Transverse Myelitis in Systemic Lupus Erythematosus: Clinical Features and Prognostic Factors in a Large Cohort of Latin American Patients.

BACKGROUND: Acute transverse myelitis (ATM) is an infrequent but severe complication of systemic lupus erythematosus (SLE). The purpose of study was to describe clinical features and prognostic factors of patients with SLE-related ATM. METHODS: In this medical records review study, data were collected from 60 patients from 16 centers seen between 1996 and 2017 who met diagnostic criteria for SLE and myelitis as defined by the American College of Rheumatology/Systemic International Collaborating Clinics and the Working Group of the Transverse Myelitis Consortium, respectively. Objective neurological impairment was measured with American Spinal Injury Association Impairment Scale (AIS) and European Database for Multiple Sclerosis Grade Scale (EGS). RESULTS: Among patients included, 95% (n = 57) were female, and the average age was 31.6 ± 9.6 years. Myelitis developed after diagnosis of SLE in 60% (n = 36). Symmetrical paraparesis with hypoesthesia, flaccidity, sphincter dysfunction, AIS = A/B, and EGS ≥ 8 was the most common presentation. Intravenous methylprednisolone was used in 95% (n = 57), and 78.3% (n = 47) received intravenous cyclophosphamide. Sensory/motor recovery at 6 months was observed in 75% (42 of 56), but only in 16.1% (9 of 56) was complete. Hypoglycorrhachia and EGS ≥ 7 in the nadir were associated with an unfavorable neurological outcome at 6 months (p < 0.05). A relapse rate during follow-up was observed in 30.4% (17 of 56). Hypoglycorrhachia and hypocomplementemia seem to be protective factors for relapse. Intravenous cyclophosphamide was associated with time delay to relapse. CONCLUSIONS: Systemic lupus erythematosus-related ATM may occur at any time of SLE course, leading to significant disability despite treatment. Relapses are infrequent and intravenous cyclophosphamide seems to delay it. Hypoglycorrhachia, hypocomplementemia, and EGS at nadir are the most important prognostic factors.

Seguridad y supervivencia de las terapias biológicas: primer informe del registro paraguayo-uruguayo de acontecimientos adversos con terapias biológicas Biobadaguay / Safety and survival associated with biologic therapies: first report of the biobadaguay on the Paraguayan-Uruguayan registry of adverse events with biologic therapies

OBJETIVOS: Analizar los acontecimientos adversos (AA) y la supervivencia de las terapias biológicas (TB) en el registro paraguayo-uruguayo de AA, Biobadaguay. MÉTODO: Estudio observacional, prospectivo de duración indeterminada. Se han incluido pacientes al inicio de la TB y controles. Se han registrado variables clínicas, biológicas y relacionadas con el tratamiento. RESULTADOS: Se realizaron 826 registros (650 TB y 176 controles). El 70,9% fueron mujeres y el diagnóstico más frecuente fue la artritis reumatoide (AR) (63,2%). La TB más utilizada fue el adalimumab (56,6%) y la causa más frecuente de interrupción, la ineficacia (42,1%). La incidencia de AA en pacientes con TB fue de 143,9 (128,8-160,8) por 1.000 pacientes/año. En el estudio comparativo de AA en función del diagnóstico, se observó que la artritis idiopática juvenil (AIJ) se asoció a más AA globales (RTI = 2,3; IC 95%: 1,6-3,4; p = 4,27×10−6), mientras que la AR se asoció a un mayor número de AA graves (RTI = 2,20; IC 95%: 1,2-4,1; p = 1,17×10−2). Por otro lado, el tratamiento con tocilizumab se asoció a una mayor tasa de AA (RTI = 2,69; IC 95%: 1,90-3,82; p = 3,13×10−8). El diagnóstico de AIJ, el tratamiento con corticoides y el número de TB previas se asociaron a la disminución de la supervivencia de las TB. CONCLUSIÓN: En este primer informe del registro Biobadaguay, la principal causa de interrupción de la TB fue la ineficacia. Con relación al diagnóstico, la AR y la AIJ se asociaron a un mayor riesgo de AA. En este registro, se identificaron variables relacionadas a una menor supervivencia de las TB

OBJECTIVE: Analyze adverse events (AE) and survival associated with biologic therapies (BT) in the Biobadaguay, the Paraguayan Uruguayan registry of adverse events. METHODS: Prospective, observational study of undetermined duration. Patients on BT at initiation and controls were included. Clinical, biological and treatment variables were registered. RESULTS: A total of 826 registers were entered (650 BT and 176 controls); 70.9% were women and rheumatoid arthritis (RA) was the most frequent diagnosis (63.2%). The BT most often used was adalimumab and the main cause of discontinuation was loss of efficacy (42.1%). The incidence of AE of patients on BT was 143.9 (128.8-160.8) per 1000 patients/year. In the comparative study of AE related to diagnosis, juvenile idiopathic arthrosis (JIA) was associated with a higher overall number of AE (RTI = 2.3; 95%CI: 1.6-3.4; P = 4.27 ×10−6), whereas RA was associated with a higher number of serious AE (RTI = 2.2; 95% CI: 1.2-4.1; P =1.17 ×10−2). On the other hand, treatment with tocilizumab was associated with a higher rate of AE (RTI = 2.69; 95% CI: 1.9-3.82; P = 3.13 ×10−8). In JIA, treatment with corticosteroids and number of previous BT was associated with a decrease in BT survival. CONCLUSION: In this first report of the Biobadaguay registry, the main cause of BT discontinuation was loss of efficacy. In terms of the diagnosis involved, RA and JIA were associated with a higher risk of AE. In this registry, variables related to a shorter survival of BT were identified

Safety and Survival Associated with Biologic Therapies: First Report of the Biobadaguay on the Paraguayan-Uruguayan Registry of Adverse Events with Biologic Therapies. / Seguridad y supervivencia de las terapias biológicas: primer informe del registro paraguayo-uruguayo de acontecimientos adversos con terapias biológicas Biobadaguay.

OBJECTIVE: Analyze adverse events (AE) and survival associated with biologic therapies (BT) in the Biobadaguay, the Paraguayan Uruguayan registry of adverse events. METHODS: Prospective, observational study of undetermined duration. Patients on BT at initiation and controls were included. Clinical, biological and treatment variables were registered. RESULTS: A total of 826 registers were entered (650 BT and 176 controls); 70.9% were women and rheumatoid arthritis (RA) was the most frequent diagnosis (63.2%). The BT most often used was adalimumab and the main cause of discontinuation was loss of efficacy (42.1%). The incidence of AE of patients on BT was 143.9 (128.8-160.8) per 1000 patients/year. In the comparative study of AE related to diagnosis, juvenile idiopathic arthrosis (JIA) was associated with a higher overall number of AE (RTI = 2.3; 95%CI: 1.6-3.4; P = 4.27 ×10-6), whereas RA was associated with a higher number of serious AE (RTI = 2.2; 95% CI: 1.2-4.1; P =1.17 ×10-2). On the other hand, treatment with tocilizumab was associated with a higher rate of AE (RTI = 2.69; 95% CI: 1.9-3.82; P = 3.13 ×10-8). In JIA, treatment with corticosteroids and number of previous BT was associated with a decrease in BT survival. CONCLUSION: In this first report of the Biobadaguay registry, the main cause of BT discontinuation was loss of efficacy. In terms of the diagnosis involved, RA and JIA were associated with a higher risk of AE. In this registry, variables related to a shorter survival of BT were identified.

Serotipos de Listeria Monocytogenes aislados de alimentos producidos en la provincia de Cautín, Chile / Serotypes of Listeria monocytogenes Isolated on Food Produced in Cautin Province, Chile

En Chile se ha aislado Listeria monocytogenes en diversos alimentos. El objetivo de este estudio fue aportar información sobre la presencia de la bacteria en longanizas artesanales (embutidos madurados), leche cruda y hortalizas producidos en la Provincia de Cautín y determinar los serotipos. Las muestras correspondieron a longaniza común artesanal, leche cruda y hortalizas, colectadas durante 2003. Para el aislamiento e identificación de L. monocytogenes se usó la metodología aprobada por el Food and Drug Administration (FDA) con incubación en caldo selectivo preenrriquecimiento para Listeria (35°C), y posterior siembra en medios selectivos Oxford y Palcam (35-37°C). Las colonias típicas fueron replicadas en caldo tripticasa de soya (TSB) y sometidas a pruebas bioquímicas de identificación. La serotipificación se realizó sobre 53 cepas, utilizando un set de antisuero comercial. L. monocytogenes se presentó en el 61,1% de las longanizas, en el 0,0% de las muestras de leche cruda y en el 16,6% de las de hortalizas. Estos resultados podrían indicar fallas en la higiene de la manipulación, en el lavado y sanitización de superficies de contacto con los alimentos. Se determinó la presencia del serotipo 4e en 3 cepas provenientes de longanizas fabricadas en la ciudad de Temuco, y 1 cepa de cada uno de los serotipos virulentos 1/2a, 1/2b y 4b, los dos primeros provenientes de longanizas y el último desde hortalizas. La presencia de estos serotipos 1/2a, 1/2b y 4b, plantean una clara amenaza de un eventual brote, particularmente en consumidores susceptibles. Estos resultados representan un importante desafío de prevención y control para las autoridades sanitarias chilenas.

It has been reported in Chile that L. monocytogenes is present in differents kind of foods. The aim of this study was to obtain information of the occurrence of the bacteria in sausages, raw milk and vegetables produced in Cautín Province, and to know the L. monocytogenes serotypes involved. For this purpose sausages, raw milk and several vegetables samples, were collected on 2003. For the isolation and identification of L. monocytogenes, the samples were grown in tripticase soy broth (TSB) inoculated into a preenrichment broth for Listeria (35°C followed by an inoculation on selectives medias Oxford and Palcam (35-37°C). Biochemical test were performed to all the typical Listeria colonies according to the methodology recommended by Bacteriological Analytical Manual (FDA). Serotyping was carried out using commercial specific antisera on 53 bacterial strains. Results of the analysis indicated the presence of L. monocytogenes in 61.1% of sausages samples, 0.0% in raw milk samples and in 16.6% of vegetables samples. These results could indicate failure in the hygiene practices, like cleaning and sanitizing the surface in contact with the food. The presence of serotipe 4e in 3 strains were found in some sausages. There was a strain of virulent serotype 1/2a, 1/2b and 4b, the first and second resulted isolated from sausages and the third one resulted from vegetables. The presence of serotypes 1/2a, 1/2b and 4b, is a threat of an eventual out-break, especially in persons quite susceptive, that is why, there is a huge risk for pubic health in customers from this region. These results represent for chilean public´s health authorities an enormous challenge for controlling and prevention procedures.