BackgroundInflammatory joint diseases (IJD) such as psoriatic arthritis (PsA) have an increased risk of cardiovascular disease (CVD) since inflammation plays a pivotal role in the pathogenesis of coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (Afib)1. Ischemic heart disease and HF are the main causes of the increased and premature mortality among patients with IJD2.Additionally, patients with PsA have a prevalence of hyperuricemia (HUC) of 32%, 3 times greater as compared with the general population, which may be related to increased cell turnover as well as the release of pro-inflammatory cytokines and tumor necrosis factor3.Prolonged exposure to high levels of uric acid (UA) has been shown to result in oxidative stress causing endothelial dysfunction, ionic channel changes, atrial and ventricular remodeling4. There is experimental evidence indicating that uric acid stimulates renin-angiotensin-aldosterone system (RAAS), and it is associated with an increase in cardiac tissue xanthine oxidase activity, all of which induce cardiomyocyte hypertrophy, myocardial oxidative stress, interstitial fibrosis and impaired diastolic relaxation5.ObjectivesThe aim of this study is to assess the correlation of HUC and the clinical expression of CVD in patients with PsA.MethodsThis is a retrospective cohort study using the 2016 National Inpatient Sample (NIS) of adults diagnosed with PsA based on ICD-10 codes, to detect the prevalence of cardiovascular (CV) conditions such as CAD, Afib, and HF with preserved ejection fraction (HFpEF) in patients with concomitant HUC or gout versus age matched controls. Chi square was used for point prevalence and multivariate linear regression adjusted for age, gender, race, CAD, diabetes mellitus, HTN, hyperlipidemia (HLD), smoking, chronic kidney disease (CKD) and Charlson comorbidity index for prevalence odds ratio (POR). We used STATA-15 for statistical analysis.ResultsWe identified 37,315 patients with PsA, of whom 2,165 had concomitant HUC or gout (5.80%). Mean age was 61 years, 57% were females. Our results showed that PsA with concomitant HUC or gout compared to PsA without HUC or gout was associated with a higher rate of Afib (17.8% vs 6.1%, p < 0.001), CAD (35.1% vs 19.4%, p < 0.001) and HFpEF (7.2% vs 3.1%, p < 0.001). Furthermore, patients with PsA and HUC/gout appeared to have more risk of developing Afib (POR 1.79; 95%-CI 1.31-2.45; p < 0.001) and HFpEF (POR 1.56; 95%-CI 1.08-2.26; p=0.018), compared to patients with normal uric acid after multivariate-adjustment for risk factors. No statistical difference in CAD was identified between the two groups (POR 1.21; 95%-CI 0.94-1.55; p=0.131) after multivariate linear regression adjustment for confounders.ConclusionThis study showed that HUC is independently associated with CVD, mainly with Afib and HFpEF in patients with PsA. It remains to be seen if a treat to target approach with normalization of UA in patients with PsA will result in improved CV outcomes. We believe that our findings merit further investig...

El desarrollo neurológico humano requiere una serie de pasos que permitan orientar, regular y diferenciar los diversos componentes cerebrales, para así garantizar, de una manera bastante precisa, la correcta organización y funcionamiento de las estructuras neuronales. La neurogénesis está clásicamente dividida en cuatro etapas consecutivas: proliferación, migración, diferenciación y maduración. En los humanos,estas ocurren desde la tercera semana de gestación hasta la vida adulta y precisan de un complejo grupo de paquetes genéticos, así como de algunos factores asociados, que se han ido descubriendo gracias a los avances en la biología molecular. El artículo es una revisión acerca del desarrollo neuroembriológico humano y los componentes genéticos más relevantes encontrados en la literatura.

Batallas simbólicas en escenarios de comunicación digital: Humanismo, valores y opinión pública ..

Background:Multiple studies have been done assessing the “weekend effect” and outcomes for hospitalized patients1,2,3,4, however, there is no data evaluating the outcome of patients with septic arthritis of a native joint (SANJ) who are admitted on the weekend compared to the rest of the week.Objectives:To evaluate whether important outcomes in SANJ, including in-hospital mortality, differ between patients admitted on weekends versus weekdays and the time to diagnostic arthrocentesis.Methods:The National Inpatient Sample (NIS) database of the year 2016 was utilized for patients admitted to the hospital with a principal discharge diagnosis of SANJ. This was a retrospective cohort study of patients hospitalized in 2016 with SANJ in hospitals across the US. Patients were included if they were adults with a principal diagnosis of SANJ based on ICD-10 codes. Admissions between midnight Friday and midnight Sunday were classified as weekend admissions. Early arthrocentesis was defined as percutaneous arthrocentesis performed within 24 hours of admission. The proportion of patients with SANJ admitted over weekends versus weekdays was determined. Odds ratios (OR) were calculated for primary and secondary outcomes including in-hospital mortality rate, rates of diagnostic arthrocentesis and early arthrocentesis, length of stay and total hospital charges, These results were compared after multivariable logistic regression adjusted for age, gender, race, day of admission, Charlson comorbidity index and median household yearly income in the patient’s zip code. We used STATA-15 for statistical analysis.Results:The study included 12819 patients with SANJ. Compared with patients admitted on weekdays, patients with SANJ admitted on weekends had increased in-hospital mortality rates (adjusted odds ratio[aOR] 3.67; 95% [CI] 1.52 – 8.86, p<.005), but similar early arthrocentesis rates ([aOR] 1.14; 95%, [CI] 0.90 – 1.45 p>0.05), length of stay (p>0.05) and hospital charges ($ 2751.11; 95% [CI] -4449.6 – 9951.8; P>0.05). However, regardless of the day of admission those who received an early arthrocentesis had lower length of stay (-1.46, p<0.05), and lower total hospital charges ($ -6527 $; p<0.05).Conclusion:This study showed that compared with patients admitted on weekdays, patients with SANJ admitted on weekends had increased mortality rates but similar length of stays and total hospital charges. However, patients who received an early arthrocentesis had significantly lower length of stay and hospital charges regardless of the day of admission. This results add weight to the hypothesis of negative outcomes in weekend admissions. Moreover, we believe that our findings require further investigation to establish the role of early arthrocentesis in the management of septic arthritis.References:[1] Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med2001;345:663-8.[2] Pauls LA, et al. The Weekend Effect in Hospitalized Patients: A Meta-Analysis. J Hosp Med. 2017Sep;12(...

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