Comparison of Central Aortic Pressure between Women with Preeclampsia and Normotensive Postpartum Women from an Urban Region of Western Mexico.

Background and Objectives: Central aortic pressure (CAP) can be measured through noninvasive methods, and CAP wave analysis can provide information about arterial stiffness. The objective of this study was to compare CAP in women with preeclampsia and normotensive postpartum women from an urban region in western Mexico. Materials and Methods: We recruited 78 women in immediate puerperium, including 39 with preeclampsia and 39 with normotension, who received delivery care in our hospital between September 2017 and January 2018. Pulse wave analysis was used to assess central hemodynamics as well as arterial stiffness with an oscillometric device. For this purpose, the measurement of the wave of the left radial artery was obtained with a wrist applanation tonometer and the ascending aortic pressure wave was generated using the accompanying software (V 1.1, Omron, Japan). Additionally, the systolic CAP, diastolic pressure, pulse pressure, heart rate, and rise rate adjusted for a heart rate of 75 bpm were determined. The radial pulse wave was calibrated using the diastolic and mean arterial pressures obtained from the left brachial artery. For all the statistical analyses, we considered p < 0.05 to be significant. Results: The results were as follows: a systolic CAP of 125.40 (SD 15.46) vs. 112.10 (SD 10.12) with p < 0.0001 for women with and without preeclampsia, respectively. Systolic CAP was significantly elevated in women with preeclampsia and could indicate an elevated risk of cardiovascular disease. Conclusion: CAP is an important parameter that can be measured in this group of patients and is significantly elevated in women with postpartum preeclampsia, even when the brachial blood pressure is normal.

Evaluation of the Effects of Atorvastatin and N-Acetyl Cysteine on Platelet Counts in Patients with Primary Immune Thrombocytopenia: An Exploratory Clinical Trial.

Objective: We aimed to evaluate the efficacy of the combination of atorvastatin and N-acetyl cysteine in increasing platelet counts in patients with immune thrombocytopenia who were resistant to steroid therapy or had a relapse after treatment. Material and Methods: The patients included in this study received oral treatment of atorvastatin at a dose of 40 mg daily and N-acetyl cysteine at a dose of 400 mg every 8 h. The desired treatment duration was 12 months, but we included patients who completed at least 1 month of treatment in the analysis. The platelet counts were measured prior to the administration of the study treatment and in the first, third, sixth, and twelfth months of treatment (if available). A p value < 0.05 was considered statistically significant. Results: We included 15 patients who met our inclusion criteria. For the total treatment duration, the global response was 60% (nine patients); eight patients (53.3%) had a complete response and one patient (6.7%) had a partial response. Six patients (40%) were considered as having undergone treatment failure. Of the responder group, five patients maintained a complete response after treatment (55.5%), three patients maintained a partial response (33.3%), and one patient (11.1%) lost their response to the treatment. All of the patients in the responder group had significant increases in their platelet counts after treatment (p < 0.05). Conclusion: This study provides evidence of a possible treatment option for patients with primary immune thrombocytopenia. However, further studies are needed.

Clinical and Biochemical Profile Associated with Renal Recovery after Acute Kidney Injury in A Mexican Population: Retrospective Cohort Study.

Background and Objectives: Our primary objective was to study the clinical and biochemical characteristics associated with acute kidney injury (AKI) remission in a group of Mexican patients. Materials and methods: We retrospectively enrolled 75 patients who were diagnosed with AKI and separated the sample into two groups: nonremitting patients (n = 27, 36%) vs. remitting patients (n = 48, 64%). Results: We found significant relationships between nonremitting AKI and previous diagnosis of chronic kidney disease (p = 0.009), higher serum creatinine (Cr) at admission (p < 0.0001), lower estimated glomerular filtration rate (eGFR) (p < 0.0001), maximum serum creatinine during hospitalization (p < 0.0001), higher fractional excretion of sodium (FENa) (p < 0.0003) and 24-h urine protein (p = 0.005), higher serum potassium on admission (p = 0.025), abnormal levels of procalcitonin (p = 0.006), and increased risk of death (p = 0.015). Conclusion: Chronic kidney disease (CKD), lower eGFR, higher levels of serum creatinine during hospitalization, higher FENa and 24-h urine protein, abnormal levels of procalcitonin, and higher serum potassium on admission were associated with nonremitting AKI. These findings may facilitate the rapid identification of patients at risk for nonremitting AKI based on clinical and biochemical characteristics. Furthermore, these findings may inform the design of timely strategies for the vigilance, prevention, and treatment of AKI.

Prevalence of Dysexecutive Symptoms in High School Students during the COVID-19 Pandemic.

This is an observational cross-sectional study designed to ascertain the prevalence and severity of dysexecutive symptoms in high school students during the COVID-19 pandemic. The validated Spanish version of the Dysexecutive Questionnaire (DEX) was used. A total of 2396 participants aged 14-22 years were included. Our sample yielded a mean DEX scale score of 28.14 ± 17.42. By the DEX classification, 889 (37.1%) students achieved optimal scores, 384 (16%) reported mild dysexecutive symptoms, 316 (13.2%) reported moderate dysexecutive symptoms, and 807 (33.7%) reported strong dysexecutive symptoms. We found a significant difference between those with and those without employed mothers, with the former scoring higher (p = 0.004), the same as those with both parents employed (p = 0.004). Adolescents face emotional susceptibility and changes in their family, social, and educational environment related to isolation, resulting in altered emotional responses and social interaction.

Current concepts on preoperative nutritional support: How, when and why?

Malnutrition is associated with several complications during hospital stay, including patients who will undergo major surgery. Therefore, it is important to optimize nutritional status in the preoperative period being the main objective restoring metabolic and immunological abnormalities. Preoperative fasting is a common practice in clinical settings, although it has been shown to induce insulin resistance. One intervention to avoid this practice is the implementation of the ERAS (Enhanced Recovery After Surgery) protocol. Proper nutritional assessment in hospitalized patients is the cornerstone to identify patients at nutritional risk, or those in malnutrition who may benefit from early nutritional interventions. The feeding route should be chosen according to the patient's condition, either orally with the use of nutritional supplements and in those where calorie requirements cannot be achieved by oral, enteral nutrition is the next logical step, reserving parenteral nutritional support in patients with non-functional gastrointestinal tracts in order to improve postoperative morbidity and mortality.

La desnutrición se asocia con una larga lista de complicaciones intrahospitalarias, incluidos aquellos pacientes que se someterán a cirugía mayor. Por lo tanto, es importante optimizar el estado nutricional en el período preoperatorio, siendo el objetivo principal la restauración de anomalías metabólicas e inmunitarias. El ayuno preoperatorio es una práctica sistemática en el ámbito clínico, a pesar de que se ha demostrado que induce resistencia a la insulina. Una de las intervenciones para evitar dicha práctica es la implementación del protocolo ERAS (Enhanced Recovery After Surgery). Una correcta valoración nutricional en los pacientes hospitalizados es de vital importancia para identificar aquellos con riesgo nutricional, o bien aquellos en desnutrición que pudieran beneficiarse de intervenciones nutricionales tempranas. La ruta de alimentación debe elegirse de acuerdo con el estado del paciente, por vía oral con el uso de suplementos nutricionales o con nutrición enteral en aquellos cuyos requerimientos calóricos no logran ser alcanzados por dicha vía, y reservando el apoyo nutricional parenteral para aquellos con tracto gastrointestinal no funcional, con el objetivo de mejorar la morbilidad y la mortalidad posoperatorias.

First Steps of the Mexico Twin Registry (RGMex-MexTR) at the University of Guadalajara.

Despite the well-known relevance of twin studies in the medical and social sciences and the growing number of twin registries throughout the world, Latin America has not fully incorporated into the twin research community. We describe the first steps taken toward developing a twin registry in Mexico: its aim, organization, recruiting potential and main short-term objectives.

Sulfato de morfina oral de liberación inmediata en pacientes con dolor por cáncer / Immediate-acting oral morphine sulfate in patients with cancer pain

Se describe la experiencia con sulfato de morfina oral de liberación inmediata para el tratamiento del dolor por cáncer, en 52 pacientes referidos a un servicio especializado para la atención de síntomas en cáncer avanzado. La morfina se utilizó durante 3399 días de tratamiento con un promedio de 65 días por pacientes. El control del dolor (medido por una Escala Visual Análoga (EVA)) fue adecuado, pues disminuyó de intensidad severa (EVA promedio 8.7) a leve (EVA promedio 1.9) en un 96 por ciento (n=50) de los pacientes. La dosis diaria promedio fue de 95.6 mg. Sólo un 50 por ciento de los pacientes requirió incremento en la dosis. Las reacciones secundarias fueron mínimas y controlables. La administración de morfiná se recomienda cada 4 horas, pero en un 83 por ciento de nuestros pacientes al inicio se logró control con la administración cada 6 horas. Este estudio confirma al sulfato de morfina como un excelente fármaco para el control del dolor por cáncer, con un mínimo de dosis y efectos secundarios. Las necesidades reales de la morfina en nuestro país son mayores que el consumo actual; debe darse a conocer con mayor amplitud a fin de tratar el dolor por cáncer