Gaceta medica de Mexico最新文献

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.

Introduction: Twin pregnancy through assisted reproduction techniques is increasing, as are the associated complications.

Objective: Compare maternal and perinatal complications associated with spontaneous twin pregnancy and through assisted reproduction techniques (ART).

Material and methods: Retrospective comparative and controlled study. It included 208 patients treated at the UMAE HGO 4 of the IMSS, divided into two groups according to the method of conception (spontaneous vs ART), comparing maternal and perinatal complications. Quantitative variables were compared with the student's T or Mann Whitney U test and qualitative variables with the chi-square test. The probability ratio was calculated with a 95 % confidence interval, with statistical significance p < 0.05.

Results: 208 patients with twin pregnancies were included; 104 (50%) conceived spontaneously and 104 (50%) by assisted reproductive techniques (ART). Maternal complications were higher in the ART group: preterm delivery (84.6 vs 60.5%), hypertensive disease (43.2 vs 19.2%), gestational diabetes (38.1 vs 24.8%), and obstetric hemorrhage (41.9 vs 25.7%). Prematurity and respiratory distress syndrome were significantly higher in the ART group.

Conclusions: Twin pregnancy due to ART increases the risk of maternal and perinatal complications, which forces us to improve prenatal control with a risk approach.

Background: The underreporting of vital statistics poses a problem for the quality of information. To address underreporting, Mexico implemented the "Intentional Search for Children Deaths" in 2002.

Objective: To analyze trends in the underreporting of deaths in neonates and children under 5 years of age (U5) from 1992 to 2022 at the national level and by state.

Material and methods: A comparative analysis was conducted between the records of the National Institute of Statistics and Geography (INEGI) and the Institute for Health Metrics and Evaluation (IHME) chosen as the gold standard after comparison with five other independent data sources. The analysis considers marginalization to describe the magnitude of underreporting.

Results: From 2001 to 2022, at the national level, the underreporting gap decreased from 38.2% to 9.0% among children U5 and from 30.7% to 5.5% in the neonatal age, with heterogeneous results across states.

Conclusions: The registration of deaths has improved; however, it is crucial to identify states needing further investigation and intervention to reduce the underreporting gap in infant mortality.