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OBJECTIVE A protective function of vitamin D in metabolic syndrome (MetS) has been described. The objective of the present study was to examine the relationship between serum 25-hydroxyvitamin D (25(OH)D) concentrations and MetS in non-diabetic systemic lupus erythematosus (SLE) women. METHODS Cross-sectional analyses of the relationship between concentrations of 25(OH)D, MetS, and its components were made in 160 non-diabetic SLE women. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria. Serum 25(OH)D was measured by chemiluminescent immunoassay. Serum 25(OH)D concentrations were categorized into quartiles (

Goals We aimed to evaluate the efficacy and safety of PB+S (pinaverium bromide 100 mg plus simethicone 300 mg) in patients with irritable bowel syndrome (IBS). Background IBS is a multifactorial disorder; thus, combination therapy with different mechanisms of action is expected to be useful. PB+S has shown effectiveness in an open-label clinical study in IBS. However, there are no placebo-controlled trials. Materials and methods IBS-Rome III patients with abdominal pain/discomfort for at least 2 days within the week prior to baseline assessment were included in this 12-week, randomized, double-blind, placebo-controlled study of PB+S versus placebo, bid. The primary endpoint was overall symptom improvement, evaluated weekly by the patient (Likert Scale). Secondary endpoints included the weekly improvement in the severity of abdominal pain and bloating assessed both by patients (10-cm Visual Analogue Scale) and investigators (Likert Scale); frequency of Bristol Scale stool types (consistency) evaluated by patients and the IBS Quality of Life scores. Results A total of 285 patients (female: 83%; 36.5±8.9 y old) received at least 1 dose of PB+S (n=140) or placebo (n=145). No difference was observed in overall symptom improvement between the groups (P=0.13). However, PB+S was superior in abdominal pain (effect size: 31%, P=0.038) and bloating (33%, P=0.019). Patients with IBS-C and IBS-M showed the best improvement in the frequency of stool types with PB+S. No differences were observed in IBS Quality of Life scores and adverse events. Conclusions PB+S was superior to placebo in improving abdominal pain and bloating in patients with active IBS. The effect on the frequency of stool consistency was particularly significant in IBS-C and IBS-M.

Introduction: Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. Aim: To present a consensus review based on evidence regarding the definition, epidemiology, pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. Methods: Three general coordinators carried out a literature review of all articles published in English and Spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: (i) definitions, epidemiology, and pathophysiology; (ii) diagnosis, and (iii) treatment. The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statements were those that reached > 75% agreement, and they were rated utilizing the GRADE system. Results and conclusions: The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy. Resumen: Introducción: Dolor torácico no cardíaco (DTNC) se define como un síndrome clínico caracterizado por dolor retroesternal semejante a la angina de pecho, pero de origen no cardiaco y generado por enfermedades esofágicas, osteomusculares, pulmonares o psiquiátricas. Objetivo: Presentar una revisión consensuada basada en evidencias sobre definición, epidemiología, fisiopatología, diagnóstico y opciones terapéuticas para pacientes con DTNC. Métodos: Tres coordinadores generales realizaron una revisión bibliográfica de todas las publicaciones en inglés y español sobre el tema y elaboraron 38 enunciados iniciales divididos en tres categorías principales: 1) definiciones, epidemiología y fisiopatología; 2) diagnóstico, y 3) tratamiento. Los enunciados fueron votados (3 rondas) utilizando el sistema Delphi, y los que alcanzaron un acuerdo > 75% fueron considerados y calificados de acuerdo con el sistema GRADE. Resultados y conclusiones: El consenso final incluyó 29 enunciados Todo paciente que debuta con dolor torácico debe ser inicialmente evaluado por un cardiólogo. La causa más común de DTNC es la enfermedad por reflujo gastroesofágico (ERGE). Como abordaje inicial, si no existen síntomas de alarma, se puede dar una prueba terapéutica con inhibidor de bomba de protones (IBP) por 2-4 semanas. Si hay disfagia o síntomas de alarma, se recomienda hacer una endoscopia. La manometría de alta resolución es el mejor método para descartar trastornos motores espásticos y acalasia. La pHmetría ayuda a demostrar exposición esofágica anormal al ácido. El tratamiento debe ser dirigido al mecanismo fisiopatológico, y puede incluir IBP, neuromoduladores y/o relajantes de músculo liso, intervención psicológica y/o terapia cognitiva, y ocasionalmente cirugía o terapia endoscópica. Keywords: Pain, Chest, Non-cardiac, GERD, Esophageal motor disorders, Mexico, Palabras clave: Dolor, Torácico, No cardíaco, ERGE, Trastornos motores esofágicos, México

Objective: The objectives of this systematic review and meta-regression were: 1) to compare the prevalence of cervical HPV infection between SLE patients and healthy controls and 2) to evaluate the relationship between cervical HPV infection and traditional and SLE-related risk factors for cervical HPV infection in these patients. Methods: We conducted a systematic literature review (PubMed, Cochrane Library, Embase, Virtual Health Library and SciELO databases) following PRISMA guidelines and using meta-regression to investigate the pooled prevalence of cervical HPV infection in adult women with SLE. The articles included were independently evaluated by two investigators who extracted information on study characteristics, defined outcomes, risk of bias and summarized strength of evidence [Quality of evidence using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence]. Using meta-regression, we further analyzed whether factors such as multiple sexual partners and immunosuppressive therapy were associated with HPV prevalence. We evaluated the quality of evidence included using the Oxford Centre for EBM levels of evidence. Pooled odds ratios (ORs) and 95% confidence intervals (CI) were calculated for studies providing data on HPV prevalence in women with SLE and in healthy controls. Results: A total of 687 articles were identified; 9 full-text articles examining the prevalence of cervical HPV infection in SLE women were included, comprising 751 SLE women. Eight studies employed PCR using general primers. The HPV prevalence varied from 3.1% to 80.7%. In the random effects meta-analysis, the pooled prevalence of cervical HPV infection in SLE vs. controls was 34.15% (95% CI: 19.6%–52.5%) vs. 15.3% (95% CI 0.79–27.8%), OR = 2.87 (95% CI: 2.20–3.76) p and lt;.0001, with large between-study heterogeneity (I2 = 95.4%). When only SLE women were evaluated, meta-regression showed no significant differences between patients with and without a background of multiple sexual partners and any immunosuppressive therapy. In addition, the prevalence of cervical HPV infection did not significantly differ between SLE patients on azathioprine or cyclophosphamide. Conclusions: This meta-analysis suggests that the prevalence of cervical HPV infection is higher in SLE women than in healthy controls. However, multiple sexual partners and any immunosuppressive therapy or specific immunosuppressive treatment (azathioprine and cyclophosphamide) were not associated with the prevalence of cervical HPV infection. © 2018 Elsevier B.V.

Background Colorectal cancer (CRC) is one of the main five causes of morbidity and mortality by oncologic diseases in our country and worldwide. Recently, fecal immunochemical test (FIT) has proven to be a noninvasive screening test that allows to select patients most likely to have a pre-malign lesion in order to perform a colonoscopy. Objective To report the findings of a CRC screening program using FIT in our country population. Method A multicentric study was performed, by inviting open population older than 50 years to participate in a CRC screening. Quantitative FIT specific for human hemoglobin was used, with a cut point of 100 ng/ml or higher to consider as positive. Those patients with positive results were asked to undergo a colonoscopy. In the cases where polypoid lesions were found, biopsies were performed. Results In total, 751 FIT were processed, and 51 (6.8) of those were positive, with a rate of 15.9 premalign lesions for 1,000 individuals, and 1.3 patients with CRC for every 1,000. Conclusions The present study matches worldwide reports, supporting the initiative of establishing a formal and standardized CRC screening program in the public health sector.

Background/Purpose Insulin resistance (IR), which adversely impacts left ventricular (LV) remodeling and function in middle-aged patients.1 Although IR may not play as marked a role in determining LV dysfunction as hypertension, the impact of IR on ventricular dysfunction is unknown in SLE patients.2 The aims of this study were: 1) to determine the role of speckle tracking echocardiography in the early detection of LV dysfunction in SLE and 2) to examine the influence of IR measured by the Quantose score on subclinical LV dysfunction using speckle tracking echocardiography in normotensive SLE patients. Methods This cross-sectional study included SLE adult women without diabetes mellitus (DM), hypertension or obesity. All participants underwent detailed two- dimensional Doppler and two-dimensional speckle tracking echocardiography. Global longitudinal strain (GLS%) and global circumferential strain (GCS%) were determined. LV diastolic dysfunction (LVDD) was verified according to current guidelines. Blood samples were drawn to estimate the Quantose score for IR, (derived from insulin, α-hydroxybutyrate, linoleoyl-glycerophosphocholine, and oleate). Results Sixty-nine patients were included (mean age: 38.9±9.9 years, mean disease duration 10.8±4.7 years). Despite a normal ejection fraction in all participants, ten (14.5%) patients had abnormal LV systolic GLS. The frequency of IR was high (65%). The GLS% and GCS% did not differ in patients with and without IR (-20.8±3.1 vs. -20.5±2.1; p=0.61 and -25.9±8.4 vs. -24.4±9.3; p=0.47, respectively). The prevalence of LVDD was 38.1% in patients with IR vs. 25.0% in patients without IR (p=0.30). E/e’ and E/A ratios did not differ significantly between groups (5.8±1.6 vs. 5.7±1.9; p=0.86 and 1.3±0.3 vs. 1.3±0.3; p=0.27). Conclusions Although IR was high in our patients with SLE, IR was not associated with either LV systolic dysfunction or LVDD in SLE patients without DM or hypertension. References Demmer R.T., Allison M.A., Cai J., et al. Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos). Circ Cardiovasc Imaging 2016;9;e005032. Tso T.K., Huang W.N. Elevation of fasting insulin and its association with cardiovascular disease risk in women with systemic lupus erythematosus. Rheumatol Int 2009;29;735–74.

Celiac disease, celiac sprue, or gluten-sensitive enteropathy, is a generalized autoimmune disease characterized by chronic inflammation and atrophy of the small bowel mucosa. It is caused by dietary exposure to gluten and affects genetically predisposed individuals. In Mexico, at least 800,000 are estimated to possibly have the disease, prompting the Asociación Mexicana de Gastroenterología to summon a multidisciplinary group of experts to develop the “Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico” and establish recommendations for the medical community, its patients, and the general population. The participating medical professionals were divided into three working groups and were given the selected bibliographic material by the coordinators (ART, LUD, JMRT), who proposed the statements that were discussed and voted upon in three sessions: two voting rounds were carried out electronically and one at a face-to-face meeting. Thirty-nine statements were accepted, and once approved, were developed and revised by the coordinators, and their final version was approved by all the participants. It was emphasized in the document that epidemiology and risk factors associated with celiac disease (first-degree relatives, autoimmune diseases, high-risk populations) in Mexico are similar to those described in other parts of the world. Standards for diagnosing the disease and its appropriate treatment in the Mexican patient were established. The guidelines also highlighted the fact that a strict gluten-free diet is essential only in persons with confirmed celiac disease, and that the role of gluten is still a subject of debate in relation to nonceliac, gluten-sensitive patients. Resumen: La enfermedad celiaca (EC), esprúe celíaco o enteropatía sensible al gluten, es una enfermedad autoinmune generalizada que se caracteriza por inflamación crónica y atrofia de la mucosa del intestino delgado, causada por la exposición al gluten de la dieta que afecta a individuos genéticamente predispuestos. En México se estima que al menos 800,000 personas podrían padecerla, por lo que la Asociación Mexicana de Gastroenterología convocó a un grupo multidisciplinario de expertos para que realizaran la Guía clínica para diagnóstico y tratamiento de enfermedad celíaca en México, y se establecieran recomendaciones para la comunidad médica, sus enfermos y la población general. Los profesionistas participantes, divididos en 3 mesas de trabajo, recibieron material bibliográfico seleccionado por los coordinadores (ART, LUD, JMRT), quienes propusieron los enunciados que fueron discutidos y votados en 3 sesiones: 2 a través de medios electrónicos y una presencial. Al final se aceptaron 39 enunciados que, una vez aprobados, fueron desarrollados y revisados por los coordinadores hasta su versión final, que fue aprobada por todos los participantes. Dentro de estas se destaca que la epidemiología y factores de riesgo asociados (familiares de primer grado, enfermedades autoinmunes, poblaciones de alto riesgo) a EC en México son similares a los descritos en otras partes del mundo. Se establecen pautas para el diagnóstico y el tratamiento apropiado de los pacientes mexicanos que la padecen. Se insiste en que una dieta estricta libre de gluten es indispensable solo en las personas con EC confirmada, y que su papel en pacientes con sensibilidad al gluten sin EC es aún un tema de controversia. Keywords: Celiac disease, Mexico, Diagnosis, Gluten, Allergy, Sensitivity, Palabras clave: Enfermedad celíaca, México, Diagnóstico, Gluten, Alergia, Sensibilidad

Important advances have been made since the last Mexican consensus on the diagnosis and treatment of Helicobacter pylori (H. pylori) infection was published in 2007. Therefore, the Asociacion Mexicana de Gastroenterologia summoned 20 experts to produce "The Fourth Mexican Consensus on Helicobacter pylori". From February to June 2017, 4 working groups were organized, a literature review was performed, and 3 voting rounds were carried out, resulting in the formulation of 32 statements for discussion and consensus. From the ensuing recommendations, it was striking that Mexico is a country with an intermediate-to-low risk for gastric cancer, despite having a high prevalence of H. pylori infection. It was also corroborated that peptic ulcer disease, premalignant lesions, and histories of gastric cancer and mucosa-associated lymphoid tissue lymphoma should be considered clear indications for eradication. The relation of H. pylori to dyspeptic symptoms continues to be controversial. Eradication triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor should no longer be considered first-line treatment, with the following 2 options proposed to take its place: quadruple therapy with bismuth (proton pump inhibitor, bismuth subcitrate, tetracycline, and metronidazole) and quadruple therapy without bismuth (proton pump inhibitor, amoxicillin, clarithromycin, and metronidazole). The need for antimicrobial sensitivity testing when 2 eradication treatments have failed was also established. Finally, the promotion of educational campaigns on the diagnosis and treatment of H. pylori for both primary care physicians and the general population were proposed.

Introduction: Significant advances have been made in the knowledge and understanding of the epidemiology, pathophysiology, diagnosis, and treatment of chronic constipation, since the publication of the 2011 guidelines on chronic constipation diagnosis and treatment in Mexico from the Asociación Mexicana de Gastroenterología. Aims: To present a consensus review of the current state of knowledge about chronic constipation, providing updated information and integrating the new scientific evidence. Methods: Three general coordinators reviewed the literature published within the time frame of January 2011 and January 2017. From that information, 62 initial statements were formulated and then sent to 12 national experts for their revision. The statements were voted upon, using the Delphi system in 3 voting rounds (2 electronic and one face-to-face). The statements were classified through the GRADE system and those that reached agreement > 75% were included in the consensus. Results and conclusions: The present consensus is made up of 42 final statements that provide updated knowledge, supplementing the information that had not been included in the previous guidelines. The strength of recommendation and quality (level) of evidence were established for each statement. The current definitions of chronic constipation, functional constipation, and opioid-induced constipation are given, and diagnostic strategies based on the available diagnostic methods are described. The consensus treatment recommendations were established from evidence on the roles of diet and exercise, fiber, laxatives, new drugs (such as prucalopride, lubiprostone, linaclotide, plecanatide), biofeedback therapy, and surgery. Resumen: Introducción: Desde la publicación de las guías de diagnóstico y tratamiento del estreñimiento crónico (EC) en México de la Asociación Mexicana de Gastroenterología en el 2011 se han producido avances significativos en el conocimiento de la epidemiología, fisiopatología, diagnóstico y tratamiento del EC. Objetivos: Presentar una revisión consensuada del estado actual de los conocimientos sobre el EC que actualice e integre las nuevas evidencias científicas. Métodos: Tres coordinadores generales realizaron una revisión de la bibliografía de enero del 2011 a enero del 2017. Con base en esta, se elaboraron 62 enunciados los cuales fueron enviados para su revisión a 12 expertos nacionales. Los enunciados fueron votados utilizando el sistema Delphi en 3 rondas de votaciones (2 electrónicas y una presencial) y calificados de acuerdo con el sistema GRADE. Aquellos que alcanzaron un acuerdo > 75% fueron considerados en este consenso. Resultados y conclusiones: El presente consenso consta de un total de 42 enunciados que actualizan la información sobre el EC y complementan la información que no había sido incluida en las guías previas. Para cada enunciado se presenta la fuerza de la recomendación y el grado de la evidencia. Se provee de una definición actualizada del EC y del EC funcional (EF), y del estreñimiento inducido por opioides (EIO). Se mencionan las estrategias diagnósticas con base en los métodos diagnósticos disponibles, y se emiten recomendaciones con respecto al tratamiento que incluye la evidencia del papel de la dieta y el ejercicio, la fibra, los laxantes, los nuevos fármacos (como prucaloprida, lubiprostona, linaclotida, plecanitida), la terapia de biorretroalimentación y la cirugía. Keywords: Consensus, Constipation, Laxatives, Fiber, Mexico, Palabras clave: Consenso, Estreñimiento, Laxantes, Fibra, México

Background There are no studies on the factors associated with gastroesophageal reflux disease (GERD) relapse in primary care patients. Aim To identify the risk factors associated with GERD relapse in primary care patients that responded adequately to short-term treatment with a proton pump inhibitor. Patients and methods A cohort study was conducted that included GERD incident cases. The patients received treatment with omeprazole for 4 weeks. The ReQuest questionnaire and a risk factor questionnaire were applied. The therapeutic success rate and relapse rate were determined at 4 and 12 weeks after treatment suspension. A logistic regression analysis of the possible risk factors for GERD relapse was carried out. Results Of the 83 patient total, 74 (89.16%) responded to treatment. Symptoms recurred in 36 patients (48.64%) at 4 weeks and in 13 patients (17.57%) at 12 weeks, with an overall relapse rate of 66.21%. The OR multivariate analysis (95% CI) showed the increases in the possibility of GERD relapse for the following factors at 12 weeks after treatment suspension: basic educational level or lower, 24.95 (1.92-323.79); overweight, 1.76 (0.22-13.64); obesity, 0.25 (0.01-3.46); smoking, 0.51 (0.06-3.88); and the consumption of 4-12 cups of coffee per month, 1.00 (0.12-7.84); citrus fruits, 14.76 (1.90-114.57); NSAIDs, 27.77 (1.12-686.11); chocolate, 0.86 (0.18-4.06); ASA 1.63 (0.12-21.63); carbonated beverages, 4.24 (0.32-55.05); spicy food 7-16 times/month, 1.39 (0.17-11.17); and spicy food ≥ 20 times/month, 4.06 (0.47-34.59). Conclusions The relapse rate after short-term treatment with omeprazole was high. The consumption of citrus fruits and NSAIDs increased the possibility of GERD relapse.

Galectin-4 has been reported to be altered in different cancer types. Its expression changes have been associated with early recurrence and metastasis. In cervical cancer (CC), galectin-4 has not been studied. The aim of the study was to determine the expression level and subcellular localization of galectin-4 in CC tissue and the concentration in the serum of patients with CC. For the analysis of serum levels of galectin-4, an ELISA assay was performed. To assess the expression in cervical tissue, immunohistochemical staining was performed. The results showed that the concentration of galectin-4 in the serum of patients with CC was higher (647.9 pg/ml) than that in the serum of women with normal cytology (382.1 pg/ml). The immunohistochemical analysis of CC samples showed a higher expression in keratinizing tumor than nonkeratinizing tumors and a trend of increased expression in tumors from patients with advanced clinical stage. In normal cervical tissue, galectin-4 was detected in the cytoplasm, and in tumor cells, the presence of galectin-4 was also detected in the nucleus, in both adenocarcinoma and squamous cervical cancer. The increase in serum concentration and different localization in the tumor cells suggest a possible role of galectin-4 in CC development.

Objective To correlate ultrasonographic and histopathological diagnosis in patients categorized as breast imaging reporting and data system (BI-RADS) 4. Method Cross-sectional study, performed on patients with BI-RADS 4 (A, B or C) diagnosed by ultrasonography in the high specialty medical unit, hospital of specialties, Centro Medico Nacional General de Division Manuel Avila Camacho, of the Instituto Mexicano del Seguro Social. Age, ultrasonographic and histopathological diagnosis, menarquia, menopause, gestations, lactation, use of contraceptives and family history of breast cancer were evaluated. Results 101 patients categorized BI-RADS 4 were included; average age was 53.0 ± 8.3 years old, 6.9% of the patients were nulliparous, 92.2% with positive breastfeeding and 25.7% had a family history of breast cancer. By ultrasonography, 55.4% of the cases were BI-RADS 4A, 22.8% 4B and 21.8% 4C. 75.2% of the biopsies performed on the patients were benign and 24.8% were malignant. The overall ultrasonographic-histopathological concordance index was 0.25; 0.11 for BI-RADS 4A, 0.22 for BI-RADS 4B and 0.63 for BI-RADS 4C. Conclusion The ultrasound-histopathological correlation is weak and inferior to that reported in the literature.

espanolIntroduccion: La evaluacion de la respuesta al tratamiento de linfoma se basa en estudios de imagen. Objetivo: Correlacionar la evaluacion de la respuesta al tratamiento de linfoma mediante tomografia axial computarizada (TAC) y tomografia por emision de positrones/tomografia computarizada (PET/TC). Metodo: Estudio observacional transversal en el que se revisaron expedientes de pacientes con linfoma en vigilancia mediante TAC y PET/TC. Resultados: La poblacion de estudio estuvo constituida por 43 pacientes con edad media de 32.7 ± 22.4 anos; 26 (60.5 %) tenian diagnostico de linfoma de Hodgkin y 17 (9.5 %), de linfoma no Hodgkin. Por TAC se diagnosticaron 34 (79.1 %) con enfermedad y nueve (20.9 %) sin enfermedad. El criterio para evaluar la respuesta fue la experiencia del medico imagenologo en 39 (90.7 %) y RECIST 1.1 en cuatro (9.3 %). Por PET/TC con 18-FDG se diagnostico falta de respuesta al tratamiento o respuesta parcial-recurrencia en 32 pacientes (74.4 %) y con respuesta al tratamiento en 11 (25.6 %); con los criterios PERCIST en 13 (30.2 %) y con los de Deuaville en 30 (69.8 %). Al comparar el diagnostico por TAC contra PET/TC, de 11 pacientes con respuesta total, tres tuvieron diagnostico tomografico similar. De los 34 pacientes con datos de enfermedad diagnosticados por tomografia, 26 tuvieron resultados similares por PET/TC con 18-FDG (p = 0.54). Conclusion: El valor de la respuesta al tratamiento por TAC en linfoma no concuerda con el obtenido mediante PET/TC con 18-FDG. EnglishIntroduction: The assessment of lymphoma response to treatment is based on imaging studies. Objective: To correlate the assessment of lymphoma treatment response by computed tomography (CT) and by positron emission tomography/computed tomography (PET/CT). Method: Cross-sectional, observational study, where records of patients with lymphoma under surveillance by CT and PET/CT were reviewed. Results: The study population consisted of 43 patients with a mean age of 32.7 ± 22.4 years; 26 (60.5 %) had a diagnosis of Hodgkin’s lymphoma and 17 (9.5 %) had non-Hodgkin lymphoma. By CT, 34 (79.1 %) were diagnosed with disease and nine (20.9 %) without disease. The criteria used to assess the response was radiologist experience in 39 (90.7 %) and RECIST 1.1 criteria in four (9.3 %). The diagnosis by 18-FDG PET/CT was no response to treatment or partial response-recurrence in 32 (74.4 %) and response to treatment in 11 (25.6 %); with PERCIST criteria in 13 (30.2 %) and Deuaville criteria in 30 (69.8 %). When the diagnosis by CT versus 18-FDG PET/CT was compared, out of 11 patients with complete response on PET/CT, three had a similar CT diagnosis. Of the 34 patients with data consistent disease diagnosed by CT, 26 had similar results by 18-FDG PET/CT (p = 0.54). Conclusion: The value of lymphoma treatment response on CT does not agree with that obtained by 18-FDG PET/CT.

Background Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystemic involvement. Gastrointestinal (GI) manifestations are frequent but functional gastrointestinal disorders (FGIDs) have scarcely been studied in SLE. To determine the prevalence of FGIDs and their potential risk factors in SLE female patients vs controls. Methods Systemic lupus erythematosus patients meeting the American College of Rheumatology (ACR) criteria and controls completed the Rome III questionnaire for FGIDs and a structured interview to assess sociodemographic, clinical, and treatment variables after excluding organic GI diseases. Logistic regression was used to determine risk factors (ie, alcohol drinking, medications) for FGIDs. Key results Responders included 113 SLE patients and 122 age-matched controls. The presence of at least one FGIDs was higher in SLE (73.4%) vs controls (54.1%), P = .003. The most frequent FGIDs in SLE patients were nausea and vomiting disorders (NVD), belching disorders, globus, anorectal pain, functional heartburn (FH), and functional bloating (FB). After adjustment for confounding variables, SLE was associated with NVD (OR: 7.1, 95% CI: 2.7-19.1) globus (3.5, 1.3-9.3), anorectal pain (3.4, 1.4-8.4), and FH (2.5, 1.5-4.4). The simultaneous presence of >1 FGID was more common in SLE patients than controls (69.8% vs 31.8%). Glucocorticoids (5.2, 1.3-19.9) and non-steroidal anti-inflammatory drugs (NSAIDs; 3.0, 1.1-8.0) were associated with any FGID in SLE patients while alcohol drinking with gallbladder/sphincter of Oddi disorders 7.4 (1.1-47.3). Conclusions and inferences Functional gastrointestinal disorders are more frequent in SLE patients compared with controls. Medication that may alter gastrointestinal homeostasis, such as glucocorticoids and NSAIDs, are potential risk factors for FGIDs in SLE.

Background Gastroesophageal reflux disease develops when the stomach contents causes troublesome symptoms and complications. Mild forms are non-erosive and erosive esophagitis, and severe forms are Barrett's esophagus and Esophageal adenocarcinoma. Matrix metalloproteinases are endopeptidases that can degrade components of the extracellular matrix, they play an important role in tumor invasion as well as in metastasis. Objective To correlate the expression of metalloproteinase 9 (MMP-9) in esophageal biopsies from patients with mild and severe forms of Gastroesophageal reflux disease. Method Cross-sectional study. The expression of MMP-9 was determined in biopsies of esophageal tissue of patients with mild and severe GRD. The included variables were age, sex, diagnosis, smoking and alcoholic habits, body mass index (BMI) and expression of MMP-9. Descriptive statistics was performed, Kappa for concordance in diagnosis as well as X2. Results There were 50 patients, 32 (64%) men and 18 (36%) women, mean age 52.13 ± 14.75 years of age. 12 (24%) with smoking and 7 (14%) with alcoholism. Average BMI was 26.71 ± 4.07 kg/m2 (15 to 33); 40 (80%) with obesity. The inter observer concordance for histopathological diagnosis was 1.0 and 0.84 for esophagitis degrees. 27 (54%) patients had esophagitis, 16 (32%) Barrett's esophagus and 7 (14%) esophageal cancer. There was expression of MMP-9 in four patients with esophagitis, five with Barrett's esophagus and five with esophageal cancer. Statistical significance was found between the expression of MMP-9 and smoking (p = 0.011) and histopathological diagnosis (p = 0.052). Conclusions The expression of MMP-9 is most common in severe forms compared to the mild forms of GRD.

Background Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystemic involvement. Gastrointestinal (GI) manifestations are frequent in patients with SLE, but functional gastrointestinal disorders (FGIDs), a heterogeneous group of GI diseases have hardly been evaluated in SLE patients. Objectives We evaluated the prevalence of FGIDs in SLE patients compared with age-matched controls and the role of potential risk factors for FGIDs. Methods SLE patients who met the ACR classification criteria for SLE and age-matched controls completed the Rome III questionnaire to assess the prevalence of FGIDs. Exclusion criteria were organic gastrointestinal disorders. Patients completed a structured interview to assess sociodemographic, clinical and treatment variables. Logistic multivariate analysis was performed to determine potential clinical factors (alcohol ingestion and medications) for FGIDS. Results The study responders included 116 SLE patients and 122 controls. The prevalence of FGIDs was higher in SLE patients than in controls (74.1% vs. 54.1%; p= 0.01). The most frequent FGIDs were nausea and vomiting disorders, belching disorders and globus pharyngeus. Anorectal disorders, mainly anorectal pain, were more frequent in SLE patients than controls (14.7% vs. 5.7%). After adjusting for confounding variables, SLE was associated with globus pharyngeus (OR: 3.5, 95%CI: 1.3-9.3), functional heartburn (OR: 2.5, 95% CI: 1.5-4.4), nausea and vomiting disorders (OR 7.1, 95% CI 2.7-19.1) and anorectal disorders (OR: 3.4, 95% CI 1.4-8.4). Overlap symptoms were present in 69.8% of patients vs. 31.8% of controls. When only SLE patients were evaluated, glucocorticoid therapy and non-steroidal anti-inflammatory drugs (NSAIDs) were associated with any FGID and functional bowel disorders, while alcohol ingestion was associated with gallbladder and sphincter of Oddi disorders. Conclusion There is a higher prevalence of FGIDs in patients with SLE and a wider distribution of various GI tract symptoms compared with controls. Medication that may alter gastrointestinal homeostasis, such as NSAIDs and protein pump inhibitors, were associated with FGIDs in SLE patients. Disclosure of Interests None declared

Background Since the publication in 2009 of the Guidelines on the Diagnosis and Treatment of Irritable Bowel Syndrome of the Asociacion Mexicana de Gastroenterologia (2009 Guidelines), there have been significant advances in our knowledge of the epidemiology, pathophysiology, diagnosis, and treatment of this disease. Aims To present a consensus review of the most current knowledge of IBS, updating the 2009 Guidelines by incorporating new internationally published scientific evidence, with a special interest in Mexican studies. Methods The PubMed literature from January 2009 to March 2015 was reviewed and complemented through a manual search. Articles in English and Spanish were included and preference was given to consensuses, guidelines, systematic reviews, and meta-analyses. Statements referring to the different aspects of the disease were formulated and voted upon by 24 gastroenterologists employing the Delphi method. Once a consensus on each statement was reached, the quality of evidence and strength of recommendation were determined through the GRADE system. Results Forty-eight statements were formulated, updating the information on IBS and adding the complementary data that did not appear in the 2009 Guidelines regarding the importance of exercise and diet, diagnostic strategies, and current therapy alternatives that were analyzed with more stringent scientific vigor or that emerged within the last 5 years. Conclusions We present herein a consensus review of the most relevant advances in the study of IBS, updating and complementing the 2009 Guidelines. Several studies conducted in Mexico were included.

BACKGROUND & AIMS: Although functional gastrointestinal disorders (FGIDs), now called disorders of gut-brain interaction, have major economic effects on health care systems and adversely affect quality of life, little is known about their global prevalence and distribution. We investigated the prevalence of and factors associated with 22 FGIDs, in 33 countries on 6 continents. METHODS: Data were collected via the Internet in 24 countries, personal interviews in 7 countries, and both in 2 countries, using the Rome IV diagnostic questionnaire, Rome III irritable bowel syndrome questions, and 80 items to identify variables associated with FGIDs. Data collection methods differed for Internet and household groups, so data analyses were conducted and reported separately. RESULTS: Among the 73,076 adult respondents (49.5% women), diagnostic criteria were met for at least 1 FGID by 40.3% persons who completed the Internet surveys (95% confidence interval [CI], 39.9-40.7) and 20.7% of persons who completed the household surveys (95% CI, 20.2-21.3). FGIDs were more prevalent among women than men, based on responses to the Internet survey (odds ratio, 1.7; 95% CI, 1.6-1.7) and household survey (odds ratio, 1.3; 95% CI, 1.3-1.4). FGIDs were associated with lower quality of life and more frequent doctor visits. Proportions of subjects with irritable bowel syndrome were lower when the Rome IV criteria were used, compared with the Rome III criteria, in the Internet survey (4.1% vs 10.1%) and household survey (1.5% vs 3.5%). CONCLUSIONS: in a large-scale multinational study, we found that more than 40% of persons worldwide have FGIDs, which affect quality of life and health care use. Although the absolute prevalence was higher among Internet respondents, similar trends and relative distributions were found in people who completed Internet vs personal interviews., Ironwood; Shire; AllerganAllergan; TakedaTakeda Pharmaceutical Company Ltd; Fundamental Research Grant Scheme (FRGS) of the Ministry of Education of Malaysia [203.PPSP.6171192]; Takeda-Israel; Romanian Society of Neurogastroenterology, The study was funded, in part, by research grants from Ironwood, Shire, Allergan, and Takeda. The study in Malaysia was funded by the Fundamental Research Grant Scheme (FRGS) of the Ministry of Education of Malaysia (Reference: 203.PPSP.6171192). The study in Israel was funded by Takeda-Israel. The study in Romania was funded by the Romanian Society of Neurogastroenterology. None of the funders was involved in the planning, design, implementation, statistical analyses or any other aspect of the study including preparation of the paper or knowledge of its contents.

The increase in cardiovascular disease (CVD) in patients with systemic lupus erythematosus (SLE) is not fully explained by traditional CVD risk factors. Regulatory T cells (Treg cells) are considered atheroprotective. We investigated the relationship between the absolute number of different phenotypes of Treg cells and abnormal carotid intima-media thickness (IMT) in women with SLE. Sixty-six women with SLE with no history of CV disease were included. Carotid IMT was quantified by ultrasound. Abnormal carotid IMT was defined as ≥0.8 mm and two groups were compared according to this definition. Flow cytometry was used to analyze Foxp3 and Helios expression in peripheral blood CD4 T cells. A significantly higher level of absolute CD4+CD25+FoxP3high T cells was present in patients with abnormal carotid IMT compared with those without (1.795±4.182 cells/μl vs. 0.274±0.784 cells/μl; p=0.003). However, no correlations were found between any Treg cell phenotypes and carotid IMT. Only the absolute number of CD4+CD45RA+FoxP3low T cells was significantly decreased in SLE patients with low HDL cholesterol compared with those with normal HDL cholesterol (0.609±2.362 cells/μl vs. 1.802±4.647 cells/μl; p=0.009 and 15.358±11.608 cells/μl vs. 28.274±34.139; p=0.012, respectively). In conclusion, in SLE women, diminished levels of Treg cells based on flow cytometry were not a good indicator of abnormal carotid IMT.

Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented. Resumen: Desde la publicación en 2008 de las guías de diagnóstico y tratamiento de la enfermedad diverticular del colon de la Asociación Mexicana de Gastroenterología ha habido avances significativos en el conocimiento de esta enfermedad. Se realizó una revisión sistemática de la literatura en PubMed de enero de 2008 a julio de 2018 con el fin de revisar y actualizar las guías 2008 y proporcionar nuevas recomendaciones basadas en la evidencia. Se incluyeron todas las publicaciones en español e inglés, de alta calidad. Se redactaron los enunciados, que fueron votados utilizando el método Delphi. Se estableció la calidad de la evidencia y la fuerza de las recomendaciones según el sistema GRADE para cada enunciado. Cuarenta y tres enunciados fueron finalmente votados y calificados. Se informan nuevos datos sobre definición, clasificación, epidemiología, fisiopatología y factores de riesgo. Se revisó con especial énfasis la utilidad de la tomografía computarizada y de la colonoscopia, así como los métodos endoscópicos para el control de la hemorragia. Se discutió sobre el tratamiento ambulatorio de la diverticulitis no complicada, el papel de la rifaximina y la mesalazina, en el manejo de la diverticulitis aguda complicada tanto en sus alternativas mínimamente invasivas hasta las opciones quirúrgicas con énfasis en sus indicaciones, limitaciones y contraindicaciones. Los nuevos enunciados proporcionan directrices basadas en la evidencia actualizada. Se presentan la discusión, el grado y la fuerza de la recomendación de cada uno de ellos. Keywords: Diverticula, Diverticulitis, Mexico, Colon, Disease, Consensus, Palabras clave: Divertículos, Diverticulitis, México, Colon, Enfermedad, Consenso

Aim: The aim of this study was to determine the relationship between thyroid disorders and prolactin in patients with and without lupus activity. Patients & methods: Women with systemic lupus erythematosus (SLE) were evaluated for lupus activity. Serum tri-iodothyronine (T3), serum thyroxine (T4) and thyroid-stimulating hormone (TSH), anti-thyroid peroxidase (anti-TPO) anti-thyroglobulin (anti-TG) and prolactin were measured. Results: 50 women with SLE with lupus activity and 50 women with SLE without activity with mean age of 34.5 ± 14.8 years and mean disease duration of 15.0 ± 2.8 years. Patients with disease activity, subclinical hypothyroidism, anti-TG and anti-TPO were more prevalent and had higher prolactin levels compared with those without disease activity. There was no difference in prolactin levels according to the presence of hypothyroidism, and antithyroid antibody positivity did not differ in patients with and without hyperprolactinemia. Conclusion: There was no relationship between thyroid ...

Background Post-infectious irritable bowel syndrome (PI-IBS) prevalence, small intestinal bacterial overgrowth (SIBO), altered microbiota, low-grade inflammation, and antibiotic therapy in IBS are all controversial issues. Aims To conduct an evidence-based review of these factors. Methods A review of the literature was carried out up to July 2012, with the inclusion of additional articles as far as August 2013, all of which were analyzed through the Oxford Centre for Evidence-Based Medicine (OCEBM) system. Results 1. There is greater SIBO probability in IBS when breath tests are performed, but prevalence varies widely (2-84%). 2. The gut microbiota in individuals with IBS is different from that in healthy subjects, but a common characteristic present in all the patients has not been established. 3. The incidence and prevalence of PI-IBS varies from 9-10% and 3-17%, respectively, and the latter decreases over time. Bacterial etiology is the most frequent but post-viral and parasitic cases have been reported. 4. A sub-group of patients has increased enterochromaffin cells, intraepithelial lymphocytes, and mast cells in the intestinal mucosa, but no differences between PI-IBS and non PI-IBS have been determined. 5. Methanogenic microbiota has been associated with IBS with constipation. 6. Rifaximin at doses of 400 mg TID/10 days or 550 mg TID/14 days is an effective treatment for the majority of overall symptoms and abdominal bloating in IBS. Retreatment effectiveness appears to be similar to that of the first cycle. Conclusions Further studies are required to determine the nature of the gut microbiota in IBS and the differences in low-grade inflammation between PI-IBS and non PI-IBS. Rifaximin has shown itself to be an effective treatment for IBS, regardless of prior factors.

Background/Aims To evaluate the effectiveness of pantoprazole magnesium (pantoprazole-Mg) 40 mg in the relief of esophageal and extra- esophageal symptoms of gastroesophageal reflux disease (GERD), particularly night-time symptoms. Methods Patients (aged 18-50 years) with 3-month history of heartburn and/or acid regurgitation plus at least one other symptom in the last week were enrolled in a nationwide, prospective and observational study in Mexico. Patients received pantoprazole-Mg 40 mg once daily during 4 weeks. Symptoms were assessed through a physician-administered structured interview and the patient- completed ReQuest in PracticeTM questionnaire. Night-time GERD was defined as arousal from sleep during the night due to GERD-associated symptoms. Results Out of 4,343 patients included at basal visit, 3,665 were considered for the effectiveness per protocol analysis. At baseline, patients had a median of 8 GERD related symptoms. Patients with night-time GERD symptoms (42.7%) were more likely to have extra-esophageal symptoms (P ＜ 0.001) than other GERD patients. Pantoprazole-Mg 40 mg once daily for 4 weeks improved a broad range of GERD-associated symptoms from baseline (80% reduction on physicians assessments; 68-77% reduction on ReQuest in PracticeTM dimensions), including both day- and night-time GERD symptoms; improvements were the greatest for extra-esophageal symptoms in patients with night-time symptoms. Pantoprazole-Mg was well tolerated. Conclusions Pantoprazole-Mg 40 mg significantly improved a broad range of esophageal and extra-esophageal GERD related symptoms including sleep disturbances, as well as well-being, in patients with daytime or night-time GERD, making it a good option for patients with GERD, especially when extra-esophageal and night-time symptoms are present. (J Neurogastroenterol Motil 2014;20:64-73)

Summary Five patients with active disseminated vitiligo were given 1 g of a chimeric (murine/human) monoclonal antibody to CD20 in a single intravenous infusion and followed-up for 6 months. Three of the patients showed an overt clinical and histological improvement of the disease, one presented slight improvement and the remaining patient showed no changes. Improvement was neither associated with changes in laboratory parameters nor to a specific human leucocyte antigen D-related (HLA-DR) phenotype. We believe that these preliminary results are encouraging, and further clinical trials should be undertaken. An important aim should be the finding of a marker with a good response to this therapeutic approach.

Introduction Health-related quality of life (HRQOL) is affected by numerous clinical variables, including disease activity, damage, fibromyalgia, depression and anxiety. However, these associations have not yet been described in Mexican patients with systemic lupus erythematosus (SLE). Objective To evaluate the relationship between disease activity, damage, depression and fibromyalgia and HRQOL measured by the LupusQoL-instrument in Mexican patients with SLE. Methods A cross-sectional study was conducted in women fulfilling the 1997 ACR classification criteria for SLE. HRQOL was evaluated using a disease-specific instrument for SLE, the LupusQoL (validated for the Spanish-speaking population). Patients were evaluated clinically to determine the degree of disease activity and damage using the Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) and Systemic Lupus International Collaborating Clinics-Damage Index (SLICC), respectively. Fibromyalgia and depression were assessed using the ACR criteria and the CES-D scale, respectively. The relationship between HRQOL and these variables was measured using Spearman’s rank correlation coefficient and linear regression analysis. Results A total of 138 women with SLE, age 40.3±11 years, disease duration 8.8±6.4 years, with disease activity in 51.4%, depression in 50%, damage in 43% and fibromyalgia in 19.6% were included. Poorer HRQOL correlated with depression (r = -0.61; p< 0.005), fibromyalgia (r = -0.42; p< 0.005), disease activity (r = -0.37; p < 0.005) and damage (r = -0.31; p < 0.005). In the multivariate linear regression analysis, damage (β = -3.756, p

The LupusQoL© questionnaire is a disease-specific health related quality of life (HRQOL) instrument for adults with systemic lupus erythematosus (SLE). The Short Form-36 (SF-36) is a generic instrument that captures the physical, psychological, and social impact. We conducted a descriptive study of women aged ≥ 18 years attending our Lupus Clinic. HRQOL was assessed by applying the LupusQoL© and SF-36. Lupus activity was measured using the Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) and chronic damage using the Systemic Lupus Collaborative Clinics Damage Index (SDI). Data were analyzed using descriptive statistics, the chi-square test and Pearson’s product moment correlation coefficient. A total of 127 patients were included with a mean age of 40.5 ± 12.6 years. The mean disease duration was 8.2 ± 5.6 years, the mean disease activity score was 2.4 ± 3.0, and the mean SDI score 0.77 ± 1.06. The mean SF-36 score was 58.1 ± 21.1 and the mean LupusQoL© score was 69 ± 22.7. The correlation between global scores of the SF-36 and LupusQoL© was rho = 0.73 ( p

Aim is to determine whether lactate clearance has value as mortality prognostic factor in shock patients, or not. A scrutiny, descriptive, prolective, homodemic, longitudinal study in patients older than 19 years, excluding chronic renal illness, hepatic insufficiency, neoplasias and diabetics on biguanides treatment, was performed. Arterial gasometry was used to obtain lactate rates at admission, 6, 12, and 24 hours as well as lactate’s clearance. Determinations between survivors and not survivors were compared, as well as correlation with APACHE II was performed. 41 patients were studied, 53.7% women and 46.3% men, mean age was 63.95 years. The diagnostics were septic shock in 29.2%, hypovolemic 63.4%, and cardiogenic 7.3%. The mortality in cardiogenic shock was 100%, with null lactate clearance. The survival rate was higher in hypovolemic shock as its lactate clearance rates (at 12 and 24 hours). Lactate clearance rates of less than 0 at 24 hours had a positive predictive value and a sensitivity of 80%. Lactate clearance at 6, 12, 24 hours among survivors and not survivors demonstrated statistical significance in the Univariate Analysis (p

The aim of the current study was to analyze the role of traditional and systemic lupus erythematosus (SLE)-related risk factors in the development of vertebral fractures. A cross-sectional study was performed in women with SLE attending a single center. A vertebral fracture was defined as a reduction of at least 20% of vertebral body height. Two hundred ten patients were studied, with median age of 43 years and median disease duration of 72 months. Osteopenia was present in 50.3% of patients and osteoporosis in 17.4%. At least one vertebral fracture was detected in 26.1%. Patients with vertebral fractures had a higher mean age (50 +/- 14 vs. 41 +/- 13.2 years, p = 0.001), disease damage (57.1% vs. 34.4%, p = 0.001), lower bone mineral density (BMD) at the total hip (0.902 +/- 0.160 vs. 982 +/- 0.137 g/cm(2), p = 0.002), and postmenopausal status (61.9% vs. 45.3%, p = 0.048). Stepwise logistic regression analysis revealed that only age (p = 0.001) and low BMD at the total hip (p = 0.007) remained as significant factors for the presence of vertebral fracture. The high prevalence of vertebral fractures in the relatively young population implies that more attention must be paid to detect and treat vertebral fractures.

The objective of this study was to analyse whether patients with systemic lupus erythematosus (SLE) without traditional risk factors for coronary artery disease (CAD) develop subclinical myocardial ischaemia in the first years after diagnosis. A cross-sectional analysis of a cohort of 200 female SLE patients was conducted. We selected those patients who fulfilled the American College of Rheumatology (ACR) SLE criteria and had no traditional risk factors for CAD, including diabetes mellitus, hypertension, obesity, hyperlipidemia, and smoking. After an initial clinical and laboratory examination, patients were evaluated using a baseline echocardiogram and a dobutamine and atropine stress echocardiogram to search for subclinical myocardial ischaemia. Forty-one patients were included in the study. The mean age at the time of the study was 34.5 ± 9.56 years (mean ± SD). The mean age at diagnosis was 30.3 ± 9.39 years. The mean time from diagnosis was 3.9 ± 3.3 years. Baseline disease activity index (MEX-SLEDAI score) showed that 92.6% of patients had disease activity, although most patients had mild activity. A dobutamine and atropine stress echocardiogram was performed in 40 patients. All 40 patients had negative tests for subclinical myocardial ischaemia. Patients without traditional risk factors for CAD do not have an increased risk for subclinical myocardial ischaemia in the first years after diagnosis. A longitudinal follow-up study of these patients is needed to confirm our findings and assess if additional non-traditional risk factors for CAD increase the risk for myocardial ischaemia. Lupus (2007) 16, 298—301.

In this study, three strains of Trypanosoma cruzi were isolated at the same time and in the same endemic region in Mexico from a human patient with chronic chagasic cardiomyopathy (RyC-H); vector (Triatoma barberi) (RyC-V); and rodent reservoir (Peromyscus peromyscus) (RyC-R). The three strains were characterized by multilocus enzyme electrophoresis, random amplified polymorphic DNA, and by pathological profiles in experimental animals (biodemes). Based on the analysis of genetic markers the three parasite strains were typed as belonging to T. cruzi I major group, discrete typing unit 1. The pathological profile of RyC-H and RyC-V strains indicated medium virulence and low mortality and, accordingly, the strains should be considered as belonging to biodeme Type III. On the other hand, the parasites from RyC-R strain induced more severe inflammatory processes and high mortality (> 40%) and were considered as belonging to biodeme Type II. The relationship between genotypes and biological characteristics in T. cruzi strains is still debated and not clearly understood. An expert committee recommended in 1999 that Biodeme Type III would correspond to T. cruzi I group, whereas Biodeme Type II, to T. cruzi II group. Our findings suggest that, at least for Mexican isolates, this correlation does not stand and that biological characteristics such as pathogenicity and virulence could be determined by factors different from those identified in the genotypic characterization.

Background. Approximately 180 million persons (~2.8%) globally are estimated to be infected by hepatitis C virus (HCV). HCV prevalence in Mexico has been estimated to be between 1.2 and 1.4%. The aim of present work was to determine the prevalence of HCV infection in patients and family members attending two primary care clinics in Puebla, Mexico. Material and methods. Patients and their accompanying family members in two clinics were invited to participate in this study between May and September 2010. Results. A total of 10,214 persons were included in the study; 120 (1.17%) persons were anti-HCV reactive. Of the reactive subjects, detection of viral RNA was determined in 114 subjects and 36 were positive (31%). The more frequent risk factors were having a family history of cirrhosis (33.1%) and having a blood transfusion prior to 1995 (29%). After a multiple logistic regression analysis only transfusion prior to 1995 resulted significant to HCV transmission (p = 0.004). The overall detected HCV genotypes were as follows: 1a (29%), 1b (48.5%), 2/2b (12.8%), and 3a (6.5%). Conclusion. The HCV prevalence in this population is in agreement with previous studies in other regions of Mexico.

Background Low bone mineral density (BMD) and vertebral fractures (VF) have been associated with atherosclerosis in the general population. We sought to investigate the relationship between BMD and VF and carotid atherosclerosis in women with systemic lupus erythematosus (SLE). Methods We studied 122 women with SLE. All patients had BMD, carotid intima-media thickness (IMT), and carotid artery atherosclerotic plaque assessment by ultrasound. Results Mean age at study entry was 44 years and mean disease duration was 11 years. Carotid plaque was found in 13 (11%) patients (9 postmenopausal and 4 premenopausal). Patients in the highest IMT quartile were more likely to be older ( p = 0.001), have a higher body mass index ( p = 0.008), and exhibit dyslipidemia at study entry ( p = 0.041), compared with the lower three quartiles. BMD at the lumbar spine was lower in patients in the highest IMT quartile compared with the lower quartiles in the multivariate logistic analysis, however, there was no association between lumbar or total hip BMD and IMT ( p = 0.91 and p = 0.6, respectively). IMT measurements did not differ according to the presence or absence of VF (0.08 ± 0.12 vs. 0.06 ± 0.03 mm, p = 0.11). A trend towards higher incidence of VF was found in patients with carotid plaque compared with those without (33% vs. 21%; p = 0.2). Conclusions In patients with SLE, the presence of carotid atherosclerosis is not associated with low BMD or VF.

Our objective was to evaluate whether vitamin D deficiency is associated with cervical human papilloma virus (HPV) infection in women with SLE. This is a cross-sectional study of 67 women with SLE. A structured questionnaire was administered to ascertain the possible risk factors associated with cervical HPV infection. A gynaecological evaluation and cervical cytology screening were made. HPV detection and genotyping was made by PCR and linear array assay. Serum 25 hydroxyvitamin D levels were quantified by chemiluminescence immunoassay. Mean age and disease duration were 44.8 ± 10.6 and 42.5 ± 11.8 years, respectively. Demographic characteristics were similar in patients with and without deficiency (

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.

Background It is accepted that patients with SLE exhibit an increased risk for low BMD and bone fractures; nevertheless, few studies have evaluated bone disorders in Latin American population. It is the first study that has evaluated frequency and correlations of low BMD in postmenopausal mestizo Mexican women with SLE Objectives To determine the frequency of osteoporosis and possible risk factor for low bone mineral density (BMD) in postmenopausal mestizo Latino American women with systemic lupus erythematosus (SLE) Methods A cross-sectional study was conducted among 100 postmenopausal patients with SLE. Patients were evaluated using a questionnaire about the follow variables: age at the time of the study, age at menopause, disease duration, disease activity, damage of the disease, cumulative corticosteroid dose, and history of fracture. Lumbar spine and hip measurements of BMD were performed by dual absorptiometry. Univariate and multivariate statistical analyses were used to assess relationship between risks factor and BMD. Results The mean age was 53.8±9.56 years and the mean SLE duration was 73.2±65 months. The mean BMD of the lumbar spine was 0.944±0.178 g/cm 2 and the hip was 0.915±0.135 g/cm 2 . Osteopenia was present in 63% and osteoporosis in 31%. In the univariate analysis, age at the time of the study and menopause duration were associated with low BMD at the hip while age at the time of the study, menopause duration and damage of the disease were associated with low BMD at the lumbar spine. In the multiple regression analysis, low BMD in lumbar spine and hip were associated only with age (B= -0.0004, P=0.017; B= -0.0006, P= Conclusions Osteopenia was found in 63% and osteoporosis in 31%. Risk factor for low BMD in both total hip and lumbar spine in postmenopausal SLE women was age. Disclosure of Interest None declared

Aims.The frequency of functional gastrointestinal disorders (FGIDs) in the general population of Mexico is unknown.Methods.To determine the prevalence of FGIDs, associated depression, and health care utilization, a population-based sampling strategy was used to select 500 households in the State of Tlaxcala, in central Mexico. Household interviews were conducted by two trained physicians using the Rome II Modular Questionnaire, a health-care and medication used questionnaire and the CES-D depression scale.Results.The most common FGIDs were IBS: 16.0% (95% CI: 12.9–19.5); functional bloating: 10.8% (8.2–13.9); unspecified functional bowel disorder: 10.6% (8.0–13.6); and functional constipation (FC): 7.4% (5.3–10.1). Uninvestigated heartburn was common: 19.6% (16.2–23.4). All FGIDs were equally prevalent among both genders, except for IBS (P=0.001), IBS-C (P<0.001), IBS-A/M (P=0.049), and FC (P=0.039) which were more frequent in women. Subjects with FGIDs reported higher frequencies of medical visits: 34.6 versus 16.8%; use of medications: 40.7 versus 21.6%; (bothP<0.001); and reported depression: 26.7 versus 6.7%, (P<0.001).Conclusion.In this first population-based study of FGIDs in Mexico, heartburn, IBS, functional distension, and FC were common. Only IBS, IBS-C, IBS-A/M, and FC were more frequent in women. Finally, FGIDs in Mexico had an increased burden of health care utilization and depression.

The objective of this study was to investigate the efficacy and safety of anti-CD20 treatment in Hispanic patients with refractory systemic lupus erythematosus and to determine whether baseline parameters predict disease flare. Fifty-two patients with systemic lupus erythematosus, 13 with active lupus nephritis, eight with thrombocytopenia, three with leukocytopenia, 25 with severe musculoskeletal involvement and three with skin involvement) refractory to conventional therapy were treated with anti-CD20 treatment (rituximab; MabThera®, Roche) plus ongoing immunosuppressive treatment. Disease activity was assessed monthly using the SLEDAI validated for the Mexican population with a follow-up period of 6 months. At 6 months of follow-up, significant clinical improvements were detected, with a reduction in the global SLEDAI validated for the Mexican population score. Five of the 13 patients with lupus nephritis (38.4%) had a complete renal response and five (38.4%) had a partial response. Rituximab was also effective in patients with autoimmune thrombocytopenia, inducing a significant increase in platelet counts (p = 0.012). Nineteen of 25 patients with severe musculoskeletal involvement had remission of arthritis. Only one of the three patients with skin involvement had no lesions at 6 months. Rituximab treatment also allowed a reduction of the oral prednisone dose in the majority of patients. No baseline predictors of flare were found. Treatment was discontinued after the first infusion in two patients due to serum sickness and in another due to pulmonary infection. In conclusion, the addition of rituximab to conventional immunosuppressive therapy may be an effective strategy for lupus nephritis, autoimmune thrombocytopenia and inflammatory polyarthritis in patients with refractory systemic lupus erythematosus. Lupus (2010) 19, 213—219.

The aim of this study was to determine the prevalence and risk factors for low bone mineral density (BMD) in women with systemic lupus erythematosus (SLE). A cross-sectional study was conducted among 100 pre-menopausal patients with SLE. Patients were evaluated using a questionnaire about the following variables: age, disease duration, disease activity, chronic disease damage, cumulative corticosteroid dose, and history of fracture. Lumbar spine and hip measurements of BMD were performed by dual absorptiometry. Univariate and multivariate statistical analyses were used to assess the relationship between risk factors and BMD. The mean age was 32.8 +/- 8.7 years, and the median duration of SLE was 73.2 +/- 65 months. The mean cumulative corticosteroid dose was 20.0 +/- 21.3 g. The mean BMD was 1.09 +/- .18 g/cm(2) in the lumbar spine and 1.0 +/- .14 g/cm(2) in the hip. Osteopenia was present in 40% of patients and osteoporosis in 5%. In the multiple regression analysis, low BMD in the lumbar spine was associated with chronic disease damage and low body mass index (BMI). Low BMD in the hip was associated with cumulative corticosteroid dose and low BMI. Chronic disease damage, low BMI, and cumulative corticosteroid dose are risks factors for low BMD in pre-menopausal SLE patients. Osteopenia was found in 40% of patients, while osteoporosis was found in only 5%.

A great variety of clinical and immunological features have been described in patients with the antiphospholipid syndrome (APS), but information on their prevalence and characteristics in Latin American mestizo patients with the primary APS is scarce. To analyze the prevalence and characteristics of the main clinical and immunological manifestations in a cohort of patients with primary APS of mestizo origin from Latin America and to compare them with the European white patients, clinical and serological characteristics of 100 patients with primary APS from Colombia, Mexico, and Ecuador were collected in a protocol form that was identical to that used to study the "Euro-Phospholipid" cohort. The cohort consisted of 92 female patients (92.0%) and eight (8.0%) male patients. They were all mestizos. The most common manifestations were deep vein thrombosis (DVT; 23.0%), livedo reticularis (18.0%), migraine (18.0%), and stroke (18.0%). The most common pregnancy morbidity was early pregnancy losses (54.1% of pregnancies). Several clinical manifestations were more prevalent in the Latin American mestizo than in the European patients (transient global amnesia, pulmonary microthrombosis, arthralgias, and early pregnancy losses) and vice-versa (DVT, stroke, pulmonary embolism, and thrombocytopenia). Latin American mestizo patients with primary APS have a wide variety of clinical and immunological manifestations with several differences in their prevalence in comparison with European white patients.

Pro-inflammatory cytokines such as tumour necrosis factor (TNF) and nitric oxide (NO) are believed to play an important role in the severity of chronic disease. When evaluated in 71 patients who were seropositive for Trypanosoma cruzi and 50 apparently healthy controls, the mean (S.D.) serum concentrations of both TNF [7.65 (1.32) nu. 4.24 (1.53) ng/ml; P0.001] and NO [114 (40) nu. 74 (21) microM; P0.0001] were found to be significantly higher in the patients than in the controls. In addition, patients with chronic, symptomatic disease affecting their hearts--eight with dilated cardiomyopathy [8.82 (1.47) ng TNF/ml; 142 (45) microM NO] and 17 others with electrocardiographic alterations [8.37 (1.26) ng TNF/ml; 134 (53) microM NO]--had significantly higher serum concentrations of these cytokines than 34 patients who were in the asymptomatic, indeterminate phase of the disease [6.38 (1.35) ng TNF/ml; 99 (28) microM NO]. In those infected with T. cruzi, it therefore appears that serum concentrations of TNF and NO correlate with disease severity, indicating that these cytokines play some role in the pathogenesis of chronic Chagas disease.

In Mexico, despite the relatively high seroprevalence of Trypanosoma cruzi infection in humans in some areas, reported morbidity of Chagas disease is not clear. We determined clinical stage in 71 individuals seropositive to T. cruzi in the state of Puebla, Mexico, an area endemic for Chagas disease with a reported seroprevalence of 7.7%. Diagnosis of Chagas disease was made by two standardized serological tests (ELISA, IHA). Individuals were stratified according to clinical studies. All patients were submitted to EKG, barium swallow, and barium enema. Groups were identified as indeterminate form (IF) asymptomatic individuals without evidence of abnormalities (n = 34 cases); those with gastrointestinal alterations (12 patients) including symptoms of abnormal relaxation of the lower esophageal sphincter and absent peristalsis in the esophageal body, grade I megaesophagus, and/or megacolon; patients with clinical manifestations and documented changes of chronic Chagas heart disease who were subdivided as follows: mild (8 patients) - mild electrocardiographic changes of ventricular repolarization, sinus bradychardia); moderate (6 patients) - left bundle branch block, right bundle branch block associated with left anterior fascicular block); severe (8 patients) - signs of cardiomegaly, dilated cardiomyopathy); and the associated form (3 cases) that included presence of both cardiomyopathy and megaesophagus. These data highlight the importance of accurate evaluation of the prevalence and clinical course of Chagas disease in endemic and non-endemic areas of Mexico.

Understanding the pathogenic mechanisms in chronic Chagas disease, a major cause of morbidity and mortality in Latin America, is essential for the design of rational therapeutic strategies. In this paper we show that the development of Chagas disease is a consequence of a long-term and complex relationship between parasite persistence and maladapted homeostatic mechanisms in the host which leads to pathologic changes. We performed a retrospective study on 50 patients with chronic Chagas disease and 50 healthy control individuals. The specific immune response was detected by ELISA and IHA tests using autochthonous antigens, inflammatory process with the cytokine tumour necrosis factor (TNF)-alpha and nitric oxide (NO), and antioxidant protection with glutathione peroxidase and superoxide dismutase (SOD) levels. We developed generalised linear modelling procedures to assess simultaneously which explanatory variables and/or their interactions better explained disease severity in patients. Our results show the existence of a strong relationship between anti-Trypanosoma cruzi levels and chronic Chagas disease (P0.0001). Taken together, the statistical data indicate both cumulative and complementary effects, where the increase in TNF-alpha (P=0.004) and NO (P=0.005) levels correlated with a reduction in glutathione peroxidase (P=0.0001) and SOD (P=0.01) levels drives the disease pathology in chronically infected patients. Our findings may have important implications for understanding host susceptibility to develop severe chronic infectious disease. In addition we show putative targets for the design of new therapeutic strategies to prevent disease progression, considering both specific treatment against the aetiological agent and modulation of the different immunopathological reactions in chronically infected individuals with chronic Chagas disease.

Background Health-related quality of life (HRQOL) is impaired in patients with systemic lupus erythematosus (SLE). Irritable bowel syndrome (IBS) is highly prevalent and also reduces HRQOL. However, the relationship between IBS in SLE and its impact on HRLQOL has not been explored. Objectives To evaluate the prevalence and risk factors for IBS in patients with SLE and its impact on HRQOL. Methods Patients with confirmed SLE according to American College of Rheumatology (ACR) criteria were included in this cross-sectional study. Sociodemographic and clinical variables were recorded. HRQOL was assessed using the Short Form 36 (SF-36) instrument; fibromyalgia (FM) and depression symptoms were also evaluated. The diagnosis of IBS was based on the Rome III criteria. Results 105 women with SLE were included. The mean age and disease duration were 43.6±11.3 and 10.4±7.3 years, respectively. FM was present in 23.8% of patients. Fifty-one (48.6%) patients were diagnosed with IBS. The prevalence of IBS-C, IBS-D and IBS-M subtypes was 23.5%, 37.3% and 39.2%, respectively. IBS-C patients had higher depression scores than those of the other subtypes. Compared with non-IBS patients, those with IBS were more likely to have FM (33.0% vs. 14.8%; p= 0.02) and had higher SLE activity scores (2.5±8.6 vs. 1.7±2.0; p=0.03). Logistic multivariate analysis showed that IBS was significantly associated with depression and FM in SLE patients (OR= 1.07 95% CI: 1.02-1.13 and OR= 2.85 95% CI: 1.1-7.4, respectively). SF-36 scores were significantly lower in IBS patients compared with non-IBS patients (49.6 ± 18.5 vs. 62.6 ± 18.1; p = 0.025). There was a trend to a lower SF-36 lower global score in patients with IBS+FM compared to those without FM (p = 0.76). Conclusions IBS is highly prevalent among women with SLE. Risk factors for this association were depression and fibromyalgia. SLE patients with IBS have worse HRQOL, independently of the presence of FM. We suggest that treating IBS may improve HRQOL in patients with SLE. References Morgan DR, Squella FE, Pena E, Mearni F, Rey E, Enriquez-Blanco HE, et al. Multinational validation of the Spanish ROME III adult diagnostic questionnaire: comparable sensitivity and specificity to English instrument. Gastroenterology 2012;138:S386. Lopez-Colombo A, Morgan D, Bravo-Gonzalez D, Montiel-Jarquin A, Mendez-Martinez S, Schmulson M. The epidemiology of functional gastrointestinal disorders in Mexico: A population-based study. Gastroenterol Res Pract 2012;2012:606174 Acknowledgements We would like to thank to David Buss for the valuable guidance and advice in this project. Disclosure of Interest None Declared