Edema facial como manifestación inicial atípica de arteritis de células gigantes: a propósito de un caso y revisión de la literatura / Facial edema as an atypical initial manifestation of giant cell arteritis: a case report and review of the literature

Introducción: la arteritis de células gigantes es la vasculitis de vaso grande más frecuente y se ve predominantemente en adultos ma-yores de 50 años. El diagnóstico es en base a la clínica que se compone de cefalea, polimialgia reumática, sensibilidad en relación a la arteria temporal, compromiso del estado general, entre otras cosas, más laboratorio que se evidencia reactantes de fase aguda elevados y anemia y se confirma con biopsia de arteria temporal. Métodos: reporte de un caso de una paciente con debut con cefalea y aumento de volumen facial, lo que conllevó un diagnóstico erróneo de celulitis facial. Debido a esta presentación atípica, se retrasó el diagnóstico de arteritis de la temporal y tratamiento oportuno. Resultados: la arteritis de células gigantes es una patología que posee un gran rango de presentaciones atípicas, lo que ocurre en hasta un 38% de los pacientes que poseen la enfermedad, manifestaciones que incluyen neuralgia del trigémino, infartos linguales, aneurismas aórticos, edema facial, entre otros. Conclusión: es muy relevante conocer las presentaciones atípicas de esta patología que son muy frecuentes de encontrar en los pacientes y conocerlas nos permite aumentar nuestra sospecha clínica permitiendo un diagnóstico y tratamiento oportuno, evitando consecuencias irreversibles por el retraso diagnóstico.

Introduction: giant cell arteritis is the most frequent large vessel vasculitis and is seen predominantly in adults over 50 years. The diag-nosis is based on the clinic that is composed of headache, polymyalgia rheumatic, sensitivity near the temporal artery, compromise of the general condition, among other things, added to a laboratory that is evidenced like severe acute phase reactants and anemia and finally, is confirmed with temporal artery biopsy. Methods: a case report of a patient who debuted with headache and increased facial volume that led to a wrong diagnosis of facial cellulite. Because of this atypical presentation of the disease, the diagnostic took more time than usual and delayed the accurate diagnosis and timely treatment; this could have caused irreversible consequences. Results:giant cell arteritis has a wide range of atypical presentations; this may occur even up to 38% of patients that have this disease; manifes-tations include: trigeminal neuralgia, lingual infarct, aortic aneurysm, facial edema, and other symptoms. Conclusion: it is important to study the atypical presentations of this pathology because they are usually founded in patients. If we are informed about the atypical presentations, we can increase our clinical suspicion, and that allows us to get the right diagnosis and opportune treatment, avoiding irreversible consequences because of a late diagnosis.

Adecuación del tratamiento inhalado en pacientes diagnosticados de Enfermedad Pulmonar Obstructiva Crónica / Suitability of inhaled therapy in patients diagnosed with chronic obstructive pulmonary disease (COPD)

Objetivo: Valorar la adecuación a las guías clínicas (GOLD) del tratamiento por vía inhalada de los pacientes diagnosticados de Enfermedad Pulmonar Obstructiva Crónica (EPOC). Diseño del estudio: Estudio observacional transversal de indicación-prescripción. Emplazamiento: Atención Primaria en la provincia de Orense. Participantes: Todos los casos de EPOC incluidos en el registro de pacientes crónicos de 28 cupos de 9 Centros de Salud de la provincia de Orense. Mediciones principales: Se determinó: edad, sexo, datos espirométricos, adecuación diagnóstica según resultados espirométricos y tratamiento farmacológico por vía inhalada (anticolinérgicos de larga duración, corticoides inhalados, beta-2 de larga duración y beta-2 de corta duración). Resultados: Eran varones 297 (77,7%) casos, con una media de edad de 77,0 (DE 11,0) años. El índice VEF1/CVF estaba registrado en 174 (45,5%) pacientes, siendo menor de 0,7 en 138 casos (36,1%), y figurando el VEF1 en 125 casos (90,6%). Fueron clasificados como Graves o Muy graves 71 pacientes (56,8%). El tratamiento era conforme a las recomendaciones en el 26,4% de los casos. En el 19,2% era incorrecto por defecto y en el 54,4% por exceso de medicación, relacionado fundamentalmente con el uso de corticoides inhalados, que estaban correctamente indicados en el 9% de los casos. No existían diferencias en el uso de fármacos en asociación en función de la gravedad de la EPOC. Conclusiones: En la terapia de la EPOC con fármacos inhalados existe una baja adecuación a los criterios recomendados en las principales guías de práctica clínica, sobre todo en el uso de corticoides (AU)

Objective: To assess the compliance of inhaled therapy in patients diagnosed with chronic obstructive lung disease to clinical guidelines (GOLD) Design: Indication/prescription cross-sectional observational study Location: Primary care in the province of Orense Participants: All cases of COPD included in the register for 28 chronic patients in 9 health centres in the province of Orense. Main Surveyed Data. The following were determined: age, sex, spirometric data, adjustment of diagnosis based on spirometric results, and inhaled drug therapy (long-acting anticholinergics, inhaled corticosteroids, long-acting beta-2 and short-acting beta-2) Results: 297 cases (77.7%) were male, with an average age of 77.0 years. The FEV1/ FVC ratio was registered in 174 (45.5%) patients. It was lower than 0.7 in 138 cases (36.1%) and FEV1 appeared in 125 cases (90.6%). 71 patients (56.8%) were classified as severe or very severe. The treatment was in accordance with recommendations in 26,4% of the cases. In 19.2% it was incorrect by default and in 54.4%, through over-medication, related primarily to the use of inhaled corticosteroids, which were correctly indicated in 9% of cases. There were no differences in the use of associated drugs based on the severity of the COPD. Conclusions: In COPD therapy with inhaled drugs, there is a low level of compliance with criteria recommended in the main clinical practice guidelines, especially regarding the use of corticosteroids (AU)

Canine leishmaniosis. Modulation of macrophage/lymphocyte interactions by L. infantum.

Canine leishmaniosis, caused by Leishmania infantum, is a systemic disease with variable clinical signs and a progressive evolution. This disease is characterized by impaired T cell-mediated immune response, which has been associated with disease chronicity and high mortality. Protective immunity against leishmaniosis is thought to be mediated by T cell and cytokine production. The T cell activation requires a primary signal delivered by the major histocompatibility complex (MHC) molecules present on the surface of antigen presenting cells, and a non-specific signal generated by co-stimulatory molecules. To characterize canine immune responses in the presence of L. infantum parasites or their antigens, in vitro cell cultures of canine macrophages and lymphocytes were established, and the macrophages presenting MHC class II molecules were evaluated as well as the expression of IL-12 and CD80-86 co-stimulatory molecules and nitric oxide production. The results showed for the first time the up-regulation of MHC class II molecules on the surface in canine peripheral blood monocyte-derived macrophages during L. infantum infection in the presence of lymphocytes. In addition, a lack of co-stimulatory expression and a reduced release of nitric oxide were observed, suggesting a loss of T cell function and consequently an inactivation of the macrophage oxidative burst which, in turn, favors the survival of Leishmania. These results constitute a new contribution for the understanding of the interactions between L. infantum and the canine immune system.