The use of ustekinumab in refractory treatment of psoriatic arthritis

We had the opportunity of read the review article of Goldenstein-Schainberg et al.1 about the most important aspects of psoriatic arthritis (PA) over the years. Related to the therapeutic aspects, it is concluded that biologic agents, especially TNF inhibitors (infliximab, etarnecept, adalimumab and golimumab), are used as drugs of last line in refractory cases of the disease. Then, based on existing literature, we show our agreement in this last statement.2,3 However, we consider important to mention alternative therapies. In the clinical trial of Griffiths et al., the autors studied 900 patients with PA who didn’t respond to treatment with one biologic agent. In order to get a better clinical response, they compared two biologic agents: ustekinumab – last biologic agent (monoclonal antibody) approved in 2009 – and etanercept. As a result, they found that patients with ustekinumab had a better and faster clinical response, with both dermatological and joint improvement.4 Cuchacovich reported the same comparison in 2011 and reassured the findings of Griffiths with ustekinumab.2 Furthermore, in the case report of Cuchacovich, the clinical improvement was demonstrated with the use of the combination of the two biologic agents mentioned earlier: ustekinumab and etanercept.3 Above all, to demonstrate the safety of ustekinumab, Cuchacovich reported its use in patients who were refractory to phototherapy, systemic corticosteroids and biologic therapy (including TNF inhibitors). The result not only was favorable but also improved the clinical response in the psoriasis area and in the severity index.2
Authors: Vega-Villanueva, Karen; Cortez-Bazán, Nathaly; Alvarado-Molina, Angela
Source: Rev. Bras. Reumatol
URL: http://hdl.handle.net/10757/314834

Early medical student contact with their health situation. A Peruvian experience.

Recientemente, Baños et al [1] publicaron en Educación Médica la experiencia piloto del nuevo grado conjunto de medicina de la Universitat Autònoma de Barcelona y la Universitat Pompeu Fabra en relación con la exposición precoz a la realidad sociosanitaria de los estudiantes y su satisfacción. Nuestra experiencia en la Escuela de Medicina de la Facultad de Ciencias de la Salud de la Universidad Peruana de Ciencias Aplicadas, en Lima, ratifica lo planteado por los autores. Desde hace cuatro años, como parte del plan de estudios, los alumnos del primer semestre visitan los diferentes centros asistenciales correspondientes al campo clínico de nuestra escuela. Estas visitas están dirigidas principalmente a que los alumnos logren cuatro objetivos: conocer el sistema de salud peruano, sensibilizar al alumno con la realidad del paciente como persona que sufre, iniciar el desarrollo de la competencia de comunicación y conocer los determinantes de la salud en nuestro medio.
Autores: Bermúdez García, Alejandro; Mory Arciniega, Claudia
Fuente: Educ. méd
URL: http://hdl.handle.net/10757/314584

Importancia de la enseñanza de la medicina basada en evidencias.

Sr. Editor: Tal como se han reseñado en este espacio otros eventos de educación médica continua (1) y se ha resaltado la importancia de nuevos aspectos útiles para el médico en el campo de la atención individual y colectiva (2), consideramos pertinente brindar algunos alcances acerca de la Medicina Basada en Evidencias (MBE) en virtud a su relevancia como instrumento valioso en el quehacer profesional. Recientemente, la Facultad de Medicina de la Universidad Central de Venezuela (UCV) tuvo la oportunidad de organizar el Simposio Internacional Principios Básicos de la Medicina Basada en Evidencias (SIPBMBE), desarrollado el 12 de febrero de 2010 en el Auditorio Lorenzo Campins y Ballester, del Decanato de Medicina de la Ciudad Universitaria, desarrollado por el Departamento de Medicina Preventiva y Social de la Escuela de Medicina Luis Razetti de esa casa superior de estudios.
Autores: Rodríguez Morales, Alfonso J.; Mezones Holguin, Edward; Tolentino Silva, Marcus; Puebla, Sergio; Orellana, Juan J.;Cárcamo, Daniel; Nunes da Silva, Everton; Risquez Parra, Alejandro; Echezuria Marval, Luis; Mayta Tristán, Percy
Fuente: Gac Méd Caracas
URL: http://hdl.handle.net/10757/314583

Bibliometrics: The Leiden Manifesto for research metrics

Data are increasingly used to govern science. Research evaluations that were once bespoke and performed by peers are now routine and reliant on metrics¹. The problem is that evaluation is now led by the data rather than by judgement. Metrics have proliferated: usually well intentioned, not always well informed, often ill applied. We risk damaging the system with the very tools designed to improve it, as evaluation is increasingly implemented by organizations without knowledge of, or advice on, good practice and interpretation.

Before 2000, there was the Science Citation Index on CD-ROM from the Institute for Scientific Information (ISI), used by experts for specialist analyses. In 2002, Thomson Reuters launched an integrated web platform, making the Web of Science database widely accessible. Competing citation indices were created: Elsevier's Scopus (released in 2004) and Google Scholar (beta version released in 2004). Web-based tools to easily compare institutional research productivity and impact were introduced, such as InCites (using the Web of Science) and SciVal (using Scopus), as well as software to analyse individual citation profiles using Google Scholar (Publish or Perish, released in 2007).

Authors: Diana Hicks, Paul Wouters, Ludo Waltman, Sarah de Rijcke& Ismael Rafols

Source: Nature

URL: Full text

Characteristics of gastroduodenal ulcers in patients with negative biopsies for Helicobacter pylori.

Objetives. To evaluate the clinical, epidemiological and endoscopic characteristics of the Helicobacter pylori (Hp) negative peptic ulcer disease. Methods. In this cross sectional study we included 651 patients diagnosed of peptic ulcer disease between January 2000 and December 2005. The diagnosis of Hp infection was established by histology. Clinical and epidemiological characteristics of patients with and without Hp infection were compared. Results. Males prevailed (69%). Hp negative ulcers were older (57,73 +/- 19,44 years old vs 50,26 +/- 18, 64 years old, P < 0.001). Clinical characteristics did not differ among both groups. Duodenal ulcer prevailed in Hp positive patients (56,5%) and gastric ulcer in Hp negative patients (53,5%). Multiple ulcers and intestinal metaplasia were more frequently found in Hp negative cases [9.3% vs 4.5 % (P = 0,015) and 34.5% vs 22.1% (P = 0,001), respectively]. Conclusion. Hp negative peptic ulcer disease is found in older patients, with a higher frequency of gastric ulcers, multiple lesions and intestinal metaplasia.
Authors: Montes Teves, Pedro; Salazar Ventura, Sonia; Monge Salgado, Eduardo
Source: Acta Gastroenterol Latinoam

URL: http://hdl.handle.net/10757/314561