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OBJECTIVES: To describe the taxonomy of the microbiota in crevicular fluid of primary Sjögren's syndrome (pSS) patients, and evaluate its association with clinical/serological variables, and oral quality of life. METHODS: Observational study that included 48 pSS without diabetes mellitus, no active neoplasia, no antibiotic use in the previous two weeks, and no current active infection. We registered demographics, oral/ocular sicca symptoms, parotid enlargement and anti-Ro/La serology. We assessed the non-stimulated whole salivary flow (NSWSF), the EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), and the Xerostomia-related Quality of Life Scale (XeQoLS). Two periodontists determined the presence of periodontal disease and collected crevicular fluid from 6 teeth using filter paper. Samples were frozen at -86°C until processing. We included 17 sex- and age-matched control subjects. Bacterial DNA was extracted from the crevicular fluid sample using a commercial kit. 16SrRNA V3-V4 region was sequenced using reversible adaptor technology. Sequences were pre-processed and analysed using QIIME2 and phyloseq software programs. Functionality profiles were predicted using the Tax4Fun2 package. RESULTS: PSS patients had more bacteria of the genera Prevotella, Streptococcus, Veillonella, Fusobacterium, and Leptotrichia and fewer bacteria of the genus Selenomonas than controls. The pSS microbiota contained more genes encoding accessory secretory proteins. Microbiota also differed between patients with anti-Ro/La status, parotid gland enlargement, and periodontal disease severity, but did not correlate with NSWSF and XeQoLS. CONCLUSIONS: The crevicular fluid microbiota of pSS patients and controls differed significantly, even in SSP patients depending on their serology, parotid gland enlargement, and periodontal disease status.
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Microbiota , Enfermedades Periodontales , Síndrome de Sjögren , Xerostomía , Humanos , Síndrome de Sjögren/complicaciones , Calidad de VidaRESUMEN
Background and Objectives: Healthcare workers (HCWs) play important roles in mitigating the COVID-19 pandemic and are more likely to become infected with COVID-19. Mexico, among other countries, had a high incidence and prevalence of cases and deaths from this disease. Material and Methods: This retrospective study evaluated the clinical characteristics as well as the geographical distribution of cases, deaths, and active cases of COVID-19 in HCWs and non-HCWs using official information from the Ministry of Health of Mexico. Results: A total of 235,343 cases of COVID-19 were reported in healthcare workers, and 2,094,191 cases were reported in non-healthcare workers. A total of 76.0% of cases in healthcare workers occurred in those who were between 25 and 50 years of age, and 71.4% of deaths occurred in those who were 50 to 69 years of age. Among healthcare workers, the most frequent comorbidities were obesity (15.2%), hypertension (10.9%), and diabetes (6.8%). Nurses were the group with the most cases (39.7%), followed by other healthcare workers (30.6%), physicians (26%), and dentists (1.6%). Physicians were the group with the most deaths (46%), followed by other professionals (30%), nurses (19%), and dentists (3%). Conclusion: These findings are likely the result of healthcare workers in Mexico being at a greater risk of exposure to SARS-CoV-2.
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COVID-19 , Pandemias , Anciano , Personal de Salud , Humanos , México/epidemiología , Estudios Retrospectivos , SARS-CoV-2RESUMEN
Ovarian cancer is the third most frequent gynaecological malignancy worldwide and in Mexico, with a high mortality rate, due to that in many cases its diagnosis is made in advanced stages. Prognosis is important for determining the subtype and the degree of evolution. During lasts years, the management of ovarian cancer has undergone an important evolution with the incorporation of new therapeutic options, which in turn represent an increase in the survival of these patients. We present recommendations for the management of ovarian cancer developed by an expert panel Mexican based on available evidence so far and the characteristics of health care in the country.
El cáncer de ovario es la tercera neoplasia maligna ginecológica más frecuente globalmente y también en México, con una elevada tasa de mortalidad debido a que en muchos casos su diagnóstico se realiza en etapas avanzadas. Para establecer su pronóstico es importante la determinación del subtipo y del grado de evolución. En los últimos años, el manejo del cáncer de ovario ha sufrido una importante evolución con la incorporación de nuevas opciones terapéuticas, que a su vez representan un incremento en la supervivencia de estas pacientes. Se presentan las recomendaciones para el manejo del cáncer de ovario elaboradas por un panel de expertos mexicanos basadas en la evidencia disponible hasta el momento y en las características de la atención sanitaria del país.
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Neoplasias Ováricas , Carcinoma Epitelial de Ovario/tratamiento farmacológico , Humanos , México/epidemiología , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/epidemiologíaRESUMEN
Resumen El cáncer de ovario es la tercera neoplasia maligna ginecológica más frecuente globalmente y también en México, con una elevada tasa de mortalidad debido a que en muchos casos su diagnóstico se realiza en etapas avanzadas. Para establecer su pronóstico es importante la determinación del subtipo y del grado de evolución. En los últimos años, el manejo del cáncer de ovario ha sufrido una importante evolución con la incorporación de nuevas opciones terapéuticas, que a su vez representan un incremento en la supervivencia de estas pacientes. Se presentan las recomendaciones para el manejo del cáncer de ovario elaboradas por un panel de expertos mexicanos basadas en la evidencia disponible hasta el momento y en las características de la atención sanitaria del país.
Abstract Ovarian cancer is the third most frequent gynaecological malignancy worldwide and in Mexico, with a high mortality rate, due to that in many cases its diagnosis is made in advanced stages. Prognosis is important for determining the subtype and the degree of evolution. During lasts years, the management of ovarian cancer has undergone an important evolution with the incorporation of new therapeutic options, which in turn represent an increase in the survival of these patients. We present recommendations for the management of ovarian cancer developed by an expert panel Mexican based on available evidence so far and the characteristics of health care in the country.
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OBJECTIVES: To evaluate the performance of the 2016 ACR-EULAR classification Sjögren's syndrome (SS) criteria for classifying patients with secondary SS. METHODS: We randomly selected 300 patients with systemic lupus erythematosus, rheumatoid arthritis and scleroderma, as well as 50 with primary SS. SS diagnosis was established by two independent rheumatologists and was based on the combination of symptoms, signs, diagnostic tests and medical chart review. We evaluated the fulfillment of the 2002 AECG, 2012 ACR and 2016 ACR/EULAR criteria, and their performance using as the gold standard the clinical diagnosis. RESULTS: We identified 154 patients with a clinical (definitive/probable) SS diagnosis, 95 patients (61.7%) fulfilled the AECG, 96 patients (62.3%) the ACR and 90 (58.4%) the 2016 ACR/EULAR criteria. Among the subset with definitive SS clinical diagnosis (n=99), 83 patients (83.8%) fulfilled the AECG, 77 (77.7%) the ACR and 79 (79.7%) the 2016 ACR/EULAR criteria. The concordance rate between the clinical diagnosis (definitive/probable) and the AECG, ACR and 2016 ACR/ EULAR criteria was κ=0.58, κ=0.55 and κ=0.60, respectively. The 2016 ACR/EULAR criteria showed the best AUCs results (0.87 definitive/probable diagnosis, 0.90 definitive diagnosis), followed by the AECG (0.82 definitive/probable diagnosis, 0.85 definitive diagnosis) and ACR (0.80 definitive/probable diagnosis, 0.79 definitive diagnosis) criteria. As a sensitivity analysis, the results were similar when excluding patients with primary SS. CONCLUSIONS: Our study provides further evidence that the 2016 ACR/EULAR criteria are applicable in the setting of secondary SS.
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Reumatología , Esclerodermia Localizada , Síndrome de Sjögren , Área Bajo la Curva , Humanos , Satisfacción Personal , Síndrome de Sjögren/diagnósticoRESUMEN
OBJECTIVE: To determine the prevalence of SS in a cohort of recent-onset SLE patients and evaluate the clinical and immunological variables that may identify SLE patients prone to develop SS. METHODS: A total of 103 patients participating in a prospective cohort of recent-onset SLE were assessed for fulfilment of the American European Consensus Group criteria for SS using a three-phase approach: screening (European questionnaire, Schirmer-I test and wafer test), confirmation (fluorescein staining test, non-stimulated whole-salivary flow and anti-Ro/La antibodies) and lip biopsy. Anti-Ro/SSA and anti-La/SSB antibodies and RF were measured at entry into the cohort and at SS assessment. RESULTS: Ninety-three females and 10 males were included. Mean age at lupus diagnosis was 25.9 ± 8.9 years, and lupus duration at SS assessment was 30.9 ± 9.1 years. SS was diagnosed in 19 (18.5%) patients, all female, and the patients were older at SLE diagnosis than patients without SS (30.8 ± 9.3 vs 24 ± 8.8 years, P = 0.004). Anti-Ro/SSA antibody was more common in SLE-SS patients (84% vs 55%, P = 0.02, LR + 1.53, 95% CI 1.14, 2.04). In the multivariate analysis, age ≥25 years and anti-Ro/SSA antibodies at SLE diagnosis were identified as predictors of SLE-SS, while the absence of anti-Ro/SSA, anti-La/SSB and RF seems to be protective (LR- 0.14, 95% CI 0.02, 0.95). CONCLUSION: The overlap of SLE and SS occurs in almost one-fifth of SLE patients and presents early during its evolution. SLE onset at age ≥25 years plus the presence of anti-Ro/SSA antibody at diagnosis are useful predictors, while the absence of anti-Ro/SSA, anti-La/SSB and RF identifies patients at lowest risk.
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Anticuerpos Antinucleares/inmunología , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/epidemiología , Síndrome de Sjögren/diagnóstico , Síndrome de Sjögren/epidemiología , Adulto , Edad de Inicio , Estudios de Cohortes , Intervalos de Confianza , Diagnóstico Precoz , Femenino , Humanos , Lupus Eritematoso Sistémico/inmunología , Masculino , Análisis Multivariante , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Medición de Riesgo , Síndrome de Sjögren/inmunología , Adulto JovenRESUMEN
Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are playing an ever increasing role in the treatment of these patients. Excellent results have been achieved in well-selected patients but there is a very steep learning curve when starting a new program. A program for peritoneal surface malignancies in which patients with PC of gastrointestinal or gynecological origin were treated using multimodality therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC was initiated in December 2007 at "Hospital Regional de Alta Especialidad de Oaxaca," Mexico. We present the results of our initial experience. From December 2007 to February 2011, 26 patients were treated with CRS and HIPEC. There were 21 female patients. Most common indication (46%) was recurrent ovarian cancer. Mean duration of surgery was 260 minutes. Mean Peritoneal Cancer Index was 9. Twenty-three (88.5%) patients had a complete cytoreduction. Major morbidity and mortality rates were 19.5 and 3.8 per cent, respectively. Mean hospital stay was 8 days. At a mean follow-up of 20 months, median survival has not been reached. Rigorous preoperative workup, strict selection criteria, and mentoring from an experienced cytoreductive surgeon are mandatory and extremely important when starting a center for PC.
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Carcinoma/tratamiento farmacológico , Carcinoma/cirugía , Quimioterapia del Cáncer por Perfusión Regional/métodos , Hipertermia Inducida , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/cirugía , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/mortalidad , Carcinoma/patología , Terapia Combinada , Femenino , Neoplasias Gastrointestinales/tratamiento farmacológico , Neoplasias Gastrointestinales/mortalidad , Neoplasias Gastrointestinales/patología , Neoplasias Gastrointestinales/cirugía , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , México , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Neoplasias Peritoneales/mortalidad , Neoplasias Peritoneales/patología , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
INTRODUCTION: Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In early clinical stages long-term survival is greater than 80%, while in advanced stages it is less than 50%. In our country there is not a standard management between institutions. GICOM collaborative group under the auspice of different institutions have made the following consensus in order to make recommendations for the management of patients with this type of neoplasm. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of four days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: Screening should be performed women at high risk (diabetics, family history of inherited colon cancer, Lynch S. type II). Endometrial thickness in postmenopausal patients is best evaluated by transvaginal US, a thickness greater than or equal to 5 mm must be evaluated. Women taking tamoxifen should be monitored using this method. Abnormal bleeding in the usual main symptom, all post menopausal women with vaginal bleeding should be evaluated. Diagnosis is made by histerescopy-guided biopsy. Magnetic resonance is the best image method as preoperative evaluation. Frozen section evaluates histologic grade, myometrial invasion, cervical and adnexal involvement. Total abdominal hysterectomy, bilateral salpingo oophorectomy, pelvic and para-aortic lymphadenectomy should be performed except in endometrial histology grades 1 and 2, less than 50% invasion of the myometrium without evidence of disease out of the uterus. Omentectomy should be done in histologies other than endometriod. Surgery should be always performed by a Gynecologic Oncologist or Surgical Oncologist, laparoscopy is an alternative, especially in patients with hypertension and diabetes for being less morbid. Adjuvant treatment after surgery includes radiation therapy to the pelvis, brachytherapy, and chemotherapy. Patients with Stages III and IV should have surgery with intention to achieve optimal cytoreduction because of the impact on survival (51 m vs. 14 m), the treatment of recurrence can be with surgery depending on the pattern of relapse, systemic chemotherapy or hormonal therapy. Follow-up of patients is basically clinical in a regular basis. CONCLUSIONS: Screening programme is only for high risk patients. Multidisciplinary treatment impacts on survival and local control of the disease, including surgery, radiation therapy and chemotherapy, hormonal treatment is reserved to selected cases of recurrence. This is the first attempt of a Mexican Collaborative Group in Gynecology to give recommendations is a special type of neoplasm.
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Carcinoma , Neoplasias Endometriales , Antineoplásicos/uso terapéutico , Carcinoma/diagnóstico , Carcinoma/epidemiología , Carcinoma/patología , Carcinoma/terapia , Quimioterapia Adyuvante , Terapia Combinada , Diagnóstico por Imagen , Neoplasias Endometriales/diagnóstico , Neoplasias Endometriales/epidemiología , Neoplasias Endometriales/patología , Neoplasias Endometriales/terapia , Antagonistas de Estrógenos/efectos adversos , Terapia de Reemplazo de Estrógeno/efectos adversos , Estrógenos/efectos adversos , Medicina Basada en la Evidencia , Femenino , Humanos , Histerectomía/métodos , Laparoscopía , Escisión del Ganglio Linfático , Tamizaje Masivo , México , Estadificación de Neoplasias/métodos , Radioterapia Adyuvante , Factores de Riesgo , Terapia Recuperativa , Tamoxifeno/efectos adversosRESUMEN
Pesticides are used intensively for crop protection in tropical fruit plantations. Assessments of the relative risks posed by pesticides are needed to assist in the development of management plans that minimize ecological impacts. In this study, the risk indicator SYNOPS_2 was used to compare risks to aquatic ecosystems by pesticides commonly used in papaya plantations. Plant interception and spray drift were measured during six applications of three pesticides (chlorothalonil, chloropyrifos, and malathion) using a turbo fan driven sprayer. Plant interception was estimated to be higher (42.6+/-12.7%; p=0.04) in late (8-14 months old) than in early (4 months old) trees (20.1+/-25.3%). Chlorothalonil concentrations of up to 11.0 microg L(-1) were found in water from an adjacent ditch after field application. Concentrations of this pesticide (7.4+/-4.1 microg L(-1)) in runoff water were also significantly (p<0.01) higher than those of malathion (2.4+/-1.9 microg L(-1)) and chlorpyrifos (0.8+/-0.5 microg L(-1)). Good correlation between measured and predicted values (r2=0.56-0.85, p<0.01) showed that SYNOPS_2 is able to describe trends in runoff pollution in papaya plantations. Linear equations were obtained in order to correct numerical disagreement between measured and calculated runoff concentrations. An independent test showed a reasonable agreement between measured chlorothalonil concentrations and the predicted values using the proposed equations. Fifteen pesticides used in papaya cultivation were ranked according to their calculated chronic biological risk index. Pesticides with the highest risk index for non-target organisms were: chlorothalonil for algae, lambda cyahalotrin for Daphnia and fish, and malathion for earthworms. Chlorothalonil was the pesticide with the highest exposure level in water and therefore represents a high risk for aquatic life. Results show that SYNOPS_2 can be used as a pesticide risk indicator on papaya and possibly other tropical fruit plantations.
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Carica , Contaminantes Ambientales/análisis , Plaguicidas/análisis , Contaminación Química del Agua/análisis , Monitoreo del Ambiente , Contaminantes Ambientales/química , Contaminantes Ambientales/toxicidad , Modelos Químicos , Nitrilos/análisis , Nitrilos/química , Nitrilos/toxicidad , Plaguicidas/química , Plaguicidas/toxicidad , Medición de Riesgo , Agua/química , Movimientos del AguaRESUMEN
OBJECTIVE: To establish the association between oral pathology and pneumonia in patients with systemic lupus erythematosus (SLE). METHODS: Thirty women with SLE, consecutively admitted for hospitalization because of pneumonia, and 60 noninfected controls with SLE (30 hospitalized and 30 ambulatory), matched by age, sex, and date of hospitalization to the cases, were enrolled. At entry, information about sociodemographic variables, traditional infection risk factors, SLE characteristics, treatment, and comorbidity was gathered by medical chart review. In every patient, one rheumatologist performed a complete physical examination, and assessed disease activity and chronic damage using validated indices; and one periodontist performed a standardized oral health evaluation including the use of 6 international oral health indices. RESULTS: Twenty-eight patients with community-acquired and 2 patients with nosocomial pneumonias were included. Age of the total study population was 38.8 +/- 14.6 years, mean number of SLE criteria 6.3 +/-1.95, and disease duration 6.6 +/- 7.2 years, with no differences among the 3 groups. Cases had greater disease activity and damage, and were taking higher doses of prednisone than ambulatory controls (p Asunto(s)
Caries Dental/etiología
, Lupus Eritematoso Sistémico/complicaciones
, Neumonía/etiología
, Adulto
, Antiinflamatorios/uso terapéutico
, Estudios de Casos y Controles
, Femenino
, Humanos
, Lupus Eritematoso Sistémico/tratamiento farmacológico
, Persona de Mediana Edad
, Análisis Multivariante
, Higiene Bucal/efectos adversos
, Prednisona/uso terapéutico
, Factores de Riesgo
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En este trabajo se estudia un Centro de Salud en Bogotá desde sus características generales, factores condicionantes del área de influencia, situación de salud del área de influencia, prestación de servicios de salud buscando la cobertura real de Centro de Salud y la calidad de la prestación de sus servicios. Para esto se estudió la infraestructura del Centro de Salud, se realizó una encuesta en la comunidad y se estudiaron muestras significativas de historias clínicas de 3 motivos de consulta al Centro de Salud. Se encontró una infraestructura adecuada para la prestación de servicios, un bajo impacto del centro en la comunidad, con una calidad de atención deficiente en contraposición a un alto costo de consulta, y por último incoordinación entre el nivel central y la unidad operativa estudiada. Si se asume un homogéneo comportamiento de las unidades operativas concluimos que la estrategia de Atención Primaria de Salud en Bogotá no esta funcionando