ABSTRACT
Seronegative arthritides are a heterogeneous group of diseases that includes rheumatoid arthritis with negative rheumatoid factor. Between 1980 and 1984 we studied 38 patients with seronegative arthritis. Thirty of these patients were reassessed in 1994 after 9 or 20 years of evolution. Seventeen patients had a diagnosis of seronegative rheumatoid arthritis; this diagnosis was maintained in 12, changed to seropositive rheumatoid arthritis in 3, to psoriatic arthritis in 1 and connective tissue disease in 1. Thirteen patients had a diagnosis of undifferentiated arthritis; in 1994 the diagnosis was maintained in 3, 7 patients were diagnosed as having a sppondyloarthropathy, 2 as having a reactive arthritis and 1 as having a connective tissue disease. In 1994, nine patients fulfilled the 1991 criteria for spondyloarthritis and 6 of these did so on admission. Six of 12 patients with seronegative rheumatoid arthritis had an active disease or used antiinflammatory drugs and 64 percent had erosions on hand X ray examination. These figures are in contrast with the enigm evolution classically attributed to this disease and agree with recent reports. The usefulness of classification criteria for rheumatoid arthritis and spondyloarthritis in the initial assessment of patients with seronegative arthritis is emphasized
Subject(s)
Humans , Male , Female , Arthritis/blood , Arthritis, Rheumatoid/diagnosis , Rheumatoid Factor/blood , Serologic Tests , Follow-Up Studies , PrognosisABSTRACT
The aim of this study was to search infections that trigger reactive arthritis. Eigthy-six patients with seronegative arthritis (SNA) were studied; 32 had reactive arthritis, 21 ankylosing spondylitis, 7 psoriatic arthritis and 26 undifferentiated seronegative oligoarthritis. As controls, 70 patients with connective tissue diseases (CTD) and 55 healthy volunteers (HV) were studied. Serological evidence for infection with Chlamydia trachomatis was studied with micro immunofluorescence, looking for L2 and BED serotypes and serological evidence for Yersinia infection, using a commercial kit. Stool cultures were done in seven patients with recent diarrhea and endourethral or endocervical cultures in 35 individuals. Serotypes L2 or BED were positive in 23 of 83 patients with SNA, 3 of 39 patients with CTD and 4 of 55 HV (p<0.03). IgG class antibodies against L2 were detected in 17 percent of SNA patients, 2.6 percent of CTD patients and 5.4 percent of HV (p<0.05). IgM class antibodies were detected in 6 SNA patients, 0 CTD patients and 2 HV (NS). 12 of 35 cultures were positive for Chlamydia. As a whole 30 percent of SNA patients has serological or bacteriological evidence for Chlamydia infection. Serology for Yersinia was positive in 39 of 81 SNA patients, 1 of 54 CTD patients and 3 of 51 HV (p<0.01). Rates of infections were similar among male, female, HLA B27 positive and HLA negative subjects. It is concluded that SNA patients have a high prevalence of infections by Chlamydia trachomatis or Yersinia enterocolitica
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Arthritis, Reactive/microbiology , Infections/diagnosis , Yersinia enterocolitica/isolation & purification , Chlamydia trachomatis/isolation & purification , Campylobacter jejuni/isolation & purification , Ureaplasma urealyticum/isolation & purification , Joint Diseases/physiopathology , Joint Diseases/microbiology , Antibodies/isolation & purification , /isolation & purificationABSTRACT
Se estudió el nivel de estrés (por escala de sucesos vitales=61 items) en 181 trabajadores de la salud, tomando el universo de dos servicios clínicos (Siquiatría, Gineco-obstetricia) y un servicio administrativo (Dirección del Servicio de Salud Occidente) y su relación con las calificaciones y licencias médicas. El promedio global de estrés en los tres servicios, en escala de 1 a 7, fue similar, siendo discretamente menor en el servicio del Hospital Siquiátrico (4,15), en relación a Obstetricia (4,44) y administrativos (4,57). Se observó una relación (r=0,99) entre licencias y nivel de estrés, en los servicios. El 67,7% del personal de siquiatría prsentó licencias en los 6 meses anteriores al estudio, a diferencia de 43,2% en obstetricia y 45,5% en administrativos. Las calificaciones presentaban una similitud evaluativa en los tres servicios. Los items de la escala que obtuvieron un mayor puntaje fueron los sucesos relacionados con pérdidas(cónyuge, familiar cercano), problemas legales y accidentes
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Health Personnel/psychology , Life Change Events , Stress, Psychological/epidemiology , Sex Factors , Marital Status , Educational StatusABSTRACT
Para medir el aislamiento, así como la sensación de apoyo familiar y de las amistades se encuestaron entre septiembre y noviembre de 1989, a 86 pacientes mayores de 65 años internados en los Servicios de Medicina, Cirugía y Urología del Hospital San Juan de Dios. De los casos incluidos en el trabajo; 34 eran hombres (39,5%) y 52 mujeres (60,5%). Entre ellos el 23% eran analfabetos. Las patologías más frecuentes fueron los tumores y las afecciones cardiovasculares y digestivas. La gran mayoría de los pacientes (93%) vivían acompañado, mientras que apenas el 7% vivían solos. La prueba de Apgar de Smilkstein, utilizada para medir la sensación de apoyo, demostró una disfunción familiar severa en el 22,1% de los casos y moderada en el 2,3%. Con respecto al apoyo de las amistades se detectó una disfunción severa en el 60,55 y moderada en el 18,6%. En base a los hallazgos expuestos se proponen diversas medidas de protección y apoyo de los senescentes de estratos sociales de bajos recursos