Rheumatoid arthritis (RA) in elderly population represents a challenge for physicians in terms of therapeutic management. Methotrexate (MTX) is the first-line treatment among conventional ...synthetic-disease-modifying anti-rheumatic drugs (cs-DMARDs); however, it is often associated with adverse events (AEs). Therefore, the objective of this study was to identify the incidence and risk factors of MTX discontinuation due to AEs in elderly patients with RA in a long-term retrospective cohort study.
Clinical sheets from elderly RA patients taking MTX from an outpatient rheumatology consult in a university centre were reviewed. To assess MTX persistence, we used Kaplan-Meir curves and Cox regression models to identify the risk of withdrawing MTX due to adverse events.
In total, 198 elderly RA patients who reported using MTX were included. Of them, the rates of definitive suspension of MTX due to AEs were 23.0% at 5 years, 35.6% at 10 years and 51.7% at 15 years. The main organs and system involved were gastrointestinal (15.7%) and mucocutaneous (3.0%). Factors associated with withdrawing MTX due to AEs were MTX dose ≥ 15 mg/wk (adjusted HR: 2.46, 95% CI: 1.22-4.96,
0.012); instead, the folic acid supplementation was protective for withdrawal (adjusted HR: 0.28, 95% CI: 0.16-0.49,
0.001).
Higher doses of MTX increase the risk of withdrawals in elderly RA, while folic acid supplementation reduces the risk. Therefore, physicians working in therapeutic management for elderly patients using MTX must focus on using lower MTX doses together with the concomitant prescription of folic acid.
La empatia observada por los profesionales de la salud en ejercicio es el producto de la calidad de la formación empática recibida desde el comienzo de sus estudios. Tal entrenamiento es un problema ...que debe ser considerado desde los primeros años de pregrado. La calidad de la salud dental comunitaria depende, en parte, de la empatía de sus profesionales. El objetivo del estudio es determinar las propiedades psicométricas de la Escala de Empatía Médica en estudiantes de Odontología de América Latina y contribuir al desarrollo de un estándar regional para evaluar las puntuaciones de empatía. Fue realizado un estudio transversal y multicéntrico. Fueron seleccionados 4407 estudiantes de 18 Escuelas de Odontología de siete países latinoamericanos (República Dominicana, Costa Rica, Panamá, Colombia, Argentina, Perú y Chile). La empatía media alcanzó 108,53 puntos (DE= 15,05), mostrando las mujeres una mayor empatía que los hombres (p<0,001). La confiabilidad de la escala global fue adecuada: a de Cronbach= 0.81 y m de McDonald= 0,87. El análisis factorial confirmatorio valida el modelo de empatia de tres factores (x2/gl= 1089,28; CFI= 0,96; TLI= 0,95; RMSEA= 0,05). Se calcularon las puntuaciones de corte para establecer los niveles de empatía y se estableció un estándar regional construido para evaluar los puntajes de los estudiantes. Se concluye que la escala es válida y una medida confiable para evaluar la empatía en estudiantes de Odontología de Latinoamérica, con un poder de discriminación adecuado e invariancia de género.
This article aims to evaluate the sliding stability of a gravity dam with a foundation failure mechanism characterized by a pre-existing subhorizontal joint set acting as a sliding plane, and with a ...potential failure path that extends through the rock mass. The safety factor is estimated using a combination of joints and rock mass strengths, using the criteria of Barton and Choubey and Hoek and Brown, respectively. Nonassociative flow rule in the rock mass has been incorporated using a constant dilation angle. The finite difference program FLAC 6.0 is employed to validate the model. The proposed analytical model provides results that are very similar to those computed with FLAC; however, as the new formulation can be implemented in a spreadsheet, the computational cost of the proposed model is significantly smaller, hence allowing to more easily conduct parametric analyses of the influence of the different input parameters on the dam’s safety.
The use of complementary therapies is highly prevalent among patients with rheumatoid arthritis (RA). Nevertheless, the use of complementary medicine could involve problems in the following of ...scientifically accepted treatments. To date, there is limited information regarding the association of nonconventional therapies with problems regarding compliance with the treatment. Therefore, the objective of this study was to identify whether the utilization of complementary therapies is associated with a high risk of problems regarding therapeutic adherence to conventional synthetic disease-modifying anti-rheumatic drugs (cs-DMARDs) in RA patients. A survey was performed with RA patients in an outpatient rheumatology clinic in a university hospital; the use of complementary therapies, as well as their type, was identified. To assess problems with therapeutic adherence, we used the four-item Morisky-Green scale. A comprehensive assessment of clinical and therapeutic characteristics was performed. Univariable and multivariable models were performed to identify the risk of problems with therapeutic adherence in users of complementary therapies. In total, 250 RA patients were included; 92% used complementary therapies. Of them, the most frequently used were herbal medicine (65%), homeopathy (64%), and cannabis and its derivatives (51%). In the univariable logistic regression analysis, the factors associated with problems in the therapeutic adherence to cs-DMARDs were age (
= 0.019), the presence of other comorbidities (
= 0.047), and the use of complementary therapies (
= 0.042). After controlling for potential confounders, the use of complementary therapies increased the risk of problems with therapeutic adherence to cs-DMARDs (adjusted OR = 2.84, 95% CI = 1.06-7.63,
= 0.037). We concluded that the use of complementary therapies increases the risk of problems with therapeutic adherence. Therefore, for physicians and healthcare professionals, the early identification of the use of nonconventional therapies in their RA patients is required, followed by a directed discussion with their patients about the risks and benefits to which they could be exposed to complementary therapies.
Rapid and reliable diagnosis of endometrial cancer (EC) in uterine aspirates is highly desirable. Current sensitivity and failure rate of histological diagnosis limit the success of this method and ...subsequent hysteroscopy is often necessary. Using quantitative reverse transcriptase‐polymerase chain reaction on RNA from uterine aspirates samples, we measured the expression level of 20 previously identified genes involved in EC pathology, created five algorithms based on combinations of five genes and evaluated their ability to diagnose EC. The algorithms were tested in a prospective, double‐blind, multicenter study. We enlisted 514 patients who presented with abnormal uterine bleeding. EC was diagnosed in 60 of the 514 patients (12%). Molecular analysis was performed on the remnants of aspirates and results were compared to the final histological diagnoses obtained through biopsies acquired by aspiration or guided by hysteroscopy, or from the specimens resected by hysterectomy. Algorithm 5 was the best performing molecular diagnostic classifier in the case–control and validation study. The molecular test had a sensitivity of 81%, specificity of 96%, positive predictive value (PPV) of 75% and negative predictive value (NPV) of 97%. A combination of the molecular and histological diagnosis had a sensitivity of 91%, specificity of 97%, PPV of 79% and NPV of 99% and the cases that could be diagnosed on uterine aspirate rose from 76 to 93% when combined with the molecular test. Incorporation of the molecular diagnosis increases the reliability of a negative diagnosis, reduces the need for hysteroscopies and helps to identify additional cases.
What's new?
Many studies report biomarker discovery using omics approaches, but few survive the translation into clinically validated diagnostic assays. Using previously identified biomarkers, here the authors set to improve the early diagnosis of endometrial cancer (EC) based on minimally invasive samples: endometrial aspirates. Current sensitivity and failure rate of histological diagnosis limit the success of aspirate‐based diagnosis and subsequent hysteroscopy is often necessary. The authors developed and clinically validated a novel molecular test, which increases the efficacy, sensitivity and negative predictive value of aspirate‐based diagnosis and has the potential to reduce the average time and cost for EC diagnosis.
This study aimed to evaluate markers of the CLOCK gene rs1801260 and rs4864548 in Mexican adolescents, addressing clinical and biological aspects previously associated with ADHD. 347 Mexican ...adolescents were assessed for mental disorders, metabolic disruption and related conditions, circadian preference, as well as genotyping for the CLOCK. We found a significant association between ADHD and the AA and AG genotypes of rs1801260. Also, we identified in the ADHD group that the total Triiodothyronine and total Thyroxine values were respectively 10 ng/dl units and 0.58 ug/dl units lower in females than in males. Previously reported common variations of the CLOCK gene have been associated with ADHD like the Rs1801260 polymorphism hereby we could consider it as risk factor, but genetic, biochemical and clinical studies in the Mexican population are entailed.
The empathy observed by practicing health professionals is the product of the quality of empathic training received from the beginning of their studies. Such training is a problem that must be ...considered from the early undergraduate years. The quality of community dental health depends, in part, on the empathy of its professionals. The objective of the study is to determine the psychometric properties of the Jefferson Medical Empathy Scale in dental students from Latin America and to contribute to the development of a regional standard for evaluating empathy scores. A cross-sectional and multicentric study was carried out. We selected 4407 students from 18 dental schools from seven Latin American countries (Dominican Republic, Costa Rica, Panama, Colombia, Argentina, Peru and Chile). The mean empathy reached 108.53 points (SD= 15.05), with women showing greater empathy than men (p<0.001). The reliability of the global scale was adequate: Cronbach's a= 0.81 and McDonald's omega= 0.87. The confirmatory factor analysis validates the three-factor model of empathy (chi square/df= 1089.28, CFI= 0.96, TLI= 0.95, RMSEA= 0.05). Cut-off scores were calculated to establish levels of empathy and a regional standard was constructed to assess student scores. It is concluded that the scale is valid and a reliable measure to assess empathy in Latin American dental students, with adequate discrimination power and gender invariance.
The Cuban Twin Registry is a nation-wide, prospective, population-based twin registry comprising all zygosity types and ages. It was initiated in 2004 to study genetic and environmental contributions ...to complex diseases with high morbidity and mortality in the Cuban population. The database contains extensive information from 55,400 twin pairs enrolled in the period 2004-2006. Additionally, 2,600 new multiple births have been included from 2007 to date. In the past 4 years, more than 130 studies have been carried out using the registry with a classical genetic epidemiological approach in which concordance rates for monozygotic and dizygotic twins and heritability of various disease traits were estimated. This article summarizes the history, registry's methodology, recent research findings, and future directions of work.
Se realizó una investigación en sistemas y servicios de salud con diseño descriptivo, en el Policlínico de Camajuaní, Villa Clara, en el período comprendido entre agosto de 2006 y agosto de 2007, con ...el objetivo de determinar el nivel de conocimiento del personal de la salud y del cuidador primario sobre cuidados paliativos a pacientes en estadio terminal por cáncer. La muestra de estudio estuvo constituida por los 32 médicos y 67 enfermeras de la familia que prestan servicios en la comunidad y por los 61 cuidadores primarios seleccionados. Los datos se obtuvieron mediante un cuestionario realizado al cuidador primario y una prueba de competencia a médicos y enfermeras. Los resultados mostraron que el conocimiento de médicos, enfermeras y del cuidador primario sobre cuidados paliativos es deficiente.
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