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Abstract Background: Primary Sjögren syndrome (pSS) is a chronic autoimmune disease with its main target being exocrine glands, and is the connective tissue disease more frequently associated with other autoimmune diseases. The aim of this study was to assess the frequency of another autoimmune rheumatic disease (ARD) developed in primary Sjögren syndrome (pSS) patients and to describe it's clinical, serological and histologic characteristics. Materials and methods: This is a retrospective cohort study. Data of patients with pSS diagnosis (American-European criteria 2002), included in the GESSAR database (Grupo de Estudio Síndrome de Sjögren, Sociedad Argentina de Reumatología) were analyzed. The development of a second ARD was registered during the follow up. Results: 681 patients were included, 94.8% female. The mean age was 54 (SD 14) years and mean age at diagnosis of 50 (SD 13) years. The mean follow-up was 4.7 (SD 4.9) years; 30 patients (4.41%, CI 95%: 3.1-5.7) developed a second ARD during the follow up, incidence rate was 9.1/1000 patients-year (IR 95%: 5.8-12.4/1000 patients-year), the most frequent being rheumatoid arthritis (RA). 96% out of these 30 patients had xerophthalmia, 86.2% xerostomia, 92% positive Schirmer test, 88.24% positive Rosa Bengala test, lisamine green or Ocular Staining Score, 81.2% positive unstimulated salivary flow, 82.1% Ro(+) and 33.33% La(+). Minor salivary gland biopsy had been performed in 14 of the 30 patients, 12 with positive results. There were no statistically significant differences respect baseline characteristics when comparing the patients who developed another ARD to the ones that did not. Conclusions: Of all the patients analyzed, 4.4% presented another ARD during their follow-up. It is important to be aware of this, to make an early and proper diagnosis and treatment of our patients. Key points Patients with primary Sjögren's Syndrome may develop another connective tissue disease during follow-up. The most frequently connective tissue disease developed during follow-up in the population of patients with primary Sjogren's Syndrome studied was rheumatoid arthritis. It is important to be aware of this to make an early and proper diagnosis.
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Abstract Introduction The endolymphatic sac is thought to maintain the hydrostatic pressure and endolymph homeostasis for the inner ear, and its dysfunction may contribute to the pathophysiology of Ménière's disease. Throughout the years, different surgical procedures for intractable vertigo secondary to Ménière's disease have been described, and though many authors consider these procedures as effective, there are some who question its long-term efficacy and even those who think that vertigo control is achieved more due to a placebo effect than because of the procedure itself. Objective To review the different surgical procedures performed in the endolymphatic sac for the treatment of Ménière's disease. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis We focus on describing the different surgical procedures performed in the endolymphatic sac, such as endolymphatic sac decompression, endolymphatic sac enhancement, endolymphatic sac shunting and endolymphatic duct blockage, their pitfalls and advantages, their results in vertigo control and the complication rates. The senior author also describes his experience after 30 years of performing endolymphatic sac surgery. Conclusions The endolymphatic sac surgery, with all its variants, is a good option for patients with incapacitating endolymphatic hydrops, providing a high percentage of vertigo control and hearing preservation.
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Las deficiencias visuales en los escolares, pueden implicar problemas en el aprendizaje y retardo en el desarrollo psicosocial. Debido a la poca información sobre esta problemática en el Distrito, se realizo este estudio de tipo descriptivo, con el objeto de determinar la prevalencia de alteraciones oculares‐visuales, en una muestra de 1.250 niños de 5 a 14 años de establecimientos oficiales y privados en Bogotá. El 42% de los niños escolares presento algún grado de deficiencia en la AV (20/25 o menor). De deficiencia disminuye a medida que aumenta la edad. En cuanto a los defectos refractivos se presentaron: hipermetropía (59.2%), astigmatismo (28.2%), miopía (4.0% y emetropía (9.0%). De los niños que presentaban déficit de la AV, el 9.6% utilizaba corrección óptica. De los que presentaban algún grado de déficit de la AV y no usaban gafas al momento del examen, el 62% eran de colegios públicos y el 38% de colegios privados. Es necesario tanto identificar el problema de salud visual como revisar las estrategias de intervención, debido al impacto positivo que la solución a este problema puede generar especialmente en la población escolar.
The visual deficiencies in schoolchildren can imply learning problems and a delay in psychosocial development. Due to lack of information in this area in the District a descriptive type of study was conducted having as its objective to determine the prevalence of visual‐ocular alterations, in a sample of 1.250 children from 5 to 14 years of age in public and private schools in Bogota. Forty two (42%) percent of schoolchildren presented some degree of deficiency in the following were the results: hypermetry (59.2%), astigmatism (28.2%), myopia (4.0%) and emetropy (9.0%). Among children that presented a deficit of AV, 9.6% used optic correctives. Among those that represented some degree of AV deficit and didn´t use eyeglasses at the moment of the exam: 62% came from public schools and 38% from private school. It is necessary to identify the visual health problem and to review the intervention strategies given the positive impact of the solution that may generated, especially in the schoolchildren.