Factores clínicos e inmunológicos asociados a la nefritis lúpica en pacientes del noroeste de Colombia.

Este estudio transversal y multicéntrico investigó las características clínicas e inmunológicas asociadas con la nefritis lúpica en pacientes colombianos de Medellín. Se incluyeron treinta y nueve pacientes con nefritis lúpica y se compararon sus características con las de 100 pacientes con lupus eritematoso sistémico (LES) sin compromiso renal. Se realizó un análisis multivariado para evaluar los factores asociados con la nefritis lúpica. Los pacientes que desarrollaron nefritis presentaron, al inicio, más úlceras orales (41% vs. 21%, OR=3,1, IC95%: 1,3-7,5, p=0,01)y eritema malar (77% vs. 45%, OR=4,4, IC95%: 1,8-10,8, p=0,001) que aquellos pacientes sin nefropatía. La nefritis lúpica se observó en 77% de los casos durante el primer año de evolución del LES. La frecuencia de anticuerpos anti-ADN fue mayor en los pacientes con nefritis; sine mbargo, las diferencias no fueron significativas (83% vs. 64%, OR=2,57, IC95%:1,03-6,41,p=0,06). La presencia de otros anticuerpos (anti-Ro, anti-La, anti-RNP, anti-Sm y anticardiolipina)en el momento del diagnóstico fue similar en ambos grupos. El perfil de los autoanticuerpos permaneció sin modificación significativa durante el curso del LES. Los pacientes con nefritis lúpica presentaron una mayor prevalencia de hipertensión arterial (60% vs 10%, OR=13,7,IC95%: 5-37, p=0,00001) y dislipidemia (30% vs 7%, OR=8,1, IC95%: 2,5-27, p=0,0006) al inicio de la enfermedad que aquellos pacientes sin nefropatía. Los pacientes con nefritis lúpica requirieron más hospitalizaciones (>1) durante el curso de la enfermedad (89% vs 60%, OR=7,8,IC95%: 2,1-29, p=0,002). En conclusión, la nefritis lúpica se presenta tempranamente en el LES. El eritema malar, las úlceras orales, la hipertensión arterial y la dislipidemia son factores asociados. A su vez, la nefritis lúpica es un factor de riesgo de hospitalizaciones repetidas. Este estudio puede ser útil en la toma de decisiones de políticas de salud para beneficio de los pacientes y reducción de costos.A cross-sectional and multicenter study was undertaken to analyze the clinical andimmunological characteristics at diagnosis associated with nephritis in northwesternColombian patients with systemic lupus erythematosus (SLE). Thirty nine patients with lupusnephritis were included and were compared to 100 SLE patients without nephritis. A multivariateanalysis was performed. The patients who developed nephritis had a higher frequency of oralulcers (41% vs. 21%, OR=3.1, 95%CI: 1.3-7.5 p= 0.01) and malar erythema (77% vs. 45%,OR=4.4, 95%CI: 1.8-10.8 p=0.001). Lupus nephritis was observed in 77% of cases during thefirst year of the disease. The frequency of anti-DNA antibodies was higher in patients withnephritis, however, differences were not statistically significant (83% vs 64%, OR=2.6, 95%CI:1.03-6.41, p=0.06). The presence of other autoantibodies (anti-Ro, anti-La, anti-RNP, anti-Smand anticardiolipin) at diagnosis was similar in both groups. This autoantibody profile remainedunchanged throughout the evolution of the disease. Patients with lupus nephritis had a higherprevalence of arterial hypertension (60% vs 10%, OR=13.7, 95%IC: 5-37, p=0.00001) andhyperlipidemia (30% vs 7%, OR=8.1, 95%IC: 2.5-27, p=0.0006) at onset. Finally, patients withlupus nephritis required more hospitalizations (>1) over the course of disease (89% vs 60%,OR=7.8, 95%CI: 2.1–29, p=0.002). In conclusion, lupus nephritis appears early during thecourse of SLE. Malar erythema, oral ulcers, hypertension and hyperlipidemia at onset of diseaseare associated factors. Lupus nephritis is a major risk factor leading to repeatedhospitalizations. This study may help to assist in public health policies in our population inorder to improve patient outcomes while simultaneously reducing disease costs

Factores clínicos y epidemiológicos asociados con nefritis lúpica en pacientes del noroccidente colombiano

A cross-sectional and multicenter study was undertaken to analyze the clinical and immunological characteristics at diagnosis associated with nephritis in northwestern Colombian patients with systemic lupus erythematosus (SLE). Thirty-nine patients with lupus nephritis were included and were compared to 100 SLE patients without nephritis. A multivariate analysis was performed. The patients who developed nephritis had a higher frequency of oral ulcers (41% vs. 21%, OR = 3.1, 95% CI: 1.3-7.5 p = 0.01) and malar erythema (77% vs. 45%, OR = 4.4, 95% CI: 1.8-10.8 p = 0.001). Lupus nephritis was observed in 77% of cases during the first year of the disease. The frequency of anti-DNA antibodies was higher in patients with nephritis, however, differences were not statistically significant (83% vs 64%, OR = 2.6, 95% CI: 1.03-6.41, p = 0.06). The presence of other autoantibodies (anti-Ro, anti-La, anti-RNP, anti-Sm and anticardiolipin) at diagnosis was similar in both groups. This autoantibody profile remained unchanged throughout the evolution of the disease. Patients with lupus nephritis had a higher prevalence of arterial hypertension (60% vs 10%, OR = 13.7, 95% IC: 5-37, p = 0.00001) and hyperlipidemia (30% vs 7%, OR = 8.1, 95% IC: 2.5-27, p = 0.0006) at onset. Finally, patients with lupus nephritis required more hospitalizations (> 1) over the course of disease (89% vs 60%, OR = 7.8, 95% CI: 2.1-29, p = 0.002). In conclusion, lupus nephritis appears early during the course of SLE. Malar erythema, oral ulcers, hypertension and hyperlipidemia at onset of disease are associated factors. Lupus nephritis is a major risk factor leading to repeated hospitalizations. This study may help to assist in public health policies in our population in order to improve patient outcomes while simultaneously reducing disease costs.Este estudio transversal y multicéntrico investigó las características clínicas e inmunológicas asociadas con la nefritis lúpica en pacientes colombianos de Medellín. Se incluyeron treinta y nueve pacientes con nefritis lúpica y se compararon sus características con las de 100 pacientes con lupus eritematoso sistémico (LES) sin compromiso renal. Se realizó un análisis multivariado para evaluar los factores asociados con la nefritis lúpica. Los pacientes que desarrollaron nefritis presentaron, al inicio, más úlceras orales (41% vs. 21%, OR=3,1, IC95%: 1,3-7,5, p=0,01) y eritema malar (77% vs. 45%, OR=4,4, IC95%: 1,8-10,8, p=0,001) que aquellos pacientes sin nefropatía. La nefritis lúpica se observó en 77% de los casos durante el primer año de evolución del LES. La frecuencia de anticuerpos anti-ADN fue mayor en los pacientes con nefritis; sin embargo, las diferencias no fueron significativas (83% vs. 64%, OR=2,57, IC95%:1,03-6,41, p=0,06). La presencia de otros anticuerpos (anti-Ro, anti-La, anti-RNP, anti-Sm y anticardiolipina) en el momento del diagnóstico fue similar en ambos grupos. El perfil de los autoanticuerpos permaneció sin modificación significativa durante el curso del LES. Los pacientes con nefritis lúpica presentaron una mayor prevalencia de hipertensión arterial (60% vs 10%, OR=13,7, IC95%: 5-37, p=0,00001) y dislipidemia (30% vs 7%, OR=8,1, IC95%: 2,5-27, p=0,0006) al inicio de la enfermedad que aquellos pacientes sin nefropatía. Los pacientes con nefritis lúpica requirieron más hospitalizaciones (>1) durante el curso de la enfermedad (89% vs 60%, OR=7,8, IC95%: 2,1-29, p=0,002). En conclusión, la nefritis lúpica se presenta tempranamente en el LES. El eritema malar, las úlceras orales, la hipertensión arterial y la dislipidemia son factores asociados. A su vez, la nefritis lúpica es un factor de riesgo de hospitalizaciones repetidas. Este estudio puede ser útil en la toma de decisiones de políticas de salud para beneficio de los pacientes y reducción de costos

Guía de práctica clínica para la prevención, diagnóstico, tratamiento y rehabilitación de la falla cardiaca en población mayor de 18 años, clasificación B, C y D

La falla cardíaca es un síndrome clínico caracterizado por síntomas y signos típicos de insuficiencia cardíaca, adicional a la evidencia objetiva de una anomalía estructural o funcional del corazón. Guía completa 2016. Guía No. 53Población mayor de 18 añosN/

Multi-ancestry GWAS reveals excitotoxicity associated with outcome after ischaemic stroke

During the first hours after stroke onset, neurological deficits can be highly unstable: some patients rapidly improve, while others deteriorate. This early neurological instability has a major impact on long-term outcome. Here, we aimed to determine the genetic architecture of early neurological instability measured by the difference between the National Institutes of Health Stroke Scale (NIHSS) within 6 h of stroke onset and NIHSS at 24 h. A total of 5876 individuals from seven countries (Spain, Finland, Poland, USA, Costa Rica, Mexico and Korea) were studied using a multi-ancestry meta-analyses. We found that 8.7% of NIHSS at 24 h of variance was explained by common genetic variations, and also that early neurological instability has a different genetic architecture from that of stroke risk. Eight loci (1p21.1, 1q42.2, 2p25.1, 2q31.2, 2q33.3, 5q33.2, 7p21.2 and 13q31.1) were genome-wide significant and explained 1.8% of the variability suggesting that additional variants influence early change in neurological deficits. We used functional genomics and bioinformatic annotation to identify the genes driving the association from each locus. Expression quantitative trait loci mapping and summary data-based Mendelian randomization indicate that ADAM23 (log Bayes factor = 5.41) was driving the association for 2q33.3. Gene-based analyses suggested that GRIA1 (log Bayes factor = 5.19), which is predominantly expressed in the brain, is the gene driving the association for the 5q33.2 locus. These analyses also nominated GNPAT (log Bayes factor = 7.64) ABCB5 (log Bayes factor = 5.97) for the 1p21.1 and 7p21.1 loci. Human brain single-nuclei RNA-sequencing indicates that the gene expression of ADAM23 and GRIA1 is enriched in neurons. ADAM23, a presynaptic protein and GRIA1, a protein subunit of the AMPA receptor, are part of a synaptic protein complex that modulates neuronal excitability. These data provide the first genetic evidence in humans that excitotoxicity may contribute to early neurological instability after acute ischaemic stroke. Ibanez et al. perform a multi-ancestry meta-analysis to investigate the genetic architecture of early stroke outcomes. Two of the eight genome-wide significant loci identified-ADAM23 and GRIA1-are involved in synaptic excitability, suggesting that excitotoxicity contributes to neurological instability after ischaemic stroke.Peer reviewe

Investigación en Matemáticas, Economía, Ciencias Sociales y Agronomía

Cada trabajo del libro incluye conclusiones para los interesados en las temáticas aludidas y en ellos nos enteramos de aspectos como los siguientes: - El mayor incremento del precio de los insumos como el maíz, sorgo y en menor medida desperdicio de pan, en relación con el menor crecimiento del precio del ganado en pie, dará como consecuencia un desabasto de carne bovina. - El agua es un recurso primordial en las zonas áridas y semiáridas de México, en tanto que su aporte limita la producción de la agricultura. En este estudio se observó que el precio real del agua es muy bajo en relación a otras zonas agrícolas del mundo. - Hoy en día en el país se consumen alrededor de 718 mil barriles diarios de gasolinas, un aproximado de 113.7 millones de litros, una cantidad tan grande que nuestro país se ve en la necesidad de importar cerca del 39 % de las gasolinas que consumimos. - Los jaliscienses radicados en Estados Unidos tienen una mayor capacidad de financiamiento del bienestar en la entidad, que el propio gobierno de ese estado. - México continuará basando sus finanzas públicas y su política de desarrollo económico en la extracción de combustibles fósiles (petróleo). Este modelo acelerará el deterioro y agotamiento de los recursos naturales. -La importancia de la agricultura orgánica radica en que retoma los tres ámbitos de la sustentabilidad; el ámbito ambiental, el económico y el social. - Es fundamental motivar la organización de los productores de haba para que ellos puedan captar una mayor proporción de los altos márgenes de precios que los consumidores están dispuestos a pagar. - Las condiciones del clima afectan a la producción agraria. Debido al fenómeno de cambio climático, es necesario contar con herramientas informáticas que proporcionen información climatológica para poder tomar medidas preventivas a favor de una mayor cantidad y calidad de producción. La herramienta de software permite la consulta del clima por localidades evitando la necesidad de contar con una estación meteorológica

First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR)

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.Fil: Pons Estel, Bernardo A.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Bonfa, Eloisa. Universidade de Sao Paulo; BrasilFil: Soriano, Enrique R.. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cardiel, Mario H.. Centro de Investigación Clínica de Morelia; MéxicoFil: Izcovich, Ariel. Hospital Alemán; ArgentinaFil: Popoff, Federico. Hospital Aleman; ArgentinaFil: Criniti, Juan M.. Hospital Alemán; ArgentinaFil: Vásquez, Gloria. Universidad de Antioquia; ColombiaFil: Massardo, Loreto. Universidad San Sebastián; ChileFil: Duarte, Margarita. Hospital de Clínicas; ParaguayFil: Barile Fabris, Leonor A.. Hospital Angeles del Pedregal; MéxicoFil: García, Mercedes A.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Amigo, Mary Carmen. Centro Médico Abc; MéxicoFil: Espada, Graciela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Catoggio, Luis J.. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Sato, Emilia Inoue. Universidade Federal de Sao Paulo; BrasilFil: Levy, Roger A.. Universidade do Estado de Rio do Janeiro; BrasilFil: Acevedo Vásquez, Eduardo M.. Universidad Nacional Mayor de San Marcos; PerúFil: Chacón Díaz, Rosa. Policlínica Méndez Gimón; VenezuelaFil: Galarza Maldonado, Claudio M.. Corporación Médica Monte Sinaí; EcuadorFil: Iglesias Gamarra, Antonio J.. Universidad Nacional de Colombia; ColombiaFil: Molina, José Fernando. Centro Integral de Reumatología; ColombiaFil: Neira, Oscar. Universidad de Chile; ChileFil: Silva, Clóvis A.. Universidade de Sao Paulo; BrasilFil: Vargas Peña, Andrea. Hospital Pasteur Montevideo; UruguayFil: Gómez Puerta, José A.. Hospital Clinic Barcelona; EspañaFil: Scolnik, Marina. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Pons Estel, Guillermo J.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; Argentina. Hospital Provincial de Rosario; ArgentinaFil: Ugolini Lopes, Michelle R.. Universidade de Sao Paulo; BrasilFil: Savio, Verónica. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Drenkard, Cristina. University of Emory; Estados UnidosFil: Alvarellos, Alejandro J.. Hospital Privado Universitario de Córdoba; ArgentinaFil: Ugarte Gil, Manuel F.. Universidad Cientifica del Sur; Perú. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Babini, Alejandra. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cavalcanti, André. Universidade Federal de Pernambuco; BrasilFil: Cardoso Linhares, Fernanda Athayde. Hospital Pasteur Montevideo; UruguayFil: Haye Salinas, Maria Jezabel. Hospital Privado Universitario de Córdoba; ArgentinaFil: Fuentes Silva, Yurilis J.. Universidad de Oriente - Núcleo Bolívar; VenezuelaFil: Montandon De Oliveira E Silva, Ana Carolina. Universidade Federal de Goiás; BrasilFil: Eraso Garnica, Ruth M.. Universidad de Antioquia; ColombiaFil: Herrera Uribe, Sebastián. Hospital General de Medellin Luz Castro de Gutiérrez; ColombiaFil: Gómez Martín, DIana. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Robaina Sevrini, Ricardo. Universidad de la República; UruguayFil: Quintana, Rosana M.. Hospital Provincial de Rosario; Argentina. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Gordon, Sergio. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Fragoso Loyo, Hilda. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Rosario, Violeta. Hospital Docente Padre Billini; República DominicanaFil: Saurit, Verónica. Hospital Privado Universitario de Córdoba; ArgentinaFil: Appenzeller, Simone. Universidade Estadual de Campinas; BrasilFil: Dos Reis Neto, Edgard Torres. Universidade Federal de Sao Paulo; BrasilFil: Cieza, Jorge. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: González Naranjo, Luis A.. Universidad de Antioquia; ColombiaFil: González Bello, Yelitza C.. Ceibac; MéxicoFil: Collado, María Victoria. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Sarano, Judith. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Retamozo, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Sattler, María E.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gamboa Cárdenas, Rocio V.. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Cairoli, Ernesto. Universidad de la República; UruguayFil: Conti, Silvana M.. Hospital Provincial de Rosario; ArgentinaFil: Amezcua Guerra, Luis M.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Silveira, Luis H.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Borba, Eduardo F.. Universidade de Sao Paulo; BrasilFil: Pera, Mariana A.. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Alba Moreyra, Paula B.. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: Arturi, Valeria. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Berbotto, Guillermo A.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gerling, Cristian. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Gobbi, Carla Andrea. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gervasoni, Viviana L.. Hospital Provincial de Rosario; ArgentinaFil: Scherbarth, Hugo R.. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Brenol, João C. Tavares. Hospital de Clinicas de Porto Alegre; BrasilFil: Cavalcanti, Fernando. Universidade Federal de Pernambuco; BrasilFil: Costallat, Lilian T. Lavras. Universidade Estadual de Campinas; BrasilFil: Da Silva, Nilzio A.. Universidade Federal de Goiás; BrasilFil: Monticielo, Odirlei A.. Hospital de Clinicas de Porto Alegre; BrasilFil: Seguro, Luciana Parente Costa. Universidade de Sao Paulo; BrasilFil: Xavier, Ricardo M.. Hospital de Clinicas de Porto Alegre; BrasilFil: Llanos, Carolina. Universidad Católica de Chile; ChileFil: Montúfar Guardado, Rubén A.. Instituto Salvadoreño de la Seguridad Social; El SalvadorFil: Garcia De La Torre, Ignacio. Hospital General de Occidente; MéxicoFil: Pineda, Carlos. Instituto Nacional de Rehabilitación; MéxicoFil: Portela Hernández, Margarita. Umae Hospital de Especialidades Centro Medico Nacional Siglo Xxi; MéxicoFil: Danza, Alvaro. Hospital Pasteur Montevideo; UruguayFil: Guibert Toledano, Marlene. Medical-surgical Research Center; CubaFil: Reyes, Gil Llerena. Medical-surgical Research Center; CubaFil: Acosta Colman, Maria Isabel. Hospital de Clínicas; ParaguayFil: Aquino, Alicia M.. Hospital de Clínicas; ParaguayFil: Mora Trujillo, Claudia S.. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Muñoz Louis, Roberto. Hospital Docente Padre Billini; República DominicanaFil: García Valladares, Ignacio. Centro de Estudios de Investigación Básica y Clínica; MéxicoFil: Orozco, María Celeste. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Burgos, Paula I.. Pontificia Universidad Católica de Chile; ChileFil: Betancur, Graciela V.. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Alarcón, Graciela S.. Universidad Peruana Cayetano Heredia; Perú. University of Alabama at Birmingahm; Estados Unido

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Enfermedades reumáticas autoinmunes en la unidad de cuidados intensivos: experiencia de un hospital terciario de referencia y revisión de la literatura

Autoimmune rheumatic diseases (AIRD) are not uncommon in the general population and up to one third of hospitalized patients with AIRD may need admission to intensive care unit (ICU). This paper describes the causes of admission, the clinical features and outcome of 24 AIRD patients admitted to a medical ICU from a third level hospital. Thirteen patients had systemic lupus erythematosus (54.2%), three rheumatoid arthritis (12.5%), three pulmonary renal syndrome (12.5%), two dermatopolymyositis (8.3%), two scleroderma (8.3%) and one antiphospholipid syndrome (4.2%). The main causes for ICU admission were rheumatic disease flare-up (37.5%), infection (37.5%) and complications derived from rheumatic disease (29.1%). Mortality during ICU stay was 16.7% (four patients). Excluding shock requiring vasopressor support, no statistical difference was found between survivors and nonsurvivors; although there was a trend to higher test severity scores (APACHE II, ODIN) in nonsurvivors. Our results reveal a lower mortality rate in AIRD patients admitted to the ICU than reported previously. Severity scores such as APACHE II are predictors of mortality in patients with AIRD in the ICU

Lupus eritematoso sistémico en varones: un estudio de 107 pacientes latinoamericanos

Clinical and laboratory features were analyzed in 107 Latin American male patients with systemic lupus erythematosus (SLE) who were compared with a group of 1,209 Latin American female patients with SLE to determine the presence of gender-associated differences. Males had an increased prevalence of renal disease, vascular thrombosis, and the presence of anti-dsDNA antibodies, as well as the use of moderate to high doses of corticosteroids, compared with female SLE patients. Although there was no difference in mortality from all causes, SLE-related mortality was higher in the male group. All these findings are consistent with a more severe disease in Latin American males than in female patients from the same region

Factores clínicos e inmunológicos asociados a la nefritis lúpica en pacientes del noroeste de Colombia.

Este estudio transversal y multicéntrico investigó las características clínicas e inmunológicas asociadas con la nefritis lúpica en pacientes colombianos de Medellín. Se incluyeron treinta y nueve pacientes con nefritis lúpica y se compararon sus características con las de 100 pacientes con lupus eritematoso sistémico (LES) sin compromiso renal. Se realizó un análisis multivariado para evaluar los factores asociados con la nefritis lúpica. Los pacientes que desarrollaron nefritis presentaron, al inicio, más úlceras orales (41% vs. 21%, OR=3,1, IC95%: 1,3-7,5, p=0,01)y eritema malar (77% vs. 45%, OR=4,4, IC95%: 1,8-10,8, p=0,001) que aquellos pacientes sin nefropatía. La nefritis lúpica se observó en 77% de los casos durante el primer año de evolución del LES. La frecuencia de anticuerpos anti-ADN fue mayor en los pacientes con nefritis; sine mbargo, las diferencias no fueron significativas (83% vs. 64%, OR=2,57, IC95%:1,03-6,41,p=0,06). La presencia de otros anticuerpos (anti-Ro, anti-La, anti-RNP, anti-Sm y anticardiolipina)en el momento del diagnóstico fue similar en ambos grupos. El perfil de los autoanticuerpos permaneció sin modificación significativa durante el curso del LES. Los pacientes con nefritis lúpica presentaron una mayor prevalencia de hipertensión arterial (60% vs 10%, OR=13,7,IC95%: 5-37, p=0,00001) y dislipidemia (30% vs 7%, OR=8,1, IC95%: 2,5-27, p=0,0006) al inicio de la enfermedad que aquellos pacientes sin nefropatía. Los pacientes con nefritis lúpica requirieron más hospitalizaciones (>1) durante el curso de la enfermedad (89% vs 60%, OR=7,8,IC95%: 2,1-29, p=0,002). En conclusión, la nefritis lúpica se presenta tempranamente en el LES. El eritema malar, las úlceras orales, la hipertensión arterial y la dislipidemia son factores asociados. A su vez, la nefritis lúpica es un factor de riesgo de hospitalizaciones repetidas. Este estudio puede ser útil en la toma de decisiones de políticas de salud para beneficio de los pacientes y reducción de costos.A cross-sectional and multicenter study was undertaken to analyze the clinical andimmunological characteristics at diagnosis associated with nephritis in northwesternColombian patients with systemic lupus erythematosus (SLE). Thirty nine patients with lupusnephritis were included and were compared to 100 SLE patients without nephritis. A multivariateanalysis was performed. The patients who developed nephritis had a higher frequency of oralulcers (41% vs. 21%, OR=3.1, 95%CI: 1.3-7.5 p= 0.01) and malar erythema (77% vs. 45%,OR=4.4, 95%CI: 1.8-10.8 p=0.001). Lupus nephritis was observed in 77% of cases during thefirst year of the disease. The frequency of anti-DNA antibodies was higher in patients withnephritis, however, differences were not statistically significant (83% vs 64%, OR=2.6, 95%CI:1.03-6.41, p=0.06). The presence of other autoantibodies (anti-Ro, anti-La, anti-RNP, anti-Smand anticardiolipin) at diagnosis was similar in both groups. This autoantibody profile remainedunchanged throughout the evolution of the disease. Patients with lupus nephritis had a higherprevalence of arterial hypertension (60% vs 10%, OR=13.7, 95%IC: 5-37, p=0.00001) andhyperlipidemia (30% vs 7%, OR=8.1, 95%IC: 2.5-27, p=0.0006) at onset. Finally, patients withlupus nephritis required more hospitalizations (>1) over the course of disease (89% vs 60%,OR=7.8, 95%CI: 2.1–29, p=0.002). In conclusion, lupus nephritis appears early during thecourse of SLE. Malar erythema, oral ulcers, hypertension and hyperlipidemia at onset of diseaseare associated factors. Lupus nephritis is a major risk factor leading to repeatedhospitalizations. This study may help to assist in public health policies in our population inorder to improve patient outcomes while simultaneously reducing disease costs