Validación del Índice Funcional para Osteoartritis de Manos (FIHOA) en pacientes con artritis reumatoidea / Validation of the Functional Index for Hand Osteoarthritis (FIHOA) in patients with rheumatoid arthritis

El FIHOA fue desarrollado para evaluar la capacidad funcional de pacientes con OA de manos. Objetivo: Validar FIHOA en pacientes con AR. Métodos: Estudio analítico, observacional prospectivo de corte transversal. Se incluyeron pacientes consecutivos con diagnóstico de AR (ACR/EULAR 2010). Se consignaron datos demográficos y características de la enfermedad. Todos los pacientes completaron los siguientes cuestionarios autoadministrados: FIHOA, HAQ-A, HAQ-UP-A y Quick DASH. En un subgrupo de pacientes, una terapista ocupacional valoró la capacidad funcional de la mano por medio del test de SODA-A. Se evaluó la reproducibilidad de FIHOA. Análisis estadístico: Estadística descriptiva. Confiabilidad con test de Cronbach. Validez de constructo con correlación de Spearman. Reproducibilidad test re-test. Modelo de regresión lineal. Resultados: Se incluyeron 100 pacientes. La prueba alfa de Cronbach fue de 0,94. No se evidenciaron preguntas redundantes. El FIHOA mostró excelente correlación con HAQ-A (r=0,89); HAQ-UP-A (r=0,89); Quick DASH (r=0,90) y SODA-A (r=-0,80); y buena correlación con DAS28-ERS (r=0,65), y con otros parámetros de la enfermedad. La reproducibilidad fue 0,73. La regresión lineal múltiple mostró como principal determinante del FIHOA a la presencia de rigidez matinal seguida por el uso de corticoides y el EVA general de pacientes. Conclusión: El FIHOA resultó ser confiable, válido y reproducible en pacientes con AR

FIHOA was developed to evaluate the functional capacity of patients with OA hands. Objetive: To validate FIHOA in patients with RA. Methods: Analytical, observational, prospective cross-sectional study. Consecutive patients with diagnosis of RA (ACR/EULAR 2010) were included. Demographic and RA characteristics were recorded. Patients completed the following self-administered questionnaires: FIHOA, HAQ-A, HAQ-UP-A and Quick DASH. For a patient subgroup, an occupational therapist performed an objective evaluation of the functional capacity of the hands using the SODA-A. Reproducibility was assessed. Statistical analysis: Descriptive statistics. Reliability with the Cronbach test. Construct validity with Spearman correlation. Reproducibility with test-retest reliability. Linear regression model. Results: One hundred patients were included. Cronbach's alpha test was 0.94. There were no redundant questions. FIHOA showed an excellent correlation with HAQ-A (r=0.89); HAQUP-A (r=0.89); Quick DASH (r=0.90) and SODA-A (r=-0.80); and a good correlation with DAS28- ERS (r=0.65) and with other disease parameters. Questionnaire reproducibility was 0.73. A multiple linear regression showed morning stiffness as the main determinant of FIHOA, followed by glucocorticoid use and patient global assessment. Conclusion: FIHOA was found to be reliable, valid and reproducible in patients with RA

Patrones de tratamiento, sobrevida y efectividad a largo plazo de agentes biológicos en pacientes con Artritis Psoriásica / Patterns of treatment, survival and long-term effectiveness of biological agents in patients with Psoriatic Arthritis

Objetivos: Evaluar los patrones de tratamiento de las DME-b (Drogas Modificadoras de la Enfermedad-biológicas), su sobrevida acumulada y su eficacia a largo plazo en pacientes con Artritis Psoriásica (APs) utilizando el índice LUNDEX. Materiales y métodos: Estudio multicéntrico retrospectivo. Se incluyeron pacientes con diagnóstico de APs que hayan iniciado tratamiento con DME-b. Se recolectaron datos sociodemográficos y clínicos. Se consignaron fechas de inicio de DME-b, tratamiento concomitante, suspensión o cambio de tratamiento, y razones de suspensión. La respuesta terapéutica se definió acorde a MDA (Minimal Disease Activity), a los 6, 12 meses y anualmente a partir del inicio de DME-b. Análisis estadístico: Test de Student y Chi². Curvas de Kaplan Meier y Log Rank. Análisis de regresión de Cox. Resultados: Se incluyeron 72 pacientes con APs, 39 (54,2%) de sexo masculino. La edad mediana fue de 54,5 años (RIC 45-61) y el tiempo mediano de evolución de la enfermedad de 11 años (RIC 6-15). 71,2% (n=42) presentaron comorbilidades. El primer DME-b fue en orden decreciente de frecuencia: Adalimumab (45,8%), Etanercept (36,1%), Certolizumab (5,6%), Infliximab (4,2%), Ustekinumab (4,2%), Abatacept (2,7%) y Golimumab (1,4%). 15 pacientes (25,4%) recibieron DME-b en monoterapia. La sobrevida media fue de 82 meses (DE±7,4). El LUNDEX del primer biológico fue 24,7% a los 6 meses y 44,3% al año. La sobrevida media de Adalimumab fue de 90 meses (DE±10,4) y de Etanercept 79 meses (DE±12). Los pacientes añosos presentaron menor sobrevida de la droga [≥55 años: X59,8 (DE±10,5) vs <55 años: X101,2 (DE±9,7), p=0,006]. Luego de ajustar por diferentes confundidores, la edad ≥55 años se mantuvo significativamente a menor sobrevida [HR=1,064 (IC=1,01-1,11) p=0,005]. El LUNDEX fue menor en obesos vs no obesos (16% vs 66% al año, p=0,89; 10,5 vs 74,9% a los 2 años, p=0,011 y 5,9 vs 81,8% a los 3 años, p=0,005). Conclusiones: La sobrevida promedio del primer DME-b fue de 6,8 años. La única variable asociada a menor sobrevida fue la mayor edad.

Objectives: To evaluate the treatment patterns of DME-b (Disease-Modifying Drugs-biological), their accumulated survival and their long-term efficacy in patients with psoriatic arthritis (PsA) using the LUNDEX index. Materials and methods: Retrospective multicentre study. We included patients diagnosed with PsA who started treatment with DME-b. Sociodemographic and clinical data were collected. BMI-D start dates, concomitant treatment, suspension or change of treatment, and reasons for suspension were recorded. The therapeutic response was defined according to MDA (Minimal Disease Activity), at 6, 12 months and annually from the beginning of DME-b. Statistical analysis: Student test and Chi². Curves of Kaplan Meier and Log Rank. Cox regression analysis. Results: We included 72 patients with PsA, 39 (54.2%) male. The median age was 54.5 years (IQR 45-61) and the median time of evolution of the disease was 11 years (IQR 6-15). 71.2% (n=42) presented comorbidities. The first DME-b was in decreasing order of frequency: Adalimumab (45.8%), Etanercept (36.1%), Certolizumab (5.6%), Infliximab (4.2%), Ustekinumab (4.2%), Abatacept (2.7%) and Golimumab (1.4%). 15 patients (25.4%) received DME-b monotherapy. The mean survival was 82 months (SD±7.4). The LUNDEX of the first biological was 24.7% at 6 months and 44.3% per year. The mean survival of Adalimumab was 90 months (SD±10.4) and Etanercept 79 months (SD±12). Older patients had a lower survival of the drug [≥55 years: X59.8 (SD±10.5) vs <55 years: X101.2 (SD±9.7), p=0.006]. After adjusting for different confounders, age ≥55 years was significantly maintained at lower survival [HR=1.064 (CI=1.01-1.11) p=0.005]. The LUNDEX was lower in obese vs. non-obese (16% vs. 66% per year, p=0.89, 10.5 vs 74.9% at 2 years, p=0.011 and 5.9 vs 81.8% at 3 years, p=0.005). Conclusions: The average survival of the first DME-b was 6.8 years. The only variable associated with lower survival was the older age.

Consumo de antiinflamatorios no esteroideos en pacientes que concurren por primera vez a un servicio de reumatología / Consumption of nonsteroidal anti-inflammaroty drug in patients attending for the first time a rehumatologic Unit

Introducción: El uso de antiinflamatorios no esteroideos (AINES) conlleva una mayor probabilidad de enfermedad gastrointestinal y cardiovascular en pacientes con factores de riesgo. Por tal motivo, se desarrollaron diversas recomendaciones con el fin de prevenir dichas complicaciones. Objetivo: Evaluar la frecuencia del consumo de AINES al momento de consultar por primera vez a un Servicio de Reumatología de demanda espontánea; y analizar tanto la conducta del médico así como el correcto cumplimiento de las recomendaciones para la toma de estos fármacos al finalizar la consulta. Material y métodos: Estudio observacional de corte transversal. Resultados: Se incluyeron 304 pacientes, 59,5% consumían AINES. La mayoría de estos pacientes presentaban riesgo gastrointestinal moderado/alto, sólo 28,3% recibían adecuada protección. De aquellos pacientes que recibían AINES, se consideró que requerían dicho tratamiento el 50%. Al finalizar la consulta, se tomó una conducta correcta en el 89% de los casos en relación al riesgo gastrointestinal. Conclusión: Más de la mitad de los pacientes consumían AINES. Se observó un buen cumplimiento de las recomendaciones por los médicos tratantes al finalizar la primera consulta. Sin embargo, es importante mencionar que el uso indiscriminado de AINES tanto por parte de los pacientes como por parte de los médicos sigue siendo alto.

Introduction: The use of Non-Steroidal Anti-Inflammatory DrugsNSAID (NSAIDS) leads to a higher probability of gastrointestinaland cardiovascular disease in patients with risk factors. Therefore,a number of recommendations were developed to prevent thesecomplications. The aim of this study was to evaluate the intake frequencyof NSAID by patients who attend to a rheumatology departmentfor the first time; and to analyze the attending physicians´ prescriptionas well as the correct implementation of the recommendationsfor the use of these drugs once this first visit was ended.Methods: We perform a cross-sectional observational study.Results: Three hundred and four patients were included, 59.5%were taking NSAIDs. Most of these patients had moderate/high gastrointestinalrisk and only 28.3% received adequate protection. Ofpatients receiving NSAIDs, it was considered that only 50% requiredsuch treatment. At the end of the first visit, the attending physiciansmade the correct implementation of the recommendations in 89%of cases in regard to gastrointestinal risk.Conclusion: More than half of the patients were taking NSAIDS.A good compliance with the recommendations by the attendingphysicians at the end of the first visit was observed. However, it isnoteworthy that the indiscriminate use of NSAIDs, both by patientsand by physicians, remains high.

Plant extracts for controlling the post-harvest anthracnose of banana fruit / Extratos de plantas para controle pos-colheita da antracnose da Banana

In banana, fruit rot is incited by Colletotrichum musae which has been the most serious post-harvest disease of immature and mature fruit. The usual control by fungicides prohibited in many countries reduces their commercial value. Therefore, two experiments were conducted to evaluate the antimicrobial activity of alternative products to the synthetic fungicides. First, berries naturally infected by anthracnose were immersed into Azadirachta indica and citric extracts at 2 and 4% (v/v) for 3 minutes and stored for 11 days under environmental conditions. Next, other berries were immersed into essential oil emulsions of Allium sativum, Copaifera langsdorfii, Cinnamomum zeylanicum and Eugenia caryophyllata at 5% for 3 minutes but stored for 11 days. Berries immersed into distilled water were used as control-treatments. The percentage of disease incidence observed in the control-treatment was similar to the ones observed in the extract of A. indica at 2%. The control-treatment showed disease severity of 75.13% and the percentage of disease control was 20.85%. Fruit immersed into distilled water presented less effectiveness than the ones immersed into citric extracts, which promoted the highest effectiveness. Citric extract at 4% was the most efficient treatment because the disease incidence was 19.44%, the disease severity was 9.34% and the disease control was 90.16%. Less severity and, consequently, more disease control were achieved by immersing the berries into the emulsion of essential oil of A. sativum, followed by treatments with C. langsdorfii, E. caryophyllata and C. zeylanicum.

Em pós-colheita, a podridão dos frutos causada por Colletotrichum musae é a doença mais importante da banana (Musa spp.), sendo presente em frutos verdes e maduros, tornando o produto pouco apresentável e inadequado à comercialização. Considerando-se os efeitos prejudiciais à saúde do tradicional método químico de controle e a proibição da utilização de fungicidas em muitos países, objetivou-se no presente trabalho avaliar bioprodutos com atividade antimicrobiana, considerados alternativos para o controle de antracnose em banana em pós-colheita. Os experimentos foram realizados com frutos de banana naturalmente infectados com Colletotrichum musae, submetidos à imersã, em extratos da planta Azadirachta indica e extratos cítricos (Ecolife), nas concentrações de 2 e 4% (v/v), permanecendo por 11 dias em condições ambientes. A emulsão composta de óleos essenciais das plantas Allium sativum, Copaifera langsdorfii, Cinnamomum zeylanicum e Eugenia caryophyllata também foi avaliada quanto a sua eficácia no controle do patógeno, permanecendo em condição ambiente por 11 dias. Frutos tratados com água destilada constituíram o tratamento controle. Os resultados obtidos demonstraram que frutos submetidos ao extrato aquoso de A. indica na concentração de 2% (88,89%) não diferiu do tratamento controle (100% de incidência da doença). O extrato cítrico a 4% promoveu percentuais de incidência, severidade e controle de 19,44; 9,34 e 90,16%, respectivamente, sendo o mais eficiente. Menor percentual de severidade e o maior percentual de controle da doença nos frutos foram proporcionados pela emulsão óleos essenciais de A. sativum, seguidos pelos tratamentos com C. langsdorfii, E. caryophyllata e C. zeylanicum.

Sarcocystis spp infection in Philippine water buffaloes (Bubalus bubalis).

In a survey of sarcocysts in muscle tissues obtained from 142 water buffaloes, 65% of the carcasses had sarcocysts. Macroscopic and two forms of microscopic sarcocysts, the spindle-shaped or fusiform sarcocysts commonly occurring in the muscles of the esophagus, throat and limbs, and the globular to oval-shaped sarcocysts which were the dominant form in the diaphragm and cervical muscle tissues were noted. Ultrastructural analysis of macroscopic and microscopic sarcocysts and their cyst wall revealed two distinct species of Sarcocystis: the macroscopic species, Sarcocystis fusiformis which has been previously reported in Philippine carabaos possessing highly dendritic cauliflower-like projections emanating from the primary cyst wall, with annulated microfilaments and numerous electron dense granules: and the Sarcocystis levinei (Dissanaike and Kan, 1978) Huong, Dubey and Uggla. 1997 exhibiting a cyst wall with undulating and hair-like villar protrusions with expanded or dome-shaped base, intermediate finger-like, and distal tapering segments which at some points join to form conical tufts. Our findings represent the first report of S. levinei in the country supported with ultrastructural analysis of the sarcocysts and cyst wall, and likewise refute earlier published reports that all microscopic sarcocysts in Philippine carabaos are developing forms of the macroscopic species, S. fusiformis. Histopathological changes such as displacement and necrosis of the surrounding host muscle tissue were observed with macroscopic sarcocysts and histologically processed tissue samples containing microscopic fusiform sarcocysts. Necrotic myofibrils and mitochondria were evident in ultrathin sections.