Factors Associated With Mortality in Patients With Immune-Mediated Rheumatic Diseases and COVID-19 From Latin America: Data From Argentina, Mexico, and Brazil.

OBJECTIVE: To describe characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) from Argentina, Mexico and Brazil, and to assess factors associated with mortality in this population. METHODS: Data from 3 national registries, SAR-COVID (Argentina), CMR-COVID (Mexico), and ReumaCoV-Brasil (Brazil), were combined. Adult patients with IMIDs and SARS-CoV-2 infection were recruited. Sociodemographic data, comorbidities, IMID clinical characteristics and treatment, and SARS-CoV-2 infection presentation and outcomes were recorded. RESULTS: A total of 4827 individuals were included: 2542 (52.7%) from SAR-COVID, 1167 (24.2%) from CMR-COVID, and 1118 (23.1%) from ReumaCoV-Brasil. Overall, 82.1% were female with a mean age of 49.7 (SD, 14.3) years; 22.7% of the patients were hospitalized, and 5.3% died because of COVID-19 (coronavirus disease 2019). Argentina and Brazil had both 4% of mortality and Mexico 9.4%. In the multivariable analysis, older age (≥60 years; odds ratio [OR], 7.4; 95% confidence interval [CI], 4.6-12.4), male sex (OR, 1.5; 95% CI, 1.1-2.1), living in Mexico (OR, 3.0; 95% CI, 2.0-4.4), comorbidity count (1 comorbidity: OR, 1.5; 95% CI, 1.0-2.1), diagnosis of connective tissue disease or vasculitis (OR, 1.8; 95% CI, 1.3-2.4), and other diseases (OR, 2.6; 95% CI, 1.6-4.1) compared with inflammatory joint disease, high disease activity (OR, 4.2; 95% CI, 2.5-7.0), and treatment with glucocorticoids (OR, 1.9; 95% CI, 1.4-2.5) or rituximab (OR, 4.2; 95% CI, 2.7-6.6) were associated with mortality. CONCLUSIONS: Mortality in patients with IMIDs was particularly high in Mexicans. Ethnic, environmental, societal factors, and different COVID-19 mitigation measures adopted have probably influenced these results.

Active lupus in Argentina: Results of a multicenter and national registry.

OBJECTIVE: To evaluate the association between patients' characteristics and disease activity in an Argentine lupus registry. METHODS: Cross-sectional study. Disease activity was stratified into: Remission off-treatment: SLEDAI = 0, without prednisone and immunosuppressive drugs. Low disease activity Toronto Cohort (LDA-TC): SLEDAI ≤2, without prednisone or immunosuppressive drugs. Modified lupus low disease activity (mLLDAS): SLEDAI score of ≤4, with no activity in major organ systems and no new features, prednisone of ≤10 mg/day and/or immunosuppressive drugs (maintenance dose) and Active disease: SLEDAI score of >4 and prednisone >10 mg/day and immunosuppressive drugs. A descriptive analysis and logistic regression model were performed. RESULTS: A total of 1346 patients were included. Of them, 1.6% achieved remission off steroids, 0.8% LDA-TC, 12.1% mLLDAS and the remaining 85.4% had active disease. Active disease was associated with younger age (p ≤ 0.001), a shorter time to diagnosis (p ≤ 0.001), higher frequency of hospitalizations (p ≤ 0.001), seizures (p = 0.022), serosal disease (p ≤ 0.001), nephritis (p ≤ 0.001), higher SDI (p ≤ 0.001), greater use of immunosuppressive therapies and higher doses of prednisone compared to those on mLLDAS. In the multivariable analysis, the variables associated with active disease were the presence of pleuritis (OR 2.1, 95% CI 1.2-3.9; p = 0.007), persistent proteinuria (OR 2.5, 95% CI 1.2-5.5; p ≤ 0.011), nephritis (OR 2.5, 95% CI 1.2-5.6; p = .018) and hospitalizations (OR 8.9, 95% CI 5.3-16.0; p ≤ 0.001) whereas age at entry into the registry was negatively associated with it (OR 0.9, 95% CI 0.9-1.0; p = 0.029). CONCLUSION: Active disease was associated with shorter time to diagnosis, worse outcomes (SDI and hospitalizations) and renal, neurological and serosal disease.

Does the Use of Immunosuppressive Drugs Impact on SARS-CoV-2 Infection Outcome? Data From A National Cohort of Patients With Immune-Mediated Inflammatory Diseases (SAR-COVID Registry).

BACKGROUND/OBJECTIVE: This study describes the impact of immunomodulatory and/or immunosuppressive (IM/IS) drugs in the outcomes of COVID-19 infection in a cohort of patients with immune-mediated inflammatory diseases (IMIDs). METHODS: Adult patients with IMIDs with a confirmed SARS-CoV-2 infection were included. Data were reported by the treating physician between August 13, 2020 and July 31, 2021. Sociodemographic data, comorbidities, and DMARDs, as well as clinical characteristics, complications, and treatment of the SARS-CoV-2 infection, were recorded. Descriptive analysis and multivariable logistic regression models were carried out. RESULTS: A total of 1672 patients with IMIDs were included, of whom 1402 were treated with IM/IS drugs. The most frequent diseases were rheumatoid arthritis (47.7%) and systemic lupus erythematosus (18.4%). COVID-19 symptoms were present in 95.2% of the patients. A total of 461 (27.6%) patients were hospitalized, 8.2% were admitted to the intensive care unit, and 4.4% died due to COVID-19.Patients without IM/IS treatment used glucocorticoids less frequently but at higher doses, had higher levels of disease activity, were significantly older, were more frequently hospitalized, admitted to the intensive care unit, and died due to COVID-19. After adjusting for these factors, treatment with IM/IS drugs was not associated with a worse COVID-19 outcome (World Health Organization-Ordinal Scale ≥5) (odds ratio, 1.24; 95% confidence interval, 0.73-2.06). CONCLUSIONS: SAR-COVID is the first multicenter Argentine registry collecting data from patients with rheumatic diseases and SARS-CoV-2 infection. After adjusting for relevant covariates, treatment with IM/IS drugs was not associated with severe COVID-19 in patients with IMIDs. STUDY REGISTRATION: This study has been registered in ClinicalTrials.gov under the number NCT04568421.

Multicenter lupus register from Argentina, the RELESSAR database: Influence of ethnicity on disease phenotype.

OBJECTIVE: The objective is to describe the main characteristics of patients with systemic lupus erythematosus (SLE) in Argentina and to examine the influence of ethnicity on the expression of the disease. PATIENTS AND METHODS: RELESSAR is a multicentre register carried out by 106 researchers from 67 rheumatologic Argentine centres. It is a cross-sectional study of SLE (1982/1997 ACR) patients. RELESSAR electronic database includes demographic, cumulative SLE manifestations, SELENA-SLEDAI, SLICC-SDI, Katz's severity and Charlson's comorbidity indexes and treatment patterns. RESULTS: We included 1,610 patients, 91.7% were female with a median age at diagnosis of 28.1 ± 12.8; 96.2% met ≥4 ACR 1982/97 criteria. Frequent manifestations were arthritis (83.5%), malar rash (79.5%), photosensitivity (75.3%), haematological (63.8%) and renal disease (47.4%), antinuclear antibodies (96%), anti-dsDNA (66.5%) and anti-Smith antibodies (29%). The mean Selena-SLEDAI score at last visit was 3.18 (SD 4.3) and mean SDI was 1 (SD 1.3). The accumulated treatments most frequently used were antimalarials (90.4%), corticosteroids (90%), azathioprine (31.8%), intravenous cyclophosphamide (30.2%), mycophenolate mofetil or mycophenolic acid (24.5%), methotrexate (19.3%), belimumab 5.3% and rituximab 5.1%. Refractory lupus was diagnosed in 9.3% of the cases. The main causes of death were lupus activity (25.0%), activity and concomitant infections (25.0%), infections (18.2%), vascular disease (13.6%) and cancer (4.5%). Mortality was associated with higher SLEDAI, Katz, damage indexes and comorbidities. Of the 1610 patients included, 44.6% were Caucasian, 44.5% Mestizo, 8.1% Amerindian and 1.2% Afro-Latin American. Mestizo patients had higher male representation, low socioeconomic status, more inadequate medical coverage, fewer formal years of education and shorter disease duration. Polyadenopathies and Raynaud's phenomenon were more frequent in Caucasians. In the logistic regression analysis higher damage index (OR 1.28, CI 95% 1.02-1.61, p = 0.03) remained associated to mestizo ethnicity. CONCLUSIONS: This study represents the largest number of adult patients with SLE studied in Argentina. Caucasian patients were differentiated by having Raynaud's phenomenon and polyadenopathy more frequently, while patients of Mestizo origin had higher damage indexes.

Clinical and Serological Features in Latin American IgG4-Related Disease Patients Differ According to Sex, Ethnicity, and Clinical Phenotype.

BACKGROUND/OBJECTIVE: Data on IgG4-related disease (IgG4-RD) come almost exclusively from cohorts from Asia, Europe, and North America. We conducted this study to describe the clinical presentation, phenotype distribution, and association with sex, ethnicity, and serological markers in a large cohort of Latin American patients with IgG4-RD. METHODS: We performed a multicenter medical records review study including 184 Latin American IgG4-RD patients. We assigned patients to clinical phenotypes: group 1 (pancreato-hepato-biliary), group 2 (retroperitoneal/aortic), group 3 (head and neck-limited), group 4 (Mikulicz/systemic), and group 5 (undefined). We focused the analysis on how sex, ethnicity, and clinical phenotype may influence the clinical and serological presentation. RESULTS: The mean age was 50.8 ± 15 years. Men and women were equally affected (52.2% vs 48.8%). Fifty-four patients (29.3%) were assigned to group 1, 21 (11.4%) to group 2, 57 (30.9%) to group 3, 32 (17.4%) to group 4, and 20 (10.8%) to group 5. Male sex was associated with biliary tract (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.36-8.26), kidney (OR, 3.4; 95% CI, 1.28-9.25), and retroperitoneal involvement (OR, 5.3; 95% CI, 1.45-20). Amerindian patients presented more frequently with atopy history and gallbladder involvement. Group 3 had a female predominance. CONCLUSIONS: Latin American patients with IgG4-RD were younger, and men and women were equally affected compared with White and Asian cohorts. They belonged more commonly to group 1 and group 3. Retroperitoneal and aortic involvement was infrequent. Clinical and serological features differed according to sex, ethnicity, and clinical phenotype.

Work productivity and activity impairment in patients with primary Sjögren's syndrome.

OBJECTIVES: In this observational, analytical, cross-sectional study we aimed to describe the impact of primary Sjögren's syndrome (pSS) on work productivity and activities of daily living (ADL) to assess the association between ADL impairment and clinical manifestations and to compare ADL impairment according to patients' socioeconomic condition. METHODS: Patients diagnosed with pSS attending 11 centres from Argentina were included. To evaluate work productivity and ADL impairment, a work productivity and activity impairment questionnaire (WPAI) was used. A multiple linear regression model was performed, considering deterioration on ADL due to health as a dependent variable, adjusted for potential confounders. RESULTS: 252 patients were included, 98.4% were women, with a mean age of 52.6 years (±14.8). The average percentage of time lost due to health was 15.7 hours (±30.1 95% CI: 9.6-21.9); the decrease in work productivity was 27.2 (±30.2 95% CI: 21.3-33.1), the total disability was 33.7 (±35.8 95% CI: 26.4-4) and ADL deterioration was 34.2 (±30.9. 95% CI: 30.4-38). In the multivariate analysis, xerostomia, arthritis and depression showed significant and independent association. The mean of ADL impairment was 38.2 (±30.7) in patients attending public centres versus 28 (± 30.6) in private centres, which was a statistically significant difference. CONCLUSIONS: We found a compromise in all WPAI domains. Arthritis, xerostomia and depression were associated significantly and independently with ADL impairment. Deterioration in ADL was greater in patients treated in public centres. Considering these aspects will allow a better understanding of patients who suffer from this disease.

Speciality training in rheumatology: Promotion, repetition and dropout rates in the city of Buenos Aires.

OBJECTIVES: To evaluate the trajectory of students enrolled in the specialty training in rheumatology. METHODS: Retrospective analysis (2009-2016). Promotion, repetition, and dropout rates were determined. Analysis was performed to define variables associated with academic success. RESULTS: Out of 119 students, the actual promotion rate was 66.4%, 11.8% failed an exam (at least) and completed the course after the stipulated time, and the dropout rate was 7.6%. Among residents, the promotion rate was 82.5% vs. 48.2% among the rest (p < 0.001), the lagging students' repetition rate was 3.2% vs. 21.4% among the rest (p 0.005), and the dropout rate was 3.2% vs. 12.5% among the rest (p = 0.06). A higher average score in medical school increased the chances of success in the postgraduate programme (OR 3.41 CI 95% 2.0-6.4; p < 0.001). CONCLUSIONS: The residency was associated with higher rates of academic success in postgraduate studies. The average score in medical school can help identify students at risk of failure.

[Quality of life of Medicine students of the National University of Córdoba, Argentina] / Calidad de vida de estudiantes de la Facultad de Medicina de la Universidad Nacional de Córdoba.

Background: Quality of life (QoL), according to the WHO, includes the perception that a person has about their physical health, level of independence, social relationships, system of values ​​and goals, expectations, standards and concerns. The medical student faces a high level of competitiveness in the course of his academic training with an increase in the workload as he progresses; this causes symptoms such as anxiety, stress, sadness, among others. If these aspects are not treated or are masked, they can turn into depression, generalized anxiety, burnout and even suicide (2). Aim: To describe the QoL of the students of medicina at the National University of Córdoba, considering the complete training cycle divided into two groups from 1 to 3° and from 4 to 5°. Methods: Cross-sectional study, through the Guarani System of the UNC. The WHOQoL-BREF online questionnaire, which uses the Likert scale, was applied to all students. This assesses the global QoL and satisfaction regarding the state of physical and psychological health, interpersonal relationships and environment. p was considered significant <0.05. This work was approved by the Adult CIEIS. Results: 854 responses were obtained, 72% were female, 43% were from another province/country and 63% corresponded to the 1-3° group. Of these, 37% rated their QoL as "fairly good", while 36% of the 4-5th grade group perceived their QoL as "normal" (p:0.0469). The most influential variables correspond to the supply of money for their needs (p:0.0005), sexual satisfaction (p:0.0056) and access to health services (p:0.0042) . Cronbach's alpha was 0.8899. Conclusion: QoL is better perceived in the 1-3 year group and economic supply, sexual satisfaction and access to health services were the main points to take care of in this medicine students.

Introducción: La calidad de vida (CV), según la OMS, comprende la percepción que tiene una persona sobre su salud física, nivel de independencia, relaciones sociales, sistema de valores y metas, expectativas, estándares y preocupaciones (1). El estudiante de medicina se enfrenta con un alto nivel de competitividad en el transcurso de su formación académica con aumento de la carga horaria a medida que avanza; esto origina síntomas como ansiedad, estrés, tristeza, entre otros.  Si tales aspectos no son tratados o son enmascarados pueden transformarse en depresión, ansiedad generalizada, burnout y hasta suicidio (2). Objetivo: Describir la CV de los estudiantes de medicina de la Universidad Nacional de Córdoba, considerando el ciclo completo de formación divididos en dos grupos de 1-3° y 4-5°. Métodos: Estudio transversal, mediante el Sistema Guaraní de la UNC se aplicó el cuestionario online WHOQOL-BREF, que utiliza escala de Likert a todos los alumnos. Este valora la CV global y satisfacción respecto al estado de salud física, psicológica, relaciones interpersonales y entorno. Se consideró significativo una p<0.05. Este trabajo fue aprobado por el CIEIS del Adulto. Resultados: Se obtuvieron 854 respuestas, el 72% fue de género femenino, el 43% es originario de otra provincia/país y el 63% correspondió al grupo de 1-3°. De estos, el 37% calificó su CV como "bastante buena", mientras que el 36% del grupo de 4-5° percibió su CV como "normal" (p:0,0469). Las variables más influyentes corresponden al abastecimiento de dinero para sus necesidades (p:0,0005), satisfacción sexual (p:0,0056) y el acceso a los servicios sanitarios (p:0,0042). El alfa de Cronbach fue 0.8899. Conclusión: La CV es mejor percibida en el grupo de 1-3° año y se destacan el suministro económico, la satisfacción sexual y el acceso a los servicios sanitarios.

Sociodemographic and clinical factors associated with poor COVID-19 outcomes in patients with rheumatic diseases: data from the SAR-COVID Registry.

BACKGROUND/OBJECTIVE: This study aims to describe the course and to identify poor prognostic factors of SARS-CoV-2 infection in patients with rheumatic diseases. METHODS: Patients ≥ 18 years of age, with a rheumatic disease, who had confirmed SARS-CoV-2 infection were consecutively included by major rheumatology centers from Argentina, in the national, observational SAR-COVID registry between August 13, 2020 and July 31, 2021. Hospitalization, oxygen requirement, and death were considered poor COVID-19 outcomes. RESULTS: A total of 1915 patients were included. The most frequent rheumatic diseases were rheumatoid arthritis (42%) and systemic lupus erythematosus (16%). Comorbidities were reported in half of them (48%). Symptoms were reported by 95% of the patients, 28% were hospitalized, 8% were admitted to the intensive care unit (ICU), and 4% died due to COVID-19. During hospitalization, 9% required non-invasive mechanical ventilation (NIMV) or high flow oxygen devices and 17% invasive mechanical ventilation (IMV). In multivariate analysis models, using poor COVID-19 outcomes as dependent variables, older age, male gender, higher disease activity, treatment with glucocorticoids or rituximab, and the presence of at least one comorbidity and a greater number of them were associated with worse prognosis. In addition, patients with public health insurance and Mestizos were more likely to require hospitalization. CONCLUSIONS: In addition to the known poor prognostic factors, in this cohort of patients with rheumatic diseases, high disease activity, and treatment with glucocorticoids and rituximab were associated with worse COVID-19 outcomes. Furthermore, patients with public health insurance and Mestizos were 44% and 39% more likely to be hospitalized, respectively. STUDY REGISTRATION: This study has been registered in ClinicalTrials.gov under the number NCT04568421. Key Points • High disease activity, and treatment with glucocorticoids and rituximab were associated with poor COVID-19 outcome in patients with rheumatic diseases. • Some socioeconomic factors related to social inequality, including non-Caucasian ethnicity and public health insurance, were associated with hospitalization due to COVID-19.

Is lupus nephritis a prognosis factor for pregnancy? Maternal and foetal outcomes.

BACKGROUND: Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications. OBJECTIVE: To evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome. METHODS: We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated. RESULTS: 121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had Class IV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P = .041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P = .047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress. CONCLUSIONS: Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.

Primary Sjögren syndrome and development of another autoimmune rheumatic disease during the follow-up.

BACKGROUND: Primary Sjögren syndrome (pSS) is a chronic autoimmune disease with its main target being exocrine glands, and is the connective tissue disease more frequently associated with other autoimmune diseases. The aim of this study was to assess the frequency of another autoimmune rheumatic disease (ARD) developed in primary Sjögren syndrome (pSS) patients and to describe it's clinical, serological and histologic characteristics. MATERIALS AND METHODS: This is a retrospective cohort study. Data of patients with pSS diagnosis (American-European criteria 2002), included in the GESSAR database (Grupo de Estudio Síndrome de Sjögren, Sociedad Argentina de Reumatología) were analyzed. The development of a second ARD was registered during the follow up. RESULTS: 681 patients were included, 94.8% female. The mean age was 54 (SD 14) years and mean age at diagnosis of 50 (SD 13) years. The mean follow-up was 4.7 (SD 4.9) years; 30 patients (4.41%, CI 95%: 3.1-5.7) developed a second ARD during the follow up, incidence rate was 9.1/1000 patients-year (IR 95%: 5.8-12.4/1000 patients-year), the most frequent being rheumatoid arthritis (RA). 96% out of these 30 patients had xerophthalmia, 86.2% xerostomia, 92% positive Schirmer test, 88.24% positive Rosa Bengala test, lisamine green or Ocular Staining Score, 81.2% positive unstimulated salivary flow, 82.1% Ro(+) and 33.33% La(+). Minor salivary gland biopsy had been performed in 14 of the 30 patients, 12 with positive results. There were no statistically significant differences respect baseline characteristics when comparing the patients who developed another ARD to the ones that did not. CONCLUSIONS: Of all the patients analyzed, 4.4% presented another ARD during their follow-up. It is important to be aware of this, to make an early and proper diagnosis and treatment of our patients.

Is Lupus Nephritis a Prognosis Factor for Pregnancy? Maternal and Foetal Outcomes. / ¿Es la nefritis lúpica un factor pronóstico en el embarazo? Resultados maternos y fetales.

BACKGROUND: Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications. OBJECTIVE: To evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome. METHODS: We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated. RESULTS: 121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had ClassIV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P=.041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P=.047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress. CONCLUSIONS: Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.

[Risk of Burnout syndrome in medical professionals in Córdoba City, Argentina] / Riesgo de Síndrome de Burnout en profesionales médicos de la ciudad de Córdoba, Argentina.

Background: Burnout syndrome is a chronic, adaptive disorder, being considered the most important cause of work injury of psychosocial cause. The objective was to know the risk of burnout in Córdoba city's physician and its relationship with sociodemographic factors and clinical and surgical specialties. Methods: An observational cross-sectional study was performed in 10 care centers in Córdoba City. Physicians were interviewed, we ask about sociodemographic variables and the Maslach Burnout Inventory questionnaire was done to objectify the risk of Burnout. The age was stratified by decades from 20 to 60 years. p < a 0,05 was considered significant. Results: 483 physicians were interviewed, 62,1% were women, 70% were between 20 and 40 years of age; 54.2% single, 42.9% had a time of exercised in the profession below 5 years. 66 of the total (16,5%) had a high risk of burnout, it was associated with the fact to work in a public establishment (p < 0.00001), to be single (p < 0.009), to work more than 60 h (p<0.001), sleeping less than 42 h per week (p < 0.005), less than five years of profession (p < 0.0002); to be from 20 to 29 years old ( p <0.0005) , the protective factor was to have children (p <0.006).There were no differences between clinical and surgical specialties. Young professionals, with lower family restraint and greater labor demand, are those that present a greater risk of burnout. Institutions should identify their risk professionals and develop mechanisms for the protection and treatment of those affected.

Introducción: El Síndrome de Burnout es un trastorno adaptativo, crónico, asociado con inadecuado afrontamiento de las demandas psicológicas del trabajo, es el origen de daño laboral de causa psicosocial más importante. Objetivo: Conocer el riesgo de Burnout en médicos de la ciudad de Córdoba, su relación con factores sociodemográficos y con especialidades clínicas o quirúrgicas. Métodos: Se realizó un estudio observacional de corte transversal en 10 centros asistenciales públicos y privados de la Ciudad de Córdoba. Se entrevistaron 483 médicos, recogiendo variables sociodemográficas y cuestionario Maslach Burnout Inventory evaluando el riesgo de Burnout. La edad fue estratificada desde los 20 años, de 10 en 10 hasta 60. p < 0,05 fue significativa. Resultados: Se entrevistaron 483 médicos, 62,1% mujeres, el 70% entre los 20 y los 40 años; 54,2% solteros, 42.9% ejerció < de 5 años la profesión; el 66 del total (16,5%) tuvo alto riesgo de Burnout, las variables asociadas fueron: trabajar en un establecimiento público (p < 0,00001), ser soltero (p < 0,009), trabajar más de 60 hs (p < 0,001), dormir menos de 42 hs semanales (p< 0,005), tener entre 20 y 29 años (p <0.0005) y tener menos de cinco años de profesión p < 0,0002; se identificó como factor protector tener hijos (p < 0,006). No hubo diferencias entre especialidades clínicas y quirúrgicas. Conclusiones: Los profesionales jóvenes, con menor contención familiar y mayor demanda laboral son los que presentan mayor riesgo de Burnout. Se deberían identificar y desarrollar mecanismos para proteger y tratar los afectados.

Assessing the determination of salivary electrolytes and anti-Ro and anti-La antibodies for the diagnosis of Sjögren's syndrome (SS).

UNLABELLED: The aim of this study was to assess changes in salivary electrolyte flow and composition and the presence of anti-Ro/SSA and anti-La/SSB serum and saliva antibodies and their implications for the non-invasive diagnosis of SS. STUDY DESIGN: 73 patients were studied, divided into the following experimental groups: primary Sjögren syndrome (SSp) (n=15), secondary SS (SSs) (n=17), dry mouth, dry eye without Sjögren's syndrome (BO) (n=20) and healthy controls (C) (n=21). We conducted a baseline assessment of salivary flow and saliva sampling for the measurement of sodium, chlorine, potassium, calcium and phosphate electrolytes, and the determination of anti-Ro/SSA and La/SSB antibodies; a serum sampling was made to assess antibody positivity. RESULTS: Salivary flow in SSp, SSs and BO was significantly lower (p<0.001) relative to C. The salivary composition of SS showed an increase of inorganic components. Anti-Ro/SSA and anti-La/SSB antibodies occurred more frequently in serum and saliva in SS patients compared with BO and C, with higher frequency of positivity in serum compared with saliva. CONCLUSION: Our results suggest new tools that could aid the non-traumatic diagnosis of the origin of hyposalivation.

Primary Sjögren's syndrome and pregnancy: A report of 18 cases. / Síndrome de Sjögren primario y embarazo: reporte de 18 casos.

Primary Sjögren's syndrome (pSS) is a condition that predominantly affects women. Reports of pregnancy outcome in these patients are limited and contradictory. OBJECTIVE: To describe pregnancy characteristics and outcomes and newborn morbidity in women with pSS. MATERIAL AND METHODS: We included women with pSS who became pregnant after the onset of the symptoms of the disease. Clinical and serological characteristics, risk factors and previous maternal comorbidities are described. For each pregnancy in a woman with pSS, we recorded pregnancy course and outcome and newborn condition. RESULTS: We assessed 11 patients with 18 pregnancies after the onset of pSS symptoms. All of them presented FAN +; 10 anti-Ro / SSA + and 7 anti-La / SSB +. The mean age in years at the onset of symptoms was 24.9 (SD 6.9) and at the time of pregnancy was 30.3 (SD 5.4). Thirteen pregnancies happened before the diagnosis, reporting only one miscarriage. Two preterm births, 1 case of oligohydramnios, 2 of premature membrane rupture and 2 low birthweight babies were reported after the onset of pSS symptoms. There was 1 newborn with congenital atrioventricular block and another with neonatal cutaneous lupus. All the women with pregnancy complications (n=6) had anti-Ro/SSA antibodies. CONCLUSIONS: Almost half of the pregnancies assessed in women with pSS were associated with complications not attributable to factors other than the disease.

Subclinical markers of atherosclerosis and cardiovascular risk factors in early arthritis. / [Marcadores subclínicos de aterosclerosis y factores de riesgo cardiovascular en artritis temprana.]

Background: Mortality from cardiovascular disease (CVD) is increased in rheumatoid arthritis, not explained by traditional cardiovascular risk factors (CVRF), suggesting a role of inflammation. This process would occur early. The common sonographic markers of subclinical atherosclerosis (SA), are increased carotid intima-media thickness (cIMT) or the presence of carotid atherosclerotic plaque and they are closely related to CVD. Aims: To evaluate sonographic markers and cardiovascular risk factors in early Arthritis (EA). Methods: A case control study of patients with EA, defined by 3 joints swollen with <1 year of evolution, served consecutively from January 2011 to may 2013, matched with healthy controls, by sex, age and cardiovascular risk factors (hypertension, diabetes mellitus, cardiovascular disease -IAM and ACV, dyslipidemia, family history of CVD) was conducted. We studied demographics data, cardiovascular risk factors, carotid ultrasound measuring increased cIMT or the presence of carotid atherosclerotic plaque in Common Carotid Artery (CCA) and Carotid Bulb (BC), laboratory test that included cholesterol, LDL, HDL, triglycerides in mg%, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR ), anti citrullinated peptide (ACCP), rheumatoid factor (RF), antinuclear antibodies (ANA). EA activity was measured by DAS 28, considering high disease activity (HDA) 5.1; moderate (MDA) from 5.1 to 3.2; and low (LDA) <3.2. Statistics: test Mann-Whitney and chi-square were used, p <0.05 was significant. Results: 25 women, 5 men, average age 43 years (DS 14.7) and 30 controls were included. The average DAS 28 was 4, 8 ± 1. 8; 47% had HDA, 33%MDA and 20%BDA. Both groups had similar values cIMT CCA (0, 57 ± 0.10 mm vs. 0.58 ± 0.15 mm, respectively, P = 0.82) and cIMT BC (0.18mm ± 0.67 vs 0.62 ± 0.15 mm respectively, P = 0.47). There were no carotid plaques. The median total cholesterol was 181,5 vs 183,5 (p = 0.35); triglycerides 99 vs 92,5 (p = 0.68); HDL 54,5 vs 52,5 (p = 0.921 and LDL 105 vs 110 (p = 0.27) in EA and controls respectively. The cIMT CCA and CB were not related to RF, ACCP, CRP, DAS 28 and smoking (NS). There was no difference in other cardiovascular risk factors Conclusions: Ultrasound evidence of atherosclerosis subclinical markers was not found in this study, suggesting that this process may occur after a year of diagnosis.

Introducción: La mortalidad por Enfermedad cardiovascular (ECV) temprana está incrementada en enfermedades inflamatorias. Los marcadores ecográficos de aterosclerosis subclínica (AS) están estrechamente relacionados con ECV. Objetivo: Evaluar marcadores de AS ecográficos y Factores de Riesgo Cardiovascular (FRCV) en Artritis temprana (AT) y correlacionarlo con la actividad de la enfermedad. Material y Métodos: Estudio transversal de casos y controles en pacientes con AT, definida por 3 articulaciones inflamadas con menos de 1 año de evolución, realizado desde 2011 a 2013, apareados con controles sanos, por sexo, edad y FRCV. Se registraron datos demográficos, FRCV, rigidez de pared (cIMT) en Arteria Carótida Común (ACC) y en Bulbo Carotídeo (BC) y presencia de placas ateroscleróticas por ecografía, perfil lipídico, Proteína C Reactiva, eritrosedimentación, anticuerpos anti péptido citrulinado, Factor reumatoide, anticuerpos antinucleares. La actividad de AT se midió por Disease Activity Score (DAS) 28. Estadística: Se usaron test U de Mann-Whitney, Kruskal Wallis y chi-cuadrado, p <0,05 fue significativo. Resultados: Se incluyeron 25 mujeres, 5 hombres con edad promedio 40 años (18-61) y 30 controles. El DAS 28 promedio fue 4,8 ±1.8. Pacientes y controles tuvieron similares valores cIMT ACC (0, 57 ±0.10 mm vs 0,58 ± 0,15 mm, respectivamente) y cIMT CB (0,67 ±0,18mm vs 0,62 ±0,15 mm), no hubo placas carotídeas y el perfil lipídico fue similar en ambos grupos, PNS. El cIMT CCA y CB no tuvieron relación con DAS 28, serología, ni FRCV, P: NS. Conclusiones: La aterosclerosis subclínica se produciría después del primer año de enfermedad en artritis temprana.

Seguridad de las drogas biológicas y sintéticas dirigidas utilizadas en pacientes con enfermedades reumáticas inmunomediadas. Datos del registro BIOBADASAR 3.0 / Safety of biological and targeted synthetic drugs in patients with immune-mediated rheumatic diseases. Data from the BIOBADASAR 3.0 registry

Introducción: conocer la seguridad de las drogas actualmente disponibles para el tratamiento de las enfermedades reumáticas es muy importante al momento de tomar decisiones terapéuticas objetivas e individualizadas en la consulta médica diaria. Asimismo, datos de la vida real amplían el conocimiento revelado por los ensayos clínicos. Objetivos: describir los eventos adversos (EA) reportados, estimar su frecuencia e identificar los factores relacionados con su desarrollo. Materiales y métodos: se utilizaron datos BIOBADASAR, un registro voluntario y prospectivo de seguimiento de EA de tratamientos biológicos y sintéticos dirigidos en pacientes con enfermedades reumáticas inmunomediadas. Los pacientes son seguidos hasta la muerte, pérdida de seguimiento o retiro del consentimiento informado. Para este análisis se extrajeron datos recopilados hasta el 31 de enero de 2023. Resultados: se incluyó un total de 6253 pacientes, los cuales aportaron 9533 ciclos de tratamiento, incluyendo 3647 (38,3%) ciclos sin drogas modificadoras de la enfermedad biológicas y sintéticas dirigidas (DME-b/sd) y 5886 (61,7%) con DME-b/sd. Dentro de estos últimos, los más utilizados fueron los inhibidores de TNF y abatacept. Se reportaron 5890 EA en un total de 2701 tratamientos (844 y 1857 sin y con DME-b/sd, respectivamente), con una incidencia de 53,9 eventos cada 1000 pacientes/año (IC 95% 51,9-55,9). La misma fue mayor en los ciclos con DME-b/sd (71,1 eventos cada 1000 pacientes/año, IC 95% 70,7-77,5 versus 33,7, IC 95% 31,5-36,1; p<0,001). Las infecciones, particularmente las de la vía aérea superior, fueron los EA más frecuentes en ambos grupos. El 10,9% fue serio y el 1,1% provocó la muerte del paciente. El 18,7% de los ciclos con DME-b/sd fue discontinuado a causa de un EA significativamente mayor a lo reportado en el otro grupo (11,5%; p<0,001). En el análisis ajustado, las DME-b/sd se asociaron a mayor riesgo de presentar al menos un EA (HR 1,82, IC 95% 1,64-1,96). De igual manera, la mayor edad, el mayor tiempo de evolución, el antecedente de enfermedad pulmonar obstructiva crónica, el diagnóstico de lupus eritematoso sistémico y el uso de corticoides se asociaron a mayor riesgo de EA. Conclusiones: la incidencia de EA fue significativamente superior durante los ciclos de tratamientos que incluían DME-b/sd.

Introduction: knowing the efficacy and safety of the drugs currently available for the treatment of rheumatic diseases is very important when making objective and individualized therapeutic decisions in daily medical consultation. Likewise, real-life data extends the knowledge revealed by clinical trials. Objectives: to describe the reported adverse events (AEs), estimate their frequency and identify factors associated to them. Materials and methods: BIOBADASAR data were used, which is a voluntary, prospective follow-up registry of AEs of biological and synthetic treatments in patients with immune-mediated rheumatic diseases. Patients are followed until death, loss of followup, or withdrawal of informed consent. To carry out this analysis, the data collected up to January 31, 2023 was extracted. Results: a total of 6253 patients were included, who contributed with 9533 treatment periods, including 3647 (38.3%) periods without b/ts-DMARDs and 5886 (61.7%) with b/ts-DMARDs. Among the latter, the most used were TNF inhibitors and abatacept. A total of 5890 AEs were reported in a total of 2701 treatments (844 and 1857 without and with b/ts-DMARDs, respectively), with an incidence of 53.9 events per 1000 patients/ year (95% CI 51.9-55.9). It was higher during the periods with b/ts-DMARDs (71.1 events per 1000 patients/year, 95% CI 70.7-77.5 vs 33.7, 95% CI 31.5-36.1, p<0.001). Infections, particularly those of the upper respiratory tract, were the most frequent AEs in both groups. 10.9% were severe and 1.1% were associated with the death of the patient. 18.7% of the periods with b/ts-DMARDs were discontinued due to an AE, significantly higher than that reported in the other group (11.5%; p<0.001). In the adjusted analysis, b/ts-DMARDs were associated with a higher risk of presenting at least one AE (HR 1.82, 95% CI 1.64-1.96). Similarly, older age, longer evolution time, history of chronic obstructive pulmonary disease, diagnosis of systemic lupus erythematosus, and use of corticosteroids were associated with a higher risk of AE. Conclusions: the incidence of AEs was significantly higher during those treatment periods that included DME-b/sd.

Frecuencia de eventos cardiovasculares en pacientes con lupus eritematoso sistémico / Frequency of cardiovascular events in patients with systemic lupus erythematosus

Resumen Introducción: el progreso en los tratamientos para el lupus eritematoso sistémico (LES) resultó en una disminución de la mortalidad; sin embargo, la enfermedad cardiovascular y las complicaciones infecciosas aún son las principales causas de muerte. La evidencia apoya la participación del sistema inmunológico en la generación de la placa aterosclerótica, así como su conexión con las enfermedades autoinmunes. Objetivos: describir la frecuencia de eventos cardiovasculares (ECV) en el Registro de Lupus Eritematoso Sistémico de la Sociedad Argentina de Reumatología (RELESSAR) transversal, así como sus principales factores de riesgo asociados. Materiales y métodos: estudio descriptivo y transversal para el cual se tomaron los pacientes ingresados en el registro RELESSAR transversal. Se describieron las variables sociodemográficas y clínicas, las comorbilidades, score de actividad y daño. ECV se definió como la presencia de al menos una de las siguientes patologías: enfermedad arterial periférica, cardiopatía isquémica o accidente cerebrovascular. El evento clasificado para el análisis fue aquel posterior al diagnóstico del LES. Se conformaron dos grupos macheados por edad y sexo 1:2. Resultados: 1515 pacientes mayores de 18 años participaron del registro. Se describieron 80 pacientes con ECV (5,3%). En este análisis se incluyeron 240 pacientes conformando dos grupos. La edad media fue de 47,8 (14,4) y 47,6 (14,2) en el grupo con y sin ECV respectivamente. Los pacientes con ECV tuvieron mayor duración del LES en meses, mayor índice de Charlson, mayor SLICC (Systemic Lupus International Collaborating Clinics/American College of Rheumatology), mayor frecuencia de manifestaciones neurológicas, síndrome antifosfolípido, hospitalizaciones y uso de ciclofosfamida. Las únicas variables asociadas en el análisis multivariado fueron el índice de Charlson (p=0,004) y el SLICC (p<0,001). Conclusiones: los ECV influyen significativamente en nuestros pacientes, y se asocian a mayor posibilidad de daño irreversible y comorbilidades.

Abstract Introduction: progress in treatments for systemic lupus erythematosus (SLE) has resulted in a decrease in mortality; however, cardiovascular and infectious diseases remain the leading causes of death. Evidence supports the involvement of the immune system in the generation of atherosclerotic plaque, as well as its connection to autoimmune diseases. Objectives: to describe the frequency of cardiovascular disease (CVD) in the cross-sectional RELESSAR registry, as well as its associated variables. Materials and methods: a descriptive and cross-sectional study was performed using patients admitted to the cross-sectional RELESSAR registry. Sociodemographic variables, clinical variables, comorbidities, activity and damage scores were described. CVD was defined as at least one of the following: peripheral arterial disease, ischemic heart disease, or cerebrovascular accident. All patients with at least one CVD were included in our analysis (heart attack, central nervous system vascular disease, and peripheral arteries atherosclerotic disease). The event classified for the analysis was that after the diagnosis of SLE. SLE diagnosis was previous to CVD. Two groups matched by age and sex, 1:2 were formed. Results: a total of 1515 patients older than 18 years participated in the registry. Eighty patients with CVD (5.3%) were described in the registry. Two-hundred and forty patients were included, according to two groups. The mean age was 47.8 (SD 14.4) and 47.6 (SD 14.2) in patients with and without CVD, respectively. Patients with CVD had a longer duration of SLE in months, a higher Charlson index, a higher SLICC, increased frequency of neurological manifestations, antiphospholipid syndrome, hospitalizations, and use of cyclophosphamide. The associated variables in the multivariate were the Charlson Index (p=0.004) and the SLICC (p<0.001). Conclusions: CVDs have a significant influence on our patients, being associated with a greater possibility of damage and comorbidities.

¿Es la nefritis lúpica un factor pronóstico en el embarazo? Resultados maternos y fetales / Is Lupus Nephritis a Prognosis Factor for Pregnancy? Maternal and Foetal Outcomes

Introducción: La preexistencia de nefritis lúpica (NL) es un factor de riesgo importante al planificar un embarazo debido al riesgo de complicaciones. Objetivo: Evaluar complicaciones maternas y fetales en la gestación de mujeres con lupus eritematoso sistémico (LES) con y sin NL previa a la concepción. Métodos: Se estudiaron retrospectivamente todas las pacientes lúpicas embarazadas con y sin NL previa, asistidas desde enero de 2015 hasta abril de 2017. Se analizaron datos demográficos, clínicos y de laboratorio, presencia de anticuerpos antifosfolípidos (AAF) y síndrome antifosfolípido (SAF) según criterios de Sydney, resultados maternos y fetales.Resultados: Se incluyeron 79 pacientes, 40 con NL previa y 39 sin NL, sumando 121 embarazos (52 sin NL y 69 con NL). El grupo NL registró mayor porcentaje de presencia de AAF, SAF y mayor SLEDAI basal, además recibieron más terapia inmunosupresora y corticoidea. En NL fue más frecuente la claseIV (47,5%): 25,8% en el grupo NL vs 10,9% (p=0,041) tuvieron reactivaciones, especialmente renales, sin desarrollo de enfermedad renal terminal. La preeclampsia fue mayor en el grupo con NL: 18,8% vs 6,3% sin NL (p=0,047). Registramos una muerte materna en el grupo NL. La vía de finalización fue cesárea (68,5% en el grupo NL y 31,5% en grupo sin NL), siendo más frecuente de urgencia en el grupo con NL. En resultados fetales, no hubo diferencia en porcentaje de nacidos vivos, peso del neonato ni edad gestacional. Se registraron 3 muertes fetales: 2 en el grupo con NL y 1 en el otro. Conclusión: Las pacientes con NL sufrieron más complicaciones maternas como brote lúpico y preeclampsia. Sin embargo, la NL no conduciría a peores resultados obstétricos ni fetales.

Background: Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications. Objective: to evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome.Methods: We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated. Results: 121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had ClassIV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P=.041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P=.047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress.Conclusions: Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.(AU)

[Lipid profile in early arthritis and its relation with inflammatory activity] / Prevalencia de dislipidemia en artritis temprana y su relación con actividad inflamatoria.

Cardiovascular risk is increased in Rheumatoid Arthritis and it is associated with higher morbility and mortality. Few studies have evaluated the lipid profile in early arthritis (EA). Aims: To study the lipid profile in patients with EA and its association with disease activity (DA). Methods: We studied 31 patients with diagnosis of EA and a control group, with age, gender and cardiovascular risk factors matched, who were attended to Rheumatology Unit at Córdoba Hospital from January 2011 to May 2013. We evaluated demographic data, lipid profile and DA by DAS28. Results: 31 patients were included with mean age of 42.3 years old, 87% female , the cholesterol level was 191.9 mg/dl, HDL 54, LDL 115.8, Triglycerides 117,6; and 31 patients were included in the control group with average age of 42.7 years old, and cholesterol level of 198.7 mg / dl, HDL 56.9 LDL 122.6, Triglycerides 99.6 (p NS). Regards disease activity, in the low DA group the Cholesterol level was 196.3 , LDL 115.8, HDL 62 y triglycerides 95.17, and in the Moderate and High DA the Cholesterol level was 190 mg/ dl, LDL 115, HDL 52 y triglycerides 122,9 (p NS) Conclusions: The lipid profile was normal and it was not associated with DA in EA patients.

El riesgo cardiovascular está aumentado en pacientes con Artritis Reumatoidea establecida, con aumento de la morbimortalidad cardiovascular, inclusive tempranamente y puede ser expresión subclínica de la enfermedad. Pocos estudios han evaluado el perfil lipídico en artritis temprana (AT). Objetivos: Determinar la prevalencia y el tipo de alteración del perfil lipídico en pacientes con AT y su asociación con la actividad de la enfermedad (AE). Material y métodos: Se estudiaron pacientes con diagnóstico de AT comparados con un grupo control, apareados por sexo, edad y factores de riesgo cardiovascular, asistidos de forma consecutiva desde enero de 2011 a mayo de 2013 en el Hospital Córdoba. Se recolectaron datos demográficos, perfil lipídico y actividad de la enfermedad (AE) por Disease Activity Score (DAS 28). Se comparó el nivel de lípidos en ambos grupos y entre pacientes con artritis según el nivel de AE, clasificándolos en Baja AE y Mediana / Alta AE. P menor a 0.05 fue considerada significativa. Resultados: El número de pacientes con Artritis temprana fue de 31, con una media de edad de 42.3 años, 87% sexo femenino y el nivel de Colesterol Total promedio fue de 191.9 mg/dl, HDL 54, LDL 115.8, Triglicéridos 117,6, mientras que el grupo control fue de 31 pacientes con una media de edad de 42.7 años, con nivel promedio de Colesterol 198.7 mg/dl, HDL 56.9, LDL 122.6, Triglicéridos 99.6 (p=NS, para todas las determinaciones). En cuanto a la actividad de la enfermedad, en el grupo de Baja AE los niveles de Colesterol fueron 196.3, LDL 115.8, HDL 62 y triglicéridos 95.17 y en el grupo moderada y alta AE, Colesterol 190,1 LDL 115, 8, HDL 52 y triglicéridos 122,9 (p NS para todas las comparaciones) Conclusion: El perfil lipídico fue normal y no se encontró asociado a la AE en pacientes con AT.