Myelopathy is a rare central nervous system (CNS) complication associated with systemic lupus erythematosus (SLE). Acute transverse myelitis (ATM) is the most frequent form of SLE-related myelopathy. Magnetic resonance imaging (MRI) typically shows increased signal intensity in T2-weighted images and cord swelling. In the present paper, we describe six cases of SLE-related myelopathy with multiple increased signals in the T2-weighted images involving continuous levels of the cervical and thoracic spinal cord, a distinctive feature recently named ‘longitudinal myelitis’. The clinical and laboratory findings are similar to those presented by ATM patients, including paraparesis, sensory level and sphincter disturbances. Four patients had positive antiphospholipid antibodies (aPL) suggesting that this could be a characteristic of longitudinal myelitis. Treatment in all cases included high doses of corticosteroids and immunosuppressive agents (intravenous (i.v.) cyclophosphamide). Anticoagulation therapy was given to one patient and two others received low doses of aspirin. The outcome was mainly unfavorable with slow improvement in only one case, no improvement in two and relapse of the myelopathy in the remaining three. In conclusion, longitudinal myelitis is an unusual form of SLE-related myelopathy, it might be associated with aPL and it has a poor prognosis.

Objectives: To describe the prevalence and distribution of anxiety and depression among Mexican population, and to examine its association with internet addiction during the COVID-19 outbreak. Design: A web-based cross-sectional study. Setting: General population in Mexico. Participants: 561 subjects were recruited (71% female, mean age of was 30.7 ± 10.6 years). Interventions: An online survey to assess personal attitudes and perceptions towards COVID-19, sleep-disorders related, the Mexican version of the Hospital Anxiety and Depression Scale (HADS) and the Internet Addiction Test (IAT) was applied. Primary and secondary outcome measures: Prevalence of anxiety, depression, internet addiction and sleep disorders and associated factors. Also, prevalence for anxiety and depression were compared to an historic control group. Results: During the initial phase of the COVID-19 pandemic the prevalence for anxiety and depression was 50% (95% CI, 45.6% to 54.1%) and 27.6%, (95% CI 23.8% to 31.4%), respectively. We found a 51% (33% to 50%) increase in anxiety and up to 86% increase in depression uring the initial weeks of the lock-down compared to the control group. According to the IAT questionnaire, 62.7% (95% CI 58.6% to 68.8%) of our population had some degree of internet addiction. Odds ratio for development of anxiety symptoms was 2.02 (95% CI1.56-2.1, p=0.0001) and for depression was 2.15 (95% CI 1.59-2.9, p=0.0001). In the multivariate analysis, younger age (p=0.006), sleep problems (p=0.000), and internet addiction ( p=0.000) were associated with anxiety and depression. Conclusions: Our study provides valuable information on the psychological impact that the COVID-19 pandemic has had on the Mexican population. As in other parts of the globe, in Mexico, fear of SARS-CoV-2 infection has had devastating consequences on mental health, such as anxiety, depression and sleeping disturbances. Internet abuse and the consequent overexposure to rapidly spreading misinformation (infodemia) are associated to anxiety and depression.

Introduction/Aim In North America and Europe, the prevalence of celiac disease (CD) might be much greater than expected in previous estimates. Until recently, the prevalence of CD in Latin America remained largely unknown. So far, information regarding CD in Mexico is limited, and it is still considered a rare disease. Our aim was to determine the prevalence of tTGA in a large group of apparently healthy blood donors. Subjects and Methods Serum samples from 1009 consecutive blood donors, who attended a third level referral center in Mexico City, were collected between June 2004 and December 2004. Only Mexican Mestizo individuals were included. All sera were tested with a new generation human recombinant protein based tTGA-IgA ELISA commercial kit (Aeskulisa tTG-IgA, Wendelsheim, Germany). The cut-off value provided by the manufacturer was 15 U/mL. Results The mean age of the blood donors was 34±10 years and 68% (n=683) were men. Six hundred fifty two subjects (65%) were born in Mexico City; and from the remaining 357 subjects, at least one was born in each of the 31 different states in our country. Twenty-seven (2.7%) blood donors were positive for tTGA-IgA; all of them with tTGA-IgA values above 30 U/mL (range 36 to 1639). Overall prevalence was 1:37 [27/1009, 95% confidence interval (CI)=1.6-3.7]. The prevalence among women was 1:33 (10/326, 95% CI=1.04-5.09) and for men 1:40 (17/683, 95% CI=1.24-3.73). Conclusions On the basis of a well-recognized serologic screening method performed to blood donor samples, we demonstrated an unexpectedly high prevalence of tTGA positivity (2.6%) in the adult Mexican Mestizo population. Thus, the prevalence of CD in Mexico could be higher or similar to that observed in other countries. This observation contributes to increase the awareness for this under diagnosed disease in clinical practice and to consider CD as a global health problem.

The treatment of esophageal (noncardiac) chest pain is unsatisfactory and there is no approved therapy. A previous uncontrolled study suggested that theophylline may be useful. Our aims were to investigate the effects of theophylline on esophageal sensorimotor function and chest pain. In a double-blind study, sensory and biomechanical properties of the esophagus were assessed using impedance planimetry in 16 patients with esophageal hypersensitivity, after intravenous theophylline or placebo. In a second, randomized 4-wk crossover study, oral theophylline and placebo were administered to 24 patients with esophageal hypersensitivity. Frequency, intensity, and duration of chest pain episodes were evaluated. After IV theophylline, chest pain thresholds (P = 0.027) and esophageal cross-sectional area (P = 0.03) increased and the esophageal wall became more distensible (P = 0.04) compared with placebo. After oral theophylline, the number of painful days (P = 0.03) and chest pain episodes (P = 0.025), pain duration (P = 0.002), and its severity (P = 0.031) decreased. Overall symptoms improved in 58% on theophylline and 6% on placebo (P < 0.02). There was no order effect. Theophylline relaxed the esophageal wall, decreased hypersensitivity, and improved chest pain. Theophylline is effective in the treatment of functional chest pain.