Cutaneous manifestations of early systemic lupus erythematosus and correlation with systemic activity

RESUMEN: Las manifestaciones cutáneas del lupus eritematoso sistémico (LES) son heterogéneas (específicas e inespecíficas). Poco se sabe acerca de la relación entre estas manifestaciones y la actividad clínica e inmunológica de la enfermedad en sus etapas iniciales. Se llevó a cabo un estudio de corte transversal en 34 pacientes con LES temprano. Se encontró una asociación significativa entre alopecia e hipocomplementemia C3 (p = 0,021), hipocomplementemia C4 (p < 0,001) y anti-Sm (p = 0,011); entre eritema malar y anti-Ro (p = 0,037) y anti-La (p = 0,037); entre fotosensibilidad y anti-RNP (p = 0,037). Se observó una tendencia a la asociación entre úlceras orales e hipocomplementemia C4 (p = 0,064). No hubo asociación entre las manifestaciones cutáneas y la presencia de anti-ADN de doble cadena (anti-ds ADN), anticuerpos anticardiolipinas, anticoagulante lúpico, VDRL falso positivo, leucopenia, trombocitopenia, hipergammaglobulinemia, elevación de la velocidad de sedimentación globular o SLEDAI. Se resalta la importancia de la relación entre las manifestaciones cutáneas inespecíficas de LES (alopecia y fotosensibilidad) y la actividad sistémica en pacientes con enfermedad temprana y la clara asociación de estas con hipocomplementemia, un marcador importante de actividad inmunológica.ABSTRACT: Cutaneous manifestations of systemic lupus erythematosus (SLE) are heterogeneous (both specific and non-specific). Little is known about the relationship between these manifestations and the clinical and immunological activity of the disease in early stages. We carried out a cross-sectional study in 34 patients with early SLE. We found a significant association between alopecia and hypocomplementemia C3 (p = 0.021), hypocomplementemia C4 (p < 0.001) and anti-Sm (p = 0.011); between malar erythema and anti-Ro (p = 0.037) and anti-La (p = 0.037); between photosensitivity and anti-RNP (p = 0.037). We observed a trend to association between oral ulcers and hypocomplementemia C4 (p = 0.064). No association was found between cutaneous manifestations and the presence of anti-ds DNA, anticardiolipin antibodies, lupus anticoagulant, false-positive VDRL, leucopenia, thrombocytopenia, hypergammaglobulinemia, elevated erythrosedimentation rate or SLEDAI. We highlight the relevance of the relationship between non-specific cutaneous manifestations of early SLE (alopecia and photosensitivity) and the systemic activity of the disease and hypocomplementemia, an important marker of immunological activity

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 17

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 17 de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada, de acceso abierto a todas las áreas del conocimiento, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico. Con esta colección, se aspira contribuir con el cultivo, la comprensión, la recopilación y la apropiación social del conocimiento en cuanto a patrimonio intangible de la humanidad, con el propósito de hacer aportes con la transformación de las relaciones socioculturales que sustentan la construcción social de los saberes y su reconocimiento como bien público

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Manifestaciones cutáneas de lupus eritematoso sistémico temprano y correlación con la actividad sistémica = Cutaneous manifestations of early systemic lupus erythematosus and correlation with systemic activity

Las manifestaciones cutáneas del lupus eritematoso sistémico (LES) son heterogéneas (espe­cíficas e inespecíficas). Poco se sabe acerca de la relación entre estas manifestaciones y la actividad clínica e inmunológica de la enfermedad en sus etapas iniciales. Se llevó a cabo un estudio de corte transversal en 34 pacientes con LES temprano. Se encontró una asociación significativa entre alopecia e hipocomplementemia C3 (p = 0,021), hipocomplementemia C4 (p < 0,001) y anti-Sm (p = 0,011); entre eritema malar y anti-Ro (p = 0,037) y anti-La (p = 0,037); entre fotosensibilidad y anti-RNP (p = 0,037). Se observó una tendencia a la asociación entre úlceras orales e hipocomplementemia C4 (p = 0,064). No hubo asociación entre las ma­nifestaciones cutáneas y la presencia de anti-ADN de doble cadena (anti-ds ADN), anticuerpos anticardiolipinas, anticoagulante lúpico, VDRL falso positivo, leucopenia, trombocitopenia, hipergammaglobulinemia, elevación de la velocidad de sedimentación globular o SLEDAI. Se resalta la importancia de la relación entre las manifestaciones cutáneas inespecíficas de LES (alopecia y fotosensibilidad) y la actividad sistémica en pacientes con enfermedad temprana y la clara asociación de estas con hipocomplementemia, un marcador importante de actividad inmunológica

Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort studyResearch in context

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017