Transhumanismo. ¿Inexorable por la ciencia que va a determinar la evolución? / Transhumanism. Inexorably by the science that will determine the evolution?

Hace 60 años Julian Huxley (1887­1975), el gran biólogo evolucionista británico, propul-sor de la eugenesia entendida como la dis-ciplina que busca el perfeccionamiento de la especie humana mediante la aplicación de las leyes de la he-rencia, escribió: "Hasta ahora la vida humana ha sido, en general, como Hobbes la describió, «desagradable, brutal y corta¼; la gran mayoría de los seres humanos (si aún no han muerto jóvenes) han sido afectados con la miseria... podemos sostener justificadamente la creencia de que existen estas tierras de posibilidad, y que las actuales limitaciones y frustraciones misera-bles de nuestra existencia podrían ser en gran medida sobrellevadas... La especie humana puede, si lo desea, trascenderse a sí misma - y no sólo de forma esporá-dica, un individuo aquí de una manera, un individuo no de otra manera, sino en su totalidad, como huma-nidad. "La especie humana puede, si así lo desea, trascen-der -no esporádicamente, un individuo de una manera aquí, otro individuo de otra forma allá, sino en su tota-lidad, como humanidad. Se requiere un término para significar ello. Tal vez Transhumanismo puede servir: el ser humano sigue siendo ser humano, pero trascien-de, dándose cuenta de las nuevas posibilidades de y para su naturaleza humana. Una vez que haya un nú-mero suficiente de personas que de verdad sean cons-cientes de que la especie humana está al borde de una nueva forma de existencia, tan diferente de la nuestra como lo es el Hombre de Pekín

Use of Hydroxychloroquine Is Associated With Improved Lipid Profile in Rheumatoid Arthritis Patients.

BACKGROUND/PURPOSE: We examined the association between hydroxychloroquine (HCQ) and plasma lipid and glucose levels in rheumatoid arthritis (RA) cohort. METHODS: This is a retrospective cohort analysis of 1261 RA patients comparing fasting lipid profiles and plasma glucose between patients who were and were not taking HCQ. We divided patients into 3 groups based on HCQ exposure during follow-up: those who had never taken HCQ, those who took it intermittently, and those who took it continuously. We used multivariable models and propensity scoring to compensate for the effect of nonrandom treatment assignment. RESULTS: We followed 1261 RA patients for a total of 4605 observations between 1996 and 2014. After adjusting for age, sex, ethnicity, other disease-modifying antirheumatic drugs (DMARDs), lipid-lowering medications, body mass index (BMI), and smoking, patients taking HCQ at baseline had significantly lower total cholesterol (TC) (P ≤ 0.001), low-density lipoprotein (LDL) (P ≤ 0.001), triglycerides (P = 0.013), and lipid profile ratios TC/high-density lipoprotein (HDL) (P ≤ 0.001) and LDL/HDL (P ≤ 0.001), as well as higher HDL (P ≤ 0.001).In longitudinal analyses, after adjusting for confounders, patients who continuously took HCQ showed significantly lower TC, LDL, TC/HDL, and LDL/HDL and higher HDL (P ≤ 0.01). Fasting plasma glucose levels were not significantly associated with HCQ exposure. CONCLUSIONS: Hydroxychloroquine use was associated with lower lipid levels but not with the plasma glucose in this RA cohort. These findings support the need for a randomized trial to establish the role of HCQ in cardiovascular disease prevention in RA patients.

Mortality in Rheumatoid Arthritis (RA): factors associated with recording RA on death certificates.

BACKGROUND: Death certificates can be used to assess disease prevalence and incidence; however, rheumatoid arthritis (RA) often remains unreported in death certificates. We sought to determine to what extent RA is underreported and what demographic and clinical characteristics could predict mention of RA in the death certificate. METHODS: We recruited 1328 patients with RA from private, public and military rheumatology practices and followed them prospectively for yearly evaluations. A rheumatologist assessed clinical characteristics of RA and comorbidities at each evaluation. Deaths were identified through family members, other physicians, obituaries and public death databases. All were confirmed with state-issued death certificates. Patients with and without RA in death certificate were compared using bivariate and multivariate analyses. RESULTS: By December 2013, 326 deaths had occurred. We received and reviewed death certificates for all confirmed deaths, of which 58 (17.7 %) mentioned RA on the death certificate. Bivariate analysis revealed that younger age, a greater number of deformities, higher Sharp score and lower socioeconomic status were each associated with recording RA. Multivariable analyses revealed that comorbidity [OR (95 % CI) = 0.84 (0.73, 0.97); P = 0.022] was inversely associated with listing RA on the death certificate, while the number of deformities [OR (95 % CI) = 1.04 (1.00, 1.07); P = 0.033] and a certified physician's signature on the death certificate [OR (95 % CI) = 4.79 (1.35, 16.9); P = 0.015] increased likelihood of reporting RA. CONCLUSION: In this cohort, RA was not listed in over 80 % of death certificates. Younger patients with fewer comorbidities and more joint deformities were more likely to have RA reported. DISCUSSION: RA is often not included in death certificates. The findings of this study suggest that older patients may have a greater number of comorbidities, thus decreasing the likelihood that RA be included when completing the death certificate.

Clinical and laboratory factors associated with interstitial lung disease in rheumatoid arthritis.

OBJECTIVE: The objective of this study is to examine the clinical, genetic, and environmental factors associated with interstitial lung disease (ILD) in rheumatoid arthritis (RA). METHOD: We recruited patients with RA from rheumatology practices at the time of a scheduled visit. Each patient participated in a comprehensive assessment that included ascertainment of age, sex, joint tenderness and swelling, subcutaneous nodules, disease severity, use of methotrexate and prednisone, smoking status, rheumatoid factor (RF), antibodies against cyclic citrullinated peptide (anti-CCP),erythrocyte sedimentation rate (ESR), the 28-joint Disease Activity Score (DAS28), and the presence of the HLA-DRB1 shared epitope (SE). As part of a thorough quantification of comorbidity, we identify all comorbid conditions, including ILD. We examined variables associated with ILD using logistic regression. We tested interaction terms between SE and other covariates. RESULTS: We studied 779 RA patients, among whom, ILD was recognized clinically in 69 (8.8 %). Variables significantly associated with ILD in a multivariable analysis included male sex, RA duration, the ESR, the DAS28, anti-CCP, and RF. There was a significant interaction between the HLA-DRB1 SE and smoking, ILD being associated with smoking only in the presence of SE. The association between ILD and anti-CCP, RF, and the ESR displayed a biological gradient, higher titers being more strongly associated with ILD. CONCLUSION: Anti-CCP antibodies and the RF may be pathogenically related to ILD. The association between ILD and smoking is dependent on the HLA-DRB1 SE, which may reflect gene-environment interaction.

Association of socioeconomic status with treatment delays, disease activity, joint damage, and disability in rheumatoid arthritis.

OBJECTIVE: To examine the association of socioeconomic status (SES) and delays in disease-modifying antirheumatic drug (DMARD) treatment with clinical measures in rheumatoid arthritis (RA) patients. METHODS: RA patients were recruited from rheumatology practices. We assessed SES based on education, occupation, and income, and divided patients into tertiles. The time from RA symptom onset to DMARD initiation (DMARD lag) was determined by self-report of the 2 dates, and distance to the rheumatologist (Distance) was obtained from Google Maps. We examined disease activity, determined by the Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28-ESR); joint damage, determined from hand radiographs by Sharp scores; and physical disability, determined by the modified Health Assessment Questionnaire (M-HAQ). We used linear regression models to examine the relationship between clinical measures and SES, Distance, and DMARD lag. RESULTS: We recruited 1,209 RA patients, 1,159 of whom had received DMARD treatment. Mean ± SD DMARD lag was 6.9 ± 9.0 years. On average, patients with lower SES waited 8.5 ± 10.2 years after onset of RA symptoms to begin DMARD treatment, compared to those in the middle and upper SES tertiles who waited 6.1 ± 7.9 years (P = 0.002) and 6.1 ± 8.6 years (P = 0.009), respectively. Each year of delayed treatment was associated with a DAS28-ESR increase of 0.02 (P ≤ 0.001), a Sharp score increase of 1.33 (P ≤ 0.001), and an M-HAQ score increase of 0.01 (P ≤ 0.001). CONCLUSION: Low SES was associated with delay in DMARD initiation, and both were independently associated with worse clinical measures in RA. Strategies to reduce treatment delay in low-SES RA patients are needed.

Historia de la enfermedad de Devic / History of Devic's disease

En este escrito hacemos una completa revisión de la enfermedad de Devic, desde sus primeras descripciones por Eugene Devic, hasta el concepto actual, donde es considerada una neuromielitis óptica. Exponemos las diferentes formas de presentación de la neuromielitis óptica así como los hallazgos clínicos y de laboratorio que permiten diferenciar esta entidad de la esclerosis múltiple, tarea que muchas veces no es fácil de realizar por la semejanza en la presentación clínica. Sin embargo es importante su diferenciación porque el tratamiento y el pronóstico difieren entre estas dos enfermedades. No obstante, el descubrimiento de los anticuerpos IgG anti NMO, dirigidos contra los canales de agua de acuaporina 4 fueron fundamentales en tal diferenciación. Realizamos una mención especial sobre la enfermedad de Devic y el lupus y finalmente hacemos unas notas sobre el tratamiento disponible para esta patología.

In this paper we do a complete review of Devic's disease, from its first descriptions by Eugene Devic, to the current concept, which is considered a neuromyelitis optica (NMO). We present the different forms of presentation of NMO as well as clinical and laboratory findings that distinguish this entity from multiple sclerosis, a task that frequently is not easy to perform because of the similarity in clinical presentation. Its differentiation is important because the treatment and prognosis differ between these two diseases. However the discovery of NMO IgG antibodies directed against aquaporin-4 water channels was a critical step in such differentiation. We made special mention of Devic's disease and lupus, and finally make some notes on the available treatment for this pathology.

Enfermedades osteocondensantes con compromiso de huesos largos: presentación de dos casos y revisión de la literatura / Sclerosing bone diseases with involvement of long bones: report of two cases and literature review

Las enfermedades osteocondensantes son un grupo de patologías poco frecuentes que se caracterizan por aumento de la masa ósea, comprometiendo tanto a huesos largos como a huesos planos. Tradicionalmente, la radiología simple ha permitido su diagnóstico al identificar patrones de afectación ósea característicos de cada enfermedad. Actualmente, la caracterización molecular y genética ha facilitado la comprensión del sustrato fisiopatológico y la expresión fenotípica de estás patologías, sin embargo, la radiología simple continua teniendo un valor inconmesurable en el reconocimiento de las enfermedades osteocondensantes.

Sclerosing bone disorders are a rare group of diseases characterized by increased bone mass in both long and flat bones. Traditionally, plain radiography has allowed the diagnosis of these diseases identifying characteristic patterns of bone involvement. At present, the molecular and genetic characterization of these diseases has provided a better understand of their pathophysiology and phenotypic expression, however plain radiography continues to have an important role in the recognition of sclerosing bone disorders.

[The role of surgical education in pregraduate medical education.]

Surgical education in pregraduate medicine is important because it is during this period where students acquire abilities that will allow them to make important future decisions when performing surgical procedures. Faculties of medicine make significant efforts to design innovative and rigorous curricula that will provide medical professionals with abilities to carryout medical procedures in a changing panorama of health systems as well as to provide scientific and technological advances. Intellectual and clinical proficiency, discipline, ethics and human values that a student acquires during pregraduate training and education will result in becoming a very efficient health professional.

Serum endoglin levels in patients suffering from systemic sclerosis and elevated systolic pulmonary arterial pressure.

Background. Pulmonary arterial hypertension (PAH) is the main cause of morbimortality in systemic sclerosis (SSc). Increased Eng expression has been demonstrated in SSc patients. Objective. Ascertaining serum levels of Eng in SSc patients with and without elevated systolic pulmonary arterial pressure (sPAP) and comparing them with that of healthy volunteers. Methods. A cross-sectional study was carried out. A commercial ELISA kit was used for measuring serum concentrations of Eng in 60 subjects: 40 patients with SSc with and without elevated sPAP, compared to 20 healthy control subjects. Elevated sPAP was detected by echocardiogram. Results. No association between positive Eng and elevated sPAP was found when compared to the SSc without elevated sPAP group (OR = 2.85; 0.65-12.88 95% CI; P = .11); however, an association was found between positive Eng and elevated sPAP compared to healthy controls (OR = 23.22; 2.46-1050.33 95% CI; P = .001), and weak association was found between the positive Eng with SSc without elevated sPAP group compared to healthy controls (OR = 8.14, 0.8-393.74 95% CI; P = .046). Conclusion. Raised serum levels of Eng in SSc patients compared to healthy controls were found, suggesting a role for Eng in SSc vasculopathy and not just in elevated sPAP. However, prospective studies are needed to verify such observations.