Durante las últimas décadas, el mundo se ha expuesto a una serie de amenazas por brotes virales emergentes de diferente índole, los cuales, sólo al estudiarlos en detalle, surge la posibilidad de comprender su verdadero impacto, no sólo de forma inmediata, si no también, a largo plazo. Recientemente, el 12 de diciembre de 2019, la Comisión Municipal de Salud de Wuhan, en la República Popular de China, hizo público un reporte de 27 casos humanos quienes cursaron con una neumonía viral, de los cuales 7 pacientes se encontraban en condiciones críticas, la cual tenía como etiología un nuevo patógeno humano con alta capacidad zoonótica, conocido provisionalmente como Coronavirus novel 2019 (2019-nCoV), y unas semanas después como Enfermedad por Coronavirus 2019 (COVID-19) causada por el virus SARS-CoV-2.
Background: Flow cytometry evaluates the number CD4-Positive T-Lymphocytes in patients infected with HIV/AIDS in anti-retroviral management, which orientates therapies towards different targets. Previously, a methodology was designed based on probability and set theories from leukocyte and lymphocyte counts of complete blood count, although predictions in time were not developed, which is why is wanted to establish a methodology of clinical applicability to temporarily forecast the values of CD4+ greater than 500, between 200 and 500 and lesser than 200 from the values of CD4+ and leukocytes of each patient. Methods: From sequential counts of CD4+ and leukocytes of 200 cases, the registries of 10 prototypical patients were observed to establish predictive patterns, and then these patterns were are applied to the remaining patients in a blind study, finding the probability of success of the methodology as well as sensitivity and specificity values. Results: 5 patterns were found with percentages greater than 99% of predictive accuracy for the distinct conditions of the methodology, with values of sensitivity and specificity of 99%. Conclusions: through a mathematical theoretical simplification, a temporal self-organization in the sequence of measurements of leukocytes and CD4+ lymphocytes were established, highlighting the loading of probability in the dynamic of CD4+ counts, useful to conduct more appropriate following ups of patients in anti-retroviral management.
El advenimiento de las terapias biológicas para el manejo de múltiples enfermedades ha estado asociado con la reactivación o susceptibilidad a ciertas entidades infecciosas durante el uso de estas. El estudio de la fisiopatología del asma ha permitido llegar al reconocimiento de los diferentes mecanismos distintivos de esta enfermedad, facilitando así el desarrollo de terapias personalizadas que apunten al proceso sistémico subyacente de la enfermedad y resulten en un mayor beneficio para el paciente. Hasta el momento, estas terapias han demostrado un gran impacto en la mejoría de los síntomas y la calidad de vida de los pacientes; sin embargo, se empieza a evidenciar que, con su uso, algunos pacientes presentan con frecuencia enfermedades de origen infeccioso, como las infecciones respiratorias de origen viral, y susceptibilidad a parasitosis, como las más relevantes, de acuerdo con el mecanismo de acción de la terapia biológica empleada en el asma.En esta revisión narrativa de la literatura, se describen los hallazgos más recientes encontrados sobre el perfil de seguridad infecciosa en el uso de omalizumab y mepolizumab, como terapia biológica con mayor estudio para el manejo del asma severo refractario, con el fin de dar a conocer los riesgos infecciosos de estas moléculas y generar algunas recomendaciones para la prevención y el manejo de estas en nuestro contexto latinoamericano.Palabras clave: asma; terapia biológica; anticuerpos monoclonales; omalizumab; mepolizumab. AbstractThe advent of biological therapy for the treatment of multiple diseases, has been related to the reactivation or susceptibility to certain infectious entities during its use. The understanding of asthma physiopathology has led to the recognition of diverse and distinctive mechanisms of the disease, allowing the development of targeted biological therapies directed to the underlying systemic disease process and resulting in a greater benefit for patients. Until present, these therapies have demonstrated a pronounced impact on symptoms improvement and on patient life quality; however, it is now being plausible the appearance of infectious diseases, such as viral respiratory infections and susceptibility to parasitism, among the most important illnesses related to mechanism of action of biological therapies used in asthma.In this narrative review we described the most recent findings found about infectious safety profile for the use of biological therapy in asthma with Mepolizumab and Omalizumab, being those two the most used biological therapies used in treatment of severe refractory asthma; with the purpose of announce the infectious risks of this molecules and generate some recommendations for prevention and management of this risks in our Latinamerican context.
Objective. To predict the amount of CD4+/μL3 in sequences of patient records with CD4 T lymphocyte values above 500 cells/μL3 and / or between 200 to 500 cells/μL3 from the absolute leukocyte count in the context of the theory of probability.Materials and methods. Two mathematical inductions were performed to find predictive mathematical relationships for CD4+/μL3 when they are above 500 cells/μL3 and between 200 to 500 cells/μL3, from the absolute count of leukocytes. Subsequently, the probability of success of the predictions was calculated, two blind studies were performed on 80 remaining data, and sensitivity and specificity were calculated for both cases.Results and discussion. If there are more than three records in time per patient, and these are above 500 CD4/μL3 cells or between 200 to 500 CD4/μL3 cells, finding that the absolute leukocyte count has a greater or equal value to three and lower to 4 for all the records, the following record will be maintained with a measurement of CD4 lymphocytes>500 or between [200, 500], if in the absolute count of leukocytes of the patient sequences a value of four is observed and CD4+ ranges from 200 to 500 cells/μL3, it can be deduced that there will be at least one measurement of CD4 +>500 cells/μL3 associated with a leukocyte measurement / μL3 greater than 3.7.Conclusions. We established two temporal mathematical patterns capable of predicting the CD4+/μL3 count from the absolute leukocyte count.
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