Update of the Mexican College of Rheumatology Guidelines for the Pharmacological Treatment of Rheumatoid Arthritis, 2018. / Actualización de las guías del tratamiento farmacológico de la artritis reumatoide del Colegio Mexicano de Reumatología 2018.

Therapeutic advances in rheumatoid arthritis require periodic review of treatment guidelines. OBJECTIVE: To update the Mexican College of Rheumatology guidelines on the pharmacological treatment of rheumatoid arthritis. METHOD: Board certified rheumatologists from different health institutions and regions of the country participated. Work teams were formed that reviewed the previous guidelines, elaborated new questions, reviewed the literature, and scored the evidence that was presented and discussed in plenary session. The conclusions were presented to infectologists, gynaecologists and patients. Recommendations were based on levels of evidence according to GRADE methodology. RESULTS: Updated recommendations on the use of available medications for rheumatoid arthritis treatment in Mexico up to 2017 are presented. The importance of adequate and sustained control of the disease is emphasized and relevant safety aspects are described. Bioethical conflicts are included, and government action is invited to strengthen correct treatment of the disease. CONCLUSIONS: The updated recommendations of the Mexican College of Rheumatology on the pharmacological treatment of rheumatoid arthritis incorporate the best available information to be used in the Mexican health care system.

Dosimetry and Calorimetry Performance of a Scientific CMOS Camera for Environmental Monitoring.

This paper explores the prospect of CMOS devices to assay lead in drinking water, using calorimetry. Lead occurs together with traces of radioisotopes, e.g., 210Pb, producing g-emissions with energies ranging from 10 keV to several 100 keV when they decay; this range is detectable in silicon sensors. In this paper we test a CMOS camera (OXFORD INSTRUMENTS Neo 5.5) for its general performance as a detector of X-rays and low energy g-rays and assess its sensitivity relative to the World Health Organization upper limit on lead in drinking water. Energies from 6 keV to 60 keV are examined. The CMOS camera has a linear energy response over this range and its energy resolution is for the most part slightly better than 2%. The Neo sCMOS is not sensitive to X-rays with energies below ~10 keV. The smallest detectable rate is 40 ± 3 mHz, corresponding to an incident activity on the chip of 7 ± 4 Bq. The estimation of the incident activity sensitivity from the detected activity relies on geometric acceptance and the measured efficiency vs. energy. We report the efficiency measurement, which is 0.08(2)% (0.0011(2)%) at 26.3 keV (59.5 keV). Taking calorimetric information into account we measure a minimal detectable rate of 4 ± 1 mHz (1.5 ± 0.1 mHz) for 26.3 keV (59.5 keV) g-rays, which corresponds to an incident activity of 1.0 ± 0.6 Bq (57 ± 33 Bq). Toy Monte Carlo and Geant4 simulations agree with these results. These results show this CMOS sensor is well-suited as a g- and X-ray detector with sensitivity at the few to 100 ppb level for 210Pb in a sample.

Malformacion uterina arteriovenosa / Uterine arteriovenous malformation

RESUMEN La malformación arteriovenosa uterina (MAVU) es una causa poco frecuente de sangrado uterino, dado que en la mayoría de casos cursa de forma asintomática. Las MAVU son dilataciones varicosas arteriovenosas intramiometriales sin afectación capilar. Plantean un reto diagnóstico y terapéutico en el esfuerzo de la preservación de la fertilidad, constituyéndose la embolización como su principal tratamiento. En la actualidad, el estándar de oro para el diagnóstico de esta patología es la angiografía. Sin embargo, las modalidades menos invasivas como la ecografía Doppler color se utilizan cada vez más para el diagnóstico. Se presenta el caso de una mujer de 20 años de edad, con antecedente de embarazo molar y sangrado menstrual excesivo debido a MAVU.

ABSTRACT Uterine arteriovenous malformation (AVMV) is a rare cause of uterine bleeding, since most cases are asymptomatic. The MAVU are intramyometrial arteriovenous variceal dilatations without capillary involvement. They propouse a diagnostic and therapeutic challenge in the effort for preservation of fertility, constituting the embolization its main treatment. At present, the gold standard for the diagnosis of this pathology is angiography. However, less invasive modalities such as color Doppler ultrasound are increasingly used for diagnosis. We present the case of a 20-year-old woman with a history of molar pregnancy and excessive menstrual bleeding due to MAVU.

Nutrición y embarazo: explorando el fenómeno en Pachacútec, Ventanilla-Callao / Nutrition and pregnancy in Pachac£tec, Ventanilla-Callao

Objetivo: Describir los hábitos alimentícios de un grupo de mujeres gestantes en una zona urbano-marginal del Callao. Métodos: Estudio observacional, descriptivo, transversal. Se encuestó a 18 mujeres gestantes que acud¡an a los talleres de psicoprofilaxis obstétrica durante el mes de junio del 2012 en el Centro de Salud Materno Infantil Pachacútec Perú-Corea en el distrito de Ventanilla, Callao. Se evaluó la frecuencia de consumo de alimentos semanal enfocando la alimentación en la etapa gestacional según los lineamientos de nutrición materno-infantil del Perú. Resultados: El consumo más frecuente de comidas por d¡a fue “3 veces” (12 gestantes), siendo los alimentos más frecuentes las frutas “más de 5 veces a la semana” (16 gestantes), carne de res “1 a 2 veces a la semana” (12 gestantes), pollo “1 a 4 veces por semana” (12 gestantes), queso “más de 5 veces a la semana” (12 gestantes), anchoveta “1 a 2 veces por semana” (11gestantes). No consumieron habitualmente sangrecita ocho gestantes. Solo siete gestantes consumieron “verduras de hoja verde” y “otras verduras” “más de 5 veces a la semana”. Ocho gestante consumieron infusiones “más de 5 veces por semana”. Ninguna gestante refirió consumir “Comida chatarra” “más de 5 veces a la semana”. Conclusiones: Es alarmante la baja ingesta de alimentos recomendados, a pesar de ser económicos y de alto valor nutricional, los cuales contribuyen al peso adecuado del recién nacido. Esto muestra que los programas de difusión de estos alimentos y elaboración de recetarios no estar¡a cumpliendo con sus objetivos.

Objective: To describe dietary habits of a group of pregnant women in a marginal urban zone of Callao. Methods: Observational, cross-sectional, descriptive study. A survey was applied to 18 pregnant women attending in psychoprophylaxis in the Health Care Center "Pachac£tec Per£-Corea" in Ventanilla; weekly frequency of food consumption was evaluated, focusing on alimentation in gestational stage according to the guidelines of Peru's infantile maternal nutrition. Results: The frequency of food consumption per day was "3 times" (12 pregnant women). Being most frequent foods fruits "more than 5 times per week" (16 pregnant women), red meat "1 to 2 times per week" (12 pregnant women), chicken "1 to 4 times per week" (12 pregnant women), cheese "more than 5 times per week" (12 pregnant women), anchovy "1 to 2 times per week" (11 pregnant women). Eight pregnants referred not habitually consumption of "sangrecita". Only 7 pregnant women consumed "green leafy vegetables" and "other vegetables" "more than 5 times per week" respectively. Eight pregnant women consumed infusions "more than 5 times for week". "Junk food" was refered to not be consumed "more than 5 times per week". Conclusions: Low intake of recommended foods is alarming, despite of being economical and highly nutritive, that allows a newborn's adequate weight. This shows that the diffusion programs of these foods and elaboration of cookbooks are not reaching their objectives.

The quality of removable prostheses in dentate, community-dwelling elderly residing in Puerto Rico.

PURPOSE: Edentulism has been decreasing in the US elderly population; however, due to the increasing number of elderly, the need for prostheses has been projected to rise over the next several decades. One of the aims of the Puerto Rican Elderly Dental Health Study (PREDHS) was to assess the quality of removable prostheses (RP) in the Puerto Rican (PR) elderly (>69 years of age) population. METHODS: A cross-sectional design, using a subgroup from the Puerto Rican Elderly: Health Conditions (PREHCO) study of dentate, community-dwelling older adults from the greater San Juan area was employed. Eligible participants were administered structured questionnaires and examined in their homes by three trained and calibrated dentists using National Institute of Dental and Craniofacial Research (NIDCR) criteria. RESULTS: One hundred and eighty three (183) participants were examined (61 males, 122 females) (p < 0.001). Overall, 64% were found to have a prosthetic problem with no statistical difference between genders. Unadjusted and age-adjusted logistic models were employed. Increasing age was associated with both upper and lower clinically defined abraded prostheses, (p = 0.007; p = 0.041, respectively). Maxillary (23%) and mandibular (27%) prostheses needed replacement due to deficiencies. CONCLUSION: RP deficiencies were found in almost two-thirds of a representative sample of dentate 70+ year-old people residing in PR. There was no difference in the proportion of deficiencies between elderly who reported a dental visit in the preceding year or not having seen a dentist. A quarter of the prostheses required replacement. The findings from this and the NHANES studies demonstrate that an engaged and recognized prosthodontic dental school faculty continues to be as important now as it was a generation ago.

Diagnóstico de leishmaniasis utilizando medio d cultivo tstb en pacientes de trópico de Cochabamba / Diagnóstico de leishmaniasis utilizando medio d cultivo tstb en pacientes de trópico de Cochabamba

Se realizó un estudio prospectivo, analítico y experimental para determinar el porcentaje de sensibilidad de un nuevo medio de cultivo para el diagnóstico de Leishmania, denominado TSTB (Torrico-Solano-Torrico-Bermúdez). Se obtuvieron las muestras por aspirado de úlceras con sospecha clínica de Leishmaniasis de pacientes provenientes del trópico de Cochabamba. Los objetivos planteados fueron determinar el porcentaje de sensibilidad del cultivo ya mencionado y analizar el crecimiento de parásitos de Leishmania. Como resultados se obtuvo un 90% de sensibilidad mediante este método diagnóstico y una mínima contaminación por hongos (mohos y levaduras); además, un cambio de coloración en el medio de cultivo debido al crecimiento y multiplicación de los parásitos por consumo de los nutrientes.

A prospective, analytic and experimental study was realized, in which we tried to determine the percentage of sensitive of a new culture medium for the diagnosis of Leishmania, denominated Torrico-Solano-Torrico-Bermudez (TSTB). Samples were obtained by a piration of ulcers with clinical suspicion of Leishmaniasis from patients proceeding from the tropical area of Cochabamba. The objectives planted were to determine the percentage of sensitive of the mentioned culture and to analyze the growth of the parasites of Leishmania. As a result, a 90 % of positivity was obtained with this diagnostic method, with a minimum contamination by fungus (moss and yeast); further more, a change in the colour of culture medium was observed, because of the growth and multiplication of the parasites by consumption of the nutrients.

Exostosis following a free gingival graft.

BACKGROUND: There have been few cases reported of exostoses following a free gingival graft. In 1980, a free gingival graft was placed on the facial level of 33-34, developing over the years a significant enlargement. In 1999, since the patient felt progressively uncomfortable with the enlarged area, its surgical reduction was proposed. METHOD: Under local anesthesia, the hard tissue developed under the previously-grafted area, was significantly reduced. The specimen, together with a fragment of the covering soft tissue, was sent for histological analysis. RESULTS: The surgical wound healed uneventfully, and the patient was satisfied with the results. The histology showed the presence of mature bone surrounded by a dense connective tissue, whereas the gingival tissue showed acanthosis and fibrosis. CONCLUSION: The development of exostoses following a free gingival graft can be considered an unpredictable, albeit infrequent side-effect of this procedure. The fact that most of these exostoses appear in the cuspid-premolar area, deserves further consideration.