Álvaro José Montiel-Jarquín

The Epidemiology of Functional Gastrointestinal Disorders in Mexico: A Population-Based Study

Aims. The frequency of functional gastrointestinal disorders (FGIDs) in the general population of Mexico is unknown. Methods. To determine the prevalence of FGIDs, associated depression, and health care utilization, a population-based sampling strategy was used to select 500 households in the State of Tlaxcala, in central Mexico. Household interviews were conducted by two trained physicians using the Rome II Modular Questionnaire, a health-care and medication used questionnaire and the CES-D depression scale. Results. The most common FGIDs were IBS: 16.0% (95% CI: 12.9–19.5); functional bloating: 10.8% (8.2–13.9); unspecified functional bowel disorder: 10.6% (8.0–13.6); and functional constipation (FC): 7.4% (5.3–10.1). Uninvestigated heartburn was common: 19.6% (16.2–23.4). All FGIDs were equally prevalent among both genders, except for IBS (P = 0.001), IBS-C (P < 0.001), IBS-A/M (P = 0.049), and FC (P = 0.039) which were more frequent in women. Subjects with FGIDs reported higher frequencies of medical visits: 34.6 versus 16.8%; use of medications: 40.7 versus 21.6%; (both P < 0.001); and reported depression: 26.7 versus 6.7%, (P < 0.001). Conclusion. In this first population-based study of FGIDs in Mexico, heartburn, IBS, functional distension, and FC were common. Only IBS, IBS-C, IBS-A/M, and FC were more frequent in women. Finally, FGIDs in Mexico had an increased burden of health care utilization and depression.

Susac's syndrome: an update.

Susacs syndrome is an infrequent neurological disorder characterized by the clinical triad of encephalopathy, hearing loss, and branch retinal artery occlusions. Its pathophysiology is not entirely clear, although it is now thought that it is most probably an immune-mediated endotheliopathy that affects the microvasculature of the brain, retina, and inner ear. An early diagnosis is important as treatment can halt disease progression and prevent permanent disability.

Factors Associated with Health-Related Quality of Life in Mexican Lupus Patients Using the LupusQol.

Introduction Health-related quality of life (HRQOL) is affected by numerous clinical variables, including disease activity, damage, fibromyalgia, depression and anxiety. However, these associations have not yet been described in Mexican patients with systemic lupus erythematosus (SLE). Objective To evaluate the relationship between disease activity, damage, depression and fibromyalgia and HRQOL measured by the LupusQoL-instrument in Mexican patients with SLE. Methods A cross-sectional study was conducted in women fulfilling the 1997 ACR classification criteria for SLE. HRQOL was evaluated using a disease-specific instrument for SLE, the LupusQoL (validated for the Spanish-speaking population). Patients were evaluated clinically to determine the degree of disease activity and damage using the Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) and Systemic Lupus International Collaborating Clinics-Damage Index (SLICC), respectively. Fibromyalgia and depression were assessed using the ACR criteria and the CES-D scale, respectively. The relationship between HRQOL and these variables was measured using Spearman’s rank correlation coefficient and linear regression analysis. Results A total of 138 women with SLE, age 40.3±11 years, disease duration 8.8±6.4 years, with disease activity in 51.4%, depression in 50%, damage in 43% and fibromyalgia in 19.6% were included. Poorer HRQOL correlated with depression (r = -0.61; p< 0.005), fibromyalgia (r = -0.42; p< 0.005), disease activity (r = -0.37; p < 0.005) and damage (r = -0.31; p < 0.005). In the multivariate linear regression analysis, damage (β = -3.756, p<0.005), fibromyalgia (β = -0.920, p<0.005), depression (β = -0.911, p<0.005) and disease activity (β = -0.911, p<0.005) were associated with poor HRQOL. Conclusion SLE disease activity, damage, fibromyalgia and depression were associated with poor HRQOL in our sample of Mexican SLE patients.

Intestinal Dysbiosis and Rheumatoid Arthritis: A Link between Gut Microbiota and the Pathogenesis of Rheumatoid Arthritis

Characterization and understanding of gut microbiota has recently increased representing a wide research field, especially in autoimmune diseases. Gut microbiota is the major source of microbes which might exert beneficial as well as pathogenic effects on human health. Intestinal microbiomes role as mediator of inflammation has only recently emerged. Microbiota has been observed to differ in subjects with early rheumatoid arthritis compared to controls, and this finding has commanded this study as a possible autoimmune process. Studies with intestinal microbiota have shown that rheumatoid arthritis is characterized by an expansion and/or decrease of bacterial groups as compared to controls. In this review, we present evidence linking intestinal dysbiosis with the autoimmune mechanisms involved in the development of rheumatoid arthritis.

AB0499 Bone Mineral Density in Postmenopausal Mexican Women with Systemic Lupus Erythematosus

Background It is accepted that patients with SLE exhibit an increased risk for low BMD and bone fractures; nevertheless, few studies have evaluated bone disorders in Latin American population. It is the first study that has evaluated frequency and correlations of low BMD in postmenopausal mestizo Mexican women with SLE Objectives To determine the frequency of osteoporosis and possible risk factor for low bone mineral density (BMD) in postmenopausal mestizo Latino American women with systemic lupus erythematosus (SLE) Methods A cross-sectional study was conducted among 100 postmenopausal patients with SLE. Patients were evaluated using a questionnaire about the follow variables: age at the time of the study, age at menopause, disease duration, disease activity, damage of the disease, cumulative corticosteroid dose, and history of fracture. Lumbar spine and hip measurements of BMD were performed by dual absorptiometry. Univariate and multivariate statistical analyses were used to assess relationship between risks factor and BMD. Results The mean age was 53.8±9.56 years and the mean SLE duration was 73.2±65 months. The mean BMD of the lumbar spine was 0.944±0.178 g/cm2 and the hip was 0.915±0.135 g/cm2. Osteopenia was present in 63% and osteoporosis in 31%. In the univariate analysis, age at the time of the study and menopause duration were associated with low BMD at the hip while age at the time of the study, menopause duration and damage of the disease were associated with low BMD at the lumbar spine. In the multiple regression analysis, low BMD in lumbar spine and hip were associated only with age (B= -0.0004, P=0.017; B= -0.0006, P= <0.05). Conclusions Osteopenia was found in 63% and osteoporosis in 31%. Risk factor for low BMD in both total hip and lumbar spine in postmenopausal SLE women was age. Disclosure of Interest None declared

Treatment for Gynaecomastia in Men. Experience with the Inferior Periareolar Incision in a Single Third Level Medical Facility

Background: Gynaecomastia is defined as an enlargement of the mammary gland in men. Objective: To evaluate Aesthetic Results of Subdermal Mastectomy by means of Inferior Periareolar Incision. Materials and Methods: Descriptive, cross sectional and prospective study. We evaluate aesthetic results of Subdermal Mastectomy by means of Inferior Periareolar Incision using Analog visual Scale applied by an another Surgeon) and a Questionnaire (Auto Evaluation). Variables: Age, Clinical Symptoms, Evolution time, Complications and Aesthetic Results. Descriptive and Inferencial Statistic was used (Wilcoxon test).

Bone mineral density and vertebral fractures in patients with systemic lupus erythematosus: A systematic review and meta-regression.

Background Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density (BMD) and vertebral fractures (VF) in patients with systemic lupus erythematosus (SLE). Therefore, the objectives of this systematic review and meta-regression were: 1) to compare BMD between SLE patients and healthy controls and 2) to evaluate the relationship between BMD and glucocorticoid therapy and VF in SLE patients. Methods and findings Articles were identified from electronic databases (PubMed, Embase, VHL, SciELO and the Cochrane Library). Prospective longitudinal and cross-sectional studies were considered for review. We evaluated the quality of the evidence included using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence. In total, 38 articles were identified and analyzed (3442 SLE cases and 6198 controls) in the analysis of BMD (9232 women and 408 men). There were significant differences in mean BMD between SLE patients and controls. BMD mean difference in cases/controls: -0.0566 95% CI (-0.071, -0.0439; p = < 0.0001). When only SLE patients were analyzed, the BMD did not significantly differ between patients who had or had not received glucocorticoid (GCT) therapy. 694 SLE patients were included in the analysis of VF (189 with VF vs. 505 without VF). Patients with VF had lower BMD than patients without VF (BMD mean difference without VF/with VF: 0.033 (95%CI: 0.006–0.060); p-value: 0.0156). Conclusions Patients with SLE had lower BMD than healthy controls. Moreover, SLE patients with VF had lower BMD than patients without VF. However, our data did not show that GCT therapy had an impact on BMD.

Aumento de la práctica de higiene de manos secundaria a la capacitación mediante un curso en línea al personal de salud de un hospital de segundo nivel de atención

Las infecciones asociadas a la atención de la salud son consideadas los efectos adversos más frecuentes derivados de la atención ospitalaria. El factor de riesgo identificado con más frecuencia es a contaminación cruzada, desde pacientes u objetos contaminaos hacia otros pacientes, utilizando generalmente como vehículo e transmisión las manos de los profesionales de salud1. A pesar de a evidencia científica, no es posible lograr el apego a la higiene e las manos, por lo que es necesario seguir buscando estrategias ue incidan sobre esta variable para lograr un cambio en la actitud el personal de salud. La Organización Mundial de la Salud (OMS) desarrolló e impleentó en 2005 un programa denominado «Manos limpias salvan idas», una estrategia multimodal con 5 pilares: cambio de sistema, ormación, educación, evaluación, clima institucional de seguriad y retroalimentación, por medio de recordatorios en el sitio de rabajo2. Una de las acciones importantes es el proceso educativo, or lo que el objetivo del estudio fue identificar si existía modificaión del porcentaje en el cumplimiento de la higiene de manos del ersonal de salud secundaria a la capacitación mediante un curso n línea. Se realizó un estudio cuasiexperimental que incluyó a 305 médios y 650 enfermeras de un hospital de segundo nivel de atención n todos los turnos laborales, utilizando como maniobra de interención un curso en línea de higiene de manos de 20 h de duración esarrollado por la División de Innovación Educativa del Instituto exicano del Seguro Social con los contenidos propuestos para apacitación por la OMS. Se utilizó un cuestionario autoaplicable e conocimientos sobre higiene de manos propuesto por la OMS ue consta de 16 reactivos enfocados a la evaluación de conociientos con variables de tipo dicotómico y 9 reactivos de opción últiple. Dicho instrumento se aplicó antes y después del curso n línea. El cumplimiento se definió como una oportunidad para la igiene de las manos mediante el lavado de manos/desinfección de cuerdo con los 5 momentos y fue evaluado mediante observación irecta por 2 observadores, uno de ellos del personal hospitalario apacitado y otro como observador externo. El periodo de segui-

Genital Mycoplasma infection among Mexican women with systemic lupus erythematosus

To assess the prevalence of genital Mycoplasma spp. among women with systemic lupus erythematosus (SLE) and to identify factors associated with such infection.

Efficiency in bracket bonding with the use of pretreatment methods to tooth enamel before acid etching: sodium hypochlorite vs. hydrogen peroxide techniques

Bond failures are produced by the existence of biofilm on the tooth surface. Because biofilm is impermeable, it prevents contact in many areas, reducing the etching effect which selectively dissolves calcified tissues but does not seem to eliminate biofilm from the tooth surface, and thus the bond between the tooth and the bracket is not strong enough. The aim of this study is to compare bracket bonding efficiency with two dental surface pretreatments: sodium hypochlorite vs. hydrogen peroxide techniques. This was a cross-sectional, comparative, in vitro study. Seventy-five premolars extracted for orthodontic purposes were evaluated. They were divided into three groups of 25 teeth and assigned randomly toone of the pretreatment techniques (5.25%sodium hypochlorite or 3.5% hydrogen peroxide) or to a control group. The most efficient pretreatment technique for bonding to brackets was sodium hypochlorite, with an average of 17.15 (kg/F). Significant differences were observed between groups (p=0.0001). The post hoc bond strength test showed statistically significant differences between the sodium hypochlorite technique and the control group (p=0.0001). The sodium hypochlorite technique improves bracket adhesion to tooth enamel.