New insights into the taxonomy of autoimmune diseases based on polyautoimmunity.

OBJECTIVE: The clinical coexistence of two or more autoimmune diseases (ADs) fulfilling classification criteria is termed "overt polyautoimmunity" (PolyA), whereas the presence of autoantibodies unrelated to an index AD, without clinical criteria fulfillment, is known as "latent PolyA". We aimed to explore a new taxonomy of ADs based on PolyA. METHODS: In a cross-sectional study of 292 subjects, we evaluated the presence of PolyA in 146, 45, 29, 17, and 17 patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), autoimmune thyroid disease (AITD) and systemic sclerosis (SSc), respectively, and 38 healthy controls. Clinical assessment, autoantibody profile (by autoantigen array chip), lymphocytes immunophenotype and cytokine profile (by flow cytometry) were evaluated simultaneously. A mixed cluster methodology was used to classify ADs. RESULTS: Latent PolyA was more frequent than overt PolyA, ranging from 69.9% in RA to 100% in SSc. Nevertheless, both latent and overt PolyA clustered together. Over-expressed IgG autoantibodies were found to be hallmarks for the identification of index ADs. The combination of autoantibodies allowed high accuracy in the classification of ADs. Three well-defined clusters based on PolyA were observed with distinctive clinical and immunological phenotypes. CONCLUSIONS: This proof-of-concept study indicates that ADs can be classified according to PolyA. PolyA should be considered in all studies dealing with ADs, including epidemiological, genetic, and clinical trials.

Clinical characterization, outcomes, and prognosis in patients with systemic lupus erythematosus admitted to the intensive care unit.

OBJECTIVE: Systemic lupus erythematosus (SLE) is a clinically heterogeneous autoimmune disease, and in some conditions, admission to the intensive care unit (ICUs) is required. This study describes the clinical and prognostic factors in SLE patients admitted to the ICU. METHODS: We conducted a retrospective study that reviewed all clinical records of patients with SLE admitted to the ICU between 2011 and 2018. RESULTS: We evaluated 188 patients, with 279 ICU admissions. Most patients were female (n = 159; 84.57%) with a median age of 35 years (interquartile range (IQR) = 25-48 years). Infection was the leading cause of admission in 77 (27.60%) cases, followed by lupus flare. The average length of hospitalization was 5 days (IQR 3-11 days), and the SLE Disease Activity Index 2000, Acute Physiology, Age and Chronic Health Evaluation (APACHE II), and Sequential Organ Failure Assessment (SOFA) scores were 9 (IQR 2-17), 14 (IQR 10-17), and 3 (IQR 2-5), respectively. Non-survivors presented with higher APACHE II and SOFA scores. Infection was the leading cause of mortality (n = 38; 20.21%), and predictors of mortality included invasive mechanical ventilation, vasoactive medication requirement, higher SOFA scores, and antiphospholipid syndrome comorbidity. CONCLUSIONS: We found that infection was the leading cause of ICU admissions and mortality in patients with SLE. Factors identified here as predictors of mortality should be accurately identified at admission for the prompt treatment of SLE patients.

Systemic lupus erythematosus in the intensive care unit: a systematic review.

Systemic lupus erythematosus (SLE) is an autoimmune disease with heterogeneous pathophysiologic mechanisms and diverse clinical manifestations. SLE is a frequent cause of intensive care unit (ICU) admissions. Multiple studies with controversial findings on the causes, evolution and outcomes of ICU-admitted patients with SLE have been published. The aim of this paper is to review the literature reporting the clinical characteristics and outcomes, such as mortality and associated factors, in such patients. Among the main causes of ICU admissions are SLE disease activity, respiratory failure, multi-organ failure and infections. The main factors associated with mortality are a high Acute Physiology and Chronic Health Evaluation (APACHE) score, the need for mechanical ventilation, and vasoactive and inotropic agent use. Reported mortality rates are 18.4%-78.5%. Therefore, it is important to evaluate SLE disease severity for optimizing clinical management and patient outcomes.

Sjögren Syndrome in the Intensive Care Unit: An Observational Study.

BACKGROUND/OBJECTIVE: Studies on the clinical characteristics, prognosis, and factors associated with mortality in patients with Sjögren syndrome (SS), particularly those in the intensive care unit (ICU), are limited. The present study aimed to describe clinical and immunological variables associated with mortality in patients with SS admitted to ICU at a single center in Cali, Colombia. METHODS: An observational, medical records review study was performed between 2011 and 2019 by reviewing the clinical records of patients with SS admitted to ICU at a high-complexity center. RESULTS: Seventy-two patients were included with a total of 117 ICU admissions (17 cases required readmission and 1 case required 17 readmissions): 103 (86.32%) were attributable to medical issues, and 14 corresponded to surgical admissions. Major causes of ICU medical admission were infection (44/103) followed by organ involvement. Only 5 admissions were related to SS due to neurological involvement. The APACHE (Acute Physiology, Age, and Chronic Health Evaluation) score was 10 (interquartile range [IQR], 7-16), the SOFA (Sequential Organ Failure Assessment) score was 2 (IQR, 0-14), and the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) score was 0 (IQR, 0-12) with higher values in the nonsurvivor group. Intensive care unit mortality was 12/72 (16.67%). CONCLUSIONS: The main cause of ICU admission was infection. Patients with increased medical requirements, such as mechanical ventilation and vasopressor support, and with higher APACHE, SOFA, and ESSDAI scores were more susceptible to poor outcomes. Moreover, 50% of deaths were attributable to SS and 25% to infection.

A multicenter observational study investigating care errors, staffing levels, and workload in small animal intensive care units.

OBJECTIVE: To investigate associations among care errors, staffing, and workload in small animal ICUs. DESIGN: Multicenter observational cohort study conducted between January 2017 and September 2018. SETTING: Three small animal teaching hospital ICUs. ANIMALS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data on patient numbers, illness severity (assesed via the acute patient physiologic and laboratory evaluation [APPLE] score), care burden, staffing levels, technician experience/education level, and care errors were collected at each study site. Care errors were categorized as major (unanticipated arrest or death; patient endangerment through IV line, arterial catheter, chest tube or other invasive device mismanagement, or errors in drug calculation/administration) or minor. Median patient:technician ratio was 4.3 (range: 1-18). Median patient illness severity was 15.1 (4.7-27.1) APPLE score units. A total of 221 major and 3,317 minor errors were observed over the study period. The odds of a major error increased by an average of 11% (odds ratio [OR] = 1.11; 95% confidence interval [CI], 1.02-1.20; P = 0.012) for each 1 patient increase in the patient:technician ratio after averaging by ICU location. The major error incident rate ratio was 2.53 (95% CI, 1.84-3.54; P < 0.001) for patient:technician ratios of >4.0 compared with ≤4.0. The odds of a major error increased by 0.5% per total unit APPLE score increase (OR = 1.005; 95% CI, 1.002-1.007; P < 0.001). The major error incident rate ratio was 1.71 (95% CI, 1.30-2.25; P < 0.001) for APPLEfast :technician ratios of >73 compared with ≤73. The odds of a major error decreased by 2% (OR = 0.98; 95% CI, 0.97-0.99; P = 0.01) for each year increase in total technician years of ICU work experience. CONCLUSIONS: Substantial reductions in major care errors may be achieved by maintaining ICU patient:technician ratios at ≤4. Technician experience and total unit burden of patient illness severity are also associated with error incidence, and should be taken into consideration when scheduling staff.

Urinary biomarkers in lupus nephritis.

Systemic lupus erythematosus (SLE) is the prototypical autoimmune disease that can affect any organ of the body. Multiple mechanisms may contribute to the pathophysiology of systemic lupus, including failure to remove apoptotic bodies, hyperactivity of self-reactive B and T lymphocytes, abnormal exposure to autoantigens, and increased levels of B-cell stimulatory cytokines. The involvement of the kidney, called lupus nephritis (LN), during the course of the disease affects between 30% and 60% of adult SLE patients, and up to 70% of children. LN is an immune-mediated glomerulonephritis that is a common and serious finding in patients with SLE. Nowadays, renal biopsy is considered the gold standard for classifying LN, besides its degree of activity or chronicity. Nevertheless, renal biopsy lacks the ability to predict which patients will respond to immunosuppressive therapy and is a costly and risky procedure that is not practical in the monitoring of LN because serial repetitions would be necessary. Consequently, many serum and urinary biomarkers have been studied in SLE patients for the complementary study of LN, existing conventional biomarkers like proteinuria, protein/creatinine ratio in spot urine, 24 â€‹h urine proteinuria, creatinine clearance, among others and non-conventional biomarkers, like Monocyte chemoattractant protein-1 (MCP-1), have been correlated with the histological findings of the different types of LN. In this article, we review the advances in lupus nephritis urinary biomarkers. Such markers ideally should be capable of predicting early sub-clinical flares and could be used to follow response to therapy. In addition, some of these markers have been found to be involved in the pathogenesis of lupus nephritis.

Mortality in patients with systemic lupus erythematosus in Colombia: a case series.

INTRODUCTION: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with high mortality rates. This study aimed to describe the main causes of death in a case series of SLE patients attended in a single center in Colombia. METHODS: We conducted a retrospective review and analysis of records of SLE patients who died between January 2011 and June 2017. We extracted the main causes of death and described variables associated with this outcome as well as variables associated with the disease and its treatment. RESULTS: From a total of 1776 patients with SLE, we identified 49 fatal cases (89.8% women, n = 44). The average age at death was 40.6 years (SD 17.4), and patients had a median of 4.5 years (IQR 2-8) of disease duration. The main findings included lymphopenia in 44 patients (89.9%), biopsy-confirmed lupus nephritis (LN)-types IV and VI-in 38 (77.6%), catastrophic antiphospholipid syndrome (CAPS) in 8 (16.3%), and persistent hypocomplementemia (C3 and C4) in 8 (16.3%). The median SLE disease activity index (SLEDAI-2K) score at the time of death was 19 (IQR 11-39). The main cause of death was SLE activity and lupus-induced damage in 22 (44.9%) patients. CONCLUSION: The main causes of death included SLE activity refractory to immunosuppressive treatment, and nosocomial bacterial infections. The patients who died had persistently high SLEDAI scores, types IV and VI LN, associated antiphospholipid syndrome, and persistent hypocomplementemia, requiring severe immunosuppression and prolonged hospitalization.

Correction to: Mortality in patients with systemic lupus erythematosus in Colombia: a case series.

The presentation of data on the Table 3 of the published version of the above mentioned article was incorrect. The heading "Bacterial infections" should be presented under the heading "Infections". The original article has been corrected.

Biblioterapia: estrategia para el bienestar emocional en niños durante la pandemia COVID-19 / Bibliotherapy: strategy for emotional well-being in children during the COVID-19 pandemic / Biblioterapia: estratégia para o bem-estar emocional das crianças durante a pandemia da COVID-19

Objetivo: Determinar el impacto de la lectura de literatura infantil como estrategia de acompañamiento y bienestar emocional en niños/as escolarizados en situación de confinamiento por la pandemia. Método: Estudio en su totalidad cuasiexperimental de antes y después, bajo enfoque mixto (cuantitativo-cualitativo) e interdisciplinar (Enfermería-Literatura-Educación). Se presentan solamente los resultados de corte cuantitativo. Con 50 participantes de 7 a 12 años, de colegios públicos de Bucaramanga (Colombia). Luego de valoración por dominios de taxonomía II de la North American Nursing Diagnosis Association/ NANDA, los participantes recibieron cuatro sesiones virtuales de lectura, aplicando la intervención biblioterapia de la Nursing Intervention Classification/NIC. En las sesiones, observadores externos evaluaron la respuesta emocional de los/as participantes a través del resultado equilibrio emocional de la escala Nursing Outcomes Classification/NOC. Resultados: Los diagnósticos NANDA más comunes fueron: Disposición para mejorar resiliencia, Impotencia y Riesgo de soledad. Muestran en los participantes una situación mental y emocional vulnerable, experimentando tristeza, miedo y aburrimiento. Ante esto, la intervención biblioterapia fue efectiva: el resultado equilibrio emocional pasó de 4.0 (NOC-inicial) a 4.8 (NOC-final). Conclusión: Se constató que la biblioterapia impacta positivamente la salud mental y el estado emocional de niños vulnerables en situaciones de crisis, al observarse mejoría en los participantes luego de la intervención de lectura.

Conceptualización de la Hoja de vida de lector como instrumento de evaluación formativa en la educación superior / Conceptualization of the reader curriculum vitae as a tool of formative assessment in higher education / Conceptualização do Currículo do Leitor como um instrumento de avaliação formativa no ensino superior

RESUMEN El objetivo de este artículo de investigación es conceptualizar la Hoja de vida de lector como instrumento de evaluación formativa al inicio de la Educación Superior: Con el fin lograr tal propósito, el Grupo de Investigación Cultura y Narración en Colombia (Cuynaco) se basa en el paradigma hermenéutico-interpretativo de las Ciencias Sociales y en el método documental de investigación con carácter proyectivo. Por tanto, se realiza, en primer lugar una revisión de la literatura en torno a instrumentos de valoración metacognitiva; por la escasez de investigaciones al respecto, se propone una aproximación al análisis bibliométrico del tema y un diálogo entre los instrumentos de evaluación hallados. En segundo lugar se expone una aproximación teórica alrededor de conceptos tales como Hoja de vida, Lector y Evaluación formativa A partir de lo anterior, surge la definición de Hoja de vida de lector como un instrumento metacognitivo con características formativas particulares en comparación con los existentes.

ABSTRACT The aim of this research article is to conceptualize the Reader Curriculum Vitae as a formative assessment tool for at the beginning of University. In order to achieve this purpose, the Research group Cuynaco bases its study on the Social Science hermeneutical approach and a documentary and projective review. Therefore, first of all, the research group conducts a literature review around metacognitive assessment tools. Due to a few studies, the group proposes an approach to the bibliometric analysis of the topic and a discussion among the found assessment tools. Second, it sets out a theoretical approach around concepts such as Curriculum Vitae, Reader and Formative Assessment. Based on the foregoing, it presents the definition of Reader Curriculum Vitae, as a metacognitive tool with particular formative characteristics, compared with the existing ones.

RESUMO O objectivo deste artigo de investigação é conceptualizar o Currículo do Leitor como um instrumento de avaliação formativa no início do Ensino Superior Para alcançar tal objectivo, o Grupo de Investigação Cultura e Narração na Colômbia (Cuynaco) baseia-se no paradigma hermenêutico-interpretativo das Ciências Sociais e no método documental de investigação com carácter projectivo. Assim, em primeiro lugar é feita uma revisão da literatura sobre instrumentos de avaliação metacognitiva; devido à escassez de investigação sobre o tema, propõe-se uma abordagem à análise bibliométrica do tema e um diálogo entre os instrumentos de avaliação encontrados. Em segundo lugar, é apresentada uma abordagem teórica em torno de conceitos tais como Folha de Vida, Leitor e Avaliação Formativa. Do acima exposto, emerge a definição da Folha de Vida do Leitor como um instrumento metacognitivo com características formativas particulares em comparação com os existentes.