Trastornos inmunitarios en paciente pediátrico con enfermedad de Behcet / Inmune disorders in a pediatric patient with Behcet's disease

Introducción: La enfermedad de Behcet es un proceso autoinflamatorio crónico que afecta arterias y venas de todos los calibres. Participan factores genéticos, microbianos e inmunológicos. Cursa con úlceras orales, genitales e inflamación ocular. Objetivo: Describir los trastornos inmunitarios en un paciente pediátrico con enfermedad de Behcet. Presentación del caso: Paciente masculino de 16 años de edad, con diagnóstico clínico de enfermedad de Behcet con marcadores serológicos de autoinmunidad negativa. Las inmunoglobulinas séricas exhibieron valores normales. Las subpoblaciones linfocitarias T CD3+CD4+ y CD3+CD8+ estuvieron elevadas. Las células B totales mostraron valores porcentuales normales, sin embargo, la subpoblación B CD5+CD19+ se encontró por encima de los valores referenciales. El paciente respondió favorablemente en relación con el curso de las infecciones a la terapia con inmunoestimulantes. Conclusiones: El tratamiento para la enfermedad de Behcet debe ser individualizado. Se debe tener en cuenta la gravedad del órgano afectado y el índice de recurrencias. Se requiere de un grupo interdisciplinario para llegar al adecuado control de la enfermedad.

Introduction: Behcet's disease is a chronic autoinflammatory process, of low frequency and unknown etiology that affects arteries and veins of all sizes, where genetic, microbial and immunological factors participate. It presents with oral and genital ulcers and ocular inflammation. Objective: To evaluate the immune disorders in a pediatric patient with Behcet's disease. Case presentation: A 16-year-old male patient with a clinical diagnosis of Behcet's disease with negative autoimmunity serological markers. Immunoglobulins exhibited normal values. CD3+CD4+ and CD3+CD8+T lymphocyte subpopulations were elevated. The B cells showed normal percentage values, however the CD5+CD19+ subpopulation B was found to be above the reference values. The patient responded favorably in relation to the course of the infections, to the therapy with immune stimulants. Conclusions: Treatment must be individualized, taking into account the severity of the affected organ and the recurrence rate. An interdisciplinary group is required to achieve adequate control of the disease.

Perspectiva clínica sobre el tratamiento antihipertensivo en adultos con hipertensión grado 1 y riesgo cardiovascular bajo a moderado: consulta internacional de expertos

[RESUMEN]. La hipertensión arterial es el principal factor de riesgo de la carga global de las enfermedades. Una pregunta en debate es si la hipertensión arterial grado 1 (140–159/90–99 mm Hg) con riesgo cardiovascular (RCV) total bajo (mortalidad cardiovascular < 1% a los 10 años) a moderado (mortalidad cardiovascular > 1% y < 5% a los 10 años) debe ser tratada con agentes antihipertensivos. Un proceso de consulta virtual internacional fue realizado para resumir las opiniones de los expertos seleccionados. Después del análisis holístico de todos los elementos epidemiológicos, clínicos, psicosociales y de salud pública, este proceso de consulta llegó al siguiente consenso para adultos hipertensos < 80 años de edad: 1) La interrogante, de si el tratamiento medicamentoso en la hipertensión grado 1 debe ser precedido por un periodo de algunas semanas o meses, durante el cual solo se recomienden medidas sobre el estilo de vida no está basada en evidencia, pero el consenso de opinión es reservar un periodo para solo cambios en el estilo de vida únicamente en los pacientes con hipertensión grado 1 “aislada” (hipertensión grado 1 no complicada con RCV total absoluto bajo, y sin otros factores de RCV mayores ni modificadores del riesgo). 2) El inicio del tratamiento antihipertensivo medicamentoso en pacientes con hipertensión grado 1 y RCV absoluto moderado no debe demorarse. 3) Los hombres ≥ 55 años y las mujeres ≥ 60 años con hipertensión grado 1 no complicada deben ser automáticamente clasificados dentro de la categoría de RCV total absoluto moderado, incluso en ausencia de otros factores de riesgo mayores y modificadores del riesgo. 4) Las estatinas deben tenerse en cuenta junto con la terapia antihipertensiva, independientemente de los valores de colesterol, en pacientes con hipertensión grado 1 y RCV moderado.

[ABSTRACT]. Hypertension is a leading risk factor for disease burden globally. An unresolved question is whether grade 1 hypertension (140-159/90-99 mmHg) with low (cardiovascular mortality < 1% at 10 years) to moderate (cardiovascular mortality > 1% and < 5% at 10 years) absolute total cardiovascular risk (CVR) should be treated with antihypertensive agents. A virtual international consultation process was undertaken to summarize the opinions of select experts. After holistic analysis of all epidemiological, clinical, psychosocial, and public health elements, this consultation process reached the following consensus in hypertensive adults aged < 80 years: (1) The question of whether drug treatment in grade 1 should be preceded by a period of some weeks or months during which only life style measures are recommended cannot be evidence based, but the consensus opinion is to have a period of lifestyle alone reserved only to patients with grade 1 “isolated” hypertension (grade 1 uncomplicated hypertension with low absolute total CVR, and without other major CVR factors and risk modifiers). (2)The initiation of antihypertensive drug therapy in grade 1 hypertension with moderate absolute total CVR should not be delayed. (3) Men ≥ 55 years and women ≥ 60 years with uncomplicated grade1 hypertension should automatically be classified within the moderate absolute total CVR category, even in the absence of other major CVR factors and risk modifiers. (4) Statins should be considered along with blood-pressure lowering therapy, irrespective of cholesterol levels, in patients with grade 1 hypertensive with moderate CVR.

Clinical Perspective on Antihypertensive Drug Treatment in Adults With Grade 1 Hypertension and Low-to-Moderate Cardiovascular Risk: An International Expert Consultation.

Hypertension is a leading risk factor for disease burden globally. An unresolved question is whether grade 1 hypertension (140-159/90-99mmHg) with low (cardiovascular mortality <1% at 10 years) to moderate (cardiovascular mortality ≥1% and <5% at 10 years) absolute total cardiovascular risk (CVR) should be treated with antihypertensive agents. A virtual international consultation process was undertaken to summarize the opinions of select experts. After holistic analysis of all epidemiological, clinical, psychosocial, and public health elements, this consultation process reached the following consensus in hypertensive adults aged <80 years: (1) The question of whether drug treatment in grade 1 should be preceded by a period of some weeks or months during which only lifestyle measures are recommended cannot be evidence based, but the consensus opinion is to have a period of lifestyle alone reserved only to patients with grade 1 "isolated" hypertension (grade 1 uncomplicated hypertension with low absolute total CVR, and without other major CVR factors and risk modifiers). (2) The initiation of antihypertensive drug therapy in grade 1 hypertension with moderate absolute total CVR should not be delayed. (3) Men ≥55 years and women ≥60 years with uncomplicated grade 1 hypertension should automatically be classified within the moderate absolute total CVR category, even in the absence of other major CVR factors and risk modifiers. (4) Statins should be considered along with blood-pressure lowering therapy, irrespective of cholesterol levels, in patients with grade 1 hypertensive with moderate CVR.

Mecanismos etiopatogénicos en la esclerosis sistémica / Ethiopathogenic Mechanisms in the Systemic Sclerosis

Se realizó un compendio de los principales factores etiopatogénicos causantes de la expresividad clínica de la esclerosis sistémica, aún no bien establecida, la asociación genética, herencia, factores ambientales y respuesta inflamatoria, su relación con infecciones endógenas comportándose de manera especial en otras enfermedades reumáticas inflamatorias. El objetivo del artículo fue describir los elementos de la etiopatogenia que distinguen a esta enfermedad del colágeno. Los mecanismos etiopatogénicos basados en anormalidades moleculares, pueden ser correctas en la esclerosis sistémica. Su espectro clínico heterogéneo responde a una etiopatogenia distinta en cada individuo, así como, a eventos complejos que pueden ocurrir en fases iniciales de la enfermedad y no a una patogenia única.

A summary of the main ethiopathogenic factors that cause the clinical expressiveness of the Systemic Sclerosis, still as soon as established, the genetic association, inheritance, environmental factors and inflammatory response, their relationship with endogenous infections behaving from a special way to other inflammatory rheumatic illnesses. The objective of this article was to describe the ethiopathogenic elements that distinguish this illness of the collagen. The ethiopathogenic mechanisms based on molecular abnormalities can be correct in the systemic sclerosis. Its heterogenic clinical spectrum responds to a different etiopathogeny in each individual, as well as to complex events that can happen in initial phases of the illness and not to a unique pathogenic.

Mecanismos etiopatogénicos en la esclerosis sistémica / Ethiopathogenic Mechanisms in the Systemic Sclerosis

Se realizó un compendio de los principales factores etiopatogénicos causantes de la expresividad clínica de la esclerosis sistémica, aún no bien establecida, la asociación genética, herencia, factores ambientales y respuesta inflamatoria, su relación con infecciones endógenas comportándose de manera especial en otras enfermedades reumáticas inflamatorias. El objetivo del artículo fue describir los elementos de la etiopatogenia que distinguen a esta enfermedad del colágeno. Los mecanismos etiopatogénicos basados en anormalidades moleculares, pueden ser correctas en la esclerosis sistémica. Su espectro clínico heterogéneo responde a una etiopatogenia distinta en cada individuo, así como, a eventos complejos que pueden ocurrir en fases iniciales de la enfermedad y no a una patogenia única(AU)

A summary of the main ethiopathogenic factors that cause the clinical expressiveness of the Systemic Sclerosis, still as soon as established, the genetic association, inheritance, environmental factors and inflammatory response, their relationship with endogenous infections behaving from a special way to other inflammatory rheumatic illnesses. The objective of this article was to describe the ethiopathogenic elements that distinguish this illness of the collagen. The ethiopathogenic mechanisms based on molecular abnormalities can be correct in the systemic sclerosis. Its heterogenic clinical spectrum responds to a different etiopathogeny in each individual, as well as to complex events that can happen in initial phases of the illness and not to a unique pathogenic(AU)

Smoking prevalence in Cienfuegos City, Cuba.

INTRODUCTION Over the last 40 years, high smoking prevalence has been reported throughout Cuba, including in Cienfuegos city in the central part of the island. OBJECTIVES Determine smoking prevalence and potential associated risk factors in Cienfuegos city for 2010-2011. METHODS A descriptive cross-sectional study was conducted in Cienfuegos city in the context of CARMEN (Collaborative Action for Risk Factor Prevention & Effective Management of Non-communicable Diseases), a PAHO multi-country initiative for a multidimensional approach to chronic non-communicable diseases. Participants totaled 2193 (aged 15-74 years), randomly selected through complex probabilistic three-stage sampling. Variables examined in relation to smoking included age, sex, skin color, civil status and educational level. RESULTS Approximately 25% of those surveyed were smokers (30.3% of men and 21.0% of women). For men, prevalence was highest in the groups aged 25-34 and 55-64 years; for women, in the group aged 45-54 years. Concerning skin color, smoking rates were higher among black and mestizo persons (29.5%); and concerning civil status, higher among those who were separated, widowed or divorced (30.0%). Smoking prevalence fell with higher educational level; in keeping with that trend, the university-educated group had the lowest prevalence (16.2%). CONCLUSIONS Although one in four Cienfuegos residents aged ≥15 years smoked in 2010-2011, prevalence there is lower than in previous surveys. Knowledge of differences observed in age, sex, skin color, civil status and educational level can be useful for planning future smoking prevention and control actions.

Chronic kidney disease in Cuba: epidemiological studies, integral medical care, and strategies for prevention.

The experience of the Republic of Cuba regarding epidemiological studies, integral medical care, and strategies for the prevention of chronic kidney disease is summarized in this report. Cuba has a National Program for Chronic Renal Disease, Dialysis, and Renal Transplantation. There is a national nephrology net, integrated by the Institute of Nephrology as the coordinator center, that has 47 nephrology services with a hemodialysis unit (24 of them with peritoneal dialysis unit), 9 transplantation centers, 33 organ procurement hospitals, and 5 histocompatibility laboratories. In 2004, the incidence rate in dialysis patients was 111 pmp, and the prevalence rate was 149 pmp, demonstrating an increasing mean of 17.0% and 10.0% per year, respectively. Renal transplantation rate was 16.6 pmp. The detection, registration, and follow-up of patients with chronic kidney disease (serum creatinine > or =1.5 mg/dL or glomerular filtration rate <60 mL/min) by family doctors was 9,761 patients, 0.87 patients per 1,000 inhabitants. In the 1980s, three population-based screening studies were performed to define the burden of chronic renal failure in different regions of Cuba. The prevalence rate was 1.1, 3.3, and 3.5 per 1,000 inhabitants, respectively. At present, another three population-based screening studies are ongoing in order to detect the chronic kidney disease in earliest stages. The continuing medical education activities have been very useful in raising the awareness of medical doctors and the basic health staff about the threats posed by and the strategies to prevent, diagnose, and treat chronic kidney disease.

Sistema de monitoreo y evaluación de la calidad de la atención médica en las enfermedades no transmisibles / System for monitoring and evaluating the quality of health care in non-communicable diseases

Con esta metodología pretendemos que se evalúe la calidad de la atención médica que se brinda a los pacientes con enfermedades no transmisibles (asma bronquial, hipertensión arterial y diabetes mellitus) en las instituciones de salud a nivel primario y secundario, pues estas son las primeras causas de muerte y discapacidad en nuestro país. Esto permitirá determinar en qué medida las acciones de salud que se realizan cumplen el objetivo fundamental de mantener, restaurar o promover salud

EPICRONI: Programa automatizado para el monitoreo y evaluación de la calidad de la atención médica de las enfermedades no transmisibles / EPICRONI: Automated program for monitoring and evaluating the medical care quality of noncommunicable diseases

EPICRONI, es un sistema útil para el procesamiento automatizado del monitoreo y evaluación de la calidad de la atención médica. Está diseñado como el complemento analítico de una metodología para evaluar la calidad de la atención médica que se brinda a los pacientes con enfermedades no transmisibles (asma bronquial, hipertensión arterial y diabetes mellitus) en las instituciones de salud a nivel primario y secundario, siendo estas las primeras causas de muerte y discapacidad en nuestro país. Como sistema computacional resulta suficiente permitiendo realizar desde la introducción de los datos hasta su procesamiento incluyendo posibilidades para la presentación de los resultados en tablas y gráficos. EPICRONI cuenta con numerosas facilidades para su uso, típicas de los más modernos sistemas interactivos así como una abundante ayuda que garantiza su exitosa manipulación y una interfase amigable con el sistema EPINFO y otros que pudieran ser utilizados para complementar el estudio, si así lo decide el usuario. El sistema EPICRONI es una aplicación confeccionada sobre Epi Info versión 6.04 factible de utilizar desde MS-DOS y desde Windows