Taking care of systemic sclerosis patients during COVID-19 pandemic : rethink the clinical activity

COVID-19 outbreak has quickly spread worldwide, causing a high pressure on the health-care system. In Italy, from March 8, 2020, all the deferrable clinical activities have been suspended to increase the health care offer for COVID-19 patients. The hospital organization has been modified also in order to assure non-COVID-19 patients assistance. The Scleroderma Unit of ASST Pini-CTO Hospital, in Milan, in the region mostly hit by SARS-CoV-2 in Italy, follows more than 600 patients affected by systemic sclerosis (SSc). Patients with SSc need a close follow-up with a regular screening of organ involvement and frequent intravenous treatments. All SSc patients have been educated about ministerial directives to limit COVID-19 spread. The organization of our Scleroderma Unit has been quickly rethought to assure SSc patients assistance in safety for them and for health-care workers during urgent visits or infusion therapies. Using electronic way of communication with frequent virtual contact and guarantying home deliveries of some therapies, we allowed a continuity of care also outside the Hospital

Corneal involvement in rheumatoid arthritis: an vivo confocal study

PURPOSE. To analyze the in vivo morphology of corneal cells and nerves in patients with rheumatoid arthritis (RA), with or without secondary Sj\uf6gren\u2019s syndrome (SSII), and to investigate the correlations between corneal alterations and RA activity. METHODS. Fifty patients with RA and 30 age- and gender-matched control subjects were studied. SSII was diagnosed according to the American-European Consensus Group criteria, and RA activity was evaluated by the Lansbury index (LI). Confocal microscopy was used to investigate corneal thickness, the number of epithelial and stromal cells, and keratocyte hyperreflectivity. In addition, the sub-basal plexus was assessed for the number, tortuosity, and reflectivity of the nerve fibers and the presence of beadlike formations. RESULTS. Sixteen percent of patients with RA also had SSII. Between the SSII and non-SSII groups, no significant differences were found in the LI or in the clinical and confocal variables. Significant differences were present between patients with RA and control subjects for all the variables studied except nerve reflectivity. In patients with RA with and without SSII, LI correlated significantly with the number of beadlike formations and the number of hyperreflective, activated keratocytes. CONCLUSIONS. Confocal microscopy of patients with RA showed several changes in corneal cells and nerves. The number of beadlike formations and the number of activated keratocytes could be interpreted as confocal signs of ocular surface disease activity. These correlations with the index of systemic disease activity, LI, may provide insight regarding the pathogenic mechanisms of dry eye in patients with RA

El error de observación y su influencia en los análisis morfológicos de restos óseos humanos. Datos de variación discreta.

        RESUMEN A partir de la década de 1960 se incrementó el empleo de los rasgos no métricos del cráneo en los análisis de relaciones poblacionales. Si bien uno de los supuestos en que se bas6 el uso de estos rasgos es la facilidad de estandarizar su registro, varios trabajos sugieren que el error interobservador en los rasgos discretos es elevado. En consecuencia, los objetivos del trabajo son evaluar el error intra e interobservador en el registro de rasgos craneales no métricos y analizar el efecto del error interobservador sobre las distancias biológicas calculadas. Con este fin, se analizó una muestra arqueológica procedente del Valle inferior del Río Negro -10 con deformación pseudocircular y 10 con deformación planolámbdica-. Se seleccionaron ocho variables discretas del cráneo que fueron relevadas por cuatro observadores. El error de observación fue evaluado mediante un diseño experimental de bloques aleatorios con tres repeticiones y el empleo del índice Kappa y la prueba de McNemar. La distancia biológica entre las dos muestras se estimó mediante la Medida Media de Divergencia y un análisis de escalamiento multidimensional. Los resultados obtenidos indican que el error intraobservador disminuyó mediante la aplicación del diseño experimental, que el error interobservador se incrementó en las sucesivas series y que las diferencias entre los observadores alteraron los resultados de las medidas de distancia calculadas entre las muestras.   ABSTRACT Since the early 1960s, there was an increasing interest in the application of non-metric cranial traits to the analysis of relationships between populations. One of the assumptions for the use of these traits is based upon the simplicity to standardize the recordings. However, several papers suggest that the interobserver error on such recordings is high. Therefore, the goals of this paper are to evaluate the intra and interobserver error on the scoring of nonmetric cranial traits, as well as to analyze the effect of the interobserver error in the biological distances estimated with them. An archeological sample (n=20) from the lower stretch Valley of Rio Negro Valley (Rio Negro Province, Argentina) was analyzed. Eight discrete variables from the skull were recorded independently by four observers. The observation error was evaluated by means of a randomized complete blocks design, with three repetitions, and employing the Kappa index and the McNemar test. The biological distance between the two samples was estimated through the Mean Measure of Divergence and a multidimensional scaling test. Our results indicate that 1) the intraobserver error Diminishes with the application of observational designs; 2) the interobserver error increases in successive series and; 3) the differences among observers modify the results of calculated biodistance between samples

Rituximab vs mycophenolate and vs cyclophosphamide pulses for induction therapy of active lupus nephritis: A clinical observational study

Objective. We report the first comparison between rituximab (RTX) and either MMF or CYC pulses in the treatment of active LN. Methods. Fifty-four patients with active LN received three methylprednisolone pulses for 3 consecutive days followed by oral prednisone and RTX 1 g at days 3 and 18 (17 patients) or MMF 2-2.5 g/day (17 patients) or six CYC pulses (0.5 g every fortnight) (20 patients). At 4 months MMF, AZA or ciclosporin were associated to prednisone as a consolidation/maintenance therapy in all groups. The outcomes of the three groups were compared at 3 and 12 months. Results. Patients in the RTX group were older, had a longer duration of SLE and LN, had more renal flares, had higher activity and had higher chronicity indexes at renal biopsy than the other two groups. Four patients in each group had acute renal dysfunction and 3c50% had nephrotic syndrome. At 3 months, proteinuria was reduced by 50% in 58.8% of patients on RTX, in 64.7% on MMF and in 63.1% on CYC. At 12 months, complete remission was present in 70.6% of patients on RTX, in 52.9% on MMF, and in 65% on CYC. Partial remission was reached in 29.4% on RTX, 41.2% on MMF, and 25% on CYC. Conclusion. RTX seems to be at least as effective as MMF and CYC pulses in inducing remission. Considering that patients treated with RTX had more negative renal prognostic factors, this drug should be considered a viable alternative for the treatment of active LN

El error de observación y su influencia en los análisis morfológicos de restos óseos humanos : Datos de variación discreta

A partir de la década de 1960 se incrementó el empleo de los rasgos no métricos del cráneo en los análisis de relaciones poblacionales. Si bien uno de los supuestos en que se basó el uso de estos rasgos es la facilidad de estandarizar su registro, varios trabajos sugieren que el error interobservador en los rasgos discretos es elevado. En consecuencia, los objetivos del trabajo son evaluar el error intra e interobservador en el registro de rasgos craneales no métricos y analizar el efecto del error interobservador sobre las distancias biológicas calculadas. Con este fin, se analizó una muestra arqueológica procedente del Valle inferior del Río Negro -10 con deformación pseudocircular y 10 con deformación planolámbdica-. Se seleccionaron ocho variables discretas del cráneo que fueron relevadas por cuatro observadores. El error de observación fue evaluado mediante un diseño experimental de bloques aleatorios con tres repeticiones y el empleo del índice Kappa y la prueba de McNemar. La distancia biológica entre las dos muestras se estimó mediante la Medida Media de Divergencia y un análisis de escalamiento multidimensional. Los resultados obtenidos indican que el error intraobservador disminuyó mediante la aplicación del diseño experimental, que el error interobservador se incrementó en las sucesivas series y que las diferencias entre los observadores alteraron los resultados de las medidas de distancia calculadas entre las muestras.Since the early 1960s, there was an increasing interest in the application of non-metric cranial traits to the analysis of relationships between populations. One of the assumptions for the use of these traits is based upon the simplicity to standardize the recordings. However, several papers suggest that the interobserver error on such recordings is high. Therefore, the goals of this paper are to evaluate the intra and interobserver error on the scoring of non-metric cranial traits, as well as to analyze the effect of the interobserver error in the biological distances estimated with them. An archeological sample (n=20) from the lower stretch Valley of Río Negro Valley (Río Negro Province, Argentina) was analyzed. Eight discrete variables from the skull were recorded independently by four observers. The observation error was evaluated by means of a randomized complete blocks design, with three repetitions, and employing the Kappa index and the McNemar test. The biological distance between the two samples was estimated through the Mean Measure of Divergence and a multidimensional scaling test. Our results indicate that 1) the intraobserver error diminishes with the application of observational designs; 2) the interobserver error increases in successive series and; 3) the differences among observers modify the results of calculated biodistance between samples.Asociación de Antropología Biológica de la República Argentina (AABRA