Posterior reversible encephalopathy syndrome (PRES) is a poorly recognized and reversible condition in systemic lupus erythematosus (SLE) that could mimic neuropsychiatric lupus. The manifestations of PRES are headache, seizures, altered level of consciousness and blindness. In most cases, computed tomography of the brain shows hypodense lesions in the parieto-occipital lobe. Although this syndrome is rare, rapid and accurate recognition allows early treatment with favorable results. We present a case report of a patient with the onset of SLE following the episode of eclampsia, and who during the late puerperium presented sustained hypertension associated with seizures and deterioration of the level of consciousness in the context of PRES.

RESUMEN INTRODUCCIÓN:La cesárea es una intervención quirúrgica que tiene por objeto extraer el producto de la concepción, vivo o muerto . En Ecuador según la encuesta ENDEMAIN entre 1994 a 2006 la tasa de cesáreas ha incrementado en un 8 .7% . Según el INEC 2006, los porcentajes de cesárea aumentan en establecimientos privados (32%) con relación a los públicos (15 .5%) . En la Fundación Pablo Jaramillo durante el año 2011 se incrementó este hecho, motivo por el cual se ha decidido realizar un estudio retrospectivo para analizar cuáles fueron las principales causas de este incremento . MATERIALES Y MÉTODOS:Es un estudio descriptivo realizado en la Fundación Pablo Jaramillo . La población a ser estudiada serán todas las mujeres embarazadas, quienes terminaron su gestación por cesárea . Las variables a emplearse son: edad materna, semanas de gestación en la que se terminó el embarazo, diagnósticos establecidos como indicación de cesárea . RESULTADOS:La primera causa de cesárea fue la cesárea anterior con un 32 .4%, luego el sufrimiento fetal agudo con un 8%, desproporción céfalo -pélvica con un 7 .8%, dilatación estacionaria con un 7,3%, trastornos hipertensivos del embarazo con 7 .3%, distocias de presentación con un 6 .4%, ruptura prematura de membranas con un 4 .1%, cesárea iterativa 1 con un 3 .4%, distocias óseas con un 3 .1% y Macrosomía fetal con un 2% . CONCLUSIÓN:La cesárea anterior fue la principal causa de cesárea en la población atendida en la Fundación Pablo Jaramillo durante el 2011 .

BackgroundIn SLE there is five times more risk of cardiovascular events (CV) compared to the general population. In Argentina, a prevalence of metabolic syndrome (MetS) was reported in 28%. The SLICC cohort found 36.5% of MS in the first 2 years of diagnosis.The neutrophil to lymphocyte ratio (NLR) is a marker of inflammation that relates the absolute count of neutrophils and lymphocytes, is a tool in the assessment of CV risk and systemic endothelial dysfunction. The NLR values reported in healthy is 1.65 (±1.47). Studies in SLE show that NLR is a marker of activity and nephritis.We aimed to determine the association of MetS with and without renal involvement, the relationship between NLR and MetS and relationship between NLR and disease activity.MethodsDescriptive, cross-sectional study.Patients with SLE (SLICC 2012) of <5 years of evolution and >18 years followed at the Güemes Hospital were included, between 06/2013 to 07/2018.Acute CV events, infections, pregnancy, diabetes and chronic kidney disease were excluded.Risk factors nontraditional were determined: antiphospholipid (aPL), GC, SLEDAI.MetS (NCEP ATP III criteria): Weight, height, abdominal perimeter (AP) and blood pressure.PCR, neutrophil and lymphocyte count, glucose, CT, TG, LDL, urea, creatinine, proteinuria/24hs, Anti DNA, C3, C4, aPL: LA, Anti B2GP and Anti aCL antibody.Statistical Analysis: Epi Info 7.2.0.ResultsA total of 42 patients were reviewed, 12 were excluded (incomplete data).Of 30 patients: 23 women (77%), mean age 39.3 (±SD 14.3), evolution of disease: 35 months (±SD 18.9), tobacco exposure: 11 (37%). Nephritis in 17 patients (51%).MetS: 13 (43.3%), components: AP increased 15 (50%), HDL low 11 (37%), hypertension 11 (37%), high TG 8 (27%), hyperglycemia 3 (10%). Overweight: 17 (57%).Mean BMI 27.4 (±DS 6.2).Characteristics of patients with and without MetS and relationship MetS and SLE with NLR. (Table).Abstract 63 Table 1Characteristics of patients with and without MetS and relationship MetS and SLE with NLRConclusionsIn our series, a greater frequency of MetS was found than literature. No relationship was found between MetS with renal involvement; however patients with MetS had higher proteinuria and elevated CRP.No relationship was found between the NLR with MetS and nephritis. The NLR was higher in patients with SLEDAI 4.The high prevalence of MetS, proteinuria, elevated CRP and NLR in our population suggest persistent inflammatory activity and probable CV morbidity, so it is important to detect it from the onset of the disease.Funding Source(s):None

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune de etiología aún desconocida, afecta a individuos genéticamente predispuestos. Es desencadenado por factores hormonales, estrogénicos, ambientales y virales como hepatitis B/C, citomegalovirus (CMV), herpes o parvovirus B19 (PVB19). El PVB19 puede afectar diferentes órganos y presentar manifestaciones clínicas e inmunológicas, similares a las que se observan en pacientes con LES. Se han descripto alteraciones inmunológicas hasta en 79% de los pacientes con infección asociada por PVB19, principalmente positivización de anticuerpos antinucleares (ANA).

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