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    ABSTRACT: Objective: To compare the clinical, demographic, and serologic characteristics and the treatment of patients diagnosed with ankylosing spondylitis (AS) from Europe (EU) and Latin America (LA). Methods: We included 3439 patients from national registries: the Spanish Registry of Spondyloarthritis (REGISPONSER), the Belgian registry (ASPECT), and the Latin American Registry of Spondyloarthropathies (RESPONDIA). We selected patients with diagnosis of AS who met the modified New York classification criteria. Demographic, clinical, disease activity, functional, and metrological measurement data were recorded. Current treatment was recorded. The population was classified into 2 groups: patients with disease duration < 10 years and those with disease duration ≥ 10 years. A descriptive and comparative analysis of variables of both groups was carried out. Results: There were 2356 patients in EU group and 1083 in LA group. Prevalence of HLA-B27 was 71% in LA group and 83% in EU group (p < 0.001). We found a greater frequency of peripheral arthritis and enthesitis (p < 0.001) in the LA population; prevalence of arthritis was 57% in LA and 42% in EU, and for enthesitis, 54% and 38%. Except for treatment with anti-tumor necrosis factor (anti-TNF), the use of nonsteroidal antiinflammatory drugs (NSAID), corticosteroids, and disease-modifying antirheumatic drugs (DMARD), and the association of anti-TNF and methotrexate use showed a significant difference (p < 0.001) in the 2 populations. Conclusion: The principal differences in the clinical manifestations of patients with AS from EU and LA were the greater frequency of peripheral arthritis and enthesitis in LA group, the higher percentage of HLA-B27 in EU group, and the form of treatment, with a greater use of NSAID, steroids, and DMARD in the LA group.
    The Journal of Rheumatology 11/2012; 39(12). DOI:10.3899/jrheum.110687
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    ABSTRACT: Liver transplantation is the only therapy for end-stage liver disease. Cirrhosis secondary to autoimmune hepatitis (AIH) is an indication in 4-6% of adult transplants. To describe the outcomes and recurrence of AIH in liver transplant patients. Twenty patients were retrospectively studied. The female/male ratio was 3:1, the median age was 36.7 years (range, 16 to 39 years), and the median MELD score was 18.5. According to serological analysis, 19 patients were AIH type 1 and one patient was AIH type 2. AIH was associated with human leukocyte antigen (HLA) DR13+ and DR4+. The overall 5-year patient and graft survival rates were 94 and 85%, respectively. Three (15.7%) cases of recurrent AIH were diagnosed based on histological evidence. Clinical and histological features of acute and chronic rejection were present in four (20%) and three (16.6%) patients, respectively. AIH frequently affected young women, was the most frequent indication for liver transplantation. Rejection and recurrence were commonly associated with AIH, but did not affect patient survival. No significant relationship between HLA-DR type and recurrence was found. Rapid progression to cirrhosis should be considered in severe recurrences.
    Annals of hepatology: official journal of the Mexican Association of Hepatology 03/2012; 11(2):222-7.
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    ABSTRACT: Research about accessibility to medicines through household surveys is very important in order to verify the reality and effectiveness of interventions done to increase the access of the population to the medications. Unfortunately, such studies, on top of being very few, have methodological problems, which mostly result from a lack of uniformity in the operational definitions of access and the differentiation with the dimensions of accessibility. The aim of this paper is to propose setting a difference between both terms. We propose an operational definition of access to medications as the process of verification of the purchase of a drug by a patient, independently from many factors that can affect this process. The term "usability of drugs" is introduced, defining it operationally as aimed at measuring the dimensions of the accessibility to the medications: physical availability, affordability, geographical accessibility, acceptability (or satisfaction).
    Revista peruana de medicina experimental y salud publica 03/2012; 29(1):119-26.


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