Niveles de inmunoglobulina A secretora en saliva en una población sana del Estado Carabobo / Salivary IgA levels in a healthy population of Carabobo state

Se cuantificaron los nievelesde IgA secretora (IgAs) en 267 individuos sanos de ambos sexos, provenientes de Valencia, Venezuela. Se distribuyeron en 7 grupos etarios: 1: <30 días (18); 2: 1 - 11 meses (34); 3: 12 - 23 meses (28); 4: 2 - 5 años (51); 5: 6 - 13 años (58); 6: 14 - 20 años (37); 7: 21 - 40 años (41). Criterios de exclusión: Grupos 1 y 2: Antecedentes prenatales de enfermedades crónicas, infecciones virales - bacterianas durante el embarazo, ruptura prematura de membranas, presencia de patologías. Grupos 3 al 7: infecciones crónicas, infecciones virales o bacterianas, alergia, ingesta de medicamentos, infecciones cavidad oral, hábitos tabáquicos positivos. Consentimiento informado por escrito indispensable. Promedio concentración IgA (Nefelometría ARRAY 360): 8,3 ± 8,7 mg/dL (mediana: 5,53 mg/dL, valores máximo y mínimo: 0 y 48,1 mg/dL). Grupo 1: 3,0 ± 6,5; 2: 10,4 ± 11.6; 3: 5,3 ± 6,3; 4: 6,3 ± 7,1; 5: 7,0 ± 4,7; 6: 10,6 ± 11,7; 7: 12,9 ± 84 mg/dL. Los niveles de IgA salival se relacionan con edad y condiciones genético ambientales, siendo importante la utilización de tablas de referencia locales

Macrophage activation syndrome in a patient with systemic onset rheumatoid arthritis: rescue with intravenous immunoglobulin therapy.

We report the case of a 7-year-old boy with systemic onset juvenile rheumatoid arthritis (JRA) who developed macrophage activation syndrome during a period of relative remission. He presented with high-grade fever, enlarged lymph nodes, acute hepatitis, severe pancytopenia, and evidence of disseminated intravascular coagulopathy. He became severely ill, with persistent mucosal bleeding, hypovolemia, and vascular instability, and he was admitted to the intensive care unit. No response was observed to treatment with high-dose intravenous corticosteroids and blood product replacements, but the patient fully recovered after the completion of two pulses of intravenous immunoglobulin. This treatment modality may be an alternative to anti-TNF-alpha and cyclosporine A for a prompt response in JRA patients with this potentially fatal condition.

[Livedo reticularis in patients with systemic lupus erythematosis and its association with anticardiolipin antibodies]. / Livedo reticularis en pacientes con Lupus Eritematoso Sistémico y su asociación con anticuerpos anticardiolipina.

With the purpose of determining whether a relationship exists between Livedo Reticularis (LR) and anticardiolipine antibodies (ACA) in patients with Systemic Lupus Erithemathosus (SLE), a clinical prospective and descriptive study was carried out on 17 female lupus patients with LR, aged 15-46, from the Immunology and Dermatology outpatient clinic of the Enrique Tejera Hospital Compound in Valencia, Venezuela, during 1998. A complete clinical evaluation of each patient was done, from which a diagnosis of LR was made. This was categorized as mild, moderate or severe (Weinstein and col. criteria), depending on the severity of the lesions. Immunoenzymatic techniques were used to determine ACA Ig or IgM. The study followed the Guidelines of Good Practices in Clinical Research, and a signed informed consent was obtained from each patient. The average age of the studied patients was 28.5 +/- 10.9 years; 52.9% of them presented serum levels of ACA IgG above normal. In all cases, levels of ACA IgM were within normal limits (4.41 +/- 2.63 U/mL. Range: 0.51-9.53). All patients with mild LR had normal levels of ACA IgG, and 83.3% and 80% of those in the Moderate and Severe categories, respectively, had high levels of ACA IgG (> or = 10 U/mL), and there was a statistically significant association between each of the three categories and their respective ACA levels (p < 0.05). 82.4% of the patients had severe manifestations of the disease which included: CNS involvement, lower limb vasculitis, renal insult, pericarditis, thrombocytopenia, and recurrent miscarriages. No statistically significant association was found between each of these manifestations and the severity of LR (p > 0.05), probably due to the small number of patients studied in each group; nor between the medium serum levels of ACA IgG and each of the manifestations, except for lower limb vasculitis (ACA IgG'values-presence or absence: Fisher p: < 0.05) However, a statistically significant association (p < 0.05) was observed when the number of severe manifestations of the disease of each patient was related to the levels of ACA IgG, and the severity of LR.

Livedo reticularis en pacientes con Lupus Eritematoso Sistémico y su asociación con anticuerpos anticardiolipina / Livedo reticularis in patients with systemic lupus erythematosis and its association with anticardiolipin antibodies

With the purpose of determining whether a relationship exists between Livedo Reticularis (LR) and anticardiolipine antibodies (ACA) in patients with Systemic Lupus Erithemathosus (SLE), a clinical prospective and descriptive study was carried out on 17 female lupus patients with LR, aged 15-46, from the Immunology and Dermatology outpatient clinic of the Enrique Tejera Hospital Compound in Valencia, Venezuela, during 1998. A complete clinical evaluation of each patient was done, from which a diagnosis of LR was made. This was categorized as mild, moderate or severe (Weinstein and col. criteria), depending on the severity of the lesions. Immunoenzymatic techniques were used to determine ACA Ig or IgM. The study followed the Guidelines of Good Practices in Clinical Research, and a signed informed consent was obtained from each patient. The average age of the studied patients was 28.5 +/- 10.9 years; 52.9 of them presented serum levels of ACA IgG above normal. In all cases, levels of ACA IgM were within normal limits (4.41 +/- 2.63 U/mL. Range: 0.51-9.53). All patients with mild LR had normal levels of ACA IgG, and 83.3 and 80 of those in the Moderate and Severe categories, respectively, had high levels of ACA IgG (> or = 10 U/mL), and there was a statistically significant association between each of the three categories and their respective ACA levels (p < 0.05). 82.4 of the patients had severe manifestations of the disease which included: CNS involvement, lower limb vasculitis, renal insult, pericarditis, thrombocytopenia, and recurrent miscarriages. No statistically significant association was found between each of these manifestations and the severity of LR (p > 0.05), probably due to the small number of patients studied in each group; nor between the medium serum levels of ACA IgG and each of the manifestations, except for lower limb vasculitis (ACA IgG'values-presence or absence: Fisher p: < 0.05) However, a statistically significant association (p < 0.05) was observed when the number of severe manifestations of the disease of each patient was related to the levels of ACA IgG, and the severity of LR.