Gaceta medica de Mexico最新文献

Background: Distraction osteogenesis is a process of induced bone generation. Various protocols have been described for the management of the latency period, distraction speed and consolidation period, with greater or lesser success.

Objective: To better understand the process of mandibular distraction and establish the determining factors and their optimal times.

Material and methods: Twenty-seven dogs were studied, which had 54 distractors placed and that underwent unidirectional, bilateral mandibular distraction osteogenesis. The distraction processes were applied using six variants, two for each factor: latency period, distraction period and distraction speed. The changes were examined by means of bone biopsies and X-rays of the area at 0, 7, 14, 21, 45 and 55 days of the process.

Results: The most efficient osteogenic distraction parameters were a latency period of five days, a consolidation period of six weeks, distraction speed of 1 mm/day for distances of less than 20 mm, and 3 mm/day for longer distances.

Conclusions: The sequential histological study allowed to observe the appearance of cellular elements (osteocytes, osteoclasts, osteoid matrix, trabeculate, etc.) and their participation in granulation tissue, newly-formed bone and compact mature bone.

Background: Age and HIV are synergistic risk factors for conditions such as HIV-associated neurocognitive disorders (HAND). Yet, it is unclear whether older persons with HIV (OPWH) display different cognitive profiles for HAND.

Objective: To describe the cognitive patterns of OPWH treated with combined antiretroviral therapy (cART).

Methods: Cross-sectional study that included 330 participants with HIV, aged 50 years or older, cared for at a tertiary care hospital in Mexico City. A short neuropsychological test battery was used to assess a wide spectrum of cognitive functions. The optimal number of cognitive clusters was determined by the silhouette method and a minimization of the Bayesian information criterion.

Results: Participants' mean age was 58.8 years (standard deviation = 6.6), and 12.1% were women. A 3-cluster solution yielded stable Jaccard coefficients (p > 0.70). Cluster 1 showed more significant impairment in visual and verbal memory domains, whereas participants in cluster 3 showed significant impairment in language, and abstraction. Cluster 2 showed no predominance of any domain for alterations.

Conclusions: There are different cognitive profiles among OAWH with HAND. These differences may be due to individual patterns of HIV-related and non-HIV-related factors.

Background: The quick Sequential Sepsis-related Organ Failure Assessment (qSOFA) is a score that has been proposed to quickly identify patients at higher risk of death.

Objective: To describe the usefulness of the qSOFA score to predict in-hospital mortality in cancer patients.

Material and methods: Cross-sectional study carried out between January 2021 and December 2022. Hospital mortality was the dependent variable. The area under the ROC curve (AUC) was calculated to determine the discriminative ability of qSOFA to predict in-hospital mortality.

Results: A total of 587 cancer patients were included. A qSOFA score higher than 1 obtained a sensitivity of 57.2%, specificity of 78.5%, a positive predictive value of 55.4% and negative predictive value of 79.7%. The AUC of qSOFA for predicting in-hospital mortality was 0.70. In-hospital mortality of patients with qSOFA scores of 2 and 3 points was 52.7 and 64.4%, respectively. In-hospital mortality was 31.9% (187/587).

Conclusion: qSOFA showed acceptable discriminative ability for predicting in-hospital mortality in cancer patients.

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.

The objective of this issue is a theoretical approach to the disadvantages involved in taking the certification exams of medical specializations through serial case reports and analyzing them with the Classical Test Theory (TCT). The certification exams of medical specializations correspond to criterial summative exams with high consequences. Therefore, it is imperative to maintain the highest quality standards in all the processes involved in preparing the exam. At present, it has been detected that some councils of medical specialties conduct the certification exams with tests that contain serial case reports and the psychometric analysis that they conduct is supported by the TCT; however, the structure of this type of test violates the fundamental assumptions of the TCT. The violation of the fundamental assumptions of the TCT in the tests constructed through serial case reports can lead to biases or misinterpretations of the results. Due to the above, it is advisable to use other psychometric models for the analysis of this type of test, or to avoid the use of serial case reports in the certification exams of medical specialties.

The exercise of all human rights is inherent to all persons, which must be guaranteed by the States regardless of the characteristics of all persons, such as age, gender, sexual preferences, ethnic origin, nationality or migratory status. This document presents a reflection on the discrimination that older people face not only because they are older (ageism), but also because of other characteristics that place them in a situation of greater vulnerability and discrimination, such as belonging to the LGBT+ community, being in prisons or having HIV. It urges reflection on the role and sensitivity with which public institutions, mainly health institutions, must have to guarantee a fundamental right such as health, not only in the physical aspect but also in the mental one. The health challenges that the country faces are presented, and a call is made to leave no one behind, encouraging the most vulnerable populations to have immediate attention free of discrimination. The elderly are the present and the future of the realities of our countries, where Mexico is no exception.

Background: Older adults have highly heterogeneous aging rates.

Objective: To explore the association of biological age (BA) and accelerated aging with frailty in community-dwelling older adults.

Methods: We assessed 735 community-dwelling older adults from the Coyocan Cohort. BA was measured using AnthropoAge, accelerated aging with AnthropoAgeAccel, and frailty using Fried's phenotype and the frailty index. We explored the association of BA and accelerated aging (AnthropoAgeAccel ≥ 0) with frailty at baseline and characterized the body composition and physical function phenotype of accelerated aging in non-frail/frail participants. We also explored accelerated aging as a risk factor for frailty progression after 3-years of follow-up.

Results: Older adults with accelerated aging have higher frailty prevalence and indices, lower handgrip strength and gait speed. AnthropoAgeAccel was associated with higher frailty indices (β = 0.0053, 95%CI 0.0027-0.0079), and increased odds of frailty at baseline (OR 1.16, 95%CI 1.09-1.25). We observed sex-based differences in body composition and physical function linked to accelerated aging in non-frail participants; however, these differences were absent in pre-frail/frail participants. Accelerated aging at baseline was associated with higher risk of frailty progression over time (OR 1.74, 95%CI 1.11-2.75).

Conclusions: Despite being intertwined, biological accelerated aging is largely independent of frailty in community-dwelling older adults.

Background: In Mexico, there is a paucity of evidence on mortality and hospitalization patterns associated with aortic aneurysms and dissections.

Objective: To analyze national databases and describe the epidemiological characteristics of different aortic pathologies.

Material and methods: Retrospective, cross-sectional, observational study, in which mortality and hospitalization attributed to aortic aneurysms and dissections were analyzed. Statistical analysis was performed on Stata 16.

Results: A total of 6,049 deaths were documented in the general population, which included 2,367 hospitalizations and 476 (20.1%) in-hospital deaths. In addition, a statistically significant age difference was found between mean age at death in the general population (69.5 years) and the in-hospital death group (64.1 years, p < 0.001). As for hospitalizations secondary to ruptured abdominal aortic aneurysms, 149 cases were identified, with a mean age of 65.6 years, out of whom 53 (35.5%) were under 65 years of age, with a mean age of 47.8 years.

Conclusions: Epidemiological reports of aortic pathology in Mexico are scarce; therefore, implementation of screening and detection programs for aortic pathologies is necessary in order to address the disparities identified in this analysis.