Can appropriate systemic treatment help protect the cornea in patients with rheumatoid arthritis? A multidisciplinary approach to autoimmune ocular involvement

Purpose: To correlate rheumatologic with ophthalmic and laboratory findings in patients with rheumatoid arthritis (RA) to identify what effect these have on development of ocular disease. Methods: This is a cross-sectional study of 172 eyes of 86 patients with RA. Patients were examined by a group of rheumatologists. Sociodemographic, clinical, and laboratory data were collected. All patients underwent complete ophthalmologic examination including corneal topography and endothelial cell count. Results: There was no significant correlation between RA-negative prognostic indicators (NPIs) and pathologic corneal findings. Patients using disease-modifying antirheumatic drugs (DMARDs) and antimalarial drugs had greater corneal volumes (mean difference 8.51 mm3, 90% confidence interval [CI], 3.98-13.04, P = 0.004; and 2.24, 90% CI, 0.32-4.54, P = 0.048, respectively). Patients using azathioprine had lower endothelial cell counts compared with those using other drugs (mean difference 180 cells/mm2, 90% CI, 69-291, P = 0.008). Patients using biologic DMARDs had better tear osmolarity values (between 280 and 300 mOsm/L) than patients not using them (mean difference 14.3 mOsm/L, P = 0.022). There was no correlation between NPIs of RA and positive keratoconus screening indices (Spearman correlation OD -0.013, P = 0.91; OS -0.033, P = 0.76). Conclusions: There was no clear correlation between RA-NPIs and pathologic corneal findings in our study. DMARDs treatment may help maintain corneal integrity in our patients and prevented collagenolytic manifestations of RA. Other medications such as azathioprine should be used carefully, as endothelial damage may potentially occur. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

Simultaneous assessment of rotavirus-specific memory B cells and serological memory after B cell depletion therapy with rituximab

Q2Q11-12The mechanisms that contribute to the maintenance of serological memory are still unclear. Rotavirus (RV) memory B cells(mBc) are enriched in IgM+and CD27-subpopulations, which are associated with autoimmune diseases pathogenesis. Inpatients with autoimmune diseases treated with Rituximab (RTX), some autoantibodies (auto-Abs) decrease after treatment,but other auto-Abs and pathogen-specific IgG Abs remain unchanged. Thus, maintenance of autoimmune and pathogen-specific serological memory may depend on the type of antigen and/or Ab isotype evaluated. Antigen-specific mBc andantigen-specific Abs of different isotypes have not been simultaneously assessed in patients after RTX treatment. To study the relationship between mBc subpopulations and serological memory we characterized total, RV- and tetanus toxoid (TT)-specific mBc by flow cytometry in patients with autoimmune diseases before and after treatment with RTX. We also measured total, RV- and TT-Abs, and some auto-Abs by kinetic nephelometry, ELISA, and EliA tests, respectively. Minor differences were observed between the relative frequencies of RV-mBc in healthy controls and patients with autoimmune disease. After RTX treatment, naı ̈ve Bc and total, RV- and TT-specific mBc [IgM+, switched (IgA+/IgG+), IgM+only, IgD+only, and CD27-(IgA+/IgG+/IgM+)] were significantly diminished. An important decrease in total plasma IgM and minor decrease in total IgG and IgA levels were also observed. IgM rheumatoid factor, IgG anti-CCP, and IgG anti-dsDNA were significantly diminished. In contrast, RV-IgA, RV-IgG and RV-IgG1, and TT-IgG titers remained stable. In conclusion, in patients with autoimmunity, serological memory against RV and TT seem to be maintained by long-lived plasma cells, unaffected by RTX, and an important proportion of total IgM and serological memory against some auto-antigens seem to be maintained by short-lived plasma cells, dependent on mBc precursors depleted by RTX

Policondritis recurrente. Estudio de 19 casos en Colombia

Resumen Objetivo: Describir el comportamiento clínico y paraclínico de la PR en la población colombiana y comparar nuestros resultados con otras series publicadas. Materiales y métodos: Estudio descriptivo observacional de 19 casos de PR presentados en 4 centros de reumatología del país durante los últimos 10 años. Los pacientes cumplieron con el diagnóstico de PR de acuerdo al parámetro establecido. Se obtuvo la frecuencia de todas las manifestaciones de la enfermedad y se compararon los hallazgos con 9 series de pacientes con PR publicadas en la literatura entre 1966 y 2007. Resultados: La edad promedio fue 46 años. Se observó una relación por género de 4:1 a favor del sexo femenino. El seguimiento se realizó por 4 años en promedio. La primera manifestación de la enfermedad fue condritis auricular en el 89%, y fue la manifestación más frecuente al presentarse en la totalidad de los casos. Respecto otras series publicadas, se encontró una menor frecuencia de artritis (21%), compromiso ocular (10%) y dermatológico (10%). El compromiso renal (10%), neurológico (5%) y la asociación con otras enfermedades autoinmunes (50%) tuvieron la frecuencia esperada. No se observó compromiso cardiovascular en esta serie. El 100% de los pacientes recibieron corticoides. Adicionalmente el 57% recibieron terapia inmunosupresora asociada. La mortalidad fue del 10% por complicaciones asociadas a la PR. Conclusiones: En este estudio, a diferencia de otras series de origen caucásico y oriental, observamos una clara predominancia del género femenino, el compromiso extracartilaginoso es menos frecuente y la condritis auricular es nuestra manifestación inicial más importante. Estos hallazgos podrían ser el reflejo de diferencias genéticas, inmunológicas o ambientales. Palabras claves: Policondritis recurrente, condritis, vasculitis, corticoides. Abstract Objective: To describe clinical and paraclinical involvement in RP in a Colombian population and compare it with another series previously published. Methods and materials: Retrospective review of 19 cases of RP presented in 4 rheumatology centers in our country in the last 10 years. All patients met diagnostic criteria previously established. In every case, each clinical feature was analized and then compared with another 9 series of RP previously published between 1966 y 2007. Results: Mean age at diagnosis was 46 years. A female predominance was observed in a relation 4:1. Mean follow-up was 4 years. Auricular condritis was the initial clinical feature in 89% of patients and finally was observed in the 100% of our report. Compared with other series, we found less frequently arthritis (21%), ocular (10%) and dermatologic involvement (10%). Renal and neurologic involvement and the association between RP and another autoimmune disorder were found in the expected frequency. We not observed any cardiovascular involvement in our serie. All of the patients received corticosteroids and 57% had had another immunosuppressive medication. Observed mortality was 10% by complications associated to RP. Conclusions: In contrast with another series from Caucasian and Oriental population, we observed a marked predominance of female sex, a minor frequency of systemic involvement and auricular condritis is our most frequent initial clinical feature. Probably, these findings are the result of a different genetic, immunological and environmental background. Key words: Relapsing polychondritis, chondritis, vasculitis, corticosteroids

Nanosized TiO2: a promising catalyst for the aldol condensation of furfural with acetone in biomass upgrading

Nanosized TiO2catalyst was successfully prepared by a simple green procedure and used in liquid phasealdol condensation of furfural with acetone, a key step in bio-fuel processing. In order to determinethe effect of calcination temperature on catalytic properties of TiO2, the as-prepared TiO2and calcinedTiO2(150–900◦C) were studied by XRD, BET, TPD-CO2/NH3, TGA/DTG and FTIR evaluation. The catalyticperformance of TiO2samples in aldol condensation of furfural with acetone was evaluated and comparedwith that of Mg–Al hydrotalcites and a BEA zeolite. These experiments showed that uncalcined TiO2possessed reasonable activity in aldol condensation of furfural to acetone and resulted in commonlyproduced condensation products. The observed catalytic behavior of TiO2could be competitive withthat reported for other inorganic solids. The calcination of TiO2resulted, however, in a decrease in itscatalytic activity due to extensive dehydration and surface dehydroxylation as well as due to changes oftextural properties resulting in a decrease in the amount of accessible active sites. Thanks to its advancedproperties, nanosized TiO2is a promising catalyst for aldol condensation of furfural with acetone andcould broaden possibilities for optimizing conditions for bio-fuel production

Inmunogenética del síndrome de Sjögren primario en colombianos

Objective: Data concerning the immunogenetic characteristics of primary Sjögren’s syndrome (SS) in Latin-Americans are scarce. A research project centered on primary SS in Colombians was initiated in January 1996 to better define these characteristics.MethodsTAP, HLA, IL-10, and microsatellites on 6p21.3 genotyping was performed by polymerase chain reaction techniques. Immunohistochemistry for Bcl-2 antagonist/killer (Bak) was performed. Autoantibodies and serum level of cytokines (IL-10, TNF-?, IFN-?, IL-4, and IL-12p70) were determined by enzyme-linked immunosorbent assay.ResultsThe HLA-DRB1*0301-DQB1*0201 haplotype was associated with disease (OR = 4.3, 95% CI: 1.6 to 11.9, P = 0.002), with a more severe histopathologic picture, and with the presence of anti-Ro and anti-La antibodies. D6S439 microsatellite polymorphism was associated with primary SS in an HLA-independent manner. The most likely gene related to the D6S439 chromosomal location appears to be BAK-1, which codes for Bak protein, expressed in salivary gland’s infiltrate from patients with primary SS but not in controls. IL-10 and IFN-? concentrations were significantly higher in patients than in controls (P 0.3, P < 0.04). Patients who produced high IL-10 levels had significantly more episodes of cutaneous vasculitis and a higher proportion the IL-10.G9 allele.ConclusionsThe HLA-DRB1*0301-DQB1*0201 haplotype and IL-10 participate in the histopathological progression of SS, autoantibody production, and clinical manifestations. Bak protein and its gene polymorphism may participate in the pathology and susceptibility of disease. HLA and cytokine (IL-10 and IFN-?) manipulation may be helpful in treating patients with primary SS

Diseño, adjudicación y ejecución del plan de mantenimiento preventivo para la red de acceso de la empresa Cellcom zona norte para el año 2005

El objetivo que se persigue, es desglosar con mucho detalles lo que un proyecto de mantenimiento de gran envergadura en telecomunicaciones debe ser, para esto se hace una planeación muy detallada de todas las áreas del conocimiento que maneja un proyecto, como son el tiempo, los costos, la calida

Autoimmune diseases in the intensive care unit. An update

Autoimmune diseases (ADs) are a challenge at the intensive care unit. The management of patients with these diseases in the critical care setting has improved over time since there are new and more aggressive alternatives to treat and diagnose them. We aimed to review the current causes of admission, clinical features, outcomes and variables associated with mortality of patients with ADs admitted to the intensive care unit (ICU). International classification criteria for ADs were used to include patients. Search was done through PubMed, SCOPUS, SciELO, and LILACS databases up to December of 2011.Twenty-nine case series and forty-one case reports were analyzed after quality assessment. Respiratory involvement was the leading cause of admission. Systemic lupus erythematosus (SLE) (33.5% of reported patients), rheumatoid arthritis (25%) and systemic vasculitis (15%) were the most frequent ADs in patients admitted to the ICU in the last decade. Mortality ranged from 17% to 55% in case series including all ADs, but in the ones that only included patients with a specific AD, such as SLE, it reached up to 79%. High APACHE score, multi-organ dysfunction, older age and cytopenia were the most reported variables associated with mortality. In conclusion, ADs should always be considered in patients with life threatening conditions that warrant critical care. Variables influencing mortality should be promptly identified in order to improve the patients' outcomes. © 2012 Elsevier B.V

Polimorfismo TAP, HLA-DQB1 y HLA-DRB1 en pacientes colombianos con síndrome de Sjögren primario

Objective: Although primary Sjögren's syndrome (pSS) has a worldwide distribution, little data is available on pSS immunogenetics in non-white populations. Thus, we investigated the influence of transporters associated with antigen processing (TAP), human leukocyte antigen (HLA)-DQB1, and HLA-DRB1 gene polymorphism in mestizo Colombian patients with pSS. Methods: In this cross-sectional and controlled study, all patients met the European criteria for classification of pSS. TAP and HLA typing was performed by polymerase chain reaction techniques. Genetic data analysis was performed to detect deviations from the expected Hardy-Weinberg (H-W) proportions and to determine the presence of population stratification or subdivision and the existence of linkage disequilibrium between pairs of loci. Results: Seventy-three Colombian patients with pSS (95% women) and 76 healthy controls were studied. Although significant associations were not observed between TAP or HLA polymorphism and disease, strong linkage disequilibrium among the loci TAP2 and DQB1 was found in patients. Deviations from the H-W expected value were found in the DQB1 locus of patients (P =.02). HLA-DRB1*0301-DQB1*0201 haplotype was associated with more severe histopathologic disease (odds ratio [OR], 15.5; 95% confidence interval [CI], 1.9-129; P =.001) and the presence of anti-Ro (OR, 3.8; 95% CI, 1-15; P =.04) and anti-La antibodies (OR, 4.3; 95% CI, 1.3-14; P =.01). Conclusion: The data show genetic evidence suggesting that, in Colombians, a region immersed or in the vicinity in the HLA class II system is strongly associated with a predisposition to acquire pSS, which is probably located between the TAP2 and HLA-DQB1 locus. Our results confirm that the HLA-DRB1*0301-DQB1*0201 haplotype participates in the pathogenesis of pSS

Artritis reumatoide en minorías.

Latin America and the Caribbean (LAC) is a rapidly growing region with almost 600 million inhabitants composed of Mexico, Central and South America, and the islands of the Caribbean [1, 2]. The Americas were first inhabited by people crossing the Bering Land Bridge from northeast Asia into Alaska well over 10,000 years ago. Native Americans descend from at least three streams of Asian gene flow [3]. Europeans arrived after 1492 following Christopher Columbus’s voyages. African people were captured and taken to America by the transatlantic slave trade from the 16th to the 19th centuries. Hence, the population of LAC comprises a variety of ancestries, ethnic groups, and races, making the region one of the most diverse in the world. The specific composition varies from country to country: many have a predominance of European-Native American, or Mestizo, population; in others, Native Americans are a majority; some are dominated by inhabitants of European ancestry; some countries’ populations are primarily Mulatto [4]. To a less extent, Black, Asian, and Zambo (mixed Black and Native American) are also identified regularly [4]. Noteworthy, ethnic self-identification is culturally and biologically complex and is not correlated with self-reported ancestry which should be no longer evaluated by questionnaire but rather by the use of ancestry informative markers (AIMs) at the molecular leve

Autoimmune diseases in the intensive care unit. An update

Autoimmune diseases (ADs) are a challenge at the intensive care unit. The management of patients with these diseases in the critical care setting has improved over time since there are new and more aggressive alternatives to treat and diagnose them. We aimed to review the current causes of admission, clinical features, outcomes and variables associated with mortality of patients with ADs admitted to the intensive care unit (ICU). International classification criteria for ADs were used to include patients. Search was done through PubMed, SCOPUS, SciELO, and LILACS databases up to December of 2011.Twenty-nine case series and forty-one case reports were analyzed after quality assessment. Respiratory involvement was the leading cause of admission. Systemic lupus erythematosus (SLE) (33.5% of reported patients), rheumatoid arthritis (25%) and systemic vasculitis (15%) were the most frequent ADs in patients admitted to the ICU in the last decade. Mortality ranged from 17% to 55% in case series including all ADs, but in the ones that only included patients with a specific AD, such as SLE, it reached up to 79%. High APACHE score, multi-organ dysfunction, older age and cytopenia were the most reported variables associated with mortality. In conclusion, ADs should always be considered in patients with life threatening conditions that warrant critical care. Variables influencing mortality should be promptly identified in order to improve the patients' outcomes. © 2012 Elsevier B.V