Ateroesclerosis carotídea en pacientes con artritis reumatoide y nódulos reumatoides

Objetivo: Determinar la asociación entre la presencia de nódulos reumatoides y el engrosamiento íntima media y placa de las arterias carótidas como marcador de ateroesclerosis. Material y métodos: Estudio observacional, transversal que incluyó 124 pacientes con artritis reumatoide del Servicio de Reumatología del Hospital Universitario “Dr. José Eleuterio González” atendidos del 2005 al 2006. La muestra se dividió en dos grupos de estudio, 62 con nódulos reumatoides y 62 sin nódulos reumatoides, pareados por edad y sexo. Se realizó historia clínica, velocidad de sedimentación globular, anti-CCP (Antipéptido Cíclico Citrulinado), factor reumatoide y ultrasonido doppler de alta resolución de carótidas. Resultados: 89.5% fueron mujeres. La prevalencia de placa carotídea fué 57% en nuestra población, superior a la reportada en la literatura, tanto en pacientes con artritis reumatoide de origen sajón (44%), como en sujetos controles sin artritis reumatoide (15%). La presencia de placa se asoció con edad, hipertensión arterial, presión sistólica y circunferencia abdominal. La media de engrosamiento intima media en pacientes con placa fue 0.08564 cm. (±0.02041). Ningún parámetro de laboratorio correlacionó con el engrosamiento de la íntima media carotídea. Conclusiones: No se encontró asociación entre los nódulos reumatoides y la presencia de placa carotídea y engrosamiento de la íntima media carotídea en pacientes con artritis reumatoide

Impact of a fall prevention program in the Internal Medicine wards of a tertiary care university hospital

Objective: To determine whether a falls prevention program reduces the incidence of falls within a hospital. Materials and methods: Each patient admitted to the Internal Medicine ward was classiied into a risk category (high, medium, low) according to the scale of J.H. Downton, and then various general and speciic measures were applied by risk group. Interventions included appointments, teaching materials, and training of medical staff and family. Furthermore, a registration system was developed that allowed adverse event fe edback to the program and identiicat ion of the causes of the fall. The SPSS version 20.0 was used for the data analysis. Descriptive analysis was used for quantitative variables, and qualitative variables were expressed as proportions. To compare the rate of pre- and post-program implementation falls, x 2 was used, with a = 0.05 determining a signiicant statistical value. Results: Since the implementation of the program, the rate of falls per 1000 days/patient decreased from 1.9 in 2007 to 0.67 in the period 2008-2013, representing a decrease of the rate of falls of up to 70%, with a statistically signiicant difference (P=.02). Conclusions: The implementation of a falls prevention program is an effective tool and reduces the rate and complications associated with them

Isolated HBsAg positivity in a Mexican patient with newly diagnosed lupus nephritis

Abstract Introduction: Hepatitis B surface antigen (HBsAg) is usually regarded as a marker of hepatitis B virus (HBV) infection. The concurrence of lupus nephritis (LN) and HBsAg-positivity is a challenge for the clinician, since immunosuppressant use may be associated with an increase in viral replication and an exacerbation of liver disease. Case presentation: Here, we describe the case of a 30-year-old Mexican woman with newly diagnosed focal proliferative LN who also tested repeatedly positive for HBsAg by chemiluminescent microparticle immunoassay (CMIA). She had no clinical features of hepatitis and her liver function tests were within normal limits. Her abdominal ultrasound was also normal. While waiting for further results, she was started on lamivudine (100 mg daily). However, total HBV core antibody test was negative. Owing to the infrequency of this serological pattern, an in vitro polymerase chain reaction (PCR) assay was performed and HBV was not detected. Overall, we interpreted these results as a false-positive screening. Methylprednisolone pulse therapy was subsequently given (1 g daily for three doses) without hepatic repercussion, neither clinically nor biochemically. Conclusions: Isolated HBsAg positivity may result from multiple causes, one of which is crossreactivity. To the best of our knowledge, this is the first report of a false-positive reading using CMIA technique in an active lupus patient. It is reasonable to stress that lupus patients with a positive screening for HBV should undergo a confirmatory assay (such as genomic detection), since this diagnosis may have important therapeutic implications. � 2016 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier. B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/

Salivary β2-microglobulin positively correlates with ESSPRI in patients with primary Sjögren's syndrome

Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disorder largely distinguished by lymphocytic exocrinopathy.1 Salivary and lachrymal glands are mainly impaired in pSS. Saliva is therefore considered an optimal biological fluid that closely reflects the underlying autoimmune exocrinopathy.1,2 For instance, in those wit

A β2‐microglobulina salivar se correlaciona positivamente com o ESSPRI em pacientes com síndrome de Sjögren primária

A síndrome de Sjögren primária (SSjP) é um transtorno autoimune sistêmico em grande parte distinguido pela exocrinopatia linfocítica.1 As glândulas salivares e lacrimais estão especialmente prejudicadas na SSjP. Portanto, considera-se que a saliva é o fluido biológico ideal para refletir fielmente a exocrinopatia autoimune subjacente.1,2 Por exemplo, em pessoas com SSjP, a 2-microglobulina (B2 M) está aumentada na saliva total.2 Essa proteína se correlaciona significativamente com a infiltrac¸ão linfocítica nas glândulas salivares labiais.3 O Eular Sjögren’s Syndrome Patient Reported Index (ESSPRI) é uma medida dos sintomas centrada no paciente. Recentemente mostrou-se que esse índice é válido, confiável e sensível a alterac¸ões em uma grande coorte de pacientes com SSj