Frequency of ANA/DFS70 autoantibodies in Colombian patients with undifferentiated connective tissue disease.

The objective was to describe the clinical characteristics and the frequency of the ANA/DFS70 autoantibodies in patients affected by undifferentiated connective tissue disease (UCTD) in a tertiary hospital in Colombia. This descriptive cross-sectional study enrolled patients who fulfilled the classification criteria for UCTD. ANAHEp- 2 test and the modified assay for ANA/DFS70 autoantibodies were performed through the indirect immunofluorescence technique. Erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and the antibodies to anti-extractable nuclear antigens, DNA, phospholipids (IgG, IgM, IgA), and cyclic citrullinated peptide were also evaluated. Fifty-three patients were studied; 42/53 (79%) tested positive for ANA and 5/42 (11.9%) for ANA/DFS70 antibodies with a dense fine speckled fluorescent pattern (AC-2) in ANA HEp-2 test that was confirmed by a modified HEp-2-DFS70 assay. Patients had arthralgia (87%, n=47), non-erosive arthritis (66%, n=34), xerostomia (64%, n=34), xerophthalmia (42%, n=22), and Raynaud's phenomenon (17%, n=9). Arthralgia, xerophthalmia, xeroderma, and absence of disease evolution to a specific disease over five years were more frequent in patients with a positive result for the anti-DFS70 antibodies. The ANA/DFS70 autoantibodies were more frequent in patients with UCTD compared to other rheumatic diseases for which they were initially evaluated. More studies are required to support the predictive role of this antibody to the absence of progression to a well-defined connective tissue disease.

Efectos del ejercicio físico terapéutico en jóvenes con trastorno por déficit de atención e hiperactividad: revisión sistemática / Effects of therapeutic physical exercise on children with attention deficit hyperactivity disorder: A systematic review

Objetivos: Determinar el impacto del ejercicio físico terapéutico en jóvenes con trastornos por déficit de atención e hiperactividad (TDAH), tanto en la sintomatología básica (hiperactividad, impulsividad y déficit de atención) como en las funciones ejecutivas. Estrategia de búsqueda: Se realizó una revisión sistemática de estudios clínicos aleatorizados siguiendo la normativa PRISMA. Se consultaron las bases de datos PubMed/Medline, Lilacs, Ibecs, Cochrane Library, Ebsco, WoS y SciELO. Además, se revisaron referencias de los artículos localizados en las bases de datos mencionadas. Selección de estudios: De un total de 36 artículos localizados, 4 estudios fueron seleccionados para la revisión sistemática. Síntesis de resultados: Todos los estudios obtuvieron mejoras significativas tanto en la sintomatología básica como en las funciones ejecutivas tras la realización de ejercicio físico terapéutico. Conclusiones: El ejercicio físico terapéutico con intensidades entre moderada y moderada-vigorosa tiene un impacto positivo en población pediátrica con TDAH. Aun así, se precisa más investigación que establezca un protocolo de actuación según el subtipo del TDAH para poder consolidar, por tanto, la evidencia científica.(AU)

Objectives: To determine the impact of therapeutic physical exercise in children with attention deficit and hyperactivity disorders (ADHD), both on basic symptomatology (hyperactivity, impulsivity, and attention deficit) and on executive functions. Search strategy: A systematic review was carried out in accordance with the PRISMA standard. Databases such as PubMed/Medline, Lilacs, Ibecs, Cochrane Library, Ebsco, WoS and SciELO were checked. Furthermore, research studies in the databases mentioned were reviewed. Selection of studies: From a total of 36 articles, 4randomized controlled trials were selected for this review. Synthesis of results: All the studies obtained significant improvements in basic symptoms as well as executive functions after therapeutic physical exercise. Conclusions: Aerobic exercise from moderate to moderate-vigorous intensity shows a positive impact in ADHD children. However, more scientific studies are needed to determinate the action criteria according to ADHD subtype.(AU)

Mortalidad en pacientes con hemorragia intracerebral asociada a anticoagulación oral. Eficacia de un protocolo de reversión y seguimiento clínico (proyecto HIC-ACO) / Mortality in patients with intracerebral haemorrhage associated with oral anticoagulation. Efficacy of a reversal protocol and clinical follow-up (ICH-OAC project)

Introducción: La hemorragia intracerebral espontánea asociada a anticoagulantes orales (HIC-ACO) presenta una elevada mortalidad. La aparición de nuevos fármacos anticoagulantes y protocolos de reversión aumenta el interés por esta entidad. Objetivos: El objetivo principal es determinar la tasa de mortalidad en pacientes con HIC-ACO (precoz, hospitalaria, global) en nuestra área sanitaria y analizar las principales variables relacionadas. El objetivo secundario es determinar la eficacia de las terapias de reversión de la anticoagulación (TRA), reflejada por la expansión radiológica del hematoma y el pronóstico funcional. Pacientes y métodos: Estudio prospectivo observacional que introdujo un protocolo dirigido al manejo de pacientes con HIC-ACO. Incluyó medidas generales y neuromonitorización, administración individualizada de TRA, tomografía craneal y seguimiento durante seis meses. Se recogieron los fármacos prescritos en el área durante este período, mortalidad y pronóstico funcional. Se diseñó un estudio bivariante y regresión logística para investigar variables relacionadas con la mortalidad. Resultados: Se incluyó a 49 pacientes durante tres años; de ellos, un 71,4% recibió TRA. La mortalidad fue del 16,3% (primeras 24 horas), el 53,1% (ingreso) y el 61,2% (180 días). Se observó una menor supervivencia entre pacientes con puntuaciones basales mayores en la National Institutes of Healt Stroke Scale (NIHSS) (p < 0,0001), valor de creatinina (p = 0,02), índice internacional normalizado (p = 0,048), volumen hemorrágico (p = 0,008), hidrocefalia (p = 0,015) y toma de acenocumarol (p = 0,030). Los pacientes que no recibieron TRA tuvieron una mayor mortalidad precoz (p = 0,003). La única variable relacionada con la mortalidad global de forma independiente fue la puntuación en la NIHSS basal (odds ratio = 1,282; intervalo de confianza al 95%: 1,023-1,608; p = 0,031)...(AU)

Introduction: Spontaneous intracerebral haemorrhage associated with oral anticoagulants (ICH-OAC) has a high mortality rate. The emergence of new anticoagulant drugs and reversal protocols increases interest in this entity. Objectives: The main objective is to determine the mortality rate in patients with ICH-OAC (early, in-hospital, global) in our health area and to analyse the main variables related to it. The secondary objective is to determine the efficacy of anticoagulation reversal therapies (ART) as reflected by radiological expansion of the haematoma and the functional prognosis. Patients and methods: A prospective observational study that introduced a protocol aimed at the management of patients with ICH-OAC. It included general measures and neuromonitoring, individualised administration of ART, cranial tomography and a six-month follow-up. Data on the drugs prescribed in the area during this period, mortality and functional prognosis were collected. A bivariate and logistic regression study was designed to investigate mortality-related variables. Results: Forty-nine patients were included over three years; of these, 71.4% received ART. Mortality was 16.3% (first 24 hours), 53.1% (admission) and 61.2% (180 days). Lower survival was observed among patients with higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001), creatinine value (p = 0.02), International Normalised Index (p = 0.048), bleeding volume (p = 0.008), hydrocephalus (p = 0.015) and acenocoumarol intake (p = 0.030). Patients who did not receive ART had a greater rate of early mortality (p = 0.003). The only variable independently related to overall mortality was the baseline NIHSS score (odds ratio = 1.282; 95% confidence interval: 1.023-1.608; p = 0.031)...(AU)

[Mortality in patients with intracerebral haemorrhage associated with oral anticoagulation. Efficacy of a reversal protocol and clinical follow-up (ICH-OAC project)]. / Mortalidad en pacientes con hemorragia intracerebral asociada a anticoagulación oral. Eficacia de un protocolo de reversión y seguimiento clínico (proyecto HIC-ACO).

INTRODUCTION: Spontaneous intracerebral haemorrhage associated with oral anticoagulants (ICH-OAC) has a high mortality rate. The emergence of new anticoagulant drugs and reversal protocols increases interest in this entity. OBJECTIVES: The main objective is to determine the mortality rate in patients with ICH-OAC (early, in-hospital, global) in our health area and to analyse the main variables related to it. The secondary objective is to determine the efficacy of anticoagulation reversal therapies (ART) as reflected by radiological expansion of the haematoma and the functional prognosis. PATIENTS AND METHODS: A prospective observational study that introduced a protocol aimed at the management of patients with ICH-OAC. It included general measures and neuromonitoring, individualised administration of ART, cranial tomography and a six-month follow-up. Data on the drugs prescribed in the area during this period, mortality and functional prognosis were collected. A bivariate and logistic regression study was designed to investigate mortality-related variables. RESULTS: Forty-nine patients were included over three years; of these, 71.4% received ART. Mortality was 16.3% (first 24 hours), 53.1% (admission) and 61.2% (180 days). Lower survival was observed among patients with higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001), creatinine value (p = 0.02), International Normalised Index (p = 0.048), bleeding volume (p = 0.008), hydrocephalus (p = 0.015) and acenocoumarol intake (p = 0.030). Patients who did not receive ART had a greater rate of early mortality (p = 0.003). The only variable independently related to overall mortality was the baseline NIHSS score (odds ratio = 1.282; 95% confidence interval: 1.023-1.608; p = 0.031). CONCLUSIONS: ICH-OAC has a high mortality rate, related to the use of acenocoumarol and regardless of the initial clinical situation. A lower rate of early mortality was found among patients who received ART.

TITLE: Mortalidad en pacientes con hemorragia intracerebral asociada a anticoagulación oral. Eficacia de un protocolo de reversión y seguimiento clínico (proyecto HIC-ACO).Introducción. La hemorragia intracerebral espontánea asociada a anticoagulantes orales (HIC-ACO) presenta una elevada mortalidad. La aparición de nuevos fármacos anticoagulantes y protocolos de reversión aumenta el interés por esta entidad. Objetivos. El objetivo principal es determinar la tasa de mortalidad en pacientes con HIC-ACO (precoz, hospitalaria, global) en nuestra área sanitaria y analizar las principales variables relacionadas. El objetivo secundario es determinar la eficacia de las terapias de reversión de la anticoagulación (TRA), reflejada por la expansión radiológica del hematoma y el pronóstico funcional. Pacientes y métodos. Estudio prospectivo observacional que introdujo un protocolo dirigido al manejo de pacientes con HIC-ACO. Incluyó medidas generales y neuromonitorización, administración individualizada de TRA, tomografía craneal y seguimiento durante seis meses. Se recogieron los fármacos prescritos en el área durante este período, mortalidad y pronóstico funcional. Se diseñó un estudio bivariante y regresión logística para investigar variables relacionadas con la mortalidad. Resultados. Se incluyó a 49 pacientes durante tres años; de ellos, un 71,4% recibió TRA. La mortalidad fue del 16,3% (primeras 24 horas), el 53,1% (ingreso) y el 61,2% (180 días). Se observó una menor supervivencia entre pacientes con puntuaciones basales mayores en la National Institutes of Healt Stroke Scale (NIHSS) (p lower than 0,0001), valor de creatinina (p = 0,02), índice internacional normalizado (p = 0,048), volumen hemorrágico (p = 0,008), hidrocefalia (p = 0,015) y toma de acenocumarol (p = 0,030). Los pacientes que no recibieron TRA tuvieron una mayor mortalidad precoz (p = 0,003). La única variable relacionada con la mortalidad global de forma independiente fue la puntuación en la NIHSS basal (odds ratio = 1,282; intervalo de confianza al 95%: 1,023-1,608; p = 0,031). Conclusiones. La HIC-ACO presenta una elevada mortalidad, relacionada con la toma de acenocumarol y de forma independiente con la situación clínica inicial. Se comprobó una menor tasa de mortalidad precoz entre pacientes que recibieron TRA.

Multiple sclerosis following SARS-CoV-2 infection.

SARS-CoV-2 infection can produce neurological features. The most common are headache, anosmia and dysgeusia but patients may also develop other central nervous system (CNS) injuries. We present a patient affected by Covid-19 who initially consulted for decreased visual acuity. The MRI showed inflammation in the right optic nerve and demyelinating lesions in the CNS. We speculate that an immune mechanism induced by SARS-CoV-2, which can activate lymphocytes and an inflammatory response, plays a role in the clinical onset of the disease. This pathogen may be associated with either the triggering or the exacerbation of inflammatory/demyelinating disease.

Clinical-radiological correlations in a de novo cavernous angioma with pseudotumor-like behavior. / Correlato clínico-radiológico de un angioma cavernoso de novo con comportamiento seudotumoral.

Cavernous angiomas are cerebral vascular malformations that are usually congenital. These lesions are characterized as dynamic. The most common phenomenon in the course of these lesions is bleeding, which can result in significant fluctuations in their size and even lead to their disappearance. This article aims to describe the behavior of a cavernous angioma in its natural history, documenting: a) its de novo appearance, a very uncommon observation, and b) its changes on imaging studies, where it grew progressively like an expanding lesion but had no clinical repercussions. On magnetic resonance imaging, atypical signs can orient the etiological diagnosis of cavernous angioma versus other alternatives: de novo appearance, fluid-fluid or air-fluid level, incomplete hypointense ring due to hemosiderin deposition, pseudotumor-like growth, pseudocyst-like or multiloculated shape, vasogenic edema, mass effect, and size greater than 3cm.

Chromium (VI) bioremediation potential of filamentous fungi isolated from Peruvian tannery industry effluents.

The tannery is an important trade in various Peruvian regions; however, tannery effluents are a serious local environmental threat due to its highly toxics components and lack of efficient treatment. The untreated effluents produced by tannery factories in Arequipa Rio Seco Industrial Park (PIRS) have formed a lake in the region nearby. In this work, we study the capability of filamentous fungi species found in this effluents lake with potential for chromium (VI) bioremediation. Fourteen species of filamentous fungi were isolated; only two species were identified Penicillium citrinum and Trichoderma viride, and third strain identified as Penicillium sp. The filamentous fungi showed that are fully tolerant to chromium (VI) concentrations up to 100 mg/L. These fungal strains showed significant growth in chromium (VI) concentrations up to 250 mg/L. Tolerant index (TI) analysis revealed that P. citrinum and T. viride began adaptation to chromium (IV) concentrations of 250 and 500 mg/L, after 6 and 12 days, respectively. When exposed to higher Cr (VI) concentrations (1000 mg/L), only T. viride was able to show growth (enhance phase). Interestingly, one of the significant responses from these fungal strains to increasing chromium (VI) concentrations was an increment in secreted laccase enzymes. Our results show tolerance and adaptation to elevated concentrations of chromium (VI) of these fungal strains suggesting their potential as effective agents for bioremediation of tannery effluents.

[Ultrasound study of the vagal nerve as a diagnostic tool in Guillain-Barre syndrome]. / Estudio ultrasonografico del nervio vago como herramienta diagnostica en el sindrome de Guillain-Barre.

TITLE: Estudio ultrasonografico del nervio vago como herramienta diagnostica en el sindrome de Guillain-Barre.

Gastrointestinal Symptoms and Elevated Levels of Anti-Saccharomyces cerevisiae Antibodies Are Associated with Higher Disease Activity in Colombian Patients with Spondyloarthritis.

BACKGROUND: Spondyloarthritis (SpA) is a group of articular inflammatory rheumatic diseases that their gastrointestinal manifestations are around 10% of their extra-articular symptoms, supporting that the inflammatory response of the intestinal mucosa could be associated with the clinical status. OBJECTIVES: To investigate the association between gastrointestinal symptoms and autoantibodies and disease activity between SpA patients, healthy subjects (HS), and patients with inflammatory bowel disease (IBD). METHODS: 102 SpA patients, 29 IBD patients, and 117 HS were included. Autoantibodies as ASCA, ANCA, anti-tTG, anti-DGP, ANA, and IgA were measured. The patients were assessed to evaluate clinical and gastrointestinal symptoms. An association analysis was performed using Chi square test and a logistic regression. RESULTS: Significant differences were found for ASCA levels in SpA (28.2%) compared to IBD (14.2%) and HS (6.0%) (p = 0.029), as well as for ANAS in SpA (49.5%) and IBD (37.9%) (p < 0.001) and abdominal pain (p = 0.012) between SpA (54.3%) and IBD (27.5%). Significant associations were found between BASDAI > 4 and gastrointestinal symptoms (p < 0.05) and IgA (p = 0.007). The association for abdominal bloating was maintained (OR: 3.93, CI-95%, 1.14-13.56; p = 0.030). CONCLUSIONS: Gastrointestinal symptoms, ASCA, ANAS, and IgA levels were associated with high disease activity in SpA compared with IBD and HS.

MÉTODOS PARA LA IDENTIFICACIÓN DEL ANTÍGENO DE HISTOCOMPATIBILIDAD HLA-B27: COMPARACIÓN DE CUATRO PROTOCOLOS TÉCNICOS / METHODS FOR IDENTIFICATION OF ANTIGEN HLA-B27 HISTOCOMPATIBILITY: FOUR TECHNICAL COMPARISONS OF PROTOCOLS / MÉTODOS PARA A IDENTIFICAÇÃO DO ANTIGÉNIO DE HISTOCOMPATIBILIDADE HLA-B27: CAMPARAÇAO DE QUATRO PROTOCOLOS TÉCNICOS

Introducción: La asociación del HLA-B27 y las Espondiloartritis, ha hecho evidente que la tipificación del HLA-B27 sea considerada como un apoyo en el diagnóstico de estas enfermedades. Los métodos más empleados para la determinación del antígeno HLA-B27 en los laboratorios clínicos y en investigación son: la microlinfocitotoxicidad (MCTX), la citometría de flujo digital (CMFd), la citometría de flujo análoga (CMFa) y la reacción en cadena de la polimerasa con primers de secuencia específicos (PCR-SSP). Objetivo: Comparar MCTX con la CMFd, la CMFa con la CMFd, y la técnica de CMFd frente a PCR-SSP. Métodos: Se analizaron 4109 solicitudes de HLA-B27 en población con manifestaciones sugestivas de EAS remitidas entre 2009 y 2012 al Hospital Militar Central y al Instituto de Referencia Andino. Se evaluaron las frecuencias obtenidas por Chi cuadrado (X2); para estimar la concordancia metodológica se utilizó el Coeficiente de Correlación Intraclase (CCI). Los análisis se realizaron con el paquete estadístico SPSS V18. Resultados: Al evaluar 467 datos por la técnica de CMFa frente a PCR-SSP, la CMFa mostró 239 resultados entre positivos y en rango indeterminado, de los cuales, luego de ser confirmados PCRSSP, solo 213 demostraron la expresión de HLA-B27 (p<0.05). Se obtuvieron 208 resultados realizados por CMFd y PCR-SSP simultáneamente, observándose una alta correspondencia entre estas técnicas (p<0.05). Para evaluar la concordancia entre la MCTX y CMFd se analizaron 34 datos, revelando un 100% de correspondencia entre esta dos metodologías (CCI=1,p<0.05). Conclusión: La citometría de flujo digital es un método rápido que presenta un desempeño altamente confiable para la identificación de HLA-B27, resultados que se recomiendan confirmar por PCR SSP.

Introduction: The association between HLA-B27 and spondyloarthritis has made clear the fact that identification of HLA-B27 antigen is considered as a support in the diagnosis of these diseases. The most commonly used methods for determination of the HLA-B27 antigen in clinical laboratories as well as in their research, are microlymphocytotoxicity (MCTX), digital flow cytometry (CMFd), analogous flow cytometry (CMFa) and the Single Specific Primer-Polymerase Chain Reaction (PCRSSP). Objective: compare the CMFd against MCTX, CMFa against CMFd and CMFd against PCR-SSP. Methods: 4109 requests for HLA-B27 were analyzed with manifestations suggestive of SpA submitted between 2009 and 2012 at Hospital Militar Central and Instituto de Referencia Andino. To analyze the frequencies Chi square (X2) was evaluated; to estimate the methodological concordance the intraclass correlation coefficient (ICC) was used. All proposed analyzes were performed with SPSS V18. Results: 467 data obtained by CMFa versus PCR-SSP evaluated the CMFA showed 239 results between positive and indeterminate range, which, after being confirmed by molecular biology (PCRSSP), only 213 showed the expression of HLA-B27 (p <0.05). PCR-SSP and CMFd performed 208 results simultaneously, showing a high correlation between these techniques (p <0.05). To evaluate the correlation between CMFd and MCTX, 34 data were analyzed, revealing a 100% match on the positive results from these two methodologies (ICC = 1, p <0.05). Conclusion: The digital flow cytometry is a rapid method that presents a highly reliable for the initial identification of HLA-B27; results confirmed by PCR SSP recommend performance.

Introdução: a associação do HLA-B27 e as Espondilartrite, evidenciou que a tipificação do HLAB27 seja considerada como um suporte no diagnóstico dessas doenças. Os métodos mais usados para a determinação do antígeno HLA-B27 nos laboratórios clínicos e no investigação são: a microlinphocitotoxicity (MCTX), a citometria de fluxo digital (CMFd), a citometria de fluxo análoga (CMFa) e a reação em cadeia de a polimerasa com primers de sequência específicos (PCR-SSP). Objetivo: Comparar MCTX com a CMFd, a CMFa com a CMFd, e a técnica de CMFd com PCRSSP. Métodos: 4109 solicitudes de HLA-B27 em população com manifestações sugestivas de EAS remitidas entre 2009 e 2012 ao Hospital Militar e ao Instituto de Referencia Andino, foram analisadas. Avaliaram-se as frequências obtidas por Chi quadrado (X2); para estimar a concordância metodológica foi utilizado o Coeficiente de Correlação Intraclasse (CCI). Os análises estão feitos com o paquete estadístico SPSS V18. Resultados: A CMFa mostrou 239 resultados entre positivos e em rango indeterminado quando avaliou-se 467 dados com a técnica de CMFa com PCR-SSP. Só 213 deles demostraram a expressão de HLA-27 (p<0.05), depois de ser confirmados PCR-SSP. Foram obtidos 208 resultados por CMFd y PCR-SSP em simultâneo, com uma alta correspondência entre estas técnicas (p<0.05). Para avaliar a concordância entre MCTX y CMFd analisaram-se 34 dados, revelando um 100% de correspondência entre as duas metodologias (CCI=, p<0.05). Conclusão: A citometria de fluxo é um método rápido que tem um desempeno muito confiável para a identificação de HLA-B27, resultados recomendados para confirmar por PCR SSP.

Proteína amiloide A sérica como marcador de inflamación sistémica en pacientes con enfermedad periodontal / Serum amiloyd A protein as a systemic inflammatory marker in patients with periodontal disease

La respuesta de fase aguda es la reacción inflamatoria inmediata del huésped que contrarresta desafíos como lesión de los tejidos, infección y trauma. Los reactantes de fase aguda que han recibido mayor atención son: proteína C reactiva (PCR), componente sérico P, proteína amiloide sérica(AAS) y alfa 1 ácido glicoproteína. Se ha establecido en décadas pasadas que las proteínas de fase aguda no solamente aparecen en procesos de enfermedades severas y agudas sino también en condiciones crónicas. El AAS es el principal componente de las placas amiloideas secundarias depositadas en los órganos principales como consecuencia de la enfermedad inflamatoria crónica. La familia de la AAS contiene un número de diferentes apolipoproteínas expresadas, las cuales son sintetizadas principalmente por el hígado. El aumento de AAS es considerado un marcador sistémico de enfermedades inflamatorias agudas y enfermedades crónicas que afecta la composición y función de lipoproteínas de alta densidad (HDL). Se ha demostrado que la intervención terapéutica en la periodontitis disminuye la inflamación y reduce el AAS significativamente y por consiguiente puede reducir el riesgo de enfermedad cardiovascular (ECV). Además es posible que pacientes con periodontitis, que presentan un aumento de la PCR y el AAS, representen un subgrupo específico en términos de riesgo para la aterosclerosis y enfermedad cardiovascular en comparación a los pacientes con periodontitis cuyos niveles plasmáticos de AAS son normales, estableciendo así una relación directa entre la enfermedad periodontal y los niveles de AAS

The acute phase response is the immediate host inflammatory reaction, which counteract challenges such as tissue injury, infection and trauma. The acute phase reactants that have receive most attention are: CRP, serum P component, serum amyloid protein and alpha 1 Acid glycoprotein. In past decades it has been established that acute phase proteins appear not only in severe disease processes but also in severe and chronic conditions. The AAS is the main component of secondary amyloid plaques deposited in major organs as a result of chronic inflammatory disease. The family of SAA contains a number of different expressed Apo lipoproteins, which are synthesized by the liver. Increased SAA is a marker of systemic acute inflammatory diseases and chronic diseases affecting the composition and function of HDL. It was show that therapeutic intervention in periodontitis diseases decreases inflammation and reduces SAA and can therefore significantly reduce the risk of CVD. Besides it is possible that patients with periodontitis, who have an increase in the levels of CRP and SAA represent a specific subgroup in terms of risk for atherosclerosis and cardiovascular illness in comparison to patients with periodontitis, whose plasma levels of SAA are normal, establishing thus a direct relation between periodontal disease and the levels SAA

Evaluación y repercusión del estado nutricional de pacientes geriátricos operados electivamente durante un bienio / Evaluation and impact of nutritional status of geriatric patients operated electively during a biennium

Introducción: sabemos actualmente que las poblaciones envejecidas poseen determinadas características que las hacen más susceptibles a la desnutrición. Los valores estimados de desnutrición en los pacientes ancianos oscilan en dependencia de un cierto número de instrumentos de cribaje. Uno de los más utilizados es la escala mínima del estado nutricional, una herramienta útil y que valida en forma simple y rápida la condición nutricia de pacientes ancianos. Objetivo: realizar una adecuada evaluación nutricional preoperatoria y posoperatoria del paciente anciano sometido a intervención quirúrgica electiva. Métodos: se realizó un estudio descriptivo, prospectivo y longitudinal, con 171 pacientes de 60 y más años de edad, sometidos a cirugía electiva para evaluar su estado nutricional preoperatorio, y la repercusión posoperatoria, en el Servicio de Cirugía General del Hospital Amalia Simoni en un bienio. Una vez realizado el formulario, los datos se procesaron en una microcomputadora, se utilizó el paquete de programas estadísticos MICROSTAT y se hallaron estadísticas descriptivas en número y porcientos. Los resultados se expresaron en forma de tablas y gráficos. Resultados: la escala mínima del estado nutricional total clasificó a los pacientes en un 50,3 % con riesgo de desnutrición, se presentó un paciente con más de 80 años sin alteraciones nutricionales, fue más frecuente la afectación nutricional en las mujeres (68,7 %), en los pacientes desnutridos, las neoplasias digestivas ocuparon el 40 %, la estadía hospitalaria en los desnutridos fue de 10,7 días. Conclusiones: el estado nutricional se comportó de manera similar en ambos sexos, sin embargo fue más frecuente la afectación nutricional en los mayores de 80 años. En los pacientes desnutridos las dolencias más frecuentes fueron las neoplasias del aparato digestivo. Se presentaron un mayor número de complicaciones en los pacientes con trastornos nutricionales con prolongación en estos grupos de la estadía hospitalaria.

Introduction: it is known presently that aged populations have certain characteristics that make them more susceptible to malnutrition. The estimated values of malnutrition in elderly patients vary depending on a certain number of screening tools. One of the most used is the minimum scale of nutritional status, a useful tool that validates in a simple and fast way the nutritional status of elderly patients. Objective: to assess the impact of preoperative and postoperative nutritional status of elderly patients undergoing elective surgery. Method: a descriptive, prospective and longitudinal study with 171 patients of 60 years and more was carried out, in the General Surgery Service at the University Hospital Amalia Simoni in a biennium. Once completed the form, data were processed in a microcomputer using the statistical program MICROSTAT and descriptive statistics in number and percents were performed. Results were expressed in charts and graphics. Results: according to the minimum scale of nutritional status, classified patients with risk of malnutrition in 50, 3 %, a patient with more than 80 years with no nutritional alterations was found, the nutritional affectation was most frequent in women (68, 7 %), and the 40 % of malnourished patients presented digestive neoplasia, their hospital stay was about 10, 7 days. Conclusions: it was appreciated that nutritional status was similar in both sexes; however it was more frequent the nutritional affectation in those older than 80 years. Digestive system neoplasms were the most frequent disease in malnourished patients. A greater number of complications in patients with nutritional disorders were presented, in these groups, hospital stay increased.

Association of tumor necrosis factor alpha-308 promoter polymorphism with spondyloarthritides patients in Colombia.

The pathogenesis of SpA is considered to be a complex and multi-factorial process and, similar to other autoimmune diseases, includes the activity of proinflammatory cytokines such as TNF alpha. Our study compared the -308 promoter polymorphism of TNF alpha with TNF alpha levels, HLA-B27 status, age at the onset of symptoms, SpA subtype and the clinical degree of activity in Colombian SpA patients and healthy subjects (HS). Comparisons of the TNF alpha-308A genotype among HS and SpA patients (P = 0.004), uSpA patients (P = 0.040), ReA patients (P = 0.001), were significantly different and AS patients (P = 0.110), as were alleles for SpAs (P = 0.007) between patients with SpAs and controls. Initial exploratory analyses demonstrated that the TNF alpha-308 SNP genotype frequencies were different among SpA patients and HS in the Colombian population studied. Furthermore, there was no significant correlation with activity and functional clinical index, serum TNF alpha level or HLA B27 status. Allele frequencies, on the other hand, were correlated with the activity clinical index.

Association between Th-17 cytokine profile and clinical features in patients with spondyloarthritis.

OBJECTIVES: In recent years, a substantial amount of information has become available on the relationship between cytokines associated with the Th-17 profile and the development of spondyloarthritis (SpA). The purpose of this study was to evaluate inflammation markers in serum and synovial fluid (SF) and levels of cytokines related to the Th-17 profile in patients with different subtypes of SpA and healthy subjects. METHODS: We evaluated this cytokine profile in light of the clinical activity of the disease in 62 patients. Serum cytokine levels (IL-17, IL-6, IL-1 alpha, TNF alpha, IFN-gamma) were measured by flow cytometry. IL-23, serum amyloid (SAA) and metalloproteinase 3 (MMP-3) were measured with ELISA. In all patients, clinical evaluation was performed using the activity and function indexes of the disease. RESULTS: A comparison showed that IL-17, IL-23, IL-1 alpha, IL-6, and TNF-alpha levels were significantly higher in the serum of SpA patients than healthy subjects (HS), and there were no differences among SpA subtypes. In SF we found higher concentrations of cytokines, but only IL-23 showed significant differences (p<0.05). We found a relationship between enthesitis and peripheral involvement and serum IL-17 levels (9 to 63 pg / ml). There was a correlation between levels above 63 pg/ml and a history of infection. Higher levels of IL-23 in synovial fluid could suggest local amplification of the Th-17 cytokine profile. CONCLUSIONS: These results suggest a possible relationship between IL-17 and enthesis involvement in SpA.

Remodelación ósea en espondiloartritis / Bone remodeling in spondyloarthritis

Las espondiloartropatías (EAS) corresponden a un grupo de patologías inflamatorias crónicas caracterizadas por proliferación ósea que progresivamente conduce a anquilosis y discapacidad funcional. Las alteraciones radiológicas observadas en dichos pacientes revelan cambios erosivos y sobrecrecimiento de estructuras óseas conocidas como sindesmofitos. Teniendo en cuenta la entesis como órgano primario de la enfermedad, varios procesos tienen lugar en este sitio anatómico: inflamación, destrucción ósea y finalmente nueva formación ósea. El proceso inflamatorio tiene como resultado un exceso de formación ósea, y el impacto neto depende de la localización, tipo celular, citoquinas y factores presentes en el micro ambiente local. Varias moléculas que actúan ya sea como moduladores inmunológicos o reguladores de la homeostasis del hueso, han sido implicadas en la mediación del imbalance entre reabsorción y formación que finalmente resulta en degeneración a nivel de la zona de entesis y/o articular. Modelos animales sugieren que la anquilosis articular que puede llegar a producirse puede ser independiente del Factor de Necrosis Tumoral Alfa; por lo tanto, el proceso de neoformación tisular puede ser considerado un blanco terapéutico adicional. La vía de señalización Wnt, considerada el principal regulador de osteoblastogénesis (Familia de glicoproteína Wnt), teniendo en cuenta su papel en cuanto a regulación del imbalance entre formación y resorción ósea, ha constituido un nuevo campo de investigación de gran interés durante los últimos años.

Spondyloarthritis are a group of chronic inflammatory diseases characterized by progressive new bone formation leading to ankylosis and functional disability. The radiographic changes in these patients may show erosive changes and overgrowth of bony structures called syndesmophytes. Given the enthesis as the primary organ of the disease, several processes take place: inflammation, bone destruction and finally new bone formation. The inflammatory process results in excess of bone formation and the impact depends on the location, cell type, cytokines and factors in the local microenvironment. Several molecules that act either as immune modulators or regulators of bone homeostasis have been implicated in mediating the imbalance between resorption and formation that ultimately results in joint degeneration. Animal models suggest that joint ankylosis may be independent of TNF alfa; therefore the process of new tissue formation can be an additional therapeutic target. The Wnt signaling pathway, considered the primary regulator of osteoblastogenesis and its role in terms of regulating the imbalance between bone formation and resorption, is a new research field of great interest in recent years.

Nuevo paradigma en espondiloartritis: Linfocitos Th-17 / New paradigm in spondyloarthritis: Lymphocytes Th-17

Las espondiloartritis son un grupo heterogéneo de enfermedades asociadas principalmente al complejo mayor de histocompatibilidad alelo HLA- B 27, y factores ambientales. La evidencia de esos desórdenes reflejan un origen autoinmune mediado por el sistema inmune adaptativo, en donde la composición de las lesiones inflamatorias está representada principalmente por macrófagos activados, linfocitos B y linfocitos T. El fenotipo y naturaleza de esas células T aún no están bien establecidos. Recientes estudios han demostrado que el clásico modelo de las células T CD4 efectoras Th-1/Th-2 en estas patologías debe ser reevaluado y darle espacio a las células Th-17 dentro de las patogenias inflamatorias articulares. Estudios preliminares dirigen la investigación hacia el eje IL-23/IL-17 en espondiloartropatías como una nueva propuesta. Considerar el bloqueo de las moléculas involucradas en esta vía podría ser interesante como nuevos blancos terapéuticos.

Spondyloarthritides are a heterogeneous group of diseases which are mainly associated with HLA B 27 and environmental factors. The evidence for these disorders reflects an adaptive immune system-mediated autoimmune origin where inflammatory lesion composition is mainly represented by activated macrophages, B lymphocytes and T lymphocytes. These T-cells phenotype and nature has not been well established. Recent studies have shown that the classical CD4+ Th-1/Th-2 effector-cell model should be reevaluated and Th-17 cells should be introduced in inflammatory joint pathogenesis. Preliminary studies have directed research towards the IL-23/IL-17 axis in spondyloarthropathies as a new proposal. The intervention of the molecules involved in this pathway might be interesting as new therapeutic targets.