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Pathogenic strains of Escherichia coli threaten public health due to their virulence factors and antibiotic resistance. Additionally, the virulence of this bacterium varies by region depending on environmental conditions, agricultural practices, and the use of antibiotics and disinfectants. However, there is limited research on the prevalence of antibiotic-resistant E. coli in agriculture. Therefore, this research aimed to determine the antibiotic resistance of E. coli isolated from the Honeydew melon production system in Hermosillo, Sonora, Mexico. Thirty-two E. coli strains were isolated from 445 samples obtained from irrigation water, harvested melons, the hands of packaging workers, boxes, and discarded melons. The resistance profile of the E. coli strains was carried out to 12 antibiotics used in antimicrobial therapeutics against this bacterium; a high level of resistance to ertapenem (100%) was detected, followed by meropenem (97%), and ampicillin (94%); 47% of the strains were classified as multidrug-resistant. It was possible to identify the prevalence of the extended-spectrum β-lactamase (ESBLs) gene blaTEM (15.6%), as well as the non-ESBL genes qepA (3.1%) and aac(6′)lb-cr (3.1%). The E. coli strains isolated from irrigation water were significantly associated with resistance to aztreonam, cefuroxime, amikacin, and sulfamethoxazole/trimethoprim. Irrigation water, packing workers’ hands, and discarded melons showed a higher prevalence of antibiotic-resistant, ESBL, and non-ESBL genes of E. coli strains in a farm and packing facility of Honeydew melon in Hermosillo, Sonora.

BACKGROUND: The prevalence of atrial fibrillation(AF) and diabetes mellitus is rising to epidemic proportions. We aimed to assess the impact of diabetes on the management and outcomes of patients with AF.METHODS: The EORP-AF General Long-Term Registry is a prospective, observational registry from 250 centres across 27 European countries. Outcomes of interest were as follows: i)rhythm control interventions; ii)quality of life; iii)healthcare resource utilisation; and iv)major adverse events.RESULTS: Of 11,028 patients with AF, the median age was 71 (63-77) years and 2537 (23.0%) had diabetes. Median follow-up was 24 months. Diabetes was related to increased use of anticoagulation but less rhythm control interventions. Using multivariable analysis, at 2-year follow-up, patients with diabetes were associated with greater levels of anxiety (p = 0.038) compared to those without diabetes. Overall, diabetes was associated with worse health during follow-up, as indicated by Health Utility Score and Visual Analogue Scale. Healthcare resource utilisation was greater with diabetes in terms of length of hospital stay (8.1 (±8.2) vs. 6.1 (±6.7) days); cardiology and internal medicine/general practitioner visits; and emergency room admissions. Diabetes was an independent risk factor of major adverse cardiovascular event (MACE; HR 1.26 [95% CI, 1.04-1.52]), all-cause mortality (HR 1.28 [95% CI, 1.08-1.52]), and cardiovascular mortality (HR 1.41 [95% CI, 1.09-1.83]).CONCLUSION: In this contemporary AF cohort, diabetes was present in 1 in 4 patients and it served as an independent risk factor for reduced quality of life, greater healthcare resource utilisation and excess MACE, all-cause mortality and cardiovascular mortality. There was increased use of anticoagulation therapy in diabetes but with less rhythm control interventions.

Multi-drug resistant (MDR) bacteria have gained importance as a health problem worldwide, and novel antibacterial agents are needed to combat them. Silver nanoparticles (AgNPs) have been studied as a potent antimicrobial agent, capable of countering MDR bacteria; nevertheless, their conventional synthesis methods can produce cytotoxicity and environmental hazards. Biosynthesis of silver nanoparticles has emerged as an alternative to reduce the cytotoxic and environmental problems derived from their chemical synthesis, using natural products as a reducing and stabilizing agent. Sonoran Desert propolis (SP) is a poplar-type propolis rich in polyphenolic compounds with remarkable biological activities, such as being antioxidant, antiproliferative, and antimicrobial, and is a suitable candidate for synthesis of AgNPs. In this study, we synthesized AgNPs using SP methanolic extract (SP-AgNPs) and evaluated the reduction capacity of their seasonal samples and main chemical constituents. Their cytotoxicity against mammalian cell lines and antibacterial activity against multi-drug resistant bacteria were assessed. Quercetin and galangin showed the best-reduction capacity for synthesizing AgNPs, as well as the seasonal sample from winter (SPw-AgNPs). The SPw-AgNPs had a mean size of around 16.5 ± 5.3 nm, were stable in different culture media, and the presence of propolis constituents was confirmed by FT-IR and HPLC assays. The SPw-AgNPs were non-cytotoxic to ARPE-19 and HeLa cell lines and presented remarkable antibacterial and antibiofilm activity against multi-drug resistant clinical isolates, with E. coli 34 and ATCC 25922 being the most susceptible (MBC = 25 μg/mL), followed by E. coli 2, 29, 37 and PNG (MBC = 50 μg/mL), and finally E. coli 37 and S. aureus ATCC 25923 (MBC = 100 μg/mL). These results demonstrated the efficacy of SP as a reducing and stabilizing agent for synthesis of AgNPs and their capacity as an antibacterial agent.

Introduction Intensive care unit (ICU)-acquired weakness is developed by 40%–46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. Objective To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). Methodology Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. Results 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. Conclusions The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it.

Resumen Introduccion La debilidad adquirida en la unidad de cuidados intensivos (DAU) es desarrollada por el 40-46% de los pacientes ingresados en UCI. Diferentes estudios han mostrado que la movilizacion temprana (MT) es segura, factible, costo-efectiva y mejora los resultados del paciente a corto y largo plazo. Objetivo Disenar un algoritmo de MT para el paciente critico en general y enumerar unas recomendaciones para la MT en subpoblaciones especificas de paciente critico con mas riesgo para la movilizacion: neurocritico, traumatico, sometido a terapias continuas de depuracion renal (TCDR) y con dispositivos de asistencia ventricular (DAV) o membrana de oxigenacion extracorporea (ECMO). Metodologia Revision en las bases de datos Medline, CINAHL, Cochrane y PEDro de estudios publicados en los ultimos 10 anos, que aporten protocolos/intervenciones de MT. Resultados Se incluyeron 30 articulos. De ellos, 21 eran para guiar la MT en el paciente critico en general, 7 en pacientes neurocriticos y/o traumaticos, uno en pacientes portadores de TCDR y uno en pacientes portadores de ECMO y/o DVA. Se disenan 2 figuras: una para la toma de decisiones teniendo en cuenta el bundle ABCDEF y la otra con los criterios de seguridad y objetivo de movilidad para cada uno. Conclusiones Los algoritmos de MT aportados pueden promover la movilizacion precoz (entre el 1.er y 5.o dia de ingreso en UCI), junto a aspectos a tener en cuenta antes de la movilizacion y criterios de seguridad para suspenderla.

El objetivo de este estudio fue proponer un plan promocional como herramienta para elevar el valor de marca en el sector cooperativista. La técnica que se utilizó fue el método teórico para conocer los factores que influyen en la marca. Se utilizó también un muestreo probabilístico por estratos para obtener una muestra de 228 clientes potenciales entre 15 a 55 años específicamente de la ciudad de Ambato. Dentro de los resultados se evaluó el valor de marca a través de 5 componentes propuestos por Aaker y la construcción de un perfil de socio, con el fin de potencializar una ventaja competitiva en el mercado a través de la aplicación de un plan promocional. Se elaboró un plan promocional que personalice la relación con su público, para dar a conocer una nueva faceta de la cooperativa, empatizada y preocupada por las necesidades de sus socios. Además, engloba la captación del mensaje (presentación y contenido) con la utilización de estrategias de valor de marca, de acuerdo con los grupos sociales a quienes estén dirigidos, para obtener una decisión de compra favorable; así como los canales por los cuales difundir la información publicitaria.

Bimonthly samplings were carried out from March 1987 to January 1988 in San Quintín Bay, B.C., in order to determine the abundance of the alga Gigartina canaliculata Harvey (Bhodophyceae-Gigartinales). The highest biomass values obtained, expressed in dry weight, were 475 + 49 g/m2 in May, 545 ±88 g/m2 in July and 377 ± 47 g/m2 in September. Extrapolated to the total area of 400,000 m2, this represents 190 ± 19 tons, 218 ± 35 tons and 150 ± 19 tons, respectively. The lowest biomass value obtained was 120 ± 35 g/m2 in January, which extrapolated to the 400,000 m2, represents 48 ± 5.2 tons. The upwelling events that occur in San Quintín Bay at the end of spring and beginning of summer (Dawson, 1951; Alvarez-Borrego and Alvarez-Borrego, 1982) coincided with the highest biomass values recorded. The functional relation of wet weight versus dry weight had a regression coefficient r = 0.94 and was expressed by the equation y = 1.75 + 0.19 x. Sexual reproduction was maximum from September to January with 95% of the cystocarpic plants and minimum in May with 50%. The minimum reproduction in May and the highest percentage of sexually mature plants found during the autumn-winter season indicate a shift in the life cycle of G. canaliculata, caused in tum by a shift in seawater temperature which is controlled by upwelling events. The plants presented a quasi-homogeneous growth throughout the year (% proteins/% carbohydrates), with a growth index of 0.22-0.29 (0.29 corresponding to March).

Peroxisomicine A1 (PA1) is a toxin isolated from the

This investigation aimed to determine the effect of high-power ultrasonic pulses on the antioxidant, antibacterial, and antiproliferative activity of sorghum (Sorghum bicolor) lignin. A lignin yield of 7.35% was obtained using the organosolv method. Additionally, the best conditions of the ultrasonic pulses were optimized to obtain a more significant increase in antioxidant capacity, resulting in 10 min for all treatments, with amplitudes of 20% for DPPH and FRAP, 18% for ABTS, and 14% for total phenols. The effect of ultrasonic pulses was mainly observed with FRAP (1694.88 µmol TE/g), indicating that the main antioxidant mechanism of lignin is through electron transport. Sorghum lignin with and without ultrasonic pulses showed high percentages of hemolysis inhibition (>80%) at concentrations of 0.003 to 0.33 mg/mL. The AB blood group and, in general, all Rh- groups are the most susceptible to hemolysis. Lignin showed high anti-inflammatory potential due to heat and hypotonicity (>82%). A higher antimicrobial activity of lignin on Escherichia coli bacteria was observed. The lignins evaluated without sonication and sonication presented higher activity in the cell line PC-3. No effect was observed on the lignin structure with the FT-IR technique between sonication and non-sonication; however, the organosolv method helped extract pure lignin according to HPLC.

BACKGROUND: Cardiac troponins (cTn) have been reported to be predictors for adverse outcomes in atrial fibrillation (AF), patients, but their actual use is still unclear.AIM: To assess the factors associated with cTn testing in routine practice and evaluate the association with outcomes.METHODS: Patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry were stratified into 3 groups according to cTn levels as (i) cTn not tested, (ii) cTn in range (≤99th percentile), (iii) cTn elevated (>99th percentile). The composite outcome of any thromboembolism /any acute coronary syndrome/cardiovascular (CV) death, defined as Major Adverse Cardiovascular Events (MACE) and all-cause death were the main endpoints.RESULTS: Among 10 445 AF patients (median age 71 years, 40.3% females) cTn were tested in 2834 (27.1%). cTn was elevated in 904/2834 (31.9%) and in-range in 1930/2834 (68.1%) patients. Female sex, in-hospital enrollment, first-detected AF, CV risk factors, history of coronary artery disease, and atypical AF symptoms were independently associated with cTn testing. Elevated cTn were independently associated with a higher risk for MACE (Model 1, hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.40-2.16, Model 2, HR 1.62, 95% CI 1.28-2.05; Model 3 HR 1.76, 95% CI 1.37-2.26) and all-cause death (Model 1, HR 1.45, 95% CI 1.21-1.74; Model 2, HR 1.36, 95% CI 1.12-1.66; Model 3, HR 1.38, 95% CI 1.12-1.71).CONCLUSIONS: Elevated cTn levels were associated with an increased risk of all-cause mortality and adverse CV events. Clinical factors that might enhance the need to rule out CAD were associated with cTn testing.

Resumen El lupus eritematoso sistemico (LES) es una enfermedad autoinmune cronica que puede comprometer cualquier organo o sistema, incluido el sistema nervioso central (SNC). Dentro del espectro de sus manifestaciones se incluye la enfermedad cerebrovascular, en la cual destacan su morbimortalidad y su discapacidad asociada. A pesar de ello, esta presentacion es muy rara como manifestacion inicial del LES, en particular el hematoma subdural. A continuacion, se presenta el caso de un paciente masculino de 57 anos que ingreso a un centro de atencion primaria con cefalea acompanada de signos de alarma, se documentaron colecciones subdurales escalonadas en la region frontal derecha, junto con una hemorragia intraparenquimatosa pontica del mismo lado, en el contexto de pancitopenia severa. En el trascurso de su evolucion y con los examenes complementarios en la busqueda de la etiologia de la pancitopenia, se concluyo, despues de excluir las causas mas comunes, un origen autoinmune en el contexto de un LES con presentacion clinica atipica.

Background/purpose Uropathogenic E. coli (UPEC) is the main cause of urinary tract infection (UTI) and it is known that pregnant women have a higher risk for UTI. UPEC has a variety of virulence and antibiotic resistance factors that facilitate its pathogenic success and it is crucial to know which are the susceptibility patterns, Extended-Spectrum-β-Lactamase (ESBL) production, virulence genes, pathogenicity islands (PAI), phylogenetic groups and serotypes among strains isolated from pregnant and non-pregnant women. Methods One hundred fifty UPEC strains were isolated from pregnant and non-pregnant women from two different Mexican states (Sonora and Puebla). Strains were analyzed using the Kirby-Bauer method for the determination of antibiotic susceptibility and ESBL. Virulence genes, PAIs and phylogenetic groups were determined using a multiplex PCR. Strains were serotyped by an agglutination assay. Blood agar and CAS agar were used for phenotypic assays. Results 92.7% of UPEC strains showed multidrug-resistant (MDR), 6.7% extremely-resistant (XDR) and 0.6% pandrug-resistant (PDR). The highest resistance was determined to be for β-lactam antibiotics (>72% in both states) and 44.5% of the UPEC strains were ESBL+. The predominant virulence genes found were fimH (100%), iucD (85%) and iha (60%). The strains isolated from pregnant women from Puebla presented a large percentage of genes associated with upper urinary tract infections. PAIs were found in 51% and 68% of the strains from Sonora and Puebla, respectively. All the strains were siderophores producers and 41.5% produced hemolysis. The serotypes found were diverse and belonged to phylogroups A, B2 and C. Conclusion The UPEC strains from this study are MDR with tendency to XDR or PDR, they can cause upper UTIs and are serotypically and phylogenetically diverse, which supports the need to develop new strategies for UTI treatment in pregnant and non-pregnant Mexican women.

Resumen Introduccion La validacion de cuestionarios es fundamental en el proceso de medicion de cualquier estudio de investigacion. El cuestionario Community Oriented Program for Control of Rheumatic Diseases (COPCORD) es util como tamizaje para la deteccion de enfermedades reumaticas. Objetivo Adecuar y validar la metodologia y el cuestionario COPCORD en poblacion colombiana. Materiales y metodos Se realizo un estudio de validacion de metodologia COPCORD que incluyo: 1) adecuacion transcultural del cuestionario COPCORD del espanol mexicano, y 2) validacion de los cuestionarios: COPCORD, cuestionario de nivel socioeconomico, uso de servicios de salud y un instrumento de calidad de vida (EQ-5D-3L), siguiendo las guias internacionales. Resultados Participaron 329 sujetos de 6 ciudades de Colombia, 10 en la primera fase del estudio y 309 en la segunda; un 67,3% fueron mujeres, con una edad promedio de 46,4 anos, con una escolaridad entre basica y media (77%). Los participantes residian en Bogota (29,4%), Barranquilla (22%), Cali (20,3%), Medellin (15,2%), Bucaramanga (6,4%) y Cucuta (6,4%). Reportaron dolor musculoesqueletico en los ultimos 7 dias el 43,6% y dolor historico el 68,9%. En 127 (41,1%) se establecio un diagnostico reumatologico: osteoartrosis (9,3%), sindrome de dolor regional (5,5%), lumbalgia (5,1%) y artritis reumatoide (0,9%). La validez interna fue de 0,70. Al comparar el cuestionario COPCORD con la revision por el reumatologo, tuvo una sensibilidad del 70,8%, una especificidad del 35%, una razon de verosimilitud positiva de 1,09 y un area bajo la curva de 0,53. Conclusiones El cuestionario COPCORD es valido como prueba de tamizaje de deteccion de malestares musculoesqueleticos y enfermedades reumaticas en poblacion colombiana.

Introduction The validation of questionnaires is fundamental in the measurement process of any research study. The Community Oriented Program for Control of Rheumatic Diseases (COPCORD) questionnaire is useful as a screening tool for the detection of rheumatic diseases. Objective To adapt and validate the methodology and the COPCORD questionnaire in the Colombian population. Materials and methods A validation study of the COPCORD methodology was carried out that included: (1) transcultural adaptation of the COPCORD questionnaire of Mexican Spanish, and (2) validation of the questionnaires: COPCORD, socioeconomic level questionnaire, use of health services and a quality of life questionnaire (EQ-5D-3L), following international guidelines. Results A total of 329 subjects of 6 cities in Colombia participated in the process, with 10 in the first phase and 309 in the second. Approximately two-thirds (67.3%) were women. The mean age was 46.4±18.4 years, with an educational level between basic and medium (77%). Participants resided in Bogota (29.4%), Barranquilla (22%), Cali (20.3%), Medellin (15.2%), Bucaramanga (6.4%), and Cucuta (6.4%). Musculoskeletal pain in the previous 7 days was reported by 43.6%, and historical pain was reported by 68.9%. A rheumatological diagnosis was established in 127 (41.1%) cases: osteoarthrosis (9.3%), regional pain syndromes (5.5%), low back pain (5.1%), and rheumatoid arthritis (0.9%). The internal validity was 0.70. When comparing the COPCORD questionnaire with the diagnosis made by the rheumatologist, it had a sensitivity of 70.8%, specificity 35%, positive likelihood ratio of 1.09 m and area under the curve of 0.53. Conclusions The COPCORD questionnaire is valid as a screening test to detect musculoskeletal complaints and rheumatic diseases in the Colombian population.

A b s t r a c t Purpose: To describe health-related QOL (HRQOL) in patients with musculoskeletal symptoms, compared to a population with other comorbidities, and a healthy population. Methods: A cross-sectional study was carried out on an open population involved in a community-oriented program for control of rheumatic diseases (COPCORD) study in Colombia, using EQ-5D-3L for estimating QOL, and the health assessment questionnaire disability index (HAQ-DI) for functional capacity. Results: Out of the total 4020 individuals evaluated, 2274 had rheumatic diseases, 642 had non-rheumatic diseases, and 1104 were healthy subjects. Spondyloarthritis (SpA) and rheumatoid arthritis (RA) patients had more complaints regarding pain/discomfort and mobility. As for daily activities, the diseases that mostly affected them were systemic lupus erythematosus (SLE) and RA. RA and fibromyalgia (FM) patients had the worst scores as regards anxiety/depression and self-care dimensions. FM patients had the lowest QOL measured by EQ-VAS (57.7 ± 26.2). The most frequent non-rheumatic diseases were cardiovascular and mental disorders, with 20% of these patients having a moderate level of pain/discomfort and anxiety/depression. The rheumatic patients reported a decrease in functional capacity (HAQ: 0.49), in contrast to the healthy population (0.01), and the population having other diseases (0.06). Conclusion: Rheumatic disease patients in Colombia had the worst QOL compared to the healthy population and patients with other comorbidities. Rheumatic patients had greater functional limitations, even more so when having comorbidities. This study revealed potential factors of interest requiring the attention of public health authorities, and for improving patients' QOL. RESUMEN Objetivo: Describir la calidad de vida relacionada con la salud en pacientes con síntomas musculoesqueléticos, en comparación con pacientes con enfermedades no reumáticas y una población sana. Métodos: Se realizó un estudio transversal en comunidad abierta, en personas involucradas en un programa orientado a la comunidad para el control de enfermedades reumáticas (COP-CORD) en Colombia, utilizando el EQ-5D-3L para estimar la calidad de vida y el cuestionario de evaluación de la salud (HAQ- DI) para la capacidad funcional. Resultados: Se evaluaron 4.020 individuos; 2.274 tenían enfermedades reumáticas, 642 tenían enfermedades no reumáticas y 1.104 eran sujetos sanos. Los pacientes con espondiloartritis (SpA) y artritis reumatoide (AR) tuvieron mayores quejas con respecto al dolor/malestar y la movilidad. En cuanto a las actividades diarias, los enfermos con lupus eritematoso sistémico (LES) y AR fueron los más afectados. Los pacientes con AR y fibromialgia (FM) tuvieron las peores puntuaciones en ansiedad/depresión en las dimensiones de cuidado personal. Los pacientes con FM tuvieron la calidad de vida más baja medida por EQ-VAS (57,7 ± 26,2). Las enfermedades no reumáticas más frecuentes fueron los trastornos cardiovasculares y mentales; el 20% de estos pacientes tenía un nivel moderado de dolor/malestar y ansiedad/depresión. Los pacientes reumáticos reportaron una disminución de la capacidad funcional (HAQ: 0,49); en contraste con la población sana (0,01) y la población con otras enfermedades (0,06). Conclusión: Los pacientes con enfermedades reumáticas en Colombia tuvieron la peor calidad de vida en comparación con la población sana y los pacientes con otras enfermedades. Los pacientes reumáticos tuvieron una mayor limitación funcional, incluso más que los que tenían otras enfermedades. Este estudio reveló posibles factores relacionados con las enfermedades reumáticas que requieren la atención de las autoridades de salud pública con el objetivo de mejorar la calidad de vida de los pacientes.

Escherichia coli is a well-recognized inhabitant of the animal and human gut. Its presence represents an essential component of the microbiome. There are six pathogenic variants of E. coli associated with diarrheal processes, known as pathotypes. These harbor genetic determinants that allow them to be classified as such. In this work, we report the presence of diarrheagenic pathotypes of E. coli strains isolated from healthy donors. Ninety E. coli strains were analyzed, of which forty-six (51%) harbored virulence markers specifics for diarrheagenic pathotypes, including four hybrids (one of them with genetic determinants of three DEC pathotypes). We also identified phylogenetic groups with a higher prevalence of B2 (45.6%) and A (17.8%). In addition, resistance to sulfonamides (100%), and aminoglycosides (100%) was found in 100% of the strains, with a lower prevalence of resistance to cefotaxime (13.3%), ceftriaxone (12.2%), fosfomycin (10%), and meropenem (0%). All analyzed strains were classified as multidrug resistant. Virulence genes were also investigated, which led us to propose three new virotypes. Among the virulence traits observed, the ability to form biofilms stands out, which was superior to that of the E. coli and Staphylococcus aureus strains used as positive controls.

The study is part of identifying the factors that affect the management of social networks for the improvement of Brand engagement in the province of Tungurahua. The research presents a qualitative approach and correlational scope. The sample comes from 384 consumers. The study hypothesis is verified, social networks have a positive influence on the brand engagement strategy. The main results show that the content that attracts the most attention from users in social networks are: news and news, comments, contests and product and promotions draws. It concludes that innovative consumers are not only interested in new things, but are also interested in representing themselves through brands associated with new products.

Introduction Rheumatic diseases are the leading cause of permanent disability. The COPCORD model is an effective tool in the determination of the prevalence of diseases. The objective of this study is to estimate the prevalence of rheumatic disease in a Colombian population over 18 years of age. Methods A prevalence study was carried out using a probabilistic method of stratified random sampling in three stages: cartographic sectors in each city, selection of the blocks of each sector, and the households of each block. The COPCORD questionnaire adapted for Colombia was applied by standardized interviewers. Confirmation of the diagnosis was made by a rheumatologist with access to all the information. Results Out of a total of 6693 patients that completed the questionnaire, 64% were women. Pain not associated with trauma was reported by 48% of the participants. The most frequent locations were: knees 35%, hands 26%, lumbar spine 20%, and shoulders 16%. Non-specific skeletal muscle discomfort, osteoarthritis, regional appendicular syndrome, and non-inflammatory low back pain, were the most prevalent diseases. Rheumatoid arthritis and chronic inflammatory low back pain were the most common inflammatory conditions. The prevalence of Chikungunya fever was estimated at 6.68%. Conclusion The prevalence of rheumatoid arthritis in Colombia is higher than commonly reported, lower than for fibromyalgia and gout, and similar for osteoarthritis, systemic lupus erythematosus and spondyloarthritis. In Colombia these diseases are a public health problem without awareness of their impact on the general population.

Bacterial infections have become one of the top ten public health concerns worldwide. These problems are aggravated with the emergence of multi-drug resistant bacterial strains. Thus, it is necessary to adopt novel technological strategies, such as development of bionanomaterials to prevent the infection, and treat this kind of bacteria. At this regard, the chemical modification of chitosan (Cs), by the covalent attachment of a hydrocarbon chain (octanoic acid), was developed to obtain hydrophobic chitosan (HCs). Then, HCs was used to synthetize nanoparticles using the well-known ionotropic gelation approach, optimizing the parameters, such as the TPP/HCs ratio and pH solution to get stable nanoparticles. Then, carvacrol (CAR) was loaded into NPs (HCs-CAR NPs) using different concentrations of 25%, 50% and 75% (%w/w CAR/HCs). The physicochemical properties for HCs-CAR NPs prepared at 50% of CAR stood out from the rest, showing a spherical morphology, with a size of 200 nm, Z potential of 10.4 mV and encapsulation efficiency of 56.28%. These formulations were chosen to evaluate the antibacterial activity, using Gram-negative (Escherichia coli) and Gram-positive bacterial model (Staphylococcus aureus). The HCs-CAR NPs showed great activity against both bacterial models, being more effective against Gram (+) strain (S. aureus), suggesting the potential application of these NPs as novel biomaterial to treat bacterial infection.

Urinary tract infections (UTIs) belong to the most common pathologies in Mexico and are mainly caused by Uropathogenic Escherichia coli (UPEC). UPEC possesses a wide diversity of virulence factors that allow it to carry out its pathogenesis mechanism in the urinary tract (UT). The development of morphotypes in UT represents an important feature of UPEC because it is associated with complications in diagnosis of UTI. The aim of this study was to determine the presence of bacterial morphotypes, virulence genes, virulence phenotypes, antibiotic resistant, and phylogenetic groups in clinical isolates of UPEC obtained from women in Sonora, Mexico. Forty UPEC isolates were obtained, and urine morphotypes were observed in 65% of the urine samples from where E. coli was isolated. Phylogenetic group B2 was the most prevalent. The most frequent virulence genes were fimH (100%), fliCD (90%), and sfaD/focC (72%). Biofilm formation (100%) and motility (98%) were the most prevalent phenotypes. Clinical isolates showed high resistance to aminoglycosides and β-lactams antibiotics. These data suggest that the search for morphotypes in urine sediment must be incorporated in the urinalysis procedure and also that clinical isolates of UPEC in this study can cause upper, lower, and recurrent UTI.

In order to evaluate the ethnoveterinary effect of Macleaya cordata extract on bacteria colony forming units (CFU) in different organs of gastrointestinal tract and productive parameters of broilers challenged with Salmonella typhimurium, eighty one day old Cobb broilers were randomly assigned either to a diet without additive or with additive at 50 g/ton during 21 days. The count of CFU of Salmonella typhimurium in crop, gizzard, and duodenum, at 21 days, showed broilers that received the Macleaya cordata extract had a reduction. The broilers also had higher final body weight, total gain, average daily gain and better feed conversion value as compared with those that had not received it. Feed intake was not affected. Results concluded that Macleaya cordata extract is an ethnoveterinary alternative efficient for control of Salmonella typhimurium and a growth promoter in broilers.

Background: The prevalence of rheumatoid arthritis (RA) in Colombia according to the COPCORD study was 1.49%. The disease burden data available in our country are based on the results of the Global Burden Disease study (GBD) of 2016. However, the GBD study takes reference data from non-Colombian residents that was extrapolated to our population, given the absence of demographic data at that moment. Objectives: To estimate the disease burden of RA for 2015 Methods: A descriptive study was developed. The reference data of the population was taken by DANE (Departamento Administrativo Nacional de Estadistica) and the WHO (World Health Organization). The GBD disability definitions were adapted from individual questions of functionality and quality of life questionnaires of the COPCORD study in Colombia (1). A Markov model was developed to calculate the years of life lost due to premature mortality (YLL), years lived with disability (YLD) and Disability-Adjusted Life Year (DALY). Results: The distribution of cases by age and severity levels of RA are shown in figure 1 and 2 respectively. Since direct death due to RA were not registered according to the search of the ICD-10 codes in DANE, the YLL was 0. The YLDs in total were 118,358. The DALYs were 118,358 for a rate of 361.54 per 100,000, which is higher than the GBD 2016 results (60 per 100.000). Conclusion: The burden disease of rheumatoid arthritis is higher than that referred by GBD. Holistic approaches are required to reduce these parameters of impact on the public health of Colombians. Our data on DALYs usefulness lies in the urgent need for an early diagnosis, to reduce disability and thereby improve the quality of life of patients. Even though, RA was not the registered primary cause of death, it is necessary to explore mortality-associated conditions due to this rheumatic disease. References [1] Londono J, Pelaez I, Cuervo F, et al. Prevalencia de la enfermedad reumatica en Colombia, segun estrategia COPCORD-Asociacion Colombiana de Reumatologia. Estudio de prevalencia de enfermedad reumatica en poblacion colombiana mayor de 18 anos. Rev Colomb Reum [Internet]. 2018;1–12. Available from: https://doi.org/10.1016/j.rcreu.2018.08.003 Disclosure of Interests: Francy Cuervo: None declared, Ana Maria Santos: None declared, Ignacio Angarita: None declared, Juan Camilo Rueda: None declared, Rodrigo Giraldo: None declared, Jesus G Ballesteros: None declared, Ingris Pelaez-Ballestas: None declared, Diana Diaz-Jimenez: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Diana Padilla-Ortiz: None declared, Viviana Reyes: None declared, Carlos Castaneda-Orjuela: None declared, John Londono: None declared

Background: Low back pain (LBP) is the second most frequent rheumatic disease in Colombia. According to the COPCORD study, LBP prevalence was 7.24% (CI 95% 6.28-8.34%) (1). Objectives: To estimate the disease burden of LBP for 2015. Methods: A descriptive study was conducted. A Markov model was developed based on cases with LBP, distribution of disability and mortality according to DANE (Departamento Administrativo Nacional de Estadistica) and the WHO (World Health Organization) reference data. The results are shown in terms of the years of life lost due to premature mortality (YLL), years lived with disability (YLD) and finally as Disability-Adjusted Life Year (DALY). Results: The distribution of cases by age of LBP are shown in figure 1. An algorithm was designed to determine the distribution in percentages of severity levels, according to the GBD definitions (figure 2). According to ICD-10 codes, 9 deaths were reported, so the YLL were 124. The YLDs were 264,658. Finally, the DALYs were 264,782 for a rate of 808.82 per 100,000, which is higher than the GBD 2016 results (647 per 100,000). Conclusion: The main cause of burden disease of rheumatic disease in Colombia is due to LBP. The burden is because of the YLD, related to the frequency of cases in people younger than 50 years of age. It is necessary for an early detection and development of intervention strategies. References [1] Londono J, Pelaez I, Cuervo F, et al. Prevalencia de la enfermedad reumatica en Colombia, segun estrategia COPCORD-Asociacion Colombiana de Reumatologia. Estudio de prevalencia de enfermedad reumatica en poblacion colombiana mayor de 18 anos. Rev Colomb Reum [Internet]. 2018;1–12. Available from: https://doi.org/10.1016/j.rcreu.2018.08.003 Disclosure of Interests: Francy Cuervo: None declared, Juan Camilo Rueda: None declared, Ana Maria Santos: None declared, Eugenia-Lucia Saldarriaga: None declared, Ignacio Angarita: None declared, Rodrigo Giraldo: None declared, Ingris Pelaez-Ballestas: None declared, Diana Diaz-Jimenez: None declared, Jesus G Ballesteros: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Diana Padilla-Ortiz: None declared, Viviana Reyes: None declared, Carlos Castaneda-Orjuela: None declared, John Londono: None declared

Background During the 2014-2015 a Chikungunya virus (CHIKV) epidemic reached Colombia. Concurrently, the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) was being developed in Colombia to establish rheumatic diseases prevalence. Since CHIKV generates rheumatic manifestations, the presence of CHIKV infection was included. Objectives Based on the population entered in this program this study was developed with the aim to describe the disability of CHIKV infection through four questionnaires (HAQ-DI, EQ-5D, EQ-5D VAS and VAS for pain). Methods World Health Organization (WHO) criteria for CHIKV diagnosis and ELISA IgG and IgM serology were performed to identify CHIKV infection. Four groups of patients were defined: true positives (WHO + and + serology), true negatives (WHO - and - serology), false positives (WHO + and - serology), false negatives (WHO - and + serology). Three scores of disability and one of pain were applied to evaluate disability. A descriptive analysis was made using the media and standard deviation for continuous variables and percentage for the categorical variables, the Odds ratio was calculated with a confidence interval of 95% and a p Results From 548 patients with clinical suspicion of CHIKV infection, 295 were positive for CHIKV IgG and/or CHIKV IgM. Functionality evaluated by HAQ-DI showed a media of 0.17 (SD±0.45), with highest score after 7 weeks since the beginning of symptoms and the lowest in patients with CHIKV IgM positive. In the EQ-5D (Figure 1), between 72% and 92% of patients didn’t report problems on the mobility, self-care, usual activities, anxiety and depression dimensions. In contrast pain and discomfort dimensions were affected from moderate to extreme (44.7% and 8.6%). There weren’t significant differences between true positives, true false, false negative within all the variables, except on the anxiety and depression dimensions where the false positives had a higher significant score in comparison to the other groups (n: 10, 38.5%; p=0.00; OR:4.17, IC:1.8-9.57). In the EQ-5D-VAS, media for VAS was 75.56 (SD±21.18) where the highest scores of VAS were found on the false negatives. In pain VAS, false positives as well as the duration greater than 7 weeks where associated with several pain (n: 10, 2.9%; OR: 0.2; IC 1.25–6.33 y n: 27, 21.3%; p=0.018; OR 2.02, IC: 1.12-3.66 respectively). Conclusion In general, the disability of CHIKV infected patients was mild to moderate, finding the most affected dimensions to be pain, discomfort, anxiety and depression. The false positives and the population with anxiety and depression are related with higher score of disability. Disclosure of Interests None declared

Background: Osteoarthritis (OA) is the most prevalent rheumatic disease in Colombia, as reported by the COPCORD 2015 study. The prevalence is 10.81% (IC 95, 9.68-12.06) (1). Objectives: To estimate the disease burden of OA for 2015 Methods: A descriptive study was developed. The reference data of the population was taken by DANE (Departamento Administrativo Nacional de Estadistica) and the WHO (World Health Organization). It was necessary to develop an algorithm to determine the distribution in percentages of severity levels, according to the GBD definitions. A Markov model was elaborated to calculate the years of life lost due to premature mortality (YLL), years lived with disability (YLD) and Disability-Adjusted Life Year (DALY). Results: Figure 1 shows the distribution of cases by age of OA, with the highest frequency of cases over 50 years in both sexes. Figure 2 describes the distribution of the severity levels of the disease, with most cases being moderately severe. The YLLs were 781 and the YLDs were 245,626. Finally, the DALYs calculated were 246,408 for a rate of 752.69 per 100,000. When compared with that reported data by the GBD 2016, the burden of disease for OA was 204 (IC95% 143-278). The results of the present study show that the burden of the disease is higher, and the conditional factor is the YLDs. Conclusion: Osteoarthritis is a frequent and disabling rheumatic disease that confers a large burden of rheumatic disease affecting people over 50 years of age. The treatment of OA should be focused on reducing disability and holistic intervention strategies to promote good quality of life. References [1] Londono J, Pelaez I, Cuervo F, et al. Prevalencia de la enfermedad reumatica en Colombia, segun estrategia COPCORD-Asociacion Colombiana de Reumatologia. Estudio de prevalencia de enfermedad reumatica en poblacion colombiana mayor de 18 anos. Rev Colomb Reum [Internet]. 2018;1–12. Available from: https://doi.org/10.1016/j.rcreu.2018.08.003 Disclosure of Interests: Francy Cuervo: None declared, Ignacio Angarita: None declared, Ana Maria Santos: None declared, Eugenia-Lucia Saldarriaga: None declared, Juan Camilo Rueda: None declared, Jesus G Ballesteros: None declared, Rodrigo Giraldo: None declared, Ingris Pelaez-Ballestas: None declared, Diana Diaz-Jimenez: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Diana Padilla-Ortiz: None declared, Viviana Reyes: None declared, Carlos Castaneda-Orjuela: None declared, John Londono: None declared

Cage aquaculture aggregates wild fauna due to food provision. Several seabirds frequent fish farms, including the European storm-petrel (Hydrobates pelagicus melitensis). This work investigates the presence of storm-petrels around two aquaculture areas interspersed between breeding colonies in western Mediterranean Sea. Contribution of aquaculture-derived resources to their diet was assessed. Storm-petrels were mist-netted at the colonies and marked by bleaching feathers. Density around aquaculture areas was estimated through visual counts. Marks recognition was conducted visually and by photo-capture. Storm-petrel regurgitates were used as target tissue to estimate diet sources contribution. Contribution of surface zooplankton, ichthyoplankton and aquaculture wastes was estimated through Bayesian mixing modelling combining carbon and nitrogen stable isotopes and fatty acids as biomarkers. Storm-petrel density was high in open-sea aquaculture area, but not observed around near shore farms. Temporal variability of storm-petrels density during the breeding season was linked to their reproductive phenology. Within the open-sea aquaculture area, bluefin tuna farm was more attractive for storm-petrels than seabream/seabass farms. Visual identification of bleaching marks was not useful. Photo-capture showed that 8.3% of the storm-petrels watched around farms were firstly trapped in some of the nearby colonies, and 91.7% were unmarked. Qualitative evidence of aquaculture-derived wastes utilization was obtained. However, its estimated contribution was low (4.3%) when compared to ichthyoplankton (61.1%) or zooplankton (34.6%). The studied open-sea farms significantly aggregated storm-petrels along their entire breeding season. Storm-petrels got a slight profit from aquaculture resources. Nevertheless, some concerns arise regarding the cost/benefit balance of the interaction.

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease characterized by inflammation of multiple joints, leading to destruction of cartilage and juxta articular bone. It eventually leads to deformity, disability, and impaired quality of life. Methotrexate (MTX) has a reported response rate of 33–65%, and this variability may be explained by genetic variations (polymorphisms) in the metabolic pathway of this drug. To evaluate possible relationships between polymorphisms in the metabolic pathway and response to MTX in patients with RA. Methodology A systematic search and review of the literature was conducted. A total of 29 studies that evaluated polymorphisms in the metabolic pathway of MTX were included, due to their full text and methodological quality. Results Of the 29 studies, five were systematic reviews and/or meta-analyses, three of which clinical trials none was triple blind and only one was double-blind, six were cohort, seven were case–control, and eight cross sectional. The polymorphism identified were: methylene tetrahydrofolate reductase, dihydrofolate reductase, thymidylate synthase, 5-amino-imidazole-4-carboxamide ribonucleotide formyl transferase (AICAR formyltransferase), 5-aminoimidazole-4-carboxamide polymorphisms formyltransferase/IMP cyclohydrolase ribonucleotide (ATIC) identified conveyors attached to ATP cassette (ABC ATP-binding cassette), folylpoly-glutamate, glutamyl hydrolase, reduced folate carrier (RFC-SLC10A1). The dihydrofolate reductase and methylene tetrahydrofolate reductase polymorphism were shown to be associated with increased MTX toxicity. RFC and C677T polymorphisms are associated with better efficacy of MTX. Conclusions The polymorphisms of methylene tetrahydrofolate reductase, C677T and RFC1-G80A generate increased efficacy and toxicity in patients treated with MTX. However, for the other polymorphisms, although studies show statistically significant associations, they are not conclusive and some are contradictory. This justifies conducting multicenter studies to assess the presence and association with the effectiveness or toxicity in patients with RA treated with MTX.

RESUMEN Introducción: Las enfermedades reumáticas son causa frecuente de discapacidad, deterioran la calidad de vida y causan alto gasto en salud. El modelo COPCORD se ha implementado universalmente para estimar su prevalencia. El objetivo es estimar la prevalencia de las enfermedades reumáticas en la población colombiana mayor de 18 arios. Métodos: Se realizó un estudio de prevalencia utilizando un método probabilístico de muestreo aleatorio estratificado en 3 etapas: selección de los sectores cartográficos en cada ciudad, selección de los bloques de cada sector y del hogar de cada bloque. El cuestionario COPCORD, adaptado para Colombia, fue aplicado por entrevistadores estandarizados. La confirmación del diagnóstico fue hecha por un reumatólogo con acceso a toda la información. Resultados: De un total de 6.693 personas encuestadas el 64% fueron mujeres. El dolor no asociado con trauma fue reportado por el 48% de los participantes. Los sitios más frecuentes fueron rodillas (35%), manos (26%), columna lumbar (20%) y hombros (16%). El malestar musculoesquelético no específico, la osteoartritis, el síndrome de dolor regional apendicular y la lumbalgia no inflamatoria fueron las enfermedades más prevalentes. La artritis reumatoide y la lumbalgia crónica inflamatoria fueron las condiciones inflamatorias más comunes. La fiebre chikungunya afectó al 6,68% de la población. Conclusión: La prevalencia de la artritis reumatoide en Colombia es mayor a lo comúnmente reportado, menor para fibromialgia y gota, y similar para osteoartritis, lupus eritematoso sistémico y espondiloartritis. En Colombia, estas enfermedades representan un problema de salud pública sin que exista conciencia de su impacto en la población general. ABSTRACT Introduction: Rheumatic diseases are the leading cause of permanent disability. The COP-CORD model is an effective tool in the determination of the prevalence of diseases. The objective of this study is to estimate the prevalence of rheumatic disease in a Colombian population over 18 years of age. Methods: A prevalence study was carried out using a probabilistic method of stratified random sampling in three stages: cartographic sectors in each city, selection of the blocks of each sector, and the households of each block. The COPCORD questionnaire adapted for Colombia was applied by standardised interviewers. Confirmation of the diagnosis was made by a rheumatologist with access to all the information. Results: Out of a total of 6,693 patients that completed the questionnaire, 64% were women. Pain not associated with trauma was reported by 48% of the participants. The most frequent locations were: knees 35%, hands 26%, lumbar spine 20%, and shoulders 16%. Nonspecific skeletal muscle discomfort, osteoarthritis, regional appendicular syndrome, and non-inflammatory low back pain, were the most prevalent diseases. Rheumatoid arthritis and chronic inflammatory low back pain were the most common inflammatory conditions. The prevalence of Chikungunya fever was estimated at 6.68%. Conclusion: The prevalence of rheumatoid arthritis in Colombia is higher than commonly reported, lower than for fibromyalgia and gout, and similar for osteoarthritis, systemic lupus erythematosus and spondylarthritis. In Colombia these diseases are a public health problem without awareness of their impact on the general population.

Background Within public health strategies, the quality of life is a fundamental factor of intervention. The EQ-5D-3L is one of the most used instruments worldwide. Objectives To describe the change in quality of life and functional limitation of patients with rheumatic diseases compared to a healthy population and patients with other systemic diseases. Methods The EQ-5D-3L survey was used in 6693 people from 6 cities in Colombia. An analytical study was developed. Results In general, the healthy population (n=1104) reported not to have problems according to the EQ-5D-3L (median: 98,34). Of the non-rheumatic patients (n=642), 20% showed a moderate compromise because of pain and discomfort, as well as anxiety and depression. Twenty percent of patients with cardiovascular disease (n=53) reported moderate limitation for mobility. Patients with cardiovascular diseases reported moderate difficulties in carrying out daily activities. * The values of each of the dimensions of the instrument are expressed in% ** HBP: high blood pressure, CVD: cardiovascular disease, TB: tuberculosis *** Mental disorders: anxiety, nervousness or depression. Patients with rheumatic diseases (n=2274) manifested different degrees of limitation in mobility and daily activities. Patients with rheumatic diseases and comorbidities had greater compromise in quality of life predominately by pain and physical discomfort (more than 50% of the patients) figure 1. Conclusions In comparison with general population, rheumatic patients had a lower quality of life, and it is even worse in patients with rheumatic diseases and comorbidities. Comprehensive care of rheumatic patients should include strategies to improve standards of quality of life such as mobility, to perform daily activities and management of problems such as pain and discomfort. There are specific factors of intervention to reduce long-term disability of patients with rheumatic diseases. Disclosure of Interest None declared

La presente investigación tiene el objetivo de identificar los factores publicitarios determinantes en la decisión de compra del consumidor del sector comercial de la provincia de Tungurahua. La metodología de la investigación es de enfoque cualitativo con un alcance descriptivo, pues describe los factores publicitarios y el comportamiento de compra de los consumidores, sin necesidad de ejercer algún tipo de influencia. Finalmente, se determinan los factores que deben ser cambiados en el diseño de un plan publicitario digital y cuál es el perfil del consumidor de la provincia de Tungurahua.

Background Treat to Target (T2T) strategy becomes from the need to develop therapeutic targets and tools to achieve defined outcomes in rheumatoid arthritis (RA), this strategy has become recognized as a standard of good practice embodying the principle that rapid attainment of remission, or low disease activity, can halt joint damage and maintain good quality of life. However, there is no direct comparison between biologics in cohorts of patients with long-standing RA using T2T approach in real-life settings, which could have implications in treatment decisions and health economics. Objectives The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) using T2T strategy for a 5 year period in patients with biological therapy in a large cohort of patients from a Colombian specialized in RA center with multidisciplinary approach. Methods A descriptive dynamic cohort study was performed. Records of patients using biological DMARD treatment (Anti-TNF and others) from specialized in RA center were reviewed; those patients were followed-up under T2T standards. Clinical follow-up was according to DAS28 as follows: every 3–5 weeks (DAS28 >5.1), every 7–9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11–13 weeks (DAS28 3.2 unless patient9s conditions don9t permit it. We divided patients in three groups: low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA) patients. Descriptive epidemiology was done, percentages and averages were calculated; the median of each variable was analyzed using t-Student assuming normality for DAS28 distribution and the level activity disease was analyzed using Pearson9s statistics. Results During 60 month period we included 695 patients with biological therapy, 85% were female and 15% male. Mean age was 58 years ± 11. At beginning mean DAS28 was 4.1±1.1 and 20% of patients were in SDA, and 55% in MDA. At the end of 5 year period mean DAS was 3.2±0.89 and only 7% of patients were in SDA and 33% in MDA. The median was analyzed using t-Student assuming normality for DAS28 distribution. It showed statistical significant improvement (p Conclusions There was a global improvement of DAS28 in a cohort of RA patients receiving biological therapy followed and treated under recommendations of T2T approach demonstrating that with the strategies mentioned above it is possible to obtain a good control of the activity of the disease. Disclosure of Interest None declared

Background Treat to Target (T2T) strategy becomes from the need to develop therapeutic targets and tools to achieve defined outcomes in rheumatoid arthritis (RA), this strategy has become recognized as a standard of good practice embodying the principle that rapid attainment of remission, or low disease activity, can halt joint damage and maintain good quality of life. Objectives The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) using T2T strategy for a 60 month period in a large cohort of patients from a Colombian specialized in RA center. Methods A descriptive cohort study was conducted. Medical records of patients from specialized in RA center were reviewed; those patients were followed-up under T2T standards and a multidisciplinary approach. Each patient had a minimum of 6 follow-up visits. Clinical follow-up was designed by the authors according to DAS28 as follows: every 3–5 weeks (DAS28 >5.1), every 7–9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11–13 weeks (DAS28 3.2 unless patient9s conditions don9t permit it; we considered this follow-up type as implementation of a T2T strategy in patients with RA. We divided patients in four groups: remission (REM), low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA) patients and the aim of the study was to look at what percentage of patients who were in moderate or severe disease activity reached a low disease activity or remission. Descriptive epidemiology was done, percentages and averages were calculated; the median of each variable was analyzed using t-Student assuming normality for DAS28 distribution and the level activity disease was analyzed using Pearson9s statistics. Results 3618 patients meet the inclusion criteria. 72% were receiving conventional DMARDs therapy and 28% were receiving biological therapy. 83% were woman and 17% were men. Mean age was 61 years ±11. Mean DAS28 at beginning was 3.3±1.3 and at the end of five year period was 2.8±0.7. The difference of medians for DAS28 at begging and at the end showed improvement with statistical significance (p Conclusions This study show evidence of an improvement in DAS28 and level of disease activity in a cohort of RA patients from a specialized center in Colombia treated under recommendations of T2T strategy; it was found a global increase in the percentage of patients in remission (REM) and decrease in moderate and severe disease activity groups. This revision shows the importance of T2T follow-up and a multidisciplinary treatment for the management or RA. Disclosure of Interest None declared

Background Treat to Target (T2T) strategy becomes from the need to develop therapeutic targets and tools to achieve defined outcomes in rheumatoid arthritis (RA), this strategy has become recognized as a standard of good practice embodying the principle that rapid attainment of remission, or low disease activity, can halt joint damage and maintain good quality of life. Objectives The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) using T2T strategy for a 5 year period in patients with conventional DMARD therapy in a large cohort of patients from a Colombian specialized in RA center with multidisciplinary care model (MCM). Methods A descriptive dynamic cohort study was performed. Records of patients using conventional DMARD treatment from specialized in RA center were reviewed; those patients were followed-up under T2T standards. Clinical follow-up was according to DAS28 as follows: every 3–5 weeks (DAS28 >5.1), every 7–9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11–13 weeks (DAS28 3.2 unless patient9s conditions don9t permit it. MCM model means that every patient is seen by the other specialties involved in care as a minimum three times a year. We divided patients in three groups: low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA) patients. Descriptive epidemiology was done, percentages and averages were calculated; the median of each variable was analyzed using t-Student assuming normality for DAS28 distribution and the level activity disease was analyzed using Pearson9s statistics. Results We included 1443 patients, 84% were women and 16% were men. Mean age was 62±11 years; mean DAS28 at beginning was 4.0±1; regarding disease activity 57% were in moderate disease activity and 17% in severe disease activity. While at 5 year follow up mean DAS was 2.92±0.65, 48% achieved remission, 30% low disease activity, with decrease to 20% in moderate disease activity and 2% in severe disease activity. Conclusions There is a significant improvement of DAS28 in a cohort of RA patients receiving only conventional DMARDs therapy, treated and followed under T2T strategy recommendations and a MCM model. Disclosure of Interest None declared

Background The lack of expertise and skills in the diagnosis of in rheumatoid arthritis (RA) in primary level of Colombian medical centers can cause misdiagnosis of rheumatic diseases. Due to this issue in a specialized center in RA we stablished a multidisciplinary model and a strict disease management algorithm to diagnose properly our patients; as a consequence we have achieved the accurate diagnosis of great proportion of patients that were false positives diagnosed initially as RA. Objectives The aim of this study was to show effectiveness and accuracy of a screening method to avoid false-positive diagnosis of RA in a cohort of patients with supposed diagnosis of RA. Methods During two years we evaluated patients with presumptive diagnosis of RA. We conducted a cross-sectional study; we included patients who were referred from primary care centers to a RA specialized center in a 24 month period with presumptive diagnosis of (RA). Each patient was evaluated to confirm or rule-out diagnosis of RA as follows: a rheumatologist fulfilled a complete medical record, including joint counts; it was assessed rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands and feet, and in some cases of persistent doubt about the diagnosis was requested comparative MRI of hands or/and feet. Descriptive epidemiology was perfomed. Results Between 2015 and 2016 6813 patients were evaluated in our specialized center, in 76% of cases RA was confirmed, the remaining 1593 patients (24%) had a wrong diagnosis of RA; of these misdiagnosed patients, (87%) were female, and 205 (13%) male, with an average age of 62±12 years. Between differential diagnosis which were found in this cohort of misdiagnosed patients: osteoarthritis in 849 patients (63.3%), Sjogren syndrome (7%) Systemic lupus erythematosus (6%) the remaining 30% of patients had conditions such as gout, psoriasis, osteoporosis, myalgia, soft tissue diseases among others. The majority of patients with wrong diagnosis took DMARDs (23%), calcium (11%), biologics (10%) acetaminophen (9%), neuropathy medications (7%), acetaminophen plus opioids (5%), osteoporosis medications (5%), opioids (4%), glucosamine (4%), diacerein (3%), the remaining patients took medications such as NSAID, glucosamine, antigout agents, gastritis drugs, among others. Conclusions The results of this program show that almost 25% patients with presumptive RA diagnosis are misdiagnosed; this is evidence that can be extrapolated to primary care centers in Colombia. The most important cofounding diagnosis was osteoarthritis and many patients were receiving DMARDs for treatment. For this reason there is an urgent need of education strategies for primary care physicians and the implementation of centers of excellence in RA, in order to conduct a proper diagnose and avoid clinical and health economics consequences of misdiagnosis. Disclosure of Interest None declared