Assessment of calcinosis in Portuguese patients with systemic sclerosis - a multicenter study.

INTRODUCTION/OBJECTIVES: The study aims to define the clinical and subclinical calcinosis prevalence, the sensitivity of radiographed site and clinical method for its diagnosis, and the phenotype of Portuguese systemic sclerosis (SSc) patients with calcinosis. METHOD: A cross-sectional multicenter study was conducted with SSc patients fulfilling Leroy/Medsger 2001 or ACR/EULAR 2013 classification criteria, registered in the Reuma.pt. Calcinosis was assessed through clinical examination and radiographs of hands, elbows, knees, and feet. Independent parametric or non-parametric tests, multivariate logistic regression, and sensitivity calculation of radiographed site and clinical method for calcinosis detection were performed. RESULTS: We included 226 patients. Clinical calcinosis was described in 63 (28.1%) and radiological calcinosis in 91 (40.3%) patients, of which 37 (40.7%) were subclinical. The most sensitive location to detect calcinosis was the hand (74.7%). Sensitivity of the clinical method was 58.2%. Calcinosis patients were more often female (p = 0.008) and older (p < 0.001) and had more frequently longer disease duration (p < 0.001), limited SSc (p = 0.017), telangiectasia (p = 0.039), digital ulcers (p = 0.001), esophageal (p < 0.001) and intestinal (p = 0.003) involvements, osteoporosis (p = 0.028), and late capillaroscopic pattern (p < 0.001). In multivariate analysis, digital ulcers (OR 2.63, 95% CI 1.02-6.78, p = 0.045) predicted overall calcinosis, esophageal involvement (OR 3.52, 95% CI 1.28-9.67, p = 0.015) and osteoporosis (OR 4.1, 95% CI 1.2-14.2, p = 0.027) predicted hand calcinosis, and late capillaroscopic pattern (OR 7.6, 95% CI 1.7-34.9, p = 0.009) predicted knee calcinosis. Anti-nuclear antibody positivity was associated with less knee calcinosis (OR 0.021, 95% CI 0.001-0477, p = 0.015). CONCLUSIONS: Subclinical calcinosis high prevalence suggests that calcinosis is underdiagnosed and radiographic screening might be relevant. Multifactorial pathogenesis may explain calcinosis predictors' variability. Key Points • Prevalence of subclinical calcinosis in SSc patients is substantial. • Hand radiographs are more sensitive to detect calcinosis than other locations or clinical method. • Digital ulcers were associated with overall calcinosis, esophageal involvement and osteoporosis were associated with hand calcinosis, and late sclerodermic pattern in nailfold capillaroscopy was associated with knee calcinosis. • Anti-nuclear antibody positivity may be a protective factor for knee calcinosis.

Spontaneous pneumomediastinum, a rare manifestation of clinically amyopathic dermatomyositis.

Clinically amyopathic dermatomyositis (CADM) is a rare condition characterized by dermatomyositis skin lesions without clinically apparent muscle involvement. Respiratory involvement is common, occurring in about half of the cases. Spontaneous pneumomediastinum (PnM) is a rare, and often fatal, complication of CADM. We report a case of a 61-year-old female patient who was diagnosed with anti-melanoma differentiation- associated gene 5 antibody-associated CADM and interstitial lung disease. She developed an extensive spontaneous PnM with subcutaneous emphysema. The patient was treated with a conservative approach which was, initially, successful in reducing the size of the PnM. However, the patient died from an eventual nosocomial pneumonia requiring mechanical ventilation. This case illustrates that improving the management of CADM associated PnM, remains a major unmet need.

Farmacontaminación El lado B de los medicamentos / Pharmaceutical pollution: The B-side of medicines

A medida que aumenta la esperanza de vida y la población envejece, el consumo de medicamentos crece, propendiendo a mejorar la salud y la calidad de vida de los usuarios. Las actividades dirigidas a su fiscalización y vigilancia son supervisadas por las agencias sanitarias; sin embargo, existe poca difusión y regulación sobre lo que sucede cuando son desechados como residuos industriales, productos no utilizados, vencidos o excretados. Se realizó una búsqueda no sistemática de la literatura con el objetivo de visibilizar la problemática de la farmacontaminación que, aun en bajas concentraciones, afecta el agua potable y altera la vida de las especies. A partir de la evidencia colectada, se advierte presencia de cafeína, ibuprofeno, diclofenac, ß-bloqueantes y carbamazepina, entre otros. Surgen así interrogantes y controversias sobre los efectos toxicológicos en el ecosistema (farmacontaminación), que sin detección en los procesos de potabilización podrían permanecer en el agua potable. Pese a que se desconocen los efectos a corto plazo en la salud humana, esta falta de evidencia no debería llevar a pensar que los riesgos son insignificantes. En Argentina, donde la normativa también es escasa, se aprecian los esfuerzos de científicos locales por determinar los efectos en lodos, suelos, biota y aguas freáticas, y de las comunidades académicas en la eliminación controlada de medicamentos

Seguridad y eficacia del cigarrillo electrónico para dejar de fumar / Safety and Efficacy of Electronic Cigarettes for Quitting Smoking

Los cigarrillos electrónicos se promocionan como alternativa para dejar de fumar o reducir el consumo de tabaco. Esta revisión sistemática evaluó su seguridad y eficacia. Según los resultados obtenidos, no hay pruebas suficientes para afirmar que este tipo de cigarrillos sean más efectivos que otros tratamientos aprobados para abandonar el hábito.

Seguridad y eficacia del cigarrillo electrónico para dejar de fumar / Safety and Efficacy of Electronic Cigarettes for Quitting Smoking

Los cigarrillos electrónicos se promocionan como alternativa para dejar de fumar o reducir el consumo de tabaco. Esta revisión sistemática evaluó su seguridad y eficacia. Según los resultados obtenidos, no hay pruebas suficientes para afirmar que este tipo de cigarrillos sean más efectivos que otros tratamientos aprobados para abandonar el hábito