Infeccion por HIV en una paciente con Lupus Cutáneo Crónico / HIV infection in a patient with chronic cutaneous lupus

We present a case of chronic cutaneous lupus erythematosus (CCLE) in a patient who subsequently became infected with human immunodeficiency virus, HIV-1. The symptoms attributed to CCLE had persisted for years, and curiously had disappeared by the time the patient probably became infected with HIV-1. Even if there is lack of evidence to consider HIV-1 infection as direct causative agent in the clinical remission of CCLE, this response is in accordance with previous reports from other authors, regarding the attenuating role of HIV on the clinical course of the systemic lupus erythematosus. Even if the number of reported cases is very low it is of the upmost importance to establish whether this hypothesis is correct or not, since both diseases present great difficulties regarding diagnosis, due to the important overlapping between symptoms and serological tests.

Lupus eritematoso sistémico y SIDA: dificultades para el diagnóstico diferencial / Systemic lupus erythematosus and AIDS: difficulties in the differential diagnosis

El Lupus Eritematoso Sistémico (LES) y la infección por el virus HIV-1 presentan algunas manifestaciones clínicas y de laboratorio similares, las que pueden inducir errores en el diagnóstico diferencial entre ambas entidades. En el presente trabajo se analizan cinco casos clínicos: dos enfermos con LES que presentaban serología falsamente positiva para HIV-1, y tres enfermos de SIDA que en algún momento de su evolución reunieron 4 o más criterios de la American Rheumatism Association, indicativos de LES. Se sugiere que las determinaciones de los anticuerpos anti-HIV-1 se realicen por no menos de tres técnicas diferentes en los pacientes que reúnan datos clínicos sugestivos de LES, reservando del HIV-1, confirmada mediante detección directa o técnicas de hibridación nuclear, debería considerarse criterio de exclusión para el diagnóstico de LES (AU)

Lupus eritematoso sistémico y SIDA. Dificultades en el diagnóstico diferencial. / [Systemic lupus erythematosus and AIDS. Difficulties in the differential diagnosis]

AIDS and systemic lupus erythematosus (SLE) share clinical and laboratory features that may difficult a differential diagnosis. We report five patients who presented diagnostic problems, two of them with SLE diagnosis and HIV-1 false-reactive screening tests, and the other three with AIDS diagnosis and clinical features fulfilling four or more ARA-clinical criteria for the diagnosis of SLE. It is recommended that tests for HIV-1 antibodies in patients with symptoms of SLE, be carried out by at least three different methods, with direct HIV-1 antigen detection as final confirmatory technique. On the other hand, as also proposed for Sjogren syndrome, the presence of HIV-1 or its antigens, established through cell-cultures or direct blood detection, should be considered as exclusion criteria for SLE diagnosis.

Infeccion por HIV en una paciente con Lupus Cutáneo Crónico. / [HIV infection in a patient with chronic cutaneous lupus]

We present a case of chronic cutaneous lupus erythematosus (CCLE) in a patient who subsequently became infected with human immunodeficiency virus, HIV-1. The symptoms attributed to CCLE had persisted for years, and curiously had disappeared by the time the patient probably became infected with HIV-1. Even if there is lack of evidence to consider HIV-1 infection as direct causative agent in the clinical remission of CCLE, this response is in accordance with previous reports from other authors, regarding the attenuating role of HIV on the clinical course of the systemic lupus erythematosus. Even if the number of reported cases is very low it is of the upmost importance to establish whether this hypothesis is correct or not, since both diseases present great difficulties regarding diagnosis, due to the important overlapping between symptoms and serological tests.

Infeccion por HIV en una paciente con Lupus Cutáneo Crónico. / [HIV infection in a patient with chronic cutaneous lupus]

We present a case of chronic cutaneous lupus erythematosus (CCLE) in a patient who subsequently became infected with human immunodeficiency virus, HIV-1. The symptoms attributed to CCLE had persisted for years, and curiously had disappeared by the time the patient probably became infected with HIV-1. Even if there is lack of evidence to consider HIV-1 infection as direct causative agent in the clinical remission of CCLE, this response is in accordance with previous reports from other authors, regarding the attenuating role of HIV on the clinical course of the systemic lupus erythematosus. Even if the number of reported cases is very low it is of the upmost importance to establish whether this hypothesis is correct or not, since both diseases present great difficulties regarding diagnosis, due to the important overlapping between symptoms and serological tests.

La hiperprolactinemia es un hallazgo frecuente en infectados por HIV pero no se correlaciona con la carga viral. / [Hyperprolactinemia is a frequent finding in HIV infection but does not correlate with viral burden]

Although many authors have reported the finding of hyperprolactinemia during the course of HIV infection, the circumstances determining the rise of prolactin (PRL) concentrations in serum are poorly understood. To analyze the relationships between serum PRL and other clinical variables in HIV-infected patients, 46 HIV-infected patients and 17 seronegative controls were studied. Serum PRL concentrations were significantly higher in the HIV-infected group (p = 0.022). Furthermore, Serum PRL and serum IgG correlated positively (Rs = 0.42; p = 0.05, Spearman-Rank). On the contrary, serum PRL concentrations did not correlate with the plasmic viral burden (Rs 0.039; p = 0.841), Our data confirm that hyperprolactinemia is a frequent finding during the course of HIV infection, and that serum PRL are independent of viral replication kinetics. Considering that a positive correlation was found between serum PRL and immunoglobulins, it is possible that serum PRL might increase in response to non specific immunological activation, or even in response to immunological activation at the onset of infections.

Propiedades inmunológicas de la prolactina. / [Immunological properties of prolactin]

A profound bi-directional interaction exists between the hormone prolactin and the immune system. Even the name [quot ]hormone[quot ] seems to be inadequate, since prolactin is clearly a growth factor and in fact it functions as an immune co-mitogenic cytokine using autocrine, paracrine and obviously endocrine mechanisms. Prolactin (PRL) stimulates lymphocyte proliferation in response to antigen and mitogens. In addition, prolactin is locally secreted by immune cells, and the pituitary production of prolactin is partially under the control of pro-inflammatory cytokines. These reciprocal influences imply the presence of specific receptors for prolactin in many immune cells, such as lymphocytes and other accessory cells. The PRL-binding to its receptor stimulates the synthesis and secretion of lymphocyte cytokines. In addition, it is a growth factor essential for at least one lymphoid cell line. The PRL-corresponding mRNA has been demonstrated in the cytoplasm of mitogen-stimulated lymphocytes, and the secretion of PRL has been well documented in lymphoid cells. Moreover, PRL acts on NK cells to induce their differentiation to prolactin-activated killer cells (PAK cells) in a dose-dependent way (activation at physiological concentrations, and cytotoxicity inhibition at tenfold higher concentrations). PRL also shows a well known capacity to induce IFN-gamma and IL-2 synthesis, suggesting their participation in the genesis of Th1-responses. These PRL immunological properties strongly support PRL as a cytokine. PRL involvement in both the normal immune response and in many pathological conditions raises important considerations regarding potential diagnostic and therapeutic applications.

Riesgo relativo de transmision del virus de la hepatitis C en pacientes politransfundidos / Relative risk of hepatitis C virus transmission in polytransfused patients

El virus de la hepatitis C (HCV) ha demostrado ser el agente responsable de una importante proporción de casos de hepatitis entre pacientos con exposición parenteral frecuente. En este trabajo, estudiamos la seroprevalencia de anticuerpos anti-HCV en 48 pacientes hemodializados y politransfundidos, 42 de los cuales recibieron 11,2 transfusiones en promedio durante el tratamiento. Los pacientes fueron estratificados en cuatro grupos según el número de transfusiones recibidas (<6-9, 10-5 y > 15 transfusiones), y se utilizaron cocientes de Odds para estimar el riesgo de presentar a anticuerpos anti-HCV para cada grupo en relación con el grupo menos expuesto. De los pacientes transfundidos, 59 por ciento presentaron anticuerpos anti-HCV. Estratificados según el número de transfusiones estos porcentajes fueron de 16 por ciento, 66 por ciento, 62,5 por ciento y 100 por ciento respectivamente. En conclusión, hallamos una elevada seroprevalencia de anticuerpos anti HCV, significativamente mayor en aquellos pacientes que recibieron mayor número de transfusiones. Nuestros resultados concuerdan estrechamente con estudios realizados en Córdoba, y destacan la necesidad de estudiar las unidades de sangre para descartar aquellas que presenten anticuerpos contra HCV (AU)

SIDA y embarazo: un caso de transmissión madre-hijo / AIDS and pregnancy: a case of mother-child transmission

Se presenta el caso de un niño de cuatro meses de edad, nacido de una madre en un estado avanzavdo de infección por el HIV, en quien se desarrolló un cuadro clínico compartible con SIDA que cumplía con la definición de caso clínico del CDC. En lo que hace al mecanismo probable de transmisión de la enfermedad, este niño nacido por cesárea no recibió en ningun momento sangre ni hemoderivados; no fue amamantado ni estuvo expuesto a punciones accidentales con material contaminado por sangre materna, y se siguieron normas estríctas tendientes a evitar todo contacto con sangre o secreciones potencialmente infectantes. Consideramos que lo más probable haya sido la transmisión madre-hijo en la vida intrauterina (AU)

SIDA y embarazo: un caso de transmisión madre-hijo. / [AIDS and pregnancy: a case of mother-child transmission]

We report the case of a 4 month old baby in an advanced stage of HIV infection with AIDS according to the CDC definition. The HIV-infected mother was sexually promiscuous and a drug addict. The timing and route of the infection are speculative. The child was born by cesarean delivery, did not receive blood or blood products and was not breast-fed. It is postulated that the most probable route of HIV infection in this child was intrauterine vertical transmission.

Riesgo relativo de transmisión del virus de la hepatitis C en pacientes politransfundidos. / [Relative risk of hepatitis C virus transmission in polytransfused patients]

Hepatitis C virus (HCV) has been shown to be responsible for a significant proportion of hepatitis cases among patients undergoing frequent blood transfusions. The prevalence in blood serum of anti-HCV antibodies was studied in 48 patients who had undergone dialysis and multiple blood transfusions. In 42 of these patients the average number of transfusions during their treatment was 11.2. The patients were stratified into four groups according to the number of transfusions received (I: < 5, II:6-9, III:10-15 and IV > 15). Odds ratios were used in order to estimate the probability of finding anti-HCV antibodies in groups II, III and IV in relation to the least exposed group I. Anti-HCV antibodies were found in 59

of patients receiving transfusions. As grouped by increasing number of transfusions, each set showed 16, 66, 62.5 and 100

presence of anti-HCV antibodies, respectively. This shows a direct correspondence between the number of transfusions and the serum-born incidence of anti-HCV antibodies. These results closely coincide with those of a similar study, done in the city of Cordoba, Argentina, in 1992. The two studies confirm the necessity to check blood units in order to discard those with anti-HCV antibodies.

La uretrotomia bajo visión directa en el tratamiento de la estrechez uretral masculina / Direct vision urethrotomy in the management of strictures of the male urethra

Dentro de la patologia urológica, la estenosis uretral masculina es uno de los capítulos que mayores controversias sucita. Básicamente han sido tres las fórmulas propuestas en su terapéutica: dilataciones periódicas, uretrotomia ciega y numerosisimas técnicas de uretroplastia cruenta. Durante la última década y merced sobre todo a los trabajos desarrollados por Sachse, la uretrotomia interna, bajo visión directa y con corte frio, ha surgido con fuerza mostrándose, cada vez más, como alternativa validad frente a otros procederes más agresivos. . Presentamos en esta revisión, los resultados obtenidos en 45 pacientes tratados con esta técnica (AU)