Abstract Background: Primary Sjögren syndrome (pSS) is a chronic autoimmune disease with its main target being exocrine glands, and is the connective tissue disease more frequently associated with other autoimmune diseases. The aim of this study was to assess the frequency of another autoimmune rheumatic disease (ARD) developed in primary Sjögren syndrome (pSS) patients and to describe it’s clinical, serological and histologic characteristics. Materials and methods: This is a retrospective cohort study. Data of patients with pSS diagnosis (American-European criteria 2002), included in the GESSAR database (Grupo de Estudio Síndrome de Sjögren, Sociedad Argentina de Reumatología) were analyzed. The development of a second ARD was registered during the follow up. Results: 681 patients were included, 94.8% female. The mean age was 54 (SD 14) years and mean age at diagnosis of 50 (SD 13) years. The mean follow-up was 4.7 (SD 4.9) years; 30 patients (4.41%, CI 95%: 3.1–5.7) developed a second ARD during the follow up, incidence rate was 9.1/1000 patients-year (IR 95%: 5.8–12.4/1000 patients-year), the most frequent being rheumatoid arthritis (RA). 96% out of these 30 patients had xerophthalmia, 86.2% xerostomia, 92% positive Schirmer test, 88.24% positive Rosa Bengala test, lisamine green or Ocular Staining Score, 81.2% positive unstimulated salivary flow, 82.1% Ro(+) and 33.33% La(+). Minor salivary gland biopsy had been performed in 14 of the 30 patients, 12 with positive results. There were no statistically significant differences respect baseline characteristics when comparing the patients who developed another ARD to the ones that did not. Conclusions: Of all the patients analyzed, 4.4% presented another ARD during their follow-up. It is important to be aware of this, to make an early and proper diagnosis and treatment of our patients. Key points Patients with primary Sjögren’s Syndrome may develop another connective tissue disease during follow-up. The most frequently connective tissue disease developed during follow-up in the population of patients with primary Sjogren’s Syndrome studied was rheumatoid arthritis. It is important to be aware of this to make an early and proper diagnosis.

Abstract Introduction The endolymphatic sac is thought to maintain the hydrostatic pressure and endolymph homeostasis for the inner ear, and its dysfunction may contribute to the pathophysiology of Ménière’s disease. Throughout the years, different surgical procedures for intractable vertigo secondary to Ménière’s disease have been described, and though many authors consider these procedures as effective, there are some who question its long-term efficacy and even those who think that vertigo control is achieved more due to a placebo effect than because of the procedure itself. Objective To review the different surgical procedures performed in the endolymphatic sac for the treatment of Ménière’s disease. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis We focus on describing the different surgical procedures performed in the endolymphatic sac, such as endolymphatic sac decompression, endolymphatic sac enhancement, endolymphatic sac shunting and endolymphatic duct blockage, their pitfalls and advantages, their results in vertigo control and the complication rates. The senior author also describes his experience after 30 years of performing endolymphatic sac surgery. Conclusions The endolymphatic sac surgery, with all its variants, is a good option for patients with incapacitating endolymphatic hydrops, providing a high percentage of vertigo control and hearing preservation.

Resumen: La utilización del análisis conjunto para estudiar procesos de decisión estratégica se considera un avance respecto a los métodos habituales post-hoc. Pero, dado que los experimentos conjuntos evalúan percepciones sobre perfiles del entorno descritos por frases, en lugar de preferencias, surge el problema de que la carga informativa que generan estos escenarios puede superar la capacidad del entrevistado, dificultando su evaluación y delimitando su uso a pocos factores. Este trabajo investiga cómo el diseño (el número de atributos) afecta a la complejidad de la evaluación y el rendimiento del experimento. Además, se propone un diseño mixto basado en bloques incompletos balanceados y, mediante un experimento, se compara su rendimiento frente a un diseño de bloques estándar. Los resultados muestran que la complejidad derivada del número de atributos tiene un efecto moderado en la variación explicada pero mayor en el peso de los factores, vislumbrando el uso de heurísticas distintas de los encuestados en el proceso de evaluación. Clasificación JEL: M31, C93, M21.

Résumé: L'utilisation de l'analyse conjointe pour étudier les processus de décision stratégique est considérée comme un progrès sur les méthodes post-hoc habituels. Mais puisque les expériences conjointes évaluent les perceptions des profils de l'environnement, décrites par des phrases au lieu des préférences, le problème se pose lorsque la charge d'informations générée par ces scénarios peut dépasser la capacité de l'enquêté, ce qui entrave son évaluation et borne son utilisation à quelques facteurs. Cet article examine comment la conception (le nombre d'attributs) affecte la complexité de l'évaluation et le rendement de l'expérience. En plus, on propose une conception mixte sur la base de blocs incomplets équilibrés et, à travers une expérience, on compare son rendement par rapport à une conception de blocs standard. Les résultats montrent que la complexité dérivée du nombre d'attributs a un effet modéré sur la variation expliquée, mais plus grande sur le poids des facteurs, ce qui permet d'envisager l'usage d'heuristiques différentes des enquêtés dans le processus d'évaluation. Clasificación JEL: M31, C93, M21.

Abstract: The use of conjoint analysis for studying strategic decision processes is considered an improvement on the usual post-hoc methods. However, since joint experiments evaluate the perceptions of profiles of the environment, described by sentences, instead of evaluating preferences, arises the problem that the reporting burden generated by these scenarios can exceed the capacity of the respondent, hampering its assessment and limiting its use to a few factors. This paper analyzes how the design (number of attributes) affects the complexity of the evaluation and the performance of the experiment. Besides, it also proposes a mixed design based on balanced incomplete blocks, comparing by experimentation its performance against a standard blocks design. Results show that complexity derived from the number of attributes has a moderate effect on the explained variation, but a greater effect in the weight of the factors, envisioning the use of different heuristics from respondents in the assessment process. Clasificación JEL: M31, C93, M21.

Resumo: A utilização da análise conjunta para estudar processos de decisão estratégica é considerada um avanço a respeito dos métodos habituais post-hoc. Porém, tendo em vista que os experimentos conjuntos avaliam percepções sobre perfis do ambiente descritos por frases, em vez de preferências, surge o problema de que a carga informativa que esses cenários geram possa superar a capacidade do entrevistado, o que dificulta sua avaliação e delimita seu uso a poucos fatores. Este trabalho pesquisa como o desenho (o número de atributos) afeta a complexidade da avaliação e do rendimento do experimento. Além disso, propõe-se um desenho misto baseado em blocos incompletos balanceados e, mediante um experimento, compara-se seu rendimento ante um desenho de blocos padrão. Os resultados mostram que a complexidade derivada do número de atributos tem um efeito moderado na variação explicada, mas maior no peso dos fatores, o que vislumbra o uso de heurísticas diferentes dos entrevistados no processo da avaliação. Clasificación JEL: M31, C93, M21.