Factors associated with early hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus.

PURPOSE: Hydroxychloroquine is currently recommended for the treatment of systemic lupus erythematosus (SLE), but it can cause irreversible retinal toxicity. This study aimed to identify factors associated with early hydroxychloroquine-induced retinal toxicity in patients with SLE from a single centre for 20 years. METHODS: SLE patients diagnosed between 1998 and 2017 and followed up for at least 1 year were included. Demographic, clinical, laboratory and therapeutic data were collected from the electronic medical records and retrospectively analysed. Early hydroxychloroquine-induced retinal toxicity was defined as the development of macular toxicity within the first 5 years of hydroxychloroquine treatment. RESULTS: A total of 345 patients followed for a median of 15 years were analysed; 337 (97.7%) patients received hydroxychloroquine, 38 (11.3%) of them presented with retinal toxicity, and 10 (3%) developed early retinal toxicity. These patients had a mean treatment duration of 3.3 years with a mean cumulative dose of 241 g. Patients were diagnosed by visual field (VF) and fundoscopy, and two were also assessed using spectral domain optical coherence tomography (SD-OCT). The median (IQR) age of patients with early toxicity was 56 (51-66) years, and 80% were female. Factors independently associated with early hydroxychloroquine-induced retinal toxicity were lupus anticoagulant positivity (OR 4.2; 95% CI 1.2-15.5) and hypercholesterolaemia (OR 5.6; 95% CI 1.5-21.5). CONCLUSION: Our results suggest that lupus anticoagulant positivity and hypercholesterolaemia among SLE patients may be risk factors for early hydroxychloroquine-induced retinal toxicity, regardless of the dose or duration of treatment.

Why lupus patients discontinue antimalarials in real life: A 50 years-experience from a reference centre.

BACKGROUND: Because of the efficacy and good safety profile of antimalarials in systemic lupus erythematosus (SLE), hydroxychloroquine (HCQ) is currently recommended in all SLE patients. However, patients' compliance was reported as suboptimal. This study aims to elucidate the reasons for discontinuing antimalarials in a large series of SLE patients followed in a single centre during the last 50 years. MATERIAL AND METHODS: Among all patients diagnosed between 1968 and 2017 at our reference centre, retrospective data were obtained from electronic medical records of SLE patients consecutively visited during 2015-2017 and controlled for at least 1 year. Demographic, clinical, laboratory and therapeutic data at disease onset and during the follow-up in the whole cohort and differences between SLE patients discontinuing and continuing on antimalarials were analysed. RESULTS: Five-hundred thirty-nine patients followed during a median of 19 years were analysed. Median age at disease diagnosis was 29 years and 91.8% were women. Antimalarials were initiated by 521 (96.7%) patients and 18 (3.3%) cases did not start them mainly because of a quiescent or life-threatening SLE disease. In the 129 (24.7%) patients starting antimalarials with subsequent discontinuation, median treatment duration was 8.4 years. The main reason leading to treatment cessation was drug toxicity in 97 (18.6%) patients, of which macular toxicity was the most frequent adverse effect (n = 80; 15.3%). Treatment was stopped because of patient's preference in 13 (2.5%) cases. The factors independently associated with antimalarial discontinuation were age at the end of follow-up (OR 1.130, 95% CI 1.005-1.269, p = 0.040), duration on antimalarials (OR 0.872, 95% CI 0.841-0.903, p < 0.001), presence of hepatitis C virus infection (HCV) (OR 13.948, 95% CI 1.321-147.324, p = 0.028) and anti-ß2-glycoprotein 1 antibodies (OR 2.275, 95% CI 1.146-4.517, p = 0.019). CONCLUSIONS: In our 50 years-experience, almost all SLE patients underwent antimalarials. These drugs are usually stopped because of adverse effects, particularly macular toxicity. After a long-term follow-up, patients' compliance to antimalarials was considerably high in our SLE patients.

Methylprednisolone Pulses and Prolonged Remission in Systemic Lupus Erythematosus: A Propensity Score Analysis of the Longitudinal Lupus-Cruces-Bordeaux Inception Cohort.

OBJECTIVE: The objective of this study was to analyze the effect of methylprednisolone pulses (MP), given during the first year after the diagnosis of systemic lupus erythematosus (SLE), in achieving prolonged remission according to the degree of lupus activity at presentation. METHODS: We conducted an observational study of routine clinical care data from the Lupus-Cruces-Bordeaux cohort. The end point was prolonged remission (ie, during five consecutive yearly visits). The effect of MP on remission during the first year was analyzed in the whole cohort and according to the baseline Systemic Lupus Erythematosus Disease Activity Index 2000 score: <6, 6 to 12, and >12, reflecting mild, moderate, and severe activity, respectively. For adjustment, logistic regression with propensity score (PS) and other therapeutic covariates was performed. RESULTS: Two hundred thirty-three patients were included. Prolonged remission was achieved by 132 patients (57%). MP were associated with prolonged remission (PS-adjusted odds ratio [OR] 2.50, 95% confidence interval [CI] 1.04-623, P = 0.042). A strong clinical effect was seen among patients with moderate (adjusted OR 5.28, 95% CI 1.27-21.97, P = 0.022) and moderate-severe SLE activity (adjusted OR 4.07, 95% CI 1.11-14.82, P = 0.033). The administration of MP resulted in reduced average dosages of prednisone during the first year among patient with moderate (mean 6.6 vs 10.2 mg/day, P = 0.017) and severe activity (mean 14 vs 28 mg/day, P = 0.015). The odds of prolonged remission were increased by longer-term use of hydroxychloroquine (HCQ) and decreased by higher initial doses of prednisone. CONCLUSION: This study supports the use of MP to induce prolonged remission in patients with SLE, particularly in those with moderate and severe activity. The extended use of HCQ also contributes to achieve prolonged remission.

New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus.

OBJECTIVE: To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity. METHODS: A cross-sectional, unicentric study was conducted on patients with SLE treated with hydroxychloroquine. Each patient underwent a comprehensive ophthalmic evaluation, comprising structural tests (spectral-domain optical coherence tomography (SD-OCT), en face OCT, en face OCT angiography (OCTA), fundus autofluorescence (FAF)) and functional tests (automated perimetry for visual field (VF) testing, multifocal electroretinography (mfERG)). A diagnosis of macular toxicity required the presence of abnormalities in at least one structural and functional test. The Kappa Concordance Index was used to assess the concordance among the different tests in detecting potential macular toxicity-associated alterations. RESULTS: Sixty-six patients with SLE (132 eyes) were consecutively enrolled. Four (6.1%) patients developed subclinical hydroxychloroquine-induced retinal toxicity without visual acuity impairment. The proportion of abnormal results was 24% for both en face OCT and en face OCTA. Regarding functional analysis, VF was less specific than mfERG in detecting subclinical retinal toxicity (VF specificity 47.5%). En face OCT and en face OCTA structural findings showed better concordance, with a kappa index >0.8, and both identified the same cases of toxicity as FAF. CONCLUSION: Although structural OCT and VF are frequently used to screen for hydroxychloroquine-induced retinal toxicity, our findings suggest that a combination of mfERG, en face OCT and en face OCTA could improve the diagnostic accuracy for subclinical retinal damage. This study emphasises the importance of a multimodal imaging strategy to promptly detect signs of hydroxychloroquine-induced retinal toxicity.

[Eosinophilic granulomatosis with polyangiitis]. / Granulomatosis eosinofílica con poliangeítis.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis characterized by the presence of asthma associated with eosinophilia, eosinophilic infiltration of different organs, and vasculitis of small and medium-sized vessels. Although classified as anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, it occurs in less than half of the patients. The disease is infrequent, typically appearing in patients with asthma and affecting multiple organs such as lung, skin and peripheral nervous system. Treatment has been based on the use of glucocorticoids and immunosuppressants. In recent years, progress has been made in the knowledge of the pathophysiology, in treatment with the inclusion of biologic agents, the classification criteria have been revised and new therapeutic recommendations have been published.

COVID-19 in Older Patients: Assessment of Post-COVID-19 Sarcopenia.

(1) Background: Acute COVID-19 infections produce alterations in the skeletal muscle, leading to acute sarcopenia, but the medium- and long-term consequences are still unknown. The aim of this study was to evaluate: (1) body composition; (2) muscle strength and the prevalence of sarcopenia; and (3) the relationship between muscle strength with symptomatic and functional evolution in older patients affected by/recovered from COVID-19; (2) Methods: A prospective, longitudinal study of patients aged ≥65 years who had suffered from COVID-19 infection between 1 March and 31 May 2020, as confirmed by PCR or subsequent seroconversion. Persistent symptoms, as well as anthropometric, clinical, and analytical characteristics, were analyzed at 3 and 12 months after infection. The degree of sarcopenia was determined by dynamometry and with SARC-F; (3) Results: 106 participants, aged 76.8 ± 7 years, were included. At 3 months postinfection, a high percentage of sarcopenic patients was found, especially among women and in those with hospitalization. At 12 months postinfection, this percentage had decreased, coinciding with a functional and symptomatic recovery, and the normalization of inflammatory parameters, especially interleukin-6 (4.7 ± 11.6 pg/mL vs. 1.5 ± 2.4 pg/mL, p < 0.05). The improvement in muscle strength was accompanied by significant weight gain (71.9 ± 12.1 kg vs. 74.7 ± 12.7 kg, p < 0.001), but not by an increase in lean mass (49.6 ± 10 vs. 49.9 ± 10, p 0.29); (4) Conclusions: Older COVID-19 survivors presented a functional, clinical, and muscular recovery 12 months postinfection. Even so, it is necessary to carry out comprehensive follow-ups and assessments that include aspects of nutrition and physical activity.

Management of Type 2 Diabetes Mellitus in Elderly Patients with Frailty and/or Sarcopenia.

The life expectancy of the population is increasing worldwide due to improvements in the prevention, diagnosis, and treatment of diseases. This favors a higher prevalence of type 2 diabetes mellitus (T2DM) in the elderly. Sarcopenia and frailty are also frequently present in aging. These three entities share common mechanisms such as insulin resistance, chronic inflammation, and mitochondrial dysfunction. The coexistence of these situations worsens the prognosis of elderly patients. In this paper, we review the main measures for the prevention and management of sarcopenia and/or frailty in elderly patients with T2DM.

Obesity, Diabetes, and Cardiovascular Risk Burden in Systemic Lupus Erythematosus: Current Approaches and Knowledge Gaps-A Rapid Scoping Review.

Obesity, diabetes mellitus, and cardiovascular risk are real challenges in systemic lupus erythematosus (SLE) clinical practice and research. The evidence of the burden of these health problems in SLE patients is determined by the methods used to assess them. Therefore, the aim of this scoping review is to map current approaches in assessing obesity, diabetes mellitus, and cardiovascular risk burden in SLE patients and to identify existing knowledge gaps in this field. This rapid scoping review was conducted according to the Joanna Briggs Institute methodology and identified 274 articles, of which 73 were included. Most studies were conducted at European institutions and patients were recruited from specialist hospital clinics, the majority of whom were women. The burden of obesity and diabetes mellitus for SLE patients was assessed mainly in terms of prevalence, impact on disease activity, and cardiometabolic risk. The burden of cardiovascular risk was assessed using multiple approaches, mainly imaging and laboratory methods, and risk factor-based scores, although there is great heterogeneity and uncertainty between the methods used. This review highlights the importance of improving and standardizing the approach to obesity, diabetes, and cardiovascular risk in SLE patients through a holistic assessment that includes lifestyle, clinical, biological, and social aspects.

Study protocol for a randomised, double-blinded, placebo-controlled phase III trial examining the add-on efficacy, cost-utility and neurobiological effects of low-dose naltrexone (LDN) in patients with fibromyalgia (INNOVA study).

INTRODUCTION: There is evidence that low-dose naltrexone (LDN; <5.0 mg/day) reduces pain and improves the quality of life of people with fibromyalgia syndrome (FMS). However, no randomised controlled trials with long-term follow-ups have been carried out. The INNOVA study will evaluate the add-on efficacy, safety, cost-utility and neurobiological effects of LDN for reducing pain in patients with FMS, with a 1-year follow-up. METHODS AND ANALYSIS: A single-site, prospective, randomised, double-blinded, placebo-controlled, parallel design phase III trial will be performed. Eligibility criteria include being adult, having a diagnosis of FMS and experiencing pain of 4 or higher on a 10-point numerical rating scale. Participants will be randomised to a LDN intervention group (4.5 mg/day) or to a placebo control group. Clinical assessments will be performed at baseline (T0), 3 months (T1), 6 months (T2) and 12 months (T3). The primary endpoint will be pain intensity. A sample size of 60 patients per study arm (120 in total), as calculated prior to recruitment for sufficient power, will be monitored between January 2022 and August 2024. Assessment will also include daily ecological momentary evaluations of FMS-related symptoms (eg, pain intensity, fatigue and sleep disturbance), and side effects via ecological momentary assessment through the Pain Monitor app during the first 3 months. Costs and quality-adjusted life years will be also calculated. Half of the participants in each arm will be scanned with MRI at T0 and T1 for changes in brain metabolites related to neuroinflammation and central sensitisation. Inflammatory biomarkers in serum will also be measured. ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and community engagement activities. TRIAL REGISTRATION NUMBER: NCT04739995.

Using Multiple Cause-of-Death Analysis to Estimate Systemic Autoimmune Disease Mortality Burden in Low- and Middle-Income Countries.

Autoimmune diseases are not always recognized as urgent health issues, despite a worldwide prevalence of 4%-5%. Most estimates come from high-income countries, as low- and middle-income countries face more issues of under-reporting. Despite this and the lack of recognition under current reporting practices, the role these diseases play in mortality must be acknowledged. In particular, considering multiple causes of death as opposed to a single cause of death results in a 1.5-4.2-fold increase in deaths classified as relating to autoimmune diseases, evidence of their share in overall mortality burden, a factor important for patient care and healthcare policy decision making. However, formulating such policies and programs for timely, appropriate diagnoses and care is stymied in low- and middle-income countries by the shortage of methodologically sound studies on mortality from systemic autoimmune diseases. This limitation exacerbates inequalities and health gaps among patients in different countries and localities. Multiple cause-of-death methodology has been validated for research on other diseases and demonstrates the mortality burden of these illnesses in countries where traditional methodological approaches, primarily based on prospective cohort studies, are not feasible. Studying mortality from systemic autoimmune diseases by analyzing multiple causes of death with data from national mortality registries is a low-cost alternative to traditional mortality analysis. The objective of this paper is to demonstrate and defend the usefulness of this approach to estimate mortality burden.

Histoplasmosis diseminada progresiva aguda en un paciente inmunocompetente / Acute progressive disseminated histoplasmosis in an immunocompetent patient

RESUMEN La histoplasmosis diseminada progresiva constituye una expresión singular y rara de la infección por Histoplasma capsulatum. Sus formas agudas de presentación suelen aparecer en pacientes con deficiencias inmunitarias graves (fundamentalmente VIH). Sin embargo, en regiones de alta endemicidad, incluso pacientes sin inmunodeficiencia demostrada pueden desarrollar esta afección. Se presentó un paciente de 47 años de edad, con antecedentes de haber sufrido un cuadro grave de histoplasmosis pulmonar 18 años antes. El paciente fue ingresado por un cuadro de: fiebre, astenia, sudoración nocturna, disnea, tos seca, hepatoesplenomegalia, anemia y trombocitopenia marcada. Progresó a una insuficiencia respiratoria aguda y fue internado en cuidados intensivos con ventilación mecánica invasiva. Se demostró crecimiento de Histoplasma capsulatum en la muestra de lavado bronquioalveolar y reacción granulomatosa no caseificante en médula ósea, confirmándose el diagnóstico de histoplasmosis diseminada progresiva. El paciente recibió tratamiento con anfotericina B y se recuperó totalmente en pocas semanas.

ABSTRACT Progressive disseminated histoplasmosis is a unique and rare expression of the infection cause by Histoplasma capsulatum. Its acute forms of presentation usually appear in patients with severe immunodeficiency disorders (mainly HIV). However, even patients without proven immunodeficiency can develop this condition in regions of high endemicity. We present a 47-year-old male patient with a previous history of severe pulmonary histoplasmosis eighteen years earlier. The patient was admitted due to the presence of fever, asthenia, night sweats, dyspnea, dry cough, hepatosplenomegaly, anemia and marked thrombocytopenia. He progressed to acute respiratory failure and was admitted to the intensive care unit requiring invasive mechanical ventilation. Growth of Histoplasma capsulatum was demonstrated in the bronchoalveolar lavage sample and a non-caseating granulomatous reaction was found in the bone marrow, confirming the diagnosis of progressive disseminated histoplasmosis. The patient received amphotericin B treatment and made a full recovery within a few weeks.

Linfohistiocitosis hemofagocítica, un síndrome potencialmente fatal. Presentación de tres casos / Hemophagocytic lymphohistiocytosis, a potentially fatal syndrome. Presentation of three cases

Introducción: La evidencia actual sobre el síndrome de linfohistiocitosis hemofagocítica se basa en series de casos y, por tanto, las decisiones clínicas se fundamentan en el criterio de expertos. En Cuba son escasos los informes publicados, lo cual valida los esfuerzos que incrementen la comprensión de esta entidad en nuestro medio. Objetivo: Describir tres casos de síndrome de linfohistiocitosis hemofagocítica secundaria, una complicación extremadamente infrecuente y poco sospechada. Casos clínicos: De los tres pacientes estudiados, dos presentaron linfoma como enfermedad subyacente. A uno de ellos se le diagnosticó un linfoma no Hodgkin de células T anaplásico en la necropsia; mientras el otro paciente fue diagnosticado y tratado precozmente por linfoma no Hodgkin de células grandes B, el cual evolucionó satisfactoriamente. El tercer paciente presentó endocarditis de valva tricúspide y alcanzó la remisión luego de tratamiento antibiótico, inmunomodulador y quirúrgico. Conclusiones: Los casos presentados destacan la complejidad del síndrome de linfohistiocitosis hemofagocítica y refuerzan la necesidad crítica de su diagnóstico y tratamiento oportuno en nuestro medio(AU)

Introduction: The current evidence about hemophagocytic lymphohistiocytosis syndrome is based on case series and, therefore, clinical decisions are based on expert criteria. In Cuba, there are few published reports, which validates the efforts that may increase understanding of this entity in our environment. Objective: To describe three cases of secondary hemophagocytic lymphohistiocytosis syndrome, an extremely rare and little suspected complication. Clinical cases: Of the three patients studied, two presented lymphoma as subjacent disease. One of them was diagnosed with anaplastic T-cell non-Hodgkin lymphoma at autopsy. The other was diagnosed and treated early for large B-cell non-Hodgkin lymphoma, and evolved satisfactorily. The third patient presented tricuspid valve endocarditis and achieved remission after antibiotic, immunomodulatory and surgical treatment. Conclusions: The cases presented highlight the complexity of hemophagocytic lymphohistiocytosis syndrome and reinforce the critical need for diagnosis and timely treatment of this condition in our setting(AU)

Enfermedad linfoproliferativa asociada a artritis reumatoide: reporte de tres casos / Lymphoproliferative disease associated with rheumatoid arthritis: report of three cases

Las investigaciones en la última década han demostrado que el riesgo de desarrollar linfoma en pacientes con artritis reumatoide es el doble que el riesgo de la población general. Sin embargo, no se cuenta con datos de la magnitud de este problema en Cuba. Se presentan los casos de tres pacientes con diagnóstico de artritis reumatoide seropositiva tratadas con metotrexate, que durante su evolución desarrollaron linfoma no Hodgkin. Las pacientes recibieron quimioterapia de primera línea y alcanzaron remisión total con supervivencia de tres años hasta el momento. El diagnóstico de las enfermedades linfoproliferativas en pacientes con artritis reumatoide es un desafío; por lo que es necesario un elevado índice de sospecha que, en ausencia de marcadores fiables de linfomagénesis, permita el manejo oportuno de estos pacientes(AU)

Research in the last decade has shown that the risk of developing lymphoma in patients with rheumatoid arthritis is twice the risk of the general population. However, there is not data on the magnitude of this problem in Cuba.We present the cases of three patients with a diagnosis of seropositive rheumatoid arthritis treated with methotrexate who during their evolution developed non-Hodgkin's lymphoma.The patients received first-line chemotherapy and they achieved total remission with three-year survival so far.The diagnosis of lymphoproliferative diseases in patients with rheumatoid arthritis is a challenge; therefore, a high index of suspicion is necessary that, in the absence of reliable markers of lymphomagenesis, allows the timely management of these patients(AU)

El índice leucoglucémico es un predictor de mortalidad por todas las causas al año en pacientes cubanos con infarto agudo de miocardio con elevación del segmento ST / The leucoglycaemic index is a predictor of one-year all-cause mortality in Cuban patients with ST-segment elevation acute myocardial infarction

RESUMEN Introducción: El índice leucoglucémico (ILG) ha sido propuesto como marcador pronóstico de muerte en pacientes con infarto agudo de miocardio; sin embargo, no existe evidencia sobre su valor pronóstico al año. Objetivos: El objetivo del estudio fue determinar el valor pronóstico del ILG en la mortalidad al año de pacientes cubanos con infarto agudo de miocardio con elevación del segmento ST. Método: Los datos fueron obtenidos de las historias clínicas y el objetivo primario fue la muerte por todas las causas al año. El ILG se calculó con los valores al ingreso. Para el análisis se dividieron los pacientes en terciles de ILG, se construyeron curvas de características operativas del receptor y de supervivencia de Kaplan-Meier. Para el análisis multivariable se utilizó la regresión de Cox. Resultados: Se analizaron 344 pacientes (mediana de edad, 68 años; el 65,7% masculino; un 25,6% diabéticos). La mortalidad fue de 25,6% y fue significativamente mayor en el tercil superior (55,7%; p<0,0001). Los pacientes fallecidos presentaron una mediana de ILG significativamente mayor que los sobrevivientes (2,18 y 1,34, respectivamente; p<0,0001). El área bajo la curva del ILG fue de 0,715 y el punto de corte: 2,2. Un valor de ILG mayor de 2,2 se asoció a una supervivencia significativamente menor (177 vs. 309 días; p<0,0001) y fue un predictor independiente de mortalidad (HR=3,56; IC 95%, 2,09-6,07; p<0,0001). Conclusiones: El índice leucoglucémico es buen predictor de mortalidad al año, por todas las causas, en pacientes con infarto agudo de miocardio con elevación del segmento ST.

ABSTRACT Introduction: The leuko-glycaemic index has been proposed as a prognostic marker of death in patients with acute myocardial infarction, but there is uncertainty surrounding its prognostic value to predict one-year mortality. Objectives: The aim of this study was to determine the prognostic value of leuko-glycaemic index for one-year mortality in Cuban patients with ST-segment elevation myocardial infarction. Methods: The data were obtained from the medical records and all cause one-year deaths was the primary endpoint. The leuko-glycaemic index was calculated from measurements at admission. The patients were divided into leuko-glycaemic index tertiles to be evaluated. Receiver operating characteristics and Kaplan-Meier survival curves were performed. Cox regression model was used for all multivariable analysis. Results: Three hundred and forty-four patients were assessed (median age, 68 years; 65.7% males; 25.6% diabetic). The mortality rate was 25.6%, being significantly higher in the upper tertile (55.7%, p<0.0001). The deceased patients presented a median of leuko-glycaemic index significantly higher than the survivors (2.18 and 1.34 respectively, p<0.0001). The area under the curve for leuko-glycaemic index was 0.715 and its cut-off value was 2.2. Any leuko-glycaemic index value higher than 2.2 was associated with significantly lower survival (177 vs. 309 days, p<0.0001) and it was an independent predictor of mortality (HR=3.56, CI 95%, 2.09-6.07, p<0.0001). Conclusions: The leuko-glycaemic index is a good predictor for all cause one-year mortality in patients with ST-segment elevation myocardial infarction.

Miocardiopatía dilatada secundaria a hipotiroidismo primario. Reporte de un caso / Dilated cardiomyopathy secondary to primary hypothyroidism. A case report

Resumen El vínculo entre el hipotiroidismo y varias enfermedades cardiovasculares va más allá de la asociación con los factores de riesgo vascular clásicos. Sin embargo, la miocardiopatía dilatada es una forma rara de presentación del hipotiroidismo. Se reporta el caso de una paciente femenina de 52 años que acude a urgencias por presentar tos húmeda, edema en miembros inferiores y disnea de esfuerzo, así como otros síntomas y signos típicos de hipotiroidismo. La radiografía de tórax revela cardiomegalia y el ecocardiograma informa ventrículo izquierdo dilatado, fracción de eyección disminuida y derrame pericárdico. La TSH estaba aumentada y T4 libre disminuida. Luego de comenzar tratamiento hormonal con levotiroxina se alcanzó la resolución de los síntomas y de las alteraciones radiológicas y ecocardiográficas. El presente caso resalta la importancia de realizar un interrogatorio exhaustivo y examen físico completo que aporten las pistas diagnósticas para sospechar el hipotiroidismo en pacientes con miocardiopatía dilatada.

ABSTRACT The link between hypothyroidism and several cardiovascular diseases goes beyond the association with classical vascular risk factors. However, dilated cardiomyopathy is a rare form of presentation of hypothyroidism. We report the case of a 52-year-old female patient who comes to the emergency room for having wet cough, lower limb edema and dyspnea on exertion, as well as other typical symptoms and signs of hypothyroidism. Chest x-ray reveals cardiomegaly and the echocardiogram reports dilated left ventricle, decreased ejection fraction and pericardial effusion. TSH was increased and free T4 was decreased. After starting hormonal treatment with levothyroxine, resolution of symptoms and radiological and echocardiographic alterations was achieved. The present case highlights the importance of a thorough interrogatory and complete physical examination that provide the diagnostic clues to suspect hypothyroidism in patients with dilated cardiomyopathy.

Revistas de Reumatología en el contexto iberoamericano / Journals of rheumatology in the iberoamerican context

Introducción: La reumatología es la especialidad médica que se encarga de prevenir, diagnosticar y tratar las enfermedades musculo esqueléticas y autoinmunes sistémicas. Se trata de una de las especialidades que más avances en diagnóstico y tratamiento ha experimentado en los últimos años. Objetivo: Exponer los principales indicadores bibliométricos de las revistas de reumatología en Iberoamérica. Método: Se realizó una búsqueda de las revistas de reumatología en diversas bases de datos y se seleccionaron las revistas vigentes que pertenecían a países Latinoamericanos, España o Portugal. Los datos generales de las revistas fueron extraídos en sus respectivos sitios web. Dada la heterogeneidad de indexación, se tomaron los indicadores provistos por el Google Académico para su comparación. Para ello se utilizó el programa Publish or Perish y se realizó una limitación temporal desde 2007 a 2017. Resultados: Las revistas con más altos indicadores de impacto a su vez son las que se encuentran en bases de datos con mayor prestigio a nivel internacional (Web of Science, Scopus y Pubmed), este es otro factor que incide en su visibilidad, hecho corroborable al identificar que los 20 artículos más citados corresponden a estas tres revistas. Conclusiones: Las herramientas bibliométricas provistas por el Google Académico permitieron estandarizar indicadores de productividad y visibilidad en las revistas estudiadas, haciendo más accesible la recuperación de información académica y el cómputo de indicadores bibliométricos(AU)

Introduction: Rheumatology is the medical specialty that is responsible for preventing, diagnosing and treating musculoskeletal and systemic autoimmune diseases. It is one of the specialties that has made the most advances in diagnosis and treatment in recent years. Objective: To explain the main bibliometric indicators of rheumatology journals in Iberoamerica. Method: A search of rheumatology journals was carried out in several databases and the current journals belonging to Latin American countries, Spain or Portugal were selected. The general data of the magazines were extracted in their respective websites. Given the heterogeneity of indexing, the indicators provided by Google Scholar were taken for comparison. For this, the Publish or Perish program was used and a temporary limitation was made from 2007 to 2017. Results: The journals with the highest impact indicators are those found in the most prestigious international databases (Web of Science, Scopus and Pubmed), this is another factor that affects their visibility, a corroborative fact by identifying that the 20 most cited articles correspond to these three journals. Conclusions: The bibliometric tools provided by the Google Scholar allowed to standardize indicators of productivity and visibility in the studied journals, making more accessible the recovery of academic information and the computation of bibliometric indicators(AU)