Temporomandibular joint dysfunction in various rheumatic diseases.

Temporomandibular disorder (TMD) is an inclusive term in which those conditions disturbing the masticatory function are embraced. It has been estimated that 33% of the population have signs of TMD, but less than 5% of the population will require treatment. The objective of this study was to measure the frequency of TMD in rheumatoid arthritis (RA), osteoarthrosis (OA), ankylosing spondylitis (AS) and systemic lupus erythematosus, and to define the limitations in everyday's life that patients perceive when present. A six-month survey of consecutive outpatients in a rheumatology clinic in a teaching hospital in Mexico was carried out. We defined TMD as: 1) the presence of pain; 2) difficulty on mouth opening, chewing or speaking; 3) the presence of non-harmonic movements of the temporomaxilar joints. All three characteristics had to be present. Z test was used to define differences between proportions. We present the results of 171 patients. Overall, 50 patients had TMD according to our operational definition (29.24%). Up to 76% of the sample had symptoms associated with the condition. TMD is more frequent in OA and in AS (29.24% vs 38% OA, P=0.009; 39% AS; P=0.005). We found no association between the severity of TMD and the request for specific attention for the discomfort produced by the condition. Only 8 of 50 (16%) patients with TMD had requested medical help for their symptoms, and they were not the most severe cases. TMD is more frequent in RA and OA. Although it may produce severe impairment, patients seem to adapt easily.

The first descriptions of therapeutic arthrocentesis: a historical note.

The existence of synovial fluid has been known since Hippocratic times. The abnormal accumulation of liquid inside the joints has been recognized as the proximal cause of rheumatic diseases since humoral theory was the dominant paradigm in Occidental medical culture. Although evacuating the excess of the abnormal humour was the target of all therapeutic measures taken during this era, no mention of arthrocentesis is found in Occidental medical texts until 1652. We present two earlier indications of arthrocentesis to treat abnormal accumulation of liquid inside the joints. One in the Codex Badianus, an Aztec manuscript written in the 16th century, and the other in the Tractado breve de medicina, published in Mexico in 1592.

Genotoxicity assessment using micronuclei assay in rheumatoid arthritis patients.

OBJECTIVES: This study investigated whether: (i) rheumatoid arthritis (RA) patients have more micronuclei (MN) than healthy controls; (ii) methotrexate (MTX) treated RA patients have more MN than those not using MTX, and (iii) folic acid supplementation decreases the number of MN in MTX treated patients. METHODS: MN assays were performed in oral mucosa sweeps of 50 consecutive MTX treated RA patients, 30 consecutive RA patients not receiving MTX and 39 healthy controls. MTX treated RA patients were then randomly placed in a cross-over design to receive folic acid supplementation, and MN assays were repeated after 6 weeks. RESULTS: The MTX-RA patients had a mean age of 46 +/- 10 yrs and a mean disease duration of 12 +/- 9 yrs; 80% were women. The MTX dose range was 8.7 +/- 1.5 mg/week and the mean duration of use was 16 +/- 18 months. In the non-MTX RA group, the mean age was 48 +/- 14 yrs, the mean disease duration was 13 +/- 9 yrs, and 87% were women. At baseline, the number of MN were significantly higher in RA patients as compared with controls (3.31 +/- 2.3 vs 0.8 +/- 0.8, p <0.001). No difference in MN numbers was observed between users and non-users of MTX. Folic acid supplementation did not decrease the MN number in the MTX treated RA patients. CONCLUSIONS: Genotoxicity, as assessed by the MN assay, is increased in RA patients. These results suggest that genotoxicity is associated with RA itself and not with MTX use. Folic acid supplementation had no effect on the number of MN.

[The "Hospital Real de San Josef de los Naturales" and the rheumatic conditions found in New Spain during the 16th century]. / L'"Hospital Real de San Josef de los Naturales" e le malattie reumatiche nella Nueva España (Messico) durante il XVI secolo.

The rheumatic conditions found in New Spain during the sixteenth century were not different from those seen in Mexico in present times. We present the humoral conceptions on which medical theory was based in those times, and the contributions made by Alonso López de Hinojosos during his practice in the Hospital Real de San Josef de los Naturales, in Mexico City. Among them were the clinical distinction between gout and rheumatoid arthritis more than one hundred years before Sydenham, and the identification of arthritis and ocular involvement associated with a contagious disease more than three hundred years before Reiter. We conclude that the analysis of ancient medical traditions is an interesting and fruitful enterprise.

Herbal therapies in rheumatology: the persistence of ancient medical practices.

OBJECTIVE: To determine how frequently herbal remedies are employed as alternative therapies in rheumatic diseases, and the historical justification for their use. METHODS: We conducted a survey in 250 outpatients in the rheumatology clinic of a teaching hospital in México. We registered general demographic information and the previous use of herbal remedies for rheumatic conditions, how effective they were, and the presence of adverse effects during their use. We identified the herbs employed, and cross-checked them with medical texts from the 16th through the 18th centuries on the use of herbal remedies. RESULTS: Of 250 surveyed patients, 126 (51%) had used herbal remedies for their rheumatic conditions. 63% of all users reported them to be effective for the purpose they had been prescribed. 12% reported adverse effects, none of them life-threatening. Being a user had no relation with the patients' formal education. Three patients did not answer the survey. We were able to identify 67 plants. One third of these are either prescribed for rheumatic conditions in the consulted bibliography, or else were used for the same purpose by ancient Mexican cultures. CONCLUSION: Herbal remedies are frequently used for rheumatic conditions. Some of them have an historical antecedent for their use in rheumatic conditions. They deserve a cautious evaluation as adjunctive therapies in rheumatic diseases.

The antiquity of rheumatoid arthritis: a reappraisal.

OBJECTIVE: To demonstrate the existence of rheumatoid arthritis (RA) before the 19th century. METHODS: Survey of primary and secondary references on the history of rheumatic diseases. RESULTS: Paleopathological evidence suggests the existence of RA in America since 8000 BC and in Europe since the 7th century. Descriptions and representations of a symmetric chronic polyarthritis producing characteristic deformities can be found in Rome since 100 BC and India since 500 BC. The first clinical distinction between RA and gout was published in Mexico in 1578. Different historical conditions contributed to lack of recognition of RA by official medicine before 1800. The recognition of RA as a distinct entity in the 19th century was influenced by socioeconomic circumstances. CONCLUSION: RA is not a recent disease. Historical investigation can provide useful clues on its pathogeny.

Paleopathology in osseous remains from the 16th century. A survey of rheumatic diseases.

OBJECTIVE: To describe the rheumatic conditions found in skeletal remains of Amerindian ancestry disinterred from a 16th century Mexican cemetery. METHODS: A physical anthropologist and 2 rheumatologists surveyed the recovered skeletal remains. RESULTS: We examined the skeletal remains of 443 subjects. We found 19 cases of Pott's disease, 17 of osteoarthrosis in various anatomical locations, 2 spondyloarthropathies, probably ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis, one probable septic arthritis in the stemoclavicular joint, and 2 compression fractures of the spine. We found no cases of gout or rheumatoid arthritis. CONCLUSION: This is the first report on the presence of rheumatic conditions in colonial Mexico. Studying the remains of these populations can provide useful information about the origin and evolution of different rheumatic conditions.

Polymerase chain reaction detection and phylogenetic characterization of an agent associated with yellow vine disease of cucurbits.

ABSTRACT Diagnosis of yellow vine disease (YVD) in cucurbits, an important disease in the south-central United States, relies on external symptom appearance, phloem discoloration, and the presence of bacterium-like organisms (BLOs) in phloem. Polymerase chain reaction (PCR) amplification of BLO nucleotide sequences was explored as a means to improve diagnostic techniques. PCR, using a primer pair based on sequences of the citrus-greening BLO, amplified a 0.15-kilobase (kb) fragment from the DNA of symptomatic plants, but not from that of asymptomatic plants. Its nucleotide sequence suggested that the DNA amplified was of pro-karyotic origin. A primer pair, designed to amplify nonspecific prokaryotic 16S rDNA, amplified a 1.5-kb DNA fragment in both the symptomatic and asymptomatic plants. The 1.5-kb fragment from the asymptomatic plants corresponded to chloroplast 16S rDNA, and the band from the symptomatic plants was composed of 16S rDNAs from both chloroplasts and a prokaryote. The nucleotide sequence of the prokaryotic DNA was determined and used to design three primers (YV1, YV2, and YV3). Fragments of 0.64 and 1.43 kb were amplified with primers YV1-YV2 and primers YV1-YV3, respectively, from symptomatic plants. Neither primer set yielded fragments from asymptomatic plants, unrelated bacteria, or selected soilborne fungal pathogens of cucurbits. Phylogenetic analysis indicated that the prokaryote is a gamma-3 proteobacterium. The consistent association of the 0.64- and 1.43-kb fragments with symptomatic plants suggests that the gamma-3 proteobacterium may be the causal agent of YVD of cantaloupe, squash, and watermelon.

[Rheumatic diseases in colonial Mexico]. / Las enfermedades reumáticas en el México colonial.

The medical texts published in New Spain between the XVI and XVIII century have not been searched until now for evidence of the existence of rheumatoid arthritis and other rheumatic diseases before the descriptions made by Sydenham. We surveyed most of the medical books written and published in New Spain from the arrival of the Spaniards to the XVIII century, and we divided the diseases with articular manifestations into four groups, according to their main clinical characteristics: pain without swelling in anatomical region; pain without swelling in several joints; pain and swelling in joints, and joint complaints associated with contagious diseases. We found that a difference was established between gout and rheumatoid arthritis one hundred years before Sydenham, according to the different evolutions of both diseases, and we present one of the oldest descriptions of reactive arthritis.

[Errors in bibliographic references in the Revista Española de Anestesiología y Reanimación: retrospective study of 1994]. / Errores en las referencias bibliográficas de la Revista Española de Anestesiología y Reanimación: estudio retrospectivo del año 1994.

OBJECTIVES: To evaluate the accuracy of bibliographic references in REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION (REDAR) and compare it with other Spanish and international journals. MATERIAL AND METHODS: One hundred references were selected at random from those published in REDAR during 1994. A citation was considered correct if there were no differences between it and the original article in any of 6 standard citation times, and if it complied with REDAR citation style. A citation was considered incorrect if there were in fact differences or if REDAR style was not followed. Errors that interfered with direct access to the original were considered serious. Also considered serious were the omission of the first author. RESULTS: Some type of error was detected in 53.9% of the references. Twelve contained a serious error, which on 5 occasions impeded finding the original article and on 6 occasions made direct access difficult. The first author was missing in 1 citation. Errors were found, in order of decreasing frequency, in authors, article titles, journal title, volume, pages and year. A single error was found in 28 citations, 2 were found in 12, 3 were found in 2 and more than 3 were found in 1. CONCLUSIONS: REDAR's rate of error in references is comparable to the rates of other Spanish journal, but it is nearly double that of international journals in anesthesiology with higher impact factors (Anesthesiology, Canadian Journal of Anaesthesia). An effort must be made by authors and editors to remedy the situation.

[Mechanical ventilation-associated pneumonia and the prevention of stress ulcer. A randomized clinical trial of antacids and ranitidine versus sucralfate]. / Neumonía asociada a ventilación mecánica y profilaxis del ulcus de estrés. Ensayo clínico aleatorizado de antiácidos y ranitidina frente a sucralfato.

BACKGROUND: To study two groups of patients intubated with different prophylaxis of stress gastric ulcer in a prospective randomized trial. The differential effect on gastric pH, gastric colonization and the incidence of pneumonia associated to mechanical ventilation (PMV) were analyzed. METHODS: A prospective randomized study was carried out in two groups of patients: 1) prophylaxis with antacids and H2 blockers (AA+H2) and 2) prophylaxis with sucralfate. Intubated patients without initial respiratory infection were included in the protocol. Periodically gastric aspirations were collected measuring gastric pH and performing semi-quantitative cultures. When pneumonia was suspected bronchial brushing was carried out with telescoped catheter (BBTC) and quantitative culture. RESULTS: Fifty-one patients were studied (n = 51), distributed into 25 in the AA+H2 group and 26 in the sucralfate group. In the first group mean pH was higher (5.3 +/- 1.7) than in the sucralfate group (3.2 +/- 2.1) (p = 0.006). Nosocomial pneumonia (NP) was suspected on 25 occasions: 20 patients were positive for NP, 11 in the AA+H2 group and nine in the sucralfate group with no significant differences being observed. S. aureus, S. pneumoniae and H. influenzae (n = 14) were the etiology of predominant PMV. The global mortality of the group was of 22%. CONCLUSIONS: The prophylaxis of stress ulcers in intubated patients treated with antacids and ranitidine provoked higher gastric pH and an increase in gastric colonization in comparison to that observed with sucralfate. No significant differences were observed in the frequency of pneumonia by PMV diagnosed by BBTC.

Transposicoes musculares com enxerto livre de pele na exposicao ossea da perna. / Muscular transpositions with free skin graft in bone exposition of the leg

Os autores realizaram uma revisao das transposicoes dos musculos gastrocnemicoporcao medial e/ou solear, no periodo de janeiro de 1976 a outubro de 1983, no Servico de Ortopedia e Traumatologia do Hospital Municipal Miguel Couto. Descrevem a tecnica empregada em 35 casos de exposicao ossea em regiao anterior da perna, em consequencia de fraturas expostas, osteomielites e necrose cutanea isquemica. Os resultados sao avaliados segundo a indicacao, eficacia e complicacoes