Variaciones por edad y sexo en las tendencias de infección por el virus de la inmunodeficiencia humana en el Instituto Mexicano del Seguro Social: 2003-2017 / Gender and age-related variations in human immunodeficiency virus infection trends at the Mexican Institute of Social Security: 2003-2017

Resumen Introducción: Hacer el diagnóstico y tratar a portadores del virus de la inmunodeficiencia humana ha llevado a identificar mayor prevalencia de esa infección y, por lo tanto, de un mayor riesgo de transmisión de este virus. Objetivo: Conocer la tendencia en México de los nuevos casos de portadores de infección por el virus de la inmunodeficiencia humana en el Instituto Mexicano del Seguro Social (IMSS) en el periodo 2003-2017. Métodos: Se analizaron pacientes asegurados en el IMSS. Se obtuvieron datos de 42 181 casos recién diagnosticados y se analizaron las variaciones relacionadas con el sexo y la edad. Se obtuvieron las tasas estandarizadas por edad por 100 000 personas. Resultados: El cambio porcentual anual promedio más alto en hombres se documentó en adolescentes varones (13.0, IC 95 % = 9.9, 16.1). Se registraron tendencias heterogéneas en las mujeres, con una disminución total significativa (-2.2, IC 95 % = -3.4, -1.0), pero también se observaron tendencias crecientes en algunos grupos. Conclusiones: Los resultados sugieren que en el IMSS, la epidemia de la inmunodeficiencia humana adquirida se concentra en hombres, con tendencia creciente particularmente en adolescentes.

Abstract Introduction: Diagnosing and treating human immunodeficiency virus carriers has led to the identification of a higher prevalence of said infection and, therefore, of a higher risk of transmission of the virus. Objective: To find out the trend of new cases of human immunodeficiency virus infection carriers at the Instituto Mexicano del Seguro Social (IMSS) in Mexico within the 2003-2017 period. Methods: Patients affiliated to the IMSS were analyzed. Data from 42,181 newly-diagnosed cases were collected, with variations related to gender and age being observed. Age-standardized rates per 100,000 population were obtained. Results: The highest mean annual percentage change in males was documented in adolescents (13.0, 95% CI = 9.9, 16.1). Heterogeneous trends were recorded for women, with a significant overall decrease (-2.2, 95% CI = -3.4,-1.0), but growing trends were also observed in some groups. Conclusions: Our results suggest that the human immunodeficiency epidemic in patients cared for at the Instituto Mexicano del Seguro Social is concentrated in males, with a growing trend particularly in adolescents.

Clinical markers associated with acute laboratory-confirmed Dengue infection: results of a national epidemiological surveillance system / Marcadores clínicos asociados con la infección de Dengue confirmada por laboratorio: resultados del sistema nacional de vigilancia epidemiológica

ABSTRACT Objective To evaluate the association of several clinical markers with acute laboratory-positive Dengue Virus infection. Methods A hospital-based case-control study was conducted in the state of Colima, Mexico, by using information from the National System of Epidemiological Surveillance (Sistema Nacional de Vigilancia Epidemiológica [SINAVE]) for Dengue. Data from 2 732 cases and 2 775 frequency-matched controls were analyzed. Odds Ratio (OR) and the 95 % Confidence Interval (CI), estimated by means of logistic regression models, were used. Results The presence of skin rash (OR=1,7; 95 % CI 1,5-2,1), persisting vomiting (OR=1,8; 95 % CI 1,5-2,3) and increased capillary fragility (petechiae, ecchymosis, hematoma or positive tourniquet test; OR=1,8; 95 % CI 1,2-2,6) were associated with laboratory-positive infection. Conclusions Three clinical markers were significantly associated with an increased risk of acute laboratory-confirmed dengue infection. These findings would support accurate and timely diagnosis of dengue in laboratory-limited settings.(AU)

RESUMEN Objetivo Evaluar la asociación de distintos marcadores clínicos con la infección por virus de Dengue, confirmada por laboratorio. Métodos Se condujo un estudio hospitalario de casos y controles, en el estado de Colima, México, usando información del Sistema Nacional de Vigilancia Epidemiológica (SINAVE) para dengue. Se analizó la información de 2 732 casos y 2 775 controles de frecuencia compatible/pareada. Se utilizó la Razón de Momios (RM) y el Intervalo de Confianza de 95 % (IC), estimado con modelos de regresión logística. Resultados La presencia de exantema (OR=1,7; 95 % CI 1,5-2,1), vómito persistente (OR=1,8; 95 % CI 1,5-2,3) y fragilidad capilar aumentada (petequias, equimosis, hematomas o prueba del torniquete positiva; OR=1,8; 95 % CI 1,2-2,6) se asociaron con la infección por dengue confirmada por laboratorio. Conclusiones Tres marcadores clínicos se asociaron significante con un riesgo incrementado de la infección aguda por dengue confirmada por laboratorio. Estos hallazgos pueden apoyar al preciso y oportuno diagnóstico de la infección en sitios con acceso limitado a laboratorios.(AU)

Frecuencia del síndrome metabólico y factores de riesgo en adultos con y sin diabetes mellitus e hipertensión arterial / Frequency of metabolic syndrome and risk factors in adults with and without diabetes mellitus and arterial hypertension

RESUMEN Objetivo Determinar la frecuencia y factores de riesgo para Síndrome Metabólico (SM) en adultos con Diabetes mellitus, hipertensión arterial y sin diabetes-hipertensión. Material y Métodos Se realizó un estudio transversal analítico en derechohabientes de ambos sexos y mayores de 20 años de los servicios de consulta externa del HGZ No. 1 IMSS Colima, México. Las variables estudiadas fueron edad, IMC, diámetro de la cintura, grado de escolaridad, estado socioeconómico, grado de actividad física, tabaquismo, antecedentes familiares para diabetes e hipertensión arterial (HTA) y parámetros bioquímicos como glucosa, colesterol HDL, triglicéridos. Resultados Se estudiaron 417 pacientes (170 hombres y 247 mujeres), con un promedio de edad 53,2 ± 13,4 años (intervalo 20 a 86 años). La frecuencia global del SM fue del 52,3 % (56 % mujeres y 46,4 % hombres). Mientras que la frecuencia del SM fue de 50 % en DM2, 42% en HTA, 80 % DM2 + HTA y 28,2 % sin DM o HTA. La frecuencia del tabaquismo fue del 27,8 % y fue un factor de riesgo importante para la totalidad de pacientes con SM, en DM2 y en DM2+HAT. Conclusiones La frecuencia del SM en adultos fue del 52,3 %, las mujeres fueron más afectadas y el tabaquismo fue el factor de riesgo más importante.(AU)

ABSTRACT Objective Determinate the frequency and the risk factors for Metabolic Syndrome in adults with diabetes mellitus, Hypertension and without Diabetes- Hypertension. Materials and Methods We realized a cross-sectional study in patients of both sexes and older than 20 years of the "Hospital General de Zona 1 IMSS" in Colima, Mexico. The variables studied were: age, BMI, waist circumference, cigarette smoking, and family history of diabetes and hypertension, and biochemical parameters, such as glucose, HDL cholesterol and triglycerides. Results A total of 417 persons were enrolled (170 men and 247 women), with an age average of 53.2 ± 13.4 years (age range, 20 to 86 years). The global frequency of the metabolic syndrome was 52.3 % (56 % in women and 46.4 % in men). While the MS frequency was 50 % in DM2, 42 % in hypertension, 80 % in DM2+hypertension and 28.2 % without DM2 and hypertension. The cigarette smoking frequency was 27.8 %, and it was an important risk factor for the totally of patients with MS, in DM2 and in DM2+hypertension. Conclusions The frequency of MS in adults was 52.3 %, women were the most affected, and cigarette smoking was the most important risk factor.(AU)

Persistent arthralgia and related risks factors in laboratory-confirmed cases of Chikungunya virus infection in Mexico / Artralgia persistente y factores de riesgos relacionados en casos confirmados por laboratorio de infección por el virus del Chikunguña en México / Artralgia persistente e fatores de riscos relacionados em casos confirmados em laboratório de infecção pelo vírus Chikungunya no México

ABSTRACT Objective To estimate the cumulative incidence of persistent arthralgia at 6 months from acute Chikungunya virus (CHIKV) infection and to evaluate the association of clinical markers with the risk of long-term arthralgia. Methods This multicenter retrospective cohort study was conducted in the Mexican state of Colima. A total of 136 individuals aged 15 years and older with serologically confirmed CHIKV infection were enrolled. Participants were interviewed at 6 months from the onset of symptoms, and self-reported persistent arthralgia (PA) was the main binary outcome. A self-report numeric rating scale (NRS) ranging from 0 to 10 was used to estimate the severity of articular pain. Results The cumulative incidence of PA was 41.9%. Severe pain (NRS ≥ 7) presented in 36.8% of participants with PA. In multiple analysis, individuals aged 40 years and older (risk ratio (RR) = 1.60; 95% confidence interval (CI), 1.03–2.48) and those with articular pain at 3 months post-infection (RR = 3.95; 95% CI, 1.95–8.01) had a significantly increased risk of PA at 6 months from CHIKV infection. Conclusions To the best of our knowledge, this is first report of a CHIKV-associated long-term outcome in Mexico, where the incidence of the infection has been high. This is also the first study in Latin America evaluating several factors associated with the risk of PA. Our findings may be useful in health care settings to stratify the risk of chronic arthralgia secondary to CHIKV infection and to identify patients who would benefit clinically from early medical intervention.

RESUMEN Objetivo Calcular la incidencia acumulada de artralgia persistente en los 6 meses siguientes a la infección aguda por el virus del Chikunguña y evaluar la asociación entre los marcadores clínicos y el riesgo de artralgia a largo plazo. Método Este estudio de cohortes multicéntrico y retrospectivo se condujo en el estado mexicano de Colima con la participación de un total de 136 personas de al menos 15 años de edad con infección aguda por el virus de Chikunguña serológicamente confirmada. Se entrevistó a los participantes en los seis meses posteriores al inicio de los síntomas, y la artralgia persistente autonotificada fue el principal resultado dicotómico. Para calcular la gravedad del dolor articular, se empleó una escala de clasificación numérica, en que el participante puntuaba la gravedad del dolor articular de 0 a 10. Resultados La incidencia acumulada de artralgia persistente fue de 41,9%. De los participantes con artralgia persistente, 36,8% presentaron un dolor intenso (igual o mayor a 7 en la escala de clasificación numérica). En varios análisis, las personas de al menos 40 años de edad (razón de riesgo [RR] = 1,60; intervalo de confianza [IC] de 95%, 1,03–2,48) y las personas que experimentaban dolor articular en los tres meses posteriores a la infección (RR = 3,95; IC de 95%, 1,95–8,01) tenían un riesgo significativamente mayor de padecer artralgia persistente en los seis meses siguientes a la infección aguda por el virus del Chikunguña. Conclusiones En la medida de nuestro conocimiento, este es el primer informe acerca de un resultado a largo plazo asociado a la infección aguda por el virus del Chikunguña en México, donde se ha registrado una incidencia alta de la infección. También es el primer estudio en el que se evalúan varios factores asociados al riesgo de artralgia persistente realizado en América Latina. Nuestros resultados pueden ser útiles en los establecimientos de atención de salud para estratificar el riesgo de padecer artralgia crónica subsecuente a la infección aguda por el virus de Chikunguña e identificar a los pacientes que se beneficiarían clínicamente de una intervención médica temprana.

RESUMO Objetivo Calcular a incidência acumulada de artralgia persistente após 6 meses de infecção aguda pelo vírus Chikungunya (CHIKV, sigla em inglês) e avaliar a associação de marcadores clínicos com o risco de artralgia a longo prazo. Métodos Este estudo de coorte retrospectivo e multicêntrico foi realizado no estado mexicano de Colima. Um total de 136 indivíduos com idade a partir de 15 anos e infecção pelo CHIKV confirmada por sorologia foram incluídos. Os participantes foram entrevistados 6 meses após o surgimento dos sintomas. O desfecho binário principal foi artralgia persistente (AP) autorrelatada. Uma escala numérica autorrelatada de 0 a 10 foi utilizada para calcular a gravidade da artralgia. Resultados A incidência acumulada de AP foi 41,9%. Dor intensa (≥ 7 na escala numérica) foi relatada por 36,8% dos participantes com PA. A análise múltipla revelou risco significantemente elevado de AP 6 meses após infecção pelo CHIKV nos indivíduos com idade igual ou superior a 40 anos (razão de risco (RR) = 1,60; intervalo de confiança (IC) de 95% = 1,03–2,48) e naqueles com dor articular 3 meses após a infecção (RR = 3,95; IC 95% = 1,95–8,01). Conclusões Até onde sabemos, este é o primeiro relato de um desfecho a longo prazo associado à infecção por CHIKV no México, país onde a incidência desta infecção foi elevada. Este é também o primeiro estudo realizado na América Latina a avaliar vários fatores associados com o risco de AP. Nossos achados talvez sejam úteis para estratificação do risco de artralgia crônica secundária à infecção pelo CHIKV e para identificação de pacientes nos quais intervenção médica precoce poderia ser benéfica do ponto de vista clínico.

Efficacy of Tamsulosin, Oxybutynin, and their combination in the control of double-j stent-related lower urinary tract symptoms

ABSTRACT Introduction and objective Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms. Methods Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21. Results Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported. Conclusions Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.

Histological changes caused by meclofenamic acid in androgen independent prostate cancer tumors: evaluation in a mouse model

ABSTRACT Meclofenamic acid is a nonsteroidal anti-inflammatory drug that has shown therapeutic potential for different types of cancers, including androgen-independent prostate neoplasms. The antitumor effect of diverse nonsteroidal anti-inflammatory drugs has been shown to be accompanied by histological and molecular changes that are responsible for this beneficial effect. The objective of the present work was to analyze the histological changes caused by meclofenamic acid in androgen-independent prostate cancer. Tumors were created in a nude mouse model using PC3 cancerous human cells. Meclofenamic acid (10 mg/kg/day; experimental group, n=5) or saline solution (control group, n=5) was administered intraperitoneally for twenty days. Histological analysis was then carried out on the tumors, describing changes in the cellular architecture, fibrosis, and quantification of cellular proliferation and tumor vasculature. Meclofenamic acid causes histological changes that indicate less tumor aggression (less hypercellularity, fewer atypical mitoses, and fewer nuclear polymorphisms), an increase in fibrosis, and reduced cellular proliferation and tumor vascularity. Further studies are needed to evaluate the molecular changes that cause the beneficial and therapeutic effects of meclofenamic acid in androgen-independent prostate cancer.