The impact of glucocorticoids and anti-cd20 therapy on cervical human papillomavirus infection risk in women with systemic lupus erythematosus

OBJECTIVE: To identify the prevalence and factors associated with cervical human papillomavirus infection in women with systemic lupus erythematosus METHODS: This cross-sectional study collected traditional and systemic lupus erythematosus-related disease risk factors, including conventional and biologic therapies. A gynecological evaluation and cervical cytology screen were performed. Human papillomavirus detection and genotyping were undertaken by PCR and linear array assay. RESULTS: A total of 148 patients were included, with a mean age and disease duration of 42.5±11.8 years and 9.7±5.3 years, respectively. The prevalence of squamous intraepithelial lesions was 6.8%. The prevalence of human papillomavirus infection was 29%, with human papillomavirus subtype 59 being the most frequent. Patients with human papillomavirus were younger than those without the infection (38.2±11.2 vs. 44.2±11.5 years, respectively; p = 0.05), and patients with the virus had higher daily prednisone doses (12.8±6.8 vs. 9.7±6.7 mg, respectively; p = 0.01) and cumulative glucocorticoid doses (14.2±9.8 vs. 9.7±7.3 g, respectively; p = 0.005) compared with patients without. Patients with human papillomavirus infection more frequently received rituximab than those without (20.9% vs. 8.5%, respectively; p = 0.03). In the multivariate analysis, only the cumulative glucocorticoid dose was associated with human papillomavirus infection. CONCLUSIONS: The cumulative glucocorticoid dose may increase the risk of human papillomavirus infection. Although rituximab administration was more frequent in patients with human papillomavirus infection, no association was found. Screening for human papillomavirus infection is recommended in women with systemic lupus erythematosus. .

The impact of glucocorticoids and anti-cd20 therapy on cervical human papillomavirus infection risk in women with systemic lupus erythematosus.

OBJECTIVE: To identify the prevalence and factors associated with cervical human papillomavirus infection in women with systemic lupus erythematosus METHODS: This cross-sectional study collected traditional and systemic lupus erythematosus-related disease risk factors, including conventional and biologic therapies. A gynecological evaluation and cervical cytology screen were performed. Human papillomavirus detection and genotyping were undertaken by PCR and linear array assay. RESULTS: A total of 148 patients were included, with a mean age and disease duration of 42.5±11.8 years and 9.7±5.3 years, respectively. The prevalence of squamous intraepithelial lesions was 6.8%. The prevalence of human papillomavirus infection was 29%, with human papillomavirus subtype 59 being the most frequent. Patients with human papillomavirus were younger than those without the infection (38.2±11.2 vs. 44.2±11.5 years, respectively; p = 0.05), and patients with the virus had higher daily prednisone doses (12.8±6.8 vs. 9.7±6.7 mg, respectively; p = 0.01) and cumulative glucocorticoid doses (14.2±9.8 vs. 9.7±7.3 g, respectively; p = 0.005) compared with patients without. Patients with human papillomavirus infection more frequently received rituximab than those without (20.9% vs. 8.5%, respectively; p = 0.03). In the multivariate analysis, only the cumulative glucocorticoid dose was associated with human papillomavirus infection. CONCLUSIONS: The cumulative glucocorticoid dose may increase the risk of human papillomavirus infection. Although rituximab administration was more frequent in patients with human papillomavirus infection, no association was found. Screening for human papillomavirus infection is recommended in women with systemic lupus erythematosus.

Susac's syndrome: an update.

Susac's syndrome is an infrequent neurological disorder characterized by the clinical triad of encephalopathy, hearing loss, and branch retinal artery occlusions. Its pathophysiology is not entirely clear, although it is now thought that it is most probably an immune-mediated endotheliopathy that affects the microvasculature of the brain, retina, and inner ear. An early diagnosis is important as treatment can halt disease progression and prevent permanent disability.

[External periareolar incision for subdermal mastectomy in men with gynecomastia]. / Mastectomia subdérmica mediante incisión periareolar externa en hombres con ginecomastia.

BACKGROUND: Gynecomastia describes a benign increase of the mammary gland in men. When medical treatment fails, symptoms and psychological alterations persist. Subdermal mastectomy is the definitive treatment and can be achieved by different incisions, each with potential complications. We undertook this study to present clinical characteristics of 11 patients with gynecomastia and the results obtained with subdermal mastectomy by means of external periareolar incision. METHODS: A descriptive cohort study in male patients with gynecomastia was carried out in a third-level medical care hospital. Patients were treated with subdermal mastectomy by means of external periareolar incision. RESULTS: There were 11 male patients with an average age of 19 years (range: 11-60 years), 3 patients (27.2%) with bilateral gynecomastia and 8 patients (72.7%) with unilateral gynecomastia. Average time of evolution was 22 months (range: 16-48 months), 9 patients (81.8%) reported pain, 11 patients (100%) reported psychological alterations with cutaneous alteration, 11 patients (100%) had normal secondary sexual characteristics, 1 patient (9%) had supernumerary nipple development, and 11 patients (100%) had well-defined lesions. According to Simon's classification: seven patients (63.6%) were classified as grade 1, three patients (27.2%) as grade 2 and one patient (9.09%) as grade 3. Each patient had a subdermal mastectomy with external periareolar incision, 11 patients (100%) had a histopathological report of gynecomastia; 1 patient (9.09%) displayed keloid healing and none displayed complications inherent to the surgical procedure. CONCLUSIONS: Mastectomy by means of external periareolar incision is useful in the treatment of gynecomastia.

[Analysis of death maternal cases during a 10-year period]. / Análisis de casos de muerte materna ocurridos en un periodo de 10 años.

OBJECTIVES: To determine the clinical features, as well as to present an analysis of the cases of maternal death during a period of ten years. PATIENTS AND METHODS: A descriptive, transverse, retrospective and cases series research was carried out. There was a revision of the expedients of maternal death occurred at the Regional General Hospital number 36 in Puebla, from January 1st, 1996 to December 31st, 2005. They were selected the patients who passed away because of obstetric death. The data collection included the following variables: age, body mass index, education, number of gestations, type of labour, prenatal control, basic cause of dead, and the month and the year in which it occurred. The descriptive statistics was used with central tendency and dispersion measurements. RESULTS: 75 maternal deaths were registered; one of them was excluded because it was not an obstetric cause. The maternal death rate was 63.46 per 100,000 born alive. The 17.5% corresponded to indirect obstetric causes and 82.5% to direct obstetric causes; the 73% were preventable, 27% were no preventable. Forty-eight cases corresponded to ages between 21 and 34 years. Forty-six cases corresponded to mothers with 2 to 4 pregnancies. In 43 cases they had a level of education which ranks between elementary and junior high school. In 31 cases they had a body mass index of 21 to 26. The eclampsia was the cause of maternal death in 20 cases and the obstetric haemorrhage in 16 cases. There were appropriate prenatal controls in 38 cases. CONCLUSIONS: The maternal death cases corresponded to an average age women, multigravidas, no obese, and apparently appropriate prenatal control. During this period there was a tendency to the decrease of obstetric haemorrhage and an increase of the preeclampsia-eclampsia as causes of maternal death.

[Oxitocin trough umbilical vein to shorten the third stage of labor]. / Oxitocina transvena umbilical para acortar el tercer periodo de trabajo de parto.

OBJECTIVE: To examine the efficacy and safety of oxitocin administered through umbilical vein after delivery to diminish the incidence of retained placenta, blood loss and third stage of labour. METHODOLOGY: A double blind, clinical trial was performed in which 64 women in labour, any age, with normal pregnancies, with gestational time between 37 to 42 weeks, were randomized to one of two groups. Group 1 received 10 UI of oxitocin (2 mL) diluted in 18 mL of saline solution through umbilical vein, immediately after delivery. Group 2 received only 20 mL of saline solution. Blood loss, time of third stage of labour, retained placenta, nausea, vomit and arterial hypotension were measured. RESULTS: Blood loss was 263.7 +/- 220.9 mL in group 1 (n=32) and 286.7 + 230.4 in group 2 (n=32) (p=0.68, Student T test). Time of third stage of labour was 265.3 +/- 383.9 seconds in group 1 and 197.1 +/- 314.3 in group 2 (p=0.44, Student T test). There was one retained placenta in group 1 and two in group 2 (RR 0.5 IC 0.04 a 5.24). There were not side effects in any group. CONCLUSIONS: Oxitocin trough umbilical vein immediately after delivery was not useful to diminish blood loss, retained placenta or time of third stage of labour.