Examinando por Materia "Latin America"
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Publicación Acceso abierto Clinical and sociodemographic factors associated with lupus nephritis in Colombian patients: A cross-sectional study(Sociedad Española de Reumatología y del Colegio Mexicano de Reumatología, 2019-11-26) Díaz Coronado, Juan C.; Rojas Villarraga, Adriana; Hernández Parra, Deicy; Betancur Vásquez, Laura; Lacouture Fierro, Jorge; González Hurtado, Daniel; González Arango, Juanita; Uribe Arango, Laura; Gaviria Aguilar, María C.; Pineda Tamayo, Ricardo A.Introduction: Over the past decades, incidence of SLE (Systemic Lupus Erythematosus) has increased due to early case detection and improved survival of patients. SLE presents at an earlier age and has a more severe presentation in African-American, Native American, Asian, and Hispanic populations. Worldwide, lupus nephritis (LN) is observed in 29–60% of SLE patients, it has a negative impact in renal survival and patient mortality. Several cohorts have established potential risk factors associated with lupus nephritis, such as male sex, serological markers, and some extra-renal manifestations. Objectives: To describe sociodemographic, clinical, immunological, and environmental risk factors in Colombian SLE patients and to compare the population with and without nephritis, in order to establish risk factors and possible associations. Materials and methods: A total of 1175 SLE patients participated in this study. During medical care, an interview and structured survey was conducted and later registered in a database. Sociodemographic, clinical, immunological, and environmental exposure variables were analyzed. Bivariate and multivariate analyses were performed using presence of LN as an outcome. Results: Prevalence of LN was 38.7%. Variables significantly associated with LN included being male (OR 1.98), a duration of SLE > 10 years (OR 1.48), positive anti-DNA (OR 1.34), positive anti-Sm (OR 1.45), and smoking (OR 1.66). Being non-smoker was a protective factor (OR 0.52). Conclusion: This study describes potentialfactors associated with lupus nephritis in a LatinAmerican population. Smoking status could be a target for intervention as it is a modifiable risk factor. The association between being male and LN is observed in Latin-American populations such as presented here. Further research in other large-scale population studies and more efforts are needed to gain better insights to explicate these relationships.Publicación Acceso abierto Management of Neuroendocrine Tumors: A Meeting of Experts from Latin America(Clinical Neuroendocrinology and Neuroendocrine Tumors, 2008) Costa, F.; Domenichini, E.; Garavito, G.; Medrano, R.; Mendez, G.; O’Connor, J.; Rojas, W.; Torres, S.; Younes, R.N.; Delle Fave, G.; Öberg, K.A panel of experts from Latin America convened in Brazil, in May of 2007, for consensus recommendations regarding the management of neuroendocrine tumors (NETs) of the gastrointestinal tract and pancreas. The recently introduced World Health Organization classification of NETs represents a step forward, but the former classification of carcinoids into foregut, midgut and hindgut is still likely to be useful in the near future. Macroscopic description of the tumor should be followed by light microscopic examination and immunohistochemical staining, whereas other techniques might not be widely available in Latin America. Surgery remains the mainstay of treatment for patients with potentially curable tumors, and adequate selection is paramount in order to optimize treatment results. Regarding systemic therapy, patients with well-differentiated tumors or islet-cell carcinomas may be categorized as having indolent disease, while patients with poorly differentiated, anaplastic, and small-cell carcinomas, or with atypical carcinoids, may be approached initially as having aggressive disease. Somatostatin analogues play a cytostatic role in indolent tumors, and chemotherapy may play a role against other, more aggressive NETs. Obviously, there is an urgent need for novel therapies that are effective against NETs.Publicación Acceso abierto Musculoskeletal evaluation in severe haemophilia A patients from Latin America(The official journal of the World Federation of Hemophilia, 2014) Ozelo, Margareth Castro; Villaça, P. R.; Pérez-Bianco, R.; García Chávez, J.; Moreno-Rodríguez, B.; Rodrigues, M.B.; Rodríguez-Grecco, I.; Solano Trujillo, María Helena; Chumpitaz, G.; Morales‐Gana, M.M.; Ruiz‐Sáez, A.There is a paucity of literature on haemophilia treatment in Latin American countries, a region characterized by rapidly improving systems of care, but with substantial disparities in treatment between countries. The aim of this study was to evaluate the musculoskeletal status of haemophilia patients from Latin America and to examine the relationship between musculoskeletal status and treatment practices across countries. The Committee of Latin America on the Therapeutics of Inhibitor Groups conducted a survey of its member country representatives on key aspects of haemophilia treatment in 10 countries. Musculoskeletal status of patients was obtained during routine comprehensive evaluations between March 2009 and March 2011. Eligible patients had severe haemophilia A (factor VIII <1%) without inhibitors (<0.6 BU mL−1) and were ≥5 years of age. Musculoskeletal status was compared between three groups of countries, based primarily on differences in the availability of long‐term prophylaxis. Overall, 143 patients (5–66 years of age) were enrolled from nine countries. In countries where long‐term prophylaxis had been available for at least 10 years (Group A), patients aged 5–10 years had significantly better mean World Federation of Hemophilia clinical scores, fewer target joints and fewer affected joints than patients from countries where long‐term prophylaxis has been available for about 5 years (Group B) or was not available (Group C). In Latin America, the musculoskeletal status of patients with severe haemophilia without inhibitors has improved significantly in association with the provision of long‐term prophylaxis. As more countries in Latin America institute this practice, further improvements are anticipated.Publicación Acceso abierto Review of clinical non-medico-legal autopsy: a descriptive study in 747 patients(Autoridad de Medicina Forense de Egipto, 2018-12) Mendoza, Oscar; Bonilla, Juan Carlos; Moreno, Liliana; Piedrahita, Carolina; Mosquera, Andrés; Parra Medina, RafaelBackground: Autopsies have been an essential element to healthcare professionals’ training, as well as to research processes, education, and public health. In spite of the decline of clinical autopsy rate after the Joint Commission on the Accreditation of Hospitals eliminated the minimum autopsy rate required for accrediting hospitals, in Colombia, South America, we have seen that this practice has been reinitiated and our institution has performed more than 200 autopsies per year. Objective: To describe the main causes of death among individuals to whom a clinical autopsy was practiced at a general hospital in Bogotá, Colombia. Methods: A descriptive study of autopsy reports during the period between January 2012 and June 2015 was conducted. Results: The study included 747 autopsies of which 58.2% were performed in males. The majority of deaths occurred among the 41 to 64 years (mean 32.53, SD 28.53) age group. The leading cause of death observed in young adults and middle-aged adults (18 to 64 years) was cardiac arrest (58.5%) associated with acute myocardial infarction, cardiomyopathies, or cardiovascular abnormalities, followed by respiratory conditions (42.6%) and cardiac sudden death as the second cause of death in young adults. Conclusions: Studies based on clinical autopsies allow precise knowledge on the main underlying causes of death in a population, as well as, enable ideas based on key data obtained to be used in the development of cardiovascular prevention strategies for the different age groups thus preventing fatal outcomes in young adults who are the active working, productive population in society.Publicación Acceso abierto Subcutaneous abatacept in rheumatoid arthritis: A real-life experience(Elsevier BV, 2019-12) Sarmiento Monroy, Juan Camilo; Parada Arias, Luisa; Rodríguez López, Milena; Rodríguez Jiménez, Mónica; Molano González, Nicólas; Rojas Villarraga, Adriana; Mantilla, Rubén DaríoObjectives: To assess the effectiveness, safety, and drug survival of subcutaneous (SC) abatacept (ABA) in a cohort of rheumatoid arthritis (RA) patients in a real-world setting. Methods: This was a retrospective cohort study from 2014 to 2018 in which patients with RA (1987 ACR criteria) were included. Patients were evaluated at a single rheumatology outpatient center in Bogot a, Colombia. The patients were classified according to their treatment background: biological-naïve (n ¼ 65), switched from IV to SC ABA administration (125 mg-wk) (n ¼ 32), and inadequate response to biological DMARD (n ¼ 62). The pri- mary endpoint was a change in DAS28-CRP and RAPID3 from baseline to 12 months. A linear mixed effect model was used to correlate repeated measures. Adverse events were assessed and recorded during each visit to the rheumatology center. Several Cox proportional hazard regression models were used to test if there were any differences in drug survival curves based on seropositivity for rheumatoid factor (RF), and anti-Cyclic Citrulli- nated Peptide Antibodies (anti-CCP). Statistical analysis was done using software R version 3.4.4. Results: A total of 159 patients were included. Baseline characteristics of patients were as follows: female gender 84%, median age of 54 years (IQR 16), median disease duration 10 years (11), RF positive 96%, anti-CCP positive 89%, erosive disease 55%, median DAS28-CRP 5.0 (2), and median RAPID3 17 (10). Concomitant use of methotrexate and SC ABA monotherapy were reported at 52% and 30% respectively. Demographics and disease characteristics were similar for all groups, except for baseline DAS28-CRP, and RAPID3 in the group that switched route of administration. The interaction between time and group was significant (p ¼ 0.0073) for RAPID3. In- fections, constitutional symptoms, and headaches were the most frequent AEs. Retention rate corresponded to 60% at 48 months. The most frequent reason for drug suspension was loss of efficacy. Median time of treatment for SC ABA was 31 months (IQR 30). The only association that reached statistical significance was anti-CCP concentration [Q1–Q4] (p ¼ 0.005). According to the Cox proportional hazard regression model, there were significant differences between survival curves for Q1 (HR 0.15; 0.03–0.64 95% CI; p ¼ 0.0096), and Q2 (HR 0.28; 0.08–0.92 95% CI; p ¼ 0.0363) compared to the seronegative group. Conclusions: The results showed an improvement in RA disease activity and physical function in patients under SC ABA treatment. Patients switching from IV to SC administration of ABA had lower activity and functional impairment at baseline. SC ABA demonstrated a good safety profile consistent with previously published data. Patients with baseline levels of anti-CCP antibody concentrations had better drug survival than seronegative patients.