Coronary Artery Disease in Systemic Lupus Erythematosus: What Do the Facts Say?

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect any organ with a predisposition for women of reproductive age. It is related to a higher risk of cardiovascular events, increasing it up to 50 times in young people, and 30% of deaths are attributed to coronary artery disease. The risk of developing cardiovascular disease in SLE is related not only to traditional cardiovascular risks factors such as advanced age, hypertension, dyslipidemia, and diabetes but also to disease-specific factors, such as degree of activity, autoantibodies, organ damage, and treatment. Accelerated atherosclerosis is one of the main contributors to pathogenesis. Manifestations range from angina to acute myocardial infarction and sudden death. Markers have been studied for the detection of subclinical disease and stratification of these patients, as well as different treatment options to improve the cardiovascular prognosis of the disease.

Myopericarditis Complicated With Cardiac Tamponade Due to Campylobacter fetus Infection.

About 90% of cases of acute pericarditis have an idiopathic or viral etiology. In some cases, it is possible to identify high-risk patients for whom hospital admission and specific etiology research are mandatory for adequate treatment. Bacterial pericarditis is uncommon and responsible for less than 1% of cases. Only 10 cases of pericarditis due to Campylobacter fetus have been documented worldwide. This case highlights the importance of good cardiac imaging, with the right clinical and microbiology-integrated approach in high-risk cases of pericardial disease.

Environ 90 % des cas de péricardite aiguë sont d'étiologie idiopathique ou virale. Dans certains cas, il est possible de déterminer les patients exposés à un risque élevé pour qui l'admission à l'hôpital et la recherche d'une étiologie précise sont indispensables pour offrir le bon traitement. La péricardite bactérienne est rare et représente moins de 1 % des cas. Seuls 10 cas de péricardite à Campylobacter fetus ont été consignés dans le monde. Ce cas illustre l'importance d'une bonne imagerie cardiaque selon une bonne approche clinique et microbiologique intégrée chez les cas exposés à un risque élevé de maladies péricardiques.

A profile of the GenePOC Carba C assay for the detection and differentiation of gene sequences associated with carbapenem-non-susceptibility.

The novel GenePOC/Revogene Carba C assay (GenePOC, Québec, Canada; now Meridian Bioscience, Cincinnati, OH, USA) is a CE-IVD marked, FDA-approved qualitative in vitro diagnostic test for the detection of genes associated with carbapenem-non-susceptibility. Colonies of Enterobacterales can be directly tested without prior DNA isolation. The test consists of a fluorescent-based real-time PCR assay that runs on the centripetal microfluidic revogene platform, providing results within 70 minutes. The assay was evaluated in two studies comprising a total of 294 molecularly characterized clinical Enterobacterales isolates. The overall sensitivity for the detection of carbapenemase gene sequences with the GenePOC assay was 100% (95% CI, 98.4% to 100). Besides the common KPC, VIM, NDM and OXA-48-like carbapenemase genes, also the very variable IMP variants were all detected. The specificity of the assay was 100% (95% CI, 98.8% to 100%). In this article the performance of the GenePOC/Revogene Carba C assay is evaluated and other currently available methods for the detection of carbapenemases are reviewed.

Relación entre salud cognitiva y adherencia farmacológica en adultos mayores con diabetes mellitus tipo 2 / Relation between Cognitive Health and Pharmacological Adherence in Older Adults with Type 2 Diabetes Mellitus

OBJETIVO: Evaluar la relación entre la salud cognitiva y la adherencia al tratamiento farmacológico en adultos mayores con diabetes mellitus tipo 2 de un centro comunitario de salud familiar de la provincia de Ñuble, Chile. MÉTODO: Estudio analítico de corte transversal. La muestra estuvo constituida por 62 adultos mayores con diagnóstico de diabetes mellitus tipo 2. La recolección de datos se realizó mediante visitas domiciliarias utilizando los instrumentos Minimental State Examination (MMSE), Test de Morisky Green Levine y un cuestionario de datos generales. Los datos fueron procesados en el programa SPSS, utilizando estadística descriptiva y analítica. El estudio contó con la aprobación de Comité de Bioética. RESULTADOS: La adherencia al tratamiento farmacológico fue del 51,6% (n = 32) y el 83,9% (n = 52) se halló sin deterioro cognitivo. De los adultos mayores no adherentes al tratamiento farmacológico, el 46,7% (n = 14) presentó un nivel de hemoglobina glicosilada (HbA1c) del 7% o más. Se encontró relación entre la salud cognitiva y la adherencia al tratamiento farmacológico (p = 0,004). CONCLUSIONES: Se halló relación entre la salud cognitiva y la adherencia al tratamiento farmacológico y una baja adherencia al tratamiento farmacológico en los adultos mayores con diabetes mellitus tipo 2. Cerca de la mitad de los adultos mayores no adherentes presentaron cifras de HbA1c superiores al 7%

OBJECTIVE: To evaluate the relationship between cognitive health and adherence to pharmacological treatment in older adults with Type 2 Diabetes Mellitus from a Community Health Center of the Province of Ñuble, Chile. METHOD: Cross-sectional analytical study, the sample consisted of 62 older adults with diagnosis of Type 2 Diabetes Mellitus. Data collection was performed through home visits using the Minimental State Examination (MMSE) instruments, Morisky Green Levine Test and a record of general data. The data were processed in the SPSS program, using descriptive and analytical statistics. The study was approved by the Bioethics committee. RESULTS: Adherence to pharmacological treatment was 51.6% (n = 32), and 83.9% (n = 52) was found without cognitive impairment. Of the non-adherent older adults to the pharmacological treatment, 46.7% (n = 14) had a level of glycosylated hemoglobin (HbA1c) of 7% or more. A relationship was found between cognitive health and adherence to pharmacological treatment (p = 0.004). CONCLUSIONS: There was a relationship between cognitive health and adherence to pharmacological treatment and a low adherence to pharmacological treatment in older adults with Type 2 Diabetes Mellitus. Nearly half of non-adherent older adults had levels of glycosylated hemoglobin (HbA1c) above the normal range

Rapid and Easy Detection of Carbapenemases in Enterobacterales in the Routine Laboratory Using the New GenePOC Carba/Revogene Carba C Assay.

The novel, real-time PCR-based GenePOC Carba assay on the microfluidic revogene platform (GenePOC, Québec, Canada; now Meridian Bioscience, Cincinnati, OH, USA) was recently designed for the detection of blaKPC, blaNDM, blaVIM, blaOXA-48-like, and blaIMP The goals of this study were to evaluate the performance of this assay, to assess its suitability for the routine microbiology laboratory, and to compare it to the Xpert Carba-R assay for the detection of carbapenemase-producing Enterobacterales (CPE) strains. The Xpert Carba-R assay (Cepheid) and the GenePOC Carba assay were challenged with a collection of 176 clinical Enterobacterales isolates. The collection included 133 CPE strains producing a total of 139 carbapenemases, including VIM (n = 48), OXA-48-like (n = 40), NDM (n = 29), KPC (n = 13), and IMP (n = 9). Six isolates produced two different carbapenemases, and 43 carbapenemase-negative isolates were included as negative controls. The overall sensitivity for carbapenemase detection was 96.4% (95% confidence interval [CI], 91.9% to 98.5%) for the Xpert Carba-R assay and 100% (95% CI, 97.3% to 100%) for the GenePOC assay. The four most common carbapenemases (NDM, KPC, OXA-48-like, and VIM) were detected with a sensitivity of 100% (95% CI, 97.1% to 100%) by the two tests, with all double carbapenemase producers being correctly detected by both assays. The sensitivity of the Xpert Carba-R assay for IMP was 44.4% (95% CI, 18.9% to 73.3%), while that of the GenePOC assay was 100% (95% CI, 70.1% to 100%). The specificity of both assays was 100% (95% CI, 91.8% to 100%). The GenePOC Carba assay showed excellent sensitivity and specificity for the five most common carbapenemases, including IMP variants. Its simplicity and short turnaround time make it suitable for use in the routine microbiology laboratory for CPE detection.

La retroalimentación constructiva en el desarrollo de habilidades comunicativas escritas e investigativas en dos generaciones de alumnos de medicina en Yucatán, México / Constructive feedback in the development of written and research communicational skills in two generations of medical students in Yucatan, Mexico

Antecedentes. La generación de competencias para la investigación en medicina es fundamental para que los médicos apliquen lashabilidades científicas en su quehacer diario; los programas académicos que incluyen la formación de habilidades investigativasrequieren a su vez habilidades para la comunicación escrita en los alumnos. La retroalimentación constructiva es un medio comúnmenteempleado en medicina, por el cual el docente acompaña al alumno, dándole a conocer sus fortalezas, debilidades y oportunidadespara un mejor desempeño, mientras asegura una evaluación justa. A pesar de ello, su aplicación más difundida es en la práctica clínicay no en el aprendizaje de la redacción y comunicación científica. Objetivo. Evaluar el impacto de la retroalimentación constructiva enel desempeño de los estudiantes en sus propuestas de protocolos clínicos y epidemiológicos considerando aspectos de redacción ymetodológicos. Diseño. Estudio analítico, prospectivo. Lugar. Universidad Marista de Mérida, Yucatán, México. Participantes. Alumnosregulares que cursaron la materia Métodos Clínicos y Epidemiológicos de la carrera de Médico Cirujano durante los ciclos escolares2014-2015 y 2015-2016. Intervención. Se evaluaron los puntajes obtenidos en el protocolo de investigación antes y después de laretroalimentación constructiva. Resultados. La media de la puntuación inicial de los protocolos fue 8,3 ± 0,8 y la media posterior a laretroalimentación constructiva fue 9,4 ± 0,9; el incremento de las puntuaciones en promedio fue de 1,1 ± 0,1 con un valor de t=7,70p=0,000. Las habilidades para la comunicación escrita que mejoraron los alumnos fueron fundamentalmente: 1. El manejo del tema,2. La organización del texto, 3. Empleo del lenguaje escrito, redacción, y 4. Fuentes de información; los alumnos presentan todaslas ideas no propias en su escrito con las citas a la fuente de donde fueron extraídas...

Background: Research and written communication skills are essential in undergraduate medical education, because medical doctors are often involved in research, and written communication is part of a medical doctor's everyday routine. Academic medical programs that include training in clinical or epidemiological research require written communication aptitudes. Constructive feedback is a review technique commonly employed in medical education that involves the professor's close surveillance of the student’s performance and a clear communication to respectfully explain to students their strengths, weaknesses and opportunities of improvement, while ensuring a fair evaluation. Even though constructive feedback is common in clinical practice, it is rarely used in undergraduate medical training in scientific writing. Objective: To evaluate the impact of constructive feedback on the academic performance of students in their clinical or epidemiological research protocol proposals, involving written and methodological aspects. Design: Analytical, prospective study. Setting: Universidad Marista de M‚rida, Yucat n, M‚xico. Participants: Students in their fourth year of medical education. Intervention: The quantitative evaluations obtained in the research protocol proposals before and after the constructive feedback were compared in 103 students in their fourth year of medical education who were attending the Clinical and Epidemiological Research Methods course during 2014-2015 and 2015-2016 school years. Results: The mean of the initial score was 8.3 ñ 0.8, and the mean post constructive feedback was 9.4 ñ 0.9; the average score increase was 1.1 ñ0.10 with t=7.70 value, p=0.000. Students improved the following communication skills: 1. Theme presentation and review, 2. Organization of a scientific manuscript, 3. Use of written language, and 4. Use of information sources...