Oral administration of resveratrol reduces oxidative stress generated in the hippocampus of Wistar rats in response to consumption of ethanol

Introduction

Chronic ethanol intake has been found to favor hippocampal deterioration and alter neuronal morphological maturation; resveratrol has been suggested as an antioxidant that may counteract these effects. The objective of this study was to analyze the effect of resveratrol on oxidative stress markers, endogenous antioxidant system in the hippocampus, and the behavior of male Wistar rats administered different concentrations of ethanol.

Methods

The animals, at 3 months old, were randomly distributed into 11 study groups (n = 6/group), orally administered (5 days on, 2 days off) with water (control), ethanol (10, 20, 30, 40 or 50%), or ethanol (10, 20, 30, 40 or 50%) plus resveratrol (10 mg/Kg/day) for 2 months. Subsequently, the production of nitrites, malondialdehyde, and 4-hydroxy-alkenal (HNE) and the enzymatic activity of catalase and superoxide dismutase (SOD) were quantified.

Results

The levels of nitric oxide and lipid peroxidation products were significantly increased in each ethanol concentration and were statistically different compared to the control group; however, resveratrol significantly reduced oxidative stress caused by high ethanol concentration. The SOD and CAT did not present significant changes with respect to the controls in any of the study groups. In the different concentrations of ethanol used, GR increases significantly in the groups administered with resveratrol but not GPx. Resveratrol was shown to maintain the results similar to the control at most ethanol concentrations.

Discussion

Our results suggest that resveratrol prevents oxidative stress induced by ethanol in the hippocampus by decreasing cellular lipid peroxidation, but does not prevent the activation of catalase or SOD enzymes; however, allows glutathione to be kept active and in adequate concentrations in its reduced form and avoids alterations in the locomotor system.

Regional moderate hyperthermia for mild-to-moderate COVID-19 (TherMoCoV study): a randomized controlled trial

Background

To prevent COVID-19 progression, low-cost alternatives that are available to all patients are needed. Diverse forms of thermotherapy have been proposed to prevent progression to severe/critical COVID-19.

Objective

The aim of this study is to evaluate the efficacy and safety of local thermotherapy to prevent disease progression in hospitalized adult patients with mild-to-moderate COVID-19.

Methods

A multicenter, open-label, parallel-group, randomized, adaptive trial is used to evaluate the efficacy and safety of local thermotherapy to prevent disease progression in hospitalized adult patients with mild-to-moderate COVID-19. Eligible hospitalized adult patients with symptoms of COVID-19 with ≤5 days from symptom onset, meeting criteria for mild or moderate COVID-19, were randomly assigned to the intervention consisting of local thermotherapy via an electric heat pad in the thorax (target temperature range 39.5–42°C) continuously for 90 min, twice daily, for 5 days, or standard care. The main outcome was the proportion of patients who progressed to severe-to-critical COVID-19 or death. Patients were randomized in a 1:1 ratio through a centralized computer-generated sequence of minimization with a random component of 20%. Participants and medical staff were not blinded to the intervention.

Results

One-hundred and five participants (thermotherapy n = 54, control n = 51) with a median age of 53 (IQR: 41–64) years were included for analysis after the early cessation of recruitment due to the closure of all temporal COVID-19 units (target sample size = 274). The primary outcome of disease progression occurred in 31.4% (16/51) of patients in the control group vs. 25.9% (14/54) of those receiving thermotherapy (risk difference = 5.5%; 95%CI: −11.8–22.7, p = 0.54). Thermotherapy was well tolerated with a median total duration of thermotherapy of 900 (IQR: 877.5–900) min. Seven (13.7%) patients in the control group and seven (12.9%) in the thermotherapy group had at least one AE (p = 0.9), none of which were causally attributed to the intervention. No statistically significant differences in serum cytokines (IL-1β, IL-6, IL-8, IL-10, IL-17, and IFN-γ) were observed between day 5 and baseline among groups.

Conclusion

Local thermotherapy was safe and well-tolerated. A non-statistically significant lower proportion of patients who experienced disease progression was found in the thermotherapy group compared to standard care. Local thermotherapy could be further studied as a strategy to prevent disease progression in ambulatory settings.

Clinical Trial registration: www.clinicaltrials.gov, identifier: NCT04363541.

Weight Gain After 12 Months of Switching to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Virologically Suppressed HIV Patients

Recent studies suggest that the introduction of antiretroviral agents such as integrase strand transfer inhibitors (INSTI) may lead to weight gain in people living with HIV (PLHIV). In this retrospective observational study, we report the weight changes observed in virologically suppressed HIV patients after 12 months of switching to bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) due to a national change in public policy in Mexico. Patients on prior regimens based on TDF/FTC or ABC/3TC plus non-nucleoside retrotranscriptase inhibitor, INSTI, or protease inhibitor were included. In the 399 patients analyzed, a significant weight increase was found, as well as an increase in body mass index (BMI), total cholesterol, low-density lipoprotein cholesterol (LDL-C), glucose, creatinine, and CD4+ cells after 12 months of switching treatment (all p ≤ .001). Mean weight gain was 1.63 kg [confidence interval (95% CI): 1.14-2.11], whereas the average percentage of weight gained was 2.5% (95% CI: 1.83-3.17). After considering the confounding effect of baseline weight status, the change in weight and BMI did not present significant differences between any of the prior treatment schemes. In conclusion, PLHIV switching to BIC/F/TAF therapy experienced weight gain after the first year of switching treatment. Although this weight gain could be due to the switch in treatment regimen, it cannot be excluded that it was caused by other factors since no comparable control group could be used for comparison.

Estimation of vaccination coverage and associated factors in older Mexican adults

National vaccination programmes recommend the influenza vaccine for older adults, but this population group has the greatest morbidity and mortality from other preventable vaccine diseases. The aim of this article is to estimate the vaccine coverage in adults aged 65 years and older and to analyse the factors that could increase or decrease vaccination uptake probability for the three listed vaccines in the national vaccination programme (influenza, tetanus and diphtheria, and pneumococcus) and the full scheme in Mexico. We conducted an analytical cross-sectional study with 2012, 2018, and 2021 rounds from the National Health and Nutrition Survey, in which we calculated the vaccine coverage estimations and performed multivariable logistic regression models to analyse the factors related to vaccine uptake. Tetanus and diphtheria vaccines had the greatest coverage estimation in all years (59-71%), whereas the pneumococcus vaccine had the lowest (32-53%). Full scheme vaccine coverage decreased from 37.80% to 24.77% in 2012 and 2021, respectively. The National Health Card property, morbidity, being a beneficiary of any health system institution, and use of preventive services increased the probability of vaccine uptake. In conclusion, vaccine coverage in older Mexican adults decreased over time, and the Mexican health system plays a strategic role in immunisation.

Hemodynamic and respiratory support in pulmonary embolism: a narrative review

Pulmonary embolism is a common and potentially fatal disease, with a significant burden on health and survival. Right ventricular dysfunction and hemodynamic instability are considered two key determinants of mortality in pulmonary embolism, which can reach up to 65% in severe cases. Therefore, timely diagnosis and management are of paramount importance to ensure the best quality of care. However, hemodynamic and respiratory support, both major constituents of management in pulmonary embolism, associated with cardiogenic shock or cardiac arrest, have been given little attention in recent years, in favor of other novel advances such as systemic thrombolysis or direct oral anticoagulants. Moreover, it has been implied that current recommendations regarding this supportive care lack enough robustness, further complicating the problem. In this review, we critically discuss and summarize the current literature concerning the hemodynamic and respiratory support in pulmonary embolism, including fluid therapy, diuretics, pharmacological support with vasopressors, inotropes and vasodilators, oxygen therapy and ventilation, and mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation and right ventricular assist devices, while also providing some insights into contemporary research gaps.

Effectiveness of a nationwide COVID-19 vaccination program in Mexico against symptomatic COVID-19, hospitalizations, and death: a retrospective analysis of national surveillance data

OBJECTIVES

Vaccination has been effective in ameliorating the impact of COVID-19. Here, we report vaccine effectiveness (VE) of the nationally available COVID-19 vaccines in Mexico.

METHODS

Retrospective analysis of a COVID-19 surveillance system to assess the VE of the BNT162b2, messenger RNA (mRNA)-12732, Gam-COVID-Vac, Ad5-nCoV, Ad26.COV2.S, ChAdOx1, and CoronaVac vaccines against SARS-CoV-2 infection, COVID-19 hospitalization, and death in Mexico. The VE was estimated using time-varying Cox proportional hazard models in vaccinated and unvaccinated adults, adjusted for age, sex, and comorbidities. VE was also estimated for adults with diabetes, aged ≥60 years, and comparing the predominance of SARS-CoV-2 variants B.1.1.519 and B.1.617.2.

RESULTS

We assessed 793,487 vaccinated and 4,792,338 unvaccinated adults between December 24, 2020 and September 27, 2021. The VE against SARS-CoV-2 infection was the highest for fully vaccinated individuals with mRNA-12732 (91.5%, 95% confidence interval [CI] 90.3-92.4) and Ad26.COV2.S (82.2%, 95% CI 81.4-82.9); for COVID-19 hospitalization, BNT162b2 (84.3%, 95% CI 83.6-84.9) and Gam-COVID-Vac (81.4% 95% CI 79.5-83.1), and for mortality, BNT162b2 (89.8%, 95% CI 89.2-90.2) and mRNA-12732 (93.5%, 95% CI 86.0-97.0). The VE decreased for all vaccines in adults aged ≥60 years, people with diabetes, and periods of Delta variant predominance.

CONCLUSION

All the vaccines implemented in Mexico were effective against SARS-CoV-2 infection, COVID-19 hospitalization, and death. Mass vaccination with multiple vaccines is useful to maximize vaccination coverage.

Association of loneliness and social isolation with all-cause mortality among older Mexican adults in the Mexican health and aging study: a retrospective observational study

BACKGROUND

Plenty of evidence shows how social isolation and loneliness are associated with increased risk for numerous diseases and mortality. But findings about their interactive or combined effects on health outcomes and mortality remains inconclusive.

OBJECTIVE

Analyze the longitudinal association of loneliness, social isolation and their interactions, with the all-cause mortality among older adults in Mexico.

METHODS

A retrospective observational study was conducted. Mexican adults older than 50 years were included. Data from the Mexican Health and Aging Study (MHAS) in the 2015 and 2018 waves were used. The subjects were classified according to their level of loneliness and the presence of social isolation. Multivariate logistic regression analyzes were performed to determine the degree of association between loneliness and social isolation with all-cause mortality at a 3-year follow-up.

RESULTS

From the total sample of 11,713 adults aged 50 years or over, 707 (6%) did not survive, 42% presented loneliness, and 53% were classified as socially isolated. After multivariate adjustment only social isolation (OR = 1.30, 95%CI:1.03-1.64) was associated with all-cause mortality, loneliness (Mild: OR = 0.83, 95%CI:0.59-1.16; Severe: OR = 1.03, 95%CI:0.71-1.64), and the interaction between loneliness and social isolation were not associated with all-cause mortality.

CONCLUSION

Social isolation, but not loneliness or their interaction, was associated with all-cause mortality in Mexican adults older than 50 years. This finding may help direct possible future interventions that help improve mental health in older adults from a highly collectivistic country.

Evaluación de las vías de deterioro de una salsa artesanal para su comercialización

Introducción: Cada vez es mayor el número de consumidores que saben apreciar la calidad de un buen producto artesano y que, por lo tanto, están dispuestos a pagar por ello. La elaboración de productos artesanales busca emplear juiciosamente la mano de obra para elaborar productos de alto valor añadido como la originalidad y cualidades sensoriales.El objetivo de este trabajo es evaluar la vida útily el factor limitante de deterioro en una salsa picante casera para su potencial comercialización. Metodología: Se evaluaron tres posibles vías de deterioro: La descomposición microbiológica (determinada por la cuenta total de bacterias mesofílicas aerobias y coliformes totales), el deterioro de las características sensoriales (por evaluación sensorial mediante escala hedónica) y el deterioro fisicoquímico determinado por la degradación de la grasa después de un almacenamiento por 4 meses a 40°C. Resultados: No se encontraron diferencias en las características sensoriales antes y después del almacenamiento (todas p<0.05).El crecimiento de mesofílicos aerobios y coliformes totales fue <10 UFC/g, de igual manera se determinó el pH para evaluar el riesgo de que pudiese ser debido a crecimiento de C. botulinum, no obstante, además de no observarse la producción de gas el pH fue de 3.6, por lo que se descartó un potencial crecimiento de este microorganismo. Conclusiones: La principal vía de deterioro en la salsa analizada es la degradación de la grasa, reflejado en los cambios de las variables fisicoquímicas acidez, índice de peróxidos, índice de yodo e índice de saponificación. Se considera que el tiempo de vida estimado para la salsa es de 3 semanas sin tratamiento térmico a temperatura ambiente o 4 meses en refrigeración también sin tratamiento térmico. El producto es bien aceptado sensorialmente, por lo que la única limitante es la degradación de la grasa en un período de conservación largo o almacenada de manera no apropiada.

Simplified acute physiology score II and Mannheim peritonitis index are associated with in-hospital mortality in patients with abdominal sepsis admitted to ICU

OBJECTIVE

The objective of this study was to assess the association and interaction of laboratory parameters, Simplified Acute Physiology Score II (SAPSII), Modified Shock Index (MSI), and Mannheim Peritonitis Index (MPI) with in-hospital mortality.

MATERIAL AND METHODS

We conducted a single-center case-control study. Adult patients with abdominal sepsis were included from May 2015 to May 2020. Baseline characteristics, laboratory parameters, SAPSII, MSI, and MPI scores at admission were collected. A principal component (PC) analysis was applied to evaluate variable interactions. In-hospital mortality risk was determined through logistic regression models.

RESULTS

One hundred and twenty-seven patients were identified, 60 of which were included for analyses. Non-survivors (48.4%) had a higher frequency of hypertension, lactate and MPI, and lower BE and alactic BE levels. Eight PCs were obtained, PC1 being a linear combination of pH, AG, cAG, alactic BE, bicarbonate, and BE. MPI (OR = 9.87, 95% CI: 3.07-36.61, p = 0.0002), SAPSII (OR = 1.07, 95% CI: 1.01-1.14, p = 0.01), and PC1 (OR = 2.13, 95% CI: 1.12-4.76, p = 0.04) were significantly associated with mortality in univariate analysis, while MPI (OR = 10.1, 95% CI: 3.03-40.06, p = 0.0003) and SAPSII (OR = 1.07, CI95%: 1.01-1.14, p = 0.02) remained significant after adjusting for age and sex.

CONCLUSION

MPI and SAPSII were associated with mortality, although the interaction of laboratory parameters was not.

[Stress, anxiety, and depression in health workers during the COVID-19 pandemic]

BACKGROUND

Mental health is an integral part of health. Having some psychiatric condition without treatment predisposes to a poor quality of life. These alterations have been found with an incidence of up to 50% in the general population. There are very few studies in Mexico on these conditions in health workers during the COVID-19 pandemic.

OBJECTIVE

To determine the prevalence of stress, anxiety, and depression during the COVID-19 pandemic in health workers.

MATERIAL AND METHODS

A descriptive, cross-sectional observational study was conducted on health workers in a tertiary hospital, through the application of randomized and self-completed surveys, in search of levels of stress, anxiety, and depression during the COVID-19 pandemic.

RESULTS

44.7% of those surveyed showed depression, 83.1% anxiety, and 66.3% stress. The main groups affected were female staff, singles, and medical residents. Those with type 2 diabetes mellitus had higher anxiety and depression.

CONCLUSION

The prevalence of stress, anxiety, and depression in health workers is similar to that of the general population in our study. Depression was the alteration most found. The scrutiny of alterations in mental health in health workers is of the utmost importance, with greater emphasis in the context of the aforementioned pandemic.

Aplicaciones clínicas de la ecuación del movimiento del sistema respiratorio para la toma de decisiones en el paciente bajo ventilación mecánica invasiva: artículo de reflexión

Introducción: la ventilación mecánica es una práctica común en las unidades de cuidados intensivos y anestesiología. Tiene implicaciones terapéuticas, pero también es potencialmente nociva para el sistema respiratorio y los órganos distantes, por lo cual es imprescindible monitorizar los parámetros ventilatorios de manera continua. Objetivo: describir la ecuación del movimiento del sistema respiratorio y sus aplicaciones clínicas en el paciente bajo ventilación mecánica. Desarrollo: la ecuación del movimiento del sistema respiratorio integra las fuerzas dinámicas generadas por el ventilador y las propiedades intrínsecas del pulmón y la caja torácica. Expresa la presión en el sistema respiratorio en relación con el volumen, la elastancia, la resistencia, el flujo de aire y las presiones generadas por el ventilador y el paciente. Las presiones elevadas en el sistema respiratorio se asocian a una mayor mortalidad en pacientes con ventilación mecánica, por lo que la identificación de los componentes que condicionan la elevación de las presiones mediante la ecuación del movimiento del sistema respiratorio permite realizar modificaciones a los parámetros programados del ventilador para mantener una ventilación protectora. Conclusión: la toma de decisiones basada en la ecuación del movimiento del sistema respiratorio permite realizar ajustes en los parámetros ventilatorios según las características y enfermedades del paciente bajo ventilación mecánica.

Combined First Month Body Weight Loss and Development of Tolerance as Predictors of 6-Month Efficacy of Mazindol in Mild and Moderate Obese Subjects

The weight loss response to anti-obesity drugs is highly variable and poorly understood, which does not allow us to know, in advance, in which subjects the drug will be effective and in which it will not. The objective of this study was to explore the body weight reduction in kilograms in the first month (1mo-BWRkg) and the development of tolerance as predictors of 6-month efficacy for treatment with 1 mg mazindol twice a day. One hundred ninety-six obese subjects were individually or jointly analyzed. Approximately 60% of subjects developed tolerance to mazindol and achieved increasing proportional levels of 6-month efficacy according to 1mo-BWRkg intervals (<1 kg, 1 to <2 kg, 2 to <4 kg and ≥4 kg). Both moT and 1mo-BWRkg were significantly correlated with the mean percentage body weight reduction (BWR%) after 6-months of treatment. The qualitative analysis of both predictors on the progressive efficacy of mazindol was used to classify patients according to expected efficacy (inefficient, slightly effective, partially effective, or fully effective), based on the mean percentage efficacy and the number of subjects reaching a BWR% of <5%, 5 to <10%, 10 to <15% or ≥15%. In conclusion, combined 1mo-BWRkg and moT were early predictors for the progressive efficacy of 6-month mazindol anti-obesity therapy. This finding represents progress in predictive, preventive, and personalized medicine which could serve for estimating the expectations of individual efficacy with the use of the drug. and highlights the basic principle of personalized medicine, “one size does not fit all”.

SOFA Score Plus Impedance Ratio Predicts Mortality in Critically Ill Patients Admitted to the Emergency Department: Retrospective Observational Study

Background: The Sequential Organ Failure Assessment (SOFA) is a scoring system used for the evaluation of disease severity and prognosis of critically ill patients. The impedance ratio (Imp-R) is a novel mortality predictor. Aims: This study aimed to evaluate the combination of the SOFA + Imp-R in the prediction of mortality in critically ill patients admitted to the Emergency Department (ED). Methods: A retrospective cohort study was performed in adult patients with acute illness admitted to the ED of a tertiary-care referral center. Baseline SOFA score and bioelectrical impedance analysis to obtain the Imp-R were performed within the first 24 h after admission to the ED. A Cox regression analysis was performed to evaluate the mortality risk of the initial SOFA score plus the Imp-R. Harrell’s C-statistic and decision curve analyses (DCA) were performed. Results: Out of 325 patients, 240 were included for analysis. Overall mortality was 31.3%. Only 21.3% of non-surviving patients died after hospital discharge, and 78.4% died during their hospital stay. Of the latter, 40.6% died in the ED. The SOFA and Imp-R values were higher in non-survivors and were significantly associated with mortality in all models. The combination of the SOFA + Imp-R significantly predicted 30-day mortality, in-hospital mortality, and ED mortality with an area under the curve (AUC) of 0.80 (95% CI: 74–0.86), 0.79 (95% CI: 0.74–0.86) and 0.75 (95% CI: 0.66–0.84), respectively. The DCA showed that combining the SOFA + Imp-R improved the prediction of mortality through the lower risk thresholds. Conclusions: The addition of the Imp-R to the baseline SOFA score on admission to the ED improves mortality prediction in severely acutely ill patients admitted to the ED.

Awake prone positioning and oxygen therapy in patients with COVID-19: the APRONOX study

BACKGROUND

The awake prone positioning strategy for patients with acute respiratory distress syndrome is a safe, simple and cost-effective technique used to improve hypoxaemia. We aimed to evaluate intubation and mortality risk in patients with coronavirus disease 2019 (COVID-19) who underwent awake prone positioning during hospitalisation.

METHODS

In this retrospective, multicentre observational study conducted between 1 May 2020 and 12 June 2020 in 27 hospitals in Mexico and Ecuador, nonintubated patients with COVID-19 managed with awake prone or awake supine positioning were included to evaluate intubation and mortality risk through logistic regression models; multivariable and centre adjustment, propensity score analyses, and E-values were calculated to limit confounding.

RESULTS

827 nonintubated patients with COVID-19 in the awake prone (n=505) and awake supine (n=322) groups were included for analysis. Fewer patients in the awake prone group required endotracheal intubation (23.6% versus 40.4%) or died (19.8% versus 37.3%). Awake prone positioning was a protective factor for intubation even after multivariable adjustment (OR 0.35, 95% CI 0.24-0.52; p<0.0001, E=2.12), which prevailed after propensity score analysis (OR 0.41, 95% CI 0.27-0.62; p<0.0001, E=1.86) and mortality (adjusted OR 0.38, 95% CI 0.26-0.55; p<0.0001, E=2.03). The main variables associated with intubation among awake prone patients were increasing age, lower baseline peripheral arterial oxygen saturation/inspiratory oxygen fraction ratio (P aO2 /F IO2 ) and management with a nonrebreather mask.

CONCLUSIONS

Awake prone positioning in hospitalised nonintubated patients with COVID-19 is associated with a lower risk of intubation and mortality.

Association of Differences in Dietary Behaviours and Lifestyle with Self-Reported Weight Gain during the COVID-19 Lockdown in a University Community from Chile: A Cross-Sectional Study

Domiciliary confinement of people is one of the main strategies to limit the impact of COVID-19. Lockdowns have led to changes in lifestyle, emotional health, and eating habits. We aimed to evaluate the association of differences in dietary behaviours and lifestyle with self-reported weight gain during the COVID-19 lockdown in Chile. In this cross-sectional analytical study, five previously validated surveys were condensed into a single 86-item online questionnaire. The survey was sent to 1000 potential participants of the university community; it was kept online for 28 days to be answered. Of the 639 respondents, the mean self-reported weight gain during confinement was 1.99 kg (standard deviation [SE]: 0.17) and 0.7 (SE: 0.06) units of body mass index (BMI) (both p < 0.001) and the median difference in body weight during lockdown was 3.3% (interquartile range [IQR]: 0.0–6.7). The differences of intake of most food groups before and during lockdown were associated with greater self-reported weight, BMI and percentage weight gain. Differences in lifestyle (odds ratio [OR] = 14.21, 95% confidence interval [95%CI]: 2.35–85.82) worsening eating habits (OR = 3.43, 95%CI: 2.31–5.09), and more consumption of sweet or filled cookies and cakes during lockdown (OR = 2.11, 95%CI: 1.42–3.13) were associated with self-reported weight gain. In conclusion, different dietary behaviours (mainly consumption of industrialized foods) during lockdown, as well as quality of life deterioration were the main factors associated with self-reported weight gain during lockdown.

Comprehensive evaluation of the impact of sociodemographic inequalities on adverse outcomes and excess mortality during the COVID-19 pandemic in Mexico City

BACKGROUND

The impact of the COVID-19 pandemic in Mexico City has been sharp, as several social inequalities at all levels coexist. Here, we conducted an in-depth evaluation of the impact of individual and municipal-level social inequalities on the COVID-19 pandemic in Mexico City.

METHODS

We analyzed suspected SARS-CoV-2 cases, from the Mexico City Epidemiological Surveillance System from February 24th, 2020, to March 31 st, 2021. COVID-19 outcomes included rates of hospitalization, severe COVID-19, invasive mechanical ventilation, and mortality. We evaluated socioeconomic occupation as an individual risk, and social lag, which captures municipal-level social vulnerability, and urban population density as proxies of structural risk factors. Impact of reductions in vehicular mobility on COVID-19 rates and the influence of risk factors were also assessed. Finally, we assessed discrepancies in COVID-19 and non-COVID-19 excess mortality using death certificates from the General Civil Registry.

RESULTS

We detected vulnerable groups who belonged to economically unfavored sectors and experienced increased risk of COVID-19 outcomes. Cases living in marginalized municipalities with high population density experienced greater for COVID-19 outcomes. Additionally, policies to reduce vehicular mobility had differential impacts modified by social lag and urban population density. Finally, we report an under-registry of COVID-19 deaths along with an excess mortality closely related to marginalized and densely populated communities in an ambulatory setting. This could be attributable to a negative impact of modified hospital admission criteria during the pandemic.

CONCLUSION

Socioeconomic occupation and municipality-wide factors played a significant role in shaping the course of the COVID-19 pandemic in Mexico City.

Obesity is a strong risk factor for short-term mortality and adverse outcomes in Mexican patients with COVID-19: a national observational study

Conflicting results have been obtained through meta-analyses for the role of obesity as a risk factor for adverse outcomes in patients with coronavirus disease-2019 (COVID-19), possibly due to the inclusion of predominantly multimorbid patients with severe COVID-19. Here, we aimed to study obesity alone or in combination with other comorbidities as a risk factor for short-term all-cause mortality and other adverse outcomes in Mexican patients evaluated for suspected COVID-19 in ambulatory units and hospitals in Mexico. We performed a retrospective observational analysis in a national cohort of 71 103 patients from all 32 states of Mexico from the National COVID-19 Epidemiological Surveillance Study. Two statistical models were applied through Cox regression to create survival models and logistic regression models to determine risk of death, hospitalisation, invasive mechanical ventilation, pneumonia and admission to an intensive care unit, conferred by obesity and other comorbidities (diabetes mellitus (DM), chronic obstructive pulmonary disease, asthma, immunosuppression, hypertension, cardiovascular disease and chronic kidney disease). Models were adjusted for other risk factors. From 24 February to 26 April 2020, 71 103 patients were evaluated for suspected COVID-19; 15 529 (21.8%) had a positive test for SARS-CoV-2; 46 960 (66.1%), negative and 8614 (12.1%), pending results. Obesity alone increased adjusted mortality risk in positive patients (hazard ratio (HR) = 2.7, 95% confidence interval (CI) 2.04-2.98), but not in negative and pending-result patients. Obesity combined with other comorbidities further increased risk of death (DM: HR = 2.79, 95% CI 2.04-3.80; immunosuppression: HR = 5.06, 95% CI 2.26-11.41; hypertension: HR = 2.30, 95% CI 1.77-3.01) and other adverse outcomes. In conclusion, obesity is a strong risk factor for short-term mortality and critical illness in Mexican patients with COVID-19; risk increases when obesity is present with other comorbidities.

All-cause mortality among patients treated with repurposed antivirals and antibiotics for COVID-19 in Mexico City: A real-world observational study

The aim of our study was to evaluate all-cause mortality risk in patients with laboratory-confirmed COVID-19 in Mexico City treated with repurposed antivirals and antibiotics. This real-world retrospective cohort study contemplated 395,343 patients evaluated for suspected COVID-19 between February 24 and September 14, 2020 in 688 primary-to-tertiary medical units in Mexico City. Patients were included with a positive RT-PCR for SARS-CoV-2; those receiving unspecified antivirals, excluded; and groups of antivirals prescribed in < 30 patients, eliminated. Survival and mortality risks were determined for patients receiving antivirals, antibiotics, both, or none. We assessed the effect of early (<2 days) versus late (>2 days) use of antivirals on mortality in a sub-cohort of patients. Multivariable adjustment, propensity score matching, generalized estimating equations, and calculation of E-values were performed to limit confounding. 136,855 patients were analyzed; mean age 44.2 (SD:16.8) years; 51.3 % were men. 16.6 % received antivirals (3 %), antibiotics (10 %), or both (3.6 %). Antivirals studied were Oseltamivir (n=8414), Amantadine (n=319), Lopinavir-Ritonavir (n=100), Rimantadine (n=61), Zanamivir (n=39), and Acyclovir (n=36). Survival with antivirals (73.7 %, p<0.0001) and antibiotics (85.8 %, p<0.0001) was lower than no antiviral/antibiotic (93.6 %). After multivariable adjustment, increased risk of death occurred with antivirals (HR=1.72, 95 % CI: 1.61-1.84) in ambulatory (HR=4.7, 95 % CI: 3.94-5.62) and non-critical (HR=2.03, 95 % CI: 1.86-2.21) patients. Oseltamivir increased mortality risk in the general population (HR=1.72, 95 % CI: 1.61-1.84), ambulatory (HR=4.79, 95 % CI: 4.01-5.75), non-critical (HR=2.05, 95 % CI: 1.88-2.23), and pregnancy (HR=8.35, 95 % CI: 1.77-39.30); as well as hospitalized (HR=1.13, 95 % CI: 1.01-1.26) and critical patients (HR=1.22, 95 % CI: 1.05-1.43) after propensity score-matching. Early versus late oseltamivir did not modify the risk. Antibiotics were a risk factor in general population (HR=1.13, 95 % CI: 1.08-1.19) and pediatrics (HR=4.22, 95 % CI: 2.01-8.86), but a protective factor in hospitalized (HR=0.81, 95 % CI: 0.77-0.86) and critical patients (HR=0.67, 95 % CI: 0.63-0.72). No significant benefit for repurposed antivirals was observed; oseltamivir was associated with increased mortality. Antibiotics increased mortality risk in the general population but may increase survival in hospitalized and critical patients.

Development and validation of the patient history COVID-19 (PH-Covid19) scoring system: a multivariable prediction model of death in Mexican patients with COVID-19

Most of the existing prediction models for COVID-19 lack validation, are inadequately reported or are at high risk of bias, a reason which has led to discourage their use. Few existing models have the potential to be extensively used by healthcare providers in low-resource settings since many require laboratory and imaging predictors. Therefore, we sought to develop and validate a multivariable prediction model of death in Mexican patients with COVID-19, by using demographic and patient history predictors. We conducted a national retrospective cohort study in two different sets of patients from the Mexican COVID-19 Epidemiologic Surveillance Study. Patients with a positive reverse transcription-polymerase chain reaction for SARS-CoV-2 and complete unduplicated data were eligible. In total, 83 779 patients were included to develop the scoring system through a multivariable Cox regression model; 100 000, to validate the model. Eight predictors (age, sex, diabetes, chronic obstructive pulmonary disease, immunosuppression, hypertension, obesity and chronic kidney disease) were included in the scoring system called PH-Covid19 (range of values: -2 to 25 points). The predictive model has a discrimination of death of 0.8 (95% confidence interval (CI) 0.796-0.804). The PH-Covid19 scoring system was developed and validated in Mexican patients to aid clinicians to stratify patients with COVID-19 at risk of fatal outcomes, allowing for better and efficient use of resources.

Atherogenic index of plasma as a marker of cardiovascular risk factors in Mexicans aged 18 to 22 years

The aim of this cross-sectional study was to evaluate the use and application of the atherogenic index of plasma (AIP) in the prediction of cardiovascular risk factors including mixed hyperlipidemia, hypertension, hyperuricemia, and metabolic syndrome in a population of young Mexican adults. Values were obtained for metabolic parameters, such as glucose, triglycerides, cholesterol (total, high-density, low-density, and very low density), systolic and diastolic blood pressure, and uric acid. Through univariate and multivariate analysis, parametric comparisons were applied and receiver operating characteristic curves were plotted. Logistic regression analysis was used to assess the risk of hyperuricemia, hypertension, mixed hyperlipidemia, and metabolic syndrome from a high AIP. Metabolic parameters and AIP had a significant correlation, with higher rates observed with increased AIP. As a set, metabolic parameters increased with an AIP >0.21 (λ Wilks = 0.58, F(14,344) = 7.7, P < 0.0001). The area under the curve was statistically significant for prediction of hyperuricemia (0.6), mixed hyperlipidemia (0.9), hypertension (0.8), and metabolic syndrome (0.95). In conclusion, in a sample of young Mexican adults, AIP was strongly associated with cardiovascular risk factors and could serve as a useful marker for the prediction of metabolic alterations related to cardiovascular disease.

IMPACT OF COMORBIDITIES IN MEXICAN SARS-COV-2-POSITIVE PATIENTS: A RETROSPECTIVE ANALYSIS IN A NATIONAL COHORT

Background

The coronavirus disease 2019 outbreak is a significant challenge for health-care systems around the world.

Objective

The objective of the study was to assess the impact of comorbidities on the case fatality rate (CFR) and the development of adverse events in patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Mexican population.

Materials and methods

We analyzed the data from 13,842 laboratory-confirmed SARS-CoV-2 patients in Mexico between January 1, 2020, and April 25, 2020. We investigated the risk of death and the development of adverse events (hospitalization, pneumonia, orotracheal intubation, and intensive care unit [ICU] admission), comparing the number of comorbidities of each patient.

Results

The patient mean age was 46.6 ± 15.6 years, 42.3% (n = 5853) of the cases were women, 38.8% of patients were hospitalized, 4.4% were intubated, 29.6% developed pneumonia, and 4.4% had critical illness. The CFR was 9.4%. The risk of hospitalization (odds ratio [OR] = 3.1, 95% confidence interval [CI]: 2.7-3.7), pneumonia (OR = 3.02, 95% CI: 2.6-3.5), ICU admission (OR = 2, 95% CI: 1.5-2.7), and CFR (hazard ratio = 3.5, 95% CI: 2.9-4.2) was higher in patients with three or more comorbidities than in patients with 1, 2, or with no comorbidities.

Conclusions

The number of comorbidities may be a determining factor in the clinical course and its outcomes in SARS-CoV-2-positive patients.

Comparison of Bioelectrical Impedance Analysis Parameters for the Detection of Fluid Overload in the Prediction of Mortality in Patients Admitted at the Emergency Department

BACKGROUND

Fluid overload (FO) in critically ill patients is associated with increased adverse events. This study aims to compare different bioelectrical impedance analysis (BIA) parameters that demonstrate FO and their association with 30-day mortality in critical patients admitted to the emergency department (ED).

METHODS

Five components of the BIA were obtained by multifrequency device-total body water (TBW), extracellular water (ECW), intracellular water (ICW), resistance (R), and reactance (Xc)-to calculate parameters (impedance vectors, impedance ratio, and the ratios of ECW to TBW, ECW to ICW, ECW to body surface area, TBW to height² , ICW to height² , Xc to height, and R to height) that have been used for the detection of FO. A concordance analysis (κ) was performed comparing every parameter with each other. Furthermore, different regression models (Cox regression) were created associating the FO for each parameter with 30-day mortality, adjusted for age, body mass index, sex, Sequential Organ Failure Assessment score, and serum albumin level.

RESULTS

A total of 142 patients were included in the study. Only FO by impedance vector analysis (relative risk [RR] = 6.4; 95% CI, 1.5-27.9; P = .01), impedance ratio (RR = 2.7; 95% CI, 1.1-7.1; P = .04), and R (RR = 2.6; 95% CI, 1.2-5.5; P = .02) increased the probability of 30-day mortality.

CONCLUSIONS

Different parameters that determine FO by BIA were associated with the mortality of patients admitted to the ED, but the impedance vector analysis was superior to any other parameter of the BIA.

Use of coconut water (Cocus nucifera L) for the development of a symbiotic functional drink

Many studies suggest that probiotic, prebiotic and symbiotic foods may be beneficial in the prevention and management of nutrition and health, the objective of this work was to develop a symbiotic drink based on coconut water. Fermentation was performed using lyophilized Lactobacillus rhamnosus SP1 and inulin as a source of soluble fiber. Different formulations were developed, determining the concentrations of fiber and probiotics. The growth of the probiotic in MRS broth was evaluated, using the plate counting technique in different periods of time. The fermentation time of the drink was 8 h and the shelf life in refrigeration was 14 days evaluated by pH and hedonic scale. The pH of the final drink was 3.48 and the probiotic content was 82 × 10 ⁸ CFU/ml. It is concluded that coconut water can be processed by adding probiotic and prebiotic characteristics with sensory acceptance and adequate preservation characteristics.

Relación de la hiperuricemia con las alteraciones metabólicas y factores de riesgo cardiovascular en jóvenes mexicanos

Introduction

Hyperuricemia is a risk factor for cardiovascular disease, but its impact has not been properly documented.

Objective

To assess the impact of hyperuricemia on metabolic parameters and cardiovascular risk factors (CRF) in apparently healthy Mexicans.

Method

Cross-sectional study of 768 young adults. Association of hyperuricemia with alterations in metabolic parameters and CRF (hypertension, mixed dyslipidemia, metabolic syndrome) was sought. Log-linear and regression models were used to determine the influence of hyperuricemia. A multivariate analysis of variance was applied to observe the interaction of hyperuricemia and overweight or obesity with changes in metabolic parameters.

Results

Metabolic parameters were higher in patients with hyperuricemia than with normal uric acid (all < 0.05). Hyperuricemia was significantly associated with hypertension (OR=6.8, 95 % CI: 1.1-46), dyslipidemia (OR=2.5, 95% CI: 1.3-4.7) and metabolic syndrome (OR=2.3, 95% CI: 1.1-4.6). Hyperuricemia and overweight or obesity significantly predict changes in cardiovascular risk metabolic parameters (Wilks' l=0.91, F (6.175)=3.1, p=0.007).

Conclusions

Hyperuricemia is significantly associated with metabolic alterations and different CRF.

Relation of body composition indexes to cardiovascular disease risk factors in young adults

BACKGROUND

To evaluate the relationship of body composition indexes with altered metabolic analytical parameters that show higher risk of cardiovascular disease in young adults.

MATERIAL AND METHODS

A cross-sectional study. Sample of 1351 young adults, different body composition parameters were obtained such as Waist Circumference (WC), Hip Circumference (HC), Body Mass Index (BMI), Body Fat% (BF%), Waist-to-height Ratio (WHtR), and Waist-Hip Ratio (WHR), conicity index (C-Index), body surface area (BSA), abdominal volume index (AVI) and deep abdominal adipose-tissue (AT). Areas under receiver operating characteristic curves (AUCs) and odds ratios for the parameters were analyzed and their optimal cut-offs. Separately a MANOVA was applied to altered metabolic analytical parameters and two body composition indexes (BMI and BSA) and their interaction.

RESULTS

BMI correlate significantly with metabolic analytical parameters (FPG r=0.08, TCh r=0.14, TGL r=0.23, HDL-C r=-0.23, LDL-C r=0.2, UA r=0.22, All P<0.01), BSA correlate with all (All P<0.001) except FPG. BMI and BSA correlate significantly with all metabolic analytical parameters (All P<0.001). The BMI individually predicts the changes of the six metabolic analytical parameters as a set [Wilk's λ=0.89, F(18,1570)=3.4, P<0.0001], but not BSA [Wilk's λ=0.98, F(6,555)=1.4, P=0.18], the interaction between these two indexes (BMI and BSA altered in the same individual) significantly predicts changes of the six metabolic analytical parameters of cardiovascular disease risk [Wilk's λ=0.97, F(6,555)=2.3, P=0.03].

CONCLUSIONS

BMI and BSA correlate with cardiovascular disease risk factor. They are superior to WC, WHtR, WHR, BF%, C-index, AVI and AT.

Mortality in adult patients with fluid overload evaluated by BIVA upon admission to the emergency department

PURPOSE OF THE STUDY

The aim of this study was to investigate the association of fluid overload, measured by bioelectrical impedance vector analysis (BIVA) and also by accumulated fluid balance, with 30-day mortality rates in patients admitted to the emergency department (ED).

DESIGN

We conducted a prospective observational study of fluid overload using BIVA, taking measures using a multiple-frequency whole-body tetrapolar equipment. Accumulated fluid balances were obtained at 24, 48 and 72 hours from ED admission and its association with 30-day mortality.

PATIENTS

109 patients admitted to the ED classified as fluid overloaded by both methods.

RESULTS

According to BIVA, 71.6% (n=78) of patients had fluid overload on ED admission. These patients were older and had higher Sequential Organ Failure Assessment scores. During a median follow-up period of 30 days, 32.1% (n=25) of patients with fluid overload evaluated by BIVA died versus none with normovolaemia (p=0.001). There was no statistically significant difference in mortality between patients with and without fluid overload as assessed by accumulated fluid balance (p=0.81).

CONCLUSIONS

Fluid overload on admission evaluated by BIVA was significantly related to mortality in patients admitted to the ED.