Background: The study of early systemic lupus erythematosus (SLE) presentation can optimize its diagnosis and treatment. Methods: The clinical charts of those patients ≥12 year sold complied with ≥ 4 criteria for SLE of the American College of Rheumatology (ACR) were reviewed. The term “early presentation of SLE” corresponded to the first year of evolution of the disease, starting with the date when the first(s) criterion/criteria were reported in the chart. The patients were grouped if they complied with a combination of ≥4, 2-3 or 1 ACR criteria for the classification of SLE through the first year of disease. The impact over the early diagnosis of SLE was estimated according to the early performance of the primary care doctor in ruling out the disease. Results: 115 patients were included. At the end of the first year, 68 patients (59.13%) met <4 ACR criteria vs. 47 (40.86%) who met ≥4 (p=0.05). Patients who met <4 criteria fulfilled ≥4 criteria within the next 10 years (mean= 4.9 years). Of the 68 cases with <4 ACR criteria, 31 (45.58%) met two or three criteria and 37 (54.41%) met one solitary criterion (p=0.46). The most frequent early single onset ACR criterion for SLE was the polyarticular inflammatory syndrome, 26 (70.20%) followed by a group of other single criterion that included cutaneous, hematologic, neurologic, cardiopulmonary, renal, and false-positive VDRL, 11 cases (29.72%) (p=0.01). An early solitary criterion-compared with those patients with ≥2- was associated with a lack of documentation -in the medical chart- of constitutional symptoms, indication of serum antibodies and referral to specialist. Conclusion: Patients with an insufficient quota of ACR criteria for SLE exceeded those with ≥4 positive criteria at the end of the first year of the disease. Patients with a single criterion of presentation compared with those patients who started with ≥2 early criteria- were associated with a delay in the early diagnosis of SLE by at least one year. Key words: ACR criteria for Systemic Lupus Erythematosus; difficult diagnosis; early manifestations of SLE; primary care physician.

Professionalism is one of the six areas of competency defined by the Accreditation Council of Graduate Medical Education (ACGME). Unprofessional behavior is the single most common cause for disciplinary action against medical students in their clinical rotations, residents, and clinical practitioners. The Association of American Medical Colleges (AAMC) and the National Board of Medical Examiners (NBME) will like to see professionalism taught and evaluated across medical school. Gross Anatomy, with cadaver laboratory dissection, is in a unique position to preside over a rich number of activities where behaviors of professionalism can be taught, practiced and rewarded. Such activities will be comparable to the behaviors of prefessionalism taught in clinical rotations. This article highlights the essential involvement and tools that can be used to teach, evaluate, and promote behaviors of pressionalism accessible in the laboratory with cadaver dissection.

Stroke, the 5th. cause of death in Venezuela, has been associated to cerebral infarction. However, there is little information concerning lethality factors. 33 atherothrombotic subtype stroke patients, 31 (96%) Latino and 2(4%) white, were admitted into a prospective study to analyze the role of 11 mortality risk factors for those patients. A mortality relative risk (RR) > 1.5 or < 1 (protective) was considered clinically important if 1 was excluded from the 95% confidence interval (95%CI). The Mantel-Haenszel Chi-square procedure was use to test statistical significance (p < 0.05). Mortality RR for patients age 65 and over (RR = 2.95) and 4 year mortality RR for male patients (RR = 2.04) were clinically and statistically significant. History of high blood pressure was protective (RR = 0.62) probably due to good medical control. Cumulative mortality was higher than that of comparable studies, even from the first week of follow-up, reaching 67% at the 4th year.