Análisis de las características clínicas, ecocardiográficas, microbiológicas y citopatológicas de derrames pericárdicos en un hospital de tercer nivel de atención / Analysis of clinical, echocardiographic, microbiological and cytopathological characteristics of pericardial effusions in a tertiary hospital care

Objetivo: Conocer la prevalencia, las causas, los hallazgos clínicos, ecocardiográficos, microbiológicos y citopatológicos de pacientes con derrame pericárdico. Métodos: Estudio observacional, retrospectivo, transversal y analítico. Se analizaron expedientes clínicos de pacientes que reciben pericardiocentesis durante un periodo de 5 años. Se empleó estadística descriptiva, con medidas de tendencia central y de dispersión para el análisis. Resultados: La prevalencia de derrame pericárdico fue del 1.1%. Predominó en mujeres (60.4%) y se observó una media de edad de 49 años. La principal causa asociada fue neoplásica, con un 32.1%, seguida de la idiopática y reumatológica con un 27.4 y 10.4%, respectivamente. Se presentó taponamiento cardiaco en un 27.1%, siendo la disnea y la presencia de tonos cardiacos apagados los datos clínicos más comunes. El colapso auricular y ventricular derechos se presentaron en el 84.9 y 75.5%, respectivamente. El estudio citopatológico de líquido pericárdico presentó un mayor rendimiento diagnóstico en el estudio de derrames asociados a neoplasias, mostrando una sensibilidad del 54%, una especificidad del 95%, un valor predictivo positivo del 85% y un valor predictivo negativo del 81%. Conclusiones: La prevalencia de derrame pericárdico en un hospital de tercer nivel fue del 1.1%, predominando la etiología neoplásica. El colapso auricular y ventricular derechos son los hallazgos ecocardiográficos más comunes en la presencia de derrame pericárdico moderado o severo. El estudio citopatológico tiene una alta especificidad ante la sospecha de causa neoplásica.

Objective: To determine the prevalence, etiology, clinical, echocardiographic, microbiological and cytopathological characteristics of patients with pericardial effusion. Methods: Observational, retrospective, cross-sectional analytical study. We reviewed medical records of patients undergoing pericardiocentesis for a 5 years period. We used descriptive statistics, measures of central tendency and dispersion for analysis. Results: The prevalence of pericardial effusion was 1.1%. Predominant in women (60.4%) and there was a mean age of 49 years. The main causes were neoplastic 32.1%, idiopathic 27.4% and rheumatological 10.4%. A percentage of 27.1 had cardiac tamponade whereas dyspnea and muffled heart sounds were the most common clinical data. The right atrial and ventricular collapse occurred in 84.9 and 75.5%, respectively. The pericardial fluid cytology yielded better in neoplastic causes a sensitivity of 54%, specificity 95%, positive predictive value 85% and negative predictive value 81%. Conclusions: The prevalence of pericardial effusion in a tertiary care hospital was 1.1%, the main cause was neoplastic. In the evaluation of moderate or severe pericardial effusion we found that right atrial and ventricular collapses were the most common echocardiographic findings. The cytopathological study had a high specificity for the diagnosis of neoplasia.

[Analysis of clinical, echocardiographic, microbiological and cytopathological characteristics of pericardial effusions in a tertiary hospital care]. / Análisis de las características clínicas, ecocardiográficas, microbiológicas y citopatológicas de derrames pericárdicos en un hospital de tercer nivel de atención.

OBJECTIVE: To determine the prevalence, etiology, clinical, echocardiographic, microbiological and cytopathological characteristics of patients with pericardial effusion. METHODS: Observational, retrospective, cross-sectional analytical study. We reviewed medical records of patients undergoing pericardiocentesis for a 5 years period. We used descriptive statistics, measures of central tendency and dispersion for analysis. RESULTS: The prevalence of pericardial effusion was 1.1%. Predominant in women (60.4%) and there was a mean age of 49 years. The main causes were neoplastic 32.1%, idiopathic 27.4% and rheumatological 10.4%. A percentage of 27.1 had cardiac tamponade whereas dyspnea and muffled heart sounds were the most common clinical data. The right atrial and ventricular collapse occurred in 84.9 and 75.5%, respectively. The pericardial fluid cytology yielded better in neoplastic causes a sensitivity of 54%, specificity 95%, positive predictive value 85% and negative predictive value 81%. CONCLUSIONS: The prevalence of pericardial effusion in a tertiary care hospital was 1.1%, the main cause was neoplastic. In the evaluation of moderate or severe pericardial effusion we found that right atrial and ventricular collapses were the most common echocardiographic findings. The cytopathological study had a high specificity for the diagnosis of neoplasia.

Casitas B lineage lymphoma b is a key regulator of peripheral tolerance in systemic lupus erythematosus.

OBJECTIVE: To analyze whether the expression and modulation of T cell receptor (TCR) signaling is dependent on Casitas B lineage lymphoma b (Cbl-b) in T cells from patients with systemic lupus erythematosus (SLE) upon stimulation with a tolerogenic substance. METHODS: Peripheral blood mononuclear cells were obtained from 20 patients with SLE (active disease or in remission) and 20 healthy controls. Levels of Cbl-b expression were measured using reverse transcription-polymerase chain reaction and Western blotting in peripheral CD4+ T cells from SLE patients and healthy controls upon anergy induction. Cell proliferation was measured using the carboxyfluorescein diacetate succinimidyl ester dilution method. Cytokine production was analyzed by luminometry, and surface expression of activation markers was assessed by flow cytometry. Transfection assays were performed to induce overexpression of Cbl-b, and phosphorylation of TCR-associated kinases was evaluated. RESULTS: CD4+ T cells from SLE patients displayed resistance to anergy (as evidenced by increased cell proliferation, interleukin-2 production, and expression of activation and costimulatory markers), and this was associated with altered Cbl-b expression. Upon ionomycin treatment, primary T cells showed enhanced MAPK activity and decreased Akt phosphorylation, which was representative of the anergic state. In T cells from lupus patients, Cbl-b overexpression led to increased expression of phosphorylated MAPK, thus indicating the reversibility of anergy resistance. CONCLUSION: These findings suggest that abnormal peripheral tolerance in SLE is caused by a deficiency in Cbl-b, and that this ubiquitin ligase plays a key role in regulating TCR signaling during the induction of peripheral tolerance.