Prevalence of axial spondyloarthritis in Colombia: data from the National Health Registry 2017-2021.

INTRODUCTION: Registries allow ascertaining the epidemiology of chronic diseases such as axial spondyloarthritis (axSpA). The Colombian Ministry of Health has implemented a National Health Registry (SISPRO) that collects data from each medical contact in the system, which provides close to universal coverage (around 98%). OBJECTIVE: To establish the 5-year prevalence of axSpA in Colombia, and to describe its demographics, using data from January 1st, 2017, to December 31st, 2021. METHODS: We performed an observational, cross-sectional study using the International Statistical Classification of Diseases and Related Health Problems as search terms related to ax-SpA, based on SISPRO data. We estimated the prevalence using three approaches: (1) ankylosing spondylitis (AS) diagnoses; (2) diagnoses compatible with axSpA; and (3) diagnoses compatible with axSpA, including sacroiliitis. We calculated prevalence per 100,000 inhabitants. RESULTS: Based on our three approaches, patients with a primary diagnosis compatible with ax-SpA ranged between 12,684 and 117,648, with an estimated 5-year adjusted prevalence between 26.3 and 244 cases per 100,000 inhabitants (0.03-0.2%). The male-to-female ratio ranged between 1.2:1 and 0.4:1, which was markedly skewed towards a higher prevalence in women when we included the code for sacroiliitis. We found the highest frequency of cases in the 50-54 years group. A differential prevalence was observed between different regions in our country, particularly in regions known to have European ancestors. CONCLUSION: This is the first study that describes demographic characteristics of ax-SpA in Colombia and offers valuable information for stakeholders. Key Points • Using the official country-level health database, the prevalence of axSpA in Colombia ranges between 26.3 and 244 cases per 100,000 inhabitants (0.03% - 0.2%) • The prevalence of axSpA peaked among the 50-54 years patient group, suggesting an increased survival • Nations with a substantial admixture, such as Colombia, may present a differential prevalence of axSpA among regions within the country • Including the ICD-10 code for sacroiliitis (M46.1) in epidemiological studies probably overestimates the frequency of axSpA.

YouTube® as a source of information for Spanish-speaking patients with rheumatoid arthritis.

INTRODUCTION: Social media (SoMe) has reshaped access to health information, which may benefit patients with rheumatoid arthritis (RA), although an evaluation of the characteristics of contents for Spanish-speaking patients is lacking. We aimed to assess patient engagement, reliability, comprehensiveness, and quality of data uploaded to YouTube® for Spanish-speaking patients. METHODS: We evaluated the videos uploaded to YouTube® in Spanish about RA. Information about video length, engagement (i.e., views, likes, popularity index), time online, and the source was retrieved; we appraised reliability (DISCERN), comprehensiveness (content score), and quality (Global Quality Score) using standardized scores. RESULTS: We included 200 videos in the study and classified 67% of the videos as useful. These videos had a higher number of views (19,491 [10,132-61,162] vs. 11,208 [8183-20,538]), a longer time online (1156 [719-2254] vs. 832 [487-1708] days), and a shorter duration (6.3 [3.4-15.8] vs. 11.8 [7.4-20.3] min). Engagement parameters were similar between useful and misleading videos. Useful videos had higher reliability, comprehensiveness, and quality scores. Useful videos were mainly uploaded by independent users and government/news agencies; academic organizations offered only 15% of useful videos. CONCLUSIONS: Most of the information in YouTube® for Spanish-speaking patients with RA is useful; however, patient engagement is similar between useful and misleading content. More substantial involvement of academia in developing high-quality educational multimedia is warranted.

YouTube® as a source of information for Spanish-speaking patients with rheumatoid arthritis / YouTube® como fuente de información para pacientes hispanohablantes con artritis reumatoide

Introduction: Social media (SoMe) has reshaped access to health information, which may benefit patients with rheumatoid arthritis (RA), although an evaluation of the characteristics of contents for Spanish-speaking patients is lacking. We aimed to assess patient engagement, reliability, comprehensiveness, and quality of data uploaded to YouTube® for Spanish-speaking patients. Methods: We evaluated the videos uploaded to YouTube® in Spanish about RA. Information about video length, engagement (i.e., views, likes, popularity index), time online, and the source was retrieved; we appraised reliability (DISCERN), comprehensiveness (content score), and quality (Global Quality Score) using standardized scores. Results: We included 200 videos in the study and classified 67% of the videos as useful. These videos had a higher number of views (19,491 [10,132–61,162] vs. 11,208 [8183–20,538]), a longer time online (1156 [719–2254] vs. 832 [487–1708] days), and a shorter duration (6.3 [3.4–15.8] vs. 11.8 [7.4–20.3] min). Engagement parameters were similar between useful and misleading videos. Useful videos had higher reliability, comprehensiveness, and quality scores. Useful videos were mainly uploaded by independent users and government/news agencies; academic organizations offered only 15% of useful videos. Conclusions: Most of the information in YouTube® for Spanish-speaking patients with RA is useful; however, patient engagement is similar between useful and misleading content. More substantial involvement of academia in developing high-quality educational multimedia is warranted.(AU)

Introducción: Las redes sociales (ReSo) han redefinido el acceso a la información en salud, beneficiando a los pacientes con artritis reumatoide (AR). No se cuenta con una evaluación de las características de su contenido para pacientes hispanohablantes. Nuestro objetivo fue evaluar los parámetros de interacción, la confiabilidad, la exhaustividad y la calidad de la información disponible en YouTube® para pacientes hispanohablantes con AR. Métodos: Evaluamos los videos en español sobre AR disponibles en YouTube®. Se extrajo información sobre la duración del video, los parámetros de interacción (por ejemplo, vistas, likes, índice de popularidad), el tiempo en línea y la fuente generadora. Estimamos la confiabilidad (DISCERN), la exhaustividad (puntaje de contenido) y la calidad (Global Quality Score) utilizando puntajes estandarizados. Resultados: Incluimos 200 videos en el estudio y clasificamos a 67% como videos útiles. Estos videos tuvieron un mayor número de vistas (19.491 [10.132-61.162] vs. 11.208 [8.183-20.538]), un mayor tiempo en línea (1.156 [719-2.254] vs. 832 [487-1.708] días) y una menor duración (6,3 [3,4-15,8] vs. 11,8 [7,4-20,3] min). Los parámetros de interacción fueron similares entre los videos útiles y los no útiles. Los videos útiles presentaron puntajes mayores de confiabilidad, exhaustividad y calidad; en su mayoría fueron generados por usuarios independientes y por organizaciones gubernamentales/agencias de noticias. Las organizaciones académicas generaron únicamente 15% de los videos útiles. Conclusiones: La mayoría de la información en YouTube® para pacientes hispanohablantes con AR es útil. Sin embargo, los parámetros de interacción son similares entre los videos útiles y los no útiles. Se requiere una mayor participación de las organizaciones académicas en el desarrollo de multimedia educativo de alta calidad.(AU)

Evaluation of diuretic efficiency of intravenous furosemide in patients with advanced heart failure in a heart failure clinic.

INTRODUCTION: Diuretic efficiency (DE) is an independent predictor of all-cause mortality in acute heart failure (HF) at long-term follow-up. The performance of DE in advanced HF and the outpatient scenario is unclear. METHODS: Survival function analysis on a retrospective cohort of patients with advanced HF followed at the outpatient clinic of Hospital Universitario San Ignacio (Bogotá, Colombia) between 2017 and 2021. DE was calculated as the average of total diuresis in milliliters divided by the dose of IV furosemide in milligrams for each 6-h session, considering all the sessions in which the patient received levosimendan and IV furosemide. We stratified DE in high or low using the median value of the cohort as the cutoff value. The primary outcome was a composite of all-cause mortality and HF hospitalizations during a 12-month follow-up. Kaplan-Meier curves and log-rank test were used to compare patients with high and low DE. RESULTS: In all, 41 patients (66.5 ± 13.2 years old, 75.6% men) were included in the study, with a median DE of 24.5 mL/mg. In total, 20 patients were categorized as low and 21 as high DE. The composite outcome occurred more often in the high DE group (13 versus 5, log-rank test p = 0.0385); the all-cause mortality rate was 29.2% and was more frequent in the high DE group (11 versus 1, log-rank test p = 0.0026). CONCLUSION: In patients with advanced HF on intermittent inotropic therapy, a high DE efficiency is associated with a higher risk of mortality or HF hospitalization in a 12-month follow-up period.

Prevalence of cardiovascular risk factors in a historical cohort of people living with human immunodeficiency virus during a 10-year period.

Objective: Data on the frequency of cardiovascular disease in people living with human immunodeficiency virus from low- and middle-income countries is scarce. Methods: We performed an observational study based on data from a historical cohort of people living with human immunodeficiency virus in Colombia during a 10-year follow-up to describe the prevalence of cardiovascular risk factors and their behavior according to CD4 count. Results: One thousand patients were initially included, out of which 390 had a 10-year follow-up. The mean age was 34 (standard deviation 10) years, and 90% were male. We observed an increase in the prevalence of dyslipidemia (29%-52%, p < 0.001) and obesity (1.1%-3.5%, p < 0.001). Major cardiovascular events occurred in less than 1% of patients. Patients with a CD4 count <200 cells/mm3 had a higher frequency of acute myocardial infarction and obesity. Conclusion: Over time, people living with human immunodeficiency virus present with an increasing prevalence of cardiovascular risk factors, particularly those with a lower CD4 count.

COVID-19 infection during blinatumomab therapy: Is safety a dilemma?

Patients with acute lymphoblastic leukemia may be particularly vulnerable to SARS-CoV-2 infection and severe illness. The mainstay of current treatment is the use of blinatumomab in patients with refractory or relapsed B-cell precursor acute lymphoblastic leukemia. We discuss the case of a patient with relapsed acute lymphoblastic leukemia who became positive for SARS-CoV-2 during blinatumomab therapy. There are no formal recommendations on the decision to continue, withhold, or delay blinatumomab treatment in these patients. More studies exploring this issue are warranted, as SARS-CoV-2 is expected to be here to stay.

Effectiveness of mobile telemonitoring applications in heart failure patients: systematic review of literature and meta-analysis.

Close and frequent follow-up of heart failure (HF) patients improves clinical outcomes. Mobile telemonitoring applications are advantageous alternatives due to their wide availability, portability, low cost, computing power, and interconnectivity. This study aims to evaluate the impact of telemonitoring apps on mortality, hospitalization, and quality of life (QoL) in HF patients. We conducted a registered (PROSPERO CRD42022299516) systematic review of randomized clinical trials (RCTs) evaluating mobile-based telemonitoring strategies in patients with HF, published between January 2000 and December 2021 in 4 databases (PubMed, EMBASE, BVSalud/LILACS, Cochrane Reviews). We assessed the risk of bias using the RoB2 tool. The outcome of interest was the effect on mortality, hospitalization risk, and/or QoL. We performed meta-analysis when appropriate; heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses are offered. We screened 900 references and 19 RCTs were included for review. The risk of bias for mortality and hospitalization was mostly low, whereas for QoL was high. We observed a reduced risk of hospitalization due to HF with the use of mobile-based telemonitoring strategies (RR 0.77 [0.67; 0.89]; I2 7%). Non-statistically significant reduction in mortality risk was observed. The impact on QoL was variable between studies, with different scores and reporting measures used, thus limiting data pooling. The use of mobile-based telemonitoring strategies in patients with HF reduces risk of hospitalization due to HF. As smartphones and wirelessly connected devices are increasingly available, further research on this topic is warranted, particularly in the foundational therapy.

Social media as source of information for Spanish-speaking patients with systemic lupus erythematosus.

INTRODUCTION: Although patients with systemic lupus erythematosus (SLE) may benefit from health-care information in social media (SoMe), they may also be prone to misleading information. An assessment of the reliability, comprehensiveness, and quality of information uploaded to SoMe for Spanish-speaking patients with SLE is lacking. METHODS: This analytical observational study evaluates the videos uploaded to YouTube® in Spanish about SLE. Information about video length, engagement (i.e., views and likes), time on the internet, popularity index, and source was retrieved, and an evaluation on reliability, comprehensiveness, and quality was performed using standardized scores. RESULTS: One hundred eighty-six videos were included in the analysis. Most videos were considered as useful (87%) or useful patient opinion (8.1%), whereas only 2.2% were considered misleading and 2.7% as misleading patient opinion. The number of views (Median 7207 vs 113,877, p = .012), popularity index (Median 13.8 vs 168.7, p < .001), number of likes (Median 155 vs 3400, p < .001), and number of dislikes (Median 3 vs 138, p = .004) were higher for misleading videos. The videos uploaded by independent users had a higher engagement than those from government or news agencies, professional organizations or academic channels. Misleading videos and those uploaded by independent users had lower rates of reliability, comprehensiveness and quality (p < .001). CONCLUSIONS: Most of the information shown in YouTube® videos on SLE tends to be useful. However, audience engagement parameters are larger for misleading videos. Exploring the qualitative features of the most popular videos is necessary to establish what features are more engaging for the audiences and to improve the content and popularity of reliable videos on chronic diseases.

Renal Amyloidosis and Crohn Disease.

Background: Secondary amyloidosis, a rare complication of Crohn disease (CD), is triggered by persistent systemic inflammation. Kidney involvement is the most frequent manifestation and is often characterized by nephrotic syndrome and kidney failure. This complication usually appears in patients with long-standing disease and is associated with increased morbidity and mortality risk. Diagnosis is by microscopic amyloid observation of tissue biopsy, and when the diagnosis is confirmed, the therapeutic objective is disease activity control. Response assessment is challenging because of a lack of reliable biomarkers. Case Report: A 56-year-old male with a long-standing history of CD treated with a tumor necrosis factor-α inhibitor presented with an acute elevation of creatinine in association with clinical and laboratory markers of nephrotic syndrome. Kidney biopsy revealed renal amyloidosis. After treatment adjustment, although a stable creatinine was achieved, the patient had persistent impaired glomerular filtration rate. Conclusion: As a systemic chronic inflammatory disorder, CD may present multisystemic morbidity, for which increased awareness among gastroenterologists is warranted. Renal amyloidosis is an infrequent extraintestinal complication of CD that may lead to chronic kidney impairment. Although evidence-based treatment is lacking, disease activity control is pivotal for management.

Levels of Evidence Supporting the North American and European Perioperative Care Guidelines for Anesthesiologists between 2010 and 2020: A Systematic Review.

BACKGROUND: Although there are thousands of published recommendations in anesthesiology clinical practice guidelines, the extent to which these are supported by high levels of evidence is not known. This study hypothesized that most recommendations in clinical practice guidelines are supported by a low level of evidence. METHODS: A registered (Prospero CRD42020202932) systematic review was conducted of anesthesia evidence-based recommendations from the major North American and European anesthesiology societies between January 2010 and September 2020 in PubMed and EMBASE. The level of evidence A, B, or C and the strength of recommendation (strong or weak) for each recommendation was mapped using the American College of Cardiology/American Heart Association classification system or the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The outcome of interest was the proportion of recommendations supported by levels of evidence A, B, and C. Changes in the level of evidence over time were examined. Risk of bias was assessed using Appraisal of Guidelines for Research and Evaluation (AGREE) II. RESULTS: In total, 60 guidelines comprising 2,280 recommendations were reviewed. Level of evidence A supported 16% (363 of 2,280) of total recommendations and 19% (288 of 1,506) of strong recommendations. Level of evidence C supported 51% (1,160 of 2,280) of all recommendations and 50% (756 of 1,506) of strong recommendations. Of all the guidelines, 73% (44 of 60) had a low risk of bias. The proportion of recommendations supported by level of evidence A versus level of evidence C (relative risk ratio, 0.93; 95% CI, 0.18 to 4.74; P = 0.933) or level of evidence B versus level of evidence C (relative risk ratio, 1.63; 95% CI, 0.72 to 3.72; P = 0.243) did not increase in guidelines that were revised. Year of publication was also not associated with increases in the proportion of recommendations supported by level of evidence A (relative risk ratio, 1.07; 95% CI, 0.93 to 1.23; P = 0.340) or level of evidence B (relative risk ratio, 1.05; 95% CI, 0.96 to 1.15; P = 0.283) compared to level of evidence C. CONCLUSIONS: Half of the recommendations in anesthesiology clinical practice guidelines are based on a low level of evidence, and this did not change over time. These findings highlight the need for additional efforts to increase the quality of evidence used to guide decision-making in anesthesiology.

Does healthcare regime affiliation influence the clinical outcomes of patients with rheumatoid arthritis?

BACKGROUND/PURPOSE: Adequate control of disease activity in rheumatoid arthritis (RA) depends, to a great extent, on the access to a rheumatologist. This study aimed to compare the disease outcomes of patients with RA, based on their healthcare regime affiliation. METHODS: A retrospective observational study of Colombian patients with RA in three outpatient services of different regimes: Contributory (CR, workers and their families with a monthly income above a yearly defined threshold, approximately US$ 220, who allocate a percentage of their income to financing the national health fund and to get access to healthcare services), subsidized (SR, a vulnerable population with a monthly income below the threshold, who have access to healthcare through the national health fund; comparable to the USA Medicaid population), and an excellence clinical care center (C3, access to specialized care, regardless of their healthcare affiliation regime). Data were collected from clinical records for 2 years of follow-up and included demographics, lag times between appointments, and time in high disease activity. We used the Mantel-Cox test for the analysis of time to remission/low disease activity. RESULTS: A total of 240 patients were included (80 patients per regime). At the start of follow-up, mean age was 53.7 years; 21.6% of patients were men; 79.6% of patients had established RA; 72.9% of patients had high disease activity. Patients in the CR had longer lag times between scheduled appointments (p < 0.0001). During follow-up, SR had the highest proportion of patients with high disease activity. Survival curve analysis showed no significant difference between SR and CR groups (p = 0.2903), but was significantly different compared with the C3 group (p < 0.0001). Median survival in high disease activity was greater in the SR group (293 days), followed by CR (254 days), and finally by C3 (64 days). CONCLUSION: Patients that were treated in the excellence clinical care center had better outcomes when compared with other regimes. These data support that healthcare regime may influence disease outcome in patients with RA. Key Points • Prompt access to healthcare in patients with rheumatoid arthritis is pivotal for an adequate control of the disease, for timely adjustment of treatment, and to reduce both the societal burden of the disease and its impact on individual well-being. • As an example of "structural iatrogenesis," healthcare regime affiliation appears to influence disease outcomes in patients with rheumatoid arthritis, in whom differences between regimes are observed. The most vulnerable patients appear to experience the worst outcomes. • Excellence clinical care centers for patients with rheumatoid arthritis should be implemented as an alternative to counteract structural healthcare barriers and as an approach to improve clinical outcomes through a tighter disease control.

Digital ulcers in systemic sclerosis / Úlceras digitales en esclerosis sistémica

ABSTRACT Vascular compromise in systemic sclerosis is a pivotal feature of the disease and plays a fundamental role in its morbidity and mortality. Raynaud's syndrome is present in almost every patient and is often reported as the first clinical manifestation. Digital ulcers may present several etiologies, although an ischemic cause is the most frequent origin and occurs in up to 50% of patients. A profound impact on daily life is often observed due to pain and functional impairment. Their primary pathophysiological mechanism is microvascular compromise, although larger vessels may be affected as well. When recurrent lesions are observed, large vessel compromise should be assessed, which may be due to the disease itself or due to atherosclerosis, whenever risk factors are present. Further, these ulcers present an increased risk of infection and progression to gangrene. The presence of digital lesions may be a marker of severity of the disease, as some reports have suggested an association with pulmonary hypertension and cardiac involvement. Treatment strategies have progressed significantly over the last years. Vasodilatation using calcium channel inhibitors is universally offered. When ischemic signs are observed, treatment should be started readily. Prostacyclin infusions should be considered in severe cases, as they have shown the capacity to foster ulceration healing. Whenever recurring lesions are observed, bosentan may be offered. Management with phosphodiesterase inhibitors may be proposed, although their positioning is unclear. Local treatment is equally important over the course of the disease. Surgical interventions are seldom needed.

RESUMEN El compromiso vascular en la esclerosis sistémica es una característica principal de la enfermedad y desempeña un papel fundamental en su morbimortalidad. El síndrome de Raynaud está presente en casi todos los pacientes, y con frecuencia es reportado como la primera manifestación clínica. Las úlceras digitales pueden tener varias etiologías, aunque una causa isquémica es el origen más frecuente y ocurre hasta en 50% de los pacientes. A menudo se observa un profundo impacto en la vida diaria debido al dolor y al deterioro funcional. Su mecanismo fisiopatológico primario es el compromiso microvascular, aunque los vasos más grandes también pueden verse afectados. Cuando se observan lesiones recurrentes se debe evaluar el compromiso de los vasos grandes, que puede deberse a la enfermedad en sí o a aterosclerosis, siempre que existan factores de riesgo. Además, estas úlceras presentan un mayor riesgo de infección y progresión a gangrena. La presencia de lesiones digitales puede ser un marcador de la gravedad de la enfermedad, ya que algunos informes han sugerido una asociación con hipertensión pulmonar y compromiso cardíaco. Las estrategias de tratamiento han progresado significativamente en los últimos anos. La vasodilatación con inhibidores de los canales de calcio se ofrece universalmente. Cuando se observan signos isquémicos el tratamiento debe iniciarse de inmediato. Las infusiones de prostaciclina se deben considerar en casos graves, ya que han demostrado la capacidad de promover la curación de la ulceración. Siempre que se observen lesiones recurrentes se puede administrar bosentán. Se puede proponer el manejo con inhibidores de la fosfodiesterasa, aunque su posicionamiento no está claro. El tratamiento local es igualmente importante durante el curso de la enfermedad. Las intervenciones quirúrgicas rara vez son necesarias.

Infections and systemic sclerosis: an emerging challenge / Infecciones y esclerosis sistémica: un desafío emergente

ABSTRACT Mounting evidence has shown non-systemic sclerosis (SSc) related complications as a rising cause of hospital admission and mortality, out of which infections are among the top-five causes. Patients with SSc are at an increased risk of infection due to several features of the treatment options and to the disease itself. For instance, lung involvement is associated with a higher frequency of respiratory infections, whereas the presence of digital ulcers or calcinosis may result in skin and soft tissue infections, and even osteomyelitis. On the other hand, the growing trend towards immunomodulation and immunosuppression in patients with autoimmune diseases will place SSc patients at a higher risk of infectious complications, including opportunistic infections. A low suspicion threshold and an increasing awareness among treating specialists, particularly rheumatologists, are warranted for prevention, early diagnosis and management of infectious complications. Nonetheless, data on risk management strategies in SSc, such as vaccination and antimicrobial prophylaxis, are scarce. A narrative non-systematic review was performed to provide an update of infectious complications in patients with SSc.

RESUMEN La evidencia creciente muestra que las complicaciones no asociadas a la esclerosis sistémica (ES) son una causa cada vez más frecuente de hospitalización y mortalidad, dentro de las cuales las infecciones se encuentran entre las primeras cinco causas. Los pacientes con ES presentan un riesgo elevado de infección asociado con las opciones terapéuticas y con la enfermedad misma. Por ejemplo, el compromiso pulmonar se asocia con una mayor frecuencia de infecciones respiratorias, mientras que la presencia de úlceras digitales o calcinosis pueden resultar en infecciones de piel y tejidos blandos, incluso en osteomielitis. Por otro lado, la tendencia creciente hacia la inmunomodulación y la inmunosupresión, como tratamiento de las enfermedades autoinmunes, pondrá a estos pacientes en un mayor riesgo de infecciones, incluidas las infecciones oportunistas. Son necesarios un umbral bajo de sospecha y un alto nivel de alerta entre las especialidades tratantes, particularmente los reumatólogos, para la prevención, el diagnóstico temprano y el manejo de las complicaciones infecciosas. Sin embargo, la información respecto a estrategias de gestión de riesgo en ES, como la vacunación o la profilaxis antibiótica, es escasa. Se realizó una revisión narrativa no sistemática que presenta una actualización sobre las complicaciones infecciosas en pacientes con ES.

Análisis bibliométrico de la investigación en lupus eritematoso sistémico en Colombia / Bibliometric analysis on the research on systemic lupus erythematosus in Colombia / Análise bibliométrica da pesquisa sobre lúpus eritematoso sistêmico na Colômbia

Objetivo: Realizar un estudio bibliométrico de la producción científica en lupus eritematoso sistémico en Colombia que describa su distribución, tendencia de desarrollo, patrón de colaboraciones nacionales e internacionales, y su impacto en la comunidad científica. Fecha y lugar de ejecución del estudio: la búsqueda fue realizada el 12 de octubre de 2017 en Bogotá, Colombia. Métodos: Se realizó un estudio bibliométrico descriptivo que evaluó las bases de datos Web of Science, Scopus y Scielo. Se analizaron la producción nacional anual, número de artículos, ciudad e institución de origen, cooperación nacional e internacional, revistas científicas, lenguaje de publicación y número de citas. Resultados: Scopus aportó 307 artículos; Web of Science, 270, y Scielo, 90. El número máximo de citaciones por artículo (19,8) y de índice h nacional (41) se encontraron en Scopus. Más del 80 % de los artículos, sin importar la base, se publicaron en los últimos 10 años. La Universidad del Rosario y la Universidad de Antioquia son las instituciones más prolíficas. Las regiones con mayor producción son Bogotá y Antioquia, seguidas por Valle del Cauca. Existe un número importante de colaboraciones nacionales e internacionales, que difieren según la base de datos. Conclusión: Se evidencia el crecimiento de la investigación en lupus eritematoso sistémico en Colombia; sin embargo, su impacto tiene un largo camino por recorrer. Se debe fortalecer el interés en reumatología e investigación desde el pregrado, particularmente con el apoyo a los semilleros de investigación y a los jóvenes investigadores.

Objective: To perform a bibliometric study on the scientific production on systemic lupus erythematosus in Colombia that describes its distribution, development trends, national and international collaboration trends, and its impact on the scientific community. Date and place of the study: The search was completed on October 12th, 2017 in Bogota, Colombia. Methods: A descriptive bibliometric study was performed using three databases, namely Web of Science, Scopus and Scielo. Annual national research output, number of articles, city and institution of origin, national and international collaboration, scientific journals, publication language, and citations number were assessed. Results: Scopus disclosed 307 articles, Web of Science 270, and Scielo 90. The highest number of citations per item (19.8) and the maximum national H index (41) were found in Scopus. More than 80 % of articles, regardless of the database, were published during the last 10 years. 'Universidad del Rosario' and 'Universidad de Antioquia' showed the highest research output. Bogotá and Antioquia, followed by Valle del Cauca, presented the highest number of articles. An important number of national and international collaborations were observed, which differed in each database. Conclusion: A significant growth of the research on systemic lupus erythematosus in Colombia was observed, however, its impact is far from being meaningful. Strategies aimed at strengthening the interest in Rheumatology and Research in undergraduate students must be encouraged, particularly supporting research seedbeds and young researchers.

Objetivo: Realizar um estudo bibliométrico da produção científica em lúpus eritematoso sistêmico Na Colômbia que descreva sua distribuição, tendência de desenvolvimento, Padrão de colaborações nacionais e internacionais e seu impacto Na comunidade científica. Data e local de execução do estudo: A busca foi realizada em 12 de outubro de 2017 em Bogotá, Colômbia. Métodos: Realizou-se um estudo bibliométrico descritivo avaliando as bases de dados Web of Science, Scopus e Scielo. Foram avaliadas a produção nacional anual, número de artigos, cidade e instituição de origem, cooperação nacional e internacional, revistas científicas, linguagem de publicação e número de citações. Resultados: Scopus fornece 307 artigos, Web of Science 270 e Scielo 90. O número máximo de citações por artigo (19.8) e de índice H nacional (41) foram encontrados em Scopus. Mais de 80 % dos artigos, independentemente da base, foram publicados nos últimos 10 anos. A "Universidad del Rosario" e a "Universidad de Antioquia" são as instituições mais prolíficas. As regiões com maior produção são Bogotá e Antioquia, seguidas por Valle del Cauca. Existe um número significativo de parcerias nacionais e internacionais, que diferem de acordo com a base de dados. Conclusão: É evidenciado o crescimento da pesquisa em lúpus eritematoso sistêmico na Colômbia, no entanto, seu impacto tem um longo caminho a percorrer. Deve-se fortalecer o interesse em Reumatologia e Pesquisa desde o Pregrau, particularmente com o apoio aos Semilleros de Pesquisa e aos Jovens Investigadores.

Utilidad del ultrasonido: Relleno de bomba intratecal en el manejo de dolor crónico. Reporte de caso / Usefulness of ultrasound: intrathecal pump refill in the management of chronic pain. A case report

Abstract Intrathecal administration for the treatment of patients with difficult to manage chronic pain represents a therapeutic breakthrough that reduces adverse effects and improves the patient's quality of life. However, the use and refill of infusion pumps entails certain risks. A difficult access to the refill port and the potential for subcutaneous infiltration are rare but potentially fatal complications. The use of ultrasonography as real-time guidance for the localization of the port has been suggested. The case of a patient with a diagnosis of ankylosing spondylitis and chronic pain, with neuroplasticity phenomena in the management of analgesia with opioid intrathecal infusion pump and the need for frequent refill is discussed. An ultrasound-guided static method using coordinates was used for a successful, free of complications refill. The technique described for the refill of intrathecal infusion pumps is a practical and innovative approach which, through adequate training, may reduce the risks and complications during the procedure in patients requiring frequent refills.

Resumen La vía de administración intratecal en el tratamiento de pacientes con dolor crónico de difícil manejo representa un avance terapéutico que disminuye efectos adversos y mejora su calidad de vida. Sin embargo, el uso y recarga de bombas de infusión presenta riesgos. Un acceso difícil al puerto de recarga y la posible infiltración subcutánea son complicaciones infrecuentes, pero potencialmente fatales. El uso de ultrasonografía como guía en tiempo real o para localización del puerto ha sido propuesto. Se presenta el caso de un paciente con diagnóstico de espondilitis anquilosante y dolor crónico con fenómenos de neuroplasticidad en manejo analgésico con bomba de infusión intratecal de opioides y necesidad de recarga frecuente, en quien se aplicó un método estático mediante coordenadas utilizando ultrasonido para guiar la recarga de forma exitosa y sin complicaciones. La técnica descrita para la recarga de bombas de infusión intratecal es una manera práctica e innovadora que, con el entrenamiento adecuado, puede disminuir los riesgos y complicaciones durante el procedimiento en pacientes con requerimiento de recarga frecuente.

Manejo de la infección por Helicobacter pylori: apreciación crítica de la literatura / Treatment of the Helicobacter pylori Infection: A Critical Appraisal of the Literature

Introducción: la infección por Helicobacter pylori es un problema de salud pública, dada su relación con cáncer gástrico. El incremento de la resistencia bacteriana limita la erradicación efectiva, a pesar del empleo de diferentes esquemas de tratamiento. Métodos: revisión de la literatura en la base de datos Pubmed/Medline entre el 1 de enero de 2015 y el 31 de diciembre de 2016 sobre el manejo del Helicobacter pylori. Resultados: se incluyeron 26 artículos. La terapia secuencial sobresale como opción de tratamiento de primera línea para escenarios como Colombia. La implementación de coadyuvantes puede influir en las tasas de erradicación. Los estudios de epidemiología local y costo-efectividad son escasos. Conclusiones: el uso y conocimiento adecuado de los esquemas de manejo puede disminuir los costos para el sistema, la resistencia antimicrobiana y favorecer la erradicación de patógenos. Se requieren estudios para generar recomendaciones locales.

Introduction: Helicobacter pylori (H. pylori) infection is a public health problem due to its relationship with gastric cáncer The escalation of antibiotic resistance hampers an effective eradication, despite the availability of treatment options. Methods: A review of the literature was performed in the database PubMed between 01/01/2015 and 31/31/2016. Results: Twenty six articles were included. Sequential therapy stands out as a first line therapy for scenarios such as Colombia. The implementation of adjuvants may have a positive impact on eradication rates. Local epidemiólogo- and cost-effectiveness studies are scarce. The results were analized by erradication therapies, coadyuvant treatment, guidelines and outcomes non mentioned in the guidelines. Conclusions: The correct use and knowledge of the different treatment options could reduce the costs for the health systems, the antibiotics resistance and could favor pathogen eradication. Further studies are required for establishing local recommendations.