Erosions on T1-Weighted Magnetic Resonance Imaging Versus Radiography of Sacroiliac Joints in Recent-Onset Axial Spondyloarthritis: 2-Year Data (EMBARK Trial and DESIR Cohort).

OBJECTIVE: (1) To compare the capacity to detect sacroiliac joint (SIJ) erosions and baseline-to-week 104 change in erosions between magnetic resonance imaging (MRI) and radiographs in recent-onset axial spondyloarthritis (axSpA); and (2) to compare treatment-discriminatory capacities of MRI and radiographic scores for erosion detection in patients receiving etanercept in the Effect of Etanercept on Symptoms and Objective Inflammation in Nonradiographic axSpA (EMBARK) trial vs controls in the DESIR (Devenir des Spondylarthropathies Indifférenciées Récentes) cohort. METHODS: Anonymized SIJ MRI and radiographs were assessed at patient and joint surface levels. Three readers evaluated MRI; 3 different readers evaluated radiographs. Final scores for comparison of radiographs and MRI for detection of erosions were assigned based on agreement of ≥ 2 of 3 readers' assessments. RESULTS: At baseline, discordance in erosion detection between imaging methods was more frequent for MRI erosions in the absence of radiographic erosions (48/224 [21.4%] patients) than for radiographic erosions in the absence of MRI erosions (14/224 [6.3%] patients; P < 0.001). After 104 weeks, a decrease in erosions was observed on MRI but not radiographs in 49/221 (22.2%) patients, and on radiographs but not MRI in 6/221 (2.7%) patients (P < 0.001). In the treatment-discriminant capacity analysis, the largest standardized differences between etanercept and control cohorts at week 104 were changes in Spondyloarthritis Research Consortium of Canada MRI erosion discrete score, changes in erosion average score, and meeting the modified New York criteria on radiographs, with unadjusted/adjusted Hedges G effect sizes of 0.40/0.50, 0.40/0.56, and 0.40/0.43, respectively. CONCLUSION: In recent-onset axSpA, SIJ erosions and erosion change were observed more frequently on MRI than radiography. The significance of interval improvement of MRI erosions warrants further research. [ClinicalTrials.gov: NCT01258738, NCT01648907].

Clinical and radiographic outcomes of shoulder hemiarthroplasty for patients with glenoid medialization.

BACKGROUND: Glenoid bone loss in shoulder arthroplasty is a difficult problem that is prone to complications because of challenges with achieving glenoid component fixation and stability. The purpose of this study was to evaluate the outcomes of primary shoulder hemiarthroplasty for patients with severe glenoid medialization precluding placement of a glenoid component. METHODS: This was a retrospective case series evaluating patients who underwent shoulder hemiarthroplasty for severe glenoid erosion and medialization between 2010 and 2020. Patients were evaluated via chart review and phone survey to determine if there were any reoperations at final follow-up and to obtain Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Simple Shoulder Test (SST) scores. Preoperative and postoperative radiographs were evaluated and compared to determine glenoid morphology, version, medialization, acromiohumeral distance, and humeral offset. Final postoperative films were also evaluated for anterosuperior migration and signs of mechanical failure, including loosening or periprosthetic fracture. RESULTS: Overall, there were 28 patients during this period who underwent shoulder hemiarthroplasty for severe glenoid medialization. Eight patients were deceased at the time of the study, 2 were unable to complete surveys because of dementia, and 7 were lost to follow-up. The final cohort included 11 shoulders and 11 patients with a mean age of 71 ± 7.1 years and mean follow-up of 6.7 years (range 1.6-13.0 years). Mean postoperative SANE, ASES, and SST scores were 80.6 ± 17.6, 71.5 ± 29.3, and 7.6 ± 2.0, respectively. There were no reoperations or revision surgeries at final follow-up. Radiographic evaluation demonstrated severe glenoid medialization and decreased lateral humeral offset, which was unchanged postoperatively. There were 2 patients with signs of anterosuperior migration at final radiographic follow-up but no signs of implant failure. CONCLUSION: Shoulder hemiarthroplasty for severe medial glenoid bone loss provides modest clinical outcomes and low rates of reoperation at mid- to long-term follow-up and is an option worth considering in cases where placement of a glenoid component is challenging because of deficient bone stock and high risk for complications.

Investigations into Increased Incidence of Severe Gizzard Erosions and Ulcerations in U.S. Commercial Broilers.

During a series of pathology surveys in four production complexes of a U.S. broiler integrator, the technical services veterinarians of an animal health company noted a high incidence of severe gizzard erosions and ulcerations (GEU), prompting further clinical investigation and a battery trial. No growth-promoting antibiotics or ionophore coccidiostats were used during the period of these surveys. All used tribasic copper chloride (TBCC) at ≤120 ppm added copper in broiler rations. Clostridium perfringens was isolated from 83% and 67% of gizzard lesions cultured in two complexes, and cecal C. perfringens most probable number determinations were higher in severely affected than in mildly affected or unaffected birds. Histopathology revealed both acellular koilin fusion defects characteristic of copper toxicity, as well as inflammatory cell infiltrates. Intralesional bacilli suggestive of C. perfringens were noted in 78% of affected flocks examined. Species E Aviadenovirus was isolated from one bird in one complex, and that bird had a single intranuclear inclusion body; no other flocks had Adenoviruses isolated or detected on PCR, nor any inclusion bodies. Other viruses detected were thought to be incidental. A pilot study using feed with supplemental copper from TBCC or copper sulfate and challenge with one of the isolated C. perfringens strains reproduced the lesions. A battery study was conducted with an unchallenged negative control group fed a diet with 16 ppm added copper, a group fed the control diet and orally challenged with 108 organisms of a field strain of C. perfringens at 21 and 22 days, and a group treated with the same diet containing 250 ppm added copper from TBCC and orally challenged with C. perfringens. Birds were necropsied at 23 and 28 days. All challenged groups developed lesions, with those receiving both TBCC and C. perfringens having significantly higher gross and histopathological lesion scores than the unchallenged negative controls. Lesions were qualitatively similar to those in the field and contained suspected C. perfringens bacilli. Because the levels of TBCC used in the commercial birds and in the battery trial generally have been considered safe, and because C. perfringens is usually regarded as a pathogen of the lower GI tract, the possible association of these two agents with GEU is a novel observation and warrants further investigation.

Investigaciones sobre el aumento de la incidencia de erosiones y ulceraciones severas en la molleja en pollos de engorde comerciales en los Estados Unidos. Durante una serie de estudios de patología en cuatro complejos de producción de un integrador de pollos de engorde de los Estados Unidos, veterinarios de servicio técnico de una empresa de salud animal observaron una alta incidencia de erosiones y ulceraciones severas de la molleja (GEU), lo que motivó una mayor investigación clínica y un estudio en batería. Durante el período de estas encuestas no se utilizaron antibióticos promotores del crecimiento ni coccidiostáticos ionóforos. Todos utilizaron cloruro de cobre tribásico (TBCC) con un nivel de ≤120 ppm de cobre agregado en raciones para pollos de engorde. Se aisló Clostridium perfringens del 83% y el 67% de las lesiones de molleja cultivadas en dos complejos, y las determinaciones del número más probable de C. perfringens en los sacos ciegos fueron mayores en aves severamente afectadas que en aves levemente afectadas o no afectadas. La histopatología reveló defectos de fusión de la capa córnea acelular característicos de la toxicidad por cobre, así como infiltrados de células inflamatorias. Se observaron bacilos intralesionales sugestivos de C. perfringens en el 78% de las parvadas afectadas examinadas. La especie Aviadenovirus E se aisló de un ave en un complejo, y esa ave tenía un único cuerpo de inclusión intranuclear; en ninguna otra parvada se aislaron o detectaron adenovirus mediante PCR, ni se observaron cuerpos de inclusión. Se pensó que otros virus detectados fueron incidentales. Un estudio piloto que utilizó alimento con cobre suplementario de cloruro de cobre tribásico o sulfato de cobre y con desafío con una de las cepas aisladas de C. perfringens reprodujo las lesiones. Se realizó un estudio de batería con un grupo de control negativo no desafiado alimentado con una dieta con 16 ppm de cobre agregado, un grupo alimentado con la dieta de control y desafiado por vía oral con 108 organismos de una cepa de campo de C. perfringens a los 21 y 22 días, y un grupo tratado con la misma dieta que contenía 250 ppm de cobre agregado de cloruro de cobre tribásico y desafiados por vía oral con C. perfringens. A las aves se les realizó la necropsia a los 23 y 28 días. Todos los grupos desafiados desarrollaron lesiones, y aquellos que recibieron cloruro de cobre tribásico y C. perfringens tuvieron puntuaciones de lesiones macroscópicas e histopatológicas significativamente más altas que los controles negativos no desafiados. Las lesiones eran cualitativamente similares a las del campo y contenían bacilos sospechosos de C. perfringens. Debido a que los niveles de cloruro de cobre tribásico utilizados en las aves comerciales y en el ensayo en batería generalmente se han considerado seguros, y debido a que C. perfringens generalmente se considera un patógeno del tracto gastrointestinal inferior, la posible asociación de estos dos agentes con erosiones y ulceraciones severas de la molleja es una observación reciente y justifica una mayor investigación.

Current Role of Conventional Radiology in Rheumatology.

The correct interpretation of the most common radiological findings in rheumatological diseases can be pivotal for an accurate diagnosis. X rays offer immediacy, worldwide availability, affordability, and the ability to detect subtle bone changes. Numerous scoring systems that have been developed to support clinical practice are based on joint damage that can be observed on X rays. Metabolic, degenerative, infective, and inflammatory processes manifest as distinct alterations in joints and their identification can be challenging. In this review, the authors will discuss the most common radiological findings in hands, hips, and the spine that can serve as valuable diagnostic tools.

Retrospective Broiler Health Survey: Scope, Parameters, and Overall Trends.

A retrospective analysis encompassing 18 yr (1999-2016) of broiler chicken health surveys from broiler production complexes throughout the United States was conducted to identify trends and areas of opportunity. The analysis used necropsy data from 19,577 broiler chickens considered to be "healthy" or "clinically normal" by visual assessment. The very low incidence of dehydrated (0.01%) or undersized (0.02%) broilers is evidence that the objective of examining "healthy" birds was achieved. The results of the correlation analysis were what was expected for "healthy" broilers, with these birds having positive correlations with skin color and size of the bursa of Fabricius. The average age of broilers included in this analysis ranged from 26.2 days in 2008 to 33.7 days in 2013. The percentage of "normal" broilers (those without visible lesions or abnormalities) varied from 5.63% in 2012 to 28.33% in 1999. The results of this study identified four areas of opportunity for improving poultry health: 1) coccidiosis, 2) oral lesions and gizzard erosions, 3) retained yolks, and 4) pododermatitis.

Encuesta retrospectiva sobre la salud de los pollos de engorde: alcance, parámetros y tendencias generales. Se realizó un análisis retrospectivo que abarcó 18 años (1999-2016) de encuestas de salud de pollo de engorde de complejos de producción en los Estados Unidos para identificar tendencias y áreas de oportunidad. El análisis utilizó datos de necropsia de 19,577 pollos de engorde considerados "saludables" o "clínicamente normales" mediante evaluación visual. La incidencia muy baja de pollos de engorde deshidratados (0.01%) o de tamaño pequeño (0.02%) es evidencia de que se logró el objetivo de examinar aves "sanas". Los resultados del análisis de correlación fueron los esperados para pollos de engorde "sanos", ya que estas aves tuvieron correlaciones positivas con el color de la piel y el tamaño de la bolsa de Fabricio. La edad promedio de los pollos de engorde incluidos en este análisis osciló entre 26.2 días en 2008 y 33.7 días en 2013. El porcentaje de pollos de engorde "normales" (aquellos sin lesiones o anomalías visibles) varió del 5.63% en 2012 al 28.33% en 1999. Los resultados de este estudio identificaron cuatro áreas de oportunidad para mejorar la salud de las aves: 1) coccidiosis, 2) lesiones orales y erosiones de la molleja, 3) retención de saco vitelino y 4) pododermatitis.

Hallazgos ultrasonográficos a nivel de articulaciones de manos y pies en sujetos voluntarios asintomáticos / Ultrasound findings in hand and foot joints of asymptomatic volunteers

Resumen Introducción: Anormalidades ultrasonográficas se describen con cierta frecuencia en articulaciones de sujetos asintomáticos, las cuales generan incertidumbre en el contexto de evaluación y tratamiento de la enfermedad articular inflamatoria; a pesar de ello, en Colombia no existen estudios al respecto y la evidencia disponible es escasa, hecha en un bajo número de participantes y con transductores menores a 18 MHz en su gran mayoría. Objetivos: Describir los hallazgos ultrasonográficos articulares en manos y pies de un grupo de voluntarios asintomáticos, su asociación con las características sociodemográficas y la concordancia intra e interobservador de sus mediciones. Materiales y métodos: Estudio descriptivo y analítico en el que se incluyeron 182 voluntarios asintomáticos. Dos médicos con experiencia en ecografía musculoesquelética evaluaron el aspecto dorsal de 5.460 recesos articulares mediante la escala semicuantitativa de Szkudlarek y la utilización de un transductor lineal de 18 MHz. Resultados: La mediana de edad de los participantes fue de 42 arios, 60,4% de ellos mujeres. En 87% de los voluntarios se identificaron en total 232 hallazgos, el 68,1% correspondió a derrame articular, 29,3% a hipertrofia sinovial, 2,1% a erosiones y 0,4% a Doppler de poder. Los pies mostraron mayores hallazgos que las manos (70,7% vs. 29,3%). Las articulaciones en las que más se identificaron anormalidades fue la primera articulación metatarsofalángica (52%), la tercera metatarsofalángica (15%) y la radiocarpiana (9,5%). Se halló relación positiva entre el derrame articular y la hipertrofia sinovial con la edad, ocupación manual exclusiva y tiempo laboral mayor de 10 años. La concordancia intraobservador fue moderada (Kappa = 0,4591) y la interobservador fue leve (Kappa = 0,2155). Conclusiones: La ausencia de señal Doppler de poder, el no compromiso radioulnar distal, la ausencia de sinovitis acompañada de erosión y una mayor predominancia de alteraciones leves al nivel de las manos, sumado a la ausencia de hallazgos al nivel de la quinta articulación metatarsiana, constituyen hallazgos potencialmente específicos de sujetos asintomáticos que merecen ser confirmados como tal en futuros estudios.

Abstract Introduction: Ultrasound (US) abnormalities have often been described in the joints of asymptomatic subjects, which may lead to uncertainty in the evaluation and treatment of inflammatory joint disease. Despite this, the available evidence is scarce, with few participants, and in the vast majority with transducers less than 18Mhz. In Colombia there are currently no published studies about this topic. Objectives: To describe the ultrasound findings in hand and foot joints in asymptomatic volunteers, their association with sociodemographic characteristics, and intra- and inter-observer concordance of the measurements. Materials and methods: Descriptive and analytical study within 182 asymptomatic volunteers. Two physicians with musculoskeletal ultrasound experience evaluated the dorsal aspect of 5460 articular recesses using the semi-quantitative scale of Szkudlarek using a 18 MHz linear transducer. Results: The median age of the participants was 42 years, including 60.4% women. A total of 232 abnormal findings were identified in 87% of the volunteers, with 68.1% corresponding to joint effusion, 29.3% synovial hypertrophy, 2.1% erosions, and 0.4% positive power Doppler. The feet evaluation showed more findings than the hands (70.7 vs. 29.3%). The joints in which most abnormalities were identified were the first metatarsophalangeal joint (52%), third metatarsophalangeal joint (15%), and radiocarpal joint (9.5%). A positive association was found between joint effusion and synovial hypertrophy with age, exclusive manual activity, and occupation for more than ten years. The intra-observer concordance was moderate (Kappa = .4591) and the inter-observer was low (Kappa = .2155). Conclusions: The absence of power Doppler signal, the absence of abnormalities in distal radioulnar, the absence of synovitis accompanied by erosion, and a greater predominance of mild alterations in the hand joints, added to the absence of findings in the fifth metatarsal joint, can be potential specific findings of asymptomatic subjects and might be confirmed in future studies.

Eritema multiforme (polimorfo). puesta al día del tema: presentación de tres casos desencadenados por infección con herpes virus simple / Erythema multiforme (polymorph). updating the topic: presentation of three cases triggered by infection with herpes virus simple

El Eritema Multiforme (EM) es una reacción poco común, aguda, de piel y mucosa. Es una reacción de hipersensibilidad, caracterizada por erupciones en piel en forma de diana, constituidas por zonas concéntricas de diferente coloración, y lesiones ulcerosas o vesículo-ampollares en mucosa. La enfermedad puede ser desencadenada por infecciones, principalmente por virus del herpes simple (HSV) y Mycoplasma pneumoniae y por ingestión de drogas, siendo las más frecuentes las sulfonamidas y las penicilinas. Se presentan tres casos relacionados a la infección por el virus del herpes simple.

Erythema multiforme (EM) is a condition acute, mucocutaneous, caused by hypersensitivity reaction, characterized by skin eruption (target lesions with concentric zones) and mucous membrane lesions (ulcerous, bullous-vesicular lesions). The disorder can be induced by infections, particularly herpes simplex(VSH) and Mycoplasma pneumoniae, or by drug intake (AINE, sulfonamides, penicillin’s) Three cases related to VHS infection, are presented.

Erosiones dentales en pacientes con diagnóstico de enfermedad por reflujo gastroesofágico en el Hospital Nacional Arzobispo Loayza / Dental erosions in patients with gastroesophageal reflux disease in national Hospital Arzobispo Loayza

INTRODUCCIÓN: La ERGE es considerada como la causa de morbilidad digestiva más frecuente en la población, siendo la erosión dental una manifestación extra esofágica en la cavidad bucal. OBJETIVOS: determinar la asociación entre erosiones dentales y esofagitis por reflujo gastroesofagico de acuerdo al grado de esofagitis, grado de erosion dental, sexo y edad. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, observacional y correlacional en 150 pacientes con ERGE diagnosticados endoscópicamente como esofagitis por reflujo gastroesofágico (graduados según clasificación de Los Angeles) en el Servicio de Gastroenterología del Hospital Arzobispo Loayza (2011-2012). Posterior a la endoscopia los pacientes fueron sometidos a una evaluación clínica dental a fin de investigar la presencia de erosiones dentales previa firma de consentimiento informado. RESULTADOS: Se obtuvo una prevalencia de 30% (45 pacientes) con erosiones dentales y ERGE, el 100% manifestó acidez en la boca y regurgitación ácida. Respecto al sexo, el femenino presentó un promedio de 2.35 erosiones en el sector anterior en la superficie palatina en grado 1 mientras que en el sexo masculino se encontró un promedio de 1.86 erosiones en el sector anterior de la superficie palatina en grado 2. De acuerdo a la edad se obtuvo un promedio de 3.50 erosiones en la superficie incisal grado 1 en el sector anterior en pacientes mayores de 70 años seguida de un promedio de 3.11 erosiones en la superficie palatina grado 1 en pacientes de 20 a 30 años. De acuerdo al total de superficies evaluadas el grupo etario comprendido entre 30 y 40 años conforman la mayoría de población afectada. Respecto al grado de esofagitis por reflujo gastroesofágico se encontró en el grupo de Esofagitis por reflujo Los Ángeles "D" un promedio de 6.0 erosiones en el sector anterior en la superficie palatina grado 2 y en el sector anterior en la superficie palatina grado 1 y en el grupo de pacientes con esofagitis Los Angeles "A" y "B" con promedios respectivos de 2.3 y 2.2 y en el sector anterior en la superficie incisal Grado 1. y esofagitis Los Angeles "D". Existe asociación significativa (p=0.002) entre el grado de esofagitis por reflujo gastroesofágico y grado de erosión dental. CONCLUSIONES: en el presente estudio se ha encontrado clara asociación entre el grado de las erosiones dentarias y el grado esofagitis por reflujo gastroesofágico. Las erosiones dentarias son más frecuentes en varones mayores de 70 años, en quienes las erosiones dentales se dieron en el sector anterior en la superficie incisal grado 1. Las superficies más erosionadas se encontraron en mujeres en el sector anterior en la superficie palatina grado 1. En pacientes con esofagitis por reflujo gastroesofágico Los Ángeles "A"," B" y "C" se observa mayor número de piezas dentarias erosionadas sea de grado 1 ó 2. Los síntomas: acidez en la boca y regurgitaciones ácidas que llegan hasta la boca son un indicador importante para la presencia de erosiones dentarias en pacientes con ERGE. La superficie palatina de las piezas antero superiores fueron las que tuvieron mayor presencia de erosiones en pacientes con ERGE.

INTRODUCTION: Gastroesophageal reflux disease (GERD) is considered as one of the most common digestive disease in the population, being the dental erosion a manifestation extra-esophageal in the oral cavity. OBJETIVES: investigate asociation between erosion and GERD according to esophagitis grade, erosion grade, sex and age. MATERIAL AND METHODS: descriptive, observational, and correlational study in 150 patients with endoscopically diagnosed GERD, grades of esophagitis according to the classification of Los Angeles, in the Department of Gastroenterology at Arzobispo Loayza Hospital (20112012). Patients after the procedure underwent a dental evaluation to investigate the presence of dental erosion by eroding tooth surface. RESULTS: We obtained a prevalence of 30% (45) patients with GERD and dental erosions of which 100% had symptoms consistent with acidity in the mouth and acid regurgitation. According to the sex the female sex showed an average of 2.35 erosions on the palatal surface in grade 1 and in male’s an average of 1.86 erosions on the palatal surface in grade 2. According to the age the highest average was 3.50 in the incisal erosion on the surface grade 1 in the anterior in patients older than 70 years followed by an average of 3.11 incisal erosion on the surface grade 1 in patients 20 to 30 years. According to the total areas assessed (by age) patients between 30 and 40 years were the most affected population. According to degree of esophagitis the follows were: an average of 6.0 erosions in the anterior palatal surface in grade 2 with esophagitis Los Angeles "D"; in the anterior palatal surface in Grade 1 with esophagitis Los Angeles "A" and "B" with respective averages of 2.3 and 2.2 and in the anterior incisal surface in Grade 1 with esophagitis Los Angeles "D". According to the Chi2 test exists a significant association (p = 0.002) between the degree of esophagitis and degree of dental erosion. CONCLUSIONS: A significant association exists between GERD and dental erosions. The presence and degree of dental erosion as predominant age occurred in patients older than 70 years in the previous Grade 1 incisal surface. According to the sex; eroded surface was predominant in females in the anterior sector palatal surface in grade 1.According to the degree of gastroesophageal reflux disease (esophagitis) is determined that the highest number of erosions was presented at the anterior sector on the palatal surface grade 2 with esophagitis Los Angeles "D". The symptoms compatible with heartburn and acid regurgitation in to the mouth that reaches to the oral cavity is an important indicator for the presence of dental erosions in patients with GERD. The tooth surface with the highest presence of dental erosions in patients with GERD was the palatal surface of anterior teeth.

Evaluación radiográfica del daño anatómico en la artritis reumatoide / Radiographic evaluation of anatomical damage in rheumatoid arthritis

En este artículo revisamos los diferentes métodos de evaluación radiográfica del daño anatómico producido por la artritis reumatoide; sus ventajas y limitaciones, así como las principales características.

In this article we reviewed the different radiologic methods of evaluation of the anatomical damage produced by rheumatoid arthritis; its advantages and limitations, as well as the main characteristics.