Rendimiento del ASAS Health Index en pacientes con Espondiloartritis de la vida real / Performance of ASAS Health Index in real life spondyloarthritis patients

Introducción: El cuestionario "Assessment of Spondyloarthritis International Society Health Index" (ASAS-HI) fue desarrollado para medir de manera global la funcionalidad y el estado de salud en pacientes con espondiloartritis (EspA). Se han propuesto puntos de corte para determinar diferentes estados de salud que fueron poco evaluados en pacientes de la vida real. Objetivos: Describir el estado de salud medido por ASAS-HI en pacientes argentinos con EspA axial (EspAax) y periférica (EspAp) en la práctica diaria y evaluar los factores asociados al pobre estado de salud. Materiales y métodos: Estudio de corte transversal, analítico y multicéntrico. Se incluyeron consecutivamente pacientes con EspAax y EspAp según criterios ASAS, de 15 centros argentinos. Análisis estadístico: Se realizó estadística descriptiva, análisis bivariado y multivariado (regresión logística múltiple) para evaluar los factores asociados al pobre estado de salud (ASAS-HI ≥12). Para analizar la validez de constructo de la herramienta se realizó correlación de Spearman entre el ASAS-HI y otros parámetros de evaluación de la enfermedad. Resultados: Se incluyeron 274 pacientes con EspA, con una edad media de 49 (±14) años y una duración mediana de la enfermedad de 62 meses (p25-75: 24-135), 155 (56,6%) de los pacientes eran de sexo masculino, 129 pacientes (47%) con EspAax y 145 (52,9%) EspAp. Según el ASAS-HI 119 pacientes (43,4%) presentaban buen estado de salud, 117 (42,7%) tenían estado de salud moderado y 38 (13.9%) pobre estado de salud. En los pacientes con EspAp el valor de ASAS-HI mediano fue de 7 (p25-75: 3-10). El ASAS-HI correlacionó positivamente con: DAS28: rho: 0.5 (p<0.001) y HAQ: rho: 0.54 (p<0.001). La variable asociada de manera independiente con pobre estado de salud fue el DAS28 (OR: 1.9, IC95% 1.1-3.4, p: 0.029). En los pacientes con EspAax el valor de ASAS-HI mediano fue de 6 (p25-75: 2.75-10). El ASAS-HI mostró correlación con: BASDAI: rho: 0.7 (p<0.001), ASDAS-ERS: rho: 0.7 (p<0,001), ASQoL: rho: 0.8 (p<0.001), BASFI rho: 0.75 (p<0.001). La variable que se asoció de manera independiente a pobre estado de salud fue el ASDAS-ERS (OR 6.6, IC95% 2-22, p 0.002). Conclusión: Un pobre estado de salud se asoció independientemente a mayor actividad de la enfermedad en pacientes con EspAax y EspAp. El ASAS-HI correlacionó con otros parámetros de la enfermedad, lo que refuerza la validez de constructo de esta nueva herramienta.

Introduction: The "Assessment of Spondyloarthritis International Society Health Index" (ASAS-HI) questionnaire was developed to globally measure function and health status in patients with spondyloarthritis (SpA). Cut-off points have been proposed to determine different health states that were poorly evaluated in real-life patients. Objectives: To describe the health status measured by ASAS-HI in Argentine patients with axial SpA (AxSpA) and peripheral SpA (SpAp) in daily practice and to evaluate the factors associated with poor health. Materials and methods: Cross-sectional, analytical and multicenter study. Patients with SpAax and SpAp were consecutively included according to ASAS criteria, from 15 Argentine centers. Statistical analysis: Descriptive statistics, bivariate and multivariate analysis (multiple logistic regression) were performed to evaluate the factors associated with poor health status (ASAS-HI ≥12). To analyze the construct validity of the tool, Spearman correlation was performed between the ASAS-HI and other disease evaluation parameters. Results: 274 patients with SpA were included, with a mean age of 49 (± 14) years and a median duration of the disease of 62 months (p25-75: 24-135), 155 (56.6%) were male, 129 patients (47%) with AxSpA and 145 (52.9%) SpAp. According to the ASAS-HI, 119 patients (43.4%) had good health, 117 (42.7%) had moderate health and 38 (13.9%) had poor health. In patients with SpAp, the mean ASAS-HI value was 7 (p25-75: 3-10). The ASAS-HI positively correlated with: DAS28: rho: 0.5 (p <0.001) and HAQ: rho: 0.54 (p <0.001). The variable independently associated with poor health status was DAS28 (OR: 1.9, 95% CI 1.1-3.4, p: 0.029). In patients with AxSpA, the mean ASAS-HI value was 6 (p25-75: 2.75-10). The ASAS-HI showed correlation with: BASDAI: rho: 0.7 (p <0.001), ASDAS-ERS: rho: 0.7 (p <0.001), ASQoL: rho: 0.8 (p <0.001), BASFI rho: 0.75 (p <0.001). The variable that was independently associated with poor health was the ASDAS-ERS (OR 6.6, 95% CI 2-22, p 0.002). Conclusion: Poor health status was independently associated with higher disease activity in patients with AxSpA and SpAp. The ASAS-HI correlated with other parameters of the disease, which reinforces the construct validity of this new tool.

BCG y Enfermedad de Hansen: estudio clínico epidemiológico / BCG and Hansen disease: clinical epidemiological study

Resumen La enfermedad de Hansen es una infección granulomatosa cuya presentación clínica y severidad depende del estado inmunológico del individuo. Dadas las similitudes en la composición antigénica entre M. tuberculosis y M. leprae, se ha estudiado la utilización de la vacuna BCG frente al Hansen. Objetivo: Determinar la relación del tamaño de la cicatriz de BCG y la severidad clínica de los pacientes con Hansen en el Instituto de Biomedicina. Métodos: Se realizó un estudio descriptivo con revisión de 150 historias clínicas de pacientes con antecedente de vacunación con BCG en la infancia y diagnóstico de Hansen entre 2008 y 2018. Se registraron las formas clínicas y severidad de la enfermedad, fenómenos reaccionales y tamaño de la cicatriz de BCG. Resultado y discusión: Existe una relación entre el tamaño de la cicatriz de BCG y la forma clínica de la enfermedad. Los pacientes con lepra lepromatosa (LL) tienden a tener ausencia de cicatriz, a diferencia de los pacientes borderline tubercoloide (BT) y lepra indeterminada (LI), que tienen un tamaño mayor de ella. Observamos mayor frecuencia de fenómenos reaccionales tipo II en pacientes sin cicatriz de BCG. Los pacientes con enfermedad más severa mostraron una tendencia a presentar tamaños menores de la cicatriz de BCG. Dichos hallazgos se corresponden con los reportados por Convit y reflejan la importancia de la respuesta inmunitaria frente a la micobacteria para controlar la enfermedad. Además, abre una opción terapéutica a seguir evaluando, que es el papel de la BCG como profilaxis y protector frente a formas severas del Hansen.

Summary Hansen's disease is a granulomatous infection whose clinical presentation and severity depend on the immunological state of the patient. Given similarities in the antigenic composition between M. tuberculosis and M. leprae, because of this the use of BCG vaccine against Hansen has been studied. Objective: Determinate the relationship between the size of the BCG scar and the clinical severity of patients with Hansen in the Biomedicine Institute. Methods: A descriptive study was carried out with a clinical history review of patients with BCG vaccination and Hansen's diagnosis between 2008 and 2018. Clinical forms and severity of the disease, reaction phenomena, and size of the BCG scar were registered. Outcome and discussion: There is a relationship between the size of BCG scar and the clinical form of the disease. Patients with LL tend to have an absence of scar in a different way of the patients with BT y LI patients who have a larger size of the scar. We observed a greater frequency of type II reaction phenomena in patients without BCG scar. Patients with more severe disease shown a tendency to present small sizes of BCG scar. These findings correspond to those reported by Convit and reflects the importance of the innate response to mycobacteria for control the disease. In addition, it has had open a therapeutic tool to continue evaluating, which is the role of BCG as prophylaxis and protector against severe forms of Hansen.

Progressive Multifocal Leukoencephalopathy after Ibrutinib Therapy for Chronic Lymphocytic Leukemia / Journal of the Korean Cancer Association, 대한암학회지

Progressive multifocal leukoencephalopathy (PML) is a devastating neurological disease observed nearly exclusively in immunocompromised patients. Recently, the introduction of monoclonal antibodies significantly inhibiting the immune system such as rituximab has led to an increase in PML cases. Although rituximab-based immunochemotherapy remains the standard of treatment for chronic lymphocytic leukemia (CLL), the importance of Bruton’s tyrosine kinase inhibitors such as ibrutinib is steadily increasing. However, long-term experiences regarding possible side effects of these new substances are rare. Here, we report the development of eventually fatal PML possibly associated with ibrutinib therapy for CLL after multiple prior treatment lines, including rituximab. To the best of our knowledge, this is the first study to report such findings. Since the last course of rituximab was applied over 3 years ago, it is conceivable that the strong B cell inhibition by ibrutinib led to PML. With increased awareness of this potential side effect, further clinical studies are certainly warranted to evaluate this possible association.

Tercer reporte de eventos adversos con tratamientos biológicos en Argentina. Informe de registro biobadasar / Thrid report of adverse events with biologics in Argentina. Report from biobadasar registry

Introducción: BIOBADASAR (Registro Argentino de Eventos Adversos con Tratamientos Biológicos en Reumatología) comenzó en agosto de 2010. La importancia de este registro es mostrar datos locales que, probablemente, puedan diferir de otros registros. El objetivo es comunicar los resultados del tercer reporte de BIOBADASAR. Métodos: Todos los pacientes con enfermedades reumáticas que requirieron tratamiento con agentes biológicos y pacientes controles sin estos tratamientos fueron incluidos en la base de datos provenientes de 32 centros participando a lo largo de la Argentina. Tres áreas de datos son analizados: características de los pacientes, tratamientos y eventos adversos...

Introduction: BIOBADASAR (Argentine Registry of Adverse Events with Biological Treatments in Rheumatology) began in August 2010. The importance of this registry is to show local data that may probably differ from other registries. The objective is to communicate the results of the third BIOBADASAR report. Methods: All patients with rheumatic diseases who required treatment with biological agents and control patients without these treatments were included in the database from 32 participating centers throughout Argentina. Three areas of data are analyzed: patient characteristics, treatments and adverse events...

A cross-sectional triangulation analysis of the knowledge, attitudes and practices of patients from the endocrinology clinic of the Philippine General Hospital on the use of herbal dietary supplements

OBJECTIVE: This study aimed to determine the knowledge, attitudes and practices (KAP) of a selected population of patients on herbal dietary supplements (HDS).METHOD: Methodological triangulation was used to generate a conceptual framework on HDS KAP. A survey of 175 patients was performed to measure knowledge and attitudes regarding HDS and SPSS was used for data analysis. Inverviews and focus group discussions (FGDs) were conducted to further explore the attitudes and practices, and constant comparison method was used for analysis of responses.RESULTS: Respondents were generally aware of HDS. Majority of survey respondents believed that HDS are different from conventional drugs (52.0%, pThe attitude toward HDS was generally positive. Majority (64.0%, pAmong the survey respondents, only 22% were HDS users. Family was shown to promote use while cost deterred their use.CONCLUSION: Individual knowledge and attitudes on HDS exert significant influence toward HDS practices. Factors that promote use are poor knowledge and positive attitudes toward HDS. Good knowledge seems to lead to judicious use or non-use.

Assessment of physician practice regarding coronary risk factor identification and management

BACKGROUND: Coronary Artery Disease (CAD) is closely associated with several major risk factors including many that can be modified or eliminated. Hypertension, diabetes mellitus, dyslipidemia, smoking and obesity are among these. Early identification of these risk factors gives the physician opportunities for primary and secondary prevention of CAD.OBJECTIVE: To assess the practice of physicians with regards identification and management of risk factors of patients with CAD at the Makati Medical Center.METHODOLOGY: Two hundred and one (201) patients admitted at the Makati Medical Center from July 2001 up to December 2001 with symptomatic or objective evidence of myocardial ischemia during treadmill exercise and angiographic findings of CAD were assessed. Identification and management of the different risk factors by the physicians were reviewed.RESULTS: Of the 201 patients 167 (83 percent) were male, 65 (32 percent) were over 65 years old and 7 (3 percent) had strong family history of CAD. One hundred twenty seven (63 percent) had hypertension, 77 (38 percent) had diabetes mellitus, 96 (47 percent) had dyslipidemia, 113 (63 percent) were obese and 103 (51 percent) were smokers. Active management was done for the hypertension, diabetes and dyslipidemia. Only 39 percent of the smokers were off the habit for more than a year and only 19 percent of the obese received counseling for weight loss and exercise.CONCLUSION: All patients identified with hypertension, dyslipidemia and diabetes mellitus were placed on appropriate diet and medications, patients with smoking problems and obesity were less consistently managed with smoking cessation approaches and weight losing manipulation through diet and exercise.

Sífiles terciaria en paciente con infección por VIH / Third syphilis in patient with infection by HIV

Se trata de un paciente masculino de 42 años en quien se asocian la infección por retrovirus, con alta carga viral y compromiso significativo de CD4; por Treponema pallidum, evidenciándose lesiones cutáneas e invasión del sistema nervioso central (SNC). Esta coinfección se caracteriza por polimorfismo clínico, lo cual abre el campo para diagnóstico diferenciales con infecciones por agentes oportunistas o neoplasis, muy frecuentes en este tipo de pacientes; más aún cuando no fue procedida por las lesiones primarias propias de lúes

Hydatid disease of the head of the femur

A case of hydatid disease is described which presented as aseptic necrosis of the head of the femur and subsequent fragmentation of the capital epiphysis. Particular reference is made to the problems of establishing the diagnosis

Brain abscesses at Mpilo Central Hospital 1982-1988

The results of the management of patients with brain abscesses have been audited. Guidelines are suggested for surgeons working under similar conditions