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Antiphospholipid syndrome (APS) is an autoimmune disease characterized by thrombosis and pregnancy morbidity (PM) obstetric events together with persistent high titers of circulating antiphospholipid antibodies (aPL). Several mechanisms that explain the development of thrombosis and PM in APS include the association of aPL with alterations in the coagulation cascade and inflammatory events. Other mechanisms disturbing cellular homeostases, such as mitochondrial dysfunction, autophagy, and cell proliferation, have been described in other autoimmune diseases. Therefore, the objective of this study was to investigate the impact of aPL from different patient populations on endothelial cell mitochondrial function, activation of the mammalian target of rapamycin (mTOR) and autophagy pathways, and cellular growth. Using an in vitro model, human umbilical vein endothelial cells (HUVECs) were treated with polyclonal immunoglobulin G (IgG) purified from the serum of women with both PM and vascular thrombosis (PM/VT), with VT only (VT), or with PM and non-criteria aPL (seronegative-obstetric APS, SN-OAPS). We included IgG from women with PM without aPL (PM/aPL-) and healthy women with previous uncomplicated pregnancies (normal human serum, NHS) as control groups. Mitochondrial function, mTOR activation, autophagy, and cell proliferation were evaluated by Western blotting, flow cytometry, and functional assays. IgG from women with PM/VT increased HUVEC mitochondrial hyperpolarization and activation of the mTOR and autophagic pathways, while IgG from patients with VT induced endothelial autophagy and cell proliferation in the absence of elevated mTOR activity or mitochondrial dysfunction. IgG from the SN-OAPS patient group had no effect on any of these HUVEC responses. In conclusion, aPL from women with PM and vascular events induce cellular stress evidenced by mitochondrial hyperpolarization and increased activation of the mTOR and autophagic pathways which may play a role in the pathogenesis of obstetric APS.

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Antiphospholipid syndrome is an autoimmune disease characterized by the persistent presence of antiphospholipid antibodies, along with occurrence of vascular thrombosis and pregnancy morbidity. The variety of antiphospholipid antibodies and their related mechanisms, as well as the behavior of disease in wide groups of patients, have led some authors to propose a differentiation of this syndrome into two independent entities: vascular and obstetric antiphospholipid syndrome. Thus, previous studies have discussed whether specific autoantibodies may be responsible for this differentiation or, in contrast, how the same antibodies are able to generate two different clinical presentations. This discussion is yet to be settled. The capability of serum IgG from patients with vascular thrombosis to trigger the biogenesis of endothelial cell-derived microparticles in vitro is one of the previously discussed differences between the clinical entities of antiphospholipid syndrome. These vesicles constitute a prothrombotic mechanism as they can directly lead to clot activation in murine models and recalcified human plasma. Nevertheless, other indirect mechanisms by which microparticles can spread a procoagulant phenotype could be critical to understanding their role in antiphospholipid syndrome. For this reason, questions regarding the cargo of microparticles, and the signaling pathways involved in their biogenesis, are of interest in attempting to explain the behavior of this autoimmune disease.

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Objective. To evaluate the aspirin resistance prevalence in patients with previous ischemic cerebrovascular disease undergoing aspirin therapy for secondary prevention. Materials and Methods. Three hundred fifty patients presenting ischemic strokes and 100 healthy controls under aspirin treatment were evaluated using the optic platelet aggregation test. Results. Aspirin resistance was found in 7.4% of the patients with ischemic stroke and 4% of controls. Aspirin resistance was associated with stroke recurrence in univariate analysis ( p = 0.004 ). Aspirin resistance was not associated with smoking, diabetes, or hypercholesterolemia. Conclusion. Aspirin resistance is present in Colombian patients with ischemic stroke as well as in healthy controls.

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Objetivo: Identificar el proceso de bioseguridad en los equipos de aerosolterapia por parte de cuidadores en atención domiciliaria en la ciudad de Cali, Colombia, en el año 2016. Método: Se realizó un estudio observacional, descriptivo y de corte transversal. La población de estudio correspondió a 54 adultos, cuidadores primarios (n=16) y profesionales (n=38) pertenecientes al programa de terapia respiratoria de la IPS SISANAR. Se diseñó un instrumento de recolección de datos, tipo encuesta. Fue utilizado el paquete estadístico Stata 10 para el análisis de los datos, los cuales fueron revisados y validados. Las frecuencias y porcentajes se calcularon, así como los intervalos de confianza al 95%. Resultados: Se encontró que el 96.3% de los participantes realiza el lavado de manos clínico antes de ejecutar la terapia nebulizada, de los cuales el 55.8% usa tapabocas para el proceso de lavado de los micronebulizadores, el 28.8% usa guantes y el 15.4% no utiliza ninguno. La desinfección de los micronebulizadores la realizó el 59.3% de los participantes. Esta desinfección es realizada principalmente con hipoclorito y gel antibacterial. Discusión: Es importante formalizar la educación oportuna por medio de protocolos, dirigidos a los pacientes y cuidadores primarios frente a los procesos de limpieza y bioseguridad en el mantenimiento de los equipos de aerosolterapia en atención domiciliaria, lo cual permitirá la disminución de sobreinfecciones asociadas con microorganismos presentes en los equipos.