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Álvarez-Hernández E, Barreira-Mercado E, Fragoso-Loyo HE, Hernández-Díaz C, Mota-Mondragón B, Muñoz-López S, Pérez-Cristóbal M, Rubio-Pérez N, Torres-Jiménez A, Vargas Guerrero A, Vázquez Del Mercado M, Villarreal-Alarcón MÁ, Pacheco-Tena C, Alpízar-Rodríguez D. Distribution and characteristics of the certification of rheumatologists in Mexico. Reumatol Clin (Engl Ed) 2023; 19:379-385. [PMID: 37156651 DOI: 10.1016/j.reumae.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/09/2022] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Describe the distribution of adult and pediatric rheumatologists with current certification in Mexico and the factors associated with this distribution. METHODS The databases of the Mexican Council of Rheumatology and the Mexican College of Rheumatology for 2020 were reviewed. The rate of rheumatologists per 100,000 inhabitants by state of the Mexican Republic was calculated. To find out the number of inhabitants by state, the results of the 2020 population census of the National Institute of Statistics and Geography were consulted. The number of rheumatologists with current certification by state, age, and sex was analyzed. RESULTS In Mexico, there are 1002 registered adult rheumatologists with a mean age of 48.12 ± 13 years. The male gender prevailed with a ratio of 1.18:1. Ninety-four pediatric rheumatologists were identified with a mean age of 42.25 ± 10.4 years, with a predominance of the female gender with a ratio of 2.2:1. In Mexico City and Jalisco, more than one rheumatologist/100,000 inhabitants were reported in the specialty of adults and only in Mexico City in pediatrics. The current certification is 65%-70% on average and the factors associated with a higher prevalence were younger age, female gender and geographic location. CONCLUSIONS There is a shortage of rheumatologists in Mexico and in the pediatric area there are underserved regions. It is important that health policies apply measures that allow a more balanced and efficient regionalization of this specialty. Although most rheumatologists have current certification, it is necessary to establish strategies to increase this proportion.
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Affiliation(s)
| | | | | | - Cristina Hernández-Díaz
- Consejo Mexicano de Reumatología, Mexico City, Mexico; Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | - César Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
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Manrique de Lara A, Colmenares-Roa T, Pascual-Ramos V, Moctezuma-Rios JF, Contreras-Yañez I, Guaracha-Basañez GA, Álvarez-Hernández E, Meza-López Y Olguín G, Peláez-Ballestas I. Sociocultural and moral narratives influencing the decision to vaccinate among rheumatic disease patients: a qualitative study. Clin Rheumatol 2023:10.1007/s10067-023-06609-5. [PMID: 37129776 PMCID: PMC10152007 DOI: 10.1007/s10067-023-06609-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION/OBJECTIVES Vaccination is a process that involves individual, social, and ethical aspects, beyond public governance of vaccines or vaccination as a public health concern. The aim of this study is to describe the sociocultural and moral narratives that influence the decision to vaccinate in general and to vaccinate against COVID-19 specifically, among patients at the rheumatology units of two hospitals. METHODS Qualitative study involving individual semi-structured interviews following an interview guide. We conducted a thematic analysis using the ATLAS.ti software, with further triangulation to verify concordance and aid in the interpretation of the data from a medical anthropology framework and using a narrative ethics approach to gain insight into the participants' underlying moral values. RESULTS We interviewed 37 patients in total, along with 3 rheumatologists. Five core themes emerged from the analysis to understand the decision to vaccinate: (1) information about vaccines and disease, (2) perceived risk-benefit of vaccination, (3) the physician-patient relationship, (4) governance of vaccination programs, (5) attitudes towards vaccines. Individual and family experiences with vaccination are diverse depending on the type of vaccine. The COVID-19 vaccine, as a new medical technology, is met with more controversy leading to hesitancy. CONCLUSIONS The decision to vaccinate among Mexican rheumatic disease patients can sometimes involve doubt and distrust, especially for those with a lupus diagnosis, but ultimately there is acceptance in most cases. Though patients make and value autonomous decisions, there is a collective process involving sociocultural and ethical aspects. Key points • The complexity of vaccine decision-making is better identified through a narrative, qualitative approach like the one used in this study, as opposed to solely quantitative approaches • Sociocultural and moral perspectives of vaccination shape decision-making and, therefore, highlight the importance of including patients in the development of effective clinical practice guidelines as well as ethically justified public policy • Sociohistorical context and personal experiences of immunization influence vaccine decision-making much more than access to biomedical information about vaccines, showing that approaches based on the information deficit model are inadequate to fight vaccine hesitancy.
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Affiliation(s)
| | | | - Virgina Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, México
| | | | - Irazú Contreras-Yañez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, México
| | | | | | | | - Ingris Peláez-Ballestas
- Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, México.
- Rheumatology Unit, Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, México.
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Gastelum-Strozzi A, Flores-Alvarado DE, Pascual-Ramos V, Álvarez-Hernández E, Pacheco-Tena CF, Guaracha-Basáñez GA, García CG, González-Chávez SA, Moctezuma-Ríos JF, Manrique de Lara A, Esquivel-Valerio JA, Contreras-Yáñez I, Galarza-Delgado DÁ, Vázquez-Mellado J, Peláez-Ballestas I, Reyes-Cordero GC. The COVID-19 epidemic curve and vaccine acceptance among patients with rheumatic diseases: an ecological study. Rheumatol Int 2023; 43:1253-1264. [PMID: 37129609 PMCID: PMC10153056 DOI: 10.1007/s00296-023-05334-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
The attitudes toward emerging COVID-19 vaccines have been of great interest worldwide, especially among vulnerable populations such as patients with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to analyze the relationship between the nationwide number of COVID-19 cases and deaths, and vaccine acceptance or hesitancy of patients with RMDs from four patient care centers in Mexico. Furthermore, we explored differences in acceptance according to specific diagnoses: rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). This ecological study was a secondary analysis of a cross-sectional study using a validated questionnaire to measure vaccine acceptance. We generated a global Likert scale to evaluate overall attitudes toward the COVID-19 vaccine. We analyzed data from 1336 patients from March to September 2021: 85.13% (1169) were women, with a mean age of 47.87 (SD 14.14) years. The most frequent diagnoses were RA (42.85%, 559) and SLE (27.08%, 393). 635(47.52%) patients were unvaccinated, 253(18.93%) had one dose and 478(35.77%) had two doses. Of all participating patients, 94% were accepting toward the COVID-19 vaccine. Vaccine acceptance remained consistently high throughout the study. However, differences in vaccine acceptance are identified when comparing diagnoses. The peak of the national epidemic curve coincided with an increase in hesitancy among patients with RA. Contrastingly, patients with SLE became more accepting as the epidemic curve peaked. Mexican patients show high acceptance of the COVID-19 vaccine, influenced in part by a patient's specific diagnosis. Furthermore, vaccine acceptance increased mirroring the curve of COVID-19 cases and deaths in the country. This should be taken into consideration when updating recommendations for clinical practice.
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Affiliation(s)
| | | | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | - César Francisco Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Circuito Universitario 31109, Campus Uach II, 31125, Chihuahua, Chih, Mexico
| | | | | | - Susana Aideé González-Chávez
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Circuito Universitario 31109, Campus Uach II, 31125, Chihuahua, Chih, Mexico
| | | | | | | | - Irazú Contreras-Yáñez
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | | | | | - Greta Cristina Reyes-Cordero
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Circuito Universitario 31109, Campus Uach II, 31125, Chihuahua, Chih, Mexico.
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Guaracha-Basañez GA, Contreras-Yáñez I, Álvarez-Hernández E, Reyes-Cordero G, Flores-Alvarado DE, González-Chávez SA, Galarza-Delgado DÁ, Martínez-Leyva PR, Moctezuma-Ríos JF, García-García C, Medrano-Ramírez G, Gastelum-Strozzi A, Pacheco-Tena C, Peláez-Ballestas I, Pascual-Ramos V. Factors associated to COVID-19 vaccine acceptance in Mexican patients with rheumatic diseases: A cross-sectional and multicenter study. Hum Vaccin Immunother 2022; 18:2049131. [PMID: 35389817 PMCID: PMC9196644 DOI: 10.1080/21645515.2022.2049131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
COVID-19 vaccination is recommended in patients with rheumatic diseases (RDs) to prevent hospitalized COVID-19 and worse outcomes. However, patients’ willingness to receive a SARS-CoV-2 vaccine and the associated factors vary across populations, vaccines, and time. The objective was to identify factors associated with COVID-19 vaccine acceptance (VA) in Mexican outpatients with RDs. This multicenter study was performed between March 1 and September 30, 2021, and four national centers contributed with patients. Participants filled out a questionnaire, which included 32 items related to patients’ perception of the patient-doctor relationship, the COVID-19 vaccine component, the pandemic severity, the RD-related disability, comorbid conditions control, immunosuppressive treatment impact on the immune system, and moral/civil position of COVID-19 vaccine. Sociodemographic, disease-related, and treatment-related variables and previous influenza record vaccination were also obtained. Multiple logistic regression analyses identified factors associated with VA, which was defined based on a questionnaire validated in our population. There were 1439 patients whose data were analyzed, and the most frequent diagnoses were Rheumatoid Arthritis in 577 patients (40.1%) and Systemic Lupus Erythematosus in 427 (29.7%). Patients were primarily middle-aged women (1235 [85.8%]), with (mean±SD) 12.1 (±4.4) years of formal education. Years of education, corticosteroid use, patient perceptions about the vaccine and the pandemic severity, patient civil/moral position regarding COVID-19 vaccine, and previous influenza vaccination were associated with VA. In Mexican patients with RDs, COVID-19 VA is associated with individual social-demographic and disease-related factors, patient´s perceptions, and previous record vaccination. This information is crucial for tailoring effective vaccine messaging in Mexican patients with RDs.
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Affiliation(s)
- Guillermo Arturo Guaracha-Basañez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | | | - Diana Elsa Flores-Alvarado
- Rheumatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Dionicio Ángel Galarza-Delgado
- Rheumatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Perla Rocío Martínez-Leyva
- Rheumatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Conrado García-García
- Department of Rheumatology, Hospital General de México "Dr. Eduardo Liceaga", México City, México
| | - Gabriel Medrano-Ramírez
- Department of Rheumatology, Hospital General de México "Dr. Eduardo Liceaga", México City, México
| | | | - César Pacheco-Tena
- Facultad de Medicina y Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | - Ingris Peláez-Ballestas
- Department of Rheumatology, Hospital General de México "Dr. Eduardo Liceaga", México City, México
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
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Cano-Gámez T, Teco-Cortes JA, Soto-Abraham MV, Álvarez-Hernández E. SARS-CoV-2 Vaccination as a Trigger for Perinuclear Antineutrophil Cytoplasmic Antibodies (p-ANCA) Associated With Rapidly Progressive Glomerulonephritis. Cureus 2022; 14:e29924. [PMID: 36348922 PMCID: PMC9633321 DOI: 10.7759/cureus.29924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic was devastating worldwide. The introduction of severe acute respiratory syndrome coronavirus 2 vaccination has reduced transmission, hospitalizations, and deaths, with infrequent major side effects. We present the case of a 51-year-old woman with rapidly progressive glomerulonephritis following COVID-19 vaccination with ChAdOx1 (AstraZeneca). Workup and histopathologic examination demonstrated active extracapillary proliferative lesions in cellular and fibrocellular crescents with extensive fibrinoid necrosis and karyorrhexis with diffuse glomerulonephritis, as well as positive perinuclear antineutrophil cytoplasmic antibodies. Treatment with cyclophosphamide and steroids was initiated with the improvement of renal function. Similar cases were seen with influenza vaccination, potentially describing vaccination as a possible trigger for anti-myeloperoxidase rapidly progressive glomerulonephritis.
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Barbosa-Cobos RE, Torres-González R, Meza-Sánchez AV, Ventura-Ríos L, Concha-Del-Río LE, Ramírez-Bello J, Álvarez-Hernández E, Meléndez-Mercado CI, Enríquez-Sosa FE, Samuria-Flores CJ, Lugo-Zamudio GE, Hernández-Díaz C. A Novel Technique for the Evaluation and Interpretation of Elastography in Salivary Gland Involvement in Primary Sjögren Syndrome. Front Med (Lausanne) 2022; 9:913589. [PMID: 35746947 PMCID: PMC9210135 DOI: 10.3389/fmed.2022.913589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Ultrasound (US) of major salivary glands (MSG) evaluates echogenicity, border features and vascularization, with elastography, it can detect tissue elasticity and glandular fibrosis, related to inflammation in Primary Sjögren’s syndrome (pSS). This study aimed to develop a novel technique by pixel analysis for evaluation and interpretation of elastography in MSG in pSS. A cross-sectional and observational multicenter study was conducted. The US of MSG performed in orthogonal planes in grayscale, Doppler, and shear-wave elastography. For elastography images of each gland were analyzed with the open-source program ImageJ to perform a pixel analysis. Statistical analysis was performed with the IBM-SPSS v25 program. Fifty-nine women with a mean age of 57.69 (23–83) years were recruited; pSS mean duration of 87 (5–275) months, and 12 healthy women without sicca symptoms as a control group with a mean age of 50.67 (42–60) years. Intragroup analysis showed p-values >0.05 between sicca symptoms, ocular/dryness tests, biopsy, US, and pixel analysis; correlation between Hocevar and pixel analysis was not found (rho < 0.1, p >0.5). MSG anatomical size was 41.7 ± 28.2 mm vs. 67.6 ± 8.8 mm (p ≤ 0.0001); unstimulated whole saliva flow rate was 0.80 ± 0.80 ml/5 min vs. 1.85 ± 1.27 ml/5 min (p = 0.016). The elastography values (absolute number of pixels) were 572.38 ± 99.21 vs. 539.69 ± 93.12 (p = 0.290). A cut-off point risk for pSS identified with less than 54% of red pixels in the global MSG mass [OR of 3.8 95% CI (1.01–15.00)]. Pixel analysis is a new tool that could lead to a better understanding of the MSG chronic inflammatory process in pSS.
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Affiliation(s)
- Rosa Elda Barbosa-Cobos
- Servicio de Reumatología, Hospital Juárez de México, Centro Médico ABC y Grupo "Manifestaciones Oculares en Reumatología" MOR, Mexico City, Mexico
| | - Rubén Torres-González
- Dirección de Educación e Investigación en Salud, Unidad Médica de Alta Especialidad (UMAE) de Traumatología, Ortopedia, Rehabilitación "Dr. Victorio de la Fuente Narváez," Instituto Mexicano del Seguro Social (IMSS) y Grupo "Manifestaciones Oculares en Reumatología" MOR, Mexico City, Mexico
| | - Ana Victoria Meza-Sánchez
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico.,División de Reumatología, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra," Mexico City, Mexico
| | - Lucio Ventura-Ríos
- División de Reumatología, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra," Mexico City, Mexico
| | - Luz Elena Concha-Del-Río
- Clínica de Enfermedades Inflamatorias Oculares, Asociación Para Evitar la Ceguera en México (APEC), Hospital de la Ceguera "Dr. Luis Sánchez Bulnes," y Grupo "Manifestaciones Oculares en Reumatología" MOR, Mexico City, Mexico
| | - Julián Ramírez-Bello
- Departamento de Endocrinología, Instituto Nacional de Cardiología, Mexico City, Mexico
| | | | | | | | - Cinthia Jahoska Samuria-Flores
- Servicio de Reumatología, Hospital Juárez de México, Centro Médico ABC y Grupo "Manifestaciones Oculares en Reumatología" MOR, Mexico City, Mexico
| | - Gustavo Esteban Lugo-Zamudio
- Servicio de Reumatología, Hospital Juárez de México, Centro Médico ABC y Grupo "Manifestaciones Oculares en Reumatología" MOR, Mexico City, Mexico
| | - Cristina Hernández-Díaz
- División de Reumatología, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra," Mexico City, Mexico
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Guaracha-Basáñez G, Contreras-Yáñez I, Álvarez-Hernández E, Román-Montes CM, Meza-López Y Olguín G, Morales-Graciano MJ, Valverde-Hernández SS, Peláez-Ballestas I, Pascual-Ramos V. COVID-19 vaccine hesitancy among Mexican outpatients with rheumatic diseases. Hum Vaccin Immunother 2021; 17:5038-5047. [PMID: 34856876 DOI: 10.1080/21645515.2021.2003649] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Vaccine hesitancy (VH) has emerged as a recognized threaten to contain the COVID-19 pandemic. Historically, low vaccine acceptance rates had been described among patients with rheumatic diseases (RMDs). The study objective was to determine COVID-19 VH among Mexican outpatients with RMDs and validate the COVID-19 VH questionnaire. This cross-sectional study was developed in three steps. Step 1 consisted of translation/cultural adaptation of the Oxford-COVID-19-VH questionnaire. Step 2 consisted of pilot testing and questionnaire feasibility, content, construct and criterion validity, reliability (internal consistency and temporal stability) and questionnaire sensitivity to change. Step 3 consisted of VH phenomenon quantification in patients from two metropolitan tertiary-care-level centers. Step 1 followed ISPOR-task-force recommendations. Patients who participated in step 2 (n = 50 for pilot testing/feasibility and n = 208 for questionnaire validation [91 in test-retest and 70 in questionnaire-sensitivity to change]) and step 3 (n = 600) were representative outpatients with RMDs. The seven-item COVID-19 VH questionnaire was found feasible, valid (experts' agreement ≥80%; a 1-factor structure accounted for 60.73% of the total variance; rho = 0.156, p = .025 between COVID-19 VH questionnaire and score from the Spanish version of the Vaccine Hesitancy Scale; and lower questionnaire scores in patients who reported 5 years-previous influenza vaccination), reliable (Cronbach's ɑ = 0.889, intra-class correlation coefficient = 0.933 and 95% confidence interval = 0.898-0.956) and sensitive to change (effect size = 1.17 and 0.86, respectively, in patients who decreased [n = 34] and increased [n = 31] questionnaire-score after intervention). VH phenomenon was 35.5%. VH phenomenon was present in a substantial number of Mexican patients with RMDs. The COVID-19 VH questionnaire showed good psychometric properties to assess COVID-19 VH in our population.
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Affiliation(s)
- Guillermo Guaracha-Basáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, Mexico
| | | | - Carla Marina Román-Montes
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | | | | | | | | | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, Mexico
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Vega-Morales D, Esquivel-Valerio JA, Vázquez-Fuentes BR, Díaz-Borjón A, Arce-Salinas CA, Álvarez-Hernández E, Torres-Roldán JF, Aguilera-Zepeda JM, Toledo-Infanson V, Alcántar-Luna E, Aldrete-Velasco JA, Martínez Hernández JL, Gutiérrez-Gómez JJ, Espinosa-Morales R. Comorbidity burden in terms of disability in patients with osteoarthritis in Mexico. The IMPACTAR registry. ACTA ACUST UNITED AC 2021; 17:440-446. [PMID: 34625146 DOI: 10.1016/j.reumae.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/30/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the comorbidities associated with disability in patients with OA in Mexico (2013-2015). MATERIAL AND METHODS A cross-sectional, retrospective and multicentre IMPACTAR study (n=7703) in Mexican patients (2013-2015). Comorbidities associated with disability were identified in 4971 patients diagnosed with OA from the IMPACTAR registry (n=7073). An adjusted logistic regression analysis was carried out by demographic, economic, clinical and medical variables. RESULTS Mean age was 63 years; and 75% of the patients were women. Subjects with OA and presence of comorbidities are 42% more likely to develop disabilities than patients without associated comorbidity, considering age, sex, family income, OA diagnosis duration, and education level. The highest rate of people with disability (28.9%) was concentrated in Region 7, which corresponds to Mexico City. There are also significant differences between median family incomes, when the income of persons with disability is under $13 000 (IQR: 9000-16 000) Mexican pesos, compared to patients without disability. Almost half of the subjects (49.6%) reported having at least one comorbidity. Arterial hypertension was the risk factor with a statistically significant difference (32.8%) among those with disability (34.7%). CONCLUSIONS Programs and interventions for OA patients should take into consideration comorbidity factors, being female, family income, and the region of residence as variables that may increase the possibility of developing an OA-associated disability.
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Affiliation(s)
- David Vega-Morales
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico; Instituto Mexicano del Seguro Social, IMSS Hospital General de Zona Número 17, Fortunato Lozano 2627, Benito Juárez, Monterrey, C.P. 64420 Nuevo León, Mexico
| | - Jorge Antonio Esquivel-Valerio
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico
| | - Alejandro Díaz-Borjón
- Hospital Angeles Lomas, Av. Vialidad de la Barranca S/N. Col. Valle de las Palmas, C.P. 52763 Mexico City, Mexico
| | - César Alejandro Arce-Salinas
- Hospital Central Sur PEMEX, Division of Internal Medicine, Fuentes del Pedregal, Tlalpan, C.P. 14140 Mexico City, Mexico
| | - Everardo Álvarez-Hernández
- Hospital General de Mexico, Doctor Balmis 148, Doctores, Delegación Cuahutemoc, C.P. 06726 Mexico City, Mexico
| | | | | | - Víctor Toledo-Infanson
- Hospital General Agua Prieta, Servicios de Salud Sonora, Calle 12 y 13 Av 22S/NInt. 3, Agua Prieta, C.P. 84200 Sonora, Mexico
| | - Ernesto Alcántar-Luna
- Hospital Angeles del Carmen, Fracc. Monraz, Monraz, Guadalajara, C.P. 44670 Jalisco, Mexico
| | | | | | | | - Rolando Espinosa-Morales
- Instituto Nacional de Rehabilitación, Departamento de Reumatología, Calz México-Xochimilco 289, Arenal Tepepan, C.P. 14389 Mexico City, Mexico.
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Caballero-Hernández CI, González-Chávez SA, Urenda-Quezada A, Reyes-Cordero GC, Peláez-Ballestas I, Álvarez-Hernández E, Pacheco-Tena C. Prevalence of complementary and alternative medicine despite limited perceived efficacy in patients with rheumatic diseases in Mexico: Cross-sectional study. PLoS One 2021; 16:e0257319. [PMID: 34582473 PMCID: PMC8478211 DOI: 10.1371/journal.pone.0257319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/28/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Complementary and alternative medicine (CAM) is frequently used by patients with rheumatic diseases (RD) to improve their symptoms; however, its diversity and availability have increased notably while scientific support for its effectiveness and adverse effects is still scarce. OBJECTIVE To describe the prevalence and diversity of CAM in patients with RD in Chihuahua, Mexico. METHODS A cross-sectional study was conducted in 500 patients with RD who were interviewed about the use of CAM to treat their disease. The interview included sociodemographic aspects, characteristics of the disease, as well as a description of CAM use, including type, frequency of use, perception of the benefit, communication with the rheumatologist, among others. RESULTS The prevalence of CAM use was reported by 59.2% of patients, which informed a total of 155 different therapies. The herbal CAM group was the most used (31.4%) and included more than 50 different therapies. The use of menthol-based and arnica ointments was highly prevalent (35%). Most patients (62.3%) reported very little or no improvement in their symptoms. Only a fourth of the patients informed the rheumatologist of the use of CAM. The use of CAM was influenced by female sex, university degree, diagnosis delay, lack adherence to the rheumatologist's treatment, family history of RD, and orthopedic devices. CONCLUSION The use of CAM in our population is highly prevalent and similar to reports in different populations suggesting a widespread use in many different societies. We found high use of herbal remedies; however, there were many different types suggesting a lack of significant effect. Patients continue using CAM despite a perception of no-effectiveness. Recurrent use of CAM is explained by factors other than its efficacy.
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Affiliation(s)
| | - Susana Aideé González-Chávez
- Facultad de Medicina y Ciencias Biomédicas, Laboratorio PABIOM, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Adelfia Urenda-Quezada
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | | | - Ingris Peláez-Ballestas
- Servicio de Reumatología, Hospital General de México “Dr. Eduardo Liceaga”, México City, México
| | | | - César Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Laboratorio PABIOM, Universidad Autónoma de Chihuahua, Chihuahua, México
- * E-mail:
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Gómez-Galicia DL, Aguilar-Castillo J, García-García C, Moctezuma-Rios JF, Álvarez-Hernández E, Medrano-Ramírez G, Casasola-Vargas J, Xibillé-Friedmann DX, Pelaez-Ballestas I, Montiel-Hernández JL. Qualitative validation of audiovisual educational material for use on rheumatoid arthritis patients. Rheumatol Int 2021; 42:2049-2059. [PMID: 34146129 DOI: 10.1007/s00296-021-04921-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Medication compliance is critical to achieve therapeutic efficacy in patients with rheumatoid arthritis; however, among other factors, low patient-health literacy plays a negative role. Therefore, the development and validation of audiovisual educational material with the participation of health specialists and patients could lead to an improved level of compliance with treatment, while favoring its acceptance. To design and validate audiovisual educational material generated by a multidisciplinary and participative group of patients and health specialists. This study was carried out using a sequential methodology, including qualitative and quantitative techniques: (1) a non-participative observational study with patients and a non-systematic literature search were performed to identify conceptual topics. (2) Pilot videos were qualitatively assessed by patients and health specialists (focus groups and expert committees). (3) Improved versions of seven videos were quantitatively evaluated by patients and specialists following qualitative criteria of attraction, understanding, involvement, acceptance and induction of action. 74 patients with RA, 10 rheumatologists, 4 pharmacists and 2 medical anthropologists participated in the different phases of validation. A total of seven videos lasting 3 min each were generated, incorporating the most relevant suggestions by patients and healthcare professionals. The final version of the videos led to a mean compliance of 96.04 ± 5.2%, according to a representative group of patients and a mean 89.6 ± 9.4%, according to health professionals. With the participation of both patients and health specialists, seven audiovisual educational video recordings were developed and validated, reaching high levels of compliance in accordance with international criteria.
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Affiliation(s)
- Diana-Lizbeth Gómez-Galicia
- Laboratory of Pharmaceutical Epidemiology, Facultad de Farmacia, Universidad Autónoma del Estado de Morelos, Cuernavaca, México
| | - Joana Aguilar-Castillo
- Laboratory of Pharmaceutical Epidemiology, Facultad de Farmacia, Universidad Autónoma del Estado de Morelos, Cuernavaca, México
| | - Conrado García-García
- Rheumatology Unit, Hospital General de México "Dr. Eduardo Liceaga", México city, México
| | | | | | | | - Julio Casasola-Vargas
- Rheumatology Unit, Hospital General de México "Dr. Eduardo Liceaga", México city, México
| | | | | | - José-Luis Montiel-Hernández
- Laboratory of Cytokines and Autoimmunity, Facultad de Farmacia, Universidad Autónoma del Estado de Morelos (UAEM), Av. Universidad 1001 col. Chamilpa, C.P. 62209, Cuernavaca, Morelos, México.
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11
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Álvarez-Hernández E, Mercado-Molina G, Barrera-Guerra RC. Validity of the Cushing's Syndrome Severity Index in Patients with Iatrogenic Cushing's Syndrome. Reumatol Clin (Engl Ed) 2021; 17:313-317. [PMID: 31843277 DOI: 10.1016/j.reuma.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/09/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Currently there are no clinimetric instruments for the measurement of the severity of iatrogenic Cushing's syndrome (ICS). Sonino et al. created a clinical severity index of endogenous Cushing's disease (CSI) but it has not been applied to patients with ICS. OBJECTIVE To validate and determine the utility of the CSI and its correlation with clinical variables in rheumatological patients with continuous use of glucocorticoids (GC). SUBJECTS AND METHODS Patients with a history of continuous systemic GC use (for at least 4 weeks) indicated for treatment of rheumatological disease were included. All the patients filled out a questionnaire on sociodemographic data, characteristics of the CG used; the way of use and the presence or absence of adverse events. The CSI was applied by 2 observers independently. Consistency, interobserver concordance and principal component analysis were calculated. RESULTS A total of 32 patients with an average age of 35.72±12.8 years were studied; 29 were women (90.6%). The average CSI score by the first observer was 3.50±2.02, and by the second observer was 2.31±1.75 (p=.004). The interobserver concordance was low in the items with imprecise definitions; for which modifications were made in the definitions to improve their performance. The CSI scores correlated with the presence of adverse effects and the type of dose used. CONCLUSIONS The CSI has an adequate correlation with clinical manifestations in patients with chronic use of GC. The clinimetric characteristics of the questionnaire improved by standardising the definitions of subjective clinical variables.
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Vega-Morales D, Esquivel-Valerio JA, Vázquez-Fuentes BR, Díaz-Borjón A, Arce-Salinas CA, Álvarez-Hernández E, Torres-Roldán JF, Aguilera-Zepeda JM, Toledo-Infanson V, Alcántar-Luna E, Aldrete-Velasco JA, Martínez Hernández JL, Gutiérrez-Gómez JJ, Espinosa-Morales R. Comorbidity burden in terms of disability in patients with osteoarthritis in Mexico. The IMPACTAR registry. Reumatol Clin (Engl Ed) 2020; 17:S1699-258X(20)30080-2. [PMID: 32563732 DOI: 10.1016/j.reuma.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the comorbidities associated with disability in patients with OA in Mexico (2013-2015). MATERIAL AND METHODS A cross-sectional, retrospective and multicentre IMPACTAR study (n=7703) in Mexican patients (2013-2015). Comorbidities associated with disability were identified in 4971 patients diagnosed with OA from the IMPACTAR registry (n=7073). An adjusted logistic regression analysis was carried out by demographic, economic, clinical and medical variables. RESULTS Mean age was 63 years; and 75% of the patients were women. Subjects with OA and presence of comorbidities are 42% more likely to develop disabilities than patients without associated comorbidity, considering age, sex, family income, OA diagnosis duration, and education level. The highest rate of people with disability (28.9%) was concentrated in Region 7, which corresponds to Mexico City. There are also significant differences between median family incomes, when the income of persons with disability is under $13 000 (IQR: 9000-16 000) Mexican pesos, compared to patients without disability. Almost half of the subjects (49.6%) reported having at least one comorbidity. Arterial hypertension was the risk factor with a statistically significant difference (32.8%) among those with disability (34.7%). CONCLUSIONS Programs and interventions for OA patients should take into consideration comorbidity factors, being female, family income, and the region of residence as variables that may increase the possibility of developing an OA-associated disability.
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Affiliation(s)
- David Vega-Morales
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico; Instituto Mexicano del Seguro Social, IMSS Hospital General de Zona Número 17, Fortunato Lozano 2627, Benito Juárez, Monterrey, C.P. 64420 Nuevo León, Mexico
| | - Jorge Antonio Esquivel-Valerio
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico
| | - Alejandro Díaz-Borjón
- Hospital Angeles Lomas, Av. Vialidad de la Barranca S/N. Col. Valle de las Palmas, C.P. 52763 Mexico City, Mexico
| | - César Alejandro Arce-Salinas
- Hospital Central Sur PEMEX, Division of Internal Medicine, Fuentes del Pedregal, Tlalpan, C.P. 14140 Mexico City, Mexico
| | - Everardo Álvarez-Hernández
- Hospital General de Mexico, Doctor Balmis 148, Doctores, Delegación Cuahutemoc, C.P. 06726 Mexico City, Mexico
| | | | | | - Víctor Toledo-Infanson
- Hospital General Agua Prieta, Servicios de Salud Sonora, Calle 12 y 13 Av 22S/NInt. 3, Agua Prieta, C.P. 84200 Sonora, Mexico
| | - Ernesto Alcántar-Luna
- Hospital Angeles del Carmen, Fracc. Monraz, Monraz, Guadalajara, C.P. 44670 Jalisco, Mexico
| | | | | | | | - Rolando Espinosa-Morales
- Instituto Nacional de Rehabilitación, Departamento de Reumatología, Calz México-Xochimilco 289, Arenal Tepepan, C.P. 14389 Mexico City, Mexico.
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Pascual-Ramos V, Contreras-Yáñez I, Arce Salinas CA, Saavedra Salinas MA, Del Mercado MVDM, López Zepeda J, Muñoz López S, Vázquez-Mellado J, Amezcua Guerra LM, Fragoso Loyo HE, Villarreal Alarcón MA, Pérez Cristobal M, Rubio Pérez EN, Torres Jiménez AR, Maldonado MDR, Álvarez-Hernández E. Evaluation of medical ethics competencies in rheumatology: local experience during national accreditation process. J Med Ethics 2019; 45:839-842. [PMID: 31604831 DOI: 10.1136/medethics-2019-105717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/18/2019] [Accepted: 09/26/2019] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Rheumatologists are the primary healthcare professionals responsible for patients with rheumatic diseases and should acquire medical ethical competencies, such as the informed consent process (ICP). The objective clinical structured examination is a valuable tool for assessing clinical competencies. We report the performance of 90 rheumatologist trainees participating in a station designed to evaluate the ICP during the 2018 and 2019 national accreditations. METHODS The station was validated and represented a medical encounter in which the rheumatologist informed a patient with systemic lupus erythematosus with clinically active nephritis about renal biopsy. A trained patient-actor and an evaluator were instructed to assess ICP skills (with a focus on kidney biopsy benefits, how the biopsy is done and potential complications) in obtaining formal informed consent, delivering bad news and overall communication with patients. The evaluator used a tailored checklist and form. RESULTS Candidate performance varied with ICP content and was superior for potential benefit information (achieved by 98.9% of the candidates) but significantly reduced for potential complications (37.8%) and biopsy description (42.2%). Only 17.8% of the candidates mentioned the legal perspective of ICP. Death (as a potential complication) was omitted by the majority of the candidates (93.3%); after the patient-actor challenged candidates, only 57.1% of them gave a clear and positive answer. Evaluators frequently rated candidate communications skills as superior (≥80%), but ≥1 negative aspect was identified in 69% of the candidates. CONCLUSIONS Ethical competencies are mandatory for professional rheumatologists. It seems necessary to include an ethics competency framework in the curriculum throughout the rheumatology residency.
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Affiliation(s)
- Virginia Pascual-Ramos
- Immunology and Rheumatology, Instituto Nacional de Ciencia Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Immunology and Rheumatology, Instituto Nacional de Ciencia Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | - María Del Rocio Maldonado
- Department of Internal Medecine, Rheumatology Unit, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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Alvarado-de la Barrera C, López-López CO, Álvarez-Hernández E, Peláez-Ballestas I, Gómez-Ruiz C, Burgos-Vargas R, Vázquez-Mellado J. Are Target Urate and Remission Possible in Severe Gout? A Five-year Cohort Study. J Rheumatol 2019; 47:132-139. [PMID: 31043541 DOI: 10.3899/jrheum.181214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Determine the proportion of patients achieving target serum urate (SU), defined as < 6 mg/dl for patients with non-severe gout and < 5 mg/dl for patients with severe gout, as well as the proportion of patients achieving remission after 5 years of followup. METHODS Patients from the Gout Study Group (GRESGO) cohort were evaluated at 6-month intervals. Demographic and clinical data were obtained at baseline. Visits included assessments of serum urate, flares, tophus burden, health-related quality of life using the EQ-5D, activity limitations using the Health Assessment Questionnaire adapted for gout, and pain level and patient's global assessment using visual analog scales. Treatment for gout and associated diseases was prescribed according to guidelines and available drugs. RESULTS Of 500 patients studied, 221 had severe gout (44%) and 279 had non-severe gout (56%) at baseline. No significant differences were observed across the study in percentages of severe gout versus non-severe gout patients achieving SU 6 mg/dl or 5 mg/dl. The highest proportion of patients achieving target SU (50-70%) and remission (39%) were found after 3-4 years of followup. In the fifth year, these proportions decreased and 28% of the patients were in remission, but only 40 patients remained in the study. None of the patients with severe gout achieved remission. CONCLUSION In patients with severe gout, target SU was hard to achieve and remission was not possible. The main obstacles for target SU and gout remission include poor medication adherence, persistent tophi, and loss to followup.
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Affiliation(s)
- Claudia Alvarado-de la Barrera
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Carlos Omar López-López
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Everardo Álvarez-Hernández
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Ingris Peláez-Ballestas
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Citlallyc Gómez-Ruiz
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Rubén Burgos-Vargas
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico.,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México
| | - Janitzia Vázquez-Mellado
- From the Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; Servicio de Reumatología, Unidad 404, Hospital General de México, Mexico City, Mexico. .,C. Alvarado-de la Barrera, PhD, Dirección de Investigación, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas; C.O. López-López, MD, PhD, Servicio de Medicina Física y Rehabilitación, Unidad 402, Hospital General de México; E. Álvarez-Hernández, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; I. Peláez-Ballestas, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México; C. Gómez-Ruiz, MD, Servicio de Reumatología, Unidad 404, Hospital General de México; R. Burgos-Vargas, MD, Servicio de Medicina Física y Rehabilitación, Unidad 402, and Servicio de Reumatología, Unidad 404, Hospital General de México; J. Vázquez-Mellado, MD, PhD, Servicio de Reumatología, Unidad 404, Hospital General de México.
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Legorreta-Haquet MV, Chávez-Rueda K, Chávez-Sánchez L, Cervera-Castillo H, Zenteno-Galindo E, Barile-Fabris L, Burgos-Vargas R, Álvarez-Hernández E, Blanco-Favela F. Function of Treg Cells Decreased in Patients With Systemic Lupus Erythematosus Due To the Effect of Prolactin. Medicine (Baltimore) 2016; 95:e2384. [PMID: 26844452 PMCID: PMC4748869 DOI: 10.1097/md.0000000000002384] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 12/11/2022] Open
Abstract
Prolactin has different functions, including cytokine secretion and inhibition of the suppressor effect of regulatory T (Treg) cells in healthy individuals. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by defects in the functions of B, T, and Treg cells. Prolactin plays an important role in the physiopathology of SLE. Our objective was to establish the participation of prolactin in the regulation of the immune response mediated by Treg cells from patients with SLE. CD4CD25CD127 cells were purified using magnetic beads and the relative expression of prolactin receptor was measured. The functional activity was evaluated by proliferation assay and cytokine secretion in activated cells, in the presence and absence of prolactin. We found that both percentage and function of Treg cells decrease in SLE patients compared to healthy individuals with statistical significance. The prolactin receptor is constitutively expressed on Treg and effector T (Teff) cells in SLE patients, and this expression is higher than in healthy individuals. The expression of this receptor differs in inactive and active patients: in the former, the expression is higher in Treg cells than in Teff cells, similar to healthy individuals, whereas there is no difference in the expression between Treg and Teff cells from active patients. In Treg:Teff cell cocultures, addition of prolactin decreases the suppressor effect exerted by Treg cells and increases IFNγ secretion. Our results suggest that prolactin plays an important role in the activation of the disease in inactive patients by decreasing the suppressor function exerted by Treg cells over Teff cells, thereby favoring an inflammatory microenvironment.
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Affiliation(s)
- María Victoria Legorreta-Haquet
- From the Unidad de Investigación Médica en Inmunología, Hospital de Pediatría, C.M.N. "Siglo XXI", IMSS, Mexico (L-HMV, C-RK, C-SL, B-FF); Departamento de Reumatología, Clínica 25, IMSS, Mexico (C-CH); Departamento de Bioquímica, Universidad Nacional Autónoma de México, Mexico (Z-GE); Departamento de Reumatología, Hospital de Especialidades, Centro Médico Nacional "Siglo XXI", Mexico (B-FL); Servicio de Reumatología, Hospital General de México, "Dr. Eduardo Liceaga", Mexico (B-VR, Á-HE)
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García-Méndez S, Rivera-Bahena CB, Montiel-Hernández JL, Xibillé-Friedmann D, Álvarez-Hernández E, Peláez-Ballestas I, Burgos-Vargas R, Vázquez-Mellado J. A Prospective Follow-Up of Adipocytokines in Cohort Patients With Gout: Association With Metabolic Syndrome But Not With Clinical Inflammatory Findings: Strobe-Compliant Article. Medicine (Baltimore) 2015; 94:e935. [PMID: 26131838 PMCID: PMC4504524 DOI: 10.1097/md.0000000000000935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to determine the levels of leptin (Lep) and adiponectin (AdipoQ) in patients with gout and its relationship with joint inflammatory data and/or with metabolic syndrome (MetS) variables, during 1 year follow-up.Forty-one patients (40 males) with gout diagnosis, attending for the first time to a rheumatology department, were included. Evaluations were performed baseline, at 6 and 12 months. Variables included the following: demographic, clinical and laboratory data related to gout and associated diseases. Lep and AdipoQ determinations by the ELISA method were performed in frozen serum from each visit. The pharmacological and no-pharmacological treatment for gout and associated diseases was individualized for each patient according to published guidelines. Statistical analysis included Mann-Whitney U test, Fisher test, x, ANOVA, Cochran Q, Pearson and Spearman correlation tests, as well as linear regression.In the baseline evaluation, 29.2% had MetS (hypertriglyceridemia 66%, hypertension 44% and obesity 37%); patients with MetS had higher C reactive protein (CRP) levels [34.1 ± 28.6 vs. 12.2 ± 11.2 mg/dL, P = 0.033]. Although not significant, also had higher Lep and lower AdipoQ levels (3.2 ± 3.0 vs. 1.9 ± 1.2 ng/mL, P = 0.142 and 40.5 ± 26.8 vs. 38.0 ± 24.9 ng/mL, P = 0.877, respectively). During follow-up, our patients had significant improvement in serum uric acid (sUA) levels and variables evaluating pain and joint swelling (P ≤ 0.05). Metabolic abnormalities tended to persist or even worsen during the monitoring period: significant increase in total cholesterol (P = 0.004), tendency to higher triglycerides (P = 0.883) and slight improvement in glycaemia (P = 0.052). Lep values increased significantly during follow-up (P = 0.001) while AdipoQ levels diminished slightly (P = 0.317). Neither Lep nor AdipoQ values showed important correlation (r > 0.5) with metabolic variables or joint swelling.This study suggests that in patients with gout, concentrations of Lep and AdipoQ are more in line with the metabolic state than with clinical disease activity.
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Affiliation(s)
- Sergio García-Méndez
- From the Servicio de Reumatología, Hospital General de México, México City (SG-M, EA-H, IP-B, RB-V, JV-M); Dirección de Planeación, Enseñanza e Investigación. Hospital Regional de Alta Especialidad de Oaxaca, San Bartolo Coyotepec, Oaxaca (SG-M); Facultad de Farmacia, Universidad Autónoma del Estado de Morelos (CBR-B, JLM-H); Servicio de Reumatología, Hospital General de Cuernavaca "Dr. José G. Parres," Cuernavaca, Morelos (DX-F); and Facultad de Medicina, Universidad Nacional Autónoma de México, México City, Mexico (IP-B, RB-V, JV-M)
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Álvarez-Hernández E, Peláez-Ballestas I, Boonen A, Vázquez-Mellado J, Hernández-Garduño A, Rivera FC, Teran-Estrada L, Ventura-Ríos L, Ramos-Remus C, Skinner-Taylor C, Goycochea-Robles MV, Bernard-Medina AG, Burgos-Vargas R. Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2012; 8:168-73. [PMID: 22704914 DOI: 10.1016/j.reuma.2012.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/17/2012] [Accepted: 05/02/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND The cost of certain diseases may lead to catastrophic expenses and impoverishment of households without full financial support by the state and other organizations. OBJECTIVE To determine the socioeconomic impact of the rheumatoid arthritis (RA) cost in the context of catastrophic expenses and impoverishment. PATIENTS AND METHODS This is a cohort-nested cross-sectional multicenter study on the cost of RA in Mexican households with partial, full, or private health care coverage. Catastrophic expenses referred to health expenses totaling >30% of the total household income. Impoverishment defined those households that could not afford the Mexican basic food basket (BFB). RESULTS We included 262 patients with a mean monthly household income (US dollars) of $376 (0–18,890.63). In all, 50.8%, 35.5%, and 13.7% of the patients had partial, full, or private health care coverage, respectively. RA annual cost was $ 5534.8 per patient (65% direct cost, 35% indirect). RA cost caused catastrophic expenses in 46.9% of households, which in the logistic regression analysis were significantly associated with the type of health care coverage (OR 2.7, 95%CI 1.6–4.7) and disease duration (OR 1.024, 95%CI 1.002–1.046). Impoverishment occurred in 66.8% of households and was associated with catastrophic expenses (OR 3.6, 95%CI 1.04–14.1), high health assessment questionnaire scores (OR 4.84 95%CI 1.01–23.3), and low socioeconomic level (OR 4.66, 95%CI 1.37–15.87). CONCLUSION The cost of RA in Mexican households, particularly those lacking full health coverage leads to catastrophic expenses and impoverishment. These findings could be the same in countries with fragmented health care systems.
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Álvarez-Hernández E, Vázquez-Mellado J, Casasola-Vargas JC, Moctezuma-Ríos JF, García-García C, Medrano-Ramírez G, Lino-Pérez L, Servín A, Codina H, Burgos-Vargas R. The Use of Glucocorticoids by Rheumatologic Patients Before Attending a Specialized Department in México. J Clin Rheumatol 2008; 14:148-52. [DOI: 10.1097/rhu.0b013e31817738bd] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Álvarez-Hernández E, Peláez-Ballestas I, Vázquez-Mellado J, Terán-Estrada L, Bernard-Medina AG, Espinoza J, Aceves-Avila FJ, Goycochea-Robles MV, Garza M, Ventura L, Burgos-Vargas R. Validation of the Health Assessment Questionnaire disability index in patients with gout. ACTA ACUST UNITED AC 2008; 59:665-9. [DOI: 10.1002/art.23575] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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