Assessment of foot impairment in systemic sclerosis: a cross-sectional study.

OBJECTIVES: To assess foot function in Systemic Sclerosis (SSc) and its association with sociodemographic and clinical factors. To evaluate mobility, foot alterations, foot pain, and foot care in these patients. METHODS: Consecutive SSc patients underwent structured interviews and physical examinations. Disability was assessed using Health Assessment Questionnaire (HAQ) and Scleroderma Health Assessment Questionnaire. (SHAQ). Foot function was measured using Foot Function Index (FFI), foot pain using a numeric pain scale (NPS), and mobility using Timed-UP-Go test (TUG). RESULTS: 101 patients were included. Forefoot pain was observed in 50.5%, hindfoot pain in 31.7%, foot ulcers in 6.9%, foot plantar callosities in 38.6%, foot arthritis in 2.97%, hallux valgus in 9.9%, claw toes in 5%, and valgus ankle in 3% of patients. The mean FFI was 3.54 (±2.6), NPS was 6.08 (±3.58), and TUG test was 10.52 (±6.5) seconds. Higher FFI scores, increased NPS, and prolonged TUG were associated with Raynaud's phenomenon severity, SHAQ, and HAQ. 36.6% of patients reported never having their feet examined, and only 32.7% had their feet examined within the past year. CONCLUSION: Foot dysfunction and pain are common in SSc. Higher FFI scores, increased pain, and prolonged TUG duration were linked to disability (HAQ and SHAQ). These analyses should be considered exploratory and require confirmation in external cohorts. Routine foot examinations were lacking in clinical practice. Improved attention for evaluating and caring for the feet in SSc patients is needed.

Safety and effectiveness of abatacept in juvenile idiopathic arthritis: results from the PRINTO/PRCSG registry.

OBJECTIVE: To report the interim 5-year safety and effectiveness of abatacept in patients with juvenile idiopathic arthritis (JIA) in the PRINTO/PRCSG registry. METHODS: The Abatacept JIA Registry (NCT01357668) is an ongoing observational study of children with JIA receiving abatacept; enrolment started in January 2013. Clinical sites enrolled patients with JIA starting or currently receiving abatacept. Eligible patients were assessed for safety (primary end point) and effectiveness over 10 years. Effectiveness was measured by clinical 10-joint Juvenile Arthritis Disease Activity Score (cJADAS10) in patients with JIA over 5 years. As-observed analysis is presented according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS: As of 31 March 2020, 587 patients were enrolled; 569 are included in this analysis (including 134 new users) with 1214.6 patient-years of safety data available. Over 5 years, the incidence rate (IR) per 100 patient-years of follow-up of serious adverse events was 5.52 (95% confidence interval [CI]: 4.27, 7.01) and of events of special interest was 3.62 (95% CI: 2.63, 4.86), with 18 serious infections (IR 1.48 [95% CI: 0.88, 2.34]). As early as month 3, 55.9% of patients achieved cJADAS10 low disease activity and inactive disease (20.3%, 72/354 and 35.6%, 126/354, respectively), sustained over 5 years. Disease activity measures improved over 5 years across JIA categories. CONCLUSION: Abatacept was well tolerated in patients with JIA, with no new safety signals identified and with well-controlled disease activity, including some patients achieving inactive disease or remission. TRIAL REGISTRATION: Clinicaltrials.gov, NCT01357668.

Early identification of the nosocomial spread of vancomycin-resistant Enterococcus faecium by Fourier-transform infrared spectroscopy and performance comparison with PFGE and WGS.

Early detection of disseminating vancomycin-resistant Enterococcus faecium (VREfm) in ICU wards is crucial for outbreak identification and the implementation of prompt infection control measures. Genotypic methods like pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) are costly and time-consuming, hindering rapid response due to batch dependency. Fourier-transform infrared spectroscopy (FT-IR) offers the potential for real-time outbreak detection and reliable strain typing. We utilized FT-IR to identify clonal VREfm dissemination and compared its performance to PFGE and WGS. Between February through October 2023, an unusually high number of VREfm were recovered at a tertiary hospital in Barcelona. Isolates were examined for antimicrobial susceptibility, carriage of vanA/vanB genes and clonality was also studied using FT-IR, PFGE, and WGS. Routine FT-IR inspections revealed recurring VREfm clustering during the outbreak's initial weeks. In total, 104 isolates were recovered from 75 patients and from multiple wards. However, only one isolate was recovered from an environmental sample, suggesting the absence of environmental reservoirs. An ST80 vancomycin-resistant (vanA) E. faecium strain was the main strain responsible for the outbreak, although a few additional VREfm strains were also identified, all belonging to CC17. PFGE and cgMLST (WGS) yielded identical clustering results to FT-IR, and WGS confirmed vanA/vanB gene carriage in all VREfm isolates. Infection control measures led to a rapid decline in VREfm isolates, with no isolates detected in November. FT-IR spectroscopy offers rapid turnaround times, sensitivity, and reproducibility, comparable to standard typing methods. It proved as an effective tool for monitoring VREfm dissemination and early outbreak detection.

2023 Brazilian Society of Rheumatology guidelines for the treatment of systemic sclerosis.

BACKGROUND: Systemic sclerosis (SSc) is a rare chronic autoimmune disease with heterogeneous manifestations. In the last decade, several clinical trials have been conducted to evaluate new treatment options for SSc. The purpose of this work is to update the recommendations of the Brazilian Society of Rheumatology in light of the new evidence available for the pharmacological management of SSc. METHODS: A systematic review including randomized clinical trials (RCTs) for predefined questions that were elaborated according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) strategy was conducted. The rating of the available evidence was performed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. To become a recommendation, at least 75% agreement of the voting panel was needed. RESULTS: Six recommendations were elaborated regarding the pharmacological treatment of Raynaud's phenomenon, the treatment (healing) and prevention of digital ulcers, skin involvement, interstitial lung disease (ILD) and gastrointestinal involvement in SSc patients based on results available from RCTs. New drugs, such as rituximab, were included as therapeutic options for skin involvement, and rituximab, tocilizumab and nintedanib were included as therapeutic options for ILD. Recommendations for the pharmacological treatment of scleroderma renal crisis and musculoskeletal involvement were elaborated based on the expert opinion of the voting panel, as no placebo-controlled RCTs were found. CONCLUSION: These guidelines updated and incorporated new treatment options for the management of SSc based on evidence from the literature and expert opinion regarding SSc, providing support for decision-making in clinical practice.

SUMOylation controls Hu antigen R posttranscriptional activity in liver cancer.

The posttranslational modification of proteins critically influences many biological processes and is a key mechanism that regulates the function of the RNA-binding protein Hu antigen R (HuR), a hub in liver cancer. Here, we show that HuR is SUMOylated in the tumor sections of patients with hepatocellular carcinoma in contrast to the surrounding tissue, as well as in human cell line and mouse models of the disease. SUMOylation of HuR promotes major cancer hallmarks, namely proliferation and invasion, whereas the absence of HuR SUMOylation results in a senescent phenotype with dysfunctional mitochondria and endoplasmic reticulum. Mechanistically, SUMOylation induces a structural rearrangement of the RNA recognition motifs that modulates HuR binding affinity to its target RNAs, further modifying the transcriptomic profile toward hepatic tumor progression. Overall, SUMOylation constitutes a mechanism of HuR regulation that could be potentially exploited as a therapeutic strategy for liver cancer.

Hematoma epidural neonatal. Tres casos y revisión de la literatura / Neonatal epidural haematoma. Presentation of 3 cases and a literature review

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Liponeurocitoma del ventrículo lateral izquierdo. Revisión del primer caso descrito en España y análisis de la bibliografía / Liponeurocytoma in the left lateral ventricle. Presentation of the first case reported in Spain and literature review

El liponeurocitoma supratentorial es un tumor excepcional, de predominio en varones jóvenes. Su localización habitual son los ventrículos laterales, siendo excepcional la afectación del iii ventrículo. Se define como un tumor neuronoglial, de bajo grado, con áreas de lipomatosis asociada. La manifestación clínica más frecuente es la derivada de la aparición de hidrocefalia e hipertensión intracraneal secundaria. Presentamos el primer caso descrito en España de esta estirpe tumoral y uno de los pocos presentados, hasta la fecha, en las bases bibliográficas. Se describe el caso de un varón de 33 años de edad, afectado de clínica sensitiva crural y cefalea de reciente inicio. El estudio radiológico mostró la presencia de una gran tumoración supratentorial, intraventricular, multiquística, heterogénea, con áreas de lipomatosis asociada. El paciente fue intervenido, consiguiéndose la exéresis tumoral completa. El diagnóstico definitivo fue de liponeurocitoma supratentorial. La presencia de una tumoración intraventricular supratentorial, con áreas de degeneración grasa, debe obligar a considerar, dentro del diagnóstico diferencial, este tipo de tumor. La resección tumoral completa se considera el tratamiento de elección

Supratentorial liponeurocytoma is a rare tumor, predominatly appearing in young males. It most commonly affects the lateral ventricles, with involvement of the third ventricle being exceptional. It is defined as a low-grade neuroglial tumor, with areas of associated lipomatosis. The most common clinical manifestation is that resulting from the presence of secondary intracranial hypertension and hydrocephalus. We present the first case reported in Spain of this tumor type and one of the few appearing in the literature so far. We report the case of a 33-year-old male patient, suffering from crural sensitive sympoms and recent onset headache. The radiographic study revealed the presence of a large supratentorial tumor; intraventricular, multicystic, heterogeneous and with areas of associated lipomatosis. The patient underwent surgery and complete tumor resection was achieved. The definitive diagnosis was of supratentorial liponeurocytoma. The presence of a supratentorial intraventricular tumor with areas of fatty degeneration should lead us to consider this type of tumor in the differential diagnosis. Complete tumor resection is considered to be the treatment of choice

Efficacy and safety of outpatient parenteral antibiotic therapy for infective endocarditis: a ten-year prospective study

Background: The length of treatment of infective endocarditis (IE) with parenteral antibiotics varies from2 to 6 weeks. Although several studies indicate that outpatient parenteral antibiotic treatment (OPAT)could be safe for uncomplicated viridans-group streptococci (VGS) IE, the experience in Spain is limited and data on other types of endocarditis and OPAT are scarce worldwide. Methods: Prospective single center study of a cohort including all patients with IE admitted to the Hospital Clinic of Barcelona OPAT program from January 1997 to December 2006.Results: During the study period, 392 consecutive episodes of IE in non-drug abusers were attended to.Of these, 73 episodes (42 native-valve, 23 prosthetic-valve, and 8 pacemaker-lead) were admitted to the OPAT program (19%). The percentage of inclusion was higher for viridans group streptococci (VGS) or Streptococcus bovis (S. bovis) IE (32% of all VGS or S. bovis IE episodes diagnosed vs. 14% of the remainingetiologies, P<.001). Twelve patients (16%) were readmitted due to complications, of which 3 died (4%).Glycopeptides use was the only predictor factor of hospital readmission (OR 4.5, 95% confidence interval1.2; 16.8, P=.026). No differences in OPAT outcome were found between VGS plus S. bovis IE and Staphylococcusaureus (S. aureus) plus coagulase-negative staphylococci IE. Patients spent a median of 17 dayon OPAT (interquartile range 11-26.5), which enabled 1,466 days of hospital stay to be saved. Conclusions: These data suggest that OPAT for IE may be a safe and effective therapeutic approach in the treatment of selected patients with types of endocarditis other than uncomplicated VGS or S. bovisendocarditis, although patients taking glycopeptides need close clinical OPAT monitoring (AU)

Antecedentes: La duración del tratamiento antibiótico endovenoso de la endocarditis infecciosa (EI) oscila entre 2 y 6 semanas. Aunque varios estudios indican que el tratamiento antibiótico a domicilio endovenoso (TADE) es seguro para el tratamiento domiciliario de la EI sobre válvula nativa no complicada por estreptococos del grupo viridans (EGV) la experiencia en España con TADE en la EI es limitada y los datos sobre otros tipos de endocarditis y TADE son escasos en todo el mundo. Métodos Estudio unicéntrico, prospectivo, de una cohorte de todos los pacientes con EI admitidos en el programa TADE en el Hospital Clínico de Barcelona entre enero de 1997 y diciembre de 2006.ResultadosDurante el período de estudio se diagnosticaron 392 episodios consecutivos de EI en pacientes no consumidores de drogas, de los cuales 73 episodios (19%) fueron admitidos en el programa de TADE: 42 EI sobre válvula nativa, 23 EI sobre válvula protésica y 8 EI sobre cable de marcapasos. El porcentaje de inclusión en la TADE fue mayor para la EI por EGV o Streptococcus bovis (S. bovis) (32%) que para el resto de etiologías (14%; p < 0,001). Doce pacientes (16%) fueron reingresados debido a las complicaciones de los cuales tres fallecieron (4%). El uso de glucopéptidos fue el único factor predictor de reingreso hospitalario (OR [intervalo de confianza del 95%] 4,5 [1,2; 16,8] p = 0,026). No se observaron diferencias entre las EI por EGV y S. bovis y las EI estafilocócicas (Staphylococcus aureus y estafilococos coagulasa-negativos) incluidas en el TADE. Los pacientes incluidos estuvieron una mediana de 17 días en tratamiento domiciliario (rango intercuartílico de 11 a 26,5), lo que permitió un ahorro de 1.466 días de estancia hospitalaria (..) (AU)

Factores de las relaciones padres-hijos que se asocian con las expectativas de vinculación y de apoyo a la autonomía que tienen los adolescentes de las relaciones románticas / Factors of Parent-child Relationships that are Associated with the Expectations of Attachment and of Fostering Autonomy in Adolescents’ Romantic Relationships

Esta investigación examinó la asociación de algunas características de las relaciones padres-hijos, específicamente la aceptación, supervisión, apertura a la comunicación y autonomía otorgada, con las expectativas de vinculación y de apoyo a la autonomía que tienen los adolescentes de las relaciones románticas. Los análisis se realizaron para la muestra total y separadamente en términos de sexo, tramos de edad y tipo de familia. Se obtuvo información de 322 adolescentes (178 hombres y 144 mujeres) con un instrumento de autorreporte. Se encontró que las características de las relaciones padres-hijos se asocian significativamente tanto con las expectativas de vinculación como con las de apoyo a la autonomía. Se concluye la importancia de propiciar relaciones padres-hijos caracterizadas por la calidez, la aceptación y la apertura a la comunicación, en las que se permita a los jóvenes expresar sus opiniones, necesidades y tomar sus propias decisiones. Se recomienda tener en cuenta que los resultados varían dependiendo del sexo, tramos de edad y tipo de familia.

This study examined the association of some characteristics of the parents-children relationships, namely acceptance, supervision, opening to communication and parental autonomy granting, with the expectations that adolescents have about attachment and the fostering of autonomy in romantic relationships. The analyses were made for the complete sample and separately in terms of sex, age groups and type of family. Information of 322 adolescents (178 men and 144 women) was obtained using a selfreport questionnaire. When analyzing the complete sample it was found that the characteristics of the parents-children relationships are significantly associated with both expectations. Nevertheless these results changed when the analyses were made differentiating by sex, age groups and type of family. It is concluded about the importance of warm, acceptant, open and autonomy granting relationships between par...