RESUMO
BACKGROUND: Data on pediatric antiphospholipid syndrome (APS) are very sparse. OBJECTIVES: To describe the main clinical characteristics, laboratory data and complications of pediatric APS patients, and to analyze the differences between primary APS and APS associated with systemic lupus erythematosus (SLE). METHODS: We retrospectively reviewed clinical and laboratory data of 32 children at the Federico Gomez children's hospital in Mexico. Nineteen patients had SLE, 12 (37.5%) had primary APS and 1 (3%) had immune thrombocytopenic purpura. We collected information on sociodemographic variables, vaccinations, age at onset, and family history of rheumatic disease, hematological disorders, skin disorders and non-thrombotic neurological disorders. Immunological features included immunoglobulin (Ig) G and IgM anticardiolipin antibodies, IgG and IgM anti-beta2 glycoprotein I antibodies, lupus anticoagulant, and anti-dsDNA and antinuclear antibodies. RESULTS: The patients included 24 females and 8 males. The most common thrombotic events were small vessel thrombosis (44%), venous thrombosis (28%) mainly deep venous thrombosis (DVT) in lower extremities, and arterial thrombosis (25%). The most common clinical non-thrombotic manifestations were hematological (53%) and neurological disorders (22%). There were no significant differences between groups with regard to the site of thrombosis, nonthrombotic clinical manifestations or laboratory features. CONCLUSIONS: There were some important differences between the clinical manifestations of APS in children compared with adults, but we found no significant differences between patients with primary and APS associated with SLE. Larger studies in Latin American APS children are necessary to determine whether there are differences between ethnic groups.
Assuntos
Síndrome Antifosfolipídica/epidemiologia , Idade de Início , Síndrome Antifosfolipídica/imunologia , Distribuição de Qui-Quadrado , Criança , Feminino , Humanos , Masculino , México/epidemiologia , Sistema de Registros , Estudos RetrospectivosRESUMO
BACKGROUND: The aim of this paper is to describe clinical aspects of the torsion of the omentum. METHODS: In this observational, retrospective study, the study group consisted of patients surgically managed for torsion of the omentum, between 1998 and 2008, in a second level medical facility in Mexico. Variables in the study included age, sex, signs and symptoms, body mass index (BMI), treatment and evolution time. Descriptive statistical analysis was employed. RESULTS: Eleven patients were confirmed torsion of omentum, 7 (63.63%) women and 4 (36.36%) men, median age 33 (20 to 58) years, BMI > 25.0 in 9 (81.81%), average evolution 6.54, SD 3.47 days. All presented with abdominal pain, 6 (54.54%) with abdominal distension, 4 (36.36%) with ambulatory difficulty, 3 (27.27%) with malaise, and 5 (45.45%) with previous surgery. In all cases diagnosis was made by means of laparotomy, treatment was the resection of the affected segment, and there were no further complications. CONCLUSIONS: Torsion of the omentum resembles acute appendicitis; abdominal pain and abdominal distension are the most common symptoms. It is often discovered during surgery and it is treated surgically by removal of the affected segment of the omentum.
RESUMO
We propose that the pathogenesis of obesity-induced osteoarthritis may be explained by the metabolic changes in the striated muscle induced by the interaction of insulin resistance and systemic inflammation in obese individuals with metabolic syndrome being osteoarthritis the latest consequence by the physiological changes seen in the metabolic syndrome. Increased levels of TH1 cytokines are produced by activated macrophages in the presence of an acute or chronic infectious disease and suppress the sensitivity of insulin receptors on the membrane of muscle cell and adipocytes. Both cells are activated by inflammatory cytokines and contribute to enhance acute inflammation and to maintain a state of chronic, low-grade inflammation in apparently healthy obese individuals. The increased number of macrophage in the adipose tissue of obese individuals acts as an amplifier of inflammation. Patients with osteoarthritis and metabolic syndrome frequently are complaining about hotness and recurrent edema of feet and hands. It is probable that hyperinsulinemia in the presence of insulin resistance and inflammation, induce vasodilation through the TNF mediated-iNOS overexpression. Patients with metabolic syndrome express clinically the consequence of a poor uptake, storage and energy expenditure by the muscle and any other insulin dependent tissue and the consequence of high insulin plasma levels are vasodilation and increased protein synthesis. The fatigue and muscle weakness induced by insulin resistance and inflammation in obese patients with metabolic syndrome increase the frequency and the intensity of traumatic events of peripheral or axial joints that result in stretch and breaking of tenoperiosteal junction and abrasive damage of cartilage and therefore in these patients with metabolic syndrome and pro-inflammatory state the reparative process of cartilage and periarticular tissues would be severely modified by the growth factor activity in presence of high levels of insulin.