Oocyte diameter predicts the maturation rate of human immature oocytes collected ex vivo.

PURPOSE: To study the impact of oocyte diameter and cumulus cell mass on the potential for final maturation of immature human oocytes in vitro. METHODS: Immature oocytes (n = 1563) from 75 women undergoing fertility preservation by ovarian tissue cryopreservation (14-41 years) were collected. After preparation of the ovarian cortex for freezing, immature oocytes were collected from the surplus medulla. After collection, IVM was performed according to standard published methods. The mass of cumulus cell surrounding the immature oocyte was grouped according to size. After IVM, each oocyte was photographed, measured, and the diameter was calculated as a mean of two perpendicular measurements. RESULTS: The diameter of the oocytes ranged from 60 to 171 µm with a mean of 115 µm (SD:12.1) and an interquartile range from 107 to 124 µm. The oocyte diameter was positively associated with a higher incidence of MII (p < 0.001). MII oocytes had a significantly larger mean diameter than MI, GV, and degenerated oocytes. The size of the cumulus cell mass was significantly associated with the MII stage (p < 0.001) and larger oocyte diameter (p < 0.001). The results further confirm that the diameter of the fully grown oocyte is reached relatively early in human follicular development and that the factors governing oocyte maturation in vitro are connected to the surrounding cell mass and the oocyte. CONCLUSION: The diameter of the oocyte is a highly determining factor in the nuclear maturation of the human oocyte during in vitro maturation, and the size of the cumulus cell mass is closely positively associated with a larger diameter.

Trastorno facticio en adultos: a propósito de un caso y revisión de literatura / Factitious disorder in adults: a case report and literature review

RESUMEN: El trastorno facticio consiste en falsificar, inducir o agravar las enfermedades para recibir atención médica, independientemente si están enfermas o no. El impacto que tiene esta patología va desde altos costos en salud asociado a la policonsulta, hospitalizaciones y tratamientos innecesarios; la funcionalidad y calidad de vida de estos pacientes, hasta el costo de vidas humanas. Este trastorno sigue siendo un desafío para los clínicos, puesto que no hay evidencia suficiente sobre la epidemiología, etiología, clínica y manejo dada su complejidad. En este artículo se presentará un caso clínico enfatizando en la evolución de la enfermedad, manejo inicial y posterior durante su hospitalización, junto con una actualización basada en la literatura, en torno al tratamiento de esta patología, con el fin de proponer intervenciones preventivas o protocolos que permitan evitar hospitalizaciones y tratamientos innecesarios. Luego se finalizará con la resolución del caso, pronóstico de esta enfermedad y una conclusión.

ABSTRACT Factitious disorder consists of falsifying, inducing or aggravating illnesses in order to receive medical attention, regardless of whether they are ill or not. The impact of this pathology ranges from high health costs associated with polyconsultation, hospitalizations and unnecessary treatments, the functionality and quality of life of these patients, up to the cost of human lives. This disorder continues to be a challenge for clinicians, since there is insufficient evidence on the epidemiology, etiology, clinic and management given its complexity. In this article, a clinical case will be presented, emphasizing the evolution of the disease, initial and subsequent management during hospitalization, together with an update based on the literature, on the treatment of this pathology, in order to propose preventive interventions or protocols that allow avoiding hospitalizations and unnecessary treatments. Then it ends with the resolution of the case, prognosis of this disease and a conclusion.

Utility of neutrophil-to-lymphocyte ratio plus C-reactive protein for infection in systemic lupus erythematosus.

OBJECTIVE: To analyze the utility of neutrophil-to-lymphocyte ratio (NLR) plus C-reactive protein (CRP) to differentiate between infection and active disease in patients with SLE. METHODS: A cross-sectional study of a cohort of patients with SLE was carried out. Blood samples from four groups (patients without infection or active disease, patients with infection, patients with active disease, and patients with both infection and active disease) before therapeutic interventions were analyzed. We excluded patients with current malignancy, pregnancy, ischemic heart disease or use of antimicrobials during previous 7 days. Hematological cell count, CRP and cultures were obtained. We constructed receiver operating characteristic curves; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: Forty patients were included. NLR cut-off ≥6.3 had sensitivity 70%, specificity 85%, PPV 83% and NPV 74% to detect patients with non-viral infections. A CRP cut-off ≥7.5 mg/L had sensitivity 90%, specificity 75%, PPV 78% and NPV 88% to detect infections regardless of SLE activity. Combination of CRP plus NLR improves the specificity to 90% and PPV to 88%. Excluding the group with both infection and active disease, CRP plus NLR expands specificity to 95% and NPV to 90%. CONCLUSION: In our experience, levels of CRP, particularly CRP plus NLR, were useful in differentiating patients with SLE from those with suspected non-viral infection regardless of the activity of the disease.

Inflammatory biomarkers, disease activity index, and self-reported disability may be predictors of chronic arthritis after chikungunya infection: brief report.

The chikungunya virus (ChikV) is a reemerging mosquito-borne pathogen that causes disabling chronic arthritis. The relationship between clinical evolution and inflammatory biomarkers in patients with ChikV-induced arthritis has not been fully described. We performed a prospective case series to evaluate the association among joint involvement, self-reported disability, and inflammatory biomarkers. Patients with ChikV infection were followed for 1 year. Joint involvement and self-reported disability were evaluated with disease activity index 28 (DAS-28) and World Health Organization Disablement Assessment Schedule II (WHODAS-II). Interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were used as biomarkers. Ten patients with mean age 48 ±15.04 years were included. Symptoms at diagnosis were fever, arthralgias, myalgias, rash, arthritis, nausea, vomiting, and back pain. Polyarticular involvement was present in seven cases. At diagnosis, measures were as follows: DAS-28, 5.08±1.11; WHODAS-II score, 72.3±10.3 %; CRP, 5.09±7.23 mg/dL; ESR, 33.5±17.5 mm/h; RF, 64±21.7 IU/mL; and IL-6, 17.6±10.3 pg/mL. Six patients developed subacute and chronic symptoms. During follow-up, DAS-28 index, WHODAS-II score, ESR, and IL-6 were statistically different in patients with subacute and chronic symptoms compared to those who resolved in the acute phase (p < 0.05). DAS-28 index, WHODAS-II score, and IL-6 were related to chronicity of articular symptoms and could be used as predictors of ChikV-induced arthritis.

Active haematological manifestations of systemic lupus erythematosus lupus are associated with a high rate of in-hospital mortality.

The aim of this study was to estimate the impact of the haematological manifestations of systemic lupus erythematosus (SLE) on mortality in hospitalized patients. For that purpose a case-control study of hospitalized patients in a medical referral centre from January 2009 to December 2014 was performed. For analysis, patients hospitalized for any haematological activity of SLE ( n = 103) were compared with patients hospitalized for other manifestations of SLE activity or complications of treatment ( n = 206). Taking as a variable outcome hospital death, an analysis of potential associated factors was performed. The most common haematological manifestation was thrombocytopenia (63.1%), followed by haemolytic anaemia (30%) and neutropenia (25.2%). In the group of haematological manifestations, 17 (16.5%) deaths were observed compared to 10 (4.8%) deaths in the control group ( P < 0.001). The causes of death were similar in both groups. In the analysis of the variables, it was found that only haematological manifestations were associated with intra-hospital death (odds ratio 3.87, 95% confidence interval 1.8-88, P < 0.001). Our study suggests that apparently any manifestation of haematological activity of SLE is associated with poor prognosis and contributes to increased hospital mortality.

Effect of ezetimibe plus pravastatin on endothelial dysfunction in patients with systemic lupus erythematosus.

BACKGROUND: Patients with systemic lupus erythematosus (SLE) have a higher risk for cardiovascular disease (CVD), not fully explained by the conventional risk factors. These patients have endothelial dysfunction (ED) as an early process of atherosclerosis, which can be reversed with therapy. OBJECTIVE: To determine the effect of ezetimibe plus pravastatin on endothelial function in patients with SLE after 12 months of treatment. PATIENTS AND METHODS: An open study, before and after, which assessed the effect of ezetimibe plus pravastatin treatment, was performed. Twenty two patients (21 women and one man) with diagnosis of SLE were studied, with a mean age 40 ± 5 years. Endothelial dysfunction was evaluated using vascular ultrasound of the brachial artery in order to measure the flow-mediated vasodilation (FMV) basal and after 12 months of treatment with pravastatin 40 mg/day plus ezetimibe 10 mg/day. In addition, a lipid profile: total cholesterol (TC), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), and serum C-reactive protein (CRP), was done. RESULTS: We found a basal FMV of 7.58% and 18.22% after 12 months of treatment, with an improvement of 10.64 points 95% CI (7.58-13.58), p < 0.001. TC decreased from 201.3 ± 58.9 mg/dL to 158.06 ± 50.13 mg/dL (p < 0.01); LDL-C from 125.78 ± 44.4 mg/dL to 78.8 ± 32.9 mg/dL (p < 0.001); HDL-C increased from 49.0 ± 16.8 mg/dL to 52.2 ± 13.8 mg/dL (p = 0.077). The basal and final concentrations of CRP were 4.49 and 2.8, respectively, with a mean decrease of 2.11 mg/dL, 95% CI (0.908-3.32), p < 0.002. Both drugs were well tolerated. CONCLUSION: Ezetimibe plus pravastatin significantly improved FMV in patients with SLE, decreasing ED and the lipid profile. This treatment ameliorated an early process of atherosclerosis and a risk factor for CVD.

Prevalencia puntual de consumo de sustancias en individuos que cometen suicidio por asfixia secundario a ahorcamiento en Santiago, 2014-2015 / Point prevalence of consumption of substances in individuals who commit suicide for asphyxia by hanging in Santiago, 2014-2015

Introducción: El trastorno por consumo de sustancias se ha asociado a suicidio, el que constituye la segunda causa de muerte en individuos entre 15 y 29 años. Dentro de los mecanismos más comunes de suicidio, se encuentra la asfixia por ahorcamiento. Objetivo: Determinar la prevalencia puntual de consumo de sustancias en individuos que ingresaron al Servicio Médico Legal (SML) de Avenida La Paz #1.012, Independencia, Santiago de Chile por suicidio secundario a asfixia por ahorcamiento durante 2014-2015. Materiales y métodos: Estudio de corte transversal en individuos que ingresaron al SML entre los años 2014-2015, cuya causa de muerte correspondiera a suicidio por asfixia por ahorcamiento y que tuvieran registros de: sexo, edad, alcoholemia y examen toxicológico. Se utilizó una plantilla Excel® 2011, determinándose estadística descriptiva y análisis porcentual. Resultados: Durante los años 2014-2015, ingresaron 8.321 individuos al SML, de los cuales se seleccionaron aleatoriamente 1.218 individuos. De dicha muestra, un 11,58% correspondió a muertes secundarias a asfixia por ahorcamiento. De éstos un 74,47% eran varones. El rango etario más frecuente correspondió a los 40-49 años. Un 49,65 % tenía alcoholemia positiva en sangre y un 58,87 % examen toxicológico positivo, siendo lo más frecuente la asociación de dos o más sustancias al momento del suicidio (39,72 %). Discusión: Se observan resultados similares en relación a edad, sexo en comparación a estudios similares, no así cuando se comparan las sustancias consumidas, donde hubo mayor prevalencia de cocaína. La prevalencia de consumo de sustancias en casos de suicidios consumados es de un 58,86%.

Introduction: The disorder for consumption of substances has been associated to suicide, this constitute the second cause of death in individuals between 15 and 29 years old. Among the most common mechanisms of suicide we found asphyxia by hanging. Objective: Determine the point prevalence in the consume of substances of individuals that were admitted in the Medical Legal Service (MLS) of Avenida La Paz #1.012, Independencia, Santiago de Chile, for secondary suicide asphyxia by hanging during 2014-2015. Materials and methods: Cross-sectional study in individuals admitted in MLS between 2014-2015, whose cause of death corresponded to suicide due asphyxia by hanging wich had registers of: sex, age, blood alcohol test and toxicological exam. A 2011 Excel® template was used, determining descriptive statistics and percentage analysis. Results: During the years 2014-2015, 8.321 were admitted in MLS, of which 1.218 were randomly selected. Of this sample, 11.58 % corresponded to secondary death to asphyxia by hanging. Of these, 74.47 % were male. The most frequent age range corresponds to 40-49 years. 46.65 % hadethanol in blood and 58.87 % positive toxicological test, being the most frequent the association of two or more substances at the moment of the suicide (39.72 %). Discussion: Similar results are observed in relation to age, sex compared to similar studies, but not when comparing substances consumed, where there was a higher prevalence of cocaine. The prevalence of substances consumed in cases of completed suicides is 58.86%.

[CHRONIC KIDNEY DISEASE AND ITS RELATIONSHIP WITH INTAKE OF TURMERIC, CATECHINS, PROANTHOCYANIDINS AND OMEGA-3]. / ENFERMEDAD RENAL CRÓNICA Y SU RELACIÓN CON LA INGESTA DE CÚRCUMA, CATEQUINAS, PROANTOCIANIDINAS Y OMEGA-3.

Chronic renal disease is characterized by decreased glomerular filtration rate (GFR) < 60 ml/min/ 1.73m2 and/or the presence of kidney damage independent of the cause for a period of 3 months or more. The treatment of more advanced stages of chronic kidney disease is dialysis, and most common form of hemodialysis. This treatment is costly in our country reaching USD 900 per person. The main cause of admission to dialysis, diabetic nephropathy remains with 34% of all revenue. This alone makes any improvement in the treatment of CKD is highly desirable. There is evidence available about the fundamental role of turmeric, proanthocyanidins, catechins and omega-3 on how these compounds are related to the response to treatment of chronic kidney disease for various reasons.

La enfermedad renal crónica se caracteriza por disminución de la velocidad de filtración glomerular (VFG) < 60 ml/min/1,73m2 y/o la presencia de daño renal independiente de la causa durante un periodo superior a tres meses. El tratamiento de las etapas más avanzadas de la enfermedad renal crónica (ERC) es la diálisis, y su forma más frecuente la hemodiálisis. Este tratamiento tiene un coste elevado en nuestro país, correspondiendo a USD 900 mensuales por persona. La causa principal de ingreso a diálisis corresponde a la nefropatía diabética, con un 34% de todos los ingresos. Solo estos indicadores justifican los esfuerzos en investigación por mejorar el tratamiento de la ERC. Existe evidencia disponible acerca del rol fundamental de cúrcuma, prontocianidinas, catequinas y omega-3 sobre cómo estos compuestos se relacionan con una mejor respuesta al tratamiento de la enfermedad renal crónica por distintas causas1.

Enfermedad renal crónica y su relación con la ingesta de cúrcuma, catequinas, proantocianidinas y omega-3 / Chronic kidney disease and its relationship with intake of turmeric, catechins, proanthocyanidins and omega-3

La enfermedad renal crónica se caracteriza por disminución de la velocidad de filtración glomerular (VFG) < 60 ml/min/1,73m2 y/o la presencia de daño renal independiente de la causa durante un periodo superior a tres meses. El tratamiento de las etapas más avanzadas de la enfermedad renal crónica (ERC) es la diálisis, y su forma más frecuente la hemodiálisis. Este tratamiento tiene un coste elevado en nuestro país, correspondiendo a USD 900 mensuales por persona. La causa principal de ingreso a diálisis corresponde a la nefropatía diabética, con un 34% de todos los ingresos. Solo estos indicadores justifican los esfuerzos en investigación por mejorar el tratamiento de la ERC. Existe evidencia disponible acerca del rol fundamental de cúrcuma, prontocianidinas, catequinas y omega-3 sobre cómo estos compuestos se relacionan con una mejor respuesta al tratamiento de la enfermedad renal crónica por distintas causas (AU)

Chronic renal disease is characterized by decreased glomerular filtration rate (GFR) < 60 ml/min/ 1.73m2 and/or the presence of kidney damage independent of the cause for a period of 3 months or more. The treatment of more advanced stages of chronic kidney disease is dialysis, and most common form of hemodialysis. This treatment is costly in our country reaching USD 900 per person. The main cause of admission to dialysis, diabetic nephropathy remains with 34% of all revenue. This alone makes any improvement in the treatment of CKD is highly desirable. There is evidence available about the fundamental role of turmeric, proanthocyanidins, catechins and omega-3 on how these compounds are related to the response to treatment of chronic kidney disease for various reasons (AU)

Development and initial validation of a damage index (DIAPS) in patients with thrombotic antiphospholipid syndrome (APS).

INTRODUCTION: In antiphospholipid syndrome (APS), certain principal manifestations are associated with a worse prognosis and organ damage. OBJECTIVE: The objective of this paper is to describe the development and initial content, criterion and construct validity of a disease-specific cumulative damage index in patients with thrombotic APS (DIAPS). METHODS: Through expert panel agreement, 47 items were considered to reflect damage in APS. This preliminary version of the DIAPS was submitted to four local and international clinical and research experts in APS who ranked each item according to severity. A Delphi exercise resulted in a final 37 item instrument. In the second phase, a cross-sectional study was conducted applying the DIAPS in patients included in a multicenter electronic registry of patients with APS. Quality of life related to health status was evaluated with the EuroQol for construct validation. An α Cronbach and correlation with the EuroQol scale were calculated with SPSS 20.0 (p < 0.05). RESULTS: We evaluated the DIAPS in 156 patients, 77% female, with a mean age at diagnosis 34.7 ± 5.5 years. A total of 69% had primary APS. Common comorbidities included obesity, depression and dyslipidemia. The most frequent manifestations resulting in sequelae were deep venous thrombosis and ischemic stroke. Blindness, retinal occlusive vessel disease, myocardial infarction, cardiac valve requiring replacement, mesenteric thrombosis, and renal insufficiency also occurred. Homogeneity: α Cronbach 0.619. DIAPS items correlated with EuroQol domains with the exception of pulmonary, renal, gastrointestinal, and endocrine systems. CONCLUSION: This study demonstrates content, criterion and construct validity of a new physician-reported instrument to assess the DIAPS. In addition, the DIAPS correlated with the EuroQol.

Primigravida is associated with flare in women with systemic lupus erythematosus.

The objective of this study was to identify risk factors associated with flare during pregnancy in women with systemic lupus erythematosus (SLE). We performed a retrospective analysis of pregnant women with SLE in a referral hospital. Flare was considered according to predetermined definitions. We analyzed 15 clinical, biochemical and immunological variables with a potential predictive value for relapse during pregnancy. We included 124 lupus pregnancies in 120 women. The relapse rate during pregnancy was 37.9% (47 episodes). The most common manifestations of flare were renal, joint, cutaneous and hematological. Patients with flare during pregnancy developed a higher frequency of preeclampsia and preterm delivery. In multivariate analysis, primigravida was a risk factor associated with any type of flare during pregnancy (OR 2.3, 95% CI 0.99-5.52, p = 0.05); on the other hand, primigravida (OR 3.6, 95% CI 1.19-11.3, p = 0.02), activity prior to pregnancy (OR 3.7, 95% CI 0.97-14.1, p = 0.05), and previous renal disease (OR 5.8, 95% CI 1.95-17.6, p = 0.001) were the principal risk factors associated with renal flare. The first pregnancy in women with SLE is associated with any type of flare. Disease activity is associated with preeclampsia and preterm delivery. Close monitoring is mandatory to identify relapses and timely treatment.

Carotid atherosclerosis is not associated with lower bone mineral density and vertebral fractures in patients with systemic lupus erythematosus.

BACKGROUND: Low bone mineral density (BMD) and vertebral fractures (VF) have been associated with atherosclerosis in the general population. We sought to investigate the relationship between BMD and VF and carotid atherosclerosis in women with systemic lupus erythematosus (SLE). METHODS: We studied 122 women with SLE. All patients had BMD, carotid intima-media thickness (IMT), and carotid artery atherosclerotic plaque assessment by ultrasound. RESULTS: Mean age at study entry was 44 years and mean disease duration was 11 years. Carotid plaque was found in 13 (11%) patients (9 postmenopausal and 4 premenopausal). Patients in the highest IMT quartile were more likely to be older (p = 0.001), have a higher body mass index (p = 0.008), and exhibit dyslipidemia at study entry (p = 0.041), compared with the lower three quartiles. BMD at the lumbar spine was lower in patients in the highest IMT quartile compared with the lower quartiles in the multivariate logistic analysis, however, there was no association between lumbar or total hip BMD and IMT (p = 0.91 and p = 0.6, respectively). IMT measurements did not differ according to the presence or absence of VF (0.08 ± 0.12 vs. 0.06 ± 0.03 mm, p = 0.11). A trend towards higher incidence of VF was found in patients with carotid plaque compared with those without (33% vs. 21%; p = 0.2). CONCLUSIONS: In patients with SLE, the presence of carotid atherosclerosis is not associated with low BMD or VF.

Efectos del ejercicio en adultos mayores / Effects of exercise in older adults

Elederly seems to be caracterized for a declinaion in physical performance, and it’s associated with frailty, and the appearance of diseases, expressed in geriatric syndromes, functional discapacity, or higly prevalent sickness. Immobility worsenes thee processes. Exercise, however, may prevent, or delay those processes and may a useful resource in most of sckness. This article is a brief review of effects of excercise in normal aging and pathologic phenomenons.

Fulminant systemic vasculitis in systemic lupus erythematosus. Case report and review of the literature.

Vasculitis in systemic lupus erythematosus (SLE) has a broad spectrum of clinical manifestations from cutaneous to visceral involvement and its prognosis ranges from mild to life-threatening. We report the case of a previously healthy 17-year-old woman with eight months' history of arthralgias and myalgias. Subsequently, she developed facial and lower limbs edema, and hair loss. Two weeks before admission to a secondary level hospital, she developed fever up to 40°C followed by abdominal pain, rectal bleeding, hematemesis and blisters on both legs, reason for which she was hospitalized. With active bullous SLE with rapidly progressive glomerulonephritis suspected, she was treated with methylprednisolone pulses without response. After one week of treatment, she was transferred to a tertiary level hospital. On admission she presented acute arterial insufficiency of the lower extremities, respiratory failure with apnea, metabolic acidosis and shock; six hours later she died. Autopsy findings showed active diffuse lupus nephritis and diffuse systemic vasculitis that involved vessels from the skin, brain, myocardium, spleen, iliac and renal arteries. In addition, serositis of the small intestine and colon, acute and chronic pericarditis, pericardial effusion and myocarditis were found. Immunologic tests confirmed SLE diagnosis. In this case the fulminant course was the result of SLE high disease activity, visceral vasculitis of several organs and late diagnosis, referral and treatment. Early diagnosis, and opportune referral to the rheumatologist for intensive treatment can improve the outlook in these patients.

Oxidative stress in Mexicans with diffuse cutaneous systemic sclerosis.

To compare oxidative stress (OS) biomarkers and antioxidant capacity of plasma (ACP) between dcSSc (diffuse cutaneous systemic sclerosis) and healthy Mexicans and their possible relationship with autoantibodies, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and uric acid (UA). We included 28 dcSSc and 28 healthy individuals. Patients were grouped in early and late dcSSc and were excluded if they had infections, neoplasias, comorbidity, or antioxidant treatment. Lipoperoxidation products (malondialdehyde), protein oxidation products (carbonyls, dityrosines), ACP, CRP, ESR, and UA were investigated. Age was 47.5 ± 10 in dcSSc versus 48 ± 7 years in controls. In dcSSc, OS was higher and ACP was decreased versus controls (p < 0.001). OS was similar in early and late dcSSc. Anti-Scl-70 (anti-topoisomerase I) was associated with a higher OS (p < 0.05). Eight dcSSc patients had hyperuricemia (28.5 %). A significant correlation between UA and malondialdehyde, dityrosines and carbonyls levels (r = 0.52, r = 0.78 and r = 0.69, p < 0.01) respectively, was found in dcSSc group. A high level of ESR was present in 71 % and CRP in 40 % of dcSSc patients. Mexican dcSSc patients had elevated lipid/protein OS with respect to healthy controls. These OS biomarkers have direct correlation with UA levels. ESR and CRP were elevated in a great number of dcSSc patients. These biochemical markers suggest that dcSSc patients have a continuous stimulus for endothelial dysfunction and accelerated atherogenesis.

Cerebral blood flow abnormalities in neurologically asymptomatic patients with primary antiphospholipid syndrome.

OBJECTIVE: To evaluate cerebral blood flow abnormalities in primary antiphospholipid syndrome (PAPS) patients without ongoing neurological manifestations. PATIENTS AND METHODS: We included 28 PAPS patients and 28 healthy controls. Carotid Doppler ultrasound, and echocardiographic evaluation were done. Transcranial Doppler ultrasonography measured mean flow velocity (MFV) in the carotid siphon, middle, anterior, posterior, intracranial vertebral arteries, and basilar artery (11 cerebral arteries). Results were considered abnormal when the MFV was out of the normal range according to age and/or flow asymmetry and/or more than four arterial segments affected. RESULTS: The mean age of patients was 41.4 ± 11.2 and 39.3 ± 8.6 years in controls. Disease duration was 11 ± 2.7 years. A significant increase in MFV in 7/11 cerebral arteries in PAPS patients, mainly in the middle and anterior cerebral arteries was found compared with controls. A significant association between lupus anticoagulant, history of stroke and obesity with a greater number of affected arteries was found. We did not find an association between MFV and abnormal echocardiography, arterial hypertension and carotid intima-media thickness. CONCLUSIONS: Asymptomatic patients with PAPS can have significantly increased MFVs. These alterations may be the consequence of accelerated atherosclerosis, PAPS vasculopathy or both. Whatever the cause, these findings can represent a risk for stroke in PAPS patients that needs the trial of other therapeutic options.

Human adjuvant disease induced by foreign substances: a new model of ASIA (Shoenfeld's syndrome).

OBJECTIVE: To investigate the clinical, laboratory and histological manifestations of patients who received illegal injections of foreign substances for cosmetic purposes. PATIENTS AND METHODS: We studied patients who met the following inclusion criteria: 1) history of application of foreign substances for cosmetic purposes, 2) clinical data of autoimmune disease or non-specific autoimmune manifestation (i.e. arthralgias, myalgia, malaise, fever, and weight loss), 3) detection of autoantibodies in patients' sera, 4) histological evidence of chronic inflammation and/or granulomatous reaction to foreign body. RESULTS: Fifty female patients aged 44.4 ± 10 years were studied. The mean time between application of foreign substances and onset of symptoms was 4.5 ± 4.3 years. Patients were followed for 12 ± 7.5 years. Forty-one patients were injected with mineral oil, nine patients received other substances: three iodine gadital, one guayacol, one guayacol plus silicone fluid, two collagen, two silicone fluid. The sites of application were: buttocks (36), legs and/or thighs (11), breasts (eight) hands and face (one), face (two) (seven patients received an injection to more than one site). Thirty patients presented with non-specific autoimmune manifestations, whereas 20 patients fulfilled the criteria for a defined autoimmune disease such as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, overlap syndrome, autoimmune hemolytic anemia, autoimmune thyroiditis, autoimmune hepatitis, and ulcerative colitis. CONCLUSIONS: Cases of human adjuvant disease following illegal injections of oil substances for cosmetic purposes are reported. Patients presented with defined autoimmune diseases as well as with non-specific autoimmune manifestations. Illegal injection of these substances could lead to serious local and systemic complications, even to death. These cases represent another model of Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA). The use of these substances should be prohibited.

Still's disease, lupus-like syndrome, and silicone breast implants. A case of 'ASIA' (Shoenfeld's syndrome).

In recent years, four conditions, siliconosis, Gulf War syndrome (GWS), macrophagic myofasciitis syndrome (MMF) and post-vaccination phenomena, were linked to a previous exposure to an adjuvant, suggesting a common denominator, and it has been proposed to incorporate comparable conditions under a common syndrome entitled Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA). We report a case of a female who at the age of 11 years was diagnosed with Still's disease. At the age of 22 she underwent silicone breast implants and presented with a transient lupus-like syndrome. Then, at 25 years old she had a severe activation of Still's disease in association with rupture of silicone breast implants. When the prostheses were removed, the clinical picture improved. This case fulfills the criteria for ASIA and complements seven previous reports of Still's disease in association with silicone breast implants.

Cambios fisiológicos asociados al envejecimiento / Physiological changes associated with normal aging

La población envejece en forma acelerada, y la comprensión de los cambios fisiológicos asociados al envejecimiento es una herramienta importante para enfrentar las demandas biomédicas y sociales de ese grupo etario. El objetivo de la presente revisión es definir los principales cambios morfológicos y funcionales en los sistemas cardiovascular, renal, nervioso central, muscular y metabolismo de la glucosa asociados a la edad. La evidencia de estudios clínicos y experimentales muestra que el envejecimiento de los vasos sanguíneos y el corazón se asocia a la pérdida de células musculares y menor distensibilidad. La fracción de eyección se mantiene constante. El riñón muestra disminución moderada de la velocidad de filtración glomerular, esclerosis vascular y glomerular, menor capacidad de concentración/dilución y de hidroxilación de la vitamina D. El cerebro disminuye su volumen, pero no por una pérdida generalizada de neuronas ni de arborización dendrítica. Hay menor capacidad de atención, memoria de trabajo y trastornosmotores. La masa muscular disminuye y aumenta su infiltración grasa, asociado a disminución progresiva de la fuerza. El aumento de grasa corporal, especialmente visceral, participaría en una mayor resistencia insulínica que asociada a la disminución de la masa de células beta facilitaría el desarrollo de diabetes. La evidencia disponible muestra importantes cambios morfológicos y funcionales asociados a la edad. El conocimiento de la población en edad media de la vida no debiera generalizarse a los adultos mayores. El reconocimiento de cambios debidos al envejecimiento normal es difícil por la gran variabilidad entre sujetos y la alta prevalencia de comorbilidad.

The population worldwide is aging rapidly and the understanding of physiological changes associated with aging is a key tool for answering the biomedical and social needs of elderly people. The aim of the present review is to describe the main morphological and functional changes of the cardiovascular system, central nervous system, kidney, skeletal muscle and glucose metabolism associated with normal aging. Clinical and experimental studies show that cardiovascular aging is associated with a reduction of muscular cells and wall distensibility. The cardiac ejection fraction does not change. With aging, the kidney develops vascular and glomerular sclerosis, with moderate reduction in glomerular filtration rate, lower concentration/dilution ability and a reduction of vitamin D synthesis. Aging associates with reduced brain volume, but without a generalized loss of neurons or dendritic arborization. Elderly people presents reduced attention span, lower work memory and motor impairment. There is a decrease in skeletal muscle mass, with increased in adipose infiltration associated with progressive force loss. The proportion of body fat, particularly the visceral fat, could play a role in the development of insulin resistance, which associated with a decrease in pancreatic beta cells may lead to the development of diabetes mellitus. The available evidence shows important morphological and physiological changes associated with aging. The knowledge of morphological characteristics and function a capabilities of middle age adults may not be extrapolated to elderly people. The identification of changes due to normal aging is hampered by the high variability among individuals and the high prevalence of co-morbidities.