Risk of Severe COVID-19 Infection in Patients With Inflammatory Rheumatic Diseases.

OBJECTIVE: To describe the cohort of patients with inflammatory rheumatic diseases (IRD) hospitalized due to SARS-CoV-2 infection in the Ramón y Cajal Hospital, and to determine the increased risk of severe coronavirus disease 2019 (COVID-19) in patients with no IRD. METHODS: This is a retrospective single-center observational study of patients with IRD actively monitored in the Department of Rheumatology who were hospitalized due to COVID-19. RESULTS: Forty-one (1.8%) out of 2315 patients admitted due to severe SARS-CoV-2 pneumonia suffered from an IRD. The admission OR for patients with IRD was 1.91 against the general population, and it was considerably higher in patients with Sjögren syndrome, vasculitis, and systemic lupus erythematosus. Twenty-seven patients were receiving treatment for IRD with corticosteroids, 23 with conventional DMARDs, 12 with biologics (7 rituximab [RTX], 4 anti-tumor necrosis factor [anti-TNF], and 1 abatacept), and 1 with Janus kinase inhibitors. Ten deaths were registered among patients with IRD. A higher hospitalization rate and a higher number of deaths were observed in patients treated with RTX (OR 12.9) but not in patients treated with anti-TNF (OR 0.9). CONCLUSION: Patients with IRD, especially autoimmune diseases and patients treated with RTX, may be at higher risk of severe pneumonia due to SARS-CoV-2 compared to the general population. More studies are needed to analyze this association further in order to help manage these patients during the pandemic.

Analysis of Complete Remission in Systemic Lupus Erythematosus Patients Over a 32-Year Period.

OBJECTIVE: Systemic lupus erythematosus (SLE) is characterized by an unpredictable and fluctuating course. Although various methods have been developed to measure disease activity, there is still a lack of consensus about the optimal criteria for SLE remission. The principal aim of our study was to identify the number of lupus patients achieving a complete remission (implying that for 3 years there were no clinical or serologic features and no treatment with steroids and immunosuppressive drugs) in a single cohort of patients followed for a period of up to 32 years. In addition, we have identified patients in clinical but not serologic remission (known as serologically active, clinically quiescent disease [SACQ]) and vice versa. We were particularly interested to determine the factors associated with complete remission. METHODS: Eligible patients were followed up in the University College Hospital Lupus cohort from January 1978 until December 2010 for a period of at least 3 years. Complete remission was defined as a period of at least 3 years with clinical inactivity (British Isles Lupus Assessment Group scores of C, D, or E only) and laboratory remission (no antibodies to double-stranded DNA and normal complement C3 levels), and being off-treatment with corticosteroids and immunosuppressants. Antimalarial and nonsteroidal antiinflammatory drugs were allowed. RESULTS: Of 624 lupus patients at our hospital, a total of 532 patients met the strict inclusion criteria for the study. Of these 532 patients, 77 patients (14.5%) achieved complete remission for at least 3 years, and 23 (4.3%) achieved complete remission for a minimum period of 10 years. Ten of these 77 patients were subsequently lost to followup, and, interestingly, flares occurred subsequently in 15 of the 67 remaining patients (22.4%). Three patients relapsed after the tenth year of remission. Forty-five patients (8.5%) fulfilled the requirement for SACQ, and 66 patients (12.4%) achieved only serologic remission. CONCLUSION: Our study indicated that 14.5% of lupus patients achieved a complete remission for 3 years. However, flares may continue to occur beyond 10 years of remission. Long-term followup of SLE is therefore mandatory.

Hemartrosis de rodilla secundaria a osteocondritis disecante (enfermedad de König) / Knee hemarthros secondary to osteochondritis dissecans (König disease)

Presentamos el caso de una hemartrosis de rodilla asociada a osteocondritis disecante en un adulto joven que consultó por urgencias debido a dolor y tumefacción de su rodilla derecha media hora después de un gesto rotacional del miembro inferior. Varios años antes el paciente sufrió un accidente deportivo en la misma rodilla por la que nunca consultó. El estudio radiológico mostró 2 fragmentos dentro de la cápsula sinovial y una artrocentesis demostró hemartrosis. Realizamos una revisión de la información disponible de esta patología infrecuente (AU)

A case is presented of a hemarthrosis associated with osteochondritis dissecans in a young man who arrived in the Emergency unit due to tender and swelling of his right knee one hour after a slightly rotational gesture of the lower limb. Many years before the patient suffered a sports injury in the same knee, but it was never assessed. Radiography studies showed bone fragments inside the synovial capsule, and the joint aspiration was compatible with hemarthrosis. A review of the available information of this uncommon condition is also presented (AU)

Rabdomiólisis secundaria a la realización de actividad física y electroestimulación simultánea: reporte de un caso / Rhabdomiolysis secondary to physical activity and simultaneous electrostimulation. A case report

No disponible

Knee hemarthros secondary to osteochondritis dissecans (König disease).

A case is presented of a hemarthrosis associated with osteochondritis dissecans in a young man who arrived in the Emergency unit due to tender and swelling of his right knee one hour after a slightly rotational gesture of the lower limb. Many years before the patient suffered a sports injury in the same knee, but it was never assessed. Radiography studies showed bone fragments inside the synovial capsule, and the joint aspiration was compatible with hemarthrosis. A review of the available information of this uncommon condition is also presented.

Es seguro realizar infiltraciones o aspiraciones articulares en pacientes anticoagulados con acenocumarol? / Is it safe to perform joint infiltrations or aspirations in patients anticoagulated with acenocoumarol?

El propósito del presente estudio es determinar la tasa de complicaciones por sangrado en pacientes anticoagulados con acenocumarol en función del índice normalizado internacional (INR) de coagulación. Se realizó un estudio retrospectivo con 901 registros de pacientes a quienes se les practicó una artrocentesis o infiltración articular entre 2009 y 2013, se agruparon los registros en función de tener un INR superior o inferior a 2,0 (268 y 633 registros, respectivamente) y se compararon las tasas de complicaciones por sangrado. Se observó una tasa de 0,37% de complicaciones por sangrado tempranas (< 24 h) en el grupo de pacientes con INR < 2 y una tasa de 0,99% en el grupo de pacientes con INR ≥ 2 (p = 0,47). Solo se presentó un caso de complicación por sangrado tardío, entre 24 h y 30 días, en el grupo de pacientes con INR ≥ 2. Concluimos que la anticoagulación oral a dosis terapéutica con acenocumarol no incrementa el riesgo de sangrado por punciones articulares (AU)

The purpose of this study is to determine the rate of bleeding complications in patient's anticoagulated with acenocoumarol according to the international normalized ratio (INR) coagulation index. A cross-sectional study was performed with 901 charts of patients who underwent arthrocentesis or joint infiltration between 2009 and 2013; the charts were grouped on the basis of having an INR higher or lower than 2.0 (268 and 633, respectively). Comparisons were performed in terms of rates of early or late bleeding complications. A 0.37% rate of early bleeding complications (<24 h) was observed in the group of patients with INR<2 and 0.99% in the group of patients with INR≥2 (P=.47). Only one case of late complication was presented by bleeding between 24 h and 30 days, in the group of patients with INR≥2. We conclude that oral anticoagulation with acenocoumarol at therapeutic doses does not increase the risk of bleeding joint punctures (AU)

Is it safe to perform joint infiltrations or aspirations in patients anticoagulated with acenocoumarol?

The purpose of this study is to determine the rate of bleeding complications in patient's anticoagulated with acenocoumarol according to the international normalized ratio (INR) coagulation index. A cross-sectional study was performed with 901 charts of patients who underwent arthrocentesis or joint infiltration between 2009 and 2013; the charts were grouped on the basis of having an INR higher or lower than 2.0 (268 and 633, respectively). Comparisons were performed in terms of rates of early or late bleeding complications. A 0.37% rate of early bleeding complications (< 24hours) was observed in the group of patients with INR<2 and 0.99% in the group of patients with INR≥2 (P=.47). Only one case of late complication was presented by bleeding between 24 hours and 30 days, in the group of patients with INR≥2. We conclude that oral anticoagulation with acenocoumarol at terapeutical doses does not increase the risk of bleeding joint punctures.

Dolor agudo neonatal con estímulos dolorosos repetitivos, estudio randomizado comparando tres métodos analgésicos no farmacológicos / Neonatal acute pain with repetitive painful stimuli, randomized trial comparing three analgesic non pharmacological methods

Introducción: La analgesia no farmacología es raramente utilizada en las unidades de neonatología. Los estímulos dolorosos repetitivos tienen efectos negativos a largo plazo. Objetivos: Verificar que los métodos analgésicos no farmacológicos son afectivos en estímulos dolorosos repetitivos; determinar cuál método es más efectivo. Material y método; Se realice un ensayo clínica, randomizado, con tres grupos formados de manera aleatoria, con recién nacidos sanos a termino por grupo. Fueron sometidos a tres estímulos dolorosos durante los tres primero días de vida (vacuna contra hepatitis B, BCG y muestra para grupo sanguíneo). El primer grupo (A) recibió lactancia materna y contacto piel como método analgésico no farmacológico durante el estímulo doloroso, el grupo (B) recibió dextrosa al 10 por ciento y el grupo (C) una tetina sin nada. Se utilizó la escala para el Dolor Agudo Neonatal (DAN, Carbajal y col.) y la Escala ABC (Bellieni y col.) para la cuantificación del dolor. Fueron comparados los 3 grupos en cada uno de los tres estímulos repetitivos. Resultados: Para ambas escalas el grupo B expresó menor dolor en los tres estímulos, con 97,5 por ciento de NO DOLOR vs 87,5 por ciento (A) y 85 por ciento (C) (p<0.036) en la escala ABC, y 95 por ciento vs 85 por ciento (A) y 70 por ciento (C) para la categoría NO DOLOR con a categoría DAN (p<0.022). Esta diferencia se mantuvo en las otras categorías de dolor. Se observó que el efecto analgésico es mayor con el estimulo repetitivos. Siendo la categoría NO DOLOR en el grupo B para el primer estimulo 70 por ciento, 85 por ciento en el segundo y 95 por ciento en el tercero (p<0.020). Este efecto se observó también en los grupos A y C. Conclusiones: la dextrosa al 10 por ciento tuvo mayor efecto analgésico comparada con los otros grupos. Los métodos analgésicos no farmacológicos estudiados aumentan su efectividad con estimulo dolorosos repetitivos.

Introduction: Non pharmacological methods are rarely used in neonatal units. repeated painful stimuli have long noxious effects. Objective: To verify the effectiveness of non pharmacological methods in repeated painful procedures; to determine which method is more effective. Material and methods: We conducted a randomized controlled trial. Newborns were randomly assigned into 3 groups (n=40 per group). All of them underwent painful procedures during the first 3 days of life (hepatitis B, BCG and blood sample for determine group and factor). Group A received breast feeding and skin to skin contact as non pharmacological method during the painful stimuli, group B receive dextrose 10 por ciento and group C only suction. Douleur Aigue Nouveauûne scores (DAN, Carvajal et al.) and ABC scale (Bellieni et al.) were used to assess neonatal pain. The 3 groups were compared in each stimulus to determine the most effective method, and the effectiveness in repeated painful stimuli. Results: Group B showed the most analgesic effect in the stimuli, with 97, 5 percent for NO PAIN vs. 87, 5 percent (A) and 85 percent (C) (p<0,036) with ABC scale, and 95 percent vs. 85 (A) and 70 percent (C) for NO PAIN with DAN scale (p<0,022). This difference was constant with all categories of pain. We observed that analgesic effect is greater in repeated painful stimuli. NO PAIN category was 70 percent in group B in the first stimuli, 85 percent in the second and 95 percent in third (9<0,020). This effect was also observed in groups A and C. Conclusions: Dextrose 10 percent seems to offer the best analgesic effect compared with breast feeding and suction. Non pharmacological methods studied increase their effectiveness in repeated painful stimuli.