Omar D. Borjas-Almaguer

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.

Lack of consistency with the consensus recommendations for the diagnosis of eosinophilic esophagitis (EoE) in published prevalence studies. A clinical and systematic review.

According to consensus recommendations, the presence of esophageal symptoms, >15 eosinophils/high‐power field and unresponsiveness to proton pump inhibitors are required for a diagnosis of eosinophilic esophagitis (EoE). Nevertheless, inconsistency in using these guidelines has been reported in recent publications. The objective of this study was to assess compliance with EoE diagnostic guidelines in published studies on EoE prevalence and to evaluate other clinical and methodological parameters.

Hipoalbuminemia en el desenlace clínico de pacientes con sangrado de tubo digestivo alto no variceal

INTRODUCTION AND AIM The role of serum albumin level in patients with non-variceal upper gastrointestinal bleeding (NVUGB) has not been extensively studied. Our aim was to evaluate the role of serum albumin on admission in terms of in-hospital mortality in patients with NVUGB. MATERIALS AND METHODS Patients admitted with NVUGB during a 4-year period were prospectively included. Demographic, clinical, and laboratory data were collected. ROC curve analysis was used to determine the cutoff value for serum albumin on admission that made a distinction between deceased patients and survivors with respect to serum albumin on admission, as well as its overall performance compared with the Rockall score. RESULTS 185 patients with NVUGB were evaluated. Men predominated (56.7%) and a mean age of 59.1±19.9 years was found. Mean serum albumin on admission was 2.9±0.9g/dl with hypoalbuminemia (< 3.5g/dl) detected on admission in 71.4% of cases. The ROC curve found that the best value for predicting hospital mortality was an albumin level of 3.1g/dl (AUROC 0.738). Mortality in patients with albumin ≥ 3.2g/dl was 1.2% compared with 11.2% in patients with albumin<3.2g/dl (P=.009; OR 9.7, 95%CI 1.2-76.5). There was no difference in overall performance between the albumin level (AUORC 0.738) and the Rockall score (AUROC 0.715) for identifying mortality. CONCLUSIONS Patients with hypoalbuminemia presenting with NVUGB have a greater in-hospital mortality rate. The serum albumin level and the Rockall score perform equally in regard to identifying the mortality rate.

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.

Causes of Infrequent Prevalence of Eosinophilic Esophagitis in Hispanics May Involve Social and Cultural Factors: Probable Role of Digestive Microbiota

We read with great interest the article by Yu Ch et al. who found in a cohort study that the prevalence of eosinophilic esophagitis (EoE) is significantly lower in Hispanic population compared to Caucasians. They also found that analysis of gene expression had similar results in subjects with EoE from both ethnic groups. The authors concluded that environmental, racial, and cultural factors should be studied to explain these marked differences [1]. A low prevalence of EoE has also been observed in our Latin American countries in the few studies published so far [2, 3]. In the light of current knowledge, we think that the prevalence of EoE in a given population is determined by the interaction of three factors with variable specific weight: (1) genetics, (2) environmental allergens, and (3) immunological susceptibility. Firstly, genetic factors have recently been identified [4]. The estimated sibling recurrence rate in EoE is approximately 80 percent, indicating a potentially significant role of genetics in this disease. In another study, the gene that encodes eotaxin-3 was the most upregulated gene in EoE [5]. Secondly, there exist some aeroallergens and food-based allergens that could have a central role. Notwithstanding, why foods and pollens that had been tolerated by humans for thousands of years now trigger EoE? Maybe sensitization of individuals (the third crucial factor) could explain this issue. This is also extended to other allergic diseases mediated through Th2 inflammatory response (implicated in the pathophysiology of EoE) such as asthma, atopic dermatitis, and allergic rhinitis. It has been shown that these allergic diseases have increased their incidence in developed countries in the last two or three decades [6]. The increase in sensitization could be the result of the modification of lifestyles as a consequence of the improvement of the socioeconomic levels in developed countries in the last decades. For example, it has been observed that the prevalence of EoE is inversely proportional to the prevalence of infection by Helicobacter pylori [7], which is still highly prevalent in Latin populations [8] and is related to low socioeconomic levels. Whether or not Helicobacter pylori could protect against EoE is a non-cleared issue. We think that the presence of the infection could be the reflection of modifications of the digestive microbiota, which is determined from birth and can suffer variations due to cesarean delivery, antibiotics use, type of diet, breast-feeding, repeated gastrointestinal infections, and rigorous aseptic codes. Along with these findings, the hygiene hypothesis postulates that the elimination of non-lethal bacterial infections mediated by the inflammatory reaction Th1 could increase the expression of inflammatory Th2 response [9]. Dysbiosis of the intestinal microbiota during the neonatal stage is linked to the development of atopy and asthma in childhood [10]. This linkage has not been studied for EoE. On the other hand, the microbiota of the stomach and esophagus have been poorly studied. In the future, these hot topics could be the subject of research to better understand the pathogenesis of EoE and the difference in prevalence among diverse populations throughout the world.

Primary biliary cholangitis associated with warm autoimmune hemolytic anemia.

There are many autoimmune diseases associated with primary biliary cholangitis (PBC), known as primary biliary cirrhosis; however, the association between PBC and warm autoimmune hemolytic anemia (wAIHA) has rarely been reported. It is documented that hemolysis is present in over 50% of the patients with chronic liver disease, regardless of the etiologies. Due to the clear and frequent relationship between PBC and many autoimmune diseases, it is reasonable to suppose that wAIHA may be another autoimmune disorder seen in association with PBC. Here we reported a 53‐year‐old female patient diagnosed with wAIHA associated with PBC.

Primary biliary cirrhosis associated with warm‐type autoimmune hemolytic anemia

There are many autoimmune diseases associated with primary biliary cholangitis (PBC), known as primary biliary cirrhosis; however, the association between PBC and warm autoimmune hemolytic anemia (wAIHA) has rarely been reported. It is documented that hemolysis is present in over 50% of the patients with chronic liver disease, regardless of the etiologies. Due to the clear and frequent relationship between PBC and many autoimmune diseases, it is reasonable to suppose that wAIHA may be another autoimmune disorder seen in association with PBC. Here we reported a 53‐year‐old female patient diagnosed with wAIHA associated with PBC.

Sheehan’s Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?

Sheehans syndrome remains a frequent obstetric complication with an uncertain pathophysiology. We aimed to assess the incidence of hypopituitarism (≥2 hormonal axis impairment) within the first six postchildbirth months and to determine the existence of anti-pituitary antibodies. From 2015 to 2017, adult pregnant women, who developed moderate to severe postpartum hemorrhage (PPH), were consecutively included in the study. Pituitary function was assessed 4 and 24 weeks after PPH. At the end of the study, anti-pituitary antibodies were assessed. Twenty women completed the study. Mean age was 26.35 (±5.83) years. The main etiology for severe PPH was uterine atony (65%) which resulted mostly in hypovolemic shock grades III-IV. Within the first four weeks after delivery, 95% of patients had at least one hormonal pituitary affected and 60% of the patients fulfilled diagnostic criteria for hypopituitarism. At the end of the study period, five patients (25%) were diagnosed with hypopituitarism (GH and cortisol axes affected). Anti-pituitary antibodies were negative in all patients. At 6 months follow-up, one in every four women with a history of moderate-to-severe PPH was found with asymptomatic nonautoimmune-mediated hypopituitarism. The role of autoimmunity in Sheehans syndrome remains uncertain. Further studies are needed to improve the remaining knowledge gaps.

Decreasing Costs in Acute Pancreatitis with Same-Admission Cholecystectomy

To the editor, We read with great interest the study by Kim et al. [1] who found that after an episode of biliary acute pancreatitis (AP), the risk of recurrent pancreatobiliary complications including acute cholecystitis, acute cholangitis, and AP was significantly increased in patients with gallstones size B5 mm and those who underwent delayed cholecystectomy (DC). Besides the importance as a clinical entity, AP has now very important economic implications. The worldwide incidence of AP has increased in recent years, becoming the third most common digestive disease requiring inpatient care with costs exceeding