Update of the guidelines for the pharmacological treatment of rheumatoid arthritis by the Mexican College of Rheumatology 2023.

OBJECTIVE: To develop updated guidelines for the pharmacological management of rheumatoid arthritis (RA). METHODS: A group of experts representative of different geographical regions and various medical services catering to the Mexican population with RA was formed. Questions based on Population, Intervention, Comparison, and Outcome (PICO) were developed, deemed clinically relevant. These questions were answered based on the results of a recent systematic literature review (SLR), and the evidence's validity was assessed using the GRADE system, considered a standard for these purposes. Subsequently, the expert group reached consensus on the direction and strength of recommendations through a multi-stage voting process. RESULTS: The updated guidelines for RA treatment stratify various therapeutic options, including different classes of DMARDs (conventional, biologicals, and JAK inhibitors), as well as NSAIDs, glucocorticoids, and analgesics. By consensus, it establishes the use of these in different subpopulations of interest among RA patients and addresses aspects related to vaccination, COVID-19, surgery, pregnancy and lactation, and others. CONCLUSIONS: This update of the Mexican guidelines for the pharmacological treatment of RA provides reference points for evidence-based decision-making, recommending patient participation in joint decision-making to achieve the greatest benefit for our patients. It also establishes recommendations for managing a variety of relevant conditions affecting our patients.

Actualización de las guías para el tratamiento farmacológico de la artritis reumatoide del Colegio Mexicano de Reumatología 2023 / Update of the guidelines for the pharmacological treatment of rheumatoid arthritis by the Mexican College of Rheumatology 2023

Desarrollar guías actualizadas para el manejo farmacológico de la artritis reumatoide (AR). Se conformó un grupo de expertos que fueran representativos de las distintas regiones geográficas y los diferentes servicios médicos que atienden a la población mexicana con AR. Se desarrollaron preguntas basadas en Población, Intervención, Comparación y Desenlace [Outcome] (PICO) que fueron consideradas relevantes desde el punto de vista clínico; las preguntas encontraron su respuesta en los resultados de una revisión sistemática de la literatura (RSL) reciente y la validez de la evidencia fue evaluada mediante el sistema GRADE, considerado un estándar para estos fines. Posteriormente, el grupo de expertos desarrollaró un acuerdo en la dirección y fuerza de las recomendaciones mediante un proceso de votación en distintas etapas. Las guías actualizadas para el tratamiento de la AR categorizan en forma estratificada a las distintas opciones terapéuticas incluyendo las distintas familias de fármacos modificadores de la enfermedad (FARME): convencionales, biológicos e inhibidores de JAK), además de AINE, glucocorticoides y analgésicos. Establece por consenso el uso de todos ellos en distintas subpoblaciones de interés de pacientes con AR, y aborda, además, aspectos relacionados con la vacunación, la COVID-19, la cirugía, el embarazo y la lactancia entre otros. La presente actualización de las guías mexicanas para el tratamiento farmacológico de la AR brinda elementos de referencia en la toma de decisiones basados en la evidencia científica más reciente, y recomienda la participación del paciente para la toma de decisiones conjuntas en la búsqueda del mayor beneficio de nuestros pacientes; establece además, recomendaciones para el manejo de una diversidad de condiciones relevantes que afectan a nuestros pacientes.

Termination of pregnancy in lupus nephritis: A bioethical analysis with the integrative method.

BACKGROUND AND OBJECTIVE: Termination of pregnancy in patients with rheumatic diseases is controversial and a bioethical analysis is rarely performed. In this study we analysed the case of a pregnant patient with lupus nephritis unresponsive to treatment, for whom termination of pregnancy is considered. METHODS: The integrative model was applied combining different normative ethical theories. RESULTS: From a utilitarian perspective, termination of pregnancy is justifiable, seeking the greatest benefit for the greatest number of stakeholders. Deontology justifies both terminating and continuing the pregnancy, focusing on the action itself and on autonomy. In virtue ethics the importance of decisions rests with the person who performs the action seeking flourishing; termination of pregnancy would be justifiable. DISCUSSION AND CONCLUSIONS: Interruption of pregnancy is a justifiable solution following the integrative model. Bioethical analysis of paradigmatic cases is essential to ensure the best possible action and as a precedent for future similar situations in rheumatology.

Bladder Cancer and Probiotics: What Do We Know So Far?

Bladder cancer is around the 10th most diagnosed cancer, although has a considerable mortality. Recent research and new methodologies have discarded the historical dogma that the bladder (and urine) was sterile under normal conditions. Specifically, only a few studies have reported a detailed analysis of the urinary microbiota in patients with bladder cancer, thus exhibiting a remarkable variability due to the low biomass of the urinary microbiota and the influence of many factors. Nevertheless, this research shows us signals that urinary microbiota is a factor to be considered in the pathophysiology of bladder cancer. More importantly, probiotics could be useful as an adjuvant therapy to reduce the recurrence rate or increase the disease-free period after surgery. In vitro studies and animal assays have shown promising results, but the research in this context has also been scarce, and only a few studies have been conducted in humans. In summary, there is little evidence of the possible beneficial effect of probiotics in controlling the overgrowth of genera that could be involved in the carcinogenesis of bladder cancer. This narrative review aims to compile all the evidence to date on the therapeutic potential of probiotics injected directly into the bladder or orally administered.

Oral intake of Kluyveromyces marxianus B0399 plus Lactobacillus rhamnosus CECT 30579 to mitigate symptoms in COVID-19 patients: A randomized open label clinical trial.

At the beginning of the SARS-CoV-2 pandemic, developing of new treatments to control the spread of infection and decrease morbidity and mortality are necessary. This prospective, open-label, case-control intervention study evaluates the impact of the oral intake of the probiotic yeast Kluyveromyces marxianus B0399 together with Lactobacillus rhamnosus CECT 30579, administered for 30 days, on the evolution of COVID-19 patients. Analysis of the digestive symptoms at the end of the follow up shows a benefit of the probiotic in the number of patients without pyrosis (100% vs 33.3%; p 0.05) and without abdominal pain (100% vs 62.5%; p 0.04). Results also show a better evolution when evaluating the difference in the overall number of patients without non-digestive symptoms at the end of the follow-up (41.7%, vs 13%; p 0.06). The percentage of improvement in the digestive symptoms (65% vs 88%; p value 0.06) and the global symptoms (digestive and non-digestive) (88.6% vs 70.8%; p value 0.03) is higher in the probiotic group. The probiotic was well tolerated with no relevant side effects and high adherence among patients. In conclusion, this coadjutant treatment seems to be promising, although results should be confirmed in new studies with higher number of patients.

Ulcera gástrica por citomegalovirus en paciente con Linfoma no Hodgkin / Gastric cytomegalovirus infection in a patient with non-Hodgkin’s lymphoma

No disponible

Bacteriemia, absceso cerebral y meningitis por Listeria monocytogenes / Bacteremia, brain abscess, and meningitis caused by Listeria monocytogenes

No disponible

[Sialidase activity in women with bacterial vaginosis]. / Actividad sialidasa en mujeres con vaginosis bacteriana.

Bacterial vaginosis (VB) is a syndrome characterized by overgrowth of endogenous Gram negative bacterial flora and the lack of the normal flora. Within bacterial enzymes, sialidases have been considered a virulence factor of many pathogenic microorganisms colonizing the different mucous membranes. Their presence in vaginal discharges can be correlated with VB. The aim of this study was to detect the activity of this enzyme in women with this syndrome and without clinical evidence of genital infection. Out of a total 112 women studied, 51 were patients with VB and the other 61 women presented normal vaginal flora. For the quantification of enzyme activity, the technique based on the enzymatic hydrolysis of a derivative acid of the acetyl metoxifenil muramic acid was used. In the studied population both groups shared values from 0.5 to 5.1 nmoles of metoxifenol, whereas only 11 out of 52 patients with VB (21.17%), registered more than 5.1 nmoles. The presence of sialidase activity is not enough to confirm VB, except for values greater than 5.5 nmoles of the metoxifenol produced in the enzymatic reaction.

Actividad sialidasa en mujeres con vaginosis bacteriana / Sialidase activity in women with bacterial vaginosis

La vaginosis bacteriana (VB) es un síndrome caracterizado por el sobrecrecimiento bacteriano deflora endógena Gram negativa, que desplaza a la flora lactobacilar normal. Dentro de las enzimasbacterianas, las sialidasas han sido consideradas factores de virulencia de muchos microorganismos patógenosque colonizan las distintas mucosas. Su presencia en fluidos vaginales puede estar correlacionada con VB. Elpropósito de este estudio fue comprobar la actividad de dicha enzima en mujeres con este síndrome y sin evidenciaclínica de infección genital. Se estudiaron 112 mujeres (51 fueron pacientes con VB y 61 mujeres conflora colonizante habitual). Para la cuantificación de la actividad sialidasa se empleó la técnica basada en lahidrólisis enzimática de un derivado ácido del ácido metoxifenil acetil murámico. En la población estudiada seencontró que ambos grupos mostraron valores comprendidos entre 0.5 a 5.1 nmoles de metoxifenol, mientrasque 11 de 52 pacientes con VB (21.17%), registraron valores superiores a 5.1 nmoles. La presencia de actividadsialidasa solamente no es índice de VB, excepto para valores mayores de 5.5 nmoles de metoxifenol, producidosen la reacción enzimática.

Bacterial vaginosis (VB) is a syndromecharacterized by overgrowth of endogenous Gram negative bacterial flora and the lack of the normalflora. Within bacterial enzymes, sialidases have been considered a virulence factor of many pathogenic microorganismscolonizing the different mucous membranes. Their presence in vaginal discharges can be correlatedwith VB. The aim of this study was to detect the activity of this enzyme in women with this syndrome andwithout clinical evidence of genital infection. Out of a total 112 women studied, 51 were patients with VB andthe other 61 women presented normal vaginal flora. For the quantification of enzyme activity, the technique basedon the enzymatic hydrolysis of a derivative acid of the acetyl metoxifenil muramic acid was used. In the studiedpopulation both groups shared values from 0.5 to 5.1 nmoles of metoxifenol, whereas only 11 out of 52 patientswith VB (21.17%), registered more than 5.1 nmoles. The presence of sialidase activity is not enough to confirmVB, except for values greater than 5.5 nmoles of the metoxifenol produced in the enzymatic reaction.

Actividad sialidasa en mujeres con vaginosis bacteriana / Sialidase activity in women with bacterial vaginosis

La vaginosis bacteriana (VB) es un síndrome caracterizado por el sobrecrecimiento bacteriano deflora endógena Gram negativa, que desplaza a la flora lactobacilar normal. Dentro de las enzimasbacterianas, las sialidasas han sido consideradas factores de virulencia de muchos microorganismos patógenosque colonizan las distintas mucosas. Su presencia en fluidos vaginales puede estar correlacionada con VB. Elpropósito de este estudio fue comprobar la actividad de dicha enzima en mujeres con este síndrome y sin evidenciaclínica de infección genital. Se estudiaron 112 mujeres (51 fueron pacientes con VB y 61 mujeres conflora colonizante habitual). Para la cuantificación de la actividad sialidasa se empleó la técnica basada en lahidrólisis enzimática de un derivado ácido del ácido metoxifenil acetil murámico. En la población estudiada seencontró que ambos grupos mostraron valores comprendidos entre 0.5 a 5.1 nmoles de metoxifenol, mientrasque 11 de 52 pacientes con VB (21.17%), registraron valores superiores a 5.1 nmoles. La presencia de actividadsialidasa solamente no es índice de VB, excepto para valores mayores de 5.5 nmoles de metoxifenol, producidosen la reacción enzimática. (AU)

Bacterial vaginosis (VB) is a syndromecharacterized by overgrowth of endogenous Gram negative bacterial flora and the lack of the normalflora. Within bacterial enzymes, sialidases have been considered a virulence factor of many pathogenic microorganismscolonizing the different mucous membranes. Their presence in vaginal discharges can be correlatedwith VB. The aim of this study was to detect the activity of this enzyme in women with this syndrome andwithout clinical evidence of genital infection. Out of a total 112 women studied, 51 were patients with VB andthe other 61 women presented normal vaginal flora. For the quantification of enzyme activity, the technique basedon the enzymatic hydrolysis of a derivative acid of the acetyl metoxifenil muramic acid was used. In the studiedpopulation both groups shared values from 0.5 to 5.1 nmoles of metoxifenol, whereas only 11 out of 52 patientswith VB (21.17%), registered more than 5.1 nmoles. The presence of sialidase activity is not enough to confirmVB, except for values greater than 5.5 nmoles of the metoxifenol produced in the enzymatic reaction. (AU)

Actividad sialidasa en mujeres con vaginosis bacteriana / Sialidase activity in women with bacterial vaginosis

La vaginosis bacteriana (VB) es un síndrome caracterizado por el sobrecrecimiento bacteriano deflora endógena Gram negativa, que desplaza a la flora lactobacilar normal. Dentro de las enzimasbacterianas, las sialidasas han sido consideradas factores de virulencia de muchos microorganismos patógenosque colonizan las distintas mucosas. Su presencia en fluidos vaginales puede estar correlacionada con VB. Elpropósito de este estudio fue comprobar la actividad de dicha enzima en mujeres con este síndrome y sin evidenciaclínica de infección genital. Se estudiaron 112 mujeres (51 fueron pacientes con VB y 61 mujeres conflora colonizante habitual). Para la cuantificación de la actividad sialidasa se empleó la técnica basada en lahidrólisis enzimática de un derivado ácido del ácido metoxifenil acetil murámico. En la población estudiada seencontró que ambos grupos mostraron valores comprendidos entre 0.5 a 5.1 nmoles de metoxifenol, mientrasque 11 de 52 pacientes con VB (21.17%), registraron valores superiores a 5.1 nmoles. La presencia de actividadsialidasa solamente no es índice de VB, excepto para valores mayores de 5.5 nmoles de metoxifenol, producidosen la reacción enzimática. (AU)

Bacterial vaginosis (VB) is a syndromecharacterized by overgrowth of endogenous Gram negative bacterial flora and the lack of the normalflora. Within bacterial enzymes, sialidases have been considered a virulence factor of many pathogenic microorganismscolonizing the different mucous membranes. Their presence in vaginal discharges can be correlatedwith VB. The aim of this study was to detect the activity of this enzyme in women with this syndrome andwithout clinical evidence of genital infection. Out of a total 112 women studied, 51 were patients with VB andthe other 61 women presented normal vaginal flora. For the quantification of enzyme activity, the technique basedon the enzymatic hydrolysis of a derivative acid of the acetyl metoxifenil muramic acid was used. In the studiedpopulation both groups shared values from 0.5 to 5.1 nmoles of metoxifenol, whereas only 11 out of 52 patientswith VB (21.17%), registered more than 5.1 nmoles. The presence of sialidase activity is not enough to confirmVB, except for values greater than 5.5 nmoles of the metoxifenol produced in the enzymatic reaction. (AU)