Update of the guidelines for the pharmacological treatment of rheumatoid arthritis by the Mexican College of Rheumatology 2023.

OBJECTIVE: To develop updated guidelines for the pharmacological management of rheumatoid arthritis (RA). METHODS: A group of experts representative of different geographical regions and various medical services catering to the Mexican population with RA was formed. Questions based on Population, Intervention, Comparison, and Outcome (PICO) were developed, deemed clinically relevant. These questions were answered based on the results of a recent systematic literature review (SLR), and the evidence's validity was assessed using the GRADE system, considered a standard for these purposes. Subsequently, the expert group reached consensus on the direction and strength of recommendations through a multi-stage voting process. RESULTS: The updated guidelines for RA treatment stratify various therapeutic options, including different classes of DMARDs (conventional, biologicals, and JAK inhibitors), as well as NSAIDs, glucocorticoids, and analgesics. By consensus, it establishes the use of these in different subpopulations of interest among RA patients and addresses aspects related to vaccination, COVID-19, surgery, pregnancy and lactation, and others. CONCLUSIONS: This update of the Mexican guidelines for the pharmacological treatment of RA provides reference points for evidence-based decision-making, recommending patient participation in joint decision-making to achieve the greatest benefit for our patients. It also establishes recommendations for managing a variety of relevant conditions affecting our patients.

Termination of pregnancy in lupus nephritis: A bioethical analysis with the integrative method.

BACKGROUND AND OBJECTIVE: Termination of pregnancy in patients with rheumatic diseases is controversial and a bioethical analysis is rarely performed. In this study we analysed the case of a pregnant patient with lupus nephritis unresponsive to treatment, for whom termination of pregnancy is considered. METHODS: The integrative model was applied combining different normative ethical theories. RESULTS: From a utilitarian perspective, termination of pregnancy is justifiable, seeking the greatest benefit for the greatest number of stakeholders. Deontology justifies both terminating and continuing the pregnancy, focusing on the action itself and on autonomy. In virtue ethics the importance of decisions rests with the person who performs the action seeking flourishing; termination of pregnancy would be justifiable. DISCUSSION AND CONCLUSIONS: Interruption of pregnancy is a justifiable solution following the integrative model. Bioethical analysis of paradigmatic cases is essential to ensure the best possible action and as a precedent for future similar situations in rheumatology.

Bladder Cancer and Probiotics: What Do We Know So Far?

Bladder cancer is around the 10th most diagnosed cancer, although has a considerable mortality. Recent research and new methodologies have discarded the historical dogma that the bladder (and urine) was sterile under normal conditions. Specifically, only a few studies have reported a detailed analysis of the urinary microbiota in patients with bladder cancer, thus exhibiting a remarkable variability due to the low biomass of the urinary microbiota and the influence of many factors. Nevertheless, this research shows us signals that urinary microbiota is a factor to be considered in the pathophysiology of bladder cancer. More importantly, probiotics could be useful as an adjuvant therapy to reduce the recurrence rate or increase the disease-free period after surgery. In vitro studies and animal assays have shown promising results, but the research in this context has also been scarce, and only a few studies have been conducted in humans. In summary, there is little evidence of the possible beneficial effect of probiotics in controlling the overgrowth of genera that could be involved in the carcinogenesis of bladder cancer. This narrative review aims to compile all the evidence to date on the therapeutic potential of probiotics injected directly into the bladder or orally administered.

Oral intake of Kluyveromyces marxianus B0399 plus Lactobacillus rhamnosus CECT 30579 to mitigate symptoms in COVID-19 patients: A randomized open label clinical trial.

At the beginning of the SARS-CoV-2 pandemic, developing of new treatments to control the spread of infection and decrease morbidity and mortality are necessary. This prospective, open-label, case-control intervention study evaluates the impact of the oral intake of the probiotic yeast Kluyveromyces marxianus B0399 together with Lactobacillus rhamnosus CECT 30579, administered for 30 days, on the evolution of COVID-19 patients. Analysis of the digestive symptoms at the end of the follow up shows a benefit of the probiotic in the number of patients without pyrosis (100% vs 33.3%; p 0.05) and without abdominal pain (100% vs 62.5%; p 0.04). Results also show a better evolution when evaluating the difference in the overall number of patients without non-digestive symptoms at the end of the follow-up (41.7%, vs 13%; p 0.06). The percentage of improvement in the digestive symptoms (65% vs 88%; p value 0.06) and the global symptoms (digestive and non-digestive) (88.6% vs 70.8%; p value 0.03) is higher in the probiotic group. The probiotic was well tolerated with no relevant side effects and high adherence among patients. In conclusion, this coadjutant treatment seems to be promising, although results should be confirmed in new studies with higher number of patients.

[Sialidase activity in women with bacterial vaginosis]. / Actividad sialidasa en mujeres con vaginosis bacteriana.

Bacterial vaginosis (VB) is a syndrome characterized by overgrowth of endogenous Gram negative bacterial flora and the lack of the normal flora. Within bacterial enzymes, sialidases have been considered a virulence factor of many pathogenic microorganisms colonizing the different mucous membranes. Their presence in vaginal discharges can be correlated with VB. The aim of this study was to detect the activity of this enzyme in women with this syndrome and without clinical evidence of genital infection. Out of a total 112 women studied, 51 were patients with VB and the other 61 women presented normal vaginal flora. For the quantification of enzyme activity, the technique based on the enzymatic hydrolysis of a derivative acid of the acetyl metoxifenil muramic acid was used. In the studied population both groups shared values from 0.5 to 5.1 nmoles of metoxifenol, whereas only 11 out of 52 patients with VB (21.17%), registered more than 5.1 nmoles. The presence of sialidase activity is not enough to confirm VB, except for values greater than 5.5 nmoles of the metoxifenol produced in the enzymatic reaction.

Actividad sialidasa en mujeres con vaginosis bacteriana / Sialidase activity in women with bacterial vaginosis

La vaginosis bacteriana (VB) es un síndrome caracterizado por el sobrecrecimiento bacteriano deflora endógena Gram negativa, que desplaza a la flora lactobacilar normal. Dentro de las enzimasbacterianas, las sialidasas han sido consideradas factores de virulencia de muchos microorganismos patógenosque colonizan las distintas mucosas. Su presencia en fluidos vaginales puede estar correlacionada con VB. Elpropósito de este estudio fue comprobar la actividad de dicha enzima en mujeres con este síndrome y sin evidenciaclínica de infección genital. Se estudiaron 112 mujeres (51 fueron pacientes con VB y 61 mujeres conflora colonizante habitual). Para la cuantificación de la actividad sialidasa se empleó la técnica basada en lahidrólisis enzimática de un derivado ácido del ácido metoxifenil acetil murámico. En la población estudiada seencontró que ambos grupos mostraron valores comprendidos entre 0.5 a 5.1 nmoles de metoxifenol, mientrasque 11 de 52 pacientes con VB (21.17%), registraron valores superiores a 5.1 nmoles. La presencia de actividadsialidasa solamente no es índice de VB, excepto para valores mayores de 5.5 nmoles de metoxifenol, producidosen la reacción enzimática.

Bacterial vaginosis (VB) is a syndromecharacterized by overgrowth of endogenous Gram negative bacterial flora and the lack of the normalflora. Within bacterial enzymes, sialidases have been considered a virulence factor of many pathogenic microorganismscolonizing the different mucous membranes. Their presence in vaginal discharges can be correlatedwith VB. The aim of this study was to detect the activity of this enzyme in women with this syndrome andwithout clinical evidence of genital infection. Out of a total 112 women studied, 51 were patients with VB andthe other 61 women presented normal vaginal flora. For the quantification of enzyme activity, the technique basedon the enzymatic hydrolysis of a derivative acid of the acetyl metoxifenil muramic acid was used. In the studiedpopulation both groups shared values from 0.5 to 5.1 nmoles of metoxifenol, whereas only 11 out of 52 patientswith VB (21.17%), registered more than 5.1 nmoles. The presence of sialidase activity is not enough to confirmVB, except for values greater than 5.5 nmoles of the metoxifenol produced in the enzymatic reaction.

Chlamydia trachomatis en una población ambulatoria hospitalaria femenina / Chlamydia trachomatis in hospitalary ambulatory women population

Chlamydia trachomatis (Ct) es considerada uno de los principales microorganismos implicados en enfermedades transmisibles sexualmente en la mujer, como ser cervicitis mucopurulenta, enfermedad inflamatoria pélvica, etc. Se estudió su prevalencia en pacientes ambulatorias no gestantes ni menopaúsicas con edades entre 13 y 52 años. En la anamnesis se registraron datos que contemplaban síntomas y factores de riesgo para la adquisición de enfermedades de transmisión sexual. Se realizaron hisopados endocervicales y vaginales para la investigación por técnicas de cultivo e identificación convencionales de patógenos causantes de cervicitis, vaginitis y vaginosis que podrían asociarse a Ct. La detección antigénica de Ct se efectuó por enzimoinmunoensayo, confirmándose las muestras positivas mediante reactivo de bloqueo (Chlamydiazyme-Abbott). La reacción inflamatoria se evaluó por observación microscópica directa en fresco (400 x). Se diagnosticó Ct en 35 pacientes (11,66 por ciento), estando como único patógeno en sólo 8 (22,85 por ciento), siendo la asociación con Gardnerella vaginalis la más frecuente (57,14 por ciento) habiéndose encontrado pluralidad etiológica en varios casos. La presencia de Ct estuvo asociada con reacción inflamatoria en un 54,28 por ciento de las pacientes y con síntomas en el 74,28 por ciento. Esto avala la necesidad de su búsqueda en toda mujer sexualmente activa que concurra a control ginecológico

Esquema simplificado de identificacion de las especies de staphylococcus coagulasa-negativa aislados de infecciones humanas / Identificacion simplified scheme for coagulase-negative staphylococcus strains isolated from human infections

Neste trabalho se identificaram 100 cepas de estafilococos coagulasa negativa de diferentes mostras clínicas. Buscando a correlaçäo entre homologia de DNA e características fenotípicas foi dividido em 2 grandes grupos pela sensibilidade à novobiocina e agregando a detecçäo de beta-galactosidasa e oxidasa em que se determinou 4 grupos (quadro 1): grupo de espécies de S. epidermidis, grupo de espécies de S.simulans: grupo de espécies de S. sapiophyticus e grupo de espécie de S. sciuri que säo factíveis de resolver em todo laboratório de microbiologia clínica. Por agregado de outras provas simples: detecçäo de ureasa, fosfatasa alcalina e beta-glucosidasa e detecçäo de aeróbica de acidez de maltosa, trehalosa e manitol se determinam as espécies de grupo S. epidermidis (quadro 2). Geralmente dada a maior frequência do S. epidermidis suficiente somente a detecäo de ureasa e fosfatasa. As espécies do grupo S. simulans se identificam com a determinaçäo de ureasa: fosfatasa alcalina e acidez de manitol (quadro 3): com a realizaçäo de ureasa e acidificaçäo de sacarosa e arabinosa se estabelece as espécies do grupo S. saprophyticus e unicamente por meio da rafinosa as espécies do grupo S. sciuri (quadro 5). A correlaçäo destas mínimas provas obtidas em nossas determinaçöes com as numerosissimas realizadas segundo apresenta o Manual de Bergey 9a. ediçäo, nos permite considerar a aplicabilidade deste esquema simples e rápido para diferenciar as espécies coagulasa negativa do gênero Staphyloccocus na maioria dos laboratórios de bacteriologia clínica