Alelo C del polimorfismo rs2209972 del gen de la enzima degradadora de insulina y enfermedad de Alzheimer en diabéticos tipo 2. Estudio de casos y controles / C allele of the rs2209972 single nucleotide polymorphism of the insulin degrading enzyme gene and Alzheimer's disease in type 2 diabetes, a case control study

Background and objective: In the last few decades we have witnessed an interesting transformation of the population pyramids throughout the world. As the population's life expectancy increases, there are more chronic diseases such as diabetes mellitus and dementias, and both of them have shown an association. General objetive: To determine the association between Alzheimer's disease in diabetic patients and the insulin degrading enzyme in outpatients of a second level Hospital in Monterrey, Mexico. Materials and methods: This was a case control study in which we included outpatients from the Geriatrics Clinic of a Hospital in Northeastern Mexico. Cases were patients with a Mini Mental Score Exam (MMSE) below 24 and DSM-IV criteria for Dementia. Controls were patients who had MMSE scores greater than 24. Results: Data from 97 patients were analyzed. Regarding physical examination and the results of laboratory tests, there were no differences between the two groups (p > 0.05). A 98% prevalence of the insulin degrading enzyme was documented in the sample studied. We found an association between a homozygous status for the CC genotype and Dementia with an estimated Odds Ratio (OR) of 2.5 (CI 95% 1.6–3.3) on the bivariate test, while, on the multivariate analysis, the OR was estimated 3.3 (CI 95% 1.3–8.2). Conclusions: Evidence shows that cognitive impairment is more frequent among those exposed to the C allele of the rs2209972 SNP of the insulin degrading enzyme gene (AU)

Fundamento y objetivo: En las últimas décadas se ha producido una transformación en las pirámides poblacionales, con un aumento en la expectativa de vida, lo que conlleva un mayor número de enfermedades crónico-degenerativas, como son la diabetes mellitus y la demencia, que han mostrado tener una asociación estrecha, pero cuya etiología aún está por discernir. El objetivo de este estudio fue determinar la asociación entre el alelo C de la enzima degradadora de insulina y la enfermedad de Alzheimer en pacientes con diabetes tipo 2. Material y métodos: Estudio de casos y controles, en el cual se incluyeron pacientes de la clínica de Geriatría del Hospital General del Noreste de México. Los casos fueron aquellos con una puntuación en el Mini-Mental State Examination (MMSE) menor de 24 y criterios para demencia de acuerdo con el DSM-IV. Los controles fueron pacientes con MMSE superior a 24. Resultados: Se analizaron datos de 97 pacientes. No hubo diferencias respecto a las características basales clínicas y de laboratorio entre los casos y los controles (p > 0,05). Se documentó una prevalencia de 98% del alelo C de la enzima degradadora de insulina. Encontramos una asociación entre homocigosidad para el genotipo CC de la enzima degradadora de insulina y enfermedad de Alzheimer, con una OR de 2,5 (IC 95% 1,6–3,3) en el examen bivariado, y en el examen multivariado se encontró asociación con una OR de 3,3 (IC 95% 1,3–8,2). Conclusiones: La evidencia muestra una asociación entre deterioro cognitivo y presencia del alelo C del polimorfismo rs2209972 del gen de la enzima degradadora de insulina (AU)

C allele of the rs2209972 single nucleotide polymorphism of the insulin degrading enzyme gene and Alzheimer's disease in type 2 diabetes, a case control study.

BACKGROUND AND OBJECTIVE: In the last few decades we have witnessed an interesting transformation of the population pyramids throughout the world. As the population's life expectancy increases, there are more chronic diseases such as diabetes mellitus and dementias, and both of them have shown an association. GENERAL OBJETIVE: To determine the association between Alzheimer's disease in diabetic patients and the insulin degrading enzyme in outpatients of a second level Hospital in Monterrey, Mexico. MATERIALS AND METHODS: This was a case control study in which we included outpatients from the Geriatrics Clinic of a Hospital in Northeastern Mexico. Cases were patients with a Mini Mental Score Exam (MMSE) below 24 and DSM-IV criteria for Dementia. Controls were patients who had MMSE scores greater than 24. RESULTS: Data from 97 patients were analyzed. Regarding physical examination and the results of laboratory tests, there were no differences between the two groups (p>0.05). A 98% prevalence of the insulin degrading enzyme was documented in the sample studied. We found an association between a homozygous status for the CC genotype and Dementia with an estimated Odds Ratio (OR) of 2.5 (CI 95% 1.6-3.3) on the bivariate test, while, on the multivariate analysis, the OR was estimated 3.3 (CI 95% 1.3-8.2). CONCLUSIONS: Evidence shows that cognitive impairment is more frequent among those exposed to the C allele of the rs2209972 SNP of the insulin degrading enzyme gene.

Asociación entre el polimorfismo c.1-765G>C del gen de la COX-2 y el deterioro cognitivo en individuos diabéticos de 65 o mas años de un Servicio de Geriatría en Monterrey, México / Association between polymorphism c.1-765G>C of the COX2 gene and cognitive impairment in individuals 65 years or more with diabetes from a Geriatric Service in Monterrey, Mexico

Background and objective: Cognitive impairment and dementia are common geriatric syndromes in diabetic patients. Inflammation plays a crucial role in the pathophysiology of Alzheimer's disease and cognitive impairment. Cyclooxygenases (COX) 1 and 2 participate in inflammation. The polymorphism c.1-765G>C of the COX2 gene might be protective against cognitive decline in Mexicans with diabetes mellitus through its reduced promotor activity. To determine the association between polymorphism c.1-765G>C of the COX2 gene and cognitive impairment in elderly adults with diabetes. Patients and methods: Case-control study. We included diabetic patients from the Geriatric Clinic of General Hospital No. 17 who were over 65 years and accepted to participate. Cases were patients with a score of 24 or less on the Mini Mental Status Examination (MMSE) and with DSM IV criteria for dementia. Controls were those with MMSE scores of 25 or greater. Results: We included 97 patients (50 cases and 47 controls). There were no differences regarding clinical and laboratory characteristics between cases and controls. The frequency of the C allele and the CG genotype was higher in controls than in cases and this difference remained significant in a multivariate analysis with an odds ratio of 0.012 (95% CI 0.001-0.091) and 0.009 (95% CI 0.001-0.076) in the bivariate and multivariate analysis, respectively, using the GG genotype frequency as a reference. Conclusion: Cognitive impairment in Mexican patients with diabetes is associated with less exposure to the CG genotype of the c.1-765G>C polymorphism of COX2 (AU)

Fundamento y objetivo: El deterioro cognitivo y la demencia son síndromes geriátricos frecuentes en los pacientes con diabetes. La inflamación es crucial en la fisiopatología de la enfermedad de Alzheimer y del deterioro cognitivo. Las ciclooxigenasas (COX) 1 y 2 participan en la inflamación. El polimorfismo c.1- 765G>C de la COX-2 protegería contra el deterioro cognitivo en adultos mayores diabéticos mexicanos por su menor actividad promotora. El objetivo de este estudio fue determinar la asociación entre el polimorfismo c.1-765G>C del gen de la COX-2 y el deterioro cognitivo en adultos mayores diabéticos. Pacientes y métodos: Estudio de tipo casos y controles. Se incluyeron pacientes diabéticos de la clínica de Geriatría del Hospital General de Zona No. 17, mayores de 65 años que aceptaron participar. Los casos fueron los pacientes con puntuación de 24 o menor en el Mini-Mental State Examination (MMSE) y criterios DSM-IV para demencia. Los controles tenían una puntuación de 25 o mayor en el MMSE. Resultados: Se incluyeron 97 pacientes (50 casos y 47 controles). No hubo diferencias respecto a las características clínicas y de laboratorio entre los casos y los controles. La frecuencia del alelo C y del genotipo CG fue mayor en los controles que en los casos, y dicha diferencia permaneció significativa en el análisis multivariado, con una razón de momios de 0,012 (IC 95% 0,001 a 0,091) y de 0,009 (IC 95% 0,001 a 0,076), en el análisis bivariado y multivariado, respectivamente, tomando como referencia la frecuencia genotípica GG. Conclusión: El deterioro cognitivo en pacientes mexicanos con diabetes se asocia con una menor exposición al polimorfismo c.1-765G>C del gen de la COX-2 (AU)

Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más / Frailty and its association with mortality, hospitalization and functional dependence in Mexicans aged 60-years or older

Fundamento y objetivo: Determinar la asociación entre fragilidad y mortalidad, dependencia funcional, caídas y hospitalizaciones en el Estudio Nacional de Salud y Envejecimiento en México (ENASEM).Sujetos y métodos: Estudio prospectivo poblacional en México en el que se seleccionaron sujetos de 60 años o más, que fueron evaluados en las variables de fragilidad durante la primera vuelta del estudio en el año 2001 y que incluyó: dificultad para levantarse de una silla después de haber estado sentado(a) durante largo tiempo, pérdida de peso de 5 kilogramos o más en los últimos dos años y falta de energía. Los sujetos fueron catalogados como robustos, prefrágiles y frágiles cuando tenían cero, una o dos de las características anteriores, respectivamente. La mortalidad, hospitalizaciones, caídas y dependencia funcional fueron evaluadas en la segunda vuelta del estudio en el año 2003. Se calculó el riesgo relativo para cada una de las complicaciones, así como análisis multivariado con regresión de Cox para el caso de mortalidad y regresión logística para el resto.Resultados: Los estados de prefragilidad y fragilidad se asociaron independientemente con mortalidad, con índices de riesgo ajustados de 1,61 (intervalo de confianza del 95% [IC 95%] 1,01-2,55) y 1,94 (IC 95% 1,20-3,13), respectivamente. Sólo el estado de fragilidad se asoció independientemente con hospitalización y dependencia funcional, con una razón de momios ajustada de 1,53 (IC 95% 1,13-2,07) y 3,07 (IC 95% 1,76-5,34), respectivamente. No hubo asociación entre los estados de prefragilidad y fragilidad con caídas. Conclusión: El estado de fragilidad se asocia independientemente con mortalidad, hospitalizaciones y disfuncionalidad en actividades básicas de la vida diaria en los siguientes dos años en población mexicana (AU)

Background and objective: To determine the association between frailty and mortality, dysfunctionality, falls and hospitalizations in the Mexican Health and Aging Study.Subjects and methods: Prospective, population study in Mexico, that included subjects of 60 years and older who were evaluated for the variables of frailty during the year 2001 (first wave of the study) which included: difficulty to rise from a chair after being seated during long time, weight loss of 5 kilograms or more in the last two years, and absence of energy. Frail subjects were considered when they had at least two conditions. The robust group was considered when they had zero conditions. Pre-frail or intermediate were those with one condition. Mortality, hospitalizations, falls, and functional dependency were evaluated during 2003 (second wave of the study). Relative risk was calculated for each complication, as well as hazard ratio and odds ratio through Cox Regression Model (for mortality) and logistic regression (for the rest of the complications) respectively, adjusted for covariates. Results: The states of frailty and pre-frailty were independently associated with mortality, hazard ratio of 1.61 (CI 95% 1.01-2.55) and 1.94 (CI 95% 1.20-3.13), respectively. Only the state of frailty was independently associated with hospitalization and functional dependence, odds ratio of 1.53 (CI 95% 1.13-2.07) and 3.07 (CI 95% 1.76-5.34). There was no association between pre-frailty or frailty with falls. Conclusion: Frailty is associated with an increase in the rate of mortality, hospitalizations and dependence in basic activities of daily life (AU)

[Frailty and its association with mortality, hospitalization and functional dependence in Mexicans aged 60-years or older]. / Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más.

BACKGROUND AND OBJECTIVE: To determine the association between frailty and mortality, dysfunctionality, falls and hospitalizations in the Mexican Health and Aging Study. SUBJECTS AND METHODS: Prospective, population study in Mexico, that included subjects of 60 years and older who were evaluated for the variables of frailty during the year 2001 (first wave of the study) which included: difficulty to rise from a chair after being seated during long time, weight loss of 5 kilograms or more in the last two years, and absence of energy. Frail subjects were considered when they had at least two conditions. The robust group was considered when they had zero conditions. Pre-frail or intermediate were those with one condition. Mortality, hospitalizations, falls, and functional dependency were evaluated during 2003 (second wave of the study). Relative risk was calculated for each complication, as well as hazard ratio and odds ratio through Cox Regression Model (for mortality) and logistic regression (for the rest of the complications) respectively, adjusted for covariates. RESULTS: The states of frailty and pre-frailty were independently associated with mortality, hazard ratio of 1.61 (CI 95% 1.01-2.55) and 1.94 (CI 95% 1.20-3.13), respectively. Only the state of frailty was independently associated with hospitalization and functional dependence, odds ratio of 1.53 (CI 95% 1.13-2.07) and 3.07 (CI 95% 1.76-5.34). There was no association between pre-frailty or frailty with falls. CONCLUSION: Frailty is associated with an increase in the rate of mortality, hospitalizations and dependence in basic activities of daily life.

[Prevalence of hypokalemia in patients with methylprednisolone pulse therapy]. / Prevalencia de hipokalemia en pacientes tratados con pulsos de metilprednisolona.

OBJECTIVE: To determine the prevalence of hypokalemia in patients with methylprednisolone pulse therapy. DESIGN: We carried out a descriptive, cross-sectional study. MATERIAL AND METHODS: We enrolled 110 outpatients who received pulse doses of 1 g of intravenous methylprednisolone for three consecutive days. Demographic variables, serum electrolytes and an electrocardiogram were documented. RESULTS: The study group consisted of 31 men (28.2%) and 79 women (71.8%). Average age was 40 +/- 13.6 years. Mild hypokalemia was present in 19 patients (17.27% [95% CI 9.75-24.79]); moderate potassium levels were found in just one patient 0.9% [IC 95 0.023-4.96]); no cases of severe hypokalemia occurred. Total prevalence was 18.18% (95% CI 10.5-25.8). There were no significant electrocardiographic changes. DISCUSSION AND CONCLUSION: Mild and moderate hypokalemia was 18.18% without clinical or electrocardiographic consequences. Since there were no cases of severe hypokalemia, close monitoring of potassium levels should be restricted to those patients with other risk factors.