Modifications in self-care, quality of life and therapeutic adherence in patients with rheumatoid arthritis during the SARS-CoV-2 pandemic treated by telehealth

Introduction: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation, causing pain and stiffness in the joints. SARS-CoV-2 increases the clinical vulnerability of the population with RA and has led to the implementation and/or development of telemedicine. Objective: To describe changes in level of therapeutic adherence, quality of life and capacity for self-care agency, during the follow-up period of a group of patients linked to a non-face-to-face multidisciplinary consultation model during the SARS-CoV-2 pandemic. Methodology: Descriptive cohort study (July to October 2020). Description of the level of therapeutic adherence (Morisky Green Test), quality of life (EuroQOL-5-Dimensions-3-Level-version) and self-care capacity (ASA-R Scale) in the context of a telehealth model. A univariate and bivariate analysis was performed (Stata Software, Considered p-value <0.05). Results: Of 71 patients treated under the telehealth model, 85.9% were women, the age range was between 33 and 86 years with a median of 63. The most prevalent comorbidity was arterial hypertension (35.2%). Quality of life did not change during follow-up nor did adherence to treatment, apart from in one item [the patients did not stop taking the medication when they were well (p = 0.029)]. In self-care capacity, there were significant improvements in five dimensions (p < 0.05), without significant differences in the global score. Conclusion: Patients with RA evaluated in the context of telehealth in a period of pandemic did not present significant changes in quality of life, adherence to treatment, or capacity for self-care, and remained close to baseline values when they attended a traditional face-to-face assessment.

INTRODUCCIÓN: La artritis reumatoide (AR) es una enfermedad autoinmune caracterizada por una inflamación crónica que produce dolor y rigidez articular. El SARS-CoV-2 aumenta la vulnerabilidad clínica en pacientes con AR, lo que ha conllevado la implementación o el desarrollo de la telesalud. OBJETIVO: Describir los cambios en el nivel de adherencia terapéutica, la calidad de vida y la capacidad de autocuidado durante el periodo de seguimiento, en un grupo de pacientes con AR vinculados con un modelo de consulta multidisciplinar no presencial, en el curso de la pandemia por SARS-CoV-2. METODOLOGÍA: Estudio de cohorte descriptiva (julio a octubre del 2020). Descripción del nivel de adherencia terapéutica (TEST MORISKY GREEN), calidad de vida (EUROQOL-5-DIMENSIONS-3-LEVEL-VERSION) y capacidad de autocuidado (Escala ASA-R) en el contexto de un modelo de telesalud. Se realizó análisis univariado y bivariado (SOFTWARE Stata®, valor de p considerado <0,05). RESULTADOS: De 71 pacientes atendidos en modalidad de telesalud, el 85,9% fueron mujeres, la mediana de la edad fue de 63 (33-86) anos. La comorbilidad más prevalente fue la hipertensión (35,2%). La calidad de vida no tuvo cambios durante el seguimiento, al igual que la adherencia al tratamiento, excepto en uno de los ítems (los pacientes no dejaron de tomar la medicación cuando se encontraban bien; p = 0,029). En la capacidad de autocuidado hubo mejoras significativas en 5 dimensiones (p < 0,05), sin diferencias significativas en el puntaje global. CONCLUSIÓN: Los pacientes con AR evaluados en el contexto de la telesalud, en un periodo de pandemia, no presentaron cambios significativos en la calidad de vida, la adherencia al tratamiento y la capacidad de autocuidado; se mantuvieron en niveles similares a los valores basales cuando asistían a valoración tradicional presencial.

Is there any relationship between massive ascites and elevated CA-125 in systemic lupus erythematosus? Case report and review of the literature.

Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease of variable presentation. Massive ascites in the context of SLE is infrequent. Even so, it has been reported that ascites may be the first manifestation of SLE. It is difficult to diagnose due to the multiple possible aetiological causes of ascites. There is a rare entity called Pseudo-Pseudo Meigs Syndrome (PPMS) in patients with SLE who have ascites, pleural effusion, and CA-125 elevation unrelated to malignancy. We present two cases of massive ascites, pleural effusion and elevation of CA-125 with a history of SLE diagnosis. One of these cases was diagnosed with PPMS and another associated with neoplasm of ovarian origin.

Asociación de medidas morfométricas con grasa en el anca en caballos de salto en una escuela ecuestre de Bogotá / Association of morphometric measurements with rump fat in jumping horses in an equestrian school in Bogotá / Associação de medidas morfométricas com gordura na anca em cavalos de salto em uma escola equestre de Bogotá

Se realizó un estudio para conocer la relación de medidas morfométricas y engrasamiento corporal medido por ultrasonido en caballos de salto de una escuela ecuestre en Bogotá. Se midieron caballos de salto machos adultos mestizos de silla argentina por criollo colombiano (n = 9) que se encontraban en entrenamiento. Las medidas analizadas fueron altura a la cruz (AC), perímetro torácico (PT), longitud corporal (LC), perímetro de caña posterior (PCP), peso real (PR), peso estimado (PES), espeso de grasa dorsal (EGD), espesor de grasa en el anca (EGA), área de ojo de lomo (AOL). Para estimar el engrasamiento se calcularon el índice de masa corporal (basado en medidas morfométricas) y el porcentaje de grasa corporal (basado en medidas de grasa por ultrasonido). Se realizó estadística descriptiva y análisis de componentes principales. Los promedios encontrados para AC, PT, LC, PCP, PES, PR, EGD, EGA y AOL fueron 1,69 ± 0,02 m, 1,89 ± 0,04 m, 1,67 ± 0,07 m, 26 ± 1,82 m, 526 ± 36 kg, 525 ± 33 kg, 2,34 ± 0,32 mm, 2,12 ± 0,15 mm y 58 ± 4,7 cm² respectivamente. El índice de masa promedio estimado fue de 183,97 ± 11 y el porcentaje de grasa corporal promedio fue de 14,07 ± 0,85. Los dos métodos para estimar el engrasamiento (r = 0,41) se correlacionaron significativamente.

The study aimed to determine the relationship of morphometric measurements and body fattening measured by ultrasound in jumping horses at an equestrian school in Bogotá. Adult male jumping horses in training, mixed breed of Argentine and Colombian Creole (n = 9), were measured. The analyzed measurements were wither height (WH), thoracic perimeter (TP), body length (BL), hind leg perimeter (HLP), actual weight (AW), estimated weight (EW), backfat thickness (BT), rump fat thickness (RFT), and loin eye area (LEA). To estimate fattening, body mass index (based on morphometric measurements) and body fat percentage (based on fat measurements by ultrasound) were calculated. Descriptive statistics and principal component analysis were performed. The averages found for WH, TP, BL, HLP, AW, EW, BT, RFT, and LEA were 1.69 ± 0.02 m, 1.89 ± 0.04 m, 1.67 ± 0.07 m, 26 ± 1.82 m, 526 ± 36 kg, 525 ± 33 kg, 2.34 ± 0.32 mm, 2.12 ± 0.15 mm, and 58 ± 4.7 cm², respectively. The estimated average body mass index was 183.97 ± 11, and the average body fat percentage was 14.07 ± 0.85. The two methods for estimating fattening (r = 0.41) were significantly correlated.

Realizou-se um estudo para conhecer a relação de medidas morfométricas e adiposidade corporal medido por ultrassom em cavalos de salto de uma escola equestre em Bogotá. Mediram-se cavalos de salto machos adultos mestiços de sela argentina por criollo colombiano (n = 9) que estavam em treinamento. As medidas analisadas foram altura até a cruz (AC), perímetro torácico (PT), longitude corporal (LC), perímetro de cana posterior (PR, PCP), peso real (PR), peso estimado (PES), espessura de gordura dorsal (EGD), espessura de gordura na anca (EGA), área de olho de lombo (AOL). Para calcular a gordura se calcularam o índice de massa corporal (baseado em medidas morfométricas) e a porcentagem de gordura corporal (baseado em medidas de gordura por ultrassom). Realizou-se estatística descritiva e análise de componentes principais. As médias encontradas para AC, PT, LC, PES, EGD, EGA e AOL foram 1,69 ± 0,02 m, 1,89 ± 0,04 m, 1,67 ± 0,07 m, 26 ± 1,82 m, 526 ± 36 kg, 525 ± 33 kg, 2,34 ± 0,32 mm, 2,12 ± 0,15 mm e 58 ± 4,7 cm² respectivamente. O índice de massa média estimada foi de 183,97 ± 11 e a porcentagem de gordura corporal média foi de 14,07 ± 0,85. Os dois métodos para estimar a adiposidade (r = 0,41) se correlacionaram significativamente.