Clinical, Laboratory, and Imaging Features Between Men and Women With Axial Spondyloarthritis in a Specialized Center in Argentina.

OBJECTIVES: The aims were to estimate the frequency of axial spondyloarthritis (axSpA) in women and to analyze the clinical, laboratory, and imaging differences with respect to men at the time of diagnosis. METHODS: Consecutive patients older than 18 years with a diagnosis of axSpA admitted to the "Reumacheck" SpA program were included between 2017 and 2022. At baseline, all patients underwent clinical assessment, laboratory tests including C-reactive protein and human leukocyte antigen B27, and imaging (plain radiography and magnetic resonance imaging of sacroiliac joints, and ultrasound of heel entheses). All evaluators were blinded to the results of the other evaluations. RESULTS: One hundred sixteen patients with a diagnosis of axSpA were included. The frequency at diagnosis in women was 61.55%. In the univariate analysis, the significant differences between women and men at diagnosis of axSpA were good response to nonsteroidal anti-inflammatory drugs, elevated C-reactive protein, New York Criteria (+), enthesis ultrasound (+), years of education, number of swollen joints, erythrosedimentation rate, and the very low frequency of bone bridges in the magnetic resonance imaging of the sacroiliac joints. In the logistic regression analysis, the dependent variable was "men," and the only feature that was independently associated was having radiographic compromise according to the New York criteria (odds ratio, 2.6). CONCLUSIONS: The frequency of axSpA in women was 61.55%; clinical, laboratory, and imaging differences were observed. Women experienced less radiographic compromise.

Repetitive sulfur dioxide exposure in mice models post-deployment respiratory syndrome.

Soldiers deployed to Iraq and Afghanistan have a higher prevalence of respiratory symptoms than nondeployed military personnel and some have been shown to have a constellation of findings on lung biopsy termed post-deployment respiratory syndrome (PDRS). Since many of the subjects in this cohort reported exposure to sulfur dioxide (SO2), we developed a model of repetitive exposure to SO2 in mice that phenocopies many aspects of PDRS, including adaptive immune activation, airway wall remodeling, and pulmonary vascular (PV) disease. Although abnormalities in small airways were not sufficient to alter lung mechanics, PV remodeling resulted in the development of pulmonary hypertension and reduced exercise tolerance in SO2-exposed mice. SO2 exposure led to increased formation of isolevuglandins (isoLGs) adducts and superoxide dismutase 2 (SOD2) acetylation in endothelial cells, which were attenuated by treatment with the isoLG scavenger 2-hydroxybenzylamine acetate (2-HOBA). In addition, 2-HOBA treatment or Siruin-3 overexpression in a transgenic mouse model prevented vascular remodeling following SO2 exposure. In summary, our results indicate that repetitive SO2 exposure recapitulates many aspects of PDRS and that oxidative stress appears to mediate PV remodeling in this model. Together, these findings provide new insights regarding the critical mechanisms underlying PDRS.NEW & NOTEWORTHY We developed a mice model of "post-deployment respiratory syndrome" (PDRS), a condition in Veterans with unexplained exertional dyspnea. Our model successfully recapitulates many of the pathological and physiological features of the syndrome, revealing involvement of the ROS-isoLGs-Sirt3-SOD2 pathway in pulmonary vasculature pathology. Our study provides additional knowledge about effects and long-term consequences of sulfur dioxide exposure on the respiratory system, serving as a valuable tool for future PDRS research.

Determinants of non-institutional childbirth: Evidence from the Peruvian demographic and health survey.

Objective: We aimed to evaluate the determinants of non-institutional delivery among women of childbearing age in Peru. Methods: We conducted a secondary analysis of data from the Peru 2019 Demographic and Family Health Survey (ENDES). This multi-stage survey sampling is representative at the urban-rural, regional, and national levels. The outcome variable was place of delivery, collected by self-reporting. Binary logistic regression models were used to assess the factors associated with non-institutionalized delivery. Thus, we estimated crude and adjusted odd ratios (aOR). For the multivariable model, the manual forward selection method and the Wald test were used to obtain a final parsimonious model. Results: The final sample included 14,061 women of reproductive age between the ages of 15 and 49. The prevalence of non-institutional delivery was 7.8 %. Multivariate regression analysis found that having a secondary education (aOR:0.48; 95 % confidence interval [CI]:0.39-0.58) or higher (aOR:0.57; 95 %CI:0.42-0.78); belonging to the second (aOR:0.26; 95 %CI:0.20-0.33), third (aOR:0.28; 95 %CI:0.21-0.38), fourth (aOR:0.21; 95 %CI:0.13-0.33), or fifth wealth quintile (aOR:0.15; 95 %CI:0.09-0.27); and suffering intimate partner violence (aOR:0.76; 95 %CI:0.64-0.91) were associated with lower odds of non-institutional delivery, while not having some type of health insurance (aOR:3.12; 95 %CI:2.47-3.95), living in a rural area (aOR:1.93; 95 %CI:1.54-2.42), and having had three or more deliveries (aOR:1.36; 95 %CI:1.07-1.72), were associated with higher odds of non-institutional delivery. Conclusions: We found that not having health insurance, residing in a rural area, and having had three or more deliveries were factors associated with non-institutional delivery in women of childbearing age. We propose that should focus public health strategies towards providing education to women about maternal health, and likewise, facilitating access to specialized health centers for rural populations.

Difficult to treat rheumatoid arthritis in a comprehensive evaluation program: frequency according to different objective evaluations.

Difficult-to-treat Rheumatoid Arthritis (RA-D2T) is a condition in which patients do not achieve the treatment target despite multiple advanced therapies, more others features. Aims: to estimate the frequency of RA-D2T in a cohort comprehensively evaluated (clinical, serology, imaging), and to analyze the associated characteristics. In a second part, the frequency of RA-D2T after 1 year of follow-up, analyzing the predictive variables at baseline and therapeutic behavior. Cross-sectional and prospective study, consecutive RA were included, then those who completed the one-year follow-up were evaluated. RA-D2T frequency was estimated (DAS28-CDAI-SDAI-Ultrasonography (US)-HAQ) at baseline and 1 year. The variables associated and those baseline predictive characteristics of D2T at 1 year, and their independent association by logistic regression were analyzed. The treatment approach was described. Two hundred seventy-six patients completed the evaluation, frequency of RA-D2T (all scores): 27.5%. Anemia, RF high titers and higher HAQ score were independent associated. At year, 125 competed follow-up. RA-D2T (all scores): 33%, D2T-US and D2T-HAQ were 14 and 18.4% (p 0.001). Predictive baseline characteristics D2T (all score): ACPA + (OR: 13.7) and X-ray erosion (OR: 2.9). D2T-US: X-ray erosion (OR: 19.7). Conventional DMARDs, corticosteroids and TNF-blockers were the drugs most used by D2T patients, Jaki were the most used in the switch. We showed different frequencies of RA-D2T according to different objective parameters (scores, images) and their association with patient characteristics. In turn, predictive variables (erosions-ACPA) for RA-D2T at 1 year were analyzed. It was shown that the Jaki were the most used drug in these patients.

Repetitive Sulfur Dioxide Exposure in Mice Models Post-Deployment Respiratory Syndrome.

Soldiers deployed to Iraq and Afghanistan have a higher prevalence of respiratory symptoms than non-deployed military personnel and some have been shown to have a constellation of findings on lung biopsy termed post-deployment respiratory syndrome (PDRS). Since many of the deployers in this cohort reported exposure to sulfur dioxide (SO 2 ), we developed a model of repetitive exposure to SO 2 in mice that phenocopies many aspects of PDRS, including adaptive immune activation, airway wall remodeling, and pulmonary vascular disease (PVD). Although abnormalities in small airways were not sufficient to alter lung mechanics, PVD was associated with the development of pulmonary hypertension and reduced exercise tolerance in SO 2 exposed mice. Further, we used pharmacologic and genetic approaches to demonstrate a critical role for oxidative stress and isolevuglandins in mediating PVD in this model. In summary, our results indicate that repetitive SO 2 exposure recapitulates many aspects of PDRS and that oxidative stress may mediate PVD in this model, which may be helpful for future mechanistic studies examining the relationship between inhaled irritants, PVD, and PDRS.

Rheumatoid arthritis monotherapy in the Jak inhibitors Era. Current prevalence and associated factors in a multicenter study.

BACKGROUND: Combined therapy constitutes the standard of care in RA. Jak inhibitors (Jaki) have shown efficacy in monotherapy, a modality used in cases where it is not possible to use Disease-Modifying Anti Rheumatic Drugs (csDMARDs). OBJECTIVES: To estimate the prevalence (total and by drug), reason for using and the increase over the time of bDMARDs or tsDMARDs as monotherapy after the availability of the Jaki. To analyze the differential characteristics between patients with monotherapy vs combined therapy. METHODS: Cross-sectional multicenter study. Consecutive patients with a diagnosis of RA (ACR/EULAR 2010) under treatment with bDMARDs or tsDMARDs started from 2013 were included. Socio-demographic, clinic, and therapeutic data were collected. RESULTS: A total of 505 RA patients were included. Since 2013, the prevalence of monotherapy usage was (any) 49%. The drugs used as monotherapy were Jaki in 41% and TNF-blockers in 30%. The leading causes of monotherapy use were intolerance/adverse events (62%), medical decision or lack of adherence (37.7%). The highest socioeconomic level and a better functional status at diagnosis were predictors of monotherapy use. The use of the second line of treatments and less polypharmacy were independent factors associated with this therapeutic modality. CONCLUSIONS: The current prevalence of monotherapy in RA was 49%, the Jaki were the most used drug in this modality. Monotherapy increases from year to year. There are differential characteristics in patients using monotherapy.

How are rheumatologists from Argentina managing patients with arthralgias suspicious for progressing to rheumatoid arthritis?

Patients with arthralgias who could be at risk of progressing to rheumatoid arthritis (RA) represent a clinical challenge. Recommendations for their management and treatment are lacking. The purpose of the present study was to determine how Argentinean rheumatologists deal with these patients. We developed an anonymous ad hoc survey which was sent to 522 Argentinean rheumatologists. The RA study group of our Argentinean Rheumatology National Society assisted in forwarding the surveys to its members via the internet (e-mail or WhatsApp). The findings of the collected data are presented as descriptive statistics. The questionnaires were completed by 255 rheumatologists (overall response rate of 48.9%), and 97.6% confirmed that their practices had received medical consultations to rule out RA in patients with arthralgias. Ultrasound (US) was the method of first choice (93.7%) as part of the evaluation of these patients. For those in whom US power Doppler signal was present in at least one joint, 93.7% of the participants would start treatment and methotrexate was the first choice (58.1%). In patients with tenosynovitis but no synovitis on US, most rheumatologists would start treatment (89.4%), being NSAIDs the drug of first choice (52.3%). Argentinean rheumatologists evaluate patients with imminent RA and treat them based on their clinical judgment and findings from the US evaluation of affected joints; the drug of first choice for these patients among these rheumatologists was methotrexate. Despite published data of recent clinical trials, recommendations for the management and treatment of these patients are necessary.

Ultrasound tenosynovitis: A differential feature of patients with seronegative rheumatoid arthritis.

OBJECTIVE: To identify differential features between patients with seropositive and seronegative rheumatoid arthritis (RA). METHOD: Prospective cohort study, including patients who were admitted for polyarthralgia. At baseline was performed: laboratory studies, X-rays of hands and feet, ultrasound of both hands with power Doppler technique, clinical data and clinimetry. In subsequent visits the definitive diagnosis of RA was established or not. It was considered as seronegative RA when patients were negative for both RF and ACPAs. RESULTS: 746 patients were included, of which 128 (17.1%) ended with a final diagnosis of RA. Of these 128 patients, 87 (67.9%) were seropositive RA, while 41 (32%) were seronegative RA. The only feature that showed significant differences was the presence of tenosynovitis detected by ultrasound with a positive power Doppler signal, 13.7% of the patients with seropositive RA vs 41.6% of the patients with seronegative RA (p=0.0028). CONCLUSION: The only differential feature of patients with seronegative RA was the higher proportion of tenosynovitis detected by ultrasound.

Ultrasound tenosynovitis: A differential feature of patients with seronegative rheumatoid arthritis / Tenosinovitis ecográfica: una característica diferencial de pacientes con artritis reumatoide seronegativa

Objective: To identify differential features between patients with seropositive and seronegative rheumatoid arthritis (RA). Method: Prospective cohort study, including patients who were admitted for polyarthralgia. At baseline was performed: laboratory studies, X-rays of hands and feet, ultrasound of both hands with power Doppler technique, clinical data and clinimetry. In subsequent visits the definitive diagnosis of RA was established or not. It was considered as seronegative RA when patients were negative for both RF and ACPAs. Results: 746 patients were included, of which 128 (17.1%) ended with a final diagnosis of RA. Of these 128 patients, 87 (67.9%) were seropositive RA, while 41 (32%) were seronegative RA. The only feature that showed significant differences was the presence of tenosynovitis detected by ultrasound with a positive power Doppler signal, 13.7% of the patients with seropositive RA vs 41.6% of the patients with seronegative RA (p=0.0028). Conclusion: The only differential feature of patients with seronegative RA was the higher proportion of tenosynovitis detected by ultrasound.(AU)

Objetivo: Identificar características diferenciales entre pacientes con artritis reumatoide (AR) seropositivos y seronegativos. Método: Estudio de cohorte prospectivo, incluyendo pacientes con poliartralgias. Al inicio se realizó: estudios de laboratorio, radiografías de manos y pies, ecografía de ambas manos con técnica power doppler, datos clínicos y clinimetría. En visitas posteriores se estableció o no el diagnóstico definitivo de AR. Se consideró AR seronegativa cuando los pacientes eran negativos tanto para factor reumatoide como para anticuerpos antipéptido cíclico citrulinado. Resultados: Se incluyeron 746 pacientes, de los cuales 128 (17,1%) terminaron con diagnóstico final de AR. De estos 128 pacientes, 87 (67,9%) eran AR seropositivos, mientras que 41 (32%) eran AR seronegativos.La única característica que mostró diferencias significativas fue la presencia de tenosinovitis detectada por ecografía con señal power doppler positiva, el 13,7% de los pacientes con AR seropositiva frente al 41,6% de los pacientes con AR seronegativa (p=0,0028). Conclusión: El único rasgo diferencial de los pacientes con AR seronegativa fue la mayor proporción de tenosinovitis detectadas por ecografía.(AU)

Psoriatic Arthritis: Differential Features at the Time of Clinical Presentation in a Large Cohort of Patients with Polyarthralgia.

OBJECTIVE: Most patients with psoriatic arthritis begin with cutaneous psoriasis, which is why all early detection strategies are based on screening in the dermatological consultation and referral to a rheu matologist. However, there are cases of patients who consult initially for musculoskeletal symptoms, mostly joint pain, regardless of family and/or personal history of psoriasis. This study aimed to esti mate the frequency of psoriatic arthritis in a cohort of patients who consulted for polyarthralgia and to determine the differential features, at the time of clinical presentation, in relation to both patients with final diagnosis other than psoriatic arthritis and patients with diagnosis of rheumatoid arthritis. METHODS: Consecutive patients with polyarthralgia (including arthralgia of the hands) were included. Clinical examination, laboratory tests, ultrasound with power Doppler of both hands, and radiography of both hands and feet were performed at baseline. All patients were followed up and the definitive diagnosis of psoriatic arthritis was established. RESULTS: A total of 1055 were included, 88 (8.3%) ended with diagnosis of psoriatic arthritis. Diagnosis of psoriatic arthritis was positively associated with a family history of psoriasis (odds ratio=4.14), pso riasis (odds ratio=78.94), radiographic erosions (odds ratio=5.74), and ultrasound with at least 1 joint with positive power Doppler (odds ratio=7.11). In comparison with rheumatoid arthritis patients, diagnosis of psoriatic arthritis was positively associated with psoriasis (odds ratio=433.42) and family history of psoriasis (odds ratio=41.63). On the other hand, it was negatively associated with positivity, for both rheumatoid factor (odds ratio=0.03) and anti-cyclic citrullinated peptide antibodies (odds ratio=0.06). CONCLUSION: The frequency of psoriatic arthritis was 8.3% and was associated with a personal and/or family history of psoriasis, radiographic erosions, and inflammatory involvement by Power Doppler Ultrasound (PDUS). In comparison with rheumatoid arthritis patients, psoriatic arthritis was associated with a personal and/or family history of psoriasis, while the presence of both rheumatoid factor and/ or anti-cyclic citrullinated peptide antibodies was shown to be a protective factor for the diagnosis of psoriatic arthritis.

Chronic low back pain: diagnostic approach for primary care

Antecedentes: El dolor lumbar es uno de los principales motivos de consulta en el primer nivel de atención, requiere múltiples intervenciones diagnósticas, así como la adopción de conductas terapéuticas, e incluso, conlleva discapacidad en los pacientes adultos. Objetivo: Brindar una aproximación clínica con orientación diagnóstica para el abordaje de los pacientes con un motivo de consulta frecuente en el primer nivel de atención. Resultados: Los autores proponen un algoritmo para el abordaje clínico del paciente con dolor lumbar crónico, orientando, además, hacia generalidades de los exámenes complementarios (química sanguínea, imágenes diagnósticas, entre otros), para evaluar en un primer nivel al paciente que acude por esta patología. Conclusiones: La propuesta presentada en este artículo permite guiar al personal médico de primer nivel de atención a través de una aproximación enfocada en las características semiológicas del dolor, así como poder correlacionar con los diagnósticos más frecuentes, a fin de remitir o dirigir al paciente de acuerdo con las necesidades particulares correspondientes.

Keywords: Background: Low back pain is one of the main complaints in primary care reported by-patients, requiring several diagnostic interventions, therapeutic approaches and even entailing disability in young adults. Objective: To provide a clinical approach, diagnostically oriented, for patients frequently consulting primary care. Results: Of the authors propose a clinical algorithm for the clinical assessment of the patient with chronic low back pain, also considering complementary tests (imaging, blood chemistry, etc.) for the evaluation in primary care of the patient with this pathology. Conclusions: The proposal provided in this article helps guide the primary care physician through an approach focusing on the semiological characteristics of pain, so that they can correlate with the most frequent diagnoses, in order to refer or direct the patient according to their particular needs.

Non-radiographic axial spondyloarthritis in South America. Burden of disease and differential features with respect to ankylosing spondylitis at time of diagnosis. A comprehensive analysis with a focus on images.

BACKGROUND: Non-radiographic axial spondyloarthritis (nr-axSpA) data from South America are scarce, especially regarding image features. Objective To estimate the frequency of nr-axSpA and ankylosing spondylitis (AS) in a cohort of Argentinian patients with chronic low back pain (LBP) and to analyze the difference between both, with focus on magnetic resonance imaging (MRI) lesions, at diagnosis. METHODS: Patients with LBP and a diagnosis of axSpA who participated in a reuma-check program were included. All patients with a suspicion of SpA were evaluated using blood analytics, HLA-B27, and images (MRI). Sociodemographic data, SpA features, diagnostic dela,y and clinimetrics were assessed by an operator who was blinded to the patient's test results. On MRI, the presence of SpA lesions was assessed and a concordance exercise was carried out between rheumatologists and radiologist. RESULT: Of 198 LBP patients, 97 had axSpA, 54% of whom were nr-axSpA. A positive MRI was found in 50%. No difference in terms of disease activity, functional impact, laboratory or treatments between nr-axSpA and AS were found. Higher frequencies of male sex and chronic lesions on sacroiliac MRI were found in AS patients. In the logistic regression, an independent association with AS diagnosis was found: male (odds ratio [OR] 4.8), MRI fat replacement (OR 4.6), MRI sclerosis (OR 7.6), and diagnostic delay of more than 2 years (OR 10). The concordance between rheumatologists and radiologists was considered good to very good (κ 0.7-0.8). CONCLUSION: The frequency of nr-axSpA was 54%. We found a higher frequency of being male, more SpA features, and a longer diagnostic delay in patients with AS. Patients with AS had more structural lesions, with a good concordance between rheumatologist and radiologist.

Factors associated with post-traumatic stress disorder symptoms in the post-quarantine context of the COVID-19 pandemic in Peruvian medical students.

Background: In March 2020, the Peruvian state introduced quarantine as a measure to control the spread of SARS-CoV-2. It has been suggested that being in quarantine is associated with the development of symptoms of Post-traumatic Stress Disorder (PTSD). The present study aims to explore the factors associated with the development of PTSD in a post-quarantine context due to COVID-19 in medical students. Objectives: To evaluate the factors associated with the development of post-quarantine PTSD symptoms in medical students from a Peruvian university. Methods: Analytical cross-sectional study. The objective will be developed after the lifting of the quarantine in Peru. Medical students enrolled during the 2020-01 academic cycle of the Peruvian University of Applied Sciences will be included. To collect the outcome variable (PTSD), the Impact of Event Scale - Revised (IES-R) will be used. The associated factors will be collected through a form that will be validated by experts and piloted in the field. The crude and adjusted coefficients will be calculated, using bivariate and multivariate linear regression models, respectively. We will use the "manual forward selection" technique to obtain a final model with minimally sufficient fit. After each model comparison and decision, multicollinearity will be evaluated with the variance inflation factor and matrix of independent variables. Results: Not having health insurance, having relatives or close friends who contracted the disease and having a lower family income are factors associated with PTSD in the post-quarantine context of the COVID-19 pandemic in medical students at a Peruvian university. Conclusions: Clinical evaluation is important for medical students with a high probability of having PTSD symptoms. We recommend conducting a longitudinal study to identify causality and other unstudied factors related to PTSD.

Consenso de inmunizaciones en adultos con enfermedades reumáticas inflamatorias crónicas autoinmunes / Consensus on immunizations in adults with autoimmune chronic inflammatory rheumatic diseases

Aumento del riesgo de infecciones prevenibles y sus complicaciones en pacientes con enfermedades reumáticas inflamatorias crónicas (ERICA), con y sin tratamiento con inmunosupresores (IS), y beneficios de la vacunación.

The Role of HLA-B27 in Argentinian Axial Spondyloarthritis Patients.

BACKGROUND: The prevalence of human leukocyte antigen B27 (HLA-B27) is variable around the world. Our objectives were to estimate the frequency of HLA-B27 in an Argentinian cohort of axial spondyloarthritis (axSpA), to evaluate the differences between HLA-B27-positive and HLA-B27-negative patients, and to analyze its performance as a diagnostic biomarker. METHODS: Observational study including patients older than 18 years, with axSpA diagnosis assessed in a fast track program (Reuma-Check SpA). All patients underwent the following: blood tests, HLA-B27, sacroiliac images, and enthesitis ultrasound. Sociodemographic data and SpA symptoms were also collected. The clinical assessor was blinded to complementary studies. For the sensitivity and specificity analysis, patients with chronic low back pain without axSpA who performed the same circuit in the same period were used as control, paired 1:1 (sex and age). RESULTS: One hundred fifty patients were included, 75 axSpA and 75 controls. The frequency of HLA-B27 was 43% (95% confidence interval [CI], 30-53). The differences between HLA-B27-positive and HLA-B27-negative patients were observed in age of low back pain onset (36 vs 46 years), BASFI (Bath Ankylosing Spondylitis Functional Index) (4 vs 5), and extra-articular SpA features such as uveitis and inflammatory bowel disease (29% vs 50%). When this frequency was compared (low back pain control group), the difference was 43% versus 9% (odds ratio, 7.7; 95% CI, 2.8-24), and HLA-B27 had a sensitivity of 43%, specificity of 91%, positive predictive value of 85%, negative predictive value of 58%, and likelihood ratio of 4.9 (95% CI, 3-8). CONCLUSIONS: The frequency of HLA-B27 in axSpA was 43%; positive patients had an earlier age of onset (36), a higher BASFI, and more SpA features. For the diagnosis of SpA, HLA-B27 had a good specificity but low sensitivity.

Guillain-Barré syndrome in patients with SARS-CoV-2 infection. Report of three cases / Síndrome de Guillain-Barré en pacientes con infección por SARS-CoV-2. Reporte de tres casos

ABSTRACT Several cases of Guillain Barre Syndrome (GBS) associated with SARS-CoV-2 have been published, most being acute inflammatory demyelinating polyradiculoneuropathy. Between April and December 2020, 1,499 cases of SARS-CoV-2 infection were admitted to Hospital del Salvador, in Santiago, Chile, serving a population of 521,920 adults. In the same period, seven cases of GBS were admitted. Three females had a demyelinated type of GBS associated with SARS-CoV-2 infection. All three presented with progressive flaccid symmetrical areflexic weakness with inability to walk, one needed intubation and mechanical ventilation due to SARS-CoV2 infection. All had a favorable, rapid response to intravenous immunoglobulin. In two patients, the onset of GBS was almost concomitant with SARS-CoV-2 infection. A causal relationship between SARS-CoV-2 and GBS has been questioned since no increase of GBS has occurred during the pandemic. However, a rise in GBS associated with SARS-CoV-2 infection could be hidden due to a general decrease of GBS due to the decrease of all other infections. Lack of reporting due to the pandemic could be an added factor.

Se han publicado varios casos de síndrome de Guillain Barre (SGB) asociados con el SARS-CoV-2, la mayoría de los cuales son polirradiculoneuropatía desmielinizante inflamatoria aguda. Entre abril y diciembre de 2020, se ingresaron 1.499 casos de infección por SARS-CoV-2 en el Hospital del Salvador de Santiago de Chile, que atiende a una población de 521.920 adultos. Durante el mismo período se admitieron siete casos de SGB. Tres pacientes de sexo femenino con SGB tipo desmielinizante asociado a una infección por SARS-CoV-2. Las tres presentaron debilidad simétrica, flácida y arrefléctica progresiva, con incapacidad para caminar, una necesitó intubación y ventilación mecánica debido a la infección por SARS-CoV2. Todas tuvieron una respuesta rápida y favorable a la inmunoglobulina intravenosa. En dos pacientes, la aparición de SGB fue casi concomitante con la infección por SARS-CoV-2. Una relación causal entre el SARS-CoV-2 y SGB ha sido cuestionada ya que no se ha producido ningún aumento de SGB durante la pandemia. Sin embargo, un aumento de SGB asociado con la infección por SARS-CoV-2 podría ocultarse en una disminución general de SGB debido a la disminución de todas las demás infecciones asociadas a este. La sub-notificación debido a la dimensión de la pandemia podría ser también un factor.

Teleconsulta médica. Análisis y recomendaciones del Departamento de Ética del Colegio Médico de Chile

The possibility of allowing patients access to health professionals, has been greatly facilitated by advances in technology. Indeed, nowadays it is possible not only direct contact between one health professional with another, but also the possibility of sending images and other tests to consult distant colleagues. This has undoubtedly enabled better health care for many patients. It is also possible for a patient to consult a doctor directly in a remote and synchronous way with oral and visual contact, thus establishing a new form of medical consultation. It is this last way of relationship, which has already spread as a practice in normal times, which arouses apprehensions about the ethical requirements that a consultation must meet. This work by the Ethics Department of the Chilean Medical Association seeks to reflect on the ethical demands of a medical consultation and on the shortcomings that teleconsultation has. It also aims to propose several recommendations, so that this new form of doctor-patient relationship serves as a complement to traditional care, without jeopardizing the objectives of a medical action.

Engagement process for patients with spondyloarthritis: PANLAR early SpA clinics project - centers of excellence.

Spondyloarthritis (SpA) is one of the most complex rheumatological diseases to diagnose and treat because, in the early stages of the disease, the inflammatory low back pain is often difficult to identify, and patients are diagnosed when they already have advanced structural processes. There is an urgent need to establish healthcare models that allow optimization of the management of these patients. The objective of this work is to propose a care model that is adaptable to the factual realities of Latin America. A systematic search of the literature terms (MeSH) was performed to search associated terms. Taking the model of the REAL-PANLAR project as an example and incorporating some related literature, a model of centers of excellence for SpA in Latin America is proposed that can be reasonably established and implemented. This model proposes 3 types of centers of excellence for SpA according to the level of complexity of each institution, and its criteria are defined based on indicators of structure, processes, and results. This is the first effort in Latin America to try to standardize the care of patients with spondyloarthritis. Key Points • The unmet needs in Latin America in the care of SpondyloArthritis (SpA), demand solutions that facilitate the rapid and assertive access of patients to specialized centers such as Center of Excellence in SpA. • This project facilitates the standardization of high-quality care for patients with SpA, starting from its diagnosis and up to clinical follow-up. • Due to standardization of care, better clinical and safety outcomes are achieved for patients, as well as patient-reported outcomes. • By standardized models of care, will be achieved a reduction in the progress of this pathology and optimization in the use of high-complexity services and high-cost therapies, improving cost-efficiency for public health systems in each country.

[Monomelic amyotrophy. Report of one case]. / Atrofia monomiélica distal de extremidad superior. Caso clínico.

Monomelic amyotrophy, also known as Hirayama disease, is a rare lower motor neuron syndrome due to localized lower motor neuron loss in the spinal cord at the cervical level. Clinically, monomelic amyotrophy is defined by the insidious onset of unilateral atrophy and weakness involving the hand and forearm, typically beginning in the second or third decade of life. We report 19-year-old man with a two years history of slowly progressive unilateral weakness and atrophy of his right-hand muscles. Neurological examination revealed weakness and atrophy in his intrinsic hand muscles, with sparing of the abductor pollicis brevis muscle. Also, mild atrophy of the ulnar aspect of the forearm was detected with sparing of the brachioradialis muscle. Electromyography showed active and chronic neurogenic changes affecting C8 and T1 myotomes, with mild chronic neurogenic changes on C7 myotome. Magnetic resonance imaging of his cervical spine revealed spinal cord atrophy involving C5 to C7 segments, associated with forward displacement of the posterior wall of the dura in cervical spine flexion. The clinical features associated with the imaging and electrophysiological findings support the diagnosis of monomelic amyotrophy.