower total capillary density (TCD) (9.2 [8.5-9.7] vs. 10.9 [9.8-12.5]) and functional capillary density (FCD) (7.0 [6.8-7.5] vs. 8.6 [7.5-9.8]) were observed in SSc patients than in healthy controls. Conclusions: SSc is related to significantly lower capillary density in the sublingual microcirculation, and the SDF imaging technique could be an alternative to nailfold video-capillaroscopy for diagnosing and following-up patients with SSc.

RESUMEN Introducción: La esclerosis sistémica (SSc) es una enfermedad autoimmune sistémica caracterizada por fibrosis, inflamación y alteraciones en la microcirculación. Objetivo: Evaluar anormalidades en la microcirculación sublingual de pacientes con diagnóstico de esclerosis sistémica y establecer diferencias en comparación con controles sanos. Métodos: Exploramos la microcirculación sublingual utilizando un dispositivo de imágenes de campo oscuro Sidestream (SDF) (Micro Scan, MicroVision Medical, Amsterdam, Holanda) en pacientes con SSc y controles. Resultados: Se evaluaron 12 pacientes con SSc estable (75% con cutánea difusa) (edad media: 52.08 ± 2.08). Un grupo de 20 voluntarios se utilizó como control. Se observó una disminución significativa en la densidad vascular total (TCD) (9.2 [8.5-9.7] vs. 10.9 [9.8-12.5]) y densidad capilar funcional (FCD) (7.0 [6.8-7.5] vs. 8.6 [7.5-9.8]) observado en pacientes con esclerosis sistémica en comparación con controles sanos. Conclusiones: La SSc se relaciona con la disminución significativa de la densidad capilar en la microcirculación sublingual, esta técnica podría ser una alternativa en pacientes críticos con esclerosis sistémica o utilizarse para seguimiento durante la hospitalización.

Cocaine-Levamisole-Induced Vasculitis/Vasculopathy Syndrome.

PURPOSE OF REVIEW: To understand the clinical spectrum of cocaine-levamisole-induced vasculitis. Worldwide recreational drug consumption is high among the adult population from various social strata. The use of cocaine with levamisole, a frequently added antiparasitic diluent, favors the manifestations of vasculitic lesions, especially in the skin. RECENT FINDINGS: New insights into immunological mechanisms involved in the pathogenesis of the disease. There are still many unknown aspects in the pathogenesis of this disease, such as the immune system interaction with p-ANCAs and the release of inflammatory NETs (neutrophil extracellular traps), which are the origin of auto-antigens and tissue damage, manifesting as vasculitic purpura on the skin. The clinical presentation constitutes a challenge for the clinician to be able to distinguish it from small-vessel vasculitides. This paper intends to improve the understanding of this condition, exhibiting the broad clinical spectrum of local and systemic manifestations of cocaine-levamisole-induced vasculitis, to facilitate a timely diagnosis, in order to take corrective measures and avoid sequelae, along with tissue damage and the consequent deformities and permanent scars.

Is Bariatric Surgery a Trigger Factor for Systemic Autoimmune Diseases?

Bariatric procedures are an effective option for weight loss and control of comorbidities in obese patients. Obesity is a proinflammatory condition in which some cytokines such as leptin, a proinflammatory protein, is elevated and adiponectin, an anti-inflammatory protein, is decreased. In patients undergoing weight reduction surgeries, these hormone levels behave paradoxically. It is not known whether bariatric surgery protects against development of autoinflammatory or autoimmune conditions; nevertheless, changes occurring in the immune system are incompletely understood. In this case series, we describe 4 patients undergoing bariatric surgery, who subsequently developed systemic autoimmune diseases. Patients in our case series were asymptomatic before surgery and developed an autoimmune disease within 11.2 months. Two women fulfilled criteria for systemic lupus erythematosus (one associated with antiphospholipid syndrome), and 2 men developed rheumatoid arthritis. A causal relationship is difficult to establish because factors that could trigger these diseases are multiple, including genetic susceptibility, time elapsed until achievement of ideal weight, and vitamin deficiencies, among others. However, clinicians must be attentive to this possible association.

[Bullous systemic lupus mimicking a Stevens-Johnson syndrome]. / Lupus ampolloso que simula síndrome de Stevens-Johnson.

Autoimmune bullous diseases represent a diagnostic challenge due to the wide spectrum of pathologies that share similar clinical features. This paper reports the case of a woman admitted with a supposed diagnosis of a Stevens-Johnson syndrome, in which the history, the profile of autoimmunity and interdisciplinary approach were of vital importance to clarify the clinical picture.

Las enfermedades ampollosas autoinmunitarias constituyen, en algunas ocasiones, un reto diagnóstico debido al amplio espectro de afecciones que comparten características clínicas similares. Se comunica el caso de una paciente que ingresó con un supuesto diagnóstico de reacción medicamentosa severa tipo síndrome de Stevens-Johnson, en la que sus antecedentes personales, perfil de autoinmunidad y aproximación interdisciplinaria fueron de vital ayuda para establecer el diagnóstico final.

Etanercept-induced pityriasis lichenoides chronica in a patient with rheumatoid arthritis.

We present a 74-year-old female patient who developed a pityriasis lichenoides chronica (PLC) during etanercept therapy. This association is not described in the literature and might be considered in the spectrum of cutaneous adverse reactions of etanercept.

Developing of Granulomatosis with Polyangiitis during Etanercept Therapy.

We describe a 67-year-old woman who developed c-ANCA positive vasculitis with involvement in eyes, skin, kidney, peripheral nerves, and upper and lower airway during treatment with etanercept therapy for rheumatoid arthritis. A diagnosis of Granulomatosis with Polyangiitis was done. Thus, anti-TNF therapy may be associated with the development of ANCA positive vasculitis.

Efficacy and safety of anti-interleukin 6 receptor monoclonal antibody (tocilizumab) in Colombian patients with Takayasu arteritis.

PURPOSE: The aim of this study was to describe the efficacy and safety of anti-interleukin 6 receptor antibody (tocilizumab [TCZ]) in patients with severe or refractory Takayasu arteritis (TA). METHODS: We describe 8 Colombian patients with severe and/or refractory TA treated with TCZ during a period of at least 9 months. Clinical, radiological, biological, and associated treatments were evaluated before, during, and after TCZ infusions. RESULTS: The median age at evaluation was 31 years (12-43 years). All patients were female and experienced clinical and biological improvement, in addition to a corticosteroid-sparing effect from a median dose of 50 mg/d at baseline (30-60 mg/d) to 6.25 mg/d (2.5-10 mg/d) at 9 months. In 4 cases, in which imaging studies were available, an improvement was observed. The median duration of TCZ infusions was 18 months (9-36 months). Major adverse effects related to TCZ were not evidenced during a period of at least 9 months of treatment. One relapse was observed. Tocilizumab was continued in all cases until the last follow-up. CONCLUSIONS: This study shows a clinical, biological, and radiological response in patients with refractory TA treated with TCZ.

Rituximab for remission induction and maintenance in refractory systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with high morbidity if untreated. Sometimes, despite aggressive treatments, the disease remains active with cumulative organic damage. We conducted a retrospective and descriptive observational study of patients with SLE refractory to conventional treatment who were treated with rituximab (RTX) as remission induction therapy and maintenance. There was a significant reduction in the conventional immunosuppressive drug dose and the number of relapses of disease. RTX appeared to be effective and safe for the induction and maintenance of remission in patient with SLE refractory to conventional treatment.

Total recovery from monoclonal gammopathy and autoimmune phenomena after parathyroidectomy.

Based on the observation of a patient with a causal relationship between hyperparathyroidism and development of both autoimmune disease and paraproteinemia, we hypothesize a novel cause of autoimmunity triggered in the context of hyperparathyroidism.

Efficacy and safety of rituximab in the treatment of vasculitic leg ulcers associated with hepatitis C virus infection.

Vasculitic leg ulcers are a cutaneous manifestation of hepatitis C virus (HCV) infection often associated with cryoglobulinemia. Their treatment is difficult and is based on steroids and immunosuppressive drugs with an erratic response and a high probability of adverse reaction. We report three patients with vasculitic leg ulcers associated with hepatitis C virus infection who were treated successfully with rituximab. The pain control and healing were achieved quickly. No adverse effects with rituximab in these patients were presented.

Efectos adversos de la terapia antitrombótica en reemplazos articulares / Adverse effects of antithrombotic therapy in arthroplasty surgery

Introducción: la enfermedad tromboembólica es la complicación más frecuente en el reemplazo total de rodilla y/o cadera. Sin profilaxis, la incidencia de la enfermedad tromboembólica en los pacientes sometidos a estas cirugías se incrementa hasta en un 50% y en el 90% de los pacientes con embolia pulmonar sintomática los coágulos provienen de las extremidades inferiores. Materiales y métodos: se diseñó un estudio tipo serie de casos con los pacientes a los que se les realizó reemplazo total de cadera o rodilla primario en el Centro Médico Imbanaco de Cali entre junio de 2009 y junio de 2010, y a quienes se les medicó como profilaxis antitrombótica clexane o rivaroxaban en un esquema extendido por 30 días. Resultados: se seleccionaron 251 pacientes, de los cuales 9 (3,6%) presentaron efectos adversos, siendo los más frecuentes las flictenas y la equimosis de la zona operatoria, con 4 pacientes. Dos pacientes presentaron infección del sitio operatorio, 2 tuvieron intolerancia al medicamento y 1 presentó necrosis grasa de la zona operatoria. Se encontraron 6 eventos adversos en pacientes medicados con clexane y 3 en pacientes que recibieron rivaroxaban. Todos los pacientes con eventos adversos eran obesos. Discusión: el porcentaje y tipo de eventos adversos fue similar a lo reportado en la literatura mundial. Es necesario realizar un trabajo con un tamaño de muestra mayor y un diseño que permita establecer factores de riesgo para la presentación de eventos adversos con el uso de rivaroxaban o clexane como medicamentos antitrombóticos.

Lenguaje oral en un grupo de niños con trastornos de aprendizaje y un grupo control / Oral language in a group of children with disorders of learning and a group control

El lenguaje oral es una conducta comunicativa, específicamente humana, que cumple un papel importante en el proceso de aprendizaje escolar en los niños. El objetivo principal fue determinar si existían diferencias en el lenguaje oral entre un grupo de niños de edad escolar diagnosticados con trastornos del aprendizaje (TA) y un grupo control. La muestra fue de 8 niños con TA y 8 niños deun grupo control, con edades entre 7 y 9 años, que se encontraban cursando básica primaria en colegios privados de estrato socieconómico medio-alto de la ciudad de Cali. Para el diagnostico de TA, seutilizo el Cuestionario de Problemas de Aprendizaje CEPA, las subescalas de lectura, escritura y cálcilo de la Evaluación Neuropsicológica Infantil (ENI), la MINI entrevista neuropsiquiátrica internacional para niños y adolescentes y la Escala de Inteligencia de Weschler (WISV-R); a los dos grupos se les aplicó la subescala de lenguaje oral de la Evaluación Neuropsicológica Infantil (ENI). Se encontró diferencia intergrupal en las tareas de repetición de palabras y no palabras, en el seguimiento de instrucciones y en larepetición de oraciones. Los hallazgos de este estudi sugieren que los niños con TA presentan un déficit en la rentención audio-verbal y fallas en la consciencia fonológica como defecto primario al trastorno(AU)

The oral language is a communicative, specifically human conduct, which fulfills an important paper in the school learning process in the children. The principal aim was to determine if differences existed in the oral language between a group of children of school age diagnosed with disorders of the learning (TA) and a group control. The sample belonged 8 children with TA and 8 children deun group control, with ages between 7 and 9 years, which were dealing basic primary in private colleges of stratum socieconómico way - high place of the city of Cali. For TA's diagnosis, seutilizo the Questionnaire of Problems of Learning VINE-STOCK, the subreading scales, writing and cálcilo of the Evaluation Neuropsicológica Infantil (ENI), the MINI interview Neuropsiquiátrica international for children and teenagers and the Scale of Weschler's Intelligence (WISV-R); to both groups there applied to them the subscale of oral language of the Evaluation Neuropsicológica Infantil (ENI). One found intergroup difference in the tasks of repetition of words and not words, in the follow-up of instructions and in larepetición of prayers. The findings of this estudi suggest that the children with TA present a deficit in the rentención verbal audio and you fail in the phonological conscience as primary fault to the disorder (AU)