Revista De Investigacion Clinica-Clinical and Translational Investigation最新文献

Background: Atrial fibrillation (AF) increases the risk of stroke, especially in patients with previous cerebrovascular disease. This risk is significantly reduced with oral anticoagulants (OAC), with direct oral anticoagulants (DOACs) being the optimal treatment.

Objectives: To study the most used anticoagulant treatment in patients with nonvalvular AF (NVAF) with and without cerebrovascular disease in Mexico.

Methods: CARMEN-AF is a national, multicentric observational registry that includes 1423 patients with AF. Patients were recruited regardless of the anticoagulant therapy. Demographics, clinical variables, comorbidities and antithrombotic treatment were compared among patients with and without a history of cerebrovascular disease.

Results: Of the 238 patients with a previous cerebrovascular disease (average age 69±13 years; 114 women [48.5%]), 99% had a previous ischemic stroke. In this subgroup, the type of AF was permanent 43.4%, persistent 20%, and paroxysmal AF was 36.6%. Principal comorbidities were hypertension 77.9%, diabetes mellitus 29.8%, and heart failure 20%. Nearly 12.4% of patients with a history of ischemic cerebrovascular disease did not receive anticoagulant (AC) treatment. Among those who did, vitamin K antagonists (VKAs) were more commonly prescribed than DOACs (37.4% vs. 25.5%).

Conclusion: In Mexico, anticoagulation rates remain low among patients with NVAF and a history of cerebrovascular disease.

Background: The scientific meetings disseminate the results of the latest research. However, if the presented work is not published later, the information is lost.

Objective: To know and compare the fate of the abstracts produced by our nephrology community that were submitted to the Instituto Mexicano de Investigaciones Nefrológicas (IMIN) and American Society of Nephrology (ASN) meetings.

Methods: All abstracts presented by Mexican authors to the ASN from 2011 to 2019 and the IMIN from 2018 to 2019 were analyzed. We captured their publication rate, time to publication, journals, and the impact factor. Publications in both cases were analyzed through PubMed and Scopus databases.

Results: Of the 382 works submitted at ASN by Mexican authors from 2011 to 2019, 141 (36.5%; p<0.001 vs. IMIN) were published. The percentage increases if only accepted abstracts are included (141 of 265, 45%). The format of the presentation affected the final publication rate, which is 81% for free communications, 41.4% for posters, and 18.6% for non-accepted works. In contrast, of the 641 works presented from the 2018-2019 annual meetings of the IMIN, 8% (n=52) have been published.

Conclusion: The publication rate of the ASN abstracts presented by Mexico is like that seen globally for international meetings. However, the publication rate of works presented in our national meeting is very low.

Background: Influenza A virus H1N1 is a significant cause of respiratory infections, leading to severe complications in some patients. Understanding the molecular differences between severe and mild cases can provide insights into the pathogenesis and potential therapeutic targets for H1N1 infections.

Objectives: The objectives of the study were to investigate the transcriptional variances in mRNA and lncRNA between severe and mild cases of H1N1 infection to discern potential markers contributing to the severity of the illness.

Methods: Transcriptome sequencing was conducted on PBMC samples from 4 severe and 4 mild H1N1-infected patients. The transcriptional profiles of mRNA and lncRNA were analyzed to identify differential expression patterns between the two groups.

Results: Analysis revealed 3655 differentially expressed genes (DEGs), including 3147 protein-coding genes and 508 lncRNAs, in severe versus mild H1N1 cases. These genes were linked to essential cellular processes like ribosome assembly and significant signaling pathways such as the MAPK signaling cascade.

Conclusion: The identified DEGs, particularly those associated with ribosome assembly and key signaling pathways, may serve as potential biomarkers for distinguishing between severe and mild H1N1 infections. This research sheds light on the distinct transcriptomic features contributing to the pathogenesis of severe H1N1 infections, offering insights into differential diagnosis and potential therapeutic targets.

Super-enhancers (SEs) play a key role in cell fate determination by regulating the transcription of cell-specific target genes and may contribute to the pathogenesis of neurodegenerative diseases. Targeted inhibition of the activity of SEs or knockout of SEs fragments may represent a novel therapeutic strategy for neurodegenerative diseases. This article mainly outlines the discovery, structure, and identification methods of SEs; lists the current SE database platforms; summarizes the main regulatory mechanisms of SEs and strategies to acquire disease-specific SEs; and reviews recent research advances on SEs in neurodegenerative diseases. These findings provide new insights into the molecular mechanisms and development of treatment for neurodegenerative diseases.

Background: Anticoagulation stewardship in warfarin users reduces thromboembolic and bleeding events and improves adherence. Limited data exist on its impact on adherence among direct oral anticoagulants (DOACs) users.

Objective: To evaluate whether inpatient and outpatient follow-up in an anticoagulation stewardship program improves adherence and clinical outcomes in DOAC users compared to usual care.

Methods: Cohort study of patients initiating DOAC therapy at a university medical center. Participants were categorized into anticoagulation stewardship and usual care cohorts. Adherence was assessed at 30, 90, and 180 days. Univariate and multivariate logistic regression models were used to identify factors associated with lower adherence.

Results: 250 patients were included, with 81 receiving anticoagulation stewardship follow up. Adherence at 30 days was intermediate-high in over 90% of participants. The no-follow-up group showed a higher proportion of patients with low adherence (9.4% versus 2.4%, p = 0.003) and bleeding complications (4.1% versus 0%, p = 0.063). Anticoagulation stewardship exhibited a trend toward higher adherence (odds ratio [OR]: 3.51; 95% confidence interval [CI]: 0.74-16.47; p = 0.107). Factors associated with lower adherence included higher educational level (OR: 0.20; 95% CI: 0.05-0.75; p = 0.018), enrollment in a subsidized health system (OR: 0.08; 95% CI: 0.01-0.64; p = 0.018), and deep venous thrombosis as an indication for anticoagulation.

Conclusion: Anticoagulation stewardship programs may enhance adherence to DOAC therapy. Prospective studies are needed to confirm these findings.

Background: Healthcare workers (HCWs) are at risk of body fluids' exposure.

Objective: The objective of this study was to study the incidence of occupational body fluid exposures in HCW at a tertiary hospital and largest coronavirus disease 2019 (COVID-19) center in Mexico.

Methods: Data on sociodemographics, exposure factors, and vaccination status were collected from questionnaires of HCWs self-reporting exposures (January 2013-December 2022). Hepatitis B and C virus (HBV and HCV) and human immunodeficiency virus (HIV) serology data were retrieved from the laboratory platform. Descriptive statistics and variable associations were analyzed.

Results: Four hundred and eighty-two exposures occurred, 311 in women (64.5%). Exposure incidence was 19.09/1000 person-years; 80% were percutaneous; and 20% were splashes. Median age of exposed HCWs was 21 years (standard deviation = 9.65). Nurses were the most exposed (n = 172, 35.6%), mainly in patients room (n = 223, 46%). About 40.5% of HCW had protective antibody titers to HBV surface antigen (anti-HBs). Self-reported vaccination status and protective anti-HBs titers had poor concordance (kappa = 0.02). One hundred and ninety-seven HCW required HIV post-exposure prophylaxis (40.8%) with no seroconversions. Exposures were highest in 2020 (78 cases, p = 0.001 vs. all years).

Conclusion: A high proportion of HCW lacked protective anti-HBs titers. Increased occupational exposures during the COVID-19 pandemic underline the need for standard precautions, HBV immunization, staff training, and post-exposure protocols to enhance pandemics preparedness.

Background: Rheumatoid arthritis (RA) diagnosis is a challenge in the initial phases of the disease when clinical symptoms are only starting to develop. Early diagnosis and treatment can promote long-term remission, reduce disability, and improve cardiovascular outcomes. Autoantibodies can help in the diagnosis and identification of RA patients in the early phases of the disease, but scarce information has been reported for the Mexican population.

Objective: To study anti-citrullinated peptide antibodies (anti-CCP) and anti-carbamylated protein antibodies (anti-CarP) in Mexican patients with RA and individuals at high risk of developing the disease.

Methods: Serum samples from long-standing and early RA patients, first-degree relatives (FstD) of RA patients, and healthy individuals were analyzed for anti-CCP and anti-CarP using enzyme-linked immunosorbent assay.

Results: Anti-CCP and anti-CarP levels were higher in the RA groups than in the FstD and healthy groups. The odds ratio (OR) for antiCCP for RA groups was 29.7 (95% confidence interval [CI] 14.2-61.9), significantly higher than the OR for anti-CarP 11.07 (95% CI 5.4-22.8). The sensitivity of anti-CCP was 85% (95% CI 76-93) higher than for anti-CarP (42.1%, 95% CI 31-54). The specificity of anti-CarP was 93.8% (95% CI 90-97) and the specificity of anti-CCP was 83.4% (95% CI 78-88). Using both tests in parallel increased sensitivity to 91%, while a sequential approach increased sensitivity to 98%.

Conclusion: Anti-CCP outperformed anti-CarP in Mexican RA patients, demonstrating greater sensitivity, while anti-CarP showed higher specificity. Combining these tests, either simultaneously or sequentially, could enhance diagnostic accuracy. (.

Background: MiR-155 plays a role in inflammatory pathways and cardiovascular diseases, though its relationship with inflammation, atherosclerosis, and outcomes in ST-elevation myocardial infarction (STEMI) is not well established.

Objective: To investigate associations between miR-155 levels, inflammation, atherosclerotic burden, and major adverse cardiovascular events (MACE) in STEMI patients.

Methods: Sixty-nine STEMI patients and 16 healthy controls were recruited from a specialized university-affiliated cardiovascular center. MiR-155 expression and serum interleukin (IL)-1β, IL-6, and tumor necrosis factor levels were measured. Patients were grouped into tertiles based on miR-155 expression. Clinical data, atherosclerotic burden (through cardiac catheterization), and in-hospital MACE were recorded.

Results: MiR-155 levels were significantly lower in STEMI patients compared to controls (median 54.2, vs. 152.8 arbitrary units; p = 0.003). Higher miR-155 tertiles were associated with a greater prevalence of three-vessel occlusion (34% vs. 13% vs. 4%; p = 0.007) and increased incidence of pulmonary edema (13% vs. 0% vs. 0%; p = 0.030). No significant correlation was found between miR-155 and inflammatory or myocardial markers.

Conclusion: Dysregulated miR-155 expression in STEMI patients may influence disease severity and MACE risk, independent of inflammation or myocardial damage markers.