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Advanced chronic kidney disease and the different modalities of renal replacement therapies have been a great limitation when prescribing the different conventional and biological therapies used for the treatment of different autoimmune diseases. Many of them persist with great activity, requiring the use of other types of medications such as glucocorticoids or non-steroidal anti-inflammatory drugs, further perpetuating their adverse effects. Addditionally, most clinical studies have excluded patients with chronic kidney disease and the evidence for continuing biological treatments in this scenario is based on pharmacokinetic properties or case reports where the outcomes have been favorable. The lack of knowledge and the absence of clear guidelines for decision-making regarding starting conventional or biological therapy in this context generate a lack of continuity in the prescription of treatments, which decreases the therapeutic response and negatively affects the quality of life. from the patients. For this reason, a narrative review is carried out with the aim of establishing a practical consensus that unifies the recommendations for each of the treatments most frequently used in the control of various autoimmune diseases in patients with advanced chronic kidney disease.

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs, and its coexistence with Giant Cell Arteritis (GCA) is extremely rare. We present, to our knowledge, the first reported case of a 56-year-old woman with SLE and extracranial GCA who presented with chest pain as the cardinal symptom. The diagnosis was subsequently confirmed by imaging studies, ruling out Takayasu arteritis and SLE-related vasculitis. She required treatment with glucocorticoids and tocilizumab, showing a satisfactory evolution. Accurate diagnosis was key to preventing serious vascular complications and achieving favorable clinical recovery., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Vergara-Serpa et al.)

Although human immunodeficiency virus (HIV)-associated arthropathy is the most frequently described joint syndrome, the spectrum of its clinical manifestations is poorly known, and it is difficult to distinguish it from reactive arthritis (ReA). Knowing how to differentiate these two conditions has major implications regarding their prognosis and treatment. We present the case of an adult patient with a history of HIV infection with adequate virological control and good adherence to antiretroviral treatment, which began with an acute clinical picture consisting of additive asymmetric oligoarthritis with subsequent transition to symmetric polyarthritis predominantly in the upper extremities, initially attributed to ReA. Finally, his immunoserological profile was determined with negative results for rheumatoid factor, anti-citrulline antibodies, and human leukocyte antigen B27, achieving complete resolution of joint symptoms five weeks after treatment with nonsteroidal anti-inflammatory drugs, hydroxychloroquine, and intermediate doses of glucocorticoids, establishing the diagnosis of HIV-associated arthropathy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Santacruz et al.)

Ecuador had substantial COVID-19-mortality during 2020 despite early implementation of non-pharmaceutical interventions (NPIs). Resource-limited settings like Ecuador have high proportions of informal labour which entail high human mobility, questioning efficacy of NPIs. We performed a retrospective observational study in Ecuador's national reference laboratory for viral respiratory infections during March 2020-February 2021 using stored respiratory specimens from 1950 patients, corresponding to 2.3% of all samples analysed within the Ecuadorian national surveillance system per week. During 2020, detection of SARS-CoV-2 (Pearson correlation; r  = -0.74; p  = 0.01) and other respiratory viruses (Pearson correlation; r  = -0.68; p  = 0.02) by real-time RT-PCR correlated negatively with NPIs stringency. Among respiratory viruses, adenoviruses (Fisher's exact-test; p  = 0.026), parainfluenzaviruses ( p  = 0.04), enteroviruses ( p  < 0.0001) and metapneumoviruses ( p  < 0.0001) occurred significantly more frequently during months of absent or non-stringent NPIs (characterized by <55% stringency according to the Oxford stringency index data for Ecuador). Phylogenomic analyses of 632 newly characterized SARS-CoV-2 genomes revealed 100 near-parallel SARS-CoV-2 introductions during early 2020 in the absence of NPIs. NPI stringency correlated negatively with the number of circulating SARS-CoV-2 lineages during 2020 ( r  = -0.69; p  = 0.02). Phylogeographic reconstructions showed differential SARS-CoV-2 dispersion patterns during 2020, with more short-distance transitions potentially associated with recreational activity during non-stringent NPIs. There were also fewer geographic transitions during strict NPIs ( n  = 450) than during non-stringent or absent NPIs ( n  = 580). Virological evidence supports that NPIs had an effect on virus spread and distribution in Ecuador, providing a template for future epidemics in resource-limited settings and contributing to a balanced assessment of societal costs entailed by strict NPIs.

Although it is widely known that joint involvement is the most frequent and prevalent manifestation of systemic lupus erythematosus (SLE), not having a validated organ-specific index for this domain in order to guide its treatment has been a major limitation. In addition, its clinical importance had been underestimated since it was not a vital risk domain; it was never the center of treatment, under the premise that in most cases its progression was slow and did not lead to significant functional disability. However, this concept has been changing due to the greater description of erosions both in ultrasonography and in osteoarticular magnetic resonance, so their identification can establish a more appropriate treatment time and thus avoid joint deformities, which in some cases can become irreversible. Recently, anifrolumab and belimumab have been able to significantly reduce the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and British Isles Lupus Assessment Group (BILAG) index scores, along with improvement in quality of life indices and a significant decrease in the required dose of glucocorticoids. Despite this, the ideal moment to consider biological therapy in this domain is not clear, since the clinical examination can sometimes be biased by the pain associated with fibromyalgia or the fatigue associated with SLE. For this reason, perhaps ultrasonography or magnetic resonance imaging, apart from differentiating the joint phenotype, can identify patients in time to define the onset of disease-modifying antirheumatic drugs and rationalize the use of glucocorticoids. The objective of this review is to characterize in detail the joint manifestations of SLE to offer the clinician a practical view of its diagnosis and treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Santacruz et al.)

Gastric cancer is a multifactorial disease with important genetic and environmental factors. It is the fifth most common cancer in incidence, and the fourth cause of death secondary to cancer. The incidence of early-onset gastric cancer is increasing worldwide, but clinical information on these patients has not been well established. We analyzed the association between age and clinical, endoscopic, and histopathological characteristics of gastric cancer at the time of diagnosis in a Latin American population. A retrospective and descriptive cross-sectional study was carried out using the database of the Gastroenterology Service of the Clínica Foscal and Clínica Foscal Internacional in Bucaramanga, Colombia. Between January 2016 and December 2019, 259 de novo gastric cancer cases were diagnosed, of which 36 patients (13.9%) were 40 years old or younger. In patients with early-onset gastric, the prevalence of gastric cancer diagnosis was lower in men. A family history of gastric cancer or any other neoplasm was not associated with a higher prevalence of gastric neoplasms. In young patients, vomiting and ascites were more common, the preferred anatomical location was the body of the stomach, and the Borrmann IV classification and the diffuse-type histology were more likely. Our study showed an approximation of the characteristics of early-onset gastric cancer in a Latin American population, where we observed that early-onset gastric cancer has different demographic, anatomical, and histological features than late-onset gastric cancer.

Introduction: the autopsy is an essential medical procedure; however, its use has declined over the decades. In autoimmune and rheumatological diseases, anatomical and microscopic diagnosis is critical to diagnose of the cause of death. For this reason, our objective is to describe the cause of death in patients diagnosed with autoimmune and rheumatic diseases who underwent an autopsy in a Pathology reference center in Colombia., Materials and Methods: a retrospective and descriptive study of autopsy reports., Results: between January 2004 and December 2019, 47 autopsies of patients with autoimmune and rheumatological diseases were performed. Systemic lupus erythematosus and rheumatoid arthritis were the most common diseases. The leading cause of death was related to infections, being opportunistic infections in the majority of the cases., Conclusions: our autopsy-based study was focused on patients with autoimmune and rheumatological conditions. Infections are the leading cause of death, particularly opportunistic infections, diagnosed mainly by microscopy. Thus, the autopsy should continue to be considered the "gold standard" to determine the cause of death in this population., Competing Interests: Conflict of interest: None., (Copyright: © 2023 The Authors.)

Background: Tuberculosis is a disease of great relevance since it is one of the leading causes of morbidity and mortality worldwide. Gastrointestinal tuberculosis is an unusual presentation. It is defined as the involvement of any segment of the digestive tract, associated viscera, and peritoneum. The study's main objective is to collect information from autopsies of patients diagnosed with gastrointestinal tuberculosis in a Pathology reference center in Colombia., Methods: This is a retrospective and descriptive study of autopsy reports. A total of 4,500 autopsies were performed between January 2004 and December 2020. The inclusion criteria were authorization of a family member following local law regulations and a final autopsy diagnosis of gastrointestinal tuberculosis using microscopic visualization., Results: Forty-eight patients with gastrointestinal tuberculosis autopsies were included in our study. Most of the patients were male ( n  = 35, 72.9%) with a median age of 40.5 years old. Human immunodeficiency virus infection history was reported in 28 cases (58.33%). The most affected gastrointestinal tract site was the terminal ileum. Ulcers and thickened epithelium were common autopsies macroscopic findings. Tuberculosis multiorgan compromise was a relevant finding in patients with gastrointestinal tuberculosis., Conclusions: Gastrointestinal tuberculosis is a disease of great importance, being its diagnosis a clinical challenge. Underdiagnosis can be reported in a high percentage of cases, so autopsy diagnosis can help reveal more accurate data about this condition., (© 2023 The Authors. Published by Elsevier Ltd on behalf of Tsinghua University Press.)

Background: Chikungunya virus (CHIKV) diagnosis has become a challenge for primary care physicians in areas where the Zika virus and/or Dengue virus are present. Case definitions for the three arboviral infections overlap., Methods: A cross-sectional analysis was carried out. A bivariate analysis was made using confirmed CHIKV infection as the outcome. Variables with significant statistical association were included in an agreement consensus. Agreed variables were analyzed in a multiple regression model. The area under the receiver operating characteristic (ROC) curve was calculated to determine a cut-off value and performance., Results: 295 patients with confirmed CHIKV infection were included. A screening tool was created using symmetric arthritis (4 points), fatigue (3 points), rash (2 points), and ankle joint pain (1 point). The ROC curve identified a cut-off value, and a score ≥ 5.5 was considered positive for identifying CHIKV patients with a sensibility of 64.4% and a specificity of 87.4%, positive predictive value of 85.5%, negative predictive value of 67.7%, area under the curve of 0.72, and an accuracy of 75%., Conclusion: We developed a screening tool for CHIKV diagnosis using only clinical symptoms as well as proposed an algorithm to aid the primary care physician.

The spectrum of pulmonary manifestations associated with mixed connective tissue disease ranges from pulmonary hypertension and interstitial lung disease to pleural effusions, alveolar hemorrhage, and complications from the thromboembolic disease. Interstitial lung disease in mixed connective tissue disease is a frequently occurring entity, although in most cases it tends to be self-limited or slowly progressive. Despite this, a significant percentage of patients may present a progressive fibrosing phenotype, thus posing a great challenge regarding its therapeutic approach, given the scarcity of clinical studies that compare the efficacy of immunosuppressants available to date. Due to this, many recommendations are extrapolated from other diseases with similar characteristics such as systemic sclerosis and systemic lupus erythematosus. That is why it is proposed to carry out an advanced search of the literature in order to clarify its clinical, radiological, and therapeutic characteristics to achieve its evaluation from a holistic point of view., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Santacruz et al.)

Background: Infections are an important cause of mortality in patients with autoimmune diseases and opportunistic infections account for a large percentage of these cases. It is often a clinical challenge to find a balance between immunosuppressive therapy and the risk of developing an infectious process., Methods: A retrospective, descriptive study of autopsy reports., Results: 15 patients with a premortem diagnosis of autoimmune disease were included. All patients died due to an opportunistic infection. The most commonly reported infection was tuberculosis, followed by invasive fungal infections., Conclusions: The most prevalent pathogens were found in our autopsy-based study of patients with autoimmune diseases and opportunistic infections. Prevention and early detection strategies are vital in order to reach a correct diagnosis and begin the appropriate treatment as soon as possible., (Copyright © 2022 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.)

Malassezia, a lipophilic and lipid-dependent yeast, is a microorganism of current interest to mycobiologists because of its role as a commensal or pathogen in health conditions such as dermatological diseases, fungemia, and, as discovered recently, cancer and certain neurological disorders. Various novel approaches in the study of Malassezia have led to increased knowledge of the cellular and molecular mechanisms of this yeast. However, additional efforts are needed for more comprehensive understanding of the behavior of Malassezia in interactions with the host. This article reviews advances useful in the experimental field for Malassezia., Competing Interests: The authors have declared that no competing interests exist.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with an unknown etiology that can affect any organ or system of the human body. Hematological, renal, or central nervous system manifestations in these patients result in great morbidity because high doses of glucocorticoids, cytotoxic medications, or biological drugs are required to control these manifestations. It is noteworthy that hematological involvement predominates during the first years of the disease and tends to last over time, with the premise that it may be the initial manifestation of the disease. Clear examples of this are the cases of hemolytic anemia and immune thrombocytopenia that can be initially classified as idiopathic or primary to be later classified as secondary when associated with infections, medications, neoplasms, or autoimmune diseases. The spectrum of hematologic manifestations in SLE is very broad, including lymphopenia, anemia, thrombocytopenia, or pancytopenia. In some cases, lymphadenopathy and splenomegaly are also identified. The vast majority of these manifestations denote high disease activity. However, many of these alterations have a multifactorial cause that must be taken into account to adopt a more complete therapeutic approach. The objective of this review is to characterize in detail the hematological manifestations of SLE to offer clinicians a practical vision of its diagnosis and treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Santacruz et al.)

Antiphospholipid syndrome (APS) is an autoimmune disease that can lead to thrombotic or obstetric complications. Recent histopathological studies have shown the absence of placental thrombosis, leading to the consideration of other pathophysiological pathways such as inflammation and complement activation. Due to this, various clinical studies are being carried out with different drug agents in order to avoid their complications. The combination of prophylactic heparin treatment and low doses of aspirin today result in successful pregnancies in most cases. Despite this, a minority of patients require alternative therapies to avoid recurrent miscarriage and decrease obstetric morbidity. Thanks to the better understanding of its pathophysiology, other treatments such as low doses of glucocorticoids, hydroxychloroquine (HCQ), immunoglobulin, pravastatin, and plasmapheresis have been considered in refractory cases, achieving favorable results. Despite the great advances regarding its treatment, unfortunately, there are no treatments with a good level of evidence to reduce late obstetric complications. The evaluation of preconception risk factors, as well as the antiphospholipid antibody profile, is necessary to establish individual risk and thus anticipate possible complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Santacruz et al.)

Systemic lupus erythematosus is a multisystemic disease that usually involves the urinary tract, often in the form of lupus nephritis. However, another form of compromise of this system is lupus cystitis, which, despite being an unusual condition, turns out to be a challenging diagnosis due to the spectrum of nonspecific abdominal and urinary symptoms. Although the exact pathophysiological mechanism of bladder inflammation remains to be established, the role of small vessel vasculitis measured by immune complexes continues to be supported as a central axis for considering possible therapeutic targets. Additionally, there are no clinical studies that dictate a guideline regarding its treatment, however, the evidence from most cases described in the literature suggests the initiation of pulses of methylprednisolone and cyclophosphamide in treatment regimens similar to those of lupus nephritis. Despite its low prevalence, obstructive complications and kidney damage can lead to increased morbidity and mortality., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Santacruz et al.)

In the current medical literature, there is increasing evidence for the involvement of the interleukin (IL)-17/23 axis and the potential role of Th17 cells in the pathogenesis of lupus nephritis. Knowledge about the interaction of these immunological pathways in the development of autoimmune diseases has led to the identification of new therapeutic strategies aimed at blocking them. For this reason, the main objective of this review focuses on knowing the recent evidence of the different anti-IL-17/23 treatment strategies in lupus nephritis and their future perspectives. A non-systematic narrative review of the literature was carried out following the objective of having the most representative information on the different anti-IL-17/23 drugs available together with the description of the pathophysiological mechanisms of this pathway involved in systemic lupus erythematosus and lupus nephritis. Despite the great existing theoretical foundation, today few clinical studies support the use of these therapies in both contexts. Nevertheless, the publication of research with a better methodology is expected to approve the indication of some of these drugs in lupus nephritis. However, the clinical response seen with ustekinumab and secukinumab in clinical studies and case reports published to date has been encouraging., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Santacruz et al.)

Malassezia spp. are lipid-dependent yeasts that have been related to skin mycobiota and dermatological and systemic diseases. Study of lipid droplets (LDs) is relevant to elucidate the unknown role of these organelles in Malassezia and to gain a broader overview of lipid metabolism in Malassezia. Here, we standardized two protocols for the analysis of LDs in M. pachydermatis and M. globosa. The first describes co-staining for confocal laser-scanning fluorescence microscopy, and the second details extraction and purification of LDs. The double stain is achieved with three different neutral lipid fluorophores, namely Nile Red, BODIPY™ 493/503, and HCS LipidTOX™ Deep Red Neutral, in combination with Calcofluor White. For LD extraction, cell wall rupture is conducted using Trichoderma harzianum enzymes and cycles of vortexing with zirconium beads. LD purification is performed in a three-step ultracentrifugation process. These standardizations will contribute to the study of the dynamics, morphology, and composition of LDs in Malassezia. © 2021 Wiley Periodicals LLC. Basic Protocol 1: Lipid droplet fluorescence staining Basic Protocol 2: Lipid droplet extraction and purification Support Protocol: Malassezia spp. culture conditions., (© 2021 Wiley Periodicals LLC.)

Malassezia yeasts are lipid dependent and part of the human and animal skin microbiome. However, they are also associated with a variety of dermatological conditions and even cause systemic infections. How these yeasts can live as commensals on the skin and switch to a pathogenic stage has long been a matter of debate. Lipids are important cellular molecules, and understanding the lipid metabolism and composition of Malassezia species is crucial to comprehending their biology and host-microbe interaction. Here, we investigated the lipid composition of Malassezia strains grown to the stationary phase in a complex Dixon medium broth. In this study, we perform a lipidomic analysis of a subset of species; in addition, we conducted a gene prediction analysis for the detection of lipid metabolic proteins. We identified 18 lipid classes and 428 lipidic compounds. The most commonly found lipids were triglycerides (TAG), sterol (CH), diglycerides (DG), fatty acids (FAs), phosphatidylcholine (PC), phosphatidylethanolamine (PE), ceramides, cholesteryl ester (CE), sphingomyelin (SM), acylcarnitine, and lysophospholipids. Particularly, we found a low content of CEs in Malassezia furfur , atypical M. furfur , and Malassezia pachydermatis and undetectable traces of these components in Malassezia globosa, Malassezia restricta , and Malassezia sympodialis . Remarkably, uncommon lipids in yeast, like diacylglyceryltrimethylhomoserine and FA esters of hydroxyl FAs, were found in a variable concentration in these Malassezia species. The latter are bioactive lipids recently reported to have antidiabetic and anti-inflammatory properties. The results obtained can be used to discriminate different Malassezia species and offer a new overview of the lipid composition of these yeasts. We could confirm the presence and the absence of certain lipid-biosynthesis genes in specific species. Further analyses are necessary to continue disclosing the complex lipidome of Malassezia species and the impact of the lipid metabolism in connection with the host interaction., (Copyright © 2020 Celis Ramírez, Amézquita, Cardona Jaramillo, Matiz-Cerón, Andrade-Martínez, Triana, Mantilla, Restrepo, Barrios and Cock.)

"Psychoanalysis versus psychiatry" and "unconscious versus brain" are classic oppositions between different perspectives on the human being and mental suffering. This article draws on certain elements of this discussion and reflects on how new ideas about the brain and biology favor closer interaction between psychoanalysis and the neurosciences. These questions are redefined through the notion of cerebral plasticity, by which the brain is open to interaction with the social environment and the influence of psychoanalytical therapy. Conceiving of the brain as a plastic organ allows for the possibility of interchange between psychoanalysis and the neurosciences.