Clinical and epidemiologic characterization of patients with systemic lupus erythematosus admitted to an intensive care unit in Colombia

Abstract Objective: Describe the clinical and epidemiologic characteristics of patients with systemic lupus erythematosus (SLE) admitted to the intensive care unit (ICU). Methods: a retrospective study with medical records review of patients with systemic lupus erythematosus (SLE) admitted to the ICU between 2004 and 2015 were included. Qualitative variables were described using absolute and relative frequencies. For quantitative variables mean value and standard deviation (SD) or median value with the interquartile range (IQR) depending on data distribution. To compare groups, it was used the Student t-test or Mann Whitney U test as appropriate and Fisher's exact test. Results: 33 patients were included, with a total of 45 ICU admissions, 29 (87.9%) were females with a median age of 26 years. The median time of diagnosis of SLE was two years, (IQR 1.5-5). The most common SLE manifestation and comorbidity were renal disease and hypertension with 27 (81.8%) and 14 (42.4%) respectively. The main reason for admittance was lupus flare with 25 events (55.5%). Infection was the second cause of admission with 19 events (42.2%). The median stay time in the ICU was four days (IQR 2-7). LODS score was 6 (RIQ 5-8), and APACHE II score was 13 (RIQ 11-17.7). There were 29 infections (64.5%) of which 20 (69%) were hospital-acquired. Four (12.1%) patients died. Conclusion: Unlike most of the previously reported series, in this study SLE activity was the most common cause of admission in the ICU. A more aggressive disease and difficulties in the ambulatory setting could explain this behavior. Despite the higher percentage of lupus flares, there was lower mortality.

Strongyloidiasis in humans: diagnostic efficacy of four conventional methods and real-time polymerase chain reaction.

INTRODUCTION: Strongyloides stercoralis is an intestinal parasitic nematode that causes hyperinfection and/or a dissemination syndrome in hosts, which is often difficult to diagnose. This study aims to compare the diagnostic efficacy of four conventional methods used to diagnose strongyloidiasis with real-time polymerase chain reaction (qPCR) to detect S. stercoralis in fecal samples. METHODS: We analyzed 143 fecal samples collected from Colombian regions with varying degrees of risk for intestinal infections caused by S. stercoralis to assess the validity, performance, overall efficiency, and concordance of the qPCR using a direct stool test, modified Ritchie concentration technique, agar plate culture, and Harada-Mori technique as reference tests. RESULTS: While four fecal samples were positive for S. stercoralis using conventional methods, 32 were positive via qPCR. The diagnostic sensitivity of the qPCR was 75% [95% confidence interval (CI): 20.07-100%], whereas its specificity, negative predictive value, negative likelihood ratio, and Youden's J index were 78.42% (95% CI: 71.22-85.62%), 99.09% (95% CI: 96.86-100%), 0.32 (95% CI: 0.06-1.74), and 0.53, respectively. In addition, the estimated kappa index between the qPCR and the conventional methods was 0.12 (95% CI: -0.020-0.26). CONCLUSIONS: The diagnostic sensitivity of qPCR to detect strongyloidiasis is analogous to that of conventional parasitology methods, with an additional advantage of being capable of identifying the parasite DNA at low sample concentrations.

Strongyloidiasis in humans: diagnostic efficacy of four conventional methods and real-time polymerase chain reaction

Abstract INTRODUCTION: Strongyloides stercoralis is an intestinal parasitic nematode that causes hyperinfection and/or a dissemination syndrome in hosts, which is often difficult to diagnose. This study aims to compare the diagnostic efficacy of four conventional methods used to diagnose strongyloidiasis with real-time polymerase chain reaction (qPCR) to detect S. stercoralis in fecal samples. METHODS: We analyzed 143 fecal samples collected from Colombian regions with varying degrees of risk for intestinal infections caused by S. stercoralis to assess the validity, performance, overall efficiency, and concordance of the qPCR using a direct stool test, modified Ritchie concentration technique, agar plate culture, and Harada-Mori technique as reference tests. RESULTS While four fecal samples were positive for S. stercoralis using conventional methods, 32 were positive via qPCR. The diagnostic sensitivity of the qPCR was 75% [95% confidence interval (CI): 20.07-100%], whereas its specificity, negative predictive value, negative likelihood ratio, and Youden's J index were 78.42% (95% CI: 71.22-85.62%), 99.09% (95% CI: 96.86-100%), 0.32 (95% CI: 0.06-1.74), and 0.53, respectively. In addition, the estimated kappa index between the qPCR and the conventional methods was 0.12 (95% CI: -0.020-0.26). CONCLUSIONS: The diagnostic sensitivity of qPCR to detect strongyloidiasis is analogous to that of conventional parasitology methods, with an additional advantage of being capable of identifying the parasite DNA at low sample concentrations.

Necrosis cutánea extensa secundaria a síndromeantifosfolípido en un paciente con infección por el virusde la inmunodeficiencia humana: reporte de caso / Extensive skin necrosis secondary to antiphospholipid syndrome in an HIV infected patient: A case report

(AU)Aunque un alto porcentaje de pacientes con infección por el virus de la inmunodeficienciahumana tienen anticuerpos antifosfolípidos, la expresión clínica como síndrome antifosfolípidoes poco frecuente. La necrosis cutánea extensa es una de las principalescaracterísticas del síndrome antifosfolípido asociado a esta infección; la piedra angularde su tratamiento consiste en anticoagulación; en casos refractarios, se ha utilizadorituximab y plasmaféresis. Se presenta el caso de un paciente con infección por el virusde la inmunodeficiencia humana quien presentó necrosis cutánea extensa refractaria amúltiples terapias, en el contexto de un síndrome antifosfolípido...

Although a high percentage of patients infected with human immunodeficiency virus have antiphospholipid antibodies, clinical expression as antiphospholipid syndrome is rare. Extensive skin necrosis is one of the main features of antiphospholipid syndrome associated with this infection. The basis of the treatment is anticoagulation, with rituximab and plasmapheresis has being used inrefractory cases. A case is presented on a patient with human immunodeficiency virus infection, who, in the context of antiphospholipid syndrome, presented with extensive skin necrosis refractory to multiple therapies.

Plasmaféresis y recambio terapéutico de plasmaen enfermedades autoinmunes: indicaciones, complicacionesy desenlaces. Descripción de una serie de casos / Plasmapheresis and therapeutic plasma exchange in autoimmune diseases: indications, complications and outcomes. A description of a case series

Introducción: El intercambio terapéutico de plasma y la plasmaféresis son procedimientosque permiten la eliminación de macromoléculas nocivas y que están indicados en algunostrastornos autoinmunes cuando está en peligro la vida o un órgano vital.Objetivos y métodos: Describir la experiencia con el uso de la plasmaféresis y el intercambioterapéutico de plasma en patologías autoinmunes en un hospital universitario de cuartonivel de complejidad, centro de referencia. Estudio descriptivo, retrospectivo, de una seriede casos.Resultados: Se incluyeron 93 pacientes; 67 tenían enfermedades autoinmunes: neurológicas(66%), hematológicas (18%) y reumatológicas (12%). El 82% del grupo tuvo una respuestafavorable (61% completa y 21% parcial). La mortalidad global fue del 6%. En el subgrupo deenfermedades reumatológicas, las indicaciones más frecuentes fueron: lupus eritematososistémico y vasculitis asociadas a anticuerpos contra el citoplasma de neutrófilo (37,5%cada una) por compromisos: respiratorio o neurológico. Las secuelas más importantesfueron neurológicas y renales. El 63% de los sujetos no presentó ningún evento adverso.Conclusiones: Los pacientes que recibieron plasmaféresis o intercambio terapéutico deplasma por enfermedades autoinmunes con una condición crítica que amenaza la vida o unórgano vital presentaron una respuesta favorable que redundó en una mejor supervivenciaa corto plazo; estas terapias son, generalmente, bien toleradas. Se requieren estudios conmayor solidez metodológica, especialmente en las enfermedades reumatológicas...

Background: Therapeutic plasma exchange and plasmapheresis are procedures that allow the removal of harmful macromolecules, and are indicated in some autoimmune disorders, when life or vital organs are in danger.Objectives and Methods: To describe the experience with the use of therapeutic plasmapheresis and plasma exchange in autoimmune diseases in a tertiary reference university hospital. A retrospective descriptive study was conducted on a series of cases.Results: Of the 93 patients included, 67 had autoimmune diseases: neurological (66%), hematological (18%), and rheumatic (12%). A favorable response was observed in 82% of the group (61% complete and 21% partial). Overall mortality was 6%. In the subgroup of rheumatology diseases, the most frequent indications were: systemic lupus erythematosus and vasculitis associated with antibodies against neutrophil cytoplasm (37.5 % each) for respiratory or neurological involvement. The most important sequelae were neurological and renal. No adverse events were reported in 63% of the subjects.Conclusions: Patients receiving therapeutic plasmapheresis or plasma exchange in autoimmune diseases with a critical life-threatening condition or a vital organ involvement had a favorable response that resulted in better short-term survival. These therapies are, generally, well tolerated. Studies with greater methodological soundness, especially in rheumatic diseases, are required...

Fractura patológica atribuible a la terapia conbisfosfonatos / Pathologic fracture attributable to bisphosphonates therapy

La osteoporosis se define como una enfermedad que afecta el sistema músculoesquelético y secaracteriza por disminución en la masa mineral ósea con deterioro de la microarquitectura deltejido óseo que predispone a fracturas como principal complicación.El alendronato es usado como terapia para el tratamiento de la osteoporosis. Uno de sus efectosadversos es la sobresupresión de los osteoclastos con el riesgo potencial de causar fracturaspor estrés.Se presenta un caso de una fractura femoral atraumática en una mujer de 42 años en terapia conalendronato durante seis años