Hipoacusia neurosensorial subclínica en pacientes femeninas con artritis reumatoide

ResumenAntecedentesLa artritis reumatoide es una entidad clínica capaz de ocasionar hipoacusia neurosensorial, pudiendo ser diagnosticada oportunamente con audiometría de altas frecuencias.ObjetivoDetectar hipoacusia neurosensorial subclínica en pacientes con artritis reumatoide.Material y métodosEstudio transversal en pacientes con artritis reumatoide, donde se realiza audiometría de hasta altas frecuencias de 125-16,000Hz y timpanometría. Los resultados fueron correlacionados con marcadores de actividad de la enfermedad y la respuesta al tratamiento.ResultadosSe realizó audiometría particularmente de altas frecuencias en 117 pacientes femeninas con edad de 19-65 años. La hipoacusia neurosensorial fue observada a una sensibilidad de tonos puros de 125-8,000Hz en el 43.59% y umbrales de tonos de 10,000-16,000Hz en el 94.02% de los pacientes en oído derecho y en el 95.73% en oído izquierdo. Audición normal en 8 (6.84%) pacientes, hipoacusia en 109 (93.16%), asimétrica en 36 (30.77%), simétrica en 73 (62.37%), bilateral en 107 (91.45%) y unilateral en 2 (1.71%); no encontramos hipoacusia de conducción o mixta. Ocho (6.83%) pacientes cursaron con vértigo, 24 (20.51%) con tinitus. Timpanograma tipo A presente en el 88.90% en oído derecho y en el 91.46% en oído izquierdo, el 5.98-10.25% tipo As; reflejo estapedial en el 75.3-85.2%. Hubo diferencia significativa (p=0.02) en discriminación del lenguaje en oído izquierdo en mayores de 50 años. No encontramos asociación con marcadores de actividad de la enfermedad. Se observó asociación con el inicio de la artritis reumatoide.ConclusionesLos pacientes con artritis reumatoide tienen alta prevalencia de hipoacusia neurosensorial para altas frecuencias.AbstractBackgroundThe rheumatoid arthritis is a clinical entity capable to cause hearing impairment that can be diagnosed promptly with high frequencies audiometry.ObjectiveTo detect subclinical sensorineural hearing loss in patients with rheumatoid arthritis.Material and methodsCross-sectional study on patients with rheumatoid arthritis performing high frequency audiometry 125Hz to 16,000Hz and tympanometry. The results were correlated with markers of disease activity and response to therapy.ResultsHigh frequency audiometry was performed in 117 female patients aged from 19 to 65 years. Sensorineural hearing loss was observed at a sensitivity of pure tones from 125 to 8,000 Hz in 43.59%, a tone threshold of 10,000 to 16,000Hz in 94.02% patients in the right ear and in 95.73% in the left ear. Hearing was normal in 8 (6.84%) patients. Hearing loss was observed in 109 (93.16%), and was asymmetric in 36 (30.77%), symmetric in 73 (62.37%), bilateral in 107 (91.45%), unilateral in 2 (1.71%), and no conduction and/or mixed hearing loss was encountered. Eight (6.83%) patients presented vertigo, 24 (20.51%) tinnitus. Tympanogram type A presented in 88.90% in the right ear and 91.46% in the left ear, with 5.98 to 10.25% type As. Stapedius reflex was present in 75.3 to 85.2%. Speech discrimination in the left ear was significantly different (p = 0.02)in the group older than 50 years. No association was found regarding markers of disease activity, but there was an association with the onset of rheumatoid arthritis disease.ConclusionsPatients with rheumatoid arthritis had a high prevalence of sensorineural hearing loss for high and very high frequencie

Autoanticuerpos anticardiolipina, anti- β2-gpi y anti- protrombina :\ua0evaluación de su frecuencia y valor predictivo de desenlace en pacientes con cardiopatía isquémica /

\ua0tesis que para obtener el grado de Doctorado en Ciencias Medicas, presenta Arnulfo Hernán Nava Zavala ; tutores principales de tesis Pedro Antonio Reyes López, Sergio Ponce de León Rosales. 42 páginas. Doctorado en Ciencias Medicas\ua0Universidad Nacional Autónoma de México,\ua02013\ua0Programa de Posgrado en Ciencias Médicas, Odontológicas y de la Salu

Avances sobre la fisiopatogenia de la artritis reumatoide, ¿tiempo para una nueva teoría?

La Artritis Reumatoide (RA) es una de las tres enfermedades más comúnmente vistas en la consulta de Reumatología, siendo causa de una gran demanda en los servicios de salud globalmente. Su etiología permanece desconocida, y aunque se han hecho intentos por reconocer el blanco autoantigénico, éste aún no se conoce. La respuesta inmune de éstos pacientes se caracteriza por la participación de múltiples células y mecanismos efectores moleculares inflamatorios. Sin embargo, de esta complicada vista emerge un punto en común, éste es, el escape a los mecanismos de control inmunológico. El entendimiento de la razón y el sentido de la pérdida de tolerancia, la activación de linfocitos T auto-reactivos y la generación de autoanticuerpos serán puntos fundamentales para entender la fisiopatología de la artritis reumatoide y desarrollar estrategias terapéuticas inmuno-específicas

Potential Uses, Limitations, and Basic Procedures of Micronuclei and Nuclear Abnormalities in Buccal Cells

The use of biomarkers as tools to evaluate genotoxicity is increasing recently. Methods that have been used previously to evaluate genomic instability are frequently expensive, complicated, and invasive. The micronuclei (MN) and nuclear abnormalities (NA) technique in buccal cells offers a great opportunity to evaluate in a clear and precise way the appearance of genetic damage whether it is present as a consequence of occupational or environmental risk. This technique is reliable, fast, relatively simple, cheap, and minimally invasive and causes no pain. So, it is well accepted by patients; it can also be used to assess the genotoxic effect derived from drug use or as a result of having a chronic disease. Furthermore the beneficial effects derived from changes in life style or taking additional supplements can also be evaluated. In the present paper, we aim to focus on the explanation of MN test and its usefulness as a biomarker; we further give details about procedures to perform and interpret the results of the test and review some factors that could have an influence on the results of the technique.El uso de biomarcadores como herramientas para evaluar la genotoxicidad está aumentando recientemente. Los métodos que se han utilizado previamente para evaluar la inestabilidad genómica son frecuentemente costosos, complicados e invasivos. La técnica de los micronúcleos (MN) y anomalías nucleares (NA) en las células bucales ofrece una gran oportunidad para evaluar de forma clara y precisa la aparición de daño genético, ya sea presente como consecuencia del riesgo ocupacional o ambiental. Esta técnica es confiable, rápida, relativamente simple, barata y mínimamente invasiva y no causa dolor. Por lo tanto, es bien aceptado por los pacientes; También puede usarse para evaluar el efecto genotóxico derivado del uso de drogas o como resultado de tener una enfermedad crónica. Además, también se pueden evaluar los efectos beneficiosos derivados de cambios en el estilo de vida o tomar suplementos adicionales. En el presente trabajo, nuestro objetivo es enfocarnos en la explicación de la prueba MN y su utilidad como biomarcador; Damos detalles sobre los procedimientos para realizar e interpretar los resultados de la prueba y revisar algunos factores que podrían influir en los resultados de la técnica

Research on quality of health care from the Mexican Social Security Institute. A bibliometric study.

Objective. To identify studies on quality of health care in the IMSS. Materials and methods. A bibliometric, descriptive cross-sectional and retrospective study was conducted, from 1992 to 2011. Results. We identified 881 research studies related to the issue of quality (CI95% 10.6-12.0) of 7 762  studies presented at the annual research meetings. 10 521 articles were published in this period of time and only 946 (CI95% 8.4-9.5) were linked to the issue of quality. Conclusions. The results of this study allowed us to identify the interest about research on quality. Further research is needed to establish what has been the impact on the improvement of quality in health care

The Hypertriglyceridemic Waist Phenotype Is Associated with Several Cardiovascular Risk Factors in Women with Rheumatoid Arthritis

Rheumatoid arthritis (RA) associates with cardiovascular risk factors (CVRF) such as dyslipidemias and systemic inflammation. Cardiovascular Disease (CVD) is the leading cause of mortality. The hypertriglyceridemic waist phenotype (HTWP) identifies increased CVRF; however, information about HTWP on RA is scarce. Objective: To evaluate the association of HTWP with CVRF in RA. Material and methods: Cross-sectional study. Women (125) with RA were included (ACR, 1987). Anthropometry, bioimpedance, body mass index (BMI), disease activity score 28 (DAS28), and health assessment questionnaire disability index (HAQ-Di) were determined. The lipid profile determination includes the atherogenic index (AI) (TC/HDL) and Framingham Risk Score. HTWP is defined as a waist circumference ≥88 cm and triglycerides ≥ 150 mg/dL. Chi-squared and Student’s t-tests were applied for comparisons. Results: HTWP was found in 38 (30.4%) patients. The subgroup with HTWP had a greater frequency of arterial hypertension (AHT) (57.9 vs. 37.9, p = 0.04), Type 2 DM (23.7 vs. 8.0, p= 0.02), BMI (29.7 ± 3.2, vs. 26.8 ± 4.3, p < 0.001), fat mass (39.3 ± 4.8 vs. 34.7 ± 6.8, p < 0.001), and AI (4.7 ± 1.2 vs. 3.7 ± 1.0, p < 0.001). No differences between DAS28 and HAQ-Di were found. HTWP was associated with the presence of MetS and CVR (p < 0.001 and p = 0.012, respectively). Conclusion: The HTWP in RA is associated with CVRF, and its potential predictive role should be evaluated in longitudinal studies

The Hypertriglyceridemic Waist Phenotype Is Associated with Several Cardiovascular Risk Factors in Women with Rheumatoid Arthritis

Rheumatoid arthritis (RA) associates with cardiovascular risk factors (CVRF) such as dyslipidemias and systemic inflammation. Cardiovascular Disease (CVD) is the leading cause of mortality. The hypertriglyceridemic waist phenotype (HTWP) identifies increased CVRF; however, information about HTWP on RA is scarce. Objective: To evaluate the association of HTWP with CVRF in RA. Material and methods: Cross-sectional study. Women (125) with RA were included (ACR, 1987). Anthropometry, bioimpedance, body mass index (BMI), disease activity score 28 (DAS28), and health assessment questionnaire disability index (HAQ-Di) were determined. The lipid profile determination includes the atherogenic index (AI) (TC/HDL) and Framingham Risk Score. HTWP is defined as a waist circumference ≥88 cm and triglycerides ≥ 150 mg/dL. Chi-squared and Student’s t-tests were applied for comparisons. Results: HTWP was found in 38 (30.4%) patients. The subgroup with HTWP had a greater frequency of arterial hypertension (AHT) (57.9 vs. 37.9, p = 0.04), Type 2 DM (23.7 vs. 8.0, p= 0.02), BMI (29.7 ± 3.2, vs. 26.8 ± 4.3, p p p p p = 0.012, respectively). Conclusion: The HTWP in RA is associated with CVRF, and its potential predictive role should be evaluated in longitudinal studies

Subclinical sensorineural hearing loss in female patients with rheumatoid arthritis

AbstractBackgroundThe rheumatoid arthritis is a clinical entity capable to cause hearing impairment that can be diagnosed promptly with high frequencies audiometry.ObjectiveTo detect subclinical sensorineural hearing loss in patients with rheumatoid arthritis.Material and methodsCross-sectional study on patients with rheumatoid arthritis performing high frequency audiometry 125Hz to 16,000Hz and tympanometry. The results were correlated with markers of disease activity and response to therapy.ResultsHigh frequency audiometry was performed in 117 female patients aged from 19 to 65 years. Sensorineural hearing loss was observed at a sensitivity of pure tones from 125 to 8000Hz in 43.59%, a tone threshold of 10,000 to 16,000Hz in 94.02% patients in the right ear and in 95.73% in the left ear. Hearing was normal in 8 (6.84%) patients. Hearing loss was observed in 109 (93.16%), and was asymmetric in 36 (30.77%), symmetric in 73 (62.37%), bilateral in 107 (91.45%), unilateral in 2 (1.71%), and no conduction and/or mixed hearing loss was encountered. Eight (6.83%) patients presented vertigo, 24 (20.51%) tinnitus. Tympanogram type A presented in 88.90% in the right ear and 91.46% in the left ear, with 5.98–10.25% type As. Stapedius reflex was present in 75.3–85.2%. Speech discrimination in the left ear was significantly different (p=0.02) in the group older than 50 years. No association was found regarding markers of disease activity, but there was an association with the onset of rheumatoid arthritis disease.ConclusionsPatients with rheumatoid arthritis had a high prevalence of sensorineural hearing loss for high and very high frequencies

Osteoprotegerin Polymorphisms in a Mexican Population with Rheumatoid Arthritis and Generalized Osteoporosis: A Preliminary Report

Bone disease in rheumatoid arthritis (RA) is a complex phenomenon where genetic risk factors have been partially evaluated. The system formed by receptor activator for nuclear factor-B (RANK), receptor activator for nuclear factor-B ligand (RANKL), and osteoprotegerin (OPG): RANK/RANKL/OPG is a crucial molecular pathway for coupling between osteoblasts and osteoclasts, since OPG is able to inhibit osteoclast differentiation and activation. We aim to evaluate the association between SNPs C950T (rs2073617), C209T (rs3134069), T245G (rs3134070) in the TNFRSF11B (OPG) gene, and osteoporosis in RA. We included 81 women with RA and 52 healthy subjects in a cross-sectional study, genotyped them, and measured bone mineral density (BMD) at the lumbar spine and the femoral neck. Mean age in RA was 50 ± 12 with disease duration of 12 ± 8 years. According to BMD results, 23 (33.3%) were normal and 46 (66.7%) had osteopenia/osteoporosis. We found a higher prevalence of C allele for C950T SNP in RA