Pan American League of Associations for Rheumatology Recommendations for the Treatment of Psoriatic Arthritis.

OBJECTIVE: Psoriatic arthritis (PsA) is chronic disease that compromises multiple domains and might be associated with progressive joint damage, increased mortality, functional limitation, and considerably impaired quality of life. Our objective was to generate evidence-based recommendations on the management of PsA in Pan American League of Associations for Rheumatology (PANLAR) countries. METHODS: We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to adapt the 2019 recommendations of the European Alliance of Associations for Rheumatology. A working group consisting of rheumatologists from various countries in Latin America identified relevant topics for the treatment of PsA in the region. The methodology team updated the evidence and synthesized the information used to generate the final recommendations. These were then discussed and defined by a panel of 31 rheumatologists from 15 countries. RESULTS: Theses guidelines report 15 recommendations addressing therapeutic targets, use of antiinflammatory agents and corticosteroids, treatment with disease-modifying antirheumatic drugs (conventional synthetic, biologic, and targeted synthetic), therapeutic failure, optimization of biologic therapy, nonpharmacological interventions, assessment tools, and follow-up of patients with PsA. CONCLUSION: Here we present a set of recommendations to guide decision making in the treatment of PsA in Latin America, based on the best evidence available, considering resources, medical expertise, and the patient's values and preferences. The successful implementation of these recommendations should be based on clinical practice conditions, healthcare settings in each country, and a tailored evaluation of patients.

Development of a novel clinimetric tool: PAtient Reported Disease Activity Index in Rheumatoid Arthritis (PARDAI-RA) by PANLAR, for the assessment of patients living with rheumatoid arthritis.

BACKGROUND: Clinical experience has shown that a single measure is not sufficient to assess disease activity in rheumatoid arthritis (RA). Various clinimetric tools are necessary to address the many clinical situations that can arise. METHODS: In order to develop a comprehensive measurement tool, the Pan American League of Associations for Rheumatology searched for the most frequent measures of disease activity applied in RA by means of a semi-systematic review of the available literature. RESULTS: We found that the most frequently reported measures of disease activity were the 28-joint Disease Activity Score, C-reactive protein, and the erythrocyte sedimentation rate, followed by patient-reported measures of pain and stiffness and many other composite indices and patient-reported outcome measures. The most frequent physician-reported sign of disease was the swollen joint count, and the most frequently self-reported feature was the increase in disease activity or flares. CONCLUSION: In this article, we present a new clinimetric tool developed based on expert consensus and on data retrieved from our search. Disease activity can be better assessed by combining various data sources, such as clinical, laboratory, and self-reported outcomes. These variables were included in our novel clinimetric tool. Key Points • The goal of treatment of RA is to achieve the best possible control of inflammation, or even remission; therefore, disease management should include systematic and regular evaluation of inflammation and health status. • Clinimetric tools evaluate a series of variables (e.g., symptoms, functional capacity, disease severity, quality of life, disease progression) and can reveal substantial prognostic and therapeutic differences between patients. • Our clinimetric tool, which is based on a combination of data (e.g., clinical variables, laboratory results, PROMs), can play a relevant role in patient assessment and care.

Pan American League of Associations for Rheumatology recommendations for the management of axial spondyloarthritis.

Axial spondyloarthritis (axSpA) comprises a spectrum of chronic inflammatory manifestations affecting the axial skeleton and represents a challenge for diagnosis and treatment. Our objective was to generate a set of evidence-based recommendations for the management of axSpA for physicians, health professionals, rheumatologists and policy decision makers in Pan American League of Associations for Rheumatology (PANLAR) countries. Grading of Recommendations, Assessment, Development and Evaluation-ADOLOPMENT methodology was used to adapt existing recommendations after performing an independent systematic search and synthesis of the literature to update the evidence. A working group consisting of rheumatologists, epidemiologists and patient representatives from countries within the Americas prioritized 13 topics relevant to the context of these countries for the management of axSpA. This Evidence-Based Guideline article reports 13 recommendations addressing therapeutic targets, the use of NSAIDs and glucocorticoids, treatment with DMARDs (including conventional synthetic, biologic and targeted synthetic DMARDs), therapeutic failure, optimization of the use of biologic DMARDs, the use of drugs for extra-musculoskeletal manifestations of axSpA, non-pharmacological interventions and the follow-up of patients with axSpA.

Epistasis of polymorphisms related to the articular cartilage extracellular matrix in knee osteoarthritis: Analysis-based multifactor dimensionality reduction.

Osteoarthritis (OA) is a complex disease with a multifactorial etiology. The genetic component is one of the main associated factors, resulting from interactions between genes and environmental factors. The aim of this study was to identify gene-gene interactions (epistasis) of the articular cartilage extracellular matrix (ECM) in knee OA. Ninety-two knee OA patients and 147 healthy individuals were included. Participants were genotyped in order to evaluate nine variants of eight genes associated with ECM metabolism using the OpenArray technology. Epistasis was analyzed using the multifactor dimensionality reduction (MDR) method. The MDR analysis showed significant gene-gene interactions between MMP3 (rs679620) and COL3A1 (rs1800255), and between COL3A1 (rs1800255) and VEGFA (rs699947) polymorphisms, with information gain values of 3.21% and 2.34%, respectively. Furthermore, in our study we found interactions in high-risk genotypes of the HIF1AN, MMP3 and COL3A1 genes; the most representative were [AA+CC+GA], [AA+CT+GA] and [AA+CT+GG], respectively; and low-risk genotypes [AA+CC+GG], [GG+TT+GA] and [AA+TT+GA], respectively. Knowing the interactions of these polymorphisms involved in articular cartilage ECM metabolism could provide a new tool to identify individuals at high risk of developing knee OA.

Riesgos prenatales, perinatales y neonatales asociados a signos neurológicos blandos / Prenatal, perinatal and neonatal risks associated with soft neurological signs

Introducción: Los signos neurológicos blandos se han asociado con dificultades motoras, alteraciones comportamentales menores e incluso como factores de vulnerabilidad para la aparición de afecciones como, esquizofrenia, trastorno de déficit de atención e hiperactividad, trastorno disocial y episodios psicóticos. Aunque la investigación sobre los signos ha venido aumentando, no se tiene claridad sobre qué puede predisponer su aparición. Objetivo: Describir la asociación entre factores de riesgo prenatales, perinatales y neonatales y la aparición de los signos neurológicos blandos en niños con estos factores riesgo y en niños sin ellos. Métodos: Estudio de tipo descriptivo comparativo, de corte transversal, con diseño no experimental. La población en estudio se conformó por 550 niños y niñas, con edades entre seis y ocho años organizados. en cuatro grupos: los que presentaban riesgos prenatales, perinatales, neonatales, y el grupo que no presentaba ningún riesgo. Las aplicaciones se llevaron a cabo durante el primer semestre de 2017. Los datos se tomaron de las historias clínicas y los. signos neurológicos blandos se evaluaron a través del apartado de la Evaluación Neuropsicológica Infantil. Resultados: La mayoría de los signos neurológicos blandos presentaron diferencias significativas y valores altos en la comparación de los rendimientos en cada uno de los grupos con riesgo. Conclusiones: la presencia de riesgos prenatales, perinatales y neonatales producen una serie de alteraciones en el desarrollo del niño que se van acumulando y pueden estar asociados con la aparición de los signos neurológicos blandos(AU)

Introduction: The soft neurological signs have been associated with motor difficulties, lower behavioural alterations and even with vulnerability factors for the appearance of conditions such as schizophrenia, attention deficit disorder and hyperactivity, disocial disorder and psychotic episodes. Although research on the signs has been increasing, it is not clear what may predispose their appearance. Objective: To describe the association between prenatal, perinatal and neonatal risk factors and the appearance of the soft neurological signs in children with these risk factors and in children without them. Methods: Descriptive, comparative, cross-sectional non-experimental design´s study. The study´s population was formed by 550 boys and girls between the ages of six and eight years organized in four groups: with prenatal risks, with perinatal risks, with neonatal risks, and the group that did not present any risks. The tests were carried out during the first semester of 2017. The data were taken from the medical records and the soft neurological signs were evaluated through the item called Neuropsychological Assessment of Children. Results: Most of the soft neurological signs showed significant differences and high values in the performance comparison in each of the groups with risks. Conclusions: The presence of prenatal, perinatal and neonatal risks produce a series of alterations in the development of the child that are accumulated and may be associated with the appearance of the soft neurological signs(AU)

Geographical trends of chikungunya and Zika in the Colombian Amazonian gateway department, Caqueta, 2015-2018 - Implications for public health and travel medicine.

BACKGROUND: Chikungunya (CHIKV) and Zika (ZIKV) significantly affected Latin America in the period 2015-2017. Most studies were reported from urban areas of Brazil and Colombia. In this paper we estimate Incidence rates for CHIKV and ZIKV in Caqueta, the Amazonian gateway area of Colombia, from 2015 to 2018. METHODS: Using surveillance data of CHIKV and ZIKV in Caqueta, Colombia, incidence rates were estimated (cases/100,000 population). Sixteen geographical information systems (GIS)-based municipal maps were developed. GIS software used was Kosmo 3.0®. RESULTS: From 1st of January 2015 to the 24th of November 2018, 825 cases of CHIK and 1079 of ZIKV were reported, yielding cumulated incidence rates of 169.42 and 221.59 cases/100,000 population respectively. In 2016, 48.7% of the CHIKV cases (402) and 96.6% of the ZIKV cases (1042) were reported. The highest number of both arboviral diseases occurred at Florencia (capital department city), 225 cases for CHIKV (127.17 cases/100,000 pop.) and 611 for ZIKV (345.34 cases/100,000 pop.). DISCUSSION: The temporo-spatial distribution of CHIKV and ZIKV infections in Caquetá reflected the pattern of concurrent epidemics, especially in 2016. Studies using GIS-linked maps are necessary to attain accurate epidemiological analyses for public health decisions. That is also useful for an epidemiologically based assessment of traveler risks when visiting specific areas in destination countries.

Impact of the gene-gene interactions related to the HIF-1α signaling pathway with the knee osteoarthritis development.

INTRODUCTION/OBJECTIVES: Articular cartilage is the target tissue of osteoarthritis (OA), and because it lacks capillary networks, the microenvironment is hypoxic. Hypoxia inducible factor-1 alpha (HIF-1α) regulates the homeostasis of this tissue. The aim of this study was to investigate whether genetic polymorphisms of the HIF-1α signaling pathway are involved in the development of knee OA. METHOD: We performed a case-control association study and genotyped 134 knee OA patients and 267 healthy controls. All participants were genotyped in order to evaluate 42 SNPs from 22 genes involved in the HIF-1α signaling pathway using the OpenArray technology. Gene-gene interactions (epistasis) were analyzed using the multifactor dimensionality reduction (MDR) method. RESULTS: The MDR analysis showed epistasis between AKT2 (rs8100018) and IGF1 (rs2288377), AKT2 (rs8100018) and IGF1 (rs35767), IGF1 (rs35767) and COL2A1 (rs1793953), and between GSK3B (rs6438552) and IGF1 (rs35767) polymorphisms, with information gain values of 21.24%, 8.37%, 9.93%, and 5.73%, respectively. Additionally, our model allowed us to identify high- and low-risk genotypes among COL2A1 rs1793953, GSK3B rs6438552, AKT2 rs8100018, and IGF1 rs35767 polymorphisms. CONCLUSIONS: Knowing the interactions of these polymorphisms involved in HIF-1α signaling pathway could provide a new diagnostic support tool to identify individuals at high risk of developing knee OA.

Gene-gene interactions of the Wnt/ß-catenin signaling pathway in knee osteoarthritis.

This study was designed to investigate whether genetic polymorphisms of the Wnt/ß-catenin signaling pathway and its interactions are involved in the development of knee osteoarthritis (KOA). Patients with KOA (n = 131) and healthy individuals (n = 190) with different ancestry from two Mexican populations (Mexico City and Guadalajara City) were analyzed. Twenty-five SNPs from thirteen genes (WISP1, DKK1, SOST, FRZB, LRP1, LRP4, LRP5, LRP6, GSKB, ADAMTS5, GDF5, FMN2 and COL11A1) involved in the Wnt/ß-catenin signaling pathway were genotyped. Genetic and allelic frequencies and gene-gene interactions were performed for this study. After adjusting for age, sex, BMI and admixture, significant associations were found for five SNPs in Mexico City: LRP6 rs12314259 (G/G genotype OR 0.22, P = 0.029; and G allele OR 0.48, P = 0.022), SOST rs851054 (C/T genotype OR 0.42, P = 0.027; and T allele OR 0.62, P = 0.026), FMN2 rs986690 (G/A genotype OR 0.42, P = 0.034; and A allele OR 0.50, P = 0.015), FRZB rs409238 (A/G genotype, OR 2.41, P = 0.022), and COL11A1 rs2615977 (A/C genotype OR 2.39, P = 0.024); no associations for Guadalajara City were found. With respect to gene-gene interactions, the pairwise interactions of WISP1-COL11A1, COL11A1-FRZB, FRZB-SOST and WISP1-FMN2 make it possible to visualize the synergistic or antagonistic effect of their genotypes or alleles in both populations. These results suggest that gene-gene interactions in the Wnt/ß-catenin signaling pathway play a role in the etiology of KOA.

The association of AKNA gene polymorphisms with knee osteoarthritis suggests the relevance of this immune response regulator in the disease genetic susceptibility.

Recent studies have identified AKNA as a potential susceptibility gene for several inflammatory diseases. Here, we aimed to assess the potential association of AKNA polymorphisms with knee osteoarthritis (KOA) susceptibility in a Mexican population, following STREGA recommendations. From a DNA bank of 181 KOA patients and 140 healthy controls, two AKNA SNPs were genotyped using TaqMan probes. The association between KOA susceptibility and AKNA polymorphisms genotypes was evaluated by multivariated logistic regression analysis. Information regarding patients' inflammatory biomarkers levels was obtained and their association with AKNA polymorphisms genotypes was assessed by lineal regression. We found a positive association with the recessive inheritance model of both AKNA polymorphisms (A/A genotype for both) and KOA susceptibility adjusting by age, body mass index (BMI), gender and place of birth (OR = 2.48, 95% CI 1.09-5.65 for rs10817595 polymorphism; and OR = 4.96; 95% CI 2.421-10.2 for rs3748176 polymorphism). Additionally these associations were also seen after stratifying patients by KOA severity and age. Furthermore the total leukocyte count was positively associated with rs10817595 AKNA polymorphism (ß = 1.39; 95% CI 0.44-2.34) adjusting by age, BMI, gender, place of birth and disease severity. We suggest that regulatory and coding polymorphisms of the inflammatory modulator gene AKNA can influence the development of KOA. Further structural and functional studies might reveal the role of AKNA in OA and other rheumatic diseases.

Rates of Serious Infections in HIV-Infected Patients Receiving Tumor Necrosis Factor Inhibitor Therapy for Concomitant Autoimmune Diseases.

OBJECTIVE: To estimate the incidence of serious infections in patients with HIV infection and autoimmune disease who were treated with tumor necrosis factor (TNF) inhibitors, and to compare these rates by stratified viral load levels. METHODS: Using a unified search strategy, 4 centers identified HIV-infected patients exposed to TNF inhibitors. Patient characteristics and infection data were assessed via chart review in all patients who were ≥18 years old and who received TNF inhibitor therapy after HIV diagnosis, between January 1999 and March 2015. RESULTS: We studied 23 patients with 26 uses of TNF inhibitor therapy (86.7 person-years of followup). Two (8.7%) experienced at least 1 serious infection episode, for an overall incidence rate of 2.55 per 100 patient-years (95% confidence interval [95% CI] 0.28-9.23). The incidence rate per 100 patient-years was 3.28 (95% CI 0.04-18.26) among patients with a viral load >500 copies/ml at therapy initiation and 2.09 (0.03-11.65) among patients with a viral load ≤500 copies/ml. CONCLUSION: This study suggests that the rate of serious infections in patients with HIV infection under active care who have received treatment with TNF inhibitors may be comparable to the rates observed in registry databases.

Review of Current Workforce for Rheumatology in the Countries of the Americas 2012-2015.

BACKGROUND: With the increases in and aging of the populations of the Americas, monitoring the number of rheumatologists is critical to address and focus on areas of greatest need. OBJECTIVES: The aim of this study was to gather data on the rheumatology workforce from 21 national societies in the Pan American League of Associations for Rheumatology (PANLAR). METHODS: In September and October 2012 and again in October and November 2015, the heads of the 21 rheumatology national societies were contacted in the 2012 survey; all national societies responded except Cuba. In the 2015 survey, all responded except Nicaragua, for which information was provided by national society presidents in adjacent countries. RESULTS: The data from 21 societies contained in PANLAR consist of 10,166 adult and 678 pediatric rheumatologists serving 961 million people. The number of rheumatologists per 100,000 population varies greatly from 3.9 per 100,000 people (Uruguay) to 0.11 per 100,000 people (Nicaragua). The number of training programs also varies widely, with some countries having no indigenous programs. The distribution of rheumatologists is mainly in the large cities, particularly in the smaller countries. Pediatric rheumatologists have dramatically increased in number in 2012, but 96% reside in 6 countries. This remains an underserved area in most countries. CONCLUSIONS: The rheumatology workforce in the Americas has improved between 2012 and 2015, especially in the number of pediatric rheumatologists. However, numerically and in the perception of the 21 member societies of PANLAR, the number is still inadequate to meet the increasing demands for rheumatologic care, especially in the care of children with rheumatic disease and in rural areas.

Ultrasound in the interstitial pulmonary fibrosis. Can it facilitate a best routine assessment in rheumatic disorders?

Ultrasound (US) is increasing its potential in the assessment of several rheumatic disorders. Recently, different applications of this imaging technique have emerged. Interesting data supporting its utility and validity in the assessment of the lung to detect and quantify interstitial pulmonary fibrosis in rheumatic diseases, even in subclinical phases, have been reported. The main purpose of this review is to provide an overview of the role of US in the assessment of interstitial pulmonary fibrosis in rheumatic disorders and to discuss the current evidence supporting its clinical relevance in daily clinical practice.

Relación entre madurez neuropsicológica y presencia-ausencia de la conducta de gateo / Neuropsychological relationship between maturity and presence-absence of crawling behavior

Resumen La madurez neuropsicológica es el nivel de organización y desarrollo madurativo que permite el desenvolvimiento de funciones conductuales y cognitivas acordes a la edad del individuo. La conducta de gateo es el primer movimiento armónico en el cual el bebé hace uso de su cabeza y de sus extremidades. Dicha conducta permite el establecimiento de conexiones entre los hemisferios cerebrales que dan lugar a la intercomunicación que simplifica el trabajo del cerebro y favorece la maduración de las funciones cognitivas. El objetivo de esta investigación fue comparar la madurez neuropsicológica en niños de 5 y 6 años de edad que presentaron la conducta de gateo con niños que no la presentaron. La muestra estuvo conformada por 50 estudiantes de colegios privados. Fue un estudio cuantitativo con un diseño transversal-descriptivo-comparativo, en el que se usó la historia clínica y el cuestionario para padres de la batería de Evaluación Neuropsicológica Infantil (ENI) de Matute, Rosselli, Ardila y Ostrosky (2007) y del Cuestionario de Madurez Neuropsicológica Infantil (CUMANIN). Se concluyó, a través de los estadísticos aplicados de Shapiro Wilcoxon, al comparar las puntuaciones de los 2 grupos, que la escala de psicomotricidad, posiblemente, depende del gateo. Con respecto al rendimiento, al comparar los 2 grupos con el estadístico Chi-cuadrada, se evidenciaron mejores resultados en 9 escalas del grupo formado por los que presentaron la conducta de gateo.

Neuropsychological maturity is the level of organization and maturational development that allows the development of behavioral and cognitive age-appropriate individual functions, crawling behavior is the first harmonic motion in which the baby uses his head and his both lower extremities as superior, to support and move, it allows the establishment of connections between brain hemispheres, leading to the intercom that simplifies the work of the brain and promotes the maturation of the cognitive functions of the infant, the objective of this research was compare neuropsychological maturity in children 5 and 6 years of age who presented behavior crawling with those who had not, the sample consisted of 50 students from private schools in central Colombia. It was a quantitative study with a comparative-descriptive cross-sectional design, in which the history and the parent questionnaire battery neuropsychological evaluation Infantil (ENI) developed by Matute, Rosselli, Ardila y Ostrosky (2007) and was used Maturity Questionnaire Neuropsychological Children (CUMANIN). First, he made the selected sample, the instruments are applied, and the results were analyzed and finally publicly sustained research. It was concluded through statistical Wilcoxon Shapiro applied to compare the scores of the two groups possibly psychomotor scale depends on crawling; regarding the performance when comparing the 2 groups with the Chi-square statistic best results are evidenced in nine scales the group presented crawling behavior with respect to the group that did not crawl.

Aspectos bioéticos de la conducta expectante en la gestante con preeclampsia grave / Bioethical aspects of expectant management in pregnant with severe preeclampsia

Objetivo: Describir los aspectos bioéticos que interactúan en la conducta expectante de la gestante con hipertensión arterial inducida por el embarazo en el Servicio de Medicina Materno Fetal de la Maternidad “Concepción Palacios”. Caracas, Venezuela 2011. Métodos: Se aplicó consentimiento informado a 188 pacientes a quien se les propuso conducta expectante, se indagó mediante cuestionario su opinión y de los médicos que actuaron en cada caso aplicando los cuatro principios básicos de la bioética. Resultados: A mayor nivel educativo, la paciente tiene mayor disponibilidad de aceptar los riesgos para la conducta expectante. Hubo 168 pacientes dispuestas a continuar el embarazo y 20 a interrumpirlo, todas las que aceptaron continuarlo a pesar de los riesgos, mostraron confianza en la información recibida. Desde la óptica del médico, se pudo apreciar que para determinar la jerarquía de los principios bioéticos en el siguiente orden: autonomía, justicia, beneficencia y no maleficencia. Cuando la conducta era negada la jerarquía cambiaba al siguiente orden: no maleficencia, beneficencia, justicia y autonomía. Diferentes opiniones se obtuvo según el estatus del médico. Conclusiones: La preeclampsia es causa importante de morbimortalidad por lo que la conducción médica, debe ser realizada a través de la aplicación de un consentimiento informado, y no involucrar los sentimientos del médico en la toma de decisiones de las pacientes.

Objective: To describe the bioethics aspects that interact in the expectant conduct of the pregnant woman with arterial hypertension induced by pregnancy at the Maternal Fetal Medicine Service of the Maternity “Concepcion Palacios”, Caracas Venezuela 2011. Methods: Informed consent was implemented to 188 patients that were proposed of expectant conduct, it was elicited by questionnaire their opinion and of the medical personal that acted in each case implementing the four bioethical principles. Results: At higher educational level, the patient has mayor availability of accepting the risks for the expectant conduct. 168 patients were willing to continue the pregnancy and 20 were willing to interrupt it, all of the patients that accepted continuing their pregnancy although risks, revealed trust in the received information. From the medical personal view, it was revealed that in order to determine the hierarchy of the bioethical principles they state in a first place the autonomy, then justice, then beneficence and lastly nonmaleficence. When the conduct was negated the hierarchy was changed to: Non-maleficence, beneficence, justice and autonomy. Different opinions were obtained according to the status of the medical personal. Conclusions: Preeclampsia is an important cause of morbidity and mortality for that purpose medical conduction must be realized through the application of the informed consent, not involving the medical personal’s feelings in the decisions of the patient.

Regional distribution of adult rheumatologists.

OBJECTIVE: To analyze the distribution of rheumatology practices in the US and factors associated with that distribution, in order to better understand the supply of the rheumatology workforce. METHODS: Using the American College of Rheumatology membership database, all practicing adult rheumatologist office addresses were mapped with ArcView software. The number of rheumatologists per Core Based Statistical Area (CBSA) was calculated. To investigate whether sociodemographic factors correlated with clustering of rheumatologists, covariates from the 2010 US Census for each CBSA, including age, sex, race/ethnicity, and median household income, were modeled. RESULTS: Many CBSAs, predominantly smaller micropolitan areas, did not have a practicing rheumatologist. For some of these smaller micropolitan areas (with populations of at least 40,000), the closest practicing rheumatologist was more than 200 miles away. However, we also identified several more-populous areas (populations of 200,000 or more) without a practicing rheumatologist. Greater numbers of rheumatologists were more likely to practice in areas with higher population densities and higher median incomes. More rheumatologists were also found in CBSAs in which there were rheumatology training programs. CONCLUSION: These findings demonstrate that many smaller regions of the country have no or few practicing adult rheumatologists. Patients with chronic rheumatic conditions in these areas likely have limited access to rheumatology care. Policy changes could address potential regional rheumatology workforce shortages, but limitations of the current data would need to be addressed prior to implementation of such changes.

Factores etiopatogénicos de la prematuridad en el hospital universitario Sant Joan de Déu de Barcelona / Etiopathogenic factors of prematurity in the Sant Joan de Déu Hospital in Barcelona (Spain)

Objetivo. Determinar la tasa de partos prematuros durante el 2010 en el Hospital Universitario Sant Joan de Déu de Barcelona, y clasificarlos según la causa principal utilizando un algoritmo de asignación etiológica para establecer las principales causas de parto prematuro. Sujetos y métodos. Se revisan todos los partos prematuros de menos de 37 semanas de gestación que se producen en el Hospital Universitario Sant Joan de Déu de Barcelona durante 2010 (396 casos), y se les asigna un grupo de etiología principal. Resultados. La tasa de parto prematuro es de 9,8%. Las causas inflamatorias representan el 36% de todos los partos prematuros seguidas de las causas idiopáticas (29%). En los partos prematuros de gestaciones múltiples las causas inflamatorias alcanzan el 44%. Conclusiones. Las causas inflamatorias son la principal etiología de parto prematuro, siendo más frecuente en las gestaciones múltiples (AU)

Objective. To determine the rate of preterm births in 2010 at the Sant Joan de Déu University Hospital in Barcelona, and classify them according to the main cause by using a mapping algorithm to establish the main etiological causes of preterm birth. Subjects and methods. All preterm births at less than 37 weeks’ gestation occurring in the Sant Joan de Déu University Hospital in 2010 (n=396) were reviewed and assigned to a group according to their primary etiology. Results. The preterm birth rate was 9.8%. Inflammatory causes accounted for 36% of all preterm births followed by idiopathic causes (29%). In preterm deliveries of multiple gestations, inflammatory causes accounted for 44%. Conclusions. Inflammatory causes are the main etiology of preterm births and are more common in multiple gestations (AU)

Características clínicas y evolución de los donantes de hígado para trasplante hepático modalidad vivo a vivo / Clinical features and outcome of liver donors for living donor liver transplantation

El trasplante hepático es la única opción terapéutica de los pacientes con enfermedad hepática terminal. El trasplante de donante cadavérico es menos probable en nuestro país. Por esto se desarrolló el programa de trasplante hepático de donante vivo desde el año 2005 en nuestro país. Se revisaron las historias de 39 donantes. Cada donante fue sometido al protocolo de evaluación pretrasplante incluyendo, laboratorio, angiotomografía, colangioresonancia, evaluación psiquiátrica, social y biopsia hepática de ser necesaria. Incluimos 39 individuos entre 18 y 52 años. Solo 9 donantes presentaron complicaciones: 4 colecciones intraabdominales, 4 infecciones de la herida, 2 fístulas biliares, 1 endocarditis, 1 enterocolitis y 1 ameritó reintervención por colección intraabdominal. No se registró mortalidad. Se realizaron 17 hepatectomías laterales izquierdas, 15 izquierdas, y 7 derechas. Posterior a 3 meses los donantes tenían el mismo volumen hepático previo a la donación. Todos están en condiciones físicas satisfactorias y regresaron a sus actividades cotidianas entre 1 y 3 meses después de la donación. La evolución de todos los donantes fue satisfactoria lográndose la reincorporación a sus actividades habituales en corto plazo. El trasplante hepático de donante vivo relacionado es un procedimiento seguro para los donantes

Liver transplantation is the only therapeutic option for patients with end stage liver disease. Liver transplantation from cadaveric donors is less probable in our country. For all this the living donor liver transplantation program was developed in our country since 2005. The medical histories of 39 donors were reviewed. Each donor underwent the pretransplant evaluation protocol that includes laboratory, angioTAC, colangioMRI, psychiatric, social evaluation and hepatic biopsy if necesary. We included 39 individuals with ages between 18 and 52 years. Only 9 donors developed complications: 4 intraabdominal collections, 4 wound infections, 2 biliary fistulae, 1 endocarditis, 1 enterocolitis, and 1 patient needed surgery for an intrabdominal collection. No mortality has been registered. 17 left lateral, 15 left and 7 right hepatectomies were done. After 3 months the donors had the same hepatic volume prior to donation surgery. They are all in excellent physical conditions and have returned to their daily activities within a period between 1 and 3 months after donation. The outcome of each donor was satisfactory being able to return to their daily activities in a short term. Living donor liver transplantation is a safe procedure for donors and constitutes an alternative for our patients that need hepatic transplantation

Cerclaje cervicouterino transabdominal en el embarazo: a propósito de 3 casos / Transabdominal cervicouterine cerclage in pregnancy: a report of 3 cases

Evaluar la técnica de cerclaje cervicouterino transabdominal durante la gestación. Estudio prospectivo, donde se seleccionaron 3 pacientes embarazadas, que cumplían los criterios de inclusión a las cuales se les realizó la técnica de cerclaje cervicouterino transabdominal entre las 14 y 17 semanas de gestación. Maternidad “Concepción Palacios”. En los 3 casos realizados se presentó una efectividad del método del 100 por ciento, lo cual es comparable con la experiencia internacional. El cerclaje cervicouterino transabdominal es una técnica reservada para pacientes bien seleccionadas que cumplan las indicaciones para su realización. Tiene buen resultado perinatal con baja incidencia de complicaciones durante su realización y durante el curso de la gestación

To evaluate the transabdominal cervicouterine cerclage technique during gestation. Prospective study of 3 pregnant patients that met the inclusion criteria to whom a transabdominal cervico-uterine cerclage technique was performed between 14 to 17 weeks of gestation. Maternidad “Concepcion Palacios”. In the 3 cases the method effectivity was 100 percent, comparable with the international experience. The transabdominal cervicouterine celclage is a technique reserved for selected patients that met the indications for its realization. It has a good perinatal result with low incidence of complications during the procedure and in the course of gestation