Objectives: Pen devices offer advantages compared with vial and syringe (VaS). The purpose of this article was to evaluate efficacy of pen devices compared to VaS. Methods: A systematic review of literature was performed in 8 different databases. References were independently screened and selected. Primary observational or experimental studies comparing pen devices with VaS for insulin administrations were included. Studies on specific populations were excluded. Risk of bias was evaluated using appropriate tools. Data on glycosylated hemoglobin (HbA1c), hypoglycemia, adherence, persistence, patient preference, and quality of life (QOL) were collected. Meta-analysis was performed when appropriate. Heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses of the available data was done. Results: In all, 10 348 articles were screened. A total of 17 studies were finally selected: 7 experimental and 10 analytical. The populations of the included articles were mainly composed of adults with type 2 diabetes mellitus. Important risk of bias was found in all of the articles, particularly experimental studies. Meta-analyses were performed for HbA1c, hypoglycemia, adherence and persistence. Pen device showed better results in mean HbA1c change, patients with hypoglycemia, adherence and persistence compared to VaS. No difference was observed in number of patients achieving <7% HbA1c. Preference studies showed a tendency favoring pen devices, however nonvalidated tools were used. One QoL study showed improvements in some subscales of SF-36. Conclusions: There is evidence that pen devices offer benefits in clinical and, less clearly, patient-reported outcomes compared to VaS for insulin administration. However, these results should be taken with caution.

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Objective To describe the impact of COVID-19 pandemic on Latin American rheumatologists from a professional, economic, and occupational point of view. Methods We conducted an observational cross-sectional study using an online survey sent to rheumatologists of each non-English-speaking country member of the Pan American League of Rheumatology Associations (PANLAR). A specific questionnaire was developed. Results Our survey included 1097 rheumatologists from 19 Latin American countries. Median (IQR) age of respondents was 48 (40-59) years and 618 (56.3%) were female. Duration of practice since graduation as rheumatologist was 17 years, and 585 (53.3%) were under 50 years of age. Most rheumatologists worked in private practice (81.8%) and almost half worked in institutional outpatient centers (55%) and in-patient care (49.9%). The median number of weekly hours (IQR) of face-to-face practice before the pandemic was 27 (15-40) but it was reduced to 10 (5- 20) during the pandemic. Telehealth was used by 866 (78.9%) respondents during the pandemic. Most common methods of communication were video calls (555; 50.6%), telephone calls (499; 45.5%) and WhatsApp voice calls (423; 38.6%). A reduction in monthly wages was reported by 946 (86.2%) respondents. Consultation fees also were reduced and 88 (8%) rheumatologists stated they had lost their jobs. A reduction in patient adherence to medication was reported by nearly 50% of respondents. Eighty-one (7.4%) rheumatologists received a COVID-19 diagnosis and 7 (8.6%) of them were hospitalized. Conclusion COVID-19 pandemic has reshaped rheumatology practice in Latin America and has had a profound impact on rheumatologists' behaviors and clinical practice.

Introduction: Candida species are commensal yeasts of the human microbiota. However, due to several host’s conditions, bloodstream infections may arise causing high morbimortality. Methods: Retrospective cross-sectional analytical study of positive blood cultures for Candida spp. between 2008-2014 at a university hospital in Bogota, Colombia. We evaluated clinical and microbiological characteristics prior to the first positive blood sample was obtained and determined associations with non-C. albicans (NCA) species infections. Results: We included 123 candidemia cases. C. albicans was the most frequently isolated species (42%). However, NCA species as a group were observed more often. Over 70% of cases were managed at the ICU, with a median stay of 14 days. Several medical factors were frequently observed, however none appeared to be associated with NCA species candidemia. Resistance to at least one antifungal agent was observed in 29% of cases, although a reduced sample of susceptibility tests was available. Conclusions: Our results support a worldwide shift towards NCA candidemia. However, clinical features were not associated with NCA infections. The identification of risk factors and the improvement of prediction scores must be prioritized, in order to identify patients at high risk who may benefit of pre-emptive therapy.

Introduction Although patients with systemic lupus erythematosus (SLE) may benefit from health-care information in social media (SoMe), they may also be prone to misleading information. An assessment of the reliability, comprehensiveness, and quality of information uploaded to SoMe for Spanish-speaking patients with SLE is lacking. Methods This analytical observational study evaluates the videos uploaded to YouTube® in Spanish about SLE. Information about video length, engagement (i.e., views and likes), time on the internet, popularity index, and source was retrieved, and an evaluation on reliability, comprehensiveness, and quality was performed using standardized scores. Results One hundred eighty-six videos were included in the analysis. Most videos were considered as useful (87%) or useful patient opinion (8.1%), whereas only 2.2% were considered misleading and 2.7% as misleading patient opinion. The number of views (Median 7207 vs 113,877, p = .012), popularity index (Median 13.8 vs 168.7, p < .001), number of likes (Median 155 vs 3400, p < .001), and number of dislikes (Median 3 vs 138, p = .004) were higher for misleading videos. The videos uploaded by independent users had a higher engagement than those from government or news agencies, professional organizations or academic channels. Misleading videos and those uploaded by independent users had lower rates of reliability, comprehensiveness and quality ( p < .001). Conclusions Most of the information shown in YouTube® videos on SLE tends to be useful. However, audience engagement parameters are larger for misleading videos. Exploring the qualitative features of the most popular videos is necessary to establish what features are more engaging for the audiences and to improve the content and popularity of reliable videos on chronic diseases.

Background:Internet is an informative source for patients with different diseases. False information in social networks about health issues is a growing problem. Rheumatology is no stranger to this problem and there is a lot of false information regarding rheumatic diseases.Objectives:To show objective data on misinformation published in social networks available to spanish-speaking rheumatic patientsMethods:We create accounts on Facebook (FB) and Google unique for this work. Multimedia was included in Spanish, with a convenience sampling according to the deployment of the platform (FB) or in descending order for reproductions on YouTube (YT). Two independent reviewers extracted information on online time, number of reproductions and characteristics of the most popular videos. Videos consulted on 10-11-18.Results:With the search term ”rheumatoid arthritis” (RA), the most reproduced video is titled ”celery green juice for arthritis” (6.4 million reproductions). Of the first 50 videos with more reproductions, 39 are of natural or home remedies such as vinegar, “moringa”, etc., and 35 videos indicate in their content, that they can cure RA. With the term ”lupus”, the most reproduced video is titled ”God’s tea, cure chronic tiredness, thyroid, arthritis, lupus and vertigo” (1.4 million reproductions). Of the first 50 videos with more reproductions, 31 correspond to natural or home remedies such as celery, thyme, diets among others and 29 videos indicate that they can cure lupus. With the term ”fibromyalgia”, the most reproduced video is entitled ”I am 61 years old and this cured my arthritis, vertigo, fibromyalgia, lupus, chronic fatigue and the thyroid” (1.1 million reproductions). Of the 50 first videos with more reproductions, 40 are of natural or home remedies such as thyme, tea, among others and 33 videos indicate that they can cure the disease. With the data of the videos uploaded online in October 2018, 50 videos were chosen in YT and FB. There was no correlation between online time and the number of views on any platform. In FB, 56% of the videos contained false information, with no difference in online time in both groups (16 [12-22] vs 18 [13-25], p = 0.3).). In YT, only 38% was considered false information, without differences between groups in online time (19 [11-26] vs 22 [12-24]).Conclusion:YT and FB are social networks with a high content of false information. The majority of available videos promise to cure different rheumatic diseases (even several simultaneously). This is the first work of a line of research that seeks to highlight the high degree of misinformation. We will continue to analyze other diseases and social networks, to make publications and communications in different media and to alert local regulatory entities.Disclosure of Interests:None declared

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