The power of us: breaking barriers and bridging the gap of ultrasound in rheumatology to empower a new generation.

OBJECTIVE: This study assesses musculoskeletal ultrasound (MSUS) knowledge, attitudes, and practices among young rheumatologists in Mexico, aiming to identify barriers and facilitators to its clinical use. METHODS: An online survey distributed to a network of young rheumatologists captured demographics, institutional, and personal MSUS information. Multivariable analysis identified factors associated with positive MSUS attitudes. RESULTS: Ninety-six rheumatologists (39.18% national response rate) completed the survey. Of respondents (54.2% females, median age 35.1 years), 81.2% deemed MSUS necessary in clinical rheumatology. The main barriers included limited training access (56.2%) and required training time (54.1%). Lack of scientific evidence was not a major barrier (60.4%). Positive MSUS attitudes were associated with learning from conferences (p = 0.029) and colleagues (p = 0.005), formal (p = 0.043), and in-person training (p = 0.020), MSUS use in practice (p = 0.027), and use by radiologists in their institute (p < 0.001). Interest in learning MSUS (88.5%) was significantly higher in those with positive attitudes (94.4%, p < 0.001). Elastic net analysis identified key drivers, including learning MSUS from conferences, colleagues, and in residency; using MSUS in practice; respondent-performed MSUS; and MSUS use by radiologists. Statistically significant associations were found with using MSUS for synovitis/inflammatory joint disease (OR = 1.43, 95% CI 1.00-2.05) and MSUS use by radiologists in respondent's institutes (OR = 1.70, 95% CI 1.20-2.90). CONCLUSION: Most young rheumatologists in Mexico recognize the necessity of MSUS in clinical practice. By addressing identified barriers, encouraging rheumatologist-radiologist collaboration, and establishing a regulatory body to certify rheumatologist's MSUS experience, there is an opportunity to empower them with the necessary skills for effective MSUS use, ultimately benefiting patient care.

Frequency of Course Remediation and the Effect on North American Pharmacist Licensure Examination Pass Rates.

Objective. Remediation is a tool that allows students to correct an academic deficiency after earning an unsatisfactory grade. There is a lack of data on remediation processes and their impact on future academic performance. This study aimed to evaluate the impact of remediation frequency on North American Pharmacist Licensure Examination (NAPLEX) performance.Methods. The primary analysis was the relationship between the NAPLEX first-time pass rate and the frequency of course remediations (no remediations, one remediation, and two or more remediations). Additional analyses included the correlation between the NAPLEX scaled score and the number of course remediations and characteristics of the course remediated.Results. A total of 116 students with NAPLEX data were included for analysis. Compared to students who never remediated, NAPLEX first-time pass rates were similar among those who remediated only one course; however, students who remediated two or more courses had significantly lower NAPLEX pass rates. Remediation in courses mapped to Pharmacy Curriculum Outcomes Assessment (PCOA) area 4.0 (clinical sciences), and courses with mixed PCOA content areas were negatively correlated with NAPLEX scaled scores. A significant negative correlation existed between remediation in students' second or third years in pharmacy school and the NAPLEX scaled score, but this correlation was not significant for students in their first year.Conclusion. Multiple course remediations are negatively correlated with NAPLEX scaled scores and a reduced first-time NAPLEX pass rate, but a single course remediation has no effect. Institutions should aim to evaluate their current remediation practices and assess whether additional support should be provided to students with multiple course remediations.

Entheseal Involvement in Spondyloarthritis (SpA) and Gout: An Ultrasound Comparative Study.

Objective: To compare the assessment of entheses in subjects with spondyloarthritis (SpA) with patients with gout by the Madrid Sonographic Enthesis Index (MASEI). Method: This cross-sectional study includes videos of entheses evaluated by ultrasound (US) of 30 patients with SpA diagnosed according to the ASAS criteria and 30 patients with gout established by the presence of monosodium urate crystals. Entheses were evaluated for MASEI in 2 Institutes located in two different countries. Demographic and clinical data were registered. Total MASEI score, MASEI-inflammatory, and MASEI-chronic damage were analyzed. Comparisons between groups were obtained by chi-square test and Student's t-test. An inter-reading US reliability was realized. Results: Patients with gout were older and had significantly more comorbidities than those with SpA. The total MASEI score was not significantly different among diseases (p = 0.07). MASEI-inflammatory was significantly more prevalent at the Achilles tendon in SpA, while the proximal patellar tendon was in gout. Power Doppler was higher in SpA compared to gout (p = 0.005). MASEI-chronic damage related to calcification/enthesophytes predominated in gout (p = 0.043), while calcaneal erosions did in SpA (p = 0.008). The inter-reader concordance was excellent (0.93, CI 95% 0.87-0.96, p = 0.001). Conclusions: SpA and gout similarly involve entheses according to MASE, however, some inflammatory and chronic lesions differ significantly depending on the underlying disease and tendon scanned.

Prolidase expression in knee osteoarthritis and healthy controls: Observational study.

ABSTRACT: Prolidase enzyme activity is important for collagen resynthesis. In late stages of osteoarthritis (OA) its activity is decreased.To evaluate prolidase expression in knees of patients undergoing total arthroplasty for OA, and compare with young people undergoing knee arthroscopy due to traumatic injuries.In this cross-sectional study we included 20 patients with OA grade IV who underwent total knee arthroplasty and 20 controls of young patients who underwent arthroscopy for another reason besides OA. All participants were evaluated by knee ultrasound before the procedure. During the procedure, synovial tissue biopsies were taken and analyzed by immunofluorescence to search inflammation. Measures of central tendency, dispersion measures and position measures were used for the case of quantitative variables. Student t test or Mann-Whitney U test, and the logistic regression of Cox, was used.Prolidase expression in the synovial biopsy was significantly lower in the OA group than in the controls (0.017 ±â€Š0.009 vs 0.062 ±â€Š0.094, P < .05). Power Doppler (PD) signal was present in the synovitis of all knee recesses of the OA group in grayscale and in 17 (85%) of knees. The mean of the micro-vessel count in patients with OA was significantly higher vs controls (11 + 5.3 vs 4 + 2.1, P = .001). The neovascularization correlated significantly with the presence of PD signal in patients with OA (1.16, 95% CI, 1.02-1.34, P = .02).The prolidase expression in the synovial membrane evaluated by immunofluorescence, in patients with late stages of knee OA, is low, which may be interpreted as an evidence of decreased collagen resynthesis.

Efficacy and safety of weekly vitamin D3 in patients with fibromyalgia: 12-week, double-blind, randomized, controlled placebo trial.

INTRODUCTION: FM is a chronic musculoskeletal disorder characterized by the presence of generalized pain. There are contradictory results regarding the prevalence and supplementation effect of vitamin D deficiency on FM patients. We aim to determine the safety and efficacy of a 12-week vitamin D supplementation on FM patients. METHODS: We conducted a randomized, placebo-controlled, double-blind clinical trial. We included female participants of 18 years old or older, who met 1990 or 2010 ACR criteria for fibromyalgia. The Spanish validated FIQ and the VAS of pain were applied at baseline. The participants were then randomized to receive placebo or 50,000 IU of Vitamin D3 PO, weekly for 12 weeks. RESULTS: We included 80 patients. There was no statistical difference in the initial and final FIQ between both groups. The FIQ delta also did not prove to be different at the end of the study. The increase in vitamin D levels in the intervention group was corroborated. Regarding serious adverse effects, none was reported in both groups. There was no statistical difference in minor adverse events. CONCLUSION: In this double-blind placebo-controlled randomized study conducted to measure the efficacy and safety of vitamin D exclusively in patients with FM, we found that there is no evidence of a trend in favor of vitamin D treatment, since we did not observe improvement in the VAS of pain or FIQ. TRIAL REGISTRY: Clinical Trials.gov number: NCT03369379 Key Points • There are conflicting results in vitamin D to treat fibromyalgia. • In this double-blind, randomized controlled trial, we did not find a difference in the VAS nor FIQ with vitamin D supplementation. • The increase in vitamin D levels in the intervention group was corroborated.

Reliability of ultrasound grading traditional score and new global OMERACT-EULAR score system (GLOESS): results from an inter- and intra-reading exercise by rheumatologists.

This study aims to test the reliability of ultrasound to graduate synovitis in static and video images, evaluating separately grayscale and power Doppler (PD), and combined. Thirteen trained rheumatologist ultrasonographers participated in two separate rounds reading 42 images, 15 static and 27 videos, of the 7-joint count [wrist, 2nd and 3rd metacarpophalangeal (MCP), 2nd and 3rd interphalangeal (IPP), 2nd and 5th metatarsophalangeal (MTP) joints]. The images were from six patients with rheumatoid arthritis, performed by one ultrasonographer. Synovitis definition was according to OMERACT. Scoring system in grayscale, PD separately, and combined (GLOESS-Global OMERACT-EULAR Score System) were reviewed before exercise. Reliability intra- and inter-reading was calculated with Cohen's kappa weighted, according to Landis and Koch. Kappa values for inter-reading were good to excellent. The minor kappa was for GLOESS in static images, and the highest was for the same scoring in videos (k 0.59 and 0.85, respectively). Excellent values were obtained for static PD in 5th MTP joint and for PD video in 2nd MTP joint. Results for GLOESS in general were good to moderate. Poor agreement was observed in 3rd MCP and 3rd IPP in all kinds of images. Intra-reading agreement were greater in grayscale and GLOESS in static images than in videos (k 0.86 vs. 0.77 and k 0.86 vs. 0.71, respectively), but PD was greater in videos than in static images (k 1.0 vs. 0.79). The reliability of the synovitis scoring through static images and videos is in general good to moderate when using grayscale and PD separately or combined.

Corrigendum to "The Overexpression of NALP3 Inflammasome in Knee Osteoarthritis Is Associated with Synovial Membrane Prolidase and NADPH Oxidase 2".

[This corrects the article DOI: 10.1155/2016/1472567.].

The Overexpression of NALP3 Inflammasome in Knee Osteoarthritis Is Associated with Synovial Membrane Prolidase and NADPH Oxidase 2.

Osteoarthritis is characterized by the presence of proinflammatory cytokines and reactive oxygen species. We aimed to clarify the role of prooxidant enzyme content at the synovial membrane level and how it correlates with the inflammatory process in patients with knee osteoarthritis (KOA). In synovial membranes from KOA patients and control group, we analyzed the protein content of prooxidant enzymes such as Nox2, xanthine oxidase (XO), and prolidase as well as the proinflammatory NALP3. Results show that protein content of prolidase and Nox2 increased 4.8- and 8.4-fold, respectively, and XO showed an increasing trend, while the NALP3 inflammasome increased 5.4-fold with respect to control group. Levels of prolidase and XO had a positive correlation between the levels of NALP3 and Nox2. By principal component analysis the protein expression pattern by study groups was evaluated. Three clusters were identified; protein expression patterns were higher for clusters two (prolidase) and three (XO and Nox2) between KOA patients and controls. Data suggest that prooxidant enzymes increase in synovial membrane of KOA patients and may contribute to the inflammatory state and degradation of the articular cartilage.

Applying a nine cell financial analysis model to home health care.

A nine-cell financial analysis model is used to evaluate the effectiveness of strategies on the economic performance of a home health care agency. Strategies associated with the drivers of economic performance are discussed: volume, unit price, unit costs of resources applied, and quantity of resources applied.

Influence of the structure of mood in the assessment of rheumatoid arthritis through the visual analog scale for pain, HAQ and DAS28.

OBJECTIVE: To analyze the effect of the structure of mood over the following assessment tools for rheumatoid arthritis: visual analog scale (VAS) for pain, HAQ and DAS28. PATIENTS AND METHODS: We studied 86 patients with recent onset rheumatoid arthritis, of which 75.7% were female, with a mean age at disease onset of 55 years. All patients were administered the Spanish version of the PANAS questionnaire that evaluates the components of positive (PA) and negative mood (AN). Patients belonged to the registry of new-onset arthritis in our center so clinical information was available for 282 patients visits. To determine the effect of PA and AN on each of the dependent variables we performed three multivariate linear regression models using generalized linear models through the Stata glm command 10.1. RESULTS: The mean score for PA and AN in our patients was similar to that described for the healthy Spanish population. The high scores on the subscale of AN were associated with worse scores in both the VAS for pain and the HAQ. By contrast, high scores on PA were associated with better outcomes of disease activity measured by DAS28. CONCLUSION: The structure of mood may influence the tools we use for evaluating patients with rheumatoid arthritis, so it might be advisable to include the PANAS questionnaire as part of that assessment.

Influencia de la estructura de los afectos en la evaluación de la artritis reumatoide mediante la escala visual analógica de dolor, el HAQ y el DAS28 / Influence of the structure of mood in the assessment of rheumatoid arthritis through the visual analog scale for pain, HAQ and DAS28

Objetivo: Analizar el efecto de la estructura del afecto en las siguientes herramientas de evaluación de la artritis reumatoide: escala visual analógica (EVA) de dolor, HAQ y DAS28. Pacientes y métodos: Se estudiaron 86 pacientes con artritis reumatoide de reciente comienzo, de los que el 75,7% eran mujeres, con una mediana de edad al inicio de la enfermedad de 55 años. A todos los pacientes se les aplicó la versión adaptada a población española del cuestionario PANAS que evalúa las componentes de afecto positivo (AP) y negativo (AN). Los pacientes pertenecían al registro de artritis de reciente comienzo de nuestro centro por lo que se disponía de información clínica de los enfermos en 282 visitas. Para determinar el efecto de AP y AN en cada una de nuestras variables dependientes se estimaron 3 modelos de regresión lineal multivariable mediante modelos lineales generalizados usando el comando glm del programa Stata 10.1. Resultados: El promedio de la puntuación de AP y AN en nuestros pacientes fue similar al descrito para la población española sana. Las puntuaciones elevadas en la subescala de AN se asociaron a peores puntuaciones, tanto en la EVA de dolor, como en el HAQ. Por el contrario, puntuaciones elevadas en AP se asociaron con una mejor evolución de la actividad de la enfermedad medida por el DAS28. Conclusión: La estructura del afecto puede influir en las herramientas que utilizamos para la evaluación de los pacientes con artritis reumatoide, por lo que podría ser recomendable incluir la realización del PANAS como parte de dicha evaluación (AU)

Objective: To analyze the effect of the structure of mood over the following assessment tools for rheumatoid arthritis: visual analog scale (VAS) for pain, HAQ and DAS28. Patients and methods: We studied 86 patients with recent onset rheumatoid arthritis, of which 75.7% were female, with a mean age at disease onset of 55 years. All patients were administered the Spanish version of the PANAS questionnaire that evaluates the components of positive (PA) and negative mood (AN). Patients belonged to the registry of new-onset arthritis in our center so clinical information was available for 282 patients visits. To determine the effect of PA and AN on each of the dependent variables we performed three multivariate linear regression models using generalized linear models through the Stata glm command 10.1. Results: The mean score for PA and AN in our patients was similar to that described for the healthy Spanish population. The high scores on the subscale of AN were associated with worse scores in both the VAS for pain and the HAQ. By contrast, high scores on PA were associated with better outcomes of disease activity measured by DAS28. Conclusion: The structure of mood may influence the tools we use for evaluating patients with rheumatoid arthritis, so it might be advisable to include the PANAS questionnaire as part of that assessment (AU)