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Latinxs in the U.S. are disproportionately affected by HIV and more likely to have delayed diagnosis than their non-Latinx peers. We developed and implemented Sólo Se Vive Una Vez (You Only Live Once), the first Spanish-language campaign aimed at improving HIV testing and prevention among Latinx immigrants in Baltimore, Maryland. Sólo Se Vive Una Vez featured a website ( www.solovive.org ) and social marketing campaign promoting free HIV testing through the Baltimore City Health Department (BCHD) clinic and Latinx outreach team. The campaign was not associated with a change in the overall number of Latinxs obtaining HIV testing. However, Latinx HIV testers who reported being exposed to the campaign had significantly higher rates of high-risk sexual behaviors, mean number of sexual partners, and substance use. The campaign was also associated with increased PrEP referrals through the BCHD Latinx outreach team.Los latinos en los Estados Unidos están desproporcionadamente afectados por el VIH y es más probable que sean diagnosticados más tarde que pacientes no latinos. Desarrollamos e implementamos Sólo Se Vive Una Vez, la primera campaña en español dirigida a mejorar la detección y prevención del VIH entre los inmigrantes latinos en Baltimore, Maryland. Sólo Se Vive Una Vez consiste en un sitio web (www.solovive.org) y una campaña en las redes sociales que promueve la prueba gratuita de VIH a través de la clínica del Departamento de Salud de la Ciudad de Baltimore así como la unidad móvil operada por nuestro equipo latino de promotores de salud. La campaña no se asoció con un cambio en el número absoluto de latinos que hicieron la prueba del VIH. Sin embargo, los latinos expuestos a la campaña que se hicieron la prueba del VIH tenían tasas más altas de conductas sexuales de alto riesgo, de parejas sexuales, y de uso de sustancias. La campaña también se asoció con un aumento de referidos a PrEP a través del equipo de promotores de salud latinos.

ObjectivePatients with early-stage, high-grade neuroendocrine cervical carcinoma typically undergo radical hysterectomy with pelvic lymphadenectomy followed by adjuvant radiotherapy and/or chemotherapy. To explore the role of radical surgery in patients with this disease, who have a high likelihood of undergoing postoperative adjuvant therapy, we aimed to determine the rate of parametrial involvement and the rate of parametrial involvement without other indications for adjuvant treatment in these patients.MethodsWe retrospectively studied patients in the Neuroendocrine Cervical Tumor Registry (NeCTuR) at our institution to identify those with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IA1-IB2, high-grade neuroendocrine cervical carcinoma who underwent up-front radical surgery with or without adjuvant therapy.ResultsOne hundred patients met the inclusion criteria. The median age was 35 years (range 22–65), and 51% (51/100) had pure high-grade neuroendocrine carcinoma. No patient had a tumor >4 cm or suspected parametrial or nodal disease before surgery. Ten patients (10%) had microscopic parametrial compromise in the final surgical specimens. Ninety-four (94%) patients underwent nodal assessment, and 19 (19%) had positive nodes. Ten patients underwent both sentinel lymph node biopsy and pelvic lymphadenectomy, and none had false-negative findings. Patients with parametrial compromise were more likely to have positive pelvic nodes (80% vs 12%, pConclusionsIn carefully selected patients with high-grade neuroendocrine cervical carcinoma, the rate of microscopic parametrial involvement is 10%. As most patients receive adjuvant treatment, we hypothesize that simple hysterectomy may be adequate when followed by adjuvant radiotherapy with concurrent cisplatin and etoposide followed by additional chemotherapy.

Primary and secondary haemophagocytic lymphohistiocytosis (HLH) are hyperferritinaemic hyperinflammatory syndromes with a common terminal pathway triggered by different etiopathogenetic factors. HLH is characterised by a decreased capacity of interferon gamma production with an activated NK phenotype profile similar to other hyperinflammatory syndromes. Viruses are closely linked to the development of HLH as infectious triggers, and the break of tolerance to self-antigens is considered a critical mechanism involved in the development of immune-mediated conditions triggered by viral infections. Emerging studies in patients with COVID-19 are suggesting a key role of monocytes/macrophages in the pathogenesis of this viral infection, and there is a significant overlap between several features reported in severe COVID-19 and the features included in the HLH-2004 diagnostic criteria. Therefore, SARS-Cov-2, as other respiratory viruses, may also be considered a potential etiological trigger of HLH. The frequency of HLH in adult patients with severe COVID-19 is lower than 5%, although this figure could be underestimated considering that most reported cases lacked information about some specific criteria (mainly the histopathological criteria and the measurement of NK cell function and sCD25 levels). Because HLH is a multi-organ syndrome, the diagnostic approach in a patient with severe COVID-19 in whom HLH is suspected must be carried out in a syndromic and holistic way, and not in the light of isolated clinical or laboratory features. In COVID-19 patients presenting with persistent high fever, progressive pancytopenia, and hepatosplenic involvement, together with the characteristic triad of laboratory abnormalities (hyperferritinaemia, hypertriglyceridaemia, and hypofibrinogenaemia), the suspicion of HLH is high, and the diagnostic workup must be completed with specific immunological and histopathological studies. Supplementary Information The online version contains supplementary material available at 10.1007/s10067-020-05569-4.

Latinxs in the United States are disproportionately affected by HIV and present with more advanced disease than their non-Latinx peers, due to numerous barriers to care including HIV stigma. We describe the adaptation, implementation, and reach of Sólo Se Vive Una Vez (You Only Live Once), Baltimore's first social marketing campaign promoting HIV screening among Spanish-speaking Latinxs. The 6-month campaign promoted free HIV testing by addressing HIV stigma. The campaign included a website, a social marketing campaign, community outreach events, and advertisements via radio, billboards, local partners, and buses. During the campaign, there were 9,784 unique website users, and ads were served to over 84,592 people on social media platforms. Among Latinx HIV testers at the Baltimore City Health Department, 31.6% reported having seen or heard of Sólo Se Vive Una Vez and 25.3% of Latinx HIV testers reported that the campaign influenced them to get tested.

Introduction: Primary Sjogren syndrome (pSS) is a systemic autoimmune disease that may affect 3 in 1,000 people within the general population. The therapeutic scenario is complex, and no therapy has proved to be able to modify the natural course of the disease, nor to prevent the most severe systemic complications.Areas covered: Recently, the EULAR 2020 Recommendations for pSS have underlined the low level of evidence supporting efficacious therapeutic approaches, lacking a definition of specific treatment targets and being far from the 'disease modification' concept that is frequently used in other diseases. Herein, the authors review the status of current targeted therapies and provide the reader with their expert opinion.Expert opinion: The progress in discovering novel treatments for pSS seem to be focused on searching new biological therapies as highly-selective drugs that can be effective without the adverse effects related to the wide, nonspecific immunosuppression induced by the drugs currently used. Most likely, the more disruptive therapeutic approach in pSS that could be seen in a few years is the use of combination strategies targeting different etiopathogenic pathways.

Objective To analyse the clinical patterns of sarcoidosis triggered by immune checkpoint inhibitors (ICIs) in patients with cancer. Patients and methods The ImmunoCancer International Registry is a big data–sharing multidisciplinary network from 18 countries dedicated to evaluating the clinical research of immune-related adverse events related to cancer immunotherapies. Results We identified 32 patients with biopsy-proven sarcoidosis. Underlying cancer included mainly melanoma (n = 24). Cancer immunotherapy consisted of monotherapy in 19 cases (anti-PD-1 in 18 and ipilimumab in 1) or combined ipilimumab + nivolumab in 13. The time median interval between initiation of ICI and sarcoidosis diagnosis was 3 months (range, 2–29 months). The use of combined ICI was associated with a shorter delay in developing sarcoidosis symptoms. The disease was symptomatic in 19 (59%) cases with mostly cutaneous, respiratory and general symptoms. The organs involved included mainly the mediastinal lymph nodes (n = 32), the lungs (n = 11), the skin (n = 10) and the eyes (n = 5). Pulmonary computed tomography studies showed bilateral hilar lymphadenopathy in all cases. There was no severe manifestation. Specific systemic therapy was required in only 12 patients (37%): oral glucocorticoids in 9, and hydroxychloroquine in 3. ICIs were held in 25 patients (78%) and definitively discontinued in 18 (56%) patients. Seven patients continued ICI treatment with a second flare in one case. In six additional patients, an ICI was reintroduced with no harm, and sarcoidosis relapsed in one of them. Conclusion Our study shows that ICI-related sarcoidosis seems to have a specific profile, possibly more benign than that of idiopathic sarcoidosis, and does not necessarily imply ICI discontinuation.

Se trata de un estudio descriptivo-retrospectivo de los pacientes con el cuadro clínico de AOS, atendidos en Consulta Externa de Neumología del Hospital San Juan de Dios, de enero de 2005 a diciembre de 2011. La información se obtuvo de los expedientes médicos, por medio de una ficha de recolección de datos. Con base en los resultados se realizó el análisis estadístico.

Objectives To describe the prevalence of previously diagnosed diabetes among Mexican adults, to characterize the associated risk factors, and to describe which glycemic control strategies are the most used. Methods We analyzed data from 8,631 adults aged ≥20 years who participated in the ENSANUT-2016 and from whom we gathered data about previously diagnosed diabetes, risk factors, glycemic control strategies, and measures to prevent complications. Results The prevalence of previously diagnosed diabetes in Mexican adults was 9.4% (10.3% in women and 8.4% in men). The adjusted OR for having diabetes was higher in adults aged ≥60 years (OR = 11.0 in women and OR = 30.7 in men) than in adults aged 20–39 years (OR = 1.0). The adjusted OR for having diabetes was higher in overweight men (OR = 1.7) than in men with normal BMI (OR = 1.0). A total of 30.5% of adults with diabetes did not report any control strategies, 44.9% measured their venous blood glucose, and 15.2% used the HbA1C as an indicator of glycemic control. Only 46.4% of them reported preventive measures. Discussion Diabetes is a common disease among Mexican adults. Being older or overweight are risk factors for an adult to be diagnosed with diabetes. Most adults with diabetes evaluate their glycemic control but only half practice preventive measures.

Background The ImmunoCancer International Registry (ICIR) is a Big Data-Sharing multidisciplinary network composed by 39 specialists in Rheumatology, Internal Medicine, Immunology and Oncology from 18 countries focused on immune-related adverse events (irAEs) related to cancer immunotherapies (CIs). Objectives To analyse the worldwide scenario of irAEs associated with the use of CIs in this Century. Methods The first objective of the ICIR has been the development of a systematic literature review crossing CIs terms with immune diseases defined according to MedDRAVR 15.0. Results The cumulated number of cases per year of irAEs has increased exponentially, with 12,648 patients who developed 13,051 irAEs reported until Dec 31, 2018: Combined CIs were used in 1962 (16%) patients, checkpoint inhibitors in 7099 (66%, overwhelmingly CTLA4 and PD1 inhibitors) and Tyrosine Kinase inhibitors in 3327 (31%); ipilimumab, nivolumab and pembrolizumab were associated with nearly 60% of reported cases. Organ-specific classification of irAEs is summarized in the figure: The Top10 irAEs included enterocolitis (18%), pneumonitis (12%), thyroiditis (11%), myocarditis (6%), myositis (5%), hypophysitis (5%), hepatitis (5%), neuropathy (4%), adrenal (3%) and joint involvement (3%). Most irAEs are organ-specific symptoms not fulfilled criteria of systemic/rheumatic diseases. Conclusion More than 13,000 cases of irAEs triggered by CIs have been reported, with the organ-specific autoimmune damage of the endocrine, digestive and pulmonary systems accounting for 70% of the total reported irAEs. Disclosure of Interests Manuel Ramos-Casals: None declared, Oliver Lambotte: None declared, Marie Kostine: None declared, Leonard Calabrese Consultant for: Bristol-Myers-Squibb, Genentech and Astra-Zeneca., Maria Suarez-Almazor : None declared, Clifton Bingham Grant/research support from: BMS, Consultant for: AbbVie, BMS, Eli Lilly, Genentech/Roche, Janssen, Pfizer, Sanofi/Regeneron, Timothy R. Radstake: None declared, Chiara Baldini: None declared, Thierry Schaeverbeke: None declared, Jacques-Eric Gottenberg Grant/research support from: Bristol-Myers Squibb, Grant/research support from: Bristol-Myers Squibb, Consultant for: Bristol-Myers Squibb, Lilly, Pfizer, Sanofi-Genzyme, UCB Pharma, Consultant for: Bristol-Myers Squibb, Eli Lilly, UCB, Sanofi-Genzyme, Pfizer, Hendrik Schulze-Koops Grant/research support from: Novartis, Pfizer, Roche, Consultant for: Abbvie, Actelion, Amgen, AstraZeneca, Biogen International, BMS, Celgene, Chugai, GSK, Hospira, Janssen-Cilag, Leo Pharmaceuticals, Lilly, MSD, Medac, Merck, Novartis, Pfizer, Hexal Sandoz, Sanofi, Roche, UCB, Paid instructor for: Abbvie, Actelion, Amgen, AstraZeneca, Biogen International, BMS, Celgene, Chugai, GSK, Hospira, Janssen-Cilag, Leo Pharmaceuticals, Lilly, MSD, Medac, Merck, Novartis, Pfizer, Hexal Sandoz, Sanofi, Roche, UCB, Speakers bureau: Abbvie, Actelion, Amgen, AstraZeneca, Biogen International, BMS, Celgene, Chugai, GSK, Hospira, Janssen-Cilag, Leo Pharmaceuticals, Lilly, MSD, Medac, Merck, Novartis, Pfizer, Hexal Sandoz, Sanofi, Roche, UCB, Jan Leipe Grant/research support from: Novartis, Pfizer; Scientific Support: Novartis, Pfizer, Consultant for: AbbVie, AstraZeneca, Bristol-Myers Squibb, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, Novartis, Roche, Sanofi, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Janssen-Cilag, Lilly, Novartis, MSD, Pfizer, Roche, Sanofi, UCB, cassandra calabrese Speakers bureau: Regeneron/Sanofi, Pilar Brito-Zeron: None declared, Alejandra Flores-Chavez: None declared, Belchin Kostov: None declared, Soledad Retamozo: None declared, Gustavo Citera: None declared, Eva Aguilar: None declared, Michael Richter: None declared, Merav Lidar: None declared, Benjamin Fisher Consultant for: Novartis, Roche, MedImmune, Bristol-Myers Squibb, Jean-Marie Michot: None declared, David Liew: None declared, Russell Buchanan: None declared, Marte Schrumpf-Heiberg: None declared, Philippe Guilpain: None declared, Debashish Danda: None declared, Peter Olsson: None declared, Yasunori Suzuki: None declared, Saadettin Kilickap: None declared, Gabriela Hernandez-Molina: None declared, Virginia Fernandes Moca Trevisani: None declared, Sonja Praprotnik: None declared, Ildiko Fanny Horvath: None declared, Naoto Azuma: None declared, Berkan Armagan: None declared, Munther Khamashta: None declared, Xavier Mariette Grant/research support from: Servier, Consultant for: AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Pfizer, UCB Pharma

Background The ImmunoCancer International Registry is a Big Data-Sharing multidisciplinary network focused on the research of the immune-related adverse events (irAEs) related to cancer immunotherapies (CIs). Objectives To analyse the worldwide scenario of rheumatic/systemic autoimmune diseases (RSirAEs) associated with the use of CIs during the last 20 years. Methods The first objective was to develop a systematic literature review crossing the CIs terms with rheumatic and systemic autoimmune diseases using MedDRAVR 15.0 terms. Results RSirAEs were identified in 11% of 12648 patients with irAEs, including 1435 cases (30% fulfilled criteria for a systemic disease) that were classified in 5 phenotypic clusters: Non-characterized cases included myositis (25%), arthritis (12%), arthralgias (8%), sicca syndrome (7%) and vasculitis (6%); sarcoidosis (6%), myasthenia gravis (5%), polymyalgia rheumatica (4%), leukocytoclastic vasculitis (3%) and giant cell arteritis (2%) were the most frequent systemic diseases identified: In comparison with patients with organ-specific irAEs, RSirAEs were more frequently associated with combined therapies (OR 2.46, CI 2.16-2.81), checkpoint inhibitors -ICis- (OR 4.01 vs TKis, CI 3.26-4.92), and PD-1is (OR 2.46 vs CTLA4is, CI95% 2.16-2.81) Conclusion Rheumatic/systemic irAEs can be divided into 5 phenotypic clusters: articular, muscular, granulomatous, vasculitic and systemic. These findings must be confirmed in real-life patients, and an international data-sharing ICIR registry is planned to be launched. References: Disclosure of Interests: Manuel Ramos-Casals: None declared, Oliver Lambotte: None declared, Marie Kostine: None declared, Leonard Calabrese Consultant for: Bristol-Myers-Squibb, Genentech and Astra-Zeneca., Maria Suarez-Almazor : None declared, Clifton Bingham Grant/research support from: BMS, Consultant for: AbbVie, BMS, Eli Lilly, Genentech/Roche, Janssen, Pfizer, Sanofi/Regeneron, Timothy R. Radstake: None declared, Chiara Baldini: None declared, Thierry Schaeverbeke: None declared, Jacques-Eric Gottenberg Grant/research support from: Bristol-Myers Squibb, Grant/research support from: Bristol-Myers Squibb, Consultant for: Bristol-Myers Squibb, Lilly, Pfizer, Sanofi-Genzyme, UCB Pharma, Consultant for: Bristol-Myers Squibb, Eli Lilly, UCB, Sanofi-Genzyme, Pfizer, Hendrik Schulze-Koops Grant/research support from: Novartis, Pfizer, Roche, Consultant for: Abbvie, Actelion, Amgen, AstraZeneca, Biogen International, BMS, Celgene, Chugai, GSK, Hospira, Janssen-Cilag, Leo Pharmaceuticals, Lilly, MSD, Medac, Merck, Novartis, Pfizer, Hexal Sandoz, Sanofi, Roche, UCB, Paid instructor for: Abbvie, Actelion, Amgen, AstraZeneca, Biogen International, BMS, Celgene, Chugai, GSK, Hospira, Janssen-Cilag, Leo Pharmaceuticals, Lilly, MSD, Medac, Merck, Novartis, Pfizer, Hexal Sandoz, Sanofi, Roche, UCB, Speakers bureau: Abbvie, Actelion, Amgen, AstraZeneca, Biogen International, BMS, Celgene, Chugai, GSK, Hospira, Janssen-Cilag, Leo Pharmaceuticals, Lilly, MSD, Medac, Merck, Novartis, Pfizer, Hexal Sandoz, Sanofi, Roche, UCB, Jan Leipe Grant/research support from: Novartis, Pfizer; Scientific Support: Novartis, Pfizer, Consultant for: AbbVie, AstraZeneca, Bristol-Myers Squibb, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, Novartis, Roche, Sanofi, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Janssen-Cilag, Lilly, Novartis, MSD, Pfizer, Roche, Sanofi, UCB, cassandra calabrese Speakers bureau: Regeneron/Sanofi, Pilar Brito-Zeron: None declared, Alejandra Flores-Chavez: None declared, Belchin Kostov: None declared, Soledad Retamozo: None declared, Gustavo Citera: None declared, Eva Aguilar: None declared, Michael Richter: None declared, Merav Lidar: None declared, Benjamin Fisher Consultant for: Novartis, Roche, MedImmune, Bristol-Myers Squibb, Jean-Marie Michot: None declared, David Liew: None declared, Russell Buchanan: None declared, Marte Schrumpf-Heiberg: None declared, Philippe Guilpain: None declared, Debashish Danda: None declared, Peter Olsson: None declared, Yasunori Suzuki: None declared, Saadettin Kilickap: None declared, Gabriela Hernandez-Molina: None declared, Virginia Fernandes Moca Trevisani: None declared, Sonja Praprotnik: None declared, Ildiko Fanny Horvath: None declared, Naoto Azuma: None declared, Berkan Armagan: None declared, Munther Khamashta: None declared, Xavier Mariette Grant/research support from: Servier, Consultant for: AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Pfizer, UCB Pharma

Various cell types participate in the tumor process, in which the mast cells have been described; however, the role they play in colorectal adenocarcinoma has not yet been fully understood. Therefore, the present work aimed to compare employing histochemistry and immunohistochemistry, the number of mast cells and the content of some cytoplasmic granules in moderately differentiated non-metastatic and metastatic colorectal adenocarcinoma, analyzing tissue samples from patients. Histochemical techniques with Toluidine Blue (TBO), Periodic Schiff Acid (PAS), Alcian Blue/Periodic Acid-Schiff (PAB) and Alcian Blue/Safranin (ABS); as well as immunohistochemical reactions with anti-antibodies anti-Tryptase and anti-Chymase were applied to quantify total mast cells and content of some cytoplasmic granules. Statistical analysis was performed using SPSS V22.0 software (p ≤ 0.05). The degree of positivity of the reaction and degranulation of mast cells was reported in percentages. In our results, we observed that there are differences in the quantity and histochemical composition of the granules of mast cells (metastatic group PAS and ABS comparing the TBO reaction), as well as in the immunohistochemical composition between Tryptase and Chymase and the number of degranulated cells in both study groups (74 % degranulated mast cells in the metastatic group, 66 % integrate mast cells in the non-metastatic group). Therefore, we consider that the differences may be some of the probable factors that lead to metastasis of colorectal adenocarcinoma.

Introduccion: La enfermedad de Kawasaki (EK) es una vasculitis sistemica aguda de pequenos y medianos vasos, que se presenta principalmente en ninos. Se manifiesta como sindrome febril aunado a datos de vasculitis, y puede causar anormalidades en las arterias coronarias en el 25% de los pacientes no tratados. El objetivo de este estudio fue describir el comportamiento clinico y la identificacion de factores de riesgo para complicaciones cardiovasculares en pacientes pediatricos con EK atendidos en un hospital de segundo nivel del noroeste de Mexico. Metodos: Bajo un diseno de serie de casos, se estudiaron pacientes pediatricos con diagnostico de EK. Se midieron variables clinicas, de laboratorio y presencia de complicaciones cardiacas, y se estimo la probabilidad de riesgo con razon de momios (RM) y asociacion con prueba de ji al cuadrado. Resultados: Se incluyeron 12 pacientes y predomino el sexo femenino; la edad media de presentacion de la EK fue de 2 anos. La presentacion clinica fue completa en el 100% de los casos y hubo ademas manifestaciones atipicas. El 50% de los pacientes estudiados presentaron complicaciones cardiovasculares; la mas comun fue afeccion coronaria (33%). Las variables sexo masculino, edad menor de 2 anos y anemia tuvieron RM de 5.5 y 10 de presentar complicaciones cardiovasculares. Conclusiones: Las complicaciones cardiovasculares de la EK son frecuentes (mas del 30% de los pacientes). Las variables sexo masculino, edad menor de 2 anos y anemia incrementaron la probabilidad de riesgo para la presencia de complicaciones cardiovasculares

Objective: To characterize the etiologies and clinical features at diagnosis of patients with hemophagocytic lymphohistiocytosis (HLH) and correlate these baseline features with survival using an etiopathogenically guided multivariable model. Patients and Methods: The Spanish Group of Autoimmune Diseases HLH Study Group, formed in 2013, is aimed at collecting adult patients with HLH diagnosed in internal medicine departments between January 3, 2013, and October 28, 2017. Results: The cohort consisted of 151 patients (91 men; mean age, 51.4 years). After a mean follow-up of 17 months (range, 1-142 months), 80 patients died. Time-to-event analyses for death identified a worse survival curve for patients with neoplasia (P

Objectives To characterise the etiologies and clinical features at diagnosis of patients with hemophagocytic lymphohistiocytosis (HLH) and correlate these baseline features with survival using an etiopathogenically-guided multivariate model. Methods The HLH Study Group of the Spanish Group of Autoimmune Diseases (GEAS) was formed in 2013 with the aim of collecting a large series of Spanish adult patients with HLH with substantial experience in the management of patients with systemic diseases. By October 2017, the database included 151 consecutive patients who fulfilled at least 5 of the 8 criteria proposed by the Histiocytosis Society in 2004. Results The cohort consisted of 151 patients (91 male, mean age 51.4 years). After a mean follow-up of 17 months, 80 (53%) patients died. With respect to the HLH-dependent variables, adenopathies (HR 0.63, p=0.040), low platelets (HR 3.39, p=0.008), leukopenia (HR 1.81, p=0.047), severe hyponatremia (HR 1.61, p=0.042), disseminated intravascular coagulation (HR 1.87, p=0.034), bacterial infection (HR 1.99, p=0.025), mixed microbiological infections (HR 3.42, p=0.008) and >1 infectious trigger (HR 2.95, p=0.003) were associated with death. Time-to-event analyses for death identified a worse survival curve for patients with neoplasia (p 1 (p=0.011) infections and glucocorticoid monotherapy (p=0.021). After adjusting for confounding variables, platelets 1 infectious trigger (HR 3.43) and mixed microbiological infection (HR 2.96) remained significant. Multivariate Cox proportional hazards regression analysis identified >1 infectious trigger (HR 2.60, 95% CI 1.16 to 5.84) as the only variable independently associated with death. Conclusions The mortality rate of adult patients diagnosed with HLH exceeds 50%. Infection with >1 microbiological agent was the only independent variable associated with mortality irrespective of the underlying disease, epidemiological profile, clinical presentation and therapeutic management. Disclosure of Interest None declared

Objectives To analyse the clinical features and outcomes of patients presenting with life-threatening systemic disease in a large cohort of Spanish patients with primary Sjogren syndrome (SjS). Methods The GEAS-SS multicenter registry was formed in 2005 with the aim of collecting a large series of Spanish patients with primary SS. By January 2018, the database included 1535 consecutive patients fulfilling the 2002/2016 criteria. Life-threatening systemic disease was defined as an activity level scored as “High” in at least one ESSDAI domain. Results 209 (14%) were classified as presenting with a life-threatening systemic disease: 194 presented one ESSDAI domain classified as high, 14 two domains and only one presented three high activity domains. The high-ESSDAI domains included lymphadenopathy in 78 (37%) cases, CNS in 28 (13%), PNS in 25 (12%), pulmonary in 25 (12%), renal in 22 (10%), cutaneous in 18 (9%), articular in 18 (9%), haematological in 7 (3%) and muscular in 4 (2%); the most frequent clinical presentations in each domain were, respectively, parotid lymphoma (n=41), focal neurological deficit (n=20), ganglionopathy (n=11), usual interstitial pneumonitis (n=9), renal failure (n=11), ulcerated cutaneous vasculitis (n=9), symmetric polyarthritis (m=17), severe thrombocytopenia (n=3) and severe myositis (n=3). With respect to therapeutic approach, 144 (69%) required glucocorticoids, 65 (31%) immunosuppressive agents and 42 (20%) biological therapies. During the follow-up, 36 (17%) patients died, mainly due to lymphoma (n=16), pulmonary fibrosis (n=5), end-stage renal failure (n=4), CNS progressive disease (n=3) and systemic vasculitis (n=3). Conclusions A 14% of patients with primary SjS develop a potentially life-threatening systemic disease (mainly lymphoma, but also severe internal organ involvements including nervous system, the lungs and the kidneys). This subset of patients requires intensive therapeutic management with a mortality rate of nearly 20% of cases. Disclosure of Interest None declared

Objectives To characterise the development of autoimmune diseases triggered by the new biological therapies used as immunotherapy in patients with advanced cancer in a real-life clinical setting. Methods In 2006, the Study Group on Autoimmune Diseases (GEAS) of the Spanish Society of Internal Medicine created the BIOGEAS project, a multicenter study devoted to collecting data on the use and safety of biological agents in adult patients. In December 2016, the cBIOGEAS-SEMI multicenter registry was formed with the aim of collecting patients with cancer treated with biological immunotherapies who developed autoimmune diseases. Results By January 2018, the cBIOGEAS-SEMI Registry includes 40 patients (26 men and 14 women, mean age of 59.7 years) who developed 54 triggered autoimmune diseases, including interstitial lung disease (n=11), enterocolitis (n=8), hypophysitis (n=6), polyarthritis (n=4), thyroiditis (n=3), vasculitis (n=3), severe cutaneous involvement (n=3), adrenalitis (n=2), Sjogren syndrome (n=2), cardiomyopathy (n=2), pancreatitis (n=2), Guillain-Barre syndrome (n=2), hepatitis (n=2) and CNS involvement, sclerosing cholangitis, glomerulonephritis and sarcoidosis (one case each). Underlying neoplasia consisted mainly in pulmonary neoplasia (n=16), melanoma (n=11) and breast cancer (n=3). The main pharmacological groups of cancer immunotherapies included PD1 inhibitors (n=26), CTL4 inhibitors (n=7), growth factor/adhesion molecules inhibitors (n=4), combined PD1/CTL4 blockade (n=2) and TK inhibitors (n=1); biologics included nivolumab (n=20), ipilimumab (n=9), pembrolizumab (n=8), trastuzumab (n=3), catumaxomab (n=1) and vemurafenib/combimetinib (n=1). Glucocorticoids were used in all cases but 4, and 9 patients required intravenous methylprednisolone pulses); 5 patients required additional immunosuppressive therapies (intravenous immunoglobulins in 4, methotrexate in one). All cases responded to treatment with glucocorticoids except 4 patients who died (3 due to ILD and one due to neurological disease). Conclusions A wide variety of systemic and organ-specific autoimmune diseases triggered by the new cancer immunotherapies is emerging. In this nationwide real-life Registry, immune checkpoint inhibitors are the biologics involved in nearly 90% of cases. We found an excellent response to glucocorticoids, with a poor prognosis in those patients who developed pulmonary and neurological autoimmune diseases. Disclosure of Interest None declared

Objectives The increasing use of biological agents has been linked with the paradoxical development of autoimmune processes. The scenario has dramatically change in recent years due to the increased number of biologics used in daily practice and the emerging use of biologics in patients with solid cancers. Methods In 2006, the Study Group on Autoimmune Diseases (GEAS) of the Spanish Society of Internal Medicine created the BIOGEAS project, a multicenter study devoted to collecting data on the use and safety of biological agents in adult patients. The aeBIOGEAS Registry (autoimmune events) was designed to collect data on autoimmune diseases secondary to the use of biologic agents, with the aim of formulating a standardised, consensual protocol for these patients, through a systematic and yearly MEDLINE search. We present the updated results of the aeBIOGEAS Registry (cases collected until Dec 31, 2017). Results The aeBIOGEAS Registry currently includes 16 123 cases of more than 50 different systemic and organ-specific triggered autoimmune diseases related to the administration of 46 different biological molecules in patients with inflammatory diseases (9907 cases, overwhelmingly rheumatic diseases in 8639) and cancer (6216 cases, overwhelmingly solid neoplasia in 5955). The main biological agents identified consisted of anti-TNF agents in 9514 cases (mainly adalimumab in 4147, infliximab in 3028 and etanercept in 1648), checkpoint inhibitors in 5264 (overwhelmingly the CTL4 inhibitor ipilimumab in 4980 cases), thyrosine kinase inhibitors in 952 (mainly imatinib in 377 cases) and B-cell targeted therapies in 298 cases. Organ-specific classification of triggered autoimmune diseases included cutaneous (n=7140), digestive (n=2323), endocrine (n=1701), pulmonary (n=1683), systemic/rheumatic (n=1230), neurological (n=1172), ocular (n=349), cardiac (n=322), haematological (n=106) and renal (n=96) diseases. The most frequently reported induced individual autoimmune diseases were psoriasis (n=6401), enterocolitis (n=1947), interstitial lung diseases (n=1680), thyroiditis (n=1076), hypophysitis (n=492), demyelinating CNS diseases (n=452), peripheral neuropathies (n=431), lupus (n=371), vasculitis (n=339), uveitis (n=298), vitiligo (n=256) and sarcoidosis (n=185). Conclusions The number and diversity of induced autoimmune disorders is increasing exponentially in parallel with the increased use of biological therapies in neoplasic diseases, which are currently representing 40% of reported cases. Management of these biologic-induced autoimmune diseases will be an increasing multidisciplinary clinical challenge in the daily practice in the next years. Disclosure of Interest None declared

Objectives To analyse the prevalence of autoimmune diseases (ADs) in Catalonia by using a public big data program (Public Data Analysis for Health Research and Innovation Program, PADRIS) Methods We used the health insurance database of the Catalan National Health Insurance (CNHI) which includes all catalan population registered as insured population in 2016. The sample included 7,483,761 inhabitants. ADs were identified according to the corresponding International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. A total of 33 autoimmune diseases were analysed classified in 4 main categories: rheumatic, systemic, organ-specific and immunodeficiency/autoinflammatory. The prevalence of ADs was calculated as the number of ADs patients divided by the total CNHI beneficiaries in the same year (rate per 1 00 000 persons, 95% confidence intervals -CI-) Results The overall prevalence of ADs was 1202 per 1 00 000 persons (95% CI 1,194–1,209); the prevalence was 1455 (95%CI 1,443–1,467) in women and 939 (95%CI 929–949) in men. ADs were classified as organ-specific (43%), systemic (33%), rheumatic (23%) and immunodeficiency/autoinflammatory (1%) autoimmune diseases. The ADs with the highest prevalence rates included psoriasis (282 cases per 100,000, 95% CI 278–286), rheumatoid arthritis (RA) (178 cases per 100,000, 95% CI 175–181), polymyalgia rheumatic (98 cases per 100,000, 95% CI 96–101), spondyloarthropathies (92 cases per 100,000, 95% CI 90–94), systemic lupus erythematosus (SLE) (68 cases per 100,000, 95% CI 66–70) and Sjogren’s syndrome (59 cases per 100,000, 95% CI 57–61). In 26 (79%) of the 33 ADs, the female:male ratio was higher than 1; the highest ratios were reported for Sjogren’s syndrome (10.5:1), primary biliary cholangitis (5.8:1), SLE (5.4:1), systemic sclerosis (3.4:1) and rheumatoid arthritis (2.6:1). An enhanced prevalence of ADs was reported in Southern regions (1225 cases per 1 00 000 persons in Barcelona/Tarragona regions -CI95% 1,216–1,233- vs 1075 cases per 1 00 000 persons in Girona/Lleida regions -CI95% 1,056–1,093-, p Conclusions Nearly 90 000 catalans are classified as having an autoimmune disease, representing a prevalence of 1.2% of the total catalan population, a rate which reaches 1.5% in women. The highest frequencies are reported for psoriasis (0.28%), rheumatoid arthritis (0.18%), polymyalgia rheumatica (0.10%), spondyloarthropathies (0.09%), lupus (0.07%) and Sjogren syndrome (0.06%). Disclosure of Interest None declared

Resumen Introduccion El sindrome de Evans se caracteriza por la disminucion de, al menos, dos lineas celulares en ausencia de otros diagnosticos. Anteriormente, se definia como el desarrollo simultaneo o secuencial de trombocitopenia inmune primaria y anemia hemolitica autoinmune sin etiologia especifica. Se ha reportado una incidencia del 37% y una mortalidad del 10% de este sindrome. Casos clinicos Se presenta la informacion clinica y la evolucion del sindrome de Evans en dos pacientes lactantes que inicialmente fueron diagnosticados con trombocitopenia inmune primaria. El diagnostico clinico se apoyo con estudios de gabinete, donde se corroboraron las alteraciones hematologicas. El manejo se realizo con esteroides e inmunoglobulina. Conclusiones En el abordaje del paciente pediatrico con trombocitopenia se deben buscar alteraciones de otra linea celular. En los casos reportados se detecto la presencia de anemia hemolitica y monocitosis, por lo que se deben incluir estudios infecciosos e inmunologicos. El tratamiento de primera linea es con esteroides, y debe considerarse la administracion de inmunoglobulina si existe trombocitopenia severa asociada, como se observo en estos casos.

Background & Aims The circadian clock system in the liver plays important roles in regulating metabolism and energy homeostasis. Restricted feeding schedules (RFS) become an entraining stimulus that promotes adaptations that form part of an alternative circadian clock known as the food entrained oscillator (FEO). The aim of this study was to evaluate the daily variations of glutamine synthetase (GS) in liver under a daytime RFS. Methods Hepatic GS properties were analysed at 3-h intervals over a 24-h period in adult male Wistar rats maintained in a 12:12 h light–dark cycle. RFS group: food access for 2-h in light phase, during 3 weeks. AL group: feeding ad libitum. Fa group: acute fast (21 h). Fa–Re group: acute fast followed by refed 2 h. mRNA expression was measured by RT-qPCR, protein presence by Western-blot and immunohistochemistry, enzyme activity by a spectrophotometric assay, and glutamine by high pressure liquid chromatography. Results and Conclusions Restricted feeding schedule induced circadian rhythmicity in mRNA levels of GS and the loss of the rhythmic pattern in mitochondrial GS activity. GS activity in liver homogenates displayed a robust rhythmic pattern in AL that was not modified by RFS. The presence of GS and its zonal distribution did not show rhythmic pattern in both groups. However, acute Fa and Fa–Re diminished GS protein and activity in liver homogenates. Hepatic glutamine concentrations showed a 24-h rhythmic pattern in both groups, in an antiphasic pattern. In conclusion, daytime RFS influences the liver GS system at different levels, that could be part of rheostatic adaptations associated to the FEO, and highlight the plasticity of this system.

HIV-related stigma has been associated with a reluctance to test for HIV among Latinos. This study assessed community HIV-related stigma within an emerging Latino immigrant receiving city. We conducted a brief survey among a convenience sample of 312 Spanish-speaking Latinos in Baltimore, Maryland. HIV-related stigma was assessed through six items. Associations between stigma items, socio-demographic characteristics, and HIV testing history were considered. Gender, education, and religiosity were significantly associated with stigmatizing HIV-related beliefs. For example, men were 3.4 times more likely to hold more than three stigmatizing beliefs than women, and were also twice as likely as women to report feeling hesitant to test for HIV for fear of people's reaction if the test is positive. These findings can help inform future stigma interventions in this community. In particular, we were able to distinguish between drivers of stigma such as fear and moralistic attitudes, highlighting specific actionable items.

ResumenEl 50% de los pacientes con síndrome de Vogt-Koyanagi-Harada presenta complicaciones oculares; de estos, el 5-10% presenta membrana neovascular y edema macular, como la paciente que presentamos. Paciente femenino de 39 años de edad con edema macular y síndrome de Vogt-Koyanagi-Harada de un año de evolución. Se aplicaron 2 inyecciones intravítreas de fármacos antiangiogénicos y su evolución fue seguida objetivamente con tomografía de coherencia óptica.DiscusiónLas inyecciones intravítreas de antiangiogénicos son una alternativa en el tratamiento del edema macular secundario a enfermedades oculares inflamatorias comparado con la terapia convencional con inyecciones de esteroides subtenonianas e intravítreas.Abstract50% of patients with syndrome Vogt-Koyanagi-Harada presents ocular complications, 5-10% have neovascular membrane and macular edema. We present a 39 years old woman with macular edema secondary to syndrome Vogt-Koyanagi-Harada, treated with antiangiogenic intravitreal injections and its evolution was objectively followed with optical coherence tomography.DiscussionAntiangiogenic intravitreal injections are an alternative for the treatment of macular edema secondary to inflammatory eye diseases compared to conventional therapy with sub-Tenon steroids and intravitreal injections.

Evans syndrome is characterized by the reduction of at least two blood cell lineages in the absence of other diagnoses; it was previously described as the simultaneous or sequential development of autoimmune hemolytic anemia and immune thrombocytopenia with unknown etiology. An incidence of 37% and mortality rate of 10% were reported for Evans syndrome.We report the clinical presentation and evolution of Evans syndrome in two infants who were initially diagnosed with immune thrombocytopenia. The clinical diagnosis was supported on complementary studies, where hematological disorders were corroborated. Both cases received treatment with steroids and intravenous immunoglobulin.For the management of children with thrombocytopenia, the pediatrician must analyze for other cell lineage disorders. In the cases that we report here, we found the presence of autoimmune hemolytic anemia and monocytosis. Therefore, infectious and immunological studies must be included. The first-line treatment of choice are steroids, and intravenous immunoglobulin can be considered if severe immune thrombocytopenia is associated, as observed in these cases.

Background: Mitral balloon valvuloplasty (MBV) is the therapy of choice for the treatment of symptomatic mitral stenosis with suitable anatomy. Although its short and mid-term results are favorable, there is a paucity of information about long-term follow-up. Aim: To assess the late results of MBV. Material and Methods: A cohort of 225 patients aged 8 to 20 years who were subjected to a MBV from 1989 to 2001, was studied. All variables at the time of the procedure, short and long-term results and major events during follow-up (new mitral intervention and mortality) were recorded. Uni and multivariate analysis were used to assess prognosis. Results: The mean follow-up lapse was 13.5 years (range 8 to 20 years). During this period, 88 patients (39.1%) remained event-free and in acceptable functional capacity. Eight percent died, 8% required a second MBV and 43.5% required a surgical mitral valve replacement. A post-procedural area equal or greater to 1.9 cm² was associated with a greater likelihood of free-event survival (log rank test: p = 0.02/Cox proportional regression model: coefficient 0.54, p = 0.04). Conclusions: MBV is effective, although there is a high chance of new interventions in the long-term follow-up. A larger post-procedure mitral area is associated with a better prognosis.

Introduccion Un numero significativo de los pacientes en quienes se implanta un stent coronario experimentan reestenosis, la cual es secundaria a proliferacion tisular. El sistema renina-angiotensina esta muy involucrado en la hiperplasia neointimal. Se conoce que la enzima conversiva de la angiotensina esta regulada en parte por el polimorfismo I/D del gen de esta enzima y sus concentraciones plasmaticas son mayores en los pacientes homozigotos D/D. En este trabajo se estudio la posibilidad de que el polimorfismo I/D pudiera estar relacionado con la reestenosis intra-stent. Metodos Estudiamos el polimorfismo I/D del gen de la enzima conversiva de la angiotensina en 48 pacientes consecutivos en quienes se implanto un stent en forma electiva, en arterias nativas y que tuvieran un reestudio angiografico a los 6 meses. Encontramos reestenosis (definida como estenosis > 50% respecto del lumen del vaso de referencia) en 23 de los 48 pacientes. Los grupos con y sin reestenosis no diferian en variables como diabetes, colesterol plasmatico o resultados inmediatos de la angioplastia. Resultados Encontramos que el 22,9% de los pacientes presentaba genotipo D/D; el 14,5% de los pacientes fueron I/I y el 62,5% de los pacientes eran heterozigotos I/D. Se pudo establecer que el 81,8% de los pacientes D/D desarrollo reestenosis intra-stent, mientras que solo el 40,0% de los pacientes heterozigotos I/D presentaron reestenosis. Los homozigotos I/I presentaron reestenosis muy raramente (14,2%). La diferencia de incidencia de reestenosis entre los grupos fue estadisticamente significativa (p Conclusiones De acuerdo con estos resultados, el polimorfismo D/D del gen de la enzima conversiva de la angiotensina puede ser un factor de riesgo de reestenosis intra-stent, mientras que los individuos con genotipo I/I practicamente no desarrollaron reestenosis.

Background The Cobra-P drug-eluting stent (DES) system consists of cobalt chromium alloy with bio-absorbable siloxane sol–gel matrix coating that elutes low dose paclitaxel within 6months. The aim of this first-in-man trial was to evaluate the safety and performance of 2 doses of the Cobra-P DES. Methods A total of 60 lesions (54 patients) were sequentially assigned to 2 different paclitaxel doses: group A (3.7μg/18mm, n=30) or group B (8μg/18mm, n=30). The primary endpoint was MACE at 4months defined as cardiac death, myocardial infarction, and target lesion revascularization. Results Patient and lesion characteristics were matched between the 2 groups except for male sex. MACE at 4months was 3.3% and 0% respectively ( P =1.000) and at 1-year follow-up remained unchanged. In-stent late loss at 4months was similar in both groups (0.36±0.30mm and 0.34±0.20mm P =.773). Conclusions In this FIM study, implantation of the Cobra-P low dose paclitaxel-eluting stent with a bioabsorbable sol–gel coating was proven to be feasible and safe. Moderate neointimal proliferation was observed as well as an acceptable MACE rate up to 1year.

En México, 28.6% de la población presentó al menos un trastorno mental alguna vez en su vida y sólo una de cada diez personas que requirieron atención psicológica accedieron a un profesional, lo cual sugiere la incorporación de alternativas que faciliten el acceso a los servicios de salud mental, como psicoterapia vía internet. En este estudio se exponen los hallazgos obtenidos de la aplicación de una intervención cognitivo-conductual vía internet para pacientes con depresión. Se informa de los datos de ocho participantes; seis mujeres y dos hombres, en un rango de edad de 19 a 48 años, con diagnóstico de depresión leve y moderada, evaluada según los criterios del dsm-iv-r. Se evaluó el tamaño del efecto de la intervención y la satisfacción del participante con la modalidad empleada. Los resultados obtenidos muestran la eficacia de la psicoterapia vía internet y su adaptación en un contexto social y cultural como el mexicano.

Objective. To evaluate the association of -174G/CIL-6polymorphism with failure in therapeutic response to methotrexate (MTX) or leflunomide (LEF). This prospective, observational cohort included 96 Mexican-Mestizo patients with moderate or severe rheumatoid arthritis (RA), initiating MTX or LEF, genotyped forIL-6-174G/C polymorphism by PCR-RFLP. Therapeutic response was strictly defined: only if patients achieved remission or low disease activity (DAS-28 < 3.2).Results. Patients with MTX or LEF had significant decrement in DAS-28 (p<0.001); nevertheless, only 14% and 12.5% achieved DAS-28 < 3.2 at 3 and 6 months. After 6 months with any of these drugs the -174G/G genotype carriers (56%) had higher risk of therapeutic failure compared with GC (RR: 1.19, 95% CI: 1.07–1.56). By analyzing each drug separately, after 6 months with LEF, GG genotype confers higher risk of therapeutic failure than GC (RR = 1.56; 95% CI = 1.05–2.3;p=0.003), or CC (RR = 1.83; 95% CI = 1.07–3.14;p=0.001). This risk was also observed in the dominant model (RR = 1.33; 95% CI = 1.03–1.72;p=0.02). Instead, in patients receiving MTX no genotype was predictor of therapeutic failure. We concluded thatIL-6-174G/G genotype confers higher risk of failure in therapeutic response to LEF in Mexicans and if confirmed in other populations this can be used as promissory genetic marker to differentiate risk of therapeutic failure to LEF.