Health status and gerontological evaluation in Mexican older adults in the face of the COVID-19 pandemic.

INTRODUCTION: Older adults constitute the most vulnerable population group to the COVID-19 pandemic. In Mexico, their biopsychosocial conditions might intensify their vulnerability. METHOD: Affiliation to health systems, health conditions and gerontological evaluation of 3,218 older adults were analyzed following the methodology of the PAHO-Mexico Health, Well-being and Aging Survey. RESULTS: 88.6 % of older adults referred being affiliated to health systems; 30.2 %, 52.4 %, 10.3 %, 4.1 % and 5.6 % referred suffering from diabetes mellitus, high blood pressure, chronic obstructive pulmonary disease, heart disease and cerebrovascular disease, respectively; 15.6 % reported urinary incontinence, and 11.3%, fecal incontinence; 12.1 % of the women referred having suffered from breast cancer at some point, and 6.3 %, cervical cancer. The habit of smoking tobacco was observed in 11.1 %, risk of malnutrition in 32.8 %, established malnutrition in 4.1 %, functional dependence for basic and instrumental activities of daily life in 16.3 % and 17.6 %, respectively. CONCLUSION: Comprehensive gerontological evaluation is essential for efficient care of older adults who suffer from COVID-19, and for adequate care of the effects or health conditions at the conclusion of the confinement imposed by the pandemic.

INTRODUCCIÓN: Los adultos mayores constituyen el grupo más vulnerable ante la pandemia por COVID-19; en México, sus condiciones biopsicosociales podrían potenciar su vulnerabilidad. MÉTODO: Se analizó afiliación a sistemas de salud, condiciones de salud y evaluación gerontológica de 3218 adultos mayores conforme a la metodología de la Encuesta Salud, Bienestar y Envejecimiento OPS-México. RESULTADOS: 88.6 % de los adultos mayores refirió afiliación a un sistema de salud; 30.2, 52.4, 10.3, 4.1 y 5.6 % indicaron padecer diabetes mellitus, hipertensión arterial, enfermedad pulmonar obstructiva crónica, enfermedad cardiaca y evento vascular cerebral, respectivamente; 15.6 % reportó incontinencia urinaria y 11.3 %, fecal; 12.1 % de las mujeres indicó haber padecido en algún momento cáncer de mama y 6.3 %, cáncer cervicouterino. Se observó hábito de fumar tabaco en 11.1 %, riesgo de malnutrición en 32.8 %, malnutrición establecida en 4.1 %, dependencia funcional para las actividades básicas en 16.3 % e instrumentales de la vida diaria en 17.6 %. CONCLUSIÓN: La evaluación gerontológica integral es fundamental para la atención eficiente de los adultos mayores que padecen COVID-19 y para la adecuada atención por los efectos o condiciones de salud al terminar el confinamiento por la pandemia.

Frecuencia de sintomatología depresiva y tratamiento en adultos mayores con acceso a servicios de salud / Frequency of depressive symptoms and treatment in older adults with access to health services / Frequência de sintomas depressivos e tratamento em idosos com acesso a serviços de saúde / Fréquence de la symptomatologie dépressive et de son traitement chez les personnes âgées ayant accès aux services de santé

Resumen Objetivo: Determinar la frecuencia de sintomatología depresiva y su tratamiento en personas adultas mayores, afiliadas a las instituciones de seguridad social de salud en México. Material y métodos: Estudio descriptivo transversal con 3,114 participantes de 7 estados del país, los cuales fueron evaluados psicológicamente, empleando la Escala de Depresión Geriátrica (GDS) de Yesavage, también se analizó su afiliación a seguridad social, funcionalidad (índices Barthel y Lawton) y estado cognoscitivo (Minimental de Folstein). El análisis de la información se realizó empleando el paquete estadístico SPSS (Statistical Package for the Social Sciences), así como los datos sociodemográficos de los participantes. Resultados: Se observó cobertura en el 88.5% de la población. La prevalencia de depresión es del 27.4% y el 96.8% de ellos no recibe tratamiento, además el 18.9% presenta dependencia funcional, el 16.2% deterioro cognoscitivo y el 7.4% ha sufrido al menos una caída con lesiones. Únicamente el 11.2% del total de enfermos fue diagnosticado en su clínica. Conclusión: La prevalencia de depresión no tratada en adultos mayores con acceso a servicios de salud es altamente significativa, es urgente la generación de protocolos, programas y capacitación de profesionales de salud que permitan identificar la patología y atender de manera integral a dicho grupo etario.

Abstract Objective: to determine the frequency of depressive symptoms and their treatment in older adults affiliated to the social health security institutions in Mexico. Material and methods: a descriptive cross-sectional study with 3,114 participants from 7 states of the country who were psychologically evaluated using the Geriatric Depression Scale (GDS) by Yesavage, also analyzed their affiliation to social security, functionality (Barthel and Lawton index) and cognitive status (Minimental State Examination of Folstein). The analysis of the information was carried out using the statistical package SPSS (Statistical Package for the Social Sciences) as well as the sociodemographic data of the participants. Results: Coverage was observed in 88.5% of the population. Prevalence of depression was 27.4% and 96.8% of them did not receive treatment. In addition 18.9% had functional dependence, 16.2% had cognitive impairment and 7.4% had suffered at least one fall with injuries. Only 11.2% of all participants were diagnosed in their clinic. Conclusion: The prevalence of untreated depression in older adults with access to health services is highly significant. It is urgent the generation of protocols, programs and training of health professionals that allow to identify the pathology and provide comprehensive care for that age group.

Sumário Objetivo: determinar a frequência dos sintomas depressivos e seu tratamento em idosos afiliados às instituições de saúde previdenciária do México. Material e métodos: estudo descritivo transversal com 3.114 participantes de 7 estados do país, avaliados psicologicamente pela Escala de Depressão Geriátrica Yesavage {GDS}, analisando também sua afiliação à seguridade social, funcionalidade (índices de Barthel e Lawton) e estado cognitivo. (Minimental de Folstein). A análise das informações foi realizada no programa estatístico SPSS (Statistical Package for the Social Sciences), além dos dados sociodemográficos dos participantes. Resultados: A cobertura foi observada em 88,5% da população. A prevalência de depressão é de 27,4% e 96,8% deles não recebem tratamento; além disso, 18,9% possuem dependência funcional, 16,2% comprometimento cognitivo e 7,4% sofreram pelo menos uma queda com lesões. Apenas 11,2% de todos os pacientes foram diagnosticados em sua clínica. Conclusão: A prevalência de depressão não tratada em idosos com acesso a serviços de saúde é altamente significativa, é urgente a geração de protocolos, programas e treinamento de profissionais de saúde para identificar a patologia e prestar assistência integral a essa faixa etária.

Résumé Objectif: Déterminer la fréquence de la symptomatologie dépressive et de son traitement chez les personnes âgées affiliées aux institutions de santé de la sécurité sociale au Mexique. Matériel et méthodes: Étude descriptive transversale avec 3 114 participants de 7 états du pays, évalués psychologiquement avec l'échelle de dépression gériatrique de Yesavage (GDS). Leur affiliation à la sécurité sociale, leur fonctionnalité (indices de Barthel et Lawton) et leur état cognitif (Folstein Minimal) ont également été évalués. L'analyse de ces informations, ainsi que des données sociodémographiques des participants, a été réalisée à l'aide du logiciel statistique SPSS (Statistical Package for the Social Sciences). Résultats: La couverture sociale a été observée chez 88,5 % de la population. La prévalence de la dépression est de 27,4% et 96,8% d'entre eux ne reçoivent pas de traitement. De plus, 18,9% présentent une dépendance fonctionnelle, 16,2% une déficience cognitive et 7,4% ont fait au moins une chute avec blessures. Seulement 11,2 % du nombre total des participants ayant une dépression ont été diagnostiqués dans leur clinique. Conclusion: La prévalence de la dépression non traitée chez les personnes âgées ayant accès aux services de santé est très importante. Il est urgent de générer des protocoles, des programmes et des formations pour les professionnels de santé qui permettent d'identifier la pathologie et de fournir une attention globale pour cette tranche d'âge.

Estado de salud y valoración gerontológica en adultos mayores mexicanos ante la pandemia por COVID-19 / Health status and gerontological evaluation in Mexican older adults in the face of the COVID-19 pandemic

Resumen Introducción: Los adultos mayores constituyen el grupo más vulnerable ante la pandemia por COVID-19; en México, sus condiciones biopsicosociales podrían potenciar su vulnerabilidad. Método: Se analizó afiliación a sistemas de salud, condiciones de salud y evaluación gerontológica de 3218 adultos mayores conforme a la metodología de la Encuesta Salud, Bienestar y Envejecimiento OPS-México. Resultados: 88.6 % de los adultos mayores refirió afiliación a un sistema de salud; 30.2, 52.4, 10.3, 4.1 y 5.6 % indicaron padecer diabetes mellitus, hipertensión arterial, enfermedad pulmonar obstructiva crónica, enfermedad cardiaca y evento vascular cerebral, respectivamente; 15.6 % reportó incontinencia urinaria y 11.3 %, fecal; 12.1 % de las mujeres indicó haber padecido en algún momento cáncer de mama y 6.3 %, cáncer cervicouterino. Se observó hábito de fumar tabaco en 11.1 %, riesgo de malnutrición en 32.8 %, malnutrición establecida en 4.1 %, dependencia funcional para las actividades básicas en 16.3 % e instrumentales de la vida diaria en 17.6 %. Conclusión: La evaluación gerontológica integral es fundamental para la atención eficiente de los adultos mayores que padecen COVID-19 y para la adecuada atención por los efectos o condiciones de salud al terminar el confinamiento por la pandemia.

Abstract Introduction: Older adults constitute the most vulnerable population group to the COVID-19 pandemic. In Mexico, their biopsychosocial conditions might intensify their vulnerability. Method: Affiliation to health systems, health conditions and gerontological evaluation of 3,218 older adults were analyzed following the methodology of the PAHO-Mexico Health, Well-being and Aging Survey. Results: 88.6 % of older adults referred being affiliated to health systems; 30.2 %, 52.4 %, 10.3 %, 4.1 % and 5.6 % referred suffering from diabetes mellitus, high blood pressure, chronic obstructive pulmonary disease, heart disease and cerebrovascular disease, respectively; 15.6 % reported urinary incontinence, and 11.3%, fecal incontinence; 12.1 % of the women referred having suffered from breast cancer at some point, and 6.3 %, cervical cancer. The habit of smoking tobacco was observed in 11.1 %, risk of malnutrition in 32.8 %, established malnutrition in 4.1 %, and functional dependence for basic and instrumental activities of daily life in 16.3 % and 17.6 %, respectively. Conclusion: Comprehensive gerontological evaluation is essential for efficient care of older adults who suffer from COVID-19, and for adequate care of the effects or health conditions at the conclusion of the confinement imposed by the pandemic.

Retiro de la ventilación mecánica / Weaning from mechanical ventilation / Retirada da ventilação mecânica

Resumen: La mayoría de los pacientes que requieren ventilación > 24 horas y mejoran pueden ser extubados tras la primera prueba de ventilación espontánea. El reto es mejorar la desconexión de los pacientes que fracasan. El retiro de la ventilación mecánica es un elemento esencial en el cuidado de los pacientes críticamente enfermos. Se revisa el proceso de liberar al paciente del soporte mecánico y de la cánula endotraqueal. El tiempo empleado en el proceso de destete representa de 40 a 50% de la duración total de la ventilación. Se recomienda: 1) Prever tres grupos en función de la dificultad y duración del destete, 2) Retiro lo más pronto posible, 3) Utilizar la prueba de ventilación espontánea para determinar si los pacientes pueden ser extubados con éxito, 4) La prueba inicial debe durar 30 minutos en respiración en tubo en T o con bajos niveles de soporte, 5) La presión de soporte y los modos de ventilación AC deben preferirse cuando han fracasado en la primera prueba, 6) Considerar ventilación no invasiva en pacientes seleccionados para acortar la duración de la intubación, pero no debe usarse de forma rutinaria como herramienta para el fracaso de la extubación.

Abstract: The majority of patients requiring ventilation> 24 hours and improving can be extubated after the first spontaneous ventilation test. The challenge is to improve the disconnection of patients who fail. The withdrawal of mechanical ventilation is an essential element in the care of critically ill patients. The process of releasing the patient from the mechanical support and the endotracheal cannula is reviewed. The time spent in the weaning process represents 40 to 50% of the total duration of ventilation. It is recommended: 1) Predict three groups depending on the difficulty and duration of weaning, 2) Removal as soon as possible, 3) Using the spontaneous ventilation test to determine if patients can be successfully extubated, 4) The initial test Should last 30 minutes in T-tube breathing or with low levels of support, 5) Support pressure and modes of AC ventilation should be preferred when they failed in the first test, 6) Consider non-invasive ventilation in selected patients to shorten The duration of intubation, but should not be routinely used as a tool for the failure of extubation.

Resumo: A maioria dos pacientes que necessitam de ventilação > 24 horas e melhoram podem ser extubados depois do primeiro teste de ventilação espontânea. O desafio é melhorar a desconexão dos pacientes que fracassam. A retirada da ventilação mecânica é um elemento essencial no tratamento dos pacientes em estado crítico. Revisamos o processo de retirada do paciente do suporte mecânico e do tubo endotraqueal. O tempo gasto no processo do desmame representa 40 a 50% da duração total da ventilação. Recomenda-se: 1) Prever três grupos, dependendo da dificuldade e duração do desmame, 2) remoção o mais rápido possível, 3) Utilização do teste de ventilação espontânea para determinar se os pacientes podem ser extubadas com êxito, 4) O teste inicial deve durar 30 minutos com respiração em tubo T ou com baixos níveis de suporte, 5) A pressão de suporte e os modos de ventilação AC deve ser eleitos quando existe uma falha no primeiro teste, 6) Considerar a ventilação não invasiva em pacientes selecionados para diminuir a duração da intubação, mas não deve ser usado rotineiramente como uma ferramenta para falha na extubação.

Condiciones biopsicosociales de adultos mayores mexicanos con diabetes mellitus.

OBJECTIVE AND METHODS: Diabetes mellitus (DM) is a global health problem, which significantly affects older adults. . The prevalence and biopsychosocial conditions of DM in older adults in the State of Hidalgo, Mexico, are analyzed using the Health and Aging Survey 2014 (SABE-Hidalgo, Mexico). RESULTS: DM in older adults presents a prevalence of 28.22% in the State, predominating in women and becoming more common with increasing age. The highest frequency occurs in residents of urban areas (57.2%), those with less schooling (79.6%), and those who live with relatives (77%). In addition, 54.7% of older adults with DM had cognitive impairment, 67.9% had arterial hypertension and 45.28% presented joint disease. 41.2% suffered falls, 68.52% visual problems and 87.3% tooth loss. Finally, 85.8% receive care but only 29.2% perceive improvement in their health. CONCLUSIONS: It is fundamental to develop integral programs and policies to care for older adults with DM.

Comparison of Enterococcus faecium and Enterococcus faecalis Strains isolated from water and clinical samples: antimicrobial susceptibility and genetic relationships.

Enterococci are part of the normal intestinal flora in a large number of mammals, and these microbes are currently used as indicators of fecal contamination in water and food for human consumption. These organisms are considered one of the primary causes of nosocomial and environmental infections due to their ability to survive in the environment and to their intrinsic resistance to antimicrobials. The aims of this study were to determine the biochemical patterns and antimicrobial susceptibilities of Enterococcus faecalis and E. faecium isolates from clinical samples and from water (groundwater, water from the Xochimilco wetland, and treated water from the Mexico City Metropolitan Area) and to determine the genetic relationships among these isolates. A total of 121 enterococcus strains were studied; 31 and 90 strains were isolated from clinical samples and water (groundwater, water from the Xochimilco wetland, and water for agricultural irrigation), respectively. Identification to the species level was performed using a multiplex PCR assay, and antimicrobial profiles were obtained using a commercial kit. Twenty-eight strains were analyzed by pulsed-field gel electrophoresis (PFGE). E. faecium strains isolated from water showed an atypical biochemical pattern. The clinical isolates showed higher resistance to antibiotics than those from water. Both the enterococci isolated from humans, and those isolated from water showed high genetic diversity according to the PFGE analysis, although some strains seemed to be closely related. In conclusion, enterococci isolated from humans and water are genetically different. However, water represents a potential route of transmission to the community and a source of antimicrobial resistance genes that may be readily transmitted to other, different bacterial species.

Polypyrimidine tract-binding protein is relocated to the cytoplasm and is required during dengue virus infection in Vero cells.

The 3' untranslated region (3'UTR) of the dengue virus (DENV) genome contain several sequences required for translation, replication and cyclization processes. This region also binds cellular proteins such as La, polypyrimidine tract-binding protein (PTB), Y box-binding protein 1, poly(A)-binding protein and the translation initiation factor eEF-1 alpha. PTB is a cellular protein that interacts with the regulatory sequences of positive-strand RNA viruses such as several picornaviruses and hepatitis C virus. In the present report, it was demonstrated that PTB translocates from the nucleus to the cytoplasm during DENV infection. At 48 h post-infection, PTB, as well as the DENV proteins NS1 and NS3, were found to co-localize with the endoplasmic reticulum marker calnexin. Silencing of PTB expression inhibited virus translation and replication, whilst overexpression of PTB augmented these processes. Thus, these results provide evidence that, during infection, PTB moves from the nucleus to the cytoplasm and plays an important role in the DENV replicative cycle.

[Clinical competence of anesthesiology residents in patients requiring hospital care in the specialty hospital "Siglo XXI"]. / Competencia clínica de los residentes de anestesiología en pacientes que requieren atención médica en un hospital de especialidades.

INTRODUCTION: The study of clinical competence is essential because it summarizes the attributes that characterize a specialist capable of providing quality health care OBJECTIVE: Investigate the development of clinical competence among anesthesiology residents that care for patients in a tertiary level facility. MATERIAL AND METHODS: In February 2007 we conducted a cross-sectional study among 42 anesthesiology residents, 21 were in second and 21 in third year. In order to measure the degree of development of clinical competence we created an instrument with four case studies that summarized patients undergoing surgical anesthetic procedure. The instrument included 200 items that explored eight indicators and covered a range of time periods: pre-trans and post anesthesia. The instrument was validated by a group of experts with clinical, teaching and publication experience. We carried out a pilot test and estimated the instrument's internal reliability using the Kuder-Richardson test (KR-21). We obtained a coefficient of 0.95. We collected the study data and instrument rating technique using a blinded design. Statistical analysis was performed using nonparametric tests. RESULTS: In the overall ranking, third-year medical residents versus sophomores, achieved the highest scores, which resulted in statistically significant differences (p = 0.045). Regarding the degree of expertise we found that most participants had scores of "very low" and "low". In the study of ratings by indicator, we noted that when comparing second vs third year residents we only found statistically significant differences in default decisions that were also potentially iatropathogenic (p = 0.026). CONCLUSION: The clinical competence of anesthesiology residents who care for patients attending a tertiary level facility is low when compared with the maximum theoretical scores they should obtain.

Radicales de oxígeno / Oxygen radicals

Durante el metabolismo el O2 produce radicales que son moléculas sumamente reactivas que pueden actual como mediadores en la fisiopatología de la muerte celular. Su principal mecanismo de citotoxicidad es la generación de las reacciones en cadena (peroxidación lipídica) en las cuales cualquier célula o estructura celular puede ser blanco (membranas celulares, ácidos nucleoicos, proteínas estructurales, etc.). Ante una producción excesiva de radicales de O2 el organismo cuenta con mecanismos de defensa (SOD, catalasa, peroxidasa, Vitamina C y E, etc.), para prevenir del daño celular. Durante los procesos isquémicos (principalmente en el SNC), se demuestra la asociación de los radicales de O2 con los eventos fisiopatológicos secundarios que causan muerte celular, por lo que la manipulación adecuada del uso farmacológico de los barredores de radicales de O2 en un proceso isquémia-anoxina-reperfusión puede servir como un coadyuvante en la terapéutica que ayude a limitar la degeneración celular y a mejorar la recuperación funcional

Prevención del calosfrío postoperatorio en pacientes bajo bloqueo peridural / Prevention of post operative shivering in patients underwent epidural blockade

Se plantea el uso del colchón térmico, durante la cirugía en pacientes con bloqueo peridural, con el fin de evitar el calosfrío (shivering). Se estudiaron 40 pacientes, grupo I(n=20) control, a temperatura ambiente, grupo II (n=20) en estudio, colocados sobre un colchón térmico a 37 grados c. Durante los períodos pre, trans y postanestésico, se monitorizó la temperatura corporal, de la superficie de la piel de los miembros superiores e inferiores, de las salas de operación y el grado de calosfrío. En el período transanestésico, la temperatura corporal fue menor en el grupo I, con diferencia significa con respecto al grupo II (p<0.05). En los pacientes con calosfrío (Grupo I), se presentó un aumento significativo de la frecuencia respiratoria durante los periodos pre y transanestésico con respecto al grupo II (p<0.001). 95 por ciento de los pacientes del grupo I, presentaron calosfrío mientras que solamente 20 por ciento de los pacientes manejados con colchón término lo presentaron. La temperatura de la sala fue mayor en el grupo II, con una diferencia significativa (p<0.001) con respecto al grupo I. La evolución de los pacientes en el periodo postanestésico fue mejor en los pacientes manejados con colchón térmico, ya que ellos no presentaron las molestias que ocasiona el calosfrío. Se recomienda el uso del colchón térmico, para evitar el calosfrío, en pacientes sometidos a cirugía bajo bloqueo peridual.