Biomarkers and sepsis severity as predictors of mechanical ventilation and mortality in COVID-19.

Introduction: Patients with septic shock face an elevated risk of mortality compared to those with sepsis. Several biomarkers, including lactate dehydrogenase, albumin, and lactate/albumin (L/A), have been associated with increased mortality in COVID-19 patients. This study aims to assess the relationship between sepsis, septic shock, and mortality, as well as the need for mechanical ventilation in COVID-19 patients. Demographic, sepsis severity factors, and biomarkers are examined. Methods: A retrospective case series from June 2020 to March 2021 included 490 patients diagnosed with sepsis or septic shock secondary to SARS-CoV-2 pneumonia. Time-to-event analyses were conducted for mechanical ventilation and mortality. Statistical significance was set at p ≤ .0038. Serum lactate, albumin, lactate/albumin ratio, C-reactive protein, platelet levels, and three sepsis severity scales, (CCI, SOFA, APACHE IV) were assessed. Results: Sepsis was identified in 352 patients (71.8%), while 138 had septic shock. Patients with septic shock were more likely to require invasive ventilator support. Factors associated with a higher risk of intubation included higher APACHE IV scores, elevated serum albumin levels, and increased L/A ratio. L/A ratio and serum lactate levels demonstrated the best diagnostic accuracy for mechanical ventilation (AUC, 0.964 and 0.946, respectively), mortality (AUC, 0.926 and 0.887, respectively). Discussion: Increased C-reactive protein, combined with increased serum lactate and a high lactate/albumin ratio, may assist clinicians in identifying COVID-19 patients at risk of mechanical ventilation and mortality upon admission. Optimal cut-off values for lactate (1.45-1.65 mmol/L) and L/A ratio (0.413) can aid in prioritizing medical care for at risk COVID-19 patients.

Comparison of Four Predictive Scores for Cardiovascular Risk in Mexican People with HIV.

Persons with HIV (PWH) face an increased risk of cardiovascular events due to immune activation, comorbidities, and certain antiretrovirals (ARVs). However, the current cardiovascular risk (CVR) scores are not specifically directed toward PWH. This study aimed to assess the agreement between different predictive CVR scores and explore their relationship with clinical and demographic data in Mexican PWH. A descriptive cross-sectional analysis was conducted in 200 PWH with a mean age of 42 years who were treated at a Mexican urban center from 2017 to 2018. The majority (83%) was on ARV treatment and 79.5% had undetectable viral loads (VLs). Moderate- to high-risk scores were infrequent, with Framingham Risk Score for Hard Coronary Heart Disease scores showing higher values, with very low concordance among all scores. Logistic regression analysis revealed significant associations between the CVR scores and the initial recorded VL, CD4 cell count, and elevated triglyceride levels. However, no associations were found with measures such as body mass index or abdominal circumference. Treatment with integrase strand transfer inhibitors (INSTIs), particularly first-generation inhibitors, showed strong associations with all predictive scores, notably ASCVD (odds ratio = 7.03, 95% confidence interval 1.67-29.64). The poor concordance among the CVR scores in PWH highlights the need for a specific score that considers comorbidities and ARV drugs. Despite the relatively young age of the participants, significant correlations were observed between INSTI use, initial VL, CD4 cell count, and triglyceride levels, which are factors not considered in the existing risk scores. Regardless of the actual value of the scores, screening for CVR in PWH is recommended.

Anthocyanin-Loaded Polymers as Promising Nature-Based, Responsive, and Bioactive Materials.

Anthocyanins are a specific group of molecules found in nature that have recently received increasing attention due to their interesting biological and colorimetric properties that have been successfully applied in several fields such as food preservation and biomedicine. Consequently, reviews devoted to a general overview of these flavonoids have proliferated in recent years. Meanwhile, the incorporation of anthocyanins into polymeric systems has become an interesting strategy to widen the applicability of these molecules and develop new smart and functional polymers in the above cited areas. However, anthocyanin-based polymers have been scarcely reviewed in the literature. Accordingly, this review aims to be a systematic summary of the most recent approaches for the incorporation of anthocyanins into macro-, micro-, or nanostructured polymers. Moreover, this work describes the fundamentals of the applicability of smart anthocyanin-based polymers and offers an updated review of their most interesting applications as sensors, biological regulators, and active materials.

Inverse percolation by removing straight semirigid rods from bilayer square lattices.

Numerical simulations and finite-size scaling analysis have been carried out to study the problem of inverse percolation by removing semirigid rods from a L×L square lattice that contains two layers (and M=L×L×2 sites). The process starts with an initial configuration where all lattice sites are occupied by single monomers (each monomer occupies one lattice site) and, consequently, the opposite sides of the lattice are connected by nearest-neighbor occupied sites. Then the system is diluted by removing groups of k consecutive monomers according to a generalized random sequential adsorption mechanism. The study is conducted by following the behavior of two critical concentrations with size k: (1) jamming coverage θ_{j,k}, which represents the concentration of occupied sites at which the jamming state is reached, and (2) inverse percolation threshold θ_{c,k}, which corresponds to the maximum concentration of occupied sites for which connectivity disappears. The obtained results indicate that (1) the jamming coverage exhibits an increasing dependence on the size k-it rapidly increases for small values of k and asymptotically converges towards a definite value for infinitely large k sizes θ_{j,k→∞}≈0.2701-and (2) the inverse percolation threshold is a decreasing function of k in the range 1≤k≤17. For k≥18, all jammed configurations are percolating states (the lattice remains connected even when the highest allowed concentration of removed sites is reached) and, consequently, there is no nonpercolating phase. This finding contrasts with the results obtained in literature for a complementary problem, where straight rigid k-mers are randomly and irreversibly deposited on a square lattice forming two layers. In this case, percolating and nonpercolating phases extend to infinity in the space of the parameter k and the model presents percolation transition for the whole range of k. The results obtained in the present study were also compared with those reported for the case of inverse percolation by removal of rigid linear k-mers from a square monolayer. The differences observed between monolayer and bilayer problems were discussed in terms of vulnerability and network robustness. Finally, the accurate determination of the critical exponents ν, ß, and γ reveals that the percolation phase transition involved in the system has the same universality class as the standard percolation problem.

Inference on a Multi-Patch Epidemic Model with Partial Mobility, Residency, and Demography: Case of the 2020 COVID-19 Outbreak in Hermosillo, Mexico.

Most studies modeling population mobility and the spread of infectious diseases, particularly those using meta-population multi-patch models, tend to focus on the theoretical properties and numerical simulation of such models. As such, there is relatively scant literature focused on numerical fit, inference, and uncertainty quantification of epidemic models with population mobility. In this research, we use three estimation techniques to solve an inverse problem and quantify its uncertainty for a human-mobility-based multi-patch epidemic model using mobile phone sensing data and confirmed COVID-19-positive cases in Hermosillo, Mexico. First, we utilize a Brownian bridge model using mobile phone GPS data to estimate the residence and mobility parameters of the epidemic model. In the second step, we estimate the optimal model epidemiological parameters by deterministically inverting the model using a Darwinian-inspired evolutionary algorithm (EA)-that is, a genetic algorithm (GA). The third part of the analysis involves performing inference and uncertainty quantification in the epidemic model using two Bayesian Monte Carlo sampling methods: t-walk and Hamiltonian Monte Carlo (HMC). The results demonstrate that the estimated model parameters and incidence adequately fit the observed daily COVID-19 incidence in Hermosillo. Moreover, the estimated parameters from the HMC method yield large credible intervals, improving their coverage for the observed and predicted daily incidences. Furthermore, we observe that the use of a multi-patch model with mobility yields improved predictions when compared to a single-patch model.

The burden of chronic obstructive pulmonary disease among hospitalised women in a developing country.

BACKGROUND: The course of chronic obstructive pulmonary disease (COPD) is different in men and women. There are limited data in Latin America regarding COPD exacerbations (ECOPD) in women. This study aims to determine the sociodemographic and clinical profile of ECOPD adjusted by gender.METHODS: Cross-sectional analytical study of all patients hospitalised due to an ECOPD in a tertiary university hospital in Colombia between 2015 and 2019. A group comparison analysis was performed between male and female groups.RESULTS: A total of 81 patients met the inclusion criteria (35.8% were women). The mean age was 71.49 years. Most of the patients were GOLD (Global Initiative for Obstructive Lung Disease) 3 and 4. A history of TB was present in 15% of our cohort. While the proportion of smokers was higher among men (OR 5.11; P = 0.013), exposure to wood smoke was significantly higher in women (OR 24; P < 0.001). Females were associated with a lower probability of having forced expiratory volume in 1 sec >0,87 L (OR 0.11; P = 0.013) and were associated with an increased probability of receiving inhaled corticosteroids during hospitalisation (OR 3.33; P = 0.023). No differences in terms of mortality or complications were found.CONCLUSION: Women with COPD are underrepresented in literature. This study was able to identify some factors related to female sex among patients hospitalised for severe ECOPD.

Tomographic findings and mortality in patients with severe and critical pneumonia with COVID-19 diagnosis.

Introduction: A high percentage of patients with non-severe (17.9%) and severe (2.9%) atypical pneumonia do not display pulmonary tomographic findings upon hospital admission; furthermore, lesion associated with COVI-19 are peripherally distributed in a multifocal ground-glass pattern, as well as displaying an irregular consolidation pattern, with a posterior or lower lobe predilection. The main objective of this study was to identify the pulmonary radiological patterns in patients diagnosed with SARS-CoV-2 pneumonia, the factors associated with the need for mechanical ventilation, as well as their survival rates at 30 days. Methods: We report the pulmonary tomographic findings of 490 consecutive patients with severe and critical pneumonia due to SARS-CoV-2. The patients were classified according to the tomography and demographic findings, sepsis severity prognostic scales, Charlson comorbidity index (CCI), the Sequential Organ Failure Assessment (SOFA), and the Acute Physiology and Chronic Health Evaluation (APACHE IV). The Kaplan-Meier method was used to calculate survival distributions. Results: 89.80% of patients had ground-glass opacities, 81.63% radiologic consolidation sign, 42.45% vascular thickening pattern, 37.55% lymphadenopathies, 14.90% pleural effusion, and 2.65% pulmonary thrombosis; meanwhile, 91.02% had bilateral lesions, 85.51% had peripheral lesions, and 75.92% had basal lobe lesions. APACHE IV (HR, 1.191, 95% CI [1.126, 1.260]), SOFA (HR, 5.178, 95%CI [3.103, 8.641]), and CCI (HR, 0.673, 95%CI [0.510, 0.889]), as well as the pulmonary damage severity index (HR, 1.282, 95%CI [1.151, 1.428]), predict the need for invasive mechanical ventilation. Only moderate ARDS patients with mild and severe lung disease showed different 30-day mortality distributions (χ2 = 7.00, p = 0.008). Discussion: Although the survival distributions did not vary significantly, an overwhelming majority of patients (i.e., 84.35%) with a higher pulmonary damage severity index (i.e., 23>) died within 30 days of hospital admission, while only 25.91% with moderate lung damage and 2.42% with mild lung damage.

Dataset on thermal comfort, perceived stress, and anxiety in university students under confinement due to COVID-19 in a hot and humid region of Mexico.

This dataset was compiled to estimate the levels of thermal comfort and mental health in a sample group of university students confined due to the COVID-19 pandemic. By the time research was carried out, these students of a hot and humid region of Mexico, had already spent 200 days on distance learning using online platforms. A total of 324 records were documented with a final sample of 316 valid participants. The total records were collected directly from the students through a web platform (Microsoft forms). This data set can be used to generate correlations between mental health, thermal comfort, and individual characteristics in the study population that will allow to identify the influence of the built environment and local climate on the levels of stress and anxiety that university students experienced under confinement. It can also be used to issue recommendations to improve the quality of built spaces and for the construction of adaptive models of thermal comfort considering mental health as a study variable.

Pulmonary thromboembolism and alveolar hemorrhage as initial manifestations of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs. SLE can affect the lung, the pulmonary vasculature, and the pleura. A 38-year-old female with limb pain and ecchymosis who later developed pulmonary thromboembolism and alveolar hemorrhage is presented here. Clinical, imaging, laboratory, and histopathological evidence is presented. The patient met the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) criteria for SLE. Furthermore, the patient had a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score of 35; thus, indicating severe disease. This case is an example of concomitant venous and arterial lung complications in an SLE patient.

A multi-source global-local model for epidemic management.

The Effective Reproduction Number Rt provides essential information for the management of an epidemic/pandemic. Projecting Rt into the future could further assist in the management process. This article proposes a methodology based on exposure scenarios to perform such a procedure. The method utilizes a compartmental model and its adequate parametrization; a way to determine suitable parameters for this model in México's case is detailed. In conjunction with the compartmental model, the projection of Rt permits estimating unobserved variables, such as the size of the asymptomatic population, and projecting into the future other relevant variables, like the active hospitalizations, using scenarios. The uses of the proposed methodologies are exemplified by analyzing the pandemic in a Mexican state; the main quantities derived from the compartmental model, such as the active and total cases, are included in the analysis. This article also presents a national summary based on the methodologies to illustrate how these procedures could be further exploited. The supporting information includes an application of the proposed methods to a metropolitan area to show that it also works well at other demographic disaggregation levels. The procedures developed in this article shed light on how to develop an effective surveillance system when information is incomplete and can be applied in cases other than México's.

High fructose diet-induced obesity worsens post-ischemic brain injury in the hippocampus of female rats.

Objectives: Cerebral ischemia is caused by a reduction of the blood flow in a specific area in the brain, triggering cellular cascades in the tissue that result in neuronal death. This phenomenon leads to neurological decline in patients with stroke. The extent of the injury after stroke could be related to the condition of obesity. Thus, we aim to analyze the effect of obesity induced by a high fructose diet (HFD) on the brain after cerebral ischemia in rats.Methods: We induced the obesity model in female Wistar rats with 20% fructose in water for 11 weeks. We then performed cerebral ischemia surgery (2-vessel occlusion), carried out the neurological test 6, 24 and 48 h post-ischemia and analyzed the histological markers.Results: The HFD induced an obese phenotype without insulin resistance. The obese rats exhibited worse neurological performance at 6 h post-ischemia and showed neuronal loss and astroglial and microglial immunoreactivity changes in the caudate putamen, motor cortex, amygdala and hippocampus at 48 h post-ischemia. However, the most commonly affected area was the hippocampus, where we found an increase in interleukin 1ß in the blood vessels of the dentate gyrus, a remarkable disruption of MAP-2+ dendrites, a loss of brain-derived neurotrophic factor and the presence of PHF-tau. In conclusion, a HFD induces an obese phenotype and worsens the neuronal loss, inflammation and plasticity impairment in the hippocampus after cerebral ischemia.

[Effectiveness of peri-articular infiltration with local anesthetic and adjuvants for post-surgical pain control in total knee replacement]. / Eficacia de la infiltración periarticular con anestésico local y adyuvantes para control del dolor postquirúrgico en la artroplastía total de rodilla.

INTRODUCTION: Total knee arthroplasty (TKA) is one of the most successful orthopedic treatments, however, it has been associated with severe postsurgical pain in 30-60% of patients. We propose that infiltration of the articular capsule of the knee during surgery will decrease postsurgical pain. MATERIAL AND METHODS: Experimental, randomized, double-blind study in patients undergoing unilateral TKA between April 2018 and January 2019. Patients were divided into two groups, the first infiltration with placebo and the second with anesthetic solution and adjuvants (fentanyl, epinephrine and ketorolac). Pain was measured with the visual analog scale (VAS) at 4, 6, 8, 12, 18, 24, 36 and 48 hours postsurgical, as well as the consumption of opioid analgesics and antiemetics. RESULTS: 20 patients in each group, with a follow-up of 4 weeks. There were no significant differences in demographic characteristics between the two groups. Better control of postsurgical pain was observed in the group that received infiltration with anesthetic and adjuvant, as well as a decrease in the consumption of opioid analgesics and antiemetics. There was no difference in bleeding or in the incidence of infections between the two groups. CONCLUSION: Peri-capsular infiltration is a safe and effective method, as part of multimodal analgesia in total knee arthroplasty, as it decreases postsurgical pain, opioid and antiemetic use and does not increase postsurgical bleeding.

INTRODUCCIÓN: La artroplastía total de rodilla (ATR) es uno de los tratamientos ortopédicos más exitosos; sin embargo, se ha asociado a dolor postquirúrgico intenso en 30-60% de los pacientes. Nosotros planteamos que la infiltración de la cápsula articular de la rodilla durante la cirugía disminuirá el dolor postquirúrgico. MATERIAL Y MÉTODOS: Estudio experimental, aleatorio, doble ciego, en pacientes sometidos a ATR unilateral entre Abril de 2018 a Enero de 2019. Los pacientes fueron divididos en dos grupos, el primero infiltración con placebo y el segundo con solución anestésica y adyuvantes (fentanilo, epinefrina y ketorolaco). Se cuantificó mediante escala visual análoga (EVA) del dolor a las cuatro, seis, ocho, 12, 18, 24, 36 y 48 horas postquirúrgicas, así como del consumo de analgésicos opioides y antieméticos. RESULTADOS: Veinte pacientes en cada grupo, con un seguimiento de cuatro semanas. No hubo diferencias significativas en las características demográficas entre ambos grupos. Se observó un mejor control del dolor postquirúrgico en el grupo que recibió infiltración con anestésico y adyuvante, además de una disminución en el consumo de analgésicos opioides y antieméticos. No hubo diferencia en sangrado ni en la incidencia de infecciones entre ambos grupos. CONCLUSIÓN: La infiltración pericapsular es un método seguro y eficaz, como parte de la analgesia multimodal en la artroplastía total de rodilla, ya que disminuye el dolor postquirúrgico, el consumo de opioides y antieméticos y no incrementa el sangrado postquirúrgico.

[Sudden cardiac death during exercise due to Brugada syndrome. Report of one case]. / Muerte súbita por fibrilación ventricular en deportista. Una presentación inusual del Síndrome de Brugada. Caso Clínico.

We report a 20-year-old male athlete who while running, presented a sudden death due to ventricular fibrillation. He was successfully rescued by cardiopulmonary resuscitation maneuvers and an automatic external defibrillator. Without evidence of structural heart disease, Brugada syndrome was diagnosed as the cause, after which a subcutaneous implantable cardioverter defibrillator was indicated. We discuss the subject of sudden cardiac death in athletes and its unusual relationship with exercise in this channelopathy.

Standard and inverse site percolation of straight rigid rods on triangular lattices: Isotropic and perfectly oriented deposition and removal.

Numerical simulations and finite-size scaling analysis have been carried out to study standard and inverse percolation of straight rigid rods on triangular lattices. In the case of standard percolation, the lattice is initially empty. Then, linear k-mers (particles occupying k consecutive sites along one of the lattice directions) are randomly and sequentially deposited on the lattice. In the case of inverse percolation, the process starts with an initial configuration where all lattice sites are occupied by single monomers (each monomer occupies one lattice site) and, consequently, the opposite sides of the lattice are connected by nearest-neighbor occupied sites. Then the system is diluted by randomly removing sets of k consecutive monomers (linear k-mers) from the lattice. Two schemes are used for the depositing/removing process: an isotropic scheme, where the deposition (removal) of the linear objects occurs with the same probability in any lattice direction, and an anisotropic (perfectly oriented) scheme, where one lattice direction is privileged for depositing (removing) the particles. The study is conducted by following the behavior of four critical concentrations with size k: (i) [(ii)] standard isotropic[oriented] percolation threshold θ_{c,k}[ϑ_{c,k}], which represents the minimum concentration of occupied sites at which an infinite cluster of occupied nearest-neighbor sites extends from one side of the system to the other. θ_{c,k}[ϑ_{c,k}] is reached by isotropic[oriented] deposition of straight rigid k-mers on an initially empty lattice; and (iii) [(iv)] inverse isotropic[oriented] percolation threshold θ_{c,k}^{i}[ϑ_{c,k}^{i}], which corresponds to the maximum concentration of occupied sites for which connectivity disappears. θ_{c,k}^{i}[ϑ_{c,k}^{i}] is reached after removing isotropic [completely aligned] straight rigid k-mers from an initially fully occupied lattice. θ_{c,k}, ϑ_{c,k}, θ_{c,k}^{i}, and ϑ_{c,k}^{i} are determined for a wide range of k (2≤k≤512). The obtained results indicate that (1)θ_{c,k}[θ_{c,k}^{i}] exhibits a nonmonotonous dependence on the size k. It decreases[increases] for small particle sizes, goes through a minimum[maximum] at around k=11, and finally increases and asymptotically converges towards a definite value for large segments θ_{c,k→∞}=0.500(2) [θ_{c,k→∞}^{i}=0.500(1)]; (2)ϑ_{c,k}[ϑ_{c,k}^{i}] depicts a monotonous behavior in terms of k. It rapidly increases[decreases] for small particle sizes and asymptotically converges towards a definite value for infinitely long k-mers ϑ_{c,k→∞}=0.5334(6) [ϑ_{c,k→∞}^{i}=0.4666(6)]; (3) for both isotropic and perfectly oriented models, the curves of standard and inverse percolation thresholds are symmetric to each other with respect to the line θ(ϑ)=0.5. Thus a complementary property is found θ_{c,k}+θ_{c,k}^{i}=1 (and ϑ_{c,k}+ϑ_{c,k}^{i}=1) which has not been observed in other regular lattices. This condition is analytically validated by using exact enumeration of configurations for small systems, and (4) in all cases, the critical concentration curves divide the θ space in a percolating region and a nonpercolating region. These phases extend to infinity in the space of the parameter k so that the model presents percolation transition for the whole range of k.

Muerte súbita por fibrilación ventricular en deportista: una presentación inusual del Síndrome de Brugada. Caso Clínico / Sudden cardiac death during exercise due to Brugada syndrome. report of one case

We report a 20-year-old male athlete who while running, presented a sudden death due to ventricular fibrillation. He was successfully rescued by cardiopulmonary resuscitation maneuvers and an automatic external defibrillator. Without evidence of structural heart disease, Brugada syndrome was diagnosed as the cause, after which a subcutaneous implantable cardioverter defibrillator was indicated. We discuss the subject of sudden cardiac death in athletes and its unusual relationship with exercise in this channelopathy.

Direct introgression of untapped diversity into elite wheat lines.

The effective utilization of natural variation has become essential in addressing the challenges that climate change and population growth pose to global food security. Currently adopted protracted approaches to introgress exotic alleles into elite cultivars need substantial transformation. Here, through a strategic three-way crossing scheme among diverse exotics and the best historical elites (exotic/elite1//elite2), 2,867 pre-breeding lines were developed, genotyped and screened for multiple agronomic traits in four mega-environments. A meta-genome-wide association study, selective sweeps and haplotype-block-based analyses unveiled selection footprints in the genomes of pre-breeding lines as well as exotic-specific associations with agronomic traits. A simulation with a neutrality assumption demonstrated that many pre-breeding lines had significant exotic contributions despite substantial selection bias towards elite genomes. National breeding programmes worldwide have adopted 95 lines for germplasm enhancement, and 7 additional lines are being advanced in varietal release trials. This study presents a great leap forwards in the mobilization of GenBank variation to the breeding pipelines.

Severe Cutaneous Adverse Reactions to Drugs in Latin America: The RACGRAD Study.

BACKGROUND AND OBJECTIVE: Severe cutaneous adverse reactions to drugs (SCARs) are associated with high morbidity and mortality and with sequelae. Objective: To characterize patients with SCARs in 8 health care institutions in Latin America. METHODS: We performed a cross-sectional, descriptive, multicenter study of patients diagnosed with SCARs in Latin America between January 2009 and December 2018. The analysis was carried out using a database in BD Clinic. RESULTS: We collected 70 patients, of whom 42 (60%) were women. Mean age was 38.7 years. Forty-two patients (60%) had DRESS-DIHS, 12 (17.1%) TEN, 5 (7.1%) SJS, 6 (8.5%) AGEP, 4 (5.7%) other reactions not classified as SCARs, and 1 (1.4%) overlapping SJS-TEN. The main causative drugs were aromatic anticonvulsants in 31 cases (44.3%), ß-lactam antibiotics in 11 cases (15.7%), and non-ß-lactam antibiotics in 6 cases (8.6%). In all of the cases, the suspected drug was withdrawn at the first sign of a SCAR. Sixty-six patients (94.2%) received anti-inflammatory treatment, mostly systemic corticosteroids. Complications occurred in 53 cases (75.7%), and 3 patients died (4.3%). Thirteen patients (18.6%) had sequelae. CONCLUSIONS: This is the first multicenter report on SCARs in Latin America. DRESS-DIHS was the most frequently reported clinical entity, and anticonvulsants were the main triggers. Most of the patients received systemic corticosteroids. Complications were frequent, and 3 patients died.

Lupus Eritematoso Sistémico y Manifestaciones en el Sistema Nervioso Central: Un desafío diagnóstico permanente: casos Clínicos / Systemic lupus erythematosus and manifestations in the Central Nervous System: a permanent diagnostic challenge. Clinical cases

La presencia de manifestaciones neuropsiquiátricas en pacientes reumatológicos trae consigo un gran desafío diagnóstico que exige una mirada amplia, desde las bases de la medicina interna, a fin de poder orientar un estudio adecuado y el tratamiento oportuno. Junto con ello, el permanente diálogo e intercambio de miradas clínicas con otras especialidades permite tener un enfoque multidisciplinario que enriquece el abordaje de estas presentaciones complejas.

The presence of neuropsychiatric manifestations in rheumatological patients brings with it a great diagnostic challenge that requires a broad view, from the foundations of internal medicine, in order to guide the appropriate study and timely treatment of these patients. Along with this, the permanent dialogue and exchange of clinical views with other specialties allows for a multidisciplinary approach that enriches the approach to these complex presentations.