No abstract

This study was conducted to assess the clinical spectrum, management, and outcome of SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C). We reviewed medical records of children with MIS-C diagnosis seen at the Children's Hospital of Michigan in Detroit between April and June 2020. Thirty-three children were identified including 22 who required critical care (group 1) and 11 with less intense inflammation (group 2). Children in group 1 were older (median 7.0 years) than those in group 2 (median 2.0 years). Abdominal pain was present in 68% of patients in group 1. Hypotension or shock was present in 17/22 patients in group 1. Thirteen (39.4%) had Kawasaki disease (KD)-like manifestations. Five developed coronary artery dilatation; All resolved on follow-up. Intravenous immunoglobulin (IVIG) was given to all patients in group 1 and 7/11 in group 2. Second-line therapy was needed in 13/22 (group 1) for persisting inflammation or myocardial dysfunction; 12 received infliximab. All patients recovered. Conclusion: MIS-C clinical manifestations may overlap with KD; however, MIS-C is likely a distinct inflammatory process characterized by reversible myocardial dysfunction and rarely coronary artery dilatation. Supportive care, IVIG, and second-line therapy with infliximab were associated with a favorable outcome.

A cross-sectional study was performed among seropositive individuals who sought HIV treatment at an outpatient clinic in San Jose, Costa Rica, to determine the prevalence, predictors, and reasons for nonadherence to antiretroviral. A structured, face-to-face interview was administered to 88 patients. The primary outcome of adherence was measured as taking 100% of medications within 3 days prior to interview. A number of risk factors, including demographic information, HIV knowledge, logistics of the regimen, and management skills were assessed. Statistical analyses included logistic regression. Eighty-five percent of patients took 100% of their medications in the last 3 days. Factors that were correlated with nonadherence included difficulty in finding transportation to the clinic (odds ratio [OR] = 6.3, p = 0.01), not laying pills out as a management skill (OR = 9.9, p = 0.01), and prescription instructions to take medication on an empty stomach (OR = 6.7, p = 0.03). HIV-positive patients in this Costa Rican sample were fairly adherent to their drug regimens. To increase adherence among non-adherent individuals, interventions that increase access in remote areas and help people manage their regimens may be beneficial.

In this study, eight common polymorphisms associated with venous thrombosis (VT) and thrombophilia factors were analyzed in a Costa Rican case-control study. With the use of polymerase chain reaction (PCR) methods the polymorphisms were detected in 120 patients and 133 controls (mean age <40 years old). It was concluded that a high level of fibrinogen, antiphospholipid antibodies, family history, and the genotype 34LeuLeu of FXIII OR 0.42 (0.20-0.89) showed a significant effect on the risk of VT. Associations between the risk of VT and genetic polymorphisms have been established. Some of these polymorphisms are highly prevalent in Caucasians, but there is a significant geographic variation in their prevalence among different populations. The results of this study support the protective effect of FXIII Val34Leu polymorphism in VT. These findings are consistent with previous reports that included other populations.

La dislipidemia es una de las complicaciones más frecuentes en los pacientes infectados por el VIH que reciben tratamiento antiretroviral. Su manejo se ve complicado por las interacciones entre algunos de las terapias hipolipemiantes y los inhibidores de proteasa. Estas guías buscan facilitar el abordaje de estos casos tanto en el diagnóstico, su clasificación y manejo no farmacológico como farmacológico.