Factors influencing dry mouth in patients with primary Sjögren syndrome: usefulness of the ESSPRI index

To evaluate health-related quality of life in a large series of primary SS patients using the recently-proposed ESSPRI questionnaire and to evaluate the relationship between the intensity of oral dryness and other signs and symptoms frequently found in these patients. METHODS: We evaluated 90 primary SS patients seen consecutively; all fulfilled the current classification criteria. All patients completed the ESSPRI questionnaire. We compared the mean values of the ESSPRI-dry mouth item with other ESSPRI items related to sicca features, general symptoms, quality of life, quality of sleep, psychological and psychiatric features, extraglandular involvement, laboratory features and immunological markers and cardiovascular risk factors. Multivariate regression analysis with a backwards stepwise selection method was performed to identify those variables that were independently associated with dry mouth. RESULTS: Mean intensity of oral dryness measured by the corresponding ESSPRI item was 7.17±0.23. Oral dryness correlated with age both at diagnosis and at study inclusion (p=0.013), but not with gender or with time of disease evolution. No significant correlation was found with the SF-36, HAQ and FIQ questionnaires. We found a significant correlation between the intensity of oral dryness and the quality of sleep (p=0.001), anxiety and depression measured by the GH28 (p=0.004 and 0.024, respectively), and a statistically-significant trend for anxiety and depression measured by the HADS (p=0.08 and 0.07, respectively). No significant correlation was found with the main extraglandular and immunological features; however, a significant correlation between oral dryness and hypertension (p=0.019), type II diabetes mellitus (p=0.005) and hypercholesterolemia (p=0.011) was found. Multivariate regression analysis shows that fatigue measured by ESSPRI (p=0.049), sleep quality (p=0.008) and hypercholesterolemia (p=0.008) were independently associated with dry mouth. CONCLUSION: We report on the usefulness of the ESSPRI index in evaluating HRQOL associated with oral dryness in primary SS patients. Oral dryness correlated with age and the other sicca symptoms measured by ESSPRI, but not with the main systemic and immunological SS features. In contrast, oral dryness was strongly correlated with fatigue, pain, psychological distress, poor sleep and vascular risk factors. A multidisciplinary therapeutic approach may be the best way of minimizing oral dryness and its consequences in primary SS patient

La renovación de la palabra en el bicentenario de la Argentina : los colores de la mirada lingüística

El libro reúne trabajos en los que se exponen resultados de investigaciones presentadas por investigadores de Argentina, Chile, Brasil, España, Italia y Alemania en el XII Congreso de la Sociedad Argentina de Lingüística (SAL), Bicentenario: la renovación de la palabra, realizado en Mendoza, Argentina, entre el 6 y el 9 de abril de 2010. Las temáticas abordadas en los 167 capítulos muestran las grandes líneas de investigación que se desarrollan fundamentalmente en nuestro país, pero también en los otros países mencionados arriba, y señalan además las áreas que recién se inician, con poca tradición en nuestro país y que deberían fomentarse. Los trabajos aquí publicados se enmarcan dentro de las siguientes disciplinas y/o campos de investigación: Fonología, Sintaxis, Semántica y Pragmática, Lingüística Cognitiva, Análisis del Discurso, Psicolingüística, Adquisición de la Lengua, Sociolingüística y Dialectología, Didáctica de la lengua, Lingüística Aplicada, Lingüística Computacional, Historia de la Lengua y la Lingüística, Lenguas Aborígenes, Filosofía del Lenguaje, Lexicología y Terminología

La consulta ginecológica: un desafío para las mujeres lesbianas y bisexuales en Chile

L’objectiu del present estudi va ser indagar en les experiències de dones lesbianes i bisexuals a la consulta ginecològica, i conèixer si, donada la seva orientació sexual han viscut experiències de violència dins d’aquesta. A més, explorem les conseqüències que haurien generat per a elles aquestes experiències de violència ginecològica. Metodologia. Estudi de caràcter qualitatiu en el qual van participar 12 dones lesbianes i bisexuals, amb les quals es van efectuar entrevistes semiestructurades i que van ser analitzades mitjançant una anàlisi temàtica de contingut. Resultats. Es van produir tres categories fonamentals: experiència en la consulta, situacions de violència ginecològica i conseqüències d’aquesta violència. Conclusions. Les principals troballes mostren que a causa dels diferents biaixos i desinformació dins de la consulta, per part de mèdics/as, infermers/as i matrones/és, les dones s’abstindrien d’assistir a aquesta, la qual cosa podria generar conseqüències a futur en relació a la seva salut sexual. De la mateixa manera, les emocions dominants són de ràbia i molèstia a causa del que consideren un tracte discriminatori, avaluant la ginecologia com una disciplina heteronormada pensada per a dones cisgènere i que té un marcat èmfasi en la reproducció de les dones més que en la seva salut.The aim of this study was to investigate the experiences of lesbian and bisexual women within the gynecological consultation, and to find out if they have experienced violence within it given their sexual orientation. In addition, we investigated the consequences that these experiences of gynecological violence would have generated for them. In the qualitative study, 12 lesbian and bisexual women participated, with whom semi-structured interviews were conducted and which were analyzed through a thematic analysis. Three fundamental themes were extracted: experience in the consultation, situations of gynecological violence and consequences of violence in her lives. The main findings show that due to the different situations of discrimination and misinformation within the consultation, women would refrain from attending it, which could generate future consequences in relation to their sexual health. The primary findings reveal that as a result of various biases and misinformation present during the consultation by healthcare professionals, women might choose not to attend. This decision could potentially lead to future repercussions concerning their sexual health. Similarly, prevalent emotions such as anger and frustration stem from the perceived discriminatory treatment. The women assess gynecology as a heteronormative field designed for cisgender women, primarily focused on women’s reproduction rather than their overall well-being.El objetivo del presente estudio fue indagar en las experiencias de mujeres lesbianas y bisexuales en la consulta ginecológica y conocer si, dada su orientación sexual, han vivido experiencias de violencia dentro de esta. Además, exploramos las consecuencias que habrían generado para ellas dichas experiencias de violencia ginecológica. Metodología. Estudio de carácter cualitativo en el que participaron 12 mujeres lesbianas y bisexuales, con las cuales se efectuaron entrevistas semiestructuradas y que fueron analizadas mediante un análisis temático de contenido. Resultados. Se produjeron tres categorías fundamentales: experiencia en la consulta, situaciones de violencia ginecológica y consecuencias de dicha violencia. Conclusiones. Los principales hallazgos muestran que, debido a los diferentes sesgos y desinformación dentro de la consulta, por parte de médicos/as, enfermeros/as y matronas/es, las mujeres se abstendrían de asistir a esta, lo que podría generar consecuencias a futuro en relación con su salud sexual. Del mismo modo, las emociones dominantes son de rabia y molestia debido a lo que consideran un trato discriminatorio, evaluando la ginecología como una disciplina hetero-normada construida para mujeres cisgénero y que tiene un marcado énfasis en la reproducción de las mujeres más que en su salud

Factors influencing dry mouth in patients with primary Sjögren syndrome: usefulness of the ESSPRI index

To evaluate health-related quality of life in a large series of primary SS patients using the recently-proposed ESSPRI questionnaire and to evaluate the relationship between the intensity of oral dryness and other signs and symptoms frequently found in these patients. METHODS: We evaluated 90 primary SS patients seen consecutively; all fulfilled the current classification criteria. All patients completed the ESSPRI questionnaire. We compared the mean values of the ESSPRI-dry mouth item with other ESSPRI items related to sicca features, general symptoms, quality of life, quality of sleep, psychological and psychiatric features, extraglandular involvement, laboratory features and immunological markers and cardiovascular risk factors. Multivariate regression analysis with a backwards stepwise selection method was performed to identify those variables that were independently associated with dry mouth. RESULTS: Mean intensity of oral dryness measured by the corresponding ESSPRI item was 7.17±0.23. Oral dryness correlated with age both at diagnosis and at study inclusion (p=0.013), but not with gender or with time of disease evolution. No significant correlation was found with the SF-36, HAQ and FIQ questionnaires. We found a significant correlation between the intensity of oral dryness and the quality of sleep (p=0.001), anxiety and depression measured by the GH28 (p=0.004 and 0.024, respectively), and a statistically-significant trend for anxiety and depression measured by the HADS (p=0.08 and 0.07, respectively). No significant correlation was found with the main extraglandular and immunological features; however, a significant correlation between oral dryness and hypertension (p=0.019), type II diabetes mellitus (p=0.005) and hypercholesterolemia (p=0.011) was found. Multivariate regression analysis shows that fatigue measured by ESSPRI (p=0.049), sleep quality (p=0.008) and hypercholesterolemia (p=0.008) were independently associated with dry mouth. CONCLUSION: We report on the usefulness of the ESSPRI index in evaluating HRQOL associated with oral dryness in primary SS patients. Oral dryness correlated with age and the other sicca symptoms measured by ESSPRI, but not with the main systemic and immunological SS features. In contrast, oral dryness was strongly correlated with fatigue, pain, psychological distress, poor sleep and vascular risk factors. A multidisciplinary therapeutic approach may be the best way of minimizing oral dryness and its consequences in primary SS patient

Factors influencing dry mouth in patients with primary Sjögren syndrome: usefulness of the ESSPRI index

To evaluate health-related quality of life in a large series of primary SS patients using the recently-proposed ESSPRI questionnaire and to evaluate the relationship between the intensity of oral dryness and other signs and symptoms frequently found in these patients. METHODS: We evaluated 90 primary SS patients seen consecutively; all fulfilled the current classification criteria. All patients completed the ESSPRI questionnaire. We compared the mean values of the ESSPRI-dry mouth item with other ESSPRI items related to sicca features, general symptoms, quality of life, quality of sleep, psychological and psychiatric features, extraglandular involvement, laboratory features and immunological markers and cardiovascular risk factors. Multivariate regression analysis with a backwards stepwise selection method was performed to identify those variables that were independently associated with dry mouth. RESULTS: Mean intensity of oral dryness measured by the corresponding ESSPRI item was 7.17±0.23. Oral dryness correlated with age both at diagnosis and at study inclusion (p=0.013), but not with gender or with time of disease evolution. No significant correlation was found with the SF-36, HAQ and FIQ questionnaires. We found a significant correlation between the intensity of oral dryness and the quality of sleep (p=0.001), anxiety and depression measured by the GH28 (p=0.004 and 0.024, respectively), and a statistically-significant trend for anxiety and depression measured by the HADS (p=0.08 and 0.07, respectively). No significant correlation was found with the main extraglandular and immunological features; however, a significant correlation between oral dryness and hypertension (p=0.019), type II diabetes mellitus (p=0.005) and hypercholesterolemia (p=0.011) was found. Multivariate regression analysis shows that fatigue measured by ESSPRI (p=0.049), sleep quality (p=0.008) and hypercholesterolemia (p=0.008) were independently associated with dry mouth. CONCLUSION: We report on the usefulness of the ESSPRI index in evaluating HRQOL associated with oral dryness in primary SS patients. Oral dryness correlated with age and the other sicca symptoms measured by ESSPRI, but not with the main systemic and immunological SS features. In contrast, oral dryness was strongly correlated with fatigue, pain, psychological distress, poor sleep and vascular risk factors. A multidisciplinary therapeutic approach may be the best way of minimizing oral dryness and its consequences in primary SS patient

Severe, life-threatening phenotype of primary Sjögren's syndrome: Clinical characterisation and outcomes in 1580 patients (GEAS-SS Registry)

To analyse the clinical features and outcomes of patients presenting with life-threatening systemic disease in a large cohort of Spanish patients with primary Sjögren´s syndrome (SS).METHODS:The GEAS-SS multicentre registry was formed in 2005 with the aim of collecting a large series of Spanish patients with primary SS, and included more than 20 Spanish reference centres with substantial experience in the management of SS patients. By January 2018, the database included 1580 consecutive patients fulfilling the 2002 classification criteria for primary SS. Severe, life-threatening systemic disease was defined as an activity level scored as "high" in at least one ESSDAI domain.RESULTS:Among 1580 patients, 208 (13%) were classified as presenting a severe, potentially life-threatening systemic disease: 193 presented one ESSDAI domain classified as high, 14 presented two high scored domains and only one presented three high activity domains. The ESSDAI domains involved consisted of lymphadenopathy in 78 (37%) cases, CNS in 28 (13%), PNS in 25 (12%), pulmonary in 25 (12%), renal in 21 (10%), cutaneous in 19 (9%), articular in 18 (9%), haematological in 7 (3%) and muscular in 4 (2%). Patients with severe systemic disease were more frequently men (p=0.001) and had a higher frequency of anaemia (p<0.001), lymphopenia (p<0.001), rheumatoid factor (p=0.021), low C3 levels (p=0.015), low C4 levels (p<0.001) and cryoglobulins (p<0.001). From a therapeutic point of view, systemic patients received more frequently glucocorticoids (p<0.001), immunosuppressants (p<0.001), intravenous immunoglobulins (p=0.008) and rituximab (p<0.001). We found an overall mortality rate of 20% in severe systemic patients, a rate that reached to 33% in patients presenting two or more high systemic involvements; these patients had a higher frequency of low C4 levels (p=0.012) and cryoglobulins (p=0.001) in comparison with those with a single severe organ involved.CONCLUSIONS:13% of patients with primary SS develop a potentially life-threatening systemic disease (mainly lymphoma, but also severe internal organ involvements including nervous system, the lungs and the kidneys). This subset of patients requires intensive therapeutic management with a mortality rate of nearly 20% of cases.Fil: Chavez Flores, Alejandra Teresa. Hospital Clinic Barcelona; EspañaFil: Kostov, Belchin. Gesclinic. Centre d'Assistència Primària ABS; EspañaFil: Solans Laqué, Roser. Hospital Vall d'Hebron; EspañaFil: Fraile, Guadalupe. Hospital Ramón y Cajal. Systemic Autoimmune Diseases Unit; EspañaFil: Maure, Brenda. Complejo Hospitalario Universitario, Vigo; EspañaFil: Feijoo-Massó, Carlos. Hospital Parc Taulí. Systemic Autoimmune Diseases Unit; EspañaFil: Rascon, Francisco Javier. Hospital Son Espases. Systemic Autoimmune Diseases Unit; EspañaFil: Perez Alvarez, Roberto. Hospital Do Meixoeiro. Department of Internal Medicine; EspañaFil: Zamora, Mónica. Hospital Virgen de las Nieves; EspañaFil: García-Pérez, Alicia. Hospital Universitario Central de Asturias; EspañaFil: Lopez-Dupla, Miguel. Hospital Joan XXIII; EspañaFil: Duarte Millán, Miguel Ángel. Hospital de Fuenlabrada; EspañaFil: Ripoll, Mar. Hospital Infanta Sofía; EspañaFil: Fonseca, Eva. Hospital de Cabueñes; EspañaFil: Guisado, Pablo. Complejo Hospitalario Ruber Juan Bravo. Department of Internal Medicine; EspañaFil: Pinilla,Blanca. Hospital Gregorio Marañón; EspañaFil: De la Red, Gloria. Hospital Esperit Sant Santa Coloma de Gramenet. Systemic Autoimmune Diseases Unit; EspañaFil: Chamorro, Antonio J.. Hospital Universitario de Salamanca. Systemic Autoimmune Diseases Unit; EspañaFil: Morcillo, César. Hospital CIMA-Sanitas. Systemic Autoimmune Diseases Unit; EspañaFil: Fanlo, Patricia. Hospital Virgen del Camino de Pamplona. Systemic Autoimmune Diseases Unit; EspañaFil: Soto-Cárdenas, María José. University of Cadiz. Department of Medicine; EspañaFil: Retamozo, Maria Soledad. Hospital Clinic. Department Of Autoimmune Diseases; España. 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: Ramos Casals, Manuel. Hospital Clinic. Department Of Autoimmune Diseases; Españ

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care