Clinical patterns and risk factors in scleritis: a multicentric study in Colombia.

PURPOSE: This study aims to describe the clinical characteristics of scleritis in a large cohort of Colombian patients and identify factors associated with the clinical presentation. METHODS: Retrospective case series of patients with scleritis from 2015 to 2020. Clinical records were obtained from seven uveitis referral centers in Colombia. Patients with a diagnosis of episcleritis were excluded. RESULTS: We evaluated 389 patients with scleritis (509 eyes). There was a female predominance (75.6%) with a mean age of 51 ± 15 years. Most cases were noninfectious (94.8%) and unilateral (69.2%). The most frequent type of inflammation was diffuse anterior scleritis (41.7%), followed by nodular scleritis (31.9%) and necrotizing scleritis (12.3%). Systemic autoimmune diseases were found in 41.3% of patients, the most common being rheumatoid arthritis (18.5%) and granulomatosis with polyangiitis (5.9%). Polyautoimmunity was found in 10.4% of those with a systemic autoimmune disease. The most frequent treatment was systemic steroids (50.9%), followed by systemic NSAIDs (32.4%). Steroid-sparing immunosuppression was required in 49.1% of patients. Systemic autoimmune diseases were more common in patients with necrotizing scleritis and those older than 40 years of age. Best-corrected visual acuity of 20/80 or worse at presentation was more common in necrotizing scleritis and subjects with associated uveitis, ocular hypertension, or who were over 40 years of age. CONCLUSIONS: This is the first study in Colombia and the largest in Latin America describing the clinical characteristics and presentation patterns of scleritis. The most common presentation was in females, with unilateral, anterior diffuse noninfectious scleritis. Systemic autoimmune diseases and polyautoimmunity were frequent, as was the need for steroid-sparing immunosuppression. Age over 40 and necrotizing scleritis were associated with higher odds of having a systemic autoimmune disease and worse visual acuity at presentation.

Coronary calcium in autoimmune diseases: A systematic literature review and meta-analysis.

BACKGROUND AND AIMS: Autoimmune diseases (AID) share various clinical signs and symptoms and pathophysiological mechanisms including the increased risk of cardiovascular disease. The coronary artery calcium score (CACS) is potentially useful in improving the cardiovascular risk assessment. The aim of this study was to evaluate CACS in six AIDs analyzed as a group compared with controls through a systematic literature review (SLR) and meta-analysis. METHODS: A literature search (Medline/OVID, Lilacs, Embase, and Cochrane/OVID) up to January 6, 2021 was made (PROSPERO CRD42020197182). Observational studies (patients with six AIDs: rheumatoid arthritis [RA], systemic lupus erythematosus [SLE], Sjögren's syndrome, systemic sclerosis, dermatopolymyositis, and antiphospholipid syndrome) compared with controls were included. CACS, reported in Agatston units, was the primary outcome in both groups. Mean differences and a random-effects model (DerSimonian and Laird) were calculated. RESULTS: Nineteen articles were meta-analyzed (4568 subjects: 2142 AID and 2426 controls). Mean age was 48.1 and 44.2 years, respectively and 75.6% and 84.9% were women, respectively. Of cases, 52.9% had RA, 44.4% SLE and 2.7% had systemic sclerosis. The pooled analysis showed a higher CACS in patients with AIDs (7.42; 95% CI 1.79 to 13.05; chi2-p = 0.01) compared with controls. Meta-regression models showed that age in cases and controls reduced the difference in CACS between groups (p < 0.05), HDL had an inverse relationship (p = 0.04), and CRP levels had a directly proportional relationship with CACS in cases (p = 0.036). CONCLUSIONS: The quantitative results of this meta-analysis suggest that CACS is higher in patients with AID, possibly due to chronic exposure to pro-inflammatory molecules. These results have clinical implications since the finding of highly elevated CACS in patients with AID will enable physicians and researchers to develop a risk stratification model that includes CACS as one of the screening tools for detecting coronary atherosclerosis in these patients.

ASIA syndrome symptoms induced by gluteal biopolymer injections: Case-series and narrative review.

BACKGROUND: The number of plastic surgery procedures have been rising in the last few years. The morbi-mortality due to illegal use of biopolymers is a public health problem. One of the clinical consequences, foreign body modelling reaction, may be a precursor of ASIA (Autoimmune/Inflammatory disease induced by adjuvants) syndrome.The objective of this article is to present a case-series study of patients who developed ASIA syndrome following gluteal injection with biopolymers and emphasize the importance of toxic exposure in triggering autoimmune responses. A surgical technique used on some of the patients in the study is described. METHODS: A group of thirteen patients, diagnosed with foreign body modelling reaction, who developed ASIA syndrome confirmed by approved criteria was followed between May 2016 and May 2018. The "Butterfly Wings Technique," a new surgical procedure for patients who have medium to severe compromise, was used on five of them.A narrative literature review was done to look for subjects with ASIA syndrome and gluteal biopolymer infiltration. RESULTS: All the patients in the present case-series with foreign body modelling reaction developed ASIA syndrome. Some of them had a background of familial autoimmunity. Five of the patients were surgically treated and saw a clinical improvement after the extraction of the biopolymer with the proposed technique.The narrative literature review identified 7 articles related to the disease through the database search. CONCLUSIONS: We suggest that foreign body modelling reaction should be considered a precursor to ASIA syndrome. New research projects will be needed in the future to evaluate the factors that determine when ASIA syndrome is triggered in a patient with this reaction.

Unstimulated whole salivary flow in Sjögren's Syndrome: systematic literature review and meta-analysis.

BACKGROUND: Sjögren's Syndrome compromises the exocrine function, producing xerostomia and xerophthalmia. It can appear as an isolated condition or associated with other autoimmune diseases (polyautoimmunity). The Unstimulated Salivary Flow rate (UWSF) is used to quantify saliva production. There is no objective evidence to differentiate the values in patients with Sjögren's versus healthy people or patients with non-Sjögren's sicca. The objective of the present review was to evaluate the UWSF in patients with Sjögren's syndrome in comparison to controls (healthy and non-Sjögren's sicca patients). METHODS: A systematic literature review was carried out (PRISMA guidelines). Analytical observational studies of cases and controls, cross-sectional studies, cohort studies and randomized clinical trials (including healthy controls) were considered. The Medline/OVID, Lilacs, Embase, and Cochrane/OVID databases were consulted. MeSH, DeCS, keywords, and Boolean operators were used. The meta-analysis (RevMan 5.2) was done through the random-effects model [mean difference (MD)]. Level and quality of evidence were evaluated by the Oxford Center Levels of Evidence and Joanna Brigs list respectively. RESULTS: Thirty-two articles were included (20 were case-control studies, 6 were cross-sectional, 2 prospective cohort, 2 retrospective cohort, and 2 studies were abstracts) and 28 were meta-analyzed. The unstimulated whole salivary flow rate in the Sjögren's group was lower than in controls (healthy and patients with non-Sjögren Sicca syndrome) (MD-0.18 ml/min; 95% CI, - 0.24 to - 0.13; chi2-P-value < 0.00001). Heterogeneity was 97% and there was publication bias (funnel plot). The level of evidence was mostly 3 or 4. The quality of evidence was met (97% of items valued). CONCLUSION: For the first time, the unstimulated whole salivary flow rate is found to be lower in patients with Sjögren's syndrome compared to controls (healthy and non-SS sicca) through a meta-analysis. TRIAL REGISTRATION: PROSPERO CRD42020211325 .

Inflammaging as a link between autoimmunity and cardiovascular disease: the case of rheumatoid arthritis.

Currently, traditional and non-traditional risk factors for cardiovascular disease have been established. The first group includes age, which constitutes one of the most important factors in the development of chronic diseases. The second group includes inflammation, the pathophysiology of which contributes to an accelerated process of vascular remodelling and atherogenesis in autoimmune diseases. Indeed, the term inflammaging has been used to refer to the inflammatory origin of ageing, explicitly due to the chronic inflammatory process associated with age (in healthy individuals). Taking this into account, it can be inferred that people with autoimmune diseases are likely to have an early acceleration of vascular ageing (vascular stiffness) as evidenced in the alteration of non-invasive cardiovascular tests such as pulse wave velocity. Thus, an association is created between autoimmunity and high morbidity and mortality rates caused by cardiovascular disease in this population group. The beneficial impact of the treatments for rheumatoid arthritis at the cardiovascular level has been reported, opening new opportunities for pharmacotherapy.

Unstimulated whole salivary flow in Sjögren's Syndrome: systematic literature review and meta-analysis

Abstract Background: Sjögren's Syndrome compromises the exocrine function, producing xerostomia and xerophthalmia. It can appear as an isolated condition or associated with other autoimmune diseases (polyautoimmunity). The Unstimulated Salivary Flow rate (UWSF) is used to quantify saliva production. There is no objective evidence to differentiate the values in patients with Sjögren's versus healthy people or patients with non-Sjögren's sicca. The objective of the present review was to evaluate the UWSF in patients with Sjögren's syndrome in comparison to controls (healthy and non-Sjögren's sicca patients). Methods: A systematic literature review was carried out (PRISMA guidelines). Analytical observational studies of cases and controls, cross-sectional studies, cohort studies and randomized clinical trials (including healthy controls) were considered. The Medline/OVID, Lilacs, Embase, and Cochrane/OVID databases were consulted. MeSH, DeCS, keywords, and Boolean operators were used. The meta-analysis (RevMan 5.2) was done through the random-effects model [mean difference (MD)]. Level and quality of evidence were evaluated by the Oxford Center Levels of Evidence and Joanna Brigs list respectively. Results: Thirty-two articles were included (20 were case-control studies,6 were cross-sectional,2 prospective cohort,2 retrospective cohort, and2 studies were abstracts) and 28 were meta-analyzed. The unstimulated whole salivary flow rate in the Sjögren's group was lower than in controls (healthy and patients with non-Sjögren Sicca syndrome) (MD-0.18 ml/min; 95% CI, −0.24 to −0.13; chi2-P-value <0.00001). Heterogeneity was 97% and there was publication bias (funnel plot). The level of evidence was mostly3 or 4. The quality of evidence was met (97% of items valued). Conclusion: For the first time, the unstimulated whole salivary flow rate is found to be lower in patients with Sjögren's syndrome compared to controls (healthy and non-SS sicca) through a meta-analysis. (AU)

Técnica de recolección del flujo salival no estimulado en el diagnóstico de pacientes con síndrome de Sjögren: unificando conceptos. Una revisión sistemática de la literatura / Unstimulated whole saliva flow collection technique in the diagnosis of patients with Sjögren's syndrome: Unifying concepts. A systematic literature review

RESUMEN El síndrome de Sjögren (SS) es una enfermedad autoinmune que compromete la función de las glándulas exocrinas, produciendo xerostomía y xeroftalmia. El método utilizado para cuantificar la disfunción glandular salival es el flujo salival no estimulado (FSNE). Describir las principales técnicas de recolección del FSNE en pacientes con SS. Revisión sistemática de la literatura (guías PRISMA) de estudios observacionales tipo casos y controles, cohorte y corte transversal que incluyeran pacientes con síntomas secos y diagnóstico de SS por criterios clasificatorios internacionales, que fueran comparados con una población de referencia sana o con síntomas secos no Sjögren y en los cuales se reportara la técnica y el valor del FSNE como desenlace principal. Para la calificación del nivel y calidad de la evidencia se utilizaron las guías Oxford y el Joanna Briggs Institute. Veintinueve artículos fueron incluidos, con una población total de 2.730 pacientes: 1.397 casos y 1.333 controles. La técnica más frecuentemente reportada fue la de Navazesh por recogida espontánea de drenaje durante 5 min. El punto de corte más frecuentemente encontrado fue 0,1 ml/min. Por primera vez se describen, a través de una revisión sistemática de la literatura, las principales técnicas utilizadas para evaluar el FSNE en individuos con SS cuando se comparan con personas sanas o con síndrome seco no SS, resaltando que es una técnica validada, no invasiva, reproducible y de bajo costo.

ABSTRACT Introduction: Sjögren's syndrome (SS) is an autoimmune disease that compromises the function of exocrine glands, producing xerostomia and xerophthalmia. The method used to quantify saliva gland dysfunction is by unstimulated whole saliva flow (UWSF).To describe the main UWSF techniques in patients with SS. Systematic review of the literature (following PRISMA guidelines) of results that include analytical observational studies of case-control, cohort, and cross-sectional studies that include patients with sicca symptoms and diagnosis of SS by international classification criteria, which were compared with healthy subjects or those with non-Sjögren sicca symptoms, and in which the technique and the value of the UWSF was reported as the main outcome. Qualification of the level and quality of the evidence was obtained using the Oxford and Joanna Briggs Institute guidelines. A total of 29 articles were included, with total population of 2,730 patients: 1,397 cases and 1,333 controls. The most frequently reported technique was that of Navazesh by spontaneous drainage collection for 5 min. The most frequent cut-off point found was 0.1ml/min. For the first time in the literature, and by using a systematic review of the literature, a description is presented of the main techniques used to evaluate UWSF in individuals with SS when compared with healthy people or with sicca non-SS syndrome, highlighting that it is a valid, non-invasive, reproducible, and low cost technique.

Proptosis ocular como una manifestación de la granulomatosis con poliangeítis (Wegener): Reporte de un caso y revisión de la literatura / Ocular proptosis as a manifestation of Wegener's granulomatosis: A case report

RESUMEN La granulomatosis con poliangeítis (Wegener) es considerada como una enfermedad granulomatosa sistémica, no infecciosa, caracterizada histológicamente por una vasculitis necrosante de pequeño vaso. El tracto respiratorio superior e inferior son los más frecuentemente afectados, en asociación a manifestaciones renales. Sin embargo, también se describe el compromiso aislado de un solo órgano, como es el caso del globo ocular y la órbita. Presentamos el caso de una mujer cuya principal manifestación consistió en un proceso inflamatorio de tejido periorbitario y proptosis del globo ocular izquierdo. La paciente fue valorada en manejo conjunto con el servicio de plástica ocular, otorrinolaringología y finalmente se derivó a reumatología para inicio de terapia inmunosupresora. Se realizó una revisión de la literatura, en búsqueda de reportes de caso y series de caso que permitieran comparar las presentaciones clínicas y desenlaces más frecuentes.

A B S T R A C T Granulomatosis with polyangiitis (Wegener) is considered as a systemic, non-infectious granulomatous disease, histologically noted for its small vessel necrotising vasculitis. The upper and lower respiratory tracts are the most frequently affected, in association with renal manifestations. However, the isolated involvement of a single organ, such as the eyeball and the orbit is also described. The case is presented of a woman whose main manifestation was an inflammatory process of periorbital tissue and proptosis of the left eyeball. The patient was evaluated jointly with eye plastic surgery, and the ear, nose and throat, and rheumatology departments. A literature review was carried out, looking for case reports and case series that allowed comparisons to made between the clinical manifestations and the most frequent outcomes.

[Bioethical issues on the access to drugs in the practice of ophthalmology in Colombia]. / Cuestiones bioéticas relacionadas con el acceso a medicamentos en el ejercicio de la oftalmología en Colombia.

Ophthalmology is a high-cost specialty in terms of medical, surgical and technological innovation and treatment. It is worrisome that in some countries patients are affected in their visual health, and therefore in their quality of life because they do not have the necessary resources for timely access to medications, medical appointments or surgical procedures. We searched in four electronic databases (ScienceDirect, MEDLINE/PubMed, ClinicalKey and SciELO), as well as in books on bioethics and Colombian laws, for articles related to bioethical issues and access to medicines in the exercise of ophthalmology. We reflect on the problem of access to ophthalmological drugs, with particular interest on how to apply the principles of bioethics on the clinical practice of patients with ophthalmological conditions. Ethical considerations are approached from the principles of Beauchamp and Childress, especially regarding the principle of justice, in order to provide health professionals in this field with arguments for medical and ethical decisions that benefit the healthcare and access to medicines for patients with ophthalmological conditions.

La oftalmología se constituye como una especialidad de alto costo en lo que respecta a tratamiento médico, quirúrgico y de innovación tecnológica. Es preocupante que en algunos países los pacientes se vean afectados en su salud visual, y por ende en su calidad de vida, por no contar con los recursos necesarios para un acceso oportuno a medicamentos, citas médicas o procedimientos quirúrgicos. A partir de la búsqueda de artículos relacionados con cuestiones bioéticas y el acceso a medicamentos en el ejercicio de la oftalmología en cuatro bases de datos electrónicas (ScienceDirect, MEDLINE/PubMed, ClinicalKey y SciELO ), así como en libros de bioética y leyes de la jurisdicción colombiana, realizamos una reflexión sobre el problema del acceso a los medicamentos oftalmológicos, centrándonos en el interés por la aplicación de la bioética en la práctica clínica y en el acceso a medicamentos de los pacientes con patologías oftalmológicas. Las consideraciones éticas se abordan desde una mirada del modelo principialista de Beauchamp y Childress, en especial considerando el principio de justicia, de modo que brinde a los profesionales de la salud en este campo, argumentos para la toma de decisiones médicas y éticas que beneficien la atención y el acceso a medicamentos de los pacientes con patologías oftalmológicas.

Actividad física en preescolares desde atención primaria orientada a la comunidad, en un municipio de Colombia / Physical activity from primary care oriented to the community for preschool children in a Colombian municipality

Introducción: la adopción y mantenimiento de hábitos saludables en los niños y sus entornos, como la actividad física, favorecen la prevención de enfermedades crónicas no transmisibles a largo plazo. Objetivo: fortalecer los conocimientos, actitudes y prácticas en torno a la actividad física en niños de 4-5 años, padres y maestros del municipio de Sopó (Cundinamarca, Colombia) desde la atención primaria orientada a la comunidad. Métodos: investigación cualitativa tipo acción-participativa realizada con 60 niños de jardines infantiles, 8 maestras, 11 padres, 2 nutricionistas y 1 integrante de la administración municipal, durante el primer semestre de 2016, mediante el tratamiento de 3 ejes: apropiación de la comunidad, motivando la actividad física y mantenimiento de la actividad física. Resultados: los padres de familia, maestras y niños reconocen la importancia de la actividad física; los padres reconocen a los hijos como motivación en el hogar sobre realizar actividad física; los niños perfeccionan su coordinación y habilidades motoras; y la comunidad es consciente de la importancia de tener hábito de actividad física para la prevención de enfermedades crónicas. Conclusiones: los niños preescolares son agentes de cambio en sus hogares y tienen el potencial de generar conciencia sobre la realización de actividad física, para ser sanos y crecer adecuadamente a través de estilos de vida saludables. Adicionalmente, padres y maestros son actores importantes en el desarrollo de actividades que involucren el desarrollo integral de la primera infancia, soporte y sostenibilidad de iniciativas de salud(AU)

Introduction: the adoption and upholding of healthy habits such as physical activity in children and their environments favor the prevention of long-term chronic non-communicable diseases. Objective: to strengthen the knowledge, attitudes and practices related with physical activity in children in ages from 4 to 5 years, parents and teachers of the municipality of Sopó (Cundinamarca, Colombia) from primary care oriented to the community. Methods: qualitative research, with a type of participatory action carried out with 60 kindergarten children, 8 teachers, 11 parents, 2 nutritionists and 1 member of the municipal administration during the first semester of 2016, through the treatment of three central themes: appropriation of the community, motivating physical activity and upholding of physical activity. Results: parents, teachers and children recognize the importance of physical activity; parents recognize children as a motivation at home for doing physical activity; children improve their coordination and motor skills; and the community is aware of the importance of having the habit of practicing physical activities for the prevention of chronic diseases. Conclusions: preschool children are agents of change in their homes and have the potential to raise awareness about the practicing of physical activity to be healthy and to grow properly through healthy lifestyles. Additionally, parents and teachers are important actors in the development of activities that involve the comprehensive development of early childhood, support and sustainability of health initiatives(AU)