Guía clínica GES de artritis idiopática juvenil 2014 / 2014 GES clinical guideline of juvenile idiopathic arthritis

La artritis idiopática juvenil (AIJ) ha sido definida por la Liga Internacional de Asociaciones de Reumatología (ILAR) como artritis de etiología desconocida que se inicia antes de los 16 años y dura por al menos seis semanas, habiendo excluido otras condiciones conocidas. La AIJ es una enfermedad cubierta por el sistema de Garantías Explícitas en Salud (GES) del Ministerio de Salud de Chile desde 2010. La presente guía, desarrollada por el Grupo Pediátrico de la Sociedad Chilena de Reumatología, consiste en una actualización de la Guía Clínica de AIJ 2010, incorporando nuevos protocolos terapéuticos y medicamentos que han demostrado un claro beneficio para niños con AIJ...

Juvenile idiopathic arthritis (JIA) has been defined by the International League of Associations for Rheumatology as arthritis of unknown etiology that begins before the sixteenth birthday and persists for at least 6 weeks with other known conditions excluded. JIA is a disease that is covered by the Explicit Health Guarantees system of the Chilean Ministry of Health since 2010. The present guideline developed by the Pediatric Group of the Chilean Rheumatology Society is an update of the 2010 JIA Clinical Guideline incorporating new treatment protocols and medications that have demonstrated clear benefits in children with JIA...

Necrolisis epidérmica tóxica como manifestación de lupus eritematoso sistémico: reporte de un caso y revisión de la literatura / Toxic epidermal necrolysis as a manifestation of systemic lupus erythematosus: report on a case and literature review

Presents a case of a young woman with a recent diagnose of systemic lupus erythematosus (SLE), with a sligth initial skin condition that envolves into toxic epidermal necrolysis (TENS): On account of this case, areview is presented of the physiopathology, clinical presentation and treatment of this infrequent form of dermatological manifestation of (SLE).

Se presenta el caso de una joven con diagnóstico reciente de lupus eritematoso sistémico (LES), con compromiso cutáneo inicial leve que evoluciona hacia necrolisis epidérmico tóxica (NET). A propósito de ello, se revisa la fisioptología, presentación clínica y tratamiento de esta infrecuente forma de manifestación dermatológica de LES.

Interleukin-6 production and deregulation of the hypothalamic-pituitary-adrenal axis in patients with major depressive disorders.

The present study was designed to determine whether an association exists between HPA activity and cytokine production in major depression (MD). In 9 patients with MD and 11 control subjects of both sexes, all drug-free, activity of the HPA axis was evaluated by circadian rhythm of plasma cortisol, 24-h free urinary cortisol, an overnight 1 mg dexamethasone suppression test, and an oCRF stimulation test. Spontaneous and LPS-stimulated production of IL-1beta, IL-6, and TNFalpha by peripheral blood mononuclear cells were also determined. We found a significantly elevated spontaneous production of IL-6 in patients with MD (3541.2 +/- 726.8 vs 380.4 +/- 77.5 pg/mL in controls, p < 0.05), while LPS-stimulated production was significantly lower in patients than in control subjects (19,867.7 +/- 3649.2 vs 33,142.2 +/- 15,47.2 pg/mL, p < 0.05). The adrenocorticotropic hormone response to oCRF, evaluated as the area under the curve (AUCACTH) was significantly lower in patients than in control subjects (p = 0.02). A positive correlation between AUCACTH and LPS-stimulated IL-6 secretion was observed in patients with MD (r = 0.75, p < 0.05) but not in controls. These findings suggest that the activation of the inflammatory response described in depression might be associated with long-term hyperactivity of the HPA axis.

Tumour necrosis factor-alpha transcription in transferrin-stimulated human blood mononuclear cells: is transferrin receptor involved in the signalling mechanism?

Transferrin (Tf) and tumour necrosis factor-alpha (TNF-alpha) participate in immune response regulation. We studied the capacity of Tf to modulate 'in vitro' TNF-alpha secretion, membrane expression and transcription by human blood mononuclear cells (BMNC). Women 25-45 years of age with normal iron status (n = 20) or with iron deficiency (ID, n = 20) due to gynaecological bleeding were studied. BMNC were incubated with different proportions of Fe-exempt and Fe-saturated Tf (apo-Tf:holo-Tf). Apo-Tf or holo-Tf uniformly induced TNF-alpha secretion in the cell supernatants from both groups. Nevertheless, cytokine levels were significantly lower in ID subjects. For all Tf-Fe saturations assayed, mean TNF-alpha levels varied between 1.4-1.6 ng/ml and 0.4-0.7 ng/ml for normal and ID women respectively (P < 0.001). The addition of apo-Tf enhanced TNF-alpha secretion in a dose-dependent manner, but the cytokine levels were lower in ID group. Tf did not induce pro-TNF-alpha expression in monocytes and lymphocytes from either group. Tf-treated cells from normal individuals expressed approximately two to three times more TNF-alpha mRNA than cells from ID subjects. Mean values ranged 96-110 atmol/ml in normal women and 24-31 atmol/ml in ID women for all Tf-Fe saturation levels tested (P < 0.001). These results show that Tf-induced TNF-alpha secretion is transcriptionally regulated. The impaired TNF-alpha transcription in cells from ID subjects indicates that the quality of the immune response is linked to the Fe status of mononuclear cells.

Leptin levels are associated with immune response in malnourished infants.

Circulating leptin levels, proinflammatory and T helper cells type 1 (Th1), Th2 cytokine production, and lymphoproliferative response were measured in 15 infants with primary moderate protein calorie malnutrition on admission and after recovery of 10% of weight. Sixteen healthy, well nourished infants of comparable age served as controls. A significant deficit in the z-score of weight for age, weight for height, body mass index, and circulating leptin and growth factors were detected in malnourished infants on admission compared with controls (P < 0.05). These deficits were associated with a significant suppression of the lymphoproliferative response, Th1, and proinflammatory cytokine production (P < 0.05). After a 10% weight gain, a significant increase in circulating leptin levels was produced in parallel with a significant increase in Th1 activity, as revealed by an enhancement in interferon-gamma and a suppression in IL-4 production. Concomitantly, the lymphoproliferative response became similar to that detected in control infants. Furthermore, a significant increase in IL-1 and TNFalpha production compared with that at admission was shown. These findings suggest an association between the increase in leptin and the immunological recovery observed following refeeding of malnourished infants.

Leptin levels and IgF-binding proteins in malnourished children: effect of weight gain.

OBJECTIVES: Although it is well known that leptin reflects body fat content in adults, the regulation of leptin levels during childhood malnutrition is poorly understood. Insulin-like growth factor I (IGF-I) and the IGF-binding proteins (IGFBPs) may play important roles in the regulation of body composition. We investigated the relation between leptin, IGF-I, and IGFBPs in children with protein-energy malnutrition (PEM; before and after recovering 10% of their initial body weights) in comparison with well-nourished children. METHODS: Fifteen PEM and 16 healthy children were studied on admission and after 10% weight gains in the malnourished group. Leptin was measured with radioimmunoassay, IGF-I and IGFBPs were measured with immunoradiometric assay. RESULTS: Patients with PEM had a significantly lower body mass index and percentage of body fat than did the control children. Before weight gain, leptin, IGF-I, and IGFBP-3 were significantly lower and IGFBP-1 was elevated in the malnourished group compared with the control group. Among PEM patients, after 10% weight gains, the levels of leptin, IGF-I, and IGFBP-3 were significantly higher and IGFBP-1 significantly lower compared with the control group. Leptin correlated significantly with IGF-I in the normal children (r(s) = 0.86, P < 0.005). On admission, no correlation was observed between leptin and IGF-I (r(s) = 0.08, P < 0.16) and between leptin and IGFBP-3 (r(s) = 0.02, P < 0.27) in the malnourished group, but those levels improved after 10% recovery of their body weights (r(s) = 0.47, P < 0.002 and r(s) = 0.42, P < 0.005, respectively). In the PEM group, IGF-I correlated significantly with IGFBP-3 when the children gained weight (before: r(s) = 0.006, P < 0.31; after: r(s) = 0.32, P < 0.01). Our study showed results similar to those of anorexia nervosa studies, but the normalization of study variables was obtained in considerable less time for the same weight gain. CONCLUSIONS: The main finding of this study was that, after refeeding with only a 10% weight gain, the PEM children normalized their leptin, IGF-I, and IGFBP-3 levels. These results provide evidence that leptin can function as link between this hormonal response and improved nutrition status.

Manifestaciones clínicas y respuesta leucocitaria producidas por la vacunación antisarampión / Clinical and leukocyte response after measles vaccination

Se analizan las manifestaciones clínicas y respuesta leucocitaria a una vacuna antisarampión con virus atenuado de la cepa Schwarz en 48 lactantes eutróficos de 12 meses. Un 66,7% de los sujetos presentó temperatura superior a 38-C, coriza (66,7%), tos (52,1%), diarrea (43,8%), exantema (14,6%). La respuesta leucocitaria se caracterizó por una caída en el recuento de linfocitos y del número absoluto de eosinófilos, con un aumento del número absoluto de baciliformes