Elevated IL-1ß levels in anti-Ro/SSA connective tissue diseases patients with prolonged corrected QTc interval.

OBJECTIVES: Patients with systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS) have increased IL-1ß levels. IL-1ß and other pro-inflammatory cytokines have a modulating activity on cardiac ion channels and have been associated with increased arrhythmic risk in rheumatoid arthritis patients. Likewise, adult patients with connective tissue diseases (CTDs) may have prolonged QTc intervals associated with the presence of anti-Ro/SSA antibodies. Our objective was to evaluate the presence of serum IL-1ß in subjects with CTDs, in relation to the presence of anti-Ro/SSA antibodies and QTc interval duration. METHODS: 12-lead electrocardiograms (ECG) were performed and blood was withdrawn, measuring electrolytes, IL-1ß anti-Ro/SSA antibodies by ELISA in 73 patients with CTDs. RESULTS: 55 patients were anti-Ro/SSA positive and 18 were anti-Ro/SSA negative. Patients with anti-Ro/SSA positive antibodies had a significantly greater median IL-1ß serum level: 7.29 (range: 0.17-17.3 pg/ml) compared to patients with anti-Ro/SSA negative antibodies whose median was: 1.67 (range 0.55-4.12 pg/ml) p<0.001. The mean QTc interval values obtained in both groups were not significantly different (417.7±23.1 vs. 414.7±21.2, p=0.63). The QTc interval was prolonged in 11 (20%) patients, who were all anti-Ro/SSA positive versus 0 (0 %) in anti-Ro/SSA negative patients p=0.05. Median IL-1ß levels were: 8.7 (range: 2.69-15.1 pg/ml) in patients with prolonged QTc interval versus median: 5.0 (range: 0.17-17.3 pg/ml) in those with normal QTc interval values (<440ms) p=0.006. CONCLUSIONS: IL-1ß is elevated in patients with CTDs that have both anti-Ro/SSA antibodies and prolonged QTc intervals.

Impact of preconception thyrotrophin on obstetric outcomes in the fertile population.

INTRODUCTION: There is evidence that subclinical hypothyroidism is associated with infertility, miscarriage and obstetric complications. However, there is controversy regarding the optimal TSH value in women seeking pregnancy. Current guidelines recommend that hypothyroid women with levothyroxine replacement who are planning pregnancy should optimise the dose of levothyroxine to achieve thyrotrophin (TSH) levels <2.5 mU/l, since these requirements increase in pregnancy, thus reducing the risk of TSH elevation during the first trimester. In women with infertility, who undergo highly complex treatments and have positive thyroid autoimmunity, values of TSH <2.5 mU/l prior to fertility treatment are suggested. Although this is a different population, these «optimal¼ TSH levels were also extended to euthyroid women without evidence of infertility, who are seeking pregnancy. OBJECTIVES: Determine whether preconception TSH levels between 2.5 and 4.64 mIU/l are associated with adverse obstetric outcomes in euthyroid women. MATERIALS AND METHODS: Retrospective cohort study. We evaluated 3265 medical records of pregnant women aged 18-40 years, euthyroid (TSH 0.5-4.64 mU/ml), with TSH measurement at least one year before gestation. 1779 met inclusion criteria. The population was divided according to categories: TSH 0.5-2.4 mU/l (optimal) and TSH 2.5-4.6 mU/l (suboptimal). Information on maternal and fetal obstetric outcomes was collected from each group. RESULTS: We found no statistical difference in the occurrence of adverse obstetric events between the two groups. There was also no difference when adjusting for thyroid autoimmunity, age, body mass index, previous diabetes and previous arterial hypertension. CONCLUSION: Our results suggest that the reference range of TSH used in the general population could be used in women seeking pregnancy, even in the presence of thyroid autoimmunity. Treatment with levothyroxine should be considered only in patients with special situations.

[Effectiveness of transthoracic echocardiogram in patent foramen ovale diagnosis. Systematic review of last ten years.] / Eficacia del ecocardiograma transtorácico para el diagnóstico de foramen oval permeable. Revisión sistemática de los últimos diez años.

Background: Transesophageal echo (TEE) bubble study is the current gold standard for patent foramen ovale (PFO) diagnosis, but it has the disadvantage of being semi-invasive and not exempted from risks. The aim of this study was to determine the accuracy of TTE compared to TEE for PFO diagnosis. Methods and results: a systematic review was done on Medline with the terms "transthoracic echocardiography, transesophageal echocardiography, patent foramen ovale, diagnosis" yielding published literature of the last ten years. The search was completed in february 2018. Of 715 articles, 10 were analyzed. The total of patients were 1268 (mean age of 47 years +/-14) with a global prevalence of PFO of 48%. The sensibility of ETT was 90 % (IC 95: 88 % - 92 %) and the specificity 92% (IC 95: 89 % - 94 %). The positive predictive value was 93% (IC 95: 90 % - 94 %) and the negative predictive value 89 % (IC 95: 87 % - 91 %). The area under the curve and Q index value were 0,97 and 0,93 respectively. The positive and negative likelihood ratio were 18,989 and 0,072 respectively. Conclusion: The ETT shows a good specificity and sensibility for PFO diagnosis with last generation equipments, contrast use and valsalva maneuver; according to the analyzed studies.

Introducción: El ecocardiograma transesofágico (ETE) con burbujas es el estudio de referencia para el diagnóstico de foramen oval permeable (FOP), es semi-invasivo y no exento de riesgos. Nuestro objetivo fue determinar la eficacia del ecocardiograma transtorácico (ETT) para el diagnóstico de FOP, en comparación con el ETE. Métodos y resultados: Se realizó una búsqueda en MEDLINE de los últimos 10 años con las palabras claves: "ecocardiograma transtorácico, ecocardiograma transesofágico, foramen oval permeable, diagnóstico". La búsqueda se completó el 28 de Febrero de 2018. De 715 artículos, se seleccionaron 10 para analizar. El total de pacientes fue 1268, edad promedio de 47 años +/-14. La prevalencia global de FOP fue de 48%. La sensibilidad del ETT fue de 90% (IC 95: 88% - 92%) y la especificidad de 92% (IC 95: 89% - 94%). El valor predictivo positivo fue de 93% (IC 95: 90% - 94%) y el valor predictivo negativo de 89% (IC 95: 87% - 91%). El área bajo la curva y el índice Q fueron 0,97 y 0,93 respectivamente. El cociente de probabilidad positivo fue de 18,989 y el negativo de 0,072. Conclusión: El ETT muestra una buena especificidad y sensibilidad para el diagnóstico de FOP con equipos de última generación, uso de contraste y maniobra de Valsalva; según los estudios analizados.

Clinical description of patients with cytoplasmic discrete dots pattern (lysosome) on indirect immunofluorescence on HEp-2 cells.

The cytoplasmic discrete dot (CDD) pattern is an unusual finding in indirect immunofluorescence, and its clinical value is unknown. To describe the clinical characteristics of patients with CDD pattern on indirect immunofluorescence (IIF) from our laboratory database and to evaluate possible associations with other autoantibodies and autoimmune diseases. This is a retrospective descriptive study. We included all patients with CDD pattern on IIF in HEp-2 cells with a titer equal or greater than 1/80, using a database of all IIF performed in a reference immunology and rheumatology laboratory between 2007 and 2015. Data on demographics, past medical history, and relevant laboratory findings were recorded and analyzed. We performed 13.056 IIF on HEp-2 cells tests between January 1, 2007 and December 31, 2015, with 6075 positive results. Among them, 5447 had nuclear pattern, 55 had both nuclear and cytoplasmic pattern, and 573 had cytoplasmic pattern. Only 21 showed a CDD pattern. Four patients were excluded since they did not have medical records at the institution. The prevalence of the CDD pattern in our laboratory was 0.35%. The median age was of 62.3 years (SD 9.16) and 100% were female. Fifty-three percent (9/17) had an autoimmune disease, Hashimoto's thyroiditis (4/9) being the most frequent one. In conclusion, cytoplasmic discrete dot pattern is an uncommon finding and its clinical value is uncertain. However, in our study, 53% of the patients had an autoimmune disease.

Multicentric prevalence study of anti P ribosomal autoantibodies in juvenile onset systemic lupus erythematosus compared with adult onset systemic lupus erythematosus.

OBJECTIVE: To investigate the prevalence and associations with clinical manifestations of anti- P ribosomal antibodies in patients with juvenile-onset and adult-onset systemic lupus erythematosus (SLE). METHODS: Clinical and serological data of 30 patients with juvenile-onset SLE (age at onset younger than 16 years old) were compared with data of 92 patients with adult-onset SLE. Symptoms occurring during the entire disease course were considered. Anti- P ribosomal antibodies were tested by ELISA. RESULTS: Anti- P ribosomal antibodies were found significantly more often in pediatric-onset SLE patients (26.7% vs. 6.5%; OR=5.21 [CI95%=1.6-16.5], p=0.003). Alopecia (OR=10.11, CI 95%=1.25-97) and skin rash (non discoid) (OR=4.1, CI 95%=1.25-13.89) were significantly associated with anti- P ribosomal antibodies. CONCLUSION: Anti-ribosomal P antibodies are more often found in patients with juvenile SLE. Alopecia and skin rash were the only clinical manifestations associated to anti-ribosomal P antibodies.

Desproporción prótesis-paciente luego de reemplazo de válvula aórtica y seguimiento a 6 años / Patient-prosthesis mismatch in aortic valve replacement: a 6 year follow up

Resumen: Introducción: La desproporción prótesis-paciente (DPP) tras cirugía valvular ocurre cuando el área efectiva de orificio protésico (AEO) es fisiológicamente demasiado pequeño en relación con el tamaño del paciente, lo que resulta en gradientes postoperatorios elevados. Material y métodos: Se realizó un estudio observacional retrospectivo. Se analizaron pacientes con estenosis aórtica sometidos a reemplazo de válvula aórtica durante el año 2010. Se calculó AEO/ASC postoperatorio, si AEO/ASC fue menor de 0,85 cm2/ m2 el paciente fue clasificado como desproporción prótesis-paciente. Los eventos clínicos analizados fueron: mortalidad por cualquier causa, recambio valvular, internación por insuficiencia cardiaca y la capacidad funcional al momento de la encuesta. Se realizaron estadísticas descriptivas para analizar las características de la población. Las variables categóricas se expresaron en porcentaje y las variables continuas en promedio y desviación estándar. El análisis estadístico se realizó con el software IBM® SPSS® 19. Resultados: Se analizaron 26 pacientes sometidos a reemplazo de válvula aórtica con un seguimiento a 6 años, 13 de ellos presentaron DPP y mayor porcentaje de disnea, internación por insuficiencia cardiaca y muerte por cualquier causa. La combinación de eventos clínicos en este grupo de pacientes fue del 53,9%. Conclusión: Se observó un mayor número de eventos cardiovasculares en aquellos pacientes que con des- proporción prótesis-paciente.

Abstract: Background: Prosthesis-patient mismatch (PPM) after aortic valve replacement is related to inferior long-term outcomes. The study aim was to describe the rate of cardiovascular events in patients with or without PPM. Methods: The study was based on a retrospective analysis of information obtained from the electronic medical record. All patients undergoing aortic valve replacement, with or without revascularization surgery during 2010 were included. The effective orifice area (EOA) of the prothesis was obtained based on prosthetic valve data from echocardiography recommendations, was related to body surface area (BSA). PPM was diagnosed when EOA / BSA was < 0.85 cm2/m2. Clinical results were evaluated in January 2017 through our electronic medical record data base and a telephone interview. Helsinki criteria for clinical research were respected. Results: 26 patients were analyzed (20 males) with mean age 64 (SD 11.5) years old. A mechanical prosthesis was implanted in 10 patients and a biological one in the remaining subjects. 13 patients had DPP (EOA/BSA 0.77 ± 0.06). At a mean follow up period of 2190 days 44% were in functional class (NYHA) II-III, 31% had been re-hospitalized for heart failure and 8% had died from cardiac causes (overall death rate 31%). The combined outcome rate (overall death, hospitalization for heart failure or re-replacement of the valve) was 54%. Among the 13 patients without PPM, 31% were in functional class II-III, there were no hospitalizations for heart failure and only 4 patients had died from cardiac causes. Combined outcome rate was 23%. Conclusions: PPM was a marker of poorer clinical results on a long term follow up of patients undergoing aortic valve replacement. Inferential statistical analysis was not performed due to the relatively low number of patients included.

Evolution of differentiated thyroid cancer during pregnancy in a community University Hospital in Buenos Aires, Argentina / Evolução do câncer diferenciado de tiroide durante a gestação em um Hospital Universitário de Buenos Aires, Argentina

OBJECTIVE: To analyze the presentation, follow-up and evolution of differentiated thyroid cancer (DTC) detected during pregnancy. SUBJECTS AND METHODS: Twenty nine women with DTC detected during pregnancy were analyzed. Group I (n = 13) was seen during pregnancy and DTC was diagnosed during gestation; detection of the nodule occurred during pregnancy (first trimester). Group II (n = 16) was seen after delivery; detection of the nodule occurred during pregnancy (second or third trimester). Complete thyroidectomy, ablative dose of radioactive iodine, and treatment with levothyroxine were performed. Follow-up: neck ultrasound; TSH, free T4, thyroglobulin, and anti-thyroglobulin antibodies with and without treatment with levothyroxine; and 131I whole body scans. Histological diagnosis, lymph node metastases, tumor size and stage, complications from pregnancy, and DTC evolution were evaluated. RESULTS: 100% of the patients had papillary thyroid carcinoma. Lymph node metastases were detected in 13 (44.8%), and invasion of adjacent extrathyroid tissue in 2 patients. Tumor size was larger in Group II: 22.1 ± 10.9 versus 13.9 ± 3.5 mm; p = 0.03. No differences were found in the tumor stages between groups. All patients had full-term pregnancies and healthy newborns. Follow-up: 5.7 ± 4.3 years; one patient had persistent disease. CONCLUSIONS: DTC detected during pregnancy had a favorable evolution. Surgery may be postponed to the post-delivery period, unless there are risk factors that justify it during pregnancy.

OBJETIVO: Analisar a apresentação, o seguimento e a evolução do câncer diferenciado da tiroide (CDT) durante a gestação. SUJEITOS E MÉTODOS: Vinte e nove mulheres com CDT detectado durante a gestação foram analisadas. O Grupo I (n = 13) foi atendido durante a gestação e o CDT foi diagnosticado durante a gravidez; a detecção do nódulo aconteceu durante a gestação (primeiro trimestre). O Grupo II (n = 16) foi atendido depois do parto; a detecção do nódulo aconteceu durante a gestação (segundo ou terceiro trimestre). Foram feitos a tiroidectomia, dose de iodo radioativo e tratamento com levotiroxina. Acompanhamento: ultrassom de pescoço; TSH, T4 livre, tiroglobulina, e anticorpos antitiroglobulina com ou sem tratamento com levotiroxina e imagens de corpo inteiro com 131I. Foram analisados o diagnóstico histológico, as metástases em linfonodos, estágio e tamanho do tumor e complicações da gestação e a evolução do CDT. RESULTADOS: Cem por cento das pacientes apresentaram carcinoma papilar da tiroide. Foram detectadas metástases em linfonodos em 13 (44,8%) pacientes e invasão de tecidos extratiroidianos adjacentes em duas pacientes. O tumor foi maior no Grupo II: 22,1 ± 10,9 versus 13,9 ± 3,5 mm; p = 0,03. Não foram observadas diferenças nos estágios dos tumores entre os grupos. Não houve partos prematuros e todos os recém-nascidos estavam saudáveis. Acompanhamento: 5,7 ± 4,3 anos; uma paciente apresentou doença persistente. CONCLUSÕES: O CDT detectado durante a gestação tem evolução favorável. A cirurgia pode ser adiada até o momento pós-parto, a não ser que haja fatores de risco que justifiquem a intervenção durante a gestação.

Taller de masculinidades. Un dispositivo grupal de articulación intersectorial para el abordaje de las violencias por motivos de género en el Municipio de Gral. Paz / Masculinities workshop. A group facility for intersectoral coordination to address gender-based violence in the Municipality of Gral. Paz

Planteada la necesidad desde la Mesa Local Intersectorial de dar respuesta a la problemática de las violencias por motivo de género en el Municipio de Gral Paz y realizando nuevas apuestas que devengan en modos de abordaje, se conforma un grupo de trabajo constituido por tres psicólogas y una trabajadora social. Trabajadoras provenientes de la Dirección de Género, CPA (Centro provincial de adicciones), Patronato de Liberados y del Servicio de Salud Mental del hospital Municipal de dicha localidad. Creándose un dispositivo de atención para varones que han sido denunciados por violencia por motivo de género, desde un modelo de abordaje psico-socio-educativo, llamado "Taller de masculinidades". El objetivo de éste trabajo es dar cuenta del desarrollo y características de éste primer taller, recorrido de 12 encuentros, para el abordaje y prevención de la violencia por motivos de género a nivel territorial comunitario. Poniendo en relevancia el trabajo de articulación intersectorial que se ha requerido para el abordaje de ésta temática a nivel local.