Intervención educativa sobre COVID-19 en adultos mayores del Consultorio Médico de la Familia No. 4. Cumanayagua, 2020 / Educational intervention on COVID-19 in older adults of the Family Doctor´s Office No. 4. Cumanayagua, 2020

RESUMEN Fundamento la pandemia de COVID-19 causa la muerte de muchas personas, fundamentalmente adultos mayores. Conocer sobre ella es una forma de prevenirla. Objetivo describir los resultados de una intervención educativa sobre COVID-19, en adultos mayores. Métodos intervención educativa realizada en un universo constituido por 230 adultos mayores, del que se seleccionó una muestra de 178 ancianos dispensarizados pertenecientes al consultorio No. 4 del Consejo Popular Brisas, en Cumanayagua. Se realizó un diagnóstico para identificar el nivel de conocimientos sobre la COVID-19, en el que se indagó sobre aspectos acerca de la enfermedad, tales como: síntomas, medidas de prevención, vías de transmisión. También se les preguntó sobre el cumplimiento de las medidas de prevención. Sobre esa base se desarrolló una intervención educativa. Resultados el 50 % presenta factores de riesgo; el conocimiento sobre sintomatología aumentó de 10, 1 % antes de la intervención a 100 % después; sobre vías de transmisión de 35, 9 % a 83,7 % y el de las medidas preventivas de 53, 9 % a 91,7 %. Aprendieron a utilizar el nasobuco de manera correcta. La satisfacción de los adultos mayores con las acciones educativas fue alta. Conclusiones después de la aplicación de las acciones educativas existió un aumento en el conocimiento sobre la enfermedad, lo que puede ser favorable para su prevención en este grupo de ancianos.

ABSTRACT Background: the COVID 19 pandemic causes the death of many people, mainly older adults. Knowing about it is one way to prevent it. Objective: to describe the results of an educational intervention on COVId 19, in older adults Methods: educational intervention carried out in a universe of 230 older adults, from which a sample of 178 dispensed elderly people belonging to the Family Doctor´s Office No. 4 in Cumanayagua was selected. A diagnosis was made to identify the level of knowledge about COVID-19, in which aspects about the disease were investigated, such as: symptoms, prevention measures, transmission routes. They were also asked about compliance with prevention measures. On that basis, an educational intervention was developed. Results: The 50 % present risk factors; knowledge about symptoms increased from 10.1% before the intervention to 100% after; on transmission routes from 35.9 % to 83.7 % and that of preventive measures from 53.9 % to 91.7 %. They learned to use the mask correctly. The satisfaction of the elderly with the educational actions was high. Conclusions: after the application of educational actions, there was an increase in knowledge about the disease, which may be favorable for its prevention in this group of elderly.

Effectiveness of switching between TNF inhibitors in patients with axial spondyloarthritis: is the reason to switch relevant?

BACKGROUND: To investigate whether the reason to discontinue the first TNF inhibitor (TNFi) affects the response to the second TNFi in axial spondyloarthritis (axSpA). METHODS: Patients with axSpA from the Rheumatic Diseases Portuguese Register (ReumaPt), who discontinued their first TNFi and started the second TNFi between June 2008 and May 2018, were included. Response was assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS) clinically important improvement (ASDAS-CII), major important improvement (ASDAS-MI), low disease activity (ASDAS-LDA), and inactive disease (ASDAS-ID). The reason for discontinuation of the first TNFi was defined, according to ASDAS-CII as primary failure (no response ≤ 6 months), secondary failure (response ≤ 6 months but lost thereafter), adverse events, and others. The association between the reason for discontinuation of the first TNFi and response to the second TNFi over time was assessed in multivariable generalized equation (GEE) models. RESULTS: In total, 193 patients were included. The reason for discontinuation of the first TNFi did not influence the response to the second TNFi, according to the ASDAS-CII. However, a difference was found with more stringent outcomes, e.g., there was a higher likelihood to achieve ASDAS-ID with the second TNFi for patients discontinuing the first TNFi due to secondary failure (OR 7.3 [95%CI 1.9; 27.7]), adverse events (OR 9.1 [2.5; 33.3]), or other reasons (OR 7.7 [1.6; 37.9]) compared to primary failure. CONCLUSION: Patients with axSpA with secondary failure to their first TNFi, compared to those with primary failure, have a better response to the second TNFi according to stringent outcomes.

Eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAI.

OBJECTIVES: To compare definitions of high disease activity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in selecting patients for treatment with biologic disease-modifying antirheumatic drugs (bDMARDs). METHODS: Patients from Rheumatic Diseases Portuguese Register (Reuma.pt) with a clinical diagnosis of axial spondyloarthritis (axSpA) were included. Four subgroups (cross-tabulation between ASDAS (≥2.1) and BASDAI (≥4) definitions of high disease activity) were compared regarding baseline characteristics and response to bDMARDs at 3 and 6 months estimated in multivariable regression models. RESULTS: Of the 594 patients included, the majority (82%) had both BASDAI≥4 and ASDAS ≥2.1. The frequency of ASDAS ≥2.1, if BASDAI<4 was much larger than the opposite (ie, ASDAS <2.1, if BASDAI≥4): 62% vs 0.8%. Compared to patients fulfilling both definitions, those with ASDAS ≥2.1 only were more likely to be male (77% vs 51%), human leucocyte antigen B27 positive (79% vs 65%) and have a higher C reactive protein (2.9 (SD 3.5) vs 2.1 (2.9)). Among bDMARD-treated patients (n=359), responses across subgroups were globally overlapping, except for the most 'stringent' outcomes. Patients captured only by ASDAS responded better compared to patients fulfilling both definitions (eg, ASDAS inactive disease at 3 months: 61% vs 25% and at 6 months: 42% vs 25%). CONCLUSION: The ASDAS definition of high disease activity is more inclusive than the BASDAI definition in selecting patients with axSpA for bDMARD treatment. The additionally 'captured' patients respond better and have higher likelihood of predictors thereof. These results support using ASDAS≥2.1 as a criterion for treatment decisions.

Early onset of Chanarin-Dorfman syndrome with severe liver involvement in a patient with a complex rearrangement of ABHD5 promoter.

BACKGROUND: α/ß-hydrolase domain-containing protein 5 (ABHD5) plays an important role in the triacylglycerols (TAG) hydrolysis. Indeed, ABHD5 is the co-activator of adipose triglyceride lipase (ATGL), that catalyses the initial step of TAG hydrolysis. Mutations in ABHD5 gene are associated with the onset of Chanarin-Dorfman syndrome (CDS), a rare autosomal recessive lipid storage disorder, characterized by non-bullous congenital ichthyosiform erythroderma (NCIE), hepatomegaly and liver steatosis. CASE PRESENTATION: We describe here a 5-years-old Brazilian child who presented with NCIE at birth and diffuse micro and macro-vesicular steatosis on liver biopsy since she was 2 years old. Molecular analysis of coding sequence and putative 5' regulatory region of ABHD5 gene was performed. A homozygous novel deletion, affecting the promoter region and the exon 1, was identified, confirming the suspected diagnosis of CDS for this patient. RT-PCR analysis showed that the genomic rearrangement completely abolished the ABHD5 gene expression in the patient, while only a partial loss of expression was detected in her parents. This is the first report describing the identification of a large deletion encompassing the promoter region of ABHD5 gene. The total loss of ABHD5 expression may explain the early onset of CDS and the severe liver involvement. After molecular diagnosis, the patient started a special diet, poor in fatty acids with medium chain triglycerides (MCT), and showed hepatic and dermatologic improvement in spite of severe molecular defect. CONCLUSIONS: This case report extends the spectrum of disease-causing ABHD5 mutations in CDS providing evidence for a novel pathogenic mechanism for this rare disorder. Moreover, our preliminary data show that early diagnosis and prompt treatment of neutral lipid accumulation might be useful for CD patients.

A FRAX model for the estimation of osteoporotic fracture probability in Portugal.

INTRODUCTION: The objective of this study was to develop a Portuguese version of the World Health Organization fracture risk assessment tool (FRAX®). METHODS: All cases of hip fracture occurred at or after 40 years of age were extracted from the Portuguese National Hospital Discharge Register from 2006 to 2010. Age and sex-ranked population estimates and mortality rates were obtained from National Statistics. Age- and gender stratified incidences were computed and the average of the five years under consideration was taken. Rates for other major fractures were imputed from the epidemiology of Sweden, as undertaken for most national FRAX® models. All methodological aspects and results were submitted to critical appraisal by a wide panel of national experts and representatives of the different stakeholders, including patients. RESULTS: Hip fracture incidence rates were higher in women than in men and increased with age. The lowest incidence was observed in 40-44 years group (14.1 and 4.0 per 100,000 inhabitants for men and women, respectively). The highest rate was observed among the 95-100 age-group (2,577.6 and 3,551.8/100,000 inhabitants, for men and women, respectively). The estimated ten-year probability for major osteoporotic fracture or hip fracture increased with decreasing T-score and with increasing age. CONCLUSIONS: Portugal has one of the lowest fracture incidences among European countries. The FRAX® tool has been successfully calibrated to the Portuguese population, and can now be used to estimate the ten-year risk of osteoporotic fractures in this country. All major stakeholders officially endorsed the Portuguese FRAX® model and co-authored this paper.

[Portuguese recommendations for pain management by pharmocotherapy in inflammatory arthritis]. / Recomendações portuguesas para o tratamento e controlo farmacológico da dor nas artropatias inflamatórias.

OBJECTIVES: To develop Portuguese evidence-based recommendations for pain management by pharmocotherapy in inflammatory arthritis. METHODS: The Portuguese project was integrated in the multinational 3E Initiative (Evidence, Expertise, Exchange) 2010 where a total of 453 rheumatologists from 17 countries have participated. The clinical questions concerning pain were formulated and the Portuguese group added 2 more questions. A systematic literature search was performed in Medline, Embase, Cochrane Library and 2008-2009 EULAR and ACR abstracts. The selected articles were systematically reviewed and the evidence was defined according to the Oxford Levels of Evidence. In each country a group of experts joined to discuss their national recommendations. In Portugal, the national meeting was held in October 2010, where 33 rheumatologists discussed and voted by Delphi method the national recommendations. Finally, the agreement among the rheumatologists and the potential impact on their clinical practice was assessed. RESULTS: Thirteen national recommendations were formulated: pain measure scores; analgesic combination therapy; pharmacotherapy in preconception, pregnancy and lactation periods; pharmacotherapy according to comorbilities; safety of NSAIDs and/or paracetamol with methotrexate combination therapy; efficacy and safety of continuous/on-demand NSAIDs; opioids, paracetamol, corticosteroids, antidepressants, neuromodulators and muscle relaxants role and effectiveness; risk factors for the development of chronic pain and the role of topic analgesics. CONCLUSION: The portuguese recommendations for the pain management by pharmacotherapy in inflammatory arthritis were formulated according to the best evidence and supported by a panel of 63 rheumatologists. The differences between the national and international recommendations are reported in this article.

2011 Portuguese recommendations for the use of biological therapies in patients with psoriatic arthritis.

OBJECTIVE: To develop recommendations for the treatment of psoriatic arthritis (PsA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. At a national meeting the recommendations were discussed and all attending rheumatologists voted on the level of agreement for each recommendation. A second draft was again circulated before publication. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with PsA. Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, enthesitis and dactylitis. CONCLUSION: These recommendations may be used for guidance in deciding which patients with PsA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

Biologicals and switch in rheumatoid arthritis throughout time - are we being more aggressive?

OBJECTIVES: To investigate the switches performed in patients with rheumatoid arthritis under biological therapy and specifically comparing the switches from earlier days with more recent switches. PATIENTS AND METHODS: Patients with rheumatoid arthritis under biological therapy followed at Hospital Garcia de Orta, Almada, and included in the Rheumatic Diseases Portuguese Register (Reuma.Pt) were included in this study. Switches occurring before and after January 2007 were compared with respect to patients' demographic and clinical characteristics, such as disease activity and duration of biological therapy. The survival of the first biological agent was compared between patients starting biological therapy before and after 2007. EULAR response and remission rate at the last evaluation were calculated. Comparisons between groups were established using a t-test or chi--square, as appropriate. Survival curves of the first biological were compared through the logrank test. RESULTS: In total, 123 patients were included in the analysis (mean age 57.0 ± 13.1 years and mean disease duration 11.7 ± 8.0 years). A total of 85 switches were documented, 20% of which took place before 2007. Comparing the switches before and after 2007, the latter were registered among older patients (recent switches 56.2 ± 12.9 years vs older switches 48.9 ± 11.0 years, p=0.04) and with a shorter duration of the first biological agent (recent switches 461.9 ± 293.2 days vs older switches 773.7 ± 475.8 days, p=0.03). No further significant differences were found, including the disease activity. The survival of the first biological was shorter in patients starting biological therapy after 2007 (2949 days for biological onset before 2007 and 818 days for onset after 2007, p <0.001). A good EULAR response was achieved by 19% and 30% of the patients, before and after 2007, respectively (p = 0.23). Remission was achieved by 14% and 22% of the patients, before and after 2007, respectively (p = 0.30). CONCLUSIONS: Switches were more frequently performed in more recent years, in older patients and with a shorter duration of biological therapy. A trend towards a better and more targeted control of the disease could be discussed in light of our results. Although switches were more frequently performed in more recent years, in older patients and with a shorter duration of biological therapy, there is still room for improvement when aiming at remission, for example by applying a tighter therapy strategy like the "treat to target model".

Patients' satisfaction with the rheumatology day care unit.

BACKGROUND: Patients receiving biological therapies are regularly evaluated and monitored at rheumatology day care units (RDCU). Despite patients' satisfaction with the delivered care and the relationship between the patient and the multidisciplinary team being acknowledged as important aspects to ensure adherence to therapy, factors associated with them have not been investigated so far. OBJECTIVES: To evaluate patients' satisfaction with the functioning of the RDCU and to identify the factors associated with the level of satisfaction. METHODS: An anonymous questionnaire was administered to all patients with rheumatoid arthritis (RA) or spondyloarthritis treated with biological drugs and followed at the RDCU at Hospital Garcia de Orta, Almada, Portugal. Satisfaction was measured using a visual analogue scale (0-100, 0 meaning completely unsatisfied, 100 meaning completely satisfied). Further information was collected on socio-demographic variables, physical conditions of the RDCU, waiting time, satisfaction with the role of medical, nursing and administrative staff (satisfaction level with their friendliness, question answering, care delivery, privacy during consultation, clarity in the information given, which was then transformed into a composite score, 0-20). Factors associated with satisfaction were studied by univariable followed by multiple linear regression to adjust for potential confounders. RESULTS: In total, 150 patients were included in the study (mean age 50.6 ± 13.7 years, 64% female, 62% RA, mean disease duration 10.6 ± 6.1 years). The majority of patients attended the RDCU for more than three years and 57% received subcutaneous therapy. The mean level of satisfaction with the RDCU was 81.9 ± 17.9. Multivariable analysis showed that intravenous therapy (ß 6.13, 95% confidence interval - CI 0.71-11.55), physician score (ß 2.28, 95%CI 1.20-3.35) and increasing levels of satisfaction with the room temperature (ß 5.64, 95%CI 3.06-8.21) and waiting time (ß 25.53, 95%CI 8.17-42.89, for a very good vs non-acceptable waiting time) were positively associated with the level of satisfaction, while the nursing score was inversely associated. CONCLUSIONS: Patients were overall very satisfied with the functioning of the RDCU. Waiting time, satisfaction with the physician role, room temperature and intravenous therapy were the main factors positively associated with the level of satisfaction.

Eficiencia del Permanganato de Potasio aplicado en las heridas sépticas en el servicio de cirugía cervico-facial / Efficiency of the Permanganato of Potassium applied in the septics wounded in the service of surgery cervix facial

se realizó un estudio a 20 pacientes con tumoraciones avanzadas y heridas sépticas con fetidez, ingresados en el servicio de cirugía cérvicofacial del Hospital Docente Oncológico "Conrado Benítez" de Santiago de Cuba, durante los meses de enero a julio de 1994.En los cuales se aplicó fomentos de Permanganato de potasio al 1x16000, 3 o 4 veces al día, en curaciones y pinceladas locales al 1 por ciento, con la misma frecuencia.El dato primario se obtuvo de las historias clínicas, donde se analizaron variables como: localización anatómica del tumor, tiempo en que desaparece la sepsis, fetidez y gérmenes aislados.Se obtuvieron resultados alentadores como desaparición de la fetidez y por consiguiente ausencia de sepsis, la no utilización de antibióticos terapia ni sistemático, ni local; debemos además señalar que en los pacientes estudiados no se detectó reacción abversa al uso del Permanganato de Potasio

Eficiencia del Permanganato de Potasio aplicado en las heridas sépticas en el servicio de cirugía cervico-facial / Efficiency of the Permanganato of Potassium applied in the septics wounded in the service of surgery cervix facial

se realizó un estudio a 20 pacientes con tumoraciones avanzadas y heridas sépticas con fetidez, ingresados en el servicio de cirugía cérvicofacial del Hospital Docente Oncológico "Conrado Benítez" de Santiago de Cuba, durante los meses de enero a julio de 1994.En los cuales se aplicó fomentos de Permanganato de potasio al 1x16000, 3 o 4 veces al día, en curaciones y pinceladas locales al 1 por ciento, con la misma frecuencia.El dato primario se obtuvo de las historias clínicas, donde se analizaron variables como: localización anatómica del tumor, tiempo en que desaparece la sepsis, fetidez y gérmenes aislados.Se obtuvieron resultados alentadores como desaparición de la fetidez y por consiguiente ausencia de sepsis, la no utilización de antibióticos terapia ni sistemático, ni local; debemos además señalar que en los pacientes estudiados no se detectó reacción abversa al uso del Permanganato de Potasio