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1.
Brasília; CONITEC; mar. 2021.
No convencional en Portugués | BRISA/RedTESA | ID: biblio-1178763

RESUMEN

INTRODUÇÃO: A MG é uma doença autoimune da junção neuromuscular que se apresenta com fraqueza muscular localizada ou generalizada. Na maioria dos casos, a doença é causada por anticorpos contra receptores de acetilcolina (anti-AChR), que estão presentes em cerca de 85% e 50% dos pacientes com as formas generalizadas e ocular, respectivamente. O diagnóstico de MG é definido de acordo com manifestações clínicas, além de provas sorológicas ou eletroneuromiográficas, que apresentam sensibilidade e especificidade variadas de acordo com a apresentação da doença. A estimulação nervosa repetitiva é o estudo eletroneuromiográfico complementar atualmente disponível no Sistema Único de Saúde (SUS) para diagnóstico de MG. TECNOLOGIA: Dosagem de anticorpo anti-receptor de acetilcolina. PERGUNTA: o exame diagnóstico de dosagem de anticorpos anti-acetilcolina pode ser uma alternativa à eletroneuromiografia (estimulação nervosa repetitiva ­ ENR) para o diagnóstico da MG? EVIDÊNCIAS CIENTÍFICAS: Uma revisão sistemática (RS) e dois estudos clínicos prospectivos de avaliação de métodos diagnósticos de MG foram incluídos. A RS incluiu sete estudos de avaliação de anticorpos anti-AChR e sete estudos de avaliação da ENR. As estimativas de acurácia do anti-AChR na RS foram agrupadas de acordo com o delineamento dos estudos, evidenciando sensibilidade de 44% a 66% na MG ocular e de 90% a 96% na MG generalizada, sem variação na especificidade (98% a 99% em ambas as apresentações). Os estudos da ENR foram muitos heterogêneos e evidenciaram sensibilidade entre 11% a 39% no diagnóstico da MG ocular, e entre 32% a 98% na MG generalizada, com especificidade elevada em ambos os casos (94% a 97%). Os estudos individuais evidenciaram sensibilidade de 73% a 74% para MG generalizada e de 38% a 70% para MG ocular para o anti-AChR, e sensibilidade de 80% a 83% para MG generalizada e de 45% a 62% para MG ocular. As avaliações do risco de viés dos estudos incluídos demonstraram alto risco de viés para a RS e baixo risco para a maioria dos domínios avaliados nos estudos de coorte. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: A estimativa de custo global anual do exame anti-AChR no cenário base foi de aproximadamente 155 mil reais, com impacto cumulativo em 5 anos de 788 mil reais. Considerando que uma parcela dos indivíduos necessitará submeter-se adicionalmente ao exame eletroneuromiográfico, o que implicaria em aproximadamente 15 mil reais a mais por ano, o custo total do diagnóstico da doença foi de cerca de 170 mil reais a mais por ano, e de cerca de 867 mil reais ao final do quinto ano de incorporação. Na análise de sensibilidade, foram observados valores de custo total de 165 mil reais no cenário mais otimista e acima de 2 milhões de reais no cenário mais pessimista, para o diagnóstico de MG no período de 5 anos. A variável de maior impacto nos resultados foi a população inicial, seguida do custo do exame anti-AChR. CONSIDERAÇÕES FINAIS: A dosagem de anticorpos anti-AChR é um exame confirmatório essencial para diagnóstico de MG. De maneira geral, os estudos evidenciam sensibilidade superior à ENR, tanto no diagnóstico da forma ocular quanto generalizada da doença, com elevada especificidade. Os estudos de ENR foram heterogêneos e evidenciaram diferentes níveis de acurácia de acordo com o número e localização dos estímulos avaliados, o que não ocorre no cenário da dosagem de anticorpos. As avaliações do risco de viés dos estudos incluídos demonstraram alto risco de viés para a RS e baixo risco para a maioria dos domínios avaliados nos estudos de coorte. Não foram identificadas recomendações de diagnóstico de MG em agências de ATS, mas diretrizes internacionais recomendam o exame como etapa inicial no diagnóstico da doença. RECOMENDAÇÃO PRELIMINAR: A Conitec, em sua 93ª reunião ordinária, realizada no dia 08 de dezembro de 2020, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar favorável à incorporação do exame de dosagem de anticorpos anti-acetilcolina para diagnóstico da Miastenia Gravis no Sistema Único de Saúde. Considerouse, entre outros fatores, que, o exame de avaliação de anticorpos anti-AChR possui uma maior sensibilidade diagnóstica em comparação ao exame eletroneuromiográfico, além disso eletroneuromiografia é um exame demorado e requer um treinamento específico para sua realização. Consequentemente, o tratamento precoce da miastenia gravis poderia ser comprometido. CONSULTA PÚBLICA: A consulta pública nº 68 ficou vigente entre os dias 05/01/2021 e 25/01/2021. Foram recebidas nove contribuições, sendo cinco pelo formulário para contribuições técnico-científicas e quatro pelo formulário para contribuições sobre experiência ou opinião. Estas foram provenientes de pacientes, familiares, amigos ou cuidadores de pacientes, profissionais de saúde ou pessoas interessadas no tema. A maioria das contribuições (77,8%) concordou com a recomendação preliminar da Conitec. Uma contribuição foi neutra (nem concorda e nem discorda) e uma contribuição discordou da recomendação preliminar da Conitec, no entanto, ambas estas contribuições não apresentaram justificativa. As contribuições abordaram, principalmente, os pontos positivos da incorporação da dosagem de anticorpos anti-AChR para o diagnóstico de MG. Não foram solicitadas alterações no texto ou apresentadas referências ou anexos. Houve apenas um argumento sobre a possibilidade de inclusão de anti MUSK para melhoria do atendimento dos demais casos negativos do anticorpo anti-receptor de acetilcolina. Porém, como não houve uma demanda ou pergunta de pesquisa priorizada no escopo, a tecnologia não foi avaliada formalmente pela Conitec. RECOMENDAÇÃO FINAL: Os membros da Conitec presentes na 95ª reunião ordinária, no dia 03 de março de 2021, consideraram que o procedimento possui um corpo de evidências que favorece o exame de dosagem de anticorpos antiacetilcolina para diagnóstico da Miastenia Gravis. Considerou-se a maior sensibilidade e facilidade deste exame comparado à eletroneuromiografia. Diante do exposto, o Plenário deliberou por unanimidade recomendar a incorporação do exame de dosagem de anticorpo anti-receptor de acetilcolina para diagnóstico de Miastenia Gravis. Foi assinado o Registro de Deliberação nº 593/2021. DECISÃO: incorporar o exame de dosagem de anticorpo antirreceptor de acetilcolina para diagnóstico de Miastenia Gravis, do Sistema Único de Saúde - SUS, conforme Portaria nº 11, publicada no Diário Oficial da União nº 74, seção 1, página 235, em 19 de abril de 2021


Asunto(s)
Humanos , Acetilcolina/sangre , Anticuerpos/sangre , Miastenia Gravis/diagnóstico , Evaluación de la Tecnología Biomédica , Sistema Único de Salud , Brasil , Análisis Costo-Beneficio/economía
2.
PLoS One ; 16(3): e0245424, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33760825

RESUMEN

SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona Virus-2), cause of COVID-19 (Coronavirus Disease of 2019), represents a significant risk to people living with pre-existing conditions associated with exacerbated inflammatory responses and consequent dysfunctional immunity. In this paper, we have evaluated the influence of obesity, a condition associated with chronic systemic inflammation, on the secretion of SARS-CoV-2-specific IgG antibodies in the blood of COVID-19 patients. Our hypothesis is that obesity is associated with reduced amounts of specific IgG antibodies. Results have confirmed our hypothesis and have shown that SARS-CoV-2 IgG antibodies are negatively associated with Body Mass Index (BMI) in COVID-19 obese patients, as expected based on the known influence of obesity on humoral immunity. Antibodies in COVID-19 obese patients are also negatively associated with serum levels of pro-inflammatory and metabolic markers of inflammaging and pulmonary inflammation, such as SAA (serum amyloid A protein), CRP (C-reactive protein), and ferritin, but positively associated with NEFA (nonesterified fatty acids). These results altogether could help to identify an inflammatory signature with strong predictive value for immune dysfunction. Inflammatory markers identified may subsequently be targeted to improve humoral immunity in individuals with obesity and in individuals with other chronic inflammatory conditions.


Asunto(s)
Anticuerpos Antivirales/inmunología , Obesidad/virología , Adulto , Anciano , Anticuerpos/sangre , Anticuerpos/inmunología , Anticuerpos Antivirales/sangre , Biomarcadores/sangre , Índice de Masa Corporal , /epidemiología , Infecciones por Coronavirus/virología , Femenino , Humanos , Inmunidad Humoral/inmunología , Inmunoglobulina A/sangre , Inmunoglobulina A/inmunología , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/metabolismo , /patogenicidad
3.
Poult Sci ; 100(2): 623-630, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33518115

RESUMEN

The immunomodulatory effect of Acanthopanax senticosus polysaccharide (ASPS) on immunosuppressed chickens induced by cyclophosphamide (Cy) was observed in this study. Four hundred 7-day-old chickens were randomly divided into 4 groups: vaccinated control group (VC group), Cy-challenged control group (Cy group), Cy-challenged + low-dose ASPS group (ASPSL + Cy group), and Cy-challenged + high-dose ASPS group (ASPSH + Cy group). All groups except the VC group were injected with Cy at a dose of 80 mg/kg/day of BW for 3 successive days to induce immunosuppression. At the age of 10 d, the ASPSL + Cy group and ASPSH + Cy group were intramuscularly injected with 0.2 mL of ASPS at the dose of 100 and 200 mg/mL/day, respectively, once a day for 3 successive days. The Cy group was injected with saline solution in the same way as the 2 ASPS groups. At the age of 14 d, the chickens were vaccinated with Newcastle disease (ND) vaccine in all groups. On day 7, 14, 21, and 28 after the vaccination, BW, lymphocyte proliferation, the serum antibody titers of the ND vaccine, the proportion of CD4+ and CD8+ T lymphocytes, and the concentrations of interferon gamma and IL-2 were determined. The results showed that chickens were injected with Cy at a dose of 80 mg/kg of BW for 3 d displayed lower immune responses than the control group, indicating that the immunosuppressive model was successfully established. At most time points, both high and low doses of ASPS could significantly promote lymphocyte proliferation; enhance BW, antibody titers, and the proportion of CD4+ and CD8+ T lymphocytes; and raised the concentrations of interferon gamma and IL-2 in Cy-treated chickens compared with those in the Cy control group (P < 0.05). These results indicated that ASPS could resist immunosuppression induced by Cy and may be a new-type immune adjuvant to improve vaccination in normal and immunosuppressed chickens.


Asunto(s)
Pollos/inmunología , Eleutherococcus/inmunología , Inmunosupresión/veterinaria , Enfermedad de Newcastle , Vacunas Virales , Adyuvantes Inmunológicos , Animales , Anticuerpos/sangre , Recuento de Linfocito CD4/métodos , Recuento de Linfocito CD4/veterinaria , Linfocitos T CD8-positivos/citología , Proliferación Celular , Ciclofosfamida/administración & dosificación , Inmunosupresores/administración & dosificación , Interferón gamma/sangre , Interleucina-2/sangre , Enfermedad de Newcastle/prevención & control , Virus de la Enfermedad de Newcastle/inmunología , Polisacáridos/inmunología , Distribución Aleatoria
4.
Medicine (Baltimore) ; 100(3): e24312, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33546061

RESUMEN

RATIONALE: Stiff-person syndrome (SPS) is a rare neurological immune disorder characterized by progressive axial and proximal limb muscle rigidity, stiffness, and painful muscle spasms. Amphiphysin antibodies are positive in approximately 5% of SPS patients. To date, there have been no relevant reports on involuntary movement in cases of SPS with amphiphysin antibodies. PATIENT CONCERNS: We describe the case of a 69-year-old man with a 2-year history of progressive stiffness in the neck, bilateral shoulders, and chest muscles, and a more-than-a-year history of dyspnea accompanied by mandibular involuntary movement. The patient was a vegetarian and had good health in the past. The family's medical history was unremarkable. DIAGNOSES: He was diagnosed with SPS based on the progressive muscle stiffness, the amphiphysin antibody seropositivity, the continuous motor activity on electromyography, and the effective treatment with benzodiazepines. INTERVENTIONS: The patient was orally administered clonazepam and baclofen, and corticosteroid IV followed by prednisone orally. OUTCOMES: In the hospital, after treatment with methylprednisolone, clonazepam, and baclofen, the patient's rigidity, stiffness, and dyspnea significantly improved. The involuntary movement of the mandible persisted throughout the treatment process. Currently, under oral treatment with baclofen and clonazepam, the patient's symptoms of muscle stiffness and dyspnea exist, and follow-up is continued. LESSONS: We report a rare and novel case of involuntary movement in SPS with amphiphysin antibodies. The present report explores the relationship between SPS and involuntary movement and expands the spectrum of clinical manifestations of SPS.


Asunto(s)
Discinesias/etiología , Proteínas del Tejido Nervioso/análisis , Síndrome de la Persona Rígida/complicaciones , Anciano , Anticuerpos/análisis , Anticuerpos/sangre , Discinesias/fisiopatología , Humanos , Masculino , Proteínas del Tejido Nervioso/sangre , Síndrome de la Persona Rígida/sangre
6.
Nutrients ; 13(1)2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33418957

RESUMEN

The current study was designed to assess the influence of consumption of ultra-processed (UPF) on oxidative/antioxidant balance and evoked inflammatory signaling in young patients with celiac disease (CD). The study included 85 children. The celiac group (n = 53) included children with CD with a long (>18 months, n = 17) or recent (<18 months, n = 36) adherence to a gluten-free diet (GFD). The control group (n = 32) included healthy children with a significantly higher consumption of UPF compared to the control group, both expressed as kcal/day (p = 0.043) and as percentage of daily energy intake (p = 0.023). Among children with CD, the group with the lowest consumption of UPF (below the 50% of daily energy intake) had a greater Mediterranean diet (MD) adherence and higher moderate physical activity levels. In addition, CD children with the lowest consumption of UPF had healthier redox (lower soluble superoxide dismutase-1 and 15-F2t-isoprostanes) and inflammatory profiles (lower macrophage inflammatory protein-1α) compared to the group with the highest consumption of UPF (all, p < 0.05) regardless of the time on a GFD. These findings highlight the importance of a correct monitoring of the GFD. An unbalanced GFD with high consumption of UPF and an unhealthy pattern with less physical activity and worse adherence to MD results in a worse inflammatory profile, which could act as a parallel pathway that could have important consequences on the pathophysiology of the disease.


Asunto(s)
Enfermedad Celíaca/metabolismo , Alimentos , Transducción de Señal , Adolescente , Anticuerpos/sangre , Antioxidantes , Biomarcadores , Niño , Dieta Sin Gluten , Dieta Mediterránea , Ingestión de Energía , Femenino , Humanos , Masculino , Estrés Oxidativo , España , Superóxido Dismutasa-1
7.
Nat Commun ; 12(1): 379, 2021 01 22.
Artículo en Inglés | MEDLINE | ID: mdl-33483508

RESUMEN

Allergic reactions occur when IgE molecules become crosslinked by antigens such as food proteins. Here we create the 'AllerScan' programmable phage display system to characterize the binding specificities of anti-allergen IgG and IgE antibodies in serum against thousands of allergenic proteins from hundreds of organisms at peptide resolution. Using AllerScan, we identify robust anti-wheat IgE reactivities in wheat allergic individuals but not in wheat-sensitized individuals. Meanwhile, a key wheat epitope in alpha purothionin elicits dominant IgE responses among allergic patients, and frequent IgG responses among sensitized and non-allergic patients. A double-blind, placebo-controlled trial shows that alpha purothionin reactivity, among others, is strongly modulated by oral immunotherapy in tolerized individuals. AllerScan may thus serve as a high-throughput platform for unbiased analysis of anti-allergen antibody specificities.


Asunto(s)
Alérgenos/inmunología , Anticuerpos/inmunología , Epítopos/inmunología , Biblioteca de Péptidos , Hipersensibilidad al Trigo/inmunología , Adolescente , Adulto , Alérgenos/genética , Anticuerpos/sangre , Péptidos Catiónicos Antimicrobianos/inmunología , Niño , Preescolar , Femenino , Humanos , Hipersensibilidad/inmunología , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Masculino , Persona de Mediana Edad , Proteínas de Plantas/inmunología , Adulto Joven
8.
Carbohydr Polym ; 254: 117251, 2021 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-33357847

RESUMEN

The research described here presents data on the effect of galactans of red algae, carrageenans (λ/µ/ν-, κ-, κ/ß-, and ι/κ-types), and agar on complement system activation in normal human serum. The experiments were based on well surfaces coated with triggering agents for binding initiating complement components -C3 and C4. The sulfated galactans inhibited C3 binding to lipopolysaccharide with direct dependence on the sulfation degree of polysaccharides. Sulfation degree was also important in carrageenans' capacity to reduce C4 binding to mannan. However, C4 binding to antibodies was considerably activated by carrageenans, especially with 3,6-anhydrogalactose. The gelling carrageenans were able to block antigen binding centers of total serum IgM and with more intensity than non-gelling. No structural characteristics mattered in ameliorating C5 cleavage by plasmin in extrinsic protease complement activation, but λ/µ/ν- and κ/ß-carrageenans almost completely inhibited C5 cleavage. Thus, galactans participated in cell surface biology by imitating surface glycans in inhibition of C3 binding and mannose binding lectin, but as to the tthe heclassical pathway these substances stimulated complement, probably due to their structure based on carrabiose.


Asunto(s)
Activación de Complemento/efectos de los fármacos , Galactanos/química , Galactanos/farmacología , Algas Marinas/química , Anticuerpos/sangre , Conformación de Carbohidratos , Secuencia de Carbohidratos , Carragenina/química , Carragenina/farmacología , Vía Alternativa del Complemento/efectos de los fármacos , Vía Clásica del Complemento/efectos de los fármacos , Galactanos/sangre , Humanos , Técnicas In Vitro , Estructura Molecular , Resonancia Magnética Nuclear Biomolecular , Polisacáridos/química , Polisacáridos/farmacología , Rhodophyta/química , Espectroscopía Infrarroja por Transformada de Fourier , Sulfatos/química
9.
Int J Infect Dis ; 104: 242-249, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33326874

RESUMEN

BACKGROUND: Susceptibility to Covid-19 has been found to be associated with the ABO blood group, with O type individuals being at a lower risk. However, the underlying mechanism has not been elucidated. Here, we aimed to test the hypothesis that Covid-19 patients might have lower levels of ABO antibodies than non-infected individuals as they could offer some degree of protection. METHODS: After showing that the viral spike protein harbors the ABO glycan epitopes when produced by cells expressing the relevant glycosyltransferases, like upper respiratory tract epithelial cells, we enrolled 290 patients with Covid-19 and 276 asymptomatic controls to compare their levels of natural ABO blood group antibodies. RESULTS: We found significantly lower IgM anti-A + anti-B agglutination scores in blood group O patients (76.93 vs 88.29, P-value = 0.034) and lower levels of anti-B (24.93 vs 30.40, P-value = 0.028) and anti-A antibodies (28.56 vs 36.50, P-value = 0.048) in blood group A and blood group B patients, respectively, compared to controls. CONCLUSION: In this study, we showed that ABO antibody levels are significantly lower in Covid-19 patients compared to controls. These findings could indicate that patients with low levels of ABO antibodies are at higher risk of being infected.


Asunto(s)
Sistema del Grupo Sanguíneo ABO/inmunología , Anticuerpos/sangre , Polisacáridos/inmunología , Glicoproteína de la Espiga del Coronavirus/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Susceptibilidad a Enfermedades , Células Epiteliales/inmunología , Epítopos/inmunología , Femenino , Galactosiltransferasas , Humanos , Inmunoglobulina M/inmunología , Masculino , Persona de Mediana Edad , Riesgo , Adulto Joven
11.
Rev. patol. respir ; 23(supl.3): S263-S267, dic. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-197102

RESUMEN

El diagnóstico microbiológico de la infección por SARS-CoV-2 es de gran importancia por su repercusión clínica a nivel individual y para la elaboración de estrategias de salud pública para intentar frenar su propagación. Actualmente la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) es la técnica de elección para el diagnóstico microbiológico del paciente sintomático por COVID-19, detectando material genético del virus en el organismo. Requiere un adecuado manejo de las muestras y un laboratorio bien equipado. Otros métodos diagnósticos utilizados son la detección de anticuerpos generados por el individuo en contacto con el virus, son útiles para el estudio de infección pasada, estudios de vacunas o estrategias epidemiológicas; y la detección de antígenos del SARS-CoV-2 en muestras biológicas, de mayor rentabilidad, menor coste y gran especificidad, pero con altas tasas de falsos negativos en pacientes con baja carga viral. Es fundamental una correcta indicación e interpretación de las pruebas diagnósticas para su mayor rentabilidad


Microbiological diagnosis of SARS-CoV-2 infection is crucial due to its clinical repercussion at the individual level and for the development of public health strategies to try to stop its spread. Currently, reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard for microbiological diagnosis of symptomatic COVID-19 patients, detecting genetic material of the virus in the body. It requires proper sample handling and a well-equipped laboratory. Other diagnostic methods used are the detection of antibodies generated by the individual in contact with the virus, useful for the study of past infection, vaccine studies or epidemiological strategies; and the detection of SARS-CoV-2 antigens in biological samples, with greater profitability, lower cost and high specificity, but with high rates of false negatives in patients with low viral load. Correct indication and interpretation of diagnostic tests is essential for greater profitability


Asunto(s)
Humanos , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Pandemias , Infecciones por Coronavirus/sangre , Neumonía Viral/sangre , Reacción en Cadena de la Polimerasa , Sensibilidad y Especificidad , Pruebas Serológicas , Anticuerpos/sangre
15.
BMJ Case Rep ; 13(9)2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-32933909

RESUMEN

Autoimmune encephalitis is a rare spectrum of disease that can be a complication of chronic immunosuppression. Diagnosis often requires the presence of antineuronal antibodies, but many causative antibodies have not yet been identified. Antibody-negative autoimmune encephalitis (AbNAE) is especially difficult to diagnose and must rely largely on exclusion of other causes. In chronically immune-suppressed transplant recipients, the differential is broad, likely resulting in underdiagnosis and worse outcomes. Here, we present a 58-year-old liver transplant recipient taking tacrolimus for prevention of chronic rejection who presented with 5 days of confusion, lethargy and lightheadedness. He was diagnosed with AbNAE after an extensive workup and recovered fully after high-dose corticosteroids. Our case highlights the importance of recognising the association between chronic immunosuppression and autoimmune encephalitis. Autoimmune encephalitis, even in the absence of characterised antibodies, should be considered when transplant recipients present with central neurologic symptoms.


Asunto(s)
Encefalitis/inducido químicamente , Enfermedad de Hashimoto/inducido químicamente , Inmunosupresión/efectos adversos , Inmunosupresores/efectos adversos , Trasplante de Hígado , Complicaciones Posoperatorias/inducido químicamente , Tacrolimus/efectos adversos , Anticuerpos/sangre , Encefalitis/sangre , Enfermedad de Hashimoto/sangre , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Factores de Tiempo
16.
J Res Health Sci ; 20(2): e00479, 2020 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-32814701

RESUMEN

BACKGROUND: COVID-19 has been the most priority of the world since the early 2020s. We aimed to investigate the importance, urgency and value of serological tests for monitoring and evaluation of COVID-19. STUDY DESIGN: Rapid review. METHODS: This study was conducted through a review of seroepidemiological studies to evaluate their strength and weakness in monitoring and predicting the epidemic situation of COVID-19. RESULTS: Conducting serological studies is an important measure to determine the status of the COVID-19 in affected countries. These studies may also be used to estimate cumulative incidence of the disease, and to get an impression about the level of the epidemic. CONCLUSION: If an accurate serological test is available it can be used for seroepidemiological studies and epidemic investigation in special context, but given the current situation, it may not be possible to be used for screening the normal population and in care and treatment. This research highlighted the importance and urgency of conducting serological studies for monitoring the COVID-19 situation and evaluation of the interventions.


Asunto(s)
Anticuerpos/sangre , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pruebas Serológicas , Betacoronavirus , Infecciones por Coronavirus/virología , Humanos , Incidencia , Pandemias , Neumonía Viral/virología , Estudios Seroepidemiológicos
17.
BMC Neurol ; 20(1): 319, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32859168

RESUMEN

BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease caused by antibodies that block or destroy nicotinic acetylcholine receptors at the neuromuscular junction. Most of MG patients need immunosuppression agents in addition to treatments that alleviate the symptoms. Intravenous immunoglobulin (IVIg) and plasma exchange are specific treatments given to patients with severe MG and myasthenia gravis crisis. IVIg therapy can cause an increase in serum viscosity; therefore, the risk for thromboembolic events, such as stroke, myocardial infarction, and pulmonary embolism, are reported after IVIg therapy. CASE PRESENTATION: An MG patient was treated with pyridostigmine bromide and prednisolone. The patient's symptoms worsened 26 days after the commencement of treatment and was presented with head drop and dyspnea. The patient was diagnosed with MG crisis and IVIg was initiated. However, the patient reported chest pain and dyspnea 3 days after IVIg had started. An electrocardiogram (ECG) revealed ST elevations in leads II, III, and aVF. A cardiac catheterization was performed and stenosis, obstruction, and sclerosis were ruled out. Glyceryl trinitrate relieved the patient's symptoms, suggesting coronary spastic angina (CSA). CONCLUSIONS: We report the first case of CSA after IVIg. Practitioners should be aware of the potential risks of CSA when administering IVIg for MG patients, in particular in old patients with vascular risk factors.


Asunto(s)
Vasoespasmo Coronario/etiología , Inmunoglobulinas Intravenosas/efectos adversos , Miastenia Gravis/tratamiento farmacológico , Anciano de 80 o más Años , Anticuerpos/sangre , Electrocardiografía , Femenino , Humanos , Inmunoglobulinas Intravenosas/administración & dosificación , Inmunosupresores/administración & dosificación , Miastenia Gravis/inmunología , Prednisolona/administración & dosificación , Bromuro de Piridostigmina/administración & dosificación , Receptores Nicotínicos/inmunología
18.
Medicine (Baltimore) ; 99(34): e21893, 2020 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-32846851

RESUMEN

We examined the blood concentrations of neutrophil gelatinase-associated lipocalin (NGAL) and citrullinated alpha enolase peptide-1 (CEP-1) antibody in sepsis patients to evaluate their potential diagnostic, classified and prognostic utility together with C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6).Sixty-nine patients admitted at the emergency department with sepsis were studied, on admission, their demographic and clinical information were recorded. Blood levels of CRP, PCT, IL-6, NGAL, and CEP-1 antibody were measured. Relationships between sequential [sepsis-related] organ failure assessment score and blood biomarkers, between acute physiology and chronic health evaluation II score and blood biomarkers were investigated. Additionally, the mutual correlation among CRP, PCT, IL-6, NGAL, and CEP-1 antibody were investigated. Diagnostic and predictive values for clinical outcomes for biomarkers were assessed by receiver operator characteristic curve.Sixty-nine participants (38 sepsis, 31 septic shock) were compared with 40 healthy controls. The levels of CRP, PCT, IL-6, and NGAL were significantly higher in sepsis patients ([59.49 ± 48.88]; 0.71, [0.13-11.72]; 60.46, [33.26-201.20]; 265.61, [185.79-500.96], respectively) compared with healthy controls ([2.05 ± 1.85]; 0.02, [0.02-0.03]; 12.08, [7.22-16.84]; 19.73, [7.66-34.39], respectively) (P < .001). CRP, PCT, IL-6, and NGAL had better discriminatory performance with an area under the receiver operator characteristic curve (AUC) of (0.98; 0.98; 0.90; 0.97, respectively), 95% confidence interval (CI) = ([0.95; 1.00]; [0.96; 1.00]; [0.84; 0.96]; [0.94; 1.00], respectively) (P < .001), with a cut off value of (8.02 mg/L [Se = 88.40%, Sp = 100.00%]; 0.06 ng/mL [Se = 94.20%, Sp = 75.00%]; 30.63 pg/mL [Se = 78.30%, Sp = 95.00%]; 95.72 ng/mL [Se = 99.00%, Sp = 92.00%], respectively). Between the sepsis group and septic shock group, PCT and NGAL were significantly higher in septic shock group (2.44, [0.49-20.36]; 294.65 [203.34-1262.47], respectively) compared with sepsis group (0.41, [0.11-2.63]; 219.94, [146.38-385.24], respectively) (P < .05). Between survivors group and nonsurvivors group, PCT was obviously elevated in nonsurvivors group (2.47, [0.70-12.49]) compare with survivors group (0.41, [0.11-8.16]) (P < .05), with an AUC of 0.69, 95% CI = (0.57; 0.81) (P < .05), while CEP-1 antibody was decreased in nonsurvivors group (14.03, [4.94-17.17]) contrast to survivors group (18.78, [8.08-39.72]) (P < .05), with an AUC of 0.67, 95% CI = (0.54; 0.80) (P < .05). Additionally, CEP-1 antibody demonstrated a negative correlation with either sequential [sepsis-related] organ failure assessment score (r = -0.31, P < .05) or PCT (r = -0.27, P < .05).As CRP, PCT, and IL-6, NGAL was valuable in sepsis diagnosis. With a classificatory value, PCT and NGAL correlated with the degree severity of sepsis. PCT and CEP-1 antibody were meaningful in sepsis prognosis. CEP-1 antibody may be a protective factor for sepsis.


Asunto(s)
Anticuerpos/sangre , Lipocalina 2/sangre , Sepsis/sangre , Sepsis/diagnóstico , Choque Séptico/diagnóstico , Anciano , Anciano de 80 o más Años , Anticuerpos Antiproteína Citrulinada/sangre , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Estudios de Casos y Controles , Diagnóstico Diferencial , Servicio de Urgencia en Hospital , Femenino , Humanos , Interleucina-6/sangre , Masculino , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Fosfopiruvato Hidratasa/metabolismo , Valor Predictivo de las Pruebas , Polipéptido alfa Relacionado con Calcitonina/sangre , Pronóstico , Estudios Prospectivos , Sepsis/clasificación , Sepsis/mortalidad , Choque Séptico/sangre
20.
Scand J Immunol ; 92(5): e12923, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32593197

RESUMEN

Antibody-mediated rejections (AMR) in the absence of circulating anti-HLA-DSA have highlighted the role of non-HLA antibodies, particularly those directed against endothelial cells. Of these, MICA (major histocompatibility complex class I chain-related molecule A) antibodies are the most notable and important because of their potential in promoting graft rejections. Limited studies have focused on the impact of MICA donor-specific antibodies (DSA) on graft outcome as compared to those that are not donor-specific (NDSA). We evaluated pre- and post-transplant sera at POD 7, 30, 90, 180 and the time of biopsy from 206 consecutive primary live donor renal transplant recipients for anti-MICA and anti-HLA antibodies using single antigen bead assay on a Luminex platform. Recipients who developed MICA antibodies and their donors were phenotyped for MICA alleles. For the purpose of antibody analysis, patients were categorized into three major groups: biopsy-proven AMR, acute cellular rejection (ACR) and those with no rejection episodes (NRE). During the mean follow-up period of 17.37 ± 6.88 months, 16 of the 206 recipients developed AMR, while ACR was observed in only 13 cases. A quarter (25%) of the AMR cases had anti-MICA antibodies as compared to 7.7% of those experiencing ACR and 6.2% of the NRE group. Allelic typing revealed that all MICA Ab +ve AMR cases were due to the presence of donor-specific antibodies. MICA-DSA even in the absence of HLA-DSA was significantly associated with AMR but not with ACR when compared with the NRE group (P = <.01).


Asunto(s)
Anticuerpos/inmunología , Antígenos HLA/inmunología , Antígenos de Histocompatibilidad Clase I/inmunología , Trasplante de Riñón/métodos , Donadores Vivos/estadística & datos numéricos , Adulto , Alelos , Anticuerpos/sangre , Células Endoteliales/inmunología , Femenino , Rechazo de Injerto/inmunología , Supervivencia de Injerto/inmunología , Antígenos HLA/genética , Antígenos de Histocompatibilidad Clase I/genética , Prueba de Histocompatibilidad , Humanos , India , Masculino , Persona de Mediana Edad , Trasplante Homólogo , Adulto Joven
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