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Resumen Antecedentes: Los trastornos musculoesqueléticos (TME) afectan a 1710 millones de personas en todo el mundo y es la principal causa de discapacidad. Objetivo: Analizar los años vividos con discapacidad (AVD) por TME en México entre 1990 y 2021. Material y métodos: Con las estimaciones del estudio de la Carga Global de la Enfermedad 2021 se analizaron los AVD por TME y sus seis categorías: osteoartritis, artritis reumatoide, gota, dolor cervical, lumbalgia y otros TME. Se evaluaron patrones y tendencias del número, tasa cruda y tasa estandarizada por edad de los AVD a nivel nacional, estatal, por grupos de edad y sexo. Resultados: Los TME constituyeron la principal causa de AVD en México entre 1990 y 2021, con un incremento de 57.3 %; pasaron de 1458.4 a 2293.7 por 100 000 habitantes. La lumbalgia (840.6 AVD) destacó con la mayor tasa en 2021 y la osteoartritis, con el mayor incremento. Los TME se incrementaron con la edad y, con excepción de la gota, afectaron más a las mujeres. Conclusiones: De 1990 a 2021, los TME constituyeron la principal causa de AVD en México, con mayor impacto en adultos y mujeres. Los TME se evidencian desde edades tempranas, de ahí la necesidad de intervenciones continuas para preservar la calidad de vida.

Abstract Background: Musculoskeletal disorders (MSD) affect 1.71 billion people worldwide and are the leading cause of disability. Objective: To analyze the years lived with disability (YLD) attributed to MSD in Mexico between 1990 and 2021. Material and methods: With estimates from the Global Burden of Disease 2021 study, the YLDs due to MSD and their six categories were analyzed, including osteoarthritis, rheumatoid arthritis, gout, neck pain, low back pain, as well as other MSDs. Patterns and trends in the number, crude rate, and YLD age-standardized rate were evaluated at the national and state levels, as well as by age group and gender. Results: MSDs were the main cause of YLDs in Mexico between 1990 and 2021, with an increase of 57.3%, going from 1,458.4 to 2,293.7 per 100,000 population. Low back pain (840.6 YLD) showed the highest rate in 2021, while osteoarthritis had the largest increase. MSDs increased with age and, and except for gout, affected women more often. Conclusions: From 1990 to 2021, MSDs were the main cause of YLDs in Mexico, with a higher impact on adults and women. MSDs can appear early in life, hence the need for continuous interventions in order to preserve quality of life.

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Background: Gout is known as arthropathy due to the deposit of monosodium urate crystals; This pathology comprises a set of clinical and radiographic tests in the context of the intra-articular presence of said crystals. It is a chronic disease associated with other comorbidities such as arterial hypertension, osteoarthritis, diabetes mellitus, etc. The case of a patient with gouty arthritis with consequent hip lesion with a pseudotumoral appearance difficult to diagnose is presented, in order to highlight the importance of this, as well as the appropriate follow-up and treatment for this chronic pathology. Clinical case: A 51-year-old male patient, with a history of hip osteoarthritis and gout. The symptoms and signs were pain in the right hip with an 8/10 on an analogue pain scale, associated with functional limitation characterized by reduced range of motion and impossibility of standing. Imaging studies are carried out which are suggestive of a tumor lesion at the proximal femur with malignant characteristics, for which a biopsy and subsequent histopathological diagnosis of gouty tophi is performed. Conclusions: Gout is a prevalent disease in the adult population, however, its infrequent joint location can result in a difficult diagnosis, so it is necessary not to rule out this entity and to carry out specific studies for its identification.

Introducción: se conoce como gota a la artropatía por depósito de cristales de urato monosódico. Esta patología comprende un conjunto de hallazgos clínicos y radiográficos en el contexto de presencia intraarticular de dichos cristales. Es una enfermedad crónica asociada a otras comorbilidades como: hipertensión arterial, osteoartrosis, diabetes mellitus, etc. Se presenta el caso de un paciente con artritis gotosa con consecuente lesión en cadera, con aspecto pseudotumoral de difícil diagnóstico, a fin de resaltar su importancia, así como el seguimiento y tratamiento oportunos para esta patología crónica. Caso clínico: paciente hombre de 51 años, con antecedentes de artritis gotosa; quien cursa con cuadro clínico de, aproximadamente, cuatro años de evolución, caracterizado por dolor en cadera derecha de intensidad 8/10 en escala análoga del dolor, sin irradiación, asociado a limitación funcional caracterizada por reducción de arcos de movilidad e imposibilidad para la bipedestación. Se realizan estudios imagenológicos los cuales son sugestivos de lesión tumoral a nivel de fémur proximal de características de malignidad, por lo cual se realiza biopsia y posterior diagnóstico histopatológico de tofos gotosos. Conclusiones: la gota es una enfermedad prevalente en la población adulta, sin embargo, la localización articular infrecuente puede resultar en un difícil diagnóstico, por lo que se requiere no descartar esta entidad y la realización de estudios específicos para su identificación.

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ABSTRACT Background: Colorectal cancer is the third most common type of cancer in both men and women and ranks second as the most common cause of cancer death in the United States. Classic risk factors include tobacco smoking, high alcohol consumption, physical inactivity and excess body weight. A prospective study found that an elevated serum uric acid was associated with higher rates of cancer-associated polyps. Interestingly, other studies found an association between elevated levels of serum uric acid and other types of cancer including colorectal cancer. Objective: Our study aimed to evaluate whether patients with chronic tophaceous gout had an increased risk of developing colorectal cancer. Methods: A validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States was utilized to construct this study. Patients aged 18 years and above were included. Individuals who have had a history of familial adenomatous polyposis, a family history of colon cancer, and those diagnosed with inflammatory bowel disease were excluded from the analysis. The risk of developing colon cancer was calculated using a multivariate regression analysis to account for potential confounders. Results: 80,927,194 individuals were screened in the database and 70,177,200 were selected in the final analysis after accounting for inclusion and exclusion criteria. Type 2 diabetics (28.57%), smokers (10.98%), obese individuals (18.71%), alcoholics (3.13%), and patients who have had a diagnosis of chronic tophaceous gout were more common in the colon cancer group compared to those without the malignancy. Using multivariate regression analysis, risk of colon cancer was calculated for male gender (OR: 1.02; 95%CI: 1.01-1.03), smokers (OR: 1.54; 95%CI: 1.52-1.56), alcoholics (OR: 1.40; 95%CI: 1.37-1.43), obese patients (OR: 1.52; 95%CI: 1.50-1.54), type 2 diabetic individuals (OR: 3.53; 95%CI: 3.50-3.57), and those who have had a diagnosis of chronic tophaceous gout (OR: 1.40; 95%CI: 2.48-3.23). Conclusion: As expected, patients with colon cancer were found to have a higher prevalence in males, obese, tobacco and alcohol users. We also demonstrated that patients with gout have a significantly higher prevalence of CRC than those who do not before and after adjusting for metabolic risk factors. In fact, uric acid was found to induce production of reactive oxygen species, thus potentially promoting tumorigenesis. It would be interesting to assess the prevalence of colon cancer in patients with gout who have a serum uric acid that is less than 7 mg/dL. This might promote a tighter control of serum uric acid levels in this population in order to decrease the risk of colon cancer.

RESUMO Contexto: O câncer colorretal é o terceiro tipo mais comum de câncer em homens e mulheres e ocupa o segundo lugar como a causa mais comum de morte por câncer nos EUA. Os fatores de risco clássicos incluem tabagismo, alto consumo de álcool, inatividade física e excesso de peso corporal. Um estudo prospectivo descobriu que um ácido úrico sérico elevado estava associado a taxas mais altas de pólipos associados ao câncer. Curiosamente, outros estudos encontraram uma associação entre níveis elevados de ácido úrico sérico e outros tipos de câncer, incluindo o câncer colorretal. Objetivo: Nosso estudo teve como objetivo avaliar se os pacientes com gota tofácea crônica tinham um risco aumentado de desenvolver câncer colorretal. Métodos: Utilizou-se um banco de dados validado multicêntrico e de plataforma de pesquisa de mais de 360 hospitais de 26 diferentes sistemas de saúde nos Estados Unidos para a construção deste estudo. Foram incluídos pacientes com 18 anos ou mais. Indivíduos com histórico de polipose adenomatosa familiar, histórico familiar de câncer de cólon e aqueles diagnosticados com doença inflamatória intestinal foram excluídos da análise. O risco de desenvolver câncer de cólon foi calculado usando uma análise de regressão multivariada para contabilizar possíveis confusões. Resultados: 80.927.194 indivíduos foram rastreados no banco de dados e 70.177.200 foram selecionados na análise final após considerar critérios de inclusão e exclusão. Diabéticos tipo 2 (28,57%), fumantes (10,98%), indivíduos obesos (18,71%), alcoólatras (3,13%) e pacientes que tiveram diagnóstico de gota tofácea crônica foram mais comuns no grupo de câncer de cólon em comparação com aqueles sem a malignidade. Usando a análise de regressão multivariada, o risco de câncer de cólon foi calculado para o sexo masculino (OR: 1,02; IC95%: 1,01-1,03), fumantes (OR: 1,54; IC95%: 1,52-1,56), alcoólatras (OR: 1,40; IC95%: 1,37-1,43), pacientes obesos (OR: 1,52; IC95%: 1,50-1,54), indivíduos diabéticos tipo 2 (OR: 3,53; IC95%: 3,50-3,57), e aqueles que tiveram diagnóstico de gota tofácea crônica (OR: 1,40; IC95%: 2,48-3,23). Conclusão: Como esperado, os pacientes com câncer de cólon foram encontrados com maior prevalência em homens, obesos, usuários de tabaco e álcool. Demonstramos também que os pacientes com gota têm uma prevalência significativamente maior de câncer colorretal do que aqueles que não a têm, antes e após o ajuste para fatores de risco metabólicos. De fato, descobriu-se que o ácido úrico induz a produção de espécies reativas de oxigênio, promovendo assim potencialmente a tumorigênese. Seria interessante avaliar a prevalência de câncer de cólon em pacientes com gota que têm um ácido úrico sérico inferior a 7 mg/dL. Isso poderia promover um controle mais rígido dos níveis de ácido úrico sérico nesta população para diminuir o risco de câncer de cólon.

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BACKGROUND: Musculoskeletal disorders (MSD) affect 1.71 billion people worldwide and are the leading cause of disability. OBJECTIVE: To analyze the years lived with disability (YLD) attributed to MSD in Mexico between 1990 and 2021. MATERIAL AND METHODS: With estimates from the Global Burden of Disease 2021 study, the YLDs due to MSD and their six categories were analyzed, including osteoarthritis, rheumatoid arthritis, gout, neck pain, low back pain, as well as other MSDs. Patterns and trends in the number, crude rate, and YLD age-standardized rate were evaluated at the national and state levels, as well as by age group and gender. RESULTS: MSDs were the main cause of YLDs in Mexico between 1990 and 2021, with an increase of 57.3%, going from 1,458.4 to 2,293.7 per 100,000 population. Low back pain (840.6 YLD) showed the highest rate in 2021, while osteoarthritis had the largest increase. MSDs increased with age and, and except for gout, affected women more often. CONCLUSIONS: From 1990 to 2021, MSDs were the main cause of YLDs in Mexico, with a higher impact on adults and women. MSDs can appear early in life, hence the need for continuous interventions in order to preserve quality of life.

ANTECEDENTES: Los trastornos musculoesqueléticos (TME) afectan a 1710 millones de personas en todo el mundo y es la principal causa de discapacidad. OBJETIVO: Analizar los años vividos con discapacidad (AVD) por TME en México entre 1990 y 2021. MATERIAL Y MÉTODOS: Con las estimaciones del estudio de la Carga Global de la Enfermedad 2021 se analizaron los AVD por TME y sus seis categorías: osteoartritis, artritis reumatoide, gota, dolor cervical, lumbalgia y otros TME. Se evaluaron patrones y tendencias del número, tasa cruda y tasa estandarizada por edad de los AVD a nivel nacional, estatal, por grupos de edad y sexo. RESULTADOS: Los TME constituyeron la principal causa de AVD en México entre 1990 y 2021, con un incremento de 57.3 %; pasaron de 1458.4 a 2293.7 por 100 000 habitantes. La lumbalgia (840.6 AVD) destacó con la mayor tasa en 2021 y la osteoartritis, con el mayor incremento. Los TME se incrementaron con la edad y, con excepción de la gota, afectaron más a las mujeres. CONCLUSIONES: De 1990 a 2021, los TME constituyeron la principal causa de AVD en México, con mayor impacto en adultos y mujeres. Los TME se evidencian desde edades tempranas, de ahí la necesidad de intervenciones continuas para preservar la calidad de vida.

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In this research, the Volumetric Median Diameters (VMDs), Relative Span (RS), percentage of droplets with a diameter smaller than 100 µm (V100), and percentage ofdrift (% drift) of four droplet classes (Fine, Medium, Coarse, and Very Coarse) were analyzedin two spray volumes (77 L.ha-1and 144 L.ha-1) employinga tank-mix of atrazine and nicosulfuron herbicides (2500 + 15 gaiha-1), usingParticle/Droplet Imaging Analyze (PDIA) and wind tunnel techniques. The experiments were performed under Completely Randomized Design, in a 4 × 2 factorial scheme (droplet classes × sprayvolumes). Data underwent analysis of variance and Tukey's test at 5%, and the correlation between variables was computedconsidering Pearson's coefficient at 1% and 5%. The VMD of all droplet classes was considerably distinct in the two spray volumes. In both application spray volumes, the minimum VMD for the Coarsedropletclass classification was not attained. The highest means of RS were detectedin the spray volume of 77 L.ha-1. All treatments demonstratedsignificant differences in the analysis of V100 and % drift, with the highest means observed in the Fine droplet (144 L.ha-1) and Medium (77 L.ha-1). A negative correlation existed between VMD × V100 and VMD × % drift and a positive correlation between V100 × % drift in the two spray volumes. RS was negatively correlated with VMD and positively with V100 and % drift, in the spray volume of 77 L.ha-1. In the spray volume of 144 L.ha-1, the correlation between RSand VMD, V100, and % drift was insignificant.

Nesta pesquisa foram avaliados os Diâmetros Medianos Volumétricos (DMVs), Amplitude Relativa (AR), percentual de gotas com diâmetro menor que 100 µm (V100) e porcentagem de deriva (% deriva) de quatro classes de gota (Fina, Média, Grossa e Muito Grossa) em dois volumes de aplicação (77L.ha-1e 144L.ha-1) utilizando a mistura dos herbicidas atrazine e nicosulfuron (2500 + 15 gi.a. ha-1), utilizando os métodos de PDIA e de túnel de vento. Os experimentos foram realizados sob o delineamento inteiramente casualizado, no esquema fatorial 4 × 2 (classes de gota × volumes de aplicação), com cinco repetições. Os dados foram submetidos à análise de variância e ao teste de Tukey a 5%, e a correlação entre as variáveis calculada considerando o coeficiente de Pearson a 1% e 5%. O DMV de todas as classes de gotas foi significativamente diferente nos dois volumes. O DMV mínimo para a classificação da classe de gota Grossa não foi atingido nos dois volumes de aplicação. As maiores médias de AR foram observadas no volume de 77 L.ha-1. Todos os tratamentos apresentaram diferenças significativas na análise de V100 e % deriva com as maiores médias observadas nas classes de gota Fina (144 L.ha-1) e Média (77 L.ha-1). Verificou-se correlação negativa entre DMV × V100 e DMV × % deriva e correlação positiva entreV100 × % deriva nos dois volumes. No volume de 77 L.ha-1 a AR correlacionou-se negativamente com o DMV e positivamente com V100 e % deriva. No volume de 144 L.ha-1 a correlação entre AR e DMV, V100 e % deriva não foi significativa.

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The present experimental work was conducted to elucidate the toxicity of nimesulide at three different doses in black kites (Milvus migrans). M. migrans is one of the most common raptors near human habitations. The goal of the current investigation was to determine whether nimesulide is similarly hazardous to raptors as was diclofenac sodium and to investigate the acute oral toxicity of nimesulide in these birds. For this study, eight adult male black kites (M. migrans) were randomly divided into four groups. M. migrans in the control group (n = 02) were not treated with nimesulide. The other three groups were given nimesulide doses. The birds in the first (n = 02) were declared the control group. The second (n = 02), third (n = 02), and fourth groups were administered nimesulide at a low, medium, and high dose of 2, 4, and 6 mg/kg live body weight of bird/day, respectively, for 10 days. Nimesulide-addled birds became listless and despondent, then anorexic. The birds were standing there with their eyes closed and showing no signs of life. There was an increase in saliva production, a slowing of breathing, and dilated pupils. No clinical signs were observed in the control group. No mortality was seen in the control or treated groups. The control group did not show lesions of gout, but black kites intoxicated with nimesulide at 2, 4, and 6 mg/kg live body weight of bird/day showed inflammation, apoptosis, hemorrhage, necrosis, and leukocytic infiltration tissues of the liver, kidney, and heart of black kites (M. migrans) treated with different concentrations of nimesulide. The treated groups also showed apoptosis of myofibrils and hyperplasia. The hypertrophy, atrophy, fibrosis, necrosis of skeletal muscles and hemorrhage were prominent in the muscles of black kites (M. migrans) intoxicated with nimesulide. All observed histological alterations got worse in a dose-related way. There was no significant difference in AST, ALT, ALP, serum uric acid, but a significant difference was observed in the values of serum urea (p = 0.001) and serum creatinine (p = 0.019).

O presente trabalho experimental foi conduzido para elucidar a toxicidade da Nimesulida em três doses diferentes em milhafres (Milvus migrans). M. migrans é uma das aves de rapina mais comuns perto de habitações humanas. O objetivo da presente investigação foi determinar se a Nimesulida é igualmente perigosa para as aves de rapina como foi o diclofenaco sódico e investigar a toxicidade oral aguda do fármaco nessas aves. Para este estudo, 8 milhafres machos adultos (M. migrans) foram aleatoriamente divididos em 4 grupos. M. migrans no grupo controle (n = 2) não foram tratados com Nimesulida. Os outros 3 grupos receberam doses do fármaco. As aves do primeiro grupo (n = 2) foram declaradas o grupo controle. O segundo (n = 2), terceiro (n = 2) e quarto grupos receberam Nimesulida nas doses baixa, média e alta de 2, 4 e 6 mg/kg de peso corporal vivo da ave/dia, respectivamente, por 10 dias. Aves confusas com Nimesulida tornaram-se apáticas e desanimadas, depois anoréxicas. Os pássaros estavam parados com os olhos fechados e sem sinais de vida. Houve um aumento na produção de saliva, lentidão na respiração e pupilas dilatadas. Nenhum sinal clínico foi observado no grupo controle. Nenhuma mortalidade foi observada nos grupos de controle ou tratados. O grupo controle não apresentou lesões de gota, mas os milhafres intoxicados com Nimesulida nas doses de 2, 4 e 6 mg/kg peso vivo da ave/dia apresentaram inflamação, apoptose, hemorragia, necrose e infiltração leucocitária nos tecidos do fígado, rim e coração de milhafre-preto tratados com diferentes concentrações de Nimesulida. Os grupos tratados também apresentaram apoptose de miofibrilas e hiperplasia. A hipertrofia, atrofia, fibrose, necrose da musculatura esquelética e hemorragia foram proeminentes nos músculos de milhafres negros intoxicados com o fármaco. Todas as alterações histológicas observadas pioraram de forma dose-dependente. Não houve diferença significativa em AST, ALT, ALP, ácido úrico sérico, no entanto, foi observada diferença significativa nos valores de ureia sérica (p = 0,001) e creatinina sérica (p = 0,019).

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La gota es el trastorno del metabolismo de las purinas que se caracteriza por acumulación de ácido úrico por aumento de su producción o por disminución de su excreción. Con el paso del tiempo, el exceso de urato monosódico permite que se deposite en diferentes tejidos del organismo; siendo particularmente infrecuente la presentación de tofos a nivel facial. Paciente masculino adulto de 56 años, con antecedente de gota hace 38 años y presencia de tofos gotosos a nivel de miembros superiores e inferiores que acude por cuadro de 4 años de evolución de lesión indurada, levemente dolorosa a nivel de tercio medio de dorso nasal que ha ido aumentando de tamaño, que causa deformidad de pirámide nasal y leve sensación de obstrucción nasal bilateral por lo que se planifica resolución quirúrgica. El análisis histopatológico de las muestras enviadas bajo exéresis quirúrgica confirma que tejido enviado corresponde a tofo gotoso. Los tofos gotosos pueden aparecer en diferentes tejidos, como cartílagos, membranas y líquido sinovial, superficies articulares, siendo excepcionalmente raro, en el miocardio, válvulas mitral y aórtica, ojos, nariz y médula espinal. El lugar de presentación puede ser muy variable, al igual que su tamaño

Gout is a purine metabolism disorder characterized by accumulation of uric acid due to increased production or decreased excretion. Over time, excess monosodium urate allows it to be accumulated in different body tissues, although the occurrence in the facial area is particularly infrequent. A 56- year-old male patient with a gout antecedent from 38 years ago that presented gouty tophi at the level of the upper and lower limbs seek medical advice due to an indurated slightly painful lesion at the level of the middle third of the nasal dorsum that started 4 years before and has been increasing in size. The lesion was causing nasal pyramid deformity and a slight sensation of bilateral nasal obstruction, for which surgical resolution is planned. The histopathological analysis of the samples sent under surgical exeresis confirms that the tissue sample corresponds to gouty tophi. Gouty tophi can appear in different tissues, such as cartilage, membranes and synovial fluid, joint surfaces, being exceptionally rare in the myocardium, mitral and aortic valves, eyes, nose and spinal cord. The place of presentation can be very variable, as well as its size

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La gota es una enfermedad reumática inflamatoria que se debe al depósito de cristales de urato monosódico en las articulaciones. En su evolución clínica se distingues dos formas: la fase aguda caracterizada por un proceso inflamatorio monoarticular agudo de gran sensibilidad, y la fase crónica o de mantenimiento, cuyo elemento fundamental es la acumulación de cristales de urato monosódico llamados tofos gotosos. Estos se presentan con mayor frecuencia en el dorso de los dedos, a nivel articular y en el pabellón auricular. Se presenta el caso de un paciente masculino, de 47 años, con diagnóstico de gota de 5 años de evolución y con tratamiento irregular. Este paciente presentó tofos gotosos en localizaciones infrecuentes que limitaron su capacidad funcional. Este caso demuestra la necesidad de un diagnóstico oportuno y una adecuada adherencia al tratamiento, por lo que se considera importante para la comunidad médica, especialmente los profesionales de la salud que atienden a pacientes con artropatía gotosa(AU)´

Gout is a rheumatic, inflammatory disease that is generated by the deposition of monosodium urate crystals at the joint level. Two forms can be distinguished in its clinical evolution: the acute phase characterized by an acute monoarticular inflammatory process of great sensitivity, and the chronic or maintenance phase where the fundamental element is the presence of accumulations of monosodium urate crystals called gouty tophi. These occur more frequently on the back of the fingers, at the joint level and in the auricle. This paper presents the case of a 47-year-old male patient, diagnosed with gout for 5 years and with irregular treatment, who presented gouty tophi in infrequent locations that limit the patient's functional capacity. The case is presented considering it important for the medical community; especially health professionals caring for patients with gouty arthropathy(AU)´

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RESUMEN Objetivos. Evaluar la exactitud de gota gruesa (GG) frente a la reacción en cadena de la polimerasa (PCR) cuantitativa para la malaria asociada al embarazo (MAE). Materiales y métodos. Se realizó una revisión sistemática de pruebas diagnósticas en nueve bases de datos. Se evaluó la calidad metodológica con QUADAS. Se estimó sensibilidad, especificidad, cociente de probabilidad positivo (CPP) y negativo (CPN), razón de odds diagnóstica (ORD) y área bajo la curva ROC. Se determinó la heterogeneidad con el estadístico Q de Der Simonian-Laird y la incertidumbre con el porcentaje de peso de cada estudio sobre el resultado global. Resultados. Se incluyeron diez estudios con 5691 gestantes, 1415 placentas y 84 neonatos. En los estudios con nPCR (PCR anidada) y qPCR (PCR cuantitativa) como estándar, los resultados de exactitud diagnóstica fueron estadísticamente similares, con sensibilidad muy baja (50 y 54%, respectivamente), alta especificidad (99% en ambos casos), alto CPP y deficiente CPN. Usando nPCR la OR diagnóstica fue 162 (IC95%=66-401) y el área bajo la curva ROC fue 95%, mientras que con qPCR fueron 231 (IC95%=27-1951) y 78%, respectivamente. Conclusiones. Mediante un protocolo exhaustivo se demostró el bajo desarrollo de investigaciones sobre la exactitud diagnóstica de la GG en MAE. Se demostró que la microscopía tiene un desempeño deficiente para el diagnóstico de infecciones asintomáticas o de baja parasitemia, lo que afianza la importancia de implementar otro tipo de técnicas en el seguimiento y control de las infecciones por malaria en las gestantes, con el fin de lograr el control y posible eliminación de la MAE.

ABSTRACT Objective. To evaluate the accuracy of thick smear (TS) versus quantitative polymerase chain reaction (PCR) for pregnancy-associated malaria (PAM). Materials and methods. We carried out a systematic review of diagnostic tests in nine databases. Methodological quality was evaluated with QUADAS. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the ROC curve were estimated. Heterogeneity was determined with the Der Simonian-Laird Q method and uncertainty with the weighted percentage of each study on the overall result. Results. We included 10 studies with 5691 pregnant women, 1415 placentas and 84 neonates. In the studies with nested PCR (nPCR) and quantitative PCR (qPCR) as the standard, the diagnostic accuracy results were statistically similar, with very low sensitivity (50 and 54%, respectively), high specificity (99% in both cases), high PLR and poor NLR. When nPCR was used, the DOR was 162 (95%CI=66-401) and the area under the ROC curve was 95%, while with qPCR it was 231 (95%CI=27-1951) and 78%, respectively. Conclusions. We demonstrated that research on the diagnostic accuracy of TS in PAM is limited. Microscopy showed poor performance in the diagnosis of asymptomatic or low parasitemia infections, which reinforces the importance of implementing other types of techniques for the follow-up and control of malaria infections in pregnant women, in order to achieve the control and possible elimination of PAM.

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RESUMEN Se presenta caso de varón con poliartritis crónica por depósito de uratos

ABSTRACT We presents a case of a man with chronic polyarthritis due to urate deposition.

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The use of dried blood spots on filter paper has been shown to be a practical alternative in several studies with humans and animals, enabling a simple means of storing and transporting viable blood samples for various laboratory analyses. However, its applicability in the measurement of progesterone in animals is scarce. Thus, the objective of this study was to evaluate the feasibility of using dried blood spots for the measurement of progesterone in sheep. In total, 38 blood samples from 6 sheep were dripped onto filter paper, and the remainder of each sample was separated into serum. The progesterone levels in the serum samples and in the dry drops were measured by enzyme immunoassay and subsequently correlated. The levels of progesterone in the serum and dry spots showed a high correlation between the matrices (R2 = 0.9694). In conclusion, this study demonstrated the feasibility of using samples of dried sheep blood spots for the measurement of progesterone, and the storage and transport technique can be applied in the field.

O uso de manchas secas de sangue em papel filtro tem se demonstrado uma alternativa prática em vários estudos com humanos e animais, possibilitando um meio simples de armazenamento e transporte de amostras de sangue viáveis para várias análises laboratoriais. Entretanto, sua aplicabilidade na dosagem de progesterona em animais é escassa. Deste modo, o objetivo deste estudo foi avaliar a viabilidade do uso de manchas secas de sangue para a dosagem de progesterona em ovinos. Assim, 38 amostras de sangue de 6 ovelhas foram gotejadas em papel filtro e o restante de cada amostra foi separado o soro. Os níveis de progesterona nas amostras de soro e nas gotas secas foram mensurados por enzimaimunoensaio e posteriormente correlacionados. Os níveis de progesterona no soro e nas manchas secas apresentaram uma alta correlação entre as matrizes (R2=0,9694). Em conclusão, este estudo demonstrou a viabilidade do uso de amostras de manchas secas de sangue de ovino para a dosagem de progesterona, podendo a técnica de armazenamento e transporte ser aplicada a campo.

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ABSTRACT Purpose: This quality and reliability study aimed to identify the mass variability of multidose eyedrops and to verify the existence of a reference pattern for the drop volume of eyedrops using standard lubricant eyedrops available on the Brazilian market. Methods: Five brands of lubricant eyedrops were evaluated. An ideal standard 20 µL drop of eyedrops from each manufacturer was captured using an adjustable micropipette. The eyedrop bottles were randomly selected, and five measurements of the samples' masses were collected using calibrated precision scales. Results: The mass of the 20 µL samples varied significantly (p<0.001) among the different manufacturers. However, among eyedrops of the same brand, mass variation was not statistically different. The global mean mass of all weighed drops was 18.24 mg, and non-uniformity was identified across all eyedrop brands. Conclusion: Significant variations in the drop masses of common lubricant eyedrops were identified using standard laboratory equipment. Heterogeneity in the drop volume of standard eyedrop medications suggest that potential dosage discrepancies exist, possibly altering treatment efficacy. A pre-established reference measure may lead to the production of more appropriately sized eyedrops for use in human eyes.

RESUMO Objetivo: Este estudo de qualidade e confiabilidade teve como objetivo identificar a variabilidade da massa do volume da gota de colírios multidose e verificar a existência de um padrão de referência para o volume da gota dos colírios usando lágrimas artificiais do mercado brasileiro. Métodos: Cinco marcas de colírios lubrificantes foram avaliadas quanto ao volume da gota. Uma gota padrão ideal de 20 µL de cada fabricante foi coletada usando uma micropipeta ajustável. Os frascos dos colírios foram selecionados aleatoriamente e cinco medidas das massas das amostras foram coletadas usando escalas de precisão calibradas. Resultados: A massa das amostras de 20 µL variou significativamente (p<0,001) entre os diferentes fabricantes. No entanto, entre os colírios da mesma marca, a variação da massa não foi estatisticamente diferente. A massa média global de todas as gotas pesadas foi de 18,24 mg e foi observada uma não-uniformidade entre todas as marcas de colírios. Conclusão: Identificou-se uma variação significativa nas massas do volume das gotas dos colírios lubrificantes, usando equipamento padrão de laboratório. A heterogeneidade no volume da gota dos colírios testados sugere a existência de discrepâncias potenciais em suas posologias, possivelmente alterando a eficácia do tratamento. Uma medida de referência pré-estabelecida pode levar à produção de colírios com gotas de tamanho mais apropriado para uso em olhos humanos.

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Introducción: La gota es una enfermedad inflamatoria crónica que generalmente cursa con hiperuricemia sobre añadida. Objetivo: Identificar la presencia de afectación cardiovascular en pacientes con diagnóstico confirmado de artropatía gotosa. Metodología: Investigación básica, no experimental, descriptiva, retrospectiva y con enfoque mixto. El universo estuvo constituido por 69 pacientes atendidos en unidades del primer nivel de atención de salud de la ciudad de Riobamba durante el periodo comprendido entre enero de 2019 y enero de 2021. La muestra quedó conformada por un total de 60 pacientes. Se realizó revisión de la historia clínica de los pacientes para obtener la información necesaria. Resultado: Promedio de edad de 53,02 años. El 35,00 por ciento de ellos presentó al menos una comorbilidad asociada, y la diabetes mellitus fue la más representada (57,14 por ciento). El 71,67 por ciento de los pacientes tenía valores normales de ácido úrico en sangre en el momento del diagnóstico y el 18,33 por ciento presentaba algún tipo de daño renal. El 36,67 por ciento de los pacientes con gota también padecían afección cardiovascular; la hipertensión arterial (59,09 por ciento) fue la más frecuentemente reportada. Conclusiones: La artropatía gotosa es una enfermedad que genera un elevado porciento de afecciones cardiovasculares dentro de las que destacan la hipertensión arterial y la insuficiencia cardiaca(AU)

Introduction: Gout is a chronic inflammatory disease that generally progresses with added hyperuricemia. Objective: To identify the presence of cardiovascular involvement in patients with a confirmed diagnosis of gouty arthropathy. Methodology: A basic, non-experimental, descriptive, retrospective and mixed-focus research was developed. The universe consisted of 69 patients treated in first-level health care units in the city of Riobamba during the period between January 2019 and January 2021. The sample was made up of a total of 60 patients. A review of the clinical history of the patients was carried out to obtain the necessary information. Result: Average age of 53.02 years. 35.00 percent of them presented at least one associated comorbidity, where diabetes mellitus was the most represented (57.14 percent). with presence of comorbidities. 71.67 percent of the patients had normal blood uric acid values at the time of diagnosis and 18.33 percent had some type of kidney damage. 36.67 percent of the patients with gout also presented cardiovascular disease, where arterial hypertension (59.09 percent) was the most frequently reported. Conclusions: Gouty arthropathy is a disease that theoretically generates a high percentage of cardiovascular diseases within of which arterial hypertension and heart failure stand out(AU)

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RESUMEN Objetivo: Identificar las características clínicas de los pacientes con gota y la forma de utilización de los medicamentos antigotosos en Colombia. Métodos: Estudio de corte transversal en el que se analizaron 310 historias clínicas de pacientes atendidos en el último trimestre del 2016 y que recibieron un medicamento antigotoso. Se identificaron variables sociodemográficas, clínicas, farmacológicas, comorbilidades y paraclínicas. Para cada medicamento antigotoso se determinó si el uso fue según las recomendaciones aprobadas por la Federal Drug Administration (FDA). Se realizaron análisis descriptivos, bivariados y multivariados. Resultados: Se evaluaron pacientes de 14 diferentes ciudades de Colombia, con un predominio masculino del 70,3% (n = 218) y una mediana de edad de 64 arios (RIC: 26-94 arios). El antigotoso más frecuentemente utilizado fue alopurinol (n = 255; 82,3%), seguido de colchicina (n = 54; 17,4%). Los diagnósticos hallados como indicación fueron: hiperuricemia (n = 181; 58,4%), gota (n = 34; 11%), artritis gotosa (n = 28; 9%). El 74,5% (n = 231) de las prescripciones tenía un uso aprobado según la FDA, especialmente alopurinol en el manejo de gota e hiperuricemias, mientras que colchicina se encontró siendo utilizada en indicaciones no aprobadas (n = 44; 81,4%). Las comorbilidades más frecuentes fueron hipertensión (68,4%) y dislipidemia (55,8%). Conclusiones: Los pacientes con gota en tratamiento farmacológico tienen una elevada frecuencia de comorbilidades cardiovasculares, y están siendo tratados con alopurinol para la prevención a largo plazo, mientras que una menor proporción recibe colchicina que comúnmente es utilizada para indicaciones no aprobadas por las agencias reguladoras.

ABSTRACT Objective: To identify the clinical characteristics of patients with gout, and the prescription patterns of anti-gout medications in Colombia. Methods: Cross-sectional study, that analysed the data from 310 medical records of patients treated in the last quarter of 2016, and who received an anti-gout medication. Sociodemographic, clinical, pharmacological, comorbidities, and paraclinical variables were identified. For each anti-gout drug used, it was determined whether the use was in accordance with Federal Drug Administration (FDA) approved recommendations. Descriptive, bivariate and multivariate analyses were performed. Results: Patients from 14 different cities in Colombia were evaluated, with a male predominance of 70.3% (n = 218) and a median age of 64 years (RIC: 26-94 years). The most frequently used anti-gout medication was allopurinol (n = 255; 82.3%), followed by colchicine (n = 54; 17.4%). The main diagnoses found as an indication were: hyperuricaemia (n=181, 58.4%), gout (n = 34; 11.0%), and gouty arthritis (n = 28; 9.0%). Almost three-quarters (74.5%; n = 231) of the prescriptions had an approved use according to the FDA, especially allopurinol in the management of gout and hyperuricaemia, while colchicine was found to be used in unapproved indications (n = 44, 81.4%). The most frequent comorbidities were hypertension (68.4%) and dyslipidaemia (55.8%). Conclusions: Patients with gout who are under pharmacological treatment have a high frequency of cardiovascular comorbidities. They were being treated with allopurinol for long-term prevention, while a smaller proportion received colchicine, which is often used for indications not approved by regulatory agencies.

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Abstract Gout is a crystalline arthropathy frequent in the population, but gouty spondyloarthropathy, also called axial gout, is uncommon. The current case report presents a rare case of cervical myelopathy secondary to axial gout. A 50-year-old female patient, without previous pathologies, presented with loss of strength, altered sensitivity, and pyramidal release for 2 years. The computed tomography showed a lytic image in the spinous process of C7, and signs of myelopathy with myelomalacia on magnetic resonance imaging of the cervical spine. After the surgical procedure and biopsy of the material, the diagnosis was gout, and treatment for the pathology was started, with complete improvement of the condition. The diagnosis of axial gout should be included in the spectrum of the differential diagnosis of diseases that affect the spine. Although gouty spondyloarthritis (or spondylitis) is uncommon, there is an underestimated occurrence due to the lack of investigation of the cases. The early diagnosis and treatment of the pathology can prevent patients from presenting complications of the disease, as reported in the present study.

Resumo A gota é uma artropatia cristalina frequente na população; entretanto, a espondiloartropatia gotosa, também chamada de gota axial, é incomum. O presente relato de caso apresenta um caso raro de mielopatia cervical secundária a gota axial. Uma paciente de 50 anos de idade, sem patologias prévias, apresentou quadro de perda de força, alteração de sensibilidade e liberação piramidal há 2 anos. A tomografia computadorizada evidenciou imagem lítica no processo espinhoso de C7, e sinais de mielopatia com mielomalácia foram observados na ressonância magnética da coluna cervical. Após o procedimento cirúrgico e biópsia do material, o diagnóstico foi de gota, e o tratamento para a patologia foi iniciado, com melhora completa do quadro. O diagnóstico de gota axial deve ser incluído no espectro do diagnóstico diferencial das doenças que acometem a coluna vertebral. Apesar de a espondiloartrite gotosa ser incomum, há uma ocorrência subestimada devido a não investigação dos casos. O diagnóstico precoce e tratamento da patologia pode evitar que pacientes apresentem complicações da doença, como a relatada no presente estudo.

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Introducción: La gota es una enfermedad metabólica caracterizada por cuadros inflamatorios monoarticulares fundamentalmente en miembros inferiores, cuyos factores de riesgo están relacionados con la nutrición: La principal complicación ocurre a nivel renal. Objetivo: Identificar el patrón nutricional de los pacientes con gota atendidos en la Consulta de Nutrición del Hospital Andino de Chimborazo entre enero del 2018 y julio del 2019. Métodos: Investigación básica, descriptiva y transversal; el universo fueron 53 pacientes con diagnóstico de gota. La muestra quedó constituida por 47 pacientes que cumplieron los criterios de inclusión. Se determinó el patrón alimentario teniendo en cuenta el estado nutricional, el perfil lipídico y el nivel de conocimiento sobre nutrición saludable. Resultados: El promedio de edad fue de 58,72 años, con predominio de pacientes blancos (55,32 por ciento) entre 50 y 59 años (44,68 por ciento) y con tiempo de evolución de la enfermedad entre 1 y 5 años (61,70 por ciento). En el 82,98 por ciento de ellos se identificaron alteraciones nutricionales por exceso, mientras que el 51,06 por ciento de ellos tenía un nivel de conocimiento bajo sobre nutrición saludable. Los triglicéridos estuvieron elevados en el 46,81 por ciento de los pacientes, mientras que el 38,30 por ciento presentó aumento del colesterol total. Conclusiones: Entre los pacientes con diagnóstico de gota existió un predominio de patrones nutricionales inadecuados. Los factores principales fueron el bajo nivel de conocimiento sobre nutrición saludable y los trastornos nutricionales por exceso. Los patrones nutricionales inadecuados favorecen la actividad de la xantino oxidasa, que aumenta la producción de ácido úrico y su acumulación sérica y articular(AU)

Introduction: Gout is a metabolic disease characterized by mono-articular inflammatory conditions primarily in the lower limbs; The main complication occurs at the renal level. Objective: The dietary pattern of patients with drops treated at the Andean Hospital of Chimborazo in the period between January 2018 and July 2019. Methods: Basic, descriptive and correlational research, universe to 53 patients with gout diagnosis. The sample consisted of 47 cases that met the inclusion criteria. The eating pattern was determined taking into account nutritional status, lipid profile and level of knowledge about healthy nutrition. Pearson's correlation coefficient was applied to identify relationship between variables. Results: Average age of 58.72 years with a predominance of patients between 50 and 59 years (44.68 percent) and with time of evolution of the disease between 1 and 5 years (61.70 percent). In 82.98 percent of the patients, excess nutritional alterations were identified, while 51.06 percent of them presented a low level of knowledge about healthy nutrition. Triglycerides were elevated in 46.81 percent of the patients, while 38.30 percent had an increase in total cholesterol. Conclusions: There was a predominance of patients with a diagnosis of gout and adequate nutritional patterns. The greatest effects were the low level of knowledge about healthy nutrition and the increased presence of excess nutritional disorders. Inadequate nutritional patterns favor the activity of xanthine oxidase by increasing the production of uric acid and its serum and joint accumulation(AU)

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Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder due to a deficiency of enzymes involved in cortisol biosynthesis. In more than 90% of cases, CAH is secondary to deleterious mutations in the CYP21A2 gene leading to 21-hydroxilase deficiency (21OHD). The CYP21A2 gene is located on the short arm of chromosome 6 (6p21·3) and encodes the cytochrome P450C21 enzyme. Neonatal screening programs detect the classic forms of CAH-21OHD quantifying 17OH-progesterone in dried blood spots (DBS). This test is very sensitive, but it has a low specificity, requiring a second sample to confirm the result. In these cases, a second-tier test in the same sample may be useful. Our aim was to evaluate a DNA extraction method from DBS and assess the performance of such DNA in the molecular analysis of the CYP21A2 gene mutations. Twelve individuals, who presumably had CAH based on the initial neonatal screening results, were analyzed using DNA extracted from freshly collected blood on EDTA and DBS. The CYP21A2 gene was analyzed by automated sequencing of all exons and intron boundaries and MLPA analysis in DBS. Molecular analysis results from both extraction methods were compared. In this study, we show that DNA extracted from neonatal screening DBS is a useful tool to define CYP21A2 gene mutations in 21-OHD diagnostic confirmation for the newborn screening program and that its results are comparable to traditional genotyping.

La hiperplasia suprarrenal congénita (HSC) es un desorden autosómico recesivo producido por la deficiencia de alguna de las enzimas involucradas en la biosíntesis de cortisol. Más del 90% se debe a mutaciones en el gen CYP21A2 que genera deficiencia de 21 hidroxilasa (21OHD). Este gen se encuentra en el brazo corto del cromosoma 6 (6p21·3) y codifica para la enzima citocromo P450C21. Los programas de pesquisa neonatal detectan la forma clásica de la HSC-21OHD cuantificando 17OH-progesterona en gota de sangre en papel de filtro (GSPF). Este test es muy sensible, pero tiene baja especificidad , por lo que se utiliza una segunda muestra para confirmar el resultado. En estos casos, una segunda determinación en la misma muestra podría ser de utilidad. Nuestro objetivo fue evaluar el método de extracción de ADN y posterior análisis molecular del gen CYP21A2 en muestras de GSPF. Analizamos doce individuos presumiblemente afectados por HSC en la pesquisa neonatal usando ADN extraído de sangre fresca recolectada sobre EDTA y de GSPF. Realizamos el análisis del gen CYP21A2 mediante secuenciación automática de todos los exones y regiones intrónicas flanqueantes y MLPA en GSPF, y comparamos los resultados con ambos métodos de extracción. En este estudio demostramos que el ADN extraído de GSPF es una herramienta muy útil para analizar las mutaciones del gen CYP21A2 en la confirmación diagnóstica de 21-OHD para los programas de pesquisa neonatal y que los resultados son comparables con la genotipificación tradicional.

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El panorama médico mundial actual está enfocado en el control de la COVID-19. La enfermedad afecta con mayor frecuencia a pacientes con enfermedades crónicas y puede concomitar con otras enfermedades virales; situación que incrementa el riesgo de complicaciones graves en los pacientes. El propósito de este estudio es dar a conocer las manifestaciones clínicas presentes en un paciente con gota en el cual concomitaron el dengue y la COVID-19. Se presenta a un paciente masculino de 50 años de edad con diagnóstico de artropatía gotosa de 5 años de evolución que comenzó con un cuadro inflamatorio atípico para esta enfermedad, acompañado de otras manifestaciones clínicas como decaimiento marcado, lesiones hemorragíparas en la piel, hematuria y disnea progresiva. Se realizó el diagnóstico de dengue y COVID-19 mediante estudios serológicos. Se aplicó el protocolo de tratamiento para ambas enfermedades, y el paciente evolucionó favorablemente hasta que fue dado de alta hospitalaria 26 días después sin que se presentaran complicaciones de la artropatía gotosa, el dengue o la COVID-19. Es importante conocer el patrón articular en el curso de las enfermedades reumáticas, pues esto, unido a las características epidemiológicas imperantes, facilita el diagnóstico de asociación de distintas enfermedades como ocurrió en el caso presentado. Se requiere crear protocolos y guías de actuación que establezcan el esquema terapéutico ante pacientes con estos diagnósticos(AU)

The current world medical panorama is focused on the control of COVID-19. The disease occurs more frequently in patients with chronic diseases and can be associated with other viral diseases; in this situation, the risk of serious complications in patient's increases. To present the clinical manifestations present in a patient with gout in whom dengue and COVID-19 coexist. A 50-year-old male patient is presented with a diagnosis of gouty arthropathy of 5 years of evolution that begins with an atypical inflammatory picture for this disease, accompanied by other clinical manifestations such as marked decay, hemorrhagic skin lesions, hematuria and progressive dyspnea. Dengue and COVID-19 diagnosis is made through serological studies. It is important to know the joint pattern in the course of rheumatic diseases, this, together with the prevailing epidemiological characteristics, facilitates the diagnosis of association of different diseases as occurred in the case presented(AU)

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Introduction: gouty arthritis is a persistent metabolic disease that produces an increase of the circulating uric acid, with the resulting deposit of monosodic urate crystals in the tissues. Objective: to characterize patients with gouty arthritis clinically and epidemiologically. Methods: a descriptive investigation of 72 patients with a diagnosis of gouty arthritis, assisted at Arnaldo Milián Castro Clinical Surgical University Hospital was carried out from January 2008 to December 2017. Results: patients between 40 and 49 years of age were the most representative group with a highest incidence in not white patients and the male sex. Obesity and hypertension prevailed as previous personal antecedents. Alcohol intake was the most represented toxic habit. A crisis of inflammation of the big toe was the more frequent starting manifestation. Swelling of soft tissues was the main radiologic alteration. Conclusion: gouty arthritis is present with a highest frequency in the male sex with a peak of incidence in the fourth decade of life. It is associated to bad diet habits and alcohol intake that could cause joint damage(AU)

Introducción: la artritis gotosa es una enfermedad metabólica persistente, que produce un aumento del ácido úrico circulante, con el consiguiente depósito de cristales de uratos monosódicos en los tejidos. Objetivo: caracterizar clínica y epidemiológicamente a los pacientes con artritis gotosa. Método: se realizó una investigación descriptiva de 72 pacientes con diagnóstico de artritis gotosa, atendidos en el Hospital Universitario Clínico Quirúrgico Arnaldo Milián Castro, entre enero del 2008 y diciembre del 2017. Resultados: los pacientes entre 40 y 49 años de edad fueron los más representativos, con mayor incidencia en no blancos y del sexo masculino. Predominó la obesidad y la hipertensión arterial como antecedentes patológicos personales. El alcohol fue el hábito tóxico mayoritariamente representado. La crisis de podagra resulto ser la manifestación inicial más usual. El aumento de partes blandas fue la principal alteración radiológica. Conclusiones: La gota se presenta con mayor frecuencia en el sexo masculino con un pico de incidencia en la cuarta década de la vida. Está asociada a malos hábitos dietéticos y al consumo de bebidas alcohólicas pudiendo ocasionar daño articular(AU)

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Resumen Introducción: Durante muchos años el ácido úrico se ha considerado como un producto metabólico inerte del metabolismo de las purinas, sin embargo, ha sido recientemente asociado a una serie de estados de enfermedad crónica. No hay hallazgos concluyentes disponibles en la actualidad para tomar una conducta activa clara respecto al tratamiento de ácido úrico sérico, y cuál sería su objetivo terapéutico. Material y métodos: Debido a esta controversia, se decidió llevar a cabo una encuesta para evaluar cuáles son las decisiones que se toman en este contexto, en el ámbito médico de la Argentina. Se consultó en qué pacientes se evaluaba en forma rutinaria el ácido úrico sérico, resultando en un 53.2% de todos los pacientes, sin diferenciar patologías, y un 11.5% refirió que no lo realiza rutinariamente. Con respecto al tratamiento sólo refirieron tratarlo con enfermedad renal un 62.5%; con diabetes 61.7%; con síndrome metabólico 60.4%; con enfermedad cardiovascular un 50.3%; con gota, cálculos renales o dolor articular, un 91.3%, 74% y 36.1% respectivamente. Resultados: Los datos de la encuesta confirman la falta de evidencia en el criterio para la selección de pacientes, a los fines de evaluar los niveles de ácido úrico sérico y su tratamiento. Conclusiones: De esta forma, se concluye que prima la necesidad de realizar estudios prospectivos y randomizados de las patologías con alta incidencia de uricemia elevada, para poder determinar normativas que orienten una conducta a los especialistas según los resultados obtenidos, y que dicha decisión no esté basada solo en la opinión de los expertos.

Abstract Introduction: For many years, uric acid was considered to be an inert product of purine metabolism; however, it has recently been associated with a number of chronic diseases. Nowadays, there are no conclusive findings available regarding a clear action plan to treat serum uric acid or which specific therapeutic goals it would have. Methods: Given this controversy, a survey was conducted in order to evaluate which decisions are taken regarding this situation within the Argentinian medical community. The question was in which cases serum uric acid was routinely assessed and the result was 53.2% no matter the pathology; 11,5% of physicians did not assess it routinely. Regarding its treatment, 62.5% of them reported to have treated it as part of kidney disease; 61.7 % as part of diabetes; 60.4% as part of metabolic syndrome; 50.3% as part of cardiovascular disease; 91.3 % as part of gout; 74% as part of renal stones, and 36.1% as part of joint pain. Results: The data collected by means of the survey show a lack of evidence for establishing the patient selection criteria when evaluating levels of serum uric acid and its treatment. Conclusions: Therefore, it is concluded that it is necessary to conduct prospective and randomized studies of conditions with a high incidence of elevated uricemia in order to develop guidelines for specialists according to results; this decision should not be based on experts' opinion alone.