Sprue-like enteropathy associated with angiotensin II receptor blockers (ARBs) is a rare cause of chronic diarrhea and malabsorption, typically characterized by villous atrophy and intraepithelial lymphocytosis mimicking celiac disease. Although olmesartan is the most frequently implicated agent, cases associated with other ARBs, including losartan, have increasingly been recognized. A 61-year-old woman with hypertension treated with losartan for three years presented with a three-month history of abdominal pain and chronic diarrhea. Upper endoscopy revealed a macroscopically and histologically normal duodenum. Colonoscopy demonstrated macroscopically normal ileal mucosa; however, ileal biopsies showed villous atrophy and marked intraepithelial lymphocytosis. Celiac serology was negative, infectious causes were excluded, and vitamin B12 deficiency was documented. In the setting of chronic exposure to losartan and after exclusion of alternative etiologies, ARB-associated sprue-like enteropathy was suspected. Losartan was discontinued and replaced with amlodipine, resulting in complete clinical resolution. This case highlights an atypical presentation of losartan-induced sprue-like enteropathy with isolated ileal involvement and a histologically normal duodenum. Clinicians should consider this entity in patients presenting with chronic diarrhea and seronegative villous atrophy, even in the absence of duodenal involvement.
ABSTRACT Understanding the immune response against HIV-1 and the natural resistance exhibited by HIV-exposed Seronegative Individuals (HESN) offers the possibility of proposing new control strategies. Several studies suggest an important role of HLA and KIR genes in protecting against HIV-1 infection. Moreover, there is an important gap in the knowledge of these genetic factors in seronegative Latin American men who have sex with men (MSM), a population largely underrepresented in HIV immunogenetic studies. This study aimed to identify HLA and KIR genetic profile associated with potential resistance to HIV-1 acquisition, in a cross-sectional study including a cohort of 60 HIV-1-seronegative Colombian MSM at low and high risk of HIV-1 infection. The high-risk group showed a higher frequency of the HLA-B*18 allele, and a lower frequency of the HLA*B35, which have been previously associated with protection and susceptibility to HIV-1 infection respectively. Likewise, the high-risk group exhibited a low frequency of Bx haplotypes, a higher frequency of one AA haplotype and differences in KIR gene profile, with a low frequency of the inhibitory KIR2DL5 and both activating KIR2DS1, KIR2DS2 and KIR2DS5 genes. These findings suggest that host immunogenetic factors may contribute to resistance to HIV-1 acquisition in highly exposed individuals. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by MinCiencias & Universidad de Antioquia, [Grant 111565740820]; and Universidad Cooperativa de Colombia [Grants INV3765, INV1900]. SAPIENCIA Alcaldia de Medellin gave funds to Ana C. Ossa-Giraldo for her doctoral studies [Extendiendo Fronteras Educativas Convocatoria 2017-2 Fund]. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the University of Antioquia School of Medicine (Act No. 007, May 22, 2014). Informed consent was obtained from all participants prior to their inclusion in the study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.
Cerebral venous thrombosis is an uncommon but potentially serious condition primarily affecting young women. Thrombosis of the vein of Labbé is a rare site of thrombosis linked to hemorrhagic venous infarction. Thrombotic events have been reported in patients with chronic primary immune thrombocytopenia (ITP) treated with thrombopoietin receptor agonists (TPO-RAs). A 33-year-old woman with chronic ITP, treated with romiplostim for five years, presented with a progressively worsening occipital headache and a generalized seizure. Computed tomography showed a left parietotemporal intraparenchymal hemorrhage. Magnetic resonance imaging and venography confirmed left sigmoid sinus thrombosis and a hemorrhagic venous infarction caused by thrombosis of the vein of Labbé, along with signs indicating a previous superior sagittal sinus thrombosis. Romiplostim was discontinued after the event, and anticoagulation, along with corticosteroids, was started due to a decline in platelet count. Common causes of cerebral venous thrombosis were investigated and ruled out. The patient was discharged asymptomatic on hospital day 12 and was seen for outpatient follow-up. This case highlights a rare presentation of Labbé vein thrombosis in the setting of long-term use of TPO-RAs and supports a possible association.
BACKGROUND:Shared decision-making (SDM) has been linked to improved patient- and physician-reported outcomes. To achieve these benefits, both parties need to agree on implementing SDM. The objective of the study was to compare the perception of SDM process implementation in daily practice between patients with rheumatic diseases (RMDs) and rheumatologists. METHODS:This cross-sectional study was conducted in April 2024 in Latin America (LATAM). Adult patients diagnosed with RMDs and rheumatologists were invited to participate in a web-based survey based on the Spanish patient version of the 9-item SDM questionnaire (SDM-Q-9) and the physician version (SDM-Q-Doc). Both versions were validated tools for evaluating patients' and physicians' perceived levels of SDM. Descriptive statistics and comparative tests (e.g., chi-square or Mann-Whitney U test) were used to analyze the data. Statistical significance was set at p<0.05, and analyses were conducted using STATA 17 software. RESULTS:We received surveys from 369 patients, primarily systemic lupus erythematosus (51.8%) and rheumatoid arthritis (19.5%), across 17 countries. The largest number of responses was from Mexico (42%) and Colombia (11.9%). The survey was completed by 144 rheumatologists from 10 countries, primarily from Colombia (52.8%) and Chile (23.6%). Physicians most frequently strongly agree/agree that they engaged in the different steps of the SDM process, compared to patients, and this difference was less evident for the step "sharing with the patient the different options for treating the condition." Also, a higher percentage of rheumatologists (96.5%) reported engaging in SDM during clinical practice compared to patients (62.3%), p=0.001. CONCLUSIONS:In LATAM, rheumatologists more frequently referred to implementing the SDM process during clinical care than patients with RMDs. Further research is needed to improve patient-centered care.
Introduction: HPN is a clonal disease of hematopoietic stem cells, characterized by intravascular hemolysis, thrombotic episodes, risk of bone marrow failure, and damage to organs such as the kidney and lung. Mutations in the PIGA gene cause a deficiency of glycosylphosphatidylinositol (GPI)-anchored proteins, increasing cellular susceptibility to complement-mediated lysis. Given its variable clinical presentation, early diagnosis and continuous monitoring with flow cytometry (CF) are crucial for effective management. Objective: To describe the application of CF in the diagnosis and follow-up of patients with HPN, highlighting its usefulness, benefits, and limitations. Methods: A literature review was conducted in databases such as PubMed, Embase, Scopus, Web of Science, and Google Scholar of studies published between January 2000 and July 2024. Studies in humans that describe the use of CF in the diagnosis and monitoring of HPN were included. Results: 40 studies were selected. CF has high sensitivity and specificity (>95%) for detecting GPI-deficient cells using markers such as CD55 and CD59. CF was effective for quantifying clonal burden, monitoring response to anti-C5 treatment, and detecting complications such as thrombosis and myelodysplastic syndromes. Advanced CF techniques allowed for the identification of clones at low levels (<0.1%), facilitating timely clinical interventions. Conclusions: Flow cytometry supports the diagnosis and monitoring of HPN, improving disease management and optimizing treatment.
