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1.
JAMA ; 322(7): 632-641, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429897

RESUMO

Importance: Maternal hypothyroidism and hyperthyroidism are risk factors for preterm birth. Milder thyroid function test abnormalities and thyroid autoimmunity are more prevalent, but it remains controversial if these are associated with preterm birth. Objective: To study if maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth. Data Sources and Study Selection: Studies were identified through a search of the Ovid MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar databases from inception to March 18, 2018, and by publishing open invitations in relevant journals. Data sets from published and unpublished prospective cohort studies with data on thyroid function tests (thyrotropin [often referred to as thyroid-stimulating hormone or TSH] and free thyroxine [FT4] concentrations) or thyroid peroxidase (TPO) antibody measurements and gestational age at birth were screened for eligibility by 2 independent reviewers. Studies in which participants received treatment based on abnormal thyroid function tests were excluded. Data Extraction and Synthesis: The primary authors provided individual participant data that were analyzed using mixed-effects models. Main Outcomes and Measures: The primary outcome was preterm birth (<37 weeks' gestational age). Results: From 2526 published reports, 35 cohorts were invited to participate. After the addition of 5 unpublished data sets, a total of 19 cohorts were included. The study population included 47 045 pregnant women (mean age, 29 years; median gestational age at blood sampling, 12.9 weeks), of whom 1234 (3.1%) had subclinical hypothyroidism (increased thyrotropin concentration with normal FT4 concentration), 904 (2.2%) had isolated hypothyroxinemia (decreased FT4 concentration with normal thyrotropin concentration), and 3043 (7.5%) were TPO antibody positive; 2357 (5.0%) had a preterm birth. The risk of preterm birth was higher for women with subclinical hypothyroidism than euthyroid women (6.1% vs 5.0%, respectively; absolute risk difference, 1.4% [95% CI, 0%-3.2%]; odds ratio [OR], 1.29 [95% CI, 1.01-1.64]). Among women with isolated hypothyroxinemia, the risk of preterm birth was 7.1% vs 5.0% in euthyroid women (absolute risk difference, 2.3% [95% CI, 0.6%-4.5%]; OR, 1.46 [95% CI, 1.12-1.90]). In continuous analyses, each 1-SD higher maternal thyrotropin concentration was associated with a higher risk of preterm birth (absolute risk difference, 0.2% [95% CI, 0%-0.4%] per 1 SD; OR, 1.04 [95% CI, 1.00-1.09] per 1 SD). Thyroid peroxidase antibody-positive women had a higher risk of preterm birth vs TPO antibody-negative women (6.6% vs 4.9%, respectively; absolute risk difference, 1.6% [95% CI, 0.7%-2.8%]; OR, 1.33 [95% CI, 1.15-1.56]). Conclusions and Relevance: Among pregnant women without overt thyroid disease, subclinical hypothyroidism, isolated hypothyroxinemia, and TPO antibody positivity were significantly associated with higher risk of preterm birth. These results provide insights toward optimizing clinical decision-making strategies that should consider the potential harms and benefits of screening programs and levothyroxine treatment during pregnancy.


Assuntos
Doenças Autoimunes/diagnóstico , Iodeto Peroxidase/imunologia , Complicações na Gravidez/diagnóstico , Nascimento Prematuro/etiologia , Doenças da Glândula Tireoide/diagnóstico , Testes de Função Tireóidea , Adulto , Autoanticorpos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/complicações , Feminino , Idade Gestacional , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/diagnóstico , Recém-Nascido , Gravidez , Complicações na Gravidez/sangue , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/complicações , Tireotropina/sangue , Tiroxina/sangue
3.
Expert Opin Drug Saf ; 18(9): 841-852, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31238745

RESUMO

Introduction: Systemic Autoimmune Diseases (SADs) include systemic lupus erythematosus, antiphospholipid antibody syndrome, rheumatoid arthritis, systemic sclerosis, Sjogren's syndrome, mixed connective tissue disease, idiopathic inflammatory myopathies and vasculitis. SADs often occur in women of childbearing age and can affect fertility. Both infertility treatments and fertility preservation techniques are thus often indicated. Areas covered: The literature regarding the safety of fertility-related drugs for both fertility preservation and infertility treatment in patients affected by SADs was reviewed. Based on current knowledge, all the options for fertility preservation should be contemplated in patients with SADs who are at risk for fertility loss, including GnRH analogue administration, oocyte/embryo vitrification and ovarian tissue cryopreservation. Similarly, if pregnancy is not contraindicated in a patient with a SAD, neither should be any fertility treatment. Expert opinion: Women with SADs should postpone conception until a stable disease has been achieved for at least 6 months. When infertility treatments are needed, women with antiphospholipid antibodies should receive concomitant anticoagulation. If in vitro fertilization/intra-cytoplasmic sperm injection and embryo transfer is required, ovarian hyperstimulation and the inherent risk of thrombosis should be eliminated by GnRH-agonist trigger and cycle segmentation. Counselling about adherence to anti-rheumatic therapy to prevent disease exacerbations is also critical.


Assuntos
Doenças Autoimunes/complicações , Preservação da Fertilidade/métodos , Infertilidade Feminina/terapia , Anticorpos Antifosfolipídeos/imunologia , Doenças Autoimunes/fisiopatologia , Criopreservação/métodos , Feminino , Fertilização In Vitro/métodos , Humanos , Infertilidade Feminina/etiologia , Gravidez , Técnicas de Reprodução Assistida
5.
Nihon Shokakibyo Gakkai Zasshi ; 116(5): 443-451, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31080225

RESUMO

In the course of treatment for myasthenia gravis, enlargement of a cystic mass in the liver with peripheral bile duct dilation, diffuse pancreatic enlargement, and serum IgG4 level elevation was identified in a 65-year-old man. Following the diagnosis of autoimmune pancreatitis, a left hepatectomy was performed because of suspected malignancy of the cystic lesion. Analysis of the resected specimen revealed the cystic lesion to be a dilated bile duct. Intraductal papillary tumor comprising fibrovascular stalks covered by neoplastic epithelium was identified in the lesion. Infiltration of IgG4-positive plasma cells was discovered around the cystic lesion. Finally, a diagnosis of intraductal papillary neoplasm of bile duct with IgG4-related sclerosing cholangitis was made. Autoimmune diseases, including IgG4-related diseases, require careful observation because of their potential for malignancy.


Assuntos
Doenças Autoimunes/diagnóstico , Colangite Esclerosante/diagnóstico , Imunoglobulina G/metabolismo , Miastenia Gravis/diagnóstico , Pancreatite/diagnóstico , Idoso , Doenças Autoimunes/complicações , Ductos Biliares , Colangite Esclerosante/complicações , Humanos , Masculino , Miastenia Gravis/complicações , Pancreatite/complicações
7.
Rev Med Suisse ; 15(645): 723-731, 2019 Apr 03.
Artigo em Francês | MEDLINE | ID: mdl-30942970

RESUMO

Over the years, the challenges of chronic HIV infection have evolved from the management of life-threatening opportunistic infections to chronic noninfectious complications. Nowadays, autoimmune disorders, which are linked to chronic immune dysregulations, have become an important issue in HIV infected patients. Although they mimic disorders and syndromes described in HIV seronegative patients, their frequency and clinical picture may differ considerably. The various immunological alterations and the production of non-specific autoantibodies often make diagnosis difficult. Moreover, the introduction of immunosuppressive therapy requires careful consideration in the presence of a chronic infection that alters the cellular immunity and increases the risk of infections.


Assuntos
Doenças Autoimunes , Infecções por HIV , Autoanticorpos , Doenças Autoimunes/complicações , HIV , Infecções por HIV/complicações , Humanos , Imunossupressão
8.
J Pediatr Endocrinol Metab ; 32(4): 355-361, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-30903759

RESUMO

Background Zinc transporter 8 autoantibodies (ZnT8Abs) together with glutamic acid decarboxylase autoantibodies (GADAbs), insulinoma antigen 2 autoantibodies (IA-2Abs) and insulin autoantibodies (IAbs) are markers of type 1 diabetes mellitus (T1DM). We studied the prevalence of ZnT8Ab in children with autoimmune thyroid diseases (AITDs) to assess the association of AITDs and T1DM at the serological level. Methods The study groups consisted of 44 children with Graves' disease (GD), 65 children with Hashimoto's thyroiditis (HT), 199 children with T1DM with or without AITDs and 58 control children. ZnT8Ab, GADAb, IA-2Ab, IAb, 21-hydroxylase autoantibodies (21-OHAbs) and acetylcholine receptor autoantibodies (AChRAbs) were measured. Results ZnT8Abs were found in 4/44 (9.1%) patients with GD, and 4/44 (9.1%) patients with GD were positive for GADAb. Of the 65 HT patients, six (9.2%) were positive for ZnT8Ab, while four (6.2%) were positive for GADAb. In the T1DM group, 128/199 (64%) of the patients were positive for ZnT8Ab, 133/199 (67%) for GADAb and 109/199 (55%) for IA-2Ab. One GD patient and one HT patient were positive for all the four diabetes-associated autoantibodies. Two HT patients were positive for three diabetes autoantibodies. Two GD (4.5%) and five HT (7.7%) patients were positive for 21-OHAb only. None of the patients had AChRAb. In the control group, 2/58 (3.4%) were positive for GADAb and 2/58 (3.4%) were positive for ZnT8Ab. Conclusions Diabetes-associated autoantibodies including ZnT8Ab were found in children and adolescents with GD and HT.


Assuntos
Autoanticorpos/sangue , Doenças Autoimunes/complicações , Biomarcadores/sangue , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/etiologia , Doenças da Glândula Tireoide/complicações , Transportador 8 de Zinco/imunologia , Adolescente , Autoanticorpos/imunologia , Doenças Autoimunes/sangue , Doenças Autoimunes/imunologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/imunologia
9.
Ann Biol Clin (Paris) ; 77(2): 179-183, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30882350

RESUMO

Acquired hemophilia A (AHA) is a rare and potentially severe bleeding disorder caused by circulating autoantibodies directed against factor (F) VIII. Apart from idiopathic cases, AHA is associated with autoimmune diseases, cancers, use of medications, pregnancy and the post-partum period. We report the case of a 78-year-old a male patient presenting with symptoms of a hematoma after a fall three days previously. He is medically followed for multiple myeloma and bullous pemphigoid. Laboratory investigations revealed isolated and recent increased of activated partial thromboplastin time (80,6/32,1s) and a markedly low FVIII activity (< 1%). The high-titer of FVIII inhibitor (19 Bethesda units/mL) confirmed the diagnosis of AHA diagnosis. The symptoms were noticeably alleviated following bortezomib, cyclophosphamide and dexamethasone therapy. This report describes a rare case of AHA associated with bullous pemphigoid and multiple myeloma. These pathologies induce an immunity modification that can predispose or be associated with the development of anti-FVIII inhibitors. This case illustrates two possible physiopathological hypotheses for the development of AHA, which will be discussed in this case report.


Assuntos
Hemofilia A/diagnóstico , Mieloma Múltiplo/diagnóstico , Penfigoide Bolhoso/diagnóstico , Idoso , Autoanticorpos/efeitos adversos , Autoanticorpos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Hemofilia A/complicações , Hemofilia A/etiologia , Hemofilia A/imunologia , Humanos , Masculino , Mieloma Múltiplo/complicações , Mieloma Múltiplo/imunologia , Penfigoide Bolhoso/complicações , Penfigoide Bolhoso/imunologia
10.
Ann Transplant ; 24: 162-167, 2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30898994

RESUMO

BACKGROUND The classical cardiovascular risk factors and changes in the circulatory system secondary to end-stage liver disease (ESLD) are associated with an increased risk of cardiac abnormalities (CAs) in patients waiting for liver transplantation (LTx). The aim of this study was to assess the relationship between the etiology of liver disease and the presence of CAs in patients qualified for LTx. MATERIAL AND METHODS The study enrolled patients qualified to LTx due to ESLD at the Clinical Hospital of the Medical University of Warsaw between 2013 and 2016. Out of 396 patients: 65, 157, 117, and 57 had ESLD due to the alcoholic liver disease (ALD), viral infections (VIR), autoimmune disorders (AUTO), and different etiologies (OTHER), respectively. RESULTS An increased frequency of hypertension and diabetes mellitus were observed in ALD and VIR groups, while for hyperlipidemia, the highest rates were observed in ALD and AUTO groups. Significant differences in CAs rates were observed for resting tachycardia, prolonged QT interval, bradycardia, and left ventricular diastolic dysfunction. After adjustment for age, MELD, and Child-Pugh scores, hyperlipidemia (26% vs. 7-15%, p<0.048) was most frequently observed in the AUTO group, while poor aerobic capacity (49% vs. 21-34%, p<0.009) dominated in the OTHER group. CONCLUSIONS The frequency of hyperlipidemia, and poor aerobic capacity were directly related to the etiology of liver disease, while the remaining associations resulted from effects of age, MELD, and Child-Pugh score.


Assuntos
Doenças Cardiovasculares/etiologia , Doença Hepática Terminal/complicações , Transplante de Fígado , Listas de Espera , Adulto , Doenças Autoimunes/complicações , Doenças Autoimunes/cirurgia , Doença Hepática Terminal/etiologia , Doença Hepática Terminal/cirurgia , Feminino , Hepatite Viral Humana/complicações , Hepatite Viral Humana/cirurgia , Humanos , Hiperlipidemias/etiologia , Hepatopatias Alcoólicas/complicações , Hepatopatias Alcoólicas/cirurgia , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Período Perioperatório/efeitos adversos , Fatores de Risco
11.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(3): 221-227, 2019 Mar 24.
Artigo em Chinês | MEDLINE | ID: mdl-30897882

RESUMO

Objective: To observe the relationship between impaired myocardial untwisting and left ventricular diastolic dysfunction in patients with autoimmune diseases (AD). Methods: In this retrospective study, 95 AD patients (27 males, (38.6±14.2) years old) were enrolled as AD group and 71 gender and age matched healthy subjects (24 males, (37.6±12.2) years old) were enrolled as control group, all underwent transthoracic echocardiography and two-dimensional speckle-tracking echocardiography (STE) in our hospital between January 2014 and June 2018. Left ventricular untwisting and diastolic function parameters were measured. Multiple logistic regression analysis was used to identify related factors of left ventricular diastolic dysfunction in AD patients. Receiver operating characteristic (ROC) curve was used to identify the diagnosis value of untwisting parameters for left ventricular diastolic dysfunction in AD patients. Results: Compared with control group, left ventricular ejection fraction was lower (58(47, 66)% vs. 67 (62, 71) %, P<0.001), E/e' was higher (10.78 (7.28, 13.65) vs. 6.30 (5.55, 7.25) , P<0.001), isovolumic relaxation time was longer (73.5 (56.5, 88.0) ms vs. 62.0 (58.0, 68.5) ms, P<0.001),and untwist slope during isovolumic relaxation period (USIR) was lower (31.92 (14.09, 54.92) °/s vs. 59.90 (40.09, 87.18) °/s, P<0.001) in AD group than in control group. Multiple logistic regression analysis showed heart rate (OR=0.885, 95%CI 0.840-0.931, P<0.001), E/e' (OR=0.655, 95%CI 0.537-0.798, P<0.001) and USIR (OR=0.986, 95%CI 0.974-0.998, P=0.020) were independently related with left ventricular diastolic dysfunction in AD patients. ROC curve showed that area under the curve (AUC) was 0.919 (P<0.001), sensitivity was 87.6%, and specificity was 88.7%, when combining the heart rate, E/e', and USIR as assessment parameters for the diagnosis of left ventricular diastolic dysfunction in AD patients at a cutoff of 0.51. Conclusions: Impairment of myocardial untwisting indicates the presence of early stage left ventricular diastolic dysfunction in AD patients. USIR may be a sensitive parameter to evaluate early stage left ventricular diastolic dysfunction in AD patients.


Assuntos
Doenças Autoimunes , Disfunção Ventricular Esquerda , Função Ventricular Esquerda , Adulto , Doenças Autoimunes/complicações , Diástole , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Disfunção Ventricular Esquerda/complicações , Adulto Jovem
12.
N Engl J Med ; 380(12): 1150-1157, 2019 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-30893535

RESUMO

A 58-year-old woman with debilitating ankylosing spondylitis who was born to consanguineous parents was found to have an apparent severe vitamin D deficiency that did not respond to supplementation. Liquid chromatography-tandem mass spectrometry showed the absence of circulating vitamin D-binding protein, and chromosomal microarray confirmed a homozygous deletion of the group-specific component (GC) gene that encodes the protein. Congenital absence of vitamin D-binding protein resulted in normocalcemia and a relatively mild disruption of bone metabolism, in this case complicated by severe autoimmune disease. (Funded by the National Institutes of Health and the University of Washington.).


Assuntos
Doenças Autoimunes/complicações , Deleção de Genes , Hidroxicolecalciferóis/sangue , Espondilite Anquilosante/genética , Deficiência de Vitamina D/genética , Proteína de Ligação a Vitamina D/genética , Cálcio/sangue , Cromatografia Líquida , Feminino , Fraturas Espontâneas/etiologia , Expressão Gênica , Homozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos , Polimorfismo de Nucleotídeo Único , Irmãos , Espondilite Anquilosante/complicações , Espectrometria de Massas em Tandem , Vitamina D/metabolismo , Proteína de Ligação a Vitamina D/deficiência
13.
Cancer Immunol Immunother ; 68(6): 917-926, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30877325

RESUMO

INTRODUCTION: Patients with pre-existing autoimmune diseases have been excluded from clinical trials of immune checkpoint inhibitors (ICIs) for cancer. Real-world evidence is necessary to understand ICI safety in this population. METHODS: Patients treated with ICIs from 2011 to 2017 were identified using data from a large health insurer. Outcomes included time to (1) any hospitalization; (2) any hospitalization with an irAE diagnosis; and (3) outpatient corticosteroid treatment. The key exposure was pre-existing autoimmune disease, ascertained within 12 months before starting ICI treatment, and defined either by strict criteria (one inpatient or two outpatient claims at least 30 days apart) or relaxed criteria only (any claim, without meeting strict criteria). RESULTS: Of 4438 ICI-treated patients, pre-existing autoimmune disease was present among 179 (4%) by strict criteria, and another 283 (6%) by relaxed criteria only. In multivariable models, pre-existing autoimmune disease by strict criteria was not associated with all-cause hospitalization (HR 1.27, 95% CI 0.998-1.62), but it was associated with hospitalization with an irAE diagnosis (HR 1.81, 95% CI 1.21-2.71) and with corticosteroid treatment (HR 1.93, 95% CI 1.35-2.76). Similarly, pre-existing autoimmune disease by relaxed criteria only was not associated with all-cause hospitalization (HR 1.11, 95% CI 0.91-1.34), but was associated with hospitalization with an irAE diagnosis (HR 1.46, 95% CI 1.06-2.01) and corticosteroid treatment (HR 1.46, 95% CI 1.13-1.88). CONCLUSION: Pre-existing autoimmune disease was not associated with time to any hospitalization after initiating ICI therapy, but it was associated with a modest increase in hospitalizations with irAE diagnoses and with corticosteroid treatment.


Assuntos
Anticorpos Monoclonais/imunologia , Doenças Autoimunes/imunologia , Antígeno B7-H1/imunologia , Antígeno CTLA-4/imunologia , Neoplasias/imunologia , Receptor de Morte Celular Programada 1/imunologia , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Doenças Autoimunes/complicações , Doenças Autoimunes/tratamento farmacológico , Antígeno B7-H1/antagonistas & inibidores , Antígeno CTLA-4/antagonistas & inibidores , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Imunoterapia/efeitos adversos , Imunoterapia/métodos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/complicações , Neoplasias/terapia , Receptor de Morte Celular Programada 1/antagonistas & inibidores
14.
Med. oral patol. oral cir. bucal (Internet) ; 24(2): e217-e230, mar. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-180646

RESUMO

Background: To give an overview on implant survival rates in patients with oral manifestations of systemic auto¬immune (oral Lichen planus (oLp), Pemphigus (Pe)), muco-cutaneous (Epidermolysis bullosa (EB)), autoimmune multisystemic rheumatic diseases (Sjögren´s syndrome (SjS), systemic Lupus erythematosus (sLE), or systemic Sclerosis (sSc)). Material and Methods: Systematic literature review (PubMed/Medline, Embase) using MESH and search term combinations, published between 1980 and August 2018 in English language reporting on dental implant-pros¬thetic rehabilitation of patients with oLp, Pe, EB, SjS, sLE, sSc, study design, age, gender, follow-up period (≥ 12 months), implant survival rate. Implant-related weighed mean values of implant survival rate (wmSR) were calculated. Results: After a mean follow-up period (mfp) of 44.6 months, a wmSR of 98.3 % was calculated from data pub-lished for patients with oLp (100 patients with 302 implants). Data of 27 patients (152 implants) with EB revealed wmSR of 98.7 % following mfp of 32.6 months. For 71 patients (272 implants) with SjS, wmSR was 94.2 % follow¬ing a mfp of 45.2 months, and for 6 patients (44 implants) with sSc, wmSR was 97.7 % after mfp of 37.5 months. One case report on one patient each with Pe (two implants) as well as sLE (6 implants) showed 100 % SR following at least 24 months. Conclusions: Guidelines regarding implant treatment of patients with oLp, Pe, EB, SjS, sLE or sSc do not exist nor are contraindicating conditions defined. Implant survival rates of patients affected are comparable to those of healthy patients. For implant-prosthetic rehabilitation of patients with Pe and sLE no conclusions can be drawn due to lack of sufficient clinical data. Implant-prosthetic treatment guidelines regarding healthy patients should be strictly fol¬lowed, but frequent recall is recommended in patients affected with oLp, SjS, EB, SSc, Pe or sLE


No disponible


Assuntos
Humanos , Implantação Dentária Endo-Óssea/métodos , Doenças Autoimunes/complicações , Síndrome de Sjogren/complicações , Líquen Plano Bucal/complicações , Epidermólise Bolhosa/complicações , Lúpus Eritematoso Sistêmico/complicações , Escleroderma Sistêmico/complicações
15.
MBio ; 10(1)2019 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-30755511

RESUMO

The region encompassing the Pacific Northwest (PNW), Vancouver Island, Oregon, and Washington has been the location of an ongoing Cryptococcus gattii outbreak since the 1990s, and there is evidence that the outbreak is expanding along the West Coast into California. Here we report a clinical case of a 69-year-old, HIV-negative man from North Carolina who was diagnosed with a fungal brain mass by magnetic resonance imaging (MRI) and pathology. He had traveled to Seattle and Vancouver 3 years earlier and to Costa Rica 4 months prior to presentation. Phenotypic evidence showed that the fungal mass isolated from the patient's brain represented C. gattii In agreement with the phenotypic results, multilocus sequence typing (MLST) provided genotypic evidence that assigned the infecting organism within the C. gattii species complex and to the C. deuterogattii VGIIa clade. Whole-genome sequencing revealed >99.99% identity with the C. deuterogattii reference strain R265, indicating that the infecting strain is derived from the highly clonal outbreak strains in the PNW. We conclude that the patient acquired the C. gattii infection during his travel to the region 3 years prior and that the infection was dormant for an extended period of time before causing disease. The patient tested positive for anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies, supporting earlier reports that implicate these autoantibodies as a risk factor associated with C. gattii infection.IMPORTANCE Mortality rates associated with C. gattii infections are estimated to be between 13% and 33%, depending on an individual's predisposition, and C. gattii has caused at least 39 deaths in the PNW region. There have been four other international travel cases reported in patients from Europe and Asia with travel history to the PNW, but this report describes the first North American traveler who acquired C. deuterogattii infection presenting within the United States and the first case of a C. deuterogattii outbreak infection associated with anti-GM-CSF autoantibodies. Early and accurate diagnoses are important for disease prevention and treatment and for control of infectious diseases. Continual reporting of C. deuterogattii infections is necessary to raise awareness of the ongoing outbreak in the PNW and to alert travelers and physicians to the areas of endemicity with potential risks.


Assuntos
Autoanticorpos/sangue , Doenças Autoimunes/complicações , Cryptococcus/isolamento & purificação , Fator Estimulador de Colônias de Granulócitos e Macrófagos/antagonistas & inibidores , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/patologia , Doença Relacionada a Viagens , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Costa Rica , Cryptococcus/classificação , Cryptococcus/genética , Genótipo , Humanos , Hospedeiro Imunocomprometido , Imagem por Ressonância Magnética , Masculino , Técnicas Microbiológicas , Tipagem de Sequências Multilocus , North Carolina , Noroeste dos Estados Unidos , Sequenciamento Completo do Genoma
16.
Anticancer Res ; 39(2): 797-802, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30711959

RESUMO

BACKGROUND/AIM: This study sought to determine whether an autoimmune background could identify patients with HER2-positive early breast cancer (EBC) who derive differential benefit from primary adjuvant trastuzumab-based therapy. PATIENTS AND METHODS: HERA is an international randomized trial of 5,102 women with HER2-positive EBC, who were enrolled to either receive adjuvant trastuzumab or not. In this exploratory analysis, the interaction between autoimmune history and the magnitude of trastuzumab benefit was evaluated. RESULTS: A total of 5,099 patients were included in the current analysis. Among them, 325 patients (6.4%) had autoimmune disease history, 295 of whom had active disease. Patients were randomly assigned to trastuzumab or no-trastuzumab groups. Similar reductions in the risk of events in patients with and without autoimmune history were observed (interaction p=0.95 for disease-free survival, and p=0.62 for overall survival). CONCLUSION: No evidence of a differential benefit from trastuzumab in patients with a medical history of autoimmune disease was found.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Doenças Autoimunes/complicações , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/imunologia , Trastuzumab/uso terapêutico , Adulto , Idoso , Neoplasias da Mama/complicações , Quimioterapia Adjuvante/efeitos adversos , Intervalo Livre de Doença , Feminino , Humanos , Cooperação Internacional , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Risco , Resultado do Tratamento
17.
Int J Mol Sci ; 20(4)2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30791371

RESUMO

The role of autoantibodies in in vitro fertilization (IVF) has been discussed for almost three decades. Nonetheless, studies are still scarce and widely controversial. The aim of this study is to provide a comprehensive systematic review on the possible complications associated to autoantibodies (AA) impeding the chances of a successful IVF cycle. An Embase, PubMed/Medline and Cochrane Central Database search was performed on 1 December 2018, from 2006 until that date. From the 598 articles yielded in the search only 44 relevant articles ultimately fulfilled the inclusion criteria and were qualitatively analyzed. Five subsets of results were identified, namely, thyroid related AA, anti-phospholipid antibodies, anti-nuclear antibodies, AA affecting the reproductive system and AA related to celiac disease. It may be implied that the majority of auto-antibodies exert a statistically significant effect on miscarriage rates, whereas the effects on clinical pregnancy and live birth rates differ according to the type of auto-antibodies. While significant research is performed in the field, the quality of evidence provided is still low. The conduction of well-designed prospective cohort studies is an absolute necessity in order to define the impact of the different types of autoantibodies on IVF outcome.


Assuntos
Autoanticorpos/imunologia , Fertilização In Vitro , Infertilidade/terapia , Anticorpos Antinucleares/imunologia , Anticorpos Antifosfolipídeos/imunologia , Especificidade de Anticorpos/imunologia , Doenças Autoimunes/complicações , Doenças Autoimunes/imunologia , Doença Celíaca/complicações , Doença Celíaca/imunologia , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Humanos , Infertilidade/etiologia , Gravidez , Glândula Tireoide/imunologia , Glândula Tireoide/metabolismo , Resultado do Tratamento
18.
Nihon Shokakibyo Gakkai Zasshi ; 116(2): 168-176, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30745555

RESUMO

We herein report the case of a 64-year-old male patient with hypopituitarism associated with autoimmune pancreatitis (AIP). The patient was previously diagnosed with AIP based on the presence of a swollen pancreas, elevated serum immunoglobulin G4, and narrowing of the pancreatic duct by imaging. Magnetic resonance imaging revealed a pituitary stem tumor, and loading test showed a decrease in the function of the anterior lobe suggesting severe failure of growth hormone secretion. Treatment with steroids was effective in reducing the pituitary lesion and improving the function of the anterior lobe. The present case illustrates the importance of pituitary function evaluation before steroid treatment in patients with AIP.


Assuntos
Doenças Autoimunes/diagnóstico , Hipopituitarismo/diagnóstico , Pancreatite/diagnóstico , Idoso , Doenças Autoimunes/complicações , Humanos , Hipopituitarismo/complicações , Imunoglobulina G , Masculino , Pâncreas , Pancreatite/complicações
19.
Autoimmun Rev ; 18(4): 415-425, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30772491

RESUMO

Sudden cardiac death (SCD) is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease. Patients with cardiomyopathies, myocarditis, ischemic heart disease and cardiac channelopathies are at risk of SCD. However, a certain percentage of autopsy-negative cases of SCD in the young (<35 years) remain unexplained even after a post-mortem genetic testing. Autoantibodies against cardiac proteins may be potentially involved in the pathogenesis of different heart diseases and in the occurrence of unexplained SCD. In this review we analyze clinical and animal studies that elucidate the prevalence of these autoantibodies in patients with different cardiac diseases and their pathophysiological relevance. We propose a classification of the autoantibodies associated with heart diseases and focus on their molecular and cellular effects. Anti-beta adrenergic receptor antibodies and anti-muscarinic acetylcholine receptor antibodies affect myocardial electrophysiological properties and were reported to be the independent predictors of SCD in patients with different heart diseases. Autoimmune mechanism is proposed for cardiac-related adverse reactions following human papillomavirus (HPV) vaccination. The pentapeptid sharing between HPV's antigens, adrenergic receptors and muscarinic acetylcholine receptors supports this assumption. The dysregulating effects of the autoantibodies against calcium and potassium ion channels can be the basis for autoimmune phenocopies of genetic cardiac channelopathies, which are also associated with SCD.


Assuntos
Autoanticorpos/efeitos adversos , Morte Súbita Cardíaca/etiologia , Imunoglobulinas/efeitos adversos , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Autoanticorpos/imunologia , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/mortalidade , Cardiomiopatias/imunologia , Cardiomiopatias/mortalidade , Testes Genéticos , Humanos , Miocardite/complicações , Miocardite/imunologia , Miocardite/mortalidade , Miocárdio/imunologia , Miocárdio/patologia , Fenótipo
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