Miopatía por cuerpos de inclusión: caso clínico y revisión de la literatura

La miositis por cuerpos de inclusión (MCI) es una patología poco común que se presenta en individuos mayores de 50 años y con mayor frecuencia en hombres, sin embargo, los síntomas pueden empezar 20 años antes de su diagnóstico. Hasta un 30% de los casos de miopatías inflamatorias pueden ser de MCI y su prevalencia varía en los diferentes países y grupos étnicos. Clínicamente se manifiesta como debilidad lentamente progresiva proximal y distal. En este artículo se presenta un caso de una paciente de 78 años con antecedentes previos de diabetes mellitus tipo 2, hipertensión arterial, e hipotiroidismo, con cuadro de 18 meses de evolución consistente en debilidad de miembros inferiores, incapacidad para subir y bajar escaleras, limitación en la marcha, acompañado de disestesias. Se realizó la medición de la creatin quinasa (CK) y su valor inicial fue 7820, la electromiografía y neuroconducciones mostraron polineuropatia axonal motora en las cuatro extremidades y miopatía inflamatoria. Se trató con glucorticoides a dosis de 1 mg/kg y después de seis meses de tratamiento no se observó mejoría. Se decide tomar biopsia muscular que mostró miopatía por cuerpos de inclusión, lo que explicó la falla terapéutica inicial. Este caso es interesante desde el punto de vista clínico, ya que no es frecuente la elevación de la CK en los niveles que presentó la paciente y por las múltiples comorbilidades asociada

Factores de asociación relacionados con el ingreso a la unidad de cuidados intensivos en pacientes con diagnostico de malaria en el Hospital Militar Central

Se llevo a cabo un Estudio Observacional Analítico de Cohorte Retrospectiva. La población estudio fueron pacientes con diagnóstico exclusivo de Malaria hospitalizados en la institución. Se calculó el tamaño de muestra utilizando el programa T AMAMU ® registrado en estudios de cohorte para estimación de proporción y una vez obtenido por aleatorización los números de historia se consultaron en el servicio de Estadística y Archivo para la recolección de información. Se revisaron 298 historias clínicas de las cuales 278 cumplían los criterios de inclusión. El análisis de la información se realizó con el programa SPSS 13.0 para Windows

Prevalence, demographics, and clinical characteristics of Latin American patients with spondyloarthritis

Large epidemiologic and clinical estimates of spondyloarthritis (SpA) in Latin America are not available. In this narrative review, our goal was to descriptively summarize the prevalence and features of SpA in Latin America, based on available small studies. A review of peer-reviewed literature identified 41 relevant publications. Of these, 11 (mostly based on Mexican data) estimated the prevalence of SpA and its subtypes, which varied from 0.28 to 0.9% (SpA), 0.02 to 0.8% (ankylosing spondylitis), 0.2 to 0.9% (axial SpA), and 0.004 to 0.08% (psoriatic arthritis). Demographic and/or clinical characteristics were reported in 31 of the 41 publications, deriving data from 3 multinational studies, as well as individual studies from Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, Uruguay, and Venezuela. Data relating to treatment, disease manifestations (articular and extra-articular), and comorbidities were summarized across the countries. Available data suggest that there is a variability in prevalence, manifestations, and comorbidities of SpA across Latin America. Basic epidemiologic and clinical data are required from several countries not currently represented. Data relating to current treatment approaches, patient outcomes, and socioeconomic impact within this large geographic region are also needed

Higher levels of secretory IgA are associated with low disease activity index in patients with reactive arthritis and undifferentiated spondyloarthritis

Introduction: Both reactive arthritis (ReA) and undifferentiated spondyloarthritis (uSpA) belong to the group of autoinflammatory diseases called spondyloarthritis (SpA). Hypotheses have been proposed about a relationship between the intestinal mucosa and inflammation of joint tissues. The role of immunoglobulin IgA or secretory immunoglobulin A (SIgA) in the inflammatory and/or clinical activity of patients with SpA remains poorly understood. Objective: To evaluate the status of total IgA and SIgA, and the association among the levels of SIgA, IgA, IgA anti-Chlamydia trachomatis, and anti-Shigella spp. with the disease activity measures, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, was compared in a cohort of patients with ReA and uSpA and healthy subjects. Methods: This was a cross-sectional study. The serum concentrations of SIgA, IgA anti-C. trachomatis, anti-Shigella spp., and total IgA were measured. Disease activity was measured in each patient by means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Statistical analysis did include as bivariate evaluation, comparisons by Student’s t-test, Kruskal–Wallis test, and U Mann–Whitney test, with a multivariate evaluation by principal components analysis (PCA). A correlation analysis was carried out using the Pearson correlation coefficient and a linear regression models. All analysis were made using Stata version 11.2® for Windows, R V3.3.21. Statistical significance was defined a p-value <0.05. Results: In all, 46 patients (78.2% men; mean age, 34.8 ± 12.3 years) and 53 controls (41% men; mean age, 32 ± 11.4 years) were included in the study. The mean serum levels of SIgA were higher in SpA patients than in healthy subjects (p < 0.001). Only SIgA levels correlated with disease activity: BASDAI (r = −0.42, p = 0.0046), ASDAS-CRP (r = −0.37, p = 0.014), and ASDAS-ESR (r = −0.45, p = 0.0021). The negative correlation between SIgA and all activity indices was higher in HLA-B27-positive patients (BASDAI r = −0.70, p = 0.0009, ASDAS-CRP r = −0.58, p = 0.0093, and ASDAS-ESR r = −0.57, p = 0.0083). The PCA showed three factors: the first component was constituted by variables referred as clinical activity measures, the second did include the serological activity markers, and the last component was compounded by age and symptoms time. Conclusion: Elevated serum levels of SIgA were found to be related with low disease activity in patients with ReA and uSpA

Predictive factors related to the progression of periodontal disease in patients with early rheumatoid arthritis: A cohort study

Background: Rheumatoid arthritis (RA) and periodontal disease are inter-related conditions. However, factors predictive of periodontal disease progression in patients with early rheumatoid arthritis (eRA) are lacking. The aim of this study was to identify factors associated with the progression of clinical attachment loss (CAL) in interproximal dental sites of eRA patients. Methods: Twenty-eight eRA patients were evaluated for the progression of CAL at 280 interproximal dental sites at 1 year of follow-up. Markers of RA activity (rheumatoid factor, erythrocyte sedimentation rate, and C-reactive protein), a marker of bone resorption (Dickkopf-related protein 1), Disease Activity Score 28 and Simple Disease Activity Index were included as potential systemic predictive factors. Plaque index, gingival index, pocket depth, clinical attachment level and Dickkopf-related protein 1 in crevicular fluid at baseline were included as potential local predictive factors. Data were analysed in a hierarchical structure using generalised linear mixed models for progression at each site (> 2 mm) during follow-up. Results: C-reactive protein level was the most important predictive systemic factor for the progression of CAL. The mean CAL and a high degree of gingival inflammation in interproximal sites at baseline were important predictive local factors (p < 0.0001). Patients who received combined treatment with disease-modifying antirheumatic drugs and corticosteroids exhibited less CAL (p < 0.0001). The predictive value of the generalised linear mixed model for progression was 85%. Conclusions: Systemic factors, including RA disease activity and baseline periodontal condition, were associated with periodontal progression. Pharmacological treatment may affect periodontal progression in patients with early RA

Bone remodeling in spondyloarthritis

Spondyloarthritis is a group of several related but phenotypically distinct chronic inflammatory diseases, characterized by progressive new bone formation which leads to ankylosis and functional disability. Radiographic images evidence not only erosive changes but also overgrowth of bony structures called syndesmophytes. These inflammation, bone destruction and new bone formation are located in the entheses, which constitutes the primary organ of the disease. As a consequence, the inflammatory process results in excess of bone formation and the impact depends on the location, cell type, cytokines and local microenvironment factors. Several molecules playing a role as immune modulators or regulators of bone homeostasis, mediate the imbalance between bone resorption and formation. In the same way, animal models suggest that joint ankylosis may be independent from the effects of tumor necrosis factor alpha. Therefore, the process of new tissue (bone) formation can be considered as an additional therapeutic target. The Wnt signaling pathway, which is considered the primary regulator of osteoblastogenesis, constitutes a new research field of great interest in the last decade

Navigating COVID-19 in the developing world

El síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) ha sido declarado una pandemia y una emergencia de salud pública mundial por la Organización Mundial de la Salud. Esta condición comenzó en China en diciembre de 2019, fue exportada por viajeros internacionales y ahora se está propagando por transmisión comunitaria con casos reportados en todos los países del mundo. Más de 3 millones de personas están infectadas al 2 de mayo de 2020, con más de 240.000 muertes reportadas [ 1 ]. La tasa de letalidad se estima en 1 a 5%, y no se ha demostrado claramente ningún tratamiento eficaz para los pacientes gravemente afectados por la enfermedad causada por el SARS-CoV-2, denominada COVID-19.The severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has been declared a pandemic and a global public health emergency by the World Health Organization. This condition began in China in December 2019, was exported by international travellers and is now spreading by community transmission with cases reported in every country around the world. Over 3 million people are infected as of 2 May 2020, with over 240,000 reported deaths The case fatality rate is estimated at 1–5%, and no effective treatment has been clearly demonstrated for patients severely affected by the disease caused by SARS-CoV-2, named COVID-19

Adipokines and periodontal markers as risk indicators of early rheumatoid arthritis: a cross-sectional study

Objective: To establish the association between adipokine levels and markers of periodontal involvement as risk indicators of early stages of RA (eRA) and the interaction between the presence of markers of periodontal disease with adipokine in eRA individuals. Materials and methods: Fifty-one patients with a diagnosis of eRA and 51 healthy controls matched for age and sex were studied. Clinical joint condition, clinical and serological markers of disease activity, serum adipokine levels (leptin, adiponectin, resistin, adipsin, vaspin, and IL-6), periodontal diagnosis, presence of Porphyromonas gingivalis, and related IgG1 and IgG2 antibodies were evaluated. Comparisons were made between eRA and healthy controls for periodontal indicators and adipokines. A subgroup analysis was realized with a non-conditional logistic regression to establish the association between the levels of leptin in individuals with eRA and controls according to the periodontal condition, presence of P. gingivalis, or high titers of IgG antibodies against P. gingivalis. Results: The condition of overweight or obesity is associated with the diagnosis of eRA (p = 0.05), and these individuals also have higher levels of leptin (p = 0.001) and vaspin (p = 0.007). Higher frequency of P. gingivalis (p = 0.001) was found in the eRa group. Individuals with eRA with higher IgG2 titers against P. gingivalis had higher levels of leptin (OR: 1.66 (CI 95% 1.01–2.73)); however, individuals with periodontitis or P. gingivalis with eRA were associated with highest levels of leptin (OR: 1.86, CI 95% 1.19–24.3; and OR: 2.04, CI 95% 1.37–3 respectively). Conclusions: eRA individuals have high levels of leptin and vaspin. However, the presence of periodontitis and related-periodontal disease markers showed an effect only in leptin levels in eRA individuals. Clinical relevance: Emphasizing in personalized medicine, monitoring serum leptin levels and periodontitis markers can improve the early diagnosis of RA

Autoantibodies and fecal calprotectin levels in a group of Colombian patients with inflammatory bowel disease

Background: The purpose of the study is to investigate the frequency of serum anti-Saccharomyces cerevisiae antibodies (ASCA), anti-neutrophil cytoplasmic antibodies (ANCA), anti-nuclear antibodies (ANAS), IgA, C reactive protein (CRP), erythrocyte sedimentation rate (ESR) and fecal calprotectin (FC) and its association between diagnosis, endoscopic findings, histopathologic and clinical activity, in patients with diagnosis or suspected inflammatory bowel disease (IBD). Methods: An observational cross-section study was designed including 52 patients with IBD or suspected IBD. ASCA, ANCA, ANAS, IgA, CRP, ESR and FC were measured. Patients were divided according to histological findings into ulcerative colitis (UC), Crohn's disease (CD) and others (normal mucosa, chronic proctocolitis, nonspecific colitis and ileitis). A descriptive analysis was made and associations were evaluated using chi2 test, Kruskal Wallis and Mann- Whitney U test. Results: The association between IBD and ASCA levels was statistically significant (p=0.036). ANCA levels showed statistical significance in IBD patients (p=0.048). When comparing FC levels within UC, CD and others a statistical significance was obtained (p=0.032). A large percentage of patients (78.5%) with high positive levels FC were classified as active histopathology. A significant percentage (54.5%) with levels up to 50 mg/kg had quiescent activity. Positive levels of FC were related with serum activity markers with statistical significance (CRP: p=0.007 and ESR: p=0.003). Conclusions: The frequencies of p-ANCA and ASCAs for UC and CD were established in a Colombian population. IBD patients with histopathologic activity had higher levels of FC. We also found that patients with quiescent disease have elevated FC levels