Evaluation of medical ethics competencies in rheumatology: local experience during national accreditation process.

INTRODUCTION: Rheumatologists are the primary healthcare professionals responsible for patients with rheumatic diseases and should acquire medical ethical competencies, such as the informed consent process (ICP). The objective clinical structured examination is a valuable tool for assessing clinical competencies. We report the performance of 90 rheumatologist trainees participating in a station designed to evaluate the ICP during the 2018 and 2019 national accreditations. METHODS: The station was validated and represented a medical encounter in which the rheumatologist informed a patient with systemic lupus erythematosus with clinically active nephritis about renal biopsy. A trained patient-actor and an evaluator were instructed to assess ICP skills (with a focus on kidney biopsy benefits, how the biopsy is done and potential complications) in obtaining formal informed consent, delivering bad news and overall communication with patients. The evaluator used a tailored checklist and form. RESULTS: Candidate performance varied with ICP content and was superior for potential benefit information (achieved by 98.9% of the candidates) but significantly reduced for potential complications (37.8%) and biopsy description (42.2%). Only 17.8% of the candidates mentioned the legal perspective of ICP. Death (as a potential complication) was omitted by the majority of the candidates (93.3%); after the patient-actor challenged candidates, only 57.1% of them gave a clear and positive answer. Evaluators frequently rated candidate communications skills as superior (≥80%), but ≥1 negative aspect was identified in 69% of the candidates. CONCLUSIONS: Ethical competencies are mandatory for professional rheumatologists. It seems necessary to include an ethics competency framework in the curriculum throughout the rheumatology residency.

EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part I: Overall methodology and clinical characterisation.

OBJECTIVES: To report methodology and overall clinical, laboratory and radiographic characteristics for Henoch-Schönlein purpura (HSP), childhood polyarteritis nodosa (c-PAN), c-Wegener granulomatosis (c-WG) and c-Takayasu arteritis (c-TA) classification criteria. METHODS: The preliminary Vienna 2005 consensus conference, which proposed preliminary criteria for paediatric vasculitides, was followed by a EULAR/PRINTO/PRES - supported validation project divided into three main steps. Step 1: retrospective/prospective web-data collection for HSP, c-PAN, c-WG and c-TA, with age at diagnosis

[Clinical characteristics of children with scleroderma in a referral hospital]. / Características clínicas de niños con esclerodermia en un hospital de referencia.

INTRODUCTION: Scleroderma is an autoimmune disease that involves the connective tissue characterized by skin fibrosis, classified as localized and systemic (participation of one or more internal organs). The primary objective of this study is to describe and analyze the clinical and laboratory findings in a group of children diagnosed with scleroderma at a referral hospital. MATERIAL AND METHODS: Extraction of data from clinical charts of children with scleroderma in the rheumatology department at the Hospital Infantil de México Federico Gómez, between January 2000 and December 2007. RESULTS: Sixty two patients were included in the group. All of them completed the classification criteria for juvenile sclerodema, both systemic and localized. The mean age at diagnosis was 7.8 (1-14) years. The mean time from disease onset to diagnosis, based on clinical manifestations, was 23 months. The lesions found were: linear scleroderma (42%), mixed morphea (22%), circumscribed morphea (19%), generalized morphea (13%) and panclerotic morphea (4%). Involvement associated with Systemic Scleroderma was gastrointestinal 100% (18 patients), pulmonary 100% (18/18), Raynaud's phenomenon 89% (16/18), proximal sclerosis 89% (16/18), sclerodactilia 67% (12/18), joint pain 28% (5/18), calcinosis 56% (10/18). Positive antinuclear antibodies (ANA) were present in 14/62 (23%) patients (10 with systemic range and 4 localized), antiSCL 70 in 2/62 (4%) cases. The most common drug used was methotrexate. CONCLUSION: The most common skin lesions found were linear morphea, followed by the mixed and circumscribed types. In systemic scleroderma the most involved systems are the gastrointestinal, respiratory and vascular (associated with Raynaud's phenomenon). There is a special need for knowledge of this disease in first contact physicians for a faster and better diagnosis and treatment, in order to avoid complications. It is also necessary to improve resources in developing countries for complimentary studies, classification, treatment and follow-up.

Características clínicas de niños con esclerodermia en un hospital de referencia / Clinical characteristics of children with scleroderma in a referral hospital

Introducción La esclerodermia es una enfermedad del tejido conectivo, autoinmunitaria y caracterizada por fibrosis de la piel; además, puede ser localizada o sistémica (participación de uno o de más órganos internos). El objetivo del presente estudio es describir y analizar las características clínicas y de laboratorio observadas en un grupo de niños con esclerodermia en un hospital de referencia. Material y métodos Recopilación de datos de los expedientes clínicos de niños con diagnóstico de esclerodermia del Departamento de Reumatología del Hospital Infantil de México Federico Gómez durante el período comprendido entre los años 2000 y 2007.ResultadosSe incluyó a 62 pacientes que cumplieron con los criterios de clasificación preliminar para esclerodermia juvenil, localizada y sistémica. La edad media al diagnóstico fue de 7,8 años (1–14). La duración media de la enfermedad al diagnóstico fue de 23 meses. Las lesiones encontradas fueron esclerodermia lineal (42%), morfea mixta (22%), morfea circunscripta (19%), morfea generalizada (13%) y morfea panesclerótica (4%). Los hallazgos asociados a esclerodermia sistémica (ES) fueron afección gastrointestinal en 18 de 18 pacientes (100%), afección pulmonar en 18 de 18 pacientes (100%), fenómeno de Raynaud en 16 de 18 pacientes (89%), esclerosis proximal en 16 de 18 pacientes (89%), esclerodactilia en 12 de 18 pacientes (67%), calcinosis en 10 de 18 pacientes (56%) y afección articular en 5 de 18 pacientes (28%). Se hallaron anticuerpos antinucleares positivos en 14 de 62 pacientes (23%) (10 con ES y 4 con esclerodermia localizada) y anticuerpos anti-Scl70 en 2 de 62 pacientes (4%). El medicamento más utilizado fue metotrexato. Conclusión Las lesiones en piel más frecuentes corresponden a morfea lineal seguida de morfea mixta y morfea circunscripta. En la ES los sistemas más frecuentemente afectados son el gastrointestinal, el respiratorio y el vascular (este último relacionado con el fenómeno de Raynaud). Se necesita de un mayor conocimiento de esta enfermedad en medicina de primer contacto para el diagnóstico rápido y tratamiento oportuno. Es importante superar la carencia de recursos en países en desarrollo para estudios auxiliares necesarios, tanto para la clasificación como para el seguimiento (AU)

Introduction Scleroderma is an autoimmune disease that involves the connective tissue characterized by skin fibrosis, classified as localized and systemic (participation of one or more internal organs). The primary objective of this study is to describe and analyze the clinical and laboratory findings in a group of children diagnosed with scleroderma at a referral hospital. Material and methods Extraction of data from clinical charts of children with scleroderma in the rheumatology department at the Hospital Infantil de México Federico Gómez, between January 2000 and December 2007. Results Sixty two patients were included in the group. All of them completed the classification criteria for juvenile sclerodema, both systemic and localized. The mean age at diagnosis was 7.8 (1–14) years. The mean time from disease onset to diagnosis, based on clinical manifestations, was 23 months. The lesions found were: linear scleroderma (42%), mixed morphea (22%), circumscribed morphea (19%), generalized morphea (13%) and panclerotic morphea (4%). Involvement associated with Systemic Scleroderma was gastrointestinal 100% (18 patients), pulmonary 100% (18/18), Raynaud's phenomenon 89% (16/18), proximal sclerosis 89% (16/18), sclerodactilia 67% (12/18), joint pain 28% (5/18), calcinosis 56% (10/18). Positive antinuclear antibodies (ANA) were present in 14/62 (23%) patients (10 with systemic range and 4 localized), antiSCL 70 in 2/62 (4%) cases. The most common drug used was methotrexate. Conclusion The most common skin lesions found were linear morphea, followed by the mixed and circumscribed types. In systemic scleroderma the most involved systems are the gastrointestinal, respiratory and vascular (associated with Raynaud's phenomenon). There is a special need for knowledge of this disease in first contact physicians for a faster and better diagnosis and treatment, in order to avoid complications. It is also necessary to improve resources in developing countries for complimentary studies, classification, treatment and follow-up (AU)

Tratamiento de fluorosis dental con peróxido de carbamida / Treatment of dental fluorosis with carbamide peroxide

La fluorosis dental es un problema de salud pública que afecta una amplia zona de México, principalmente en las regiones centro y norte. El objetivo del presente estudio fue evaluar la efectividad clínica del tratamiento a base de peróxido de carbamida en casos de fluorosis dental. Un ensayo clínico fue llevado a cabo en 38 pacientes quienes fueron seleccionados a través de un método no probabilístico consecutivo; para el examen de fluorosis dental se utilizó el índice de superficie dental, las pruebas estadísticas empleadas fueron U de Mann-whitney y Kappa ponderada Los resultados muestran diferencias estadísticamente significativas entre antes y después del tratamiento (p < 0.05). El tratamiento de fluorosis dental con peróxido de carbamida ofrece ventajas como bajo costo, fácil aplicación y desgaste mínimo de esmalte