Abraham Zonana-Nacach

Infections in outpatients with systemic lupus erythematosus: a prospective study

The objective of this study was to assess the incidence and risk factors of infections in 200 SLE outpatients. All outpatients with active or inactive SLE without infections in the previous month were included. They were assessed every 3 months. Major infections were those requiring hospitalization and parental antibiotic therapy; minor infections required oral or topical therapy. Sociodemographic, disease activity using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), therapy and laboratory variables were evaluated. After a follow-up of 22 7 months, 65 (32%) patients had infections; 35% of those were major. The most common sites for infection were urinary (26%), skin (23%), systemic (12%), and vaginal (9%). At infection onset, 50 of 65 patients (77%) had disease activity, with a mean SLEDAI score of 6.1. The variables signifycantly associated with infection in the univariate analyses were the presence of disease activity, SLEDAI score, renal activity, prednisone dose, and IV cyclophosphamide. The only variable associated with infection in the multivariate analyses was a SLEDAI score of 4 or higher. Most infections in SLE outpatients were single, minor, non-life threatening, and associated with disease activity independently of sociodemographic and therapeutic factors.

Measurement of damage in 210 Mexican patients with systemic lupus erythematosus: relationship with disease duration

The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index is a validated instrument specifically designed to ascertain damage in SLE; this instrument has been applied mainly to Caucasians and African-American SLE patients. The objective of this study was to assess damage using the SLICC/ACR Damage Index in Mexican SLE patients. The SLICC/ACR Damage Index was applied to 210 consecutive SLE patients with disease of variable duration. The SLICC/ACR Damage Index was assessed by review of hospital clinical records, interview and physical examination. One hundred and seventeen (55.5%) patients had some damage. The proportion of patients with damage increased significantly with disease duration (33% at 1–60 months, 66% at 61–120 months and 70% at ≥121 months, P < 0.001). The main organ systems involved were musculoskeletal (osteonecrosis), neuropsychiatric (neuropathy, seizures), gonadal (amenorrhea prior to age 40 years), ocular (cataracts), renal (glomerular filtration < 50%) and peripheral vascular (permanent damage by venous thrombosis). Damage was frequent, increased over time, particularly for ocular, renal, musculoskeletal and gonadal. Patients who experienced damage were older, had a longer disease duration, a greater number of ACR criteria at diagnosis, and were more likely to have renal involvement and antibodies to dsDNA. The damage occurred in many different domains and started to develop early after disease onset. Mexican patients had more peripheral vascular and gonadal involvement compared with published data from non-Hispanic SLE populations.

Disease activity, damage and survival in Mexican patients with acute severe systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a clinical syndrome of varying severity. Although the survival and prognosis of SLE have steadily improved, there is a group of patients who present an acute fatal outcome despite aggressive therapy. We designed this study to evaluate the factors associated with mortality in patients with acute severe SLE. During 2004—06, 41 Mexican SLE patients that could not be managed in the out-patient clinic and with acute severe major organ system involvement [nephritis, severe thrombocytopenia (platelet count below 20 000 per μL) acute neuropsychiatric pulmonary, gastrointestinal or cardiac disease and generalized vasculitis] were studied. During the first admission, disease activity (SLE Disease Activity Index (SLEDAI), SLE Activity Measured), damage [SLE International Collaborating Clinics (SLICC)], and therapy were assessed. Survival using Kaplan—Meier curves, odd ratios with 95% confidence interval and logistic regression analysis were used to determine risk factors for mortality. Ninety percent were female with a mean age of 29 ± 19 years and mean disease duration of 21 ± 9 months. The principal causes of first admission were renal (27%), SNC (22%) and cardiopulmonary (15%). After a mean follow-up of 9.7 ± 6 months, 16 (39%) patients died. Deceased patients had significantly higher SLEDAI (P = 0.004), and SLICC (P = 0.03) scores. The manifestations associated with mortality were renal disease activity (odds ratio, OR 4.6, confidence interval, CI 95% 1.0—20.6), infections (OR 3.2 CI 95% 2.0—5.3) and thrombocytopenia (OR 4.0, CI 95% 1.0—15.9). The survival at 9.7 months was 72, 62 and 50% in patients with an SLEDAI score of 3—10, 11—20 and ≥21, respectively. The SLEDAI score, the presence of damage and infection were associated with death in patients with acute severe SLE. Lupus (2007) 16, 997—1000.

Efecto de la ganancia de peso gestacional en la madre y el neonato

OBJETIVO: Evaluar el efecto de la ganancia de peso gestacional (GPG) en la madre y el neonato. MATERIAL Y METODOS: Se incluyeron 1 000 mujeres en puerperio inmediato atendidas en el Hospital de Ginecologia del Instituto Mexicano del Seguro Social, en Tijuana, Baja California, Mexico. Se considero una GPG optima si en las mujeres con bajo peso, peso normal, sobrepeso u obesidad previo al embarazo, la GPG fue < 18 kg, < 16 kg, < 11.5 kg y < 9 kg, respectivamente. RESULTADOS: Treinta y ocho por ciento de las mujeres tuvieron una GPG mayor a la recomendada, lo cual se asocio con oligo/ polihidramnios (RM 2.1, IC 95% 1.04-4.2) y cesareas (RM 1.8, IC 95% 1.1-3.0) en las mujeres con peso normal previo al embarazo; con preeclampsia (RM 2.2 IC 95% I.I-4.6) y macrosomia (RM 2.5, IC 95% I.I-5.6) en las mujeres con sobrepeso, y con macrosomia (RM 6.6 IC 95% I.8-23) en las mujeres con obesidad. El peso previo al embarazo, mas que la ganancia de peso gestacional, se asocio con diabetes gestacional. CONCLUSIONES: Un aumento de riesgo de complicaciones obstetricas y del neonato fue asociado con una GPG mayor a la recomendada.

Factores de riesgo relacionados con lupus eritematoso sistémico en población mexicana

Objetivo. Evaluar los factores de riesgo asociados con el desarrollo de lupus eritematoso sistemico en poblacion mexicana. Material y metodos. Estudio de casos y controles, efectuado en junio de 1996 en el Departamento de Reumatologia del Hospital de Especialidades del Centro Medico Nacional Siglo XXI (HE CMN), del Instituto Mexicano del Seguro Social, de la Ciudad de Mexico. Se estudiaron 130 pacientes (casos) que presentaban cuatro o mas criterios de clasificacion de lupus eritematoso sistemico (LES) y con una evolucion de la enfermedad menor de cinco anos. Los controles fueron pacientes hospitalizados por enfermedades agudas no autoinmunes. Fueron pareados 1:1 por edad y sexo; ambos grupos se evaluaron a traves de una entrevista directa y la aplicacion de un cuestionario estructurado. Se estudiaron los siguientes factores de riesgo: geneticos (historia familiar de LES o enfermedad de tejido conjuntivo), sociodemograficos (raza, lugar de residencia, educacion, ingreso mensual); hormonales (anticonceptivos orales, terapia hormonal de remplazo y ginecobstetricos); ambientales (productos para el cabello, cohabitacion con perros, infecciones, alergias). El analisis estadistico fue hecho con razon de momios (RM) IC 95% y regresion logistica. Resultados. El analisis estadistico multivariado mostro asociacion con el antecedente familiar de LES (RM 4.2, IC 95% 1.17-15.2) u otra ETC (RM 2.6, IC 95% 1.15-4.5), uso de anticonceptivos orales por mas de un ano (RM 2.1, IC 95% 1.13-4.3), faringoamigdalitis de repeticion (RM 2.1, IC 95% 1.18 - 3.6) y farmacos (RM 5.0, IC 95% 1.62 - 21.6). No hubo relacion con factores socieconomicos, el uso de productos para el cabello, con asma o con antecedentes alergicos. Conclusiones. Factores geneticos como el antecedente heredo-familiar de LES o enfermedad de tejido conjuntivo en familiares de primer grado continuan siendo factores importantes en el desarrollo de LES. Otros factores de riesgo como el uso de farmacos, uso de anticonceptivos orales, faringitis de repeticion, posiblemente interactuan en un huesped geneticamente susceptible para el desarrollo de la enfermedad.

Factores asociados a violencia doméstica en mujeres mexicanas vistas en primer nivel atención

OBJECTIVE To assess the prevalence and risk factors for intimate-partner violence (IPV) in women who attended a Family Medicine Unit in Tijuana, Mexico. METHODS A total of 297 women were interviewed and evaluated using two validated scales: violence and severity index and family APGAR to assess family functioning and IPV respectively. RESULTS The mean age (± SD) was 40.6±13.8 years, and 120 (40.4%) women had suffered IPV: 47 (15.8%) psychological violence; 31 (10.4%) sexual violence; 77 (25.9%) physical violence, and in 19 (6.4%) there were actions that threatened the lives of women. The most common causes of domestic violence were women who reported that their partner had been jealous, or suspicion from friends (37.4%). Twenty two (7.4%) of the women with domestic violence reported that they had sought help. CONCLUSIONS The prevalence of IPV was high and associated with the education level of the couple and family functioning.