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A cross-sectional and multicenter study was undertaken to analyze the clinical and immunological characteristics at diagnosis associated with nephritis in northwestern Colombian patients with systemic lupus erythematosus (SLE). Thirty nine patients with lupus nephritis were included and were compared to 100 SLE patients without nephritis. A multivariate analysis was performed. The patients who developed nephritis had a higher frequency of oral ulcers (41% vs. 21%, OR=3.1, 95%CI: 1.3-7.5 p= 0.01) and malar erythema (77% vs. 45%, OR=4.4, 95%CI: 1.8-10.8 p=0.001). Lupus nephritis was observed in 77% of cases during the first year of the disease. The frequency of anti-DNA antibodies was higher in patients with nephritis, however, differences were not statistically significant (83% vs 64%, OR=2.6, 95%CI: 1.03-6.41, p=0.06). The presence of other autoantibodies (anti-Ro, anti-La, anti-RNP, anti-Sm and anticardiolipin) at diagnosis was similar in both groups. This autoantibody profile remained unchanged throughout the evolution of the disease. Patients with lupus nephritis had a higher prevalence of arterial hypertension (60% vs 10%, OR=13.7, 95%IC: 5-37, p=0.00001) and hyperlipidemia (30% vs 7%, OR=8.1, 95%IC: 2.5-27, p=0.0006) at onset. Finally, patients with lupus nephritis required more hospitalizations (>1) over the course of disease (89% vs 60%, OR=7.8, 95%CI: 2.1-29, p=0.002). In conclusion, lupus nephritis appears early during the course of SLE. Malar erythema, oral ulcers, hypertension and hyperlipidemia at onset of disease are associated factors. Lupus nephritis is a major risk factor leading to repeated hospitalizations. This study may help to assist in public health policies in our population in order to improve patient outcomes while simultaneously reducing disease costs.Key words: systemic lupus erythematosus, lupus nephritis, risk factors, autoantibodies, hypertension, hyperlipidemia, Colombia. Factores clínicos y epidemiológicos asociados con nefritis lúpica en pacientes del noroccidente colombianoEste estudio transversal y multicéntrico investigó las características clínicas e inmunológicas asociadas con la nefritis lúpica en pacientes colombianos de Medellín. Se incluyeron treinta y nueve pacientes con nefritis lúpica y se compararon sus características con las de 100 pacientes con lupus eritematoso sistémico (LES) sin compromiso renal. Se realizó un análisis multivariado para evaluar los factores asociados con la nefritis lúpica. Los pacientes que desarrollaron nefritis presentaron, al inicio, más úlceras orales (41% vs. 21%,OR=3,1, IC95%: 1,(3)(4)(5)(6)(7)5, p=0,01) y eritema malar (77% vs. 45%,OR=4,4, IC95%: 1,(8)(9)(10)8, p=0,001) que aquellos pacientes sin nefropatía. La nefritis lúpica se observó en 77% de los casos durante el primer año de evolución del LES. La frecuencia de anticuerpos anti-ADN fue mayor en los pacientes con nefritis; sin embargo, las diferencias no fueron significativas (83% vs. 64%, OR=2,57, IC95%:1,03-6,41, p=0,06). La presencia de otros anticuerpos (anti-Ro, anti-La, an...

Breast cancer screening programs have been effective in detecting tumors prior to symptoms. Recently, there has been concern over the issue of over-diagnosis, that is, diagnosis of a breast cancer that does not manifest prior to death. Estimates for over-diagnosis vary, ranging from 7% to 52%. This variability may be due partially to issues associated with bias and/or incorrect inferences associated with the lack of probability modeling. A critical issue is how to evaluate the long-term effects due to continued screening. Participants in a periodic screening program can be classified into four mutually exclusive groups depending on whether individuals are diagnosed and whether their symptoms appear prior to death: True-early-detection; No-early-detection; Over-diagnosis; and Not-so-necessary. All initially superficially healthy people will eventually fall into one of these four categories. This manuscript reviews the major methodologies associated with the over-diagnosis and long-term effects of breast cancer screening.

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