Lupus enteritis: A 10-year experience in a single Latin American center.

OBJECTIVE: The objective is to compare the clinical and laboratory characteristics of systemic lupus erythematosus (SLE) patients with and without lupus enteritis (LE) and to identify the factors associated with the occurrence of LE. METHODS: We performed a retrospective, case-control study in hospitalized patients with SLE who were admitted to our tertiary hospital between January 2012 and December 2021. Sixteen LE patients (cases) were matched (1:3 ratio) for sex and birth year with 48 non-LE patients (controls). Univariable and multivariable logistic regression analyses were used to identify the variables associated with LE. RESULTS: Of 2,479 SLE patients who were admitted to our hospital as inpatients, 16 (0.65%) were diagnosed as having LE. All patients, cases and controls, were of Mestizo ethnicity. SLE was diagnosed simultaneously with the first episode of LE in 10 (62.5%) patients. The median time from SLE diagnosis to the first episode of LE was 7 (IQR 0-78) months. LE patients had a shorter median disease duration [7 (0-78) vs 34 (9.5-79) months], and a significantly longer hospital stay (28.3 ± 15.8 vs 6.5 ± 7.9 days, p < 0.001) than non-LE patients. Most LE patients (93.8%) had concomitant lupus nephritis. LE patients had higher SLEDAI-2K scores than those without LE (20.5 ± 9.4 vs 9.8 ± 10.4, p < 0.001). By multivariable analysis, a higher SLEDAI-2K score (OR 1.10, 95% CI 1.02-1.18; p = 0.015) was independently associated with LE occurrence after adjusting for cutaneous involvement, lymphocyte count, serum creatinine, and serum complement C4. Recurrence was observed in two patients (12.5%), both with a bowel wall thickening > 8 mm. The two patients with large intestine-dominant LE developed intestinal pseudo-obstruction. No patient had life-threatening complications (intestinal hemorrhage, infarction, or perforation), and there were no deaths induced directly by LE itself. CONCLUSION: In patients of Mestizo ethnicity, LE occurs during the early course of SLE, frequently is one of the presenting manifestations of SLE, and in most cases, it presents with concomitant lupus nephritis. Higher levels of disease activity at diagnosis were independently associated with LE occurrence and when recurrences occur, they do so in the context of severe wall thickness.

Autoimmune hepatitis and systemic sclerosis A rare overlap

Autoimmune hepatitis concomitant with other immune-mediated diseases is an increasingly recognized condition which is difficult to diagnose. We present the case of a 42-year-old woman with no significant medical history who consulted due to progressive growth of an abdominal mass in the right hypochondriac region and associated constitutional syndrome. The physical exam showed hepatomegaly, calcinosis and salt-and-pepper depigmentation of the skin, and Raynaud's phenomenon in the hands. Paraclinical tests reported elevated transaminases and IgM immunoglobulin, as well as positive antinuclear antibodies (ANAs) and smooth muscle antibodies (SMAs), along with imaging signs of portal hypertension. A liver biopsy was compatible with autoimmune hepatitis, and treatment was begun with corticosteroids, with an adequate response. Systemic sclerosis is one of the autoimmune diseases which can present in a patient with autoimmune hepatitis. Suspecting, diagnosing and following up these diseases in this type of patients is key in their comprehensive management. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2609).

Organ damage in systemic lupus erythematosus / Daño orgánico en lupus eritematoso sistémico

ABSTRACT Damage reflects the irreversible changes that occur in systemic lupus erythematosus (SLE) patients as a consequence of the disease, its treatment or comorbidities. The pattern of damage increases in a steady linear fashion over time. At least half of all patients with SLE will have some form of organ damage 10 years after their diagnosis. Factors associated with the occurrence of damage include older age, disease duration, male gender, non-Caucasian ethnicity, disease activity, corticosteroid use, poverty, hypertension and abnormal illness behaviors. In contrast, antimalarials are protective against damage. Since damage predicts further damage and mortality, prevention of damage accrual should be a major therapeutic goal in SLE. Novel therapies for SLE that achieve better control of the disease and with corticosteroid-sparing properties, may lead to improved outcomes in patients as they will reduce damage accrual and improve survival.

RESUMEN El daño refleja los cambios irreversibles que se producen en los pacientes con lupus eritematoso sistémico (LES) como consecuencia de la enfermedad, de su tratamiento o por causa de comorbilidades. El patrón de dano aumenta de forma lineal, constante a lo largo del tiempo. Al menos la mitad de todos los pacientes con LES presentará alguna forma de daño orgánico 10 años después de haber sido diagnosticados. Entre los factores asociados con el desarrollo de dano encontramos la edad avanzada, la duración de la enfermedad, el sexo masculino, la etnia no caucásica, la actividad de la enfermedad, el uso de corticoesteroides, la pobreza, la hipertensión y comportamientos anormales de la enfermedad; por otra parte, los antimaláricos protegen contra el dano de la enfermedad. Puesto que la presencia de daño es un predictor de danno adicional y de mortalidad, la prevención de acumulación de dano deberá ser un objetivo terapéutico fundamental en LES. Los tratamientos novedosos para el LES que logren un mejor control de la enfermedad y que tengan propiedades ahorradoras de corticoesteroides, podrían lograr mejores desenlaces en los pacientes, pues reducirían el daño acumulado y mejorarían la sobrevida.

Are chimeric antigen receptor T cells (CAR-T cells) the future in immunotherapy for autoimmune diseases?

OBJECTIVE: CAR-T cell therapy has revolutionized the treatment of oncological diseases, and potential uses in autoimmune diseases have recently been described. The review aims to integrate the available data on treatment with CAR-T cells, emphasizing autoimmune diseases, to determine therapeutic advances and their possible future clinical applicability in autoimmunity. MATERIALS AND METHODS: A search was performed in PubMed with the keywords "Chimeric Antigen Receptor" and "CART cell". The documents of interest were selected, and a critical review of the information was carried out. RESULTS: In the treatment of autoimmune diseases, in preclinical models, three different cellular strategies have been used, which include Chimeric antigen receptor T cells, Chimeric autoantibody receptor T cells, and Chimeric antigen receptor in regulatory T lymphocytes. All three types of therapy have been effective. The potential adverse effects within them, cytokine release syndrome, cellular toxicity and neurotoxicity must always be kept in mind. CONCLUSIONS: Although information in humans is not yet available, preclinical models of CAR-T cells in the treatment of autoimmune diseases show promising results, so that in the future, they may become a useful and effective therapy in the treatment of these pathologies.

Leucemia mieloide aguda y policondritis recurrente ¿casualidad o relación causal? / Acute myeloid leukemya and relapsing polychondritis. Chance or causal relationship?

La policondritis recurrente o recidivante es una enfermedad sistémica crónica autoinmune, caracterizada por la inflamación de tejidos cartilaginosos asociada en pocos casos a enfermedades malignas hematológicas. Presentamos el caso de una paciente femenina de 26 años que cursaba concomitantemente con leucemia mieloide aguda (LMA). La manifestación inicial fue una afección cutánea en forma de eritema nodoso, y posteriormente se diagnosticó LMA; durante la fase de aplasia posquimioterapia desarrolló inflamación bilateral del cartílago auricular (condritis auricular) y síndrome vertiginoso con evolución clínica satisfactoria al tratamiento inmunosupresor con glucocorticoides. Conclusiones: Es difícil definir si existe asociación entre la policondritis recidivante y la leucemia mieloide aguda, la quimioterapia o la sumatoria de las dos noxas. Una vez que se establece el diagnóstico se debe iniciar oportunamente la administración de glucocorticoide a altas dosis, ya que pudieran aparecer complicaciones como la necrosis del cartílago y la pérdida de la región afectada. En contraste, el uso de los glucocorticoides tiene una excelente respuesta con modulación completa de la enfermedad, tal como se muestra en el caso presentado(AU)

Relapsing polychondritis is a systemic, chronic and autoimmune disease characterized by the inflammation of cartilaginous tissues. This disease is associated in a few cases with malignant hematological diseases. We present a case of a patient with relapsing polychondritis and concomitantly with acute myeloid leukemia. A 26-year-old female patient, with cutaneous affection as initial manifestation categorized as erythema nodosum. Then she was diagnosed with acute myeloid leukemia. In the aplasia post-chemotherapy phase, the patient developed bilateral inflammation of the ear cartilage (auricular chondritis) and a vertiginous syndrome with satisfactory clinical evolution to immunosuppressive treatment with glucocorticoids. Conclusion: Relapsing polychondritis usually presents with cartilaginous involvement, such as bilateral atrial chondritis, as shown in the case. Early diagnosis and timely treatment are necessary to achieve a good clinical response. Subsequent studies are necessary to evaluate the association between relapsing polychondritis and hematological alterations such as acute myeloid leukemia and the use of chemotherapy(AU)

Acute respiratory involvement in Colombian patients with systemic lupus erythematosus undergoing chest computed tomography.

INTRODUCTION: Systemic lupus erythematosus (SLE) is an inflammatory disease which affects multiple organs. The respiratory system is compromised in 1.6% to 36% of the patients with SLE. The objective of this study was to know the prevalence of these alterations, their associated variables, and outcomes in patients with SLE between 2012 and 2017. METHODS: A cross-sectional study of 200 patients with SLE underwent chest computed tomography (CT). The primary outcome was acute respiratory involvement (ARI). A descriptive, bivariate and multivariate analysis were performed using Stata 12.0 software. RESULTS: ARI was present in 40% of the SLE patients undergoing chest CT. The most frequent ARI was pleural effusion in 33%, followed by pneumonia (16.5%), lupus pneumonitis (9%), pulmonary embolism (3%) and pulmonary hemorrhage (2.5%). In bivariate and multivariate analysis a statistically significant association between ARI and nephropathy, hematological impairment, active disease, dead, readmission and prolonged hospital stay was found. CONCLUSION: This is the first Colombian study that evaluates ARI in patients with SLE. ARI is an important and frequent condition in patients with SLE, pleural effusion being the most prevalent cause of ARI. There are some variables (nephropathy, hematological impairment and activity disease) that are associated with ARI and could be the basis of intervention.

Factores asociados a estancia prolongada en una población de pacientes con exacerbación de Enfermedad Pulmonar Obstructiva Crónica en un hospital de referencia del Nororiente Colombiano / Factors Associated with a Prolonged Hospital Length of Stay in a Population of Patients with Exacerbation of Chronic Obstructive Pulmonary Disease in a Reference Hospital in Northeastern Colombia

La estancia hospitalaria prolongada durante un episodio de exacerbación en Enfermedad Pulmonar Obstructiva Crónica representa una condición que aumenta el riesgo de complicaciones médicas asociadas. Objetivo: El objetivo de este estudio fue determinar los factores asociados a una estancia hospitalaria prolongada en exacerbaciones de Enfermedad Pulmonar Obstructiva Crónica, a través de un modelo de predicción. Materiales y métodos: En un estudio de tipo corte transversal recopilamos los datos de los registros médicos en un hospital localizado en la región oriente de Colombia, entre los años 2012-2014. Se realizó análisis descriptivo, bivariado y multivariado Resultados: Un total de 212 pacientes fueron incluidos en este estudio, 61.32% presentaron estancia hospitalaria prolongada. Encontramos asociación estadística significativa entre estancia hospitalaria prolongada y las variables independientes producto del análisis bivariado: disnea (OR: 2.87 p = 0.04), fiebre (OR: 2; p = 0.02), oxígeno hospitalario (OR: 2.34, p = 0.003), anticolinérgicos hospitalarios (OR: 2.91, p = 0.002), antibiótico hospitalario (OR: 2.25, p = 0.004), segmentados (OR: 1.02, p= 0.01) y linfocitos (OR: 0.95, p = 0.003). El modelo predictivo tenía un valor de p de 0.4950 en el análisis de bondad (prueba de Pearson) y un valor de p de 0.2689 en el test de bondad de ajuste (prueba de Hosmer-Lemeshow) indicando adecuado ajuste. Además, el modelo presentó un área bajo la curva de 0.6588. Conclusiones: Nuestro modelo de predicción incluyo las variables: edad, anticolinérgicos y segmentados, por su asociación significativa. Tiene adecuado ajuste y con un buen patrón de predicción.

Factors Associated with a Prolonged Hospital Length of Stay in a Population of Patients with Exacerbation of Chronic Obstructive Pulmonary Disease in a Reference Hospital in Northeastern Colombia / Factores asociados a estancia prolongada en una población de pacientes con exacerbación de Enfermedad Pulmonar Obstructiva Crónica en un hospital de referencia del Nororiente Colombiano

A prolonged hospital length of stay during an episode of exacerbation of chronic obstructive pulmonary disease is a condition that increases the risk of suffering associated medical complications. Objective: The objective of this study was to determine the factors associated with a prolonged hospital length of stay in exacerbations of chronic obstructive pulmonary disease through a prediction model. Materials and Methods: In a cross-sectional study we gathered the data of the medical records of a hospital located in the Eastern region of Colombia, between years 2012 and 2014. We carried out a descriptive, bivariate and multivariate analysis. Results: A total of 212 patients were included in this study. 61.32% showed a prolonged hospital length of stay. We found a significant statistical association between the prolonged hospital stay and the independent variables of the bivariate analysis: dyspnea (OR [Odds Ratio]: 2.87 p = 0.04), fever (OR: 2; p = 0.02), inpatient oxygen (OR: 2.34, p = 0.003), inpatient anticholinergics (OR: 2.91, p = 0.002), inpatient antibiotic (OR: 2.25, p= 0.004), segs (OR: 1.02, p= 0.01) and lymphocytes (OR: 0.95, p = 0.003). The predictive model had a p value of 0.4950 in the analysis of goodness (Pearson Test) and a p value of 0.2689 in the goodness of fit test (Hosmer-Lemeshow Test), indicating an adequate fit. Also, the model showed an area under the curve of 0.6588. Conclusions: Our prediction model included the following variables: age, anticholinergics and segs, for their significant association. It has an adequate fit and a good pattern of prediction.

Systemic lupus erythematosus, gender differences in Colombian patients.

The objective of this study was to compare the clinical and immunological presentation of SLE between males and females in a Colombian SLE population. A cross-sectional, retrospective study was performed that evaluated patients with SLE over 6 years. The dependent variables were systemic complications, duration of hospitalization, readmission, and death. Descriptive, group comparison, bivariate, and multivariate analysis were performed using Stata 12.0 software 200 patients were included in this study, 84.5% were females and 15.5% males. Longer hospitalizations, readmissions, respiratory compromise, higher activity disease (ECLAM score), smoking, and use of cyclophosphamide in the past 3 months were more prevalent in males. In the bivariate and multivariate analysis, we found an increased risk in males of respiratory symptoms (OR 3.35), anti-DNA antibody (OR 2.46), smoking (OR 4.2), cyclophosphamide use (OR 3.23), chronic pulmonary alterations (OR 2.51), readmission (OR 2.88), long hospitalization (OR 3.12), and death (OR: 3.31). This is the first study that shows the differences related to gender in Colombian SLE patients. Males with SLE have more disease activity compare with females. Also, we found that males have more risk of pulmonary impairment, longer hospitalizations, hospital readmissions, and deaths.

Factores asociados con la presencia de secuelas fibrocavitarias torácicas en pacientes con antecedente de tuberculosis pulmonar del Hospital Universitario de Santander, Bucaramanga, Colombia / Factors associated with the presence of thoracic fibrocavitary sequelae in patients with a history of pulmonary tuberculosis from Hospital Universitario de Santander, Bucaramanga, Colombia

Objetivo: Determinar las variables relacionadas con el desarrollo de secuelas fibrocavitarias torácicas en pacientes con antecedente de tuberculosis pulmonar en Santander. Métodos: Cohorte retrospectiva de 141 pacientes con diagnóstico previo de tuberculosis, captados mediante muestreo no probabilístico de casos consecutivos en consulta de neumología (Hospital Universitario de Santander). Se realizó un análisis descriptivo, bivariado y multivariado a las variables recolectadas de las historias clínicas. Resultados: El 66% de los pacientes pertenecían al sexo masculino, con una edad promedio de 52 ± 16,91 años, evidenciando un tiempo promedio desde el contagio hasta el momento de la captación de 69 meses y un antecedente de tabaquismo del 46%. El 68% referían tos y se realizó fibrobroncoscopia al 41%. El 89% mostraron algún tipo de secuelas, distribuidas así: Torácicas parenquimatosas 88%, Pleurales 30%, Vías respiratorias 45%, Mediastinales 38% y Vasculares 5%. Fueron variables asociadas a la presencia de alguna secuela la edad del paciente; el tiempo mayor a 17 meses desde el diagnóstico de tuberculosis; la edad de diagnóstico de tuberculosis; la confirmación diagnóstica de tuberculosis por fibrobroncoscopia y síntomas como disnea, cianosis y tos. Discusión: El presente estudio estableció la prevalencia de secuelas de tuberculosis en el 88,65% de los sujetos con tuberculosis curada en Bucaramanga, Santander, Colombia. Es el primer estudio en la región en el que se evaluaron factores asociados con el desarrollo de secuelas de tuberculosis, encontrando como factor importante el uso de fibrobroncoscopia como método diagnóstico.

Factors associated with the presence of thoracic fibrocavitary sequelae in patients with a history of pulmonary tuberculosis from Hospital Universitario de Santander, Bucaramanga, Colombia

Objective: To determine the variables associated with the development of thoracic fibrocavitary sequelae in patients with a history of pulmonary tuberculosis in Santander. Methods: A retrospective cohort of 141 patients previously diagnosed with tuberculosis, recruited using non-probability consecutive sampling at pneumology consultations (Hospital Universitario de Santander). A descriptive, bivariate and multivariate analysis was performed with all the variables collected from the medical records. Results: Sixty-six percent of the patients were males, with an average age of 52+/-16.91 years, evidencing an average time span of 69 months from the moment of the infection to the moment they were recruited, and a history of tobacco use of 46%. Sixty-eight percent stated they had cough and a fibrobronchoscopy was performed in 41%. Eighty-nine percent exhibited some type of sequelae, classified as follows: Parenchymal thoracic 88%, pleural 30%, respiratory tract 45%, mediastinal 38% and vascular 5%. The variables associated with the presence of a sequela were the age of the patient; a period of time exceeding 17 months since the moment of the tuberculosis diagnosis; the age of diagnosis; the diagnostic confirmation of tuberculosis by fibrobronchoscopy and symptoms such as dyspnea, cyanosis and cough. Discussion: This study establishes the incidence of tuberculosis sequelae in 88.65% of the subjects with tuberculosis treated in Bucaramanga, Santander, Colombia. It is the first study in the region evaluating the factors associated with the development of tuberculosis sequelae, in which the use of fibrobronchoscopies as a diagnostic method was found to be an important factor.

Factores asociados con la presentación de afecciones respiratorias en pacientes con Artritis Reumatoide en una institución de Colombia entre el año 2012 y 2015 / Factors Associated with the Presentation of Respiratory Disease in Patients with Rheumatoid arthritis in an Institution of Colombia between 2012 and 2015

Introducción: La artritis reumatoide afecta al 1% de la población mundial, presentando alteraciones respiratorias hasta en el 73% de los pacientes. En Colombia no se han realizado estudios que evalúen la relación entre la presencia de alteraciones pulmonares y artritis reumatoide. Objetivo: Determinar los factores asociados a afecciones respiratorias en pacientes con artritis reumatoide. Métodos: Estudio de casos y controles (1:2) para 125 pacientes con artritis reumatoide. Se realizó análisis descriptivo, bivariado y multivariado. Resultados: La edad media de los casos fue 60,19 y de los controles 53,15 años, el 66,67% de los casos y el 86,75% de los controles fueron mujeres. La frecuencia respiratoria(FR), puntuación de actividad de enfermedad (DAS 28), tabaquismo, exposición a biomasa, disnea, pérdida de peso y actividad severa de enfermedad fueron mayor en los casos. El uso de antiinfamatorios no esteroideos(AINEs) y lefunomida predominó en los controles. El análisis bivariado mostró significancia estadística con asociación positiva entre alteraciones respiratorias y edad, sexo, tabaquismo, exposición a biomasa, disnea, pérdida de peso, FR, DAS 28 y actividad severa de enfermedad. Hubo asociación negativa estadísticamente significativa con AINEs y lefunomida. En el análisis multivariado se obtuvo significancia estadística con edad mayor 65 años, exposición a biomasa, tos, disnea, actividad severa y AINEs. Discusión: Se obtienen resultados similares a los encontrados en otros estudios, adicionalmente la presencia de exposición a biomasa se muestra como una variable fuertemente asociada a la presentación de alteraciones pulmonares en sujetos con artritis reumatoide en nuestra población.

Introduction: Rheumatoid arthritis affects 1% of the world population, and up to 73% of patients present respiratory disorders. In Colombia, there are no studies evaluating the relationship between the presence of pulmonary disorders and rheumatoid arthritis. Objective: To determine the factors associated with respiratory diseases in patients with rheumatoid arthritis. Methods: Case-control study (1:2) in 125 patients with rheumatoid arthritis. Descriptive, bivariate and multivariate analysis. Results: The mean age was 60.19 for cases and 53.15 years old for controls. 66.67% of cases and 86.75% of controls were female. The respiratory rate (RR), Disease Activity Score (DAS 28), smoking, exposure to biomass, dyspnea, weight loss and severe disease activity were higher in cases. The use of nonsteroidal antiinfammatory drugs (NSAIDs) and lefunomide predominated in controls. The bivariate analysis showed statistical significance with positive correlation between respiratory disorders and age, sex, smoking, exposure to biomass, dyspnea, weight loss, RR, DAS 28 and severe disease activity. There was a statistically significant negative correlation with lefunomide and NSAIDs. The multivariate analysis showed statistical significance in patients older than 65 years old, exposure to biomass, cough, dyspnea, severe activity and use of NSAIDs. Discussion: The results obtained are similar to those found in other studies. In addition, the presence of exposure to biomass appears as a variable strongly associated with the presentation of pulmonary disorders in patients with rheumatoid arthritis in our midst.

Secuelas estructurales y funcionales de tuberculosis pulmonar: una revisión de tema / Structural and Functional Sequelae of Pulmonary Tuberculosis: a Review

Las características biológicas del bacilo mycobacterium tuberculosis le permiten afectar casi cualquier tejido. Al ser la tuberculosis pulmonar la entidad más frecuente, se presenta la posibilidad de diseminación de la enfermedad a nivel torácico, lo que genera la aparición de secuelas que pueden afectar los órganos vitales de la caja torácica, tales como la vía aérea, el parénquima pulmonar, el sistema vascular pulmonar, el espacio pleural y la región mediastinal. Esto genera, además, la manifestación de trastornos funcionales que afectan directamente el pronóstico y la calidad de vida de los pacientes. La presente revisión trata de las secuelas torácicas encontradas en pacientes con antecedente de tuberculosis pulmonar. Estas se clasificaron así: secuelas de la vía aérea, secuelas parenquimatosas, secuelas pleurales, secuelas mediastinales, secuelas vasculares y secuelas funcionales.

Because of its biologic characteristics, the Mycobacterium tuberculosis can affect any tissue of the human body. Since the lungs are the most frequently affected organs, it is common the dissemination of the infection in the thorax with the development of sequelae in the pulmonary parenchyma, the airways, the vascular pulmonary system, the pleural space and the mediastinum. The sequelae lead to functional disturbances with a direct effect on the prognosis and the quality of life of the patients. This is a review of the thoracic sequelae in patients with a history of pulmonary tuberculosis. The sequelae were classifed as airways, parenchymal, pleural, mediastinal, vascular and functional sequelae.

Exacerbaciones agudas por agentes infecciosos en pacientes con enfermedad pulmonar estructural / Acute exacerbations by infectious agents in patients with structural lung disease

La enfermedad pulmonar estructural se define como toda patología que altera la arquitectura de la vía aérea inferior y el parénquima pulmonar, lo que predispone a colonización microbiológica. Entre las enfermedades catalogadas como enfermedad pulmonar estructural se encuentran la enfermedad pulmonar obstructiva crónica, las bronquiectasias y las cavitaciones como secuelas de enfermedades necrosantes. La manifestación aguda de síntomas respiratorios bajos constituye una exacerbación que deteriora el estado basal clínico, por lo que es indispensable reconocer el papel de las infecciones como causantes de estas exacerbaciones; los agentes infecciosos más comunes son: Haemophilus influenzae, Streptococcus pneumoniae y patógenos virales en la enfermedad pulmonar obstructiva crónica y Haemophilus influenzae, Moraxella catharralis y Pseudomonas aeruginosa en las bronquiectasias. En las exacerbaciones de secuelas fibrocavitarias se encuentran los mismos gérmenes de las otras alteraciones estructurales, además de hongos y micobacterias en cerca del 40%...

The structural pulmonary disease is defined as any pathology that alters the architecture of lower airway and lung parenchyma, which predisposes to microbial colonization. Among the diseases classified as structural pulmonary disease we find chronic obstructive pulmonary disease, bronchiectasis and caverns as sequelae of necrotizing diseases. Acute manifestation of lower respiratory symptoms constitutes an exacerbation that deteriorates clinical baseline condition, so it is essential to establish the role of infections as cause of these exacerbations; the most common infectious agents are: Haemophilus influenzae, Streptococcus pneumoniae and viral pathogens in chronic obstructive pulmonary disease and Haemophilus influenzae, Moraxella catarrhalis and Pseudomonas aeruginosa in bronchiectasis. In exacerbations of fibrocavitary sequelae are the same germs than other structural alterations, besides fingi and mycobacteria in about 40%...

Mecanismos fisiopatológicos del síndrome antifosfolípidos / Phatophysiological Mechanism of the Antiphospholipid Syndrome

Introducción: el síndrome antifosfolípidos es una enfermedad de reciente aparición, por lo que no se cuenta con una prevalencia real, sin embargo afecta aproximadamente a 0,5% de la población, principalmente a mujeres; siendo una importante causa de trombosis arterial, venosa o de pequeños vasos y alteraciones obstétricas. Objetivo: hacer una revisión para integrar el conocimiento de los mecanismos implicados en las vías patológicas del síndrome antifosfolípidos que involucran anticuerpos y sustancias endógenas, para que sea usado en el diagnóstico y tratamiento de esta enfermedad. Conclusiones: en el síndrome antifosfolípidos participan varios componentes, entre ellos el anticuerpo anti-Beta2-Glicoproteína1, anticoagulante lúpico, anticuerpos anti-cardiolipina, anticuerpos anti-serin proteasas, anticuerpos anti-anexina A5, sistema del complemento y factor tisular, que al realizar su acción son los causantes de las manifestaciones trombóticas y alteraciones obstétricas. El entender los mecanismos de acción de dichos componentes, puede contribuir al mejoramiento diagnóstico y creación de herramientas terapéuticas para disminuir la mortalidad y morbilidad causada por el síndrome antifosfolípidos. (MÉD.UIS. 2014;27(1):43-50).

Introduction: the antiphospholipid syndrome is an emerging disease, so there is no real prevalence, however affects approximately 0.5% of the population, mainly women , being a major cause of arterial , venous, or small vessel and obstetric disorders. Objective: to revise to integrate knowledge of the mechanisms involved in pathological pathways involving antiphospholipid antibody syndrome and endogenous substances, to be used in the diagnosis and treatment of this disease. Conclusions: antiphospholipid syndrome involves several components, including the anti - Beta2 - Glicoproteina 1, lupus anticoagulant, anticardiolipin antibodies, anti- serine proteases, antiannexin A5 antibodies, complement system and tissue factor, that doing their actions are causing thrombotic manifestations and obstetric disorders. Understanding the mechanisms of action of these components can contribute to improved diagnostic and therapeutic tool created to reduce mortality and morbidity caused by antiphospholipid syndrome. (MÉD.UIS. 2014;27(1):43-50).