The Delphi method in rheumatology research : are we doing it right?

Q4Artículo de reflexión1-13Introduction The Delphi method is a technique for reaching consensus by a group of experts that express their opinion on a particular issue. It has been widely used in different areas of knowledge, including health sciences. Rheumatology is one of the medical specialties that has most widely used this consensus technique. Objectives To review the ideal process for implementing the Delphi method. To describe the current impact of the Delphi method on health research, and take a critical look at its application in rheumatology research. Materials and Methods The frequency of use of the Delphi method in publications indexed in MEDLINE was evaluated, as an approach to measure its use in health sciences. A search of the articles reporting the use of the Delphi method as a research tool in rheumatology was conducted. Results A total of 4,574 articles were found when searching Medline using the MeSH “Delphi Technique”. The analysis included 148 articles that applied the Delphi method in rheumatology research. According to the findings, the application of the method did not follow the guidelines originally defined, either because of failure to meet its distinctive characteristics, or because of omission of one its phases, or lack of rigor in the implementation of the different phases; so much so, that in the end, only one fifth of the articles analyzed met the distinctive characteristics of the methodology, which could jeopardize the validity of the research results reported. Conclusions There is a growing trend to use the Delphi method in health research, and rheumatology is no exception. The lack of standardization and failure to adhere to the Delphy methodology may jeopardize the validity of the results obtained from its use in research. Researchers should take into account the basic methodological premises of the Delphi method and include them in their work

Use and Impact of Social Networks on Physical Medicine and Rehabilitation Scientific Journals

Q4Objectives: Our research seeks to examine the correlation between the presence of physical medicine and rehabilitation journals in social networks and the SJR impact factor. Methods: We carried out a correlation study. For the research, we took into account all physical medicine and rehabilitation journals included in the SCImago Journal Rank. The number of followers on Twitter, Facebook, YouTube, and the number of tweets were extracted from verified accounts. Journal differences according to the presence in social networks were evaluated using non-parametric tests, and the Spearman correlation coefficient was calculated between the metrics of dissemination in social networks and the SCImago Journal Rank. Results: Out of 122 physical medicine and rehabilitation journals, 25.4% had the presence in one social network. The H Index medians (32 vs 17, P=0.014) and of the SJR (0.67 vs 0.32, P= 0.001) were better in journals with the presence in social networks. A moderate correlation was found between the SJR and the number of followers on Twitter (r=0.5, P=0.066). The global correlation between the SJR and followers on Facebook was acceptable (r=0.4, P=0.1205). Discussion: Our data show that scientific journals of physical medicine and rehabilitation with presence in social networks have superior quality metrics. Additionally, SJR and the indicators of dissemination in social networks are moderately correlated. Both metrics offer complementary information. Presence in social networks could improve the visibility of journals and their interaction with readers.Revista Internacional - Indexad

THU0626 Social networks as a source of information for patients with rheumatic diseases

Background: Internet is an informative source for patients with different diseases. False information in social networks about health issues is a growing problem. Rheumatology is no stranger to this problem and there is a lot of false information regarding rheumatic diseases. Objectives: To show objective data on misinformation published in social networks available to spanish-speaking rheumatic patients Methods: We create accounts on Facebook (FB) and Google unique for this work. Multimedia was included in Spanish, with a convenience sampling according to the deployment of the platform (FB) or in descending order for reproductions on YouTube (YT). Two independent reviewers extracted information on online time, number of reproductions and characteristics of the most popular videos. Videos consulted on 10-11-18. Results: With the search term ”rheumatoid arthritis” (RA), the most reproduced video is titled ”celery green juice for arthritis” (6.4 million reproductions). Of the first 50 videos with more reproductions, 39 are of natural or home remedies such as vinegar, “moringa”, etc., and 35 videos indicate in their content, that they can cure RA. With the term ”lupus”, the most reproduced video is titled ”God’s tea, cure chronic tiredness, thyroid, arthritis, lupus and vertigo” (1.4 million reproductions). Of the first 50 videos with more reproductions, 31 correspond to natural or home remedies such as celery, thyme, diets among others and 29 videos indicate that they can cure lupus. With the term ”fibromyalgia”, the most reproduced video is entitled ”I am 61 years old and this cured my arthritis, vertigo, fibromyalgia, lupus, chronic fatigue and the thyroid” (1.1 million reproductions). Of the 50 first videos with more reproductions, 40 are of natural or home remedies such as thyme, tea, among others and 33 videos indicate that they can cure the disease. With the data of the videos uploaded online in October 2018, 50 videos were chosen in YT and FB. There was no correlation between online time and the number of views on any platform. In FB, 56% of the videos contained false information, with no difference in online time in both groups (16 [12-22] vs 18 [13-25], p = 0.3).). In YT, only 38% was considered false information, without differences between groups in online time (19 [11-26] vs 22 [12-24])

Relationship between internal medicine journals’ activity on social networks and the citations they receive

Antecedentes y objetivo Las redes sociales son medios de divulgación de información científica. Se han generado métricas alternativas que evalúan el impacto de publicaciones científicas en redes sociales. Este estudio busca evaluar si existe correlación entre la actividad de las revistas de medicina interna en las redes sociales y las métricas tradicionales basadas en citaciones. Métodos Se identificaron las revistas de medicina interna a partir de la base de datos SCImago. Se extrajo información de las métricas tradicionales y alternativas de actividad de las revistas en Facebook, Twitter, YouTube e Instagram. Se evaluó correlación mediante el coeficiente de Spearman. Resultados De un total de 134 revistas de medicina interna, 17 contaban con presencia en las redes sociales evaluadas. El índice SJR fue más alto en revistas con red social vs. sin red social (59 vs. 18, p<0,0001), y la correlación global entre el índice SJR y el número de seguidores/año en Facebook fue muy fuerte (coeficiente de Spearman 0,95, p<0,05) y fuerte para el número de seguidores/año en Twitter (coeficiente de Spearman 0,54, p <0,05). Conclusiones Nuestro estudio sugiere que existe una correlación muy fuerte entre las métricas de actividad de las redes sociales, comparado con las métricas tradicionales basadas en el número de citaciones en revistas de medicina interna.Q3Background and objectives Social networks are a means for disseminating scientific information. Alternative metrics assessing the impact of scientific publications on social networks have been created. Our study aims to assess the correlation between the activity of internal medicine journals on social networks and traditional metrics based on citations. Methods Internal medicine journals were identified in the SCImago-Scopus database and information on traditional impact metrics was extracted. In addition, alternative metrics of activity were determined for Facebook, Twitter, YouTube, and Instagram. The correlation was assessed through Spearman's correlation coefficient. Results Of 134 Internal Medicine journals, 17 had a presence on the social networks evaluated. The SJR index was higher in journals with a presence on social networks vs. those without (59 vs. 18, p <.0001). The overall correlation between the SJR index and the number of followers/year was very strong for Facebook (Spearman's correlation coefficient 0.95, p <.05) and strong for Twitter (Spearman's correlation coefficient 0.54 p <.05). Conclusions Our study suggests that there is a very strong correlation between social network activity metrics (mainly Facebook and Twitter) compared to traditional metrics based on the number of citations of internal medicine journals.Revista Internacional - Indexad

Idiopathic retroperitoneal fibrosis

Mujer de 36 años de edad quien consulta por cuadro clínico de ocho meses de evolución consistente en dolor abdominal, asociado a diarrea y emesis, siendo manejada inicialmente como cuadro de colon irritable. Ante la persistencia del dolor solicitan estudios imagenológicos con hallazgos sugestivos de masa retroperitoneal por lo cual remiten para valoración por cirugía. Al examen físico se encuentra dolor a la palpación abdominal generalizada sin adenopatías o masas. Paraclínicos con resonancia abdominal evidenciando masa sólida retroperitoneal de localización paraaórtica izquierda y espacio interaortocavo, englobando de forma circunferencial la aorta abdominal a la emergencia de arterias renales comprometiendo tejidos adyacentes, con disminución del tamaño del riñón izquierdo, compensando con hipertrofia del riñón derecho. Marcadores tumorales negativos, colonoscopia sin evidencia de masas. Es llevada a biopsia guiada por TAC con patología conclusiva de fibrosis retroperitoneal idiopática. Conclusión: se presenta un caso de fibrosis retrooperitoneal idiopática, enfermedad de muy baja frecuencia de presentación en la práctica clínica diariaCaso Clínico260-262The case of a 36-year-old woman who consults for history of abdominal pain associated to diarrhea and emesis of eight months of evolution, being initially handled as irritable bowel syndrome, is presented. Given the persistence of pain, imaging studies suggestive of retroperitoneal mass were requested and were referred for assessment by surgery. Physical examination showed generalized pain at abdominal palpation without lymphadenopathy or masses. Abdominal resonance showed solid retroperitoneal mass of left para-aortic location and interaortocaval space, circumferentially encompassing the abdominal aorta at the emergence of renal arteries engaging adjacent tissue with decreased size of the left kidney, compensated by right kidney hyperthrophy. Tumor markers were negative, and colonoscopy did not show evidence of masses. A carried CT-guided biopsy was performed with conclusive pathology of idiopathic retroperitoneal fibrosis. Conclusion: a case of idiopathic retroperitoneal fibrosis, disease with very low frequency in everyday clinical practice, is presente

Conversion of latent tuberculosis in a group of patients treated with biologic therapy in a Rheumatology unit

Objetivo: los pacientes que padecen enfermedades reumáticas, en tratamiento con terapia biológica, tienen como consecuencia la inmunosupresión y el riesgo de reactivación de enfermedades latentes crónicas como la tuberculosis. Dado que no existen estimativos de este riesgo en Colombia, se consideró importante realizar un estudio que evaluara la incidencia de tuberculosis latente en esta población. Métodos: se hizo un estudio descriptivo basado en una cohorte histórica, que incluyó pacientes de la Unidad de Reumatología del Hospital Universitario de San Ignacio, en Bogotá (Colombia). Se evaluaron 78 candidatos a terapia biológica, libres de tuberculosis activa o latente, al ingreso a la cohorte. Se realizó prueba cutánea de tuberculina (Tubersol® Sanofi Pasteur) al inicio de la terapia biológica y controles a los seis meses. Se definió conversión de tuberculosis latente como viraje de PPD mayor a 5 mm respecto a la inicial. Resultados: 78 pacientes cumplieron criterios de inclusión. 27 presentaron datos incompletos y por esto fueron excluidos. Se incluyeron para el análisis 51 pacientes, 12 de los cuales presentaron viraje de PPD (23,5%). Conclusiones: este estudio demuestra la alta incidencia de conversión de tuberculosis latente y por tanto el alto riesgo al que se someten los pacientes en terapia biológica, punto de partida para optimizar el estudio y seguimiento de los mismos.Artículo original116-122OBJECTIVE: Patients with rheumatic diseases who undergo treatment with biologic therapies have immunosuppression as a consequence, and are at risk for reactivation of chronic latent diseases such as tuberculosis. Since there are no estimations of this risk in Colombia, it was considered important to carry out a study aimed at assessing the incidence of latent tuberculosis in this population. METHODS: A descriptive study based on a historical cohort was carried out. It included patients of the Rheumatology Unit of Hospital Universitario de San Ignacio, in Bogotá (Colombia). 78 candidates for biologic therapy were assessed, who were free of latent or active tuberculosis on admission to the cohort. Cutaneous tuberculin testing (Tubersol® Sanofi Pasteur) was done at the beginning of biologic therapy and controlled after six months. Conversion of latent tuberculosis was defined as a PPD shift greater than 5 mm with respect to the initial response. RESULTS: 78 patients met inclusion criteria. 25 had incomplete data and were therefore excluded. 51 patients were included for analysis, 12 of whom showed PPD shift (23,5%). CONCLUSIONS: This study demonstrates the high incidence of conversion of latent tuberculosis, and therefore the high risk of patients on biologic therapy. This should be a starting point for optimizing the study and followup of these patients

Crioglobulinemia esencial como causa de hemorragia alveolar - reporte de caso y revisión de la literatura

Presentamos el caso de una paciente quien ingresa por la presencia de lesiones petequiales, artralgias y una úlcera en miembro inferior. La presencia de azoados en ascenso progresivo se documenta durante su estancia. Se instaura manejo con corticoide IV sin respuesta y se obtienen mejoría con plasmaféresis. Posteriormente se observa la presencia de deterioro del patrón respiratorio, disnea sumado a la presencia de compromiso pulmonar en parches por medio de tomografía de tórax y con evidencia de hemorragia alveolar. Se descartan causas autoinmunes e infecciosas, así como neoplasias hematológicas. Se concluye que la presencia de crioglobulinemia es la única causa de dicha entidad

Prevalence of rheumatic disease in a cohort of patients with human immunodeficiency virus infection

Objetivo: Describir la prevalencia de enfermedades reumáticas en una cohorte de pacientes con infección por VIH y sus características demográficas y clínicas. Pacientes y métodos: Estudio descriptivo de corte transversal de una cohorte de 1.712 pacientes con infección por VIH, en un hospital universitario, seguidos desde enero del 2005 hasta septiembre del 2013. Resultados: Se encontró una prevalencia de enfermedades reumáticas del 5,2% (n= 89 casos), el 24% de sexo femenino y el 76% de sexo masculino. Edad promedio ± desviación estándar 45 ± 11 anos. ˜ Las enfermedades encontradas fueron: artritis reactiva 15% (n= 14), artrosis 15% (n= 14), púrpura trombocitopénica inmune 11% (n= 10), otras 59% (n= 53). El tiempo promedio entre el diagnóstico de VIH y la condición reumática fue de 73 ± 66 meses. Dentro de las comorbilidades se encontraron: dislipidemia 39% (n= 43), hepatitis B 17% (n= 19), lipodistrofia 11% (n= 12), herpes zóster 10% (n= 11) e hipotiroidismo 9% (n= 10). Conclusiones: Se presenta información respecto a las comorbilidades reumáticas en una cohorte de pacientes con infección por VIH. Como se ha documentado en otras series, la artritis reactiva fue la enfermedad reumática más frecuente junto con osteoartrosis. Nuestro estudio evidencia una tendencia hacia el envejecimiento de los pacientes con VIH gracias a un mejor control de la enfermedad, con el uso de terapia antirretroviral, lo cual aumenta la prevalencia de osteoartrosis. © 2014 Asociación Colombiana de Reumatología. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.Artículo original79-83Objective: To describe the prevalence of rheumatic diseases in a cohort of patients with HIV infection attending a university hospital, along with their demographic and clinicalfeatures. Patients and methods: Cross-sectional study of 1712 outpatients with HIV infection treated at a university hospital between January 2005 and September 2013. Results: There was a prevalence of rheumatic diseases of 5.2% (n=89) in the patients studies, with 76% being male patients. The mean age of onset was 45 ± 11 years. Fourteen patients had reactive arthritis (15%), 14 had osteoarthritis (15%), 10 had immune thrombocytopenic purpura (11%), and 53 had other conditions (59%). The mean time between HIV diagnosis and rheumatic condition onset was 73 ± 66 months. The most prevalent comorbidities were dyslipidemia in 12 patients (11%), hepatitis B in 19 (17%), lipodystrophy in 12 (11%), herpes zoster in 11 (10%) and hypothyroidism in 10 (9%). Conclusions: A description is presented on the rheumatic diseases found in a cohort of patients with HIV infection. As reported in previous series, reactive arthritis is the most frequent rheumatic condition along with osteoarthritis. This study shows a trend towards successful aging of HIV patients due to a better control of the disease with the use of antiretroviral therapy, but with an increasing prevalence of osteoarthritis. © 2014 Asociación Colombiana de Reumatología. Published by Elsevier España, S.L.U. All rights reserved

Next-generation sequencing of bile cell-free DNA for the early detection of patients with malignant biliary strictures

Objective: despite significant progresses in imaging and pathological evaluation, early differentiation between benign and malignant biliary strictures remains challenging. Endoscopic retrograde cholangiopancreatography (ERCP) is used to investigate biliary strictures, enabling the collection of bile. We tested the diagnostic potential of next-generation sequencing (NGS) mutational analysis of bile cell-free DNA (cfDNA). Design: a prospective cohort of patients with suspicious biliary strictures (n=68) was studied. The performance of initial pathological diagnosis was compared with that of the mutational analysis of bile cfDNA collected at the time of first ERCP using an NGS panel open to clinical laboratory implementation, the Oncomine Pan-Cancer Cell-Free assay. Results: an initial pathological diagnosis classified these strictures as of benign (n=26), indeterminate (n=9) or malignant (n=33) origin. Sensitivity and specificity of this diagnosis were 60% and 100%, respectively, as on follow-up 14 of the 26 and eight of the nine initially benign or indeterminate strictures resulted malignant. Sensitivity and specificity for malignancy of our NGS assay, herein named Bilemut, were 96.4% and 69.2%, respectively. Importantly, one of the four Bilemut false positives developed pancreatic cancer after extended follow-up. Remarkably, the sensitivity for malignancy of Bilemut was 100% in patients with an initial diagnosis of benign or indeterminate strictures. Analysis of 30 paired bile and tissue samples also demonstrated the superior performance of Bilemut. Conclusion: implementation of Bilemut at the initial diagnostic stage for biliary strictures can significantly improve detection of malignancy, reduce delays in the clinical management of patients and assist in selecting patients for targeted therapies.Funding: we thank the financial support of CIBERehd; grants PI16/01126 and PI19/00163 from Instituto de Salud Carlos III (ISCIII) cofinanced by ’Fondo Europeo de Desarrollo Regional’ (FEDER) ’Una manera de hacer Europa’; grants 58/2017 and 55/2018 from Gobierno de Navarra Salud; grant 0011-1411-2020-000010 from AGATA Strategic Project from Gobierno de Navarra; grant 2020/101 from Euroregion Nouvelle Aquitaine-Euskadi-Navarra; Fundación Eugenio Rodríguez Pascual; Fundación Mario Losantos, Fundación M Torres; grant 2018/117 from AMMF, the Cholangiocarcinoma Charity; the COST Action CA181122 Euro-cholangio-Net; POSTD18014AREC postdoctoral fellowship from AECC to MA; and Ramón y Cajal Program contracts RYC-2014-15242 and RYC-2018-024475-1 to FJC and MGFB

Pilot multi-omic analysis of human bile from benign and malignant biliary strictures: a machine-learning approach

Cholangiocarcinoma (CCA) and pancreatic adenocarcinoma (PDAC) may lead to the development of extrahepatic obstructive cholestasis. However, biliary stenoses can also be caused by benign conditions, and the identification of their etiology still remains a clinical challenge. We performed metabolomic and proteomic analyses of bile from patients with benign (n = 36) and malignant conditions, CCA (n = 36) or PDAC (n = 57), undergoing endoscopic retrograde cholangiopancreatography with the aim of characterizing bile composition in biliopancreatic disease and identifying biomarkers for the differential diagnosis of biliary strictures. Comprehensive analyses of lipids, bile acids and small molecules were carried out using mass spectrometry (MS) and nuclear magnetic resonance spectroscopy (1H-NMR) in all patients. MS analysis of bile proteome was performed in five patients per group. We implemented artificial intelligence tools for the selection of biomarkers and algorithms with predictive capacity. Our machine-learning pipeline included the generation of synthetic data with properties of real data, the selection of potential biomarkers (metabolites or proteins) and their analysis with neural networks (NN). Selected biomarkers were then validated with real data. We identified panels of lipids (n = 10) and proteins (n = 5) that when analyzed with NN algorithms discriminated between patients with and without cancer with an unprecedented accuracy.This research was funded by: Instituto de Salud Carlos III (ISCIII) co-financed by Fondo Europeo de Desarrollo Regional (FEDER) Una manera de hacer Europa, grant numbers: PI16/01126 (M.A.A.), PI19/00819 (M.J.M. and J.J.G.M.), PI15/01132, PI18/01075 and Miguel Servet Program CON14/00129 (J.M.B.); Fundación Científica de la Asociación Española Contra el Cáncer (AECC Scientific Foundation), grant name: Rare Cancers 2017 (J.M.U., M.L.M., J.M.B., M.J.M., R.I.R.M., M.G.F.-B., C.B., M.A.A.); Gobierno de Navarra Salud, grant number 58/17 (J.M.U., M.A.A.); La Caixa Foundation, grant name: HEPACARE (C.B., M.A.A.); AMMF The Cholangiocarcinoma Charity, UK, grant number: 2018/117 (F.J.C. and M.A.A.); PSC Partners US, PSC Supports UK, grant number 06119JB (J.M.B.); Horizon 2020 (H2020) ESCALON project, grant number H2020-SC1-BHC-2018–2020 (J.M.B.); BIOEF (Basque Foundation for Innovation and Health Research: EiTB Maratoia, grant numbers BIO15/CA/016/BD (J.M.B.) and BIO15/CA/011 (M.A.A.). Department of Health of the Basque Country, grant number 2017111010 (J.M.B.). La Caixa Foundation, grant number: LCF/PR/HP17/52190004 (M.L.M.), Mineco-Feder, grant number SAF2017-87301-R (M.L.M.), Fundación BBVA grant name: Ayudas a Equipos de Investigación Científica Umbrella 2018 (M.L.M.). MCIU, grant number: Severo Ochoa Excellence Accreditation SEV-2016-0644 (M.L.M.). Part of the equipment used in this work was co-funded by the Generalitat Valenciana and European Regional Development Fund (FEDER) funds (PO FEDER of Comunitat Valenciana 2014–2020). Gobierno de Navarra fellowship to L.C. (Leticia Colyn); AECC post-doctoral fellowship to M.A.; Ramón y Cajal Program contracts RYC-2014-15242 and RYC2018-024475-1 to F.J.C. and M.G.F.-B., respectively. The generous support from: Fundación Eugenio Rodríguez Pascual, Fundación Echébano, Fundación Mario Losantos, Fundación M Torres and Mr. Eduardo Avila are acknowledged. The CNB-CSIC Proteomics Unit belongs to ProteoRed, PRB3-ISCIII, supported by grant PT17/0019/0001 (F.J.C.). Comunidad de Madrid Grant B2017/BMD-3817 (F.J.C.).Peer reviewe