Objective.: Determine the proportion of patients achieving target serum urate (SU), defined as < 6 mg/dl for patients with non-severe gout and < 5 mg/dl for patients with severe gout, as well as the proportion of patients achieving remission after 5 years of followup.Methods.: Patients from the Gout Study Group (GRESGO) cohort were evaluated at 6-month intervals. Demographic and clinical data were obtained at baseline. Visits included assessments of serum urate, flares, tophus burden, health-related quality of life using the EQ-5D, activity limitations using the Health Assessment Questionnaire adapted for gout, and pain level and patient’s global assessment using visual analog scales. Treatment for gout and associated diseases was prescribed according to guidelines and available drugs.Results.: Of 500 patients studied, 221 had severe gout (44%) and 279 had non-severe gout (56%) at baseline. No significant differences were observed across the study in percentages of severe gout versus non-severe gout patients achieving SU 6 mg/dl or 5 mg/dl. The highest proportion of patients achieving target SU (50–70%) and remission (39%) were found after 3–4 years of followup. In the fifth year, these proportions decreased and 28% of the patients were in remission, but only 40 patients remained in the study. None of the patients with severe gout achieved remission.Conclusion.: In patients with severe gout, target SU was hard to achieve and remission was not possible. The main obstacles for target SU and gout remission include poor medication adherence, persistent tophi, and loss to followup.

Background: Pressure ulcers constitute a major health care burden, characterized by significant morbidity, diminished quality of life, and elevated treatment costs. Wheelchair users are predisposed to pressure ulcers due to sustained ischial and sacral interface pressures resulting from prolonged periods of sitting. Implementation of pressure-relieving interventions, including specialized seating systems engineered to redistribute load and augment the weight-bearing surface area, is critical for mitigating the risk of pressure ulcers. Objective: This study aimed to evaluate a methodology for the custom fabrication of pressure relief cushions, through the user-cushion interface pressure mapping to reduce high-pressure areas and increase contact area in wheelchair users. Methods: First, a validation study was carried out with 7 healthy volunteers. The pressure was determined with an FSA sensor (BodiTrak BT1510, Vista Medical Manufactures), and the cushion profile was obtained through a linear relation with pressure values. In the second phase, 10 cushions for wheelchair users were manufactured and tested. The resulting data from buttock pressure using a flat foam, Jay X2 (gel-foam), ROHO high profile (air), and customed-contoured cushions were analyzed and compared using the following 4 variables: peak pressure, peak pressure index, mean pressure, and contact area. Results: In the validation study, the statistically significant difference between the flat and the custom-contoured cushion showed a better performance in pressure relief for the custom cushion (mean pressure 27.3, SD 4.5 mm Hg and 34.6, SD 3.5 mm Hg; P<.001). Regarding the study with wheelchair users, custom-contoured cushions had lower peak pressure (mean 91.3, SD 36 mm Hg), peak pressure index (mean 69.5, SD 33.7 mm Hg), and mean pressure (34.2, SD 17.4 mm Hg) against flat, Jay X2, and ROHO high profile cushions (P<.005). The contact area (mean 1457.6, SD 254.1 cm²) was greater for the contoured cushion (P<.001) than for flat and ROHO high profile (Permobile) cushions; nevertheless, it was not significantly different from Jay X2 (P=.59). Conclusions: The main finding is that the buttock pressure mapping method produces custom-contoured cushions that, compared with commercial cushions, have good pressure distribution and increased contact area. These results suggest that pressure mapping is a good alternative for manufacturing affordable custom-contoured cushions that can prevent the development of pressure ulcers.

Introduction: The benefits of exercise in patients with obesity are clear; physical performance and quality of life improve after exercise programs in patients with obesity. Our aim was to evaluate the usefulness of an easy, structured, and home-based exercise program to improve physical performance and quality-of-life in patients with obesity. Methods: A cohort of patients with obesity (BMI ≥30 kg/m2) was recruited during 2017–2020. Patients who met the inclusion criteria were invited and those who accepted signed informed consent. Patients were evaluated by the same team of physicians who performed the 6-min walking test and collected the clinical and biochemical variables, also applied quality-of-life questionnaire at baseline and 3 months after starting the exercise program that was divided in two levels: level 1: active mobilization of four limbs (15 min) + cardiovascular exercise (15 min walking), 5 days/week; level 2: eight strengthening exercises for upper and lower limbs with an elastic band + cardiovascular exercise (15 min walking), 5 days/week. This study used means (SD), frequencies (percent), Student's t test, and Pearson correlation test. Results: We included 151 patients, mostly women (81.5%), age 46.3 ± 9.8 years old, BMI 40.3 ± 8.56 kg/m2, 34.4% performed some type of exercise, and the most frequents comorbidities were dyslipidemia and diabetes. After 3 months, 86 patients (57%) remained in the study and attended the final evaluation. Evident changes in physical performance were reported (distance traveled, speed walking and VO2max); however, improvement in quality of life was remarkable. Conclusion: An easy, structured, and home-based exercise program improves physical performance and quality of life in patients with obesity, without losing its benefits for the health.

Background: Electrodiagnostic (EDx) studies are crucial for diagnosing neuromuscular diseases and are considered a complement to neurological examinations. Their effectiveness is highly dependent on the quality of the initial clinical diagnosis, medical history, and physical examination. This study aims to evaluate the concordance between clinical diagnoses and EDx findings, and to identify the primary specialties and clinical data justifying EDx referrals. Methods: This retrospective study included data from referral forms and EDx reports for nerve conduction studies and electromyography at Hospital General de México “Dr. Eduardo Liceaga” from January 2022 to January 2023. Statistical analyses involved descriptive statistics, Cohen’s Kappa coefficient, and binary logistic regression to assess diagnostic concordance and the influence of clinical symptoms. Results: Out of 1065 referral requests, 61.8% had their clinical diagnosis confirmed through EDx studies. Most requests originated from orthopedics (25.7%), rheumatology (17.5%), and neurology (17.4%). Although 79.5% of requests included symptoms, only 32.1% included a physical examination. Common diagnoses included radiculopathy (34.6%), polyneuropathy (22.7%), and carpal tunnel syndrome (22.4%). Concordance between clinical and electrophysiological diagnoses had a coefficient of 0.578 (95% CI: 0.537–0.619; p < 0.001). Pain and weakness were significantly associated with diagnostic confirmation (pain: OR 3.1; 95% CI: 1.79–5.48; p < 0.001; weakness: OR 2.46; 95% CI: 1.35–4.48; p = 0.003). Neurology had the highest concordance (0.853; 95% CI: 0.829–0.878), while neurosurgery had the lowest (0.502; 95% CI: 0.378–0.627). Conclusions: EDx studies are valuable, yet their concordance with clinical diagnoses is limited. The experience of the requesting physician significantly impacts diagnostic accuracy. Enhancing referral information is essential for improving EDx study effectiveness and reducing unnecessary procedures, thereby improving patient outcomes and managing costs.