Tuberculoma epidural espinal simulando Síndrome de Guillain-Barré: presentación de un caso

ABSTRACTThe central nervous system is one of the most affected focus in extrapulmonary tuberculosis, however, spinal epidural tuberculoma is considered very unusual. We present a clinical report of a four years old patient who presented with clinical symptoms of a progressive quadriparesis. The cerebroespinal fluid examination showed protein-cell dissociation, and the diagnosis of Guillain Barré syndrome was made. However, because it called the attention the appearance of meningeal signs, a magnetic resonance imaging was performed,and evidenced a compressive lesion in the cervicodorsal level. It was explored by neurosurgery, finding an epidural lesion studied by cultures and polymerase chain reaction. Both reported positive results for Mycobacterium tuberculosis. The anti-tuberculosis treatment was started and a progressive clinical improvement was observed with recuperation of the gait after the surgical procedure. MÉD.UIS.2016;29(2):155-9.Keywords: Tuberculosis. Central Nervous System. Tuberculoma.El sistema nervioso central es uno de los focos extrapulmonares afectados con mayor frecuencia por tuberculosis, no obstante, el tuberculoma epidural espinal es considerado una rareza. Se presenta el caso de un paciente de cuatro años de edad, quien consulta por cuadro de cuadriparesia progresiva. Al examen de líquido cefalorraquídeo se evidenció disociación proteínico celular diagnosticándose síndrome de Guillain Barré, sin embargo, tras la aparición de signos meníngeos, se realizó una resonancia nuclear magnética de columna en la que se evidenció lesión compresiva a nivel cervicodorsal que fue posteriormente explorada quirúrgicamente por neurocirugía,encontrándose una lesión epidural cuyo estudio microbiológico, cultivo y estudio de reacción en cadena de la polimerasa se reportaron positivos para Mycobacterium tuberculosis, por lo que se inició tratamiento antituberculoso observándose mejoría clínica y progresiva con recuperación de la marcha tras el procedimiento quirúrgico. MÉD.UIS. 2016;29(2):155-9.Palabras clave: Tuberculosis. Sistema Nervioso Central. Tuberculoma

Síndrome de encefalopatía posterior reversible secundaria a tacrolimus

Los inhibidores de la calcineurina, la ciclosporina y el tacrolimus han jugado un papel preponderante en la prevención de los episodios de rechazo y de la enfermedad de injerto contra el huésped en pacientes tratados mediante el trasplante de órgano sólido y de la médula ósea. No obstante, el tacrolimus presenta efectos adversos relacionados con la neurotoxicidad, siendo el síndrome de encefalopatía posterior reversible la consecuencia más severa de dicha neurotoxicidad. El reporte de nuestro caso es de una mujer de 30 años de edad, con 2 días de evolución de cefalea intensa en la frente, náuseas, emesis, hiporexia y epigastralgia, afebril. Antecedente de un trasplante cardiaco 45 días antes, en tratamiento inmunosupresor con tacrolimus y micofenolato mofetilo. Se documentan niveles de tacrolimus adecuados (12,1 ng/ml), los estudios imagenológicos normales y los resultados de laboratorio negativos para infección, lo que permite descartar las causas vasculares e infecciosas y la neurotoxicidad por el tacrolimus. Sin embargo, ante el desarrollo de alteraciones neuropsiquiátricas, y a pesar de niveles de tacrolimus < 5,5 ng/ml, se realiza nueva resonancia nuclear magnética cerebral con hallazgos que indican síndrome de leucoencefalopatía posterior reversible. Se suspende el tacrolimus y se inicia tratamiento con everolimus, lográndose remisión total. Este sería el primer caso reportado en el cual las alteraciones imagenológicas asociadas al síndrome de encefalopatía posterior reversible se desarrollaron en una paciente intervenida de trasplante cardiaco con niveles de tacrolimus < 10 ng/ml. El reporte de este caso permitirá a los grupos médicos tratantes considerar este diagnóstico a pesar de niveles de tacrolimus en rango terapéutico, de manera que se realice un reconocimiento y tratamiento oportuno, evitando así el desarrollo de complicaciones o secuelas neurológicas

Aborto recurrente de etiología aloinmune

Los mecanismos que subyacen la reproducción humana son muy complejos, por lo que cualquier pérdida gestacional implica el tener que considerar diversas etiologías, más aun si se trata de pérdidas gestacionales recurrentes dentro de las que la inmunidad juega un papel especialmente importante. Desde hace varias décadas, el factor aloinmune ha sido reconocido como un desencadenante frecuente de la interrupción del embarazo, haciéndose de esta forma relevante su estudio en mujeres con aborto recurrente. En el presente artículo, a partir de una búsqueda sistemática de información, se revisan con detalle los aspectos relacionados con la fisiopatología, el diagnóstico y el tratamiento del aborto recurrente de etiología aloinmune, buscando con esto sensibilizar al profesional de la salud sobre su consideración ante una mujer con pérdida recurrente de la gestación.http://revistas.utp.edu.co/index.php/revistamedicaThe mechanisms underlying the human reproduction are very complex, so any pregnancy loss implies the need of considering various etiologies, even more if those pregnancy losses are recurrent within which the immunity plays an important role. since decades, the alloimmune factor has been recognized as a frequent trigger of the pregnancy interruption, thus becoming relevant its study in women with recurrent miscarriage. in the present article, through a systematic search of information, details concerning to the physiopathology, diagnosis and treatment of the recurrent miscarriage of alloimmune etiology are reviewed, looking to sensitize the health professional about its consideration when evaluating a woman with recurrent pregnancy loss

Aborto Recurrente de Etiología Autoinmune

El curso normal del embarazo implica una serie de cambios inmunológicos que permiten el desarrollo armónico fetal. En mujeres con pérdida recurrente de la gestación, diversas etiologías se han relacionado como desencadenantes de dichas pérdidas; jugando el factor autoinmune un papel cada vez más importante. En el presente artículo, a partir de una búsqueda sistemática de información, se exponen en detalle los aspectos inmunológicos del embarazo normal, así como las alteraciones  que a este nivel se presentan en mujeres con aborto recurrente. Además, se realiza una orientación diagnóstica y se exponen las diversas opciones terapéuticas utilizadas, haciendo énfasis en la necesidad de establecer protocolos estandarizados para el manejo de esta entidad.Palabras clave: Aborto habitual; autoinmunidad; anticuerpos antifosfolípidos; embarazo; resultado del embarazo

Tuberculoma epidural espinal simulando Síndrome de Guillain-Barré: presentación de un caso

El sistema nervioso central es uno de los focos extrapulmonares afectados con mayor frecuencia por tuberculosis, no obstante, el tuberculoma epidural espinal es considerado una rareza. Se presenta el caso de un paciente de cuatro años de edad, quien consulta por cuadro de cuadriparesia progresiva. Al examen de líquido cefalorraquídeo se evidenció disociación proteínico celular diagnosticándose síndrome de Guillain Barré, sin embargo, tras la aparición de signos meníngeos, se realizó una resonancia nuclear magnética de columna en la que se evidenció lesión compresiva a nivel cervicodorsal que fue posteriormente explorada quirúrgicamente por neurocirugía, encontrándose una lesión epidural cuyo estudio microbiológico, cultivo y estudio de reacción en cadena de la polimerasa se reportaron positivos para Mycobacterium tuberculosis, por lo que se inició tratamiento antituberculoso observándose mejoría clínica y progresiva con recuperación de la marcha tras el procedimiento quirúrgico

Observation of sizeable ω\omega contribution to χc1(3872)→π+π−J/ψ\chi_{c1}(3872) \to \pi^+\pi^- J/\psi decays

Resonant structures in the dipion mass spectrum from $\chi_{c1}(3872)\to\pi^+\pi^- J/\psi$ decays, produced via $B^+\to K^+\chi_{c1}(3872)$ decays, are analyzed using proton-proton collision data collected by the LHCb experiment, corresponding to an integrated luminosity of 9 fb$^{-1}$. A sizeable contribution from the isospin conserving $\chi_{c1}(3872)\to\omega J/\psi$ decay is established for the first time, $(21.4\pm2.3\pm2.0)\%$, with a significance of more than $7.1\sigma$. The amplitude of isospin violating decay, $\chi_{c1}(3872)\to\rho^0 J/\psi$, relative to isospin conserving decay, $\chi_{c1}(3872)\to\omega J/\psi$, is properly determined, and it is a factor of six larger than expected for a pure charmonium state.Resonant structures in the dipion mass spectrum from χc1(3872)→π+π-J/ψ decays, produced via B+→K+χc1(3872) decays, are analyzed using proton-proton collision data collected by the LHCb experiment, corresponding to an integrated luminosity of 9  fb-1. A sizeable contribution from the isospin conserving χc1(3872)→ωJ/ψ decay is established for the first time, (21.4±2.3±2.0)%, with a significance of more than 7.1σ. The amplitude of isospin violating decay, χc1(3872)→ρ0J/ψ, relative to isospin conserving decay, χc1(3872)→ωJ/ψ, is properly determined, and it is a factor of 6 larger than expected for a pure charmonium state.Resonant structures in the dipion mass spectrum from $\chi_{c1}(3872)\to\pi^+\pi^- J/\psi$ decays, produced via $B^+\to K^+\chi_{c1}(3872)$ decays, are analyzed using proton-proton collision data collected by the LHCb experiment, corresponding to an integrated luminosity of 9 $fb^{-1}$. A sizeable contribution from the isospin conserving $\chi_{c1}(3872)\to\omega J/\psi$ decay is established for the first time, $(21.4\pm2.3\pm2.0)\%$, with a significance of more than $7.1\sigma$. The amplitude of isospin violating decay, $\chi_{c1}(3872)\to\rho^0 J/\psi$, relative to isospin conserving decay, $\chi_{c1}(3872)\to\omega J/\psi$, is properly determined, and it is a factor of six larger than expected for a pure charmonium state

Search for the rare hadronic decay Bs0→ppˉB_s^0\to p \bar{p}

A search for the rare hadronic decay Bs0→pp¯ is performed using proton-proton collision data recorded by the LHCb experiment at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 6  fb-1. No evidence of the decay is found and an upper limit on its branching fraction is set at B(Bs0→pp¯)&lt;4.4(5.1)×10-9 at 90% (95%) confidence level; this is currently the world’s best upper limit. The decay mode B0→pp¯ is measured with very large significance, confirming the first observation by the LHCb experiment in 2017. The branching fraction is determined to be B(B0→pp¯)=(1.27±0.15±0.05±0.04)×10-8, where the first uncertainty is statistical, the second is systematic and the third is due to the external branching fraction of the normalization channel B0→K+π-. The combination of the two LHCb measurements of the B0→pp¯ branching fraction yields B(B0→pp¯)=(1.27±0.13±0.05±0.03)×10-8.A search for the rare hadronic decay $B_s^0\to p \bar{p}$ is performed using proton-proton collision data recorded by the LHCb experiment at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 6 fb$^{-1}$. No evidence of the decay is found and an upper limit on its branching fraction is set at ${\cal B}(B_s^0\to p \bar{p}) < 4.4~(5.1) \times 10^{-9}$ at 90% (95%) confidence level; this is currently the world's best upper limit. The decay mode $B^0\to p \bar{p}$ is measured with very large significance, confirming the first observation by the LHCb experiment in 2017. The branching fraction is determined to be ${\cal B}(B^0\to p \bar{p}) = \rm (1.27 \pm 0.15 \pm 0.05 \pm 0.04) \times 10^{-8}$, where the first uncertainty is statistical, the second is systematic and the third is due to the external branching fraction of the normalization channel $B^0\to K^+\pi^-$. The combination of the two LHCb measurements of the $B^0\to p \bar{p}$ branching fraction yields ${\cal B}(B^0\to p \bar{p}) = \rm (1.27 \pm 0.13 \pm 0.05 \pm 0.03) \times 10^{-8}$

Nuclear modification factor of neutral pions in the forward and backward regions in ppPb collisions

The nuclear modification factor of neutral pions is measured in proton-lead collisions collected at a center-of-mass energy per nucleon of $8.16$ TeV with the LHCb detector. The $\pi^0$ production cross section is measured differentially in transverse momentum ($p_{T}$) for 1.5π0 production cross section is measured differentially in transverse momentum (pT) for 1.5<pT<10.0  GeV and in center-of-mass pseudorapidity (ηc.m.) regions 2.5<ηc.m.<3.5 (forward) and -4.0<ηc.m.<-3.0 (backward) defined relative to the proton beam direction. The forward measurement shows a sizable suppression of π0 production, while the backward measurement shows the first evidence of π0 enhancement in proton-lead collisions at the LHC. Together, these measurements provide precise constraints on models of nuclear structure and particle production in high-energy nuclear collisions.The nuclear modification factor of neutral pions is measured in proton-lead collisions collected at a center-of-mass energy per nucleon of 8.16~{\rm TeV}$with the LHCb detector. The$\pi^0$production cross section is measured differentially in transverse momentum ($p_{\rm T}$) for$1.5<p_{\rm T}<10.0~{\rm GeV}$and in center-of-mass pseudorapidity ($\eta_{\rm c.m.}$) regions$2.5<\eta_{\rm c.m.}<3.5$(forward) and$-4.0<\eta_{\rm c.m.}<-3.0$(backward) defined relative to the proton beam direction. The forward measurement shows a sizable suppression of$\pi^0$production, while the backward measurement shows the first evidence of$\pi^0$ enhancement in proton-lead collisions at the LHC. Together, these measurements provide precise constraints on models of nuclear structure and particle production in high-energy nuclear collisions

Measurement of CP asymmetries in D(s)+→ηπ+ {D}_{(s)}^{+}\to \eta {\pi}^{+} and D(s)+→η′π+ {D}_{(s)}^{+}\to {\eta}^{\prime }{\pi}^{+} decays

Searches for CP violation in the decays ${D}_{(s)}^{+}\to \eta {\pi}^{+}$ and ${D}_{(s)}^{+}\to {\eta}^{\prime }{\pi}^{+}$ are performed using pp collision data corresponding to 6 fb$^{−1}$ of integrated luminosity collected by the LHCb experiment. The calibration channels ${D}_{(s)}^{+}\to \phi {\pi}^{+}$ are used to remove production and detection asymmetries. The resulting CP-violating asymmetries are${\displaystyle \begin{array}{l}{\mathcal{A}}^{CP}=\left({D}^{+}\to \eta {\pi}^{+}\right)=\left(0.34\pm 0.66\pm 0.16\pm 0.05\right)\%,\\ {}{\mathcal{A}}^{CP}=\left({D}_s^{+}\to \eta {\pi}^{+}\right)=\left(0.32\pm 0.51\pm 0.12\right)\%,\\ {}\begin{array}{l}{\mathcal{A}}^{CP}=\left({D}^{+}\to {\eta}^{\prime }{\pi}^{+}\right)=\left(0.49\pm 0.18\pm 0.06\pm 0.05\right)\%,\\ {}{\mathcal{A}}^{CP}=\left({D}_s^{+}\to {\eta}^{\prime }{\pi}^{+}\right)=\left(0.01\pm 0.12\pm 0.08\right)\%,\end{array}\end{array}}$where the first uncertainty is statistical, the second is systematic and the third, relevant for the D$^{+}$ channels, is due to the uncertainty on ${\mathcal{A}}^{CP}=\left({D}^{+}\to \phi {\pi}^{+}\right)$. These measurements, currently the most precise for three of the four channels considered, are consistent with the absence of CP violation. A combination of these results with previous LHCb measurements is presented.[graphic not available: see fulltext]Searches for $CP$ violation in the decays $D^+_{(s)}\rightarrow \eta \pi^+$ and $D^+_{(s)}\rightarrow \eta^{\prime} \pi^+$ are performed using $pp$ collision data corresponding to 6 fb$^{-1}$ of integrated luminosity collected by the LHCb experiment. The calibration channels $D^+_{(s)}\rightarrow \phi \pi^+$ are used to remove production and detection asymmetries. The resulting $CP$-violating asymmetries are $A^{CP}(D^+ \rightarrow \eta \pi^+) = (0.34 \pm 0.66 \pm 0.16 \pm 0.05)\%$, $A^{CP}(D^+_s \rightarrow \eta \pi^+) = (0.32 \pm 0.51 \pm 0.12)\%$, $A^{CP}(D^+ \rightarrow \eta^{\prime} \pi^+) = (0.49 \pm 0.18 \pm 0.06 \pm 0.05)\%$, $A^{CP}(D^+_s \rightarrow \eta^{\prime} \pi^+) = (0.01 \pm 0.12 \pm 0.08)\%$, where the first uncertainty is statistical, the second is systematic and the third, relevant for the $D^+$ channels, is due to the uncertainty on $A^{CP}(D^+ \to \phi \pi^+)$. These measurements, currently the most precise for three of the four channels considered, are consistent with the absence of $CP$ violation. A combination of these results with previous LHCb measurements is presented

Amplitude analysis of the Λc+→pK−π+\Lambda^+_c\to pK^-\pi^+ decay and Λc+\Lambda^+_c baryon polarization measurement in semileptonic beauty hadron decays

An amplitude analysis of $\Lambda^+_c \to pK^-\pi^+$ decays together with a measurement of the $\Lambda^+_c$ polarization vector in semileptonic beauty hadron decays is presented. A sample of $400\,000$ candidates is selected from proton-proton collisions recorded by the LHCb detector at a center-of-mass energy of 13 TeV. An amplitude model is developed and the resonance fractions as well as two- and three-body decay parameters are reported. The mass and width of the $\Lambda(2000)$ state are also determined. A significant $\Lambda^+_c$ polarization is found. A large sensitivity of the $\Lambda^+_c \to pK^-\pi^+$ decay to the polarization is seen, making the amplitude model suitable for $\Lambda^+_c$ polarization measurements in other systems.An amplitude analysis of Λc+→pK-π+ decays together with a measurement of the Λc+ polarization vector in semiōleptonic beauty hadron decays is presented. A sample of 400 000 candidates is selected from proton-proton collisions recorded by the LHCb detector at a center-of-mass energy of 13 TeV. An amplitude model is developed and the resonance fractions as well as two- and three-body decay parameters are reported. The mass and width of the Λ(2000) state are also determined. A significant Λc+ polarization is found. A large sensitivity of the Λc+→pK-π+ decay to the polarization is seen, making the amplitude model suitable for Λc+ polarization measurements in other systems.An amplitude analysis of $\Lambda^+_c \to pK^-\pi^+$ decays together with a measurement of the $\Lambda^+_c$ polarization vector in semileptonic beauty hadron decays is presented. A sample of $400\,000$ candidates is selected from proton-proton collisions recorded by the LHCb detector at a center-of-mass energy of 13 TeV. An amplitude model is developed and the resonance fractions as well as two- and three-body decay parameters are reported. The mass and width of the $\Lambda(2000)$ state are also determined. A significant $\Lambda^+_c$ polarization is found. A large sensitivity of the $\Lambda^+_c \to pK^-\pi^+$ decay to the polarization is seen, making the amplitude model suitable for $\Lambda^+_c$ polarization measurements in other systems