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Background Inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been widely implemented in low- and middle-income countries. However, immunogenicity in immunocompromised patients has not been established. Herein, we aimed to evaluate immune response to CoronaVac vaccine in these patients. Methods This prospective cohort study included 193 participants with 5 different immunocompromising conditions and 67 controls, receiving 2 doses of CoronaVac 8–12 weeks before enrollment. The study was conducted between May and August 2021, at Red de Salud UC-CHRISTUS, Santiago, Chile. Neutralizing antibody (NAb) positivity, total anti–SARS-CoV-2 immunoglobulin G antibody (TAb) concentrations, and T-cell responses were determined. Results NAb positivity and median neutralizing activity were 83.1% and 51.2% for the control group versus 20.6% and 5.7% (both P Conclusions Diverse immunocompromising conditions markedly reduce the humoral response to CoronaVac vaccine. These findings suggest that a boosting vaccination strategy should be considered in these vulnerable patients. Clinical Trials Registration NCT04888793.

Objective The aim of this study was to evaluate the psychometric properties of the Chilean version of the Fibromyalgia Survey Questionnaire (FSQ). Methods Women with fibromyalgia (FM; n = 214), women with rheumatoid arthritis (RA; n = 97), and women without chronic pain (attended at the gynecologist, G; n = 117) from the Red de Salud UC CHRISTUS (Santiago, Chile) participated. Women with FM completed the FSQ, Fibromyalgia Impact Questionnaire (Revised Version), Numerical Pain Rating Scale, Pain Catastrophizing Scale, Pain Vigilance and Awareness Questionnaire, Patient Health Questionnaire 15, and Short-Form Health Survey. Two weeks later, they completed the FSQ again by phone (n = 120). Results The FSQ total scale showed excellent to good internal consistency at T1 (α = 0.91, ω = 0.91) and T2 (α = 0.78, ω = 0.78), and good test-retest reliability (intraclass correlation coefficient, 0.79; 95% confidence interval [CI], 0.72-0.85). It showed medium to large correlations with the other measures. Discriminant analysis between the FM group and the control group (RA and G) revealed that the FSQ total scale reached a classification accuracy of 81.3%. Receiver operating characteristic curve (adjusted area under the curve, 0.88; 95% CI, 0.85-0.92) showed that the best FSQ cutoff was 17, resulting in sensitivity of 89% (95% CI, 0.84-0.93) and specificity of 75% (95% CI, 0.69-0.80). Considering the FM diagnosis performed by a rheumatologist as the criterion standard, sensitivity and specificity of the modified 2010 American College of Rheumatology preliminary criteria for FM were 92.8% (95% CI, 0.88-0.96) and 63.4% (95% CI, 0.57-0.70), respectively. Conclusions The Chilean version of the FSQ presents good psychometric properties and is a useful tool in clinical settings to assist in FM diagnosis and symptom assessment. A cutoff score of 17 or higher seems to be the most appropriate for Chilean population.

Objective.Genetic and environmental backgrounds influence the development of rheumatoid arthritis (RA). In Latin America, epidemiologic data are scarce. We aimed to determine the prevalence of RA in Chile in a population-based study.Methods.The National Health Survey was a cross-sectional household survey with a stratified multistage probability sample of 6233 participants performed between August 2016 and March 2017. A screening instrument for RA was applied to a random sample of 3847 subjects > 30 years old. Positive screening was defined by at least 1 of the following: 2 swollen joints for at least 4 consecutive weeks (past/present), and/or a diagnosis of arthritis in the past. Individuals with positive screening had rheumatoid factor, anticitrullinated protein antibodies, and C-reactive protein measured, as well as clinical examination performed by a rheumatologist. Self-report of doctor-diagnosed RA was also performed.Results.The screening questionnaire was applied to 2998 subjects. A positive screening was found for 783 (22.1%). Among subjects with positive screening, 493 (66%) had a clinical evaluation performed by a rheumatologist. Using the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria, prevalence was 0.6% (95% CI 0.3–1.2). Prevalence was higher in women, and 3.3% of subjects self-reported having RA.Conclusion.According to this national population-based study, RA prevalence in Chile is 0.6% (0.3–1.2), a value similar to what has been found in developed countries and slightly lower than some Latin American countries. Self-reporting leads to overestimating RA.

BACKGROUND Symptom management in rheumatoid arthritis (RA) remains a complex challenge. Widespread use of cannabis-based medicines for a myriad of symptoms has fostered rheumatology patients' interest. However, their safety and efficacy in RA remain unclear. OBJECTIVE The aim of this study was to perform a structured summary of the body of evidence in order to determine whether cannabis, cannabis-derived products, and synthetic cannabinoids are an effective treatment for rheumatoid arthritis. METHODS An electronic search in Epistemonikos database was performed to identify systematic reviews and their primary studies that addressed our clinical question. The body of evidence was collected in a pivot table in Epistemonikos. Information and data from the primary studies were extracted from the identified reviews. Finally, extracted data were reanalyzed, and a summary of findings table was generated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Twenty-six systematic reviews were identified which included in total only 1 randomized trial assessing our clinical question. CONCLUSIONS Cannabis, cannabis-derived products and synthetic cannabinoids may slightly reduce disease activity in patients with RA. Its use may result in little to no difference in pain reduction and may slightly increase nervous system adverse events. The evidence is very uncertain about the effect of cannabis, cannabis-derived products, and synthetic cannabinoids on serious adverse events risk.

Objective.Subjects with rheumatoid arthritis (RA) are at higher risk of developing cardiovascular disease, which is their leading cause of death. Conflicting evidence exists regarding the efficacy of aspirin (ASA) as primary prevention. We evaluated whether a protective association exists between ASA and myocardial infarction (MI) in RA subjects.Methods.In the United Kingdom, persons age ≥ 60 years receive free ASA by prescription and 75% of use is by prescription. Subjects ≥ 60 years with RA in the population-based The Health Improvement Network database constituted our study population. We excluded patients with history of MI, angina, stroke, peripheral vascular disease, or coronary artery procedures. Our main outcome was the occurrence of fatal and nonfatal MI. We performed a case-crossover study with each subject contributing a hazard period and a control period 90 days prior to the MI. In addition, to minimize confounding by indication, a propensity score (PS)–matched cohort study was performed, considering all patients with RA with an incident prescription of low-dose ASA as our exposed group.Results.We did not find a protective effect in the case-crossover study (OR 1.83, 95% CI 0.71–4.71), with 55 subjects exposed in the hazard period and 44 in the control period. Similarly, among 1836 subjects included in the PS-matched cohort study (918 ASA users and 918 ASA non-users), we did not find a protective effect of low ASA on MI (HR 1.39, 95% CI 0.87–2.23).Conclusion.We did not find a protective effect of ASA on MI in patients with RA when used as primary prophylaxis.

The successful implementation of personalized medicine will rely on the integration of information obtained at the level of populations with the specific biological, genetic, and clinical characteristics of an individual. However, because genome-wide association studies tend to focus on populations of European descent, there is a wide gap to bridge between Caucasian and non-Caucasian populations before personalized medicine can be fully implemented, and rheumatoid arthritis (RA) is not an exception. In this review, we discuss advances in our understanding of genetic determinants of RA risk among global populations, with a focus on the Latin American population. Geographically restricted genetic diversity may have important implications for health and disease that will remain unknown until genetic association studies have been extended to include Latin American and other currently under-represented ancestries. The next few years will witness many breakthroughs in personalized medicine, including applications for common diseases and risk stratification instruments for targeted prevention/intervention strategies. Not all of these applications may be extrapolated from the Caucasian experience to Latin American or other under-represented populations. Sin financiación 4.945 JCR (2020) Q1, 15/108 Health Care Sciences & Services 1.254 SJR (2020) Q1, 380/2448 Medicine (miscellaneous) No data IDR 2019 UEM

The term spondyloarthritis (SpA) encompasses a group of chronic inflammatory diseases with common features in terms of clinical presentation and genetic predisposition. SpA is characterized by inflammation of the spine and peripheral joints, and is also be associated with extra-articular inflammatory manifestations such as psoriasis, uveitis, or inflammatory bowel disease (IBD). The etiology of SpA is not completely understood, but it is known to have a strong genetic component dominated by the human leukocyte antigen (HLA)-B27. In the last few years, our understanding of genetic susceptibility to SpA, particularly ankylosing spondylitis (AS), has greatly improved thanks to the findings derived from powered genome-wide association studies (GWAS) based on single nucleotide polymorphism (SNP) arrays. These studies have identified many candidate genes, therefore providing new potential directions in the exploration of disease mechanisms, especially with regard to the key role of the immune system in the pathogenesis of SpA. SpA is a complex disease where genetic variability, environmental factors, and random events interact to trigger pathological pathways. The aim of this review is to summarize current findings on the genetics of SpA, some of which might help to study new treatment approaches. Sin financiación 4.945 JCR (2020) Q1, 15/107 Health Care Sciences & Services 1.254 SJR (2020) Q1, 380/2447 Medicine (miscellaneous) No data IDR 2020 UEM

Background: Genetic and environmental backgrounds influence the development of rheumatoid arthritis (RA) and its frequency has regional variations. In Latin America epidemiologic data are scarce. Objectives: We aimed to determine the prevalence of RA in Chile as part of the National Health Survey (ENS, Encuesta Nacional de Salud). Methods: ENS was a cross-sectional household survey with a stratified multistage probability sample of 6,233 participants performed between August 2016 and March 2017. A screening instrument for RA was applied to a random sample of 3,700 subjects >30 years old.1, 2 Positive screening was defined by at least one of the following: (i) 2 swollen joints for at least 4 consecutive weeks (past or present) and/or (ii) a diagnosis of arthritis in the past. Individuals with positive screening had Rheumatoid Factor, Anti-citrullinated protein antibodies, and C-reactive protein measured and clinical examination was performed by a rheumatologist. Self-report of doctor-diagnosed RA was also performed. Results: The screening questionnaire was applied to 2,998 subjects. Seven hundred and thirty-eight (22.1%) had a positive screening. Among the subjects with a positive screening 493 (66%) had consulted a rheumatologist. Thirty-one subjects had RA according to the ACR/EULAR 2010 classification criteria, which corresponds to 0.6% (95%CI 0.3, 1.2). Three point three per cent reported having RA. Prevalence was higher in women and in high SES. Conclusion: According to this national population-based study RA prevalence in Chile is 0.6% (0.3, 1.2). This is similar to the prevalence previously reported in developed countries, which is noteworthy given the differences in sociodemographic characteristics which exist compared to Chile. Self-reporting leads to an important overestimation of RA. Our study suggests there is a higher risk of RA in subjects with high SES in this region. References [1] MacGregor AJ, Riste LK, Hazes JMW, Silman AJ. Low prevalence of rheumatoid arthritis in Black Caribbeans compared with Whites in inner city Manchester. Ann Rheum Dis 1994;53:293–7 [2] Carmona L, et al. The prevalence of rheumatoid arthritis in the general population of Spain. Rheumatology (Oxford). 2002;41(1):88-95. Disclosure of Interests: josefina duran: None declared, loreto massardo Speakers bureau: Werfen, carolina llanos: None declared, sergio iacobelli: None declared, Paula Burgos: None declared, Raquel Aguilera: None declared, maria eugenia martinez: None declared, marcela cisternas: None declared, macarena armstrong: None declared, mirentxu iruretagoyena: None declared, francisco radrigan: None declared, alvaro passi: None declared, pablo riedemann: None declared, camila cifuentes: None declared, lucero hagedorn: None declared, natalia crisostomo: None declared, alvaro cisternas: None declared, paula margozzini: None declared

It has been suggested that environmental and lifestyle factors might contribute to the severity and progression of inflammation in rheumatoid arthritis. An intervention generating high interest due to its supposed anti-inflammatory properties is the Mediterranean diet.We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach.We identified seven systematic reviews including four primary studies, of which only one corresponded to a randomized trial. We concluded Mediterranean diet may make little or no difference in pain or disease activity and may slightly increase weight in rheumatoid arthritis patients, but the certainty of the evidence is low. On the other hand, it was not possible to clearly establish whether Mediterranean diet has any effect on functionality, morning stiffness or quality of life as the certainty of the existing evidence has been assessed as very low.Se ha planteado que factores ambientales y relacionados con el estilo de vida pueden contribuir a la severidad y progresión de la inflamación en la artritis reumatoide. Una intervención que genera un alto interés, debido a sus supuestas propiedades antiinflamatorias es la dieta mediterránea.Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE.Identificamos siete revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, de los cuales sólo uno corresponde a un ensayo aleatorizado. Concluimos que la dieta mediterránea podría hacer poca o nula diferencia en el dolor articular o actividad de la enfermedad, y aumentar levemente el peso en pacientes con artritis reumatoide, pero la certeza de la evidencia es baja. Por otra parte, no es posible establecer con claridad si la dieta mediterránea tiene algún efecto sobre la funcionalidad, rigidez matinal o calidad de vida, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.

We report a 68 years old woman presenting with pain and swelling in her left elbow. An elbow magnetic resonance with gadolinium evidenced bone marrow infiltration and a bone infarct. Given these findings, a body CT scan was performed which showed multiple mesenteric adenopathies and a large retroperitoneal mass. A lymph node biopsy confirmed a B cell Lymphoma. Monoarthritis with no systemic manifestations represents a highly uncommon form of presentation of lymphoma. Moreover it usually affects inferior limbs, particularly in the presence of bone infarction.

ObjectivesTo evaluate if optimal dose of either oral or injectable regimens of methotrexate (MTX) of 25 mg/week was used in the comparator arms of studies comparing biologic drugs with MTX in rheumatoid arthritis (RA).MethodsA systematic literature search was carried out in MEDLINE, EMBASE and the Cochrane Library databases for randomised controlled trials comparing biologics with MTX in RA. A systematic review was performed among studies that met predefined criteria focusing on assessment of dose of MTX used in the comparator arm. Study authors were contacted when necessary. Study quality was assessed.ResultsA total of 3276 references were identified and 13 trials were included. We obtained maximal dose and regimen for all. The maximal dose of MTX used in the comparator arm of the trials was no more than 20 mg/week in any trial and for all but one trial, MTX was given orally and not by injection. The trial that used an injectable form reached a maximum of 15 mg/week.ConclusionsA suboptimal dose of MTX was used in biological clinical trials performed in RA, particularly regarding route of administration. This may have biased findings in favour of biological agents.

Biologic anti-rheumatic drugs are used with less frequency among older patients compared to young patients. This population is less represented in studies performed to evaluate the efficacy and safety of this drugs. We aimed to assess the efficacy and safety of biological agents between the older RA patients compared to young.A comprehensive, systematic search was conducted in major indexing databases using key terms for RA and each biological agent. The review process was completed by 2 investigators. Both randomized controlled trials and observational studies of at least 6-month duration conducted in adult RA patients were included. Outcomes of interest were clinical efficacy and safety. Effect-estimates were pooled using random-effects modeling if 4 or more studies used the same scale and time-frame for measuring outcomes.24 studies (16 focusing on anti-TNF agents) representing 63,705 patients (24% were older) were included. Older RA patients had worse baseline RA disease activity, longer disease duration at the time of enrollment in the trial (14.4 ± 3.6 vs. 10.9 ± 3.6 years; p 0.001) and higher steroid use (73.2 vs. 64.7%, p 0.001) than younger. 5 out of 6 studies assessing anti-TNF agents showed worse efficacy outcomes in older patients. The pooled OR of infection and ADRs with anti-TNF agents in older compared to young RA patients was OR 1.59 (95% CI: 1.45-1.76) and 1.40 (95% CI: 1.23-1.61) respectively.Older patients had worse safety and efficacy with biological agents but also had worse baseline disease activity. There was significant heterogeneity in reporting outcomes and very limited studies in biological agents other than anti-TNF drugs.

Background Rheumatoid arthritis (RA) patients are disproportionately older (33% >60 years). With improved biologic therapy for RA, there is a need to understand the efficacy and safety of biologic therapies in older RA (oRA) patients. Objectives To systematically review published literature to summarize the available evidence of efficacy and safety of biologic agents in oRA compared to young RA (yRA) patients. Methods A search in EMBASE, MedLine, Toxline, clinicaltrials.gov and Cochrane database was performed to identify clinical trials (RCT) and observational (OBS) studies of >6 months comparing the efficacy and safety of biologic agents in oRA relative to yRA. The biologics of interest were all anti-TNF agents, abatacept (ABA), tocilizumab (TCZ), rituximab (RTX) and tofacitinib (TOF). English language studies conducted in adult RA that reported age-associated outcomes were included. Studies assessing juveniles, inflammatory arthritis or not reporting older age outcomes were excluded. Safety outcomes included infections, adverse drug reactions (ADR), and malignancy. 2 independent rheumatologists reviewed abstracts, full text articles, and abstracted data from included articles. Conflicts were resolved by a 3rd reviewer. Abstracted data was summarized and evaluated for use within a meta-analysis Results Of 5353 abstracts, 187 were identified for full text review and 32 articles were included in this review. Articles were focused on efficacy (n=9), safety (n=15), or both (n=8). Most articles (n=22; 69%) focused on anti-TNF agents, then TCZ (n=4), ABA (n=2), TOF (n=2), RTX (n=1) and all biologics (n=1). Most studies were OBS studies (n=28, 88%) and fewer (n=4) were post-hoc analyses of RCT. In total, 99947 unique patients were identified, of which ∼24% were older. Most studies used valid definitions of RA and outcomes; only 25% of the studies have Out of the 12 efficacy studies focusing on anti-TNF agents, 9 (75%) showed a reduced efficacy in oRA on DAS28, HAQ, CDAI, SDAI, EULAR or ACR response scales relative to yRA. Studies focusing on TCZ (n=2) and RTX (n=1) also showed a reduced efficacy in oRA. OBS studies in ABA (n=2) showed comparable efficacy in oRA and yRA. Meta-analysis was limited by heterogeneity. Safety was the focus of anti-TNF (n=15), TCZ (n=3), 2 on TOF (n=2), 1 on ABA (n=1), RTX and all biologics (n=1) studies. Among these 23 safety studies, 74% (n=17) demonstrated worse safety outcomes in oRA. like in oRA. Of studies focusing on infection in anti-TNF agents, 82% (9 of 11) reported increased risk in oRA. Among the anti-TNF studies, 2 out of the 4 (50%) measured more ADR in oRA. A meta analysis of 4 studies reporting infectious outcomes in anti-TNF agents at >1 year found a pooled risk estimate was 1.59 (95% CI 1.45–1.76). Conclusions There is heterogeneity within the literature of biological agents in RA, particularly when age is considered. Given the anticipated population increase in the oRA, there is an urgent need for analysis of these medications in oRA patients for both safety and efficacy. Disclosure of Interest None declared

International audience; OBJECTIVE:To evaluate whether patients with RA who belong to the spectrum of fibromyalgic RA (FRA) have an impaired response to treatment measured by traditional activity scores.METHODS:Patients from the ESPOIR cohort were analysed. This prospective cohort included 813 patients with early arthritis not initially receiving DMARDs. Among the 697 patients who met RA classification criteria, we studied two groups, one with and the other without FRA. The following endpoints were compared at 6, 12 and 18 months using a mixed linear regression model: 28-joint DAS (DAS28), Simple Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and HAQ. In addition, attainment of low disease activity (LDA; DAS28

We appreciate the editorial Dr Kremer1 wrote regarding our article2 and we want to clarify some of the issues he raises. Dr Kremer states that there is no evidence of benefit from increasing the methotrexate dose from 20 to 25 mg ‘given the appropriate parenteral route of administration’. What he states is accurate; it is a bit misleading, as evidence does exist of the benefit of switching from oral to subcutaneous methotrexate, which was a focus of our paper. In a crossover trial …

Background: Arterial gasometry is considered the gold standard for establishing a diagnosis of respiratory failure of any etiology. However, there are some circumstances in which it loses specificity, making necessary to consider other tests such as pulse oximetry to adequately determine hypoxemia. We report a 67 years old patient with sudden hypoacusia, right hemiparesis and polypnea. His laboratory exams on admission, showed extreme hypoxemia in several readings, without correlation to the patient's clinical condition nor the pulse oximetry, and a leukocytosis of 800.000 cells x ml, with many immature cells. Chronic myeloid leukemia was diagnosed and treatment with hydroxyurea was initiated, achieving normalization in the arterial gases in accordance with the fall of the white cell count. Interpretation of laboratory findings according to the general clinical context of the patient allowed to suspect a spurious hypoxemia, saving the patient from unnecessary and risky interventions.

Arterial gasometry is considered the gold standard for establishing a diagnosis of respiratory failure of any etiology. However, there are some circumstances in which it loses specificity, making necessary to consider other tests such as pulse oximetry to adequately determine hypoxemia. We report a 67 years old patient with sudden hypoacusia, right hemiparesis and polypnea. His laboratory exams on admission, showed extreme hypoxemia in several readings, without correlation to the patient's clinical condition nor the pulse oximetry, and a leukocytosis of 800.000 cells x ml, with many immature cells. Chronic myeloid leukemia was diagnosed and treatment with hydroxyurea was initiated, achieving normalization in the arterial gases in accordance with the fall of the white cell count. Interpretation of laboratory findings according to the general clinical context of the patient allowed to suspect a spurious hypoxemia, saving the patient from unnecessary and risky interventions.

The classical manifestations of Behçet disease are mouth ana genital ulcers, cutaneous lesions ana ocular involvement. The central nervous system is affected in 5 to 59% of the cases, usually in the form of meningoencephalitis or sinus venous thrombosis. We report a 17-year-old femóle presenting with a two weeks history of progressive headache, nausea and blurred vision. An initial magnetic resonance was normal. Fifteen days later she was admitted to the hospital due to progression of visual impairment. She gave a history of oral ulcers and arthralgias. A new magnetic resonance was normal. A lumbar puncture showed a cerebrospinal fluid with a protein concentration of 14 mg/dl, a glucose concentration of 64 mg/dl, 20 fresh red blood cells and a pressure of 26 cm H(2)0. The diagnosis of a pseudotumor cerebri, secondary to Behçet disease was raised and the patient was treated with colchicine and acetazolamide. The evolution was torpid and an anterior uveitis was also found. After discharge, she continued with oral and genital ulcers and was treated with infliximab. Despite treatment, headache persists.

The classical manifestations of Behçet disease are mouth ana genital ulcers, cutaneous lesions ana ocular involvement. The central nervous system is affected in 5 to 59% of the cases, usually in the form of meningoencephalitis or sinus venous thrombosis. We report a 17-year-old femóle presenting with a two weeks history of progressive headache, nausea and blurred vision. An initial magnetic resonance was normal. Fifteen days later she was admitted to the hospital due to progression of visual impairment. Shegave a history of oral ulcers and arthralgias. A new magnetic resonance was normal. A lumbar puncture showed a cerebrospinal fluid with a protein concentration of 14 mg/dl, aglucose concentration of 64 mg/dl, 20fresh red blood cells and a pressure of 26 cm H(2)0. The diagnosis of a pseudotumor cerebri, secondary to Behçet disease was raised and the patient was treated with colchicine and acetazolamide. The evolution was torpid and an anterior uveitis was alsofound. After discharge, she continued with oral and genital ulcers and was treated with infliximab. Despite treatment, headache persists.

Coronary thrombosis as a manifestation of the antiphospholipid syndrome is very uncommon. We report a 25 year-old male without known cardiovascular risk factors that suffered an acute myocardial infarction as the initial manifestation of the antiphospholipid syndrome. His coronary angiogram demonstrated a single thrombotic lesion in the anterior descending artery without coronary atheromatosis. Anticardiolipin, anti B2 Glycoprotein I antibodies, and lupus anticoagulant were all positive. Besides the usual management of the coronary thrombosis, the patient was treated with permanent oral anticoagulation. Three months later, a CT coronary angiogram showed complete reperfusion of the involved artery .

Coronary thrombosis as a manifestation of the antiphospholipid syndrome is very uncommon. We report a 25 year-old male without known cardiovascular risk factors that suffered an acute myocardial infarction as the initial manifestation of the antiphospholipid syndrome. His coronary angiogram demonstrated a single thrombotic lesion in the anterior descending artery without coronary atheromatosis. Anticardiolipin, anti B2 Glycoprotein I antibodies, and lupus anticoagulant were all positive. Besides the usual management of the coronary thrombosis, the patient was treated with permanent oral anticoagulation. Three months later, a CT coronary angiogram showed complete reperfusion of the involved artery .

Para determinar el grupo de compatibilidad y sensibilidad a fungicidas de aislamientos de Phytophthora capsici presentes en el estado de Guanajuato, México, en 1999 se colectaron raíces de chile infectadas por este patógeno en cuatro localidades de los municipios de Salvatierra y Silao. De este material se obtuvieron ocho aislamientos, los cuales se cultivaron en medio de jugo de tomate-agar para la producción de oosporas, y en harina de maíz agar para la producción de esporangios. Del total de aislamientos, cuatro fueron del grupo A1 y cuatro del grupo A2. De 14 aislamientos evaluados para sensibilidad a fungicidas, nueve fueron insensibles a azoxystrobin, metalaxyl y propamocarb, y sensibles a 2tiocianometiltiobenzotiasol (TCMTB); cuatro fueron insensibles a azoxystrobin y propamocarb, y sensibles a metalaxyl y TCMTB; y uno fue insensible a propamocarb y sensible a azoxystrobin, metalaxyl y TCMTB. Los cuatro aislamientos del grupo A1 y tres del tipo A2 fueron insensibles a metalaxyl. Los resultados obtenidos de compatibilidad fisiológica y sensibilidad a fungicidas, indican la presencia de variabilidad de P. capsici en la región Centro de México

Introduction Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by microvascular damage, inflammation, and fibrosis. It has become increasingly evident that platelets, beyond regulating hemostasis, are important in inflammation and innate immunity. Platelets may be an important source of proinflammatory and profibrotic cytokines in the vascular microenvironment. In this study, we sought to assess the contribution of platelet-derived factors in patients with SSc to the angiogenesis of human dermal microvascular endothelial cells (DMVECs) in a tubule formation assay and to characterize the secretion of profibrotic and proinflammatory cytokines in these platelets. Methods We analyzed platelets obtained from 30 patients with SSc and 12 healthy control subjects. Angiogenesis was evaluated in vitro with a DMVEC tubule formation assay on Matrigel and platelet-derived angiogenic factors such as vascular endothelial growth factor (VEGF), 165b isoform (VEGF165b), and cytokine secretion was evaluated. Platelet serotonin content was also determined. Results When DMVECs were incubated with SSc platelet releasates, tubule formation was significantly inhibited (p