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

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.

Incidence of spinal cancer in a tertiary care hospital in Mexico / Incidência de câncer da coluna vertebral em um hospital de terceiro nível de atenção no México / Incidencia de cáncer de columna vertebral en un hospital de tercer nivel de atención en México

ABSTRACT Objective To determine the incidence of primary malignant bone tumors of the spine in a High Specialty Orthopedics and Traumatology Medical Unit. Methods Review study. The study included patients receiving benefits from the Mexican Social Security Institute of all ages and both sexes with malignant spinal bone tumors during the period from 2010 to 2017. The descriptive statistics used were central tendency measures and dispersion in the SPSS v. 22 program from IBM. The results are presented in tables and figures. Results There were 107 patients, 56 (52.34%) men, 51 (47.66%) women with a mean age of 59.75 + 10.76 years (minimum 35, maximum 88). There were 46,840 hospital discharges during the period, for an annual average of 5,855 and a monthly average of 487.91. Of the 107 study cases, 78 (72.89%) were in the lumbosacral, 15 (14.01%) in the cervical, and 14 (13.08%) in the thoracic region. The incidence for the period was 1.9/1000 discharges, 1.38in 2010 increasing to 2.32 in 2017. Conclusions The behavior of primary malignant spinal tumors has increased its presentation from 2010 to 2017 . Level of evidence III; Non-analytical, descriptive study.

RESUMO Objetivo Conhecer a incidência de tumores ósseos malignos primários da coluna vertebral em uma unidade médica de alta especialidade médica em Ortopedia e Traumatologia. Métodos Estudo de revisão. O período do estudo incluiu os anos de 2010 a 2017 incluindo pacientes com tumores ósseos malignos da coluna vertebral, de todas as idades e ambos os sexos e usuários do IMSS (Instituto Mexicano de Seguridade Social). Foram utilizadas medidas estatísticas descritivas de tendência central e de dispersão no programa SPSS v. 22 IBM. Os resultados são apresentados em tabelas e gráficos. Resultados O estudo incluiu 107 pacientes, 56 (52,34%) homens e 51 mulheres (47,66%); idade média 59,75 + 10,76 anos (mínima 35, máxima 88). As altas hospitalares durante o período foram 46840, média anual de 5855 e média mensal de 487,91; dos tumores malignos 78 (72,89%) foram na região lombossacra, 15 (14,01%) na região cervical e 14 (13,08%) na região torácica. A incidência do período foi de 1,9/1000 altas, 1,38 em 2010, aumentando para 2,32 em 2017. Conclusões O comportamento dos tumores malignos primários da coluna vertebral tem aumentado desde 2010 a 2017. Nível de evidência III; Estudo analítico-descritivo.

RESUMEN Objetivo Conocer la incidencia de tumores óseos malignos primarios de columna vertebral en una Unidad Médica de Alta Especialidad en Ortopedia y Traumatología. Métodos Estudio de revisión. El período de estudio comprendió los años 2010 a 2017, incluyendo a pacientes con tumores óseos malignos de columna vertebral, de todas las edades y ambos sexos, y usuarios del IMSS (Instituto Mexicano del Seguro Social). Fueron utilizadas medidas estadísticas descriptivas de tendencia central y de dispersión en el programa SPSS v. 22 de IBM. Los resultados son presentados en tablas y gráficos. Resultados El estudio incluyó a 107 pacientes, 56 hombres (52,34%), y 51 mujeres (47,66%); edad promedio 59,75 + 10,76 años (mínima 35, máxima 88). Las altas hospitalarias durante el período fueron 46840, promedio anual de 5855 y promedio mensual de 487,91; de los tumores malignos, 78 (72,89%) casos en la región lumbosacra, 15 (14,01%) en la región cervical y 14 (13,08 %) en la región torácica. La incidencia del período fue 1,9/1000 altas, 1,38 en 2010, aumentando para 2,32 en 2017. Conclusiones El comportamiento de los tumores malignos primarios de columna vertebral ha aumentado desde 2010 a 2017. Nivel de evidencia III; Estudio analítico-descriptivo.

Vitamin D in systemic lupus erythematosus with and without lupus nephritis.

INTRODUCCIÓN: Las concentraciones séricas subóptimas de vitamina D se presentan en múltiples enfermedades crónicas, como las enfermedades autoinmunitarias. Los objetivos del estudio fueron: 1) comparar las concentraciones séricas de 25-hidroxivitamina D (25OHD3) en pacientes con lupus eritematoso sistémico (LES) con y sin nefritis lúpica (NL), y 2) evaluar la asociación de las concentraciones séricas de 25OHD3 con la actividad de la enfermedad. MATERIAL Y MÉTODOS: Estudio comparativo, transversal, que incluyó 48 mujeres con LES, con y sin NL. Se excluyeron aquellas con enfermedad renal crónica en estadio IV, cáncer, hiperparatiroidismo, embarazo o lactancia. La actividad fue evaluada con el instrumento SLEDAI-2K. La concentración sérica de 25OHD3 se determinó mediante inmunoanálisis quimioluminiscente. RESULTADOS: La media de edad de las pacientes con y sin NL fue de 36.3 ± 8.6 años y 42.7 ± 7.6 años, respectivamente. Se observó una elevada prevalencia de valores subóptimos de 25OHD3 en todas las pacientes (93%). Las concentraciones séricas de 25OHD3 fueron diferentes entre pacientes con y sin NL: 21.5 ± 6.8 ng/ml frente a 19.2 ± 7.1 ng/ml (p = 0.362). No se encontró correlación entre la concentración sérica de 25OHD3 y la actividad de la enfermedad (r = -045, p = 0.761). CONCLUSIONES: En pacientes con LES, las concentraciones séricas de 25OHD3 fueran diferentes entre pacientes con y sin NL; sin embargo, esta diferencia no fue significativa. Además, no se encontró correlación entre las concentraciones séricas de 25OHD3 y la actividad de la enfermedad evaluada por SLEDAI-2K. BACKGROUND: Sub-optimal serum vitamin D levels occur in multiple chronic diseases such as autoimmune diseases. The objectives of this study were: 1) compare the serum concentration of 25-hidroxivitamin D (25OHD3) in patients with systemic lupus erythematosus (SLE) with and without lupus nephritis (LN), and 2) evaluate the association of serum concentration of 25OHD3 with the activity of the disease. MATERIAL AND METHODS: A comparative, cross-sectional study was conducted, including 48 women with SLE, with and without clinical diagnosis of LN, according to the score of renal activity evaluated by SLEDAI-2K. Patients with stage IV chronic kidney disease, cancer, hyperparathyroidism, pregnancy and lactation were excluded. The activity was evaluated by the SLEDAI-2K instrument. The serum concentration of 25OHD3 was assessed by chemiluminescent immunoassay. RESULTS: The mean age of patients with and without LN was 36.3 ± 8.6 and 42.7 ± 7.6 years, respectively. High prevalence of suboptimal 25OHD3 levels was observed (93%). 25OHD3 concentrations were different between patients with and without LN, 21.5 ± 6.8 ng/mL vs. 19.2 ± 7.1 ng/mL (p = 0.362). No correlation was found between serum 25OHD3 concentration (r = −045, p = 0.761). CONCLUSIONS: There were no differences found in serum concentrations of 25OHD3 in patients with or without NL. Moreover, no correlation was found between serum 25OHD3 levels and the activity of the disease evaluated by SLEDAI-2K.

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

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.

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

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.

Funcionalidad, calidad de vida y grado de dolor en 243 pacientes con lumbalgia crónica degenerativa / FUNCTIONALITY, QUALITY OF LIFE, AND PAIN INTENSITY IN 243 PATIENTS WITH DEGENERATIVE CHRONIC LUMBAR DISEASE

Introducción: La enfermedad degenerativa lumbar ocasiona lumbalgia, es la patología musculo esquelética más frecuente en mayores de 65 años, la segunda causa de las consultas médicas en primer nivel, quinta en admisión en hospitales y tercera de cirugía de columna lumbar que ocasiona incapacidad y limitación de actividades cotidianas. El objetivo es correlacionar la calidad de vida con limitación funcional en pacientes con lumbalgia crónica degenerativa. Metodología: estudio transversal, en 243 adultos mayores con lumbalgia degenerativa, de ambos géneros, mayores de 65 años, con lumbalgia crónica y limitación funcional de actividades cotidianas. Se utilizó Escala Visual Analógica (EVA), Cuestionario de Salud SF-36 y Escala de Incapacidad por Dolor Lumbar de OSWESTRY. La estadística fue descriptiva y correlación Spearman. Resultados: N=273, edad media 77 ± 6.9 años, 63.38% fueron mujeres, 48.97% pensionados, 20.17% analfabetas, 25.10% nivel secundaria, 65.85% casados. En el SF-36: calidad de vida promedio 39.2, con mayor afectación en el dominio de funcionamiento social: media 51.99; OSWESTRY: imitación funcional mínima y moderada en 23.9%, limitación severa a máxima en 76.1%; EVA: 59.3% dolor leve a moderado y 40.7% dolor intenso y con el peor dolor posible; hubo correlación negativa entre SF-36 y OSWESTRY: -.830, p=0.000; tambien correlación negativa entre calidad de vida y grado de dolor: -.798 p<0.0001 y correlación positiva entre limitación funcional y grado de dolor: 0.734 p=0.000. Conclusión: La calidad de vida tiene correlación negativa con limitación funcional y dolor; la correlación entre limitación funcional y dolor es positiva en adultos mayores con lumbalgia crónica

Introduction: Lumbar degenerative disease causes lumbago, is the most common muscleskeletal pathology in patients over 65 yearsold and the second leading cause of medical consultations at first medical level, the fifth in hospital admissions and third of lumbar spine surgery. It causes disability and limitation of daily activities. The objective is to correlate the quality of life with functional limitation in patients with Atraumatic Chronic Lumbago. Methods: Cross-sectional study in 243, older than 65 years old, male and female, with Atraumatic Chronic Lumbago and functional limitation of daily activities. Visual Analog Scale (VAS), SF-36 and Oswestry questionaries were applied. Descriptive and correlation statistics were used. Results: N=273, mean age 77 ± 6.9 years, 63.38% women, 48.97% pensioners, 20.17% illiterate, 25.10% High School level and 65.85% were married. SF-36: 39.2 quality of life average was 39.2, with greater involvement in the social functioning domain: 51.99 media. OSWESTRY: moderate and low functional limitation in 23.9%, severe to maximum limitation in 76.1%; VAS mild to moderate pain in 59.3% and 40.7% severe pain and worst pain possible; there were negative correlation between SF -36 and OSWESTRY -.830, p= 0.000 and between quality of life and degree of pain: -.798 p < 0.0001; correlation between and positive degree of functional limitation and degree of pain was positive: 0.734 p=0.000. Conclusion: Quality of life is negatively correlated with pain and functional limitation; and the correlation between pain and functional limitation is positive in older adults with chronic low back pain

Vitamin D and Sjögren syndrome.

The immunomodulatory effects of vitamin D have been extensively studied in the context of autoimmunity. Multiple studies have demonstrated a high prevalence of vitamin D deficiency in autoimmune diseases. Recently, a possible protective role of vitamin D in autoimmunity has been described; however, this function remains controversial. Few studies have investigated the role of vitamin D in patients with Sjögren syndrome (SS). In this review, we compiled the main features of SS pathogenesis, the vitamin D immunomodulatory effects and the possible interaction between both. Data suggests that vitamin D may play a role in the SS pathogenesis. In addition, vitamin D low levels have been found in SS patients, which are associated with extra-glandular manifestations, such as lymphoma or neuropathy, suggesting a possible benefit effect of vitamin D in SS.

Costes directos de atención médica del pie diabético en el segundo nivel de atención médica / Direct costs in the management of diabetic foot

Introducción: Una de las complicaciones frecuentes de la diabetes mellitus es el pie diabético; su manejo oportuno define el futuro funcional del paciente y disminuye el gasto en la atención de estos pacientes. Objetivo: Analizar los costos directos en la atención de pacientes con pie diabético con base en la escala de Wagner. Material y métodos: Estudio transversal en pacientes con pie diabético en el que se analizaron los costes directos de la atención médica; se evaluaron días de hospitalización, estudios de laboratorio e imagen, debridaciones quirúrgicas, amputaciones menores y amputaciones mayores. En todo momento se conservó el anonimato de los participantes. Resultados: Se incluyeron 68 pacientes con pie diabético. De estos, 22 se eliminaron por tener expedientes clínicos incompletos, quedando finalmente 46 pacientes. Treinta y tres (72%) eran hombres, con una edad promedio de 59 años. Se observó incremento de los costos promedio/totales en forma ascendente desde el Wagner 1 al Wagner 5. Los costos directos más altos de hospitalización se atribuyeron a los costes día/cama y a las debridaciones quirúrgicas. Conclusiones: El incremento del coste de atención es directamente proporcional a la escala de Wagner. Este estudio constituye un punto de partida hacia la cuantificación de la carga económica del pie diabético en instituciones de seguridad social. La atención médica en estos pacientes es menor en el I nivel comparada con el II nivel de atención. El diagnóstico precoz disminuiría los costes de la atención de estos pacientes.

Introduction: Diabetic foot is one of the common complications of diabetes mellitus, early management defines the functional future of the patient and reduces the cost in attention. Objective: To analyze the direct costs of patients diagnosed with diabetic foot based on Wagner Scale. Material and methods: Cross-sectional study, in patients with diabetic foot; direct costs of medical care were evaluated: days of hospitalization, laboratory and imaging tests, surgical debridations, minor and major amputations were evaluated. At all times the anonymity of the participants was preserved. Results: There were 68 patients with diabetic foot, of these 22 were removed for having incomplete medical records, being included 46 patients: 33(72%) men, mean age 59 years-old. Ascending increase in average and total costs was observed, from 1 to 5 Wagner Classification. Direct costs were higher in day hospitalization and debridations compared to others. Conclusions: This study is a starting point for the quantification of the economic burden of diabetic foot in Social Security Institutions. A guide based treatment for diabetic foot whould lower direct costs for these patients. Medical attention costs in these patients are less in I Level Medical Facility compared with II Level.

[Five-year survival analysis in patients with penile cancer]. / Análisis de supervivencia a cinco años en pacientes con cáncer de pene.

BACKGROUND: Short-term survival of penile cancer is poor. The objective was to describe the 5-years penile cancer survival. METHODS: Retrospective cohort study. We included patients with penile cancer managed surgically from 2010 to 2014. Descriptive statistics were used for socio-demographic variables and the Kaplan-Meier estimator for survival function. RESULTS: We studied 22 patients with a mean age of 64.95 years and a time of evolution of 25 months after the diagnosis. 68.2% of patients smoked or had human papillomavirus (HPV); they all presented phimosis; 72.7% had pain in the penis and the groin area; 81.8% had palpable lymph nodes and 45.5% lesions ≥ 3 cm; 86.3% were diagnosed in clinical stage IIIa. 59.1% underwent partial penectomy and 86.4% had squamous cell variety. 40.9% of patients died six months after the surgery. 66% of the smokers presented metastasis; all of the patients that smoked and had HPV infection had neurovascular invasion and died; 83.3% of the patients (n = 6) who underwent partial penectomy and positive lymph node dissection due to metastases died. The 5-years mortality of patients with penile cancer was 40.9%. CONCLUSION: Tobacco use and HPV increase morbidity and mortality in patients with penile cancer; lesions greater than 5 cm are more common in smokers. The size of the lesion increases with the delay in treatment.

Introducción: la sobrevida del cáncer de pene es pobre a corto plazo. El objetivo fue describir la supervivencia de pacientes con cáncer de pene a cinco años. Métodos: estudio de cohorte retrospectivo. Se incluyeron pacientes con cáncer de pene manejados quirúrgicamente durante el periodo de 2010 a 2014. La estadística fue descriptiva y se usó el estimador de Kaplan-Meier para analizar la función de supervivencia. Resultados: se estudiaron 22 pacientes, con edad media de 64.95 años y tiempo de evolución del cáncer al diagnóstico de 25 meses. El 68.2% era fumador o presentó VPH; todos tuvieron fimosis; 72.7% tuvo dolor en pene e ingle; 81.8% presentó ganglios palpables y 45.5% lesiones ≥ 3 cm. El 86.3% se diagnosticó en estadio clínico mayor de IIIa. Al 59.1% se le realizó penectomía parcial y 86.4% fue de variedad epidermoide. El 40.9% de los pacientes falleció a los seis meses después del tratamiento quirúrgico. El 66.6% de los fumadores presentó metástasis; todos los que presentaban tabaquismo más infección por VPH tuvieron invasión neurovascular y fallecieron. Al 83.3% (n = 6) de los pacientes a los que se les realizó penectomía parcial y disección ganglionar con ganglios positivos por metástasis fallecieron. La mortalidad fue de 40.9% a cinco años. Conclusión: el tabaquismo y el VPH aumentan la morbimortalidad en pacientes con cáncer de pene; las lesiones mayores de 5 cm se presentan más en fumadores. El tamaño de la lesión aumenta con la demora diagnóstica.

Tratamiento de la ginecomastia: Diferencias entre la incisión periareolar externa y la incisión periareolar inferior en mastectomía subdérmica / Treatment for gynecomastia: Differences for the external and inferior periareolar incision for subdermal mastectomy

Introducción: La ginecomastia define el aumento benigno del tamaño de la glándula mamaria en el hombre. Existen diversos abordajes quirúrgicos para la resección de la lesión, cada una con resultados diferentes. Material y métodos; Estudio transversal. Se incluyeron pacientes con ginecomastia operados de mastectomía subdérmica mediante incisión periareolar externa e incisión periareolar inferior. Para la aleatorización se tomó en cuenta los grados IIb y III de Simon, distribuyendo uno a uno para cada tipo de incisión. Los resultados estéticos fueron evaluados por un cirujano experimentado, tomando como excelentes cuando hubo una cicatrización correcta sin deformidad del área, buenos cuando la cicatrización fue buena sin deformidad del área y mala cuando hubo deformidad del área operada. Resultados: Fueron operados 24 pacientes, el 50% por incisión periareolar externa y el 50% por incisión periareolar inferior. La edad promedio fue 25,58 y 27,58 años respectivamente, sin diferencias significativas p = 0,513. Todos los pacientes tuvieron características sexuales secundarias normales. La etiología fue idiopática en 23 pacientes (95,83%). El tiempo promedio de evolución fue 32,28 meses y en todos el resultado histopatológico fue ginecomastia. La evaluación del aspecto estético de la incisión y el área afectada en los pacientes operados mediante incisión periareolar externa (n = 12) fue mala en un paciente (8,33%), buena en 2 (16,66%) y excelente en 9 pacientes (75%), mientras que en los pacientes operados mediante incisión periareolar inferior, fue buena en el 100% de los pacientes, y mala y excelente en ningún paciente, con diferencias estadísticamente significativas para ambas incisiones, p = 0,000. Ningún paciente presentó complicaciones. Conclusión: Ambas incisiones son seguras. La incisión periareolar externa ofrece mejores resultados que la incisión periareolar inferior para realizar mastectomía subdérmica en pacientes con ginecomastia en todos los grados Simon.

Introduction: Gynecomastia defines the benign enlargement of the mammary gland in man. There are several surgical approaches for resection of the lesion, each with different results. Material and methods: Cross-sectional study. There were included patients with gynecomastia, operated by means of external and inferior periareolar incision. For randomization was took into account degrees IIb and III of Simon, distributing one to one for each type of incision, the cosmetic results were evaluated by an experienced surgeon, taking as excellent results when there was a proper healing without deformity of the area, good results when healing was good without deformity, and bad results when there was deformity of the operated area. Results: There were 24 patients, 50% operated by external periareolar incision and 50% by lower periareolar incision. The mean age was 25.58 and 27.58 years old for each group, with no significant statistically differences (P = .513). All patients had normal secondary sexual characteristics. The etiology was idiopathic in 23 (95.83%). The average evolution time was 32.28 months, on all histopathological result was gynecomastia. The evaluation of the aesthetic aspect of the incision and the area affected in patients operated by external periareolar incision (n = 12) was bad to 1 (8.33%), good in 2 (16.66%) and excellent in 9 (75%) patients; 100% of the patients operated by inferior periareolar incision presented good results, there were statistically significant differences for both incisions, P = .000. There were no complications. Conclusion: Both incisions are safe, periareolar external incision provides better results than the inferior periareolar incision for patients with gynecomastia in all degrees of Simon.

Vitamin D insufficiency and deficiency in mexican patients with systemic lupus erythematosus: Prevalence and relationship with disease activity. / Insuficiencia y deficiencia de vitamina D en pacientes mexicanas con lupus eritematoso sistémico: prevalencia y relación con actividad de la enfermedad.

OBJECTIVES: To determine and compare the prevalence of vitamin D insufficiency and deficiency in patients with systemic lupus erythematosus (SLE) with and without disease activity. PATIENTS AND METHODS: We made a comparative, observational, cross-sectional, prospective study of 137 women with SLE according to American College of Rheumatology criteria. Patients with chronic kidney disease, cancer, hyperparathyroidism, pregnancy, and lactation were excluded. Disease activity was assessed using the MEX-SLEDAI score: a score of ≥3 was considered as disease activity. Data were collected on diabetes mellitus, the use of corticosteroids, chloroquine, and immunosuppressants, photoprotection and vitamin D supplementation. Vitamin D levels were measured by chemiluminescent immunoassay: insufficiency was defined as serum 25-hydroxyvitamin D <30ng/ml and deficiency as <10ng/ml. RESULTS: 137 women with SLE (mean age 45.9±11.6 years, disease duration 7.7±3.4 years) were evaluated. Mean disease activity was 2 (0-8): 106 patients had no disease activity and 31 had active disease (77.4% versus 22.6%). Vitamin D insufficiency and deficiency was found in 122(89.0%) and 4 (2.9%) patients, respectively. There was no significant difference in vitamin D levels between patients with and without active disease (19.3±4.5 versus 19.7±6.8; P=.75). No correlation between the MEX-SLEDAI score (P=.21), photosensitivity, photoprotection, prednisone or chloroquine use and vitamin D supplementation was found. CONCLUSIONS: Women with SLE had a high prevalence of vitamin D insufficient. No association between vitamin D levels and disease activity was found.