El metotrexato: Uso, experiencia, necesidades y expectativas en las enfermedades reumáticas

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de Lectura: 13-01-2023Esta tesis tiene embargado el acceso al texto completo hasta el 13-07-2024En la actualidad, el metotrexato (MTX) es el fármaco antirreumático modificador de la enfermedad (FAME) más utilizado en reumatología, por su efectividad para el control sintomático, el retraso en el daño articular, su bajo coste y su buen perfil de seguridad. El MTX es un análogo estructural del ácido fólico que actúa inhibiendo competitivamente la enzima dihidrofolato reductasa (DHFR), la cual participa en la formación del ácido folínico que es necesario para la formación del nucleósido timidina, requerido para la síntesis de ADN, ARN, timidilatos y proteínas. El MTX actúa inhibiendo parcialmente el sistema inmunitario y, reduciendo la inflamación articular autoinmunitaria a largo plazo. El tratamiento con FAME ha de ser precoz e intenso en el control de la actividad inflamatoria, dentro de la denominada «ventana de oportunidad terapéutica», con un control estrecho del curso clínico (tight control) que permita un tratamiento dinámico para conseguir el objetivo, que debería ser la remisión clínica o, alternativamente, un estado de bajo nivel de actividad. Al cabo de un año, hasta la mitad de los pacientes con Artritis Reumatoide interrumpen el MTX y la adherencia y persistencia del MTX, medida con una amplia variedad de herramientas diferentes, parece muy variable. Para mejorar el tratamiento de la enfermedad, es esencial identificar los factores que provocan la falta de adherencia a los fármacos, puesto que, una adherencia inadecuada o deficiente reduce la eficacia del tratamiento, lo que puede dar lugar a complicaciones y al deterioro de la salud y el bienestar de los enfermos. El objetivo general de la tesis es conocer las necesidades no cubiertas de los pacientes con enfermedades reumáticas al inicio y durante la continuidad del tratamiento con MTX y sugerir posibles soluciones. Encontramos que el MTX subcutáneo presenta un perfil de seguridad y eficacia adecuado, con un nivel de adherencia variable, aunque la falta de un criterio estandarizado para la medida de adherencia dificulta su valoración. Para investigar las barreras y los facilitadores de la adherencia al MTX en personas con enfermedades reumáticas y explorar la experiencia de la toma de decisiones compartida se realizaron tres grupos focales que permitieron identificar 4 aspectos diferentes: 1)relacionados con el medicamento, 2)relativos a la relación médico paciente, 3)en relación al entorno social; y 4) aspectos prácticas de la propia administración del fármaco. Todos ellos podrían ayudar a mejorar la adherencia, incluyendo la información de calidad, especialmente sobre los eventos adversos, el papel del entorno y la toma de decisiones compartida. Para corroborar la validez de estos resultados, se realizó una encuesta online. De las respuestas obtenidas se corroboró que los pacientes en tratamiento con MTX por una enfermedad autoinmune demandan más información escrita o en la web de mejor calidad que la que se ofrece actualmente en sus clínicas. En base a toda la información recabada y su discusión se decidió la elaboración de una hoja de información al paciente, un listado de comprobación para el reumatólogo y un posible itinerario de la enfermedad del paciente, para que éste tome conciencia de la enfermedad crónica que presenta y la necesidad de tratamiento y controles periódicos que requier

Remote Interpreting Systems: Is All That Glitters Gold?

Los recientes avances en las tecnologías de la interpretación atraen cada vez más la atención de los investigadores y de los profesionales y el auge se ha producido tras las restricciones derivadas de la COVID-19. Aunque tradicionalmente los intérpretes no se han beneficiado de los avances tecnológicos como sí lo han hecho los traductores (Costa et al., 2018), marzo de 2020 supuso un punto de inflexión y, desde entonces, el mercado de la interpretación remota ha experimentado una gran evolución y transformación. Conscientes de que esta nueva forma de interpretación necesita de sistemas, de plataformas y de software para que los profesionales puedan llevar a cabo la mediación interlingüística, en este trabajo pretendemos obtener una aproximación de los principales sistemas de interpretación remota disponibles en el mercado desde la perspectiva de los intérpretes profesionales. En consecuencia, a partir de una muestra de sistemas de interpretación remota, basándonos para su selección en el criterio del uso, establecemos los parámetros de análisis para comprobar si estos sistemas se adecuan a las necesidades de los intérpretes profesionales. Evaluamos cada sistema de acuerdo a los parámetros establecidos, contrastamos los resultados y extraemos las conclusiones.Recent advances in interpreting technologies are increasingly attracting researchers and practitioners, which has rose after the restrictions from COVID-19. Although interpreters have not traditionally benefited from technological advances compared to translators (Costa et al., 2018), the remote interpreting market had a turning point in March 2020 and since then, has undergone a major evolution and transformation. In this context, this new way of interpreting needs systems, platforms, and software for professionals to carry out interlinguistic mediation. In this paper, we aim to obtain an approximation of the main remote interpreting systems available from the perspective of professional interpreters. Consequently, from a selection of remote interpreting systems based on the criterion of use, we establish the parameters of analysis to check if these systems meet the needs of professional interpreters. We evaluate each system according to the established parameters, compare the results and draw conclusions

Patients' perceptions on shared decision making during prescription of subcutaneous biological drug treatments for inflammatory arthritis: the RHEU-LIFE survey

Short report[Abstract] Objectives: The aim of this study was to explore the preferences of patients with rheumatic diseases and their perceived experience regarding participation in shared decision making (SDM) when they were prescribed a subcutaneous (SC) biological drug. Methods: A printed survey was handed to 1,000 patients with inflammatory rheumatic diseases treated with SC biological drug. The survey included closed questions about preferences regarding decision making and about patients' experience when they were prescribed an SC biological drug. Descriptive statistics were performed with stratification by patient profiles, using chi-square for comparisons between groups. Results: A total of 592 surveys were received (response rate 59.2%, mean age 51.7 years, 57.6% women). Some 28.2% of patients reported preferring to take part in treatment selection, a percentage that was higher in younger patients, in those with higher academic degree and in those who search information in sources different to that of health care professionals. Over half of patients (56.3%) perceived that the rheumatologist considered their opinion when prescribing an SC biological drug, a percentage higher in younger people. Only in 40.8% of cases did the patients' preference match their perception of their participation in the process. No differences were observed by sex, disease or number of biologics. Conclusions: Patients with inflammatory rheumatic diseases want information about their treatments but mostly leave the prescription decision to the rheumatologist. Younger people, or those with higher academic degree, more often want to participate in the SDM. There are discrepancies between patient preferences and perceptions of this process

Pure Membranous Lupus Nephritis: Description of a Cohort of 150 Patients and Review of the Literature

Objectives The course and long-term outcome of pure membranous lupus nephritis (MLN) are little understood. The aims of this study are to evaluate the clinical features, course, outcome and prognostic indicators in pure MLN and to determine the impact of ethnicity and the type of health insurance on the course and prognosis of pure MLN. Methods We conducted a retrospective review of medical records of 150 patients with pure MLN from Spain and the USA. Results Mean age was 34.2±12.5 and 80% were women. Sixty-eight percent of patients had nephrotic syndrome at diagnosis. The average serum creatinine was 0.98±0.78mg/dl. Six percent of patients died and 5.3% developed end-stage renal disease (ESRD). ESRD was predicted by male sex, hypertension, dyslipidemia, high basal 24h-proteinuria, high basal serum creatinine and a low basal creatinine clearance. Age, cardiac insufficiency, peripheral artheriopathy, hemodialysis and not having received mycophenolate mofetil or antimalarials for MLN predicted death. Conclusions Pure MLN frequently presents with nephrotic syndrome, high proteinuria and normal serum creatinine. Its prognosis is favourable in maintaining renal function although proteinuria usually persists over time. Baseline cardiovascular disease and not having a health insurance are related with poor prognosis

Pure Membranous Lupus Nephritis: Description of a Cohort of 150 Patients and Review of the Literature

Objectives The course and long-term outcome of pure membranous lupus nephritis (MLN) are little understood. The aims of this study are to evaluate the clinical features, course, outcome and prognostic indicators in pure MLN and to determine the impact of ethnicity and the type of health insurance on the course and prognosis of pure MLN. Methods We conducted a retrospective review of medical records of 150 patients with pure MLN from Spain and the USA. Results Mean age was 34.2±12.5 and 80% were women. Sixty-eight percent of patients had nephrotic syndrome at diagnosis. The average serum creatinine was 0.98±0.78mg/dl. Six percent of patients died and 5.3% developed end-stage renal disease (ESRD). ESRD was predicted by male sex, hypertension, dyslipidemia, high basal 24h-proteinuria, high basal serum creatinine and a low basal creatinine clearance. Age, cardiac insufficiency, peripheral artheriopathy, hemodialysis and not having received mycophenolate mofetil or antimalarials for MLN predicted death. Conclusions Pure MLN frequently presents with nephrotic syndrome, high proteinuria and normal serum creatinine. Its prognosis is favourable in maintaining renal function although proteinuria usually persists over time. Baseline cardiovascular disease and not having a health insurance are related with poor prognosis

Maria Zambrano: Razón poética, de honda raíz de amor

Tesis doctoral inédita, leída en la Universidad Autónoma de Madrid, Facultad de Filosofía y Letras, Departamento de Filosofía. Fecha de lectura: 26-6-200

Validation of electrodeposited 241Am alpha-particle sources for use in liquified gas detectors at cryogenic temperature

This paper describes a procedure for the validation of alpha-particle sources (exempt unsealed sources) to be used in experimental setups with liquefied gases at cryogenic temperatures (down to −196 °C) and high vacuum. These setups are of interest for the development and characterization of neutrino and dark matter detectors based on liquid argon, among others. Due to the high purity requirements, the sources have to withstand high vacuum and cryogenic temperatures for extended periods. The validation procedure has been applied to 241Am sources produced by electrodeposition

Prevalence and Incidence of Uveitis: A Systematic Review and Meta-analysis

Background: Although the impact of uveitis on people's lives is clear, the frequency of this condition is unclear.Objective: To estimate the prevalence and incidence of uveitis. Methods: A systematic review with meta-analysis was conducted. Medline, Embase, and Cochrane Library were searched from inception to January 2019. The quality of the included studies was critically appraised with a grading system based on the Oxford Levels of Evidence. A detailed description of the populations studied and of factors affecting estimates was undertaken. Pooled analyses were conducted using a random-effects approach and expressed as incidence rates per 100,000 with 95% confidence intervals. Subgroup analyses by geographical region were conducted along with meta-regression to analyze possible factors for heterogeneity. Results: A total of 49 studies were included and critically appraised. Twenty-two were population-based, and 27 hospital-based. Heterogeneity was substantial in terms of populations studied, methods for ascertaining uveitis, including definitions, and reporting of results. This was especially important in prevalence studies, with data ranging from 9 to 730 cases per 100,000. For incidence studies, the meta-analysis yielded a pooled incidence of 50.45 per 100.000. The meta-regression showed the geographic region as an important explanatory factor of the heterogeneity between studies. Conclusion: Population-based estimates of the epidemiology of uveitis vary widely, owing to methodologies employed, definitions of uveitis and geographical regions; the representativeness and generalizability of many epidemiological studies of uveitis are limited.Proyecto UveCAMSociedad de Reumatología de Castilla La Mancha (España)No data JCR 20210.776 SJR (2021) Q2, 42/128 OphthalmologyNo data IDR 2020UE