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1.
Rev. Ciênc. Plur ; 8(3): 27644, out. 2022. ilus, tab
Article in Portuguese | LILACS, BBO | ID: biblio-1399339

ABSTRACT

Introdução:uma vez conhecidos os mecanismos de patogênese do SARS-CoV-2, vários métodos de tratamento para a COVID-19 foram desenvolvidos, dentre eles destaca-se o uso dos anticorpos monoclonais para o contexto de pacientes em estágios graves da doença. Objetivo: compreender se o uso dos anticorpos monoclonais para tratamento da COVID-19 grave interfere nos níveis séricos da angiotensina II. Metodologia:Para a realização dessa pesquisa foram selecionados através do DeCS e MeSH os descritores "COVID-19", "Angiotensin II" e "Antibodies, Monoclonal" e seus respectivos "entry terms" sugeridos pela base MeSH. Posteriormente,utilizando-se os operadores booleanos OR e AND, foi montada uma estratégia de busca, a qual foi utilizada nas bases de dados PUBMED, EMBASE, Web of Science, Cochrane Library e Scopus, sem restrição dedata de publicação ou idioma. Resultados:ao final do processo de seleção dos artigos, 29 foram selecionados para a leitura e análise completa. Nesta revisão, foram abordados diferentes tipos de anticorpos monoclonais, os quais foram oportunamente agrupados de acordo com o seu mecanismo de ação. Conclusão: foi possível concluir que das cinco classes de anticorpos monoclonais tratadas neste trabalho, três potencialmente podem causar alterações nos níveis séricos de angiotensina II (AU).


Introduction:once the mechanisms of pathogenesis of SARS-CoV-2 are known, several methods of treatment for COVID-19 have been developed, among them the use of monoclonal antibodies for the context of patients in severe stages of the disease. Purpose:to understand whether the use of monoclonal antibodies for the treatment of severe COVID-19 interferes with serum angiotensin II levels. Methodology:For this research were selected through DeCS and MeSH the descriptors "COVID-19", "Angiotensin II" and "Antibodies, Monoclonal" and their respective entry "Terms" suggested by the MeSH database. Subsequently, using the boolean operators OR and AND, a search strategy was set up, which was used in the databases PUBMED, EMBASE, Web of Science, Cochrane Library and Scopus, without restriction of publication date or language. Results:at the end of the article selection process, 29 were selected for reading and full analysis. In this review, different types of monoclonal antibodies were addressed, which were opportunely grouped according to their mechanism of action. Conclusion:it was possible to conclude that of the five classes of monoclonal antibodies treated in this study, three potentially can cause changes in serum levels of angiotensin II (AU).


Introducción:Una vez conocidos los mecanismos de patogénesis del SARSCoV-2, se desarrollaron variosmétodos de tratamiento para el COVID-19, entre ellos, el uso de anticuerpos monoclonales para el contexto de pacientes en fases graves de la enfermedad. Objetivo:Comprender si el uso de anticuerpos monoclonales para el tratamiento de la COVID-19 grave interfiere en los niveles séricos de angiotensina II. Metodología:Los descriptores "COVID-19", "Angiotensina II", "Anticuerpos, Monoclonales" y sus respectivos "entry terms" (términos de entrada) sugeridos por el MeSH fueron seleccionados a través de DeCS yMeSH. Posteriormente, utilizando los operadores booleanos OR y AND, se estableció una estrategia de búsqueda que se utilizó en las bases de datos PUBMED, EMBASE, Web of Science, Cochrane Library y Scopus, sin restricción de fecha de publicación ni de idioma. Resultados:Al final del proceso de selección de artículos, se seleccionaron 29 artículos para su lectura y análisis completos. En esta revisión se han abordado diferentes tipos de anticuerpos monoclonales, que se han agrupado oportunamente según su mecanismo de acción. Conclusión:Se pudo concluir que de las cinco clases de anticuerpos monoclonales tratados en este trabajo, tres pueden potencialmente causar alteraciones en los niveles séricos de angiotensina II (AU).


Subject(s)
Angiotensin II , COVID-19/drug therapy , Immunologic Factors/therapeutic use , Antibodies, Monoclonal/therapeutic use , SARS-CoV-2/enzymology
2.
Arq. bras. oftalmol ; 85(4): 411-414, July-Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1383815

ABSTRACT

ABSTRACT The purpose of this study is to report the clinical features and outcomes of ocular surface toxicity following depatuxizumab mafoditin (ABT-414) therapy for unresectable glioblastoma. Ocular signs and symptoms of three patients treated with ABT-414 during a phase III trial for glioblastoma multiforme were evaluated. Both eyes of all patients were damaged during the week after the first infusion of the ABT-414 molecule. In all patients, mild-to-moderate keratitis could be ascertained, along with decreased visual acuity and blurred vision, as well as foreign-body sensation and redness. Symptoms and visual acuity improved 4 weeks. In conclusion, ABT-414 therapy may cause transient ocular surface toxicity. The initiation of artificial tears and lubricant ointment was enough to control the ocular surface signs and symptoms. A multidisciplinary approach, complete ophthalmologic monitorization, and elaboration of protocols are required to adequately manage these patients.


RESUMO Nosso objetivo é relatar as características clínicas e os resultados da toxicidade na superfície ocular após a terapia com depatuxizumabe mafodotina (ABT-414) para glioblastoma irressecável. Os sinais e sintomas oculares de três pacientes que foram tratados com ABT-414 durante um estudo de fase III para glioblastoma multiforme foram avaliados. Ambos os olhos de todos os pacientes foram danificados durante a semana após a primeira infusão da molécula ABT-414. Em todos os pacientes, uma ceratite de leve a moderada pode ser verificada, juntamente com uma diminuição da acuidade visual e visão turva, bem como sensação de corpo estranho e vermelhidão. Os sintomas e a acuidade visual melhoraram em um período de 4 semanas. Em conclusão, a terapia com ABT-414 pode causar toxicidade transitória na superfície ocular. A iniciação com lágrimas artificiais e pomada lubrificante foi suficiente para controlar os sinais e sintomas na superfície ocular. Uma abordagem multidisciplinar, com acompanhamento oftalmológico completo e a elaboração de protocolos são necessários para o manejo adequado desses pacientes.

3.
Rev. med. vet. (Bogota) ; (44): 25-31, Jan.-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1377004

ABSTRACT

Abstract Current knowledge of Toxoplasma gondii infection in Venezuelan ecosystems is limited. Mammals and birds are intermediate hosts, and felid species are definitive hosts. In most human-altered habitats, the domestic cat is the predominant definitive host. Cats are important in the epidemiology of T. gondii infection because they are the only hosts that can excrete environmentally resistant oocysts. Other carnivores can be infected consuming tissue cysts when feeding on infected animals and by incidental ingestion of oocysts from environmental contamination. This study aimed to quantify the values of antibodies for T. gondii in blood serum of some felids' species employing the technique of indirect hemagglutination. In the present study, seropositivity of T. gondii was determined in serum of 35 animals (22 stray cats and 13 wild cats) from Venezuela, South America. Antibodies to T. gondii were found in 21 of 22 (95.45 %) stray cats' titers of 1:64 in four, 1:128 in four, 1:256 in one, 1:512 in one, 1:1024 in three, and 1:2048 or higher in eight. In four of six (66.67 %) ocelots' titers of 1:64 in one, 1:256 in one, 1:1024 in one, and one with titers 1:2048. In three of four (75.00 %) jaguars' titers of 1:512 in one, and two with titers 1:2048. The Kruskal-Wallis test showed a statistically significant difference between species (H = 8.413, p = 0 .015).


Resumen El conocimiento actual de la infección por Toxoplasma gondii en los ecosistemas venezolanos es limitado. Los mamíferos y las aves son hospedadores intermedios y los félidos son hospedadores definitivos. En la mayoría de los hábitats alterados por el hombre, el gato doméstico es el hospedador definitivo predominante. Los gatos son importantes en la epidemiología de la infección por T. gondii porque son los únicos hospedadores que pueden excretar los ooquistes resistentes al medio ambiente. Otros carnívoros pueden infectarse por el consumo de quistes tisulares al alimentarse de animales infectados y por la ingestión incidental de ooquistes procedentes de la contaminación ambiental. Este estudio tuvo como objetivo cuantificar los valores de anticuerpos para T. gondii en el suero sanguíneo de algunas especies de félidos mediante la técnica de hemoaglutinación indirecta. En el presente estudio se determinó la seropositividad de T. gondii en el suero de 35 animales (22 gatos callejeros y 13 felinos silvestres) de Venezuela, Sudamérica. Los anticuerpos contra T. gondii se encontraron en 21 de 22 (95,45 %) gatos callejeros con títulos de 1:64 en cuatro, 1:128 en cuatro, 1:256 en uno, 1:512 en uno, 1:1024 en tres y 1:2048 o más en ocho. En cuatro de seis (66,67 %) ocelotes con títulos de 1:64 en uno, 1:256 en uno, 1:1024 en uno, y uno con títulos 1:2048. En 3 de 4 (75,00 %) jaguares con títulos de 1:512 en uno, y dos con títulos 1:2048. La prueba de Kruskal-Wallis mostró una diferencia estadísticamente significativa entre las especies (H = 8,413, p = 0,015).

4.
Int. j. cardiovasc. sci. (Impr.) ; 35(3): 354-363, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1375637

ABSTRACT

Abstract Background: Different immune mechanisms of myocardial damage involved in the pathophysiology of Chagas disease coexist with high titers of autoantibodies induced by T. cruzi . There are few studies in the literature about the adaptive role of anti-β1 and anti-M2 antibodies in chronic Chagas cardiomyopathy (CCC). Objectives: To evaluate the association between anti-β1 and anti-M2 antibodies with heart rate variability (HRV) parameters on 24h Holter monitoring and the rate-pressure product (RPP) on cardiopulmonary exercise testing (CPET). Methods: Anti-β1 and anti-M2 antibody titers were measured by enzyme-linked immunosorbent assay (ELISA) in 64 patients affected by CCC. Analysis of HRV was performed through the time-domain indices NNs, mean NN, SDNN, SDANN, SDNN index, NNNs, RMSSD, and pNN50. Spearman's correlation coefficient was used to assess the association between antibody titers and numerical variables. The Mann-Whitney test was used for comparison between two groups. Multiple linear regression was used to identify independent variables capable of explaining anti-β1 and anti-M2 antibody titers at the 5% significance level. Results: On 24h Holter, during the period of greatest parasympathetic activation (2:00-6:00 a.m.), an inverse association was found between anti-β1 titers and SDNN (rs=-0.13, p =0.041, n=43), as well as a direct association between anti-M2 titers and SDANN ( r s=0.317, p =0.039, n=43). Regarding CPET variables, anti-β1 titers were directly associated with RPP (rs=0.371, p =0.005, n=56). The subgroup of patients with a normal chronotropic response showed higher anti-β1 titers than the subgroup with an impaired response (p=0.023). RPP was an independent explanatory variable for anti-β1 titers, although with a low coefficient of determination (R2=0.147). Conclusion: The findings of this study suggest that, in patients with CCC, anti-β1 and anti-M2 antibodies may affect HRV parameters. RPP was directly associated with higher anti-β1 titers.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Autonomic Nervous System/physiology , Chagas Cardiomyopathy/physiopathology , Receptors, Adrenergic, beta-1/physiology , Receptor, Muscarinic M2/physiology , Chronic Disease , Cross-Sectional Studies , Antibodies, Bispecific , Exercise Test
5.
Medwave ; 22(5): e8743, jun.-2022.
Article in English, Spanish | LILACS | ID: biblio-1378540

ABSTRACT

Los bloqueos auriculoventriculares son aberraciones cronotrópicas producidas por alteraciones de índole multifactorial en el sistema de inervación cardíaco. Específicamente se localizan entre las vías internodales que conducen el potencial de acción desde el nodo sinusal hasta el nodo auriculoventricular. Estos representan el 2,3% de las alteraciones cardíacas en la vida intrauterina, registrándose un caso por cada 20 000 a 25 000 nacidos vivos. Sin embargo, su ocurrencia en la infancia temprana y la edad escolar es desconocida. Asimismo, el porcentaje de causas idiopáticas de bloqueos auriculoventriculares en esta etapa de la vida es desconocido hasta el momento en Colombia. Dentro de las posibles etiologías se han documentado causas congénitas y adquiridas. Algunos ejemplos son casos aislados producto de isoinmunización materna, en hijo de madre lúpica o en coexistencia con alteraciones estructurales como anomalías del septo interventricular de índole neoplásico, defectos relacionados al ostium y la tabicación de las cámaras cardíacas. También se han descrito casos secundarios a infección por virus sincitial respiratorio y miocarditis vírica concomitante, incluyendo cardiomiopatías de origen inmune, reumático, infeccioso, tumoral, estructural, además de aquellas con compromiso mitocondrial en el cardiomiocito (síndrome de Kearns Sayre) con presentación más tardía con afectación multiorgánica. Todas ellas destacan por un fenómeno en común a nivel celular, referente a la inflamación crónica con reparación fibrótica en el sistema de conducción cardíaco, que conlleva alteraciones de la transmisión del potencial de acción y bradicardia con asíncrona auriculoventricular. También se han reportado causas idiopáticas descritas en el debut de una disautonomía primaria. Se presenta el caso de una paciente de 11 años con crisis de cefalea y síntomas vegetativos paroxísticos asociados a lipotimias a repetición, con posteriores estudios de extensión sin identificación de alteraciones estructurales ni hallazgos autoinmunes. A la niña se le diagnosticó bloqueo auriculoventricular completo, idiopático por lo que recibió manejo expectante por parte del servicio de electrofisiología.


Atrioventricular blocks are chronotropic abnormalities produced by multifactorial alterations in the cardiac innervation system, specifically between the internodal pathways between the sinus node and the atrioventricular node. These bradyarrhythmias represent 2.3% of cardiac alterations in intrauterine life, registering one case for every 20 000 to 25 000 live births. However, its occurrence in childhood and adolescence is unknown. Likewise, the percentage of idiopathic atrioventricular blocks in this group in Colombia is unknown to date. Among the possible etiol-ogies, congenital and acquired causes have been documented. Some examples are isolated cases found in pregnancies with maternal isoimmunization, from carriers with lupus, and in coexis-tence with structural alterations, such as anomalies of the interventricular septum due to cardiac tumors and defects in the ostium and septation of the cardiac chambers. Atrioventricular blocks are also associated with respiratory syncytial virus infection and concomitant viral myocarditis and with cardiomyopathies of immune, rheumatic, infectious, tumoral, and structural origin, in addition to mitochondrial diseases such as Kearns Sayre syndrome, presenting with multi- organ involvement. These etiologies lead to chronic inflammation with fibrotic repair in the cardiac conduction system, which alters the transmission of the action potential and bradycardia with atrioventricular asynchrony. Idiopathic causes described in the onset of primary dysautonomia have also been reported. We present the case of an 11- year- old patient with a headache crisis and paroxysmal vegetative symptoms associated with repeated fainting, with subsequent studies where no structural alterations or autoimmune findings were identified. The patient was diag-nosed with idiopathic complete atrioventricular block and received expectant management by the electrophysiology service.


Subject(s)
Humans , Child , Adolescent , Atrioventricular Block/complications , Colombia , Electrocardiography
6.
Rev. Assoc. Med. Bras. (1992) ; 68(5): 670-674, May 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1376190

ABSTRACT

SUMMARY OBJECTIVE: To assess the prevalence of maternal alloantibodies in pregnant women at a maternity hospital in northeastern Brazil and describe their perinatal outcomes. METHODS: A retrospective cohort study reviewed maternal and newborn medical records between January 2017 and October 2018 to assess for the presence of maternal alloantibodies. RESULTS: The following maternal alloantibodies were found in the 41 cases surveyed: anti-D, 28 cases (45%); anti-C, 7 cases (11%); anti-c, 1 case (1.6%); anti-E, 4 cases (6.4%); anti-Cw, 1 case (1.6%); anti-K, 2 cases (3.2%); anti-Jka, 1 case (1.6%); anti-M, 3 cases (4.8%); anti-Fya, 2 cases (3.2%); anti-Fyb, 1 case (1.6%); anti-Lea, 5 cases (8%); anti-Leb, 3 cases (4.8%); and anti-Dia, 4 cases (6.4%). Anti-D antibodies were the most frequent cause of erythrocyte alloimmunization (80%). Fetal anemia was observed in four pregnancies based on the peak systolic velocity of the middle cerebral artery. In one case, the mother showed anti-M, and anti-Lea alloimmunization, but the direct antiglobulin test results for the newborn were negative, and no unfavorable neonatal outcomes were observed. In one case of a mother with anti-C and anti-D alloimmunization, the neonate showed anti-D antibodies only in the serological panel and required phototherapy. Neonates with plasma antibodies and jaundice requiring phototherapy only had a serological panel with anti-D, anti-C, anti-c, and anti-E antibodies. Intervention was required for 2.5% of pregnant women with positive antibody screens and 81% of newborns with positive direct antiglobulin test results. CONCLUSION: Despite being a rare condition, maternal alloimmunization by irregular antibodies can result in high perinatal morbidity and mortality.

7.
Rev. Ciênc. Méd. Biol. (Impr.) ; 21(1): 40-45, maio 05,2022. fig
Article in Portuguese | LILACS | ID: biblio-1370563

ABSTRACT

Introduction: dengue is a most common mosquito-borne viral disease in the Americas and tropical countries. Objective: in this work, mice were hyperimmunized with DENV 4 antigen to produce monoclonal antibodies (mAbs). Methodology: DENV 4 (GenBank KC806069) was inoculated in C6/36 cell monolayers cultivated in Leibovitz's 15 medium supplemented with 5% fetal bovine serum and incubated at 28 oC. The virus stock was submitted to concentration and ultracentrifugation and stored at -80 oC until use (VC DENV 4). Balb/c mice were injected intraperitoneally with 50µg of DENV-4 and successive intraperitoneal injections of 25 µg of VCDENV 4 with Freund's incomplete adjuvant were performed. The spleen cells were fused to SP2/0 myeloma cells with PEG 1540 and distributed in 96-well microplates with Iscove's modified medium with Hipoxantina­Aminopterina­Timidina. Hybridoma screening by indirect ELISA showed positive results for six mAbs, and their characterization was performed by Western blotting and Indirect Immunofluorescence (IFI) techniques. Results: the six mAbs showed strong recognition of prM (24/29 kDa), and minor reaction to E protein (66 kDa), E/E protein dimer (105 kDa), and NS1 (49 kDa) protein in two mAbs. The use of mAbs anti-prM as a diagnostic tool using IFI has been demonstrated to detect DENV-4 antigen in infected cells or tissues. Conclusion: DENV 4 generate mAbs with strong reactivity to prM with potential use to confirm the presence of DENV 4 antigen in tissues or infected cells.


Introdução: a dengue é uma doença viral transmitida por mosquitos comumente das Américas e países tropicais. Objetivo: neste trabalho, camundongos foram hiperimunizados com antígeno DENV 4 para produzir anticorpos monoclonais (mAbs). Metodologia: DENV 4 (GenBank KC806069) foi inoculado em monocamadas de células C6 / 36 cultivadas em meio Leibovitz 15 suplementado com 5% de soro fetal bovino e incubadas a 28oC. O estoque viral foi submetido à concentração, ultracentrifugação e armazenado a -80 oC (VC DENV 4). Camundongos Balb / c foram injetados intraperitonealmente com 50 µg de VC DENV-4 e injeções intraperitoneais sucessivas de 25 µg de antigeno com adjuvante incompleto de Freund. As células do baço foram misturadas a células SP2/0 com PEG 1540 e distribuídas em microplacas de 96 poços com meio Iscove Modificado em presença de Hipoxantina ­ Aminopterina ­ Timidina. A triagem de hibridomas por ELISA indireto apresentou resultados positivos para seis mAbs, e sua caracterização foi realizada por técnicas de Western blotting e Imunofluorescência Indireta (IFI). Resultados: os seis mAbs mostraram forte reconhecimento de prM (24/29 kDa) e reação menor à proteína E (66 kDa), dímero de proteína E / E (105 kDa) e proteína NS1 (49 kDa) em dois mAbs. O uso de mAbs anti-prM como uma ferramenta de diagnóstico utilizando IFI demonstrou eficacia em detectar o antígeno DENV-4 em células ou tecidos infectados. Conclusão: o mAbs produzidos para DENV 4 demonstraram uma forte reatividade contra prM, e poderiam ser uma ferramenta de uso potencial no diagnóstico de DENV 4 .


Subject(s)
Animals , Rats , Dengue , Mice , Antibodies, Monoclonal
8.
Arq. neuropsiquiatr ; 80(5,supl.1): 214-217, May 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1393934

ABSTRACT

ABSTRACT Migraine is a prevalent disorder and a cause of high disability, influenced by modifiable and non-modifiable risk factors. Comorbid and psychiatric illnesses are prevalent in migraine patients and should be considered when choosing preventive drugs. There have been unforeseen problems with the use of preventive treatment of migraine with oral drugs, mainly due to side-effects that cannot be tolerated and lack of efficacy, leading to high discontinuation rates. Anti-CGRP monoclonal antibodies (mAbs) have shown better tolerance profiles, based on the low dropout rates in clinical trials due to adverse events. First-line therapy is a term most expressed in some medical specialties that adopt standardized protocol treatments and may not be suitable for treating migraine. Regarding efficacy, mAbs don't seem to perform much better than the current prophylactic oral drugs in reduction of monthly migraine days compared to placebo. Monoclonal antibodies against CGRP pathway have been prescribed recently, which raises some concern about their safety in the long term. Only side effects observation will confirm whether CGRP blockade causes susceptibility to severe side-effects, at least to specific subpopulations. CGRP may play a role in regulating uteroplacental blood flow and myometrial and uterine relaxation, as well as blood pressure control, raising the suspicion that its blockade could cause complications during pregnancy. Recent guidelines retain the recommendation of starting preventive treatment of migraine with oral drugs. Both the fact that it is new and costs are the reason why guidelines recommend the prescription of mAbs only after failure of at least two oral drugs.


RESUMO A migrânea é uma condição prevalente e motivo de grande incapacidade, influenciada por fatores de risco modificáveis e não-modificáveis. Comorbidades e doenças psiquiátricas são prevalentes em doentes com migrânea e devem ser levadas em consideração na escolha do tratamento profilático com medicações orais. Os anticorpos monoclonais anti-CGRP possuem melhor perfil de tolerabilidade, baseando-se nos baixos indicadores de desistência devido a efeitos colaterais em ensaios clínicos. O termo "tratamento de primeira linha" é muito utilizado em algumas especialidades médicas que adotam protocolos de tratamento padronizados e pode não ser adequado à migrânea. Quanto à eficácia, os anticorpos monoclonais não possuem desempenho muito superior que os medicamentos profiláticos orais atuais no tocante à redução de dias de migrânea por mês, quando comparados ao placebo. Os anticorpos monoclonais anti-CGRP são recentes no mercado, o que leva a suspeitas quanto à sua segurança a longo prazo. Apenas a vigilância de efeitos adversos confirmará se o bloqueio da via do CGRP não leva à suscetibilidade de efeitos colaterais graves, ao menos em subpopulações específicas. O CGRP pode ter um papel na regulação do fluxo sanguíneo uteroplacentário, bem como no relaxamento do miométrio e do útero e controle da pressão arterial, levando à possibilidade de que o seu bloqueio poderia causar complicações durante a gestação. Guidelines recentes recomendam o início do tratamento preventivo da migrânea com drogas orais. Tanto a precocidade quanto os elevados custos são a razão porque os guidelines orientam a prescrição de anticorpos monoclonais após falha a pelo menos duas medicações orais.

9.
Arq. neuropsiquiatr ; 80(5,supl.1): 218-226, May 2022. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1393954

ABSTRACT

ABSTRACT The result of more than thirty years of research, anti-CGRP monoclonal antibodies are currently the state of the art for migraine preventive therapy. Their efficacy and safety, supported by an already large and growing body of evidence, are added by many other advantages: an early onset of action, favorable posology, negligible pharmacological interaction, and a broad-reaching efficacy in many challenging clinical contexts. When compared to standard prophylactics, these novel medications seem at least as efficacious, clearly more tolerable and, consequently, with a superior adherence profile. Furthermore, recently published analyses indicate that they are cost-effective, especially among those with chronic migraine. Yet, current guidelines endorse their use only after multiple other preventives have failed or have been deemed not tolerable. Although this recommendation may have been sensible at first, the now available data strongly point that time has come for anti-CGRP monoclonal antibodies to be acknowledged as first-line treatments for migraine patients with severe disability. For these individuals, delaying treatment until several other alternatives have failed incurs in significant losses, both economically and to many relevant aspects of their lives.


RESUMO Frutos de mais de 30 anos de pesquisa, os anticorpos monoclonais anti-CGRP são atualmente o que há de mais moderno no tratamento preventivo da migrânea. À sua eficácia e segurança, já bem estabelecidos por um grande corpo de evidências, acrescentam-se outras vantagens: um início precoce de ação, posologia favorável, mínima interação farmacológica, e eficácia comprovada em uma variedade de contextos clínicos frequentemente desafiadores. Quando comparados a outros profiláticos, estas medicações aparentam ser ao menos tão eficazes, evidentemente mais toleráveis e, portanto, com melhor perfil de adesão. Ademais, estudos recentemente publicados indicam que elas são custo-efetivas, especialmente entre pacientes com migrânea crônica. Ainda assim, as diretrizes atuais orientam o seu uso apenas caso haja refratariedade ou intolerância a múltiplos outros preventivos. Apesar de esta recomendação poder ter sido sensata a priori, os dados disponíveis atualmente corroboram que já é tempo de estes anticorpos monoclonais serem reconhecidos como tratamentos de primeira linha para a migrânea associada à incapacidade grave. Para estes pacientes, demorar a oferecer este tratamento até que outras múltiplas alternativas tenham falhado, leva a perdas significativas, tanto economicamente quanto em múltiplos outros aspectos relevantes das suas vidas.

10.
Gac. méd. Méx ; 158(2): 81-85, mar.-abr. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1375532

ABSTRACT

Resumen Introducción: El estudio de anticuerpos IgG anti-SARS-CoV-2 permite identificar individuos asintomáticos con COVID-19 y evaluar la inmunidad posinfección y posvacunación. Objetivo: Conocer el comportamiento de los anticuerpos IgG anti-SARS-CoV-2 pre y posvacunación en trabajadores de un centro oncológico. Métodos: Antes de aplicar la vacuna se analizaron los anticuerpos IgG anti-SARS-CoV-2 (n = 171) con la evaluación de IgG anti-N; después de la segunda dosis se evaluó IgG anti-S (n = 60). Resultados: Prevacunación, los anticuerpos IgG estaban presentes en 18.71 % de los participantes; se detectaron en 65.22 % de aquellos con antecedente de diagnóstico de COVID-19 y en 11.49 % de aquellos sin antecedentes. Los profesiones con mayor prevalencia fueron enfermeros (28.26 %), paramédicos (27.59 %) y administrativos (27.78 %), p < 0.01. La anosmia, ageusia y opresión en el pecho se asociaron a la presencia de IgG (p < 0.05). Posvacunación, todos los participantes desarrollaron IgG; las personas con diagnóstico previo de COVID-19 presentaron mayores títulos: 10 277 versus 6819 UA/mL, p < 0.001. Conclusiones: El estudio de anticuerpos IgG anti-SARS-CoV-2 permitió identificar a trabajadores de salud asintomáticos. Un alto porcentaje de los participantes con diagnóstico previo de COVID-19 presentó anticuerpos. Todos los participantes desarrollaron anticuerpos IgG posvacunación; las personas con infección previa presentaron una cuantificación más alta de títulos.


Abstract Introduction: The study of anti-SARS-CoV-2 IgG antibodies allows asymptomatic individuals with COVID-19 to be identified, and post-infection and post-vaccination immunity status to be evaluated. Objective: To know the behavior of anti-SARS-CoV-2 IgG antibodies before and after vaccination in workers of a cancer center. Methods: Prior to the application of the vaccine, the presence of anti-SARS-CoV-2 IgG antibodies (n = 171) was analyzed by evaluating anti-N IgG antibodies; post-vaccination, after receiving the second dose, anti-S IgG antibodies were evaluated (n = 60). Results: Prior to vaccination, IgG antibodies were present in 18.71% of participants; they were detected in 65.22% of those with prior history of COVID-19 diagnosis and in 11.49% of those without it. The positions with the highest prevalence were nurses (28.26%), paramedics (27.59%) and administrative workers (27.78%), p < 0.01. Anosmia, ageusia and chest tightness were associated with the presence of IgG (p < 0.05). Post-vaccination, all participants developed IgG antibodies; people with a previous COVID-19 diagnosis had higher titers: 10,277 vs. 6,819 AU/mL, p < 0.001. Conclusions: The study of anti-SARS-CoV-2 IgG allowed asymptomatic health workers to be identified. A high percentage of participants with prior COVID-19 diagnosis had antibodies. All participants developed IgG after vaccination, with higher titers being identified in those with previous infection.

11.
Gac. méd. Méx ; 158(2): 108-114, mar.-abr. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1375536

ABSTRACT

Resumen Introducción: La fibromialgia (FM) es un síndrome no degenerativo caracterizado por dolor musculoesquelético crónico y generalizado; así como por alteraciones anímicas, de memoria y sueño. Objetivo: Buscar anticuerpos antineurales (AANeu) séricos en pacientes con FM para descartar etiología autoinmune. Métodos: Se aplicó el Cuestionario de Impacto en Fibromialgia (FIQ) y el Inventario de Depresión de Beck (BDI). La inmunorreactividad y el blanco reconocido por los sueros de pacientes con FM y sujetos sanos se analizó con inmunofluorescencia indirecta y Western blot. Resultados: Los valores de FIQ y BDI estuvieron significativamente alterados en los pacientes con FM, en comparación con los de los controles (FIQ, 70 ± 25 versus 12 ± 12, p < 0.0001; BDI, 17 ± 11 versus 4 ± 3, p < 0.0002). Solo cinco de 15 sueros de pacientes con FM tuvieron AANeu dirigidos específicamente contra las neuronas del núcleo vestibular medio del tronco encefálico; estos no se detectaron en los 14 sueros de los controles. Los AANeu reconocieron una proteína de 45 kDa. Conclusiones: El 30 % de los pacientes con FM tiene AANeu no descritos antes. Será necesario evaluar la inmunorreactividad antineural en una muestra más grande y determinar el papel de los AANeu en la fisiopatología de la FM.


Abstract Introduction: Fibromyalgia (FM) is a non-degenerative syndrome characterized by generalized, chronic musculoskeletal pain, as well as mood, memory and sleep disorders. Objective: To search for serum anti-neural antibodies (ANeuA) in patients with FM (FMP) in order to rule out autoimmune etiology. Methods: The Fibromyalgia Impact Questionnaire (FIQ) and BECK’s depression inventory (BDI) were applied. Immunorreactivity and the target recognized on the sera from FMPs and healthy subjects were analyzed by indirect immunofluorescence and Western blot. Results: Both FIQ and BDI values were significantly altered in FMPs in comparison with those of controls (FIQ, 70 ± 25 vs. 12 ± 12, p < 0.0001; BDI, 17 ± 11 vs. 4 ± 3, p < 0.0002). Only five out of 15 FMP sera had ANeuA specifically directed against neurons from the medial vestibular nucleus of the brainstem. This immunoreactivity was not detected in the sera from the 14 controls. ANeuA recognized a 45 kDa protein. Conclusions: 30% of FMPs have ANeuA that have not been described before. In future studies, it will be necessary for anti-neural immunoreactivity to be determined in a larger sample and for the role of ANeuAs in the pathophysiology of FM to be established.

12.
J. bras. nefrol ; 44(1): 121-125, Jan-Mar. 2022. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1365028

ABSTRACT

Abstract Antineutrophil cytoplasmic antibodies (ANCAs) are associated with small vessel vasculitis but their prevalence is not rare in other immune diseases. In lupus nephritis (LN), their pathological role and clinical relevance have been the target of controversial views. We present a case of acute kidney injury and nephrotic syndrome in a young woman with diffuse global proliferative and membranous nephritis on her kidney biopsy, showing a full-house immunofluorescence pattern, very allusive of class IV + V LN, but lacking associated clinical criteria and laboratory findings to support the diagnosis of systemic lupus erythematosus (SLE). Furthermore, the patient presented with high titers of ANCA, steadily decreasing alongside the renal function and proteinuria improvements, with mycophenolate mofetil (MMF) and steroid treatment. The authors believe this is a case of lupus-like nephritis, in which ANCAs are immunological markers, although they are not directly involved in the pathogenesis.


Resumo Os anticorpos anticitoplasma de neutrófilos (ANCAs) estão associados à vasculite de pequenos vasos, no entanto, a sua prevalência não é rara em outras doenças imunológicas. Na nefrite lúpica (LN), o seu papel patológico e relevância clínica têm sido alvo de pontos de vista controversos. Apresentamos um caso de lesão renal aguda e síndrome nefrótica em uma jovem com nefrite proliferativa difusa e membranosa em sua biópsia renal, muito alusivo a NL classe IV + V, com um padrão full house na imunofluorescência, mas sem critérios clínicos e achados laboratoriais para corroborar o diagnóstico de lúpus eritematoso sistêmico (LES). Não obstante, a paciente apresentou títulos elevados de ANCA, que diminuiram progressivamente com a melhoria da função renal e da proteinúria, após tratamento com micofenolato de mofetil (MMF) e esteróide. Os autores acreditam que se trata de um caso de nefrite semelhante à nefrite lúpica, em que os ANCAs são marcadores imunológicos, embora não estejam diretamente envolvidos na patogênese.

13.
J. bras. nefrol ; 44(1): 42-47, Jan-Mar. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1365035

ABSTRACT

Abstract Some cases of patients with IgA nephropathy diagnosed via kidney biopsy and antineutrophil cytoplasmic antibody (ANCA) positivity have been reported. This article describes a case series comprising patients with IgA nephropathy and ANCA positivity seen at a medical center in the city of São Paulo, Brazil, from 1996 to 2016. A total of 111 patients underwent diagnostic kidney biopsies for IgA nephropathy. Five were ANCA-positive at the time of diagnosis; their mean age was 45 ± 15.3 years and they were predominantly females with a mean proteinuria of 2.2 ± 0.9 g/day and a median serum creatinine level of 2.5 (2.0 - 8,6) mg/dL; all had hematuria. Four of the five were cANCA-positive (80%); all had normal serum C3 and C4 levels; and 80% were positive for ANA. One case presented an association with infection, but no associations were found with medication. One patient had granuloma and another had a collapsing lesion. This article describes the cases of five ANCA-positive patients (with predominantly cANCA positivity) submitted to diagnostic kidney biopsies for IgA nephropathy; one patient had a collapsing lesion, but progressed well.


Resumo Alguns casos clínicos de biópsia renal diagnóstica de nefropatia por IgA em pacientes com títulos séricos positivos de anticorpo anticitoplasma de neutrófilos (ANCA) vêm sendo publicados. Descreve-se uma série de casos de nefropatia por IgA com ANCA positivo de centro único da cidade de São Paulo, Brasil, no período de 1996 a 2016. No período estudado, houve 111 pacientes com biópsia renal com diagnóstico de nefropatia por IgA; destes, 5 tinham ANCA positivo ao diagnóstico com média de idade de 45 ± 15,3 anos, predominando o sexo feminino, com média de proteinúria de 2,2 ± 0,9 g/dia, hematúria presente em 100% dos casos e mediana de creatinina sérica de 2,5 (2,0 - 8,6) mg/dL. O cANCA foi o padrão mais encontrado, em 4 dos 5 casos (80%), com os níveis séricos das frações de complemento C3 e C4 normais em todos e FAN positivo em 80% dos casos. Houve associação com infecções em um caso, mas sem associação com medicações. À microscopia óptica, um dos pacientes tinha granuloma e outro, lesão colapsante. Em resumo, descreve-se cinco casos de pacientes com biopsia renal diagnóstica de nefropatia por IgA com ANCA sérico positivo predominando cANCA, destacando um paciente desse grupo com microscopia óptica com lesão colapsante que, apesar disso, teve boa evolução.

14.
Acta neurol. colomb ; 38(1,supl.1): 1-22, ene.-mar. 2022. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1383394

ABSTRACT

RESUMEN INTRODUCCIÓN: El desarrollo de anticuerpos monoclonales (mAbs) contra el péptido relacionado con el gen de la calcitonina (CGRP) ha determinado una nueva era terapéutica en la profilaxis de migraña, demostrando su efectividad en pacientes con migraña episódica (ME) y migraña crónica (MC), con respuesta desde pacientes naïve hasta refractarios a múltiples medicamentos. La disminución del 50% de los ataques de migraña al mes (DMM) durante los primeros 3 meses de uso es el desenlace aproximado en el 50% de los pacientes que reciben esta terapia. OBJETIVO: Este consenso de la Asociación Colombiana de Neurología (ACN) tiene el objetivo de guiar la selección y uso racional de los mAbs antiCGRP en pacientes con ME y MC. MATERIALES Y MÉTODOS: El comité de cefalea de la ACN mediante la aplicación de la metodología Delphi y discusiones en reuniones posteriores desarrolló un documento en formato de consenso soportado en literatura y recomendaciones de expertos. RESULTADOS: Se obtuvieron respuestas de 14 expertos en cefalea sobre moléculas utilizadas en profilaxis de migraña, analizando su aplicabilidad en situaciones clínicas frecuentes. DISCUSIÓN: Los mAbs antiCGRP han demostrado efectividad con adecuado soporte fisiopatológico, considerando que son moléculas de alto precio en una enfermedad de alta prevalencia, existe la necesidad de guíar la selección del paciente que mejor puede beneficiarse de su administración CONCLUSIONES: Los mAbs antiCGRP están recomendados en pacientes con ME y MC que presentan falla terapéutica a otras moléculas profilácticas.


ABSTRACT INTRODUCTION: The development of monoclonal antibodies (mAbs) against Calcitonin Gene Related Peptide (CGRP) has determined a new therapeutic era in migraine prophylaxis, demonstrating its effectiveness in patients with episodic migraine (EM) and chronic migraine (CM), obtaining a response in naive patients and in those who are refractory to multiple medications. A 50% decrease in migraine attacks per month during the first 3 months of use is the approximate outcome in 50% of patients receiving this therapy. OBJECTIVE: This consensus from the Colombian Association of Neurology (ACN) has the objective of serving as a guide for the rational use of antiCGRP mAbs in patients with EM and CM. METHODS AND MATERIALS: The headache committee through the application of the Delphi methodology and discussions in subsequent meetings, develops this consensus, supported in the published literature and expert recommendations. RESULTS: Fourteen answers from headache experts were received regarding the use of drugs for migraine prophylaxis, analyzing their applicability in frequent clinical situations. DISCUSSION: AntiCGRP mAbs have proved their effectiveness with adequate pathophysiological support, but with a high price in a highly prevalent disease, there is then a need to select the patient who best benefits from this therapy. CONCLUSIONS: AntiCGRP mAbs are recommended in patients with EM and CM that have previously failed to other prophylactic drugs.

15.
J. coloproctol. (Rio J., Impr.) ; 42(1): 20-24, Jan.-Mar. 2022. tab
Article in English | LILACS | ID: biblio-1375757

ABSTRACT

Background: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Celiac disease (CD), a treatable autoimmune enteropathy, with varied presentations, may simulate clinically symptoms of IBS. The aim of the present study is to screen for CD in patients with IBS diagnosed based on the Rome III criteria. Patients and Methods: A cross-sectional study was conducted at a secondary care gastrointestinal unit in Al-Salam General Hospital in Mosul city, Iraq, from November 2015 to October 2016. All patients fulfilling the Rome III criteria for IBS were screened for CD using antitissue transglutaminase IgA antibodies (anti-tTG). Patients who tested positive were subjected to endoscopic duodenal biopsy to confirm the diagnosis of CD. Results: A total of 100 patients were included in the present study (58 female and 42 male), the mean age of the participants was 40.8 years old (standard deviation [SD]±11.57). Ten patients (10/100, 10%) tested positive for anti-tTG antibodies. Five of the seropositive patients (5/10, 50%) showed positive biopsy results according to the Marsh classification, 3 of whom having diarrhea, and 2 with constipation. Conclusion: Positive serology and biopsy results suggestive of CDare common among patients with IBS. Screening patients with IBS for CD is justified. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Celiac Disease/diagnosis , Irritable Bowel Syndrome , Autoantibodies/analysis , Cross-Sectional Studies , Diagnosis, Differential
16.
Arq. Asma, Alerg. Imunol ; 6(1): 84-90, jan.mar.2022. ilus
Article in English, Portuguese | LILACS | ID: biblio-1400109

ABSTRACT

O SARS-CoV-2 é causador da doença infecciosa COVID-19. A infecção estimula o sistema imunológico a produzir citocinas próinflamatórias. A principal citocina envolvida é a IL-6, e está ligada à gravidade da doença. Devido à associação dos altos níveis de IL-6 com a mortalidade na COVID-19, investiga-se sobre o uso de tocilizumabe (TCZ), um anticorpo monoclonal humanizado antirreceptor de IL-6 humana. O objetivo desta revisão sistemática é avaliar a eficácia do uso do TCZ em pacientes com COVID-19 grave. As buscas foram feitas através das bases de dados Science Direct e PubMed em setembro de 2021. Foram incluídos os ensaios clínicos randomizados com pacientes em um único estágio de COVID-19, casos graves e sem restrição de idade, os quais receberam o TCZ como medicação de intervenção combinado a tratamentos protocolados por cada hospital e associado a corticosteroides. A análise desses estudos demonstrou resultados significantes sobre o uso de TCZ em casos severos de COVID-19. O uso de TCZ associado a glicocorticoides levou a uma redução no índice de mortalidade e de submissão a ventilações mecânicas e a uma melhora expressiva em relação à escala "WHO-endorsed 7-point ordinal scale". Entretanto, não houve melhora relevante quanto ao uso do TCZ de maneira isolada.


SARS-CoV-2 causes the COVID-19 infectious disease that affects the respiratory tract. From the beginning of the infection, the immune system starts to produce pro-inflammatory cytokines and chemokines. The main cytokine involved is IL-6 and is linked to the severity and prognosis of the disease, as it provokes a storm of cytokines and severe inflammatory responses. Due to the association of high levels of IL-6 with severity and mortality in COVID-19, the use of Tocilizumab (TCZ), a humanized anti-human IL-6 receptor monoclonal antibody, which binds to IL receptors, is being investigated. -6 and blocks intracellular signaling reducing cytokine storm and hyperinflammatory state. The aim of this review is to assess the effectiveness of using TCZ in the treatment of patients with severe COVID-19. Searches were performed using the Science Direct and PubMed databases in May 2021. Randomized clinical trials with patients in a single stage of COVID­19, severe cases and without age restriction, who received TCZ as medication for treatment, were included. Intervention was combined with treatments protocoled by each hospital and associated with corticosteroids. The analysis of these studies showed significant results regarding the use of TCZ in severe cases of COVID-19. The use of TCZ associated with glucocorticoids led to a reduction in the rate of mortality and compliance with mechanical ventilation and a significant improvement in relation to the "WHO-endorsed 7-point ordinal scale". However, there was no evidence of relevant improvement when using TCZ alone.


Subject(s)
Humans , Antibodies, Monoclonal, Humanized , SARS-CoV-2 , COVID-19 , Patients , Respiration, Artificial , Therapeutics , Cytokines , Interleukin-6 , Adrenal Cortex Hormones , Receptors, Interleukin-6 , PubMed , Cytokine Release Syndrome , Immune System
17.
Arq. Asma, Alerg. Imunol ; 6(1): 127-133, jan.mar.2022. ilus
Article in English, Portuguese | LILACS | ID: biblio-1400122

ABSTRACT

A doença de Castleman é um distúrbio linfoproliferativo raro, podendo se manifestar sob a forma de massas localizadas ou como doença multicêntrica. A doença de Castleman multicêntrica é caracterizada por adenopatias generalizadas, visceromegalias, manifestações autoimunes e infecções recorrentes. Este artigo apresenta o relato de caso de anemia hemolítica autoimune por anticorpos quentes em paciente com doença de Castleman multicêntrica. Resposta eficaz foi obtida com uso de corticoterapia sistêmica e tocilizumabe.


Castleman disease is a rare lymphoproliferative disorder that can manifest as localized masses or as multicentric disease. Multicentric Castleman disease is characterized by generalized adenopathies, visceromegaly, autoimmune manifestations, and recurrent infections. This article presents the case report of a patient with multicentric Castleman's disease and autoimmune hemolytic anemia by warm antibodies. Effective response was obtained with systemic corticotherapy and tocilizumab.


Subject(s)
Humans , Male , Adult , Castleman Disease , Anemia, Hemolytic, Autoimmune , Patients , Adrenal Cortex Hormones/therapeutic use , Antibodies, Monoclonal, Humanized , Lymphoproliferative Disorders , Antibodies
18.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1390292

ABSTRACT

RESUMEN Introducción: los anticuerpos antinucleares son muy utilizados en la práctica médica como marcadores de autoinmunidad y en el diagnóstico de enfermedades autoinmunes. Sin embargo, estos anticuerpos son la expresión de otros trastornos más allá de las colagenopatías e incluso pueden estar presentes en la población aparentemente sana sin representar un riesgo para la salud de estos en el futuro. Objetivo: determinar la prevalencia de anticuerpos antinucleares en médicos residentes aparentemente sanos del Hospital de Clínicas, San Lorenzo, en el año 2021. Material y métodos: se realizó un estudio descriptivo prospectivo y transversal en 150 médicos residentes aparentemente sanos en el Hospital de Clínicas de la ciudad de San Lorenzo, Paraguay, en el periodo de junio a septiembre de 2021. Se determinaron los anticuerpos antinucleares tipo inmunoglobulina G mediante inmunofluorescencia indirecta en células HEp-2. Resultados: la prevalencia de anticuerpos antinucleares fue 11,3%. La mayoría de los sujetos con resultados positivos fueron mujeres (76,5%, p<0,05). Las titulaciones más frecuentes fueron 1:80 y 1:160 por igual (35,3% cada una) y entre los sujetos reactivos el patrón nuclear granular fino denso (AC2) fue el más prevalente (52,9%). Conclusión: la prevalencia de anticuerpos nucleares fue 11,3%, la mayor frecuencia se vio en mujeres, las titulaciones más comunes fueron 1:80 y 1:160 y el patrón más habitual fue el nuclear granular fino denso.


ABSTRACT Introduction: Antinuclear antibodies are widely used in medical practice as autoimmunity markers and in the diagnosis of autoimmune diseases. However, these antibodies are the expression of other disorders beyond collagenopathies and may even be present in the apparently healthy population without representing a risk to their health in the future. Objective: To determine the prevalence of antinuclear antibodies in apparently healthy residents of the Hospital de Clínicas, San Lorenzo, in 2021. Material and methods: A descriptive, prospective and cross-sectional study was carried out in 150 apparently healthy resident physicians at the Hospital de Clínicas in the city of San Lorenzo, Paraguay, from June to September 2021. Immunoglobulin G-type antinuclear antibodies were determined using Indirect immunofluorescence in HEp-2 cells. Results: The prevalence of antinuclear antibodies was 11.3%. Most of the subjects with positive results were women (76.5%, p <0.05). The most frequent titrations were 1:80 and 1:160 equally (35.3% each) and among the reactive subjects the nuclear dense fine speckled pattern (AC2) was the most prevalent (52.9%). Conclusion: The prevalence of nuclear antibodies was 11.3%, the highest frequency was seen in women, the most common titers were 1:80 and 1: 160 and the most common pattern was the nuclear dense fine speckled.

19.
Medicina (B.Aires) ; 82(1): 3-12, feb. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1365122

ABSTRACT

Resumen Luego de la infección por SARS-CoV-2 se producen anticuerpos específicos y continúa siendo objeto de estudio su cinética, cuantificación y umbral protector. Nuestro objetivo fue estudiar la cinética de aparición de anticuerpos IgG/IgM anti SARS-CoV-2, magnitud de respuesta y duración en el tiempo, en 55 pacientes hospitalizados por COVID-19, y relacionar el patrón de respuesta con diferentes parámetros demográ ficos y clínicos. Medidas con un ensayo cualitativo automatizado, VIDAS® SARS-Cov-2 (Biomerieux - ELFA) se evaluaron las variaciones en la concentración de anticuerpos a lo largo del tiempo con un modelo generalizado de efectos fijos. Todos los pacientes seroconvirtieron IgM e IgG, al día 10 y 10.5 respectivamente, patrón sincrónico mayoritario; no siendo de utilidad la IgM aislada como indicador de respuesta aguda. La sensibilidad clínica fue: semana 1, 30%, semanas 2 y 3, 72%, 4: 91% y 8: 96%. IgG permaneció detectable hasta los 6 meses (período de seguimiento) con gran heterogeneidad de magnitud; IgM negativizó en el 90.9% de los pacientes. Observamos un nivel mayor de IgM en los pacientes > 56 años, y en hombres respecto a mujeres. En pacientes con enfer medad pulmonar obstructiva crónica la respuesta de IgM está aumentada; los inmunocomprometidos y aquellos con enfermedad pulmonar intersticial difusa tuvieron menor IgM e IgG respectivamente. De nuestro grupo de pacientes, aquellos que requirieron cuidados críticos, asistencia respiratoria mecánica y los que fallecieron no presentaron diferencias significativas en magnitud de respuesta humoral respecto de quienes tuvieron un curso menos grave. La metodología utilizada refleja adecuadamente la cinética de anticuerpos.


Abstract Specific antibodies are produced after infection by SARS-CoV2. Currently, the understanding of antibody responses following infection with SARS-CoV-2 is limited including the magnitude, duration of responses and correlates of protective immunity following infection. Here we intended to characterize humoral immune response in a cohort of 55 hospitalized patients for COVID-19 and its relationship with different demographic and clinical parameters. The ELFA assay VIDAS® SARS-Cov-2 (Biomerieux) measured IgG/IgM antibodies. Their concentration over time was evaluated with a fixed effects generalized linear model. All patients seroconverted IgM and IgG, at day 10 and 10.5 respectively, showing a majority synchronous pattern; IgM alone would not be useful as a marker of acute response. Clini cal sensitivity was: week 1, 30%, weeks 2 and 3, 72%, 4: 91% and 8: 96%. IgG seropositivity was sustained in patients up to 180 days (last time point measured), in contrast, IgM response was short-lived (91days) in 90.9% of patients. Longer term follow-up is needed to determine the duration of IgG responses. We observed a higher level of IgM in patients > 56 years, and in men compared to women. In chronic obstructive pulmonary disease patients, the IgM response is increased, while in immunocompromised and interstitial lung disease patients, IgM and IgG were lower, respectively. Those patients who required critical care, mechanical ventilation and those who died did not present significant differences in the magnitude of humoral response compared to those who had a less severe course. The methodology used adequately reflects the kinetics of antibodies.

20.
Rev. Fac. Med. UNAM ; 65(1): 26-36, ene.-feb. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1376288

ABSTRACT

Resumen Infection by SARS-CoV-2 virus is not solely limited to the common clinical presentation of acute respiratory distress syndrome, mainly because a wide spectrum of clinical manifestation has been observed. These presentations include, but are not limited to, neurological, cardiovascular, throm- boembolic, hematologic, and autoimmune presentations. Within this wide spectrum, cases of autoimmune hemolytic anemia due to SARS-CoV-2 infection are rising. This is why primary care physicians should be ready to identify this clinical entity appropriately.


Abstract Infection by SARS-CoV-2 virus is not solely limited to the common clinical presentation of acute respiratory distress syndrome, mainly because a wide spectrum of clinical manifestation has been observed. These presentations include, but are not limited to, neurological, cardiovascular, throm- boembolic, hematologic, and autoimmune presentations. Within this wide spectrum, cases of autoimmune hemolytic anemia due to SARS-CoV-2 infection are rising. This is why primary care physicians should be ready to identify this clinical entity appropriately.

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