RESUMO
Resumen Caso clínico: Se describe un caso clínico poco frecuente en un paciente inmunocomprometido con hallazgo histopatológico de infestación parasitaria. Es un paciente masculino de edad media que habita en zona subtropical con diagnóstico de enfermedad de Crohn tratado con corticoide e inmunomoduladores, presentaba dolor abdominal y anemia crónica de 1 año de evolución, analítica negativa para parásitos, reactantes de fase aguda normales, gastroscopia y colonoscopia previas (6 meses) sin hallazgos relevantes. Por la persistencia del cuadro clínico se repitieron los estudios endoscópicos en los que se visualizaron hemorragias subepiteliales con resultados histopatológicos de Strongyloides stercoralis. Conclusión: En el contexto de un paciente inmunocomprometido, en zona endémica y con evolución tórpida, debe obligar a realizar un diagnóstico diferencial en el que se debe sospechar siempre de infestación parasitaria. Aunque la endoscopia no se necesita para el diagnóstico de estrongiloidiasis, su intervención puede ser oportuna.
Abstract Clinical case: The following is a rare clinical case in an immunocompromised patient with histopathological findings of parasitic infestation. The patient is a middle-aged male who lives in a subtropical area and has a diagnosis of Crohn's disease treated with corticosteroids and immunomodulators. The patient presented with abdominal pain and chronic anemia for 1 year, with negative laboratory tests for parasites and normal acute phase reactants. Gastroscopy and colonoscopy were performed before the consultation (6 months) without relevant findings. Due to the persistence of the symptoms, endoscopic studies were repeated, finding subepithelial bleeding with histopathological results of Strongyloides stercoralis. Conclusion: In the context of an immunocompromised patient living in an endemic area and with a torpid evolution, a differential diagnosis should be made always suspecting a parasitic infestation. Although endoscopy is not necessary to diagnose strongyloidiasis, its use may be convenient.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doença de Crohn , Strongyloides stercoralis , Parasitos , Pacientes , Dor Abdominal , Colonoscopia , Gastroscopia , Hemorragia , AnemiaRESUMO
Resumen Las vasculitis leucocitoclásticas se definen como el daño e inflamación de las paredes vasculares, son aquellas vasculitis de pequeños vasos que anatomopatológicamente presentan leucocitoclasia y puede observarse como una manifestación extraintestinal de la enfermedad inflamatoria intestinal. En la colitis ulcerativa se presentan en menor frecuencia, por inmunocomplejos generados en la mucosa intestinal debido a la exposición del tejido linfoide submucoso a antígenos fecales; podrían precipitarse en las paredes de los pequeños vasos. Se pueden asociar con Clostridium difficile, que es un bacilo grampositivo esporulado, anaerobio estricto, que se encuentra normalmente en el medio ambiente y produce colitis, que se manifiesta como un cuadro diarreico presentado después de la ingesta de antibióticos y altera la flora bacteriana común de este órgano. El caso se trata de un paciente 36 años de edad con cuadro de diarreas líquidas con moco y escaso sangrado; se realizó un estudio endoscópico y anatomopatológico en el que se observó colitis ulcerativa con coproparasitario positivo para antígeno de C. difficile, y en su hospitalización presentó lesiones dérmicas petequiales y necróticas en el cuarto dedo de la mano izquierda, que en la biopsia dio como resultado vasculitis de pequeños vasos. En este artículo se revisan de forma práctica los aspectos relacionados con la fisiopatología, histología, tratamiento y diagnósticos de la manifestación extraintestinal dermatológica rara, como la vasculitis leucocitoclástica en pacientes con colitis ulcerativas asociadas con Clostridium.
Abstract Leukocytoclastic vasculitis is defined as the damage and inflammation of the vascular walls. The term refers to vasculitis of the small vessels that anatomopathologically present leukocytoclasia and it can be seen as an extra-intestinal manifestation of inflammatory bowel disease. In ulcerative colitis, it occurs less frequently due to immune complexes produced in the intestinal mucosa by exposure of the submucosal lymphoid tissue to fecal antigens, which could precipitate in the walls of the small vessels. This condition can be associated with Clostridium difficile, which is a gram-positive, sporulated, strict anaerobic bacillus, normally found in the environment. It causes colitis that manifests as a diarrheal disease following the ingestion of antibiotics that alter the common bacterial flora of this organ. This is the case report of a 36-year-old patient with liquid diarrhea with mucus and scarce bleeding. Endoscopic and anatomopathological studies were performed, finding ulcerative colitis with positive coproparasite for Clostridium difficile antigen. The patient was hospitalized, and during his stay, he presented with petechiae and necrotic skin lesions on the fourth finger of the left hand. Skin biopsy showed small vessel vasculitis. This article is a practical review of the pathophysiology, histology, treatment, and diagnosis of a rare dermatologic extraintestinal manifestation, namely, leukocytoclastic vasculitis, in patients with C. difficile-associated ulcerative colitis.
Assuntos
Humanos , Masculino , Adulto , Vasculite , Doenças Inflamatórias Intestinais , Colite Ulcerativa , Clostridioides difficile , Pele , Terapêutica , Diarreia , Dedos , HistologiaRESUMO
The abundance of California sea lions (Zalophus californianus) (CSLs) and Guadalupe fur seals (Arctocephalus philippii townsendi) (GFSs) from the San Benito Archipelago (SBA) was determined through nine monthly surveys in 2014-2015. Assessment of their foraging habits was examined based on the isotopic analysis of pups (maternal indicators) (SIAR/SIBER-R). Environmental variability between 2014 and 2015 was also analyzed, in terms of sea surface temperature (SST) and chlorophyll (Chl-a) concentration. Both otariids reached their highest abundance in July of both years; however, relative to 2014, the 2015 survey showed a 59.7% decline in the total GFS abundance and a 42.9% decrease of GFS pups, while total CSL abundance decreased 52.0% and CSL pup presence decreased in 61.7%. All monthly surveys for both otariids showed a similar trend (>50% decrease in 2015). Compared to 2014, the 2015 GFSs isotopic niche was three times larger (2.0 in 2015, 0.6 in 2014) and the δ13C was significantly lower. CSLs also showed significantly lower δ13C and higher δ15N in 2015. Interannual segregation was greater for CSLs, and their pup body mass was also significantly lower during the 2015 breeding season (mean = 8.7 kg) than in the same season of 2014 (mean = 9.9 kg). The decrease in δ13C for both otariids reflected a more oceanic foraging; most likely associated with the decline in primary productivity in surrounding areas to the SBA, related to a higher SST caused by the 2015 ENSO, with a subsequent increase in foraging effort. These would explain the fewer observed individuals on land, especially pups, which showed diminished body condition (CSLs). This study highlights the importance of marine mammals as sentinel species that respond dynamically to changes in environment, providing valuable information on the effect of ENSO on pinnipeds in Mexican waters.
Assuntos
El Niño Oscilação Sul , Comportamento Alimentar/fisiologia , Otárias/fisiologia , Ilhas , Leões-Marinhos/fisiologia , Animais , Cruzamento , Isótopos de Carbono , Meio Ambiente , Geografia , Marcação por Isótopo , México , Isótopos de Nitrogênio , Estações do Ano , TemperaturaRESUMO
Thermosensitive macroporous scaffolds of poly(N-isopropylacrylamide) (polyNIPA) loaded with chitosan/bemiparin nanoparticles are prepared by the free radical polymerization in cryogenic conditions. Chitosan/bemiparin nanoparticles of 102 ± 6.5 nm diameter are prepared by complex coacervation and loaded into polyNIPA cryogels. SEM image reveal the highly porous structure of cryogels and the integration of nanoparticles into the macroporous system. Volume phase transition temperature (VPT) and total freezing water content of cryogels are established by differential scanning calorimetry, and their porosity is determined by image-NMR. Swelling of cryogels (above and below the VPT) is highly dependent on nanoparticles concentration. In vitro release profile of bemiparin from cryogel is highly modulated by the presence of chitosan. Bemiparin released from nanoparticles preserves its biological activity, as shown by the BaF32 cell proliferation assay. Cryogels are not cytotoxic for the human fibroblast cells and present excellent properties for application on tissue engineering and controlled release of heparin.
Assuntos
Resinas Acrílicas/química , Quitosana/química , Criogéis , Preparações de Ação Retardada/química , Heparina de Baixo Peso Molecular/química , Nanopartículas/química , Resinas Acrílicas/farmacologia , Linfócitos B/citologia , Linfócitos B/efeitos dos fármacos , Materiais Biocompatíveis , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Preparações de Ação Retardada/farmacologia , Fibroblastos/citologia , Fibroblastos/efeitos dos fármacos , Heparina de Baixo Peso Molecular/farmacologia , Humanos , Cinética , Microscopia Eletrônica de Varredura , Tamanho da Partícula , Polimerização , Porosidade , Temperatura , Engenharia Tecidual , Alicerces TeciduaisRESUMO
Films and sponges of chitosan (CHI), chitosan/hyaluronic acid (CHI-HA) and chitosan/chondroitin sulphate (CHI-CHOS), were prepared by film deposition or lyophilization (sponges), avoiding the formation of interpolyelectrolyte complexes. The biological behaviour of the systems was analysed by studying the cell behaviour using a fibroblast cell line and standard biological MTT and Alamar Blue tests. The morphology of films, sponges and cell seeded samples was analysed by ESEM. The results obtained indicate that all the systems can be considered as good supports for cell adhesion and proliferation, but there is specific activation of the proliferative process in the presence of hyaluronic acid and chondroitin sulphate.