Guillermo Delgado-García

O volume plaquetário médio está reduzido em adultos com lúpus ativo

BACKGROUND Only a few biomarkers are available for assessing disease activity in systemic lupus erythematosus (SLE). Mean platelet volume (MPV) has been recently studied as an inflammatory biomarker. It is currently unclear whether MPV may also play a role as a biomarker of disease activity in adult patients with SLE. OBJECTIVE We investigated the association between MPV and disease activity in adult patients with SLE. METHODS In this retrospective study, we compared two groups of adult patients divided according to disease activity (36 per group). Subjects were age- and gender-matched. RESULTS MPV was significantly decreased with respect to those of inactive patients (7.16±1.39 vs. 8.16±1.50, p=0.005). At a cutoff level of 8.32 fL, MPV has a sensitivity of 86% and a specificity of 41% for the detection of disease activity. A modest positive correlation was found between MPV and albumin (r=0.407, p=0.001), which in turn is inversely associated with disease activity. CONCLUSIONS In summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

Mean platelet volume is decreased in adults with active lupus disease

BACKGROUND Only a few biomarkers are available for assessing disease activity in systemic lupus erythematosus (SLE). Mean platelet volume (MPV) has been recently studied as an inflammatory biomarker. It is currently unclear whether MPV may also play a role as a biomarker of disease activity in adult patients with SLE. OBJECTIVE We investigated the association between MPV and disease activity in adult patients with SLE. METHODS In this retrospective study, we compared two groups of adult patients divided according to disease activity (36 per group). Subjects were age- and gender-matched. RESULTS MPV was significantly decreased with respect to those of inactive patients (7.16±1.39 vs. 8.16±1.50, p=0.005). At a cutoff level of 8.32fL, MPV has a sensitivity of 86% and a specificity of 41% for the detection of disease activity. A modest positive correlation was found between MPV and albumin (r=0.407, p=0.001), which in turn is inversely associated with disease activity. CONCLUSIONS In summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

Portal vein thrombosis in patients with cirrhosis: just a common finding or a predictor of poor outcome?

BACKGROUND & AIMS It is unclear whether portal vein thrombosis (PVT) unrelated to malignancy is associated with reduced survival or it is an epiphenomenon of advanced cirrhosis. The objective of this study was to assess clinical outcome in cirrhotic patients with PVT not associated with malignancy and determine its prevalence. MATERIAL AND METHODS Retrospective search in one center from June 2011 to December 2014. RESULTS 169 patients, 55 women and 114 men, median age 54 (19-90) years. Thirteen had PVT (7.6%). None of the patients received anticoagulant treatment. The PVT group was younger (49 [25-62] vs. 55 [19-90] years p = 0.025). Child A patients were more frequent in PVT and Child C in Non-PVT. Median Model for End Stage Liver Disease (MELD) score was lower in PVT (12 [8-21] vs. 19 [7-51] p ≤ 0.001) p ≤ 0.001). There was no difference between upper gastrointestinal bleeding and spontaneous bacterial peritonitis in the groups. Encephalopathy grade 3-4 (4 [30.8%] vs. 73 [46.8%] p = 0,007) and large volume ascites (5 [38.5%] vs. 89 [57.1%] p= 0,012) was more common in non-PVT. Survival was better for PVT (16.5 ± 27.9 vs. 4.13 ± 12.2 months p = 0.005). CONCLUSIONS We found that PVT itself does not lead to a worse prognosis. The most reliable predictor for clinical outcome remains the MELD score. The presence of PVT could be just an epiphenomenon and not a marker of advanced cirrhosis.

Acute apixaban treatment of heparin-induced thrombocytopenia

fashion [5]. This case report was subsequently published in full text [6]. In their review, Skelley et al. stated that MEDLINE and Google Scholar searches (March 1966–2016) were conducted. Since these searches were limited to English, our full-text report was not included. However, in February 2016, our report was reviewed in Reactions Weekly [7] and this journal is available on Google Scholar. The English version of our case report is now available online [8]. To the best of our knowledge, ours is the first report describing the use of apixaban in the acute treatment of HIT.

From supine to standing: in vivo segregation of myogenic and baroreceptor vasoconstriction in humans

Myogenic vascular response is a form of systemic and regional vasoconstriction produced increasing the intra‐arterial pressure by gravity. Here, the vasoconstriction due to the myogenic response, induced by the gravitational action in a dependent limb, is separated from that caused by the baroreceptor reflex. Regional changes of skin blood flow (SBF), total blood volume of the finger (TBVF), pulse pressure (PP), heart rate (HR), systolic, and diastolic blood pressure (BP) were analyzed in 10 healthy young subjects in supine and upright positions. By lowering the arm in supine position, SBF decreased compared to its basal measurement, PR increased, and PP contracted, indicating arterial vasoconstriction that rise BP. TBVF increased, demonstrating an increment in venous volume. HR did not change, reflecting no action of the baroreceptor reflex. In upright position with lowered arm, there was an additional increase in BP variables, demonstrating vasoconstriction. Moreover, BP and HR showed oscillations at 0.1 Hz reflecting the entrance of the baroreceptor reflex. The action of gravity in a dependent limb in supine position induces a regional vasoconstriction and an increase of BP due to activation of the myogenic response, while the baroreceptor reflex or other neural factors do not appear to operate. In the upright position with the arm dependent, there is a further increase in regional vasoconstriction and BP with reciprocal changes in HR, indicating the entrance of the baroreceptor superimposed to the myogenic response. This study demonstrates that the myogenic and baroreceptor vasoconstriction can be separated in vivo.

Histopathology and Antibodies

We read with great interest the case reported by Jun and Jung in this journal, since acute aortic aneurysm and myasthenia gravis (MG) have only been reported together very infrequently in the literature. However, it is important to note that some points that we consider relevant were not detailed enough. The first point that strikes us is the paucity of histopathological information, which is essential for the definite diagnosis of IgG4-related disease (IgG4-RD). The absence of perianeurysmal fibrosis is mentioned. Nevertheless, this is not the only histopathological feature described in these cases. So far, in this patient, the diagnosis of IgG4-RD could be considered only as possible. The second and last of these points is related to the diagnosis of MG. It would be quite valuable to know the specific antibodies involved in this particular case (anti-acetylcholine receptor antibodies or antimuscle-specific kinase [anti-MuSK] antibodies), since the case of a 54-year-old female patient with anti-MuSK MG associated with IgG4-RD was recently reported. The elucidation of the antibodies involved in the present case might possibly strengthen the association between IgG4-RD and anti-MuSK MG. ORCID iD

Neurocysticercosis: mimics and chameleons

Neurocysticercosis is the most common parasitic neurological disease worldwide, yet in Europe, it remains relatively uncommon, with many practitioners rarely seeing a case. However, immigration and international travel mean that it is becoming increasingly recognised and diagnosed in developed countries. Being a treatable condition, it is essential to be familiar with the diagnosis and to appreciate its mimics and breadth of its possible clinical presentations.

Obstetric outcomes in a Mexican cohort of patients with AQP4-antibody-seropositive neuromyelitis optica

BACKGROUND Previous studies have investigated the influence of neuromyelitis optica (NMO) on pregnancy in other ethnic groups. However, there are potential variations among ethnic groups. The obstetric outcome of Mexican patients with NMO and AQP4-IgG positivity (AQP4-IgG[+]) is currently unknown. OBJECTIVE To describe the obstetric history of Mexican patients with NMO and AQP4-IgG(+). METHODS Patients with NMO and AQP4-IgG(+) were identified from the database of the Demyelinating Diseases Clinic. These patients were interviewed by telephone. RESULTS Out of a total of 40 eligible patients, 29 were contacted and completed the survey. Of these, 19 patients reported at least one previous pregnancy. In total, 50 pregnancies were reported: 44 of them occurred ≥ 3 years before the first clinical manifestation, 1 occurred ≥ 1 years before, and 1 occurred after the first manifestation. Of all pregnancies, 12 were pregnancy losses: 5 were classified as miscarriages and 3 as stillbirths. Of all pregnancy losses, 10 occurred ≥ 3 years before the diagnosis, 1 occurred after the first manifestation. All pregnancy losses occurred in 8 patients. CONCLUSIONS Close to half of the patients with previous pregnancies reported at least one pregnancy loss, most of these occurred ≥ 3 years before the diagnosis. This percentage is higher than expected for their age group in our country.

BS09. Latency of the skin vasomotor reflex of the finger to an electrical stimulus to the median nerve

Introduction An electrical pulse to a sensory or mixed peripheral nerve elicits activation of the skin sympathetic response (SSR) and the latency and the duration of the response can thereby be attained. We reasoned that an electrical stimulus may also activate the sympathetic C fibers to the skin blood vessels of the hand and the latency and duration of the skin vasomotor reflexes (VSRs) could also be obtained. Methods We evaluated 30 healthy subjects aged 20–35 years. The subjects had no history of peripheral or central nervous system disease. A 0.5 ms pulse with an intensity four times the threshold was delivered to the right median nerve at the wrist. The stimulus was given at random every 40–60 s. We gave three stimuli to each subject. We recorded the SSR in the palm of the left hand and the VSRs in the tip of the left index finger. The pulsatile skin blood flow (SBF) was recorded with an infrared photoplethysmograph located at the pad of the right index finger. Results All subjects displayed both a SSR and a VSR. The mean latency of the SSR was 1.3 ± 0.3 s with a mean duration of 5.9 ± 0.6 s. The mean latency of the VSR (first decreased pulse) was 3 ± 0.5 s and the mean duration of the VSR was 9.5 ± 2 s. The VSR had a longer latency and lasted more than the SSR. The decrease in the amplitude of the SBF had a mean or 50 ± 8 per cent of the basal flow. Conclusion The SSR and VSRs reflect sympathetic C fibers traffic to the eccrine sweat glands and the skin microcirculation, respectively. The longer latency of the VSRs, compared to the SSR, may reflect a slower conduction time of the sympathetic C fibers to the skin blood vessels or be the consequence of the physiological properties of the response of the neuro-effector junction of the skin blood vessels. This technique allows a quantitative measurement of the latency and duration of the VSRs and is potentially useful for the study of peripheral and central autonomic disorders.

A β2‐microglobulina salivar se correlaciona positivamente com o ESSPRI em pacientes com síndrome de Sjögren primária

Felipe Garza-Garcíaa, Guillermo Delgado-Garcíaa,∗, Mario Garza-Elizondob, Luis Ángel Ceceñas-Falcónc, Dionicio Galarza-Delgadoa,b, Janett Riega-Torresb a Universidad Autónoma de Nuevo León, Hospital Universitario, Departamento de Medicina Interna, Monterrey, Mexico b Universidad Autónoma de Nuevo León, Hospital Universitario, Servicio de Reumatología, Monterrey, Mexico c Universidad Autónoma de Nuevo León, Hospital Universitario, Servicio de Anatomía Patológica, Monterrey, Mexico