Gaceta medica de Mexico最新文献

Type 2 diabetes (T2DM) is a public health problem and the second leading cause of death in Mexico. More than 20 years after the human genome project was completed, the development of innovative technologies and methodologies to determine the genetic risk factors that predispose an individual to develop this and other pathologies, have made the implementation of genomic medicine as part of clinical practice become a reality. Although in Mexico genomic studies are still in the beginning, these have generated knowledge about the etiopathogenesis of T2DM. In this review, we will address genomic knowledge applications in clinical practice, as well as the advances in the genomics of T2DM in Mexico.

Type 2 diabetes mellitus (T2DM), diabetic nephropathy, retinopathy, and neuropathy represent significant public health challenges in Mexico. The multifactorial nature of these conditions, influenced by both environmental and genetic factors, underscores the complexity of their development. Therefore, it is essential to design new preventive strategies to reduce mortality rates and the substantial economic burden they impose. This review examines genetic variants associated with these pathologies, aiming to establish genetic profiles that explain predisposition in the Mexican population. An extensive search of scientific publications was conducted, selecting studies on nuclear DNA and mitochondrial DNA variants associated with these diseases in different global populations, with a focus on Mexico. Among these variants, genes with critical molecular mechanisms for disease development and progression were identified. Additionally, genetic variants unique to the Mexican population were found. Based on this review, we conclude that increasing genetic association studies is crucial to validate previously described variants and identify new ones, which could serve as molecular markers for predisposition and progression in the Mexican population.

Backgound: Postoperative pain after thoracotomy can be severe.

Objective: To assess whether low-dose morphine-assisted thoracic epidural analgesia (TEA) reduces pain (as measured by the visual analogue scale - VAS) and opioid consumption more than erector spinae plane block (ESP) in patients after thoracotomy.

Material and methods: 140 patients scheduled for elective thoracotomy (69 with TEA and 71 with ESP) were evaluated. VAS scores, respiratory capacity, nausea, vomiting, pruritus and opioid consumption were recorded at different intervals after the operation (30 min, 2, 6, 12 and 24 hours).

Results: Patients with TEA had significantly lower VAS scores in all postoperative measurements compared to the ESP group (p < 0.001). Respiratory capacity was also higher in the TEA group (p < 0.001). Postoperative opioid consumption was lower in the TEA group (p < 0.001), although there were no differences in intraoperative consumption (p = 1).

Conclusion: Thoracic epidural analgesia with low-dose morphine improves long-term postoperative pain control compared with ESP block.

In Mexico, cancer is the leading cause of death from disease among children between the ages of 5 and 14, with more than 2000 deaths annually. Acute leukemia is the most common malignancy, with a prevalence of 48% and an estimated five-year overall survival rate of 45% to 73%. Correct immunization of these children is essential, although it is often not possible to carry it out during times of greatest risk. There are several types of vaccines, and their use in patients with acute lymphoblastic leukemia depends on their mechanism for generating immunity. Non-live vaccines based on toxoids, protein subunits, bacterial antigens, or immunogenic proteins obtained with recombinant technology are not contraindicated during chemotherapy. At the Pediatric Hematology Service of the La Raza National Medical Center of the Mexican Social Security Institute, we conducted a review of the vaccines available in the country, their indications, and the scientific evidence on safety and efficacy, as well as the best time to administer them during and after oncological treatment.

Background: Personalized medicine allows the selection of the drug and dose based on the patient's genetic information, which is imperative in the treatment of diabetes and hypercholesterolemia, diseases with high prevalence in Mexico.

Objective: To integrate pharmacogenetic and genomic research on antidiabetic and antihypercholesterolemic drugs in Mexican patients.

Material and methods: We integrated our research, relating it with similar research from national and foreign laboratories.

Results: For antidiabetic pharmacological treatments, variants in the ABCC8 and KCNJ11 genes were consistently associated with the response to sulfonylureas, while variants in the SLC47A1, SLC28A1 and ABCG2 genes explained up to 55% of the variability in the response to metformin. Regarding hypercholesterolemia, atorvastatin treatment is influenced by variants in the genes MTHFR, DRD3, GSTM3, TNFα MDR1, SLCO1BI, ABCB1, CYP2D6, CYP2B6, NAT2 and COMT.

Conclusion: Our findings highlight the need to integrate pharmacogenetics into clinical practice to achieve greater therapeu tic success in diabetes and hypercholesterolemia.

Background: Metabolic syndrome (MS) is composed of abnormalities such as central obesity, insulin resistance, hypertension and dyslipidemia.

Objective: To implement a neural network to predict MS from cholesterol, triglycerides, high density lipoproteins (HDL), obesity and hypertension.

Material and methods: Analytical and cross-sectional study with 1878 patients from databases in Venezuela, Thailand and Indonesia. Variables such as MS, hypertension, obesity, HDL, triglycerides and total cholesterol were included. Multilayer perceptron neural networks were used, evaluated with classification tables, area under the curve (AUC) and performance metrics (sensitivity, specificity, positive and negative predictive values).

Results: The neural network showed a high capacity to predict MS, with a low percentage of incorrect predictions both in the training set (15.80%) and in the test set (18.20%). In training, the overall accuracy was 84.20%, with higher accuracy for cases without MS (88.30%) than for cases with MS (77.80%). In testing, the overall accuracy was 81.80%, also with higher accuracy for cases without MS (86.60%) than for cases with MS (74.80%). The AUC was 0.911, indicating an outstanding predictive capacity. Regarding the model performance, the sensitivity was 81.25% in training and 79.26% in testing, while the specificity reached 85.92% and 83.33%, respectively. The positive predictive value was 77.80% in training and 74.78% in testing, and the negative predictive value was 88.30% and 86.57%, respectively.

Conclusions: The multilayer perceptron neural network is an effective tool to predict MS, showing an outstanding predictive capacity.

Obesity is characterized by excess body fat, metabolic dysfunction, and an increased risk of developing other chronic diseases. This review aims to describe the main molecular mechanisms involved in metabolic diseases associated with obesity and to highlight the most recent studies on Nutritional Genomics in the Mexican population. The findings show that in Mexico, multiple observational and experimental investigations have been carried out on the gene-nutrient interaction, and its effect on human health. Changes in the eating pattern towards obesogenic diets and the presence of certain genetic variants can predispose to developing obesity and other disorders. These genetic variants could have a differential impact on each ethnicity; some of them have been identified in Caucasian populations, and they have subsequently been analyzed in the Mexican population (e.g., CAPN10, apolipoproteins, and PPARs). On the contrary, there are genetic variants that are more frequent (almost exclusive) to the Mexican population, and that have been consistently associated with metabolic alterations. For example, the rs9282541-ABCA1 variant associated with lower HDL-C concentrations. These findings highlight the importance of studying these genetic variants in different populations, to establish better strategies for the prevention, prognosis and treatment of metabolic diseases.

Background: Mucormycosis is an infection caused by Mucorales. Management includes surgical treatment and antifungals.

Objective: To describe the surgical and medical complications associated with mucormycosis in a third-level hospital.

Material and methods: Records of patients with mucormycosis treated between 2019 and 2022 were collected.

Results: A total of 25 patients were obtained, 17 (68%) men and 8 (32%) women. Surgical complications occurred on admission in 16% and early in 4% of cases. The most frequent medical complications were soft tissue infection on admission (84%) and late sepsis (52%). Amphotericin B deoxycholate was used in all cases, finding hypokalemia in 20 (80%), hypomagnesemia in 18 (72%), and acute kidney injury in 15 (60%).

Conclusions: The most commonly performed surgery was surgical debridement on admission (76%). Surgical complications occurred mainly on admission (16%). The most frequent medical complications were soft tissue infection on admission (84%) and late sepsis (52%). Due to the high cost of the liposomal and lipid forms of amphotericin, the use of amphotericin B deoxycholate continues to persist in our setting, which leads to a high degree of renal toxicity and hydroelectrolytic alterations.