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Introducción: El 9 de marzo de 2020 se confirma el primer caso de COVID-19 en la República de Panamá. Según el reporte #46 de Panamá emitido por la OPS el 26 de enero de 2021, Panamá es el segundo país de las Américas con más alta incidencia después de Estados Unidos. Métodos: El diseño del estudio es observacional retrospectivo. En este estudio participaron 140 pacientes de 3 instituciones privadas localizadas en el área metropolitana de la República de Panamá. Resultados: De la muestra, 65.71% eran hombres y 34.29% eran mujeres, 72 (51.43%) pacientes fueron hospitalizados. La edad media fue de 48.39 años. El 49% de los pacientes presentaron antecedentes personales patológicos, el más común fue hipertensión arterial (63.27%). Los síntomas más frecuentes encontramos fiebre (71.43%), tos (61.43%), fatiga (50.71%) y disnea (32.86%). Del total de pacientes, 55.71% recibió tratamiento intrahospitalario, 11.51% fue admitido a UCI, 9.29% sufrió complicaciones y las más frecuente fue falla respiratoria (61.54%). De los medicamentos utilizados en ese periodo de tiempo lo más comúnmente usado fue la hidroxicloroquina (91.03%) y la azitromicina (84.62%). Conclusiones: Se encontraron resultados similares a estudios descriptivos realizados en distintos países con modelos similares al nuestro.

Background/objective Demand for rheumatology care has steadily increased in recent years. The number of specialists in this field, however, seems insufficient. No recent studies have diagnosed the attributes of rheumatology training in Latin America. Methods This is a descriptive cross-sectional study. We obtained data on each country through local rheumatologists of the Pan-American League Against Rheumatism, who acted as principal investigators for participating countries. Our sample was analyzed and described through means and standard deviations or through frequencies and percentages, depending on the variable. Results Countries with the most rheumatology-training programs were Brazil (n = 50), Argentina (n = 18), and Mexico (n = 15). Ecuador, Honduras, and Nicaragua do not have rheumatology-training programs. The countries with the most available slots for rheumatology residents were Brazil (n = 126) and Argentina (n = 36). To be admitted into rheumatology training, candidates were required to have completed graduate studies in internal medicine in 42.1% of the programs. In 8 countries (42.1%), residents are not required to pay tuition; the median cost of tuition in the remaining countries is US $528 (interquartile range, US $2153). Conclusions Conditions associated with rheumatology training in Latin America vary. Significant differences exist in income and tuition fees for residents, for example, and 4 countries in Latin America do not currently offer programs. Information collected in this study will be useful when comparing the status of rheumatology services offered in Latin America with those in other countries. Most countries require a wider offering of rheumatology-training programs, as well as more available slots.

Studies conducted by various scientific societies have shown that the demand for specialized rheumatology care is greater than the projected growth of the workforce. Our research aims to assess the current status of the rheumatology workforce in Latin America.This is a descriptive, cross-sectional study. A survey was created on the RedCap platform. Data were analyzed with STATA 15® Software. We present descriptive analyses. The rate of inhabitants per rheumatologist was calculated using the number of rheumatologists practicing in each country and the inhabitants for year 2020.Our sample was composed by 19 PANLAR member countries in Latin America. Latin America has one rheumatologist per 106,838 inhabitants. The highest rate of rheumatologist per inhabitants was found in Uruguay (1 per 27,426 inhabitants), and the lowest was found in Nicaragua (1 per 640,648 inhabitants). Mean age was 51.59 (SD12.70), ranging between 28 and 96 years of age. Mean monthly compensation was USD $2382.6 (SD$1462.5). The country with lowest salary was Venezuela ($197), whereas the highest was Costa Rica ($4500).There is a high variability in rheumatologists' workforce characteristics in Latin America. These results could lead to policies aiming to increase the availability and income of rheumatologists, in order to increase opportunity and quality of care of patients living with rheumatic diseases. Key Points • The rheumatologists' workforce varies significantly among Latin American countries. • The supply of rheumatologists is insufficient for meeting the increasing need for specialists in this field.

Rheumatic diseases are a reason for frequent consultation with primary care doctors. Unfortunately, there is a high percentage of misdiagnosis.To design an algorithm to be used by primary care physicians to improve the diagnostic approach of the patient with joint pain, and thus improve the diagnostic capacity in four rheumatic diseases.Based on the information obtained from a literature review, we identified the main symptoms, signs, and paraclinical tests related to the diagnosis of rheumatoid arthritis, spondyloarthritis with peripheral involvement, systemic lupus erythematosus with joint involvement, and osteoarthritis. We conducted 3 consultations with a group of expert rheumatologists, using the Delphi technique, to design a diagnostic algorithm that has as a starting point "joint pain" as a common symptom for the four diseases.Thirty-nine rheumatologists from 18 countries of Ibero-America participated in the Delphi exercise. In the first consultation, we presented 94 items to the experts (35 symptoms, 31 signs, and 28 paraclinical tests) candidates to be part of the algorithm; 74 items (25 symptoms, 27 signs, and 22 paraclinical tests) were chosen. In the second consultation, the decision nodes of the algorithm were chosen, and in the third, its final structure was defined. The Delphi exercise lasted 8 months; 100% of the experts participated in the three consultations.We present an algorithm designed through an international consensus of experts, in which Delphi methodology was used, to support primary care physicians in the clinical approach to patients with joint pain. Key Points • We developed an algorithm with the participation of rheumatologists from 18 countries of Ibero-America, which gives a global vision of the clinical context of the patient with joint pain. • We integrated four rheumatic diseases into one tool with one common symptom: joint pain. It is a novel tool, as it is the first algorithm that will support the primary care physician in the consideration of four different rheumatic diseases. • It will improve the correct diagnosis and reduce the number of paraclinical tests requested by primary care physicians, in the management of patients with joint pain. This point was verified in a recently published study in the journal Rheumatology International (reference number 31).

Biologics have improved the treatment of rheumatic diseases, resulting in better outcomes. However, their high cost limits access for many patients in both North America and Latin America. Following patent expiration for biologicals, the availability of biosimilars, which typically are less expensive due to lower development costs, provides additional treatment options for patients with rheumatic diseases. The availability of biosimilars in North American and Latin American countries is evolving, with differing regulations and clinical indications. The objective of the study was to present the consensus statement on biosimilars in rheumatology developed by Pan American League of Associations for Rheumatology (PANLAR). Using a modified Delphi process approach, the following topics were addressed: regulation, efficacy and safety, extrapolation of indications, interchangeability, automatic substitution, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. Consensus was achieved when there was agreement among 80% or more of the panel members. Three Delphi rounds were conducted to reach consensus. Questionnaires were sent electronically to panel members and comments about each question were solicited. Eight recommendations were formulated regarding regulation, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. The recommendations highlighted that, after receiving regulatory approval, pharmacovigilance is a fundamental strategy to ensure safety of all medications. Registries should be employed to monitor use of biosimilars and to identify potential adverse effects. The price of biosimilars should be significantly lower than that of reference products to enhance patient access. Biomimics are not biosimilars and, if they are to be marketed, they must first be evaluated and approved according to established regulatory pathways for novel biopharmaceuticals. • Biologics have improved the treatment of rheumatic diseases. • Their high cost limits access for many patients in both North America and Latin America. • Biosimilars typically are less expensive, providing additional treatment options for patients with rheumatic diseases. • PANLAR presents its consensus on biosimilars in rheumatology

ObjectiveTo describe the effect of the coronavirus disease 2019 (COVID-19) pandemic on Latin American rheumatologists from a professional, economic, and occupational point of view.MethodsWe conducted an observational cross-sectional study using an online survey sent to rheumatologists of each non–English-speaking country member of the Pan American League of Rheumatology Associations (PANLAR). A specific questionnaire was developed.ResultsOur survey included 1097 rheumatologists from 19 Latin American countries. Median (IQR) age of respondents was 48 (40–59) years and 618 (56.3%) were female. Duration of practice since graduation as a rheumatologist was 17 years, and 585 (53.3%) were aged < 50 years. Most rheumatologists worked in private practice (81.8%) and almost half worked in institutional outpatient centers (55%) and inpatient care (49.9%). The median number of weekly hours (IQR) of face-to-face practice before the pandemic was 27 (15–40) hours, but was reduced to 10 (5–20) hours during the pandemic. Telehealth was used by 866 (78.9%) respondents during the pandemic. Most common methods of communication were video calls (555; 50.6%), telephone calls (499; 45.5%), and WhatsApp voice calls (423; 38.6%). A reduction in monthly wages was reported by 946 (86.2%) respondents. Consultation fees also were reduced and 88 (8%) rheumatologists stated they had lost their jobs. A reduction in patient adherence to medication was reported by nearly 50% of respondents. Eighty-one (7.4%) rheumatologists received a COVID-19 diagnosis and 7 (8.6%) of them were hospitalized.ConclusionThe COVID-19 pandemic has reshaped rheumatology practice in Latin America and has had a profound effect on rheumatologists’ behaviors and clinical practice.

The two co-authors of the mentioned above article were incorrect. The correct are authors should have been "P. A. Beltrán" instead of "P. A. B. Roa" and "J. F. Diaz-Coto" instead of "L. Diaz Soto".

BACKGROUND Studies to date regarding hyperuricemia and gout in the postrenal transplant (RT) setting do not distinguish neither if patients with gout after the allograft had or did not have hyperuricemia before been transplanted nor if data concerning to hyperuricemia correspond to prevalent or incident cases. Among RT patients, we assessed (1) the incidence of gout in recipients with and without hyperuricemia pre-RT and (2) the incidence of hyperuricemia during the follow-up. METHODS We selected from our RT registry (1989-2003) 236 subjects who were transplanted in our institution, with at least 1 year follow-up, without gout pre-RT, with at least one measurement of serum uric acid pre-RT and two post-RT. Immunosuppressants, demographic, and clinical features were registered. Survival curves for hyperuricemia and gout were derived using the Kaplan-Meier method and were statistically tested by log rank test. RESULTS The median follow-up was 4.8 years (1.0-14.9), 43% were women, with a mean body mass index of 22.7+/-3.7 kg/m2 and a mean age at the moment of transplant of 32.4+/-11 years. The incidence of hyperuricemia was 315.2 x 1000 patient-years. Hyperuricemia was diagnosed in half of the subjects during the first year of follow-up. The incidence of gout was 19.7 x 1000 and 2.67 x 1000 patient-years in the groups with and without hyperuricemia pretransplant, respectively (Log rank 9.44, P

Resume Nous decrivons une observation de polyarthrite due a Mycobacterium bovis chez un Mexicain de 37 ans. Un dermatologue avait porte un diagnostic de psoriasis deux ans plus tot. La survenue un an apres ce diagnostic d'une arthrite symetrique des genoux et des chevilles a conduit a l'administration de trois doses d'etanercept. L'arthrite s'est etendue aux carpes et aux metacarpophalangiennes. L'examen a mis en evidence une dactylite multifocale et un abces periarticulaire de la cheville gauche. Le tableau s'est alors enrichi d'une fievre, d'une toux et d'adenopathies. L'imagerie par resonance magnetique de la cheville a revele une osteomyelite du calcaneum avec un abces posterieur. La tomodensitometrie a mis en evidence un epanchement pleural peu abondant, qui s'est avere etre un exsudat. La ponction de la cheville a ramene un liquide caseeux contenant des bacilles acidoresistants. Une synovite granulomateuse a ete observee sur les biopsies synoviales du genou et de la cheville. Un fragment biopsique d'adenopathie contenait des granulomes sieges d'une necrose caseeuse. Une souche de M. bovis a ete isolee un mois apres la mise en culture de ces tissus. Le traitement antituberculeux est en cours et la reponse est satisfaisante. La tuberculose bovine est devenue tres rare, mais reste neanmoins d'actualite. Les formes revelees par une polyarthrite sont exceptionnelles et soulevent d'importantes difficultes diagnostiques.

We describe a 37-year-old Mexican man with incapacitating polyarticular arthritis secondary to Mycobacterium bovis infection. A dermatologist diagnosed psoriasis two years before admission. One year later due to symmetric ankle and knee arthritis, he was treated with three doses of etanercept. The arthritis extended to the carpus and metacarpophalangeal joints. Multifocal dactylitis and a left ankle periarticular abscess were documented. Concomitantly he developed fever, cough, and adenopathies. Ankle MRI showed osteomyelitis of the calcaneous with a posterior abscess. A CT-body scan documented mild pleural effusion that corresponded to an exudate. An ankle aspiration yielded a caseous fluid with acid-fast bacilli. Knee and ankle synovial biopsies documented a granulomatous synovitis. A lymph node biopsy showed granulomas with caseous necrosis. After 1 month, Mycobacterium bovis was isolated from these tissues. Antituberculous regimen was started with satisfactory response. Although largely eradicated, bovine tuberculosis still occurs. Nevertheless, the clinical presentation as polyarthritis is very uncommon and represents a diagnostic challenge.