Efectividad de reslizumab en asma grave no controlada (AGNC) eosinofílica con poliposis nasal asociada / Effectiveness of reslizumab in severe uncontrolled asthma (AGNC) eosinophilic with associated nasal polyposis

In order to better characterize the profile of asthmatic patients who could benefit from monoclonal antibody treatments, the present study evaluated the effectiveness of reslizumab after one year of treatment in patients with severe uncontrolled eosinophilic asthma, distinguishing those with chronic rhinosinusitis. with associated nasal polyposis (RSCcNP). Reslizumab proved to be effective in this series of patients by reducing asthma exacerbations, improving lung function and asthma control, in addition to reducing the size and symptoms caused by nasal polyposis. (AU)

Con el fin de caracterizar mejor el perfil de pacientes asmáticos que podrían beneficiarse de tratamientos con anticuerpos monoclonales, en el presente estudio se evaluó la efectividad de reslizumab tras un año de tratamiento en pacientes con asma grave no controlada eosinofílica, distinguiendo aquellos que presentaban rinosinusitis crónica con poliposis nasal (RSCcPN) asociada. Reslizumab demostró ser efectivo en esta serie de pacientes al reducir las agudizaciones asmáticas, mejorar la función pulmonar y el control del asma, además de lograr disminuir el tamaño y sintomatología ocasionada por la poliposis nasal. (AU)

Neumomediastino en Covid-19 / Pneumomediastinum in Covid-19

El objetivo del presente estudio de serie de casos se centra en la descripción de las posibles causas responsables de la aparición de neumomediastino en la infección por el virus SARS-CoV-2. Para ello se han descrito las características de los pacientes ingresados en el Hospital de Jerez de la Frontera que desarrollaron esta complicación, detallando los factores de riesgo, motivo de ingreso hospitalario, factores desencadenantes de neumomediastino, así como la clínica y tipo de oxigenoterapia recibida durante su ingreso. Tras su estudio, se concluye que la etiología más probable de aparición de neumomediastino en estos cuatro sujetos fue la neumonía bilateral por el virus SARS-CoV-2, pudiendo también contribuir de manera importante en su desarrollo, la utilización de ventilación mecánica no invasiva. (AU)

The objective of this case series study focuses on the description of the possible causes responsible for the appearance of pneumomediastinum in SARS-CoV-2 virus infection. To this end, the characteristics of the patients admitted to the Jerez de la Frontera Hospital who developed this complication have been described, detailing the risk factors, reason for hospital admission, factors that trigger pneumomediastinum, as well as the clinic and type of oxygen therapy received during treatment. Your income. After their study, it is concluded that the most likely etiology of the appearance of pneumomediastinum in these four subjects was bilateral pneumonia due to the SARS-CoV-2 virus, and the use of noninvasive mechanical ventilation may also contribute significantly to its development. (AU)

Quilotórax con características de trasudado en paciente con cirrosis hepática avanzada / [Chylothorax with characteristics of transudate in a patient with advanced liver cirrhosis]

El quilotórax es una patología infrecuente e infradiagnosticada en la cirrosis hepática, que se caracteriza por la determinación de >110 mg/dl de triglicéridos o presencia de quilomicrones en el líquido pleural. Fisiopatológicamente aparece por cambios en el sistema linfático secundarios a la hipertensión portal. El tratamiento es principalmente conservador, aunque el TIPS podría ser una opción segura y útil en estos pacientes al actuar sobre la hemodinámica portal. Presentamos el caso de una paciente con esta entidad y que se manejó de forma conjunta entre Digestivo y Neumología. (AU)

Chylothorax is an infrequent and underdiagnosed pathology in liver cirrhosis, characterized by the determination of >110 mg/dl of triglycerides or the presence of chylomicrons in the pleural fluid. Pathophysiologically, it appears due to changes in the lymphatic system secondary to portal hypertension. Treatment is mainly conservative, although TIPS could be a safe and useful option in these patients by acting on portal haemodynamics. We present the case of a patient with this entity and that was managed jointly between Digestive and Pulmonology. (AU)

Peculiaridades diagnósticas y evolutivas de la glomerulonefritis membranosa lúpica / Diagnostic and evolutive characteristics of lupus membranous glomerulonephritis

Introducción: En ocasiones resulta difícil diferenciar la glomerulonefritis membranosa lúpica (GNML) de la Glomerulonefritis membranosa idiopática. Por otro lado, se conoce poco acerca de la historia natural de dicha enfermedad. Métodos: Presentamos un estudio retrospectivo de 16 pacientes diagnosticados de GNML tipos Va (GNML 'pura') y Vb (con proliferación mesangial). En cada uno de los casos analizamos las características clínicas y analíticas en el momento del inicio de la enfermedad y a lo largo del seguimiento. Resultados: Siete pacientes (43 por ciento) no presentaban ninguna manifestación clínica extrarrenal sugerente de Lupus eritematoso sistémico (LES) en el momento del diagnóstico. El síndrome nefrótico constituyó la forma más habitual de presentación (81 por ciento). 14 pacientes (87 por ciento) presentaban positividad para los anticuerpos antinucleares (ANA) pero a título bajo en la mayoría de los casos; los anticuerpos anti-DNA fueron positivos en 3 casos (18 por ciento) y sólo se detectó hipocomplementemia en 2 pacientes (12 por ciento). Desde el punto de vista histopatológico, los hallazgos más relevantes fueron la presencia de depósitos de Cl q (83 por ciento) y de depósitos electrondensos subendoteliales y mesangiales en el estudio ultraestructural. El abordaje terapéutico consistió en corticosteroides, añadiendo medicación inmunosupresora cuando no se obtenía respuesta en un período de 2 a 3 meses. En los últimos años hemos utilizado un inhibidor del enzima convertidor de angiotensina antes de utilizar la terapia inmunosupresora. Al final del seguimiento, 6 pacientes (42 por ciento) desarrollaron una insuficiencia renal crónica y 8 (58 por ciento) mantuvieron una función renal normal. La supervivencia actuarial renal es del 100 por ciento a los 5 años y del 75 por ciento a los 10 años. El mantenimiento de o la evolución hacia una proteinuria en rango no nefrótico fue el único parámetro que se asoció de manera significativa con un mejor pronóstico renal. Conclusión: La GNML puede presentarse sin ninguna sintomatología extrarrenal sugerente de LES e incluso con negatividad para los marcadores serológicos propios de esta enfermedad. Casi la mitad de los pacientes con GNML (42 por ciento) desarrollaron una insuficiencia renal crónica. La evolución hacia una proteinuria no nefrótica se correlacionó con el mantenimiento de una función renal normal. (AU)

[Diagnostic and clinical course features of lupus membranous glomerulonephritis]. / Peculiaridades diagnósticas y evolutivas de la glomerulonefritis membranosa lúpica.

BACKGROUND: Lupus membranous glomerulonephritis (LMG) is sometimes difficult to distinguish from idiopathic membranous glomerulonephritis (IMG) and little is known about its natural history. METHODS: We have performed a retrospective study of 16 patients with LMG, types Va ("pure" LMG) (8 patients) and Vb (mesangial proliferation) (8 patients). Analytical and clinical characteristics were analyzed in each case at the onset of the disease and during follow-up. RESULTS: At the time of diagnosis, 7 patients (43%) did not present any extrarenal manifestations of systemic lupus erythematosus (SLE). Nephrotic syndrome was the most common clinical presentation (81%). 14 patients (87%) showed positive antinuclear antibodies (ANA), but at low titres (< 1/300); anti-DNA antibodies were positive only in 3 cases (18%) and hypocomplementemia was observed in 2 (12%). The most relevant histological findings were the presence of Clq deposits (83%) and subendothelial and mesangial deposits. Treatment consisted of corticosteroids, adding immunosuppression when no response was obtained in 2-3 months. In recent years, an angiotensin-converting enzyme inhibitor (ACEI) was added before immunosuppression. At the end of the study, 6 patients (42%) developed chronic renal insufficiency and 8 (58%) renainea with normal renal function. Actuarial renal survival was 100% at 5 years and 75% at 10 years. The evolution towards a non-nephrotic range proteinuria throughout the follow-up was the only parameter significantly associated with a good prognosis. CONCLUSIONS: LMG can present without extra-renal symptoms of SLE and even with very poor expression of its serological markers. Almost half of the patients (42%) developed chronic renal insufficiency. The evolution towards a non-nephrotic range proteinuria correlated with the maintenance of a normal renal function.

Comparison of in vitro effects of triflusal and acetysalicylic acid on nitric oxide synthesis by human neutrophils.

Recent studies have suggested that the protective anti-ischemic effects of acetylsalicylic acid are stronger than the inhibition of platelet thromboxane A2 synthesis. Since ischemic events still occur in acetylsalicylic acid-treated patients, the development of new drugs with more powerful protective effects is needed. We compared the effects of a new platelet antiaggregating drug, 2-acetoxy-4-trifluoromethyl-benzoic acid (triflusal) and of acetylsalicylic acid on the interaction between human neutrophils and platelets, examining the capability of neutrophils to generate nitric oxide (NO). Triflusal, in the presence of neutrophils, showed a greater antiplatelet potency than acetylsalicylic acid to inhibit thrombin-induced platelet activation. Significant stimulation of NO-mediated mechanisms in the presence of acetylsalicylic acid or triflusal was demonstrated by the following findings: (1) increased metabolism of arginine to citrulline, (2) increase of cGMP in the platelet/neutrophil system and (3) the inhibitory action of the L-arginine (L-Arg) competitive analogue, NG-nitro-L-arginine-methyl ester (L-NAME), which was reversed by L-Arg. Triflusal increased the stimulation of NO synthesis by neutrophils more than did of acetylsalicylic acid. The main metabolite of triflusal, 2-hydroxy-4-trifluoromethylbenzoic acid (HTB), alone or in combination with acetylsalicylic acid, did not modify NO production by neutrophils. Therefore, the whole molecule of triflusal is needed to stimulate NO production by neutrophils. Our results show that, in the presence of neutrophils, triflusal exerts an antiplatelet effect greater than that of acetylsalicylic acid, demonstrating a more powerful stimulation of the NO/cGMP system. The present results indicate that it is possible to develop new and more potent acetylsalicylic acid-related antiplatelet drugs for the prevention of the myocardial ischemic/reperfusion processes.

[in vitro activity of carbapenems against Enterobacteriaceae and Pseudomonas aeruginosa hyperproducers of group 1 chromosomal beta-lactamases]. / Actividad in vitro de los carbapenémicos frente a Enterobacteriaceae y Pseudomonas aeruginosa hiperproductoras de betalactamasas cromosómicas del grupo 1.

Resistance to imipenem and meropenem, reported sporadically in Enterobacteriaceae and more frequently in Pseudomonas aeruginosa, can be caused, among other mechanisms, by the combination of changes in permeability and hyperproduction of inducible chromosomal beta-lactamases. In this study, the in vitro activity of imipenem and meropenem was analysed by the agar dilution method against cefotaxime, ceftazidime, and aztreonam resistant clinical strains of Enterobacteriaceae (n = 202) and P. aeruginosa (n = 90). This phenotype is consistent with the hyperproduction of group 1 chromosomal beta-lactamases and was previously determined in stably derepressed mutants in the same species, obtained from strains with inducible beta-lactamase expression by selection with cefotaxime and ceftazidime. Likewise, the activity of imipenem and meropenem against the same number of clinical isolates susceptible to cefotaxime, ceftazidime, and aztreonam was evaluated. In general, imipenem and meropenem showed an excellent activity, which was intrinsically greater for meropenem against Enterobacteriaceae and P. aeruginosa organisms. Nevertheless, imipenem and meropenem activity was slightly affected on cefotaxime, ceftazidime, and aztreonam resistant isolates of E. cloacae (MIC90, 1 and 0.2 microgram/ml, respectively), E. aerogenes (1 and 0.2 microgram/ml), C. freundii (1 and 0.1 microgram/ml), M. morganii (1 and 0.5 microgram/ml), and S. marcescens (4 and 0.5 micrograms/ml). On the other hand, the activity of imipenem and meropenem against ceftazidime and aztreonam resistant isolates of P. aeruginosa was more significantly affected, with MIC90 values of 64 and 16 micrograms/ml, respectively.

Endogenous angiotensin II produced by endothelium regulates interleukin-1beta-stimulated nitric oxide generation in rat isolated vessels.

The endothelium is a source of several factors that regulate vascular functions. Angiotensin II is one of the main active factors released by the endothelium. The aim of the present work was to analyze the role of angiotensin II released by the endothelium in the regulation of the inducible nitric oxide synthase expression in rat isolated aortic vessels. Interleukin-1beta (0.03 U/L) stimulated nitrite release by the aortic vessels. The nitrite released was less in vessels with endothelium than in deendothelialized aortic segments. This effect was accompanied by a reduced expression of the inducible nitric oxide synthase in the aortic rings with endothelium. Exogenous angiotensin II inhibited IL-1beta-stimulated inducible nitric oxide synthase protein expression in both deendothelialized vessels and those with endothelium, although with reduced ability on the aortic segments with endothelium by a nitric oxide-independent mechanism. In the aortic rings with endothelium, either inhibition of the AT-1 receptor with losartan or blocking of angiotensin II generation with fosinopril enhanced interleukin-1beta-stimulated inducible nitric oxide synthase protein expression. In conclusion, the endothelium decreases inducible nitric oxide synthase expression in the vascular wall. Angiotensin II released from endothelial cells is a main mediator responsible for this inhibition through an AT-1-type receptor-dependent mechanism.

[Diagnosis of renovascular disease by heart catheterization]. / Diagnóstico de enfermedad renovascular mediante cateterismo cardíaco.

Atherosclerotic renovascular disease is a common entity, particularly in persons older than 50 years of age and especially in those patients with other evidence of atherosclerotic vascular disease. The illness clearly progresses in some patients, and progression rate appears to be highly variable. Taken into account the apparent high prevalence of renovascular disease in older persons, it is possible that this disorder be the cause of end stage renal disease in 5% to 15% of patients currently entering the dialysis program each year. Surgery and percutaneous angioplasty can both improve renal function in patients with renal artery stenosis. We describe a patient in whom the detection of renovascular disease was made accidentally at the time of coronary arteriography. He presented an acute renal failure after use of angiotensin-converting enzyme inhibitors and/or contrast media associated nephrotoxicity, and was treated with percutaneous transluminal balloon angioplasty and had a successful outcome.

Endothelial cells inhibit NO generation by vascular smooth muscle cells. Role of transforming growth factor-beta.

Endothelial cell (EC)-released agents are active regulators of vascular smooth muscle cell (VSMC) functions. The first aim of the present work was to analyze the effect of ECs on interleukin-1 beta (IL-1 beta)-induced NO production by SMCs. Bovine aortic ECs (BAECs) and BVSMCs in culture were used for the study. IL-1 beta (0.03 U/L) stimulated nitrite production by BVSMCs. This increase was smaller in the presence of BAECs. This effect was accompanied by reduced expression of inducible NO synthase (iNOS) in BVSMCs coincubated with BAECs, as analyzed by Western blot analysis. The reduction in iNOS protein expression was partially reversed by a polyclonal antibody against transforming growth factor-beta (TGF-beta). Furthermore, we examined the cytotoxic effect of the NO released from BVSMCs on both BAECs and the BVSMCs themselves. Incubation of BAECs with IL-1 beta-prestimulated BVSMCs induced EC toxicity, which was partially inhibited by an inhibitor of NO synthesis, NG-nitro-L-arginine methyl ester, or an inhibitor of iNOS expression, dexamethasone. No cytotoxic effect of IL-1 beta on BVSMCs themselves was detected. ECs modulate iNOS expression in SMCs by mechanisms that include a TGF-beta-dependent pathway. The NO released from SMCs exerts cytotoxic effects on the adjacent endothelium without altering the viability of the SMCs.

Human immunodeficiency virus-1 infection in an infertile population.

OBJECTIVE: The aim of our study was to determine the prevalence of human immunodeficiency virus-1 (HIV-1) in an infertile population. DESIGN: The study design included a retrospective anonymous survey of clinical data and screening for HIV-1 antibody by enzyme-linked immunoabsorbent assay (ELISA) in stored sera. Samples that were ELISA-positive were further tested by Western blot assay. Frequency distributions were analyzed by Fisher's exact test. SETTING: University tertiary care center. PARTICIPANTS: Based on availability of stored frozen sera, the total study population included 182 of 304 consecutively registered infertile couples. RESULTS: Seventy-five percent of the study population were found to have one or more risk factors for HIV infection. Of the 252 sera tested, 10 were repeatedly reactive by ELISA, and Western blot testing confirmed HIV-1 infection in one woman and two men. CONCLUSIONS: This relatively high HIV-1 seroprevalence (male: 2.6%; female: 0.6%) in a low-middle class infertile population emphasizes the urgent need to implement on-site HIV-infection counseling aimed at preventing the spread of disease to the healthy partner and fetus and to discuss therapeutic and reproductive options.