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1.
Clin Rheumatol ; 39(1): 135-147, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31650389

RESUMO

We presented an update in the field of hypouricemia, which is defined as a serum urate concentration of < 2 mg/dL (119 µmol/L), for the practicing rheumatologist, who usually is the consulting physician in cases of disorders of urate metabolism. We performed a narrative review through a literature search for original and review articles in the field of human hypouricemia published between January 1950 and July 2018. We divided the etiology of hypouricemia into two main categories: those associated with a decrease in urate production and those promoting the elimination of urate via the kidneys. The most common conditions associated with these categories are discussed. Furthermore, the etiology of hypouricemia may be associated with certain medications prescribed by the practicing rheumatologists, such as the following: urate-lowering drugs (allopurinol and febuxostat); recombinant uricase (pegloticase); uricosuric agents (probenecid, benzbromarone); urate transporter URAT1 inhibitor (lesinurad); angiotensin II receptor blocker (losartan); fenofibrate; high-dose trimethoprim-sulfamethoxazole; some NSAID; and high-dose salicylate therapy. The rheumatologist is considered an expert in the metabolism of urate and its associated pathological conditions. Therefore, specialists must recognize hypouricemia as a biomarker of various pathological and potentially harmful conditions, highlighting the importance of conducting a deeper clinical investigation to reach a more accurate diagnosis and treatment.

2.
Clin Rheumatol ; 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31691863

RESUMO

Clinical evaluation of rheumatic and musculoskeletal diseases through images is a challenge for the beginner rheumatologist since image diagnosis is an expert task with a long learning curve. The aim of this work was to present a narrative review on the main ultrasound computer-aided diagnosis systems that may help clinicians thanks to the progress made in the application of artificial intelligence techniques. We performed a literature review searching for original articles in seven repositories, from 1970 to 2019, and identified 11 main methods currently used in ultrasound computer-aided diagnosis systems. Also, we found that rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, and idiopathic inflammatory myopathies are the four musculoskeletal and rheumatic diseases most studied that use these innovative systems, with an overall accuracy of > 75%.

3.
Dig Dis Sci ; 2019 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-31494751

RESUMO

BACKGROUND/AIMS: Nausea is a major complaint of gastroparesis (GP), and the pathophysiology of this condition is poorly understood. Therefore, this study utilized fMRI to investigate the possible central nervous system (CNS) mechanisms of nausea in 10 GP patients versus 8 healthy controls (HCs). METHODS: Nausea severity was assessed on a 0-10 scale and presented as mean ± SD. Nausea was increased from baseline utilizing up to 30 min of visual stimulation (VS). Functional network connectivity was measured with fMRI at baseline and after 30 min of VS. fMRI data were preprocessed using statistical parametric mapping software. Thirty-four independent components were identified as meaningful resting-state networks (RSNs) by group independent component analysis. The Functional Network Connectivity (FNC) among 5 RSNs considered important in CNS nausea mechanisms was calculated as the Pearson's pairwise correlation. RESULTS: Baseline nausea score in GP patients was 2.7 ± 2.0 and increased to 7.0 ± 1.5 after stimulation (P < 0.01). In HCs nausea scores did not increase from baseline after stimulus (0.3 ± 0.5). When comparing GP patients to HCs after VS, a significant reduction (P < 0.001) in bilateral insula network connectivity compared to the right insula network was detected. No significant differences in connectivity were noted among the other RSNs. Additionally, the average gray matter volume was non-significantly reduced in the insula in GP patients compared to HC. CONCLUSIONS: The insula connectivity network is impaired in nauseated GP patients. This phenomenon could explain the susceptibility of GP patients to nausea or may have resulted from a state of chronic nausea.

4.
Pharmacoepidemiol Drug Saf ; 28(8): 1035-1044, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31148288

RESUMO

PURPOSE: This review summarises the current status of regulatory guidelines for the approval of biosimilars in Latin America and highlights the main barriers to effective pharmacovigilance in this region. We also report results from a survey of Latin American rheumatologists assessing their understanding of prescribing biosimilars and the pharmacovigilance of these drugs. METHODS: We reviewed the current guidelines for the regulatory approval of biosimilars and barriers to effective pharmacovigilance in Latin American countries. Rheumatologists attending the II Pan-American League of Rheumatology Associations PANLAR Review Course (Biosimilars update) in Lima, Peru were asked to complete a short survey to determine their knowledge of biosimilars. RESULTS: Many Latin American countries continue to lag behind Europe and the United States in establishing regulatory guidance and effective pharmacovigilance systems for biosimilars. Results from our survey also highlight a lack of awareness regarding the availability of biosimilars, their nomenclature, automatic substitution, and reporting adverse drug reactions because of these drugs. CONCLUSIONS: The main barriers to effective pharmacovigilance in Latin America are the lack of consensus on the interchangeability of reference biologics and biosimilars, and the need for more suitably trained personnel to carry out effective postmarketing pharmacovigilance of biosimilars. Inconsistencies in biosimilar nomenclature make it difficult to adequately trace drugs and record adverse drug reactions associated with their use, creating a barrier to the global pharmacovigilance of biologics.

5.
Clin Rheumatol ; 38(9): 2327-2337, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31177397

RESUMO

OBJECTIVE: The aim of this work was to produce a consensus-based report for capillaroscopy in rheumatology to be used in daily clinical practice. METHODS: A written Delphi questionnaire regarding capillaroscopy report was developed from a literature review and expert consensus. The Delphi questionnaire was sent to an international panel including 25 rheumatologists experts in capillaroscopy, asking them to rate their level of agreement or disagreement with each statement. The exercise consisted of three online rounds and a face-to-face (live meeting) that took place in the PANLAR 2018 congress held in Buenos Aires, Argentina. RESULTS: The participants to the first, second, third, and face-to-face round were 22, 21, 21, and 16 rheumatologists, respectively. Fifty-five items were discussed in the first round, 58 in the second, 22 in the third, and 9 in the face-to-face meeting. At the end of the exercise, 46 recommendations for the capillaroscopy report in rheumatology reached a consensus. CONCLUSION: This is the first consensus-based report in capillaroscopy. It will be useful in daily clinical practice and to address the effort of the standardization in the technique. KEY POINTS: • The current lack of consensus for the capillaroscopy report makes difficult the interpretation of findings as well as follow-up of rheumatic diseases. • This study produced the first international consensus for the format and content of the naifold capillaroscopy report in rheumatology. • The report is an integral part of the capillaroscopy examination and its use in a homogeneous form can help in the correct interpretation of findings in daily practice.

6.
Clin Rheumatol ; 38(6): 1785-1789, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31093788

RESUMO

Social media has become a key component of contemporary medicine, and the rheumatology subspecialty is not an exemption. We found that just six of the 40 key peer-reviewed rheumatology journals have found it sensible to incorporate the new appointment of a Social Media Editor-or a similar designation-into their Editorial Boards. We propose that the role of a social media editor is a trinomial: not only a technological work to promote digital engagement but also an activity of ethical guidance and a cultural challenge dealing with worldwide cultural and mindset diversity.


Assuntos
Políticas Editoriais , Editoração/tendências , Mídias Sociais/tendências , Humanos , Disseminação de Informação/métodos , Publicações Periódicas como Assunto , Reumatologia/tendências
7.
Rheumatol Int ; 39(4): 585-593, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30421102

RESUMO

The aim of this review was to provide an overall overview of the past, present, and future situations and main challenges that are facing Mexican Rheumatology as a medical subspecialty in the context of their national healthcare system, where a deficit of workforce at the national level coexists with a shortage of specialists in the less-developed southern states of the country and a great surplus of professionals within large metropolitan areas. We also analyzed the prevalence and burden of Rheumatic and Musculoskeletal Diseases (RMDs), the structural composition and distribution of Mexican Rheumatology, and the clinical profile of the Mexican Rheumatologist. Last, we examined comorbidities, education and training programs and one scenario for Mexican Rheumatology wherein the principal main threats and opportunities are determined.


Assuntos
Doenças Musculoesqueléticas/epidemiologia , Doenças Reumáticas/epidemiologia , Reumatologia/educação , Assistência à Saúde , Mão de Obra em Saúde , Disparidades em Assistência à Saúde , Humanos , México/epidemiologia , Prevalência , Reumatologistas , Determinantes Sociais da Saúde
8.
Appl Neuropsychol Child ; 8(1): 1-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28937800

RESUMO

Healthcare for poor children, also known as Medicaid, is disproportionately relied upon by citizens of poor states such as New Mexico, where (a) there are more unintended pregnancies, (b) domestic violence during and after pregnancies occurs with regularity, (c) youth substance use is much more common, (d) crime rates are some of the worst in the country, (e) many never graduate from high school, and (f) incarceration is often inevitable. Yet, there is a dearth of research into the neuropsychological health of these children. Meanwhile, nonneuropsychologists working for managed care organizations routinely deny authorization for neuropsychological testing based on a lack of medical necessity. The present article addresses the question of neuropsychological medical necessity using community-based neuropsychological data from New Mexico collected on Medicaid and non-Medicaid youth via retroactive chart review. Downstream fiscal implications that are related to the eventual cost of mental illness and crime among those with poor neuropsychological health are discussed.


Assuntos
Disfunção Cognitiva/epidemiologia , Entrevista Psicológica , Delinquência Juvenil/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Modelos Estatísticos , Transtornos do Neurodesenvolvimento/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Escalas de Wechsler/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Mães/estatística & dados numéricos , New Mexico/epidemiologia , Gravidez , Gravidez não Planejada , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
9.
J Clin Rheumatol ; 25(2): 101-107, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30028809

RESUMO

BACKGROUND/OBJECTIVE: Although mortality rates related with chikungunya (CHIK) outbreaks in Latin America's (LA's) dengue-endemic rural and new urban regions are low, dealing with symptoms and sequelae can both produce a significant burden of disease and diminish quality of life-from many months to years-after the acute phase of the infection, with a significant impact on public and individual health.The aim of this work was to establish Pan-American League of Associations for Rheumatology-Central American, Caribbean and Andean Rheumatology Association (ACCAR) consensus-conference endorsements and recommendations on the diagnosis and treatment of CHIK-related inflammatory arthropathies transmitted by Aedes aegypti and Aedes albopictus in LA. METHODS: Based on the Consensus Development Conference format, a panel of ACCAR rheumatologist voting members (n = 10) took part in this Pan-American League of Associations for Rheumatology initiative. Experts voted from a previous content analysis of the medical literature on CHIK, 4 subsequent topic conferences, and a workshop. Consensus represents the majority agreement (≥80%) achieved for each recommendation. RESULTS: The experts' panel reached 4 overarching principles: (1) CHIK virus (CHIKV) is a re-emergent virus transmitted by 2 species of mosquitoes: A. aegypti and A. albopictus; (2) CHIKV caused massive outbreaks in LA; (3) chronic CHIKV infection produces an inflammatory joint disease that, in some cases, can last for several months to years, and (4) currently, there are no vaccines or antivirals licensed for CHIKV infections. RECOMMENDATIONS: Pan-American League of Associations for Rheumatology-ACCAR achieved 13 endorsements and recommendations on CHIK categorized in 3 groups: (1) epidemiology and clinical manifestations, (2) diagnosis, and (3) treatment, representing the consensus agreement from the panel's members.


Assuntos
Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Febre de Chikungunya/complicações , Política de Saúde , Reumatologia , Artrite Infecciosa/virologia , Consenso , Humanos , América Latina , Sociedades Médicas
10.
Rheumatol Int ; 38(10): 1791-1805, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30099591

RESUMO

Ultrasound (US) is an accessible imaging technique with a possible role to diagnose active sacroiliitis, so this technique is projected as a promising diagnostic tool for the diagnosis of SpA. We analyse the available evidence about the use of US as a diagnostic tool in sacroiliitis in patients with SpA, by a systemic review of the literature fulfilling OMERACT criteria. A systematic literature search for original articles was carried out using four databases (Medline, Embase, Scopus and Web of Science). Data from studies were included only if participants had SpA and a US examination of sacroiliac joint (SIJ) was performed. The methodological quality of the studies was assessed using QUADAS-2 tool. Thirteen studies were included. All studies were observational, prospective and cross-sectional. In most articles (76.9%), the main US finding compatible with sacroiliitis evaluated was the presence of vascularisation (Doppler signals) with measurements of the resistive index (RI). The sensitivity and specificity analysis were performed in seven studies (58.8%) and were good, with a median of 90 and 89.2%, respectively. The studies showed a positive to moderate a strong correlation between the US and the gold standard but this was optimal only in four studies. In general, the agreement was good in all studies (≥ 0.80). The methods of evaluation of sacroiliitis vary between the studies included. To date, there is not enough evidence to support the use of ultrasound as a diagnostic method for sacroiliitis but it has potential to identify structural lesions at SIJ's level.


Assuntos
Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/patologia , Sacroileíte/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Estudos Transversais , Humanos , Estudos Prospectivos , Espondilartrite/diagnóstico por imagem , Ultrassonografia Doppler/normas
13.
Cir Cir ; 86(3): 228-236, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29950741

RESUMO

Introducción: La proteína de respuesta temprana a crecimiento 1 (EGR-1) es un factor de transcripción involucrado en la diferenciación y la proliferación celulares, cuya expresión es regulada por su promotor en respuesta a diversos factores físicos y químicos, y a fármacos. Aquí se describen algunos de los principales efectos de los fármacos esteroides y del factor de crecimiento epitelial 1 (EGF-1) sobre la actividad del promotor, mediante un sistema reportero transducido por el adenovirus AdΔegr-1-Luc7 en fibroblastos primarios humanos. Método: Los fibroblastos primarios humanos fueron cultivados en pase 5, transducidos con AdΔegr-1-Luc7 y expuestos a betametasona, hidrocortisona, dexametasona, testosterona, beta-estradiol y EGF-1 durante 1, 3 y 6 horas. La actividad de reportero fue cuantificada por luminometría y ajustada a la concentración de proteínas totales. Resultados: La actividad del promotor en presencia de betametasona, hidrocortisona, dexametasona, testosterona y beta-estradiol fue similar a la actividad basal del promotor a las 1, 3 y 6 horas. El control positivo mostró una actividad 17.8 veces mayor a las 6 horas (p ≤ 0.05). De manera similar, las células expuestas a EGF-1 mostraron una actividad 22.07 veces mayor que las células sin fármaco. Conclusión: La actividad del promotor Egr-1 en fibroblastos humanos es regulada negativamente por los fármacos esteroides y positivamente por el EGF-1. Introduction: The early growth response protein (EGR-1) is a transcription factor involved in cell differentiation and proliferation, whose expression is regulated by its promoter in response to various physical, chemical and drug factors. Hereby, we describe some of the main effects of steroid drugs and EGF-1 on promoter activity, through a reporter system transduced by AdΔegr-1-Luc7 in human primary fibroblasts (HPF). Methods: Human primary fibroblasts transduced with AdΔegr-1-Luc7 were exposed to betamethasone, hydrocortisone, dexamethasone, testosterone, beta-estradiol, and EGF-1 during 1, 3 and 6 h. Reporter assay was quantified by luminometry. Results: The activity of the promoter in presence of betamethasone, hydrocortisone, dexamethasone, testosterone and beta-estradiol were similar to the basal activity of the promoter at 1, 3 and 6 h. The positive control showed an activity 17.8 folds higher (p ≤ 0.05) at 6 h. EGF-1 showed activity of 22.07 folds greater than cells without drug. Conclusion: The activity of the EGR-1 promoter in human fibroblasts is negatively regulated by steroid drugs and positively by the EGF-1.


Assuntos
Proteína 1 de Resposta de Crescimento Precoce/efeitos dos fármacos , Fibroblastos , Transdução Genética/métodos , Adenoviridae , Humanos
14.
J Clin Rheumatol ; 24(4): 224-227, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29782409

RESUMO

Case reports have a long-standing tradition in the current rheumatology literature. We aimed to present the main points of view regarding the importance, meaning, and barriers of consent for publishing under the comprehensive protection of patients' rights within this genre. We encourage Latin American editors and authors of rheumatology journals to adopt the best ethical practices in the field, avoiding security and legal liabilities from a regional perspective.


Assuntos
Consentimento Livre e Esclarecido , Editoração/ética , Editoração/legislação & jurisprudência , Reumatologia , Políticas Editoriais , Humanos , América Latina , Publicações Periódicas como Assunto
15.
Innov Clin Neurosci ; 15(1-2): 33-35, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29497578

RESUMO

Highly active antiretroviral therapy is well-established in the treatment of human immunodeficiency virus (HIV)-positive patients. Nonadherence with therapy regimens often leads to the occurrence of opportunistic infections that further complicate treatment and challenge the treating physician. We report a young HIV-positive patient who suffered from progressive multifocal leukoencephalopathy caused by the human John Cunningham virus and showed objective clinical improvement after adding mirtazapine to the treatment regimen, an observation that is supported by the emerging literature.

16.
Salud Publica Mex ; 59(4): 429-436, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29211264

RESUMO

Some interpretations frequently argue that three Disability Models (DM) (Charity, Medical/Rehabilitation, and Social) correspond to historical periods in terms of chronological succession. These views permeate a priori within major official documents on the subject in Mexico. This paper intends to test whether this association is plausible by applying a timeline method. A document search was made with inclusion and exclusion criteria in databases to select representative studies with which to depict milestones in the timelines for each period. The following is demonstrated: 1) models should be considered as categories of analysis and not as historical periods, in that the prevalence of elements of the three models is present to date, and 2) the association between disability models and historical periods results in teleological interpretations of the history of disability in Mexico.


Assuntos
Pessoas com Deficiência/reabilitação , Modelos Teóricos , Atitude Frente a Saúde , Instituições de Caridade/história , Avaliação da Deficiência , Pessoas com Deficiência/história , Pessoas com Deficiência/estatística & dados numéricos , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , México/epidemiologia , Previdência Social/história , Seguridade Social/história
17.
Salud pública Méx ; 59(4): 429-436, Jul.-Aug. 2017. tab
Artigo em Inglês | LILACS-Express | ID: biblio-903773

RESUMO

Abstract: Some interpretations frequently argue that three Disability Models (DM) (Charity, Medical/Rehabilitation, and Social) correspond to historical periods in terms of chronological succession. These views permeate a priori within major official documents on the subject in Mexico. This paper intends to test whether this association is plausible by applying a timeline method. A document search was made with inclusion and exclusion criteria in databases to select representative studies with which to depict milestones in the timelines for each period. The following is demonstrated: 1) models should be considered as categories of analysis and not as historical periods, in that the prevalence of elements of the three models is present to date, and 2) the association between disability models and historical periods results in teleological interpretations of the history of disability in Mexico.


Resumen: Se argumenta que tres modelos de discapacidad (de prescindencia, médico/rehabilitador y social) se corresponden con periodos históricos en sucesión cronológica. Esta visión a priori ha permeado dentro de los principales documentos oficiales sobre el tema en México. El presente trabajo se propone probar si esta asociación es plausible, mediante la aplicación de una metodología de línea temporal. Se diseñó una estrategia de búsqueda con criterios de inclusión y exclusión en bases de datos para seleccionar estudios representativos, con los cuales se retomaron hitos a representar en la línea temporal por cada periodo. Se muestra que los modelos deben plantearse como categorías de análisis y no como periodos históricos, dado que: 1) existe prevalencia de elementos de los tres modelos en la coyuntura actual y 2) la asociación entre modelos y periodos da lugar a interpretaciones teleológicas de la historia de la discapacidad en México.

19.
Proc (Bayl Univ Med Cent) ; 30(3): 365-367, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28670090

RESUMO

Neurocysticercosis is a parasitic infection of the central nervous system with the cysts of Taenia solium, the pig tapeworm. Infection presents with a pleomorphic picture depending on the stage and location of the infection and the immune response of the infected host. Historically confined to the developing world, neurocysticercosis is no longer limited to endemic regions, as globalization, travel, and immigration permit the spread of the infection. We report a young Hispanic patient who was diagnosed with neurocysticercosis of the fourth ventricle and subsequent hydrocephalus.

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