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

Unassigned: Random renal biopsy is considered the gold standard for the diagnosis of systemic renal disorders. Percutaneous biopsy remains a safe option for most patients; however, the percutaneous approach may be considered too risky in approximately 5-10% of patients. In these high-risk patients, transjugular renal biopsy (TJRB) may represent an underutilized alternative. TJRB is a technically difficult procedure with a learning curve of approximately 10 cases. When performed properly, TJRB is a safe alternative to percutaneous biopsy in patients with renal failure or who are at high risk of bleeding. This article aims to provide a comprehensive review of the indications, techniques, precautions, and complications of TJRB, a possibly underutilized technique. (Rev Invest Clin. 2024;76(5):207-12).

Unassigned: Background: COVID-19 is a disease that had a great impact in the world, generating lifestyle changes; among these are changes in sleep quality, with the elderly being one of the most affected age groups. Objective: To identify sleep alterations in Mexican people older than 60 years post COVID-19 pandemic. Methods: We performed a descriptive study on subjects older than 60 years from the aging cohort of the National Institute of Respiratory Diseases. Demographic data, sleep questionnaires (Pittsburgh), and quality of life (SF-12) were assessed pre-pandemic. During the period from June 2021 to August 2022, the questionnaires were repeated post-pandemic through telephone. Qualitative variables were analyzed with frequencies and percentages, whereas quantitative variables were analyzed with means and standard deviations. The groups were compared using the X² test and Student's t-test. Results: We analyzed 279 subjects who completed two questionnaires. An alteration in sleep quality variables was observed post-COVID, including a decrease in sleep hours (7.33 h versus 7.17 h, p = 0.03), and a trend to a longer time to fall asleep (23 m vs 27 m, p = 0.06). In the questionnaire on toxicology, we found higher alcohol consumption (18% vs. 27%, p = 0.01) and vitamin ingestion (34% vs. 46%, p = 0.003). Subjects also described more nighttime awakenings, with more than 3 times per week (25% vs. 44%, p < 0.0001), generating a worse auto perception of healthy well-being (88.3 vs. 82.02 p < 0.0001). Conclusions: The COVID-19 pandemic affected sleep quality in different aspects, and it increased the consumption of alcohol and vitamins. (Rev Invest Clin. 2024;76(6):239-42).

Background: Chronic myelogenous leukemia is a neoplastic proliferation of the granulocytic series. In Mexico, chronic myelogenous leukemia accounts for approximately 10% of all leukemias. Tyrosine-kinase inhibitors are considered front-line therapy in high-income countries, whereas allogeneic hematopoietic stem cell transplantation is a recognized therapeutic approach, mainly in low- and middle-income countries.

Objective: To analyze the overall survival of persons with chronic myelogenous leukemia who have received tyrosine-kinase inhibitors or allogeneic hematopoietic stem cell transplantation in a medical center, since 1994, and briefly discuss the current indications of these treatments in the tyrosine-kinase inhibitors era.

Methods: We retrospectively analyzed all patients with a diagnosis of chronic myelogenous leukemia treated in a medical center between 1994 and 2023; subsets of individuals who received an allogeneic hematopoietic stem cell transplantation or tyrosine-kinase inhibitors therapy as first-line treatment were analyzed.

Results: 60 persons with chronic myelogenous leukemia were treated with allogeneic hematopoietic stem cell transplantation or tyrosine-kinase inhibitors: 35 received an allogeneic hematopoietic stem cell transplantation, whereas 25 were given tyrosine-kinase inhibitors. All patients who underwent an allogeneic hematopoietic stem cell transplantation engrafted successfully, and the procedure was completed on an outpatient basis in most cases (29/35). The median survival in allogeneic hematopoietic stem cell transplantation was 78.3 months (CI 95%: 0-205.6) and in persons given tyrosine-kinase inhibitors the median was not reached.

Conclusion: Tyrosine-kinase inhibitors were significantly superior to allogeneic hematopoietic stem cell transplantation in prolonging the overall survival of persons with chronic myelogenous leukemia in our single institution experience.

Unassigned: Background: Smoking remains a significant issue that increases the prevalence of multiple sclerosis (MS) and its progression to secondary progressive forms. Objectives: The goal is to identify the relationship between smoking and disease progression in MS patients who have undergone autologous hematopoietic stem cell transplantation (auto-HSCT) at the Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Mexico. Methods: This retrospective study involved MS patients treated with auto-HSCT, followed for 12 months. The response to transplantation was measured using the difference in Expanded Disability Status Scale (EDSS) scores before and 12 months after the transplant. A difference of -0.5 or greater indicated a good response, while a difference below 0.5 indicated a poor response. Results: The study included 419 patients, with a median age of 47 years (IQR: 40-53). The majority were non-smokers (315) compared to smokers/ex-smokers (104). In patients with PMSS, EDSS stabilization at 12 months was observed in both smokers/ex-smokers (median 6, interquartile range (IQR) = 1 vs. 6, IQR = 1, p = 0.466) and non-smokers (median 6, IQR = 1 vs. 6, IQR = 1.5, p = 0.001), although non-smokers showed a statistically significant difference. Conclusion: Smoking may negatively impact MS progression, especially in its progressive forms. (Rev Invest Clin. 2024;76(5):223-9).

Background: Osteoarthritis is a frequent rheumatic disease. Some single-nucleotide polymorphisms of the gene associated with fat mass and obesity are associated with increased body mass index and knee osteoarthritis.

Objective: The objective of this study was to analyze the association of single nucleotide polymorphism rs1477196 of the fat mass and obesity gene with primary knee osteoarthritis.

Methods: This observational and cross-sectional study included 347 Mexican participants. We performed the genotypification analysis with TaqMan® probe C_2031262_10 for rs1477196 (Thermo Fisher Scientific). Multivariate analysis included covariables such as age, type 2 diabetes, obesity, and postmenopause.

Results: Type 2 diabetes, obesity, and postmenopause were associated with primary knee osteoarthritis in female participants. We did not find an association between rs1477196 and obesity. In the codominant and dominant genetic models, rs1477196 was significantly associated with primary knee osteoarthritis only in the female group, including in the model adjusted by other covariables (odds ratio = 2.517; 1.035-6.123; p = 0.042 and odds ratio = 2.387; 1.054-5.407; p = 0.037, respectively). The interaction between rs1477196 and obesity was significantly associated with primary knee osteoarthritis in female participants (p = 0.039 and p = 0.043).

Conclusions: Our findings suggest that the rs1477196 variant of the fat and obesity mass gene may be associated with the risk of primary knee osteoarthritis in women.

Unassigned: Background: Since to the prognosis of lung squamous cell carcinoma is generally poor, there is an urgent need to innovate new prognostic biomarkers and therapeutic targets to improve patient outcomes. Objectives: Our goal was to develop a novel multi-gene prognostic model linked to neutrophils for predicting lung squamous cell carcinoma prognosis. Methods: We utilized messenger RNA expression profiles and relevant clinical data of lung squamous cell carcinoma patients from the Cancer Genome Atlas database. Through K-means clustering, least absolute shrinkage and selection operator regression, and univariate/multivariate Cox regression analyses, we identified 12 neutrophil-related genes strongly related to patient survival and constructed a prognostic model. We verified the stability of the model in the Cancer Genome Atlas database and gene expression omnibus validation set, demonstrating the robust predictive performance of the model. Results: Immunoinfiltration analysis revealed remarkably elevated levels of infiltration for natural killer cells resting and monocytes in the high-risk group compared to the low-risk group, while macrophages had considerably lower infiltration in the high risk group. Most immune checkpoint genes, including programmed cell death protein 1 and cytotoxic T-lymphocyte-associated antigen 4, exhibited high expression levels in the high risk group. Tumor immune dysfunction and exclusion scores and immunophenoscore results suggested a potential inclination toward immunotherapy in the "RIC" version V2 revised high risk group. Moreover, prediction results from the CellMiner database revealed great correlations between drug sensitivity (e.g., Vinorelbine and PKI-587) and prognostic genes. Conclusion: Overall, our study established a reliable prognostic risk model that possessed significant value in predicting the overall survival of lung squamous cell carcinoma patients and may guide personalized treatment strategies. (Rev Invest Clin. 2024;76(2):116-31).

Unassigned: Background: Clinical practice has advanced toward a combined diagnostic approach that involves clinical criteria and biological markers for Alzheimer's disease (AD) and other dementias. Objective: To establish the level of diagnostic agreement between an initial clinical diagnosis and cerebrospinal fluid (CSF) and [18F]-fluorodeoxyglucose (FDG)-positron emission tomography (PET) biomarkers in a cohort of patients from a memory clinic. Methods: This is a observational, retrospective, cohort study conducted at an outpatient memory clinic. Between July 2018 and September 2023, data from adults' ≥ 55 years with a mild cognitive impairment or dementia diagnosis without etiological diagnosis were obtained, complemented with the evaluation of biomarkers in CSF and [18F] FDG-PET biomarker assessment were included. Kappa coefficients (κ) were used to establish the level of agreement between CSF and [18F] FDG-PET results. Results: Seventy-seven patients had an available [18F] FDG-PET scan, and 25 (32.5%) had both biomarkers. We observed a fair-to-moderate diagnostic agreement between patients' initial and their final diagnosis in the presence of CSF (κ = 0.233, 95% confidence interval [CI]: -0.099-0.566) and [18F] FDG-PET (κ = 0.451, 95% CI: 0.277-0.625, p < 0.001) results. The Kappa value for diagnostic concordance between [18F] FDG-PET and CSF to differentiate between AD and other dementias was 0.733 (95% CI: 0.425-1.000, p < 0.005). Conclusion: This study demonstrates good agreement between the CSF and FDG-PET biomarkers to differentiate AD from other dementias. (Rev Invest Clin. 2024;76(5):230-7).

Unassigned: Background: Limited information exists regarding the pathophysiological interactions between osteoporosis and chronic obstructive pulmonary disease (COPD). Objective: To study the association of Osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-Β ligand (RANKL) in male COPD patients. Methods: An observational clinical study was conducted at Penang General Hospital in Malaysia. Participants were divided into three groups: COPD patients with osteoporosis, COPD patients without osteoporosis, and healthy participants of the same age groups. Serum OPG (sOPG) and RANKL (sRANKL) levels were investigated. Results: The mean age of COPD patients was 64.10 ± 10.04 years. COPD patients had lower body mass index (23.22 ± 6.43) than healthy participants (27.32 ± 6.80). The T-score was significantly lower among COPD patients than healthy participants (p = 0.018). The sOPG concentration among healthy participants was significantly higher (361.90 ± 29.10 pg/mL, p < 0.001) than in the other groups, while the sRANKL concentration was not significantly different. The serum OPG/RANKL concentration was markedly higher in the control group than in the COPD patient group (p < 0.05). The COPD patients with osteoporosis had significantly lower pulmonary parameters (forced expiratory volume in the first [FEV]1% and FEV₁/[forced vital capacity] (FVC), p < 0.01) and more dyspnea (modified medical research council = 2.60 ± 0.78 versus 1.90 ± 0.70, p < 0.01) than did the patients without osteoporosis. Furthermore, patients with severe COPD had a 3 times greater risk of developing osteoporosis (OR = 2.997 [95% CI = 2.181, 4.118], p < 0.001), while spirometric parameters had a significant inverse relationship with osteoporosis (FEV₁% OR = 0.970, [95% CI = 0.954, 0.986], p = 0.001; FEV₁/FVC OR = 0.984, (95% CI = 0.970, 0.999], p = 0.035). Conclusion: The study concluded that COPD patients had lower sOPG levels, leading to decreased OPG/RANKL ratio and faster bone resorption. Low bone mineral density was associated with more severe COPD. (Rev Invest Clin. 2024;76(6):262-73).

Unassigned: Background: The effective use of combination antiretroviral therapy (ART) has significantly improved the life expectancy of people living with the human immunodeficiency virus (HIV). However, complications have shifted from opportunistic infections to issues such as drug toxicity and resistance, as well as an increase in premature cardiovascular diseases (CVD). These conditions are attributed to chronic immune activation and persistent inflammation caused by HIV, along with lipid abnormalities and insulin resistance. Objective: The objective of the study was to predict cardiovascular risk at 5 and 10 years in people living with HIV with combination ART using three algorithmic models. Methods: This study included 186 HIV-seropositive patients under treatment. The variables analyzed included anthropometric measurements, family history of hypertension and CVDs, years of infection, years of treatment, and treatment scheme. We used three well-established algorithmic models for assessing cardiovascular risk: Framingham (10-year period), Data Collection on Adverse Events of Anti-HIV Drugs Study (D: A: D) reduced, and full (5-year period). Results: Approximately 65% of the study participants were undergoing a treatment regimen comprising two nucleoside reverse transcriptase inhibitors (NRTIs) combined with a non-NRTIs. The mean body mass index analysis indicated that 28.5% of the participants were overweight and 17.7% obese. In addition, 53.8% of the patients exhibited hypertriglyceridemia, and 54.8% met the diagnostic criteria for metabolic syndrome. The D: A: D reduced and full models identified significant risk factors for individuals over 30 years of age, highlighting notable associations with cholesterol levels, triglyceride levels, and smoking status. In contrast, the Framingham model did not demonstrate significant risk associations. (Rev Invest Clin. 2024;76(6):274-85).

Background: Human immunodeficiency virus (HIV) drug resistance is a major cause of treatment failure in children and adolescents infected with the virus.

Objectives: The objectives of the study are to investigate HIV drug resistance (HIVDR) in patients who attended a referral care center in Argentina over a 15-year period and to compare mutational patterns between HIV-1 polsequences characterized as B or BF recombinants.

Methods: Individual resistance-associated mutations (RAMs) (to protease and reverse transcriptase inhibitors) were identified according to IAS-USA guidelines in 374 HIV-1-infected children and adolescents. HIV-1 subtype was characterized by phylogenetic and recombination analysis using MEGA5.1 and Simplot. Poisson linear regression was used to model the dynamics of the RAMs over time.

Results: The prevalence of RAMs to protease inhibitors (R2 = 0.52, p = 0.0012) and nucleoside reverse transcriptase inhibitors (R2 = 0.30, p = 0.0225) decreased over time. HIVDR to non-nucleoside reverse transcriptase inhibitors remained moderate to high, ranging between 33% and 76%. BF recombinants showed a higher frequency of thymidine analog mutation 1 RAMs profile and I54V mutation.

Conclusion: In Argentina, HIVDR observed in children and adolescents has decreased over the past 15 years, regardless of the viral subtype. (REV INVEST CLIN. 2024;76(1):29-36).