Concordancia de los nuevos criterios ACR/EULAR y los ACR 1980 para la clasificación de la esclerosis sistémica / Concordance of the new ACR/EULAR criteria and the ACR 1980 for the classification of systemic sclerosis

Objetivo: Evaluar cumplimiento, y así mismo concordancia y discordancia de los criterios de clasificación de Esclerosis Sistémica (ES) ACR/EULAR 2013 y ACR 1980 en pacientes con diagnóstico clínico de la enfermedad. Método: Se incluyeron 169 pacientes con diagnóstico de Esclerosis Sistémica. Resultados: El 72,2 por ciento cumplía los criterios ACR 1980, y el 99,4 por ciento (168 pacientes) cumplía los criterios ACR/EULAR 2013. La concordancia absoluta de toda la muestra fue 72,7 por ciento, para el subtipo limitado 35,2 por ciento, y 100 por ciento el difuso. Se subanalizaron los pacientes con limitada que sólo cumplían criterios ACR/EULAR 2013, y se comparó con el resto de las limitadas. Los primeros presentaron en forma estadísticamente significativa menor esclerodactilia distal a MCF, menor presencia de úlceras digitales y pitting scars, menor afectación intersticial pulmonar, y mayor daño microvascular en la capilaroscopia. Conclusión: Los nuevos criterios de clasificación de Esclerosis Sistémica serían más adecuados para detectar esclerodermias limitadas, siendo dicho hallazgo estadísticamente significativo.

Objective: To evaluate the performance, and likewise concordance and discordance of the classification criteria of Systemic Sclerosis ACR/EULAR 2013 and ACR 1980 in a group of patients with clinical diagnosis of SSc. Methods: We enrolled 169 patients with diagnosis of Systemic Sclerosis. Results: 72.2 percent met the 1980 ACR criteria, and 99.4 percent met the ACR/EULAR 2013 criteria. The absolute agreement of the entire sample was 72.7 percent, 35.2 percent for the limited subtype, and 100 percent for the diffuse. Those patients with limited subtype who only met the ACR/EULAR 2013 criteria were compared with the rest of limited patients. The first group had statistically significantly lower sclerodactyly distal to MCF, lower presence of digital ulcers and pitting scars, less interstitial lung involvement, and greater abnormal nail fold capillaries. Conclusion: The new classification criteria for systemic sclerosis seem to be more suitable for detecting limited scleroderma. In the present study, statistically significant discrepancy was found in the limited subtype.

[Effect of low doses of oral pamidronate (APD) on the calcemia of osteopenic or osteoporotic patients]. / Efecto de bajas dosis del pamidronato (APD) oral sobre la calcemia de pacientes osteopenicas u osteoporoticas.

Oral pamidronate (APD) at high doses (400-900 mg/day) is employed as antiresorptive agent for the treatment of Paget's disease. In some occasions hypocalcemia may occur, and is interpreted as a relative overdosage. To avoid this complication and the consequent PTH release, supplementation with calcium salts is recommended. In osteoporotic syndromes, APD is prescribed at a lower dosage (200 mg/day) and currently calcium or vitamin D are also systematically added. But at this low dose the antiresorptive activity is partial and transient. In order to observe the effects on calcemia of multiple therapy, data from 129 postmenopausal women with the diagnosis of osteopenia or osteoporosis treated with 200 mg/day of APD soft capsules during 6-10 months, were gathered retrospectively. The first group (n: 13) received APD alone; the second group was supplemented with 1 g/day calcium salts (n: 61); the third group received 0.015-0.025 mg/day vitamina D (n: 10); and the fourth received both calcium plus vitamin D (n: 45). In samples of 24 h, urine, calcium, creatinine, hydroxyproline, and serum total calcium were measured before and after therapy. No hypocalcemia was detected. All groups, except the one treated with APD alone, showed a significant trend to increase their calcemia values between normal ranges (Table 1, 2). Only in one patient treated with APD + Ca + vitamin D, hypercalcemia was detected. Measuring HOP/Cr and Ca/Cr in urine as resorption markers, showed that 27% of the APD + Ca group and 33% of the APD + Ca + vitamin D group showed scant or any repercussion on mentioned resorption indexes, meaning that the response to APD could be hindered in those cases. In conclusion, while using low doses of oral APD, calcium salts should not be systematically recommended. There is no trend to hypocalcemia. Furthermore, calcium salts may favor drug interactions and so induce digestive side effects or poor responses. Calcium supplementation should be prescribed only on the basis of low calcium diet and not to prevent APD collateral effects on calcemia.

[Kinetics of chemoluminiscence of rat intestine during ischemia and reperfusion]. / Cinética de la quimioluminescencia del intestino de la rata durante isquemia y reperfusión.

Oxygen free radicals are involved in ischemic and reperfusion tissular injuries. Chemiluminescence of organs reflects the steady state level of peroxy radicals, usually generated by oxygen radicals. In this study, chemiluminescence of intestine has been determined in rats subjected to 2, 5 or 10 min of occlusive ischemia by ligation. During the ischemic period, chemoluminescence tends to decrease. After delegation, a constant response, a chemiluminescence overshoot, can be obtained only in the group of rats subjected to 2 min of ligation. This methodology does not provide constant results with longer periods of ligation. In other groups of rats subjected to 2 min of ligation and then delegated, the kinetics of the organ emission in function of time show a mean overshoot of about 44% after 3 min of reperfusion. This early excess of chemiluminescence is maintained for the first 10 to 20 min after delegation, but not for longer periods. The administration of a free radical scavenger, thioctic acid 100 mg/kg i.p., prevents or reduces the amount of the overshoot previously described during the 20 min postdelegation follow-up period. These data suggest that excessive oxygen radical generation occurs in vivo during the early minutes of reperfusion and may be the consequence of very fast enzymatic changes during the short-term previous hypoxic period. Further studies are needed to demonstrate the subsequent functional alteration and the pathological implication of this phenomenon.

Cinetica de la quimioluminescencia del intestino de la rata durante isquemia y reperfusion / Kinetics of luminiscence of rat intestine during ischemia and reperfusion

En este estudio se determina in vivo la quimioluminescencia del intestino de rata sometido a isquemia provocada por una ligadura oclusiva y luego durante la reperfusión al desligar el órgano. La quimioluminescencia del órgano en función del tiempo, en animales sometidos a 2, 5 y 10 minutos de isquemia tiende a disminuir rápidamente. En intestinos de ratas ligados durante 2 minutos y luego desligados, comparados con intestinos no ligados, se muestra un exceso medio de quimioluminescencia del 44% aproximadamente luego de 2 a 3 minutos de iniciada la reperfusión. Este exceso inicial de quimioluminescencia se mantiene entre los primeros 10 a 20 minutos posteriores a la desligadura, no habiéndose registrado períodos más prolongados. la administración de un atrapador de radicales libres, ácido tióctico 100 mg/kg, i.p. evita o reduce el exceso de quimioluminescencia descripto, por un período de por lo menos 20 minutos. Estos datos concuerdan con la sugerencia de que la generación excesiva de radicales del oxígeno tiene lugar in vivo desde los minutos iniciales de la reperfusión y puede ser la consecuencia de cambios enzimáticos producidos muy rápidamente durante el anterior período hipóxico

Cinética de la quimioluminescencia del intestino de la rata durante isquemia y reperfusión. / [Kinetics of chemoluminiscence of rat intestine during ischemia and reperfusion]

Oxygen free radicals are involved in ischemic and reperfusion tissular injuries. Chemiluminescence of organs reflects the steady state level of peroxy radicals, usually generated by oxygen radicals. In this study, chemiluminescence of intestine has been determined in rats subjected to 2, 5 or 10 min of occlusive ischemia by ligation. During the ischemic period, chemoluminescence tends to decrease. After delegation, a constant response, a chemiluminescence overshoot, can be obtained only in the group of rats subjected to 2 min of ligation. This methodology does not provide constant results with longer periods of ligation. In other groups of rats subjected to 2 min of ligation and then delegated, the kinetics of the organ emission in function of time show a mean overshoot of about 44

after 3 min of reperfusion. This early excess of chemiluminescence is maintained for the first 10 to 20 min after delegation, but not for longer periods. The administration of a free radical scavenger, thioctic acid 100 mg/kg i.p., prevents or reduces the amount of the overshoot previously described during the 20 min postdelegation follow-up period. These data suggest that excessive oxygen radical generation occurs in vivo during the early minutes of reperfusion and may be the consequence of very fast enzymatic changes during the short-term previous hypoxic period. Further studies are needed to demonstrate the subsequent functional alteration and the pathological implication of this phenomenon.

Cinetica de la quimioluminescencia del intestino de la rata durante isquemia y reperfusion / Kinetics of luminiscence of rat intestine during ischemia and reperfusion

En este estudio se determina in vivo la quimioluminescencia del intestino de rata sometido a isquemia provocada por una ligadura oclusiva y luego durante la reperfusión al desligar el órgano. La quimioluminescencia del órgano en función del tiempo, en animales sometidos a 2, 5 y 10 minutos de isquemia tiende a disminuir rápidamente. En intestinos de ratas ligados durante 2 minutos y luego desligados, comparados con intestinos no ligados, se muestra un exceso medio de quimioluminescencia del 44% aproximadamente luego de 2 a 3 minutos de iniciada la reperfusión. Este exceso inicial de quimioluminescencia se mantiene entre los primeros 10 a 20 minutos posteriores a la desligadura, no habiéndose registrado períodos más prolongados. la administración de un atrapador de radicales libres, ácido tióctico 100 mg/kg, i.p. evita o reduce el exceso de quimioluminescencia descripto, por un período de por lo menos 20 minutos. Estos datos concuerdan con la sugerencia de que la generación excesiva de radicales del oxígeno tiene lugar in vivo desde los minutos iniciales de la reperfusión y puede ser la consecuencia de cambios enzimáticos producidos muy rápidamente durante el anterior período hipóxico (AU)

[Gastrointestinal involvement in progressive systemic sclerosis]. / Compromiso gastrointestinal en la esclerosis sistémica progresiva.

25 patients with clinical, radiological and manometrical features of PSS in the gastrointestinal tract were reviewed, looking mainly for the esophageal involvement. All of the data obtained in our serie agreed with those of most of the authors. Outlining: The lack of relationship between the evolution of the skin involvement and GI tract involvement. The high incidence of esophageal involvement, especially functional alterations even in the absence of clinical and/or radiological symptomatology. The usefulness of manometric method in the diagnosis of motor involvement of esophages, especially for the evaluation of lower esophageal esphincter. Although the esophageal and intestinal involvement are more frequent and well known, any area of the GI tract may be damaged during the course of this disease. Since up to now, an ethiological therapy to stop the course of the disease is not known, it's important to search for earlier alterations in order to start with a pathophysiological and symptomatic treatment to avoid complications.

Compromiso gastrointestinal en la esclerosis sistémica progresiva. / [Gastrointestinal involvement in progressive systemic sclerosis]

25 patients with clinical, radiological and manometrical features of PSS in the gastrointestinal tract were reviewed, looking mainly for the esophageal involvement. All of the data obtained in our serie agreed with those of most of the authors. Outlining: The lack of relationship between the evolution of the skin involvement and GI tract involvement. The high incidence of esophageal involvement, especially functional alterations even in the absence of clinical and/or radiological symptomatology. The usefulness of manometric method in the diagnosis of motor involvement of esophages, especially for the evaluation of lower esophageal esphincter. Although the esophageal and intestinal involvement are more frequent and well known, any area of the GI tract may be damaged during the course of this disease. Since up to now, an ethiological therapy to stop the course of the disease is not known, its important to search for earlier alterations in order to start with a pathophysiological and symptomatic treatment to avoid complications.