SLE is a chronic autoimmune disease involving multiple systems. Patients with SLE are highly susceptible to infections due to the combined effects of their immunosuppressive therapy and the abnormalities of the immune system that the disease itself causes, which can increase mortality in these patients. The differentiation of SLE activity and infection in a febrile patient with SLE is extremely difficult. Activity indexes are useful to identify patients with lupus flares but some clinical and biological abnormalities may, however, make it difficult to differentiate flares from infection. Several biological markers are now recognized as potential tools to establish the difference between SLE activity and infection, including CRP and procalcitonin. It is possible, however, that the use of only one biomarker is not sufficient to confirm or discard infection. This means that new scores, which include different biomarkers, might represent a better solution for differentiating these two clinical pictures. This review article describes several markers that are currently used, or have the potential, to differentiate infection from SLE flares.

Background/Objective Differentiating systemic lupus erythematosus (SLE) activity from infections in febrile patients is difficult because of similar initial clinical presentation. The aim of this study is to evaluate the usefulness of a number of biomarkers for differentiating infections from activity in SLE patients admitted with systemic inflammatory response (SIRS). Methods Patients with SLE and SIRS admitted to the emergency room were included in this study. Measurements of different markers including procalcitonin, neutrophil CD64 expression and presepsin, were performed. Infection was considered present when positive cultures and/or polymerase chain reaction were obtained. Sensitivity and specificity were calculated for all biomarkers. Results Twenty-seven patients were admitted, 23 women (82.5%), mean age 33.2 years. An infectious disease was confirmed in 12 cases. Markers for SLE activity including anti-DNA titers by IIF ( p = 0.041) and enzyme-linked immunosorbent assay ( p = 0.009) were used for differentiating SLE flares from infection. On the contrary, increased procalcitonin ( p = 0.047), neutrophil CD64 expression by flow cytometry ( p = 0.037) and presepsin ( p = 0.037) levels were observed in infected SLE patients. Conclusions High neutrophil CD64 expression, presepsin and procalcitonin levels are useful to differentiate infections from activity in SLE patients. In most cases, a positive bioscore that includes these three markers demonstrate the presence of an infectious disease.

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Background: Covid-19 represented a health, humanitarian and economic crisis that affected the world's population, causing changes in the dynamics, structure and behavior of society. Health services were reorganized or interrupted due to the change in the prioritization of health needs and tele-abortion was one of the alternatives to ensure access to safe abortion during the pandemic. Aim: To identify the challenges and opportunities for the provision of tele-abortion services in Colombia, specifically in the Profamilia Association during and after the Covid-19 health emergency. Methods: Qualitative exploratory-descriptive research, based on the methodology of systematization of experiences, developed in three stages: the review of public policy documents, the use of manuscript and oral primary sources, and the analysis of the information collected. Results: In Colombia, the health crisis led to a more accelerated implementation of telemedicine and telehealth standards. The implementation of tele-abortion services in Profamilia began in 2020 through the "Mía Kit" as part of a strategy to expand the right to self-managed abortion. The organization faced challenges and opportunities at the organizational, socio-political and cultural levels. The challenges were related to the need for training in the effective use of Information and Communication Technologies, the lack of guidelines for the provision of tele-abortion services and social imaginaries about the suitability of face-to-face care. Opportunities were found to be related to national coverage, protocols, programs and organizational policies on abortion care, and the preference of some users to receive abortion care in a non-face-to-face setting. Conclusion: Tele-abortion represents an opportunity to reduce the stigma associated with this intervention, allowing women to access this service in an environment they consider adequate and safe. Virtual advising and accompaniment are essential for this practice to be effective.

Background There are many patients with osteoarthritis (OA) that are misdiagnosed as rheumatoid arthritis (RA) in general practice in Colombia. False positive diagnosis of RA is made on the basis of proximal or distal compromise in hands associated with low level positive rheumatoid factor. As a result, they are treated with disease modifying anti-rheumatic drugs (DMARDs), leading to higher economic costs for health system. Objectives The aim of this study was to calculate the possible direct economic costs of care of OA patients misdiagnosed as RA in a 12 month period in a cohort of patients derived to a specialized RA center in Colombia. Methods A descriptive cross sectional study was performed. Patients derived during a 12 month period to a RA specialized center with presumptive diagnosis of this disease and found finally diagnosed with OA were included in analysis. For confirmation or ruling-out RA diagnosis was followed a standardized protocol by a rheumatologist. Percentages and averages were calculated for demographic and clinical characteristics of the cohort of patients in which final diagnosis of OA was made. We described the direct costs in colombian pesos (COP) of their care assuming an average of 4 visits/year to general practitioner (6.000 COP/consultation), 2 visits/year for physiatrist and orthopedics (16.000 COP/consultation) and 4 set/year of conventional laboratories (40.000 COP/set). Cost of medication doses were calculated for an average use of methotrexate, sulfasalazine, chloroquine and prednisolone (103.000 COP/monthly). Indirect costs were not calculated. Results From 2841 patients evaluated, in 1511 patients (53.2%) diagnosis of RA was confirmed, the remaining 1330 patients (46.8%) had a wrong diagnosis of RA. Between incorrect differential diagnosis were found: osteoarthritis in 896 patients (67.36%), systemic lupus erythematosus in 104 patients (7.81%), Sjögren syndrome in 50 patients (3.75%), spondyloarthropathies in 45 patients (3.38%), gout in 28 patients (2.1%) and other diagnoses in 15.56% of the remaining population. As above mentioned, 896 patients (67.36% of misdiagnosed patients) had finally OA. Of this patients, 629 (76.2%) were women and 267 (29.79%) men, with an average age of 59.5 years (range between 9-92 years). For each patient we calculated 24.000 COP/year for general practitioner visits, 64.000 COP/year for specialized medicine visits, 160.000 COP/year for laboratory sets and 1’236.000 COP/year for medications. This leads to a total cost of 1’484.000 COP/year per patient. From a total of 896 misdiagnosed patients the cost rises to 1’329’664.000 COP. These patients had an average of 4.5 years of wrong treatment for their misdiagnosis, making the cost rise up to 5’983’488.000 COP (3 million US dollars). Conclusions There is an important economic implication of the misdiagnosis of OA as RA, being this the most frequent mistake in the diagnosis of this disease. The implementation of educational programs for health care primary physicians and specialized RA centers cou...