Prevalence and factors associated with musculoskeletal disorders and rheumatic diseases in indigenous Maya-Yucateco people: a cross-sectional community-based study.

This study aimed to estimate the prevalence of musculoskeletal disorders and rheumatic diseases in indigenous Maya-Yucateco communities using Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology. The study population comprised subjects aged ≥18 years from 11 communities in the municipality of Chankom, Yucatan. An analytical cross-sectional study was performed, and a census was used. Subjects positive for musculoskeletal (MSK) pain were examined by trained physicians. A total of 1523 community members were interviewed. The mean age was 45.2 years (standard deviation (SD) 17.9), and 917 (60.2 %) were women. Overall, 592 individuals (38.8 %; 95 % CI 36.3-41.3 %) had experienced MSK pain in the last 7 days. The pain intensity was reported as "strong" to "severe" in 43.4 %. The diagnoses were rheumatic regional pain syndromes in 165 (10.8 %; 95 % CI 9.4-12.5), low back pain in 153 (10.0 %; 95 % CI 8.5-11.6), osteoarthritis in 144 (9.4 %; 95 % CI 8.0-11.0), fibromyalgia in 35 (2.2 %; 95 % CI 1.6-3.1), rheumatoid arthritis in 17 (1.1 %; 95 % CI 0.6-1.7), undifferentiated arthritis in 8 (0.5 %; 95 % CI 0.2-0.8), and gout in 1 (0.06 %; 95 % CI 0.001-0.3). Older age, being female, disability, and physically demanding work were associated with a greater likelihood of having a rheumatic disease. In conclusion, MSK pain and rheumatic diseases were highly prevalent. The high impact of rheumatic diseases on daily activities in this indigenous population suggests the need to organize culturally-sensitive community interventions for the prevention of disabilities caused by MSK disorders and diseases.

Educational impact of a clinical anatomy workshop on 1st-year orthopedic and rheumatology fellows in Mexico City.

We aim to study the educational impact of a clinical anatomy workshop in 1st-year orthopedic and rheumatology fellows. First-year rheumatology fellows (N = 17) and a convenience sample of 1st-year orthopedic fellows (N = 14) from Mexico City in the 9th month of training participated in the study. The pre- and the post- workshop tests included the same 20 questions that had to be answered by identification or demonstration of relevant anatomical items. The questions, arranged by anatomical regions, were asked in five dynamic stations. Overall, the 31 participants showed an increase of correct answers, from a median of 6 (range 1 to 12) in the pre-workshop test, to a median of 14 (range 7 to 19) in the post-workshop test. In the pre-workshop test, the correct median answers were 7 (range 2 to 12) in the orthopedic fellows and 5 (range 1 to 10) in the rheumatology fellows (p = 0.297). Corresponding scores in the post-workshop were 15 (range 10 to 19) and 12 (range 7 to 18) (p = 0.026) showing a significant difference favoring the orthopedic group. Our clinical anatomy workshop was efficacious, in the short term, as a teaching instrument for 1st-year orthopedic and rheumatology fellows. The post-workshop scores, although significantly improved in both groups, particularly in the orthopedic fellows, were still suboptimal. Further refinements of our workshop might yield better results.

Complementary or alternative therapy use and health status in systemic lupus erythematosus.

Despite their unproven efficacy and safety concerns, complementary and alternative therapies (CAT) are used by a high proportion of patients with systemic lupus erythematosus (SLE). A prospective survey of past and present CAT use was done on 192 patients (36.5 +/- 12.7 years; 106 +/- 85 months of disease duration; 94% women) with an SLE diagnosis according to ACR criteria. Quality of life [Short Form 36 (SF-36)] and cumulated damage (SLICC/ACR) were compared between CAT users and non-users. In all, 103 (53.6%; 95% CI: 46.8-60.9) patients were CAT users (median: two remedies/patient): two (1%) in the alternative mode (CAT instead of allopathic treatment); 101 (52.6%) in the complementary mode (CAT in addition to allopathic treatment). A univariate analysis showed CAT users to have higher cumulated damage (P = 0.01) levels, as well as lower physical function (P = 0.05), social function (P = 0.05) and bodily pain (P = 0.02) domain scores in the SF-36 survey. After adjustment for disease duration with a linear model, only differences in bodily pain (P = 0.04) and cumulated damage (P = 0.05) remained statistically significant. CAT use is apparently associated with lower health status in patients with SLE from Yucatan, Mexico. Because the study was cross-sectional, more research is needed to define the directionality of this association.

[Effect of short-term nonsteroidal antiinflammatory therapy on mean blood pressure. A prospective, randomized clinical trial]. / Efecto del tratamiento a corto plazo con antiinflamatorios no esteroideos en la presión arterial media. Un ensayo clínico aleatorizado.

Our objective was to evaluate the effect of short-term therapy with nonsteroidal antiinflammatory drugs (NSAID) on mean blood pressure (MBP). Two hundred thirty-three consecutive patients (185 women, 54 men; 53.9±13.5 years) requiring NSAID therapy were prospectively randomized to: indomethacin (21 patients), naproxen (33 patients), diclofenac (40 patients), sulindac (42 patients), meloxicam (35 patients) and celecoxib (40 patients) for 8.5±2 days. BP was measured at the beginning and end of follow-up using a Kenz OS22 monitor. At the end of follow-up, 211 (88%) patients were still available for evaluation. A slight posttreatment decrease in MBP (-1.4±9.0 mm Hg, 95%CI: -2.7 to -0.2) was found. No significant differences in posttreatment changes in MBP were found among the distinct NSAIDs evaluated. Fifty-five patients (23%; 95% CI: 18-29) showed a posttreatment increase in MBP of>5 mm Hg. This increase was not associated with hypertension, old age, or any specific NSAID. We conclude that, overall, shortterm NSAID therapy does not seem to have a clinically significant effect on MAP. However, 23% of patients undergoing this therapy showed an increase in MBP that, if persistent, could lead to a higher risk of cardiovascular disease. Further research is needed to identify whether this outcome persists in long-term NSAID therapy.

Prolactin in human systemic lupus erythematosus.

In the last decade, evidence has accumulated to support the hypothesis that both mild and moderate elevations of serum prolactin (PRL) participate in the clinical expression and pathogenesis of systemic lupus erythematosus (SLE). Hyperprolactinemia (HPRL) has been found in 20-30% of patients with SLE. HPRL seems to be associated with clinical activity of SLE during pregnancy. Although the relationship between HPRL and active SLE in non-pregnant patients is controversial, recent clinical and experimental studies support the potential role of prolactin (PRL) as a promoter of clinical activity and severity of SLE. Mild elevations of serum PRL secondary to microadenoma could trigger the onset of SLE in a subset of patients. Elevated PRL and interleukin (IL)-6 have been found in the urine of patients with active lupus nephritis and in cerebrospinal fluid (CSF) of patients with active central nervous system (CNS) SLE. PRL may therefore participate in the pathogenesis of lupus nephritis and cerebritis, and the presence of PRL may reflect an abnormal communication between the immune system and the neuroendocrine system in active SLE. Lymphocytes from patients with active SLE produce increased amounts of PRL, and this extrapituitary PRL may participate in aberrant immune processes in SLE. There is exciting new evidence that HPRL in SLE may be explained by stimulation of pituitary PRL secretion by cytokines. In addition, defects in peptidergic modulators and dopamine metabolism have been described in patients with SLE. The interactions between PRL, cytoquines, autoantibodies and organ involvement suggest that PRL participates in local and generalized immune and inflammatory processes and acts as a bridge between the neuroendocrine and immune systems in SLE. Understanding the interactions between these systems in SLE will help us to understand and treat this important autoimmune disease.

Risk factors for plantar talalgia in nonathletes: a case-control study.

A variety of factors have been considered as contributing to plantar talalgia pain syndromes. This study was designed to explore a series of possible contributors to the etiology of plantar talalgia (PT) specifically in nonathletes. The influence of body mass index (BMI), SCFP thickness and compressibility index, plantar and heel surface area, BMI/heel area ratio, heel-lifting device utilization, a standing job, heel malalignment, and a calcaneal spur (CS) over the risk of developing PT was analyzed by a case-control design. Eighty-five cases were compared with 58 controls of similar age and sex. After logistic regression analysis, only CS (relative risk 2.5 95%, CI 1.1-6) associated with PT, whereas other biomechanical, lifestyle, and clinical variables were not as clearly associated with PT risk in those nonathletes studied here. Our results suggest that a reappraisal of some factors previously thought to increase risk or suggest therapeutic manipulations for plantar talalgia in nonathletes is needed.

Bromocriptine in systemic lupus erythematosus: a double-blind, randomized, placebo-controlled study.

The objective of this study was to investigate the efficacy and safety of bromocriptine (BRC) as an adjunct to conventional treatment in systemic lupus erythematosus (SLE). A prospective, double-blind, randomized, placebo-controlled study compared BRC at a fixed daily dosage of 2.5 mg with placebo. Patients were followed for 2-17 months (mean 12.5 months). Disease activity was assessed using the SLE Disease Activity Index (SLEDAI), numbers of flares were recorded, and serum prolactin (PRL) levels were obtained at intervals during the study. Patients were allowed to take prednisone and immunosuppressive drugs. Sixty-six patients with SLE entered the study. Thirty-six were treated with BRC, and 30 controls received placebo. Sixteen patients were removed from the study during the treatment period: five in each group left the study because of adverse effects, five became pregnant, and one patient who took placebo died with central nervous system lupus. Four patients in the BRC treatment group and three patients in the placebo group moved away or stopped coming for study visits for unknown reasons, and were lost to follow-up during the course. At entry, serum PRL was (mean+/-s.d.) 24.8 ng/ml+/-18.4 in the BRC treatment group. This value fell to 5.8+/-9.0 after 12 months of treatment. Corresponding PRL values in controls were 23.7+/-22.1 pretreatment and 20.3+/-14 after 12 months. PRL levels in BRC-treated subjects were significantly lower than levels in control subjects after 3, 6, 9, and 12 months of treatment. The SLEDAI score on the fifth protocol visit was decreased significantly in the BRC group vs controls: 0.9+/-1.4 vs 2.6+/-4.5 (P < 0.05). Although the absolute number of flares in each group was similar, the mean number of flares/patient/month was decreased significantly in the BRC group compared to the control group (0.08+/-0.1 vs 0.18+/-0.2, P = 0.03). Long term treatment with a low dose of BRC appears to be a safe and effective means of decreasing SLE flares in SLE patients.

Risk factors for mild intraoperative hypothermia.

In this study, the authors prospectively followed one-hundred thirty patients undergoing surgery in order to investigate the influence of age, surgery time, surgical room temperature, major surgery, blood transfusion, gender, and anesthetic method in the occurrence of mild intraoperative hypothermia (MIH). Sixty-one patients (47%) were female and 69 (53%) were male, and patient's mean age was 42 +/- 20 years. Fifty-three patients (41%) developed MIH. Fifty-two (40 %) underwent major surgery, 65 (50%) patients were scored as ASA I (American Society Anesthesia), 52 (40%), ASA II and 13 (10%), ASA III or IV. Sixty-four (49.2%) received balanced general anesthesia, 22 (17%), spinal lumbar anesthesia, 20 (15.3%), epidural lumbar anesthesia and 24 (18.5%), miscellaneous anesthesia. Thirteen (10%) received blood transfusion, mean surgery time was 83 +/- 59 min and mean surgical room temperature was 22.9 +/- 1.2 degrees C. Regression logistic with backward elimination method was employed to determine the impact of all variables over development of MIH. Only major surgery (Odds Ratio 2.8) and blood transfusion (Odds Ratio 6.7) were identified as risk factors for MIH.