[Study to improve the quality of life in perimenopausal women from the community pharmacy. Research protocol pilot study -m+45]. / Estudio de mejora de la calidad de vida en mujeres perimenopaúsicas desde la farmacia comunitaria. Protocolo de investigación estudio piloto -m+45.

The menopause is a stage in a woman's life, characterised by oestrogen and progestogen deficiency, which can cause a series of symptoms of varying intensity among women. When they appear, their quality of life can be affected to a greater or lesser extent, so it is important to identify them and intervene by offering appropriate solutions. There are different validated scales, although in recent years the Menopause Rating Scale (MRS) has been one of the most widely used in global research.Taking into account the healthcare work of the community pharmacist, it is appropriate to suggest a project to measure the perception of quality of life in women aged from 45 to 64 years before and after a structured intervention to assess its impact on general wellbeing.A study was proposed in community pharmacies that were be randomly distributed into intervention and control groups. The study was offered to women who came to collect medication related to this stage or requested information or recommendations as long as they signed the informed consent form and did not suffer cognitive or language difficulties that would not allow them to understand the study. Two questionnaires were carried out on the first visit, which were repeated on the second visit, after 3 months, as well as a third, only on the second visit, on sources of information. The intervention group received on the initial visit, after data collection, health education and recommendations of commercially available products related to the characteristic symptoms.

Effect of Abiotic Treatments on Agricultural Plastic Waste: Efficiency of the Degradation Processes.

In this study, four different plastic materials usually used in the agricultural sector (polystyrene film (PS), polyethylene terephthalate film (PET), low-density polyethylene film (LDPE) and linear low-density polyethylene film (LLDPE)) were subjected to different abiotic treatments, including photo-oxidation (ultraviolet and e-beam radiation) and thermochemical treatments, to enhance polymer degradation. The extensive use of these polymers leads to large amounts of plastic waste generation, including small plastic pieces, known as microplastics, which affect the quality of the agricultural environment, including soil fertility and quality. Therefore, polymer degradation strategies are needed to effectively reduce plastic waste to protect the agricultural sector. The degree of polymer degradation was assessed by the use of thermal and spectroscopic analyses, such as TGA and FTIR. In addition, efficiency, cost-benefits, and potential side-effects were also evaluated to propose the optimal degradation strategy to reduce plastic waste from the point of view of efficiency. The results obtained showed that the pre-treatments based on photo-oxidation (ultraviolet B and C and e-beam radiation) were more efficient and had a better cost-benefit for the degradation of the polymers studied in relation to the thermochemical treatments. Specifically, ultraviolet photo-oxidation worked well for PS and PET, requiring low energy and medium times. However, e-beam radiation was recommended for PE (LDPE and LLDPE) degradation, since high energy and long times were needed when ultraviolet energy was applied to this polymer. Furthermore, the overall efficiency of the plastic degradation of pre-treatments should be studied using a multicriteria approach, since FTIR assessments, in some cases, only consider oxidation processes on the plastic surface and do not show the potential integrity changes on the plastic probes.

Enhancing earthworm (Lumbricus terrestris) tolerance to plastic contamination through gut microbiome fortification with plastic-degrading microorganisms.

Microorganisms from L. terrestris gut previously exposed to different types of plastic (PET, LDPE, LLDPE, and PS) were studied to be used as probiotics of earthworms in plastic-contaminated soils (LDPE, LLDPE and recycled mulching film) at mesocosm-scale trials. The most abundant morphotypes with enzymatic capacities of interest were identified. Pseudomonas alkylphenolica (PL4) and Pseudomonas putida (PL5) strains were selected to be used as inoculants using Morus alba leaves as carriers to strengthen the intestinal microbiota of earthworms. Culture (selective cetrimide agar medium) and molecular (qPCR) techniques were used to trace the presence of the inoculum in the intestine of the earthworms. Additionally, a metataxonomic analysis was carried out to study the biodiversity and functionality of the earthworm microbiome, and their measure of survival and weight. Probiotics improved the survival rates of earthworms exposed to plastics, which also increased the abundance of microbial groups of interest in plastic bioremediation tasks.

Effect of Pharmaceutical Intervention in Pharmacologically Treated Hypertensive Patients-A Cluster-Randomized Clinical Trial: AFPRES-CLM Study.

BACKGROUND: Evaluate the effect of a community pharmaceutical intervention on the control of blood pressure in hypertensive patients treated pharmacologically. METHODS: A cluster-randomized clinical trial of 6 months was carried out. It was conducted in the Autonomous Community of Castilla-La Mancha (Spain). Sixty-three community pharmacies and 347 patients completed the study. Intervention patients received the community pharmaceutical intervention based on a protocol that addresses the individual needs of each patient related to the control of their blood pressure, which included Health Education, Pharmacotherapy Follow-up and 24 h Ambulatory Blood Pressure Measurement. Control patients received usual care in the community pharmacy. RESULTS: The pharmaceutical intervention resulted in better control of blood pressure (85.8% vs. 66.3% p < 0.001), lower use of emergencies (p = 0.002) and improvement trends in the physical components of quality of life, measured by SF-36 questionnaire, after 6 months of pharmaceutical intervention. No significant changes were observed for any of these variables in the control group. There were also detected 354 negative medication-related outcomes that were satisfactorily resolved in a 74.9% of the cases and 330 healthcare education interventions and 29 Ambulatory Blood Pressure Monitorings were performed in order to increase adherence to pharmacological treatment and minimize Negative Outcomes associated with Medication and prevent medication-related problems. CONCLUSIONS: Community pharmaceutical intervention can increase hypertensive patients with controlled blood pressure, after 6 months, compared with usual care.

[Strategy to optimize patient safety in the community pharmacy dispensing service. Proposed checklists]. / Estrategia para optimizar la seguridad del paciente en el servicio de dispensación en farmacia comunitaria. Propuesta de listados de verificación.

Dispensing is the most requested and important service within the tasks performed by the pharmacist, in his day-to-day work, in the community pharmacy. The aim of dispensing is to guarantee the patient's access to the medicine in an adequate and controlled manner. During that process, the community pharmacist has the obligation, as a healthcare professional, to actively participate in a committed manner in the detection of possible medication or medication-related errors.SEFAC´s patient safety group has developed, as the beginning of a series of future projects, checklists and best guidelines for medicines formulated as transdermal patches, modified release forms or orodispersible tablets. The aim of this initiative is to minimize as far as possible, by means of a prior interview with the patient and the use of these tools, any errors or problems that might arise with these drugs, thereby ensuring patient safety.A pilot project is expected to begin throughout 2023 in community pharmacies that collaborate with SEFAC's patient safety group. Therefore, they will be able to collect and report the results obtained.

Is Dairy Effluent an Alternative for Maize Crop Fertigation in Semiarid Regions? An Approach to Agronomic and Environmental Effects.

The reuse of effluents from intensive dairy farms combined with localized irrigation techniques (fertigation) has become a promising alternative to increase crop productivity while reducing the environmental impact of waste accumulation and industrial fertilizers production. Currently, the reuse of dairy effluents through fertigation by subsurface drip irrigation (SDI) systems is of vital importance for arid regions but it has been poorly studied. The present study aimed to assess the greenhouse gas (GHG) emissions, soil properties, and crop yield of a maize crop fertigated with either treated dairy effluent or dissolved granulated urea applied through an SDI system at a normalized N application rate of 200 kg N ha-1. Fertilizer application was divided into six fertigation events. GHG fluxes were measured during fertigation (62-day) using static chambers. Soil properties were measured previous to fertilizer applications and at the harvest coinciding with crop yield estimation. A slight increase in soil organic matter was observed in both treatments for the 20-60 cm soil depth. Both treatments also showed similar maize yields, but the dairy effluent increased net GHG emissions more than urea during the fertigation period. Nevertheless, the net GHG emissions from the dairy effluent were lower than the theoretical CO2eq emission that would have been emitted during urea manufacturing or the longer storage of the effluent if it had not been used, showing the need for life-cycle assessments. Local-specific emission factors for N2O were determined (0.07%), which were substantially lower than the default value (0.5%) of IPCC 2019. Thus, the subsurface drip irrigation systems can lead to low GHG emissions, although further studies are needed.

Bacterial and fungal community dynamics during different stages of agro-industrial waste composting and its relationship with compost suppressiveness.

Composting is an advantageous and efficient process for recycling organic waste and producing organic fertilizers, and many kinds of microorganisms are involved in obtaining quality compost with suppressive activity against soil-borne pathogens. The aim of this work was to evaluate the main differences in the effects of three composting piles on the whole bacterial and fungal communities of baby-leaf lettuce crops and to determine the specific communities by high-throughput sequencing related to suppressiveness against the soil-borne plant pathogen Pythium irregulare- (P. irregulare). Compost pile A was composed of 47% vineyard pruning waste, 34% tomato waste and 19% leek waste; pile B was composed of 54% vineyard pruning waste and 46% tomato waste; and pile C was composed of 42% vineyard pruning waste, 25% tomato waste and 33% olive mill cake. The temperature and the chemical properties of the piles were monitored throughout the composting process. In addition, the potential suppressive capacity of the three composts (C_A, C_B and C_C) against P. irregulare in baby-leaf lettuce was assessed. We found that the bacterial community changed according to the composting phases and composting pile and was sensitive to chemical changes throughout the composting process. The fungal community, on the other hand, did not change between the composting piles and proved to be less influenced by chemical properties, but it did change, principally, according to the composting phases. All composts obtained were considered stable and mature, while compost C_C showed higher maturity than composts C_A and C_B. During composting, the three piles contained a greater relative abundance of Bacterioidetes, Proteobacterias and Actinobacterias related to the suppression of soil-borne pathogens such as Pythium irregulare. Composts C_A and C_B, however, showed higher suppressiveness against P. irregulare than compost C_C. Deeper study showed that this observed suppressiveness was favored by a higher abundance of genera that have been described as potential suppressive against P. irregulare, such as Aspergillus, Penicillium, Truepera and Luteimonas.

The influence of feedstocks and additives in 23 added-value composts as a growing media component on Pythium irregulare suppressivity.

Alternative materials with added-value functions, such as phytopathogen suppression and biostimulant and/or biofertilising activity, have been proposed as peat substitutes in growing media. The aim of this work was to evaluate the effect of 23 agro-industrial composts as components of growing media for baby-leaf lettuce transplant production and their activity against the plant pathogen Pythium irregulare. The composts were produced by mixing different starting feedstocks-tomato waste, leek waste, olive mill cake and vineyard pruning waste-with different additives (coffee, thyme, lavender and rockrose waste), which were incorporated at the beginning of the maturation phase. The results obtained indicated that the composts were mature enough to be used as growing media. The fresh weight of the lettuce plants grown with the different composts was significantly higher than in plants obtained with peat. Composts with the coffee additive produced higher lettuce fresh weight, while those with thyme yielded a lower fresh weight. Moreover, composts as components of growing media showed significantly higher P. irregulare suppressiveness than peat. The composts with additives produced lower lettuce fresh weight than composts without additives, but showed higher suppressiveness. Composts with additives showed opposite results depending on whether they were exposed to pathogens or not. Composts with additives showed opposite results according to pathogen pressure or not. Out of all the composts studied, the compost with tomato waste and leek waste as the initial feedstock, and lavender as an additive, showed the highest suppressive capacity. After lettuce harvesting, the growing media with composts showed significantly lower concentrations of P. irregulare than peat. Principal Component Analysis (PCA) revealed that the growing media with compost can be grouped together according to the additive type.

Microbial communities of the olive mill wastewater sludge stored in evaporation ponds: The resource for sustainable bioremediation.

Olive Mill Wastewater (OMW) is a polluting residue from the olive oil industry. It is usually stored in open-air unprotected evaporation ponds where their sediments accumulate. This study compares the characteristics of OMW sludges stored for long-time in evaporation ponds and assesses their impact on the underlying soil layer. Physicochemical parameters, toxicity bioassays, and full characterization of the microbial community were analyzed. The extension of the polluting effects was assessed by analysis of toxicity, microbial biomass carbon, and respiration. Geostatistics was used to predict their spatial distribution. Organic matter and polyphenol content besides toxicity levels determine variations between OMW sludges and have a high impact on the microbiota they contain. The microbial community was abundant, diverse, and functionally active. However, the biodegradability of the sludges was hindered by the toxicity levels. Toxicity and biomass carbon were higher on the surface of the ponds than in the soil layer revealing a reduced leach flow and depletion of contaminants. The natural microbiota might be biostimulated by means of applying sustainable and feasible biological treatments in order to favor the OMW sludges bioremediation. These results open up the possibility of solving the environmental concern caused by its storage in similar scenarios, which are common in olive oil-producing countries.

Bioremediation of Olive Mill Wastewater sediments in evaporation ponds through in situ composting assisted by bioaugmentation.

The common method for the disposal of olive oil mill wastewater (OMW) has been its accumulation in evaporation ponds where OMW sediments concentrate. Due to the phytotoxic and antimicrobial effect of OMW, leaks from ponds can pollute soils and water bodies. This work focuses on the search for microorganisms that can be used as inocula for bioremediation of polluted matrices in OMW ponds by means of in situ composting. Two fungi isolated from OMW sediments, Aspergillus ochraceus H2 and Scedosporium apiospermum H16, presented suitable capabilities for this use as a consortium. Composting eliminated the phyto- and ecotoxicity of OMW sediments by depleting their main toxic components. Inoculation with the fungal consortium improved the bioremediation efficacy of the technique by hastening the decrease of phytotoxicity and ecotoxicity and enhancing phytostimulant property of compost produced. This procedure constitutes a promising strategy for bioremediation of OMW polluted sites.

SIMSWASTE-AD - A modelling framework for the environmental assessment of agricultural waste management strategies: Anaerobic digestion.

On-farm anaerobic digestion (AD) has been promoted due to its improved environmental performance, which is based on a number of life cycle assessments (LCA). However, the influence of site-specific conditions and practices on AD performance is rarely captured in LCA studies and the effects on C and N cycles are often overlooked. In this paper, a new model for AD (SIMSWASTE-AD) is described in full and tested against a selection of available measured data. Good agreement between modelled and measured values was obtained, reflecting the model capability to predict biogas production (r2=0.84) and N mineralization (r2=0.85) under a range of substrate mixtures and operational conditions. SIMSWASTE-AD was also used to simulate C and N flows and GHG emissions for a set of scenarios exploring different AD technology levels, feedstock mixtures and climate conditions. The importance of post-digestion emissions and its relationship with the AD performance have been stressed as crucial factors to reduce the net GHG emissions (-75%) but also to enhance digestate fertilizer potential (15%). Gas tight digestate storage with residual biogas collection is highly recommended (especially in temperate to warm climates), as well as those operational conditions that can improve the process efficiency on degrading VS (e.g. thermophilic range, longer hydraulic retention time). Beyond the effects on the manure management stage, SIMSWASTE-AD also aims to help account for potential effects of AD on other stages by providing the C and nutrient flows. While primarily designed to be applied within the SIMSDAIRY modelling framework, it can also interact with other models implemented in integrated approaches. Such system scope assessments are essential for stakeholders and policy makers in order to develop effective strategies for reducing GHG emissions and environmental issues in the agriculture sector.

Agroindustrial composts to reduce the use of peat and fungicides in the cultivation of muskmelon seedlings.

BACKGROUND: Environmental concerns about peat extraction in wetland ecosystems have increased. Therefore, there is an international effort to evaluate alternative organic substrates for the partial substitution of peat. The aim of this work was to use different composts (C1-C10) obtained from the fruit and vegetable processing industry (pepper, carrot, broccoli, orange, artichoke residues, sewage sludge (citric and pepper) and vineyard pruning wastes) to produce added-value composts as growing media with suppressive effect against Fusarium oxysporum f.sp. melonis (FOM) in muskmelon. RESULTS: Composts showed values of water-soluble carbon fractions and dehydrogenase activity that allowed them to be considered mature and stabilized. All compost treatments produced significantly (F = 7.382; P < 0.05) higher fresh shoot weight than peat, treatment T-C2 showing the highest values. Treatments T-C5, T-C7 and T-C8 showed percentages of disease incidence that were significantly (F = 16.052; P < 0.05) the lowest, relative to peat, followed by T-C6, T-C10, T-C1 and T-C9 with values below 50%. CONCLUSION: Composts produced are suitable components of mixed compost-peat growing media, providing a 50% substitution of peat. Furthermore, some of these composts also showed an added value as a suppressive organic medium against Fusarium wilt in muskmelon seedling, a fact probably related to high pH and pepper wastes and high content of pruning waste as initial raw materials. © 2016 Society of Chemical Industry.

Windrow composting as horticultural waste management strategy - A case study in Ecuador.

In Ecuador, enormous quantities of vegetable wastes are produced annually from the horticultural industries. Composting can be a feasible treatment to stabilise horticultural wastes and, thus, to improve their properties for use as organic fertilisers. In this study, two different piles were prepared, using laying hen manure and sawdust mixed with broccoli or tomato waste, respectively, and composted by the turned windrow composting system. Throughout the composting process, the temperature of the mixtures was monitored and physico-chemical and chemical properties and the degree of maturity were determined. Also, principal component analysis was used to interpret the data set of compost characteristics. In both piles, the temperature exceeded 55°C for more than 2weeks, which ensured maximum pathogen reduction. Organic matter (OM) losses followed a first-order kinetic equation in both piles. The final composts showed a suitable degree of stability and maturity and an absence of phytotoxins, as observed in the evolution and final values of the total organic carbon/total nitrogen ratio (Corg/NT<20), water-soluble organic carbon (Cw<1.7%), germination index (GI>50%) and cation exchange capacity (CEC>67meq (100g OM)(-1)). As well, the evolution of different humification indexes during composting was a good indicator of the OM humification process. The type of vegetable waste used influenced OM and NT mineralisation and the final properties of the composts, showing the mixture with tomato waste a higher fertilising capacity and less environmental problems.

Rapid estimation of nutritional elements on citrus leaves by near infrared reflectance spectroscopy.

Sufficient nutrient application is one of the most important factors in producing quality citrus fruits. One of the main guides in planning citrus fertilizer programs is by directly monitoring the plant nutrient content. However, this requires analysis of a large number of leaf samples using expensive and time-consuming chemical techniques. Over the last 5 years, it has been demonstrated that it is possible to quantitatively estimate certain nutritional elements in citrus leaves by using the spectral reflectance values, obtained by using near infrared reflectance spectroscopy (NIRS). This technique is rapid, non-destructive, cost-effective and environmentally friendly. Therefore, the estimation of macro and micronutrients in citrus leaves by this method would be beneficial in identifying the mineral status of the trees. However, to be used effectively NIRS must be evaluated against the standard techniques across different cultivars. In this study, NIRS spectral analysis, and subsequent nutrient estimations for N, K, Ca, Mg, B, Fe, Cu, Mn, and Zn concentration, were performed using 217 leaf samples from different citrus trees species. Partial least square regression and different pre-processing signal treatments were used to generate the best estimation against the current best practice techniques. It was verified a high proficiency in the estimation of N (Rv = 0.99) and Ca (Rv = 0.98) as well as achieving acceptable estimation for K, Mg, Fe, and Zn. However, no successful calibrations were obtained for the estimation of B, Cu, and Mn.

Gaseous emissions from management of solid waste: a systematic review.

The establishment of sustainable soil waste management practices implies minimizing their environmental losses associated with climate change (greenhouse gases: GHGs) and ecosystems acidification (ammonia: NH3 ). Although a number of management strategies for solid waste management have been investigated to quantify nitrogen (N) and carbon (C) losses in relation to varied environmental and operational conditions, their overall effect is still uncertain. In this context, we have analyzed the current scientific information through a systematic review. We quantified the response of GHG emissions, NH3 emissions, and total N losses to different solid waste management strategies (conventional solid storage, turned composting, forced aerated composting, covering, compaction, addition/substitution of bulking agents and the use of additives). Our study is based on a meta-analysis of 50 research articles involving 304 observations. Our results indicated that improving the structure of the pile (waste or manure heap) via addition or substitution of certain bulking agents significantly reduced nitrous oxide (N2 O) and methane (CH4 ) emissions by 53% and 71%, respectively. Turned composting systems, unlike forced aerated composted systems, showed potential for reducing GHGs (N2 O: 50% and CH4 : 71%). Bulking agents and both composting systems involved a certain degree of pollution swapping as they significantly promoted NH3 emissions by 35%, 54%, and 121% for bulking agents, turned and forced aerated composting, respectively. Strategies based on the restriction of O2 supply, such as covering or compaction, did not show significant effects on reducing GHGs but substantially decreased NH3 emissions by 61% and 54% for covering and compaction, respectively. The use of specific additives significantly reduced NH3 losses by 69%. Our meta-analysis suggested that there is enough evidence to refine future Intergovernmental Panel on Climate Change (IPCC) methodologies from solid waste, especially for solid waste composting practices. More holistic and integrated approaches are therefore required to develop more sustainable solid waste management systems.

Estimation of parameters in sewage sludge by near-infrared reflectance spectroscopy (NIRS) using several regression tools.

Sewage sludge application to agricultural soils is a common practice in several countries in the European Union. Nevertheless, the application dose constitutes an essential aspect that must be taken into account in order to minimize environmental impacts. In this study, near infrared reflectance spectroscopy (NIRS) was used to estimate in sewage sludge samples several parameters related to agronomic and environmental issues, such as the contents in organic matter, nitrogen and other nutrients, metals and carbon fractions, among others. In our study (using 380 biosolid samples), two regression models were fitted: the common partial least square regression (PLSR) and the penalized signal regression (PSR). Using PLSR, NIRS became a feasible tool to estimate several parameters with good goodness of fit, such as total organic matter, total organic carbon, total nitrogen, water-soluble carbon, extractable organic carbon, fulvic acid-like carbon, electrical conductivity, Mg, Fe and Cr, among other parameters, in sewage sludge samples. For parameters such as C/N ratio, humic acid-like carbon, humification index, the percentage of humic acid-like carbon, the polymerization ratio, P, K, Cu, Pb, Zn, Ni and Hg, the performance of NIRS calibrations developed with PLSR was not sufficiently good. Nevertheless, the use of PSR provided successful calibrations for all parameters.

Quality assessment of tomato landraces and virus-resistant breeding lines: quick estimation by near infrared reflectance spectroscopy.

BACKGROUND: Several tomato landraces are very popular in south-eastern Spain for their organoleptic fruit quality, but these cultivars are highly susceptible to several viruses. A breeding programme is being carried out for the introduction of virus resistances into these landraces. In the last steps of our breeding programme a high number of breeding lines must be evaluated for agronomic and organoleptic quality parameters. Near infrared reflectance spectroscopy (NIRS) technology shows considerable promise and is ideally suited to the requirements of breeders. RESULTS: Significant differences between a set of 35 tomato breeding lines, seven landraces and one commercial hybrid were observed for quality and mineral content parameters, suggesting that there are considerable levels of genetic diversity between the cultivar groups studied. Using NIRS on dry samples of tomato constitutes a feasible technique to estimate the content of several minerals (C, N, P, K, Ca, Na, Mn, Mg and Cu) according to the coefficient of determination for calibration (R(2) > 0.90). NIRS estimations of soluble solids content and titratable acidity obtained were considered useful only for general screening purposes. CONCLUSIONS: NIRS technology may be a useful tool in the selection of lines coming out of tomato breeding programs, allowing a quick estimation of mineral content. However, the estimation of soluble solids content and titratable acidity by NIRS must be improved.

Study of the evolution of organic matter during composting of winery and distillery residues by classical and chemometric analysis.

The aim of the present paper is to evaluate the changes of organic matter during the composting process of fresh winery and distillery residues (WDR) by means of classical and chemometric analysis of (13)C cross-polarization magic angle spinning (CPMAS) NMR and Fourier transform infrared (FT-IR) spectra. (13)C NMR spectroscopy displayed a preferential biodegradation of carbohydrates as well as an accumulation of aliphatic chains (cutin- and suberin-like substances). This preferential biodegradation of the organic fractions reduces the landfill emission potential. Although the composition of the input mixture strongly affects the shape of the infrared (IR) spectra, typical bands of components can be selected and used to follow the composting process; that is, changes in the relative absorbances of the band of nitrate (at 1384 cm(-1)) and in the band of carbohydrates (at 1037 cm(-1)) have been observed. In addition, different chemometric tools, such as partial least-squares (PLS), interval PLS (iPLS), backward iPLS (biPLS), and genetic algorithm (GA), have been used to find the most relevant spectral region during the composting process. Chemometric analysis based on the combined and sequential use of iPLS and GA has been revealed as a very powerful tool for the detection in samples of the most relevant spectral region related to the composting process. From the obtained results, it can be concluded that CPMAS (13)C NMR supported by FT-IR could provide information about the evolution and characteristics of the organic matter during the composting process in order to avoid contamination problems after its use as amendment in agriculture or after landfilling.

Eritrosedimentación, leucopenia, linfopenia y anticuerpo anti-DNA nativo en lupus eritematoso sistémico. Asociación con actividad y daño orgánico / Erythrocyte sedimentation rate, leukopenia, lymphopenia and anti-double stranded DNA antibodies in systemic lupus erythematosus. Association with activity and organ damage

Introducción: La eritrosedimentación (VSG), la leucopenia, la linfopeniay los anticuerpos anti-DNA de doble cadena (anti-DNAn), se han asociado con la actividad del lupus eritematoso sistémico (LES). Su relación con el daño acumulado no es clara. Objetivo: Determinar si la elevación de la VSG, la leucopenia, la linfopenia y el anti-DNAn se relacionan con la actividad o el daño acumulado. Métodos: Se revisaron historias clinicas de pacientes con LES de tres centros de reumatología. Se registraron hemograma, VSG, anti DNAny actividad del LES (SLEDAI) en la primera consulta, cada tres a seis meses y en caso de sospecha de activación. Se evaluó daño orgánico (SLICC/ACR), al primero, tercero, quinto y décimo año de seguimiento. Para analizar leucopenia y actividad de LES, se elaboró una escala sin leucopenia (SLEDAI-L). Los pacientes fueron distribuidos en cuatro grupos de acuerdo al promedio de VSG, leucocitos, linfocitos y clasificados como anti-DNAn positivos o negativos. La media del promedio del SLEDAI y del último SLICC/ACR fueron comparadas entre los grupos de VSG, recuento de linfocitos y entre pacientes anti-DNAn positivos o negativos. La media del promedio de SLEDAI-L y del último SLICC/ACR se compararon entre los grupos de leucocitos. Resultados: De 86 pacientes (75 mujeres, edad media 35,5 ± 10,8 años), 60% tuvieron VSG elevada leve, con un promedio de recuento de leucocitos y linfocitos normal de 92% y 65%, respectivamente y 58% fueron anti-DNAn negativo. La comparación de la media del promedio de SLEDAI y el promedio de SLICC/ACR entre los grupos de VSG, recuento de linfocitos y entre pacientes anti-DNAn positivo y negativo no mostró diferencias significativas, de la misma forma que la media de SLEDAI-L y de SLICC/ACR entre los grupos de recuento de leucocitos. Conclusión: El promedio de elevación de VSG, leucopenia y linfopenia y el anti-DNAn no mostraron asociación con la actividad o el daño acumulado por el LES.