Enfermería de Práctica Avanzada en el Sistema de Salud: evolución, aceptación y reconocimiento / Advanced Practice Nursing in the Health System: evolution, acceptance and recognition

Introducción: se estima escasez de 5.9 millones de profesionistas de la salud a nivel mundial. La Enfermería de Práctica Avanzada (EPA), cuenta con conocimientos, competencias y habilidades clínicas específicas para actuar en situaciones de déficit de personal médico, tratando desde enfermedades agudas hasta crónico degenerativas, preservando tanto la salud mental como física. Objetivo: Determinar el desempeño de la Enfermería de Práctica Avanzada en el Sector Salud. Metodología: revisión sistemática sobre la EPA, que incluyó revisiones y artículos originales del periodo 2013-2022 en español e inglés, acerca de su desempeño: evolución, aceptación y reconocimiento. Para la identificación, cribado e inclusión de los artículos se utilizó el modelo PRISMA 2020. Resultados: de un total de 838 artículos identificados, se incluyeron 20 artículos y 7 de otras fuentes como citas y otros sitios web, obteniendo un total de 27 artículos de revisión, que abordan la evolución, la aceptación y reconocimiento. Se realizó análisis cualitativo. Conclusiones: el desempeño de EPA surge por las demandas poblacionales de atención primaria a la salud, diversos países ya cuentan con EPA, asistiendo a sus habitantes desde sus especialidades. La EPA es diversa y extensa, su profesionalización debe ser continua y permanente. En México falta camino para tomar la EPA como parte del equipo multidisciplinario

Abstract Introduction: About 5.9 millions healthcare professionals lack across the world. The Advanced Practice Nursing (APN), has specific knowledge, competences, and clinical abilities to act in medical absence, taking care from acute illness until chronic diseases, preserving both mental and physical health. Objective: To determine the Advanced Practice Nursing (APN) performance in the Health Sector. Methods: A systematic review about APN, including reviews and original articles from the period 2013-2022 in Spanish and English, about performance: evolution, acceptance and recognition. For the identification, screening, and inclusion of the articles the PRISMA 2020 model was used. Results: Of 838 total identified articles, 20 articles were included from the search and 7 from other sources such as citations and other websites, obtaining 27 total articles to be reviewed, which regard the evolution, acceptance and recognition. A qualitative analysis was performed. Conclusions: The APN performance arose because of demands for primary health care; several countries already have APN, providing care to inhabitants through their different specialties. APN is diverse and extensive, its professionalization must be continuous and permanent. In Mexico there is still some way to go to APN to take part in the multidisciplinary team.

Lactate and pH values in newborns with a history of acute fetal distress / Valores de lactato y pH en recién nacidos con antecedente de sufrimiento fetal agudo

Abstract Background: Acute fetal distress (AFD) is a condition that requires timely diagnosis because it generates hypoxia, acidosis, and even intrauterine death. This study aimed to determine lactate and pH values in the umbilical cord in full-term newborns (NBs) with a history of AFD. Methods: We conducted a cross-sectional study in full-term NBs of mothers with at least one perinatal, neonatal, or gasometric AFD antecedent. Neonatal morbidity was considered: if 1-min Apgar ≤ 6, or advanced neonatal maneuvers, or neonatal intensive care unit (NICU) admissions were necessary. The cutoff points were lactate > 4mmol/L and pH < 7.2. Results: Of 66 NBs, 33.3% of mothers presented at least one antecedent for developing AFD; 22.7% presented hypertensive pregnancy disease, 13.6% oligohydramnios, and 63.6% other factors. Perinatally, 28.7% required advanced neonatal resuscitation maneuvers and 7.5% admission to the NICU. In the gasometry, the lactate and pH values for the neonatal morbidity of the NBs' group were 4.726 ± 1.401 and 7.293 ± 0.056, respectively, versus 2.240 ± 0.318 and 7.359 ± 0.022 (p < 0.05) for the group without associated neonatal morbidity. Conclusions: Lactate values in the umbilical cord increased by 25%, and pH decreased by one percent in NBs with a history of AFD and associated morbidity.

Resumen Introducción: El sufrimiento fetal agudo (SFA) es una condición que amerita un diagnóstico oportuno debido a que genera hipoxia, acidosis e incluso la muerte intrauterina. El objetivo de este estudio fue determinar los valores de lactato y pH en cordón umbilical en recién nacidos de término con antecedente SFA. Métodos: Se llevó a cabo un estudio transversal, en recién nacidos a término, de madres que tuvieron al menos un antecedente para SFA de tipo perinatal, neonatal o gasométrico. Se consideró morbilidad neonatal cuando presentaron Apgar al minuto ≤ 6, o requirieron maniobras avanzadas de reanimación neonatal, o ingreso a Unidad de Cuidados Intensivos Neonatales (UCIN). El punto de corte fue > 4 mmol/L para los valores de lactato y pH < 7.2. Resultados: De un total de 66 recién nacidos, el 33.3% de las madres presentaron al menos un antecedente para desarrollar SFA; el 22.7% presentó enfermedad hipertensiva del embarazo, el 13.6%, oligohidramnios, y el 63.6%, otros factores. El 28.7% requirieron maniobras avanzadas de la reanimación neonatal y el 7.5%, el ingreso a la UCIN. En la gasometría, el valor de lactato y pH para el grupo de recién nacidos con morbilidad neonatal fue de 4.726 ± 1.401 y 7.293 ± 0.056 respectivamente, versus 2.240 ± 0.318 y 7.359 ± 0.022 (p < 0.05) para el grupo sin morbilidad neonatal asociada. Conclusiones: Se observó un incremento del 25% de los valores de lactato en cordón umbilical y una disminución del 1% del pH en los recién nacidos con antecedente de SFA y morbilidad asociada.

Prevalencia de cardiopatías congénitas en un hospital de segundo nivel que ameritaron tratamiento quirúrgico / Prevalence of surgical treatment in congenital heart disease

Resumen Objetivo: Determinar la prevalencia de cardiopatías congénitas (CC) en un hospital de segundo nivel que ameritaron tratamiento quirúrgico. Material y métodos: Estudio descriptivo, realizado en pacientes con diagnóstico de CC en una unidad de segundo nivel de atención del Instituto Mexicano del Seguro Social (IMSS) en Puebla, México durante el periodo de 2016-2017, se incluyeron expedientes de recién nacidos (RN) a término hasta los 14 años, analizando variables sociodemográficas, tipo de CC y corto circuito, presencia de anomalías asociadas y envío a un tercer nivel de atención para tratamiento quirúrgico. La información fue recolectada y analizada mediante el programa SPSS Statistics v25. Resultados: La prevalencia hospitalaria de CC que requirieron envío a tercer nivel de atención para tratamiento quirúrgico fue 6.8% en 2016 y 6.6% en 2017, la mediana de edad fue 1 año. El 77.2% de las CC fueron acianógenas, la persistencia del conducto arterioso (PCA) fue el corto circuito más frecuente y 19.2% presentó síndrome de Down como anomalía congénita asociada. Conclusión: Obtuvimos una prevalencia similar a otras regiones de México, siendo las CC acianógenas la causa más frecuente de los tratamientos quirúrgicos. La detección y referencia oportuna mejorara la atención y calidad de vida en estos pacientes.

Abstract Objective: To determine the prevalence of congenital heart disease (CHD) in a second level hospital that required surgical treatment. Material and methods: Descriptive study carried out in patients diagnosed with CHD in a second level hospital of the Mexican Social Security Institute (IMSS) in Puebla, Mexico during the period 2016-2017. Records of full-term newborns (NB) up to 14 years of age analyzing sociodemographic variables, type of CHD and short-circuit, presence of associated anomalies, and referral to a third level hospital for surgical treatment were included. Data were collected and analyzed using the SPSS Statistics v25 program. Results: The hospital prevalence of CHD that required referral to the third level hospital for surgical treatment was 6.8% in 2016 and 6.6% in 2017; the median age was 1 year. The 77.2% of CHDs were non-cyanotic, patent ductus arteriosus (PDA) was the most common shunt, and 19.2% had Down syndrome as an associated congenital anomaly. Conclusion: We obtained a similar prevalence to other regions of Mexico, with acyanotic CHD being the most frequent cause of surgical treatments. Timely detection and referral will improve care and quality of life in these patients.

[Depression, anxiety and quality of life in pediatric patients with leukemia]. / Depresión, ansiedad y calidad de vida en pacientes pediátricos con leucemia.

Background: Leukemia is the most frequent cancer in children and adolescents, and it has a high prevalence of depression and anxiety which deteriorates the quality of life related to health. The symptoms of depression and anxiety may go unnoticed by the physician as a normal response during cancer treatment. Objective: To determine the prevalence of depression, anxiety and health-related quality of life in pediatric patients with leukemia. Material and methods: study with the participation of Mexican children and adolescents with leukemia whose depression was determined with the Childhood Depression Inventory, their anxiety with the Spence Childhood Anxiety Scale, and their health-related quality of life (HRQoL) with PedsQL 4.0. Results: 37 participants, with a median age of 11 years (8-14 years); 19 (51.4%) were male. The marital status of the parents in 25 participants (67.5%) was married, in 10 (27%) had a domestic partnership, in one (2.7%) had divorced parents and in one it was single (2.7%). The prevailing religion was Catholic in 29 (78.3%); 16 patients (43.2%) reported depression, 10% anxiety and 94.5% reported an adequate health-related quality of life, with an average of 74.2 +- 16.2. Conclusions: Depression was the most prevalent, followed by anxiety. Health-related quality of life was reported as good. The harmful impact is still prevalent in a vulnerable population, which must be attended in a comprehensive and timely manner at all levels of care.

Introducción: la leucemia es el cáncer más frecuente en niños y adolescentes, y tiene una alta prevalencia de depresión y ansiedad que deterioran la calidad de vida relacionada con la salud. Los síntomas de depresión y ansiedad pueden pasar inadvertidos por el médico al considerar que son una respuesta normal durante el tratamiento del cáncer. Objetivo: determinar la prevalencia de depresión, ansiedad y calidad de vida relacionada con la salud en pacientes pediátricos con leucemia. Material y métodos: estudio en el que participaron niños y adolescentes mexicanos con leucemia cuya depresión se estableció con el Inventario de Depresión Infantil, su ansiedad con la Escala de Ansiedad Infantil Spence y su calidad de vida relacionada con la salud (CVRS) con el PedsQL 4.0. Resultados: fueron 37 participantes, con una mediana de edad de 11 años (8-14 años); 19 (51.4%) fueron del género masculino. Los padres de 25 pacientes (67.5%) estaban casados, los de 10 (27%) en unión libre, el de uno estaba divorciado (2.7%) y el de otro soltero (2.7%). La religión prevalente fue la católica en 29 (78.3%); 16 pacientes (43.2%) reportaron depresión, 10% ansiedad y 94.5% reportó adecuada calidad de vida relacionada con la salud, con un promedio de 74.2 +- 16.2. Conclusiones: la depresión fue la más prevalente, seguida de la ansiedad; la calidad de vida relacionada con la salud se reportó como buena. El impacto nocivo aún sigue siendo prevalente en una población vulnerable, la cual se debe atender de manera integral y oportuna en todos los niveles de atención.

[Influence of risk factors on mortality from COVID-19]. / Influencia de factores de riesgo sobre mortalidad por COVID-19.

Background: The main risk factors studied that have an influence on mortality from COVID-19 have so far been inconclusive in the world literature, mainly in relation to the male gender. Objective: To determine which are the main risk factors that influence a higher mortality from COVID-19. Material and methods: A case-control study was conducted, including 1190 patients with positive RT-PCR. The risk factors studied were: gender, age, systemic arterial hypertension (SAH), Diabetes mellitus (DM), obesity, Chronic Obstructive Pulmonary Disease (COPD), asthma, smoking, immunosuppressants, Human Immunodeficiency Virus (HIV), influenza vaccine. In the Group of Cases: they died from COVID-19 (n = 576), while in the Controls group: they survived (n = 614). The statistical plan included cross-tables and multivariate logistic regression model to determine the influence of these risk factors on mortality from COVID-19. Results: We found no statistically significant differences between cases and controls in relation to gender. However, the cases were aged >60 years, SAH, DM, obesity compared to controls. Conclusions: Male gender was not a risk factor for mortality from COVID-19, however, other risk factors such as age over 60 years, being hypertensive, diabetic and obese, were corroborated as such for a higher mortality from COVID-19.

Introducción: los principales factores de riesgo estudiados que tienen influencia sobre la mortalidad por COVID-19 han sido hasta el momento inconclusos en la literatura mundial, principalmente en relación al sexo masculino. Objetivo: determinar cuáles son los principales factores de riesgo que influyen sobre una mayor mortalidad por COVID-19. Material y métodos: se realizó un estudio de casos y controles, incluyendo a 1190 pacientes con PCR-RT positiva. Los factores de riesgo estudiados fueron: sexo, edad, presencia de hipertensión arterial sistémica (HAS), diabetes mellitus (DM), obesidad, enfermedad pulmonar obstructiva crónica (EPOC), asma, tabaquismo, pacientes con ingesta de inmunosupresores, portadores del virus de inmunodeficiencia humana (VIH) y vacuna de influenza. En el grupo de casos fallecieron por COVID-19 (n = 576), mientras que en el de controles sobrevivieron (n = 614). El plan estadístico incluyó tablas cruzadas y modelo de regresión logística multivariable para determinar la influencia de estos factores de riesgo sobre la mortalidad por COVID-19. Resultados: no encontramos diferencias estadísticamente significativas entre casos y controles en relación al sexo. Sin embargo, los casos presentaron: edad > 60 años, HAS, DM y obesidad, en comparación con los controles. Conclusiones: el sexo masculino no fue factor de riesgo para mortalidad por COVID-19, sin embargo, otros factores de riesgo como edad mayor de 60 años, ser hipertenso, diabético y obeso, sí se corroboraron como tales para una mayor mortalidad por COVID-19.

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

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.

Estudio de casos confirmados de brucelosis humana en Puebla, México / Study of confirmed cases of human brucellosis in Puebla, Mexico

INTRODUCCIÓN: La brucelosis humana es un problema zoo-sanitario global. México es uno de los principales países que se ven afectados, el diagnóstico oportuno y las pruebas serológicas confirmatorias son la base para la detección. OBJETIVO: Conocer la frecuencia de casos confirmados de brucelosis en diferentes Unidades de Medicina Familiar del Instituto Mexicano del Seguro Social en el estado de Puebla, México. PACIENTES Y MÉTODOS: Estudio transversal en pacientes de ambos sexos, adultos y pediátricos, con manifestaciones clínicas sugestivas de brucelosis; se realizaron pruebas serológicas para el diagnóstico confirmatorio. RESULTADOS: De un total de 77 pacientes, se obtuvieron 39 (50,6%) casos positivos, 21 (27,3%) casos saliendo de la infección, 9 (11,7%) negativos y 8 (10,4%) con memoria inmunológica; de los casos positivos, 32 (82,1%) eran adultos y 30 (76,9%) fueron del género femenino. CONCLUSIÓN: Del total de muestras, la mitad tuvo diagnóstico de brucelosis, las manifestaciones clínicas de los pacientes estudiados fueron inespecíficas, lo cual resalta la importancia del diagnóstico de laboratorio.

BACKGROUND: Human brucellosis is a global health problem. Mexico is one of the main countries affected; timely diagnosis and serological tests are the basis for detection. AIM: To know the frequency of confirmed cases of brucellosis in different of Family Medicine Units of the Mexican Social Security Institute in the state of Puebla, Mexico. METHODS: Cross-sectional study in patients of both genders, adults and pediatrics, with clinical manifestations suggestive of brucellosis; serological tests were performed for the confirmatory diagnosis. RESULTS: Out of a total of 77 patients, 39 (50.6%) were positive, 21 (27.3%) cases coming out of infection, 9 (11.7%) were negative and 8 (10.4%) were defined with immunological memory; of positive cases, 32 (82.1%) were found in the adult group and 30 (76.9%) were female. CONCLUSION: Around half of samples were confirmed as brucellosis, the clinical manifestations of the patients studied were non-specific, which highlights the importance of laboratory diagnosis.

Follow-up to the baby friendly hospital initiative in two hospitals of the Mexican Social Security Institute / Seguimiento de la iniciativa hospital amigo del niño y la niña en dos hospitales del Instituto Mexicano del Seguro Social

Abstract Background: The Baby Friendly Hospital Initiative has proven to be effective to increase exclusive and prolonged breastfeeding. Material and methods: Longitudinal study, in two hospitals of second level, in the period from 2015 to 2018. A percentage above 85% in each step was considered acceptable. The statistical analysis was descriptive using student's t test to compare the mean between the two hospitals and ANOVA to compare the mean throughout time in SPSS v.25. Results: Steps 1 and 7 were different between the hospitals with p = 0.010 and p = 0.023, respectively. In the follow-up, General Zone Hospital No. 5 kept steps 1, 2, 3, 7, 8, and 9 above 85%, while those who did not were steps 4, 5, 6, and 10, p = 0.37. Steps of General Hospital No. 15 that remained over 85% were 1, 3, 7, and 9; those that oscillated over time with a <85% rating were steps 2, 4, 5, 6, 8, and 10, p = 0.003. Conclusion: Monitoring child-friendly hospitals allow us to observe areas of opportunity to strengthen training for both clinical and non-clinical staff, pregnant women, the general population, and to improve exclusive and prolonged breastfeeding.

Resumen Introducción: La Iniciativa Hospital Amigo del Niño y la Niña ha probado ser efectiva para mejorar la lactancia materna exclusiva y prolongada. Material y métodos: Estudio longitudinal, en dos hospitales de segundo nivel, en el periodo de 2015 a 2018. Un porcentaje superior al 85% en cada paso se consideró aceptable. El análisis estadístico fue descriptivo, utilizando la prueba t de Student para comparar las medias entre los dos hospitales y el análisis de la varianza para compararlas a lo largo del tiempo empleando el programa SPSS v.25. Resultados: Los pasos 1 y 7 variaron entre los hospitales (con p = 0.010 y p = 0.023, respectivamente). En el seguimiento, el Hospital General de Zona (HGZ) 5 mantuvo los pasos 1, 2, 3, 7, 8 y 9 por encima del 85%, y < 85% los pasos 4, 5, 6 y 10 (p = 0.37). Las medidas del HGZ 15 que se mantuvieron > 85% fueron 1, 3, 7 y 9; aquellos que oscilaron a lo largo del tiempo con una calificación < 85% fueron los pasos 2, 4, 5, 6, 8 y 10 (p = 0.003). Conclusión: Estos seguimientos permiten observar áreas de oportunidad para reforzar la capacitación al personal clínico y no clínico como a las mujeres embarazadas, a la población en general y para mejorar la lactancia materna exclusiva y prolongada.

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.

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.

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

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.

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.