[Anesthesiologist's aptitude for peri-operative detection and treatment of latex allergy]

BACKGROUND: Latex allergy is the second cause of perioperative anaphylaxis. Anesthesiologists play a key role in opportune identification of risk factors, as well as clinical diagnosis and therapeutic management. OBJECTIVE: To evaluate the anesthesiologists aptitude to identify and treat latex allergy. PARTICIPANTS AND METHODS: Sixty-six anesthesiologists from five general hospitals located at Guadalajara, Jalisco, Mexico, were evaluated. Aptitude was determined by applying a validated structured instrument. Aptitude levels were measured by using an ordinal scale. Comparisons were performed using Mann Whitney U test. RESULTS: Anesthesiologist's global aptitude ranged from -2 to 27 with a median of 8 (from a maximum value in the scale of 40); frequencies by each category of the scale were: Random 48 (72.7%), Very bad 11 (16.7%), Bad 4 (6.1%) and Medium only 3 (4.5%). Both Good and Very good categories registered no anesthesiologist. The relationship of this indicator with other variables did not reach statistical significance (KW 6.478; p = 0.16617). CONCLUSIONS: A suboptimal aptitude was identified among anesthesiologists regarding identification of latex allergy. A need to establish new strategies for educative intervention in order to improve this issue was identified

Anesthesiologist's aptitude for pre-operative detection and treatment of latex allergy

Background: Latex allergy is the second cause of perioperative anaphylaxis. Anesthesiologists play a key role in opportune identification of risk factors, as well as clinical diagnosis and therapeutic management. Objective: To evaluate the anesthesiologists aptitude to identify and treat latex allergy. Participants and methods: Sixty-six anesthesiologists from five general hospitals located at Guadalajara, Jalisco, Mexico, were evaluated. Aptitude was determined by applying a validated structured instrument. Aptitude levels were measured by using an ordinal scale. Comparisons were performed using Mann Whitney U test. Results: Anesthesiologist's global aptitude ranged from -2 to 27 with a median of 8 (from a maximum value in the scale of 40); frequencies by each category of the scale were: Random 48 (72.7%), Very bad 11 (16.7%), Bad 4 (6.1%) and Medium only 3 (4.5%). Both Good and Very good categories registered no anesthesiologist. The relationship of this indicator with other variables did not reach statistical significance (KW 6.478; p = 0.16617). Conclusions: A suboptimal aptitude was identified among anesthesiologists regarding identification of latex allergy. A need to establish new strategies for educative intervention in order to improve this issue was identified

Anesthesiologist's aptitude for pre-operative detection and treatment of latex allergy

Background: Latex allergy is the second cause of perioperative anaphylaxis. Anesthesiologists play a key role in opportune identification of risk factors, as well as clinical diagnosis and therapeutic management. Objective: To evaluate the anesthesiologists aptitude to identify and treat latex allergy. Participants and methods: Sixty-six anesthesiologists from five general hospitals located at Guadalajara, Jalisco, Mexico, were evaluated. Aptitude was determined by applying a validated structured instrument. Aptitude levels were measured by using an ordinal scale. Comparisons were performed using Mann Whitney U test. Results: Anesthesiologist's global aptitude ranged from -2 to 27 with a median of 8 (from a maximum value in the scale of 40); frequencies by each category of the scale were: Random 48 (72.7%), Very bad 11 (16.7%), Bad 4 (6.1%) and Medium only 3 (4.5%). Both Good and Very good categories registered no anesthesiologist. The relationship of this indicator with other variables did not reach statistical significance (KW 6.478; p = 0.16617). Conclusions: A suboptimal aptitude was identified among anesthesiologists regarding identification of latex allergy. A need to establish new strategies for educative intervention in order to improve this issue was identified

[Anesthesiologist's aptitude for peri-operative detection and treatment of latex allergy]

BACKGROUND: Latex allergy is the second cause of perioperative anaphylaxis. Anesthesiologists play a key role in opportune identification of risk factors, as well as clinical diagnosis and therapeutic management. OBJECTIVE: To evaluate the anesthesiologists aptitude to identify and treat latex allergy. PARTICIPANTS AND METHODS: Sixty-six anesthesiologists from five general hospitals located at Guadalajara, Jalisco, Mexico, were evaluated. Aptitude was determined by applying a validated structured instrument. Aptitude levels were measured by using an ordinal scale. Comparisons were performed using Mann Whitney U test. RESULTS: Anesthesiologist's global aptitude ranged from -2 to 27 with a median of 8 (from a maximum value in the scale of 40); frequencies by each category of the scale were: Random 48 (72.7%), Very bad 11 (16.7%), Bad 4 (6.1%) and Medium only 3 (4.5%). Both Good and Very good categories registered no anesthesiologist. The relationship of this indicator with other variables did not reach statistical significance (KW 6.478; p = 0.16617). CONCLUSIONS: A suboptimal aptitude was identified among anesthesiologists regarding identification of latex allergy. A need to establish new strategies for educative intervention in order to improve this issue was identified

Clinical competence for autoimmune and non-autoimmune rheumatic disorders in primary care

Objective: To evaluate the competence of the primary care physicians for the evaluation of rheumatic disorders. Participants and methods: In a cross-sectional survey we included primary care physicians working at the official Mexican Social Security Institute that provides nation-wide health-care for salaried workers. Four hospitals from 23 potentially eligible primary-care hospitals in Guadalajara, Jalisco, Mexico, were randomly selected. From these hospitals the physicians who agree to participate were asked to answer a questionnaire for clinical competence. Using a Delphi modified approach; this questionnaire was elaborated by a group of rheumatologists and researchers working in continuous medical education. A Kuder-Richardson reliability index was computed in 0.94. The diseases included in the questionnaire were: 1) rheumatoid arthritis, 2) Sjögren syndrome, 3) gout, 4) osteoarthritis and 5) systemic lupus erythematosus and questions regarding to these were made using the technique of "representative patients". Domains included in the questionnaire were: assessment of risk factors, strategies for diagnosis, and treatment. According to the scores obtained in the questionnaire the ranges for clinical competence were: very high level 93-110 points, high level 75-92, moderate 57-74, low 39-56, very low 21-38 and <20 points was considered obtained by chance. Results: One-hundred and four primary care physicians were interviewed. From the total, 60 (58%) physicians had the speciality of family physician. Only 11% (95% CI 5-17) of the interviewed had a high level of competence according to the instrument. Moderate competence was achieved by 20% (95% CI 13-27), whereas suboptimal levels had 51%: being low 31% (95% CI 22-40), very low 20% (95% CI 13-27). An additional 18% had scores obtained by chance (95% CI 11-25). There was no statistical difference in the scores between physicians with or without the specialty in family medicine. Conclusions: These results pointed-out a sub-optimal competence in a significant proportion of the primary care-physicians attending rheumatic disorders. Higher efforts need to be made to increase the levels of competence and improve the effectiveness of continuous medical education for these physicians

Human papillomavirus infection in systemic rheumatic disorders: Current concepts, challenges and expectations

There is strong evidence that women with systemic rheumatic disorders, particularly systemic lupus erythematosus (SLE) have an increased risk for developing cervical cancer. Several epidemiological studies have shown causal relationship between human papilloma virus (HPV) infection and cervical neoplasia in general population, nevertheless; information about the impact of HPV infection in women with rheumatic disorders treated with immunosuppressive drugs or biologic therapy is still evolving. HPV infection is more frequently observed in some rheumatic systemic diseases mainly in SLE with relevant data available. Prevalence figures in SLE for HPV infection vary from 11.8% to 54%. Recently, our group reported in Mexican women with SLE, HPV infection is 14.7%, a figure that is important for Latin America where cervical cancer is highly prevalent. Longitudinal designs have been rarely performed; one study reported an increase in frequency of HPV infection from 12.5% to 25% after 3 years of follow-up. In SLE there is a high frequency of infection with several type of virus (around 17%), most of them considered as high-risk virus for cervical neoplasia. Data in African American women with SLE show that around 3% have high-grade squamous intraepithelial lesions (HSIL) and 1.2% cervical cancer. Epidemiological studies of HPV infection in other rheumatic diseases are infrequent; our group reported HPV infection in 31% of the rheumatoid arthritis (RA) patients, whereas others reported 3% in Sjögren syndrome. Although common risk factors such as age, occupation, lifetime sexual partners, other sexually transmitted co-infections, or early age at first intercourse, are related with HPV; in rheumatic disorders the association between HPV infection with utilization of immunosuppressive drugs or with longer duration of treatment with corticosteroids but with no disease activity is relevant. Some immune abnormalities induced by the treatment have been associated with an increased frequency of HPV, where lower levels of B lymphocytes and NK cells in peripheral blood are observed in SLE under treatment with immunosuppressive drugs. TNF-α is involved in signaling apoptosis in infected cells, participating in the inhibition of viral replication, therefore TNF inhibitors may theoretically increase the risk for persistent infection but data supporting this hypothesis are still insufficient. HPV immunization with recombinant vaccine is useful to prevent precancerous cervical lesions, although; some autoimmune adverse events have been developed after the vaccine application including Guillain-Barré, transverse myelitis, optic neuritis, multiple sclerosis or myasthenia gravis, and there are some rare case-reports of RA, SLE, mixed connective tissue disease, Sjogren syndrome, dermatomyositis and scleroderma developed after the vaccination. On counterpart, vaccination is safe in patients with inactive RA or SLE. No significant differences in seroconversion rates have been observed between users and non users of immunosuppressive drugs except for mycophenolate mofetil. In summary, HPV infection in rheumatic disorders is an exciting area for research and a future task is to design a clinical guide for preventive measures in these patients, as well as a strategy for follow-up and treatment in those patients who have HPV infection; particularly for those who receive immunosuppressive therapy or anti-TNF agents. © 2013 by Nova Science Publishers, Inc. All rights reserved

Clinical competence for autoimmune and non-autoimmune rheumatic disorders in primary care

Objective: To evaluate the competence of the primary care physicians for the evaluation of rheumatic disorders. Participants and methods: In a cross-sectional survey we included primary care physicians working at the official Mexican Social Security Institute that provides nation-wide health-care for salaried workers. Four hospitals from 23 potentially eligible primary-care hospitals in Guadalajara, Jalisco, Mexico, were randomly selected. From these hospitals the physicians who agree to participate were asked to answer a questionnaire for clinical competence. Using a Delphi modified approach; this questionnaire was elaborated by a group of rheumatologists and researchers working in continuous medical education. A Kuder-Richardson reliability index was computed in 0.94. The diseases included in the questionnaire were: 1) rheumatoid arthritis, 2) Sjögren syndrome, 3) gout, 4) osteoarthritis and 5) systemic lupus erythematosus and questions regarding to these were made using the technique of "representative patients". Domains included in the questionnaire were: assessment of risk factors, strategies for diagnosis, and treatment. According to the scores obtained in the questionnaire the ranges for clinical competence were: very high level 93-110 points, high level 75-92, moderate 57-74, low 39-56, very low 21-38 and <20 points was considered obtained by chance. Results: One-hundred and four primary care physicians were interviewed. From the total, 60 (58%) physicians had the speciality of family physician. Only 11% (95% CI 5-17) of the interviewed had a high level of competence according to the instrument. Moderate competence was achieved by 20% (95% CI 13-27), whereas suboptimal levels had 51%: being low 31% (95% CI 22-40), very low 20% (95% CI 13-27). An additional 18% had scores obtained by chance (95% CI 11-25). There was no statistical difference in the scores between physicians with or without the specialty in family medicine. Conclusions: These results pointed-out a sub-optimal competence in a significant proportion of the primary care-physicians attending rheumatic disorders. Higher efforts need to be made to increase the levels of competence and improve the effectiveness of continuous medical education for these physicians

Efficacy of methotrexate in ankylosing spondylitis: A randomized, double blind, placebo controlled trial

Objective. To evaluate the efficacy and safety of methotrexate (MTX) compared with placebo in patients with active ankylosing spondylitis (AS). Methods. This 24 week, double bind, randomized, placebo controlled trial compared the response between MTX 7.5 mg/week or placebo in patients with active AS. The primary outcome measure was a composite index of improvement in 5 of the following scales: severity of morning stiffness, physical well being, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S), and physician and patient global assessment of disease activity. Results. Seventeen patients received MTX and 18 placebo. In the intention-to-treat analysis at 24 weeks, 53% of patients in the MTX group had a treatment response, compared with 17% in the placebo group (p = 0.03). We observed significant improvements with MTX in physical well being (p = 0.009), BASDAI (p = 0.02), BASFI (p = 0.02), physician global assessment (p < 0.001), patient global assessment (p = 0.03), and HAQ-S (p = 0.02). In the adjusted analysis only MTX determined the improvement in the primary outcome. At the end of the trial, one patient with MTX withdrew due to a lack of compliance, and one with placebo due to a lack of efficacy. We did not observe significant differences in rates of side effects between the 2 groups. Conclusion. MTX is safe and effective for patients with AS. Longterm studies are needed to evaluate the permanence of its benefit

Efficacy of methotrexate in ankylosing spondylitis: A randomized, double blind, placebo controlled trial

Objective. To evaluate the efficacy and safety of methotrexate (MTX) compared with placebo in patients with active ankylosing spondylitis (AS). Methods. This 24 week, double bind, randomized, placebo controlled trial compared the response between MTX 7.5 mg/week or placebo in patients with active AS. The primary outcome measure was a composite index of improvement in 5 of the following scales: severity of morning stiffness, physical well being, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S), and physician and patient global assessment of disease activity. Results. Seventeen patients received MTX and 18 placebo. In the intention-to-treat analysis at 24 weeks, 53% of patients in the MTX group had a treatment response, compared with 17% in the placebo group (p = 0.03). We observed significant improvements with MTX in physical well being (p = 0.009), BASDAI (p = 0.02), BASFI (p = 0.02), physician global assessment (p < 0.001), patient global assessment (p = 0.03), and HAQ-S (p = 0.02). In the adjusted analysis only MTX determined the improvement in the primary outcome. At the end of the trial, one patient with MTX withdrew due to a lack of compliance, and one with placebo due to a lack of efficacy. We did not observe significant differences in rates of side effects between the 2 groups. Conclusion. MTX is safe and effective for patients with AS. Longterm studies are needed to evaluate the permanence of its benefit

Factors associated with permanent work disability in mexican patients with rheumatoid arthritis. A case-control study

Objective. To assess factors associated with permanent work disability (PWD) in Mexican subjects with rheumatoid arthritis (RA). Methods. From a database of 300 salaried workers with RA, we evaluated 35 cases that developed PWD. These cases were compared with 70 controls randomly selected from the same database who were active workers. The assessment included the following variables: sociodemographic, education, employment, and clinical characteristics of the disease. Logistic regression analysis was performed to adjust variables associated with PWD. Odds ratios and their 95% confidence intervals (95% CI) were computed. Results. Factors associated with PWD in the unadjusted analysis were: lower education level (OR 3.27, 95% CI 1.28-8.49, p = 0.006), > 2 year delay in prescription of a disease modifying antirheumatic drug (DMARD) (OR 4.29, 95% CI 1.49-12.73, p = 0.02), joint prosthesis (OR 8.93, 95% CI 2.02-45.04, p < 0.001), severe radiographic damage (OR 3.33, 95% CI 1.20-9.46, p = 0.01), comorbidity (OR 7.54, 95% CI 1.94-34.25, p < 0.001), and positive rheumatoid factor (RF) (OR 3.53, 95% CI 0.98-13.76, p = 0.03). In the multivariate model PWD was predicted by lower education (OR 3.3, 95% CI 1.1-9.7, p = 0.03), positive RF (OR 4.9, 95% CI 1.2-19.7, p = 0.03), and delay in the prescription of a DMARD (OR 3.3, 95% CI 1.1-10.1, p = 0.04). Conclusion. A low education level, positive RF, and delay in the use of DMARD are risk factors for PWD. Strategies to decrease rates of PWD should include an earlier treatment with DMARD