Rituximab in Refractory Chronic Spontaneous Urticaria: An Encouraging Therapeutic Approach.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a frequent mast cell-driven disease that affects approximately 0.5-1% of the population. Antihistamines are currently the drugs of choice in patients with CSU. Omalizumab has been shown to be very effective in CSU and has been recently approved as second-line therapy. However, although its introduction has markedly improved the therapeutic possibilities for CSU, there is still a hard core of patients who do not respond and require effective treatment. METHODS: We report the case of a patient who achieved an 8-month remission of refractory CSU following the use of rituximab, and perform a review of the literature regarding the use of rituximab in CSU. RESULTS: There was a remarkable improvement in her CSU after the administration of rituximab maintained over time. CONCLUSION: Rituximab is a chimeric murine/human monoclonal antibody directed against CD20, which depletes memory B-lymphocytes that are necessary for autoantibody production. The abrogation of the autoantibody production is the proposed mechanism by which it may alleviate the symptoms of CSU.

Potential polymorphic CYP1A2 and CYP2D6-mediated pharmacokinetic interactions between risperidone or olanzapine and selected drugs intended to treat COVID-19.

Risperidone/olanzapine are antipsychotics used in Peru to control symptoms of psychosis. The objective was to review the available evidence on potential pharmacokinetic interactions mediated by CYP1A2 and CYP2D6 polymorphic genes between risperidone or olanzapine and selected drugs for the treatment of COVID-19. A bibliographic search was conducted in SciELO and PubMed/Medline. The selection criteria included all types of articles in English and Spanish languages. In this review, the CYP1A2/CYP2D6/CYP3A4 genes that encode their respective enzymes have been described. The olanzapine/risperidone association increases the risk of prolonging the QT interval; chloroquine/hydroxychloroquine decreases metabolism and increases plasma concentration of risperidone; ritonavir decreases metabolism and increases plasma levels of hydroxychloroquine and lopinavir with the risk of prolonging the QT interval of the cardiac cycle and with a tendency to progression towards Torsades de Pointes. Ritonavir increases metabolism and decreases plasma levels of olanzapine. A low incidence of adverse effect was found between risperidone/azithromycin and olanzapine with azithromycin and hydroxychloroquine. Regarding the association of genes: CYP1A2*1D increases and CYP1A2*1F decreases the plasma concentration of olanzapine. Risperidone plasma levels are increased in CYP2D6 intermediate and poor metabolizers compared with normal metabolizers. Other studies indicate no significant association between poor metabolizers of CYP1A2 and CYP2D6 with increased pharmacokinetic parameters. It is concluded that there are potential risks of prolonging the QT interval due to pharmacokinetic interactions mediated by polymorphic genes CYP1A2 and CYP2D6 between risperidone or olanzapine and the drugs selected for the treatment of COVID-19.

CYP2D6 and CYP2C19 Genes Associated with Tricontinental and Latin American Ancestry of Pe-ruvians.

Precision medicine seeks to individualize the dose from the beginning of phar-macological therapy based on the characteristics of each patient, genes involved in the metabolic phenotype, ethnicity or miscegenation, with the purpose to minimize adverse effects and optimize drug efficacy. The objective was to re-view studies that describe the association of the CYP2D6 and CYP2C19 genes with the tricontinental and Latin American ancestry of Peruvians. A biblio-graphic search was carried out in PubMed/Medline and SciELO, with various descriptors in Spanish and English. The results of this review confirm that the ethnic origin of Peruvians is triconti-nental due to European (mainly Spanish), African and Asian migration, in addi-tion to Latin American migration, being 60.2% mixed, 25.8% Amerindian, 5.9% white, 3.6% African descent, 1.2% Chinese and Japanese descent, and 3.3% unspecified. Studies on CYP2C19*3, CYP2D6*2, *3 and *6 have been reported in Peruvians, and the frequency is similar to that studied in Ecuadori-ans and Colombians. The CYP2C19*3, CYP2D6*3, and CYP2D6*6 alleles found in Peruvians are common in Europeans, Africans, and Asians; while CYP2D6*4 in Africans and CYP2D6*2 related to Asians. In some studies, the ethnic/gene association has not been demonstrated; while others have shown a significant association, which is why further investigation is warranted. It is concluded that the studies on CYP2D6 and CYP2C19 genes associated with the tricontinental and Latin American ancestry of Peruvians are little, and ac-cording to what has been investigated, the CYP2C19*3, CYP2D6*2, *3, *4 and *6 alleles have more related to their ancestry.

The Effect of Alcohol on Cardiovascular Risk Factors: Is There New Information?

The effects of alcohol on cardiovascular health are heterogeneous and vary according toconsumption dose and pattern. These effects have classically been described as having a J-shapedcurve, in which low-to-moderate consumption is associated with less risk than lifetime abstention,and heavy drinkers show the highest risk. Nonetheless, the beneficial effects of alcohol have beenquestioned due to the difficulties in establishing a safe drinking threshold. This review focuses onthe association between alcohol consumption and cardiovascular risk factors and the underlyingmechanisms of damage, with review of the literature from the last 10 years.

Niveles plasmáticos de Vitamina D en adultos mayores de Lima Metropolitana, Perú

Objetivo. Determinar los niveles plasmáticos de vitamina D y su relación con la ocupación, procedencia y los valores de calcio, leucocitos, hemoglobina y plaquetas en adultos mayores de Lima Metropolitana. Método. Estudio observacional descriptivo de corte transversal, participaron 100 adultos mayores de uno u otro sexo de Lima Metropolitana, ellos fueron reclutados durante las estaciones de invierno-primavera del 2022, los niveles de vitamina D se categorizó como suficiente, insuficiente y deficiente, las concentraciones séricas de vitamina D se midieron por radioinmunoensayo. La relación de variables se realizó con el coeficiente de correlación de Spearman y regresión logística. Resultados. La edad media fue 69.6 años, el 71%, fueron del sexo femenino, la concentración media de vitamina D fue 36.56 ng/ml, el 13% tuvieron niveles de deficiente, y el 32% de insuficiente y el 53% suficientes. Según sexo, el 77,7% de los que tuvieron niveles de deficiente/insuficiente fueron mujeres. En el análisis bivariado no hubo correlación entre los valores de vitamina D con calcio, hemoglobina leucocitos y plaquetas, los que procedieron de distritos de menor temperatura tuvieron 2,25 veces más riesgo de tener niveles insuficientes/deficiente de vitamina D. Conclusiones. El 45% de los adultos mayores tuvieron niveles deficientes/insuficiente de vitamina D, siendo más frecuente en las mujeres y de los procedentes de distritos de menor promedio de temperatura.

Objective. To determine the plasmatic levels of vitamin D and its relationship with the occupation, origin and the values of calcium, leukocytes, hemoglobin and platelets in older adults of Metropolitan Lima. Methods Observational descriptive cross-sectional study, 100 older adults of either sex from Metropolitan Lima participated, they were recruited during the winter-spring seasons of 2022, vitamin D levels were categorised as sufficient, insufficient, and deficient, serum vitamin D concentrations were measured by radioimmunoassay. The relationship of variables was established with the Spearman correlation coefficient and logistic regression. Results. The mean age was 69.6 years, 71% were women, the mean vitamin D concentration was 36.56 ng/ml, 13% had deficient levels, 32% were insufficient and 53% sufficient. By sex, 77.7% of those with deficient/insufficient levels were women. In the bivariate analysis, there was no correlation between vitamin D values with calcium, hemoglobin, leukocytes and platelets; those who came from districts with lower temperatures had a 2.25 times greater risk of having insufficient/deficient levels of vitamin D. Conclusions. 45% of older adults had deficient/insufficient levels of vitamin D, more frequent in women and those coming from districts with lower average temperatures.

[Clinical features and outcome in patients with mucormycosis in a tertiary hospital (2012-2016)]. / Características clínicas y evolución de los pacientes diagnosticados de mucormicosis en un hospital de tercer nivel (2012-2016).

BACKGROUND: The most common presentation of mucormycosis in the past was the nasosinusal involvement in patients with diabetic ketoacidosis. However, in the last few years, new groups of patients with risk of mucormycosis have emerged. AIMS AND METHODS: Retrospective analysis of the characteristics, treatment and evolution of patients with mucormycosis in a tertiary hospital in the years 2012-2016. RESULTS: Of the 12 patients included in the study, 7 had a haematological disease as a predisposing factor, most of them (6 patients) related to transplantation of haematopoietic progenitors. Only one patient had diabetic ketoacidosis. Seven out of the twelve patients were receiving an antifungal treatment at the onset of symptoms, and 9 patients had received them three months before. The clinical presentation was rhinosinusal (16.6%), localised lung disease (33.3%), and musculoskeletal (25%) and disseminated disease (25%). Surgical debridement was performed on 8 patients. Combination therapy with amphotericin B and posaconazole was received by 6 patients (16% mortality), and 4 patients were treated with amphotericin B alone (50% mortality), with an overall mortality of 41%. The mortality of patients with pulmonary involvement was 71%, increasing to 100% in the case of disseminated disease. None of the patients with only musculoskeletal involvement died. CONCLUSIONS: Mucormycosis has a high mortality rate, especially the pulmonary forms. Musculoskeletal involvement had a better prognosis. The main group at risk was that of patients with haematopoietic stem cell transplantation. Combination therapy had better results than monotherapy, although more experience is needed to define the most appropriate treatment.

Aclorhidria, gastrinemia y mucosa gástrica normal en sujetos de altura / Aclorhidria, gartrin blood and normal gastric mucosa in altitude subjets

De acuerdo a los esquemas conocidos, no se admite la existencia de aclorhidria con mucosa gástrica normal. Reportamos en un grupo de habitantes de altura, aclorhidria con mucosa gástrica normal verificada endoscópica e histológicamente. Asimismo, la aclorhidria basal e histamino resistente se acompaña de una mayor gastrinemia en comparación con un grupo normoclorhídrico, apreciándose una relación inversa entre acidez y gastrina. Una marcada disminución de células parietales o ausencia de receptores de gastrina e histamina estarían determinando la aclorhidria, y una hiperfunción o hiperplasia de células G la gastrinemia incrementada