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Ítem Calcium, channels, intracellular signaling and autoimmunity(2014-01-01) Cañas Dávila, Carlos AlbertoCalcium (Ca2+) is an important cation able to function as a second messenger in different cells of the immune system, particularly in B and T lymphocytes, macrophages, and mastocytes, among others. Recent discoveries related to the entry of Ca2+ through the store-operated calcium entry (SOCE) have opened a new investigation area about the cell destiny regulated by Ca2+ especially in B and T lymphocytes. SOCE acts through calcium-release-activated calcium (CRAC) channels. The function of CRAC depends upon two recently discovered regulators: the Ca2+ sensor in the endoplasmic reticulum or stromal interaction molecule (STIM-1) and one subunit of CRAC channels called Orai1. This review focuses on the role of Ca2+ signals in B and T lymphocytes functions, the signaling pathways leading to Ca2+ influx, and the relationship between Ca2+ signals and autoimmune diseases.
Ítem Local cartilage trauma as a pathogenic factor in autoimmunity (one hypothesis based on patients with relapsing polychondritis triggered by cartilage trauma).(Elsevier, 2012-01-01) Bonilla Abadía, FabioIn the recent years, it has been of great interest to study the binding mechanism between the innate and adaptive immune responses as interrelated processes for the development of multiple autoimmune diseases. Infection has been a well-known trigger of autoimmunity and trauma has been related as well too. Cryptogenic antigens release, recognition of pathogenic structure, and metabolic changes generated by both stimuli begin an inflammatory process which in turn activates the immune system amplifying T and B cell responses. The development of relapsing polychondritis after trauma may have a direct association with these events and in turn probably trigger autoimmune phenomena.Ítem Diabetic muscle infarction: two cases: one with recurrent and bilateral lesions and one with usual unilateral involvement.(Lippincott, Williams & Wilkins, 2013-04-01) Cadavid Aljure, DahyanaDiabetic muscle infarction is a rare complication of diabetes. We describe 2 cases of diabetic muscle infarction, each one of them with a particular form of clinical presentation: recurrence, bilateral engagement, and unilateral compromise. Both cases had history of poorly controlled diabetes mellitus and diabetic nephropathy. The diagnosis was based on clinical, imaging, and anatomopathological features. The treatment was with a close control of diabetes mellitus, analgesics, short-term immobilization, and physical therapy.Ítem Pneumocystis jirovecii pneumonia in two patients with systemic lupus erythematosus after rituximab therapy(Springer-Verlag London Ltd, 2014-03-01) Betancurt, J. F.New cases of Pneumocystis jirovecii pneumonia (PJP) have recently been reported in patients with systemic lupus erythematosus (SLE) after rituximab therapy. Several factors may contribute to susceptibility to P. jirovecii infection in this type of patients, including the immunological characteristics of the disease, the mechanisms of rituximab action, environmental factors, and the biological characteristics of the fungus. We report two patients with SLE who developed PJP after rituximab therapy.Ítem Psychiatric manifestations in patients with dysautonomy associated with systemic lupus erythematosus(SAGE Publications, 2012-09-01) Bonilla Abadía, FabioThe psychiatric manifestations of three patients with systemic lupus erythematosus (SLE) and neuropathic dysautonomic processes are described. All patients had a severe form of SLE with neurological, renal, articular, pulmonary or haematological manifestations. All three have two types of psychiatric manifestations: (1) a chronic and progressive depression and (2) a complex dissociative disorder during the acute episodes of postural hypotension. A provocative test with SPECT with 99mTc-HmPAO to be done during the episode of orthostatic hypotension may contribute to clinical assessment of complex changes in cerebral regional perfusion.Ítem The importance of evolution in the development and course of rheumatoid arthritis(Elsevier, 2014-06-01) Cañas Dávila, Carlos AlbertoRheumatoid arthritis (RA) is a complex autoimmune disease of recent evolutionary origin. Genetic drift determines diverse polymorphisms implicated in the susceptibility to RA including the major histocompatibility complex (MHC) class II genes in the so-called shared epitope. These genes originated after the divergence between Homo and Pan from their common ancestry Ardipithecus ramidus about 5 million years ago. Natural selection determined the particular changes in the legs (bipedal position), hands, neck, brain and eusociality in humans which influence the clinical presentation of RA. In this article, we hypothesized that the origin and course of RA may be explainable in the light of evolution.Ítem Efficacy of anti-interleukin-6 receptor antibody (tocilizumab) in colombian patients with takayasu’s arteritis(BMJ Publishing Group Ltd, 2013-06-01) Izquierdo, Jorge H.Background Takayasu’s arteritis (TA) is a chronic vasculitis that involves aorta and its main branches, where interleukin-6 (IL-6) seems to play a pathogenic role (1,2). The effect in four patients treated with the anti-IL-6 receptor (IL-6R) antibody Tocilizumab was evaluated. Objectives to describe the effect of Tocilizumab in patients of Takayasu’s arteritis. Methods We reviewed the clinical records of 4 patients with TA diagnosed according to current criteria, treated between 2010 and 2011 in a tertiary center in Cali, Colombia. Four patients with a refractory disease to multiple treatments, was began treatment with Tocilizumab at a dose of 8 mg/kg every month in association with metothrexate and/or steroids. Two patients were treated previously with infliximab (IFX) without control of disease. This cases were reported previously (3). Results The cases summaries are as follows: Case 1. A 30 year-old woman with a diagnosis of TA since 2003 presented panaortitis, with involvement of supra-aortic,Ítem Recovery of severe muscular and fascial calcinosis after treatment with bisphosphonates in a child with juvenile dermatomyositis(Lippincott Williams and Wilkins, 2015-08-01) Bonilla Abadía, FabioAbstract: Juvenile dermatomyositis (JDM) is a serious systemic autoimmune condition primarily affecting proximal muscles and skin, which is frequently associated with calcinosis. We report a case of a 10-year-old boy with JDM and severe calcification deposits along fasciae and muscle planes. He complained of symptoms associated to JDM with pulmonary involvement since 1 year before receiving medical attention. Three months before consultation, he experienced bilateral leg pain accompanied by progressive hardening of muscles and the presence of small nodules around the elbows and submandibular region. Computed tomography images revealed a severe “eggshell” calcification pattern of the lower-limb muscular fasciae. Significant clinical and radiological improvement was achieved after 30 months of alendronate therapyÍtem Severe deformans tophaceous gouty arthritis(Elsevier, 2017-03-01) Zuñiga Velásquez, AliciaA 61-year-old man with a 20-year history of gout with severe functional disability was evaluated in our service. He received alopurinol and colchicine without response. Physical examination revealed bilateral great deformity, multiple tophi and edema of hands (Fig. 1), feet and knees. Serum uric acid was elevated: 11.2 mg/dL (reference value: 3.4–7.0 mg/dL). Hands X-ray AP view demonstrated, in both hands (Fig. 2A [left] and B [right]), conserved bone mineralization with severe soft-tissue swelling, extensive erosions with sclerotic borders (white arrows), precipitation of calcium with urate crystals giving density to the tophi (head arrows), bone spiculations (black arrows) and osteolytic expansive lesions in multiple heads of metacarpophalangic joint (double-head arrows).Ítem Direct oral anticoagulants in antiphospholipid syndrome: A real life case series(SAGE Publications Ltd, 2016-01-06) Cañas Dávila, Carlos AlbertoAim The aim of this study was to describe a case series of patients with primary or secondary antiphospholipid syndrome (APS) treated with direct oral anticoagulants (DOACs). Patients and methods Clinical charts of eight patients with thrombotic primary or secondary APS treated with direct oral anticoagulants (DOACs) between January 2012 and May 2015 were reviewed. Results The mean age was 45 ± 14.36 (range 27-69 years). Four patients had secondary APS (50%). All patients were initially treated with warfarin by a mean time of 70.87 ± 57.32 months (range 17-153 months). Changes in anticoagulation were defined by recurring thrombosis in five patients (62.5%) and life-threatening bleeding in the other three cases. Seven patients (87.5%) received rivaroxaban treatment and one patient (12.5%) apixaban. The mean follow-up period with DOACs was 19 ± 10.06 months (range 2-36 months). There was no recurrence of thrombosis by the time of data collection. Conclusions Despite not being the standard treatment in APS, we propose DOACs as a rational alternative for the management of patients with this diagnosis. Further interventional clinical studies are necessary for possible standardization of this therapy in APS patients.