The disease specificity of antibodies to rheumatoid arthritis nuclear antigen (RANA) was examined by comparing anti-RANA titers in sera from 100 patients with rheumatoid arthritis (RA) with sera from ...93 healthy controls. Anti-RANA antibodies were found in 86% of the RA sera and 56% of the controls. The higher titers in the RA sera were unrelated to clinical features or to measurements of circulating immune complexes or rheumatoid factors. To study the relationship of these antibodies to previous Epstein-Barr virus (EBV) infection, antibodies to the EB virus capsid antigen (VCA) were examined and found in 94% of the RA sera and 97% of the adult controls. Four of the six RA sera without anti-VCA antibodies had detectable anti-RANA antibodies, so that we might suggest anti-RANA can arise in the absence of EBV infection. From absorption experiments with non-EBV transformed extracts, we inferred that high anti-RANA titers could be due to reactions with non-Epstein-Bar virus related nuclear antigens. These data cast doubt on current speculation about a possible pathogenic role for Epstein-Barr virus in this disease.
Se pretende averiguar si existe relación entre la calidad de la historia clínica (HC) de atención primaria y el control metabólico de pacientes con diabetes mellitus (DM).
Observacional, ...retrospectivo.
Quince centros de salud del Área de Segovia.
Un total de 315 pacientes diabéticos, seleccionados aleatoriamente entre los que tienen registro del tipo de DM, fecha y resultado de al menos una HbA1c y tratamiento en el momento de la última HbA1c.
Se mide la calidad de las HC por la media de registro, en los 13 meses anteriores a la última HbA1c, de los siguientes ítems: peso y talla, pulsos periféricos, sensibilidad, examen de los pies, creatinina, proteinuria, microalbuminuria, glucemias, fondo de ojo, ECG, consejo de dieta, tabaco y alcohol. Se recogen otras variables que pueden condicionar la HbA1c, patologías crónicas y patologías relacionadas con la DM. De los pacientes tratados con dieta o antidiabéticos orales (ADO), los de HC de calidad ≤ 49% presentan una HbA1c media de 7,40%, mientras los de HC de calidad ≥ 50% tienen una media de 6,94% (diferencia, 0,46; IC del 95%, 0,03-0,90; p = 0,038). Esta disminución no es atribuible a diferencias en edad, género, años de evolución o IMC. El riesgo de tener una HbA1c ≥ 7,5% es el doble en pacientes con HC de calidad ≤ 49%, que en los de HC de calidad ≥ 50% (OR, 2,06; IC del 95%, 1,14-3,72). En los tratados con insulina, no se ha demostrado asociación entre calidad de HC y HbA1c.
El seguimiento de las recomendaciones de actuación clínica se asocia a mejor control metabólico en diabéticos tratados con dieta-ADO. Esta asociación no se ha comprobado en los tratados con insulina.
To investigate whether there is a relationship between the quality of the clinical history (CH) in primary care and metabolic control of patients with diabetes (DM).
Retrospective and observational.
15 health centres in the Segovia Area.
315 diabetic patients, selected at random from among those with a record of the type of DM, date and outcome of at least one HbA1c and treatment at the time of the most recent HbA1c.
The quality of the clinical histories was measured through the mean of recording of the following items in the 13 months previous to the most recent HbA1c: weight and height, peripheral pulses, sensitivity, foot examination, creatinine, proteinuria, microalbuminuria, glucaemia levels, back of eye, ECG, and diet, tobacco and alcohol counselling. Other variables that could condition the HbA1c, chronic pathologies and those related to DM, were gathered too. Of patients treated with diet or oral diabetic drugs, patients with a clinical history of ≤ 49% quality had a mean HbA1c of 7.40%, whereas those with CH of ≥ 50% quality had an average of 6.94% (0.46 difference; 95% CI, 0.03-0.90; p = 0.038). This drop was not attributable to age, gender, years of evolution or BMI differences. The risk of having an HbA1c ≥ 7.5% is double in patients with a CH of ≤ 49% quality than in those with CH of ≥ 50% quality (OR = 2.06; 95% CI, 1.14-3.72). In insulin-treated patients, no association between CH quality and HbA1c was found.
Follow-up of the recommendations for clinical action is associated with better metabolic control in diabetics treated with diet - oral diabetic drugs. This association was not found in insulin-treated patients.
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