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Saavedra Salinas M.A.,National Autonomous University of Mexico | Barrera Cruz A.,Area de Desarrollo de Guias de Practica Clinica | Cabral Castaneda A.R.,Federal University of Bahia | Jara Quezada L.J.,Direccion de Educacion e Investigacion | And 22 more authors.
Reumatologia Clinica | Year: 2015

Background: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. Objectives: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus, rheumatoid arthritis (RA) and antiphospholipid syndrome (APS). Methodology: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and staging of recommendations, internal validation by peers and external validation of the final document. The quality criteria of the AGREE II instrument were followed. Results: The panels answered 37 questions related to maternal and fetal care in lupus erythematosus, RA and APS, as well as for use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. In this second part, the recommendations for pregnant women with RA, APS and the use of antirheumatic drugs during pregnancy and lactation are presented. Conclusions: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with RA and APS integrate the best available evidence for the treatment and follow-up of patients with these conditions. © 2014 Elsevier España, S.L.U.. Source


Saavedra M.A.,Hospital de Especialidades Dr. Antonio Fraga Mouret | Saavedra M.A.,National Autonomous University of Mexico | Cruz-Reyes C.,Hospital de Especialidades Dr. Antonio Fraga Mouret | Vera-Lastra O.,Hospital de Especialidades Dr. Antonio Fraga Mouret | And 6 more authors.
Clinical Rheumatology | Year: 2012

Previous reports suggest that renal involvement before pregnancy or active renal disease during pregnancy may be associated with poor fetal and maternal outcomes in systemic lupus erythematosus (SLE) women. We report our experience of fetal and maternal complications in pregnant lupus women with and without previous lupus nephritis. We analyzed the clinical records of pregnant SLE patients attended in a tertiary reference center during a 5-year period. Patients were allocated into two groups according to the presence or absence of previous lupus nephritis. Women were evaluated monthly during pregnancy and at least 1 month postpartum. Maternal and fetal outcomes of pregnancy were abstracted. We included 95 pregnancies in 92 patients. Compared with pregnant women without lupus nephritis (n=60), pregnancies with previous lupus nephritis (n=35) were associated with a higher risk of maternal complications (88.5% vs. 43.3%, p=0.00001), higher rate of lupus flares (54.2% vs. 25%, p=0.004), and renal flares (45.7% vs. 6.6%, p=0.00001), but most of which in most instances were reversible. On the other hand, fetal outcome was similar in both groups. Multivariate analysis showed that previous lupus nephritis and active lupus at conception were predictors of adverse maternal outcome. Pregnancies in women with previous lupus nephritis had a higher rate of maternal complications in comparison with those without. However, fetal prognosis was similar in both groups. © Clinical Rheumatology 2012. Source


Saavedra Salinas M.A.,Hospital de Especialidades Dr. Antonio Fraga Mouret | Barrera Cruz A.,Area de Desarrollo de Guias de Practica Clinica | Cabral Castaneda A.R.,Federal University of Bahia | Jara Quezada L.J.,National Autonomous University of Mexico | And 22 more authors.
Reumatologia Clinica | Year: 2015

Background: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. Objectives: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphospholipid antibody syndrome (APS). Methodology: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and grading of recommendations, internal validation by peers, and external validation of the final document. The quality criteria of the AGREE II instrument were followed. Results: The various panels answered the 37 questions related to maternal and fetal care in SLE, RA, and APS, as well as to the use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. We present the recommendations for pregnant women with SLE in this first part. Conclusions: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with SLE integrate the best available evidence for the treatment and follow-up of patients with these conditions. © 2014 Elsevier España, S.L.U. Source


Beristain Hernandez J.L.,Hospital de Especialidades Dr. Antonio Fraga Mouret | Servin Torres E.,Hospital de Especialidades Dr. Antonio Fraga Mouret | Sosa Caballero A.,Hospital de Especialidades Dr. Antonio Fraga Mouret | Velazquez Garcia J.A.,Hospital de Especialidades Dr. Antonio Fraga Mouret | And 9 more authors.
Endocrinologia y Nutricion | Year: 2010

Background: 99mTc sestamibi scanning and aspiration biopsy can predict the histopathological result of a thyroid nodule fairly accurately. Objective: To determine the accuracy of 99mTc sestamibi scanning in detecting malignancy in patients with thyroid nodule confirmed by definitive histopathological report after thyroidectomy. Material and methods: A total of 69 patients with a solitary thyroid nodule were studied. In all patients, fine needle aspiration, total thyroidectomy for suspected thyroid cancer, and histological analysis of the surgical specimen were performed. There were 54 patients with a positive 99mTc sestamibi scan; of these, malignancy was confirmed by histological analysis in 25 and excluded in 29. There were 15 patients with a negative 99mTc sestamibi scan; of these, three had a final diagnosis of cancer and 12 were confirmed as cancer-free. Results: The diagnostic accuracy of 99mTc sestamibi scanning in detecting malignancy in thyroid nodules was determined through a statistical analysis. 99mTc sestamibi scan for thyroid cancer had a sensitivity of 89.28% and a specificity of 29.25%. The positive predictive value was 46.29% and the negative predictive value was 80%. Conclusions: We believe that 99mTc sestamibi scan should be routinely used in all patients with a thyroid nodule and an indeterminate result on fine needle aspiration. This procedure is most useful in excluding malignancy in patients with a negative 99mTc sestamibi scan. © 2010 SEEN. Source


Estudillo Z.F.B.,Hospital de Especialidades Dr. Antonio Fraga Mouret | Diaz N.P.,Hospital de Especialidades Dr. Antonio Fraga Mouret | Ibarra M.M.L.,Hospital de Especialidades Dr. Antonio Fraga Mouret | De Jesus Quintal Ramirez M.,Hospital de Especialidades Dr. Antonio Fraga Mouret
Dermatologia Revista Mexicana | Year: 2012

Primary cutaneous diffuse large B-cell lymphomas are a neoplastic proliferation of B lymphocytes that presents as aneoformation with cutaneous exclusive localization. The genesis of this neoplasim is still unknown. We report the case of a 68-year-old male, previously healthy, who presents an 18-months evolution slow growth neoformation in thorax. Source

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