Electron density-based GPT for optimization and suggestion of host-guest binders.

Here we present a machine learning model trained on electron density for the production of host-guest binders. These are read out as simplified molecular-input line-entry system (SMILES) format with >98% accuracy, enabling a complete characterization of the molecules in two dimensions. Our model generates three-dimensional representations of the electron density and electrostatic potentials of host-guest systems using a variational autoencoder, and then utilizes these representations to optimize the generation of guests via gradient descent. Finally the guests are converted to SMILES using a transformer. The successful practical application of our model to established molecular host systems, cucurbit[n]uril and metal-organic cages, resulted in the discovery of 9 previously validated guests for CB[6] and 7 unreported guests (with association constant Ka ranging from 13.5 M-1 to 5,470 M-1) and the discovery of 4 unreported guests for [Pd214]4+ (with Ka ranging from 44 M-1 to 529 M-1).

Protocol to Induce the Temporary Opening of the Blood-Brain Barrier with Short-Time Focused Ultrasound in Rats.

Brain neurodegenerative diseases are central nervous system (CNS) affections typically common in older adults. A new therapeutic approach for them consists of providing specific drugs to the CNS through blood circulation; however, the Blood-Brain Barrier (BBB) prevents almost 100% of neurotherapeutics from reaching the brain. There are indications that Focused Ultrasound (FUS), temporarily placed in the BBB, can achieve a controlled increase in temperature at its focus, allowing temporary, localized, and reversible opening of this barrier, which facilitates the temporary delivery of specific drugs. This work presents a FUS-based protocol for the local, temporary, and reversible opening of the BBB in Wistar rats. The proposed protocol specifies certain power, treatment times, and duty cycle to controllably increase the temperature at the region of interest, i.e., the substantia nigra. Numerical simulations using commercial software based on the finite element method were carried out to determine the optimal size of the craniotomies for nearly full-acoustic transmission. Experiments in rats were performed with the parameters used during computational simulations to determine the adequate opening of the BBB. For this, craniotomies of different sizes were made at coordinates of the substantia nigra, and FUS was applied from the exterior. The opening of the BBB was evaluated using Evans Blue (EB) as an indicator of the crossing of the dye from the blood vessels to brain tissue. Numerical simulations demonstrated a major distance reached by the ultrasound focus with a bigger diameter. Experimental results show the local, temporary, and reversible opening of the BBB through a 10 mm diameter craniotomy, which effectively allowed placing the ultrasound focus over the substantia nigra, unlike a 6 mm diameter craniotomy in which there is a deviation of the focus through that window. Moreover, from these results, it was also determined that the disruption of the BBB was reversible, with an opening duration of 6 h after FUS application. The experimental work developed in this study resulted in a minimally invasive method for the temporary opening of the BBB.

Prevalencia de osteoporosis en Colombia: datos del registro nacional de salud del 2012 al 2018 / Prevalence of osteoporosis in Colombia: Data from the National Health Registry from 2012 to 2018

Introducción: La osteoporosis es considerada un problema de salud pública, ya que, al aumentar el riesgo de fracturas, genera un alto coste para el sistema de salud. En Colombia, el Ministerio de Salud utiliza la herramienta SISPRO para recolectar información del sistema de salud. La información almacenada en SISPRO es pública y disponible para la investigación. Este artículo presenta un análisis de la prevalencia y características de los pacientes con osteoporosis a partir de los datos del 2012 al 2018. Objetivos: Estimar la prevalencia de osteoporosis entre enero de 2012 a diciembre de 2018 y describir las características demográficas de los pacientes. Métodos: Estudio descriptivo de corte transversal en el que se tomaron los datos de SISPRO, utilizando como palabras clave los diagnósticos del manual internacional de enfermedades relacionados con el diagnóstico de osteoporosis. Resultados: Se documentaron 249.803 individuos mayores de 50 años con diagnóstico de osteoporosis, estimando una prevalencia de 2.440 casos por 100.000 habitantes mayores de 50 años (basado en una población total de 10.236.132), siendo más frecuente en mujeres (92%), con una relación mujer a hombre de 12,3:1. Conclusión: Este estudio muestra una baja prevalencia respecto a las estimaciones y proyecciones. Dados estos resultados es necesario trabajar en promover políticas en salud para los pacientes con osteoporosis.(AU)

Introduction: Osteoporosis is considered a healthcare problem due to the increased risk of fractures and high cost of care. In Colombia, the Ministry of Health introduced SISPRO, a tool to collect nationwide information from the health system. The information collected from SISPRO is available for scientific analysis. This article presents an analysis of the prevalence and characteristics of patients with osteoporosis using data from 2012 to 2018. Aim: To estimate prevalence of osteoporosis between January 2012 to December 2018 and describe the patients’ demographic characteristics. Methods: This is a descriptive epidemiological study using the International Statistical Classification of Diseases and Related Health Problems related to osteoporosis as search terms using the SISPRO database. Results: National records report 249,803 patients over 50 years old diagnosed with osteoporosis. The estimated prevalence is 2,440 cases per 100,000 inhabitants over 50 years old (based on a total population of 10,236,132), being more frequent in women (92% of cases), with a female/male ratio of 12.3:1. Conclusion: This study shows a lower prevalence than previous estimates or projections. Given these findings we think it is necessary to act to promote health policies for patients with osteoporosis.(AU)

Prevalence of osteoporosis in Colombia: Data from the National Health Registry from 2012 to 2018.

INTRODUCTION: Osteoporosis is considered a healthcare problem due to the increased risk of fractures and high cost of care. In Colombia, the Ministry of Health introduced SISPRO, a tool to collect nationwide information from the health system. The information collected from SISPRO is available for scientific analysis. This article presents an analysis of the prevalence and characteristics of patients with osteoporosis using data from 2012 to 2018. AIM: To estimate prevalence of osteoporosis between January 2012 to December 2018 and describe the patients' demographic characteristics. METHODS: This is a descriptive epidemiological study using the International Statistical Classification of Diseases and Related Health Problems related to osteoporosis as search terms using the SISPRO database. RESULTS: National records report 249,803 patients over 50 years old diagnosed with osteoporosis. The estimated prevalence is 2440 cases per 100,000 inhabitants over 50 years old (based on a total population of 10,236,132), being more frequent in women (92% of cases), with a female/male ratio of 12.3:1. CONCLUSION: This study shows a lower prevalence than previous estimates or projections. Given these findings we think it is necessary to act to promote health policies for patients with osteoporosis.

Conceptos y percepciones acerca del diagnóstico y tratamiento de la fibromialgia en un grupo de reumatólogos colombianos / Concepts and perceptions about fibromyalgia diagnosis and treatment among colombian rheumatologists

RESUMEN Introducción: La fibromialgia es una enfermedad crónica caracterizada por la presencia de dolor músculo esquelético, usualmente asociada a otros síntomas como depresión, fatiga, trastornos del sueño, entre otros. Los conceptos y las percepciones sobre el diagnóstico y el tratamiento de la fibromialgia, entre médicos reumatólogos, no se conocen objetivamente. El propósito de este estudio es describir los conceptos y percepciones sobre el diagnóstico y tratamiento de la fibromialgia, entre un grupo de médicos reumatólogos en Colombia. Métodos: Estudio descriptivo de corte transversal. A través de un grupo focal en el que participaron dos reumatólogos y un experto en métodos de investigación cualitativa, se diseñó una encuesta para evaluar las percepciones y conceptos que los médicos reumatólogos tienen sobre el diagnóstico y el tratamiento de la fibromialgia. La encuesta se aplicó de forma autoadministrada y anónima a médicos reumatólogos pertenecientes a la Asociación Colombiana de Reumatología. Resultados: Encuesta aplicada a 139 reumatólogos. El 25,2% (n = 35) considera que no hay suficiente evidencia para considerar la fibromialgia como una enfermedad; 32,4% (n = 45) usa los criterios ACR (American College of Rheumatology) de 1990 para diagnosticar pacientes con fibromialgia, a pesar de que el 92,1% (n = 128) considera que estos criterios no son suficientes para el diagnóstico de fibromialgia. Los medicamentos más empleados para el manejo de fibromialgia son los antidepresivos, prescritos por el 90,6% (n = 126) de los encuestados, seguido por anticonvulsivantes 64,7% (n = 90) y analgésicos 26,6% (n = 37). Un 76,3% (n = 106) de los reumatólogos considera que el manejo del paciente con fibromialgia debe tener un enfoque multidisciplinario. Por su parte, 81,3% (n = 113) de los reumatólogos considera que el paciente con fibromialgia debe tener como médico tratante principal a un especialista distinto al reumatólogo. Conclusión: El presente estudio muestra información acerca de las distintas percepciones acerca del diagnóstico y tratamiento de fibromialgia entre un grupo de reumatólogos colombianos, documentándose un frecuente uso de los criterios de clasificación ACR 1990. En cuanto a tratamiento, se observa un alto porcentaje de uso de medicamentos, en especial antidepresivos y analgésicos. La mayoría de los reumatólogos considera que los médicos fisiatras, deben ser los líderes del manejo interdisciplinario en el tratamiento del paciente con fibromialgia.

ABSTRACT Bacfeground: Fibromyalgia is a chronic disease characterised by the presence of widespread and persistent musculoskeletal pain associated with a variety of symptoms. The concepts and perceptions around the diagnosis and treatment of fibromyalgia among rheumatologists are not objectively known. The purpose of this study is to obtain objective data using a survey and then describe the concepts and perceptions on the diagnosis and treatment of fibromyalgia among Colombian rheumatologists. Methods: A cross-sectional study was performed using a focus group, consisting of two rheumatologists and one expert in qualitative research methods. A questionnaire was designed to evaluate the perceptions and concepts that rheumatologists have on the diagnosis and treatment of fibromyalgia. The questionnaire was self-completed and anonymous by rheumatologists from the Colombian Association of Rheumatology. Results: A total of 139 rheumatologists completed the questionnaire, with 25.2% (n = 35) of rheumatologists considering that there is not enough evidence to recognise fibromyalgia as a disease. Around one-third (32.4%, n = 45) consider that the 1990 ACR (American College of Rheumatology) criteria are not sufficient to diagnose fibromyalgia, despite the fact that 92.1% (n = 128) of them use the criteria as a tool to approach the diagnosis when suspecting fibromyalgia. The most formulated medications for managing fibromyalgia are antidepressants and analgesics, with both groups being used by 90.6% (n = 126) of the respondents, followed by antiepileptics in 64.7% (n = 90) and analgesics in 26.6% (n = 37). More than three-quarters (76.3%, n = 106) of rheumatologists consider that there should be a multidisciplinary approach to the patient with fibromyalgia. Conclusion: Objective information is presented on the perceptions of fibromyalgia among a group of Colombian rheumatologists, reporting a frequent use of the ACR 1990 classification criteria. As regards treatment, a high percentage use antidepressants and antiepileptics. Most rheumatologists believe that a rehabilitation physician should be among the leaders of multidisciplinary management in the treatment of fibromyalgia patients.

Prevalence of systemic sclerosis in Colombia: Data from the National Health Registry 2012-2016.

Introduction: Systemic sclerosis is an autoimmune disease that characteristically presents with fibrosis and vasculopathy. In Latin America, the information on the epidemiology of this disease is scarce and records are essential to know its behavior in the populations. In Colombia, the Ministry of Health uses the SISPRO tool to collect information on the unified national health system which offers nearly universal coverage (around 95%). This public information makes it possible to perform epidemiological studies on different diseases. Objectives: Using the SISPRO data corresponding to the years 2012-2016, we analyzed the prevalence and characteristics of patients with systemic sclerosis. Methods: A descriptive cross-sectional study was performed based on the SISPRO data; we used as keywords the diagnoses of the International Classification of Diseases related to the diagnosis of systemic sclerosis. Results: A total of 11,300 individuals diagnosed with systemic sclerosis were documented. The estimated prevalence was 23.7 cases per 100,000 inhabitants (based on a total population of 47,663,162); this disease is more frequent in the age group of 65-69 years in females (77%), and has a female:male ratio of 3.27:1. Conclusion: This study describes the epidemiological characteristics of systemic sclerosis in Colombia, based on official statistics from the Ministry of Health. The results provide a new vision of this disease in Latin America and open the door to future research, in order to better understand the particular characteristics of this disease in our country and our region.

Prevalence of inflammatory bowel disease and related arthritis in Colombia, according to information from the Health and Social Protection Data System / Prevalencia en Colombia de la enfermedad inflamatoria intestinal y el compromiso articular asociado, según información del Sistema Integral de Información de la Protección Social

ABSTRACT Introduction: Registries are essential to keep track of inflammatory bowel disease (IBD) and related arthritis epidemiology, and to provide better care to patients. In Colombia, the health ministry has adopted a tool, SISPRO, to gather all information coming from the whole health system structure. Given that the information collected from SISPRO is available for anyone, it provides an opportunity to get an insight into health topics. Objectives: The data collected from SISPRO were used to analyse the prevalence and specific characteristics of patients with IBD and related arthritis registered between 2012 and 2016. Methods: This is a descriptive epidemiological study using the International Statistical Classification of Diseases and Related Health Problem as keywords related to IBD and related arthritis during the analysis of SISPRO data. Results: National records report 42,647 patients with a diagnosis of IBD for an estimated prevalence of 87/100,000 subjects, being more frequent in women. The prevalence of Crohn's disease was 17/100,000 subjects, and 113/100,000 subjects for ulcerative colitis. The prevalence of arthritis related to inflammatory bowel disease was 5/100,000 subjects. Conclusions: This is the first study that describes the demographic characteristics of IBD in Colombia. This study is in accordance with that previously described in the available literature, which supports the theory about increasing global prevalence of IBD. Also, there are some differences between Colombian regions, which could be related to environmental factors and ancestry, which deserve further study.

RESUMEN Introducción: Los registros son esenciales para seguir la epidemiología de la enfermedad inflamatoria intestinal (EII) y el compromiso articular asociado y brindar mejor atención a los pacientes. En Colombia, el Ministerio de Salud y de la Protección Social utiliza la herramienta SISPRO para recolectar información del sistema de salud, la cual es de dominio público y amerita un análisis como el realizado en este trabajo. Objetivos: Utilizando los datos de SISPRO se realizó un análisis de la prevalencia y las características de los pacientes con EII y artritis relacionada, con los registros correspondientes a los arios 2012 a 2016. Métodos: Estudio descriptivo de corte transversal en el que se tomaron los datos de SISPRO, utilizando como palabras clave los diagnósticos del manual internacional de enfermedades relacionados con el diagnóstico de EII y la artritis asociada. Resultados: Se documentaron 42.647 individuos con diagnóstico de EII, con una pre-valencia estimada de 87 casos por 100.000 habitantes, más frecuente en mujeres. La prevalencia de la enfermedad de Crohn fue de 17 por 100.000 habitantes y la colitis ulcerativa de 113 por 100.000 habitantes. La prevalencia del compromiso articular asociado a EII fue de 5 por 100.000 habitantes. Conclusión: Este es el primer estudio que describe las características demográficas de la EII en Colombia. Los resultados son acordes con lo reportado en la literatura mundial y la teoría del aumento de la prevalencia de la EII. Así mismo, existen diferencias entre regiones que pueden estar relacionadas con ancestría y factores medioambientales que requieren estudios complementarios.

Prevalence of polymyalgia rheumatica in Colombia: data from the national health registry 2012-2016.

Polymyalgia rheumatica (PMR) affects elderly patients and is characterized by pain and stiffness of the shoulder girdle, pelvic girdle and cervical region, which can be associated with the presence of giant cell arteritis. Data on the epidemiology of this disease in Latin America are scarce. In Colombia, the Ministry of Health introduced SISPRO, a tool to collect nation-wide information from the health system. The information collected from SISPRO is available for scientific analysis. Using SISPRO data for the years 2012-2016, an analysis was made on the prevalence and characteristics of patients diagnosed with PMR. This is a descriptive epidemiological study using the International Statistical Classification of Diseases and Related Health Problems as search terms related to PMR, based on SISPRO data. Criteria for diagnosis are not explicitly addressed in each individual case. National records report 19,901 individuals diagnosed with PMR and estimated prevalence of 2 cases per 1000 inhabitants over 50 years old (based on a total population of 47,663,162), being more frequent in women (86% of cases), with a female/male ratio of 6.2:1. This is the first study that describes the demographic characteristics of PMR in Colombia. Our results are consistent with the age-related increase in prevalence and gender ratio. Likewise, there are differences between regions, which may be related to ancestry and environmental factors, which require further studies.

The effect of an educational intervention, based on clinical simulation, on the diagnosis of rheumatoid arthritis and osteoarthritis.

OBJECTIVE: The aim of the present study was to evaluate the effectiveness of an educational tool for general physicians, based on rheumatological clinical simulation, for the diagnosis of rheumatoid arthritis and osteoarthritis. METHODS: A randomized clinical study was carried out, in which the physician research subjects were assigned to one of two groups: the experimental group (educational intervention for rheumatoid arthritis with clinical simulation) or the control group (educational intervention for the basic aspects of the diagnosis and treatment of osteoporosis). Four weeks after the educational intervention, the members of both groups completed an examination that included four clinical cases with real patients, two clinical cases with two clinical simulation models and six virtual clinical cases. In this examination, the participants noted clinical findings, established a diagnosis and defined the complementary tests they would request, if necessary, to corroborate their diagnosis. RESULTS: A total of 160 doctors participated (80 in the active educational intervention for rheumatoid arthritis and 80 in the control group), of whom 89 were women (56%). The mean age was 35 (standard deviation 7.7) years. Success was defined as a physician correctly diagnosing at least 10 of the 12 cases presented. A significant difference of 81.3% (95% confidence interval 72-90%; p < 0.001) in success was found in favour of the active group (88.8% versus 7.5%). A greater number of correct answers was found in the active group compared with the control group in the detection of clinical findings and in the number of complementary tests requested (p < 0.001). CONCLUSIONS: The study showed the effectiveness of an educational intervention based on clinical simulation to improve the diagnostic approach to rheumatoid arthritis and osteoarthritis. The results open a new horizon in the teaching of rheumatology.

Leflunomide-induced Stevens Johnson syndrome in a patient with systemic lupus erythematosus / Síndrome de Stevens Johnson inducido por leflunomida en un paciente con lupus eritematoso sistémico

Abstract Leflunomide is an immunomodulatory agent widely used in rheumatoid arthritis and other rheumatic diseases like psoriatic arthritis and systemic lupus erythematosus. Although its safety profile is generally good, side effects have been reported in up to 20% of cases. Severe reactions, such as toxic epidermal necrolysis and Stevens Johnson syndrome are rare. The case is presented of a leflunomide-induced Stevens Johnson syndrome in a patient with systemic lupus erythematosus.

Resumen La leflunomida es un agente inmunomodulador de amplio uso en artritis reumatoide y también empleado en otras enfermedades reumáticas como artritis psoriásica y lupus eritematoso sistémico. Aunque su perfil de seguridad en general es bueno, se han reportado reacciones secundarias hasta en un 20%, aunque casos severos como necrólisis epidérmica tóxica y síndrome de Stevens Johnson son de muy baja frecuencia de presentación. Reportamos un caso de síndrome de Stevens Johnson inducido por leflunomida en una paciente con lupus eritematoso sistémico.

Characteristics and factors associated with depression in the elderly in Spain from a gender perspective.

INTRODUCTION: Depression is a main cause of disability and it is a priority public health problem among the elderly because of its significant consequences regarding morbidity and mortality, especially in women. METHODS: We selected records of people aged 65 and over out of the 2014 European Health Survey in Spain (n=6,520). We then performed a descriptive analysis stratified by gender of relevant variables such as demographic, socioeconomic, health status, health care and health determinants. We studied its connection with the presence of depressive disorders diagnosed by the PHQ-8 questionnaire. In a second phase we adjusted logistic regression models in order to assess depressive disorders based on the significant variables. RESULTS: 12.6% of depressive disorders are detected (16.8% women; 7.1% men). Many of the variables are related to depressive disorders in bivariate analysis; however, only a regular or bad/very bad perceived state of health (ORm=6.7; ORw=3.8); bedrest; the difficulty or inability to walk; and severe (ORm=3.5, ORw=2) and extreme pain (ORm=5; ORw=3.9) remain after multivariate adjustment in both sexes. Differentially depression in women is connected with not being able to read or write, the presence of chronic disease, and lack of interest from others; and in men a moderate degree of pain. CONCLUSIONS: The greater frequency and vulnerability of depression in elderly women may be connected to their educational level, their suffering from chronic diseases and social support. Longitudinal studies need to be undertaken to confirm the role and influence of these factors.

Características y factores asociados a la depresión en el anciano en España desde una perspectiva de género / Characteristics and factors associated with depression in the elderly in Spain from a gender perspective

Introducción. La depresión es causa principal de discapacidad y constituye en el anciano un problema prioritario de salud pública por sus relevantes consecuencias en morbimortalidad, especialmente en mujeres. Metodología. Se seleccionan los registros de edad igual o superior a 65 años de la Encuesta Europea de Salud en España 2014 (n=6.520). Se realiza un análisis descriptivo estratificado por sexo de variables relevantes sociodemográficas, socioeconómicas, de estado de salud, asistencia sanitaria y determinantes de salud, estudiando su asociación con la presencia de trastornos depresivos diagnosticados mediante el cuestionario PHQ-8. En una segunda fase se ajustan modelos de regresión logística para evaluar los trastornos depresivos en función de las variables significativas. Resultados. Se detectan un 12,6% de trastornos depresivos (16,8% mujeres; 7,1% hombres). Gran parte de las variables estudiadas se relacionan con los trastornos depresivos en el análisis bivariante, mientras sólo un estado regular o malo/muy malo de salud percibida (ORh=6,7; ORm=3,8), la permanencia en cama, la dificultad o no poder caminar y el dolor severo (ORh=3,5; ORm=2) y extremo (ORh=5; ORm=3,9) permanecen después del ajuste multivariante en ambos sexos. De manera diferencial se asocian con la depresión en la mujer el no saber leer/escribir, la presencia de enfermedad crónica y la falta de interés de otras personas, y en el hombre el grado moderado de dolor. Conclusiones. La mayor frecuencia y vulnerabilidad de depresión en mujeres ancianas puede guardar relación con el nivel educativo, la patología crónica y el apoyo social. Es necesario emprender estudios longitudinales que ratifiquen el papel e influencia de éstos y otros factores (AU)

Introduction. Depression is a main cause of disability and it is a priority public health problem among the elderly because of its significant consequences regarding morbidity and mortality, especially in women. Methods. We selected records of people aged 65 and over out of the 2014 European Health Survey in Spain (n=6,520). We then performed a descriptive analysis stratified by gender of relevant variables such as demographic, socioeconomic, health status, health care and health determinants. We studied its connection with the presence of depressive disorders diagnosed by the PHQ-8 questionnaire. In a second phase we adjusted logistic regression models in order to assess depressive disorders based on the significant variables. Results.12.6% of depressive disorders are detected (16.8% women; 7.1% men). Many of the variables are related to depressive disorders in bivariate analysis; however, only a regular or bad/very bad perceived state of health (ORm=6.7; ORw=3.8); bedrest; the difficulty or inability to walk; and severe (ORm=3.5, ORw=2) and extreme pain (ORm=5; ORw=3.9) remain after multivariate adjustment in both sexes Differentially depression in women is connected with not being able to read or write, the presence of chronic disease, and lack of interest from others; and in men a moderate degree of pain. Conclusions.The greater frequency and vulnerability of depression in elderly women may be connected to their educational level, their suffering from chronic diseases and (AU)

Traducción y validación de la versión en español del cuestionario ToPAS (Toronto Psoriatic Arthritis Screening Questionnaire), para el tamizaje de pacientes con artritis psoriásica en la consulta dermatológica en Colombia / Translation and validation of the Spanish version of the ToPAS (Toronto Psoriatic Arthritis Screening) questionnaire for use on patients with psoriatic arthritis in Dermatology clinics in Colombia

Resumen Introducción: Los instrumentos de tamizaje de artritis psoriásica son una herramienta útil en la consulta dermatológica, para optimizar la remisión al reumatólogo. La herramienta Toronto Psoriatic Arthritis Screening Questionnaire (ToPAS) ha sido desarrollada y validada en Canadá. Objetivos: Traducir y aplicar algunas pruebas de validación de la escala ToPAS para ser utilizada en la consulta dermatológica en Colombia. Métodos: Estudio de traducción y validación de escalas. Resultados: Se llevó a cabo la traducción y validación del ToPAS con una metodología estandarizada, obteniendo un documento en español con el cual se realizó una prueba piloto del documento final en 20 pacientes con diagnóstico de psoriasis y artritis psoriásica, con el fin de evaluar los ítems en cuanto a aspectos como comprensión, ambigüedad y tiempo de respuesta. Posteriormente, el instrumento se aplicó a 108 pacientes, 65 (60,2%) eran hombres, 36 (33,3%) tenían diagnóstico de artritis psoriásica y 72 (66,6%) solo psoriasis. Se consideró como punto de corte un puntaje > 8 puntos, encontrando una sensibilidad del 75% y una especificidad del 92%, valor predictivo positivo del 82% y valor predictivo negativo del 88%. Para evaluar la confiabilidad test-retest se seleccionaron los últimos 25 participantes, calculándose el coeficiente de correlación de Pearson para evaluar la correlación entre la primera y la segunda aplicación del ToPAS; el valor de p fue de 0,94, valor que representa un alto nivel de correlación entre la primera y la segunda aplicación. Conclusiones: Se realizó la traducción, validación y evaluación de características operativas de la encuesta ToPAS para detección de artritis psoriásica, constituyéndose en una herramienta práctica para uso en la consulta dermatológica.

Abstract Introduction: Psoriatic arthritis screening tools are useful for the rheumatologist in optimising referrals to the dermatology clinic. The Toronto Psoriatic Arthritis Screening Questionnaire (ToPAS) is a tool that has been developed and validated in Canada. Objectives: To translate, and perform some validation tests on TOPAS for use in dermatology clinics in Colombia. Methods: Translation and validation of scales. Results: ToPAS was translated using standardised methodology. A pilot test was conducted on 20 patients diagnosed with psoriasis and psoriatic arthritis using the final version of the document translated into Spanish, in order to evaluate items of aspects such as understanding, ambiguity, and response time. The tool was then used on 108 patients, including 65 (60.2%) males, with 36 (33.3%) cases with a diagnosis of psoriatic arthritis, and 72 (64.7%) with psoriasis only. Using a cut-off score > 8 points, it showed a sensitivity of 75% and specificity 92%, positive predictive value 82% and negative predictive value of 88%. To assess the reliability test re-test, 25 participants were selected and Pearson correlation coefficient was calculated to evaluate the correlation between the first and second application of ToPAS, which gave a value of P = .94, which represents a high level of correlation between the first and second application. Conclusions: A translation, validation and evaluation of operational characteristics of the ToPAS questionnaire was conducted, being a practical tool for use in the dermatology clinic.

Lupus cutáneo inducido por adalimumab / Adalimumab-induced cutaneous lupus

La terapia antifactor de necrosis tumoral se ha convertido en los últimos años en uno de los pilares fundamentales para el tratamiento de la artritis reumatoide. El adalimumab es un anticuerpo monoclonal humanizado empleado en el tratamiento de la artritis reumatoide. Se describe un caso de lupus cutáneo inducido por adalimumab.

Tumor necrosis factor inhibitors have become one of the most important treatments of rheumatoid arthritis. Adalimumab is a monoclonal antibody used for the treatment of this condition. A case is described of adalimumab induced cutaneous lupus.

Meningoencefalitis criptococócica en una paciente con artritis reumatoide tratada con metotrexato y prednisona / Cryptococcal meningoencephalitis in a patient with rheumatoid arthritis treated with methotrexate and prednisone

No disponible

Colon capsule endoscopy is a safe and useful tool to assess disease parameters in patients with ulcerative colitis.

OBJECTIVE: Colon capsule endoscopy (CCE) is a new endoscopic technique that is minimally invasive and allows evaluation of the colon mucosa without pain, sedation, and gas insufflation. To date, few studies have investigated the use of CCE in patients with ulcerative colitis (UC). This study compares the ability of CCE and a conventional colonoscopy to assess mucosal disease activity and the extent of inflammatory mucosa in patients with UC. METHODS: Forty-two patients (27 men, mean age 48.5 years) with known UC and indication for colonoscopy were enrolled in this single-blind, prospective study. All patients underwent CCE, followed by a colonoscopy. The activity and extent of the disease was assessed using Mayo scores and Montreal scores, respectively. RESULTS: There was a good correlation between CCE and colonoscopy in disease severity (κ=0.79; 95% confidence interval: 0.62-0.96) and extent of inflammation (κ=0.71; 95% confidence interval: 0.52-0.90) observed. The ability of CCE to assess a broad segment of distal ileum led to a change in the diagnosis of UC to ileocolonic Crohn's disease in three patients. Bowel preparation was considered adequate in 80% of the patients and no serious adverse events related to the CCE procedure or bowel preparation were reported. CONCLUSION: CCE is a safe and useful method for the evaluation of patients with UC. The ability of CCE to assess distal ileum provides an advantage to colonoscopy as CCE can identify patients who have been incorrectly diagnosed with UC, resulting in a change in their diagnosis to Crohn's disease.

Artritis reumatoide en paciente con infección por VIH / Rheumatoid arthritis in an HIV infected patient

Se presenta el caso clínico de una mujer de 35 años con infección por VIH, desde hace6 años, en manejo antirretroviral, sin antecedentes de enfermedad reumática previa,quien presenta cuadro de poliartralgias de predominio en manos, asociado a sinovitis,con elevación de reactantes de fase aguda, factor reumatoide y anti CCP positivos,configurándose diagnóstico de artritis reumatoide. Esta enfermedad tiene una bajaincidencia en el contexto de infección por retrovirus y se considera asociada al síndromede reconstitución inmune posterior a terapia antirretroviral. Se inicia manejo con fármacosmodificadores con lo cual se obtiene control de la enfermedad autoinmune.

The case is presented of a 35 year-old woman with an HIV infection for 6 years and on antiretroviral treatment, She had no previous history of rheumatic disease. She presented with polyarthralgias, predominantly in hands associated with synovitis, elevated acute phase reactants, with both rheumatoid factor and anti-CCP positive. Thus she was diagnosed with rheumatoid arthritis. This disease has a low incidence in the context of retrovirus infection and is considered secondary to Immune Reconstitution Syndrome after antiretroviral therapy. Management starts with modifying drugs, thereby gaining control of the autoimmune disease.

Factores asociados al ingreso hospitalario y evaluación de un programa de gestión de casos para trastorno mental grave mediante un estudio de cohortes históricas / Factors associated with hospital admission and evaluation of a case management program for severe mental disorder by a historical cohort study

Introducción: Las personas con trastorno mental grave (TMG) presentan serias dificultades para desarrollar una vida normalizada, por lo que son necesarios programas de atención comunitaria que mejoren sus condiciones de vida e integración social. Este trabajo pretende evaluar el funcionamiento de un programa de gestión de casos (PGC) en Segovia (España). Metodología: Se realiza una primera fase descriptiva valorando el funcionamiento del PGC en 2011 mediante variables sociodemográficas, asistenciales y clínicas. Se estudian los factores asociados a la ocurrencia de ingreso hospitalario. Finalmente, mediante un diseño de cohortes históricas, se evalúa el riesgo de ingreso del PGC comparando con una cohorte no expuesta. Se emplean técnicas estadísticas bi y multivariantes con cálculo de riesgos relativos e intervalos de confianza. Resultados: En 2011 se atiende a 82 pacientes en el PGC, principalmente hombres de mediana edad. La evolución clínica media es de 19 años y la permanencia media en el PGC superior a los 6 años. El 78% pertenecen al espectro diagnóstico de la esquizofrenia. El ingreso afecta al 27% de los pacientes. Ser mujer, ser atendido por equipos de salud mental I-II, el aumento de visitas domiciliarias y el abandono del seguimiento son los factores predictores de ingreso, mientras la mayor evolución clínica es factor protector. No se detecta efecto protector del PGC frente al ingreso hospitalario en los diferentes análisis del estudio de cohortes históricas. Conclusiones: Es necesario evaluar de forma sistemática los programas de atención comunitaria dirigidos al TMG con el fin de realizar ajustes y modificaciones tendentes a la mejora de su efectividad clínica (AU)

Introduction: People with severe mental disorder (SMD) have serious difficulties in developing a normal life, so community care programs to improve their living conditions and social integration are necessary. This work evaluates the performance of a case management program (CMP) in Segovia (Spain).Methodology: We conduct a first descriptive phase evaluating the performance of the CMP in 2011 by sociodemographic, health services and clinical variables. We study the factors associated with the occurrence of hospital admission. Finally, using a historical cohort design, we assess the risk of hospital admission of CMP compared to unexposed cohort. Bi and multivariate statistical techniques are employed to perform the analysis with the calculation of relative risks and confidence intervals. Results: In 2011, 82 patients are cared for in the CMP, mainly middle-aged men. The average clinical course is 19 years and the average stay in the CMP over 6 years. 78%belong to the diagnosis of schizophrenia spectrum. Income affects 27% of patients. Women, mental health teams I-II, increased home visits and abandonment of monitoring are predictors of income, while the highest level of clinical course is protective. No protective effect of income is detected for the CMP in the different analyzes of the historical cohort study. Conclusions: It is necessary to systematically assess community care programs directed at SMD to make adjustments and modifications aiming at improving their clinical effectiveness (AU)

[Factors associated with hospital admission and evaluation of a case management program for severe mental disorder by a historical cohort study]. / Factores asociados al ingreso hospitalario y evaluación de un programa de gestión de casos para trastorno mental grave mediante un estudio de cohortes históricas.

INTRODUCTION: People with severe mental disorder (SMD) have serious difficulties in developing a normal life, so community care programs to improve their living conditions and social integration are necessary. This work evaluates the performance of a case management program (CMP) in Segovia (Spain). METHODOLOGY: We conduct a first descriptive phase evaluating the performance of the CMP in 2011 by sociodemographic, health services and clinical variables. We study the factors associated with the occurrence of hospital admission. Finally, using a historical cohort design, we assess the risk of hospital admission of CMP compared to unexposed cohort. Bi and multivariate statistical techniques are employed to perform the analysis with the calculation of relative risks and confidence intervals. RESULTS: In 2011, 82 patients are cared for in the CMP, mainly middle-aged men. The average clinical course is 19 years and the average stay in the CMP over 6 years. 78% belong to the diagnosis of schizophrenia spectrum. Income affects 27% of patients. Women, mental health teams I-II, increased home visits and abandonment of monitoring are predictors of income, while the highest level of clinical course is protective. No protective effect of income is detected for the CMP in the different analyzes of the historical cohort study. CONCLUSIONS: It is necessary to systematically assess community care programs directed at SMD to make adjustments and modifications aiming at improving their clinical effectiveness.