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2.
Allergol. immunopatol ; 48(1): 18-25, ene.-feb. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-186587

RESUMO

Introduction and objectives: Connective tissue diseases are inflammatory, autoimmune diseases and threaten quality of life. To determine the relationship between staining patterns of antinuclear antibodies and antibodies against extractable nuclear antigens in patients with connective tissue disease. Materials and methods: Observational, basic, analytical and transversal study. Study conducted in the Immunology Service of the Arzobispo Loayza National Hospital between January 2017 and June 2017. We analyzed 291 samples of patients with CTD and for the detection of anti-nuclear antibody staining patterns, the immunological kit and observation with microscope of at 40X Immunofluorescence and for the detection of the antibodies against extractable nuclear antigens. The Immunoblot method was employed. Statistical analyses were carried out with the statistical package SPSS version 21 for Windows. We used the Pearson Chi-square test for the categorical variables, a value of p < 0.05 was considered significant. Results: There was a significant relationship p < 0.05 of the homogeneous pattern, the mottled pattern with Anti-histones (p = 0.000), Anti-nucleosomes (p = 0.000), Anti-Ro 52 (p = 0.000), Anti-SSA (p = 0.001), Anti-SSB (p = 0.003), Anti-dsDNA (p = 0.000) with the Pearson Chi-square test. There was a significant relationship of p < 0.05 of the centromeric pattern with Anti-Cenp B (p = 0.000) with Fisher's exact statistic. Conclusions: There was a significant relationship between the anti-nuclear antibody staining patterns and the antibodies to the core extractable antigens in patients with systemic lupus erythematosus, Sjögren's syndrome, Calcinosis, Raynaud's phenomenon, esophageal Dysmotility, sclerodactyly and Telangiectasia (CREST), Scleroderma and Polymyositis


No disponible


Assuntos
Humanos , Anticorpos Antinucleares/análise , Anticorpos/análise , Antígenos Nucleares/imunologia , Doenças do Tecido Conjuntivo/imunologia , Autoimunidade/imunologia , DNA/análise , Doenças do Tecido Conjuntivo/diagnóstico , Estudos Transversais , Microscopia de Fluorescência , Técnica Indireta de Fluorescência para Anticorpo , Proteína Centromérica A , Autoanticorpos/imunologia
3.
Reumatol. clín. (Barc.) ; 15(6): e111-e113, nov.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-189665

RESUMO

Las miopatías inflamatorias idiopáticas son un grupo heterogéneo de miopatías potencialmente tratables. Se clasifican en 4 subtipos: dermatomiositis, polimiositis, miositis autoinmune necrosante y miositis por cuerpos de inclusión, en función de las características clínicas e histológicas. Los anticuerpos asociados a miositis y los autoanticuerpos específicos de miositis se encuentran frecuentemente en pacientes con miopatías inflamatorias, siendo útiles en el diagnóstico y clasificación. El anticuerpo anti-histidil tRNA sintetasa es el más prevalente y el más específico para polimiositis. El anticuerpo de partícula de reconocimiento de señal es también un autoanticuerpo especıfico para polimiositis, pero más infrecuente, y raramente se encuentra en pacientes que presentan otros autoanticuerpos específicos para miositis. En este trabajo se presenta un paciente con polimiositis en el que coexisten los 2 autoanticuerpos en el suero, lo que se considera una situación clínica extremadamente rara. Aquí analizamos la evolución clínica y hallazgos para examinar el efecto de la coexistencia y la posible interacción sobre el pronóstico


Idiopathic inflammatory myopathies are a heterogeneous group of potentially treatable myopathies. They are classified, on the basis of clinical and histopathological features, into four subtypes: dermatomyositis, polymyositis, necrotizing autoimmune myositis and inclusion-body myositis. Myositis-associated antibodies and myositis-specific autoantibodies are frequently found in patients with idiopathic inflammatory myopathies, and are useful in the diagnosis and classification. Anti-histidyl transfer RNA synthetase antibody is the most widely prevalent and is highly specific for polymyositis. Signal recognition particle antibody is also a specific autoantibody for polymyositis, but it is infrequent and rarely found in patients having other myositis-specific autoantibodies. We present a man with polymyositis who had both antibodies in serum, which is considered an extremely rare clinical situation. Here we analyze the clinical course and findings, and examine the effect of the coexistence and possible interaction on prognosis


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Autoanticorpos/sangue , Histidina-tRNA Ligase/imunologia , Polimiosite/sangue , Partícula de Reconhecimento de Sinal/imunologia
4.
Med. clín (Ed. impr.) ; 153(9): 360-367, nov. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-186270

RESUMO

Las neuropatías inflamatorias son un grupo heterogéneo de enfermedades raras del sistema nervioso caracterizadas por la disfunción y el daño de diferentes estructuras de los nervios periféricos. Este grupo incluye el síndrome de Guillain-Barré, la polirradiculoneuropatía inflamatoria desmielinizante crónica, la neuropatía motora multifocal o las neuropatías asociadas a gammapatía monoclonal. La inmunopatogenia de estas enfermedades no es bien conocida, pero las células B y los autoanticuerpos parecen tener un papel clave en su desarrollo. Se han descrito autoanticuerpos dirigidos contra estructuras del nervio periférico como los gangliósidos, los anticuerpos dirigidos contra proteínas del nodo de Ranvier o la glucoproteína asociada a la mielina, que permiten identificar subgrupos de pacientes con fenotipos clínicos específicos asociados a dichos autoanticuerpos. Por todo ello, estos anticuerpos son de gran utilidad en la práctica clínica. Esta revisión se centra en la relevancia diagnóstica y terapéutica de los autoanticuerpos en las neuropatías inmunomediadas


Inflammatory neuropathies are a rare and heterogeneous group of diseases of the nervous system characterized by the dysfunction and damage of different structures of the peripheral nerves. This group includes Guillain-Barré syndrome, chronic demyelinating inflammatory polyradiculoneuropathy, multifocal motor neuropathy or neuropathies associated with monoclonal gammopathy. The aetiology of these diseases is unknown, but B cells and autoantibodies play a key role in their pathogenesis. Autoantibodies against peripheral nerve molecules such as gangliosides, proteins of the Ranvier node or myelin-associated glycoprotein have been described, allowing the identification of subgroups of patients with specific clinical phenotypes. For all these reasons, these antibodies are useful in clinical practice. This review focuses on the diagnostic and therapeutic relevance of autoantibodies in inflammatory neuropathies


Assuntos
Humanos , Autoanticorpos/uso terapêutico , Síndrome de Guillain-Barré/diagnóstico , Doenças do Sistema Nervoso Periférico/diagnóstico , Autoanticorpos/metabolismo , Síndrome de Guillain-Barré/imunologia , Síndrome de Guillain-Barré/patologia , Gangliosídeos/administração & dosagem , Mimetismo Molecular , Bandas Oligoclonais , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico
7.
Acta otorrinolaringol. esp ; 70(4): 229-234, jul.-ago. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-185400

RESUMO

Objective: This is the first report dealing with immune-mediated inner ear disease (IMIED) hearing loss in a group of patients affected with autoimmune thyroid disease (AITD), whose treatment required corticosteroids, despite being treated with levothyroxine. Immunopathology linking the inner ear and the thyroid gland is also presented. Patients: A total of 220 patients were selected with sensorineural hearing loss (SNHL) of causes other than presbycusis. Audiometry was performed and pure tone average was calculated before and after treatment with corticosteroids. Results: Eighty-four (84) patients had SNHL of autoimmune origin, and 15 patients were diagnosed with AITD (Hashimoto's disease). Bilateral hearing loss was observed in 10 patients (66.5%). Sudden sensorineural hearing loss was the most frequent clinical form of presentation. Nine patients showed a hearing recovery greater than 10 dB after corticosteroid treatment. Conclusions: Acquired hypothyroidism is thought to affect hearing due to different mechanisms. Although specific hormonal therapy may improve peripheral or central auditory disorders associated with hypothyroidism, the presence of IMIED in AITD patients requires another approach. Altered immune regulatory mechanisms involving Treg cells and CD4+CD45RO cells have been suggested in patients with AITD and IMIED. In the present study, although all the patients with hypothyroidism and subclinical hypothyroidism were being treated with levothyroxine, immune-mediated hearing loss was observed. Therapy with corticosteroids could achieve hearing recovery. Since inner ear and thyroid gland share possible antigen targets, we highlight the existence of IMIED in AITD patients and the importance of implementing appropriate therapy with corticosteroids


Objetivo: Este es el primer trabajo que trata la hipoacusia por enfermedad inmune-mediada del oído interno (IMIED) en un grupo de pacientes afectados de tiroiditis autoinmune (AITD), cuyo tratamiento requirió corticosteroides, a pesar de haber sido tratados con levotiroxina. También se presenta la inmunopatología que vincula el oído interno y la glándula tiroides. Pacientes: Se seleccionó un total de 220 pacientes con hipoacusia neurosensorial (SNHL) por causas diferentes a presbiacusia. A todos los pacientes se les realizó una audiometría, calculándose la media de tonos puros antes y después del tratamiento con corticosteroides. Resultados: Ochenta y cuatro (84) pacientes tenían SNHL de origen autoinmune, y 15 pacientes fueron diagnosticados de AITD (Enfermedad de Hashimoto). Se observó hipoacusia bilateral en 10 pacientes (66,5%). La sordera súbita fue la forma de presentación clínica más frecuente. Nueve pacientes presentaron una recuperación auditiva superior a 10 dB tras el tratamiento con corticosteroides. Conclusiones: Se piensa que el hipotiroidismo adquirido afecta a la audición por diferentes mecanismos. Aunque la terapia hormonal específica puede mejorar los trastornos auditivos periféricos o centrales asociados al hipotiroidismo, la presencia de IMIED en los pacientes de AITD requiere otro abordaje. Se ha sugerido una alteración de los mecanismos reguladores de la respuesta inmune que implica a las células de Treg y a las células CD4+CD45RO en los pacientes con AITD e IMIED. En el presente estudio, a pesar de que todos los pacientes con hipotiroidismo e hipotiroidismo subclínico estaban siendo tratados con levotiroxina, se observó hipoacusia inmuno-mediada. La terapia con corticosteroides podría lograr una recuperación auditiva. Dado que el oído interno y la glándula tiroides comparten posibles antígenos diana, destacamos la existencia de IMIED en los pacientes de AITD, y la instauración de una terapia adecuada con corticosteroides


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Perda Auditiva Neurossensorial/etiologia , Tireoidite Autoimune/complicações , Especificidade de Anticorpos , Autoanticorpos , Autoantígenos/imunologia , Linfócitos T CD4-Positivos/imunologia , Doença de Hashimoto/complicações , Doença de Hashimoto/tratamento farmacológico , Doença de Hashimoto/imunologia , Perda Auditiva Neurossensorial , Perda Auditiva Neurossensorial/imunologia , Perda Auditiva Neurossensorial/prevenção & controle , Metilprednisolona/uso terapêutico , Transportadores de Sulfato/imunologia , Linfócitos T Reguladores/imunologia , Tireoidite Autoimune/tratamento farmacológico , Tiroxina/uso terapêutico
10.
Gastroenterol. hepatol. (Ed. impr.) ; 42(2): 82-89, feb. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-182096

RESUMO

Introduction: The cytoplasmic rods-rings (RR) pattern is found in hepatitis C (HCV) patients treated with interferon-ribavirin when studied with ANA-IIF. Ribavirin aggregates/induces antigenic changes in IMPDH-2, an enzyme necessary for ribavirin action. Patients and method: Prospective search for anti-RR autoantibodies (HEp-2, INOVA) in patients treated with direct-acting antivirals (DAAs) from October 2015 to June 2017. HCV-negative patients from up to June 2016 acted as controls. Anti-RR was analyzed at baseline and, mainly, during treatment and follow-up. The Chi-square test, Student's t-test and a logistic regression analysis were performed. Results: Between October 2015 and June 2016, 1258 men and 2389 women who were HCV-negative and 137 men and 112 women who were HCV-positive patients were studied. Approximately 22.9% of HCV-negative and 13.2% of HCV-positive were ANA-IIF-positive (p<0.05). Three HCV-negative (0.08%) and 23 (9.2%) HCV-positive patients had anti-RR (p<0.001). A total of 122 patients received DAAs; 30 received DAA+RBV; 46 pre-treated with IFN-RBV received DAA; 31 pre-treated with IFN-RBV received DAA+RBV; 16 received IFNpeg-RBV; and 24 received IFN-RBV-DAA. None of the 122 DAA-treated patients showed anti-RR; anti-RR were identified in 14.8% of those treated with DAA-RBV; in 25.9% of those pre-treated with IFN-RBV receiving DAA; in 22.2% of IFN-RBV-pre-treated patients who received DAA+RBV; in 7.4% of those treated with IFNpeg-RBV and in 29.6% of those treated with IFNpeg-RBV-DAA. The multivariate analysis showed significant associations between anti-RR and "Exposure to IFN" and "Time of exposure to RBV". Conclusions: Anti-RR autoantibodies were detected only in patients with current or past treatments with RBV, even in cases in which only DAAs were later administered


Introducción: La investigación de ANA-IFI en pacientes con hepatitis C tratados con interferón-ribavirina ha detectado un patrón citoplasmático en bastones y anillos. La ribavirina agregaría e induciría cambios antigénicos en la IMPDH-2, enzima imprescindible para su acción. Pacientes y método: Investigar las tasas de anti-RR (HEp-2, INOVA) en pacientes tratados con antivirales de acción directa (AAD) entre octubre-2015 y junio-2017. Como controles se han utilizado los pacientes VHC-negativo habidos hasta junio-2016. Los anti-RR se analizaron antes del tratamiento y, mayoritariamente, durante y después del mismo. Se han utilizado las pruebas Chi-cuadrado, T de Student y de regresión logística. Resultados: Entre octubre-2015 y junio-2016 hubo 1.258 varones y 2.389 mujeres VHC-negativo y 137 varones y 112 mujeres VHC-positivo. El 22,9% de los VHC-negativo y el 13,2% de los VHC-positivo fueron ANA-IFI-positivo (p<0,05). Tres pacientes (0,08%) VHC-negativo y 23 (9,2%) VHC-positivo fueron anti-RR+ (p<0,001). Ciento veintidós pacientes recibieron AAD; 30, AAD+RBV; 46 pretratados con IFN-RBV recibieron AAD; 31, pretratados con IFN-RBV, recibieron AAD+RBV; 16 IFNpeg-RBV; 24 IFN-RBV-AAD. Ningún paciente con AAD mostró anti-RR; tuvieron anti-RR el 14,8% de los tratados con AAD+RBV; 25,9% de los pretratados con IFN-RBV que recibieron AAD; 22,2% de los pretratados con IFN-RBV que recibieron AAD+RBV; 7,4% de los tratados con IFNpeg-RBV; el 29,6% de los tratados con IFNpeg-RBV-AAD. El análisis multivariante asoció significativamente la presencia de anti-RR con «Exposición al IFN» y «Tiempo de exposición a ribavirina». Conclusiones: Los autoanticuerpos anti-RR solo se han detectado en pacientes tratados con ribavirina, incluso cuando después se utilizaron solamente AAD


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Antivirais/uso terapêutico , Autoanticorpos/imunologia , Citoesqueleto/imunologia , Interferons/uso terapêutico , Ribavirina/uso terapêutico , Estudos de Coortes , Quimioterapia Combinada
11.
Nutr. hosp ; 35(6): 1387-1393, nov.-dic. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-181481

RESUMO

Introduction: adequate iodine intake during pregnancy is essential for the synthesis of thyroid hormones, which are important for the physiological functions of the mother and appropriate maturation of the central nervous system of the fetus. Objective: the objective of the present study was to determine the levels of urinary iodine excretion and thyroid function, antioxidants and oxidative stress markers in pregnant women. Methods: the study was conducted on 191 pregnant women and 62 non-pregnant women who were evaluated regarding nutritional status. Analyses of urinary iodine, of oxidative stress markers and thyroid function were performed, revealing iodine insufficiency in 81 pregnant women. Results: there was no change in the thyroid stimulating hormone concentration in 89% of the pregnant women. Antithyroperoxidase antibody values were higher in the control group compared to the pregnant women's group (64.5% and 12.6%, respectively) and antithyroglobulin antibody values were also higher in the control group (11.6%). Assessment of oxidative stress revealed higher levels of advanced oxidation protein products, of total antioxidant capacity and of superoxide dismutase antioxidants in pregnant women. Classification of ioduria with respect to oxidative stress markers revealed lower α-tocopherol levels for the pregnant women with iodine insufficiency. Conclusion: on this basis, the results suggest that iodine insufficiency did not induce changes in thyroid stimulating hormone levels or antibodies and those pregnant women with adequate urinary iodine excretion had a better profile of the α-tocopherol antioxidant, indicating that iodine may play a significant role in antioxidant capacity during gestation


Introducción: la ingesta adecuada de yodo durante el embarazo es esencial para la síntesis de las hormonas tiroideas, que son importantes para las funciones fisiológicas de la madre y la maduración apropiada del sistema nervioso central del feto. Objetivo: el objetivo del presente estudio fue determinar los niveles de excreción de yodo urinario y función tiroidea, antioxidantes y marcadores de estrés oxidativo en mujeres embarazadas. Métodos: el estudio se realizó en 191 mujeres embarazadas y 62 mujeres no embarazadas que fueron evaluadas con respecto al estado nutricional. Se realizaron análisis de yodo urinario, marcadores de estrés oxidativo y función tiroidea, que revelaron insuficiencia de yodo en 81 embarazadas. Resultados: no hubo cambios en la concentración de hormona estimulante tiroidea en el 89% de las mujeres embarazadas. Los valores de anticuerpos antitiroperoxidasa fueron mayores en el grupo control en comparación con el grupo de mujeres embarazadas (64,5% y 12,6%, respectivamente) y los de anticuerpos antitiroglobulina fueron también mayores en el grupo control (11,6%). La evaluación del estrés oxidativo reveló niveles más altos de productos avanzados de proteína de oxidación, de capacidad antioxidante total y de antioxidantes de superóxido dismutasa en mujeres embarazadas. La clasificación de la yoduria con respecto a marcadores de estrés oxidativo reveló menores niveles de α-tocoferol para las mujeres embarazadas con insuficiencia de yodo. Conclusión: sobre esta base, los resultados sugieren que la insuficiencia de yodo no indujo cambios en los niveles de hormona estimulante de la tiroides o anticuerpos y las mujeres embarazadas con excreción urinaria adecuada de yodo tuvieron un mejor perfil del antioxidante α-tocoferol, lo que indica que el yodo puede desempeñar un papel significativo en la capacidad antioxidante durante la gestación


Assuntos
Humanos , Feminino , Gravidez , Adulto , Iodo/deficiência , Iodo/urina , Estado Nutricional , Estresse Oxidativo/fisiologia , Glândula Tireoide/fisiologia , Antioxidantes/análise , Autoanticorpos/sangue , Complicações na Gravidez , Terceiro Trimestre da Gravidez , Superóxido Dismutase/sangue , Hormônios Tireóideos/sangue , Hormônios Tireóideos/metabolismo
15.
Endocrinol. diabetes nutr. (Ed. impr.) ; 65(8): 444-450, oct. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176286

RESUMO

Introducción: Los anticuerpos antiperoxidasa tiroidea (ATPO) en la gestación pueden influir en el desarrollo de hipotiroidismo subclínico gestacional (HSG). Ambas entidades parecen asociarse a complicaciones maternas y fetales. Los objetivos de este estudio son analizar si existe relación entre los valores de TSH y ATPO durante el embarazo, los posibles efectos sobre complicaciones gestacionales y perinatales, y valorar si los ATPO detectables, pero no positivos, influyen en el desarrollo de HSG. Metodología: Estudio prospectivo realizado en el área sanitaria del Complejo Asistencial Universitario de León (CAULE), donde se realiza cribado universal para disfunción tiroidea gestacional entre la semana 7-13 de gestación. Se recogieron datos de TSH, ATPO, obstétricos y neonatales de los partos de 2016. Se considera ATPO positivo si≥35UI/ml. En estudio previo se estableció valor TSH>3,72 mU/L como corte para HSG. Resultados: Se analizaron registros correspondientes a 1.980 partos en CAULE, 21 abortos y 18 partos fuera del centro. Se realizó cribado a 1.670 gestantes (84,34%): 142(8,50%) tuvieron ATPO positivos. La detección de ATPO positivo se asoció con el diagnóstico de HSG (p<0,01) y con media de TSH significativamente mayor (3,51 vs. 2,46mU/L; p=0,03). No encontramos diferencias significativas en las complicaciones gestacionales o neonatales. En el grupo con ATPO indetectable (<10Ul/ml) la media de TSH fue ligeramente inferior que en el grupo con valores de ATPO 10-35UI/ml, pero sin diferencias significativas (p=0,89). Conclusión: La presencia de ATPO positivo se asocia con valores de TSH más elevados y con mayor riesgo de HSG, pero no incrementa la tasa de complicaciones materno-fetales


Introduction: During pregnancy, thyroid peroxidase (TPO) antibodies may increase the risk of developing subclinical hypothyroidism (SCH). Both conditions appear to be associated to maternal-fetal complications. The objectives of this study were to analyze if a relationship exists between TSH and TPO levels during pregnancy and the potential effects on gestational and perinatal complications, and to assess whether detectable, but not positive, TPO levels have an impact on development of gestational SCH. Methods: A prospective study was conducted at the Leon Health Area (CAULE), where universal screening for gestational thyroid dysfunction is performed between weeks 7-13 of pregnancy. Data on TSH and TPO levels and gestational and perinatal complications were collected for all 2016 deliveries. Positive TPO antibodies were defined as values≥35IU/mL. In a previous study, a TSH level>3.72mU/L was established as the cut-off value for gestational SCH. Results: Records corresponding to 1,980 deliveries at CAULE, 21 abortions, and 18 deliveries outside the hospital were analyzed. Of the 1,670 pregnant women screened (84.34%), 142 (8.50%) had positive TPO antibodies and their presence was associated to diagnosis of SCH (P<0.01) and to significantly higher mean TSH levels (3.51mU/L vs. 2.46mU/L, P=0.03). There were no significant differences in gestational or neonatal complications. In the group with undetectable TPO antibodies (<10lU/mL), the mean TSH levels was slightly lower than in the group with TPO values ranging from 10-35 IU/mL, but the difference was not significant (P=0.89). Conclusion: Presence of positive TPO antibodies is associated to higher TSH levels and higher risk of gestational SCH, but does not increase the rate of maternal-fetal complications


Assuntos
Humanos , Feminino , Gravidez , Tireotropina/análise , Autoanticorpos/sangue , Hipotireoidismo/etiologia , Complicações na Gravidez/fisiopatologia , Autoanticorpos/imunologia , Autoantígenos/imunologia , Iodeto Peroxidase/imunologia , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/complicações , Idade Gestacional , Primeiro Trimestre da Gravidez , Gravidez , Estudos Prospectivos , Programas de Rastreamento/métodos
18.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 44(3): 174-179, abr. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-173469

RESUMO

Introducción. El objetivo del presente trabajo es estudiar la prevalencia y las características clínicas y epidemiológicas de la enfermedad hipotiroidea en el adulto, a través del registro de datos electrónicos de la historia clínica. Material y métodos. Estudio observacional, descriptivo y transversal. La población diana eran los pacientes de los centros de salud de Lucena I y II (Córdoba). Criterios de inclusión: pacientes que tuvieran 14 años o más, diagnosticados de hipotiroidismo, nacidos y con residencia en Lucena. Se seleccionaron 214 pacientes a través de un muestreo aleatorio, los cuales se sometieron a una entrevista clínica mediante un cuestionario. Resultados. La edad media de los pacientes fue de 49,71 años (DT 17,03; IC 95% 47,34-51,98), siendo el 85,5% mujeres. El 74,8% son diagnosticados de hipotiroidismo subclínico frente al 18,7% de hipotiroidismo primario y un 6,5% de hipotiroidismo secundario. El 53,7% (IC 95% 46,81-60,59) de los pacientes diagnosticados de hipotiroidismo no tienen pedidos los anticuerpos tiroideos; sin embargo, un 75,2% (IC 95% 68,89-80,86) están recibiendo tratamiento con levotiroxina. La prevalencia de hipotiroidismo fue de un 5,7% (IC 95% 5,46-5,96). Conclusiones. El hipotiroidismo subclínico es muy frecuente en las consultas de Atención Primaria. Muchos pacientes no están correctamente diagnosticados y otros están sobremedicados, por lo que sería preciso revisar el diagnóstico


Introduction. The objective of the present study is to study the prevalence, as well as the clinical and epidemiological characteristics of hypothyroid disease in adults using the computerised clinical records. Material and methods. Observational, descriptive and cross-sectional study. The target population was the patients of the health centres of Lucena I and II (Córdoba). Inclusion criteria: Patients 14 years or older, diagnosed with hypothyroidism, born and resident in Lucena. Two hundred and fourteen patients were recruited by random sampling, who then underwent a clinical interview using a questionnaire. Results. The mean age of the patients was 49.71 years (SD 17.03; 95% CI 47.34-51.98), with 85.5% women. A diagnosis of sub-clinical hypothyroidism was found in 74.8%, compared to 18.7% of primary hypothyroidism, and 6.5% of secondary hypothyroidism. The 53.7% (95% CI 46.81-60.59) of patients diagnosed with hypothyroidism did not have thyroid antibodies results. However, 75.2% (95% CI 68.89-80.86) were being treated with levothyroxine. The prevalence of hypothyroidism was 5.7% (95% CI 5.46-5.96). Conclusions. Sub-clinical hypothyroidism is very common in Primary Care clinics. Many patients are not correctly diagnosed and many are over-medicated, suggesting a need to review the diagnosis


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Autoanticorpos/imunologia , Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Tiroxina/administração & dosagem , Hipotireoidismo/epidemiologia , Inquéritos e Questionários , Espanha , Atenção Primária à Saúde , Prevalência
19.
Allergol. immunopatol ; 46(2): 127-135, mar.-abr. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-172170

RESUMO

Background: Common variable immunodeficiency (CVID) is one of the most prevalent symptomatic primary immunodeficiencies (PIDs), which manifests a wide clinical variability such as autoimmunity, as well as T cell and B cell abnormalities. Methods: A total of 72 patients with CVID were enrolled in this study. Patients were evaluated for clinical manifestations and classified according to the presence or absence of autoimmune disease. We measured regulatory T cells (Tregs) and B-cell subsets using flow cytometry, as well as specific antibody response (SAR) to pneumococcal vaccine, autoantibodies and anti-IgA in patients. Results: Twenty-nine patients (40.3%) have shown at least one autoimmune manifestation. Autoimmune cytopenias and autoimmune gastrointestinal diseases were the most common. A significant association was detected between autoimmunity and presence of hepatomegaly and splenomegaly. Among CVID patients, 38.5% and 79.3% presented a defect in Tregs and switched memory B-cells, respectively, whereas 69.0% presented CD21low B cell expansion. Among patients with a defect in Treg, switched memory and CD21low B cell, the frequency of autoimmunity was 80.0%, 52.2% and 55.0%, respectively. A negative correlation was observed between the frequency of Tregs and CD21low B cell population. 82.2% of patients had a defective SAR which was associated with the lack of autoantibodies. Conclusions: Autoimmunity may be the first clinical manifestation of CVID, thus routine screening of immunoglobulins is suggested for patients with autoimmunity. Lack of SAR in CVID is associated with the lack of specific autoantibodies in patients with autoimmunity. It is suggested that physicians use alternative diagnostic procedures (AU)


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Assuntos
Humanos , Imunodeficiência de Variável Comum/complicações , Doenças Autoimunes/epidemiologia , Subpopulações de Linfócitos B/imunologia , Linfócitos T Reguladores/imunologia , Vacinas Pneumocócicas/imunologia , Autoanticorpos/imunologia , Imunodeficiência de Variável Comum/imunologia
20.
Reumatol. clín. (Barc.) ; 14(1): 46-48, ene.-feb. 2018. graf
Artigo em Inglês | IBECS | ID: ibc-170372

RESUMO

Hypertriglyceridemia is common in children with systemic lupus erythematosus (SLE). A retrospective analysis of the baseline clinical-pathological presentation and treatment outcome (status of lipid profiles) was performed in two children with SLE, who presented with extreme hypertriglyceridemia over a follow-up period of four weeks. The children were treated with prednisolone, mycophenolate mofetil (MMF), hydroxychloroquine and hypolipidemic agents, depending on their disease status. On serial follow-up, the first child showed a significantly raised serum triglyceride level after receiving one week of oral prednisolone therapy. Anti-lipoprotein-lipase (LPL) autoantibody was absent. Lipid profile levels of this child gradually improved after replacing oral prednisolone with another immunosuppressant, namely MMF. The second child presented with extreme hypertriglyceridemia with positive anti-LPL autoantibody. She responded to plasmapheresis followed by increasing the dose of immunosuppressant. So, extreme hypertriglyceridemia in children with SLE may be steroid induced or due to presence of anti-LPL auto antibody. Management should be individualized depending on the etiology (AU)


La hipertrigliceridemia es común en niños con lupus eritematoso sistémico. Un análisis retrospectivo de la presentación clínico-patológica al inicio del estudio y los resultados del tratamiento (estado de los perfiles lipídicos) se llevó a cabo en 2 niños con lupus eritematoso sistémico, que presentaron hipertrigliceridemia extrema durante un período de seguimiento de 4 semanas. Los niños fueron tratados con prednisolona, micofenolatomofetil, hidroxicloroquina y agentes hipolipidemiantes, dependiendo de su estado de salud. En el seguimiento, el primer niño mostró un nivel de triglicéridos en suero significativamente elevado después de recibir una semana de tratamiento con prednisolona oral. No existían anticuerpos antilipoproteína lipasa. Los niveles de perfil de lípidos de este niño mejoraron gradualmente después de sustituir la prednisolona oral con otro inmunosupresor, a saber micofenolatomofetil. El segundo niño presentó hipertrigliceridemia extrema con autoanticuerpos antilipoproteína lipasa-positivos. Ella respondió a la plasmaféresis seguida del incremento de la dosis de inmunosupresores. Por lo tanto, la hipertrigliceridemia extrema en niños con lupus eritematoso sistémico puede ser inducida por esteroides o debido a la presencia de autoanticuerpos antilipoproteína lipasa. El manejo debe ser individualizado en función de la etiología (AU)


Assuntos
Humanos , Feminino , Criança , Hipertrigliceridemia/tratamento farmacológico , Lúpus Eritematoso Sistêmico/complicações , Encefalopatia Hipertensiva/complicações , Estudos Retrospectivos , Lipase Lipoproteica/análise , Autoanticorpos/análise , Rosuvastatina Cálcica/uso terapêutico , Prednisolona/uso terapêutico , Dieta com Restrição de Gorduras , Anti-Hipertensivos/uso terapêutico , Hematúria/etiologia , Edema/etiologia
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