Carlos Alberto Cañas

Introduction: This study aimed to determine the expression of cannabinoid receptors in lymphocytes from patients with systemic lupus erythematosus (SLE) compared with healthy controls, and to evaluate whether receptor expression is associated with disease activity. Methods: Using peripheral blood mononuclear cells from 35 SLE patients and 35 healthy controls, we employed multiparametric flow cytometry to characterize T-cell and B-cell subpopulations and their expression of cannabinoid receptors 1 (CB1R) and 2 (CB2R). Results: Our results reveal a significant imbalance in receptor expression: SLE patients exhibited higher CB2R and lower CB1R levels compared with controls across multiple subsets. Notably, CB1R expression strongly correlated with disease activity, while patients in remission showed expression patterns more similar to healthy individuals. Furthermore, CB2R expression in specific B-cell subsets correlated with clinical manifestations, and its distribution pattern demonstrated a significant ability to distinguish between active disease and remission in ROC analysis. Discussion: These findings indicate that SLE is characterized by altered cannabinoid receptor profiles in lymphocytes, suggesting that CB1R and CB2R modulation could serve as both a clinical biomarker and a potential therapeutic target for managing the disease.

Introduction: Type B insulin resistance syndrome (TBIRS) is an immune-mediated disorder characterized by severe acanthosis nigricans and difficult-to-control diabetes mellitus. This condition represents a complex clinical challenge. Objective: To describe the case of a patient compatible with Type B insulin resistance syndrome, highlighting the challenges in glycemic control and the response to immunosuppressive therapy combined with a hybrid continuous subcutaneous insulin infusion system. Case Presentation: A 57-year-old woman with a history of limited cutaneous systemic sclerosis and type 2 diabetes mellitus presented with severe insulin resistance, acanthosis nigricans, and markedly elevated blood glucose levels. Anti-insulin receptor antibodies were consistently negative. The patient received multiple treatments, including plasmapheresis, immunosuppressive therapy, and continuous subcutaneous insulin infusion using a MiniMed® 780G system, resulting in improved continuous glucose monitoring metrics and a reduction in daily insulin requirements. Discussion: This case suggests a possible association between systemic sclerosis and Type B insulin resistance syndrome despite persistently negative anti-insulin receptor antibodies. A false-negative result may be explained by prior immunomodulatory treatments. The combination of immunosuppressive therapy and a hybrid closed-loop continuous subcutaneous insulin infusion system demonstrated favorable clinical outcomes. Conclusion: This case report contributes to the. understanding of Type B insulin resistance syndrome and highlights the potential benefit of integrating immunosuppressive therapies with advanced insulin delivery technologies. Further studies are needed to define their role in the management of patients with severe insulin resistance

Objectives: To compare the treatments used for the first episode of lupus nephritis (LN) in two Latin American cohorts (historical and contemporary) over a 25-year period, and their associations with clinical outcomes. Methods: Patients with biopsy-confirmed first LN episode were classified as non-proliferative (class V) or proliferative (classes III/IV). Sociodemographic, clinical, and treatment variables were described. Propensity score matching was used to examine the associations with four outcomes: mortality, damage accrual (SDI), hospitalization, and end-stage renal disease (ESRD). Results: A total of 532 SLE patients were included: 362 from GLADEL 1.0 (historical cohort) and 170 from GLADEL 2.0. (contemporary). Compared to GLADEL 1.0, patients in GLADEL 2.0 received lower doses of oral glucocorticoids (GC), more frequently GC pulses and antimalarials but less frequently cyclophosphamide. An increase in the use of mycophenolate mofetil and other immunosuppressants was also observed. In the logistic regression models, SDI was associated with baseline SDI and GC pulses, whereas belonging to the GLADEL 2.0 was a protective factor. Mortality was associated with Mestizo ethnicity and partial health coverage; antimalarial was identified as a protective factor. Hospitalizations were associated with baseline SLEDAI and SDI, follow-up time, and lower educational level. Belonging to the GLADEL 2.0 cohort was protective against the occurrence of ESRD. Conclusions: Patients in the contemporary cohort benefited from advances in treatment strategies, with less cumulative damage and progression to ESRD, although mortality remained unchanged. These improvements likely reflect the increased use of newer therapies, more targeted approaches, in line with current treatment guidelines, and better access to specialized care.

This review traces the historical trajectory of ophidiology (the study of snakes) and ophidism (snakebite envenoming) within the Colombian context. Despite the profound cultural and scientific significance of the human–serpent relationship in the region, the relevant literature remains fragmented, with foundational historical works neither digitized nor readily accessible. To address this, we conducted a narrative review of primary sources spanning from the pre-Colombian era to the present. Our methodology involved sourcing material from specialized libraries, historical archives, personal collections and contemporary scientific databases. The analysis identifies and contextualizes pivotal contributions across distinct historical periods, from early archeological evidence and colonial accounts to foundational eighteenth-century works and the formalized scientific studies of the last two centuries. The review culminates by highlighting how modern Colombian research, including significant international collaborations, is now producing influential work on snake biology, venoms and envenoming that commands global attention.

Objective To assess the efficacy and safety of subcutaneous perispinal infiltration of low dose of triamcinolone and lidocaine indicated for pain control in patients with cervical osteoarthritis (COA). Methods Patients with symptomatic COA resistant to conventional treatment including anti-inflammatory drugs, analgesics, and physical therapy were included. Technetium-99 m pyrophosphate (99mTc-PYP) scintigraphy and computerized tomography (CT) fusion scans images were used for diagnosis of COA and as a guide for level(s) of infiltration(s). Infiltration consisted of subcutaneous administration of 1 cc of a mixture of triamcinolone (6 mg/0.7 cc) and 2% lidocaine (6 mg/0.3 cc) into the posterior central interspinal area, at the levels where the greatest uptake of the radiotracer was observed. Response was assessed using a pain analogue scale (PAS) (range 0–10 with 10 representing worst pain). Results Forty-two patients were included. Thirty-six (85.7%) were women. The mean age was 59.2 years. Three months after infiltration clinical improvement was confirmed by a decrease in the PAS value: before and after infiltrations was 7.26 (range 4–10, SD:1.48) and 1.97 (range 0–6, SD:1.24), respectively. This difference being statistically significant (P < 0.05). No patient presented local or systemic adverse effects. Conclusions Low dose subcutaneous perispinal injection of triamcinolone and lidocaine may offer clinical benefits for patients with symptomatic COA refractory to conventional treatments. 99mTc-PYP/CT fusion scans images were useful as a guide for localization of infiltrations.

Envenomation caused by venomous snakes can induce clinical symptoms and signs resembling those of traumatic acute compartment syndrome (ACS), but it is uncertain whether its treatment guidelines are applicable or beneficial for ACS that is associated to snakebites. Nonetheless, recommendations for the diagnosis and treatment of trauma-induced ACS, particularly following fractures of the tibial diaphysis, are extrapolated to the diagnosis and treatment of snakebites despite evidence that the ensuing injuries are frequently not true ACS. Most biologists agree that the venom of snakes, especially those of the Crotalinae family (vipers) evolved to immobilize, kill, and initiate the digestion of their prey. The human local effects of viper envenoming are the result of digestion like those described in biological processes as acute pancreatitis, including secondary inflammatory and induction of reparative effects. The first-line treatment should focus on mitigation of venom-induced tissue digestion rather than surgery solution for “ACS-like” symptoms and signs. This type of analysis leads to questioning that treatment of ACS associated with snakebite cannot be extrapolated from recommendations formulated for trauma-induced ACS. The cornerstone of snake envenoming treatment is antivenom, and some clinical and experimental experiences start to show that surgical procedures frequently employed for trauma-induced ACS, such as debridement and fasciotomy, may be exaggerated and even deleterious in most viper bite envenoming.