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M H Cardiel

Publications and source records attributed to M H Cardiel.

At least 37 records · Page 2Linked to original sources
PubMed1996

Systemic lupus erythematosus in males. A study of 107 Latin American patients.

Clinical and laboratory features were analyzed in 107 Latin American male patients with systemic lupus erythematosus (SLE) who were compared with a group of 1,209 Latin American female patients with SLE to determine the presence of gender-associated differences. Males had an increased prevalence of renal disease, vascular thrombosis, and the presence of anti-dsDNA antibodies, as well as the use of moderate to high doses of corticosteroids, compared with female SLE patients. Although there was no difference in mortality from all causes, SLE-related mortality was higher in the male group. All these findings are consistent with a more severe disease in Latin American males than in female patients from the same region.

Adolescent↗
PubMed1996

Validity of retrospective disease activity assessment in systemic lupus erythematosus.

OBJECTIVE: To evaluate the validity of retrospective disease activity assessment derived from clinical charts. METHODS: We prospectively evaluated 37 patients with systemic lupus erythematosus (SLE) in 90 visits using the SLE Disease Activity Index (SLEDAI), the Mexican SLEDAI (Mex-SLEDAI), and the Lupus Activity Criteria Count (LACC) indices. Routine clinical observations were written by rheumatologists blind to index scores. These notes were reviewed 2 years later to obtain retrospective index scores and their validity was assessed using prospective scores as the standard. Statistical analysis was by Spearman's rank correlation coefficient (rs), Wilcoxon matched pairs test, kappa statistic, and intraclass correlation coefficient (ri). We calculated the sensitivity and specificity of retrospective indices to detect active disease. RESULTS: Median retrospective scores were lower in all indices: SLEDAI (4 VS 2, p =0.004, RS = 0.68, ri = 0.30); Mex-SLEDAI (2 vs 1, p < 0.0003, rs = 0.79, ri = 0.31); and LACC (1 vs 1, p = 0.007, rs = 0.65, ri = 0.21). Used to detect active SLE, the retrospective SLEDAI had a sensitivity of 0.68 and a specificity of 0.86; corresponding values for the Mex-SLEDAI were 0.72 and 0.91, and for the LACC, 0.77 and 0.76. CONCLUSION: Retrospective disease activity indices tended to provide lower scores than prospective evaluations. They often missed patients with mildly active disease, but when positive they were good predictors of disease activity.

Adolescent↗
PubMed1995

Factors associated with chronic renal failure in 121 patients with diffuse proliferative lupus nephritis: a case-control study.

Lupus nephritis remains an important problem in patients with systemic lupus erythematosus (SLE). Some patients with diffuse proliferative lupus nephritis (DPLN) develop chronic renal failure (CRF). A case-control study was designed to determine the variables associated with CRF in patients with DPLN. We studied 121 patients with biopsy-proven DPLN seen in our institution from 1970 to 1988. There were 34 patients who developed CRF, the remaining were their controls. Clinical charts were reviewed and a pathologist re-scored blindly both activity and chronicity indices. The mean of age at SLE onset was 24.1 +/- 7.9 years; the mean disease duration was 9.2 +/- 6.1 years for controls and 6.1 +/- 5 years for patients. The main variables associated with CRF were male sex. HR (hazard ratio): 12.6 (95% CI 1.6-98.2); activity index, HR 2.59 (1.07-6.3); severe infections, HR 2.9 (1.2-7.3): number of antihypertensive drugs, HR 2.5 (1.4-4.7); cellular crescents, HR 1.6 (1.2-2): and interstitial inflammation, HR 2.7 (1.5-5.1). A protective effect was observed with longer use of < or = 20 mg of prednisone, HR 0.53 (95% CI 0.34-08): azathioprine, HR 0.6 (0.4-0.8); and length of formal education. HR 0.3 (0.09-0.94). Our results indicate that maleness, activity index, extracapillary proliferation and interstitial inflammation, as well as hypertension and severe infections associate with CRF in patients with DPLN, and treatment and higher education, perhaps through better therapeutic compliance, may be protective.

Adolescent↗
PubMed1994

The contribution of resting heart rate and routine blood tests to the clinical assessment of disease activity in systemic lupus erythematosus.

OBJECTIVE: To contrast the contribution of simple clinical tests, such as resting heart rate (HR), complete blood count (CBC), and erythrocyte sedimentation rate (ESR), versus immunological tests in the assessment of disease activity in systemic lupus erythematosus (SLE). METHODS: During an evaluation of disease activity indices in SLE, 39 patients had a full clinical evaluation in 99 visits including a disease activity index (MEX-SLEDAI), and serial measurements of HR, ESR, CBC, complement (C3, C4) and anti-dsDNA antibody levels (Farr). RESULTS: Resting HR exhibited the highest correlation with MEX-SLEDAI scores (rs = 0.62). Thus, the disease was active (MEX-SLEDAI score of 2 or more) in all but one of 15 patients (93.3%) that had an HR > 90/min during the study. Hemoglobin levels (Hb) and ESR showed the second highest correlation (rs = -0.51, and 0.50, respectively). Seventeen patients had an Hb < 13 g/dl at least once; 14 (82.4%) had active disease during the study. Lymphocyte count, C3 levels, and anti-dsDNA levels correlated less strongly with disease activity (rs = -0.27, -0.29, and 0.30 respectively). Forward stepwise multiple regression analysis showed that HR, Ht, and C3 were independent markers of disease activity in this population (R2 = 0.51, p < 0.0001). CONCLUSION: Closer attention to resting HR and CBC results may improve the assessment of disease activity in SLE.

Adolescent↗
PubMed1994

Quality of life in rheumatoid arthritis: validation of a Spanish version of the Arthritis Impact Measurement Scales (Spanish-AIMS)

OBJECTIVE: To translate and validate The Arthritis Impact Measurement Scales (AIMS) to be used by Spanish speaking populations. METHODS: We administered the questionnaire to 97 outpatients with rheumatoid arthritis (RA) during routine patient care, in most cases with a trained interviewer. Reliability was assessed in stable patients using test-retest at a one-month interval. Internal consistency was evaluated with the coefficient of reliability. Convergent and construct validation was tested using ARA functional class, disease severity, disease activity, patient global assessment, and pain scores. Responsiveness was evaluated with one-tailed Student's t test and percentage of change. RESULTS: Test-retest reliability was statistically significant for all scales except Activities of Daily Living and Anxiety. The coefficient of reliability was > 0.7 for all scales. Convergent and construct validity was detected with the constructs employed (Pearson's r > 0.4). Four/nine scales detected improvement (p < 0.05) in those patients in whom clinical change was recorded. CONCLUSION: The Spanish-AIMS retained the methodological properties of the original version and can be used as an outcome measure in Spanish speaking patients with RA.

Activities of Daily Living↗
PubMed1992

Measurement of disease activity in systemic lupus erythematosus. Prospective validation of 3 clinical indices.

Several clinical indices have been proposed to measure disease activity in patients with systemic lupus erythematosus. Only a few have been subjected to extensive analysis. We report a methodological comparison of reliability, validity, responsiveness, and feasibility of the Lupus Activity Criteria Count, the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and our own simplified modification of the latter (MEX-SLEDAI). They were applied prospectively to 39 patients with diverse degrees of disease activity in 3 consecutive visits. Inter-observer reliability outweighed experts' evaluation (rs = 0.86 to 0.89, p < 0.0001 versus 0.74). Significant association was demonstrated between indices and experts' judgment, managing physician's opinion, changes in treatment and clinical course. Moreover, indices showed good convergent validity (rs = 0.76 to 0.79, p < 0.0001), and responsiveness. MEX-SLEDAI was the least expensive instrument.

Adolescent↗
PubMed1989

Comparison between 3 diagnostic criteria for mixed connective tissue disease. Study of 593 patients.

We tested patients with a well defined connective tissue disease (CTD) against 3 different sets of criteria for mixed connective tissue disease (MCTD). Included were 200 patients with systemic lupus erythematosus (SLE), 80 with MCTD, 100 with rheumatoid arthritis (RA), 80 with scleroderma, 53 with dermato/polymyositis (DM/PM) and 80 with primary Sjögren's syndrome (SS). The 3 sets of criteria fared similarly in capturing nearly all MCTD patients. They also were similar in ruling out most of the other CTD except for 11 patients with SLE, 36 with scleroderma, 13 with DM/PM and 3 with SS who fulfilled the category of possible MCTD included in the set of criteria proposed by Sharp. Because the set of criteria we proposed includes only 5 clinical manifestations (edema of the hands, synovitis, myositis, Raynaud's phenomenon, and acrosclerosis) whereas the other 2 sets include 15 and 13, respectively, it would seem that the 5 included in our criteria are core manifestations of MCTD. Of the 80 patients with MCTD 32 had all 5, 38 had 4, and 10 had 3 of these manifestations. The sensitivity of 3 or more of these clinical criteria for MCTD was 100%, whereas the specificity which, with the clinical criteria was 91.8%, rose to 99.6% with the presence of anti-RNP antibody. However, because testing of our criteria was made internally, they should be further tested, along with the other 2 sets of criteria by unrelated groups of clinical investigators, perhaps in a multicenter study.

Arthritis, Rheumatoid↗
PubMed1989

Antiphospholipid arterial vasculopathy.

We describe 3 relatively young patients who developed arterial occlusions in a limb requiring amputation. All 3 had antiphospholipid antibodies (APLA). In one, these appeared as part of the clinical and serologic spectrum of systemic lupus erythematosus and in the other 2 as a component of a primary antiphospholipid syndrome. Their arterial angiograms showed gradual narrowing of the arterial lumen and the histopathologic study showed striking intimal and medial proliferation as well as some increase in thickness of the adventitia. There was little evidence of thrombosis but in the 2 patients who were amputated early there was mononuclear cell infiltrate of the large arteries and in all 3 there was also leukocytoclastic vasculitis in the skin and/or muscle. We believe this represents a new form of vasculopathy, probably related to the presence of APLA, possibly triggered by the occurrence of vasculitis.

Adolescent↗
PubMedDate not supplied

Immunogenetics of mixed connective tissue disease in a Mexican Mestizo population.

OBJECTIVE: The aim of this study was to determine the HLA antigens in Mexican Mestizo patients with mixed connective tissue disease (MCTD). METHODS: We studied 30 patients with MCTD and 99 healthy controls. HLA-A, -B, and -DQ antigens were typed by microlymphocytotoxicity assays. DRB1, DQA1 and DQB1 alleles were oligotyped. RESULTS: HLA-A2 and HLA-B35 were the most frequent MHC class I alleles in MCTD patients, although they were not statistically more frequent than in the controls. According to serological tests, the most frequent DQ allele in the patients was DQ1, which was statistically increased when compared with controls (p = 0.0051). By oligotyping, the DR1 allele and the DQB1*0501 specificities were significantly increased in the patients vs. controls (p = 0.032 and 0.027, respectively). CONCLUSION: The elevated levels of DQ1 found in Mexican MCTD patients, although weak, may indicate a particular genetic susceptibility, since there are previous reports of associations of other alleles (such as DR4) with MCTD in other populations. The increase in DQB1*0501 may account for the increase in DQ1. DQB1*0501 has also been reported in black patients with anti-RNP autoantibodies, compared with black patients without anti-RNP or anti-Sm.

Adult↗
PubMedDate not supplied

Prevalence of musculoskeletal complaints and disability in Cuba. A community-based study using the COPCORD core questionnaire.

OBJECTIVE: Rheumatic diseases are prevalent conditions around the world, but precise information is not easily obtainable in developing countries. The aim of this study was to estimate the prevalence of musculoskeletal complaints in the community in Cuba using the ILAR/COPCORD core questionnaire and published methodologies. METHODS: The ILAR/COPCORD core questionnaire was administered in the form of a home survey to 300 adult subjects. Cases, defined as those with present pain and no trauma, underwent a physical examination and selected laboratory or X ray evaluations. RESULTS: The questionnaire was filled out in a mean time of 8 minutes. Ninety-one subjects had present musculoskeletal pain not related to trauma and 83 had had pain in the past. The most frequently affected regions were the lower back (14%); cervical spine (14%); knee (11.5%) and shoulders (10%). Osteoarthritis was the most common diagnosis (19.6%). A total of 166 subjects sought professional help; 56 were treated by a rheumatologist. Most subjects were satisfied with the results of their medical treatment. CONCLUSIONS: Musculoskeletal symptoms were prevalent in this community. A larger study will be necessary to obtain a better estimate of diagnoses with a low prevalence.

Adult↗
PubMedDate not supplied

Risk factors associated with mortality in systemic lupus erythematosus. A case-control study in a tertiary care center in Mexico City.

OBJECTIVE: To identify the mortality risk factors in a group of Mexican patients with SLE. METHODS: A case-control autopsy study in a tertiary care center in Mexico, City. Patients with SLE who died during 1958 to 1994 with an autopsy study were selected as cases, and alive patients matched by age (+/- 3 years), decade of SLE onset, and disease duration (+/- 5 years) were defined as controls. Clinical charts were reviewed looking at clinical variables. SLE disease activity was evaluated with the MexSledai index, and SLE disease severity with the Severity Index. Variables were classified as present at any moment during the follow-up and 3 months before death in cases or cut-off date in controls. STATISTICAL ANALYSIS: matched univariate and multivariate analysis by multiple logistic regression were performed, and the results were presented as odds ratio and 95% confidence intervals (OR, 95%CI). RESULTS: 76 matched pairs of patients were studied. Age, gender, and years offormal education were similar in the cases and controls. Variables associated with mortality three months before death were: lung involvement OR= 15.6, 95%CI (4.8-50.3), p<0.001; severe thrombocytopenia 9.6 (2.9-31.7), p<0.001; heart involvement 5.8 (2.6-13.0), p<0.001; and the severity index (cases 8.8 mu, 2.4 sigma vs controls 3.5, 2.0, respectively) 2.2 (1.5-3.4), p<0.001. Variables associated with mortality detected at any moment before death were kidney involvement 2.16 (1.09-4.29), p<0.02; the steroid therapeutic index 2.3 (1.2-4.5), p<0.001; number of previous admissions 2.4 (1.4-4.3), p<0.001; the MEX-SLEDAI index (cases 21.6 mu 6.3 sigma vs controls 12.6, 5.8), 1.2 (1.1-1.3), p<0.001; and the number of severe infections 14.4 (4.4-46.2), p<0.001. Protective variables were skin involvement 0.1 (0.3-0.6), p<0.001; daily dose of chloroquine (cases 3.9 mu, 24.1 sigma vs controls 39.4, 60.0 mg), p <0.0001 and the time from thefirst SLE symptom to the patient's demise or the cut-off date 0.7(0.6-0.9), p<0.001. Multiple logistic regression showed that the model which best explained mortality consisted of a severity index 2.6 (1.7-3.8), p<0.001; heart disease 6.5 (1.5-28.2), p=0.01, and steroid therapeutic index 3.3 (1.6-6.6), p=0.001. CONCLUSIONS: An active SLE with multi-organic involvement, steroids and infections were associated with mortality in Mexican patients with lupus attended in a tertiary care center A protective effect of cutaneous disease and chloroquine use was observed.

Adolescent↗
PubMedDate not supplied

Community based study to estimate prevalence, burden of illness and help seeking behavior in rheumatic diseases in Mexico City. A COPCORD study.

OBJECTIVE: To estimate the prevalence, burden of illness and help seeking behavior of musculoskeletal complaints and provide point prevalence estimates of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis and gout among adult population in a suburban community in Mexico city. METHODS: Home survey of adults in a balanced and stratified sample validated against physical exam. Three trained interviewers applied a validated COPCORD core questionnaire. Subjects with pain (in the last seven days or ever) > or = 4 (0-10) and no trauma; or with current or past disability were evaluated preferably the same day by a trained clinician in a structured interview. A diagnosis using ACR criteria when available, recommendation or referral was provided as required. Analysis was based on descriptive statistics of participant characteristics, pain site and distribution, patterns of help seeking behavior. Point prevalence with 95% confidence intervals of most common diseases and associated disability rate. RESULTS: 1169 men and 1331 women were included. Pain in the last 7 days not associated with trauma was reported in 419 (17%) participants. The most common sites of involvement were knee (12.3%); low back (6.3%); ankles (6%) and shoulders (5.3%). The mean/SD pain score was 4.8/2.5. Thirteen percent of the total sample had some treatment. The general practitioner treated 72% of those; 75% perceived good efficacy with medications. Point prevalence estimates and 95% CI were: disability: 1.4% (0.0-1.9); osteoarthritis: 2.3% (1.7-2.9); fibromyalgia: 1.4 (1.0-2.0); low back pain: 6.3% (5.4-7.3); rheumatoid arthritis: 0.3% (0.1-0.6) and gout 0.4% (0.1-0.7). CONCLUSION: Pain in the last 7 days due to musculoskeletal disorders is 17% in this community. Medications were commonly prescribed. Point prevalence estimates of most common diagnoses was similar to other community surveys using COPCORD methodology but very different help seeking behavior.

Adolescent↗
PubMedDate not supplied

Biological relevance of the polymorphism in the CCR5 gene in refractory and non-refractory rheumatoid arthritis in Mexicans.

OBJECTIVE: The aim of this study was to analyze the frequencies of the CCR5 delta 32 deletion and HLA class II alleles in Mexican Amerindian populations and its relevance in the development and severity of RA. METHODS: We studied 212 Mexican Mestizo subjects (40 patients with refractory RA, 102 patients with non-refractory RA and 70 healthy individuals). At the same time, to evaluate the ethnicity of the CCR5 delta 32 deletion we also studied 192 individuals from three Mexican Amerindian populations (70 Mayo (Capomo) individuals, 61 Teenek individuals, and 61 Mazatecan Indians). The delta 32 deletion in the CCR5 structural gene and HLA-DRB1 were determined by a PCR-SSP and a PCR-SSO procedure, respectively. RESULTS: In the non-refractory RA group the CCR5 delta 32 gene frequency was 0.019 and the following genotype frequencies were observed: CCR5/CCR5 = 98.0%, CCR5/CCR5 delta 32 = 1.9% and CCR5 delta 32/CCR5 delta = 1.0%. In the refractory RA group the CCR5 delta 32 gene frequency was 0.025 and the genotype distribution was similar to that in the non-refractory RA group. The deletion was not detected in the Mexican Mestizo healthy group, or among the Teenek and Mayo Amerindians, all being individuals homozygous for the wild type allele. In the Mazatecan group the deletion frequency was 1.6% (g.f. = 0.016). We observed a significant increase in the frequency of the DRB1*07 allele in severe RA patients in relation to the non-severe RA group (p = 0.02, OR = 5.65, 95% CI = 0.95-43.05). CONCLUSION: Our results suggest that the CCR5 delta 32 deletion is not common in Mexican Amerindian populations and this study does not support an important role of CCR5 delta 32 in the pathogenesis of RA or a severe form of the disease in Mexicans.

Adult↗
PubMedDate not supplied

Translation, cross-cultural adaptation, and validation of the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Dougados Functional Index (DFI) in a Spanish speaking population with spondyloarthropathies.

OBJECTIVES: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index (DFI) are the most commonly used instruments to measure disease activity and functioning in ankylosing spondylitis (AS). The aim of this study was to translate, adapt and validate these instruments into the Spanish language. METHODS: The BASDAI, BASFI, and DFI questionnaires were translated into Spanish by three independent bilingual physicians who were familiar with the medical aspects of AS and by one professional translator. Two rheumatologists familiar with instrument validation, and who were aware of the purpose of the study, examined semantic, idiomatic and conceptual issues and produced by consensus unified versions of each instrument. English back-translations from the Spanish were done by a professional translator unaware of the original version. Both English versions were compared, and where needed, modifications to the Spanish versions were made. The Spanish versions were administered to 61 ambulatory patients with AS and to 80 patients with undifferentiated spondyloarthropathy for validation purposes. Reliability and responsiveness were measured in 28 patients participating in a physiotherapy program. RESULTS: Reliability showed an acceptable 24-hour test-retest intraclass correlation coefficient (ICC)--BASFI ICC: 0.68, 95% CI: 0.29-0.85; BASDAI ICC: 0.74, 95% CI: 0.52-0.88 and DFI ICC: 0.87, 95% CI: 0.73-0.94. The construct validity of the instruments was evaluated, and BASDAI was correlated with disease activity measured by the total enthesis count (rs: 0.34); general well being in the last week (rs: 0.7); spinal pain (rs: 0.53) and duration of morning stiffness (rs: 0.64). BASFI correlated with Schöber's test (rs: -0.4); occipital-wall distance (rs: 0.38) and thoracic expansion (rs: -0.3). DFI correlated with Schöber's test (rs: -0.36); occipital-wall distance (rs: 0.29) and chest expansion (rs: -0.3). The correlation among DFI and BASFI was rs: 0.83. All instruments showed clinical responsiveness in the physiotherapy program (baseline and end of program; mean +/- SD): BASDAI: 6.25 +/- 1.97 and 3.07 +/- 2.04 (p = 0.0001); BASFI: 5.68 +/- 2.29 and 2.88 +/- 1.77 (p = 0.0001); DFI: 16 +/- 7.6 and 8.0 +/- 5.5 (p = 0.001) with effect sizes and standardized effect sizes > 1. CONCLUSIONS: The Mexican Spanish versions of the BASDAI, BASFI, and DFI showed adequate reliability, validity and responsiveness to clinical change. These instruments can be used in the clinical evaluation of Spanish-speaking patients with AS.

Activities of Daily Living↗
PubMedDate not supplied

Type of statistical techniques in rheumatology and internal medicine journals.

A comparison of the prevalence and type of statistical analysis used in internal medicine and rheumatology journals was done. Four representative journals of each specialty were selected and twelve original articles were randomly obtained from each journal. The papers were reviewed twice within a three month interval by the same evaluator following published definitions for classification. The rheumatology journals tended to use fewer (80 versus 115) and simpler statistical techniques (X3 = 4.28, DF = 1, p = 0.03; OR, 95% CI = 3.21, 1.05-10.85). There was a statistical difference in the utilization of statistical procedures among journals in the four categories evaluated. Seven statistical techniques were required to have access to 86% of statistical tests used in rheumatology journals (t-tests, contingency tables, descriptive statistics, non-parametric comparisons, anova, multiple regression, and Pearson's correlation). The internal medicine journals required six statistical procedures to have access to 85% of the tests (contingency tables, survival analysis, epidemiologic statistics, t-tests, non-parametric statistics, and anova). Our results could be useful to plan medical education in biostatistics emphasizing the statistical techniques most commonly used in these areas.

Internal Medicine↗
PubMedDate not supplied

Factors associated with disease severity in Mexican patients with rheumatoid arthritis.

OBJECTIVE: To investigate clinical, demographic, laboratory, and behavioral variables associated with disease severity in rheumatoid arthritis (RA). METHODS: A case-control study was carried out in a tertiary care center. Participants were RA patients, 16-65 years of age, with a disease duration of > or = 2 years. Selection criteria were established in advance. The sample size was calculated taking into account the prevalence of a low formal education level (< 6 years of school) in a sample of 60 patients. Controls for each case were paired according to age, sex, rheumatoid factor, and disease duration for a case/control ratio of 1:1.8. Cases were defined as those patients having at least two of the following: failure to respond to > or = 3 disease modifying anti-rheumatic drugs, score > or = 3/10 on the Disability Index of the Health Assessment Questionnaire, and disease severity > or = 4/10 as judged by the treating physician on a visual analogue scale. Controls were obtained from the same group but without such characteristics. All of the clinical charts were blindly evaluated for the clinical, demographic, laboratory, and behavioral variables. Descriptive statistics, univariate and multivariate analysis, odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. RESULTS: We studied 46 cases and 82 controls. Univariate analysis showed that severity was associated with a low level of formal education (OR 3.15, CI 1.38-7.13), use of non-conventional therapy (OR 2.7, CI 1.34-5.49), treatment with oral steroids (OR 2.6, CI 1.28-6.8), compliance, and disease duration before a confirmed diagnosis of RA. These variables remained in the multivariate model. A low hemoglobin level and an increased platelet count were the biological variables associated with severity. CONCLUSIONS: The evaluation of RA must be conducted in a socio-cultural context since this is in some way linked to disease severity.

Adolescent↗