Hospital Ángeles del Pedregal

To identify factors associated with individual Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) accrual items in 1385 patients from the Latin American SLE incident cohort (GLADEL (Grupo Latino Americano Del Estudio de Lupus)).

Longitudinal cohort study. SDI assessed yearly, and damage accrual defined as a SDI change in any individual item during follow-up. Sociodemographic and clinical characteristics at entry, along with regular medication use up to the month prior to each damage item accrued, were analysed using multivariate Cox proportional hazard models with time-varying hazard risk effect performed. Models for overall damage and 10 items with at least 28 patients per item are reported.

New damage was accrued by 658 patients with SLE (48%) over a median of 54 months (p25–75: 29–71) of follow-up. Mestizo ethnicity, recent SLE Disease Activity Index (SLEDAI) and immunosuppressants were predictors of overall damage accrual, while antimalarials and rural residence were protectors; mixed effects were observed for SDI >0 and glucocorticoids (GCs) use. Protectors for scarring chronic alopecia (23.7% at 7 years follow-up) included older age, longer disease duration, diagnostic delay, SDI >0 and cytotoxic use. Proteinuria >3.5 g/24 hours (11.5% at 7 years follow-up) was associated with protective factors like older age, longer disease duration and higher GCs dose, while risk factors were Mestizo ethnicity, low medical coverage, higher SLEDAI scores and cytotoxic use. In addition, Mestizo ethnicity was a risk factor for estimated glomerular filtration rate <50% and end-stage renal disease (ESRD) whereas antimalarial protected from ESRD. GCs were risk factors for pericarditis, retinal change or optic atrophy but provided protection against proteinuria >3.5 g/24 hours. Recent disease activity and cytotoxic use were significant risk factors for additional items.

Factors associated with damage accrual differ substantially by individual SDI items. Mestizo ethnicity and recent disease activity increased renal risks, while antimalarials were protective. GCs showed mixed effects. Item-specific strategies are crucial to mitigate long-term damage.

Methotrexate (MTX) is an antimetabolite with immunosuppressive and antineoplastic properties extensively used in cancer treatment. It is administered through various routes, including intravenous and intrathecal. MTX inhibits the dihydrofolate reductase, thereby disrupting folic acid metabolism and impending DNA synthesis. Despite its efficacy, MTX administration can result in significant toxicity, affecting multiple organs and leading to potential side effects like myelosuppression, hepatotoxicity, renal failure, mucositis and neurotoxicity. MTX-induced neurotoxicity is a critical problem, with manifestations varying from hours to years post-administration, ranging from transient and reversible to severe presentations. Several risk factors may contribute to MTX-induced neurotoxicity, including genetic predisposition, drug interactions, renal impairment and concurrent radiotherapy. Management strategies in preventing and mitigating neurotoxicity are based on supportive measures such as hydration, leucovorin rescue and the use of glucarpidase. This review focusses on the neurotoxic effects of MTX, a global health issue in the growing cancer population.

The emergence of spine surgery fellowship programs in Mexico is gaining significance; however, there exists a paucity of available information pertaining to the specific requirements and criteria employed for candidate selection, operational structure, and educational framework, which affects the ability of potential applicants to make informed decisions about their training options.

A systematic web search was executed to identify the official websites of the predominant private and public health care institutions that provide spine fellowship programs in Mexico. This search was carried out by 3 spine surgery fellows between December 2023 and January 2024 utilizing the Google search engine with specific keywords previously employed in similar studies. Subsequently, we performed an evaluation to ascertain the existence of 13 elements that are pertinent to residency candidates and the ease of finding information for each program.

Twenty-five spine surgery fellowship programs were identified. Of these, 14 (56%) are endorsed by the Autonomous University of Mexico, 2 (8%) by La Salle University, and the remainder by various universities such as the Autonomous University of Guadalajara and the Autonomous University of Chihuahua, among others. The majority of programs were listed on the website of the Mexican Association of Spine Surgeons, with contact information being readily available in most cases (72%), whereas details about program chairs were primarily found on hospital websites (16%). The simplicity of the search revealed that 88% of programs could be easily located online.

Numerous spine surgery training programs are deficient in thorough online information, which creates challenges for prospective national and international applicants seeking details. Most programs depend on their reputation instead of an online presence, indicating a chance to improve marketing and visibility of spine surgery fellowship programs in Mexico.

The training of spine surgeons is extremely important, so the visibility of training programs helps promote this specialty and, therefore, the training of surgeons.