Evaluation of belimumab treatment in patients with systemic lupus erythematosus in a clinical practice setting: Results from a 24-month OBSErve study in Argentina.

OBJECTIVE: To describe clinical effectiveness of belimumab for systemic lupus erythematosus (SLE) in real-world practice in Argentina. METHODS: This retrospective, observational study analysed medical record data of patients with SLE treated with belimumab in 15 centres in Argentina. Primary endpoint: overall clinical response (assessed on a scale similar to the 6-point Physician Global Assessment) at months 6, 12, 18 and 24, all versus index (belimumab initiation). Secondary endpoints: improvement in disease activity (SELENA-SLEDAI), SLE manifestations, and corticosteroid dose change. RESULTS: Records for 81 patients (91% female) were analysed. Clinical improvements were reported for 95%, 95%, 98% and 100% patients at 6, 12, 18, and 24 months post index, respectively. Mean SELENA-SLEDAI score decreased from 11.21 at index to 4.76, 3.77, 3.86 and 2.17 at 6, 12, 18, and 24 months post index, respectively. Number of flares decreased from 1.05 at index to 0.21, 0.09, 0.22 and 0.30 at 6, 12, 18, and 24 months post index, respectively. Mean corticosteroid dose was 14.59 mg/day at index, and 6.45, 5.18, 5.17 and 4.78 mg/day at 6, 12, 18, and 24 months post index, respectively. CONCLUSIONS: Real-world patients with SLE treated with belimumab in Argentina demonstrated clinical improvements and reductions in corticosteroid dose.

Síndrome de OHVIRA: reporte de 3 casos / OHVIRA syndrome: three case report

ANTECEDENTES: el síndrome de OHVIRA es una malformación uterina caracterizada por un útero didelfo, una hemivagina ciega total o parcial y agenesia renal ipsilateral. Se describen 3 casos diagnosticados y tratados entre 2015 y 2017. CASOS CLÍNICOS: Caso 1: paciente de 11 años con agenesia renal izquierda, que consultó por dismenorrea intensa. En la ecografía se objetivó un útero didelfo, hematosálpinx y hematómetra que se drenaron en quirófano mediante incisión en el tabique vaginal evolucionando favorablemente. Caso 2: paciente de 16 años con síndrome de Rett y agenesia renal izquierda que consultó por amenorrea tras menarquia de 4 meses. En la ecografía se descubre un útero didelfo y hematocolpos. Se realizó drenaje y apertura del tabique vaginal con éxito. Caso 3: paciente de 16 años que acudió por dismenorrea e intenso dolor anal. Se diagnostica por ecografía útero didelfo, hematosálpinx y vagina izquierda ciega con hematocolpos. No se puede drenar la colección por la alta densidad del material por lo que se decide, junto con cirugía pediátrica, realizar hemihisterectomía, colposalpinguectomía y exéresis de hemivagina ciega izquierda por laparoscopia. CONCLUSIONES: ante el hallazgo en una paciente de una malformación o agenesia renal se deberían investigar posibles malformaciones genitales asociadas como el síndrome de OHVIRA, ya que el diagnóstico y tratamiento tempranos de estas últimas reducen el sufrimiento y previenen complicaciones

BACKGROUND: OHVIRA syndrome is a uterine malformation characterized by uterus didelphys, total or partial blind hemivagina, and ipsilateral renal agenesis. Three cases diagnosed and treated between 2015 and 2017 are described. CLINICAL CASE: Case 1: 11-year-old patient who consulted for intense dysmenorrhea; ultrasound showed a uterus didelphy, hematosalpinx and hematometra that were drained in the operating room by incision in the vaginal septum, making good progress. Case 2: A 16-year-old patient with Rett syndrome and renal agenesis who consulted for amenorrhea after menarche of 4 months. On ultrasound was found a uterus didelphy and hematocolpos. Drainage and opening of the vaginal septum were performed successfully. Case 3: A 16-year-old pacient who came for dysmenorrhea and intense anal pain; by ultrasound she was diagnosed of uterus didelphy, hematosalpinx and left blind vagina with hematocolpos. The collection could not be drained because of the high density of the material so it was decided, together with pediatric surgery dept, to perform a hemihysterectomy, colposalpinguectomy and exeresis of left blind hemivagina by laparoscopy. CONCLUSION: Given the finding of renal agenesia or renal malformations, possible associated genital malformations as OHVIRA syndrome should be investigated since early diagnosis and treatment could reduce suffering and prevent complications

[Control of cardiovascular risk factors in type 2 diabetes in a specialized diabetic clinic]. / Control de los factores de riesgo cardiovascular en diabetes tipo 2 en una consulta monográfica.

BACKGROUND: Achieving an adequate control of glycaemic and cardiovascular risk factors (CVRFs) is essential in patients with type 2 diabetes mellitus (T2DM). However, several studies have shown that the percentage of patients achieving these goals is scarce. We evaluated the degree of control of CVRFs target goals in T2DM patients who regularly attend a specialized diabetic clinic. METHODS: We studied T2DM patients who attended the specialized Diabetic Unit at the Department of Endocrinology of Clínica Universitaria de Navarra with a minimum follow-up of one year. Clinical characteristics, chronic complications and treatments were collected and patients were classified into groups according to the fulfilment of target glycated haemoglobin (HbA1c), LDL cholesterol and blood pressure (BP) levels, predefined according to the presence of different comorbidities and the duration of T2DM. RESULTS: We analysed 137 patients (75% men) with T2DM, with an average age of 67 years and a 12.7 year duration of diabetes. During follow-up, 83.9% of the patients were within the individualized HbA1c target, 76.6% considering BP and 67.2% in terms of LDL-cholesterol. In addition, 68% had concomitantly the three main variables within the target. CONCLUSIONS: In our population of T2DM, HbA1c, LDL cholesterol and BP targets were achieved in a substantial proportion of patients (67-91%). Perhaps the intense and individualized care offered through a specialized diabetes unit may explain these results.

Control de los factores de riesgo cardiovascular en diabetes tipo 2 en una consulta monográfica / Control of cardiovascular risk factors in type 2 diabetesin a specialized diabetic clinic

Fundamento: Un adecuado control de la glucemia y de los factores de riesgo cardiovascular (FRCV) es fundamental en los pacientes con diabetes mellitus tipo 2 (DM2). Sin embargo, diversos estudios han demostrado que el porcentaje de pacientes que alcanzan dichos objetivos es escaso. Hemos evaluado el grado de control de FRCV en pacientes DM2 que acuden con regularidad a una consulta monográfica de diabetes. Pacientes y métodos: Se han estudiado los pacientes con DM2 que acudían a revisión al departamento de Endocrinología de la Clínica Universidad de Navarra con un seguimiento mínimo de un año. Se presentan las características clínicas, complicaciones crónicas y tratamiento médico, así como la clasificación en grupos según el cumplimiento de los objetivos de hemoglobina glicada (HbA1c), perfil lipídico (LDL-colesterol) y presión arterial (PA) individualizados según comorbilidades y años de evolución de la DM2. Resultados: Se han analizado 137 pacientes (75% hombres) con DM2, 67 años de edad media y 12,7 años de evolución. Durante el seguimiento, se encontraron dentro del rango objetivo individualizado de HbA1c el 83,9% de los pacientes, el 67,2% en cuanto a LDL-colesterol y el 76,6% considerando PA. Además, el 68% presentaron las tres variables principales dentro del objetivo. Conclusiones: En nuestra población de DM2 la consecución de objetivos de HbA1c, LDL-colesterol y PA se alcanza en una importante proporción de pacientes (67-91%). Posiblemente la intensa e individualizada atención ofrecida a través de una unidad de diabetes especializada pueda explicar estos resultados (AU)

Background: Achieving an adequate control of glycaemic and cardiovascular risk factors (CVRFs) is essential in patients with type 2 diabetes mellitus (T2DM). However, several studies have shown that the percentage of patients achieving these goals is scarce. We evaluated the degree of control of CVRFs target goals in T2DM patients who regularly attend a specialized diabetic clinic. Methods: We studied T2DM patients who attended the specialized Diabetic Unit at the Department of Endocrinology of Clínica Universidad de Navarra with a minimum follow-up of one year. Clinical characteristics, chronic complications and treatments were collected and patients were classified into groups according to the fulfilment of target glycated haemoglobin (HbA1c), LDL cholesterol and blood pressure (BP) levels, predefined according to the presence of different comorbidities and the duration of T2DM. Results: We analysed 137 patients (75% men) with T2DM, with an average age of 67 years and a 12.7 year duration of diabetes. During follow-up, 83.9% of the patients were within the individualized HbA1c target, 76.6% considering BP and 67.2% in terms of LDL-cholesterol. In addition, 68% had concomitantly the three main variables within the target. Conclusions: In our population of T2DM, HbA1c, LDL colesterol and BP targets were achieved in a substantial proportion of patients (67-91%). Perhaps the intense and individualized care offered through a specialized diabetes unit may explain these results (AU)

[Acute urinary retention of psychogenic cause in a girl]. / Retención aguda de orina de causa psicógena en una niña.

Psychogenic acute urine retention is not as common as once was thought to be, but even more infrequent is its presentation in children. Explanation of one case of psychogenic acute urine retention (A.U.R.) in a female child, including analysis of diagnosis and treatment.