Risk of diabetes mellitus in systemic lupus erythematosus: systematic review and meta-analysis.

OBJECTIVE: To investigate the risk of DM and evaluate the impact of SLE therapies on the risk of developing DM in patients with SLE. METHODS: Electronic database searches of PubMed, Embase, Cochrane Library and Web of Science were performed from inception to February 2023. Cohort and cross-sectional studies that analysed the risk of DM in patients with SLE were included. The associations between diabetes and antirheumatic agents, such as antimalarials and glucocorticoids, were analysed in cohort studies. Data were pooled using fixed- or random-effects meta-analysis to estimate pooled odd ratios (OR), relative risks (RR) and 95% confidence intervals (CIs). This study was registered with PROSPERO (CRD42023402774). RESULTS: A total of 37 studies (23 cross-sectional and 14 cohort studies) involving 266 537 patients with SLE were included. The pooled analyses from cross-sectional studies and cohort studies did not show an increased risk of DM in SLE patients (OR = 1.05, 95% CI 0.87-1.27; P = 0.63 and RR = 1.32, 95% CI 0.93-1.87; P = 0.12, respectively). However, several cohort studies consistently demonstrated a reduced risk of diabetes with antimalarials, while glucocorticoid use has been associated with an increased risk of developing diabetes. Age, sex, hypertension and immunosuppressants have not been identified as risk factors for DM in SLE patients. CONCLUSION: Although there was no increased risk of DM in patients with SLE compared with controls, HCQ users or adherents had a decreased risk, whereas glucocorticoid users had an increased risk.

Low disease activity state associated with fewer incident vertebral fractures in Mestizo women with systemic lupus erythematosus.

BACKGROUND: Low disease activity state (LDAS) has been linked to a significant reduction in flares and damage accrual in patients with systemic lupus erythematosus (SLE); however, the effect of LDAS on the risk of vertebral fractures (VFs) in subjects with SLE is unknown, considering that low bone mineral density (BMD) and VF are frequent in SLE. OBJECTIVE: to evaluate whether achieving LDAS ≥50% of the observation time prevents new VF and BMD changes in Mestizo women. METHODS: We carried out a longitudinal, observational, and retrospective study. Mestizo women with SLE were included for a median of an 8-year follow-up. LDAS was described as Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score ≤4, prednisone ≤7.5 mg/day, and stable immunosuppressive therapies. BMD measurements and lateral thoracic and lumbar radiographs for a semiquantitative analysis for VF were assessed at baseline and during the follow-up. Uni- and multivariable interval-censored survival regression models were carried out. RESULTS: We included 110 patients: 35 (31.8%) had new VF. A total of 56 patients (50.1%) achieved LDAS ≥50% of the time during the follow-up and achieved a significantly lesser risk of incident VF (HR = 0.16; 95% CI, 0.06-0.49). After adjusting by age, BMI, menopause, prevalent VF, baseline BMD, cumulative glucocorticoid use, and anti-osteoporotic therapy, LDAS-50 was significantly related to a decrease in the risk of a new VF (HR = 0.39; 95% CI, 0.16-0.98). There was no association between LDAS and BMD measurement changes. When only patients on LDAS but not in remission (n = 43) were evaluated for the risk of incident VF, both uni- and multivariate analyses were significant (HR = 0.12; 95 CI, 0.04-47; p = 0.001, and HR = 0.26; 95% CI, 0.7-0.88; p = 0.03). CONCLUSIONS: LDAS ≥50% of the time was significantly associated with a diminished risk of new VF in Mestizo women with SLE, even in patients not in remission. However, LDAS did not help modify BMD changes over time.

SLICC-Frailty Index and Its Association with Low Bone Mineral Density and Vertebral Fractures in Women with Systemic Lupus Erythematosus.

The Systemic Lupus International Clinics (SLICC)-Frailty Index (FI) is associated with adverse outcomes in systemic lupus erythematosus (SLE). However, to our knowledge, its association with bone mineral density (BMD) and vertebral fractures (VF), has not been investigated using a standardized methods. Our aim was to evaluate the relationship between frailty assessed by SLICC-FI, and BMD and VF in Mestizo women with SLE. Adult women were included in this cross-sectional study. Information concerning the risk factors for VF and BMD in the lumbar spine and total hip was acquired. SLICC-FI was assessed at baseline. A semi-quantitative method was utilized to evaluate the prevalence of VF on lateral thoracolumbar radiographs. Univariate and multivariate regression analyses were performed adjusting for age, body mass index (BMI), SLE duration, cumulative glucocorticoid dose, bisphosphonate use, and BMD measurements. We included 202 women with SLE (mean age [SD] = 43.3 [13.6] years). The mean (SD) SLICC-FI value was 0.14 (0.09). Eleven (5.4%) patients were categorized as robust, 62 (30.7%) as relatively less fit, 84 (41.6%) as least fit, and 45 (22.3%) as frail. Both univariate and multivariate models showed associations between frailty (defined as SLICC-FI > 0.21) and prevalent VF in the entire population (OR 5.76, 95% CI 2.53-13.12; P < 0.001) and in the premenopausal group (OR 4.29, 95% CI; P = 0.047). We also found an association between the SLICC-FI and low BMD. In conclusion, frailty assessed by SLICC-FI might be associated with VF and low BMD in mestizo females with SLE.

Trends in mortality in patients with systemic autoimmune rheumatic diseases (SARD) during the COVID-19 pandemic in Mexico.

The study aimed to analyze the influence of the COVID-19 pandemic on mortality rates in patients with systemic autoimmune rheumatic diseases (SARD) in Mexico. We selected SARD-related deaths using National Open Data and Information from the Ministry of Health, Mexico, and ICD-10 codes. We assessed the observed compared to the predicted mortality values for 2020 and 2021, employing trends from 2010 to 2019 with joinpoint and prediction modelling analyses. Among 12,742 deaths due to SARD between 2010 and 2021, the age-standardized mortality rate (ASMR) increased significantly between 2010 and 2019 (pre-pandemic) (annual percentage change [APC] 1.1%; 95% CI 0.2-2.1), followed by a non-significant decrease during the pandemic period (APC 13.9%; 95% CI 13.9-5.3). In addition, the observed ASMR of 1.19 for 2020 for SARD and of 1.14 for 2021 were lower than the predicted values of 1.25 (95% CI 1.22-1.28) for 2020 and 1.25 (95% CI 1.20-1.30) for 2021. Similar findings were identified for specific SARD, mainly systemic lupus erythematosus (SLE), or by sex or age group. Interestingly, the observed mortality rates for SLE in the Southern region of 1.00 in 2020 and 1.01 in 2021 were both significantly greater than the predicted values of 0.71 (95% CI 0.65-0.77) in 2020 and 0.71 (95% CI 0.63-0.79). In Mexico, the observed SARD mortality rates were not higher than the expected values during the pandemic, except for SLE in the Southern region. No differences by sex or age group were identified.

Metabolomic Profile of Insulin Resistance Women with Systemic Lupus Erythematosus.

The aims of this study were in systemic lupus erythematosus (SLE) patients: 1) to compare the metabolomic profile of insulin resistance (IR) with controls and 2) to correlate the metabolomic profile with other IR surrogates and SLE disease variables and vitamin levels. In this cross-sectional study, serum samples were collected from women with SLE (n=64) and gender- and age-matched controls (n=71), which were not diabetic. Serum metabolomic profiling was performed using UPLC-MS-MS (Quantse score). HOMA and QUICKI were carried out. Serum 25(OH)D concentrations were measured by chemiluminescent immunoassay. In women with SLE, the metabolomic Quantose score significantly correlated with HOMA-IR, HOMA2-IR, and QUICKI. Although concentrations of IR metabolites were not different between SLE patients and controls, fasting plasma insulin levels were higher and insulin sensitivity lower in SLE women. Interestingly, the Quantose IR score was significantly correlated with complement C3 levels (r=0.7; p=0.001). 25 (OH)D did not correlate with any metabolite or the Quantose IR index. Quantose IR may be a useful tool for IR assessment. There was a possible correlation between the metabolomic profile and complement C3 levels. The implementation of this metabolic strategy may help develop biochemical insight into metabolic disorders in SLE.

Current state and completeness of reporting clinical prediction models using machine learning in systemic lupus erythematosus: A systematic review.

OBJECTIVE: We carried out a systematic review (SR) of adherence in diagnostic and prognostic applications of ML in SLE using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) Statement. METHODS: A SR employing five databases was conducted from its inception until December 2021. We identified articles that evaluated the utilization of ML for prognostic and/or diagnostic purposes. This SR was reported based on the PRISMA guidelines. The TRIPOD statement assessed adherence to reporting standards. Assessment for risk of bias was done using PROBAST tool. RESULTS: We included 45 studies: 29 (64.4%) diagnostic and 16 (35.5%) prognostic prediction- model studies. Overall, articles adhered by between 17% and 67% (median 43%, IQR 37-49%) to TRIPOD items. Only few articles reported the model's predictive performance (2.3%, 95% CI 0.06-12.0), testing of interaction terms (2.3%, 95% CI 0.06-12.0), flow of participants (50%, 95% CI; 34.6-65.4), blinding of predictors (2.3%, 95% CI 0.06-12.0), handling of missing data (36.4%, 95% CI 22.4-52.2), and appropriate title (20.5%, 95% CI 9.8-35.3). Some items were almost completely reported: the source of data (88.6%, 95% CI 75.4-96.2), eligibility criteria (86.4%, 95% CI 76.2-96.5), and interpretation of findings (88.6%, 95% CI 75.4-96.2). In addition, most of model studies had high risk of bias. CONCLUSIONS: The reporting adherence of ML-based model developed for SLE, is currently inadequate. Several items deemed crucial for transparent reporting were not fully reported in studies on ML-based prediction models. REVIEW REGISTRATION: PROSPERO ID# CRD42021284881. (Amended to limit the scope).

[Respiratory triage classification in a hospital converted to attend COVID-19 pandemic]. / Clasificación de triage respiratorio en hospital reconvertido para atender la pandemia por COVID-19cl.

Background: The classification of respiratory triage is important, since its objective is reducing the risk of contagion and identifying the patient with respiratory symptoms. Objective: To compare the respiratory triage classification at admission of patients with COVID-19 and with the National Early Warning Score (NEWS) 2 scale. Material and methods: Observational, comparative, cross-sectional, retrospective study. 398 records of patients admitted to Respiratory Triage of a second level hospital were included. The triage color at admission was compared with the color in the re-classification with NEWS 2 scale. For the statistical analysis, percentages and frequencies were used; for qualitative variables, it was used chi-squared with a p value < 0.05. Results: The average age was 57 years. The most frequent gender was male with 60.3%, and their main signs and symptoms were dyspnea 45.7%, coughing 41.3% and fever 32.7%; for women, the frequency was 39.7% and the main symptoms were dyspnea 32.2%, coughing 26.5% and headache 23.9%. The most frequent comorbidities in male and female were, respectively, cardiovascular disease in 20.3% and 19.7%, type 2 diabetes in 17.9% and 14.5%, and chronic kidney disease in 5.2% and 4.7%. The classified color in Respiratory Triage with the highest percentaje at admission was yellow with 64.%; however, with the NEWS 2 re-classification the color with the highest percentage was red, with 50.8%. Conclusion: The classification was performed inadequately, since only 21.8% were compatible with both classifications.

Introducción: la clasificación de triage respiratorio es importante, pues tiene el objetivo de reducir el riesgo de contagio e identificar al paciente con síntomas respiratorios. Objetivo: comparar la clasificación de triage respiratorio al ingreso de pacientes con COVID-19 y con la escala National Early Warning Score (NEWS) 2. Material y métodos: estudio observacional, comparativo, transversal, retrospectivo y unicéntrico. Se incluyeron 398 expedientes de pacientes que ingresaron al Área de Triage Respiratorio de un hospital de segundo nivel. Se comparó el color del triage al ingreso con el color en la reclasificación utilizando la escala NEWS 2. Para el análisis estadístico, se usaron porcentajes y frecuencias; para variables cualitativas se usó chi cuadrada con un valor de p < 0.05. Resultados: la edad promedio fue de 57 años. Predominaron los hombres, con 60.3% y sus principales signos y síntomas fueron disnea 45.7%, tos 41.3% y fiebre 32.7%; hubo 39.7% de mujeres y sus síntomas fueron disnea 32.2%, tos 26.5% y cefalea 23.9%. Las comorbilidades más frecuentes en hombres y mujeres fueron: enfermedad cardiovascular 20.3 y 19.7%; diabetes tipo 2, 17.9 y 14.5%; enfermedad renal crónica, 5.2 y 4.7%, respectivamente. El color clasificado en triage respiratorio con mayor porcentaje a su ingreso fue amarillo con 64.6%; sin embargo, con la reclasificación de NEWS 2 el color con mayor porcentaje fue el rojo, con 50.8%. Conclusión: la clasificación del color se realizó de forma inadecuada, pues solo el 21.8% fueron compatibles con ambas clasificaciones.

Decrease in COVID-19 adverse outcomes in adults during the Delta and Omicron SARS-CoV-2 waves, after vaccination in Mexico.

Mexico, one of the countries severely affected by COVID-19, accumulated more than 5. 1 all-cause excess deaths/1,000 inhabitants and 2.5 COVID-19 confirmed deaths/1,000 inhabitants, in 2 years. In this scenario of high SARS-CoV-2 circulation, we analyzed the effectiveness of the country's vaccination strategy that used 7 different vaccines from around the world, and focused on vaccinating the oldest population first. We analyzed the national dataset published by Mexican health authorities, as a retrospective cohort, separating cases, hospitalizations, deaths and excess deaths by wave and age group. We explored if the vaccination strategy was effective to limit severe COVID-19 during the active outbreaks caused by Delta and Omicron variants. Vaccination of the eldest third of the population reduced COVID-19 hospitalizations, deaths and excess deaths by 46-55% in the third wave driven by Delta SARS-CoV-2. These adverse outcomes dropped 74-85% by the fourth wave driven by Omicron, when all adults had access to vaccines. Vaccine access for the pregnant resulted in 85-90% decrease in COVID-19 fatalities in pregnant individuals and 80% decrease in infants 0 years old by the Omicron wave. In contrast, in the rest of the pediatric population that did not access vaccination before the period analyzed, COVID-19 hospitalizations increased >40% during the Delta and Omicron waves. Our analysis suggests that the vaccination strategy in Mexico has been successful to limit population mortality and decrease severe COVID-19, but children in Mexico still need access to SARS-CoV-2 vaccines to limit severe COVID-19, in particular those 1-4 years old.

Trends in all-cause hospitalizations for systemic lupus erythematosus in Mexico, 2000-2019.

BACKGROUND: Hospitalizations due to systemic lupus erythematosus (SLE) incur substantial resource use. Hospitalization trends provide a key benchmark of the disease burden. However, there is little long-term data in Mexico. Therefore, we evaluated Mexican hospitalization trends for SLE during 2000-2019. METHODS: Hospitalization trends of SLE were studied using data from 2000 to 2019 releases of the National Dynamic Cubes of the General Direction of Health Information, which provides data on hospitalization discharges in Mexico. Patients aged ≥15 years hospitalized during the study period with a principal discharge diagnosis of SLE (ICD-10 code M32) were included. RESULTS: From 2000 to 2019, there were 17,081 hospitalizations for SLE, of which 87.6% were in females and 87% in subjects aged 15-44 years. From 2000 to 2019, the age-standardized hospitalization rate for patients with SLE increased from 0.38 per 100,000 persons to 0.65 per 100,000 persons with an average annual percentage change (APC) of 2.9% (95% CI 6.2-63.2). Although there was a significant uptrend from 2000 through 2011, there was a significant decline from 2011 to 2019 (APC: -4.8%, 95% CI -7.0% to -2.5%). Similar trends were identified in subjects aged 15-44 years and in both sexes. The length of stay and inpatient mortality decreased between 2000-2009 and 2010-2019. CONCLUSIONS: Although there was a substantial increase in SLE hospitalizations in 2000-2019, in 2011-2019, a decreased trend was reported in younger patients and in females and males. The length of stay was also reduced.

Temporal Trends in Mortality in Patients with Systemic Sclerosis in Public Hospitals Across Mexico from 1998-2017.

OBJECTIVE: To investigate national temporal trends over time in mortality rates in patients with systemic sclerosis (SSc) in Mexico between 1998 and 2017. METHODS: Deaths between 1998 and 2017 were extracted from General Board of Health Information (DGIS) Open Access datasets. 2We identified all persons aged ≥15 years with a diagnosis of SSc (ICD-10 code M34). We calculated the age-standardized mortality rate (ASMR) for SSc and non-SSc (information provided by the National Institute of Statistics, Geography, and Informatics). A Joinpoint regression model was used to determine mortality trends by sex and geographic regions. Annual percentage change (APC) and average APC (AAPC) were calculated using Joinpoint analysis. RESULTS: From 1998 to 2017, the overall ASMR of SSc increased (AAPC = 2.5%), whereas the ASMR for non-SSc remained stable. By subpopulations, females, and males with SSc had a significant uptrend in the ASMR (APC = 4.6 and 4.4%, respectively), between 1998 and 2008 for the former and between 1998 and 2010 for the later. Females had a non-significant ASMR uptrend between 2008 and 2017 and males a non-significant ASMR decline between 2010 and 2017. Women had a higher SSc-ASMR to non-SSc-ASMR ratio than males. The relative cumulative change between 1998 and 2017 differed between females (78.1%) and males (50.8%), and residents of the Southern region had the largest cumulative change (147.8%). CONCLUSIONS: SSc mortality rate increased in Mexico between 1998 to 2017, with SSc mortality higher than non-SSc mortality. However, the SSc mortality rate steeply increased in the first ten years but has plateaued in the last 10 years of the study period. Variations by sex and geographic regions were also identified.

[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.

[Confinement and social distancing: stress, anxiety, depression in children and adolescents]. / Confinamiento y distanciamiento social: estrés, ansiedad, depresión en niños y adolescentes.

Among the strategies to avoid COVID-19 disease that affects the world population it is keeping away from contagion through confinement and social distancing, which can cause in children and adolescents a change in the psychosocial environment with a high prevalence of psychological and psychiatric disorders, such as stress, anxiety disorders, depressive disorders, risk of suicide and eating disorders. During confinement, were made school closures, shutdowns of recreational and sports spaces, cancellation of outdoor activities, which can have consequences in social habits, sleep, modifications in the eating pattern that entails alterations in anthropometric variables, neurophysiological alterations with behaviors that affect mental health, in addition to the frustration of not executing plans, fear, boredom and the uncertainty of the duration of the pandemic could lead to further stress. Social distancing favors a reduction in interaction, is related to anxiety, stress and depression, in addition to the concern of infecting the family. These scenarios can generate stress for parents, domestic violence and uncontrolled use of the internet. Children and adolescents are vulnerable populations that adapt to the environment in crisis. The objective of this work was to review the influence of confinement and social distancing on stress, anxiety and depression in children and adolescents.

Entre las estrategias para evitar la enfermedad por COVID-19 que afecta a la población mundial está evitar el contagio a partir del confinamiento y el distanciamiento social, lo que puede ocasionar en niños y adolescentes un cambio en el entorno psicosocial con alta prevalencia de alteraciones psicológicas y psiquiátricas, como estrés, transtornos de ansiedad, transtornos depresivos, riesgo de suicidio y trastornos de la conducta alimentaria. Durante el confinamiento se realizaron cierres de escuelas, de espacios recreativos y deportivos, cancelación de actividades fuera de casa, lo cual puede tener consecuencias en los hábitos sociales, del sueño, modificaciones en el patrón de alimentación que conllevan alteraciones en las variables antropométricas, alteraciones neurofisiológicas conductuales que afectan la salud mental, además de la frustración de la no ejecución de planes, miedo, aburrimiento y la incertidumbre de la duración, los cuales podrían generar mayor estrés. El distanciamiento social propicia una reducción de la interacción y se relaciona con ansiedad, estrés y depresión, además de la preocupación de contagiar a la familia. Estos escenarios pueden generar estrés en los padres, violencia intrafamiliar y uso descontrolado de internet. Los niños y adolescentes son población vulnerable que se adapta al entorno en crisis generadas por el confinamiento y distanciamiento social. El objetivo de este trabajo fue revisar la influencia del confinamiento y el distanciamiento social en el estrés, la ansiedad y la depresión de niños y adolescentes.

Genetic component of autoimmune rheumatological diseases.

The purpose of this review is to present the main aspects of the genetic component of autoimmune rheumatic diseases, including the characteristics of the multifactorial or polygenic inheritance model, and its monogenic forms, as well as the main associated genes in both cases. The epigenetic changes involved, and the influence of the environment and sex that confer greater risk to women suffering from any of these diseases. Finally, to make known the advances that the study of omic sciences has allowed, opening the way to a new molecular classification of these diseases, aimed at personalized medicine. A review of the literature of the last 5 years, of English-language publications, in the PubMed database was performed and 28 review articles, and 19 original articles were included. Knowledge of the genetic factors involved in the aetiology of autoimmune rheumatic diseases, thanks to the availability of molecular studies, allows a better understanding of their pathophysiology and the possibility of diagnosis and treatment based on molecular markers in the future.

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

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.

A Retrospective Analysis of Longitudinal Changes in Bone Mineral Density in Women with Systemic Lupus Erythematosus.

Most prospective studies of bone mineral density (BMD) in systemic lupus erythematosus (SLE) patients have been of relatively short duration, with a maximum of 6 years. To describe long-term changes in BMD in women with SLE and identify risk factors associated with BMD loss. We retrospectively evaluated 132 adult Mexican-Mestizo women with SLE who underwent dual X-ray absorptiometry (DXA). Demographic and clinical data were collected and BMD at the lumbar spine (L1-L4) and total hip were collected at baseline and during the follow up. At baseline, the mean age of participants was 43.4 ± 12.5 years, 50.8% had osteopenia and 11% osteoporosis. The median follow-up was 13 (IQR 10.2-14.0) years. During follow up, 79% of patients used glucocorticoid (GCT). The mean percentage of changes in BMD during follow up were: - 14.03 ± 11.25% (- 1.49%/year) at the lumbar spine, and - 15.77 ± 11.57% (- 1.78%/year) at the total hip, with significant changes (p < 0.001 for both comparisons). Multivariate analysis showed older age, GCT use at baseline, and transition to the menopause during the follow-up were significantly associated with greater reductions in BMD. This retrospective longitudinal study found significant BMD loss at the lumbar spine and hip. Older age, menopausal transition and GCT use were independently associated with BMD decline in women with SLE.

Medication adherence is influenced by resilience in patients with systemic lupus erythematosus.

OBJECTIVE: Evidence on the relationship between resilience and medication adherence in systemic lupus erythematosus (SLE) patients is lacking. We aimed to examine the impact of resilience on medication adherence in SLE patients. METHOD: In a cross-sectional analysis SLE outpatients were assessed for resilience (Connor-Davison Resilience Scale, CD-RISC), depressive symptoms (CES-D) and medication adherence (Compliance Questionnaire for Rheumatology [CQR]). The disease activity index (mexSLEDAI) and damage (SLICC Damage Index) were administered. Factors independently associated with adherence were identified using multivariate logistic regression. RESULTS: Of the 157 patients, 152 (96.8%) were female with a median age of 45.9 (IQR: 39.0-55.5) years and disease duration of 14 (IQR: 10.0-19.0) years. Medication adherence (CQR ≥80%) and depressive symptoms were found in 74.5% and 43.9% of patients, respectively. Adherent patients had a lower CES-D score and a higher CD-RISC score. In the multivariate analysis adjusting for demographic and clinical confounders, resilience and older age protected against non-adherence (OR 0.96, [95% CI 0.94-0.99] and OR 0.96 [95% CI 0.93-0.98], respectively). CONCLUSION: In SLE patients, resilience and older age, which possibly associated with better medication adherence, may protect against non-adherence.

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.

[Serum levels of vitamin D in systemic lupus erythematosus patients (SLE) and their relationship with disease activity: longitudinal study]. / Niveles séricos de vitamina D en pacientes con lupus eritematoso sistémico (LES) y su asociación con la actividad de la enfermedad: estudio longitudinal.

OBJECTIVE: To determine changes over time of serum levels of 25-hydroxy vitamin D (25(OH)D) in Mexican patients with SLE and their relationship with disease activity. MATERIALS AND METHODS: Longitudinal and observational study. Women with SLE were included. Serum levels of 25(OH)D were measured at baseline and after two years; the disease activity was measured with MEX-SLEDAI. Patients with initial suboptimal levels of 25(OH)D received supplements or increased doses of calcitriol. RESULTS: 105 women with SLE were included, mean age 49.4 ± 11 years. Serum levels of 25(OH)D were higher at two years (baseline 20 ± 6.8 vs. follow-up 22.7 ± 7.7; p = < 0.001). There were no differences between disease activity scores at baseline and two years (baseline 1.7 ± 1.9 vs. follow-up 1.1 ± 1.7; p = 0.7). Serum levels of 25(OH)D did not correlate with disease activity during the follow up, p = 0.7. No correlation was found between changes in MEX-SLEDAI scores and serum levels of 25(OH)D, p = 0.87. CONCLUSION: Mexican women with SLE had increased serum levels of 25(OH)D. No correlation between serum levels of 25(OH)D and disease activity was found.