Search

Objectives: Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images. Methods: Based on the results from a systematic literature review, several findings were identified for defining the presence of ILD by ultrasound (i.e., Am-lines, B-lines, pleural cysts and pleural line irregularity). Therefore, a Delphi survey was conducted among 23 experts in sonography to agree on which findings should be included and on their definitions. Subsequently, a web-reliability exercise was performed to test the reliability of the agreed definitions on video-clips, by using kappa statistics. Results: After three rounds of Delphi an agreement >75 % was obtained to include and define B-lines and pleural line irregularity as elementary lesions to assess. The reliability in the web-based exercise, consisting of 80 video-clips (30 for pleural line irregularity, 50 for B-lines), showed moderate inter-reader reliability for both B-lines (kappa = 0.51) and pleural line irregularity (kappa = 0.58), while intra-reader reliability was good for both B-lines (kappa = 0.72) and pleural line irregularity (kappa = 0.75). Conclusion: Consensus-based ultrasound definitions for B-lines and pleural line irregularity were obtained, with moderate to good reliability to detect these lesions using video-clips. The next step will be testing the reliability in patients with ILD linked to RMDs and to propose a consensual a

Objective: To evaluate whether the addition of colchicine to standard of care (SOC) results in better outcomes in hospitalized patients with COVID-19. Design: This interventional, multicenter, randomized, phase 2 study, evaluated colchicine 1.5 mg/day added to SOC in hospitalized COVID-19 patients (COLVID-19 trial) and 227 patients were recruited. The primary outcome was the rate of critical disease in 30 days defined as need of mechanical ventilation, intensive care unit (ICU), or death. Results: 152 non-anti-SARS-CoV-2-vaccinated patients (colchicine vs controls: 77vs75, mean age 69.1±13.1 vs 67.9±15 years, 39% vs 33.3% females, respectively) were analyzed. There was no difference in co-primary end-points between patients treated with colchicine compared to controls (mechanical ventilation 5.2% vs 4%, ICU 1.3% vs 5.3%, death 9.1% vs 6.7%, overall 11 (14.3%) vs 10 (13.3%) patients, P=ns, respectively). Mean time to discharge was similar (colchicine vs controls 14.1±10.4 vs 14.7±8.1 days). Older age (>60 years, P=0.025), P/F<275 mmHg (P=0.005), AST>40 U/L (P<0.001), pre-existent heart (P=0.02), lung (P=0.003), upper-gastrointestinal (P=0.014), lower-gastrointestinal diseases (P=0.009) and cancer (P=0.008) were predictive of achieving the primary outcome. Diarrhoea (9.1% vs 0%, p=0.0031) and increased levels of AST at 6 days (76.9±91.8 vs 33.5±20.7 U/l, P=0.016) were more frequent in the colchicine group. Conclusion: Colchicine did not reduce the rate and the time to the critical stage. Colchicine was relatively safe although adverse hepatic effects require caution. We confirm that older (>60 years) patients with comorbidities are characterized by worse outcome.

Acquired hemophilia A (HAA) is a rare hematological disease, characterized by the presence of antibodies against circulating factor VIII. It occurs in adults and in half of the cases in association with autoimmune, malignant processes (oncohematological and solid tumors), dermatological diseases, allergies and in women during pregnancy, childbirth or puerperium. Hemorrhagic manifestations are diverse, predominantly spontaneous skin bleeding. Diagnosis is accurate by measuring the activity of factor VIII and the presence of its inhibitor. We present a case report of a 36-year-old patient in the early puerperium who presented with spontaneous hematomas, visceral bleeding and prolonged coagulation times. Postpartum HAA was diagnosed with good evolution after immunosuppressive treatment. Postpartum HAA has a very low incidence and, consequently, there are few cases described. Its delay in diagnosis is a conditioning factor for the high percentage of mortality. Hence the interest in publishing this case., La hemofilia A adquirida (HAA) es una enfermedadhematológica infrecuente, caracterizada por la presencia de anticuerpos contra el factor VIII circulante. Se presenta en personas adultas y en la mitad de los casos en asociación a procesos autoinmunitarios, malignos (oncohematológicos y tumores sólidos), enfermedades dermatológicas, alergias y en mujeres durante embarazo, parto o puerperio. Las manifestaciones hemorrágicas son diversas, predominando el sangrado cutáneo espontáneo. El diagnóstico se realiza midiendo la actividad del factor VIII y la presencia de su inhibidor. Reportamos el caso de una paciente de 36 años cursando 36° día de puerperio que se presenta con hematomas espontáneos, sangrado visceral y tiempos de coagulación prolongados. Se realizó diagnóstico de HAA posparto con buena evolución posterior al tratamiento inmunosupresor. La HAA posparto presenta muy baja incidencia y, en consecuencia, existen pocos casos descriptos. Su retraso en el diagnóstico es un condicionante para el elevado porcentaje de mortalidad. De aquí el interés en la publicación de este caso.