Search

Introducción: las manifestaciones hematológicas en el lupus eritematoso sistémico (LES) son frecuentes. La leucopenia se presenta del 50 al 60% de los casos, pero solo el 17% tiene un recuento leucocitario

Resumen Introducción: las manifestaciones hematológicas en el lupus eritematoso sistémico (LES) son frecuentes. La leucopenia se presenta del 50 al 60% de los casos, pero solo el 17% tiene un recuento leucocitario

BackgroundInterstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) account for 60% of deaths related to scleroderma (SSc). The erythrocyte distribution width (RDW) has been used as a marker of poor prognosis in different pathologies. In SSc, RDW has been found to be elevated in PAH and has been proposed as a predictor of cardiorespiratory compromise.ObjectivesThe aim of this study is to evaluate the association between increased RDW and the presence of EPI in patients with SSc.MethodsThis is a multicenter, retrospective, cross-sectional study of patients diagnosed with SSc (ACR/EULAR 2013) from January 2011 to August 2021. Other concomitant autoimmune diseases, malignancy, active infections, iron-deficiency or pernicious anaemia and transfused patients were excluded. The diagnosis of PID was made by high-resolution computed tomography (HR-CT) and the extension evaluated by Goh criteria. A review of medical records was conducted, collecting clinical and demographic characteristics, interstitial pattern by HR-CT, assessed, acute phase reactants, capillaroscopy, functional respiratory tests (PFT) and echocardiographic resolution. Patients diagnosed with PAH by right heart catheterization were not excluded in this study but recorded.ResultsSeventy-five patients were included, with a mean age of 59.4 (SD 14.1 CI95% 56-6), from which 67 (89%) were women. A median of 8 years of disease evolution was observed RIC 8). Limited SS was observed in 50 (66%) and diffuse SS in 24 (32%). EPI was observed in 50 (66%) of which NSIP 25 (33%), NSIP-f 15 (20%) and UIP 10 (13%). The extension of the disease was limited in 25 (33%) and extensive in 19 (25%). Capillaroscopic findings were normal in 2 (3.4%), nonspecific in 1 (1.7%), early SD in 9 (15.3%), active SD in 22 (37.3%), and late SD in 25 (42.4%); in sixteen patients there was no capillaroscopy.We observed an increase in RDW in the EPI group with a statistically significant difference OR 6.06 CI95% 2-17 (p 0.001).The median RDW is higher in patients with ILD and PAH than in healthy people (pWe found a low negative correlation between RDW / FVC r (63) -.25 p 0.042 and RDW / FEV1 r (63) .30 p 0.015.ConclusionIn the present study we have been able to evidence that there is a statistically significant relationship between the percentage of RDW and the presence of PID. When analysing the association between patients without pulmonary compromise, ILD and PAH and the percentage of RDW, we were able to find a statistically significant difference between the three groups. It is necessary to continue with studies with a larger number of patients to grant robustness to the results.References[1]Muangchan, et al: 15% rule in SSc. The Journal of Rheumatology 2013; 40; 9; doi:10.3899/jrheum.121380.[2]Cottin and Brown. Interstitial lung disease associated with systemic sclerosis (Ssc-ILD) Respiratory Research (2019) 20:13[3]Thayer, T. E. et al. Unbiased Phenome-wide Association Studies of Red Cell Distribution Width Identifies Key Associations with Pulmonary Hypertension. Annals of the American Thoracic Society. doi:10.1513/annalsats.201809-594oc.[4]Zhao J,Mo H, Guo X,Wang Q, Xu D, Hou Y, Tian Z, Liu Y,Wang H, Lai J, Li M, ZengX (2018) Red blood cell distribution width as a related factor of pulmonary arterial hypertension in patients with systemic sclerosis. Clin Rheumatol 37:979–985.[5]Goh NSL, Desai SR, Veeraraghavan S, et al. Interstitial Lung Disease in Systemic Sclerosis: A Simple Staging System. American Journal of Respiratory and Critical Care Medicine. 2008. June;177(11):1248–54.[6]Hax V, Bredemeier M, Didonet Moro AL, et al. Clinical algorithms for the diagnosis and prognosis of interstitial lung disease in systemic sclerosis. Seminars in Arthritis and Rheumatism. 2017. October;47(2):228–34.[7]Peralta S. Guías Argentinas De Consenso En Diagnóstico Y Tratamiento De La Hipertensión Pulmonar. Sociedad Argentina de Cardiología. Área de Consensos y Normas. Vol 85 Suplemento 3. Octubre 2017.AcknowledgementsParticipating centersDisclosure of InterestsNone declared

In this paper, we tackle the Beta anomaly, namely the fact that high-Beta assets tend to be associated with lower risk-adjusted returns than low-Beta assets, and connect it to mutual funds' expectations. We present a model with two types of investors, mutual funds and hedge funds, with heterogeneous market expectations and margin constraints. We show that the Beta anomaly is especially present for stocks purchased by over-optimistic mutual funds. On the empirical side, we first introduce a mutual fund-level measure of market expectations. Then, portfolio analyses and regressions confirm the model's prediction. The results are robust to alternative definitions of the mutual funds’ market beliefs variable that correct for stock picking, and carry predictive power for mutual funds' returns.

Introducción: La glomerulonefritis rápidamente progresiva (GNRP) no se presenta como manifestación extraarticular de la Artritis Psoriasica (APs). Las GNRP son frecuentemente relacionadas a vasculitis ANCA asociadas (VAA). Según la bibliografía, no es inusual encontrar depósitos de inmunocomplejos (IC) en las lesiones glomerulares de VAA. Existen publicaciones de casos en donde la presencia de una VAA podría estar asociada a la terapia con anti-TNFα. Caso: Mujer de 56 años de edad con artritis psoriásica en tratamiento con metotrexato y etanercept. Debido a infección de vías aéreas suspende etanercept y, posterior a la suspensión, evoluciona con síndrome nefrítico con biopsia renal que evidencia GN con depósitos de IC poco característicos y ANCA c / PR3 (+) en altos títulos.Conclusiones: Presentamos una paciente en la cual la manifestación de dos entidades, aparentemente no relacionadas, representa un reto diagnóstico y terapéutico. La relación con el tratamiento anti-TNFα ha sido descripta, aunque no pueda demostrarse su relación causal. La mayoría de las biopsias renales de las VAA no presentan depósitos inmunes en la IF; aunque en un porcentaje bajo pueden visualizarse grados variables de complemento e inmunocomplejos.

Background:SARS-CoV-2 infection can present with a broad clinical spectrum, from asymptomatic to lethal. Different risk factors have been recognized. Socio-economic status and educational level may affect access to the healthcare system and therefore COVID-19 infection outcome.Objectives:The aim of this study was to assess the association between socio-demographic status and educational level and SARS-CoV-2 outcomes, such as hospitalization, ICU admission, need for mechanical ventilation and death, in Argentinean patients with rheumatic diseases from the SAR-COVID Registry.Methods:We performed a cross-sectional study of consecutive adult patients with rheumatic diseases and SARS-CoV-2 infection included in the multicentric Argentinean SAR-COVID Registry. The following variables were included: gender, ethnicity, age, health insurance, educational level (under or over 12 years of education), socio-economic level according to Graffar Scale in high, medium-high, medium, medium-low, low; underlying rheumatic disease, its duration and treatment at the time of infection.SARS-CoV-2 infection outcomes were: hospitalization, admission to ICU, mechanical ventilation requirement and death.Statistical analysis was performed using Chi2, Fisher, T-test, ANOVA.Results:Five hundred and twenty-five patients were included, 422 (80.4%) were female, with a mean age of 51.3 years (SD 15.2). Most of them were caucasians (48%) or mestizos (43%) and 96.8% lived in an urban environment. Almost half of the patients (47%) were categorized as middle-class, 24% middle-high or high class, 21% middle-low or low. 48.4% of the patients were employed. Regarding educational level, 54% had more than 12 years of education.The most prevalent rheumatic disease was Rheumatoid Arthritis (40.4%), followed by Systemic Lupus Erythematosus (14.9%), Sjögren (5.5%) and Psoriatic Arthritis (5.5%). Treatments used at the time of SARS-CoV-2 infection were corticosteroids (19%), cs-DMARDs (49%), and b- and ts-DMARDs (16%).Overall hospitalization frequency was 35%, median hospital stay was 10 days (IQR 10 days), 11.6% were admitted to the ICU, 10% required mechanical ventilation and the global mortality was 8%.Notably, patients with less than 12 years of education required mechanical ventilation more frequently than the more educated ones (11.9% vs. 5.6%, p=0.026) and showed a higher mortality due to COVID-19 (9% vs. 2.8%, p=0.0004).Patients categorized as upper social classes (middle-high and high) were admitted to the hospital on a more frequent basis (74.4% of cases), when compared with middle class (64.4%) and middle-low and low class (58%) (p=0.77). Median duration of hospitalization for the aforementioned groups was 12.5 (IQR 17.3), 10 (IQR 9) and 10.5 (IQR 9.3) days respectively (p=0.60).Patients with health insurance were found to be hospitalized more frequently in comparison to those without insurance (42.4% vs. 33.7%, p=0.14), but showed similar admission rates to the ICU (11.8% vs. 12.8%; p=0.78), need for mechanical ventilation (10.7% vs. 8.7%; p=0.70) and mortality (7.1% vs. 6.5%; p=0.99).Caucasian patients had fewer hospital admissions when compared against other ethnicities (mestizos mostly) (26.1% vs. 43.4%; pConclusion:Patients with lower educational level needed twice the frequency of mechanical ventilation, and showed thrice the mortality than those with more than 12 years of education.Albeit patients in upper social stratus and those with health insurance were admitted to the hospital in a more frequent manner, no statistically significant differences were found regarding the need for ICU, mechanical ventilation or mortality.Caucasians were hospitalized less frequently than mestizos, but had no significant differences in the other measured outcomes.Disclosure of Interests:Laura Sorrentino Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Jonathan Rebak Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Federico Maldonado Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Vanessa Viviana Castro Coello Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Alejandro Brigante Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Adriana Hamaui Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Diana Dubinsky Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Roberto Baez Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Cecilia Pisoni Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carla Gobbi Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Leandro Carlevaris Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Romina Tanten Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Adriana Karina Cogo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria DeLaVega Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Rodolfo Perez Alamino Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria Alicia Lazaro Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Mariana Pera Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Susana Isabel Pineda Vidal Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria Elena Calvo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Debora Guaglianone Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carla G Alonso Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Mara Guinsburg Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Cinthya Retamozo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carolina Aeschlimann Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Rosana Quintana Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Karen Roberts Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carolina Ayelen Isnardi Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Guillermo Pons Estel Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.

El presente trabajo analiza las posibles alternativas que los productores y acopiadores de Sorgo y Girasol podrían utilizar para disminuir la volatilidad de sus cosechas y acopios, sin la necesidad de pactar una venta a futuro en vista de la inexistencia de un mercado de derivados financieros para estos activos.\nMediante análisis estadístico es posible analizar la factibilidad de utilizar instrumentos financieros derivados actualmente disponibles en el mercado para otros activos y determinar si éstos pueden ser aplicados a los granos bajo análisis. Subsiguientemente, vía modelos de simulación continua es posible determinar patrones de comportamiento de la variable precio en los cultivos, lo cual posibilita el diseño de una opción exótica hecha a medida para estos activos.\nLa hipótesis general de este trabajo enuncia que es posible disminuir la volatilidad del retorno de un cultivo para el cual no existe un mercado de futuros propio mediante la implementación de una cobertura cruzada u opción exótica.\nLos resultados obtenidos no refutan la hipótesis general, pudiéndose verificar disminuciones en la volatilidad de la cosecha o acopio en los casos donde el productor o acopiador hayan tomado cobertura utilizando la opción exótica diseñada. Los resultados también indican que no es posible adoptar una política de cobertura cruzada con los contratos futuros de otros activos para el Sorgo y el Girasol.\nLa implicancia de estos resultados sugiere que los productores y acopiadores pueden contar con un instrumento financiero derivado operado en el mercado formal y regulado, gozando de las garantías de cumplimiento las cuales no están siempre presentes en los acuerdos de ventas pactadas a futuro.\nComo limitaciones al alcance se considera el plazo del período de estudio debido a la disponibilidad estadística de los datos hacia el pasado. Extender este estudio hacia futuro posibilitará una mejor calibración del modelo y brindará un mayor nivel de precisión en cuanto la efectividad de la cobertura resultante de la toma de la opción. Fil: Hamaui, Eduardo Martin. Universidad de Buenos Aires. Facultad de Ciencias Económicas

The paper investigates how the characteristics of the distribution network and the affiliation to a banking group affect mutual funds performance exploiting a unique dataset with extremely detailed information on funds’ portfolios and bank-issuer relationships for the period 2006-2017. We find that bank-affiliated mutual funds underperform independent ones. The structure of the distribution channels is a key-factor affecting mutual funds' performance: when bank platforms become by far the prevalent channel for the distribution of funds’ shares, asset management companies are captured by banks. As for bank affiliation, results show a positive bias of bank-controlled mutual funds towards securities issued by their own banking group clients (of the lending and investment banking divisions) and by institutions belonging to their own banking group; this last bias is exacerbated for mutual funds belonging to undercapitalized banking groups. The structure of the distribution channels explains two thirds of bank-affiliated mutual funds underperformance, whereas investment biases explain one fourth of the observed differential in returns with independent mutual funds.

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune de etiología aún desconocida, afecta a individuos genéticamente predispuestos. Es desencadenado por factores hormonales, estrogénicos, ambientales y virales como hepatitis B/C, citomegalovirus (CMV), herpes o parvovirus B19 (PVB19). El PVB19 puede afectar diferentes órganos y presentar manifestaciones clínicas e inmunológicas, similares a las que se observan en pacientes con LES. Se han descripto alteraciones inmunológicas hasta en 79% de los pacientes con infección asociada por PVB19, principalmente positivización de anticuerpos antinucleares (ANA).

Background Rheumatoid factor (RF) in SLE is found in around 25% of patients. Authors associate it with cutaneous involvement, Sicca, anti Ro (+) and a protective role in glomerulonephritis (GMN), suggested by the finding of less frequent and less severe nephritis in lupus patients with RF(+) as in patients with RA. The proposed protective mechanisms of RF include preventing the complement from joining immune-complexes (IC) and avoiding the IC deposit in the glomerulus. We aimed to determine the clinical and immunological profile of SLE patients with and without RF and to determine the association between RF and GMN. Methods Descriptive, retrospective study of SLE (SLICC 2012) patients selected from Rheumatology department of Guemes Hospital, from January 2015-August 2018. We collected data on demographics, cutaneous-articular, renal, hematological and CNS involvement. Immunoserology: RF IgM by immunoturbidimetric (+)>30 UI/ml, anti Ro, anti La, anti Sm, anti RNP (ELISA), ANA (Hep 2), Anti DNA (Crithidia lucilliae), C3, C4, aPL at least one of the following: LI, anti 2GP1 IgG/IgM, Anti aCL IgG/IgM. Statistical Analysis: Epiinfo version 7.2.0.1. Results We reviewed 147 clinical histories, 107 with RF ordered. Female 93/107 (86.9%), mean age 41.6 years (SD ±13.8). Disease duration 98 months (SD ±80.6). Tobacco exposure 10/107 (9.35%). RF (+) 22/107 (20.5%), RF median titer 228.8 IU/ml (31–2825 IU/ml). RF level in patients with GMN was 142 IU/ml (39–191), without GMN 258 IU/ml (31–2825) p=0.46. RF level in patients with anti Ro (+) was 248 IU/ml (31–2825), Ro (-) 52.5 IU/ml (31–74) p=0.37. RF (-) subgroup showed statistically significant association with female sex, discoid lesions and aPL presence. RF(+) was associated with Ab Ro, La and patients with RA. (Table 1). Not found significant association with: rash, photosensivity, oral ulcer, joint pain, arthritis, serositis, neurologic and hematological involvement. In those with GMN, we found a significant association with Ab Ro(+) in the absence of RF (table 1). Conclusions Similar RF frequency was found as the published literature. There was no association with nephritis but the mean RF titer was higher in patients without GMN. The detection of Ab clusters associated with RF may be useful to suggest absence of renal involvement. Funding Source(s): None

Background In SLE there is five times more risk of cardiovascular events (CV) compared to the general population. In Argentina, a prevalence of metabolic syndrome (MetS) was reported in 28%. The SLICC cohort found 36.5% of MS in the first 2 years of diagnosis. The neutrophil to lymphocyte ratio (NLR) is a marker of inflammation that relates the absolute count of neutrophils and lymphocytes, is a tool in the assessment of CV risk and systemic endothelial dysfunction. The NLR values reported in healthy is 1.65 (±1.47). Studies in SLE show that NLR is a marker of activity and nephritis. We aimed to determine the association of MetS with and without renal involvement, the relationship between NLR and MetS and relationship between NLR and disease activity. Methods Descriptive, cross-sectional study. Patients with SLE (SLICC 2012) of 18 years followed at the Guemes Hospital were included, between 06/2013 to 07/2018. Acute CV events, infections, pregnancy, diabetes and chronic kidney disease were excluded. Risk factors nontraditional were determined: antiphospholipid (aPL), GC, SLEDAI. MetS (NCEP ATP III criteria): Weight, height, abdominal perimeter (AP) and blood pressure. PCR, neutrophil and lymphocyte count, glucose, CT, TG, LDL, urea, creatinine, proteinuria/24hs, Anti DNA, C3, C4, aPL: LA, Anti B2GP and Anti aCL antibody. Statistical Analysis: Epi Info 7.2.0. Results A total of 42 patients were reviewed, 12 were excluded (incomplete data). Of 30 patients: 23 women (77%), mean age 39.3 (±SD 14.3), evolution of disease: 35 months (±SD 18.9), tobacco exposure: 11 (37%). Nephritis in 17 patients (51%). MetS: 13 (43.3%), components: AP increased 15 (50%), HDL low 11 (37%), hypertension 11 (37%), high TG 8 (27%), hyperglycemia 3 (10%). Overweight: 17 (57%). Mean BMI 27.4 (±DS 6.2). Characteristics of patients with and without MetS and relationship MetS and SLE with NLR. (Table). Conclusions In our series, a greater frequency of MetS was found than literature. No relationship was found between MetS with renal involvement; however patients with MetS had higher proteinuria and elevated CRP. No relationship was found between the NLR with MetS and nephritis. The NLR was higher in patients with SLEDAI 4. The high prevalence of MetS, proteinuria, elevated CRP and NLR in our population suggest persistent inflammatory activity and probable CV morbidity, so it is important to detect it from the onset of the disease. Funding Source(s): None

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune de etiología aún desconocida, afecta a individuos genéticamente predispuestos. Es desencadenado por factores hormonales, estrogénicos, ambientales y virales como hepatitis B/C, citomegalovirus (CMV), herpes o parvovirus B19 (PVB19). El PVB19 puede afectar diferentes órganos y presentar manifestaciones clínicas e inmunológicas, similares a las que se observan en pacientes con LES. Se han descripto alteraciones inmunológicas hasta en 79% de los pacientes con infección asociada por PVB19, principalmente positivización de anticuerpos antinucleares (ANA). Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology that affects genetically predisposed individuals. It is triggered by hormonal, estrogenic, environmental and viral factors such as hepatitis B/C, cytomegalovirus (CMV), herpes or parvovirus B19 (PVB19). PVB19 can affect different organs and present clinical and immunological diseases, as well as those observed in patients with SLE. Immunological alterations have been described in up to 79% of patients with infection associated with PVB19, mainly positivization of antinuclear antibodies (ANA).

Introducción: La glomerulonefritis rápidamente progresiva (GNRP) no se presenta como manifestación extraarticular de la Artritis Psoriasica (APs). Las GNRP son frecuentemente relacionadas a vasculitis ANCA asociadas (VAA). Según la bibliografía, no es inusual encontrar depósitos de inmunocomplejos (IC) en las lesiones glomerulares de VAA. Existen publicaciones de casos en donde la presencia de una VAA podría estar asociada a la terapia con anti-TNFα. Caso: Mujer de 56 años de edad con artritis psoriásica en tratamiento con metotrexato y etanercept. Debido a infección de vías aéreas suspende etanercept y, posterior a la suspensión, evoluciona con síndrome nefrítico con biopsia renal que evidencia GN con depósitos de IC poco característicos y ANCA c / PR3 (+) en altos títulos. Conclusiones: Presentamos una paciente en la cual la manifestación de dos entidades, aparentemente no relacionadas, representa un reto diagnóstico y terapéutico. La relación con el tratamiento anti-TNFα ha sido descripta aunque no pueda demostrarse su relación causal. La mayoría de las biopsias renales de las VAA no presentan depósitos inmunes en la IF; aunque en un porcentaje bajo pueden visualizarse grados variables de complemento e inmunocomplejos. Introduction: Anti-TNFα has changed the evolution and prognosis in psoriatic arthritis (PsA). Among the adverse events (AD) of these treatments, rapidly progressive glomerulonephritis (GNRP) has been described. In 80% of cases of GNRP, vasculitis is associated to ANCA (AAV). According to the literature, it is not unusual to find immune complex deposits (IC) in glomerular AAV lesions. There are publications of cases in which the presence of an AAV could be associated with the anti-TNFα therapy. Case: A 56-year-old woman with psoriatic arthritis under treatment with methotrexate and etanercept. Due to airway infection, etanercept is suspended and after the suspension evolves with nephritic syndrome with renal biopsy, which shows GN with uncharacteristic IC deposits and ANCA c / PR3 (+) in high titers. Conclusions: We present a patient in whom the manifestation of two entities, apparently unrelated, represents a diagnostic and therapeutic challenge. The relationship with the anti-TNFα treatment has been described, although its causal relationship can not be demonstrated. Most renal biopsies of AAV do not have immune deposits in the IF; although in a low percentage variable degrees of complement and immune complex deposits can be visualized.

La enfermedad de Still del adulto (ESA) es un proceso inflamatorio sistémico, de etiología desconocida, que se caracteriza por fiebre, artritis y eritema evanescente, además de valores elevados de ferritina sérica. Sin embargo, hasta la fecha, no hay una prueba definitiva de laboratorio o de imagen disponible para su diagnóstico, por lo tanto la ESA es un diagnóstico de exclusión. Presentamos el caso de una mujer de 44 años con manifestación cutánea atípica de ESA y cuadro clínico de 1 año de evolución caracterizado por fiebre de 40°C, linfadenopatía, hiperferritinemia, y que en la sistemática de estudio presentó positividad para anti-CCP (anticuerpo antipéptido cíclico citrulinado). Adult Still's disease (ASD) is a systemic inflammatory process, of unknown etiology, characterized by fever, arthritis and evanescent erythema, in addition to elevated serum ferritin values. However, to date, there is no definitive laboratory or imaging test available to diagnose it, therefore ASD is a diagnosis of exclusion. We present the case of a 44-year-old woman with atypical cutaneous manifestation of ESA and positivity of ACPA (anti-cyclic citrullinated peptide antibody).

This year, following the European Medicines Agency (EMA) relocation due to the Brexit process, the 13th Pharmacovigilance Conference organized by Medicines for Europe took place in Amsterdam, the Netherlands. The pharmaceutical industry is usually associated with the development and launch of new drugs for the market, but it is also committed to finding new ways of making existing drugs and processes (e.g., pharmacovigilance [PV]) more efficient and better for patients. In relation to this, a variety of topics were on the agenda at the conference, including updates on the progress of the EudraVigilance (EV) system for monitoring and analyzing potential drug-related adverse events, as well as highlights on the E.U. Network Strategy to 2025 and the EMA multi-annual work program related to big data acceptability, electronic product information (ePI) Key Principles and Roadmap for implementation, and work-sharing ongoing projects for achieving harmonization of requirements and processes. Adrian van den Hoven (Director General, Medicines for Europe) opened the conference looking towards the future, emphasizing what the current PV system needs to do in order to adapt to new landscapes. With big data, robotization, automation or globalization, there are many opportunities to streamline and become smarter on the horizon.

Italy is the first country to have experimented with both accruals and retrospective capital gains taxation along the lines suggested by Vickrey (1939) and Meade (1978). This paper describes the Italian experience, highlighting its peculiar features and the lessons that can be learned by other countries wishing to pursue these approaches. It illustrates the mechanics of the adjustments to the realization based capital gains tax and how far they diverge from the original proposals. The paper also draws attention to the administrative and political difficulties encountered in implementing the reform. These factors ultimately resulted in a repeal of retrospective taxation, and, in due course, may also entail the abolition of taxation on an accrual basis. The paper highlights the crucial role that financial intermediaries can play in lowering compliance costs under a proportional tax system and the effects on tax revenues.