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El confinamiento durante la pandemia COVID-19 aumentó el uso de la tecnología en la educación. En este trabajo se presenta un estudio descriptivo y correlacional, con un análisis estadístico de 29,180 respuestas de alumnos inscritos en un programa en línea para acreditar el bachillerato. Los resultados muestran diferencias significativas debido a la pandemia: se incrementó la matrícula, aumentó el porcentaje de alumnos que provienen de secundarias privadas y de aquellos que habían tomado previamente cursos en línea; los alumnos dedicaron más tiempo a sus cursos, se conectaron más desde sus casas y pasaron más tiempo en Internet.

Estudio descriptivo y correlacional, con enfoque cuantitativo y diseño no experimental, que compara los perfiles de estudiantes del Instituto de Aprendizaje en Línea (INSTAL), que ingresan al programa educativo virtual “Tu Prepa en 4 meses”, que los preparará para el examen nacional para obtener la acreditación del bachillerato. Con la información obtenida de la encuesta que se aplica en el curso de Inducción, y que fue respondida por 3,478 alumnos a lo largo de un año, se determinaron las variables de estudio. Se analizaron características entre los alumnos según su secundaria de procedencia. Los resultados muestran diferencias significativas entre los alumnos que estudiaron en secundaria pública y los que estudiaron en escuela privada. Los estudiantes provenientes de escuelas privadas, en comparación con los de públicas, son más jóvenes, tienen mayor nivel socioeconómico y sus padres tienen mayor escolaridad. Se observó mejor desempeño académico en los alumnos provenientes de escuelas públicas.

Objective To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD). Methods This was an observational, multicentre study of RA-ILD patients treated with at least one dose of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect. Results We studied 263 RA-ILD patients [150 women/113 men; mean (s.d.) age 64.6 (10) years]. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25–3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6–36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P Conclusion ABA may be an effective and safe treatment for patients with RA-ILD.

To study the predictive value of clinical remission definitions and ultrasound (US) examination on X-ray progression in rheumatoid arthritis (RA). This was an observational prospective multicenter 1-year follow-up cohort of RA patients with moderate disease activity (3.2 DAS28 ≤ 5.1) who started anti-TNF therapy. DAS28ESR, DAS28CRP, SDAI, CDAI, and ACR/EULAR remission criteria were applied and reduced 12-joint US examination was performed at baseline and at 6 and 12 months. At baseline and month 12, radiographs of hands and feet were obtained in a subset of patients. A blind independent reader scored radiographs. X-ray progression was defined as Sharp van der Heijde change score 1 and no progression was defined as ≤0. 319 of 357 patients completed the study; patients had a mean (SD) age of 53.5 (13.1) years, with a disease duration of 7.5 (7.1) years. Laboratory, clinical, and US values significantly improved at month 6, except CRP, with additional improvement at month 12. Remission and low disease activity rates increased at follow-up. In the subset of 115 patients with radiological studies, clinical remission by any definition was not significantly associated with X-ray progression. Patients without PD signal at baseline and month 6 were a lower risk of X-ray progression than patients with PD signal, OR 0.197 (95% CI 0.046-0.861) and 0.134 (95% CI 0.047-0.378), respectively. Absence of PD signal, but not clinical remission predicts lack of X-ray progression. A feasible 12-joint US examination may add relevant information to RA remission criteria.

Objective: To compare the prevalence of the main comorbidities in two large cohorts of patients with Primary Sjogren's Syndrome (pSS) and Systemic Lupus Erythematosus (SLE), with focus on cardiovascular (CV) diseases. Methods: Cross-sectional multicenter study where the prevalence of more relevant comorbidities in two cohorts was compared. Patients under follow-up from the SJOGRENSER (Spanish Rheumatology Society Register of pSS) and RELESSER (Spanish Rheumatology Society Register of SLE) registries, and who fulfilled the 2002-AECG and 1997-ACR classification criteria, respectively, were included. A binomial logistic regression analysis was carried out to explore potential differences, making general adjustments for age, sex and disease duration and specific adjustments for each variable, including CV risk factors and treatments, when it was judged appropriate. Results: A total of 437 pSS patients (95% female) and 2,926 SLE patients (89% female) were included. Mean age: 58.6 (p55-p75: 50.0-69.9) and 45.1 years (36.4-56.3), respectively (p

OBJECTIVE: Interstitial lung disease (ILD) is one of the most serious complications of rheumatoid arthritis (RA). In the present study, we aimed to assess the efficacy of abatacept (ABA) in patients with ILD associated to RA. METHODS: National multicenter, non-controlled, open-label registry study of RA patients with ILD treated with ABA. RESULTS: 63 patients (36 women) with RA-associated ILD undergoing ABA therapy were studied. The mean ± standard deviation age at the time of the study was 63.2 ± 9.8 years. The median duration of RA and ILD from diagnosis were 6.8 and 1 year, respectively. RA was seropositive in 55 patients (87.3%). In 15 (23.8%) of 63 patients the development of ILD was closely related to the administration of synthetic or biologic disease modifying anti-rheumatic drugs. After a follow-up of 9.4 ± 3.2 months, two-thirds of patients remained stable whereas one-quarter experienced improvement in the Modified Medical Research Council scale. At that time forced vital capacity remained stable in almost two-thirds of patents and improved in one out of five patients assessed. Also, diffusing capacity of the lung for carbon monoxide remained stable in almost two-thirds and showed improvement in a quarter of the patients assessed. At 12 months, 50% of the 22 patients in whom chest HRCT scan was performed due persistence of respiratory symptoms showed stabilization, 8 (36.4%) improvement and 3 worsening of the HRCT scan pattern. Eleven of 63 patients had to discontinue ABA, mainly due to adverse events. CONCLUSION: ABA appears to be an effective in RA-associated ILD. Funding: This work was partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from ‘‘Instituto de Salud Carlos III’’ (ISCIII), Spain.

En este texto se describe la construcción de un plan de estudios de biología de grado noveno para dos instituciones de la Secretaria de Educación del Distrito, teniendo como base el concepto estructurante de clonación. Lo anterior surge de la necesidad de diseñar y desarrollar estrategias que permitan una nueva arquitectura de los planes de estudio más coherentes, integrales y holísticos y que a la vez sean más cercanos a los intereses y realidad de los estudiantes.

El objetivo de este estudio fue analizar los niveles de estado de ánimo y ansiedad precompetitiva, según el nivel de los deportistas. Han participado un total de 183 deportistas con edades entre 26 y 59 años (M= 41.14; DT= 6.43); 179 eran hombres y solamente cuatro mujeres. Se utilizaron los siguientes instrumentos: Competitive State Anxiety Inventory-2 y Profile of Mood States. Se realizó un análisis multivariante de la varianza y se realizó el cálculo de la dispersión de los impactos a través de un programa informático diseñado para tal efecto. Se halló una relación directamente lineal entre el rendimiento, el vigor y la autoconfianza; y una relación inversamente lineal entre éste y la ansiedad somática. En las variables del estado de ánimo se encontró el denominado “perfil iceberg”. Respecto a la dispersión de los impactos se observó una descentralización con tendencia hacia la izquierda y hacia abajo, siendo mayor la dispersión a medida que desciende la categoría. Por otra parte los tiradores diestros agrupan a la izquierda y los zurdos a la derecha.

To compare the prevalence of the main comorbidities in 2 large cohorts of patients with primary Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE), with a focus on cardiovascular (CV) diseases.This was a cross-sectional multicenter study where the prevalence of more relevant comorbidities in 2 cohorts was compared. Patients under followup from SJOGRENSER (Spanish Rheumatology Society Registry of Primary SS) and RELESSER (Spanish Rheumatology Society Registry of SLE), and who fulfilled the 2002 American-European Consensus Group and 1997 American College of Rheumatology classification criteria, respectively, were included. A binomial logistic regression analysis was carried out to explore potential differences, making general adjustments for age, sex, and disease duration and specific adjustments for each variable, including CV risk factors and treatments, when appropriate.A total of 437 primary SS patients (95% female) and 2,926 SLE patients (89% female) were included. The mean age was 58.6 years (interquartile range [IQR] 50.0-69.9 years) for primary SS patients and 45.1 years (IQR 36.4-56.3 years) for SLE patients (P 0.001), and disease duration was 10.4 years (IQR 6.0-16.7 years) and 13.0 years (IQR 7.45-19.76 years), respectively (P 0.001). Smoking, dyslipidemia, and arterial hypertension were associated less frequently with primary SS (odds ratio [OR] 0.36 [95% confidence interval (95% CI) 0.28-0.48], 0.74 [95% CI 0.58-0.94], and 0.50 [95% CI 0.38-0.66], respectively) as were life-threatening CV events (i.e., stroke or myocardial infarction; OR 0.57 [95% CI 0.35-0.92]). Conversely, lymphoma was associated more frequently with primary SS (OR 4.41 [95% CI 1.35-14.43]). The prevalence of severe infection was lower in primary SS than in SLE (10.1% versus 16.9%; OR 0.54 [95% CI 0.39-0.76]; P 0.001).Primary SS patients have a consistently less serious CV comorbidity burden and a lower prevalence of severe infection than those with SLE. In contrast, their risk of lymphoma is greater.

Objectives. To identify patterns (clusters) of damage manifestations within a large cohort of SLE patients and evaluate the potential association of these clusters with a higher risk of mortality. Methods. This is a multicentre, descriptive, cross-sectional study of a cohort of 3656 SLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestations were identified. Then, overall clusters were compared as well as the subgroup of patients within every cluster with disease duration shorter than 5 years. Results. Three damage clusters were identified. Cluster (80.6% of patients) presented a lower amount of individuals with damage (23.2 vs 10096 in clusters 2 and 3. P < 0.001). Cluster 2 (11.4% of patients) was characterized by musculoskeletal damage in all patients. Cluster 3 0.096 of patients) was the only group with cardiovascular damage, and this was present in all patients. The overall mortality rate of patients in clusters 2 and 3 was higher than that in cluster 1 (P < 0.001 for both comparisons) and in patients with disease duration shorter than 5 years as well. Conclusion. In a large cohort of SLE patients, cardiovascular and musculoskeletal damage manifestations were the two dominant forms of damage to sort patients into clinically meaningful clusters. Both in early and late stages of the disease, there was a significant association of these clusters with an increased risk of mortality. Physicians should pay special attention to the early prevention of damage in these two systems.

OBJECTIVES: To estimate the incidence of severe infection and investigate the associated factors and clinical impact in a large systemic lupus erythematosus (SLE) retrospective cohort. METHODS: All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ?4 ACR-97 SLE criteria were retrospectively investigated for severe infections. Patients with and without infections were compared in terms of SLE severity, damage, comorbidities, and demographic characteristics. A multivariable Cox regression model was built to calculate hazard ratios (HRs) for the first infection. RESULTS: A total of 3658 SLE patients were included: 90% female, median age 32.9 years (DQ 9.7), and mean follow-up (months) 120.2 (±87.6). A total of 705 (19.3%) patients suffered ?1 severe infection. Total severe infections recorded in these patients numbered 1227. The incidence rate was 29.2 (95% CI: 27.6-30.9) infections per 1000 patient years. Time from first infection to second infection was significantly shorter than time from diagnosis to first infection (p < 0.000). Although respiratory infections were the most common (35.5%), bloodstream infections were the most frequent cause of mortality by infection (42.0%). In the Cox regression analysis, the following were all associated with infection: age at diagnosis (HR = 1.016, 95% CI: 1.009-1.023), Latin-American (Amerindian-Mestizo) ethnicity (HR = 2.151, 95% CI: 1.539-3.005), corticosteroids (?10mg/day) (HR = 1.271, 95% CI: 1.034-1.561), immunosuppressors (HR = 1.348, 95% CI: 1.079-1.684), hospitalization by SLE (HR = 2.567, 95% CI: 1.905-3.459), Katz severity index (HR = 1.160, 95% CI: 1.105-1.217), SLICC/ACR damage index (HR = 1.069, 95% CI: 1.031-1.108), and smoking (HR = 1.332, 95% CI: 1.121-1.583). Duration of antimalarial use (months) proved protective (HR = 0.998, 95% CI: 0.997-0.999). CONCLUSIONS: Severe infection constitutes a predictor of poor prognosis in SLE patients, is more common in Latin-Americans and is associated with age, previous infection, and smoking. Antimalarials exerted a protective effect. Spanish Foundation of Rheumatology. FIS/ISCIII (grant number PI11/02857). Dr. Pego-Reigosa is supported by Grant 316265 (BIOCAPS) from the European Union 7th Framework Programme (FP7/REGPOT-2012–2013.1).

The objective of this study is to determine the prevalence of fibromyalgia (FM) in systemic lupus erythematosus (SLE) patients and to study its relationship to depression and other SLE-related factors.A cross-sectional data analysis from the RELESSER-Transversal Spanish Registry, which includes SLE patients in a national multicentre retrospective charts review, was performed.patients who fulfilled ≥4 ACR 1997 SLE criteria. Main variables were disease duration, depression, sociodemographics, comorbidities, SLE activity symptoms, serological findings, therapies and different disease status indices. Statistical analyses included a descriptive, associative and logistic regression analyses. A literature review was performed.3,591 SLE patients were included, 90.1% women, 34.6 years of age at diagnosis (SD 14.6 years) and 93.1% Caucasians. FM prevalence was 6.2%. SLE patients with disease duration5 years showed more FM than those with duration5 years: 6.9% vs. 4.0%, respectively (p0.05). SLE-FM patients showed higher prevalence of depression compared to non-FM-SLE patients: 53.1% vs. 14.6%, respectively (p0.001). After adjusting by risk factors, the OR (CI) of suffering depression in FM-SLE patients was 6.779 (4.770-9.636), p0.001. The OR of having secondary Sjögren's 2.447 (1.662-3.604), p0.001, photosensitivity 2.184 (1.431-3.334), p0.001, and oral ulcers 1.436 (1.005-2.051), p=0.047.Prevalence of FM in Caucasian SLE patients was high compared to the general population, and was significantly higher in those in later stages of disease. SLE patients with depression showed a strong risk of developing FM. Photosensitivity, oral ulcers and secondary Sjögren's were the only SLE-related factors associated with FM.

The aim of the study was to identify and describe the patterns of use of tocilizumab in clinical practice to ensure safety and optimal management of rheumatoid arthritis (RA). This is a 12-month prospective observational study in patients with moderate or severe RA of ≥6 months’ duration who have started tocilizumab after failure of at least one previous disease-modifying antirheumatic drug (DMARD) including TNF inhibitors. For some analyses, patients were categorized by the use of tocilizumab as monotherapy or in combination, and by previous use of biological therapy. Overall, 379 were evaluable (84.4 % received tocilizumab after prior biologics and 78.4 % in combination with classic DMARDs). Tocilizumab was discontinued in 68/379 (17.9 %) patients after a median of 6.7 (3.7–10.4) months, mainly due to a lack of efficacy (24/379, 6.3 %) and adverse events (23/379, 6.1 %). Of 131 temporary interruptions of tocilizumab required in 101/379 (26.6 %) patients, 81/131 (61.8 %) were related to adverse events, and in 120/131 (91.6 %) cases, tocilizumab was reintroduced at 8 mg/kg. Thirty-six tocilizumab dose reductions occurred in 34/379 (9 %) patients due to abnormal laboratory values in 20/34 (55.6 %) cases. DAS28-ESR scores decreased from baseline (5.6 ± 1.0) to week 24 (3.0 ± 1.4) and week 52 (2.7 ± 1.3). DAS28 response differed between biologics-naive and biologics-experienced patients, both at weeks 24 and 52. In clinical practice, tocilizumab is effective in RA while retaining the expected safety and tolerability profile. Tocilizumab seems to be more effective for biologics-naive patients than for biologics-experienced patients, while it proves to be similarly effective when used in combination or monotherapy.

Lo transcendental de este estudio, consiste en divulgar en la Sociedad en General en nuestro país, pero sobre todo a la Comunidad Vallartense de los beneficios que se obtienen utilizando la Energía Solar, transformándola en Energía Eléctrica sin efectos de contaminación ambiental, para ser aplicada en el Centro Universitario de la Costa y en los Hogares de Puerto Vallarta, Jalisco. Es importante dar a conocer a los usuarios de la energía eléctrica, los consumos de watts requeridos en cualquier aparato electrodoméstico u equipo de oficina.Las incubadoras juegan un papel positivo en materia energética, así como en la obtención de apoyos económicos a través de las PIMEX y MIPYMEX que promueve el Gobierno Federal, Estatal y Municipal.Los estudiantes de las materias de Costos Básicos, Análisis Integral de los Elementos del Costo de la Carrera de la Licenciatura en Contaduría Pública del Centro Universitario de la Costa de la Universidad de Guadalajara realizan Proyectos en materia de Transformación de la energía solar a eléctrica, de ensamblaje y costeo de paneles solares.La Comisión Federal de Electricidad modifica a través de la Comisión Reguladora de Electricidad (CRE) Otorgar la opción de generar su propia energía, tanto en los comercios, residencias e industrias sin contaminar el medio ambiente generando energía limpia a través de paneles solares.

Objective.To investigate the response to therapy of entheseal abnormalities assessed with power Doppler (PD) ultrasound (US) in spondyloarthropathies (SpA).Methods.A total of 327 patients with active SpA who were starting anti-tumor necrosis factor (TNF) therapy were prospectively recruited at 35 Spanish centers. A PDUS examination of 14 peripheral entheses was performed by the same investigator in each center at baseline and at 6 months. The following elementary lesions were assessed at each enthesis (presence/absence): morphologic abnormalities (hypoechogenicity and/or thickening), entheseal calcific deposits, cortical abnormalities (bone erosion and/or proliferation), adjacent bursitis and intraenthesis and perienthesis (tendon body and/or bursa) PD signal. Response to therapy of each elementary lesion was assessed by calculating change in the cumulative presence from baseline to 6 months. Intraobserver reliability of PDUS was evaluated by blindly assessing the stored baseline images 3 months after the real-time examination.Results.Complete data were obtained on 197 patients who received anti-TNF therapy for 6 months. In 91.4% of the patients there were gray-scale or PD elementary lesions at baseline and at 6 months. Cumulative entheseal morphologic abnormalities, intraenthesis PD, perienthesis PD, and bursitis showed a significant decrease from baseline to 6 months (p < 0.05). There was high intraobserver reliability for all elementary lesions (interclass correlation coefficient > 0.90, p < 0.0005).Conclusion.Entheseal morphologic abnormalities, PD signal, and bursitis were US abnormalities that were responsive to anti-TNF therapy in SpA. PDUS can be a reproducible method for multicenter monitoring of therapeutic response in enthesitis of SpA.

To analyze patients attending rheumatology units of the public health service in Galicia (Spain).We performed a multicenter study. Outpatients from all rheumatology clinics of the Galician health service were included over a 1-week period.A total of 1,357 outpatients were studied (422 new patients and 935 follow-up patients). The mean ages were 55.1±15.6 and 56.9 ± 16.7 years, respectively. Among new patients, 22.5% had inflammatory disease, and 77.5% had noninflammatory disorders. The main source of patient referral was primary care. The overall kappa index in the analysis of agreement between the diagnosis of the referring physician and that of the rheumatologist was 0.8 (95% CI: 0.73-0.86). Agreement was appreciably lower in the group with inflammatory diseases. Among follow-up patients, those with a diagnosis of inflammatory disorders represented 63.4% of the total. This group showed a higher score in the HAQ test and had a greater frequency of patients with permanent work disability. Overall, patients with inflammatory disease required longer consultations than the remaining patients, and their discharge rate was considerably lower.In rheumatology outpatient clinics, patients with inflammatory diseases are more numerous, spend longer in consultations, have greater disability, are more likely to show permanent work disability, and tend to accumulate with the passage of time. Agreement was high in the diagnosis of noninflammatory diseases, contrasting with the high referral rate.

Background Currently, there is not substantial evidence about tocilizumab (TCZ) use for the treatment of rheumatoid arthritis (RA) outside of clinical trials. Objectives To describe usage patterns and dosage of TCZ, as well as its effectiveness and safety profile under real conditions of use. Methods This is a 12-month prospective, observational study carried out in 40 Spanish centers. The study population consisted of adult patients with moderate or severe RA and disease duration of ≥6 months who initiated treatment with TCZ after failure of at least one previous DMARD or TNF inhibitor. Final results are presented. Results A total of 379 patients were evaluated (83% female) with a median age of 57 years (47-66). At baseline, patients had mean disease duration of 12.1±8.2 years, 70.5% were rheumatoid factor positive and 68% anti-CCP positive. Mean baseline DAS28, SDAI, HAQ scores and CRP levels were 5.6±1.0, 22.9±15, 1.6±0.7 and 5.6±11.6 mg/dl, respectively. 78.4% of patients received TCZ in combination and 84.4% after prior use of biological agents. 97.6% of patients initiated TCZ at dose of 8 mg/kg. During the follow-up period, 68 (17.9%) discontinued TCZ treatment due to inadequate response (35.3%) and as result of adverse events (33.8%). At the end of follow-up, the mean DAS28 decreased significantly from baseline (5.6±1.0 vs 2.8±1.4; p Conclusions Final results of this study indicate that in daily clinical practice, tocilizumab is a safe and effective treatment for moderate or severe RA, with the majority of patients having a good EULAR response and a disease remission being achieved in 51.3% of patients. Tocilizumab proves to have a similar efficacy profile regardless of the use pattern as monotherapy or in combination, and the line-biological option may be used. Disclosure of Interest : None Declared

How the concept of the tuberous sclerosis complex (TSC) has developed over a period of time spanning 160 years has come form simple clinical observations, pathological studies and technological advances of imaging methods. It all began with PFO Rayer's color plate of a drawing of a patient who apparently had facial angiofibroma, published in the year 1835, and continued with von Recklinghausen's report of cardiac myomas and cerebral sclerosis in a newborn who had died minutes after birth. The seminal contribution was provided by D.M. Bourneville who, in 1880, reported and named as tuberous sclerosis the neuropathological findings in a young patient with seizures, hemiplegia, and mental subnormality who also had renal tumors. We now know that TSC is a hamartomatosis, and thanks to studies of recent years using positional cloning and DNA analysis, we are beginning to understand the biological mechanisms of these disorders which include NF1, NF2 and von Hippel-Lindau disease. Unique to TSC is that it is both phenotypically and genotypically heterogeneous. One of two suspected genes found in chromosome 16 by positional cloning has been cloned ( TSC2 ). Another one that was discovered earlier in chromosome 9 ( TSC1 ) has not yet been characterized. The gene product from TSC2 has been named tuberin .