Isolated HBsAg positivity in a Mexican patient with newly diagnosed lupus nephritis

Abstract Introduction: Hepatitis B surface antigen (HBsAg) is usually regarded as a marker of hepatitis B virus (HBV) infection. The concurrence of lupus nephritis (LN) and HBsAg-positivity is a challenge for the clinician, since immunosuppressant use may be associated with an increase in viral replication and an exacerbation of liver disease. Case presentation: Here, we describe the case of a 30-year-old Mexican woman with newly diagnosed focal proliferative LN who also tested repeatedly positive for HBsAg by chemiluminescent microparticle immunoassay (CMIA). She had no clinical features of hepatitis and her liver function tests were within normal limits. Her abdominal ultrasound was also normal. While waiting for further results, she was started on lamivudine (100 mg daily). However, total HBV core antibody test was negative. Owing to the infrequency of this serological pattern, an in vitro polymerase chain reaction (PCR) assay was performed and HBV was not detected. Overall, we interpreted these results as a false-positive screening. Methylprednisolone pulse therapy was subsequently given (1 g daily for three doses) without hepatic repercussion, neither clinically nor biochemically. Conclusions: Isolated HBsAg positivity may result from multiple causes, one of which is crossreactivity. To the best of our knowledge, this is the first report of a false-positive reading using CMIA technique in an active lupus patient. It is reasonable to stress that lupus patients with a positive screening for HBV should undergo a confirmatory assay (such as genomic detection), since this diagnosis may have important therapeutic implications. � 2016 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier. B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/

Lectina fijadora de manosa en la respuesta inmunitaria innata

La lectina fijadora de manosa (MBL) es una proteína cuyo gen (MBL2) se encuentra en el brazo largo del cromosoma 10. Sus concentraciones en suero pueden ser afectadas por tres variaciones genéticas (B, C y D) en la porción estructural del gen MBL2 y a dos variaciones adicionales en la región promotora del mismo, que generan dos sitios polimórficos (H/L y X/Y). Estos polimorfismos generan diversos haplotipos en algunas comunidades humanas y algunos de estos haplotipos podrían incrementar la susceptibilidad a infecciones, lupus eritematoso generalizado y artritis reumatoide. Este estudio revisa los polimorfismos del gen MBL2 y su relación con la salud en poblaciones humanas afectadas

Utilidad del Ultrasonido Pulmonar en el Punto de Atención para la evaluación de la Enfermedad Pulmonar Intersticial asociada Enfermedades del Tejido Conectivo

La Enfermedad Pulmonar Intersticial (EPI) representa una complicación grave en enfermedades del tejido conectivo (ETC). Los métodos tradicionales de evaluación, como la Tomografía Pulmonar de Alta Resolución (TACAR), plantean desafíos debido a su radiación y costos, lo que hace necesario explorar alternativas como el Ultrasonido en el Punto de Atención (UEPA). El presente estudio buscó evaluar la utilidad del UEPA en la EPI asociada a ETC. El estudio incluyó un diseño transversal, descriptivo y de cohorte realizado en el Servicio de Reumatología del Hospital Universitario "Dr. José E. González", utilizando registros clínicos y realizando UEPA en pacientes mayores de edad con EPI-ETC. Se analizaron datos de 34 participantes con EPI-ETC. Se observó que la edad promedio fue de 62.8 años, con predominancia total femenina. La Artritis Reumatoide fue la ETC más frecuente (32%), y se encontraron diferencias significativas en la edad entre diferentes patologías de base. La mayoría recibía Mofetil Micofenolato y solo algunos FARME adicionales, sin diferencias significativas entre ETC. Se detectó alta correlación entre los equipos de UEPA, aunque el abordaje de 14 EIC con equipo de bolsillo mostró mayor visibilidad. En conclusión, el Ultrasonido Pulmonar en el Punto de Atención es una herramienta útil y confiable para evaluar la EPI-ETC, detectando cambios correlacionados con métodos más convencionales como la Tomografía Pulmonar de Alta Resolución, aunque se requieren más estudios longitudinales para evaluar su utilidad en el seguimiento y tratamiento de estas enfermedade

Prevalencia e impacto de la violencia íntima de pareja en mujres con lupus eritematoso sistémico

Objective: Stress and trauma are psychosocial factors with an impact on the course of systemic lupus erythematosus (SLE). The influence of violence on SLE has not been entirely explored, even though women (including patients with rheumatic diseases) are a vulnerable population to any form of violence. This study aims to assess the prevalence and impact of intimate partner violence (IPV) on healthrelated quality of life in women with SLE. Methods: An observational, cross-sectional, and analytical study was conducted at a rheumatology clinic of a university hospital from September 2022 and September 2023. We evaluated the presence of IPV in 85 women with SLE with the Hurt, Insulted, Threatened with Harm and Screamed at (HITS) questionnaire and the Index of Spouse Abuse (ISA), and quality of life with LupusQoL. Results: The prevalence by HITS score of past-year IPV was 24.4% and of lifetime IPV was 36.5%. Past-year non-physical violence was present in 17.1% of patients by ISA, and 27.1% were victims in their lifetime. While in physical violence, 7.3% were victims in the previous year and 21.2% in their lifetime. The total quality of life and the emotional domain by LupusQoL were diminished in victims of past-year IPV, compared to those who weren’t exposed (p = 0.018 and p = 0.036, respectively). Past-year HITS score correlated with the physician global assessment (PGA) (rho = 0.301, p = 0.006), while lifetime HITS score correlated with PGA (rho = 0.329, p = 0.002) and SLEDAI-2K (rho = 0.277, p = 0.010). Conclusion: We found that 1 in 4 women suffered IPV in the previous year, and those who were exposed had diminished quality of life. Also, the severity of the abuse correlated with disease activity. The findings of this study highlight the relevance of assessing psychosocial factors in these patients to achieve better comprehensive care

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 10

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 10, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones

Severe gastrointestinal involvement in adult-onset Henoch–Schönlein purpura associated with clarithromycin-resistant Helicobacter pylori infection

Background: Henoch–Schönlein purpura (HSP) is an uncommon vasculitis in adults. Gastrointestinal involvement is part of the classical tetrad and can present as bleeding. Helicobacter pylori infection in the setting of HSP has been reported a few times in the literature and may be involved in the pathogenesis of this disease as a triggering agent. Case report: A 48-year-old man presented to the emergency department with 9 days of acute symmetric additive polyarthritis, 2 days of palpable purpura involving lower limbs, recent-onset intense mesogastric pain and hematochezia. H. pylori was detected in gastric tissue and triple therapy (clarithromycin, amoxicillin and omeprazole) was started. Gastrointestinal bleeding and other symptoms stopped 24 h after steroid initiation and he was later discharged on prednisone (1 mg/kg) and azathioprine (100 mg/day). Shortly after discharge he was readmitted with hematochezia and clarithromycin-resistant H. pylori infection was suspected. Bleeding stopped following reinstitution of corticosteroids and a second-line scheme (levofloxacin, amoxicillin and omeprazole) was introduced. Corticosteroids were gradually tapered and he remained on azathioprine. Nine months later he was doing fine. The pertinent literature is briefly discussed, highlighting the previous cases of concurrent diagnosis in adult patients. Conclusion: To the best of our knowledge, this is the first report describing resistance to clarithromycin-containing triple therapy in a H. pylori-infected adult patient with HSP. Gastrointestinal bleeding remains one of the most feared manifestations of HSP. These patients may benefit from H. pylori screening, as this might positively affect their prognosis. Further studies in adults are nevertheless needed to clarify this association and its therapeutic impact