Effect of police enforcement and extreme social inequalities on violence and mental health among women who sell sex: findings from a cohort study in London, UK.

OBJECTIVES: To examine legal and social determinants of violence, anxiety/depression among sex workers. METHODS: A participatory prospective cohort study among women (inclusive of transgender) ≥18 years, selling sex in the last 3 months in London between 2018 and 2019. We used logistic generalised estimating equation models to measure associations between structural factors on recent (6 months) violence from clients or others (local residents, strangers), depression/anxiety (Patient Health Questionnaire-4). RESULTS: 197 sex workers were recruited (96% cisgender-women; 46% street-based; 54% off-street) and 60% completed a follow-up questionnaire. Street-based sex workers experienced greater inequalities compared with off-street in relation to recent violence from clients (73% vs 36%); police (42% vs 7%); intimate partner violence (IPV) (56% vs 18%) and others (67% vs 17%), as well as homelessness (65% vs 7%) and recent law enforcement (87% vs 9%). Prevalence of any STI was 17.5% (17/97). For street-based sex workers, recent arrest was associated with violence from others (adjusted OR (aOR) 2.77; 95% CI 1.11 to 6.94) and displacement by police was associated with client violence (aOR 4.35; 95% CI 1.36 to 13.90). Financial difficulties were also associated with client violence (aOR 4.66; 95% CI 1.64 to 13.24). Disability (aOR 3.85; 95% CI 1.49 to 9.95) and client violence (aOR 2.55; 95% CI 1.10 to 5.91) were associated with anxiety/depression. For off-street sex workers, financial difficulties (aOR 3.66; 95% CI 1.64 to 8.18), unstable residency (aOR 3.19; 95% CI 1.36 to 7.49), IPV (aOR 3.77; 95% CI 1.30 to 11.00) and alcohol/drug use were associated with client violence (aOR 3.16; 95% CI 1.26 to 7.92), while always screening and refusing clients was protective (aOR 0.36; 95% CI 0.15 to 0.87). Disability (aOR 5.83; 95% CI 2.34 to 14.51), unmet mental health needs (aOR 3.08; 95% CI 1.15 to 8.23) and past eviction (aOR 3.99; 95% CI 1.23 to 12.92) were associated with anxiety/depression. CONCLUSIONS: Violence, anxiety/depression are linked to poverty, unstable housing and police enforcement. We need to modify laws to allow sex workers to work safely and increase availability of housing and mental health services.

The Effect of Systemic Racism and Homophobia on Police Enforcement and Sexual and Emotional Violence among Sex Workers in East London: Findings from a Cohort Study.

There is extensive qualitative evidence of violence and enforcement impacting sex workers who are ethnically or racially minoritized, and gender or sexual minority sex workers, but there is little quantitative evidence. Baseline and follow-up data were collected among 288 sex workers of diverse genders (cis/transgender women and men and non-binary people) in London (2018-2019). Interviewer-administered and self-completed questionnaires included reports of rape, emotional violence, and (un)lawful police encounters. We used generalized estimating equation models (Stata vs 16.1) to measure associations between (i) ethnic/racial identity (Black, Asian, mixed or multiple vs White) and recent (6 months) or past police enforcement and (ii) ethnic/racial and sexual identity (lesbian, gay or bisexual (LGB) vs. heterosexual) with recent rape and emotional violence (there was insufficient data to examine the association with transgender/non-binary identities). Ethnically/racially minoritized sex workers (26.4%) reported more police encounters partly due to increased representation in street settings (51.4% vs 30.7% off-street, p = 0.002). After accounting for street setting, ethnically/racially minoritized sex workers had higher odds of recent arrest (adjusted odds ratio 2.8, 95% CI 1.3-5.8), past imprisonment (aOR 2.3, 95% CI 1.1-5.0), police extortion (aOR 3.3, 95% CI 1.4-7.8), and rape (aOR 3.6, 95% CI 1.1-11.5). LGB-identifying sex workers (55.4%) were more vulnerable to rape (aOR 2.4, 95% CI 1.1-5.2) and emotional violence. Sex workers identifying as ethnically/racially minoritized (aOR 2.1, 95% CI 1.0-4.5), LGB (aOR 2.0, 95% CI 1.0-4.0), or who use drugs (aOR 2.0, 95% CI 1.1-3.8) were more likely to have experienced emotional violence than white-identifying, heterosexual or those who did not use drugs. Experience of any recent police enforcement was associated with increased odds of rape (aOR 3.6, 95% CI 1.3-8.4) and emotional violence (aOR 4.9, 95% CI 1.8-13.0). Findings show how police enforcement disproportionately targets ethnically/racially minoritized sex workers and contributes to increased risk of rape and emotional violence, which is elevated among sexual and ethnically/racially minoritized workers.

Comparative Study of the Antibacterial, Biodegradable, and Biocompatibility Properties of Composite and Bi-Layer Films of Chitosan/Gelatin Coated with Silver Particles.

The dressings are materials that can improve the wound-healing process in patients with medical issues. Polymeric films are frequently used as dressings with multiple biological properties. Chitosan and gelatin are the most used polymers in tissue regeneration processes. There are usually several configurations of films for dressings, among which the composite (mixture of two or more materials) and layered ones stand out (layers). This study analyzed the antibacterial, degradable, and biocompatible properties of chitosan and gelatin films in 2 configurations, composite and bilayer, composite. In addition, a silver coating was added to enhance the antibacterial properties of both configurations. After the study, it was found that the bilayer films have a higher antibacterial activity than the composite films, having inhibition halos between 23% and 78% in Gram-negative bacteria. In addition, the bilayer films increased the fibroblast cell proliferation process, reaching up to 192% cell viability after 48 h of incubation. On the other hand, composite films have greater stability since they are thicker, with 276 µm, 243.8 µm, and 239 µm compared to 236 µm, 233 µm, and 219 µm thick for bilayer films; and a low degradation rate compared to bilayer films.

O-carboxymethyl chitosan/gelatin/silver-copper hydroxyapatite composite films with enhanced antibacterial and wound healing properties.

Wound dressing composite films of O-carboxymethyl chitosan (OCMC) and gelatin were prepared and mixed with hydroxyapatite (HA) composited with Silver (Ag) and Copper (Cu) at different concentrations. The chemical, thermal, morphological, and biological properties of the composite films were studied. The analysis by FTIR confirmed the presence of interactions between gelatin and OCMC, and at the same time, the polymer matrix interactions with Ag-Cu/HA complex. The inclusion of nanoparticle to the composite was associated with an improvement of the thermal stability, morphological roughness, a 9-12% more hydrophobic behavior (composite C1, C5, and C8), increase in antibacterial activity from 23.2 to 33.1% for gram negative bacteria and from 37.28 to 40.59% for gram positive bacteria, and with a cell viability greater than 100% for 24 and 72 h. The films obtained can serve as a wound healing dressing and regenerating biomaterial.

The effect of Allium cepa extract on the chitosan/PLGA scaffolds bioactivity.

Allium cepa extracts (AC) allow the fabrication of a biomaterial that, together with chitosan and PLGA, could be osteoconductive and promote a better and faster regeneration of bone tissue, with biocompatibility and biomineralization properties. In this work, scaffolds were developed by the thermally induced phase separation (TIPS) technique. An in vitro bioactivity analysis was performed using simulated body fluid (SBF). Scanning electron microscopy (SEM), energy dispersion spectroscopy, and infrared spectroscopy were used for the scaffolds characterization. The results showed a structure with a pore size distribution between 50 and 100 µm, which allowed the uniform formation of biological apatite crystals on the surface of the scaffolds. The chitosan/policaprolactone/Allium cepa scaffold (ChPAC) showed the most promising results with a ratio of P/Ca between 1.6 and 1.7, a value very close to that of hydroxyapatite.

Recommendations of the Mexican College of Rheumatology for the management of psoriatic arthritis.

Psoriatic arthritis is a chronic systemic inflammatory disease that affects the skin, musculoskeletal structures and other organs and systems compromising functionality, quality of life and reducing the life expectancy of patients. It is a complex disease that requires specialist and timely care and management. The alternatives for treating the manifestations of psoriatic arthritis have increased and the effect of the different agents on specific manifestations has been clarified in recent studies. Therefore, we should incorporate the available evidence to build a strategy for the treatment of these patients. The Mexican College of Rheumatology selected a committee to evaluate these different alternatives and make recommendations. METHODS: The study group included 16 rheumatologists and 3 certified dermatologists, selected from different health institutions and regions of the country. An executive committee was formed to coordinate the meetings and a committee of experts selected the literature search criteria, prepared the research questions, rated the quality of the evidence, and produced the recommendations in the different disease domains based on the GRADE methodology. RESULTS: 24 updated recommendations were generated for the treatment of patients with psoriatic arthritis. The recommendations establish the role of the drugs currently available in our country. The importance of adequate disease control is emphasized, individualizing the level of involvement of each patient in each of the six domains potentially affected by the disease. In addition, the sequence in the choice of treatments available for each domain is established, based on their efficacy, safety profile and accessibility. CONCLUSIONS: With this consensus document, it will be possible to improve the care of patients with psoriatic arthritis. The recommendations were generated based on the best available information and in consideration of the Mexican health system.

Recommendations of the Mexican College of Rheumatology for the management of psoriatic arthritis. / Recomendaciones del Colegio Mexicano de Reumatología para el manejo de la artritis psoriásica.

Psoriatic arthritis is a chronic systemic inflammatory disease that affects the skin, musculoskeletal structures and other organs and systems compromising functionality, quality of life and reducing the life expectancy of patients. It is a complex disease that requires specialist and timely care and management. The alternatives for treating the manifestations of psoriatic arthritis have increased and the effect of the different agents on specific manifestations has been clarified in recent studies. Therefore, we should incorporate the available evidence to build a strategy for the treatment of these patients. The Mexican College of Rheumatology selected a committee to evaluate these different alternatives and make recommendations. METHODS: The study group included 16 rheumatologists and 3 certified dermatologists, selected from different health institutions and regions of the country. An executive committee was formed to coordinate the meetings and a committee of experts selected the literature search criteria, prepared the research questions, rated the quality of the evidence, and produced the recommendations in the different disease domains based on the GRADE methodology. RESULTS: 24 updated recommendations were generated for the treatment of patients with psoriatic arthritis. The recommendations establish the role of the drugs currently available in our country. The importance of adequate disease control is emphasized, individualizing the level of involvement of each patient in each of the six domains potentially affected by the disease. In addition, the sequence in the choice of treatments available for each domain is established, based on their efficacy, safety profile and accessibility. CONCLUSIONS: With this consensus document, it will be possible to improve the care of patients with psoriatic arthritis. The recommendations were generated based on the best available information and in consideration of the Mexican health system.

Evaluation of in vitro bioactivity and in vitro biocompatibility of Polycaprolactone/Hyaluronic acid/Multiwalled Carbon Nanotubes/Extract from Mimosa tenuiflora composites.

BACKGROUND: The development of biomaterial scaffolds and implementation of tissue engineering techniques are necessary. Therefore, Polycaprolactone/Sodium Hyaluronate/Multiwalled Carbon Nanotubes/Extract of Mimosa tenuiflora composites have been produced by a thermally-induced phase separation method. OBJECTIVE: The objective of this research was to evaluate the in vitro bioactivity and in vitro biocompatibility of the composites. METHODS: The in vitro bioactivity of the composites was assessed by soaking them in simulated body fluid for 7, 14, 21, and 28 days. The structure and composition of the composites were analyzed using scanning electron microscopy coupled with energy dispersive spectroscopy and Fourier transform infrared spectroscopy. Also, the in vitro biocompatibility of the composites was evaluated by means of alkaline phosphatase activity of the osteoblasts and by measuring the metabolic activity of the cells using MTT assay. RESULTS: The results show a porous and interconnected morphology with enhanced bioactivity. It was observed that the incorporation of Mimosa tenuiflora in the composites promotes increased viability of osteoblasts in the scaffolds. CONCLUSIONS: The results show the efficiency of bioactive and biocompatible composites and their potential as candidates for tissue engineering applications.

Mucoadhesive polymeric systems for vaginal drug delivery: a systemic review / Sistemas poliméricos mucoadhesivos para la liberación vaginal de fármacos: revisión sistemática

ABSTRACT Intravaginal drug administration has many advantages in comparison to other delivery routes: its local and systemic effect, lower dosages, and easiness of administration. Furthermore, makes it a reliable and comfortable way of therapy. This route can be used to prevent and treat a wide range of conditions including, sexually transmitted infections (STIs), hormonal treatment, birth control, and cancer treatment. The dosage forms may vary from ovules, tablets, rings, gels, creams, films and many more; lately adding the mucoadhesiveness to the characteristics to reduce the waste of active molecules. This review focuses on the way mucoadhesive polymeric systems have been applied in vaginal delivery. This review presents a bibliographical compilation of results from various investigations published in scientific databases: Science Direct, SciELO, and PubMed Central. Results compiled demonstrate that the intravaginal drug administration can be an alternative form of medication for women with more stable and prolonged results than traditional routes requiring lower doses and avoiding the first-pass effect.

RESUMEN La administración de fármacos por vía intravaginal cuenta con múltiples ventajas a comparación de otras rutas, puede lograr un efecto tanto local como sistémico, las dosis requeridas son menores, facilidad de administración entre otras, hacen que esta forma de administración sea confiable y cómoda. Esta vía de administración puede ser empleada para prevenir y tratar diferentes trastornos, como enfermedades de transmisión sexual, desordenes hormonales, anticonceptivos y tratamiento contra el cáncer. La presentación de las dosis puede variar, desde óvulos, tabletas, anillos, geles, cremas, películas entre otros, agregando a esta, en los últimos tiempos, la característica de mucoadhesividad para reducir el desecho de moléculas activas. Este trabajo se enfoca en las aplicaciones que han tenido los sistemas poliméricos mucoadhesivos en la vía intravaginal. La bibliografía recolectada se obtuvo de bases de datos como Science direct, SciELO, y PubMed Central. Los resultados obtenidos demuestran que la administración de fármacos por vía intravaginal puede ser una forma alternativa para medicación en mujeres, con resultados más estables y prolongados que otras rutas, requiriendo menores dosis y evitando el efecto de primer paso.

Efectos de los medios sociales en la eficacia política, capital social y participación política de los jóvenes universitarios en México y Colombia

En los últimos años se han incrementado los estudios académicos sobre los efectos de los medios sociales en la participación política convencional. Existen dos dimensiones que aparecen de manera constante en esta línea de investigación emergente: la construcción del capital social y el sentimiento de eficacia política. En el presente estudio se compara a dos grupos de jóvenes universitarios de dos diferentes países latinoamericanos (México y Colombia) en torno a sus respuestas de acciones que confirman su sentimiento de eficacia política, así como los elementos que les permiten construir capital social con la ayuda de los medios sociales. De igual manera, se lleva a cabo una relación de estos conceptos con su participación dentro y fuera de línea. Respecto a las conclusiones, no se encontraron grandes variaciones entre los dos grupos que participaron en el estudio. No obstante, los resultados confirman una tendencia que ha aparecido en otros estudios similares: la participación política dentro y fuera de línea tiene una fuerte relación entre sí, así como con los constructos de capital social y eficacia política.

Academic studies on the effects of social media on conventional political participation have increased in recent years. There are two dimensions that appear constantly in this line of emerging research: the construction of social capital and the sentiment of political efficacy. In this study, two groups of university students from different Latin American countries (Mexico and Colombia) are compared around their responses of actions that confirm their sentiment of political efficacy, as well as the elements that allow them to construct social capital with the help of the media, social. In the same way, these concepts are related to their participation inside and outside social media. Among the conclusions we found that there were no great variations between the two groups that participated in the study. However, the results confirm a trend that has been identified in other similar projects: political participation inside and outside social media has a strong relationship with each other, as well as with the constructs of social capital and political efficiency.

Os estudos acadêmicos sobre os efeitos das mídias sociais na participação política convencional aumentaram nos últimos anos. Existem duas dimensões que aparecem constantemente nessa linha de investigação emergente: a construção do capital social e o sentimento de eficacia política. Este estudo compara dois grupos de estudantes universitários de dois países latinoamericanos diferentes (México e Colômbia) em torno de suas respostas a ações que confirmam seu senso de eficacia política, bem como os elementos que lhes permitem construir capital social com a ajuda das mídias sociais. Da mesma forma, esses conceitos estão relacionados á sua participação dentro e fora da linha. Entre as conclusões, descobrimos que não houve grandes variações entre os dois grupos que participaram da pesquisa. Não obstante o que precede, os resultados confirmam uma tendência que foi identificada em outras pesquisas similares: a participação política dentro e fora da linha tem uma forte relação entre si, assim como com as construções de capital social e eficacia política.

Ensayo a ciego simple del efecto hipoglucemiante de phyllanthus niruri (huevito escondido) y su combinación con azadirachta indica (NIM) en ratas wistar / A simple blind test of hypoglycemic effect of phyllanthus niruri (huevito escondido) and its combination with azadirachta indica (NIM) in wistar rats

Objetivo: valorar el efecto hipoglucemiante de un extracto acuoso de la planta entera Phyllantus niruri, hojas de Azadirachta indica y su combinación. Métodos: Se diseñó un ensayo cruzado a ciego simple, preparándose extractos acuosos de hojas de A. indica y planta entera de P. niruri, colocando 70 g en 200 mL de agua a 55-60 °C, conformando tres tratamientos: uno para cada extracto y el tercero la combinación. Como control positivo o de referencia se utilizó el extracto de A. Indica. Se emplearon 18 ratas Wistar a las que se administró el tratamiento vía oral una sola vez, a razón de 5 mL/300 g de peso. La glucemia se midió con un glucómetro One Touch Ultra antes y 2h después del tratamiento. Se aplicó la prueba ANOVA a los datos. Resultados: Hubo disminución de la glucemia con los tres tratamientos. No se encontró diferencia entre los tratamientos probados. Conclusiones: el extracto acuoso de la planta entera de Phyllanthus niruri tiene un efecto hipoglucemiante similar al extracto acuoso de hojas de Azadirachta indica. No hubo evidencia de efecto sinérgico.

Objective: to evaluate the hypoglycemic effect of aqueous extract of Phyllanthus niruri whole plant and its combination with one of Azadirachta indica leaves. Methods: A single-blind crossover trial was design. One for each extract and the third corresponding to the combination: aqueous extracts of leaves of Azadirachta indica and whole plant Phyllanthus niruri, placing 70 g of the plant material in 200 mL of water at 55-60 ° C, three treatments were prepared. The comparison was performed using the extract of Azadirachta indica as control. Eighteen Wistar rats were used. Treatment was given orally at a dose of 5 mL/300 g. Glucose measurement was made with a glucometer One Touch Ultra before and 2h after administration of the treatment. ANOVA was applied to the data. Results: There was a decrease in blood glucose levels with the three treatments. No difference was found between the tested treatments regarding the hypoglycemic effect. Conclusions: The aqueous extract of the whole plant of Phyllanthus niruri has a similar hypoglycemic effect to aqueous extract of Azadirachta indica leaves. There was no evidence of synergistic effect.

[Efficacy of rituximab versus cyclophosphamide in lupus patients with severe manifestations. A randomized and multicenter study]. / Eficacia de rituximab comparado con ciclofosfamida en pacientes con manifestaciones graves de lupus eritematoso generalizado. Estudio aleatorizado y multicéntrico.

UNLABELLED: There are no controlled studies that compare the efficacy of RTX with standard treatment, such as cyclophosphamide, in patients with systemic lupus erythematosus (SLE). OBJECTIVE: The objective of this study was to compare the efficacy of rituximab to that of cyclophosphamide in patients with severe manifestations of SLE. MATERIALS AND METHOD: This is a multicenter, randomized open and controlled trial in adults with a diagnosis of active SLE. Patients were randomized into two groups; group 1: treated with RTX and group 2: cyclophosphamide pulses with the same steroid scheme. We registered MEX-SLEDAI, steroid requirements and adverse events for 12 months. Descriptive and comparative statistic analysis was performed. RESULTS: 19 patients were included, 17 females, mean age 35.7±12.1 years and duration of disease 5.6 years (range 0.35 to 30.8 years). There were no differences at baseline regarding gender, age, duration of disease, previous treatments or disease activity between both groups. MEX-SLEDAI was reduced from 12 to 3 in group 1 and from 9 to 2 in group 2 (p=0.80). Nevertheless, patients treated with RTX had a faster improvement. There was no difference in the cumulative steroid dose. Both groups had significant reduction in antinuclear antibody levels and similar increase in C3 levels. Adverse events were similar in both groups. CONCLUSION: This comparative clinical study in patients with SLE shows that rituximab can be as useful as cyclophosphamide for severe manifestations, maybe showing a faster response. Adverse events were no different. Rituximab should be considered as an adequate alternative for this group of patients.

Actividad garrapaticida de Azadirachta indica A. Juss. (nim) / Tick control activity of Azadirachta indica A. Juss. (neem)

Introducción: la infestación por garrapatas constituye en muchos países un grave problema que limita la producción agropecuaria, altera la salud de animales productores de alimento, de animales de compañía y quizá en muchas ocasiones también del ser humano. La planta Azadirachta indica A. Juss. es una de las más estudiadas por su amplia actividad biocida, en particular para artrópodos. Por considerarse fuente de acaricidas biodegradables, la actividad garrapaticida de sus extractos obtenidos, sobre todo de hojas y semillas, ha sido investigada de modo insistente; sin embargo, la información potencialmente útil continúa estando dispersa, variable desde el punto de vista metodológico o de su eficacia, y no pocas veces contradictoria. Objetivo: recopilar y analizar la información publicada disponible sobre el efecto garrapaticida de Azadirachta indica. Métodos: se realizó una revisión de la literatura sobre la base del motor de búsqueda Google y la base de datos PubMed a partir del año 2000, con el fin de organizar la información disponible sobre la actividad garrapaticida de la planta. Resultados: se logró recopilar y organizar información sobre la actividad garrapaticida de Azadirachta indica A. Juss., considerando especialmente parte de la planta empleada, tipo de extracto elaborado, productos disponibles, metodología para su preparación, tipo de ensayo in vivo o in vitro, dosificación, efectos sobre el parásito y eficacia. Conclusiones: puede considerarse la planta lo suficiente bien estudiada en cuanto a sus efectos garrapaticidas, se requiere probar la incorporación de sus extractos a productos como baños, champús, jabones y otros, así como comprobar la persistencia de sus propiedades y eficacia.

Introduction: tick infestation is a serious problem in many countries, for it affects agricultural yield and the health of food-producing animals, pets and on many occasions even human beings. Azadirachta indica A. Juss. is one of the most widely studied plants, due to its broad biocide activity, particularly against arthropods. Considered a source of biodegradable acaricides, the tick control activity of the extracts obtained mainly from its leaves and seeds has been widely studied. However, potentially useful information about the subject is still scattered, methodologically variegated, of varying effectiveness and often contradictory. Objective: collect and analyze the available published information about the tick control effect of Azadirachta indica. Methods: a bibliographic review was conducted based on Google search engine and PubMed database as of the year 2000, with the purpose of organizing the information available about the tick control activity of the plant. Results: information about the tick control activity of Azadirachta indica A. Juss. was gathered and organized according to the plant section used, type of extract obtained, available products, preparation methodology, in vivo or in vitro assay type, dosing, effects on the parasite and effectiveness. Conclusions: the tick control effects of the plant may be considered to be sufficiently studied. Incorporation of its extracts into products such as baths, shampoo, soap and others, require further research. Persistence of its properties and effectiveness should also be verified.

Sphygmomanometry-evoked allodynia--a simple bedside test indicative of fibromyalgia: a multicenter developmental study.

BACKGROUND: One of the 2 classification criteria for fibromyalgia (FM) is the presence of tender points on specific anatomic sites. It has been established that these tender points reflect a state of generalized allodynia (defined as pain resulting from a stimulus that does not normally provoke pain). Patients with FM often describe pain elicitation during blood pressure testing (sphygmomanometry). OBJECTIVE: The objective of this study was to define if a universally used clinical test, sphygmomanometry, is helpful in the identification of patients with FM. METHODS: The authors conducted a prospective multicenter study in 3 different public rheumatology outpatient services. Each center studied 20 patients with FM, 20 with rheumatoid arthritis, 20 with osteoarthritis, and 20 healthy individuals. The following question was asked of each participant: "When I take your blood pressure, tell me if the cuff's pressure brings forth pain." The blood pressure cuff was inflated at an approximate rate of 10 mm Hg per second up to 180 mm Hg or to the point when pain was elicited. RESULTS: Sixty-nine percent of patients with FM had sphygmomanometry-evoked allodynia in contrast to 10% of patients with osteoarthritis, 5% with rheumatoid arthritis, and 2% of healthy individuals (P < 0.001). The mean blood pressure value at which allodynia was elicited was lower in patients with FM (143 +/- 40 mm Hg) when compared with the other 3 groups (176 +/- 11 mm Hg) or higher (P < 0.001). In patients with FM, there was a significant negative correlation between the blood pressure value at which allodynia developed and total Fibromyalgia Impact Questionnaire (FIQ) score, number of tender points, and the FIQ visual analog scales for pain intensity and fatigue (P < 0.05). The test yields a diagnostic sensitivity for FM of 0.7, specificity 0.96, positive predictive value 0.86, and negative predictive value 0.91. CONCLUSIONS: In this developmental study of patients attending rheumatology clinics, the generation of pain during blood pressure testing was strongly associated with the diagnosis of FM. This robust linkage probably reflects a tautologic phenomenon. A sine qua nonelement for FM diagnosis is the presence of tender points in discrete anatomic sites. These tender points in turn reflect a state of generalized mechanical allodynia that can be locally elicited by the cuff pressure during blood pressure testing. Sphygmomanometry is a simple bedside test that may be useful in the recognition of patients with FM. Blood pressure testing is a universal procedure in all clinical environments. Based on our results, we suggest searching for FM features in any person who has sphygmomanometry-evoked allodynia.

Hipotermia y corazón / Hypothermia and heart

Las ondas J o de Osborn son deflexiones positivas al final del complejo QRS, que han sido descritas en electrocardiogramas de pacientes con hipotermia. Se presenta el caso de un paciente masculino de 62 años de edad con hipotermia, cuyo electrocardiograma mostró bradicardia sinusal y ondas de OSBORN...

Cardiopatía por estrés (TAKOTSUBO) en niño de 2 años tras cierre quirúrgico de comunicación interventricular / Stress cardiopathy (TAKOTSUBO) in a 2-year-old boy after surgical closure of ventricular septal defect

La cardiomiopatía por estrés (de Takotsubo) es un síndrome caracterizado por disfunción ventricular izquierda transitoria, con anomalías de la contractilidad características, predominantemente a nivel apical. Presentamos el caso de un niño de 2 años quién desarrolló una cardiomiopatía de Takotsubo después del cierre quirúrgico de una comunicación interventricular. Este síndrome es poco común en niños, y a nuestro conocimiento, este es el primer caso de este tipo de cardiomiopatía tras cirugía cardíaca en un niño.

Reumatólogos certificados en la República Méxicana: cuántos somos y dónde estamos

El último censo de población y vivienda (1990) reporta una cifra de 81'249,465 habitantes que se asientan sobre una superficie territorial del 1'967,183 Km cuadrados, lo cual da una densidad de población de 41 habitantes por Km cuadrado. El Consejo Mexicano de Reumatología, inicia su certificación para especialistas en 1975 con el reconocimiento de 31 reumatólogos logrando una cobertura de 10 estados con el mayor asentamiento en el Distrito Federal (16 = 51 por ciento). Con el inicio de la resistencia para especialización en Reumatología, se tiene una producción promedio de 15 especialistas por año y para 1985, se registran 169 reumatólogos, en tanto que para 1992, se tiene la cifra de 285 distribuidos en 28 estados con el mayor número en el D.F. De acuerdo con la tasa media, el crecimiento anual de la población 2.6 por ciento; la producción y distribución de reumatólogos es inadecuada ya que hay entidades que tienen un reumatólogo para una población de 84,038 a 2'620,637 habitantes. se sugiere un estudio de mercado y comportamiento del mismo para ofrecer una mejor distribución de los reumatólogos de nuevo egreso y poder obtener así una mejor cobertura poblacional

Indoprofen en osteoartrosis. / Indoprofen in osteaorthrosis

Se llevo al cabo un estudio abierto en 56 pacientes con osteoartrosis, para evaluar la eficacia y tolerancia del indoprofen a dosis de 600 mg al dia, por via oral. Los resultados obtenidos fueron optimos en 90,5%, buenos en el 7.1% y malos en el 2.4% de los pacientes. La mejoria clinica se observo desde la primera semana de tratamiento. La significacion estadistica fue de p < 0.01 en todos los parametros evaluados. Los efectos secundarios fueron leves y desaparecieron espontaneamente

Fractura por estrés en artritis reumatoide / Stress fracture in rheumatoid artritis

Objetivo. Describir las características clínicas y radiográficas de siete pacientes con artritis reumatoide (AR) que presentaron ocho fracturas por estrés (FE). Método. En un lapso de 10 años se reunieron retrospectivamente siete casos de pacientes con AR, que estaban bajo tratamiento y control médico. La información se obtuvo de los expedientes clínicos y estudios radiográficos. Resultados. Todas las pacientes fueron mujeres con edad promedio de 51.2 años, duración promedio de la enfermedad, 13.2 años y factor reumatoide seropositivo. Como parte de su esquema de tratamineto, todas recibían antiinflamatorio no esteroideo e inductores de remisión. Las siete pacientes estaban recibiendo dosis bajas de corticoesteroides por vía oral. Previo a la FE se enocntraban en clase funcional I-II y sin causa aparente cursaron con datos de inflamación peri o paraarticular. La radiografía inicial no fue concluyente en todos los casos, pero 3 y 4 semanas después se hizo evidente el trazo de fractura. Todas las fracturas ocurrieron en extremidad pélvica (4 en metatarsianos, 2 en el peroné y una doble en iliopubis e isquiopubis). En todos los casos se hizo un manejo conservador, con respuesta satisfactoria. Conclusiones. El dolor, la inflamación y la limitación de la función, con topografía peri o paraarticular cuando ocurre en pacientes con AR deben orientar a la posibilidad de fracturas por estrés. El seguimiento radiológico permite confirmar o descartar dicha posibilidad

Timpanoplastia: cinco años de experiencia en un hospital de enseñanza / Tympanoplasty: five years experience in a teaching hospital

Se realizó un estudio retrospectivo en el que se incluyeron 66 pacientes con perforaciones timpánicas, tanto marginales como centrales, que fueron sometidos a timpanoplastia en un periodo de cinco años en el Servicio de Otorrinolaringología del Hospital Regional Primero de Octubre. Se presenta la experiencia obtenida con técnicas de timpanoplastia, tanto por vía endaural como retroauricular. Con la utilización de injertos de fascia de músculo temporal se logró el cierre de la perforación en un 65 por ciento de casos y con pericondrio de trago en un 63 por ciento. Los procedimientos fueron realizados por médicos en entrenamiento bajo estrecha supervisión