La resistencia antimicrobiana, una amenaza en tres dimensiones.

Entre los principales problemas de Salud Pública podemos identificar a la resistencia antimicrobiana (RAM), definida por la Organización Mundial de la Salud (OMS) como aquella que se produce cuando los microorganismos (bacterias, hongos, virus y parásitos) sufren cambios al verse expuestos a los antimicrobianos, resultando que los medicamentos se vuelvan ineficaces y las infecciones persistan.

Chorea gravidarum associated with systemic lupus erythematosus and antiphospholipid syndrome: case report.

Las manifestaciones neuropsiquiátricas en los pacientes con lupus eritematoso sistémico (LES) y síndrome antifosfolípido (SAF) secundario son muy frecuentes. En ambos casos, la fisiopatología se correlaciona con vasculopatía asociada a anticuerpos antifosfolípido y neurotoxicidad por anticuerpos y citocinas. La corea es el único trastorno del movimiento incluido en los 19 síndromes neuropsiquiátricos del LES según el American College of Rheumatology, con presentación inusual (prevalencia del 2%), y puede ocurrir como primera manifestación de la enfermedad. Se describe el caso de una paciente de 17 años con corea desencadenada durante el embarazo como manifestación inicial de LES y SAF.Neuropsychiatric symptoms of systemic lupus erythematosus (SLE) and secondary antiphospholipid syndrome (APS) are very common. In both cases, pathophysiology is correlated to vasculopathy associated to antiphospholipid antibodies as well as neurotoxicity mediated by antibodies and cytokines. Chorea, instead, is the only movement disorder included in the 19 SLE's neuropsychiatric syndromes described by the American College of Rheumatology. Nevertheless, its presence is unusual with a prevalence of about 2%, and could appear as an early manifestation of the disease. The case of a 17-year-old pregnant woman in whom chorea was an early manifestation of SLE and APS.

Acute myocardial infarction, as a rare manifestation in granulomatosis with polyangiitis.

La granulomatosis con poliangeítis es una vasculitis de pequeños vasos asociada a la presencia de anticuerpos anticitoplasma de neutrófilos, con manifestaciones cardíacas que son poco frecuentes, como pericarditis, miocarditis, arteritis coronaria y enfermedad valvular. Reportamos el caso de un paciente de 49 años con reciente diagnóstico de granulomatosis con poliangeítis, quien presentó infarto agudo del miocardio. Se consideró la actividad de la enfermedad como causa del infarto. Las manifestaciones clínicas cardiovasculares en la granulomatosis con poliangeítis son relevantes por ser marcadores de mal pronóstico.Granulomatosis with polyangiitis is a small vessel vasculitis associated to anti-neutrophil cytoplasmic antibodies, in which the cardiac manifestations are not common, as pericarditis, cardiomyopathy, coronary artery disease and vascular disease. We report a clinical case of a 49-year-old man with a recent diagnosis of granulomatosis with polyangiitis, he presented myocardial infarction. Disease activity was considered the cause of myocardial infarction. Cardiovascular clinical manifestations in granulomatosis with polyangiitis are relevant because are markers of poor prognosis.

Endogenous stimulation is responsible for the high frequency of IL-17A-producing neutrophils in patients with rheumatoid arthritis.

BACKGROUND: Neutrophils play an important role in the pathogenesis of rheumatoid arthritis (RA). It has recently been reported that in addition to T helper (Th) 17 cells, other cells, including neutrophils, produce IL-17A, an important inflammatory cytokine involved in the pathogenesis of RA. The purpose of this study was to examine the presence of interleukin 17A-producing neutrophils in patients with RA. METHODS: We performed a cross-sectional study including 106 patients with RA and 56 healthy individuals. Whole peripheral blood cells were analyzed by flow cytometry to identify CD66b+ CD177+ IL-17A+ neutrophils and CD3+ CD4+ IL-17A+ T cells. Serum levels of IL-17A and IL-6 were measured by means of cytometry bead array (CBA). In purified neutrophils, mRNA levels of IL-17 and RORγ were measured by RT-PCR. In addition, purified neutrophils from patients and healthy controls were stimulated with the cytokines IL-6 and IL-23 to evaluate differences in their capacity to produce IL-17A. RESULTS: Neutrophils from RA patients expressed IL-17 and RORγ mRNA. Consequently, these cells also expressed IL-17A. Serum IL-17A levels but not Th17 cell numbers were increased in RA patients. Neutrophils positive for cytoplasmic IL-17A were more abundant in patients with RA (mean 1.2 ± 3.18%) than in healthy individuals (mean 0.07 ± 0.1%) (p < 0.0001). Although increased IL-17A+ neutrophil numbers were present in RA patients regardless of disease activity (mean 6.5 ± 5.14%), they were more frequent in patients with a more recent diagnosis (mean time after disease onset 3.5 ± 4.24 years). IL-6 and IL-23 induced the expression of RORγ but failed to induce IL-17A expression by neutrophils from RA patients and healthy individuals after a 3 h stimulation. CONCLUSION: IL-17A-producing neutrophils are increased in some RA patients, which are not related to disease activity but have an increased frequency in patients with recent-onset disease. This finding suggests that IL-17A-producing neutrophils play an early role in the development of RA.

Policondritis recidivante: análisis de 11 pacientes / Relapsing polychondritis: an analysis of 11 patients

Objetivo: Analizar 11 casos de policondritis recidivante reportados por 3 centros hospitalarios de México. Pacientes y método: Se analiza sexo, edad a la presentación de la enfermedad, tiempo de evolución al momento del diagnóstico, manifestaciones clínicas iniciales y durante el seguimiento, tratamiento inicial, así como el esquema terapéutico empleado en la fase “crónica” de la enfermedad. Resultados: Se describió a 8 mujeres y 3 varones con edad promedio al inicio de 40,8 años. El tiempo de evolución al momento del diagnóstico fue de 4 meses a 4 años. Las principales manifestaciones fueron: condritis auricular en 8 (72,7%) de los casos, hipoacusia en 4 (36,3%) y disfonía en 4 (36,3%). Las complicaciones incluyeron estenosis subglótica en 4 (36,3%) pacientes, epiescleritis en 2 (18,1%), y desprendimiento de retina y córnea con lesión macular en 1 (9%); 2 (18,1%) tuvieron hipoacusia conductiva y sensorial; 2 (18,1%), glomerulonefritis y 1 (9%), insuficiencia mitral y tricuspídea. Todos los pacientes recibieron tratamiento a base de prednisona. Los inmunosupresores más usados fueron: ciclofosfamida, metotrexato y azatioprina. Conclusiones: Ésta es la mayor serie publicada en México y comparte datos clínicos y de evolución comunicados en otras series y en la literatura. La respuesta a esteroides es buena; sin embargo, es necesario considerar otras opciones terapéuticas, ya que la enfermedad continúa progresando y recidivando (AU)

Objective: To analyze 11 patients with relapsing polychondritis reported by 3 hospitals in our country. Patients and method: We describe 11 cases of relapsing polychondritis reported by 3 hospitals in our country, analizing gender, age at the beginning of the disease, delay time in diagnosis, clinical manifestations at the beginning of the disease and during follow-up, initial treatment, and treatment in the “chronic phase” of the disease. Results: We described 8 female patients and 4 males, with a mean age of 40.8 years. The delay time in diagnosis was from 4 months to 4 years. The main manifestations were: auricular chondritis in 8 patients (72.7%), hearing loss in 4 (36.3%), and dysphonia in 4 (36.3%). The complications included subglotic stenosis in 4 patients (36.3%), epiescleritis in 2 (18.1%), 1 retinal and corneal dettachment with macular lesion (9%), conductive and sensorial hearing loss in 2 (18.1%), glomerulonephritis in 2 (18.1%), and mitral and tricuspid insufficiency in one patient (9.0%). All of them received prednisone. Cyclophosphamide, methotrexate, and azathioprine were the most common immunosupressors used. Conclusions: This is the largest cohort reported in our country, sharing clinical and outcome patterns reported in other series and in the literature. Response to steroids is good, however, we need to consider other therapeutic options because the disease continues progressing and relapsing (AU)

[Relapsing polychondritis: an analysis of 11 patients]. / Policondritis recidivante: análisis de 11 pacientes.

OBJECTIVE: To analyze 11 patients with relapsing polychondritis reported by 3 hospitals in our country. PATIENTS AND METHOD: We describe 11 cases of relapsing polychondritis reported by 3 hospitals in our country, analizing gender, age at the beginning of the disease, delay time in diagnosis, clinical manifestations at the beginning of the disease and during follow-up, initial treatment, and treatment in the "chronic phase" of the disease. RESULTS: We described 8 female patients and 4 males, with a mean age of 40.8 years. The delay time in diagnosis was from 4 months to 4 years. The main manifestations were: auricular chondritis in 8 patients (72.7%), hearing loss in 4 (36.3%), and dysphonia in 4 (36.3%). The complications included subglotic stenosis in 4 patients (36.3%), epiescleritis in 2 (18.1%), 1 retinal and corneal dettachment with macular lesion (9%), conductive and sensorial hearing loss in 2 (18.1%), glomerulonephritis in 2 (18.1%), and mitral and tricuspid insufficiency in one patient (9.0%). All of them received prednisone. Cyclophosphamide, methotrexate, and azathioprine were the most common immunosupressors used. CONCLUSIONS: This is the largest cohort reported in our country, sharing clinical and outcome patterns reported in other series and in the literature. Response to steroids is good, however, we need to consider other therapeutic options because the disease continues progressing and relapsing.