[Lymphocyte-to-C-reactive protein ratio in COVID-19: an unexplored tool]. / índice linfocito proteína C reactiva en COVID-19: una herramienta poco explorada.

BACKGROUND: COVID-19 develops severe inflammatory responses that can lead to death. It is essential in a pandemic to have accessible instruments to estimate the prognosis of the disease. The lymphocyte-to-C-reactive protein ratio (LCR) is a predictive biomarker studied in oncology, which could have some advantages in COVID-19 patients in the early stages of the disease. Our objective was to estimate the risk of LCR < 100 and mortality in hospitalized patients with COVID-19. METHODS: hospitalized patients with COVID-19 seen between March to October 2020 were included. The patients were grouped according to LCR < 100 and LCR > 100. A Cox regression model was performed to estimate the association between LCR < 100 and mortality. RESULTS: we included 730 patients with COVID-19. The mean age at diagnosis was 49.9 years (SD 16.8) and 401 (55%) were men. Cox regression model showed an association between LCR <100 and mortality (HR 6.2; 95% CI 1.6 to 23.5; p 0.008), adjusting by age. severe pneumonia, intensive care requirements, and comorbidities. CONCLUSION: LPCR <100 in the initial assessment of hospitalized patients with COVID-19 suggests a higher risk of mortality.

Introducción: El COVID-19 genera respuestas inflamatorias graves que pueden terminar en la muerte. En pandemia resulta fundamental tener instrumentos de f ácil acceso que estimen su evolución. El índice linfocito proteína C reactiva (LPCR) es un marcador pronóstico estudiado en patología oncológica que podría mostrar ventajas en la etapa precoz de la enfermedad por COVID-19. Objetivo: estimar los niveles de LPCR < 100 y su riesgo de mortalidad en pacientes internados con COVID-19. Métodos: Se incluyeron pacientes con COVID 19 que ingresaron a la sala de internación general desde marzo hasta octubre de 2020. Se realizó un modelo de regresión de Cox para estimar la relación entre el LPCR < 100 y mortalidad. Resultados: Se incluyeron 730 pacientes. La edad media de presentación fue 49.9 años (DE 16.8) y 401 (55%) fueron hombres. La mediana de días de internación fue 8 (RIC 6). El modelo de regresión de Cox evidenció asociación entre LPCR <100 y mortalidad (HR 6.2; IC95% 1.6 a 23.5; p 0.008) ajustado por edad, neumonía grave, pases a terapia intensiva, hipertensión arterial, y comorbilidades. Discusión: El LPCR <100 en la evaluación inicial de los pacientes que se internan con COVID-19 podría sugerir mayor riesgo de mortalidad.

Índice linfocito proteína c reactiva en COVID-19: una herramienta poco explorada / Lymphocyte-to-C-reactive protein ratio in COVID-19: an unexplored tool

Resumen Introducción: El COVID-19 genera respuestas inflamatorias graves que pueden terminar en la muerte. En pandemia resulta fundamental tener instrumentos de fácil acceso que estimen su evolu ción. El índice linfocito proteína C reactiva (LPCR) es un marcador pronóstico estudiado en patología oncológica que podría mostrar ventajas en la etapa precoz de la enfermedad por COVID-19. Objetivo: estimar los niveles de LPCR < 100 y su riesgo de mortalidad en pacientes internados con COVID-19. Métodos: Se incluyeron pacientes con COVID 19 que ingresaron a la sala de internación general desde marzo hasta octubre de 2020. Se realizó un modelo de regresión de Cox para estimar la relación entre el LPCR < 100 y mortalidad. Resulta dos: Se incluyeron 730 pacientes. La edad media de presentación fue 49.9 años (DE 16.8) y 401 (55%) fueron hombres. La mediana de días de internación fue 8 (RIC 6). El modelo de regresión de Cox evidenció asociación entre LPCR <100 y mortalidad (HR 6.2; IC95% 1.6 a 23.5; p 0.008) ajustado por edad, neumonía grave, pases a terapia intensiva, hipertensión arterial, y comorbilidades. Discusión: El LPCR <100 en la evaluación inicial de los pacientes que se internan con COVID-19 podría sugerir mayor riesgo de mortalidad.

Abstract Background: COVID-19 develops severe inflammatory responses that can lead to death. It is es sential in a pandemic to have accessible instruments to estimate the prognosis of the disease. The lymphocyte-to- C-reactive protein ratio (LCR) is a predictive biomarker studied in oncology, which could have some advantages in COVID-19 patients in the early stages of the disease. Our objective was to estimate the risk of LCR < 100 and mortality in hospitalized patients with COVID-19. Methods: hospitalized patients with COVID-19 seen between March to October 2020 were included. The patients were grouped according to LCR < 100 and LCR > 100. A Cox regression model was performed to estimate the association between LCR < 100 and mortality. Results: we included 730 patients with COVID-19. The mean age at diagnosis was 49.9 years (SD 16.8) and 401 (55%) were men. Cox regression model showed an association between LCR <100 and mortality (HR 6.2; 95% CI 1.6 to 23.5; p 0.008), adjusting by age. severe pneumonia, intensive care requirements, and comorbidities. Conclusion: LPCR <100 in the initial assessment of hospitalized patients with COVID-19 suggests a higher risk of mortality.

Rehabilitación cardiorrespiratoria en hipertensión pulmonar: experiencia en un centro de referencia / Cardiorespiratory rehabilitation in pulmonary hypertension: experience in a reference center

RESUMEN Introducción: La hipertensión pulmonar (HP) abarca un grupo heterogéneo de enfermedades que genera discapacidad y aumento de la morbimortalidad. La rehabilitación cardiorrespiratoria (RC) es un recurso terapéutico subutilizado en esta condición. Objetivo: Estimar los efectos de un programa de RC en una prueba de caminata de campo y en la calidad de vida de pacientes con diagnóstico de HP de los grupos I y IV. Materiales y Métodos: Los pacientes fueron evaluados antes y después de la intervención mediante la prueba de caminata de 6 minutos (PC6M) y el Saint George's Respiratory Questionnaire (SGRQ). El programa de RC consistió en 8 semanas de ejercicios supervisados con modalidad institucional. Resultados: Se incluyeron 19 pacientes con diagnóstico de HP precapilar por cateterismo cardíaco derecho, 18 mujeres (94,7%) con una media de edad de 45,5 ± 14,3 años. Trece (68,4%) presentaron HP del grupo I, y 6 (31,6%) HP del grupo IV. Se observaron cambios estadísticamente significativos en la PC6M (diferencia de medias -DM- 31 ± 27,3 metros; p <0,001), y en el SGRQ (DM 8,2 ± 10,2; p<0,01). No se reportaron eventos adversos graves durante el programa. Conclusiones: Nuestro estudio sugiere que un programa de RC supervisado en pacientes con HP podría mejorar la distancia caminada y la calidad de vida.

ABSTRACT Background: Pulmonary hypertension (PH) comprises a heterogeneous group of diseases resulting in disability and increased morbidity and mortality. Cardiopulmonary rehabilitation (CR) is a therapeutic resource not widely used in this condition. Objective: The aim of this study was to evaluate the effects of a CR program on a walking test and on the quality of life in patients with group 1 and group 4 PH Methods: Patients were evaluated before and after the intervention with the six-minute walk test (6MWT) and Saint George's Respiratory Questionnaire (SGRQ). The program consisted of 8 weeks of supervised exercises within the institution. Results: Nineteen patients with precapillary PH diagnosed by right heart catheterization were included; 18 were women (94.7%) with a mean age of 45.5±14.3 years. Thirteen (68.4%) patients had group 1 PH and 6 (31.6%) had group 4 PH. There were statistically significant changes in the 6MWT [mean difference (MD) 31±27.3 m; p<0.001], and in the SGRQ (MD 8.2±10.2; p<0.01). No adverse events were reported during the program. Conclusions: Our study suggests that a supervised CR program in patients with PH could improve the distance walked and the quality of life.

Performance of Ultrasonography Compared to Conventional Radiography for the Diagnosis of Osteoarthritis in Patients With Knee Pain.

Purpose: To investigate the performance of ultrasonography (US) for the detection of knee osteoarthritis (OA) in patients suffering from knee pain, compared to conventional radiographs. Methods: Cross-sectional study performed at a university teaching hospital. Consecutive patients complaining of unilateral or bilateral mechanical knee pain who signed an informed consent were included. All patients underwent simultaneously an ultrasonographic and a radiographic evaluation of the knee. Exclusion criteria were age under 18 years, prior diagnosis of knee OA, diagnosis of inflammatory arthritis, history of knee surgery or trauma, severe knee deformities, and corticosteroid injection within the last 2 months. The diagnostic properties of US for the detection of knee OA were evaluated using radiological data as the reference method. Evaluated test properties were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the positive and negative likelihood ratio (LR+ and LR-). Results: Three-hundred twenty-two knees (281 patients) were included. Radiographic degenerative changes were present in 56.8% (183) of the evaluated knees. Regarding the diagnostic properties of the US, the presence of either osteophytes or the compromise of the femoral hyaline cartilage had the best sensitivity to detect OA (95%), with a NPV of 92% and a LR- of 0,07, while the combined identification of osteophytes and compromise of the femoral hyaline cartilage had the best specificity (94%), with 94% PPV and a LR+ of 13. Conclusion: US demonstrated an excellent sensitivity with an adequate specificity for the detection of radiographic knee OA.

Incidence of cancer in a cohort of patients with primary Sjögren syndrome in Argentina.

Primary Sjögren syndrome (pSS) is usually a mild disease, but serious complications such as non-Hodgkin lymphoma-and hypothetically other malignancies-may develop. The aim of this study was to evaluate both overall and specific incidence of cancer in a cohort of patients with pSS compared to the expected incidence in general population of Argentina. Retrospective analytic study of pSS patients fulfilling American-European Consensus Group (AECG) criteria, followed from the time of their diagnosis until the end of the study, death, loss of follow- up, or being given a diagnosis of cancer. Cancer incidence for the general population was obtained from GLOBOCAN 2018, and demographic information was obtained from the national institute for statistics and census. Age- and sex-specific Standardized Incidence Ratio (SIR) were then calculated. One hundred fifty-seven patients, with a mean age of 57.8 years (SD 18.3), were included. Mean patient follow-up duration was 7.37 years (SD 4.2), contributing to a total of 1158 patient/years. Fifteen patients developed a malignancy during follow-up. Cancer incidence for pSS patients was compared with the general population's incidence through SIRs. Female patient's SIRs for overall cancer was 4.17 (95% CI 2.30-6.87), non-Hodgkin lymphoma 41.40 (95% CI 10.12-102.1), multiple myeloma 41.49 (95% CI 1.14-167.28), tongue cancer 44.4 (95% CI 1.23-177.31), uterus cancer 8.39 (95% CI 0.19-40.73), lung cancer 4.51 (95% CI 0.1-22.16), and breast cancer 3.76 (95% CI 1.04-9.45). An increased overall cancer risk, and particularly for non-Hodgkin lymphoma, multiple myeloma, breast cancer and tongue cancer was observed in female pSS patients compared to control group.