Prevalence of latent and overt polyautoimmunity in type 1 diabetes: A systematic review and meta-analysis.

BACKGROUND: Patients afflicted by type 1 diabetes (T1D) exhibit polyautoimmunity (PolyA). However, the frequency and distribution of PolyA in T1D is still unknown. OBJECTIVE: We conducted a systematic review and meta-analysis to define the prevalence of latent and overt PolyA in individuals with T1D. METHODS: Following PRISMA guidelines, a comprehensive search across medical databases identified studies on latent and overt PolyA in T1D. Two researchers independently screened, extracted data, and assessed study quality. A random effects model was utilized to calculate the pooled prevalence, along with its corresponding 95 % confidence interval (CI), for latent PolyA and overt PolyA. Meta-regression analysis was conducted to study the effect of study designs, age, sex, and duration of disease on pooled prevalence. RESULTS: A total of 158 articles, encompassing a diverse composition of study designs were scrutinized. The analysis included 270,890 individuals with a confirmed diagnosis of T1D. The gender was evenly distributed (50.30 % male). Notably, our analysis unveiled an overt PolyA prevalence rate of 8.50 % (95 % CI, 6.77 to 10.62), with North America having the highest rates (14.50 %, 95 % CI, 7.58 to 24.89). This PolyA profile was further characterized by a substantial incidence of concurrent autoimmune thyroid disease (7.44 %, 95 % CI, 5.65 to 9.74). Moreover, we identified a notable prevalence of latent PolyA in the T1D population, quantified at 14.45 % (95 % CI, 11.17 to 18.49) being most frequent in Asia (23.29 %, 95 % CI, 16.29 to 32.15) and Oceania (21.53 %, 95 % CI, 16.48 to 27.62). Remarkably, this latent PolyA phenomenon primarily featured an array of autoantibodies, including rheumatoid factor, followed by Ro52, thyroid peroxidase antibodies, and thyroglobulin antibodies. Duration of the disease was associated with a highest frequency of latent (ß: 0.0456, P-value: 0.0140) and overt PolyA (ß: 0.0373, P-value: 0.0152). No difference in the pooled prevalence by study design was observed. CONCLUSION: This meta-analysis constitutes a substantial advancement in the realm of early detection of PolyA in the context of T1D. Individuals with T1D should regularly undergo assessments to identify potential concurrent autoimmune diseases, especially as they age.

Predictors of mortality in hospitalised patients with COVID-19: a 1-year case-control study.

BACKGROUND: A paucity of predictive models assessing risk factors for COVID-19 mortality that extend beyond age and gender in Latino population is evident in the current academic literature. OBJECTIVES: To determine the associated factors with mortality, in addition to age and sex during the first year of the pandemic. DESIGN: A case-control study with retrospective revision of clinical and paraclinical variables by systematic revision of clinical records was conducted. Multiple imputations by chained equation were implemented to account for missing variables. Classification and regression trees (CART) were estimated to evaluate the interaction of associated factors on admission and their role in predicting mortality during hospitalisation. No intervention was performed. SETTING: High-complexity centre above 2640 m above sea level (masl) in Colombia. PARTICIPANTS: A population sample of 564 patients admitted to the hospital with confirmed COVID-19 by PCR. Deceased patients (n=282) and a control group (n=282), matched by age, sex and month of admission, were included. MAIN OUTCOME MEASURE: Mortality during hospitalisation. MAIN RESULTS: After the imputation of datasets, CART analysis estimated 11 clinical profiles based on respiratory distress, haemoglobin, lactate dehydrogenase, partial pressure of oxygen to inspired partial pressure of oxygen ratio, chronic kidney disease, ferritin, creatinine and leucocytes on admission. The accuracy model for prediction was 80.4% (95% CI 71.8% to 87.3%), with an area under the curve of 78.8% (95% CI 69.63% to 87.93%). CONCLUSIONS: This study discloses new interactions between clinical and paraclinical features beyond age and sex influencing mortality in COVID-19 patients. Furthermore, the predictive model could offer new clues for the personalised management of this condition in clinical settings.

Kawasaki disease in Colombia: A systematic review and contrast with multisystem inflammatory syndrome in children associated with COVID-19

Introduction: Kawasaki disease (KD) is an acute vasculitis with multisystem involvement. Recently, the increasing incidence of a condition that closely resembles KD in many cases, named multisystem inflammatory syndrome in children (MIS-C), has set off alarms amid the current worldwide coronavirus disease-19 (COVID-19) pandemic. Hence, the aim is to conduct a systematic review of the literature about KD in Colombia and contrast it with COVID-19-related MIS-C. Materials and methods: A search was carried out in both international and Latin American electronic databases for publications concerning patients with KD in the Colombian population. Records were then screened by titles and/or abstracts, assessed for eligibility, and reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. The search included studies reporting MIS-C associated with COVID-19, and compared these patients with our findings of KD in Colombia. Results: Out of 36 publications retrieved, 17 were included, representing 120 individuals. Male to female ratio was 1.6, and most patients (90.4%) were aged 5 years or less. Among the main features of KD, fever was the most frequent (96.2% of the patients), while cervical lymphadenopathy was present in only 40.6%. Intravenous immunoglobulin was administered in 91.4% cases and 6.2% were resistant. Cardiac involvement was found in around 30%, and 20% had coronary artery lesions. Comparison between MIS-C associated with COVID-19 and KD in Colombia indicates that patients affected by MIS-C were older (72.2% of MIS-C patients > 5 years), had higher rates of cardiac involvement, and required critical care more often. Conclusions: Our findings of KD in Colombia are consistent with the available descriptions of KD in the scientific literature. Given the increasing rate of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in Colombia and Latin America, our study raises awareness about MIS-C in pediatric patients with COVID-19 and its relationship with KD.

Introducción: La enfermedad de Kawasaki (EK) es una vasculitis aguda con compromiso multisistémico. Recientemente, la incidencia creciente de una condición que se asemeja en forma considerable a la EK en muchos casos, denominada síndrome inflamatorio multisistémico (SIMS) en niños, ha encendido las alarmas en medio de la actual pandemia mundial de la enfermedad COVID-19. Por consiguiente, nos propusimos realizar una revisión sistemática de la literatura acerca de la EK en Colombia y contrastarla con el SIMS relacionado con COVID-19 en niños. Materiales y métodos: Buscamos publicaciones respecto a pacientes con EK en población colombiana, en bases de datos electrónicas tanto internacionales como latinoamericanas. Los registros hallados fueron tamizados por títulos o resúmenes, evaluados para elegibilidad y revisados. Se siguieron las guías Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Posteriormente, buscamos estudios que reportaran SIMS temporalmente asociado con COVID-19 en niños y comparamos estos pacientes con nuestros hallazgos de EK en Colombia. Resultados: De 36 publicaciones encontradas se incluyeron 17, las cuales representaron 120 individuos. La razón hombre a mujer fue de 1,6 y la mayoría de los pacientes (90,4%) tenía 5 anos o menos. Entre las principales características de EK, la fiebre fue la más frecuente (96,2%), mientras que la linfadenopatía cervical estuvo presente solo en el 40,6%. La inmunoglobulina intravenosa se administró en el 91,4% de los casos y 6,2% presentaron resistencia. Se encontró compromiso cardiaco en alrededor del 30% de los pacientes, en tanto que el 20% tuvo lesiones de arterias coronarias. La comparación entre las características clínicas de la EK y el SIMS asociado a COVID-19 mostró que los individuos afectados por el SIMS eran mayores (72,2% con SIMS tenían más de cinco anos), tuvieron mayores índices de compromiso cardiaco y requirieron cuidado crítico con mayor frecuencia. Conclusiones: Nuestros hallazgos de EK en Colombia son consistentes con las descripciones disponibles de esta enfermedad en la literatura científica. Debido al aumento de infección por SARS-CoV-2 en Colombia y Latinoamérica, nuestro estudio busca crear conciencia sobre el SIMS en pacientes pediátricos con COVID-19 y su relación con la EK.

Respuesta autoinmune en individuos infectados por el virus ZIKA (RAIZ) / Autoinmune response in people infected with ZIKA viruS (RAIZ)

En el presente artículo se presenta una revisión de los principales resultados del proyecto RAIZ, acrónimo de "Respuesta autoinmune en individuos infectados por el virus Zika", originado por dos eventos mutuamente relacionados, la asociación entre un virus emergente en el continente, el virus Zika (vZika), y una enfermedad neuromuscular poco prevalente en Colombia, el síndrome de Guillain-Barré. Después de la llegada del virus al país se observó que las zonas donde se reportaban brotes del virus, se documentaba un aumento en los casos de síndrome de Guillain-Barré y otros síndromes neurológicos, que generó un gran interés para entender los mecanismos subyacentes de la infección asociados con autoinmunidad neurológica. Mediante la realización del primer estudio de casos y controles de Zika, Guillain-Barré y otros síndromes neurológicos, se comprobó dicha asociación en Colombia. A lo largo del proyecto, además, se investigaron los principales mecanismos asociados, mediante estudios de seroprevalencia de otras infecciones, inmunológicos y genéticos

This article presents a review of the main results of the RAIZ project, acronym of "Autoimmune response in individuals infected with the Zika virus", originated by two mutually related events: the association between an emerging virus on the continent, the Zika virus (vZika), and a neuromuscular disease not very prevalent in Colombia, the Guillain-Barré syndrome. After the arrival of the virus in the country it was observed that in the areas of outbreaks an increase of cases of Guillain-Barré syndrome and other neurological syndromes was documented, which generated a great interest in the understanding of the underlying mechanisms of the infection associated with neurological autoimmunity. By conducting the first case-control study on Zika, Guillain-Barré and other neurological syndromes in Colombia, the association was verified. Throughout the project, the main associated mechanisms were addressed through analyses of other infections, immunological analysis and the first genome-wide association study

Interacciones entre citoquinas y resiliencia en pacientes con esclerosis sistémica / Interactions between Cytokines and resilience in patients with systemic sclerosis

Introducción: Resiliencia es la habilidad de responder de manera positiva a eventos adversos. Ésta puede ser influenciada por factores como el estrés crónico, la actividad física y afeccio-nes autoinmunes y/o inflamatorias como la esclerosis sistémica (ES) (1). Objetivo: Evaluar un panel de citoquinas y su asociación con resiliencia, severidad de los síntomas y actividad física en pacientes con ES. Métodos: Este fue un estudio exploratorio que incluyó 35 mujeres con ES. Las características clínicas, incluidas la severidad de los síntomas, la actividad física, la resiliencia así como un panel de 15 citoquinas fueron evaluados simultáneamente.

Plausibilidad genética de la infección por el virus del Zika y el síndrome de Guillain-Barré / Genetic plausibility of infection by the Zika virus syndrome Guillain - Barré Syndrome

Introducción: La infección por el virus del Zika (ZIKV) es, en la mayoría de los casos, asinto-mática o se presenta como una enfermedad leve y auto-limitada, principalmente con erupción cutánea, fiebre, artralgias y conjuntivitis. Sin embargo, en algunos pacientes puede producir efectos graves en el sistema nervioso, entre los cuales se destaca el síndrome de Guillain-Ba-rré (SGB), una polirradiculoneuropatía aguda, con características autoinmunes y, por lo ge-neral, desmielinizante. Objetivo: Realizar el primer estudio de asociación del genoma com-pleto en pacientes con infección por ZIKV y en aquellos que desarrollaron SGB post-viral.