Utility of neutrophil-to-lymphocyte ratio plus C-reactive protein for infection in systemic lupus erythematosus.

OBJECTIVE: To analyze the utility of neutrophil-to-lymphocyte ratio (NLR) plus C-reactive protein (CRP) to differentiate between infection and active disease in patients with SLE. METHODS: A cross-sectional study of a cohort of patients with SLE was carried out. Blood samples from four groups (patients without infection or active disease, patients with infection, patients with active disease, and patients with both infection and active disease) before therapeutic interventions were analyzed. We excluded patients with current malignancy, pregnancy, ischemic heart disease or use of antimicrobials during previous 7 days. Hematological cell count, CRP and cultures were obtained. We constructed receiver operating characteristic curves; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: Forty patients were included. NLR cut-off ≥6.3 had sensitivity 70%, specificity 85%, PPV 83% and NPV 74% to detect patients with non-viral infections. A CRP cut-off ≥7.5 mg/L had sensitivity 90%, specificity 75%, PPV 78% and NPV 88% to detect infections regardless of SLE activity. Combination of CRP plus NLR improves the specificity to 90% and PPV to 88%. Excluding the group with both infection and active disease, CRP plus NLR expands specificity to 95% and NPV to 90%. CONCLUSION: In our experience, levels of CRP, particularly CRP plus NLR, were useful in differentiating patients with SLE from those with suspected non-viral infection regardless of the activity of the disease.

Active haematological manifestations of systemic lupus erythematosus lupus are associated with a high rate of in-hospital mortality.

The aim of this study was to estimate the impact of the haematological manifestations of systemic lupus erythematosus (SLE) on mortality in hospitalized patients. For that purpose a case-control study of hospitalized patients in a medical referral centre from January 2009 to December 2014 was performed. For analysis, patients hospitalized for any haematological activity of SLE ( n = 103) were compared with patients hospitalized for other manifestations of SLE activity or complications of treatment ( n = 206). Taking as a variable outcome hospital death, an analysis of potential associated factors was performed. The most common haematological manifestation was thrombocytopenia (63.1%), followed by haemolytic anaemia (30%) and neutropenia (25.2%). In the group of haematological manifestations, 17 (16.5%) deaths were observed compared to 10 (4.8%) deaths in the control group ( P < 0.001). The causes of death were similar in both groups. In the analysis of the variables, it was found that only haematological manifestations were associated with intra-hospital death (odds ratio 3.87, 95% confidence interval 1.8-88, P < 0.001). Our study suggests that apparently any manifestation of haematological activity of SLE is associated with poor prognosis and contributes to increased hospital mortality.

Educational impact of a clinical anatomy workshop on 1st-year orthopedic and rheumatology fellows in Mexico City.

We aim to study the educational impact of a clinical anatomy workshop in 1st-year orthopedic and rheumatology fellows. First-year rheumatology fellows (N = 17) and a convenience sample of 1st-year orthopedic fellows (N = 14) from Mexico City in the 9th month of training participated in the study. The pre- and the post- workshop tests included the same 20 questions that had to be answered by identification or demonstration of relevant anatomical items. The questions, arranged by anatomical regions, were asked in five dynamic stations. Overall, the 31 participants showed an increase of correct answers, from a median of 6 (range 1 to 12) in the pre-workshop test, to a median of 14 (range 7 to 19) in the post-workshop test. In the pre-workshop test, the correct median answers were 7 (range 2 to 12) in the orthopedic fellows and 5 (range 1 to 10) in the rheumatology fellows (p = 0.297). Corresponding scores in the post-workshop were 15 (range 10 to 19) and 12 (range 7 to 18) (p = 0.026) showing a significant difference favoring the orthopedic group. Our clinical anatomy workshop was efficacious, in the short term, as a teaching instrument for 1st-year orthopedic and rheumatology fellows. The post-workshop scores, although significantly improved in both groups, particularly in the orthopedic fellows, were still suboptimal. Further refinements of our workshop might yield better results.

Primigravida is associated with flare in women with systemic lupus erythematosus.

The objective of this study was to identify risk factors associated with flare during pregnancy in women with systemic lupus erythematosus (SLE). We performed a retrospective analysis of pregnant women with SLE in a referral hospital. Flare was considered according to predetermined definitions. We analyzed 15 clinical, biochemical and immunological variables with a potential predictive value for relapse during pregnancy. We included 124 lupus pregnancies in 120 women. The relapse rate during pregnancy was 37.9% (47 episodes). The most common manifestations of flare were renal, joint, cutaneous and hematological. Patients with flare during pregnancy developed a higher frequency of preeclampsia and preterm delivery. In multivariate analysis, primigravida was a risk factor associated with any type of flare during pregnancy (OR 2.3, 95% CI 0.99-5.52, p = 0.05); on the other hand, primigravida (OR 3.6, 95% CI 1.19-11.3, p = 0.02), activity prior to pregnancy (OR 3.7, 95% CI 0.97-14.1, p = 0.05), and previous renal disease (OR 5.8, 95% CI 1.95-17.6, p = 0.001) were the principal risk factors associated with renal flare. The first pregnancy in women with SLE is associated with any type of flare. Disease activity is associated with preeclampsia and preterm delivery. Close monitoring is mandatory to identify relapses and timely treatment.

Fulminant systemic vasculitis in systemic lupus erythematosus. Case report and review of the literature.

Vasculitis in systemic lupus erythematosus (SLE) has a broad spectrum of clinical manifestations from cutaneous to visceral involvement and its prognosis ranges from mild to life-threatening. We report the case of a previously healthy 17-year-old woman with eight months' history of arthralgias and myalgias. Subsequently, she developed facial and lower limbs edema, and hair loss. Two weeks before admission to a secondary level hospital, she developed fever up to 40°C followed by abdominal pain, rectal bleeding, hematemesis and blisters on both legs, reason for which she was hospitalized. With active bullous SLE with rapidly progressive glomerulonephritis suspected, she was treated with methylprednisolone pulses without response. After one week of treatment, she was transferred to a tertiary level hospital. On admission she presented acute arterial insufficiency of the lower extremities, respiratory failure with apnea, metabolic acidosis and shock; six hours later she died. Autopsy findings showed active diffuse lupus nephritis and diffuse systemic vasculitis that involved vessels from the skin, brain, myocardium, spleen, iliac and renal arteries. In addition, serositis of the small intestine and colon, acute and chronic pericarditis, pericardial effusion and myocarditis were found. Immunologic tests confirmed SLE diagnosis. In this case the fulminant course was the result of SLE high disease activity, visceral vasculitis of several organs and late diagnosis, referral and treatment. Early diagnosis, and opportune referral to the rheumatologist for intensive treatment can improve the outlook in these patients.

The ACTN3 R577X polymorphism is associated with inflammatory myopathies in a Mexican population.

BACKGROUND: The ACTN3 gene encodes the fast muscle protein α-actinin-3. The ACTN3 R577X polymorphism is a premature stop codon and results in absence of α-actinin-3 in 577XX homozygotes. The aim of this study was to determine the ACTN3 genotype in idiopathic inflammatory myopathies (IIMs). METHODS: We performed ACTN3 genotyping on 27 patients with dermatomyositis (DM), 10 with polymyositis (PM), and 85 healthy subjects. Muscle enzyme levels of creatine phosphokinase (CPK), lactic dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were recorded at the time of diagnosis and recruitment. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and the allele frequency was analysed. RESULTS: A total of 36% of healthy subjects had the ACTN3 577XX polymorphism (α-actinin-3 deficiency), 18% had the 577RR (homozygous wild type) genotype, and 46% 577RX (heterozygous). In DM/PM, 70% had the ACTN3 577XX polymorphism, 6% RR, and 24% RX [odds ratio (OR) 4.12, 95% confidence interval (CI) 1.67-10.33, p < 0.001]. In healthy subjects, the R allele was present in 41% and the X allele in 59% compared to 18% and 82%, respectively, in the IIM group (OR 3.21, 95% CI 1.57-6.66, p < 0.001). Thus, the ACTN3 577X allele seemed to increase the risk of developing IIM, and DM in particular, although this was not related to severity of expression of the phenotype. CONCLUSIONS: The ACTN3 577X allele appeared to increase the risk of developing IIM; 70% of IIM patients were deficient in α-actinin-3. By contrast, ACTN3 577XX patients seemed to have less severe disease as reflected in lower muscle enzyme levels.

Still's disease, lupus-like syndrome, and silicone breast implants. A case of 'ASIA' (Shoenfeld's syndrome).

In recent years, four conditions, siliconosis, Gulf War syndrome (GWS), macrophagic myofasciitis syndrome (MMF) and post-vaccination phenomena, were linked to a previous exposure to an adjuvant, suggesting a common denominator, and it has been proposed to incorporate comparable conditions under a common syndrome entitled Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA). We report a case of a female who at the age of 11 years was diagnosed with Still's disease. At the age of 22 she underwent silicone breast implants and presented with a transient lupus-like syndrome. Then, at 25 years old she had a severe activation of Still's disease in association with rupture of silicone breast implants. When the prostheses were removed, the clinical picture improved. This case fulfills the criteria for ASIA and complements seven previous reports of Still's disease in association with silicone breast implants.

Localizar y reconducir al paciente a la oficina de farmacia en la corrección de errores de dispensación. Resultados en un área sanitaria de Madrid / Locating and bringing back the patient to the office of pharmacy for the dispensation errors correction. Results in a sanitary area of Madrid

Objetivos: Incrementar la seguridad en la utilización de los medicamentos por parte de los usuarios a los que se haya realizado una dispensación errónea y que puedan originar riesgos a su salud, mediante la localización del paciente, y derivarle de nuevo a la oficina de farmacia (OF) para corregir el error. Establecer una herramienta de ayuda al farmacéutico comunitario (FC) en su labor profesional. Incrementar la calidad en el proceso de dispensación. Conocer las especialidades farmacéuticas que generan mayor número de errores. Cumplir con la ley de protección de datos de los pacientes. Métodos: Una vez aprobado y consensuado el protocolo de actuación ante errores de dispensación, cuando se origina una consulta que contiene un error de este tipo, el FC cumplimenta un cuestionario con información de la farmacia, el médico prescriptor, el paciente y el medicamento involucrado, y lo notifica al Servicio de Farmacia de Atención Primaria (SFAP). A través del programa de Tarjeta Sanitaria Individual, se obtiene información sobre los usuarios del Sistema Nacional de Salud, registrándoselas consultas en una base de datos. Se localiza a los pacientes, indicándoles que acudan a la OF o se pongan en comunicación con ésta para corregir el error. Asimismo, la OF informa al SFAP cuando se ha corregido el error. Resultados: Este procedimiento de actuación permite localizar a los pacientes a quienes se les originó un error en la dispensación y corregirlo. Permite determinar cuáles son las especialidades farmacéuticas en las que más veces se originan errores.Conclusiones: La implantación del protocolo logró detectar cuáles son los medicamentos en los que más veces se originan errores en su dispensación. Logró resolver el problema que surge en este acto, al poder localizar al paciente y reconducir el error originado, e incrementar la seguridad y la calidad en la asistencia y la atención farmacéutica (AU)

Objectives: Increase the safe use of medicines by patients, to whom mistakes in dispensations process have been made and that could originate risk to their health. By locating the patient and deriving again to the Office of Pharmacy (OP) to correct the error. Establish a tool, to help the Community Pharmacists (CP)in their professional work. Increase the quality of the dispensing process. To know the pharmaceutical specialities that generates a greater number of errors. Complying with the data protection law of the patients. Methods: Once approved and with consensus of the protocol of action for errors of dispensation, when there is a query that identifies a dispensing error, CP fills a questionnaire with information about the pharmacy, the medical prescriber, the patient and the medication involved, and notifies all of it to the Primary Care Pharmacy Department (SFAP). Through the Individual Sanitary Card program, you get the personal information needed from the National Health System, with queries in the database. The patients are located, telling them to go to the OP or to be in contact with them so as to address the mistake. Likewise, the OP informs the SFAP when the error has been corrected. Results: The present procedure of action allows locating the patients to whom an error in the dispensation process was made correcting it. It allows determining which pharmaceutical specialities are the ones which most often cause mistakes. Conclusions: The implementation of a protocol, detected the medications that more often are involved in dispensing errors. Managing to solve the problem that arises in the act, by locating the patient and by bringing, being able to resolve the mistake improve the safety and quality in the assistance of pharmaceutical care (AU)

Second national external quality assessment scheme in hematology: the Philippine experience.

The Philippine Council for Quality Assurance In Clinical Laboratories has conducted two National External Quality Assessment Schemes (NEQAS) in Hematology. The first survey was conducted in December 1999 and the second in August 2000, with 95 and 187 laboratories, using mostly automated analyzers, participating respectively. Control materials were distributed during a two-week period by human network, and analyzed over a six to eight week period. For the first survey, only 36 laboratories (38.0%) submitted results. Data was divided into 4 peer groups based on the manufacturer. Since most of the samples were hemolysed upon analysis, only WBC and HGB parameters were evaluated. No outliers were detected in each peer group after analysis by the 'Peer Group Mean and SDI' method. Using the clinical laboratory improvement act of 1988 proficiency testing criteria (CLIA'88), only 5 results (13.9%) were unsatisfactory for WBC, and all results were satisfactory for HGB. For the second survey, 87 laboratories (47%) responded. Data was divided into 5 peer groups. There were few incidents of sample deterioration. Although majority of the coefficient of variations were acceptable, about 23 (12.6%) participants showed abnormality in at least one parameter after analysis by the 'Peer Group Mean and SDI'. Using CLIA'88, 5 WBC (6.5%), 6 RBC (7.6%), 8 HGB (9.7%), 15 HCT (19.0%), and 7 PLT (8.0%) results were unsatisfactory. In summary, the first NEQAS study served as a pilot study. Valuable lessons were learned for the improvement of the second NEQAS. The second NEQAS study was marked by a much larger sample size and better results.

Sex differences in aversive and appetitive conditioning in two strains of rats.

In order to examine sex differences in non sexual behavior, 40 rats of each sex from two strains (gray, A x C and albino, Sprague-Dawley) were trained, using different experimental procedures. In Experiment I, aversive conditioning in a one-way (easy task) and a two-way (difficult task) active avoidance task was examined. Results consistently showed that males of both strains were inferior to females in the acquisition of the two-way avoidance task. A significant interaction between sex of both strains and the difficulty of the task was found. In Experiment II, rats were trained in a Sutherland Apparatus in an easy (black vs. white) and a difficult (horizontal vs. vertical) visual discrimination task, using appetitive reinforcement; no differences between sexes were observed. A significant interaction, however, was found between strain and task, indicating a lower performance of the A x C strain in the difficult task. The results are discussed within the theoretical framework of the Yerkes-Dodson Law, which states a relationship between drive level, performance and different degrees of task difficulty.

Evaluacion de la afasia con la Bateria Luria-Nebraska. / Evaluation of aphasia with Luria-Nebraska Battery

En este trabajo se dan los antecedentes historicos de la Bateria Luria-Nebraska a continuacion de la cual sigue una descripcion de las pruebas que la constituyen. Se senala su relevancia para la evaluacion de las afasias, para cuyo fin se seleccionaron todos los casos de Afasia (N = 4), que se encontraron en una muestra de 50 pacientes con dano organico cerebral que fueron examinados con la Bateria para su adaptacion en Chile. Se confeccionaron los perfiles respectivos de un caso de afasia motora, afasia amnestica progresiva, afasia de nominacion y afasia global o mixta.Se discuten las bases teoricas de la Bateria, que puede resumirse en el concepto de "sistema funcional" de Luria. Se finaliza con la informacion relativa a las investigaciones actuales en Estados Unidos, la que sigue dos principales tendencias: los estudios de validez, y aquellos que pretender probar la teoria de funcion cerebral de Luria, la que puede hacerse a traves de un cuidadoso analisis cuantitativo y cualitativo de los itemes de la Bateria

Effects of dimepramine fumarate on physiological and cognitive behaviors of Parkinson patients.

Nine patients 55 to 74 years old with Parkinson's disease were tested before and after treatment with 50 to 225 mg dimepramine fumarate (CIBA G-31406) for about three weeks daily in order to determine the drug's effects on electrodermal responsiveness to a series of unpredictably occurring loud sounds. Twelve control subjects were tested and retested with the same procedure. In addition, the Parkinson patients received a number of cognitive tests before and after drug treatment. Results indicated that the drug tends to decrease autonomic arousal responses as measured by resting conductance levels, number of fluctuations in skin conduction per minute, orienting response, and habituation rate. These decreases in measures of arousal generally were accompanied by lowered performance scores on several tests of memory and temporal discrimination ability.