Factores relacionados con el riesgo de trombosis en pacientes con lupus y positividad para anticuerpos antifosfolipídicos

Fundamento y objetivo Los anticuerpos antifosfolipidicos (AAF) aparecen con frecuencia asociados al lupus eritematoso sistemico (LES), con lo que aumenta el riesgo de trombosis. El objetivo del presente trabajo ha sido analizar el perfil temporal y los factores de riesgo de accidentes tromboticos en pacientes con LES. Pacientes y metodo Se ha realizado un estudio retrospectivo en 102 pacientes con LES controlados en nuestra unidad –edad media de 37,5 anos (extremos, 8-85); 90 mujeres–, con una mediana de seguimiento de 72 meses (extremos, 9-324). Del total de la muestra, 41 (40,2%) presentaban AAF positivos. La probabilidad de presentar un accidente trombotico durante el seguimiento se calc…

Anomalías de la vena cava y trombosis venosa profunda

Resumen Estudio prospectivo de 116 pacientes menores de 50 anos con trombosis venosa profunda (TVP) de los miembros inferiores, en el que se valora la presencia de anomalias de la vena cava inferior (VCI) como factor de riesgo de la TVP. Se practico a todos una eco-Doppler; cuando tenian afeccion iliaca se realizaba tambien flebografia, y cuando el drenaje a la VCI era deficiente, se completaba el estudio con resonancia magnetica o tomografia computarizada. En todos los pacientes tambien se realizaron las siguientes determinaciones: antitrombina, deficit de proteina C y S, factor V Leiden, protrombina G20210A y anticuerpos antifosfolipidicos. Tambien se valoraron los factores de riesgo adqu…

Immunoglobulin G4-Related Aortitis and Severe Aortic Valve Stenosis Treated With Transcatheter Aortic Valve Replacement and Immunosuppression.

Abstract IgG4-related disease is an immune-mediated fibro-inflammatory disorder with multisystemic involvement. Aortitis and peri-aortitis are the most common cardiovascular manifestations of the disease. We present the case of a 65-year-old man with symptomatic severe aortic stenosis and concomitant IgG4 aortitis. The diagnosis was confirmed by IgG4 serum levels, positive positron emission computed tomography (PET-CT) scans, and pathology from mediastinal dissection. Surgical aortic valve replacement (SAVR) was unfeasible owing to extensive mediastinal fibrosis, and transcatheter aortic valve replacement (TAVR) was successfully performed. As ascending aorta access for SAVR in IgG4 aortitis…

Urinary exosome miR-146a is a potential marker of albuminuria in essential hypertension

Abstract Background There is increasing interest in using extracellular vesicle-derived microRNAs (miRNAs) as biomarkers in renal dysfunction and injury. Preliminary evidence indicates that miRNAs regulate the progression of glomerular disease. Indeed, exosomes from the renal system have provided novel evidence in the clinical setting of albuminuria. Thus, the aim of this study was to quantify the urinary miRNAs present in exosome and microvesicles (MVs), and to assess their association with the presence of increased urinary albumin excretion in essential hypertension. Methods Exosomes were collected from urine specimens from a cohort of hypertensive patients with (n = 24) or without albumi…

Reversible posterior leukoencephalopathy secondary to indinavir-induced hypertensive crisis: A case report

Reversible posterior leukoencephalopathy syndrome (RPLS) is an uncommon entity related to multiple and different pathologies, the most common being hypertensive crisis. It is believed to be secondary to the breakdown on the blood-brain barrier. At the beginning, it is undistinguishable from other leukoencephalopathies. However, the disappearance of brain lesions after removal of the potential cause, establish the differential diagnosis with other leukoencephalopathies. We present the case of an HIV-infected patient with a RPLS related to a hypertensive crisis short after the initiation of indinavir-containing highly active antiretroviral therapy. Once blood pressure was controlled and indin…

Prognostic Factors of Death in 151 Adults With Hemophagocytic Syndrome: Etiopathogenically Driven Analysis.

Objective: To characterize the etiologies and clinical features at diagnosis of patients with hemophagocytic lymphohistiocytosis (HLH) and correlate these baseline features with survival using an etiopathogenically guided multivariable model. Patients and Methods: The Spanish Group of Autoimmune Diseases HLH Study Group, formed in 2013, is aimed at collecting adult patients with HLH diagnosed in internal medicine departments between January 3, 2013, and October 28, 2017. Results: The cohort consisted of 151 patients (91 men; mean age, 51.4 years). After a mean follow-up of 17 months (range, 1-142 months), 80 patients died. Time-to-event analyses for death identified a worse survival curve f…

Estudio prospectivo de los factores de riesgo y las características clínicas de la enfermedad tromboembólica en pacientes jóvenes

Fundamento y objetivo El objetivo del presente trabajo es el estudio de los factores de riesgo de la enfermedad tromboembolica en pacientes jovenes y la descripcion de sus caracteristicas clinicas segun la etiologia Pacientes y metodo Estudio prospectivo de 100 pacientes menores de 50 anos, no afectados de neoplasias ni enfermedades cronicas, que requirieron ingreso hospitalario por enfermedad tromboembolica. El diagnostico morfologico se realizo con eco-Doppler, flebografia, gammagrafia pulmonar o tomografia computarizada. Los factores de riesgo valorados fueron deficit de antitrombina, deficit de proteina C y S, factor V Leiden, protrombina G20210A, hiperhomocisteinemia, elevacion del inh…

Should we look for silent pulmonary embolism in patients with deep venous thrombosis?

Background Asymptomatic or silent pulmonary embolism (S-PE) in patients with deep vein thrombosis has been the focus of numerous publications with the objective of determining the incidence of S-PE and assessing whether its existence has any clinical or therapeutic consequences that outweigh the risks associated with the diagnostic tests performed and the increased healthcare costs. The objectives were to assess the incidence of S-PE using computed tomography angiogram (CTA), to understand the epidemiological factors that might trigger embolism, and to assess whether D-dimer (DD) predicts the existence of S-PE’s. Methods A prospective and consecutive assessment of 103 hospitalized patients …

[Inferior vena cava malformations and deep venous thrombosis].

We carried out a prospective study of 116 patients under 50 years of age who had deep venous thrombosis of the lower extremities to determine whether the presence of congenital anomaly of the inferior vena cava (IVC) was a risk factor for the disease. All patients were investigated by Doppler echography. Some 37 patients who had iliac vein occlusion also underwent phlebography. In 10 patients in whom the IVC was difficult to image, magnetic resonance angiography or computerized axial tomography was carried out. In all patients, studies of antithrombin, protein C and protein S deficiency, factor V Leiden, prothrombin G20210A, antiphospholipid antibodies, and acquired risk factors were also p…

Urinary levels of sirtuin-1 associated with disease activity in lupus nephritis.

Identifying new markers of disease flares in lupus nephritis (LN) that facilitate patient stratification and prognosis is important. Therefore, the aim of the present study was to analyze whether urinary SIRT1 expression was altered in LN and whether SIRT1 values in urine could be valuable biomarker of disease activity. In a cohort study, urinary pellets from 40 patients diagnosed with systemic lupus erythematosus (SLE) were analyzed. Clinical measures of lupus activity were assessed. The expression of SIRT1 was quantified by quantitative PCR (qRT-PCR) and immunoblot, then compared between patients with active lupus nephritis, in remission and healthy controls. Association with lupus activi…

Similar Clinical Course and Significance of Circulating Innate and Adaptive Immune Cell Counts in STEMI and COVID-19

This study aimed to assess the time course of circulating neutrophil and lymphocyte counts and their ratio (NLR) in ST-segment elevation myocardial infarction (STEMI) and coronavirus disease (COVID)-19 and explore their associations with clinical events and structural damage. Circulating neutrophil, lymphocyte and NLR were sequentially measured in 659 patients admitted for STEMI and in 103 COVID-19 patients. The dynamics detected in STEMI (within a few hours) were replicated in COVID-19 (within a few days). In both entities patients with events and with severe structural damage displayed higher neutrophil and lower lymphocyte counts. In both scenarios, higher maximum neutrophil and lower mi…

Telitromicina, un posible nuevo potenciador del acenocumarol

SARS‐CoV‐2‐reactive interferon‐γ‐producing CD8+ T cells in patients hospitalized with coronavirus disease 2019

Abstract There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) T‐cell immune responses in patients with coronavirus disease 2019 (COVID‐19). Both CD4+ and CD8+ T cells may be instrumental in resolution of and protection from SARS‐CoV‐2 infection. Here, we tested 25 hospitalized patients either with microbiologically documented COVID‐19 (n = 19) or highly suspected of having the disease (n = 6) for presence of SARS‐CoV‐2‐reactive CD69+ expressing interferon‐γ (IFN‐γ) producing CD8+ T cells using flow‐cytometry for intracellular cytokine staining assay. Two sets of overlapping peptides encompassing the SARS‐CoV‐2 Spike glycoprotein N‐terminal 1 to 643 am…

Estudio ONTARGET. Diseño y objetivos. Sus resultados. ¿Qué cuestiones pendientes resolverán?

En los ultimos anos, el sistema renina-angiotensina-aldosterona (SRAA) ha centrado gran parte de la investigacion en la fisiopatologia cardiovascular. Se han alcanzado profundos conocimientos sobre su regulacion, su papel en la homeostasis de los sistemas cardiovascular y renal y su participacion en gran parte de los procesos patologicos que acontecen en el sistema cardiovascular y en el rinon. La utilizacion de inhibidores de la enzima de conversion de angiotensina (IECA) y de bloquedores selectivos del receptor AT1 de la angiotensina II (ARA-II) reduce la morbilidad y la mortalidad cardiovasculares mas alla de su impacto en los valores de presion arterial. Pese a ello, la morbilidad y la …

Factores que influyen en la diferencia de medida de presión arterial entre el método auscultatorio y el oscilométrico

Fundamento y objetivo El metodo auscultatorio mediante esfigmomanometro de mercurio esta siendo sustituido por otros metodos de medida de presion arterial, de los que el mas utilizado es el oscilometrico. Se analiza las posibles discrepancias de medida entre ambos metodos y los factores que influyen en ellas. Material y metodo Se obtuvieron medidas de presion arterial (PA) mediante esfigmomanometro de mercurio, con un monitor Spacelabs, en el mismo brazo y mediante un metodo secuencial. La relacion entre ambas medidas se analizo mediante los coeficientes de correlacion de Pearson y el metodo de Bland y Altman. Se calcularon las diferencias entre ambos metodos de medida. Se analizo los facto…

IgA-Dominant Infection-Associated Glomerulonephritis Following SARS-CoV-2 Infection

The renal involvement of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported. The etiology of kidney injury appears to be tubular, mainly due to the expression of angiotensin-converting enzyme 2, the key joint receptor for SARS-CoV-2; however, cases with glomerular implication have also been documented. The multifactorial origin of this renal involvement could include virus-mediated injury, cytokine storm, angiotensin II pathway activation, complement dysregulation, hyper-coagulation, and microangiopathy. We present the renal histological findings from a patient who developed acute kidney injury and de novo nephrotic syndrome, highly suggestive of acute IgA-domina…

Co-detection of respiratory pathogens in patients hospitalized with Coronavirus viral disease-2019 pneumonia.

ABSTRACTThere is scarce information on the frequency of co-detection of respiratory pathogens (RP) in patients with Covid-19. Documentation of coinfections in Covid-19 pneumonia patients may be relevant for appropriate clinical and therapeutic management of patients. Between March 4th and March 28th, 2020, a total of 183 adult patients testing positive by SARS CoV-2 RT-PCR on respiratory specimens were hospitalized with interstitial pneumonia at our center, of whom 103 were tested for other RP by a multiplexed PCR assay. Three patients had a positive result for either one (n=2; Coronavirus HKU1 or Mycoplasma pneumoniae) or two targets (n=1; Influenza virus A (H3) and Respiratory syncytial v…

SARS-CoV-2-reactive interferon-γ-producing CD8+ T cells in patients hospitalized with Coronavirus viral disease-2019

There is limited information on SARS-CoV-2 T-cell immune responses in patients with Covid-19. Both CD4+ and CD8+ T cells may be instrumental in the resolution of and protection from SARS-CoV-2 infection. Here, we tested 25 hospitalized patients with either microbiologically documented Covid-19 (n=19) or highly suspected of having the disease (n=6) for the presence of SARS-CoV-2-reactive- CD69+-expressing interferon-gamma;-producing-(IFN-gamma;) CD8+ T cells by a flow-cytometry for intracelular cytokine staining assay. Two sets of overlapping peptides encompassing the SARS-CoV-2 Spike glycoprotein N-terminal 1-643 amino acid sequence and the entire sequence of SARS-CoV-2 M protein were used …

Alteración renal en la infección por el virus de la inmunodeficiencia humana

Fundamento y objetivo Aunque la enfermedad renal se esta convirtiendo en un problema emergente en la poblacion infectada por el virus de la inmunodeficiencia humana (VIH), se tiene muy escasa informacion sobre su curso natural. El objetivo del presente estudio es analizar las lesiones renales en una serie de autopsias de pacientes con infeccion por el VIH en ausencia de tratamiento antirretroviral Pacientes y metodo Se han revisado retrospectivamente datos de las autopsias de 61 sujetos infectados por el VIH (edad media [DE], 36,9 [8,4] anos; un 58,6% eran adictos a drogas por via parenteral y el 84%, varones) fallecidos en nuestro hospital entre 1984 y 1997. Ningun paciente recibio tratami…