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Radin M, Cecchi I, Crisafulli F, Klumb EM, de Jesús GR, Lacerda MI, Saavedra MÁ, Reyes-Navarro GV, Iaccarino L, Larosa M, Moroni G, Tamborini F, Roccatello D, Andreoli L, Sciascia S, Chighizola CB. Complement levels during the first trimester predict disease flare and adverse pregnancy outcomes in systemic lupus erythematosus: A network meta-analysis on 532 pregnancies. Autoimmun Rev 2023; 22:103467. [PMID: 37852515 DOI: 10.1016/j.autrev.2023.103467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Complement levels have been proposed as candidate biomarkers of disease activity and obstetric risk in systemic lupus erythematosus (SLE) pregnancies, but their reliability has been questioned due to the physiologic fluctuations of complement during gestation. Thus, this network meta-analysis aimed at assessing the clinical significance of complement fluctuations in lupus pregnant women. METHODS Corresponding authors of 19 studies meeting inclusion criteria were invited to contribute with additional data including C3 and C4 levels [before pregnancy, at conception, in every trimester (T) and 3 months after delivery]; data were pooled together in a network meta-analysis. RESULTS A total of 532 lupus women from four studies were included in the analysis. In SLE women, C3 and C4 increased progressively during gestation: levels remained stable during T1 and peaked in T2 to decrease in T3. Patients with previous lupus nephritis (LN) and those who experienced flares during pregnancy had significantly lower mean levels of C3 and C4 at all timepoints. The lowest levels of complement were observed, particularly during T1, in patients with LN and gestational flare. Both reduction and the lack of increase of C3 and C4 levels at T1 versus conception were associated with gestational flares, particularly in LN patients. Pregnancies with flare had a statistically significant higher rate of maternal and fetal complications(60% versus 50.3%; p = 0.03). CONCLUSIONS Low complement levels, particularly in T1, were associated with a higher frequency of gestational flare. Either reduction or smaller increase of C3 and/or C4 levels, even within normal range, might predict flares especially in early gestation.
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Affiliation(s)
- Massimo Radin
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Irene Cecchi
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST SpedaliCivili of Brescia, University of Brescia, Brescia, Italy
| | - Evandro Mendes Klumb
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Miguel Ángel Saavedra
- RheumatologyDepartment, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy; Division of Rheumatology, Department of Locomotor System, ASL3, Genoa, Italy
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy; IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | | | - Dario Roccatello
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST SpedaliCivili of Brescia, University of Brescia, Brescia, Italy
| | - Savino Sciascia
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
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Ordoñez-González I, López-Zamora B, Medina G, Reyes-Navarro GV, Navarro AO, Cruz-Domínguez MP, Vera-Lastra O, Saavedra MÁ. Human monkeypox coinfection with syphilis in an immunocompromised patient. Dermatol Reports 2023; 15:9591. [PMID: 37397408 PMCID: PMC10312107 DOI: 10.4081/dr.2022.9591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 07/04/2023] Open
Abstract
Monkeypox is a viral zoonosis from the Poxviridae family that spreads at an unprecedented rate. It is transmitted through contact with skin lesions, respiratory droplets, body fluids, and sexual contact. The diverse presentation of the disease leads to misdiagnosis. Thus, clinicians should have a high index of suspicion, mainly with diseases with skin lesions. The most vulnerable group to developing this disease are individuals with risky sexual relationships, sexually transmitted infections, or human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). To date, only one case of coinfection with the monkeypox virus, syphilis, and HIV has been reported; however, no cases have been revealed in the Mexican territory. Herein we describe an unusual case of syphilis-monkeypox coinfection in an immunocompromised patient; despite his coinfection, he had a favorable prognosis. Furthermore, we attach allusive pictures of the natural evolution of dermatological lesions.
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Affiliation(s)
| | | | - Gabriela Medina
- Unidad de Investigación de Medicina Translacional, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Mexico City
- Universidad Nacional Autónoma de México, Mexico City
| | | | - Alberto Ordinola Navarro
- Universidad Nacional Autónoma de México, Mexico City
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - María Pilar Cruz-Domínguez
- Universidad Nacional Autónoma de México, Mexico City
- Dirección de Educación e Investigación, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Mexico City
| | - Olga Vera-Lastra
- Universidad Nacional Autónoma de México, Mexico City
- Departamento de Medicina Interna, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Mexico City
| | - Miguel Ángel Saavedra
- Universidad Nacional Autónoma de México, Mexico City
- División de Investigación, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico
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Reyes-Villarreal JC, Morales-Gutiérrez JE, López-Zamora B, Reyes-Navarro GV, Ordoñez-González I, Triana-González S, Peralta-Amaro AL. [Leuko-glycemic index in patients with ST elevation myocardial infarction]. Rev Med Inst Mex Seguro Soc 2022; 60:142-148. [PMID: 35758939 PMCID: PMC10396030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/14/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND The myocardial infarction-associated (MI) mortality is not only due cardiovascular complications, but intrahospital non-cardiovascular complications (IHnCVCs). The leuko-glycemic index (LGI) has been used as a prognostic marker for the development of cardiovascular complications in MI. We focused this study on identifying the cut-off point of LGI for the IHnCVCs development in patients with ST-segment elevation myocardial infarction (STEMI). MATERIAL AND METHODS In this single-center and crosssectional design, we included patients with STEMI. The biochemical analysis included glucose and leucocytes; with them we calculated the LGI. Receiver operating characteristic curve, univariate and bivariate analysis, and multivariate analysis for IHnCVCs development were performed. A p < 0.05 was considered statistically significant. RESULTS We included 1294 patients, 79.8% were men and 20.2% women. The main comorbidities were hypertension, diabetes mellitus and dyslipidemia. Six hundred forty-four (49.8%) patients presented IHNCVCs. The LGI > 1200 (AUC 0.817) predict the IHNCVCs development in STEMI patients. The variables that increased the IHNCVCs development were LGI > 1200, creatinine > 0.91 mg/dL, diabetes mellitus and age > 65 years. Hospital acquired pneumonia and cardiovascular complications increase the risk of death among STEMI patients. CONCLUSION A LGI > 1200 increased, just over nine times, the risk of IHnCVC development in STEMI patients.
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Affiliation(s)
- Juan Carlos Reyes-Villarreal
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Departamento de Medicina Interna. Ciudad de México, México
| | - Joel Eduardo Morales-Gutiérrez
- Universidad Juárez Autónoma de Tabasco, Escuela de Medicina, División Académica de Ciencias de la Salud. Villahermosa, Tabasco, México
| | - Berenice López-Zamora
- Universidad Juárez Autónoma de Tabasco, Escuela de Medicina, División Académica de Ciencias de la Salud. Villahermosa, Tabasco, México
| | | | - Irvin Ordoñez-González
- Universidad Veracruzana, Campus Veracruz, Facultad de Medicina. Veracruz, Veracruz, México
| | - Salma Triana-González
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Departamento de Medicina Interna. Ciudad de México, México
| | - Ana Lilia Peralta-Amaro
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Departamento de Medicina Interna. Ciudad de México, México
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López-Zamora B, Ordoñez-González I, Morales-Montalvo SI, Medina-García G, Velázquez-García JA, Montes-Cortés DH, Reyes-Navarro GV, Romero-Tapia SJ, Jara-Quezada LJ, Cruz-Domínguez MDP. [Blood groups and SARS-CoV-2 in health professionals from a single center]. Rev Med Inst Mex Seguro Soc 2021; 59:395-403. [PMID: 34914348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The possibility that the blood group (BG) predisposes to SARS-CoV-2 infection is controversial. OBJECTIVE To compare the prevalence of BG, anti-IgG SARS-CoV-2, and more frequent symptoms in convalescent health personnel vs controls prior to vaccination. MATERIAL AND METHODS Analytical cross-sectional design of cases and controls, which included health personnel, from March to June 2020, confirmed with (polymerase chain reaction) PCR-SARS-CoV-2 and negative controls with PCR and anti-IgG-SARS-CoV-2. Participants were questioned concerning symptoms and BG was determined. It was used descriptive statistics and comparative analysis with chi squared, Fisher's exact test, Student's t, and Mann Whitney's U tests. RESULTS Of 218 workers, 102 (46.8%) were confirmed cases for SARS-CoV-2 (convalescent) and 116 controls. The distribution of BG was similar between cases and controls, being BG-O + the most frequent (52.9%). The risk of becoming infected by SARS-CoV-2 for BG-O compared to BGNo-O showed a lower trend (odds ratio [OR] 0.725, 95% confidence interval [95% CI] 0.416-1.261, p = ns). The BG-A (28.4%) compared with BG-No-A (71.6%) showed a trend of increased risk in BG-A (OR 1.523, 95% CI 0.818-2.837, p = ns). The presence of SARS-CoV-2 IgG antibodies was 85% in the convalescent group. CONCLUSIONS The prevalence of infected was proportionally higher for BG-A and lower for BG-O. About 15% did not develop SARS-CoV-2 antibodies after overcoming COVID-19 disease.
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Affiliation(s)
- Berenice López-Zamora
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Escuela de Medicina. Villahermosa, Tabasco, México
| | - Irvin Ordoñez-González
- Universidad Veracruzana, Campus Veracruz, Facultad de Medicina. Veracruz, Veracruz, México
| | - Susana Isabel Morales-Montalvo
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Campus Casco de Santo Tomás, Sección de Estudios de Posgrado de Investigación. Ciudad de México, México
| | - Gabriela Medina-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Unidad de Investigación en Medicina Traslacional en Enfermedades Hemato-oncológicas. Ciudad de México, México
| | - José Arturo Velázquez-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Dirección General. Ciudad de México, México
| | - Daniel Héctor Montes-Cortés
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital General "Dr. Gaudencio González Garza", Servicio de Urgencias. Ciudad de México, México
| | | | - Sergio Jesús Romero-Tapia
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Escuela de Medicina, Departamento de Investigación. Villahermosa, Tabasco, México
| | - Luis Javier Jara-Quezada
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Dirección de Educación e Investigación en Salud. Ciudad de México, México
| | - María Del Pilar Cruz-Domínguez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", División de Investigación en Salud. Ciudad de México, México
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Medina-García G, Ordoñez-González I, Reyes-Navarro GV, López-Zamora B, Saavedra MÁ, Cruz-Domínguez MP, Vera-Lastra O. [Late onset primary antiphospholipid syndrome in the older adult]. Rev Med Inst Mex Seguro Soc 2021; 59:248-252. [PMID: 34374754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is a systemic autoimmune disease, characterized by arterial or venous thrombosis and/or obstetric events in the presence of antiphospholipid antibodies (aPL). It is usually diagnosed in patients between the ages of 15 and 50 years, and there are 5 new cases per 100,000 people per year. It is reported a case of APS, which it is present in an older adult with an unusual clinical manifestation. CLINICAL CASE Female patient without history of autoimmune diseases, at age 70 presented hemolytic anemia, Coombs direct positive, classified as autoimmune hemolytic anemia (AHAI) Coombs+, and severe thrombocytopenia. Other immunological, infectious, and lymphoid proliferative disorders and solid tumors were ruled out. Fisher-Evans syndrome (FES) was diagnosed with good response to treatment. Three months later, the patient presented deep venous thrombosis in the left pelvic limb, positive antiphospholipid antibodies (aPL) and positive aloantibodies were determined, establishing the diagnosis of primary APS and FES as its initial manifestation. Since then, the patient has been in treatment with acenocoumarol and prednisone without new recurrences of thrombosis, with persistence of moderate thrombocytopenia, without adding another clinical manifestation in 15 years of follow-up. CONCLUSION The unusual presentation of this disease in older adults with comorbidities should not rule out the possibility of the development of a primary autoimmune disease, so it should be considered for diagnosis in this age group.
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Affiliation(s)
- Gabriela Medina-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Unidad de Investigación en Medicina Traslacional. Ciudad de México, México
| | - Irvin Ordoñez-González
- Universidad Veracruzana, Campus Veracruz, Facultad de Medicina. Veracruz, Veracruz, México
| | | | - Berenice López-Zamora
- Universidad Juárez Autónoma de Tabasco, Facultad de Medicina. Villahermosa, Tabasco, México
| | - Miguel Ángel Saavedra
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Departamento de Reumatología. Ciudad de México, México
| | - María Pilar Cruz-Domínguez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", División de Investigación. Ciudad de México, México
| | - Olga Vera-Lastra
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Departamento de Medicina Interna. Ciudad de México, México
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Morales-Gutiérrez JE, Silva-Medina MA, Cuadros-Moreno J, Cuevas-Bulnes JJ, Medina-García G, Espinoza JL, Reyes-Navarro GV, Vera-Lastra OL. [Pulmonary alveolar proteinosis. Report of a case]. Rev Med Inst Mex Seguro Soc 2021; 59:347-351. [PMID: 35019256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/24/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoprotein material in the alveoli. It is classified as primary, secondary and congenital. The primary form, of autoimmune origin, is characterized by antibodies against granulocyte-macrophage colony stimulating factor (GM-CSF). The aim of this article is to present a case of PAP with adequate response to treatment with bronchoalveolar lavage (BAL) and GM-CSF. CLINICAL CASE A 28-year-old female patient who started with mild to moderate effort dyspnea, distal cyanosis and lower respiratory tract infection. We found restrictive pattern respiratory function tests, chest X-ray with bilateral nodular reticulum pattern and high-resolution tomography with ground glass image and bronchiectasis, besides video bronchoscopy with inflammatory process. The open biopsy revealed data of alveolar proteinaceous material and mononuclear infiltrate. Treatment was given with BAL and GM-CSF which was suspended by dermal reaction. The patient had a satisfactory evolution and is currently asymptomatic. CONCLUSION The present case had clinical, imaging and histological manifestations for the diagnosis of autoimmune PAP with a satisfactory response to treatment. Although PAP is a low prevalence entity, the diagnosis and therapeutic options must be taken into account, including BAL and GM-CSF, since this factor is required for surfactant factor homeostasis.
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Affiliation(s)
- Joel Eduardo Morales-Gutiérrez
- Universidad Juárez Autónoma de Tabasco, Escuela de Medicina, División Académica de Ciencias de la Salud. Villahermosa, Tabasco, México
| | - Marco Antonio Silva-Medina
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret". Servicio de Medicina Interna. Ciudad de México, México
| | - Juan Cuadros-Moreno
- Instituto Mexicano del Seguro Social, Coordinación de Educación en Salud, División de Innovación. Ciudad de México, México
| | - Julian Jesús Cuevas-Bulnes
- Centro de Radiodiagnóstico Computarizado Médico de Tabasco S.A. de C.V., Servicio de Neumología Pediátrica. Villahermosa, Tabasco, México
| | - Gabriela Medina-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Unidad de Investigación en Medicina Traslacional en Enfermedades Hemato-oncológicas. Ciudad de México, México
| | - José Luis Espinoza
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Servicio de Neumología. Ciudad de México, México
| | | | - Olga Lidia Vera-Lastra
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Departamento de Medicina Interna. Ciudad de México, México
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