Ocular cicatricial pemphigoid: Methotrexate as an initial treatment?

OBJECTIVE

To analyse the clinical/epidemiological data, the management and the treatments established in patients with Ocular Cicatricial Pemphigoid (OCP) in a Rheumatology Service.

MATERIAL AND METHODS

Review of clinical histories of patients with OCP referred by ophthalmology between 2008 and 2019.

RESULTS

In our series of 27 patients, 67% were diagnosed and referred in the last 2 years. Most in Foster stage 1. Of the patients, 18.5% presented associated Sjogren's syndrome, with poor progression: 88.8% received Methotrexate, 74% used it as monotherapy and 66% continued with said treatment up to the end. Eighteen point five percent had to combine or rotate therapies, the drugs used were mycophenolate, azathioprine, cyclophosphamide, sirolimus, etanercept, rituximab: 29% used steroids. Only in 2 eyes was stage progression observed. There were no serious adverse events, and 37% had mild adverse events.

CONCLUSION

Starting immunosuppressive therapy early is essential, methotrexate being a good initial alternative in our experience, and treatment must be escalated in line with disease progression.

Ocular Cicatricial Pemphigoid: Methotrexate as an Initial Treatment?

OBJECTIVE

To analyse the clinical / epidemiological data, the management and the treatments established in patients with ocular cicatricial pemphigoid in a Rheumatology Service.

MATERIAL AND METHODS

Review of clinical histories of patients with ocular cicatricial pemphigoid referred by ophthalmology between 2008 and 2019.

RESULTS

In our series of 27 patients, 67% were diagnosed and referred in the last 2 years. Most in Foster stage 1. Of the patients, 18.5% presented associated Sjogren's syndrome, with poor progression: 88.8% received Methotrexate, 74% used it as monotherapy and 66% continued with said treatment up to the end. Eighteen point five percent had to combine or rotate therapies, the drugs used were mycophenolate, azathioprine, cyclophosphamide, sirolimus, etanercept, rituximab: 29% used steroids. Only in 2 eyes was stage progression observed. There were no serious adverse events, and 37% had mild adverse events.

CONCLUSION

Starting immunosuppressive therapy early is essential, methotrexate being a good initial alternative in our experience, and treatment must be escalated in line with disease progression.

Photocatalytic Activity of ZnO-Biochar Hybrid Composites

<span>Photodegradation of methylene blue (MB) was studied on ZnO in presence of home-made biochars </span><span>prepared by different methods. MB photodegradation was performed under UV-visible irradiation to verify </span><span>the scaling-up of ZnO-AC hybrid materials. It was verified that oxygenated surface groups on carbon were </span><span>photochemically active in the photodegradation of MB and a synergy effect between both solids has been </span><span>estimated from the first-order apparent rate-constants. This effect enhances the photoactivity of ZnO up to </span><span>a factor about 2.5 and the difference in photoactivity in the binary materials was associated to the surface </span><span>properties of AC.</span>

Male Partner Risk Behaviors Are Associated With Reactive Rapid HIV Antibody Tests Among Pregnant Mexican Women: Implications for Prevention of Vertical and Sexual HIV Transmission in Concentrated HIV Epidemics

Mexico's policies on antenatal HIV testing are contradictory, and little is known about social and behavioral characteristics that increase pregnant Mexican women's risks of acquiring HIV. We analyzed the association between risk behaviors reported by pregnant women for themselves and their male partners, and women's rapid HIV antibody test results from a large national sample. Three quarters of pregnant women with a reactive test did not report risk behaviors for themselves and one third did not report risk behaviors for themselves or their male partners. In the retrospective case-control analysis, other than reporting multiple sexual partners, reactive pregnant women reported risk behaviors did not differ from nonreactive women's behaviors. However, reactive pregnant women were significantly more likely to have reported risk behaviors for male partners. Our findings support universal offer of antenatal HIV testing and suggest that HIV prevention for women should focus on reducing risk of HIV acquisition within stable relationships.

Influence of anatase and rutile phase in TiO2 upon the photocatalytic degradation of methylene blue under solar irradiation in presence of activated carbon

The influence of activated carbon (AC) on the photocatalytic activity of different crystalline TiO2 phases was verified in the photocatalytic degradation of methylene blue under UV and solar irradiation. The results showed a volcano trend with a maximum photoactivity for the crystalline phase ratio of anatase:rutile equal to 80:20 both under UV or solar irradiation. By contrast, in presence of AC the photocatalytic activity of the binary materials of TiO2/AC followed an exponential trend, increasing as a function of the increase in anatase proportion in the TiO2 framework. The increase in the photoactivity of the binary material TiO2/AC relative to neat TiO2 was up to 22 and about 17 times higher under UV and visible irradiation, respectively. The present results suggest that AC interacts more efficiently with anatase phase than with rutile phase.

Stability of plasma electrolytic oxidation coating on titanium in artificial saliva

Bioactive PEO coating on titanium with high Ca/P ratio was fabricated and characterized with respect to its morphology, composition and microstructure. Long-term electrochemical stability of the coating and Ti(4+) ion release was evaluated in artificial saliva. Influence of the lactic acid and fluoride ions on corrosion protection mechanism of the coated titanium was assessed using AC and DC electrochemical tests. The PEO-treated titanium maintained high passivity in the broad range of potentials up to 2.5 V (Ag/AgCl) for up to 8 weeks of immersion in unmodified saliva and exhibited Ti(4+) ion release <0.002 µg cm(-2) days(-1). The high corrosion resistance of the coating is determined by diffusion of reacting species through the coating and resistance of the inner dense part of the coating adjacent to the substrate. Acidification of saliva in the absence of fluoride ions does not affect the surface passivity, but the presence of 0.1 % of fluoride ions at pH ≤4.0 causes loss of adhesion of the coating due to inwards migration of fluoride ions and their adsorption at the substrate/coating interface in the presence of polarisation.

Risk factors for intestinal ischaemia among patients registered in a UK primary care database: a nested case-control study

BACKGROUND

Intestinal ischaemia, including ischaemic colitis and acute mesenteric ischaemia, causes significant morbidity and mortality. Few population-based studies have estimated incidence and potential risk factors for this disease.

AIMS

To estimate the incidence of intestinal ischaemia and identify the associated risk factors in cohorts: (i) patients with irritable bowel syndrome and/or chronic constipation (IBS/CC/both), (ii) individuals free of these conditions.

METHODS

Population-based case-control analysis nested in a cohort of patients with first ever recorded diagnosis of IBS/CC/both and a cohort free of these conditions from general population using the General Practice Research Database.

RESULTS

Of 78 cases of intestinal ischaemia, 71 were from general population, seven from the IBS/CC/both cohort. Incidence rate of intestinal ischaemia in IBS/CC/both patients vs. general population was 4.49:1.09 per 100,000 person-years; age- and gender-adjusted incidence rate ratio (95% CI) was 2.7 (1.2-5.9). Inflammatory bowel disease and heart failure showed an association with ischaemic colitis [OR (95% CI): 4.2 (0.5-38.4) and 5.6 (2.2-14.1)], but none with acute mesenteric ischaemia. Diabetes and prior cardiovascular surgery were associated with higher risk of acute mesenteric ischaemia, but showed no association with ischaemic colitis.

CONCLUSIONS

Results suggest that different risk factors are associated with acute mesenteric ischaemia and ischaemic colitis. However, due to small number of patients, associations should be carefully interpreted.

Epidemiology of peptic ulcer disease in cirrhotic patients: role of Helicobacter pylori infection

OBJECTIVE

The aim of this study was to investigate the clinical and epidemiological factors associated with the appearance of peptic ulcer in patients with cirrhosis and, in particular, the role of Helicobacter pylori infection.

METHODS

A total of 201 of 220 consecutive patients included in a prospective study that aimed to evaluate the effect of dietary intervention on cirrhotic complications and survival underwent upper gastrointestinal endoscopy. At entry, an epidemiological and clinical questionnaire was completed and the presence of peptic ulcer disease or esophageal varices at endoscopy was prospectively collected. Sera were obtained and stored at -70 degrees C until analyzed, being tested afterward for Helicobacter pylori antibodies using a commercial ELISA kit.

RESULTS

Eleven of 201 patients had borderline anti-Helicobacter pylori IgG titers and were excluded from further analysis. In the remaining 190 patients, point prevalence of peptic ulcer was 10.5% and lifetime prevalence 24.7%. Multivariate analysis selected male sex (OR 2.3; 95%CI 1.09-4.89) and Helicobacter pylori seropositivity (OR: 1.7, 95%CI 1.02-2.81) as the variables independently related to peptic ulcer disease.

CONCLUSIONS

Male sex and seropositivity for Helicobacter pylori are the major risk factors for peptic ulcer in cirrhosis.

Seroprevalence and epidemiology of Helicobacter pylori infection in patients with cirrhosis

BACKGROUND

Helicobacter pylori infection is the major pathogenic factor for peptic ulcer disease. Its epidemiology is not fully known; few data are available in patients with chronic liver disease.

AIMS

To investigate the seroprevalence and factors associated with Helicobacter pylori infection in a series of liver cirrhosis patients.

METHODS

Two hundred and twenty consecutive patients were prospectively included in a study aimed to evaluate the effect of dietary intervention on cirrhosis complications and survival. At inclusion, an epidemiological and clinical questionnaire was completed. Sera were obtained and stored at -70 degrees C until analyzed. They were tested for Helicobacter pylori antibodies using a commercial ELISA kit.

RESULTS

Eleven out of 220 patients had borderline anti-Helicobacter pylori IgG titers. Of the remaining 209 patients, 105 (50.2%) showed positive titers of Helicobacter pylori IgG. Univariate analysis showed that Helicobacter pylori infection was more frequent in older patients, those born outside Catalonia, and in patients with a low educational level. Past ethanol consumption and current smoking correlated negatively with Helicobacter pylori infection. Multivariate analysis selected age (OR 3.1. 95% CI 1.46-6.45), educational level (OR 2.2. 95% CI 1.18-4.2) and alcohol consumption (OR 0.7. 95% CI 0.45-0.99) as the variables independently related to Helicobacter pylori infection.

CONCLUSIONS

Helicobacter pylori infection in cirrhosis has the same epidemiological pattern as in the general population. Suggestions that the etiology or the severity of the liver disease could be related to Helicobacter pylori infection were not confirmed by our study.

[Cancer mortality in the counties of Catalonia (1983-1989)]

OBJECTIVES

To compare mortality among counties (comarques) in Catalonia, Spain for the most frequent malignant tumors.

METHODS

Overall mortality data and for five specific tumor sites were analyzed for a five-year period (1983-1989). Crude and site-specific mortality rates were computed. The comparison between counties was adjusted for the 1986 population of Catalonia using the direct method. Comparative mortality ratios (CMR) were obtained for each county with respect to Catalonia.

RESULTS

Overall cancer mortality was higher in the Barcelonès for men and in Osona form women. The CMR for men in the Barcelonès was the highest for cancer of the trachea, bronchi and lungs; the CMR in Solsonès was the highest for stomach cancer, while in Cerdanya it was the highest for colorectal cancer. Among women, the highest CMR for cancer of the trachea, bronchi and lungs was in Montsià, whereas for breast cancer it was Baix Empordà, and Alt Urgell for stomach cancer.

CONCLUSIONS

Comparative analyses of cancer mortality by county in Catalonia and sex underscores differences in its distribution, allowing the orientation of cancer control policies and research to be developed in each geographical area.

Factors related to the failure of endoscopic injection therapy for bleeding gastric ulcer

BACKGROUND

Although endoscopic injection therapy is effective in controlling initial haemorrhage from peptic ulcer, between 10% to 30% of patients suffer rebleeding.

AIM

To assess the factors that may predict the failure of endoscopic injection in patients bleeding from high risk gastric ulcer.

SUBJECTS

One hundred and seventy eight patients admitted for a gastric ulcer with a bleeding or a non-bleeding visible vessel were included.

METHODS

Patients received endoscopic therapy by injection for adrenaline and polidocanol. Twelve clinical and endoscopic variables were entered into a multivariate logistic regression model to ascertain their significance as predictive factor of therapeutic failure.

RESULTS

Eighty seven per cent (155 of 178) of patients had no further bleeding after endoscopic therapy. Endoscopic injection failed in 23 (13%) patients: 20 (12%) continued to bleed or rebleed, and three (1%) patients could not be treated because of inaccessibility of the lesion. Logistic regression analysis showed that therapeutic failure was significantly related to: (1) the presence of hypovolaemic shock (p = 0.09, OR 2.38, 95% CI: 0.86, 6.56), (2) the presence of active bleeding at endoscopy (p = 0.02, OR 2.98, 95% CI: 1.12, 7.91), (3) ulcer location high on the lesser curvature (p = 0.04, OR 2.79, 95% CI: 1.01, 7.69), and (4) ulcer size larger than 2 cm (p = 0.01, OR 3.64, 95% CI: 1.34, 9.89).

CONCLUSION

These variables may enable identification of those patients bleeding from gastric ulcer who would not benefit from injection therapy.

Lung cancer mortality among males of Catalonia and Spain compared with other European countries between 1975-1977 and 1987-1989

This study compares the lung cancer mortality rates among males in the years 1975-1977 and 1987-1989 in Catalonia and Spain with other European countries selected for their geographical proximity. Adjusted calculations using the direct method have been made for male lung cancer mortality. Adjusted truncated rates for the age groups 0-44, 45-64 and more than 65 years were also calculated, as well as percent differences between the mortality rates of each period studied. Lung cancer mortality rates for males in Catalonia and Spain show relative increments of 46.58% and 52.41%, respectively. In contrast, lung cancer mortality in countries such as England-Wales and Switzerland have decreased. Moreover, the 0-44 year age group in Catalonia and Spain shows the absolute highest rates in the 1987-1989 period among all the countries analyzed. The marked contrast of the lung cancer mortality rate evolution in Catalonia and Spain compared with some other European countries and the considerable increase of the mortality in younger age groups indicate the need to intensify lung cancer control measures.

Changes in cancer mortality in Catalonia and Spain (1975-77 and 1987-89). A comparison with other European countries

Comparisons of cancer mortality in Catalonia and Spain have shown an intermediate position of these areas in relation to the rest of Europe. This study compares the overall cancer mortality in Catalonia and Spain in the periods 1975-77 and 1987-89 in relation to other European countries selected on the basis of geographical proximity and availability of information. Adjusted and truncated cancer mortality rates and relative changes in these rates have been assessed for both sexes. The mortality rate for males in Catalonia, Spain, Italy, Portugal and France has increased from 1975-77 to 1987-89 with relative increments of 13.5%, 13.7%, 10.1%, 9.6% and 4.3% respectively, whereas in Switzerland and England and Wales this rate has decreased. The mortality rate for females showed a slight drop between the two periods in all the studied countries except England and Wales and Portugal. By age groups, in males, the 0-44 year interval in Catalonia, Spain, France and Portugal, in descending order, showed the highest rates. The marked contrast of the evolution of the cancer mortality rate in Catalonia, Spain, Italy, France and Portugal, compared with Switzerland and England and Wales, and especially the considerable increase of the mortality in young people in Catalonia, indicates the extremely urgent need for all countries to adopt the measures to control cancer that have already shown themselves to be effective elsewhere.

Topical pharyngeal anesthesia improves tolerance of upper gastrointestinal endoscopy: a randomized double-blind study

BACKGROUND AND STUDY AIMS

The usefulness of topical pharyngeal anesthesia is not well established. The aim of the present study was to determine its benefits in relation to patient tolerance and facilitation of the procedure in unsedated patients undergoing upper gastrointestinal endoscopy.

PATIENTS AND METHODS

A randomized double-blind study comparing Topicaina spray - a mixture of benzocaine butyl aminobenzoate (butoforme), amethocaine, and butacaine - and a placebo was carried out on 256 outpatients referred for diagnostic endoscopy. No additional premedication was used. After the examination, both the tolerance to and difficulty of the intubation and examination were evaluated by patients and endoscopists respectively, using visual analogue scales and a questionnaire.

RESULTS

Three patients (1.2%) did not tolerate the endoscopy. One patient was excluded for unexpected therapeutic endoscopy. One hundred twenty-five patients received the active spray and 127 received the placebo. The two groups were similar with respect to patient characteristics. Both intubation and examination, assessed with visual analogue scales, were better tolerated (both p = 0.0001) and more easily performed (p = 0.02 and p = 0.0001 respectively) in the active treatment group. Patients receiving the active spray had a better tolerance for the procedure, according to questionnaire replies.

CONCLUSIONS

Topical pharyngeal anesthesia in unsedated patients undergoing diagnostic upper gastrointestinal endoscopy improves tolerance and makes examination easier.

[Accessory spleen: compensating hypertrophy after of splenectomy. A case report]

The prevalence of accessory spleens has been reported to be about 7.1% in infants. When these patients undergo splenectomy without removal of the accessory spleen, the latter develop hypertrophy later in life and can reach the size of a normal spleen, with clinical manifestations similar to the ones before surgery. We report the case, of fourteen-old boy, who had splenectomy 7 year ago, for refractory and recurrent thrombocytopenia, who had splenectomy at age 7 years because of persistent thrombocytopaenia, resistant to non-surgical treatment, and who was found by conventional ultrasound study, doppler duplex color and selective angiography to have a hypertrophied spleen with sings of portal thrombosis and portal hypertension.

[Evaluation of the design and reliability of a questionnaire to identify elderly individuals in need for social and health services]

BACKGROUND

To assess the construction of a short screening questionnaire designed for the detection of elderly people living in the community and in need of social and health care, and to test the reliability of the scores obtained on the scales of Activities of Daily Living (ADL) and mobility through its application.

METHODS

A short screening questionnaire of 11 items was designed to score elderly community dwellings on the scales of ADL and mobility of the International Classification of Impairments, Disabilities and Handicaps of the WHO (ICIDH). A random sample of 1,000 people aged 65 and over from the community of a geographical area of Catalonia (Spain) were interviewed in 1989, either by telephone or in-home personal interview, by non-professional trained interviewers on the basis of the mentioned schedule, and scored on the ICIDH ADL and Mobility scales. The design of the screening questionnaire was evaluated on the construction, content and wording through a 16 opinion statements questionnaire upon which 12 professionals, familiarized with questionnaire construction, expressed agreement or disagreement. To test reliability, each interviewer re-scored, one month apart, 20 subjects based on the information they had registered on the questionnaires, and following the same procedure, a gold standard observer re-scored all 1,000 interviews. In addition, a number of interviews were tape recorded, with previous consent of the subjects, and re-scored by 9 different observers. Interobserver and intraobserver reliability was measured with Cohen's weighted kappa coefficient.

RESULTS

The average time of questionnaire administration was approximately 10 +/- 5 min. Although the instrument was said to be a good tool for the interviewer to score the subjects on the scales, wording of some items of the questionnaire need to be reviewed. Both intraobserver and interobserver reliability were high: kappa coefficients of 0.79-0.97 and > 0.75 respectively.

CONCLUSIONS

The use of a simple and reliable ADL and mobility questionnaire is a practical way to obtain information on the functional status of elderly people living at home, and to select elderly people for a further comprehensive assessment of their social and health care needs for planning the appropriate services in the community.

[Tendencies of mortality from cardiovascular diseases in Catalonia: 1975-1992]

BACKGROUND

There is an uncertainty of which is going to be the trend of cardiovascular disease in Spain. In the present study cardiovascular disease mortality is described from 1975 to 1992 in Catalonia, and a prediction until 1997 is made, assuming the same trend. Possible causes of this trend are analyzed.

METHODS

Deaths from cardiovascular disease, ischaemic heart disease and stroke have been identified from 1975 to 1992. It has been used the direct method for standardization by age and sex, using the European population as the standard population. Logarithmic transformations of the standardized rates were used for each cause of death and for both sexes. Linear regression analysis was used to adjust the evolution of the rates in the time period.

RESULTS

There is a reduction of 2.6% and 2.7% by year in rates for cardiovascular diseases mortality for both males and females respectively, a reduction of 1.2% by year in rates for ischaemic heart disease in males and a reduction of 1.8% in females, and a reduction of 4.0% and 4.2% for stroke in males and females respectively.

CONCLUSIONS

Trends in cardiovascular disease mortality reveal a decline for both males and females, mostly due to a reduction in stroke mortality; ischaemic heart disease mortality slightly decreased specifically during the period 1983-1992.

[Usefulness of dilatation in esophageal stricture in children]

During 8 years, 140 children aged from 23 days old to 12 years old with the diagnosis of esophageal narrowness of different etiologies were studied. They had been treated through periodic dilatations according to their needs; the number of dilatations varied in relation to the clinic entity, age and time passed since the beginning of treatment standing out that the precocious dilatations had a greater success as less of them were required, specially in children with esophageal narrowness post ingestion of caustic and those with post surgical narrowness from correction of esophageal atresia. Among the patients who finished the treatment with dilatations, 81.4% were success fully resolved including 14.2% who needed surgical treatment, that is, resection of stenosis in 7.15%, transposition of colon in 4.28%, and required Nissen operation in 2.85% of patients.

Endoscopic cholangiopancreatography in the infant: evaluation of a new prototype pediatric duodenoscope

The usefulness of a new pediatric duodenoscope PJF in the diagnosis of neonatal cholestasis was studied in 23 infants with ages ranging from 19 to 150 days. In 22 of 23 infants the papilla was cannulated. In 13 of 14 neonates (93%) with neonatal hepatitis, the common bile duct was opacified and biliary atresia was excluded. In one of two neonates with choledochal cyst, the common bile duct was demonstrated. In six of seven neonates (86%) with biliary atresia, only the pancreatic duct was demonstrated and the diagnosis was suspected. Although absence of a common bile duct opacification does not rule out biliary atresia, ERCP with the new duodenoscope proved to be most useful in the diagnosis of normal biliary tree and served to avoid unnecessary surgery in most infants with neonatal cholestasis.