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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2022;158:43-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Normotensive pheochromocytoma associated with ganglioneuroma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "43" "paginaFinal" => "44" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Feocromocitoma normotensivo asociado a ganglioneuroma" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 875 "Ancho" => 2917 "Tamanyo" => 396373 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Computed tomography, showing the left adrenal tumor (red circle), mixed, predominantly cystic, with septa in its interior that enhance with contrast. (B) Macroscopy of the adrenal tumor: a sector of the remaining compressed adrenal is visualized (arrow). (C) Histopathological findings (hematoxylin and eosin staining), microscopic examination of pheochromocytoma. Tumor cells show eosinophilic cytoplasm, without evident cellular or nuclear atypia, separated by fine connective tracts.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gabriela Mintegui, Beatriz Mendoza, Carolina Guarneri" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Gabriela" "apellidos" => "Mintegui" ] 1 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Mendoza" ] 2 => array:2 [ "nombre" => "Carolina" "apellidos" => "Guarneri" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0025775321002451" "doi" => "10.1016/j.medcli.2021.03.032" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321002451?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006835?idApp=UINPBA00004N" "url" => "/23870206/0000015800000001/v2_202201200752/S2387020621006835/v2_202201200752/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2387020621006720" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.05.008" "estado" => "S300" "fechaPublicacion" => "2022-01-07" "aid" => "5705" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2022;158:41-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Mid-term effects of SARS-CoV-2 infection on cardiovascular outcomes" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "41" "paginaFinal" => "42" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efectos cardiovasculares a medio plazo de la infección por SARS-CoV-2" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2258 "Ancho" => 1500 "Tamanyo" => 179042 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">All-cause death and cardiovascular outcomes at six months follow-up in patients with or without COVID-19. (A) All-cause death time-to-event curve. (B) Six months follow-up cardiovascular outcomes. ACS, acute coronary syndrome; CV, cardiovascular; HFH, heart failure hospitalization; PE, pulmonary embolism.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Victor Arévalos, Luis Ortega-Paz, Salvatore Brugaletta" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Victor" "apellidos" => "Arévalos" ] 1 => array:2 [ "nombre" => "Luis" "apellidos" => "Ortega-Paz" ] 2 => array:2 [ "nombre" => "Salvatore" "apellidos" => "Brugaletta" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006720?idApp=UINPBA00004N" "url" => "/23870206/0000015800000001/v2_202201200752/S2387020621006720/v2_202201200752/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Belimumab in refractory systemic lupus erythematosus pleural effusion" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "42" "paginaFinal" => "43" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Vicenç Torrente-Segarra, Maria Bonet" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Vicenç" "apellidos" => "Torrente-Segarra" "email" => array:1 [ 0 => "vtorrente@csap.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Maria" "apellidos" => "Bonet" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Rheumatology Department; Hospital Comarcal Alt Penedès-Garraf (CSAPG), Vilafranca del Penedès, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de belimumab en derrame pleural secundario a lupus eritematoso sistémico refractario" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the publication in Medicina Clínica by Salman-Monte et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> describing belimumab as a useful alternative therapy in systemic lupus erythematosus serositis (SLE). This research group have published satisfactory treatment response to belimumab for refractory pericarditis<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> and pleuritis<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> in SLE who fulfilled 1982 American College of Rheumatology criteria for SLE.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Mainly, SLE patients who develop refractory serositis may show short or long-standing SLE course. Several immunosuppressants (methotrexate, hydroxychloroquine, leflunomide along with low-medium prednisone dosage; and aspirin for the pericarditis SLE patient) were prescribed to control other than serositis symptoms. Since majority of these SLE features are frequent and mild, though, the need to control patients’ serositis symptoms, short of breath and serositis severity (massive pleuritis) made the authors try belimumab in order to control disease activity. Despite patients had previously failed to control disease activity through several treatments, belimumab showed both rapid efficacy and safety. Within a span of 6 months, both patients showed significant clinical improvement with no SLE flares and prednisone dosage was lowered. Altohugh several trials of belimumab have been performed in SLE, there is no specific data in serositis outcome, nor even in clinical practice.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a 29-year old woman with stablished SLE diagnosed in April 2018 with following ACR SLE criteria: malar rash, oral ulcers, photosensitivity, positive antinuclear antibodies (ANA) (1/640 titer) and anti-dsDNA antibodies testing. The patient also showed Raynaud's phenomenon hypocomplementaemia, positive RNP and Sm antibodies testing and polyarthralgia and fatigue. Initially, the patient responded to low-dose prednisone and hydroxychloroquine therapy. Patient also suffered from mild allergic asthma. In September 2019 the patient showed short of breath, chest pain, non-productive cough and a massive left pleuritis in the X-ray testing with an exudative pleural effusion evidence after performing diagnostic thoracocentesis. After common respiratory and systemic infections and malignant, metabolic, cardiac and renal conditions were ruled out, patient initiated high-prednisone dosage and mycophenolate mophetil 720<span class="elsevierStyleHsp" style=""></span>mg daily, alongside hydroxychloroquine. Despite observing a moderate response after eight months of treatment, a moderate right pleuritis image in the routinely X-ray testing was demonstrated, higher anti-dsDNA level and worse hypocomplementaemia were present. Therefore, we considered mycophenolate mophetil as insufficient to control SLE activity (SLEDAI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8) and subcutaneous belimumab was started. Since belimumab was initiated, the patient showed slow but evident improvement (negativization of anti-dsDNA levels, normalization of complement levels, significant X-ray and clinical improvement), allowing to reduce prednisone to 5<span class="elsevierStyleHsp" style=""></span>mg daily and stop mycophenolate mophetil treatment within six months.</p><p id="par0015" class="elsevierStylePara elsevierViewall">To the best of our knowledge, the case we present is the second pleuritis SLE patient who show positive outcome during belimumab treatment, and the third suffering serositis (pleuritis and/or pericarditis) as well. In our case, a bilateral involvement was seen after intensive immunosuppressant and prednisone therapy. The latter highlights the need to control the underlying disease as, despite receiving intensive immunosuppressant treatment, the patient showed worsening of her pulmonary SLE involvement and evidence of serological SLE flare. Belimumab offered an alternative to better control disease in our case and we suggest including ‘serositis’ to the spectrum of SLE treatable features with belilmumab when other more well-known immunosuppressants fail to control SLE activity.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors do not have conflict of interest for this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Belimumab, a useful alternative therapy in systemic lupus erythematosus serositis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.C. Salman-Monte" 1 => "I. Carrión-Barberà" 2 => "E. Rodríguez García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2020" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful treatment of systemic lupus erythematosus pleuropericarditis with belimumab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Carrión-Barberà" 1 => "T.C. Salman-Monte" 2 => "S. Castell" 3 => "F. Castro-Domínguez" 4 => "F. Ojeda" 5 => "J. Monfort" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5152/eurjrheum.2019.17169" "Revista" => array:6 [ "tituloSerie" => "Eur J Rheumatol" "fecha" => "2019" "volumen" => "6" "paginaInicial" => "150" "paginaFinal" => "152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31364982" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The 1982 revised criteria for the classification of systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.M. Tan" 1 => "A.S. Cohen" 2 => "J.F. Fries" 3 => "A.T. Masi" 4 => "D.J. McShane" 5 => "N.F. Rothfield" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.1780251101" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1982" "volumen" => "25" "paginaInicial" => "1271" "paginaFinal" => "1277" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7138600" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Response to belimumab among patients with systemic lupus erythematosus in clinical practice settings: 24-month results from the OBSErve study in the USA" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.E. Collins" 1 => "M. Dall’Era" 2 => "H. Kan" 3 => "C. Macahilig" 4 => "C. Molta" 5 => "V. Koscielny" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/lupus-2015-000118" "Revista" => array:5 [ "tituloSerie" => "Lupus Sci Med" "fecha" => "2016" "volumen" => "3" "paginaInicial" => "e000118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26835146" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015800000001/v2_202201200752/S2387020621006823/v2_202201200752/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015800000001/v2_202201200752/S2387020621006823/v2_202201200752/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006823?idApp=UINPBA00004N" ]
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