[Correlation between Predictive Index of Difficult Intubation and Cormack]. / Correlación entre el Índice predictivo de intubación difícil y el Cormack.

Background: More than 600 people die each year in developed countries from complications at the time of orotracheal intubation. Studies have shown that all predictors used so far have low ability to predict difficult airway. When analyzing this ability, both clinical suspicion, indirect laryngoscopy and even the different individual examinations showed predictive values higher than 80%. Objective: To evaluate the concordance between the Predictive Index of Difficult Intubation (PIDI) and the Cormack regarding the diagnosis of difficult intubation in patients undergoing open and laparoscopic cholecystectomy under balanced general anesthesia. Material and methods: Observational, prospective, cross-sectional, analytical concordance study, carried out in patients aged 18 to 60 who underwent open and laparoscopic cholecystectomy. The sample was probabilistic, the statistical analysis applied univariate and bivariate, specifically the Kappa index. Results: A total of 96 patients were analyzed; 77 were female with a mean age of 40.4 years. Said sample presented a PIDI of easy intubation in 75%, discreet difficulty in 21.9% and frank difficulty in 3.1%. After conventional direct laryngoscopy, 75% presented Cormack I, 16.7% presented Cormack II, 8.3% presented Cormack III. The bivariate analysis with the Kappa index statistic showed a value of 0.242. Conclusions: It is accepted the alternative hypothesis demonstrating that there is a correlation between the PIDI and the Cormack concerning the diagnosis of difficult intubation in patients undergoing open and laparoscopic cholecystectomy under balanced general anesthesia.

Introducción: más de 600 personas mueren al año en los países desarrollados por complicaciones con la intubación orotraqueal. Estudios han demostrado que todos los predictores utilizados hasta el momento tienen baja capacidad para predecir la vía aérea difícil. Al analizar esta capacidad, tanto la sospecha clínica como la laringoscopía indirecta y los diferentes exámenes individuales mostraron valores predictivos superiores al 80%. Objetivo: evaluar la concordancia entre el Índice predictivo de intubación difícil (IPID) y el Cormack respecto al diagnóstico de intubación difícil en pacientes intervenidos de colecistectomía abierta y laparoscópica bajo anestesia general balanceada. Material y métodos: estudio observacional, prospectivo, transversal, analítico de concordancia, realizado en pacientes de 18 a 60 años intervenidos de colecistectomía abierta y laparoscópica. La muestra fue de tipo probabilístico, el análisis estadístico aplicado univariado y bivariado, específicamente el Índice de Kappa. Resultados: se analizaron 96 pacientes; 77 fueron del sexo femenino, con una media de 40.4 años de edad. Se presentó un IPID de intubación fácil en 75%, dificultad discreta en 21.9% y dificultad franca en 3.1%. Posterior a la laringoscopía directa convencional, 75% presentó Cormack I, 16.7% Cormack II y 8.3% Cormack III. El análisis bivariado con el Índice de Kappa evidenció un valor de 0.242. Conclusiones: se acepta la hipótesis alterna que demuestra que sí hay correlación entre el IPID y el Cormack respecto al diagnóstico de intubación difícil en pacientes intervenidos de colecistectomía abierta y laparoscópica bajo anestesia general balanceada.

Association of total and pancreatic serum amylase enzymatic activity with insulin resistance and the glucose and insulin responses to oral starch test in Mexican children.

BACKGROUND/OBJECTIVES: Little is known about the effect of serum amylase enzymatic activity on glucose metabolism. We investigated the association of serum amylase enzymatic activity with fasting plasma glucose, insulin resistance (IR), and the plasma glucose and insulin response to an oral starch test (OST) in Mexican children. METHODS: Anthropometric data, glucose and insulin levels, and the serum enzymatic activity of total (AMYt), salivary (AMY1), and pancreatic (AMY2) amylase were analysed in 764 children (Nnormal weight  = 427/Nobesity  = 337). After categorization into low (LA) and high (HA) AMYt, an OST with commercial white bread was performed in 39 children (Nnormal weight  = 17/Nobesity  = 22). RESULTS: A positive association between serum enzymatic activity of AMY2 and IR was observed in children with obesity (p = 0.018). Children with normal weight had lower plasma glucose and insulin response to OST than children with obesity (Pglucose  = 4.1 × 10-12 ; Pinsulin  = 2.1 × 10-15 ). Compared with the LA group, children with HA showed lower plasma glucose and insulin response to OST (Pglucose ≤ 0.040; Pinsulin ≤ 0.015). CONCLUSION: Our results suggest that AMY2 is positively associated with IR. A high level of AMYt is related to lower glucose and insulin responses to OST in Mexican children, regardless of their weight status.

The MC4R p.Ile269Asn mutation confers a high risk for type 2 diabetes in the Mexican population via obesity dependent and independent effects.

We investigated the association between the loss-of-function mutation MC4R p.Ile269Asn and T2D risk in the Mexican population. We enrolled 6929 adults [3175 T2D cases and 3754 normal glucose tolerant (NGT) controls] and 994 NGT children in the study. Anthropometric data and T2D-related quantitative traits were studied in 994 NGT children and 3754 NGT adults. The MC4R p.Ile269Asn mutation was genotyped using TaqMan. The MC4R p.Ile269Asn mutation was associated with T2D [OR = 2.00, 95% confidence interval (CI) 1.35-2.97, p = 0.00057] in Mexican adults. Additional adjustment for body-mass index (BMI) attenuated but did not remove the association (OR = 1.70, 95% CI 1.13-2.56, p = 0.011). The MC4R p.Ile269Asn mutation was associated with T2D (OR = 1.88, 95% CI 1.14-3.08, p = 0.013) in a subset of 1269 T2D cases and 1269 NGT controls matched for sex, age, and BMI. A mediation analysis estimated that BMI accounts for 22.7% of the association between MC4R p.Ile269Asn mutation and T2D risk (p = 4.55 × 10-6). An association was observed between the MC4R p.Ile269Asn mutation and BMI in NGT children and adults (children: beta = 3.731 ± 0.958, p = 0.0001; adults: beta = 2.269 ± 0.536, p = 2.3 × 10-5). In contrast, the mutation was not associated with T2D-related quantitative traits. We demonstrate that the MC4R p.Ile269Asn mutation predisposes to T2D via obesity-dependent and independent effects in the Mexican population.

Causal Association of Haptoglobin With Obesity in Mexican Children: A Mendelian Randomization Study.

CONTEXT: Little is known about the association between haptoglobin level and cardiometabolic traits. A previous genome-wide association study identified rs2000999 in the HP gene as the stronger genetic contributor to serum haptoglobin level in European populations. OBJECTIVE AND DESIGN: We investigated the association of HP rs2000999 with serum haptoglobin and childhood and adult obesity in up to 540/697 and 592/691 Mexican cases and controls, respectively. Anthropometric and biochemical data were collected. Serum haptoglobin was measured by an immunoturbidimetry assay. HP rs2000999 was genotyped using the TaqMan technology. Mendelian randomization analysis was performed using the Wald and inverse variance weighting methods. RESULTS: Haptoglobin level was positively associated with childhood and adult obesity. HP rs2000999 G allele was positively associated with haptoglobin level in children and adults. HP rs2000999 G allele was positively associated with childhood but not adult obesity. The association between HP rs2000999 and childhood obesity was removed after adjusting for haptoglobin level. In a Mendelian randomization analysis, haptoglobin level genetically predicted by HP rs2000999 showed a significant causal effect on childhood obesity by the Wald and inverse variance weighting methods. CONCLUSION: Our data provide evidence for the first time for a causal positive association between serum haptoglobin level and childhood obesity in the Mexican population. Our study contributes to the genetic elucidation of childhood obesity and proposes haptoglobin as an important biomarker and treatment target for obesity.