Clinical characteristics and outcomes of patients with inflammatory and autoimmune rheumatological diseases admitted for intensive care in Colombia.

OBJECTIVE: Contemporary studies reporting outcomes of critical care in patients with inflammatory and autoimmune rheumatological diseases are scarce. This study describes 15 years of experience from 2005-2019 in a Colombian referral hospital. METHODS: This observational, descriptive, consecutive case series study was performed on adult patients with inflammatory and autoimmune rheumatic diseases who were admitted to the intensive care unit (ICU) of the San Ignacio University Hospital in Bogotá (Colombia), from January 1, 2005, to December 21, 2019. We describe the sociodemographic characteristics, admission causes and criteria, lengths of stay, immunosuppressive treatment, systemic support, and mortality. RESULTS: The study included 300 patients with a median age of 48 years [interquartile range (IQR) 31-62 years], predominantly female (76%). Disease exacerbations (30%), infections (17.6%), and cardiovascular diseases (15%) were the main causes of admission. Respiratory failure (23%) most commonly caused by septic shock (24%) was the principal indication for intensive care admission. The most frequent infections were community-acquired pneumonia (11.6%) and soft-tissue infections (9%). In 40.3% of patients, inotropic and vasopressor support was required. The median length of stay was 4 days (IQR 2-8), and global mortality was 21.6%. CONCLUSIONS: Rheumatic diseases in the ICU are still associated with high morbidity and mortality. Patients with inflammatory and autoimmune rheumatic diseases require a meticulous clinical approach, strict clinical monitoring, frequent assessment of complications, evaluation of systemic support needs, and specific management.

Epidemiology and demographics of cutaneous lupus erythematosus in Colombia between 2015 and 2019.

Cutaneous lupus erythematosus (CLE) is classified into three groups - acute, subacute, and chronic - based on clinical and histopathological characteristics. The risk of systemic manifestations varies among these groups. There are few studies on CLE epidemiology. For this reason, this paper aims to describe CLE prevalence and demographics in Colombia between 2015 and 2019. This descriptive, cross-sectional study used the international classification of diseases, tenth revision, for CLE subtypes, utilizing official data from the Colombian Ministry of Health. In people older than 19 years, 26,356 CLE cases were registered, yielding a prevalence of 76 cases per 100,000 population. CLE was more frequent in females, at a 5:1 ratio compared to males. The most common clinical presentation was discoid lupus erythematosus, in 45% of cases. The majority of cases occurred in people between 55 and 59 years old. This is the first study that describes CLE demographics in adults in Colombia. Findings regarding clinical subtypes and female predominance are consistent with those in the medical literature.

Frequency of use and cost of biologic treatment for inflammatory bowel disease and inflammatory bowel disease-associated arthropathy in Colombia in 2019.

INTRODUCTION AND AIMS: Inflammatory bowel disease (IBD) has a high economic burden due to its chronicity. Treatment has evolved, thanks to the understanding of IBD pathogenesis and the advent of biologic therapy, albeit the latter increases direct costs. The aim of the present study was to calculate the total cost and cost per patient/year of biologic therapy for IBD and IBD-associated arthropathy in Colombia. METHODS: A descriptive study was conducted. The data were obtained from the Comprehensive Social Protection Information System of the Department of Health for the year 2019, utilizing the medical diagnosis codes of the International Classification of Diseases related to IBD and IBD-associated arthropathy as keywords. RESULTS: The prevalence of IBD and IBD-associated arthropathy was 61 cases per 100,000 inhabitants, with a female-to-male ratio of 1.5:1. Joint involvement was 3%, and 6.3% of the persons with IBD and IBD-associated arthropathy received biologic therapy. Adalimumab was the most widely prescribed biologic drug (49.2%). Biologic therapy had a cost of $15,926,302 USD and the mean cost per patient/year was $18,428 USD. Adalimumab had the highest impact on healthcare resource utilization, with a total cost of $7,672,320 USD. According to subtype, ulcerative colitis had the highest cost ($10,932,489 USD). CONCLUSION: Biologic therapy is expensive, but its annual cost in Colombia is lower than that of other countries due to the government's regulation of high-cost medications.

YouTube® in Spanish as an information source for patients with autoimmune hepatitis.

INTRODUCTION AND AIM: A large number of patients with autoimmune hepatitis (AH) seek information about their disease on the Internet. The reliability, comprehensiveness, and quality of said information in Spanish has not been studied. Our aim was to describe the characteristics of the information about AH on YouTube®. METHODS: An analytic observational study evaluated videos in Spanish about AH available on YouTube®, describing their general characteristics, viewer engagement, and information sources. Standardized tools were utilized to analyze reliability (DISCERN), comprehensiveness, and overall quality (Global Quality Score [GQS]). RESULTS: One hundred videos were included, 93% of which provided information from healthcare professionals (group 1), and 7% of which reflected patient opinions (group 2). There were differences in the median reliability (DISCERN 4 vs 2, p ≤ 0.05) and comprehensiveness (4 vs 2, p ≤ 0.05) scores between groups, but equal overall quality (GQS 3 vs 2, p = 0.2). Reliability (DISCERN 4; RIC 3-4) and comprehensiveness (4.5; IQR 3-5) were higher in videos by professional organizations, compared with those by independent users, healthcare information websites, and for-profit organizations (DISCERN 3; IQR 2.5-3.5) (p < 0.001). Reliability (DISCERN 2; IQR 1.5-3), comprehensiveness (2; IQR 1.5-2.5), and quality (GQS 2.5; IQR 1.5-3.5) were lower for videos made by for-profit organizations. CONCLUSION: The majority of videos about AH in Spanish on YouTube® have good reliability, comprehensiveness, and quality. Videos created by academic organizations had higher scores, thus their collaboration, with respect to patient opinion videos, is suggested.

YouTube® in Spanish as a source of information for patients with inflammatory bowel disease.

INTRODUCTION AND AIM: The majority of patients with inflammatory bowel disease (IBD) seek information about their disease on the Internet. The reliability, comprehensiveness, and quality of said information in Spanish has not previously been studied. MATERIALS AND METHODS: An analytic observational study was conducted that included YouTube® videos on IBD available in Spanish, describing general characteristics, engagement, and sources. Standard tools for evaluating reliability (DISCERN), comprehensiveness, and overall quality (Global Quality Score, GQS) were employed. RESULTS: One hundred videos were included. Eighty-eight videos consisted of information produced by healthcare professionals (group 1) and 12 included patient opinions (group 2). There were no differences in the median scores for reliability (DISCERN 3 vs 3, p = 0.554) or comprehensiveness (3 vs 2.5, p = 0.768) between the two groups, but there was greater overall quality in the group 2 videos (GQS 3 vs 4, p = 0.007). Reliability was higher for the videos produced by professional organizations (DISCERN 4; IQR 3-4), when compared with healthcare information websites and for-profit agencies (DISCERN 3; IQR 2.5-3.5) (p < 0.001), but the videos with healthcare information website and for-profit sources had a higher quality score (GQS 3 vs 4, p < 0.001). Comprehensiveness scores were similar. CONCLUSION: The majority of YouTube® videos in Spanish on IBD have good reliability, comprehensiveness, and quality. Reliability was greater for the videos produced by professional organizations, whereas quality was higher for those created from healthcare information websites and for-profit agencies.

Frequency of ANA/DFS70 autoantibodies in Colombian patients with undifferentiated connective tissue disease.

The objective was to describe the clinical characteristics and the frequency of the ANA/DFS70 autoantibodies in patients affected by undifferentiated connective tissue disease (UCTD) in a tertiary hospital in Colombia. This descriptive cross-sectional study enrolled patients who fulfilled the classification criteria for UCTD. ANAHEp- 2 test and the modified assay for ANA/DFS70 autoantibodies were performed through the indirect immunofluorescence technique. Erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and the antibodies to anti-extractable nuclear antigens, DNA, phospholipids (IgG, IgM, IgA), and cyclic citrullinated peptide were also evaluated. Fifty-three patients were studied; 42/53 (79%) tested positive for ANA and 5/42 (11.9%) for ANA/DFS70 antibodies with a dense fine speckled fluorescent pattern (AC-2) in ANA HEp-2 test that was confirmed by a modified HEp-2-DFS70 assay. Patients had arthralgia (87%, n=47), non-erosive arthritis (66%, n=34), xerostomia (64%, n=34), xerophthalmia (42%, n=22), and Raynaud's phenomenon (17%, n=9). Arthralgia, xerophthalmia, xeroderma, and absence of disease evolution to a specific disease over five years were more frequent in patients with a positive result for the anti-DFS70 antibodies. The ANA/DFS70 autoantibodies were more frequent in patients with UCTD compared to other rheumatic diseases for which they were initially evaluated. More studies are required to support the predictive role of this antibody to the absence of progression to a well-defined connective tissue disease.

Conocimientos y decisiones clínicas de los odontólogos colombianos acerca del riesgo de las osteonecrosis de los maxilares en pacientes que reciben tratamiento para la osteoporosis / Knowledge and clinical decisions of Colombian dentists about the risk of osteonecrosis of the jaws in patients receiving treatment for osteoporosis

Introducción: La osteonecrosis de los maxilares es una reacción adversa severa poco frecuente, asociado a la administración de medicamentos utilizados para el tratamiento de la osteoporosis y cáncer, como los bisfosfonatos y el denosumab. Sin embargo, muchos profesionales suspenden estos medicamentos, o difieren los procedimientos hasta tener aval del médico tratante. El presente estudio evalúa los conocimientos y actitudes de un grupo de odontólogos colombianos, con respecto al riesgo de desarrollar osteonecrosis de maxilar con el uso de bisfosfonatos y denosumab.Métodos: Se diseñó una encuesta a partir de un grupo focal que fue avalada por expertos. Se obtuvo una herramienta de 30 preguntas, la cual fue enviada a un grupo de odontólogos, cirujanos maxilofaciales, periodoncistas y rehabilitadores orales afiliados a las sociedades odontológicas a través del software Survey Monkey.Resultados: Se analizaron las respuestas de 187 odontólogos (42,6% con estudios de posgrado). El 50,3% de los odontólogos consideraron equivocadamente, que el uso de bisfosfonatos es una contraindicación absoluta para procedimientos odontológicos mayores, y el 51,3% lo consideraron para el uso de denosumab. El 74,6% de los profesionales solicitarían innecesariamente aval del médico tratante para programar procedimientos en pacientes que reciben bisfosfonatos, y el 43,8% para pacientes con denosumab. Los hallazgos fueron similares independientemente de los años de experiencia o el nivel de educativo.Conclusión: Los resultados de nuestro estudio sugieren que hay bajo conocimiento, en relación al riesgo de desarrollar osteonecrosis de maxilar con el uso de medicamentos para el manejo de la osteoporosis. (AU)

Relación entre la actividad en las redes sociales de las revistas de medicina interna y las citaciones que reciben / Relationship between internal medicine journals’ activity on social networks and the citations they receive

Antecedentes y objetivo: Las redes sociales son medios de divulgación de información científica. Se han generado métricas alternativas que evalúan el impacto de publicaciones científicas en redes sociales. Este estudio busca evaluar si existe correlación entre la actividad de las revistas de medicina interna en las redes sociales y las métricas tradicionales basadas en citaciones. Métodos: Se identificaron las revistas de medicina interna a partir de la base de datos SCImago. Se extrajo información de las métricas tradicionales y alternativas de actividad de las revistas en Facebook, Twitter, YouTube e Instagram. Se evaluó correlación mediante el coeficiente de Spearman. Resultados: De un total de 134 revistas de medicina interna, 17 contaban con presencia en las redes sociales evaluadas. El índice SJR fue más alto en revistas con red social vs. sin red social (59 vs. 18, p<0,0001), y la correlación global entre el índice SJR y el número de seguidores/año en Facebook fue muy fuerte (coeficiente de Spearman 0,95, p<0,05) y fuerte para el número de seguidores/año en Twitter (coeficiente de Spearman 0,54, p <0,05). Conclusiones: Nuestro estudio sugiere que existe una correlación muy fuerte entre las métricas de actividad de las redes sociales, comparado con las métricas tradicionales basadas en el número de citaciones en revistas de medicina interna (AU)

Background and objectives: Social networks are a means for disseminating scientific information. Alternative metrics assessing the impact of scientific publications on social networks have been created. Our study aims to assess the correlation between the activity of internal medicine journals on social networks and traditional metrics based on citations. Methods: Internal medicine journals were identified in the SCImago-Scopus database and information on traditional impact metrics was extracted. In addition, alternative metrics of activity were determined for Facebook, Twitter, YouTube, and Instagram. The correlation was assessed through Spearman's correlation coefficient. Results: Of 134 Internal Medicine journals, 17 had a presence on the social networks evaluated. The SJR index was higher in journals with a presence on social networks vs. those without (59 vs. 18, p <.0001). The overall correlation between the SJR index and the number of followers/year was very strong for Facebook (Spearman's correlation coefficient 0.95, p <.05) and strong for Twitter (Spearman's correlation coefficient 0.54 p <.05). Conclusions: Our study suggests that there is a very strong correlation between social network activity metrics (mainly Facebook and Twitter) compared to traditional metrics based on the number of citations of internal medicine journals (AU)

Relationship between internal medicine journals' activity on social networks and the citations they receive.

BACKGROUND AND OBJECTIVES: Social networks are a means for disseminating scientific information. Alternative metrics assessing the impact of scientific publications on social networks have been created. Our study aims to assess the correlation between the activity of internal medicine journals on social networks and traditional metrics based on citations. METHODS: Internal medicine journals were identified in the SCImago-Scopus database and information on traditional impact metrics was extracted. In addition, alternative metrics of activity were determined for Facebook, Twitter, YouTube, and Instagram. The correlation was assessed through Spearman's correlation coefficient. RESULTS: Of 134 Internal Medicine journals, 17 had a presence on the social networks evaluated. The SJR index was higher in journals with a presence on social networks vs. those without (59 vs. 18, p < .0001). The overall correlation between the SJR index and the number of followers/year was very strong for Facebook (Spearman's correlation coefficient 0.95, p < .05) and strong for Twitter (Spearman's correlation coefficient 0.54 p < .05). CONCLUSIONS: Our study suggests that there is a very strong correlation between social network activity metrics (mainly Facebook and Twitter) compared to traditional metrics based on the number of citations of internal medicine journals.

Self-management in patients with type 2 diabetes: Group-based versus individual education. A systematic review with meta-analysis of randomized trails.

AIM: Patient education is an essential component of the treatment of type 2 diabetes mellitus (T2DM). The present meta-analysis was aimed at verifying the efficacy of group-based versus individual education for self-management in patients with T2DM. DATA SYNTHESIS: A Medline and Embase search up to January 1st, 2021, was performed, including Randomized Controlled Trials (RCT) with duration>6 months, enrolling patients with T2DM and comparing individual-based with group-based educational programs. The primary outcome was endpoint HbA1c; secondary endpoints were lipid profile, body weight, blood pressure, patients' adherence/knowledge, and quality of life. The weighed difference in means (WMD) and Mantel-Haenzel Odds Ratio (MH-OR), with 95% Confidence Interval (CI), were calculated. We retrieved 14 RCT. No significant between-group difference in HbA1c (WMD -0.39[-0.89; 0.09] mmol/mol, p = 0.11) was observed. At metaregression analyses, longer trial duration, higher baseline mean age and duration of diabetes, and lower baseline HbA1c were correlated with greater efficacy of group-based programs in reducing HbA1c. When analyzed separately, trials excluding insulin-treated patients showed a significant reduction of HbA1c in favor of group education. CONCLUSIONS: In patients with T2DM, group education has similar efficacy as individual education on glucose control. Group programs are associated with an improved quality of life and patients' knowledge. PROSPERO AND OSF REGISTRATION: ID243149.

Voriconazole-induced periostitis.

Voriconazole is a fluorinated drug from the triazole group that is widely used in the prophylaxis and treatment of fungal infections in immunosuppressed patients. Chronic use of this medication can generate, as an adverse effect, a multifocal, asymmetric, diffuse and nodular periosteal reaction, associated with severe and disabling skeletal pain and elevated alkaline phosphatase and serum fluoride. Radiography is the imaging technique of choice for periostitis diagnosis. In general, clinical manifestations and radiographic findings disappear, when the drug is discontinued. We report the clinical case of a 44 year-old woman diagnosed with acute myeloid leukemia, who developed an invasive fungal infection treated with voriconazole after a stem cell transplant. Nine months after starting antifungal treatment, she manifested symptoms and radiological signs compatible with periostitis. Due to clinical suspicion, we decided to suspend voriconazole, with consequent resolution of clinical manifestations and radiological findings.

Anesthesia using microcannula and sharp needle in upper blepharoplasty: A randomized, double-blind clinical trial evaluating pain, bruising, and ecchymoses.

INTRODUCTION: With the emergence of blunt-tipped microcannulas, there is a hypothesis that these could cause less damage and reduce pain as compared to conventional sharp needles in eyelid surgery. The purpose is to determine whether an 18G blunt-tipped cannula can be better than a 26G needle. METHODS: This prospective, observer-blinded, randomized clinical trial was conducted from June 2017 to December 2018. Sixty-eight patients were randomized to receive local anesthesia injections for upper blepharoplasty. Infiltration was performed by using a 26-gauge sharp needle on one side and on the other side, infiltration was performed by using an 18-gauge stainless-steel blunt-tipped microcannula. A numeric rating scale (NRS) from 0 to 10 was used to blindly assess pain in patients receiving anesthesia injections with both needle types. Photographs of the eyelids of each patient were taken in five different periods and used by three blinded observers to identify bruise or ecchymoses. RESULTS: A total of 136 eyelid operations were performed. There was no statistically significant difference when both groups were compared; however, the average score of pain was higher in patients taking the infiltration through the needle (2.85 versus 2.50). Regarding the evaluation of bruising and ecchymoses, the results showed that, in the five periods evaluated, there was no statistical difference in bruising and ecchymosis in the eyelids when taking the infiltration through a sharp needle when compared with that of the eyelids taking infiltration through a (blunt-tipped) microcannula. CONCLUSION: The evaluation of the blunt-tipped microcannula showed a lower pain score mean than that obtained for the sharp needle (2.5 versus 2.85) (p > 0.05). There was no statistically significant difference in the bruising and ecchymosis courses.