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Data regarding COVID-19 vaccine efficacy and adverse events (AE) in patients with autoimmune and inflammatory rheumatic diseases (AIIRD) have been published recently although these mostly include the mRNA vaccines (Pfizer-BioNTech and Moderna) and the ChAdOx1 nCoV-19/AZD1222 (Oxford-AstraZeneca). This research aimed to study the prevalence of AE presented with six different SARS-CoV-2 vaccines {ChadOX1 nCoV-19 (AZD1222), Ad5-nCoV2, Ad26.COV2.S, mRNA-1273, BNT162b2, and CoronaVac} in Mexican patients with AIIRD. We performed a cross-sectional study about vaccine history. Two hundred and twenty five consecutive patients were recruited, mean age was 50.7 years and the majority (n = 213; 94.6%) were females. One hundred and seven (47.5%) received BNT162b2 mRNA, 34 (15.1%) Ad5-nCoV, 29 (12.8%) mRNA-1273, 28 (12.4%) ChAdOX1 nCoV-19 (AZD1222), 22 (9.7%) CoronaVac and 5 (2.2%) Ad26.COV2.S. The vaccines that had the most AE proportionally to the number of patients vaccinated were Janssen (5; 100%) followed by Pfizer-BioNTEch (86; 80%) and CanSinoBIO (27; 79.4%). Localized pain was the most frequent (158; 70.2%) AE. Fatigue (78; 34.7%), headache (69; 30.6%) and muscle ache (66; 29.3%) were the most common systemic symptoms. No serious AE that required medical attention or hospitalization were reported. The current results support the safety of different COVID-19 vaccines in patients with AIIRD. This information can help fight vaccine hesitancy in this population.

The objective was to compare the prevalence of subclinical atherosclerosis and cardiovascular risk (CVR) reclassification using six CVR algorithms and a carotid ultrasound in psoriatic arthritis (PsA) patients and controls. The method was cross-sectional study. A total of 81 patients aged 40-75 years, who fulfilled the 2006 CASPAR criteria and 81 controls matched by age, gender, and comorbidities were recruited. CVR was evaluated according to six CVR algorithms, including Framingham Risk Score (FRS)-lipids, FRS-body mass index (BMI), Atherosclerotic Cardiovascular Disease (ASCVD) Algorithm, Systematic Coronary Risk Evaluation (SCORE), QRISK3, and Reynolds Risk Score (RRS). A carotid ultrasound was performed to identify the presence of carotid plaque (CP) defined as a carotid intima media thickness ≥ 1.2 mm or a focal narrowing of the surrounding lumen ≥ 0.5mm. Patients with presence of CP, classified in the low-moderate risk by the CVR algorithms, were reclassified to a higher risk category. CP was more prevalent in PsA patients (44.4% vs 24.7%, p = 0.008), as was subclinical atherosclerosis (51.9% vs 33.3%, p = 0.017). When comparing the CVR reclassification to a higher risk category, a difference was found in the six CVR algorithms. The reclassification was more prevalent in PsA patients: 30.8% vs 12.3%, p = 0.004 with FRS-lipids; 28.4% vs 9.9%, p = 0.003 with FRS-BMI; 40.7% vs 19.8%, p = 0.003 with SCORE; 30.9% vs 16.0%, p = 0.026 with ASCVD algorithm; 37.0% vs 19.8%, p = 0.015 with RRS; and 33.3% vs 16.0%, p = 0.011 with QRISK3. The CVR algorithms underestimate the actual CVR of PsA patients. A carotid ultrasound should be considered as part of the CVR evaluation of PsA patients. KEY POINTS: • Subclinical atherosclerosis was more prevalent in psoriatic arthritis patients than controls. • Cardiovascular risk reclassification, through a carotid ultrasound, according to traditional cardiovascular risk algorithms was more common in psoriatic arthritis patients. • The cardiovascular risk algorithm that showed the lowest reclassification rate in psoriatic arthritis patients was the FRS-BMI. • All cardiovascular risk algorithms underestimate the actual risk of psoriatic arthritis patients, preventing the initiation of an adequate cardiovascular treatment.

Background: RA patients have high latent tuberculosis(LTBI)prevalence(20-37%)1. In Mexico,ranges from 21.7% to 31.3% using tuberculin skin test (TST)2. The methods to detect LTBI are TST and IGRAs. QuantiFERON Gold-Plus (QTF-Plus)uses an antigen tube (TB1) that stimulates CD4+T cells and an additional tube (TB2) that also stimulates CD8+T cells3. Objectives: Determine the LTBI prevalence,variables that predict QTF-Plus and TST results and the concordance between TST and QTF-Plus in RA patients. Methods: A cross-sectional study in RA patients from the rheumatology department of the University Hospital “Jose E. Gonzalez” in Mexico between October 2017 and June 2018. RA patients with ACR/EULAR 2010 classification criteria without a history of tuberculosis (TB) were included.QFT-Plus was performed according to manufacturer instructions.TST was applied with the Mantoux technique; a ≥5mm cutoff was used.The square chi and Fisher test were used for proportions, Mann-Whitney to compare means,trend analysis using linear trend test and a binary logistic regression model for variables related to positivity to both tests. Results: We included 111 patients (table 1), the mean age was 51.9 years, 92.3% were women,disease duration 8.7±8.8 years. QTF-Plus was positive in 46 (44.6%) patients. TST was positive in 31(27.9%) patients.Agreement between tests was 73.7% (kappa=0.45, p Conclusion: The LTBI prevalence in RA patients in our study is similar to countries with a high TB burden.We recommend considering RA patients as a high-risk population for LTBI.An intermediate agreement between TST and QTF-Plus was found.The use of antimalarials and ≥2DMARDs influence the TST reactivity,none of the variables altered the QTF-Plus results.Based on the results, we recommend the QuantiFERON Gold Plus over TST for the LTBI screening in RA patients. References: [1] Sester M,et al.Am J Respir Crit Care Med.2014;190(10):1168–76. [2] Perez-Barbosa L,et al.Rheumatol Int.2015;35(9):1555–9. [3] Takasaki J,et al.J Infect Chemother.2018;24(3):188–92. Disclosure of Interests: None declared

Background: There is a 50% increase in cardiovascular mortality in RA compared to controls. Chronic inflammation causes endothelial dysfunction and accelerated atherosclerosis. Key molecular pathways in this process are dependent on cytokines like TNF-α, IL-1, IL-6, among others, which are shared with RA. Increased disease activity could contribute to atherosclerosis. Carotid ultrasound (US) has recently been recommended as a screening tool for early detection of subclinical atherosclerosis. Objectives: To compare different cytokines between Mexican-mestizo RA-subjects with/without carotid plaque (CP). Methods: An observational cross-sectional trial was designed. Inclusion criteria: age between 40-75 years old, fulfillment of the 2010 ACR/EULAR classification criteria, and detection of a CP during a carotid US. Subjects with a prior diagnosis of cardiovascular disease or a poor US window were excluded. RA subjects were matched to controls (RA patients without CP) by age and cardiovascular (CV) comorbidities. Every subject had a carotid US performed; reviewed by two board-certified radiologists. Cytokines measured were IL-1, IL-6, TNF-α, VCAM-1, ICAM-1 and MMP-9, using an ELISA reader (Glomax E9032). Descriptive analysis was done with frequencies (%), median (q25-q75), and comparisons between groups with Chi square test and Mann U Whitney’s test. Results: 71 subjects were included, 95.8% were females, with a median age of 58 years (54-65). Levels of cytokines in Table 1. Comparisons between groups are in Table 2. Groups were well balanced, with no differences in CV comorbidities (p>0.05). No significant differences among cytokine levels regarding CP were found. Subjects in remission (n=12, 33%) had a lower prevalence of CP (p Conclusion: In our cohort subjects in remission had a lower prevalence of CP (OR= 0.3, 0.1-0.9). No difference was found between cytokines regarding CP. Subjects with active disease had a higher level of IL-1 than subjects in remission. To our best knowledge, this is the first study to evaluate levels of cytokines in Mexican RA-subjects. References [1] Lopez R, et al. Cardiovascular risk assessment in patients with rheumatoid arthritis. Autoimmun Rev2016. [2] Pasceri V, et al. A tale of two diseases: Atherosclerosis and rheumatoid arthritis Circulation1999. Disclosure of Interests: None declared

Background: Heterogeneity regarding clinical and laboratory findings at diagnosis of acute lymphoblastic leukemia exists. The frequency of complete blood count abnormalities and its combinations, symptoms and physical findings were investigated in Hispanic children from an open population at the diagnosis of acute lymphoblastic leukemia. Methods: The patient charts and electronic records of under 16-year-old children diagnosed with acute lymphoblastic leukemia over 10 years at a regional hematology center of a university hospital were analyzed to retrieve data concerning the complete blood count at first evaluation. Type and distribution of abnormal data, frequency of symptoms and physical findings at presentation were documented. Results: The records of 203 children aged 0–15 years diagnosed with acute lymphoblastic leukemia from 2006 to 2016 were revisited. The results of the blood workup showed a median white blood cell count of 7120 × 109/L (range: 450–600,000 × 109/L), and a median hemoglobin concentration of 7.5 g/dL (range: 2.4–15.3 g/dL), whereas the median platelet count was 47,400 × 109/L (range: 4000–544,000 × 109/L). Leukocytosis and leukopenia were present in 36.6% and 36.1% of cases, respectively; anemia was diagnosed in 82.9% children. The order of frequency for major clinical symptoms was fatigue 62%, fever 60%, bone and joint pain 39%, hyporexia 33% and weight loss 21%, while main physical findings were hepatomegaly 78%, splenomegaly 63%, lymphadenopathy 57%, pallor 48%, and purpura 30%. Conclusion: Data differing from those classically expected at diagnosis of acute lymphoblastic leukemia in children were documented in a cohort of Hispanic children over one decade with a wide spectrum of complete blood count abnormalities, forms of presentation and frequency of physical findings. Keywords: Acute lymphoblastic leukemia, Complete blood count, Leukocytosis, Hepatomegaly, Splenomegaly

Background:Psoriatic arthritis (PsA) patients have a higher risk of developing a cardiovascular (CV) event than the general population due to an increased prevalence of traditional CV risk factors and to disease characteristics such as disease duration and activity. The carotid ultrasound (US) is a non-invasive diagnostic tool that can detect the presence of subclinical atherosclerosis which is directly associated with the risk of developing a CV event.Objectives:The aim of this study is to compare the prevalence of subclinical atherosclerosis detected by carotid US in PsA patients and controls.Methods:This is a cross-sectional, observational, and comparative study. A total of seventy-five PsA patients aged 40-75 years old, who fulfilled the 2006 CASPAR criteria and seventy-five matched controls by age (±5 years), gender and comorbidities were recruited for this study. Patients with history of a previous CV event and pregnant women were excluded from this study. A high-resolution B mode carotid US was performed in all study subjects by a certified radiologist. Subclinical atherosclerosis was defined as the presence of a carotid plaque (CP) or an increased carotid intima media thickness (cIMT). The presence of CP was defined as a cIMT ≥1.2mm or a focal narrowing ≥0.5mm in the surrounding lumen. An increased cIMT was considered as a value ≥0.8mm. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with χ2 test for qualitative variables and Student´s t test and Mann-Whitney’s U test for quantitative variables. A p value Results:There were no differences when comparing the demographic characteristics between both groups (Table 1). When comparing the carotid US findings, a statistically significant difference was found in the prevalence of CP, which was higher in the PsA group (44.0% vs 26.7%, p=0.026), in the presence of unilateral CP (25.3% vs 10.7%, p=0.019) and in the presence of subclinical atherosclerosis (52.0% vs 34.7%, p=0.032) (Figure 1).Conclusion:The prevalence of subclinical atherosclerosis was higher in PsA patients than controls, and this could be attributed to an increase in the inflammatory burden of these patients. The carotid US should be considered as part of the CV evaluation in all PsA patients, identifying those who would benefit from an opportune treatment preventing the development of a CV event.References:[1]Yim KM, Armstrong AW. Updates on cardiovascular comorbidities associated with psoriatic diseases: epidemiology and mechanisms. Rheumatol Int. 2017;37(1):97–105.Table 1.Demographic and clinical characteristics of psoriatic arthritis patients and controls.PsA(n=75)Controls(n=75)pAge years, mean ± DE53.89 ± 10.5954.25 ± 7.08NSFemale gender, n (%)43 (57.3)43 (57.3)NST2DM, n (%)16 (21.3)15 (20.0)NSHTN, n (%)28 (37.3)21 (28.0)NSDyslipidemia, n (%)33 (44.0)28 (37.3)NSObesity, n (%)31 (41.3)32 (42.7)NSActive smoking, n (%)14 (18.7)18 (24.0)NSBMI kg/m2, median (p25-p75)29.32 (26.23-32.03)28.9 (25.4-33.5)NSDisease duration years, median (p25-p75)5.0 (3.0-10.0)--DAPSA, median (p25-p75)12.6 (5.3-22.9)--Glucocorticoids, n (%)10 (13.3)--MTX, n (%)51 (68.0)--bDMARD, n (%)28 (37.3)--PsA, psoriatic arthritis; NS, not significant; T2DM, type 2 diabetes mellitus; HTN, hypertension; BMI, body mass index; DAPSA, disease activity for psoriatic arthritis; MTX, methotrexate; bDMARD, biological disease modifying antirheumatic drug.Disclosure of Interests:None declared

Objective: By applying receiver operating characteristic curve analysis, the objective of this study was to see whether hemoglobin levels reflect body iron stores in a group of pregnant women at term who, by using serum ferritin as the reference test, had a high pre-test prob- ability of having iron deficiency anemia. Likewise, we evaluated the ability of hemoglobin and maternal serum ferritin levels to predict iron deficiency anemia in newborns. Methods: Hemoglobin and serum ferritin were measured in 187 pregnant women at term belonging to a group with a high pre-test probability of iron deficiency anemia and their newborns. Women with Hb

Background and Aims In high-income countries, treatment protocols for acute lymphoblastic leukemia (ALL) in children lead to a 5-year overall survival (OS) approaching 90%. There is scarce information on protocols and results of therapy from low-middle income countries (LMIC). We documented the results of treating children with ALL with two protocols in consecutive 5-year periods at a reference center in northeast Mexico. Patients and Methods Children ≤16 years of age diagnosed with ALL treated with two protocols were studied. Each protocol was used for 5 years; 246 children, 112 in protocol 1 and 134 in protocol 2, were included. Protocols were BFM-inspired and adapted from several regimens; protocol 2 was intended to decrease toxicity and need for hospitalization. Event-free survival (EFS) and overall survival (OS) were determined using the Kaplan-Meier method. Results In protocol 1, 103 patients (91.96%) achieved complete remission compared to 106 (79.10%) in protocol 2 (p = 0.001). The 5-year OS was 67.1% for protocol 1 vs. 55.5% for protocol 2, whereas EFS was 58.2% vs. 36.9%, respectively. Relapse occurred in 45 patients (40.17%) in protocol 1 vs. 42 (31.34%) in protocol 2 (p = 0.181). OS 1 year after relapse was 52.4% vs. 57.1%, respectively. No difference in relapse rate was documented. Conclusions No improvement in survival rates of children with ALL from a low-income group living in a LMIC was achieved over a decade. Implementation of contemporary protocols with a high success rate is mandatory.

We present the case of a human immunodeficiency virus (HIV)-infected patient who arrived at our emergency department with fever, headache and exertional dyspnea. Throughout their stay, a chest x-ray was taken and a rounded opacity in his left lung was observed. CT images showed same abnormality and also ground glass opacities were seen. Symptoms and images strongly suggested a pulmonary infection due to pneumocystis jirovecii, however a presence of a round lesion should always lead to neoplasia being suspected. We empirically started treatment based on trimethoprim and sulfamethoxazole. Once available, flexible bronchoscopy and bronchoalveolar lavage was performed and stained preparations from his respiratory specimens confirmed the diagnosis of pulmonary pneumocystis infection. Finally, after 4 days of antibiotic therapy, an important clinical improvement was documented; a new chest x-ray was performed and the previous rounded opacity was absent. This finding strongly suggested a case of round pneumonia.