Publications by authors named "Socorro Méndez Martínez"

20 Publications

  • Page 1 of 1

Human mesenchymal stem cells for the management of systemic sclerosis. Systematic review.

Autoimmun Rev 2021 Apr 18;20(6):102831. Epub 2021 Apr 18.

Research Institute, Fundación Universitaria De Ciencias De La Salud, University of Health Sciences, Bogota, Colombia.

Introduction: Sistemic Sclerosis (SSc) is a heterogeneous autoimmune disease with a high rate of progression and therapeutic failure, and treatment is a challenge, new therapeutic proposals being needed, being mesenchymal stem cells (MSCs) considered as alternative therapy for SSc for its immunomodulatory capacity. We evaluated the efficacy and safety of human MSC (hMSC) in patients with SSc through a systematic literature review (SLR).

Methods: SLR (PRISMA guideline) on MEDLINE/OVID, LILACS, EMBASE, and Cochrane/OVID bases (until July 2020, without limits). All types of clinical studies were considered: patients ≥18 years old with SSc and treatment with hMSC.

Exclusion Criteria: animal models, autologous/allogenic hematopoietic stem cell transplants, narrative reviews, letters to the editor. MeSH and "Key word" terms were used. The level of evidence and the quality rating were rated [Joanna Briggs Institute (JBI) lists]. Registration in PROSPERO repository (ID CRD42020185245) The Synthesis Without Meta-analysis (SWiM) guideline was followed.

Results: We initially identified 508 articles, of which 11 were finally included (8 case series and 3 case reports). The 11 articles included 101 patients (85 female, age range 18-75 years). The level of evidence was mostly 4 (JBI); the quality of evidence was met (≥50% of JBI items). SWiM showed that vascular skin involvement (digital ulcers, necrosis, and gangrene) and associated pain were the predominant outcomes, while improvements were found in almost all cases. One patient died in the first month, and the frequency of complications was low. Expanded hMSCs were used in 24 patients and other cell sources in the remaining patients.

Conclusion: There is too little reported data to reach definite conclusions about the use of hMSC in SSc. Further studies with better epidemiological designs are needed to evaluate the benefit of hMSCs in SSc patients.
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http://dx.doi.org/10.1016/j.autrev.2021.102831DOI Listing
April 2021

A Retrospective Analysis of Longitudinal Changes in Bone Mineral Density in Women with Systemic Lupus Erythematosus.

Calcif Tissue Int 2021 Apr 17. Epub 2021 Apr 17.

Research in Health Coordination, Mexican Social Security Institute, Puebla, Puebla, Mexico.

Most prospective studies of bone mineral density (BMD) in systemic lupus erythematosus (SLE) patients have been of relatively short duration, with a maximum of 6 years. To describe long-term changes in BMD in women with SLE and identify risk factors associated with BMD loss. We retrospectively evaluated 132 adult Mexican-Mestizo women with SLE who underwent dual X-ray absorptiometry (DXA). Demographic and clinical data were collected and BMD at the lumbar spine (L1-L4) and total hip were collected at baseline and during the follow up. At baseline, the mean age of participants was 43.4 ± 12.5 years, 50.8% had osteopenia and 11% osteoporosis. The median follow-up was 13 (IQR 10.2-14.0) years. During follow up, 79% of patients used glucocorticoid (GCT). The mean percentage of changes in BMD during follow up were: - 14.03 ± 11.25% (- 1.49%/year) at the lumbar spine, and - 15.77 ± 11.57% (- 1.78%/year) at the total hip, with significant changes (p < 0.001 for both comparisons). Multivariate analysis showed older age, GCT use at baseline, and transition to the menopause during the follow-up were significantly associated with greater reductions in BMD. This retrospective longitudinal study found significant BMD loss at the lumbar spine and hip. Older age, menopausal transition and GCT use were independently associated with BMD decline in women with SLE.
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http://dx.doi.org/10.1007/s00223-021-00845-0DOI Listing
April 2021

Medication adherence is influenced by resilience in patients with systemic lupus erythematosus.

Lupus 2021 Apr 1:9612033211004722. Epub 2021 Apr 1.

Research Coordination, Mexican Social Security Institute, Puebla. México.

Objective: Evidence on the relationship between resilience and medication adherence in systemic lupus erythematosus (SLE) patients is lacking. We aimed to examine the impact of resilience on medication adherence in SLE patients.

Method: In a cross-sectional analysis SLE outpatients were assessed for resilience (Connor-Davison Resilience Scale, CD-RISC), depressive symptoms (CES-D) and medication adherence (Compliance Questionnaire for Rheumatology [CQR]). The disease activity index (mexSLEDAI) and damage (SLICC Damage Index) were administered. Factors independently associated with adherence were identified using multivariate logistic regression.

Results: Of the 157 patients, 152 (96.8%) were female with a median age of 45.9 (IQR: 39.0-55.5) years and disease duration of 14 (IQR: 10.0-19.0) years. Medication adherence (CQR ≥80%) and depressive symptoms were found in 74.5% and 43.9% of patients, respectively. Adherent patients had a lower CES-D score and a higher CD-RISC score. In the multivariate analysis adjusting for demographic and clinical confounders, resilience and older age protected against non-adherence (OR 0.96, [95% CI 0.94-0.99] and OR 0.96 [95% CI 0.93-0.98], respectively).

Conclusion: In SLE patients, resilience and older age, which possibly associated with better medication adherence, may protect against non-adherence.
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http://dx.doi.org/10.1177/09612033211004722DOI Listing
April 2021

[Breastfeeding and infant feeding in the first level of attention].

Rev Med Inst Mex Seguro Soc 2019 Dec 30;57(6):387-394. Epub 2019 Dec 30.

Instituto Mexicano del Seguro Social, Órgano de Operación Administrativa Desconcentrada Estatal Puebla, Coordinación Auxiliar Médica de Investigación en Salud. Puebla, Puebla, México

Breastfeeding is one of the oldest and most useful practices for human race. It is crucial for optimal newborn development and yet the stigma built around it has proven to be devastating for its implementation over the years. For the past few decades, numerous studies have been conducted to shed light on the countless benefits of breastfeeding and to cast off the taboo around it. In 1991 the World Health Organization, together with the United Nations International Children's Emergency Fund, created the Baby-Friendly Hospital Initiative (BFHI) with the aim of protecting, promoting and strengthening breastfeeding in hospitals and health centers, through the implementation of . There are a number of requirements that must be fulfilled in order to implement this initiative. However, due to local and regional characteristics of each health care unit, a certain degree of adequacy of these steps is required for its implementation. Therefore, at the (Mexican Institute for Social Security), seven steps and three annexes have been adapted for their implementation in the first level health care units of this institution.
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December 2019

Comparing cytology, colposcopy and human papillomavirus cervical intraepithelial lesion screening methods in women with systemic lupus erythematosus.

Lupus 2020 Aug 5;29(9):1060-1066. Epub 2020 Jun 5.

Gynaecology Service, Hospital Universitario de Puebla, México.

Objective: To compare the performance of cytology, colposcopy and human papillomavirus in detecting cervical intraepithelial lesions in women with systemic lupus erythematosus.

Methods: Papanicolaou smears (normal, low-grade squamous intraepithelial lesion, high grade squamous intraepithelial lesion), colposcopy findings, human papillomavirus and co-testing (Papanicolaou smear + human papillomavirus) were compared with cervical biopsy findings in women with systemic lupus erythematosus. Sensitivity, specificity, false-positive and false-negative rates, positive and negative predictive values and likelihood ratios of cytologic smears, colposcopy findings, human papillomavirus and co-testing were determined.

Results: Cytology and colposcopy were performed in 170 systemic lupus erythematosus women (mean age and disease duration of 43.7±12.1 years and 9.7±5.3 years, respectively) and biopsies were performed in 55 patients (38.2% normal, 60.0% low-grade squamous intraepithelial lesion and 1.8% high grade squamous intraepithelial lesion). The sensitivity, specificity, positive predictive value and negative predictive value of cytology were 14.7% (95% confidence interval 5.5-31.8%), 95.2% (95% confidence interval 74.1-99.7%), 83.3% (95% confidence interval 36.4-99.1%) and 40.8% (95% confidence interval 27.3-55.7%), respectively. The sensitivity, specificity and positive predictive value of colposcopy findings were 100.0% (95% confidence interval 87.3-100.0%), 0.0% (95% confidence interval 0.0-19.2%) and 61.8% (95% confidence interval 47.7-74.2%), respectively. The sensitivity and specificity of co-testing were 8.0% (95% confidence interval 1.3-27.5%) and 100.0% (95% confidence interval 71.6-100.0%). The positive predictive value and negative predictive values were 100.0% (95% confidence interval 19.7-100.0%) and 36.1% (95% confidence interval 33.5-38.8%), respectively.

Conclusions: In systemic lupus erythematosus patients, colposcopy impressions were more sensitive than cytology and co-testing. However, cytology and co-testing were the most specific tests. The results should be interpreted with caution due to the small sample size.
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http://dx.doi.org/10.1177/0961203320931176DOI Listing
August 2020

[Therapeutic options for the management of severe Covid-19: A rheumatology perspective].

Reumatol Clin 2020 May 16. Epub 2020 May 16.

Coordinación de Investigación en Salud, Delegación Puebla, Instituto Mexicano del Seguro Social, Puebla, México.

The novel SARS-CoV-2 human coronavirus in Wuhan, China, has triggered a worldwide respiratory disease outbreak (COVID-19). Acute respiratory distress syndrome (ARDS), multiorgan dysfunction and thrombotic events are among the leading causes of death in critically ill patients with COVID-19. The elevated inflammatory cytokines suggest that a "cytokine storm", also known as cytokine release syndrome (CRS), may play a major role in the pathology of COVID-19. In addition to anti-viral therapy and supportive treatment in critically ill patients, unique medications for this condition are also under investigation. Here we reviewed therapeutic options, including the antibody therapy that might be an immediate strategy for SARS-CoV-2 therapy.
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http://dx.doi.org/10.1016/j.reuma.2020.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229930PMC
May 2020

The Melanocortin 4 Receptor p.Ile269Asn Mutation Is Associated with Childhood and Adult Obesity in Mexicans.

J Clin Endocrinol Metab 2020 04;105(4)

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.

Context: Rare partial/complete loss-of-function mutations in the melanocortin-4 receptor (MC4R) gene are the most common cause of Mendelian obesity in European populations, but their contribution to obesity in the Mexican population is unclear.

Objective And Design: We investigated whether deleterious mutations in MC4R contribute to obesity in Mexican children and adults.

Results: We provide evidence that the MC4R p.Ile269Asn (rs79783591) mutation may have arisen in modern human populations from a founder event in native Mexicans. The MC4R Isoleucine 269 is perfectly conserved across 184 species, which suggests a critical role for the amino acid in MC4R activity. Four in silico tools (SIFT, PolyPhen-2, CADD, MutPred2) predicted a deleterious impact of the p.Ile269Asn substitution on MC4R function. The MC4R p.Ile269Asn mutation was associated with childhood (Ncontrols = 952, Ncases = 661, odds ratio (OR) = 3.06, 95% confidence interval (95%CI) [1.94-4.85]) and adult obesity (Ncontrols = 1445, Ncases = 2,487, OR = 2.58, 95%CI [1.52-4.39]). The frequency of the MC4R p.Ile269Asn mutation ranged from 0.52 to 0.59% and 1.53 to 1.59% in children and adults with normal weight and obesity, respectively. The MC4R p.Ile269Asn mutation co-segregated perfectly with obesity in 5 multigenerational Mexican pedigrees. While adults with obesity carrying the p.Ile269Asn mutation had higher BMI values than noncarriers, this trend was not observed in children. The MC4R p.Ile269Asn mutation accounted for a population attributable risk of 1.28% and 0.68% for childhood and adult obesity, respectively, in the Mexican population.

Conclusion: The MC4R p.Ile269Asn mutation may have emerged as a founder mutation in native Mexicans and is associated with childhood and adult obesity in the modern Mexican population.
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http://dx.doi.org/10.1210/clinem/dgz276DOI Listing
April 2020

Helicobacter pylori infection and gastroduodenal lesions in patients with systemic lupus erythematosus.

Clin Rheumatol 2020 Feb 12;39(2):463-469. Epub 2019 Nov 12.

Puebla Research Coordination, Highly Specialized Medical Unit, UMAE CMNMAC, Instituto Mexicano del Seguro Social, Puebla, México.

Objective: The aim of this study was to determine the frequency of Helicobacter pylori in SLE patients and to compare clinical characteristics and gastroduodenal lesions in patients with and without H. pylori infection.

Methods: Adult SLE patients were selected and subjected to endoscopy. Gastroduodenal lesions were examined by endoscopy and biopsy (antrum and corpus). Biopsies were evaluated by hematoxylin and eosin and Giemsa staining. Immunochromatographic membrane-based assay using amplification was used to test for H. pylori antigen (coproantigen) in stool samples in all participants. Clinical characteristics and gastroduodenal lesions were compared between patients with and without H. pylori infection.

Results: A total of 118 SLE patients were included (mean age 44.7 ± 11.7 years, mean disease duration 11.6 ± 6.0 years), of whom 101 (85.6%) were receiving non-steroidal anti-inflammatory drugs (NSAIDs). The coproantigen test was positive in 32 (27.1%) patients. H. pylori was present in twenty six patients (22.0%) in the gastric biopsy. The frequency of gastric erosions and gastric ulcers were 55.1% and 0.8%, respectively. Gastric erosions were less frequent in SLE patients with H. pylori infection than those without H. pylori (43.5.7% vs. 62.5%; p = 0.04). The age, disease duration, disease activity, chronic damage, gastroprotective drugs, and immunosuppressive therapy did not differ between the two groups.

Conclusions: We found a high frequency of H. pylori infection in SLE patients. The severity of SLE and reception of gastroprotective therapy do not seem to be related to H. pylori infection. Immunosuppressive therapy may not be protective against H. pylori infection in SLE patients.Key Points• In patients with systemic lupus erythematosus (SLE), the frequency of Helicobacter pylori infection was 39% and gastric erosions were frequent.• Disease activity, chronic damage, gastroprotective drugs, and immunosuppressive therapy may not affect the prevalence of H. pylori infection in SLE patients.
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http://dx.doi.org/10.1007/s10067-019-04805-wDOI Listing
February 2020

25-Hydroxyvitamin D concentrations and risk of metabolic syndrome in systemic lupus erythematosus women.

Int J Rheum Dis 2019 Nov 9;22(11):2067-2072. Epub 2019 Oct 9.

Laboratorios Clínicos de Puebla, Puebla, Mexico.

Objective: A protective function of vitamin D in metabolic syndrome (MetS) has been described. The objective of the present study was to examine the relationship between serum 25-hydroxyvitamin D (25(OH)D) concentrations and MetS in non-diabetic systemic lupus erythematosus (SLE) women.

Methods: Cross-sectional analyses of the relationship between concentrations of 25(OH)D, MetS, and its components were made in 160 non-diabetic SLE women. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria. Serum 25(OH)D was measured by chemiluminescent immunoassay. Serum 25(OH)D concentrations were categorized into quartiles (<16.6, 16.6-21.1, 21.2-26.3, ≥26.4 ng/mL).

Results: A total of 79 (49.3%) SLE women had MetS. Without adjusting for body mass index (BMI) or smoking, the odds of having MetS decreased according to increasing quartiles of 25(OH)D concentrations (P for trend = .03). The odds ratio (OR) of having MetS was 0.4 (95% confidence interval: 0.2-0.9, P = .04) for the highest vs the lowest quartile of 25(OH)D concentrations when adjusted by age. The crude OR of having elevated hypertriglyceridemia decreased according to increasing quartiles of 25(OH)D concentrations (P for trend = .036). However, further adjustments for BMI and smoking removed the inverse association between 25(OH)D concentrations and MetS and its individual components.

Conclusion: In non-diabetic SLE women with mild activity, 25(OH)D concentrations are not associated with MetS and its components.
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http://dx.doi.org/10.1111/1756-185X.13715DOI Listing
November 2019

Systemic lupus erythematosus and hypertension.

Autoimmun Rev 2019 Oct 12;18(10):102371. Epub 2019 Aug 12.

Department of Autoimmune Disease, Hospital Clinic, Barcelona, Spain. Electronic address:

Systemic lupus erythematosus (SLE) is associated with a high burden of cardiovascular disease (CVD), which is in part imputed to classical vascular risk factors such as hypertension. Hypertension is frequent among patients with SLE and studies show it is more prevalent in SLE patients than in people without SLE. Despite the high frequency of hypertension in SLE patients, the pathophysiological mechanisms underlying the development of hypertension remain poorly understood. 24-h ambulatory blood pressure monitoring has emerged as a valuable tool in determining blood pressure (BP) in SLE patients in whom hypertension has been associated with damage accrual, stroke and cognitive dysfunction. Although prevalent, current guidelines neglect the specific management of hypertension in SLE patients in their recommendations. This review discusses the mechanisms that may lead to hypertension and the literature evaluating hypertension screening and management in SLE patients.
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http://dx.doi.org/10.1016/j.autrev.2019.102371DOI Listing
October 2019

Functional gastrointestinal disorders in women with systemic lupus erythematosus: A case-control study.

Neurogastroenterol Motil 2019 11 1;31(11):e13693. Epub 2019 Aug 1.

Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Investigación en Medicina Experimental, Facultad de Medicina-Universidad Nacional Autónoma de México (UNAM)-Hospital General de México, Dr. Eduardo Liceaga., Mexico City, México.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystemic involvement. Gastrointestinal (GI) manifestations are frequent but functional gastrointestinal disorders (FGIDs) have scarcely been studied in SLE. To determine the prevalence of FGIDs and their potential risk factors in SLE female patients vs controls.

Methods: Systemic lupus erythematosus patients meeting the American College of Rheumatology (ACR) criteria and controls completed the Rome III questionnaire for FGIDs and a structured interview to assess sociodemographic, clinical, and treatment variables after excluding organic GI diseases. Logistic regression was used to determine risk factors (ie, alcohol drinking, medications) for FGIDs.

Key Results: Responders included 113 SLE patients and 122 age-matched controls. The presence of at least one FGIDs was higher in SLE (73.4%) vs controls (54.1%), P = .003. The most frequent FGIDs in SLE patients were nausea and vomiting disorders (NVD), belching disorders, globus, anorectal pain, functional heartburn (FH), and functional bloating (FB). After adjustment for confounding variables, SLE was associated with NVD (OR: 7.1, 95% CI: 2.7-19.1) globus (3.5, 1.3-9.3), anorectal pain (3.4, 1.4-8.4), and FH (2.5, 1.5-4.4). The simultaneous presence of >1 FGID was more common in SLE patients than controls (69.8% vs 31.8%). Glucocorticoids (5.2, 1.3-19.9) and non-steroidal anti-inflammatory drugs (NSAIDs; 3.0, 1.1-8.0) were associated with any FGID in SLE patients while alcohol drinking with gallbladder/sphincter of Oddi disorders 7.4 (1.1-47.3).

Conclusions And Inferences: Functional gastrointestinal disorders are more frequent in SLE patients compared with controls. Medication that may alter gastrointestinal homeostasis, such as glucocorticoids and NSAIDs, are potential risk factors for FGIDs in SLE.
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http://dx.doi.org/10.1111/nmo.13693DOI Listing
November 2019

Associations between resilience and sociodemographic factors and depressive symptoms in women with systemic lupus erythematosus.

J Psychosom Res 2019 07 9;122:39-42. Epub 2019 May 9.

Puebla Research Coordination, High-Specialty Medical Unit, Specialty Hospital of Puebla, Instituto Mexicano del Seguro Social, Puebla, Mexico.

Objective: To compare resilience in women with SLE and healthy women and determine whether sociodemographic factors and depressive symptoms were associated with resilience in patients with SLE.

Methods: This was a cross-sectional study. Participants were 123 women with SLE according to the ACR criteria and 132 age-matched healthy women (median = 45 (IQR = 34-54) years). Scales administered were: SLEDAI-2 K for disease activity, Graffar method, SLICC damage index, Center for Epidemiologic Studies Depression Scale, and the Spanish version of the Resilience Scale of Wagnild and Young. The statistical analysis was made using the Student t, Mann Whitney, Chi-square, and Spearman's Rho tests and multivariate analysis with a generalized linear model (GLM). Statistical significance was set as p < .05.

Results: There were no differences in resilience scores between women with SLE and healthy women (median = 80, IQR = 75-87 vs. median = 80, IQR = 74-86.75, p = .38), although patients with SLE had higher self-efficacy scores (median = 47 IQR = 43-50 vs. median = 45, IQR = 42-48, p = .002) and depressive symptoms (median = 10, IQR = 5-18 vs. median = 8, IQR = 5-18, p = .01). The overall resilience score correlated with depressive symptoms (r = -0.537, p < .01). The GLM showed no association between sociodemographic factors and resilience in patients with SLE.

Conclusions: Resilience did not differ between women with SLE and healthy women. In patients with SLE, depressive symptoms may influence resilience and its domains, but sociodemographic factors do not.

Public Health Significance Statement: The results suggest that resilience was similar between females with systemic lupus erythematosus (SLE) and age-matched healthy women. Depressive symptoms correlated negatively with resilience in patients with SLE. Sociodemographic factors were not associated with resilience in patients with SLE.
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http://dx.doi.org/10.1016/j.jpsychores.2019.05.002DOI Listing
July 2019

The Role of Circulating Regulatory T Cell Levels on Subclinical Atherosclerosis and Cardiovascular Risk Factors in Women with Systemic Lupus Erythematosus.

Mediators Inflamm 2018 18;2018:3271572. Epub 2018 Dec 18.

Laboratorios Clínicos de Puebla, Puebla, Mexico.

The increase in cardiovascular disease (CVD) in patients with systemic lupus erythematosus (SLE) is not fully explained by traditional CVD risk factors. Regulatory T cells (Treg cells) are considered atheroprotective. We investigated the relationship between the absolute number of different phenotypes of Treg cells and abnormal carotid intima-media thickness (IMT) in women with SLE. Sixty-six women with SLE with no history of CV disease were included. Carotid IMT was quantified by ultrasound. Abnormal carotid IMT was defined as ≥0.8 mm and two groups were compared according to this definition. Flow cytometry was used to analyze Foxp3 and Helios expression in peripheral blood CD4 T cells. A significantly higher level of absolute CD4+CD25+FoxP3 T cells was present in patients with abnormal carotid IMT compared with those without (1.795 ± 4.182 cells/l vs. 0.274 ± 0.784 cells/l; = 0.003). However, no correlations were found between any Treg cell phenotypes and carotid IMT. Only the absolute number of CD4+CD45RA+FoxP3 T cells was significantly decreased in SLE patients with low HDL cholesterol compared with those with normal HDL cholesterol (0.609 ± 2.362 cells/l vs. 1.802 ± 4.647 cells/l; = 0.009 and 15.358 ± 11.608 cells/l vs. 28.274 ± 34.139; = 0.012, respectively). In conclusion, in SLE women, diminished levels of Treg cells based on flow cytometry were not a good indicator of abnormal carotid IMT.
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http://dx.doi.org/10.1155/2018/3271572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312616PMC
May 2019

Clinical relevance of P-glycoprotein activity on peripheral blood mononuclear cells and polymorphonuclear neutrophils to methotrexate in systemic lupus erythematosus patients.

Clin Rheumatol 2017 Oct 14;36(10):2267-2272. Epub 2017 Jun 14.

Laboratorios Clínicos de Puebla, Puebla, México.

To elucidate the relationship between P-glycoprotein activity on peripheral blood leukocytes of systemic lupus erythematosus (SLE) patients with lupus arthritis and the clinical response to methotrexate. An observational study was made in patients with SLE according to ACR criteria 1997 who had arthralgia and arthritis and received methotrexate for ≥3 months. Methotrexate responders and non-responders were compared according to the Clinical Disease Activity Index. Mononuclear cells and polymorphonuclear neutrophils were isolated from SLE patients and P-glycoprotein expression was measured using the relative fluorescence index and percentage of positive cells. The chi-square test was used to compare P-glycoprotein activity between responders and non-responders. Thirty-two patients with a mean age of 45.4 ± 10.7 years were included: 34.4% had a response to methotrexate and 65.6% did not. Mean relative fluorescence units of both mononuclear cells and polymorphonuclear neutrophils were significantly lower in patients with a good response (7.0 ± 4.3 vs. 9.6 ± 3.8; p = 0.041 and 4.2 ± 3.5 vs. 7.6 ± 4.0; p = 0.004). The prevalence of low fluorescence levels (<6 relative fluorescence units), signifying higher P-glycoprotein activity of both mononuclear cells and polymorphonuclear neutrophils, was higher in methotrexate responders than in non-responders (27.3 vs. 4.8%; p = 0.10 and 81.8 vs. 23.8%; p = 0.003, respectively). In SLE patients with joint involvement treated with methotrexate, P-glycoprotein activity was higher in responders to methotrexate than in non-responders. Further studies are required to determine the mechanisms behind this finding and whether P-glycoprotein activity mediates alterations in methotrexate efficacy.
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http://dx.doi.org/10.1007/s10067-017-3728-0DOI Listing
October 2017

Incidence of Vertebral Fractures in Women with Systemic Lupus Erythematosus After 8 Years of Follow-Up.

Calcif Tissue Int 2017 09 15;101(3):291-299. Epub 2017 May 15.

Department of Autoimmune Diseases, Hospital Clinic, Catalonia, Spain.

The aim of this study was to evaluate possible associations between potential risk factors and the occurrence of established vertebral fractures (VF) in Mexican patients with systemic lupus erythematosus (SLE). Consecutive patients with SLE were enrolled in a prospective, observational study from 2006 to 2015. Information on potential risk factors, including demographics, clinical data, and bone mineral density (BMD) at the lumbar spine and hip on dual-energy X-ray absorptiometry was collected at baseline and follow-up. Semiquantitative analysis was used to determine incident VF on lateral thoracic and lumbar radiographs, defined as any vertebral body graded normal at baseline and at least mildly deformed (20-25% reduction or more in any vertebral height) during follow-up. Differences in baseline characteristics were assessed in patients with and without new radiographic VF. Of 110 SLE patients included, with a median follow-up of 8 (IQR 8-9) years, 22 (20%) had radiographic VF at baseline; 35 (32%) patients had a new VF. The annual incidence rate of new morphometric VF was 3.5 (95% CI 2.4-4.91) per 100 patient/years. Most fractures were mild or moderate and biconcave shaped. Incident VF were significantly associated with baseline BMD at the total hip and longer disease duration. Cumulative glucocorticoid dose, postmenopausal status, and previous prevalent VF were not associated with VF. In this SLE cohort in daily clinical practice, new VF were frequently present in SLE patients, especially those with longer disease duration and low-hip BMD.
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http://dx.doi.org/10.1007/s00223-017-0286-zDOI Listing
September 2017

Genital Mycoplasma infection among Mexican women with systemic lupus erythematosus.

Int J Gynaecol Obstet 2017 Jul 25;138(1):17-22. Epub 2017 Apr 25.

Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain.

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

Methods: A cross-sectional study was conducted among patients with SLE and healthy women who attended a hospital in Puebla, Mexico, between July 29, 2014, and January 4, 2015. All participants were aged 18 years or older and sexually active. A structured interview assessed sociodemographic, obstetric, gynecologic, and clinical characteristics. Disease activity was evaluated using the Mexican SLE Disease Activity Index. Polymerase chain reaction was used to detect the presence of Mycoplasma spp. in genital samples.

Results: Ureaplasma urealyticum was the only genital mycoplasma detected; it was present in 32 (24.6%) of 130 patients with SLE and 12 (12.8%) of 94 healthy women. Patients with SLE had increased odds of infection (odds ratio 2.120, 95% confidence interval 1.046-4.296). Among patients with SLE, multiparity was more common in those with U. urealyticum infection (P=0.043).

Conclusion: One-quarter of women with SLE had genital infection with U. urealyticum. An association was found between infection and multiparity among women with SLE.
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http://dx.doi.org/10.1002/ijgo.12154DOI Listing
July 2017

[Down syndrome and heart block secondary to neonatal lupus].

Rev Med Inst Mex Seguro Soc 2017 Jan-Feb;55(1):128-132

Departamento de Cardiología Pediátrica, Hospital General Regional 36, Instituto Mexicano del Seguro Social, Puebla, Puebla, México.

In Down syndrome, so far, has not been reported it's association with congenital heart block, this entity is rare and occurred in only 1% of mothers who have systemic lupus erythematosus, the presence of anti-Ro antibodies cross the placenta presenting neonatal lupus with skin lesions and congenital heart block, bradycardia, which is why we describe the following case. This is a new male end product of asymptomatic young mother, but serological birth with stigmata of Down syndrome, birth presents congenital bradycardia rare manifestation abnormalities, but common in children of mothers with lupus are initiated study protocol, realizing you including laboratory tests and immunological studies cabinet as electrocardiogram and echocardiogram, which gave tone to take the mother immunological studies, being positive antiRo. We concluded that the risk of heart block in a patient with Down syndrome is the same as for the general population.
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August 2017

[Serum levels of vitamin D in systemic lupus erythematosus patients (SLE) and their relationship with disease activity: longitudinal study].

Gac Med Mex 2016 Oct;152(Suppl 2):32-37

Unidad de Investigación de Enfermedades Autoinmunes Sistémicas, Hospital General Regional No. 36, IMSS, Puebla, Pue., México.

Objective: To determine changes over time of serum levels of 25-hydroxy vitamin D (25(OH)D) in Mexican patients with SLE and their relationship with disease activity.

Materials And Methods: Longitudinal and observational study. Women with SLE were included. Serum levels of 25(OH)D were measured at baseline and after two years; the disease activity was measured with MEX-SLEDAI. Patients with initial suboptimal levels of 25(OH)D received supplements or increased doses of calcitriol.

Results: 105 women with SLE were included, mean age 49.4 ± 11 years. Serum levels of 25(OH)D were higher at two years (baseline 20 ± 6.8 vs. follow-up 22.7 ± 7.7; p = < 0.001). There were no differences between disease activity scores at baseline and two years (baseline 1.7 ± 1.9 vs. follow-up 1.1 ± 1.7; p = 0.7). Serum levels of 25(OH)D did not correlate with disease activity during the follow up, p = 0.7. No correlation was found between changes in MEX-SLEDAI scores and serum levels of 25(OH)D, p = 0.87.

Conclusion: Mexican women with SLE had increased serum levels of 25(OH)D. No correlation between serum levels of 25(OH)D and disease activity was found.
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October 2016

The epidemiology of functional gastrointestinal disorders in Mexico: a population-based study.

Gastroenterol Res Pract 2012 19;2012:606174. Epub 2012 Mar 19.

Puebla Research Coordination, Instituto Mexicano del Seguro Social, CP 72000 Puebla-PUE, Mexico.

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.
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http://dx.doi.org/10.1155/2012/606174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313569PMC
August 2012