Estudio multicéntrico de deterioro cognitivo en lupus eritematoso sistémico: ECLES / Multicenter study of cognitive decline in systemic lupus erythematousus: ECLES

Introducción: los pacientes lúpicos presentan un riesgo incrementado de deterioro cognitivo (DC) comparado con individuos sanos, el cual puede ser debido a múltiples causas. Objetivo: Describir la frecuencia y características del deterioro cognitivo en pacientes con lupus sin manifestaciones neuropsiquiátricas conocidas. Materiales y método: Se incluyeron pacientes de 16 a 55 años con diagnóstico de LES según criterios del Colegio Americano de Reumatología (ACR) de 1997. Se incluyeron test neuropsicológicos acordes a la propuesta del ACR y el cuestionario de Beck para evaluar depresión. Se definió DC a valores de <2 o más desvíos estándar comparada con la media de población normal en al menos un test. Se consideró focal cuando afectó una o más medidas de un dominio y multifocal en 2 o más dominios. Para comparar proporciones se utilizó prueba exacta de Fisher y para comparar variables numéricas se usó prueba de Kruskal-Wallis. Se consideró significativo un valor de p <0,05. Resultados: Se estudiaron 86 pacientes con lupus, el 90% de origen caucásico, 8% mestizos y 1% amerindio. El 82% alcanzó nivel secundario. La frecuencia de DC fue del 65% (56/86). Los dominios afectados: memoria 45%, funciones ejecutivas 30%, atención 29%, lenguaje 4,6%. Se detectó depresión en un 48% de los pacientes. Se analizaron diferentes factores de riesgo, sin hallar diferencias estadísticamente significativas a excepción de la etnia (p=0,02). Conclusión: Se halló una frecuencia elevada de deterioro cognitivo en pacientes con LES, los pacientes no caucásicos tuvieron mayor DC con diferencias significativas en comparación con los pacientes caucásicos.

Background: patients with systemic lupus erythematosus (SLE)have an increased risk of cognitive impairment (CI) compared tohealthy individuals and it may be due to multiple causes. Objective: To determine the frequency and characteristics of CI inlupus patients without known previous neuropsychiatric events. Methods: Patients aged 16 to 55 fulfilling the 1997 ACR criteria forSLE were included. The neuropsychological test battery proposedby the ACR was used to determine CI and Beck depression werealso assessed. CI was defined as values of ≤2 standard deviationscompared to the mean of the general population in at least one test. It was considered focal involvement if it affected one or more measuresof a single domain and multifocal if 2 or more domains wasaffected. To compare proportions, Fisher’s exact test was used andto compare numerical variables, Kruskal-Wallis. A value of p <0.05was considered significant. Results: 86 patients were evaluated, 90% were Caucasian, 8%mestizos and 1% Amerindian. 82% had high school. CI was foundin 65% of patients (56/86). The affected domains were: memory45%, executive functions 30%, attention 29% and language 4.6%. Depression was detected in 48% of patients. Different risk factorswere analyzed and found no statistically significant differences exceptfor ethnicity (p=0.02). Conclusion: A high frequency of CI was found in patients with SLE,non-Caucasian had higher CI with significant differences in comparisonwith Caucasian patients.

Investigation of gold nanoparticle radiosensitization mechanisms using a free radical scavenger and protons of different energies.

Gold nanoparticles (GNPs) have been shown to sensitize cancer cells to x-ray radiation, particularly at kV energies where photoelectric interactions dominate and the high atomic number of gold makes a large difference to x-ray absorption. Protons have a high cross-section for gold at a large range of relevant clinical energies, and so potentially could be used with GNPs for increased therapeutic effect.Here, we investigate the contribution of secondary electron emission to cancer cell radiosensitization and investigate how this parameter is affected by proton energy and a free radical scavenger. We simulate the emission from a realistic cell phantom containing GNPs after traversal by protons and x-rays with different energies. We find that with a range of proton energies (1-250 MeV) there is a small increase in secondaries compared to a much larger increase with x-rays. Secondary electrons are known to produce toxic free radicals. Using a cancer cell line in vitro we find that a free radical scavenger has no protective effect on cells containing GNPs irradiated with 3 MeV protons, while it does protect against cells irradiated with x-rays. We conclude that GNP generated free radicals are a major cause of radiosensitization and that there is likely to be much less dose enhancement effect with clinical proton beams compared to x-rays.

Structural redundancy of data from wastewater treatment systems. Determination of individual balance equations.

Although data reconciliation is intensely applied in process engineering, almost none of its powerful methods are employed for validation of operational data from wastewater treatment plants. This is partly due to some prerequisites that are difficult to meet including steady state, known variances of process variables and absence of gross errors. However, an algorithm can be derived from the classical approaches to data reconciliation that allows to find a comprehensive set of equations describing redundancy in the data when measured and unmeasured variables (flows and concentrations) are defined. This is a precondition for methods of data validation based on individual mass balances such as CUSUM charts. The procedure can also be applied to verify the necessity of existing or additional measurements with respect to the improvement of the data's redundancy. Results are given for a large wastewater treatment plant. The introduction aims at establishing a link between methods known from data reconciliation in process engineering and their application in wastewater treatment.

Dynamic mass balancing for wastewater treatment data quality control using CUSUM charts.

Mass balancing is a widely used tool for data quality control in wastewater treatment. It can effectively detect systematic errors in data. To overcome the limitations of the mean balancing error as a measure of data quality, a well established method for statistical process control (the CUSUM chart) is adopted for application on the error vector of balancing data. Two examples show how time periods with stable low mass balancing errors can be detected by the method. The detectability of such time periods depends on the variability of the balancing error which is an important measure for the precision of the data.

Ciclofosfamida (CIC) en lupus eritematoso sistémico (LES): dosis acumulada y eventos adversos: estudio multicéntrico / Cyclophosphamide (CYC) in systemic lupus erythematosus accumulated dose and adverse events: multicentric study

Objetivo: Describir los eventos adversos (EA) asociados a ciclofosfamiday su relación con la dosis acumulada. Material y método: Se revisaron las historias clínicas de pacientes con LES (Criterios ACR) de 6 centros de Reumatología de la Argentina. Se incluyeron 81 pacientes (72 mujeres y 9 hombres) que habían recibido tratamiento con pulsos mensuales de CIC (0,5-1g/m2). Se estudiaron los EA asociados a CIC, dosis acumulada, dosis de corticosteroides y actividad de la enfermedad al momento del evento. Se excluyeron los pacientes con otro tratamiento inmunosupresor. Resultados: La edad de diagnóstico del LES fue x¯ 26 años (DS 11,3); tiempo de evolución de la enfermedad x¯ 6,2 años (DS 5,9). La edad al inicio de CIC fue x¯ 30 años (DS 12,4). Se encontraron 105 eventos adversos asociados a CIC en 53 pacientes (65,4%). Infección (45%) fue el efecto más frecuente, fatal en 6 pacientes; intolerancia gástrica (náuseas y vómitos) en 21% y las citopenias 14,3%. Tres pacientes (2,8%) presentaron amenorrea y sólo una cistitis hemorrágica. No se detectaron neoplasias. La mediana de dosis acumulada al momento del EA fue 2600 mg. Al comparar los pacientes con y sin EA, no se encontraron diferencias significativas en el SLEDAI ni en la dosis de prednisona recibida. No se encontró asociación entre dosis acumulada de CIC y náuseas, vómitos, convulsiones y citopenias (p NS). Al aplicar el modelo de riesgo proporcional para eventos múltiples, el riesgo de infecciones aumentaba a mayor dosis de CIC. Los pacientes que fallecieron por sepsis recibieron una dosis mediana de CIC de 4000 mg. Conclusiones: 1) La dosis acumulada de CIC se asoció a infecciones: mayor dosis, mayor número de infecciones. 2) Náuseas, vómitos, convulsiones y citopenias fueron eventos independientes de la dosis de CIC.

Prevalencia de psoriasis secundaria a agentes biológicos en pacientes con artritis reumatoidea / Prevalence of psoriasis in patients with rheumatoid arthritis treated with biological agents

Los objetivos del estudio fueron determinar la prevalencia de psoriasis en pacientes con Artritis Reumatoidea (AR) tratados con Agentes Biológicos (AB) y analizar sus características clínicas en una población de Tucumán.Se incluyeron 284 pacientes con AR. Ciento cuarenta y ocho en tratamiento con AB y 136 pacientes en tratamiento con Drogas Modificadoras de AR (DMAR), seleccionados por muestreo aleatorio simple. De los 284 pacientes evaluados, 242 (85%) fueron de sexo femenino, edad media de 56,4 años ± 13,4, la edad media al diagnóstico de AR fue de 42,3 años ± 16,7 con un tiempo de evolución de la enfermedad de 11,9 años ± 8,5. Doscientos cuarenta y un pacientes (85%) fueron seropositivos para Factor Reumatoideo (FR). Ciento treinta y seis (48%) fueron tratados con DMAR y 148 (52%) con AB. Al comparar ambos grupos, no hubo diferencias significativas entre edad media, edad media al diagnóstico de AR y presencia de factor reumatoideo. Cinco de los 148 pacientes en tratamiento biológico desarrollaron psoriasis. La prevalencia de psoriasis cutánea fue 3,4% (IC 95% 1,1-7,7). La mayoría de los casos se presentaron como psoriasis gutata. La duración media del tratamiento hasta la aparición de psoriasis fue de 31,6 meses (DS 26,8). Un paciente teníaantecedentes familiares de psoriasis. Ningún paciente del grupo DMAR desarrolló psoriasis (p <0,0001). En 2 pacientes que suspendieron el AB hubo remisión completa de la manifestación cutánea y en 3 pacientes que mantuvieron el tratamiento las manifestaciones cutáneas persistieron. No se encontró asociación entre el desarrollo de psoriasis y edad al diagnóstico, tiempo de evolución de AR y tiempo de tratamiento con AB (p = NS). Concluimos que la prevalencia de psoriasis en pacientes tratados con AB (etanercept, adalimumab y abatacept) fue 3,4%. El desarrollo de psoriasis cutánea no se asoció a edad al diagnóstico, tiempo de evolución de AR ni tiempo de tratamiento con agentes biológicos.

The objectives of this study were to determine the prevalence of psoriasis in patients with rheumatoid arthritis (RA) who were treated with biological agents (BA) and analize its clinical features in apopulation of Tucumán. We included 284 patients with RA. One hundred and forty-eight patients received treated with AB and 136 patients were treated with disease modifying anti-rheumatic drugs (DMARD), and they were selected by simple random sampling. Of the 284 patients evaluated, 242 (85%) were female, mean age was 56.4 ± 13.4 years, mean age at diagnosis of RA was 42.3 ± 16.7 years with a mean time of disease progression of 11.9 ± 8.5 years. Two hundred and fourty-one patients (85%) were seropositive for rheumatoid factor. One hundred thirty-six patients (48%) were treated with DMARD and 148 (52%) received BA. When we compared both groups, there was no significant difference between mean age, age at diagnosis of RA and presence of rheumatoid factor.Five of 148 patients developed psoriasis in the BA group, after receiving the first BA. The prevalence of cutaneous psoriasis was 3.4% (95% CI 1.1-7.7). Most cases were presented as gutata psoriasis. The average duration of treatment to onset of psoriasis was31.6 months (SD 26.8). One patient had a family history of psoriasis. In the group with DMARD, neither patient developed psoriasis (p<0.0001). Remission of the cutaneous manifestation was observed in 2 patients that discontinued the BA and 3 maintained treatment with persistance of the symptoms. No association was found between the development of psoriasis and age at diagnosis, RA duration and treatment time with BA (p = NS). We conclude that the prevalence of psoriasis in patients treated with BA (etanercept, adalimumab and abatacept) was 3.4%. The development of skin psoriasis was not associated with age at diagnosis, RA duration or time of treatment with biological agents.

Metabolic syndrome in Argentinean patients with systemic lupus erythematosus.

The objective was to determine the prevalence of the metabolic syndrome (MS) in patients with systemic lupus erythematosus (SLE) in Argentina, to assess the factors associated to it, and to compare the results with a control group with non-inflammatory disorders. The study included 147 patients with SLE and 119 controls. MS was defined according to criteria by the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) Scientific Statement. Demographic characteristics, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) were assessed as well as administration, maximum dose and cumulative dose of prednisone and hydroxychloroquine (HCQ). MS prevalence was 28.6% (CI 95%: 21.4-36.6) in patients with SLE and 16% in controls (P = 0.0019). Patients with SLE presented higher arterial hypertension frequency compared with controls (43 vs 25%, P = 0.007). When comparing lupus patients with MS (n = 41) and without MS (n = 106), no significant differences were observed regarding duration of the disease, SLEDAI or cumulative prednisone dose. Cumulative damage was associated independently with MS (OR 1.98; P = 0.021), whereas HCQ use was found to be protective (OR 0.13; P = 0.015). Patients with lupus presented higher MS prevalence than controls with non-inflammatory disorders, and occurrence of arterial hypertension was also higher. MS was associated with cumulative damage; the use of HCQ showed to be protective against presence of MS.

Post-traumatic stress disorder in women with eating disorders.

OBJECTIVE: The aim of the study was to assess the frequency of co-morbid post-traumatic stress disorders (PTSD) in women with eating disorders (ED). METHOD: 277 women aged 17 to 50 with a current DSM-IV ED were included. 84 were diagnosed with anorexia nervosa (AN), 152 with bulimia nervosa (BN) and 41 with ED not otherwise specified (EDNOS). Structured Clinical Interviews (SCID-I and SCID-II) were performed. RESULTS: Sixty-eight participants (24.5%) reported unwanted sexual experiences (USE). Fifty-two participants (18.8%) reported some form of childhood sexual abuse (CSA). Four participants (1.4%) met the criteria for PTSD according to the Diagnostic and Statistical Manual-IV (DSM-IV). Participants with a history of USE did not differ from those without USE with regard to ED diagnosis, but were diagnosed more often with any Axis I or Axis II disorder. CONCLUSIONS: The prevalence of PTSD in this sample of women with ED was low (1.4%), despite a USE rate of 24.5%.

Compromiso cardíaco en hijos de madres con Lupus Eritematoso Sistémico (LES) / Cardiac compromise in children born from Mathers suffering from Systemic Lupus Erythematosus (SLE)

Objetivo: Analizar la presencia de trastornos de la conducción tempranos y tardíos en hijos de madres lúpicas y su asociación con anti-Ro/SSA. Material y método: Se estudiaron 41 hijos de 29 madres con LES (criterios ACR), a quienes se les realizó evaluación cardiovascular, ECG y serología para anti-Ro/SSA a los neonatos y a las madres. Se analizaron variables relacionadas al embarazo, puerperio y al LES. Resultados: La edad X de los hijos al momento de la evaluación fue 9.6 años (DS 8.8). En 29 embarazos (71%), las madres tenían diagnóstico previo de LES, tiempo de evolución de la enfermedad X 7.4 años (DS 6). Once de ellas (27%) reactivaron su enfermedad durante el embarazo. El 31% de las madres (9) fueron anti-Ro positivas. Sólo 2 niños fueron anti-Ro positivos, ninguno de ellos con lupus neonatal. Tres niños (7%) presentaron patología cardíaca al nacer: 1) Niña con bloqueo cardíaco congénito (BCC) que requirió marcapasos y falleció a los 3 años de edad por insuficiencia cardíaca secundaria a miocardiopatía dilatada; 2) Niño con bradicardia transitoria; 3) Niña con malformación cardíaca severa. Ninguno deellos fue anti-Ro positivo. La presencia de anti-Ro en madres con LES no se asoció a complicaciones del embarazo, enfermedades neonatales, patología cardíaca ni reactivación del LES (p=NS) Conclusión: En esta población de madres lúpicas, la presencia de anti-Ro/SSA no se asoció a compromiso cardíaco en sus hijos

Influencia de factores sociodemográficos en actividad de enfermedad, estadofuncional y calidad de vida de pacientes con artritis psoriásica / Influence of sociodemographic features on clinical manifestations, disease activity, functional status and quality of life of patients with psoriatic artritis

Objetivo: Determinar la influencia de factores sociodemográficos en las manifestaciones clínicas, actividad de la enfermedad, estado funcional y calidad de vida de pacientes con artritis psoriásica (APs). Métodos: Se incluyeron 148 pacientes con APs reclutados de varios centros de reumatología de Argentina. Se determinaron factores sociodemográficos: edad, sexo, raza, nivel de educación, fuentes de ingreso personal, escala de Graffar y clases sociales. Al inicio de la enfermedad se evaluaron las siguientes variables: edad al inicio, duración de la enfermedad, manifestaciones clínicas y forma clínica de presentación. La actividad de la enfermedad fue evaluada mediante número de articulaciones activas, escala visual análoga (EVA) global del paciente y BASDAI. El estado funcional y la calidad de vida de los pacientes se determinó por medio de BASFI, ASQoL y SF-12 (Versión 1.0). Para el análisis estadístico de los datos obtenidos se utilizó test de Chi-cuadrado, test exacto de Fisher y test de Kruskal-Wallis. Resultados: De los 148 pacientes, 58,8% fueron mujeres con una edad media al inicio de la enfermedad de 53,2 ± 13,6 años y una duración media de enfermedad de 9,3 ± 8,9 años. La edad al inicio, el sexo, la raza y la escala de Graffar no estuvieron asociados con manifestaciones clínicas, actividad de la enfermedad, estado funcional y calidad de vida

Obesity and hunger among Mexican-Indian migrant children on the US-Mexico border.

BACKGROUND: Although Mexican-Indian migrant workers live under precarious conditions in both Mexico and the USA, they have more access to food than they did in their original communities. The nutritional status and food security among the children of these workers have not been reported. OBJECTIVE: The purpose of this study was to assess the prevalence of overweight, obesity, undernutrition and hunger among migrant children in a city on the US-Mexico border. DESIGN: During 2001-2002, a total of 1767 children from six schools from the Tijuana Indian school system was measured to assess anthropometric status. Third and fifth grade children were also interviewed for their perception of hunger experience and dietary intake by 24-h recall method. RESULTS: The overall prevalence of overweight and obesity was 38%. Abdominal obesity was found in 26% of subjects, while 43% had both obesity and abdominal obesity. The prevalence of undernutrition according to weight-for-age was 1.2%, and by height-for-age it was 4.8%. The prevalence of hunger was 2.5%, and at risk of hunger was 44%. Daily intake of food groups in servings was: 8.7 grains, 1.2 fruit, 1.0 vegetable, 2.1 milk and 2.6 meat. Only one child (0.07%) consumed The Apple of Health recommended portions. CONCLUSIONS: This study confirmed the coexistence of obesity, hunger, undernutrition and limited food group consumption among Indian children living in a prosperous and the largest US-Mexico border city.

Systemic lupus erythematosus-associated pulmonary hypertension: good outcome following sildenafil therapy.

A 46-year-old woman with systemic lupus erythematosus (SLE) and concomitant severe pulmonary hypertension (PH) is described. Other secondary causes of PH including thromboembolism, phospholipid syndrome, valvular disease and interstitial pulmonary involvement were ruled out. Owing to her lack of clinical response to conventional therapy, sildenafil was begun at increasing doses up to 400 mg daily. Both clinical and hemodynamic improvement ensued. This appears to be the first clinical report of the use of sildenafil in SLE followed by resolution of severe PH.

Local and systemic tolerability of magnesium sulphate for tocolysis.

An open-label, randomised, parallel-group, study was conducted in three study centres in women with premature labor and indication for a single agent intravenous tocolysis therapy with magnesium sulphate. The aim of this study was to examine the local and general tolerability and side-effects of magnesium sulphate for tocolysis. Furthermore, we tested the tolerability of a ready-for-use magnesium solution. No measurements of efficacy were performed during this study. Initially, patients received a loading dose of 4.0 g magnesium sulphate administered over 30 min. Thereafter, a continuous intravenous infusion of 1-2 g magnesium sulphate per hour up to 21 days was given. Venous score (Maddox), vital signs, adverse events as well as general tolerability (assessed by investigator and patients) and blood parameters were assessed. We showed good local and systemic tolerability of high dose magnesium sulphate for tocolysis. Only seven patients (15%) were withdrawn from the study prematurely due to minor adverse events. Potential serious complications of MgSO(4) such as respiratory arrest or clinically relevant respiratory depression were not observed. The most frequently reported local adverse events were injection site pain, itching, erythema, swelling, induration and palpable venous cord. The most common systemic adverse events considered to be possibly related to the study drugs involved the nervous system (dizziness) followed by the digestive system (nausea, constipation). Systolic and diastolic blood pressure changed only slightly during the treatment. Respiratory rate and body temperature remained stable also. Toxic magnesium levels (>2.5 mmol/l) were not observed. The assessment of the clinical investigators with regard to tolerability was very good or good in 72.5% of the patients. The introduction of the ready-to-use solution has the advantage of eliminating the need to mix the solution prior to administration. This means a lower risk of overdose and contamination.

[Determinants in the careers of male and female physicians from the viewpoint of chief physicians]. / Karriereentwicklung von Arztinnen und Arzten aus der Sicht von Chefärzten und Chefärztinnen1.

BACKGROUND AND OBJECTIVE: Chief physicians play an important role for physicians' careers by providing advanced training and allocating time and research resources. This study examined which characteristics will help physicians to achieve a leadership position and how chief physicians conduct career promotion. SAMPLE AND METHODS: All 532 chief physicians in Switzerland's German speaking cantons with medical schools were approached with a questionnaire covering professional motivation and personal attributes of career-oriented physicians career-promoting personal and institutional factors, and type of career promotion. RESULTS: 207 chief physicians (189 men, 18 women; participation rate 38.9 %;) participated. Respondents rated achievement motivation combined with professional interest and job enjoyment (intrinsic), and interest in advancement and social prestige (extrinsic motivation) as beneficial. Extraprofessional concerns such as family obligations and leisure interests were viewed as less important. Instrumental attributes were rated as advantageous. Expressive qualities were also seen as beneficial but less crucial. Ratings were independent of respondents' age, specialty, or type of workplace. The following personal factors were named: professional commitment, professional and social competence, goal orientation, endurance, and strength of character. The institutional factors referred to quality of training and teaching, a good work atmosphere, a transparent and flexible clinic structure. Career promotion was offered predominantly in the form of coaching, career planning, and support in job search. CONCLUSION: Career promotion should be more targeted and structured, e. g. be conducted in mentoring programmes, thus providing the prerequisites for a truly equal career promotion of female and male physicians.

Prevalence of known P-fimbrial G alleles in Escherichia coli and identification of a new adhesin class.

Screening a large Escherichia coli collection for P-fimbrial adhesin classes identified 20 unclassifiable strains. Cloning and sequencing of papG from an unclassifiable strain identified another G allele. The novel adhesin gene has 65% identity to the class I adhesin gene, 44% identity to the class II adhesin gene, and 43% identity to the class III adhesin gene.

Lupus en hombres: comparación con mujeres y con lo descripto en la literatura / Lupus in men: comparation with women and with preview literature

Se realizó un estudio retrospectivo con 30 pacientes masculinos portadores de LES y 60 mujeres como control. La edad media de inicio del LES fue semejante en ambos grupos (26 años). Serositis fue más frecuente en hombres y rash malar y fotosensibilidad en mujeres (ambas de manera estadísticamente significativa), no así el desorden neurológico (más frecuente en hombres) y linfopenia y FAN (+) (más frecuente en mujeres) que no tuvieron significancia estadística. No hubo diferencias con respecto a la ingesta de antipalúdicos e inmunosupresores entre ambos grupos. Cuando se comparó este grupo LES masculino con lo descripto en la literatura se halló mayor frecuencia de rash malar y leucopenia en nuestra serie y menor frecuencia de FAN, proteinuria, hipocomplementeria y trombocitopenia

Distribution of a persistent sodium current across the ventricular wall in guinea pigs.

A tetrodotoxin-sensitive persistent sodium current, I(pNa), was found in guinea pig ventricular myocytes by whole-cell patch clamping. This current was characterized in cells derived from the basal left ventricular subendocardium, midmyocardium, and subepicardium. Midmyocardial cells show a statistically significant (P<0.05) smaller I(pNa) than subendocardial and subepicardial myocytes. There was no significant difference in I(pNa) current density between subepicardial and subendocardial cells. Computer modeling studies support a role of this current in the dispersion of action potential duration across the ventricular wall.

Systemic lupus erythematosus: mortality and survival in Argentina. A multicenter study.

OBJECTIVE: To analyze the factors associated with mortality, survival and causes of death in patients with systemic lupus erythematosus (SLE) in Argentina. PATIENTS AND METHOD: A series of 366 patients with SLE (45 men and 321 women), mean age 29 y (range 11-70 y) and mean disease duration 6 y, was evaluated from 1990 to 1998. A total of 57 clinical, serological and therapeutic variables were studied. RESULTS: Five- and 10-year survival was 91% and 85% respectively. Forty four patients died (12%): 54% due to sepsis and 32% due to active SLE. Mortality risk factors included heart involvement CRR 3.82), hyperlipidemia (RR 2.72), renal damage (RR 2. 62), infections (RR 2.44), lung disease (RR 2.20) and myositis (RR 2. 07). High-dose prednisone (RR 3.4) or cyclophosphamide (RR 9.19) treatments increased the risk of sepsis (P=0.003) as a cause of death. However, corticosteroids, antimalarial agents and accumulated cyclophosphamide doses proved to be protective factors in overall mortality figures (RR <1). CONCLUSIONS: The main risk factors of death in SLE were heart involvement, hyperlipidemia and renal damage. Treatment with steroids, antimalarial agents and cyclophosphamide improved survival. High-dose corticosteroids and cyclophosphamide were associated with sepsis as a cause of death.

Comparison of step and ramp voltage clamp on background currents in guinea-pig ventricular cells.

Isolated cardiac ventricular myocytes from guinea-pig were used to investigate the effect of voltage clamp protocols on background Na+ current (ib.Na) and inward rectifier current (i K1). Using long (4 s) clamp pulses and very long step clamps, the i-V relations showed that removal of Na+ reduces the amplitude and shifts the voltage dependence of i K1 (Spindler et al. 1998). Ramp clamps, however, gave more complicated results, with slower ramps more often giving the same results as steps and pulses. Both i K1 itself and, during faster ramps, other currents show hysteresis, so masking the steady-state changes. Using pulses, TTX had no effect on steady-state current. Small differences occurred in the ramps, but even at fast ramp speeds the effects are very much smaller than in Purkinje tissue. Only part of ib,Na is TTX sensitive and the effect does not occur in all cells.

Human immunodeficiency virus infection associated arthritis: clinical characteristics.

OBJECTIVE: To define the frequency and characteristics of human immunodeficiency virus (HIV) associated arthritis. METHODS: A total of 270 patients with HIV infection were prospectively evaluated for the presence of rheumatic complaints. Diagnosis of HIV infection was performed by ELISA and confirmed by Western blot, and all HIV patients were classified according to the US Centers for Disease Control criteria. RESULTS: Twenty-one (7.8%) patients presented with HIV associated arthritis. Other arthritides including HLA-B27 related, such as Reiter's syndrome, psoriatic arthritis, and rheumatoid arthritis, were excluded. Seventeen were men and 4 women, with a mean age of 34.8 years (SD 11.1). Fourteen (66%) were homosexuals, 4 (19%) intravenous drug users, and 3 (14%) heterosexuals. Twelve (57%) were in stage IV, 5 (23%) in stage III, and 4 (9%) in stage II. Ten (47%) patients had oligoarticular involvement, 8 (38%) monoarticular, 2 (9%) asymmetric polyarthritis, and one (4%) symmetric polyarthritis. Rheumatoid factor and HLA-B27 antigen were negative in all (15) patients studied. The mean duration of arthritis was 2 weeks (1-24). No differences in duration of arthritis were found among the different risk factors (p = 0.811), HIV stages (p = 0.205), and type of articular involvement (p = 0.252). There was, however, a trend between the number of involved joints and stages of HIV infection (p = 0.13). CONCLUSION: The pattern of joint involvement of HIV associated arthritis is similar to that of other viral disorders: acute onset, short duration, no recurrences, and no erosive changes.