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Background: Systemic lupus erythematosus (SLE) is associated with clinical burden for the patient and organ damage. The development of therapies for SLE has been constrained by clinical and biologic heterogeneity. These represent challenges in clinical trial design and endpoint selection. Objective: To identify the most relevant descriptors for efficacy, endpoints, disease activity, organ damage, quality of life (QoL), and Patient Reported Outcome Measures (PROMs) in the treatment of SLE. Methods: A Delphi study was conducted using a national expert panel of clinicians in the treatment of SLE. A steering committee composed of 3 opinion leaders with deep expertise in SLE treatment was defined. The steering committee analyzed and appraised the evidence, designed the Delphi study, defined the statements, and analyzed the expert panel responses. A 2-round Delphi survey was conducted. Participants were asked to rate the statements using a five-point Likert scale. Results: Nine experts participated in the Delphi survey. After the two rounds, the consensus was reached on 18 of the 23 statements: 2 statements were included in the “efficacy” domain, 2 in the “glucocorticoid-sparing” domain, 2 in the “endpoint evaluation” domain, 4 in the “score” domain, 1 in the “disease activity” domain, 1 in the “organ damage” domain, 1 in the “QoL” domain, 2 in the “PROMs” domain, 1 in the “AIFA monitoring” domain and 2 in the “extra” domain. No statements reached consensus within the “onset” domain. Conclusion: In this Delphi study, 18 statements across 11 domains were agreed upon for the treatment of SLE.

El objetivo del estudio fue establecer las propiedades psicométricas para Colombia de la Escala de Prejuicios Sutiles y Manifiestos elaborada por Pettigrew y Meertens (1995) y adaptada al español por Rueda y Navas (1996), tomando como población objetivo los inmigrantes venezolanos que han llegado a Colombia. La muestra fue de 1078 colombianos residentes en Barranquilla (Atlántico) seleccionados intencionalmente, con edades entre 18 y 78 años (M = 34.6 y DE = 13.4). Un 49% (n=523) eran hombres. Los resultados indican una consistencia interna para la escala global de α =.84 y ω = .85. La subescala de Prejuicio Sutil muestra una consistencia interna de α = .74 y ω = .75, y la de Prejuicio Manifiesto de α = .78 y ω = .80. Con el Análisis Factorial Confirmatorio se ratifica la estructura factorial, pero se cambia el ítem 17 de factor y se elimina el ítem 7, quedando en total con 19 ítems. Se describen las limitaciones.

Endometriosis is defined as the presence of endometrial tissue outside the uterus. The bowel is not often affected. There are no specific clinical findings for intestinal endometriosis. It is typically asymptomatic, but sometimes can present with abdominal pain, diarrhoea, constipation or intestinal obstruction. Ileal perforation is a rare complication of intestinal endometriosis and only a few cases have been reported in the literature. Intestinal endometriosis can mimic many gastrointestinal diseases, such as irritable bowel syndrome, inflammatory bowel disease, infections and neoplasms. The diagnosis is made by laparoscopy or laparotomy. We present a case of a woman with intermittent abdominal pain and ileal perforation secondary to intestinal endometriosis.

Objectives: To describe the use of genotype resistance testing (GRT) for virological failure in clinical practice, and the long-term clinical and virological evolution in patients for whom it is requested. To identify the predictive factors of virological failure in patients with antiretroviral (ARV) salvage therapy., Methods: Observational study in HIV-infected patients for whom GRT was requested for virological failure (VF) in the period of 1 October 1999 to 31 December 2001. Logistic regression analysis was used to determine the predictive factors of virological progression., Results: Over the period studied, 196 patients required GRT for VF (15%) among those monitored in specific units. GRT was mainly requested for patients who had been extensively pretreated for a mean of 5 years and with a median of 5 ARV combinations. Half the patients presented 3 or more mutations associated with thymidine analogs (TAMs), mutations associated with non-nucleoside analogs (NNRTIs), and 5 or more mutations associated with protease inhibitors (PIs). In 143 (74%) patients, the RTV regimen was changed on the basis of GRT results. In the intent-to-treat analysis, the percentage of patients with plasma VL < 400 cop/mL at 6, 12 and 18 months was 41%, 29% and 17%, respectively. In the on-treatment analysis, the results were 50%, 48% and 46%, respectively. Mean CD4 lymphocyte increase was 59.74 and 94 cells/mm 3. The variables predicting virological failure (plasma VL > 400 cop/mL) at 12 months were plasma VL > 30,000 cop/mL (OR 6, 1.8-19.5) and accumulation of 3 or more TAMs (OR 4.4, 1.3-15) at the start of ARV salvage therapy., Conclusion: Even though in clinical practice GRT is requested for patients with various treatment failures, when ART salvage treatment was started, plasma VL was undetectable and immunological response persisted in 40% of patients followed-up for 18 months. The factors best predicting virological evolution were VL and the number of baseline TAMs.

Tenofovir, a new nucleotide reverse transcriptase inhibitor that has good antiviral activity against drug-resistant strains of HIV, is structurally similar to cidofovir and adefovir and seems to be less nephrotoxic. Nephrotoxicity of cidofovir and adefovir is well established and they have been associated with increase for acute renal insufficiency due to tubular toxicity, possibly induced via mitochondrial deplection. Tenofovir has little mithocondrial toxicity in in vitro assays and early clinical studies. However some cases of renal tubular dysfuntion and renal failure related to tenofovir treatment have been published recently. Increased plasma concentrations of didanosine were observed after the adition of tenofovir and protease inhibitors can interact with the renal transport of organic anions leading to proximal tubular intracellular accumulation of tenofovir, yield Fanconi syndrome-type tubulopathy. We present a case in wich acute renal failure and proximal tubular dysfunction developed after therapy with tenofovir in a patiente with HIV who had suffered from complications of didanosine treatment. Although nephrotoxicity certainly occurs much less frequently with tenofovir that it does with other nuclotide analogues, use of tenofovir by patients with underlying renal disfuntion, for longer durations and/or associated with didanosine or lopinavir-ritonavir, might be associated with renal toxicity. Patients receiving tenofovir must be monitored for sings of tubulopathy with simple tests such us glycosuria, phosphaturia, proteinuria, phosphoremia and renal function, as well as assessment for signs of mithocondrial toxicity when a nucleoside analogue is being administered, and therapy should be stopped to avoid the risk of definitive renal failure.

Lipoid proteinosis is an infrequent disease characterized by the deposition of a PAS-positive diastase-resistant hyaline material in the skin and respiratory tract, although it can also be deposited in internal organs, in a generally asymptomatic manner. The earliest clinical manifestation is hoarseness. Clinical cutaneous manifestations come later, in the form of hyperkeratotic lesions located on the trunk, elbows, axillae, groins, backs of hands, palms and soles. A lesion typical of the disease is moniliform blepharosis, which consists of beaded papules along the eyelid margins. Also characteristic is the presence of comma-shaped intracranial calcifications in the temporal lobes. The course of the disease is progressive, with a normal life expectancy. It affects men and women equally, with worldwide distribution. The diagnosis is based on the clinical symptoms and the histology. At this time, there is no effective treatment for the disease. We present a case of lipoid proteinosis in a 23-year-old woman, with typical clinical and histological characteristics.

Objective: To analyze in-hospital and 2-year survival of patients who require mechanical ventilation with intubation after acute respiratory failure due to exacerbation of chronic obstructive pulmonary disease (COPD). The secondary objective was to identify the prognostic factors for in-hospital mortality and mortality at 2 years., Patients and Methods: We retrospectively studied 101 patients with suspected COPD admitted to the intensive care unit between July 1993 and December 1998. Variables potentially related to mortality were analyzed with a univariate model and by logistic regression., Results: In-hospital survival was 74.3% and 2-year survival was 55.4%. Survival at 2 years was 81% for patients discharged from hospital. The variables associated with in-hospital mortality were age greater than 65 years, electrocardiographic diagnosis of chronic cor pulmonale, and development of multiorgan dysfunction syndrome. No factors predictive of mortality at 2 years were identified., Conclusions: The in-hospital survival rate for patients with an acute exacerbation of COPD who require mechanical ventilation is good and the 2-year survival rate is acceptable. Age, electrocardiographic signs of cor pulmonale, and development of multiorgan dysfunction syndrome were associated with greater risk of in-hospital mortality.

Calciphylaxis is an unusual complication of chronic renal failure associated with increased morbidity and mortality. This presentation is a clinical case describing a patient parathyreidectomized in 1997, followed by the condition was clinically suspected and then confirmed by skin biopsy. PTHi levels above 400 pg/ml together with scintigraphic images suggesting parathyroid nodules resulted in the decision to try a new surgical procedure, which yielded two nodules of thyroideal tissue. After the surgery and in spite of this pathology result, the patient recovered completely from her symptoms. This corroborates the theory that the etiology of calciphylaxis is multifactorial, acquiring special relevance the use of calcium-containing phosphathe binders (representing a high risk of hypercalcemia) in the treatment of Chronic Renal Disease.