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1.
Arch Osteoporos ; 16(1): 60, 2021 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-33813663

RESUMO

We analyzed the long-term persistence of treatment in a FLS. During follow-up, 15.2% of patients had a refracture and 23.8% died. At the 5-year checkup, 74% had started treatment (associated with female sex, previous use of bisphosphonate, and referral to an osteoporosis clinic). Persistence at 1 and 5 years was 70.6% and 46.5%, respectively. INTRODUCTION: To analyze the long-term persistence of treatment in a fracture liaison service (FLS). METHODS: Patients ≥ 50 years with a fragility fracture attended between 2012 and 2016 who were recommended for treatment to prevent new fractures were included. Baseline data included demographics, type of fracture, previous treatment, and FRAX® items. Five years later, patient records were reviewed and the following data were collected: [1] survival; [2] refracture; [3] initiation of treatment, persistence, and medication possession ratio (MPR) > 80%. RESULTS: We included 888 patients, mean age 75 years, 83% women, and mean follow-up 56 months. During follow-up, 135 patients (15.2%) had a refracture (109 major fractures, 50 hip refractures) and 212 patients died (23.8%); at the 5-year checkup, 657 patients (74%) had started some type of treatment. Factors associated with the start of treatment were female sex (OR 2.10; 95% CI: 1.42-3.11), previous use of bisphosphonate (OR 3.91; 95% CI: 2.23-6.86), and referral to an osteoporosis clinic (OR 1.46; 95% CI: 1.02-2.07). Persistence decreased from 70.6% at 12 months to 46.5% at 60 months. An MPR > 80% was confirmed in 449 patients, 68.3% of whom were under treatment. A total of 521 and 447 patients received treatment for at least 24 and 36 months, respectively (79.3% and 68.0% of those who started treatment). CONCLUSIONS: Patients with fragility fractures attended at an FLS showed optimal long-term persistence of treatment. These data can help healthcare managers better calculate the cost-effectiveness of implementing the FLS model.

2.
Arthritis Res Ther ; 23(1): 111, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849644

RESUMO

BACKGROUND: Vaspin is a novel anti-inflammatory adipokine associated with cardiovascular (CV) disease and inflammation in chronic inflammatory conditions different from axial spondyloarthritis (axSpA). Given the high incidence of CV disease (mainly due to accelerated atherosclerosis) exhibited by axSpA patients, we wondered if vaspin could also be a key molecule in this process. However, data on the role of vaspin regarding atherosclerotic disease in the context of axSpA is scarce. For this reason, we aimed to evaluate the implication of vaspin, at the genetic and serological level, in subclinical atherosclerosis and CV risk in axSpA. METHODS: This study included 510 patients diagnosed with axSpA. Carotid ultrasound (US) was performed to evaluate the presence of subclinical atherosclerosis. Three vaspin gene variants (rs2236242, rs7159023, and rs35262691) were genotyped by TaqMan probes. Serum vaspin levels were assessed by enzyme-linked immunosorbent assay. Statistical analysis was performed using STATA® v.11.1. RESULTS: Serum vaspin levels were significantly higher in female patients than in males and also in obese patients when compared to those with normal weight (p < 0.05). At the genetic level, we disclosed that the minor allele of rs2236242 (A) was associated with lower serum vaspin levels in axSpA, while the rs7159023 minor allele (A) was linked to higher serum levels (p < 0.05). When the three polymorphisms assessed were combined conforming haplotypes, we disclosed that the TGC haplotype related to high serum levels of vaspin (p = 0.01). However, no statistically significant association was observed between vaspin and markers of subclinical atherosclerosis, both at the genetic and serological level. CONCLUSIONS: Our results revealed that vaspin is linked to CV risk factors that may influence on the atherosclerotic process in axSpA. Additionally, we disclosed that serum vaspin concentration is genetically modulated in a large cohort of patients with axSpA.

3.
Semin Arthritis Rheum ; 51(2): 395-403, 2021 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-33607385

RESUMO

OBJECTIVES: To compare the atherosclerosis disease burden between ankylosing spondylitis (AS) and non-radiographic (nr) axial spondyloarthritis (axSpA) and establish a model that allows to identify high-cardiovascular (CV) risk in axial spondyloarthritis patients. METHODS: Cross-sectional study from the AtheSpAin cohort, a Spanish multicenter cohort aimed to study atherosclerosis in axSpA. Carotid ultrasound (US) was performed to determine the carotid intima-media wall thickness (cIMT) and detect the presence of carotid plaques. The European cardiovascular disease risk assessment model, the Systematic COronary Risk Evaluation (SCORE), was also applied. RESULTS: A set of 639 patients with AS and 167 patients with nr-axSpA without history of CV events were recruited. AS patients were older showing more CV risk factors and higher values of C reactive protein and erythrocyte sedimentation rate (ESR) than those with nr-axSpA. However, no difference in the prevalence of carotid plaques or in the cIMT was found between both groups in the adjusted analysis. The percentage of patients reclassified from the low and moderate CV risk categories to the very high-risk category due to the presence of carotid plaques was comparable in AS and nr-axSpA (10.7% versus 10.1% and 40.5% versus 45.5%, respectively). A model containing age, BASFI and ESR applied to moderate risk axSpA patients identified 41% of these patients as having very high-risk patients with high specificity (88%). CONCLUSION: The atherosclerosis burden is similar in nr-axSpA and AS. As occurred for AS, more than 40% of axSpA patients included in the category of moderate CV risk according to the SCORE are reclassified into very high risk after carotid US, and a clinically relevant proportion of them can be detected by applying a model containing age, BASFI and ESR.

4.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33627247

RESUMO

BACKGROUND: There are no guidelines to screen haemato-oncologic children when a tuberculosis (TB) outbreak is suspected. METHODS: After exposition to an adult with active TB, children exposed from a haemato-oncology unit were screened according to immunosuppression status and time of exposure. Until an evaluation after 8-12 weeks from last exposure, isoniazid was indicated to those with negative initial work-up. RESULTS: After 210 interventions, we detected a case of pulmonary TB, and another with latent TB infection. Pulmonary findings and treatment approach were challenging in some patients. CONCLUSIONS: The TB screening of oncologic children required a multidisciplinary approach, and clinicians managed challenging situations.

6.
Rev. colomb. cir ; 36(1): 35-41, 20210000. fig
Artigo em Espanhol | LILACS | ID: biblio-1148498

RESUMO

Introducción. La pandemia por SARS-CoV-2 modificó la prestación de servicios de salud para priorizar el manejo de los casos emergentes. La Asociación Colombiana de Cirugía fue una de las primeras en liderar dichas iniciativas. Este estudio describe el comportamiento de los servicios de salud de un centro especializado en patología de cabeza y cuello en Medellín, Colombia. Métodos. Este es un análisis retrospectivo de una cohorte prospectiva, en el que se usó la base de datos administrativa. Las variables analizadas fueron el número y tipo de consultas y procedimientos, realizados en el periodo de enero-julio de 2109 y su comparación con el mismo periodo de 2020. Se realizó un análisis descriptivo usando porcentajes, promedio y desviación estándar. Resultados. Se analizaron 3521 consultas y 866 procedimientos quirúrgicos. Se observó una caída del número de consultas, que alcanzó su punto más bajo en el mes de abril, con un 33,9 % de disminución El porcentaje de consultas de telemedicina aumentó desde marzo de 2020, hasta alcanzar un 98 % en el mes de abril. Se observó una caída del número de procedimientos, con un aumento compensatorio en junio del 62,5 %. A la fecha, ningún paciente ni integrante del equipo de atención en salud ha presentado infección por COVID-19. Discusión. La pandemia de COVID-19 tuvo un efecto importante en el número de consultas y de procedimientos quirúrgicos de cabeza y cuello. La estrategia de telemedicina ayudó a compensar la disminución del acceso a la atención especializada


Introduction. The SARS-CoV-2 pandemic modified the provision of health services to prioritize the management of emerging cases. The Colombian Association of Surgery was one of the first to lead these initiatives. This study describes the behavior of the health services of a center specialized in head and neck pathology in Medellín, Colombia. Methods. This is a retrospective analysis of a prospective cohort, in which the administrative database was used. The variables analyzed were the number and type of consultations and procedures, carried out in the period from January to July 2019 and their comparison with the same period in 2020. A descriptive analysis was carried out using percentages, average and standard deviation. Results. On the database, 3,521 consultations and 866 surgical procedures were analyzed. A drop in the number of consultations was observed, reaching its lowest point in the month of April, with a 33.9% decrease. The percentage of telemedicine consultations increased since March 2020, reaching 98% in the month of April. A drop in the number of procedures was observed, with a compensatory increase in June of 62.5%. To date, no patient or member of the health care team has developed a COVID-19 infection. Discussion. The COVID-19 pandemic had a significant effect on the number of consultations and head and neck surgical procedures. The telemedicine strategy helped to compensate the decrease in access to specialized care


Assuntos
Humanos , Infecções por Coronavirus , Cirurgia Geral , Vírus da SARS , Neoplasias de Cabeça e Pescoço
7.
Ann Med ; 53(1): 197-207, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33345622

RESUMO

BACKGROUND: COVID-19 counts 46 million people infected and killed more than 1.2 million. Hypoxaemia is one of the main clinical manifestations, especially in severe cases. HIF1α is a master transcription factor involved in the cellular response to oxygen levels. The immunopathogenesis of this severe form of COVID-19 is poorly understood. METHODS: We performed scRNAseq from leukocytes from five critically ill COVID-19 patients and characterized the expression of hypoxia-inducible factor1α and its transcriptionally regulated genes. Also performed metanalysis from the publicly available RNAseq data from COVID-19 bronchoalveolar cells. RESULTS: Critically-ill COVID-19 patients show a shift towards an immature myeloid profile in peripheral blood cells, including band neutrophils, immature monocytes, metamyelocytes, monocyte-macrophages, monocytoid precursors, and promyelocytes-myelocytes, together with mature monocytes and segmented neutrophils. May be the result of a physiological response known as emergency myelopoiesis. These cellular subsets and bronchoalveolar cells express HIF1α and their transcriptional targets related to inflammation (CXCL8, CXCR1, CXCR2, and CXCR4); virus sensing, (TLR2 and TLR4); and metabolism (SLC2A3, PFKFB3, PGK1, GAPDH and SOD2). CONCLUSIONS: The up-regulation and participation of HIF1α in events such as inflammation, immunometabolism, and TLR make it a potential molecular marker for COVID-19 severity and, interestingly, could represent a potential target for molecular therapy. Key messages Critically ill COVID-19 patients show emergency myelopoiesis. HIF1α and its transcriptionally regulated genes are expressed in immature myeloid cells which could serve as molecular targets. HIF1α and its transcriptionally regulated genes is also expressed in lung cells from critically ill COVID-19 patients which may partially explain the hypoxia related events.


Assuntos
/genética , Estado Terminal , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Células Mieloides/metabolismo , Análise de Sequência de RNA/métodos , Feminino , Humanos , Masculino , RNA Mensageiro/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Regulação para Cima
8.
Entropy (Basel) ; 22(4)2020 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-33286263

RESUMO

Providing the visual complexity of an image in terms of impact or aesthetic preference can be of great applicability in areas such as psychology or marketing. To this end, certain areas such as Computer Vision have focused on identifying features and computational models that allow for satisfactory results. This paper studies the application of recent ML models using input images evaluated by humans and characterized by features related to visual complexity. According to the experiments carried out, it was confirmed that one of these methods, Correlation by Genetic Search (CGS), based on the search for minimum sets of features that maximize the correlation of the model with respect to the input data, predicted human ratings of image visual complexity better than any other model referenced to date in terms of correlation, RMSE or minimum number of features required by the model. In addition, the variability of these terms were studied eliminating images considered as outliers in previous studies, observing the robustness of the method when selecting the most important variables to make the prediction.

9.
Artigo em Inglês | MEDLINE | ID: mdl-33295631

RESUMO

OBJECTIVE: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a serine protease that regulates cholesterol metabolism and has been linked to cardiovascular (CV) risk. The purpose of the present study was to examine whether PCSK9 levels are related to abnormalities in the lipid profile and the development of atherosclerosis that occurs in patients with axial SpA (axSpA). METHODS: We performed a cross-sectional study that encompassed 545 individuals; 299 patients with axSpA and 246 statin use-matched controls. PCSK9 and standard lipid profiles were analysed in patients and controls. Carotid intima-media thickness (cIMT) and carotid plaques were assessed in patients. A multivariable analysis, adjusted for standard CV risk factors, was performed to evaluate the influence of PCSK9 on axSpA-related dyslipidaemia and subclinical carotid atherosclerosis. RESULTS: Total cholesterol, high-density lipoprotein and low density lipoprotein cholesterol, lipoprotein (a) and apolipoprotein A1 were significantly lower in axSpA patients than controls. PCSK9 serum levels [ß coefficient -44 ng/dl (95% CI -60, -27), P = 0.000] were also downregulated in axSpA patients after fully multivariable adjustment. ASDAS-CRP was found to be independently and significantly related to PCSK9 [ß coefficient 10 ng/dl (95% CI 1, 18), P = 0.023] after analysing fully adjusted models that took age, sex and the rest of the lipid profile molecules into account. Whereas patients taking prednisone showed higher serum levels of PCSK9 [55 ng/ml (95% CI 24, 8), P = 0.001], those under anti-TNF-α therapies exhibited lower levels [ß coefficient -26 ng/ml (95% CI -43, -9], P = 0.003]. CONCLUSION: PCSK9 is downregulated in patients with axSpA. Disease activity is positive and significantly related to PSCK9. Anti-TNF-therapy yields a reduction in PCSK9 serum levels.

10.
An Pediatr (Barc) ; 2020 Nov 02.
Artigo em Espanhol | MEDLINE | ID: mdl-33328150

RESUMO

INTRODUCTION: Telemedicine is an attractive option for the follow-up of paediatric patients with SARS-CoV-2 infection. The aim of this article is to describe the experience with telephone consultations in a tertiary hospital. PATIENTS AND METHODS: Retrospective descriptive study of children with confirmed or probable diagnosis of COVID-19 attended by telephone consultations in Hospital La Paz (Madrid) between March and June 2020. Patients were referred from the Emergency Department after being discharged from the hospital. Telephone consultations were made every 48hours until symptoms resolved, then weekly until completing 14 days without symptoms. RESULTS: A total of 72 children were included, with median age of 83.5 months (IQR=16.3-157.5). Of those 46 (63.9%) were male, and 14 (19.4%) had comorbidities. There were 32 (44.4%) hospital admissions. COVID-19 diagnosis was confirmed in 33 children by RT-PCR, and in 7 by serology tests. The seroconversion rate was 67.7% in those patients with a positive RT-PCR. Other infections were found in 7 patients (5 Mycoplasma pneumoniae, 1 parvovirus, and 1 cytomegalovirus). Median symptom duration was 25.5 days (IQR=13.8-37), while median follow-up duration was 28 days (IQR=21-39). The median number of telephone consultations per patient was 6 (IQR=4-8). Clinical worsening was reported in 19 (26.4%) during follow-up, and 14 (19.4%) were re-evaluated in the Emergency Department. One patient required hospital admission, but he had a favourable outcome. CONCLUSIONS: Children with suspected SARS-CoV-2 infection should be followed-up due to prolonged duration of symptoms, and the risk of clinical deterioration. Telephone consultations are a useful and safe alternative for the follow-up of patients with mild symptoms, and for children discharged from the hospital.

11.
Arch Med Res ; 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33248817

RESUMO

BACKGROUND: SARS-CoV-2, the etiological agent causing COVID-19, has infected more than 27 million people with over 894000 deaths worldwide since its emergence in December 2019. Factors for severe diseases, such as diabetes, hypertension, and obesity have been identified however, the precise pathogenesis is poorly understood. To understand its pathophysiology and to develop effective therapeutic strategies, it is essential to define the prevailing immune cellular subsets. METHODS: We performed whole circulating immune cells scRNAseq from five critically ill COVID-19 patients, trajectory and gene ontology analysis. RESULTS: Immature myeloid populations, such as promyelocytes-myelocytes, metamyelocytes, band neutrophils, monocytoid precursors, and activated monocytes predominated. The trajectory with pseudotime analysis supported the finding of immature cell states. While the gene ontology showed myeloid cell activation in immune response, DNA and RNA processing, defense response to the virus, and response to type 1 interferon. Lymphoid lineage was scarce. Expression of genes such as C/EBPß, IRF1and FOSL2 potentially suggests the induction of trained immunity. CONCLUSIONS: Our results uncover transcriptomic profiles related to immature myeloid lineages and suggest the potential induction of trained immunity.

12.
An Pediatr (Barc) ; 2020 Oct 31.
Artigo em Espanhol | MEDLINE | ID: mdl-33132066

RESUMO

A new paediatric multisystem inflammatory syndrome, linked to SARS-CoV-2, has been described. The clinical picture is variable and is associated with an active or recent infection due to SARS-CoV-2. A review of the existing literature by a multidisciplinary group of paediatric specialists is presented in this document. Later, they make recommendations on the stabilisation, diagnosis, and treatment of this syndrome.

13.
Reumatol. clín. (Barc.) ; 16(5,pt.2): 405-409, sept.-oct. 2020. tab
Artigo em Inglês | IBECS-Express | IBECS | ID: ibc-ET1-6654

RESUMO

INTRODUCTION: Rheumatoid arthritis (RA) is the most frequent chronic polyarthritis. The current goal of RA treatment is to achieve clinical remission. OBJECTIVE: The goal of this study was to determine the prevalence of remission in a cohort of patients from clinical practice, and to identify potentially modifiable factors associated with remission. METHODS: A retrospective study was performed on a cohort of RA patients seen at the first consultation at the HUGC Rheumatology Service Dr. Negrín (HUGCDN) between first of January 2000 and thirtieth of April 2014. Sustained remission was defined as DAS28 less than 2.6 in the last two available visits in the medical history. RESULTS: A total of 463 patients were consecutively included, most (75%) women, with a mean age at the onset of RA of 50 years and a mean duration of the disease at follow-up of 8 years. 46% of the patients achieved sustained remission. Multiple logistic regression analyses found male sex (P=.031, OR 1.7, 95% CI 1.05-2.82), diagnosis in the first year of symptoms (P=.023, OR 1.7, 95% CI 1.07-2.69) and the initial DAS28 (P=.035) to be independent predictors for sustained remission. CONCLUSIONS: The 46% of the patients with RA followed in the HUGC Dr. Negrín are in persistent remission, being the early diagnosis a modifiable factor predictor of remission. Thus, an objective of the Rheumatology Service should be to improve the diagnostic delay of RA in the health area


INTRODUCCIÓN: La artritis reumatoide (AR) es la poliartritis crónica más frecuente. El objetivo actual del tratamiento de la AR es lograr la remisión clínica. OBJETIVO: El objetivo de este estudio fue determinar la prevalencia de la remisión en una cohorte de pacientes de la práctica clínica, e identificar factores potencialmente modificables asociados con la remisión. MÉTODOS: Se realizó un estudio retrospectivo en una cohorte de pacientes con AR observada en la primera consulta del Servicio de Reumatología del Hospital Universitario de Gran Canaria Dr. Negrín (HUGCDN) entre el primero de enero de 2000 y el 30 de abril de 2014. La remisión mantenida se definió como DAS28 menor de 2,6 en las 2 últimas visitas recogidas en la historia clínica. RESULTADOS: Se incluyeron consecutivamente 463 pacientes, la mayoría (75%) mujeres, con una edad media al inicio de la AR de 50 años y la duración media de la enfermedad en el seguimiento de 8 años. El 46% de los pacientes alcanzaron la remisión sostenida. Los análisis de regresión logística múltiple encontraron que el sexo masculino (p = 0,031; OR: 1,7; IC del 95%: 1,05-2,82), el diagnóstico en el primer año de síntomas (p = 0,023; OR: 1,7; IC del 95%: 1,07-2,69) y el DAS28 inicial (p = 0,035) fueron factores predictores independientes de remisión sostenida. CONCLUSIONES: El 46% de los pacientes con AR seguidos en el HUGCDN están en remisión persistente, siendo el diagnóstico precoz un factor predictor modificable de la remisión. Así, un objetivo del servicio de reumatología debe ser mejorar el retraso diagnóstico de la AR en el área de salud

14.
Larenas-Linnemann, Désirée; Rodríguez-Pérez, Noel; Luna-Pech, Jorge A; Rodríguez-González, Mónica; Blandón-Vijil, María Virginia; Del-Río-Navarro, Blanca E; Costa-Domínguez, María Del Carmen; Navarrete-Rodríguez, Elsy Maureen; Macouzet-Sánchez, Carlos; Ortega-Martell, José Antonio; Pozo-Beltrán, César Fireth; Estrada-Cardona, Alan; Arias-Cruz, Alfredo; Rodríguez Galván, Karen Guadalupe; Brito-Díaz, Herson; Canseco-Raymundo, María Del Rosario; Castelán-Chávez, Enrique Emanuel; Escalante-Domínguez, Alberto José; Gálvez-Romero, José Luis; Gómez-Vera, Javier; González-Díaz, Sandra Nora; Guerrero-Núñez, María Gracia Belinda; Hernández-Colín, Dante Daniel; Macías-Weinmann, Alejandra; Mendoza-Hernández, David Alejandro; Meneses-Sánchez, Néstor Alejandro; Mogica-Martínez, María Dolores; Moncayo-Coello, Carol Vivian; Montiel-Herrera, Juan Manuel; O'Farril-Romanillos, Patricia María; Onuma-Takane, Ernesto; Ortega-Cisneros, Margarita; Rangel-Garza, Lorena; Stone-Aguilar, Héctor; Torres-Lozano, Carlos; Venegas-Montoya, Edna; Wakida-Kusunoki, Guillermo; Partida-Gaytán, Armando; López-García, Aída Inés; Macías-Robles, Ana Paola; Ambriz-Moreno, María de Jesús; Azamar-Jácome, Amyra Ali; Beltrán-De Paz, Claudia Yusdivia; Caballero-López, Chrystopherson; Fernández de Córdova-Aguirre, Juan Carlos; Fernández-Soto, José Roberto; Lozano-Sáenz, José Santos; Oyoqui-Flores, José Joel; Osorio-Escamilla, Roberto Efrain; Ramírez-Jiménez, Fernando.
World Allergy Organ J ; 13(8): 100444, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32884611

RESUMO

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, Supplementary data) concluded the following. Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50-200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.

15.
Arch Med Res ; 51(7): 645-653, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32611485

RESUMO

BACKGROUND: The SARS-CoV-2 is the etiological agent causing COVID-19 which has infected more than 2 million people with more than 200000 deaths since its emergence in December 2019. In the majority of cases patients are either asymptomatic or show mild to moderate symptoms and signs of a common cold. A subset of patients, however, develop a severe atypical pneumonia, with the characteristic ground-glass appearance on chest x-ray and computerized tomography, which evolves into an acute respiratory distress syndrome, that requires mechanical ventilation and eventually results in multiple organ failure and death. The Molecular pathogenesis of COVID-19 is still unknown. AIM OF THE STUDY: In the present work we performed a stringent metanalysis from the publicly available RNAseq data from bronchoalveolar cells and peripheral blood mononuclear cells to elucidate molecular alterations and cellular deconvolution to identify immune cell profiles. RESULTS: Alterations in genes involved in hyaluronan, glycosaminoglycan and mucopolysaccharides metabolism were over-represented in bronchoalveolar cells infected by SARS-CoV-2, as well as potential lung infiltration with neutrophils, T CD4+ cell and macrophages. The blood mononuclear cells presented a proliferative state. Dramatic reduction of NK and T lymphocytes, whereas an exacerbated increase in monocytes. CONCLUSIONS: In summary our results revealed molecular pathogenesis of the SARS-CoV-2 infection to bronchoalveolar cells inducing the hyaluronan and glycosaminoglycan metabolism that could shape partially the components of the ground-glass opacities observed in CT. And the potential immune response profile in COVID-19.

16.
BMC Mol Cell Biol ; 21(1): 52, 2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32640984

RESUMO

BACKGROUND: The main challenge in cancer research is the identification of different omic variables that present a prognostic value and personalised diagnosis for each tumour. The fact that the diagnosis is personalised opens the doors to the design and discovery of new specific treatments for each patient. In this context, this work offers new ways to reuse existing databases and work to create added value in research. Three published signatures with significante prognostic value in Colon Adenocarcinoma (COAD) were indentified. These signatures were combined in a new meta-signature and validated with main Machine Learning (ML) and conventional statistical techniques. In addition, a drug repurposing experiment was carried out through Molecular Docking (MD) methodology in order to identify new potential treatments in COAD. RESULTS: The prognostic potential of the signature was validated by means of ML algorithms and differential gene expression analysis. The results obtained supported the possibility that this meta-signature could harbor genes of interest for the prognosis and treatment of COAD. We studied drug repurposing following a molecular docking (MD) analysis, where the different protein data bank (PDB) structures of the genes of the meta-signature (in total 155) were confronted with 81 anti-cancer drugs approved by the FDA. We observed four interactions of interest: GLTP - Nilotinib, PTPRN - Venetoclax, VEGFA - Venetoclax and FABP6 - Abemaciclib. The FABP6 gene and its role within different metabolic pathways were studied in tumour and normal tissue and we observed the capability of the FABP6 gene to be a therapeutic target. Our in silico results showed a significant specificity of the union of the protein products of the FABP6 gene as well as the known action of Abemaciclib as an inhibitor of the CDK4/6 protein and therefore, of the cell cycle. CONCLUSIONS: The results of our ML and differential expression experiments have first shown the FABP6 gene as a possible new cancer biomarker due to its specificity in colonic tumour tissue and no expression in healthy adjacent tissue. Next, the MD analysis showed that the drug Abemaciclib characteristic affinity for the different protein structures of the FABP6 gene. Therefore, in silico experiments have shown a new opportunity that should be validated experimentally, thus helping to reduce the cost and speed of drug screening. For these reasons, we propose the validation of the drug Abemaciclib for the treatment of colon cancer.

17.
Sci Rep ; 10(1): 9636, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32541676

RESUMO

Cardiovascular (CV) disease is the main cause of mortality in axial spondyloarthritis (axSpA). CV risk is enhanced by dysregulation of adipokines. Low omentin levels were associated with metabolic dysfunction and CV disease in conditions different from axSpA. Accordingly, we evaluated the genetic and functional implication of omentin in CV risk and subclinical atherosclerosis in a cohort of 385 axSpA patients. Subclinical atherosclerosis was evaluated by carotid ultrasound. Omentin rs12409609, in linkage disequilibrium with a polymorphism associated with CV risk, was genotyped in 385 patients and 84 controls. Serum omentin levels were also determined. omentin mRNA expression was assessed in a subgroup of individuals. Serum and mRNA omentin levels were lower in axSpA compared to controls. Low serum omentin levels were related to male sex, obesity, inflammatory bowel disease (IBD) and high atherogenic index. rs12409609 minor allele was associated with low omentin mRNA expression in axSpA. No association was observed with subclinical atherosclerosis at the genetic or functional level. In conclusion, in our study low omentin serum levels were associated with CV risk factors in axSpA. Furthermore, rs12409609 minor allele may be downregulating the expression of omentin. These data support a role of omentin as a CV risk biomarker in axSpA.

18.
Reumatol. clín. (Barc.) ; 16(3): 203-215, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-194353

RESUMO

OBJETIVO: Generar una norma de calidad para el manejo del paciente con artritis psoriásica (APs). MÉTODOS: Metodología cualitativa que incluyó: 1) dos grupos focales (uno con pacientes con APs y otro con especialistas no reumatólogos implicados en su cuidado); 2) revisión de la literatura publicada sobre documentos en el ámbito de la calidad asistencial en APs; 3) reunión de grupo nominal donde 15 expertos reumatólogos generaron, de forma consensuada, una serie de criterios de calidad así como fórmulas o medidas objetivas cuantificables para evaluarlas; 4) Delphi para establecer la factibilidad, prioridad y grado de acuerdo con los criterios de calidad, y 5) generación de estándares de calidad y sus atributos. Se realizó un análisis descriptivo de los resultados. RESULTADOS: Se generaron 59 estándares de calidad, 18 de los cuales de cumplimiento obligatorio, agrupados en 4 bloques según unos objetivos específicos: 1) acortar el tiempo hasta el diagnóstico (n=6); 2) optimizar el manejo de la enfermedad (n=26); 3) mejorar la colaboración multidisciplinar (n=9), y 4) mejorar la monitorización (n=18). Para evaluar el cumplimiento de estos estándares en muchos casos se revisarán las historias clínicas. Otras fuentes serán la memoria del servicio y del hospital así como los buscadores bibliográficos. En cuanto al nivel de exigencia a la hora de considerar por cumplido el estándar, algunos son de tipo sí/no, otros están desde el 50 al 100%, y en este rango muchos en el 80%. CONCLUSIONES: Esta norma de calidad debe ayudar en la mejora de la calidad de atención para el paciente con APs


OBJECTIVE: To generate a quality standard for the management of patients with psoriatic arthritis (PsA). METHODS: We employed qualitative methodology that included: 1) Two focus groups (one with patients with PsA and another with non-rheumatologist specialists involved in the care of PsA patients); 2) A narrative literature review of published documents related to the quality of care in PsA; 3) A nominal group meeting in which 15 expert rheumatologists generated and reached a consensus on a series of quality criteria, as well as formulas or quantifiable objective measures to evaluate them; 4) The Delphi method to establish the feasibility, priority and agreement with the quality criteria; 5) A final generation of standards of care and their attributes. A descriptive analysis of the results was carried out. RESULTS: A total of 59 standards of care was generated, 18 of mandatory compliance, grouped into 4 blocks according to specific objectives: 1) early diagnosis (n=6); 2) optimizing the management of the disease (n=26); 3) multidisciplinary collaboration (n=9); 4) monitoring improvement (n=18). To assess compliance with these standards of care, in many cases, the medical records will be reviewed. Other sources will be the records of the service and hospital and bibliographic databases. Regarding the level of compliance, for some of the standards of care this is yes/no; for others, compliance ranges from 50% to 100% and, in this range, in many cases, compliance was 80%. CONCLUSIONS: This set of standards of care should help improve quality of care in PsA patients


Assuntos
Humanos , Padrões de Referência , Artrite Psoriásica/epidemiologia , Projetos , Comunicação Interdisciplinar , Pesquisa Qualitativa , Grupos Focais/estatística & dados numéricos , Técnica Delfos , Administração dos Cuidados ao Paciente
19.
Pediatr Infect Dis J ; 39(9): 833-834, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32453197

RESUMO

An 8-month-old child under tuberculosis treatment presented with multiple ecchymotic lesions. A severe coagulopathy was evidenced compatible with vitamin K deficiency [II (3%), VII (2%), IX (3%) and X (1%)]. It was reversed with vitamin K and plasma administration. Rifampicin-induced vitamin K deficiency is very rare, reported only once before, possibly related to an inhibition of vitamin K cycle.

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