Risk factors associated with COVID-19 mortality in Mexico.

BACKGROUND: On December 31, 2019, one of the most serious pandemics in recent times made its appearance. Certain health conditions, such as obesity and diabetes mellitus, have been described to be related to COVID-19 unfavorable outcomes. OBJECTIVE: To identify factors associated with mortality in patients with COVID-19. MATERIAL AND METHODS: Retrospective cohort of 998,639 patients. Patient sociodemographic and clinical characteristics were analyzed, with survivors being compared with the deceased individuals. Cox proportional hazards model was used to identify variables predictive of COVID-19-associated mortality. RESULTS: Among the deceased patients, men accounted for 64.3%, and women, for 35.7%, with the difference being statistically significant. Subjects older than 80 years had a 13-fold higher risk of dying from COVID-19 (95% CI = 12,469, 13,586), while chronic kidney disease entailed a risk 1.5 times higher (95% CI = 1,341, 1,798), and diabetes mellitus involved a risk 1.25 times higher (95% CI = 1.238,1.276). CONCLUSIONS: Age, sex, diabetes mellitus and obesity were found to be predictors of COVID-19 mortality. Further research related to chronic obstructive pulmonary disease, cardiovascular diseases, smoking and pregnancy is suggested.

ANTECEDENTES: El 31 de diciembre de 2019, se inició una de las pandemias más graves de los últimos tiempos. Se ha descrito que ciertas condiciones de salud, como la obesidad y la diabetes mellitus, están relacionadas con desenlaces desfavorables por COVID-19. OBJETIVO: Identificar factores asociados a mortalidad en pacientes con COVID-19. MATERIAL Y MÉTODOS: Cohorte retrospectiva de 998 639 pacientes. Se analizaron las características sociodemográficas y clínicas de los pacientes, y se compararon supervivientes con fallecidos. Se utilizó el modelo de riesgos proporcionales de Cox para la identificación de variables predictivas de defunción por COVID-19. RESULTADOS: Entre los fallecidos, los hombres representaron 64.3 % y las mujeres 35.7 %, diferencia que resultó estadísticamente significativa. Las personas con más de 80 años presentaron un riesgo 13 veces mayor de morir por COVID-19 (IC 95 % = 12.469,13.586) y la enfermedad renal crónica, un riesgo de 1.5 (IC 95 % = 1.341, 1.798); la diabetes mellitus tuvo un riesgo de 1.25 (IC 95 % = 1.238,1.276). CONCLUSIONES: La edad, el sexo, la diabetes mellitus y la obesidad resultaron ser entidades predictivas de muerte por COVID-19. Se sugiere más investigación relacionada con enfermedad pulmonar obstructiva crónica, enfermedades cardiovasculares, tabaquismo y embarazo.

Study of the metabolic syndrome severity index as a predictive factor of a major cardiovascular event in premenopausal women with systemic lupus erythematosus. / Estudio del índice de gravedad del síndrome metabólico como factor predictivo de un episodio cardiovascular mayor en mujeres premenopáusicas con lupus eritematoso sistémico.

BACKGROUND: Patients with systemic lupus erythematosus (SLE) have an increased risk of metabolic syndrome (MS) and cardiovascular (CV) disease. MS is evaluated binary, limiting the understanding of each component's severity individually. Therefore, severity scores for MS that evaluate them separately have been developed. This study aims to determine the prognosis between MS severity and the occurrence of major adverse cardiovascular events (MACE) in SLE patients. METHODS: Ten-year follow-up cohort study. Premenopausal>18-year-old women with a previous diagnosis of SLE were included. Patients with recent CV events, pregnancy, thyroid disease, and liposuction were excluded. The variables of interest were CV events; the confounding variables, and the MS severity indexes were examined. Hazard ratios and Kaplan-Meier survival curves were estimated through Cox regression. RESULTS: A total of 238 women were analyzed: 22 presented MACE, and 216 did not. MS prevalence, measured according to consensus and ATP-III criteria, was higher in MACE patients (50 and 40,95%, respectively). The MetSx-IMC severity index was higher within the MACE group. Cox analysis showed an increase in the MetSx-IMC associated with the risk of suffering MACE in a 1.107 ratio. CONCLUSIONS: The MetSx-IMC severity index, contrary to the binary approaches, is recommended to evaluate MS as a predictor of MACE in SLE patients. Offering improved and more accurate prognosis in patients at risk of developing MCE.

Factores de riesgo asociados a mortalidad por COVID-19 en México / Risk factors associated with COVID-19 mortality in Mexico

Resumen Antecedentes: El 31 de diciembre de 2019, se inició una de las pandemias más graves de los últimos tiempos. Se ha descrito que ciertas condiciones de salud, como la obesidad y la diabetes mellitus, están relacionadas con desenlaces desfavorables por COVID-19. Objetivo: Identificar factores asociados a mortalidad en pacientes con COVID-19. Material y métodos: Cohorte retrospectiva de 998 639 pacientes. Se analizaron las características sociodemográficas y clínicas de los pacientes, y se compararon supervivientes con fallecidos. Se utilizó el modelo de riesgos proporcionales de Cox para la identificación de variables predictivas de defunción por COVID-19. Resultados: Entre los fallecidos, los hombres representaron 64.3 % y las mujeres 35.7 %, diferencia que resultó estadísticamente significativa. Las personas con más de 80 años presentaron un riesgo 13 veces mayor de morir por COVID-19 (IC 95 % = 12.469,13.586) y la enfermedad renal crónica, un riesgo de 1.5 (IC 95 % = 1.341, 1.798); la diabetes mellitus tuvo un riesgo de 1.25 (IC 95 % = 1.238,1.276). Conclusiones: La edad, el sexo, la diabetes mellitus y la obesidad resultaron ser entidades predictivas de muerte por COVID-19. Se sugiere más investigación relacionada con enfermedad pulmonar obstructiva crónica, enfermedades cardiovasculares, tabaquismo y embarazo.

Abstract Background: On December 31, 2019, one of the most serious pandemics in recent times made its appearance. Certain health conditions, such as obesity and diabetes mellitus, have been described to be related to COVID-19 unfavorable outcomes. Objective: To identify factors associated with mortality in patients with COVID-19. Material and methods: Retrospective cohort of 998,639 patients. Patient sociodemographic and clinical characteristics were analyzed, with survivors being compared with the deceased individuals. Cox proportional hazards model was used to identify variables predictive of COVID-19-associated mortality. Results: Among the deceased patients, men accounted for 64.3%, and women, for 35.7%, with the difference being statistically significant. Subjects older than 80 years had a 13-fold higher risk of dying from COVID-19 (95% CI = 12,469, 13,586), while chronic kidney disease entailed a risk 1.5 times higher (95% CI = 1,341, 1,798), and diabetes mellitus involved a risk 1.25 times higher (95% CI = 1.238,1.276). Conclusions: Age, sex, diabetes mellitus and obesity were found to be predictors of COVID-19 mortality. Further research related to chronic obstructive pulmonary disease, cardiovascular diseases, smoking and pregnancy is suggested.

Impact Evaluation of An Interdisciplinary Educational Intervention to Health Professionals for the Treatment of Mild to Moderate Child Malnutrition in Mexico: A Difference-in-Differences Analysis.

The prevalence of undernutrition in Mexican children younger than 5 years old has been 14% since 2006. There are clinical practice guidelines for mild to moderate malnutrition in children in the Mexican health system; however, they are not applied. In addition, the knowledge and practices of health professionals (HP) to treat malnutrition in health centers are insufficient to perform adequate assessments and correct treatments. An impact evaluation of an interdisciplinary educational intervention was carried out on 78 HPs for the treatment of children with mild to moderate malnutrition of low resources, with 39 in the intervention group and 37 in the counterfactual group, estimated as the comparison group. A Food and Agriculture Organization (FAO)-validated questionnaire adapted to child malnutrition about knowledge, attitudes, and practices was applied before, after, and 2 months after a malnutrition workshop. The difference-in-differences analysis showed that the educational intervention group had a significant improvement in knowledge, attitudes, and practices before and after the intervention (grades of 54.6 to 79.2 respectively, p = 0.0001), compared with the comparison group (grades of 79.2 and 53.4, respectively, p = 0.0001), which was maintained over two months (grades of 71.8 versus 49.8, p = 0.0001, respectively). The multivariate analysis showed that the probability of improvement in learning by 30% was 95-fold higher in the educational intervention group versus the comparison group, OR = 95.1 (95% CI 14.9-603.0), and this factor was independent of sex, age, education, or hospital position. Despite the availability of clinical practice guidelines for the assessment and treatment for child malnutrition, education in malnutrition for HPs is effective and needed to achieve a significant improvement in children's health.

Symptom cluster analysis of long COVID-19 in patients discharged from the Temporary COVID-19 Hospital in Mexico City.

INTRODUCTION: Several reports have emerged describing the long-term consequences of COVID-19 and its effects on multiple systems. METHODS: As further research is needed, we conducted a longitudinal observational study to report the prevalence and associated risk factors of the long-term health consequences of COVID-19 by symptom clusters in patients discharged from the Temporary COVID-19 Hospital (TCH) in Mexico City. Self-reported clinical symptom data were collected via telephone calls over 90 days post-discharge. Among 4670 patients, we identified 45 symptoms across eight symptom clusters (neurological; mood disorders; systemic; respiratory; musculoskeletal; ear, nose, and throat; dermatological; and gastrointestinal). RESULTS: We observed that the neurological, dermatological, and mood disorder symptom clusters persisted in >30% of patients at 90 days post-discharge. Although most symptoms decreased in frequency between day 30 and 90, alopecia and the dermatological symptom cluster significantly increased (p < 0.00001). Women were more prone than men to develop long-term symptoms, and invasive mechanical ventilation also increased the frequency of symptoms at 30 days post-discharge. CONCLUSION: Overall, we observed that symptoms often persisted regardless of disease severity. We hope these findings will help promote public health strategies that ensure equity in the access to solutions focused on the long-term consequences of COVID-19.

Prognostic validity of a clinical trunk control test for independence and walking in individuals with spinal cord injury.

Objective: The objective of the present work was to determine the prognostic validity of the trunk control test for walking and independence in individuals with SCI.Design: A cohort, prospective study was carried out in all individuals with sub-acute SCI.Setting: All inpatients at the Mexico City based National Rehabilitation Institute (INR).Participants: Ninety individuals with a clinical diagnosis of sub-acute SCI, American Spinal Injury Association Impairment Scale (AIS) A-D, and that have not participated in a rehabilitation program were included. Thirty-five individuals had good initial trunk control and the remaining 55 had poor trunk control. All individuals participated in a standard rehabilitation program subsequently.Interventions: N/AOutcome Measures: The trunk control test was performed at baseline. At 1, 3, 6, 9 and 12 months after the first evaluation, walking and independence were assessed.Results: Survival Analysis revealed that 62.5% and 100% individuals with good trunk control at baseline assessment were respectively walking and independent in ADL at 12 months and 14% and 48% individuals with poor trunk control were walking and independent in ADL. Cox regression analysis revealed that individuals with good trunk control were 4.6 times more likely to walk independently at 12 months and 2.9 times more likely to be independent in activities of daily living.Conclusion: The present study revealed that the trunk control test is useful for providing a prognosis of independence and walking at 1 year in individuals with SCI, independently of the neurologic level and the severity of the injury.

Soluble Intercellular Adhesion Molecule-1 (sICAM-1) as a Biomarker of Vascular Cognitive Impairment in Older Adults.

BACKGROUND: Endothelial dysfunction and subsequent inflammation contribute to the development of vascular cognitive impairment (VCI). Soluble intercellular adhesion molecule-1 (sICAM-1) is upregulated in endothelial dysfunction and promotes an inflammatory response; however, the relationship between sICAM-1 and VCI remains equivocal. OBJECTIVE: To determine whether sICAM-1 contributes to the prediction of VCI. METHODS: Community-dwelling older adults (n = 172) from the "Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults" (COSFOMA) study were identified as VCI or controls using standard neuropsychological evaluations and neuroimaging. sICAM-1 was quantified using ELISA, and multivariate logistic regression determined the association between sICAM-1 and VCI. RESULTS: A total of 31 VCI cases were identified. sICAM-1 was higher in VCI (VCI: 450.7 [241.6] ng/mL vs. controls: 296.9 [140.9] ng/mL). sICAM-1 concentrations above the 90th percentile (464.1 ng/mL) were associated with VCI group membership in all models (OR: 6.9, 95% CI: 1.1-42.2). The final saturated model explained 64% of the variance in VCI group membership. CONCLUSION: High concentrations of sICAM-1 are independently associated with VCI group membership. Efforts to further characterize the relationship between indices of endothelial dysfunction and pathological changes to the aging brain should be further pursued.

Oral Disease and 3-Year Incidence of Frailty in Mexican Older Adults.

BACKGROUND: Poor oral health has been associated with some components of frailty. The objective of this study was to identify the association between clinical measures of oral health and the incidence of frailty among community-dwelling older adults aged 70 or older in Mexico City. METHODS: A 3-year cohort study with a probabilistic representative sample of home-dwelling elders of one district of Mexico City was performed. Baseline and follow-up interview and oral clinical evaluations were carried out by standardized examiners in participants' homes. Dependent variable was incident frailty defined according to the frailty phenotype. Independent variables were the utilization of dental services, the presence of xerostomia, the number of natural teeth, use of removable dental prostheses, presence of severe periodontitis, and presence of root remnants. Sociodemographic, behavioral, and health measures were included as confounders. The association between oral health conditions and incident frailty was modeled using Poisson regression models with robust variance estimators. The models were adjusted for confounders and interactions. RESULTS: We identified a 14.8% cumulative incidence of frailty. Each additional tooth was associated with a lower probability of developing frailty by 5.0% (risk ratio = 0.90; 95% CI 1.02-1.10). The 3-year risk ratio of developing frailty was 2.13 times higher (95% CI 1.01-4.50) among participants having severe periodontitis. CONCLUSIONS: The number of teeth and the presence of severe periodontitis are associated with the development of frailty after controlling for confounders. Further studies are needed on this topic.

El índice pulso-masa como factor pronóstico de eventos cardiovasculares en mujeres con lupus eritematoso sistémico / The pulse-mass index as a predictor of cardiovascular events in women with systemic lupus erythematosus

Antecedentes: Los enfermos de lupus eritematoso generalizado (LEG), comparados con el resto de la población, tienen 3 veces más riesgo de muerte; los eventos cardiovasculares (ECV) son una de las principales causas. Existen índices como cintura-talla (ICT), cintura-cadera (ICC) y el pulso-masa (IPM) que pronostican ECV; su comportamiento se desconoce en el LEG. El objetivo de este estudio fue determinar el valor pronóstico del IPM en el desarrollo de ECV en mujeres premenopáusicas con LEG. Metodología: Estudio de cohorte. Se incluyó a mujeres premenopáusicas con LEG, sin ECV previo; se excluyó a las pacientes que presentaran síndrome antifosfolípido (SAF), que estuvieran embarazadas, con enfermedad tiroidea, liposucción reciente y enfermedad renal crónica. Las variables de exposición fueron: IPM, ICT, ICC y síndrome metabólico al momento del ingreso a la cohorte. Se consideraron como variables confusoras el tiempo de evolución, actividad de la enfermedad, daño acumulado y tratamiento. Por medio de citas semestrales, registro de urgencias y hospitalización, se midieron los ECV. Se utilizó análisis de riesgos proporcionales de Cox y sobrevida por Kaplan-Meier. Resultados: Se incluyó a 238 mujeres con mediana de edad de 31 años (18-52), con seguimiento de 8 años. Se presentaron 22 casos (9,6%) de ECV. En el anáisis de regresión de Cox las variables pronósticas fueron: IPM con HR = 8,1 (IC95%: 1,1-65), síndrome metabólico con 2,4 (IC95%: 1-5,8), daño acumulado con HR = 1,5 (IC95%: 1,1-2,2) y porcentaje de grasa corporal con HR = 2,8 (IC95%: 1,1-6,9). Conclusiones: El IPM es un buen factor pronóstico de ECV en mujeres con LEG (AU)

Background: Patients with systemic lupus erythematosus (SLE) have 3 times the risk of death compared to the rest of the population, with cardiovascular events (CVD) being one of the main causes. Índices such as waist-height (W-Ht I), waist-hip (W-Hp I) and pulse-mass (PMI) predict CVD, though the behaviour is unknown in patients with SLE. The aim of this study was to determine the prognostic value of PMI in the development of CVD in premenopausal women with SLE. Methodology: Cohort study. Included were premenopausal women with SLE without prior CVD; excluded were those patients with antiphospholipid syndrome (APS), pregnancy, thyroid disease, recent liposuction, and chronic kidney disease. Exposure variables were: PMI, W-Ht I, W-Hp I and metabolic syndrome at onset of the cohort. Considered confounding variables were time of evolution, disease activity, cumulative damage and treatment. Through semi-annual appointments, accident and emergency admittance and hospitalisation records the CVD were screened. Analysis was performed with Cox for proportional hazards and survival with Kaplan Meier. Results: We included 238 women with a median age of 31 (18-52) years, with a follow-up of 8 years. We identified 22 (9.6%) cases of CVD. In the Cox proportional hazards analysis, the prognostic variables were: PMI with HR = 8.1 (95% CI: 1.1-65), metabolic syndrome with 2.4 (95% CI: 1-5.8), cumulative damage with HR = 1.5 (95% CI: 1.1-2.2) and body fat percentage HR = 2.8 (95% CI: 1.1-6.9) Conclusions: The PMI is a better predictor factor of CVD in women with SLE (AU)

The pulse-mass index as a predictor of cardiovascular events in women with systemic lupus erythematosus. / El índice pulso-masa como factor pronóstico de eventos cardiovasculares en mujeres con lupus eritematoso sistémico.

BACKGROUND: Patients with systemic lupus erythematosus (SLE) have 3times the risk of death compared to the rest of the population, with cardiovascular events (CVD) being one of the main causes. Índices such as waist-height (W-Ht I), waist-hip (W-Hp I) and pulse-mass (PMI) predict CVD, though the behaviour is unknown in patients with SLE. The aim of this study was to determine the prognostic value of PMI in the development of CVD in premenopausal women with SLE. METHODOLOGY: Cohort study. Included were premenopausal women with SLE without prior CVD; excluded were those patients with antiphospholipid syndrome (APS), pregnancy, thyroid disease, recent liposuction, and chronic kidney disease. Exposure variables were: PMI, W-Ht I, W-Hp I and metabolic syndrome at onset of the cohort. Considered confounding variables were time of evolution, disease activity, cumulative damage and treatment. Through semi-annual appointments, accident and emergency admittance and hospitalisation records the CVD were screened. Analysis was performed with Cox for proportional hazards and survival with Kaplan Meier. RESULTS: We included 238 women with a median age of 31 (18-52) years, with a follow-up of 8years. We identified 22 (9.6%) cases of CVD. In the Cox proportional hazards analysis, the prognostic variables were: PMI with HR=8.1 (95% CI: 1.1-65), metabolic syndrome with 2.4 (95% CI: 1-5.8), cumulative damage with HR=1.5 (95% CI: 1.1-2.2) and body fat percentage HR=2.8 (95% CI: 1.1-6.9) CONCLUSIONS: The PMI is a better predictor factor of CVD in women with SLE.

Prescription patterns of antihypertensives in a community health centre in Mexico City: a drug utilization study.

Hypertension is highly prevalent; in Mexico, the 2012 National Health and Nutrition Survey reported a prevalence of hypertension of 31.5% in the adult population. Pharmacological treatment is the commonest intervention and has been shown to reduce cardiovascular mortality and morbidity, and total mortality. Accordingly, the type and number of antihypertensives used and the outcome - in terms of blood pressure (BP) control - are important. Therefore, our purpose is to learn the pattern of antihypertensive drug prescription and explore the determinants of BP control in an urban population in Mexico. A retrospective cross-sectional drug utilization study was conducted. Medical records from a community health centre were searched to identify those corresponding to patients diagnosed with hypertension; information upon antihypertensives used and control of the disease was carefully retrieved. A logistic regression model was built to know the main determinants of BP control. A sample of 345 clinical records of interest was identified. Most patients received antihypertensives (86.4%); the leading medications used were angiotensin-converting enzyme inhibitors, 63.8%; beta-blockers (26.5%), diuretics (19.8%), angiotensin-receptor blockers (15.8%) and calcium-channel blockers (6.4%). Only the age (≥55 years) and BMI (>30) of the patients, and the age of the doctors (≥55 years), had an important influence on BP control. Obesity is a particular and important determinant of uncontrolled hypertension; it is worth to act on body weight, on an individual basis. As lack of control has been also tied to elderly doctors, an education programme could be envisaged.

Desarrollo y validación de la Escala de Mortalidad Neonatal-9 México para predecir la mortalidad en neonatos críticamente enfermos / Development and validation of the Neonatal Mortality Score-9 Mexico to predict mortality in critically ill neonates

Introducción. Las escalas pronósticas son de utilidad para el médico que ejerce en las unidades de cuidados intensivos neonatales. Existen escalas neonatales validadas, en su mayoría para neonatos de bajo peso al nacer. El objetivo fue crear y validar una escala predictora de mortalidad en neonatos que incluyera nuevas variables pronósticas. Población y métodos. Se realizó el estudio en un hospital materno-infantil de la ciudad de México, del Instituto Mexicano del Seguro Social. En la primera fase, se diseñó un estudio de casos y controles anidado en una cohorte (neonatos ingresados con criterios de gravedad durante el primer día de vida), en el que se identificó y construyó una escala con parámetros graduales de puntuación acumulativa de nueve variables independientes para predecir muerte: peso, acidemia metabólica, lactato, paO2/FiO2, p(A-a) O2, A/a, plaquetas y glucosa sérica. La validación se realizó en una cohorte prospectiva, de las mismas características, tomando como variable de desenlace la mortalidad hasta el séptimo día. Resultados. La cohorte incipiente estuvo conformada por 424 neonatos. Se seleccionaron 22 casos y 132 controles, y se identificaron 9 variables, que conformaron la escala nombrada escala de mortalidad neonatal-9 México. La cohorte de validación estuvo integrada por 227 neonatos. Se registraron 44 (19%) defunciones, con un área bajo la curva de 0,92. Con una puntuación de entre 16 y 18, se reportó un hazard ratio de 85 (11-102), una especificidad de 99%, un valor predictivo positivo de 71% y un valor predictivo negativo de 90%. Conclusiones. La escala propuesta es un instrumento fiable para predecir la gravedad en neonatos.(AU)

Introduction. Prognostic scales or scores are useful for physicians who work in neonatal intensive care units. There are several validated neonatal scores but they are mostly applicable to low birth weight infants. The aim of this study was to develop and validate a mortality prognostic score in newborn infants, that would include new prognostic outcome measures. Population and Methods. The study was conducted in a mother and child hospital in the city of Mexico, part of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). In the first phase of the study, a nested case-control study was designed (newborn infants admitted on the basis of severity criteria during the first day of life), in which a scale was identified and developed with gradual parameters of cumulative score consisting of nine independent outcome measures to predict death, as follows: weight, metabolic acidemia, lactate, PaO2/FiO2, p(A-a) O2, A/a, platelets and serum glucose.Validation was performed in a matched prospective cohort, using 7-day mortality as an endpoint. Results. The initial cohort consisted of 424 newborn infants. Twenty-two cases and 132 controls were selected; and 9 outcome measures were identified, making up the scale named neonatal mortality score-9 Mexico. The validation cohort consisted of 227 newborn infants. Forty-four (19%) deaths were recorded, with an area under the curve (AUC) of 0.92. With a score between 16 and 18, an 85 (11-102) hazard ratio, 99% specificity, 71% positive predictive value and 90% negative predictive value were reported. Conclusions .The proposed scale is a reliable tool to predict severity in newborn infants.(AU)

Desarrollo y validación de la Escala de Mortalidad Neonatal-9 México para predecir la mortalidad en neonatos críticamente enfermos / Development and validation of the Neonatal Mortality Score-9 Mexico to predict mortality in critically ill neonates

Introducción. Las escalas pronósticas son de utilidad para el médico que ejerce en las unidades de cuidados intensivos neonatales. Existen escalas neonatales validadas, en su mayoría para neonatos de bajo peso al nacer. El objetivo fue crear y validar una escala predictora de mortalidad en neonatos que incluyera nuevas variables pronósticas. Población y métodos. Se realizó el estudio en un hospital materno-infantil de la ciudad de México, del Instituto Mexicano del Seguro Social. En la primera fase, se diseñó un estudio de casos y controles anidado en una cohorte (neonatos ingresados con criterios de gravedad durante el primer día de vida), en el que se identificó y construyó una escala con parámetros graduales de puntuación acumulativa de nueve variables independientes para predecir muerte: peso, acidemia metabólica, lactato, paO2/FiO2, p(A-a) O2, A/a, plaquetas y glucosa sérica. La validación se realizó en una cohorte prospectiva, de las mismas características, tomando como variable de desenlace la mortalidad hasta el séptimo día. Resultados. La cohorte incipiente estuvo conformada por 424 neonatos. Se seleccionaron 22 casos y 132 controles, y se identificaron 9 variables, que conformaron la escala nombrada escala de mortalidad neonatal-9 México. La cohorte de validación estuvo integrada por 227 neonatos. Se registraron 44 (19%) defunciones, con un área bajo la curva de 0,92. Con una puntuación de entre 16 y 18, se reportó un hazard ratio de 85 (11-102), una especificidad de 99%, un valor predictivo positivo de 71% y un valor predictivo negativo de 90%. Conclusiones. La escala propuesta es un instrumento fiable para predecir la gravedad en neonatos.

Introduction. Prognostic scales or scores are useful for physicians who work in neonatal intensive care units. There are several validated neonatal scores but they are mostly applicable to low birth weight infants. The aim of this study was to develop and validate a mortality prognostic score in newborn infants, that would include new prognostic outcome measures. Population and Methods. The study was conducted in a mother and child hospital in the city of Mexico, part of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). In the first phase of the study, a nested case-control study was designed (newborn infants admitted on the basis of severity criteria during the first day of life), in which a scale was identified and developed with gradual parameters of cumulative score consisting of nine independent outcome measures to predict death, as follows: weight, metabolic acidemia, lactate, PaO2/FiO2, p(A-a) O2, A/a, platelets and serum glucose.Validation was performed in a matched prospective cohort, using 7-day mortality as an endpoint. Results. The initial cohort consisted of 424 newborn infants. Twenty-two cases and 132 controls were selected; and 9 outcome measures were identified, making up the scale named neonatal mortality score-9 Mexico. The validation cohort consisted of 227 newborn infants. Forty-four (19%) deaths were recorded, with an area under the curve (AUC) of 0.92. With a score between 16 and 18, an 85 (11-102) hazard ratio, 99% specificity, 71% positive predictive value and 90% negative predictive value were reported. Conclusions .The proposed scale is a reliable tool to predict severity in newborn infants.

Development and validation of the Neonatal Mortality Score-9 Mexico to predict mortality in critically ill neonates.

INTRODUCTION: Prognostic scales or scores are useful for physicians who work in neonatal intensive care units. There are several validated neonatal scores but they are mostly applicable to low birth weight infants. The aim of this study was to develop and validate a mortality prognostic score in newborn infants, that would include new prognostic outcome measures. POPULATION AND METHODS: The study was conducted in a mother and child hospital in the city of Mexico, part of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). In the first phase of the study, a nested case-control study was designed (newborn infants admitted on the basis of severity criteria during the first day of life), in which a scale was identified and developed with gradual parameters of cumulative score consisting of nine independent outcome measures to predict death, as follows: weight, metabolic acidemia, lactate, PaO2/FiO2, p(A-a) O2, A/a, platelets and serum glucose.Validation was performed in a matched prospective cohort, using 7-day mortality as an endpoint. RESULTS: The initial cohort consisted of 424 newborn infants. Twenty-two cases and 132 controls were selected; and 9 outcome measures were identified, making up the scale named neonatal mortality score-9 Mexico. The validation cohort consisted of 227 newborn infants. Forty-four (19%) deaths were recorded, with an area under the curve (AUC) of 0.92. With a score between 16 and 18, an 85 (11-102) hazard ratio, 99% specificity, 71% positive predictive value and 90% negative predictive value were reported. Conclusions .The proposed scale is a reliable tool to predict severity in newborn infants.

Prognostic value of metabolic syndrome for the development of cardiovascular disease in a cohort of premenopausal women with systemic lupus erythematosus / Estimación del valor pronóstico del síndrome metabólico para el desarrollo de enfermedad cardiovascular en una cohorte de mujeres premenopaúsicas con lupus eritematoso sistémico

Background and objective: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease of unknown etiology. In lupus patients there is an increased cardiovascular risk due to an accelerated atherogenesis. Furthermore, Metabolic Syndrome (MS) adds an independent risk for developing Cardiovascular Disease (CVD) in the population. Therefore, it is important to determine whether lupus patients have an increased risk of developing Cardiovascular Disease in the presence of MS. To estimate the prognostic value of MS in the incidence of cardiovascular events in a cohort of premenopausal patients with SLE. Methodology: Cohort study in 238 patients was carried out. Clinical, biochemical, dietetic and anthropometric evaluations were performed. Patients were classified according to the prevalence of MS in 2001. There was a patient follow-up from 2001 to 2008. In 2008, after studying the records, we obtained the “cases” (patients with CVD) and the “no cases” (patients without CVD). Results: The basal prevalence of MS in the cohort was of 21.8% (ATPIII). The MS component with the highest prevalence in the population studied in 2001 was low HDL-Cholesterol (<50 mg/dL) with a prevalence of 55.0%. The cumulative incidence of CVD in the group with MS was 17.3% and in the group without MS it was 7.0% with a Relative Risk (RR) of 2.48 (1.12–5.46) and p < 0.05. In the multivariable analysis it was noted that MS is a predictive factor of CVD. Conclusions: We observed the prognostic value of MS for an increased risk of cardiovascular damage in premenopausal patients with lupus (AU)

Fundamento y objetivo: El Lupus eritematoso sistémico (LES) es una enfermedad crónica, autoinmune, de etiología desconocida que afecta principalmente a mujeres en edad reproductiva. En pacientes con lupus existe un elevado riesgo cardiovascular debido a un proceso aterogénico acelerado. Aunado a esto, el síndrome metabólico (SM) representa un riesgo independiente para el desarrollo de enfermedad cardiovascular (ECV) en población general. Estimar el valor pronóstico del síndrome metabólico en la incidencia de eventos cardiovasculares en una cohorte de pacientes premenopáusicas con LEG. Metodología: Estudio de cohorte en 238 pacientes. Se realizaron evaluaciones clínicas, bioquímicas, dietéticas y antropométricas. Se clasificó a las pacientes con respecto a la presencia de síndrome metabólico en 2001. A partir del 2001 se inició seguimiento de las pacientes hasta el 2008 cuando a partir de la revisión de los expedientes se obtuvo a los “casos” (pacientes con enfermedad cardiovascular) y los “no casos” (pacientes sin enfermedad cardiovascular). Resultados: La prevalencia basal de síndrome metabólico en la cohorte fue 21.8% (ATPIII). El componente del SM con mayor prevalencia en la población estudiada en el 2001 fue el colesterol-HDL bajo (<50 mg/dL) con una prevalencia de 55.0%. La incidencia acumulada de ECV en el grupo con síndrome metabólico (SM) fue de 17.3% y en el grupo sin SM fue de 7.0% con un riesgo relativo (RR) de 2.48 (1.12-5.46) y una p < 0.05. En el análisis multivariado se observó que el SM es un factor predictivo de enfermedad cardiovascular. Conclusiones: El SM es un factor riesgo de daño cardiovascular en pacientes premenopáusicas con lupus (AU)

Prognostic value of metabolic syndrome for the development of cardiovascular disease in a cohort of premenopausal women with systemic lupus erythematosus.

BACKGROUND AND OBJECTIVE: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease of unknown etiology. In lupus patients there is an increased cardiovascular risk due to an accelerated atherogenesis. Furthermore, Metabolic Syndrome (MS) adds an independent risk for developing Cardiovascular Disease (CVD) in the population. Therefore, it is important to determine whether lupus patients have an increased risk of developing Cardiovascular Disease in the presence of MS. To estimate the prognostic value of MS in the incidence of cardiovascular events in a cohort of premenopausal patients with SLE. METHODOLOGY: Cohort study in 238 patients was carried out. Clinical, biochemical, dietetic and anthropometric evaluations were performed. Patients were classified according to the prevalence of MS in 2001. There was a patient follow-up from 2001 to 2008. In 2008, after studying the records, we obtained the "cases" (patients with CVD) and the "no cases" (patients without CVD). RESULTS: The basal prevalence of MS in the cohort was of 21.8% (ATPIII). The MS component with the highest prevalence in the population studied in 2001 was low HDL-Cholesterol (<50mg/dL) with a prevalence of 55.0%. The cumulative incidence of CVD in the group with MS was 17.3% and in the group without MS it was 7.0% with a Relative Risk (RR) of 2.48 (1.12-5.46) and p<0.05. In the multivariable analysis it was noted that MS is a predictive factor of CVD. CONCLUSIONS: We observed the prognostic value of MS for an increased risk of cardiovascular damage in premenopausal patients with lupus.

Consideraciones éticas del diagnóstico prenatal de la enfermedad de Huntington / Ethical considerations in the prenatal diagnosis of Huntington's disease

La enfermedad de Huntington (EH) es una condición neurodegenerativa de origen genético por la expansión de repetidos de trinucleótidos que codifican tractos de poliglutamina. Tiene un modelo de herencia autosómico dominante, de inicio en la vida adulta, que suele presentarse entre los 37 y 55 años, con una esperanza de vida de 15 años después de iniciados los síntomas. Se encuentra asociada a la generación de movimientos involuntarios, desarrollo de alteraciones psiquiátricas y deterioro cognitivo. El diagnóstico es clínico y molecular, una vez iniciados los síntomas. Existen dos maneras de realizar una detección temprana en aquellas parejas con sospecha o con diagnóstico confirmatorio de alguno de sus miembros: mediante el abordaje prenatal y preimplantación. La postura actual sobre la realización del diagnóstico antenatal sólo se realiza en aquellas parejas que desean interrumpir el embarazo. En el presente ensayo, se analiza esta postura mediante el principialismo médico, concluyendo lo siguiente: en cuestión de autonomía, no se respeta la integridad del ser humano portador de la enfermedad. No es justo realizar una prueba para determinar la conducta de interrumpir el embarazo cuando existen otras enfermedades con pronósticos similares que no cuentan con la misma oportunidad de diagnóstico. Se viola la beneficencia y la no maleficencia al promover la muerte. Sugerimos que la participación del médico debe impulsar la mejor situación para ofrecer la noticia de la confirmación diagnóstica, preparando a la familia y al paciente en los aspectos emocional, físico y nutricional para el momento en que se inicien los síntomas.

Huntington disease is a neurodegenerative disorder caused by expanded trinucleotides which encode polyglutamine tracts. The disease is inherited as an autosomal dominant trait with onset in adult life, normally between 37 to 55 years. Once the symptoms have started, life expectancy will be 15 years. The diagnosis is clinical and molecular after the establishment of the symptomatology. It is characterized by involuntary movements, psychiatric illness and cognitive impairment. There are two ways to approach the antenatal diagnosis in couples with familial background: prenatal and preimplantation. The current posture related to antenatal diagnosis is only for couples that desire termination of the pregnancy. This essay discusses this situation through medical principlism, and arrives to the following conclusions: regarding the principles of autonomy and integrity of the human being, the carrier of the disease is not respected. It does not seem fair to perform a test to determine the behavior of ending a life during pregnancy, while there are other diseases with similar prognosis that do not have the same diagnostic possibilities. This violates the principles of beneficence and non-maleficence, promoting death. We suggest that medical participation must promote the best conditions to confirm the diagnosis, and prepare both family and patient concerning the emotional, physical and nutritional aspects for the moment of the onset of the symptomatology.

[Hyperglycemia as a risk factor for mortality in critically ill neonates]. / La hiperglucemia como factor predictor de mortalidad en neonatos críticamente enfermos.

BACKGROUND: The sick neonate is susceptible to uncontrolled hyperglycemia by several factors. Our objective was to determine the mortality-predictive role of hyperglycemia in critically ill neonates. METHODS: A cohort study was conducted in neonates admitted during the first hour of life in the intensive care unit. Prenatal and perinatal variables were recorded including ventilatory management, comorbidities, arterial blood gas, blood chemistry and blood count. Serum glucose greater than or equal to 126 mg/dL and greater than or equal to 180 mg/dL was considered consistent with hyperglycemia in neonates born at term and preterm infants, respectively. The children were followed until discharge from the unit. Measures of central tendency and dispersion for quantitative variables and frequencies for qualitative variables were obtained, as well as Kaplan-Meier curves. Association test using the chi-square test for exposed and non-exposed groups and Cox regression analysis was performed and risk calculation was made using the hazard ratio. RESULTS: Out of 146 patients, 16 died (10.7 %). Most common causes were respiratory distress syndrome, perinatal asphyxia, meconium aspiration and sepsis. Association was found between hyperglycemia and chest compression, metabolic acidemia, hyperlactatemia, mechanical ventilatory support, intraventricular hemorrhage and death. CONCLUSIONS: Hyperglycemia was an independent risk factor for the prediction of death, with a likelihood of death of 56.8 % when it was present.

INTRODUCCIÓN: el neonato enfermo es susceptible al descontrol de la glucosa por varios factores. Nuestro objetivo fue determinar el papel predictor de mortalidad de la hiperglucemia en neonatos críticamente enfermos. MÉTODOS: se realizó un estudio de cohorte en neonatos que durante la primera hora de vida ingresaron a cuidados intensivos. Se registraron variables prenatales, perinatales, manejo ventilatorio, comorbilidades, gasometría arterial, química sanguínea y biometría hemática. Se consideró que la glucosa sérica mayor o igual a 126 y mayor o igual a 180 mg/dL indicaba hiperglucemia en los neonatos a término y en los pretérmino, respectivamente. Se realizó seguimiento hasta el egreso de la unidad. Se obtuvieron medidas de dispersión y de tendencia central para las variables cuantitativas y frecuencias para las cualitativas, así como curvas de Kaplan-Meier. Se realizó prueba de asociación por chi cuadrada para los grupos expuestos y no expuestos, análisis de regresión de Cox y cálculo de riesgo por hazard ratio. RESULTADOS: de 146 pacientes, fallecieron 16 (10.7 %). Las principales causas fueron síndrome de dificultad respiratoria, asfixia perinatal, aspiración de meconio y sepsis. Se encontró asociación entre hiperglucemia y compresión torácica, acidemia metabólica, hiperlactatemia, asistencia mecánica ventilatoria, hemorragia intraventricular y muerte. CONCLUSIONES: la hiperglucemia fue un factor de riesgo independiente para predecir muerte, con probabilidad de muerte de 56.8 % cuando se encontró presente.

Early changes in the components of the metabolic syndrome in a group of smokers after tobacco cessation.

AIM: We aimed to examine the prevalence of early changes in some components of metabolic syndrome after smoking cessation. METHODS: Forty-eight heavy smokers from the Tobacco Cessation Clinic (24 women/24 men), average age of 49.4 years, were included in this study. They smoked a mean of 19.92 cigarettes per day and had smoked 33.23 packages per year during 33.4 years. Participants were included in a treatment group based on cognitive behavior therapy (CBT); 16 participants received varenicline and the other 16 nicotine replacement therapy (NRT). The target quit day was scheduled for week 3 through abrupt cessation. Abstinence was confirmed with exhaled carbon monoxide (CO) levels. Blood pressure, body mass index (BMI), and waist circumference (WC) were evaluated weekly. Glucose, triglycerides, high density lipoproteins (HDL-C), and insulin to determine the homeostasis model assessment (HOMA) index were determined in blood samples at weeks 1, 4, and 10. As a control group 96 healthy nonsmokers were matched by age and sex. RESULTS: The mean BMI in smokers was 26.94 kg/m(2) and in nonsmokers 26.23 kg/m(2). Smokers showed hypertension, hypertriglyceridemia, and lower levels of HDL-C than nonsmokers. Percentages of cessation in week 3 were 81% for NRT and 93% for CBT and varenicline. The mean weight increase at the end of the treatment was 1.09 kg in the CBT group, 1.06 kg in the NRT group, and 1.17 kg in the varenicline group. The prevalence of metabolic syndrome was 31.25% in week 1 and 29.16% at the end. There were reductions in the number of subjects with hypertension, glucose alterations, hypertriglyceridemia, and low HDL levels. CONCLUSIONS: Benefits of quitting smoking exceeded by far the risks associated with the amount of weight gained.

[What you should know of the arterial blood gases during the watch]. / Lo que debe conocerse de la gasometría durante la guardia.

Gasometry is the measurement of dissolved gases in the blood, by measuring pH, carbon dioxide pressure (pCO(2)), serum bicarbonate (HCO(3-)), and lactate and serum electrolytes: sodium, potassium and chlorine you can make a diagnosis, etiology and treatment in the critically ill patient. The aim is to provide five steps for the interpretation of blood gases by: 1. The definition of acidemia or acidosis, or alkalemia or alkalosis. 2. Defining the metabolic component or respiratory. 3. To determine the anion gap; levels above 15 ± 2 determine other likely causes of excess anions (methanol, uremia, diabetic ketoacidosis, paraldehyde, ionized, lactic acidosis, ethylene glycol and salicylates. 4. Compensation, using the Winter formula. 5. The delta gap, with the formula for determining intrinsic and metabolic alkalosis. When anion gap is normal, is calculated urinary anion gap; the value is negative if the loss is extrarenal, contrary to the positive result is renal etiology.