Determinación de agentes etiológicos bacterianos de la úlcera corneal en Canis familiaris de Trujillo, 2020

En el presente trabajo de investigación con el objetivo de determinar los agentes etiológicos bacterianos implicados en la infección de la úlcera corneal en caninos de Trujillo, se tomaron 27 perros durante el periodo comprendido entre noviembre – marzo 2020, bajo los criterios de inclusión: cualquier rango de edad, raza, sexo, confirmados con úlcera corneal mediante la prueba de fluoresceína y con antecedentes de la patología. Fueron examinados y muestreados para determinar el agente bacteriano mediante tinción Gram y crecimiento en cultivos microbiológicos, además se evaluaron las variables sexo, edad, raza, convivencia con otros animales, gravedad, ojo afectado, signos clínicos, y alteraciones que influencian la presentación de esta patología. Se obtuvieron 44 aislamientos en total, siendo Staphylococcus sp. (38%), la especie bacteriana aislada con mayor frecuencia. Los perros adultos (51.7%), de raza (65%), machos (62%), que convivían con otros animales (72%), con lesión unilateral (44%), triquiasis (63%), blefaritis (60%), conjuntivitis (53%) y gravedad profunda (47%) fueron los hallazgos más frecuentes. La prueba de Chi cuadrado determinó asociación de la gravedad superficial con signos clínicos de epifora (p=0.009), hipopión (p=0.000), edema (p=0.000), dolor (p=0.026) y uveítis (p=0.045); y, la gravedad profunda con epifora (p=0.035), hipopión (p=0.001), fotofobia (p=0.031), edema (p=0.002) y uveítis (p=0.045). Se concluye que Staphylococcus sp. es el agente bacteriano más frecuente de la úlcera corneal, manifestada en canes adultos, de raza, machos, que convivían con otros animales, con alteraciones como triquiasis, conjuntivitis y blefaritis. Así mismo, asociación significativa entre el signo clínico de dolor y la gravedad superficial, y fotofobia para la gravedad profunda. Siendo epifora, hipopión, edema, y uveitis, asociados para ambas presentaciones de gravedad.In the present research work with the objective of determining the bacterial etiological agents involved in corneal ulcer infection in canines from Trujillo, 27 dogs were taken during the period between November - February 2020, under the inclusion criteria: any range of age, race, sex, confirmed with corneal ulcer by means of the fluorescein test and with a history of the pathology. They were examined and sampled to determine the bacterial agent by Gram staining and growth in microbiological cultures, in addition the variables sex, age, breed, living with other animals, severity, affected eye, clinical signs, and alterations that influence the presentation of this disease were evaluated. pathology. A total of 44 isolates were obtained, with Staphylococcus sp. (38%), the most frequently isolated bacterial species. Adult dogs (51.7%), purebred (65%), males (62%), living with other animals (72%), with unilateral lesion (44%), trichiasis (63%), blepharitis (60 %), conjunctivitis (53%) and deep ulcer (47%) were the most frequent findings. The Chi-square test determined the association of superficial severity with clinical signs of epiphora (p=0.009), hypopyon (p=0.000), edema (p=0.000), pain (p=0.026) and uveitis (p=0.045); and deep severity with epiphora (p=0.035), hypopyon (p=0.001), photophobia (p=0.031), edema (p=0.002) and uveitis (p=0.045). It is concluded that Staphylococcus sp. It is the most frequent bacterial agent of corneal ulcer, manifested in adult, purebred, male dogs that lived with other animals, with alterations such as trichiasis, conjunctivitis, and blepharitis. Likewise, significant association between the clinical sign of pain and superficial severity, and photophobia for deep severity. Being epiphora, hypopyon, edema, and uveitis, associated for both presentations of severity.Tesi

Diversidad y composición florística de un área de bosque de terrazas en la comunidad nativa aguaruna Huascayacu, en el Alto Mayo, San Martín - Perú

Universidad Nacional Agraria La Molina. Facultad de Ciencias Forestales. Departamento Académico de Manejo ForestalSe estableció una parcela permanente de 1 ha (100m x 100m) en Bosque Premontano Tropical en zona de Terrazas; en la Comunidad Nativa Aguaruna Huascayacu, en el Alto Mayo, departamento de San Martín; a partir de ella, se estudió la Diversidad arbórea, Composición Florística y Estructura preliminar del Bosque; para ello se marcaron, midieron, colectaron e identificaron todos los árboles con dap 10 cm. También se hizo una recopilación de la información existente sobre parcelas de 1 ha, levantadas en Bosque Húmedo Tropical de Sudamérica, usando similar metodología y se buscó la relación existente entre la Diversidad Alfa precipitación, estacionalidad de precipitación y la altitud. Se encontró un total de 131 especies (Diversidad Alfa), 552 individuos, 33 familias y 61 géneros. Las familias más abundantes encontradas son: Lauraceae, Arecaceae y Burseraceae; las 5 especies más abundantes son Wendlandiella sp. (Arecaceae), Socratea exorrhiza (Arecaceae), Nectandra longifolia (Lauraceae), Protium sp.2 (Burseraceae) y Nectandra lineatifolia (Lauraceae). La distribución por categorías diamétricas presentó la característica forma de “J” invertida, el área basal promedio 18,34 m2/ha. Se observó, que para las parcelas estudiadas, la relación existente entre la diversidad alfa y la precipitación total anual no es predecible; en cuanto a la relación de estacionalidad de precipitación con diversidad alfa, se puede decir que existe una relación inversa entre ambas variables, a mayor estacionalidad de precipitación, el número de especies tiende a disminuir; por otro lado, para los plots estudiados, se observa que a medida que aumenta la altitud, el número de especies disminuye; así, plots levantados en zonas bajas presentan entre 200 a más de 300 spp/ha, en altitudes entre los 500 a 1500 msnm el número de especies disminuye (80 -130 spp / ha);sin embargo, se observa que plots levantados en bosques montanos nublados ( 1600 – 2500 msnm) la diversidad aumenta (150 especies / ha ) comparados con los levantados en bosque premontanos.Tesi

Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: Results from the COVID-19 Global Rheumatology Alliance Vaccine Survey

BACKGROUND: We describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine. METHODS: From 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, beliefs and intent about discontinuing disease-modifying antirheumatic drugs (DMARDs) around the time of vaccination, and patient-reported adverse events after vaccination. RESULTS: We analysed 2860 adults with systemic rheumatic diseases who received COVID-19 vaccination (mean age 55.3 years, 86.7% female, 86.3% white). Types of COVID-19 vaccines were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%). The most common rheumatic disease was rheumatoid arthritis (42.3%), and 81.2% of respondents were on a DMARD. The majority (81.9%) reported communicating with clinicians about vaccination. Most (66.9%) were willing to temporarily discontinue DMARDs to improve vaccine efficacy, although many (44.3%) were concerned about rheumatic disease flares. After vaccination, the most reported patient-reported adverse events were fatigue/somnolence (33.4%), headache (27.7%), muscle/joint pains (22.8%) and fever/chills (19.9%). Rheumatic disease flares that required medication changes occurred in 4.6%. CONCLUSION: Among adults with systemic rheumatic disease who received COVID-19 vaccination, patient-reported adverse events were typical of those reported in the general population. Most patients were willing to temporarily discontinue DMARDs to improve vaccine efficacy. The relatively low frequency of rheumatic disease flare requiring medications was reassuring

Sobrepeso y obesidad pregestacional asociados a preeclampsia en la Micro Red Progreso - MINSA, 2018

Se realizó el presente estudio con el objetivo de determinar la relación entre el sobrepeso y la obesidad pregestacional como factor de riesgo asociados a preeclampsia. Se ejecutó una investigación de tipo observacional analítica, retrospectiva con diseño de caso control. La muestra estuvo conformada por 60 gestantes atendidas en la Microrred Progreso, los casos fueron 20 gestantes referidas al Hospital La Caleta por diagnóstico de preeclampsia y los controles 40 gestantes que culminaron su parto satisfactoriamente en el Centro de Salud. Se concluye que la obesidad y el sobrepeso son factores de riesgo para preeclampsia.Tesi

Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry : a retrospective cohort study

Funding Information: This study was funded by the American College of Rheumatology and the European League Against Rheumatism. The views expressed herein are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the American College of Rheumatology, the European Alliance of Associations for Rheumatology, the UK National Health Service, the NIHR, the UK Department of Health, or any other organisation. Patient research partners (KB and LN) were involved in the design, conduct, reporting and interpretation of the results of this study. Patient partners have participated in the development of this manuscript and are listed as coauthors. Funding Information: SES reports funding from a Vasculitis Clinical Research Consortium (VCRC)–Vasculitis Foundation Fellowship (the VCRC is part of the Rare Diseases Clinical Research Network, an initiative of the Office of Rare Diseases Research, National Center for Advancing Translational Science [NCATS], and is funded by a collaboration between NCATS and the National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIAMS; U54 AR057319]). RC reports speaker's fees from Janssen, Roche, Sanofi, and Abbvie outside the submitted work. CH received funding under a sponsored research agreement from Vifor Pharmaceuticals, outside the submitted work. SLM has received consulting fees from AbbVie; consulting fees from AstraZeneca; other from Roche-Chugai; consulting fees from Sanofi; and non-financial support from Roche, all outside the submitted work; and is a patron of the patient charity PMRGCAuk. PM is a Medical Research Council-GlaxoSmithKline (MRC-GSK) EMINENT clinical training fellow, who has received project funding from this organisation, outside the submitted work; has received funding from the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (UCLH BRC); reports grants from MRC-GSK; reports personal fees from Swedish Orphan Biovitrum and Lilly; and reports consultancy fees from Abbvie and Pfizer, all outside the submitted work. LN reports being a trustee of the charity PMR-GRA Scotland. JSA reports grants from the National Institute of Health (NIH) and NIAMS, the Rheumatology Research Foundation, the Brigham Research Institute, the R Bruce and Joan M Mickey Research Scholar Fund, and Amgen; grants and personal fees from Bristol-Myers Squibb; and personal fees from Gilead, Inova, Janssen, Optum, and Pfizer, all outside the submitted work. AD-G is supported by the US Centers for Disease Control and Prevention, the Rheumatology Research Foundation Scientist Development Award, the Robert D and Patricia E Kern Center for the Science of Health Care Delivery, and the Women's Health Career Enhancement Award outside the submitted work. KLH reports receiving speaker's fees from Abbvie; grant income from Bristol-Myers Squibb, UCB Pharma, and Pfizer, all outside the submitted work; and is supported by the NIHR Manchester Biomedical Research Centre outside the submitted work. RG reports non-financial support from Pfizer Australia and Janssen Australia; and personal fees from Pfizer Australia, Cornerstones, Janssen New Zealand, and Novartis, all outside the submitted work. UM-L is supported by grants from the German Ministry of Research and Education and the German Research Foundation outside the submitted work. MAG reports funding from the NIH and the NIAMS. PCR reports personal fees from Abbvie and Gilead; grants and personal fees from Janssen, Novartis, UCB Pharma, and Pfizer; non-financial support from Bristol-Myers Squibb and Pfizer; and personal fees from Lilly and Roche, all outside the submitted work. JY reports no competing interests related to this work; is supported by grants from NIH (K24 AR074534 and P30 AR070155); and reports consulting fees from Eli Lilly, Pfizer, Aurinia, and AstraZeneca, all outside the submitted work. PMM has received consulting or speaker's fees from Abbvie, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Roche, and UCB Pharma, all outside the submitted work (all <$10 000); and is supported by the NIHR UCLH BRC outside the submitted work. ES is a board member of the Canadian Arthritis Patient Alliance, which is a patient-run, volunteer-based organisation, whose activities are largely supported by independent grants from pharmaceutical companies. JWL reports grants from Pfizer, outside the submitted work. JSH reports no competing interests related to this work; is supported by grants from the Rheumatology Research Foundation; receives salary support from the Childhood Arthritis and Rheumatology Research Alliance; and reports consulting fees for Novartis, Swedish Orphan Biovitrum, and Biogen, all outside the submitted work (<$10 000). PS reports no competing interests related to this work, but reports receiving honorarium for editing social media for the American College of Rheumatology journals (<$10 000). SBh reports receiving non-branded consulting fees from AbbVie, Amgen, Horizon, Novartis, and Pfizer (<$10 000 from each)outside the submitted work. ZSW reports receiving grant support from Bristol-Myers Squibb and Principia-Sanofi; has consulted for Viela Bio and MedPace; and is supported by grants from the National Institutes of Health, all outside the submitted work. AS reports personal fees for lectures from AbbVie, Celltrion, Lilly, Merck Sharp & Dohme, Roche, Bristol-Myers Squibb, and Pfizer outside the submitted work. EFM has received grants from Abbvie, Novartis, Lilly Portugal, Amgen Biofarmacêutica, Grünenthal SA, Merck Sharp & Dohme, Medac, and A Menarini Portugal-Farmacêutica SA; grants and non-financial support from Pfizer; and non-financial support from Grünenthal, all outside the submitted work. LG reports research grants from Amgen, Galapagos, Janssen, Lilly, Pfizer, Sandoz, and Sanofi; consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Biogen, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, and UCB Pharma, all outside the submitted work. LC declares no competing interests related to this study, but her institute works by contract for laboratories among other institutions, such as Abbvie Spain, Eisai, Gebro Pharma, Merck Sharp & Dohme España SA, Novartis Farmaceutica, Pfizer, Roche Farma, Sanofi Aventis, Astellas Pharma, Actelion Pharmaceuticals España, Grünenthal, and UCB Pharma. NJP reports grants from NIH during the conduct of the study. MU-G reports grants from Pfizer and Janssen, outside the submitted work. SBa reports grants and personal fees from Alexion Pharma, outside the submitted work. RV reports grants from Novartis, Pfizer, and Bristol-Myers Squibb, outside the submitted work. All other authors declare no competing interests. Funding Information: This study was funded by the American College of Rheumatology and the European League Against Rheumatism. The views expressed herein are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the American College of Rheumatology, the European Alliance of Associations for Rheumatology, the UK National Health Service, the NIHR, the UK Department of Health, or any other organisation. Patient research partners (KB and LN) were involved in the design, conduct, reporting and interpretation of the results of this study. Patient partners have participated in the development of this manuscript and are listed as coauthors. Publisher Copyright: © 2021 Elsevier LtdBackground: Patients with primary systemic vasculitis or polymyalgia rheumatica might be at a high risk for poor COVID-19 outcomes due to the treatments used, the potential organ damage cause by primary systemic vasculitis, and the demographic factors associated with these conditions. We therefore aimed to investigate factors associated with COVID-19 outcomes in patients with primary systemic vasculitis or polymyalgia rheumatica. Methods: In this retrospective cohort study, adult patients (aged ≥18 years) diagnosed with COVID-19 between March 12, 2020, and April 12, 2021, who had a history of primary systemic vasculitis (antineutrophil cytoplasmic antibody [ANCA]-associated vasculitis, giant cell arteritis, Behçet's syndrome, or other vasculitis) or polymyalgia rheumatica, and were reported to the COVID-19 Global Rheumatology Alliance registry were included. To assess COVID-19 outcomes in patients, we used an ordinal COVID-19 severity scale, defined as: (1) no hospitalisation; (2) hospitalisation without supplemental oxygen; (3) hospitalisation with any supplemental oxygen or ventilation; or (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios (ORs), adjusting for age, sex, time period, number of comorbidities, smoking status, obesity, glucocorticoid use, disease activity, region, and medication category. Analyses were also stratified by type of rheumatic disease. Findings: Of 1202 eligible patients identified in the registry, 733 (61·0%) were women and 469 (39·0%) were men, and their mean age was 63·8 years (SD 17·1). A total of 374 (31·1%) patients had polymyalgia rheumatica, 353 (29·4%) had ANCA-associated vasculitis, 183 (15·2%) had giant cell arteritis, 112 (9·3%) had Behçet's syndrome, and 180 (15·0%) had other vasculitis. Of 1020 (84·9%) patients with outcome data, 512 (50·2%) were not hospitalised, 114 (11·2%) were hospitalised and did not receive supplemental oxygen, 239 (23·4%) were hospitalised and received ventilation or supplemental oxygen, and 155 (15·2%) died. A higher odds of poor COVID-19 outcomes were observed in patients who were older (per each additional decade of life OR 1·44 [95% CI 1·31–1·57]), were male compared with female (1·38 [1·05–1·80]), had more comorbidities (per each additional comorbidity 1·39 [1·23–1·58]), were taking 10 mg/day or more of prednisolone compared with none (2·14 [1·50–3·04]), or had moderate, or high or severe disease activity compared with those who had disease remission or low disease activity (2·12 [1·49–3·02]). Risk factors varied among different disease subtypes. Interpretation: Among patients with primary systemic vasculitis and polymyalgia rheumatica, severe COVID-19 outcomes were associated with variable and largely unmodifiable risk factors, such as age, sex, and number of comorbidities, as well as treatments, including high-dose glucocorticoids. Our results could be used to inform mitigation strategies for patients with these diseases. Funding: American College of Rheumatology and the European Alliance of Associations for Rheumatology.publishersversionPeer reviewe

Giant Cell Arteritis and COVID-19: Similarities and Discriminators. A Systematic Literature Review

OBJECTIVE: To identify shared and distinct features of giant cell arteritis (GCA) and Coronavirus disease 2019 (COVID-19) to reduce diagnostic error that could cause delays in correct treatment. METHODS: Two systematic literature reviews determined the frequency of clinical features of GCA and COVID-19 in published reports. Frequencies in each disease were summarised using median and range. RESULTS: Headache was common in GCA but was also observed in COVID-19 (66% for GCA, 10% for COVID-19). Jaw claudication or visual loss (43% and 26% in GCA, respectively) were not reported in COVID-19. Both diseases featured fatigue (38% for GCA, 43% for COVID-19) and elevated inflammatory markers (CRP elevated in 100% of GCA, 66% of COVID-19), but platelet count was elevated in 47% of GCA but 4% of COVID-19. Cough and fever were commonly reported in COVID-19 and less frequently in GCA (cough, 63% for COVID-19 versus 12% for GCA; fever, 83% for COVID-19 versus 27% for GCA). Gastrointestinal upset was occasionally reported in COVID-19 (8%), rarely in GCA (4%). Lymphopenia was more common in COVID-19 than GCA (53% in COVID-19, 2% in GCA). Alteration of smell and taste been described in GCA but their frequency is unclear. CONCLUSION: Overlapping features of GCA and COVID-19 include headache, fever, elevated CRP and cough. Jaw claudication, visual loss, platelet count and lymphocyte count may be more discriminatory. Physicians should be aware of the possibility of diagnostic confusion. We have designed a simple checklist to aid evidence-based evaluation of patients with suspected GCA

Dr. Conway et al reply

We thank Sauret et al for their interest in our systematic literature review that explored potential diagnostic confusion between giant cell arteritis (GCA) and the coronavirus disease 2019 (COVID-19). This was a particularly important consideration during the early months of the COVID-19 pandemic, when community testing for SARS-CoV-2 was limited and diagnostic tests for GCA were restricted or unavailable due to redeployment of staff.</p

Clinical pathways for patients with giant cell arteritis during the COVID-19 pandemic: an international perspective

Giant cell arteritis, a common primary systemic vasculitis affecting older people, presents acutely as a medical emergency and requires rapid specialist assessment and treatment to prevent irreversible vision loss. Disruption of the health-care system caused by the COVID-19 pandemic exposed weak points in clinical pathways for diagnosis and treatment of giant cell arteritis, but has also permitted innovative solutions. The essential roles played by all professionals, including general practitioners and surgeons, in treating these patients have become evident. Patients must also be involved in the reshaping of clinical services. As an international group of authors involved in the care of patients with giant cell arteritis, we reflect in this Viewpoint on rapid service adaptations during the first peak of COVID-19, evaluate challenges, and consider implications for the future

A pragmatic randomized trial comparing tablet computer informed consent to traditional paper-based methods for an osteoporosis study

AbstractObjectiveMethods to improve informed consent efficiency and effectiveness are needed for pragmatic clinical trials. We compared informed consent using a tablet computer to a paper approach to assess comprehension and satisfaction of patients and clinic staff for a future osteoporosis clinical trial.MethodsNine community-based practices identified and recruited patients to compare the informed consent processes (tablet vs. paper) in a mock osteoporosis clinical trial. The tablet informed consent included an animation summarizing the trial, complete informed consent document, and questions to assess and reinforce comprehension of the study. Participants were women age ≥55 years with ≥1 year of alendronate use. We surveyed participants to assess comprehension and satisfaction and office staff for satisfaction and perceived time demands.ResultsThe nine practices enrolled 33 participants. There was not a significant difference in comprehension between the tablet vs. paper informed consent [mean (SD) tablet: 12.2 (1.0) vs. paper: 11.4 (1.7)]. Office staff preferred the tablet to the paper informed consent for identifying potential study participants (two-sided t-test p = 0.02) despite an increased perceived time spent to complete the tablet process [tablet: 28.3 min (SD 16.3) vs. paper: 19.0 min (SD 6.9); p = 0.08].ConclusionsAlthough, there were no significant differences in participant satisfaction and comprehension with the tablet informed consent compared to a paper informed consent, patients and office staff trended towards greater satisfaction with the tablet informed consent. Larger studies are needed to further evaluate the utility of electronic informed consent in pragmatic clinical trials