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Anti-synthetase syndrome (AS) is a subset of idiopathic inflammatory myopathy (IIM) characterized by the presence of anti-aminoacyl-transfer RNA synthetase accompanied by myositis, interstitial lung disease and other clinical features. According to a recent multicentric study, 31% of AS patients present skin lesions compatible with dermatomyositis, but sclerodermiform features are rare. Therefore, we aimed to report the case of a patient with simultaneous diagnosis of AS, deep morphea, vasculitic neuropathy, and myelodysplastic syndrome and review the current literature regarding these uncommon associations. A 57 year old man with axial and symmetrical proximal muscle weakness, skin thickening and B symptoms, later diagnosed with PL7 + AS, deep morphea, myelodysplastic syndrome (MDS) and vasculitic neuropathy documented by histopathologic studies and immunologic assessments. Since both AS and deep morphea share the vasculopathic changes and type II interferon-induced inflammation, we hypothesize that they may share pathogenic mechanisms. The muscle biopsy of the patient was consistent with AS and showed focal neutrophil infiltration. The patient received intensive immunosuppressive therapy for AS and vasculitic neuropathy, with high dose steroids, intravenous immunoglobulin (IVIg) and rituximab. Nonetheless, he suffered an unfavorable evolution with a fatal outcome due to septic shock. Albeit sclerodermiform features are rare in patients with AS, we propose a pathogenic link among AS, deep morphea and the autoimmune/autoinflammatory signs of MDS. The vasculopathic changes along with the activation of the innate and adaptive immune system leading to the production of proinflammatory cytokines may have been one of the contributing factors for the coexisting diagnosis of the patient.
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Síndromes Mielodisplásicos , Miositis , Esclerodermia Localizada , Humanos , Masculino , Persona de Mediana Edad , Miositis/inmunología , Miositis/tratamiento farmacológico , Miositis/diagnóstico , Esclerodermia Localizada/tratamiento farmacológico , Esclerodermia Localizada/inmunología , Esclerodermia Localizada/patología , Síndromes Mielodisplásicos/complicaciones , Síndromes Mielodisplásicos/inmunología , Síndromes Mielodisplásicos/tratamiento farmacológico , Síndromes Mielodisplásicos/diagnóstico , Resultado Fatal , Inmunosupresores/uso terapéutico , Autoanticuerpos/sangre , Aminoacil-ARNt Sintetasas/inmunologíaRESUMEN
The coronavirus disease 2019 (COVID-19) survivors are frequently observed to present persistent symptoms constituting what has been called "post-acute COVID-19 syndrome" (PACS) or "long COVID-19". Some clinical risk factors have been identified to be associated with PACS development; however, specific mechanisms responsible for PACS pathology remain unknown. This study investigates clinical, immunological, and metabolomic risk factors associated with post-acute COVID-19 syndrome (PACS) in 51 patients, assessed 7-19 months after acute infection. Among the participants, 62.7% were male and 37.2% were female, with an average age of 47.8 years. At the follow-up, 37.2% met the criteria for PACS, revealing significant differences in immunological and metabolomic profiles at the time of acute infection. Patients with PACS were characterized by elevated levels of mature low-density granulocytes (LDGs), interleukin-8 (IL-8), pyruvate, pseudouridine, and cystine. Baseline multivariate analysis showed increased pyruvate and decreased alpha tocopherol levels. At follow-up, there was a decrease in absolute B lymphocytes and an increase in non-classical monocytes and 3-hydroxyisovaleric acid levels. These findings suggest that specific immunological and metabolomic markers during acute infection can help identify patients at higher risk of developing persistent PACS.
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COVID-19 , Síndrome Post Agudo de COVID-19 , SARS-CoV-2 , Humanos , Femenino , COVID-19/inmunología , COVID-19/metabolismo , COVID-19/complicaciones , Masculino , Persona de Mediana Edad , Adulto , Factores de Riesgo , Biomarcadores , Metabolómica/métodos , Anciano , Metaboloma , Interleucina-8/metabolismoRESUMEN
BACKGROUND AND PURPOSE: Gastrointestinal tumours overexpress voltage-gated calcium (CaV3) channels (CaV3.1, 3.2 and 3.3). CaV3 channels regulate cell growth and apoptosis colorectal cancer. Gossypol, a polyphenolic aldehyde found in the cotton plant, has anti-tumour properties and inhibits CaV3 currents. A systematic study was performed on gossypol blocking mechanism on CaV3 channels and its potential anticancer effects in colon cancer cells, which express CaV3 isoforms. EXPERIMENTAL APPROACH: Transcripts for CaV3 proteins were analysed in gastrointestinal cancers using public repositories and in human colorectal cancer cell lines HCT116, SW480 and SW620. The gossypol blocking mechanism on CaV3 channels was investigated by combining heterologous expression systems and patch-clamp experiments. The anti-tumoural properties of gossypol were estimated by cell proliferation, viability and cell cycle assays. Ca2+ dynamics were evaluated with cytosolic and endoplasmic reticulum (ER) Ca2+ indicators. KEY RESULTS: High levels of CaV3 transcripts correlate with poor prognosis in gastrointestinal cancers. Gossypol blockade of CaV3 isoforms is concentration- and use-dependent interacting with the closed, activated and inactivated conformations of CaV3 channels. Gossypol and CaV3 channels down-regulation inhibit colorectal cancer cell proliferation by arresting cell cycles at the G0/G1 and G2/M phases, respectively. CaV3 channels underlie the vectorial Ca2+ uptake by endoplasmic reticulum in colorectal cancer cells. CONCLUSION AND IMPLICATIONS: Gossypol differentially blocked CaV3 channel and its anticancer activity was correlated with high levels of CaV3.1 and CaV3.2 in colorectal cancer cells. The CaV3 regulates cell proliferation and Ca2+ dynamics in colorectal cancer cells. Understanding this blocking mechanism maybe improve cancer therapies.
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Bloqueadores de los Canales de Calcio , Canales de Calcio Tipo T , Proliferación Celular , Neoplasias del Colon , Gosipol , Humanos , Gosipol/farmacología , Gosipol/análogos & derivados , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/patología , Neoplasias del Colon/metabolismo , Bloqueadores de los Canales de Calcio/farmacología , Proliferación Celular/efectos de los fármacos , Canales de Calcio Tipo T/metabolismo , Canales de Calcio Tipo T/genética , Puntos de Control de la Fase G1 del Ciclo Celular/efectos de los fármacos , Calcio/metabolismo , Línea Celular Tumoral , Fase de Descanso del Ciclo Celular/efectos de los fármacos , Antineoplásicos/farmacologíaAsunto(s)
Mediastinitis , Enfermedades Periodontales , Absceso Retrofaríngeo , Infecciones de los Tejidos Blandos , Humanos , Masculino , Antibacterianos/uso terapéutico , Mediastinitis/diagnóstico por imagen , Mediastinitis/etiología , Mediastinitis/patología , Mediastinitis/terapia , Necrosis , Absceso Retrofaríngeo/diagnóstico por imagen , Absceso Retrofaríngeo/etiología , Absceso Retrofaríngeo/patología , Absceso Retrofaríngeo/terapia , Infecciones de los Tejidos Blandos/diagnóstico por imagen , Infecciones de los Tejidos Blandos/etiología , Infecciones de los Tejidos Blandos/patología , Infecciones de los Tejidos Blandos/terapia , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Enfermedades Periodontales/complicaciones , Enfermedades Periodontales/diagnóstico por imagen , Enfermedades Periodontales/patología , Enfermedades Periodontales/terapiaRESUMEN
Abstract Introduction: Upper endoscopy is the standard method for diagnosing early-stage gastric cancer. However, according to estimates, up to 20% of tumors are not detected, and their accuracy may be affected by the variability in their performance. In Colombia, most diagnoses take place in advanced stages, which aggravates the problem. Protocols have been proposed to ensure the complete observation of areas prone to premalignant lesions to address variability. Objective: To build and validate an automatic audit system for endoscopies using artificial intelligence techniques. Methodology: In this study, 96 patients from a teaching hospital underwent video-documented endoscopies, spanning 22 stations rearranged to minimize overlaps and improve the identification of 13 key gastric regions. An advanced convolutional network was used to process the images, extracting visual characteristics, which facilitated the training of artificial intelligence in the classification of these areas. Results: the model, called Gastro UNAL, was trained and validated with images of 67 patients (70% of cases) and tested with 29 different patients (30% of cases), which reached an average sensitivity of 85,5% and a specificity of 98,8% in detecting the 13 gastric regions. Conclusions: The effectiveness of the model suggests its potential to ensure the quality and accuracy of endoscopies. This approach could confirm the regions evaluated, alerting less experienced or trained endoscopists about blind spots in the examinations, thus, increasing the quality of these procedures.
Resumen Introducción: La endoscopia digestiva alta es el método estándar para diagnosticar el cáncer gástrico en etapas tempranas. Sin embargo, su precisión puede verse afectada por la variabilidad en su realización, y se estiman hasta 20% de tumores no detectados. En Colombia, la mayoría de los diagnósticos se realizan en etapas avanzadas, lo que agrava el problema. Para abordar la variabilidad, se han propuesto protocolos con el fin de asegurar la observación completa de áreas propensas a lesiones premalignas. Objetivo: Construir y validar un sistema de auditoría automática para endoscopias usando técnicas de inteligencia artificial. Metodología: En este estudio, 96 pacientes de un hospital universitario se sometieron a endoscopias documentadas en video, abarcando 22 estaciones reorganizadas para minimizar solapamientos y mejorar la identificación de 13 regiones gástricas clave. Se utilizó una red convolucional avanzada para procesar las imágenes, extrayendo características visuales, lo que facilitó el entrenamiento de la inteligencia artificial en la clasificación de estas áreas. Resultados: El modelo, llamado Gastro UNAL, fue entrenado y validado con imágenes de 67 pacientes (70% de los casos) y probado con 29 pacientes distintos (30% de los casos), con lo que alcanzó una sensibilidad promedio del 85,5% y una especificidad del 98,8% en la detección de las 13 regiones gástricas. Conclusiones: La eficacia del modelo sugiere su potencial para asegurar la calidad y precisión de las endoscopias. Este enfoque podría confirmar las regiones evaluadas, alertando puntos ciegos en la exploración a los endoscopistas con menos experiencia o en entrenamiento, de tal forma que se aumente la calidad de estos procedimientos.
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Up to 30% of patients with celiac disease (CD) suffer from concurrent autoimmune disease, compared to 3% of the general population. The association between CD and the current clinical phenotypes of inflammatory myopathies (IIM) patients has not been thoroughly addressed. Assess the CD features among patients with IIM and their relationship with the clinical phenotype and the myositis specific (MSA) and associated antibodies (MAA). For this cross-sectional study, we recruited 99 adult patients classified as IIM from a tertiary center in Mexico. We assessed serum MSA, MAA, and CD-associated autoantibodies (IgA anti-tissue transglutaminase (tTG) and both IgA and IgG anti-deaminated gliadin peptide (DGP)). Patients with highly suggestive serology for CD were then tested for IgG anti-endomysium antibodies, and a duodenal biopsy was performed. 70.7% of patients were positive for at least one antibody. Nine duodenal biopsies were taken, revealing findings compatible with celiac disease in two cases. Subjects with anti-MDA5 antibodies were more likely to have positive anti-tTG IgA antibodies (OR 6.76, 95% CI 1.85-24.62, P = 0.013) and suggestive CD serology (OR 6.41, 95% CI 1.62-25.29, P = 0.009). Patients with anti-Mi2 antibodies were more likely to have positive anti-DGP IgG antibodies (OR 3.35, 95% CI 1.12-9.96, P = 0.039), while positivity for these autoantibodies was less frequent in patients with anti-NXP2 antibodies (OR 0.22, 95% CI 0.06-0.80, P = 0.035). There is a higher prevalence of serologic and definite CD in patients with IIM compared to the general population. Identifying this subgroup of patients may have prognostic and therapeutic implications. Key points ⢠The study estimated a serological celiac disease (CD) prevalence of 70.7% in patients with idiopathic inflammatory myopathies (IIM) and a biopsy-confirmed prevalence of 2%, suggesting that IIM patients should be considered a high-risk population for CD. ⢠We identified a significant association between serological CD and the presence of anti-MDA5 and anti-Mi2 antibodies, suggesting a potential justification for celiac disease screening in this specific subgroup of patients. ⢠The impact of gluten-free diets on IIM patients with serological markers of CD remains untested and warrants further investigation through prospective, randomized studies.
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Autoanticuerpos , Enfermedad Celíaca , Miositis , Humanos , Enfermedad Celíaca/epidemiología , Enfermedad Celíaca/inmunología , Enfermedad Celíaca/sangre , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/complicaciones , Estudios Transversales , Femenino , Masculino , Persona de Mediana Edad , Adulto , Prevalencia , Autoanticuerpos/sangre , Miositis/inmunología , Miositis/epidemiología , Miositis/sangre , México/epidemiología , Transglutaminasas/inmunología , Anciano , Inmunoglobulina A/sangre , Gliadina/inmunología , Inmunoglobulina G/sangre , Proteína Glutamina Gamma Glutamiltransferasa 2RESUMEN
Hepatocellular carcinoma (HCC) is the most common primary malignancy in the liver and is the third cause of cancer-related death worldwide. Surveillance with abdominal ultrasound should be offered to individuals at high risk for developing HCC. Accurate diagnosis, staging, and liver function are crucial when determining the optimal therapeutic approach. The BCLC staging system is widely endorsed in Western countries. Managing this pathology requires a multidisciplinary, personalized approach, generally with a multimodal strategy. Surgery remains the only curative option, albeit local and systemic therapy may also increase survival when surgery is not suitable. In advanced disease, systemic treatment should be offered to patients with ECOG/PS 0-1 and Child-Pugh class A.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/patología , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/patología , Estadificación de Neoplasias , Terapia Combinada , Oncología MédicaRESUMEN
Colonoscopy is the choice procedure to diagnose, screening, and treat the colon and rectum cancer, from early detection of small precancerous lesions (polyps), to confirmation of malign masses. However, the high variability of the organ appearance and the complex shape of both the colon wall and structures of interest make this exploration difficult. Learned visuospatial and perceptual abilities mitigate technical limitations in clinical practice by proper estimation of the intestinal depth. This work introduces a novel methodology to estimate colon depth maps in single frames from monocular colonoscopy videos. The generated depth map is inferred from the shading variation of the colon wall with respect to the light source, as learned from a realistic synthetic database. Briefly, a classic convolutional neural network architecture is trained from scratch to estimate the depth map, improving sharp depth estimations in haustral folds and polyps by a custom loss function that minimizes the estimation error in edges and curvatures. The network was trained by a custom synthetic colonoscopy database herein constructed and released, composed of 248400 frames (47 videos), with depth annotations at the level of pixels. This collection comprehends 5 subsets of videos with progressively higher levels of visual complexity. Evaluation of the depth estimation with the synthetic database reached a threshold accuracy of 95.65%, and a mean-RMSE of 0.451cm, while a qualitative assessment with a real database showed consistent depth estimations, visually evaluated by the expert gastroenterologist coauthoring this paper. Finally, the method achieved competitive performance with respect to another state-of-the-art method using a public synthetic database and comparable results in a set of images with other five state-of-the-art methods. Additionally, three-dimensional reconstructions demonstrated useful approximations of the gastrointestinal tract geometry. Code for reproducing the reported results and the dataset are available at https://github.com/Cimalab-unal/ColonDepthEstimation.
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Colon , Colonoscopía , Bases de Datos Factuales , Humanos , Colonoscopía/métodos , Colon/diagnóstico por imagen , Redes Neurales de la Computación , Pólipos del Colon/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodosRESUMEN
RESUMEN Introducción: La adolescencia se caracteriza por una etapa de cambios que pueden implicar la aparición de conductas como el consumo de sustancias, las conductas sexuales de riesgo, la conducta suicida y la violencia, entre otras; es por ello que prácticas como el Mindfulness y la habilidad para percibir, comprender y regular emociones como la Inteligencia Emocional (IE) han mostrado efectos sobre dichas conductas. Objetivo: Analizar la evidencia científica disponible sobre el Mindfulness y la Inteligencia Emocional en los adolescentes. Material y métodos: Se realizó una revisión sistemática, para la estrategia de búsqueda se utilizaron descriptores en los idiomas inglés (Mindfulness, emotional intelligence, adolescent) y español (atención plena, inteligencia emocional, adolescente). Resultados: Se identificó que existe una relación y efecto positivo y significativo entre la práctica del Mindfulness y la Inteligencia Emocional. Conclusión: Los participantes con mayor nivel de atención plena son aquellos que tienen mejores capacidades de regulación emocional, de ser más conscientes de sus emociones, competentes para hacer frente a los problemas y tienen mejores relaciones interpersonales.
ABSTRACT Introduction: Adolescence is characterized by a stage of changes that may involve the appearance of behaviors such as substance use, risky sexual behaviors, suicidal behavior and violence, among others, which is why practices such as Mindfulness and the ability to perceive, understand and regulate emotions such as Emotional Intelligence (EI) have shown effects on such behaviors. Objective: To analyze the available scientific evidence on Mindfulness and Emotional Intelligence in adolescents. Material and methods: A systematic review was carried out, using descriptors in English (Mindfulness, "emotional intelligence", "adolescent") and Spanish ("atención plena", "inteligencia emocional", "adolescente") for the search strategy. Results: It was identified that there is a positive and significant relationship and effect between the practice of Mindfulness and Emotional Intelligence. Conclusion: Participants with a higher level of mindfulness are those who have better emotional regulation skills, are more aware of their emotions, competent to cope with problems and have better interpersonal relationships.
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Introduction: Serine proteases play a critical role during SARS-CoV-2 infection. Therefore, polymorphisms of transmembrane protease serine 2 (TMPRSS2) and serpine family E member 1 (SERPINE1) could help to elucidate the contribution of variability to COVID-19 outcomes. Methods: To evaluate the genetic variants of the genes previously associated with COVID-19 outcomes, we performed a cross-sectional study in which 1536 SARS-CoV-2-positive participants were enrolled. TMPRSS2 (rs2070788, rs75603675, rs12329760) and SERPINE1 (rs2227631, rs2227667, rs2070682, rs2227692) were genotyped using the Open Array Platform. The association of polymorphisms with disease outcomes was determined by logistic regression analysis adjusted for covariates (age, sex, hypertension, type 2 diabetes, and obesity). Results: According to our codominant model, the GA genotype of rs2227667 (OR=0.55; 95% CI = 0.36-0.84; p=0.006) and the AG genotype of rs2227667 (OR=0.59; 95% CI = 0.38-0.91; p=0.02) of SERPINE1 played a protective role against disease. However, the rs2227692 T allele and TT genotype SERPINE1 (OR=1.45; 95% CI = 1.11-1.91; p=0.006; OR=2.08; 95% CI = 1.22-3.57; p=0.007; respectively) were associated with a decreased risk of death. Similarly, the rs75603675 AA genotype TMPRSS2 had an OR of 1.97 (95% CI = 1.07-3.6; p=0.03) for deceased patients. Finally, the rs2227692 T allele SERPINE1 was associated with increased D-dimer levels (OR=1.24; 95% CI = 1.03-1.48; p=0.02). Discussion: Our data suggest that the rs75603675 TMPRSS2 and rs2227692 SERPINE1 polymorphisms are associated with a poor outcome. Additionally, rs2227692 SERPINE1 could participate in hypercoagulable conditions in critical COVID-19 patients, and this genetic variant could contribute to the identification of new pharmacological targets and treatment strategies to block the inhibition of TMPRSS2 entry into SARS-CoV-2.
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COVID-19 , Diabetes Mellitus Tipo 2 , Humanos , COVID-19/genética , Serina Proteasas , SARS-CoV-2 , Estudios TransversalesRESUMEN
Idiopathic inflammatory myopathies are a heterogeneous group of rare autoimmune disorders characterized by progressive muscle weakness and the histopathologic findings of inflammatory infiltrates in muscle tissue. Although their pathogenesis remains indefinite, the association of autoantibodies with clinical manifestations and the evidence of high effectiveness of depleting therapies suggest that B cells could be implicated. Therefore, we explored the landscape of peripheral B cells in this disease by multiparametric flow cytometry, finding significant numerical decreases in memory and double-negative subsets, as well as an expansion of the naive compartment relative to healthy controls, that contribute to defining disease-associated B-cell subset signatures and correlating with different clinical features of patients. Additionally, we determined the potential value of these subsets as diagnostic biomarkers, thus positioning B cells as neglected key elements possibly participating in idiopathic inflammatory myopathy onset or development.
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Subgrupos de Linfocitos B , Biomarcadores , Miositis , Humanos , Miositis/inmunología , Miositis/patología , Subgrupos de Linfocitos B/inmunología , Subgrupos de Linfocitos B/metabolismo , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Citometría de FlujoRESUMEN
OBJECTIVE: To address the relationship between systemic lupus erythematosus (SLE) disease activity and the functional parameters of the innate immunity. METHODS: We evaluated a cohort of 26 adult SLE patients and 10 sex and age-paired healthy donors. When the patients had a disease flare (baseline) and when they achieve clinical response (follow-up), we assessed the systemic lupus erythematosus disease activity index 2 K (SLEDAI 2 K) and the following parameters with flow cytometry and confocal microscopy: monocyte subsets, their expression of TLR2, phagocytic monocytes and neutrophils using the pHrodo Red E. coli BioParticles, the respiratory burst with 123-dihydrorhodamine in neutrophils, and the spontaneous and lipopolysaccharide (LPS)-induced production of neutrophil extracellular traps (NETs). We used the Wilcoxon test to compare the paired medians with interquartile range (IQR) and the Mann-Whitney U test for independent medians. To assess the effect of prednisone and SLEDAI 2 K on the mentioned parameters, we applied a generalized mixed linear model. RESULTS: Twenty-three patients (88.4%) were women. The SLEDAI 2 K was higher at baseline 8 (6-14) in comparison to that at follow-up (6 (4-8), P = 0.028). At baseline, SLE patients had a decreased percentage of intermediate monocytes, a higher expression of TLR2 in total monocytes, increased phagocytosis in monocytes and neutrophils, a decreased respiratory burst intensity, and an increased production of NETs. In the mix model, the SLEDAI 2 K was the main factor influencing these functional innate immune parameters. CONCLUSION: Disease activity regulates the innate immune function in SLE which may contribute to the clinical features and infection predisposition. Key points ⢠This is the first cohort study addressing the effect of disease activity and prednisone use on the innate immune function of lupus patients. ⢠Our results show that the disease activity is a key regulator of the respiratory burst, phagocytosis, and the production of neutrophil extracellular traps. ⢠Also, we observed a differential proportion of monocyte subsets according to SLE disease activity. ⢠We consider that our manuscript contributes to the evidence addressing the intrinsic immune abnormalities of patients with SLE regardless of the use of immunosuppressants and set the bases for new research work considering the disease activity as an element to decide the prescription and duration of antibiotic prophylaxis in SLE patients, which is of interest to all rheumatologists.
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Lupus Eritematoso Sistémico , Receptor Toll-Like 2 , Adulto , Humanos , Femenino , Masculino , Prednisona/uso terapéutico , Estudios de Cohortes , Escherichia coli , Lupus Eritematoso Sistémico/tratamiento farmacológico , InmunidadRESUMEN
Introducción: diversos estudios sugieren que existe una diferencia en el estrés percibido (EP) entre sexos en la población general. Sin embargo, hay escasas publicaciones que describan las diferencias de percepción del estrés entre sexos durante el confinamiento por COVID-19 en personas con diabetes mellitus (DM). Objetivos: evaluar las diferencias entre sexos relacionadas con el EP y la ansiedad en personas con DM durante el confinamiento por COVID-19 en Argentina. Materiales y métodos: estudio multicéntrico, observacional y transversal. Se incluyeron adultos con DM1 y DM2. El grado de estrés se evaluó por la escala de estrés percibido (perceived stress scale, PSS) y la ansiedad por el inventario de ansiedad de Beck (Beck anxiety inventory, BAI). Resultados: se incluyeron 2.273 pacientes (52,5% mujeres). En el análisis univariado, las puntuaciones de BAI y PSS fueron significativamente más altas en las mujeres con DM versus los hombres (BAI 8,9 versus 6,6; p<0,001 y PSS 14,3 versus 11,8; p<0,001). En el análisis multivariado, el sexo femenino se asoció significativamente con mayores puntuaciones de BAI y PSS después de ajustar por tipo de DM, edad, nivel de A1c, nivel educativo, condición de vivir solo/a, y presencia de comorbilidades o complicaciones (p<0,001). En la regresión lineal múltiple, las puntuaciones de BAI y PSS se asociaron significativamente con el sexo femenino (BAI p<0,0001 y PSS p<0,0013). Conclusiones: en los pacientes con DM, el sexo femenino se asoció con puntuaciones más altas de ansiedad y EP en el contexto de aislamiento durante la pandemia de COVID-19 en Argentina(AU)
Introduction: many studies suggest that there is a difference among genders in perceived stress (PS) in the general population. Descriptions of gender differences in PS during COVID- 19 lockdown in people with diabetes mellitus (DM) are lacking. Objectives: assess the differences regarding PS and anxiety between genders among people with DM during COVID-19 pandemic lockdown. Materials and methods: multi-center, cross-sectional observational study. Adults with type 1 DM (T1DM) and type 2 DM (T2DM) were included. Degree of stress was evaluated by the Perceived Stress Scale (PSS) and anxiety by the Beck anxiety inventory (BAI). Results: 2,273 patients (52.5% female) were included. Univariate analysis: BAI and PSS scores were significantly higher in women with diabetes vs. men (BAI 8.9 vs 6.6, p<0.001, PSS 14.3 vs 11.8, p<0.001). Multivariate analysis: female gender was significantly associated with BAI and PSS scores after adjustments to the type of DM, age, A1c, educational level, living alone condition and the presence of comorbidities or complications (p<0.001). In multiple linear regression, BAI and PSS scores were significantly associated with female gender a (BAI p<0.0001 and PSS p<0.0013]. Conclusions: in patients with DM female gender was associated with higher scores of anxiety and PS, in a context of isolation due to COVID-19 pandemic in Argentina(AU)
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Diabetes Mellitus , Ansiedad , Sexo , Adaptación Psicológica , COVID-19RESUMEN
Introduction: Good bowel preparation is essential for a quality colonoscopy. Thus, evaluating the risk factors associated with poor preparation is necessary. This problem has not been widely addressed in Colombia. Aim: To identify the factors associated with poor intestinal preparation. Materials and methods: Observational, analytical, cross-sectional, multicenter study in patients > 18 years of age who underwent colonoscopy and attended gastroenterology services between January and June 2020 in Bogotá. A Boston scale > 6 was defined as good preparation, and a Boston scale ≤ 6 was defined as poor preparation. Results: 265 patients were included, of whom 205 (77.4%) were well prepared and 60 (22.6%) had inadequate preparation. Factors associated with poor bowel preparation were age older than 60 years (odds ratio [OR]: 1.359; 95% confidence interval [CI]: 1.059-1.745; p = 0.026); male sex (OR: 1.573; 95% CI: 1.128-2.194; p = 0.012); obesity (BMI > 30 kg/m2; OR: 2.539; 95% CI: 1.388-4.645; p = 0.002); constipation (OR: 1.924; 95% CI: 1.154-3.208; p = 0.014); the use of antidepressants (OR: 2.897; 95% CI: 1.199-6.997; p = 0.014) and calcium antagonists (OR: 2.445; 95% CI: 1.292-4.630; p = 0.005), and having abdominopelvic surgeries (OR: 1.325 95% CI: 1.042-1.684, p = 0.034). Regarding the procedure, there was less polyp detection per patient (p = 0.04) and less minute (p = 0.020) and flat (p = 0.047) polyp detection in the poor bowel preparation group. Conclusions: This is the first study in Colombia in which the factors associated with poor intestinal preparation are described and include variables not explored in other studies. The results found are similar to those reported in the literature. These studies should be promoted with more patients, establishing a score for predicting poor preparation.
Introducción: una buena preparación intestinal es fundamental para una colonoscopia de calidad. Por eso es importante evaluar los factores de riesgo asociados a una mala preparación. Este problema no se ha abordado ampliamente en Colombia, por lo cual el objetivo de este estudio es identificar los factores asociados a una mala preparación intestinal. Métodos: estudio observacional, analítico, transversal, multicéntrico en pacientes > 18 años sometidos a colonoscopia que asistieron a los servicios de gastroenterología entre enero y junio de 2020 en la ciudad de Bogotá. Se definió como buena preparación una escala de Boston > 6, y como mala preparación una escala de Boston ≤ 6. Resultados: se incluyeron a 265 pacientes, de los cuales 205 (77,4%) estaban bien preparados y 60 (22,6%) tenían una preparación inadecuada. Los factores asociados a mala preparación intestinal fueron edad mayor de 60 años (odds ratio [OR]: 1,359; intervalo de confianza [IC] del 95%: 1,059-1,745; p = 0,026); sexo masculino (OR: 1,573; IC 95%: 1,128-2,194; p = 0,012); obesidad (IMC > 30 kg/m2; OR: 2,539; IC 95%: 1,388-4,645; p = 0,002); estreñimiento (OR: 1,924; IC 95%: 1,154-3,208; p = 0,014); el uso de antidepresivos (OR: 2,897; IC 95%: 1,199-6,997; p = 0,014) y antagonistas del calcio (OR: 2,445; IC 95%:1,292-4,630; p = 0,005) y tener cirugías abdominopélvicas (OR: 1,325; IC 95%: 1,042-1,684; p = 0,034). En cuanto al procedimiento, hubo una menor cantidad de detección de pólipos por paciente (p = 0,04) y menor detección de pólipo diminuto (p = 0,020) y plano (p = 0,047) en el grupo de mala preparación intestinal. Conclusiones: este es el primer estudio en Colombia en el cual se describen los factores asociados a la mala preparación intestinal e incluye variables no exploradas en otros estudios. Los resultados encontrados son similares a los reportados en la literatura. Se debe impulsar este tipo de estudios con una mayor cantidad de pacientes y plantear un puntaje de predicción de mala preparación.
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Resumen Objetivo: Conocer la relación de la inteligencia emocional (IE), satisfacción laboral y consumo de alcohol en el personal de enfermería que labora en un hospital de tercer nivel de atención. Materiales y métodos: Estudio descriptivo, transversal y correlacional. La muestra fue de 129 profesionales de enfermería que laboran en un hospital de tercer nivel, divididos en áreas críticas y no críticas. Los instrumentos utilizados fueron una Cédula de Datos Socio-demográficos, Trait Meta Mood Scale (TMMS-24), Cuestionario de Satisfacción Laboral S10/12 y AUDIT. Resultados: El 75% fueron mujeres, con estudios de licenciatura, más del 45% consumieron alcohol en la última semana. Se encontró que existe una relación positiva y significativa entre la inteligencia emocional y la satisfacción laboral (rs = .236, p < .001), también se encontró relación negativa y ssignificativa entre la satisfacción laboral y el consumo de alcohol (rs = -.195, p < .05). Conclusiones: Se muestran diferencias entre la IE, la satisfacción laboral y el consumo de alcohol en el personal de enfermería de acuerdo con el área en la que labora. Así mismo se observa la relación positiva entre la IE y la satisfacción llaboral, además de relación negativa entre satisfacción laboral y consumo de alcohol. Este estudio manifiesta la importancia de conocer a profundidad que factores impactan el cuidado que proporciona el personal de enfermería dentro de los servicios hospitalarios y cuáles son los métodos que utilizan para afrontarlos.
Abstract Objective: To know the relationship between emotional intelligence, job satisfaction and alcohol consumption in nursing staff working in a tertiary care hospital. Materials and methods: Descriptive, cross-sectional, and correlational study. The sample consisted of 129 nursing professionals who work in a third level hospital, divided into critical and non-critical areas. The instruments used were a Socio-demographic Data Sheet, Trait Meta Mood Scale (TMMS-24), Job Satisfaction Questionnaire S10/12 and AUDIT. Results: 75% were women, with undergraduate studies, more than 45% consumed in the last week. It was found that there is a positive and significant relationship between emotional intelligence and job satisfaction (rs = .236, p < .001), a negative and significant relationship was also found between job satisfaction and alcohol consumption (rs = -.195, p < .05). Conclusions: Differences are shown between EI, job satisfaction and alcohol consumption in nursing staff according to the area in which they work. Likewise, there is a positive relationship between EI and job satisfaction and a negative relationship between job satisfaction and alcohol consumption. This study demonstrates the importance of knowing in depth what factors impact the care provided by nursing staff within hospital services and what are the methods used to deal with them.
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Studies of cellular and cytokine profiles have contributed to the inflammation hypothesis of schizophrenia; however, precise markers of inflammatory dysfunction remain elusive. A number of proton magnetic resonance spectroscopy (1H-MRS) studies in patients with first-episode psychosis (FEP) have shown higher brain levels of metabolites such as glutamate, myo-inositol (mI) and choline-containing compounds (tCho), suggesting neuroinflammation. Here, we present peripheral inflammatory profiles in antipsychotic-naive FEP patients and age-and-sex matched healthy controls, as well as cortical glutamate, mI and tCho levels using 1H-MRS. Inflammatory profiles were analyzed using cytokine production by peripheral blood mononuclear cells, that were either spontaneous or stimulated, in 48 FEP patients and 23 controls. 1H-MRS of the medial prefrontal cortex was obtained in 29 FEP patients and 18 controls. Finally, 16 FEP patients were rescanned after 4 weeks of treatment (open-label) with Risperidone. FEP patients showed a higher proportion of proinflammatory Th1/Th17 subset, and an increased spontaneous production of Interleukin (IL)-6, IL-2 and IL-4 compared with the control group. Results obtained from 1H-MRS showed no significant difference in either glutamate, mI or tCho between FEP and control groups. At baseline, CD8% showed a negative correlation with glutamate in FEP patients; after 4 weeks of risperidone treatment, the FEP group exhibited a decrease in glutamate levels which positively correlated with CD4 + T cells. Nevertheless, these correlations did not survive correction for multiple comparisons. FEP patients show evidence of immune dysregulation, affecting both the innate and adaptive immune response, with a predominantly Th2 signature. These findings, along with the changes produced by antipsychotic treatment, could be associated with both systemic and central inflammatory processes in schizophrenia.
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Antipsicóticos , Neuroquímica , Trastornos Psicóticos , Humanos , Risperidona/uso terapéutico , Antipsicóticos/uso terapéutico , Leucocitos Mononucleares/metabolismo , Ácido Glutámico/metabolismo , Interleucina-6 , Inflamación/complicacionesRESUMEN
Introduction: Immunoglobulin A (IgA) is the main antibody isotype in body fluids such as tears, intestinal mucous, colostrum, and saliva. There are two subtypes of IgA in humans: IgA1, mainly present in blood and mucosal sites, and IgA2, preferentially expressed in mucosal sites like the colon. In clinical practice, immunoglobulins are typically measured in venous or capillary blood; however, alternative samples, including saliva, are now being considered, given their non-invasive and easy collection nature. Several autoimmune diseases have been related to diverse abnormalities in oral mucosal immunity, such as rheumatoid arthritis, Sjogren's syndrome, and systemic lupus erythematosus (SLE). Methods: We decided to evaluate the levels of both IgA subtypes in the saliva of SLE patients. A light chain capture-based ELISA measured specific IgA1 and IgA2 levels in a cohort of SLE patients compared with age and gender-matched healthy volunteers. Results: Surprisingly, our results indicated that in the saliva of SLE patients, total IgA and IgA1 subtype were significantly elevated; we also found that salivary IgA levels, particularly IgA2, positively correlate with anti-dsDNA IgG antibody titers. Strikingly, we also detected the presence of salivary anti-nucleosome IgA antibodies in SLE patients, a feature not previously reported elsewhere. Conclusions: According to our results and upon necessary validation, IgA characterization in saliva could represent a potentially helpful tool in the clinical care of SLE patients with the advantage of being a more straightforward, faster, and safer method than manipulating blood samples.
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Inmunoglobulina A Secretora , Lupus Eritematoso Sistémico , Humanos , Inmunoglobulina A , Inmunoglobulina G , Mucosa Bucal , BiomarcadoresRESUMEN
Skeletal muscle is one of the most abundant tissues of the human body and is responsible for the generation of movement. Muscle injuries can lead to severe disability. Skeletal muscle is characterized by an important regeneration capacity, which is possible due to the interaction between the myoblasts and immune cells. Neutrophils are fundamental as inducers of muscle damage and as promoters of the initial inflammatory response which eventually allows the muscle repair. The main functions of the neutrophils are phagocytosis, respiratory burst, degranulation, and the production of neutrophil extracellular traps (NETs). An overactivation of neutrophils after muscle injuries may lead to an expansion of the initial damage and can hamper the successful muscle repair. The importance of neutrophils as inducers of muscle damage extends beyond acute muscle injury and recently, neutrophils have become more relevant as part of the immunopathogenesis of chronic muscle diseases like idiopathic inflammatory myopathies (IIM). This heterogeneous group of systemic autoimmune diseases is characterized by the presence of muscle inflammation with a variable amount of extramuscular features. In IIM, neutrophils have been found to have a role as biomarkers of disease activity, and their expansion in peripheral blood is related to certain clinical features like interstitial lung disease (ILD) and cancer. On the other hand, low density granulocytes (LDG) are a distinctive subtype of neutrophils characterized by an enhanced production of NETs. These cells along with the NETs have also been related to disease activity and certain clinical features like ILD, vasculopathy, calcinosis, dermatosis, and cutaneous ulcers. The role of NETs in the immunopathogenesis of IIM is supported by an enhanced production and deficient degradation of NETs that have been observed in patients with dermatomyositis and anti-synthetase syndrome. Finally, new interest has arisen in the study of other phenotypes of LDG with a phenotype corresponding to myeloid-derived suppressor cells, which were also found to be expanded in patients with IIM and were related to disease activity. In this review, we discuss the role of neutrophils as both orchestrators of muscle repair and inducers of muscle damage, focusing on the immunopathogenesis of IIM.
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Dermatomiositis , Enfermedades Pulmonares Intersticiales , Enfermedades Musculares , Miositis , Humanos , Neutrófilos , Músculo Esquelético/patología , RegeneraciónRESUMEN
BACKGROUND: Currently, there is scant information regarding the features associated to the persistence of post-COVID-19 syndrome, which is the main aim of the present study. METHODS: A cohort study of 102 COVID-19 patients was conducted. The post-COVID-19 symptoms were assessed by a standardised questionnaire. Lymphocyte immunophenotyping was performed by flow cytometry and chemokines/cytokines, neutrophil extracellular traps, the tripartite motif 63, anti-cellular, and anti-SARS-CoV-2 IgG antibodies were addressed in serum. The primary outcome was the persistence of post-COVID-19 syndrome after six months follow-up. RESULTS: Thirteen patients (12.7%) developed the primary outcome and had a more frequent history of post-COVID-19 syndrome 3 months after infection onset (p = .044), increased levels of IL-1α (p = .011) and IP-10 (p = .037) and increased CD57 expression in CD8+ T cells (p = .003). There was a trend towards higher levels of IFN-γ (p = .051), IL-1ß (p = .062) and IL-6 (p = .087). The history of post COVID-19 in the previous 3 months, obesity, baseline serum MIP-1α and IP-10, and CD57 expression in CD8+ T cells were independently associated with the persistence of post-COVID-19 syndrome. CONCLUSION: Our data suggest an important relationship between a pro-inflammatory state mediated through metabolic pathways related to obesity and increased cellular senescence as a key element in the persistence of post-COVID-19 syndrome at six months of follow-up.
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COVID-19 , Humanos , COVID-19/complicaciones , Proyectos Piloto , Síndrome Post Agudo de COVID-19 , Linfocitos T CD8-positivos , Estudios de Cohortes , Quimiocina CXCL10 , ObesidadRESUMEN
OBJECTIVE: Variants in STAT4 are associated with systemic lupus erythematosus (SLE) and other autoimmune diseases. We undertook this study to investigate how disease-associated variants affect STAT4 expression, in particular in CD4+ T cells where STAT4 plays an essential role. METHODS: We compared Th1 differentiation between naive CD4+ T cells from healthy donors homozygous for the risk (R/R) or nonrisk (NR/NR) alleles. We analyzed epigenetic marks in STAT4 and evaluated the relevance of its third intron, assessed the consequences of Stat4 overexpression in vivo in mice, and analyzed the effects of the STAT4 genotype in patients with lupus nephritis. RESULTS: Naive CD4+ T cells from NR/NR healthy donors down-regulated STAT4 in response to interleukin-12 (IL-12). In contrast, cells from R/R healthy donors maintained high levels. R/R cells exhibited a higher abundance of transcriptionally active STAT4 and increased interferon-γ production. Accordingly, R/R healthy donors exhibited a stronger induction of local active enhancer marks. Genetic editing confirmed the presence of a negative regulatory region in the STAT4 third intron, where most of the SLE-associated STAT4 single-nucleotide polymorphisms (SNPs) are located. In vivo forced expression demonstrated that increases in Stat4 levels in T cells enhanced glomerulonephritis in mice. Accordingly, the R/R genotype was associated with suboptimal response to treatment and with worse clinical outcomes in patients with proliferative lupus nephritis. CONCLUSION: The SLE-associated STAT4 haplotype correlates with an abnormal IL-12-mediated STAT4 transcriptional regulation. Carriers of the risk variant exhibit exaggerated CD4+ proinflammatory capacities that, in the context of SLE, contribute to more severe disease. R/R patients may benefit from blockade of the IL-12/STAT4 pathway.