Levels of satisfaction with rheumatoid arthritis treatment and associated alignment between physicians and patients across Latin America.

INTRODUCTION: Discordance (misalignment) regarding treatment satisfaction may exist in real-life clinical practice between patients and their physicians. We aimed to assess physician and patient treatment satisfaction levels and associated degree of misalignment in rheumatoid arthritis (RA). METHOD: A point-in-time, multinational survey of patients and physicians was conducted in Latin America from December 2014 to October 2015. Physician- and patient-reported satisfaction levels with current RA treatment, alignment levels in satisfaction perception, and factors associated with satisfaction misalignment were assessed through bivariate and logistic regression analyses. RESULTS: Participating physicians (N = 114) completed 555 patient record forms (PRFs); 372 patients completed self-complete questionnaires (PSC). A total of 346 physician-patient pairs were analyzed. Physicians reported satisfaction with current disease control in 270/346 (78.0%) PRFs; patients reported such satisfaction in 286/346 (82.7%) PSCs. Physician-patient alignment was observed in 78.6% of pairs. Compared with aligned patients, misaligned patients were younger, more likely to have moderate or severe disease (physician subjectively defined), deteriorating or unstable disease (physician subjectively defined), been exposed to a greater number of advanced therapy lines (biologic or Janus kinase inhibitor), greater current pain, a current acute episode, poorer health, and greater disability and impairment. Misaligned patients were less likely to be in remission. Logistic regression analysis revealed that misaligned patients were more likely to experience greater activity impairment. CONCLUSIONS: High treatment satisfaction and alignment were observed among RA patients and their physicians in Latin America. Misaligned patients were more likely to report more severe disease and were less likely to be in remission. Addressing misalignment may lead to improved RA disease control.Key Points• High treatment satisfaction was observed among RA patients and their treating physicians in Latin America.• One-fifth of physician-patient pairs were misaligned in treatment satisfaction.• Patients misaligned with their physicians reported higher disease activity, lower quality of life, and greater disability than those who were aligned with their physicians.• Understanding and addressing misalignment in treatment satisfaction may improve outcomes in this patient population.

Epidemiology of inflammatory bowel disease in Mexico and Colombia: Analysis of health databases, mathematical modelling and a case-series study.

BACKGROUND AND AIMS: Ulcerative Colitis (UC) and Crohn's Disease (CD) have a major impact on quality of life and medical costs. The aim of the study was to estimate the prevalence, incidence and clinical phenotypes of Inflammatory Bowel Disease (IBD) cases in Mexico and Colombia. METHODS: We analyzed official administrative and health databases, used mathematical modelling to estimate the incidence and complete prevalence, and performed a case-series of IBD patients at a referral center both in Mexico and Colombia. RESULTS: The age-adjusted complete prevalence of UC per 100,000 inhabitants for 2015/2016 ranged from 15.65 to 71.19 in Mexico and from 27.40 to 69.97 in Colombia depending on the model considered. The prevalence of CD per 100,000 inhabitants in Mexico ranged from 15.45 to 18.08 and from 16.75 to 18.43 in Colombia. In Mexico, the age-adjusted incidence of UC per 100,000 inhabitants per year ranged from 0.90 to 2.30, and from 0.55 to 2.33 in Colombia. The incidence for CD in Mexico ranged from 0.35 to 0.66 whereas in Colombia, the age-adjusted incidence of CD ranged from 0.30 to 0.57. The case-series included 200 IBD patients from Mexico and 204 patients from Colombia. The UC/CD prevalence ratio in Mexico and Colombia was 1.50:1 and 4.5:1 respectively. In Mexico, the female/male prevalence ratio for UC was 1.50:1 and 1.28:1 for CD, while in Colombia this ratio was 0.68:1 for UC and 0.8:1 for CD. In Mexico the relapse rate for UC was 63.3% and 72.5% for CD, while those rates in Colombia were 58.2% for UC and 58.3% for CD. CONCLUSIONS: The estimated burden of disease of IBD in Mexico and Colombia is not negligible. Although these findings need to be confirmed by population-based studies, they are useful for decision-makers, practitioners and patients with this condition.

Comparison of the amplitude of the P-wave from intracardiac electrocardiogram obtained by means of a central venous catheter filled with saline solution to that obtained via esophageal electrocardiogram.

Recognition of the P wave is important for the correct characterization of atrial and ventricular arrhythmias. When the P wave is difficult to identify on standard electrocardiography (SECG), either esophageal electrocardiography (EECG) or intracardiac electrocardiography (IC-ECG), central venous catheter may be used. The feasibility of these methods has already been demonstrated, but there is no published study comparing them. This study compared the amplitude of the P wave obtained by IC-ECG with those of the P waves obtained by EECG and SECG. SECG, EECG, and IC-ECG were performed on each patient. IC-ECG and EECG made it possible to register P waves larger than registered by SECG (p <0.00001). The difference between the largest P waves obtained with IC-ECG (5.93 +/- 3.56 mm) and EECG (4.67 +/- 2.16 mm) was not statistically significant (p = 0.1953). In conclusion, IC-ECG is easy to perform and magnifies the P wave at least as effectively as EECG.

Miocardiopatía hipertrófica apical que simula un síndrome coronario agudo: Aporte de la ecocardiografía tridimensional / Apical Hypertrophic Myocardiopathy Mimicking Acute Coronary Syndrome: Contribution of Three-Dimensional Echocardiography

La miocardiopatía hipertrófica apical es una entidad que se caracteriza por la presencia de hipertrofia predominante de los segmentos apicales del ventrículo izquierdo. Esta forma de miocardiopatía hipertrófica en general presenta una evolución clínica y un pronóstico benignos. Sin embargo, la típica presencia de alteraciones significativas del electrocardiograma puede simular la existencia de enfermedad coronaria, motivo por el cual el diagnóstico definitivo por técnicas de imagen tiene una gran implicación clínica. En esta presentación se describe un caso de miocardiopatía hipertrófica apical en el contexto de dolor precordial y dificultades diagnósticas, en el que se demuestran las ventajas de la ecocardiografía tridimensional para su evaluación.

Apical hypertrophic myocardiopathy is characterized by the presence of hypertrophy localized to the left ventricular apex. This type of hypertrophic myocardiopathy usually presents favorable clinical outcomes and a benign prognosis. Nevertheless, the typical presence of significant alterations in the electrocardiogram may mimic the existence of coronary artery disease. In this sense, image tests have great clinical implications to arrive at a definite diagnosis. We present a case report of apical hypertrophic myocardiopathy in a context of chest pain and difficulties to perform a diagnosis; the advantages of three-dimensional echocardiography for the assessment of this disorder are described.